Postnatal clinics failing mothers

By Vision Reporter

THE recently article about the rate of infant mortality in Uganda deeply saddened me. It reminded me of a two-week-old baby girl that I received at the nutrition unit weighing 1.8kg. It was so thin that its chances of survival were zero. <br>

By Gloria Kirungi

THE recently article about the rate of infant mortality in Uganda deeply saddened me. It reminded me of a two-week-old baby girl that I received at the nutrition unit weighing 1.8kg. It was so thin that its chances of survival were zero.

I stared regrettably at this first-time mother (Jane), who had lost all hope for her first born baby. I later discovered that the baby was delivered at the health facility weighing 2kg, but surprisingly, the mother was not counseled on the basics of motherhood during antenatal and after birth.

Jane did not even know how to breastfeed her baby and the importance of the practice, yet she attended all the ante-natal sessions as required at the health facility. I then sympathized with the many children who die due to negligible issues and with the mothers who are left to cope with motherhood all by themselves.

With breastfeeding, this baby was able to gain the appropriate weight. One of the key issues that should be addressed during antenatal and postnatal checkups is infant and young child feeding.

Emphasis should be on breast-feeding and weaning, diseases and hygiene. All mothers should attend the sessions regardless of how many children they have had. Breastfeeding is feeding the baby on breast milk.

Exclusive breastfeeding means feeding the baby on only breast milk, excluding any fluid or solid. It has been recommended internationally to breastfeed a child during the first six months.

Below are the advantages of exclusive breastfeeding. Breast milk provides protection to the baby. The first milk, colostrums (yellow-ish), contains a high concentration of immune factors antibodies which offer maximum protection to the baby.

Breast milk is a complete food containing all the nutrients in the right amounts. The nutrients promote growth and development, provide energy, repair and maintain body tissues during the first six months. Breastfeeding promotes a mother’s recovery from childbirth traumas.

This is linked to hormonal interaction that exists between lactation and recovery. Breastfeeding exclusively is a relatively effective family planning method. It reduces the risk of conception before six months.

Breast milk is free, hygienic and readily available at all times for the baby. The practice provides ample time for interaction between the mother and the baby. Breastfeeding reduces morbidity and mortality in infants when initiated within the first day after birth.

The mortality is lowered even in exclusively breastfed infants. In the case of HIV, one out of 10 babies gets infected with HIV through breastfeeding, two out of 10 through pregnancy and delivery complications and seven out of 10 are not infected before the age of six months, according to the Ministry of Health.

It is, therefore, possible to reduce the risk of transmission of HIV from the mother to the child through breastfeeding by using appropriate infant feeding methods. HIV-positive mothers are encouraged to discuss with health worker the best infant feeding practices.

The following are the possible and safe infant feeding options: Exclusive breastfeeding for three to six months and replacement feeding thereafter.

However, during exclusive breastfeeding, caution should be taken to prevent transmission. Artificial feeding using infant formula. The choice of the formula, preparation method, storage and hygiene are crucial.

Wet nursing, where a baby is breastfed by another mother of choice, not the biological one, is discouraged although it is also a possible option.

Effects of poor feeding
Poor feeding is evident in the rate of stunting, wasting and underweight among the under five children. This is accompanied by increased of morbidity and mortality resulting into low growth rate.

This has resulted into low growth rate leading to low production in the country in the long run because the children will not grow to their full productive potential. Statistics show that in Africa, only 47 to 57% of infants below two months are exclusively breastfed.

For children between two to five months, this percentage falls to 25 to 31%. Six percent children, aged six to 11 months have stopped breastfeeding. This is mainly attributed to the short maternity leave entitlement for mothers, minimum support from fathers and lack of awareness on breastfeeding.

It is also caused by cultural beliefs, diseases and changing lifestyle. Even with optimum breastfeeding, children will become stunted if they do not get adequate quantity and quality of complementary foods after six months.

Most incidents of stunting and wasting (outside of famine situations) happen in the first two years of life when children have a high demand for nutrients.

This age group also has a high rate of infectious diseases such as diarrhoea that adversely affect growth and nutritional status.

Recommendations
Children should be exclusively breastfed for the first six months. There should also be continued breastfeeding through the second year of life. Working mothers are encouraged to press the breast milk every morning, ensure its proper storage and have it given to the baby during the day.

Complementary feeding practices need to focus on both feeding frequency and energy density and ensure quality diet, including sufficient micronutrients.

Mothers are encouraged to seek more information from qualified personnel on appropriate infant feeding practices. This will help improve the health and nutrition status of the children, hence good health.

Replacement feeding is the recommended practice after exclusive breastfeeding period for HIV-positive mothers because it increases the risk of transmission of the virus to the baby through breast milk.

Risk factors for HIV-positive babies
Sores on nipples breast abscess and mastitis
Sores on the baby’s mouth
Recent infection of the mother with HIV
Whether the mother is in AIDS clinical stage
Breastfeeding for more than six months
Mixed feeding (alternating breastfeeding with food).

The writer is a nutritionist at Kim’s Medical Centre kirungigloria@yahoo.com

Postnatal clinics failing mothers