Breasfeeding Survey in Refugee Camps in Macedonia

BREASFEEDING SURVEY IN REFUGEE CAMPS IN MACEDONIA

Biljana Ancevska Stojanoska,MD, Nadica Janeva,MD,Katerina Venovska,MD

Centar for family motherhood and childhood support- Ibfan Macedonia,

29 November 27b Skopje, 1000,Macedonia e-mail:

More than 300.000 Kosovar refugees crossed the Macedonian border from March to June 1999.

120000-140000 were accommodated in camps. There has been concern in the national and international community that infant feeding practices were inappropriate in the refugee camps. So by may combine nutritional and health surveys were initiated in 3 larger camps separetely and the fourth survey was conducted using the four smaller camps together. The aim of the surveys was to assess the prevalence of breast feeding and feeding pattern in infants and young children. A systematic random sample of household was taken, a household being defined as a group of persons occupying the same structure and sharing the household resources .The survey population included 1421 households and 1001 children age under 5 years. Within the questionnaire there were two questions each with yes/no answer :“.Does your child receive breast milk ? and “Does your child receive infant formula?” From the results of all 4 surveys

combined , more than 2/3 of children less than 4 months were receiving breast milk and only one in twenty was receiving infant formula(table 1). It can be also stated that 23% of children <4 months were receiving neither breast milk or formula. In other words 23% of children in refugees camps in Macedonia were not receiving appropriate nutrition..

Table 1:Infant feeding among children<12 months by age .Kosovar refugees in camps in Macedonia

We didn’t ask what food those 23% of children not receiving breast milk or infant formula were receiving. But several factors point to cows milk and complementary foods because at the time of the survey there was liquid milk distribution for the population ,with those under three years receiving an additional ratio. Although Balkans states were generally recognized as breast feeding societies , it was also well known that in Kosovo infant feeding practices were more often inappropriate. Early introduced of complementary foods was common among Kosovo mothers. Cows milk mixed with bread or biscuits was the normal weaning food, and the mothers in the camps recognized liquid milk as appropriate food for their children under 4 months. Some mothers who were not receiving enough food for themselves chose not to breast fed in order to give their children “good” donated food. Following the emergency, infant formula, baby cereals, dehydrated baby meals and prepared jars of fruits and mixed meals for weaning purpose were brought up into the country and distributed to international NGO’s. The knowledge and attitudes of intnernational staff were extremely variable. There were some individuals with sound knowledge and understanding of the International Code of marketing of breastmilk substitutes and were implementing good practice. Other international staff were clearly not very knowledgeable about breastfeeding issues at all. Instead of conclusion we will present infant feeding interventions in Macedonia during the refugee crisis:

a) Mother and baby “station” were the main focus on infant feeding intervention for the refugee population b) 5 days training programme to provide primary health care (PHC) training for NGO health workers with one day allocated for breastfeeding.

c) Conducting theorethical and on job training for NGO’s health staff working in the camps

d) Availability of training material with approriate information about breasfeeding on local linguages

e) Initiative of Unicef to deal with infant formula in the country so they were stored and not distributed on.

References:

1.Woodruff BA,McBurney R, Janeva N, Stojanoska B, Venovska K, Report: Nutritional and health survey of Kosovar refugees in the camps in FYRMacedonia

2.Vivienne Forsythe, Report of WHO infant feeding consultancy to the FYRMacedonia

3.Meeting the nutritional needs of infannt during emergencies:recent experiances and dilemmas,Report of an international workshop IMCH,London ,november 1999