BARRIERS TO EXCLUSIVE BREASTFEEDING AND STRATEGIES TO IMPROVE THE UPTAKE

IN THE EAST REGION OF CAMEROON

Adidja AMANI, MD MPH Fulbright Alumnus Performance-based Financing Healthworkforce development IYCF specialist, EBF advocate Head of Child Health Service Ministry of Public Health- Cameroon

MAY 2015

Background:

Neonatal mortality in Cameroon accounts for about

50%and26%ofinfantdeathsandchildrespectively

(DHS, 2011) furthermore, neonatal mortality rate

increasedfrom41to29and31deathsper1,000live

birthsin1998,2004and2011respectively.

According to the Lancet Child Survival Series 2003,

breastfeeding is the single largest impact on infant

mortalityofallpreventiveinterventions.TheMinistry

of Public Health of Cameroon recommends that

infants be exclusively breastfed until the age of six

months;however, theexclusivebreastfeedingrate is

very low in Cameroon, 20% (DHS‐MICS 2011),

moreover52%ofbreastfedchildrenreceivedfoodsbeforethestartofbreastfeeding.

Improving the duration of exclusive breastfeeding is a national and international

priority.

AteamfromtheMinistryofPublicHealthwentforatrainingof30healthworkerson

essentialcareofthenewbornswithagreatemphasisonexclusivebreastfeeding.This

was the occasion to gather Information on the perceived barriers to exclusive

breastfeedingandthesolutionstoimprovetheuptake.Theparticipantscamefrom4

healthdistricts:Batouri,Delele,BertouaandKette.

TheObjective

Theobjectiveoftheexercisewastounderstandthebarriersanddeterminestrategies

tocreateahigherdemandforexclusivebreastfeeding(EBF).

Themethodologyused tocollect thedatawasparticipative. Indepth interviewswas

appliedonspecificaspects.

Figure1:AmapofCameroonwitharedcrescentdepictingtherefugeeszones.Source:UNHCR2015

ASSESSMENT OF THE BARRIERS TO EXCLUSIVE BREASTFEEDING IN THE EAST

REGIONOFCAMEROON

TheEastRegionisthelargestofallregionsofCameroonbutintermsofdensity,itis

the leastpopulated. Itspopulation isestimatedat873,891 inhabitantsdistributed in

14healthdistricts.Currently,theEastregionofCameroonhoststhelargestnumberof

Central African refugees (UNHCR, 2015) including 60,000 people from theMbororo

tribe.

Figure 2: Health workers during the practical session Figure 3 Overview of participants during a presentation

Themainobstacleswerecitedbyorderofprioritiesandincluded:

• Rejection of colostrums. The yellowish appearance of colustrum was

associatedwith ibeing “dirty”, spoiled and tainted, because it has stayed for

long in thebreast.The first action is toextract it and throw it away toallow the

“cleaning” of the breast. This practice is mostly done as soon as the woman

delivers, independentlyofwhether thedeliveryhappens in ahealth facility or at

home.Theact of expressing the colustrumand throw it, isusuallyperformedby

elderly women, in particular mother in laws. Meanwhile the newborn is given

sweetenedwater.

• Theperceivedinsufficientbreastmilksupplyisoneofthemostcommonlycited

reasons for early cessation of breastfeeding and early introduction of

complementaryfoods;

• A perceived state ofmalnutrition of themother. 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”)aregiventothenewbornasreplacementstogivehim“strength”

• Competing priorities. Breastfeeding is not a priority and is perceived as a

stumblingblocktoincomegeneratingactivitiesandparticularlyfarming. Noneof

the30healthworkersknewaboutthemethodofpumping,expressingandstoring

breast milk as a strategy to continue breastfeeding in lactating socio‐economic

activewomen

• Thebelief thatmilk ispoisoned especiallywhen 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),itwasreportedthatprefertofeedcowmilktotheirnewborn;

thecowmilkisperceivedtobericherthanbreastmilk;

• Inurbanareasof theEast regionandparticularly inBertoua,practicing formula

feedingisperceivedasagoodindicatorofahighsocialstatus;

• Low literacyrateof thepopulationand the languagebarrier betweenhealth

personnel and the community who do not usually speak neither English nor

French;

• Ignorance/ lack of accuratenutritional information/knowledge and skills of

healthworkersoninfantfeedingpractices.Ofthe30healthworkersthatattended

the training none of them was consistently asking about the newborn feeding

practices.

STRATEGIESTOIMPROVETHEUPTAKEOFEXCLUSIVEBREASTFEEDINGINTHE

EASTREGION

In other to generate quantifiable and sustainable results of the feeding practices of

infantsoftheEastregion,healthworkersrecommendedthefollowings:

1. Dialoguewithkeyinfluencersoffeedingpractices:traditionalbirthattendants,

and mothers in law with emphasis on inter‐personal communication and

community‐basedapproaches

2. Emphasize themethod of pumping, expressing and storing breast milk as a

strategy to continue breastfeeding in lactating women, given that 85% of the

populationarefarmers.

3. Donotuse classicmedia channels,which are radio and televisionbecause the

signalsdonot reach theareasofDelele,Batouri andKette andelectricpower is

saidtobe“unreliable’.

4. Donotusewrittenpostersandbrochuresbecausethemajorityofthetargeted

populationisilliterate.Pictureswillleadbetterresults.

5. Build the capacity of elderly women and traditional leaders to address

culturalbeliefs incompatiblewithEBFmessages.Theyaremore listened to, than

health workers and community health workers. Moreover tailor messages to

mothersinlawandtraditionalbirthattendants,thekeyinfluencers.

For a long lasting impact of these interventions, the author also suggests the

introductionofthenutritionmodulesinthecurriculumofhealthworkers.