1. The New Infant and Young Child Feeding Practices Indicator: Measuring for Meaningful Results Global Health Mini-U October 5, 2007 Erin Boyd

2. Outline Definition of IYCF Rationale Applications Practical Exercises

3. What is the IYCF Indicator? Measures IYCF practices among children 6-23 months Consists of 3 components: 1.Continued breastfeeding or feeding of milk or milk products 1.Fed (solid/semi-solid foods) minimum number of times per day according to age and breastfeeding status 1.Fed the minimum number of food groups per day according to breastfeeding status

4. The 3 Components of the IYCF Indicator ComponentsBreastfeeding status BreastfedNon-Breastfed 1. Breastfed or fed milk or milk products, 6-23 m Continued breastfeeding (A)Fed milk or milk products (B) 2. Fed (solid/semi-solid foods) min number of times per day 6-8 m 9-23 m Two Three (C) Four Four (D) 3. Fed min number of food groups per day 6-23 m Three (E)Four (F)

5. Rationale for the IYCF Indicator

6. Growth Faltering by Age Source: Shrimpton et al. 2001

7. WHO/PAHO Issue Guiding Principles for Infant and Young Child Feeding Practices

8. Breastfed ChildNon Breastfed Child Introduce complementary foods at 6 m with continued breastfeeding; Exclusive breastfeeding from birth to 6 m Not Applicable Continue BF frequently and on-demand until 24+ months Not Applicable Fluid needs. -400-600 ml/day of add’l fluids in a temperate climate; - 800-1200 ml/day of add’l fluids in a hot climate. Guiding Principles for Feeding Breastfed and Non- Breastfed Children, 6-23 months (1)

9. Guiding Principles for Feeding Breastfed and Non- Breastfed Children, 6-23 months (2) Breastfed ChildNon-Breastfed Child Practice Responsive Feeding Safely prepare and store CF Start with small amounts of food at 6 m. Increase quantity of food as child gets older Provide adequate amounts of food. Increase quantity as child gets older. Increase food consistency and variety as infant gets older

10. Guiding Principles for Feeding Breastfed and Non- Breastfed Children, 6-23 months (3) Breastfed ChildNon-breastfed Child Frequency of Feeding: Min # “meals”/day CF = - 2-3 for children 6-8 m - 3-4 for children 9-23 m Frequency of Feeding: Min # “meals”/day = - 4-5 for children 6-8 m - 4-5 for children 9-23 m Nutrient Content of Foods: Feed a variety -meat, poultry, fish or eggs daily -Vitamin A rich fruits and vegetables daily Nutrient Content of Foods: Feed a variety -meat, poultry, fish or eggs -Vitamin A rich fruits and vegetables -Milk and milk products from acceptable sources

11. Breastfed ChildNon-Breastfed Child Use vitamin-mineral supplements or fortified complementary foods as needed Use vitamin-mineral supplements or fortified products as needed During illness: Increase fluid intake, incl. breastmilk. Encourage child to eat. After illness: increase amount and frequency of feeding During illness: Increase fluid intake. Encourage child to eat. After illness: increase amount and frequency of feeding Guiding Principles for Feeding Breastfed and Non- Breastfed Children, 6-23 months (4)

12. Traditional Indicators Breastfeeding initiation Exclusive breastfeeding rate Complementary feeding rate, 6-9 m Continued breastfeeding Median duration of breastfeeding

13. Advantages of the new IYCF indicator : Operationalizes three components of WHO guiding principles for breastfed and non- breastfed children, 6-23 m Updated questionnaire and tabulation plan reflects expert recommendation for collecting data on 24h dietary recall, and assessment of exclusive breastfeeding Harmonized with the current DHS tabulation plan Tells us useful information for programs

14. IYCF Data collection Collected in any type of household surveys (DHS, KPC) using standard sampling methodologies (30 cluster, etc.) Advocating to include in MICS (UN) Mothers of children between 6-23 months are asked a series of questions to assess IYCF practices consisting of 3 components NGOs, UN agencies, CAs, NGOs, etc.

15. Breastfeeding Status Continued breastfeeding Are you still breastfeeding For how many months did you breastfeed the child Did the child drink anything with a nipple yesterday or last night Did the child drink/eat Breast milk, plain water, commercially produced infant formula, fortified commercially available infant and young child food Porridge or gruel

16. Number of feedings How many times did the child eat solid, semi-solid or soft foods other than liquids yesterday during the day or at night?

17. Number of food groups: 1.Milk other than breastmilk, cheese or yogurt, infant formula 2.Foods made from grains, roots, and tubers, including porridge, fortified baby food from grains 3.Vitamin A rich fruits and vegetables (and red palm oil) 4.Other fruits and vegetables 5.Eggs 6.Meat, poultry, fish, shellfish (and organ meats) 7.Legumes and nuts 8.Foods made with oil, fat, butter

18. What NEW Indicators for IYCF can be operationalized from the GP? IYCF PracticeProxy Measure 1. Energy IntakeFrequency of Feeding 2. Dietary QualityFood Group Diversity

19. Frequency of Feeding Indicator, 6-23 m Indicator: % of children 6-23 m who ate solid or semi-solid foods at least the minimum number of times in the 24 hours preceding the survey, according to age and BF status Note: Indicator can also be disaggregated by age, or BF status, when there are sufficient sample sizes

20. Dietary Diversity Indicator, 6-23 m Indicator: % of children 6-23 m who received minimum dietary (food group) diversity in 24 hours preceding the survey, according to BF status Note: Indicator can also be disaggregated by age, or BF status, when there are sufficient sample sizes

21. Current Status of IYCF Indicator: 1998-2004- Retrospective analysis of 43 countries Since 2005 the DHS included IYCF Will continue to include with possible further refinements

23. Practical Exercise Any mothers of children 6-23 months? Groups of 3 maximum (mothers as respondents)

24. 24 KPC Module 2: Breastfeeding and Infant and Young Child Feeding. June 2006. http://www.childsurvival.com/kpc- 2000/mod2_06_28_06.doc PAHO/WHO. Guiding Principles for Complementary Feeding of the Breastfed Child. Washington, DC/Geneva, Switzerland: PAHO/WHO, 2003. http://www.who.int/child-adolescent- health/New_Publications/NUTRITION/guiding_principles.pdf WHO. Guiding Principles for Feeding Non-breastfed Children 6 to 24 Months of Age. Geneva, Switzerland: WHO, 2005. http://www.who.int/child-adolescent- health/New_Publications/NUTRITION/ISBN_92_4_159343_1.pdf Mukuria, Kothari, Abderrahim. Infant and Young Child Feeding Update. Calverton, MD: ORC Macro, September 2006. References

25. References and Acknowledgements Kristen Cashin, Alison Tumilowicz from FANTA, www.fantaproject.org, provided this presentation and practical exercise for adaptation for the Mini-U. www.fantaproject.org Eunyong Chung, Frances Davidson and Emily Wainwright from USAID/HIDN/NUT provided useful feedback and questions.