Revisiting Trials of Improved Practices Methodology_Schofield_5.10.11

Trial of improved practices for an Urban IYCF program

Lilly Schofield

Evaluation and Research Advisor

Concern Worldwide Kenya

Core Spring Meeting, May 2011

Objective:

TIPs was used to investigate the feasibility and acceptability of the standard IYCF messages outlined by the MoH1 and method of delivery

1 See “National Strategy on Infant and Young Child feeding 2007-2010”, MoPHS, GoK and Infant and Young Child Feeding counseling: an integrated course. WHO and UNICEF.2006.

Implementation: Household trials

Project baseline identified 4 key groups to target in urban slums setting:

Caregivers of 6-23 months old, Mothers of <6 month olds-working outside the

home, Mothers of <6 month olds-not working outside the

home, Mothers of <6 months living with HIV and AIDS

STEP 1: Initial household visits

Community Health Workers trained in IYCF counseling and TIPs conducted initial visit with one caregiver from each group to collect data on current IYCF practices and child care.

Common feeding problems: 0-6 months-both working and non-working

mothers: Mixed feeding, reduced feeding during illness, poor position

and attachment leading to breast problems

6-23 months: Poor diversity-giving porridge only, low frequency of

feeding

HIV+ mothers 0-6 months: Mixed feeding (sugar water), reduced feeding during illness

STEP 2: Counseling Visit

CHWs returned and negotiated with caregivers to try a maximum of 3 new practices to address poor feeding practices for at least one week

STEP 3: Evaluation Visit

CHWs returned to HH one + weeks later and interviewed caregiver on changed practices, challenges, reactions, modifications, etc.

STEP 4: Verification

Verification of household visit findings and refinement of messages was done through focus groups with respondents falling into the same four categories

Recommendations for Program:

Discussion of motivators and barriers identified.

Led to seeking 2 tools that could address messages that had resistance to change (negative reactions to the recommended practice)

Modification of standard counseling approach Tools for expressing breastmilk-

Demonstration breast model for mothers, counseling care for secondary caregivers on importance of expression

Cost of diverse diet Common barrier given by mothers was that a

diverse diet was “too expensive”-card showing locally available foods purchased at local prices developed to highlight that more diverse

Conclusion:

TIPs was an effective approach for revising existing IYCF approaches for a urban slum setting

TIPs process also highlighted need for further emphasis on counseling skills in standard IYCF training for community workers

Thank You!