POLICY BRIEF Infant and Young Child Feeding Practices IN Tehuledere, SOUTH WOLLO, AMHARA, ETHIOPIA Information about current health and nutrition HIGHLIGHTS practices at the community level is essential for • Malnutrition among children in Tehuledere is high. understanding where problems lie and making decisions about what steps can be taken to Stunting is especially serious, affecting 26 percent of support improvements. This brief provides children younger than 2 years. summary information on infant and young child • Infant and young child feeding is suboptimal. While most feeding (IYCF) practices in Tehuledere, a woreda children (75 percent) start consuming foods in addition (district) in South Wollo zone of Amhara Region, to breastmilk at 6–8 months of age, their diets are not Ethiopia. The data were gathered during a recent household survey conducted in 12 woredas in sufficiently diverse. The World Health Organization South Wollo, where efforts are under way by (WHO) recommends a diet that includes foods from the Alive & Thrive initiative, in partnership with four or more of the recommended food groups.3 In Concern Worldwide, to improve IYCF practices. Tehuledere, on average, children eat from only 1.8 food groups per day, and only 6 percent of children receive The data focus on the underlying and immediate foods from at least four of the recommended groups. In causes of malnutrition in the first 1,000 days particular, consumption of foods that contain sufficient of life—conception to 2 years of age—and are intended for use by woreda-level decisionmakers iron (meat or iron-fortified foods) is low. (administrators, nutrition officers, health • The diets of mothers/caregivers in Tehuledere also are extension officers, agriculture officers and not sufficiently diverse: only 26 percent eat foods from others) who can contribute to positive changes. four or more of the recommended food groups. They are meant to serve as a basis for designing action plans at the woreda level and to support • Home visits by Health Extension Workers (HEWs), the goals of the National Nutrition Programme’s Health Development Army (HDA) volunteers and other “Lifecycle Approach,” which emphasizes the first frontline workers are not adequate. In the three months 1,000 days.1 preceding the survey, only 22 percent of households POPULATION OF TEHULEDERE2 received a visit by a HEW and only 5 percent were Women: 62,971 visited by a HDA volunteer. Further, information Men: 71,353 Total: 134,324 provided during the visits lacked comprehensive messages on IYCF practices. www.aliveandthrive.org JUNE 2015 A total of 3,583 mothers/caregivers of children aged 0–23 months participated in the survey. Among the sample of KEY RECOMMENDATIONS: children, 54 percent were boys and 46 percent were girls. • To reduce stunting in Tehuledere, the diets of Of these, 42 percent were 0–5 months old and 58 percent children younger than 2 years should be improved were 6–23 months old. to include more diversity. Children should consume Of the households surveyed, 29 percent reported being foods from at least four of the WHO-recommended either a current or former member of PSNP and 7 percent food groups, including a serving of meat, milk were members of the Household Asset Building Programme, or eggs. another food security program of the Ethiopian government. • Visits by HEWs and HDA volunteers should be more frequent and include counseling on SURVEY FINDINGS LEVELS OF HOUSEHOLD FOOD SECURITY exclusive breastfeeding, the timely introduction of In Tehuledere, approximately 36 percent of households complementary foods and specific foods to were identified as having secure access to food; 18 give to children older than 6 months in addition percent experienced mild food insecurity; 40 percent to breastmilk. experienced moderate insecurity; and 6 percent were severely food insecure. NUTRITIONAL STATUS OF CHILDREN YOUNGER Why are the first 1,000 days important? THAN 2 YEARS Investments in good nutrition during the first 1,000 days of Stunting rates of children Figure 1: Prevalence of stunting by age group a child’s life contribute to his or her long-term health and younger than 2 years in wellbeing, and can also benefit future generations. Tehuledere were high (26 Stunting percent), as at the national Underweight The biggest window of opportunity for preventing level (29 percent). Across Wasting undernutrition in the first 1,000 days of life is the period all woredas, stunting rates when a child consumes foods in addition to breastmilk started increasing at 6 Medium Maximum (6–23 months of age). A large proportion of stunting in months of age and reached low-income countries occurs during this critical period.3 a high of 45 percent among Cereals Cereals children aged 12–23 months mo mo mo Legumes Legumes If children in Tehuledere eat better, they will grow better— (Figure 1). Stunting is caused both physically and mentally. This will improve their learning by a combination of factors, including long-term insufficient Milk and milk products Milk and milk products capacity, as well as their employment opportunities later in food intake, poor IYCF practices and frequent infections Meat Meat life. Girls will also grow into women who are better prepared early in life. Eggs Eggs to bring healthy infants into the world. Vit A rich fruits and vegetables Vit A rich fruits and vegetables INITIATION OF BREASTFEEDING Other fruits and vegetables Other fruits and vegetables Initiation of breastfeeding within the first hour after birth BACKGROUND 0 20 40 60 80 100 0 20 40 60 80 100 The data included in this brief were collected as part of a can help prevent neonatal death, especially in preterm and household survey conducted in October and November low-birthweight infants. Colostrum, the sticky, yellow-white of 2014 by Addis Ababa University. They will provide a early milk, rich in antibodies, vitamin A and otherStrachy protective staple foods Strachy staple foods baseline for a comparative evaluation of two intervention factors, has been called baby’s first immunization. InfantsLegumes Legumes should be given no prelacteal feedsi such as water, otherNuts and seeds Nuts and seeds packages designed to integrate IYCF activities into Ethiopia’s Dairy Dairy Productive Safety Net Programme (PSNP), which is “aimed liquids or ritual foods. Meat Meat at enabling the rural poor facing chronic food insecurity to Eggs Eggs In Tehuledere, only 69 percent of womenVitamin surveyed A rich dark saidleafy vegetables Vitamin A rich dark leafy vegetables resist shocks, create assets and become food self-sufficient Other Vit A rich fruits and vegetables Other Vit A rich fruits and vegetables through the provision of food and/or cash transfers.”4 they had initiated breastfeeding of their youngest infantOther vegetables Other vegetables within the first hour of birth and 81 percent reported thatOther fruits Other fruits 0 20 40 60 80 100 0 20 40 60 80 100 The survey was carried out in 72 kebeles (wards or they had given their baby colostrum. In addition, 24 percent neighborhood associations) randomly selected from 12 of infants had received prelacteal feeds. Sugar/glucoseMaximum ^ Medium ^ woredas: Albuko, Ambasel, Borena, Kelela, Kutaber, Mahal water or raw butter was given most frequently. 100 100 Saint, Mekedela, Saint Ajibar, Tehuledere, Tenta, Wogedi i and Worebabo. Foods given to newborns before breastfeeding has been established. 80 80 60 60 2 40 40 20 20 0 0 Dairy MeatEggs Meat Eggs Cereals Legumes Legumes Other fruits Nuts and seeds Other vegetables Strachy staple foods Milk and milk products Other fruits and vegetables $ Vit A rich fruits and vegetables Vitamin A rich dark leafy vegetables BF = breastfeeding Other Vit A rich fruits and vegetables CF = complementary feeding 68 68 $ ITN = insecticide treated nets Amhara Amhara National National 49 49 $ 39 37 39 37 5 $ 9 9 6 4 6 4 BF CF ery SH oid eria ITN Zinc cine A cine g India c ox c thiopia Ni a W amin A a mo mo mo mo mo mo mo mo mo mo E angladesh an dliv Vit B Hib v anus t Cle et asles v T Me Source: Hoddinott et al EXCLUSIVE BREASTFEEDING Many foods were introduced to children very late. This was especially critical for milk, meat, eggs and legumes. Milk Breastmilk contains all the nutrients that a baby needs for Stunting the first six months of life. WHO recommends exclusive (otherUnderweight than breastmilk) and eggs were generally introduced Wasting breastfeeding—with no other foods or fluids including at 14 months. Green leafy vegetables, fruits and legumes were introduced at 17 months on average and meat as late water—until a baby is six months of age. At the time of the as 18 months. survey, a significant proportion (83 percent) of babies 0-5 Medium Maximum months of age were being exclusively breastfed. DIETS OF MOTHERS Cereals Cereals INTRODUCTION OF COMPLEMENTARY FOODS AT Only mo 26 percent mo of mothers mo reported having consumed Legumes Legumes 6 MONTHS at least one serving from at least four of the WHO- Milk and milk products Milk and milk products A large proportion of child stunting occurs within 6–23 recommended food groups the previous day. Very few Meat Meat months of age. Appropriate feeding promotes growth and mothers reported having eaten animal products like milk, prevents stunting during this time, and the timing as well meat or eggs (Figure 3). Consumption of vitaminEggs A rich fruits Eggs as the quality of the foods is crucial. More diverse diets are and vegetables like pumpkin,Vit A richcarrots fruits andand vegetables kale was also very Vit A rich fruits and vegetables associated with lower stunting rates.2 low. Mothers consumed moreOther legumes fruits and than vegetables children, however. Other fruits and vegetables 0 20 40 60 80 100 0 20 40 60 80 100 Figure 3: Food groups consumed by mothers in the day In Tehuledere, introduction of foods in addition to preceding the survey (at least one serving) N=1,198 breastmilk appeared timely for most children, with 75 percent of caregivers reporting they began to feed solid Strachy staple foods Strachy staple foods Legumes Legumes and semisolid foods when a child was 6–8 months of age.