Hello,

To support BMS, GOAL Ethiopia is providing Liptomil, for mothers unable to breastfeed and orphans. In the MAMI centre, We show them how to prepare, feed, and store. I have shared one case study below from our Gambela MAMI experiance.

Successful Breast Milk Substitute Programme support to infants who are dependent on Breast Milk substitutes under Management of small & nutritionally At-risk Infants under six months & their Mothers (MAMI) program

Since 2014, GOAL facilitates nutrition services in two large refugee camps namely Tierkadi and Kule in Gambella region with a population of over 100,000 South Sudanese refugees.

Breastfeeding is highly acceptable amongst the refugee population, however, individual infants needing supported artificial feeding are encountered, these infants are highly vulnerable and require urgent and targeted protection and support as they are at risk of morbidity and mortality. In GOAL’s comprehensive nutrition programme there are clear operating procedures for handling breastmilk substitutes and support to artificially fed infants.

Breast Milk substitutes (BMS) are only provided for individual infants 0 - <6 months of age where the need has been established using skilled individual assessment. The criteria for BMS use are as follows:

• Infants 0 - <6 months who are not breastfed and for whom relactation or wet nursing is not possible. This may include orphaned or abandoned infants or infants who have never been breastfed.

• Infants 0 - <6 months who are mixed fed whilst being supported to transition to exclusive breastfeeding. In this case, BMS is used temporarily (for a maximum of 2 months) while the mother/ caregiver is relactating or re-establishing exclusive breastfeeding.

• In exceptional situations where the mother and/or infant has a medical condition, and they are unable to breastfeed and wet nursing is not possible.

In 2014, during the war in South Sudan, Nyarek Chuol and her husband fled South Sudan with their children and sought refuge in Tierkidi refugee camp. In 2020, Nyarek was pregnant, when she was ready to give birth, she went to the health centre in Tierkadi refugee camp. During labor, she experienced obstetric complications and was referred to Jimma hospital, where she gave birth to a healthy baby girl named Nyabum. Following a seven-day stay in the hospital, she was referred back to the refugee camp with her infant, however, she became ill again after fifteen days and was referred to the health centre, where she was admitted and treated for her illness but, on the fifth day Nyarek Chuol passed way, in November 2020 at the health centre.

Following Nyarek’s death, the grandmother took care of the infant, but she was not able to breastfeed, re-lactate or afford to buy powedered milk. So, GOAL supported the infant with breast milk substitutes. The GOAL counselors provided advice for Nyabum’s grandmother in the nutrition centre daily on the preparation, feeding, and storage of the milk until she was well able to prepare the formula milk by herself for Nyabum. Then the grandmother was given formula milk to use at home and she was followed up in her home daily by GOAL’s community outreach agents and she returned every third day to the nutrition centre for assessment and for restocking of milk and materials.

Nyabum is now one year old, she now weights 7.4kg, Height is 68cm MUAC 13CM and Weight for Ht Z-score=>-2. GOAL continues to support Nyabum with play therapy and in the Blanket supplementary feeding programme and her grandmother in the fresh food voucher programme. She is happy and content in this challenging environment, far from her family’s native home.

Very nice example. Thank you for sharing.

Liya - could we use your story of Nyarek Chuol and her baby as a short case history in the South Sudan Medical Journal - see http://www.southsudanmedicaljournal.com/?

If so, could you email me at annpburgess AT gmail.com?

Thanks, Ann

Hello Alice

In the case of Colombia we do not have a specifically successful experience, however, our IYCF-E global advisor suggested us to share the experience we had.

 
In principle we planned that women diagnosed with HIV who were prohibited from breastfeeding (by public policy of the country) and who did not have access to the health system, which by law, delivers the BMS for 12 months, could be targeted to apply the characterization of the multipurpose cash assistance program currently implemented by SC.

As they would be fully identified, the amount of the transfer would be increased, since the transfer currently provided by the program is too low to be able to access the BMS. In the plan, these beneficiaries of extra transfers would be accompanied by the nutrition team of the territory where the mothers are located, to follow up on the preparation, hygiene and supply. 

Unfortunately, we were unable to convince the consortium with which we implemented the multipurpose cash assistance program to advocate with the national authorities, who have limited the value of emergency program transfers, to assimilate it to that of the country's social protection programs. 

I know it is not a successful experience, but as Isabelle mentioned, maybe it can be useful in the planning you are doing. 

Regards

First I want to thank Liya for sharing GOALS clear criteria for BMS supplementation program. Very clear!

Andrea's response, although not very successful, is also useful to know. We need to learn how to do better.

Thank you Andrea and Liya for sharing your experiences.

We have not yet been able to identify any succesful examples of the use of vouchers or cash in BMS programming, I am wondering if this has infact ever been done!

I wonder whether, even if not done directly, cash programming has been done in a context with prevalent BMS-dependent infants and included a consideration on BMS in the design e.g. ensuring that cash-receiving households with BMS-dependent infants are identified and provided with counselling and required support for exploring alternative, safer feeding methods and/or minimising associated risks of BMS use.

Dear colleagues,

We are still seeking operational experiences and examples of where Cash/Voucher Assistance Top Ups have been used to faciliate access to BMS as part of an Artficial Feeding in Emergencies Intervention for BMS-dependent infants or where unrestricted cash transfer programmes have been implemented which target mothers/families in settings where BMS was available. 

Ref OG-IFE 2017, Section 6.20: "Where unrestricted cash transfer programmes are implemented and BMS is available, BMS should not be excluded as an option for purchase by households support (see 5.25 and 6.25). In such instances, accompany cash transfer programmes with strong messaging on the value of breastfeeding, on recommended IYCF practices, and provide information on where all infants can access IYCF support."

This post is to enquire whether any examples have emerged since Alice first posted, (particularly in light of the recent Ukraine Crisis within which CVA is being used as an intervention, formula feeding rates are high and - within refugee host countries - BMS is easily accessible.) 

Thank you!

Isabelle