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Completing the Nutrition and Health Package

Completing the Nutrition and Health Package. Dr Arun Gupta MD FIAP State Health Consultation, Bihar. 5 March 2011. First year is critical!. Malnutrition strikes the most in infancy beginning in 3-4 th month , 29-30 % 6 months. Goes up and peaks by 18 months, flat curve after that (NFHS 3).

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Completing the Nutrition and Health Package

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  1. Completing the Nutrition and Health Package Dr Arun Gupta MD FIAP State Health Consultation, Bihar. 5 March 2011

  2. First year is critical! Malnutrition strikes the most in infancy beginning in 3-4th month , 29-30 % 6 months. Goes up and peaks by 18 months, flat curve after that (NFHS 3) Brain development 10 lakh children die during first month, 14 lakhs by 1 year, and 20 lakhs by 5 yrs. Underweight (-2sd) NFHS-3 Over 60 million 1 2 3 4 5 Years of life

  3. Three Major Killers MOSTLY PREVENTABLE Neonatal disorders Diarrhoea Pneumonia Breastfeeding is the No. 1 preventive intervention compared to any other intervention Lancet Series on child survival, and now on newborn survival : 2003 and 2004 Source: Robert et al. LANCET 2003;361:2226-34

  4. Bihar Indicators

  5. Bihar Indicators in Numbers

  6. Risk of neonatal mortality according to time of initiation of breastfeeding Six times more risk of death Additional benefits Pediatrics 2006;117:380-386

  7. Percentage of Neonatal Deaths (2-28 days) Saved with Early Initiation Risk of neonatal death is 4 fold, if milk based fluids or solids are given to breastfed neonates Imitation after day 1 is associated with 2.4 fold increase in risk of death PEDIATRICS 2006; 117:380-386

  8. 1st hour initiation cuts 22% of all newborn deaths INITIATION OF BREASTFEEDING If we enhance initiation of BF within one hour 100% 40% NEONATAL DEATHS SAVED 10 Lac Neonatal Deaths 2.5 lac 2.5 lac babies will be saved Pediatrics 2006;117:380-386

  9. U-5 child deaths (%) saved with key interventions in India Lancet Child Survival Series,2003

  10. Deaths attributed to sub-optimal breastfeeding among children

  11. Long term Impact of BREASTFEEDING Subjects who were breastfed experienced lower mean blood pressure and total cholesterol, as well as higher performance in intelligence tests. Prevalence of overweight/obesity and type-2 diabetes was lower among breastfed subjects. WHO, 2007

  12. Initiation of breastfeeding within one hour of birth in Bihar 0-29% scores as Red; 30-49% as Yellow; 50-89% scores as Blue; 90-00% scores as Green.

  13. Exclusive breastfeeding in Bihar 0-11% scores as Red; 12-49% as Yellow; 50-89% scores as Blue; 90-00% scores as Green.

  14. Gap in Feeding Practices(DLHS 3)

  15. Treatment of childhood diseases (DLHS-3)

  16. How to complete the health and Nutrition package • Maternal care and nutrition • Safe delivery • Health check up for all ailments, newborn infections, diarrhea, ARI, fevers • Immunization • Growth monitoring • Early breastfeeding within one hour • Exclusive breastfeeding for the first six months • Timely and appropriate complementary feeding after six months along with continued breastfeeding

  17. Core IYCF Indices Early initiation of breastfeeding within one hour Exclusive breastfeeding for the first 6 months Continued breastfeeding at 1 year Introduction of solid, semi-solid or soft foods at six months Minimum dietary diversity Minimum meal frequency Minimum acceptable diet Consumption of iron-rich or iron-fortified foods WHO, June 2010

  18. Enhancing optimal breastfeeding Programmatic focus on early and exclusive breastfeeding Build skilled capacity among the health workers both at block and village level Do not allow Interference of formula industry in planning and programme Ensure maternity benefits for all women

  19. What is special about training on IYCF

  20. Confidence building measures vs. Information or promotion For milk ejection 3/4

  21. Protecting from baby food industry

  22. 3 main strategies • PROMOTION • Campaigns • Social mobilization • PROTECTION • Code implementation Successful Breastfeeding • SUPPORT • Skilled support • Work site support • Maternity benefits

  23. 4 support strategies • EDUCATION & TRAINING • Pre/In service • School/college • COORDINATION • Budget • Policy Successful Breastfeeding • RESEARCH • Programme and policy evaluation • Implementation • INFORMATION • Data collection • Monitoring

  24. Count each child who falters at the earliest

  25. Growth chart

  26. Universal Growth Monitoring Health check ups, Nutrition counselling on the way

  27. Exclusive Breastfeeding Phase

  28. Complementary Feeding Phase

  29. Compliance with MGRS feeding criteria by site and overall

  30. WHO Growth standards How children should grow Lactation Counseling by well trained counsellors ( 5 days training ) Helping/ assistance with initiation soon after birth Preventing and resolving lactation problems. The first visit by a lactation counsellor within 24 h of delivery Subsequent visits occurred at 7, 14 and 30 d, and monthly thereafter until the sixth month.

  31. ‘3 in 1’ Training Programme

  32. What do you want to achieve? • Motivation • Preventing and solving the problem of ‘not enough milk’ • Building confidence • Maintenance of exclusive breastfeeding for the first six months • Prevention of breast problems like sore nipples, mastitis ( 13% in various studies) • Timely and appropriate complementary feeding after six months along with continued breastfeeding

  33. How we did it in Punjab • 10 districts • Middle level trainers : doctors and nurses • Received 6 day training • Imparted 3- day training to frontline workers

  34. Lalitpur Model • Breastfeeding counselling and support services have been created for over 2 years • Graduate women trained as block mentors provides supervision and training to about 3 women in each village creating a network • Early breastfeeding ,Exclusive breastfeeding for the first six months and complementary feeding all have shown improvement significantly.

  35. Infant and young child feeding practices before and after intervention in Lalitpur District (600 villages)

  36. MEP..the minimum essential programme of services in NRHM Nutrition support to mothers, maternity benefits ,IGMSY, Family counsellors IYCF by a 3 day training, at birth assistance, home visits 4 in 2 weeks, and then every 2 weeks for 2 months, and every month till 12 months District level and above, medical colleges. SPECIALIST COUNSELLOR on IYCF IN ALL PUBLIC AND PRIVATE HOSPS Block/PHC Block Mentors of IYCF, act as trainers, supervisors, support on difficult problems in Breastfeeding like not enough milk, engorgement, mastitis etc. Cluster of 5-10 Family

  37. Thanks !

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