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NATIONAL LACTATION CENTRE

BFHIISSUES IN MALAYSIA

by

DR PARAMJOTHI P.Senior Consultant

Department of Obstetrics & Gynaecology

and

HeadNational Lactation Centre

Hospital Selayang

2DR. PARAM

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BFHI

Introduced in 1993 – 18 years ago

Initial euphoria

Certification/Plaque - UNICEF

Failures - Reassessments

LACTATION MANAGEMENTLACTATION MANAGEMENT

DR. PARAM

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LACTATION MANAGEMENT

Cross-sectional studies from industrialised and developing countries have clearly shown :

“Health Professionals, Administrators and Policy Makers lack knowledgeabout BF and their attitudes and

practices are often not supportive of BF.”

BFHI

DR. PARAM

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PRIORITY

LOW!!!

Low at ALL levels

Administrators / Policy makers

Clinicians (especially Obstetricians)

Monitoring - poor

LACTATION MANAGEMENT

DR. PARAM

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BFHI Step I

POLICY

Name-sake only

Policy details not implemented

No reviews/updates

Public not informed

DR. PARAM

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BFHI Step 2

TRAINING

Pitfalls

Just a formality

No training after course / practice

Unable to provide / disseminate

DR. PARAM

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BFHI Step 2

TRAINING

Specialists/Consultants – shy-away

Medical Officers - compulsory

House Officers - not involved!

Nurses - excellent

Doctors combined with nurses to pass Step 2DR. PARAM

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BFHI Step 2

TotalNumber

TotalTrained

Percentage(%)

TotalNOT

Trained

Percentage(%)

Doctors 189 78 41.3 111 58.7

Nurses 980 692 70.6 288 29.4

STAFF TRAININGSELANGOR STATE - HEALTH

ANALYSIS - AUGUST 2004

DR. PARAM

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BFHI Step 2

TRAINING - DOCTORS

Obstetricians - mostly not interested, not trained

Refuse to attend courses - “no time”, “boring”

Training CD - inadequate

Courses run by nurses - negative attitude

Forced to attend - failure to understand the importance DR. PARAM

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BFHI Step 3PATIENT TRAINING

Needs improvement

Importance of Antenatal Education vs

at delivery/postpartum

Booking/Only delivery at hospital

Health Clinics - inadequate- Hospital based programme

DR. PARAM

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BFHI Step 3

Compliance

Ethnic differencesChinese?

Educated vs Rest

Urban vs Rural

Return to work

DR. PARAM

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LACTATION MANAGEMENT

Chinese Mothers : Reasons for not BF

Herbs, alcohol, oily food (linseed oil). Mostly eating habits

Babies looked after by :• Mother, Mother-in-law• Baby sitters• Professional Confinement Amahs

Breast size

BFHI - STEP 3

DR. PARAM

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BFHI Step 4

LABOUR & DELIVERY

Skin to skin

Initiation – patchy

Caesarean section - epidural- spinal

Param’s Technique – 11 Steps

Skin to skin & Initiation in OT - not done

Separation still practised (private sector)DR. PARAM

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BFHI Step 7

ROOMING-IN

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BFHI Step 8

DEMAND FEEDING

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DEMAND AND EXCLUSIVE

DR. PARAM

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BFHI Step 10

Support

Poor / Non-existant

Main reason – discontinuation

Support Group Training

Lactation Clinics

Doctors – input necessary

DR. PARAM

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BFHI Step 11 / Item 11

Infant Formula Code

Gentlemen’s agreement

No punitive action

Purchases ?? - Public- Private

4th Version 1st August 2008

Infant Formula Companies – not helping

DR. PARAM

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BFHIPrivate Hospitals

MOH plan – Dec. 2003

Only 6 out of 200 +

Not Compulsary

Loose patients / Financial loss

Senior Consultants – not interested

Policy bad

Owners / administrators..?? DR. PARAM

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LACTATION MANAGEMENT

BFHI Certification - UNICEF Plaque

Initial euphoriaProgramme dormant/ “sleep mode”Activated weeks before reassessmentUNICEF plaque - negative impactMOH information of dates for reassessmentReady/Not ready

PROGRAMME NOT ACTIVEACTIVATED ONLY FOR REASSESSMENT

DR. PARAM

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LACTATION MANAGEMENT

MONITORING TOOLS

Special training needed

Advised by MOH - 3/6 monthly

Usually done before assessments (2 years)

*Policy must be changed*Monthly*Immediate action to correct problems

DR. PARAM

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LACTATION MANAGEMENT

LACTATION COMMITTEE

Obstetrician as ChairmanRepresentatives :Administrators - SeniorSenior staff - Specialists, DoctorsAll wards - SistersOBGYN & PaediatricsMatron

Representatives from all Health Centres referring casesFMS3 monthly meetings DR. PARAM

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LACTATION MANAGEMENT

BFHI REASSESSMENTS

Sudden - anytime after expiry

Ongoing programme

Prevent preparation for assessments

Punitive action for failures

Feeder HCs assessed together (2006 criteria)

DR. PARAM

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LACTATION MANAGEMENT

PRIVATE HOSPITALS

Serious lack of commitment

Practices guided by clients comfort

Financial considerations

Completely overlook long-term health benefits

BFHI - Problems

DR. PARAM

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BFHI

DOCTORS???

________________________________________

NATIONALLACTATION

CENTREDR. PARAM

30DR. PARAM

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BFHI

BUDGET AND FINANCES ???

32THANK YOUTHANK YOU