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National Capacity Building Program on Infant & Young Child Feeding
Dr M.M.A.Faridi MD,DCH,MNAMS,FIAP
Professor & Head, Dept of PediatricsUniversity 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
050
100
150
Glo
bal
mo
rtal
ity
pe
r 10
00
bir
ths
1960 1980 2000 2020Year
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;117:380-386
Relative Mortality Risk in Relative Mortality Risk in Absence of BreastfeedingAbsence of Breastfeeding
0
1
2
3
4
5
6
<2 2-3 4-5 6-8 9-11 12-13
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 InterventionsU-5 Child Deaths (%) Saved with Preventive Interventions
0 2 4 6 8 10 12 14
Breastfeeding
Compementary feding
Zinc
Hibvac
Clean delivery
Water, Sanitaion, hygiene
Antesteroids
Vit A
TT
NB temp control
Nevirapine +no BF
Measles vac
Antibiofor PROM
Percentages
Quality of Life & Early Feeding
Neonatal Onset of Adult Diseases
Optimal Infant and Young Child Optimal Infant and Young Child FeedingFeeding
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
En
erg
y (k
cal/d
ay)
1000
800
0-2 m 3-5 m
Age (months)
Energy Gap
Energy from breast milk
6-8 m 9-11 m 12-23 m
600
400
200
0
Stomach sizeStomach size
200 ml
Thickness of FeedThickness 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
DuringLabor
0-6 mo 6-24 mo
7% 15% 8% 7%
Source: JAMA 2000,200163% Escape Infection
AIM of Infant Feeding in HIV
HIV Free Survival
No Spill over effect
MTCT: Early Mixed breastfeeding
7
16
19
25
7
2426
36
0
5
10
15
20
25
30
35
40
Birth 3 mo 6 mo 15 mo
% EBF to 3 moPartial BF
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 %
0
10
20
30
40
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 HIVnegative 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 1993
2. Breastfeeding-complementary feeding counseling training course (45 hr/6 days), BPNI-2001
3.HIV and Infant feeding Counseling- A Training Course ( 18 hr/3days ), WHO-Unicef 2000
4.Complementary feeding counseling Training course ( 17 hr/3 days ), WHO 2002
Duration of earlier training courses
* Counselor: 5+3+3=11 days [40+18+17 hr]
*Trainer:11+11=22 days [80+38+34 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 CourseThe ‘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 trainersRole of IBFAN/BPNI
Phase Time Resource Participant Method Outcome
I 6 days Course
director
6 NT tn Prepared 6 NT
II 7 days -do- 24 LE tn
Trainee
practice24 LE
III 2 days -do- 6 CD tn
TPDR 6 CD
Thank You