Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Attachment parenting wikipedia , lookup
Sudden infant death syndrome wikipedia , lookup
Breast milk wikipedia , lookup
Neonatal intensive care unit wikipedia , lookup
Neonatal infection wikipedia , lookup
Breastfeeding promotion wikipedia , lookup
Breastfeeding wikipedia , lookup
Breastfeeding in public wikipedia , lookup
Infant feeding post-tsunami 1 Infant feeding in the post Indian Ocean tsunami context: reports, theory and action Karleen D Gribble BRurSc PhD Telephone: 02 43284340 Fax: 02 96859343 Email: [email protected] School of Nursing, Family and Community Health University of Western Sydney Locked Bag 1797 Penrith South DC NSW 1797 Australia Infant feeding post-tsunami 2 Infant feeding in the post Indian Ocean tsunami context: reports, theory and action Abstract The recent Indian Ocean tsunami resulted in a large-scale disaster in which millions of people required emergency assistance. Reports that some of the assistance provided included the disorganised or liberal distribution of breastmilk substitutes in relief aid are concerning. The reason for this concern is that in emergency situations children who are not breastfed are at a much greater risk of illness and death. Thus, the supply of breastmilk substitutes in such circumstances should be tightly controlled and provided only when absolutely necessary in order to prevent unnecessary weaning. Close supervision of the use of breastmilk substitutes should also be provided so as to minimise risk. In addition, breastfeeding should be protected promoted and supported with exploration of the options of relactation and wet nursing when an infant is not being breastfed. Each infant feeding situation is different and the appropriate solution to any challenge must be individually determined as seen in the examples presented. Those who have knowledge of the risk of breastmilk substitutes in emergency situations can assist by making aid agencies aware of the issues surrounding infant feeding in emergencies, reporting the inappropriate use of breastmilk substitutes and educating others on the value of protecting and supporting breastfeeding, regardless of the context. Key words: breastfeeding, emergency, infant formula, relactation Infant feeding post-tsunami 3 Introduction The tsunami that devastated communities in or bordering the Indian Ocean on December 26th, 2004 was arguably the most destructive natural disaster of modern times. The resultant death toll exceeded 200 000, more than 5 million people were left without basic services and 1.5 million children were orphaned or separated from their families.1 Extensive media attention brought the reality of the tragedy to the notice of the global population and an unprecedented response in giving to aid appeals resulted.2 Staff and volunteers from a multitude of major and minor non-governmental aid agencies as well as many unaffiliated volunteers quickly mobilised to provide emergency relief3 with their efforts widely reported in the media. Those with expertise in the wellbeing of young children examined such media reports carefully because of concern that there could be well-meaning but dangerous distribution of breastmilk substitutes occurring as a part of aid efforts. Unfortunately, there were several worrisome accounts regarding the supply of breastmilk substitutes in tsunami-affected areas. In early January 2005, the website of the aid agency IsrAID included a photo of a Western aid worker in a refugee camp demonstrating how to use breastmilk substitutes. In this photo, mothers sit with their babies and toddlers on their laps. One child is clearly breastfed.4 The text of an associated press release reads, “A delegation has begun teaching mothers how to properly use infant formula to feed their children. As a result of the Tsunami many women were traumatised and no longer able to properly breastfeed. Over 60 mothers brought their children aged ½ year to 3, to the camp. They wished to learn how to properly maintain hygiene while feeding their Infant feeding post-tsunami 4 children with the infant formula provided by our feeding centre. Word has spread, and every day new parents arrive.”5 Somewhat less obvious, but nonetheless disturbing, an article in the Sydney Morning Herald describes how an unaffiliated Australian volunteer in a refugee camp “...gets details of the numbers of families at each camp so she can supply….infant formula to babies.” The volunteer states, “At the moment some babies are being given the wrong formula and the mothers don’t know how to use it. It’s a little bit disorganised.”6 The problem of breastmilk substitutes in emergency situations Concerns associated with the inappropriate distribution of breastmilk substitutes are well founded. According to the World Health Organisation, in the disrupted circumstances that accompany emergencies artificially fed babies have a 1300% increased risk of death from diarrhoeal disease and a 200% increased risk of death from respiratory disease as compared to babies who are breastfed.7 The reasons for this high risk are that the clean water and fuel required for safe artificial feeding are usually scarce in emergency situations while unsanitary and crowded conditions allow diarrhoeal diseases (the most common cause of death in emergency situations)8,9 to flourish.7 In addition, babies that are artificially fed are inherently more vulnerable to disease since they do not receive the anti-infective antibodies that are in breastmilk.7 Experience from past emergencies has been that the risk of death for young children in emergency situations is very high with reported crude mortality rates ranging from 12 to 75%.9,10,11 As one health worker Infant feeding post-tsunami 5 reported, “Younger children require exclusive breastfeeding if they are to have any chance of survival.”12 The poorly controlled distribution of breastmilk substitutes is dangerous because it undermines breastfeeding. Thus, while some babies may have been artificially fed prior to an emergency, easy access to breastmilk substitutes has a direct impact in promoting weaning from the breast and increasing infant mortality.13,14,15 As described by one health care professional in reference to a past emergency, “(this disaster took) infant formula off the shelves where it was too expensive to buy and put it into the clinics and food distributions centres where it is free.”14 Unfortunately, the inappropriate distribution of breastmilk substitutes has had an impact in the current disaster and, for example, in the Indonesian city of Banda Aceh “relief supplies of infant formula has (sic) discouraged breastfeeding and is causing problems, e.g., difficulty finding drinking water to mix with the formula, additional serious health risks for all formula fed babies.”16 The supply of any type of powdered milk is an issue because of the danger of it being used as a breastmilk substitute.17 Thus, in any emergency relief work powdered milk should not be distributed on its own but may be mixed with a milled fortified staple.17,18 A problem in past emergencies that has re-emerged in the post-Tsunami relief work is the unsolicited donation of breastmilk substitutes. From breastmilk substitute manufacturers to individual families who were a part of ad hoc collections, large quantities of breastmilk substitutes were transported into tsunami-affected areas, with the general approval of the public. Thus, one breastmilk substitute manufacturer proudly proclaimed via a news Infant feeding post-tsunami 6 distribution service that they were “donating infant formula and pediatric nutritional drinks to the victims of the Indian Ocean Tsunami disaster…..Many babies and children in the areas affected by the Tsunami will benefit from this type of donation”19 and schools, clubs and individuals made “tsunami” appeals requesting donations of breastmilk substitutes and feeding bottles.20,21,22 Such unsolicited donations are problematic for a number of reasons. Firstly, controlling their distribution can be very difficult and donated breastmilk substitutes may be sent to areas where they are not needed but are nonetheless distributed by those ignorant of the risk.14 Secondly, the products themselves may be unsuitable because they have passed their use-by date, are not labelled with instructions in the language required or are simply nutritionally inappropriate.14 Thirdly, disposal of unusable donations can be difficult and expensive (e.g., during the 1999 Balkan crisis, the destruction of one unusable donation of milk was estimated to have cost US$500 000).14 Despite the problems associated with donated breastmilk substitutes, soon after the Indian Ocean tsunami some aid agencies were also actively requesting donations of milk powder and distributing them.16 The situation was so serious and widespread that it was necessary for Unicef’s Nutrition Section Chief to circulate a letter warning non-governmental aid agencies of the danger milk powder and breastmilk substitutes could pose.23 While most major aid agencies have policies that specify how infant feeding in emergency situations should be handled, it is clear that many smaller agencies do not. In addition, even where there are policies in place, ensuring all staff are adequately trained in this area is difficult. This is particularly the case in large emergencies where coordination challenges can Infant feeding post-tsunami 7 exacerbate the difficulties of making all staff in all agencies aware of procedures.14 Without specific education on the subject, individuals involved in aid work may unwittingly cause harm. Thus, Western staff may extrapolate the experience in their home country of breastmilk substitutes as “just fine” to the emergency situation. This is easy to understand because the infant mortality rate in most Western countries is low and the increased risk of death in non-breastfed babies relatively small. There is little research in this area but a recent study found a 27% increase.24 Local aid workers may believe that the wide distribution of breastmilk substitutes is desirable because of the large quantity of donations arriving in relief aid and the economic value of breastmilk substitutes may make it difficult for aid workers to reject. Mothers may also actively seek breastmilk substitutes believing that such expensive milks are better for their babies than anything they can produce.25 Unfortunately, once breastmilk substitutes have been inappropriately distributed it can be difficult to ameliorate the situation.14 Addressing infant feeding in emergency situations There is consensus amongst the major health and aid agencies on how to manage infant feeding issues in emergency situations17 as outlined below. 1) Women breastfeeding their children are to be supported. This involves giving them given appropriate information, practical assistance and encouragement to continue breastfeeding, especially if they are experiencing difficulties.17 The general recommendation that mothers should be supported to exclusively breastfeed their babies for 6 months and then continue to breastfeed for up to 2 years or beyond also applies in emergency situations.7,11,18 Infant feeding post-tsunami 8 2) Mothers who have weaned their babies should be encouraged, and provided with assistance to relactate as a first choice intervention.17 Relactation being the process by which weaning is reversed.26,27 3) In cases where there are babies whose mothers have died or cannot be located, the option of wet nursing should be explored. In such situations babies may be breastfed by a woman who is already lactating or a friend or relative may relactate or induce lactation.7,15 In locations where there is a high prevalence of HIV infection, care needs to be taken with wet nursing but it is still an option to be explored.28,29,30 4) Only in instances where mothers have weaned and for some reason relactation is not possible or a baby has lost his/her mother and wet nursing is not an acceptable solution should artificial feeding be supported and assistance needs to be provided to minimise risk.15 Such assistance should include ensuring the mother has access to a constant supply of breastmilk substitutes and the necessary resources for preparation. It should also include education on preparation and close monitoring of the use of the breastmilk substitute and health of the baby.15 Where artificial feeding is necessary infants should be fed using cup or spoon. Feeding bottles or teats should never be used due to the risk of bacterial contamination.11,17 It should also be noted that women who are relactating or inducing lactation may need some breastmilk substitute supplements for their babies until their milk supply is sufficient.13,17 Infant feeding post-tsunami 9 Thus, it is clear that distribution of breastmilk substitutes should be tightly controlled, carefully monitored and only provided as a last resort to babies with a clear need.13 The number of infants requiring breastmilk substitutes in most situations is likely to be small15,17 however, when breastmilk substitutes are used appropriately lives can be saved. Supporting Mothers In emergency situations, providing support for mothers to continue to breastfeeding their children is vital. In some circumstances women or aid workers may believe that trauma or stress can prevent mothers from producing sufficient milk for their babies14 (as was described in the previously quoted IsrAID press release).15 However, psychological stress does not impede milk production and the inhibitory effect of stress on the milk ejection reflex will be overcome if the baby continues suckling.14,31 It should be noted that breastfeeding may assist mothers to cope better with their difficult circumstances as breastfeeding decreases mothers’ response to both physical and psychological stress.32 In addition, since breastfeeding involves close physical contact and the release of the hormones oxytocin and prolactin promoting mothering behaviour 33 it may also assist traumatised mothers to be more responsive in their care giving and thus maximise child survival and limit the emotional damage of trauma.7,34,35 Another circumstance in which mothers or aid workers may believe women will be unable to breastfeed is if the mother is malnourished. However, women who are malnourished will continue to make milk in all but the most extreme of cases and in such situations feeding the mother will enable her to feed her child.15,36 Infant feeding post-tsunami 10 Nevertheless, when circumstances are difficult, mothers and caregivers may need special attention and support in order to breastfeed.15 The experience of workers in the field is that it is helpful to provide physical and emotional nourishment via “safe spaces” where stress is reduced and women can find appropriate rations and knowledgeable breastfeeding support.13,18,37 Placing mothers in contact with other mothers who will provide mother-to-mother support is desirable.15 Clearly each infant feeding situation presents differently and resourcefulness on behalf of the carers of infants and aid workers is required in order to minimise the use of breastmilk substitutes and maximise infant survival. Some extracts of published examples of how breastfeeding has been supported in emergency situations follow. A newspaper article describes how a community found care solutions for one family of motherless children after the Indian Ocean tsunami. Her mother and brother are dead, her father is in hospital and her home, by the beach, has been washed away. Two sisters and a brother survive, and like her, are being watched over by former neighbours.…In her makeshift cradle- a sari wrapped around a beam- six month old Senaka knows nothing of these things. She is being breastfed by a family friend Ranaseelan Jeweta, who is also nursing her own baby. “There’s nobody else to do it. The mother is gone. I have to look after her. I have enough milk,” she said.38 Infant feeding post-tsunami 11 And from a previous emergency, an aid worker describes how a number of people worked together to ensure that a baby was given the care she needed. An infant was brought to us whose mother had died, it was already wasted but thirsty and eager to drink…I asked a lactating woman to feed this child in addition to her own since she had enough milk for two. Initially it was quite difficult to get her agreement. I was told that it was culturally unacceptable as the child was no relative. The priest had to help me to persuade her to at least breastfeed the infant until it would recover and reach normal weight. We also promised her extra food for herself. The next day a young woman was brought to the hospital and introduced as the younger sister of the dead mother. She agreed without any resistance to breastfeed her related child. As far as I remember, this young woman had never given birth to a child before herself. These two women saved the infant’s life. The orphan had to be fed frequently. With every feed it attached first to the aunt’s breast to suck. As soon as the sucking became slightly weaker, the baby was attached to the breast of the other lactating woman to satisfy the baby before exhaustion and frustration… It took at least 2-3 weeks until the young woman was able to fully breastfeed the infant. The two women became quite close to each other... The baby developed well. This young woman managed in spite of the difficult circumstances with the help of her family.39 From a specialist in infant and young child feeding in emergency situations, a report of the systematic support of breastfeeding of severely malnourished babies in a refugee camp. Infant feeding post-tsunami 12 Aid workers were faced with infants of less than 6 months at high risk of death…. Although formula feeding was likely to prevent death and ensure recovery it meant, almost always, the end of breastfeeding. In the prevailing circumstances, the then formula fed infant would then be at high risk of relapse due to infection and underfeeding40... We have repeatedly tried “trials” of exclusive breastfeeding in these wasted infants: they are almost always insufficiently strong to stimulate increased breast milk output41…(We employed a) “supplemental suckling” technique. One hour after each 3 hourly breastfeed, that is at 3 hourly intervals, each infant was breastfed again but at this time one end of a size 8 nasogastric tube was placed alongside the mother’s nipple in the infant’s mouth while the other end was below the surface of a rehabilitation infant formula. As the infant suckled, it also sucked on the tube and obtained the formula40…The infants rapidly gained weight AND stimulated the breast more and more as they regained their strength - so that after about 10 days the supplemented `suckling could be stopped and they continued to gain weight at an accelerated rate on breastmilk alone.41 And finally, from an aid worker, how “safe spaces” for breastfeeding support developed in a refugee camp A tent set up for washing babies and staffed by relief workers became an ad hoc meeting place for breastfeeding support. Women with infants found that they could take care of their older children while also consulting with advisors, nurses and midwives about their breastfeeding concerns. Soon each of the 6 (refugee) Infant feeding post-tsunami 13 camps (in that area) had a space set aside where mothers could breastfeed and bathe their children. This enhanced support for breastfeeding….raised awareness of the indiscriminate use of infant formula in the camps and led to its regulation. A relactation programme was started to help mothers who had used donated formula to resume breastfeeding.42 Encouraging the appropriate provision of aid Those who have knowledge of the issues surrounding infant feeding in emergencies have a role to play in encouraging the support of breastfeeding and discouraging the inappropriate use of breastmilk substitutes in such situations. Firstly, individuals can make the aid agency recipients of their monetary contributions aware of the need to adequately train staff to protect and support breastfeeding. They can ensure that the agency has an appropriate policy on infant feeding in emergencies before donating43 (suitable training and information packages are available for free download online).15 In cases where aid agencies are working with overseas partner organisations they should be alerted to the fact that they are also responsible for ensuring that their partner has a suitable infant feeding policy and the ability to implement it.14 Secondly, individuals can be alert to reports of the inappropriate use of breastmilk substitutes in media or aid agency bulletins and inform the relevant authorities (which may mean bringing the issue to the attention of the aid agency or Unicef). If individuals become aware of relief drives requesting donations of breastmilk substitutes or feeding Infant feeding post-tsunami 14 bottles, making them aware of the damage that such donations can cause may prevent inappropriate in-kind donations. Finally, individuals can educate others in the context in which they live and work on the value of protecting and supporting breastfeeding in all environments. The higher the level of knowledge about breastfeeding in the general population the greater chance there is that aid and health care workers might understand the importance of breastfeeding and have the knowledge to support mothers to breastfeed in emergency situations. Conclusion Reports of the liberal or disorganised distribution of breastmilk substitutes by aid workers post the Indian Ocean Tsunami are concerning because of the risk that breastmilk substitutes pose to babies. Supporting and protecting breastfeeding in emergency situations remains the best way in which to maximise the survival of vulnerable infants. Aid agencies and individuals who donate to them are responsible for ensuring that appropriate infant feeding policies are in place and are being followed in emergency situations. References 1. Thieren M. Asian tsunami: death-toll addiction and its downside. Bulletin of the World Health Organisation 2005; 83: 82. Infant feeding post-tsunami 15 2. Anonymous. One world, one response- needed, but not yet forthcoming. The Lancet 2005; 365: 95-96. 3. Lee ACK. The tsunami and the dangers of goodwill. British Medical Journal 2005; 330: 261. 4. IsrAID. Photograph: Ms Gal Lusky, Head of the Israeli Delegation to Sri Lanka, teaches mothers how to use substituted infant formula, 2005. This photograph has now been removed from the website but it was originally retrieved from http://www.israaid.org.il/story_page.asp?id=447 5. Anonymous. Israeli volunteer workers treating thousands in Sri Lanka, 2005. Retrieved online from http://www.israel21c.org/bin/en.jsp?enDispWho=InThePress&enPage=BlankPage&enDi splay=view&enDispWhat=Zone&enZone=InThePress&Date=01/17/05 6. Connolly E. Angel of Thailand back on the front line. Sydney Morning Herald 2005; 7 February, pp. 1,12. 7. World Health Organization. Infant Feeding in Emergencies, A Guide for Mothers, 1997. Retrieved online from http://www.euro.who.int/document/e56303.pdf 8. Toole MJ, Waldman RJ. The public health aspects of complex emergencies and refugee situations. Annual Review of Public Health 1997; 18: 283-312. 9. Yip R, Sharp TW. Acute malnutrition and high childhood mortality related to Diarrhea, lessons from the 1991 Kurdish refugee crisis. Journal of the American Medical Association 1993; 270: 587-590. Infant feeding post-tsunami 16 10. Khan MU. Clinical illnesses and causes of death in a Burmese refugee camp in Bangladesh. International Journal of Epidemiology 1983; 12: 460-464. 11. O’Conner ME, Burkle FM, Olness K. Infant feeding practices in complex emergencies: a case study approach. Prehospital and Disaster Medicine 2001; 16: 231238. 12. Puoane T, Sanders D, Chopra M et al. Evaluating the clinical management of severely malnourished children. The South African Medical Journal 2001; 91: 137-141. 13. IBFAN. Infant Feeding in Emergencies, 2000. Retrieved online from http://www.ibfan.org/english/activities/emergencies/ife01.html 14. Borrel A, Taylor A, McGrath M, et al. From policy to practice: challenges in infant feeding in emergencies during the Balkan crisis. Disasters 2001; 25: 149-163. 15. World Health Organisation, UNICEF, LINKAGES, Emergency Nutrition Network. Infant Feeding in Emergencies. Module 1 for Emergency Relief Staff. Draft Manual for Orientation, Reading and Reference, 2001. Retrieved online from http://www.ennonline.net/ife/module1/ife1dwnld.html 16. Lim R. Aceh Midwifery Relief UpdateTsunami 2004 Updates, Letters to Midwifery Today 2005; January 18. Retrieved online from http://www.midwiferytoday.com/news/news_tsunami.asp 17. Seal A, Taylor A, Gostelow L, McGrath M. Review of policies and guidelines on infant feeding in emergencies: common ground and gaps. Disasters 2001; 25: 136-148. Infant feeding post-tsunami 17 18. World Health Organisation. Infant and Young Child Feeding in the Current Asian Emergency, 2005. Retrieved online from http://www.who.int/child-adolescenthealth/Emergencies/IYCF_emergencies.htm 19. Bright Beginnings Nutritionals. Bright Beginnings ™,the infant formula endorsed by Brooke Shields, donates infant formula and pediatric nutritional drinks to victims of the Indian Ocean Tsunami, 2005. Retrieved online from http://www.prnewswire.com/cgibin/stories.pl?ACCT=105&STORY=/www/story/01-25-2005/0002902203 20. Mercedes College. Tsunami Disaster Relief Appeal, 2005. Retrieved online from http://www.mercedes.adl.catholic.edu.au/tsunami.cfm 21. ABC Western Australia. Exporter seeks supplies for tsunami relief plan, 2005. Retrieved online from http://abc.net.au/wa/news/200412/s1273526.htm 22. Anonymous. Tsunami Victims Relief in Sri Lanka. The McGill Tribune 2005; March 31. Retrieved online from http://www.mcgilltribune.com/news/2005/01/25/News/Tsunami.Victims.Relief.In.Sri.La nka-839875.shtml. 23. Gross R. Reminder message sent by Nutrition Chief Rainer Gross to UNICEF Country Offices, 2004. Retrieved online from http://www.waba.org.my/docs/Emergency%20email.doc 24. Chen A, Rogan WJ. Breastfeeding and the risk of postneonatal death in the United States. Pediatrics 2004; 113: e435-e439. 25. Stojanoska BA, Janeva N, Venovska K. Mother baby station- breast feeding counselling experience in refugee camps in Macedonia. An Asia Pacific Conference of Infant feeding post-tsunami 18 the GIMS Linking & Nurturing Mother Support and Strengthening Maternity Protection, 21 – 25 April 2002, Kuala Lumpur, Malaysia. Retrieved online from http://www.waba.org.my/gims/papers/Biljana-W5.doc 26. World Health Organisation. Relactation: a Review of Experience and Recommendations for Practice. World Health Organisation, Geneva, 1998. Retrieved online from http://www.who.int/child-adolescenthealth/New_Publications/NUTRITION/WHO_CHS_CAH_98_14.pdf 27. Australian Breastfeeding Association. Relactation and adoptive breastfeeding. Melbourne: Australian Breastfeeding Association, 2004. 28. Leyenaar J. Human immuno-deficiency virus and infant feeding in complex humanitarian emergencies: priorities and policy considerations. Disasters 2004; 28: 1-15. 29. Piwoz EG. What are the options? Using formative research to adapt global recommendations on HIV and infant feeding to the local context. World Health Organisation, Geneva, 2004. Retrieved online from http://www.who.int/child-adolescenthealth/New_Publications/NUTRITION/ISBN_92_4_159136_6.pdf 30. World Health Organization,UNICEF, United Nations Population Fund, UNAIDS. HIV and infant feeding, guidelines for decision makers, 2003. Retrieved online from http://www.who.int/child-adolescenthealth/New_Publications/NUTRITION/HIV_IF_DM.pdf 31. Kelly M. Infant feeding in emergencies. Disasters 1993; 17: 110-121. Infant feeding post-tsunami 19 32. Groer MW, Davis MW, Hemphill J. Postpartum stress: current concepts and the possible protective role of breastfeeding. Journal of Obstetrics, Gynecology and Neonatal Nursing 2002; 31: 411-417. 33. Uvnas-Moberg K, Widstrom AM, Werner S, Matthiesen AS, Winberg J. Oxytocin and prolactin levels in breast-feeding women. Acta Obstetrica et Gynecologica Scandinavica 1990; 69, 301-306. 34. Brandt, K., Andrews, C.M., & Kvale, J. Mother-infant interaction and breastfeeding outcome 6 weeks after birth. Journal of Obstetric, Gynecologic and Neonatal Nursing 1998; 27: 169-174. 35. De Andraca, I., Salas, M.I., Lopez, C., Cayazzo, M.S., & Icaza, G. Effect of breast feeding and psychosocial variables upon psychomotor development of 12 month infants. Archivos Latinoamericanos de Nutricion 1999; 49: 223-231. 36. Wellstart International. Breastfeeding in Emergency Situations, 2004. Retrieved online from http://www.waba.org.my/Breastfeeding%20in%20Emergency%20Situations,%20revision %202005.doc 37. Unicef. Information on infant and young child feeding in emergencies for Unicef offices and partners, 2005. Retrieved online from http://www.usbreastfeeding.org/Issue-Papers/Emergency.pdf 38. Farouque F. A village destroyed, the count goes on. Sydney Morning Herald 2004; 31 December. Retrieved online from http://www.smh.com.au/news/Asia-Tsunami/A-villagedestroyed-the-count-goes-on/2004/12/30/1104344930483.html. Infant feeding post-tsunami 20 39. Krumme B. Relactation in difficult circumstances: rising to the challenge. Shared Experiences in Infant and Young Child Feeding, 2003. Retrieved online from http://www.ennonline.net/ife/ifecasestudies.pdf 40. Golden BE, Corbett M, McBurney R, Golden MH. Current issues in tropical paediatric infectious diseases. Malnutrition: trials and triumphs. Transactions of the Royal Society of Tropical Medicine and Hygiene 2000; 94: 12-13. 41. Golden M. Young Infant and Malnutrition, 2000. Accessed online from http://www.univ-lille1.fr/pfeda/Ngonut/2000/0001g.htm 42. Aidwatch. Aid Watch Tsunami Appeal Donation Guide, 2005. Retrieved online from http://www.aidwatch.org.au/assets/aw00641/tsunami%20guide2.pdf 42. Unicef. Mothers and babies benefit from a place of their own: two success stories. BFHI News 1999; Sept/Oct p7.