6. Visible Change (independent survey
and data collected through PGs)
2001 2009
IMR 85/100 44/1000
Mean age at marriage 15 years 18 Years
Under nutrition 6m-1yrs (< -2SD) 52.5% 39.3%
Under nutrition 1Yr-2yrs (< -2SD) 53.6% 35.2%
Slide 6
7. MSGs-Village Level IYCF
Support
• The 3 member team of AWWs, ASHA Dai,
Link mothers from each village trained to
promote and support optimal infant and
young child feeding
• 600 Mother Support Groups formed in 6
blocks of Lalitpur
• 1847 local women trained for 3 days for 24
hour counselling/referral support in the
villages
Slide 7
8. Village Level activities
• Antenatal education of mothers about
advantages of breastmilk and breastfeeding
and how to succeed in breastfeeding.
• Early initiation of breastfeeding
• Helping mothers to learn positioning and
attachment for effective breastfeeding
• Prevention of breastfeeding difficulties and
breast conditions
• Expression of breast milk and katori feeding
• Exclusivity of breastfeeding
Slide 8
9. Activities contd…
• Identification of sick babies and their referral
• KMC
• Preparing good complementary food for
babies and foods to feed
• Feeding skills for complementary feeding
• Variety and amount of foods for growing
children
• Growth monitoring
• Recording of births & deaths
• Reports
Slide 9
11. Trainings (Year 2007, 2008 & 2009)
• Middle Level Trainers Training - 2 batches of 26+24 (7
day integrated 3 in 1 module of BPNI/IBFAN) (50
persons trained at Dept. of Pediatrics, BRD Medical
College, Gorakhpur)
• Training of Front Line Workers – (80 batches X 3 day)
total of 2447 ASHAs, AWWs, Dais and mother support
groups trained.
• Twenty Four ICDS Supervisors were oriented (1 Day) x 2
trainings.
• The 152 LHVs, ANMs and staff nurses from health and
family welfare department were trained in 3 day module
Slide 11
12. Growth Cards & Counseling
• Growth Cards (Wt for age, WHO GS)
– Registered (births) - 62324 (2007 onwards)
– Follow up growth cards - 26333 (from 0-2 yrs)
– Follow up for 365 days - 13162 births
– Wt for age and length for age - 1532 & 1940 (6m-2yrs)
• IYCF Counseling at house holds
– By Block/District Counselors - Twice in a month in each
village
– By Village Counselors - 10 visits in first 6months,
6 visits in next 6 months
and 3 visits in 2nd yr
IYCF Counseling at block and district level by counselors- every days
Slide 12
14. Meetings at all Levels
• Review meetings at District level, chaired by DM
• Monthly Block level meetings
• World Breastfeeding Week Celebrated (1-7 August)
• Mother Support Groups’ meetings
Slide 14
16. Feeds
• 100 gm. pack
• 6-1 yr 25 gm. 2 time in a day
• 1-2 yr 35 gm. 2 time in a day
Slide 16
17. Status of IYCF
key Indicators Baseline Evaluation
Survey Survey
(2006) (2008)
Initiation of breastfeeding 10.9 72.0
within an hour (%)
Initiation of breastfeeding within 1-3 hours (%) 22.8 15.0
Pre-lacteal feeding (%) 67.0 15.0
Exclusively breastfed for 6 months(%) 7.0 62.0
Introduction of thick Complementary feed 53.8 85.0
between 6-
8 m (%)
Introduction of compliments at 6 m (%) 43.6 49.0
Introduction of compliments at 8m (%) 10.2 36.0
Slide 17
18. Status of IYCF
90 85
80 72
70 62
Percentage of mothers by
60 53.8 initiation of bfdg within an
hour
50 Percentage of mothers who
exclusively breastfed the child
40 for 6 months
Percentage of mothers by
30 complementary feeding (6-
8months)
20
10.9
7
10
0
Baseline Survey (Nov- Evaluation Survey
2007) (March-08)
Slide 18
19. Mothers perception on health of
their Children
Dec- 2006 Jan.2009
Healthy 47.1% 80.5%
Slide 19
20. Nutritional status of babies
(weight for age) (n=1940, July 1-15th, 2009)
Age Group Normal Under nutrition
(boys and girls Total
(-2 to +2zscore ) (<-2zscore)
combined)
6m – 12m 691 516(26.59%) 175(9.02%)
1 yr – 2yr 1249 905(46.64%) 344(17.73%)
Total 1940 1421(73.24%) 519(26.75%)
Slide 20
21. SAM (Weight for Length)
(n=1940, July 1-15th-2009)
<-3SD <-3SD
Age Group Total
(Girls) (Boys)
6m – 12m 64 30(1.54%) 34(1.75%)
1 yr – 2yr 70 33(1.74%) 37(1.90%)
Total 134(6.9%) 63(3.24%) 71(3.65%)
Slide 21
23. MAJOR
WORLDWID
E CAUSES
OF DEATH
AMONG
CHILDREN
UNDER AGE
FIVE, 2000
Sources: For cause-specific mortality: EPI/WHO
For deaths associated with malnutrition: Caulfield LE, Black RE
Malnutrition and Global burden of diseases: underweight and cause specific mortality (paper in preparation)
Slide 23
24. Where is crisis, which one is
neglected?
• Death in 1 yr @ IMR (2008) 44/1000 live birth = 579
• Death in 1st month (2/3rd of IMR) = 386
• Death in 1m-12m period = 193
• Death in 1st wk (40% of IMR) = 231
• 84% neonatal deaths are due to 3 conditions- infections (42%),
asphyxia (32%) and prematurity (15%)
• Number of children with SAM (6m-12m), @(6.9%) = 873
• Death among SAM children(6-24m) (@10%) = 88
Total birth in 1yr (13162)
Slide 24
25. Where do we need to invest
• Unit cost per child in IYCF counseling =Rs
200 per child per yr
• Need to invest in IYCF promotion
• Integrating in public health programme
Slide 25
29. Case-1
• Sore nipple, engorgement
• Helped to succeed
30. Case-2
• Perceived not enough milk
• Initiation at 30mts of birth
• Baby cried during night & was given animal milk
• Improving position & attachment, giving
information
• Mother succeeded
31. Case-3
Mother name : Smt Lakshmi
Father Name : Khushi lal
Baby Name: Sunder
Address : Lakhanpura,
Jakhaura, Lalitpur
Pain during feeding-not able to feed
Observation-
∆ Sore nipple engorgement
Skills - ∆ Confidence building
∆ Expression
∆ Katori feeding
∆ Position and Attachment
∆ Succeeded in breastfeeding
Slide 31
32. Case-4
Mother name : Smt Teja
Father Name : Mauji Sheriya
Baby Name : M
Address : Jamundhana,
Birdha, Lalitpur
Sick mother, not feeding right under
nourished baby
Observation-
Poor attachment
Skills - ∆ Open questions
∆ non verbal comm., empathy
∆ Accepting
∆ Informing
∆ Helping in positioning &
attachment
∆ Explaining others what has
been done
Result - Succeeded
Slide 32
33. Case-5
Village visit
∆ Mobilishing peoples support
∆ Listening mothers and
observing breastfeeding
∆ Helping mothers to improve
attachment
∆ Measuring weight gain
∆ Mothers confident in
breastfeeding
∆ Dietary history
∆ Demonstration of making
babies feed and active
feeding
Slide 33
34. Case-6
Severely undernourished orphaned
Tribal child
∆ Carried to PHC and NRT
centre
∆ Vit-A, drugs and Locally
prepared cereal mix with oil
∆ Wt. gain
Slide 34
