Complementary Feeding: the gap, causal analysis and possible solution

in resource and knowledge poor situation

Dr. S.K. Roy

Chairman

Bangladesh Breastfeeding foundation

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.

Nutrition triangle (UNICEF)

Disease Control

Caring Practices

Food Security Breastfeeding

Complementary Feeding

Optimal Infant and Young Child Feeding practices by age of Child0------------------------------------------------------------------------------------240 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.

Age in month

6

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

BF

CF

Neurological Development, enhance later school performance.

Develop a global partnership and multicultural collaboration

Reduce infectious disease incidence and severity and thus Reduce child Mortality,

•Combat HIV, malaria, and other diseases

Promotegender equality,and empower women

Decreased milk industry waste, Ensure environmental sustainability

Provides Low cost , high quality food,thus Eradicate poverty, and hunger

Improve maternal health

Current Situation of CF in South Asian Countries

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

Trend in Timely CF rate in Bangladesh according to birth order

12.2 14.123.5

76.3 76.3 76.3

0102030405060708090

First born 2nd -4th 5 or more

Timely CF rate 2000 Timely CF rate 2004

Timely CF rate in Bangladesh according to House hold wealth index

12.7

4.5

19.624

20

78.8

66.9

80.1

71.6

82.9

0

10

20

30

40

50

60

70

80

90

Poorest Poorer Middle Richer Richest

Timely CF rate 2000 Timely CF rate 2004

*p<0.01

*

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

55

45 43

36

18

1013

16

56

48 4846

0

10

20

30

40

50

60

BDHS 1996-97 BDHS 1999-2000 BDHS 2004 BDHS 2007

Stunting (height for age) Westing (wt for ht) Underweight (wt for age)

BDHS 2007

Trend in undernutrition in children aged 6-59 months in Bangladesh, 1985 to 2005 (NCHS)

0

10

20

30

40

50

60

70

80

1985-86 1989-90 1992 1995-96 2000 2005

Underweight Stunting Wasting MUAC <125 mmm

UNICEF/BBS-2005

Trend in Infant and Childhood mortality, 1989 to 2006

BDHS 2007

87 82

66 65

525037

3024

14

133

116

9488

65

0

20

40

60

80

100

120

140

BDHS 1986-93

BDHS 1992-96

BDHS 1995-99

BDHS 1999-2003

BDHS 2003-2006

Infant mortality Child mortality <5 mortality

Prevalence of NS in children aged <5 in South Asian

Country (NCHS)Country Underweight Stunting Wasting

Afghanistan 39 54 7

Bangladesh 45 40 13

Bhutan 19 40 3

India 47 46 16

Maldives 30 25 13

Nepal 48 51 10

Pakistan 38 37 13

Sri Lanka 29 14 14

Gap and Causal analysis

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

Minimum Acceptable Diet(Four or more food groups)

Age (Months)

Country 6-8 mo (%)

9-11 mo (%)

12-17 mo (%) 18-23 mo (%)

Bangladesh (2007) 16.1 39.4 48.4 57.9

India (2005-06) 10.1 25.6 42.9 47.5

Nepal (2006) 36.0 51.8 74.8 72.8

Indonesia (2007) 46.8 74.3 84.5 87.5

Minimal Meal Frequency(Four or more times)

Age (Months)

Country 6-8 mo (%)

9-11 mo (%)

12-17 mo (%) 18-23 mo (%)

Bangladesh (2007) 59.7 74.0 84.6 93.5

India (2005-06) 21.6 15.6 26.1 28.9

Nepal (2006) 63.9 73.7 87.4 90.7

Indonesia (2007) 3.4 7.7 13.8 13.5

SAIFRN – Complementary Feeding Analyses

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

Rate of protein rich food intake ( Meat, fish, poultry and Eggs)

5 south Asian countries

Rate of giving protein rich diet in different age

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

Rate of carbohydrate rich food intake

Prevention of malnutrition using home based complementary Feeding

Roy et al 2008

Intervention

Control

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

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

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

Continue…………..Health system support

Strategy 5: Baby-friendly Hospital InitiativeStrategy 6: Mainstreaming & prioritization of IYCF

activities

Strategy 7:Knowledge & skills of health service providers

Community based support

Strategy 8: Community based support for IYCF

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.

Community based nutrition programme components for development of Complementary feeding:

Menus of activities Support system Level of activity

1.food production 1.Tranning 1.facilitators2. nutrition education 2.Funding 2.mobilizers3. food sanitation/safety 3.problem solving 3.community level4. antenatal care 4.supertion 4.household 5.GMP 5.plan/plans 5.individual6. breast feeding 6.implementation7. other activities 7.planning and

evaluation

Feed your baby adequate and safe complementary

feeding for healthy nation.

-Thank you

.