Infant and Young Child Feeding

1

• Infant and Young Child Feeding
• North East Consultation Meet on Nutrition
• Shillong, 17-18 February, 2005

Dr. Tarsem Jindal MD FIAP Coordinator, Programs
BPNI HOD Pediatrics, Jaipur Golden Hospital,
Delhi
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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

3
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 20033612226-34
4
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

5
Global Strategy for Infant and Young Child
Feeding

• Adopted by the WHA and UNICEF Executive board in
  2002

6
National guidelines on IYCF launched 6 August,
2004
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The law to protect, promote and support
breastfeeding 6 August,2004
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Focus on under three malnutrition
First three years are for ever..
NFHS-2, 1998-99
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Malnutrition A silent emergency
Promoting early child development is crucial...
Children 0- 3 years
10
Under-5 deaths preventable through universal
coverage with individual interventions (2000)
India
Source Jones et al. LANCET 200336265-71
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Challenge Universal Coverage (90)

• Both RCH and ICDS need to respond
• Opportunity ICDS Universalisation and RCH II !

12
The deficit to Make up!
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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

14
10th Five year Plan GOALS
100
80
80.0
75.0
60
50.0
40
41.2
20
33.5
15.8
0
Exclusive
breastfeeding
(0-6 months)
NFHS-2
Tenth Plan Goal
Note NFHS 2 data for exclusive breastfeeding is
the simple average of 0-3 4-6 months period.
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10th Five Year Plan GoalsExclusive Breastfeeding
in Northern Eastern States
Note NFHS 2 data for exclusive breastfeeding 0-3
months and 10th Plan Goals data is 0-6 months
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Global evidence what works
17
Effect of Community-based Promotion of Exclusive
Breastfeeding on Diarrhoeal Illness and Growth A
Cluster Randomized Control Trial
Bhandari et al. LANCET 2003 3611418-1423
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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
BPNI (Unpublished Data, 2004)
19
Effect of Communitybased Peer Counsellors on
Exclusive Breastfeeding Practices in Dhaka,
Bangladesh A Randomised Control Trial.
Haider R et al. The Lancet 2000 356 1643-1647.
20
Efficacy of Home-based Peer Counselling to
Promote Exclusive Breastfeeding A Randomised
Controlled Trial (Mexico)
Source Morrow AL et al. The Lancet 1999
3531226-1231
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What is common to these 4?

• Skills of health workers or peer counsellors
• IYCF counselling is made available

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• What are the key obstacles?

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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

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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 dont have enough milk

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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

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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

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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

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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.

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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.

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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.

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Thank you