capacity building training for middle level trainers on ... · preventing morbidities and mortality...

Capacity Building Training for Middle Level Trainers on Infant and

Young Child Feeding (IYCF) counselling in 38 Districts of Bihar

AReportofTraining122MiddlelevelTrainers

Submitted by

Breastfeeding Promotion Network of India (BPNI) BP-33, Pitampura, Delhi-110034 Email: [email protected] Website: www.bpni.org

Contents

1. Introduction

2. BPNI’s Training Course on Infant and Young Child Feeding Counselling

3. Implementing Training of MLTs in Haryana

4. Training Workshops

5. Pre-and Post- Training Assessment

6. Glimpses from training sessions at Haryana

7. Epilogue

Annexures

1. Introduction This is a report of an collaborative training programme on Infant and Young Child Feeding (IYCF) Counselling implemented in the state of Bihar, India, by the United Nations International Children’s Fund (UNICEF); Integrated Child Development Services (ICDS) and Breastfeeding Promotion Network of India (BPNI). The programme included training of Middle Level Trainers (MLTs) for ICDS workers in all 38 districts of Bihar. A total MLTs were 122 ICDS workers were trained over a period of one and half months.

1.1 Importance of Optimal Infant and Young Child Feeding (IYCF) for Child Survival and Nutrition

This is now a documented fact that mother needs support to initiate breastfeeding with in one hour of birth and to practice exclusive breastfeeding. The reason for introducing supplements to breast milk leading to mixed feeding in Indian mothers is perceived milk insufficiency.1 Although there is a complex pattern of immediate and underlying causes for this; most instances can be prevented or treated. Various other lactation difficulties, which are preventable to a large extent, may also contribute to premature cessation of breastfeeding. Health workers must be enabled to assess these lactation difficulties and offer appropriate counseling for the community as well as for the individual mother. There is evidence to suggest that individual and group counseling is effective tool to improve duration of exclusive breastfeeding.8 In the WHO Child Growth Standards study, trained lactation counselors supported the mothers to prevent and manage breastfeeding difficulties from soon after birth and at specified times during the first year after birth. By using this strategy, good compliance to exclusive breastfeeding was achieved in all the participating countries including India.2 A Cochrane review on support for breastfeeding mothers concluded that training on infant and young child feeding, which in turn led to more qualified professional and lay support to the mothers, resulted in prolonged breastfeeding duration.3 The promotion of breastfeeding intervention trial (PROBIT) has also documented a significant improvement in the rates of exclusive breastfeeding in the intervention group, who received skilled, counseling support from the trained health workers.4 Bhandari et al (2003) conducted a cluster randomized controlled trial in Haryana, India to assess the effect of a 3 day-training programme. The training was based on the Integrated Management of Childhood Illnesses Training Manual on Breastfeeding Counseling of traditional birth attendants, social village-based workers (Anganwadi workers) and auxiliary nurse midwives. Improved rates of exclusive breastfeeding and reduction of diarrhea was documented.5 To achieve the goal of providing counseling and education in breastfeeding and complementary feeding to each lactating mother, it is mandatory that frontline workers like ASHA & ANM workers should be empowered using a standard training course in knowledge

1 Oommen A, Vatsa M, Paul VK, Aggarwal R.. Breastfeeding Practices of Urban and Rural Mothers.Ind Pediatr 2009;46:891-894. 2 WHO Multicentre Growth Reference Study Group. Breastfeeding in the WHO Multicentre Growth Reference Study. Acta Pædiatrica 2006; Suppl 450:161-26. 3 Britton C, McCormick FM, Renfrew MJ, Wade A, King SE. Support for breastfeeding mothers. Cochrane Database Syst Rev. 2007 Jan 24;(1):CD001141. 4 Kramer MS, Chalmers B, Hodnett ED, Sevkovskaya Z, Dzikovich I, Shapiro S et al. PROBIT Study Group (Promotion of Breastfeeding Intervention Trial). Promotion of Breastfeeding Intervention Trial (PROBIT): a randomized trial in the Republic of Belarus. JAMA. 2001 Jan 24-31;285(4):413-20. 5 Bhandari N, Bahl R, Mazumdar S, Martines J, Black RE, Bhan MK(Infant Feeding Study Group). Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomized controlled trial. Lancet 2003; 361(9367): 1418-1423.

and skills in IYCF which is imparted by trained personnel. The trained ASHA & ANM workers will be capable of providing counseling to the families using simple pictorial communication guide through facility meetings, home visits, group meetings etc.

1.2 UNICEF & ICDS

UNICEF supports the Government in its objectives to reduce and prevent malnutrition, and to improve the development of children under three-years-old. UNICEF is assisting the government to further expand and enhance the quality of ICDS in various ways: by improving the training of anganwadi workers; by developing innovative communication approaches with mothers; helping to improve monitoring and reporting systems; providing essential supplies; by developing community based early childcare Interventions.

Integrated Child Development Services (ICDS) in India is the world’s largest integrated early childhood programme, with over 40,000 centres nationwide. The purpose of ICDS is to improve the health, nutrition and development of children. The programme has matured and expanded, despite difficulties in adapting to the vastly different local circumstances found on the Indian subcontinent. UNICEF helped launch the ICDS program and continues to provide financial and technical assistance along with the World Bank.

1.3 Relevance of Breastfeeding and Optimal Infant and Young Child Feeding (IYCF) for Child Survival and Nutrition

The Global Strategy for Infant and Young Child Feeding as well as the National guidelines on infant and young child feeding in India recommend early initiation of breastfeeding within one hour and exclusive breastfeeding for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. 6, 7

The Global Strategy for Infant and Young Child Feeding also states that “Even though it is a natural act, breastfeeding is also a learned behaviour. Virtually all mothers can breastfeed provided they have accurate information, and support within their families and communities and from the health care system. They should also have access to skilled practical help from, for example, trained health workers, lay and peer counsellors, and certified lactation consultants, who can help to build mothers’ confidence, improve feeding technique, and prevent or resolve breastfeeding problems.”

Scientific evidence is available to establish breastfeeding and optimal IYCF practices as an effective tool to improve child health prevent malnutrition and reduce neonatal, infant and child mortality. Initiation of breastfeeding within an hour of birth is known to reduce infection specific neonatal mortality, and this impact is independent of the effect of exclusive breastfeeding during the first month of life. 8 Sub-optimal breastfeeding is estimated to be responsible for 1.4 million child deaths and 43.5 million Disability Adjusted Life Years (DALYs), with non-exclusive breastfeeding during 0-6 months accounting for 77 percent (1.06 million) of the deaths and 85 percent of the DALYs. Partial breastfeeding (breast milk

6 WHO. Global Strategy on Infant and Young Child Feeding, 2003. World Health Organization, Geneva. 7 Ministry of Women and Child Development, Food and Nutrition Board, Government of India. National guidelines on Infant and Young

Child Feeding, Second Edition, 2006.

8 Edmond KM, Kirkwood BR, Amenga-Etego S, Owusu-Agyei S, Hurt LS. Effect of early infant feeding practices on infection-specific neonatal mortality: an investigation of the causal links with observational data from rural Ghana. Am J Clin Nutr 2007; 86: 1126-1131.

plus other milks or foods) increases child mortality by 2.8 times as compared to exclusive breastfeeding.9 A systematic review of effective interventions for improving child survival concluded that for three major causes of child morbidity and mortality i.e. neonatal sepsis, diarrhoea and pneumonia, universalization of breastfeeding (exclusive breastfeeding for the first six months and continued breastfeeding for second six months) is a highly effective preventive intervention which could prevent 13% of all child deaths. An additional 6% death can be prevented with appropriate complementary feeding. 10 It is well documented that optimal breastfeeding reduces the risk of infectious diseases like diarrohea and pneumonia sub.11,12Optimal complementary feeding could substantially reduce stunting and related burden of disease.13 Breastfeeding may also enhance effect of some vaccine.14 In addition to preventing morbidities and mortality in children, breastfeeding also have long term effects on health and have a protective role in hypertension, diabetes type II, obesity and hypercholesterolemia.15

1.4 Status of IYCF practices in India and Bihar

India has dismal rates of infant feeding practices and these are not rising satisfactorily.

National rates for initiation of breastfeeding within one hour of birth are 24.5 percent;

exclusive breastfeeding for the first six months of life is only 46.4 percent and Introduction

of complementary feeding along with continued breastfeeding between 6‐9 months is 55.8

percent. For Bihar initiation of breastfeeding within one hour is 4 percent, exclusive

breastfeeding for first six months of life is 27.9 percent and introduction of complementary

feeding along with continued breastfeeding between 6‐9 months is 57.3 percent.16

9 Black RE, Allen LH, Bhutta ZA, et al. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 2008; 371: 243-260. 10 Jones G, Steketee RW, Black RE, Bhutta ZA, Morris S S, and the Bellagio Child Survival Study Group. How many child deaths can we

prevent this year? Lancet 2003; 362: 65‐71.

11 WHO. Diarroheal disease. Fact sheet no. 330, August 2009. Available at:

http://www.who.int/mediacentre/factsheets/fs330/en/index.html Accessed 20th February 2012.

12 Rudan I, Boschi‐Pinto C, Biloglav Z, Mulholland K, Campbell H. Epidemiology and etiology of childhood pneumonia. Bulletin of the World

Health Organization 2008; 86(5):408‐16.

13 Bhutta ZA et al. What works? Interventions for maternal and child undernutrition and survival. Lancet 2008; 371(9610):417 – 440. 14 Jackson KM. Breastfeeding, the Immune Response, and Long-term Health. JAOA 2006; 106 (4 ): 203-207. 15 Horta BL, Bahl R, Martines JC, Victora CG (Eds.). Evidence on the long-term effects of breastfeeding: systematic reviews and meta-analysis. World Health Organization, Geneva, 2007. 16International Institute for Population Sciences. National Family Health Survey - 3. Available at: http://www.nfhsindia.org/NFHS-3%20Data/VOL-1/Chapter%2010%20-%20Nutrition%20and%20Anaemia%20%28608K%29.pdf. Accessed on 8th August, 2012.

Table No.1: Two Key Indicators of IYCF Practices in Districts of Bihar (source DLHS ‐ 3)

S.No. Districts Children breastfed within one hour of birth(%)

Children (age 6 months above) exclusively breastfed (%)

1 Vaishali 35.5 36.4 2 Muzaffarpur 15.2 5.2 3 Sheohar 7.3 24.4 4 Sitamarhi 11.5 21.6 5 Champaran (E) 7.1 5.3 6 Champaran (W) 8.8 6.9 7 Madhubani 9.6 4.9 8 Gopalganj 12.4 1.3 9 Lakhisarai 13.8 19.3 10 Saran 17.1 14.6 11 Siwan 13.8 2.8 12 Samastipur 12.4 5.6 13 Darhbhanga 16.8 3.5 14 Begusarai 9.9 4.2 15 Supaul 13.1 7.7 16 Nalanda 31.7 20.7 17 Khagaria 11.9 6.2 18 Madhepura 10.6 26.7 19 Saharsa 15.8 31 20 Araria 20.2 2.7 21 Kishanganj 12.2 8.7 22 Kaithar 14.1 14.8 23 Purnia 11.4 11.5 24 Bhagalpur 23.1 36.1 25 Banka 16.7 5.1 26 Munger 21.9 14.2 27 Sheikhpura 10.4 12.5 28 Nawada 10.9 12.9 29 Kaimur 30.6 14.0 30 Jamui 16.0 25.0 31 Rohtas 16.2 17.6 32 Aurangabad 14.0 25.1 33 Gaya 22.2 7.3 35 Jehanabad 21.4 10.9 36 Buxar 22.7 16.3 37 Bhojpur 20.9 35.3 38 Patna 18.9 15.5 Bihar 4 27.9

Source: District Level Household and facility Survey 3, 2007-08. Ministry of health and family welfare, Government of India. Available at http:// www.rchiips.org/pdf/report/bh.pdf), accessed on march 3rd,2014.

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Chapter 2 - BPNI’s Training Course on Infant and Young Child Feeding Counselling

2.1 The Breastfeeding Promotion Network of India (BPNI) conducts training of trainers (Middle

Level trainer – MLTs) of the health functionaries at state and district level. The skill training of

trainers and frontline workers is accomplish using the training package titled “Infant and Young

Child Feeding Counselling : A Training Course, (Integrated Breastfeeding, Complementary feeding,

Infant feeding & HIV Counselling and Growth Monitoring)- The 4 in 1Course”. This course is a

comprehensive and integrated course developed by BPNI along with its partners. This course is

based on WHO / UNICEF Training Courses – “Breastfeeding Counselling – A Training Course”,

“HIV and Infant Feeding Counselling – A Training Course” and “Complementary Feeding

Counselling – A Training Course”. The course for the frontline workers has been field tested by

National Institute of Public Cooperation and Child Development (NIPCCD), Government of India.

The course has also been endorsed by the Indian Academy of Paediatrics (IAP), Indian Medical

Association (IMA) and Indian Academy of Preventive and social Medicine (IAPSM).

2.2 Course Material of Infant and Young Child Feeding Counseling Training

BPNI has developed training material for training programmes for middle level trainers and frontline workers.

2.2.1. The Trainer’s Guide for Middle Level Trainers

The Trainer’s Guide is a comprehensive manual with a total of 27 sessions

covering topics on breastfeeding, complementary feeding, HIV and Infant

feeding and Growth monitoring. It is an essential tool for the trainer, and

contains all the information needed, with detailed instructions on how to

conduct each session. It describes the teaching methods used. It also contains

practical guidelines, summary boxes, forms, lists, and checklists; and the

stories used during the course.

2.2.2. Teaching aids for Middle Level Trainers

Along with training manual, all trainers are provided with a

set of laminated flash cards spiral bound as teaching aid to

be used while teaching frontline workers.

2.2.3. Manual for Frontline Workers

This manual contains 21 sessions. Each Frontline worker is provided

with a reference manual which will help

her to counsel mothers and family

members.

Table No. 2: Training kit for Middle level trainers

S.N. Training Material Training Tool

1 Training Guide for Training MLT Doll

2 Teaching Aids Breast Model

3 Manual for Frontline Workers (Hindi) Syringe, Breast Pump

4 Counseling Guide for Frontline Workers (Flip Chart)-Hindi

Bowl, Cup

5 Breastfeeding and Complementary Feeding: A Guide for Parents (Hindi)

Measuring jar

6

CD “Maa Ka Pyaar Shishu Ahaar” Full & Quarter Plates, Spoon,

7 The Law to Protect Promote and Support Breastfeeding

Writing Pad, Pen. Pencil, Eraser, Sharpener

Table No. 3: Training kit for Frontline worker

S.No Content

1 Manual for Frontline Workers (Hindi)

2 Counseling Guide for Frontline Workers (Flip Chart)-(Hindi)

3 Breastfeeding and Complementary Feeding: A Guide for Parents (Hindi)

3. Implementing Training of MLTs in Bihar ICDS Bihar & BPNI Delhi jointly implemented the training programme for MLTs (ICDS workers like -AWW, LS, Training tutors, Principals etc)with an objective to enhance early and exclusive breastfeeding for the first six months and initiation of timely complementary along with importance of Growth Monitoring in 38 districts of Bihar State.

3.1. Submission and approval of project proposal for trainings

A Preliminary meeting of BPNI Team was held with , Secretary Mission director NRHM Haryana in Patna in 2012, regarding for training of MLT on IYCF Counselling Course.

The process for this activity started when BPNI got a proposal to ICDS Government of Bihar through UNICEF, for training of Middle Level Trainers on IYCF Counselling in all the districts of Bihar and got an approval through mail in 26th September 2013. (Annexure-1 ) with ICDS official letters.(Annexure-2, 3)

In reference with the proposal, BPNI send a budget to ICDS, Government of Bihar and UNICEF (Annexure-4)

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Chapter 5: Pre- and Post- Training Assessment

To assess the improvement in the knowledge of trainees, self-administered pre- and post test questionnaire were designed. The pre- and post test questionnaire aimed at capturing the change in knowledge levels and handling practical issues in IYCF counseling. Assessment findings are given in the table no. 5

Table No. 5: Pre- and Post-Intervention assessment of knowledge of MLT trainers

S.No. Correct Response

Question pertaining to N=388

Pre Test (%) Post Test (%)

1

Knowledge about optimal infant and young child feeding practices

76 (62.30) 104(85.25)

2 composition of breast milk

76 (62.30) 86(70.49)

3

benefits of breastfeeding mother

69(56.56) 99(81.15)

4 Dangers of pre lacteal feeds

67(54.92) 91(74.59)

5 Duration Of breastfeeding

85(69.67) 108(88.52)

6

Factors which enhance prolactin reflex

56(45.90) 101(82.79)

7 Functions of Oxytocin reflex

20(16.39) 69(56.56)

8 Factors which hinder Oxytocin reflex

45(36.89) 75(61.48)

9

Key for enhancing breast milk production

12(9.84) 72(59.02)

10 Sign of good attachment

27(22.13) 90(73.77)

11 Causes of sore nipples

40(32.79) 70(57.38)

12

Reliable sign of enough milk being received by baby

25(20.49) 89(72.95)

13

Questions regarding IMS (Infant milk Substitute)Act 71.3 (58.44) 84.6(69.34)

14 Appropriate age of starting complementary foods

76(62.30) 100

15 Foods rich in Vitamin A

79(64.75) 110(90.16)

16 Foods for children in disease

72(59.02) 105(86.07)

17 The Growth Chart used in NRHM/ ICDS has How many curves 76(62.30) 81(66.39)

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50(40.98) 62(50.82)

19 which indices are used for Growth Monitoring

37(30.33) 69(56.56)

20 What should happen at a routine 'well-child' Visit 91(74.59) 103(84.43)

TOTAL 1293 1938

Analysis of data showed that after training there was a significant improvement in knowledge about various facets of breastfeeding and complementary feeding and Growth monitoring among participants. Post-intervention, a high proportion of participants responded with correct answers as compared to Pre-intervention on question related with sign of good attachment (22% to 74%) , food for child in disease (59% to 86%), Key for enhancing breast milk production (9.84% to 59.02%) and functions of Oxytocin reflex (16.39% to 56.56%) etc as u see in Table No. 5.

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7: Epilogue

UNICEF Bihar, ICDS & Breastfeeding Promotion Network of India (BPNI) worked together

with an objective to enhance early and exclusive breastfeeding for the first six months in 38

districts of Bihar state through capacity building of the district level ICDS workers (Lady

Supervisors, Training tutors, Principals etc). For BPNI training team, this was a very satisfying

experience due to an enthusiastic participation by the trainees and appropriate administrative

assistance at state and district level. Trainees were also very happy to get new insight in the

subject and to acquire knowledge and skills on this important aspect of maternal and child care.

The training programme has once again established the fact that it is possible and feasible to

impart skill training with in the health system in reasonable resources. We hope, this endeavour

will help in improving infant and young child feeding practices in Bihar. This will be useful to assess

knowledge, attitude and practices of trainees in future to provide any refresher course if required.

Annexures

Annexure 1: Mail from UNICEF, Bihar to BPNI after getting proposal to ICDS, Government of Bihar.

Annexure 2: Letters from ICDS, Bihar

Annexure 3: Training plan for IYCF Training Annexure4: Schedule of Trainings Annexure 5: List of Middle Level trainers who were Trained. Annexure6: List Of BPNI National Trainers Annexure 7: Course content of Middle Level Trainers Annexure 8: Training Schedule for Training of Middle Level Trainers Annexure9: Specimen of Training Certificates. Annexure 10: Experiences of BPNI in conducting trainings in IYCF counselling Annexure 11: BPNI Training Cell.

Annexure -1

Mail from UNICEF, Bihar to BPNI after getting proposal to ICDS, Government of Bihar.

To: <[email protected]>, "Dr. J P dadhich" <[email protected]>

Cc: "Manish Kumar (BPNI)" <[email protected]>, <[email protected]>, Shivani Dar

<[email protected]>, Shivendra Pandeya <[email protected]>, Yameen Mazumder

<[email protected]>

Subject: IYCF training

Dear Dr Thakur and Dr Dadhich,

As discussed with you in the evening today, I am extremely happy to share the letter issued by ICDS

Directorate for developing Mid Level Trainers in the state of Bihar. This is a major step in pushing the IYCF

agenda in the state with ICDS department after the National Guidelines for IYCF has been released by GoI in

2013. The Directorate has asked UNICEF, BPNI and NMCH to support this initiative (Thus logo of all these along

with ICDS Directorate logo needs to incorporated in the training materials).

(See attached file: IYCF training letter from ICDS ‐ letter no.5053‐ 26‐09‐2013.pdf)(See attached file: IYCF

training letter from ICDS ‐ letter no.5053‐page 2 ‐ 26‐09‐2013.pdf)

Lets make this a huge success.

Best regards,

Dr. Alok I Ranjan Nutrition Specialist, UNICEF Office of Bihar Tel: (+91) 7766900788, Office: (+91) 612- 3984600 Skype: dralokiranjan Email: [email protected],

United Nations Children’s Fund UNICEF Office of Bihar, 8 Patliputra Colony, Patna, Bihar- 8460013 Follow us on Facebook, Twitter, YouTube and at www.unicef.org

Annexure -2

Letters from ICDS, Bihar

Annexure -3

Training plan for IYCF Training

Annexure -4

Schedule of Trainings

Month

Date

Venue of Training

No. of MLTs

October 2013

21-27 Oct.

NMCH, Hospital Patna (Maurya Hotel)

25

November 2013

17-23 Nov.

NMCH, Hospital Patna (Orange Inn Hotel)

23

November 2013

24-30 Nov.


23

December 2013

2-8 Dec.


27

December 2013

9-15 Dec.


24

Annexure -5

List of Middle Level Trainers Who Were Trained

Batch-1 Dr. Anita Sinha Dr. Kumari Arti Dr. Kusum Sharma Dr. Alka Ram Ms. Jaya Mr. Shambhoo Tiwari Mr. Uttam Kumar Ms. Bibha Rani

Ms. Kamini Ms. Bala Kumari Mr. Prakash Singh Mr. Rakesh Ms. Pranita Kumari Dr. Rakesh Kumar Dr. Mohan Kejriwal Md. Parwez Alam

Ms. Chitra Kumari Dr. Sudha Kumari Ms. Mridula Chandra Ms. Sarita Durgdung Ms. Nitu Chandra Dr. Anju giri Dr. Meera Kumari Dr. Tabbassum Ahmed Dr. Indu Kumari

Batch-2 Ms. Nitu Kumari Ms. Shweta Gautam Ms. Madhulika rani Ms. Sangeeta Kumari Ms. Anita Sinha Ms. Premsheela Kumari Ms. Anju Kumari Ms. Punam Kumar

Ms. Hina Ms. Nirmala Kumari Ms. Neera Jha Ms. Mamta Kumari Ms. Mamta Kumari Ms. Bandana Jha Ms. Anjana Kumari Ms. Pushpa Kumari

Ms. Vandana Edward

Ms. Punam Kumari

Ms. Priti Lata

Ms. Anjana Kumari

Ms. Shobhna Ghosh

Mr. Naseem Ahmed Ms. Kiran kumara Ms. Sheela Devi

Batch-3 Mr. Mahesh kumar Mr. Rakesh kumar Ms. Shagufta parveen Ms. Ishrat Parveen Ms. Kavita kumara Ms. Kalpana Kumari Ms. Kumari Pushpa Ms. Chitra Sharma

Ms. Sulekha Kumari Ms. Priyanka Kumari Ms. Sangeeta Kumari Ms. Shashi Kumari Ms. Manibala Ms. Snehlata Kumari Ms. Rizwana Parveen Ms. Guddi Kumari

Ms. Sangeeta Kumari Ms. Kumari Koma Ms. Chandrima

Chaudhary Ms. Kaushalya Kumari Ms. Saraswati pandey Ms. Nutan kumara Ms. Ramawati kumari

Batch-4 Ms. Sujata Jaiswal Ms. Raj Shree

choudhary Ms. Ruma Kumari Ms. Pushpa Mishra Ms. Radha kumara Ms. Sheela Kumari Ms. Kanchan Kumari Ms. Priya Bharti Ms. Samta Kumari

Ms. Vibha Kumari Ms. Wajda Khatoon Ms. Vibha Kumari Ms. Jyotsna Suman Ms. Raka Sahay Ms. Soni Kumari Ms. Nutan kumara Ms. Sunita Kumari Ms. Abha Kumari Ms. Ranju Verma

Ms. Gouri Kumari Ms. Manju Devi Ms. Ladli Noorjahan Ms. Chandrakala

Kumari Ms. Mitali Kumari Ms. Sangita Kumari Ms. Rashmi Ranjan Ms. Meena Kumari

Batch-5 Ms. Kriti Kotnala Ms. Renu Chaurasia Ms. Kanchan Kumari Ms. Punam Kumari Ms. Darakshan zabi Ms. Shruti Sinha Ms. Priyanka Sinha Ms. Asu Preet

Ms. Madhulika Ms. Archana Ms. Pushpa Kumari Ms. Kiran Kumari Ms. Leela Kumari Ms. Suman Kumari Ms. Veena Kumari Ms. Soni Kumari

Ms. Babita Kumari Ms. Vibha Kumari Ms. Nitu Kumari Ms. Neetu Kumari Ms. Mira Kumari Ms. Sneh lata Ms. Seema Kumari Ms. Binda Kumari

Annexure -6

List of BPNI National Trainers

S.

No.

Trainers Contact No Email

1 Dr.MMA Faridi 9868399740

Delhi

[email protected]

2 Ms Fariha Siddiqui 8860025078

Delhi

[email protected]

3 Dr. Anita Gupta 9810617023

Delhi

[email protected]

4 Mr. Manish Kumar 8860673836

Delhi

[email protected]

5 Dr. Neelam verma 9431034788 [email protected]

6 Dr. Surinder Bisht 9312006729 [email protected]

7 Dr. K.P.Kushwah 9415210282 [email protected]

Annexure -7

Infant and young child feeding counselling: A TRAINING COURSE

Course Contents of Middle Level Trainers

Introduction

Session 1 Why Optimal Infant and Young Child Feeding

Session 2 Production and intake of breast milk

Session 3 Assessing and Observing a Breastfeed

Session 4 Listening and Learning

Session 5 Building Confidence, Giving Support and Checking Understanding

Session 6 Antenatal Preparation and Establishing Community Breastfeeding Support

Session 7 Positioning Baby at the Breast

Session 8 Breast conditions

Session 9 Refusal to breastfeed and crying

Session 10 Expressing breast milk

Session 11 Not enough milk

Session 12 Breastfeeding Low Birth Weight Babies & Twins

Session 13 Complementary Feeding - Foods to Fill the Nutrient Gap

Session 14 Feeding Techniques and Strategies

Session 15 Institutionalizing Skilled Infant and Young Child Feeding Counselling

Session 16 Nutrition of Lactating Mothers and their Health and Fertility

Session 17 Breastfeeding by Working Mothers

Session 18 Breastfeeding in Special Circumstances Specially HIV & Infant Feeding

Session 19 Clinical Practice 1 Listening and learning, confidence building, giving support Assessing a breastfeed and Positioning a baby at the breast

Session 20 Clinical Practice 2 Listening and Learning, Building confidence, giving support Counselling for Complementary Feeding

Session 21 IMS Act

Session 22 Growth Monitoring and Measuring

Session 23 Growth Monitoring by Growth Charts

Session 24 Measuring Growth: Taking Action

Session 25 Clinical Practice 3: Measuring weight & length, Counselling for infant feeding

Session 26 Practice 1: Preparation of complementary feed

Session 27 Practice 2: Preparation of Replacement feed

Annexure -8

Specimen of Training Certificates

Annexure -9

Experiences of BPNI in Conducting Training In IYCF Counselling

Training on lactation management and breastfeeding and complementary feeding counselling has been a regular activity undertaken by BPNI since its inception in 1991. BPNI developed with its partners the integrated course on breastfeeding, complementary feeding and HIV and infant feeding counselling in 2003-04.A fourth component of growth monitoring was added in 2011. The integrated counselling course of BPNI has two major elements. The first is to develop “Infant and young child feeding counselling specialist” and the second is to develop “middle level trainers” and “family counsellors”. Following is the list of training programmes conducted by BPNI during last 5 years in collaboration with various state governments, medical colleges, and international agencies.

S.No. Name of the Project Supporting organization Duration of the project

1 Training of MLTs and Frontline Workers in IYCF for 38 districts of Bihar Venue: NMCH Medical College, Patna

Women & Child Development Department Bihar(ICDS), with UNICEF, Bihar

Oct. – Dec. 2013

2 International Training of Trainers on IYCF Counselling & IYCF Counselling Specialists Venue: UCMS & GTB Hospital, Delhi

BPNI, Department of Paediatrics, UCMS & GTB Hospital, Delhi

24 june- 7 july 2013

3 IYCF Counselling Specialists training Venue: Kalawati saran Hospital, Delhi

BPNI, Department of Paediatrics, Kalawati saran Hospital, Delhi

17-23 June 2013

4 Training of Middle level Trainers in IYCF. Venue: SHIFW, Panchkula

National Rural Health Mission, Haryana

March 2013

5 Training of MLTs and Frontline Workers in IYCF for Districts Punjab Venue: Civil Hospital Tarn Taran and Muktsar (PUNJAB)

Department of Health and Family Welfare, National Rural Health Mission, Government Of Punjab

Jan-Feb 2013

6 Preparation of IYCF Counselling Specialists The “4 in 1” Venue: Govt Hospital, Hindupur, AP

Women Development & Child Welfare Department, Government of Andhra Pradesh

21-27 June 2012

7 Training of Trainers on IYCF Counselling & IYCF Counselling Specialists Venue: UCMS & GTB Hospital, Delhi


14-27 May 2012

8 Training of Middle Level Trainers and Yashodas in 33 district of Rajasthan Venue: District Hospitals, Rajasthan

NRHM Rajasthan and NIPI India

Dec 2011-Mar 2012


9 Preparation of IYCF Counselling Specialists Venue: G R Medical College, Gwalior

BPNI, Department of Paediatrics G R Medical College, Gwalior

14-20 Nov 2011

10 Preparation of IYCF Counselling Specialists Venue: Govt Hospital, Hindupur, AP


10-16 Oct 2011

11 Preparation of IYCF Counselling Specialists Venue: UCMS & GTB Hospital, Delhi


26 Sep - 2 Oct 2011

12 Capacity Building of State Mentors Improving breastfeeding and other IYCF practices in Bihar Venue: Eras Medical College Lucknow, UP

Plan International (India Chapter) & Eras Medical College Lucknow, UP

26th April - 3rd May, 2011

13 Capacity Building of State Mentors Improving breastfeeding and other IYCF practices in Uttar Pradesh Venue: Eras Medical College Lucknow, UP


28th March - 4th April, 2011

14 Training of MLTs and Frontline Workers in IYCF for 8 districts of Punjab Venue: 8 District Hospitals

Department of Health & Family Welfare, National Rural Health Mission, Government of Punjab

October 2010- March 2011

15 International Outreach Course on Breastfeeding: Advocacy & Practice Course Venue: BRD Medical Colledge, Gorakhpur, UP

UCL Institute of Child Health, London, BRD Medical College, Gorakhpur & BPNI

Nov 21-Dec 4, 2010



1-7 Nov 2010; 23-29 Nov 2010; 16-22 Feb 2011



26 Nov-3 Dec 2010

18 Preparation of IYCF Counselling Specialists Venue: Govt Hospital, Hindupur, A P

BPNI, District Hospital, Hindupur

10-16 Oct 2011



23-29 August 2010

20 Training of MLTs and Frontline Workers in IYCF for districts of Firozpur and Gurdaspur Venue: District Hospital at Firozpur


Jan-April 2009


and Gurdaspur

21 Preparation of Middle Level Trainer in the field of IYCF Venue: PGIMER, Rohtak, Haryana

Women & Child Development Department, Government of Haryana

25-30 May 2009; 24-29 Dec, 2008

22 Preparation of State Mentors in the field of IYCF (6 batches) Venue: District Hospital, Hindupur, AP


6-13 Dec 2008; 13-18 Feb 2009; 18-29 Jun 2009; 16-21 July 2009; 16-21Aug 2009; 16-21 Sept 2009

23 Preparation of National Trainers & IYCF Counselling Specialists Venue: PGIMER, Rohtak, Haryana

Department of Health Services, Government of Haryana

21 Nov-3 Dec 2008

24 Preparation of Middle Level Trainers (MLTs)

CARE Jharkhand

26 Sep-1 Oct 2008

25 Preparation of IYCF Counselling Specialists The “4 in 1” Venue: Govt Hospital, Hindupur, AP


21-27 June 2012

26 Training of Trainers on IYCF Counselling & IYCF Counselling Specialists Venue: UCMS & GTB Hospital, Delhi


14-27 May 2012

27 Training of Middle Level Trainers and Yashodas in 33 district of Rajasthan Venue: District Hospitals, Rajasthan

NRHM Rajasthan and NIPI India

Dec 2011-Mar 2012



14-20 Nov 2011



10-16 Oct 2011



26 Sep - 2 Oct 2011

31 Capacity Building of State Mentors Improving breastfeeding and other IYCF practices in Bihar Venue: Eras Medical College Lucknow, UP


26th April - 3rd May, 2011

32 Capacity Building of State Mentors Improving breastfeeding and other IYCF practices in Uttar Pradesh Venue: Eras Medical College Lucknow, UP


28th March - 4th April, 2011


33 Training of MLTs and Frontline Workers in IYCF for 8 districts of Punjab Venue: 8 District Hospitals


October 2010- March 2011

34 International Outreach Course on Breastfeeding: Advocacy & Practice Course Venue: BRD Medical Colledge, Gorakhpur, UP

UCL Institute of Child Health, London, BRD Medical College, Gorakhpur & BPNI

Nov 21-Dec 4, 2010



1-7 Nov 2010; 23-29 Nov 2010; 16-22 Feb 2011

Annexure -10

BPNI Training Cell (2011)

Chairperson Prof. (Dr) K.P. Kushwaha Principal & Dean B.R.D Medical College Gorakhpur, Uttar Pradesh email: [email protected]

Co-Chairperson Prof. (Dr) MMA Faridi Professor & Head, Department of Pediatrics University College of Medical Science & GTB Hospital Dilshad Garden, Delhi-110095 Email: [email protected]

Coordinator Mr. P.K. Sudhir BPNI BP-33, Pitampura, Delhi-110034 Email: [email protected]

Members

Dr. Kesavulu Civil Surgeon Government Hospital (Hindupur) Andhra Pradesh-515201 Email: [email protected]

Dr Pardeep Khanna Senior Professor & Head Department of Community Medicine Pt. B.D. Sharma P.G.I.M.S. Rohtak-124001, Haryana Email: [email protected], [email protected]

Dr Ramneek Sharma Surya Foundation House No- 3139, Sector 28-D Chandigarh-160002 Email: [email protected] [email protected]

Dr. Rajinder Gulati Medical Officer Pediatrician Punjab Civil Medical Servicer 46-L, Model Town, Ludhiana-141002 Punjab Email: [email protected]

Dr. Anita Gupta Chief Medical Officer Department of Community Medicine UCMS & GTB Hospital Delhi-110092 Email: [email protected]

Dr. Sangeeta Rani Guru Gobind Singh Govt. Hospital Raghubir Nagar Delhi Email: [email protected]

Dr. S. Aneja Professor & Head of Pediatrics Lady Harding Medical College Bangla Sahib Road, Delhi-110001 Email: [email protected]

Breastfeeding Promotion Network of India (BPNI)

BP-33, Pitampura, Delhi-110034 Tel: +91-11-2734306, 42683059

Tel/Fax: +91-11-27343606 Email: [email protected]. Website: www.bpni.org

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