Evidence to strengthen Infant and Young Child Feeding (IYCF) in Nutrition and Child Health Policies and Programmes South Asia Infant Feeding Research Network (SAIFRN) Presented by Upul Senarath Faculty of Medicine, University of Colombo, Sri Lanka What Causes Child Undernutrition? Death, Inadequate Growth & Development Inadequate Dietary Intake Inadequate Access to Food Manifestation Disease Inadequate Care for Children and Women Insufficient Health Services & Unhealthy Environment Immediate Causes Underlying Causes Inadequate Education Resources and Control Human, economic and organizational resources Political and Ideological Superstructure Basic Causes Economic Structure Potential Resources UNICEF, 1999 Strategy for improved nutrition of children and women in developing countries Objective To highlight effective interventions aimed at strengthening infant and young children feeding (IYCF) practices, that could be useful in shaping policies and programmes IYCF – an evidence-based intervention “ Optimal infant and young child feeding is essential for child survival, growth and development” – Child Survival Series. The Lancet 2003 – Newborn Survival Series. The Lancet 2005 – Childhood Development in Developing Countries Series. The Lancet 2007 – Maternal and Child Undernutrition Series. The Lancet 2008 Relative Risk on all cause mortality in infants <6 months Category Type of feeding EBF (Contrast group) Predominately breastfed Only breast milk Partially breastfed Breastfeeding + other milk or semisolids/solids No breastfeeding Breast milk + water or water based liquids No breast milk RR [95% CI] 1.0 1.48 [1.23-1.92] 2.85 [1.99-5.10] 14.0 [6.09-34.05] Source: Black et al. Maternal and Child Underntrition series, Lancet 2008 Evidence-based approaches to promote breastfeeding • Maternity care practices: Institutional changes in maternity care practices effectively increase breastfeeding initiation and duration rates – Fairbank et al., 2000 , Kramer et al., 2001, Perez-Escamilla, 2002 • Professional support: professional counselors effective in extending the duration of any breastfeeding – Sikorski et al., 2002 • Community-based breastfeeding promotion and support: improve breastfeeding practices in developing countries – Jayatilleka & Fernando, 2002, Dewey et al., 2008 Evidence-based approaches to Improve complementary feeding • Nutrition education improves caregiver practices – Guldan et al., 2000; Bandari et al., 2004 • Use of high-quality locally-available foods improves complementary feeding: Locally available low-cost foods to create adequate complementary foods – Ferguson et al 2006 • Use of multiple channels to educate and counsel caregivers (from communication through mass media to individual counselling). Interventions…complementary feeding • Use of supplements (vitamin-mineral powders, and lipidbased nutrient supplements) Zoltkin et al, 2003; Adu-Afarwuah et al 2007 • Use of fortified complementary foods ensures availability of quality complementary foods, locally or industrially processed, and promoting consumption Dhinger et al 2004 • Use of blended complementary food together with multimicronutrient powders and counselling on complementary feeding practices improved growth more than provision of the food alone Avula et al 2010 Educational interventions on complementary feeding: A review • Evidence from 15 studies: educational intervention can effectively improve complementary feeding practices and child nutrition and growth • Health education and communication strategies – – – – Nutrition counseling Group training Recipe and demonstration of preparation Community Mobilization / Training Influential people Source: Shi and Zhang, 2011. Innovative approaches – examples from South Asia • Telephone counseling using mobile phones – Rural villages In Nagpur, India • Peer counseling – Urban slums in Mirpur, Dhaka, Bangladesh • Ready to use therapeutic food (RUTF) using local ingredients – flood affected districts in Sindh Province, Pakistan Mirpur “Sishu Pusti” study in Bangladesh Research Priorities • Analysis of IYCF policies and programmes • Programme costs and cost-effectiveness • Immediate causes for failure of optimal feeding– attitudes, behavioural and other aspects • Bio-availability of nutrients in ‘traditional’ complementary foods • Impacts of micronutrient powders and enhanced micronutrient products on health and development Conclusions • Appropriate breastfeeding and complementary feeding are among the most effective interventions to promote child health, growth and development. • In the past decades, the evidence for essential actions to promote exclusive breastfeeding has been strengthened considerably. • More recently, progress has been made in defining standards for complementary feeding. However, the process of translating these standards into specific policies and programmatic actions is less well developed.