Alive & Thrive is a six-year (2009-2014) initiative to improve infant and young child feeding practices by increasing rates of exclusive breastfeeding and improving complementary feeding practices. The first two years provide a window of opportunity to prevent child deaths and ensure healthy growth and brain development. Alive & Thrive (A&T) aims to reach more than 16 million children under two years old in Bangladesh, Ethiopia, and Viet Nam through various delivery models. Learning will be shared widely to inform policies and programs throughout the world. Alive & Thrive is funded by the Bill & Melinda Gates Foundation and managed by FHI 360. Other members of the A&T consortium include BRAC, GMMB, International Food Policy Research Institute (IFPRI), Save the Children, University of California-Davis, and World Vision. Suggested citation: Ali D, Tedla M, Subandoro A, Bamezai A, Rawat R, Menon P. Alive & Thrive Baseline Survey Report: Ethiopia. Washington, D.C.: Alive & Thrive, 2011. Alive & Thrive FHI 360 1825 Connecticut Avenue, NW Suite S680 Washington, DC 20009-5721 Tel: (202) 884-8000 Fax: (202) 464-3966 [email protected] www.aliveandthrive.org Table of Contents List of Tables ................................................................................................................................................ vi List of Figures ............................................................................................................................................. viii List of Annex Tables ..................................................................................................................................... ix List of Annex Figures ..................................................................................................................................... x Acronyms .................................................................................................................................................... xii Executive Summary ..................................................................................................................................... xiv 1. Introduction ............................................................................................................................................. 1 1.1 Brief Overview of the Nutrition Situation in Ethiopia ........................................................................ 1 1.2 Description of Alive & Thrive Program in Ethiopia ............................................................................ 1 1.3 Objectives of the Impact Evaluation .................................................................................................. 4 1.4 Structure of the Report ...................................................................................................................... 4 2. Methods ................................................................................................................................................... 6 2.1 Conceptual Framework ...................................................................................................................... 6 2.2 Evaluation Design ............................................................................................................................... 6 2.2.1 Description of evaluation design ................................................................................................ 6 2.2.2 Sample size .................................................................................................................................. 8 2.2.3 Sampling and selection of eligible households ........................................................................... 8 2.3 Data Collection Methods ................................................................................................................. 10 2.3.1 Design and content of survey questionnaires .......................................................................... 10 2.4 Training of Personnel ....................................................................................................................... 13 2.4.1 Training of interviewers ............................................................................................................ 13 2.4.2 Training and standardization in anthropometric measurements ............................................. 15 2.5 Fieldwork Logistics ........................................................................................................................... 16 2.5.1 Composition of survey team ..................................................................................................... 16 2.5.2 Administration of the household survey and anthropometric measurements ........................ 16 2.5.3 Administration of the community and health staff questionnaires ......................................... 17 2.5.4 Supervision and quality control ................................................................................................ 17 2.5.5 Fieldwork constraints ................................................................................................................ 17 2.5.6 Data management ..................................................................................................................... 18 2.5.7 Data analysis ............................................................................................................................. 18 2.5.8 Limitation of the survey ............................................................................................................ 18 3. Results: Sample Characteristics ............................................................................................................. 20 3.1 Variables ........................................................................................................................................... 20 3.2 Results of Sample Characteristics .................................................................................................... 20 iii 4. Results: Key Impact Indicators ............................................................................................................... 23 4.1 Variables ........................................................................................................................................... 23 4.2 Results: Core A&T Impact Indicators ............................................................................................... 23 4.3 Results: Anthropometric Outcomes................................................................................................. 24 4.3.1 Mean anthropometric indices ................................................................................................... 24 4.3.2 Stunting, underweight, and wasting ......................................................................................... 29 4.4 Results: IYCF Indicators .................................................................................................................... 32 4.4.1 Overall patterns of IYCF ............................................................................................................ 32 4.4.2 Breastfeeding-related practices ................................................................................................ 34 4.4.3 Complementary feeding-related practices ............................................................................... 36 4.5 Chapter Summary ............................................................................................................................ 38 5. Results: IYCF Practices, Challenges, and Child Feeding Knowledge ....................................................... 40 5.1 Variables ........................................................................................................................................... 40 5.2 Breastfeeding Challenges ................................................................................................................. 41 5.3 Complementary Practices and Challenges ....................................................................................... 42 5.4 Knowledge about IYCF Practices ...................................................................................................... 45 5.5 Awareness, Trial, and Adoption of Key IYCF Practices ..................................................................... 50 5.6 Chapter Summary ............................................................................................................................ 51 6. Results: Use of A&T Platform ................................................................................................................. 52 6.1 Variables ........................................................................................................................................... 52 6.2 Community/Health System Platform ............................................................................................... 52 6.3 Exposure to Media ........................................................................................................................... 57 6.4 Access and Use of Markets .............................................................................................................. 59 6.5 Chapter Summary ............................................................................................................................ 60 7. Results: Child, Caregiver, and Household Characteristics That Influence