Table 1.
Summary of actions documented with respect to key infant and young child feeding practices in Senegal
| Key practice* | Summarized findings by type of document reviewed, with selected national‐level findings† | |||||||
|---|---|---|---|---|---|---|---|---|
| Policies | Formative research | Protocols/training | Programmes | Intended programme coverage | Actual programme coverage | Programme monitoring | Surveys and evaluation | |
| Promotion of optimal feeding practices | ||||||||
| Timely introduction BF, 1 h | ✓ | ✓ | ✓ | ✓ | National | National | ✓(BFHI ‡ ) | 23% § |
| EBF to 6 months | ✓ | ✓ | ✓/–✓ | ✓/–✓ | National | National | (✓) | 15%, 4–5 months, 34%, <6 months ¶ |
| Continued BF to 24 months | ✓ | ✓ | ✓ | ✓ | National | National | (✓) | 42%** |
| Introduce CF at 6 months | ✓ | ✓ | ✓ | ✓ | National | Sub‐national | (✓) | 50% †† |
| Nutrient dense CF | ✓ | N/I | ✓ | ✓ | National | Sub‐national | (✓) | 23% VA‐FV 29% MFPE ‡‡ |
| Responsive feeding | N/I | N/I | ✓ | ✓ | National | Sub‐national | N/I | N/I |
| Appropriate frequency/consistency | ✓ | N/I | ✓ | ✓ | National | Sub‐national | N/I | 49% §§ |
| Dietary assessments | N/I | (FRAT ¶¶ ) | N/I | N/I | N/I | (National) ¶¶ | N/I | N/I |
| Prevention of micronutrient deficiencies | ||||||||
| Vitamin A supplements young children | ✓ | ✓ | ✓ | ✓ | National | 75%*** | (✓) | N/I |
| Post‐partum vitamin A | (✓) | N/I | ✓ | ✓ | National | 27% ††† | (✓) | 13% ‡‡‡ |
| Zinc to treat diarrhoea | ✓ | N/I | ✓ | ✓ | National | Sub‐national | (✓) | N/I |
| Prevention of zinc deficiency | N/I | N/I | N/I | N/I | N/I | N/I | N/I | N/I |
| Anaemia prevention (malaria, parasites) | ✓ | ✓ | ✓ | ✓ | National | N/I | 10% ITN §§§ 10% ITN ¶¶¶ | 83% anaemia**** |
| Anaemia prevention (iron–folic acid in pregnancy/post‐partum) | ✓ | ✓ | ✓ | ✓ | National | Sub‐national | 40% FAF †††† | 59% anaemia ‡‡‡‡ |
| Assessment of iron deficiency anaemia | N/I | N/I | N/I | N/I | N/I | N/I | N/I | N/I |
| Iodine programmes | ✓ | ✓ | ✓ | ✓ | National | N/I | 35% §§§§ 23% ¶¶¶¶ | N/I |
| Other nutrition support | ||||||||
| Management of malnutrition | ✓ | ✓ | ✓ | ✓ | National | Sub‐national | ✓ | 9% WHZ 15% WAZ 20% HAZ***** |
| Prevention MTCT HIV/AFASS | (✓) | (✓) | ✓ | ✓ | National | Sub‐national | ✓ ††††† , (8) 61% ‡‡‡‡‡ | (✓) §§§§§ , (9) |
| Food security | ✓ | N/I | N/I | N/I | vulnerable | vulnerable | (✓) | ✓/VAM |
| Hygiene and food safety | ✓ | N/I | ✓ | ✓ | National | Sub‐national | 77% ¶¶¶¶¶ | |
| Related tasks | ||||||||
| IEC/BCC in programmes† | ✓ | N/I | ✓ | ✓ | National | Sub‐national | 62%******, (10) | N/I |
EXPLANATION OF TABLE HEADERS AND MARKINGS:
✓ Confirmed documentation of actions specific to these key practices.
N/I No documentation of the activity was provided or identified.
(✓) Actions more generally related to the key practices, but without referencing the practice specifically.
–✓ Practice that is addressed but that is not specifically consistent with international norms – e.g. in case of anaemia: haemoglobin assessments are used and these cannot distinguish the cause of the anaemia, but treatments only address iron deficiency anaemia.
n/a Not applicable.
*KEY PRACTICES AND RELATED ACTIVITIES AS OUTLINED IN THE DETAILED METHODS PAPER IN THIS ISSUE (7) , TEXTBOX 1.
Timely introduction of breastfeeding 1 h, commencement of breastfeeding within the first hour after birth.
EBF to 6 months, exclusive breastfeeding, with no other food or drink, other than required medications, until the infant is 6 months of age.
Continued BF to 24 months, continuation of any breastfeeding until at least 24 months of age as complementary foods (CFs) are consumed.
Initiation of CF at 6 months, gradual commencement of CF at 6 months of age.
Nutrient dense CF, promotion of CFs that are high in nutrient density, particularly animal source foods and other foods high in vitamin A, iron, zinc.
Responsive feeding, encouragement to assist the infant or child to eat and to feed in response to hunger cues.
Appropriate frequency/consistency, encouragement to increase the frequency of CF meals or snack as the child ages (two meals for breastfed infants 6–8 months, three meals for breastfed children 9–23 months, four meals for non‐breastfed children 6–23 months; ‘meals’ include both meals and snacks, other than trivial amounts, and breast milk), and to increase the consistency as teeth erupt and eating abilities improve.
Dietary assessments to evaluate consumption, indicates whether dietary assessments are being conducted, particularly those that move beyond food frequency questionnaires.
Vitamin A supplements young children, commencement of vitamin A supplements (VAS) at 6 months of age and repeated doses every 6 months.
Post‐partum maternal vitamin A, VAS to mothers within 6 weeks of birth.
Zinc to treat diarrhoea, 10 mg day−1 for 10–14 days for infants and 20 mg day−1 for 10–14 days for children 12–59 months.
Prevention of zinc deficiency, provision of fortified foods or zinc supplements to prevent the development of zinc deficiency among children >6 months.
Anaemia prevention (malaria, parasites), iron/folate supplementation during pregnancy, insecticide‐treated bed nets (ITN) for children and women of childbearing years, anti‐parasite treatments for children and women of childbearing years.
Assessment of iron deficiency anaemia, any programme to go beyond the basic assessment of haemoglobin or hematocrit to assess actual type of anaemia, such as use of serum ferritin or transferrin receptor to assess iron deficiency anaemia.
Iodine programmes, promotion of the use of iodized salt; universal salt iodization or other universal method of providing iodine with programmes to control the production and distribution of these products.
Management of malnutrition, diagnosis of the degree of malnutrition, treatment at reference centres/hospitals for severe acute malnutrition and appropriate follow‐up in the community, or local health centre; or community‐based treatment programmes for moderately malnourished children.
Prevention of MTCT HIV/AFASS, appropriate antiretroviral treatments for HIV+ women during and following pregnancy to avoid transmission to the infant, exclusive breastfeeding to 6 months, breast milk substitutes only when exclusive breastfeeding is not possible. Substitutes should be acceptable, feasible, affordable, sustainable and safe, weaning should be gradual or EBF should be followed by partial breastfeeding depending on the risk factors (see Textbox 4 of the detailed methods paper in reference (7)).
Food security, programmatic activities with impact on infant and young child nutrition (IYCN), including agency response to crises, tracking markers of food security and food aid distributions.
Hygiene and food safety, all aspects of appropriate hand washing with soap, proper storage of food to prevent contamination and environmental cleanliness, particularly appropriate disposal of human wastes (latrines, toilets, burial).
CATEGORIES OF ACTIONS.
Policies, nationally written and ratified policies, strategies or plans of action.
Formative research; studies that specifically assess barriers and beliefs among the target population regarding each topic and bibliographic survey of published studies identified through PubMed search of ‘nutrition’ plus either ‘child’ or ‘woman’ plus the name of the country and/or by key informant.
Training/curricula, programme protocols, university or vocational school curricula or other related curricula that specifically and correctly addresses each desired practice, these include pre‐ and in‐service training manuals.
Programmes, documented programmes that are functioning at some level that are intended to specifically address each key practice listed.
Intended programme coverage, the level at which the programme is meant to be implemented, according to programme documentation/plans.
Actual programme coverage, the extent of programme implementation that was confirmed in one of the received documents.
Programme monitoring, monitoring activities that are conducted for a given programme that specifically quantify programme coverage, training, activities implemented, whether messages are retained by caregivers.
Surveys and evaluations, studies that have been conducted to evaluate changes in specific population indicators in response to a programme and/or cross‐sectional surveys.
ADDITIONAL INFORMATION
BFHI = Baby Friendly Hospital Initiative implemented at specified hospitals and health centres and adherence to the international Code of the marketing of breast milk substitutes.
§ Per cent of infants reportedly put to the breast within one hour of birth, DHS 2005.
¶ Per cent of infants reportedly consuming exclusively breast milk the day prior to the survey, DHS 2005.
Per cent of children 20–23 months still consuming breast milk; calculated as 100% – the percentage NOT consuming breast milk, DHS 2005.
Per cent of infants 6–7 months reportedly consuming complementary foods (beyond liquids) the day prior to the survey, DHS 2005.
Per cent of children <3 years consuming vitamin A fruits and vegetables (VA‐FV), or animal source foods (MFPE = meat, fish, poultry, eggs), DHS 2005.
Per cent of children 6–23 months who reportedly consumed the minimum number of meals during the day prior to the survey, DHS 2005.
¶¶ FRAT survey to assess the frequency and quantity of consumption of selected possible food vehicles for fortification programmes, 2006.
Per cent of children 6–59 months who reportedly received vitamin A supplement during the previous 6 months, DHS 2005.
††† Per cent of women who received vitamin A supplement early post‐partum following the last pregnancy occurring in the prior 5 years, DHS 2005.
‡‡‡ Per cent of women who reported night blindness during the last pregnancy that occurred within the prior 5 years, DHS 2005.
§§§ Per cent of children who slept under an insecticide treated bed net the night before the survey, DHS 2005.
¶¶¶ Per cent of pregnant women who slept under an insecticide treated bed net the night before the survey, DHS 2005.
Per cent of children 6–59 months with haemoglobin concentration <11.0 g dL−1, DHS 2005.
Per cent of women who reported taking iron–folic acid supplements ≥90 days during the last pregnancy occurring in previous 5 years, DHS 2005.
Per cent of women 15–49 years with haemoglobin concentration <11.0 g dL−1, DHS 2005.
Per cent of children <5 years living in households with adequately iodized salt (≥15 ppm), DHS 2005.
Per cent of tested households in which the salt was adequately iodized (≥15 ppm), DHS 2005.
Per cent of children <5 years < −2 z‐score, weight‐for‐height (WHZ), weight‐for‐age (WAZ), height‐for‐age (HAZ), by WHO Child Growth Standards, DHS 2005.
Reports using evaluations from the first phase of a malnutrition prevention programme in enhancing the second phase, CAMA‐MBOUR project, (8).
Per cent of women 15–49 years reporting knowledge that HIV can be transmitted by breastfeeding, DHS 2005.
Very limited survey of infant feeding choices of six HIV‐positive mothers, (9).
¶¶¶¶¶ Per cent of households with access to toilet or latrine for disposal of human wastes (use for disposal of children's wastes not included), DHS 2005.
Per cent of participation in weekly education sessions during 6‐month intervention in a community nutrition programme, (10).