INFANT FEEDING IN A REFUGEE CAMP Experience from Bangladesh

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INFANT FEEDING IN A REFUGEE CAMP Experience from
Bangladesh

• UNHCR

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Outline

• Overview of the camp situation
• Infant feeding in the camps
• Case 1
• Case 2
• Wet nursing advantages and disadvantages
• -1- Cultural background
• -2- HIV considerations
• Conclusion

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Overview of the camp situation
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Overview of the camp situation

• A general food ration is distributed to 22,000
  registered refugees in the official camps but
  omits 5,000 unregistered refugees
• Refugees have no access to land for cultivation
  and are officially not allowed to work household
  income is minimal

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Overview of the camps situation

• UNHCR survey in 2007(implemented by HKI) global
  acute malnutrition prevalence in 6 to 59 months
  12.1 and 64 of 6 to 59 months are anemic
  (Hblt 11g/dl)
• General lack of food diversity especially animal
  protein is reported

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Case 1
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Case 1 in the feeding center

• Nutritionist Hello, good morning, how are you
  today?
• Refugee with baby Good Thank you!
• N How is your child doing today?
• R This is not my child, it is an orphan. His
  mother died while giving birth to him 25 days
  ago.
• N Oh, I see, and you are taking care of him
• R yes
• N Are you a relative?
• R Not really, his mother was a friend.
• N I am so sorry for her death. Are you finding
  trouble feeding him?
• R I put water with some white powder

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Comments on the discussion

• White powder could be inappropriate
• Please share your thoughts_______

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Case 1 in the feeding center

• N White powder?
• R yes, the same they use in the inpatient center
  
• N Did they provide you with that powder or did
  you purchase it
• R no I bought it
• N Ok, so how can you make sure that it is the
  same powder, did anything or anyone indicate it
  to you?
• R No, I cannot read but the powder was white and
  it looked the same
• NI understand. What about the dosage, how many
  teaspoons do you use?
• R Oh just a little bit, I dont have enough and
  cannot afford to buy more

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Comments on the discussion

• Inpatient center provides F100
• Caretaker cannot read
• Preparation is not appropriate
• Caretaker cannot afford the powder
• Please share your thoughts_____

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Comments on the discussion
Item Cost in Taka
Daily labor 70 -80 /day
Cheapest rice 27 /kg
Lentils 30 /kg
Vegetables 70 /kg
Fish and shrimps 60 /kg
Meat and Dairy Products 170 /kg
Infant formula tin 300 / tin
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Case 1 in the feeding center

• N I see! And do you boil the water you use?
• R No, the water is clean, I prefer to save
  cooking fuel
• N I see! Do you feed the child anything else?
• R Yes, often I give him some rice
• N Would you please provide us with the packet of
  powder you purchased?
• R sure, 5 minutes later comes back with a full
  cream powder packet with a large inscription
  saying is not appropriate for infant below 1
  year

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Comments on the discussion

• Water is not boiled
• Caretaker cannot afford fuel
• Not exclusive artificial feeding/mixed feedings
• Full cream powder not appropriate for infants
• Please share your thoughts________

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Imagining that this is not a refugee camp, what
conditions would lead to the same answers?

• Illiteracy
• Poverty
• Lack of community awareness
• Presence of misconceptions
• Healthcare the money making machine

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Case 2
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Case 2 Summary

• Mother died shortly after delivery and an aunt
  naturally became the wet nurse. it is highly
  viewed in the Muslim community, you know, since
  Mohammed the prophet had a wet nurse. The
  caretaker wet-nurses the child and attends to all
  his needs

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Comments on the case

• Culturally appropriate practice naturally
  undertaken in the community
• Supported by religious beliefs

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Wet-nursing Disadvantages

• Breastfeeding is a risk for HIV transmission and
  wet nurses should undergo Voluntary Counseling
  and Testing (VCT)
• Night feeds are problematic if the wet nurse
  lives far away from the orphan and caretaker
• Wet-nurses day to day duties that interfere with
  attending to the orphan

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Wet-nursing Advantages

• Infant formula is not AFASS in this context
• Wet-nursing is done naturally and is culturally
  accepted
• Wet nurses (as are all lactating women) are
  provided with a package services/interventions to
  promote optimal health and nutrition status
• Some of this also aims to decrease the risk of
  HIV transmission (malaria prevention and
  treatment, breast care and nipple care,
  detection and treatment of oral candidiasis in
  the infant)

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HIV Situation

• Bangladesh is experiencing a low level HIV
  epidemic
• Level of HIV infection in southern Bangladesh
  where the refugees are located is extremely low
  (no HIV detected in sex workers or injecting drug
  users in nearest sites in 2006 surveillance)
• However, wet nursing need to ensure that the
  donor is HIV negative
• But many challenges in this regard

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Challenges wet nursing and HIV

• National HIV capacity, including in HIV VCT, is
  very weak
• Availability of quality HIV VCT is very limited
  and closest sites outside of the camp are
  targeting most- at-risk populations
• Level of knowledge relating to HIV is poor and
  stigma is prevalent
• A minimum care and support package needs to be
  put in place before undergoing VCT

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Conclusion HIV and Wet nursing

• Despite the operational and contextual
  constraints UNHCR will work with its implementing
  and operational partners to ensure that before
  potential wet nurses begin to breastfeed infants,
  they are HIV negative
• This will require the provision of VCT

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Thank you