Infant nutrition in North Iraq

V. Scherbaum, Stuttgart-Hohenheim

The nutritional status of mothers and children in North Iraq was evaluated with special regard to the inclusion of infant formula into the general food ration.

Since 1996, the World Food Programme has been responsible for the distribution of food aid to the northern regions, as provided by the Government of Iraq under the UN-SCR 986 distribution plans. The distribution of infant formula has increased from 1.8 kg to 3.6 kg per month since 1996. A recent UNICEF survey in Northern Iraq has found a high percentage of bottle-fed infants (64 %), i.e. a 25 to 30 % increase since August 1996. Correspondingly, exclusive breastfeeding rates have been low; at present 7 % of infants aged 0-6 months are exclusively breastfed. This is also due to the fact that the medical staff has no adequate knowledge of breastfeeding management and counselling issues.

According to information from beneficiaries, the distribution of infant formula is inadequate in several aspects. For example, infant formula No. 1 (suitable from birth to 6 months), No. 2 (follow-on formula, six months onwards) and Cerelac (a commercial complementary food) are distributed on a monthly basis to each infant during the first year of life, irrespective of his/her age. Instructions on the infant formula tins are written in English and Arabic only and not in Kurdish language; 51% of the women in Northern Iraq are illiterate anyway. If the mothers do not know the differences in the composition of various breast milk substitutes, or have no possibility of exchanging the tins with neighbours, infant feeding is very likely to be inadequate.

Infant formula in the food basket prevent mothers from breastfeeding. Breast milk substitutes are frequently mixed with (unclean) water available in limited quantities and handled under extremely hot conditions. Consequently, bottle-feeding coupled with inadequate (clean) water supplies is one of the reasons for infant malnutrition, morbidity and mortality, especially in risk groups (displaced people and returnees) living in remote areas with limited access to medical institutions.

Reports of health institutions suggested a correlation between severe malnutrition among infants and the prevalence of bottle feeding in Northern Iraq. Visits to four different paediatric wards revealed inadequate management of severe malnutrition, such as e.g. lack of therapeutic milk and modified oral rehydration solution during the initial stage of treatment and insufficient knowledge of the rehabilitation phase. Mothers, furthermore, usually continue to offer mixed or bottle-feeding during their stay in the paediatric wards as they had done before admission.

Accordingly, strategies to protect and support breastfeeding are urgently needed. The indiscriminate distribution of infant formula has to be stopped. Breast milk substitutes should only be supplied to infants in whom the individual need has been diagnosed. The medical personnel must be instructed in the fields of promotion of exclusive breastfeeding and management of severe malnutrition. EU12/03

Keywords: Infant nutrition / North Iraq / nutritional situation / children / mothers

Sie finden den Artikel in deutscher Sprache in Ernährungs-Umschau 12/03 ab Seite 476.