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Infant and Young Child Feeding in Emergencies (IFE)

Infant and Young Child Feeding in Emergencies (IFE). A. Maclaine, Philippines 2009. WHY is IFE important? BECAUSE INFANTS & YOUNG CHILDREN ARE EXTREMELY VULNERABLE. Even in healthy populations child morbidity and crude mortality can increase by 20% in 2 weeks.

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Infant and Young Child Feeding in Emergencies (IFE)

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  1. Infant and Young Child Feeding in Emergencies (IFE) A. Maclaine, Philippines 2009

  2. WHY is IFE important?BECAUSE INFANTS & YOUNG CHILDREN ARE EXTREMELY VULNERABLE

  3. Even in healthy populations child morbidity and crude mortality can increase by 20% in 2 weeks

  4. In emergencies rates of child mortality can soar from 2 to 70 times higherthan average

  5. Infants and children are the most vulnerable... Increased deaths (mortality) people of all ages children under 5 years Deaths/10,000/Day Camp location Refugee Nutrition Information System, ACC/SCN at WHO, Geneva. For 1998 & 1999

  6. YOUNG infants are particularly vulnerable Asad Zaidi, Unicef, A. Maclaine. Philippines, 2009

  7. Risks of death highest for the youngest at therapeutic feeding centres in Afghanistan, 1999 IFE 1/2 Deaths as % of admissions Age (months) Golden M. Comment on including infants in nutrition surveys: experiences of ACF in Kabul City. Field Exchange 2000;9:16-17

  8. Breastfeeding protects Especially the youngest infants WHO Collaborative Study Team. Effects of breastfeeding on infant and child mortality due to infectious disease in less developed countries: a pooled analysis. The Lancet 2000;355:451-5 IFE 1/4 Times more likely to die if not breastfed Risk of death if breastfed is equivalent to one. Age in months

  9. Particular high risk of Diarrhoea and ARTI Malnutrition CAN LEAD TO: ILL HEALTH, POOR DEVELOPMENT AFFECT CAN LAST FOR LIFE DEATH Risks of not breastfeeding Aceh

  10. BOTSWANANov 2005 – Feb 2006: Unusually heavy rains, floodingBotswana under-5 diarrhoea

  11. Risk factors for diarrhoea & death following flooding Amongst children hospitalised (n=154): • Not breastfeeding: 50.0 (4.5 – 100) • Storing drinking water: 3.7 (1.5 – 9.1) • Overflowing latrines: 3.0 (1.1 – 8.6) • Standing water near home: 2.6 (1.1 – 6.3) • Caregivers not washing hands: 2.5 (1.1 – 5.0) Risk factors for death (amongst hospitalised children): • not being breastfed (OR 8.5, p=0.04) • kwashiorkor (OR 2.6, p=0.03).

  12. WHY? Why is there high infant morbidity & mortality due to artificial feeding in emergencies compared to breastfeeding?

  13. Why? (1) Due to intrinsic contamination of infant formula – it is NOT sterile Photo credit: Ali Maclaine, 2006

  14. Why? (2) Due to (a) lack of water Water for sale in Pakistan, post-earthquake Asad Zaidi, UNICEF Pakistan A 3 month old bottle-fed baby needs 1 litre of water per day to mix with the formula powder. Another 2 litres are needed to sterilize the bottles and teats.

  15. (b) contamination of water (poor water & sanitation conditions) Photo credit: Ali Maclaine, 2006 Bangladesh

  16. Often not helped by overcrowded conditions & people on the move… Picture credit: yayasan IDEP foundation Aceh post-tsunami

  17. Why? (3) Due to mode of feeding - bottles & teats are hard to sterilise especially with lack of water, fuel, equipment, etc... Bangladesh, post cyclone Sidr, 2007 Pakistan, post-earthquake Maaike Arts, UNICEF Pakistan Photo credit: Ali Maclaine 2007

  18. Why? (4) Due to infant formula being made up incorrectly (over or under-diluted) Photo credit: Ali Maclaine, 2006 Photo credit: Ali Maclaine, 2007 Mother’s in rural Bangladesh where there is high illiteracy rate Lebanon, conflict 2006 – mother with donated formula – she was worried it was going to run out…

  19. Why? (5) Due to lack of other supporting resources e.g. fuel, cleaning equipment, cooking pots, time constraints, etc Photo credit: Ali Maclaine, 2007 People have lost cooking pots, etc after floods Bangladesh, 2007. People queuing for relief items after cyclone

  20. Why? (6) Due to a change in circumstances…Even if artificial feeding before the crisis was ‘safe’.Theemergency takes away those conditions and the mother’s ability to produce formula safely. USA – post Hurricane Katrina. Mother’s trying to formula feed in the Super Dome.

  21. Why? (7) Because, infant formula does not have the protective properties of breastmilk or safe feeding mode - breastfeeding

  22. AIMS IN THIS EMERGENCY: • Protect optimal IYCF • Initiation in the first hour after birth • Exclusive breastfeeding for 6 months (NOTHING else but breastmilk on demand day and night • Continued breastfeeding for 2 years or more • After 6 months – safe and appropriate complementary foods foods

  23. Ensuring that new born infants exclusively breastfeed from birth (TARGET PREGNANT WOMEN & MOTHERS OF NEW BORNS) • Means ensuring that exclusively breastfed mothers continue to do so. (TARGET EXCLUSIVE BREASTFEEDERS) • Ensuring that mixed feeding mothers of infants <6 months start exclusively breastfeed (TARGET MIXED FEEDERS) • Minimise risks of artificial feeding (TARGET ARTIFICIALLY FEEDING CAREGIVERS) • (Supporting complementary feeding – ensuring breastfeeding is continued at same level as before and ADD other nutritious foods.)

  24. Response based on the Operational Guidance on IFE Available online: www.ennonline.net/ife (along with other IFE materials) Contact UNICEF: emonsef@unicef.org for IFE orientation, training, further IFE resources

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