BABY FRIENDLY SPACES IN EMERGENCIES

Emergency situations can seriously threaten breastfeeding practices and consequently child nutrition, health, and survival. When people are affected by disaster or crisis, their lives are disrupted. The risks to feeding and caring practices for infants, young children, their mothers, and caregivers are high alongside increased vulnerability to diarrhea and other diseases due to situations of poor nutrition, reduced access to food and deterioration in living conditions. Consequently, under nutrition and mortality increases. The stress of an emergency can significantly disrupt a mother’s milk flow, the timely support of Infant and Young Child Feeding (IYCF) is necessary from the earliest days of an emergency to save lives.

In emergencies, many young mums arrive at the camp and Medical Teams’ health facilities exhausted and hungry because they have not eaten for many days. They are often traumatized and as a result are providing no breast milk. Providing them with a safe, supportive space offers comfort and with the nutrition counselling and skills provided by the nutritionists and mother support group members monitoring the corners, lactation rates have increased.

In 2020, the Medical Teams International (Uganda) nutrition team designed, implemented, and established IYCF corners, also known as baby friendly spaces, and supportive spaces in several health facilities in the Nakivale and Oruchinga settlements. This was part of the strategy to reduce malnutrition and to prevent morbidity and mortality of infants associated with poor infant and young child feeding. In addition, the IYCF corners were designed to support the nutrition, health, and development of infants by encouraging good breastfeeding practices and providing special attention to complementary feeding for young children and support to pregnant and lactating women.

IYCF corners or baby friendly tents and spaces are safe, low stress spaces where mothers can breastfeed, rest and receive skilled counselling and targeted advice about breastfeeding and nutrition for their children and themselves. As well as these IYCF corner services, Medical Teams provides information and referral to specialty departments, assessment of mother–baby pairing, early childhood development, learning and play sessions. Psychosocial support, including relaxation and mindful exercises are also in demand.

Many of our activities extend beyond the IYCF corner, including home visits to encourage the involvement of family members (especially husbands) who play an important role in making decisions about how children are fed and cared for in the household.

In 2020, COVID19 severely restricted this life saving service. Only 39 IYCF sessions were carried out in eight baby friendly spaces. But, with restrictions on social gathering lifted and COVID19 more manageable, in 2021 Medical Teams was able to restart the services and we had a huge increase: 1,168 sessions involving 6,648 clients. The lives of many mothers, infants and young children have been saved because conditions that protect breastfeeding and reduce personal stress have been created and promoted.

in 2021 Medical Teams was able to restart the services and we had a huge increase: 1,168 sessions involving 6,648 clients

Provision and guidance on use of breast milk substitutes to support orphans has promoted their survival and has reduced the negative effects resulting from unsolicited and unmonitored use of breast milk substitutes. Personal assistance to mothers affected by HIV, EBOLA and COVID19 has promoted good nutrition for infants and young children without transmission of diseases to the infants and young children. Mothers and caregivers have been supported and provided with sustainable solutions for infants for whom breastfeeding is not an option especially orphans and vulnerable children. Many of these infants have achieved their growth potential on replacement feeding using fresh cow’s milk. Families have been helped to adapt care practices to the emergency and to post emergency.

A SUCCESS STORY: BREASTFEEDING, MEN AND SAVING LIVES OF INFANTS AND YOUNG CHILDREN        

When Kaviira Rebecca gave birth prematurely to her first daughter, Judith Karhatwa at the maternity ward in Nakivale, she didn’t know how to feed her baby or care for herself to increase her breast milk supply. The Medical Teams midwife referred her to the IYCF corner where a nutritionist helped her know how to feed her low-birth-weight baby to ensure she is healthy and strong.

Rebecca was accompanied by her husband, Jile Karato to the IYCF corner where baby Judith was diagnosed with severe acute malnutrition, and mum Rebecca with moderate acute malnutrition. The breastfeeding problem was classified as moderate because the infant wasn’t suckling well, was not well attached, and had had less than eight breastfeeds since the time she was delivered more than 24 hours previously.

Mum and Dad were counselled and, from the options provided, chose exclusive breastfeeding as the feeding option they wanted to pursue. Mum, Rebecca was shown the best breastfeeding position (cross cradle) for small babies, how to position and attach the baby and advised how to increase her breast milk supply. She was also attached to a lead mother from her village who would visit her at her home, be a safety companion and help her stay on track.

Rebecca was also enrolled on the targeted supplementary feeding program to manage and treat malnutrition where she was given three kilograms of supper cereal once every two weeks to enable her to gain weight, increase her breast milk production and finally improve her nutrition status.

Karato (Dad) was asked to support Rebecca while at home especially with house chores so that she has time to breastfeed the baby on demand, to enable her to recover well and to ensure she keeps the appointment dates given to them at the corner for continuous assessment and reviews.

Jile accompanied Rebecca and Judith for all their reviews in the IYCF corner at the health centre. They have both been part of the discussions to develop the actions needed to keep their baby healthy. Jile continues to support Rebecca in all matters that concern baby Judith including other hospital visits like immunization and medical treatment.

The weights of baby and Mum have significantly improved each time they have come for review at the Medical Teams IYCF corner. They feel uplifted and have hope that their baby will continue to improve.

When discharged, after three months, baby Judith had gained a weight of 5.2 kgs from her birth weight of 1.9 kgs and Rebecca’s MUAC measurements had also improved.

Rebecca says, “it’s because of the efforts of the Medical Teams nutritionists and lead mothers who continuously advised me and educated me at the IYCF corner, and the full support my husband (Jile) gave me while at home that Judith and my nutrition status has improved.”

(Written by: Babirye Judith. Medical Teams International, Nutritionist, Nakivale, Uganda.)