Optimal
Infant and Young Child Feeding
Relevance for child survival, health and
nutrition
Dr. JP Dadhich
MD (Pediatrics), FNNF
National Coordinator,
Breastfeeding Promotion Network of India (BPNI)
Karnataka state advocacy meeting
Bengaluru, 28th December 2013
Outline
• Importance of optimal IYCF practices
• Status of IYCF and Nutrition in Karnataka
• How to improve IYCF practices
IMPORTANCE OF OPTIMAL IYCF
PRACTICES
Optimal Infant and Young Child
Feeding
•
•
•
•
Begin breastfeeding within an hour
Exclusive breastfeeding for the first six months
Complementary feeding after six months
Continued breastfeeding for 2 years or beyond
First year is critical for child survival, growth
and development!
Brain development
Underweight (-2sd) NFHS-3
Child
Deaths
Over 60 million
Years of life
Under-five child deaths (%) 2011
5 countries
contribute
50% global
child deaths
http://www.childinfo.org/mortality_underfive.php
India – Causes of Child Deaths
• 1.7m (23% of world
total) U5 children
died in 2010
• 51% deaths occurred
in first month
• Major causes:
– pneumonia
– prematurity
– diarrhea
cherg.org/publications/Global-Child-Mortality-Estimates.pptxcherg.org/publications/Global-Child-MortalityBPNI
Estimates.pptx
7
http://www.unsystem.org/scn/Publications/AnnualMeeting/SC
N34).p
BPNI
8
Contribution of undernutrition to
child mortality
Shaded area
indicates
contribution of
undernutrition
to each cause
of death
Source: WHO 2009. Global health risks: mortality and burden of disease attributable to selected
major risks.
Risk of neonatal mortality according to time of initiation
of breastfeeding
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
4.2
Six times more risk of death
2.3
0.7
1.2
With in 1 From 1 hour
hour
to end of
day 1
Pediatrics 2006;117:380-386
2.6
Day 2
Day 3
After day 3
Source: Edmonds EK et al, 2007
Early Initiation - Potential Mechanisms
• Suckling shortly after birth have a greater chance
of successfully establishing and sustaining
breastfeeding throughout infancy
• Rich immune and non-immune components that
are important for early gut growth and resistance
to infection
• Early feeding with non human milk proteins may
severely disrupt normal gut function, introduce
infection
• Promotion of warmth and protection may reduce
the risk of death from hypothermia
U-5 child deaths (%) saved by universalising
key interventions in India
15
Oral rehydration therapy
Antibiotics for pneumonia
6
Newborn resuscitation
4
Breastfeeding
15
Complementary Feeding
6
4
Clean delivery
Water, sanitation, hygiene
3
Vitamin A
2
Measles vaccine
1
0
2
4
6
8
10
12
14
16
Percentages
Lancet Child Survival Series,2003, Jones G et al. Indian J Pediatr 2006
Breastfeeding Saves Lives!
Source: Black RE et al, 2013
Breastfeeding promotion could potentially prevent
250,000 child deaths due to pneumonia
and diarrhea
UNICEF 2013 –Landscape Report
Evidence on the long-term effects of breastfeeding
Systemic Reviews and Meta - Analyses
Protective effect on
NCDs
• High Blood pressure
• Hypercholesterolemia
• Risk of overweight and
obesity
• Risk of type-2 diabetes
World Health Organization 2007, 2013
Breastfeeding and School
Achievements/intelligence Levels
• Increased cognitive development
• Positive association with educational
attainment
– LCPUFA – important for retinal and cortical brain
development
– Bonding between mother and child
Breastfeeding and Blood Pressure in Later
Life
• Small but significant protective effects of
breastfeeding on systolic and diastolic
blood pressure
Long-chain PUFA – important structural
components of tissue membrane system
(vascular endothelium)
Protective effect against overweight
Low sodium level
Breastfeeding and Blood Cholesterol in Later
Life
• Lower mean cholesterol in adults who were
breastfed
– High cholesterol in breastmilk – down
regulation of hepatic hydroxymethyl glutaryl
coenzyme A -  synthesis of cholesterol later in
life
Breastfeeding and the Risk of Overweight
and Obesity in Later Life
• Small protective effect on prevalence of obesity
–  Protein content of breastmilk
– Lesser insulin response to feeding – less deposition of fat
and decreased number of adipocytes
– Adapt more readily to new foods such as vegetables –
reduced calorie density
Breastfeeding and the Risk of
Type – 2 Diabetes
• Protective effect on type –2 diabetes
– Fasting glucose level is inversely correlated to
LCPUFA in skeletal muscle membrane
– Formula fed infants have higher basal and post-
prandial insulin and neurotensin levels – early
insulin resistance and DM-2
Beneficial effects of breast milk in the NICU on the
developmental outcome of ELBW infants at 18 months
of age n=1035
• Multivariate analyses, a significant independent association of breast
milk on all 4 primary outcomes:
–
–
–
–
•
Mental Development Index
Psychomotor Development Index
Behavior Rating Scale
incidence of re-hospitalization
For every 10-mL/kg per day increase in breast milk ingestion, the Mental Development
Index increased by 0.53 points, the Psychomotor Development Index increased by 0.63
points, the Behavior Rating Scale percentile score increased by 0.82 points, and the
likelihood of rehospitalization decreased by 6%
Vohr BR et al.Pediatrics. 2006 Jul;118(1):e115-23. Center for Research for Mothers and
Children, National Institute of Child Health and Human Development, Maryland
Effects of breastfeeding on maternal health
Outcome
BF measure
Effect size
Ovarian cancer
BF duration (months)
Risk reduced 28% for each year
of BF
Breast cancer
BF duration (months)
Risk reduced 4.3% (1st report)
and 28% (2nd report) for each
year of breastfeeding
Diabetes type 2
BF duration (months)
Risk reduced 4% (1st analysis)
and 12% (2nd analysis) for each
year of breastfeeding
No BF versus EBF for 6 months
Risk increased by 29%
Hypertension
Lutter and Lutter. Fetal and early childhood undernutrition, mortality, and lifelong health. Science; 2012.
Status of IYCF and Nutrition in
STATUS OF IYCF PRACTICES IN
Karnataka
KARNATAKA
Initiation of Breastfeeding Within 1 Hr
Institutional Delivery – 65.1% (DLHS 3)
Exclusive Breastfeeding in Karnataka
100
80
68.2
Percentage
66.5
58.6
60
40
20
0
NFHS-2
NFHS-3
DLHS-3
Exclusive Breastfeeding Declines Rapidly
(NFHS-3)
Complementary Feeding quality and
quantity is inadequate (NFHS-3)
Reasons for sub-optimal IYCF practices
• Inadequate and Inappropriate
– Information to mother and family
– Skilled support to the mother
• Cultural
Beliefs,
Inexperience
Traditional
Practices,
• Aggressive marketing practices by the industry
• Lack of adequate maternity benefits
Trends in Children’s Nutritional Status in
Karnataka (Percentage of children under three year)
Note: Nutritional status estimates are based on the 2006 WHO International
Reference Population
HOW TO IMPROVE IYCF PRACTICES
What Action is required to improve
IYCF Pratices?
Policy, Plan and
Coordination
Training
International
Code, WHA
Communication
and Information
Health,
Nutrition care
System
Maternity
Protection
Protection
Promotion
Support
Mother support,
community
outreach
IYCF in difficult
circumstances
BFHI
Breastfeeding Gear Model
Pérez-Escamilla R et al. Adv Nutr. 2012
Coordinated actions improve
breastfeeding practices
Exclusive breastfeeding among <
6 mo
Median Breastfeeding Duration months
33
Chronology of initiatives at the global and national
level and changes in breastfeeding duration
in Brazil, 1974-2006
Global initiatives
16
14
Code of marketing
approved by World
Health Assembly
12
10
International Baby
Food Action Network
established
USAID-funded
health worker
capacity
development
program
8
Months
Baby Friendly Hospital
Initiative launched
Interagency Group
on BF established
Global Strategy
for Infant and
Young Child
Feeding approved
WHO BF
Training courses by World Health
Assembly
disseminated
World BF week
established
Innocenti Declaration
approved by 64
countries
6
4
2
BF training plan
implemented
Code monitoring;
Code
legislation
legislation
strengthened
strengthened
19
74
19
75
19
76
19
77
19
78
19
79
19
80
19
81
19
82
19
83
19
84
19
85
19
86
19
87
19
88
19
89
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
20
02
20
03
20
04
20
05
20
06
0
National initiatives
Social mobilization
Code legislation
passed,
maternity
Int. Baby Food protection
World BF
Action Network strengthened
week
launched
established
Network of human milk
banks established
Source: Lutter and Morrow; Advances in Nutrition; 2013.
Changes in the duration of breastfeeding (months )
and WBTi Score
16
14
Meses
12
10
8
6
4
2
0
1986-88
Brasil
2006-2010
Colombia
México
Republica Dominicana
60
50
40
WBTi score
30
20
10
0
Brasil
Chessa Lutter, 2012
Colombia
México
República
Dominicana
Breastfeeding Counseling works!
Method of
Counseling
Individual
counseling
Increase in Odds of EBF
Neonatal Period
At Six Months
3.45 (95%CI 2.205.42) p<0.00001
1.93(95% CI1.18 –
3.15) p<0.00001
3.88 (95% CI 2.097.22) p<0.0001
5.19 (95% CI 1.9014.15) p<0.00001
15 studies
Group
Counseling
6 studies
Meta-analysis on breastfeeding promotion strategies and feeding
patterns Haider BA, Bhutta ZA. Lancet 2008.
Counseling Works !
• Individual and group counseling are effective
tools to improve duration of excl. breastfeeding
• For COMPLEMENTARY FEEDING : Education and
counselling on CF in food secure homes, PLUS food
supplements in food insecure homes
Bhutta ZA et al. What works? Interventions for maternal and child undernutrition and
survival. Lancet 2008; 371(9610):417 – 440
Conclusions
• Appropriate IYCF practices are cornerstone for
child survival and nutrition
• Status of IYCF practices is dismal
• It is feasible to improve IYCF practices with
coordinated multifaceted action
• There is a need to develop a state/country
level action plan for protecting, promoting
and supporting breastfeeding and CF.
“The nature has designed the provision that
infants be fed upon their mother’s milk. They
find their food and mother at the same time.
It’s a complete nourishment for them both
for their body and soul”
Rabindranath Tagore
Thanks!!!
jpdadhich@bpni.org