The National Infant Feeding Situation

Training of the Trainers

Baby-Friendly Hospital Initiative
SELASI: 11-13 March 2011
 Objectives
At the conclusion of this session participants
will be able to:
• Describe and apply WHO’s IYCF
recommendations
• Describe the terms used for breastfeeding and
complementary feeding
• Describe the IYCF situation in Indonesia, incl.
BF and CF patterns and trends over time
 Statement Member Countries
WHO-Executive Board, 15 January 2011
• Reaffirmed WHO recommendations on IYCF are
based on the best available evidence and free from
conflict of interest.
• The latest systematic review of the evidence in 2009
(Kramer et al and the Cochrane Library) support
current recommendations.
• Advantages over EBF for 4 mos; lower risk of GI
infection; rapid maternal weight loss after birth;
delayed return of menstrual period; no adverse
effects on growth.
• Disadvantages reduced level of iron in some
developing country settings.
 Facts on Nutrition

• Foundation for Health and Development

• Means stronger immune systems, less illness
and better health for people
• Healthy children learn better for better
generation –more productive, able to break
cycles of poverty, realize their full potential-
 Facts on Breastfeeding
• One of the most effective ways to ensure child
health and survival
• Contributes to prevent a million avoidable child
deaths each year
• EBF infants have 2.5 times fewer illness episodes,
25 times less likely to die from diarrhea, 3 times
less likely to die from ARI
• Globally < 40% of infants U6 mos are EBF (2009)
• Indonesia: EBF 15.3% (Riskesdas, 2010)
 Facts on IYCF
• Peak of malnutrition: 6-28 mos of age,
contributes to 50% of mortality.
• 1/3 of malnutrition is due to faulty feeding
practices.
• Counseling on BF and CF leads to improve
feeding practices, improves intakes and
growth, lowering incidence of diarrhea.
Critical Period of Child’s Growth
 WHO’s IYCF recommendations
• Initiate breastfeeding within one hour of
birth.
• Breastfeed exclusively for the first six
months of age (180 days).
• Thereafter give nutritionally adequate and
safe complementary foods to all children.
• Continue breastfeeding for up to two years of
age or beyond.
 BF and CF terms and definitions
• Exclusive breastfeeding
• Partial/Mixed breastfeeding
• Bottle-feeding
• Artificial feeding
• Replacement feeding
• Complementary feeding
Health MDGs scorecard for WHO regions
 Health MDGs scorecard-ASEAN

Timor
Cambodia Indonesia Lao PDR Malaysia Myanmar Philippines Thailand Vietnam China India
Leste
U5 underweight 29 17.9 32 8 32 21 9 46 20 7 46
IMR 69 34 48 6 50 26 24 98 12 18 57
U5 MR 89 44 61 6 67 32 28 130 14 21 85
Measles imm. Coverage 92 75 59 95 81 88 84 42 97 99 59
MMR 290 228 580 31 380 94 14 420 56 38 301
SBA % births 44 82 20 100 68 60 98 32 88 98 54
Contraceptive use 40 56 32 51 79 87
HIV/AIDS prevalence 0.8 0.1 0.2 0.5 0.1 <0.1 1.5 <0.1 0.5 0.1 0.9
Malaria mortality 1.9 0.1 0.1 0.3 <0.1 <0.1 <0.1 <0.1
TB treatment % success rate 94 92 72 95 89 85 92 94
Water % improved sources 61 88 57 100 79 91 92 56 94 89 85
Sanitation % improved fac. 29 78 53 96 83 76 98 19 75 55 52
Source: Achieving the Health-related MDGs in the WPR, WHO, 2010 progress report; Health in Asia and the Pacific, WHO, 2008; 11 health questions about the 11
SEAR countries, WHO,2007.
insufficient
on track off track
progress
 Key questions to compare the
Indonesia/Province/District situation with
WHO IYCF recommendations
• Percentage of babies breastfeeding exclusively
for the first six months of life (180 days)
• Percentage of babies exclusively breastfeeding
by month, up to 6 months
• Percentage of babies with appropriate
complementary feeding
• Median duration of breastfeeding (in months)
Persentase menyusui eksklusif bayi 0-5 bln
menurut umur (Riskesdas 2010)
Umur Bayi Menyusui Eksklusif

0 bulan 39.8

1 bulan 32.5

2 bulan 30.7

3 bulan 25.2

4 bulan 26.3

5 bulan 15.3
 Persentase proses mulai menyusui
(Riskesdas, 2010)

< 1 jam 1-6 jam 7-23 jam 24-47 jam > 48 jam

Provinsi Maluku Kalsel Bengkulu DI Yogya Sulbar

terburuk 13.6 31.4 3.7 4.3 2.4

Indonesia 29.3 40.7 7.6 11.3 11.1

Provinsi NTT Kalbar Lampung Gorontalo Kepri

terbaik 56.2 56.3 13.9 20.0 23.2
Persentase pola menyusui pada bayi 0-5 bulan,
menurut umur (Riskesdas, 2010)

Kelompok umur Menyusui Menyusui Menyusui partial

eksklusif predominan
0 bulan 39.8 5.1 55.1

1 bulan 32.5 4.4 63.1

2 bulan 30.7 4.1 65.2

3 bulan 25.2 4.4 70.4

4 bulan 26.3 3.0 70.7

5 bulan 15.3 1.5 83.2

 Key questions to compare health facility
data with WHO recommendations
• Early initiation: Percentage of babies who start
breastfeeding within 1 hour of birth
• Rooming-in: Percentage of babies who “room-in” on
a 24-hour basis with their mothers after delivery
• Exclusive breastfeeding: Percentage of babies who
are exclusively breastfed from birth to discharge
• Bottle-feeding: Percentage of babies who are getting
any feeds from bottles between birth and discharge
Terima Kasih