Improving Complementary Feeding Practices in Afghanistan

1
Improving Complementary Feeding Practices in
Afghanistan
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• Initial Results of TIPS in Afghanistan
• By 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 malnutrition
• 6-10 acute malnutrition in 6-59 m
• 9-16 acute malnutrition in 6-29 m
• High rates of MDDs
• (MOPH, 2003)
• Iron deficiency 70 of children
• (38 anemic) and 48 of women
• (25 anemic)
• Vitamin A (night blindness) 20 women
• Vitamin C up to 10 in some areas
• scurvy epidemics 2002 2003

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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.

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Common Breastfeeding Problems

• Ritual foods given at birth
• Mothers breastmilk insufficient (link to
  mothers mental health)
• Cease breastfeeding when child is sick, or mother
  sick
• Cease breastfeeding when pregnant

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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

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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

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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

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TIPS Approach
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• 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
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• 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
Badakshan
Herat
Kabul
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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 childs diet but
  not their own (too poor)
• Contradictory advice from doctors (esp. About
  breastfeeding)

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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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