By Nancy Mukelabai

 Malnutrition of both mothers and children is a key factor in child morbidity and mortality among low income families in Zambia.  Ensuring adequate nutrition among the vulnerable population is a serious challenge which has always required full attention from government and other stakeholders.

A number of factors operating at different levels determine under-nutrition among children, some of the broad categories that influence an individual’s nutrition status are food, care and health; meaning adequate nutrition requires the appropriate levels of all the three.

As it is well known, rapid growth of a child occurs within the 1st 1000 days of life. This starts from conception, foetal life, birth and infancy of up to the second birthday of a child.

Under-nutrition during foetal and early childhood development period leads to a negative impact on the brain development, structure and cognitive function. This results in poor performance in school, leading to reduced productivity and income earning capacity in adult life.

With the above background, the government through the National Food and Nutrition Commission (NFNC) has been implementing programmes with different government sectors in addressing malnutrition and stunting levels in children. The sectors are Agriculture, Fisheries and Livestock, Health, Community Development and Social Services, Education, Local Government, and Forestry.

Kalabo is among the districts of Western province with stunting levels at 29.1 percent. This in itself led to the district being among those implementing Scaling Up Nutrition (SUN) programmes in the country.

Priority interventions to be scaled up were identified as nutrition specific interventions which are programmes that address the immediate determinants of foetal and child nutrition and development; while nutrition sensitive interventions address the underlying determinants of child nutrition and development such as food security, hygienic environment and access to health services.

The key implementing sectors have been conducting programmes with the target population of pregnant and breast feeding mothers, and households of children aged two years and below. Various trainings were being conducted on nutrition sensitive messages, cooking demonstrations, child growth monitoring and provision of agricultural inputs, social protection and water and sanitation services.

However, despite all the programmes in place, it has still been learnt that not all of the targeted population was reached. This could have been because each sector had their own target beneficiaries, meaning that the target beneficiaries could have been accessing interventions from either one or two sectors, but surely not from all. This negatively affected the intended purpose of reducing malnutrition and stunting levels among children below two years old.

As a result, a new concept has been brought in of Nutrition Support Groups (NSGs) in Kalabo district. These are a modified version of care groups which serve as vehicle for promoting the adoption of positive health and nutrition practices and also the consumption of nutrient-dense and protein-rich foods at house hold level.

NSGs are important for achieving convergence of interventions to the target beneficiaries or maximum impact on stunting reduction. The whole purpose is to ensure that each target household receives interventions from all the key implementing sectors through the volunteers and the promoters of each support group.

Though the government workforce to be used is mainly from the Ministry of Health, the households are to be reached with a multi-sectorial package of Social Behavioral Change (SBC) messages for improved nutrition. The NSG model has two types of volunteers who are the promoters and the volunteers who are selected from the beneficiaries in line with the peer-to-peer behavior change approach on which the model is anchored.

The duty of the promoters is to work with the implementing sectors in their zones by facilitating trainings, collecting and analyzing household data and reporting. While, the role of the volunteers is to visit the neighbor households monthly and also to mobilize them in participating in community activities that address nutrition issues.

According to the NFNC District Coordinator Ms. Inonge Nosiku, the model has led to a direct link to the beneficiary households under MCDP II.

“The Nutrition Support Group model is very good as it has resulted into direct linkages between the implementing sectors and the beneficiaries. As this requires all sectors to meet at one point unlike before, it therefore makes the beneficiaries improve their nutrition knowledge and status in all aspects that address good cooking and feeding methods, good agricultural practices, access to clean and hygiene environment and social protection services at household level. This is the convergence which is important for scaling up essential interventions in the 1st 1000 most critical days as sectors plan together to cover the same wards and not separately’’, Ms. Nosiku explained.

Yuka Ward Field Supervisor Wamulume Wamui confirmed that the NSG model has actually improved in enlightening the mothers on the full SUN package of interventions.

“There is a visible direct link from the sectors and the field supervisors to the promoters, then the volunteers up to the mothers throughout the wards as they are grouped in tens, making each and every mother reachable as the nutrition supervisors and volunteers work within their neighborhoods,’’ Mr. Wamui explained.

As government is working hard in reducing malnutrition and stunting levels in children in the country, it is imperative that workable measures are put in place. And these measures have to reach the targeted beneficiaries in full, which in turn will result in improved nutrition knowledge and practices at household level.

Since the use of Nutrition Support Groups (NSGs) has been identified as the best avenue of delivering nutrition lessons and inputs to the beneficiaries, there is hope that better results will be achieved under the MCDP II. Pregnant, breast feeding women and households with children below two years old are being encouraged to join nutrition support groups in their wards.

When all the sectors work together by meeting the same target at the same time, more children under two years of age will be saved from stunting and other forms of malnutrition. -NAIS