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Transcript of National Capacity Building Program on Infant & Young Child Feeding Dr M.M.A.Faridi MD,DCH,MNAMS,FIAP...
![Page 1: National Capacity Building Program on Infant & Young Child Feeding Dr M.M.A.Faridi MD,DCH,MNAMS,FIAP Professor & Head, Dept of Pediatrics University College.](https://reader036.fdocuments.us/reader036/viewer/2022062716/56649e045503460f94aefff9/html5/thumbnails/1.jpg)
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
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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
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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
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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
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The State of the World’s Breastfeeding
South Asia 2006
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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
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Quality of Life & Early Feeding
Neonatal Onset of Adult Diseases
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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.
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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
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Expression of Breastmilk
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Cup Feeding
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Nasogastric Feeding
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Complementary Feeding: Issues
• When to start
• What to start
• How to give
• How much to give
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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
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Stomach sizeStomach size
200 ml
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Thickness of FeedThickness of Feed
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Feeding situation
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Key Message
• Help child to learn eating
• A growing child needs increasing amounts of food
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Mother To Child Transmission of HIV
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Vertical Risk of HIV Transmission
DuringLabor
0-6 mo 6-24 mo
7% 15% 8% 7%
Source: JAMA 2000,200163% Escape Infection
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AIM of Infant Feeding in HIV
HIV Free Survival
No Spill over effect
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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
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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
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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.
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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
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Universalization of Optimum IYCF
Every mother/family well informed,
empowered and counseled for IYCF by child friendly health delivery system
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How to achieve universal IYCF
Country needs
National IYCF Program
that
reaches to every mother
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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
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IYCF Training Course
To bring “Desired” change in Counselors Three Components:
• Cognitive Domain----Knowledge
• Psychomotor Domain-Skills
• Affective Domain-----Communication
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Curriculum of Training Course
1.Contents
2.Process
3.Resources
4.Evaluation
5.Feed back
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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
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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
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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
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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
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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
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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
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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
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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.
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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
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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
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Thank You