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Behavioral Change for Improved Nutrition among pastoralists in Ethiopia (BCIN)

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

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Behavioral Change for Improved Nutrition among pastoralists in Ethiopia (BCIN)

  1. 1. Behavioral Change for Improved Nutrition among pastoralists in Ethiopia (BCIN) VÉTÉRINAIRES SANS FRONTIÈRES SUISSE 1
  2. 2. Preliminary findings on the Baseline Study for Barriers to optimal Maternal, Infant and Young Child Feeding Practices Lensse Gobu (BSc, MPH) May 16, 2016 2
  3. 3. Outline of the Presentation  Summary  Background  The existing platforms  Objectives and research questions  Study design and methods used  Major Preliminary findings  Conclusion 3
  4. 4. Project Summary 4 Title Behavioural Change for Improved Nutrition among Pastoralists (BCIN) The Research Action research on Maternal, Infant and Young child- feeding practices in pastoral households of Somali Region, Ethiopia Thematic Category ‘How can agriculture and the wider agri-food systems become more nutrition-sensitive and have a greater impact on nutrition outcomes?’ Lead Institution VSF Suisse Donor IFPRI Proposed end date August 2016 Partners & collaborations Jigjiga University, Woreda Livestock Crop and Rural Development Office; Woreda Health Offices in Moyale, Mubarek, Gode and Hargelle Woredas, FAO
  5. 5. Background • Ethiopia towards achieving the nutrition targets of MDG1 – But still holds one of the highest stunting rates in the world • Somali region of Ethiopia is one of the pastoralist areas frequently affected by Emergency nutrition situation. 5
  6. 6. Status of malnutrition in Somali Region of Ethiopia • Stunting (chronic malnutrition) prevalence is 33% • Wasting (acute malnutrition)- 22% (the highest from all regions) • Underweight- 33.5% (third highest from all regions of Ethiopia) Source EDHS 2011 6
  7. 7. Current Status of Nutrition in Liben Zone • According to the Deyr 2015 seasonal needs assessment report (conducted 24/10/2015— 12/11/2015); – there have been recurrent trend of malnutrition in most of the woredas of Liban zone due to poor livestock production (Dolo Ado) – 501 cases of SAM in Dolo ado woreda – 81 SAM without complication cases in Moyale, – 80 SAM without complication from Filtu woreda, – 55 SAM without complication from Hudet woreda. 7
  8. 8. Current situation , Liben Zone……cont’d • Malnutrition is among the top 5 causes of morbidity in Children <5 in all Woredas; – 4th in Dolo Ado, Filtu and Mubarek – 5th in Deka Suftu, Hudet and Moyale (Source: Deyr 2015 seasonal needs assessment report) 8
  9. 9. The context • Behavior is a very important limiting factor for optimal nutrition • SBCC, adapted to local contexts, is widely accepted as an effective mechanism for improving MIYCN practices at household level. • However- little evidence to assist relevant actors in understanding which SBCC approaches and tools are most effective. 9
  10. 10. The Existing community platforms – PFS (Pastoral Field Schools) • ‘Schools without walls’ that introduce new technological innovations while building on indigenous knowledge. • A group of b/n 25 and 30 pastoralists (including elders, men, women and youths) who meet regularly over a defined period of time to make observations that relate livestock production to the rangeland ecosystem. 10
  11. 11. The Existing community platforms – VICOBA (Village Community Banks) • Aim – to improve the cash availability at village level (in absence of financial institutions), – to mitigate times of crisis and stimulate IGAs 11  Savings-and-loans group
  12. 12. General Objective of the research: to assess the role of pastoral community platforms in increasing community awareness on key Maternal Infant and Young Child Nutrition (MIYCN) practices, and through this to effect positive behavioural changes. 12
  13. 13. Specific Objectives To identify and analyse the limiting factors to behavioural change in MIYCN in pastoral communities. To measure the feasibility and effectiveness of integrating SBCC for MIYCN into existing pastoral community platforms. To provide evidence-based recommendations for efficient nutrition-related SBCC approaches for rural agricultural and pastoralist communities. 13
  14. 14. Research Questions Are existing community platforms successful at channelling behavioural-change communication to enhance knowledge and attitudes and to optimise maternal, infant and young child feeding practices? 14
  15. 15. 15 Intervention Group Arda Ola, Katama, El-dher & Majire in Moyale and Mubarek 02 Kebeles - PFS and VICOBA are active Intervention Study (15 months) Comparison Group Meleb, El-gof, Kajowa and Raro in Moyale and Jara Kebeles in Mubarek. - No PFS and VICOBA Documentation and dissemination of results End line Study Baseline Study No intervention other than the health facility based routine behavioral interventions Cascaded Training for PFS and VICOBA 471 471
  16. 16. Tools (for quantitative Survey) • Standard KAP survey questionnaire - UN-FAO’s 2014 Guideline for Assessing Nutrition-Related KAP. • Pretested on d/t population before the baseline survey 16
  17. 17. Quantitative Survey - Conducted on 942 mothers having children 23 months or less (471 in each wing) Qualitative Study - Conducted to explore and understand the barriers to optimal MIYCN practices - FGD- conducted with mothers of children <5 years in El-dher, El-gof, Katama and Malab Kebeles of Moyale and Mubarek 02 Kebele - KII- conducted with Community Volunteers in Arda ola, El-dher, El-gof and Malab Kebeles of Moyale Woreda. 17
  18. 18. Definition of Optimal Maternal, Infant and Young Child Feeding/Nutrition 18
  19. 19. Key recommendations/ optimal MIYCN • Feeding pregnant women – One extra meal a day, eating a diversified diet • Feeding lactating women – 2 extra meal a day, diversified nutritious diet • Infants 0-6 months – Early initiation of BF- within 1 hour of birth – Feeding the colostrum – Exclusive breastfeeding 0-6 months • Infants and young children 6-23 months – Feeding diversified and nutritious diet at least 3 times a day 19
  20. 20. Preliminiary Findings on the Baseline assessment 20
  21. 21. Socio-demographic characteristics Respondents category by group Study (n=471) % Comparison (n=471) % Age Group (Year) 15-20 140 29.7% 48 10.2% 21-30 222 47.1% 240 51.0% 31-40 96 20.4% 174 36.9% 41-49 13 2.8% 9 1.9% Total 471 100.0% 471 100.0% Educational Status None 453 96.2% 463 98.3% Primary school and above 18 3.8% 8 1.7% Total 471 100.0% 471 100.0% Main source of income Animal & animal product sales 350 74.3% 334 70.9% Crop sales and trade 26 5.5% 16 3.4% Casual labor and wage employment 57 12.1% 102 21.7% Others 38 8.1% 19 4.0% Total 471 100.0% 471 100.0% Wealth status Taajir/Duresa 7 1.5% 1 0.2% Bulti-Qeba/Jirata 182 38.9% 124 26.3% Miskin 256 54.7% 306 65.0% Feqir 23 4.9% 40 8.5% Total 468 100.0% 471 100.0% Family size Less than or equal 6 people 281 59.7% 313 66.5% Greater than 6 people 190 40.3% 158 33.5% Total 471 100.0% 471 100.0% 21
  22. 22. Wealth Category No. Wealth category (higher to lower) Descriptions (livelihood sources and resources) Local name English names 1. Tajira/ Duressa Rich - Someone who can sell his livestock and change it to money; - Someone who can build a house in the town near the main road; - He has > 100 camels, > 100 cattle& > 200 shoats* 2. Bulti Qaba/ Jiraataa Medium - 10-50 camels, 20-50 cattle, 20-100 shoats. 3. Miskiina Poor - Up to 10 camels, 10 cattle and 20 shoats. 4 Qole/ Feqir Very Poor No livestock at all 22
  23. 23. * If someone has only shoats (even >200), he’s not called ‘Tajira’. They mentioned a Geri proverb where the goat herself says to someone having only shoats, ‘Naaf jette intala biyyaa hin fuudhin, gadi lakkisuuf jirta!’ meaning ‘Don’t get married to a (our) woman depending on me; lest you’ll leave her’ This was mentioned to show that shoats are not considered as a sustainable asset, as they are vulnerable to loss. 23
  24. 24. Proportional piling method used for wealth ranking 24 Wealth ranking exercise in Daresalam Kebele of Moyale Woreda
  25. 25. Barriers to Optimal Maternal, Infant an Young Child Practices Findings from the Focus Group Discussions 25
  26. 26. Exclusive breastfeeding rate Group Total Study Group Comparison group Exclusive breastfeeding No Count 86 130 216 % within Group 72.3% 85.5% 79.7% Yes Count 33 22 55 % within Group 27.7% 14.5% 20.3% Total Count 119 152 271 % within Group 100.0% 100.0% 100.0% 26
  27. 27. Focus Group Discussions • FGD was conducted with mothers having children less than 5 years of age (excluded from the quantitative survey). • 4 kebeles in Moyale Woreda – El-Dher – El-Gof – Katama – Maleb • 1 kebele in Mubarek Woreda – Mubarek 02 27
  28. 28. Barriers to optimal feeding practices of pregnant Women Economic Problems ++++ ‘Feeding with family’/ ‘as usual’ +++++ Loss of appetite +++ Not feeling comfortable ++ ‘No space to eat’ + 28 +++++ Majority ++++ Average +++ Some ++ Few + Very few
  29. 29. Barriers, pregnant women…cont’d • One FGD Participant in Mubarek 02 Kebele said “….even if I know and believe that when I’m pregnant taking additional meal is important for me and the growing baby inside my womb, but I couldn’t afford to do so. So what do I have to do? … no food… no habit…no time!” 29
  30. 30. Barriers to optimal feeding practices of lactating mothers Economic Problems ++ ‘Feeding with family’ / ‘Feeding as usual’ +++++ Heavy workload on women and no time +++ ‘We are pastoral Women’…. (misconception) ++ 30 FGD participant in El-dher mentioned “We are pastoral and we do not have a good practice of feeding ourselves, and our baby. We spend our time in fetching water, and bush for collecting woods. (W1) …I remember one time I was far from home leaving my two week old baby a the whole day to fetch water and wood.’
  31. 31. Barriers, lactating mothers……cont’d • One FGD Participant in Mubarek 02 Kebele said “We have a problem to afford food and a breastfeeding mother receives a meal that is prepared for the whole family, and it might be twice or once per day.” • Another participant mentioned, “Previously, a goat will slaughtered for a mother in the first 40 days of her delivery. But now I get a cup of milk for survival.’ 31
  32. 32. Barriers to optimal feeding practices of Infant and young children Problem on the availability of food in the house ++ Insufficient breastmilk +++++ Inaccessibility of water ++++ Time constraint ++++ Lack of support from men ++ Misconception - “We are pastoral Women”.... - “The Child is unable to digest”… - “…the stomach is small” +++ ++ + 32
  33. 33. Barriers, feeding infants and young children….cont’d • Early initiation of Breastfeeding – FGD in Mubarek 02 Kebele; “In our community, if the mother’s breast couldn’t produce milk immediately after she gives birth, the newborn receives water or camel milk. Another participant mentioned; “I usually give my newborn water or camel milk on the first day and breast milk on the next day.” 33
  34. 34. Barriers, feeding infants and young children….cont’d • Feeding the colostrum – Given to the child +++ (El-gof, Mubarek 02, Katama Kebeles) • FGD participants in El-Dher kebele “we remove first drop of colostrum to the ground. I never give my child this (colostrum).” Another participant mentioned “… for this child, I gave the first milk since I came to know that first milk is important and nutritious for newborns.” 34
  35. 35. Barriers, feeding infants and young children….cont’d • Feeding children > 6 months “The young child receives additional food which is prepared for the whole family, more frequently tea, or sugar with water, or camel milk till lunch or dinner time. 35
  36. 36. Barriers, feeding infants and young children….cont’d • Feeding young children (6-23 years old); FGD participant in El-dher Kebele “…we feed our children rice, animal milk, maize and tea twice in a day. …. the baby’s stomach is small and not have ability to digest frequently and therefore it is enough for the baby to get once or twice per day with whole family…… we will not prepare a meal for a child alone.” 36
  37. 37. Cultural beliefs related to feeding and nutrition (From the intervention…) • It is not good that a pregnant woman feeds frequently because her baby will grow in her belly and make her labor difficult. • Feeding organ meat – It is not good for a man to eat the heart of an animal because it will affect his braveness. • Feeding on poultry – There is a mixed type of belief; in pure pastoral Kebeles like ‘Katama’ it is taboo, whereas in agro- pastoral ones like El-dher and Arda-ola it is well accepted 37
  38. 38. KAP on Food Safety and Personal Hygiene Part of the quantitative survey 38
  39. 39. KAP on Food Safety and Personal Hygiene Variables Response Respondents by group Study Comparison Frequency Percentage Frequency Percentage Had proper practice of food safety Yes 351 74.5 412 87.5 No 120 25.5 59 12.5 Had proper practice of hand washing Yes 188 39.9 238 50.5 No 283 60.1 233 49.5 Ever heard about food safety Yes 148 31.4 204 43.3 No 323 68.6 267 56.7 Proper knowledge of hand washing [k607M] Yes 99 21 12 2.6 No 372 79 459 97.4 Perceived of susceptibility related to food safety Yes 366 77.7 423 89.9 No 105 22.3 48 10.1 Perceived of barriers related to Food Safety and Personnel Hygiene Yes 30 6.4 10 2.1 No 441 93.6 461 97.9 Perceived of benefits related to Food Safety and Personnel Hygiene Yes 415 88.1 413 87.7 No 56 11.9 58 12.3 39
  40. 40. Conclusion • Majority (> 70%) of the respondents depend on sales of animal and animal products sale as a major source of income. • Wealth classification in Moyale and Mubarek Woredas depend on ownership of livestock. • Low EBF rate (<30%) in both the study and comparison Kebeles. • It is a common practice for mothers to feed themselves when pregnant and breastfeeding, as well as young children with the rest of the family. 40
  41. 41. Conclusion…. Cont’d • Barriers to optimal MIYCN – Misconception on optimal feeding practices – Economic problem on mothers in not being able to purchase according to what their children need. – heavy workload on women and minimal support from their husband, time constraint. 41
  42. 42. WHAT WE DO 42 to promote Environmental Health Our goal: Sustainable livestock based livelihoods to support Livestock Health to ensure People’s Health
  43. 43. WHAT WE DO 43 to promote Environmental Health Our goal: Sustainable livestock based livelihoods to support Livestock Health to ensure People’s Health