Key Message Dissections on Complementary Feeding and Assessing the Favorable and Unfavorable Behaviors/Practices on Maternal Nutrition

1. Key Message Dissections on
Complementary Feeding and
Assessing the Favorable and
Unfavorable Behaviors/Practices
on Maternal Nutrition
Mohammad Aslam Shaiekh
MPH/HPE
1

2. Background
• Inappropriate complementary feeding practice is
one of the main reasons for malnutrition among
Nepal children aged less than two years.
• Exclusive breastfeeding for the first six months
followed by complementary feeding along with
breastfeeding is vital for proper growth and
development of a child [4].
• An inadequate complementary food is a major
cause of the very high prevalence of malnutrition
in the developing world and this may have long-
term implications for growth, development, and
health
2

3. Background
• Maternal dietary practices during pregnancy and
postpartum play an important role in determining
the long-term health and nutritional status of
both the mother and her growing fetus.
• Poor dietary practices during pregnancy may
result in increased rates of stillbirths, premature
birth, low birth weight, maternal and prenatal
death.
3

4. Background: Child Feeding
• NDHS Report 2016 shows, 47%of children age
6-23 months receive meals with the minimum
recommended diversity (at least four food
groups).
• 36% of children under age 5 are stunted (short
for their age), 10% are wasted (thin for their
height), 27% are underweight (thin for their age),
and 1% are overweight (heavy for their height)
[3].
4

5. Rationale
• Identification of the favorable and unfavorable
behavior helps in effective implementation of the
Malnutrition prevention and control program then
reduction of maternal and child mortality. and
also helps to development of implementation
strategies.
• Dissection on message will provide key features
and their information to change the feeding
practices among children and to provide
feedback/suggestion for remodeling of the
messages.
5

6. Objectives
General Objective
To assess the favorable and unfavorable practices on
maternal nutrition
To dissect the Key Message/Information about Child
feeding
Specific objectives
To develop the survey tool
To conduct the survey assessment
To assess the favorable and unfavorable behavior on
Maternal Nutriton.
To dissect the key features on messages related to
child feeding developed by MoHP.
6

7. Methodology
• Literature review was done to identify the
variables of maternal nutrition.
• And from the review of different literature I got
the following variables to assess the favorable
and unfavorable behaviors of maternal nutrition:
 Dietary intake
 Food avoidances
 Dietary taboos
 Decision making power in family
 Physical workload
 Health seeking behaviors (Iron intake, ANC/PNC
Visits, Nutrition practices)
7

8. Methodology
• Based on the variables, questionnaire was
developed to assess the favorable and
unfavorable nutritional behavior among pregnant
and postpartum mothers.
• The collected information have analyzed to
assess the practices/behaviors.
8

9. Findings: Dietary Intake
Favorable Behaviours Unfavorable
Behaviours
Associated Factors
Same amount and
frequency of food
consumption in
pregnancy as in normal
period
No adequate knowledge
that extra energy is
required during the
pregnancy period
No Ensure/follow up of
“HAREK BAR, KHANA
CHAR” and no balanced
diet
No knowledge about
every meal should have
at least one items from
the four types of
categorize food items
like Cereals, Meat and
animal products, fruits
and vegetables and
Gedagudi.
Use locally available
vegetables in their farm
9

10. Findings: Dietary Intake
Favorable
Behaviours
Unfavorable
Behaviours
Associated Factors
No timely eating
practices
Busy in indoor works
and no support from
family members
Use of filtered water
Use of Iodized salts
(having logo of two
child)
No proper tighten of
cover and open
insincerity
consumption of fresh
fruits and vegetables
10

11. Findings: Food Avoidance
Favorable
Behaviours
Unfavorable
Behaviours
Associated Factors
No green leafy
vegetables
consumption
Mother thinks it cause
diarrhoea and cold to
baby
Use of chilly and Spicy
foods
It gives tastes for
foods.
Avoidance of
fish/meats
Bad scent/smell
associated with
vomiting tendency in
some mother
Use of Pickles and
acetic foods more
It is believe that acetic
food decrease the
tendency of vomiting in
pregnancy
11

12. Findings: Dietary Taboos
Favorable
Behaviours
Unfavorable
Behaviours
Associated Factors
Fasting during
pregnancy
No colostrum feeding
to baby
It is believed that
colostrum milk is
unhygienic so it should
not feed to baby
Practice of feeding
honey to newborn
baby
It is believed that
feeding sweet foods to
baby will speak polite
and gentle talk in their
future life
Avoidance of hot and
cold foods
12

13. Findings: Decision Making
Power in Family for Food
Preferences
Favorable
Behaviours
Unfavorable
Behaviours
Associated
Factors
Practice of taking
meal after eating
the male and
senior member of
family
Traditional Beliefs
Male member
gives priority in
selection for
nutrition decision
(Choice of what to
Male dominant
society
13

14. Findings: Decision Making
Power in Family for Food
PreferencesFavorable Behaviours Unfavorable
Behaviours
Associated Factors
ANC and PNC check up
Use of Iron and folic acid
Immunization
No exclusive breast
feeding up to 6 months.
Inadequate knowledge
no aware about the
importance of exclusive
breastfeeding
Bottle feeding to their
child
No colostrum feeding
Heavy loading in
pregnancy
No family support,
Nuclear family
No personal and
environment hygiene
14

15. key Message
Dissections on Child
Feeding
15

16. Identification of the Message
• The message on “Complementary Feeding
Practice” was selected from “Maternal, Infant and
Young Child Nutrition (MIYCN) Flipchart-2072”
published by former Child Health Division
(CHD)/Department of health Services in the fiscal
year 2072.
• This flipchart can also be found from the given link
http://www.chd.gov.np/downloads/3%20MIYCN_Fli
pchart.pdf [1]. This was developed and printed in
technical and financial support of USAID.
16

17. 17

18. Methodology
18

19. • Study Area: khudi
• Study Participants: Married women of
Reproductive age
• Study Techniques :
Literature review and critical analysis was
done for message dissection.
Household visits and interviews were carried
out to assess socio-demographic
characteristics and favorable and unfavorable
behaviors on maternal nutrition using semi-
structured questionnaire.
 Study Tools
MIYCN Flipchart-2072” published by former
Child Health Division (CHD)/Department of
health Services in the fiscal year 2072.
19

20. Target Audience of Message
• This message is targeted for mothers of 6-24
months of children. When breast milk is no
longer enough to meet the nutritional needs
of the infant, complementary foods should be
added to the diet of the child.
• The transition from exclusive breastfeeding to
family foods, referred to as complementary
feeding, typically covers the period from 6 to
24 months of age, and is a very vulnerable
period.
20

21. Details of Message Dissection
Format/design
• The Message have attractive caption which give concept
about complementary feeding and related behaviors
• The message is kept inside the rectangular text box with
bold letters and different suitable color has used to make
visible and attractive.
• The Message have clear, simple and understanding
figures with symbolic of Frequency and quantity of food
complementary food consumption
• The major key message and related other information
are in the form of text message and has addressed the
areas of behavior change for Infant and young child
feeding practices recommend exclusive breastfeeding up
to age of six months, timely initiation of feeding solid,
semisolid foods from six months onwards.
21

22. Details of Message Dissection
Focus of key message
• A child of 6-9 months should have 3 times
complementary feeding in a day along with
breastfed. In initial should start with 2-3 small
spoon and gradual increase up to one tea glass
(125 ml) feedings in a one time.
• A child of 9-12 months should have 3 times
complementary feeding (Up to one tea glass every
time) and one times snacks along with breastfed.
• A child of 12-9 months should have 3 times
complementary feeding (Up to two tea glasses
(250 ml) every time) and two times snacks along
with breastfed.
22

23. Details of Message Dissection
Focus of key message
• The meal should have soft, semi-solid and dense
(No high amount of water).
• Ensure “HAREK BAR, KHANA CHAR”.
• Use iodized salt and filtered and boiled water
• Active feeding to children by playing, providing
dolls, singing etc. to encourage feed more.
• Special attention should maintain for hygiene and
sanitation.
• Regular growth monitoring of children to ensure
the nutrition.
• Encourage parents to have Vitamin-A to their
children 23

24. Dissection of Messages on
KABA Perspectives
Knowledge and Attitude:
The message basically have focused to provide
knowledge on
• Importance of breastfeeding up to 6-23 months of
children
• Features of complementary feedings (AFATVAH:
Age, Frequency, Amount, Thickness, Variety, Active
feeding, Hygiene)
• Encourage to promote locally available foods items
and production
• Additional behavior like consumption of iodized
salts, boiled/filtered water, Vitamin A and growth
monitoring.
• Encourage to maintain personal hygiene . 24

25. Dissection of Messages on
KABA Perspectives
Recommended Behaviours:
• A child of 6-9 months should have 3 times
complementary feeding in a day along with
breastfed. In initial should start with 2-3 small spoon
and gradual increase up to one tea glass (125 ml)
feedings in a one time.
• A child of 9-12 months should have 3 times
complementary feeding (Up to one tea glass every
time) and one times snacks along with breastfed.
• A child of 12-9 months should have 3 times
complementary feeding (Up to two tea glasses (250
ml) every time) and two times snacks along with
breastfed.
• The meal should have soft, semi-solid and
dense/thickness (No high amount of water). 25

26. Dissection of Messages on
KABA Perspectives
Action oriented message:
Active Feedings:
• Encourage children to feed as much as possible
with active and patience to feed their children.
• Feed Children with playing and talking.
• Family member should also be active to feed the
children wel
• Make happy to baby by telling story and playing
with toys .
• Use clean bowls and spoons when feeding
26

27. Dissection of Messages on
KABA Perspectives
Action oriented message:
 Sanitation and Hygiene Maintenance
• Washing hands with soapy water before cooking, before
meals, and before feeding children, before touching. The
child should wash his hands with soapy water before
eating food Use only purified (Boiled, filtered, use
chlorine) water.
• All members of the household pay attention to hygiene
 Ensure “HAREK BAR, KHANA CHAR”.
• Ensure the at least one food items from the each four
categories of food items in every feedings like Cereals
(maize, wheat, corn, rice, kodo, fapar, potatoes, sweat
potato etc), Gedagudi (Beans, lentils, grams, almond),
Fruits and Vegetables, meat and animal products.
27

28. NHEICC Strategies on Message
and Media Development
• Advocacy - Get political and social commitment
and gain support for specific health issues for the
successful implementation of the program
• Social mobilization – mobilize society, network
and resources at the district and community level
for the successful implementation of the program
• Behavior Change Communication- inform
people about health issues, services available and
promote positive behaviors
28

29. Drawback of Messages
• Multiple message in a same flip
• Different pictures have been used which
may not be understandable for all people
29

30. Approaches
• Audio
• Audio/Video
• Print
• Interpersonal Communication
• Digital Media
• Visual
30

31. Media/Message Development
• NHEICC plays key role in production of HPEC
media/messages in close coordination with
different department and centers of DoHS as per
their needs. At the same time, it also develops
different media production for different health
events.
• It develops produces and air the messages
through radio, TV, and FM stations. During the
process, in coordination with experts, it finalizes
the messages and made MOU with the vendors
for production and with message dissemination
stations (Radio, TV, FM, Press etc.)
31

32. Media/Message Development
• NHEICC conducts a workshop at the beginning of
the program for idea generation to strengthen
HEIC programs.
• It conducts various types of workshops to utilize
most of all available expertise in HEIC program
development and generate partnership in its
implementation.
• NHEICC takes support and make partnership with
other governmental organizations, INGOs, NGOs
and private sectors and other stakeholders to
develop strategic HEIC plan, manage plan and put
it into action. 32

33. Conclusion
 The Knowledge on feeding practices of infants
and young children is essential for improving
health and nutrition status.
 Hence, these messages provide the knowledge
and information about proper feeding practices
among under 2 years children.
 From the K-A-B-A perspectives it has more
emphasize on proper feeding practices, and
action to be taken to promote the nutrition status
of children.
33

34. Conclusion
• Dietary practices of pregnant and postpartum
women were suboptimal some have good
practices and some have conservative believes
towards the food consumption.
• Dietary practices can be influenced by culture,
socioeconomic and environmental determinants.
34

35. Recommendations
• Make a simple flips and no more messages in single
sheets
• Define the meanings of Symbolic messages like
meaning of half sun, full sun and moon in the given
pictures.
• Improving knowledge on nutrition through nutrition
education and integrating key nutrition messages.
• Social and Behavior change communication (SBCC) for
changing unhealthy behavior and practices among
mothers
• Availability of food stocks in the home
• Family support to pregnant women and postpartum
35

36. Skill Developed
• Literature Review to identify the possible
variable for further study
• Development of tool for formative
research
• Conduction of formative research
• Assess the favorable and unfavorable
nutrition practices.
36

37. References
• http://www.chd.gov.np/downloads/3%20MIYCN_Flipchart.pdf.
• https://www.who.int/nutrition/topics/complementary_feeding/en/
• MDHS Report-2016.
• Knowledge and practice of Mothers of under Two Years Children on
Complementary Feeding at Bharatpur Hospital, Chitwan, Nepal.,
JAAR
• Michaelsen, K.M., Weaver, L., Branca, F., Robertson, A. (2003).
Feeding and nutrition of infant and children, guideline for the WHO
europeean region with emphasis on the former soviet countries.
• Gartoulla, R. K. (2009). Nepal Nutrition Assessment and Gap
analysis final report
37