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Infant and Young Child Feeding in Emergencies (IFE)

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Presentation on theme: "Infant and Young Child Feeding in Emergencies (IFE)"— Presentation transcript:

1 Infant and Young Child Feeding in Emergencies (IFE)

2 Learning Objectives Define optimal infant and young child feeding practices and relevance in emergencies Identify key policy guidance relevant to IFE Describe a minimum response on IFE Appreciate importance of strong coordination, communication and orientation/training Identify emergency preparedness activities 12

3 IFE concerns the protection and support of safe and appropriate (optimal) feeding for infants and young children in all types of emergencies, wherever they happen in the world. Protection of non-breastfed infants by minimising the risks of artificial feeding The well-being of mothers (nutritional, mental & physical health) is critical to the well-being of their children. What is IFE? 13

4 14 Pakistan, 2010

5 Early initiation of breastfeeding (within 1 hour of birth) Exclusive breastfeeding (0-<6m) Continued breastfeeding (2 years or beyond) Complementary foods Safe and appropriate infant and young child feeding in emergencies Complementary feeding (6-<24m) Optimal infant and young child feeding recommendations 15

6 Exclusive breastfeeding within one hour of birth saves infant and mothers lives Early initiation of breastfeeding 16

7 Include early initiation of breastfeeding as a key intervention in reproductive health services and nutrition programmes Assess and support capacity of maternity services and traditional birth attendants to provide skilled breastfeeding support and encourage skin- to-skin contact Implement Baby-Friendly Hospital Initiative (BFHI) 10 steps to successful breastfeeding Promote early initiation of breastfeeding through antenatal services 17 Steps to support early initiation

8 Only breastmilk, no other liquids or solids, not even water, with the exception of necessary vitamins, mineral supplements or medicines. 0-<6 months Exclusive breastfeeding 18

9 Complement not substitute………… 19

10 6-<24 month olds Support for continued breastfeeding for 2 years or beyond Introduce safe and appropriate complementary foods Frequent feeding, adequate food, appropriate texture and variety, active feeding, hygienically prepared (FATVAH) Complementary feeding 110

11 FrequencyFrequent feeding AmountAdequate amounts of food TextureAppropriate consistency VarietyA variety of different foods ActiveResponsive feeding HygieneHygienically prepared Complementary feeding is more than just food…… World Viision, Kenya

12 Continuum of Infant and Young Child Feeding in South Sudan Source: Southern Sudan 2010 Household Survey abridged report, April 2011

13 Which do you think is the most effective intervention to prevent under five deaths? Insecticide treated materials Hib (meningitis) vaccine Breastfeeding and complementary feeding Vitamin A and Zinc 113

14 Preventative interventionsProportion of under 5 deaths prevented Exclusive and continued breastfeeding until 1 year of age 13% Insecticide treated materials7% Appropriate complementary feeding6% Zinc5% Clean delivery4% Hib vaccine4% Water, sanitation, hygiene3% Antenatal steroids3% Newborn temperature management2% Vitamin A2% Answer: Breastfeeding and complementary feeding 114

15 UNDERNUTRITION underlies 53% of under five deaths Maternal and child undernutrition contributes to 35% U5 deaths Adapted from Bryce et al, Lancet 2005; Black et al, Lancet 2008 & Caulfield et al, Am J Clin Nutr 2002 Causes of death in children under 5,

16 Age (months) The younger the infant, the more vulnerable Risk of death if breastfed is equivalent to one WHO Collaborative Study, Lancet, 2000 The younger the infant, the more vulnerable if not breastfed 116

17 Protection and support of optimal infant and young child feeding is essential in both prevention and treatment of acute malnutrition U2s contribute to global burden of acute malnutrition Niger, % of 43,529 malnourished children admitted for therapeutic care were U2 Defourny et al, Field Exchange, Many emergencies characterised by increase in acute malnutrition prevalence 117

18 Why is infant and young child feeding important in emergencies? Provides food security for the infant without dependence on supplies Reduces maternal bleeding after delivery by helping the uterus to contract Protects against pregnancy ( birth spacing) Makes caring for baby easier Places less burden on the healthcare system Empowers mothers Reduces the risk of some cancers Gives long-term health benefits to the child Promotes bonding between mother and baby 118

19 No active protection Infant formula powder is not sterile Increases food insecurity and dependency Bottle feeding increases risk Why artificial feeding is always risky Bottle and teats extra source of infection Costly in time, resources and care Artificial feeding is always risky 119

20 Reasons for risky feeding practices Pre-emergency feeding practices may be sub- optimal A proportion of infants may not be breastfed when an emergency hits During an emergency, inappropriate aid may increase artificial feeding. Reasons for risky feeding practices 120

21 Relation between prevalence of diarrhoea and receipt of donated infant formula, Yogyakarta Indonesia post-2006 earthquake. Risks of untargeted distribution fuelled by donations Yogyakarta Indonesia post-2006 earthquake Relation between prevalence of diarrhoea and receipt of donated infant formula in children U2 Source: Hipgrave, et al: Accepted Public Health Nutrition Journal,

22 Artificially fed infants are highly vulnerable in emergencies Mixed fed babies lose protection and invite infection 122

23 Artificial feeding is where an infant or young child is fed with a breast milk substitute (BMS) Infant formula is an appropriate BMS as it meets a specified formulation (Codex Alimentarius) Infant formula is usually non-sterile powder, or a sterile liquid as a ready-to-use-infant-formula (RUIF) If breastfeeding is not possible and breastmilk is unavailable, infants require a BMS: – until breastfeeding is re-established – or until at least 6 months of age – up to a maximum of 12 months Cows milk is considered an appropriate BMS after 12 months 123 Managing artificial feeding in emergencies

24 Indications for artificial feeding in emergencies The mother has died or is absent for an unavoidable reason The infant has been rejected by the mother due to having experienced rape or psychosocial trauma Acceptable maternal or infant medical reasons for use of breastmilk substitutes The infant was dependent on artificial feeding when emergency occurred During relactation or whilst moving from mixed feeding to exclusive breastfeeding 124

25 Artificial feeding intervention Avoid, minimise and manage risks Based on skilled assessment Acceptable breastmilk substitute for as long as he or she needs it. Expertise and capacity - breastfeeding counselling, logistics, supplies, medical and nutritional support and monitoring. A last resort, when other safer options have been first eliminated. Avoid, minimise and manage risks Based on skilled assessment Acceptable breastmilk substitute for as long as he or she needs it. Expertise and capacity - breastfeeding counselling, logistics, supplies, medical and nutritional support and monitoring. A last resort, when other safer options have been first eliminated. Myanmar, A young infant and mother identified as in need of skilled support to establish breastfeeding and minimise the risks of artificial feeding. 125

26 PhysicalPractical Breastfeeding is a lifeline in emergencies NutritionalImmunological/PhysiologicalPsychologicalMaternal 126

27 Frontline assistance to breastfeeding women and their children may involve: Encouraging and supporting effective breastfeeding Enabling access to age- appropriate, safe and appropriate complementary foods Enabling access to services Ensure access to basic frontline feeding support 1 27

28 Advise the family and mother how important the mother is to the nourishment and well being of her baby. Encourage skin to skin contact between the mother and infant and frequent breastfeeding. Refer the mother to any psychosocial services support available, and for medical assessment. Register/ensure the family know how to access food, shelter Refer for more specialised assistance for breastfeeding support, if/as available. Be alert for donations of infant formula – a good media story. Ensure access to basic frontline feeding support 128

29 Risk of HIV transmission from mother-to-child Most HIV-positive mothers will not transmit HIV to their infants Transmission of HIV virus from the HIV-positive mother may occur either during pregnancy, delivery or through breastfeeding Transmission rate, without any antiretroviral drugs (ARV) intervention, is estimated at 5-10% during pregnancy 10-20% during labour and delivery (the time of greatest risk) The risk of transmission through breastfeeding is estimated at 5-20%, if a baby is breastfed for 2 years Transmission through breastfeeding is more likely if a woman becomes infected with HIV during the breastfeeding period 129

30 Consider HIV-free child survival (risk of HIV transmission and non-HIV causes of death) What are infant feeding recommendations where HIV is prevalent? 130

31 Exclusive breastfeeding for the first six months, followed by continued breastfeeding for 2 years or beyond, with the introduction of safe and appropriate complementary feeding HIV status of mother unknown or HIV negative WHO recommendations on infant feeding and HIV (2010) If then 131

32 Exclusive breastfeeding for the first six months, followed by continued breastfeeding for at least 1 year, with the introduction of safe and appropriate complementary feeding Mother is HIV-infected & on ARVs If unless Replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS) then WHO recommendations on infant feeding and HIV (2010) 132

33 Where HIV status of an individual mother is unknown or she is HIV negative, then recommended feeding practices are the same optimal feeding practices as for the general population, irrespective of the prevalence of HIV in the population. This offers the best chance of child survival. Infant feeding and HIV 133

34 1.If a mothers HIV status is unknown, she should replacement feed until she knows it is safe to breastfeed 2.An HIV-infected mother should breastfeed for 6 months only, then quickly switch to replacement feeding 3.HIV-infected infants have a better chance of survival if breastfed 4.HIV-infected mothers should be discouraged from breastfeeding if there are no ARVs available True or false? 134

35 1.If a mothers HIV status is unknown, she should replacement feed until she knows it is safe to breastfeed 2.A HIV infected mother should breastfeed for 6 months only, then quickly switch to relacement feeding 3.HIV infected infants have a better chance of survival if breastfed 4.HIV-infected mothers should be discouraged from breastfeeding if there are no ARVs available True or false? 135

36 Common misconceptions and myths with breastfeeding THESE ARE NOT TRUE: Stress prevents mothers from producing milk or makes the milk dry up. A malnourished mother cannot breastfeed. When a woman has been raped, she cannot breastfeed. The breastmilk has gone bad. Breastmilk just goes away and that after a few weeks or months, all mothers lose their milk. A mother should stop breastfeeding if the baby has diarrhoea. Once stopped, breastfeeding cannot be started again. A pregnant mother cannot breastfeed. Women with breasts or nipples that are small, flat or soft cannot breastfeed. Small babies need additional fluids such as water and tea. HIV-positive mothers should never breastfeed. 136

37 The International Code of Marketing of Breastmilk Substitutes Protection from commercial influences on infant feeding choices. It does not ban the use of infant formula or bottles. Controls how breastmilk substitutes, bottles and teats are produced, packaged, promoted and provided. The Code prohibits free/low cost supplies in any part of the health care system. Governments encouraged to take legislative measures. Adoption and adherence to the Code is a minimum requirement worldwide. Upholding the Code is even more critical in emergencies. The International Code = World Health Assembly (WHA) Resolution (1981) + subsequent relevant WHA Resolutions 137

38 The companies who produce BMS Those involved in the humanitarian response Emergencies may be seen as an opportunity to open or strengthen a market for infant formula & baby foods or as a public relations exercise Often violations of the International Code in emergencies are unintentional but reflect poor awareness of the provisions of the Code Violations of the International Code in Emergencies Breastmilk substitute (BMS): any food being marketed or otherwise represented as a partial or total replacement of breastmilk, whether or not suitable for that purpose International Code violations in emergencies 138

39 Infant and young child feeding is included in Sphere indicators to meet minimum standards on Food Assistance, Nutrition and Food Security Infant and young child feeding is a key consideration for other sectors, e.g. WASH, Health, Security Upholding the International Code and the Operational Guidance on IFE are central to meeting Sphere standards The Sphere Project 139

40 Minimum response in every emergency 140

41 Minimum response on IFE Coordinated timely response informed by assessed need Protective, well communicated policy & legislation Simple measures across sectors that prioritise infants & young children and their carergivers Basic interventions to protect and support optimal IYCF Technical capacity Strong communication Capacity building (orientation & training) Emergency preparedness Accountable to actions and inaction 141

42 What must you do to protect and support safe and appropriate IFE? 142

43 143 Be ready with frontline assistance for mothers and children

44 A stressed mother can successfully breastfeed Acute stress can temporarily affect let down or release of breastmilk. Reassuring support will help decrease a mothers stress and increase her confidence. Protection, shelter, and a reassuring atmosphere will all help. Breastfeeding helps reduce stress in mothers. Breastmilk production is not affected by chronic stress. 144

45 Moderate malnutrition Does not affect breastmilk production but can affect micronutrient content. Micronutrient supplementation may be needed. Severe malnutrition Breastmilk production and quality may be reduced. Therapeutic care for mother and skilled breastfeeding support needed. A malnourished mother can successfully breastfeed Feed the mother and let her feed her baby 145

46 Breastfeeding counselling is an emergency response Skilled breastfeeding support 146

47 Prioritise pregnant and lactating women for shelter, food, water and security 147

48 Offer safe places for breastfeeding and feeding support 148

49 Skilled support for challenging cases 149

50 Management of acute malnutrition in infants under 6 months Currently management of infants <6 months is largely facility-based Admission and discharge indicators should include breastfeeding status Where appropriate infants <6 months should be included in nutrition surveys to determine programme coverage and burden of disease For breastfed infants, case management should aim to restore exclusive breastfeeding For non-breastfed infants, infant formula feeding should be supported for 12 months Strategies with potential for effective community-based care include breastfeeding support, psychosocial support and womens groups programmes 150

51 Locate technical capacity Wet nurse relactates an abandoned baby (Myanmar, 2008) Unaccompanied infants with no source of breastmilk (Rwanda, 1994) 151

52 Make sure every newborn initiates breastfeeding within 1 hour of birth 152

53 Ensure access to safe and adequate complementary foods, appropriate to needs and context 153

54 Coordination is critical UNICEF lead coordinating agency on IFE within UN system IASC Nutrition Cluster Core Commitments to Children In collaboration with government & other agencies Specification detailed in the Operational Guidance on IFE 154

55 WHO WFP Current members and associate members : Collaborative effort on IFE 155

56 International Code in emergencies Emergency preparedness: Strong, enforced national legislation Protection: Uphold provisions of the International Code Accountability: Monitor and report on Code violations 156

57 Donated (free) or subsidised supplies of breastmilk substitutes (e.g. infant formula) should be avoided. Donations of bottles and teats should be refused in emergency situations. Any well-meant but ill-advised donations of breastmilk substitutes, bottles and teats should be placed under the control of a single designated agency. Operational Guidance on IFE, v2.1, Feb, 2007 Do not seek or accept donations of BMS, bottles & teats 157

58 Dried milk products should be distributed only when pre-mixed with a milled staple food and should not be distributed as a single commodity Use BMS to prepare a fortified blended food for use as complementary food for infants over 6 months Use BMS in institutional nutrition support, eg., elderly, orphans Use in preparation of biscuits and cakes that can be distributed to flood affected population Use BMS in animal feeding Operational Guidance on IFE, v2.1, Feb, 2007 There is no distribution of free or subsidised milk powder or of liquid milk as a single commodity Key Indicator. Food Aid Planning Standard 2. Sphere, 2011 Do not distribute milk powder or liquid milk as a single commodity 158

59 Communicate clearly on IFE Should be… Consistent Technically sound Strong Responsive Innovative Press offices and general media are key influences resources 159

60 DoD photo by: TSGT PERRY HEIMER Orientation of key players: Nutritionists & breastfeeding counsellors Health and nutrition staff Media and press agencies Donors Military Water and sanitation staff Capacity development and training of nutrition and health staff Be prepared and prepare others 160

61 Key messages Emergencies are highly infectious environments Breastfeeding and complementary feeding are life saving interventions U2s are highly vulnerable, the younger the child the greater the risk Non-breastfed infants are particularly at risk of malnutrition, illness and death Artificial feeding is risky, difficult and resource intensive Donations and untargeted distribution of milk increase morbidity in children HIV-free child survival, not just HIV transmission, is the consideration 161

62 We gratefully acknowledge the support of the IFE Core Group in the development of this content 162


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