1. Multi-Indicator Cluster Survey in Macedonia- Breastfeeding Patterns in Children 0-24 Months

2. Some demographic and health indicators* §Total number of the population 2.007.523 §Annual number of live births 27.309 §Birth rate-14.1%0 §Infant mortality rate14.9%0 §Perinatal mortality rate18.7%0 §* 1999

3. Health and nutritional survey 1994 Breastfeeding rate and nutritional patterns in infants §Exclusive breastfeeding rate (0-4 months) -8.1% §Predominant breasfeeding rate 70.4% §Stop breastfeeding rate 21.6%  59% (first weeks)  26.9% (5-8 weeks)  14.1%(9-13 weeks)

4. The steps of National Breastfeeding policy development in Macedonia §1994 -Health and nutritional survey in children under 5 §1996- Breastfeeding course: London Practice and policy - Ministry of health representatives participation §1997 -Establishment of National Breastfeeding committee §1997-1998- Breastfeeding training course for primary health care provider §1999-Baby friendly hospital initiative §1999 Multi-indicator cluster survey §2000- Breastfeeding community support- MtMSG and celebration of WBW §2000- Implementation of the Code(some articles) in Consumer protection low §Nine months maternity leave

5. Multi-Indicator cluster survey 1999 §Main objective Þachievement of the goals of the World Summit for Children §Specific objective Ýnutritional status of mother and children Ýmicronutrient deficiencies Ýevaluation of feeding patterns of infants and small children

6. The information of infant feeding pattern was collected with 24 hour recall questionnaire using the following indicators:  Exclusive breast feeding rate (0-4 m)  Exclusive breast feeding rate (0-6 m)  Predominant breast feeding rate (0-4 m)  Predominant breast feeding rate (0-6 m)  Timely complementary feeding (6-9m)  Continued breast feeding at 1 year

7. Prevalence of breastfeeding in children 0-24 months by population strata Pearson Chi -square :0.9, p=0.34

8. Feeding pattern of Children 0-4 m and 0-6 m by Population strata Pearson Chi -square :5.24, p=0.15

9. Prevalence of Exclusive Breastfeeding in Children 0-24 m, by Population strata Age in months

10. Prevalence of breastfeeding in different ethnic groups in children 0-24 months

11. Prevalence of exclusive breastfeeding in different ethnic groups in children 0-6 months

12. Habit of breastfeeding in children 0-24 months by population strata

13. 0-6 months 7-12 months 13-24 months 1 2 3 urban rural Median number of suckling during the night in children 0-24 m, per population strata A g e total

14. 1 2 3 4 5 6 0-6 7-12 13-24 Age in months urban rural total Median number of suckling during the day in children 0-24 m,by population strata

15. Time lapse after birth for breastfeeding children 0-24 months by population strata

16. Reasons for breastfeedig cessation for children 0-24 by population strata

17. Progress towards the achievement of the goals for year 2000 of the world summit for children Year 2000 goal §Year 2000 goal 1994 MIKS 1999 MIKS Progress Empowerment of all women to breastfeed their children exclusi- vely for four to six months and to continue breastfeeding, with complementary food, well into the second year 0-4 months Exclusive BF 8% Predominant BF =78% 0-4 months Exclusive BF 45% Predominant BF =34% Good achievement of the goal that still needs educational efforts

18. NATIONAL REPORT CARD ON BREASTFEEDING* GLOPAR - Global Participatory Action Research Project by WABA IndicatorsScore Rate  EBFR at 6 months 4  National breastfeeding policy 10  % of BFH 8  Implementation of ICMBS 9  Maternity leave 9 m 10 Total 41

19. SCORE RATING  41-50 - Excellent  36-40 - Very Good  31-35 - Good  26-30 - Average  21-25 - Poor  16-20 - Bad  11-15 - Vary Bad  0-10 - Terrible Excellent 41

21. NUTRITIONAL SURVEY IN REFUGEE CAMPS IN MACEDONIA B.Ancevska MD, N.Janeva MD, K.Venovska MD Collaborative Study : AAA. UNHCR, UNICEF, IMCH

22. More than 300,000 Kosovar refugees crossed the Macedonian border from March to June 1999. 120.000 - 140.000 were accommodated in 7 camps with rapid population movement Health condition was generally good Food distribution was considered adequate but inconsistent in nutritional content and frequency of distribution

23. Goals an objective of the survey  the survey was designed to span several sectors of refugee needs in order to provide recommendations to international organizations serving the refugees in camps in R.M Specific objective among children under 5 years of age  determine the nutritional status  estimate the prevalence of breast feeding and infant feeding practice  estimate the prevalence of diarrhea and ARI  estimate the immunization coverage

24. Sampling methodology and sample size  A systematic random sample of household was taken, a household being defined as a group of persons occupying the some structure and sharing the household resources  The survey population included 1421 households and 1001 children under 5 years  Research tool -questionnaire for interviewing caregivers of young children “ Are you breast feeding your child?” “ Are you feeding your child with infant formula?”

25. Demographic distribution of children less than 5 years of age among Kosovar refugees in camps in R.M Age group (months) 0- 5 95 9.4 6-17 207 20,7 18-29 210 21.0 30-41 217 21.7 42-53 190 19.0 54-59 82 8.2 Number % Total 1001 100 10.4 % of all population were children under 5

26. Infant feeding among children < 12 months BF Formula Both Neither Age group N % N % N % N % < 4 months 40 70 3 5 1 1 13 23 4- 7 months 36 51 10 14 4 6 21 30 8-11 months 34 43 11 14 2 3 32 41 All ages 110 53 24 12 7 3 56 32 23

27.  What food those 23% of infants under 4 months received cow’s milk bread and biscuits

28. BABY FOOD DONATION*  infant formula  baby cereals  dehydrated baby meals  jars of fruits and mix meal for weaning purpose * A calculation of the quantities of formula at the and of July. 99 indicate that there was enough to feed approximately 22% of the infants fin the refugee population for 6 months * Violation of the International Code of Marketing of Breast Milk Substitutes * Source of donation-unknown

29. Infant feeding intervention in Macedonia during refugee crisis  Mother and baby - station  5 day training programme to provide PHC training for NGO health workers with one day allocated for breast feeding  On job training for NGO health staff in camps  Availability of training material with appropriate information about breast feeding  UNICEF Initiative to store infant formula donation