Watching children grow in Senegal

In the village of Affé in northern Senegal, community health worker Ndèye Sock, right, discusses feeding habits with a mother, Atta Diaw Niang, to agree on ways to increase the weight of her child. Photo by Babacar Niang, BASICS/USAID

Malnutrition is a serious issue in Senegal: 22% of children under the age of five are stunted, and 20% are underweight. In response, USAID’s BASICS project, in partnership with the Ministry of Health and non-governmental organizations, helped set up essential nutrition activities and growth monitoring as a national strategy. Its success has caught the eye of national health officials.

Traditionally, growth monitoring involves weighing infants and children under three years old each month, plotting their weights on a chart, and advising mothers on improved feeding when the child’s growth pattern falls below an acceptable range. The Government of Senegal currently provides these services to children under three in 34 districts, covering 20% of the population.

Recently, however, research has shown that it is much more difficult for children who fail to achieve normal nutritional status by age two to achieve it later in life, so growth monitoring has less benefit after three years of age. And mothers do not always respond well to standard feeding advice, often finding it overwhelming.

In light of these findings, USAID, through its BASICS project, developed a “community-based growth promotion” pilot project to enhance growth monitoring in Senegal by focusing all efforts on children younger than two years; using minimum weight gain rather than the pattern of the growth line as the trigger for intervention; negotiating simple changes in feeding practices with mothers rather than promoting more complicated feeding approaches; and engaging the entire community to ensure proper child growth. In fact, it is the communities who support the volunteer health workers who carry out the growth monitoring.

Community health workers first ask mothers of underweight children about current feeding practices and health problems. Then they discuss simple options, such as breastfeeding two extra times each day. Together, the mother and the volunteer “negotiate” a written agreement for one new action, and at the next monthly weighing session the volunteer reviews this agreement to see if the mother was able to follow-through on it. If the child’s growth recovers, the mother takes pride in her own success and ability to respond to her child’s needs. If the mother could not keep the agreement, workers help her find other options.

In Senegal, community-based growth promotion was introduced in the areas surrounding the health post in the village of Affé, in the Louga region. After only 12 months, the pilot showed impressive results: more than 90% of mothers regularly brought their children for weighing; 70% of children showed adequate weight gain each month; and malnutrition decreased by 37% among children younger than two years of age.

One mother stated that she noticed improvements in many of the children in Affé as a result of the community-based growth monitoring. “Many babies were very thin when they were enrolled, and are now big,” she said.

The community-based approach also produced other important benefits for child health in the communities. For example, frequent counseling had the result that more than 95% of mothers recognized “danger signs” for serious illness, and the proportion of pregnant women who attended the recommended three antenatal visits increased from 3% to 62%.

The pilot is now expanding to eight districts in Senegal. Its overwhelming success also caught the attention of the national nutrition program, which has decided to introduce the community-based growth promotion concepts on a national scale in February 2006.