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Dr. Arun Gupta MD FIAP Founder and National Coordinator Breastfeeding Promotion Network of India (BPNI) and Regional Coordinator IBFAN Asia. Breastfeeding: The 1 st Hour Save ONE Million Babies. Breastfeeding: The 1 st Hour Save ONE Million Babies. Dr.Arun Gupta MD FIAP, India.

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Dr. Arun Gupta MD FIAP

Founder and National Coordinator

Breastfeeding Promotion Network of India (BPNI) and Regional Coordinator IBFAN Asia

Breastfeeding: The 1st Hour Save ONE Million Babies

WBW 2007


Breastfeeding the 1 st hour save one million babies

Breastfeeding: The 1st Hour Save ONE Million Babies

Dr.Arun Gupta MD FIAP, India

WBW 2007


How babies do in 1st minutes of life
How babies do in 1st minutes of life

  • Lets see the video clip

WBW 2007


Outline
Outline

  • Objectives and background

  • Little bit about history

  • Scientific evidence

  • Importance of the theme

  • Call for a Worldwide response : what next !

WBW 2007


Beginning breastfeeding within one hour beginning life with life
Beginning Breastfeeding within ONEhour :Beginning life with “life”

WBW 2007


Objectives
Objectives

  • To draw the attention of participants of GOLD 2007, on the theme of WBW 2007

  • Share some scientific data

  • To explain how important it is to mainstream support during first hour to ALL mothers

    • to save ONEmillion babies with just ONE action,

    • just ONEhour support and just ONE message….

  • To seek support from and encourage participants to establish breastfeeding within ONE hour as key indicator of health progress by the local and national governments, international organisations and all other communities locally and globally.

  • To seek support of participants to further the message and reach try to make a campaign on this issue.

WBW 2007


Background
Background

  • 36% of all child deaths are ‘neonatal’

  • Lancet Neonatal series recognised 16 interventions and exclusive breastfeeding is one

  • Early initiation of breastfeeding within one hour was not on the list

  • New study presents increased risk of neonatal deaths in addition to earlier data on exclusive breastfeeding

  • Poor coverage of Initiation of breastfeeding within one hour of birth , only 1 in 3.

  • Nov 2005 Lancet did an article on tracking of child survival interventions; Initiation of breastfeeding within one hour of birth was added in the newborn health section

WBW 2007



Bfhi 1992
BFHI 1992

  • Step 4 was, “Help mothers initiate breastfeeding within a half-hour of birth”

WBW 2007


World summit for children commitments
World Summit for Children Commitments

  • Millennium Development Goals (MDG) 4 calls for U-5 child mortality to go down to HALF by 2015.

  • UNICEF priority is in 60 countries ( U5MR>90/100live births, or No. of U5 deaths >50,000

  • These 60 countries account for 91% of all neonatal deaths

  • Almost all neonatal deaths occur in developing countries

WBW 2007



Risk of neonatal mortality according to time of initiation of breastfeeding
Risk of neonatal mortality according to time of initiation of breastfeeding

Six times more risk of death

This is in addition to earlier data set on child survival

Pediatrics 2006;117:380-386

WBW 2007


1st hour initiation cuts 22 of all deaths
1st hour initiation cuts 22% of all deaths of breastfeeding

INITIATION OF BREASTFEEDING

If we enhance initiation of BF within one hour

100%

30%

NEONATAL DEATHS SAVED

1 million

4 million

Pediatrics 2006;117:380-386

WBW 2007


Potential mechanisms
Potential Mechanisms of breastfeeding

  • Suckling shortly after birth have a greater chance of successfully establishing and sustaining breastfeeding throughout infancy.

  • However, the effect of early initiation persisted after controlling for established neonatal breastfeeding patterns.

  • Early feeding with non human milk proteins may severely disrupt normal gut function

  • Rich immune and non-immune components that are important for early gut growth and resistance to infection.

  • Promotion of warmth and protection may reduce the risk of death from hypothermia.

WBW 2007


Key findings of the study
Key findings of the study of breastfeeding

  • Sample more than 10,000 babies

  • 30% of the study population initiated breastfeeding after day 1 (late initiation)

  • 30% were not exclusively breastfed in the neonatal period

  • Exclusive breastfeeding was associated with a 4 fold reduction in risk of death when compared to infants who were fed solids or other milk. This confirms previous findings.

WBW 2007


Importance of findings
Importance of Findings of breastfeeding

  • An additional 2.5 fold reduction in risk of death was demonstrated in babies who survived to day 2 who initiated breastfeeding on the first day of life (early initiation) compared to infants who initiated after the first day of life (late initiation).

  • This type of effect of early initiation has never been reported.

WBW 2007


What it means
What it means? of breastfeeding

  • Translating these benefits to the whole population of neonates (breastfed and not breastfed) means that 16% of neonatal lives can be saved if all babies were breastfed from day 1, and 22% if breastfeeding were started within the first hour.

WBW 2007


Global impact of increases in coverage and promotion of early initiation of breastfeeding in less developed settings.

  • Projected absolute numbers of lives saved and the proportion of neonatal deaths avoided if 99% of infants initiated breastfeeding during the first hour or during the first day of life. **

  • Only 38 of the 60 countries had data available on initiation of breastfeeding within 1 hour and 1 day of birth.

  • The neonatal mortality rate for these 38 countries ranged from 15-70/1,000 live births.

  • For rest of 22 countries regional averages were used

    **Karen M Edmond, Ellie C Bard, Betty R Kirkwood, Meeting the millennium development goals for child survival: global impact of early initiation of breastfeeding on neonatal mortality. (Un published)

WBW 2007


Authors intervention models a and b lives saved estimated for universal coverage 99 and 90

A : BF initiated within one hour early initiation of breastfeeding in less developed settings.

99% : 1.11 million lives saved, 31% of all newborn deaths, and 11% of U5 child deaths

90%: 0.972 million lives saved, 27% of all newborn deaths and 10% of U5 child deaths

B: BF initiated within one day

99% : 0.866 million lives saved, 24% of all newborn deaths, and 9% of U5 child deaths

90%: 0.680 million lives saved, 19 % of all newborn deaths and 7% of U5 child deaths

Authors’ Intervention Models A and B : Lives saved estimated for universal coverage: 99%, and 90%

WBW 2007


Risk of newborn deaths
Risk of newborn deaths early initiation of breastfeeding in less developed settings.

  • BF Initiated Ad OR Attributable Risk

  • 1st hour 1 -

  • Day 1 , later 1.44 31%

  • After Day 1 2.88 65.3%

  • Day 1 vs. later 2.40 58.3%

WBW 2007


Concluding finding
Concluding finding early initiation of breastfeeding in less developed settings.

  • Neonatal mortality could be reduced by 24% if 99% of infants initiated breastfeeding on day 1 of life and by 31% if 99% of initiation was within the first hour.

  • Numbers of lives saved were estimated to be 867,000 and 1,117,000 in these two cases."

  • The model is based on a single dataset; Similar data from other countries should be collated/collected as a priority.

  • If risks from Ghana are confirmed EARLY BF initiation should be added to key child survival interventions & monitored.

  • Potentially about 30% of newborn deaths (10% of U5 deaths) might be prevented with universal coverage of BF initiation within the 1st hour

WBW 2007


Other benefits of the one hour
Other benefits of the early initiation of breastfeeding in less developed settings.ONE hour !!!

WBW 2007


Benefits to both women and babies
Benefits to both women and babies early initiation of breastfeeding in less developed settings.

  • Nourishment and its first immunisation.

  • Production of milk enough for the next feed.

  • It makes use of the baby’s sucking reflex (which is strongest during the 1st hour) to establish proper latching.

  • Prevent blood loss in the women.

  • Provides the skin-to-skin contact and warmth that babies need most, particularly premature and low birth weight babies.

  • It is more beneficial for low weight babies because they are more likely to die, and they need more support at birth to be able to suck well.

WBW 2007


How to help women to begin breastfeeding within the 1st hour
How to help women to begin breastfeeding within the 1st hour?

  • Women need minimum essential support to succeed tin exclusive breastfeeding including early breastfeeding e.g.

    • assistance at time of birth to initiate the process of breastfeeding

    • help and a policy to keep the baby and mother together after delivery

    • avoidance of giving pre-lacteal feeds and artificial nipple/teats

    • Accurate information

    • Breastfeeding education and counseling during pregnancy

    • Maternity benefits like leave and cash benefits for poor women and Crèches

WBW 2007


Where we stand initiation of breastfeeding within one hour
Where we stand ? hour?Initiation of breastfeeding within ONE hour

  • In 38 countries : 26-52 (36 median)

  • South Asia worst hit , but needed most

WBW 2007


The state of world s initiation of breastfeeding
The State of World’s Initiation of breastfeeding hour?

Mapping Information

  • Blank /No colour: Data not reported/available

    2. Red: Initiation of breastfeeding within one hour rate Below 29%

    3. Yellow: Initiation of breastfeeding within one hour rate 30-49%

    4. Blue: Initiation of breastfeeding within one hour rate 50-89 %

    5. Green: Initiation of breastfeeding within one hour rate 90% or more

WBW 2007


Why world breastfeeding week wbw 2007 for one hour support
Why World Breastfeeding Week(WBW):2007 for hour?ONE hour support

Currently this is not a key indicator

  • UN reports on child nutrition like UNICEF’s annual SOWC

  • Other global and national reports.

  • Do you think It should be reported periodically an all child health reports ?

  • Do you think it should become a standard of care in a health care setting?

WBW 2007


What next
What next? hour?

  • Advocacy for support to mothers during 4th stage of labour

  • Policy : Coverage, promotion and reporting should improve along with exclusive breastfeeding for 0-6 months.

  • Services: BFHI should make at least this as doable intervention and as a “standard of good hospital practice”

  • Family level: All women should be supported at birth at home/ family level and increased awareness of family members is required to create suitable environment

WBW 2007


What next? hour?

  • Similar data sets are needed from other countries

  • ‘Breastfeeding education and support’ should be considered a key child survival intervention and placed equal to immunization’

  • Policy, programmes, services and family level support should be made available as an entitlement

  • Campaign to get people thinking about it, Women and men, Youth in particular

  • Internet campaign on listing support by 1 million people over next 3 - years: can we do it?

WBW 2007


WBW 2007 hour?


WBW 2007 hour?


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