1. BFCHI: BABY FRIENDLY COMMUNITY HEALTH INITIATIVE PROJECT LALITPUR Dr. K P Kushwaha Principal, Prof & Head, BRD Medical College, Gorakhpur

2. Project Objectives  To improve breastfeeding and complementary feeding indicators through family and facility based counseling  To assess effect of counseling on IYCF pattern  To find effect of improved IYCF practices on health Total Population =9,7,7447 Mother and babies reached= 1,80,000

3. Interventions  Pre / post intervention assessment  District level sensitization for administrators, health/ICDS/NGO workers, teachers and panchayat workers (84)  Recruitment and training of 51 local graduates as MLT and facility based trainers at medical College ; 7 days x 2 trainings  Identification and training of family counselors at blocks (3858)(4 days training)  Establishing counseling centers in every villages and health facility (1286 MSGs)

4. Sensitization of administration and health officials

5. Training ICDS and health workers using BPNI module

6. Training of MSG’s by middle level trainers using BPNI module

7. o MSGs :Trained in basic knowledge and skills of breastfeeding and complementary feeding ( 1286 villages) o Under direct supervision of MLTs - designated as “ facility level counselors ” and “ trainers” of MSGs ( 48/ 24/12) o Supported by trained health workers: at PHCs and district hospital Village and facility Level IYCF Support…. – The MSG’s - 24 hours a day throughout the year

8. Setting up of village resource centres

9. Support of BFCHI: Creating and Supporting Mother Support Groups

10. Village Level activities Helping mother to learn breastfeeding positioning Demonstrating a thick consistency Complement and feeding skill

11. Village Level activities  Antenatal education of mothers  Early initiation of breastfeeding  Helping mothers to learn positioning and attachment for effective breastfeeding  Expression of breastmilk and katori feeding  Exclusivity of breastfeeding  Preparation/demonstration of good complementary food  Training mothers to Feed enough, frequently, variety of foods through praising  Helping mothers and babies in feeding difficulty  Weekly Health and Nutrition Day (Saturday)

12. Results Primary outcomes P- value- <0.001 for all outcomes Pre-intervention-2006 ; Post-intervention-2011

13. Results Primary outcomes P- value- <0.001 for both outcomes

14. Results Secondary outcomes- Mother’s confidence P- value- <0.001 for all outcomes

15. Results Secondary outcomes- Mother’s confidence P- value- <0.001 for all outcomes

16. Mothers perception on health of their Children Slide 16

17. Effect of Peer Counselling by Mother Support Groups on Infant and Young Child Feeding Practices: The Lalitpur Experience Komal P. Kushwaha1*, Jhuma Sankar2, M. Jeeva Sankar2, Arun Gupta3, J. P. Dadhich4, Y. P. Gupta5,Girish C. Bhatt1, Dilshad A. Ansari1, B. Sharma1 Citation : Kushwaha KP, Sankar J, Sankar MJ, Gupta A, Dadhich JP, et al. (2014) Effect of Peer Counselling by Mother Support Groups on Infant and Young Child Feeding Practices: The Lalitpur Experience. PLoS ONE 9(11): e109181. doi:10.1371/journal.pone.0109181

18. Strengths  There is unequivocal evidence on importance of peer group/community based counseling in improving nutritional and health status of children by improving IYCF practices in the community  It is the largest community based study till date on peer counseling, use of local resources from community  The reach was universal : 75000 families with more than 80% of mothers counseled on more than two occasions  The project created 1286 MSGs and 7 resource centers, integrated in state health system  Cost of the project was Rs 386 per family

19. Recommendations for improving nutritional and health status of children  Establishing national and State resource centers in partnership with BPNI.  Creating managerial and administrative body for IYCF training, counseling and monitoring at state and district level  Establishing community and facility based IYCF counseling centre and deploying trained IYCF counselors  Setting up training resource centre and counseling centre for IYCF in Medical Colleges and other college as essential standard practice  Improving health and nutritional status of mothers through comprehensive adolescent girl care

20. THANKS