Sustainable Nutrition Interventions for the First 1000 Days
Chronic malnutrition is rooted in the first 1,000 days of a human’s life — a period from conception to the newborn’s second birthday. It causes millions of under five deaths and stunted children are more vulnerable to poor performance at school and low productivity at work during adulthood because of delayed mental and physical development.
In 2010, in Burera, a district located in Northern Rwanda, slightly more than half (52%) of children under the age of five years were suffering from chronic malnutrition (stunting). This prevalence was much higher than the 44% chronic malnutrition rate nationally. In response to these findings, the government of Rwanda has developed and decentralized a number of nutrition interventions to eliminate malnutrition, focusing on the critical window of opportunity to eliminate all forms of malnutrition in the first 1,000 days of a child’s life.
During my Global Health Corps fellowship working for the Rwanda Ministry of Health (MoH) in Burera district this past year, I have worked closely ith community health workers (CHWs), or “Abajyanama b’Ubuzima” as they are locally known. CHWs have proven to be vital in promoting universal coverage and ensuring sustainable implementation of existing nutrition interventions for children and pregnant and lactating mothers.
In Burera district, CHWs are required to have at least six years of education and are elected by communities in which they are permanent residents. Burera has approximately 1,900 CHWs distributed in 571 villages, roughly three to four CHWs per village. Generally, CHWs are volunteers and there are two CHWs in charge of community health, nutrition and HIV/AIDS prevention (binomes) and one specific maternal health worker (Animatrice de Santé Maternelle (ASM)).
Burera district community-based nutrition interventions to promote good nutrition during the first 1,000 days of life include:
· monthly malnutrition screening of children under five years of age and pregnant and lactating mothers for timely identification and treatment of acute malnutrition
· monthly nutrition education through cooking demonstration sessions and nutrition-related behavior change communication campaigns
· distribution of micronutrient supplementations like iron folate for pregnant mothers during antenatal care services (ANC), Vitamin A for mothers in post-partum, Vitamin A for children 6–59 months, and multiple micronutrient powders, locally known as ONGERA for children 6–23 months.
I saw up close how CHWs volunteered to help Burera district implement all nutrition interventions for the first 1,000 days of life with monthly average achievements of more than ninety percent of coverage in approximately 60,000 of target population.
During my fellowship year, I was responsible for ensuring regular collection of nutrition data on a monthly basis throughout Burera district, conducting quarterly monitoring site visits down to the village level and assisting with planning and coordination of activities for the 1,000 days campaign. I saw up close how CHWs volunteered to help Burera district implement all nutrition interventions for the first 1,000 days of life with monthly average achievements of more than ninety percent of coverage in approximately 60,000 of target population. On average, they screened 99% of children 6–59 months and 97% of pregnant and 90% of lactating mothers for malnutrition using mid-upper arm circumference (MUAC). They helped with the distribution of micronutrient supplements and led nutrition education through cooking demonstration sessions. I was particularly impressed with the efforts of CHWs to increase the proportion of villages who are regularly conducting the distribution of ONGERA to reach 97% of children 6–23 months in just five months after Burera district started the implementation of this activity in August 2015.
The first 1,000 days of life campaign, powered by CHWs, has clearly contributed to reducing malnutrition in Burera district. During the period 2010–2015, stunting rates dropped from 52.0% to 42.9%, while the monthly average number of outpatient acute malnourished children decreased by 76% from 360 in 2011 to 85 in 2015. Recently, the United Nations (UN), Non-Government Organizations (NGOs), development agencies, foundations and developing countries have partnered to establish and scale-up nutrition interventions to end malnutrition, especially during the first 1,000 days of life. Other resource-limited settings can learn a lot from Burera district’s CHW model to implement and maintain affordable and life-saving nutrition interventions which will involve everyone in the target population.
