Accelerating improvements in nutritional and health status of young children in the Sahel region of Sub-Saharan Africa: review of international guidelines on infant and young child feeding and nutrition

Abstract

The United Nations Convention on the Rights of the Child holds governments responsible to ensure children's right to the highest attainable standard of health by providing breastfeeding support, and access to nutritious foods, appropriate health care, and clean drinking water. International experts have identified key child care practices and programmatic activities that are proven to be effective at reducing infant and young child undernutrition, morbidity, and mortality. Nevertheless, progress towards reducing the prevalence of undernutrition has been sporadic across countries of the Sahel sub-region of Sub-Saharan Africa. In view of this uneven progress, a working group of international agencies was convened to 'Reposition children's right to adequate nutrition in the Sahel.' The first step towards this goal was to organize a situational analysis of the legislative, research, and programmatic activities related to infant and young child nutrition (IYCN) in six countries of the sub-region: Burkina Faso, Chad, Mali, Mauritania, Niger, and Senegal. The purposes of this introductory paper are to review current information concerning the nutritional and health status of infants and young children in the Sahel and to summarize international guidelines on optimal IYCN practices. These guidelines were used in completing the above-mentioned situational analyses and encompass specific recommendations on: (i) breastfeeding (introduction within the first hour after birth, exclusivity to 6 months, continuation to at least 24 months); (ii) complementary feeding (introduction at 6 months, use of nutrient dense foods, adequate frequency and consistency, and responsive feeding); (iii) prevention and/or treatment of micronutrient deficiencies (vitamin A, zinc, iron and anaemia, and iodine); (iv) prevention and/or treatment of acute malnutrition; (v) feeding practices adapted to the maternal situation to reduce mother-to-child transmission of HIV; (vi) activities to ensure food security; and (vii) the promotion of hygienic practices concerning food preparation and storage and environmental sanitation. The following papers in this issue will present results of the situational analyses for the individual countries.

Figure 1

Map of the Sahelian countries included in the situational analysis. Map courtesy of OCHA, Dakar, Senegal Regional Office.

Figure 2

Conceptual framework of malnutrition (11). Figure adapted from original source (11) by the United Nations Children's Fund (UNICEF) in the 1998 State of the World's Children and printed here with permission from UNICEF West and Central Africa Regional Office.

Figure 3

Prevalence of children <5 years of age suffering from moderate and severe underweight (weight‐for‐age z‐score <−2) and Millennium Development Goal (MDG 1.8) in six countries of the Sahel*†. *Final columns indicate MDG 1.8 of a 50% underweight reduction between 1990 and 2015. †Data from Demographical and Health Surveys and Multiple Indicator Cluster Survey⁵ as presented in the World Health Organization (WHO) Global Database on Child Growth and Malnutrition (3), using WHO child growth standards. Data: Millenium Development Goals Indicators, Official UN site, http://unstats.un.org/unsd/mdg/Data.aspx.

Figure 4

Mortality rate among children <5 years of age and Millennium Development Goal (MDG 4.1) in six countries of the Sahel*†. *Final columns indicate a 2/3 reduction (MDG 4.1) between 1990 and 2015. †1990 estimates were obtained 13 February 2009 from the United Nations Children's Fund, Childinfo.org (26). Data: Childinfo.org for mortality rate among <5 years/1000 live births, by year of survey.

Figure 5

Trends in prevalence of exclusive breastfeeding during the first 6 months of life, by country and years of survey, horizontal line indicates j50% prevalence. *Data with asterisk from Multiple Indicator Cluster Survey⁵ data all others from Demographic and Health Survey data.

Figure 6

Optimal steps in moving a desired practice from conception through programme implementation and eventual national coverage of successful programmes.

Figure 7

Decision tree for assessing, referring and/or treating severe acute malnutrition in the community when resources are not sufficient to also allow treatment of moderate malnutrition, based on recommendations from references 128, 130. *Resources include ready‐to‐use foods (RUTF). Figure based on recommendations from: WHO child growth standards and the identification of severe acute malnutrition in infants and children, 2009 and Community‐based management of severe acute malnutrition, May 2007; recommendations for children 6–60 months. MAM, moderate acute malnutrition; MUAC, mid‐upper arm circumference; WHO, World Health Organization.