ABSTRACT
Background: Globally, multisectoral coordination for nutrition is needed to tackle multiple determinants of undernutrition and address unacceptably high rates of stunting in young children. Tanzania has strong national policies and implementation plans to strengthen multisectoral nutrition (MSN) governance, yet local actors must transcend sector silos to fully implement MSN actions in communities. Objectives: We engaged with Nutrition Officers in Regional Secretariats and District Councils to explore strategies, barriers, and facilitators for creating novel "MSN action teams." Methods: An initial "Learning Exchange" workshop gathered input from nutrition staff in 5 regions and invited their participation in mentoring and supporting MSN collaboration. Regional Nutrition Officers piloted action teams in their districts, supporting District Nutrition Officers to create teams of 3-4 officers from relevant sectors (agriculture, community development, health, education) to plan and implement community-based activities consistent with sector priorities and national policy. To learn from stakeholder experiences, longitudinal data were collected through individual semistructured interviews and documentation of activities; 27 officers were interviewed 1-4 times over 14 mo. Results: Four districts successfully created action teams that bridged communication gaps between administrators and implementors; made progress on advocacy, collaboration, and budgeting for nutrition; and initiated MSN implementation in communities. Participants identified strategies to overcome challenges to cross-sector collaboration including heavy workloads and limited resources and supervisor buy-in. Based on their experiences and innovations in creating MSN action teams, stakeholders shared valuable recommendations for peer learning across sectors to scale up MSN collaboration. Officers' presentation of insights to regional and district leaders buoyed interest in MSN action teams as a feasible and acceptable approach to strengthen local governance and implementation to improve child nutrition. Conclusions: Experience-based input from government officers engaged in novel community and intersectoral collaborations provided actionable guidance for putting national MSN policy into practice and leveraging the capacity of implementation staff.
ABSTRACT
BACKGROUND: Effective promotion of exclusive breast-feeding (EBF) is needed to improve child nutrition and survival. OBJECTIVE: We explored barriers and facilitators to EBF in rural Tanzania and assessed parents' willingness and ability to try specific recommended EBF practices plus strategies for men to support breast-feeding. METHODS: We conducted Trials of Improved Practices in 36 households with infants <6 months. Fathers participated in focus group discussions on ways to support breast-feeding. Fathers and mothers were individually interviewed 2 and 3 times, respectively, about their willingness to try and experience with selected new practices. We analyzed data thematically. RESULTS: Common barriers to EBF were (1) use of gripe water and traditional medicines for perceived symptoms of infantile distress; (2) mothers' workloads and time away from infants, limiting availability for EBF; and (3) water given for perceived thirst. Although several mothers expressed concerns about breast-milk insufficiency, few were giving other foods. After counseling, most mothers reported breast-feeding more optimally. Some reported improved breast-milk supply. Fathers saw their roles as providing food to mothers to ensure sufficient breast-milk and encouraging new practices. Dominant gender roles and work away from home were barriers even if fathers were willing to help with household chores. Fathers mostly provided emotional support or encouraged others to help with chores. CONCLUSION: Exclusive breast-feeding promotion needs to address concerns about infantile distress and help parents develop effective soothing techniques while avoiding nonprescribed medicines. Engaging men in EBF interventions could help change social norms and facilitate men's involvement in improving breast-feeding practices.
