Early Childhood Development
Children's first one thousand days
Evidence shows that the first years of a child’s life set the stage for all future growth. In the earliest years of life, especially from pregnancy to two years old, babies and children need nutrition, protection and stimulation for healthy brain development. Yet too many children are still missing out on the ‘eat, play and love’ while their brains need to develop. Put simply, we do not care for children’s brains the way we care for their bodies.
The first 1000 days of is a vital period in a child’s life cycle to ensure children get off to the best start in life. But many children in Malawi face challenges from the day they are born to reasons including parents or guardians not having the opportunity or knowledge to develop positive parenting skills, poor health care and nutrition, little early stimulation and learning, and the lack of a protective environment. The challenges increase when children are also affected by HIV/AIDS and humanitarian disasters.
There has been some progress on Malawi's commitment to early childhood development (ECD), including reducing stunting and child deaths, increasing birth registration and enrolment of young children in early education programmes. However, challenges remain to ensure that all children in Malawi, including the most disadvantaged and vulnerable, benefit from improved parenting practices, better ECD interventions and services, and early learning opportunities.
Early childhood development, or ECD, refers to the physical, cognitive, linguistic, and socio-emotional development of a child from pregnancy through the first two years of life. The right interventions at the right time can boost a child’s development and provide a fair start in life for every child. For babies born into deprivation, intervening early, when the brain is rapidly developing, can reverse harm and help build resilience.
UNICEF is supporting the expansion of ECD services through community-based care centres. We are also working with the Government to improve policies and learning frameworks. One of these is the Care for Child Development framework which was developed by UNICEF and the World Health Organization. It guides health workers and other counsellors as they help families build stronger relationships with their children and solve problems in caring for their children at home. The framework also highlights the links between ECD and other development areas including health, nutrition, early childcare, learning, and development services.
In UNICEF’s 2019 to 2023 country programme, the agency will continue to support interventions to improve early childhood development through the life cycle approach. These include improving the early identification of malnutrition through MUAC screening, treatment and management of children with severe acute malnutrition. . In order to achieve early identification of children with severe acute malnutrition in the community, trained community health workers and care group promoters measure the mid-upper arm circumference of infants and children and examine them for bilateral pitting oedema on a monthly basis. The community’s awareness of acute malnutrition as a public health issue and strengthening prevention malnutrition is enhanced through C4D activities. Infants and children aged 6–59 months with mid-upper arm circumference <115 mm, or have any degree of bilateral oedema, are immediately referred for to the nearest health facility for the management of acute malnutrition. Follow-up of infants and children with severe acute malnutrition periodically during and after discharge from treatment at the health facility is essential to ensure compliance, assess response to treatment and avoid relapse.
UNICEF is also supporting the MoH to strengthen integration of management of acute malnutrition including therapeutic supplies into the national health system. Currently RUTF, F75 and F100 are on the essential medical supplies list (EML) and integrated within the national health supply chain management system. UNICEF continues to procure nutrition, vaccines, and essential medicine supplies on behalf of government while advocating for government to increase its domestic resource mobilization in the procurement of these essential commodities continue. Recently such advocacy lead to 380% increase in the government budget for immunization services from MK263 million in 2018-19 to MK1 billion in 2019-2020. The Central Medical Stores Trust (CMST) is responsible for storage of therapeutic nutrition supplies at national level and distribution to the health facilities while the pharmacy department is responsible for storage and dispensing nutrition therapeutic supplies to end users in the same way they manage medicines. In addition, nutrition supplies are now monitored and reported through the Ministry of Health Open Logistics Management Information Systems (LMIS) online platform.
The accountability in the management of nutrition supplies has greatly improved with the integration into the national supply chain management system. UNICEF is also strengthening end user monitoring to ensure supplies are used for the intended purposes.
Although massive gains have been realized in stunting reduction, UNICEF realizes that 37% of children below the age of five years are stunted. The stunting program intends to contribute to reducing stunting in Malawi from 37% to 30% by 2023, by focusing on children aged 0 to 23 months and pregnant women. Through the stunting reduction ,UNICEF is working in collaboration with the Government of Malawi in the implementation of the SUN initiative and the 1000 First Days Program, adolescent nutrition and Early Childhood development interventions using a multisectoral approach. Additionally, UNICEF is also stepping up efforts on improving the quality of diets for children through improved support to promotion and protection of exclusive breastfeeding for the first six months and continued breastfeeding up two years. The promotion of adequate complementary feeding through promotion of integrated homestead farming, improved utilization of diversified diets through food preservation, processing and meal preparation. UNICEF is supporting the improvement of the quality of complementary feeding for children through home fortification using Multiple Micronutrient Powders. In additional maternal nutrition intervetions through improving quality of diets, antenatal care good health seeking behaviours. Central to these approaches are evidence-based communication for development approaches which UNICEF is applying to support the improved adoption of good nutrition practices and behaviours. UNICEF continues to engage and empower various stakeholders and groups from national, district and community level for adoption of various MIYCN practices and behaviours. Using community, media and service delivery platforms, UNICEF is also actively creating demand for nutrition services and facilitating adoption of various nutrition practices and behaviours and promoting health seeking behavior through community behavior tracking mechanism. Through C4D interventions, UNICEF is also actively mobilizing, engaging and empowering adolescents with good nutrition practices to facilitate adoption optimal nutrition behaviours . In addition to empowering adolescents with good nutrition practices, to ensure that pre-conception measures are done to prevent maternal anemia and low birth weight babies, UNICEF is supporting Government in provision of Weekly Iron and Folic acid supplements and annual deworming tablets to adolescent girls aged 10-19 years to prevent anaemia. The prevalence of anaemia in this age group is high at 35.3% hence the aim is to build the Iron and Folic stores for the adolescent girls as they transition into adulthood.
Building on the concept of integration and ensuring every child has access to essential health services and a clean environment UNICEF continues to invest in the following areas; Maternal and child healthcare, Water, Sanitation and Hygiene (WASH), HIV, community resilience and capacity building of healthcare workers. The key to achieving success is the strengthening of community structures by providing a platform for key stakeholders and resources to convene at the grassroots. Leveraging on such community platforms UNICEF continues to support village health workers to provide clinics for under five children including new vaccine introductions such as the malaria vaccine and ensuring every Malawian child is fully protected against diseases e.g. measles and vitamin A deficiency. These efforts have led to reducing the rate of unimmunized children by 50% and over 8,700 children commencing early treatment for possible severe bacterial infection (PSBI) such as meningitis thereby further reducing childhood morbidity and mortality. UNICEF is further committed to ensuring improved maternal and newborn care with more than 90% deliveries being conducted by skilled birth attendants and increased access to HIV testing services for early diagnosis and treatment within 8 weeks of birth.
UNICEF supports clean health facilities and sustainable access to clean water via the Malawi WASH program providing solar powered water schemes to maternity centers serving over 20,000 users, and in 2018 over 20 water schemes serving healthcare facilities were constructed for the government. UNICEF continues to support Malawi during humanitarian emergencies such as the 2019 Ida Cyclone which caused widespread floods, displacement of people and disruption of regular health programmes in 14 cholera prone districts. Due to efforts from UNICEF and other partners there was no widespread cholera outbreak. There were only 26 cases of cholera and 1 death compared to over 3500 cases and 93 deaths recorded in 2015-2018.
In addition, UNICEF has adopted innovative approaches such as drone technology in the supplies of essential commodities to inaccessible areas. For instance, using drones to create a humanitarian corridor during Cyclone Ida in 2019 for supplies. This technology is being considered for the current COVID-19 outbreak. In collaboration with academia employing climate/seasonality modelling in predicting diseases such as cholera and malaria.
In ensuring every child is tracked and the continued success of ECD; UNICEF, UNDP with the Malawi Government has made great progress in registering over 300,000 under 5 children in 2019 an increase of 180% from 2018. UNICEF has also created multidisciplinary taskforces to holistically address every component of the child from 0-5years , as well as support the learning and stimulation of pre-school children in Community Based Child Care Centres