Infant and Young

Child Feeding
North East Consultation Meet on Nutrition
Shillong, 17-18 February, 2005

Dr. Tarsem Jindal MD FIAP

Coordinator, Programs BPNI
HOD Pediatrics, Jaipur Golden Hospital, Delhi
IYCF relevance
 This is the “Direct intervention” needing action
 Key component of “care” , less understood
 Ensures survival
 Ensures optimal development on infants and
young children
 Global and national guidelines
 Legal protection
 Global evidence what works
 INDIA: Report Card
Survival
2.4 million U-5 deaths in India

AIDS
Three Major Killers in India
Other Diarrhoea
Malaria Neonatal sepsis
Measles
Diarrhoea
Pneumonia
Pneumonia
Neonatal
Unknown
disorders
Breastfeeding is No. 1
intervention for all the three

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

INDIA : Report card :
Development
 Estimates : About 36
million U-3 children are
underweight and thus
Normal
under developed.
Underweight/under
 Impaired cognitive, dev.

physical, psychosocial
development
 Impairs intelligence,
strength, energy and
productivity
Global Strategy for Infant
and Young Child Feeding

 Adopted by the
WHA and UNICEF
Executive board in
2002
National guidelines on IYCF
launched 6 August, 2004
The law to protect, promote
and support breastfeeding: 6
August,2004
Focus on under three
malnutrition

60 58.5 58.4

50

40 37.5

30
23.1 24.1
20
11.9 11.8
10
2
0
<6 months 6-11 months 12-23 months 24-35 months

%-2SD %-3SD

First three years are for ever…..

NFHS-2, 1998-99
Malnutrition : A silent
emergency
Promoting early child development is crucial...
51.5%
47.0% 47.1% 45.5%

19.3%
15.5%

Underweight Stunted Wasted

NFHS 1 (1992-93) NFHS 2 (1998-99)

Children 0- 3 years
Under-5 deaths preventable through universal coverage with individual
interventions (2000)

Percent
India 0% 2% 4% 6% 8% 10% 12% 14% 16% 18%

Breastfeeding

Complementary feeding

Clean delivery

Hib vaccine

Clean water, sanitation, hygiene

Zinc
Intervention

Vitamin A

Antenatal steroids

Newborn temperature management

Tetanus toxoid

Antibiotics for PRM

Measles vaccine

Nivirapine and replacement feeding

Insecticide-treated materials

Antimalarial IPT in pregnancy

Source: Jones et al. LANCET 2003;362:65-71 1

Challenge : Universal Coverage
(90%)

 Both RCH
and ICDS
need to
respond
 Opportunity : ICDS
Universalisation and
RCH II !
The deficit to
Make up!

100%

80%

60%

40%

20%

0%
Exclusive Breastfeeding (0-6 months)
Best possible start rather a
head start to life……

Early child care

including early start
to breastfeeding sets
the road to sound
development and
prepares babies for
better learning
 10th Five year Plan

GOALS
100%
80% 80.0% 75.0%
60% 50.0%
40%
41.2%
20% 15.8%
33.5%

0%
Initiation of Exclusive Complementary
breastfeeding within breastfeeding feeding (6-9 months)
one hour (0-6 months)

NFHS-2 Tenth Plan Goal

Note: NFHS 2 data for exclusive breastfeeding is the simple
average of 0-3 & 4-6 months period.
10th Five Year Plan Goals
Exclusive Breastfeeding in Northern
Eastern States
120
100
100

80 70
59 63.6
61.6
60
49.1
40 23.6
69.7 23.3
20 42.5 40.7 43.9
33.9
16.1 16.3
0

Sikkim
Assam

Mizoram
Arunachal

Meghalaya

Nagaland
Manipur

Tripura
Pradesh

NFHS-2 10 Plan Goals

Note: NFHS 2 data for exclusive breastfeeding 0-3 months and

10th Plan Goals data is 0-6 months
Global evidence what
works
 Effect of Community-based Promotion of
Exclusive Breastfeeding on Diarrhoeal Illness
and Growth: A Cluster Randomized Control
Trial

70%

60%

50%

40%

30%

20%

10%

0%
Initiation of Not Giving Exclusive
breastfeeding Prelacteal Feeds Breastfeeding for Control
within 3 hours the First 6 months Interventional

Bhandari et al. LANCET 2003; 361:1418-1423

Effect of Counselling on Infant and Young Child Feeding
by Trained Community Workers on Exclusive
Breastfeeding: A Study from 235 Villages in 3 Blocks of
District Bhuj, Gujarat
70%

60%

50%

40%

30%

20%

10%

0%
Initiation of Not Giving Exclusive
breastfeeding Prelacteal Feeds Breastfeeding for Control
within 1 hours the First 6 months Interventional

BPNI (Unpublished Data, 2004)

 Effect of Community–based Peer Counsellors
on Exclusive Breastfeeding Practices in
Dhaka, Bangladesh: A Randomised Control
Trial.
70%

60%

50%

40%

30%

20%

10%

0%
Initiation of Not Giving Exclusive
breastfeeding Prelacteal Feeds Breastfeeding for Control
within 1 hour the First 5 months Interventional

Haider R et al. The Lancet 2000; 356: 1643-1647.

 Efficacy of Home-based Peer Counselling
to Promote Exclusive Breastfeeding: A
Randomised Controlled Trial (Mexico)

60%

50%

40%

30%

20%

10%

0% Control
Exclusive Breastfeeding for the First 6 months Interventional

Source: Morrow AL et al. The Lancet 1999; 353:1226-1231

What is common to
these 4?
 Skillsof health workers or peer
counsellors
 IYCF counselling is made
available
What are the key
obstacles?
 The HIV argument
 Evidence that ‘mixed
feeding’ doubles the risk of
transmission through
breastfeeding

 Given that we are a

population of ‘mixed-fed’
babies, investments must
be made to scale up
exclusive breastfeeding in
ALL babies to minimize
transmission and options
for the HIV+
What are the obstacles
(49 districts study)?
 Frontline workers don't carry clear
concepts and lack skills to help women
 Confusing messages to mothers
 Doctors are not clear on the optimal
feeding recommendations and push “own
opinion”.
 Mothers feel they don’t have enough milk
The challenge
 Provision of skilled Infant and Young
Child Feeding counseling as a “service”
 Clearly , lack of skills with the frontline
workers is an issue and a challenge
If we are not knowledgeable or skilled
we tend to ignore the issue and
become silent endorsers
ICDS deficits vis a vis
IYCF
 Not seen as an issue, 0-6 months does
not exist
 Neglected training skills, Training weakest
component
 Counseling/education is ignored, 30% ,
below average rating
 Growth monitoring is without context
Redefine the role of
frontline workers : Equip
them with skills and
Specifics
 Need to re look at frontline workers
assignments
 AW: Main responsibility :Nutrition and
health education
 IYCF Counseling with a context
preventing malnutrition and enhancing
development
Recommendations
 Plan of action to implement the
National Guidelines on Infant and
Young Child Feeding.
 Adequately resourced action plan on
IYCF for the State to achieve results
by 2007-08, with monitoring and
evaluation components.
Recommendations
(contd…)
 Capacity building in each state: core of
IYCF trainers.
 Adopting basic training of frontline
workers within ICDS training plans.
 Keeping exclusive breastfeeding for
first six months as indicator of
progress in MPRs, QPRs.
BPNI activity in NE States
 Child Survival and Development Report Card
in all NE states
 Status of Infant and Young Child Feeding
study in 6 districts of NE states.
 Guidelines for Breastfeeding and
complementary Feeding in 5 languages.
 Network of 258 BPNI members in all NE
states.
 Resource of National Trainers on IYCF
counseling course.
Thank you