Infant and Young Child Feeding

North East Consultation Meet on Nutrition Shillong, 17-18 February, 2005

Dr. Tarsem Jindal MD FIAP Coordinator, Programs BPNI HOD Pediatrics, Jaipur Golden Hospital, Delhi

IYCF relevance

This is the Direct intervention needing action Key component of care , less understood Ensures survival Ensures optimal development on infants and young children Global and national guidelines Legal protection Global evidence what works

INDIA: Report Card Survival

2.4 million U-5 deaths in India

Other Malaria Measles

AIDS

Diarrhoea

Pneumonia Unknown

Three Major Killers in India Neonatal sepsis Diarrhoea Pneumonia Breastfeeding is No. 1 intervention for all the three

Neonatal disorders

Source: Robert et al. LANCET 2003;361:2226-34

INDIA : Report card : Development

Estimates : About 36 million U-3 children are underweight and thus under developed. Impaired cognitive, physical, psychosocial development Impairs intelligence, strength, energy and productivity

Normal Underweight/under dev.

Global Strategy for Infant and Young Child Feeding

Adopted by the WHA and UNICEF Executive board in 2002

National guidelines on IYCF launched 6 August, 2004

The law to protect, promote and support breastfeeding: 6

August,2004

Focus on under three malnutrition

60 50 40 30 20 10 0
11.9 2 11.8 23.1 37.5 24.1 58.5 58.4

<6 months

6-11 months 12-23 months 24-35 months %-2SD %-3SD

First three years are for ever..

NFHS-2, 1998-99

Malnutrition : A silent emergency

Promoting early child development is crucial...
51.5% 47.0% 47.1% 45.5%

19.3%

15.5%

Underweight

Stunted NFHS 1 (1992-93) NFHS 2 (1998-99)

Wasted

Children 0- 3 years

Under-5 deaths preventable through universal coverage with individual interventions (2000)
Percent 0%
Breastfeeding Complementary feeding Clean delivery Hib vaccine Clean water, sanitation, hygiene Zinc

India

2%

4%

6%

8% 10% 12% 14% 16% 18%

Intervention

Vitamin A Antenatal steroids Newborn temperature management Tetanus toxoid Antibiotics for PRM Measles vaccine Nivirapine and replacement feeding Insecticide-treated materials Antimalarial IPT in pregnancy

Source: Jones et al. LANCET 2003;362:65-71

10

Challenge : Universal Coverage (90%)

Both RCH and ICDS need to respond

Opportunity : ICDS Universalisation and RCH II !

The deficit to

Make up!
100%

80%

60%

40%

20%

0%

Exclusive Breastfeeding (0-6 months)

Best possible start rather a head start to life

Early child care including early start to breastfeeding sets the road to sound development and prepares babies for better learning

10th Five year Plan

GOALS
100% 80% 60% 40% 20% 0%
80.0% 50.0% 41.2% 15.8% 33.5% Complementary feeding (6-9 months) 75.0%

Initiation of breastfeeding within one hour

Exclusive breastfeeding (0-6 months)

NFHS-2

Tenth Plan Goal

Note: NFHS 2 data for exclusive breastfeeding is the simple average of 0-3 & 4-6 months period.

10th Five Year Plan Goals

Exclusive Breastfeeding in Northern Eastern States

120 100 80 60 40 20 0 33.9 42.5 16.1 61.6 49.1 69.7 23.3 40.7 43.9 16.3 23.6 59 100 70 63.6

Assam

Arunachal Pradesh

Mizoram

Meghalaya

Nagaland

Manipur

Sikkim

NFHS-2

10 Plan Goals

Note: NFHS 2 data for exclusive breastfeeding 0-3 months and 10th Plan Goals data is 0-6 months

Tripura

Global evidence what works

Effect of Community-based Promotion of Exclusive Breastfeeding on Diarrhoeal Illness and Growth: A Cluster Randomized Control Trial
70% 60% 50% 40% 30% 20% 10% 0%

Initiation of breastfeeding within 3 hours

Not Giving Prelacteal Feeds

Exclusive Breastfeeding for Control the First 6 months Interventional

Bhandari et al. LANCET 2003; 361:1418-1423

Effect of Counselling on Infant and Young Child Feeding by Trained Community Workers on Exclusive Breastfeeding: A Study from 235 Villages in 3 Blocks of District Bhuj, Gujarat
70% 60% 50% 40% 30% 20% 10% 0%

Initiation of breastfeeding within 1 hours

Not Giving Prelacteal Feeds

Exclusive Breastfeeding for Control the First 6 months Interventional

BPNI (Unpublished Data, 2004)

Effect of Communitybased Peer Counsellors on Exclusive Breastfeeding Practices in Dhaka, Bangladesh: A Randomised Control Trial.
70% 60% 50% 40% 30% 20% 10% 0%

Initiation of breastfeeding within 1 hour

Not Giving Prelacteal Feeds

Exclusive Breastfeeding for Control the First 5 months Interventional

Haider R et al. The Lancet 2000; 356: 1643-1647.

Efficacy of Home-based Peer Counselling to Promote Exclusive Breastfeeding: A Randomised Controlled Trial (Mexico)
60% 50% 40% 30% 20% 10% 0% Control Interventional

Exclusive Breastfeeding for the First 6 months

Source: Morrow AL et al. The Lancet 1999; 353:1226-1231

What is common to these 4?

Skills

of health workers or peer counsellors IYCF counselling is made available

What are the key obstacles?

The HIV argument

Evidence that mixed feeding doubles the risk of transmission through breastfeeding

Given that we are a population of mixed-fed babies, investments must be made to scale up exclusive breastfeeding in ALL babies to minimize transmission and options for the HIV+

What are the obstacles (49 districts study)?

Frontline workers don't carry clear concepts and lack skills to help women Confusing messages to mothers Doctors are not clear on the optimal feeding recommendations and push own opinion. Mothers feel they dont have enough

milk

The challenge
Provision of skilled Infant and Young Child Feeding counseling as a service Clearly , lack of skills with the frontline workers is an issue and a challenge

If we are not knowledgeable or skilled we tend to ignore the issue and become silent endorsers

ICDS deficits vis a vis IYCF

Not seen as an issue, 0-6 months does not exist Neglected training skills, Training weakest component Counseling/education is ignored, 30% , below average rating Growth monitoring is without context

Redefine the role of frontline workers : Equip them with skills and Specifics
Need to re look at frontline workers assignments AW: Main responsibility :Nutrition and health education

IYCF Counseling with a context preventing malnutrition and enhancing development

Recommendations

Plan of action to implement the National Guidelines on Infant and Young Child Feeding. Adequately resourced action plan on IYCF for the State to achieve results by 2007-08, with monitoring and evaluation components.

Recommendations
(contd)

Capacity building in each state: core of IYCF trainers. Adopting basic training of frontline workers within ICDS training plans. Keeping exclusive breastfeeding for first six months as indicator of progress in MPRs, QPRs.

BPNI activity in NE States

Child Survival and Development Report Card in all NE states Status of Infant and Young Child Feeding study in 6 districts of NE states. Guidelines for Breastfeeding and complementary Feeding in 5 languages. Network of 258 BPNI members in all NE states. Resource of National Trainers on IYCF counseling course.

Thank you