National Capacity Building Program on Infant & Young Child Feeding Dr M.M.A.Faridi MD,DCH,MNAMS,FIAP Professor & Head, Dept of Pediatrics University College of Medical Sciences & GTB Hospital, Delhi And Course Director, BPNI T-O-T in IYCF Counseling Course Director, WHO T-O-T in IYCF Counseling

Neonatal deaths and the Millennium Development Goals Millennium Development Goal 4 can only be achieved if neonatal deaths are addressed Global mortality per 1000 births Year Under-5 mortality rate Late neonatal mortality Early neonatal mortality Target for MDG-4

1st hour initiation cuts 22% of all deaths 100% 15.8% 11 Lac Neonatal Deaths ( 2.5 lac If we enhance initiation of BF within one hour 2.5 lac babies will be saved INITIATION OF BREASTFEEDING NEONATAL DEATHS SAVED Pediatrics 2006;117:

Relative Mortality Risk in Absence of Breastfeeding < The LANCET 2000; 355:451-5 Age in months

The State of the World’s Breastfeeding South Asia 2006

U-5 Child Deaths (%) Saved with Preventive Interventions Percentages

Quality of Life & Early Feeding Neonatal Onset of Adult Diseases

Optimal Infant and Young Child Feeding Optimal feeding defines exclusive breastfeeding from birth to six months of age and there after continued breastfeeding for 2 years or beyond with adequate, safe and timely family foods and liquids to meet nutritional needs.

Is Breast feeding So Simple? Animal Kingdom: 1.Offspring on feet 2.Moves to udders 3.Makes position No role of Mother Human Beings: 1.Baby holds neck 3 mo 2.Walks at 1 yr 3.Mother makes position No role of Baby

Expression of Breastmilk

Cup Feeding

Nasogastric Feeding

Complementary Feeding: Issues When to start What to start How to give How much to give

Energy required by age and the amount supplied from breast milk Energy (kcal/day) m3-5 m Age (months) Energy Gap Energy from breast milk 6-8 m9-11 m12-23 m

Stomach size 200 ml

Thickness of Feed

Feeding situation

Key Message Help child to learn eating A growing child needs increasing amounts of food

Mother To Child Transmission of HIV

Vertical Risk of HIV Transmission During Labor 0-6 mo6-24 mo 7% 15% 8%7% Source: JAMA 2000, % Escape Infection

AIM of Infant Feeding in HIV HIV Free Survival No Spill over effect

MTCT: Early Mixed breastfeeding Coutsoudis et al, 1999; 2001 Cumulative HIV transmission Durban, SA

Breastfeeding and HIV Transmission Breast fed Compliance: 96% Mortality: 24.2% 16% excess risk Formula fed Compliance:70% Mortality: 20% Transmission rate %

IF Policy For Replacement Feeding A = Acceptability  Will ‘not BF’ stigmatize mother? F= Feasibility  Is RF feasible? A= Affordability  Can family afford animal milk? S= Safety  Can family safely give RF feed? S= Sustainability  Can family sustain RF.

Following VCCT and HIV+ve test Feeding options Exclusive BF-6 continued Breastfeeding -24 Replacement feeding: Home-prepared Commercial Modified breastfeeding:  Exclusive BF-6, RF   Express-heat treated BM Breastfeeding by an HIV negative mother Donor Milk

Universalization of Optimum IYCF Every mother/family well informed, empowered and counseled for IYCF by child friendly health delivery system

How to achieve universal IYCF Country needs National IYCF Program that reaches to every mother

What is Training? Oxford Dictionary 2001 Train v:teach a person a particular skill or type of behavior n:a series of connected events or thoughts Oxford Thesaurus 2001 Train v: 1.Coach,discipline,teach, educate,instruct,tutor, prepare 2.Do exercises,rehearse, practise

IYCF Training Course To bring “Desired” change in Counselors Three Components: Cognitive Domain----Knowledge Psychomotor Domain-Skills Affective Domain-----Communication

Curriculum of Training Course 1.Contents 2.Process 3.Resources 4.Evaluation 5.Feed back

Curriculum: Contents Optimal infant nutrition, physio-anatomy of BF, suckling, BM expression, breast conditions, positioning/attachment, BF problems, Optimum replacement feeding Vertical HIV transmission, IF practices, AFASS Timely optimum complementary feeding Listening, learning, confidence building skills Maternal health, nutrition, maternity protection IF in emergency: earthquake, tsunami, floods

Curriculum:Process Schedule: Duration, continuity, attention- span, time for prep/practice Methodology: Facilitates learning Cl exp-Demonstration,bed side observation (live, simulated) UNCLE- Role play,stories,exercises,self learning, group discussion

What was available as training course 1.Breastfeeding counseling: A Training course (40 hr/5 days ), WHO-Unicef Breastfeeding-complementary feeding counseling training course (45 hr/6 days), BPNI HIV and Infant feeding Counseling- A Training Course ( 18 hr/3days ), WHO-Unicef Complementary feeding counseling Training course ( 17 hr/3 days ), WHO 2002

Duration of earlier training courses * Counselor: 5+3+3=11 days [ hr] *Trainer:11+11=22 days [ hr] Three sittings

IYCF Training Courses Available Three courses are currently advocated 1.WHO Integrated Course 2.IFC Breastfeeding Advocacy Course 3.IBFAN/BPNI ‘3 in 1’ IYCF Course

IYCF Counseling: An integrated WHO course To familiarize basic health worker with IYCF counseling To solve common IYCF difficulties To refer complicated cases. *No compressive grassroot level IYCF program *IYCF specialist needs further training

Breastfeeding: Advocacy & Practice Main emphasis on breastfeeding and BFHI CF and HIV & IF are taken as related issues 2 wk course, does not produce IYCF trainers or course directors

IYCF Counseling – A Training Course The ‘3 in 1 course’ To build national team for skill building of All HW in IYCF counseling. To create IYCF counseling specialists to manage All IYCF difficulties in Every situation.

 6 days manual, training guide  National capacity building plan for IYCF National Trainer Middle Level Trainer 3 days training guide Front Line Health Worker counseling flip chart Mother/family 

Training national trainers Role of IBFAN/BPNI PhaseTimeResourceParticipantMethodOutcome I6 daysCourse director 6 NT tn Prepared 6 NT II7 days-do-24 LE tn Trainee practice 24 LE III2 days-do-6 CD tn TPDR6 CD

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