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Step up for Breastfeeding

August 3, 2022
Breastfeeding

The World Breastfeeding week 2022 is focused on strengthening the capacity of actors that have to protect, promote and support breastfeeding across different levels of society. Target audiences include governments, health systems, workplaces and communities that ought to be informed, educated and empowered to strengthen their capacity to provide and sustain breastfeeding-friendly environments for families in the post pandemic world. For so long we have focused on promotion of breastfeeding from the angle of families, yet there are major players in this whole chain who determine the success of the promotion of breastfeeding of children. The objective of the World Breastfeeding Week for 2022 is to inform, anchor, engage and galvanise action on breastfeeding and related issues.

According to WABA, the COVID19 pandemic and geopolitical conflicts have widened and deepened inequalities, tipping more people into food insecurities. The limitations to the health system’s capacity has also attributed to the deterioration of breastfeeding support. This is attributed to lack of staff due to illness leaving the remaining few overwhelmed and other tasks shifted to untrained personnel.

It goes without saying that targeted outreach by breastmilk substitutes industry undermine breastfeeding and in-turn influence parents’ infant feeding decisions. I have seen statements like ” Even formula fed babies grow just fine” Whilst this looks like an innocent statement it can be misleading and undermine the immense benefits your baby can get from breast milk.

This year, WABA has come up with the Warm Chain Support for Breastfeeding. Supporting breastfeeding involves many actors and levels. The warm chain support for breastfeeding involves supporting women from the health service, community and workplace to optimally breastfeed, progressing from one level to another. There is urgent need for education to improve and increase the capacity of all actors who work along the warm chain.

Actors in the warm Chain

Health Care Actors

These play an essential role in the support of breastfeeding and as such need a consistent and appropriate evidence based education, both pre-service and in-service training. There is need to fully understand mother-friendly care and Baby Friendly Hospital Initiative (BFHI) so as to implement the health facility policies and specific breastfeeding counselling competencies. Cultural practices and beliefs affect breastfeeding and as such they need to be trained on the International code of Marketing of Breastmilk Substitutes (the Code) to be equipped on how to meet their responsibilities. These health care actors include; breastfeeding councilors, breastfeeding support groups, community health workers, certified lactation consultants, family doctors and general practitioners, midwives and nurses, nutritionists and dietitians, pediatricians, obstetricians, health care administrators and policy markers in the health system.

UNICEF Lao PDR on Twitter: "WHO and UNICEF launched the Baby-friendly Hospital Initiative (BFHI) to help motivate facilities providing maternity and newborn services worldwide to implement the Ten Steps to Successful Breastfeeding.

BFHI

Community actors

These support in national and international advocacy to protect, promote and support breastfeeding. They need awareness in the tactics that Breastmilk substitutes industries use in providing misinformation and unethical promotion on breast milk substitutes. There is need for education on how to support parents and how they can collaboratively work with health care actors to fill in the existing breastfeeding gaps. The community actors include academicians, community members, employers, faith groups, environmentalists, family members and media.

Support for breastfeeding does not start only when the baby is born but starts from conception. During pregnancy and before birth, parents need to prepare for breastfeeding and this is crucial during pregnancy. A lot can change for the better at this stage. Parents need education and anticipatory breastfeeding counselling right from the first trimester during antenatal visits. They ought to know the importance of breastfeeding, it’s health, social and economic benefits. All antenatal staff need to be trained on up to date evidence based information and counselling in order to be in the right position to assist parents. In addition, this is the time to connect parents to community networks for support beyond the health facility.

At the stage of labour and delivery, medical interventions that interfere with both initiation and establishment breastfeeding should be minimised. According to WABA, maternity services often lack a mother friendly care policy or they do not implement the existing policies fully. Poor implementation of the Baby Friendly Hospital Initiative  (BFHI), results in failure of the practice of the early skin to skin contact appropriately, unnecessary separation of mothers and babies as well as initiation of breastfeeding. All this comes at the cost of the mother and child thus the need to ensure that health workers are competent in all these things.

During postpartum care (for the mother) and post natal care (for the Baby) especially in the first six weeks of birth, there is need to teach mothers how to express milk and situations when this might be useful. Safe storage of the expressed milk ought to be taught and fears towards expressing allayed. Health care and community actors require competency to show a mother how to latch her baby and support her especially in the times of a low breastmilk supply.

Covid19 and the increasing geopolitical conflicts have also showed us that there is need to support breastfeeding under special circumstances and/emergencies. Parents need to be taught that breastfeeding can save lives during special circumstances and emergencies. Experts advise that in such circumstances, the order of preferences should be expressed milk from the infant’s mother, breastmilk from a healthy wet nurse or human milk bank or breastmilk substitute, preferably infant formula fed from a cup. The options must be informed based on cultural context, acceptability by mothers and service availability.

It is now your role to identify where in the chain you can support breastfeeding. Whilst the onus falls more on policy makers in the country, we also have to be willing to participate and implement in our areas of influence, whatever that looks like to you.

Let us set up for breasting, educate and support.

Happy World breastfeeding week 2022

See you next Wednesday

 

 

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Nutrition

Hemorrhoids and diet

July 27, 2022
Hemorrhoids

The embarrassment, isolation and shame cannot begin to explain the agony people suffering from hemorrhoids (HEM-uh-roids) also known as piles endure. Extreme pain, itchiness, discomfort and bleeding from the back passage leaves a lot to be desired when dealing with this condition. Daily routines can be greatly affected depending on the severity and sadly many only seek for intervention when it is a bit late because of the shame that it carries with it.

What Are Hemorrhoids? Symptoms, Causes, Diagnosis, Treatment, and Prevention | Everyday Health

What are hemorrhoids?

Hemorrhoids are swollen veins in your anus and lower rectum, similar to varicose veins. Hemorrhoids can develop inside the rectum (internal hemorrhoids) or under the skin around the anus (external hemorrhoids). The signs and symptoms of hemorrhoids usually depend on the type of hemorrhoid, that is to say internal or external. External hemorrhoids are usually characterised by itching or irritation in your anal region, pain or discomfort, swelling around your anus and bleeding. Internal hemorrhoids are usually characterised by painless bleeding during bowel movements and or a prolapsed or protruding hemorrhoid resulting in pain and irritation.

Who is at risk?

Hemorrhoids occur when the veins around your anus stretch under pressure and end up bulging or swelling.

Hemorrhoids are more likely to occur if you:

  • Are pregnant
  • Sit on the toilet for too long
  • Are obese.
  • Have a low fiber diet
  • Do things that make you strain more, such as heavy lifting
  • Have a family history of hemorrhoids
  • Have long-term or chronic constipation or diarrhea
  • Are between 45 and 65 years old

Hemorrhoids: Causes and Risk Factors

Can diet help?

Lifestyle changes have proven to be an effective remedy for hemorrhoids both preventative and lessening of the symptoms. Some people have also managed to escape the knife (surgery) with diet alone. A balanced, high-fiber diet, together with plenty of fluids, softens the stool and increases its bulk, which will help you avoid the straining that can cause hemorrhoids or worsen its symptoms. Together with your doctor and dietician, you will be able to draw out a plan on the management of this condition. I have put down below some of the lifestyle changes you can employ but please remember this is for only information purposes, do not replace this for a diagnosis but reach out to a physician for a proper diagnosis.

Lifestyle changes

You can help prevent hemorrhoids or minimize flare-ups by making simple lifestyle changes:

  1. Drink water


    Drinking plenty of water a day can help reduce the risk of constipation and keep bowel movements soft and easy to pass.

  2. Eat a balanced, high-fiber diet


    Work with your dietician to come up with a balanced diet that is fiber rich, both soluble and insoluble fiber. If you are prone to diarrhea, he or she will be in position to walk the journey with you to reduce the symptoms and avoid it.

  3. Get some exercise


    It goes without asking how exercise is a key part in one’s health. It aids in digestion and tones the supporting muscles of the anal and rectal area as well as the abdomen. Do non strenuous exercise though and be sure to check in with your healthcare provider.

  4. Do Kegel exercises


    For pregnant mothers, kegel exercises are important as they help strengthen the pelvic floor plus anal and rectal muscles after childbirth. This will aid in digestion and prevent constipation. To do a Kegel exercise, tighten your vaginal muscles (as you would if you needed to stop urinating midstream), hold it for a few seconds, release and repeat several times. It’s a discreet exercise you can do almost anywhere.

  5. Maintain a healthy weight


    Extra weight can put more pressure on your abdomen, which increases your chances of getting hemorrhoids. Maintain a healthy weight at all times.

If you do not have hemorrhoids yet, try not to put yourself in a position that would put you at risk. If you have them already, despite the embarrassment it carries, reach out to someone and find yourself some help. Remember it is possible to escape the knife only if you can catch it early.

Best of luck.

See you next Wednesday

 

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Nutrition

Nutrition fact labels

July 20, 2022
Labels

Packed food items often have information that comes with it but I bet many of us do not go past the name of the item and ingredients some times when the food item is new. How many times do you walk into a supermarket or grocery store and care to read the labels before making the decision to buy that food item? Always? Never thought about it? or you don’t think it is important?

At the back of every food packaging there is always labels that ideally should be read by everyone as a determinant for the purchase of that food. That is what we call a nutrition label or food label. Nutrition labels describe the nutrient content of a food and are intended to guide the consumer in food selection. The nutrition information provided must be selected on the basis of consistency with dietary recommendations.

 Food labelling is not only vital but also a legal requirement if you’re a food producer. Understanding food labels helps consumers make informed decisions when purchasing food and helps them to store and use the food they’ve purchased safely.

What is a nutrition fact label?

The nutrition facts label is a label required on most packaged food in many countries, showing what nutrients and other ingredients are in the food. Labels are usually based on official nutritional rating systems. The label breaks down the amount of calories, carbs, fat, fiber, protein, and vitamins per serving of the food, making it easier to compare the nutrition of similar products.

Importance of nutrition labels

Nutrition facts labels tell you about the nutrition of a particular product. This information includes serving size, number of servings in the package, calories per serving and the amount of various nutrients contained in the product. Once you understand the labels, they can help you follow a healthy diet and make it easier to choose the most nutritious foods between two different foods.

You can compare the labels to determine which foods are lowest in calories, fat, saturated fat, trans fat, cholesterol, sodium and sugar. These are the ingredients you should limit for good health. Checking the ingredients list will help you avoid foods that contain additives or other ingredients that you want to avoid. The foods with the fewest ingredients and those that only contain ingredients that you would have in your own kitchen are healthier than those with lots of ingredients you don’t recognize.

Sample Label for Frozen Lasagna

How to understand and use nutrition labels

Servings

Serving Size Sample Label

Serving sizes are standardized to make it easier to compare similar foods; they are provided in familiar units, such as cups or pieces, followed by the metric amount, e.g., the number of grams (g). The serving size reflects the amount that people typically eat or drink. It is not a recommendation of how much you should eat or drink.

It’s important to realize that all the nutrient amounts shown on the label, including the number of calories, refer to the size of the serving. Pay attention to the serving size, especially how many servings there are in the food package. In the sample label, one serving of this particular food equals 1 cup. If you ate two cups, you would be consuming two servings. That is two times the calories and nutrients shown in the sample label, so you would need to double the nutrient and calorie amounts, to see what you are getting in two servings.

Calories

Calories Sample Label

Calories is a measure of how much energy you get from a serving of this food. Remember the number of servings you consume determines the number of calories you actually eat for example, there are 280 calories in one serving of our food above. If you ate the entire package you would have consumed 1,120 calories. (280 calories multiplied by 4 servings)

To achieve or maintain a healthy body weight, balance the number of calories you eat and drink with the number of calories your body uses. 2,000 calories a day is used as a general guide for nutrition advice. Your calorie needs may be higher or lower and vary depending on your age, sex, height, weight, and physical activity level.

Daily Value

Percent Daily Value on Sample Label

The daily value is expressed in percentages. it is the percentage of the Daily Value for each nutrient in a serving of the food. The Daily Values are reference amounts (expressed in grams, milligrams, or micrograms) of nutrients to consume or not to exceed each day. The % daily value shows how much a nutrient in a serving of a food contributes to a total daily diet thus helping you determine if a serving of food is high or low in a nutrient. It saves you the trouble of having to interpret the nutrient numbers by putting it on a scale of (0-100). Therefore the higher the percentage of the daily value of a particular nutrient, the higher you are getting of that nutrient per serving.

Nutrients

Nutrients on Sample Label

This section indicates the key nutrients that impact your health. With this you can be able to look for foods that contain more of the nutrients you want to get more of and less of the nutrients you may want to limit.

When it comes to sugars, unlike before where the label only indicated total sugars, provisions have been made to include added sugars separate because total sugars included even the natural sugars present in the food which can be misleading. 

Saturated fat, sodium, and added sugars are nutrients listed on the label that may be associated with adverse health effects so choose foods that have less of these and emphasize foods with more desirable nutrients like dietary fiber, vitamin D, calcium, iron, potassium e.t.c

I hope this brings us closer to interpreting the nutrition of a particular food you are purchasing. 

In conclusion

According to the Food and Agriculture Organization (FAO), one of the main drivers for nutrition labelling is the increased prevalence of diet-related non-communicable diseases and these labels can be effective instruments in helping consumers to make healthful food choices. To maximize the potential of nutrition labels and health claims to improve public health, awareness campaigns and education programmes should be provided on an ongoing basis to help consumers to understand and use labels appropriately.

Take time to read that label on your favorite food, you will be surprised what you find. A healthy diet is crucial throughout your lifetime and paying attention to nutrition labels is a good step toward improving ones overall diet.

See next Wednesday

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Nutrition

Childhood obesity, the ticking time bomb

July 13, 2022
Obesity

According to the Global Nutrition Report of 2021, Globally, we are off course to meet five out of six global maternal, infant and young children nutrition (MIYCN) targets, on stunting, wasting, low birth weight, anemia and childhood overweight. We are also off course for meeting all diet-related non-communicable disease (NCD) targets, on salt intake, raised blood pressure, adult obesity and diabetes.

Worldwide 38.9 million (5.7%) children are overweight. Child overweight is on the rise, as is the prevalence of adult obesity (12.3% among men and 16.2% among women, compared with  9.2% and 13.2% in 2010). The prevalence of overweight (including obesity) in children and adolescents has increased worldwide, from 17.0% among boys and 15.5% among girls aged 5–9 years, and 14.4% and 13.8% respectively among adolescents (aged 10–19 years) in 2010 to 24.5% (male) and 21.4% (female) among children and 20.2% (male) and 18.4% (female) among adolescents in 2019.

If the numbers do not move you, try going into the supermarkets on a Saturday in Kampala, the sight is worrying. The number of visibly overweight children is disturbing.

Childhood Obesity also known as pediatric obesity is a condition in which a child is significantly overweight for his or her age and height. Obesity in a young age creates a serious risk of type two diabetes, high blood pressure and high cholesterol. I once read a quote that said “If we stuff our children with fast food and cans of soda, do they become ticking timebombs of poor health? Ready to explode at any moment into fully-fledged type two diabetes?“

Lifestyle issues as well as eating habits is most to blame for this. There is need for public health prevention. I like to say we can never speak enough until we see a desirable change. From the moment a child is born parents need to be guided more since it is them who decide what’s eaten in the house. We live in an era where parents have ‘little time’ to prepare healthier meals and opt for convenient foods which are mostly fast foods and highly refined there by increasing the risk of these children to obesity.

Preventing Childhood Obesity - HealthScopeHealthScope

Tips on preventing childhood obesity

Promote a healthy lifestyle

This is the first stop in fighting this battle. Nutrition is such a big determinant of how a child lives and thrives in life. Matter of fact, a compromised nutrition status of a child has long term effects in a child’s life and we emphasize good nutrition for children especially those under the age of five because they are at the peak of their growth. Healthy meals and snacks are important for provision of nutrients for their growing bodies while modeling healthy eating behavior and attitudes.

Children even at a tender age can be given nutrition education and ought to be involved in the process of getting their food onto their plates such that they develop and adopt a healthy lifestyle that they will carry on through out their lives. Include regular age appropriate physical activity in the lives of these children and reduce sedentary activity such as watching television.

Next time when you are packing your child’s lunch box, think better the foods you are choosing to include.

Be a role model

Walk the talk dear parent. Children learn the most be observation. Having healthy meals, participating in regular physical activities will set the stage for your child. Gradually work to change the family’s eating habits and activity levels if you are not doing that already.

If your child is already overweight, refrain from the temptation of putting your child on a diet, they will miss out on key nutrients they require for their growth. Instead of focusing on their weight, turn your attention to changing the undesirable behaviour and the weight will even out as their height increases.

Do not use food as a reward or withhold food as a punishment

The relationship with food just like any relationship is important. Children need to learn how to respect their hunger and fullness cues. They need to learn that people eat when they are hungry and stop eating when they are satisfied. Whenever these cues are overrun, children tend to over eat thus promoting overweight.

Using food as a reward may be a problem as children will fail to eat once a reward is not in view.

Reduce sugar and fat

Refrain from giving children beverages with added sugars and reduce processed foods as these have alot of fat. In addition to increasing the risk of being overweight when children consume beverages with a high sugar content and foods with high fats, they also lose appetite for healthier meals which they need anyway.

Seek medical intervention early

It is important that if you have concerns about your child’s weight, you speak to a physician early. Ensure that your child’s growth in regularly monitored and implement all the things that you are advised to do knowing that it is in the best interest of your child and your wallet.

Share with me some of the ways you using to avoid your child from becoming overweight or if your child is already overweight what are you doing to make the situation better.

See you next Wednesday 

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Nutrition

Maternal mortality

July 6, 2022

Yesterday I woke up to a disturbing story in the New-vision newspaper of Tuesday, 5th July 2022 and this is what it read. “16 mothers die everyday due to negligence, extortion” A story is told of a mother, 23 years of age from Kiboga district who loses her life and that of her new born baby because of lack of platelets at the hospital as well as where she was transferred (Hoima Hospital). The different accounts given of what took place that day are even more disturbing. This is one of the many stories you will hear about maternal mortality in Uganda.

Maternal Mortality

SDG 3-Target 1

Sustainable Development Goal (SDG) 3 target 1 is to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030. According to the Uganda Demographic Health Survey (UDHS), maternal mortality rates refer to the number of maternal deaths per 1,000 women age 15-49.  The number of deaths is the number of sisters reported as having died in the 7 years preceding the survey either during pregnancy or delivery, or in the 42 days following the delivery, by their age group at the time of death. Deaths due to accident or violence are excluded. The maternal mortality ratio for the 7-year period before the 2016 UDHS is estimated at 336 maternal deaths per 100,000 live births. We have only 8 years to reduce this number if we meet our SDG 3 target goal 1. (With our current situation I cannot tell you that I am very confident).

This not only grieves my heart but also freaks me out because that can be me or anyone I know. No one deserves to die giving life for goodness sake neither does a child deserve to die coming to life. Some of the reasons given for these number of deaths in the newspaper article include; lack of infrastructure, gaps in human resources, inadequate supplies and commodities, knowledge and skills gap among health workers to mention but a few. The question for you and I is what can we do?

According to a report on Reducing maternal mortality by UNFPA, almost all cases of maternal mortality are preventable but if this is so, what is failing us and causing so much grief to you and I? A lack of information among many is one of the reasons sighted and if just 2 sentences in this blog will help prevent just 1 mother from dying at their next child birth, my life is more than complete.

Where to start

Teenage Pregnancy | Plan International

Teenage pregnancies

An old saying goes ” Prevention is better than cure”. According to World Health Organisation, The risk of maternal mortality is highest for adolescent girls under 15 years old and complications in pregnancy and childbirth are higher among adolescent girls age 10-19 (compared to women aged 20-24). Teenage pregnancy and motherhood has been a major health and social concern in Uganda for some time.
The 2016 UDHS results showed that 25% of women age 15-19 have begun childbearing; 19% have had alive birth, and 5% are pregnant with their first child. The health, social and economic consequences that come with teenage pregnancies are too undesirable therefore better to prevent than to deal with the consequences. The next you are drawn to a teenager, think about the many things at stake especially for the girl. Do not let the wig and booty fool you. It could be your sister someone is messing with. It can surely wait.

Pregnancy related complications

These may not be completely done away with but something can still be done. Many of these develop during pregnancy and most are preventable or treatable. Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care. These pregnancy related complications include but are not limited to severe bleeding (mostly bleeding after childbirth), infections (usually after childbirth), high blood pressure during pregnancy (pre-eclampsia and eclampsia) to mention but a few.

First and fore most the onus is on you to care for your own life. No one will like or love your life more than your self thus the need to choose you first. Your mother, man or pastor will not do that for you. Dear lady don’t wait to conceive to start on the healthy journey. Some of these complications like severe bleeding, pre-eclampsia can be avoided or at-least their severity reduced if you prepared your body early enough. Pregnancy is an intense period that requires all hands on deck for you to go through it and bring forth healthy life. Take care of your body if you have plans of creating life so that we can avoid or reduce the risk of maternal mortality.

I cannot over emphasize the need for antenatal care. I know of some people who go only to find out the sex of their child and that is it. Why do you do yourself a disservice to this extent? It is in routine antenatal care visits that unwanted pregnancy and other post pregnancy complications can be prevented. Going back to the story I began with, low platelets in the blood can be detected early enough during these visits and early preparations can be done. Yes! I know our hospitals are not doing the best but atleast let us do our part. Remember no one will love your life more than you do. Do not give up the fight. Ask as many questions as you can, even those you consider silly or obvious. It could be the one to save your life and the unborn child.

Kolhapur illegal abortion

Unsafe abortion

According to World Health Organisation, nearly 8 % of maternal deaths worldwide are abortion-related and 99.5% of these occurring in developing regions. In Africa, 99% of abortions are unsafe resulting in one maternal death per 150 cases. It is high time we embraced comprehensive sexuality education to avoid having our girls finding themselves at cross roads that may warranty abortions. Culprits who defile, rape girls and women ought to be seriously apprehended and let us save the mothers of this nation.

These are some of the things I could point out for now, what do you have in mind? Please share with me in the comment section. If you think this is worthy information to pass on to someone for whom it can benefit, the pleasure is all mine.

Thank you for always coming back

See you next Wednesday.

 

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