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Improving Infant & Young Child Feeding Practices Across Private Health Facilities Through Interpersonal Communication in Lagos, And Rural & Urban Kaduna States

Through a strategic public-private partnership to improve breastfeeding in Nigeria,  the Wellbeing Foundation Africa have partnered with McCann Global Health, FHI360l, the Bill & Melinda Gates Foundation, Alive and Thrive, and the Governments of Canada and Ireland on a commitment to finding opportunities to support behavior change programs to promote appropriate Improving Infant & Young Child Feeding (IYCF) behaviors through enhanced interpersonal communication across Private health facilities in Lagos, and Rural and Urban Kaduna States. 

This partnership consolidated its engagement expertise in private sector approaches to behavior change communications, community engagement, health training, and private-public partnerships which created a pathway for the development and scale up of a private health care model for breastfeeding support across fourteen (14) LGAs; Ajeromi, Agege, Apapa, Eti-Osa, Ikeja, Lagos Mainland, Kosofe, Surulere, Somolu, Ojo, Kaduna North, Chikun, Igabi, and Zaria both Lagos and Kaduna states. 

Early and exclusive breastfeeding for the first six months of life is the single most important nutritional determinant for child survival. Yet, in Nigeria, where more than 800,000 children under the age of five die each year, a majority of new mothers do not engage in optimal breastfeeding practice. Nationwide, only 33% of children are breastfed within the first hour of birth, and only 17% are exclusively breastfed for the first six months of life. Furthermore, poor infant and young child feeding (IYCF) practices contribute to the prevalence of stunting (37%), wasting (18%), and underweight children (29%) throughout the country.

In light of this, there has been an urgent need to reframe early and exclusive breastfeeding as an essential practice for all new mothers and their infants, and to leverage the multiple touch points during and following their pregnancy. Considering the complex nature of the issue, mass education and awareness efforts alone are likely not to be successful. This issue must be approached from multiple levels, and utilize a variety of channels and measures to create an environment conducive to optimal breastfeeding practices.

In Nigeria, the Alive & Thrive project working alongside the Government of Nigeria and other key stakeholders sought out to enhance child health, nutrition and cognitive development outcomes and save lives through a sustainable national program of optimum breastfeeding and complementary feeding practices in children through a four-component framework; 

  1. Policy/advocacy
  2. Interpersonal communication and community mobilization
  3. Mass communication
  4. Strategic use of data. 

To achieve its goals, the project was divided into two phases:  

  • Early Implementation Phase (EIP) 
  • Scale-Up Phase 

Early Implementation Phase

In Lagos state, the EIP was implemented from January 2018 - March 2018 in 7 private facilities (Med-In Specialist Hospital, Inland Specialist Hospital, Ola-Ayoka Convalescence Clinic, Child-Kid Children Hospital (Strictly Paediatric), Aplomb Medical Centre, Nimbus Medical Centre and PeachCare Medical Centre) in Ogudu Ward in Kosofe LGA to learn lessons for scale up of program implementation for both Kaduna and Lagos states. 

This was initiated by advocacy visits by the WBFA team and FHI360 team to state partners, including HEFAMAA; an agency responsible for improving the quality and efficiency of health facilities in Lagos by monitoring and regulating the activities of health facilities and also the AGPMPN, Lagos Chapter, an umbrella association for private medical practitioners. The outcome of the visits solidified partnerships and sustainability that lasted even after implementation closeout in May, 2020.

Saddled with two key objectives;

  1. Improve and maintain a high prevalence of early initiation of breastfeeding within the first hour of delivery in-facility in 745 private health facilities in A&T intervention LGAs in Kaduna and Lagos states.
  2. Improve and maintain a high prevalence of exclusive breastfeeding among infants 0-5.9 months in 745 private health facilities in A&T intervention LGAs in Kaduna and Lagos states.

WBFA engaged the target beneficiaries at the private health facilities and reached a total of 563,178 clinic attendees; Pregnant Women, Mothers of Children less than 6 months, Mothers of children 6 to 23 months, Women of child bearing age, Adult male, Older women and at the sick child clinic were reached with key Maternal, Infant and Young Child Feeding messages on Early Initiation, Exclusive Breastfeeding and Minimum Dietary Diversity during several counseling sessions in both states. 

Breastfeeding Simulators Presentation

Scale-Up Phase

In Lagos and Kaduna states, between April 2018 - May 2020 activation of facilities and program implementation of the scale-up phase commenced which incorporated the learnings and findings from the EIP phase to ensure optimal output in the phase. 

To further upskill our midwives, health workers, and inter-personal community interlocutors, ensuring they are empowered and engendered to build on the program’s success, independently and continuously, Wellbeing Foundation Africa with the support of Laerdal Medical, donated state-of-the-art breastfeeding simulators to 74 health facilities across Lagos and Kaduna states implementing health facilities to aid education and improve knowledge on the physical anatomy and physiology of lactation and breastfeeding so that our breastfeeding guardians may accelerate nutrition results for better health outcomes for women and their families in Nigeria.

The outreach and cross-fertilization of the WBFA Alive and Thrive Infant and Young Child Feeding programme successfully reached over 200,000 antenatal care attendees, 120,000 mothers of children less than 2 years and 15,000 family members with an increased counselling content of facility healthcare workers in IYCF. 

Success Story: Leading Exclusive breastfeeding Success Story in Kaduna

A beneficiary of the A&T IYCF program Mallama Amina Sani Abubakar from Kaduna state excitedly gave her testmonies of successfully exclusively breastfeeding her triplets. She said, “I have 5 children and my third births are these triplets. During my first and second birth, I was not opportune to practice exclusive breastfeeding due to ignorant relatives who pestered me to practice mixed feeding of water, infant formula and breast milk. During my antenatal clinic at Giwa hospital for the triplets, I received focused one on one counseling on Infant and Young Child Feeding practices; Early initiation of breast milk within the first hour of delivery, exclusive breastfeeding of up to six months without water or infant formula and Dietary Diversity. Initially, I thought I would not be able to practice EBF on my triplets but I was encouraged by the health care workers. I must confess, it is the best practice a mother could give to her child. Comparing my older children to the triplets, it was from one sickness to another while the triplet has never fallen ill. My husband has been a huge support during these periods”.  my Husband stood and supported me right from my prenatal stage” While the father of the triplets, Ibraheem Baba also shared his own testimonies ''These triplets were given birth on Feb. 6th 2019 and by August 6th 2019 they turned 6 months and so far, i must say economically EBF saves money!  i do not spend money buying infant formula, all i do is to make sure my wife feeds very well. He added by saying ''we experienced this great result because there was no influence of relatives/family member unlike when she gave birth to the first and second kids that's why I stood my ground and made sure she practiced EBF. I and my wife have been conveying our testimonies and encouraging friends and neighbors to practice same''