A team from the Ministry of Public Health went for a training of 30 health workers on essential care of the newborns with a great emphasis on exclusive breastfeeding. This was the occasion to gather Information on the perceived barriers to exclusive breastfeeding and the solutions to improve the uptake. The participants came from 4 health districts: Batouri, Delele , Bertoua and Kette.

1. BARRIERS TO EXCLUSIVE BREASTFEEDING
AND STRATEGIES TO IMPROVE THE UPTAKE
IN THE EAST REGION OF CAMEROON
Adidja AMANI, MD MPH
Fulbright Alumnus
Performance-based Financing
Healthworkforce development
IYCF specialist, EBF advocate
Head of Child Health Service
Ministry of Public Health- Cameroon
MAY 2015

2. Background:
Neonatal mortality in Cameroon accounts for about
50% and 26% of infant deaths and child respectively
(DHS, 2011) furthermore, neonatal mortality rate
increased from 41 to 29 and 31 deaths per 1,000 live
births in 1998, 2004 and 2011 respectively.
According to the Lancet Child Survival Series 2003,
breastfeeding is the single largest impact on infant
mortality of all preventive interventions. The Ministry
of Public Health of Cameroon recommends that
infants be exclusively breastfed until the age of six
months; however, the exclusive breastfeeding rate is
very low in Cameroon, 20% (DHS‐MICS 2011),
moreover 52% of breastfed children received foods before the start of breastfeeding.
Improving the duration of exclusive breastfeeding is a national and international
priority.
A team from the Ministry of Public Health went for a training of 30 health workers on
essential care of the newborns with a great emphasis on exclusive breastfeeding. This
was the occasion to gather Information on the perceived barriers to exclusive
breastfeeding and the solutions to improve the uptake. The participants came from 4
health districts: Batouri, Delele , Bertoua and Kette.
The Objective
The objective of the exercise was to understand the barriers and determine strategies
to create a higher demand for exclusive breastfeeding (EBF).
The methodology used to collect the data was participative. In depth interviews was
applied on specific aspects.
Figure 1 : A map of Cameroon with a
red crescent depicting the refugees
zones . Source: UNHCR 2015

3.
ASSESSMENT OF THE BARRIERS TO EXCLUSIVE BREASTFEEDING IN THE EAST
REGION OF CAMEROON
The East Region is the largest of all regions of Cameroon but in terms of density, it is
the least populated. Its population is estimated at 873,891 inhabitants distributed in
14 health districts. Currently, the East region of Cameroon hosts the largest number of
Central African refugees (UNHCR, 2015) including 60,000 people from the Mbororo
tribe.
Figure 2: Health workers during the practical session Figure 3 Overview of participants during a presentation
The main obstacles were cited by order of priorities and included:
• Rejection of colostrums. The yellowish appearance of colustrum was
associated with ibeing “dirty”, spoiled and tainted, because it has stayed for
long in the breast. The first action is to extract it and throw it away to allow the
“cleaning” of the breast. This practice is mostly done as soon as the woman
delivers, independently of whether the delivery happens in a health facility or at
home. The act of expressing the colustrum and throw it, is usually performed by
elderly women, in particular mother in laws. Meanwhile the newborn is given
sweetened water.
• The perceived insufficient breast milk supply is one of the most commonly cited
reasons for early cessation of breastfeeding and early introduction of
complementary foods;
• A perceived state of malnutrition of the mother. It is believed both by health

4. workers and mothers as the main cause of insufficient milk and the reason for
discontinuing breastfeeding. Green vegetables (“kakko”) and cassava porridge
“kammo”) are given to the newborn as replacements to give him “strength”
• Competing priorities. Breastfeeding is not a priority and is perceived as a
stumbling block to income generating activities and particularly farming. None of
the 30 health workers knew about the method of pumping, expressing and storing
breast milk as a strategy to continue breastfeeding in lactating socio‐economic
active women
• The belief that milk is poisoned especially when there is a history of previous
neonatal deaths and therefore not breastfeeding is believed to save the live of
newborns.
• For the Bororos of the Central African Republic (a tribe of shepherds nomadic
cattle‐herders ), it was reported that prefer to feed cow milk to their newborn;
the cow milk is perceived to be richer than breastmilk;
• In urban areas of the East region and particularly in Bertoua, practicing formula
feeding is perceived as a good indicator of a high social status;
• Low literacy rate of the population and the language barrier between health
personnel and the community who do not usually speak neither English nor
French;
• Ignorance/ lack of accurate nutritional information/ knowledge and skills of
health workers on infant feeding practices. Of the 30 health workers that attended
the training none of them was consistently asking about the newborn feeding
practices.
STRATEGIES TO IMPROVE THE UPTAKE OF EXCLUSIVE BREASTFEEDING IN THE
EAST REGION
In other to generate quantifiable and sustainable results of the feeding practices of
infants of the East region, health workers recommended the followings:

5. 1. Dialogue with key influencers of feeding practices: traditional birth attendants,
and mothers in law with emphasis on inter‐personal communication and
community‐based approaches
2. Emphasize the method of pumping, expressing and storing breast milk as a
strategy to continue breastfeeding in lactating women, given that 85% of the
population are farmers.
3. Do not use classic media channels, which are radio and television because the
signals do not reach the areas of Delele, Batouri and Kette and electric power is
said to be “unreliable’.
4. Do not use written posters and brochures because the majority of the targeted
population is illiterate. Pictures will lead better results.
5. Build the capacity of elderly women and traditional leaders to address
cultural beliefs incompatible with EBF messages. They are more listened to, than
health workers and community health workers. Moreover tailor messages to
mothers in law and traditional birth attendants, the key influencers.
For a long lasting impact of these interventions, the author also suggests the
introduction of the nutrition modules in the curriculum of health workers.