It takes a village to raise a parent

Group counselling for nutrition education

UNICEF Tanzania
Mother looking at healthy food options.
28 June 2019

“Education is a right of life,” states a sign in the village of Isansa, Mbozi district. Actually, this is the slogan of the local secondary school, but there’s always more to it as the adults of Isansa are learning how to combat malnutrition and keep their children healthy from day one, even before they are born.

When Evelyn Mwasenga was just one month old, her mother Lydia Andrew Sambo, now 22, started feeding her porridge. She didn’t question the older women who said the baby was crying because she was hungry and that breastmilk was not enough. After all, they were older, wiser and experienced.

But when she took her to the clinic, Evelyn didn’t always show healthy weight gain. Both mother and child struggled, and Lydia felt she was missing something.

Three months pregnant with her second child, Prosper, Lydia was determined to fill in the gaps and joined the village group counselling programme for monthly sessions with the local community health workers (CHW).

The sessions are part of Accelerated Stunting Reduction Programme (ASRP), a Government umbrella programme implemented by UNICEF and NGO partners in a number of regions across Tanzania. The four year initiative was launched in 2015 with the aim to contribute to the national targets of reducing stunting during a critical period in a child’s life, i.e. from conception till 24 months. The programme takes a community-based comprehensive approach, which aims to both increase the proportion of pregnant women and caregivers of children under two years old who practice key nutrition-relevant behaviours, and increase the availability of diverse nutrient-rich foods at the household level in the project area.

In the past, attention was focused on addressing malnutrition, which required immediate response to prevent critical development problems caused by nutritional deficiencies. Now, says Magdalena Mtoni, coordinator of the UNICEF programme in the region, is time to focus on stunting, which calls for a long-term approach. “The world should address stunting because stunting in children leads to stunted adults,” says Magdalena.

More than 2.7 million Tanzanian children under five were estimated to be stunted in the 2015 DHS survey and more than 600,000 children under five were estimated to be suffering from acute malnutrition. Stunting has lifelong consequences. In comparison to a wellnourished child, a stunted child completes fewer years of schooling, learns more slowly, and earns lower wages in adulthood, making them much more likely to stay trapped in a cycle of poverty, according to data from the Tanzania Joint Multi-Sectoral Nutrition Review in 2016.

After participating in informational sessions led by UNICEF-trained CHWs, which include antenatal care, breastfeeding, adequate nutrition, and hygiene management, Lydia’s entire family is enjoying improved well-being. Lydia breastfed Prosper exclusively for the first six months, giving him the nutrition and immunization benefits she’d learned about at the local ASRP sessions by a trained CHW, and at 13 months old, Prosper is strong and gaining weight adequately. Much of the programme footwork is carried out by CHWs, who are elected by the community and work with village leaders and local health facilities to collect and report data for improved coordination and allocation of resources.

UNICEF and partners have trained the CHWs in health tools aimed at detecting early signs of malnutrition and stunting such as anthropomorphic measurements, and in preventative measures such as deworming and vitamin supplementation.

According to Magdalena, the programme adds value to the alreadyimportant role of the CWHs, who become the “middleman extending the facility services into the community.”

Community health workers Godi Mwapashe and Thabit Nzowa speak about the impact of the programme: “We see an overall improvement in the village health and fewer cases of acute malnutrition. In fact, in the recent round   of measurements, we did not find any stunted children in the 80 households of Isansa and the neighbouring hamlet.” They are satisfied but cautious; ultimately the village will have to sustain the programme on its own.

Lydia’s husband, Patrick Mwasenga, has also benefited from ASRP. Patrick followed Lydia into the programme and he now takes time out from his mobile men’s clothing business to attend. Since Patrick began attending the programme, he has shown a greater interest in his children’s health and his wife’s well-being and has even begun sharing household responsibilities

Family portrait of Pastor Isack Masako Nwoza, his wife Dorcas and their three children.
Pastor Isack Masako Nwoza, his wife Dorcas and their three children. Pastor Isack advocates the community health counselling as a religious leader and as a husband and urges men to participate.

A majority of children aged between three and four in 74 countries, or about 40 million, have fathers who do not play or engage in early learning activities with them, according to a recent UNICEF study.

Getting fathers involved in children’s development is critical, and studies show that this has a significant effect on their neuro- cognitive development, and sets them up for success as adults. In addition, unequal intra-household decision making between men and women, and men’s control over resources, have a negative impact on children’s survival and health.

UNICEF’s supported ASRP incorporates male parents’ engagement as a strategy to empower them to play a greater role in decisions that can significantly increase positive health and well-being outcomes for families.

Pastor Isack Masako Nwoza also attends the group informational sessions provided by CHWs with his wife Dorcas. He sees his responsibility as two-fold. As a husband, it is his duty to help raise his children; as a religious leader, he must lead by example. He is a strong programme advocate and encourages men in his community to care for their pregnant wives and their children. He also stresses on the benefits they will reap: healthy, strong children. Pastor Isack says that the programme has enabled fathers to have more than knowledge of nutrition, hygiene and health. Initially a challenge to tradition, more men now know they too are responsible for raising their children.

His wife Dorcas joined the programme when she was three months pregnant with her third child. She wasn’t feeling strong enough, meals were monotonous, and she knew there was more to learn. These days, she is gradually supplementing her baby’s diet after six months of exclusive breastfeeding, and explains that the baby’s nutrition and health starts with that of the mother. “I had some of the information before but not the whole picture, the programme brought it together”, she adds.

Patrick Mwasenga is a hands-on father to little Evelyn and Prosper.
Patrick Mwasenga is a hands-on father to little Evelyn and Prosper.