[CCIH-Haiti] Joint statement from WHO, UNICEF, and WFP regarding appropriate feeding for infants and young children in Haiti]
Sharon Franzén
sfranzen at ccih.org
Wed Feb 17 07:44:29 EST 2010
JOINT STATEMENT ON APPROPRIATE FEEDING FOR INFANTS AND YOUNG CHILDREN IN
HAITI
Please find below and attached a recent statement aimed at preventing
illness in infants and young children in Haiti due to unsafe feeding
practices.
The conclusion to the statement is:
UNICEF, WHO and WFP strongly urge all who are involved in funding, planning
and implementing the emergency response in Haiti to avoid unnecessary
illness and death by promoting, protecting and supporting breastfeeding and
appropriate complementary feeding and by preventing uncontrolled
distribution and use of breast-milk substitutes. Public and private sector
entities and individuals who wish to support infants and young children and
their mothers and caregivers in this emergency should donate funds rather
than send goods. We further urge governments and partners to include
capacity building for breastfeeding and infant and young child feeding as
part of emergency preparedness and planning, and to commit financial and
human resources for appropriate and timely protection, promotion and support
of optimal infant and young child feeding in this and other emergencies.
This statement highlights the following points:
· Chronic and acute malnutrition and communicable diseases put
Haitian children under five at risk even before the earthquake. The current
situation increases this risk tremendously for many reasons including
decreased access to safe water and poor sanitary conditions, and the fact
that many children are orphaned or separated from their families.
· Attention to appropriate feeding and care of infants and young
children is essential during this time of emergency.
· All children under six months should be exclusively breastfed and
all efforts to encourage this should be made, including encouraging mothers
who have decreased or stopped breastfeeding to begin again (relactation).
· Breast-feeding mothers should be given skilled support necessary
to enable them to continue to breastfeed as long a possible, including
shelter, food, security, and water and sanitation; enabling mother-to-mother
support; providing specific space for skilled breastfeeding counseling and
support.
· Non-breastfed infants under six months need to be identified and
closely monitored. If breastfeeding is not an option, breast-milk
substitutes are necessary and must be accompanied by training on hygiene,
preparation and use to minimize their associated risks. These supplements
should be given to infants in a cup or spoon because bottles and nipples are
more difficult to sterilize. Any needed breast-milk substitutes should
adhere to Codex Alimentarius Standards and should be procured in an
efficient and rapid manner, in coordination with UNICEF, the nutrition
coordinating agency in Haiti. The preferred type of breast-milk substitute
is ready-to-use formula.
· Children from the age of six months require nutrient-rich,
age-appropriate and safe complementary foods in addition to breast milk.
Priority should be placed on locally available, culturally acceptable,
nutritionally adequate and age-appropriate foods. Micronutrient powders that
can be added to local foods, emergency rations or blended foods will also
improve dietary quality.
· Mothers known to be HIV-infected should be supported to
exclusively breastfeed their infants for the first six months of life, to
introduce appropriate complementary foods thereafter, and to continue
breastfeeding for the first 12 months, along with provision of ARVs.
(additional guidance is being prepared)
· Treatment of severely malnourished children, whether facility or
community based, should be implemented in accordance with international
standards and best practice and closely monitored.
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Call for support for appropriate
infant and young child feeding in Haiti
UNICEF, WHO and WFP call for support for appropriate infant and young child
feeding in the
current emergency, and caution about unnecessary and potentially harmful
donations and use of
breast-milk substitutes
During emergency situations, disease and death rates among under-five
children are higher than for any
other age group; the younger the infant the higher the risk. Mortality risk
is particularly high because of
the combined impact of a greatly increased prevalence of communicable
diseases and diarrhoea and
soaring rates of under-nutrition. Appropriate feeding and care of infants
and young children is
essential to preventing malnutrition, morbidity and mortality.
Major health problems among Haitian children, which have been exacerbated by
this crisis, are acute and
chronic malnutrition and communicable diseases. Given the structural damage
caused by the earthquake
to water supply systems, there is an additional risk of water borne diseases
affecting large numbers of the
urban, rural and displaced populations. Many infants and young children have
been orphaned or
separated from their mothers. Risks to children in Haiti are exacerbated by
pre-earthquake poor infant
and young child feeding practices and malnutrition. In this emergency
situation, the lifeline offered by
exclusive breastfeeding to children for the first six months of life and
continued breastfeeding with
complementary feeding for two years or more is of utmost importance and must
be protected, promoted
and supported as much as possible.
Most mothers initiate breastfeeding in Haiti, and the majority of infants
less than six months of age were
at least partially breastfed prior to the earthquake. At this stage it is
critical to encourage and support
mothers to initiate breastfeeding immediately after the delivery,
exclusively breastfeed up to six months
and for those with infants below six months who ‘mix feed’ to revert to
exclusive breastfeeding. Nonbreastfed
infants are at especially high risk and need early identification and
targeted skilled support,
including re-establishing breastfeeding (relactation).
Protection and support for breastfeeding women
No food or liquid other than breast milk, not even water, is needed to meet
an infant’s nutritional and
fluid requirements during the first six months of life. The valuable
protection from infection that
breastfeeding confers is all the more important in environments without safe
water supply and sanitation.
Therefore, creation of a protective environment and provision of skilled
support to breastfeeding women
are essential interventions. There is a common misconception that in
emergencies, many mothers can no
longer breastfeed adequately because of stress or inadequate nutrition.
Concern for these mothers and
their infants can fuel donations of breastmilk substitutes (BMS) such as
infant formula. Although stress
can temporarily interfere with the flow of breastmilk, it is not likely to
inhibit breastmilk production,
provided mothers and infants remain together and are supported to initiate
and continue breastfeeding.
Mothers who lack food or who are malnourished can still breastfeed.
Provision of adequate fluids and
food for mothers must be a priority as it will help to protect their health
and well-being as well as that of
their young children.
Basic interventions to facilitate breastfeeding include prioritising mothers
with young children for
shelter, food, security, and water and sanitation, enabling mother-to-mother
support, providing specific
space for skilled breastfeeding counselling and support to maintain or
re-establish lactation. Traumatised
and depressed mothers may have difficulty responding to their infants and
require particular mental and
emotional support. UNICEF, WHO and other organizations involved in infant
feeding in emergencies
will support training of staff on individual assessment of the best options
for feeding infants, as well as
education and support of caregivers on optimal infant feeding in these
emergency circumstances.
Feeding of the non-breastfed child less than six months of age
Infants less than six months of age who are not breastfed need urgent
identification and targeted skilled
support. The priority to feed these infants should be relactation. If this
is not possible or when artificial
feeding is indicated by skilled staff such as health providers or infant
feeding counsellors, breast-milk
substitutes are necessary and must be accompanied by training on hygiene,
preparation and use to
minimise their associated risks. Artificial feeding in an emergency carries
high risks of malnutrition,
illness and death and is a last resort only when other safer options have
first been fully explored.
Any needed breast-milk substitutes should adhere to Codex Alimentarius
Standards and should be
procured in an efficient and rapid manner, in coordination with UNICEF, the
nutrition coordinating
agency in Haiti. The preferred type of breast-milk substitute is
ready-to-use formula. Any distribution
and use of breast-milk substitutes should be carefully monitored to ensure
that only the designated
infants receive the product. For further information UNICEF should be
contacted (see contact below).
When breast-milk substitutes are used caregivers should be encouraged and
taught to feed with a cup and
spoon. Bottles and teats should not be provided as they are more difficult
to clean. Skilled support by
appropriately trained staff should be provided to caregivers on how to use
the breast-milk substitute
safely. Because infants’ receiving breast-milk substitutes are at increased
risk for illness, a mechanism
to monitor their health should be established.
Donations and procurement of breast-milk substitutes and other milk products
In accordance with internationally accepted guidelines, donations of infant
formula, bottles and teats and
other powdered or liquid milk and milk products should not be made.
Experience with past emergencies
has shown an excessive quantity of products, which are poorly targeted,
endangering infants’ lives. Any
procurement of breast milk substitutes should be based on careful needs
assessment and in coordination
with UNICEF. Human milk donations while safe when processed and pasteurized
in a human milk bank
also require fully functioning cold chains. Such conditions are not
currently met in Haiti and human milk
donations cannot be used at present. All queries and any donations that do
appear should be directed to
UNICEF, the designated nutrition coordinating agency in Haiti.
Complementary feeding of children above six months of age
Children from the age of six months require nutrient-rich, age-appropriate
and safe complementary foods
in addition to breast milk. Priority should be placed on locally available,
culturally acceptable,
nutritionally adequate and age-appropriate foods. When cooking facilities
are non existent or severely
limited, ready-to-use fortified foods are an option. Micronutrient powders
that can be added to local
foods, emergency rations or blended foods will also improve dietary quality.
In addition, once cooking
facilities have been set up, provision of fortified blended food is
recommended. A monitoring system to
ensure the appropriate targeting, distribution and use of food and food
products for infants and young
children should be established.
Feeding infants and young children in the context of HIV
Mothers known to be HIV-infected should be supported to exclusively
breastfeed their infants for the
first six months of life, to introduce appropriate complementary foods
thereafter, and to continue
breastfeeding for the first 12 months, along with provision of ARVs, as per
current WHO
recommendations on HIV and infant feeding (see references below). If an
HIV-positive mother was
already giving her child commercial infant formula, she should receive an
adequate supply of ready-touse
formula and support. A separate guidance is being prepared for the situation
in Haiti.
Treatment of severe acute malnutrition
Treatment of severely malnourished children, whether facility or community
based, should be
implemented in accordance with international standards and best practice and
closely monitored.
Specially formulated therapeutic milks F75 and F100 and ready to use
therapeutic food are required.
Conclusion
UNICEF, WHO and WFP strongly urge all who are involved in funding, planning
and implementing the
emergency response in Haiti to avoid unnecessary illness and death by
promoting, protecting and
supporting breastfeeding and appropriate complementary feeding and by
preventing uncontrolled
distribution and use of breast-milk substitutes. Public and private sector
entities and individuals who
wish to support infants and young children and their mothers and caregivers
in this emergency should
donate funds rather than send goods. We further urge governments and
partners to include capacity
building for breastfeeding and infant and young child feeding as part of
emergency preparedness and
planning, and to commit financial and human resources for appropriate and
timely protection, promotion
and support of optimal infant and young child feeding in this and other
emergencies.
For more information please contact:
UNICEF Nutrition Section, New York:
Ilka Esquivel, iesquivel at unicef.org, tel: + 1 212 326 7756,
Nune Mangasaryan, nmangasaryan at unicef.org, tel: +1 212 326 7159
UNICEF office in Port-au-Prince:
Mija-Tesse Ververs, Nutrition Cluster Coordinator in Haiti,
mijaververs at hotmail.com
Marie-Claude Désilets, desilets26 at hotmail.com and mdesilets at unicef.org, tel:
(509 ) 2245 3525
WFP office in Rome:
Tina van den Briel, Tina.VanDenBriel at wfp.org, tel. +39 06 6513 2171
WHO offices in Geneva and Washington DC (PAHO):
Zita Weise Prinzo, weiseprinzoz at who.int, tel: + 41 22 791 4440
Chessa Lutter, lutterch at paho.org, tel: + 1 202 974-3871
WHO office Port-au-Prince:
Montserrat Escruela, Mescruela at yahoo.com and montserrates at hai.ops-oms.org,
tel: +501 244 7675
References1
Operational Guidance on Infant and Young Child Feeding in Emergencies, v2.1,
Feb 2007
http://www.ennonline.net/ife/view.aspx?resid=6
Messages for the media in Haiti:http://www.ennonline.net/resources/735
Guide for the media on infant and young child feeding in emergencies:
http://www.ennonline.net/pool/files/ife/ife-media-guide-french(1).pdf
<http://www.ennonline.net/pool/files/ife/ife-media-guide-french%281%29.pdf>
Module 2 on Infant Feeding in Emergencies, v1.1, Dec 2007, for health and
nutrition workers in emergency
situations. http://www.ennonline.net/ife/view.aspx?resid=4
HIV and Infant Feeding: Revised Principles and Recommendations. Rapid
Advice. WHO. 2009.
http://www.who.int/child_adolescent_health/documents/9789241598873/en/index.
html
International Code of Marketing of Breastmilk Substitutes and subsequent
relevant World Health Assembly
Resolutions. WHO (1981):
http://www.unicef.org/nutrition/files/nutrition_code_english.pdf
and: http://www.ibfan.org/site2005/Pages/list2.php?iui=1
<http://www.ibfan.org/site2005/Pages/list2.php?iui=1&cat_id=46> &cat_id=46
Global Nutrition Cluster Toolkit on Nutrition in Emergencies :
http://www.humanitarianreform.org/humanitarianreform/Portals/1/cluster%20app
roach%20page/clusters%20pages
/Nutrition/Global_Nutrition_Cluster_Nutrition_Emergencies_Toolkit_June_2008.
pdf
1 Contributions to this joint statement were made by the ENN/IFE Core Group
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