Arun Gupta Regional Coordinator IBFAN Asia Effect of peer counselling by mother support groups on Infant and Young Child Feeding practices: The Lalitpur Experience Arun Gupta Regional Coordinator IBFAN Asia

Based on this publication Effect of peer counselling by mother support groups on Infant and Young Child Feeding practices: The Lalitpur ExperienceKushwaha KP, Sankar J, Sankar MJ, Gupta A, Dadhich JP, Gupta YP, Bhatt GC, Ansari DA, Sharma B. PLOS One 2014, 9(11):e109181 Based on this publication

BFCHI: BABY FRIENDLY COMMUNITY HEALTH INITIATIVE PROJECT LALITPUR Dr. K P Kushwaha Principal, Prof & Head, BRD Medical College, Gorakhpur District Administration, Lalitpur B.R.D. Medical College, Gorakhpur

Project Area Slide 4 “BFCHI” (Baby Friendly Community Health Initiative) implemented in all the 6 blocks of Lalitpur

Objective To evaluate the effect of peer counseling by mother support groups (MSGs) in improving the infant and young child feeding practices in the community

Methods This was a quasi-experimental before and after study conducted over a period of 5 years (Dec 2006-2011) by Department of Paediatrics, BRD Medical College, Gorakhpur in collaboration with UNICEF office of UP The study population comprised of mother infant pairs The intervention comprised of counseling and providing support to these mothers by the MSGs Both facility and community based strategy were used

Methods Step 1 Assessment of IYCF practices in 6 blocks of district Lalitpur (pre intervention research) Step 2 Develop consensus on the goal, purpose, objectives, expected results of the BFCHI plan of action (protocol development) Step 3 Co-ordination with ICDS, Health, NGOs, local leaders, primary school teachers in order to develop MSGs (capacity building) Step 4 Training of resource persons (middle level trainers) using IBFAN/WHO/BPNI/UNICEF 3 in 1 modules

Methods Training of MSGs by middle level trainers Step 5 Training of MSGs by middle level trainers Step 6 Setting up of village resource centers, 6 block IYCF centers (2 IYCF counsellors available for 6 hrs/day) and referral center for referred cases from field Step 7 Home visits by MSG members (10 visits in first 6 months, 6 visits in next 6 months and 3 visits in 2nd year) Step 8 Counselling and helping mothers with feeding difficulties and reinforcing optimal practices Step 9 Re-assessment of outcome variables of interest in the community

Results

Results Feeding parameter Pre-intervention (T0) N=421 Post –intervention (T1) N=480 p value T0 vs T1 Post-intervention (T2) N=597 T0 vs T2 Not seeking help from family members 264 (62%) 382 (80%) P<0.0001 549 (91%) Help by trained worker/ANM/Dai/Doctor 35 (8%) 200 (42%) 280 (47%) Help by doctor 21 (5%) 14 (3%) 0.05 58 (10%) P=0.002 Mother’s belief about her milk supply as sufficient (confidence) 63 (15%) 192 (40%) 327 (55%) Self stopping of sucking of child during feeding (responsive feeding) 83 (20%) 315 (65%) 330 (55%)

Strengths There is unequivocal evidence on importance of peer group/community based counselling in reducing infant/child mortality by improving IYCF practices in the community It is the largest community based study till date on peer counselling, use of local resources from community The reach was universal with more than 80% of mothers counselled on more than one occasion The project created over 1000 MSGs and 6 resource centers, integrated in state health system The project demonstrated real convergence at village level and heightened motivation of workers to prevent malnutrition and morbidity in infants and young children

Results Sustained in 2013 UNICEF did an external evaluation in 2013 that showed its results are sustained.

Conclusions https://www.youtube.com/watch?v=n8SQ-o6quug ( Lalitpur Personified Version 2015) A significant improvement in the breastfeeding and IYCF practices Peer counseling by MSGs improved the IYCF practices in the district and could be sustained We did the costing per birth : 4.7 US $. ( training, capacity building, refresher courses, honorarium for workers

Thank You !!