Dr. Desmond Okocha
Adequate nutrition during infancy and early childhood is a basic requirement for the development of a child. Adequate nutrition is defined as the intake and utilization of enough energy and nutrients to maintain the wellbeing, health, and productivity of an individual. The period of birth to 2 years of age is recognized as a critical period that requires adequate nutrition for a child’s optimum development. Malnutrition in children manifests as stunting, wasting, and underweight in individuals. In the long term, malnutrition can result in impairment of intellectual performance and work capacity. It could also have adverse reproductive consequences, delayed mental and physical development as well as death during childhood, adolescence, and adulthood.
Malnutrition is recognized as a global problem. It is the underlying cause of more than half the deaths of children less than five years of age. Well over two-thirds of malnutrition-related deaths occur in the first year of life. In Nigeria, malnutrition is widespread. 41% of all children less than five years of age are stunted, 14% wasted and 23% are underweight. The immediate causes of malnutrition in the first two years of life are inappropriate breastfeeding and complementary feeding practices coupled with high rates of infections. 35% of Nigerian infants are given complementary foods too early and they are often of poor nutritional value.
Nigeria has a mother-to-child transmission rate of 40%. Over 85,000 newborn babies are at risk of HIV infection annually. It has been estimated that over 6,000,000 babies will be born annually in Nigeria. The country has a national HIV seroprevalence of 4.6% among pregnant women attending antenatal clinic. Other conditions worthy of attention include sick infants, those with persistent diarrhea, infants living with HIV and AIDS, infants of adolescent mothers, and those with cleft palate. The main source of HIV infection in young children is the mother-to-child transmission. This could occur during pregnancy, labour, delivery, and breastfeeding. Without intervention, breastfeeding is estimated to contribute about 15% of mother-to-child transmission.
Protection, promotion, and support for breastfeeding are extremely important in order not to lose the gains made in child survival during the last few years. The provisions of international conventions, agreements, and national legal instruments have been recognized in the articulation of this Policy.
The overall goal of the National Policy on Infant and Young Child Feeding in Nigeria is to ensure the optimal growth, protection, and development of the Nigerian child from birth to the first five years of life.
Infant and young child feeding is an integral part of the overall objective of ensuring the socio-economic well-being of all Nigerians, but it still has other objectives which include:
- To create and sustain a positive image for breastfeeding throughout society.
- To empower all women (including women who work outside their homes) to adopt and practice optimal infant feeding.
- To promote the timely introduction of appropriate and adequate breastfeeding up to 24 months and beyond.
- To ensure the provision of specific feeding recommendations for all infants and children, respective of their circumstances of birth and health status.
- To protect, promote and support exclusive breastfeeding in the first six months of life.
- To support and enhance the provision of an enabling environment without any form of discrimination for working mothers, fathers, and other caregivers.
- To promote the prevention of mother-to-child transmission of HIV and ensure HIV-free survival through safe measures.
Optimal Infant and Young Child Feeding (Exclusive Breastfeeding)
All mothers shall be encouraged and educated to exclusively breastfeed their babies on demand until the age of 6 months. And during breastfeeding mothers are advised to take adequate nutrients. Exclusive breastfeeding for the first six months is the national policy. There are children in special circumstances who need further attention and extra support to meet their nutritional requirements.
These groups include:
- Infants of HIV positive mothers
- Sick infants, particularly with persistent diarrhea
- Low birth weight infants
- Motherless/adopted infants
- Infants and young children in emergency situations
- Infants of adolescent mothers
- Infants with cleft-palate
Infants and young children 6 months and above (Complementary Feeding)
Complementary feeding is the process of giving infant food in addition to breast milk. Complementary feeding should commence when the infant is 6 months old. Infants are particularly vulnerable during this transition period as new foods are introduced. This applies to children in both the general population and special situations. Mothers and caregivers shall be encouraged to practice responsive feeding using the principle of psycho-social care. The guiding principle shall be that of frequency, adequacy, density, utilization, and safety (FADUS) of the complimentary food. Consequently, it is important that the nutritional needs of the infant be met.
“HIV -free survival” of HIV-exposed infants, and not just prevention of HIV infection, shall be the cornerstone of the Policy of Government for infant feeding in the context of HIV. All HIV-infected mothers, with appropriate ARV prophylaxis, shall exclusively breastfeed their infants for the first 6 months of life. Mothers and caregivers should be counseled to increase the frequency of breastfeeding and increase fluid intake for sick infants and young children. Continue to provide soft, appetizing, and nutritionally adequate favorite foods and give at least one extra meal per day for one month after an illness.
HIV-positive infants and young children shall be given the necessary support to receive optimal nutrition. Mothers are advised to continue breastfeeding day and night, continue the feeding recommendation for the child’s age and give extra fluids, Solution of Oral Rehydration Salt or Salt Sugar Solution (ORS\SSS) to children with persistent diarrhea and add an extra mile per day for children who are no longer breastfeeding. Breast milk is particularly important for preterm infants and the small proportion of term infants with very low birth weight. For this reason, mothers shall be encouraged to breastfeed frequently.
It is the policy of the government to protect the rights of all Infants and Young Children in emergency situations. The importance of protection, promotion, and support of breastfeeding shall be emphasized. The rapid assessment shall be conducted at the early stages. Adolescent mothers require additional nutritional care both for their healthy growth and that of their babies. Adolescent mothers shall be counseled to introduce locally sourced complementary foods from the age of six months in addition to breastfeeding. Infants with a cleft palate may have difficulties with eating. This may affect their growth and development. It is recommended that: Caregivers introduce locally sourced complementary foods from the age of six months in addition to breastfeeding. Breastfeeding mothers need adequate food and nutrients and are encouraged to build their nutritional status before pregnancy and continue to feed adequately before and after delivery.
The National Policy on Infant and Young Child Feeding in Nigeria shall achieve its goal and objectives through the following key strategies:
- Legal, gender, and cultural considerations
- Advocacy and social mobilization
- Communication for Behavior and Social Change (CBSC)
- Capacity building and development
- Counseling and Support services
- Monitoring and Evaluation
Roles of Stakeholders in the National Policy on Infant and Young Child Feeding in Nigeria
The Federal Government shall have a budget line for the implementation of a program on infant and young child feeding. The Nutrition Division of the Federal Ministry of Health (FMOH) will be the focal point in the drive towards optimal infant and Young Child Feeding. The FMOH will train and re-train relevant health care providers involved in the implementation of this Policy. It will facilitate, appropriate micronutrient supplementation of infants and young children through the National Primary Health Care Development Agency (NPHCDA) and other relevant bodies. It is also intended to include infant and young child feeding in the school curriculum.
The State Governments shall have a budget line for the implementation of programs on infant and young child feeding. They will also have responsibility for coordination and harmonization of matters related to this Policy through the State Committee on Food and Nutrition.
The Local Government shall have a budget line for the implementation of programs on infant and young child feeding, have responsibility for coordination and harmonization of matters related to this Policy through the Local Government Committee on Food and Nutrition (LGCFN), and provide necessary structures for the effective implementation, supervision, monitoring and evaluation of this Policy at community levels.
Universities and Research Institutions
Universities and Research Institutions shall be supported to respond to the research needs of governments and other stakeholders for improved infant and young child feeding in Nigeria. They will provide technical support to relevant agencies and organizations to conduct research.
Organized Private Sector
The organized Private Sector shall ensure compliance with laid down Government regulations and guidelines on issues relevant to this Policy.
Non-Governmental Organizations and Civil Society Organizations
The Non-Governmental Organizations and Civil Society Organizations shall advocate for, and mobilize resources to support the implementation of this Policy and provide the necessary support to communities for improved participation and ownership of programs and activities targeted at promoting infant and young child feeding.
Professional Groups and Associations
Professional Groups and Associations shall advocate for, and mobilize resources to support the implementation of this Policy. Shall provide technical support on training and capacity building. Shall recognize achievements and promote the maintenance of standards.
Media Organizations and Practitioners
These include print and electronic media and their roles shall be the complementing efforts of the Government in disseminating information on infant and young child feeding at all levels and participating actively in advocacy, social, and resource mobilization for infant and young child feeding activities.
The Development Partners shall place infant and young child feeding high in their support agenda. They shall serve as advocates for increased human, financial and institutional resources for the implementation of this Policy.