1. Maretha le Roux INP Manager
Developing best practices and overcoming challenges: “The Northern Cape experience”
Maretha le Roux
INP Manager

2. Outline Geography Demographics EBF in the NC Methodology Results
Conclusions
Acknowledgements

3. Geography

4. Districts 26 Sub-districts 17 Hospitals 33 CHCs 136 PHCs 57 Dietitians
20 Ass nutr

5. Demographics Indicator Value Under 5 population 112 975 Stunting
*DHIS
Stunting
22.8% boys; 15% girls
*Shisana et al. 2013
Low Birth Weight rate
20%
Teenage pregnancy rate
10%
Fetal Alcohol Syndrome
12% in De Aar; 7% in Upington
*Urban et al. 2008
Vitamin A deficiency
5,8 %
*Faber et al. 2015

6. EBF rates at 14 weeks in NC
*DHIS

7. EBF 4-8 weeks postpartum – 12/13 SAPMTCT report

8. Methodology 2014 MNCWH&N Mid-term review facility tool
Semi-structured interviews were conducted
Open ended questions – antenatal and postnatal mothers

9. Results Strong leadership and champions for nutrition
Dietitians & nutritionists in key positions
Chief dietitians report to DM
Ownership & accountability
Technology – w/app groups
Paediatrician & interns trained
DCST available in advisory
capacity

10. Results (cont) Committed managers Regular INP meetings
Perinatal meetings at facilities & districts
Trainings ongoing
Teamwork also other allied health workers
PHC regularly visited
Strong referral system
Model “moms”

11. Results (cont) Tshwane Declaration
Removal of formula from PHC facilities
Clinicians, PN and CHW support
Dietitians issue formula
MBFI (50%)
ANC checklist
KMC
HMB (2) with satellites (11)

12. Results (cont) Consistent and simplified messages
“only” vs “exclusive”
Mothers receive the
same message
Displayed
IEC material

13. Conclusions Quality & coverage of IYCF counselling
Strong nutrition staff component
Functioning referral systems
quality and coverage of IYCF and PMTCT counselling in the NC was found to be good and resulted in high EBF initiation rates. The presence of seven MBFI-accredited facilities and milk banks support the initiation of EBF even in LBW and very LBW infants. The strong nutrition staff component together with EBF “champions” in the NC

14. Acknowledgements UNICEF - Dr. A Feeley & Ms. R. Rasool
NMMU - Dr. L. Steenkamp
PATH – Ms. H. Mabasa
National DoH – Ms. A. Behr
NC DoH - Staff