Dr. S.K. Roy
Chairman
Bangladesh Breastfeeding foundation

 Appropriate feeding practices are essential for the nutrition,growth,development and survival of infants and young children.
 These feeding practices, known collectively as
Infant and young child feeding (IYCF) practices, include breastfeeding and complementary feeding.

Disease
Control
(UNICEF)
Food Security
 Breastfeeding
 Complementary Feeding
Caring
Practices

0
Optimal Infant and Young Child Feeding practices by age of Child
6
0 -----------------------------------------------------------------------------------24
Age in month
24
Initiate BF within half hour of birth
No prelacteal feeds
Give colostrum
Exclusive breastfeeding
No bottle Feeding
Don’t start CF
Continue breastfeeding
No bottle feeding
Feed CF 2-3 times a day plus snacks
Feed CF 3-4 times a day plus snacks
Increase frequency, amount & variety of CF, including animal foods, fruits & legumes, Oils/Fat.

Significance
• age-appropriate can have a major impact on child survival
• 19% per cent of all under-5 deaths in the developing world could be prevented by appropriate CF (Lancet 2003)
• Even with optimum breastfeeding children will become stunted if they do not receive sufficient quantities of quality complementary foods after six months of age (Lancet 2008)
• Malnutrition rates rise very steeply and peak in CF age (6-23 mo)
• Malnutrition is related to inappropriate feeding practices

Develop a global partnership and multicultural collaboration
Decreased milk industry waste,
Ensure environmental sustainability
•Combat HIV, malaria, and other diseases
Provides Low cost , high quality food,thus
Eradicate poverty, and hunger
Neurological
Development, enhance later school performance.
BF
CF
Promote gender equality, and empower women
Improve maternal health
Reduce infectious disease incidence and severity and thus
Reduce child
Mortality,

Rate of Timely initiation of complementary feeding
(Introduction of any solid/semi solid food (age 6-7mo)
84,3
67,6
52,7
61,2
37,4
Feeding rate
BAN IND NEP
5 South Asian countries
INDO PAK

90
80
70
60
50
40
30
20
10
0
Trend in Timely CF rate in Bangladesh according to birth order
Tim ely CF rate 2000 Tim ely CF rate 2004
76.3
76.3
76.3
12.2
14.1
23.5
First born 2nd -4th 5 or m ore

Timely CF rate in Bangladesh according to
House hold wealth index
Timely CF rate 2000 Timely CF rate 2004
90
80
70
60
50
40
*
78.8
30
20
10
12.7
0
Poorest
* p<0.01
4.5
66.9
Poorer
19.6
80.1
Middle
24
71.6
Richer
20
82.9
Richest

Trend of nutritional status of <5 children 1996 to 2007 in Bangladesh
Stunting (height for age) Westing (wt for ht) Underweight (wt for age)
60
50
55
56
48
45
40
30
18
20
10
10
0
BDHS 1996-97 BDHS 1999-2000
BDHS 2007
43
13
48
BDHS 2004
36
16
46
BDHS 2007

Trend in undernutrition in children aged 6-59 months in Bangladesh, 1985 to 2005 (NCHS)
Underweight
80
70
60
50
40
30
20
10
0
1985-86 1989-90
Stunting
1992
Wasting
1995-96
MUAC <125 mmm
2000 2005
UNICEF/BBS-2005

140
120
100
80
60
40
20
0
Trend in Infant and Childhood mortality,
1989 to 2006
Infant mortality Child mortality <5 mortality
133
116
94
87 88
82
66 65
50 52
37
30
24
14
65
BDHS 2007
BDHS 1986-
93
BDHS 1992-
96
BDHS 1995-
99
BDHS 1999-
2003
BDHS 2003-
2006

Prevalence of NS in children aged <5 in South Asian
Country
Afghanistan
Bangladesh
Bhutan
India
Maldives
Nepal
Pakistan
Sri Lanka
Country (NCHS)
Underweight Stunting
47
30
48
38
29
39
45
19
46
25
51
37
14
54
40
40
Wasting
16
13
10
13
14
7
13
3

The gaps in complementary feeding practices
• Rate of Minimal acceptable diet and minimum meal frequency are not satisfactory in the south Asian countries
• Rate of receiving infant formula remains high
• Only 1 in 10 children are given Protein rich foods (meat , fish , poultry , and eggs) at 6-7 months of age
• Cereal based complementary food is more common or major source of energy
• Consumption of vitamin and mineral rich food items remain low
• Consumption of oil rich food items (fat , ghee, ,or butter) are low
• Milk products , such as cheese and yogurt are even less likely to be given to young children, and

Country
Bangladesh (2007)
India (2005-06)
Nepal (2006)
Indonesia (2007)
Age (Months)
6-8 mo
(%)
9-11 mo
(%)
12-17 mo (%)
16.1
10.1
36.0
46.8
39.4
25.6
51.8
74.3
48.4
42.9
74.8
84.5
18-23 mo
(%)
57.9
47.5
72.8
87.5

Country
Bangladesh (2007)
India (2005-06)
Nepal (2006)
Indonesia (2007)
Age (Months)
6-8 mo
(%)
9-11 mo
(%)
12-17 mo (%)
59.7
21.6
63.9
3.4
74.0
15.6
73.7
7.7
84.6
26.1
87.4
13.8
18-23 mo
(%)
93.5
28.9
90.7
13.5

SAIFRN – Complementary Feeding Analyses

35
30
25
20
15
10
5
0
Rate of receiving infant formula/other milk as complementary food(age 6-7 mo)
Infant formula
15.4%
Nepal
4.6%
30.1%
Infant formula
Bangladesh Indonesia

Rate of protein rich food intake ( Meat, fish, poultry and Eggs)
Protein rich food
25
20
15
35
30
10
5
0
10.1
BAN
30.7
9.9
21.4
protein rich food
INDO NEP PAK
5 south Asian countries
2.1
India

30
25
20
40
35
15
10
5
0
Rate of giving protein rich diet in different age
10.1
16.3
30.7
35.2
9.9
10.6
6-7 month of age
6-9 month of age
BAN INDO NEP

Rate of vitamin A containing food intake(fruits and vegetables) (age 6-7 mo)
35
30
25
20
15
10
5
0
26
BAN
6-7 month of age
47.6
INDO
7.6
NEP
7.4
6-7 month of age

Rate of carbohydrate rich food intake percentage of Carbohydrate rich food intake
80.1
70
60
50
40
90
80
30
20
10
0
50.1
Bangladesh Indonesia Nepal
58.4
India
43.9
percentage of Carbohydrate rich food intake

Prevention of malnutrition using home based complementary Feeding
Intervention
Control
Roy et al 2008

 Get the IYCF policy and programs implemented
 Resource allocation to make it happen in SA
 Ensure EIB in every household through MSG
 Mainstream IYCF in Heath systems
 Institutional capacity building on IYCF strategies
 Convergence to IYCF by all health programs
 Campaign and Advocacy at all levels with evidences

• Implementation of comprehensive policies by the
Government
• Full support for two years of breastfeeding or more
• Promotion of timely, adequate, safe and appropriate complementary feeding
• Guidance on IYCF in especially difficult circumstances
• Legislation or suitable measures giving effect to the
International Code

IYCF strategy in Bangladesh
The National Strategy outlines responsibilities of stakeholders and nine priority strategies:
• Legislation, policy, and standards: BMS marketing Code,
• maternity protection in the workplace, Codex standards for
• complementary foods, and national policies and plans
• Health system support: BFHI, mainstreaming and prioritization of
• IYCF activities, and knowledge and skills of health service
• providers
• Community-based support: community-based networks supportive of IYCF
• IYCF in exceptionally difficulty circumstances: enabling environments for appropriate IYCF practices
• in cases of HIV infection, emergencies, and malnutrition

Priority strategies for IYCF in Bangladesh
Legislation, policy and standards
Strategy 1: Code of marketing of breast-milk substitutes
Strategy 2: Maternity protection in the workplace
Strategy 3: Codex standards
Strategy 4: National policies and plans

Health system support
Strategy 5: Baby-friendly Hospital Initiative
Strategy 6: Mainstreaming & prioritization of IYCF activities
Strategy 7: Knowledge & skills of health service providers
Community based support
Strategy 8: Community based support for IYCF

 For infants up to 6 months exclusive breast feeding should be encouraged and promoted as the most desirable feeding practice.
 For older infants and older children, raising community awareness of the critical importance of the timely introduction of adequate quantities of safe nutritious complementary foods is key for improving nutrition
 Behavior change communication is very important for the success of complementary feeding.
 Action should be taken by the mother, her family, her employer, community, and many others in support of breast feeding and complementary feeding practices to meet the nutritional needs of the child.

Community based nutrition programme components for development of Complementary feeding:
Menus of activities Support system Level of activity
1.food production 1.Tranning
4. antenatal care 4.supertion
5.GMP
6. breast feeding
5.plan/plans
6.implementation
1.facilitators
2. nutrition education 2.Funding 2.mobilizers
3. food sanitation/safety 3.problem solving 3.community level
4.household
5.individual
7. other activities 7.planning and evaluation

Feed your baby adequate and safe complementary feeding for healthy nation.
-Thank you

.