National training on IFE in Sri Lanka

By Moazeem Hossain

Dr. Moazzem Hossain is the Chief of the Health and Nutrition Section of UNICEF Sri Lanka, and Nutrition Cluster Coordinator in Sri Lanka.

The author would like to acknowledge the contribution of the delegates (Drs Renuka, Sudharshini and Lalith) for facilitating the workshop and Ms. Chayatri for notes taking and compilation.

This piece summarises an IFE training led by country delegates as an action arising from the regional IFE workshop held in Bali 10-13th March 2008.

The National Workshop on Infant Feeding in Emergencies (IFE) was held on the 16th and 17th of June 2008 in Colombo, under the auspices of the Nutrition Cluster in Sri Lanka in collaboration with the Family Health Bureau (FHB). The two day workshop consisted of a series of presentations, each with questions and answers opportunities and panel discussions. The workshop focused on developing an understanding of the importance of IFE. The specific objectives were to understand why IFE is important in emergencies, appreciate the advantages of breastfeeding and the risks of artificial feeding and how best to protect and support safe and appropriate IFE.

The workshop was attended by 35 participants from United Nations (UN) agencies, project coordinators from international non-governmental organisations (NGOs), District Medical Officers and Medical officers from the Maternal and Child Health (MCH) Unit.

The workshop started with a welcome address from the Director of MCH, the FHB and UNICEF. The first day consisted of four presentations and group work. Dr. SM Hossain (UNICEF Sri Lanka) opened the workshop and introduced the importance of IFE, the Operational Guidance on IFE and the International Code of Marketing of Breastmilk Substitutes. Dr. Anoma Jayatilake gave a very comprehensive account on breastfeeding and appropriate counselling skills and Dr. Renuka Jayatissa gave a brief overview on rapid assessments. After each presentation, workshop participants were given practice exercises to test their grasp of the topic just covered - all showed a good understanding.

The emphasis on the second day of the workshop was sharing the experiences of the Bali IFE workshop , presented by Dr. Renuka Jayatissa. She concluded her report by sharing the pledge for action issued by the workshop participants to promote, protect and support breastfeeding during emergencies, to prevent the inappropriate use of breast-milk substitutes and to support infant and young child feeding in general.

Dr. Lalith Chadradasa followed with a presentation on IFE media exposure in emergencies. He explained that the media can play a major role in emergencies - not only in highlighting problems but also providing an opportunity for intervention through communication. However, often the media delivers the wrong messages during emergencies, either because the media writer/source is ignorant of the issues or the receiver misunderstands the information or has misconceptions around IFE.

The final presentation of the workshop was on preventing and controlling micronutrient deficiencies in populations affected by emergencies, by Ms.Vishaka Thilakeratne. The major deficiencies include Vitamin A, Iron, Zinc and Iodine. She emphasised that in order to meet the micronutrient requirements during emergencies, foods fortified with micronutrients should be provided, e.g. corn-soya blend, biscuits, vegetable oil enriched with vitamin A, and iodised salt. It was pointed out that these foods must be appropriately fortified, taking into account that other unfortified foods will meet a share of micronutrient needs. It was also highlighted that fortified foods may not meet the requirements of pregnant women, lactating women and young children. In these cases, supplementation is warranted and UNICEF and the World Health Organisation (WHO) have developed a daily multiple micronutrient formula to meet the recommended nutrient intake (RNI).

Ms. Thilakaratne elaborated on micronutrient supplementation programmes in the context of Sri Lanka, where a supplementation programme is already in place for mothers and young children. She considered the current increase in food prices would have an impact on nutritional status and considered it timely to intervene with supplementation. She concluded by emphasising that supplementation should not be a long term intervention strategy.

The participants then broke up into groups and were asked to consider two scenarios: Aftermath of the Pakistan earthquake and Refugees in Tanzania. The four groups were tasked to select the criteria they would use to identify best practices and then select best practice interventions.

The final item of the workshop was the drafting of a national policy on IFE (modelled on a process used at the Bali workshop to generate a Joint Statement), which was facilitated by Drs Shudharshini Fernandopulle and S.M Hossain. Inputs were received from participants and it was agreed that during emergencies, the key areas to concentrate on are to protect, promote and support breastfeeding, to prevent donations of breastmilk substitutes and powdered milks, to ensure availability of age appropriate complementary foods and supplements and in only exceptional circumstances, support replacement/ artificial feeding. Following the workshop, the national policy directive to Support and Ensure Appropriate and Adequate Infant Feeding during Emergencies was finalised and is pending approval by the Director General of Health Services, Ministry of Health Care and Nutrition, Government of Sri Lanka. The whole workshop was facilitated and coordinated by Dr. Sudharshini Fernandopulle from MoH FHB, who attended the regional IFE workshop in Bali to represent the Government of Sri Lanka.

For more information, including copies of workshop presentations and the policy directive, contact: Dr SM Hossain, UNICEF, email: smhossain@unicef.org