Project Management on

Pre-lacteal Feeding

Prepared and Submitted by: Basanta Chalise(01) MHP&E

IOM

Analysis of Situation

Step 1- Identifying and Understanding the ProblemStep 2- Determining Potential AudiencesStep 3- Identifying Potential Communication ResourcesStep 4- Assessing the EnvironmentStep 5- SWOT analysis

Identifying and Understanding the Problem

Background• Exclusive breastfeeding (EBF) for first six months of life is

beneficial to child and mother [1,2].• EBF protects a child from under nutrition and gastro-

enteristis. In the long run, EBF is protective against a number of chronic disease such as leukaemia, type 2 diabetes, and obesity [3,4].

• Breastfeeding also has proven benefits for the neuro-cognitive development of the child, protection from childhood respiratory illness and protection for the mother from breast cancer.

• EBF also saves the cost associated with illnesses that arise out of the above mentioned illnesses [5].

Background• For these reasons, the World Health Organization

(WHO), United Nations Children’s Fund (UNICEF) and Ministry of Health and Population Nepal recommend and promote exclusive breastfeeding for first six months of life and continuation of breastfeeding thereafter [6-8].

• Any food provided to a newborn before the initiation of mother’s breastfeeding is considered to be a prelacteal feed. The type of prelacteal feeds depends on the culture. It may include ghee (refined butter), honey, sugar, sugar juice, unboiled cow/goat milk etc [9].

Background

• The practice of prelacteal feeding is a major cultural practice still prevalent in many places throughout South Asia regions [9].

• All prelacteal feeds are provided for non nutritional reasons such as clearing the throat/bowel; or thinking that mother’s milk is insufficient or the colostrum is too heavy for the newborn to digest [9].

• Prelacteal feeds have lesser nutrient and immunological value; and are often likely to introduce contaminants [9].

Background • Introduction of prelacteal feeds is a known barrier to

continuation of exclusive breastfeeding. By definition, a child provided with prelacteal feeds is not exclusively breastfed.

• Knowledge on the determinants of introduction of prelacteal feeds is essential to promote exclusive breastfeeding and early initiation of breastfeeding.

• The prevalence of prelacteal feeding is 26.5% (NDHS 2011).• It has been estimated that if coverage was universal,

exclusive breastfeeding could save under five deaths by 13%.

Vision

There will be no practice of pre-lacteal feeding in newborn.

Desired behaviors

• Avoid pre-lacteal feeding and practice exclusive Breastfeeding

Health Problem Analysis Worksheet

Health Problem

Prevalence Incidence

Severity Desired prevention/Treatment Behaviours

Sources of Information On this Health Problem

Prelacteal feeding

26.5% (Within 3 days after delivery)

Main barrier for EBF

• Increase in at least four ANC visit• Institutional delivery • Avoid pre-lacteal feeding and practice exclusive Breastfeeding(WHO recommends 90% exclusive BF)

NDHS 2011

Determining Potential Audiences

Common Characteristics of Potential Audiences

• Wealth quintile • Age of mother at pregnancy• Maternal education• Mother’s occupation • The number of ANC visits• Sex of child• Birth order • Birth interval • Size of child at birth • Ecological region and• Development region

Identify known barrier to behavior change

• Availability – One of the study done in Bhaktapur district in 2012 showed that 72.3% women didn’t had information about Breastfeeding during ANC visit.[10]

• Accessibility – Due to geographical difficulties, unavailability of HWs, traditional home delivery practices etc (Fifty-eight percent of mothers received antenatal care from a skilled provider (a doctor, nurse, or midwife) for their most recent birth in the five years preceding the survey). (NDHS 2011)

• Affordability – ANC services are provided free of cost in government institutions. In addition they can get incentive after institutional delivery.

• Acceptability – in most of the society of Nepal there is practice of pre lacteal feeding before colostrum feeding.

Potential Primary Audiences WorksheetAudience Common

characteristicsStage of Behaviour Change

Known Barriers of Behaviour Change

Sources of Information on this audience

Pregnant women

AgeOccupation Education levelBirth orderBirth interval Ecological regionDevelopment region

i. Pre-knowledgeable

ii. knowledgeable

i. Lack of knowledge about harmful effects of prelacteal feeding

ii. Due to cultural norms they are forced to practice.

Different Qualitative and quantitative research

Potential influencing Audiences worksheet Name of Potential audience

Primary audience influenced

Estimated power of influence

Attitude toward behaviour change of primary audience

Means of inflence/channels

From where does this potential audience obtain information

Husbands and Mother in law

Just delivered mother

Strong Accept the benefit of colostrum feeding and avoid pre-lacteal feeding

CounselingMass mediaCommunity mobilization

Health centreRadio, televisionSocial network

Identifying Potential Communication resources

Health communication worksheetCategory of communication

Communication manager

Channel/Format Key Message Intended Audiences

Interpersonal Health workers (ANM/AHW/SN/HA)

Health centres (health post/PHCC/Hospital)

Start breastfeeding as soon as possible within an hour after delivery

Pregnant women

Community oriented

FCHVsLocal NGOsSchool teachers

Folk mediaRally Educational activites

Avoid prelacteal feedingMothers milk is the best food for babies

General community people focusing on husband, mother in law of pregnant women

Mass media Project manager

Local newspaper, TV, Radio

Colostrum is natural vaccination for newbornAvoid prelacteal feeding Excusive Breastfeeding upto 6 months and continue BF for 2 years

Pregnant womenMothersHusband General people

Assessing the Environment

Health Service and Product Support Worksheet

Product/service offered

Offered by Availability Accessibility

Affordability

Acceptability

Sources of information

Counseling during ANC visit to pregnant women

MoHP Health institutions (ORC/EPI clinic/HP/PHCC/Hospitals)

Community has easy access

Free of cost Acceptable but in some cases limited due to cultural practices

MoHP

Social, Economic, or political conditionsSocial conditions

Cultural practices may hamper the avoidance of prelacteal feeding

Economic conditions

Due to expensive cost of prelacteal feeding this may create positive impact for the avoidance of prelacteal feedingLimited access to mass media

Political conditions

Favorable environment with support from national, municipal and local government with extensive participation from of local people

SWOT analysis Strengths Weakness

• The proposed behaviour is effective in promoting exclusive breastfeeding thereby significantly reduce infant and child mortality• It helps to reduce incidence of infections among newborns• This project has strong political support• Counseling is provided along with method of BF and hygiene of breast.• Involvement of husband, mother in law, teachers, local leaders etc

• Harmful cultural practice like introduction of ghee, honey, sugar, janmaghuti etc.• high prevalence of illeteracy in general community.• limited access to mass media.

Opportunities Threats

• Different external partners are working in this issues.• High penetration of social media and mobile phone that make easy to disseminate information

• No clear message delivery by external development partners.• Unnecessary advertisement of baby milk, products from mass media like TV, radio

References 1. Ip S, Chung M, Raman G, Trikalinos TA, Lau J: A summary of the agency for healthcare research and

quality's evidence report on breastfeeding in developed countries. Breastfeed Med 2009, 4(Suppl 1):S17–S30.

2. World Health Organization: Infant and young child feeding: model chapter for textbooks for medical students and allied health professionals. Geneva: World Health Organization; 2009.

3. Jones ME, Swerdlow AJ, Gill LE, Goldacre MJ: Pre-natal and early life risk factors for childhood onset diabetes mellitus: a record linkage study. Int J Epidemiol 1998, 27:444–449.

4. Pettitt DJ, Forman MR, Hanson RL, Knowler WC, Bennett PH: Breastfeeding and incidence of non-insulin-dependent diabetes mellitus in Pima Indians. Lancet 1997, 350:166–168.

5. Kramer MS: "Breast is best": the evidence. Early Hum Dev 2010, 86:729–732.6. The World Health Organization: Indicators for assessing infant and young child feeding practices.

Geneva: The World Health Organization; 2008.7. Baby friendly hospital initiative (BFHI): http://www.unicef.org/nutrition/index_24806.html.8. Ministry of Health and Population: Annual report. Kathmandu: Department of Health Services.

2010/2011.9. Laroia N, Sharma D: The religious and cultural bases for breastfeeding practices among the Hindus.

Breastfeed Med 2006, 1:94–98.10. Ulak M, Chandyo RK, Mellander L, Shrestha PS, Strand TA. Infant feeding practices in Bhaktapur,

Nepal: across-sectional, health facility based survey. International Breastfeeding Journal 2012, 7:1A field Guide to Designing A Health Communication Strategy, Population Communication

Services, JHU

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