Dhaka Sunday May 06, 2012

Breastfeeding is a must for healthy growth

Rizanuzzaman Laskar

Sitting outside her mud house, Aarathi Robidas, 20, breastfeeds her 4-month-old child, in the village of Porbo Sadarghar in Sunamganj. Photo: Noorani

BABIES who are breastfed are likely to have better lung function, lower risks of asthma, better aptitude skills and even are better in relieving pain, various researches and studies suggest.

The benefits are not limited for just the newborns. Mothers who breastfeed their babies tend to cut risks of diabetes, says a 2010 Pennsylvania study.

On the other side of the coin, babies who aren't breastfed have a higher risk of infection, and are more likely to spend time in hospital during their first year, other researches show.

And yet, in Bangladesh, only around half of the mothers initiate breastfeeding within one hour of birth, according to the Demographic and Health Survey (BDHS)-2007.

If all newborns in the country were to be breastfed within one hour of birth, about 37,000 neonatal deaths could be averted annually, the study concluded.

Last year's BDHS statistics, however, give a more favourable picture. It says that almost all Bangladeshi babies are breastfed for the first year of life. And children are breastfed for an extended time with 90 percent children aging 20-23 months are still receiving breast milk.

However, only about one third of babies in Bangladesh receive the recommended exclusive breastfeeding (i.e. no other drinks or food) for the first six months of life with the statistics suggesting that complementary foods are introduced at too an early an age.

Bootle feeding is also not uncommon in the country, the survey further added, with one in five children (6-9 months) being fed with a bottle with a nipple.

The World Health Organisation recommends that infants start breastfeeding within one hour of life, are exclusively breastfed for six months, with timely initiation of adequate, safe and properly fed complementary foods while continuing breastfeeding for up to two years of age or beyond.

It contains all the nutrients needed by children in the first six months of life. Supplementing breast milk before the child is six months of age is also discouraged because it increases the likelihood of contamination, and hence risk of diarrhoea.

So, despite all the advice that 'breast is best' for their baby, why do so few continue breastfeeding?

Because mothers often receive inadequate support; cracked nipples, infections such as mastitis, problems in getting a baby to latch on properly or the demands of establishing breastfeeding while looking after older children can all hinder breastfeeding, experts say.

In a more general level, increasing numbers of working mothers and availability of artificial substitutes are also major reasons, they add.

Experts believe that longer maternal leaves could be a solution for working mothers. The government has already made sure that mothers working for the government gets six months of maternity leave.

However, things remain different in the private sector where different organisations and companies have different policies on the issue, which have caught the eyes of the Prime Minister herself.

Addressing last year's World Breastfeeding Week in August, the Prime Minister had said: “It is very unfortunate that many private sector employers do not allow six-month maternity leave to the expectant mothers working in their organisations, though all the government offices have already implemented it.”

She had also urged the private sector to set up breastfeeding corners for creating ideal environment for new mothers.

Breastfeeding corners should also be set up at the shopping malls and bus, rail and launch stations, she had added.

Children born in health facilities are also less likely to get breast milk within one hour of birth compared to their counterparts born in homes, studies have suggested.

A general tendency of providing pre-lacteal feeds [liquids/ foods given during the first three days of life] is widely practiced with more than half of the newborns, experts suggest.

The Breast-Milk Substitutes (Regulation of Marketing) Ordinance 1984 prohibits anyone from making, exhibiting, distributing, circulating, displaying or publishing any advertisement on the use of breast-milk substitutes or implying to create the belief or impression that breast-milk substitute feeding is equivalent or superior to breast-milk feeding.

However, due to weak coordination, limited coverage and ineffective community activities, low consumer awareness about the dangers of formula milk, absence of specific guidelines for IYCF, inadequate recognition of complementary feeding, questionable quality of services in baby-friendly facilities, lack of a standardised monitoring system is pulling the pace of breast feeding development.

Experts suggest comprehensive and effective activities at social level and special emphasis at family level. Individual concern and family support are crucially needed for having a healthy child followed by policy, social, organisational and community based activities.

While the trends are promising, continuing it in the future poses a challenge, experts added.

Our children deserve the best and we need to ensure that they get the best start in life by supporting breast-feeding.

Maternal anemia needs to be checked as a precondition

Pankaj Karmakar

  A woman feeds her child a specially prepared mix for malnourished children after adding Multiple Micro Nutrient, MMP powder in a nutrition centre in Madanpur, Sunamganj. Photo: Noorani

ADDING a huge burden on the national economy, anaemia has emerged as a severe public health problem in Bangladesh. The prevalence of anaemia is especially high among pregnant women, adolescent girls and young children.

Around 45 percent women in Bangladesh suffer from anaemia during pregnancy, say experts.

Iron deficiency along with hookworm infection, vitamin A deficiency, malaria infection, chronic infections like TB/ HIV, Hemoglobinopathies and Thalassemia are the main reasons for anaemia.

Due to iron deficiency the key reasons for anaemia around 400,000 people die annually across the world. Around 60 percent of total anaemia is caused by iron deficiency.

Because of anaemia, women face different sorts of complications during delivery. The complications include prolonged labour during delivery, delivering underweight child, maternal and neonatal death.

Maternal anaemia also increases the risk of maternal death and infants of mothers who suffer from iron deficiency are more likely to have low iron stores and become anaemic. It also causes preterm delivery.

During pregnancy, the demand of blood of a woman increases sharply as her blood circulation increases. A mother has to fulfil her body's demand as well as feed the foetus.

That is why if a mother suffers from anaemia, it poses severe risk on her health, said Dr. Tahmeed Ahmed, director, Centre for Nutrition and Food Security of ICDDR,B.

Due to anaemia, the resistance of a human body sharply reduces and the anaemic persons become hub of infectious diseases.


Income of a person, who works on daily productivity basis, drastically reduces as working capacity, efficiency and endurance also reduce.

Moreover, the cognitive development of people is severely hindered due to anaemia. An anaemic woman cannot concentrate on her job.

Referring to the economic loss, Dr. Tahmeed said the nation has to lose 7.9 percent of its total Gross Domestic Product (GDP).

The government has taken different initiatives to address the issue. The initiatives include, among other things, micronutrient supplementation, dietary improvement, parasitic disease control, food fortification and family planning and safe motherhood.

Among those micronutrient supplementation, parasitic disease control and family planning and safe motherhood are being running well, while dietary improvement and food fortification programme has seen little improvement.

He also stressed the need for controlling anaemia and said that it must be prioritised to achieve several of the Millennium Development Goals (MDGs) by 2015.

Food fortification aims to supply micronutrients in amounts that are provided by a good, well-balanced diet, and improve the nutritional status of a large proportion of the population. Fortification requires neither changes in existing food pattern nor individual compliance.

Aiming to address maternal anaemia, the government has introduced a programme under which 100 Iron Folic Acid (IFA) tablets are distributed among the pregnant women.

In most of the cases, pregnant women do not receive the tablets. Even though some mothers receive those, they do not take it properly for several reasons.

16.3 percent pregnant women does not consider it as necessary, 25.5 percent due to objection of family members, 12 percent due to side-effects of tablets, 19.5 percent due to lack of supply, 6.1 percent forget to take it and other factors.

The tablets are given wrapped in a normal paper. Whenever the IFA tablets come to contact with air, its colour becomes black. That is why women and their family members become apprehensive about it and give up taking those tablets.

The government should distribute the tablets packed in a bottle or blister packet, suggested Dr. Tahmeed.

Even the health workers do not know about the necessity of IFA tablets. That is why they cannot brief their customers well.

Talking about government's different policies for improvement of maternal and child health, Dr. Tahmeed said there are a number of government policies to address the issue, but their progress of implementation is very disheartening.

Political willingness and mass awareness are needed to address the 'national problem', opined the nutrition expert.

'Appropriate awareness is essential'

Md Humayun Kabir, Secretary, Ministry of Health and Family Planning, talks to The Daily Star


EXCLUSIVE breast feeding practice up to the age of six months is very much essential for a child's growth, the government has taken a number of initiatives to promote the practice across the country, said Health Secretary Md. Humayun Kabir.

The recent study shows that 64 percent new born children across the country are provided with exclusive breast feeding, he said.

"We are working to make mothers and other family member aware so that all the children can get exclusive breast feeding up to the age of six months," he said.

The government is operating National Nutrition Services (NNS) programme across the country. Under this programme it is trying to make the practice more popular.

"We also provide awareness materials through our field level health workers," said Humayun.

Talking about maternal anemia, he termed it a severe problem as an anemic woman gives birth to an anemic child, he said.

"As the main reason of anemia is malnutrition and iron deficiency, we should lay emphasis on reducing the rate of malnutrition. We are trying to address the issue through our NNS programme," said the health secretary.

The government is providing Iron Folic Acid (IFA) tablets through local level healthcare centres to address the problem, he said.

"But those women, who are not aware of the necessity of IFA tablets or remain out of our network, cannot receive the tablets. But we want to cover all the women," he said.

About complementary feeding, he said this issue is getting priority in the National Nutrition Service.

"We are disseminating suggestions and guidelines of complementary feeding to the people through our Infant and Young Child Feeding (IYCF) programme at different government hospitals at district level," he said.

Appropriate IYCF practice is a key area to improve better child survival, growth and development, he said.

About handwashing practice with soap at different key moments in a day, he said the practice can be improved though behaviour change.

"I think almost all the families, even the extreme poor families, can afford a soap whether it is costly or less-costly. But the practice completely depends on behaviour change," he said.

However, Humayun Kabir admitted that currently there is no effective mass awareness campaign to promote the hand washing practice in Bangladesh.

"But we are trying to disseminate message through different health related programmes and health education," he said.

He also stressed the need for collaboration between the government's agencies and NGOs to improve the country's overall health sector.

'Nothing can substitute breast milk'

Prof Soofia Khatoon, Secretary, Bangladesh Breastfeeding Foundation and Head of Paediatrics Department, Shaheed Suhrawardy Medical College and Hospital, talks to The Daily Star

NO formula can substitute breast milk for a newborn's survival and well being, says Prof Soofia Khatoon, Secretary of Bangladesh Breastfeeding Foundation.

It provides nourishment to the babies, reinforces their body's ability to fight infection, enhances their aptitude skill and makes it more likely to decrease health complications when they grow up, she said.

“The importance of breastfeeding for children cannot be stressed enough,” said Prof Khatoon, who is also the Head of the Paediatrics Department of Dhaka's Shaheed Suhrawardy Medical College and Hospital.

It is recommended that the diet of a newborn should exclusively comprise breast milk for the first six months, she said adding that whether the mother keeps to the recommendation or not would have both short term and long term consequences.

However, only 64 percent of mothers exclusively breastfeed their babies for the first six months in Bangladesh, said Prof Khatoon quoting the Bangladesh Demographics and Health Survey-2011 (BDHS).

A major reason for the low percentage is attractively marketed alternatives to breast-milk.

“This is alarming,” she said, “there are so much advertisement and promotion for artificial milk for babies”.

What is more alarming is the fact that many well-known consumer companies are promoting these products a practice that is completely illegal under the Breast-milk Substitutes (Regulation of Marketing) Ordinance of 1984, she added.

Increasing number of working mothers is another reason. But the fact that the government has decided to give six months of maternity leave to mothers was a big step towards solving that problem.

However, some mothers usually spend the maternity leave by going to vacations instead of taking care of their babies, she observed.

Also, the private sector should come forward and offer paid maternity leave to mothers like the government, she said, adding that the Prime Minister herself has urged the private sector to do it.

After six months of exclusive breastfeeding, children should be given complementary foods to add more nutrients to their diets.

“Many mothers are seen giving 'shuji' to their babies. What the mothers usually do is add the shuji to water and feed that, which is not right,” added Dr Khatoon.

Lentil, sugar and oil should be added to the shuji before it is given to the children, she said stressing on the need to give homemade food rather than consumer foods.

“Oil is very important, as it provides them with necessary calories and fat,” she said. “However, breastfeeding should go on along with the complementary feeding.”

It is called “complementary feeding” because it is supposed to complement breastfeeding, she added.

Hygiene is very important for children, she said adding that hands should be washed and foods served to the babies should be fresh to avoid infection.

Many doctors suggest that mothers suffering from physical illness such as Typhoid, TB or other diseases should not breastfeed their babies, which is a blatantly wrong advice, said Prof Khatoon.

Even while suffering from sickness, mothers can breastfeed their babies without consequences, she added.

Breastfeeding is not healthy for just the babies, she said. “Breastfeeding cuts chances of breast cancer. Every year of breastfeeding reduces chances of breast cancer by 4.3 percent. It can save lives of many mothers.”

Immunity and Nutrition

Let's make habit of hand washing mandatory

Pankaj Karmakar

DESPITE massive campaign, hand washing with soap at five critical times a day is staying far behind from reaching its expected level as the people especially in rural areas do not continue the practice regularly.

At present, only 0.6 percent people wash hands with soap before preparing food, 3.9 percent before serving food, 1.9 percent before eating, 1.0 percent after eating, 1.8 percent before feeding a child, 24 percent after cleaning child anus, 24 percent after defecation, 6.5 percent after returning home and 31 percent after cleaning or handling cow dung.

A study by the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) that was published in May last year showed the statistics.

The five key moments for hand washing in a day are -- after defecation, after handling child faeces or cleaning a child who has defecated, before preparing food, before feeding a child and before taking food.

In rural lifestyle, people both male and female have to contribute to their family's income-generating activities through dealing with domestic animals, cow dung and other sorts of garbage.

They need to wash their hands with soap at least 10 to 15 times a day to protect themselves and their children from germs and to keep a sound family health.

The times include before serving food, after eating, after returning home, after cleaning cow dung or other garbage and outside compound, say experts.

Some study found that it is difficult to afford a soap for a extreme poor family, while low-income people use soap miserly to preserve money for food and other essentials.

"It costs Tk 20 to Tk 25 to buy a soap. I along with my family members use soap while taking bath only," said Abul Kashem, a rickshaw puller of the city's Shahbagh area.

Hand washing practice is closely related with different childhood diseases especially diarrhoea. Several study findings prove that hand washing practice is particularly important for improving child health.

Unsafe water, poor sanitation and unhygienic living conditions claim many lives each year an estimated 1.2 million children die from diarrhoea alone across the world, said a Unicef report.

Among many factors, feeding children in unhygienic way is one of the major contributors to malnutrition in infancy and causes diarrhoea and other diseases, said health experts.

  A young girl child washes her hands using a hand-washing device outside a sanitary latrine in Kondarpar village in Kamarganj Union of Gaibandha Sadar.

Around half of the children and one-third of the women of the country suffer from malnutrition, said a paper that was personated in a seminar titled "Food and Nutrition Security in Bangladesh," jointly organised by USAID and ICDDR,B in an auditorium of ICDDR,B on October 25 last year.

Along with unhygienic feeding process, inappropriate feeding practices have been identified as major causes of malnutrition in young children in developing countries including Bangladesh.

Complementary feeding means that children should be provided extra food along with breast feeding. This practice should start from month six of a child's age and continue up to the age of 24 months.

Dr Tahmeed Ahmed, Director, Centre for Nutrition and Food Security, ICDDR,B, said only 21 percent children in Bangladesh take proper complementary food.

Poverty and lack of knowledge are the main reasons for not providing adequate complementary food to children, said Dr. Tahmeed.

Varieties in food items like vegetable, animal protein should be given to children at least three to four times in a day, he added.

Due to poverty, only 20 percent of children can take egg, 12 percent can eat meat and 40 percent gets fish daily, he said, adding, "We need to promote animal source of protein to meet the optimum level of protein for children."

Dr. Tahmeed also recommended setting up an industry at the coastal area for processing the sea fish into dry fish because those contain huge amount of protein.

The dry fish full of protein should be converted into powder and distributed among the people to meet the demand of protein. This can be a significant intervention for reducing the rate of malnutrition among children, he said.

The next issue of Promoting Chid Rights will be published on June 3, 2012. Readers are welcome to send their feedback by e-mail to: shahu_madan@yahoo.com
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