Impact Of Infant And Young Child Feeding

Background and Rationale

Discuss about the Impact of Infant and Young Child Feeding.

Maternal and infant under-nutrition remain among the most damaging and pressing challenges facing infants especially in low and middle-income economies. Under-nutrition negatively affects both the cognitive and physical growth of a child. The World Health Organization (2009) approximates that 35%to 45% of child deaths are related to under-nutrition. Under-nutrition also prevents a considerable number of the survivors from fully developing to their potential. Furthermore, WHO estimated that in 2016 the number of obese children under five years had reached 41 million, 52 million were wasted and too thin for their height, and 155 million were stunted and too short for their age. Few children meet the recommended breastfeeding and nutritional complimentary foods frequency necessary for their age(Prudhon et al., 2017). To ensure that children develop and grow to their full health potential, adequate nutrition is necessary during their infancy and early childhood (Patel et al., 2015). Mothers and health care professionals should, therefore, prioritize improving IYCF practices.

To improve the health of children, the WHO prescribes IYCF as one of the most effectives methods. It is imperative for health workers to support or help both the mothers and families to adopt appropriate and sustainable IYCF practices. This support is in terms ofhelping mothers solve feeding challenges, providing expert counsel, giving appropriate advice, and knowing where and when to refer their clients if highly complicated feeding complications arise(Prudhon et al., 2017). Therefore, it is important for healthcare professionals to poses the necessary knowledge and skills to assist mothers and their families in improving their IYCF practices. IYCF education promotes economic development at both the family level and national level by reducing health costs and improving child development.

1. To evaluate thebehavioral changeofIYCF education onmothers, families, and healthcare practitioners.
2. To reduce the infant mortality rate in Nepal by improve the nutritionof infants.

IYCF education interventionsare necessary to reduce infant mortality rate and ensure children develop to their full potential. This research specifically aims to answer the following IYCF questions.

1. Can infant mortality rates in Nepal be reduced by imlementing IYCF education programs?
2. What is the importance of implementing IYCF education aimed at trainingnutrition and maternal healthcare practitioners?
3. Is IYCF educationcost-effective to health facilities and Nepal?

Countries in South Asian countries such as Nepal are faced with a persistently high child mortality and under-nutrition rate. Poor IYCF practices significantly contributes to the under-nutrition and high mortality rates. Interventions and strategies should be established to improve the nutrition of families and the community, promote appropriate breastfeeding practices, and complementary feeding in Nepal. These interventions can be reinforced by relevant government policies to improve their outcome.In order to meet their nutrition targets, UNICEF and WHO identified policies as key in the creation of environments that support efficient IYCF practices.The IYCF Global Strategy developed UNICEF and WHO recognizes that to alleviate the risk of infant mortality and morbidity, it is important to ensure exclusive breastfeeding and complementary feeding in infnats below six months of age (Dykes& Hall-Moran,2009). 

Financial and Economic Benefits

To improve the chances of survical, improved health and improved development of infants, it is important exclusive breastfeed infants below six months of age. This prevents life-long effects such as impaired social and intellectual development, reduced productivity, and poor school performance. This Strategy underlines the courses of action for providing support to mothers and families as they carry out their roles. It is important to develop approaches for improving feeding practices that are tailored to specific countries. The Strategy further recognizes that the health and nutrition of mothers and their babies cannot be separated. Despite the numerous studies emphasizing the importance of breastfeeding in promoting infant survival, developing countries experience gaps in implementing the Global IYCF Strategy by WHO and UNICEF (2003).Governments need to facilitate an environment that is favorable for implementation of the Strategy. Measure to ensure optimal breastfeeding should be enforced. Optimal breastfeeding includes initiating breastfeeding during the infant’s first hour, exclusively breastfeeding for the first few months, and continuing breastfeeding after one year together with adequate complementary feeding.

According to a recent analysis by Edmond et al. (2006), sub-optimum breastfeeding, especially in infants who are not breastfed exclusively during the first six half-year since birth, causes10% of gastro-intestinal infection burden andup to the death of up to 1.4 million infants below five years of age.Another research activityconducted in Ghana came to the conclusionthat 16% of infant deaths could be avoided if the infants were breastfed from the first dayand if they were breastfed from the first hour the rate of avoidable infant deaths could be up to 22%(Edmond et al., 2006).This is partly due to the long thought fact that the immune and nutritional properties of maternal colostrum provide additional protection to the infant (Morales et al., 2012).The infant mortality rate was discovered to be associatedclosely with the type of breastfeeding practiced by healthcare attendants and mothers. Infants who were predominantly or partially breastfedwere exposed to a higher mortality risk compared to infants who were breastfed exclusively. This is particularly relevant for mothers and healthcare professionals in Africa and Asian countries where despite the fact that women already predominantly or exclusively breastfeed their babies, the infant mortality and neonatal mortality rates are still high. The study identified the type of breastfeeding pattern, initiation timing, and promotion of breastfeeding as a key strategy for ensuring child survival.

The financial and economic benefits of education on health systems in developing countries is analyzed at micro and macroeconomic levels. A study by Hollar-Bhar et al. (2015) identified breastfeeding counselingas among the most cost-effective child care interventions for reducing mortality and morbidity rates. For every infant death averted, breastfeeding promotion programs such as counseling incur a cost of $100 to $200 similar to rotavirus and measles vaccination (Caulfield et al., 2006). According to Hollar-Bhar et al. (2015), the global sales of supplements and baby foods such as milk formula increased significantly between 2003 and 2013 from $22.4 billion to approximately $58billion. Most of these sales were recorded in Asian countriesand were characterized by a rapid decrease in breastfeeding practices in highly populated low and middle-income countries like Indonesia, China, and Nepal (Hollar-Bhar et al., 2015).To determine the cost-effectiveness of infant and young child feeding practices, it is imperative to estimate the financial outlays. These costs include costs associated with legislation and developing policies, media campaigns, training of community volunteers and health workers in counseling, and monitoring costs.In addition, when infants fall ill due to poor breastfeeding habits, the human capital development of the mothers is affected as they miss work (Ickes et al., 2017).In order to reduce cases of under-nutrition in populations with food insecurity, it is important to adopt strategies such as cash transfers, food supplements, and nutritional counseling.To implement these strategies, it is necessary to consider their budgetary feasibility and economic relevance.

Role of Healthcare Workers

Due to their influence, health workers play an important role in ensuring effectiveIYCF practices (Samuel, Olaolorun & Adeniyi, 2016).It is crucial to conduct supportive supervision to build the competency and capacity of community workers and healthcare professionals to implement IYCF support and counseling (focusing on breastfeeding and complementary feeding). Further, actions in maternity facilities to encourage breastfeeding practices should be enforced through institutionalizations of the Global IYCF Strategy.

According to a UNICEF report in 2015, infants should be breastfed exclusivelyfor the first six mothssince birth. WHO reports on infant and young child feeding in 1991 and 2008 recommend exclusive breastfeeding as one of the best and natural methods of preventing infant illnesses and ensuring infants develop to their full potential.Exclusive breastfeeding has been estimated to decrease cases of infant mortality in developing countries such as Nepal by up to 13% (Chung et al., 2007). Further, a recent study on promotingIYCF education among health workers focusing on exclusive breastfeeding by Edmond et al. (2006) found that the likelihood of mothers whoreceived the IYCF counseling to exclusively breastfeedtheir newborn infants wasconsiderably increased in the first six months. UNICEF approximates that infants who are exclusively breastfed are upto 14 times more probability to survive their first six months of life compared to children who are not breastfed.This is in part due to the drastic reduction of deaths as a result of diarrhea and respiratory infection (Lamberti et al., 2011)

The rationale behind conducting IYCF education in Nepal is based on timely initiation of breastfeedingas from the first hour, breastfeeding exclusively from birth to six months, and continued breastfeeding after the first year. Earlyinitiation of breastfeeding helps improve the mortality of newborns and prevents the onset of various infection (Edmond et al., 2006).Breastfeeding within an infant’s first hour of birth stimulates the production of colostrum which is important for the infants immune protection and a source of much-needed nutrients.There are numerous benefits of exclusive breastfeedingduring an infant’s first six months. According to Lamberti et al.(2011), one of the mainbenefitsconferred is the drasticreduction in gastrointestinal infections especially in developing countries such as Nepal. Partially breastfeed, and non-breastfed infants are exposed to a high mortality risk from infections such as diarrhea. Reports by WHO and UNICEF recommend that children should continue breastfeeding upto two years or more. This is because breast milk is an important source of nutrients as well as energy. Continued breastfeeding has long-lasting positive effects on the development and health of children during their early childhood.Education on efficient breastfeeding practicesgreatly reduces the mortality rates among infants and ensures their development to full potential (Reinbott et al., 2015). Training health personnel on effectiveIYCF practices is important to enhance cost-effective breastfeeding practices(Samuel, Olaolorun & Adeniyi, 2016).

This IYCF education intervention primarily aims to decrease infant mortality rates in Nepal by approximately 40% while encouraging exclusive breastfeeding. The propsed action plan should ensure compliance with ethical guidelines prescribed in the Helsinki Declaration and must be consequently cleared by Nepal’s Ethical Review Board. Infants and mothers who require medical attention must be promptly attended to in standard medical centers.

The main approaches and activities to improving the impact of IYCF education among mothers and health workers in Nepal will be aimed at improving the availability of information, improving IYCF behavior and awareness among caregivers, establishing a supportive policy environment, and capacity building among health care professionals. The funding to cover these activities will be sourced from international organizations such as WHO and UNICEF, government funding through Nepal’s health ministry, community contribution, and other available sources.

To improve the accessibility of correct information on IYCF, the eisting information and documents will be evaluated along with the breastfeeding habits in different ethnic groups and regions of Nepal. The existing material will be updatedin accordance with the latest guidelines from WHO and UNICEF reports on IYCFpractices. New material tailored to the demographic structure and background of Nepal will be developed after careful research. Guidelines on appropriate breastfeeding practice will be provided through posters, leaflets, social media posts, and flip charts in various maternal health facilities. Furthermore, counseling software on IYCF practices will be provided to nutrition counseling centers and health facilities.  A distribution network to provide information to families and the community will be established together with the relevant communication equipment. An important strategy to enforce IYCF education will be to provide refreshtraining programs to update nutrition counselors and health carepractitioners on IYCF communication skills, utilization of the new IYCF material, proper breastfeeding practice, and updated nutrition knowledge.

To improve the behavior and awareness on appropriate IYCF practices among mothers, the community, and other caregivers, activities to communicate this information will be carried out through mass media (Mashreky et al., 2015). Communication campaigns will be organized in Nepal. Examples of these campaigns include ‘Nepal Breastfeeding Week’ and ‘Mother and Child Nutrition Week.’ Furthermore, to improve breastfeeding behavior among caregivers, reproductive-aged women, and mothers in Nepal, training will be conducted. Guidelines prescribed by WHO and UNICEF will be distributed to health facilities and families. Organizing contests and advertisement campaigns through the internet and social media will be used to spread awareness on proper weaning practices rapidly.

It is important to review prenatal care policies to ensure that their implementation is supportiveof proper breastfeeding practices (Harris et al., 2016). An evaluation and situational analysis on possible constraints hindering the implementation of proper breastfeeding regulations and guidelines will be conducted in the Nepal community. Workshops and meetings aimed at developing an effective and complete policy framework will be organized.To attract interest and draw attention to IYCF interventions, advocacy meeting will be held. It is also important to establish and train a team dedicated to ensuring proper IYCF practices are enforced in various regions in Nepal. Appropriate breastfeeding programs will be strengthened by cooperating with existing projects.In addition, centers providing counseling on infant nutrition will be set up.

It is crucial to ensure that health workers and other infant nutrition caregivers have the relevant knowledge and skills (Baker et al., 2013). This will be achieved through providing training activities to refresh the caregivers’ competency in providing appropriate breastfeeding and complementary feeding practices. Training material containing updated information from recent research activities on breastfeeding practiceswill be provided to healthcare practitioners. It is, however,important to continue research on proper breastfeeding practices among mothers in Nepal. Studies should be carried out to continuously improve breastfeeding practices to reduce infant mortality rates and improve both their mental and physical development.

To evaluate the impact of IYCF education on reducing infant mortality rates, measures will be put in place to ensure localities from various regions in Nepal report the progress of their program implementation and the outcomes. An effectiveness trial will be conducted among low socio-economic mothers and to educate mothers and heathcare practitioners on proper IYCF practices to reduce infant mortality and ensure infants develop to their full potential.The impact of providing IYCF education to caregivers and families inlow socio-economical groups will be assessed. The essential indicators such as thetiming of breastfeeding, exclusive breastfeeding, continued breastfeeding, training health workers, and the cost-benefit of the action plan will be periodically monitored. After monitoring the above indicators, an evaluation of the impact and effectiveness of the action plan for reducing infant mortality through IYCF education will be conducted to ensure the continued improvement of breastfeeding practices.An analysis on the cost-effectiveness of IYCF education will be based on outcomes and costs recorded in the study. The costs of this IYCF strategy will include service delivery andorganizational costs,salary expenses incurred as a result of using health professional, andthe cost of other relevant materials. These implementation expenses will determined after an analysis of participatinghealth service facilities, nutrition centers,and financial records derived from the health care projects.Specifically,medical and nutritional health personnel will collect weight and height measurements using existing methods and record the data on infant growth chart to determine the development progress of the infants. Infant mortality will be measured in terms of the number of infant deaths recorded within one year since birth.

Developing effective and sustainable interventions to improve complementary feeding will be integral components of efforts to reach the child survival and malnutrition Sustainable Development Goals (SDGs). The proposed research will provide high-level evidence of the efficacy of peer counseling to support proper breastfeeding and complementary feeding approaches and reduce malnutrition in young children in rural Nepal. The findings will provide crucial interventions prescribing the appropriate approaches that healthcare practitioners should emulate in Nepalandthe generalSouth Asia. The outcomes and finding of this research project are expected to greatly affect the infant healthcare practices in Nepal. The study should be able to assist in reducing the infant mortality rate in Nepal by providing relevant IYCF education on infant nutrition.

There is a need to ascertain that health practices support, promote, and protect exclusive breastfeeding and adequate complementary feeding.Exclusive breastfeeding not only reduces the mortality rate of infants but is also associated with better educational performance, improved cognitive ability, and the healthy development of the brain.Infant and young child education promote economic developmentat both the family level and national level by reducing health costs and improving child development (Srivastava & Sandhu, 2007).Poor breastfeeding programs result in increased health care costs due to high child morbidity and the consequences of not breastfeeding such as chronic illnesses and obesity. It is therefore important to establish cost-effective IYCF practices in low-income countries such as Nepal.Health workers play an essential role in ensuringadequateIYCF practices. It is crucial to conduct supportive supervision to build the competency and capacity of community workers and healthcare professionals. This study is therefore significant in reducing infant mortality rates by ensuring mothers and caregivers have the necessary skills and knowledge for appropriate breastfeeding practicesandemphasizing the cost-effectivenessof breastfeeding in Nepal.

The research activity to determine the impact of IYCF education on the mortality rate of infants in Nepal will be carried out over a three period covering all activities from setting up the project to preparing a final report based on the results derived from the study. The following tableoutlines the timing of activitiesin the study.

Task and Activities

1st Year Quarters

2nd Year Quarters

3rdYear Quarters

1

2

3

4

1

2

3

4

1

2

3

4

Ethics clearance

/

Project set-up

/

Formative research

/

Formulation of intervention

/

Determine research instruments

/

Pilot study

/

Enrolment of research subjects

/

/

/

/

Implementation of action plan

/

/

/

/

/

/

/

/

/

Surveys

/

/

/

/

/

Follow up studies

/

/

/

/

/

/

/

/

/

Data entry

/

/

/

/

/

/

/

/

/

Data analysis

/

The research project is estimated to cost $199k. Thisis after considering the travel and communication expenses, salaries, consumables and materials, equipment, miscellaneous expenses, and other indirect costs. The following table shows costs and their drivers expected to be incurred while researching the impact of IYCF education on infant mortality rates in Nepal.

Activities and Items	Amount of $
Salaries	96890
Consumables and other materials	24400
Equipment	19000
Communication and travel expenses	24500
Miscellaneous expenses	11600
Total direct costs	173390
Indirect costs (15% of subtotal)	26009
GRAND TOTAL	$199,399

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