Role of health care system in promoting early and exclusive breastfeeding and related economic gains Dr M.M.A.Faridi MD,DCH,MNAMS,FIAP MD,DCH,MNAMS,FIAP Professor & Head, Dept of Pediatrics University College of Medical Sciences & GTB Hospital, Delhi

South Asia contributes one-third of global under five deaths(10.9 m) South Asia 34% SS Africa 41% Others 25% 5.8 million

Exclusive breastfeeding falls rapidly from first month onwards (NFHS , India)

Under-5 deaths preventable through universal coverage with individual interventions (2000) India * Breastfeeding: Exclusive for first 6 months and continued for 6 to 12 months Source: Jones et al. LANCET 2003;362: %2%4%6%8%10%12%14%16%18% Breastfeeding* Complementary feeding Clean delivery Hib vaccine Clean water, sanitation, hygiene Zinc 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 Intervention Percent

Risk of Death From Diarrhoea With Different Methods of Feeding CG Victora et al, Brazil, Lancet 8/8/87 19/6

Risk of neonatal mortality according to time of initiation of breastfeeding Pediatrics 2006;117: times more risk

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 Pediatrics 2006;117:

Impact of Exclusive breastfeeding on IMR – Bangladesh model Influence of exclusive breastfeeding in early infancy on the risk of infant deaths, especially those attributable to respiratory infections (ARI) and diarrhea Rapid reduction in IMR by 31% when exclusive breastfeeding was increased from 39 to 70 % Shams Arifeen etal. Pediatrics 2001

Economic Value of Breastfeeding Market Value of breastmilk : difficult to put a cost ! In the Milk banks of Norway it is available at 50 $ per liter At Current level of production of breastmilk in India : theoretical capacity million liters / year Gupta A, Khanna K. Economic value of breastfeeding in India, The National Medical Journal of India,1999

U 5 DEATHS FROM SPECIFIC CAUSES PREVENTABLE THROUGH LISTED INTERVENTIONS – India Model Disease/ Condition U5 Deaths (in ‘000) 2000 Percent of total U5 Deaths Preventable U5 Deaths Diarrhea55623%506 (91%) Pneumonia54423%366 (66%) Neonates – severe infections 2169 %205 (95%) Total131655%1077 (84%) Jones Gareth, Schultink Werner, Babille Marzio. IJP 2006.

Core Package of Essential Health Intervention Assessment by the national commission on macro economics and health – 2005, India Core PackageApproximate No. (2005) Total cost for treatment US $ millions ARI:Pneumonia34,184, (OPD) Diarrhea –some dehydration 34,184, (OPD) Diarrhea - severe dehydration 34, (OPD) Neonatal Sepsis250, (IPD) NRHM – Framework for Implementation , MOHFW

Cost of Health Care and Breastfeeding A study from USA, looked into the excess cost of health care services for three illnesses i.e. Lower respiratory tract illnesses, otitis media, and gastrointestinal illness in formula-fed infants in the first year of life There were 2033 excess office visits, 212 excess days of hospitalization, and 609 excess prescriptions for these three illnesses per 1000 never-breastfed infants compared with 1000 infants exclusively breastfed for at least 3 months Additional health care services cost the managed care health system between $331 and $475 per never-breastfed infant during the first year of life. Thomas M. Ball and Anne L, Pediatrics (1999).

Cost of Health Care and Breastfeeding Cost of treatment of medical conditions in the non-breastfed babies – Infant Diarrhea - $291.3 m – Respiratory Syncitial Virus - $225 m – IDDM - $ $ M – Otitis Media - $660 m Riordan JMRiordan JM. J Hum Lact.1997; 13(2):

Cost of Health Care and Breastfeeding Breastfeeding levels 1998 Breastfeeding Surgeon generals’ targets At hospital discharge 64%75% At 6 months 29%50% Saving of a minimum of $ 3.6 billion Weimer J. USDA economic research service, 2001.

Cost of training Counselors –Bhuj, India (BPNI, 2003) US $ 5 for training of the counselor per pregnant women Annual births are 25 million One time cost of training all the counselors is US $ 125(5x25) Million

Conclusions Early and exclusive breastfeeding may prove to be an important economic intervention in resource crunched developing countries due to  Reduced infant mortality  Reduced costs of infant and child illness  Productivity gain from increased cognitive ability  Reduced costs of chronic diseases  Reduced cost of feeding

Thank you !