BREASTFEEDING PROMOTION EFFORTS IN MALAYSIA

Transcription

1 BREASTFEEDING PROMOTION EFFORTS IN MALAYSIA ROKIAH DON MINISTRY OF HEALTH MALAYSIA Global Breastfeeding Partners Forum October 17-19, 2010 Penang

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3 CONTENT Demography Organisation Health Care Delivery System Breastfeeding Status Promotional Strategies Challenges

4 DEMOGRAPHY (2009) Population Total Male Female Total Population 28,306,700 14,407,200 (50.9%) Population by Age Group 13,899,400 (49.1%) Below 15 years 9,014,700 (31.9%) years 18,005,700 (63.6%) 65 years & above 1,286,200 (4.5%) Maternal Mortality Rate (per 100,000 live births) 28.9 (2008) 40.0 (2001) Perinatal Mortality Rate (per 1,000 births) 7.4 (2008) 3.9 (2000) 4,647,100 (32.2%) 9,157,400 (63.6%) 602,800 (4.2%) 4,367,700 (31.4%) 8,848,300 (63.7%) 683,500 (4.9%) (2008) 40.0 (2001) 7.9 (2008) 6.8 (2008) Neonatal Mortality Rate (per 1,000 live births) 4.0 (2008) 4.5 (2008) 3.5 (2008) Infant Mortality Rate (per 1,000 live births) 6.4 (2008) 7.5 (2000) Toddler Mortality Rate (per 1,000 population aged 1-4 years) 7.0 (2008) 5.7 (2008) 0.4 (2008) 0.5 (2008) 0.4 (2008) Under-5 Mortality Rate (per 1,000 live births) 8.1 (2008) 8.9 (2008) 7.3 (2008) Life Expectancy at Birth (in years) (2008) (2008) Source : Health Facts 2009

5 MINISTER OF HEALTH ORGANISATION CHART MINISTRY OF HEALTH MALAYSIA DEPUTY MINISTER OF HEALTH SECRETARY GENERAL OF HEALTH PARLIAMENTARY SECRETARY OF HEALTH PUBLIC RELATIONS OFFICER DIRECTOR-GENERAL OF HEALTH LEGAL ADVISOR INTERNAL AUDITOR INDUSTRIAL HEALTH & CORPORATE POLICY DEPUTY SECRETARY- GENERAL (MANAGEMENT) Human Resource Manpower Planning & Training Management Services Competency Development DEPUTY DG OF HEALTH (MEDICAL) DEPUTY DG OF HEALTH (PUBLIC HEALTH) Medical Development Disease Control Medical Practice Dental Services Telehealth Family Health Development DEPUTY SECRETARY- Nutrition GENERAL (FINANCE) Food Safety & Quality Control Finance Health Education Procurement and Privatisation Accounts Communication & Information Technology DEPUTY DG OF HEALTH (RESEARCH & TECHNICAL SUPPORT) Planning & Development Pharmacy Services Engineering Services National Institute of Health Traditional & Complimentary Medicine 13 State Health Directors

6 ORGANISATION CHART OF NUTRITION DIVISION Director Nutrition Policy & Standard Section Nutrition Operational Section Nutrition Development NPANM/ TWG Nutrition Promotion Nutrition Surveillance Nutrition Rehabilitation Professional Development Infant & Young Child Feeding Research Micronutrient Deficiency Standard & Quality Adolescent Nutrition and Schools Nutrition Surveillance Macronutrient Deficiency Nutrition Information Centre Adult, Elderly and People with Special Needs Nutrition & Disease

7 HEALTH SERVICES AT DISTRICT LEVEL DISTRICT HEALTH OFFICE HEALTH CLINIC COMMUNITY CLINICS / KLINIK DESA

8 RURAL HEALTH SERVICES : 2-TIER 2 SYSTEM HEALTH CLINIC 15,000-20,000 POP. COMMUNITY CLINICS / KLINIK DESA 4,000 POP.

9 NUMBER OF HEALTH FACILITIES IN MALAYSIA (2009) HEALTH CARE FACILITIES TOTAL GOVERNMENT (MOH) HOSPITALS 130 DISTRICT HEALTH OFFICES 131 HEALTH CLINICS 808 COMMUNITY CLINICS/ KLINIK DESA 1920 MATERNAL & CHILD HEALTH CLINICS 90 MOBILE HEALTH CLINICS 196 PRIVATE (LICENSED) HOSPITALS 209 MATERNITY HOMES 21 NURSING HOMES 12 Source : Health Facts 2009

10 MMR MALAYSIA MMR in 1991 = 44 per 100,000 livebirths MMR in 2008 = 28.9 per 100,000 livebirths Source : Department of statistics, Malaysia

11 EVER BREASTFED TREND IN MALAYSIA Source : Malaysian Family Life Survey & National Health and Morbidity Survey

12 COMPARISON WITH OTHER COUNTRIES Country (Maternity leave) Year % Infants ever breastfed Malaysia (8 weeks) Indonesia 2002/ Philippines India 1999/ Egypt Armenia United Kingdom (52 weeks) Canada (17 weeks) 2006/ Sweden (14 weeks) Switzerland (8 weeks) Source : World Health Organization

13 EARLY INITIATION OF BREASTFEEDING 22.3%* Source : National Health and Morbidity Survey II & III

14 EXCLUSIVE BREASTFEEDING AT 6 MONTHS COMPARED WITH OTHER COUNTRIES Source : World Health Organization

15 MATERNITY LEAVE (WEEKS) Source: ILO Maternity Leave Data Base accessed on 28 May 2009

16 Breastfeeding Education public mass media Mass media advertisement milk industries Code of Ethics for the Marketing of Infant Foods and Related Products Research Breastfeeding data collection HMIS Child Health Card Training in-service for all health professionals teachers BREASTFEEDING PROMOTION Social Support maternity leave mother-support group legal provision (Food Act 1983) employer Baby Friendly Hospital Initiative government private Curriculum Development school (2 o children) nursing colleges in-service medical school Environmental Support building by laws hospital infrastructure BP facilities in shopping centres

17 2010 Review the BFHI implementation August 2008 Launch of the National Lactation Centre and New Revised Code of Ethics Mid 2005 National Breastfeeding Policy (1993) reviewed Actions by Ministry of Health Malaysia 2006 Revised Malaysian Breastfeeding Policy announced September 2005 Guideline of Infant & Young Child Feeding reviewed, in line with new Malaysian Breastfeeding Policy and RNI (2005)

18 PROMOTIONAL STRATEGIES Nutrition Education Growth monitoring (home-based card) Nutrition advice/ talks (individual & groups) Nutrition counselling Cooking demonstrations (clinics & community) Video shows via Child health clinics Antenatal clinics Postnatal clinics Home visits for priority cases

19 Training PROMOTIONAL STRATEGIES - Lactation Management Education for health professionals (18/20 hours) - Breastfeeding Counselling Course for health professionals (40 hours) - Mother-to-mother support training for breastfeeding mothers - Post-basic training for nurses (long distance) - Pre-marital counselling course - Training of extension workers co-ordinated by the Technical Working Group (Training) under the National Plan of Action for Nutrition of Malaysia (NPANM) intersectoral collaboration

20 Introduced 1993 Designated PROMOTIONAL STRATEGIES Baby-friendly Hospital Initiative (BFHI) Consequences government hospitals within MOH 6 private hospitals improvement in maternity care of BFHI - ever breastfed rates - public and policy makers awareness - Improve early initiation of breastfeeding - positive response of public towards the health system - multidisciplinary teamwork - paediatric wards; mothers caring for and nursing infants Sustenance - monitoring & re-assessment tools Committee - BFHI Recognition Committee

21 PROMOTIONAL STRATEGIES Regulatory and ethical measures 1) Food Regulations 1985 and Food Act 1983 have several provisions to protect infant feeding - Section 389 Devoted to provisions for Infant Formula (15 subsections) to protect breastfeeding - Section 390 Canned food for infants and children - Section 391 Cereal-based food for infants and children

22 PROMOTIONAL STRATEGIES Regulatory and ethical measures 2) Code of Ethics for Infant Formula Products 1979 (revised 1983, 1985, 1995, 2008) Scope Organisation Monitoring : Covers the basic principles of marketing and product information of designated products and complementary foods in Malaysia. It also provide guidelines on ethical practices for manufacturer and distributors of designated products and complementary foods; and health professionals and health personnel in the health care system : National Committee Vetting Committee Disciplinary Committee State Committee : State Monitoring Team - Health care system - Retail outlets - Child care centre

23 PROMOTIONAL STRATEGIES School Curriculum Form four Form four Form five Form five The Ministry of Education has taken steps to include breastfeeding in a section on infant and child care for the Secondary 4 and 5 in the Physical and Health Education Curriculum

24 Media PROMOTIONAL STRATEGIES Printed and electronic media to create public awareness on nutrition in line with the thematic Healthy Lifestyle Campaign since May 1991 Leaflets, booklets, pamphlets, flyers, posters Publication of advertorials, feature articles, quizzes in local vernacular newspapers and magazines on healthy eating for all age groups Radio (interviews and spot announcement) Television (talk shows, nutrition segments, commercials) Billboards Cinema advertisements Bus panel advertisements Messages on Ministry of Health vehicles Portal MyHEALTH (

25 Social Support PROMOTIONAL STRATEGIES 60 days paid maternity leave 1,825 days (5 years) no-pay leave (Pekeliling Perkhidmatan Bil. 15 Tahun 2007) 90 days paid maternity leave (Budget Announcement 2011) 7 days paternity leave Breastfeeding facilities at workplace (Health clinics) Breastfeeding facilities at shopping centre (SOGO, Jaya Jusco) Tax relief for companies that make available child care facilities at workplace (Sime Darby) Active involvement of NGOs information, support and counselling to mothers (PPPIM, PPPLM) World Breastfeeding Week (1-7 August)

26 PROMOTIONAL STRATEGIES Research Various studies and surveys have been undertaken. These include : 1) The National Health and Morbidity Surveys 2) Health Systems Research: To study the Strengths & Weaknesses in Implementation of the 10 Steps To Successful Breastfeeding in Kluang Hospital 3) A study on the Knowledge of Doctors & Nurses regarding Breastfeeding: Effect of Lactation Management Education 4) A study on the Assessment of the Baby- Friendly Hospital Initiative in 5 General Hospitals using WHO Assessment Tools 5) A study on the Breastfeeding Practices in Negeri Sembilan

27 CHALLENGES Working mothers and breastfeeding work patterns facilities for breastfeeding and breast milk expression Established mother support groups BFHI implementation in private hospitals strategies? Role of professional bodies in breastfeeding promotion eliminate dependency on commercial sources of funds? Reported violations of the Code of Ethics for the Marketing of Infant Foods and Related Products role of international organisations

28 Thank you