Lalitpur – Community based counseling on
IYCF
Winning under nutrition and improving child health
Slide 2
Project Area
“BFCHI” (Baby Friendly Community Health Initiative) implemented in all the 6 blocks of Lalitpur
Slide 3
Infrastructure for IYCF Infrastructure for IYCF counseling in counseling in LalitpurLalitpur
• Total population - 9,94,470
• Intervention population - over 62 thousand children
(Jan.2007 to Feb.2009)
• Births (from 1stJan, 07–31st Dec-08) - 62324
• Follow up for 0-24m - 26333
• Follow up for 1yr - 13162
(from Jan, 07– Dec-07)
• IYCF counselors - 51 (yr 07), 24 (yr 08-09)
• Block Monitors - 2 (yr 07), 8(yr 08), 4 (yr 09)
Slide 4
Infrastructure Infrastructure contdcontd……
Trained MSGs - 1847 (607 centers)(607 centers)
ASHA - 495AWWs - 600Trained Mothers - 752
Performance of Centers
Above Average - 4 meeting/month = 28%
Average - 3 meeting/month = 35%
Below average - <2 meeting/month = 37%
Slide 5
Visible Change (independent survey Visible Change (independent survey and data collected through PGs)and data collected through PGs)
35.2%53.6%Under nutrition 1Yr-2yrs (< -2SD)
39.3%52.5%Under nutrition 6m-1yrs (< -2SD)
18 Years15 yearsMean age at marriage
44/100085/100IMR
20092001
Slide 6
MSGsMSGs--Village Level IYCF Village Level IYCF SupportSupport
• The 3 member team of AWWs, ASHA Dai, Link mothers from each village trained to promote and support optimal infant and young child feeding
• 600 Mother Support Groups formed in 6 blocks of Lalitpur
• 1847 local women trained for 3 days for 24 hour counselling/referral support in the villages
Slide 7
Village Level activitiesVillage Level activities
• Antenatal education of mothers about advantages of breastmilk and breastfeeding and how to succeed in breastfeeding.
• Early initiation of breastfeeding
• Helping mothers to learn positioning and attachment for effective breastfeeding
• Prevention of breastfeeding difficulties and breast conditions
• Expression of breast milk and katori feeding
• Exclusivity of breastfeeding
Slide 8
Activities Activities contdcontd……
• Identification of sick babies and their referral
• KMC
• Preparing good complementary food for babies and foods to feed
• Feeding skills for complementary feeding
• Variety and amount of foods for growing children
• Growth monitoring
• Recording of births & deaths
• Reports
Slide 9
Functional IYCF Counseling Functional IYCF Counseling CentresCentres
• District: 1
• Block: 6
• Village: 600
607 IYCF Counseling Centers functional in Lalitpur
Slide 10
Trainings (Trainings (Year 2007, 2008 & 2009)Year 2007, 2008 & 2009)
• Middle Level Trainers Training - 2 batches of 26+24 (7
day integrated 3 in 1 module of BPNI/IBFAN) (50
persons trained at Dept. of Pediatrics, BRD Medical
College, Gorakhpur)
• Training of Front Line Workers – (80 batches X 3 day)
total of 2447 ASHAs, AWWs, Dais and mother support
groups trained.
• Twenty Four ICDS Supervisors were oriented (1 Day) x 2
trainings.
• The 152 LHVs, ANMs and staff nurses from health and
family welfare department were trained in 3 day module
Slide 11
Growth Cards & CounselingGrowth Cards & Counseling
• Growth Cards (Wt for age, WHO GS)– Registered (births) - 62324 (2007 onwards)– Follow up growth cards - 26333 (from 0-2 yrs)– Follow up for 365 days - 13162 births– Wt for age and length for age - 1532 & 1940 (6m-2yrs)
• IYCF Counseling at house holds– By Block/District Counselors - Twice in a month in each
village
– By Village Counselors - 10 visits in first 6months,
6 visits in next 6 months and 3 visits in 2nd yr
IYCF Counseling at block and district level by counselors- every days
Slide 12
Meetings at all LevelsMeetings at all Levels
• Review meetings at District level, chaired by DM
• Monthly Block level meetings
• World Breastfeeding Week Celebrated (1-7 August)
• Mother Support Groups’ meetings
Slide 14
Low Cost Complementary Food Low Cost Complementary Food Preparation Preparation
• Wheat & Green Gram Mix Preparation-
Ingredients:
� Whole wheat 500 gm.
� Whole Green Gram 200 gm
� Nutritive Value/100gm
� Calories 342
� Protein 15.9
Slide 15
Status of IYCFStatus of IYCF
36.010.2Introduction of compliments at 8m (%)
49.043.6Introduction of compliments at 6 m (%)
85.053.8Introduction of thick Complementary feed between 6-8 m (%)
62.07.0Exclusively breastfed for 6 months(%)
15.067.0Pre-lacteal feeding (%)
15.022.8Initiation of breastfeeding within 1-3 hours (%)
72.010.9Initiation of breastfeedingwithin an hour (%)
EvaluationSurvey (2008)
BaselineSurvey(2006)
key Indicators
Slide 17
Status of IYCFStatus of IYCF
10.9
72
7
6253.8
85
0
10
20
30
40
50
60
70
80
90
Baseline Survey (Nov-
2007)
Evaluation Survey
(March-08)
Percentage of mothers byinitiation of bfdg within anhour
Percentage of mothers whoexclusively breastfed the childfor 6 months
Percentage of mothers bycomplementary feeding (6-8months)
Slide 18
Mothers perception on health of Mothers perception on health of their Children their Children
Dec- 2006 Jan.2009
Healthy 47.1% 80.5%
Slide 19
Nutritional status of babiesNutritional status of babies(weight for age) (n=1940, July 1(weight for age) (n=1940, July 1--1515thth, 2009), 2009)
1940
1249
691
Total
519(26.75%)1421(73.24%)Total
344(17.73%)905(46.64%)1 yr – 2yr
175(9.02%)516(26.59%)6m – 12m
Under nutrition (<-2zscore)
Normal
(-2 to +2zscore )
Age Group (boys and girls
combined)
Slide 20
SAM (Weight for Length) SAM (Weight for Length) (n=1940, July 1-15th-2009)
134(6.9%)
70
64
Total
71(3.65%)63(3.24%)Total
37(1.90%)33(1.74%)1 yr – 2yr
34(1.75%)30(1.54%)6m – 12m
<-3SD (Boys)
<-3SD (Girls)
Age Group
Slide 21
MAJOR MAJOR
WORLDWIDWORLDWIDE CAUSES E CAUSES OF DEATH OF DEATH AMONG AMONG CHILDREN CHILDREN
UNDER AGE UNDER AGE FIVE, 2000FIVE, 2000
Sources: For cause-specific mortality: EPI/WHO
For deaths associated with malnutrition: Caulfield LE, Black RE
Malnutrition and Global burden of diseases: underweight and cause specific mortality (paper in preparation)
Slide 23
Where is crisis, which one is Where is crisis, which one is
neglected?neglected?
• Death in 1 yr @ IMR (2008) 44/1000 live birth = 579
• Death in 1stmonth (2/3rd of IMR) = 386
• Death in 1m-12m period = 193
• Death in 1stwk (40% of IMR) = 231
• 84% neonatal deaths are due to 3 conditions- infections (42%), asphyxia (32%) and prematurity (15%)
• Number of children with SAM (6m-12m), @(6.9%) = 873
• Death among SAM children(6-24m) (@10%) = 88
Total birth in 1yr (13162)Slide 24
Where do we need to investWhere do we need to invest
• Unit cost per child in IYCF counseling =Rs200 per child per yr
• Need to invest in IYCF promotion
• Integrating in public health programme
Slide 25
• Perceived not enough milk
• Initiation at 30mts of birth
• Baby cried during night & was given animal milk
• Improving position & attachment, giving information
• Mother succeeded
Case-2
Case-3Mother name : Smt LakshmiFather Name : Khushi lalBaby Name: SunderAddress : Lakhanpura,
Jakhaura, Lalitpur
Pain during feeding-not able to feed
Observation-
∆ Sore nipple engorgement
Skills - ∆ Confidence building∆ Expression∆ Katori feeding∆ Position and Attachment∆ Succeeded in breastfeeding
Slide 31
Case-4
Slide 32
Mother name : Smt TejaFather Name : Mauji SheriyaBaby Name : MAddress : Jamundhana,
Birdha, Lalitpur
Sick mother, not feeding right under nourished baby
Observation-Poor attachment
Skills - ∆ Open questions∆ non verbal comm., empathy ∆ Accepting∆ Informing∆ Helping in positioning &
attachment∆ Explaining others what has been done
Result - Succeeded
Case-5
Slide 33
Village visit∆ Mobilishing peoples support∆ Listening mothers and
observing breastfeeding ∆ Helping mothers to improve
attachment ∆ Measuring weight gain∆ Mothers confident in breastfeeding
∆ Dietary history∆ Demonstration of making
babies feed and active feeding
Slide 34
Case-6
Severely undernourished orphaned Tribal child
∆ Carried to PHC and NRT centre
∆ Vit-A, drugs and Locally prepared cereal mix with oil ∆ Wt. gain