Project Support Communications Newsletter • Information Division, UNICEF. New York, NT. 10017

The Promotion of Breastfeeding and Proper Weaning Practices in the Ivory Coast

by Ute Deseniss, UNICEF—Abidjan

"Do you have children?" "Yes, I have 29 children" that my wives breastfeed the children as long "Were they breastfed?" we asked a vigorous as possible, as I know it is important for the man of about fifty while pretesting the draft of children, especially baby boys, so that they will the breastfeeding poster at the National Social always come back to their mothers" Security Office in Abidjan, the capital of the It was interesting to note that all male re- Ivory Coast. spondents expressed their support for breast- 1 "Sure; he affirmed, "all my children were feeding while the reaction from female breastfed, and I will have more children, and respondents was quite different. This con- they will all be breastfed:' firmed the result of a survey which revealed He is a Muslim and has four wives. He works that only 0.7% of 421 children were bottle-fed as an accountant in a private enterprise in an due to the decision of the husband. inland town of the Ivory Coast. While looking This was part of the survey undertaken bv again at the poster, he continued, "It is good to the Ivorian National Public Health Institute see this African woman breastfeeding her baby. (INSP) from December 1981 to May 1982 in- This is something so natural, but people start vestigating the child feeding practices in and to forget it, and it may even disappear one day. around Abidjan. In collaboration with 20socio- So it is good to remind us not to give up our medical centres for MCH Care, the health traditions.' education team of the INSP examined the He read the text under the picture about the nutritional status of 2284 children and found advantages of breastfeeding and said, "I insisted that about 20.3% of them were malnourished.

(Continued on page 2) Breastfeeding & Proper notice. This affected the campaign in the sense that it lacked a logical Weaning Practices progression. Nevertheless the public became aware of the importance of breast- feeding. Several times we witnessed (Continued from page 1) people making remarks like: "...at least now we have proof that breast- According to the survey, 96% of UNICEF staff, particularly the Re- feeding is the best for the baby." the examined children were breast- gional Nutrition and PSC Advisers, The campaign aimed at a nation- fed for about six months. Malnutri- became more and more involved. wide sensitization about the advan- tion before six months was only This was especially true in the con- tages of breastfeeding It did not about 8.3%.This proves that breast- ception and preparation of the two intend to frustrate mothers who can- milk is the most appropriate food for posters and booklets The WHO and not fully breastfeed because they babies for the first six months. Mal- UNICEF Representatives in the Ivory have to work to earn a living, or nutrition increased to 17.6% for the Coast were interviewed on TV on the attend classes.To deal with the prob- one-year olds and to 33.9% for the 12 breastfeeding code, and the Regional lem of working mothers, the training to 17-month-olds.This is due to a Information Officer had at prime of the nounous (nannies), who look rather late introduction of supple- time an exclusive interview on the "B" after the babies while the mothers go mentary food. Indeed, children in of UNICEF's GOBI (Growth Monitor- to work, is considered as one of the the Ivory Coast are weaned on the ing, Oral Rehydration Therapy, follow-up activities of the campaign. average between the age of 11 and 15 Breastfeeding, Immunization)! In general these nounous are young months, varying from one ethnic During the second phase of the girls without any schooling.They are group to another. On the basis of this campaign, the Regional Nutrition mostly members of the extended survey, the CMSP decided to carry out Adviser contributed to the National family of the children that they look a nutrition education programme, Child Nutrition Workshop on after. They come from the village starting with a nationwide sensitiza- Growth Monitoring, and the Re- attracted by the city life. Unfortu- tion campaign for the revalorization gional PSC Officer demonstrated nately, research showed that only of breastfeeding and proper wean- educational techniques on Oral Re- 20% of these nounous know how to ing practices based on local food hydration Therapy. prepare infant formula correctly. products. It is too early at this stage to say The training approach agreed on is The campaign, which was launched anything definite about the impact to first make an inventory of their on television by the Ministry of Pub- of the campaign. An evaluation is educational needs, and then prepare lic Health and Population on 4 April planned for the second half of 1984. the training package. Personnel from 1983, lasted until the end of 1983. It However, there is no doubt that the Social Centres and MCH Centres will was divided into two parts.The first campaign had at least succeeded in visit spots where nounous usually sit part, lasting until the end of July raising awareness.The breastfeeding together and talk in the afternoon, 1983, dealt exclusively with breast- theme became a regular feature in with the babies in their arms or on feeding The second part, from Octo- the media The posters were hung up their backs, or crawling on the floor. ber to December 1983, emphasized not only in MCH Centres, but also in These leisurely moments offer appropriate weaning practices. public places. Even while waiting for opportunities for educating the All kinds of communications the bus, people's attention was nounous on appropriate infant for- media, such as TV, radio, newspaper, drawn to the breastfeeding poster mula preparation, hygiene, weaning poster, booklet, and popular song, placed on the back of the buses. practices, first aid, etc. were used in the campaign.The INSP The campaign was probably With reference to weaning, special contacted UNICEF for funds to cover biased towards the urban audience. activities on family nutrition educa- the production costs of the posters, All programmes, except a few radio tion are envisaged. Malnutrition of booklets, and the expenses for a broadcasts, were in French.There children is often a consequence of health education workshop for its was also too much dependence on the mother's ignorance of a balanced paramedical staff working in the TV, which was not very reliable as diet, and not necessarily a problem of MCH Centres. programmes could be cancelled and means.Thus the weaning poster ex In the course of the cooperation, schedules changed without prior (Continued on page 3) ICuntimird f)-play an important role in port that they need. An appropriate ing, foi strength,and for protection. tht1 promotion and protection ul family nutrition education pro- The tradition ol serving food to \wv.n breastfeeding and proper weaning grarniiK! is prohahly a g(«)d starter lo before the other familv members practices by providing their \vi\os get the men involved.

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Cloth posters in support of the Baluchistan Integrated Area Development (BIAD) Programme printed locally using the silk-screen printing technique. For more information on the Communication aspect of the BIAD Programme, write to Dr. Pamela Hunte, UNICEF Sub-Office, 80-B, E-5, Satellite Town, Quetta, Pakistan. Pakistan: ORT Promotion !^s%ggg^a=% Messages for Community Education

1- If not treated immediately, di- too much water.These are signs arrhoea can be dangerous.Vour 19. Cover your food to protect it of danger. from flies and dirt. Your baby's child can die from diarrhoea. 10. When you see t he danger signs, 2. If your child passes three or food must be kept clean or he rush your child to the health will get diarrhoea. more loose watery stools in a centre day, he has diarrhoea. 20. Keep your home clean, espe- 11. Take your child to the health cially the floor. Your children 3. Diarrhoea is dangerous. Much centre if he has diarrhoea and water is lost. Diarrhoea brings play on the floor and will get you cannot feel his pulse.Take diarrhoea from dirt there. malnutrition. him if he keeps vomiting. Take 4. Sometimes a child with diar- 21. Build a latrine if you can Let him if he absolutely refuses to the whole family use it. rhoea starts vomiting. This drink. Always try to feed Elaj-e- speeds up water loss, and the 22. Have your child immunized Julab on the way there. against the worst diseases. You danger is greater. 12. If diarrhoea is only mild, keep 5. When your child has diarrhoea, must go three times. Immuni- on giving Elaj-e-Julab to your zation is free. give Elaj-e-Julab (ORS). Give it baby at regular intervals^Tea, every few minutes. Give it as 23. Your baby should be weighed rice water, or herb water is also regularly to ensure that his much as he wants. good for diarrhoea. 6. Elaj-e-Julab called Nimkol is health is progressing satisfac- 13. During diarrhoea, keep on torily after sickness. available free from all health breastfeeding. facilities. Or you can buy Elaj-e- 24. Thousands of Pakistani children 14. Do not stop feeding your child die from diarrhoea. Look after when he has diarrhoea. 7. To prepare Elaj-e-Julab, pour your baby. Give him Elaj-e-Julab 15. When your child starts getting when he has diarrhoea. four glasses of drinking water better, encourage him to take into a pot and add a small packet semi-solid foods, even if he does of Nimkol. For a large packet, Basic Messages for not want to. Dahi, khitchri, and National ORT Campaign take one seer of water.This can mashed banana are good. be used for 24 hours 16. Breastfeeding is the best way 1. Diarrhoea can kill. •8. If Elaj-e-Julab is not available, it to protect a baby against diar- can be prepared at home. Put 2. Elaj-e-Julab is the best treatment. two scoops of sugar and two 17. To prevent diarrhoea, always pinches (using three fingers) of 3. If it is not available, make it feed your child with a cup and yourself. salt into one seer of drinkng spoon, never with a bottle. water. Lemon or orange juice 4. For mild diarrhoea, give drinks Bottle-feeding often causes freely. can also be added. diarrhoea. 5. Continue breastfeeding and a. If your baby's eyes are sunken. 18. Wash your hands before pre- his mouth, tongue, and eyes dry, giving other foods. paring food or feeding vour 6. If diarrhoea is very bad, or and his skin when pinched does baby. Wash your child's hands not go back quickly, he has lost continues for two to three before he eats. days, see a health worker. -nkmesMgcWkcbnfMMo^^^ Diarrhoea—Still a Mystery Killer by Lorna Clarke, UNICEF—Islamabad

Julaab. Dast. Paichach. Tatiyan. It is Knowledge • Local water-based medicines hard lo believe that such exotic • Over one third of the respond- were also given: green tea. car- names from the Punjab province in ents knew weakness and stom- damom water, egg-white and Pakistan could refer to one of the ach pain as symptoms of diar- country's most virulent child- rhoea other than lots of loose • Some people gave castor oil but killers—diarrhoea. This disease ac- watery stools. Very tew people luckily these were few. counts for between 20-40% of infant knew any other symptoms. • 81% of the mothers said they deaths in Pakistan. But why should • Overfeeding was stated as the continued breastfeeding, but on this seemingly simple ailment be a main cause of diarrhoea. Bad double-checking, though three killer in so many families? In an effort food and teething were also cited quarters of the respondents had to unshroud the mystery, a study of as causes, but no one considered children in the 0-2 age-group, 180 women with children under five dirt or infection to be related to only 19 were actually breast- was undertaken in six Punjab villages diarrhoea. feeding and 66 were bottle- to determine. • The majority stated that diar- feeding. • What people know (Knowledge) rhoea was not infectious, and • Of the 22 persons who knew of about diarrhoea, its causes, nearly half (41%) were not sure ORS, 17 had actually used it and symptoms, prevention, cure, and if a child could or could not die knew how to prepare it correctly. relationship to bottle-feeding, of diarrhoea. • Nearly 90% of all the respond- and about Oral Rehydralion Salts • Only 12% of the respondents had ents consulted a doctor in diar- seen ORS. rhoea cases, but it is not clear • How they feel (Attitude) about whether in all cases the title re- the seriousness of diarrhoea, the Attitude fers to a trained medical prac- type and necessity of treatment; • Nearly three quarters of the titioner. about breastfeeding as a preven- mothers felt that diarrhoea • Some people (though compara- tive measure; and ORS as an was NOT a good thing. tively few) waited three days, effective medicine!' • Two thirds of the mothers felt and in some instances as much • What they actually do (Practice) that bottle-fed babies were more as five days, before seeking as- in diarrhoea cases from onset to prone to diarrhoea. sistance in diarrhoea cases. A end and after, either because of • Half of the mothers fell that few never bothered at all. or despite this knowledge and breastfeeding prevented diar- • Some interesting though ineffec- attitude. tive remedies were used even by Attempts were made to define the • Drink was considered more ac- people who did consult a physi- influence of social, demographic, and ceptable and useful during diar- cian, such as massaging with geographical characteristics on these rhoea than food (80% saw food herbs and oils, and putting an Knowledge, Attitude, and Practice as exacerbating diarrhoea). egg on the child's head. (KAP) levels. • Certain foods like rice and a It is hoped that the findings will mixture of rice and pulses were Generally it was found by cross- help us direct our programmes as considered harmful in diarrhoea tabulation that: well as communication strategies to • Access to health facilities did not make diarrhoea an understood and, appreciably affect KAP levels therefore, controllable disease. Practice concerning diarrhoea and ORS • Proper diet was the best pre- FINDINGS ventive measure practised by • Age, experience, and education Some of our discoveries were mothers—including exclusion of did not seem to significantly expected; others were real eve- sour and gas-causing food. affect KAP levels among mothers openers—but all signs pointed to the • Brand medicine was the major as far as diarrhoea was con- fact that for most people diarrhoea curative (45% of the mothers cerned. remains a killer shrouded in mvsterv. used this). (Cimtinued on fwge 7) The Child Survival Revolution Postal Campaign

by Richard Pordes, UNICEF— New York

A new initiative—the Child Survival Revolution Postal asked to assist in the implementation of this campaign. Campaign—has been launched to create awareness of the By individually contacting National Postal Administrations goals of the Child Survival Revolution (CSR) which is a in their particular country, they will be able to highlight world-wide effort to save the lives and improve the well- the major communications role the post offices can play being of children through the use of low-cost measures. in this life-saving effort. It is hoped that maximum com- Al UNICEF's request, the International Bureau of the pliance can be achieved from the postal administrations Universal Postal Union (UPU) in Berne, Switzerland, re- in the production and distribution of stamps, cancella- cently asked each country's postal administration to use tions, and posters about the CSR. postage stamps, wall posters as well as other means to UNICEF has also asked the UPU to include the CSR highlight four of the basic themes of the CSR (Growth Postal Campaign on the agenda of the upcoming UPU Monitoring, Oral Rehydration Therapy, Breastfeeding, Congress in Hamburg, Federal Republic of Germany, this Immunization). Post offices offer opportunities for June. The possibility of an invitation for the Executive displaying in a convenient and highly visible area locally- Director of UN ICEF or another high-level UN ICEF official designed and -produced posters using symbols and to address the assembled delegates is being explored. slogans that demonstrate the importance of these four The postal campaign themes. offers new and crea- The growing use of the postage stamp as a vehicle for tive opportunities for public awareness and public education suggests that it UNICEF to take advan- can also be an extremely effective way of conveying the tage of a communica- CSR message. Since postage stamps must be issued any- tions and information way, this measure is also cost-free. vehicle available in all In many developing countries, the postal system is one developing countries. of the few distribution and communication vehicles It could also open which reach into remote or inaccessible rural areas. doors to other commu- Moreover, in many towns and villages, the post office is nications media by located in the centre of a community, with regular visits making Ministries of by hundreds of people daily. For this reason, this Postal Communication aware Campaign offers a potentially effective way of publiciz- of the importance of ing the essential messages of the CSR. the CSR. UNICEF Regional and Field Representatives are being

{Continued from page f>) • There is widespread misunder- information was previously known CONCLUSIONS standing amongst mothers about to us, but the study has provided The study is a preliminary test to diarrhoea, its causes, symptoms, quantifiable data about the impor- determine the usefulness of this ex- tant socio-cultural factors connected ercise for replication on a larger scale • Optimum breastfeeding is not to the high incidence of diarrhoeal in other areas of the country. The being practised, and KAP levels diseases. We now have a sound basis results are, however, area-specific are low regarding its effective- for the design of messages. teaching and may not necessarily apply else- ness in preventing and helping materials, and communications where, though experience has diarrhoea cases training for lady health visitors and taught us that similar myths and • ORS is still virtually unknown. other community workers to enable problems prevail throughout the KAP levels are low among them to better communicate with country. mothers. the rest of the population, especially It is clear from this studv that: As mentioned before, much of this mothers of children under five. Staff Changes

APPOINTMENTS CHANGES IN FUNCTIONAL TITLE AT DUTY STATION Mr. Juan Braun, Regional PSC Officer, Nairobi. Mrs. Scholaslica Kimaryo, PSC Officer, Dar-es-Salaam. Ms. MoniqueClesca, AssistantPl/PSCOfficer.Port-au-Prince. Ms. Suha Majdalani, Assistant PSC Officer, Beirut. Mr. Valcin GCHpinar, Assistant PSC Officer, Ankara. Mr. Francisco Sandoval, PSC Officer, Guatemala City Mr. David Nturibi. Co-ordinator, Regional PSC IVaining Programme, Nairobi. CHANGES IN DUTY STATION AND FUNCTIONAL TITLE Mr. Hugh Higby, Art and Design Officer, Nairobi. Mr. Moncef Bouhafa, PSC Officer, Nairobi. Mr. Mohammed Salem, Communications Officer, Abu SEPARATION Mr. Kabwe Kasoma. Co-ordinator, Regional PSC Training Mr. Lakshman Wickramasinghe, PSC Officer. Colombo Programme. Nairobi. Health and Nutrition Learning Package

This learning package contains an assortment of com- • A plastic bangle for measuring mid-arm-circumfer- munication aids: ences to judge the nutritional status of the child. • Booklets on infant care, protein energy deficiency, • A tricolor tape for measuring the middle portion of environmental sanitation, and immunization. the upper left arm to assess the nutritional status of • A Leaflet on iron deficiency anaemia. the child. • A Flashcard Story on the importance of Vitamin A The booklets, leaflet, and flashcard story are all simply •Picture and Poetry to teach the importance of written, and well-illustrated.They are interesting to read, Vitamin A and easy to understand. The other items included are •Nursery Rhymes to explain the importance of all very practical for keeping track of the nutritional personal hygiene to children, and to teach children and immunization status of the child.This is a very use- about nutritious foods. ful learning package. It was designed and tested by the Vikram A. Sarabhai Community Science Centre in OTHER ITEMS Ahmedabad, India For more information, contact • A card on the immunization status of the child. UNICEF, RegionalOfficeforSouth Central Asia, UNICEF •Arehydrationspoon. House. 73 Lodi Estate, New Delhi—110003. India.

ooo Nursery Rhyme on Nutritional Foods.

Newsletter Articles appearing in the PSC Newsletter express the views of their p/C authors and not necessarily those of UNfCEF or of the Editor, de Sign 8/20/2007 3:09:05 PM Login Name Saroja Douglas

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PSC Newsletter. Vol 8, No.1, April 1984. Produced by PSC Service, UNICEF Hq, New York Date Created / From Date Date Registered Date Closed / To Date 4/1/1984 8/10/2007 at 2:21 PM

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Lead article: The promotion of breastfeeding and proper weaning practices in the Ivory Coast, by Ute Deseniss, UNCIEF, Abidjan; Other contents: Pakistan oral rehydration promotion, based on documents from David Mason, UNICEF, Islamabad; Diarrhoea - still a mystery killer, by Lorna Clarke, UNICEF, Islamabad; The Child Survival Revolution Postal Campaign, by Richard Pordes, UNICEF, New York; UNICEF Staff changes; Health and nutrition learning package (booklets, leaflet, flashcard story, picture and poetry, nursery rhymes).

Print Name of Person Submit Image Signature of Person Submit Number of images without cover SIMULA %X)u^L/tf I So*^ ^>^/\\ I 7