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

Improving Complementary Feeding Practices

in Afghanistan

Initial Results of TIPS in AfghanistanBy 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 malnutrition6-10% acute malnutrition in 6-59 m9-16% 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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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 mother’s mental health)

• Cease breastfeeding when child is sick, or mother sick

• Cease breastfeeding when pregnant

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

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

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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

TIPS Approach

• Test in real home situation, in average households with average resources

• Consultative process / negotiation, where families have a choice → Move from ideal recommendation to practical recommendation

• Step by step process / interim target

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TIPS process• Preparatory phase:

- List common problems and prepare counselling guide

- Identify locations and age groups- Train teams

• Implementation phase:- Cooking demonstration & selection of households- Assessment visit- Counselling Visit- Follow-up visit

• Evaluation and analysis (workshop):– summarise findings– discussion with all concerned / consensus– identify issues for further investigation– develop plan for wider dissemination of well-tested

recommendations including recipes

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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

Herat

Badakshan

Kabul

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 child’s diet but not their own (too poor)

• Contradictory advice from doctors (esp. About breastfeeding)

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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