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This case study developed by the GNC Technical Alliance documents the DRC’s experience of supporting non-breastfed children during an Ebola Virus Disease epidemic to inform future guidance and programming in this gap area. The case study was developed through a desk review of available resources and policies, along with key informant interviews with UNICEF, WFP, ADRA and Ministry of Health personnel involved in the response.

ABOUT THIS BRIEF:

In every emergency, it is necessary to assess and act to protect and support the care and nutrition needs of both breastfed and non-breastfed infants and young children (Operational Guidance on Infant and Young Child Feeding in Emergencies, 2017 www.ennonline.net//resources/operationalguidancev32017).

This case study focuses on support for nonbreastfed children in the context of Ebola as this is a relatively new area of programming with limited documentation to date. In 2019, the Global Nutrition Cluster (GNC) Technical Alliance (formally GTAM) examined technical challenges commonly faced by Nutrition in Emergencies (NiE) practitioners and the gaps in knowledge and guidance contributing to these challenges. The related report identified “strong global guidance on the management of nonbreastfed children during emergencies” as a priority technical gap, highlighting challenges that practitioners frequently experience. During the 2019 GNC Annual Meeting, an urgent call was put out for the revision of global guidance on Ebola Virus Disease (EVD) to ensure that Infant and Young Child Feeding in Emergencies (IYCF-E) is adequately integrated.

This technical brief documents the DRC’s experience of supporting non-breastfed children during an EVD epidemic to inform future guidance and programming in this gap area. This case study was developed through a desk review of available resources and policies as well as key informant interviews with UNICEF, WFP, ADRA and Ministry of Health personnel involved in the response.

BACKGROUND

On 1 August 2018, an Ebola Virus Disease (EVD) outbreak was declared in the Democratic Republic of the Congo (DRC). Almost a year later, on 17 July 2019, the World Health Organisation (WHO) declared the EVD outbreak a Public Health Emergency of international concern. By the time the outbreak was declared over on the 25 June 2020, a total of 3,470 confirmed and probable cases – including 2,280 deaths – had been reported, making it the worst EVD outbreak in the country’s history and the second largest and deadliest globally. 57% (1970) of the cases were female, among them were mothers who – in line with global and national guidance – were recommended to stop breastfeeding to prevent transmission of the virus to their child. To ensure these infants and young children continued to be nourished, over 3,000 affected infants (0-11 months) and young children (12-23 months) received breastmilk substitutes (BMS) as part of a comprehensive package of support that was integrated into the EVD response. This case study details how this was done as well as lessons learned during the process.

CONTEXT

The outbreak occurred in both urban and rural parts of North Eastern DRC, a densely populated area with a high population movement. As a result of decades of conflict, the region suffers from a chronic and complex humanitarian crisis. Prior to the outbreak, an estimated 3.58 million people were already in need of humanitarian assistance in the two worst affected provinces, North Kivu and Ituri. As with the rest of the country, these two affected provinces faced high rates of undernutrition (stunting prevalence of 49.6% for North Kivu and 47.1% for Ituri and wasting prevalence 4.6% in North Kivu and 11.2% in Ituri). At the start of the outbreak, several territories in both the North Kivu and Ituri provinces were estimated to be facing a food security crisis (phase 3). Coverage of key nutrition interventions was low due to funding constraints.

INFANT AND YOUNG CHILD FEEDING PRACTICES

Breastfeeding is common in North Eastern DRC, with upwards of 95% of mothers in the affected provinces initiating breastfeeding after birth (DHS 2013-14). A MICS Survey (2017-2018) reported exclusive breastfeeding rates of 65.2% in Ituri and 83.7% in North Kivu (the national average is 53.5%). Complementary feeding is largely inadequate, with just 13.8% and 11.8% of children aged 6-23 months receiving the minimum acceptable diet in North Kivu and Ituri respectively (DHS 2013-14). Contributing factors include poor availability, accessibility, and (seasonal) affordability of adequate and diverse foods, inadequate services and sub-optimal caregiver knowledge of appropriate infant and child feeding practices.