Ensuring optimal breastfeeding and complementary feeding

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Ensuring optimal breastfeeding and complementary
feeding

• Dr Arun Gupta MD FIAP
• ICMR New Delhi
• 23 Feb 2011

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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)

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2
3
4
5
Years of life
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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 20033612226-34
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Risk of neonatal mortality according to time of
initiation of breastfeeding
Six times more risk of death
Additional benefits
Pediatrics 2006117380-386
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U-5 child deaths () saved with key interventions
in India
Lancet Child Survival Series,2003
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Deaths attributed to sub-optimal breastfeeding
among children
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1st hour initiation cuts 22 of all newborn
deaths
If we enhance initiation of BF within one hour
INITIATION OF BREASTFEEDING
100
40
10 Lac Neonatal Deaths
2.5 lac
NEONATAL DEATHS SAVED
2.5 lac babies will be saved
Pediatrics 2006117380-386
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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
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Exclusive breastfeeding Reduces HIV Transmission
Risk(Lancet 2007)
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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.htmBR)
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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.htmBR)
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Districts Level Performance(Number 534-DLHS 2008)
Initiation of BF within 1 hour Exclusive breastfeeding
RED 138 112
YELLOW 197 373
BLUE 194 49
GREEN 5 0
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Trends Initiation of Breastfeeding Within 1 hour
Source NFHS-3, 2006
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Breastfeeding patterns by age
Source NFHS-3, 2006
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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

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Seven Strategies

• Promotion
• Campaigns
• Social mobilization

• Support
• Skilled support
• Work site support
• Maternity benefits

• Coordination
• Budget
• Policy

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What Works BF Counseling !Meta-analysis on
breastfeeding promotion strategies and feeding
patternsHaider BA, Bhutta ZA. Lancet 2008.
Method of Counseling Increase in Odds of EBF Increase in Odds of EBF
Method of Counseling Neonatal Period At Six Months
Individual counseling 15 studies 3.45 (95CI 2.20-5.42) plt0.00001 1.93(95 CI1.18 3.15) plt0.00001
Group Counseling 6 studies 3.88 (95 CI 2.09-7.22) plt0.0001 5.19 (95 CI 1.90-14.15) plt0.00001
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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.

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Compliance with MGRS feeding criteria by site and
overall
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Work at basics !
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Prolactin Reflex
Secretion continues AFTER feed to produce NEXT
feed
To increase milk production
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Oxytocin Reflex
For milk ejection
3/3
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Helping and Hindering the Oxytocin Reflex
For milk ejection
3/4
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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.

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3 in 1 Training Programme
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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

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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
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Thanks !