At the 2016 CCIH Annual Conference, Kate Reinsma of the Cameroon Baptist Convention Health Services discusses the organization's program to improve nutrition among mothers and children.

1. “MY TESTIMONY IS THE GROWTH OF MY BABY”:THE EFFECTIVENESS AND
ACCEPTABILITY OF THE NUTRITION IMPROVEMENT PROGRAM ON INFANT AND
YOUNG CHILD FEEDING AND NUTRITIONAL STATUS
CAMEROON BAPTIST CONVENTION HEALTH SERVICES NUTRITION IMPROVEMENT PROGRAM
KATE REINSMA,¹ NKUOH GODLOVE,2 PIUSTIH3
1 NUTRITION ADVISOR, CAMEROON BAPTIST CONVENTION HEALTH SERVICES
2 PROGRAM SUPERVISOR,CAMEROON BAPTIST CONVENTION HEALTH SERVICES
3 DIRECTOR,CAMEROON BAPTIST CONVENTION HEALTH SERVICES

2. ACKNOWLEDGEMENTS
 Nutrition Embedded Evaluation Program (NEEP)
team (PATH, DFID)
 Data collectors
 NIP Staff
 Participants

3. INTRODUCTION
 International consensus is building to address
maternal and child under nutrition since sluggish
improvement is an underlying factor in the
diminished achievement of the Millennium
Development Goals 4 and 5, Reducing Child
Mortality and Improving Maternal Health, and
economic development.1
 In 2010 the Scaling Up Nutrition (SUN)
network emerged and in 2012 the World Health
Assembly endorsed a Comprehensive
Implementation Plan on Maternal, Infant and
Young Child Nutrition
1Shrimpton R, Hughes R, Recine E, Mason JB, Sanders D, Marks GC, Margetts B: Nutrition capacity development: a practice framework. Public Health
Nutrition 2014, 17(03):682-688.

4. NUTRITION AND SUSTAINABLE DEVELOPMENT GOALS
 2.1 by 2030 end hunger and ensure access by
all people, in particular the poor and people in
vulnerable situations including infants, to safe,
nutritious and sufficient food all year round
 2.2 by 2030 end all forms of malnutrition,
including achieving by 2025 the internationally
agreed targets on stunting and wasting in
children under five years of age, and address the
nutritional needs of adolescent girls, pregnant
and lactating women, and older persons2
2https://sustainabledevelopment.un.org/?page=view&nr=164&type=230&menu=2059

5. INTRODUCTION
 Despite the renewed international
focus on nutrition, little attention is
paid to nutrition capacity development
 It is estimated that 2,000 trained
nutrition professionals are needed for
the West African Region, but currently
there are only 7003
3Sodjinou, R., et al., A systematic assessment of the current capacity to act in nutrition inWest Africa: cross-country similarities and differences. Global Health
Action, 2014. 7: p. 24763.

6. INTRODUCTION: CAMEROON BAPTIST CONVENTION HEALTH
SERVICES
 The Cameroon Baptist Convention Health
Services (CBCHS) is a nonprofit, faith-
based healthcare organization
 It comprises 6 hospitals, over 25
integrated Health Centers, and 50 primary
Health Centers in 6 of Cameroon’s 10
regions
 The mission of CBCHS is to provide care
to all as an expression of Christian love
with the overall purpose of bringing others
to God through Jesus Christ

7. BACKGROUND OF PROJECT
 Since 2007 the Cameroon Baptist Convention
Health Services’ (CBCHS) Nutrition Improvement
Program (NIP) has trained over 40 Nutrition
counsellors and integrated into Prevention of
Mother-to-ChildTransmission (PMTCT) of HIV
programs, infant welfare clinics (IWC), and
antenatal clinics to improve infant and young child
feeding (IYCF) practices.
7

8. BACKGROUND OF PROJECT
In 2012 the World Health Assembly endorsed a Comprehensive Implementation Plan on Maternal,
Infant andYoung Child Nutrition which included 6 global targets or goals namely:
 40% reduction of stunting in children younger than 5 years.
 50% reduction in prevalence of anemia in reproductive-aged women
 30% reduction in annual incidence of low-birth weight
 No increase in childhood overweight
 Increase rate of exclusive breastfeeding(EBF) until 6 months postpartum to at least 50%
 Reduce and maintain childhood wasting to <5%.

9. SPECIFIC OBJECTIVES
 Determine the effectiveness of infant feeding counseling by comparing the proportion of
wasted and stunted children at NIP sites and non-NIP sites.
 Determine effectiveness of IYCF by comparing exclusive breastfeeding (EBF) and
complementary feeding (CF) practices between caregivers at NIP sites and non-NIP sites.
 Explore the acceptability IYCF counseling among caregivers and nutrition counselors
through focus group discussions (FGDs).

10. STUDY AREA AND TARGET POPULATION
 Northwest and Southwest Regions of
Cameroon
 Rural and Urban Health Centers
 760 Caregivers with children:
 0-5 months (130)
 6-8 months (630)
10

11. METHODS
 Cross-sectional, mixed-method evaluation design
 Caregivers completed a survey to determine EBF
and CF practices and their children’s weight and
height.
 Using systematic random sampling, caregivers were
recruited from NIP sites (n=359) and non-NIP
sites (n=424) at IWCs in the Northwest (NWR)
and Southwest Regions (SWR) of Cameroon
between October 2014-April 2015.
11

12. 968
Caregivers
Interviewed
109
Caregivers
not eligible
769
Caregivers
eligible and
questionnaire
administered
354
at NIP Sites
Infants 0-5
months: 61
Infants 6-8
months:
293
415 at Non-
NIP Sites
Infants 0-5
months: 75
Infants 6-8
months: 340
199
Inaccurately
completed
surveys
Data
Collection

13. METHODS
 Differences in EBF and CF practices and
children’s linear growth between NIP and
non-NIP sites were determined using chi-
square and logistic regression
 FGDs in the NWR and SWR of Cameroon
(4 with caregivers, 2 with nutrition
counselors, N=68) measured acceptability of
nutrition counseling 13

14. RESULTS OF INFANT FEEDING SURVEY
27.2
27.33
27.52
27.15
26
26.5
27
27.5
28
NIP: 0-5 months non-NIP: 0-5 months NIP: 6-8 months non-NIP: 6-8 months
Mean Age of Caregivers

15. RESULTS OF INFANT FEEDING SURVEY
11.74
10.44 10.29
11.12
9
10
11
12
13
NIP: 0-5 months non-NIP: 0-5 months NIP: 6-8 months non-NIP: 6-8 months
Mean Years of Education

16. RESULTS OF INFANT FEEDING SURVEY
0
10
20
30
40
50
60
70
80
90
100
NIP: 0-5 months non-NIP: 0-5
months
NIP: 6-8 months non-NIP: 6-8
months
0.3
16.7
1.3
24.7
1.2
83.3
98.7
74.9
98.8
Religion
Other
Muslim
Christian

17. RESULTS OF INFANT FEEDING SURVEY
0
5
10
15
20
25
30
35
40
45
50
NIP: 0-5 months non-NIP: 0-5
months
NIP: 6-8 months non-NIP: 6-8
months
16.4
1.3 2.4 0.9
11.5 13.3
9.6
13.9
9.8
16
9.6
17.2
29.5
41.3
31.1
47.3
32.8
28
47.4
20.7
Occupation
Health worker
Student
Civil Servant/Business
Self-employed
Housewife/Farmer

18. RESULTS OF INFANT FEEDING SURVEY
21.88
[VALUE]*
29.59
[VALUE]*
0
5
10
15
20
25
30
35
NIP: 0-5 months non-NIP: 0-5 months NIP: 6-8 months non-NIP: 6-8 months
Number of Months Planning to Breastfeed
* Significant difference between caregivers at NIP and non-NIP sites, p< .05

19. RESULTS OF INFANT FEEDING SURVEY
[VALUE]*
56
0
10
20
30
40
50
60
70
80
90
100
NIP: 0-5 months non-NIP: 0-5 months
Exclusive Breastfeeding
*Caregivers at NIP sites are 6 times more likely to exclusively breastfeed compared to caregivers at non-
NIP sites, even after adjusting for differences in occupation, religion, and number of months planning to
breastfeed (X2= 19.2, p<.00, OR=6.78).

20. RESULTS OF INFANT FEEDING SURVEY
71
68.2
63
64
65
66
67
68
69
70
71
72
73
NIP: 6-8 months non-NIP: 6-8 months
Complementary Feeding

21. RESULTS OF INFANT FEEDING SURVEY
21.3
34.7
12.6
[VALUE]*
0
10
20
30
40
50
60
NIP: 0-5 months non-NIP: 0-5 months NIP: 6-8 months non-NIP: 6-8 months
Nutritional Status: Stunting
*Children 6-8 months at non-NIP sites are 5 times more likely to be stunted compared to children at
NIP sites, even after adjusting for differences in occupation, religion, number of months planning to
breastfeed, rural environment, attending other InfantWelfare Clinics, and non-biological caregiver
(X2=92.08, p<.00, OR=5.4)

22. RESULTS OF INFANT FEEDING SURVEY
[VALUE]*
0
2.7 2.6
0
1
2
3
4
5
6
7
8
9
NIP: 0-5 months non-NIP: 0-5 months NIP: 6-8 months non-NIP: 6-8 months
Nutritional Status: Wasting
*Significantly more children wasted at NIP sites compared to non-NIP sites (X2=4.27, p=.04)

23. FOCUS GROUP DISCUSSIONS (FGDS)
 FGDs in the NWR and SWR of
Cameroon (4 with caregivers (N=49), 2
with nutrition counselors, N=19)
measured acceptability of nutrition
counseling.

24. NUMBER OF FGD PARTICIPANTS
17
11 11
10
0
2
4
6
8
10
12
14
16
18
SW Urban SW Rural NW Urban NW Rural
Number of Participants
FOCUS GROUP DISCUSSION PARTICIPANTS

25. FOCUS GROUP DISCUSSION PARTICIPANTS
28
29 29
28
27
27.5
28
28.5
29
29.5
Mean Age of Participants
SW Urban SW Rural NW Urban NW Rural

26. FOCUS GROUP DISCUSSION PARTICIPANTS
5
4
7
4
0
1
2
3
4
5
6
7
8
Mean Age of Children in Months
SW Urban SW Rural NW Urban NW Rural

27. FGD WITH NUTRITION COUNSELORS
11
1.3
7
1.7
0
2
4
6
8
10
12
Number Average Years Working
NW Counselors SW Counselors

28. THEMES FROM FOCUS GROUP DISCUSSIONS
Two themes emerged that influence acceptability of IYCF counseling:
1. Respect for nutrition counselor
 Professional
 Available
2. Positive experience with following advice
 Child is healthy
 Coincides with other previous experiences
28

29. SHELBY’S STORY
 Received nutrition counseling right
after delivery at the maternity and IWC
 “There is a significant difference
between Shelby and her other children
being that she is strong and very
healthy, intelligent, smart and hardly
consults in the hospital.”

30. IMPLICATIONS
 Training a cadre of nutrition counselors and
integrate them into hospital servcies (maternity,
ANC, IWC, PMTCT) is an effective and
acceptable method to improve human capacity to
meet theWHA, SUN, and sustainable health goals
30