Transcript Document

Role of health care system in
promoting early and exclusive
breastfeeding and related
economic gains
Dr M.M.A.Faridi
MD,DCH,MNAMS,FIAP
Professor & Head, Dept of Pediatrics
University College of Medical Sciences & GTB
Hospital, Delhi
Mortality rates in South Asia
300
200
100
0
IMR
Afg Ba Bh Ind Ma Ne Pa Sril Sou
165 56 67 62 35 59 80 12 66
U5MR 257 77 80 85 46 76 101 14 92
NMR 121 36 38 43 37 40 49 11
IMR U5MR NMR
South Asia contributes one-third of global
under five deaths(10.9 m)
Others
25%
SS Africa
41%
South Asia
34%
5.8 million
Underweight children under five
(Millions) Total 146 millions
south Asia
Latin America
CEE/CIS
ME,N africa
E/S Africa
W/C Africa
E Asia/Pacific
22
17
78
16
8
1 4
Exclusive breastfeeding falls rapidly from
first month onwards
(NFHS-2-1999, India)
Exclusive Breastfeeding
100%
90%
Percentages
80%
72%
70%
61%
60%
54.2%
50%
43.3%
40%
37%
30%
25.3%
20%
19.4%
10%
0%
<1
1
2
3
Age in Months
4
5
6
Under-5 deaths preventable through universal coverage with
individual interventions (2000)
India
Percent
0%
2%
4%
6%
8%
10%
12%
14%
16%
Breastfeeding*
Complementary feeding
Clean delivery
Hib vaccine
Intervention
Clean water, sanitation, hygiene
Zinc
Vitamin A
Antenatal steroids
Newborn temperature management
Tetanus toxoid
Antibiotics for PRM
Measles vaccine
Nivirapine and replacement feeding
Insecticide-treated materials
Antimalarial IPT in pregnancy
*Breastfeeding: Exclusive for first 6 months and continued for 6 to 12 months
Source: Jones et al. LANCET 2003;362:65-71
18%
Risk of Death From Diarrhoea With
Different Methods of Feeding
Infants 8 days to 12 months
1
Breast only
3.4
Breast & cow's milk
4.5
Breast & formula
11.6
Cow's milk only
16.3
Formula only
23
Formula only (age less than 2 months)
0
5
10
15
20
25
Relative risk of death
CG Victora et al, Brazil, Lancet 8/8/87
19/6
Risk of neonatal mortality according to time
of initiation of breastfeeding
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
4.2
6 times
more risk
2.3
2.6
1.2
0.7
With in 1 From 1 hour
hour
to end of day
1
Pediatrics 2006;117:380-386
Day 2
Day 3
After day 3
1st hour initiation cuts 22% of all
deaths
If we enhance initiation of
BF within one hour
15.8%
11 Lac
Neonatal
Deaths
100%
2.5
lac
2.5 lac babies will be saved
Pediatrics 2006;117:380-386
Impact of Exclusive breastfeeding
on IMR – Bangladesh model
• Influence of exclusive breastfeeding in
early infancy on the risk of infant deaths,
especially those attributable to respiratory
infections (ARI) and diarrhea
• Rapid reduction in IMR by 31% when
exclusive breastfeeding was increased
from 39 to 70 %
Shams Arifeen etal. Pediatrics 2001
Economic Value of
Breastfeeding
• Market Value of breastmilk : difficult to put
a cost !
• In the Milk banks of Norway it is available
at 50 $ per liter
• At Current level of production of
breastmilk in India : theoretical capacity 4000 million liters / year
Gupta A, Khanna K. Economic value of breastfeeding in India, The
National Medical Journal of India,1999
U 5 DEATHS FROM SPECIFIC CAUSES PREVENTABLE
THROUGH LISTED INTERVENTIONS – India Model
Disease/
Condition
U5 Deaths (in
‘000) 2000
Percent of
total U5
Deaths
Preventable
U5 Deaths
Diarrhea
556
23%
506 (91%)
Pneumonia
544
23%
366 (66%)
Neonates –
severe
infections
216
9%
205 (95%)
Total
1316
55%
1077 (84%)
Jones Gareth, Schultink Werner, Babille Marzio. IJP 2006.
Core Package of Essential Health Intervention
Assessment by the national commission on macro economics and
–2005, IndiaNo.
Core Package health
Approximate
Total cost for
(2005)
treatment
US $ millions
ARI:Pneumonia
34,184,386
105.14
(OPD)
Diarrhea –some
dehydration
34,184,386
200.51
(OPD)
Diarrhea - severe
dehydration
34,18439
55.21 (OPD)
Neonatal Sepsis
250,000
38.04
(IPD)
NRHM – Framework for Implementation 2005-2012, MOHFW
Cost of Health Care and
Breastfeeding
• A study from USA, looked into the excess cost of health care
services for three illnesses i.e. Lower respiratory tract illnesses, otitis
media, and gastrointestinal illness in formula-fed infants in the first
year of life
• There were 2033 excess office visits, 212 excess days of
hospitalization, and 609 excess prescriptions for these three
illnesses per 1000 never-breastfed infants compared with 1000
infants exclusively breastfed for at least 3 months
• Additional health care services cost the managed care health
system between $331 and $475 per never-breastfed infant during
the first year of life.
Thomas M. Ball and Anne L, Pediatrics (1999).
Cost of Health Care and
Breastfeeding
• Cost of treatment of medical conditions in
the non-breastfed babies
–
–
–
–
Infant Diarrhea - $291.3 m
Respiratory Syncitial Virus - $225 m
IDDM - $ 9.6 - $ 124.8 M
Otitis Media - $660 m
Riordan JM. J Hum Lact.1997; 13(2): 93-97.
Cost of Health Care and
Breastfeeding
At hospital
discharge
At 6
months
Breastfeeding levels
1998
Breastfeeding Surgeon
generals’ targets
64%
75%
29%
50%
Saving of a minimum of $ 3.6 billion
Weimer J. USDA economic research service, 2001.
Cost of training Counselors –Bhuj,
India (BPNI, 2003)
• US $ 5 for training of the counselor per
pregnant women
• Annual births are 25 million
• One time cost of training all the counselors
is US $ 125(5x25) Million
Conclusions
Early and exclusive breastfeeding may prove to
be an important economic intervention in
resource crunched developing countries due to
Reduced infant mortality
Reduced costs of infant and child illness
Productivity gain from increased cognitive ability
Reduced costs of chronic diseases
Reduced cost of feeding
• Thank you !