Infant and Young Child Feeding North East Consultation Meet on Nutrition Shillong, 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 Three Major Killers in India Neonatal sepsis Diarrhoea Pneumonia Breastfeeding is No. 1 intervention for all the three Source: Robert et al. LANCET 2003;361:

INDIA : Report card : Development Estimates : About 36 million U-3 children are underweight and thus under developed. Impaired cognitive, 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 NFHS-2, First three years are for ever…..

Children 0- 3 years Malnutrition : A silent emergency Promoting early child development is crucial...

10 Under-5 deaths preventable through universal coverage with individual interventions (2000) India Source: Jones et al. LANCET 2003;362:65-71

Challenge : Universal Coverage (90%) Both RCH and ICDS need to respond Opportunity : ICDS Universalisation and RCH II !

The deficit to Make up!

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

10 th Five year Plan GOALS 50.0% 80.0% 75.0% 15.8% 41.2% 33.5% 0% 20% 40% 60% 80% 100% NFHS-2Tenth Plan Goal Initiation of breastfeeding within one hour Exclusive breastfeeding (0-6 months) Complementary feeding (6-9 months) Note: NFHS 2 data for exclusive breastfeeding is the simple average of 0-3 & 4-6 months period.

10 th Five Year Plan Goals Exclusive Breastfeeding in Northern Eastern States Note: NFHS 2 data for exclusive breastfeeding 0-3 months and 10 th 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 Bhandari et al. LANCET 2003; 361:

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 BPNI (Unpublished Data, 2004)

Effect of Community–based Peer Counsellors on Exclusive Breastfeeding Practices in Dhaka, Bangladesh: A Randomised Control Trial. Haider R et al. The Lancet 2000; 356:

Efficacy of Home-based Peer Counselling to Promote Exclusive Breastfeeding: A Randomised Controlled Trial (Mexico) Source: Morrow AL et al. The Lancet 1999; 353:

What is common to these 4? Skills of 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 , 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