Infant and Young Child Feeding Practices in Borena, SOUTH WOLLO, AMHARA, ETHIOPIA

POLICY BRIEF Infant and Young Child Feeding Practices IN Borena, SOUTH WOLLO, AMHARA, ETHIOPIA Information about current health and nutrition HIGHLIGHTS practices at the community level is essential for • Malnutrition among children in Borena is high. Stunting understanding where problems lie and making decisions about what steps can be taken to is especially serious, affecting 31 percent of children support improvements. This brief provides younger than 2 years. summary information on infant and young child • Infant and young child feeding is suboptimal. While feeding (IYCF) practices in Borena, a woreda most children (79 percent) start consuming foods in (district) in South Wollo zone of Amhara Region, addition to breastmilk at 6–8 months of age, their Ethiopia. The data were gathered during a recent household survey conducted in 12 woredas in diets are not sufficiently diverse. The World Health South Wollo, where efforts are under way by Organization (WHO) recommends a diet that includes the Alive & Thrive initiative, in partnership with foods from four or more of the recommended food Concern Worldwide, to improve IYCF practices. groups.3 In Borena, on average, children eat from only 1.9 food groups per day, and only 8 percent of children The data focus on the underlying and immediate receive foods from at least four of the recommended causes of malnutrition in the first 1,000 days groups. In particular, consumption of foods that contain of life—conception to 2 years of age—and are intended for use by woreda-level decisionmakers sufficient iron (meat or iron-fortified foods) is low. (administrators, nutrition officers, health extension • The diets of mothers/caregivers in Borena also are not officers, agriculture officers and others) who can sufficiently diverse: only 29 percent eat foods from four contribute to positive changes. They are meant or more of the recommended food groups. to serve as a basis for designing action plans at the woreda level and to support the goals of • Home visits by Health Extension Workers (HEWs), the National Nutrition Programme’s “Lifecycle Health Development Army (HDA) volunteers and 1 Approach,” which emphasizes the first 1,000 days. other frontline workers are not adequate. In the three months preceding the survey, only 22 percent POPULATION OF BORENA2 of households received a visit by a HEW and only 5 Women: 88,019 percent were visited by a HDA volunteer. Further, Men: 87,038 Total: 175,057 information provided during the visits lacked comprehensive messages on IYCF practices. www.aliveandthrive.org JUNE 2015 Cereals Legumes Milk and milk products Meat Eggs Vit A rich fruits and vegetables Other fruits and vegetables 0 20 40 60 80 100 Strachy staple foods Legumes Nuts and seeds Dairy Meat Eggs Vitamin A rich dark leafy vegetables Other Vit A rich fruits and vegetables Other vegetables Of these, 42 percent wereOther 0–5 fruits months old and 58 percent were 6–23 months old. 0 20 40 60 80 100 KEY RECOMMENDATIONS: • To reduce stunting in Borena, the diets of children Of the households surveyed, 29 percent reported being 100 younger than 2 years should be improved to include either100 a current or former member of PSNP and 7 percent were members of the Household Asset Building Programme, more diversity. Children should consume foods 80 80 another food security program of the Ethiopian government. from at least four of the WHO-recommended food 60 60 groups, including a serving of meat, milk or eggs. SURVEY FINDINGS 40 40 • Visits by HEWs and HDA volunteers should be LEVELS OF HOUSEHOLD FOOD SECURITY more frequent and include counseling on exclusive In 20Borena, approximately 36 percent of20 households were identified as having secure access to food; 18 percent experi- breastfeeding, the timely introduction of comple- 0 0 enced mild food insecurity; 40 percent experienced moderate mentary foods and specific foods to give to children Dairy MeatEggs Meat Eggs insecurity; and 6 percent were severelyCereals food insecure. Legumes Legumes older than 6 months in addition to breastmilk. Other fruits Nuts and seeds Other vegetables Strachy stapleNUTRITIONAL foods STATUS OF CHILDREN YOUNGER Milk and milk products THAN 2 YEARS Other fruits and vegetables Vit A rich fruits and vegetables $ Stunting rates of children Figure 1: Prevalence of Why are the first 1,000 days important? Vitamin A rich dark leafy vegetables BF = breastfeeding youngerOther Vit than A rich fruits 2 andyears vegetables in Borena stunting by age group Investments in good nutrition duringCF the= complemen first 1,000tary feeding days 68 68 $ ITN = insecticide treated nets were high (26 percent), as at Amhara of a child’s life contribute to his or her long-term health and Amhara National the nationalNational level (29 percent). wellbeing, and can also benefit future generations. 49 49 $ Across all woredas, stunting 39 37 39 37 5 $ rates started increasing at 6 The biggest window of opportunity for preventing undernutrition in the first 1,000 days of life is the period months of age and reached 9 9 when a child consumes foods in addition to breastmilk a high6 of4 45 percent among 6 4 (6–23 months of age). A large proportion of stunting in children aged 12–23 months BF CF ery SH oid eria ITN Zinc cine A cine g India c ox c 3 thiopia Ni a W amin A a (Figuremo 1).mo Stuntingmo mois causedmo mo mo mo mo mo low-incomeE countries occurs during this critical period. angladesh an dliv Vit B Hib v anus t Cle et asles v by a combination of factors, T Me IfSource: children Hoddinott in Borena et al eat better, they will grow better—both including long-term insufficient food intake, poor IYCF physically and mentally. This will improve their learning practices and frequent infections early in life. capacity, as well as their employment opportunities later in INITIATION OF BREASTFEEDING life. Girls will also grow into women who are better prepared Initiation of breastfeeding within the first hour after birth to bring healthy infants into the world. can help prevent neonatal death, especially in preterm and BACKGROUND low-birthweight infants. Colostrum, the sticky, yellow-white early milk, rich in antibodies, vitamin A and other protective The data included in this brief were collected as part of a factors, has been called baby’s first immunization. Infants household survey conducted in October and November should be given no prelacteal feedsi such as water, other of 2014 by Addis Ababa University. They will provide a liquids or ritual foods. baseline for a comparative evaluation of two intervention packages designed to integrate IYCF activities into Ethiopia’s In Borena, only 69 percent of women surveyed said they Productive Safety Net Programme (PSNP), which is “aimed had initiated breastfeeding of their youngest infant within at enabling the rural poor facing chronic food insecurity to the first hour of birth and 81 percent reported that they resist shocks, create assets and become food self-sufficient had given their baby colostrum. In addition, 24 percent of through the provision of food and/or cash transfers.”4 infants had received prelacteal feeds. Sugar/glucose water or raw butter was given most frequently. The survey was carried out in 72 kebeles (wards or neighbor- hood associations) randomly selected from 12 woredas: Albu- EXCLUSIVE BREASTFEEDING ko, Ambasel, Borena, Kelela, Kutaber, Mahal Saint, Mekedela, Breastmilk contains all the nutrients that a baby needs Saint Ajibar, Tehuledere, Tenta, Wogedi and Worebabo. for the first six months of life. WHO recommends exclusive breastfeeding—with no other foods or fluids including A total of 3,583 mothers/caregivers of children aged 0–23 water—until a baby is six months of age. At the time of the months participated in the survey. Among the sample of survey, a significant proportion (74 percent) of babies 0-5 children, 54 percent were boys and 46 percent were girls. months of age were being exclusively breastfed. i 2 Foods given to newborns before breastfeeding has been established. INTRODUCTION OF COMPLEMENTARY FOODS AT DIETS OF MOTHERS 6 MONTHS Only 29 percent of mothers reported having consumed A large proportion of child stunting occurs within 6–23 at least one serving fromCereals at least four of the WHO- months of age. Appropriate feeding promotes growth and recommended foodLegumes groups the previous day. Very few prevents stunting during this time, and the timing as well mothers reportedMilk and milk having products eaten animal products like milk, as the quality of the foods is crucial. More diverse diets are meat or eggs (Figure 3).Meat Consumption of vitamin A rich 2 associated with lower stunting rates. fruits and vegetables likeEggs pumpkin, carrots and kale was also very low. Mothers consumed more legumes than Vit A rich fruits and vegetables In Borena, introduction of foods in addition to breastmilk ap- children, however. Other fruits and vegetables peared timely for most children, with 75 percent of caregivers 0% 20% 40% 60% 80% 100% reporting they began to feed solid and semisolid foods when Figure 3: Food groups consumed by mothers in the day preceding the survey (at least one serving) N=1,198 a child was 6–8 months of age. For 25 percent of children, however, solid foods were introduced later than 6–8 months. Strachy staple foods Legumes In addition, foods introduced to young children were not Nuts and seeds Dairy sufficiently varied. According to WHO, children should be Meat fed from at least four of the recommended food groups Eggs each day: grains, roots and tubers; legumes and nuts; dairy Vitamin A rich dark leafy vegetables Other Vit A rich fruits and vegetables products; flesh foods (meat, fish, poultry, liver or other Other vegetables organ meats); eggs; vitamin A rich fruits and vegetables; Other fruits 0% 20% 40% 60% 80% 100% and other fruits and vegetables.5 The survey found that only 8 percent of children in Borena HANDWASHING PRACTICES were receiving foods from the recommended four or more 100 Handwashing with soap and water100 before preparing or food groups each day; on average, eating from only 1.9 of giving a child food and after using a latrine or cleaning a 80 80 these groups (Figure 2).

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