It is well known that the process of human development starts right after conception and continues throughout all the stages of life, including pregnancy, after birth, childhood and other subsequent stages of life.
It is, however, very important for us to acknowledge that some stages are more critical to human development than others in terms of normal brain development, as well as other aspects of life, such as speech and social behaviours. This, therefore, calls for the need to put more attention in these phases of life in order to have a society that will have a child with the full potential to develop into a complete and well-balanced person that will have a long-standing impact on themselves, families, communities as well as the nation at large.
Scientific evidence has shown that the first three years are the most important in the life of a child. Up to 80 per cent of the child’s brain development occurs in the first three years, hence, this makes it the most vulnerable stage to environmental factors. Any deficiencies in the nutrients needed for normal brain development during this period could result into irreversible significant impairments in the subsequent stages of life.
According to the Rwanda Early Childhood Development Policy, 2016 (EDP, Rwanda 2016), Rwanda had an estimated population of children of around five million, of which about 15 per cent were under the age of six (early childhood).
This is a very significant portion of the country’s populace and represents the future Rwanda. Therefore, timely intervention will help in developing the country that we wish to see tomorrow.
Nurturing a child well requires interplay by many parties, including but not limited to, the parents/ families, societies, as well as the government.
This starts as early as proper child planning before conception, so that appropriate measures are taken in preparation for a healthy pregnancy. A healthy baby comes from a healthy pregnancy.
According to World Health Organisation (WHO) recommendation, all women from the moment they plan to conceive until 12 weeks of pregnancy, should take a folic acid supplement (400 µg folic acid daily). This folic acid (also called folate) is a vitamin needed for the baby’s spine, brain structures and other parts of the body to develop normally.
However, currently most pregnancies are unplanned and many women don’t find out that they’re pregnant until four to five weeks into the pregnancy, and by this time, the baby’s spine and brain structures have already started to develop, and this can be associated with poor pregnancy outcomes with birth defects of the central nervous system, as well as orofacial defects, among others.
Only 44 per cent of pregnant women complete at least four of the prescribed antenatal healthcare visits (MINISANTE 2014/15). This shows poor pregnancy care which can be associated with poor outcome, including increased risk of mother-to-child transmission for HIV positive mothers.
It is important to acknowledge that the health and availability of a mother plays a big role in the early development phase of a child. Thus, measures to improve maternal health and reduce maternal mortality directly improve the early childhood development. Maternal mortality in Rwanda has been showing a steady reduction over the years (210, DHS 2014/ 2015) and an increase in percentage of pregnant mothers giving birth from a health facility. Data shows that averagely, 91 per cent of pregnant mothers in Rwanda give birth in a health facility, although the attendance is as high as 97 per cent in urban centres and as low as 89 per cent in rural areas (MINISANTE, 2014/2015).
The nutrition status of a child during this early childhood phase plays a major role in their development, hence needs proper dedication. The recommended adequate breastfeeding for at least the first six months of life isn’t fulfilled by some mothers due to factors such as poor maternal nutritional status, unavailability or ignorance.
About 38 per cent of children under the age of five are stunted and in general, poor early child growth and prevalence of anaemia which is an outcome of poor child diet is high at 36.5 per cent, causing irreversible child developmental delays (MINISANTE 2014/2015).
This early childhood phase is also very vulnerable to certain diseases (such as preterm birth complications, infections to new-borns, pneumonia, diarrhoea, malaria as well as malnutrition, and etcetera) which when proper intervention is delayed can easily lead to death. The neonatal mortality rate (death before end of month of life) is 20 per 1,000 births, a drop from 27 in 2010. The infant mortality rate and under five years mortality rates are at 32 and 50 respectively per 1,000 live births (MINISANTE 2014/2015).
Dr Ian Shyaka , Resident in Plastic surgery, Rwanda Military Hospital,