MANAGING INFANTS AND CHILD FEEDING DURING EMERGENCY
– Kusum Karki
After the earthquake we were engaged in various organizations working to protect and promote the lives of the affected people and I was appointed as the camp manager to manage the camp of infants and young child affected due to the devastating earthquake. Mostly affected were the infant, young child and women .so as to run our program effectively and efficiently we updated the past policies and developed new ones. Along with this we interacted with other various organizations working in the field of child health care management, breast feeding management, government, medical and non-medical personnel, and many more working during such emergency condition. We mainly focused on the health of the young child and infants as they were at the greatest risk. we conducted Routine monitoring and evaluation programs so as to improve the service being provided. We managed the feeding environment as per the WASH criteria. We made the Provision to ensure proper hygiene and sanitation around the camp so as to reduce the transmission of various diseases among each other. We Disaggregated program data for children under five years old by gender and by age as follows: 0-5 months, 6-11 months, 12-23 months and 24-59 months. We gave our first priority to exclusive breast feeding and when such condition were not feasible then human donor milk was searched ,searching of wet nurses taking in account of the WASH conditions and if all these conditions were not feasible then we used infant formula through individual-level assessment and feed accordingly. Average infant formula needs for an infant less than six months of age are (Ready to Use Infant Formula) RUIF: 750ml/day; 22.5L/month; 135L/6 months, and(Powdered Infant Formula) PIF: 116g/day; 3.5kg/month; 21kg/6 months and the blanket distribution of BMS should was restricted.
On 25 April, a 7.8 magnitude earthquake struck Nepal causing widespread destruction and loss of life. The initial earthquake was followed by thousands of aftershocks and another powerful quake on 12 May measuring 7.3 in magnitude. The earthquakes caused 8,659 deaths (4,771 female; 3,887 male) and injured over 100,000 people – 384 people are still missing. Of the 75 districts in Nepal, 14 were severely affected. Over 500,000 houses have been destroyed and 269,000 damaged. Over 1,000 health facilities were destroyed or severely damaged including primary health care centers, village health posts and birthing centers. About 32 per cent of facilities providing specialized maternal and neonatal services were also destroyed. Children and infants are at the greatest risk after the earthquake With nearly two million children affected by Saturday’s deadly earthquake in which has claimed more 3,500 lives.
The World Health Organization and UNICEF Global Strategy on Infant and Young Child Feeding recommends that infants be exclusively breastfed for the first six months of life and then continue to be breastfed, with the addition of complementary foods, for two years or more . In an emergency situation, infants who are exclusively breastfed have their health and well being protected by the food, water and immune factors provided by breast milk. Breastfeeding also mitigates physiological responses to stress in both infants and their mothers, helping them to cope with the stress of being caught up in an emergency situation. But during emergency such conditions might not be possible due to various factors. And the best way to cope with this situation is to provide them formula milk.
FINDINGS AND MANAGEMENT
In early response, we consulted national/sub-national preparedness plans, policies and procedures and uphold relevant legislation and international standards. We Developed missing and updated existing policy guidance in close collaboration with government authorities and seek to strengthen relevant national/sub-national policies. We Developed and updated past policies and associated procedures in preparedness. We Enacted legislation and adopted policies in line with the WHO Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children. We Sensitized relevant personnel across sectors to support IFE, including those dealing directly with affected women and children; those in decision-making positions; those whose operations affect IYCF; those handling any donations; and those mobilizing resources for the response. Target groups for sensitization include government staff, sector/cluster leads, donors, rapid-response personnel, camp managers, communications teams, logisticians, the media, volunteers, among others. We mainly focused to counsel mothers and infants with heightened needs, such as stressed or traumatized mothers, malnourished infants and mothers, low birth weight (LBW) infants and disabled infants with feeding difficulties. We Coordinated with the government to make the program more effective. We Coordinated with other sectors to identify opportunities for multi-sector collaboration in needs assessment and programming and to inform sector policies, actions plans and risk management regarding IFE.
We Assessed the needs and priorities for IFE response and monitored the impact of interventions, humanitarian action and inaction. We Prioritized assessment of acute needs and difficulties that expose children to the greatest risk. We Gathered qualitative and quantitative data in preparedness, early needs assessment and representative surveys. We Invested in gathering reliable, accurate, systematic and coordinated information and triangulated information sources. we Disaggregated data for children under two years old by gender and by age as follows: 0-5 months , 6-11 months, 12-23 months, disaggregated key information by ethnicity, location, etc. to enable equity analysis. Managed and monitored WASH environment, including access to safe water and sanitation, and social norms on hygiene. Find out date about Pre-emergency feeding practices, including prevalence of: breastfeeding initiation in newborns; early and exclusive breastfeeding in infants under six months; non-breastfed infants under six months; continued breastfeeding at one year and at two years; minimum acceptable diet; bottle feeding (at any age); BMS use, including infant formula. Intervention strategies included objectives, target population, expected outputs and outcomes .We Ensured that gender equality and equity are integrated consistently in disaster prevention, humanitarian response and recovery program.
We Protected, promoted and supported early initiation of exclusive breastfeeding in all newborn infants. Ensured birth registration of newborns within two weeks of delivery and coordinated with other sectors (such as health, food security and social protection) to facilitate access to supportive services. We used breastfeeding supplementary feeding devices and breast pumps only when their use is vital and where it is possible to clean them adequately, such as in a clinical setting.
We intervened to protect and support infants and children who are not breastfed to meet nutritional needs and minimize risks. The consequences of not breastfeeding were influenced by the age of the child (the youngest are most vulnerable); the infectious disease environment; access to assured supplies of appropriate BMS, fuel and feeding/cooking equipment; and WASH conditions. Where an infant is not breastfed by his/her mother ,we quickly explored, in priority order, the viability of relactation , wet nursing and donor human milk, informed by cultural context, current acceptability to mothers and service availability. When those options were not acceptable to mothers/caregivers or feasible to deliver, we enabled access to an assured supply of an appropriate BMS, accompanied by an essential package of support .Infant formula is the appropriate BMS for infants less than six months of age. Alternative milks were used as a BMS in children aged six months and older, such as pasteurized or boiled full-cream animal milk (cow, goat, buffalo, sheep, camel), ultra-high temperature (UHT) milk, reconstituted evaporated (but not condensed) milk, fermented milk or yogurt . Use of infant formula in children over six months of age depended on pre-emergency practices, resources available, sources of safe alternative milks, adequacy of complementary foods, and government and agency policies. Home-modified animal milk was not used for infants less than six months of age due to significant nutritional inadequacy. BMS requirement may be temporary or longer term. Temporary BMS indications included: during relactation; transition from mixed feeding to exclusive breastfeeding; short-term separation of infant and mother; short-term waiting period until wet nurse or donor human milk is available. Longer-term BMS indications included: infant not breastfed pre-crisis; mother not wishing or unable to relactate orphaned infant; infant whose mother is absent long-term; specific infant or maternal medical conditions ; very ill mother; infant rejected by mother. We Determined infant formula need through individual-level assessment by a qualified health or nutrition worker trained in breastfeeding and infant feeding issues. We Provided infant formula for as long as the infant needed it.
Complementary feeding interventions depended on the context, objectives and timeframe of the response. Key considerations in determining complementary feeding response include pre-existing and existing nutrient gaps; seasonality; socio-cultural beliefs; food security; current access to appropriate foods; quality of locally available complementary foods, including commercial products; WHO Guidance on ending inappropriate promotion of foods for infants and young children of available products; cost; proportion of non-breastfed infants and children ; reports of children with disability-associated feeding difficulties; maternal nutrition; WASH conditions; the nature and capacity of existing markets and delivery systems; national legislation related to food and drugs, particularly importation; and evidence of impact of different approaches in a given or similar context. For children aged 6-59 months, multiple-micronutrient supplements were provided to meet nutrition requirements. We Supported breastfeeding women who are known to be HIV uninfected or whose HIV status is unknown to exclusively breastfeed for the first six months of life and to continue breastfeeding. We assessed the impact of human and animal infectious disease outbreaks. We did not accepted donated BMS, other milk products or feeding equipments .
Average infant formula needs for an infant less than six months of age are RUIF: 750ml/day; 22.5L/month; 135L/6 months, and PIF: 116g/day; 3.5kg/month; 21kg/6months. We Liaised with WASH provider agencies to secure priority access of families with infants using BMS to WASH services and meet minimum standards. We Enabled access to cleaning equipment and advice on hygienic preparation and storage of supplies. We Discouraged the use of feeding bottles and teats due to high risk of contamination and difficulty with cleaning. We Supported use of cups (without spouts) from birth. Cups with lids and disposable were used .We used various sterilization techniques to clean up the various equipments. We Did not used general or blanket distributions as a platform to supply BMS rather we used BMS on the the basis of individual level assessment as per their need.
During the emergency or any other condition exclusive breastfeeding is the most important to protect and promote infants health. If such condition are not feasible then alternative need to be searched like wet nursing, human donor milk, etc as per the WASH criteria. At last if all such conditions are not feasible then provide BMS as per the need and the criteria set up by the WHO. Routine evaluation and assessment is a most to run the program effectively. Multisectorial coordination is a most while working in such emergency condition. Plans and policies need to be developed and updated as per the condition. Care should be based on the equity basis rather than equality one. Personal hygiene and sanitation should be given top priority while conducting such program. WASH environment need to be focused and given top priority so as to reduce the further burden of outbreak of various infectious and communicable diseases.so lastly, we were able to manage the camp effectively and were able to save lives of many.