BARRIERS TO EXCLUSIVE BREASTFEEDING AND STRATEGIES TO IMPROVE THE UPTAKE IN THE EAST REGION OF CAMEROON

Background:

Neonatal mortality in Cameroon accounts for about 50% and 26% of infant deaths and child respectively (DHS, 2011) furthermore, neonatal mortality rate increased from 41 to 29 and 31 deaths per 1,000 live births in 1998, 2004 and 2011 respectively.

According to the Lancet Child Survival Series 2003, breastfeeding is the single largest impact on infant mortality of all preventive interventions. The Ministry of Public Health of Cameroon recommends that infants be exclusively breastfed until the age of six months; however, the exclusive breastfeeding rate is very low in Cameroon, 20% (DHS-MICS 2011), moreover 52% of breastfed children received foods before the start of breastfeeding. Improving the duration of exclusive breastfeeding is a national and international priority.

A team from the Ministry of Public Health went for a training of 30 health workers on essential care of the newborns with a great emphasis on exclusive breastfeeding. This was the occasion to gather Information on the perceived barriers to exclusive breastfeeding and the solutions to improve the uptake. The participants came from 4 health districts: Batouri, Delele , Bertoua and Kette.  

The Objective

The objective of the exercise was to understand the barriers and determine strategies to create a higher demand for exclusive breastfeeding (EBF).  

The methodology used to collect the data was participative. In depth interviews was applied on specific aspects.

Map of Cameroon-Refugees areas in the East region. Source UNHCR

ASSESSMENT OF THE BARRIERS TO EXCLUSIVE BREASTFEEDING IN THE EAST REGION OF CAMEROON

The East Region is the largest of all regions of Cameroon but in terms of density, it is the least populated. Its population is estimated at 873,891 inhabitants distributed in 14 health districts. Currently, the East region of Cameroon hosts the largest number of Central African refugees (UNHCR, 2015) including 60,000 people from the Mbororo tribe.         

The main obstacles were cited by order of priorities and included:

·      Rejection of colostrums. The yellowish appearance of colustrum was associated with ibeing “dirty”, spoiled and tainted, because it has stayed for long in the breast. The first action is to extract it and throw it away to allow the “cleaning” of the breast. This practice is mostly done as soon as the woman delivers, independently of whether the delivery happens in a health facility or at home. The act of expressing the colustrum and throw it, is usually performed by elderly women, in particular mother in laws.  Meanwhile the newborn is given sweetened water.

·      The perceived insufficient breast milk supply is one of the most commonly cited reasons for early cessation of breastfeeding and early introduction of complementary foods;

·      A perceived state of malnutrition of the mother. It is believed both by health workers and mothers as the main cause of insufficient milk and the reason for  discontinuing breastfeeding. Green vegetables (“kakko”) and cassava porridge “kammo”) are given to the newborn as replacements to give him “strength”

·      Competing priorities. Breastfeeding is not a priority and is perceived as a stumbling block to income generating activities and particularly farming.  None of the 30 health workers knew about the method of pumping, expressing and storing breast milk as a strategy to continue breastfeeding in lactating socio-economic active women

·      The belief that milk is poisoned especially when there is a history of previous neonatal deaths and therefore not breastfeeding is believed to save the live of newborns.

·      For the Bororos of the Central African Republic (a tribe of shepherds nomadic cattle-herders ), it was reported that prefer to feed cow milk to their newborn; the cow milk is perceived to be richer than breastmilk;

·      In urban areas of the East region and particularly in Bertoua, practicing formula feeding is perceived as a good indicator of a high social status;

·      Low literacy rate of the population and the language barrier between health personnel and the community who do not usually speak neither English nor French;

·      Ignorance/ lack of accurate nutritional information/ knowledge and skills of health workers on infant feeding practices. Of the 30 health workers that attended the training none of them was consistently asking about the newborn feeding practices.

STRATEGIES TO IMPROVE THE UPTAKE OF EXCLUSIVE BREASTFEEDING IN THE EAST REGION

In other to generate quantifiable and sustainable results of the feeding practices of infants of the East region, health workers recommended the followings:

1.     Dialogue with key influencers of feeding practices: traditional birth attendants, and mothers in law with emphasis on inter-personal communication and community-based approaches

2.     Emphasize the method of pumping, expressing and storing breast milk as a strategy to continue breastfeeding in lactating women, given that 85% of the population are farmers.

3.     Do not use classic media channels, which are radio and television because the signals do not reach the areas of Delele, Batouri and Kette  and electric power is said to be “unreliable’.

4.     Do not use written posters and brochures because the majority of the targeted population is illiterate. Pictures will lead better results.

5.     Build the capacity of elderly women and traditional leaders to address cultural beliefs incompatible with EBF messages. They are more listened to, than health workers and community health workers. Moreover tailor messages to mothers in law and traditional birth attendants, the key influencers.

For a long lasting impact of these interventions, the author also suggests the introduction of the nutrition modules in the curriculum of health workers.