Pilot implementation of a monitoring and enforcement system for the International Code of Marketing of Breast-milk Substitutes in Cambodia.

Globally, monitoring and enforcement mechanisms for the World Health Organization's International Code of Marketing of Breast-milk Substitutes are often lacking. The Cambodian government adopted the Code as the national standard in Sub-Decree 133 on Marketing of Products for Infant and Young Child Feeding. Following the formation of a multisectoral Oversight Board and development of detailed guidance documents for the implementation and enforcement of Sub-Decree 133, a 7-month pilot was conducted in 2017 to trial a monitoring system in four urban areas of Cambodia. The pilot included training of monitors from the Ministries of Health and Commerce, screening for violations at retail locations and health facilities, testing reporting mechanisms, and taking actions against violators. During the pilot, 85 national- and subnational-level monitors were trained, 392 site visits were made, 2,377 monitoring checklists were completed, and 11 warning letters were issued to violators. Half of the completed checklists (52.9%) indicated Code violations, yet monitors submitted zero violation reports. The pilot revealed modifications needed to the monitoring system: integrate monitor trainings into existing ministry training curricula for sustainability; enhance targeting of monitors for Sub-Decree training; delineate clear roles and responsibilities for the national and subnational levels; simplify monitoring checklists and violation reports; and improve integration of monitoring activities into routine ministry operations. Before the Sub-Decree 133 monitoring and enforcement system is implemented throughout Cambodia, revisions must be made to ensure the viability of this system. Challenges and lessons learned can also guide Code monitoring efforts being undertaken by other countries.

[First year of life. Human milk and human milk substitutes]. / Primer año de vida. Leche humana y sucedáneos de la leche humana.

The nutritional improvement of mothers and their children is one of the most cost-effective tools to achieve optimal human growth and development. The World Health Organization recommends offering «exclusive breastfeeding for the first six months, and then begin the introduction of safe and nutritious food while breastfeeding continues until the second year of life.¼ Since the second half of the 20th century to date extraordinary progress in the manufacturing and formulation of substitutes for human milk has been accomplished, these being partial or complete substitutes for human milk, whether or not suitable for this purpose. Whole (cow´s) milk is not an adequate substitute for human milk during the first six months of life because of its great nutritional disparity and excess solutes with potential deleterious effects in infants. Therefore, it is an ethical responsibility of health professional to educate and advise parents and caregivers on the proper and timely use of human milk substitutes available in our country.