CDC/UNICEF IYCF Assessment - PowerPoint Presentation

Slide1

CDC/UNICEFIYCF Assessment in IDPs in Kharkiv, Dnipropetrovsk, and Zaporizhia oblasts

July 10, 2016

Slide2

IntroductionFocused on oblasts with highest numbers of IDPs outside of conflict Zone169,800 IDPs in Kharkiv82,986 IDPs in

Dnipropetrovsk

63,434 IDPs in Zaporizhia

Nutrition sub-cluster strategy

IYCF Education Counseling

Complementary baby

baskets

Goal: Collect information to inform key issues for Nutrition sub-cluster

Slide3

MethodsObtained lists of registered IDPs in each oblastRandomly selected households for calling

Child <2 in household, still living in oblast, agree to interview

Survey conducted from June 8 until June 19, 2015

Sample size based on proportion of IDPs in each oblast

230

Kharkiv

130 Dnipropetrovsk

117 Zaporizhia

477 Total

Good representation

492 children 0-23 months interviewed for MICS 2012 survey in Eastern Region

Slide4

Methods2 Focus Group Discussions with IDP mothers of children 0-23 months in each oblast (6 total):IDPs living in rented housing (more educated, urban, better SES)

7 mothers in Kharkiv

9 mothers in Dnipropetrovsk

3 mothers in Zaporizhia

IDPs living in collective center (less educated, more rural, poor SES)

10 mothers in Kharkiv

9

mothers

in Dnipropetrovsk

5 mothers in Zaporizhia

Slide5

Methods2 Key Informant interviews in each oblast (6 total)Kharkiv: Postnatal

Interview: Pediatrician

Postnatal Interview: Pediatrician

Dnipropetrovsk:

Prenatal Interview: Ob/

Gyn

Postnatal Interview: Pediatrician

Zaporizhia:

Birth Clinic Interview: Midwife

Postnatal Interview: Pediatrician

Slide6

Child Characteristics

 

Child Characteristics

Total

(N=477)

Gender (n, %)

 

Male

247 (51.8)

Female

230 (48.2)

Age (months) (n,%)

 

0-5

66 (13.8)

6-11

163 (34.2)

12-17

152 (31.9)

18-23

96 (20.1)

Mean (SD)

12.8 (5.8)

Slide7

Maternal Characteristics

Maternal Characteristics

Total (N=458

)

Age, years (n, %)

 

< 25 years

64 (14.0)

25-29 years

157 (34.3)

30-34 years

151 (33.0)

>=35 years

86 (18.8)

Mean (SD)

30.1 (5.3)

Education level (n, %)

 

Incomplete secondary school

7 (1.5)

Complete secondary school

20 (

4.4)

Professional secondary education

139 (

30.4)

Incomplete higher education

19 (

4.1)

Complete higher education or above

273 (59.6)

Total # of children born to mother (n, %)

 

1

197 (43.0)

2-3

244 (

53.3)

>= 4

17 (3.7)

Slide8

Household Characteristics

 

Household Characteristics

Total

(N=458)

Household location (n, %)

 

Oblast Center

347 (75.8)

Other City

92 (20.1)

Village

19 (4.1)

Living situation (n, %)

 

Living w/ relatives or friends (no fee)

78 (17.0)

Renting an apartment or house (

for

fee

)

348 (76.0)

Collective center

31 (6.8)

Other

1 (0.2)

Permanent Address Left From (n, %)

 

Donetsk

289 (63.1)

Luhansk

162 (35.4)

Other

7 (1.5)

Length of displacement, months (n, %)

 

<6 months

42 (9.2)

6-11 months

289 (63.1)

>= 12 months

127 (27.7)

Slide9

WHO Indicator

IYCF Survey

%

(95%

CI)

MICS 2012

Eastern

Region (%)

Ever

breastfed (N=children 0-23

mo

)

93.3

(90.7-95.2)

96.7

Early Initiation of Breastfeeding

(within 1 hour of birth)(N=children 0-23 mo)63.7 (59.2-68.1)61.5Exclusive breastfeeding <6 mo (N=children 0-5 mo)25.8 (16.5-37.9)21.3Predominant breastfeeding <6 mo (N=children 0-5 mo)45.5 (33.1-58.2)47.5Continued breastfeeding at 1 year (N=children 12-15 mo)53.5 (43.2-63.6)33.4Continued breastfeeding at 2 years (N=children 20-23 mo)20.6 (11.5-32.7)31.1Age-appropriate breastfeeding (N=children 0-23 mo)42.3 (37.9-46.9)22.3Introduction of solid, semi-solid, or soft foods (N=children 6-8 mo)98.6 (92.5-99.9)43.2Bottle Feeding (N=children 0-23 mo)68.1 (63.7-72.3)51.1Minimum Meal Frequency (N=children 6-23 mo) Breastfeeding96.2 (92.4-98.5)32.1 Non-Breastfeeding98.7 (96.1-99.7)89.3 Total97.6 (95.6-98.8)67.2

WHO Indicators

Slide10

WHO Indicators

 

Age (months)

Indicator

6-11 mo

(N=163)

(n, %, (95%CI))

12-17 mo

(N=152)

(n, %, (95%CI))

18-23 mo

(N=96)

(n, %, (95%CI))

6-23 mo

(N=411)

(n, %, (95%CI))

Dietary Diversity*    <3 Food groups given yesterday2213.5 (8.6-19.7)42.6 (0.72-6.6)22.1 (0.25-7.3)286.8 (4.6-9.7)3 Food groups given yesterday5332.5 (25.4-40.3)2516.4 (10.9-23.3)1414.6 (8.2-23.3)9222.4 (18.4-26.7>= 4 Food groups given yesterday8854.0 (46.0-61.8)12380.9 (73.8-86.6)8083.3 (74.4-90.1)29170.8 (66.1-75.2)Consumption of iron-rich foods given yesterday** 13884.7 (78.2-89.8)13488.2 (81.9-92.8)9598.9 (94.3-99.9)36783.4 (80.0-86.9)*Includes 6 Foods Groups: Grains, roots, and tubers; Legumes and nuts; Dairy products (milk, yogurt, and cheese); Flesh foods (meat, fish, poultry, and liver/organ meats); Eggs; Fruits and vegetables**Includes meat, eggs, and formula

Slide11

Breastfeeding Beliefs and Practices

Indicator

n (%)

Reason stopped breastfeeding among mothers who ever breastfed (N=210)

 

Stress related to conflict

63 (30)

Stress unrelated to conflict

7 (3.3)

Not enough food for mother

14 (6.7)

Work schedule

1 (0.5)

Problems with attachment

23 (11.0)

Use of bottle for feeding

4 (1.9) Other89 (42.4) Don’t know9 (4.3)Mother’s opinion of age child should stop breastfeeding (N=458)  < 6 months1 (0.2) 6-11 months16 (3.5) 12 months198 (43.2) 13-17 months33 (7.2) 18-23 months71 (15.5) 24 months114 (24.9) > 24 months21 (4.6) Don’t know4 (0.9)

Slide12

Reason stopped breastfeeding among mothers who ever breastfed

All Mothers

(N=210)

Mothers who stopped when baby was <6 mo

(N=105)

Stress related to conflict

63 (30)

48 (45.7)

Stress unrelated to conflict

7 (3.3)

3 (2.9)

Not enough food for mother

14 (6.7)

10 (9.5)

Work schedule

1 (0.5)

0 (0) Problems with attachment23 (11.0)10 (9.5) Use of bottle for feeding4 (1.9)1 (1.0) Other89 (42.4)29 (27.6) Don’t know9 (4.3)4 (3.8)

Slide13

Foods Given Yesterday to Children <6 months not exclusively breastfed

 

BF Practices

Type of Food

Not

Currently

Breastfeeding

n (%)

(N=17)

Currently Breastfeeding

n (%)

(N=32)

Water

14 (82.4)

28 (87.5)

Tea or herbal tea8 (47.1)5 (15.6)Fruit or vegetable juice3 (17.7)1 (3.1)Soda drinks or other sweetened drinks2 (11.8)2 (6.3)Infant formula17 (100)15 (46.9)Animal milk1 (5.9)1 (3.1)Sour milk drinks0 (0)0 (0)Cottage cheese or cheese0 (0)0 (0)Infant commercial porridge4 (23.5)4 (12.5)Semolina homemade2 (11.8)0 (0)Buckwheat porridge homemade0 (0)1 (3.1)Other homemade porridge0 (0)1 (3.1)Mashed potato2 (11.8)3 (9.4)Commercial baby fruit or vegetable puree3 (29.4)2 (6.3)Fruits4 (23.5)1 (3.1)Vegetables1 (5.9)1 (2.3)Peas or beans0 (0)

0 (0)

Meat homemade

0 (0)

0 (0)

Commercial meat puree

1 (5.9)

0 (0)

Eggs

0 (0)

0 (0)

Bread or pasta

3 (17.7)

2 (6.3)

Fats

0 (0)

0 (0)

Sweets

0 (0)

0 (0)

Slide14

Foods Given Yesterday to Children 6-23 months

 

Age (months)

Type of Food

6-11 (n, %)

(N=163)

12-17 (n, %)

(N=152)

18-23 (n, %)

(N=96)

Total Including children

<6 months

(

n,

%)

(N=477)Water153 (93.9)136 (89.5)92 (95.8)423 (88.7)Tea or herbal tea48 (29.4)69 (45.4)65 (67.7)195 (40.9)Fruit or vegetable juice49 (30.1)60 (39.5)43 (44.8)156 (32.7)Soda drinks or other sweetened drinks41 (25.2)63 (41.4)46 (47.9)154 (32.3)Infant formula70 (42.9)39 (25.7)16 (16.7)157 (32.9)Animal milk31 (19.0)65 (42.8)49 (51.0)147 (30.8)Sour milk drinks55 (33.7)94 (61.8)47 (49.0)196 (41.1)Cottage cheese or cheese78 (47.9)96 (63.2)51 (53.1)225 (47.2)Infant commercial porridge103 (63.2)67 (44.1)19 (19.8)197 (41.3)Semolina homemade26 (16.0)33 (21.7)

33 (34.4)

94 (19.7)

Buckwheat porridge homemade

22 (13.5)

42 (27.6)

32 (33.3)

97 (20.3)

Other homemade porridge

33 (20.2)

64 (42.1)

44 (45.8)

142 (29.8)

Mashed potato

81 (49.7)

64 (42.1)

38 (39.6)

188 (39.4)

Commercial baby fruit or vegetable puree

80 (49.1)

45

(29.6)

13 (13.5)

145 (30.4)

Fruits

107 (65.6)

116 (76.3)

81 (84.4)

309 (64.8)

Vegetables

106 (65.0)

129 (84.9)

88 (91.7)

325 (68.1)

Peas or beans

4 (2.5)

6 (3.9)

15 (15.6)

25 (5.2)

Meat homemade

82 (50.3)

115 (75.7)

85 (88.5)

282 (59.1)

Commercial meat puree

22 (13.5)

10 (6.6)

4 (4.2)

37 (7.8)

Eggs

32 (19.6)

52 (34.2)

36 (37.5)

120 (25.2)

Bread or pasta

108 (66.3)

136 (89.5)

91 (94.8)

340 (71.3)

Fats

63 (38.7)

85 (55.9)

65 (67.7)

213 (44.7)

Sweets

16 (9.8)

32 (21.1)

53 (55.2)

101 (21.2)

Slide15

Iron and Protein Containing Foods

Number

of Days Given in Past Week

Age 6-11 Months

(N=163)

Age 12-23 Months

(N=248)

# of Days Meat (n, %)

 

 

0 Days

45 (27.6)

8 (3.2)

1-2 Days

20 (12.3)

21 (8.5)

>=3 Days98 (60.1)219 (88.3)# of Days Eggs (n, %)   0 Days72 (44.2)52 (21.0) 1-2 Days46 (28.2)90 (36.3) >=3 Days45 (27.6)106 (42.7)

Slide16

Children 6-11 mo Given Commercial Foods Yesterday

SES Indicator

Formula

Commercial

Porridge

Meat Puree

Fruit/Veg Puree

Head of household

 

 

 

 

Male

(N=84)

37 (44.0)

57 (67.9)

16 (19.0)42 (50.0)Female (N=73)28 (38.4)42 (57.5)5 (6.8)34 (46.6)Resident of household currently earning money     No (N=76)33 (43.4)48 (63.2)5 (6.6)34 (44.7)Yes (N=81)32 (39.5)51 (63.0)16 (19.8)42 (51.9)Living situation     Living w/ relatives or friends (no fee) (N=25)10 (40.0)11 (44.0)2 (8.0)8 (32.0)Renting an apartment or house (for fee) (N=122)51 (41.8)85 (69.7)19 (15.6)65 (53.3)Collective center (N=10)4 (40.0)3 (30.0)0 (0)3 (30.0)Mother Education

 

 

 

 

Did not complete higher

education (N=60)

30 (50.0)

36 (60.0)

5 (8.3)

34 (56.7)

Completed

higher education (N=97)

35 (36.1)

63 (64.9)

16 (16.5)

42 (43.4)

Slide17

Slide18

MUAC Children <2 Years

 

Age (months)

MUAC (mm)

6-11

N=163

(

n,

%, 95%CI)

12-23

N=248

(n, %, 95%CI)

<115

0 (0)

0 (0)

115-125

1 0.6 (0.02-3.4)1 0.4 (0.01-2.2) >125162 99.4 (96.6-99.9)247 99.6 (97.8-99.9)

Slide19

MUAC Children 2-4 Years

MUAC (mm)

(n, %)

 

<115

0 (0)

115-125

0 (0)

>125

57

(100)

Slide20

Access to Services

Access to Services

(n,%)

Attempted to register child at

clinic

(N=477)

 

No

28 (5.9)

Yes

448 (93.9)

Don’t know

1 (0.2)

Child registered at clinic

(N=448)

 

No4 (0.9) Yes444 (99.1)Difficulties registering child at clinic (N=448)  No434 (96.9) Yes14 (3.1)Difficulties faced during registration at clinic (N=14)  Required unavailable documents3 (21.4) Required registration as IDP6 (42.9) Required payment0 (0) Other8 (57.1)

Slide21

Humanitarian Assistance

Humanitarian Assistance

Total

(N=458

)

Cash or voucher assistance received (n, %)

353 (77.1)

Food assistance received (n, %)

399 (87.1)

Non-food assistance received (n, %)

397 (86.7)

Baby

food assistance received (n, %)

323

(70.5)

Number of Times 1130 (27.3) 2-3125 (26.2) >368 (14.3)Items included in baby food assistance package (n, %) (N=323)  Infant formula143 (44.3) Fruit or vegetable puree159 (49.2) Meat puree9 (2.8) Commercial baby porridge182 (56.4) Semolina17 (5.3) Other porridge33 (10.2) Other34 (10.5)

Slide22

Water and Sanitation

Safe Water and Hand Washing

Total

(N=454

)

Running water in home (n, %)

 

No

16 (3.5)

Yes

438 (96.5)

Main source of water for drinking/cooking

(

n, %)

 

Bottled280 (61.7) Tap106 (23.3) Well43 (9.5) Water pump7 (1.5) Other18 (4.0)Ability to boil water (n, %)454 (100)Times used soap in last 2 days (n, %)  0-4 times7 (1.5) 5-10 times35 (7.6) >10 times415 (90.6) Don’t know1 (0.2)

Slide23

Key Message From Focus Groups and Key Informant Interviews

Slide24

Information and services in health systemMandatory home visits post-partum by doctor and nurse in 1st month, then monthly visits to polyclinic

Test

Hb

at 9 months

Generally no difficulties for IDPs to register for medical services

Courses for future mothers exist both pre-natal and post-natal, but may not be communicated to all

Pediatricians are used and trusted by more educated

Medical staff in some areas seem to provide incorrect advice (early intro of water, early complementary feeding)

Slide25

Information and services in health systemRural mothers seem to have less access and use of medical staff and courses/servicesMothers with prior children rely on own prior experiences

Less educated seem to rely more on grandmother’s advice

Many mothers also rely on advice from friends with children

Educated mothers often rely on internet for advice

Slide26

BreastfeedingInitiation – almost universalEarly introduction of water“Babies need water when it is hot out”

Some health workers seem to advise to introduce water and teas very early

If breast milk perceived as “not enough” introduce formula

Many mothers were offered to buy formula in hospital

Slide27

Breastfeeding problemsStress – major problem, many perceive to lose milk because of stress of war and displacementSupport BF in birth clinic in the first few days – major problem (esp. for first mothers)

More educated – difficulties of adhering to “hypoallergenic diet” (expensive)

Maternal nutrition is not perceived as a major problem, although mentioned

Working schedule of the mother – not a major problem since IDP mothers rarely work

Slide28

Complementary feedingEarly introduction of complementary feeding (at 3-4 mo) in some in less educated, rural mothersStandard MoH

advice – from 6 months, table for portion sizes and intro schedule for food groups

Most common foods currently used: mashed potatoes, baby porridges, semolina, buckwheat, fruit/vegetable purees

Many mothers making homemade purees now instead of purchasing purees in cans because of cost

Some mothers boiling water and using animal’s milk because can’t afford formula

Slide29

Complementary feedingNo problems with introducing meats, liver, yolk at 6 moMeat well liked and accepted by childrenSome mothers prefer milk-free, some with-milk porridges

Semolina is less preferred by some mothers, but generally common, buckwheat is also common and well liked, many consider buckwheat most useful porridge, but also most expensive

Slide30

Complementary feeding problems Mothers try hard not to impact child’s diet due to lack of money, prioritize the childUse less preferred meats (chicken)Some mothers can only afford meat once per week

Lack of access to milk and milk products and fresh fruits/vegetables in collective center

No way to make homemade fruit/veg/meat purees in collective centers

Try to give the same products to children but less frequently

Slide31

AssistanceMostly sporadic one-time assistance depending on ad hoc donations, no systematic consistent assistance packagesOrganizations giving assistance dependent on OblastNo information materials on BF/CF

No counseling on BF/CF at (or linked to) the point of distribution

No comprehensive list of organizations mothers can go to for assistance

Some assistance packages not age appropriate

Slide32

Conclusions and Recommendations

Slide33

ConclusionsNon-exclusive breastfeeding for infants <6 months is a major issueWater, tea, juice, and formula are the most common liquids given to babies <6 months who are not exclusively breastfed

Beliefs on early water introduction a major challenge

Some health care workers recommend early introduction of water

Commercial porridges, mashed potatoes, and fruit/vegetable puree are the most common foods given to babies <6 months not exclusively breastfed

Stress related to the conflict is the most common reason mothers stopped breastfeeding

Slide34

ConclusionsMalnutrition is not a major problem in this populationNo child

with severe acute malnutrition (MUAC

<

115)

2

children with moderate malnutrition (MUAC 115-125

)

Commercial porridges are the most common porridges given when children are <12 months

Buckwheat and semolina are both well accepted, but semolina may

be less preferred by

some

In general, meat

is perceived valuable and well accepted, including commercial purees (although most women cannot afford

)

Many children 6-11 months receive iron and protein containing foods <3 days per week

Mothers may believe that children in this age group should not be eating these foods often

Slide35

ConclusionsMost IDP families have not had problems registering their children at health clinics, treated the same as other childrenMost mothers trust p

ediatrician

for advice

Some

pediatricians

/midwives giving incorrect information on feeding practices (early introduction of water, advising mother to give formula, etc.)

Many mothers now use the internet for advice

Although a high

proportion of families

have received

humanitarian

assistance, very few receive baby food assistance regularly

A high proportion of families received formula in their most recent baby food assistance package

Slide36

RecommendationsEducate and train health care workers on providing the correct information to mothersNo early introduction of

liquids

Advocate for timely (at 6

mo

) introduction of complementary foods, no complementary foods in <6

mo

Increase resources for breastfeeding education for mothers in polyclinics, points of assistance distribution, collective centers, etc.

Information on the effects of stress on breastfeeding, problems with attachment, effects of bottle feeding, etc.

Provide information to mothers before birth so they are prepared

Additional counseling capacity (outside of polyclinics),

especially in collective

centers

and at the point of assistance distribution

Availability of skilled consultants for on-the phone advice (free hotline)

Slide37

RecommendationsEducate humanitarian and volunteer organizations on age appropriate distribution of formulaProvide targeted assistance packages for different age

groups

Provide

to beneficiaries a

list of humanitarian and volunteer organizations who are providing baby food assistance

Perhaps in

polyclinics, social service offices, etc.

Include key educational messages

on

infant and young child feeding

(as leaflets) in

complementary baby baskets

Create a nutrition website women can

access

for

correct information on breastfeeding/complementary feeding