Transcript sc_ukraine_iycf-e - HumanitarianResponse

Working together
for the nutritional health of vulnerable
populations
Prepared and presented by:
Deborah Joy Wilson
Humanitarian Nutrition Advisor
Save the Children
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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 children, pregnant & lactating women
(PLW) and elderly.
Indicator: Number of vulnerable groups including children pregnant
& lactating women (PLW) & elderly reached out with interventions
to support, protect & promote appropriate nutrition
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Infant and Young Child Feeding
in
Ukraine
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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
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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
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Recommended IYCF Practices
Recommendations of the WHO, UNICEF and Ukraine MoH for infants &
young children to achieve optimal growth, development & health:
• Exclusive breastfeeding until the age of 6 months
• Introduction of nutritionally age-appropriate, adequate & safe soft, semisolid & solid complementary foods starting at 6 months
• Continue breast-feeding up to the age of two years or beyond
Appropriate and timely support of IYCF-E saves lives
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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)
- High use of bottles/teats (mean 68.1% - 72.5%)
- Indiscriminate distributions of infant formula by agencies
- Use of teas & water for infants <6 months (intro mean 3.1 mo)
- Early introduction of complementary foods (mean 4-5 mo)
- Duration of continued breastfeeding (mean 31.8%; 53.5% at 1 year)
• No elevated wasting in children 6-23 months (prevalence below 1%)
(Save the Children - UNICEF IYCF-E Assessment June 2015: IDPs. Kramatorsk; Sloviansk; Svytahirsk)
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…GCAs context
• Commonly given first foods: commercial porridge, semolina porridge,
commercial baby fruit/vegetable puree
• Since January 2014 main baby-food assistance items received were fruit/
vegetable purees, porridges/cereals, infant formula
o Some commercial porridges brands taste not liked
o Indiscriminate infant formula distributions -Infant formula received by
78.3% of HHQ infants <1 year regardless of feeding status
o Malutka infant formula reported as allergenic & cause diarrhoea
• Priority foods include: Cereal mixtures infant formula (including nondairy/lactose-free brands), fruit & vegetable puree, fresh vegetables meat
products, bottled water
• The majority of mothers prefer cooking food, rather than use of
commercial baby foods
• Most have facilities to boil water (98.8%)
• Erroneous, belief bottled water is safe for babies because it is sterile
• Lack of refrigerators, especially in some collective centres
(Save the Children - UNICEF IYCF-E Assessment June 2015: IDPs. Kramatorsk; Sloviansk; Svytahirsk)
Use of infant formula
• Should only be used for medical reasons, based on assessment &
ongoing growth support by a health professional
o Lacks breast milk’s precise infant-specific balance of nutrients &
appropriate temperature
o Do not contain antibodies to protect against illness
o Increase risk of infection, compared to exclusively breastfed babies, via
bacteria & parasites that can contaminate water supplies, infant formula
& feeding equipment during preparation & use
o Can be incorrectly prepared
o More difficult to digest
o Mixed feeding (formula + breastmilk) causes mother to make less
breastmilk, as breastmilk production works on a demand-supply basis
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The IFE Operational Guidance for Infant &
Young Child Feeding in Emergencies
• The decision to accept, procure, use or distribute infant formula in an
emergency must be made by informed, technical personnel in
consultation with the coordinating agency, lead technical agencies and
governed by strict criteria
• Breast milk substitutes, other milk products, bottles and teats must never
be included in a general ration distribution
• Breast milk substitutes and other milk products must only be distributed
according to recognized strict criteria and only provided to mothers or
caregivers for those infants who need them
• The use of bottles and teats in emergency contexts should be actively
avoided
(IFE Core Group, Operational Guidance on Infant and Young Child Feeding in Emergencies (for emergency
relief staff and programme managers), version 2.1, February 2007)
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Use of Bottles & Teats
• Feeding bottles with teats should not be used
o May make it more difficult for the baby to learn to attach well at the
breast due to “nipple confusion”
o They decrease suckling, therefore mother produces less milk
o Compromises breastfeeding frequency, intensity & duration, as well as
increased risk of dental disease & otitis media
o Bottles & teats are difficult to clean
o When bottle feeding is associated with unhygienic conditions and poor
preparation of infant formula, it puts the infant at increased risk of
diarrhoea
o Increases risk of infant not receiving adequate stimulation & attention
during feeds
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Teas & Water not for infants <6months
• Teas (typically camomile, dill or fennel tea & dill water) are commonly
given as digestives & calmatives, & plain water is given in hot ambient
conditions
o Increase the risk of getting sick from bacteria
o May inhibit iron absorption, contributing to anaemia
o May cause toxicity
• Breast milk contains all the –well-absorbed- water a young baby needs
Complementary foods –need timely, safe, appropriate
• Too early an introduction of complementary foods increases risk of
infection & reduces the benefit of exclusive breastfeeding
• Too late an introduction can result in interruption of growth, undernutrition & an increased risk of illness
• Safe storage, preparation, cooking & serving of foods & liquids impt to
reduce illness
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Myths or Fact?
1. Breast milk is not enough for my baby
? Myth or fact
2. I’m not getting enough food / The type of food I am eating is not good
so I am not enough / good quality producing milk
? Myth or fact
3. Breastmilk does not have enough fat
? Myth or fact
4. Stress made my “milk dry up”
? Myth or fact
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…fact
1. A mother does produce enough breast milk for her baby
• Milk production works on a supply-and-demand basis: as long as the
baby is put to the breast, is well attached and is allowed to suckle as
often and as long as he/she demands, supply will meet all the baby’s
needs.
• If the baby is hungry and feeding frequently, is gaining weight, does not
look visibly thin and is producing pale urine about 6 times a day they are
getting enough milk. Exclusively breastfed babies grow at a slower rate
than formula fed babies, but this is healthier for the baby
2. Mothers not eating a good diet can breastfeed well
• Even mild and moderate malnutrition in women will not decrease milk
production.
• Feed the mother so that she can feed her infant. All mothers need extra
fluids and food to maintain their strength and prevent getting
undernourished
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…fact
3. Breastmilk does not have enough fat
• Breastmilk contains all the fat baby needs, including special fats for brain
development
• Ensure mother feeds empties one breast before feeding from the other,
because as the baby breastfeeds the milk’s fat content gradually
increases as the breast drains more fully
4. Stress made my “milk dry up”
• Stress may interfere with milk flow, through temporarily interrupting the
milk let-down reflex, although milk production continues based on a
hormone-controlled supply-demand basis
• Frequent suckling by baby at the breast promotes milk flow & produces
hormones that calm mother & baby
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‘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
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Integrating IYCF
into
Food Security
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IYCF – Food Security Sector Linkages
• Inadequate food intake -quantity & quality- is an immediate cause of
under/malnutrition (along with caring practices & health)
• Food Security responses should consider activities to prevent initial
occurrence & recurrence of under/malnutrition
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Understanding inter-sectoral linkages
The Under-Nutrition IYC Causal Framework
Under-Nutrition
Outcome
Immediate
Causes
Inadequate
Dietary Intake
Underlying
Insufficient
Health /
Access to Food
Nutrition Affordability,availability,accessibility
Causes
Food
Disease
Inadequate
Care for Mothers
and Children
Care
Inadequate health services &
unhealthy environment
Health
Adapted from Unicef
Integrating IYCF into Food Security & livelihoods
• Know & promote the benefits of breastfeeding & safe appropriate CF
• Understand the situation –background nutrition/IYCF data & policies
• Conduct causal analyses ie assess & monitor whether/ how food security
may be an underlying cause of undernutrition & poor feeding practices, &
how FSL interventions might improve nutrition outcomes
o Ensure demographic data includes gender & age (0-5mo, 6-11mo, 12-23mo)
• Integrate IYCF considerations into assessments, policies, strategic plans,
programme activities & monitoring
o Integrate vulnerable families with children 0-23 mo of age at risk of undernutrition (or under-nourished) into FSL programmes
o Ensure FSL activities do no harm’ to breastfeeding or caregiving, through
targeting, group education & informational materials
• Support the controlled & safer use of infant formula
o Refer formula fed infants, for targeted support
o Know the guidelines in ‘The Code’ & ‘The Operational Guidance’
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…integration
o Ensure no untargeted/indiscriminate distributions of infant formula,
powdered milk or liquid milk products as single commodities, according to
‘The Code’
o Report untargeted distributions of infant formula to UNICEF
o Provide IYCF-E orientations for staff of agencies distributing baby food (incl
health & social service facilities), highlighting adherence to The Code
• Prioritise safe & appropriate complementary foods in distributions
o Collaborate with Nutrition Sub-Cluster to design appropriate rations
o Consult caregivers on appropriate & priority baby food basket items
• Ensure distributions efficiency, considering childcare capacity
• Collaborate with nutrition sector, designing & combining nutrition/IYCF &
food security communication (advocacy, messaging, education, trainings)
o Accompany food distributions with messaging/pamphlets on breastfeeding,
timely, safe & nutritious complementary food use
o Provide group IYCF education at distribution points
o Clearly communicate details about food distributions
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Nutrition Sub-Cluster Key Messages
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Food Security
for the nutrition of
Older People
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Why this presentation?
• Inform of the nutritional needs of older people
• Identify factors that affect older people’s nutritional vulnerability
• Provide guidance on interventions to support the nutrition of older people
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Nutrition for Older People
• Energy needs typically decrease with ageing
(-result of decreased basal metabolism, due to relatively less lean body mass.
Physical activity moderates the decline)
• Protein requirements: tend to be similar to younger adults
• Fat intake needs to be moderate
• Micronutrients stay the same or tend to increase with ageing
o MNs of concern: iron, calcium, vitamin D, vitamin B12 + fibre & water
o MN deficiencies are significantly associated with frailty of older
people; occur most frequently in individuals with a monotonous or
restricted diet, reduced absorption, infection or illness, acute malnutrition
 The nutrient density of food should increase to compensate for lower
energy intake
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Nutritional Vulnerability
• Older people have specific needs in relation to their general food intake,
micronutrient requirements & palatability of food, which makes them
particularly vulnerable to disruptions in food security
• Vulnerability can be exacerbated in emergency contexts –however older
people vary greatly in their health status & ability to adapt
• Reasons for nutritional vulnerability are multifaceted & include
physiological, psychological & social changes associated with ageing
which affect food intake & body weight, possibly exacerbated by the
presence of disease & illness
• Factors affecting nutritional vulnerability operate at individual,
community or population, & programme design levels
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Understanding Vulnerability
Individual level:
• Physiological changes with age can change the ability to access, prepare &
digest food –affecting nutrient availability and utilization
• Illness eg chronic disease & infections can alter/↑micronutrient needs
• Depression & loneliness can induce anorexia (appetite loss)
Community or population level:
• Stressful events eg displacement, loss of livelihood & death; disruption or
loss of social/community support structures; loss of social status
• Psychosocial & cultural factors
• Gender: women commonly socially & economically disadvantaged
• Economic: poverty notably affects older people
Programme design level:
• Few nutrition interventions include older people
• Lack of documented experiences of nutrition interventions for older people
• Lack of inclusion in assessments leads to lack of or inappropriately designed
services or responses for older people
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Interventions for older people
• Older people may have particular nutritional, physiological, social,
cultural & health needs that will not be met by food, or a food
distribution alone
• Non-food + food-based interventions are required –across sectorsconsidering all the different determinants of under-nutrition &
vulnerability
• A ‘one-size-fits-all’ approach won’t work as causes of under-nutrition &
determinants of nutritional vulnerability are complex
 Engage older people in discussions on the appropriateness & design of
interventions
 Base interventions for older people on the principles of:
Heterogeneity. Appreciative recognition. Dignity. Consultation, active
participation & decision-making. Non-discrimination. Inclusion.
Mainstreaming & Targeting. Accommodation. Gender sensitivity.
Building capacity
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Food-based Interventions
Preventing under-nutrition in older people can be addressed through the
through various food aid mechanisms, including:
• General food distribution
• Blanket supplementary food distribution
• Targeted supplementary food distribution
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Strategies to prevent & treat micronutrient deficiencies
 Food rations need to be planned or adapted with consideration of:
o availability; accessibility; consumption; utilisation
o energy composition & micronutrient content
o Home gardening initiatives, as appropriate considering possible physical
& medical constraints
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…food-based interventions for older people
Availability
• Ensure non-discrimination by age in receiving assistance
• Involve older people in assessing the food supply context & needs
Access
• Include in assessments & registration, ensuring visibility
• Include in food security (food basket/voucher/gardening) programmes
• Ensure older people are registered & informed of their food entitlements,
distribution locations, times & dates
• Ensure services, supplies & distribution points are easily & safely accessible
• Consider cultural & social norms & intra-household food distribution
Utilization and consumption
• Assure appropriateness, dietary diversity & nutrient density of rations
• Consider age-related changes affecting the ability to prepare, chew & digest
foods, acceptability & palatability
• Support provision of equipment to store, prepare & eat food
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Non-food Interventions
Non-food interventions to prevent under-nutrition in older people are
intersectoral, & include:
•
•
•
•
•
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Community-based nutrition programmes
Health & psychological support
Social support
Community care/support programmes
Income & livelihood support eg cash transfers
Environmental support (including appropriate shelter & equipment)
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THANK YOU!
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