National Capacity Building Program on Infant & Young Child Feeding

Dr M.M.A.Faridi MD,DCH,MNAMS,FIAP

Professor & Head, Dept of PediatricsUniversity College of Medical Sciences & GTB Hospital, Delhi

And Course Director, BPNI T-O-T in IYCF Counseling

Course Director, WHO T-O-T in IYCF Counseling

Neonatal deaths and the Millennium Development Goals

Millennium Development Goal 4 can only be achieved if neonatal deaths are addressed

050

100

150

Glo

bal

mo

rtal

ity

pe

r 10

00

bir

ths

1960 1980 2000 2020Year

Under-5 mortality rate

Late neonatal mortality

Early neonatal mortality

Target for

MDG-4

1st hour initiation cuts 22% of all deaths

100%15.8%

11 Lac Neonatal Deaths

(2.5 lac

If we enhance initiation of BF within one hour

2.5 lac babies will be saved

INITIATION OF BREASTFEEDING

NEONATAL DEATHS SAVED

Pediatrics 2006;117:380-386

Relative Mortality Risk in Relative Mortality Risk in Absence of BreastfeedingAbsence of Breastfeeding

0

1

2

3

4

5

6

<2 2-3 4-5 6-8 9-11 12-13

The LANCET 2000; 355:451-5

Age in months

The State of the World’s Breastfeeding

South Asia 2006

U-5 Child Deaths (%) Saved with Preventive InterventionsU-5 Child Deaths (%) Saved with Preventive Interventions

0 2 4 6 8 10 12 14

Breastfeeding

Compementary feding

Zinc

Hibvac

Clean delivery

Water, Sanitaion, hygiene

Antesteroids

Vit A

TT

NB temp control

Nevirapine +no BF

Measles vac

Antibiofor PROM

Percentages

Quality of Life & Early Feeding

Neonatal Onset of Adult Diseases

Optimal Infant and Young Child Optimal Infant and Young Child FeedingFeeding

Optimal feeding defines exclusive breastfeeding from birth to six months of age and there after continued breastfeeding for 2 years or beyond with adequate, safe and timely family foods and liquids to meet nutritional needs.

Is Breast feeding So Simple?

Animal Kingdom:

1.Offspring on feet

2.Moves to udders

3.Makes position

No role of Mother

Human Beings:

1.Baby holds neck 3 mo

2.Walks at 1 yr

3.Mother makes position

No role of Baby

Expression of Breastmilk

Cup Feeding

Nasogastric Feeding

Complementary Feeding: Issues

• When to start

• What to start

• How to give

• How much to give

Energy required by age and the amount supplied from breast milk

En

erg

y (k

cal/d

ay)

1000

800

0-2 m 3-5 m

Age (months)

Energy Gap

Energy from breast milk

6-8 m 9-11 m 12-23 m

600

400

200

0

Stomach sizeStomach size

200 ml

Thickness of FeedThickness of Feed

Feeding situation

Key Message

• Help child to learn eating

• A growing child needs increasing amounts of food

Mother To Child Transmission of HIV

Vertical Risk of HIV Transmission

DuringLabor

0-6 mo 6-24 mo

7% 15% 8% 7%

Source: JAMA 2000,200163% Escape Infection

AIM of Infant Feeding in HIV

HIV Free Survival

No Spill over effect

MTCT: Early Mixed breastfeeding

7

16

19

25

7

2426

36

0

5

10

15

20

25

30

35

40

Birth 3 mo 6 mo 15 mo

% EBF to 3 moPartial BF

Coutsoudis et al, 1999; 2001

Cumulative HIV transmission Durban, SA

Breastfeeding and HIV Transmission

Breast fed Compliance: 96%Mortality: 24.2%

16% excess risk

Formula fed Compliance:70%

Mortality: 20%

Transmission rate %

0

10

20

30

40

IF Policy For Replacement Feeding

A = Acceptability Will ‘not BF’ stigmatize mother?

F= Feasibility Is RF feasible?

A= Affordability Can family afford animal milk?

S= Safety Can family safely give RF feed?

S= Sustainability Can family sustain RF.

Following VCCT and HIV+ve test

Feeding options

Exclusive BF-6 continued

Breastfeeding -24

Replacement feeding:• Home-prepared • Commercial

Modified breastfeeding: Exclusive BF-6, RF

Express-heat treated BM

•Breastfeeding by an HIVnegative mother

•Donor Milk

Universalization of Optimum IYCF

Every mother/family well informed,

empowered and counseled for IYCF by child friendly health delivery system

How to achieve universal IYCF

Country needs

National IYCF Program

that

reaches to every mother

What is Training?

Oxford Dictionary 2001

Train v:teach a person a particular skill or type of behavior

n:a series of connected events or thoughts

Oxford Thesaurus 2001

Train v:

1.Coach,discipline,teach,

educate,instruct,tutor,

prepare

2.Do exercises,rehearse,

practise

IYCF Training Course

To bring “Desired” change in Counselors Three Components:

• Cognitive Domain----Knowledge

• Psychomotor Domain-Skills

• Affective Domain-----Communication

Curriculum of Training Course

1.Contents

2.Process

3.Resources

4.Evaluation

5.Feed back

Curriculum: Contents

• Optimal infant nutrition, physio-anatomy of BF, suckling, BM expression, breast conditions, positioning/attachment, BF problems,

• Optimum replacement feeding • Vertical HIV transmission, IF practices, AFASS• Timely optimum complementary feeding• Listening, learning, confidence building skills • Maternal health, nutrition, maternity protection• IF in emergency: earthquake, tsunami, floods

Curriculum:Process

• Schedule: Duration, continuity, attention- span, time for prep/practice

• Methodology: Facilitates learning

• Cl exp-Demonstration,bed side observation

(live, simulated)

• UNCLE- Role play,stories,exercises,self learning, group discussion

What was available as training course

1.Breastfeeding counseling: A Training course

(40 hr/5 days ), WHO-Unicef 1993

2. Breastfeeding-complementary feeding counseling training course (45 hr/6 days), BPNI-2001

3.HIV and Infant feeding Counseling- A Training Course ( 18 hr/3days ), WHO-Unicef 2000

4.Complementary feeding counseling Training course ( 17 hr/3 days ), WHO 2002

Duration of earlier training courses

* Counselor: 5+3+3=11 days [40+18+17 hr]

*Trainer:11+11=22 days [80+38+34 hr]

Three sittings

IYCF Training Courses Available

Three courses are currently advocated

1. WHO Integrated Course

2. IFC Breastfeeding Advocacy Course

3. IBFAN/BPNI ‘3 in 1’ IYCF Course

IYCF Counseling: An integrated WHO course

• To familiarize basic health worker with IYCF counseling

• To solve common IYCF difficulties

• To refer complicated cases.

*No compressive grassroot level IYCF program

*IYCF specialist needs further training

Breastfeeding: Advocacy & Practice

• Main emphasis on breastfeeding and BFHI

• CF and HIV & IF are taken as related issues

• 2 wk course, does not produce IYCF trainers or course directors

IYCF Counseling – A Training CourseThe ‘3 in 1 course’

• To build national team for skill building of All HW in IYCF counseling.

• To create IYCF counseling specialists to manage All IYCF difficulties in Every situation.

6 days manual, training guide

National capacity building plan for IYCF

National Trainer

Middle Level Trainer

3 days training guide

Front Line Health Worker

counseling flip chart

Mother/family

Training national trainersRole of IBFAN/BPNI

Phase Time Resource Participant Method Outcome

I 6 days Course

director

6 NT tn Prepared 6 NT

II 7 days -do- 24 LE tn

Trainee

practice24 LE

III 2 days -do- 6 CD tn

TPDR 6 CD

Thank You