INTERNATIONAL CONFERENCE ON CSR AND COMBATING MALNUTRITION:

OBTAINING MILLENNIUM DEVELOPMENT GOALS (MDGs) IN INDONESIA

Grand Sahid Jaya Hotel, 13 – 14 December 2010

Session 1: Prevention & Intervention in Improving The National Nutrition Status in Indonesia

Dr. Utami Roesli, Sp. A., Head of Lactation Center Indonesia

GOLDEN STANDARD

OF INFANT

FEEDING2

Dr. Utami Roesli SpA, MBA, IBCLC, FABMSentra Laktasi Indonesia

International Women's s day 3

1. Early Initiation 2. Exclusive BF for 6 mo

3. Complementary food after 6 mo

4. Continued BF for up to 2 years

WHA No 55.25 thn 2002

International Women's s day 4

1 Early Initiation of Breastfeeding

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Early Initiation of Breastfeeding by facilitating

uninterrupted, extended, early skin to skin mother-baby

contact for a at least one hour or until the first feeding

finish

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Studies show:

• Mother - Baby interact within the first minutesafter birth (Marshall Klaus: Mother and Infant : Early Emotional Ties Ped 1998)

• The mother’s skin can adjust its temperature to the baby’s needs (thermoregulation)

( Fransson A Arch Dis Child Fetal Neonatal Ed 90 : 2005,; Niels Bergman: Kangoroo Care 2005 , Bergstorm et al Acta Paediatr 2007)

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Within several minutes after birththe baby can instinctually crawltowards his mother’s breasts, attach himself to her nipple, and begin to suckle.

(“the Breast Crawl” )(Marshall Klaus: Mother and Infant : Early Emotional Ties Ped 1998, UNICEF India: BREAST CRAWL Initiation of breastfeeding by breast crawl. UNICEF India 2007 )

7Dr. Utami Roesli SpA. MBA, IBCLC, FABM

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Study of 10,947 babies was conducted from July 03 to June 04

Early initiation of breastfeeding by facilitating skin to skin contact for at least one hour, will reduced 22 %mortality of newborns

If the first skin to skin contact after 2 hours before 24 hours, a reduction of 16% mortality of newborns

Mortality rates of newborns increase significantly with each day of delayed initiation of breastfeeding

MOTHER AND BABY IN A STABLE CONDATION

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CAESARIAN SECTION TWIN PREGNANCY TWIN & C- SECTION

International Women's s day 10

2. Exclusive BF for 6 mo

Exclusive breastfeeding means giving baby only breastmilk and no other liquids or solid , not even water. Drops or syrups of vitamins, mineral supplements or medicine are permitted

International Women's s day 11

3. Complementary food after 6 months

After 6 months all babies required other foods to complement breast milkIndigenous family food reduced 6% U5 mortality rateComplementary food should :

timelyadequatesafeproperly fed

International Women's s day 12

4. Continued BF for up to 2 years

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Increased risk of childhood cancer (leukemia lymphocytic, Neuroblastoma, Lymphoma Maligna) (DundarozR et al 2002 , UK Childhood Cancer Investigation 2001,Bener 2001,Daniels 2002, Svanborg 2003.

Increased risk of acute respiratory diseases .

(Bachrach VRG 2003)

Increased risk of Gastrointestinal infections ( Kramer

MS et al JAMA 2001)

Increased risk of Diabetes (Sadauskaite-Kuehne 2004, Monetini 2002,Young 20020)

Increased risk of Coronary deseases (Smith 2004,Lucas 2004,Owen 2002,Singhal 2001)

Risk of not giving Golden Standard

Indonesian Breastfeeding Center

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Increased risk of Chronic disease ( Davis 2001, Ivarsson 2002)

Increased risk of allergy (Soarinen 1995, Wright 1995,Kerkhof 2003)

Increased risk of Asthma (Dell 2001, Oddy 2002, Oddy 2003)

Increased risk for infection from contaminated formula such as E. Sakazakii infection (Weir E 2002,Van Acker 2001)

Increased risk of Obesity (Armstrong 2002, Frye 2003, Weyerman 2006)

Increased risk of Mortality ( Arifeen 2001, Chen 2004, Edmond 2006, the

Lancet Child Survival Series 2003)

Indonesian Breastfeeding Center

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There is a relationship between exclusive breastfeeding with lower prevalence of malnutrition for children below 6 months( Vesel Linda et al : Use of New WHO Child Growth

Standards to assess how infant malnutrition relates to breastffeeding and mortality. Bull WHO 39-48: 88: 2010 )

Indonesian Beastfeeding Center

INCREASED OF MALNUTRITION

Study recruited 2900 pregnant women, followed the live births for 14 years.

Mental Health Status was assessed by the Child Behaviour Checklist at 2, 6, 8 , 10 and 14 years

Conclusion : Breastfeeding for a longer duration appears to have benefits for the onward MENTAL Health of a child

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Wendy H Oddy et al, Australia, Journal of Pediatrics ; Oct 2009

Internalizing Problems

Withdrawn

Anxious/depressed

Psychosomatic

Attention Problems (Autism)

Thought Problems

Externalizing Problems

Social Problems

Deliquent Behaviour

Aggressive Behaviour

International Women's s day 17

Decreasing 8 behavioralpsychopathology syndrome

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EVERY 2 ½ MINUTES

ONE INDONESIAN UNDER-FIVE

DIES

HELP

Indonesian Breastfeeding Center

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8,6%

MPASI

Indonesian Breastfeeding Center

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• The most Effective & Efficient nterventions to reduced infant mortality and

morbidity is : Breastfeeding counselling • to reduce stunting : Complementary Feeding intervention

If a new vaccine that could prevent more than one million child deaths a year, cheap, safe, administered orally, and required no cold chain ;became available; it would become an immediate public health imperative.

We would all invest in developing and promoting this vaccine. We already have it – it is breastmilk

Early initiation ,Exclusive breastfeeding , Indigenous Family Food, Continued Breastfeeding up to 2 years – Golden Standard of Infant Feeding-can do all this and more

Lancet 1994

Thank You

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1. Academy of Breastfeeding Medicine Protocol Committee: Protocol #5: Peripartum breastfeeding management for

the healthy mother and Infant at term. Ritrieved May 2007.

2. American College of Obstretics and Gynecology : Breastfeeding Maternal and Infant aspects. Special report from

ACOG Clin Rev, 12 ( supp), 1s – 16s ( 2007)

3. Edmond K et all . Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Paediatrics 117: 380-386;

2006

4. Gupta Arun : Breastfeeding :The 1st Hour Save ONE Million Babies. Gold 07 Global online Lactation Discussion

June

2007, WBW 2007

5. HSP USAID leaflet : Kesehatan Bayi Baru Lahir, Kesehatan Anak; 2007

6. Jones at al :Child Survival II: How many child deaths can we prevent this year ?. The Lancet 362: 65-71, 2003

7. Klaus Marshall : Mother and Infant : Early Emotional Ties . Paediatrics. 102 : 1244 -1998

7. Kroeger & Smith : Impact of birthing practices on breastfeeding. Protecting the mother and baby continuum.

Boston Jones and Bartlett ( 2004)8. .Linghard R : Delivery self attachment . The lancet 336: 1105 – 07. 1990

9. Roesli U : Foto-foto koleksi pribadi 2007

10. .Robert et al :How 9,7 million under 5 children die in 42 countries. The Lancet 361: 2226-34 . 2003

11. .UNICEF dan WHO: Baby-Friendly Hospital Initiative : Revised, Updated and Expanded for Integrated Care.

Section 3

Breastfeeding Promotion and support in a baby-friendly hospital. A 20 hours course for maternity staff. Unicef ,

WHO

2006

12. UNICEF India: BREAST CRAWL Initiation of breastfeeding by breast crawl. UNICEF India 2007

13. WABA : Breasrfeeding :the 1st Hour Save One Million babies .Action Folder World Breastfeeding Week 2007

14. WHO Collaborative Study Team. Effect of breastfeeding on infant and child mortality due to infectious disease in

less

developed countries a pooled analysis. The Lancet 355: 415-5: 2000

15 . WHO , UNICEF, UNFPA : Integrated Management of Pregnancy and Childbirth: Pregnancy, Childbirth,

Postpartum a

and ewborn care .A guide for essential practice. Sec ed. WHO 2006