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FOCUSING on IMPROVING COMPLEMENTARY FEEDING in ETHIOPIA Trials of Improved Practices in an Urban Area

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FOCUSING on IMPROVING COMPLEMENTARY FEEDING in ETHIOPIA Trials of Improved Practices in an Urban Area USAID’S INFANT & YOUNG CHILD NUTRITION PROJECT PATH/Evelyn Hockstein PATH/Evelyn ETHIOPIA FOCUSING ON IMPROVING COMPLEMENTARY FEEDING IN ETHIOPIA Trials of Improved Practices in an Urban Area DECEMBER 2011 This document was produced through support provided by the United States Agency for International Development, under the terms of Cooperative Agreement No. GPO-A-00-06-00008-00. The opinions herein are those of the author(s) and do not necessarily reflect the views of the United States Agency for International Development. IYCN is implemented by PATH in collaboration with CARE; The Manoff Group; and University Research Co., LLC. 455 Massachusetts Avenue NW, Suite 1000 Washington, DC 20001 USA Tel: (202) 822-0033 Fax: (202) 457-1466 Email: [email protected] Web: www.iycn.org Table of contents Acronym list ................................................................................................................................ 4 Acknowledgments ...................................................................................................................... 5 About the Infant & Young Child Nutrition Project.................................................................... 5 Executive summary .................................................................................................................... 6 Conclusions ................................................................................................................................ 8 Background ................................................................................................................................. 9 Overview of infant and young child nutrition status ............................................................... 9 Overview of information on complementary feeding practices ........................................... 10 Research methodology ............................................................................................................ 11 Results of household trials ...................................................................................................... 15 Results by age group ............................................................................................................... 17 Children 6–8 months ............................................................................................................................... 17 Current practices ..................................................................................................................................... 17 Overview of TIPs .................................................................................................................................... 18 Detailed results by recommendation ....................................................................................................... 18 Review of 24-hour food recalls ............................................................................................................... 20 Conclusions ............................................................................................................................................. 21 Children 9–11 months .............................................................................................................. 21 Current practices ..................................................................................................................................... 22 Overview of TIPs .................................................................................................................................... 22 Detailed results by recommendation ....................................................................................................... 22 Review of 24-hour food recalls ............................................................................................................... 23 Conclusions ............................................................................................................................................. 24 Overview of TIPs .................................................................................................................................... 25 Detailed results by recommendation ....................................................................................................... 25 Review of 24-hour food recalls ............................................................................................................... 27 Conclusions ............................................................................................................................................. 28 Children 18–24 months ............................................................................................................ 29 Current practices ..................................................................................................................................... 29 Overview of TIPs .................................................................................................................................... 29 2 Detailed results by recommendation ....................................................................................................... 30 Review of 24-hour food recalls ............................................................................................................... 31 Conclusions ............................................................................................................................................. 33 Overall conclusions .................................................................................................................. 33 Positive Child feeding practices .............................................................................................................. 33 Poor practices that can be improved ....................................................................................................... 34 Appendix 1: The Research Team ............................................................................................ 36 Appendix 2: Assessment and Counseling Guide for Complementary Feeding Practices 37 Appendix 3: Tally of all Recommendations Offered .............................................................. 40 Appendix 4: Energy and Micronutrient Values used in 24-Hour Recall Analysis ............... 42 3 Acronym list ANC antenatal care DHS Demographic Health Survey FGD focus group discussion IYCF infant and young child feeding IYCN Infant & Young Child Nutrition Project OVC orphans and vulnerable children PMTCT prevention of mother-to-child transmission RTs Recipe Trials TIPs Trials of Improved Practices UGP Urban Garden Program USAID United States Agency for International Development 4 Acknowledgments We would like to thank the teams of researchers (see Annex I) who interviewed and counseled mothers during the Trials of Improved Infant Feeding Practices (TIPs) and the families who let them into their homes. We appreciate the time they gave to share their opinions and thoughts on their current practices and the new practices they tried over the course of the two household visits. We would also like to thank the Agricultural Extension Workers and Community Mobilizers from the Urban Garden Project (UGP) who helped to identify and guide our household visits during the course of this research. Their assistance was invaluable to implementing this research in a timely and effective manner. We also appreciate the support of the national- and regional- level staff of UGP, including Nancy Russell, Ketema Abebe, Alem Yalew, Kinfachew Demeke, Gebru Tilaye, and Fikre Enque. About the Infant & Young Child Nutrition Project The IYCN Project is the United States Agency for International Development’s (USAID’s) flagship project on infant and young child nutrition (IYCN). Begun in 2006, the five-year project aims to improve nutrition for mothers, infants, and young children, and prevent the transmission of HIV to infants and children. IYCN builds on 25 years of USAID leadership in maternal, infant, and young child nutrition. Our focus is on proven interventions that are effective during pregnancy and through the first two years of life. For more information, please visit www.iycn.org. 5 Executive summary Inappropriate complementary feeding practices are a major contributor to poor nutrition status among children under two in Ethiopia. The just-released preliminary results from the 2011 Demographic Health Survey (DHS) show that stunting, under-weight, and wasting persist as major public health problems. Rates of malnutrition have declined only slightly in the past five years, with 44.4 percent stunting, 28.7 percent under-weight, and 9.7 percent wasting. These national levels mask geographic differences—malnutrition is higher in rural versus urban areas, and some regions are more severely affected—but to a certain extent, malnutrition cuts across all income levels. It is not exclusively an economic issue. Encouraging and supporting appropriate complementary feeding practices for children under age two are critical elements of efforts to address malnutrition. The promotion of generic messages based on international guiding principles for complementary feeding has not resulted in positive change in practices. The Infant & Young Child Nutrition (IYCN) Project supported the implementation of qualitative research—a set of Trials of Improved Practices (TIPs)—in an effort to better understand current practices among an urban population, some of who are engaged in the USAID’s Urban Gardens
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