INFANT AND YOUNG CHILD FEEDING

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INFANT AND YOUNG CHILD FEEDING

• NEW DIRECTIONS AND PROGRAM STRATEGIES
• Global Health Mini-University
• October 27, 2006
• By Rae Galloway

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WHY IS INFANT AND YOUNG CHILD FEEDING SO
IMPORTANT?

• BECAUSE POOR INTAKE OF FOOD (QUANTITY AND
  QUALITY), EITHER DURING PREGANCY OR IN THE FIRST
  TWO YEARS OF LIFE, IS THE CAUSE OF MALNUTRITION
  IN DEVELOPING COUNTRIES.

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IN THIS SESSION WE WILL ANSWER THE FOLLOWING
QUESTIONS

• WHY IS IT IMPORTANT TO REDUCE MALNUTRITION?
• HOW PREVALENT IS MALNUTRITION AND WHEN DOES IT
  OCCUR?
• WHAT ARE GOOD PRACTICES FOR INFANT AND YOUNG
  CHILDREN FEEDING?
• WHY ARE INADEQUATE INFANT AND YOUNG CHILD FEEDING
  PRACTICES THE MAJOR CAUSE OF MALNUTRITION?
• WHAT PROGRESS HAS BEEN MADE IN ADDRESSING IYCF
  AND WHAT ARE THE GAPS?
• WHAT ARE THE PROGRAM GAPS AND HOW CAN THEY BE
  ADDRESSED?

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Why is it Important to Address Malnutrition?Becau
se Reducing Malnutrition is Essential for Poverty
Reduction

• GDP losses at least 2-3
• Leads to a gt10 potential reduction in lifetime
  earnings for each malnourished individual
• Malnutrition (stunting) in early years linked to
  a
• 4.6 cm loss of height in adolescence
• 0.7 grades loss of schooling
• 7 month delay in starting school

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WHY IS IT IMPORTANT TO ADDRESS MALNUTRITION?

• Because 50 of Child Deaths Are Associated With
  Malnutrition

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How Prevalent is Malnutrition? (Trends in
underweight children 0-4 years, 1980-2005)
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THE PROBLEM OF MALNUTRITION IS STILL EXTENSIVE
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MOST OF THE MALNOURISHED STILL LIVE IN ASIA BUT
IN SUB-SAHARAN AFRICA PREVALENCE IS INCREASING

• Proportion of the Worlds Underweight Children by
  Region (2020)

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HAVE REDUCTIONS IN MALNUTRITION BEEN SIMILAR TO
REDUCTIONS IN CHILD MORTALITY?

• Mean Changes in Child Mortality, Under-Five
  Mortality and Child Malnutrition From National
  Surveys (Pelletier Frongillo, 2002)

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WHAT ARE THE CAUSES OF MALNUTRITION?
                                                
           ltgt Source UNICEF 1997

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DISEASE-MALNUTRITION INTERACTIONS

                                                
            Source Andrew Tomkins and Fiona
Watson, Malnutrition and Infection, ACC/SCN,
Geneva 1989
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WHAT ARE GOOD PRACTICES FOR INFANT AND YOUNG
CHILD FEEDING
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GOOD PRACTICES FOR INFANT AND YOUNG CHILD FEEDING
INCLUDES CARING FOR CHILDREN WITH SPECIAL NEEDS

• CHILDREN WHO ARE SICK NEED TO RECEIVE TREATMENT
  FOR THEIR ILLNESS
• CHILDREN WHO ARE SICK NEED TO BE FED DURING THE
  ILLNESS AND NEED TO RECEIVE MORE FOOD AFTER THEY
  RECOVER FROM ILLNESS (RECUPERATIVE FEEDING)
• CHILDREN WHO WONT EAT (E.G., ANOREXIC) NEED TO
  BE ACTIVELY FED OR COAXED TO EAT
• CHILDREN WHO ARE LOW BIRTHWEIGHT NEED IRON
  SUPPLEMENTS AT ABOUT 2 MOS. OF AGE AND ALL
  CHILDREN NEED IRON SUPPLEMENTS AFTER 6 MOS.
• CHILDREN LIVING IN CULTURES WHERE DIETS ARE
  MONOTONOUS MAY NEED MICRONUTRIENT SUPPLEMENTS
  (SPECIAL FORTIFIED COMPLEMENTARY FOODS OR
  MICRONUTRIENTS ADDED TO THEIR FOOD)

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GOOD PRACTICES FOR INFANT AND YOUNG CHILD FEEDING
INCLUDES CARING FOR CHILDREN WITH SPECIAL NEEDS

• MOTHERS WHO ARE HIV NEED COUNSELING ON HOW TO
  SAFELY AND ADEQUATELY FEED THEIR NEWBORNS
• CHILDREN OF HIV MOTHERS SHOULD RECEIVE
  REPLACEMENT FEEDING IF IT IS ACCEPTABLE,
  FEASIBLE, AFFORDABLE, SUSTAINABLE AND SAFE
• IF REPLACEMENT FEEDING IS NOT AFASS, THEN HIV
  MOTHERS NEED COUNSELING ON THE SAFEST WAY TO FEED
  THEIR INFANTS TO ENSURE CHILD SURVIVAL FROM HIV
  AND OTHER CHILDHOOD ILLNESSES (DIARRHEA)

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WHAT PROPORTION OF MOTHERS CAN WE GIVE COUNSELING
TO PREVENT MOTHER-TO-CHILD TRANSMISSION? (MALAWI
CASE)

• TOTAL POPULATION 10 M.
• PREGNANT WOMEN (4) 400,000
• CHILDRENlt1 YEAR 400,000 (BEST CASE SCENARIO)
• CHILDREN AT RISK OF MALNUTRITION 200,000
• MOTHERS TESTED FOR HIV (20) 80,000
• MOTHERS TESTED WHO ARE HIV (13) 10,400
• 10,400 MOTHERS NEED SPECIAL COUNSELING TO PREVENT
  MOTHER-TO-CHILD TRANSMISSION
• 380,000 MOTHERS NEED COUNSELING ON IYCF

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The Progression of Malnutrition Percentage of
Underweight Children by Age Group
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When Malnutrition Occurs The Window of
Opportunity for Improving Nutrition is very
smallpregnancy until 18-24 months of age
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MALNUTRITION OCCURS IN THE FIRST YEAR OF LIFE
BECAUSE ENERGY DEMANDS ARE HIGHEST AT THIS TIME
WEIGHT GAIN IN A WELL-NOURISHED CHILD THE FIRST
YEAR OF LIFE IS CRITICAL
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Even Though the Amount of Weight Gain is Large,
the Amount of Extra Energy Needed to Prevent
Malnutrition is Small
Kcal/day
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THE ENERGY GAP IS CAUSED BY AN INFORMATION GAP

• A STUDY IN LAO PDR FOUND THAT VILLAGE LEADERS
  IDENTIFIED 55 FOOD ITEMS CONSUMED IN THE VILLAGE
• LESS THAN 20 FOOD ITEMS WERE BEING FED TO
  CHILDREN AND HALF OF THESE, FRUITS AND
  VEGETABLES, WERE FED TO ONLY A FEW CHILDREN
  (EXCEPT BANANA WHICH WAS MORE POPULAR)
• MEAT AND OTHER ANIMAL PRODUCTS WERE FED TO ONLY A
  FEW CHILDREN

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REASONS WHY LAO CHILDREN WERE NOT FED CERTAIN
FOODS

• MOTHERS FROM TWO ETHINIC GROUPS DID NOT
  BREASTFEED EXCLUSIVELY FOR 6 MONTHS BECAUSE THEY
  BELIEVED THEIR MILK WAS NOT SUFFICIENT FOR THEIR
  INFANTS
• PARENTS DID NOT BELIEVE CHILDREN COULD DIGEST
  CERTAIN FOODS WHICH WOULD CAUSE DIARRHEA
• EGGS WERE THOUGHT TO CAUSE PARASITES, DIARRHEA
  AND HARM TEETH

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It is Estimated that Over Half of Malnutrition
Occurs in Families with Adequate Food
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ARE MOTHERS WILLING AND ABLE TO CHANGE THE WAY
THEY FEED THEIR YOUNG CHILDRENTRIALS OF IMPROVED
PRACTICES FROM LAO PDR
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What Evidence Do We Have That Improving Infant
and Young Child Feeding Reduces Malnutrition?

• Case 1 Thailand

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Thailand Key Features

• National Program
• A total of 600,000 village volunteers were
  trained growth monitoring and nutrition
  education by village communicators (110 HHs) and
  village volunteers (1100-200 HHs)
• Promotion of locally produced foods as
  supplements for malnourished children
• Integration of nutrition in Ministry of Health
  extension programs with village volunteers
  assisting
• Training on nutrition for community workers,
  youth groups, day care centers, workers of
  Ministry of the Interior
• Nutrition education in school curriculums
• Targeted Program to Poorest Areas
• Provision of basic primary health and nutrition
  services
• Provision of latrines and clean water
• Literacy programs
• Agricultural production projects
• Village development and employment projects

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What Evidence Do We Have That Improving Infant
and Young Child Feeding Reduces Malnutrition?

• Case 2 Indonesia

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Indonesia Key Features

• 3 m. village volunteers trained (110 children or
  160 people)
• Monthly growth monitoring and promotion
  (nutrition counseling)
• Growth monitoring sessions used as an entry point
  for other child health services
• The focus was on child growth and catching early
  growth faltering
• Targeted food supplements for severely
  malnourished children
• The first program to develop nutrition counseling
  materials based on formative research with
  mothers for village workers to use
• Commitment by government was high

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To Address Malnutrition It Cannot Be Business
as Usual
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To Address Malnutrition It Cannot Be Business
as Usual (cont)
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Major Shifts in Approaches are Needed to Address
Malnutrition
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FUTURE CHALLENGES

• TARGET CHILDREN lt1-2 YEARS OF AGE TO PREVENT
  MALNUTRITION
• PROMOTE INTEGRATED PROGRAMS AT THE COMMUNITY
  LEVEL TO IMPROVE CHILD HEALTH AND NUTRITONAL
  STATUS
• ADDRESS ALL INFANT AND YOUNG CHILD FEEDING
  PRACTICES (BF CF) TO ENSURE ADEQUATE CHILDREN
  RECEIVE ADEQUATE ENERGY
• IMPROVE THE QUALITY OF COMPLEMENTARY FOODS
  (FORTIFICATION, DIVERSIFICATION, EXPAND THE
  NUMBER OF FOODS AVAILABLE TO CHILDREN)

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FUTURE CHALLENGES

• MAKE FREQUENT CONTACT WITH MOTHERS AND CHILDREN
  TO CATCH EARLY GROWTH FALTERING
• GIVE ACTION ORIENTED MESSAGES THROUGH ONE-ON-ONE
  COUNSELING TO CHANGE FEEDING PRACTICES (INCREASE
  NUMBER OF MEALS, QUALITY, ACTIVE FEEDING)
• PAY ATTENTION TO THE FEEDING PRACTICES OF
  CHILDREN WITH SPECIAL NEEDS (THOSE WITH HIV
  MOTHERS)

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FUTURE CHALLENGES

• ACCESS EACH FAMILIES NEED FOR ADDITIONAL
  FOODDONT GIVE FOOD TO FAMILIES WHO DONT NEED
  IT
• UNDERSTAND WHY AND WHEN MOTHERS UTILIZE
  INFORMATION AND WHY THEY DONT
• BE FLEXIBLE TO THE NEEDS AND DESIRES OF MOTHERS
• SEEK SUPPORT FOR MOTHERS FROM OTHER FAMILY MEMBERS

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TAKE-HOME MESSAGES OR PEARLS

• MALNUTRITION IS A SERIOUS AND PREVALENT PROBLEM
• MALNUTRITION INCREASES MORBIDITY AND MORTALITY
  AND DECREASES EDUCATIONAL ACHIEVEMENT AND
  LIFETIME EARNINGS
• INADEQUATE INFANT AND YOUNG CHILD FEEDING IS THE
  MAJOR CAUSE OF MALNUTRITION
• INADEQUATE IYCF IS NOT PRIMARILY DUE TO LACK OF
  FOOD (QUANTITY) AT THE HOUSEHOLD LEVEL BUT
  BECAUSE OF POOR PRACTICES
• LACK OF INFORMATION ABOUT HOW FEEDING YOUNG
  CHILDREN IS A MAJOR REASON FOR POOR BREASTFEEDING
  AND COMPLEMENTARY FEEDING OF INFANTS AND YOUNG
  CHILDREN

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FINAL MESSAGE ITS TIME TO SCALE UP PROGRAMS
AND GET THE MESSAGE TO FAMILIES ABOUT HOW TO FEED
THEIR INFANTS AND YOUNG CHILDREN!