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NATIONAL LACTATION CENTRE
BFHIISSUES IN MALAYSIA
by
DR PARAMJOTHI P.Senior Consultant
Department of Obstetrics & Gynaecology
and
HeadNational Lactation Centre
Hospital Selayang
2DR. PARAM
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BFHI
Introduced in 1993 – 18 years ago
Initial euphoria
Certification/Plaque - UNICEF
Failures - Reassessments
LACTATION MANAGEMENTLACTATION MANAGEMENT
DR. PARAM
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LACTATION MANAGEMENT
Cross-sectional studies from industrialised and developing countries have clearly shown :
“Health Professionals, Administrators and Policy Makers lack knowledgeabout BF and their attitudes and
practices are often not supportive of BF.”
BFHI
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PRIORITY
LOW!!!
Low at ALL levels
Administrators / Policy makers
Clinicians (especially Obstetricians)
Monitoring - poor
LACTATION MANAGEMENT
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BFHI Step I
POLICY
Name-sake only
Policy details not implemented
No reviews/updates
Public not informed
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BFHI Step 2
TRAINING
Pitfalls
Just a formality
No training after course / practice
Unable to provide / disseminate
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BFHI Step 2
TRAINING
Specialists/Consultants – shy-away
Medical Officers - compulsory
House Officers - not involved!
Nurses - excellent
Doctors combined with nurses to pass Step 2DR. PARAM
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BFHI Step 2
TotalNumber
TotalTrained
Percentage(%)
TotalNOT
Trained
Percentage(%)
Doctors 189 78 41.3 111 58.7
Nurses 980 692 70.6 288 29.4
STAFF TRAININGSELANGOR STATE - HEALTH
ANALYSIS - AUGUST 2004
DR. PARAM
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BFHI Step 2
TRAINING - DOCTORS
Obstetricians - mostly not interested, not trained
Refuse to attend courses - “no time”, “boring”
Training CD - inadequate
Courses run by nurses - negative attitude
Forced to attend - failure to understand the importance DR. PARAM
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BFHI Step 3PATIENT TRAINING
Needs improvement
Importance of Antenatal Education vs
at delivery/postpartum
Booking/Only delivery at hospital
Health Clinics - inadequate- Hospital based programme
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BFHI Step 3
Compliance
Ethnic differencesChinese?
Educated vs Rest
Urban vs Rural
Return to work
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LACTATION MANAGEMENT
Chinese Mothers : Reasons for not BF
Herbs, alcohol, oily food (linseed oil). Mostly eating habits
Babies looked after by :• Mother, Mother-in-law• Baby sitters• Professional Confinement Amahs
Breast size
BFHI - STEP 3
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BFHI Step 4
LABOUR & DELIVERY
Skin to skin
Initiation – patchy
Caesarean section - epidural- spinal
Param’s Technique – 11 Steps
Skin to skin & Initiation in OT - not done
Separation still practised (private sector)DR. PARAM
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BFHI Step 7
ROOMING-IN
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BFHI Step 8
DEMAND FEEDING
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DEMAND AND EXCLUSIVE
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BFHI Step 10
Support
Poor / Non-existant
Main reason – discontinuation
Support Group Training
Lactation Clinics
Doctors – input necessary
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BFHI Step 11 / Item 11
Infant Formula Code
Gentlemen’s agreement
No punitive action
Purchases ?? - Public- Private
4th Version 1st August 2008
Infant Formula Companies – not helping
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BFHIPrivate Hospitals
MOH plan – Dec. 2003
Only 6 out of 200 +
Not Compulsary
Loose patients / Financial loss
Senior Consultants – not interested
Policy bad
Owners / administrators..?? DR. PARAM
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LACTATION MANAGEMENT
BFHI Certification - UNICEF Plaque
Initial euphoriaProgramme dormant/ “sleep mode”Activated weeks before reassessmentUNICEF plaque - negative impactMOH information of dates for reassessmentReady/Not ready
PROGRAMME NOT ACTIVEACTIVATED ONLY FOR REASSESSMENT
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LACTATION MANAGEMENT
MONITORING TOOLS
Special training needed
Advised by MOH - 3/6 monthly
Usually done before assessments (2 years)
*Policy must be changed*Monthly*Immediate action to correct problems
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LACTATION MANAGEMENT
LACTATION COMMITTEE
Obstetrician as ChairmanRepresentatives :Administrators - SeniorSenior staff - Specialists, DoctorsAll wards - SistersOBGYN & PaediatricsMatron
Representatives from all Health Centres referring casesFMS3 monthly meetings DR. PARAM
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LACTATION MANAGEMENT
BFHI REASSESSMENTS
Sudden - anytime after expiry
Ongoing programme
Prevent preparation for assessments
Punitive action for failures
Feeder HCs assessed together (2006 criteria)
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LACTATION MANAGEMENT
PRIVATE HOSPITALS
Serious lack of commitment
Practices guided by clients comfort
Financial considerations
Completely overlook long-term health benefits
BFHI - Problems
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BFHI
DOCTORS???
________________________________________
NATIONALLACTATION
CENTREDR. PARAM
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BFHI
BUDGET AND FINANCES ???
32THANK YOUTHANK YOU