Ten Steps to Successful Breastfeeding
The Mother and Child Health and Education Trust takes great pleasure in
presenting our new website
Ten Steps to Successful Breastfeeding and the new 10 step video series,
in association with UNICEF Maharashtra, to support this year's
World Breastfeeding Week campaign.
Research shows that the best feeding option globally is initiation of
breastfeeding within the first half-hour of life, exclusive breastfeeding
for a full six months, safe, age-appropriate and adequate complementary
foods from six months, and continued breastfeeding through the second year
or beyond. Breastfeeding improves short and long term maternal health; and
can contribute to the attainment of the
Development Goals (MDGs) 4: Reduce Child Mortality and 5: Improve
Maternal Health (www.un.org/milleniumgoals)
to which many countries and agencies are committed.
The Baby-Friendly Hospital Initiative (BFHI), launched in 1991, is an effort
by UNICEF and the World Health Organization to ensure that all maternities,
whether free standing or in a hospital, become centres of breastfeeding
support. A maternity facility can be designated 'baby-friendly' when it does
not accept free or low-cost breastmilk substitutes, feeding bottles or
teats, and has implemented 10 specific steps to support successful
breastfeeding. The process is currently controlled by national breastfeeding
authorities, using Global Criteria that can be applied to maternity care in
In an effort to revitalise and expand the initiative, this year's World
Breastfeeding Week (WBW) highlights these Ten Steps to Successful
Breastfeeding - "Breastfeeding: Just 10 Steps. The Baby-Friendly Way". The
WBW is the greatest outreach vehicle for the breastfeeding movement, being
celebrated in over 120 countries. It promotes, protects and supports
breastfeeding. Officially it is celebrated from 1–7 August. However,
groups may choose other dates to make it a more successful event in their
countries. For more information on the theme, exciting activities &
materials for download, please visit the
Action at community level is particularly important, since globally only 56%
of women deliver their babies in a health facility, (only 33% in the least
developed countries) and they may be discharged within a day or two. Women
need ongoing support in the community whether they deliver in hospital or at
home. The steps practised in hospital, even Step 10, are not enough to
enable women to sustain exclusive breastfeeding.
The full video series is available for viewing and download at
14 October, 2009
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Diarrhoea: Why children are still dying and what can be done
Diarrhoea is the second leading cause of death among children under five
globally. Nearly one in five child deaths – about 1.5 million each year – is
due to diarrhoea. It kills more young children than AIDS, malaria and
measles combined. Today, only 39 per cent of children with diarrhoea in
developing countries receive the recommended treatment, and limited trend
data suggest that there has been little progress since 2000.
The objective of this WHO/UNICEF report is to focus attention on the
prevention and management of diarrhoeal diseases as central to improving
child survival. It examines the latest available information on the burden
and distribution of childhood diarrhoea. It also analyses how well countries
are doing in making available key interventions proven to reduce its toll.
Most importantly, it lays out a new strategy for diarrhoea control, one that
is based on interventions drawn from different sectors that have
demonstrated potential to save children's lives. It sets out a
that includes a treatment package to reduce childhood diarrhoea deaths, as
well as a prevention package to make a lasting reduction in the diarrhoea
burden in the medium to long term.
The report highlights the proven diarrhoeal disease prevention and treatment solutions already available today. Many children in the developing world
cannot access urgent medical care for severe illnesses, making prevention methods—including improved hygiene, sanitation, safe drinking water,
exclusive breastfeeding, and vaccines preventing rotavirus—critical components of diarrhoeal disease control. When diarrhoea occurs, it can be
effectively treated with simple solutions, including oral rehydration therapy/oral rehydration solution, zinc and other micronutrients, and continued feeding.
Clinical management of acute diarrhoea
World Health Organization (WHO), UNICEF
This official joint statement updates previous WHO/UNICEF recommendations on the management of acute diarrhea, taking into
consideration new research findings that indicate the success of interventions incorporating reduced-osmolarity ORS and zinc
English 241kb •
Español 409kb •
Diarrhoea treatment guidelines including new recommendations for the use of ORS and zinc supplementation for clinic-based
US Agency for International Development (USAID) Micronutrient Program
These guidelines were developed to advise clinic-based health workers on implementing the latest WHO/UNICEF recommendations for ORS
and zinc supplementation in the clinical management of diarrhoea.
English 401kb •
Español 331kb •
Français 171kb •
Guidelines for new diarrhea treatment protocols for community-based healthcare workers
USAID Micronutrient Program
These guidelines were developed to advise community health care workers who assist parents with home treatment of children with
diarrhea with regard to the latest WHO/UNICEF recommendations.
English 128kb •
This website provides up-to-date and comprehensive information and links to resources on diarrhoea, dehydration, oral rehydration,
breastfeeding, and related topics.
A simple solution
This news article provides a comprehensive update on the current use of ORS to treat severe diarrhea, as well as other promising
interventions, including rotavirus vaccines.
Implementing the new recommendations on the clinical management of diarrhoea - guidelines for policy makers and programme
This manual advises policy makers and program managers on implementing and/or scaling up use of the new ORS formulation and zinc
supplementation for the clinical management of diarrheal disease, as recommended by WHO and UNICEF.
English 377kb •
Français 527kb •
The treatment of diarrhoea: A manual for physicians and other senior health workers
Developed for physicians treating infectious diarrhea in young children, this manual has been updated to include guidelines for the
use of reduced-osmolarity ORS and zinc supplements.
English 1mb •
The evolution of diarrhoeal and acute respiratory disease control at WHO: Achievements 1980–95 in research, development and
This document summarizes the evolution of WHO’s strategy toward researching and implementing interventions for diarrheal disease and
acute respiratory disease control in the developing world, including a focus on current integrated strategies for child health.
consultation on oral rehydration salts (ORS) formulation
WHO, UNICEF (WHO/FCH/CAH/01.22)
This meeting report provides background information essential to an expert committee’s consensus toward reducing the osmolarity of
previous ORS standards.
Improved formula for oral
rehydration salts to save children’s lives
This press release announces WHO and UNICEF adoption of the new, reduced-osmolarity formulation of ORS and provides links to
informative resources from both organizations.
Monograph for oral rehydration salts
WHO, The International Pharmacopoeia
This updated monograph on the new, low-osmolarity formula of ORS was revised to provide the quality specifications as adopted by the
WHO Expert Committee on Specifications for Pharmaceutical Preparations in October 2005. The monograph was prepared for inclusion in
the fourth edition of The International Pharmacopoeia, currently in press.
Oral rehydration salts: Production of the new ORS
WHO, UNICEF (WHO/FCH/CAH/06.1)
Updated in 2006, this manual provides comprehensive information on manufacturing the new formula of low-osmolarity ORS.
Managing acute gastroenteritis among children: Oral rehydration, maintenance, and nutritional therapy
US Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. 52(RR-16):1-16.
This publication provides guidelines for the use of ORS for clinical management of diarrhea, discusses various formulations of ORS,
addresses challenges related to the administration of ORS, and encourages the use of ORS in the home to potentially avoid clinic
visits and hospitalizations.
Reducing deaths from diarrhea through oral rehydration therapy
Victora CG, Bryce J, Fontaine O, Monasch R. Bulletin of the World Health Organization. 78(10):1246-1255.
This report evaluates global use of ORS and its impact on reducing diarrheal disease mortality. The authors call for continued and
improved data collection regarding the use of ORS and note the benefits such data offer toward informing public health policies and
diarrhoeal diseases: Information for pharmacists and other drug sellers
WHO Department of Child and Adolescent Health and Development
This guide aims to improve the practices of pharmacists and drug sellers by providing details on avoiding inappropriate
interventions for diarrhea, including underuse of ORS and overuse of antibiotics.
Clinical trials of improved oral rehydration salt formulations: A review
Bhan M, Mahalanabis D, Fontaine O, Pierce N. Bulletin of the World Health Organization. 72(6):945–955.
The authors of this review assess the efficacy and use of different formulations of ORS, as determined in previously published
Falling diarrhoea mortality in Northeastern Brazil: Did ORT play a role?
Victora C, Olinto M, Barros F, Nobre L. Health Policy and Planning. 11(2):132–141.
This study provides data that supports the impact of ORS on dramatic reductions in diarrhea deaths recorded after its introduction
in Brazil in the 1980s.
Impact of oral rehydration and selected public health interventions on reduction of mortality from childhood diarrhoeal diseases
Gutierrez G, et al. Bulletin of the World Health Organization.74(2):189–197.
This study evaluates the impact of education, ORS introduction, and sanitation improvements on the incidence of diarrheal disease
mortality in Mexico between 1978 and 1993.
Multicentre evaluation of reduced-osmolarity oral rehydration salts solution (abstract only)
International Study Group on Reduced-osmolarity ORS Solutions. Lancet. 345(8945):282-285.
The investigators in this study compared the efficacy of reduced-osmolarity and standard ORS in children with acute diarrhea in four
developing countries and determined that reduced-osmolarity ORS is the more appropriate intervention for children with non-cholera
Reduced osmolarity oral rehydration solution for treating dehydration due to diarrhoea in children: Systematic review
Hahn S, Kim Y, Garner P. British Medical Journal; 323:81–85.
Another evaluation of standard versus reduced-osmolarity ORS, this analysis involved data from 15 trials and determined that
treatment with reduced-osmolarity solution resulted in decreased stool output and vomiting and reduced the need for intravenous
Symptomatic hyponatremia during treatment of
dehydrating diarrheal disease with reduced osmolarity oral rehydration solution (abstract only)
Alam N, et al. Journal of the American Medical Association. 296:567-573.
Authors of this study evaluated the risk of hyponatremia, or reduced sodium levels in the blood, among infants hospitalized with
dehydrating diarrhea and treated with reduced-osmolarity ORS. The investigators found no increased risk for hyponatremia when the
new ORS formulation was used to treat the infants' dehydration.