in Government Controlled Areas of Donetsk and Luhansk oblasts September 26 2016 Nutrition SubCluster of the Health and Nutrition Cluster Кластерная группа по питанию Кластера здравоохранения и питания ID: 934816
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Slide1
UNICEF/CDCAssessment of Pregnant Womenin Government Controlled Areas of Donetsk and Luhansk oblasts
September 26, 2016
Nutrition Sub-Cluster of the Health and Nutrition Cluster
Кластерная группа по питанию Кластера здравоохранения и питанияhttps://www.humanitarianresponse.info/operations/ukraine/nutrition
Slide2Introduction
In January 2016, the Ukrainian Ministry of Health and UNICEF implemented an anemia surveillance system for pregnant
women in government
controlled areas (GCA) of Donetsk and Luhansk oblastsSentinel surveillance sites were selected in both areas (5 in Donetsk and 5 in Luhansk)High levels of anemia were detected in both areasNo assessments of anemia prevalence and risk factors for pregnant women have been completed
Slide3Assessment GoalCollect information on nutrition and breastfeeding beliefs among pregnant women in order to help design and inform
interventions of the key partner agencies working in the health and nutrition sectors. Specifically,
provide advice on the requirements for adapted and targeted assistance for
pregnant women living in the government controlled areas of Donetsk and Luhansk oblasts.
Slide4MethodsQuantitativeCross-sectional health facility based survey
QualitativeFocus group discussionsKey informant interviews
Slide5SamplingObtained lists of all antenatal health facilities in GCA in Donetsk and Luhansk oblasts
Selected health facilities servicing the highest proportion of pregnant women and those included as sentinel sites for anemia surveillanceAll pregnant women who visited selected health facilities the day of the survey were included
Slide6Survey Sites-Donetsk
Survey Sites
Number pregnant women
Proportion of pregnant women in oblastBakhmut3480.05Druzhkivka2620.04Kostyantynivka
388
0.06
Mykolayivka
182
0.03
Slovyansk
448
0.06
Kramatorsk
777
0.11
Dobropillya
198
0.03
Myrnograd (formerly Dimitrov)
273
0.04
Pokrovs’ke (formerly Krasnoarmiysk)
363
0.05
Selidove
166
0.02
Velyka Novosilka
122
0.02
Mariupol
2090
0.30
Total
5617
0.80
Slide7Survey Sites-Donetsk
Survey Sites
Number pregnant women
Proportion of pregnant women in oblastBakhmut3480.05Druzhkivka2620.04Kostyantynivka
388
0.06
Mykolayivka
182
0.03
Slovyansk
448
0.06
Kramatorsk
777
0.11
Dobropillya
198
0.03
Myrnograd (formerly Dimitrov)
273
0.04
Pokrovs’ke (formerly Krasnoarmiysk)
3630.05Selidove1660.02Velyka Novosilka1220.02Mariupol20900.30Total56170.80
Slide8Survey Sites-Luhansk
Survey Sites
Number pregnant women
Proportion of pregnant women in oblastLisichansk3440.19Rubizhne2310.13Severodonetsk248
0.14
Kreminna
129
0.07
Svatove
151
0.08
Starobilsk
242
0.13
Novopskov
113
0.06
Bilovodsk
103
0.06
Total
15610.87
Slide9Survey Sites-Luhansk
Survey Sites
Number pregnant women
Proportion of pregnant women in oblastLisichansk3440.19Rubizhne2310.13Severodonetsk2480.14
Kreminna
129
0.07
Svatove
151
0.08
Starobilsk
242
0.13
Novopskov
113
0.06
Bilovodsk
103
0.06
Total
1561
0.87
Slide10Inclusion CriteriaPregnant women visiting the health facility on the day the survey was conducted
Consented to participate in the survey
Slide11Survey Administration
Sample size of 550 pregnant women275 women from both Donetsk and Luhansk oblastsSample was allocated to prenatal clinics proportional to the number of pregnant women registered at the clinic
Data collection was conducted from
29 August to 9 September 2016 10 trained data collectors
Slide12Survey TopicsQuestions
Household and individual demographics, incomeInformation on previous children
Access to humanitarian assistanceFood intake and dietary diversity
Supplementation during pregnancyBreastfeeding information and beliefsReported hemoglobin levelFrom health card
Slide13Questionnaire-Demographics and Income
Weeks pregnant
Education
AgeMarital statusLiving situationHead of householdIDP statusNumber of people in householdEmployment statusTotal incomeNumber of antenatal care visitsWeeks pregnant at first visit
Slide14Questionnaire-Previous Children
Number of children given birth to
Age of youngest child
Slide15Receipt of aid
Cash/Vouchers
Food
Non-foodQuestionnaire-Humanitarian Assistance
Slide16Questionnaire-Nutrition and Food Insecurity
Nutrition
Foods eaten yesterday
Number of meals eaten yesterdayAmount of iron-rich foods eaten yesterdayNumber of times food groups eaten in past weekIndividual dietary diversityCalculated based on the Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) developed by the Food and Agriculture Organization (FAO) of the United Nations and the USAID’s Food and Nutrition Technical Assistance III Project (FANTA)1
1. FAO and FHI 360.2016.
Minimum Dietary Diversity for Women: A Guide for Measurement
. Rome: FAO.
Slide17Questionnaire-Supplementation
Currently taking/ever took nutritional supplements/vitamins during this pregnancy
Reasons for not taking supplements
Supplements currently takingName, amount, who recommendedSupplements taken in the pastName, how many weeks took supplement, reason stopped
Slide18Questionnaire-Breastfeeding Information/Beliefs
Prenatal courses available at clinic
Information on breastfeeding provided at individual health care visits
Breastfeeding/complementary feeding counselingBreastfeeding beliefsBreastfeeding initiationExclusive breastfeedingContinued breastfeedingComplementary feeding
Slide19Questionnaire-Hemoglobin
Hemoglobin levels
From medical record card
Slide20Focus Group Discussions4 Focus Group (FG) Discussions with pregnant women:
Women without childrenWomen with childrenSingle womenWomen from rural areas
Range of 7-8 participants in each focus group
Slide21Key Informant Interviews5 Key informant interviews (KII) with pregnant women:
Single womanIDPWoman with first childWoman with previous children
Woman from rural area
Slide22Household Survey Results
Slide23Demographic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Age (years), n (%)
< 25 years
76 (25.9)
90 (32.3)
166 (29.0)
25-29 years
122 (41.5)
84 (30.1)
206 (36.0)
30-34 years
67 (22.8)
67 (24.0)
134 (23.3)
>=35 years
29 (9.9)38 (13.6)
67 (11.7)
Mean (SD)
27.6 (5.0)
28.0 (7.1)
0.049
27.8 (6.1)
Weeks Pregnant (weeks
), n (%)
<28 Weeks
116 (39.5)
149 (53.4)
265 (46.3)
>=28 Weeks
178 (60.5)
130 (46.6)
308 (53.8)
Mean (SD)
28.8 (11.5)
26.6 (14.0)
0.034
27.7 (12.8)
Number of antenatal care
visits, n (%)
0.093
One
10 (3.4)
13 (4.7)
23 (4.0)
Two
26 (8.8)
30 (10.8)
56 (9.8)
Three
22 (7.5)
32 (11.5)
54 (9.4)
Four or more
236 (80.3)
204 (73.1)
440 (76.8)
Number of weeks pregnant at first visit,
Mean
(SD)
10.2 (5.6)
9.9 (4.2)
0.422
10.0 (5.0)
Slide24Demographic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Age (years), n (%)
< 25 years
76 (25.9)
90 (32.3)
166 (29.0)
25-29 years
122 (41.5)
84 (30.1)
206 (36.0)
30-34 years
67 (22.8)
67 (24.0)
134 (23.3)
>=35 years
29 (9.9)38 (13.6)
67 (11.7)
Mean (SD)
27.6 (5.0)
28.0 (7.1)
0.049
27.8 (6.1)
Weeks Pregnant (weeks
), n (%)
<28 Weeks
116 (39.5)
149 (53.4)
265 (46.3)
>=28 Weeks
178 (60.5)
130 (46.6)
308 (53.8)
Mean (SD)
28.8 (11.5)
26.6 (14.0)
0.034
27.7 (12.8)
Number of antenatal care
visits, n (%)
0.093
One
10 (3.4)
13 (4.7)
23 (4.0)
Two
26 (8.8)
30 (10.8)
56 (9.8)
Three
22 (7.5)
32 (11.5)
54 (9.4)
Four or more
236 (80.3)
204 (73.1)
440 (76.8)Number of weeks pregnant at first visit, Mean (SD)10.2 (5.6)9.9 (4.2)0.42210.0 (5.0)
Slide25Demographic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Age (years), n (%)
< 25 years
76 (25.9)
90 (32.3)
166 (29.0)
25-29 years
122 (41.5)
84 (30.1)
206 (36.0)
30-34 years
67 (22.8)
67 (24.0)
134 (23.3)
>=35 years
29 (9.9)38 (13.6)
67 (11.7)
Mean (SD)
27.6 (5.0)
28.0 (7.1)
0.049
27.8 (6.1)
Weeks Pregnant (weeks
), n (%)
<28 Weeks
116 (39.5)
149 (53.4)
265 (46.3)
>=28 Weeks
178 (60.5)
130 (46.6)
308 (53.8)
Mean (SD)
28.8 (11.5)
26.6 (14.0)
0.034
27.7 (12.8)
Number of antenatal care
visits, n (%)
0.093
One
10 (3.4)
13 (4.7)
23 (4.0)
Two
26 (8.8)
30 (10.8)
56 (9.8)
Three
22 (7.5)
32 (11.5)
54 (9.4)
Four or more
236 (80.3)
204 (73.1)
440 (76.8)Number of weeks pregnant at first visit, Mean (SD)10.2 (5.6)9.9 (4.2)0.42210.0 (5.0)
Slide26Demographic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Age (years), n (%)
< 25 years
76 (25.9)
90 (32.3)
166 (29.0)
25-29 years
122 (41.5)
84 (30.1)
206 (36.0)
30-34 years
67 (22.8)
67 (24.0)
134 (23.3)
>=35 years
29 (9.9)38 (13.6)
67 (11.7)
Mean (SD)
27.6 (5.0)
28.0 (7.1)
0.049
27.8 (6.1)
Weeks Pregnant (weeks
), n (%)
<28 Weeks
116 (39.5)
149 (53.4)
265 (46.3)
>=28 Weeks
178 (60.5)
130 (46.6)
308 (53.8)
Mean (SD)
28.8 (11.5)
26.6 (14.0)
0.034
27.7 (12.8)
Number of antenatal care
visits, n (%)
0.093
One
10 (3.4)
13 (4.7)
23 (4.0)
Two
26 (8.8)
30 (10.8)
56 (9.8)
Three
22 (7.5)
32 (11.5)
54 (9.4)
Four or more
236 (80.3)
204 (73.1)
440 (76.8)Number of weeks pregnant at first visit, Mean (SD)10.2 (5.6)9.9 (4.2)0.42210.0 (5.0)
Slide27Demographic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Age (years), n (%)
< 25 years
76 (25.9)
90 (32.3)
166 (29.0)
25-29 years
122 (41.5)
84 (30.1)
206 (36.0)
30-34 years
67 (22.8)
67 (24.0)
134 (23.3)
>=35 years
29 (9.9)38 (13.6)
67 (11.7)
Mean (SD)
27.6 (5.0)
28.0 (7.1)
0.049
27.8 (6.1)
Weeks Pregnant (weeks
), n (%)
<28 Weeks
116 (39.5)
149 (53.4)
265 (46.3)
>=28 Weeks
178 (60.5)
130 (46.6)
308 (53.8)
Mean (SD)
28.8 (11.5)
26.6 (14.0)
0.034
27.7 (12.8)
Number of antenatal care
visits, n (%)
0.093
One
10 (3.4)
13 (4.7)
23 (4.0)
Two
26 (8.8)
30 (10.8)
56 (9.8)
Three
22 (7.5)
32 (11.5)
54 (9.4)
Four or more
236 (80.3)
204 (73.1)
440 (76.8)Number of weeks pregnant at first visit, Mean (SD)10.2 (5.6)9.9 (4.2)0.42210.0 (5.0)
Slide28Demographic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Marital Status, n (%)
0.715
Single
, living with partner
57 (19.4)
55 (19.7)
112 (19.6)
Single
, living without partner
20 (6.8)
19 (6.8)
39 (6.8)
Married
, living with husband215 (73.1)201 (72.0) 416 (72.6) Married, living without husband1 (0.3)
0 (0)
1 (0.2)
Other
1 (0.3)
4 (1.4)
5 (0.9)
Education
level,
n (%)
0.014
Incomplete/complete
secondary
school
27 (9.2)
19 (6.8)
46 (8.0)
Professional
secondary education
114 (38.8)
145 (52.0)
259 (45.2)
Incomplete
higher education
19 (6.5)
25 (9.0)
44 (7.7)
Complete
higher education or above
134 (45.6)
90 (32.3)
224 (39.1)
Employment
Status, n (%)
0.913
Not working/unemployed125 (42.5)127 (45.5) 252 (44.0) Employed and working87 (29.6)90 (32.3) 177 (30.9) Maternity leave81 (27.6)58 (20.8) 139 (24.2) Other1 (0.3)
4 (1.4)
5 (0.9)
Slide29Demographic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Marital Status, n (%)
0.715
Single
, living with partner
57 (19.4)
55 (19.7)
112 (19.6)
Single
, living without partner
20 (6.8)
19 (6.8)
39 (6.8)
Married
, living with husband215 (73.1)201 (72.0) 416 (72.6) Married, living without husband1 (0.3)
0 (0)
1 (0.2)
Other
1 (0.3)
4 (1.4)
5 (0.9)
Education
level,
n (%)
0.014
Incomplete/complete
secondary
school
27 (9.2)
19 (6.8)
46 (8.0)
Professional
secondary education
114 (38.8)
145 (52.0)
259 (45.2)
Incomplete
higher education
19 (6.5)
25 (9.0)
44 (7.7)
Complete
higher education or above
134 (45.6)
90 (32.3)
224 (39.1)
Employment
Status, n (%)
0.913
Not working/unemployed125 (42.5)127 (45.5) 252 (44.0) Employed and working87 (29.6)90 (32.3) 177 (30.9) Maternity leave81 (27.6)58 (20.8) 139 (24.2) Other1 (0.3)
4 (1.4)
5 (0.9)
Slide30Demographic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Marital Status, n (%)
0.715
Single
, living with partner
57 (19.4)
55 (19.7)
112 (19.6)
Single
, living without partner
20 (6.8)
19 (6.8)
39 (6.8)
Married
, living with husband215 (73.1)201 (72.0) 416 (72.6) Married, living without husband1 (0.3)
0 (0)
1 (0.2)
Other
1 (0.3)
4 (1.4)
5 (0.9)
Education
level,
n (%)
0.014
Incomplete/complete
secondary
school
27 (9.2)
19 (6.8)
46 (8.0)
Professional
secondary education
114 (38.8)
145 (52.0)
259 (45.2)
Incomplete
higher education
19 (6.5)
25 (9.0)
44 (7.7)
Complete
higher education or above
134 (45.6)
90 (32.3)
224 (39.1)
Employment
Status, n (%)
0.913
Not working/unemployed125 (42.5)127 (45.5) 252 (44.0) Employed and working87 (29.6)90 (32.3) 177 (30.9) Maternity leave81 (27.6)58 (20.8) 139 (24.2) Other1 (0.3)
4 (1.4)
5 (0.9)
Slide31Demographic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Marital Status, n (%)
0.715
Single
, living with partner
57 (19.4)
55 (19.7)
112 (19.6)
Single
, living without partner
20 (6.8)
19 (6.8)
39 (6.8)
Married
, living with husband215 (73.1)201 (72.0) 416 (72.6) Married, living without husband1 (0.3)
0 (0)
1 (0.2)
Other
1 (0.3)
4 (1.4)
5 (0.9)
Education
level,
n (%)
0.014
Incomplete/complete
secondary
school
27 (9.2)
19 (6.8)
46 (8.0)
Professional
secondary education
114 (38.8)
145 (52.0)
259 (45.2)
Incomplete
higher education
19 (6.5)
25 (9.0)
44 (7.7)
Complete
higher education or above
134 (45.6)
90 (32.3)
224 (39.1)
Employment
Status, n (%)
0.913
Not working/unemployed125 (42.5)127 (45.5) 252 (44.0) Employed and working87 (29.6)90 (32.3) 177 (30.9) Maternity leave81 (27.6)58 (20.8) 139 (24.2) Other1 (0.3)
4 (1.4)
5 (0.9)
Slide32Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Total # of children born to mother, n (%)
0.371
0
156 (53.1)
140 (50.2)
296 (51.7)
1
112 (38.1)
104 (37.3)
216 (37.7)
2
15 (5.1)
27 (9.7)
42 (7.3)
>=3
11 (3.7)
8 (2.9)
19 (3.3)
Age of youngest child born to mother (years)
Mean (SD)
8.6 (16.2)
7.8 (11.8)
0.445
8.2 (14.2)
Median (IQR)
5 (3-9)
6 (3-10)
5 (3-9)
Information on previous children
Slide33Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Total # of children born to mother, n (%)
0.371
0
156 (53.1)
140 (50.2)
296 (51.7)
1
112 (38.1)
104 (37.3)
216 (37.7)
2
15 (5.1)
27 (9.7)
42 (7.3)
>=3
11 (3.7)
8 (2.9)
19 (3.3)
Age of youngest child born to mother (years)
Mean (SD)
8.6 (16.2)
7.8 (11.8)
0.445
8.2 (14.2)
Median (IQR)
5 (3-9)
6 (3-10)
5 (3-9)
Information on previous children
Slide34Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Total # of children born to mother, n (%)
0.371
0
156 (53.1)
140 (50.2)
296 (51.7)
1
112 (38.1)
104 (37.3)
216 (37.7)
2
15 (5.1)
27 (9.7)
42 (7.3)
>=3
11 (3.7)
8 (2.9)
19 (3.3)
Age of youngest child born to mother (years)
Mean (SD)
8.6 (16.2)
7.8 (11.8)
0.445
8.2 (14.2)
Median (IQR)
5 (3-9)
6 (3-10)
5 (3-9)
Information on previous children
Slide35Household Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Living situation, n (%)
0.197
Own house or apartment (no fee)
199 (67.7)
196 (70.3)
395 (68.9)
Living w/ relatives or friends (no fee)
31 (10.5)
36 (12.9)
67 (11.7)
Renting an apartment or house (for
fee
)
62 (21.1)
47 (16.9)
109 (19.0) Other2 (0.7)0 (0)
2 (0.4)
Head of
household, n
(%)
0.933
Male
134 (45.6)
117 (41.9)
251 (43.8)
Female
49 (16.7)
71 (25.5)
120 (20.9)
Both
111 (37.8)
90 (32.2)
201 (35.1)
Don’t know
0 (0)
1 (0.4)
1 (0.2)
Total # of people in household
Mean (SD)
3.0 (1.1)
3.2 (1.2)
0.038
3.1 (1.2)
Median (IQR)
3 (2-3)
3 (2-4)
3 (2-4)
Live with
parents
,
n (%)
76 (25.9)
84 (30.1)
0.257
160 (27.9)
Slide36Household Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Living situation, n (%)
0.197
Own house or apartment (no fee)
199 (67.7)
196 (70.3)
395 (68.9)
Living w/ relatives or friends (no fee)
31 (10.5)
36 (12.9)
67 (11.7)
Renting an apartment or house (for
fee
)
62 (21.1)
47 (16.9)
109 (19.0) Other2 (0.7)0 (0)
2 (0.4)
Head of
household, n
(%)
0.933
Male
134 (45.6)
117 (41.9)
251 (43.8)
Female
49 (16.7)
71 (25.5)
120 (20.9)
Both
111 (37.8)
90 (32.2)
201 (35.1)
Don’t know
0 (0)
1 (0.4)
1 (0.2)
Total # of people in household
Mean (SD)
3.0 (1.1)
3.2 (1.2)
0.038
3.1 (1.2)
Median (IQR)
3 (2-3)
3 (2-4)
3 (2-4)
Live with
parents
,
n (%)
76 (25.9)
84 (30.1)
0.257
160 (27.9)
Slide37Household Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Living situation, n (%)
0.197
Own house or apartment (no fee)
199 (67.7)
196 (70.3)
395 (68.9)
Living w/ relatives or friends (no fee)
31 (10.5)
36 (12.9)
67 (11.7)
Renting an apartment or house (for
fee
)
62 (21.1)
47 (16.9)
109 (19.0) Other2 (0.7)0 (0)
2 (0.4)
Head of
household, n
(%)
0.933
Male
134 (45.6)
117 (41.9)
251 (43.8)
Female
49 (16.7)
71 (25.5)
120 (20.9)
Both
111 (37.8)
90 (32.2)
201 (35.1)
Don’t know
0 (0)
1 (0.4)
1 (0.2)
Total # of people in household
Mean (SD)
3.0 (1.1)
3.2 (1.2)
0.038
3.1 (1.2)
Median (IQR)
3 (2-3)
3 (2-4)
3 (2-4)
Live with
parents
,
n (%)
76 (25.9)
84 (30.1)
0.257
160 (27.9)
Slide38Household Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Living situation, n (%)
0.197
Own house or apartment (no fee)
199 (67.7)
196 (70.3)
395 (68.9)
Living w/ relatives or friends (no fee)
31 (10.5)
36 (12.9)
67 (11.7)
Renting an apartment or house (for
fee
)
62 (21.1)
47 (16.9)
109 (19.0) Other2 (0.7)0 (0)
2 (0.4)
Head of
household, n
(%)
0.933
Male
134 (45.6)
117 (41.9)
251 (43.8)
Female
49 (16.7)
71 (25.5)
120 (20.9)
Both
111 (37.8)
90 (32.2)
201 (35.1)
Don’t know
0 (0)
1 (0.4)
1 (0.2)
Total # of people in household
Mean (SD)
3.0 (1.1)
3.2 (1.2)
0.038
3.1 (1.2)
Median (IQR)
3 (2-3)
3 (2-4)
3 (2-4)
Live with
parents
,
n (%)
76 (25.9)
84 (30.1)
0.257
160 (27.9)
Slide39Socioeconomic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Received humanitarian assistance in the last 3 months, n (%)18 (6.1)
6 (2.2)
24 (4.2)
Resident of household currently earning
money, n (%)
274 (93.2)
266 (95.3)
0.272
540 (94.2)
Total monthly household income (UAH)
N=266
N=236
N=502
Mean (SD)
5829.4 (3120.6)
4439.9 (2442.2)
<0.0001
5176.2 (2903.5)
Median (IQR)
5000 (4000-8000)
4000 (3000-5000)
5000 (3000-7000)
Total monthly household income per capita (UAH)
Mean (SD)
2219.4 (1386.4)
1587.8 (1049.1)
<0.0001
1922.4 (1277.7)
Median (IQR)
2000 (1000-3000)
1333 (855-2000)
1667 (1000-2500)
Household income per capita ($/day
), n (%)
<0.0001
<$2
91 (34.2)
124 (52.5)
215 (42.8)
$2 to <$3
56 (21.1)
61 (25.9)
117 (23.3)
$3 to <$4
46 (17.3)
29 (12.3)
75 (14.9)
>= $4
73 (27.4)
22 (9.3)
95 (18.9)
Slide40Socioeconomic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Received humanitarian assistance in the last 3 months, n (%)18 (6.1)
6 (2.2)
24 (4.2)
Resident of household currently earning
money, n (%)
274 (93.2)
266 (95.3)
0.272
540 (94.2)
Total monthly household income (UAH)
N=266
N=236
N=502
Mean (SD)
5829.4 (3120.6)
4439.9 (2442.2)
<0.0001
5176.2 (2903.5)
Median (IQR)
5000 (4000-8000)
4000 (3000-5000)
5000 (3000-7000)
Total monthly household income per capita (UAH)
Mean (SD)
2219.4 (1386.4)
1587.8 (1049.1)
<0.0001
1922.4 (1277.7)
Median (IQR)
2000 (1000-3000)
1333 (855-2000)
1667 (1000-2500)
Household income per capita ($/day
), n (%)
<0.0001
<$2
91 (34.2)
124 (52.5)
215 (42.8)
$2 to <$3
56 (21.1)
61 (25.9)
117 (23.3)
$3 to <$4
46 (17.3)
29 (12.3)
75 (14.9)
>= $4
73 (27.4)
22 (9.3)
95 (18.9)
Slide41Socioeconomic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Received humanitarian assistance in the last 3 months, n (%)18 (6.1)
6 (2.2)
24 (4.2)
Resident of household currently earning
money, n (%)
274 (93.2)
266 (95.3)
0.272
540 (94.2)
Total monthly household income (UAH)
N=266
N=236
N=502
Mean (SD)
5829.4 (3120.6)
4439.9 (2442.2)
<0.0001
5176.2 (2903.5)
Median (IQR)
5000 (4000-8000)
4000 (3000-5000)
5000 (3000-7000)
Total monthly household income per capita (UAH)
Mean (SD)
2219.4 (1386.4)
1587.8 (1049.1)
<0.0001
1922.4 (1277.7)
Median (IQR)
2000 (1000-3000)
1333 (855-2000)
1667 (1000-2500)
Household income per capita ($/day
), n (%)
<0.0001
<$2
91 (34.2)
124 (52.5)
215 (42.8)
$2 to <$3
56 (21.1)
61 (25.9)
117 (23.3)
$3 to <$4
46 (17.3)
29 (12.3)
75 (14.9)
>= $4
73 (27.4)
22 (9.3)
95 (18.9)
Slide42Socioeconomic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Received humanitarian assistance in the last 3 months, n (%)18 (6.1)
6 (2.2)
24 (4.2)
Resident of household currently earning
money, n (%)
274 (93.2)
266 (95.3)
0.272
540 (94.2)
Total monthly household income (UAH)
N=266
N=236
N=502
Mean (SD)
5829.4 (3120.6)
4439.9 (2442.2)
<0.0001
5176.2 (2903.5)
Median (IQR)
5000 (4000-8000)
4000 (3000-5000)
5000 (3000-7000)
Total monthly household income per capita (UAH)
Mean (SD)
2219.4 (1386.4)
1587.8 (1049.1)
<0.0001
1922.4 (1277.7)
Median (IQR)
2000 (1000-3000)
1333 (855-2000)
1667 (1000-2500)
Household income per capita ($/day
), n (%)
<0.0001
<$2
91 (34.2)
124 (52.5)
215 (42.8)
$2 to <$3
56 (21.1)
61 (25.9)
117 (23.3)
$3 to <$4
46 (17.3)
29 (12.3)
75 (14.9)
>= $4
73 (27.4)
22 (9.3)
95 (18.9)
Slide43Socioeconomic Characteristics
Donetsk
(N=294)
Luhansk(N=279)P-valueTotal(N=573)Received humanitarian assistance in the last 3 months, n (%)18 (6.1)
6 (2.2)
24 (4.2)
Resident of household currently earning
money, n (%)
274 (93.2)
266 (95.3)
0.272
540 (94.2)
Total monthly household income (UAH)
N=266
N=236
N=502
Mean (SD)
5829.4 (3120.6)
4439.9 (2442.2)
<0.0001
5176.2 (2903.5)
Median (IQR)
5000 (4000-8000)
4000 (3000-5000)
5000 (3000-7000)
Total monthly household income per capita (UAH)
Mean (SD)
2219.4 (1386.4)
1587.8 (1049.1)
<0.0001
1922.4 (1277.7)
Median (IQR)
2000 (1000-3000)
1333 (855-2000)
1667 (1000-2500)
Household income per capita ($/day
), n (%)
<0.0001
<$2
91 (34.2)
124 (52.5)
215 (42.8)
$2 to <$3
56 (21.1)
61 (25.9)
117 (23.3)
$3 to <$4
46 (17.3)
29 (12.3)
75 (14.9)
>= $4
73 (27.4)
22 (9.3)
95 (18.9)
Slide44IDP Status
Donetsk
(N=294)
Luhansk(N=279)Total(N=573)Currently displaced due to conflict, n (%)30 (10.2)23 (8.2)53 (9.3)
N=30
N=23
N=53
Permanent address displaced
from,
n (%)
Donetsk oblast
28 (93.3)
0 (0)
28 (52.8)
Luhansk oblast
1 (3.3)
23 (100)
24 (45.3)
Other
1 (3.3)0 (0)1 (1.9)
N=263
N=256
N=519
Returned from displacement due to
conflict, n (%)
64 (24.3)
29 (11.3)
93 (17.9)
Number of months displaced
N=64
N=29
N=93
Mean (SD)
5.1 (6.8)
7.3 (7.3)
5.8 (7.0)
Median (IQR)
2 (1-6)
3 (2-12)
3 (1-7)
Number of months since returned
N=64
N=29
N=93
Mean (SD)
19.4 (7.9)
17.7 (8.3)
18.8 (8.1)
Median (IQR)
24 (18-25)
23 (12-24)
24 (12-24)
Slide45IDP Status
Donetsk
(N=294)
Luhansk(N=279)Total(N=573)Currently displaced due to conflict, n (%)30 (10.2)23 (8.2)53 (9.3)
N=30
N=23
N=53
Permanent address displaced
from,
n (%)
Donetsk oblast
28 (93.3)
0 (0)
28 (52.8)
Luhansk oblast
1 (3.3)
23 (100)
24 (45.3)
Other
1 (3.3)0 (0)1 (1.9)
N=263
N=256
N=519
Returned from displacement due to
conflict, n (%)
64 (24.3)
29 (11.3)
93 (17.9)
Number of months displaced
N=64
N=29
N=93
Mean (SD)
5.1 (6.8)
7.3 (7.3)
5.8 (7.0)
Median (IQR)
2 (1-6)
3 (2-12)
3 (1-7)
Number of months since returned
N=64
N=29
N=93
Mean (SD)
19.4 (7.9)
17.7 (8.3)
18.8 (8.1)
Median (IQR)
24 (18-25)
23 (12-24)
24 (12-24)
Slide46IDP Status
Donetsk
(N=294)
Luhansk(N=279)Total(N=573)Currently displaced due to conflict, n (%)30 (10.2)23 (8.2)53 (9.3)
N=30
N=23
N=53
Permanent address displaced
from,
n (%)
Donetsk oblast
28 (93.3)
0 (0)
28 (52.8)
Luhansk oblast
1 (3.3)
23 (100)
24 (45.3)
Other
1 (3.3)0 (0)1 (1.9)
N=263
N=256
N=519
Returned from displacement due to
conflict, n (%)
64 (24.3)
29 (11.3)
93 (17.9)
Number of months displaced
N=64
N=29
N=93
Mean (SD)
5.1 (6.8)
7.3 (7.3)
5.8 (7.0)
Median (IQR)
2 (1-6)
3 (2-12)
3 (1-7)
Number of months since returned
N=64
N=29
N=93
Mean (SD)
19.4 (7.9)
17.7 (8.3)
18.8 (8.1)
Median (IQR)
24 (18-25)
23 (12-24)
24 (12-24)
Slide47IDP Status
Donetsk
(N=294)
Luhansk(N=279)Total(N=573)Currently displaced due to conflict, n (%)30 (10.2)23 (8.2)53 (9.3)
N=30
N=23
N=53
Permanent address displaced
from,
n (%)
Donetsk oblast
28 (93.3)
0 (0)
28 (52.8)
Luhansk oblast
1 (3.3)
23 (100)
24 (45.3)
Other
1 (3.3)0 (0)1 (1.9)
N=263
N=256
N=519
Returned from displacement due to
conflict, n (%)
64 (24.3)
29 (11.3)
93 (17.9)
Number of months displaced
N=64
N=29
N=93
Mean (SD)
5.1 (6.8)
7.3 (7.3)
5.8 (7.0)
Median (IQR)
2 (1-6)
3 (2-12)
3 (1-7)
Number of months since returned
N=64
N=29
N=93
Mean (SD)
19.4 (7.9)
17.7 (8.3)
18.8 (8.1)
Median (IQR)
24 (18-25)
23 (12-24)
24 (12-24)
Slide48IDP Status
Donetsk
(N=294)
Luhansk(N=279)Total(N=573)Currently displaced due to conflict, n (%)30 (10.2)23 (8.2)53 (9.3)
N=30
N=23
N=53
Permanent address displaced
from,
n (%)
Donetsk oblast
28 (93.3)
0 (0)
28 (52.8)
Luhansk oblast
1 (3.3)
23 (100)
24 (45.3)
Other
1 (3.3)0 (0)1 (1.9)
N=263
N=256
N=519
Returned from displacement due to
conflict, n (%)
64 (24.3)
29 (11.3)
93 (17.9)
Number of months displaced
N=64
N=29
N=93
Mean (SD)
5.1 (6.8)
7.3 (7.3)
5.8 (7.0)
Median (IQR)
2 (1-6)
3 (2-12)
3 (1-7)
Number of months since returned
N=64
N=29
N=93
Mean (SD)
19.4 (7.9)
17.7 (8.3)
18.8 (8.1)
Median (IQR)
24 (18-25)
23 (12-24)
24 (12-24)
Slide49Nutrition
Slide50Types of Foods Eaten Yesterday
Slide51Dietary Diversity by Oblast
Indicator
Donetsk
(N=294) Luhansk(N=279) P=valueTotal(N=573)Number of food groups consumed yesterday1
Mean (SD)
5.9 (1.1)
6.0 (1.1)
0.100
5.9 (1.1)
Median (IQR)
6 (5-7)
6 (5-7)
6 (5-7)
Women with adequate dietary diversity
2
, n (%)
264 (89.8)
253 (90.7)
0.722517 (90.2)Consumption of iron-rich foods yesterday3, n (%)273 (92.9)
259 (92.8)
0.991
532 (92.8)
Number of meals eaten yesterday
Mean (SD)
4.7 (0.9)
5.7 (1.6)
<0.0001
5.2 (1.4)
Median (IQR)
5 (4-5)
6 (5-6)
5 (4-6)
1
Includes 10 Food Groups used for Women’s Dietary Diversity Score (WDDS): Starchy staples; dark green leafy vegetables; other vitamin A rich fruits and vegetables; other fruits; other vegetables; meat, poultry, and fish; eggs; legumes; nuts and seeds; milk and milk products
2
Consumed 5 or more of the 10 food groups in the day preceding the survey
3
Includes organ meat, flesh meat, and fish
Slide52Dietary Diversity by Oblast
Indicator
Donetsk
(N=294) Luhansk(N=279) P=valueTotal(N=573)Number of food groups consumed yesterday1
Mean (SD)
5.9 (1.1)
6.0 (1.1)
0.100
5.9 (1.1)
Median (IQR)
6 (5-7)
6 (5-7)
6 (5-7)
Women with adequate dietary diversity
2
, n (%)
264 (89.8)
253 (90.7)
0.722517 (90.2)Consumption of iron-rich foods yesterday3, n (%)273 (92.9)
259 (92.8)
0.991
532 (92.8)
Number of meals eaten yesterday
Mean (SD)
4.7 (0.9)
5.7 (1.6)
<0.0001
5.2 (1.4)
Median (IQR)
5 (4-5)
6 (5-6)
5 (4-6)
1
Includes 10 Food Groups used for Women’s Dietary Diversity Score (WDDS): Starchy staples; dark green leafy vegetables; other vitamin A rich fruits and vegetables; other fruits; other vegetables; meat, poultry, and fish; eggs; legumes; nuts and seeds; milk and milk products
2
Consumed 5 or more of the 10 food groups in the day preceding the survey
3
Includes organ meat, flesh meat, and fish
Slide53Dietary Diversity by Oblast
Indicator
Donetsk
(N=294) Luhansk(N=279) P=valueTotal(N=573)Number of food groups consumed yesterday1
Mean (SD)
5.9 (1.1)
6.0 (1.1)
0.100
5.9 (1.1)
Median (IQR)
6 (5-7)
6 (5-7)
6 (5-7)
Women with adequate dietary diversity
2
, n (%)
264 (89.8)
253 (90.7)
0.722517 (90.2)Consumption of iron-rich foods yesterday3, n (%)273 (92.9)
259 (92.8)
0.991
532 (92.8)
Number of meals eaten yesterday
Mean (SD)
4.7 (0.9)
5.7 (1.6)
<0.0001
5.2 (1.4)
Median (IQR)
5 (4-5)
6 (5-6)
5 (4-6)
1
Includes 10 Food Groups used for Women’s Dietary Diversity Score (WDDS): Starchy staples; dark green leafy vegetables; other vitamin A rich fruits and vegetables; other fruits; other vegetables; meat, poultry, and fish; eggs; legumes; nuts and seeds; milk and milk products
2
Consumed 5 or more of the 10 food groups in the day preceding the survey
3
Includes organ meat, flesh meat, and fish
Slide54Mean Number of Days Foods Eaten in Past Week by Oblast
Slide55Dietary Diversity by Household Income per capita
<$
2/dayN=215$2 to <$3/dayN=117$3 to <$4/dayN=75>=$4N=95
Food groups consumed yesterday
Mean (SD)
5.9 (1.1)
6.1 (1.1)
5.9 (1.3)
5.8 (1.2)
Median (IQR)
6 (5-7)
6 (5-7)
6 (5-7)
6 (5-7)
Iron-rich foods yesterday, n (%)
193 (89.8)
113 (96.6)
69 (92.0)90 (94.7)
Slide56Dietary Diversity by Household Income per capita
<$
2/dayN=215$2 to <$3/dayN=117$3 to <$4/dayN=75>=$4N=95
Food groups consumed yesterday
Mean (SD)
5.9 (1.1)
6.1 (1.1)
5.9 (1.3)
5.8 (1.2)
Median (IQR)
6 (5-7)
6 (5-7)
6 (5-7)
6 (5-7)
Iron-rich foods yesterday, n (%)
193 (89.8)
113 (96.6)
69 (92.0)90 (94.7)
Slide57Diet and Nutrition – FG and KII Common Themes
Respondents eat 3 to 7 meals
per day. Typically – 3 main meals and 2-3 additional (fruits, tea, candies or cookies)Common foods:
soup, borsch, porridge, buckwheat, cereals, potatoes, fresh seasonal vegetables and meat, milk products (cheese, yogurt)Stop consuming spicy, sour, and smoked products, alcohol, fizzy drinks, chips, coffee.Fish is not common. Some women used to eat salty or smoked fish, but now it is not recommended.Meat is common. Women prefer: poultry, turkey, rabbit, beef – steamed or boiled in most cases, sometimes fried.
Slide58In general women try to eat what they really want instead of following all advice from doctors. Diet has not changed dramatically. Meals have become more
frequent.Most important foods for pregnant women to
eat: fresh vegetables and fruits, dairy
, meat, products containing iron (beef, liver, pomegranate, apples and other red vegetables and fruits: tomatoes, currant).Decisions about diet: intuition, own body needs, information from doctors and older relatives.Diet and Nutrition – FG and KII Common Themes
Slide59Diet and Nutrition – FG and KII Notable Differences
Some women believe individual diet is affected by
a woman’s own body, previous preferences, and term
of pregnancy.Women for which this is their first child are more strict about the quality of their food.Women who already have children have comparatively relaxed attitudes to what they eat.Food quality depends on the season. Women with previous pregnancies which were not during the summer did not eat as much fruits and vegetables as they eat now.
Slide60Supplementation
Slide61Supplementation for pregnant women
Overall
N=573n (%)DonetskN=294n (%)LuhanskN=279n (%)Currently taking supplement245 (42.8)
138 (46.9)
107 (38.4)
Took supplements in the past during this pregnancy
189 (33.0)
101 (34.4)
88 (31.5)
Not taking/never took supplements during this pregnancy
139 (24.2)
55 (18.7)
84 (30.1)
Slide62Supplementation for pregnant women
Overall
N=573n (%)DonetskN=294n (%)LuhanskN=279n (%)Currently taking supplement245 (42.8)
138 (46.9)
107 (38.4)
Took supplements in the past during this pregnancy
189 (33.0)
101 (34.4)
88 (31.5)
Not taking/never took supplements during this pregnancy
139 (24.2)
55 (18.7)
84 (30.1)
Slide63Supplementation for pregnant women
Overall
N=573n (%)DonetskN=294n (%)LuhanskN=279n (%)Currently taking supplement245 (42.8)
138 (46.9)
107 (38.4)
Took supplements in the past during this pregnancy
189 (33.0)
101 (34.4)
88 (31.5)
Not taking/never took supplements during this pregnancy
139 (24.2)
55 (18.7)
84 (30.1)
Slide64Supplementation for pregnant women
Overall
N=573n (%)DonetskN=294n (%)LuhanskN=279n (%)Currently taking supplement245 (42.8)
138 (46.9)
107 (38.4)
Took supplements in the past during this pregnancy
189 (33.0)
101 (34.4)
88 (31.5)
Not taking/never took supplements during this pregnancy
139 (24.2)
55 (18.7)
84 (30.1)
Slide65Type of Supplement
Overall
N=573Early Pregnancy<28 WeeksN=265Late Pregnancy>=28 WeeksN=308Currently taking supplement, n (%)Any supplement
245 (42.8)
121 (45.7)
124 (40.2)
Folic acid
55 (9.6)
44 (16.6)
11 (3.6)
Iron or Folic acid/Iron
38 (6.6)
9 (3.4)
29 (9.4)
Multivitamin with iron
131 (22.9)
54 (20.4)
77 (25.0)
Any type of iron supplement
158 (27.6)
61 (23.0)
97 (31.5)
Other supplements (no iron)
95 (16.6)
56 (21.1)
39 (12.7)
Women Currently taking Supplements
Slide66Type of Supplement
Overall
N=573Early Pregnancy<28 WeeksN=265Late Pregnancy>=28 WeeksN=308Currently taking supplement, n (%)Any supplement245 (42.8)
121 (45.7)
124 (40.2)
Folic acid
55 (9.6)
44 (16.6)
11 (3.6)
Iron or Folic acid/Iron
38 (6.6)
9 (3.4)
29 (9.4)
Multivitamin with iron
131 (22.9)
54 (20.4)
77 (25.0)
Any type of iron supplement
158 (27.6)
61 (23.0)
97 (31.5)
Other supplements (no iron)
95 (16.6)
56 (21.1)
39 (12.7)
Women Currently taking Supplements
Slide67Type of Supplement
Overall
N=573Early Pregnancy<28 WeeksN=265Late Pregnancy>=28 WeeksN=308Currently taking supplement, n (%)Any supplement245 (42.8)
121 (45.7)
124 (40.2)
Folic acid
55 (9.6)
44 (16.6)
11 (3.6)
Iron or Folic acid/Iron
38 (6.6)
9 (3.4)
29 (9.4)
Multivitamin with iron
131 (22.9)
54 (20.4)
77 (25.0)
Any type of iron supplement
158 (27.6)
61 (23.0)
97 (31.5)
Other supplements (no iron)
95 (16.6)
56 (21.1)
39 (12.7)
Women Currently taking Supplements
Slide68Type of Supplement
Overall
N=573Early Pregnancy<28 WeeksN=265Late Pregnancy>=28 WeeksN=308Currently taking supplement, n (%)Any supplement245 (42.8)
121 (45.7)
124 (40.2)
Folic acid
55 (9.6)
44 (16.6)
11 (3.6)
Iron or Folic acid/Iron
38 (6.6)
9 (3.4)
29 (9.4)
Multivitamin with iron
131 (22.9)
54 (20.4)
77 (25.0)
Any type of iron supplement
158 (27.6)
61 (23.0)
97 (31.5)
Other supplements (no iron)
95 (16.6)
56 (21.1)
39 (12.7)
Women Currently taking Supplements
Slide69Type of Supplement
Overall
N=573Early Pregnancy<28 WeeksN=265Late Pregnancy>=28 WeeksN=308Currently taking supplement, n (%)Any supplement245 (42.8)
121 (45.7)
124 (40.2)
Folic acid
55 (9.6)
44 (16.6)
11 (3.6)
Iron or Folic acid/Iron
38 (6.6)
9 (3.4)
29 (9.4)
Multivitamin with iron
131 (22.9)
54 (20.4)
77 (25.0)
Any type of iron supplement
158 (27.6)
61 (23.0)
97 (31.5)
Other supplements (no iron)
95 (16.6)
56 (21.1)
39 (12.7)
Women Currently taking Supplements
Slide70Type of Supplement
Overall
N=573Early Pregnancy<28 WeeksN=265Late Pregnancy>=28 WeeksN=308Took supplements in the past during this pregnancy, n (%)Any supplement
189 (33.0)
69 (26.0)
120 (39.0)
Folic acid
104 (18.2)
46 (17.4)
58 (18.8)
Iron or Folic acid/Iron
13 (2.3)
3 (1.1)
10 (3.3)
Multivitamin with iron
91 (15.9)
19 (7.2)
72 (23.4)
Any type of iron supplement
101 (17.6)
22 (8.3)
79 (25.7)Other supplements (no iron)
69 (12.0)
21 (7.9)
48 (15.6)
Women who took supplements in the past
Slide71Type of Supplement
Overall
N=573Early Pregnancy<28 WeeksN=265Late Pregnancy>=28 WeeksN=308Took supplements in the past during this pregnancy, n (%)Any supplement189 (33.0)
69 (26.0)
120 (39.0)
Folic acid
104 (18.2)
46 (17.4)
58 (18.8)
Iron or Folic acid/Iron
13 (2.3)
3 (1.1)
10 (3.3)
Multivitamin with iron
91 (15.9)
19 (7.2)
72 (23.4)
Any type of iron supplement
101 (17.6)
22 (8.3)
79 (25.7)
Other supplements (no iron)
69 (12.0)
21 (7.9)
48 (15.6)
Women who took supplements in the past
Slide72Type of Supplement
Overall
N=573Early Pregnancy<28 WeeksN=265Late Pregnancy>=28 WeeksN=308Took supplements in the past during this pregnancy, n (%)Any supplement189 (33.0)
69 (26.0)
120 (39.0)
Folic acid
104 (18.2)
46 (17.4)
58 (18.8)
Iron or Folic acid/Iron
13 (2.3)
3 (1.1)
10 (3.3)
Multivitamin with iron
91 (15.9)
19 (7.2)
72 (23.4)
Any type of iron supplement
101 (17.6)
22 (8.3)
79 (25.7)
Other supplements (no iron)
69 (12.0)
21 (7.9)
48 (15.6)
Women who took supplements in the past
Slide73Overall
(N=573)
Donetsk
(N=294)Luhansk(N=279)Why not currently/evertook supplements during this pregnancy (All Women), n (%)
Not prescribed
115 (20.1)
42 (14.3)
73 (26.2)
Too expensive
6 (1.0)
5 (1.7)
1 (0.4)
Decided I don’t need
16 (2.8)
7 (2.4)
9 (3.2)
Other/DK
2 (1.7)
1 (0.3)
1 (0.4)
Why not currently/ever
took supplements during this pregnancy (Only women not taking/never took),
n (%)N=139N=55
N=84
Not prescribed
115 (82.7)
42 (
76.4)
73 (86.9)
Too expensive
6 (4.3)
5 (9.1)
1 (1.2)
Decided I don’t need
16 (11.5)
7 (12.7)
9 (10.7)
Other/DK
2 (1.4)
1 (1.8)
1 (1.2)
Reasons why women never took supplements in this pregnancy
Slide74Overall
(N=573)
Donetsk
(N=294)Luhansk(N=279)Why not currently/evertook supplements during this pregnancy (All Women), n (%)
Not prescribed
115 (20.1)
42 (14.3)
73 (26.2)
Too expensive
6 (1.0)
5 (1.7)
1 (0.4)
Decided I don’t need
16 (2.8)
7 (2.4)
9 (3.2)
Other/DK
2 (1.7)
1 (0.3)
1 (0.4)
Why not currently/ever
took supplements during this pregnancy (Only women not taking/never took),
n (%)N=139N=55
N=84
Not prescribed
115 (82.7)
42 (
76.4)
73 (86.9)
Too expensive
6 (4.3)
5 (9.1)
1 (1.2)
Decided I don’t need
16 (11.5)
7 (12.7)
9 (10.7)
Other/DK
2 (1.4)
1 (1.8)
1 (1.2)
Reasons why women never took supplements in this pregnancy
Slide75Overall
(N=573)
Donetsk
(N=294)Luhansk(N=279)Why not currently/evertook supplements during this pregnancy (All Women), n (%)
Not prescribed
115 (20.1)
42 (14.3)
73 (26.2)
Too expensive
6 (1.0)
5 (1.7)
1 (0.4)
Decided I don’t need
16 (2.8)
7 (2.4)
9 (3.2)
Other/DK
2 (1.7)
1 (0.3)
1 (0.4)
Why not currently/ever
took supplements during this pregnancy (Only women not taking/never took),
n (%)N=139N=55
N=84
Not prescribed
115 (82.7)
42 (
76.4)
73 (86.9)
Too expensive
6 (4.3)
5 (9.1)
1 (1.2)
Decided I don’t need
16 (11.5)
7 (12.7)
9 (10.7)
Other/DK
2 (1.4)
1 (1.8)
1 (1.2)
Reasons why women never took supplements in this pregnancy
Slide76Folic acid
(N=104)
Iron or Folic acid/Iron (N=13)Multivitamin with iron (N=91)Other supplements (N=69)Reason stopped taking supplement, n (%)
Health care provider
advised
to
stop
87 (83.7)
9 (69.2)
57 (62.6)
53 (76.8)
Too expensive
0
1 (7.7)
6 (6.6)
2 (2.9)
Decided herself doesn’t need
13 (12.5)
2 (15.4)
19 (20.9)
13 (18.8)Family/friends advised not to take2 (1.9)
2 (2.2)
1 (1.50)
Bad side effects
0
1 (7.7)
4 (4.4)
0
Other/DK
2 (1.9)
0
3 (3.3)
0
Duration of supplementation (weeks)
Mean (SD)
6.7 (4.3)
2.8 (2.1)
8.1 (6.5)
5.7 (6.0)
Reasons women stopped taking supplements (N=189)
Slide77Folic acid
(N=104)
Iron or Folic acid/Iron (N=13)Multivitamin with iron (N=91)Other supplements (N=69)Reason stopped taking supplement, n (%)
Health care provider
advised
to
stop
87 (83.7)
9 (69.2)
57 (62.6)
53 (76.8)
Too expensive
0
1 (7.7)
6 (6.6)
2 (2.9)
Decided herself doesn’t need
13 (12.5)
2 (15.4)
19 (20.9)
13 (18.8)Family/friends advised not to take2 (1.9)
2 (2.2)
1 (1.50)
Bad side effects
0
1 (7.7)
4 (4.4)
0
Other/DK
2 (1.9)
0
3 (3.3)
0
Duration of supplementation (weeks)
Mean (SD)
6.7 (4.3)
2.8 (2.1)
8.1 (6.5)
5.7 (6.0)
Reasons women stopped taking supplements (N=189)
Slide78Folic acid
(N=104)
Iron or Folic acid/Iron (N=13)Multivitamin with iron (N=91)Other supplements (N=69)Reason stopped taking supplement, n (%)
Health care provider
advised
to
stop
87 (83.7)
9 (69.2)
57 (62.6)
53 (76.8)
Too expensive
0
1 (7.7)
6 (6.6)
2 (2.9)
Decided herself doesn’t need
13 (12.5)
2 (15.4)
19 (20.9)
13 (18.8)Family/friends advised not to take2 (1.9)
2 (2.2)
1 (1.50)
Bad side effects
0
1 (7.7)
4 (4.4)
0
Other/DK
2 (1.9)
0
3 (3.3)
0
Duration of supplementation (weeks)
Mean (SD)
6.7 (4.3)
2.8 (2.1)
8.1 (6.5)
5.7 (6.0)
Reasons women stopped taking supplements (N=189)
Slide79Folic acid
(N=104)
Iron or Folic acid/Iron (N=13)Multivitamin with iron (N=91)Other supplements (N=69)Reason stopped taking supplement, n (%)
Health care provider
advised
to
stop
87 (83.7)
9 (69.2)
57 (62.6)
53 (76.8)
Too expensive
0
1 (7.7)
6 (6.6)
2 (2.9)
Decided herself doesn’t need
13 (12.5)
2 (15.4)
19 (20.9)
13 (18.8)Family/friends advised not to take2 (1.9)
2 (2.2)
1 (1.50)
Bad side effects
0
1 (7.7)
4 (4.4)
0
Other/DK
2 (1.9)
0
3 (3.3)
0
Duration of supplementation (weeks)
Mean (SD)
6.7 (4.3)
2.8 (2.1)
8.1 (6.5)
5.7 (6.0)
Reasons women stopped taking supplements (N=189)
Slide80Supplements – FG and KII Common Themes
Almost all women take vitamins/supplements prescribed by a doctor.
Doctor prescribes vitamins on the basis of test results and health condition
of women. Women rarely decide to take vitamins without prescription.In general, all supplements are available in pharmacies.Women believe that supplements are good for the future baby. Women also decide to follow the doctor's advice and take supplements because they improve the condition of their hair, nails, and teeth.Some women believe that taking supplements is not necessary because their pregnancies are in the summer seasonLots of vitamins in fresh fruits and vegetables availableIf tests are normal, they do not take supplements despite the doctor's advice.If possible, pregnant women buy Ukrainian brands of supplements because they are cheaper.Some women believe that taking a lot of vitamins can be harmful.
Slide81Supplements – FG and KII Notable Differences
Women who already have children more often decide not to take supplements when they see that their health condition is normal or has improved
without doctor’s consultation.IDP women or women from families with low income may refuse to
take supplements if they are expensive.
Slide82Anemia
Slide83Percentage of women with anemia by oblast
32.0%
Slide84Percentage of women with anemia by income per capita
Slide85Indicator
<28 Weeks
(
N=227) >=28 Weeks(N=306) n (%)95% CIn (%)95% CI
Anemia
classification,
n (%)
Total
(<110 g/L)
60 (26.4)
20.8-32.7
105 (34.3)
29.0-39.9
Mild
(100-109 g/L)
44 (19.4)
14.4-25.1
75 (24.5)
19.8-29.7 Moderate (70-99 g/L)16 (7.1)4.1-11.230 (9.8)
6.7-13.7
Hemoglobin levels (g/L)
Mean (SD)
116.0 (11.7
)
112.9 (10.3
)
Median (IQR)
116 (108-124)
114 (106-119)
Women with anemia by early/late pregnancy
Slide86Indicator
<28 Weeks
(
N=227) >=28 Weeks(N=306) n (%)95% CIn (%)95% CI
Anemia
classification,
n (%)
Total
(<110 g/L)
60 (26.4)
20.8-32.7
105 (34.3)
29.0-39.9
Mild
(100-109 g/L)
44 (19.4)
14.4-25.1
75 (24.5)
19.8-29.7 Moderate (70-99 g/L)16 (7.1)4.1-11.230 (9.8)
6.7-13.7
Hemoglobin levels (g/L)
Mean (SD)
116.0 (11.7
)
112.9 (10.3
)
Median (IQR)
116 (108-124)
114 (106-119)
Women with anemia by early/late pregnancy
Slide87Indicator
<28 Weeks
(
N=227) >=28 Weeks(N=306) n (%)95% CIn (%)95% CI
Anemia
classification,
n (%)
Total
(<110 g/L)
60 (26.4)
20.8-32.7
105 (34.3)
29.0-39.9
Mild
(100-109 g/L)
44 (19.4)
14.4-25.1
75 (24.5)
19.8-29.7 Moderate (70-99 g/L)16 (7.1)4.1-11.230 (9.8)
6.7-13.7
Hemoglobin levels (g/L)
Mean (SD)
116.0 (11.7
)
112.9 (10.3
)
Median (IQR)
116 (108-124)
114 (106-119)
Women with anemia by early/late pregnancy
P=0.001
Slide88Women with anemia taking iron supplements currently or in the past
Indicator
Moderate
70-99 g/LMild100-109 g/LTotal Anemia<110 g/L DonetskN=24n (%)
Luhansk
N=22
n
(%)
Donetsk
N=62
n
(%)
Luhansk
N=57
n
(%)
Donetsk
N=86
n
(%)
Luhansk
N=79
n (%)Currently taking iron supplements9 (37.5)11 (50.0)28 (45.2)19 (33.3)
37 (43.0)
30 (38.0)
Took iron supplements in the past
8 (33.3)
3 (13.6)
10 (16.1)
9 (15.8)
18 (20.9)
12 (15.2)
Took
iron supplements in the past or currently taking
17 (70.8)
14 (63.6)
38 (61.3)
28 (49.1)
55 (63.9)
42 (53.2)
Slide89Women with anemia taking iron supplements currently or in the past
Indicator
Moderate
70-99 g/LMild100-109 g/LTotal Anemia<110 g/L DonetskN=24n
(%)
Luhansk
N=22
n
(%)
Donetsk
N=62
n
(%)
Luhansk
N=57
n
(%)
Donetsk
N=86
n
(%)
Luhansk
N=79n (%)Currently taking iron supplements9 (37.5)11 (50.0)28 (45.2)19 (33.3)
37 (43.0)
30 (38.0)
Took iron supplements in the past
8 (33.3)
3 (13.6)
10 (16.1)
9 (15.8)
18 (20.9)
12 (15.2)
Took
iron supplements in the past or currently taking
17 (70.8)
14 (63.6)
38 (61.3)
28 (49.1)
55 (63.9)
42 (53.2)
Slide90Women with anemia taking iron supplements currently or in the past
Indicator
Moderate
70-99 g/LMild100-109 g/LTotal Anemia<110 g/L DonetskN=24n
(%)
Luhansk
N=22
n
(%)
Donetsk
N=62
n
(%)
Luhansk
N=57
n
(%)
Donetsk
N=86
n
(%)
Luhansk
N=79n (%)Currently taking iron supplements9 (37.5)11 (50.0)28 (45.2)19 (33.3)
37 (43.0)
30 (38.0)
Took iron supplements in the past
8 (33.3)
3 (13.6)
10 (16.1)
9 (15.8)
18 (20.9)
12 (15.2)
Took
iron supplements in the past or currently taking
17 (70.8)
14 (63.6)
38 (61.3)
28 (49.1)
55 (63.9)
42 (53.2)
Slide91Women with anemia taking iron supplements currently or in the past
Indicator
Moderate
70-99 g/LMild100-109 g/LTotal Anemia<110 g/L DonetskN=24n
(%)
Luhansk
N=22
n
(%)
Donetsk
N=62
n
(%)
Luhansk
N=57
n
(%)
Donetsk
N=86
n
(%)
Luhansk
N=79n (%)Currently taking iron supplements9 (37.5)11 (50.0)28 (45.2)19 (33.3)
37 (43.0)
30 (38.0)
Took iron supplements in the past
8 (33.3)
3 (13.6)
10 (16.1)
9 (15.8)
18 (20.9)
12 (15.2)
Took
iron supplements in the past or currently taking
17 (70.8)
14 (63.6)
38 (61.3)
28 (49.1)
55 (63.9)
42 (53.2)
Slide92Anemia – FG and KII Common Themes
Most women are aware of anemia. They believe anemia is associated with low hemoglobin, iron deficiency, and lack of oxygen in the
blood and anemia can be dangerous for the development of the future baby.
Sources of information about anemia: doctors (cardiologists, therapists, gynecologists), own experience during first pregnancy, knowledge from high and secondary education.Products that are necessary to use in order to increase hemoglobin levels: liver, meat, apples, pomegranate juice, tomatoes and other vegetables and red fruits, seaweed.Factors that can cause anemia: poor quality food, lack of meat in the diet, different infection, influenza.Blood test (including hemoglobin level) are taken regularly during pregnancy (3-4 times).
Slide93Anemia – FG and KII Notable Differences
Those women who have low hemoglobin levels
and who were pregnant before know more about anemia.
In Rubizhne all women who had low level of hemoglobin during pregnancy were given free iron pills called “humanitarian pills”.
Slide94Breastfeeding Information
Slide95Prenatal
Courses
Donetsk
(N=294) Luhansk(N=279)Total(N=573)Prenatal courses offered, n (%)
No
118 (40.2)
172 (61.7)
290 (50.6)
Yes, at clinic
165 (56.1)
103 (36.9)
268 (46.8)
Yes, private courses
1 (0.3)
1 (0.3)
2 (0.3)
Don’t know
10 (3.4)
3 (1.1)
13 (2.3)
Attendance of prenatal
courses, n (%)
All
women
54/294
(18.4
)
39/279
(14.0
)
93/573
(16.2
)
Woman
in early term (<28 weeks)
6/116
(5.2)
10/149
(6.7)
16/265
(6.0)
Woman in late term (>= 28 weeks)
48/178
(27.0)
29/130
(22.3)
77/308
(25.0)
How many sessions
attended, n
(%)
One
29 (35.2)
13 (33.3)
32 (34.4)
Two
9 (16.7)
13 (33.3)
22 (23.7)
Three8 (14.8)12 (30.8)20 (21.5) Four or more18 (33.3)1 (2.6)19 (20.4) N=54N=39N=93Discussed breastfeeding or complementary feeding at courses, n (%)38 (70.4)26 (66.7)64 (68.8)
Slide96Prenatal
Courses
Donetsk
(N=294) Luhansk(N=279)Total(N=573)Prenatal courses offered, n (%)
No
118 (40.2)
172 (61.7)
290 (50.6)
Yes, at clinic
165 (56.1)
103 (36.9)
268 (46.8)
Yes, private courses
1 (0.3)
1 (0.3)
2 (0.3)
Don’t know
10 (3.4)
3 (1.1)
13 (2.3)
Attendance of prenatal
courses, n (%)
All
women
54/294
(18.4
)
39/279
(14.0
)
93/573
(16.2
)
Woman
in early term (<28 weeks)
6/116
(5.2)
10/149
(6.7)
16/265
(6.0)
Woman in late term (>= 28 weeks)
48/178
(27.0)
29/130
(22.3)
77/308
(25.0)
How many sessions
attended, n
(%)
One
29 (35.2)
13 (33.3)
32 (34.4)
Two
9 (16.7)
13 (33.3)
22 (23.7)
Three8 (14.8)12 (30.8)20 (21.5) Four or more18 (33.3)1 (2.6)19 (20.4) N=54N=39N=93Discussed breastfeeding or complementary feeding at courses, n (%)38 (70.4)26 (66.7)64 (68.8)
Slide97Prenatal
Courses
Donetsk
(N=294) Luhansk(N=279)Total(N=573)Prenatal courses offered, n (%)
No
118 (40.2)
172 (61.7)
290 (50.6)
Yes, at clinic
165 (56.1)
103 (36.9)
268 (46.8)
Yes, private courses
1 (0.3)
1 (0.3)
2 (0.3)
Don’t know
10 (3.4)
3 (1.1)
13 (2.3)
Attendance of prenatal
courses, n (%)
All
women
54/294
(18.4
)
39/279
(14.0
)
93/573
(16.2
)
Woman
in early term (<28 weeks)
6/116
(5.2)
10/149
(6.7)
16/265
(6.0)
Woman in late term (>= 28 weeks)
48/178
(27.0)
29/130
(22.3)
77/308
(25.0)
How many sessions
attended, n
(%)
One
29 (35.2)
13 (33.3)
32 (34.4)
Two
9 (16.7)
13 (33.3)
22 (23.7)
Three8 (14.8)12 (30.8)20 (21.5) Four or more18 (33.3)1 (2.6)19 (20.4) N=54N=39N=93Discussed breastfeeding or complementary feeding at courses, n (%)38 (70.4)26 (66.7)64 (68.8)
Slide98Prenatal
Courses
Donetsk
(N=294) Luhansk(N=279)Total(N=573)Prenatal courses offered, n (%)
No
118 (40.2)
172 (61.7)
290 (50.6)
Yes, at clinic
165 (56.1)
103 (36.9)
268 (46.8)
Yes, private courses
1 (0.3)
1 (0.3)
2 (0.3)
Don’t know
10 (3.4)
3 (1.1)
13 (2.3)
Attendance of prenatal
courses, n (%)
All
women
54/294
(18.4
)
39/279
(14.0
)
93/573
(16.2
)
Woman
in early term (<28 weeks)
6/116
(5.2)
10/149
(6.7)
16/265
(6.0)
Woman in late term (>= 28 weeks)
48/178
(27.0)
29/130
(22.3)
77/308
(25.0)
How many sessions
attended, n
(%)
One
29 (35.2)
13 (33.3)
32 (34.4)
Two
9 (16.7)
13 (33.3)
22 (23.7)
Three8 (14.8)12 (30.8)20 (21.5) Four or more18 (33.3)1 (2.6)19 (20.4) N=54N=39N=93Discussed breastfeeding or complementary feeding at courses, n (%)38 (70.4)26 (66.7)64 (68.8)
Slide99Prenatal
Courses
Donetsk
(N=294) Luhansk(N=279)Total(N=573)Prenatal courses offered, n (%)
No
118 (40.2)
172 (61.7)
290 (50.6)
Yes, at clinic
165 (56.1)
103 (36.9)
268 (46.8)
Yes, private courses
1 (0.3)
1 (0.3)
2 (0.3)
Don’t know
10 (3.4)
3 (1.1)
13 (2.3)
Attendance of prenatal
courses, n (%)
All
women
54/294
(18.4
)
39/279
(14.0
)
93/573
(16.2
)
Woman
in early term (<28 weeks)
6/116
(5.2)
10/149
(6.7)
16/265
(6.0)
Woman in late term (>= 28 weeks)
48/178
(27.0)
29/130
(22.3)
77/308
(25.0)
How many sessions
attended, n
(%)
One
29 (35.2)
13 (33.3)
32 (34.4)
Two
9 (16.7)
13 (33.3)
22 (23.7)
Three8 (14.8)12 (30.8)20 (21.5) Four or more18 (33.3)1 (2.6)19 (20.4) N=54N=39N=93Discussed breastfeeding or complementary feeding at courses, n (%)38 (70.4)26 (66.7)64 (68.8)
Slide100Prenatal
Courses
Donetsk
(N=294) Luhansk(N=279)Total(N=573)Prenatal courses offered, n (%)
No
118 (40.2)
172 (61.7)
290 (50.6)
Yes, at clinic
165 (56.1)
103 (36.9)
268 (46.8)
Yes, private courses
1 (0.3)
1 (0.3)
2 (0.3)
Don’t know
10 (3.4)
3 (1.1)
13 (2.3)
Attendance of prenatal
courses, n (%)
All
women
54/294
(18.4
)
39/279
(14.0
)
93/573
(16.2
)
Woman
in early term (<28 weeks)
6/116
(5.2)
10/149
(6.7)
16/265
(6.0)
Woman in late term (>= 28 weeks)
48/178
(27.0)
29/130
(22.3)
77/308
(25.0)
How many sessions
attended, n
(%)
One
29 (35.2)
13 (33.3)
32 (34.4)
Two
9 (16.7)
13 (33.3)
22 (23.7)
Three8 (14.8)12 (30.8)20 (21.5) Four or more18 (33.3)1 (2.6)19 (20.4) N=54N=39N=93Discussed breastfeeding or complementary feeding at courses, n (%)38 (70.4)26 (66.7)64 (68.8)
Slide101Donetsk
N=38
n (%)LuhanskN=26n (%)TotalN=64n (%)When to begin breastfeeding
Did not discuss
1 (2.6)
0
1 (1.6)
<1 hour
29 (76.3)
26 (100)
55 (85.9)
1-24 hours
3 (7.9)
0
3 (4.7)
>24 hours
0
0
0
Other/DK5 (13.2)0
5 (7.8)
Until what age to exclusively
breastfeed
Did not discuss
7 (18.4)
1 (3.8)
8 (12.5)
<6 months
7 (18.4)
6 (23.1)
13 (20.3)
6 months
17 (44.8)
17 (65.5)
34 (53.1)
>6 months
0
1 (3.8)
1 (1.6)
Don’t know
7 (18.4)
1 (3.8)
8 (12.5)
Breastfeeding information at prenatal courses
Slide102Donetsk
N=38
n (%)LuhanskN=26n (%)TotalN=64n (%)When to begin breastfeeding
Did not discuss
1 (2.6)
0
1 (1.6)
<1 hour
29 (76.3)
26 (100)
55 (85.9)
1-24 hours
3 (7.9)
0
3 (4.7)
>24 hours
0
0
0
Other/DK
5 (13.2)0
5 (7.8)
Until what age to exclusively breastfeed
Did not discuss
7 (18.4)
1 (3.8)
8 (12.5)
<6 months
7 (18.4)
6 (23.1)
13 (20.3)
6 months
17 (44.8)
17 (65.5)
34 (53.1)
>6 months
0
1 (3.8)
1 (1.6)
Don’t know
7 (18.4)
1 (3.8)
8 (12.5)
Breastfeeding information at prenatal courses
Slide103Donetsk
N=38
n (%)LuhanskN=26n (%)TotalN=64n (%)When to begin breastfeeding
Did not discuss
1 (2.6)
0
1 (1.6)
<1 hour
29 (76.3)
26 (100)
55 (85.9)
1-24 hours
3 (7.9)
0
3 (4.7)
>24 hours
0
0
0
Other/DK
5 (13.2)0
5 (7.8)
Until what age to exclusively breastfeed
Did not discuss
7 (18.4)
1 (3.8)
8 (12.5)
<6 months
7 (18.4)
6 (23.1)
13 (20.3)
6 months
17 (44.8)
17 (65.5)
34 (53.1)
>6 months
0
1 (3.8)
1 (1.6)
Don’t know
7 (18.4)
1 (3.8)
8 (12.5)
Breastfeeding information at prenatal courses
Slide104Donetsk
N=38
n (%)LuhanskN=26n (%)TotalN=64n (%)Until what age to continue breastfeeding
Did not discuss
6 (15.8)
3 (11.5)
9 (14.1)
12 months
16 (42.1)
11 (42.3)
27 (42.2)
13-23 months
6 (15.8)
1 (3.8)
7 (10.9)
24 months
3 (7.9)
6 (23.1)
9 (14.1)
>24 months
01 (3.8)
1 (1.6)
Don’t know
7 (18.4)
4 (15.5)
11 (17.1)
At what age to start complementary foods
Did not discuss
3 (7.9)
1 (3.9)
4 (6.3)
<6 months
2 (5.3)
5 (19.2)
7 (10.9)
6 months
26 (68.4)
14 (53.8)
40 (62.5)
>6 months
1 (2.6)
5 (19.2)
6 (9.4)
Don’t know
6 (15.8)
1 (3.9)
7 (10.9)
Breastfeeding information at prenatal courses
Slide105Donetsk
N=38
n (%)LuhanskN=26n (%)TotalN=64n (%)Until what age to continue breastfeeding
Did not discuss
6 (15.8)
3 (11.5)
9 (14.1)
12 months
16 (42.1)
11 (42.3)
27 (42.2)
13-23 months
6 (15.8)
1 (3.8)
7 (10.9)
24 months
3 (7.9)
6 (23.1)
9 (14.1)
>24 months
01 (3.8)
1 (1.6)
Don’t know
7 (18.4)
4 (15.5)
11 (17.1)
At what age to start complementary foods
Did not discuss
3 (7.9)
1 (3.9)
4 (6.3)
<6 months
2 (5.3)
5 (19.2)
7 (10.9)
6 months
26 (68.4)
14 (53.8)
40 (62.5)
>6 months
1 (2.6)
5 (19.2)
6 (9.4)
Don’t know
6 (15.8)
1 (3.9)
7 (10.9)
Breastfeeding information at prenatal courses
Slide106Donetsk
N=38
n (%)LuhanskN=26n (%)TotalN=64n (%)Until what age to continue breastfeeding
Did not discuss
6 (15.8)
3 (11.5)
9 (14.1)
12 months
16 (42.1)
11 (42.3)
27 (42.2)
13-23 months
6 (15.8)
1 (3.8)
7 (10.9)
24 months
3 (7.9)
6 (23.1)
9 (14.1)
>24 months
01 (3.8)
1 (1.6)
Don’t know
7 (18.4)
4 (15.5)
11 (17.1)
At what age to start complementary foods
Did not discuss
3 (7.9)
1 (3.9)
4 (6.3)
<6 months
2 (5.3)
5 (19.2)
7 (10.9)
6 months
26 (68.4)
14 (53.8)
40 (62.5)
>6 months
1 (2.6)
5 (19.2)
6 (9.4)
Don’t know
6 (15.8)
1 (3.9)
7 (10.9)
Breastfeeding information at prenatal courses
Slide107Donetsk
(N=294
)
n (%)Luhansk(N=279)n (%)Total(N=573)n (%)Discussed breastfeeding with health care provider62 (21.1)32 (11.5)94 (16.4)
N=62
N=32
N=94
When to begin breastfeeding
Did not discuss
5 (8.1)
2 (6.3)
7 (7.5)
<1 hour
46 (74.2)
26 (81.2)
72 (76.6)
1-24 hours
5 (8.1)
3 (9.4)8 (8.5)
>24 hours
2 (3.2)
0
2 (2.1)
Other/Don’t know
4 (6.4)
1 (3.1)
5 (5.3)
Until what age to exclusively breastfeed
Did not discuss
20 (32.3)
9 (28.1)
29 (30.9)
<6 months
13 (21.0)
9 (28.1)
22 (23.4)
6 months
21 (33.9)
11 (34.4)
32 (34.0)
Don’t know
8 (12.9)
3 (9.4)
11 (11.7)
Breastfeeding information at individual doctor’s visits
Slide108Donetsk
(N=294
)
n (%)Luhansk(N=279)n (%)Total(N=573)n (%)Discussed breastfeeding with health care provider62 (21.1)32 (11.5)94 (16.4)
N=62
N=32
N=94
When to begin breastfeeding
Did not discuss
5 (8.1)
2 (6.3)
7 (7.5)
<1 hour
46 (74.2)
26 (81.2)
72 (76.6)
1-24 hours
5 (8.1)
3 (9.4)8 (8.5) >24 hours
2 (3.2)
0
2 (2.1)
Other/Don’t know
4 (6.4)
1 (3.1)
5 (5.3)
Until what age to exclusively breastfeed
Did not discuss
20 (32.3)
9 (28.1)
29 (30.9)
<6 months
13 (21.0)
9 (28.1)
22 (23.4)
6 months
21 (33.9)
11 (34.4)
32 (34.0)
Don’t know
8 (12.9)
3 (9.4)
11 (11.7)
Breastfeeding information at individual doctor’s visits
Slide109Donetsk
(N=294
)
n (%)Luhansk(N=279)n (%)Total(N=573)n (%)Discussed breastfeeding with health care provider62 (21.1)32 (11.5)94 (16.4)
N=62
N=32
N=94
When to begin breastfeeding
Did not discuss
5 (8.1)
2 (6.3)
7 (7.5)
<1 hour
46 (74.2)
26 (81.2)
72 (76.6)
1-24 hours
5 (8.1)
3 (9.4)8 (8.5) >24 hours
2 (3.2)
0
2 (2.1)
Other/Don’t know
4 (6.4)
1 (3.1)
5 (5.3)
Until what age to exclusively breastfeed
Did not discuss
20 (32.3)
9 (28.1)
29 (30.9)
<6 months
13 (21.0)
9 (28.1)
22 (23.4)
6 months
21 (33.9)
11 (34.4)
32 (34.0)
Don’t know
8 (12.9)
3 (9.4)
11 (11.7)
Breastfeeding information at individual doctor’s visits
Slide110Donetsk
(N=294
)
n (%)Luhansk(N=279)n (%)Total(N=573)n (%)Discussed breastfeeding with health care provider62 (21.1)32 (11.5)94 (16.4)
N=62
N=32
N=94
When to begin breastfeeding
Did not discuss
5 (8.1)
2 (6.3)
7 (7.5)
<1 hour
46 (74.2)
26 (81.2)
72 (76.6)
1-24 hours
5 (8.1)
3 (9.4)8 (8.5) >24 hours
2 (3.2)
0
2 (2.1)
Other/Don’t know
4 (6.4)
1 (3.1)
5 (5.3)
Until what age to exclusively breastfeed
Did not discuss
20 (32.3)
9 (28.1)
29 (30.9)
<6 months
13 (21.0)
9 (28.1)
22 (23.4)
6 months
21 (33.9)
11 (34.4)
32 (34.0)
Don’t know
8 (12.9)
3 (9.4)
11 (11.7)
Breastfeeding information at individual doctor’s visits
Slide111Donetsk
(
N=62)
n (%)Luhansk(N=32) n (%)Total(N=94)n (%)Until what age to continue breastfeeding
Did not discuss
18 (29.0)
18 (25.0)
26 (27.7)
<12 months
2 (3.2)
2 (6.3)
4 (4.3)
12 months
22 (35.5)
10 (31.3)
32 (34.0)
13-23 months
3 (4.8)
1 (3.0)
4 (4.3)
24 months
9 (14.5)
5 (15.6)14 (14.9)
>24 months
2 (3.2)
2 (6.3)
4 (4.3)
Don’t know
6 (9.8)
4 (12.5)
10 (10.5)
At what age to start complementary foods
Did not discuss
14 (22.6)
6 (18.8)
20 (21.3)
<6 months
12 (19.4)
5 (15.6)
17 (18.1)
6 months
29 (46.8)
19 (59.4)
48 (51.1)
>6 months
2 (3.2)
1 (3.1)
3 (3.2)
Don’t know
5 (8.0)
1 (3.1)
6 (6.3)
Breastfeeding information at individual doctor’s visits
Slide112Donetsk
(
N=62)
n (%)Luhansk(N=32) n (%)Total(N=94)n (%)Until what age to continue breastfeeding
Did not discuss
18 (29.0)
18 (25.0)
26 (27.7)
<12 months
2 (3.2)
2 (6.3)
4 (4.3)
12 months
22 (35.5)
10 (31.3)
32 (34.0)
13-23 months
3 (4.8)
1 (3.0)
4 (4.3)
24 months
9 (14.5)
5 (15.6)14 (14.9)
>24 months
2 (3.2)
2 (6.3)
4 (4.3)
Don’t know
6 (9.8)
4 (12.5)
10 (10.5)
At what age to start complementary foods
Did not discuss
14 (22.6)
6 (18.8)
20 (21.3)
<6 months
12 (19.4)
5 (15.6)
17 (18.1)
6 months
29 (46.8)
19 (59.4)
48 (51.1)
>6 months
2 (3.2)
1 (3.1)
3 (3.2)
Don’t know
5 (8.0)
1 (3.1)
6 (6.3)
Breastfeeding information at individual doctor’s visits
Slide113Donetsk
(
N=62)
n (%)Luhansk(N=32) n (%)Total(N=94)n (%)Until what age to continue breastfeeding
Did not discuss
18 (29.0)
18 (25.0)
26 (27.7)
<12 months
2 (3.2)
2 (6.3)
4 (4.3)
12 months
22 (35.5)
10 (31.3)
32 (34.0)
13-23 months
3 (4.8)
1 (3.0)
4 (4.3)
24 months
9 (14.5)
5 (15.6)14 (14.9)
>24 months
2 (3.2)
2 (6.3)
4 (4.3)
Don’t know
6 (9.8)
4 (12.5)
10 (10.5)
At what age to start complementary foods
Did not discuss
14 (22.6)
6 (18.8)
20 (21.3)
<6 months
12 (19.4)
5 (15.6)
17 (18.1)
6 months
29 (46.8)
19 (59.4)
48 (51.1)
>6 months
2 (3.2)
1 (3.1)
3 (3.2)
Don’t know
5 (8.0)
1 (3.1)
6 (6.3)
Breastfeeding information at individual doctor’s visits
Slide114B
reastfeeding beliefs-Breastfeeding initiation
81.6%
Slide115B
reastfeeding beliefs- Exclusive breastfeeding
29.3%
Slide116B
reastfeeding beliefs- Continued breastfeeding
18.9%
Slide117B
reastfeeding beliefs- Continued breastfeeding
18.9%
Donetsk- 17.0%Luhansk- 20.7%
Slide118Breastfeeding beliefs-Complementary feeding
56.1%
Slide119Information on Infant Feeding for Mothers – FG and KII Common Themes
Courses for future mothers are
theoretically available in facilities. Nobody
attended, because respondents told doctors do not actually conduct such lectures and often simply put a note in the clinical record of pregnant woman if she would have attended. Lack of courses were explained by doctors that they do not have enough staff and time to do it. Sources of information about breastfeeding: experience of a previous pregnancy, advice from: pediatricians, mothers, friends, relatives, internet (websites for pregnant women, forums), Dr. Komorowski.In hospitals, there are posters that provide information about breastfeeding which women read. In addition, facilities have brochures and magazines promoting breastfeeding.
Slide120Information on Infant Feeding for Mothers – FG and KII Common Themes
Most of the women believe that:
Mothers should begin breastfeeding from birth if there are no problems with lactation.M
others should feed their babies only breast milk and nothing else until 4-8 months. However when asked about water, many women thought it could be added from the first days to the first month, depending on needs of babyPediatricians recommend to add water to avoid flatulence (just boiled water of fennel / chamomile water) from first days/months.Mothers should start giving their baby complementary foods at 4-8 months. 6 months is the most popular age according to all sources of information.It is important to breastfeed the child until at least 12 months.1.5-2 years is the maximumLate breastfeeding can be difficult, because child should be independent from mother in kindergarten.
Slide121Information on Infant Feeding for Mothers – FG and KII Notable Differences
Women who are in the early stages of pregnancy are less aware of breastfeeding. They
have not had time to find out about this topic. Some of them are waiting for
what health care workers in the hospital will tell them after giving birth.First children of some women were bottle-fed milk because of problems with lactation. With current baby they plan to practice breastfeeding, but are not worried about it since their first baby was fine.2 women attended private courses for future mothers in Severodonetsk. They found it useful.
Slide122Conclusions and Recommendations
Slide123Discussion-Demographics/Income70% of women were less than 30 years oldAverage age was 27.8 yearsAbout half of women (46%) were in early pregnancy and half (54%) were in late pregnancy
The majority of women (93%) live with a partnerMany women living in poverty
43% of people living on <$2/day66% living on <$3/day
Slide124Discussion-AssistanceFew households (about 4%) are receiving any kind of humanitarian assistance
About 10% of our sample were IDPs18% of women left during shelling and then returned
On average women were displaced for about 6 monthsThose who left returned on average about 18 months ago
Slide125Discussion-NutritionMost common foods eaten are cereals/grains, white/yellow potatoes, fruits, vegetables, and meatsMean number of food groups eaten in day preceding survey was 5.9
93% of women consumed iron-rich foods in the day preceding the survey90% of women had adequate dietary diversityNo notable differences in dietary diversity by income
Slide126About 29% of women are currently taking iron supplements
23% of women in early pregnancy
32% of women in late pregnancy
18% of women not currently taking iron supplements but took iron supplements in the past8% of women in early pregnancy26% of women in late pregnancyOnly about 35% of women are currently taking supplements containing folic acid37% of women in early pregnancyAbout ¼ of women never took any supplementsMost women did not take any supplements because they were not prescribedCost of supplements was not a major issueDiscussion-Supplementation
Slide127Overall, about 30% of pregnant women had anemiaAbout 9% had moderate anemiaNo severe anemia foundLevels about the same in Donetsk and Luhansk (32% vs. 30%)Anemia increases with pregnancy term
26% of women in early pregnancy34% of women in late pregnancyNo clear difference by income level, although those with low income were slightly higher
Only about 41% of women with anemia are currently taking iron supplements44% of women with moderate anemia
Discussion-Anemia
Slide128About 47% of women knew of prenatal courses availableOnly about 16% attended Women reported receiving some incorrect breastfeeding information at courses:14% did not remember being told to start breastfeeding within 1 hour of birth
47% did not remember being told to
exclusively breastfeed until 6 months84%
did not remember being told to continue breastfeeding until 24 months or beyond37% did not remember being told to begin complementary feeding at 6 monthsDiscussion-Breastfeeding Information
Slide129About 16% of women discussed breastfeeding at individual doctor’s visitsWomen reported receiving some incorrect breastfeeding information at doctor’s visits:23% did not remember being told to start breastfeeding within 1 hour of birth
66% did not remember being told to exclusively breastfeed until 6 months
81% did not remember being told to
continue breastfeeding until 24 months or beyond49% did not remember being told to begin complementary feeding at 6 monthsDiscussion-Breastfeeding Information
Slide130According to women’s own opinions:87% believed they should start breastfeeding within 1 hour of birth27% believed they should exclusively breastfeed until 6 months19% believed they should continue breastfeeding until 24 months or beyond
52% believed they should begin complementary feeding at 6 months
Discussion-Breastfeeding Beliefs
Slide131Recommendations
Recommend iron supplementation for all pregnant women for GCA in Donetsk and Luhansk and provide free of cost for those who can not affordExpand anemia surveillance to other health facilities in Donetsk and Luhansk and other oblasts in Ukraine
Engage in promotional activities on breastfeeding and complementary feeding
Information on problems with attachment, effects of bottle feeding, etc.Provide information to mothers before birth so they are preparedAdditional counseling capacity (outside of polyclinics)Availability of skilled consultants for on-the phone advice (free hotline)Strengthen the capacity of health care workers to correctly counsel mothers on breastfeeding and complementary feedingNo early introduction of liquidsIntroduction of complementary foods at 6 monthsContinued breastfeeding until 24 months and beyond
Slide132Questions
Slide133Donetsk
(N=269)
Luhansk(N=264) Total(N=533) n (%)95% CI
n (%)
95% CI
n (%)
95% CI
Anemia
classification
Total
(<110 g/L)
86 (32.0)
26.4-37.9
79 (29.9)
24.4-35.8
165 (31.0)27.1-35.1 Mild (100-109 g/L)62 (23.1)
18.2-28.5
57 (21.6)
16.8-27.0
119 (22.3)
18.9-26.1
Moderate
(70-99 g/L)
24 (8.9)
5.8-13.0
22 (8.3)
5.3-12.3
46 (8.6)
6.4-11.3
Hemoglobin levels (g/L)
Mean (SD)
115.1 (12.0
)
113 (9.8
)
114.2 (11.0)
Median (IQR)
116 (106-123)
114 (108-119)
115 (107-121)
P=0.047
Women with anemia by oblast
Slide134Location
Jan
Feb
MarAprMayJuneJulAugPokrovs’ke (formerly Krasnoarmiysk)202033.39.112.5
0
9.1
27.3
Slovyansk
9.4
15
17
17.4
19.6
19.3
20.4
20.9
Velyka Novosilka
22.2
27.5
21.1
28.1
59.1
24.429.221.2Mariupol16.225.525.115.422.33526.529.5Bakhmut (formerly Artemivsk)
27.3
22.1
15.3
16.9
24.6
16.8
11.8
22.3
Total
15.7
19.7
19.4
17.1
21.5
23.6
20.6
22.8
Donetsk Sentinel Surveillance Sites by Month
Slide135Location
Jan
Feb
MarAprMayJuneJulAugLisichansk22.121.42626
31.7
22.7
21.1
28.6
Rubizhne
58.1
67.7
68.3
55.6
63.2
66.7
73.3
32.7
Svatove
100
55
43.4
45.7
72.175.27466.3Starobilsk474630.433.728.927.833.845Novopskov
16.4
15
13.8
15.6
28.6
25.9
31.7
21.9
Total
40.5
44.8
36.2
34.3
42.6
43.5
42.5
40.2
Luhansk Sentinel Surveillance Sites by Month
Slide136Location
Prevalence
of anemia
LUHANSK OBLASTSentinel Surveillance(January-August 2016)%Surveyn/N (%)Lisichansk24.522/59 (37.3)
Rubizhne
60.0
12/38 (31.6)
Svatove
63.4
14/26 (53.9)
Starobilsk
37.5
7/40 (17.5)
Novopskov
20.9
3/21 (14.3)
Total
40.7
79/264 (29.9)
DONETSK OBLAST
Pokrovs’ke
(formerly
Krasnoarmiysk)14.32/19 (10.5)
Slovyansk
18.3
7/25 (28.0)
Velyka
Novosilka
27.2
0/6 (0)
Mariupol
24.5
26/96 (27.1)
Bakhmut
(formerly
Artemivsk
)
19.7
6/16 (37.50)
Total
20.2
86/269 (32.0)
Slide137Breastfeeding beliefs-Breastfeeding initiation (N=573)
86.6%
Slide138Breastfeeding beliefs-Exclusive breastfeeding (N=573)
26.7%
Slide139Breastfeeding beliefs-Complementary feeding (N=573)