Multi-Indicator Cluster Survey in Macedonia Breastfeeding Patterns in Children 0-24 Months

Some demographic and health indicators*

 Total number of the population 2.007.523

 Annual number of live births 27.309

 Birth rate-14.1%0  Infant mortality rate14.9%0  Perinatal mortality rate18.7%0  * 1999

Health and nutritional survey 1994 Breastfeeding rate and nutritional patterns in infants



Exclusive breastfeeding rate (0-4 months) -8.1%



Predominant breasfeeding rate 70.4%



Stop breastfeeding rate 21.6%

 59% (first weeks)  26.9% (5-8 weeks)  14.1%(9-13 weeks)

The steps of National Breastfeeding policy development in Macedonia

        

1994

-Health and nutritional survey in children under 5

1996

- Breastfeeding course: London Practice and policy - Ministry of health representatives participation

1997

-Establishment of National Breastfeeding committee

1997-1998

- Breastfeeding training course for primary health care provider

1999 -

Baby friendly hospital initiative

1999

Multi-indicator cluster survey

2000

- Breastfeeding community support MtMSG and celebration of WBW

2000

- Implementation of the Code(some articles) in Consumer protection low

Nine months maternity leave

Multi-Indicator cluster survey 1999

  Main objective achievement of the goals of the World Summit for Children   Specific objective nutritional status of mother and children   micronutrient deficiencies evaluation of feeding patterns of infants and small children

The information of infant feeding pattern was collected with

24 hour recall questionnaire

using the following indicators:  Exclusive breast feeding rate (0-4 m)  Exclusive breast feeding rate (0-6 m)  Predominant breast feeding rate (0-4 m)  Predominant breast feeding rate (0-6 m)  Timely complementary feeding (6-9m)  Continued breast feeding at 1 year

Prevalence of breastfeeding in children 0-24 months by population strata Urban

Row % 95% CI

Rural

Row % 95% CI

Total

Row % 95% CI

Breastfeeding Yes 625 92.5

87.4-97.5

609 91.0

86.5-95.5

1234 91.8

88.4-95.3

No 51

7.5

2.5-12.6

60

9.0

4.5-13.5

111

8.2

4.7-11.6

Total 676

100

669

100

1345

100 Pearson Chi -square :0.9, p=0.34

Feeding pattern of Children 0-4 m and 0-6 m by Population strata

Urban Rural Total Urban Rural Total Exclusive 46.8

42.7

45.3

Exclusive 38.6

33.6

36.6

Predominant 37.8

0-4 months

Non breastfed 14.4

Breastfed + other energetic foods 0.9

34.1

36.5

20.7

16.7

2.4

1.5

Predominant 31.9

0-6 months

Non breastfed 29.9

Breastfed + other energetic foods 0.6

27.9

30.3

35 31.3

3.6

1.8

Total 100 100 100 Total 100 100 100 Pearson Chi -square :5.24, p=0.15

Prevalence of Exclusive Breastfeeding in Children 0-24 m, by Population strata 30 20 10 0 80 70 60 50 40 rural urban 1 2 3 4 5

Age in months

6 7 12 13-24

Prevalence of breastfeeding in different ethnic groups in children 0-24 months Total Other Turkish Roma Albanian Macedonian 0 20 40 60 80 Yes 100 No

Prevalence of exclusive breastfeeding in different ethnic groups in children 0-6 months Total Other Turkish Roma Albanian Macedonian Yes No 0 20 40 60 80 100 120

Habit of breastfeeding in children 0-24 months by population strata on demand at fixed interval TOTAL RURAL URBAN 0 20 40 URBAN RURAL TOTAL 60 at fixed interval on demand 4.6

95.4

1.5

98.5

3.4

96.6

80 100 120

3 2 1 Median number of suckling during the night in children 0-24 m , per population strata urban rural total 0-6 months 7-12 months 13-24 months A g e

3 2 1 6 5 4 Median number of suckling during the day in children 0-24 m,by population strata urban rural total 0-6 7-12 13-24 Age in months

Time lapse after birth for breastfeeding children 0-24 months by population strata

80 60 40 20 0 URBAN RURAL TOTAL 30 min 3.3

12.8

7.4

6 hours >6 hours 29.9

27.8

29 66.9

59.3

63.6

URBAN RURAL TOTAL

Reasons for breastfeedig cessation for children 0-24 by population strata

Pregnancy No time No wight Baby's illness Mother's illness No milk 0 20 40 60 80 100 total rural urban

Progress towards the achievement of the goals for year 2000 of the world summit for children



Year 2000 goal 1994 MIKS 1999 MIKS Progress

Year 2000 goal Empowerment of all women to breastfeed their children exclusi vely for four to six months and to continue breastfeeding, with complementary food, well into the second year 0-4 months Exclusive BF

8%

Predominant BF =78% 0-4 months Exclusive BF

45%

Predominant BF =34% Good achievement of the goal that still needs educational efforts

NATIONAL REPORT CARD ON BREASTFEEDING*

Indicators Score Rate  EBFR at 6 months 4  National breastfeeding policy 10  % of BFH 8  Implementation of ICMBS 9  Maternity leave 9 m 10

Total 41

GLOPAR - Global Participatory Action Research Project by WABA

SCORE RATING

        41-50 - Excellent 36-40 - Very Good 31-35 - Good 26-30 - Average 21-25 - Poor 16-20 - Bad 11-15 - Vary Bad 0-10 - Terrible Excellent 41

NUTRITIONAL SURVEY IN REFUGEE CAMPS IN MACEDONIA

B.Ancevska MD, N.Janeva MD, K.Venovska MD

Collaborative Study : AAA. UNHCR, UNICEF, IMCH

•More than 300,000 Kosovar refugees crossed the Macedonian border from March to June 1999 . •120.000 - 140.000 were accommodated in 7 camps with rapid population movement •Health condition was generally good •Food distribution was considered adequate but inconsistent in nutritional content and frequency of distribution

Goals an objective of the survey

 the survey was designed to span several sectors of refugee needs in order to provide recommendations to international organizations serving the refugees in camps in R.M

Specific objective among children under 5 years of age

  determine the nutritional status estimate the prevalence of breast feeding and infant feeding practice  estimate the prevalence of diarrhea and ARI  estimate the immunization coverage

Sampling methodology and sample size

 A systematic random sample of household was taken, a household being defined as a group of persons occupying the some structure and sharing the household resources  The survey population included 1421 households and 1001 children under 5 years  Research tool -questionnaire for interviewing caregivers of young children “ Are you breast feeding your child?” “ Are you feeding your child with infant formula?”

Demographic distribution of children less than 5 years of age among Kosovar refugees in camps in R.M

Age group (months) Number % 0- 5 95 9.4

6-17 207 20,7 18-29 210 21.0

30-41 217 21.7

42-53 190 19.0

54-59 82 8.2

Total 1001 100 10.4 % of all population were children under 5

Infant feeding among children < 12 months

BF Formula Both Neither

Age group N % N % N % N % < 4 months 40

70

3

5

1

1

13

23

4- 7 months 36

51

8-11 months 34

43

All ages 110

53

10 11 24

14 14 12

4 2 7

6 3 3

21 32 56

30 41 32



What food those 23% of infants under 4 months received

cow’s milk bread and biscuits

BABY FOOD DONATION*

    infant formula baby cereals dehydrated baby meals jars of fruits and mix meal for weaning purpose * * * A calculation of the quantities of formula at the and of July. 99 indicate that there was enough to feed approximately

22%

of the infants fin the refugee population

for 6 months

Violation of the International Code of Marketing of Breast Milk Substitutes Source of donation-unknown

Infant feeding intervention in Macedonia during refugee crisis  Mother and baby - station  5 day training programme to provide PHC training for NGO health workers with one day allocated for breast feeding  On job training for NGO health staff in camps  Availability of training material with appropriate information about breast feeding  UNICEF Initiative to store infant formula donation