Working together for the nutritional health of vulnerable populations

1. Working together for the nutritional health of vulnerable populations

2. The overall objective of the Health and Nutrition Cluster Response is to reduce avoidable morbidity and mortality associated with the conflict and subsequent displacement Objective 3: To prevent excessive nutrition-related morbidity and mortality of vulnerable groups including acutely malnourished children pregnant and lactating women (PLW) & elderly Indicator: Number of vulnerable groups including children pregnant & lactating women (PLW) and elderlyreached out with interventions to support, protect and promote appropriate nutrition

3. Why this presentation? • Enhance understanding of the importance of protecting, promoting & supporting safe & appropriate infant & young child feeding (IYCF) • Inform what the current context in eastern Ukraine means for IYCF • Identify the need for nutrition-specific & nutrition-sensitive WASH approaches, targeting infants & young children

4. Importance of protecting, promoting & supporting safe and appropriate IYCF • Children <2 years most vulnerable to illness & death • Critical period for physical, mental & emotional development • Age-specific nutrition needs; risk of infection; complete dependency on others for care • Nutritional & psychosocial deficits during this time period can result in lifelong impairment & disability

5. Recommended IYCF Practices Recommendations of the Ukraine MoH. WHO & UNICEF for infants & young children to achieve optimal growth, development & health: • Exclusive breastfeeding until the age of 6 months, commencing within 1 hour of birth • Introduction of nutritionally age-appropriate, adequate & safe soft, semi-solid & solid complementary foods starting at 6 months • Continued breast-feeding up to the age of two years or beyond Appropriate & timely support of IYCF-E saves lives

6. Context in GCAs of eastern Ukraine • Suboptimal young child feeding practices • Low rates exclusive breastfeeding , infants <6 months (mean 13.8%; 25.8%) • Mixed feeding –breastfeeding &infant formula (intro mean 3.1 mo; 4.2 mo) • Use of teas & water for infants <6 months (intro mean 3.1 mo) • High use of bottles/teats (mean 68.1% - 72.5%) • Early introduction of complementary foods (mean 4-5 mo) • Duration of continued breastfeeding (mean 31.8%; 53.5% at 1 year) • Indiscriminate distributions of infant formula by agencies • No elevated wasting in children 6-23 months (prevalence below 1%) (Save the Children - UNICEF IYCF-E Assessment June 2015: IDPs. Kramatorsk; Sloviansk; Svytahirsk)

7. …GCAs context • Lack of refrigerators, especially in some collective centres • Most have access to running water (97.6%) • Most have facilities to boil water (98.8%) • Preparing food & drinks for infants • bottled or tap water (Kramatorsk & Slovianske) well use (Sviatohirst) • Sub-optimal water quality in conflict affected areas • Erroneous, belief bottled water is safe for babies because it is sterile • Access to soap, primarily through self-purchase • Hygiene products requested: diapers, soap, baby creams, shampoo, wet wipes, children’s laundry detergent + teething gel (Save the Children - UNICEF IYCF-E Assessment June 2015: IDPs. Kramatorsk; Sloviansk; Svytahirsk) • ? Prevalence of blue baby syndrome (methaemoglobinaemia) & water-borne diseases eg hepatitis A, cholera in Ukraine

8. ‘Nutrition-sensitive’ & ‘Nutrition-specific’ Nutrition-specific interventions address the immediate causes of under-nutrition, like inadequate dietary intake and some of the underlying causes like feeding practices and access to food Nutrition-sensitive interventions can address some of the underlying and basic causes of under/malnutrition by incorporating nutrition goals and actions from a wide range of sectors. They can also serve as delivery platforms for nutrition-specific interventions

9. Inadequate Dietary Intake Immediate Causes Underlying Health /Nutrition Causes InsufficientAccess to Food Inadequate Care for Mothers and Children Inadequate health services & unhealthy environment (incl poor WASH) Understanding inter-sectoral linkagesThe Under-Nutrition Causal Framework Under-Nutrition Outcome Disease (incldiarrhoea, helminth infections &conditions such as environmental enteropathy Health Food Care Adapted from Unicef 2013

10. Integrating IYCF into WASH

11. Infection - Malnutrition Cycle Inadequate dietary intake Appetite loss Nutrient loss Malabsorption Altered metabolism Increased energy & nutrient needs Weight loss Growth faltering Lowered immunity Increased susceptibility Disease (increased severity & duration)

12. F-diagram (adapted from Perez et al., 2012)

13. IYCF – WASH Linkages • WASH & nutrition activities have several possible linkages and can achieve common outcomes • Poor water & sanitation is an underlying cause of malnutrition • Improper sanitation facilities, waste disposal & water/food management can lead to food/water contamination • Poor personal & food-feeding/water hygiene practices increase the risk of diarrheal diseases • Poor WASH may lead to changes in the intestinal flora, causing longer time for poorly nourished or ill children to recover, or promote relapse • Hygiene kits can contain items to support young children’s nutrition

14. Use of infant formula • Infant formula should only be used for medical reasons, based on assessment & ongoing growth support by a health professional • Lacks breast milk’s precise infant-specific balance of nutrients &appropriate temperature • Do not contain antibodies to protect against illness • Increase risk of infection, compared to exclusively breastfed babies, via bacteria &parasites that can contaminate water supplies, infant formula & feeding equipment during preparation & use • Can be incorrectly prepared • More difficult to digest • Mixed feeding (formula + breastmilk) causes mother to make less breastmilk, as breastmilkproduction works on a demand-supply basis • Breastmilk is the most nutritious and safe food for infant and young children

15. Use of bottles & Teats • Feeding bottles with teats should not be used • May make it more difficult for the baby to learn to attach well at the breast due to “nipple confusion” • They decrease suckling, therefore mother produces less milk • Compromises breastfeeding frequency, intensity & duration, as well as increased risk of dental disease & otitis media • Bottles & teats are difficult to clean • When bottle feeding is associated with unhygienic conditions and poor preparation of infant formula, it puts the infant at increased risk of diarrhoea • Increases risk of infant not receiving adequate stimulation & attention during feeds

16. Safe complementary feeding Timely introduction of complementary foods –at 6 months Continued breastfeeding until 2 years of age or beyond Safe storage, preparation, cooking & serving of foods & liquids Optimal handwashing practices, esp at critical periods, with soap & water

17. Integrating IYCF into WASH • Understand the situation –background nutrition/IYCF data & policies • Consider caregivers of children <2 years as priority targets for WASH activities • Integrate IYCF considerations into assessments, policies, strategic plans, programme activities & monitoring, in collaboration with Nutrition Sector • Train staff on the links between infection, IYCF & under/malnutrition • Know & promote the benefits of breastfeeding, safe feeding & hygiene • Be informed, & provide information, on how to minimize the risks associated with unsafe & inappropriate feeding • Know the guidelines in ‘The Code’ & ‘The Operational Guidance’ • Support the controlled & safer use of infant formula • Refer formula fed infants, for targeted support • Report untargeted distributions of infant formula, to the Nutrition sector Coordinator

18. …integrating IYCF into WASH Distribute hygiene kits for infants & young children with nutrition-supportive nutrition items egdiapers, baby creams, shampoo, wet wipes, children’s laundry detergent and soap + teething gel Provide clean water & cups for non-breastfed infants …taking care not to undermine breastfeeding eg BF mothers receive goods of same or greater value Collaborate with nutrition sector on development of targeted hygiene messaging and education/training Provide hygiene items to caregivers attending nutrition/IYCF education sessions Ensure appropriate WASH facilities at health/nutrition services (eg baby-friendly spaces)

19. Nutrition Sub-Cluster Key IYCF Messages

20. THANK YOU!