Globally, malnutrition is the underlying cause of an estimated 35 per cent of deaths of children under five years of age.
In Cambodia, malnutrition affects the majority of children under the age of five. It is caused by the inability to afford nutritious food, high rates of infectious disease and inappropriate feeding practices. The consequences of malnutrition are severe: it is one of the top underlying causes of child mortality and morbidity in Cambodia and its lasting repercussions continue into adulthood, impairing both mental and physical development that results in poor performance in school and limited opportunities for work in later life.
Malnutrition’s visible impact can be seen across Cambodia. Roughly 40 per cent of children age five and under are too small for their age and another 28 per cent are underweight. A smaller, though troubling, 11 per cent of children are wasted (thin). Cambodian women are equally susceptible to malnutrition, with 19 per cent of women between 15 and 49 considered too thin – a situation that increases risk for complications during birth and leads to low birth weight of their babies.
Although great strides have been made in breastfeeding promotion, recommended levels of complementary feeding practices are extremely low and remain an important contributing factor to the high rates of malnutrition in Cambodia. Proper understanding of what and how to give complementary food to children is very important, particularly for those aged six months to 24 months.
Complementary foods are rarely introduced at the correct age of six months. In most cases, mothers start weaning when the baby is four months old, and some mothers wait longer than six months. The complementary foods which are typically provided are lacking in protein, fat, vitamins and minerals.
Mothers and caretakers play a very critical role in making sure that children receive appropriate complementary feeding (with a focus on a variety of ingredients and thickness of porridge). In order to achieve this, there is a need to develop an effective national communication strategy to promote appropriate complementary feeding practices in Cambodia
In April, the National Centre for Health Promotion and the National Maternal and Child Health Centre in close collaboration with the United Nations Children’s Fund (UNICEF) and other development partners launched a communications for behavioural impact campaign to promote complementary feeding in Cambodia.
Financially supported by Spain through the United Nations Millennium Development Goals Achievement Fund and USAID, the campaign will contribute to improving the nutritional status of Cambodian children by increasing the rate of appropriate complementary feeding practices of infants and young children age six months to 24 months.
Ultimately, implementing infant and young child feeding activities will contribute to the reduction of child malnutrition and will accelerate achievement of the Millennium Development Goals one and four, eradicate extreme poverty and hunger; and reduce child mortality respectively.
What can women do to improve nutrition?
It is important for women to realise that the nutritional status of their child largely depends on their own nutrition before, during and after pregnancy; as their nutrition has an impact on their child’s nutrition. Once pregnancy is suspected, it is important for women to confirm their pregnancy as quickly as possible. Once confirmed the pregnant woman should eat more, take iron tablets, and start monitoring her weight gain.
Deficiencies of iron and zinc are among the top public health concerns in the country, and for some people, iron tablets can cause side effects such as nausea or black coloured stools. However, side effects can be reduced by taking the tablet at night and after a meal. During pregnancy a woman needs around 400 extra calories every day; this is roughly equivalent to one extra meal each day.
Ideally, weight gain should be tailored for the individual. There is no specific rule for weight gain during the first three months because of individual variation, but during the last six months a general rule is that a woman should gain at least one kilo per month. For the whole pregnancy, it is normal to gain eight to12 kilos.
After the birth of the child, the mother should start breastfeeding immediately and continue taking micronutrient tablets. Although some mothers believe they can’t breastfeed or do not have enough breast milk, this is very rare. If the child is positioned correctly to breastfeed, nearly all mothers have plenty of breast milk. Until six months of age, children only need breast milk for good nutrition.
Avoiding giving tea, water, or other drinks and foods also avoids germs that can make a child sick. This is important healthy behaviour for good nutrition of children because it reduces illness and breast milk contains many healthy substances that are not found in infant formula or other milk products.
In Cambodia the 2005 Law on Marketing of Products for Infant and Young Child Feeding restricts marketing of infant formula, including prohibiting doctors and nurses from promoting infant formula or giving samples to their patients. The law is not always followed.
It is important for mothers to know that breast milk is best and that feeding infant formula puts their child at a higher risk of dying before age five and of developing chronic disease such as diabetes later in life.
At six months of age, additional food is needed, but it is recommended for a mother to continue breastfeeding until the child is two years old. When additional food is started at six months, it is important for parents to know that rice is not enough for good nutrition. Different foods, such as fish, eggs, meat, oil, vegetables and fruit, should be added over time to make sure that children get the calories, vitamins and minerals that they need for good nutrition.
Many children older than six months get too little or not the right complementary food because parents lack knowledge or cannot afford nutritious food. Hidden hunger in the form of micronutrient deficiency is an added risk to children. Although the majority of children now receive vitamin A supplements an increase from 29 per cent in 2000 to 71 per cent in 2010, those who do not receive the supplement face an increased risk of child mortality or blindness. Meanwhile, 55 per cent of children and almost half of women of reproductive age are anaemic.
Good nutrition will help a child to recover quickly from illness. If a child has diarrhoea or other common illnesses it is important to keep breastfeeding and keep giving the child food. This may be difficult because illness affects a child’s appetite, but giving more food and liquid during sickness promotes recovery and maintains good nutrition.
After birth, parents should also start monitoring the weight gain of their child. As with a pregnant woman, child weight gain should be individualised because there are differences between girls and boys and all children will gain weight differently, but some general guidance include:
From birth, a child’s weight should almost double after the first three months and double again around two years of age.
At one year the child should weigh around 9 kilos. If a child is not gaining weight, parents should seek care from a trained health provider such as a doctor or nurse. Finally, increased attention to sanitation and hygiene, especially regular hand-washing, can help to ensure good nutrition of children.
For more information about complementary feeding practices in Cambodia, please contact UNICEF nutrition specialist Joel Conkle at [email protected]