BREASTFEEDING KEY TO SAVING CHILDREN’S LIVES
Ten steps to successful breastfeeding highlighted during World Breastfeeding Week
During World Breastfeeding Week, celebrated from 1 to 7 August in more than 170 countries, the World Health Organization (WHO) reiterates its call on health facilities and health workers to implement ten steps to help mothers breastfeed successfully and improve their babies’ health and chances of survival.
Breast milk is the ideal food for newborns and infants. It is safe, gives babies the nutrients they need for healthy development and contains antibodies that help protect infants from common childhood illnesses. While exclusive breastfeeding for the first six months of life is on the rise in many countries, further improvement of breastfeeding rates is critical to improve the nutrition and the health of infants and children. For a variety of reasons, including the lack of breastfeeding counselling, still too many mothers stop exclusive breastfeeding within a few weeks after delivery.
“It is estimated that around 35% of infants aged 0 to 6 months are exclusively breastfed in the world today,” says Dr Elizabeth Mason, Director of WHO’s Department of Child and Adolescent Health and Development. “But if all babies and young children were breastfed exclusively for their first six months of life and then given nutritious complementary food with continued breastfeeding up to two years of age, the lives of an additional 1.5 million children under five would be saved every year.”
The “Ten Steps to Successful Breastfeeding” were developed by WHO and UNICEF to ensure maternity services are providing the right start for every infant and the necessary support for mothers to breastfeed. Today this check-list is used by hospitals in more than 150 countries.
The Ten Steps for health facilities to take towards ensuring successful breastfeeding are as follows:
- Have a written breastfeeding policy that is routinely communicated to all health care staff.
- Train all health care staff in the skills necessary to implement this policy.
- Inform all pregnant women about the benefits and management of breastfeeding.
- Help mothers initiate breastfeeding within half an hour of birth.
- Show mothers how to breastfeed and how to maintain lactation even if they should be separated from their infants.
- Give newborn infants no food or drink other than breast milk unless medically indicated.
- Practise “rooming in” – allowing mothers and infants to remain together – 24 hours a day.
- Encourage breastfeeding on demand – whenever the baby is hungry.
- Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
- Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.
Malnutrition is responsible for one-third of the 8.8 million deaths annually among children under five. It can be a direct cause of death but is also the most important single risk factor for disease in young children. Over two thirds of these deaths, which are often associated with inappropriate feeding practices such as bottle-feeding or untimely and inadequate complementary foods, occur during the first months of life.
“Increasing breastfeeding rates is a key component of the plan to improve infant and young child nutrition,” says Randa Saadeh, Coordinator of the Nutrition in the Life Course unit at WHO. “A renewed effort to make more hospitals ‘baby friendly’ has the potential to give millions more babies a healthy start in life.”
================
MORE THAN FIVE MILLION PEOPLE RECEIVING HIV TREATMENT
World Health Organization advises earlier treatment among people with HIV
An estimated 5.2 million people were receiving life-saving HIV treatment at the end of 2009, according to the latest update from the World Health Organization (WHO).
WHO estimates that 1.2 million people started treatment in 2009, bringing the total number of people receiving treatment to 5.2 million, compared to 4 million at the end of 2008.
“This is the largest increase in people accessing treatment in a single year. It is an extremely encouraging development,” says Dr Hiroki Nakatani, WHO Assistant Director-General for HIV, Tuberculosis, Malaria and Neglected Tropical Diseases.
At the XVIII International AIDS Conference, WHO is calling for earlier treatment for people with HIV. The objective is to begin HIV treatment before they become ill because of weakened immunity.
“Starting treatment earlier gives us an opportunity to enable people living with HIV to stay healthier and live longer,” says Dr Gottfried Hirnschall, WHO Director of HIV/AIDS.
Estimates developed through epidemiological modeling suggest that HIV-related mortality can be reduced by 20% between 2010 and 2015 if these guidelines for early treatment are broadly implemented.
Earlier treatment can prevent opportunistic infections including tuberculosis (TB), the number one killer of people with HIV. Deaths from TB can be reduced by as much as 90%, if people with both HIV and TB start treatment earlier.
The strength of a person’s immune system is measured by CD4 cells. A healthy person has a CD4 count of 1000 – 1500 cells/mm3. WHO previously recommended starting HIV treatment when a person’s CD4 count drops below 200 cells/mm3 but now advises starting HIV treatment at 350 cells/mm3 or below.
“In addition to saving lives, earlier treatment also has prevention benefits,” Dr Hirnschall says. “Because treatment reduces the level of virus in the body, it means HIV-positive people are less likely to pass the virus on to their partners.”
WHO’s treatment guidelines expand the number of people recommended for HIV treatment from an estimated 10 million to an estimated 15 million. The cost needed for HIV treatment in 2010 will be about US$ 9 billion, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).
“The investments we make today can not only save millions of lives but millions of dollars tomorrow,” said Dr Bernhard Schwartlander, Director, Evidence, Strategy and Results, UNAIDS. “People with weaker immune systems who come late for treatment require more complex and costly drugs and services than those who start treatment earlier and are healthier.”
Since 2003 – which marked the launch of the historic “3 by 5” initiative to provide access to HIV treatment to 3 million people living in low- and middle-income countries by the end of 2005 – the number of people receiving HIV treatment has increased 12-fold.
================
WHO RESPONDS TO HEALTH NEEDS IN PAKISTAN FLOODS
The worst floods on record in Pakistan are placing the health of hundreds of thousands of people at risk, with a high threat of water-borne disease outbreaks and immense damage to health facilities. The World Health Organization (WHO) is coordinating the response of health partners and supporting Pakistani authorities by sending medicines and related health supplies capable of treating more than 200,000 people to the affected areas in the northwestern region of the country.
Major health concerns at the moment are the control of water-borne diseases, including diarrhoeal diseases and respiratory infections, treating the injured, helping to ensure the quality of clean drinking water and ensuring public access to health facilities with the emphasis on increasing the number of female health workers.
About 46 of Pakistan’s 135 districts have been affected by the flooding. At least 39 health facilities have been destroyed, resulting in a loss of tons of medicines. There is a tremendous need for more medical and related materials to treat people affected by the humanitarian emergency, as well as to immunize children, particularly against polio and measles.
Static and mobile medical teams are providing outreach services to affected areas especially with maternal, neonatal and child health, nutrition and psychosocial support. By the end of 2 August, dozens of mobile teams and fixed health facilities had treated more than 15,000 patients, many of whom were suffering from diarrhoea.
WHO is working with the Pakistani Ministry of Health, National Disaster Management Authority, Provincial Departments of Health as well as partner healthcare providers within the Health Cluster network of international and local organizations. A disease outbreak early warning system is active and, as yet, no outbreaks of diseases have been confirmed, however concern of the disease outbreaks remains high.
WHO has sent large shipments of medicines and supplies to treat people for diarrhoea, respiratory infections, wounds, and other health conditions. To ensure people have access to clean, safe supplies of drinking water, WHO has also provided 102,000 aqua tablets and 4600 water purifying sachets to health facilities in Peshawar and Nowshera.
But the scale of the emergency means more medical supplies will be needed. Other urgent needs identified by an initial assessment conducted by UN agencies include:
- Providing psychosocial support to the affected population;
- Hygiene promotion interventions – providing water purification tablets, safe water, water chlorination;
- Tents for temporary health facilities;
- Strengthening the referral system to higher levels of health care;
- Vaccination campaigns.
================
NEW WHO GUIDANCE TO IMPROVE USE OF MEDICINES FOR CHILDREN
The first ever WHO Model Formulary for Children released by the World Health Organization (WHO) provides information on how to use over 240 essential medicines for treating illness and disease in children from 0 to 12 years of age. This means that for the first time medical practitioners worldwide have access to standardized information on the recommended use, dosage, adverse effects, and contraindications of these medicines for use in children. A number of individual countries have developed their own formularies over the years, but until now there was no single comprehensive guide to using medicines in children for all countries.
“To be effective, medicines must be carefully chosen and the dose adjusted to suit the age, weight and needs of children,” said Dr Hans Hogerzeil, Director of Essential medicines and pharmaceutical policies at WHO . “Without a global guide, many health-care professionals have had to prescribe medicines based on very limited evidence.”
The new Formulary is based on the best global evidence available as to which medicines should be used to treat specific conditions, how they should be administered and in what dose. Accurate dosing of medicines for use in children is essential, particularly those between 0-12 months. A dosing error in a child this small can have devastating results.
The Formulary will help health-care providers prescribe the right medicine, in the right formulation and the right dose. It also highlights what precautions to take, what adverse reactions may need to be monitored, and what kind of interactions may occur if the patient is taking other medications. For example, the Formulary indicates that ibuprofen, which is frequently given to children to treat pain, can have negative interactions when taken with any one of twenty-one listed medicines. It is also important to give this medicine with or after food.
In the case of medicines to treat malaria or HIV, the Formulary highlights the need for better fixed dose combinations – several medicines in one pill – for effective and safe treatment in children. Currently very few fixed dose combinations exist for children; just one anti-malarial and two antiretrovirals to treat children with HIV.
In developing the Formulary a number of areas were identified where more research is needed to provide better treatment for children, such as child appropriate antibiotics to treat pneumonia and specific medicines for neonatal care.
Each year 8.8 million children under five die (2008 data). Many of these deaths are caused by diseases which could be avoided with the use of safe essential medicines formulated appropriately for children. These include diarrhoea and pneumonia as well as conditions such as severe bacterial infections in newborns.