ensuring optimal breastfeeding and complementary feeding

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Ensuring optimal breastfeeding Ensuring optimal breastfeeding and complementary feedingand complementary feeding

Dr Arun Gupta MD FIAPDr Arun Gupta MD FIAP

ICMR New DelhiICMR New Delhi

23 Feb 201123 Feb 2011

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First year is critical!First year is critical!

Malnutrition strikes the most in infancy beginning in 3-4Malnutrition strikes the most in infancy beginning in 3-4 thth month , 29-30 % 6 months. Goes up and peaks by 18 month , 29-30 % 6 months. Goes up and peaks by 18 months, flat curve after that (NFHS 3)months, flat curve after that (NFHS 3)

Years of life

Brain development

Underweight (-2sd) NFHS-3

Over 60 million

10 lakh children

die during

first month,

14 lakhs by

1 year, and 20 lakhs

by 5 yrs.

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Diarrhoea

Neonatal disordersUnknown

Pneumonia

MeaslesMalaria

Other AIDS Neonatal disorders

Diarrhoea

Pneumonia

Source: Robert et al. LANCET 2003;361:2226-34

Three Major Killers

Breastfeeding is the No. 1 preventive intervention compared to any other intervention Lancet Series on child survival, and now on newborn survival : 2003 and 2004

MOSTLY PREVENTABLE

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Risk of neonatal mortality according to time of initiation

of breastfeeding

0.71.2

2.32.6

4.2

00.5

11.5

22.5

33.5

44.5

With in 1hour

From 1 hourto end of day

1

Day 2 Day 3 After day 3

Pediatrics 2006;117:380-386

Six times more risk of death

Additional benefits

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are needed to see this picture. U-5 child deaths (%) saved with U-5 child deaths (%) saved with key interventions in Indiakey interventions in India

1

2

3

4

6

15

4

6

15

0 2 4 6 8 10 12 14 16

Measles vaccine

Vitamin A

Water, sanitation, hygiene

Clean delivery

Complementary Feeding

Breastfeeding

Newborn resuscitation

Antibiotics for pneumonia

Oral rehydration therapy

Percentages

Lancet Child Survival Series,2003

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are needed to see this picture. Deaths attributed to sub-optimal Deaths attributed to sub-optimal breastfeeding among childrenbreastfeeding among children

53

18

55

20

0

10

20

30

40

50

60

Lower RespiratoryTrach (LRT)

Diarrhoeal Diseases(DD)

0-6 months

6-12 months

Public Health Nutr. 2006 Sep; 9(6): 673-85

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are needed to see this picture. 1st hour initiation cuts 22% 1st hour initiation cuts 22% of all newborn deathsof all newborn deaths

100%40%

10 Lac Neonatal Deaths

2.5 lac

If we enhance initiation of BF within one hour

2.5 lac babies will be saved

INITIATION OF BREASTFEEDING

NEONATAL DEATHS SAVED

Pediatrics 2006;117:380-386

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are needed to see this picture. Long term Impact of Long term Impact of BREASTFEEDINGBREASTFEEDING

Subjects who were breastfed Subjects who were breastfed experienced lower mean blood experienced lower mean blood

pressure and total cholesterol, as pressure and total cholesterol, as well as higher performance in well as higher performance in

intelligence tests. Prevalence of intelligence tests. Prevalence of overweight/obesity and type-2 overweight/obesity and type-2

diabetes was lower among diabetes was lower among breastfed subjects.breastfed subjects.

WHO, 2007

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Exclusive breastfeeding Reduces HIV Transmission Risk(Lancet 2007)

12

11

0

2

4

6

8

10

12

Haz

ard

Rat

io

ExclusiveBreastfeeding

Breastmilk +Formula

Breastmilk +Solids

1010



0

10

20

30

40

50

60

70

80

90

100

State of breastfeeding within one hour of birth (%) by Districts

Source: DLHS Fact Sheets 2007-2008 (http://nrhm-mis.nic.in/ui/Reports/DLHSIII/dlhs08_release_1.htm#BR)

155 Lacs out of 260 Lacs born DONOT

1111



0

10

20

30

40

50

60

70

80

90

100

State of exclusive breastfeeding for State of exclusive breastfeeding for the first six months by Districts the first six months by Districts

Source: DLHS Fact Sheets 2007-2008 (http://nrhm-mis.nic.in/ui/Reports/DLHSIII/dlhs08_release_1.htm#BR)

140 lacs out of 260 lacs born DONOT

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are needed to see this picture. Districts Level PerformanceDistricts Level Performance(Number 534-DLHS 2008)(Number 534-DLHS 2008)

Initiation of BF Initiation of BF within 1 hourwithin 1 hour

Exclusive Exclusive breastfeedingbreastfeeding

RED 138 112

YELLOW 197 373

BLUE 194 49

GREEN 5 0

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Trends :Initiation of Breastfeeding Within 1 hour

0

20

40

60

80

100

NFHS-1 (1992-93) NFHS-2 (1998-99) NFHS-3 (2005-2006)

Per

cen

tag

es

Source: NFHS-3, 2006

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Breastfeeding patterns by Breastfeeding patterns by ageage

0

10

20

30

40

50

60

70

80

2 months 4 months 6 months

Exclusively breastfed BM+Plain water only

BM+Other milk BM+complementary foods

Source: NFHS-3, 2006

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are needed to see this picture. Challenges in achieving optimal Challenges in achieving optimal breastfeedingbreastfeeding

Lack of programmatic focus on exclusive Lack of programmatic focus on exclusive breastfeedingbreastfeedingLack of skilled capacity among the health Lack of skilled capacity among the health workersworkersInterference of formula industry in planning Interference of formula industry in planning processprocessLack of maternity benefits for all womenLack of maternity benefits for all women

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Seven Strategies Seven Strategies

Education and

Training•Pre/In service

•School/college

Information•Data collection

•Monitoring

Protection of Breastfeeding

•Code implementation

Research•Programme and policy evaluation

•Implementation

Successful

Breastfeeding

Support•Skilled support•Work site support

•Maternity benefits

Coordination•Budget•Policy

Promotion•Campaigns

•Social mobilization

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are needed to see this picture. What Works – BF Counseling !What Works – BF Counseling !Meta-analysis on breastfeeding promotion strategies and feeding patterns

Haider BA, Bhutta ZA. Lancet 2008.

Method of Method of CounselingCounseling

Increase in Odds of EBFIncrease in Odds of EBF

Neonatal PeriodNeonatal Period At Six MonthsAt Six Months

Individual Individual counselingcounseling15 studies15 studies

3.45 (95%CI 3.45 (95%CI 2.20-5.42) 2.20-5.42) p<0.00001p<0.00001

1.93(95% 1.93(95% CI1.18 – 3.15) CI1.18 – 3.15) p<0.00001p<0.00001

Group Group CounselingCounseling6 studies6 studies

3.88 (95% CI 3.88 (95% CI 2.09-7.22) 2.09-7.22) p<0.0001p<0.0001

5.19 (95% CI 5.19 (95% CI 1.90-14.15) 1.90-14.15) p<0.00001p<0.00001

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WHO Growth standardsWHO Growth standards

Lactation Counseling by well trained counsellorsLactation Counseling by well trained counsellorsHelping/ assistance with initiation soon after birthHelping/ assistance with initiation soon after birthPreventing and resolving lactation problems.Preventing and resolving lactation problems.The first visit by a lactation counsellor within 24 h The first visit by a lactation counsellor within 24 h of deliveryof deliverySubsequent visits occurred at 7, 14 and 30 d, and Subsequent visits occurred at 7, 14 and 30 d, and monthly thereafter until the sixth month.monthly thereafter until the sixth month.

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are needed to see this picture. Compliance with MGRS feeding Compliance with MGRS feeding criteria by site and overallcriteria by site and overall

2020



Work at basics !Work at basics !

2121



Prolactin ReflexProlactin ReflexSecretion continues AFTER feed to produce NEXT feed

To increase milk production

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Oxytocin ReflexOxytocin Reflex

For milk ejection

3/3

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are needed to see this picture. Helping and Hindering the Oxytocin Helping and Hindering the Oxytocin ReflexReflex

For milk ejection3/4

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are needed to see this picture. Training materials that W.H.O. Training materials that W.H.O. ProvidedProvided

For specialized counsellorsFor specialized counsellors

1993 : Breastfeeding counselling : 5 days1993 : Breastfeeding counselling : 5 days

2000 : HIV Infant feeding : Addl. 3 days 2000 : HIV Infant feeding : Addl. 3 days

2003 : Complementary feeding : Addl. 3 days2003 : Complementary feeding : Addl. 3 days

For lay counsellorsFor lay counsellors

2005: Infant and young child feeding : 5 days.2005: Infant and young child feeding : 5 days.

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‘‘3 in 1’ Training Programme3 in 1’ Training Programme

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What do you want to achieve?What do you want to achieve?

MotivationMotivationPreventing and solving the problem of ‘not enough Preventing and solving the problem of ‘not enough milk’milk’Building confidenceBuilding confidenceMaintenance of exclusive breastfeeding for the Maintenance of exclusive breastfeeding for the first six months first six months Prevention of breast problems like sore nipples, Prevention of breast problems like sore nipples, mastitis ( 13% in various studies)mastitis ( 13% in various studies)Timely and appropriate complementary feeding Timely and appropriate complementary feeding after six months along with continued after six months along with continued breastfeeding breastfeeding

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MEP..the minimum essential MEP..the minimum essential programme of servicesprogramme of services

SPECIALIST COUNSELLOR with 7 day training SPECIALIST COUNSELLOR with 7 day training to deal with BREASTFEEDING , to deal with BREASTFEEDING , COMPLEMENTARY FEEDING and infant COMPLEMENTARY FEEDING and infant feeding and HIV feeding and HIV

Nutrition support to mothers, maternity Nutrition support to mothers, maternity benefits ,IGMSY, Family counselor benefits ,IGMSY, Family counselor IYCF by a 3 day training, at birth IYCF by a 3 day training, at birth assistance, home visits 4 in 2 weeks, assistance, home visits 4 in 2 weeks, and then every 2 weeks.and then every 2 weeks.

Family

Cluster of 5-10

Block/PHC

District level and above, medical colleges.

SPECIALIST COUNSELLORSPECIALIST COUNSELLOR

SPECIALIST SPECIALIST COUNSELLOR COUNSELLOR IN ALL PUBLIC AND PRIVATE HOSPS

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Thanks !Thanks !

ensuring optimal breastfeeding and complementary feeding

Documents

exclusive breastfeeding

state of breastfeeding

suboptimal breastfeeding

child deaths

hour initiation cuts

newborn survival

time of initiation

initiation of bf