COE Revision-data slides

The Facts - Breastfeeding
•Exclusive breast feeding has increased by more than 20% from around
1995-2011 from 34% to 43% respectively (UNICEF, 2012)
Source: UNICEF global database 2012, from multiple indicator cluster surveys (MICS), demographic health surveys (DHS)
and other national surveys
NHMS III, 2006
•Ever Breast fed – upward trending, 95%
•Exclusive Breast feeding –14.5%
NPANM 2015
•4 months exclusive breastfeeding
target: 40% (achievement in year 2012: 49.0% vs 2011 of 44.9%)
•6 months exclusive breastfeeding
– target: 35% (achievement in year 2012: 30.5% vs 2011 of 23.3%)
The Facts - Breastfeeding
• WHO recommendation if breastfeeding is not possible
– wet-nursing or a human milk bank
– Home-prepared formula with micronutrient
– Infant formulas based on Codex standards
The Facts - Breastfeeding
The Facts - Breastfeeding
Source: Adapted from presentation – 1st COE Revision, 24th Feb 2014, & NHMSIII, 2006
The Facts - Breastfeeding
• Some of the factors based on 7
independent research papers
from Malaysia
Inadequate health education
Insufficient milk
late initiation of breastfeeding
breastfeeding difficulties
breastmilk expression
• Other factors based on 7
independent research papers
from other countries
– lack of knowledge, support and
help with BF difficulties.
– breastfeeding breaks are not
– quality infant care near her
workplace is inaccessible or
– no facilities are available for
pumping or storing milk
Research has not shown that marketing of FMPC
or pregnant/lactating milk products affects
breastfeeding rate in Malaysia
The Facts - Breastfeeding
Reference paper (details of paper incl
author, title of study, journal, volume and Factors impacting breastfeeding according to paper
Tan KL. Knowledge, attitute and practice on
factors associated with not practicing exclusive breastfeeding were
breastfeeding in Klang, Malaysia. The
International Medical Journal. 2009; 8 (1): mothers’ ethnicity, working status, household income and infant gender.
Breastfeeding was associated with mothers delivering in government
hospitals and with good knowledge of breastfeeding. Continued
Tan KL. Breastfeeding practice in Klang
District. Malaysian Journal of Public Health promotional efforts targeted at private hospitals with information on
breastfeeding should result in further increase in breastfeeding prevalence.
Medicine 2007; 7(2): 10-14
Osman A & Md Isa Z. Nutritional status of
woman & children in Malaysian rural
populations. Asia Pacific Journal of Clinical
Nutrition. 1995, 4 : 319-324
Sellapan M & Shamsuddin K. Major factors
influencing breastfeeding practice among
Indian mothers in estates. Jurnal Kesihatan
Masyarakat 1997; 12 (1).
Tengku Alina TI et al. Factors Predicting
Early Discontinuation of Exclusive
Breastfeeding among Women in Kelantan,
Malaysia. Health and the Environment
Journal 2013; Vol 4 (No.1)
Mohd Amin R et al. Work related
determinants of breastfeeding
discontinuation among employed mothers in
Malaysia. International Breastfeeding
Journal 2011; 6:4
Tengku Alina TI et al. Breast milk
expression among formally employed
women in urban and rural Malaysia: A
Breastfeeding is still a common practise in rural area. However,
inadequate health education tended to reduce the duration of breastfeeding
& increased early weaning.
Two main reasons given by mothers for not breastfeeding were work and
insufficient milk.
Discontinuation of exclusive breastfeeding was associated with the late
initiation of breastfeeding, breastfeeding difficulties, prenatal intended
duration and breastmilk expression.
important that workplaces provide adequate breastfeeding facilities such
as a room in which to express breast milk and a refrigerator, and allow
mothers flexible time to express breast milk.
Many women are unable to practice exclusive breastfeeding because they
are separated from their infants while working. Expressing their breast
milk helps them to continue breastfeeding. More practical and focused
education, as well as provision of facilities, is needed for women to
effectively and safely express and store their breast milk. The issue of
inadequate milk production should be emphasized, especially by
Why the need for FMPC?
Supplement the nutritional needs of children from the age of 1-9 years
FMPC products comply with the FMPC Standard (Regulation 91B of the Food
Act & Regulations 1985)
Formulated to help meet the nutritional needs of children based on
recommendations of the Malaysian Recommended Nutrient Intake (MRNI)
guidelines to provide at least 1/3 of MRNI for children
Milk products are good sources of calcium and several other nutrients such as
protein, vitamin A, vitamin B1, B6 & B12, magnesium, phosphorus and zinc.
Milk products is also one of the most nutrient dense foods and is
recommended by the Malaysian Food Guide Pyramid.
The structure/composition of FMPC is also amenable to taste innovation, able
to take on the addition of functional ingredients and able to act as a carrier
for mandatory/required nutrients for this population.
The Facts – Nutrition Status of Children
Children 1 to 3 years of age are the most susceptible to undernutrition, children 4 to 6 years are at higher risk of being overweight
Key recommendation by Malaysian Dietary Guideline to consume milk and
milk products 2-3 servings daily
Malaysia: Nutritional Intervention Plan needed
• Studies have shown that:
– More than 1/3 of children (aged 6 months to 12 years) did not
achieve the Malaysian RNI for energy, Ca and vitamin D (Poh BK
et al, 2013)
– Significant decrease in Ca intake vs RNI in children (4-6 years)
from both rural and urban areas (Abdul Aziz MF & Naleena Devi
N, 2012)
– Mean HAZ (height-for-age) and WAZ (weight-for-age) status
was least satisfactory after about 6 months, suggesting a
faltering in growth rate at an age that coincides with
dependence on complementary feeding (Khor GL et al, 2009)
Poh BK et al, 2013. Nutritional status and dietary intakes of children aged 6 months to 12 years: findings of the Nutrition
Survey of Malaysian Children (SEANUTS Malaysia), British Journal of Nutrition (2013), 110, S21–S35
Abdul Aziz MF & Naleena Devi. Nutritional status and eating practices among children aged 4-6 years old in selected urban &
rural kindergarten in Selangor, Malaysia 2012; 4(4): 116-131
Khor GL et al, 2009. Nutritional Status of Children below Five Years in Malaysia: Anthropometric Analyses from the Third
National Health and Morbidity Survey III (NHMS, 2006), Mal J Nutrition 15(2):121-136, 2009
Preferred Choice of Drinks Among Children Aged 11
malt drink
Source: Babolian H.R and Karim A, MS . Factors affecting milk consumption among school children in
urban and rural areas of Selangor, Malaysia. International Food Research Journal 17:651-660 (2010)
Phillipines case studies
The National Nutrition Survey Data collected regularly between 2005 and 2011 by the Food
and Nutrition Research Institute (FNRI), provides a clear picture of the effect of this
•Overall Nutritional Impact, 2005-2011 as a result of the Revised Milk Code
 Underweight malnutrition did not change (20.2%)
 Stunting increased .5%, (33.1% to 33.6%)
 Wasting increased 1.5% (5.8% to 7.3%)
 Overweight malnutrition increased 1.8%(2.5% to 4.3%)
Why the need for Maternal milk
formulations? (1)
• Maternal milk formulations are dietary milk supplements for
pregnant and lactating women and are intended to meet their
nutritional needs, and are not related to infant feeding.
• Maternal milk plays an important role in supplementing the diet of
pregnant and lactating women, so that they receive adequate
nutrition to provide for their own needs during pregnancy and
lactation, and to support the growth of the fetus.
• Furthermore, maternal malnutrition is a key contributor to poor fetal
growth, low birth weight (LBW) and infant morbidity and mortality
and can cause long-term, irreversible and detrimental cognitive,
motor and health impairments (Abu-Saad K & Fraser D, 2010;
Victoria CG et al, 2008; Kanade AN et al, 2008)
Abu-Saad K and Fraser D, 2010. Maternal Nutrition and Birth Outcomes. Epidemiol Rev 2010;32:5–25
Victoria CG et al, Maternal and child undernutrition: consequences for adult health and human capital. Lancet 2008; 371: 340–57
Kanade AN et al, 2008. Maternal Nutrition and Birth Size among Urban Affluent and Rural Women in India. Journal of the American College of
Nutrition, Vol. 27, No. 1, 137–145 (2008)
Why the need for Maternal milk
formulations? (2)
Allen, L. SCN News. 1994; (11):21-4. Maternal Micronutrient Malnutrition:
Effects on Breast Milk and Infant Nutrition, and Priorities for Intervention
– From a global perspective, lactating women are more likely to suffer
from micronutrient deficiencies than from a shortage of dietary energy
or protein
– Also, micronutrient deficiencies are more likely to affect breastmilk
composition, and the development and nutritional status of the infant
– Dietary interventions or supplementation can increase the secretion of
many of these nutrients in breast milk, and improve infant nutritional
– Suggested Priorities for Maternal Micronutrient Supplementation During
• Thiamin, Riboflavin, Vitamin B-6, Vitamin B-12, Vitamin A, Vitamin D
• Iodine, Selenium, Folic acid, Calcium, Iron, Copper, Zinc
Source: Allen L. Maternal Micronutrient Malnutrition: Effects on Breast Milk and Infant Nutrition, and Priorities for Intervention.
SCN News 1994; 11: 21-4