Nigeria: How Covid-19 Threatens Nigeria's Exclusive Breastfeeding Target

Barely a month after she gave birth to her first daughter, Halima Ibrahim took ill in late February, about the same time Nigeria recorded its index case of COVID-19 in an Italian traveller.

"I was diagnosed with typhoid fever and I think it affected the quality of my breast milk because the baby was not sucking", Mrs Ibrahim, who lives with her disc jockey (DJ) husband, Valentine, in an Abuja suburb, told PREMIUM TIMES on Wednesday night.

Because of the situation, she was advised by her doctors to abandon her earlier plans of six months of exclusive breastfeeding and start shuffling breast milk with baby food and water.

Exclusive breastfeeding is when an infant receives only breast milk. No other liquids or solids are given - not even water - with the exception of oral re-hydration solution, or drops/syrups of vitamins, minerals or medicines.

Exclusive breastfeeding, especially for the six months of the child life, is important as the nutrients they obtain enable them to grow both mentally and physically, Mariam Ahmed, Global Youth Leader on Nutrition, said.

But unfortunately, not every woman does that. Mrs Ibrahim who suffered typhoid for more than three weeks while following the doctor's instruction is not equipped with the right information on the essence of total breastfeeding and the handling of an infant in the middle of the COVID-19 pandemic.

In late March, she returned to the Asokoro General Hospital, Abuja where she was receiving counselling on breastfeeding.

Unfortunately, it was the same week Nigeria imposed a total lockdown on Abuja, Lagos and Ogun in a bid to slow the spread of COVID-19 in Africa's most populous country.

Though the restrictions did not apply to hospitals and other essential workers, it reduced medical services in health institutions to the barest minimum.

She said she missed out on exclusive breastfeeding. "I continued with breast milk, baby food and water".

COVID-19 Situation: Misinformation

In the wake of the COVID-19 pandemic, like Mrs Ibrahim, a lot of Nigerian women are missing out on exclusive breastfeeding, especially due to misinformation about the nature of the disease and what needs to be done to avoid it.

The rate of exclusive breastfeeding in Nigeria is one of the lowest in sub-Saharan Africa. Even before the pandemic, 70 per cent of Nigerian infants were not being exclusively breastfed.

Breastfeeding programmes, which are currently under threat due to the pandemic, had helped in improving breastfeeding behaviours in Nigeria.

In 2013, the Nigeria Demographic Health Survey (NDHS) put the country's exclusive breastfeeding at 17 per cent. The rate was upped in the 2018 NDHS to 29 per cent

But the misinformation about COVID-19 has now been added to the mix of factors impeding exclusive breastfeeding.

When she was not allowed services at the hospital, Mrs Ibrahim resorted to second-hand information from other women.

But it is hard to separate the truth from falsehood without proper medical counsel, as COVID-19 has brought with it a wave of rumours, mixed messages and deliberate misinformation across Nigeria.

This is putting a strain on Nigeria's target of using exclusive breastfeeding to tackle Severe Acute Malnutrition (SAM) in children under five.

SAM or extremely low weight-for-height, is estimated to affect about a million children under age five in Nigeria every year, contributing to as many as 100,000 deaths per year.

The development of SAM in infants under six months of age commonly reflects sub-optimal feeding practices, especially breastfeeding practices, the World Health Organization (WHO) said.

WHO said SAM is increasingly being recognised in infants and is often associated with higher mortality in young infants than in older infants and children.

Off-track?

"Nigeria is making progress but it is slow and as it stands, if we don't put extra efforts then the country is unlikely to meet the World Health assembly targets of 60 per cent of infants being exclusively breastfed by 2025," Simeon Nanama, a Chief Nutritionist, United Nation's Children Fund (UNICEF), said.

While there is little improvement, health experts believe the current rate is still far below global standard and off-track from the 60 per cent target by 2025. As of 2016, neighbouring Ghana already had an exclusiveJus breastfeeding rate of 52 per cent.

"The country was already off-track even before the COVID-19 pandemic", said Mr Nanama. "The pandemic that came in represents another challenge for exclusive breastfeeding with the likelihood of even drawing down the level of progress.

"This is because COVID-19 comes with so many things like fear from the mothers that breastfeeding when they feel like they are sick may contaminate the baby or the reverse.

"Also the fact that the lockdown and other measures have put many households in very complex challenging economic situations where they are struggling to even put food on the table. We know very well that when the mother is not well fed, milk cannot be produced enough to meet the requirements of the baby."

As Nigeria continues to see surging COVID-19 cases, hospitals around the country are limiting visitors and unnecessary contact inside their buildings to prevent the spread of the highly contagious virus.

Tayo Fatinikun, a social and health development advocate, said the situation has disrupted medical services with some families "caught up in the notion of not breastfeeding their infants to prevent COVID-19."

World Breastfeeding Week

The 2020 World Breastfeeding Week, which runs from August 1 to August 7, highlights the importance of protecting and promoting women's access to skilled breastfeeding counselling as a critical component of breastfeeding support.

This year's theme for the week is "Support breastfeeding for a healthier planet".

Commemorating the event, WHO on Sunday said skilled counselling services can ensure mothers and families receive this support, along with the information, advice, and reassurance they need to nourish their babies in the best way.

"Breastfeeding counselling can help mothers to build confidence while respecting their individual circumstances and choices," said UNICEF Executive Director, Henrietta Fore, and WHO Director-General, Tedros Ghebreyesus, in their joint statement.

"Counselling can empower women to overcome challenges and prevent feeding and care practices that may interfere with optimal breastfeeding, such as the provision of unnecessary liquids, foods, and breast milk substitutes to infants and young children."

Mrs Ibrahim said if she had continued her regular visit to the hospital, she would have had a better understanding on how to feed her baby.

"It's my first child so I don't really know much. The pandemic really changed a lot of things. There is no job so I no longer get money to even buy good baby food. Sometimes, I give her all kinds of solid food including rice and swallow," she said.

Recommendations

Though coronavirus does not pass through breast milk, there is a chance of spread through respiratory droplets and contacts, health experts say.

"This can be minimised if appropriate infection prevention and control measures are observed", Mr Fatinikun, the health development advocate, said. "It is important to wash your hands frequently along with using an alcohol-based sanitiser before touching the baby".

The health advocate also suggested making use of face masks when breastfeeding to prevent the spread of infection via respiratory droplets.

"It is also important to ensure that all surfaces that the mother touches are disinfected regularly", he said.

"What we know so far is that the virus cannot be transmitted through milk especially when the mother is going by the existing COVID-19 measures of wearing masks amongst others", Mr Nanama, the UNICEF nutritionist said.

"It will require a renewed effort by government and other partners to ensure we continue to empower women and give them the information required to make the best choices for themselves and the babies."

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