Assessment of asparagus powder distribution program on breastfeeding promotion: perspectives from mothers and health service providers, 2017.

Research Report.

SUMMARY: World Health Organization (WHO) recommends exclusive breastfeeding starting within one hour after birth until six months with continued breastfeeding for at least till one year. The Breast milk contains nutrient proteins, non- protein nitrogen compounds, enzymes, lipids, oligosaccharides, hormones, growth factors, host defense agents, vitamin A, C, B complex, binding proteins, lysozyme and antibodies as well as many other factors that build a strong and healthy human being. Prolactin is the hormone responsible in producing milk. Ideally, women can produce enough milk to meet their infant's demand. However, insufficient milk production is a common problem in Nepal or around the world. Insufficient milk production is one of the most common reasons for discontinuing breastfeeding. Ayurveda is a system of medicine that is based on use of herbs and herbal formulations for providing comprehensive and holistic treatment for human health improvement. Asparagus racemosus, traditionally known as Shatavari is one of the important medicinal herbs that has been used in Ayurveda since pre-vedic time because they were safe to use, cheap and easily available, had no side effects and no residual effects on both lactating women and baby. It belongs to Asparagaceae family. It is being traditionally used as female reproductive tonic. Shatavari has important role to maintain health of female as having action of Rasayan and Balya. The Department of Ayurveda has initiated the distribution of Asparagus powder among lactating women since 2066/67 to support breast milk secretion. The drug distribution program comprises supply of Asparagus powder at the Zonal/District hospitals and Ayurvedic dispensaries along with health education on exclusive breastfeeding to improve child nutritional status. Women receiving services from Zonal/District hospitals and Ayurvedic dispensaries who exclusively breastfed their babies are required to take a regular dose of Asparagus powder for six months. Then, women and their infants are regularly assessed for their health and nutritional status. This study assesses the effectiveness of the Asparagus powder distribution program on breastfeeding promotion. Moreover, the study assesses the mother's and health service provider's perspectives on the effectiveness of Asparagus powder distribution program. Study used multiple methods to collect the data from three districts that were selected randomly from three ecological belts (Mountain, Hill and Tarai), one from each belt. Dolakha, Panchthar, and Rupandehi districts were selected considering the ecological belts. Furthermore, from each district, one Ayurvedic center/dispensary that distributes Asparagus powder to lactating women was selected. In the selected center, we conducted one key informant interview (KII) with focal person at dispensary and one KII with health center officials to collect providers' perspectives precisely. Also, we conducted two focus group discussions (FGDs) in each district with lactating women who have used Asparagus powder in last six months. Specifically, one FGD with the lactating women those were using the Asparagus powder from the health center and one FGD with the same group treated at the dispensary. Thus, a total of 6 KIIs with providers and 5 FGDs with lactating women were conducted. The study revealed that Asparagus powder was distributed to all the women who had child less than six months of age without assessing the sufficiency of milk production across the districts. In some communities, the Asparagus powder was distributed from the immunization center whoever visited the centre for vaccination. Also, FCHVs distributed the Asparagus powder to those who did not visit the center. The main reason of mass distribution was to cover the women those not visiting the Ayurveda health centre. Among those women who have been using the Asparagus powder, instruction regarding dosage was confusing and inconsistent. In some district, they took 2 mg two times a day, whereas in some areas 6mg twice a day. They were prescribed to take one spoon. However, the information on spoon size was not clear. Moreover, clients were explained that the Asparagus powder has no side effects to anyone even among lactating women if it is consumed more than the recommended dosage. Since the dose was not clear to the clients, a guideline with clear instruction on dose, duration, possible side effects, complications and its effectiveness would be instrumental in order to promote use of Asparagus powder. Study revealed that very few lactating women were using the Asparagus powder, mainly due to the lack of awareness on the breastfeeding promotion program. So, airing message through different media would play a vital role on breastfeeding promotion. As there was inconsistency in record keeping system in different districts, it would be helpful to prepare a guideline on record keeping and organize training to the service providers on record keeping and its importance, strengthening the Health Management Information System. Since Female Community Health Volunteers (FCHVs) establishes link between health facilities and community members. So, mainstreaming FCHVs to continuous improvement of program have been crucial to the program's success.