By Milka Njeri, Research Assistant, APHRC
Recent statistics indicate that poor maternal and child nutrition are the underlying causes of 3.5 million deaths every year and 35 percent of disease burden for children under five years globally (Bryce et al. 2008). In Kenya, neonatal and infant mortality rates are relatively high at 31 and 52 in 1000 live births respectively (KDHS 2008/09).
Effect of maternal nutrition on infant and child mortality has been the subject of concern with an increase in the pool of scientific knowledge showing that poorly nourished mothers are at a higher risk of giving birth to low birth-weight babies, while facing multiple threats to their own health. Their babies in turn face greater risk of neonatal deaths and, if they survive, will have to reckon with poor growth, ill health, and slow cognitive development in childhood.
As a result, numerous programmes have been initiated to improve maternal and newborn health including the Baby-Friendly Hospital Initiative (BFHI), a global programme that aims at enhancing optimal levels of maternal and infant feeding and care in healthcare facilities. The envisaged results of these programmes, however, have not been satisfactorily achieved due to several challenges that constantly cripple their efforts.
Some of these challenges include retrogressive myths and cultural beliefs, which contribute to reluctance to adopt good practices through behavior change in relation to maternal and child nutrition. With the high levels of literacy reported in Kenya, it may seem inconceivable that such beliefs still exist but in reality, they are very present and are a major hurdle that must be addressed and overcome if the Millennium Development Goals 4 and 5 of reducing child mortality and improving maternal health respectively, are to be realized.
A study done by the African Population and Health Research Center (APHRC) among residents of two informal settlements in Nairobi indicate that pregnant women avoid some foods as dictated by myths and their cultural beliefs. Of importance are eggs which are avoided in some communities during pregnancy and infancy for fear that they cause delayed or slurred speech in children. A fruit a day keeps the doctor away’ does not work in some of these communities as pregnant women are discouraged from eating various fruits including avocados and bananas as they are alleged to have a lot of ‘energy’ and may cause the fetus to grow ‘too big’ resulting in mothers having complications while giving birth and forcing them to undergo caesarean section during delivery (something they’d rather avoid).
Others often refrain from eating some animal protein like fish, chicken and beef also in the fear that the unborn baby will ‘overgrow’ in the womb and cause birth complications as above. Having heavy meals a few days before delivery is also not recommended in some communities as the mother may have a ‘poop’ during delivery which is deemed as very embarrassing for the mother.
However, no scientific evidence has linked moderate intake of any of these foods to any birth complications and the truth is that these foods are excellent and affordable sources of the much needed nutrients during pregnancy. Avoiding them thus may mean missing out on essential nutrients and limited food diversity which eventually results in poor maternal nutrition and consequently, increased risks of infant and child morbidity and mortality. Unfortunately, the same cultural beliefs also prohibit pregnant women from seeking professional advice from health care facilities from where they could receive the right information, further complicating the situation.
APHRC is in the process of implementing a community based intervention programme in these two informal settlements in Nairobi where the study dubbed Maternal Infant and Young Child Nutrition (MIYCN) project is being conducted. The three- year intervention is funded by the Wellcome Trust and aims at actualizing the BFH initiative at the community level through the already existing community health strategy. This will involve personalized home-based counselling of pregnant women and mothers of infants in both Korogocho and Viwandani, on optimal maternal, infant and young child nutrition by community health workers. It is envisaged that this study will be beneficial in, among other things, demystifying all these harmful cultural beliefs and myths existing in these communities, thus improving maternal and child nutrition and consequently preventing any complications that may arise in the critical first 1,000 days of a child’s life as a result of poor nutrition. This will ensure a healthy, productive and intellectual future generation.
It is hoped that if the project is proven to be effective and worthwhile, it will be adopted by the Kenyan government for scaling up countrywide.