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effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
effect of breastfeeding and complementary feeding counseling in large community
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effect of breastfeeding and complementary feeding counseling in large community

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  • 1. Dr. K P Kushwaha Prof & Head, BRD Medical College, Gorakhpur
  • 2. Lalitpur – Community based counseling on IYCF Winning under nutrition and improving child health Slide 2
  • 3. Project Area “BFCHI” (Baby Friendly Community Health Initiative) implemented in all the 6 blocks of Lalitpur Slide 3
  • 4. Infrastructure for IYCF counseling in Lalitpur • Total population - 9,94,470 • Intervention population - over 62 thousand children (Jan.2007 to Feb.2009) • Births (from 1stJan, 07–31st Dec-08) - 62324 • Follow up for 0-24m - 26333 • Follow up for 1yr - 13162 (from Jan, 07– Dec-07) • IYCF counselors - 51 (yr 07), 24 (yr 08-09) • Block Monitors - 2 (yr 07), 8(yr 08), 4 (yr 09) Slide 4
  • 5. Infrastructure contd… Trained MSGs - 1847 (607 centers) ASHA - 495 AWWs - 600 Trained Mothers - 752 Performance of Centers Above Average - 4 meeting/month = 28% Average - 3 meeting/month = 35% Below average - <2 meeting/month = 37% Slide 5
  • 6. Visible Change (independent survey and data collected through PGs) 2001 2009 IMR 85/100 44/1000 Mean age at marriage 15 years 18 Years Under nutrition 6m-1yrs (< -2SD) 52.5% 39.3% Under nutrition 1Yr-2yrs (< -2SD) 53.6% 35.2% Slide 6
  • 7. MSGs-Village Level IYCF Support • The 3 member team of AWWs, ASHA Dai, Link mothers from each village trained to promote and support optimal infant and young child feeding • 600 Mother Support Groups formed in 6 blocks of Lalitpur • 1847 local women trained for 3 days for 24 hour counselling/referral support in the villages Slide 7
  • 8. Village Level activities • Antenatal education of mothers about advantages of breastmilk and breastfeeding and how to succeed in breastfeeding. • Early initiation of breastfeeding • Helping mothers to learn positioning and attachment for effective breastfeeding • Prevention of breastfeeding difficulties and breast conditions • Expression of breast milk and katori feeding • Exclusivity of breastfeeding Slide 8
  • 9. Activities contd… • Identification of sick babies and their referral • KMC • Preparing good complementary food for babies and foods to feed • Feeding skills for complementary feeding • Variety and amount of foods for growing children • Growth monitoring • Recording of births & deaths • Reports Slide 9
  • 10. Functional IYCF Counseling Centres • District: 1 • Block: 6 • Village: 600 607 IYCF Counseling Centers functional in Lalitpur Slide 10
  • 11. Trainings (Year 2007, 2008 & 2009) • Middle Level Trainers Training - 2 batches of 26+24 (7 day integrated 3 in 1 module of BPNI/IBFAN) (50 persons trained at Dept. of Pediatrics, BRD Medical College, Gorakhpur) • Training of Front Line Workers – (80 batches X 3 day) total of 2447 ASHAs, AWWs, Dais and mother support groups trained. • Twenty Four ICDS Supervisors were oriented (1 Day) x 2 trainings. • The 152 LHVs, ANMs and staff nurses from health and family welfare department were trained in 3 day module Slide 11
  • 12. Growth Cards & Counseling • Growth Cards (Wt for age, WHO GS) – Registered (births) - 62324 (2007 onwards) – Follow up growth cards - 26333 (from 0-2 yrs) – Follow up for 365 days - 13162 births – Wt for age and length for age - 1532 & 1940 (6m-2yrs) • IYCF Counseling at house holds – By Block/District Counselors - Twice in a month in each village – By Village Counselors - 10 visits in first 6months, 6 visits in next 6 months and 3 visits in 2nd yr IYCF Counseling at block and district level by counselors- every days Slide 12
  • 13. Growth Cards Slide 13
  • 14. Meetings at all Levels • Review meetings at District level, chaired by DM • Monthly Block level meetings • World Breastfeeding Week Celebrated (1-7 August) • Mother Support Groups’ meetings Slide 14
  • 15. Low Cost Complementary Food Preparation • Wheat & Green Gram Mix Preparation- Ingredients: Whole wheat 500 gm. Whole Green Gram 200 gm Nutritive Value/100gm Calories 342 Protein 15.9 Slide 15
  • 16. Feeds • 100 gm. pack • 6-1 yr 25 gm. 2 time in a day • 1-2 yr 35 gm. 2 time in a day Slide 16
  • 17. Status of IYCF key Indicators Baseline Evaluation Survey Survey (2006) (2008) Initiation of breastfeeding 10.9 72.0 within an hour (%) Initiation of breastfeeding within 1-3 hours (%) 22.8 15.0 Pre-lacteal feeding (%) 67.0 15.0 Exclusively breastfed for 6 months(%) 7.0 62.0 Introduction of thick Complementary feed 53.8 85.0 between 6- 8 m (%) Introduction of compliments at 6 m (%) 43.6 49.0 Introduction of compliments at 8m (%) 10.2 36.0 Slide 17
  • 18. Status of IYCF 90 85 80 72 70 62 Percentage of mothers by 60 53.8 initiation of bfdg within an hour 50 Percentage of mothers who exclusively breastfed the child 40 for 6 months Percentage of mothers by 30 complementary feeding (6- 8months) 20 10.9 7 10 0 Baseline Survey (Nov- Evaluation Survey 2007) (March-08) Slide 18
  • 19. Mothers perception on health of their Children Dec- 2006 Jan.2009 Healthy 47.1% 80.5% Slide 19
  • 20. Nutritional status of babies (weight for age) (n=1940, July 1-15th, 2009) Age Group Normal Under nutrition (boys and girls Total (-2 to +2zscore ) (<-2zscore) combined) 6m – 12m 691 516(26.59%) 175(9.02%) 1 yr – 2yr 1249 905(46.64%) 344(17.73%) Total 1940 1421(73.24%) 519(26.75%) Slide 20
  • 21. SAM (Weight for Length) (n=1940, July 1-15th-2009) <-3SD <-3SD Age Group Total (Girls) (Boys) 6m – 12m 64 30(1.54%) 34(1.75%) 1 yr – 2yr 70 33(1.74%) 37(1.90%) Total 134(6.9%) 63(3.24%) 71(3.65%) Slide 21
  • 22. Undernutrition SA M Slide 22
  • 23. MAJOR WORLDWID E CAUSES OF DEATH AMONG CHILDREN UNDER AGE FIVE, 2000 Sources: For cause-specific mortality: EPI/WHO For deaths associated with malnutrition: Caulfield LE, Black RE Malnutrition and Global burden of diseases: underweight and cause specific mortality (paper in preparation) Slide 23
  • 24. Where is crisis, which one is neglected? • Death in 1 yr @ IMR (2008) 44/1000 live birth = 579 • Death in 1st month (2/3rd of IMR) = 386 • Death in 1m-12m period = 193 • Death in 1st wk (40% of IMR) = 231 • 84% neonatal deaths are due to 3 conditions- infections (42%), asphyxia (32%) and prematurity (15%) • Number of children with SAM (6m-12m), @(6.9%) = 873 • Death among SAM children(6-24m) (@10%) = 88 Total birth in 1yr (13162) Slide 24
  • 25. Where do we need to invest • Unit cost per child in IYCF counseling =Rs 200 per child per yr • Need to invest in IYCF promotion • Integrating in public health programme Slide 25
  • 26. Slide 26
  • 27. Conti…. District & Block Level Counsellors Slide 27
  • 28. Cases
  • 29. Case-1 • Sore nipple, engorgement • Helped to succeed
  • 30. Case-2 • Perceived not enough milk • Initiation at 30mts of birth • Baby cried during night & was given animal milk • Improving position & attachment, giving information • Mother succeeded
  • 31. Case-3 Mother name : Smt Lakshmi Father Name : Khushi lal Baby Name: Sunder Address : Lakhanpura, Jakhaura, Lalitpur Pain during feeding-not able to feed Observation- ∆ Sore nipple engorgement Skills - ∆ Confidence building ∆ Expression ∆ Katori feeding ∆ Position and Attachment ∆ Succeeded in breastfeeding Slide 31
  • 32. Case-4 Mother name : Smt Teja Father Name : Mauji Sheriya Baby Name : M Address : Jamundhana, Birdha, Lalitpur Sick mother, not feeding right under nourished baby Observation- Poor attachment Skills - ∆ Open questions ∆ non verbal comm., empathy ∆ Accepting ∆ Informing ∆ Helping in positioning & attachment ∆ Explaining others what has been done Result - Succeeded Slide 32
  • 33. Case-5 Village visit ∆ Mobilishing peoples support ∆ Listening mothers and observing breastfeeding ∆ Helping mothers to improve attachment ∆ Measuring weight gain ∆ Mothers confident in breastfeeding ∆ Dietary history ∆ Demonstration of making babies feed and active feeding Slide 33
  • 34. Case-6 Severely undernourished orphaned Tribal child ∆ Carried to PHC and NRT centre ∆ Vit-A, drugs and Locally prepared cereal mix with oil ∆ Wt. gain Slide 34

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