breastfeeding tsek* tama, sapat, esklusibo
TRANSCRIPT
PROTECT INFANT HEALTH. SAVE LIVES.
BREASTFEEDING
TSEK Tama, Sapat, Esklusibo
Contents
1. Situation of Infants and Children
2. Current Evidence for Breastfeeding
3. National & Health Policies
4. National Programs & Strategies
5. Breastfeeding TSEK: Protecting Community Infants & Young Children
The Situation of Infants and Children
1
4
“The State shall protect and promote the right to health of the people and shall instill health consciousness among them.
Philippine Constitution, Art 2, Section 15
The State protects a Child’s right to Life and Good Health
5
Our National Commitment
The Philippines is committed to achieve the Millennium Development Goals
(MGD) by 2015.
One of 4 children, under 5 years, is malnourished
NUTRITIONAL
STATUS
PREVALENCE ESTIMATED
NUMBER
(IN MILLION)*
Underweight 26.2% 3.35
Underheight 27.9% 3.57
Thinness 6.1% 0.78
Overweight 2.0% 0.26
Source: 7th National Nutrition Survey, 2008
• The continued high rates of moderate and severe stunting (30%) and low birthweight (20%) highlight the need for greater attention to improving maternal nutrition and complementary feeding.
The State of the World’s Children 2009
8
Poor Nutritional Status
Predisposes to:
• increased severity and duration of diarrhea attacks
• Increased risk of dying from diarrhea
Ashworth and Feachem. Interventions for the control of diarrhoeal diseases among young children: weaning education.
Bulletin of the World Health Organization, 63 (6): 1115-1127 (1985)
9
Mortality Impact of Underweight
5% reduction in low weight for age by 2005
30% reduction in child mortality
10
Source: Pelletier and Frongillo. 2003. Pooled analysis of data from 59 countries from 1966 to 1996.
Breastfeeding evens the playing field
Breastfeeding is a natural "safety net" against the worst effects of poverty...it is almost as if breastfeeding takes the infant out of poverty for those first few months in order to give the child a fairer start in life and compensate for the injustice of the world into which it was born.
James P. Grant Former Executive Director UNICEF
3
4 Reduce by two
thirds the
under-five
mortality rate
between 1990
and 2015
Key Facts • 7.6 million children under the age of five die
every year (2010 figures).
• More than half of these early child deaths are due to conditions that could be prevented or treated with access to simple, affordable interventions.
• Leading causes of death in under-five children are pneumonia, preterm birth complications, diarrhoea, birth asphyxia and malaria. About one third of all child deaths are linked to malnutrition.
13 Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
CAUSES OF UNDER FIVE DEATHS, 2010
1 of 4 Philippine children under five years of age are at risk of infection & death
Source: WHO. Global Health Observatory (http://www.who.int/gho/child_health/en/index.html)
Our newborns are at risk of dying in the first 2 days of life
Strategies
• appropriate home care and timely treatment of complications for newborns
• integrated management of childhood illness for all children under five years old
• expanded program on immunization
• infant and young child feeding
16
Exclusive Breastfeeding Rates by Region
Why breast milk?
Breast milk Artificial Milk
Protein Correct amount
Easy to digest
Partly corrected
Fat Enough essential fatty
acids, lipase to digest
No lipase
Water Enough May need extra
Anti-Infective
Properties Present
Immunizes & Protects
ABSENT
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993
(WHO/CDR/93.6).
19
“If a new vaccine became available that could prevent one million or more child deaths a year, and that was moreover cheap, safe, administered orally, and required no cold chain, it would become an immediate public health imperative.
Breastfeeding can do all this and more.”
- 1994
Evidence presented in the Series on Child Survival 2003 , Series on Neonatal Survival 2005 , and the Series on Maternal and Child Undernutrition 2008 , clearly pointed out the importance of exclusive breastfeeding for the first six months of life which could save more lives than any other intervention studied while enhancing nutritional status
20
The Clinical Evidence on Exclusive Breastfeeding at Birth to 6 months
2
Effect of Breastfeeding
22
• For the vast majority of infants and young children throughout the world, breastfeeding saves lives prevents morbidity promotes optimal physical and cognitive development reduces the risk of some chronic diseases
• Evidence of the benefits of breastfeeding for mothers is growing as well
Leon-Cava et al. Quantifying the Benefits of Breastfeeding: A Summary of the Evidence. Washington, D.C.: PAHO © 2002
Infant Morbidity and Mortality
• The greatest and most obvious benefits of breastfeeding are for the immediate health and survival of the infant
23
Infant Morbidity and Mortality
• Rates of diarrhea, respiratory tract infections, otitis media, and other infections, as well as deaths due to these diseases, are all lower in breastfed than in non-breastfed infants
• Exclusively breastfed infants have at least 2½ times fewer illness episodes than infants fed breast-milk substitutes.
24 Source: Jones et al., 2003,; Chandra, 1979; Feachem, 1984; and Victora, 1987.
Protection Against Infection
25
INFECTIONS
% REDUCTION
Acute otitis media (exclusive BF 3-6 mos.)
50%
Recurrent otitis media (exclusive BF >6 mos.)
77%
Upper respiratory tract infection (exclusive BF >6 mos.)
64%
Lower respiratory tract infection (exclusive BF >6 mos.)
77%
Gastroenteritis 64%
Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012
Neonatal Conditions
INFECTIONS
% REDUCTION
Necrotizing enterocolitis 77%
RSV bronchiolitis (exclusive BF >4 mos.)
74%
Sudden Infant Death Syndrome (SIDS) (any > 1 month)
36%
Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012
Percentage of infants 2-7 months of age reported as experiencing ear infections, by feeding category in
the preceding month in the U.S.
Adapted from: Scariati PD, Grummer-Strawn LM, Fein SB. A longitudinal analysis of infant morbidity
and the extent of breastfeeding in the United States. Pediatrics, 1997, 99(6).
Risk of diarrhea by feeding method for infants aged 0-2 months, Philippines
Adapted from: Popkin BM, Adair L, Akin JS, Black R, et al. Breastfeeding and diarrheal morbidity.
Pediatrics, 1990, 86(6): 874-882.
Type of Feeding
• Hospitalized low birth weight infants who were fed with formula milk had 4 times the incidence of serious illness compared to those infants who were breastfed.
29
Randomized Controlled Trial of Low Birth Weight Hospitalized Neonates comparing type of feeding
vs. percentage with serious illness
• There is a 2-4 fold increase in neonatal mortality rate (NMR) in not receiving colostrum. There is a 5-13% decrease in NMR with exclusive breastfeeding
• Babies who were not breastfed in the first 6 months of their lives are 25 times more likely to die than those who experienced exclusive breastfeeding from the time they were born.
Infant Mortality
Source: Jones et al., 2003,; Chandra, 1979; Feachem, 1984; and Victora, 1987.
• The timing of initiation of breastfeeding is
important as there is a higher risk of death among infants with longer delay in the initiation of breastfeeding.
Early Breastfeeding initiation
Mullany LC, et al. JNutr, 2008; 138(3):599-603.
Delaying Initiation of breastfeeding increases risk of infection-related death
Nepal 2008 N = 22,838 breastfed babies
Relative risks of death from diarrhoeal disease by age and breastfeeding category in Latin America
Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant
mortality in Latin America. BMJ, 2001, 323: 1-5.
Relative risks of death from acute respiratory infections by age and breastfeeding category
in Latin America
Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of breast feeding on infant
mortality in Latin America. BMJ, 2001, 323: 1-5.
Protection Against Allergy
36
ILLNESS
% REDUCTION
Atopic dermatitis (negative family history) (exclusive BF > 3 mos.)
27%
Atopic dermatitis (positive family history) (exclusive BF > 3 mos.)
42%
Asthma (atopic family history) (exclusive BF > 3 mos.)
40%
Asthma (no atopic family history) (exclusive BF > 3 mos.)
26%
Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012
Protection Against Diseases
37
DISEASE
% REDUCTION
Type I diabetes
(exclusive BF > 3 mos.)
30%
Type 2 diabetes
(any)
40%
Leukemia (ALL)
(exclusive BF > 6 mos.)
20%
Leukemia (AML)
(exclusive BF > 6 mos.)
15%
Obesity (any)
24%
Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk,
originally published online February 27, 2012
Breastfeeding decreases the prevalence of obesity in childhood at age five and six years, Germany
Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and
obesity: cross sectional study. BMJ, 1999, 319:147-150.
Breastfeeding increases intelligence
Child Development
• Breastfeeding was associated with significantly higher scores for cognitive development than was formula feeding
• Premature infants derive more benefits from breast milk than do full-term infants
• The benefits of breastfeeding increased with duration
Anderson et al. Breast-feeding and cognitive development: a meta-analysis. Am J Clin Nutr 1999;70:525–35
40
Child Development
Largest randomized trial ever conducted in the area of human lactation (17,046 infants) strongly suggest that with prolonged and exclusive breastfeeding:
• Improvement in cognitive development as measured by IQ (verbal IQ, performance IQ, full-scale IQ)
• Teachers’ academic ratings at age 6.5 years were significantly higher for both reading and writing
Kramer et al. Breastfeeding and Child Cognitive Development :New Evidence From a Large Randomized Trial.
Arch Gen Psychiatry. 2008;65(5):578-584 41
Duration of breastfeeding associated with higher
IQ scores in young adults, Denmark
Adapted from: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association between duration of
breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.
43
Benefits of breastfeeding
for the mother
Short-term Benefits
• Decreased post-partum blood loss
• Rapid involution of the uterus
• Decrease in post-partum depression
• Increased child spacing due to lactation amenorrhea
44
Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, originally published online February 27, 2012
Long-term Benefits • Reduced risk of chronic diseases:
Type 2 diabetes mellitus (no history of gestational DM)
Rheumatoid arthritis
Cardiovascular disease (hypertension, hyperlipidemia)
Breast cancer (primarily premenopausal)
Ovarian cancer
• Significantly decreased rate of child abuse/ neglect
45 Source: American Academy of Pediatrics Policy Statement: Breastfeeding and the Use of Human Milk, originally published online February 27, 2012
0 1 2 3 4 5 6
Adapted from: Beral V et al. (Collaborative group on hormonal factors in breast cancer).
Breast cancer and breastfeeding: collaborative reanalysis of individual data from 47
epidemiological studies in 30 countries… Lancet 2002; 360: 187-95.
Breast cancer and breastfeeding:
Analysis of data from 47 epidemiological studies
in 30 countries
Risks of artificial feeding
• Interferes with bonding
• More diarrhea and respiratory infections
• Persistent diarrhea
• Malnutrition Vitamin A deficiency
• More likely to die
• More allergy and milk intolerance
• Increased risk of some chronic diseases
• Overweight
• Lower scores on intelligence tests
• May become pregnant sooner
• Increased risk of anemia, ovarian and breast cancer
Mother
Adapted from: Breastfeeding counselling: A training course. Geneva, World Health Organization, 1993 (WHO/CDR/93.6).
Baby
Exclusive Breastfeeding Protects Infant Health & Saves Newborn Lives
Laws & Policies on Exclusive Breastfeeding for 6 Months
3
Key Health Policies Mandate Breastfeeding for Infants & Young Children
• Republic Act 7600 Rooming-in and Breastfeeding Act and IRR
• Republic Act 10028 An Act Providing Incentives to All Government and Private
Health Institutions with Rooming-In and Breastfeeding Practices and For other Purposes
• Executive Order 51, s. 1986 National Code of Marketing of Breastmilk Substitutes and
Products (“The Milk Code”)
DOH Administrative Orders
• 2005-0014 – National Policies on Infant and Young Child Feeding
• 2006-0012 –Implementing Rules and Regulation of E.O. 51, Otherwise known as “The Milk Code,” Relevant International Agreements, Penalizing Violations Thereof, and for Other Purposes
• 2007-0026 – Revitalization of the Mother-Baby Friendly Hospital Initiative in Health Facilities with Maternity and Newborn Care Services
• 2008-0029 - Mother-Baby Friendly Hospitals
• 2009-0025 - Adopting Policies and Guidelines on Essential Newborn Care
• 2010-0010 - Revised Policy on Micronutrient Supplementation to Support Achievement of 2015 MDG Targets to Reduce Under-five and Maternal Deaths and Address Micronutrient Needs of Other Population Groups
Key Health Policies Mandate Breastfeeding for Infants & Young Children
Key Health Policies
Philhealth • No. 12-2005 – Adoption of PhilHealth Benchbook on
Performance Improvement of Health Services
• No. 26-2005 – Requirement for Accredited Hospitals to be “Mother-Baby Friendly Hospitals”
• No. 34-2006 – PhilHealth Newborn Care Package
DILG
National Programs
Promoting Health & Lives of
Infants & Young Children
4
National Infant Young Child Feeding Strategy
2011 – 2016
Source: NCDPC, Department of Health
Children have the right to adequate nutrition and access to safe and nutritious food, and both are essential for fulfilling their right to the highest attainable standard of health. Infant Young Child Feeding Policy (IYCF), 2011-2015
Department of Health
Infant Youth Child Feeding Strategy, 2011-2016
• GOAL
Reduction of child mortality and morbidity through optimal feeding of infants and young children
OUTCOMES By 2016:
• 90 percent of newborns are initiated to breastfeeding within one hour after birth;
• 70 percent of infants are exclusively breastfeed for the first 6 months of life; and
• 95 percent of infants are given timely adequate and safe complementary food starting at 6 months of age.
Since 2008: Mother Newborn Child Health & Nutrition (MNCHN) Service Package
Financing
Health Facilities and Service Packages
Human Resource
Health Products and Pharmaceuticals
Other Support Systems
Pre-Pregnancy Services
Antenatal care Postpartum and Postnatal Care
Care during Delivery
Our Maternal, Newborn and Child Protection Strategy
PRENATAL AT BIRTH EXCLUSIVE FOR 6 MONTHS
SUPPLEMENTARY FOODS FOR 2
YEARS
Health Plan Essential Intrapartum and Newborn Care
in Facilities
“EINC Unang Yakap”
Exclusive Breastfeeding for 6 Months
in Communities
“Breastfeeding TSEK”
Infant and Young Child Feeding
(IYCF) Strategy
Unang Yakap 4&5
Safer, evidence-based, better quality care
for mothers & newborns in all health facilities
Breastfeeding
is the national health strategy to protect infant health & save lives
(DOH, IYCF 2011-2016)
Breastfeeding TSEK: Exclusive Breastfeeding to 6 Months
5
Tama - immediate
and appropriate
breastfeeding within one
hour after birth
• Sapat - mother’s milk
is sufficient ( in
nutrients and quantity)
for the baby up to 6
months
EKsklusibo - exclusive
breastfeeding for 6 months,
just pure mother’s breast
milk only, not even water.
Helping mothers to initiate and to exclusively breastfeed…
needs an Inter-sectoral Response
The MDG-F Joint Program:
• The Breastfeeding TSEK campaign is a component of the Joint Program by the UN Country Team to help the Philippines achieve MDG # 1 and 4
• Supported by the Spanish Government
• It is called the MDG-F 2030: Ensuring Food Security and Nutrition for Children 0-24 months in the Philippines
LGU Policies for
EINC Unang Yakap
& Breastfeeding
TSEK
LGU Allocation of Resources for EINC
Unang Yakap & Breastfeeding TSEK
Mobilization & Advocacy -Mothers -Health Professionals -Private Sector
Building Competence &
Commitment of Health
Professionals & Team TSEK
Health Governance: Unang Yakap & Breastfeeding TSEK
Peer Counselling Scaled Up for Breastfeeding Mother & Babies,
Pre, At-birth and 6 months
Plans & Policies: EINC in
Hospitals & TSEK Plan
LGU Policies for
Breastfeeding
TSEK
LGU Allocation of
Resources to sustain
LGU TSEK
Private Sector Mobilization
& Advocacy
Building Competence &
Commitment of the Team
TSEK Core Group
Breastfeeding TSEK in LGUs
Community Peer Counselling
Scaled Up for Breastfeeding
Mother & Babies
Health Staff develop TSEK
Plan for City Health
Investment Plan
Breastfeeding TSEK in LGUs
Key Action Steps
1) Update LGU Ordinances & Health Policies
2) Train LGU Health Staff & TSEK Peer Counsellors
3) Develop the Breastfeeding TSEK Plan & incorporate into LGU Health Plan
4) Mobilize TSEK Counsellors and build strong community support
5) Mobilize private sector support: private health sector, academe, business,
6) Monitor, Innovate & Sustain Breastfeeding TSEK
Step 1: Formal LGU Support
• LGU Ordinances & Guidelines
• Advocacy with LGU Stakeholders
– Powerpoint presentations and handouts for LCEs and TSEK Peer Counselors for use of CHDs
– Visual promotional materials to be used by Mayors/ LGUs
– Sample press stories, radio scripts for Mayors/LGUs to promote local initiatives on keeping mother and baby safe and healthy
Step 2: Training of Peer Counselors • Training of Peer Counselors (PCs):
A Training Institution , ARUGAAN, was hired to conduct the Peer Counselor’s Training- training design is done and trainer’s reference manual being finalized after the pilot run in 3 cities
PC trainings conducted in Quezon City, Marikina, Pasig, Taguig, Caloocan, Navotas, Parañaque, Pasay, Mandaluyong, Makati - a total of about 1,800 PCs trained
Mentoring done in Quezon City, Marikina, Pasig, Taguig, Caloocan, Navotas, Parañaque,
Training of Peer Counselors
Step 3: Mentoring Done at the Barangay House to House Visits Practicum w/ Mentors
Regular monthly meetings w/ midwives to process (share and learn) experiences in actual counseling
Step 4: Monitoring with TSEKlist Card
Step 5: Mobilizing LGU Partnerships
• Advocacy Kits & Materials
• Joint issuance with DSWD, Dep Ed, DILG, Civil Service
• MOAs with NGOs, civic and professional societies and groups
Step 6: Sustain Breastfeeding TSEK
• Enact LGU policy allocating resources for Breastfeeding TSEK
• Build breastfeeding facilities
• Expand and motivate the TSEK Peer Counsellors
• Strengthen mothers education
• Build capacity of health facilities & LGU health professionals for safe & quality Essential Intrapartum and Newborn Care or “Unang Yakap”
Educate, Create, Support: Doctors, Nurses, Midwives Mothers & Families
Erase Breastfeeding Myths Practice Exclusive Breastfeeding for 6 Months
Proteksyon ng Sanggol.
Pamana ng Buhay.
Alagang Tunay.
THANK YOU