Maternal and
Child Nutrition
Programme
Micronutrient
Deficiency Control
Programme
NaNA HQ
Other Nutrition
Programmes
Food Quality and
Safety Support
Programme
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Background
1. Nutrition Policy and Institutional Capacity Building
1.1 Review of the National Nutrition Policy
1.2 Regional Consultative Meeting on the Draft Policy
1.3 Pre-Validation of the Revised Nutrition Policy with the Stakeholders
1.4 Finalisation of Scheme of Service
1.5 Capacity Building
2. Micronutrient Deficiency Control programme
2.1 National VAS and Deworming Campaign
2.1 Development of Monitoring Tools for VAS and deworming
2.3 Training of Health Workers on VAS and Deworming Monitoring Tools
2.4 Procurement of Computers and Laptops for VAS
2.5 Stakeholders Meeting of Salt Iodisation
2.6 Mobile Salt Iodisation
3. Maternal and Child Nutrition Programme
3.1 The Baby Friendly Community Initiative (BFCI)
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3.1.1 Review of the BFCI Training Manual
3.1.2 Training of Trainers and the Village Support Groups (VSG)
3.2 Gambia National Nutrition Surveillance Programme (GNNSP)
3.2.1 Review and Updating of the Surveillance Tools
3.2.2 Pre-Surveillance Workshop
3.3 Management of Severe Acute Malnutrition (SAM)
3.3.1 Completion of the Development of Training Modules for the
Management of Severe Malnutrition
3.3.2 Pre-Testing and Printing of the Training Manual for the
Management of Severe Acute Malnutrition
3.3.3 Training of Nurses on Management of SAM at RVTH
3.3.4 Training of Community Health Nurses (CHN) and RHT
members on the management of SAM
3.3.5 Training of Community Representatives on SAM
3.4 Training of Health Workers on Maternal Nutrition Using
the Lifecycle Approach
3.5 World Breastfeeding Week Celebration
3.5.1 A speech by Her Excellency
3.5.2 Celebration by BFHI health facilities
3.5.3 Celebration in the Communities
3.5.4 Celebration by NaNA Children’s Club
3.5.5 Radio Programme
3.6 Training of Trainers and Participants on the Integrated IYCF in LRR
3.7 Training of Midwives and TBA on the Integrated IYCF
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4. Food Quality and Safety Support Programme
4.1 Public Hearing on the Draft Standards on Fats and Oils
4.2 Better Training for Safer Food (BTSF) Project
4.3 Roundtable Dialogue on Responsible Advertisement
4.4 Setting up of Taskforces to Develop Standards
4.5 Implementation of the Bio security Support Project
4.6 Facilitation of NCSPSC Meetings
4.7 PLOM Establishment and Meetings
4.8 NCSPSC strategic plan Finalisation
5. Other Nutrition Programmes
5.1 Food Vulnerability and Mapping survey Restitution
5.2 Nutrition Education in Lower Basic Schools Projects
5.3 Clinic Based Nutrition Counselling for Diabetics & Hypertensive
5.4 Monitoring and supervision of programmes
6. Partnership Meetings, International Conferences and Seminars
6.1 Joint NaNA Medical Research Council (MRC) Meeting and support
6.2 Mid Term Review of the ECOWAS Nutrition Forum in Abidjan
6.3 WAHO internship meeting in Ouagadougou
6.4 Food Composition and Data Base Training in Ghana
6.5 Visit of Liverpool John Moore University students
Challenges
Priorities for 2009
Conclusion
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AIDS
BFCI
BFHI
BMI
BTSF
CBGM
Acquire Immuno-Deficiency Syndrome
Baby Friendly Community Initiative
Baby Friendly Hospital Initiative
Body Mass Index
Better Training for Safer Foods
Community Based Growth Monitoring
CHN Community Health Nurse
CILSS Permanent Inter-state Committee for Drought Control in the Sahel
CRR
EC
Central River Region
European Commission
ECOWAS Economic Committee of West African States
EPI Expanded Programme on Immunisation
FAO Food and Agriculture Organisation
GHP Good Hygiene Practices
GNNSP Gambia National Nutrition Surveillance Programme
GRTS
HIV
Gambia Radio and Television Services
Human Immuno-Deficiency Virus
HKI
IBFAN
IDA
Hellen Keller International
International Baby Food Action Network
Iron Deficiency Anaemia
IDD
IEC
Iodine Deficiency Disorders
Information, Education and Communication
IMNCI Integrated Management of Neonatal and Childhood Diseases
IT
IYCF
LoA
LRR
Information Technology
Infant and Young Child Feeding
Letter of Agreement
Lower River Region
MDI
MOA
MoH
Management Development Institute
Ministry of Agriculture
Ministry of Health
MOSBSE Ministry of Basic and Secondary Education
MRC Medical research Council
MSc Master of Science
MTR
NaNA
NAS
NBR
Mid term review
National Nutrition Agency
National AIDS Secretariat
North Bank Region
NCC
NCD
National Codex Committee
Non-Communicable Diseases
NCSPSC National Code/Sanitary and Phytosanitary Committee
NFO Nutrition Field Officer
NUSAPPS Nutrition, Food Security and Public Policies in the Sahel
PCV
PHC
Peace Corps Volunteer
Primary Health care
PLOM
PVS
RCH
Policy, Legal, Organisational and Management
Performance of Veterinary Services
Reproductive and Child Health
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WHO
WR
RHT
RUTF
RVTH
SAM
Regional Health Team
Ready to Use Therapeutic Feed
Royal Victoria Teaching Hospital
Severe Acute Malnutrition
SME
SPS
TAC
TBA
Small and Medium Enterprises
Sanitary and Phytosanitary
Technical Advisory Committee
Traditional Birth Attendant
TCP Technical Cooperation Programme
TOT Training of Trainers
UNICEF
United Nations Children’s fund
UNSCN
URR
USI
United Nations Scientific Committee on Nutrition
Upper River Region
Universal Salt Iodisation
UTG
VAD
VAMU
VAS
VDC
VHS
VSG
WABA
WAHO
WBW
University of The Gambia
Vitamin A Deficiency
Food Vulnerability in Urban Areas
Vitamin A Supplementation
Village Development Committee
Village Health Service
Village Support Group
World Alliance for Breastfeeding Action
West Africa Health Organisation
World Breastfeeding Week
World Health Organisation
Western Region
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Background:
The National Nutrition Agency (NaNA), established in 2000, is responsible for coordinating all nutrition and nutrition related activities in the country; facilitating inter-sectoral collaboration in the area of nutrition, and implementing the National Nutrition Policy. The Agency is also responsible for the coordination of the implementation of the Food Act, 2005, the International
Baby Food Action Network (IBFAN) Gambia Chapter, and is the secretariat to the National
Codex/Sanitary and Phytosanitary Committee (NCSPSC). During the year 2009, with the support of its partners, the Agency implemented and coordinated series of activities in collaboration with its stakeholders.
This report highlights the status of activity implementation and challenges faced in 2009 and the priorities set for the coming years. The report is divided into six programmatic areas:
1. Nutrition Policy and Institutional Capacity Building
1.1 Review of the Policy
The National Nutrition Policy (2000 – 2004) has elapsed its lifespan and has been reviewed.
An expert consultative team was set up to review the policy document. The new draft policy
(2010 – 2020) has included critical areas of concern to the advancement of nutrition in the country.
1.2 Regional Consultative Meetings on the Draft Policy
After the drafting of the national nutrition policy 2010 – 2020 by an expert consultative team, it was subjected to regional consultative meetings held in all the regions and the two municipalities. This accorded the technical advisory committees (TAC) in the regions the opportunity to review and comment on the draft policy. The suggestions and concerns of the
TACs were reviewed and incorporated into the final document.
1.3 Pre-validation of the Revised National Nutrition Policy (2010 – 2020) with the
Stakeholders
After subjecting the draft nutrition policy to regional and municipal reviews, a two day prevalidation was organized at the central level for the technical experts and programme officres.
This was aimed at including the views and comments of technical stakeholders into the policy before finalisation to ensure that sectoral issues are mainstreamed in to the document.
1.4 Finalisation of Scheme of Service
The draft scheme of service for the Agency has been finalised and approved by the Agency
Board. The scheme outlines the services and staffing requirement of the Agency.
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1.5 Capacity Building
For any institution to function effectively there must be trained, qualified, skilled and experienced personnel. In line with this, the Agency has supported and facilitated a number of capacity building activities for its staff including the starting of an MSc Programme in Public
Health (Health Promotion and Environmental Health) with Leeds Metropolitan University in collaboration with the University of The Gambia (UTG) by three (3) senior staff with one senior staff nearing completion of the course. One (1) staff is currently undertaking a Diploma in Community Health Programme in Kenya. Similarly, one (1) staff completed a Management
Course at the Management Development Institute (MDI), another completed a two week course on Financial Management and Budgeting in Ghana. Three (3) other staff completed BSc
Programmes at the UTG – two (2) in Public and Environmental Health and 1 in Management.
Additionally, a new Peace Corps Volunteers (PCV), who is a dietician, has joined the Agency for a two year period. This will strengthen and improve the capacity of the Agency in fulfilling its roles and responsibilities effectively and efficiently.
2. Micronutrient Deficiency Control Programme
Micronutrient deficiency has long been recognized as an important contributor to the global burden of diseases. It affects several million people around the world and contributes to growth retardation, impaired intellectual performance, reduced work capacity, morbidity and mortality.
These lead to socioeconomic retardation of entire communities and therefore nations. The three most common forms of micronutrient deficiency of public health importance in The Gambia are Iodine Deficiency Disorders (IDD), Vitamin A Deficiency (VAD) and Iron Deficiency
Anaemia (IDA). The prevalence of these micronutrient deficiencies in The Gambia range from mild to severe.
The Government of The Gambia is committed to the control and virtual elimination of these deficiencies. For this to happen, the country is set to achieve not only universally set targets, but also country specific goals. Through NaNA, programmes geared towards achieving these goals have been implemented. The following activities were undertaken during 2009:
2.1 National Vitamin A Supplementation (VAS) and Deworming Campaign
A month long national Vitamin A Supplementation and Deworming Campaign was conducted from November to December. The aim of this activity is to ensure that at least 80% of children
6 – 59 months are supplemented with vitamin A and that 80% of those between 12 and 59 months are dewormed. At the end of the campaign 86% of children 6 – 59 months were supplemented with vitamin A and 82% were dewormed, thus exceeding established goals.
2.2 Development of Monitoring Tools for VAS and Deworming
Vitamin A Deficiency and worm infestations are prevalent in The Gambia and the Agency has been implementing strategies to both control and prevent them. The interventions put in place include public awareness creation, supplementation with a high dose Vitamin A capsule and deworming of children with Mebendazole tablets, promoting the production and consumption of foods rich in the micronutrients as well as environmental sanitation and personal hygiene. A
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routine VAS has now been fully incorporated into the Reproductive and Child Health (RCH) and Expanded Programme on Immunisation (EPI) programmes with coverage of 87% and 78% for children 6 – 59 months and post partum mothers within 8 weeks after delivery respectively.
These strategies need to be closely monitored to assure continued compliance.
In order for these strategies to be effectively monitored, the Agency, with support from Hellen
Keller International (HKI) and in collaboration with partners, developed a monitoring tool for the routine vitamin A supplementation and deworming Programme. The Tool has been finalized for use at the regional and central levels to monitor progress.
2.3 Training of Health Workers on VAS and Deworming Monitoring Tools
Following the finalisation of the monitoring tools, 300 staff from heath facilities and Regional
Health Teams were trained on the tools. This initiative, supported by Helen Keller International
(HKI) was aimed at empowering staff and strengthening the VAS and deworming programme.
2.4 Procurement of Computers and Laptops for VAS
The Agency has procured 6 computers for the Nutrition Field Officers and 2 laptops for the
Central Level Officers to facilitate monitoring of the VAS/Deworming programme at the regional and central levels. The finalized monitoring tool was installed in each of these computers and laptops for use. These are being used to monitor VAS and deworming.
2.5 Mobile Salt Iodisation
As part of the strategies used to achieve Universal Salt Iodisation (USI) and to ensure that iodized salt is consumed in the most remote communities, a mobile salt iodization programme was carried out throughout the country. During this exercise, salt producing communities and major markets were visited and their salts iodized and bagged for free.
For the year under review, the mobile iodization team was able to iodize 123.5 metric tons of salt from the communities throughout the country. There are plans to continue the mobile iodisation whilst the communities that were supported with iodisation plants continue to produce and iodise salt. This is aimed at making iodised salt accessible and available at the household level throughout the country, thus reducing the incidence of goitre and impaired mental and physical development due to iodine deficiency.
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3. Maternal and Child Nutrition Programme:
Optimal maternal nutrition before, during and after pregnancy is a very good predictor of pregnancy outcome. Mothers/women who are well nourished are less likely to be anaemic or deliver low birth weight babies. This in turn will help to reduce both infant and maternal morbidity and mortality. In The Gambia, the maternal mortality ratio stands at 556/100,000 live births while Low Birth Weight (LBW) is estimated at 19.9% of all births. Infant mortality is 75/ 1000 live births. Maternal malnutrition and poor feeding and caring practices contribute significantly to these unacceptably high rates. Under this programme, the following activities were implemented or continued during 2009:
3.1
The Baby Friendly Community Initiative (BFCI)
The Baby Friendly Community Initiative (BFCI) programme is a comprehensive nutrition and health education package developed by the National Nutrition Agency (NaNA), to improve the health and nutritional status of communities particularly women and children. The concept of the BFCI is based on the UNICEF/WHO global strategic initiative of the Baby Friendly
Hospital Initiative (BFHI) that goes beyond breastfeeding to include maternal nutrition and environmental sanitation and personal hygiene. Within the BFCI programme activities implemented included:
3.1.1 Training of Trainers and the Village Support Groups (VSG)
The BFCI training of trainers workshops were held at the Upper River, Central River and
Western Regions. A total of 46 trainers comprising all the VHS/CHNs in the three regions and staff from the Regional Health Team were trained. As part of expanding the BFCI programme,
33 communities were identified in the URR, CRR and Western Regions for 2009. Following their selection, a five day sensitization was carried out in these communities to discuss with them the BFCI programme and concept. Following the community sensitizations on the programme, 5 women and 3 men were selected from each community for training to form the
Village Support Groups. A total of 264 community representatives (men and women) from the thirty-three communities were then trained by the trainers (CHNs and RHT members) on the components of the BFCI. This brings the total BFCI implementing communities in the country to 326 with 2556 VSG members trained.
3.1.2 Review of the BFCI Training Manual
The BFCI training manual that was developed during the pilot phase and used throughout the expansion period has been reviewed. The revised manual covers 23 sessions and includes management of severe acute malnutrition, infant feeding and HIV and AIDS, micronutrient deficiency control and management of diet related non-communicable diseases. Two hundred copies of the manual has been produced and printed for subsequent trainings.
3.2
Gambia National Nutrition Surveillance Programme (GNNSP)
The Nutrition Surveillance of children under five in The Gambia is one of the oldest community based programmes of the Agency. Every year the exercise is carried out twice in
Primary Health Care (PHC) communities by Village Health Service Community Health Nurses
(VHS/CHNs). The overall coverage of under five children assessed from 69 Primary Health
Care circuits during the August/September exercise this year was 63,062. This figure indicated a 4% increase in the number of under five children assessed nationally over the past year’s figure of 60,577. The national prevalence of wasting was 8.1% and 2.1% compared to 9.2% and 1.6% of last year using the local and international cut off points respectively. These cut
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offs provide data on the incidence of mild, moderate and severe malnutrition (local cut off) and moderate and severe malnutrition (international cut off).
3.2.1 Review and Updating of the Surveillance Tools
The Nutrition surveillance tool including forms A and B and the indicator were reviewed and updated by a team comprising community health nurses, regional health team members and central level staff. The revised tool will be adopted for use in the programme.
3.2.2 Pre-Surveillance Workshop
Two rounds of pre-surveillance workshops were conducted for the VHS/CHNs and RHTs in all the six Health Regions before the commencement of each surveillance exercise. This is crucial as new CHNs are deployed in some of the PHC circuits who have had no experience in conducting the surveillance. Also during the workshop, results of the previous surveillance are discussed and recommendations made for the improvement of the programme. A total number of 81 people (VHS/CHNs and RHT) attended and participated in the workshops.
3.3
Management of Severe Acute Malnutrition (SAM)
While there is a long tradition of community based care and rehabilitation of severely malnourished children, this has not been effectively implemented in our communities. Most malnourished children from our communities are treated at the health facilities. However, in the recent past research has shown that severely malnourished children can be effectively managed at community level. Last year, the Agency in collaboration with partners developed a national protocol on the management of severely malnourished children at both health facility and community levels and embarked on a programme for the management of SAM.
3.3.1
Completion of the Development of Training Modules for the Management of
Severe Malnutrition
In order to improve and strengthen the management of children who are severely malnourished and hence reduce the high case fatality rates, the Agency with support from UNICEF developed training modules based on the National Protocol on the Management of Severe
Malnutrition. The modules were developed in collaboration with staff from the Ministry of
Health and lecturers from health training institutions. These modules are being used to train nurses, doctors and other caregivers on how to manage severely malnourished children at both the health facility and at home.
3.3.2 Pre-Testing and Printing of the Training Manual for the Management of SAM
After drafting the training module on SAM, a five day training was organized for senior nurses and doctors to pre-test the modules. The training accorded the Agency the opportunity to test the modules and make corrections as necessary. The pre-testing was also used as a training of trainers where a total of 15health workers participated. Comments and corrections were
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incorporated in the final modules, which were then sent for printing and production. A total of
50 sets of the training modules were produced.
3.3.3 Training of Nurses on Management of Severe Acute Malnutrition at RVTH
A nationwide training of nurses on the management of SAM was undertaken at three sites in the country: Bansasng, Farafenni and Banjul. The aim of the training was to increase the knowledge and skills of nurses in the management of SAM at both health facility and community levels in order to reduce childhood mortality. A total of 90 nurses from both the public and private sector were trained.
3.3.4 Training of CHN and RHT members on the management of SAM
In order to improve the management of severely malnourished children and reduce childhood mortality, the Agency with support from UNICEF has trained 69 CHNs and 12 RHT Staff on the management of the moderate and severely malnourished children identified during the routine nutrition surveillance programme. They are also provided with Ready to Use
Therapeutic Feeds (RUTF) to facilitate the management of these children at their homes.
During this year, all the children who were identified as moderately and severely malnourished during the surveillance were enrolled in the programme and managed using the ready to use therapeutic feeds (RUTF)
3.3.5 Training of Community Representatives on SAM
After the training of the CHNS and RHT Staff, 125 Community representatives, mainly TBAs,
Village Health Workers and other Village Support Group members were trained on the management of children with severe acute malnutrition at home using the RUTF. They will work with the CHNs to ensure that children on the treatment comply and will also monitor their progress.
3.4 Training of Health Workers on Maternal Nutrition Using the Lifecycle Approach
The Agency with support from the West Africa Health Organisation (WAHO) conducted a training of health workers on maternal nutrition using the lifecycle approach. The training is aimed at building the capacity of health workers to improve pregnancy outcomes through the reduction of maternal malnutrition. The trainings were carried out in collaboration with the
Ministry of Health (MoH) with a total of 150 health workers trained across the country.
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3.5
World Breastfeeding Week Celebration
World Breastfeeding Week (WBW), observed throughout the world by the international community was celebrated in The Gambia throughout the whole month of August. The adoption of a month long celebration in The Gambia was implemented a few years ago and continues to be effective. Each year, the World Alliance for Breastfeeding Action (WABA) chooses a relevant theme to celebrate the week. This year the theme was: BREASTFEEDING
A VITAL EMERGENCY RESPONSE- ARE YOU READY. The aims of the theme are:
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To reinforce the vital role breastfeeding plays in emergency responses
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To advocate for active support and protection of breastfeeding even during emergency
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To inform people and communities on how they can actively support breastfeeding before and during emergency
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To mobilise action and promote networking and collaboration between those with management skills and those involved in emergency responses
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To expand awareness of the need for and the value of providing support to a breastfeeding mother.
This year’s month long celebration took the form of open field days, sensitisation and radio and TV programmes aimed at promoting and supporting breastfeeding. The National Nutrition
Agency and its partners planned and implemented a series of activities to mark the month long celebration which included:
3.5.1
A speech by Her Excellency
The Vice President, who is also the Minister responsible for Nutrition, Population and
Women’s Affairs and the Chairperson of the National Nutrition Council, delivered a speech on the theme on the eve of the month, which was aired over the national radio and television. Her
Excellency the Vice President reiterated the importance of the month long celebration and urged people to listen to and act on the messages and advice that would be given.
3.5.2
Celebration by BFHI health facilities
As part of celebration for the WBW 19 health facilities implementing the Baby Friendly
Hospital Initiative (BFHI) took part in this year’s commemoration. Each of the facilities organised field days within their catchment areas, where speeches to promote appropriate infant and young child feeding practices were made. The speeches were followed by quiz competitions in which participants who answered questions correctly were given prizes including flasks, pans, bowls, towels, shoes, bath pans and baby clothing.
3.5.3
Celebration in the Communities
Five health regions (Upper River, Central River, Lower River, North Bank West and Western
Regions) organised open field days at a central location in one village within each region and was attended by other surrounding villages. The various field days were held at Bulock
(Western Region), Kanuma (North Bank West Region), Wellingara (Lower River Region)
Katamina (Central River Region) and Kumbija (Upper River Region). All programmes were
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covered by the Gambia Radio and Television Services (GRTS) to create further awareness of the importance of breastfeeding and the theme of the celebration. The open field days served to provide entertainment as well as education.
3.5.4
Celebration by NaNA Children’s Club
The NaNA Children’s Club commemorated the WBW with a symposium organised by club members presenting papers they have written on various aspect of the theme. The symposium included discussions, questions and answers, and singing.
3.5.5 Radio Programme
A series of radio programmes on the national, private and community radio stations sensitised the general public on the importance of breastfeeding.
3.6 Training of Trainers and Participants on the Integrated IYCF
Optimal nutrition is a basic requirement for attaining good health and this is especially important for children under 5 years of age. The high prevalence of infant and child morbidity and mortality is associated with many factors, including poor feeding practices. Optimal feeding practices include early initiation of breastfeeding, exclusive breastfeeding for the first six months, timely and appropriate complementation of breastfeeding with age appropriate locally available foods and continued breastfeeding up to or beyond 2 years. The threat to optimal IYCF has been exacerbated by the emergence of HIV/AIDS which may be transmitted through breastfeeding. This was recognised by the World Health Organisation (WHO) and
UNICEF when developing the Global Strategy on Infant and Young Child Feeding in 2002.
In its efforts to improve infant and young child feeding practices as well as to reduce malnutrition, morbidity and mortality, the Agency, with support from WHO/AFRO and WHO
Country Office, conducted a 5 days training of trainers (TOT) on the WHO Integrated Infant and Young Child Feeding in LRR. The participants include NFOs, Regional Public Health
Nurses (RPHN) and senior nurses. The objectives of this training were:
1.
To enhance the knowledge and skills of health care providers in infant and young child feeding practices.
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To reduce childhood malnutrition
3.
To promote optimal infant feeding practices in The Gambia
4.
To reduce childhood morbidity and mortality
A total of ten (10) participants were trained as trainers
3.7 Training of Midwives and Traditional Birth Attendants (TBA) on the Integrated
IYCF
Following the training of trainers on IYCF, health workers (nurses, midwives and public health officers) and TBAs were trained on integrated IYCF. The trainings were done at the regional level with a total of 100 health workers and 400 TBAs attending. This serve to increase the knowledge and skills of these caregivers regarding optimal IYCF practices.
4. Food Quality and Safety Support Programme:
During recent years there has been an increase in news coverage about food supply concerns and growing recognition by the public of the need for safer food. Parallel to this has been the rapid increase in nutrition- related diseases such as diabetes and hypertension. The public has
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consequently become more aware and concerned about the health risks posed by pathogens and potentially hazardous chemicals in food. Changes in the way food is produced, distributed and consumed globally and locally presents new challenges for ensuring the safety and wholesomeness of our foods. With a large proportion of our food imported, the concern for food safety becomes critical for public health and trade. Under this programme the following activities were implemented during 2009:
4.1 Public Hearing on the Draft Standards on Fats and Oils
In 2008 a draft standard on edible fats and oils was developed. The draft standard was subjected to a one day public hearing to sensitise the public on the standards and to incorporate their views into the document before being finalized. The participants at the hearing included people from the media, business community, public servants, consumer protection groups and community based organisations.
4.2 Better Training for Safer Food (BTSF) Project
The European Commission (EC) has embarked on a new project (2009 – 2010) under the
BTSF Programme to strengthen national and regional sanitary and phytosanitary (SPS) capacities in Africa. The National Codex and Sanitary and Phytosanitary Committee
(NSCSPC) was assigned by the Ministry of Trade, Industry and Employment to response to the call by EC for support. Consequently, the NCSPSC submitted a proposal to the EC for consideration. As part of requirements for support from the project, the NCSPSC identified its
Secretary as the focal point/project coordinator to facilitate communication and implementation of project activities.
The proposal for support submitted by the NCSPSC identifies the following priority areas:
Food safety issues specific to SPS, Zoosanitary issues, Phytosanitary issues, and cross cutting issues. The NCSPSC specifically identified poultry and meat processing as priority areas for the project support. The EC identified Mr Jordge Saludes as a consultant to carry out an inception mission with the aim of doing an initial assessment of 8 small and medium enterprises (SME) identified to be part of the project. The objectives of his mission were to identify the stakeholders and their priority areas as well as to identify beneficiaries and partners.
A second consultant, Mr Kirtle, in partnership with a locally identified consultant, Mr Gomez, carried out a mission on good hygiene practices (GHP) within the poultry industry. The aim of their mission was to carry out a detailed assessment of the poultry establishments, conduct training and develop a work plan for the improvement of GHP within the selected establishments.
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The EC also responded to the request from the NCSPSC to carry out a performance of veterinary services (PVS) assessment of the country’s veterinary services, and a four man mission conducted the PVS of the country’s veterinary services. The mission has submitted a draft report which highlighted some key important recommendations for comments and consideration. This will be followed by another mission to carry out a PVS gap analysis.
As part of the support for the project a regional workshop on harmonization of integrated inspection systems was held in Ghana. The workshop was attended by 3 participants from The
Gambia, two from the public sector and one from the private sector.
4.3 Roundtable Dialogue on Responsible Advertisement
A roundtable dialogue involving people in the media, advertisement agents, the private sector and public regulation authorities was held at NaNA. This was aimed at creating dialogue among stakeholders involved in the marketing and advertisement of foods. At the end of the meeting the following recommendations were made:
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Establishment of a body that will check and approve any advertisements before it is aired
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Empowerment and capacity building of relevant stakeholders in the food control system to include the media houses and advertisement agents

Strengthen monitoring and control points to prevent the in-flow of sub-standard food products into the country
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Develop codes of ethics, standards and regulations for responsible advertisement, particularly of foods, to be strictly followed by the marketing departments of all media houses.
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Broaden and continue the dialogue strategy to reach a wider audience
4.4 Setting up of Taskforces to Develop Standards
Six taskforces with expertise from diverse backgrounds were set up to develop standards on a range of commodities. These included poultry and poultry products, labeling, mineral and other waters, groundnut, street foods and advertisement codes. Draft standards for these commodities and codes were produced and will be finalized for adoption by the relevant authorities.
4.5 Implementation of the Biosecurity Support Project Phase II
In trying to address the growing concern for food safety, The Gambia recognised that efforts must be made to improve animal and plant health in order to produce and consume safe food.
The country has also recognized that work in the areas of food safety, animal and plant health can be better coordinated and streamlined to improve domestic food security with increased access to safe food. This integrated approach to food safety, animal and plant health, as well as associated environmental risk, has been termed “Biosecurity” by FAO. Improving national biosecurity enables countries to participate in an increasingly standards-driven international food and agricultural trading market, and can be instrumental in helping to alleviate poverty in
The Gambia.
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The National Codex, Sanitary and Phytosanitary Committee of the Gambia (NCSPSC) benefitted from a pilot project from the Food and Agriculture Organization of the United
Nations (FAO) from October 2008to March 2009. The project a) identified the major components and stakeholders in the national food safety, animal and plant health system; b) assessed capacity needs, gaps and overlaps in this area; and c) further developed a strategic plan for implementing an integrated approach to food safety, animal and plant health (a
“Biosecurity” approach) in The Gambia. Based on the success of this pilot project, FAO signed a Letter of Agreement (LoA) with the NCSPSC to implement a second phase of the project from August- December 2009, and assigned an international consultant, Dr. Londa
Vanderwal, to assist with its implementation. This project was designed to address some of the items identified in the strategic plan, particularly technical activities related to policy development, strengthening laboratories, inspection and monitoring, capacity building and information exchange in food safety, animal and plant health.
Activities Undertaken in Project
At the initial stage of implementation of the project a brief assessment of the current biosecurity capacity needs was carried out and the project activities planned accordingly.
These were followed by a series of activities including:
Assessment of the inspection and certification systems
Training of the NCSPSC on Codex and SPS procedures and Biosecurity issues
Training of laboratory technicians on laboratory safety procedures and quality assurance
Training of local food processors on Good Hygienic Practices (GHP)- including review of GHP manuals
Training of inspectors - including review of inspection guidelines
Workshop on networking of laboratories
Development of a national Biosecurity policy framework and stakeholder consultation workshop
Development and printing of brochures on the NCSPSC for policy makers, and on food safety, sanitary and Phytosanitary matters for the general public
Development and printing of a manual on the application of GHPs for local street food vendors
Development and printing of a manual on the application of GHPs for local cereals processors
Development and printing of guideline for inspection for food inspectors
Project Outcomes and Next Steps
The project was successful in meeting the objectives stated in the Letter of Agreement focusing on strengthening food safety, animal and plant health in The Gambia, and particularly the integration of these areas. The National Codex, Sanitary and Phytosanitary Committee appreciates the assistance provided to it by FAO and is planning to continue in the activities initiated in this project, particularly in the further development, validation, implementation, and follow-up activities of the Biosecurity policy framework. The Committee is in the process of developing more detail project proposals to request for funding.
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Facilitation of NCSPSC Meetings
The Secretariat, under the coordination and support of NaNA has facilitated meetings of the
NCSPSC that met four times during the year to discuss pertinent issues concerning food safety and control. Meetings are usually held in the afternoons between 13.00 and 16.00 pm at NaNA conference room. The Secretariat took and prepared minutes of all the meetings for circulation.
Policy, Legal, Organisational and Management (PLOM) Establishment and Meetings
As part of efforts to strengthen collaboration and communication, the technical chairpersons sub-committee of the NCSPSC was expanded with the establishment of the policy, legal, organisation and management (PLOM) to include heads of key institution stakeholders. PLOM has held several meetings to discuss relevant issues pertaining to food safety and quality in the country.
NCSPSC Strategic Plan Finalisation
A five year strategic plan 2009 – 2013 was developed with the aim of providing strategic direction and focus to the NCSPSC to improve food safety and quality. The plan was finalized after several expert review meetings and workshops, facilitated by the secretariat at NaNA, were conducted.
5.
Other Nutrition Programmes
5.1
Food Vulnerability and Mapping Survey Restitution
The results of the assessment of food vulnerability in the urban areas of the city of Banjul and the Kanifing Municipality conducted by the Agency in 2008 in collaboration with CILSS were disseminated to stakeholders at a one day forum. This gave the stakeholders an opportunity to acquire information on the status of food vulnerability and to voice their views and comments on the document.
5.2 Nutrition Education in Lower Basic Schools Projects
As part of the TCP/GAM3202D on the Technical Preparation of Nutrition Education in Lower
Basic Schools signed between the Government of The Gambia and FAO, a situational analysis was conducted in 10 pilot schools and their catchment areas. This was aimed at assessing the current knowledge, attitude and practices of pupils, teachers and communities on nutrition education. A draft report was distributed to the various stakeholders for comments. The report is now finalised and being used for the preparation of teaching and learning materials.
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5.3 Clinic Based Nutrition Counselling for Patients with Diabetes and Hypertension
This ongoing clinic based nutrition education at the Royal Victoria Teaching Hospital (RVTH) is conducted twice a week for diabetes and hypertensive patients referred by their doctors. The aim is to inform, educate and counsel patients and their families on the management of diet related non-communicable diseases (NCDs). During the clinic, blood glucose measurements, blood pressure, name, age, sex, ethnicity and address are recorded. Weights and height measurements are also taken, body mass index (BMI) calculated and recorded. IEC brochures, developed by NaNA are handed out to the patients after the sessions for reference. This programme is increasingly being important as there has been a noticeable increase in the incidence of these diseases with urbanisation.
5.4
Monitoring and Supervision of Programmes
Quarterly monitoring and supportive supervisory exercises are carried out to assess implementation progress and to boost morale of staff and communities. Problems and constraints identified are shared and discussed with stakeholders for redress. The monitoring also accords an opportunity for meeting with the NFOs to support and strengthen their efforts in the regions.
6. Partnership Meetings, International Conferences and Seminars
Attending meetings, workshops and conferences form an integral part of NaNA’s activities.
This is aimed at ensuring NaNA’s input, collaboration and participation in such fora as well as allowing staff to share and exchange experiences with stakeholders and collaborators.
During the year, staff of NaNA have attended several national and international meetings, workshops, seminars and conferences. Key among these are:
6.1
Joint NaNA Medical Research Council (MRC) Meeting and support
The National Nutrition Agency and MRC Human Nutrition Group in Keneba and the London
School of Hygiene and Tropical Medicine has instituted quarterly meetings to discuss and share research and programme results. In 2009, three such meetings took place to update each organisation on status of on ongoing researches and programmes.
Through this partnership, the Agency received support from The Gambia Malnutrition Trust
Fund for the management of severe malnutrition in the Royal Victoria Teaching Hospital
(RVTH). This resulted in the training of nurses on the management of severe malnutrition and the provision of allowances for them for one year. Some utensils and materials were provided to the paediatric ward to facilitate the management and feeding of malnourished children.
6.2
Mid Term Review of the ECOWAS Nutrition Forum in Abidjan
The West African Health Organisation (WAHO) has been co-coordinating the ECOWAS
Nutrition Forum and the ECOWAS Nutrition Focal Points Network. The forum has been organized on a bi annual basis, since 2004. The mid term review (MTR) meeting are organized in between fora and give an opportunity to member state representatives to assess the level of
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implementation of the previous forum recommendations (Tackling the Double Burden of
Malnutrition), held in Cap Verde in 2006 and the recommendations of the forum of Freetown
(Food and Nutrition Security) in 2008.
The main reason for implementing the MTR meeting is to maintain and strengthen the national networks, by sharing the experiences of other countries and helping to identify best and promising practices to implement or enhance in the sub region. However, implementation of the recommendations requires resources to enable countries implement them. The MTR also provides a platform to share constrains and opportunities for moving forward.
This second mid term review meeting of the nutrition focal points was held in Abidjan from
23 rd
to 25 th
September 2009 and was attended by all but one of the focal points or their representatives and partners. The meeting shared and exchanged information and ideas on the state of implementation of the Cape Verde and Freetown recommendations. The meeting was also used to train focal points on IT. At the end of the meeting the following recommendations were made:
To WAHO:
1.
Standardize the format of presentations for the countries for effective harmonization
2.
Request partners to assist countries in the implementation of the recommendations
To Countries:
3.
Provide reports of activities implemented to achieve the forum recommendations
4.
Share best and promising practices with each other for up scaling
To Partners:
5.
Improve coordination of interventions in terms of support and assistance to countries
6.
Assess the need for the new WHO growth standards, which have been recommended for adoption by each country, especially capacity building on anthropometry.
The next ECOWAS Nutrition Forum will be held at Abidjan with the theme “ Planning and
Financing Nutrition Programmes in West Africa
”
6.3
West Africa Health Organisation (WAHO) Internship Meeting in Ouagadougou
WAHO has developed an 8 month internship programme for placing the youth to learn about the work being done in the sub-region and institutional operations. The programme also provides an opportunity for the interns to learn a second language. This meeting in
Ouagadougou aimed to train mentors for the participants and to bring together mentors and interns. This is the third year that NaNA is hosting an intern from WAHO. For three consecutive years, the Agency has been hosting and supporting interns from various countries including Cote’ Ivoire, Mali and Burkina Faso.
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6.4 Food Composition and Data Base Training in Ghana
A two week regional food composition, database and biodiversity training was organised by the FAO in collaboration with Biodiversity International and the University of Ghana. This training brought together experts from nutrition, health and agriculture to share and facilitate the development of a food composition database for local foods. Two participants from The
Gambia, one from NaNA and one from the Food Technology Services of the Ministry of
Agriculture attended the training.
6.5 Visit of Liverpool John Moore University students
A group of students pursuing an MSc degree in Public Health at Liverpool John Moore
University visited the BFCI community of Manduar in Kiang West. This is the fifth year for such a visit aimed at understudying BFCI in Manduar. As part of the link between the university and the community a day care centre is being built in the community with the support of the students.
7.0 Challenges

Sustained adequate resources, both financial and human, to planned and implement nutrition activities

Inadequate transport

Effective enforcement of legislations

Sustenance of inter-sectoral collaboration and coordination
8. Priorities for 2009

Develop Strategic Plan of Action for the implementation of the revised National
Nutrition Policy

Complete the transformation of the Agency into a fully fledged one

Expand the Integrated Anaemia Control Programme in 50 villages

Intensify IEC on the Prevention of Micronutrient Deficiencies Control

Expand the BFCI and the Community Based Growth Monitoring (CBGM)

Strengthen the Baby Friendly Hospital Initiative (BFHI) in one Facility per Region

Establish a Policy Analysis and Planning Unit at NaNA

Strengthen the Management of Severe Acute Malnutrition (SAM) programme

Improve coordination of the Food Act 2005 implementation

Implementing the Rapid Response Nutrition Security Project
9. Conclusion
During this year the Agency has realized significant achievements not only in the implementation of programmes, their management and coordination but also accomplished policy and institutional strengthening. However, much more could have been done with adequate resources.
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