Dr. S.K. Roy Chairman Bangladesh Breastfeeding foundation

1. Complementary Feeding: the gap, causal analysis and possible solution in resource and knowledge poor situation Dr. S.K. Roy Chairman Bangladesh Breastfeeding foundation

2. Introduction • 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.

3. Nutrition triangle (UNICEF) Food Security • Breastfeeding • Complementary Feeding Disease Control Caring Practices

4. Optimal Infant and Young Child Feeding practices by age of Child 6 0------------------------------------------------------------------------------------24 24 0 Age in month 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.

5. 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

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

7. Current Situation of CF in South Asian Countries

8. Rate of Timely initiation of complementary feeding (Introduction of any solid/semi solid food (age 6-7mo)

9. Trend in Timely CF rate in Bangladesh according to birth order

10. Timely CF rate in Bangladesh according to House hold wealth index * *p<0.01

11. Trend of nutritional status of <5 children 1996 to 2007 in Bangladesh BDHS 2007

12. Trend in undernutrition in children aged 6-59 months in Bangladesh, 1985 to 2005 (NCHS) UNICEF/BBS-2005

13. Trend in Infant and Childhood mortality, 1989 to 2006 BDHS 2007

14. Prevalence of NS in children aged <5 in South Asian Country(NCHS)

15. Gap and Causal analysis

16. 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

17. Minimum Acceptable Diet(Four or more food groups)

18. Minimal Meal Frequency(Four or more times)

19. SAIFRN – Complementary Feeding Analyses

20. Rate of receiving infant formula/other milk as complementary food(age 6-7 mo)

21. Rate of protein rich food intake ( Meat, fish, poultry and Eggs) 5 south Asian countries

22. Rate of giving protein rich diet in different age

23. Rate of vitamin A containing food intake(fruits and vegetables) (age 6-7 mo)

24. Rate of carbohydrate rich food intake

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

27. What are needed now • 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

28. The Global Strategy of IYCF • 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

30. 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

31. 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

32. Continue………….. 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

33. Recommendation • 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.

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

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

36. . THANK YOU