Transcript Trials of Improved Practices

Improving Complementary
Feeding Practices
in Afghanistan
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Initial Results of TIPS in Afghanistan
By Charlotte Dufour
FAO & Ministry of Agriculture, Afghanistan
The nutritional situation
• Very high mortality: 26% children
die before age 5
• +/- 50% of chronic malnutrition
6-10% acute malnutrition in 6-59 m
9-16% acute malnutrition in 6-29 m
• High rates of MDDs
(MOPH, 2003)
– Iron deficiency: ≥ 70% of children
(38% anemic) and 48% of women
(25% anemic)
– Vitamin A (night blindness): 20% women
– Vitamin C: up to 10% in some areas;
scurvy epidemics 2002 & 2003
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Causes of malnutrition
• Underlying Causes:
– low diet diversity
– improper feeding practices
– poor hygiene & access to health
services
• Basic causes:
– Destroyed economic, natural, physical
and social capital
– Limited access to land & water
– Low level of education
– Poor condition of women
– Many consequent pregnancies
– High unemployment
– Conflict and lack of governance
– Etc.
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Common Breastfeeding
Problems
• Ritual foods given at birth
• Mothers’ breastmilk ‘insufficient’ (link to
mother’s mental health)
• Cease breastfeeding when child is sick, or
mother sick
• Cease breastfeeding when pregnant
Complementary Feeding Problems
• Early or Late introduction of complementary
foods
• Do not prepare separate foods for children
• Family dish is often not energy-dense (e.g.
watery soup)
• Low consumption of vegetables, fruits, and
animal foods
• Low meal frequency
• Poor food hygiene
• Food beliefs restrict consumption of some foods
Mothers’ feeding patterns
• Family diet is often poor in fruits, vegetables,
meat
• Several consequent pregnancies
• Mothers do not increase the number of meals
when pregnant or lactating
• Food beliefs restrict
consumption
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of certain foods
TIPS Methodology: Objectives
• To identify & document current feeding practices
(good & bad)
• To understand reasons for the practices
• To identify factors that can motivate households
to change
• To identify how far households are prepared to
change and constraints to change
In Afghanistan: to develop a manual of improved
recipes and feeding practices, adapted to
various regions
TIPS Approach
• Test in real home
situation, in average
households with
average resources
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• Consultative process / negotiation, where families
have a choice
→ Move from ideal recommendation to practical
recommendation
• Step by step process / interim target
TIPS process
• Preparatory phase:
- List common problems and prepare
counselling guide
- Identify locations and age groups
- Train teams
• Implementation phase:
-
Cooking demonstration & selection of households
Assessment visit
Counselling Visit
Follow-up visit
• Evaluation and analysis (workshop):
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–
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summarise findings
discussion with all concerned / consensus
identify issues for further investigation
develop plan for wider dissemination of well-tested
recommendations including recipes
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TIPS in Afghanistan
• Collection of information on food availability, seasonality and beliefs
• Mission by Charity Dirorimwe:
- field visit
- training of staff
- Development of improved recipes
Bamyan
Badakshan
• Field work in 3 provinces
and in Kabul (2 villages)
Herat
Kabul
Constraints to TIPS implementation
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No trained nutritionists → need strong supervision
Food seasonality
→ need 2 rounds
Difficult access in winter
Difficult to cover diversity of entire country
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Despite constraints, positive initial
results
• Confirmed lack of knowledge as cause of
(preventable) malnutrition
• Very high interest of
mothers
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• Kids love the recipes!
• Mothers change their cooking and purchasing patterns
The story of Nazeer Ahmad
Constraints to change
• Limited access to diverse foods
• Low income
• Mothers willing to improve their child’s diet
but not their own (too poor)
• Contradictory advice from doctors (esp.
About breastfeeding)
Next steps
• Summarize findings in workshop
• Prepare manual of improved recipes and feeding
practices
• Integrate cooking demonstrations as part of:
- Literacy classes
- Agricultural projects
- Health education in clinics
- Breastfeeding counselling
(collaboration with UNICEF)
• Need to improve training of
nutrition educators on
participatory techniques
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