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Workshop report

"Practical Considerations for Childfeeding in East, Central and Southern African Countries." Arusha, Tanzania December 16-19, 1981. Organization Committee: Dr. T. N. Maletnlema, Tanzanian Food and Nutrition Centre, Dar es Salaam, Tanzania, and Professor J.G.A.J. Hautvast, Department of Human Nutrition, Agricultural University, Wageningen, The Netherlands.

SUMMARY

The workshop was attended on invitation by representatives of five African countries: Mozambique, Rwanda, Tanzania, Uganda, and Zimbabwe. In addition, several observers and other resource persons participated. The central theme of the workshop was the young child during the weaning period. This child needs proper feeding for adequate growth and development. The primary concern is, and will be, the improvement of homemade weaning foods. Also, there is a limited role for commercially prepared weaning foods, especially those using locally or regionally obtained raw materials.

The subject of child-weaning practices was extensively discussed. Concentration should be on when and with what to wean. As to weaning time, the period from four to six months is considered best. Too late or too early weaning may be dangerous for the growth and development of the child. The most important weaning foods are the homemade ones.

Very relevant information was presented about child-weaning practices in the different countries and about engoing action programmes to improve the situation. Also, the role of village weaning foods was extensively discussed. Village weaning foods should meet certain criteria: adequate energy density, hygiene, low cost, easy availability, palatability, short preparation time, good shelf-life, proper packaging, etc. Village weaning food programmes should be based on local weaning recipes. Which appropriate technology has to be developed to assist women in preparing homemade weaning foods? On the basis of the papers delivered by the participants, and after extensive discussions, the constraints, findings, and actions with regard to weaning foods were formulated as follows:

CONSTRAINTS

In the final analysis, factors that lead to malnutrition in children are within the family unit, but the standard methods of studying nutrition problems tend to stop at the village (community) level and by so doing only the community-felt needs are seen. A number of serious individual family member problems are therefore not taken into consideration.

The participants decided to refer to the factors leading to malnutrition in children as "constraints to successful weaning practices." These constraints can be found at different levels of the community and it was agreed to identify the main constraints for commercial homemade weaning foods at the family, village, and national levels (see table 1). From this table it is easy to conclude that many sectors have to cooperate to remove or minimize the constraints.

Family Level

For commercial weaning foods at the family level, cost, acceptability, and availability are the major constraints, but lack of knowledge, improper control of budget, associated with low purchasing power and generalized poverty, often compound the constraints. Family ten" signs, leading to parent or child abuse, alcoholism, and divorces are often the underlying causes of malnutrition. Low sanitation leading to diseases and poor production is equally important.

Homemade weaning foods are affected by constraints very similar to those above, but in addition, the laborious and time-consuming methods of preparing these foods, coupled with shortage of suitable utensils, storage facilities, etc. form strong constraints against these foods.

Village Level

Many villages have no organizational structure to handle weaning foods activities, and where some kind of organization exists, the attention given to weaning foods is minimal or at times negative. Improper and inadequate communication with families on the one hand and with the national decision-makers on the other, is also a major constraint, just as are the other constraints mentioned at the family level.

National Level

A vertical approach to the malnutrition problem by the various sectors has tended to sustain and increase constraints. Lack of sufficient funds and trained staff, insufficiency of relevant and reliable data, and the poor technology available to weaning food makers at home and in industry, make it almost impossible to encourage the preparation and manufacture of such foods. Difficulties of quality and price controls were also seen as major constraints for commercial weaning foods.

TABLE 1. Some Constraints with Regard to Weaning Foods

Family Village National
Commercial weaning foods
- acceptability - organization - vertical approach; need for national, multisectoral coordination
- availability - availability
- lack of awareness and knowledge - communication - low funds
- poverty   - insufficient appropriately trained
- family tension personnel
- diseases - relevant data
- sanitation (in particular water) - technology
- adaptability of services resulting from an inappropriate training and approach
- quality and price control
Homemade weaning foods
- poverty - harvest - relevant data
- lack of awareness and knowledge - storage - technology
- availability - communication - agricultural policy
- preparation of food (fuel, work load, child care, time) - environment - low prestige foods
- organization (e.g., exchange of crops with other villages)  
- storage
- diseases  
- sanitation (in particular water)
- harvest
- family tension

Regarding staff training, it was observed that there is a lot of improper and irrelevant training for personnel involved in food and nutrition in the various sectors. Homemade weaning foods have a low prestige at the national level where a food and nutrition policy has yet to be formulated.

FINDINGS

  1. Malnutrition in children under the age of five years starts mainly during the weaning period. This finding stresses the correlation between weaning and malnutrition.
  2. The majority of the homemade weaning foods do not provide adequate amounts of energy and nutrients required by the under-fives.
  3. Present methods of preparing homemade weaning foods are in many ways laborious and inefficient.
  4. Feeding children bulky meals and infrequency of eating leads to a low energy, protein, and nutrient intake.
  5. Commercial weaning foods are too costly for the majority of the population.
  6. The mother needs an easy-to-prepare weaning food if she is to keep up with her work schedule.
  7. Data availability on weaning foods is insufficient and sometimes unreliable.
  8. Locally prepared "low cost" weaning foods are faced with various problems of acceptability, distribution, maintenance of production, and costs (examples of products are LISHA, FAFFA, etc.). Although the description "low cost" weaning foods is used, these products are not low in cost, but they are appropriately referred to as "low cost" when compared to the standard weaning foods manufactured by the multinational companies.
  9. In a few places where, among other changes that have occurred, weaning foods have been improved by the addition of high-protein and energy-rich foods the health of children has also improved.
  10. Early introduction of breast-milk substitutes tends to lead to early introduction of other weaning foods.
  11. Poor sanitation and unhealthy living conditions of the family render weaning food preparation prone to contamination.

ACTIONS

  1. More and relevant planning data have to be collected on:
  • the role and efficiency of homemade weaning foods
  • the need for commercial weaning foods and what type of foods for whom
  • utensils for preparation, feeding, and storage of foods.
  1. Proper evaluation of the usefulness of existing homemade weaning foods, with suggestions for improvement, should be carried out. The preparation of a manual would be useful.
  2. If data collected indicate the necessity, then commercial weaning foods should be introduced with emphasis on using local raw materials to minimize imports. This pertains especially to two foods:
  • the ordinary/complete foods and
  • the concentrates to be added to a staple.

The price should be as low as possible and the quality should be strictly controlled.

  1. Continuous education of parents should be emphasized.
  2. Practical training for personnel involved in nutrition education and the production of weaning foods should be intensified.
  3. Inter- and intra-country meetings to monitor and evaluate performance should be held regularly.
  4. The WHO/UNICEF Code of Marketing of Breast milk Substitutes should be implemented.