Plan for comprehensive diarrhea control

Diarrhoea

Diarrhoea remains the second most common cause of death among

children under five globally. Nearly one in five child deaths – about

1.5 million each year – is due to diarrhoea. It kills more young

children than AIDS, malaria and measles combined

Each year, an estimated 2.5 billion cases of diarrhoea occur among children under five years of age, and estimates suggest that overall incidence has remained relatively stable over the past two decades.

More than half of these cases are in Africa and South Asia  where bouts of diarrhoea are more likely to result in death or other severe outcomes.

The incidence of diarrhoeal diseases varies greatly with the seasons and a child’s age. The youngest children are most vulnerable:

Incidence is highest in the first two years of life and declines as a child grows older.

6-point plan for comprehensive diarrhea control.

 The plan includes a treatment package to significantly reduce child deaths due to diarrhoea, and a prevention package to make a lasting reduction in the diarrhoea burden for years to come

1.   Oral rehydration therapy and continued feeding is a life-saving treatment, which only 39  per cent of children with diarrhoea in developing countries receive.

2.   Zinc tablets are still largely unavailable in most developing countries, although their effectiveness in reducing the severity and duration of diarrhoea episodes is well known.

3.   Immunization against rotavirus, which results in an estimated 40 per cent of hospital admissions due to diarrhoea among children under five, is urgently needed worldwide, especially in Africa and Asia.

4.   Safe water, adequate sanitation and proper hygiene are too often forgotten foundations of good health. Handwashing with soap alone could potentially reduce the number of diarrhoea cases by over 40 per cent.

5.   Breastfeeding is critical to both the prevention and treatment of diarrhoea. Infants who are exclusively breastfed for the first six months of life and continue to be breastfed until two years of age and beyond develop fewer infections and have less severe illnesses, including diarrhoea.

6.   Vitamin A supplementation has been shown to significantly reduce child deaths, mostly from diarrhoea and measles.

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World Health

Optimal Breastfeeding Practices for Infants 0–6 Months

•     Put the baby to the breast immediately after birth and allow baby to remain with the mother.

•     Breastfeed frequently, as often as the baby wants, day and night.

•     Give only breastmilk the first 6 months, with no water, other liquids, or foods (exclusive breastfeeding).

•     Continue breastfeeding even if the mother or the baby becomes ill.

•     Avoid using bottles, pacifiers (dummies), or other artificial nipples.

•      Mothers should eat and drink sufficient to satisfy their own hunger and thirst.

Signs of Proper Positioning and Attachment-Baby to Mother for Breastfeeding

When positioning and attachment are correct:

•     The baby’s whole body is facing the breast, and the baby’s stomach is

touching the mother’s stomach.

•     The baby’s head, back, and buttocks are in a straight line.

•     The baby’s face is close to the breast.

•     The baby is brought to the breast with buttocks supported.

•     The baby’s chin is touching the breast.

•     The baby’s mouth is wide open.

•     The baby’s lower lip is curled outward.

•     More areola is showing above the baby’s upper lip and less below the lower lip (baby should take most of the dark part into his/her mouth).

•     The baby takes slow, deep sucks.

•     The baby is relaxed and satisfied at the end of the feed.

•     The mother does not feel nipple pain.

•     The mother may be able to hear the baby swallow.

•     The breast feels softer after a feeding.

The Advantages of Breastfeeding Baby

Colostrum

• Chief defense against infection

• High in protein

• First immunization

Breastmilk

•     Supplies all necessary nutrients in proper proportion

•     Digests easily without causing constipation

•     Protects against diarrhea

•     Provides antibodies that protect against common illnesses

•     Protects against infection, including ear infections

•     During illness helps keep baby well-hydrated

•     Reduces the risk of developing allergies

•     Is always ready at the right temperature

•     Increases mental development

•     Prevents hypoglycemia (low blood sugar)

•     Promotes proper jaw, teeth, and speech development

•     Is comforting to fussy, overtired, ill, or hurt baby

Early skin to skin contact

•     Stabilizes temperature and prevents hypothermia (cold)

•     Promotes bonding

Mother

·         Reduces blood loss after birth (early/immediate breastfeeding) and helps expel the placenta

·         Saves time and money

·         Makes night feedings easier

·         Delays return of fertility

·         Reduces the risk of breast and ovarian cancer

·         Is available 24 hours a day

·         Ensures close physical contact

·         Makes mother calmer and more relaxed because of hormones

Family

•     Is economical

•     Is accessible

•     Needs no preparation

•     Reduces cost for medicines for sick baby

•     Delays new pregnancy

Strategies for Improving Nutrition of Children

For the last 30 years, nutritionists have noted that many child deaths are due to the indirect effects of malnutrition on immunity and susceptibility to infection
A 1995 study² confirmed this link, attributing more than 50 percent of deaths in children younger than five years old to malnutrition, either directly or indirectly. Undernutrition is an underlying cause in the main killers of children - diarrhea, pneumonia, malaria, measles and AIDS.
Malnutrition, including vitamin and mineral deficiencies in children younger than five years of age is often the result of a complex set of factors. But most simply put, it stems from poor maternal nutrion, poor feeding practices, too little food, and too much disease
Malnutrition begins in the womb but the process of growth faltering occurs mainly in the first year of life and has lasting impact. Once growth faltering occurs, it is difficult for a child to physically develop at a normal pace. Therefore, an early focus on key infant feeding behaviors - initiation of breastfeeding within the first hour of birth, exclusive breastfeeding to six months, and complementary feeding thereafter - is essential.

The Lancet, a prestigious medical journal, ran a 2003 series on child survival that estimates that breastfeeding could prevent 13 percent of the deaths in children younger than five years old, or about 1.3 million deaths each year. Breastfeeding ranked first in The Lancet's list of prevention interventions. Complementary feeding ranked third place in The Lancet series in terms of key prevention interventions.

Essential Interventions for Reducing Malnutrition in Infants and Young Children in India

Essential Interventions for Reducing Malnutrition in Infants and Young Children in India

1. Timely initiation of breastfeeding within one hour of birth:

Every newborn starts breastfeeding within one hour of birth to take advantage of the newborn’s intense suckling reflex and alert state and to stimulate breast milk production. Good breastfeeding skills- including proper positioning and attachment are established to increase the newborn’s suckling efficiency, mother’s breast milk production, and infant’s breast milk intake.

2. Exclusive breastfeeding during the first six months of life:

Every infant is exclusively breastfed in the first six months of life. The infant is fed only breast milk and is not given any fluids, milk, or foods, not even water. Exclusive breastfeeding, with frequent, on demand Feedings ensures maximum protection against malnutrition, disease, and death, while contributing to Child spacing and lower fertility rates.

3. Timely introduction of complementary foods at six months:

Every infant starts receiving complementary foods by the beginning of the seventh month of life, while breastfeeding continues until 24 months and beyond. By the beginning of the seventh month of life, breast milk alone cannot meet an infant’s energy and nutrient requirements. At this time complementary feeding should begin. Introducing complementary foods before is both unnecessary and dangerous.

4. Age-appropriate complementary feeding, adequate in terms of quality, quantity and frequency for children 6-24 months:

Every child 6-24 months old is fed age-appropriate, energy and nutrient-dense, diverse complementary foods with increased quantities, nutrient density, and frequency as the child increases in age. Child feeding is responsive and active. Children are given prophylactic iron and folic acid supplements to prevent anemia. Hygienic practices are followed when feeding children.

5. Safe handling of complementary foods and hygienic complementary feeding

practices:

Every child 6-24 months old is fed using safe handling (preparation and storage) and hygienic feeding practices of complementary foods by – among others - washing caregivers’ and children’s hands before food preparation and eating, serving foods immediately after preparation, using clean utensils, and avoiding feeding bottles.

6. Full immunization and bi-annual vitamin A supplementation with deworming: Every child is protected from vaccine preventable diseases through a full course of immunisation delivered through the routine immunisation system at set times in the child’s fi rst year of life. In addition, all children 6-59 months old are further protected from mortality, morbidity, and malnutrition with preventive vitamin A supplementation and deworming twice yearly.

7. Frequent, appropriate, and active feeding for children during and after illness, including oral rehydration with zinc supplementation during diarrhoea:

Every child is fed, actively and frequently, with age-appropriate and nutrient dense foods, during and after illness, while frequent, on demand breastfeeding continues to increase fluid and nutrient intake. Children with diarrhoea also receive appropriate rehydration therapy including a full course of zinc supplements as per national guidelines for the treatment of diarrhoea.

8. Timely and quality therapeutic feeding and care for all children with severe cute

malnutrition:

 Every child with severe acute malnutrition is provided with therapeutic foods and care in a timely manner, for life-saving rapid weight gain and recovery. Care for children with severe acute malnutrition requires early case detection (before the development of medical complications), optimal therapeutic feeding and care protocols, and access to therapeutic foods, including ready-to-use therapeutic foods.

9. Improved food and nutrient intake for adolescent girls particularly to prevent

anaemia:

Every adolescent girl is protected against nutritional deficiencies and anaemia through dietary counseling, weekly iron and folic acid supplementation, twice yearly (six months apart) deworming prophylaxis, and life-skills development to avoid early marriage and early pregnancy.

10. Improved food and nutrient intake for adult women, including during pregnancy and lactation:

Every woman has access to sufficient quality and quantity of food, including during pregnancy and lactation. Every pregnant woman and lactating mother takes iron and folic acid supplements daily to reduce maternal anaemia and improve pregnancy and lactation outcomes. Universal regular consumption of salt with adequate levels of iodine (> 15 ppm) is required, especially for pregnant women, in order to prevent foetal brain damage associated with iodine deficiency

The Malnutrition Removal Campaign

• Complete (100%) survey of all children in the 0-6 age group. 
• 100% registration of all such children. 
• 100% weighing of all such children. 
• On the basis of weighing, classification of all children into normal/grade 1 to 4 categories (as appropriate).
• Special concentration on children in Grade 3 & 4 stages of malnutrition; regular weighing, providing for health & nutrition measures for these children. 
• Initiating measures for ensuring health and nutrition of pregnant mothers to reduce incidence of low birth weight children.
• Greater attention to children in the 0-3 age group given the greater incidence of malnutrition in this age group and its implications for the future development of the child. 
• Analysis of data to bring out the relative incidence of malnutrition based on age, gender & social status (scheduled caste/tribe) etc.