Global Recommendations on Complementary Feeding Need for a Relook

Transcription

1 Global Recommendations on Complementary Feeding Need for a Relook K.P. Kushwaha, Professor(Pediatrics), Principal and Dean B R D Medical College, Gorakhpur

2 Opportunities, confusion and sale

3 Global Situation of Child health and nutrition Prevalence of child mortality and child under nutrition is still very high in the world Asian countries contribute significantly to these indicators

4 Prevalence of under nutrition in children below 5 yrs of age in Asia (UN estimates) Stunting ( HAZ<-2) 26.8% Wasting (WHZ<-2) 10.1% Sever wasting (WHZ<-3) 3.6% Under weight (WAZ<-2) 19.3% Prof. Robert E Black, Lancet, 2013;

5 Stunting sets in and peaks during infancy and young childhood

6 Global deaths in under fives attributed to under nutrition Stunting ( 1-59m ) 14.7% ( UN prevalence estimate) Underweight 14.4% ( UN ) Sub optimal breastfeeding 11.6% ( UN) Prof. Robert E Black, Lancet,Vol:382; ,

7 Effect of nutrition-related interventions on stunting in 36 countries 99% coverage with hygiene interventions % coverage with zinc supplementation % coverage with feeding interventions (promotion of complementary feeding and other supportive strategies) % coverage with multiple micronutrient supplementation in pregnancy % coverage with intermittent preventive treatment % coverage with balanced energy protein supplementation Relative reduction in prevalence of stunting at 12 months LSMCU 2008

8 Global Documents Global Strategy for Infant and Young Children (2002) WHO guiding principles for complementary feeding of the breastfed child (2002)

9 Global Strategy for Infant and Young Child Feeding WHO/UNICEF, 2003

10 Global Strategy for Infant and Young Child Feeding (WHO/UNICEF) Complementary foods be: timely Adequate Safe properly fed (counseling in feeding Safe skills)

11 Global Strategy for Infant and Young Child Feeding (WHO/UNICEF) Appropriate complementary feeding depends on accurate information and skilled support from the family, community and health care system. 15. Providing sound and culture-specific nutrition counseling to mothers of young children and recommending the widest possible use of indigenous foodstuffs

12 Global Strategy for Infant and Young Child Feeding (WHO/UNICEF) In addition, low-cost complementary foods, prepared with locally available ingredients using small-scale production technologies in community settings and Industrially processed complementary foods also provide an option.. Processed-food products are also recommended.

13 Global Strategy for Infant and Young Child Feeding (WHO/UNICEF) Food fortification and universal or targeted nutrient supplementation may also help to ensure that older infants and young children receive adequate amounts of micronutrients.

14 Guiding principles for complementary feeding of the breastfed child PAHO/WHO, 2002

15 Guiding Principles for Complementary Feeding of the Breastfeeding Child Duration of exclusive breastfeeding and age of introduction of complementary food Maintenance of Breastfeeding RESPONSIVE FEEDING SAFE PREPARATION AND STORAGE OF COMPLEMENTARY FOODS AMOUNT OF COMPLEMENTARY FOOD NEEDED

16 Guiding Principles for Complementary Feeding of the Breastfeeding Child FOOD CONSISTENCY MEAL FREQUENCY AND ENERGY DENSITY NUTRIENT CONTENT OF COMPLEMENTARY FOODS USE OF VITAMIN-MINERAL SUPPLEMENTS OR FORTIFIED PRODUCTS FOR INFANT AND MOTHER FEEDING DURING AND AFTER ILLNESS

17 International Code of Marketing of Breast milk Substitutes WHO, 1981

18 International Code: 1981 It is minimum Provision for safe and adequate nutrition for infants Regulates marketing of commercial infant foods and drinks Prohibits creating opportunity for Sale Prohibits promotion Creates opportunity for Health promotion

19 Confusing the issue of complementary feeding and processed foods As we have guideline for replacement feeding and for infant formula. Are guidelines giving opportunity for Sale?

20 Are recommendations not Promotion? Why guidelines on complementary foods end at 24 months?

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22 Promoting Commercial Comp. Foods Adviser - Britannia Nutrition Foundation Some commentators have argued that particular interpretations of the code have almost completely driven the private sector out of efforts to improve the nutrition of children aged 6 24 months.

23 GAIN promotes commercial CF Supports companies and agencies in the development, production and marketing of: Fortified complementary foods (FCF) Complementary food supplements (CFS), and Multiple micronutrient powders (MNP) to improve nutritional status of older infants and young children

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25 GAIN - Complementary food fortification in Kenya

26 No guidelines for feeding of above 24m olds Opportunity for promotion of baby foods through : Marketing Advertisement Gifts Rebate Spill over effect on under 24m

27 No separate food pyramid for infants and young children Milk and non veg. foods to be brought down Oil and sugar are needed to increase calorie density Mix of cereals, on veg. foods and fruits and vegetables may need different proportion

28 Why to permit place for commercial dominance? Opportunities for baby food marketing: Guideline: Update on management of SAM,WHO,2013 : recommends RUTF Supplementary feeding program School health and midday meal program Public Private partnership in public health and nutrition NGOs based on industry support

29 Opportunities, confusion and sale

30 The commercial needs Tried and tested 3 Cs 1. Convince if possible 2. Confuse if necessary 3. Corrupt if nothing else works

31 Powerful Third C

32 What are recent evidences?

33 Science of commercial foods: Processed baby foods lack nutritional value Ada L Garcia ;ADC, Sept,9,2013 Analyzed 462 commercial food products Home made foods better than any of commercial foods

34 FAO : Trial of improved practices ( TIPs) Complementary foods should be With Community based/home based counseling Locally available nutrient dense foods Culturally appropriate Marketing of any food product for child consumer below 12 yrs is inherently deceptive and misleading Abstract thinking comes by 13 yrs.

35 Marketing of commercial foods will undermine health promotion Public citizen (202),588, organizations and thousands of Moms and citizens urge companies to end unethical promotion of their products. (Unethical trading) Reuters, World top food companies ( $3.4 trillion) announce to improve advertizing to show that they are responsive and responsible (? Ethical trading)

36 Are responsive advertisements really responsible? Deceiving tactics are more harmful Healthy foods ( deceptive) Natural foods Locally sourced Antibiotic free Organic Scooby-Doo cereal

37 Systemic review of 14 nutritional interventions Journal de Pediatrica /04/ groups 1. Supplementary foods 2. Specially prepared foods 3. Only nutritional counseling Third group has added advantages over others two

38 16 RCTs and quasi experimental studies Lassi ZS, BMC Public health quoted by Prof.Zulfiqar A Bhutta in Lancet,2013, Food secure Population: Nutrition education resulted in 1. Enhanced ht gain ( SMD 0.35 ) 2. Enhanced ht for age( SMD 0.22 ) 3. Enhanced wt gain ( SMD 0.40 ) No effect on stunting and WAZ

39 16 RCTs and quasi experimental studies Lassi ZS, BMC Public health quoted by Prof.Zulfiqar A Bhutta in Lancet,2013, Food insecure population: Nutrition education resulted in improved 1.HAZ 2. WAZ and 3. Stunting Food provision +/- nutrition education resulted in improvement in 1.HAZ 2.WAZ and 3. no effect on stunting

40 BFCHI Lalitpur Around 1286 MSGs working with support of BFCHI project 1124 at AWCs 162(288 members) in Sahariya (96) and Majras (66) Promoting IYCF practices in the community through holding community meetings and Home visits. 51 Counselors supported the MSGs Demonstrating a thick consistency Complement and feeding skill Percentage of mothers started appropriate complimentary feeding (6-8 months) 53.6% in (2006-Baseline) 83% in (2012-endline) assessment by UNICEF

41 Recommendations Define appropriate Political will and Government policies to Promote, protect and support CF and for food growth Define participation of civil societies Make Uniform definitions of various terms used for complementary feeding and guidelines Recommendations on macronutrient and micronutrient need to be consistent and updated Protect home cooked complementary feeding Improved breastfeeding knowledge and techniques and introduction of new growth standards need newer research on assessment of average milk production and needs of amount, frequency and diversity of complementary feeds

42 Thanks