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