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Revitalization of BFHI

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'

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Revitalization of BFHI

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  1. Revitalization of BFHI Randa Saadeh Scientist Nutrition for Health and Development SCN, Rome, 2007

  2. In 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'

  3. And other global strategies and joint initiatives • Global strategy for infant and young child feeding WHO/UNICEF (2002) • Innocenti Declaration 2005 WHO/UNICEF on IYCF AEM, IBFAN, ILCA, LLLI, Wellstart, WABA • Durban statement on Nutrition and HIV WHO/UNICEF/WFP/UNAIDS/FAO/UNHCR (2005)

  4. Now where do we stand?Have  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

  5. BFHI update and changes • Scientific-evidence • Sections of new package • Expansion and integration options • Technical updates on 'Ten Steps' and clinical practice

  6. Why now and what has been done?

  7. Optimal Infant feeding practice reduces Under-five mortalitySource: Lancet Child Survival Series 2003 expected % of reduction in U5M intervention

  8. WHO Child Growth Standards A growth chart for the 21st century

  9. Comparison of WHO with NCHS length/height-for-age z-scores for boys • 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

  10. Policy 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.

  11. ObesityIs the other side of the spectrum of malnutrition We know enough this still a challenge Facts • 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. Picture removed…

  12. BFHI update and changes • Scientific-evidence • Sections of new package • Expansion and integration options • Technical updates on 'Ten Steps? and clinical practice

  13. Baby-friendly Hospital InitiativeRevised, Updated and Expandedfor Integrated Care January 2006 Section 1: Background and Implementation Section 2: Course for Decision-makers Section 3: "20 hour" Course for Maternity Staff Section 4: Hospital Self-appraisal & Monitoring Section 5: External Assessment & Reassessment

  14. 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

  15. 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

  16. Selected enhancements to the Ten Steps • Step 2: Addition of interviews of non-clinical staff • Step 4: Skin-to-skin and initiation of BF Change 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."

  17. 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

  18. BFHI update and changes • Scientific-evidence • Sections of new package • Expansion and integration options • Technical updates on 'Ten Steps' and clinical practice

  19. Expansion options 1.5.1 Baby-friendly Communities 1.5.2 BFHI and PMTCT 1.5.3 Mother-baby friendly care 1.5.4 Baby-friendly NICUs 1.5.5 Baby-friendly Paediatric Care

  20. Baby-friendly health care – everywhere! • Integration into Child Survival strategies • Integration into IMCI • Integration into Maternal Survival • Integration with EPI campaigns • Integration into Emergency preparedness and emergency response • Others?

  21. BFHI update and changes • Scientific-evidence • Sections of new package • Expansion and integration options • Technical updates on 'Ten Steps? and clinical practice

  22. Underway… • Revision of the 'Scientific basis for the Ten Steps' • Physiological basis • Strengthening 'Step 10' and link to community

  23. Finer points of skilled practical management - infant not ready to feed immediately after delivery Picture removed…

  24. ...the same baby showing signs of readiness to feed 30-40 minutes after delivery Picture removed…

  25. …..stretching and twisting the nipple to help the baby to attach - but not effective Picture removed… Picture removed…

  26. Baby’s real need - early skin-to-skin contact on the delivery table Picture removed…

  27. Kangaroo Mother Care 12/2 Picture removed… Dr Nils Bergman, Cape Town, South Africa

  28. Picture removed… Slide 4v

  29. For revitalization of BFHIIn short • keep alive • sustain progress • ensure quality and adherence to global criteria • use concept but stay focused • show its effectiveness and health impacts

  30. Working togetherat different levels and partners International Organizations Industry High quality of care for mothers and children Governments MOHs and others NGOs Civil society groups Professional/scientific groups Religious group Regional/ countries offices

  31. Working 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

  32. Thank you!

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