Transcript Document

Global Strategy On Infant and Young
Child Feeding
State of Implementation
in the context of MDG4
Country: Nepal
Presentation by: Raj Kumar Pokharel
Chief, Nutrition Section
Child Health Division/DoHS, MoHP
MDG –4
Mortality Rates
Indicator
Under Five
Population
Under Five
Mortality
IMR
NMR
Status 1991 Target 2015 Status 2006
2751353
4825567
4038702
162
54
61
108
34
48
52.4
17
33
Ref.: HMIS Report 2001 & NDHS 2006,
State World’s Newborns, Nepal 2002
MDG 1
Nutritional Status of Children U5
Indicator
Status in 2001
Status in
2006
20-35% (Various
15-30% (Various
Hospital Based Studies)
Hospital Based Studies)
% under-fives stunted
57
49
% under-fives
underweight
43
39
% low birth weight
Ref. : NDHS 2001 & 2006
MDG 4 Tracking
Indicator
Coverage Level
DPT immunization
89
Measles immunization
85
Use of improved drinking water
facility
Use of improved sanitation facility
81.9
Skilled attendant at delivery
43.7
TT protection at birth
78.1
ORT for Diarrhea
92
22.7
Ref.: NDHS 2006
IYCF Practices
Indicator
Status in 2001
Status in 2006
Initiation of breastfeeding
within 1 hour
31.1
35.4
Exclusive Breastfeeding
for first 6 months
68.3
53
Median Duration of
Breastfeeding
33
34
Bottle Feeding (< 6 mo.)
3.9
4
Complementary Feeding
(6 - 9 mo.)
66.2
75
Ref. : NDHS 2001 & 2006
IYCF Policy Development
In line with Global Strategy, National
Strategy on IYCF, was approved in 2004 in
Nepal and one of the major element is;
“Reduction of PEM situation through
promoting BF practice in under five
children”
Breastfeeding: Policy
• Early Initiation of Breastfeeding within one
hour of Birth.
• Exclusive Breastfeeding up to 6 months.
• Continuous Breastfeeding for at least for 2
years with timely introduction of
complementary feeding after 6 months.
Ref.: Infant & Young Child Feeding Strategy, 2004
Development of Human Resources as
per Policy
• Masters Trainers at National Level in 2005
• Trainers for Training in Regional Level in 2006.
• District level training on IYCF has been planned
and will be conducted in all 75 districts of Nepal up
to community level HWs from 2008 within 3 years
• Aimed to provide training/orientation also to
community level health volunteers (FCHVs)
Program
• Advocacy for Maternal leave for 4 months and paternal leave
with full pay, and implementation in all working places
• Promotion of early initiation of breastfeeding and exclusive
breastfeeding for 6 months through :
• Celebration of breastfeeding week
• Media orientation and mobilization
• Intensive promotion in community level through partners
like UNICEF and other NGOs.
• Advocacy for protection from commercial promotional
practices which undermine optimal BF practices by
strengthening the implementation of the Breastmilk
(Marketing Control) Substitutes Act.
Ref.: Infant & Young Child Feeding Strategy, 2004
Program
•
•
•
Awareness raising to Health Workers about exclusive
Breastfeeding in relation to HIV with emphasise on
special counselling to HIV positive mothers (PMTCT).
Promotion of mother and children friendly environment
in health facilities in relation to maternity services
(ANC, birthing practices and postpartum care) through
reactivation of BFHI concept
Creation of baby friendly communities supportive of
mothers, fostered by family/community support groups
and trained counsellors.
Ref.: Infant & Young Child Feeding Strategy, 2004,
Coordination
• A committee on IYCF constituted representing members
from program partners and stakeholders like UNICEF, Baby
Friendly Hospitals, WHO, NEPAS and NGOs.
• National IYCF polices and strategies developed in
coordination with concerned partners and stakeholders.
• Review, translation and printing of IYCF modules of WHO
in Nepali for district level training is in process.
• Certification of breastmilk substitute products is being
approved by Department of Food Technology and Quality
Control and Breast milk Substitute Sub Committee on label
approval.
Baby Friendly Hospital Initiative
• 7 Hospitals were declared as Baby Friendly
Hospitals.
• Training provided to Doctors and Nurses on
BFHI.
• Medical staffs encourage new mothers for
early initiation and exclusive breast feeding.
Implementation of the
International Code
• National Policies and Strategies formulated in line with the
international code.
• Breastfeeding messages standardized according to
international code, and monitored by Nutrition Program of
MoHP.
• Orientation provided to implementing partners about the
international code.
• Media personals were oriented about the international code
in 2007.
Maternity Protection
• Nepal Government passed the rule of 60
days maternity leave and 15 days paternity
leave for maternity protection.
Health and Nutrition Care
• Early initiation of breastfeeding and exclusive breastfeeding
promoted through neonatal health strategy, MNH strategy.
• Importance of Postpartum mother’s nutrition is being
promoted through different IEC channel.
• Continued support for the community nutrition program in
DACAW districts.
Community Outreach
• Breastfeeding messages promoted through out
reach clinics and health facilities.
• FCHVs and mothers group mobilized to
disseminate breastfeeding message and
encouraged communities to improve Breast
feeding practices.
• Social Mobilizers of implementing partners
mobilized to disseminate breastfeeding message
and encouraged communities to improve Breast
feeding practices.
Information Support
• Growth monitoring & counseling booklet developed for
supporting health workers and community level
volunteers.
• Breastfeeding manual is already in place for health
workers.
• Development of IYCF manual in Nepali is in process.
• Different IEC materials on breastfeeding promotion
developed and distributed through government and non
government channels.
• Breastfeeding messages integrated into other health
communication materials.
Infant Feeding and HIV
• UN recommendations for breast feeding
practices in the context of HIV included in
the “National Guidelines on PMTCT of
HIV, 2005”.
• However, orientation on PMTCT package
up to community level yet has to be
conducted.
Infant Feeding During
Emergencies
• Rehabilitation Centers located at various
parts of country is supported with GON
budget and therapeutic foods.
• Expansion of NRH is in process and will be
established at 5 more hospitals within 2008
• During recent flooding in Terai regions,
emergency medical package was given.
Monitoring and Evaluation
• Growth Monitoring with counseling
through health facility is under mainstream
health program.
• HMIS is regularly collecting GM reports,
and accordingly feedback is providing
during regional review meetings.
• Periodic Surveys e.g. NDHS, MNSS,
IDDSS
Gaps in Exclusive Breastfeeding
 Majority of mothers at community have lack of knowledge and
skills on exclusive BF e.g. early initiation, non-use of Prelacteal
food, techniques, duration of BF etc.
 Majority of mothers at community have lack of knowledge and
skills on BF+ Complementary Feeding e.g. types, frequency,
quantity etc.
 Inadequate awareness raising efforts to community for family
support to mother for promotion of BF and sharing workload
 Lack of baby friendly environment
 Insufficient maternity leave
 Aggressive commercial promotional practices
 Lack of awareness of legal provision among people and
multisectoral assistance is required for strong initiation and
effective law implementation
 Slow expansion of IYCF Counseling Training to district and
community level HWs and health volunteers.
Gaps In Complementary Feeding
• Lack of knowledge on nutritional value enriched food,
practice and attitude
Low feeding frequency
Poor hygiene, food taboos
Inappropriate feeding practice
Lack of enabling environment
Lack of time for mothers and care givers
Lack of efforts for media motivation for awareness
raising
Lack of monitoring on implementation of policies
Poverty
Thank you