Situational analysis of infant and young child nutrition activities in the Sahel – executive summary

Several international agencies and non-governmental organizations joined forces in 2007 to support an initiative to ‘Reposition children's right to adequate nutrition in the Sahel’. The overarching goal articulated by these organizations was to achieve optimal feeding of ≥80% of children 0–24 months based on relevant and internationally agreed-upon child-feeding indicators. An early activity of the working group for this infant and young child nutrition (IYCN) initiative was to carry out a situational analysis to evaluate IYCN activities being conducted in six Sahelian countries of West and Central Africa, namely, Burkina Faso, Chad, Mali, Mauritania, Niger and Senegal (1–6). The objectives of this analysis were to compile, analyse and interpret available information on infant and child feeding, and the nutrition and health situation of children 80% of children 6–59 months through national campaigns in all countries included in this report (8). However, these campaigns are not yet taking place semi-annually in all countries, few women are reached with VAS early post-partum (22–48%) and it is uncertain how many infants are receiving these supplements at 6 months of age. In the past decade, Senegal and Mali have been conducting nearly annual national campaigns to promote breastfeeding and several other countries have commenced these campaigns more recently. Although substantial increases in breastfeeding have been reported in some of the reviewed countries, Senegal and Mali are the only two countries reaching >30% prevalence of exclusive breastfeeding among infants 0–6 months. Even with these increases, the prevalence is considerably less than what is needed to achieve substantial impacts on infant morbidity and mortality. National Demographic and Health Surveys (DHS) and/or Multiple Indicator Cluster Surveys (MICS) are conducted in all countries, and some other national nutrition surveys are also scheduled sporadically between rounds of the DHS/MICS. However, few programme-specific evaluations have been conducted, and even fewer of these evaluations assessed baseline and follow-up data in intervention and comparable non-intervention sites. Among those studies that did include baseline and follow-up surveys, the statistical analyses were inadequate to confirm whether changes in the intervention sites were significantly different from changes in the non-intervention sites. Thus, it is uncertain whether any reported changes were in fact because of the programme activities or other extraneous factors. Further, most M&E activities assessed the logistics of the programme delivery, such as the number of staff trained and the number of participants served, but few assessed the quality of programme components or evaluated whether the programme had a measureable impact on health and nutrition status of the recipients. Therefore, most M&E activities reviewed did not permit identification of effective programme components for expansion nationally or internationally. We also found gaps across countries in available documentation. Some documents were not readily available for review or the programme activities had not been documented. There has been insufficient or no progress in the region towards the Millennium Development Goal 1.8: to halve underweight among children less than 5 years of age between 1990 and 2015. Mali, Mauritania and Senegal have made the most progress among the countries included in this analysis. Niger and Senegal appear to be on track towards MDG 4.1: to reduce by two-thirds mortality rates among children less than 5 years of age in the same period. Despite this progress, Niger and Senegal are still ranked 13th and 29th globally in high child mortality rates. In addition to the previously mentioned activities, we also identified national-level collaborative nutrition working groups in Burkina Faso, Mali, Mauritania, Niger and Senegal, with varying levels of participation and meeting frequency. The REACH initiative (Ending Child Hunger and Undernutrition Initiaitve) was piloted in Mauritania and assisted the government in organizing a multi-sector nutrition coordination unit with support from the office of the Prime Minister. Several key informants and some programme documents also identified gaps in human, institutional and financial resources to carry out nutrition-related activities in these countries. Although we identified progress in various nutrition-related activities across all countries included in this situational analysis, Senegal appears to have made the most overall progress towards improving infant and young child nutritional status. Because of inadequate research and programme M&E, we could not confirm the source of this progress. However, Senegal has been host to a combination of critical nutrition activities that likely contributed to the progress identified. Most of these activities were also conducted in various forms in other countries, but not in combination. These activities include the formation and high-level support of a multi-sector national nutrition counsel to coordinate nutrition-related activities in Senegal; implementation of semi-annual VAS campaigns, for which financial responsibilities are being systematically transferred from international donors to national- and district-level budgets; national annual breastfeeding campaigns to support local programmatic activities; and national-level nutrition programmes with educational messages that were reportedly developed based on research of barriers to optimal feeding practices. Finally, these activities were supported by a concerted national strategy to reinforce nutrition activities. Unfortunately, reports of some of these activities were no longer available for review and, as previously mentioned, the programme evaluations did not include the required details to confirm the impact of the programme. Regional level awareness of and responses to existing nutrition problems are evidenced by such regional activities as the adoption of pertinent nutrition resolutions by the Ordinary Assembly of Health Ministers of the Economic Community of West African States in 2007 (fortification of wheat flour with iron, zinc and B vitamins and cooking oil with vitamin A) and 2009 (promoting key nutrition activities of): (i) capacity building for public health nutrition; (ii) VAS for child survival; (iii) IYCN; and (iv) Integrated Management of Acute Malnutrition, and the establishment of a regional repository of relevant national and international documents. Additional regional-level activities include the promotion of the West Africa Capacity Development Initiative (9) (working to improve and increase local training of nutrition professionals, relevant laboratory facilities and applied research capacity) and implementation of the REACH – Ending child hunger and undernutrition initiative in at least two countries (supporting and promoting effective multi-sector national collaboration and coordination of nutrition activities, organizing nutrition training for the media, http://www.reach-partnership.org/home). The activities reported in identified documents clearly demonstrate that governmental and non-governmental agencies are working to improve the nutritional situation for infants and young children in the region. Existing national nutrition policies have established a good foundation for implementing appropriate IYCN-related activities in the six Sahelian countries included in this situational analysis. However, limited programme coverage and often inadequate M&E hinder identification of effective programmes for expansion nationally and internationally. The findings of these situational analyses highlight the need to: (i) continue support and expansion of effective IYCN activities, in addition to expansion of the promotion of exclusive breastfeeding up to 6 months of age and VAS; (ii) improve M&E and utilize findings to guide programme design; (iii) improve collaboration among scientists, educators and programme developers to ensure that scientific efforts are guided by programme needs and training materials and programmes are evidence based; (iv) ensure that documentation on nutrition training, programmes and evaluations is readily available nationally, and where appropriate, internationally; (v) support effective supervision and training of health workers at all levels and in adequate numbers to carry out these activities; and (vi) continue collaborative efforts of national and international agencies towards repositioning children's right to adequate nutrition. Financial support to initiate and carry out the situational analyses was provided by the founding agencies and organizations of the IYCN initiative, in alphabetical order: the Food and Agriculture Organization of the United Nations, Helen Keller International, Micronutrient Initiative, Save the Children, the World Food Programme of the United Nations, the United Nations Children's Fund and the World Health Organization. Completion of this analysis required assistance from government officials, nutrition focal points and other representatives working in infant and young child feeding and related areas. The agencies that provided information for the completion of these analyses are listed in each of the country reports to follow in this issue. We are sincerely grateful for their assistance. Review of key internationally recommended infant and young child nutrition practices to accelerate efforts to improve nutritional and health status of infants and young children in the Sahel region of Sub-Saharan Africa Situational analysis of infant and young child nutrition policies and programmatic activities in Burkina Faso Situational analysis of infant and young child nutrition policies and programmatic activities in Chad Situational analysis of infant and young child nutrition policies and programmatic activities in Mali Situational analysis of infant and young child nutrition policies and programmatic activities in the Islamic Republic of Mauritania Situational analysis of infant and young child nutrition policies and programmatic activities in Niger Situational analysis of infant and young child nutrition policies and programmatic activities in Senegal The way forward: repositioning children's right to adequate nutrition in the Sahel

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• Strengthening public health nutrition research and training capacities in West Africa

  Open Access•Kendall H Brown, Milla Mclachlan et al.•Global Public Health•2010

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• Situational analysis of infant and young child nutrition policies and programmatic activities in Senegal

  Open Access•Sara E Wuehler, Sara Wuehler et al.•Maternal and Child Nutrition•2011

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• Situational analysis of infant and young child nutrition policies and programmatic activities in Niger

  Open Access•Sara E Wuehler, Sara Wuehler et al.•Maternal and Child Nutrition•2011

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• Situational analysis of infant and young child nutrition policies and programmatic activities in Mali

  Open Access•Sara E Wuehler, Sara Wuehler et al.•Maternal and Child Nutrition•2011

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• Situational analysis of infant and young child nutrition policies and programmatic activities in Burkina Faso

  Open Access•Sara E Wuehler, Sara Wuehler et al.•Maternal and Child Nutrition•2011

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