Namibia launches child survival strategy

· 26% of children under five stunted · 13% underweight · 48% anaemic · Many not exclusively breastfed · Link between nutrition and intelligence · US$50 million needed over 3 years The Ministry of Health and Social Services, in collaboration with the United Nations Children's Fund (Unicef), the World Health Organisation and United States Agency for International Development (USAID) will today launch the Child Survival Strategy: A Promise Renewed for Child Survival in Namibia, as the country moves to improve the nutritional status of children under the age of five years. South African music sensation Yvonne Chaka Chaka, who is a Unicef Goodwill Ambassador, will join Prime Minister Hage Geingob, former Prime Minister Nahas Angula, Health and Social Services Minister Richard Kamwi and other dignitaries at the launch. Great expectations The child survival strategy is part of the outcomes of the broader Namibian Alliance for Improved Nutrition (NAFIN) which Angula convened. NAFIN will also today launch the Scaling Up Nutrition (SUN) Country Implementation Plan to reduce stunting in the country. Angula expressed optimism that investing in the nutrition of children would benefit the country in the immediate and long term. “Good nutrition enhances child survival,” he said in an interview. Kamwi, who was one of the ministers that met in the United States of America in 2012 to renew the promise on child survival, said he was excited about the launch. “There are things that are dear to my heart. This is one of them. There is no reason why we should let our under-five children die. We need to do something. We have been working hard and our Demographic Health Survey which will be launched soon shows that there has been a decline in child and maternal mortality. We are also seeing malnutrition decreasing in our country,” Kamwi said. He said although Namibia, like other developing countries, would most likely not meet Millennium Development Goals 4 and 5 on child and maternal mortality, it was encouraging that the country had made remarkable progress in that regard. “Namibia is one of the countries that are leading in addressing child and maternal mortality. We have a very high antenatal care of about 97% while 87% of all deliveries take place in facilities attended to by a skilled birth attendant. As a developing country we should pat ourselves,” he said, adding that immunisation rates against measles were high. “One of the killer diseases for children under five years is malaria. Since 2010 Namibia has exceeded both the Abuja Declaration and roll back malaria targets. We are eliminating malaria and this has enabled us to significantly reduce HIV/Aids mortality. Mother to Child transmission rates of HIV/Aids have gone down to about four percent.” The SUN plan proposes the scaling up of selected high-impact interventions to contribute to the accelerated reduction of under-five morbidity and mortality in order to achieve national and international targets by 2018. Michaela de Soussa, the Unicef representative in Namibia, said various studies to determine the nutritional status of Namibian children show that although much has been done, the country still faces major challenges. She cited the 2013 Namibian Demographic and Health Survey, whose preliminary report indicates that 26% of children under five are stunted or short for their age, 6% are wasted or too thin for their height, while 13% are underweight. While this is a slight improvement since the previous DHS which was conducted in 2006, De Soussa said the results point to the need to do more in the area of child nutrition. The 2013 DHS also reported that 48% of children under the age of five years were suffering from anaemia. The 2006 DHS did not investigate anaemia amongst children. The Health Ministry, with support from Unicef and WHO, is now conducting a study on infant and young child feeding practices, including breastfeeding and complementary feeding practices. De Soussa said this study, which is expected to be finalised before the end of this year, will provide information about what infants and young children are being fed and whether this is nutritionally adequate to meet their growth and development needs. “The findings will be used to improve the ministry’s programmes and services for women and children with regard to nutrition.” Most common nutritional problem There are different types of malnutrition and in Namibia, the most significant problem is a form of chronic malnutrition called stunting. “A child who is stunted is too short for their age. However, there are other developmental implications of stunting that affect a child’s potential as an adult. Stunting results not only in restricted growth in height but it also in cognitive development deficits that are irreversible once the child reaches the age of two years,” De Soussa explained. She said stunting was due to many different factors including poor infant feeding practices such as inadequate duration of exclusive breastfeeding between when the infant is born and reaches the age of six months. Poor complementary feeding practices, where children are not fed the right amount of food, inadequate variety or food of poor nutritional value can also cause stunting. Other causes of stunting include repeated illness and infection, poor maternal health and poor nutritional status of young girls. “One of the most significant contributors to stunting in Namibia is likely the link with poor sanitation and hygiene. The practice of open defecation has been shown by research as a major contributor to stunting.” The 2013 DHS shows the region with the highest prevalence of stunting is Ohangwena (36.5%) followed by Hardap (29.1%) and Karas (27%). The Kunene Region has a stunting prevalence of 19.3%, which is below the national average of 26%. Unicef has been working with the Health Ministry to develop and implement a programme whereby Health Extension Workers (HEWs) are trained to operate in the most difficult to reach areas of the country. The HEWs are trained to detect acute malnutrition among other health and social issues and to refer children and women to health facilities when necessary. Unicef is also working in partnership with the Namibian Red Cross Society. Volunteers have been trained to screen children for malnutrition and refer them to health facilities. Breast is best De Soussa said to improve the nutritional status of infants and young children, Namibia should - apart from eliminating open defecation - increase the number of infants who are exclusively breastfed from birth to six months of age. “This is not happening in Namibia. The DHS shows that only 27% of infants aged six months are being fed only breast milk. When such infants are fed other foods and liquids other than breast milk, they become at much greater risk of infections, illness and death.” Elsewhere children's food is fortified with key nutrients. De Soussa explained that Namibia has a voluntary food fortification programme that has been running for at least the past 10 years. “Namib Mills produces flour that is fortified with nutrients, which can be bought from stores throughout the country. The Namibian Alliance for Improved Nutrition (NAFIN) has commissioned a study to investigate the feasibility of small millers fortifying flour. In addition to population-based fortification programmes, the ministry is investigating the potential for home fortification using a micronutrient powder, which can be added to the food fed to young children.” Multi-sectoral approach De Soussa explained that to reduce stunting in the country, a multi-sectoral approach is needed. “This means that sectors such as water and sanitation, agriculture, education and social welfare need to take responsibility for investing in interventions that have the potential to support improvements in the nutritional status of children.” Such interventions include support for home gardens and improving household access to nutritious foods, elimination of open defecation and increasing the number of people who wash their hands with soap at critical times. Increasing social safety nets for families, improving school meal programmes and improving national and regional preparedness and response to emergencies and disease outbreaks are other options. It has been estimated that US$50 million is required to fully implement the SUN country implementation plan over three years. “If fully implemented it is expected that stunting can be reduced to below 20% by 2016. If the goal to reduce stunting to less than 20% by 2016 is achieved, not only will more Namibian children survive, they will also have the potential to thrive.” Many studies have shown that there is a positive correlation between stunting or chronic malnutrition poor cognitive development that affects a child’s potential to learn. De Soussa said that investing in nutrition has been proven to be one of the most cost effective ways of achieving national development goals. WINDHOEK MOSES MAGADZA