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Ensuring optimal breastfeeding and complementary feeding

Ensuring optimal breastfeeding and complementary feeding. Dr Arun Gupta MD FIAP ICMR New Delhi 23 Feb 2011. First year is critical!. Malnutrition strikes the most in infancy beginning in 3-4 th month , 29-30 % 6 months. Goes up and peaks by 18 months, flat curve after that (NFHS 3).

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Ensuring optimal breastfeeding and complementary feeding

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  1. Ensuring optimal breastfeeding and complementary feeding Dr Arun Gupta MD FIAP ICMR New Delhi 23 Feb 2011

  2. First year is critical! Malnutrition strikes the most in infancy beginning in 3-4th month , 29-30 % 6 months. Goes up and peaks by 18 months, flat curve after that (NFHS 3) Brain development 10 lakh children die during first month, 14 lakhs by 1 year, and 20 lakhs by 5 yrs. Underweight (-2sd) NFHS-3 Over 60 million 1 2 3 4 5 Years of life

  3. Three Major Killers MOSTLY PREVENTABLE Neonatal disorders Diarrhoea Pneumonia 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 Source: Robert et al. LANCET 2003;361:2226-34

  4. Risk of neonatal mortality according to time of initiation of breastfeeding Six times more risk of death Additional benefits Pediatrics 2006;117:380-386

  5. U-5 child deaths (%) saved with key interventions in India Lancet Child Survival Series,2003

  6. Deaths attributed to sub-optimal breastfeeding among children

  7. 1st hour initiation cuts 22% of all newborn deaths INITIATION OF BREASTFEEDING If we enhance initiation of BF within one hour 100% 40% NEONATAL DEATHS SAVED 10 Lac Neonatal Deaths 2.5 lac 2.5 lac babies will be saved Pediatrics 2006;117:380-386

  8. Long term Impact of BREASTFEEDING Subjects who were breastfed experienced lower mean blood pressure and total cholesterol, as well as higher performance in intelligence tests. Prevalence of overweight/obesity and type-2 diabetes was lower among breastfed subjects. WHO, 2007

  9. Exclusive breastfeeding Reduces HIV Transmission Risk(Lancet 2007)

  10. State of breastfeeding within one hour of birth (%) by Districts 155 Lacs out of 260 Lacs born DONOT Source: DLHS Fact Sheets 2007-2008 (http://nrhm-mis.nic.in/ui/Reports/DLHSIII/dlhs08_release_1.htm#BR)

  11. State of exclusive breastfeeding for the first six months by Districts 140 lacs out of 260 lacs born DONOT Source: DLHS Fact Sheets 2007-2008 (http://nrhm-mis.nic.in/ui/Reports/DLHSIII/dlhs08_release_1.htm#BR)

  12. Districts Level Performance(Number 534-DLHS 2008)

  13. Trends :Initiation of Breastfeeding Within 1 hour Source: NFHS-3, 2006

  14. Breastfeeding patterns by age Source: NFHS-3, 2006

  15. Challenges in achieving optimal breastfeeding Lack of programmatic focus on exclusive breastfeeding Lack of skilled capacity among the health workers Interference of formula industry in planning process Lack of maternity benefits for all women

  16. Seven Strategies • Promotion • Campaigns • Social mobilization • Support • Skilled support • Work site support • Maternity benefits • Coordination • Budget • Policy

  17. What Works – BF Counseling !Meta-analysis on breastfeeding promotion strategies and feeding patternsHaider BA, Bhutta ZA. Lancet 2008.

  18. WHO Growth standards Lactation Counseling by well trained counsellors Helping/ assistance with initiation soon after birth Preventing and resolving lactation problems. The first visit by a lactation counsellor within 24 h of delivery Subsequent visits occurred at 7, 14 and 30 d, and monthly thereafter until the sixth month.

  19. Compliance with MGRS feeding criteria by site and overall

  20. Work at basics !

  21. Prolactin Reflex Secretion continues AFTER feed to produce NEXT feed To increase milk production

  22. Oxytocin Reflex For milk ejection 3/3

  23. Helping and Hindering the Oxytocin Reflex For milk ejection 3/4

  24. Training materials that W.H.O. Provided For specialized counsellors • 1993 : Breastfeeding counselling : 5 days • 2000 : HIV Infant feeding : Addl. 3 days • 2003 : Complementary feeding : Addl. 3 days For lay counsellors • 2005: Infant and young child feeding : 5 days.

  25. ‘3 in 1’ Training Programme

  26. What do you want to achieve? • Motivation • Preventing and solving the problem of ‘not enough milk’ • Building confidence • Maintenance of exclusive breastfeeding for the first six months • Prevention of breast problems like sore nipples, mastitis ( 13% in various studies) • Timely and appropriate complementary feeding after six months along with continued breastfeeding

  27. MEP..the minimum essential programme of services SPECIALIST COUNSELLOR with 7 day training to deal with BREASTFEEDING , COMPLEMENTARY FEEDING and infant feeding and HIV Nutrition support to mothers, maternity benefits ,IGMSY, Family counselor IYCF by a 3 day training, at birth assistance, home visits 4 in 2 weeks, and then every 2 weeks. District level and above, medical colleges. SPECIALIST COUNSELLOR IN ALL PUBLIC AND PRIVATE HOSPS SPECIALIST COUNSELLOR Block/PHC Cluster of 5-10 Family

  28. Thanks !

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