Rapid Assessment Report

Rapid Assessment Report Infant and Young Child Feeding in Emergencies in Selected Unions Affected by Cyclone Sidr December 2007-January 2008 Urmila, mother of three, receives salt, rice, split peas, high energy biscuits, and oil at Save the Children’s food distribution Acknowledgements Grateful thanks to the many people that contributed to this rapid assessment. The staff of Save the Children, including Dr. S M Younus Ali, Dr. Sheikh Shahed Rahman, Dr. Md. Jahirul Alam Azad, Mollah Mahmud Ahmed, Bazlul Kabir Zoarder, Ershadul Hoque, Toby Stillman, Frances Mason and Vicky Sibson. The Bangladesh Breastfeeding Foundation, including staff members Ms. Jolly Khanam, Ms Aklima Parvin and Ms Shafia Khatun. Dr. Khurshid Talukder, Consultant Paediatrician and Research Co-ordinator, Centre for Woman and Child Health (CWCH) ELMA Philanthropies for their generous support to Save the Children’s Emergency Health and Nutrition Response for Bangladeshi Children and Families Affected by Cyclone SIDR Special thanks to the mothers and caregivers who gave their time and thoughts so graciously at such a busy and difficult time. Main author: Ms. Ali Maclaine M.A. (Hons), MSc. Consultant Nutritionist specialising in infant and young child feeding, especially in emergencies. E-mail: [email protected] or [email protected] 2 Table of Contents I. Acronyms………………………………………………………………………………….…….4 II. Key Definitions…………..………………………………………………………….…………4 III. Background and Introduction………………………...……………………….…………….5 IV. Assessment Overview………………..………………………………………….……………7 V. Assessment Results…………………….…………………………….………………………..8 VI. Recommendations and Conclusion………………...………………………………………14 Annexure 1. Save the Children’s Emergency Maternal and Child Health and Nutrition Interventions 2. Background data on IYCF practices in Bangladesh, pre-cyclone 3. A Joint Statement by the Ministry of Health and Family Welfare, Government of Bangladesh and UNICEF and WHO 4. Breastfeeding Protects Children in Emergencies, Joint Statements by Bangladesh Breastfeeding Foundation, WHO and UNICEF 5. Assessment Activities and Locations 6. Limitations of the IFE assessment 7. Demographic data of 15 selected union councils 8. BBF leaflets being printed by UNICEF for distribution to mothers post-cyclone 3 Acronyms: BBF - Bangladesh Breastfeeding Foundation FO – Field Officer BBS – Bangladesh Bureau of Statistics GOB – Government of Bangladesh BCC – Behaviour Change Communication IFE – Infant and young child feeding in BDHS – Bangladesh Demographic and Health emergencies Survey IYCF – Infant and young child feeding BMS – Breastmilk Substitute (see Key MCHN – Maternal/Child Health Nutrition Definitions below) MDG – Millennium Development Goal CHV – Community Health Volunteer MIC – Multiple Indicator Cluster survey CSB – Corn soya blend NGO – Non-governmental organisation CWCH - Centre for Woman and Child Health TBA – Traditional Birth Attendant CMNS – Child and Mother Nutrition Survey UNICEF – United Nations Children’s Fund EBF – Exclusive Breastfeeding (see Key WAZ – Weight for age z-score Definitions below) WHO – World Health Organisation FGD – Focus Group Discussion WSB – Wheat soya blend Key Definitions: Breastmilk Substitute (BMS): any food being marketed or otherwise represented as a partial or total replacement for breastmilk, whether or not suitable for that purpose. Note: In practical terms, foods may be considered BMS depending on how they are marketed or represented. These include infant formula, other milk products, therapeutic milk, and bottle-fed complementary foods marketed for children up to two years of age and complementary foods, juices, teas marketed for infants under six months. Complementary food: any food, whether industrially produced or locally-prepared, used as a complement to breastmilk or to a breastmilk substitute and that should be introduced after six completed months of age (180 days). See ‘timely complementary feeding’ below. Note: The term ‘infant complementary food’ is often used to distinguish between complementary food referred to in the context of infant and young child feeding, and complementary food used in the context of food aid (i.e. foods, beyond the basic food aid commodities, given to an affected population to diversify their dietary intake and complement the ration, e.g. fresh fruit and vegetables, condiments or spices. Infant complementary foods should not be marketed for infants under six completed months of age. Exclusive breastfeeding: an infant receives only breastmilk and no other liquids or solids, not even water, with the exception of drops or syrups consisting of vitamins, mineral supplements or medicines. Infant: a child aged less than 12 months. Infant formula: a breastmilk substitute formulated industrially in accordance with applicable Codex Alimentarius standards (developed by the joint FAO/WHO Food Standards Programme). Commercial infant formula is infant formula manufactured for sale and may be available for purchase in local markets. Generic infant formula is unbranded and is not available on the open market, thus requiring a separate supply chain. Mixed feeding: breastfeeding a child while also giving non-human milk and/or fluid or solid food. Optimal infant and young child feeding: early initiation (within one hour of birth) of exclusive breastfeeding, exclusive breastfeeding for the first six months of life, followed by nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Timely complementary feeding: the child receives age-appropriate, adequate and safe solid or semi-solid food in addition to breastmilk or a breastmilk substitute. Complementary foods should be introduced after six completed months (180 days). 4 I. Background and Introduction Introduction. Super-cyclone Sidr hit the southern coast of Bangladesh on 15th November 2007, heavily affecting 15 districts in Barisal division. Save the Children, which has worked in Bangladesh since 1979, was one of the few international humanitarian agencies with emergency responders positioned in the storm’s path. The cyclone first struck Hiron Point in the Sundarbans area, immediately adjacent to Barisal, where Save the Children has extensive health, nutrition, disaster prevention and preparedness programmes. Following the cyclone, Save the Children rapidly expanded its programme area and is now working in seven districts of Barisal and Khulna division with shelter, protection, education, food and other interventions. The agency’s emergency health and nutrition program, implemented in 15 cyclone- affected unions of Barguna and Patuakhali districts, focuses largely on protecting the health and well- being of young children and women of reproductive age as communities begin to recover from the cyclone. Save the Children’s Emergency Health and Nutrition team is promoting 12 key maternal and child health practices and services/interventions, including immediate and exclusive breastfeeding, micronutrient supplementation, clean water and hygiene (See Annex 1 for a complete list of promoted interventions). The project is being implemented in close collaboration with the Ministry of Health and several local non-governmental agencies. Overview of Infant and Young Child Feeding in Emergencies (IFE) Ideally, all infants and young children should be fed using optimal infant and young child feeding (IYCF) practices: (i) initiation of breastfeeding within 1 hour of birth, (ii) followed by exclusive breastfeeding for six completed months (180 days), and (iii) from six months of age introduction of adequate and safe complementary foods along with continued breastfeeding for two years and more. Unfortunately, many children in the world are not fed this way, leading to undernutrition, morbidity and death. Experience worldwide clearly demonstrates that during emergencies, when optimal infant feeding practices are even more important in supporting and protecting children, they are often undermined further by factors such as donations of breastmilk substitutes (BMS) and misconceptions surrounding the robustness of breastfeeding. As a result, infant morbidity and mortality often increases. During emergencies, the rates of child mortality can soar from two to 70 times higher than average and, even in previously healthy populations, child morbidity and crude mortality rates can increase twenty-fold in a period of just two weeks1. Undertaking a rapid IFE assessment and providing IFE support have consequently become major strategies in reducing child morbidity and mortality during humanitarian emergency response. Background on Bangladesh Infant and Young Child Feeding While Bangladesh has a strong culture of breastfeeding with 98% of children being breastfed sometime in their lives (BDHS 2004), many feeding practices are not optimal. As Graph 1 (next page) shows, despite commitment by the government and agencies optimal IYCF practice rates have remained static since the mid 1990’s, with, for example, exclusive breastfeeding hovering between 37- 46% nationally (it is currently 43%, BDHS 2007). In poor, rural communities affected by Cyclone Sidr practices appear to be even worse with, for example, >40% of infants being introduced complementary foods at one month of age2 (see Annex 2 for pre-cyclone IYCF conditions in Bangladesh and Barisal). 1 Guiding principles for feeding infants and young children during emergencies. WHO, 2004 2 Jibon-o-Jibika Baseline Survey Report (2005). Save the Children-USA, Bangladesh. January 2007 5 The effect

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