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Feeding the unborn babies

By Severin Kabakama

Dr Severin Kabakama (MD Dar) is Assistant Project Officer (Early Child Development) in the Western Tanzania Refugee Program, UNICEF Kasulu Field Office. He has worked for twelve years as medical officer in Tanzania (of which 5 year have been spent with the Rwandese, Congolese and Burundian refugee programs in Western Tanzania)

In 1998, UNICEF initiated a supplementary feeding program for pregnant women in the Kigoma/Kagera refugee program of Western Tanzania. The programme which is still ongoing was implemented in order to reduce the prevalence of low birth weight and improve pregnancy outcome. Prevalence of low birth weight in the camps at the start of the intervention was 30% (Low Birth Weight is defined as weighing less than 2500g at birth). The main causes of LBW are malaria, HIV infection, worm infestation and lack of adequate nutrient intake during pregnancy. Women enrolled in the programme are given a dry takehome ration from the second trimester (from 16 weeks gestation age) to delivery. Approximately 30,000 pregnant women in eleven refugee camps are involved in the intervention.

The World Food Program (WFP) provides the supplementary ration while UNICEF through operational partnership with implementing agencies, closely monitors the implementation of the programmes and its outcome.

Ration size and quality

The daily ration comprises 200g of CSB (Corn Soya Blend), 20g of vegetable oil and 20g of sugar per pregnant woman providing a total of 1018 Kcal (38g of protein). This is distributed every two weeks at the nutrition supplementation Unit. In total it is assumed that a pregnant woman receives about 3180 Kcal per person per day if the general ration is included (2100 Kcal1 per person per day from general distribution).

The weighing, mixing and distribution of the supplement is normally carried out by the pregnant women themselves, who have been recruited onto the programme through their attendance at antenatal clinics where verification of gestation age is necessary.

The distribution process

Names are called out by a nutrition attendant with each beneficiary receiving a "premix" for 14 days - about 3.36Kg. As large numbers are always involved (approximately 400 for a camp of 38,000 refugees), a roster for each block/village in the camp is used to avoid congestion and time wasting. Nutritional education (emphasising the nutritional value of the supplementary ration) and cooking demonstrations are frequently conducted at the distribution site.

Main findings and lessons learnt

The programme has contributed to a reduction in low birth weight in the camps. Prevalence of LBW has decreased from 30% to 8.5 - 10% in different camps. These results are similar to a study in Gambia in 1997 where a 50% reduction in LBW was observed after supplementation with groundnut-based high energy biscuits (providing 1000 kcal per person per day).

The success of the program is mainly due to close cooperation between the pregnant women themselves, the service providers at the antenatal clinic and the personnel at the supplementary feeding units.

Added impacts and benefits of the programme

Programme Constraints

Show footnotes

1Comprising of 360g maize meal/grain (410g), 120g pulses, 40g CSB and 20g vegetable oil per person per day (pppd). An additional 50 g of maize is provided to offset the milling costs and wastage totalling 410g pppd.

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Severin Kabakama (2001). Feeding the unborn babies. Field Exchange 12, April 2001. p25. www.ennonline.net/fex/12/feeding

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