Dr. K P KushwahaProf & Head,

BRD Medical College, Gorakhpur

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

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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)

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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%

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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

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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

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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

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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

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Functional IYCF Counseling Functional IYCF Counseling CentresCentres

• District: 1

• Block: 6

• Village: 600

607 IYCF Counseling Centers functional in Lalitpur

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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

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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

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Growth CardsGrowth Cards

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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

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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

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Feeds Feeds

• 100 gm. pack

• 6-1 yr 25 gm. 2 time in a day

• 1-2 yr 35 gm. 2 time in a day

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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

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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)

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Mothers perception on health of Mothers perception on health of their Children their Children

Dec- 2006 Jan.2009

Healthy 47.1% 80.5%

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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)

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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

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SAM

UndernutritionUndernutrition

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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)

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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

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Conti….

District & Block Level Counsellors

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Cases Cases

• Sore nipple, engorgement

• Helped to succeed

Case-1

• 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

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Case-4

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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

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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

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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