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Improving Complementary Feeding Practices in Afghanistan

Improving Complementary Feeding Practices in Afghanistan. Picture removed…. Initial Results of TIPS in Afghanistan By Charlotte Dufour FAO & Ministry of Agriculture, Afghanistan. The nutritional situation. Very high mortality: 26% children die before age 5

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Improving Complementary Feeding Practices in Afghanistan

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  1. Improving Complementary Feeding Practices in Afghanistan Picture removed… Initial Results of TIPS in Afghanistan By Charlotte Dufour FAO & Ministry of Agriculture, Afghanistan

  2. The nutritional situation • Very high mortality: 26% children die before age 5 • +/- 50% of chronic malnutrition 6-10% acute malnutrition in 6-59 m 9-16% acute malnutrition in 6-29 m • High rates of MDDs (MOPH, 2003) • Iron deficiency: ≥ 70% of children (38% anemic) and 48% of women (25% anemic) • Vitamin A (night blindness): 20% women • Vitamin C: up to 10% in some areas; scurvy epidemics 2002 & 2003 Picture removed…

  3. 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. Picture removed…

  4. 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

  5. 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

  6. 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…

  7. 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

  8. Picture removed… 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

  9. Picture removed… 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

  10. 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 Badakshan Herat Kabul

  11. 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 Picture removed…

  12. 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 Picture removed…

  13. 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)

  14. 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 Picture removed…

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