Problem: What problem is this project trying to address?
The first two years of a child’s life are crucial to cognitive and physical development, affecting both the child’s early and adult years. Improper nutrition in the first two years of a child’s life, part of which includes a lack of breastfeeding and early introduction of formula, can result in a number of short and long term negative effects in terms of psychological and physical diseases as well as neuro-development delay. In 2010, the millennium development goals (MDGs) confirmed that malnutrition is one of the main causes of death of children under five. Additional causes are low breastfeeding rates and infection due to poor prenatal care. While there have been successful efforts by the government, the United Nations, and CSOs to reduce child mortality rates under the age of five, there have been minimal efforts that focus specifically on improving child development and survival for children under the age of two.
Despite reduced mortality rates for children under five, children under the age of two in Egypt are not meeting growth indicators such as height, weight, hearing ability, motor development and other benchmarks that need to be reached by a certain age, which is in part due to malnutrition. Mothers are not receiving adequate information regarding child health and nutrition from doctors, practitioners and health workers. Further, there is a lack of training on nutrition for health professionals, community workers, and doctors. As a result of poor nutrition, children under two continue to suffer from a variety of ailments including stunted growth (underweight and under height benchmarks according to age) iron deficiency, malnourishment, low immunity (breastfeeding increases immunity), and increased mortality rates. A lack of proper nutrition during the first two years of life has also been found to increase the incidence of childhood allergies, obesity, diabetes, and infections (mainly pneumonia and gastroenteritis). Not only does poor child nutrition affect early life, it also has negative long term effects such as an increased incidence of adulthood medical problems like hypertension, obesity and coronary heart diseases. Further, individuals and families suffer from high medical expenses and communities have to spend excess costs in health resources as a direct result of poor nutrition during early childhood. Currently, more than 50% of Egyptian children have stunted physical and cognitive development, making optimal child nutrition under two a national priority.
The widespread, long-term health benefits of breastfeeding are well-documented. Despite this, only 28% of Egyptian babies are exclusively breast fed during the first six months (Egypt, DHS 2008) and 58% of Egyptian mothers were found to stop breastfeeding because of wrong beliefs of insufficient milk, lack of information on the benefits of breastfeeding, and lack of help from nurses on lactation management (unpublished research by Abla et al 2012). The lack of breastfeeding and increased use of formula was found to be responsible for 22% of neonatal deaths. Further, 81% of mothers reported that they do not get enough help with breastfeeding after the birth of their child and 71% of mothers who went for a follow up visit reported a general need for proper education on child nutrition. There are currently only 250 lactation consultants in all of Egypt and little to no resources regarding what and how to feed the child during the first two years of life—especially after the mother stops breastfeeding. Thus, mothers have very few resources and help available in regards to breastfeeding and child nutrition.
Additionally, 90% of medical school graduates do not have the opportunity for hands-on training since further university medical schooling is granted only to those who are in the top of the class. Newly graduated pediatric doctors are eager to pursue continuing education and specialized training to work in sub-specialties like neo-natal care, which requires specific training on children between zero to six months as well as after care and specific child nutrition practices that are needed until the age of two to ensure the optimal survival of the baby, but don’t have the avenue since there is no outlet for training outside the public university system.
Solution: What is the proposed solution? Please be specific!
By creating an institutionalized system to provide support and resources for new mothers, Abla is promoting optimal child nutrition practices for children in the first two years of life, countering common misconceptions that are perpetuated by unskilled or misinformed health professionals or the community. Abla focuses on educating and changing the behavior of new mothers so that they adhere to proper and safe nutrition practices for their children.
After realizing that doctors and even nurses often do not have the time, capacity, or sometimes knowledge to advise new mothers, Abla introduced a new profession in to the Egyptian health system for licensed “Child Nutritional Counselors.” Coming primarily from outside of the medical profession, this newly crafted profession is changing the landscape of the healthcare system as the counselors dedicate themselves to serving new mothers in hospitals primary care clinics, community centers, and in the mothers’ homes. Child Nutritional Counselors focus on educating and changing the behavior of new mothers so that they adhere to proper and safe nutrition practices for their children. Their support fills in a noted gap of services when it comes to consulting with mothers on lactation practices and the introduction of healthy foods according to children’s age brackets.
Although Abla works with traditional healthcare actors—doctors and nurses—to ensure that they have the right information to pass on to mothers, key to her work is engaging with people who are closest to mothers, are trusted by them and have the power to influence their decisions such as other mothers, midwives, family members, and community actors. Though seemingly simple provisions, the impact of systemizing and institutionalizing support services and resources for new Egyptian mothers cannot be underestimated. By completing a training and certification, these nutritional counselors can provide real-time health and nutritional support to new mothers during their child’s first two years of life – the most critical years for cognitive and physical development. In doing so, Abla is strategically targeting the most crucial population to help reach optimal nutrition rates in Egypt.
Acknowledging the value of Abla’s work, the Egyptian Ministry of Health and Population has agreed to adopt and integrate this new certification in to the public healthcare system. In addition, the government has pledged to support Abla’s plan to create Child Nutrition Centers within public hospitals, Primary Health Care center, and community centers. Her work has been widely recognized and is spreading throughout the country.