COVID-19 and the new normal for MIYCN practice

Social distancing at a hospital in Viet Nam is one example of modifications in service delivery due to COVID-19.

At a recent virtual meeting of stakeholders in Southeast Asia discussing a new agenda for maternal, infant and young child nutrition, the moderator came prepared: She segued between topics with quotes about change.

“We’ve been challenged to do things differently and this workshop is no different,” said Jane Badham, the moderator and a nutritionist who has worked with Alive & Thrive on a number of initiatives.

One segue was, “The art of life is a constant readjustment to our surroundings – and boy in 2020 have we all had to make constant adaptions to how we live, work, play and connect with people!” In another she quoted the entrepreneur Richard Branson: “Every success story is a tale of constant adaption, revision and change.”

The point was clear: the COVID-19 pandemic has forced nutrition programs to adapt to the dramatic changes the disease has wrought, disrupting critical aspects of life that in turn affect nutrition: livelihoods and food systems, health systems and government programs.

Social distancing measures to prevent the spread of the coronavirus halted in-person events and activities of every kind – from workshops and conferences to visits to health clinics and markets (and every place in between). The need to respond led governments and other institutions to shift budgets. The airborne nature of the virus’s transmission led to new behavior change guidance – generally, for everyone going out into public spaces, and specifically for mothers nursing newborns, among others.

In Nigeria, a WhatsApp group allows health workers to answer questions and provide information to pregnant women and recently delivered women.

“The impact of COVID-19 on MIYCN is very context specific,” said Roger Mathisen, regional director of the Alive & Thrive program in Southeast Asia. “We have countries like Viet Nam and Cambodia in our region with no new cases for weeks or months and things going on as usual more or less, and countries like Indonesia, Philippines, and Myanmar with high numbers of cases and massive restrictions or even widespread stay-at-home orders (Myanmar).”

In West Africa, Burkina Faso and Senegal saw a sharp increase in the number of COVID-19 cases in March and April and cases quickly spread to all 17 countries in the region. However, by early April many West African governments had closed airports and borders; implemented social distancing measures, including curfews; and adopted mandatory mask wearing policies.

The region has been much less impacted for reasons that are as yet unclear; however this needs to be interpreted with caution as testing data may be incomplete, noted Manisha Tharaney, Program Director of the A&T office for the region.

“Many West African governments opened up for business in May and June,” she said. “They have been following social distancing protocols during meetings and workshops and working remotely wherever possible, but in a few countries it is business as usual.”

However, the virus has impacted the daily lives of people across the region and livelihoods, particularly in urban areas where business activity has dropped significantly, have suffered.

Beyond immediate response, COVID-19 will have long-term multi-sectoral impacts, a USAID global review, “Over the Horizon,” concluded. The review concluded that the pandemic is “a health crisis of enormous scale: COVID-19 is overwhelming health care providers, facilities, and supply chains. Beyond the direct impact of the virus, the burden of other disease may grow. For example, nearly 120 million children risk missing measles vaccines this year.” Additionally, more than 132 million people are expected to experience chronic food insecurity.

Clearly, from service delivery to research, nutrition programs are no longer doing business as usual – indeed, there probably will be no “business as usual” again for a while. So what does the new context require of nutrition practitioners?

Mobile service delivery. In Kaduna State, Nigeria, the use of mobile platforms allowed health workers to provide dietary diversity messages to participants in a program to improve dietary diversity among children 6-23 months old by targeting fathers and religious leaders. The messages were delivered via SMS text messages and in WhatsApp groups. Teams in Bangladesh similarly adapted an initiative that had relied on in-person visits by developing a “mobile MIYCN” service for participants. The significant growth of cell phone ownership and cell phone communication coverage over the past decade have made these innovations possible. Community radio, which reaches millions in many rural areas across the globe, could similarly serve as a platform, teams noted.

Virtual meetings. Shortly after social distancing policies and interventions went into effect globally, in-person meetings became impossible – organizers simply canceled in-person events. But although nutrition stakeholders were grounded, webinars allowed them to continue meeting colleagues worldwide to share information and knowledge. Because of the important role they are playing to help people connect, A&T has introduced a calendar of webinars of interest to stakeholders. Alert us to a webinar of interest: Send us an email or share on social media using the hashtag #OnlineMIYCN.

e-learning. In 2019, Alive & Thrive launched an IYCF e-learning hub, featuring a course on infant and young child feeding practices called “Investing in Child Nutrition.” This comprehensive course now includes the latest guidance for breastfeeding with COVID-19. Though access is limited by connectivity, e-learning courses allow for training to continue in a time when in-person training workshops are impossible or at least severely limited. Enrollments in the course has increased since the pandemic. It is based on the World Health Organization (WHO) Combined Course on Growth Assessment and Infant and Young Child Feeding Counselling with supplemental content from WHO, UNICEF, the Global Health Media Project, and the Raising Children Network (Australia).

In Viet Nam, popular influencer Quang Dang participated in a dance challenge to celebrate World Food Day with Alive & Thrive support.

Similar courses allow people to access information and knowledge that would otherwise be unavailable. But the courses do require internet connectivity, which is a significant barrier for millions of people particularly in low and middle income countries. Some courses have been updated to reflect COVID-19 guidance, while others, like the Tufts University Friedman School of Nutrition Science and Policy series, has introduced specific online trainings on the topic.

Using social media. Twitter, Facebook, Instagram, TikTok, Snapchat and other social media platforms offer numerous opportunities to deliver MIYCN messages. In honor of World Food Day 2020, A&T partnered with popular Vietnamese influencer Quang Dang to launch a dance challenge on Tiktok to raise awareness of the importance and benefits of breastfeeding. Programs can use digital platforms to reach audiences with key information, eliciting engagement that portends changes in behavior (although much more research is needed to clarify the role, if any, social media can play in achieving such changes).

As COVID-19 continues to affect lives worldwide, adapting to the pandemic means different things for different contexts. More research will help to clarify what modifications are most effective. Indeed, A&T and partners have modified some implementation research activities to learn what those adaptations might be.