Joshua case study on Nutrition in COVID-19 – Zimbabwe

DORICA (37) is a mother of four, who lives in the drought-stricken district of Binga in Zimbabwe. She has a two-year-old Joshua, and also lives with her four-year-old granddaughter Dorcas. Juggling from one odd job to another has become a daily routine for Dorcas and her husband, as they struggle to provide meals for their family of seven, without a reliable source of income.

By Sophie Hamandishe

Despite these challenges, Dorica has remained resolute when it comes to matters of feeding her son Joshua and ensuring that he remains healthy.

She says the secret to her son’s current good health is breastfeeding, as well as feeding him according to the Infant and Young Child Feeding practise guidelines that she learnt at the Mother’s Support Group meetings in her village.

From the time Joshua was two weeks old, Dorica carried him with her when going for piece jobs, so that she could breastfeed him as often as possible. Dorica is grateful to the Village Health Worker who empowered her to make such decisions at the mother’s support group meetings in her village.

In response to the COVID-19 pandemic and to prevent the spread of Coronavirus, Dorica and other support group members in her village have adapted their activities to protect themselves, and their babies from contracting COVID-19. They now meet in small groups, maintain social distance, wear face masks and wash their hands with soap and water prior to their meetings.

In addition, her son Joshua and other children under five in the village have been given individual MUAC tapes for use at home and at the community active screening point, to prevent the spread on COVID-19 among babies through use of the same MUAC tape during active screening.

Consecutive years of drought and an under-performing economy have seen food insecurity levels worsening across Zimbabwe’s rural and urban areas.

The situation has further deteriorated due to the COVID-19 pandemic which has led to company closures, restrictions on the operating environment, reduced informal sector activities owing to COVID-19 induced lockdown.

This has reduced household income levels across the country, thereby threatening the rights of children to survive. Many hard-hit families have been forced to take desperate measures to survive such as reducing their daily meal intake and reducing their dietary diversity. An estimated 1.1M children and women are in need of humanitarian nutrition assistance including 98,112 wasted children (3.6% of children under five) who are requiring immediate life-saving nutrition treatment.

Save the Children is implementing the Nutrition in Emergencies project in partnership with the Ministry of Health and Child Care, across five drought affected districts in Zimbabwe. The project supports 90,150 children under five including Joshua, pregnant and lactating women through the provision of life-saving nutrition treatment to all children affected by acute malnutrition. The mothers are supported through community level Infant and Young Child Feeding in Emergencies (IYCF-e), promotion of exclusive breastfeeding, mother-led active screening, COVID-19 awareness and prevention, promotion of exclusive breast feeding among other nutrition interventions in the context of the drought and COVID-19 emergency.

Dorica’s story in her own words (Quotes):

“My name is Dorica and I am 37-year-old woman who lives in Binga. I have a two-year-old son called Joshua, but I am a mother of four. I also stay with Dorcas, my four-year-old granddaughter. We are seven people in total at my homestead, four are children, while three are adults.

My husband doesn’t work. We survive on piece jobs. We do not choose the jobs that we do. I can do any job, as long as I will get paid something. I often get paid a tin of ground millet or sorghum. Last year (2019) I harvested a bucket of sorghum only. I had planted on a very huge piece of land, but my harvest was as good as nothing because of erratic rains. I hadn’t planted a lot of cereals as such, because I had no seed.

I however managed to get “uludhe” (a green leaf vegetable) and okra and dried these for future use. Okra is our main relish. I don’t have any chickens or goats. I recently planted vegetables in my garden but my neighbour’s

chickens have been coming and eating my vegetables. My son Joshua is growing up well and healthy. I waited for two weeks only after giving birth to Joshua, then I went back to doing odd jobs. Despite my so only being two weeks old, I took him with me when I went to do the odd jobs, so that he could breastfeed. I made sure I ate enough food to make me healthy enough to breastfeed my son. I don’t think he had enough milk because he would often cry. However, I didn’t give up and I continued breastfeeding him.

Here and there I cuddled him and put him on my back. He would breastfeed until my breast became hot. I breastfed Joshua up to six months and never gave him any other food. I had been told at the clinic that babies should not be given solids or water until they get to six months. They need breastmilk only, and it protects the child from childhood illnesses. The baby also gets his water from the milk.

After six months, I started feeding my baby maize meal porridge. I had no peanut butter then, so it was plain porridge. I made sure that my baby eats warm food all the time. I however did not stop breastfeeding him.

If I get maize I cook sadza, vegetables and I add vegetable oil. Joshua is growing up well. From birth until now at two years old, he only got sick once. That happened when he was seevn months old. He got sick, was vomiting and had loss of appetite. I took him to the clinic and they examined him, weighed him and he recorded 7 kgs. They gave me some tablets and salt and sugar solution for my baby. Thereafter he slept well and his health improved. This time he is not sick.

I make sure that my son is weighed every month. I last had him weighed this month on July 21 (2020). Our babies are weighed at the community meeting place, next to the Village Health Worker’s homestead. We start by singing, have health lessons and then have our babies weighed. We are often taught about the types of food that we should feed our children, body building foods for our babies. For example, pumpkin seeds can be roasted, ground and when mixed with vegetables it creates a peanut-butter-like mixture.

At times I make peanut butter using the nuts found inside the amarula fruit. When cooking vegetables, I add the peanut butter and feed my son. Joshua loves eating vegetables with peanut butter so much. We were also taught that Mopani worms (edible caterpillar that is rich in protein) are good for the baby. You first have to grind them so that they are easily palatable for the baby, and then you add peanut butter. They are a form of nutritious food for the baby.

This time we don’t meet in large numbers at the community meeting point for mothers because of Coronavirus. The village Health Worker waits until we are about five or six and she starts the health talk session and weighs our babies. Soon after having your baby weighed you go back home. But this time around, we all go to the meeting point while wearing face masks. You can’t even go anywhere without the mask. Even at the local clinic if you have no face mask, they will tell you to go back home and get a mask.

But these young children remove face masks, even if you put one on them. I heard that we must only put a mask on a child who is above two yrs. Out clinic staff are the ones who told us to wear face masks. We now seat apart from each other. Even when I go for piece jobs I wear a face mask. When I go to receive food aid, we now seat one metre away from each other and we no longer do handshakes when greeting one another.

I was given a MUAC tape (malnutrition measurement tape) by our Village Health Worker in July, and it is for use on my child. The tape is used to measure if the baby is growing up well. It is used it to measure the child’s growth on the left hand and you check the figures. So you can read and tell the figure of your child’s MUAC, if it’s 12, 15 or 17. I tell the Village Health Worker these figures when I meet her.

My baby is usually measuring 15 on the MUAC tape. We were told that we are now being given MUAC tapes so that we measure your babies on our own at home, because there is Coronavirus. It is good because it shows how the child is growing. Last month, I went to the support group meeting, where Joshua was weighed and his MUAC reading was 15.

Our Village Health Worker also talks to us about Coronavirus. She said we must maintain a distance from each other, stay at home and also place home-made hand washing facility at the gate and at the toilets. If one has no soap- they can add ash to the water. All visitors should wash their hands first. But I have not put the hand washing facility at the gate to my homestead as I have no empty container for water storage. I only have one water storage container which I placed outside the toilet. My son Joshua loves washing his hands.”

Background / Project information

Climate related disasters including widespread drought and cyclones have resulted in an unprecedented humanitarian crisis in Zimbabwe. The situation is worsened by the declining economic situation in the country, characterised by high unemployment, rising food prices and shortages of cash. Amid all this, is the COVID-19 emergency which the country is battling to contain, and a COVID-19 induced lockdown which has plunged families further into crisis.

Approximately 3.58 million people (38% of the rural population) are in Crisis (IPC Phase 3) or worse and require urgent action to reduce food consumptions gaps and save livelihoods. Approximately, 2.47 million people face Crisis conditions (IPC Phase 3) whilst 1.10 million are in Emergency (IPC Phase 4). An additional estimate of 2.68 million people faces Stressed conditions (IPC Phase 2). Many hard-hit families have been forced to take desperate measures to survive such as reducing their daily meal intake and reducing their dietary diversity.

An estimated 1.1M children and women are in need of humanitarian nutrition assistance including 98,112 wasted children (3.6% of children under five) who are requiring immediate life-saving nutrition treatment Save the Children in partnership with the Ministry of Health and Child Care (MoHCC) are implementing a nutrition project – Providing lifesaving and protective nutrition intervention to most vulnerable children and women in 5 drought affected districts in Zimbabwe. The project aims to provide life-saving nutrition treatment to all children affected by acute malnutrition in 5 priority rural and urban locations in the country. These project districts are Bulawayo, Chimanimani, Hurungwe, Kariba, Kariba Urban and Binga. The UNICEF funded nutrition project is being implemented over a six-month period from March 2020 to August 2020 and target 90 150 children.

Main interventions under the project include coordinating the nutrition response to women and children affected by the drought, providing life-saving nutrition treatment to all children affected by acute malnutrition, providing community level Infant and Young Child Feeding in Emergencies (IYCF-e) support to parents and caregivers of children below the age of two years, strengthening data collection, reporting and information systems at all levels from community to national level for use in decision making and effective nutrition response, as well as publicising nutrition services provided to the community.

Save the Children has worked in Zimbabwe since 1983 and is currently scaling up its emergency response to help the most vulnerable children. The response is focusing on food security, health, nutrition, education and child protection. Save the Children’s Health and Nutrition programme is implementing emergency nutrition and water, sanitation and hygiene (WASH) programming to improve access to basic nutrition services and reduce the risk of disease outbreaks.

About the writer: Sophie Hamandishe is the Communications and Advocacy Advisor for Save the Children in Zimbabwe

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