S.O.S for Mercy, Twins and Triplets

The story of Mercy’s twins and triplets
By James Achanyi-Fontem, Cameroon Link
Cameroon Link received Atabong Mercy, 26 years and mother of eight children at its counselling centre in Bonabéri-Douala. Mercy was born on the 3rd December 1982 and she started her marital life at 16 and in eleven years gave birth to eight children, amongst them twins and triplets out of five pregnancies. The first child in the family ZANFACK Gaston and Atabong Mercy was born in 1997 and at 11, DEMEFFO Joshua Stollone is already in college. The second, DEMEFFO Carine was born in 1999 before the twins : DEMEFFO Reine and DEMEFFO Bétanie in 2001. In 2003 DEMEFFO Blessing was delivered before the arrival of the triplets: Demeffo Dani Chama, Demeffo Daniella Chékina and Demeffo Asonganyi Daniel on the 25 August 2007.
We discovered Atabong Mercy and her triplets during an educative talk organized to the documentation centre of Cameroon Link on the 6th August 2008 during open door celebrations of the World Breastfeeding Week. On that sunny day, the triplets were 11 months 19 days old and Mercy brought them to participate at the educative talk organized on the open door occasion. This gave the opportunity for others to listen to Mercy’s testimony on how she successfully breastfed all her children exclusively for six months and above for some of her children.
Atabong Mercy is an exceptional mother because in Cameroon it is often believed that when a woman gives birth to twins and if amongst the babies, there is a boy and a girl, she will no longer give birth to twins during other deliveries. Atabong Mercy crushed this rule by making the exception by deliverin,g triplets. Atabong Mercy is today called "Magni", the traditional title to honour a mother of twins or triplets. Magni needs to be encouraged for her to bring up her children well and give the children equal opportunities like all others. We conducted the interview that follows for Not For Fathers Only, as Atabong Mercy tells the story of her motherhood and the type of assistance she receives from her husband, ZANFACK Gaston.
Question : Hello, Mercy ! You are welcome to the WABA Mother Support Taskforce Newsletter. Can you tell us the story about how you discovered Gaston, your dear husband. How did your relationship start?
Mercy: I met my husband when I was aged of 16 years. I had just obtained my Primary and Elementary School Education Certificate, CEPE. When I discovered Gaston, my going to school stopped because we were in love.
Q: What was your husband at that time?
M: He was a palm wine tapper (vigneur) and he also broke pebbles to sell to those building houses.He also travelled a lot to Nigeria for trading. Gaston had a lot difficulties and problems in his life before bankruptcy when in Nigeria. He finally decided to return to live in the village. This was still not easy for him because people mocked at him lot.
Q: When did you begin to give birth to your children?
M: We had two children when we were in the village : DEMEFFO Joshua Stallone and DEMEFFO Carine. The first was in 1997. We moved to Douala when my husband found a job at the sea port in the economic capital of Cameroon. As a lorry driver, he travelled to the Republic of Congo to distribute products manufactured in Cameroon by their company. It is in Douala that we got our twins: DEMEFFO Reine and DEMEFFO Bétanie. The twins were followed by a girl, DEMEFFO Blessing before the triplets: Demeffo Dani Chama, Demeffo Daniella Chékina and Demeffo Asonganyi Daniel on the 25th August 2007. At that time, my husband had got a new job with PASTA food company.
Q: How did it happen that at your young age of 16 years you decided to get married to Gaston who had no job?
M : He had no job, but we loved ourselves and agreed to stay together as a couple. At the time I knew him, he was a typhoid patient and was very often sick. Looking at his situation, from time to time, I went to tap the palm wine in his place for use to make some money. I also broke pebbles in his place and gathered them to sell. My family in Lebialem opposed my relationship with Gaston. My parents propsed several postulants to me for marriage, but I repelled the proposals though these persons were richer than Gaston. I believed that marry ing someone who is rich does not replace love and happiness. I preferred to remain in the home where God had first chosen for me. With a lot of pressure of my parents, I escaped from our home and left to join Gaston where he was staying in the village.
Q : So, you escaped from your family to join Gaston’s home ?
M : Yes ! I escaped to join him, and it when he got a job that Gaston visited my parents to pay the dowry to my family to legalize our marriage by Cameroon tradition. So, we are married legally.
Q: In what year did you start your dating relationship?
M: We started our love affair in 1996 and I became pregnant, though still very small. Luckily I got my first child in 1997 without a problem and the second in 1999. That is how we continued to create our own family with deliveries between two and three years intervals. The twins were born in 2001 followed by the fourth pregnancy in 2004 before the fifth which brought the triplets in 2007.
Q : When we look at the gaps between your baby deliveries, it is imaged that you had wanted to opt for a good planning family scheme. But your five deliveries that have given eight children. What is your impression after having delivered twins and then triplets ?
M: As mother, I believe that children come from God and I have accepted all my children. They do not get sick very often and I believe that it is God who protects them.
Q : You participated in the educative talk on the promotion of exclusive breastfeeding during first six months of the life of babies. With your multiple deliveries, how did you organize breastfeeding of your children ?
M : All my children have had the privilege to be breastfed exclusively for six month and above for some. During my stay in the village, there was no conflict between the breastmilk and artificial milk because the poor peasant mothers do not have the means to invest on formulae products. We count on our gardens and farms to feed our children and families. I breastfed my first son for seven month exclusively and I gave him all the food we ate at home from the eighth month. He was breastfed for twenty four months even when we complimented with household meals. The others were also breastfed exclusively for six months.
Q:What is your observation when you successfull breastfeed your children ?M: First, they do not cry and I have observed that my children do not fall sick regularly. The first was admitted in college at 11 years and while in primary school he was always amongst the first ten in their class. We have no money, and our children support us by doing well in school. It is when I listened to two programmes on the activities of Cameroon Link on Radio and Television announcing the open door educative talk that i decided to come and participate with a testimony of how i breastfed my twins and triplets. Other mothers in the hall were anxious to carry my babies to feel their weight. Many were very surprised, though happy with what they witnessed about the triplets. My triplets began to move at 11 months. The others moved a little bit earlier at 10 months. But I have to testify that I had a lot problems breastfeeding three children, one after the other. It was necessary for me to eat regular balanced diets and drink a lot water. As the children aged in weeks and months, my breast produced milk, but it was not always enough for the three children if breastfed at the same moment. As I began lossing weight myself, I had to plannify the breastfeeding hours in way to spread the periods with a difference of one hour for each child. This permitted two children to be sleeping when one of them was suckled. It was not easy, but I managed it.
I believed that my breast did not produce enough milk at one point because I worked a lot at home and in the farm. I did not get enough assistance from my family relatives or the community. This is explained by the fact that everyone was engaged in their own farm work and care for their own children and families. This pushed me to wean them at ten months when they started getting up and standing. Another problem is that when children start moving they eat a lot. I need help and assistance for their feeding. Certainly in three years, it would be the problem of sending them to school. This necessitates money. It is for these reasons that I decided to participate at Cameroon Link open door educative talk. In other countries, mothers like us are assisted by the government, but since I started getting my children, the twins and later the triplets, I have received not aid from the government or public as yet. Persons of will good should know this and come to my aid through Cameroon Link.
Q : How did you organize complementary feeding of your children?
M : In the village, we have gardens that produce vegetables, farms for subsistence crops that produce food and we have also a small poultry farm that produces eggs and chickens for the household and for sale. I associate all these items to feed my children. What I sell assists me to give them clothing. I thank God because they are not sick. What I have also observed is that their growth rate decreased when I stopped to breastfeed the triplets. It is important to continue to breastfeed a baby even when he or she has begun to eat others foods. As a baby grows, he or she spends a lot of energy in playing too.
Q : Why did you remain in the village when your husband worked in Douala?
M: I remained in the village because the accommodation was not enough for ou large family. Accommodation in Douala City is very expensive and our family income is not enough. The cost of life in general is very high, especially if we consider the current food market prices. My husband did not get a job rapidly and even what he has currently is temporary occupation. One could therefore not live in Douala with all these children because others needed to continue to go to school. Schooling costs are less expensive to the village.
Q : Your husband is truck driver and his profession keeps him regularly on the move How do you organize to discuss problems related to the children’s care with him ?
M: Our situation is truly difficult. My husband is constantly in search of a better job because he earns only " Eighty Five Thousand Francs CFA (US$ 210) a month as salary. This is very small for a large family of ten persons. This means that each person in our family of the ten lives on US$ 20 only for a month. This is why the absence of my husband from the house does not disturb me a lot. During his multiple trips, we are constantly on the telephone to discuss family problems, because even when he is around during the weekends on Sunday, he is always tired and his does not remain long with us. We cannot do otherwise.
Q: You do not have a job and your husband’s job is not a permanent one with PASTA. How do you arrange to meet up with the basic needs of yours eight children ?
M: As I told you, my husband’s salary is only CFA 85.000 (US$210) a month and this amount is insufficient for our needs. However, through his job as truck driver, he obtains some small favour with financial out comes. This is against professional norms, but he feels obliged to make ends meet, though the high risks. If his supervisors know about his extra activities, he may be dismissed from job.
Q : If a good Samaritan wanted to come to your aid, what will be your priority?
M : As a mother with many children, I wish to be trained at a home economics center, where I can start apprenticeship to become a seamstress, beauty hairdresser or learn any other trade to generate resources or get a job for myself too. In this way, I could be able to assist my husband. I think also of clothing, health and education of my children as a priority. Our aims is to get permanent housing for the family as whole. Finally, I would like to see my husband have a stable job that could assist us to bring up our children well.
Q : Tell us the story of the pregnancy of your triplets?
M: When I went for pre-natal consultation in the hospiatl, the medical doctor made me to understand that I waited twins. At only five months of pregnancy my belly was very large that I understood we had to wait for a second set of twins in the family. I went constantly to the hopital but at one stage I became very tired and never wanted to move anymore. I no longer wanted to return to the hospital and my sister was afraid that I could deliver at home and not in the hospital. The delivery took place in the hospital when my pregnancy was nine months and I was very weak. It was my elder sister persuaded me to go to the hospital. Immediately I arrived, I was taken to the delivery room and the children started coming out one after the other every three minutes. I delivered normally, but we had prepared only for two children and a third come. Each child came after three minutes. The third was wrapped with a napkin and clothes came only later. I thank God because all the children had good weight. I returned to the house three days after my hospitalization in the maternity for post natal follow up.
Q : How are the triplets today?
M: They are all well. The triplets carry do not fall sick regularly. Since we stay in a marshy area of Bonabéri-Douala, they have malaria once in a while. They eat well and sleep well.
Q : If I understand youl, apart from the small sicknesses, they are growing normally ?

M: Yes. They are growing very fast.
Q : Thank you, Mrs. Atabong Mercy for your time and testimony.
M: It is me to thank you for allowing me to express my views and request for help. …

Transnational Relations of Mbororo Migrant Families

Transnational Relations of Mbororo Migrant Families
By James Achanyi-Fontem
The 2nd General Assembly of the Mbororo migrant network of associations held in Douala recently. Some 200 delegates from the three Northern , East, Centre and Littoral provinces attended the one full day of deliberations on how to promote gender and development for the integration of the Mbororos in national plans.
Associations from the different provinces are grouped under the Mbororo network organisation « SURAMAMA ». Opening the deliberations in the presence of the provincial delegate for the promotion of the woman and the family, Suzanne Patricia Bebe, Team leader Hassan Hamadou, told the delegates that all human beings are equal in the eye of God, irrespective of the political, religious or cultural background. With this, he invited delegates to exchange ideas and make proposals on how to develop strategies for the intergation of the marginalized Mbororo groups in cameroon in national development policies to reduce their migration into other countries.
Suzanne Patricia Bebe lauded the initiative of the Surmama and announced the decision to put the Mbororo women at the centre of celebrations marking the Africa Women’s Day 2008 in Cameroon. She observed that the integration of the Mbororos has been a challenge to the government, because these are people who migrate constantly and do not have birth certificates and do not establish marriage certificates for the establishment of socio-economic development security. They hardly carry identification papers and though composed of very large populations, have a low education rate.
The Provincial delegation for the promotion of the woman and the family joined in the organization of Mother/Father support activities to empower the Cameroon Mbororo woman through existing organized groups like Suramama.
Reports made by the different group leaders from Garoua, Bertoua, Yaounde, Bamenda and Douala approved that alphabetisation of the Mbororo remains a major problem, due to their normadic activities. Their normadic life style does not make them benefit from the common soci-ecnomic and education possibilities granted by the government and international communities.
Women are a target for alphabetisation because this will empower them and assist in the promotion of infant immunisation of Mbororo children between zero and 5 years, encourage HIV/AIDS prevention and promote the fight against malnutrition. Suramama has worked out a collaboration partnership with the provincial delegation for public health and legal organization to prevent violence against women.
A close look at the Mbororo Community structures show that the margin between the man and the woman is very wide. The woman reamins marginalized and uneducated, compared to the opportunities accorded to the man or boy-child. The girl-child is given out to early marriages in exchange of cows as dowry. For every 100 Mbororo in Cameroon, only two have national identity cards.
To reverse the situation, Horé Poulakou, a Mbororo association located in Garoua with over 500 members has engaged in the promotion of the education of the girl child and the established of national identity cards for newly born babies as well as the aged who do not have one.
The General assemmbly organized in Douala was an opportunity to evaluate how far the Mbororo have gone with their self-help integration and development projects with the last five years. Suramama is in its third cycle. The third cycle started with the success story of registration of some 600 Mbororo children in primary schools in the Adamaoua, though the classrooms remain congested, due to the lack of enough classrooms, benches, and teachers.
Suramama partnership with other local association in Cameroon started 6 years ago in the area of capacity building, health promotion of the Mbororos through immunisation campaigns in Ndobo – Bonendale communities, promotion of mother and child care, infant and young child feeding , organisation of educative talks on the importance of child education and the protection of the rights of the mother and the child, promotion of micro-economic activities as a source of women’s empowerment and the promotion of networking of the Mbororo associations.
Addressing the audience at the general assembly, Dr. Michaele Pelican, who lectures at the Department of Social anthropology in the University of Zurich, Switzerland presented a paper on her research studies on Mbororo Muslim migrants from Cameroon in various parts of the world, their experiences with western and islamic educational nteworks as well as with work opportunities in African countries and the Arab world.
Her paper also dealt with the migrants' impact on their home area and their contribution to economic, political, religious and social change. Transnationalism is a relatively new concept in the study of migration, she told the delegates, as it refers to mobility across multiple national borders and to migrants enter1aining regular and sustained contacts with individuals/communities in two or more nation states.
While much research on African migrants has concentrated on migration to the West and the migrants' integration into the host society, the focus of her research on the migrants' relations with their home communities as weil as on the perception of these relations both by migrants' and their relatives and friends at home, narrowed its focus on Mbororor Muslim migrants and their migratory movements within Africa and to the Arab/Muslim world.
Since the Muslim community of Cameroon is ethnically heterogeneous, the research concentrates on the migration trajectories of pastoral Foulbe (Mbororo) and Hausa from northwest Cameroon. Both groups have considerable historical experience of pastoral and trade mobility, and their par1icipation in international migration may be conceptualised as an extension of their "culture of mobility".
Frequently, international mobility is closely linked to labour and urban migration. Moreover, it requires networks of information and facilitation that are mostly found in urban centres. The on-going research will include extended phases of fieldwork both in the home regions of the study communities as well as in the cities of southern Cameroon, Yaoundé and Douala.
As concerns the migration destinations, Gabon, South Africa and Dubai will be considered. The choice of these destinations is based on their popularity among Cameroonian migrants as well as on the comparative opportunities they offer. As a neighbouring country to Cameroon, Gabon supports different types of transnational relations as compared to South Africa where regular mobility to Cameroon requires considerable economic resources. Dubai, on the other hand, allows us to investigate linkages between historical and modern experiences of trade mobility as weil as the possible impact of a Muslim environment on the migrants' transnational relations.
Researchlng transnational migration requires also the researcher's mobility. Due to its multi-sited character, the project is extending over a period of two years (2008-2010) and will involve substantial travel and research within Cameroon (Centre, Littoral, West, Nor1hwest,
Adamaoua. North. Far Nor1h) as well as within Africa (Gabon, South Africa) and Dubai.
Michaele Pelican, better known within the Mbororo environment as Aïshatu, is an anthropologist and post-doctoral researcher . Her other works include research on transformation of the socio-economic situation of Mbororo women in North West Cameroon published in 1996 and the inter-ethnic relations of Mbororo, Hause and Grassfielders in Misaje of North West from 2000 -2002.

Pilot Community Social Health Security Management

Regional Snap Shot - Cameroon
Gender Focus Training of Stakeholders on Mutual Health Insurance
By Roseline Ajongafac
On the 23rd and 24th October, 2008 the Chairman of the Pilot Community Social Health Security Project of the Health District of Bonassama, James Achanyi-Fontem, presided over the training of staff and executive bureau members on the management of Mutual Health Insurance Schemes. Opening the workshop, James Achanyi-Fontem said, this was an initiative supported by the ministry of public health through the very poor and heavy indebted countries fund of which Cameroon qualified.
The senior supervisor of the project is the director of Association of Partners of Community Social Insurance Systems in Cameroon, APCAS, Jean Keumo. The training took place in the presence of the representative of the Health District Hospital, Dr. Obam Enam, who also coordinates the Red Cross Crescent in Bonaberi-Douala.
The trainers included Ntock Mouhammed, Chair of the Health Solidarity Association (ASSA), Mrs. Ndoutou Toto Caliste and Kom Doleesse. Douala IV Municipality was represented by the 3rd Deputy Mayor, Kammogne Therese, who promised to advocate for support by the councilors through their participation.
The chairperson of the board of directors, James Achanyi-Fontem, said the objectives of activities, included the negotiation of conventions with health facilities in the health districts of Deido and Bonassama after the creation of the insurance scheme stakeholders committees. This new social security system that focuses on gender promotion aims at making health care accessible to all at low cost. The Community Social Health Security System would contribute to the permanent education of the population and circulate up dates on health care and environmental protection possibilities available.
The members were advised to reflect on micro-projects which on realization would assist in raising fund to be directed in durable initiative that would benefit the entire community and the stakeholder. To achieve this, Achanyi-Fontem added, members should collaborate with other organizations with similar objectives through the organization of conferences, workshops, round table debates on health and community education on relevant issues.
The adhesion to the health security scheme should be with distinction of sex or religion, and members should be be good morality. Dr. Obam Enam welcomed the participants at the workshop which took place at the conference and counseling centre of the HIV screening and care unit of the Health District Hospital of Bonassama. He invited the participants to be attentive to the different presentations which fall in line with national health policy of decentralization for community ownership of health care initiatives in Cameroon.
The principal facilitator, Ntock Mouhammed, in the first module talked about the context and present the origin of the initiative of community health security, which leads to everyone having access to adequate care at all times.
Ntock Mouhammed said, the initiative is based on self-help traditional solidarity systems. He added that self-help is based on reciprocal principles, while solidarity aims at extending a hand to the less advantaged groups in the community. When assisting the less advantage, the stakeholders do not expected any other benefits from them as exchange form the aid given.
Self help can be realized in several forms which include, labour, human resource, financial and material assistance because individuals, families and communities are always confronted with births, marriages, diseases, deaths, and so on. Without joined efforts, it is often difficult to properly address the above issues in the African communities.
It would be recalled that Cameroon like other Africsn countries achieved its independence by inheriting health systems which promoted and guaranteed free health care and treatment of its citizens. But the petrol and financial cris of 1980s reversed the situation by making governments incapable of continuing with free treatment due to the lack of resources.
It was during the conception of the Bamako initiative in 1987, that health ministers of the Africa continent found that free health care to the populations was not realistic due to the galloping economies and populations. This led to the putting in place of the new strategy which required the recovery of health care cost from the sick, while the governments took care of infrastructure, management, training and the payment of the salaries of staff.
From the diagnosis of 2001, it became evident that only 15% of population had access to health care in Cameroon. The principal cause identified was the weak or absence of resources, due the the heavy contributions to keep house holds secured through adequate nutrition and spending on health care. At this period, the public treasury became incapable of paying health bills, while guarantees by the public and private enterprises became limited
The solution by the ministry of public health was to initiate two reforms, which touched on the management systems of hospitals and the promotion of self-help community health initiatives by developing mutual health care insurance systems.
The current system promoted is based on solidarity amongst members of a community, participative and functional democracy where the community elects it own leaders by themselves, the liberty to adhere and belong for the promotion of autonomy, the development of the individual, and above all taking responsibility and operating as a not-for-profit mutual organization.
It should be noted that the principle of solidarity remains the basic foundation of mutual health security systems, because every registered member pays a contribution that is independent of personal risk. This contribution is the same for irrespective of age, sex and state of health of the registered member. In the same way, everyone benefits from the same services in case of illness.
This means that the Mutual Health Security scheme installs a solidarity system between the sick and those who are not, whether young or old and even between the different professional categories.
Addressing the issue of managing registration of members, Mrs. Ndoutou Toto Calixte, reiterated that mutual health insurance systems can survive only when the membership is consistent and members pay their contributions regularly. She distributed work tools with all the relevant information for guaranteeing good governance and transparency in the management of dues contributed. These tools included the membership registration form, the register of beneficiaries, the recapitulative sheet of contributions and the register of contributions.
On the other hand, Mrs. Kom Dolesse, emphasized on the use of management principles that guarantee good book keeping of money collected from members. She added that the contributions are needed for the autonomous functioning of the organization and the reimbursement of health bills of its members.
She enumerated the five different types of contributions which include:
Provisional contributions (Budget0
Registered contributions (dues collected in the current year)
Acquired contributions (left-over after spending)
Advanced contributions (payments received in advance of determined period)
Debt collection (owed dues collected as arrears)

The methods of calculating the contributions also differ and put in four categories:
General contributions
Fix semester contribution per family
Fix semester contribution per beneficiary
Contribution per group
Proportional contribution

As concerns the Community health Security Schemes of Bonassama Health District, the members opted for calculations to be done on basis of fix semester or annual contributions per beneficiary. Before closing the first day of deliberations, participants decided on the type of health offers that would be available for all who subscribe to the health security policy.
The goes with the establishment of partnership conventions with the selected health facilities after verification of the rates adopted for health services offered by the facilities. The target of mutual health security schemes is to get health services to all within a community at an affordable rate. Through this system, health coverage is more effective and covers a wide range of diseases very common in the community.
It was recalled again and again that the mutual health security organization is made up of volunteers that share the responsibility of caring for illnesses and other health risks, especially as the participation in contributions is uniform.
From what was said, it became evident that community mutual health security schemes are another excellent channel of developing a country, guaranteeing health, social and economic well being of individuals, families and the community as a whole.
Within the health fr5ame work, this facilitates access to health care, contributes to the amelioration of the quality of health care, increases the rate of health care visits in facilities and reduces auto-medication and use of poorly conserved street hawking drugs and medication.
In the social plan, this assists the populations to organize themselves for ownership of their health care system through jointly finding solutions to problems faced by the community‘s less advantage and poor populations. Since health care becomes cheap, it is accessible to all at the same moment.
This system encourages communities to acquire the spirit of saving to prepare for emergencies. In reducing expenditure on house hold health care through the solidarity health security scheme, everyone wins by paying less the US $ 2 per person each month for health coverage equivalent to US$ 100 per year.

HIV/AIDS AND NUTRITION

HIV/AIDS AND NUTRITION
By James Achanyi-Fontem

HIV infection not only compromises the nutritional status of infected individuals, but poor nutritional status can affect the progression of the infection. Research to identify nutritional interventions has been undertaken in Africa by the Commonwealth Regional Health Community Secretariat in Africa seeking to:
•review what is known about the clinical and social dimensions of HIV and nutrition
•synthesise current understanding of the role of macro and micro nutrients in HIV
•describe the impact of HIV on nutritional status and the impact of nutritional status on HIV progression and transmission particularly mother-to-child transmission (MCTC)
•highlight important research from Africa
•identify gaps in research and make recommendations.

Epidemiology and social impact
Although the number of infected people is increasing in Cameroon, HIV/AIDS affects a disproportionate number of young women and large number of children. Declining life expectancy and changing population structure are harming economic and social development, including food security, illness and death from AIDS cab profoundly affect a family’s ability to provide adequate food and nutrition for its members, particularly for young children who are already vulnerable.
An estimated 12 million children in Africa have lost one parent or both before the age of 15. This highly vulnerable group is expected to grow dramatically.

Paediatric HIV/AIDS
Infants can acquire HIV from their mothers during pregnancy, at the time of delivery ,or during breastfeeding. If no interventions are in place to prevent mother-to-child transmission, about 5 – 10% of infants will be infected during pregnancy, about 10 – 20 % will become infected during delivery; and another 10 – 20% will become infected fi breastfed to one year or longer.
In these cases, children are more likely to suffer from failure to thrive and low weight-for-age than uninfected children. Disease progression may be more rapid than among children in industrialised countries because of endemic malnutrition, frequent exposure to infectious diseases, and limited access to health care and treatments.
According to the WHO recent clinical approach to diagnosing HIV in children living where testing is not available, the following guidelines suggest that, where three out of seven conditions are present, HIV infection should be suspected. These are the seven conditions:
*two or more chest infections requiring antibiotics (pneumonia) in the past two months
•one or more episodes of persistent diarrhoea or two or more episodes of acute diarrhoea in the past two months
•a patient with tuberculosis
•oral candidacies (thrush)
•enlarged lymph nodes in tow or more sites
•growth faltering (weight curve flat or falling for two consecutive months)
•weight-for-age below the 3rd percentile, using international growth reference standards.

Malnutrition
Malnutrition in its many forms is endemic and measurements of body size indicate protein-energy malnutrition, but micro nutrient malnutrition in its milder forms is not easily recognised. The most commonly reported micro nutrient deficiencies are iron, vitamin A, and iodine.
Deficiencies in other vitamins and minerals are not commonly reported , but occur frequently where diets are lacking in variety and contain few animal products. Malnutrition in children is increasing due to HIV/AIDS and other factors that affect food security , access to health care, and family caring practices. Vitamin A deficiency is widespread, and about 60% of African children under five years , and half of all pregnant women , suffer from anaemia.

The clinical context
Nutritional status affects the progression of HIV disease . Infectious diseases, no matter how mild, influence nutritional status. Conversely nutritional deficiency, if sufficiently severe, will impair resistance to infection.
Infants and young children are frequently malnourished, so the differentiation of HIV malnutrition from other causes is difficult. HIV not only destroys the CD4 cells of the immune system, but also affects the cells of the intestine, brain and other organs.
Infections lead to reduced dietary intake and nutrient absorption, whilst increasing utilisation and excretion of proteins and micro nutrients. The immune system responds to infection by releasing pro-oxidant cytokines, which demand increase demand for and utilisation of anti-oxidant vitamins and minerals.
Oxidative stress occurs when there are not enough antioxidants to form enzymes needed to respond to the pro-oxidant immune response. Oxidative stress may hasten HIV replication and increase production of hormones involved in the metabolism of carbohydrates, proteins and fats, contributing to further weight loss.

The social context
Quality of life is seriously affected by HIV infection. Weight loss leads to fatigue and decreasing physical activity. Entire families are affected when infected adults cannot work steadily and provide for their dependants, but face increased expense when infected members require medication and continued care.
A common result is food security, which is especially severe in female-headed households and in areas where farming is a primary occupation. Parental death is a frequent precipitating cause of childhood malnutrition.

Weight loss and wasting in HIV/AIDS
The syndrome once known as ‘slim disease’ typically found in AIDS patients is a severe nutritional manifestation of the disease. In earlier stages of HIV infection, weight loss typically follows one of two patterns: slow and progressive weight loss from anorexia and gastrointestinal disturbances, and rapid episodic weight loss from acute infection.

Sometimes overlapping processes cause weight loss and wasting.
1. Reduction in food intake due to physical or psychological factors affecting food availability and nutritional quality, and the side-effects of drugs.
2. Nutrient malabsorption due to frequent diarrhoea and possible damage to intestinal cells by the virus. Fat malabsorption also affects the absorption and utilisation of fat-soluble vitamins (A,E), further compromising nutritional and immune status).
3. Metabolic alterations is also a serious problem. Infection results in increased energy and protein requirements. Furthermore , severe reduction of food intake can cause changes in metabolism, as the body uses up carbohydrate reserves and begins to break down protein to produce glucose, causing muscle – wasting cachexia. This process occurs when skeletal muscle is broken down for proteins required to bind and clear infectious agents.
Malnutrition due to the first two processes may be reduced by treating the immediate source of the problem (other infections) and providing well-tolerated foods to the infected individual, whilst increasing food intake during convalescence.
Weight loss and wasting due to metabolic changes cannot be reversed by feeding alone. Industrialised countries have used expensive appetite stimulants and hormones to treat wasting in AIDS patients. However, a less expensive supplement on weight again appeals to depend upon the stage of the disease. Nutrition supplementation combined with glutamate and antioxidants appears to be effective over a 3-month period .
Other nutritional supplements tested, such as fish oil supplements and high energy-protein drinks, have resulted in improved weight again among some HIV-infected adults. The impact of these supplements on weight again appears to depend upon the stage of the disease. Nutrition supplementation combined with counselling about appropriate diet has had the greatest impact before the onset of chronic secondary infections. Unfortunately, relatively few people in Cameroon learn of their status early in the disease, in time to take preventive actions.

Vitamins and minerals in HIV/AIDS
The table below summarises the role of vitamins and minerals in supporting body functions and the immune system. HIV – infected individuals have decreased absorption, excessive urinary loss, and low blood concentrations of several nutrients.
It is not known if these deficiencies are independent markers of disease progression or whether they are causally related to the worsening symptoms of HIV/AIDS. But low intakes and pre-existing malnutrition are likely to worsen the impact of HIV on immune function.
Metabolic alterations that accompany acute infections
Protein
Increased urinary nitrogen loss
Increased protein turnover
Decreased skeletal muscle protein synthesis
Increased skeletal muscle breakdown
Increased hepatic protein synthesis
Lipid (Fat)
Hypertriglyceridemia
Increased hepatic de novo fatty acid synthesis
Increased hepatic triglyceride esterification
Increased very low-density lipoprotein production
Decreased peripheral lipoprotein lipase activity
Increased adiposity triglyceride lipase
Carbohydrate
Hyperglycaemia
Insulin resistance
Increased peripheral glucose utilisation
Increased gluconeogenesis
These are causally related to the worsening symptoms of HIV/AIDS; But low intakes and pre-existing malnutrition are likely to worsen the impact of HIV on immune function.

Haem iron sources (high absorption) include red meat, liver, fish, poultry , shellfish. Non haem iron sources (low absorption) include eggs, legumes, peanuts, some cereals, and dried fruits.
Vitamin C, haem iron foods and some fermented foods increase non-haem iron absorption. Tea, coffee and some grains and green leafy vegetables (with phytate) decrease non-haem iron absorption.
Calcium
Required for building strong bones and teeth. Important for normal heart and muscle functions, blood clotting and pressure, and immune defences. Milk, yoghurt, cheese, green leafy vegetables, broccoli, dried fish with bones that are eaten, legumes, peas.
Zinc
Important for function of many enzymes. Acts as an anti-oxidant. Involved with making genetic material and proteins, immune reactions, transport of vitamin A, taste perception, wound healing, and sperm production. Meat, fish, poultry, shellfish, whole grain cereals, legumes, peanuts, milk, cheese, yoghurt, vegetables.
Selenium
Acts as an antioxidant together with vitamin E. Prevents the impairing of heart muscles. Meat, eggs, sea food, whole grains, plants grown in selenium rich soil.
Magnesium
Important for building strong bones and teeth, protein synthesis, muscle contraction, transmission of nerve impulses. Nuts, legumes, whole grain cereals, dark green vegetables, sea food
Iodine Ensures the development and the proper functioning of the brain and of the nervous system. Important for growth, development, metabolism Sea food, iodised salt, plant grown in iodine-rich soil.
Micro nutrient deficiencies:
•vary across populations and according to disease stage
•are associated with accelerated progression of the disease
•are predictive of HIV-associated mortality.
Micro nutrient supplementation has thus the potential to be an affordable public health measure.
Selenium deficiency is unusual in most populations of Cameroon. Deficiency impairs the immune system and has been associated with faster HIV progression. Selenium is believed to play an important role in reducing oxidative stress and animal studies suggested that lack of it increases viral pathogenicity.

Micronutrients and Mother-to-Child- transmission (MCTC) of HIV
High viral load due to recent or advanced infection increases the likelihood that HIV will pass on to the baby during pregnancy, delivery, or breastfeeding. If malnutrition –facilitated immune suppression contributes to high viral load, then the risk of MCTC is greater. Some micronutrient deficiencies during pregnancy (vitamin A and zinc) result in reduced foetal nutrient stores, which may affect their immune status and subsequently increase their vulnerability to HIV.
In addition, malnutrition during pregnancy may further erode the woman’s immune status and possibly accelerate disease progression. According to studies carried out, breastfeeding mothers with HIV lost more weight and died earlier than those also HIV infected who did not breastfeed.

Interpreting the results
What is known to favour the continuous increase in the HIV figures in Africa than in the industrialised countries could be related to the following views:
•The general level of nutrition is higher in industrialised countries than in Africa. Nutritional interventions may therefore have a greater impact in Africa.
•Most studies of adults in industrialised countries have been among homosexual men and /or drug users. Their diet and health status are likely to be quite different from HIV – infected adults in Africa.
•Most Americans and Europeans are taking anti-retroviral drugs and treatment for secondary infections, including nutritionally fortified foods and supplements. These are not generally available or consumed by Africans. Nutritional interventions have had a positive impact in populations also receiving antiretroviral drugs.

HIV+ and Nutrition Support
Nutrition programmes serving people with HIV/AIDS have significantly increased their quality of life. Programmes addressing the needs of people living with HIV and AIDS can have varied objectives. These objectives will depend on the needs of the population and the stage of HIV disease in individual participants.
For people with HIV but no opportunistic or secondary infections, programmes should focus on building nutrition stores to prevent nutrition deterioration. People with AIDS, at the other end of the spectrum, will require palliative nutrition care.
Specific objectives for nutritional care and support programmes may include:
•improving nutrition, diet and eating habits
•building or replenishing body stores of Micronutrients
•preventing weight loss
•preserving muscle mass
•preventing food borne illness
•preparing for and managing AIDS related symptoms that affect food consumption
•ensuring that nutritious food is available to AIDS-affected families
Nutritional support should be provided within the context of holistic care and people with HIV/AIDS should be allowed to participate in providing programme services .
Components of a holistic care programme include counselling for emotional and psychological stress, physical exercise , health care and treatment of opportunistic infections. Nutritional programmes may include one or more of the following :
•education regarding diet
•safe water , personal hygiene , and food safety
•support for healthy members of family affected by HIV/AIDS
•nutrition supplements , group meals, or food baskets
•home-delivered ready-to-eat foods for AIDS patients

Recommendations for nutrition care
Recommendations vary according to the nutritional status, stage of infection, and level of disease. In the asymptomatic stage, advice will focus on maintaining health and building nutrition stores in the body.
In later stages, advice may shift to address the problems of anorexia, infections causing protein catabolism, and to mitigate the adverse nutritional effects of chronic diarrhoea and other secondary infections.
Nutritional support is more likely to be effective during the early stages of the disease, but this requires early diagnosis and early detection of the disease is rare in Cameroon.
For HIV-positive asymptomatic individuals, a healthy diet that is adequate i terms of energy, protein, fat, and other essential nutrients should be promoted as a key component for positive living, and to prolong the period between HIV infection and the onset of secondary infections attributed to AIDS. Local available foods should be recommended and these should be familiar to all health care providers, and made accessible , along with sources of social support , to families affected by HIV/AIDS.
Nutritional counselling should include information on appropriate diets, taking into account the individual’s particular preferences and needs in terms of age, sex, and physiological state- for example, pregnancy, lactation, engaged in strenuous physical labour and so on.
Even those who are asymptomatic have increased metabolism due to the HIV infection. The potential for increasing nutritional reserves and improving dietary intake are greater when an individual is still relatively healthy. Therefore , programmes should emphasise building nutritional reserves at an early stage.
People with HIV/AIDS should be encouraged to maintain physical activity. Weight –bearing exercise may help build lean body mass. Exercise also stimulates appetite. Counselling should also include discussion on personal hygiene, safety in food preparation and cooking, and emphasise the importance of seeking immediate attention for digestive or other health related problems. Preventing food and water borne infections is especially important in people with compromised immune systems.
HIV-positive individuals experiencing weight loss
Most early weight loss is the result of depressed appetite during secondary infections, particularly diarrhoea. Nutrition advice for managing common conditions and maintaining intake by having more frequent meals, and well liked foods, suggests that intake should be increased during periods of recovery from infection.
All people with HIV/AIDS at whatever stage should be advised against unhealthy lifestyles that include alcohol consumption, tobacco and drug use, and unsafe sexual practices, which increase the risk of infections. They should be advised to have all infections treated immediately and completely, to maintain personal hygiene, and to prevent food contamination at all times.

Recommendations for nutritional support for people with HIV
The advice is similar except that the emphasis shifts from preventing to mitigating the nutritional consequences of the disease and preserving functional independence wherever possible. Preservation of lean body mass is important.
Protein-energy consumption should be maintained and medical recommendation should be followed for specific symptoms. Foods low in insoluble fibre and fat should be avoided to minimise gastro-intestinal discomfort and, during periods of nausea and vomiting, people should be encouraged to eat small snacks.
Fluid intake should be maintained at all times , especially during periods of diarrhoea. Specific eating times should be set and made pleasant and supportive. It should be noted that several medications against opportunistic infections have nutritional consequences or side effects such as nausea and vomiting.
In situation of food insecurity, programmes providing food supplements should insure that rations are of sufficient size to meet the needs of the HIV/AIDS patient and his /her dependants. All family members are extremely vulnerable in this situation.

Nutrition Care for children with HIV
Children with mothers who are HIV-positive are especially vulnerable, as a result of their own infection with HIV or because of the deteriorating health of one or both parents. In this case, recommendations should follow those for all young children but take into account the increased nutritional requirements that accompany the infection.
Children less than 2 years need to be fed patiently and persistently with supervision and love, especially as they are likely to be frequently ill. Solid foods can be introduced gradually in small portions at least three times a day, and by the time they are one year old most children can eat adult diet as long as food is cut or mashed and not too spicy.
Variety and foods containing essential vitamins are a priority – locally available fruits and vegetables, and animal products and fortified food if available. Nutritious snacks between meals can be provided to increase consumption.
The following guidelines are suggested for nutritional management of HIV infected children :
•regular monitoring of weight, growth, and development
•review of child’s diet at every health visit
•immunisation and prophylactic vitamin A supplements
•prompt treatment of any secondary infection and maintenance of food and fluid intake
•for those who are severely malnourished , local guidelines should be followed ; entered or parenteral nutrition should be considered if available.

PRACTICAL SUGGESTIONS ON HOW TO MAXIMIZE FOOD INTAKE DURING AND FOLLOWING COMMON HIV INFECTIONS
Symptom Suggested strategy
Fever and loss of appetite
Drink high energy, high protein liquids and fruit juice
Eat small portions of soft, preferred foods with a pleasing aroma and texture throughout the day
Eat nutritious snacks whenever possible

Sore mouth and throat
Avoid citrus fruits, tomato, and spicy foods
Avoid very sweet foods
Drink high energy, high protein liquids with a straw
Eat foods at room temperature or cooler
Eat thick, smooth foods such as pudding, porridge, mashed potatoes, mashed carrots or other non acidic vegetables and fruits
Nausea and vomiting
Eat small snacks throughout the day and avoid large mealss
Eat crackers, toast, and other plain, dry foods
Avoid foods that have a strong aroma
Drink diluted fruit juices, other liquids, and soup
Eat simple boiled foods, such as porridge, potatoes, beans
Loose bowels
Eat bananas, mashed fruits, soft rice, porridge
Eat smaller meals more often
Eliminate dairy products to see if they are the cause
Decrease high – fat foods
Don’t eat foods with insoluble fibre (“roughage”)
Drink liquids often
Fat malabsorption
Eliminate oils, butter, margarine, and foods that contain or were prepared with them
Eat only lean meats
Eat fruit and vegetables and other low-fat foods
Severe diarrhoea
Drink liquids frequently
Drink oral rehydration solution
Drink diluted juices
Eat bananas, mashed fruits, soft rice, porridge
Fatigue, lethargy
Have someone pre-cook foods to avoid energy and time spent in preparation( care with re-heating)
Eat fresh fruits that don’t require preparation
Eat snack foods often throughout the day
Drink high energy, high protein liquids
Set aside time each day for eating

HIV AND INFANT FEEDING
HIV was first detected in breast milk in the mid-1980s, creating problems as to how to advise HIV-infected mothers on the feeding of their infants. The risk of transmitting HIV through breastfeeding must be balanced against the risks that can result from not breastfeeding.
Breastfeeding is near universal in Cameroon, making it hard to conduct studies on the risks of artificial feeding. The lack of data makes it difficult to balance these risks. As at now, HIV prevalence is high and rising in pregnant women in Cameroon, so it is important that guidance should be developed to help reduce the risk of mother-to-child transmission (MCTC). It must be borne in mind that breastfeeding in Cameroon is recommended usually from birth and may continue in most cases to over 24 months, but also that complementary foods are often introduced within the first 3 months of life.
In the resource poor settings, the many benefits of breastfeeding become especially important and the risks associated with the alternatives to breastfeeding also become greater. In developing countries like Cameroon, the high cost and irregular supply of breast milk substitutes, and the lack of safe water to make up such foods, results in higher levels of morbidity and mortality for infants who are not breastfed.
Studies carried in Cameroon by Cameroon Link have found that babies who are not breastfed in the first month of life are six times more likely to die than breastfed babies. The protective effect of breastfeeding declines with age but remains significant for the first 8 months of infancy, and it is greatest among mothers with limited education.
In some district hospitals in Cameroon, for an HIV-infected mother, the decision whether to break with tradition and not breastfeed, or to run the risk of transmitting the virus through breastfeeding, imposes a heavy burden. A woman who does not breastfeed may be stigmatised and others will suspect she has HIV, and there could be many adverse social consequences.
A woman may try to hide her HIV status by breastfeeding but also use artificial feeding in an attempt to reduce the risks to the baby. This , however, exposes her baby to both sets of risks. For now , options for replacement of infant feeds to HIV-positive mothers and children for the first six months are discussed by the UN agencies like UNICEF,WHO, and WHA.
On the other hand, there is information on home-prepared foods for children over this age. These guide are generic and should be locally adapted. Through counselling, they should also be tailored to individual circumstances . Local guidelines are being developed in Cameroon, but little is known about their implementation or effectiveness. What is known is that it is difficult to achieve safe replacement feeding in Cameroon for now.

HIV transmission through breastfeeding
The mechanisms of HIV transmission through breastfeeding are not clear but the virus probably infects the infant through breaches in the integrity of the intestinal mucosa. An improved understanding of how HIV transmission through breastfeeding occurs might make it possible to reduce the transmission risk.
Data suggest that 10 – 20 % of babies born to HIV-positive mothers will become infected through breastfeeding when it continues beyond one year. Several factors associated with increased risk of breastfeeding transmission have been identified. Those for which there is strong evidence of increased risk include:
*high maternal HIV load (found in recent infection and in advanced disease)
•clinical symptoms of advanced disease
•immune deficiency (low CD4 and high CD8 counts)
•duration of breastfeeding
•breastfeeding whilst experiencing mastitis, abscesses, or ripple fissures.

Exclusive breastfeeding
Exclusive breastfeeding defined as breastfeeding without any supplementary food or liquid, is generally recommended for the first 6 months of life. It reduces mortality from diarrhoea and respiratory infections and protects against other diseases. Infants who are breastfed exclusively for at least 3 months have significantly lower HIV transmission at 3 and 6 months compared with infants who received breast milk plus other feeds (“mixed feeding”) within the first 3 months of life.
The rate of transmission in exclusively breastfed infants and infants who were never breastfed were similar , 19,4 % at 6 months. In contrast, 26,1 % of infants who were mixed fed are HIV-positive at this age. At 15 months, 24,7% of babies exclusively breastfed for at least 3 months are HIV-infected , compared with 35,9% of the babies who are mixed fed in the early months of life.

Mastitis
Mastitis is a condition resulting from inadequate or poor drainage of milk from the breast. It may be either infectious or non-infectious in origin. Mastitis affects up to a third of breastfeeding women, usually in the first 3 months after delivery. Some vitamin deficiencies may increase the risk of mastitis.
Mastitis can be treated with low-cost antibiotics. Counselling women about good breastfeeding techniques can help them avoid problems that would cause elevated milk sodium, poor milk drainage and inflammation leading to mastitis, as well as nipple problems which may also increase the risk of HIV transmission.

Antiretroviral drug trials for prevention of MTCT
Short-course , prophylactic Antiretroviral drugs (ARV) are the most effective way to reduce MTCT during pregnancy, labour and delivery, and through breastfeeding during the first days of infant life.
It must also be recognised that ARV protocols require the identification of HIV-positive women through voluntary counselling and testing (VCT) services, which need to be expanded in Cameroon.

Recommendations for making breastfeeding safer in the context of HIV
Mothers have a right to information and support so that they can feed their babies safely. They must know their HIV status and they must understand the consequences of each feeding option.
Most of the options for reducing MTCT discussed in this presentation so far only apply to those women who know their HIV status. In Cameroon, however, the vast majority of HIV-infected mothers are unaware of this.
The UN policy is that breastfeeding should be promoted and supported among women who are HIV-negative and those who do not know their HIV status. The following recommendations are therefore made.
•Breastfeeding should begin within 30 minutes of birth
•Breastfeeding skills (Proper position and attachment, how and when to feed the baby ) comfortably) should be established immediately.
•Infants should be fed frequently, ‘on demand’.
•Breastfeeding should be exclusive (no other solids or liquids) for about the first six months.
•Age-appropriate complementary foods should be introduced at 6 months;
•Women at risk of HIV should take steps to avoid infection during the breastfeeding period. (Risk of MTCT is greater immediately after infection because of elevated levels of the virus in the blood).
•Mothers should seek immediate treatment for breast inflammation, cracked nipples or infant mouth sores.
•If such problems occur in one breast only, mothers should express and discard milk from that breast.
These “safer” breastfeeding practices are important for public health programs because they may reduce transmission risks when mothers are:
•unaware of their HIV-status
•HIV-negative but at risk of infection
•HIV-positive but have decided to breastfeed.

Supporting First-time Mother for Breastfeeding Protection and Promotion

Supporting First-time Mother for Breastfeeding Protection and Promotion
By James Achanyi-Fontem, Coordinator, WABA MWG

The birth of baby sparks a board range of emotions in a woman. Her body and life are disrupted. This is a part of the process of adapting to her baby and learning what motherhood is all about. After the birth of the baby, as it is true during pregnancy and birth, the mother needs the advice or assistance of a professional.
Depression
The mother experiences a sudden change of mood after the baby is born. She is overwhelmed and exhausted. This is normal, if the mother is tired. All first-time mothers experience the blues for brief periods of time. Post-partum blues can last for several hours, several days and even up to two(2) weeks depending on the condition of the mother.
At this moment, it is important for the mother to discuss her feelings with her partner or another loved one. She should contact other mothers or experienced parents. The mother should encourage contact between her skin and that of the baby (skin-to-skin contact) and savour happy moments. This will overcome the difficult moments.
If after doing the above, you are not at ease for several days and even weeks, you are suffering from post-partum depression. Please, it is adviseable to consult a doctor or psychologist. They bring a smile back to the mother’s face and enable them to fully enjoy motherhood.
Importance of Rest
To recover physically and emotionally from childbirth, first-time mothers need plenty of rest. It takes several weeks for her to regain normal energy level. She has to be patient, take care of herself and should not hesitate to seek help when it is needed. The mother should adjust her rest period to the schedule of the baby’s feeling.
At this time, the man should help change the baby’s diaper and carry the baby to the mother to nurse on the baby’s demand. A baby can’t wait. If the man is absent, a family member or friend should help during the first days, so that the mother can rest.
The mother should plan no other activities during the first week after baby’s delivery. This is the period for the initiation of attachment. Mothers need help for up to three weeks for house work care, cooking and caring for other children. Nice babies often wake up their mothers at night and this is a good reason to rest when the baby is at sleep during the day.
Blood Loss
For one or two days after giving birth, blood loss in the mother is abundant than during menstruation. The bleeding then diminishes later and change texture. The colour will change gradually from pinkish to increasingly pale brown. The mother occasionally discharges a blood clot in the morning after urinating or breastfeeding.
An unusual effort and a caesarian section may cause redder, more abundant blood loss. It should be noted that a resumption of bleeding, approximately 10 days after childbirth, stems from the healing of the placenta site. Blood loss usually lasts for 3 to 6 weeks. Mothers are advised not to use tampons, but sanitary napkins without plastic linings, since the linings can be irritating. If the discharges of blood clots are large, consult a doctor or midwife immediately.
Contractions
When nursing the baby, the mother may feel uterine after-pains. To relieve the pain, it is advised that you consult a doctor or mid wife.
Healing Perineum
Mothers may experience a burning sensation when urinating. Mothers should not hesitate to splash warm water on the valves as they urinate. In case of bowel movements, the mothers should relax.
Hygiene
Hygiene is very important. To avoid health problems, mothers take a bath everyday. Mothers should change their sanitary napkins at least every four hours and they should wash their hands after using the toilet each time.
Exercise
Wait for several weeks before undertaking an exercise program to restore the figure. Mothers should avoid overly long walks. If they leave the house, they should know that they will be tired more readily and sometimes suddenly.
Healthy Weight
The mothers should maintain health diets. Within several months at the most, their bodies will exhaust the reserves accumulated during pregnancy. She will be able to resume physical activity gradually two months after giving birth.
The mothers should be patient, because the weight gained in 9 months cannot be eliminated in just a few days. Mothers should resist the temptation to lose weight quickly if she is breastfeeding. It is reasonable to lose 1 to 2 kgs in weight every month after delivery. Mothers should take note that a calorie-reduced diet may curtail the milk production of the mother and lower her energy level.
Sexual Desire
Fatigue, adaptation to parental role, time devoted to baby care, physical or emotional complications and hormonal changes reduce sexual desire in the mother after delivery. Once she has adapted to the situation, she should once again enjoy intimacy and sexual relations with the man.
Couples resume sexual relations several weeks after childbirth. Mothers can wait even longer if their vagina continues to be sensitive. If they are still bleeding or if they are very tired.. It should be noted that during breastfeeding the mother’s baby releases hormones that can prevent her vagina from properly lubricating itself. If need be, she should use a water-based lubricant to facilitate caressing of the genital organ and penetration.
Contraception
Giving birth to children demand a great deal of energy. Mothers are advised to avoid too close pregnancies. Mothers and partners should consult a doctor pr mid wife for family planning assistance. If a woman is not breastfeeding, she should seek advice promptly because ovulation usually resumes between the third and sixth seek after childbirth.
Mothers should not rely solely on breastfeeding to avoid getting pregnant, because it is not a reliable birth control method. Exclusive breastfeeding delays ovulation and can prevent pregnancy by 98 per cent of the time, when the mother has not menstruated or lost blood after the 56th day (8 weeks) following childbirth.
Exclusive breastfeeding is when the infant under 6 months of age is breastfed day and night on demand and the child is not consuming any other milk or foods and is not using a pacifier. At this time, the baby does not sleep more than 6 consecutive hours at night.
Birth Control
When a mother is controlling birth she is advised not to use the conventional contraceptive pill that combines estrogen and progesterone before she has weaned her baby. It reduces milk production. The birth-control pill Micronor (Norethindrone) is a better choice. The doctor or midwife may also suggest progesterone in injections, and when the production of milk decreases, the mother should consult an expert in breastfeeding issues. The natural Billing contraceptive methods and symptom-thermic methods are effective and very satisfactory, but demand attention.
Mother not Breastfeeding Contraception
The methods mentioned here work and are suitable, but the mother may want to take the birth control pill. If possible, she has to wait until the menstruation resumes and the menstrual cycle is re-established normally.
Breastfeeding and Diet
The mother’s diet does not need to be perfect in order to produce quality milk. But the mother must eat properly to re-establish her nutritional reserves after pregnancy and childbirth, in order to avoid exhaustion.
Apart from taking three meals a day, the breastfeeding mother is advised to take several snacks depending on her appetite. Mothers should eat healthy food, fruits, vegetables, muffins, bread, nuts, cheese and yogurt.
Mothers are not required to eat too much, but have to maintain adequate portion sizes as it was in the case during pregnancy. There are four food groups: grain products, vegetables and fruits, and meat and alternatives, and milk products. A mother who eats well or properly, does not need to take vitamins or mineral supplements, even while breastfeeding.
Milk Products
Milk products provide protein and calcium which two nutrients that are very important for breastfeeding.
Fish
Some fish species absorb pollutants, which enter breastmilk and can harm the baby. Mothers should avoid sword fish, shark and fresh or frozen tuna. Other fish like bass, northern pike, walleyed pike, muskellunge, lake trout, lobster tomalley liver, caviar and fish liver should also be avoid.
Water
If a mother’s urine is dark or cloudy, it means that she is not drinking enough water. The mother should drink water, milk, eat fruits or vegetable juice, drink herbal tea and take broth. However, it has been observed that drinking large amounts of water does increase the amount of milk that the breast would produce.
Reminder
It is important to note that some foods alter the taste of milk, but infants adopt with time. However, some babies will react badly to certain foods. When this happens, you should stop eating the foods for several days and then re-introduce later gradually, while monitoring the child’s reaction
Constipation
It is normal not to have a bowel movement for 2 or 3 days after a vaginal birth. It will be between 3 – 5 days for caesarian section. Beyond these periods, expect to have constipation due to the pain stemming from the episiotomy, hormones, lack of activity, dehydration and administered medication.
For more click here: www.waba.org.my Click here to return to home page http://cameroonlink.blogspot.com

First-time Father Initiation for Mother Support

Men’s Involvement for Breastfeeding Protection and Promotion
James Achanyi-Fontem, Coordinator – WABA MWG
Preparing to become a first-time father and play fatherhood role from the time of the conception of the partner is exciting and means embarking upon a remarkable adventure. The secrets of fatherhood will be revealed to the first-time family head or parent through the activities of this Men’s Initiative web site “Not for Fathers Only”, as many will be expressing their happiness and the pride of fatherhood.
The challenge is that, not enough is said about paternity, as men are relegated to the position of simple providers. It is the role of the men’s initiative to come up with new models of activities to involve husbands and partners for the effective protection and promotion of mother support for breastfeeding.
New Role
Men await their new born babies for a period of nine months. Within this period, men monitor the pregnancies, though a few attend pre-natal lectures with their partners, and only feel the baby move in the womb with sharing the same bed.
When the baby arrives, their lives change dramatically, and their schedules and homes are turned up side down. The men’s initiative aims at eliminating panic during the pregnancy and delivery preparatory fatherhood period.
Caring for Baby
There is no easy formula for becoming a prefect father or parent. The best way is to participate in caring for the baby. What is important is that the father and mother agree on shared values and anticipate results.
Support for family circle
Support from family and friends have value during the period of adaptation. The father should accept offers of help, by delegating household tasks and meal preparations. Men should protect both the couple’s and family’s intimacy when giving help. One has to be different as parent, which is as a father and mother, because parenting is learned day by day.
Feeding the baby together
During the first six (6) months, breastfeeding is by far the best for a baby. Men can play key roles as partners for the mother and child. A breastfeeding mother needs encouragement, especially when she is going through a difficult period.
Men can assist in shopping, cooking and laundry. Men can learn a lot about their babies by changing her diaper, when it is wet, holding her, rocking her, singing to her, bathing her or simply carrying her to the mother for nursing.
Men should learn how to put the babies on their chest to get them to sleep. All children need reassuring, comforting, physical contact with their fathers. Let the children teach the fathers their role. They do not expect you to be prefect, but to be present.
Men at Work
Men’s involvement and participation can make all the difference in women’s lives due to number factors:
1. Men often decide whether a daughter will get married young or have a chance to complete an education. Early marriage can lead to high risk pregnancy.
2. Men play a key role in deciding how many children the couple will have, and when. These decisions can shape the future of the whole family.
3. Men often make financial decisions and some of the decisions can be a matter of life or death.
4. As political, community and religious leaders, men shape public opinion. Their support for women’s health and well being can affect the care that pregnant women receive.
5. In the absence of a vaccine or cure, men’s behaviour is crucial to preventing the spread of HIV. Women are increasingly at risk.
Importance of fatherhood relationship
While the father-child relationship is different from mother-child relationship, it is very important for both girls and boys. A father often establishes special bond with a new born by playing with her. Such bonds become more important over time.
A father provides a model that is different from that of the mother. He likes to play actively with his child, and is usually stricter and often more inclined to encourage the child to explore her environment and search for independence.
This relationship affects interaction between the child and her peers and adults. However, the mother and father must agree on family rules and their application.
Activities
1. Attract attention by inviting politicians and celebrities to make public statements and take a leadership role in promoting men’s involvement in maternal health.
2. Include men in the planning and execution of activities for the promotion and protection of breastfeeding.
3. Organize public contests for posters, essays and plays.
4. Involve men in promoting Gender Equity and Women’s Reproductive Health.
Support the WABA Men’s Initiative by filling the endorsement form at www.waba.org.my/men/and send it to us.Click here to return to the home page http://cameroonlink.blogspot.com

MWG TAKES OFF WITH NEW WABA CYCLE

MWG TAKES OFF WITH NEW WABA CYCLE
Roseline Ajonglefac , Cameroon Link

The International Coordinator of WABA Men’s initiative received the first men’s special fellowship offer as senior breastfeeding advocate to attend training on in-house policy orientation and participate in the 7th Global Breastfeeding Partners Meeting (GBPM VI) in Penang, Malaysia from September 21 to October 15. The orientation on WABA policy and philosophy took place from 20th September to 6th October 2008, followed by a complimentary feeding and food workshop (7th -8th October and later the Global Breastfeeding Partners Meeting (9th-10th October). Special strategic meetings on how to involve men in all regions took place thereafter with leaders of well established taskforces and working groups.
There was a lot learned from the presentations, group discussions and exchanges in plenary during the sessions. It would be recalled that the orientation training came as a result of the consultation with members of the WABA Men’s, and Gender Working Group, and Mother Support Task Force that led to the appointment of James Achanyi-Fontem as the Coordinator of the Men's Working Group (MWG). The position was formerly held by Co-coordinators, Ray Maseko(Swaziland) and Per Gunner Engblom(Sweden) since October 2006.
After the introduction of what WABA is all about and who are the icons by Julianna Lim Abdullah, WABA Coordinator of information, education and communication, James was treated to several planning meetings with the Co-Directors, Susan Siew and Sarah Amin on the direction of activities.
During these meetings, the co-directors encouraged all the staff and icons to join them in welcoming James to the exciting and challenging role of coordinating the MWG agenda. The Secretariat team, particularly, Julianna, worked with James on various activities successfully during the three-week internship, which resulted to the initiation of a plan of action for the period running from 2008 to 2010. Latsmi Menon who coordinates the Gender Working Group also held meetings to high light the work done by WABA so far and where the men’s working group is to join for the promotion of gender initiatives considered vital for moving breastfeeding protection and promotion one step ahead. Julianna is the liaison person at the WABA Secretariat to support the MWG Coordinator in his efforts.
Policy orientation sessions resulted in defining clear areas of work and collaboration with the different taskforces, working groups and regional core partners and organizations. Some of the areas include:
* continued involvement of men in World Breastfeeding Week and other social mobilization activities;
* joint and/or coordinated advocacy strategies on various key issues (mother support, women and work, HIV, birthing, BFHI, community support and assistance), including through a Rapid Response System;
* increased advocacy to health professionals and around the Doctors’ Initiative and addressing challenges in the medical curricula;
* complementing Core Partner (CP) skills and activities in capacity building/ training, including pre and in-service training and counseling skills;
* increased focus on gender mainstreaming, men and youth outreach and involvement;
* joint development of breastfeeding/IYCF materials and dissemination of such materials;
* continued coordination among the CPs through the annual GBPMs and the Global Forum for breastfeeding promotion scheduled in Quebec, Canada in 2010 and,
* continuation of fellowship programmes at the WABA Secretariat with CPs and network partners.
According to WABA co-directors, prosperity is particularly an important theme as all of us move from one project cycle to another. The new WABA Strategic Plan which runs from 2008 – 2012 was discussed and adopted by members of the steering committee in Penang. The SP has some new programme focus, especially in the area of capacity building and e-activism. This is justified by the fact that, « Not For Fathers Only » e-newsletter will be launched in January 2009 to focus on men’s involvement activities with special focus on the regional snap shots. The MWG will also continue to contribute to the MSTF e-newsletter.
It was obvious from the look of issues during the GBPM that starting from 2007 the WABA Secretariat had been focusing on sowing the harvest for the new cycle and continues to do so by raising new funds for breastfeeding work to continue to meet the challenges.
Some of the key issues of concerns for 2008 and beyond brought up by the GBPM VII and which need addressing by the network at large are:
* corporate globalization and its negative impact on breastfeeding and optimal IYCF;
* commercial complementary and infant feeding ;
* public private partnerships (PPP) - why should the breastfeeding movement be concerned?
* reinvigorating UN initiatives especially the BFHI globally.
All CPs agreed that these issues are of concern and WABA icons developed position papers that were shared with the network representatives from the regions.

Profile of WABA MWG Coordinator

Coordinator, WABA Men's Working Group

Following a consultation with members of the World Alliance for Breastfeeding Action (WABA) Men's, and Gender Working Group, and Mother Support Task Force, the International Secreatariat was pleased to make it public that James Achanyi-Fontem is the Coordinator of the Men's Working Group (MWG) from 2008. This position was formerly held by Co-coordinators, Ray Maseko (Swazliand) and Per Gunner Engblom (Sweden) since Oct 2006.
James Achanyi-Fontem is 53 years of age and is a Health Journalist and Communication Consultant. He is also a father of six children (3 Girls and 3 Boys) and a grand father of three (two boys and one girl). All of them were breastfed. As the first son of his family, he was breastfed for 36 months. His grand children were also exclusively breastfed for the first six months.
He worked as a health journalist and broadcaster for 30 years with the Cameroon Radio Television, CRTV before retiring. He is now the National Coordinator of Cameroon Link, an umbrealla registered charity, not-for-profit organisation, involved in the promotion of, community health, humanitarian assistance, socio-economic development, and human rights advocacy created. He is also the current Chairperson of the Cameroon Breastfeeding Protection and Promotion Task Force, the Mutual Health Insurance Group of Bonassama Health District and Coordinator of the Anti-Corruption Committee of the Health District Hospital of Bonassama. He Coordinates the IBFAN Cameroon Group and Fine Forest Foundation Cameroon activities. He is also the Chairperson of the Federation of Cameroon Breastfeeding. He had held the positions of Editorial Advisor and Editor-in-chief of a some five different national tabloid newspapers and magazines from 1984 to 2004. James has been an active member of the Men’s Initiative, contributing to the Regional Snapshots project and through Cameroon Link. He has done a tremendous amount of work on issues surrounding support and training for fathers and families before his appointment as the Internataional Coordinator of the WABA Men’s Working Group.
Since his appointment, James Achanyi-Fontem has initiated a number of ways to get men involved in the protection and promotion of breastfeeding.
Why Involve Men in Breastfeeding?

Breastfeeding is an important part of Infant and Young Child Feeding, Reproductive Health and Nutrition. Reproductive Health biologically involves the man and the woman and the attitudes of men towards breastfeeding strongly influence the mother’s own point of view.
Men are generally one important source of support in mother’s decision to breastfeed and in its successful implementation. There is also a positive connection between the degree of men’s support and the total duration of breastfeeding.
A Men’s Involvement in the breastfeeding situation strengthens his relationship to both the mother and the baby, and helps him to develop his fatherhood role in general. Highlighting the father’s role in more general terms like parenting can broaden the argument for mother support, which is beneficial for both and the baby.

Advantages of a Men’s role in Fatherhood
Acclaimed researchers quote several advantages when both the father and mother are active and engaged in child care, compared to when only one is active. For example:
• Children psychological development and social skills are favoured by communication with committed father and mother.
• Men develop their empathic ability during pre-natal and post natal consultations and during this period, women are generally educated and trained on child bearing.
• A more equal division of responsibilities increases the possibilities for both parents to fill many roles within the family complex, which tend to make them more satisfied with their lives.
• Cultures with committed men to child care have reduced hostility and violence against women.
Men’s Role As Gender Issue
Gender is considering masculinity versus feminity, which is a system of continually evolving social practices that define roles, assigns resources and establishes power relations.
From the above observation, gender roles are dynamic, constructed through social interaction, reinforced and reproduced by social institutions. Gender equity and equality work towards a society where women and men have equal opportunities, rights and obligations in all aspects of life. From a gender perspective, how paid work and care giving are combined, reflects assumptions and norms in the gendered situations of family and work.
Gender researcher (Linda Haas and others) claim that as long as women are assumed to be more responsible than men for child care, especially qs women’s role as mothers will continue to be a major obstacle to their achieving economic and social equality with men. Therefore, fathers’ involvement in child care including breastfeeding is clearly a gender issue.
Enabling Men to be Supportive
Men’s Education
Many men need to be better prepared to assume a role as breastfeeding supporter. Studies have shown that breastfeeding education and promotion programmes have effects on knowledge, attitudes and support for breastfeeding. Evidence suggests that even simple and inexpensive interventions can increase the level of breastfeeding knowledge of men.
It is important that men understand what it means for a woman, both physically and psychologically, to go through pregnancy, delivery and start breastfeeding. Well informed men know the importance of being patient and sensitive as the mothers recover from the baby delivery experience and gain confidence in breastfeeding.
By importing the same knowledge and sharing the breastfeeding moments, the man helps the new mother to gain breastfeeding skills. He can also protect her from misinformation about breastfeeding in the community, or even from friends and relatives. Sharing child care and responsibilities of the life strengthens parental relationship in the difficult period of transition and adjustment.
Most preparatory courses for parents are organized at the pre-natal and post natal units of health facilities. The education is generally of a practical nature and focuses on medical factors of pregnancy, baby delivery and breastfeeding. This important forum involves issues of social and individual changes, and creates space for especially men to reflect on their situation and role. By focusing on and activating men, their role strengthens and they get a wider knowledge, more adjusted to their life situation and thus more useful to them.
Many different ways exist to construct a forum for men, where they can get information and discuss parenthood. The right way to trigger the process depends on the interests and needs of the men’s support group created which we aim at. Men’s groups operate differently a few months before baby delivery and differently thereafter. It is generally easier to reach men before baby delivery compared to a few days and weeks after. The period immediately after baby delivery is the time when most decisions about how the baby will be feed and nourished.
The most crucial step is how you invite men to participate in decision making with their partners. The knowledge and experiences of the resource persons during this period of fatherhood counseling reflects the importance of the information, message and the type of the decision that would be taken. It is important to use well known and accepted channels for specific messages.
To reach men, it might be most appropriate that the counselor is a man, because birds of the same feathers fly together. The counseling forum should be able to address other complimentary issues that men would like to discuss. Most women do not talk when men are around and even some men also do not voice their opinions when women are around.
That is why, it is advised to organize separate counseling sessions for men and women, as well as joint session with equal numbers for both target groups.
Men’s Support Groups
Men need support to be supportive. It is a matter of team work and reciprocity. A man that views himself as a subordinate in his own family and plays his role only out of expectation, does not usually give high quality support due to the lack of confidence.
It is important for women to trust their partners to win their confidence. When a man is confident, he obviously joins his partner in child care sharing of responsibilities. The man should be motivated to understand the advantages of spending time with the baby to encourage attachment, as this is beneficial for the well being of the whole family.
Before becoming a first-time mother, women have the advantage of getting information from counselors or health consultants during the pre and post natal period. Men have a right to this counseling opportunity too, but they are not offered these rights in health facilities due to shortages of staff. This explains why, it is not often expected of men to engage in caring for the new born. WABA Men’s Initiative aims at reversing this situation.
Mother often need time and space for relaxation, especially when the baby is anxious or ill. If baby – father attachment had been encouraged immediately after delivery, the man will help out in such situations. This will allow the mother to be able to be alone during her relaxation period, to rest and regain strength without having to worry about the two others. This procedure requires that the mother is willing to have confidence in the father that he will care for the baby well.
It is also know that breastfeeding can sometimes inhibit fathers from developing close relationship with their children and this has a negative effect on parenthood relations. Most often at this time, men feel excluded, jealous and resentful to the detriment of breastfeeding success and to the relationship between the father and the mother. Helping men to find other ways and situations where they can develop a close relationship with their children will be important and necessary. Men need to be offered the knowledge and support to minimize negative effects in the family due to breastfeeding.
Me also sometimes feel neglected and made disassociated by relatives, friends and even the maternity services. Men should be made to feel themselves as parents and not only like baby sitters or child care takers. The maternity services should develop strategies to improve on this relationship between the couple.
Giving the Right Information
Information can, if delivered in a right way influence men and change their views and behaviour. Engaging with family professionals can impact positively on fathers’ negative behaviour and parenting styles, increase their knowledge and understanding of child development, increase their confidence in their parenting skills, and lead to more sensitive and positive parenting and to greater involvement in infant and child care, and in interaction with children.
Men should be encouraged to be present during delivery by their partners. Their presence during delivery seems to have positive effects on the wellbeing of both the mother and the baby. Having the father nearby during the first hour of labour seems to make it easier for mother to successfully initiate breastfeeding and also seems to positively influence the duration of breastfeeding.
Men’s Attitude towards Breastfeeding
Some men have misconception and negative attitudes towards breastfeeding. To overcome these obstacles, issues of breastfeeding need to be discussed with both men and women during pregnancy and childbirth preparation visits. Health professional should make information available to both the father and mother.
The two most common perceptions with negative attitudes of men is the exposure of the mother’s breast and that breastfeeding will make them less attractive. Actually, there is not much knowledge about why some fathers have negative views about breastfeeding. If we knew more about this, better measures would be taken to correct the situation.
As described above, a mother’s perception of her partner’s attitudes towards breastfeeding influences her choice of infant feeding method. However, she is often wrong about this. Scientific research has shown that men may have more favourable attitudes towards breastfeeding than their partners think.
Postpartum Depression
Postpartum depression is a common affliction which severely can lower women’s incentive to breastfeed and in other ways cause difficulties to babies’ health. If rightly informed, men can be made to care for the psychological health of their partner, as they are likely to know them rather well and notice if there is some serious trouble arising. If necessary, help can be requested through contact with the local breastfeeding counsellor or health consultant.
First-time Fathers
First-time fathers can be seen as a special risk group. They have a difficult time identifying themselves as fathers and surprisingly enough, health professionals tend to neglect them. With young couples, the quality of the relationship between both seems to be the most important factor for high men’s involvement the months after childbirth. This another argument for involving the importance of parenthood in the information offered at the maternity health care centre by professionals.
Learning about Gender Issues
A men’s relation to breastfeeding aims at improving on the environment and perceptions of what their role should be. Traditionally, caring for children is not an important part of the concept of masculinity, as it is the concept of feminity. Gender issues must be discussed and men’s ideas about masculinity must be challenged.
Just like the mother, fathers need knowledge and incentives to be supportive. Attitudes concerning breastfeeding are influenced from all kinds of sources surrounding the family – relatives, friends, practitioners, legislators – and these attitudes can be linked to values of lifestyle and stereotype gender roles. In perspective, breastfeeding should be a concern, not only for the father, but for all men.
Men’s Initiative Activities
1. Breastfeeding Promotion and protection through information and education
2. Parenting interventions focused on Gender Equality Promotion
3. Organization of capacity building training for health professionals on methods to reach, educate and empowerment men and youths on breastfeeding promotion
4. Prepare course tools for gender equality promotion in the context of breastfeeding to transform Men’s Support Groups into Breastfeeding Advocate.
5. Advocate for maternity legislation for the protection of women and child rights to breastfeeding.
6. Encourage women to let their partners know that they approve of their exclusively breastfeeding babies for the first six months with complimentary feeding thereafter, and continued breastfeeding up to 24 months and above.
7. Advocacy for legislature to give more opportunities to engage more in concerns of home and child care, and mothers should be given the possibilities to engage in bread-winning jobs.
8. Encourage the creation of many Men’s Support Groups, especially for assisting infants in vulnerable life situation.
9. Increase the knowledge of fathers of “newly born”, who do not have all the facts necessary for appropriate and adequate child care.
10. Collect information and snap shots for publication in the e-newsletter « Not for Fathers Only » as exchange channel of experiences and promotion of dialogue.
It is recalled that, the World Alliance for Breastfeeding Action (WABA) is a global network of individuals and organisations concerned with the protection, promotion and support of breastfeeding worldwide based on the Innocenti Declarations, the Ten Links for Nurturing the Future and the WHO/UNICEF Global Strategy for Infant and Young Child Feeding. Its core partners are International Baby Food Action Network (IBFAN), La Leche League International (LLLI), International Lactation Consultant Association (ILCA), Wellstart International and Academy of Breastfeeding Medicine (ABM). WABA is in consultative status with UNICEF and an NGO in Special Consultative Status with the Economic and Social Council of the United Nations (ECOSOC).
WABA, PO Box 1200, 10850 Penang, Malaysia
Tel: 604-658 4816 Fax: 604-657 2655
Email: waba@streamyx.com
Website:www.waba.org.my