Revitalization of BFHI

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Revitalization of BFHIRevitalization of BFHI

Randa SaadehScientist

Nutrition for Health and DevelopmentSCN, Rome, 2007

Nutrition for Health and Development

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In response to WHA mandateIn response to WHA mandate

59th WHA (WHA59.21) Infant and young child nutrition (2006) 'revitalization of Baby-friendly Hospital Initiative to protect, promote and support breastfeeding'

Nutrition and HIV/AIDS (WHA 59.11) urging Member States 'encouraging revitalization of the Baby-Friendly Hospital Initiative in the light of HIV/AIDS'


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And other global strategies And other global strategies and joint initiativesand joint initiatives

Global strategy for infant and young child feeding WHO/UNICEF (2002)

Innocenti Declaration 2005WHO/UNICEF on IYCF AEM, IBFAN, ILCA, LLLI, Wellstart, WABA

Durban statement on Nutrition and HIVWHO/UNICEF/WFP/UNAIDS/FAO/UNHCR (2005)


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Now where do we stand?Now where do we stand?Have Have 20 000 BFHs – However… 20 000 BFHs – However…

not accelerating at same pace and reluctance to achieve baby-friendly status especially in private hospitals

Lack of support and recognition from governments some ‘slippage’, i.e. falling back into old patterns rates of exclusive breastfeeding for the first 6 months are still relatively low-

38% counselling skills and coverage by health-care workers still need to be

enhanced poor supervision of trained staff and monitoring of quality of services

provided weakened commitment in the face of HIV/AIDS pandemic and the number

and gravity of other emergencies influence of infant food industry


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BFHI update and changesBFHI update and changes

Scientific-evidence

Sections of new package

Expansion and integration options

Technical updates on 'Ten Steps' and clinical practice

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Why now and what has Why now and what has been done?been done?


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3%

3%

4%

4%

5%

6%

7%

13%

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

Antenatal steroids

Water, sanitation,hygiene

Clean delivery

Hib vaccine

Zinc

Continued BF withComplementary feeding

Insecticide treatedmaterials

Exclusive Breastfeeding

Optimal Infant feeding practice reduces Under-five mortalityOptimal Infant feeding practice reduces Under-five mortalitySource: Lancet Child Survival Series 2003Source: Lancet Child Survival Series 2003

expected % of reduction in U5M

inte

rven

tion


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WHO Child Growth StandardsWHO Child Growth Standards

A growthchart for the 21st

century 1 year 2 years 3 years 4 years 5 years


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Comparison of WHO with NCHS length/height-for-Comparison of WHO with NCHS length/height-for-age z-scores for boysage z-scores for boys

Age (months)

Leng

th /

Hei

ght (

cm)

6080

100

120

0 2 4 6 8 12 16 20 24 28 32 36 40 44 48 52 56 60

0

-1

-2

-3

1

2

3

WHONCHS

Source: MGRS Group. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length,weight-for-height and BMI-for-age: Methods and development. Geneva: World Health Organization, 2006


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Policy Statements on infant feedingPolicy Statements on infant feeding

"The breastfed infant is the normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short- and long-term outcomes", American Academy of Pediatrics, 1997

"The promotion and practice of breastfeeding is essential to the achievement of optimal infant and child health, growth and development", American Academy of Pediatrics, 2005

National infant feeding policies of many countries recommend exclusive breastfeeding as the optimal source of nutrition for the first six months of life.


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ObesityObesityIs the other side of the spectrum of malnutritionIs the other side of the spectrum of malnutrition

Breastfed babies could have 30% reduced risk of becoming obese children compared with bottlefed children

Overweight children are at higher risk of becoming overweight adolescent and adults. Other factors include exercise and hereditary.

FactsWe know enough this still a challenge

Picture removed…


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Scientific-evidence



Technical updates on 'Ten Steps? and clinical practice


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Baby-friendly Hospital InitiativeBaby-friendly Hospital InitiativeRevised, Updated and ExpandedRevised, Updated and Expanded

for Integrated Carefor Integrated Care

Section 1: Background and ImplementationSection 2: Course for Decision-makersSection 3: "20 hour" Course for Maternity StaffSection 4: Hospital Self-appraisal & MonitoringSection 5: External Assessment & Reassessment

January 2006January 2006


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New 20-hour Course New 20-hour Course

focuses on helping staff members support mothers to succeed with early and exclusive breastfeeding and help implement the “Ten Steps”

content includes:– HIV and infant feeding– Mother-friendly birthing practices and

breastfeeding– Support for women who are not breastfeeding


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The revised BFHI assessment tools are:The revised BFHI assessment tools are:

Still focused on what mothers and staff know and can do, rather than self-reporting by management

Revised to reflect current evidence and added emphasis on the Code and support for non-BF mothers

Revised to include optional "modules" on:–HIV and infant feeding–Mother-friendly care


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Selected enhancements to the Selected enhancements to the Ten StepsTen Steps

Step 2: Addition of interviews of non-clinical staffStep 4: Skin-to-skin and initiation of BFChange in interpretation of step from: "Help mothers initiate breastfeeding within a half-hour

of birth" to "Place babies in skin-to-skin contact with their mother

immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed."


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Step 6: Updates to the acceptable medical reasons for supplementation

Step 8: Feeding on "demand" changed to "feeding on cue"

Step 10: Post-discharge support Addition of assessment of early post-discharge

follow-up and referral system


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Scientific-evidence



Technical updates on 'Ten Steps' and clinical practice


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Expansion optionsExpansion options

1.5.1 Baby-friendly Communities1.5.2 BFHI and PMTCT

1.5.3 Mother-baby friendly care1.5.4 Baby-friendly NICUs

1.5.5 Baby-friendly Paediatric Care


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Baby-friendly health care – everywhere!Baby-friendly health care – everywhere!

Integration into Child Survival strategiesIntegration into IMCIIntegration into Maternal SurvivalIntegration with EPI campaignsIntegration into Emergency

preparedness and emergency responseOthers?


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Scientific-evidence



Technical updates on 'Ten Steps? and clinical practice


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Underway…Underway…

Revision of the 'Scientific basis for the Ten Steps'

Physiological basis

Strengthening 'Step 10' and link to community


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Finer points of skilled practical management - Finer points of skilled practical management - infant not ready to feed immediately after deliveryinfant not ready to feed immediately after delivery

Picture removed…


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...the same baby showing signs of readiness to feed 30-40 ...the same baby showing signs of readiness to feed 30-40 minutes after deliveryminutes after delivery

Picture removed…


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……..stretching and twisting the nipple to help the baby to ..stretching and twisting the nipple to help the baby to attach - but not effectiveattach - but not effective

Picture removed…Picture removed…


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Baby’s real need - early skin-to-skin contact on the Baby’s real need - early skin-to-skin contact on the delivery tabledelivery table

Picture removed…


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Kangaroo Kangaroo Mother Mother CareCare

Dr N

ils B

ergm

an, C

ape

Tow

n, S

outh

Afri

ca12/2

Picture removed…


28 Slide 4v

Picture removed…


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For revitalization of BFHIFor revitalization of BFHIIn shortIn short

keep alive

sustain progress

ensure quality and adherence to global criteria

use concept but stay focused

show its effectiveness and health impacts


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Working togetherWorking togetherat different levels and partnersat different levels and partners

High quality of care for

mothers and children

International Organizations

GovernmentsMOHs and others

Regional/ countries offices

NGOs

Professional/scientific groups

Civil society groups

Industry

Religious group


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Working together with critical partnersWorking together with critical partners

all have a role with assigned responsibilities and obligations

expand and integrate within a defined framework but

follow agreed joint guidelines of working with private sectors and avoid conflict of interest

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Thank you!Thank you!

Documents

Revitalization of BFHI