The New Infant and Young Child Feeding Practices Indicator:

Measuring for Meaningful Results

Global Health Mini-U October 5, 2007

Erin Boyd

Outline

• Definition of IYCF• Rationale• Applications• Practical Exercises

What is the IYCF Indicator?

• Measures IYCF practices among children 6-23 months• Consists of 3 components:

1. Continued breastfeeding or feeding of milk or milk products

1. Fed (solid/semi-solid foods) minimum number of times per day according to age and breastfeeding status

1. Fed the minimum number of food groups per day according to breastfeeding status

The 3 Components of the IYCF Indicator

Components Breastfeeding status

Breastfed Non-Breastfed

1. Breastfed or fed milk or milk products, 6-23 m

Continued breastfeeding (A) Fed milk or milk products (B)

2. Fed (solid/semi-solid foods) min number of times per day

6-8 m

9-23 mTwo

Three (C)

Four

Four (D)

3. Fed min number of food groups per day

6-23 m Three (E) Four (F)

Rationale for the IYCF Indicator

Growth Faltering by Age

-2

-1.75

-1.5

-1.25

-1

-0.75

-0.5

-0.25

0

0.25

0.5

0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60

Age (months)

Weig

ht

for

ag

e Z

-sco

re

Africa Latin America and Caribbean AsiaSource: Shrimpton et al. 2001

WHO/PAHO Issue Guiding Principles for Infant and Young Child Feeding Practices

Breastfed Child Non Breastfed Child

Introduce complementary foods at 6 m with continued breastfeeding; Exclusive breastfeeding from birth to 6 m

Not Applicable

Continue BF frequently and on-demand until 24+ months

Not Applicable

Not Applicable Fluid needs.-400-600 ml/day of add’l fluids in a temperate climate; - 800-1200 ml/day of add’l fluids in a hot climate.

Guiding Principles for Feeding Breastfed and Non- Breastfed Children, 6-23 months (1)

Guiding Principles for Feeding Breastfed and Non- Breastfed Children, 6-23 months (2)

Breastfed Child Non-Breastfed Child

Practice Responsive Feeding Practice Responsive Feeding

Safely prepare and store CF Safely prepare and store CF

Start with small amounts of food at 6 m. Increase quantity of food as child gets older

Provide adequate amounts of food. Increase quantity as child gets older.

Increase food consistency and variety as infant gets older

Increase food consistency and variety as infant gets older

Guiding Principles for Feeding Breastfed and Non- Breastfed Children, 6-23 months (3)

Breastfed Child Non-breastfed Child

Frequency of Feeding: Min # “meals”/day CF =

- 2-3 for children 6-8 m

- 3-4 for children 9-23 m

Frequency of Feeding:Min # “meals”/day =

- 4-5 for children 6-8 m

- 4-5 for children 9-23 m

Nutrient Content of Foods: Feed a variety-meat, poultry, fish or eggs daily-Vitamin A rich fruits and vegetables daily

Nutrient Content of Foods: Feed a variety-meat, poultry, fish or eggs-Vitamin A rich fruits and vegetables-Milk and milk products from acceptable sources

Breastfed Child Non-Breastfed Child

Use vitamin-mineral supplements or fortified complementary foods as needed

Use vitamin-mineral supplements or fortified products as needed

During illness: Increase fluid intake, incl. breastmilk. Encourage child to eat. After illness: increase amount and frequency of feeding

During illness: Increase fluid intake. Encourage child to eat. After illness: increase amount and frequency of feeding

Guiding Principles for Feeding Breastfed and Non- Breastfed Children, 6-23 months (4)

Traditional Indicators

• Breastfeeding initiation• Exclusive breastfeeding rate• Complementary feeding rate, 6-9 m• Continued breastfeeding• Median duration of breastfeeding

Advantages of the new IYCF indicator:

• Operationalizes three components of WHO guiding principles for breastfed and non- breastfed children, 6-23 m

• Updated questionnaire and tabulation plan reflects expert recommendation for collecting data on 24h dietary recall, and assessment of exclusive breastfeeding

• Harmonized with the current DHS tabulation plan

• Tells us useful information for programs

IYCF Data collection

• Collected in any type of household surveys (DHS, KPC) using standard sampling methodologies (30 cluster, etc.)

• Advocating to include in MICS (UN)• Mothers of children between 6-23 months are asked

a series of questions to assess IYCF practices consisting of 3 components

• NGOs, UN agencies, CAs, NGOs, etc.

Breastfeeding Status

• Continued breastfeeding• Are you still breastfeeding• For how many months did you breastfeed the child• Did the child drink anything with a nipple yesterday or last night• Did the child drink/eat• Breast milk, plain water, commercially produced infant formula,

fortified commercially available infant and young child food• Porridge or gruel

Number of feedings

• How many times did the child eat solid, semi-solid or soft foods other than liquids yesterday during the day or at night?

Number of food groups:

1. Milk other than breastmilk, cheese or yogurt, infant formula2. Foods made from grains, roots, and tubers, including porridge,

fortified baby food from grains3. Vitamin A rich fruits and vegetables (and red palm oil)4. Other fruits and vegetables5. Eggs6. Meat, poultry, fish, shellfish (and organ meats)7. Legumes and nuts8. Foods made with oil, fat, butter

What NEW Indicators for IYCF can be operationalized from the GP?

IYCF Practice Proxy Measure

1. Energy Intake Frequency of Feeding

2. Dietary Quality Food Group Diversity

Frequency of Feeding Indicator, 6-23 m

Indicator: % of children 6-23 m who ate solid or semi-solid foods at least the minimum number of times in the 24 hours preceding the survey, according to age and BF status

Note: Indicator can also be disaggregated by age, or BF status, when there are sufficient sample sizes

Dietary Diversity Indicator, 6-23 m

Indicator: % of children 6-23 m who received minimum dietary (food group) diversity in 24 hours preceding the survey, according to BF status

Note: Indicator can also be disaggregated by age, or BF status, when there are sufficient sample sizes

Current Status of IYCF Indicator:

• 1998-2004- Retrospective analysis of 43 countries • Since 2005 the DHS included IYCF• Will continue to include with possible further

refinements

Practical Exercise

• Any mothers of children 6-23 months?• Groups of 3 maximum (mothers as respondents)

24

KPC Module 2: Breastfeeding and Infant and Young Child Feeding. June 2006. http://www.childsurvival.com/kpc-2000/mod2_06_28_06.doc

PAHO/WHO. Guiding Principles for Complementary Feeding of the Breastfed Child. Washington, DC/Geneva, Switzerland: PAHO/WHO, 2003. http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/guiding_principles.pdf

WHO. Guiding Principles for Feeding Non-breastfed Children 6 to 24 Months of Age. Geneva, Switzerland: WHO, 2005. http://www.who.int/child-adolescent-health/New_Publications/NUTRITION/ISBN_92_4_159343_1.pdf

Mukuria, Kothari, Abderrahim. Infant and Young Child Feeding Update. Calverton, MD: ORC Macro, September 2006.

References

References and Acknowledgements

• Kristen Cashin, Alison Tumilowicz from FANTA, www.fantaproject.org, provided this presentation and practical exercise for adaptation for the Mini-U.

• Eunyong Chung, Frances Davidson and Emily Wainwright from USAID/HIDN/NUT provided useful feedback and questions.