Tag Archives: Malnutrition

World Breastfeeding Week

This week is the 20th World Breastfeeding Week, an initiative started by the WHO (World Health Organization) and UNICEF (United Nations Children’s Fund) to promote breastfeeding, especially in developing countries. While New York City Mayor Bloomberg’s breastfeeding initiative, which was appropriately announced this week, has ignited a heated debate in Western media about a mother’s right to choose formula or breastfeeding, the situation is quite different in developing countries. (To read about Latch On NYC, check out the press release here.)

The benefits of breast milk cannot be overstated in developing countries (and developed too).

  • Breast milk is the only source of Immunoglobulin A, an antibody required to protect newborns from illness.
  • It is a guaranteed source of clean water.
  • Despite a mother’s nutritional status, it will always retain the proper balance of fat, protein, and other nutrients necessary to promote healthy growth in babies and infants, whereas mothers may end up watering down formula to make their supply last longer. Additionally, the fat and protein in breast milk are more easily absorbed than the nutrients in formula, and breast milk is easier for the baby’s sensitive gastrointestinal tract to handle.
  • The iron in breast milk is more readily absorbed than the iron in cow’s milk or formula (50% versus 10%).
  • It’s free!

There are numerous benefits to the mother as well, but I’m only focusing on the nutritional and immunological benefits to children right now.

Formula companies may send representatives to developing countries to promote their product and distribute free samples to new mothers, even though this has been declared illegal by the WHO in a document referred to as “The Code” (The International Code of Marketing of Breast-Milk Substitutes – you can read it here). The problem is that once the mothers go home, they often cannot afford to buy more formula, but they are no longer producing enough milk since they have been feeding their babies formula. In 2012, most (if not all) formula companies ignore The Code; hence the need for World Breastfeeding Week.

Cambodia has the highest rate of mortality for children under 5 in Southeast Asia due to malnutrition and associated illnesses (such as diarrhea and respiratory infections). This is why nutrition education is an important component of FoF. Our baseline survey’s module on knowledge and attitudes should help us identify what information women are lacking so that we can provide them with the tools to help their children. We will also be incorporating the country’s current complementary feeding strategy, which educates parents on how and when to start adding nutritious foods to a breast milk diet. The Phnom Penh Post published an informative article about this two months ago (you can find it here). The WHO recommends that women should breastfeed exclusively until 6 months of age, and then start introducing foods while continuing to breastfeed until their child is at least 2 years old.

The theme of this year’s World Breastfeeding Week in Cambodia is “Baby needs mom made, not man made“. This slogan has been printed on t-shirts and banners to promote the message. In addition, there will be a round-table discussion on the dangers of bottle feeding, a radio call-in program for women to ask questions related to bottle feeding, press releases in local papers and TV spots promoting this year’s theme.

For more information about World Breastfeeding Week, check out the World Breastfeeding Website.

Anthropometry: Height and Weight

Module 8 takes note of other measurements as well. These include height or length (if a child is < 85 cm, measuring their length provides a more accurate measurement) and weight. Since the focus of FoF is to eliminate “hidden hunger”, these measurements provide us with a lot of information about the nutritional status of the women and children we’re meeting. A woman or child may look healthy enough – their bones won’t be visible, or their bellies won’t be swollen (indicators of Marasmus and Kwashiorkor, both of which are types of severe acute malnutrition, or SAM). However, when we have their height/length, weight and age, we can use this information to compare them to healthy individuals of the same age and gender to get a better picture of their health.

There are three indicators that we use:

  1. Height/length for age – when we know a person’s height and their age, we can compare them to the average height for a healthy individual of the same age and gender. If the person is significantly short for his or her age, we call this stunting. It is a sign of chronic malnutrition.
  2. Weight for height – we can use an adult’s weight and height to calculate their body mass index, or BMI. A healthy BMI is anywhere from 18.5-24.9. Anything below 18.5 means a person is malnourished. In children, we compare their weight to the weight of a healthy reference child of the same height. If the child is significantly lighter than the reference child, we call this wasting, which indicates acute malnutrition.
  3. Weight for age – when we know a person’s weight and their age, we can compare them to the average weight for their age and gender group. If the person is light for his or her age, he/she is considered to be underweight.

Here are some pictures from the field.

 

Baseline: Day 2

Today we continued surveying villages in the Svay Antor district. Our enumerators acted like total pros, even though this was only their second day in the field.

I sat in on a 24 hour recall in the morning and a survey in the afternoon. The village where the recall took place was stunning. There was lush greenery everywhere, gorgeous views of rice fields, and a beautiful temple that we paused to admire.

Walking through a village in Svay Antor on our way to a 24 hour recall.

The path leading to a temple.

News of our arrival in the village spread quickly, and people kept coming into the house to look at us foreigners. We experienced a range of responses, from surprise, to fear (especially on behalf of the children who had probably never seen foreigners before), to warm smiles, to nosy grandmothers wanting to know if I was single or married!

This visit was the first time I stepped into a house, which was fascinating after only sitting under houses yesterday and in Kampong Chhnang. I finally saw what is under the roof of a typical (n=2) house: a big room with rolled up bamboo mats that are used as beds, and a TV. The TV surprised me given how few possessions people have, and how undeveloped the electrical infrastructure is in the region.

Being inside the house highlighted another way in which Cambodian culture differs from North American culture. In Cambodia, everyone sleeps together in the same room, which is also the living space during the day. This contrasts with the typical family dwelling in Vancouver (and probably most of the West) where almost everyone has their own bedroom, which is used mainly for sleeping.

We went to another village in the afternoon. I spent part of the time there sitting at the village chief’s house, which was the hub of a lot of action. Our anthropometry and hemoglobin analysis teams were set up at the chief’s house, so every mother and child that we surveyed came over. Today was the first day that I saw visible signs of malnutrition. The children we’ve seen in the past few days haven’t demonstrated any clinical symptoms of malnutrition. Today, however, we saw children with light, almost blond, hair. This is a sign that their diet is lacking in protein.

The supervisors also used the village chief’s house as a home base, so I observed them troubleshooting as problems arose (I will be writing a post about the types of problems we’ve encountered as baseline continues).

On top of all of that, a few people were bagging rice that had been harvested recently.

Bagging rice that is still in its husk.

But the kids were most excited about the arrival of the ice cream moto.

Trying to decide what to get from the ice cream moto!

Tomorrow we’ll be going to a health center to watch the first day of blood collection. This is a large, important (and expensive) undertaking, so hopefully it goes smoothly.