OUAGADOUGOU, 3 August 2009 (IRIN) - In the Sahelian desert country of Burkina Faso, water is often linked to life, but for newborns up to six months of age it can mean death when it dilutes the medicinal effects of their mother's breast milk, says the World Health Organization (WHO).

IRIN met with researchers in Burkina Faso's capital, Ouagadougou, who are investigating why the country has one of the region's lowest exclusive breastfeeding rates – around six percent according to preliminary government data. This is the first article in a five-part series about breastfeeding in West Africa to mark World Breastfeeding Week.

WHO and the UN Children's Fund (UNICEF) recommend feeding newborns only breast milk for their first six months to reduce the chances of developing diarrhoea and pneumonia, among the biggest child killers.

Various studies have shown that the disease-fighting nutrients and antibodies in breast milk can be neutralized when water and other foods are also given to the baby during this period.

Marcel Daba Bengaly, a biochemist and nutritionist who is leading 20 researchers in a UNICEF-funded study on breastfeeding practices in Burkina Faso, told IRIN that interviews with more than 1,000 pregnant women, mothers, fathers, opinion leaders, community elders and birthing attendants nationwide have shown exclusive breastfeeding to be an "unwelcome, impossible and foreign" concept in Burkina Faso.

The group's final report will be submitted to UNICEF in mid-August.

Water

"A mother's milk is not enough to nourish a child [participants said]. Water is offered to visitors and because newborns are considered visitors from another world, water becomes the first liquid of life," Bengaly told IRIN. "The first instinct is to give the baby water, lest it depart from this world."

The caregivers simply did not realize the limits of babies' systems. During interviews among the country's nine largest ethnic groups, researchers learned that besides breast milk, babies were given water mixed with ash, shea butter, plants or sugar in the belief these mixtures can cure, cleanse, protect from spirits and ward off death, Bengaly said.

Mixtures

What goes into a concoction varies by region and ethnicity. "Near Niger [the neighbouring country to the west], where the climate is hot and dry, a mother's milk is seen as too hot for the child and must be followed by water so the baby can cool down," Bengaly told IRIN.

"In peri-urban areas the air quality is poor, so families seek concoctions that can flush out impurities or protect the baby from evil spirits, without realizing that an infant cannot support the plant extracts that adults can," said the biochemist, who added that these extracts could damage the newborn's kidneys, while poor water quality increased the risk of waterborne diseases.

None of this was apparent to the babies' families said sociologist graduate student, Fatimata Borro, who conducted interviews among the Samo ethnic population. "The child [is perceived as] coming from another world, and all must be done to ensure the child stays in this world, including using traditional medicine."

Exclusive breastfeeding was seen as a luxury for the rich, said Bengaly. Some survey participants said babies living in air-conditioned homes could afford to be fed milk all the time because of the lack of heat and dust, which would need to be counteracted with water.

Malnutrition

Sometimes a diet of only breast milk went against tradition. Ami Ouedraogo, 22, told IRIN she did not exclusively breastfeed her nine-month-old child because that is not how child-rearing was done in her village. "Everyone feeds their babies water as well as breast milk."

She was with her daughter, Sofieta, whose height, arm circumference and weight were being measured by health workers from the Red Cross-Belgium at a weekly nutrition clinic in Tanlili village in Ouahigouya district, about 200km northwest of Ouagadougou.

After nine weeks of surveillance, Ouedraogo's baby weighed 5.6kg, half a kilogram more than her first weigh-in on 5 June, but not enough to change her classification as malnourished.

Exclusive breastfeeding provides all the energy and nutrients the infant needs for the first months of life, it continues to provide up to half or more of a child's nutritional needs during the second half of the first year, and up to one-third during the second year of life, WHO has noted.

Lack of exclusive breastfeeding during the earliest months can contribute to malnutrition. More than one million children's lives could be saved every year through improved breastfeeding practices, according to WHO and UNICEF.

The main barrier to changing breastfeeding practices was a reluctance to let go of customs, Bengaly told IRIN. "Women value their own milk and the intimacy breastfeeding nurtures, but breastfeed exclusively? Impossible, in their eyes."

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