18th february 2015 - food and agriculture organization · cnp community nutrition promoter cso...
TRANSCRIPT
“Improving food security and nutrition policies and programme outreach” (IFSN)
and “Improving the dietary intakes and nutritional status of infants
and young children through improved food security and complementary feeding counselling” (IMCF)
Dissemination meeting
18th February 2015
“Improving food security and nutrition policies and programme outreach” (IFSN)
and “Improving the dietary intakes and nutritional status of infants and young children through improved food
security and complementary feeding counselling” (IMCF)
Dissemination meeting
Food and Agriculture Organization of the United Nations April 2015
In collaboration with:
Institute of Nutritional Sciences, Justus Liebig University, Giessen, Germany
Agricultural Extension Department, Bunda Campus, Lilongwe University of Agriculture and Natural Resources, Lilongwe, Malawi
Ministry of Agriculture, Irrigation and Water Development, Department of
Extension Services
Ministry of Health, Department of Nutrition and Department of Clinical Services
The designations employed and the presentation of material in this information product do not imply
the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the
United Nations (FAO) concerning the legal or development status of any country, territory, city or area
or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of
specific companies or products of manufacturers, whether or not these have been patented, does not
imply that these have been endorsed or recommended by FAO in preference to others of a similar
nature that are not mentioned.
The views expressed in this information product are those of the author(s) and do not necessarily
reflect the views or policies of FAO.
© FAO, 2015
FAO encourages the use, reproduction and dissemination of material in this information product.
Except where otherwise indicated, material may be copied, downloaded and printed for private study,
research and teaching purposes, or for use in non-commercial products or services, provided that
appropriate acknowledgement of FAO as the source and copyright holder is given and that FAO’s
endorsement of users’ views, products or services is not implied in any way.
All requests for translation and adaptation rights, and for resale and other commercial use rights
should be made via www.fao.org/contact-us/licence-request or addressed to [email protected].
FAO information products are available on the FAO website (www.fao.org/publications) and can be
purchased through [email protected].
Contact information FAO headquarters: Nutrition Education and Consumer Awareness Group Nutrition Division Food and Agriculture Organization of the United Nations Viale delle Terme di Caracalla, 00153 Rome, Italy Email: [email protected] Homepage: Linking Agriculture to Nutrition Education to Improve Infant and Young Child Feeding www.fao.org/nutrition/education/iycf/en/ Contact information FAO Representation in Malawi: Ms Stacia Nordin, RD (Registered Dietitian) Nutrition Officer, Food Security & Policy Food and Agriculture Organization of the United Nations FAO Representation in Malawi Evelyn Courts, Plot No. 13/31, Area 13, Lilongwe, Malawi Email: [email protected] Homepage: FAO Representation in Malawi www.coin.fao.org/cms/world/malawi/en/Home.html Cover photo: ©FAO / Trevor Nyondo
Table of contents
Acknowledgements ……………………………………………………………………………………………………………………. vi
Acronyms ……………………………………….………………………………………………………………………………………….. vii
Executive Summary ………………………………………………………………………………………………………………. ix
1. Opening Session …………………………………………………………………………………………………………………… 1
2. Session 1: Applied research in the context of an FAO food security and nutrition project -
findings of the IMCF project………………………………………………………………………………………..….……….
1
3. Session 2: Lessons learned and implications on programmes and future research .….……..…… 9
4. Wrap-up Session …………………………………………………………………………………………………………..…...... 15
Annex 1 - National Dissemination Meeting Programme ………………………………………..…………………… 17
Annex 2 - National Dissemination Meeting Participant List ………………………………………………………… 19
Annex 3 - Food Security Summary Sheet ………………………………………………………………………………….… 21
Annex 4 - IYCF Summary Sheet ………………………………………………………………………………………………..…. 23
vi
Acknowledgements This report provides proceedings for a National Dissemination meeting of the Food and Agriculture Organization (FAO) of the United Nations project entitled: “Improving food security and nutrition policies and programme outreach” (IFSN) and the research/advocacy project entitled: “Improving the dietary intakes and nutritional status of infants and young children through improved food security and complementary feeding counselling” (IMCF).
IFSN is supported by FAO Malawi and implemented by the Ministry of Agriculture, Irrigation and Water Development (MoAIWD) and the Ministry of Health (MoH) in the districts of Kasungu and Mzimba. IFSN is funded by the Government of Flanders under Project GDCP/MLW/001/FLA 2011-2015 (Phase II). IMCF is implemented by FAO’s Nutrition Education and Consumer Awareness Group and the research component is led by the Institute of Nutritional Sciences, Justus Liebig University (JLU), Giessen, Germany partnered with the Agricultural Extension Department of Bunda Campus, Lilongwe University of Agriculture and Natural Resources (LUANAR), Malawi. IMCF is funded by the German Federal Ministry of Food and Agriculture (BMEL) under Project GCP/INT/108/GER. The Dissemination meeting was held on 18th February 2015 in Lilongwe, Malawi and included representatives from MoAIWD, MoH Clinical Services (Nutrition) and the Department of Nutrition, HIV and AIDS (DNHA), and the Ministry of Information, Tourism and Culture (MoITC), donors, UN agencies, Non-Governmental Organisations (NGOs), civil society, research institutes, academia, FAO staff from Headquarters (HQ) and Malawi, and professors and post-graduate students from JLU and LUANAR. This report was prepared by Elizabeth Westaway, Julia Garz and Esther Evang, and finalised by Ellen Muehlhoff. Contributions from Irmgard Jordan and Judith Kuchenbecker from JLU; Gabriella Chiutsi-Phiri, from LUANAR, Theresa Jeremias from FAO HQ, and Stacia Nordin and Wells Kumwenda from FAO Malawi are gratefully acknowledged. Many thanks go to the staff of the FAO Malawi Country Office for their support in preparing and organising the Dissemination meeting.
vii
Acronyms
AEC Area Executive Committee
AEDO Agricultural Extension Development Officer
AEHO Assistant Environmental Health Officer
ASF Animal Source Foods
CDDS Child Dietary Diversity Score
CHV Community Health Volunteer
CNP Community Nutrition Promoter
CSO Civil Society Organisation
CSONA Civil Society Organisation Nutrition Alliance
DADO District Agricultural Development Officer
DAES Director of Agricultural Extension and Services
DEC District Executive Committee
DID Differences in Differences
DNCC District Nutrition Coordination Committee
DNHA Department of Nutrition, HIV and AIDS
DSA Daily Subsistence Allowance
EPA Extension Planning Area
FAO Food and Agriculture Organization of the United Nations
FGD Focus Group Discussion
FFS Farmer Field School
FNO Food and Nutrition Officer
HAZ Height-for-Age Z-score
HIV Human Immunodeficiency Virus
HQ Headquarters
HSA Health Surveillance Assistant
IEC Information, Education and Communication
IFSN Improving food security and nutrition policies and programme outreach
IMCF Improving the dietary intakes and nutritional status of infants and young children through improved food security and complementary feeding counselling
IYCF Infant and Young Child Feeding
JFFLS Junior Farmer Field and Life School
JLU Justus Liebig University
LS Longitudinal Study
LUANAR Lilongwe University of Agriculture and Natural Resources
MAD Minimum Acceptable Diet
MDD Minimum Dietary Diversity
MMF Minimum Meal Frequency
MoAIWD Ministry of Agriculture, Irrigation and Water Development
MoH Ministry of Health
NECS Nutrition Education and Communication Strategy
NGO Non-Governmental Organisation
NRC Natural Resources College
SUN Scaling Up Nutrition
TIPs Trials of Improved Practices
TWG Technical Working Group
WASH Water, Sanitation and Hygiene
viii
ix
Executive Summary Malawi has a high burden of chronic undernutrition with 47.8 percent of children under 5 years being
stunted (DHS, 2010).1 Major causes of childhood stunting include inadequate complementary feeding
and care practices such as low dietary diversity and poor quality foods. Exclusive breastfeeding for the
first 6 months and continued breastfeeding up to 2 years of age are essential for optimal child growth.
In addition, adequate, safe and appropriate complementary feeding for children aged 6-23 months,
and good water, sanitation and hygiene contribute to child well-being. Furthermore, the promotion of
nutrient-rich foods and home-based diets can be effective in improving children’s nutrition. However,
agricultural production in Malawi focuses largely on maize and family diets rarely cover all
recommended six food groups.2
Since 2011, the Food and Agriculture Organization (FAO) of the United Nations in collaboration with
the Government of Malawi has been implementing Phase II of the nutrition-sensitive agriculture
project entitled: “Improving food security and nutrition policies and programme outreach” (IFSN) with
the objective of strengthening government capacities to improve and diversify food production. The
project primarily targets smallholder farmers with a combination of food security and nutrition
education activities, focusing on improved infant and young child feeding (IYCF). This integrated
approach aims to diversify household agriculture production and consumption to match the
recommended six food groups, particularly with regard to the diversification of complementary foods
for children aged 6-23 months.
Parallel to the IFSN project, a 5-year research/advocacy project entitled: “Improving the dietary intakes
and nutritional status of infants and young children through improved food security and
complementary feeding counselling” (IMCF) has been implemented by FAO in collaboration with Justus
Liebig University (JLU) Giessen, Germany and Lilongwe University of Agriculture and Natural Resources
(LUANAR).3 IMCF aims to assess the effectiveness of IFSN project activities on children’s dietary intake,
micronutrient status and growth, and to determine the nutrition impact of combining food security
with nutrition education interventions. The IMCF study design included cross-sectional and
longitudinal studies, pre- and post-training tests; focus group discussions (FGD); interviews;
observations; blood specimens; and anthropometry.
This report provides proceedings of a joint FAO/JLU Dissemination meeting held on 18th February 2015
in Lilongwe, Malawi to present preliminary results of the IMCF project and lessons learned from a FAO
process review of the IFSN project. Sixty-one participants attended the meeting from government at
national and district levels, donors, UN agencies, Non-Governmental Organisations (NGOs), research
institutes and academia.
The IMCF research team presented preliminary results4 on changes in Height-for-Age Z-score (HAZ),
breastfeeding status, minimum acceptable diet (MAD), minimum dietary diversity (MDD) and
1 National Statistical Office (NSO) and ICF Macro (2011) Malawi Demographic and Health Survey 2010. Zomba, Malawi and Calverton, Maryland, USA: NSO and ICF Macro.
2 The Malawian recommended six food groups are: staples, vegetables, fruit, legumes and nuts, animal source foods (ASF), and fats.
3 The IMCF project also includes a similar study in Cambodia on a FAO nutrition-sensitive agriculture project in collaboration with JLU and Mahidol University, Thailand.
4 IMCF project preliminary results presented at the FAO/JLU Dissemination meeting have not yet been published.
x
minimum meal frequency (MMF) (World Health Organization, 2008)5 of caregiver/child pairs aged
under 2 years in intervention and control areas. The proportion of study population benefitting from
food security and nutrition education interventions was 17 percent at mid-term and 7 percent at
impact. During the study period, breastfeeding remained at approximately 100 percent and meal
frequency remained stable. MAD and MDD improved in the intervention area only. There were no
differences in mean HAZ between intervention and control at baseline while at mid-term, mean HAZ
in the intervention group improved significantly due to the combination of food security and nutrition
education interventions. Being a beneficiary of an IFSN food security intervention showed an indirect
effect on Child Dietary Diversity Score (CDDS) while participation in a nutrition education intervention
had direct effects on CDDS. The study concluded that the combination of food security and nutrition
education interventions improves children’s nutritional status and dietary diversity at the community
level.
Qualitative results from FGDs with grandmothers and caregivers on improving IYCF practices looked at
the influence of other household and community members on behaviour change. Adoption of
improved IYCF was facilitated through: (1) increased knowledge; (2) children enjoying the taste of
enriched porridges; (3) seeing an improvement in child health; and (4) having supportive
grandmothers, fathers and other non-family members. Hindering factors included unsupportive
communities and food shortages. Analysis of the longitudinal study (LS) showed that children of
caregivers who participated in all nutrition education sessions (i.e. nine sessions plus the graduation
ceremony) had better growth than those who attended fewer sessions.
The FAO team presented results from a process review of the IYCF intervention conducted in
September – October 2014 to complement IMCF research findings, collect data on the linkages of the
IFSN food security and nutrition education activities, and develop lessons learned. IFSN key strengths
included strong partnerships with government and the community; joint development of Information,
Education and Communication (IEC) materials with government staff and community members; and
joint health and agricultural extension trainings for capacity building. Some key challenges were non-
harmonised targeting of agricultural and nutrition support; insufficient agricultural diversification to
enable dietary diversification, especially with regard to ASF, vegetables and fruit; weak coordination
and collaboration of District Executive Committee (DEC) with the District Nutrition Coordination
Committee (DNCC); lack of refresher trainings for frontline workers and community volunteers; and
high workloads and vacancies of government staff. It was concluded that food-based approaches
focusing on the use of local foods are feasible for improving child feeding and preventing malnutrition.
However, efforts are needed to step-up and integrate support services by the different sectors. Hence,
recommendations are to: (1) provide timely agricultural support according to the seasonal agricultural
calendar with a special focus on producing diverse nutrient-rich foods from all the six food groups; (2)
strengthen the DNCC and regularity of meetings; (3) establish a comprehensive, continuous training
system at all levels of health and agriculture extension systems; and (4) rationalise workload of
government staff.
Members of government, civil society and academia provided their inputs on several issues:
strengthening nutrition collaboration between agriculture and health at field level, in operational
5 World Health Organization (2008) Indicators for Assessing Infant and Young Child Feeding Practices, Part I – Definitions; Part – Measurement. Geneva: World Health Organization.
xi
research and preparing staff for extension services; and strengthening district coordination for
collaboration.
The following key points were raised: 1. Partnerships – synergies: Should include different sectors, organisations, macro-/ meso-/ micro-
levels, ages, genders and types of people with a clear understanding of different stakeholders’
roles.
2. Strengthening existing structures and systems at all levels: Develop/strengthen multisectoral
nutrition policies and strategies; ensure collaboration and support to the DNCC/Technical Working
Group (TWG) at national and district levels; provide additional staffing at Extension Planning Area
(EPA)/Health Catchment Area and frontline workers, including the addition of a Food and Nutrition
Officer (FNO) in the EPA office to provide support to frontline workers; and enhance capacity
development (at pre- and in-service levels).
3. National scale-up and sustainability of programmes: Requires MoAIWD and MoH support to
district and extension structures as well as communities.
4. Research and Data: Documentation of case studies, lessons learned and best practices are
essential when undertaking projects, and the results of the IMCF research study are positive
showing improvements in dietary diversity, minimum acceptable diets and child growth.
Final considerations were: It is important to use the findings of the IMCF research study in order to
improve agriculture’s key role in nutrition. Hence, FAO will bring IMCF research and IFSN project results
to the highest level of MoAIWD, collaborate with UNICEF to jointly support MoAIWD and MoH to scale
up this work on nutrition and on Water, Sanitation and Hygiene (WASH), and ensure that donors who
support nutrition take into account the results of this research. MoAIWD will ensure that best practices
enter strategies, continue to support implementing districts with ongoing activities, and brief key
departments and positions within the Ministries. It is important to determine if the IYCF groups can
transition into the Scaling Up Nutrition (SUN) community care group model, continue with existing
structures in a multisectoral way, and capitalise on the comparative advantage of different sectors and
positions.
xii
1
Opening session6 Sixty-one participants7 (Annex 2) attended the Dissemination meeting from government at national
and district levels, donors, UN agencies, NGOs, research institutes and academia. They were welcomed
to the Dissemination meeting and introduced to each other by Dr Alexander Kalimbira, Head of
Department of Human Nutrition and Health, LUANAR, Malawi.
Ms Florence Rolle, FAO Country Representative for Malawi, noted recent progress in reducing hunger
and malnutrition in Malawi, but that numbers are still unacceptably high. She called upon the audience
to act to end hunger and malnutrition in Malawi and highlighted that intersectoral partnerships
between agriculture and health, including community, district and national levels, are essential to
tackle malnutrition. Effective nutrition-sensitive agriculture interventions need to target children as
well as women and men of all ages. Ms Rolle mentioned that the project has had issues with day-to-
day data, but FAO is pleased with their partnership with Justus Liebig University (JLU) and LUANAR,
which has collected relevant data. She also stressed the comparative advantage of FAO in supporting
the government to mainstream project activities into day-to-day work plans, the 5-year agendas, and
the need for a national framework. She concluded that reduction of malnutrition can be achieved quite
fast where there is a strong political will and action, such as in Brazil, which has been strong in this
area.
Mr Victor Sandikonda, Deputy Secretary of the Department of Nutrition, HIV and AIDS (DNHA), MoH,
remarked that Malawi has made gains in child survival and maternal health, especially in reducing
underweight, but nutrition data has not improved for stunting and anaemia. Malawi still faces
challenges of inadequate sanitation, water, education, low dietary intake and inadequate knowledge
of diverse food production and utilisation. In response, Malawi has put in place a number of policies
and programmes, notably Scaling Up Nutrition (SUN), which brings all sectors together around
nutrition. The partnership between DNHA, MoH, FAO, JLU and LUANAR facilitated the successful
implementation of the IFSN and IMCF projects as well as integration of IEC materials into the national
level. Mr Sandikonda underscored the timeliness of the IMCF research findings for integration into
policy and strategy that is under review. He expressed the willingness of the government to improve
the impact of nutrition programmes in Malawi and to bring them to scale.
Session 1: Applied research in the context of an FAO food security and
nutrition project – Findings of the IMCF project The first session was chaired by Professor Michael Krawinkel from JLU who flagged up the lack of
research on food-based approaches compared to research on nutrient supplementation, and the need
to acknowledge the full complexity of nutrition.
6 The Dissemination meeting programme is provided in Annex 1. 7 Participants covered eight districts: Balaka, Karonga, Kasungu, Lilongwe, Mzimba, Nkhata Bay, Ntchisi and Zomba.
2
Aims of the meeting
Specific aims of the Dissemination meeting presented by Ms Stacia Nordin, FAO Nutrition Officer
included:
Share the IMCF research and IFSN project experiences and results8
Discuss the IMCF research and IFSN project results
Document the discussions and integrate feedback into the final steps of IMCF research and
IFSN project documentation and dissemination
Share IFSN project IEC material9
Overview of the project “Improving food security and nutrition policies and programme
outreach”
Ms Theresa Jeremias, FAO Nutrition Officer and Mr Wells Kumwenda, IFSN Project Manager –
Outreach Component, provided an overview of the IFSN project. Malawi has a high burden of chronic
undernutrition with 47.8 percent of children under 5 years stunted, 13.8 percent underweight and 4.1
percent wasted (National Statistical Office (NSO) and ICF Macro, 2011). This is due to a number of
reasons: early introduction of food to children aged 2-4 months; giving children water with herbs
(dawale); provision of watery porridge; low feeding frequency and lack of food diversity; low
consumption of vegetables, fruit, fats and animal source foods (ASF); feeding from the family plate;
and poor hygiene practices. However, the first 1,000 days of life provides a ‘window of opportunity’ to
prevent stunting and enables children to develop their full growth potential through: exclusive
breastfeeding for the first 6 months; continued breastfeeding up to 2 years of age; adequate, safe and
appropriate complementary feeding from 6-23 months; and good water, sanitation and hygiene.
Promotion of nutrient-rich foods and home-based diets can be effective in improving children’s
nutrition. However, agricultural production in Malawi focuses mainly on cereals, such as maize (and
rice), and fruit and livestock production are limited. In addition, poor diversification of livestock,
orchards and nutritious crops, exacerbated by seasonality, result in family diets that do not cover the
recommended six food groups. Hence, the IFSN project has aimed to improve food security and
nutrition by: (1) provision of nutrition education in agriculture and health to increase the impact of
knowledge and skills on production, processing, storage and utilisation, including improved
complementary feeding; (2) distribution of a range of agricultural inputs to vulnerable households,
including those with young children and pregnant women; and (3) increased diversification of local
production to include different livestock and nutritious food crops covering the six food groups.
Phase II of the IFSN project was implemented in six new Extension Planning Areas (EPAs); three in
Kasungu and three in Mzimba districts, in addition to continuing to provide support to the six EPAs
from Phase I.
8 The 7-year IFSN project has been implemented in two phases. The Dissemination meeting is only about Phase II (2011-2015) with different rounds of activities. These include Round 1 (2012-13), Round 2 (2013-14) and Round 3 (2014-15). The IMCF research focused on Round 1 and the IFSN process review on Round 1 and Round 2. IFSN is still supporting the implementation of Round 3, which will end in March 2015.
9 IFSN project IEC materials are available at: http://www.fao.org/nutrition/education/iycf/en/
3
Key food security activities included (Annex 3):
Promotion of diversified food production (i.e. livestock, crops, etc.) to improve availability,
access and utilisation of all six food groups
Capacity building of farmers, Lead Farmers and frontline workers through Farmer Field Schools
(FFS) and Junior Farmer Field and Life Schools (JFFLS)10
Promotion of income-generating activities: fruit trees, bees, mushrooms, vegetables, cassava,
Irish potatoes and yellow-fleshed sweet potatoes
Promotion of environment, soil and water conservation
Improved water and sanitation
Promotion of small-scale irrigation, gravity fed treadle pumps and residual moisture
Key IYCF activities included (Annex 4):
Formative research: In 2011, Trials of Improved Practices (TIPs) were undertaken with
caregivers in 10 villages over two seasons (September 2011 – July 2012) to test the feasibility
and acceptability of enriched porridge11 recipes using diversified locally available foods
Training/sensitisation: Trainings of trainers were conducted with key IYCF staff from the
District Nutrition Coordinating Committee (DNCC), followed by a sensitisation of supervisors
and local leaders, and training of frontline workers from agriculture and health with their
Community Nutrition Promoters (CNPs), one from agriculture (a Lead Farmer) and the other
from health (a Community Health Volunteer [CHV])
Weekly or fortnightly nutrition education sessions including cooking demonstrations using IEC
material: Two CNPs work as a team in their own village with a group of 15 caregivers who have
a child aged 6-18 months (on recruitment) and hold ten nutrition education sessions. Special
sessions involve grandmothers and husbands, and the tenth session is a caregiver graduation
ceremony
Monitoring, supervision and reporting by frontline workers, area supervisors, DNCC and
national coordinators
Review and planning meetings at community, area and district levels attended by national
coordinators
While the IYCF intervention was being implemented, the IMCF project was building evidence on
improving the nutrition of children aged 6-23 months with local foods by assessing the effectiveness
of the food security and nutrition education activities, and measuring the impact on diets,
micronutrient status and growth. Few studies have documented an approach that links diversified
agricultural production with nutrition education to improve the health of children and the IMCF project
aimed to contribute to filling this gap.
Overview of the research “Improving the dietary intakes and nutritional status of infants
and young children through improved food security and complementary feeding
counselling”
Dr Irmgard Jordan, Research Fellow and Co-Principal Investigator from JLU presented the IMCF
research project conducted by JLU and LUANAR. The IMCF research has four hypotheses:
10 Nutrition and health education messages were integrated into FFS and JFFLS. 11 Enriched porridge is made with ingredients from several food groups, usually 4-5 food groups.
4
1. TIPs formative research generates behaviour change communication messages and
nutritionally improved recipes that lead to lasting improvements in complementary feeding
practices, dietary intakes and child nutritional status
2. Locally available and affordable foods can provide a significant contribution to the nutritional
requirements of children aged 6-23 months
3. Nutrition education with a focus on IYCF and linked with a food security intervention can
improve child feeding practices and nutritional status
4. Using locally available foods for improving complementary feeding practices and children’s
nutritional status is a sustainable strategy which can be replicated by households at low cost
and taken to scale using available government services
The IMCF study design12 was as follows:
Table 1: IMCF study design and dates of assessment
Research method
Date Description
Cross-sectional baseline survey
July - August 2011
Districts and villages targeted for the first cycle of agricultural input distribution were selected through restricted cluster randomisation to determine intervention and control areas (villages in the intervention area were benefitting from the IFSN nutrition education intervention as well as the food security/agriculture intervention; villages within the control area were benefitting from the IFSN food security/agriculture intervention only).
Anthropometric measurements of mothers and children, and motor milestones
Blood samples to test for maternal anaemia and child anaemia, iron deficiency and vitamin A deficiency
Impact pathway analysis
December 2012 - April 2014
Pre- and post-training knowledge tests in all training levels (Master Trainers, CNPs and caregivers) prior to, directly after and 6 months after the nutrition education training sessions; FGDs with caregivers and grandmothers; observations on trainings, including nutrition education groups 1 and 2,13 and interviews with Health Surveillance Assistants (HSAs), fathers and other key stakeholders
Longitudinal study
July 2013 - July 2014
Data collection every three months on a cohort of children in intervention and control areas14
Cross-sectional mid-term survey
August 2013 Follow up on the potential impact of the first nutrition education sessions and the food security intervention
Cross-sectional impact survey
August 2014 Follow up on anthropometry, motor milestones, maternal anaemia and child anaemia, iron deficiency and vitamin A deficiency
Discussion:
Was the one-year duration of the food security and nutrition education interventions enough for
beneficiary adoption of improved IYCF practices? – IFSN responded that the recipes had been tested
during TIPs to ensure acceptability and feasibility of the proposed innovations. They were tested in the
home environment in a participatory manner to ensure that households could put the recommended
12 The study is registered at the German Clinical Trial Register (DRKS): https://drks-neu.uniklinik-freiburg.de/drks_web/setLocale_EN.do
13 Some villages had two subsequent groups participating in nutrition education training. 14 LS eligibility criteria in the intervention area: 1. Participant in the nutrition education intervention, 2. Mother with children
6-9 months of age. Eligibility criteria in the control area: 1. Mother with children matched by age and sex with children from the intervention group.
5
enriched porridge recipes into practice. Food security interventions were also done in a participatory
manner, supporting MoAIWD extension services through lead farmers and FFS.
How did the study design control for residual knowledge? – JLU explained that an extensive household
questionnaire was used at baseline to assess existing knowledge and ascertain the sources of
information.
How was the second hypothesis tested? – JLU clarified that a LUANAR MSc student has undertaken a
laboratory study in which porridges were cooked in line with standard family practice. They also
prepared the porridges in the laboratory used by families after they had received nutrition education
to analyse the nutritional content and to compare nutrient values with the recommended dietary
allowance (RDA). Data will be available by the end of the project.
Which strategies were used to involve men? – IFSN replied that men have an important role in
agriculture but also at home as complementary feeding is not just the responsibility of the caregiver.
Some nutrition education sessions were targeted to both women and men to raise men’s awareness
of the need to ensure a diverse food supply and diet but also to alleviate women’s workload to allow
them to care appropriately for their children.
Impact of food security intervention and nutrition education – results from baseline, mid-
term and impact surveys in Malawi
Ms Judith Kuchenbecker, PhD Student from JLU presented the quantitative results of the IMCF
research. Three cross-sectional nutrition surveys were conducted in 24 sections (12 in Kasungu and 12
in Mzimba district; in all six IFSN project EPAs). In all surveys, the study population were primary
caregivers and children under 2 years of age. In the baseline survey, sample size was calculated on
Height for Age Z-score (HAZ) for children under 2 years of age. After the baseline survey, sections within
the study area were randomly allocated to either an intervention or a control area. For the mid-term
survey, sample size was calculated on child dietary diversity score (CDDS)15 and in the impact survey
on HAZ. At mid-term, a total of 33 percent of nutrition education participants were identified (11
percent had completed the nutrition education, 22 percent had not attended all nutrition education
sessions). In the impact survey, 30 percent of nutrition education participants had completed the
sessions. The proportion of the study population participating in both the agriculture and nutrition
interventions was 17 percent at mid-term and 7 percent at impact ( Table 2).
15 Assuming that changes in dietary diversity could already be observed after a relatively short intervention period, but not in HAZ.
Table 2: Programme coverage in IMCF research area
NA
NA
6
The following WHO (2008) IYCF indicators were assessed using qualitative 24-hour recall:
breastfeeding status, minimum acceptable diet (MAD), minimum dietary diversity (MDD) and
minimum meal frequency (MMF). During the last 3 years, breastfeeding remained at approximately
100 percent, MAD improved in the intervention area only, MDD increased from 63 percent to 71
percent in the intervention area and meal frequency remained stable. The consumption of ASF
increased to over 50 percent and legume consumption increased to approximately 80 percent from
baseline to impact. There were no differences in mean HAZ of children aged 6-23 months between the
intervention and control at baseline; however, at mid-term, changes in mean HAZ within this age group
were observed. Based on a “differences in differences” (DID) analysis, mean HAZ between the
intervention (-0.17) and control (-0.19) were significantly different which can be related to the
intervention: food security/agriculture intervention and nutrition education. To gain more insight, a
sub-group analysis of the study population at mid-term was carried out, and the highest estimated
marginal means of HAZ were reached by children from households within the intervention area who
participated in both IFSN food security and nutrition education interventions. However, the DID
analysis did not show any significant differences in mean HAZ between the intervention (-0.17) and
control (-0.18) at impact. Participation in FFS or being an IFSN input beneficiary showed an indirect
effect on CDDS, which is related to wealth. Participation in nutrition education, however, had a direct
effect on CDDS, which was not related to wealth. It was concluded that combined food security and
participatory nutrition education interventions had the highest impact on children’s nutritional status
and dietary diversity at community level ( Figure 1).
Figure 1: Sub-group analysis of study population at mid-term
Factors that influenced adoption of improved IYCF practices in Kasungu and Mzimba
districts
Ms Gabriella Chiutsi Phiri, PhD Student from JLU/LUANAR presented qualitative research results of
factors leading to behavioural change in improved IYCF practices. Although nutrition education often
neglects the influence of other household and community members on behaviour change apart from
the caregiver, the IYCF intervention also included grandmothers, fathers and local leaders in the
nutrition education sessions. Hence, separate FGDs were conducted with grandmothers and caregivers
in four villages and audiotaped. After transcription, data was analysed in the original languages
7
Chichewa or Chitumbuka using content analysis. The results showed that adoption of improved IYCF
was facilitated through: (1) improved knowledge, especially on meal frequency, preparation of
enriched porridges16 and hygienic practices;17 (2) maternal perception that children liked the taste of
enriched porridges as they ate more once enriched porridge was prepared; (3) maternal perception of
improved child health;18 and (4) having supportive grandmothers, fathers and other non-family
members. Hindering factors included unsupportive communities and food shortages. In terms of
unsupportive communities, there were instances where grandmothers and other women of child
bearing age were discouraging caregivers from preparing porridge mixed with vegetables as they felt
this was contrary to traditional food practices, and fathers did not purchase nutrient-rich ingredients,
i.e. meat and fish for enriching porridges. In addition, food shortages (i.e. legumes) during the rainy
season at household and market levels hindered prompt use of knowledge gained to prepare mixed
foods. It was concluded that nutrition education was effective in promoting adoption of IYCF practices
and that adoption was best where families and communities were supportive.
Discussion:
How has MoAIWD been involved? – IFSN responded that there was government involvement in project
activities, especially by District Agricultural Development Officers (DADOs) and Agriculture Extension
Development Officers (AEDOs) in carrying out beneficiary selection, training and monitoring.
Why has there been low coverage of integrated food security and nutrition education activities? – JLU
commented that mothers with children under 2 years have many responsibilities, being involved in
productive and reproductive activities. Thus, they are difficult to target in addition to which women
are still not fully considered as recipients of agricultural support. Hence, it is important to find ways to
target them, particularly as the highest impact occurred when households were targeted with both
food security and nutrition education activities. Achieving a high degree of joint targeting of food
security and nutrition education (on IYCF) activities has also been an issue in the MALIS project in
Cambodia, as evidenced by JLU research. This is an important issue to be addressed by nutrition
sensitive agriculture programmes.
What does the term “unsupportive communities” imply? – JLU clarified that in Round 1, community
sensitisations about the benefits of the IYCF intervention did not sufficiently include grandmothers,
fathers and local leaders, to encourage their support and avoid inter- and intra-generational conflicts.
IFSN added that lessons from Round 1 were applied to the subsequent villages and community
acceptance and participation improved in Round 2 through more intensive community sensitisation
and mobilisation, and this is to be strengthened even further in Round 3.
16 After caregivers were informed about the importance of dietary diversity, they used more food groups, particularly ASF and vitamin A rich foods.
17 The results were corroborated by LS findings where the prevalence of children achieving MDD increased from approximately 45 percent at t1 in the intervention area to more than 75 percent from t2 to t5 and, MDD score was low in the control area. ASF consumption increased in the intervention area from 1.5 days per week at t1 to 3.5 days per week from t2 to t4. The consumption of vitamin A rich foods (i.e. vegetables, roots and fruits) might have been affected by seasonality, being 5.5 days per week during the rainy season and ranging from less than 2 to less than 3.5 times per week during the dry season. The vitamin A consumption trend was similar both in the control and intervention areas though the intervention area had slightly higher values.
18 Caregivers defined good health variously in terms of children playing independently, reduced morbidity and no severe malnutrition case. The results were corroborated by LS findings where there was 5 percent difference in stunting at t5 of children in the intervention area compared to the control area. It was noted that children of caregivers who participated in all nutrition education sessions had significantly better growth than those who attended less than nine sessions.
8
What HAZ cut-off was used? - JLU explained that instead of cut-offs, at baseline, mean HAZ values
were used from the Malawi DHS (2010) for sample size calculations. At impact, the baseline values
were used and the protocol was changed from 15 to 16 percent difference in mean HAZ values
between the intervention and control, to keep a reasonable sample size.
How did the research assess the retention of knowledge since completion of the nutrition education
sessions? – JLU replied that between the beginning of the nutrition education and one month after
completion of the sessions beneficiary knowledge increased significantly. However, six months after
the sessions, there was a loss of knowledge which was not significant for IYCF group 1 but significant
for IYCF group 2 (p<0.05) suggesting that a continuation of nutrition education is needed if gains in
knowledge are to be sustained. Unfortunately, the research was only able to report on people’s
knowledge and perceptions, and relied on grandmothers’ and fathers’ reports on adoption of nutrition
practices.
Did the research look at age effects of early introduction of family foods? – JLU remarked that age
effects were not studied in particular but observations showed that family food was introduced too
early. Hence, there is a need for more emphasis on family nutrition in future nutrition education that
also considers cultural practices of how children move from mashed to solid foods and how this
transition is influenced by seasonal availability of foods.
Did the research consider confounding factors e.g. through other sources of information that could
have influenced the results? – JLU explained that different sources were considered including radio
programmes, campaigns, the Farm Input Subsidy Programme (FISP), and other development projects
although the latter were very limited in number. Food security activities were similar in both the
intervention and control areas, but the food security participation was unequal. Hence, a sub-group
analysis facilitated the disaggregation of results and looked at the link between food security and
nutrition education.
Is the 5 percent height gain (cm) in-line with the set Malawi Government target of 5.55 percent annual
reduction in stunting? – JLU commented that the IMCF results refer to 5 percent height gain in cm,
and do not relate to a percentage of stunting reduction. The 5 percent difference in height growth was
seen among the LS participants whose mothers received nutrition education. Also important to note
is that the research looked at 0-23 months only and the national 5.55 percent stunting reduction target
refers to children under 5 years.
Why did the dietary diversity stagnate between midterm and impact despite the initial increase
between baseline and midterm? – JLU posited that this could be due to lower IFSN programme support
(i.e. agricultural inputs and nutrition education are supported for one year, then the project support
moved to another area), indicating that continued capacity building of the extension system to provide
ongoing community support is essential to sustain positive nutrition outcomes.
Are there socio-economic constraints preventing mothers from using high-value crops for consumption,
such as vegetables and legumes, in porridge, instead of selling them? – JLU concurred that research
findings showed that some households grew diverse crops such as vegetables and legumes, but
preferred to sell them to generate income instead of using these high-value crops for enriching
porridge.
9
Did mothers change their own dietary practices, such as increased dietary diversification? – JLU
commented that the research did not assess and calculate a Women’s Dietary Diversity Score (WDDS)
but a small increase in mothers’ body mass index (BMI) was observed in the intervention areas.
How sustainable are the food security and nutrition education interventions? – IFSN mentioned that
training on crops was conducted in FFS and farmers will continue their knowledge sharing. Training on
livestock breeding and disease prevention was undertaken in a livestock pass-on programme, and local
leaders and the DADO will identify a new group to ensure continuity. Training in communities was also
undertaken on irrigation and boreholes by the MoAIWD, and MoH brought in sanitation and hygiene
to work with the groups. In terms of the nutrition education intervention, communities have shown a
strong interest, with IYCF beneficiaries being asked to share what they have learned and, in some
Round 1 villages, a third group has been established by CNPs. However, there is a need for standardised
volunteer support to minimise dropout. In addition, government capacity should be strengthened to
facilitate improved support to CNPs and particularly the provision of refresher trainings.
How will these results be taken forward by DNHA, MoAIWD and MOH and scaled up? – MoAIWD stated
that they are excited by the findings associated with nutrition education, complementary feeding and
the recipes, they want to prioritise nutrition and also strengthen nutrition-sensitive agriculture
programmes as a bigger part of their work. MoAIWD hoped for scale-up of the best practices identified
so that access to nutrition education is increased and mainstreamed in order to reduce malnutrition.
In the past, nutrition has been considered more of a curative approach to health rather than as
preventative, and it is hoped that through partnership with MoH, preventative work can be scaled up
in future.
How will FAO and JLU consolidate and take forward the results? – FAO acknowledged that the IFSN
project is phasing out and due to close shortly; however, once documented, the lessons learned will
be presented in a meeting at FAO Headquarters in July 2015, synthesised into best practices and shared
widely in the international nutrition community. JLU will publish peer-reviewed articles with FAO and
present the findings at conferences.
Session 2: Lessons learned and implications on programmes and future
research The second session was chaired by Mr Nikolas Bosscher, Deputy General Representative Attaché,
Government of Flanders who stressed the importance of developing and using lessons learned to
improve programming and policy.
FAO IYCF Process Review19
Dr Elizabeth Westaway, FAO HQ Nutrition Consultant, presented findings of a process review of the
IYCF intervention conducted in September – October 2014.20 Its objectives were to complement IMCF
research findings, collect data on the linkages of IFSN food security and nutrition education activities
19 An IYCF intervention process review report is forthcoming. 20 The IYCF process review was conducted by Dr Elizabeth Westaway (FAO HQ Nutrition Consultant) with support from Ms
Marion Sanuka and Mr Charles Makuya (Research Assistants) and the IFSN project team during September-October 2014.
10
and develop lessons learned. The process review focused on Round 1 and 2 of the IFSN project and
was undertaken in purposively chosen EPAs in Kasungu and Mzimba districts and randomly selected
IYCF villages. Data collection methods included 26 interviews21 and 14 FGDs.22
Four key strengths were:
1. Strong partnership with government: By supporting existing structures in Health, Education, Local
Government and the community
2. IEC materials were jointly developed and adapted: With all levels of project and government staff,
and parts of the IYCF counselling booklet have been integrated into the national standardised
counselling card collection
3. Joint agricultural and health extension trainings were conducted with AEDOs/HSAs, Agriculture
Extension Development Coordinators (AEDCs)/Assistant Environmental Health Officers (AEHOs),
and Lead Farmers/CHVs
4. Practical learning environment for nutrition education sessions: Women felt comfortable in small
peer groups and grandmothers became advocates of improved childcare and feeding practices.
Six key challenges were underscored:
1. Targeting: Agricultural support rarely targets families with young children and the IFSN project did
not initially include them in vulnerability criteria to receive agricultural inputs and training
(including participation in FFS). Also there is insufficient agricultural diversification to enable
dietary diversification, especially with regard to ASF, vegetables and fruit
2. Coordination and collaboration: Government staff manage many separate projects and there are
vacancies at all levels resulting in a high workload. Key district coordination positions are vacant
resulting in weak coordination of the District Executive Committee (DEC) with the DNCC
3. Capacity building and implementation: CNP trainings were not designed well enough for
community level understanding, CNPs often did not have adequate facilitation skills, and different
daily subsistence allowance (DSA) rates and incentives were used by different partners causing
jealousy and competition, and deterring self-development
4. Behaviour change: There was a lack of diverse ingredients at home for caregivers to put into
practice what was learned, they had a poor understanding of food substitutes, processing and
storage, and often introduced family foods too early
5. Supervision, monitoring and reporting: The government struggled to conduct regular supervision
and reporting, and found it difficult supervising staff from other sectors, and supervising nutrition
education sessions during the rainy season
6. Sustainability: Policies and strategies are often not implemented well at district, area and
community levels, nutrition is still considered a health issue rather than an issue for agriculture
and other sectors,23 IYCF activities are perceived as project-based and there is a lack of government
resources for ongoing trainings.
21 Interviews were held with: IFSN project staff, NGO staff, district and national government staff, and caregivers (Round 2 Group 1)
22 FGDs were conducted with: caregivers (Round 1 and 2), CNPs (Round 1 and 2), grandmothers (participants and non-participants of nutrition education sessions), fathers (Round 2), JFFLS students, HSAs, AEDOs and local leaders.
23 Food-based/preventive approaches are not usually considered a health issue.
11
Recommendations were formed from the lessons learned:
Food-based and dietary approaches using local food are possible and feasible for improving young
child feeding and can make a difference with appropriate support. More investment in agriculture
and health, with a special focus on producing diverse nutrient-rich foods according to the six food
groups and the seasonal agricultural calendar, are needed to support this preventative approach
For agriculture to have an impact on nutrition there is an urgent need to ensure timely provision
of nutritionally appropriate agricultural support (education, targeting input support where
needed) to families with young children. This needs to be harmonised with health and nutrition
education interventions
A comprehensive, training system at pre- and in-service levels is needed for agriculture and health
extension systems (i.e. all front line workers and supervisors) to ensure that nutrition activities,
particularly nutrition education, are integrated and applied in daily work
Advocacy and sensitisation needs to be stepped up to encourage participation, ownership and
empowerment of government, frontline workers, local leaders and community members
DNCC meetings for coordination of nutrition activities should be strengthened at district level and
the DNCC should be empowered to make and implement nutrition programming decisions through
the DEC
The nutrition education sessions focusing on food-based approaches and local foods should be
improved so that they meet specific learning needs, are implemented to complement other
community activities and upgraded periodically
Participatory community-based nutrition education, offering opportunities for practical learning,
is key for behaviour change
Overall family nutrition education needs to be strengthened and this can be done by including
recipes for improved family meals
To ensure more families are reached with nutrition advice, the concept of the Farm Home
Assistants that existed in the 1990s and earlier should be revisited to strengthen the team of
frontline workers
To ensure better supervision, monitoring and reporting, there is a need to review, clarify and
organise workload of government staff and ensure that staff have all the resources and tools
needed to implement their work
To ensure clear participation of government staff and frontline workers in trainings and other
activities, and a review of DSA regulations for rural sites is necessary which all partners should
adhere to.
Discussion:
How does poor knowledge of food substitutes relate to behaviour changes? – FAO explained that
seasonal availability of foods affected the ability of mothers to prepare enriched porridge recipes, as
mothers did not fully understand the substitution of alternative foods to prepare a nutritious porridge.
It is therefore important for villages to understand how to develop a seasonal food availability
calendar, including nutrient-rich indigenous foods, to ensure that CNPs teach feasible porridge recipes
and are able to substitute different foods within each food group.
How can the importance of nutrition be strengthened? – FAO stressed that nutrition is a cross-cutting
issue and all frontline workers should have training on nutrition. The Government of Flanders
remarked that topics are implemented in silos, so it is important to have agriculture-nutrition linkages.
12
Can the government consider the Farm Home Assistants concept? – MoAIWD explained that they are
trying to have FNOs placed at the EPA level and that the Department of Land Resources and
Conservation (LRCD) is trying to re-instate positions that were decommissioned. DNHA advocated for
a Community Nutrition and HIV Worker that is planned for the frontline staff level.
How can all these issues be addressed so that similar discussions are not held again in a few years’
time? – FAO concurred that there is a need for everyone to work together to find solutions; it is not
the task of one sector or one person or one group, but the responsibility of everyone working together.
How much government commitment is there to utilise this operational research in programming and
planning? – MoAIWD indicated the government’s readiness to consider using the research findings,
especially with regard to mainstreaming nutrition in agricultural extension.
Panel discussion, lessons learned for continuing/improving
Panellists24 representing MoAIWD food and nutrition (national and district levels), MoH clinical
nutrition services, DNHA, the Civil Society Organisation Nutrition Alliance (CSONA) and Natural
Resources College (NRC) were invited to comment on and debate the following key issues identified
by the process review: strengthening nutrition collaboration between agriculture and health at field
level, in operational research and preparing staff for extension services; and strengthening district
coordination for collaboration.
Strengthening nutrition collaboration between agriculture and health at field level
It is important for different governmental bodies to strengthen the intersectoral approach for
coordination at all levels (i.e. national, regional, district, EPA and community), to include Civil Society
Organisations (CSOs) and other stakeholders, and be guided by the National Communication Strategy.
At the moment these linkages are too weak. The SUN Nutrition Education and Communication Strategy
(NECS) was developed to provide guidance on how to work multisectorally at all levels. Therefore, it is
important to read, use and share these documents (or summaries that are available), and DNHA is in
place to make sure that these documents are understood and being implemented. MoH noted that
most people turn to the health sector for nutrition issues, but this should not be the case. If
malnutrition comes to the health sector it means that agriculture has not done its work with food;
when agriculture and partners are doing their work with food then there is less work in the health
sector.
The Agricultural Sector Wide Approach (ASWAp) is the main agriculture policy document, but it does
not have a focus area on nutrition, nor is it included as a cross-cutting issue, so agriculture is not
accountable for nutrition. Education has a nutrition strategy (i.e. School Health and Nutrition [SHN]
Strategy that guides all stakeholders, but there is no nutrition strategy in the agriculture sector and a
guiding document is needed to make people accountable. Recently, the Department of Extension
Services (DAES) has been working very closely with the agriculture planning department to prioritise
nutrition in policy and programming, but it is constrained by the lack of resources.
24 The panellists were: Kondwani Mpeniuwawa (DNHA), Mzondwase Mgomezulu (MoAIWD), Takondwa Minjale (MoAIWD), Tapiwa Ngulube (MoH) Virginia Mzunzu (CSONA), and Liz Saka (NRC).
13
The DNHA and other stakeholders are reviewing the National Nutrition Policy and Strategic Plan to
ensure that they are evidence-based, nutrition-sensitive, include emerging issues, and the documents
are implemented. The IYCF strategy will be reviewed next to ensure strengthening of the multisectoral
approach. However, lessons learned from the IFSN project have already been incorporated, such as
the counselling cards and complementary feeding module that are adopted and used nationwide.
MoAIWD noted that most people attending this Dissemination meeting were from the food and
nutrition, and health sectors. It was acknowledged that another TWG was not needed, but that a sub-
committee under DNHA would be more useful where food issues can be discussed, and best practices
identified and then scaled up.
Strengthening nutrition collaboration in operational research
DNHA recognised that the results of the operational research provided an evidence base for stronger
integration of nutrition into national policies (i.e. the National Nutrition Policy and the Agriculture
Policy).
NRC emphasised the need for funding as part of capacity development in order to conduct operational
research as well as increased information sharing, like in the IMCF and IFSN projects. In addition, local
research capacities should be supported and strengthened.
Strengthening nutrition in preparing staff for extension services
It is important that training institutions adequately prepare staff to address agriculture, nutrition and
health issues on the ground, and to increase collaboration between stakeholders. To do this, training
institutions need to be involved in shaping national policies and programmes so that they have the
latest information to share with their students.
NRC considered information sharing is key between government, private sector, NGOs and other
stakeholders to develop relevant curricula that incorporate evidence-based policies, best-practice and
effective programmes. In addition, curricula reviews need to include inputs from all sectors.
Capacity building of trainers in training institutions is required on how agriculture and health topics
are delivered by extension workers to ensure that they have the necessary knowledge and skills
required for delivery and communication for frontline work.
NRC also advocated the development and signing of a charter between training institutions and
government/NGOs to enable graduates to be employed where needed (as this was considered to be
the reason why there is a huge gap of extension workers in the communities).
Strengthening district coordination for collaboration
It is important not to create more structures in the district but to better use the existing ones to access
the community, such as the Area Executive Committee (AEC). Hence, a stronger emphasis on
community sensitisation and a greater understanding of the multisectoral nature of nutrition are
essential to improve collaboration.
There is need for a mapping of the different nutrition actors at district level, for the DEC and the DNCC
to have clear terms of reference and membership strategies for all nutrition actors (including CSOs),
and to meet regularly. This process is part of the SUN NECS.
14
Currently, new projects come to the District Council and the DEC, but it is difficult to properly scrutinise
them at that level, and they also require technical expertise and understanding of where the need is.
Hence, the DEC should have the DNCC initially vet nutrition interventions and then refer them to the
DEC for approval. However, weak coordination makes this difficult. Nonetheless, if projects go to the
DNCC they can be fairly distributed throughout the district, and guided by nutrition policy and
programming needs.
MoAIWD called for best practices to be documented, communicated and implemented, and for
government staff to work more strategically in order to scale up effective interventions. It was
suggested that instead of spreading out in a piecemeal fashion, stakeholders should start to work
together strategically in the same area - not just in agriculture and health – but also in water and
sanitation and other sectors with linkages to nutrition. By working intensively in this collaborative
manner, the different stakeholders can show impact together and then scale up. Other work would
still continue in the district, but this multisectoral approach would show that combined extension
messages are necessary to improve nutrition (this is also the Model Village Approach).25
Discussion:
Why has MoAIWD stated that there is no nutrition in ASWAp? – LUANAR wished to make clear that
contrary to what MoAIWD had stated, ASWAp does contain activities mentioned under nutrition
security, and the National Nutrition Policy highlights mandates for different ministries with MoAIWD
being key to nutrition implementation. MoAIWD clarified that the ASWAp document does mention
nutrition, but that there is no resource allocation and no clarity on who does what for nutrition. Despite
that, nutrition has advocated to be included in the Food Security and TWG, which is coordinated by
the Crops Department, and the Technology Generation and Dissemination TWG, coordinated by the
Department of Agriculture Research. The Department of Agriculture Extension works very closely with
the planning department and they want to make nutrition (policy) a priority, but are not resourced
sufficiently to take the lead and implement.
What is the benefit of establishing the DNCC and becoming a member? – DNHA confirmed that they
are responsible for overall coordination of nutrition in the country. It is recognised that the weakness
is at district level as the DNCC needs to coordinate with the DEC, but this is not happening. Hence, it is
important to establish the DNCC, and development partners should support districts in setting up their
DNCC; TORs have already been sent to District Councils. MoAIWD added that the DNCC is a sub-
committee under DEC, it harmonises activities, ensures fairness of input distribution (as some NGOs
target the same areas with similar projects) and scrutinises nutrition interventions before submission
to the DEC for approval. The Mzimba FNO explained that the DNCC is supposed to meet quarterly, and
be chaired by the FNO until the DCs office has a District Nutrition Coordinator, although this has been
dormant it will be restarted. Members include all nutrition NGOs and CSOs as well as government staff
from the different sectors (agriculture, health, development and social welfare), and every partner
25 Model villages are villages that work towards becoming a model for all recommended agriculture practices promoted by
the MoAIWD: production in gardens, orchards, field; soil and water conservation; integrated animal production (livestock,
fisheries, bees); food processing and linkages with other sectors for health, sanitation, hygiene, community development. Villages are supported and monitored in their progress and reach milestones until they achieve the status of a Model Village.
15
should bring a quarterly report. It was suggested that field visits are organised to facilitate coordination
and learning.
Has the NRC charter been discussed with the government as this has been tried before and not worked?
– NRC stated that they do not currently have a clear charter with the government. However, they need
to agree on very specific training needs with the government, i.e. courses with food security/nutrition
components and to train a certain number of people who will then get work.
Wrap-up session The following key points were distilled by the Rapporteurs and Nutritionists from MoAIWD and MoH
from the day’s proceedings and presented by Ms Stacia Nordin, FAO Nutrition Officer, on behalf of the
Dissemination meeting secretariat:
Partnerships – synergies
It is important to adopt an intersectoral approach (i.e. nutrition is broader than only being a
health/treatment issue). Almost all sectors have a role in nutrition and each needs to be strengthened
and complement each other’s work (i.e. harmonise targeting of agriculture and health activities and
distribute as a package).
Different stakeholders should be included from the private and public sectors (i.e. civil society, faith-
based organisations and NGOs), from the community, EPA, district, regional, national and global as
well as different types of people of all ages and genders at the micro-level (i.e. grandmothers, fathers,
siblings, especially sisters) to create supportive households and communities.
All stakeholders at each level need to have a clear understanding of their roles and to have regular
communication and feedback.
Strengthen existing structures and systems
It is important to develop/strengthen multisectoral nutrition policies and strategies for each sector,
such as has been happening in education with the SHN strategy, and in health with the IYCF strategy.
The same should be done for agriculture. Nutrition committees and TWG need to be strengthened at
national and district (DNCC) levels to continue through to AEC and community levels (SUN strategy).
In addition, the DEC needs to empower the DNCC to decide what work needs to be done by new
nutrition projects and where the work needs to take place.
Nutrition projects need to have continuous, effective communication and a close working relationship
between the project, government and community, with more backstopping of the government and
community systems, so that dependence on the project is minimised.
Nutrition extension requires additional staffing at EPA/health catchment area and frontline worker
level26 - filling of vacant agriculture and health frontline staff, adding a nutrition frontline worker
and/or placing a FNO at EPA level to support nutrition mainstreaming in all sector extension staff. It is,
26 Previously, up until 1998, there were agriculture-nutrition extension staff (Farm Home Assistants) and community
development-nutrition frontline workers (Home Craft Workers). These were phased out leaving the frontline service with no nutrition extension expertise.
16
therefore, important to improve integrated training at LUANAR (i.e. Bunda Campus and NRC) for pre-
and in-service levels.
National scale-up and sustainability of programmes
For work to continue, MoAIWD and MoH need to encourage trickledown of support from the DNCC
and EPA levels to frontline workers and CNPs so that provision of support to communities and technical
backstopping (i.e. monitoring, supervision and reporting) is seen as part of routine work. In addition,
the government requires information on the cost of running the IFSN project so that they can maintain
and scale up.
Research and Data
It is important to note that the research remained separate from the IFSN project and did not interfere,
get involved with or influence the implementation. In addition, it was observed that documentation of
case studies, lessons learned and best practices are essential when undertaking projects (i.e. IMCF
research and FAO process review results are to be communicated within the Government of Malawi
and presented in a meeting at FAO Headquarters in July 2015).
Chiefly, the results are positive, showing improvements in dietary diversity and minimum acceptable
diets, and some improvements in growth. Results were particularly promising where there was active
participation, attendance, family and community support, and food security and nutrition education
activities were harmonised.
Wrap-up and closing remarks
In closing, Dr Alexander Kalimbira highlighted the FAO Country Representative’s four opening remarks:
1. Resources to eliminate hunger and malnutrition; 2. Need for an intersectoral approach; 3. Research
and data; and 4. National framework, and strong political will and action for sustainability. He
reiterated the Deputy Secretary, DNHA’s remarks: that Malawi still has challenges; the timeliness of
the IMCF research; and that DNHA is ready to integrate nutrition into national programming.
Ms Florence Rolle, FAO Country Representative thanked everyone for their active participation in the meeting and expressed particular thanks to IFSN staff for their commitment and dedication throughout
the project’s seven years of implementation; she also expressed her gratitude to the Government of
Flanders for funding the project. She underlined the importance of utilising the IMCF research findings
in order to improve the integration of nutrition into agriculture. She also committed herself to bring
IMCF research and IFSN project results to the highest level of MoAIWD; collaborate with UNICEF to
work on Water, Sanitation and Hygiene (WASH) and nutrition; and ensure that donors (e.g. European
Union) who support nutrition take into account the results of this research.
Ms Mzondwase Mgomezulu, Deputy Director of Food and Nutrition in the DAES underlined the
uniqueness of the IMCF research in the framework of the IFSN project. She closed by emphasising the
need for ensuring that best practices enter agricultural strategies; continuing to support implementing
districts with ongoing activities and completing Round 3 of nutrition education training; and briefing
key departments and positions within the Ministries on the research outcomes and lessons for
programme and policy development. She stressed the importance of determining if the IYCF groups
can transition into the SUN community care group model, continuing with existing structures in a
multisectoral way, and capitalising on the comparative advantage of different sectors and positions.
17
Annex 1 - National Dissemination Meeting Programme IFSN and IMCF Project Dissemination Meeting. Ufulu Gardens, Lilongwe, Malawi 18th February 2015
08.30 Registration MoAIWD
Opening
Meeting Chair, LUANAR Dr Alexander Kalimbira
09.00 Opening, Welcome and Introductions Meeting Chair 09.10 Remarks FAO Malawi Representative FAO Malawi, Representative
Florence Rolle 09.20 Remarks DS Nutrition, HIV and AIDS MoH, DNHA, Deputy
Secretary Victor Sandikonda
09.30 Group Photo
Health Break
Ufulu
Session 1: Applied research in the context of an FAO food security and nutrition project - Findings of the IMCF project
Session Chair JLU Prof Michael Krawinkel
10.00 Aim of the meeting in the framework of the IMCF project FAO Malawi, Nutrition Stacia Nordin
10.10 1. Overview “Improving Food Security and Nutrition” project FAO HQ, Nutrition Theresa Jeremias FAO IFSN Project Manager Wells Kumwenda
10.30 2. Overview of the research aims and protocols JLU Nutrition Dr Irmgard Jordan
10.40 Brief Q&A Session Chair
10.50 3. Impact of food security intervention and nutrition education - results from baseline, mid-term and impact surveys in Malawi
JLU Judith Kuchenbecker
11.10 4. The factors that influenced adoption of improved infant and young child feeding (IYCF) practices in Kasungu and Mzimba districts
JLU / LUANAR Gabriella Chiutsi Phiri
11.30 Discussion Session Chair
12.15 Lunch Ufulu
Session 2: Lessons learned and Implications on programmes and future research
Session Chair MoAIWD, Director of Agricultural Extension and Services (DAES) Stella Kankwamba
13.15 5. FAO IYCF Process Review Discussion
FAO HQ, Nutrition Dr Elizabeth Westaway
14.00 6. Panel discussion, lessons learned for continuing/improving: Topics:
- Strengthening nutrition collaboration between agriculture and health at field level, in operational research and preparing staff for extension services
- Strengthening district coordination for collaboration
Panellists: - Mzimba and Kasungu Nutrition Takondwa Minjale - CSONA Virginia Mzunzu - MoAIWD Mzondwase Mgomezulu - MoH Tapiwa Ngulube - NRC Liz Saka
Session Chair
18
- DNHA Kondwani Mpeniuwawa
Discussion 15.00 Nutrition Break Ufulu Wrap-up Meeting Chair, LUANAR
Dr Alexander Kalimbira 15.30 7. Summary of Key points from today
Discussion Rapporteurs (Stacia Nordin, Theresa Jeremias, Judith Kuchenbecker)
15.45 8. Wrap-up Meeting Chair
16.00 9. Closing remarks FAO Malawi Representative, Florence Rolle DNHA, Deputy Director Nutrition, Kondwani Mpeniuwawa
FAO DNHA
16.30 End of day Meeting Chair
19
Annex 2 - National Dissemination Meeting Participant List Name Title, Designation and Organisation E-mail address
Margaret Lwanda Deputy Director Food and Nutrition, Lilongwe,
MoAIWD
Glory Phiri FNO, District Agriculture Office, Kasungu,
MoAIWD
none
Eunice Nyirenda FNO, Agriculture Development Division,
Kasungu, MoAIWD
Takondwa Minjale FNO, District Agriculture Office, Mzimba,
MoAIWD
Madalitso Chuma FNO, District Agriculture Office, Balaka,
MoAIWD
Sonintcho Chisomo Msadala FNO, District Agriculture Office, Ntchisi,
MoAIWD
Harriet Ng’ona FNO, District Agriculture Office, Karonga,
MoAIWD
none
Victor Sandikonda Deputy Secretary , DNHA, Lilongwe, MoH [email protected]
Felix Pensulo Phiri Deputy Director Nutrition, DNHA, Lilongwe,
MoH
Kondwani Mpeniuwawa Chief Nutrition, DNHA, Lilongwe, MoH [email protected]
Tapiwa Ngulube Nutritionist, Lilongwe, MoH [email protected]
Peter C. Kamuloni Environmental Health Officer, District Health
Officer, Kasungu, MoH
Gladys Manyenje Nutritionist, District Health Office, Kasungu,
MoH
Alexander Kadam'manja Environmental Health Officer, District Health
Office, Mzimba, MoH
Thomas Luweya Nutritionist, District Health Office, Zomba, MoH [email protected]
Dickson Mambulu District Health Office, Balaka, MoH [email protected]
Egrina Kwalingana IYCF Coordinator, District Health Office, Balaka,
MoH
Langani Dorcus Nyirenda Nutrition Officer, District Health Office, Ntchisi,
MoH
Hamilton Gondwe Nutritionist, District Health Office, Karonga,
MoH
Jason Chigamba Nutritionist, District Health Office, NkhataBay,
MoH
Dalitso Kang’ombe Chief Nutrition and HIV, HQ Lilongwe, Ministry
of Information, Tourism and Culture
Liz Saka Lecturer, Lilongwe, NRC [email protected]
Naomi Mkandawire Lecturer, Lilongwe, NRC [email protected]
Marion Sanuka Lecturer, Lilongwe, NRC [email protected]
Julita Manda Nutrition Advisor, Lilongwe, World
Bank/Canada
Tomaida S. Msiska Programme Manager, Lilongwe, EU [email protected]
Nikolas Bosscher Deputy General Representative Attaché
Development Cooperation, Lilongwe, Flanders
Katja M. Altincicek Nutrition Advisor, Lilongwe, German Society for
International Cooperation (GIZ)
Mpumulo Jawati Nutritionist, Lilongwe, Irish Aid [email protected]
Jecinter Akinyi Oketch Specialist in Nutrition, Lilongwe, United
Nations Children's Fund (UNICEF)
Esnart Phiri Nutrition Officer, Lilongwe, United Nations
Children's Fund (UNICEF)
Trust Mlambo Coordinator, CIFF, Ntchisi, World Food
Programme of the United Nations (WFP)
20
Name Title, Designation and Organisation E-mail address Emma Chimzukira Nutrition, Lilongwe, World Food Programme
(WFP)
Robert Ackatia-Armah Regional Nutritionist, Kigali/Rwanda,
International Potato Center
Thoko Kalanje CWW OFSP, Lilongwe, International Potato
Center
Virginia Mzunzu Nutritionist, Lilongwe, CSONA [email protected]
Agness Chikoko Nutritionist, Zomba, Emmanuel International [email protected]
Ulemu Mvula Programme Officer, Lilongwe, Feed the
Children
Nick Mwisama Lilongwe, International Food Policy Research
Institute (IFPRI)
Anthony Kulemba Monitoring and Evaluation Coordinator, Balaka,
Project Concern International
Blessings Njolomole Nutrition Advisor, Zomba, Project Concern
International
Prince Nyirongo Nutritionist, Ntchsi, World Vision International [email protected]
Florence Rolle Representative, Lilongwe, FAO [email protected]
Wells Kumwenda IFSN Project Manager – Outreach Component,
Kasungu, FAO
Lawrence Chakholoma IFSN District Nutritionist, Kasungu, FAO [email protected]
Soka Chitaya IFSN District Coordinator Kasungu, FAO [email protected]
Olipa Banda IFSN Admin, Kasungu, FAO [email protected]
Benjamin Mtika IFSN, District Coordinator Mzimba, FAO [email protected]
Dr Elizabeth Westaway Nutrition Consultant, HQ Rome/Italy, FAO [email protected]
Prof Michael Krawinkel Professor, Institute of Nutritional Science,
IMCF, Germany, JLU
Judith Kuchenbecker PhD Candidate, IMCF, Germany, JLU [email protected]
Dr Agnes Mwangwela Dean of Nutrition and Head of Food Security,
Lilongwe, LUANAR
Dr Alexander Kalimbira Head of Department of Human Nutrition and
Health, Lilongwe, LUANAR
Dr Beatrice Mtimuni Associate Professor, Human Nutrition,
Lilongwe, LUANAR
Dr Charles Masangano Associate Professor, Agricultural Extension,
Lilongwe, LUANAR
Numeri C. Geresomo Lecturer, Lilongwe, LUANAR [email protected]
Gabriella Chiutsi Phiri PhD Candidate, IMCF, Lilongwe, LUANAR [email protected]
Dissemination Meeting Secretariat
Mzondwase Agnes
Mgomezulu
Deputy Director Food and Nutrition, DAES,
Lilongwe, MoAIWD
Theresa Jeremias Nutrition Consultant, HQ Rome/Italy, FAO [email protected]
Stacia Nordin Nutrition Officer, Lilongwe, FAO [email protected]
Dr Irmgard Jordan Research Fellow, Institute of Nutritional
Science, IMCF, Germany, JLU
giessen.de
21
Annex 3 - Food Security Summary Sheet
Improving Food Security and Nutrition (IFSN) Policies and Programme Outreach
Malawi, February 2015
Introduction: The nutrition-sensitive agriculture project “Improving Food Security and Nutrition Policies
and Programme Outreach (IFSN)” was implemented in Malawi from 2008-2015. Its objective was to
contribute to achieving the Malawian Development Goals (MDGs) by improving the food and nutrition
security of vulnerable populations in Mzimba and Kasungu Districts, Malawi with a focus on child nutrition
and complementary feeding. The project supported evidence-based policy and programme
improvements with the Ministries of Agriculture, Health and Education.
Target population and project area: In two project phases (2008-2011 and 2011-2015), the project
targeted a total of twelve Extension Planning Areas (EPAs) in Kasungu and Mzimba Districts. Project
activities were designed to benefit households with the following vulnerability criteria: extremely poor;
child or female-headed; caring for orphans or caring for people living with HIV/AIDS or other chronic
diseases. Additionally, households were targeted with pregnant women, children less than two years of
age, widows and elderly people living on their own. In Phase 1 and 2 the emphasis was on improving food
security and nutrition for vulnerable households, while in phase 2 the project also undertook capacity
building of Government staff, Lead Farmers through Farmer Field Schools (FFS) and school children
through Junior Farmer Field and Life Schools (JFFLS).
Farmer Field Schools and Junior Farmer Field and Life Schools: FFS and JFFLS were specific elements of
the food security intervention, which provided new knowledge and practices to groups of farmers and
youth on diversified crops production as well as life and business skills. As a result, the project assisted
the target population to make informed decisions on daily life and managing their farming activities.
Diversified agriculture: Specialised community-based organisations with 10-15 farmers promoted
diversified agriculture to support availability, access and utilisation of the six Malawi food groups:
Malawi Food Groups Promoted variety of local and seasonal crops and animal source foods
1. Staples Maize, cassava, yellow orange-fleshed sweet potatoes, Irish potatoes
2. Fruit Mangoes, papayas, bananas, watermelons, hibiscus (Chidede), guavas, oranges, Mexican apples
3. Vegetables Leafy greens, onions, tomatoes, mushrooms
4. Legumes and nuts Cowpeas, kidney beans, pigeon peas, soya
5. Animal source foods
Dairy animals (cows in Phase 1, goats in Phase 2), sheep, pigs, chicken, guinea fowls, rabbits, fish
6. Fats Avocado, Sunflower
The project provided inputs to vulnerable households to improve consumption of animal source foods at
household level and to increase quantity and variety of animal products for sale at local markets:
22
Animal source food
Input Pass-on
Dairy cows
63 11
Goats 6,952 1,468
Sheep 244 11
Pigs 2,117 1,342
Chickens 6,000 not applicable
Fish 81 dams and
ponds not applicable
Income-generating activities: Approximately 48,000 food trees such as mango, guava, bananas, orange,
avocado pears and Mexican apples were provided to 16,000 farm households and cassava, Irish potatoes
and yellow-fleshed sweet potatoes were promoted for sale. The project also promoted bee keeping and
mushroom production to diversify farmers’ sources of incomes.
Environment, soil and water conservation: The project provided inputs and training to enable the
planting of 7,000,000 trees in village community forests for climate change mitigation. Diverse seeds,
fertiliser and training on manure making for soil fertility, pit planting, and mulching were provided. The
project also promoted irrigation farming through trainings and the distribution of 476 treadle pumps and
140 sprays to farmers in irrigation groups.
Water and sanitation: Thirty boreholes (20 in Kasungu and 10 in Mzimba) were installed and trainings
were conducted on the maintenance of 500 water points from a gravity-fed water system to enable more
than 2,500 families to access potable water. The project also provided materials for the construction of
improved latrines.
Capacity building: Lead Farmers and frontline staff in FFS were trained and reached 4,600 farmers in
community-based organisations. Additionally, JFFLS facilitators were trained and reached 3,300 students.
Diverse crop production
Dietary diversification Animal source food
production
For more information contact:
Nutrition Education and Consumer Awareness Group, FAO hadquarters
www.fao.org/nutrition/education/infant-and-young-child-feeding/en/
23
Annex 4 - IYCF Summary Sheet
Improving Infant and Young Child Feeding (IYCF)
A component of the Improving Food Security and Nutrition (IFSN) project (2011-15) in Malawi
Supported by FAO with funding from the Government of Flanders Department of Foreign Affairs
Introduction: The nutrition education intervention “Kupititsa Patsogolo Kadyetsedwe Koyenela Ka Ana” (“Let us
Improve Child Feeding”) was integrated into the FAO nutrition-sensitive agriculture project “Improving Food
Security and Nutrition Policies and Programme Outreach (IFSN)” in Kasungu and Mzimba Districts, Malawi from
2011-15. The overall objective of the IFSN project was to contribute through policy and programme advisory
services to the achievement of the Government’s Development Goals by improving the food and nutrition security
of the Malawian population. The nutrition education intervention was specifically aimed at improving the dietary
intake of families and young children through nutrition and health education.
Child malnutrition in Malawi: Almost 50 percent of children less than five years of age are chronically
malnourished according to the 2010 Malawi Demographic and Health Survey. Major causes include inadequate
complementary feeding and care practices such as low dietary diversity and poor quality foods. Additionally,
inadequate breastfeeding practices, diseases, poor water, sanitation and hygiene, and other diverse household
and family factors contribute to undernutrition.
Nutrition Education to improve infant and young child feeding (IYCF): The nutrition education intervention
consisted of training sessions on improved IYCF practices with four participatory cooking demonstrations which
targeted caregivers of children aged 6-18 months. The training sessions disseminated culturally acceptable and
feasible practices which were field-tested and adapted to the needs of the community. Caregivers learned how a
diversified diet based on locally available foods can improve children’s nutritional status in combination with good
hygiene and health practices. The preparation of local and seasonal foods was encouraged, including diversified
staple foods, vegetables, fruit, legumes, nuts, animal source foods (e.g. mice, insects, eggs, milk, fish), and fats.
Project area: Three rounds of the nutrition education intervention were implemented in a total of 430 villages in
three Extension Planning Areas (EPAs) of Kasungu and Mzimba Districts from 2011-15. Round 1 covered 180
villages in 2012/13, which were studied by a research team from Justus Liebig University (JLU) Giessen, Germany.
Round 2 covered 150 new villages in additional sections of the EPAs during 2013/14. A process review was
conducted in October 2014 to explore strengths and challenges in a sample of villages from round 1 and 2. Round
3 covered 100 new villages in further sections of the EPA and started in January 2015. Round 1 and 2 reached
8,713 caregiver/child pairs and an additional 1,936 fathers, grandmothers and community leaders, resulting in a
total of 10,649 beneficiaries. Round 3 will have reached approximately 2,000 beneficiaries by July 2015.
Implementation: The nutrition education intervention was initiated by 29 Trainers of Trainers (ToTs) from
relevant members of the District Nutrition Coordinating Committee (DNCC), area supervisors and frontline staff
from Agriculture, Health, Education and Community Services in Kasungu and Mzimba Districts. They trained 249
supervisors and 968 Community Nutrition Promoters (CNP) from the Agriculture and Health sectors. CNPs worked
in their own villages to facilitate ten nutrition education sessions with 15 caregivers of children aged 6-18 months.
Fathers, village leaders and grandparents were encouraged to attend the sessions due to their important role in
family support and decision-making. The nutrition education groups met on a weekly or bi-weekly basis over a
period of five months for approximately 2 hours per session.
Nutrition education materials: The materials used in the sessions were adapted from the UNICEF Child Feeding
template for Africa, which included a range of topics on food-based nutrients, dietary diversity, food
preparation, water, sanitation and hygiene as well as danger signs of childhood diseases.
24
Title Content and use
Facilitator’s Book and Counselling Cards
The book provided technical support to the ToTs and CNPs and optimally prepared them for each
nutrition education session. Examples for dialogues and educational activities which were described
in the book supported the CNPs to provide community-adapted nutrition education to caregivers
and other community members.
Key Messages Book for Caregivers
During the nutrition education sessions, CNPs used these A3-sized books that were shared among
small groups of caregivers, fathers and grandmothers. The field-tested key messages were presented
in the local languages Chichewa and Chitumbuka with culturally-appropriate illustrations of good
childcare and feeding practices.
Recipe Book This recipe book contained tested recipes to enrich porridges with local and seasonal nutrient-dense
foods. They were used for the participatory cooking demonstrations which took place during the
sessions 2, 4, 7 and 9.
Graduation ceremonies: With the completion of each nutrition education group, caregivers received a certificate
during graduation ceremonies which were organised by frontline staff, CNPs and their communities, with support
from supervisors and district staff. The ceremony reinforced behaviour change among caregivers and sensitised
the community on nutrition: the Malawi six food groups, water, sanitation, health care and crosscutting issues of
gender, environment and community empowerment. To encourage the formation of new nutrition education
groups, the villages retained the set of nutrition education materials.
Monitoring and Evaluation: Trainers were involved in monitoring, supervision and reporting activities:
CNPs recorded attendance in the nutrition education sessions and conducted household visits to support the
adoption of improved childcare and feeding practices.
Frontline staff supported 2-10 villages and attended a number of nutrition education sessions to support the
CNPs. They undertook growth monitoring when equipment was available.
Supervisors at EPA and Health Centre Level supervised approximately 10-20 frontline staff and compiled
quarterly reports, which were sent to District Nutritionists from agriculture and health sectors. The District
Food and Nutrition Officer (FNO) collected all reports and submitted copies to the FAO project support unit.
Government and project staff collected attendance registers of nutrition education sessions from the EPAs
and sent them to the District Agriculture Office (DAO) where data was input, analysed and reported on
quarterly and after field visits. Data was consolidated by the FNO and copies were submitted to the FAO
project support unit at district level. All data was uploaded into the IFSN project database for the food
security and nutrition education interventions.
Research study:
A research team from JLU Giessen, Germany analysed and documented changes in household food practices,
child growth and iron status in households from nutrition education round 1. Baseline, mid-term and impact
surveys were conducted as well as a longitudinal study. The researchers collected anthropometric
measurements, blood specimens and data on dietary intake. Additionally, focus group discussions and
interviews were carried out.
For more information contact:
Nutrition Education and Consumer Awareness Group, FAO hadquarters
www.fao.org/nutrition/education/infant-and-young-child-feeding/en/