revitalization of bfhi
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Revitalization of BFHI. Randa Saadeh Scientist Nutrition for Health and Development SCN, Rome, 2007. In response to WHA mandate. 59 th WHA (WHA59.21) Infant and young child nutrition (2006) 'revitalization of Baby-friendly Hospital Initiative to protect, promote and support breastfeeding' - PowerPoint PPT PresentationTRANSCRIPT
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Revitalization of BFHIRevitalization of BFHI
Randa SaadehScientist
Nutrition for Health and DevelopmentSCN, Rome, 2007
Nutrition for Health and Development
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In response to WHA mandateIn response to WHA mandate
59th WHA (WHA59.21) Infant and young child nutrition (2006) 'revitalization of Baby-friendly Hospital Initiative to protect, promote and support breastfeeding'
Nutrition and HIV/AIDS (WHA 59.11) urging Member States 'encouraging revitalization of the Baby-Friendly Hospital Initiative in the light of HIV/AIDS'
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And other global strategies And other global strategies and joint initiativesand joint initiatives
Global strategy for infant and young child feeding WHO/UNICEF (2002)
Innocenti Declaration 2005WHO/UNICEF on IYCF AEM, IBFAN, ILCA, LLLI, Wellstart, WABA
Durban statement on Nutrition and HIVWHO/UNICEF/WFP/UNAIDS/FAO/UNHCR (2005)
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Now where do we stand?Now where do we stand?Have Have 20 000 BFHs – However… 20 000 BFHs – However…
not accelerating at same pace and reluctance to achieve baby-friendly status especially in private hospitals
Lack of support and recognition from governments some ‘slippage’, i.e. falling back into old patterns rates of exclusive breastfeeding for the first 6 months are still relatively low-
38% counselling skills and coverage by health-care workers still need to be
enhanced poor supervision of trained staff and monitoring of quality of services
provided weakened commitment in the face of HIV/AIDS pandemic and the number
and gravity of other emergencies influence of infant food industry
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BFHI update and changesBFHI update and changes
Scientific-evidence
Sections of new package
Expansion and integration options
Technical updates on 'Ten Steps' and clinical practice
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Why now and what has Why now and what has been done?been done?
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3%
3%
4%
4%
5%
6%
7%
13%
0% 2% 4% 6% 8% 10% 12% 14%
Antenatal steroids
Water, sanitation,hygiene
Clean delivery
Hib vaccine
Zinc
Continued BF withComplementary feeding
Insecticide treatedmaterials
Exclusive Breastfeeding
Optimal Infant feeding practice reduces Under-five mortalityOptimal Infant feeding practice reduces Under-five mortalitySource: Lancet Child Survival Series 2003Source: Lancet Child Survival Series 2003
expected % of reduction in U5M
inte
rven
tion
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WHO Child Growth StandardsWHO Child Growth Standards
A growthchart for the 21st
century 1 year 2 years 3 years 4 years 5 years
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Comparison of WHO with NCHS length/height-for-Comparison of WHO with NCHS length/height-for-age z-scores for boysage z-scores for boys
Age (months)
Leng
th /
Hei
ght (
cm)
6080
100
120
0 2 4 6 8 12 16 20 24 28 32 36 40 44 48 52 56 60
0
-1
-2
-3
1
2
3
WHONCHS
Source: MGRS Group. WHO Child Growth Standards: Length/height-for-age, weight-for-age, weight-for-length,weight-for-height and BMI-for-age: Methods and development. Geneva: World Health Organization, 2006
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Policy Statements on infant feedingPolicy Statements on infant feeding
"The breastfed infant is the normative model against which all alternative feeding methods must be measured with regard to growth, health, development, and all other short- and long-term outcomes", American Academy of Pediatrics, 1997
"The promotion and practice of breastfeeding is essential to the achievement of optimal infant and child health, growth and development", American Academy of Pediatrics, 2005
National infant feeding policies of many countries recommend exclusive breastfeeding as the optimal source of nutrition for the first six months of life.
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ObesityObesityIs the other side of the spectrum of malnutritionIs the other side of the spectrum of malnutrition
Breastfed babies could have 30% reduced risk of becoming obese children compared with bottlefed children
Overweight children are at higher risk of becoming overweight adolescent and adults. Other factors include exercise and hereditary.
FactsWe know enough this still a challenge
Picture removed…
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BFHI update and changesBFHI update and changes
Scientific-evidence
Sections of new package
Expansion and integration options
Technical updates on 'Ten Steps? and clinical practice
Nutrition for Health and Development
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Baby-friendly Hospital InitiativeBaby-friendly Hospital InitiativeRevised, Updated and ExpandedRevised, Updated and Expanded
for Integrated Carefor Integrated Care
Section 1: Background and ImplementationSection 2: Course for Decision-makersSection 3: "20 hour" Course for Maternity StaffSection 4: Hospital Self-appraisal & MonitoringSection 5: External Assessment & Reassessment
January 2006January 2006
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New 20-hour Course New 20-hour Course
focuses on helping staff members support mothers to succeed with early and exclusive breastfeeding and help implement the “Ten Steps”
content includes:– HIV and infant feeding– Mother-friendly birthing practices and
breastfeeding– Support for women who are not breastfeeding
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The revised BFHI assessment tools are:The revised BFHI assessment tools are:
Still focused on what mothers and staff know and can do, rather than self-reporting by management
Revised to reflect current evidence and added emphasis on the Code and support for non-BF mothers
Revised to include optional "modules" on:–HIV and infant feeding–Mother-friendly care
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Selected enhancements to the Selected enhancements to the Ten StepsTen Steps
Step 2: Addition of interviews of non-clinical staffStep 4: Skin-to-skin and initiation of BFChange in interpretation of step from: "Help mothers initiate breastfeeding within a half-hour
of birth" to "Place babies in skin-to-skin contact with their mother
immediately following birth for at least an hour and encourage mothers to recognize when their babies are ready to breastfeed, offering help if needed."
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Step 6: Updates to the acceptable medical reasons for supplementation
Step 8: Feeding on "demand" changed to "feeding on cue"
Step 10: Post-discharge support Addition of assessment of early post-discharge
follow-up and referral system
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BFHI update and changesBFHI update and changes
Scientific-evidence
Sections of new package
Expansion and integration options
Technical updates on 'Ten Steps' and clinical practice
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Expansion optionsExpansion options
1.5.1 Baby-friendly Communities1.5.2 BFHI and PMTCT
1.5.3 Mother-baby friendly care1.5.4 Baby-friendly NICUs
1.5.5 Baby-friendly Paediatric Care
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Baby-friendly health care – everywhere!Baby-friendly health care – everywhere!
Integration into Child Survival strategiesIntegration into IMCIIntegration into Maternal SurvivalIntegration with EPI campaignsIntegration into Emergency
preparedness and emergency responseOthers?
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BFHI update and changesBFHI update and changes
Scientific-evidence
Sections of new package
Expansion and integration options
Technical updates on 'Ten Steps? and clinical practice
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Underway…Underway…
Revision of the 'Scientific basis for the Ten Steps'
Physiological basis
Strengthening 'Step 10' and link to community
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Finer points of skilled practical management - Finer points of skilled practical management - infant not ready to feed immediately after deliveryinfant not ready to feed immediately after delivery
Picture removed…
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...the same baby showing signs of readiness to feed 30-40 ...the same baby showing signs of readiness to feed 30-40 minutes after deliveryminutes after delivery
Picture removed…
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……..stretching and twisting the nipple to help the baby to ..stretching and twisting the nipple to help the baby to attach - but not effectiveattach - but not effective
Picture removed…Picture removed…
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Baby’s real need - early skin-to-skin contact on the Baby’s real need - early skin-to-skin contact on the delivery tabledelivery table
Picture removed…
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Kangaroo Kangaroo Mother Mother CareCare
Dr N
ils B
ergm
an, C
ape
Tow
n, S
outh
Afri
ca12/2
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For revitalization of BFHIFor revitalization of BFHIIn shortIn short
keep alive
sustain progress
ensure quality and adherence to global criteria
use concept but stay focused
show its effectiveness and health impacts
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Working togetherWorking togetherat different levels and partnersat different levels and partners
High quality of care for
mothers and children
International Organizations
GovernmentsMOHs and others
Regional/ countries offices
NGOs
Professional/scientific groups
Civil society groups
Industry
Religious group
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Working together with critical partnersWorking together with critical partners
all have a role with assigned responsibilities and obligations
expand and integrate within a defined framework but
follow agreed joint guidelines of working with private sectors and avoid conflict of interest
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Thank you!Thank you!