Guinea-Bissau: Dispelling myths on child nutrition

Diara Cassama remembers the shock she had when a community health worker told her that her 14-month-old daughter, Suncar, would die unless she took her to the hospital immediately. Suncar was severely malnourished and had chronic diarrhoea.

But it was not easy to reach a hospital quickly. The bus only left the following day and Cassama had to arrange for her brother-in-law to look after her four other children as her husband was away. The 35-kilometre journey next day to the central hospital in the north-eastern region of Gabu took her four hours. Suncar became extremely weak.

When they arrived at the hospital, Suncar was admitted and treated for severe acute malnutrition. She weighed only 4 kilos. It was the second time Suncar had been admitted to hospital with the same condition. The first time, she was 5 months old and weighed 3 kilos. Fortunately, Suncar is still in the ‘window of opportunity’ where the effects of chronic malnutrition can be treated. However, over 2 years of age, chronic malnutrition results in irreversible physical and cognitive stunting which means

that the children will be too short for their age and their brains may never fully develop, which will lead to them underperforming in school and having low levels of productivity in adult life.[1] In Guinea-Bissau over a quarter of children under the age of 5 are stunted.

Two months later, Suncar has made a good recovery. After her treatment at the nutrition recuperation centre located in the hospital grounds, Suncar’s weight has gone up to 5.1 kilos. Also, Cassama, who is 27 and has never been to school, says she feels more confident about caring for Suncar and from now on will listen to the advice of her community health worker even when it contradicts that given by her family. For example, the community health worker had advised Cassama to give birth in the hospital and exclusively breastfeed, but she did neither. Cassama gave birth to Suncar at home as she had done for her four other children, assisted only by her sister-in-law, and soon after the birth she mixed her breast milk with a type of herbal tea known locally as Cha Concababa. “My family told me it is good for the baby as it stops the baby crying,” says Cassama.

[1] MICS 2019.

Also in the nutrition recuperation centre is Sona Fati. She gave birth to triplets a month ago at the hospital; all of them weighed less than 2 kilos. “Although this is not a case of malnutrition, we will keep the mother and babies here until the babies weigh at least 3 kilos and are out of danger,” says Sulimane Balde, the health volunteer who works in the centre.

Fati already has two sets of twins, making her a mother of seven. “They (the triplets) all have names: Sana, Sene and Satam,” says Fati proudly. Their births have been registered and they have had their first vaccinations.

Although challenging for mothers of twins or multiple births to  exclusively breastfeed, it is important for the first six months. However, many mothers have the preconception that it is impossible to exclusively breastfeed more than one baby so they often give porridge with the breastmilk.

Fati looks relaxed as she breastfeeds one of the babies while the other two sleep after being fed.  However, Fati concedes that she is worried about her children’s future. “I’m not sure how I will feed all of them,” she says. Fati has never been to school, her husband is unemployed and they have no plot of land to farm.

Both Cassama and Fati show the complexities of addressing malnutrition in the country. For example, in Guinea-Bissau, about 40 per cent of babies do not benefit from exclusive breastfeeding in the first six months of life and about 88 per cent of children aged 6-24 months lack an adequate minimum diet.[1] In addition, challenges persist with sanitation and hygiene which contribute to malnutrition, and poverty is prevalent. Therefore, “addressing malnutrition needs a collaborative approach among different sectors,” says Nutrition Specialist, Iama Sanha. “Improving knowledge about good nutrition is key, particularly convincing mothers to exclusively breastfeed up to six months and showing them how to prepare local, nutritious food to prevent the relapse of malnourished children after they have recovered.”

“Also, we need to assist health technicians and community health workers to investigate the root causes of malnutrition,” says Iama. “Community health workers, in particular, have a critical role in dispelling myths and carrying out early nutrition screening and referrals.” 

Recognizing this, UNICEF has trained health professionals and community health workers on a protocol for Integrated Management of Acute Malnutrition (IMAM) and has also trained over 75 mother support groups in four regions, including Gabu.

Most cases of malnutrition that are referred early enough have positive outcomes. The next day Suncar is discharged, hopefully not to return. During her two-month stay in the hospital, Casssama has been learning how to prepare safe, age-appropriate and nutritious meals for Suncar. “Before, I was just giving her porridge, but now I know how to use vegetables, eggs and fruit,” says Cassama who is smiling broadly.

As for Fati, she continues to stay at the recuperation centre. “We need to make sure she is eating healthily and we have to support her so she feels confident about her ability to exclusively breastfeed her babies,” says Balde.

[1] MICS 2019