Mother, Infant and Young Child Nutrition & Malnutrition Mother, Infant and Young Child Nutrition & Malnutrition - Feeding practices including micronutrient deficiencies prevention, control of wasting, stunting and underweight
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Mother, Infant and Young Child Nutrition and Malnutrition

Mother, Infant and Young Child
Nutrition and Malnutrition

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AFASS Principles

AFASS Principles

AFASS means the mother/family:

  • Accept not to breastfeed and thus use exclusive replacement feeding through Breast Milk Substitute (BMS).
  • Consider the Breast Milk Substitute Feasible given the extended family/community but also nature of work and lifestyle of the mother/family.
  • Can Afford to supply enough Breast Milk Substitute feeds for the duration the child needs the alternative e.g. 6 months + other 12-18 months when on complementary foods.
  • Can Sustain the supply of the Breast Milk Substitute and sustain support from the family.
  • Will maintain Safe conditions for the feeds, e.g. in that they have water, storage facilities and sanitation standards.

AFASS Assessment Table

It is important that the decision is made by the mother/family based on an informed understanding of her/their situation.

This table includes key questions to help making an informed and objective decision.

Question Breastfeeding Replacement feeding
Where do you get your drinking water? River, stream, pond, or well Piped water at home or can buy clean water
What kind of latrine/toilet do you have? None or pit latrine Waterborne latrine or flush toilet
How much money could you afford for formula each month?
Ps: calculate the amount based on the local costs
Less than minimum required amount available for formula each month Minimum amount required for formula every month
Do you have a refrigerator with reliable power? No, or irregular power supply Yes
Can you prepare each feed with boiled water and clean utensils? No Yes
How would you arrange night feeds? Preparation of milk feeds at night difficult Preparation of milk feeds at night possible.
Does your family know that you are HIV positive? No Yes
Is your family supportive of milk feeding and are they willing to help? Family not supportive and not willing to help, or don?t know- can?t discuss Family supportive and willing to help

AFASS Criteria

Acceptable: The mother perceives no problem in replacement feeding. Potential problems may be cultural, social, or due to fear of stigma and discrimination.

Feasible: The mother (or family) has adequate time, knowledge, skills, resources and support to correctly mix formula or milk and feed the infant up to 12 times in 24 hours.

Affordable: The mother and family, with community or health system support if necessary, can pay the cost of replacement feeding without harming the health or nutrition status of the family.

Sustainable: Availability of a continuous supply of all ingredients needed for safe replacement feeding for up to one year of age or longer.

Safe: Replacement foods are correctly and hygienically prepared and stored, and fed preferably by cup.

Source: IMCI Complementary Course on HIV/AIDS; Module 3; Counselling the HIV Positive Mother. WHO 2007

14 September, 2019

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