IYCF KAP Survey Kohat district Khyber Pakhtunkhwa (KP)Province Pakistan September 2013 Title: IYCF Knowledge, Attitude and Practice Survey Place: Kohat District, KP Province, Pakistan Funded By: ECHO By: Hailu Wondim, Action Against Hunger / ACF International ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013 Acknowledgement We greatly appreciate the involvement and support of Khyber Pakhtunkhwa (KP) province department of health nutrition cell and Kohat district health office. This survey could not have been completed without the commitment and hard work of ACF International capital office and Peshawar field office management team, logistics, administration and Program Quality and Accountability (PQA) department of Peshawar and Kohat. Our heartfelt appreciation goes to the survey team (supervisor, data analyst, team leaders and enumerators) who put all their efforts to produce a quality data. We are also thankful to the mothers/caretakers of children who give their time to these survey team members by responding to the questions raised by the survey team. This survey report has been produced with the financial assistance of the European Commission. The views expressed herein should not be taken, in any way, to reflect the official opinion of the European Commission. Page 2 ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013 Table of Content 1. Executive Summary ...................................................................................................................... 5 2. Background .................................................................................................................................... 7 3. Survey Objectives ......................................................................................................................... 8 3.1 General objective ................................................................................................................ 8 3.2 Specific Objectives .............................................................................................................. 8 4. Methodology .................................................................................................................................. 9 4.1 Study area.............................................................................................................................. 9 4.2 Study period .......................................................................................................................... 9 4.3 Study design .......................................................................................................................... 9 4.4 Study population .................................................................................................................. 9 4.5 Sample size ............................................................................................................................ 9 4.6 Sampling procedures ......................................................................................................... 10 4.6.1 Cluster selection: ....................................................................................................... 10 4.6.2 Household selection: ................................................................................................. 10 4.6.3 Children selection: ..................................................................................................... 10 4.6.4 Data to be collected .................................................................................................. 10 4.6.5 Survey Tool .................................................................................................................. 10 5. Organization of the survey ....................................................................................................... 10 5.1 Meeting with the Province and District authorities ..................................................... 10 5.2 Data collectors recruitment and training ...................................................................... 10 5.3 Team work in the field ...................................................................................................... 11 5.4 Data Quality ........................................................................................................................ 11 5.5 Ethical considerations ....................................................................................................... 11 5.6 Data entry, analysis, reporting ........................................................................................ 11 6. Result ........................................................................................................................................... 11 6.1 Demographic characteristics of sampled children ....................................................... 11 6.2 Demographic characteristics of mothers/caretakers of sampled children .............. 12 6.3 Infant and young child feeding knowledge and attitude ............................................ 13 6.4 Infant and Young Child Feeding Practices ..................................................................... 14 6.5 Food Security and livelihood ............................................................................................ 18 6.6 Water and Sanitation ......................................................................................................... 19 6.7 Health ................................................................................................................................... 20 7. Discussion .................................................................................................................................... 20 8. Conclusion ................................................................................................................................... 22 9. Recommendations ...................................................................................................................... 23 6. Annexes ........................................................................................................................................ 25 Annex 1: Survey schedule ................................................................................................................ 25 Annex 2: Selected clusters/Villages for IYCF KAP Survey .......................................................... 26 Annex 3: The main IYCF indicators collected and the source of data ...................................... 27 Annex 4: Comparison of the results with national and regional figures .................................. 29 Page 3 ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013 ACRONYMS and ABREVIATIONS ACF Action Contre La Faim/ Action Against Hunger BCG Bacillus Calmette–Guérin CMAM Community Based Management of Acute Malnutrition CMR Crude Mortality Rate DHO District Health Office DoH Department of Health FGD Focus Group Discussion FSL Food Security and Livelihood ENA Emergency Nutrition Assessment GAM Global Acute Malnutrition HQ Head Quarter IDP Internally Displaced People IYCF Infant and Young Child Feeding IVAP Internally Vulnerability Assessment & Profiling KAP Knowledge, Attitude and Practice KP Khyber Pakhtunkhwa MUAC Mid Upper Arm Circumference NRSP National Rural Support Program PDAR Person Days At Risk UC Union Council SMART Standard Monitoring and Assessment of Relief and Transition WHO World Health Organization WASH Water Sanitation and Hygiene Page 4 ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013 1. Executive Summary Kohat district is located 180km from Islamabad and 65km from Peshawar (the provincial capital). ACF International supports the Department of Health (DoH) in Community Management of Acute Malnutrition (CMAM) in 5 Union Councils (UCs) with funds from the Humanitarian Aid and Civil Protection department of the European Commission (ECHO). This one year ECHO project integrates food security and livelihoods (FSL), Infant and young child feeding (IYCF) and nutrition education as well as Water, Sanitation and Hygiene (WASH) activities. This baseline study had one primary objective which was to understand the communities Knowledge, Attitudes, and Practices (KAP) on IYCF in five UCs in Kohat district where ACF is implementing its IYCF project integrated to CMAM. The results underscore that most of the infant and young child feeding practices are below the national average1. The following are the findings of this survey: Information communities obtained about child feeding originated from the same sources and showed a similar trend of utilization. Health facility and home visit are the most common places where mothers/care takers get information about child feeding. However, community sensitization event is not common in the study area to pass information about child feeding. More than half (58.2%, n=107) of mothers/caretakers believe that breast feeding should be started immediately after the child is born. More than thirteen percent (13.6%, n=24) of them think it should be started at after one day. Nearly half of the mothers/caretakers (45.7%) know that a child should be exclusively breast fed for the first six months of his/her life. Only less than half of the mothers (47.3%) know the appropriate age of initiating complementary food (which is 6 months). The most common contact persons for child feeding information in the surveyed community are Nurses/Dispensers