improving complementary feeding practices in afghanistan initial results of tips in afghanistan by...
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Improving Complementary Feeding Practices
in Afghanistan
Initial Results of TIPS in AfghanistanBy Charlotte Dufour
FAO & Ministry of Agriculture, Afghanistan
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The nutritional situation• Very high mortality: 26% children
die before age 5
• +/- 50% of chronic malnutrition6-10% acute malnutrition in 6-59 m9-16% 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
of certain foods Picture removed…
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
• Consultative process / negotiation, where families have a choice → Move from ideal recommendation to practical recommendation
• Step by step process / interim target
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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):– 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
• Field work in 3 provinces and in Kabul (2 villages)
Bamyan
Herat
Badakshan
Kabul
Constraints to TIPS implementation
• 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
• Kids love the recipes!
• Mothers change their cooking and purchasing patterns
The story of Nazeer Ahmad
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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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