Siti Norjinah Moin. Prof Dr Adlina Suleiman

Transcription

1 One Asia Breastfeeding Partners Forum Luang Prabang BFHI in Malaysia Siti Norjinah Moin President Malaysian Breastfeeding Association Prof Dr Adlina Suleiman Head of Community Medicine Faculty of Medicine and Defence Health, National Defence University Malaysia

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3 BFHI in Malaysia Objectives Overview i of Vital Statistics ti ti and Breastfeeding Rates in Malaysia Past experiences : BFHI assessment in Malaysia a SWOT Analysis Beyond BFHI: Looking to the future

4 Vital Statistics 2011 Toddler Mortality Rate = 6.5 per 1000 live births Neonatal Mortality Rate = 3.4 per 1000 live births Infant Mortality Rate = 5.6 per 1000 live births Birth Rate (2012) = 20.7 per 1000 population Fertility Rate = 2.61 births per woman Live Expectancy = years

5 Nutritional Status 2006 Underweight = 12.9% Thin = 13.2% Stunting = 17.2% At risk of overweight = 7.7% Overweight = 6.4% (Source: Analysis of third national morbidity survey 2006 at art2.pdf

6 Overview of Breastfeeding Situation in Malaysia Source: Ministry of Health Malaysia % of mothers ever breastfeeding their infants as compared to 94.7% in 2006 Prevalence of exclusive breastfeeding at 6 months 27% in 1996, down to 14.4% in 2009 and up to 16.2% in % were still being breast fed at two years of age up to 37.4% in 2010 Initiation of breastfeeding 1996 = 41% 2006 = 63% 2012 = 90%

7 1998 WE WERE THE THIRD COUNTRY WITH THE MOST NUMBER OF BF HOSPITALS (ALL 118 GOVERNMENT HOSPITALS) BEHIND FIRST SWEDEN AND SECOND OMAN

8 BFHI HOSPITALS IN MALAYSIA HOSPITALS THAT ARE BABY FRIENDLY ALL 139 GOVERNMENT HOSPITALS ALL 4 TEACHING HOSPITALS 2 OUT OF 3 ARMED FORCES HOSPITALS 8 OUT OF 200 PRIVATE HOSPITALS (source: baby friendly hospitalsurged , August )

9 BFHI ASSESSMENT IN MALAYSIA A REVIEW Source: BFHI Assessment of : KPJ Selangor KPJ Kajang HUKM Hospital Klang Hospital Seremban

10 SWOT ANALYSIS STRENGTH Good initiation rates for both public and private hospital..good effort by all medical staff Implement skin to skin concept and rooming in Nursing staff are trained 20 hrs Lactation Management course most staff but lacking in 40 hrs LM course Mj Majority of mothers are well informed on all aspects of breastfeeding

11 SWOT ANALYSIS WEAKNESS Antenatal class has Frisogold file with mothers milk sample one of the O&G consultant has made a contract with this company to give incentive for antenatal talk goody bag : violation of ethical code 4.5, 4.9, 5.7, 5.8 (Suggest if need sponsorship company that produces diapers/baby care products) Some nursing staff not confident of positioning i varieties Correct C hold finger cannot be at the areola border, a bit lower Positioning teach varieties such as cross cradle, football because most of them only know cradle hold

12 SWOT ANALYSIS OPPORTUNITIES o o o o The INTERNET way forward to advocate breastfeeding especially for our youths.children are well versed with information search, more receptive Pressure by UNICEF/WHO on Governments to promote breastfeeding Malaysian government : Code into Law Milk Formula getting to be quite expensive to purchase Lactation management curriculum has been developed and incorporated dfor nursing schools and some medical schools in Malaysia

13 SWOT ANALYSIS THREATS Mothers first time mothers do not have enough knowledge beyond what is taught in the clinics/hospitals Most tmothers not breastfeeding up to 2 years passive `Attitude towards breastfeeding take the easy way out Many Malaysian parents do not read : books/internet Too many mommy and bb baby clubs offered by formula companies

14 SWOT ANALYSIS THREATS Doctors Especially in private hospitals and clinics are not promoting breastfeeding Professional Bodies Working with industry accepting sponsorship Conflict of interest Media Advocate milk formula even though not directly by advertising the follow on milk and mothers milk Give free samples of mothers milk to clinics/hospitals

15 Private Hospitals SWOT ANALYSIS THREATS More concerned on the service to the mother baby pair where paying patients and their family who demand that the new mother rest after delivery Work with milk companies that support them financiallyi

16 LOOKING TO THE FUTURE Increasing incidence of chronic diseases and obesity among our children who are not breastfed: need to encourage breastfeeding as a preventive measure Breastfeeding promotion: Make breastfeeding as easy as possible for the mother strengthen health care system, train health care providers, baby friendly hospital initiative, implementing code of ethics of marketing for infant formula, community participation.

17 LOOKING TO THE FUTURE Many working mothers either mix feed or stop breastfeeding when they return to work there is a need to increase child care at workplace to encourage working mothers to breastfeed Need role models eg Actresses/Singers/Royalty to Need role models eg. Actresses/Singers/Royalty to become advocates of breastfeeding.

18 Celebrity Involvement: Flash Mob KLCC 2011

19 BF Campaigns: Flash Mob KLCC 2012

20 Latest Breastfeeding Event Flash Mob KLCC 2013

21 IN THE FUTURE: BFHI REGIONAL TRAINING and RESEARCH INSTITUTE RATIONALE 1. The current method of assessing Baby Friendly Hospital is government based which is self contained. Trained assessors assess their counterparts within the same ministry which is a conflict of interest and raises the question of bias. 2. In most countries, the 20 hour BFHI training module is basic and diluted trainers are trained only once and most are not trained by experts from WHO/UNICEF. The training of trainers goes from central to district to hospital level (echo training). There is no monitoring of the quality of teaching at different levels and there is no ISO certification for this course. Many baby friendly hospitals are also not monitored after receiving the BF status.

22 BFHI REGIONAL TRAINING and RESEARCH INSTITUTE 3. The BFHI assessors are also trained by the Ministry of Health taking nurses and health professionals from their own setting who then cross evaluate themselves. Some members of NGO s are also trained as assessors but they are seldom called in to evaluate MOH hospitals. Doctors are currently looking down on the BFHI certification program because the BFHI assessors are usually nurses.

23 BFHI REGIONAL TRAINING and RESEARCH INSTITUTE 4. The IBCLC certifies lactation consultants worldwide. Many of their consultants are unable to handle breastfeeding problems at hospital level and complex cases, at the same time they have not contributed to any improvement in breastfeeding rates. Anyone with enough exposure to BF can take the examination, even though they have no medical related background. This lack of skills have resulted in somecases thatt have been wrongly advised di dthus resulting in failure to breastfeed. Some consultants misuse this qualification to conduct business and to force mothers to buy equipment such as breast pumps.

24 WHO ARE WE: NORJINAH AND ADLINA THE FIRST BATCH OF TRAINERS (80HRS) TRAINED BY WHO FELICITY SAVAGE IN 1993: REGIONAL BF COUNSELLING COURSE WE TRAINED THE TRAINER (40HRS) FOR THE MINISTRY OF HEALTH THE FIRST BATCH OF BFHI ASSESSORS TRAINED BY WHO RANDA SAADI IN 1995 ATTENDED THE BFHI ASSESSORS NEW CRITERIA SEMINAR IN 2011

25 WHO ARE WE: NORJINAH AND ADLINA WE TRAINED REPRESENTATIVE FROM INDONESIA (SEMARANG, JAKARTA AND SURABAYA WHO WERE A PAEDIATRICIAN, OBS AND GYNAECOLOGIST AND A MATRON) AS WELL AS 2 FROM MYANMAR IN WE WERE CHOSEN BY DR LE MAUNG WHO WAS THE DIRECTOR UNICEF REGIONAL AT THAT TIME ADLINA: : INTERNATIONAL BOARD CERTIFIED LACTATION CONSULTANT, PROFESSOR AT NDUM, SET UP 3 MEDICAL SCHOOLS (UiTM, MAHSA UC AND NDUM) AND FAMILIAR WITH CURRICULUM DEVELOPMENT.

26 BFHI REGIONAL TRAINING and RESEARCH INSTITUTE An independent organization is needed to monitor and evaluate BFHI Status, to conduct proper high quality training of breastfeeding counseling at all levels, train BFHI assessors and conduct research on breastfeeding in the region. This institute will run in collaboration with IBFAN, WABA, ICDC mother to mother support group, professional bodies and universities from all over the world.

27 BFHI REGIONAL TRAINING and RESEARCH INSTITUTE The curriculum will undergo the scrutiny of an international board of experts along the lines of the Malaysian Accreditation Standards. The training programs will be continuous at different levels from beginners to advanced and thereafter constant updates.

28 EXAMPLE:

29 BFHI REGIONAL TRAINING and RESEARCH INSTITUTE Certificates, Diplomas and Degrees There will be an evaluation system where assessment tools should be used to determine performance and certificates t issued only onpassing the exams. Assessment will involve international external examiners from all over the world. Should the candidate not pass the exam they are not allowed to teach, train nor assess any BFHI facilities. This would give credibility and maintain the This would give credibility and maintain the standards of BFHI implementation.

30 SCOPE OF BFHI RTR Institute STANDARDIZED EVALUATION OF BFHI FOR HOSPITALS IN ASIA BREASTFEEDING COUNSELING TRAINING CERTIFICATE COURSE 20 HRS, 40HRS BREASTFEEDING COUNSELING TRAINING THE TRAINER CERTIFICATE C COURSE 80 HRS CERTIFICATE COURSES IN LACTATION EDUCATION BIRTH AND POSTPARTUM DOULA CERTIFICATE COURSE DIPLOMA AND DEGREE IN LACTATION MANAGEMENT

31 VISION BFHI REGIONAL TRAINING AND RESEARCH INSTITUTE BFHI UNIVERSITY COLLEGE (Adding Masters courses) 10 15Yrs 15Yrs BFHI UNIVERSITY (Adding PhD courses)

32 IN THE FUTURE: BFHI REGIONAL TRAINING INSTITUTE (BRTI) This Institute will be set-up in Kuala Lumpur Malaysia. BIB Malaysia (lead by Siti Norjinah Moin) has initiated the move by having discussions with WHO and UNICEF in Malaysia. Certificate and Diploma programs is being developed using Ministry of Education Malaysia guidelines by Prof Dr Adlina Suleiman to be forwarded to MOE for approval.

33 You must be the change you want tto see in the world. - Mahatma Gandhi What you do TODAY can improve all your Tomorrows Terima Kasih Thank You