1. World breastfeeding Trends Initiative: regional perspective Percy Chipepera Chief Programme Office: IBFAN Africa Presented at the 9 th IBFAN Africa regional Conference, Kampala, Uganda

2. What is WBTi? The WBTi is an IBFAN and WABA innovative initiative started in India by IBFAN Asia. It is based on two global monitoring initiatives: The WABA GLOPAR 1993 (global participatory action research for Innocenti) The WHO monitoring tool that was introduced together with the Global Strategy in 2003 to assess national practices, policies and programmes.

3. OBJECTIVES OF WBTi The World Breastfeeding Trends Initiative is designed to assist countries in assessing the strengths and weaknesses of their policies and programmes to protect, promote and support optimal infant and young child feeding practices. It clearly identifies the gaps to help governments, development and implementing partners to commit resources where they are most needed

4. Specifically: To effect assessment of the implementation of the Global Strategy To provide evidence based data for comparison between countries/regions To provide advocacy tool for policy makers and other players To track trends, gauge changes in individual indicators and establish the cause for positive change or non change.

5. The current status in the region A total of 17 countries have completed the assessment and are uploaded on http://worldbreastfeedingtrends.org/country-report- wbti/http://worldbreastfeedingtrends.org/country-report- wbti/ Two more countries, Nigeria and Mauritius are finalising their reports There are 15 indicators that are assessed

6. Scoring for the 5 IYCF Practices

7. Early initiation of breastfeeding The average proportion of babies initiated to breastfeeding within one hour of birth in the 17 countries was 59.4%, with a range from 35% in Sao Tome & Principe to 95.6% in Cameroon. Only Malawi and Cameroon were coded “green” but none of the countries was coded “red”;

8. Early Initiation of Breastfeeding: %

9. Exclusive breastfeeding The average proportion of babies aged 0-6 months exclusively breastfed in the previous 24 hours in the 17 countries was 44%, with a range from 20% in Cameroon to 72.4% in Malawi. None of the countries was coded “green” or “red”;

10. Exclusive breastfeeding

11. Median Duration of breastfeeding (Months) The reported median duration of breastfeeding ranged from 12.5 months in Botswana to 25 months in Ethiopia. Only Ethiopia and Malawi were coded “green” and six countries were coded “red” (Zimbabwe, Cameroon, Swaziland, Lesotho, Cape Verde and Botswana);

12. Median duration of breastfeeding in months

13. Bottle feeding Two countries were coded “red”, Cameroon that reported 75% of infants less than 6 months of age being bottle fed, and Mozambique with 30%. Malawi with 3.8% and Zambia with 3.5% were coded “blue) but none of the countries was coded “green”

14. Percentage of Children bottle fed: percentage

15. Complementary Feeding The average proportion of infants in the 17 countries receiving complementary foods at 6-9 months was 70%, with a range from 30% in the Gambia to 92.8% in Zambia. Three countries were coded “red”, Ethiopia (51%), Botswana (45.5%) and the Gambia (30%) but none of the countries was coded “green”.

16. % of Children 6-9 months receiving Complementary feeding

17. Key for national Programmes and policies: Score out of 10Colour rating 0-3.5Red 4-6.5Yellow 7-9Blue >9Green

18. National Policy, Programme and Coordination: The average total score for the 17 countries was 5.7, with a range from zero for Sao Tome & Principe and Cape Verde to nine for Zambia, Kenya and Ghana. Three countries, (Sao Tome & Principe, Cape Verde and Mozambique with score 2), were coded “red” while the three with Score nine were coded “green”;

19. National Policy, Programme and Coordination: Out of 10

20. Baby Friendly Hospital Initiative: Out of 10 The total average scores from the 17 countries was 4.0, with a range from Swaziland with 8.5 to zero in Sao Tome & Principe, Ethiopia and Cameroon. Five countries were coded “red”, including Lesotho (score 1.5) and Botswana (score 2.5) but none of the countries was coded “green”;

21. Baby friendly Hospital Initiative: Out of 10

22. Implementation of the International Code: Out of 10 The average score for the 17 countries was 6.8, with a range from 2 by Lesotho to 10 by Ghana and the Gambia. The two countries with scores of ten were coded “green” while Lesotho was the only country coded “red”;

23. Implementation of the International Code : Out of 10

24. Maternity Protection: Out of 10 The average score from the 17 countries was 3.2, with a range from eight by Tanzania to score of 0.5 by Malawi. Six countries were coded “red”, including Malawi, Swaziland and Uganda (each score 1.5); Botswana, the Gambia and Sao Tome & Principe (each score 2.5), but none of the countries was coded “green”

25. Maternity Protection: Out of 10

26. Health and Nutrition Care System: Out of 10 The average score from the 17 selected countries was 7.2, with a range from zero in Cape Verde to score 10 in Mozambique. Five countries were coded “green” including Mozambique, Lesotho and Cameroon (each score 9.5), Sao Tome & Principe and Kenya (each score 9). Only Cape Verde was coded “red”;

27. Health and Nutrition Care System: out of 10

28. Mother Support and Community Outreach: Out of 10 The average score for 17 countries was 6.1 with a range from score 8 each in Zimbabwe, Zambia, Mozambique, Lesotho and the Gambia to zero in Cape Verde. Cape Verde was the only country coded “red” but none of the countries was coded “green”;

29. Mother Support and Community Outreach: Out of 10

30. Information Support: Out of 10 The average score for 17 countries was 7.8, with range from score 10 each in Mozambique, Kenya and the Gambia to score 4 in Zimbabwe. Seven countries were coded “green”, including Mozambique, Kenya, the Gambia and Swaziland, Malawi, Lesotho and Cameroon (each with score 9), but none of the countries was coded “red”;

31. Information Support: Out of 10

32. Infant Feeding and HIV: Out of 10 The average score for the 17 countries was 7.8, with range from score 9.5 in Malawi to score zero in Cape Verde. Nine countries were coded “green”, including Malawi and Zambia, Uganda, Swaziland, Sao Tome & Principe, Lesotho, Kenya, the Gambia and Cameroon (each with score 9), but only Cape Verde was coded “red”;

33. Infant Feeding and HIV: Out of 10

34. Infant Feeding During Emergencies: Out of 10 The average score for the 17 countries was 3.9, with range from score 10 in Malawi to score zero each in Swaziland, Sao Tome & Principe, the Gambia and Cape Verde. Only Malawi was coded “green” but six countries were coded “red” including the four with zero score plus Ghana and Botswana, each with score of one; and

35. Infant Feeding During Emergencies: Out of 10

36. Monitoring and Evaluation: Out of 10 The average score for the 17 countries was 6.9, with range from 10 in Sao Tome & Principe to score zero in Cape Verde. Three countries were coded “green”, including Sao Tome & Principe plus Malawi and Ghana (each with score of 9) but only Cape Verde was coded “red”.

37. Monitoring and Evaluation: Out of 10

38. Recommendations: General Countries that have initiated the WBTi process should improve coordination and resource mobilization /allocation in order to adequately address infant and young child feeding policies, programmes and practices Countries that have initiated the WBTi process should plan to conduct re-assessments after 3 – 5 years to determine the trends and review the actions taken Countries that have not yet initiated the WBTi process should begin using the tool for determining their performance

39. Specific Recommendations Re-invigorate BFHI at country level to cover all health facilities that provide antenatal and maternity services Ensure ratification is done, and implementation of the Maternity Protection Convention No. 163 and accompanying recommendations Strengthen integration of infant and young child feeding during emergencies into the existing IYCF policy and disaster management planning Develop comprehensive IYCF policy with operation plans and resources for operationalization Strengthen the community support and outreach programmes into IYCF policy and programmes, including the baby-friendly community initiatives Legislate the International Code and all relevant subsequent WHA resolutions, followed by implementation, including raising of public awareness about the Code Include the IYCF indicators in the national monitoring and evaluation frameworks, including the periodic national surveys Consolidate on the gains made in the areas of Health and Nutrition systems, the Information System, and HIV and Infant Feeding