Since 25 August, 2017 over 693,000 Rohingya have been forced from Myanmar due to mass violence, seeking refuge in neighboring Bangladesh. Nutritional surveys during 2017 revealed worrying levels of malnutrition and poor infant feeding practices, including high numbers of infants not exclusively breastfeeding. Infants under 6 months who are not exclusively breastfed are particularly vulnerable to morbidity and mortality and require specialized feeding support, especially in emergency contexts.
Research Aim
To describe Save the Children International’s experiences supporting wet nursing, relactation, and artificial feeding for non-breastfed infants under 6 months in the Rohingya Response, Bangladesh.
Methods
A retrospective analysis was conducted of routine program data and documentation from Save the Children International’s infant and young child feeding in emergencies interventions for the Rohingya Response, Bangladesh, from November 2017 to April 2018. The study population were infants under 6 months identified as not breastfed during the initial assessment (N = 15).
Results
Although wet nursing was attempted with all infants, it was successful with 6 (40%) of the infants. Additionally, 1 (6.7%) infant’s mother was able to successfully relactate. The remaining infants ended up requiring feeding with human milk substitutes.
Conclusion
Gaps exist in operational guidance to support non-breastfed infants with wet nursing and relactation in emergency settings, as well as on how to operationalize safe human milk substitute programming in line with national policies and regulations. There is an urgent need to address this gap to protect the lives of non-breastfed infants in emergencies worldwide.
Action Contre la Faim France. (2014). Baby friendly spaces holistic approach for pregnant, lactating women and their very young children in emergency. Paris: ACF International.
4.
Action Contre la Faim International. (2012). Guidelines for the integrated management of severe acute malnutrition: In- and out- patient treatment. Paris: ACF International.
5.
AlsammanS. (2014). Managing infant and young child feeding in refugee camps in Jordan. Field Exchange (48), 85.
6.
BanapurmathS.BanapurmathC. R.KesareeN. (2003). Initiation of lactation and establishing relactation in outpatients. Indian Pediatrics, 40(4), 343–7.
7.
BaumgartelK.SneeringerL.CohenS. (2016). From royal wet nurses to Facebook: The evolution of breastmilk sharing. Breastfeeding Review, 24(3), 25–32.
8.
ChanE.ChiuC.ChanG. (2018). Medical and health risks associated with communicable diseases of Rohingya refugees in Bangladesh 2017. International Journal of Infectious Diseases, 68, 39–43. doi:10.1016/j.ijid.2018.01.001
9.
ChowdhuryR.SinhaB.SankarM.TanejaS.BhandariN.RollinsN.. . . MartinesJ. (2015). Breastfeeding and maternal health outcomes: A systematic review and meta-analysis. Acta Paediatrica, 104(467), 96–113. doi:10.1111/apa.13102
DarjaniP.Shaker-BerbariL. (2014). Infant and young child feeding support in Lebanon: Strengthening the national system. Field Exchange (48), 20.
12.
de BrabandereA.DavidA.DozioE.BizouerneC. (2014). Baby friendly spaces. Holistic approach for pregnant, lactating women and their very young children in emergency. Action Contre la Faim.
EL-KhuffashA.UngerS. (2012). The concept of milk kinship in Islam: Issues raised when offering preterm infants of muslim families donor human milk. Journal of Human Lactation, 28(2), 125–127. doi:10.1177/0890334411434803
15.
Emergency Nutrition Network. (2018). Wet nursing guidance: Emergency contexts, infant and young child feeding interventions forum. https://www.en-net.org/question/3194.aspx
16.
Emergency Nutrition Network, GOAL, London School of Hygiene and Tropical Medicine (LSHTM), & Save the Children. (2018). C-MAMI Tool. https://www.ennonline.net/c-mami
17.
GribbleK.FernandesC. (2018). Considerations regarding the use of infant formula products in infant and young child feeding in emergencies (IYCF-E) programs. World Nutrition, 9(3), 261–283. https://doi.org/10.26596/wn.201893261-283
HortaB. (2019). Breastfeeding: Investing in the future. Breastfeeding Medicine, 14 (Suppl. 1), S-11–S-12. doi:10.1089/bfm.2019.0032
20.
HusseinG.ElmusharafK. (2019). Mention of ethical review and informed consent in the reports of research undertaken during the armed conflict in Darfur: A systematic review. BMC Medical Ethics, 20(1). doi:10.1186/s12910-019-0377-7
21.
IFE Core Group. (2017). Infant and young child feeding in emergencies: Operational guidance for emergency relief staff and programme managers. Emergency Nutrition Network. https://www.ennonline.net/operationalguidance-v3-2017
22.
Institute of Public Health and Nutrition, Directorate General of Health Services, Ministry of Health and Family Welfare & Government of Bangladesh. (2007). National strategy for infant and young child feeding. Institute of Public Health and Nutrition. https://extranet.who.int/nutrition/gina/en/node/8025
KelishadiR.FarajianS. (2014). The protective effects of breastfeeding on chronic non-communicable diseases in adulthood: A review of evidence. Advanced Biomedical Research, 3(3). doi:10.4103/2277-9175.124629
27.
KrummeB. (1991). Case study 17 in IFE: GIFA/ENN Project. Relactation/wet nursing: Relactation in difficult circumstances: Rising to the challenge. https://www.ennonline.net/relactationwetnursing2
28.
LeidmanE.HumphreysA.Greene CramerB.Toroitich-Van MilL.WilkinsonC.NarayanA.BilukhaO. (2018). Acute malnutrition and anemia among Rohingya children in Kutupalong camp, Bangladesh. The Journal of the American Medical Association, 319(14), 1505–1506. doi:10.1001/jama.2018.2405
MoranL.GiladJ. (2007). From folklore to scientific evidence: Breast-feeding and wet-nursing in Islam and the case of non-puerperal lactation. International Journal of Biomedical Science, 3(4), 251–7.
31.
OnyangoA.BorghiE.de OnisM.del Carmen CasanovasM.GarzaC. (2014). Complementary feeding and attained linear growth among 6–23 month-old children. Public Health Nutrition, 17(9), 1975–1983.
32.
SankarM.SinhaB.ChowdhuryR.BhandariN.TanejaS.MartinesJ.BahlR. (2015). Optimal breastfeeding practices and infant and child mortality: A systematic review and meta-analysis. Acta Paediatrica, 104(467), 3–13. doi:10.1111/apa.13147
33.
ScherbaumV.SrourM. (2016). The role of breastfeeding in the prevention of childhood malnutrition. World Review of Nutrition & Dietetics, 115, 82–97. doi:10.1159/000442075
SriramanN.EvansA.LawrenceR.NobleL.DirectorsT. A. (2018). Academy of Breastfeeding Medicine’s 2017 position statement on informal breast milk sharing for the term healthy infant. Breastfeeding Medicine, 13(1), 2–4. doi:https://doi.org/10.1089/bfm.2017.29064.nks
StuebeA.GrewenK.Meltzer-BrodyS. (2013). Association between maternal mood and oxytocin response to breastfeeding. Journal of Women’s Health, 22(4), 352–61. doi:10.1089/jwh.2012.3768
38.
United Nations Children’s Fund (UNICEF). (2011). Harmonised Training Package. Module 13: Management of severe acute malnutrition. Emergency Nutrition Network. https://www.ennonline.net/htpv2module13
39.
United Nations Children’s Fund & World Health Organization. (2018). Capture the moment: Early initiation of breastfeeding: The best start for every newborn. UNICEF.
40.
United Nations High Commissioner for Refugees (UNHCR). (2018). Bangladesh refugee emergency: Population factsheet. Cox’s Bazar: UNHCR.
41.
VictoraC.BahlR.BarrosA.FrançaG.HortonS.KrasevecJ., . . . Lancet Breastfeeding Series Group. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7
World Health Assembly. (2018). World Health Assembly 71.9. Geneva: WHA.
44.
World Health Organization. (1981). International code of marketing of breast-milk substitutes. Geneva: WHO.
45.
World Health Organization. (1998). Relactation: Review of experience and recommendations for practice. Geneva: WHO.
46.
World Health Organization. (2008). Indicators for assessing infant and young child feeding practices: Part 1: Definitions. Geneva: WHO.
47.
World Health Organization. (2010). Indicators for assessing infant and young child feeding practices Part 2 measurement. Geneva: World Health Organization (WHO).
48.
World Health Organization & United Nations Children’s Fund. (2003). Global strategy for infant and young child feeding. Geneva: WHO.
49.
World Health Organization, United Nations High Commissioner for Refugees, International Federation of Red Cross & World Food Program. (2000). The management of nutrition in major emergencies. Geneva: WHO.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
