SAIFRN SEMINAR-2012: Peer counselling intervention to improve IYCF Iqbal Kabir, MBBS, MD, PhD Vice Chairperson, Bangladesh Breastfeeding Foundation Dhaka, Bangladesh Presentation outline 1. 2. 3. 4. 5. Brief Background Peer counseling for EBF Peer counseling for complementary feeding Lessons learned Way forward 2 Introduction/Background • • • • Initiation of breastfeeding within first hour remains low in Bangladesh and south Asian countries. IYCF practices in south Asia including Bangladesh is not satisfactory. The rates of EBF remains low (36%-42%) for last 15-20 years. SAIFRN is working to produce evidence base to identify reasons by analyzing the existing data set (DHS) To develop/conduct intervention studies to improve IYCF in this region, thereby child survival. 3 Breastfeeding counseling in a diarrhoeal disease hospital; Bull WHO, 1996, Haider R, Kabir I et al. Methods: • Infants (n=250) aged up to 12 weeks who were admitted to ICDDR,B hospital with diarrhea, were randomly assigned to BF counseling and control (usual heath education) group. • Mothers in the intervention group received individual (oneto-one) counseling: at least three counseling sessions during their hospital stay by trained BF counselors. • Data on feeding practice collected by research assistant after 2 weeks at home 4 Effects of BF Counseling in Dhaka hospital: Rates of EBF at discharge and 2-weeks follow-up Interven Control 80% 70% 60% 50% 40% 30% 20% 10% 0% At Disch at 2-week 5 Effect of a community-based peer counsellors on exclusive breastfeeding practices in Dhaka: a randomised controlled trial Haider R, Ashworth A, Kabir I, Huttly SRA; The Lancet 2000 Rates of EBF in the intervention and control groups 100 90 89 85 84 78 Percent % 80 70 70 60 50 40 32 30 23 17 20 11 10 6 0 1-mon 2-mon 3-mon Interven 7 4-mon Control 5-mon Individual Counselling 8 9 Control Individual Group 10 6 M on th 5 M on th 4 M on th 3 M on th 2 M on th 1 th M on Po st d el . 100 90 80 70 60 50 40 30 20 10 0 IMPACT OF COUNSELLING ON THE COMPLEMENTARY FEEDING PRACTICES IN AN URBAN COMMUNITY I. Kabir, R. Haider, A. Ashworth, SRA Huttley, S. Banu, T. Faruque, F. Begum Firu 11 Methods: 1.Two types CF were promoted; 1) Rice-gruel with or without milk, oil and pinch of salt, 2) Khichuri; Rice+lentil+oil 2. When the infant were 5 months old, mothers were counseled and asked to start the CF along with breastfeeding 3. A 24-h dietary recall method was used to assess the BF and CF status 4. A portion of different complementary foods which were fed to their infants, brought to nutrition laboratory were analyzed for energy, protein and fat content 12 Proportions of infants fed different types of CF in the intervention and control areas . Age of Infants Types of CF Control n=277 Interventin n=279 P value 6 months Rice-gruel 62% 74% <0.01 Khichuri 9% 18% <0.01 Rice-gruel 60% 67% <0.05 Khichuri 13% 26% <0.01 Rice-gruel 52% 57% 0.3 Khichuri 13% 29% 0.05 8 months 10 months 13 Total energy intake (kcal) from CF of control and intervention infants Age of infants 6 Months 8 Months 10 Months Food items Control Intervention Gruel+Khichuri 208 (27-1357) 204 (15-1357) Other foods 80 (10-697) 76 (8-650) Gruel+Khichuri 244 (13-1792) 268 (10-1450) Other foods 66 (9-460) 54 (5-558) Gruel+Khichuri 271 (13-1460) 253 (3-1075) Other foods 80 (4-1135) 76 (5-664) 14 Total energy, protein and fat Contents of CF Recommended and practices by mothers CF Types Nutrients Requirement Actual Gaps (%) Rice Gruel Energy (Kcal/100gm) 75 62 -18 Protein (gm %) 1.22 1.14 -7 Fat (gm%) 2.17 1.65 -14 Energy (Kcal/100gm) 99 72 -27 Protein (gm%) 4.16 2.91 -30 Fat (gm%) 3.33 1.81 -46 Khichuri 15 SAIFRN STUDIES-2012 16 Minimum acceptable diet (breastfed children only) 6-23 months Sri Lanka Nepal India Bangladesh 0 20 17 40 60 Percentage 80 100 Determinants of not having adequate CF The most consistent determinants across all countries are; *Lack of maternal education. *Lower household wealth. Other factors found in more than 1 country: • limited exposure to media • inadequate antenatal care • lack of postnatal contacts 18 Future issues and what is next??  Knowledge and understanding of CF still limited  CF is culture-specific and can not be promoted as prescription ; in contrast to BF, that is universal  More research are required to identify best CF; locally available, affordable  Extended peer counseling to improve the whole IYCF practice (such as MSPT)  Development of national document on policy, guideline on IYCF.  Integration of IYCF into major MCH, health and nutrition programs. 19 . 20