Preliminary findings on the Baseline Study forBarriers to optimal Maternal, Infant and Young Child Feeding Practices by Lensse Gobu

1. Behavioral Change for Improved
Nutrition among pastoralists in
Ethiopia (BCIN)
VÉTÉRINAIRES
SANS FRONTIÈRES
SUISSE
1

2. Preliminary findings on the Baseline Study for
Barriers to optimal Maternal, Infant and Young
Child Feeding Practices
Lensse Gobu (BSc, MPH)
May 16, 2016
2

3. Outline of the Presentation
 Summary
 Background
 The existing platforms
 Objectives and research questions
 Study design and methods used
 Major Preliminary findings
 Conclusion
3

4. Project Summary
4
Title Behavioural Change for Improved Nutrition among
Pastoralists (BCIN)
The Research Action research on Maternal, Infant and Young child-
feeding practices in pastoral households of Somali
Region, Ethiopia
Thematic Category ‘How can agriculture and the wider agri-food
systems become more nutrition-sensitive and have
a greater impact on nutrition outcomes?’
Lead Institution VSF Suisse
Donor IFPRI
Proposed end date August 2016
Partners &
collaborations
Jigjiga University, Woreda Livestock Crop and
Rural Development Office; Woreda Health Offices
in Moyale, Mubarek, Gode and Hargelle Woredas,
FAO

5. Background
• Ethiopia towards achieving the nutrition
targets of MDG1
– But still holds one of the highest stunting rates in
the world
• Somali region of Ethiopia is one of the
pastoralist areas frequently affected by
Emergency nutrition situation.
5

6. Status of malnutrition in Somali Region of
Ethiopia
• Stunting (chronic malnutrition) prevalence is
33%
• Wasting (acute malnutrition)- 22% (the highest
from all regions)
• Underweight- 33.5% (third highest from all
regions of Ethiopia)
Source EDHS 2011
6

7. Current Status of Nutrition in Liben Zone
• According to the Deyr 2015 seasonal needs
assessment report (conducted 24/10/2015—
12/11/2015);
– there have been recurrent trend of malnutrition in
most of the woredas of Liban zone due to poor
livestock production (Dolo Ado)
– 501 cases of SAM in Dolo ado woreda
– 81 SAM without complication cases in Moyale,
– 80 SAM without complication from Filtu woreda,
– 55 SAM without complication from Hudet woreda.
7

8. Current situation , Liben Zone……cont’d
• Malnutrition is among the top 5 causes of
morbidity in Children <5 in all Woredas;
– 4th in Dolo Ado, Filtu and Mubarek
– 5th in Deka Suftu, Hudet and Moyale
(Source: Deyr 2015 seasonal needs assessment report)
8

9. The context
• Behavior is a very important limiting factor for
optimal nutrition
• SBCC, adapted to local contexts, is widely
accepted as an effective mechanism for
improving MIYCN practices at household level.
• However- little evidence to assist relevant
actors in understanding which SBCC
approaches and tools are most effective.
9

10. The Existing community platforms –
PFS (Pastoral Field Schools)
• ‘Schools without walls’
that introduce new
technological innovations
while building on
indigenous knowledge.
• A group of b/n 25 and 30
pastoralists (including
elders, men, women and
youths) who meet
regularly over a defined
period of time to make
observations that relate
livestock production to
the rangeland ecosystem.
10

11. The Existing community platforms –
VICOBA (Village Community Banks)
• Aim
– to improve the cash
availability at village
level (in absence of
financial institutions),
– to mitigate times of
crisis and stimulate
IGAs
11
 Savings-and-loans group

12. General Objective of the research: to assess the role
of pastoral community platforms in increasing
community awareness on key Maternal Infant and
Young Child Nutrition (MIYCN) practices, and through
this to effect positive behavioural changes.
12

13. Specific Objectives
To identify and analyse the limiting factors to
behavioural change in MIYCN in pastoral communities.
To measure the feasibility and effectiveness of
integrating SBCC for MIYCN into existing pastoral
community platforms.
To provide evidence-based recommendations for
efficient nutrition-related SBCC approaches for rural
agricultural and pastoralist communities.
13

14. Research Questions
Are existing community platforms successful at
channelling behavioural-change
communication to enhance knowledge and
attitudes and to optimise maternal, infant and
young child feeding practices?
14

15. 15
Intervention Group
Arda Ola, Katama, El-dher &
Majire in Moyale and Mubarek
02 Kebeles
- PFS and VICOBA are active
Intervention Study
(15 months)
Comparison Group
Meleb, El-gof, Kajowa and Raro in
Moyale and Jara Kebeles in Mubarek.
- No PFS and VICOBA
Documentation and
dissemination of results
End line Study
Baseline Study
No intervention other than
the health facility based
routine behavioral
interventions
Cascaded Training for PFS
and VICOBA
471 471

16. Tools (for quantitative Survey)
• Standard KAP survey
questionnaire - UN-FAO’s
2014 Guideline for
Assessing Nutrition-Related
KAP.
• Pretested on d/t
population before the
baseline survey
16

17. Quantitative Survey
- Conducted on 942 mothers having children 23
months or less (471 in each wing)
Qualitative Study
- Conducted to explore and understand the barriers to
optimal MIYCN practices
- FGD- conducted with mothers of children <5 years in
El-dher, El-gof, Katama and Malab Kebeles of Moyale
and Mubarek 02 Kebele
- KII- conducted with Community Volunteers in Arda
ola, El-dher, El-gof and Malab Kebeles of Moyale
Woreda.
17

18. Definition of Optimal Maternal,
Infant and Young Child
Feeding/Nutrition
18

19. Key recommendations/ optimal MIYCN
• Feeding pregnant women
– One extra meal a day, eating a diversified diet
• Feeding lactating women
– 2 extra meal a day, diversified nutritious diet
• Infants 0-6 months
– Early initiation of BF- within 1 hour of birth
– Feeding the colostrum
– Exclusive breastfeeding 0-6 months
• Infants and young children 6-23 months
– Feeding diversified and nutritious diet at least 3 times a
day
19

20. Preliminiary Findings on the
Baseline assessment
20

21. Socio-demographic characteristics
Respondents category by group
Study
(n=471) %
Comparison
(n=471) %
Age Group (Year)
15-20 140 29.7% 48 10.2%
21-30 222 47.1% 240 51.0%
31-40 96 20.4% 174 36.9%
41-49 13 2.8% 9 1.9%
Total 471 100.0% 471 100.0%
Educational Status
None 453 96.2% 463 98.3%
Primary school and above 18 3.8% 8 1.7%
Total 471 100.0% 471 100.0%
Main source of income
Animal & animal product sales 350 74.3% 334 70.9%
Crop sales and trade 26 5.5% 16 3.4%
Casual labor and wage employment 57 12.1% 102 21.7%
Others 38 8.1% 19 4.0%
Total 471 100.0% 471 100.0%
Wealth status
Taajir/Duresa 7 1.5% 1 0.2%
Bulti-Qeba/Jirata 182 38.9% 124 26.3%
Miskin 256 54.7% 306 65.0%
Feqir 23 4.9% 40 8.5%
Total 468 100.0% 471 100.0%
Family size
Less than or equal 6 people 281 59.7% 313 66.5%
Greater than 6 people 190 40.3% 158 33.5%
Total 471 100.0% 471 100.0%
21

22. Wealth Category
No. Wealth category
(higher to lower)
Descriptions (livelihood sources and
resources)
Local name English
names
1. Tajira/
Duressa
Rich - Someone who can sell his livestock and
change it to money;
- Someone who can build a house in the town
near the main road;
- He has > 100 camels, > 100 cattle& > 200
shoats*
2. Bulti Qaba/
Jiraataa
Medium
- 10-50 camels, 20-50 cattle, 20-100 shoats.
3. Miskiina Poor
- Up to 10 camels, 10 cattle and 20 shoats.
4 Qole/ Feqir Very Poor
No livestock at all
22

23. * If someone has only shoats (even >200), he’s not
called ‘Tajira’. They mentioned a Geri proverb where
the goat herself says to someone having only shoats,
‘Naaf jette intala biyyaa hin fuudhin, gadi lakkisuuf
jirta!’
meaning ‘Don’t get married to a (our) woman
depending on me; lest you’ll leave her’
This was mentioned to show that shoats are not
considered as a sustainable asset, as they are
vulnerable to loss.
23

24. Proportional piling method used for
wealth ranking
24
Wealth ranking exercise in Daresalam Kebele of
Moyale Woreda

25. Barriers to Optimal Maternal,
Infant an Young Child Practices
Findings from the Focus Group
Discussions
25

26. Exclusive breastfeeding rate
Group Total
Study Group Comparison
group
Exclusive
breastfeeding
No
Count 86 130 216
% within
Group
72.3% 85.5% 79.7%
Yes
Count 33 22 55
% within
Group
27.7% 14.5% 20.3%
Total
Count 119 152 271
% within
Group
100.0% 100.0% 100.0%
26

27. Focus Group Discussions
• FGD was conducted with mothers having
children less than 5 years of age (excluded from
the quantitative survey).
• 4 kebeles in Moyale Woreda
– El-Dher
– El-Gof
– Katama
– Maleb
• 1 kebele in Mubarek Woreda
– Mubarek 02
27

28. Barriers to optimal feeding practices of
pregnant Women
Economic Problems ++++
‘Feeding with family’/ ‘as
usual’
+++++
Loss of appetite +++
Not feeling comfortable ++
‘No space to eat’ +
28
+++++ Majority
++++ Average
+++ Some
++ Few
+ Very few

29. Barriers, pregnant women…cont’d
• One FGD Participant in Mubarek 02 Kebele
said
“….even if I know and believe that when I’m
pregnant taking additional meal is important for
me and the growing baby inside my womb, but I
couldn’t afford to do so. So what do I have to do? …
no food… no habit…no time!”
29

30. Barriers to optimal feeding practices of
lactating mothers
Economic Problems ++
‘Feeding with family’ / ‘Feeding as usual’ +++++
Heavy workload on women and no time +++
‘We are pastoral Women’…. (misconception) ++
30
FGD participant in El-dher mentioned
“We are pastoral and we do not have a good practice of
feeding ourselves, and our baby. We spend our time in fetching
water, and bush for collecting woods. (W1) …I remember one
time I was far from home leaving my two week old baby a the
whole day to fetch water and wood.’

31. Barriers, lactating mothers……cont’d
• One FGD Participant in Mubarek 02 Kebele said
“We have a problem to afford food and a breastfeeding
mother receives a meal that is prepared for the whole
family, and it might be twice or once per day.”
• Another participant mentioned,
“Previously, a goat will slaughtered for a mother in the first
40 days of her delivery. But now I get a cup of milk for
survival.’
31

32. Barriers to optimal feeding practices of
Infant and young children
Problem on the availability of food in the house ++
Insufficient breastmilk +++++
Inaccessibility of water ++++
Time constraint ++++
Lack of support from men ++
Misconception
- “We are pastoral Women”....
- “The Child is unable to digest”…
- “…the stomach is small”
+++
++
+
32

33. Barriers, feeding infants and young
children….cont’d
• Early initiation of Breastfeeding
– FGD in Mubarek 02 Kebele;
“In our community, if the mother’s breast couldn’t
produce milk immediately after she gives birth, the
newborn receives water or camel milk.
Another participant mentioned;
“I usually give my newborn water or camel milk on
the first day and breast milk on the next day.”
33

34. Barriers, feeding infants and young
children….cont’d
• Feeding the colostrum
– Given to the child +++ (El-gof, Mubarek 02, Katama
Kebeles)
• FGD participants in El-Dher kebele
“we remove first drop of colostrum to the ground. I
never give my child this (colostrum).”
Another participant mentioned
“… for this child, I gave the first milk since I came to
know that first milk is important and nutritious for
newborns.”
34

35. Barriers, feeding infants and young
children….cont’d
• Feeding children > 6 months
“The young child receives additional food which
is prepared for the whole family, more
frequently tea, or sugar with water, or camel
milk till lunch or dinner time.
35

36. Barriers, feeding infants and young
children….cont’d
• Feeding young children (6-23 years old);
FGD participant in El-dher Kebele
“…we feed our children rice, animal milk, maize
and tea twice in a day. …. the baby’s stomach is
small and not have ability to digest frequently
and therefore it is enough for the baby to get
once or twice per day with whole family…… we
will not prepare a meal for a child alone.”
36

37. Cultural beliefs related to feeding and
nutrition (From the intervention…)
• It is not good that a pregnant woman feeds
frequently because her baby will grow in her
belly and make her labor difficult.
• Feeding organ meat
– It is not good for a man to eat the heart of an animal
because it will affect his braveness.
• Feeding on poultry
– There is a mixed type of belief; in pure pastoral
Kebeles like ‘Katama’ it is taboo, whereas in agro-
pastoral ones like El-dher and Arda-ola it is well
accepted
37

38. KAP on Food Safety and Personal Hygiene
Part of the quantitative survey
38

39. KAP on Food Safety and Personal Hygiene
Variables Response Respondents by group
Study Comparison
Frequency Percentage Frequency Percentage
Had proper practice of food safety Yes 351 74.5 412 87.5
No 120 25.5 59 12.5
Had proper practice of hand
washing
Yes 188 39.9 238 50.5
No 283 60.1 233 49.5
Ever heard about food safety Yes 148 31.4 204 43.3
No 323 68.6 267 56.7
Proper knowledge of hand washing
[k607M]
Yes 99 21 12 2.6
No 372 79 459 97.4
Perceived of susceptibility related to
food safety
Yes 366 77.7 423 89.9
No 105 22.3 48 10.1
Perceived of barriers related to Food
Safety and Personnel Hygiene
Yes 30 6.4 10 2.1
No 441 93.6 461 97.9
Perceived of benefits related to
Food Safety and Personnel Hygiene
Yes 415 88.1 413 87.7
No 56 11.9 58 12.3
39

40. Conclusion
• Majority (> 70%) of the respondents depend on sales
of animal and animal products sale as a major source
of income.
• Wealth classification in Moyale and Mubarek
Woredas depend on ownership of livestock.
• Low EBF rate (<30%) in both the study and
comparison Kebeles.
• It is a common practice for mothers to feed
themselves when pregnant and breastfeeding, as well
as young children with the rest of the family.
40

41. Conclusion…. Cont’d
• Barriers to optimal MIYCN
– Misconception on optimal feeding practices
– Economic problem on mothers in not being able
to purchase according to what their children
need.
– heavy workload on women and minimal support
from their husband, time constraint.
41

42. WHAT WE DO
42
to promote
Environmental
Health
Our goal:
Sustainable livestock
based livelihoods
to support
Livestock
Health
to ensure
People’s
Health

43. WHAT WE DO
43
to promote
Environmental
Health
Our goal:
Sustainable livestock
based livelihoods
to support
Livestock
Health
to ensure
People’s
Health