Infant and Young Child

FeedingNorth East Consultation Meet on Nutrition

Shillong, 17-18 February, 2005

Dr. Tarsem Jindal MD FIAPCoordinator, Programs BPNIHOD 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

Diarrhoea

Neonatal disordersUnknown

Pneumonia

MeaslesMalaria

Other AIDS

INDIA: Report Card Survival 2.4 million U-5 deaths in India

Three Major Killers in India

Neonatal sepsis

Diarrhoea

Pneumonia

Breastfeeding is No. 1 intervention for all the three

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/underdev.

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

11.9

2

37.5

11.8

58.5

23.1

58.4

24.1

0

10

20

30

40

50

60

<6 months 6-11 months 12-23 months 24-35 months

%-2SD %-3SD

NFHS-2, 1998-99First three years are for ever…..

51.5%47.1%

19.3%

47.0% 45.5%

15.5%

Underweight Stunted Wasted

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

Children 0- 3 years

Malnutrition : A silent emergency

Promoting early child development is crucial...

10

0% 2% 4% 6% 8% 10% 12% 14% 16% 18%

Breastfeeding

Complementary feeding

Clean delivery

Hib vaccine

Clean water, sanitation, hygiene

Zinc

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

Inte

rve

ntio

nPercent

Under-5 deaths preventable through universal coverage with individual interventions (2000)

India

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

Challenge : Universal Coverage (90%)

Both RCH and ICDS need to respond

Opportunity : ICDS Universalisation and RCH II !

The deficit to

Make up!

0%

20%

40%

60%

80%

100%

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

50.0%80.0% 75.0%

15.8%41.2% 33.5%

0%20%40%60%80%

100%

NFHS-2 Tenth Plan Goal

Initiation ofbreastfeeding within

one hour

Exclusivebreastfeeding (0-6 months)

Complementaryfeeding (6-9 months)

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

33.9 42.5

69.7

16.140.7 43.9

16.3

70

23.6

63.659

23.3

100

61.6

49.1

0

20

40

60

80

100

120A

run

ach

alP

rad

esh

Ass

am

Man

ipu

r

Meg

hal

aya

Miz

ora

m

Nag

alan

d

Sik

kim

Tri

pu

ra

NFHS-2 10 Plan Goals

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

Global evidence what works

Effect of Community-based Promotion of Exclusive Breastfeeding on Diarrhoeal Illness and Growth: A Cluster Randomized Control Trial

0%

10%

20%

30%

40%

50%

60%

70%

Initiation ofbreastfeedingwithin 3 hours

Not GivingPrelacteal Feeds

ExclusiveBreastfeeding forthe First 6 months

ControlInterventional

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

0%

10%

20%

30%

40%

50%

60%

70%

Initiation ofbreastfeedingwithin 1 hours

Not GivingPrelacteal Feeds

ExclusiveBreastfeeding forthe First 6 months

ControlInterventional

BPNI (Unpublished Data, 2004)

Effect of Community–based Peer Counsellors on Exclusive Breastfeeding Practices in Dhaka, Bangladesh: A Randomised Control Trial.

0%

10%

20%

30%

40%

50%

60%

70%

Initiation ofbreastfeedingwithin 1 hour

Not GivingPrelacteal Feeds

ExclusiveBreastfeeding forthe First 5 months

ControlInterventional

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)

0%

10%

20%

30%

40%

50%

60%

Exclusive Breastfeeding for the First 6 monthsControlInterventional

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 don’t 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