Evidence to strengthen Infant and Young Child Feeding (IYCF)

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.