Perspectives from Women in Bonsaaso on Nutrition Interventions
Written by: Uyen K Huynh & Meena Lee
In Bonsaaso, Ghana, it is common practice to feed newborn babies water. Water in this district can be infected with rotavirus, which can cause dangerous bouts of diarrhea in newborns, exacerbating Bonsaaso’s malnutrition problem. Changing long-held beliefs – even beliefs that negatively impact community health – can be difficult, but the Millennium Villages Project (MVP) has adopted a number of innovative behavior-change initiatives to tackle malnutrition.
Educating mothers on safe ways to feed children, particularly newborns, is a core feature of MVP’s maternal and child health interventions. This is especially emphasized during antenatal and postnatal periods. Teaching new mothers takes place both at the Bonsaaso clinics, as well as in homes by Community Health Workers (CHWs). During prenatal visits, the women receive training on how to feed their child after birth. They are also instructed to give birth in a clinic or hospital where they will have access to trained midwives and medical technologies should complications arise. New mothers are also taught how to take care of themselves and track their child’s development.
“In the home [prior to receiving antenatal care], you’re pregnant and you want to take care at home. [You take] lots of local medicine—boiling leaves, drink it, and use it for animals and all that,” said a woman interviewed at Tontokrom Health Center in Bonsaaso as part of a focus group on institutional deliveries. “In the hospital, they give you education on how to handle yourself, what kind of food to eat,” she contrasted.
Women in the Bonsasso region have stated that before receiving antenatal care, they thought it was acceptable to feed her newborn water for the first six months, and food within the first four to five days. Now, through the MVP initiative, they have learned the correct way to feed her child – six months of exclusive breastfeeding, followed by the introduction of local foods such as porridge with beans and soup flavored with fish.
Expanding the skills and providing necessary equipment for CHW program has been critical improving maternal and child health. CHWs are trained government volunteers who provide basic healthcare assistance and advice in rural areas where healthcare centers and clinics are sparse. Visiting households monthly, they take measurements, provide basic information such as better feeding practices and how to treat diarrhea, and make referrals to hospitals for more serious health concerns. MVP’s support towards the CHW program has been to train, supervise them, as well as, provide them with tools that include smart-phones which enable them to track and monitor pregnant women and children.
Before MVP’s arrival, no functioning CHW system was in place in the Bonsaaso region. As of 2011, MVP had trained and hired 38 CHWs, many of whom came from the local villages. MVP negotiated a CHW salary paid for by the government, while agreeing to pay additional monetary incentives. This has helped to retain many trained and qualified CHWs.
In many of the villages in the Bonsaaso cluster, the CHWs employ the mid-upper arm circumference (MUAC) tracking system, which easily diagnoses malnutrition. The nutrition team in Bonsaaso has encouraged the CHWs to take MUAC measurements during their home visits because it is often inconvenient for mothers to travel to the clinic.
One CHW stated, “Before we had MUAC tapes, we asked children to come to the clinic and get weighed. But those that would come usually didn’t have any nutritional problem. It was the children who couldn’t make it to the clinic…these are children who are most at risk.”
Another CHW stated, “I know some CHWs do not always visit the households they are supposed to visit, especially during the rainy season when it is hard to reach the homes.”
MVP is working to fix such standardization issues in healthcare practices, which are due largely to the vast geographical spread of villages in the Bonsaaso cluster, but MVP has seen great progress when it comes to overcoming long-held community beliefs – as can be seen from the results of a focus group held on nutrition.
A translator for the female participants of the focus group said, “When they give birth to the newborn babies, the grandparents of the babies want to give the babies water. They [the women] don’t believe in that.” This anecdotal evidence suggests a generational shift in behavioral practices relating to child nutrition in Bonsaaso, which we believe will have positive health benefits for the community.