Docstoc

Rapid-infant-feeding-assessment

Document Sample
Rapid-infant-feeding-assessment Powered By Docstoc
					Rapid infant feeding assessment Key findings of Individual Interviews of caretakers with 0-6/6-12 month old infants Temporary Shelters, Myaung Mya Town, Ayeyarwaddy (Delta) Division May 18th 2008 Conducted by: Aye Aye Khaine, Program Manager, Nutrition Program Hthan Zar Lian, Area Manager, Nutrition Program Zaw Min Lay, Project Assistant, Nutrition Program Dr. Aung Kaung Myat, Volunteer Dr. Aung Myo Thant, Volunteer Contact Victoria Sibson (Emergencies Nutrition Adviser), v.sibson@savethechildren.org.uk for further information Aims: Following reports of 10 motherless infants <12 months in the temporary shelters of Myaung Mya town, this rapid assessment was undertaken to investigate the feasibility of alternative feeding, without using infant formula or breastmilk substitute, for motherless infants 0-6 or 6-12 months old. The main purposes were to offer sound advice rapidly to the caretakers of these infants, and to better understand the perception and the acceptability of affected communities regarding wetnursing and/or spoon-feeding expressed breastmilk for those infants. There were also questions regarding assessing the food being provided currently and before the storm hit. Method: The assessment team included 3 members from Save the Children Nutrition Program and 2 volunteer medical doctors. Individual interviews were conducted using a short semi structured questionnaire. Caretakers of motherless infants under 12 months were sought for interview through consultation with Save the Children Child Protection staff. Interviews also took place with some mothers of infants <12 months old. Interviews took place on the 18th of May, 08 at 7 different temporary shelters in Myaung Mya Town, Ayeyarwaddy (Delta) Division. A quick review of secondary data on infant and young child feeding practices pre cyclone was also undertaken to inform interpretation of the interviews and preliminary recommendations. Results: A total of 13 caretakers participated in the interviews. Among the 13 infants, 7 were female infants and 6 were male infants. 4 were less than 6 months old and 9 were 6-12 months old. The youngest infant was 17 days old. Out of caretakers interviewed infants, only 5 have no mothers. 2 out of 3 mothers reportedly died in the storm.

Nutritional Care Assessment – Temporary Shelters, Myaung Mya Town

1

All caretakers came from villages surrounding Laputta town. They were sent to temporary shelters in Myaung Mya due to the over flow of affected people in shelters in Laputta Town. Many of them do not know where they will be settled or relocated. Many female caretakers we interviewed were concerned about the return to their original/former locations (villages) as there are nothing left. Regarding wet nursing or spoon feeding of expressed breastmilk, the acceptability among the caretakers is high. Some mothers were already wet nursing near by infants in the temporary shelter. However, a few mothers think that the breast milk production has ‘gone slow’ due to the wet nursing of an additional infant. In a few cases, the infants refused to be given the breast-milk of a wet nurse mother. The reasons why the infants would refuse to get another mother's breast milk is not clearly known among the assessment team. One respondent expressed uncertainty about spoon feeding of breast milk as she/he thought that the breast milk will be sour already when it is time to spoon feed an infant. 24 hour diet recall for the infants suggests low rates of exclusive breastfeeding for infants 0-6 months. And, that caretakers, understandably, are giving only the food they are being provided by the shelter organizer to the infant. The caretakers have no means to access markets for additional food items as they have no income. The main food items being given to the infants are cooked rice and high energy biscuits. Less than 6 months old babies, especially with no mother, are given milk made from powder or evaporated milk drinks, while a few other <6 months old were given breast milk from a wet nurse. Even before the cyclone, good diversity of food being given to above 6 months old rarely came up during the interview. A few mothers (2-3) were also already introducing mashed rice (namely, Kazi) to the <6 months old babies in their villages before the cyclone. Taking into considerations of these caretakers having to rely on the shelter-provided food, feeding a quality diet to infants 6-12 months old is currently difficult. As mentioned earlier, most food that come through food aid are basic food items such as rice. The adult caretakers feed what they get to eat to the child as well. In addition to feeding situation, it was observed that many of the infants are not fully or warmly dressed. 3 infants were having diarrhea. A few infants look weak and/or thin (no anthropometric assessment was undertaken). Considering the type and amount of food currently being provided to the affected communities in shelter setting and the special situation of infants left with no mothers, it is challenging to encourage exclusive breastfeeding and continued breast feed the child (>6 months old) with complimentary foods as per standard practice. For the mothers with infants < 6 months old, the current environment does not facilitate them for caring the infant in a quiet place. Pre existing poor feeding practices are also a challenge (see below). As the weather is very rainy, the caretakers strongly expressed an immediate need for more baby cloths (diaper-like cloth) wraps, baby (cosmetic) powder, and thermos flasks. Some caretakers expressed the need for very basic minimal cooking utensils. The most concern that women expressed was that they would like to have a stable shelter to come back to after working. A few women imagined themselves to settle in the town where they are currently placed. Many of them, especially women, expressed a desire to get back to work, which is impossible with no farm implements (e.g. fish net, etc…). Summary: The interviews suggest current suboptimal infant feeding practices and extra challenges facing motherless infants, but positive views towards wet nursing. If nutritional needs of these young
Nutritional Care Assessment – Temporary Shelters, Myaung Mya Town

2

children are not addressed appropriately in very coming days, the risk for becoming malnourished in these children is very high. Recommendations are made below, but first an awareness of pre cyclone situation will be useful to guide messages and interventions: Pre cyclone situation: A quick review of relevant secondary data1 on infant and young child feeding practices suggests that pre cyclone immediate breastfeeding is common, pre-lacteals likely rare and on demand feeding and prolonged breastfeeding to 2 years common. But also that early (before 6 months) introduction of water is likely, making exclusive breastfeeding rate low (MICS 2000 - 0-3 months 16%, with 70% receiving water or other liquids from soon after birth). National and more local studies show that complementary feeding mostly starts earlier than the recommended 6 months (MICS 2000 - 40-50% before 4 months); but in a significant proportion of children, also late (MICS 2000 - 15% at 9 months). In a small study in Minbu, 7% of 463 children reportedly received infant formula as their first food/drink. Rice is nearly always the first food, pre chewed by the mother, or squeezed through a sieve. Sometimes salt is added, and probably less often, oil. Findings of a previous Save the Children study in Kangidaunt, Ayeyarwaddy Division, shows that early introduction of complementary foods (commonly before 1 month, sometimes at 7 days) is a common practice amongst the mothers from all wealth groups considered to make the child stronger and healthier and enabling the mother to go out and work in the fields. Complementary feeding is likely also insufficiently frequent, and using low nutrient, low energy density foods (e.g. soups, low use of animal source foods). Foods given to the child depend on what is available, affordable and the beliefs of the caretaker (nb. Household Economic Assessments undertaken to date indicate largely unaffordability of good quality diets at the household level2). The Minbu study found that diversity and frequency (assessed against international benchmarks) worsened with age. Working mothers reportedly do make use of commercial baby foods, some of poor nutrient value, e.g. instant rice powder. Recommendations:  Actions to support optimal infant and young child feeding should adhere to the Operational Guidance on Infant and Young Child Feeding in Emergencies, Infant and Young Child Feeding in Emergencies Operational Guidance. Version 2.1 Feb 2007, IFE Core Group (available online at www.ennonline.net).  Further assessments of need are required in order to know where and how to respond appropriately  ‘Safe spaces’ are required for children and caretakers to feed their child appropriately in a calm environment. These can be integrated in to other program activities as appropriate
1

Review of currently used infant feeding guidelines and information on infant feeding practices in Myanmar, Dec 13th 2001, Carol Williams; Nutrition, food security and livelihoods assessment, Minbu township, Myanmar. NovDec 2007. Oxfam and SCUK (internal draft not for circulation), Susana Rafalli and U Thein Zaw; Household Economy Assessment Kangyidaunt Township (Ayeyarwaddy); Causal Analysis of Malnutrition Kangyidaunt Township (Ayeyarwaddy); Environmental Health and Child Well-being Household Survey in Kangyidaunt (Ayeyarwaddy) March 2006 2 Chastre C. “The Minimum Cost of a Healthy Diet. Findings from piloting a new methodology in four study locations”. SC – UK. 2007

Nutritional Care Assessment – Temporary Shelters, Myaung Mya Town

3

 



 

Broad education messaging is required on optimal infant and young child feeding practices (focusing on immediate and exclusive breastfeeding, dangers of infant formula, timely introduction of complementary foods). Key messages should be agreed across agencies. If exclusive breastfeeding is to be promoted now, consistent messaging is required. Where skilled assistance is not currently available, and given the difficult and unsanitary working environment, Save the Children is encouraging wet nursing/spoon feeding breast milk where mothers are not available to infants 0-12 months old. As soon as possible, skilled breast feeding counselors are essential to support appropriate feeding on a case by case basis, particularly for infants 0-6 month old, who have no possibility for being wet nursed and require support to safely artificially feed, but also to support re-lactation where required. Improved access to good quality complimentary foods is needed for children above 6 months old. Options are improved rations consistent with Sphere minimum standards, or support for local purchase of foods if available, e.g. through a voucher system. A longer term livelihood recovery plan is also greatly needed if broader food security issues, which impact heavily on the care of children, is to improve3.

Annex Name of Temporary Shelters: Tan 250 (Factory) Bay Htote (Factory) Mote Soe Kwin (Primary School) B.E.H.S 4 B.E.H.S 5 Church

3

Save the Children have written a short paper relevant to this sector titled „Myanmar‟s Cyclone Nargis: Recovering Food Security and Livelihood Strategies‟

Nutritional Care Assessment – Temporary Shelters, Myaung Mya Town

4


				
DOCUMENT INFO
Shared By:
Tags: Rapid, -infa
Stats:
views:249
posted:11/27/2009
language:English
pages:4
Description: Rapid-infant-feeding-assessment