Nutrition

Good nutrition is essential to human well-being. Before birth and through infancy, good nutrition allows brain functioning to evolve without impairment and immune systems to develop more robustly. The nutrition department mandate is to ensure optimal nutrition of all people living in the Region to enhance health and capacity for economic growth and development.

 

Key Activities Carried Out in 2016

Monitoring, Supervision and Technical Support to Districts

The unit under took various monitoring and technical supports visits to various districts during the period under review. Whiles some of these visits were to provide technical support in a specific programme area, the team also used the opportunity to mentor nutrition officers and other health staff and provide on the job coaching. These include:

  • Community Management of Acute Malnutrition (CMAM): Two monitoring visits were carried out to supervise and mentor staff providing CMAM services at Atebubu Amantin and Techiman Municipal. All the twelve (12) OPC sites in Atebubu-Amanten District were visited twice each whiles four (4) out of the sixteen (16) OPC and 1 IPC site at Techiman municipal was visited.
  • NutritionAssessment and Counselling support (NACS): The nutrition unit jointly undertook supportive supervision, monitoring and mentoring with the TB/HIV team to five (5) districts to assess the nutrition counselling and support given to   TB/HIV clients. Districts visited include: Asutifi North and South, Dormaa Municipal, Jaman South and Tano South.
  • Routine Vitamin A supplementation (VAS): Following regional bottleneck analysis, strategy development to increase routine Vitamin A supplementation in especially children 12- 59 months in all districts, the Regional Team carried out supportive supervision visits to each of the 27 districts within the region. Another visit was made by a joint team of nutrition officers from GHS, headquarters and the RHD to three selected districts including Dormaa East, Tano North and Techiman Municipality. The districts were selected based on their performance in certain nutrition indicators especially vitamin A.
  • Community Infant and Young Child Feeding (C-IYCF): The Regional Nutrition team carried out first technical support visits to five newly trained C-IYCF districts. The distrists were: Sene East, Wenchi Municipal, Jaman North, kintampo South and Tain districts. Techiman Municipal and Sunyani west who have been implementing the intervention since 2013 were also visited. 
  • BFHI monitoring in five facilities: Monitoring and reassessment was conducted by a team of Regional Officers in collaboration with the MEBCI Team in five (5) facilities to determine their level of adherence to Baby-Friendly Health Facility Initiative (BFHI) practices. Facilities assessed include Dormaa Presbyterian Hospital, Berekum Holy family Hospital, Wenchi Methodist hospital,, Kintampo Municipal Hospital, and Atebubu Government Hospital.The outcome of the assessment showed that all the facilities did not meet the criteria for maintaining their Baby Friendly status. There was therefore the need for staff to be retrained.  .
  • Data validation to monitor nutrition data:  The Unit conducted monthly data validation of the DHIMS data and provided feedback to districts. Furthermore the unit analyzed the first and second quarter nutrition data and gave feedback on performance to all districts.

Training

  • Trainer of Trainers in Essential Nutrition Actions (ENA): The ENA is a global strategy to integrate health services aimed at improving maternal and child health and nutrition. The nutrition unit organized two sessions of TOT trainings together with the health promotion officer for various categories of district staff delivering maternal and child health services including nutrition officers, midwives, public health and community health nurses. The districts were grouped into zones. The first zonal TOT took place in Domaa Ahenkro and included twenty six (26) from Domaa Municipal, Dormaa East, Domaa West, Jaman North and South, Brekum districts. The second ToT on ENAs was organized for thirty five (35) staff from ten districts.
  • Training in Lactation management (BFHI): as part of efforts to increase the number of baby friendly facilities in the Brong Ahafo region and ultimately increase the rate of exclusive breastfeeding for six months, a regional TOT on BFHI or Lactation management was conducted for one hundred and sixty one staff in twenty facilities including five facilities. Following the Lactation Management training, the regional nutrition unit supported the various facilities to organize one day BFHI orientation for all staff in their facilities.
  • Regional Bottle Neck Analysis Workshop to strengthen routine Vitamin A supplementation: Data from the DHIMS on VAS indicates very low coverages of children within the age range of 12-59 months in Brong Ahafo. As part of efforts to increase VAS among this age group, the Regional health directorate with support from UNICEF conduct a BNA on VAS in all the districts Brong Ahafo Region. The A regional bottleneck analysis workshop was organised for 54 staff from all the districts (two from each) as well as three staff from RHD.Following the regional training, RHD supported all districts to conduct district level bottleneck analyses training and capacity building for frontline to strengthen routine VAS and improve uptake of VAS service.
  • Training in community infant and young child feeing: The Nutrition unit conducted TOT in five disricts including, Wenchi Municipal, Jaman North, Tain district, Kintampo south and Sene East, twenty five trainers were trained in community infant and young child feeding(C-IYCF) and supported by the unit to in turn train 125 counsellors ( 25 from each district)

Review meeting

During the year, two review meetings were held by the nutrition unit. The first was a one day’s meeting organised for Nutrition Officers to review the nutrition activities for the year 2015 in the region as well as the challenges and way forward to help improve upon nutritional indicators in the region. The second review meeting was held to review prorogues made on the implementation of strategies drawn during the VAS BNA workshop. The aim is to identify strategies which are effective and re-strategize if need be. The meeting included nutrition officers and public health nurses from the districts, representatives from UNICEF and the Deputy Director, Nutrition from GHS, Headquarters.

 

1.1.1Growth Monitoring and Promotion (GMP)

Growth monitoring was routinely carried out in all districts to assess the growth of children below the age of five years. This helps to identify children who are not growing well and to take remedial action by way of counselling in order to prevent them from becoming severely malnourished. It also helps to identify children who are moderately or severely malnourished for rehabilitation.

Growth Monitoring and Promotion Coverage by Age Group

A total of 100,944 out an expected number of 105,963 children within the age s of 0-11 months representing 95.3% were registered during Growth Monitoring and Promotion in 2016. Meanwhile the coverages for 12-23 and 24-59 age groups were only 40.7% and 11.9% respectively.

Table 6.8: GMP Coverage by Age Groups

AGE (MONTHS)

Target population

Number of children registered

% coverage

0-11 months

106,246

100,944

94. 8%

12-24 months

106,246

43,115

40.5%

24-59 months

319,378

37,872

11.9%

Total

52,915

181,931

34. 2%

The proportion of children in the various age bands decrease as the children get older. Children in the 24 - 59 month age record the least. This can be attributed to the reluctance of mothers to send children to CWC once they complete their immunization and also because most children aged 24 months and above are now attending nursery schools or kindergartens. There is the need to encourage mothers/caregivers to send older children for growth monitoring. Furthermore, Districts have to extend child health services into Nursery schools and kindergartens where most of these children can be found.

Growth Monitoring Coverage by District

Generally GMP coverage by districts were low in 2016 compared to the two previous years (2014 and 2015). Comparing the absolute figures of GMP attendance recorded in children 0-59 months over the three year period in the districts showed that GMP attendance in children0-59 months were lower compared to the previous two years.

Nutrition status of children 0-59 months

The prevalence of malnutrition in the 0-59months children population were check during CWC registration  using the weight for age indicator. All children whose weight for age fall below the -2z score line were categorized as moderate underweight and their caregivers were counselled on appropriate feeding practices. Children whose weight for age fall below the -3z score curve are severely underweight and were referred for treatment and nutritional rehabilitation.

Table 6.9: Incidence of malnutrition (underweight) among Children under five

Age

Registrants

Severe underweight

(< -3SD)

Moderate underweight

(-2SD to < -3SD

Total underweight

(-2SD to < -3SD )

 

 

Number

%

Number

%

Number

%

0-11

100,944

473

0.5

5,514

5.5

5,987

6.0

12-23

43,115

209

0.5

2,726

6.3

2,935

6.8

24-59

37,872

138

0.4

1,995

5.3

2,133

5.7

Total

181,931

820

0.5

10,235

5.6

11,055

6.1

The prevalence of 6.0% and 6.8% underweight 0 -11 and in the 12-24 months population respectively is an indication of poor breast feeding and complementary feeding practices. There is the need to scale up the community infant and young child feeding (IYCF) to train more counsellors in IYCF in all districts counsel mothers on appropriate child feeding practices.

1.1.1Infant and Young Child Feeding

GHS recommends that children be put to the breast within the first 30 minutes of birth and that children be exclusively breastfed during the first 6 months of life.

A total of 64,651 out of the 65,686 mothers who delivered in health facilities representing 98.4% initiated breastfeeding within 30 minutes after birth, while 63,607 representing 96.8% were practicing Exclusive Breastfeeding at discharge. The percentage reduced further to 83.2% and 65.7% for mothers who practiced EBF for 3 months and 6 months respectively. Though some gains have been made, there is the need to increase the efforts to ensure the percentages are increased to 80% for exclusive breastfeeding up to six months.

 

Table 6.10: Performance in Ifant and Young Child feeding Indicators

INDICATOR

Number

% Coverage

Number of mother delivered at facility

65686

 

Lactating Mothers initiating EBF within 30mins of birth

64651

98.4%

Lactating Mothers practicing EBF as at discharge

63607

96.8%

Number of children assessed for feeding at 3 months

109670

 

children exclusive breastfeeding at 3 status months

91335

83.2%

Number of children assessed for feeding at 6 months

130424

 

children started Complementary feeding status at 6 months

857546

65.7

Total number of children in C-IYCF register

10478

 

Total number of children in C-IYCF register (new + old) visited at least once in the month

7725

73.7%

 

1.1.2Vitamin A Supplementation

Vitamin A supplementation for children under five was carried out at all Child Welfare Clinics in the region. Maternal Vitamin A supplementation was carried out at maternity wards and post natal clinics. Coverages in the 12-59 months group have been very low over the years compared to the 6-11 months age group. This is because mothers stop sending children for CWC after their first year of life or after completing the routine immunizations