Integrated KAP Survey Knowledge, Attitudes, and Practices Jamshoro District, Sindh Province, Pakistan December 2016 Table of Contents Acknowledgments ....................................................................................................................................................... 3 Acronyms and Abbreviations ....................................................................................................................................... 4 1. Executive Summary .......................................................................................................................................... 5 2. Introduction......................................................................................................................................................... 7 3. Survey Objectives ............................................................................................................................................. 9 4. Methodology....................................................................................................................................................... 9 4.1 Type of Survey and Survey Area ................................................................................................................. 9 4.2 Study Period .................................................................................................................................................. 10 4.3 Study Population .......................................................................................................................................... 10 4.4 Study Design and Sample Size .................................................................................................................. 10 4.6 Sample Size .................................................................................................................................................. 11 4.7 Data Collection Methods ............................................................................................................................. 11 4.8 Training and Formation of Survey Teams ................................................................................................ 12 4.9 Data Analysis ................................................................................................................................................ 12 5. Results .............................................................................................................................................................. 12 5.1 Infant and Young Child Feeding ................................................................................................................ 12 5.2 Water and Sanitation ................................................................................................................................... 19 5.3 MORBIDITY ................................................................................................................................................... 25 5.4 Food Security ................................................................................................................................................ 27 6. Conclusion ........................................................................................................................................................ 30 7. Recommendations .......................................................................................................................................... 31 Annex I: Sampled clusters list for district Jamshoro .................................................................................................. 32 Annex II. Key indicators used to measure IYCF practices for children aged 0-23 months ......................................... 33 Annex IV: Focus group discussion guide for IYCF ....................................................................................................... 36 Annex V: Focus group discussion guide for WASH and food security ....................................................................... 38 Page 1 of 38 List of figures Figure 1: MAP of Jamshoro district .............................................................................................................................. 7 Figure 3: Distribution of number of children across age group and sex .................................................................... 13 Figure 4: Liquids given in 1st three days after birth ................................................................................................... 15 Figure 5 Knowledge of mother regarding infant and young child feeding ................................................................ 18 Figure 6: Distance to main source of water/responsible family members for fetching water .................................. 21 Figure 7: Water treatment methods locally used ...................................................................................................... 22 Figure 8: Stool disposal practices ............................................................................................................................... 24 Figure 9: Handwashing timings .................................................................................................................................. 24 Figure 10: Water borne diseases in households ........................................................................................................ 26 Figure 11: Figure illustrate categorized households HDDS ........................................................................................ 28 Figure 12: Foods eaten by household members........................................................................................................ 28 Figure 13: Coping Strategy Score ............................................................................................................................... 29 Figure 14: Type of coping strategy adapted by household ........................................................................................ 30 Figure 15: proportion of household adapted one or more rCSI ................................................................................ 30 List of tables Table 1: Summery of all Indicators: ............................................................................................................................. 6 Table 2 Indicators of interest ....................................................................................................................................... 9 Table 3 Summary of infant and young child feeding practices .................................................................................. 14 Table 4: Mothers’ knowledge about IYCF key messages ........................................................................................... 18 Table 5: Knowledge about colostrum and pregnant/lactating women’s health care-seeking behavior ................... 19 Table 6: Main source of water and related information ........................................................................................... 20 Table 7: Water quality and testing............................................................................................................................. 21 Table 8: Protected toilet use ...................................................................................................................................... 22 Table 9: Stool disposal practices ................................................................................................................................ 23 Table 10: Handwashing location and material .......................................................................................................... 24 Table 11: Wastewater drainage system .................................................................................................................... 25 Table 12: Morbidity and expenditures ...................................................................................................................... 26 Table 13: Household Dietary Diversity ...................................................................................................................... 27 Table 14: Reducing Coping Strategy Index ................................................................................................................ 29 Page 2 of 38 Acknowledgments We are grateful to the Nutrition Support Program (NSP) – Sindh for their trust in Action Against Hunger, and for providing this opportunity to generate evidence about Jamshoro. Technical supervision and inputs from NSP have been instrumental in carrying out these activities. We would like to show our gratitude to Action Against Hunger’s technical advisors, national staff members, technical persons, and support team members for their contributions. We appreciate the hard work of staff members, especially Ms. Imelda Awino (Health and Nutrition Advisor) and Ms. Jennifer Majer (Monitoring and Evaluation Officer), Mr. Shahid Fazal (DCD Programs), and Mr. Muhammad Ali (Survey Manager) for their technical insights and leadership throughout the survey and for management of fieldwork, data quality, and reporting. We would like to extend our gratitude to the locally-hired enumerators and data analysts for their dedication and hard work at the field level. In addition, we owe our sincere gratitude to the participating community members for their valuable time and for providing the required information.