IYCF KAP Survey - Action Against Hunger · 3.1 General objective ... ACF IYCF KAP Survey in Kohat district of KP ... The survey collected information regarding IYCF knowledge, attitude

Title: IYCF Knowledge, Attitude and Practice Survey

Place: Kohat District, KP Province, Pakistan

Funded By: ECHO

By: Hailu Wondim, Action Against Hunger / ACF International

IYCF KAP Survey Kohat district

Khyber Pakhtunkhwa (KP)Province

Pakistan

September 2013

ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013

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Acknowledgement

We greatly appreciate the involvement and support of Khyber Pakhtunkhwa (KP) province department of health nutrition cell and Kohat district health office.

This survey could not have been completed without the commitment and hard work of ACF International capital office and Peshawar field office management team, logistics, administration and Program Quality and Accountability (PQA) department of Peshawar and Kohat.

Our heartfelt appreciation goes to the survey team (supervisor, data analyst, team leaders and enumerators) who put all their efforts to produce a quality data. We are also thankful to the mothers/caretakers of children who give their time to these survey team members by responding to the questions raised by the survey team.

This survey report has been produced with the financial assistance of the European Commission. The views expressed herein should not be taken, in any way, to reflect the official opinion of the European Commission.


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Table of Content

1. Executive Summary ...................................................................................................................... 5 2. Background .................................................................................................................................... 7 3. Survey Objectives ......................................................................................................................... 8

3.1 General objective ................................................................................................................ 8 3.2 Specific Objectives .............................................................................................................. 8

4. Methodology .................................................................................................................................. 9 4.1 Study area.............................................................................................................................. 9 4.2 Study period .......................................................................................................................... 9 4.3 Study design .......................................................................................................................... 9 4.4 Study population .................................................................................................................. 9 4.5 Sample size ............................................................................................................................ 9 4.6 Sampling procedures ......................................................................................................... 10

4.6.1 Cluster selection: ....................................................................................................... 10 4.6.2 Household selection: ................................................................................................. 10 4.6.3 Children selection: ..................................................................................................... 10 4.6.4 Data to be collected .................................................................................................. 10 4.6.5 Survey Tool .................................................................................................................. 10

5. Organization of the survey ....................................................................................................... 10 5.1 Meeting with the Province and District authorities ..................................................... 10 5.2 Data collectors recruitment and training ...................................................................... 10 5.3 Team work in the field ...................................................................................................... 11 5.4 Data Quality ........................................................................................................................ 11 5.5 Ethical considerations ....................................................................................................... 11 5.6 Data entry, analysis, reporting ........................................................................................ 11

6. Result ........................................................................................................................................... 11 6.1 Demographic characteristics of sampled children ....................................................... 11 6.2 Demographic characteristics of mothers/caretakers of sampled children .............. 12 6.3 Infant and young child feeding knowledge and attitude ............................................ 13 6.4 Infant and Young Child Feeding Practices ..................................................................... 14 6.5 Food Security and livelihood ............................................................................................ 18 6.6 Water and Sanitation ......................................................................................................... 19 6.7 Health ................................................................................................................................... 20

7. Discussion .................................................................................................................................... 20 8. Conclusion ................................................................................................................................... 22 9. Recommendations ...................................................................................................................... 23 6. Annexes ........................................................................................................................................ 25 Annex 1: Survey schedule ................................................................................................................ 25 Annex 2: Selected clusters/Villages for IYCF KAP Survey .......................................................... 26 Annex 3: The main IYCF indicators collected and the source of data ...................................... 27 Annex 4: Comparison of the results with national and regional figures .................................. 29


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ACRONYMS and ABREVIATIONS

ACF Action Contre La Faim/ Action Against Hunger

BCG Bacillus Calmette–Guérin

CMAM Community Based Management of Acute Malnutrition

CMR Crude Mortality Rate

DHO District Health Office

DoH Department of Health

FGD Focus Group Discussion

FSL Food Security and Livelihood

ENA Emergency Nutrition Assessment

GAM Global Acute Malnutrition

HQ Head Quarter

IDP Internally Displaced People

IYCF Infant and Young Child Feeding

IVAP Internally Vulnerability Assessment & Profiling

KAP Knowledge, Attitude and Practice

KP Khyber Pakhtunkhwa

MUAC Mid Upper Arm Circumference

NRSP National Rural Support Program

PDAR Person Days At Risk

UC Union Council

SMART Standard Monitoring and Assessment of Relief and Transition

WHO World Health Organization

WASH Water Sanitation and Hygiene


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1. Executive Summary

Kohat district is located 180km from Islamabad and 65km from Peshawar (the provincial capital). ACF International supports the Department of Health (DoH) in Community Management of Acute Malnutrition (CMAM) in 5 Union Councils (UCs) with funds from the Humanitarian Aid and Civil Protection department of the European Commission (ECHO). This one year ECHO project integrates food security and livelihoods (FSL), Infant and young child feeding (IYCF) and nutrition education as well as Water, Sanitation and Hygiene (WASH) activities.

This baseline study had one primary objective which was to understand the communities Knowledge, Attitudes, and Practices (KAP) on IYCF in five UCs in Kohat district where ACF is implementing its IYCF project integrated to CMAM. The results underscore that most of the infant and young child feeding practices are below the national average1. The following are the findings of this survey:

Information communities obtained about child feeding originated from the same sources and showed a similar trend of utilization. Health facility and home visit are the most common places where mothers/care takers get information about child feeding. However, community sensitization event is not common in the study area to pass information about child feeding.

More than half (58.2%, n=107) of mothers/caretakers believe that breast feeding should be started immediately after the child is born. More than thirteen percent (13.6%, n=24) of them think it should be started at after one day.

Nearly half of the mothers/caretakers (45.7%) know that a child should be exclusively breast fed for the first six months of his/her life.

Only less than half of the mothers (47.3%) know the appropriate age of initiating complementary food (which is 6 months).

The most common contact persons for child feeding information in the surveyed community are Nurses/Dispensers and family/friends.

Proportion of children 0 to 23 months who were put to the breast within one hour of birth was 39.4%.

Proportion of infants aged 0-5 months who are exclusively breastfed was 65.9%.

Only 27% of children are breast fed for at least two year.

Complementary foods are introduced in a timely fashion for three-fourth (69.7%) of

children. This indicates children aged 6 to 9 months are given complementary feeding as per WHO recommendation.

1NNS Pakistan, 2011


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Overall, nearly one in five (18.15%) children age 6-23 months are fed appropriately, based on the recommended infant and young child feeding (IYCF) practices.

Proportion of children aged 0-23 months who receive iron-rich food or iron-fortified food (specially designed for infants and young children, or that is fortified in the home) is low. Only 25% of children under the age of two years had received iron rich food.

Overforty(44.6%) percent of mother fed their children using bottle feeding.


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2. Background

The 24 districts making up the Khyber Pakhtunkhwa (KP) province are: Chitral, Upper Dir, Lower Dir, Swat, Kohistan, Shangla, Batagram, Buner, Manshera, Malakand, Maradan, Swabi, Haripur, Abottabad, Charasadda, Peshawar, Nowshera, Kohat, Hangu, Karak, Bannu, LakkiMarawat, Tank, and DI Khan.

Kohat district is located 180km from Islamabad and 65km from Peshawar (the provincial capital). It is sub-divided into 33 Union Councils (UCs). It is bordered by Peshawar district in the north, Hangu and Kurak in the south, Nowshera in the east, and Oarkzai Agency in the west (Figure 1).

Figure 1: Map of Kohat District and ACF nutrition program implementation union council, August 2013

Kohat is the 14th most highly populated district of KP. It has a total population of 1,043,850 and under five population of 177,455 (17%)2. Military operation in Bajur district and insurgency activity throughout 2011 caused a significant number of displaced to Kohat District. The majority of Internally Displaced People (IDP) stay with host communities, stretching the capacity of households who employ distress mechanisms to overcome the additional strain. During 2012 Kohat has received part of the newly displaced population from Khyber Agency, thus the pressure on traditional livelihoods in combination with structural vulnerabilities has had the effect of reducing the overall quality of life and resilience for the region. Kohat has very little Water Sanitation and Hygiene (WASH)

2 District Health Office


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infrastructure/services. Based on the Internally Vulnerability Assessment and Profiling (IVAP) Report in July 2011, Kohat hosts the third largest population of IDPs in KP, with almost 18,111 families and the second largest population of unregistered IDPs3.

ACF International supports the Department of Health (DoH) in Community Management of Acute Malnutrition (CMAM) in 5 UCs with funds from the Humanitarian Aid and Civil Protection department of the European Commission (ECHO). This one year ECHO project integrates food security and livelihoods (FSL), Infant and young child feeding (IYCF) and nutrition education as well as Water, Sanitation and Hygiene (WASH) activities.

The proposed strategy for nutrition is designed to ensure the provision of lifesaving nutrition services for acutely malnourished children, pregnant and lactating women in camps and off-camps; to prevent poor nutritional outcome through rigorous promotion of optimal infant feeding practices, proper hygiene/sanitation and improved maternal nutrition; micronutrient supplementation and nutrition education on locally available foods; setting up of a robust reporting and information system and monitoring mechanism; and an emphasis on capacity development of health care providers for all target areas to be implemented in partnership with the DoH and provincial nutrition cells in KP & FATA.

In the back drop of this and as a follow-up of the efforts that is going to be implemented in Kohat district, there was a need to establish baseline information through an assessment of knowledge, attitude and practices of the community with regards to infant and young child feeding practices.

3. Survey Objectives

3.1 General objective

The main objective of this survey was to determine knowledge, attitude, and practice of infant and young child feeding practices of population of Kohat district of KP province so as to establish a bench mark for the program implementation.

3.2 Specific Objectives

To obtain quantitative data on infant and young child feeding practices using the WHO4 IYCF indicators.

To assess the consumption of the different types of food for children aged from 6-23 months with in the 24 hours prior to the survey, and hence estimate the food diversity within the last 24hours.

To assess the factors related to IYCF practices.

To make recommendations based on findings.

3 IVAP Assessment in KPK/FATA, government of Pakistan, July 2011 4Indicators for the assessment of infant and young child feeding practice, WHO 2010


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4. Methodology

4.1 Study area The survey was conducted in 5 UCS of Kohat District (urban 4, urban 6, Jerma, Bilitang, and KahrimattoUCs) where ACF is implementing IYCF Project (Indicated in figure 1).

4.2 Study period The study was conducted from September 5 –10, 2013.

4.3 Study design The survey was a cross sectional study with two-stage cluster sampling using 'WHO model for vaccination survey'. Villages are considered as the smallest geographical unit (clusters). Focus Group discussions (FGD) were conducted in every selected village with pregnant and lactating women and mothers who hadunder two years of age children.

4.4 Study population

1. Mothers of children under two years of age: To estimate the infant and young child feeding practice relevant information was gathered from mothers of children who are under two years of age in all selected villages.

2. Households: Household food security and WASH information was collected from selected households in all selected villages.

4.5 Sample size The sample size was derived using the formula:

𝑁 = 2 t (p × q)𝑑

The parameters used for the calculation are listedin Table 1:

Table 1: Parameters used in calculation of sample size calculation IYCF KAP.

Parameter Definition value

N Sample size:

𝑁 = 2 t (p × q)𝑑

𝑁 = 2 1.96 (0.5 × 0.5)0.1

=192.08 rounded up to 210

t Error risk. t=1.96 at 95% confidence interval

p Expected prevalence Used 50% corresponding to p=0.5 as proportion

q 1-p Thus q=1-0.5=0.5

d Degree of accuracy (10% for ACF KAP survey) and given as 0.1 proportion


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The sample size was estimated at 192 households and rounded up to 210 including a 10% non-response rate. This came down to 30 clusters of 7 people each (World Health Organization (WHO) model5 used for vaccination surveys).

4.6 Sampling procedures

4.6.1 Cluster selection: Each village in the District was considered as a cluster and the clusters to be sampled wereselected with probability proportionate to size (PPS). All villages of the district along with their respective populations wereentered into ENA software; the software automatically selected the number of clusters to be included in the study.

4.6.2 Household selection: Sample households wereselected using simple random sampling. This household selection method was preferred because it is objective, easy for monitoring and makes the process more transparent to the local community. Preliminary contact with local village leaders was made to prepare household lists in each village. Enumerators used random number table to select the households from the sampling frame (household list).

4.6.3 Children selection: Within selected households, all children under the age of two years was included in the survey.

4.6.4 Data to be collected The survey collected information regarding IYCF knowledge, attitude and practice (KAP) of mother of children under two year of age.

4.6.5 Survey Tool Age of children was assessed using local events calendar prepared with the local community. The data collection formats were adapted from WHO 2010 guideline for the assessment of infant and young child feeding6. All the survey tools were translated to the local language, pretested and improved to strengthen the data collection.

5. Organization of the survey

5.1 Meeting with the Province and District authorities

Before the survey was conducted relevant Provincial and District sector offices were briefed about the background, purpose, objectives and methods for the survey and their cooperation secured. The authorities were requested to officially inform the communities (villages) where the assessment took place. Relevant sectors were invited to supervise the training and data collection and recruit additional data collectors needed.

5.2 Data collectors recruitment and training Five teams of three people each (two female and one male), one team leader and two data collectors collected the data.

5 The Expanded Program on immunization (EPI) method 6 Assessment of IYCF guideline 2010, WHO


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Prior to the data collection, two days training was given for the enumerators and team leaders on data collection procedures, interviewing and assessment of child age. The data collection forms and questionnaires were pilot tested in villages not selected to be part of the larger survey, to ensure that the interviewers and respondents understand the questions and that interviewers follow correct protocols.

5.3 Team work in the field Team leaders with the best service and experience, wereguiding the teams. The team leaders were responsible for the overall quality of activities and teams performance. Additionally, supervisors from ACF, representatives from DHO and representatives from Provincial health department and a survey manager from ACF were closely supervising the teams throughout the survey.

5.4 Data Quality Each questionnaire and data sheet were checked each night prior to the data entry. The data was entered on daily basis and missing data identified. Based on the results supervisors were giving feedback to enumerators every day before enumerators depart to the next day data collection.

5.5 Ethical considerations All relevant Provincial and District stakeholders were informed of the study objectives, methods and their roles and their permission sought. Verbal consent was sought from care takers of the children and household heads for voluntary participation in the survey. The identity of the participants was kept anonymous. Those who didnot wish to participate in the survey were respected for their self-determination / decisions. All the information collected wastreated as strictly confidential.

5.6 Data entry, analysis, reporting Data entry and analysis was done using Epi info 3.5.4 (June 2012 version).

6. Result

6.1 Demographic characteristics of sampled children Two hundred fourteen (214) households where assessed, of these households, one eighty five (185) children under 2 were included in the study: 93 (50.3%) girls and 92 (49.7%) boys (Table 2). The average age of the children was 11.4 months. The ratio of children 0-11 months to children 12-23 months was 0.99.

Table 2: Demographic characteristics of surveyed children, Kohat District, September 2013

n %

Sex (N=185)


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Male 92 49.3%

Female 93 50.3%

Age (months) (N=185)

0 - 5 44 23.8%

6 - 8 26 14.1%

9 - 11 22 11.9%

12 - 17 48 25.9%

18 - 23 45 24.3%

6.2 Demographic characteristics of mothers/caretakers of sampled children

Two hundred fourteen (214) mothers / caretakers of all children were included in the survey. Eighty one percent (81%) of the mothers did not have any formal education or have never attended "Madarsa"7. Only forty (40) of the mothers can read and write. Of motherswho can read and write, 37% of them had primary education (Table 3).

Table 3: Background characteristics of mothers/caretakers Kohat district, September 2013

n %

Education status (N=214)

No education 133 62.1

Formal education/"Madarsa" 81 37,9

Highest grade in formal education or "Madarsa" (n=81)

Primary 30 37.0%

Middle 14 17.3%

Metrics 14 17.3%

Bachelor 9 11.1%

Master 7 8.6%

"Madrasa" 7 8.6%

Marital status (N=214)

7Madersa is formal Islamic school


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Married or living with their partner 214 100%

6.3 Infant and young child feeding knowledge and attitude

a. Early initiation of breast feeding (EIBF) More than half (58.2%, n=107) of mothers/caretakers believe that breast feeding should be started immediately after the child is born. More than thirteen percent (13.6%, n=24) of them think it should be started at after one day. Two thirds (69.6%, n=128) of mothers reported that they have heard a message about early initiation of breast feeding, the most common source of information are dispensers/nurses (47.7%, n=61) and family and/or friends (35.9%, n=46). Lady health volunteers, community leaders and TV/Radio are uncommon sources of information for initiation of breast feeding.

Figure 2: Common contact points for exclusive breast feeding message, Kohat district, September, 2013

Time of pregnancy and delivery are very common contact timesto pass information to mothers/caretakers about early initiation of breast feeding, in 67.2% and 24.2% of mothers/caretakers respectively (Figure 2). Home visits and health facility visit were found to be very good channels of information with 57.8% of mothers receiving breast feeding messages during health facility visit and 40.6% during home visit.

b. Exclusive breast feeding (EBF) Nearly half of the mothers/caretakers (45.7%) know that a child should be exclusively breast fed for the first six months of his/her life. Only 51.1% of mothers have heard a message about appropriate exclusive breast feeding; of those who have heard the message 57.4% of them heard it from dispensers/nurses and 31.9% from friends/family.

The most common contact point for EBF message was found to be during pregnancy (in 72.8% of the mothers/caretakers).

01020304050607080

perc

enta

ge

Sources of EBF messages


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c. Timely initiation of complementary feeding (TICF) In the surveyed community, even though sixty percent (60%) of mothers had received message about complementary feeding, only less than half of the mothers (47.3%) know the appropriate age of initiating complementary food (which is 6 months). Similar to messages about EIBF and EBF, the most common source of TICF information was dispenser/nurse (53.6%) and friends/family (31.8%).

Information about child feeding originated from the same sources and showed a similar trend of utilization (Figure 3).

Figure 1: Source/place of child feeding information, Kohat District, September, 2013

6.4 Infant and Young Child Feeding Practices

1. Initiation of breastfeeding within one hour of birth Fifty nine percent (59%) of the interviewed women reported starting breastfeeding within three hours of giving birth (Figure 4). Overall, two thirds of mothers reported starting breastfeeding withinthe first 12 hours of the birth of the child. Thirty nine percent of the children born in the last two years were breastfed within one hour of being born.

57.8%

0.8%

40.6%

0.8%

64.9%

3.2%

31.9%

0.0%

59.1%

3.6%

37.3%

0.0%

Health facility Community event Home visit Other

Source of information about child feeding

EIBF EBF TICF


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Figure 2: Time of initiation of breastfeeding, Kohat district, September 2013

2. Exclusive breastfeeding

It is recommended that children should be exclusively fed breast milk during the first six months, as it provides all the necessary nutrients for the infants’ growth and protects the child from illness. From the sampled communities, 65.9% (n=29) of mothers of children aged 0-5 months reported that the children were exclusively breastfed during the 24 hours preceding the study.

Breast milk in the first three days of birth, colostrum, contains antibodies and nutrients required to support the new born during this period. In the surveyed community one out of five mothers (n=35) disposed of the colostrum.

3. Minimum dietary diversity Among children aged 6-23 months (N=141), 21.3% (n=30) consumed foods from four or more food groups during the day prior to the study (Figure 5).

Figure 3: Dietary diversity of children 6-23 months, Kohat District, September 2013

0 1 2 3 4 5 6 7 8 10 12 ≥24 Percent 39% 2% 11% 7% 3% 3% 1% 1% 1% 1% 6% 3%

0%5%

10%15%20%25%30%35%40%45%

Perc

ent

of c

hild

ren

Hours elapsed

Time of initation of breast feeding

Zero food group

9%

One food group 16%

Two food groups

31%

Three food groups

23%

Four + food groups

21%

Food group/s consumed


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Legumes, flesh foods, and egg are consumed rarely compared to other food groups (Figure 6).

Figure 6: Percentage of children who consumed items from each food group in the previous 24 hours, Kohat District, September, 2013

4. Minimum meal frequency

The WHO recommends that breastfed children consume solid, semi-solid or soft foods at least twice a day between the ages of 6-8 months and at least 3 times a day between the ages of 9-23 months8. In Kohat District, 68.1% (n=96) of children aged 6-23 months met this requirement.

5. Minimum acceptable diet Children 6-23 months are getting an acceptable diet when they are breastfed or are given milk, have the appropriate food diversity score and have the minimum required number of meals per day. In the studied population, although meal frequency was moderate9, the number of food groups consumed was not (less than four). As a result, only 18.4% of children aged 6-23 months were consuming the minimum acceptable diet.

6. Consumption of Iron-rich foods Iron-rich foods included flesh foods (meat and organ) and fish. Around 25% of children aged 6-23 months consumed flesh/fish foods the day preceding the study.

7. Consumption of Vitamin A rich fruits and vegetables Vitamin A is an essential micronutrient for the immune system. Severe vitamin A deficiency can cause eye damage, increase the severity of infections such as measles and pneumonia in children and slows recovery. Vitamin A is found in breast milk, liver, egg, mango, papaya, carrot and dark green vegetables. In the surveyed community only half (50%)of children aged 6–23 months, had consumed vitamin A rich fruits and vegetables the day preceding the study.

8 http://www.who.int/mediacentre/factsheets/fs342/en/index.html 9the recommended food frequency is 2 or more times per day for children 6-8 months and 3 or more times per day. Moderate= >50% of the subject practicing the behavior.

87%

6%

50%

25% 19%

50%

0%

Percentage of children who consumed foods from each food groups in the previous 24 hours


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8. Children ever breast fed, continuation of breastfeeding at one and two years old

Almost all children had been breastfed at some point (95.1%). However, only one third (28%) of surveyed children were breast feeding at the time of the survey. Of those mothers who are not currently breast feeding (28%, n=49) their main reason for not breast feeding their child was breast not having enough milk (32.7) and being pregnant (40.8%)(Figure 7).

Figure 7: Reasons for cessation of breast feeding before child reaches age of 23 months, Kohat district, September, 2013

Two-thirds(73.3%, n=11) of children aged 12-15 months werestill breastfed at the time of the survey. However, only (26.9% n=7) of children 20-23 month were still being breastfed at the time of the study.

9. Timely introduction of solid, semi-solid or soft foods and complementary food The two indicators denote the same features but they refer to different age groups: 6-8 months and 6-9 months respectively. Breast milk can adequately fulfil the needs of a newborn up to 6 months. But after six months they need additional food supplement. In the surveyed community, however, nearly one-third of the children were not started with complementary food at 6 – 9 months old. Appropriate introduction of solid, semisolid or soft foods was 69.2%, and complementary food was 69.7%.

10. Bottle feeding Feeding young children using a bottle is common in the survey community. Nearly half of children (44.6%) 0-23 months receive food from a bottle.

10% 4%

2%

33% 8% 2%

41% 51%

Reason for cessation of breast feeding

Mother ill/weak Other Nipple/Breast problem

Not enough milk Child refused Weaning age/age to stop

Became pregnant


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6.5 Food Security and livelihood

Among the 206 households (HHs) include in this survey, 91.3% of the households are residents of the district where as the remaining are IDPs (8.7%). Nearly half of the IDP (44.4%) have been displaced since 2008 to 2009. Among the 206 surveyed HHs 96.6% of them are male headed households.

Majority of the respondents (81.1%, n=167 households) replied they have no food in the store when asked about food sources for the coming three months. Nearly two third (68.1%, n=114 households) of them are planning to buy their food for the next three months’ consumption (Figure 9).

Figure 8: Expected source of food for the coming three months, Kohat district,

September 2013

The most common income generating activity in the surveyed villages are agriculture (34.5%, n=10 villages) and daily labour (34.5%, n=10).

Nearly half of the surveyed communities reported that physical condition of their livestock was poor (48.0%) or very poor (4.0%) at the time of the survey. The common reasons for the poor or very poor livestock physical condition was lack of grazing areas, and lack of veterinary services (Figure 10).

2%

68%

28%

1% 1%

Expected main source of food for the coming three months

Own production

Bought

Borrowed

Relief food

Other


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Figure 9: Reason for poor livestock physical condition, Kohat district, September, 2013

More than ninety percent (90%) of the surveyed community have cultivated at least 50% of the land in the last cultivation season. However, only 30.4% of them cultivated 100% of their land.

Only one village out of thirty (1/30) has received any agricultural support from National Rural Support Program (NRSP). The support that the one community received was restocking of livestock.

6.6 Water and Sanitation

Focus group discussion in all surveyed villages showed that 62.0% communities use water from "relatively improved sources"10, i.e., protected spring and well (31%) and piped water (31%). The remaining communities used water from "unsafe sources"11 like surface water, river, unprotected spring and well.

From the household interview (N=206), 91.3% of the community do nothing12 with water before drinking (they don't boil, filter or treat with chemicals).

Ninety seven percent (97%) of communities access water source within 30 minute walk, and three percent (3%) of communities between 30 minutes and one hour walk.

Thirty eight percent (38%) of surveyed communities experienced shortage of drinking water during the three months preceding the survey. The common reasons given for the shortage of water was source become dirty (27.3%) and source was broken (27.3%).

The hand washing practice of the community as assessed by the household survey is "poor"13. Only 14.1% (n=29 household members) practice hand washing before eating food,

10 Relatively improved source, which does not necessarily mean the water is tested or treated. 11 Unsafe source indicates a relatively unsafeness than the content of the water in these sources 12No treatment is done before drinking the water fetched from all sources. 13Many of them not practicing in at least five important occasions.

23%

8%

23% 23%

23%

Reasons for poor or very poor livestock condition

Lack of grazing Lack of water

Disease Lack of veternary service

Other


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2.4% after defecation/visiting toilet and 1.0% before feeding the children. Detailed data is presented in Table 4.

Table 4: Hand washing practice, Kohat district September

Hand washing during Frequency Percent

Before preparing food/cooking 168 81.6%

Before eating 29 14.1%

Before feeding children 2 1.0%

After going to toilet/defecation 5 2.4%

After cleaning child's bottom 1 0.5%

After vulvae hygiene 1 0.5%

Total 206 100%

With regards to child faeces, only fifty nine of the households(28.6%) practice appropriate disposal. The remaining households either throw it out with other rubbish/trash or scatter it around their compound.

6.7 Health

During the three months before the survey 34.5% communities (n=10 villages) reported occurrence of disease outbreaks in their villages, mainly from other reasons (5/10)14, followed bydiarrhoea (2/10), measles (2/10) and malaria (1/10).

In most of the villages (79.3%, n=23 villages),the last vaccination campaign conducted was in the month of August, 2013 and the vaccination given to the children was Oral Polio Vaccine (OPV).

In the same period there was no report of unusual outmigration from all surveyed villages.

7. Discussion The IYCF practices in the surveyed community when compared with the national average and regional average15 is relatively poor with regards to breast feeding and better with regards to complimentary feeding practices.Indeed, early initiation of breast feeding is 39.4% in the surveyed communitywhereas the provincial average for KP is 74.3%. During a discussion with mothers of children under the age of two, most mothers mentioned the first food that is given to children is ether honey, "Ghurti" (herbal drink), green tea or sugar water. This could be one of the reasons which delay early initiation of breast feeding.

143 villages unknown cases and 2 village common cold 15 National nutrition survey of Pakistan, 2011


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Nearly two thirds of mothers exclusively breastfed their child up to the age of six months. The main reasons given by mothers who do not exclusively breastfeed their child up to the age of six months is insufficient breast milk, mothers’ illness (particularly breast/nipple problem) and the mother being pregnant. Mothers stop breast feeding when they get pregnant as there is a common belief that breast feeding a child while pregnant will make the mother and the unborn child weak.

Continued breast feeding up to the age of two years is poor compared to the provincial average. The main reason a mother will stop breast feeding before the child is two years is if she became pregnant.

Nearly seventy percent (70%) of mothers initiate complementary feeding at the age of six months. This is encouraging compared to the national and regional average which is 51.3% and 35.3% respectively. For some of those who are not starting complementary feeding on time their main reason is fear of indigestion that might be caused by the food. Other mothers reported that the child refuses to take any food other than breast milk.

A mother mentioned:

"I wanted to start complementary feeding at the age of six months but I didn't know what to feed him with. There is no elder in the house who can give me advice on this".

Duringa discussion about the source of information about child feeding, most of the mothers mentioned the main sources of information are from doctors during delivery, from grandmothers and TV/radios. This is a little bit contradiction with the findings of the household interview, where mothers mentioned that the main source of information is from dispenser/nurses and family/friends. However, to get information from the doctor a mother should travel a long distance which is not culturally acceptable.

A mother mentioned that:

"The best information I got is from the doctor when I gave birth to my child. However I am not allowed to visit the health facility due to its far distance from my village."

The following are myths on child feeding in the surveyed community:

"Giving banana for a child who is fed on cow milk will cause a chest problem"

"Rice cooked with meat should never be given to a child who is less than two years of age since it causes abdominal cramp"

"Giving pulses, meat and lady finger to a child will cause gastric problem"

"Giving grape to a child will cause respiratory problem"

"If a child is sick within seven days after being born, don't give beef and chicken to the mother. It will exacerbate the problem the child has."

It will be important to consider such myths when defining activities on IYCF.


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8. Conclusion The base line study had one primary objective which was to understand the communities KAP on IYCF in five UCs in Kohat district where ACF is implementing its nutrition and IYCF project. The results underscore that most of the infant and young child feeding practices are below the national average16. The following are the findings of this survey:

Information about child feeding originated from the same sources and showed a similar trend of utilization. Health facility and home visit are the most common places where mothers/care takers get information about child feeding. However, community sensitization event is not common in the study area to pass information about child feeding.

More than half (58.2%, n=107) of mothers/caretakers believe that breast feeding should be started immediately after the child is born. More than thirteen percent (13.6%, n=24) of them think it should be started at after one day.

Nearly half of the mothers/caretakers (45.7%) know that a child should be exclusively breast fed for the first six months of his/her life.

Only less than half of the mothers (47.3%) know the appropriate age of initiating complementary food (which is 6 months).

The most common contact persons for child feeding information in the surveyed community are Nurses/Dispensers and family/friends.

Proportion of children 0 to 23 months who were put to the breast within one hour of birth was 39.4%.

Proportion of infants aged 0-5 months who are exclusively breastfed was 65.9%.

Only 27% of children are breast fed for at least two year.

Complementary foods are introduced in a timely fashion for three-fourth (69.7%) of

children. This indicates children aged 6 to 9 months are given complementary feeding as per WHO recommendation.

Overall, nearly one in five (18.15%) children age 6-23 months are fed appropriately,

based on the recommended IYCF practices.

Proportion of children aged 0-23 months who receive iron-rich food or iron-fortified food (specially designed for infants and young children, or that is fortified in the home) is low. Only 25% of children under the age of two years had received iron rich food.

Around thirty (44.6%) percent of mother fed their children using bottle feeding.

Majority of the respondents (81.1%, n=167 households) replied they have no food in

the store when asked about food sources for the coming three months. Nearly two

16NNS Pakistan, 2011


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third (68.1%, n=114 households) of them are planning to buy their food for the next three months consumption.

Nearly half of the surveyed communities reported that physical condition of their livestock was poor (48.0%) or very poor (4.0%) at the time of the survey. The common reasons for the poor or very poor livestock physical condition was lack of grazing disease, and lack of veterinary service.

Only one village out of thirty (1/30) has received any agricultural support from NRSP. The support that one village received was restocking of livestock.

From the household interview (N=206), 91.3% of the community do nothing with water before drinking (they don't boil, filter or treat with chemicals).

Thirty eight percent (38%) of surveyed communities experienced shortage of drinking water during the three months preceding the survey. The common reasons given for the shortage of water was source become dirty (27.3%) and source was broken (27.3%).

The hand washing practice of the community as assessedby the household survey is "poor". Only one percent of mothers (n=2) practice hand washing before feeding children. 14.1% (n=29 household members) practice hand washing before eating food.

Only only fifty nine of the households (28.6%)of the households practice appropriate child faeces disposal.

During the three months before the survey 34.5% communities (n=10 villages) reported occurrence of disease outbreaks in their villages.

9. Recommendations 9.1 Infant and Young Child Feeding (IYCF)

Most infant and young child feeding practices and hygienepracticesare below the national average (early initiation of breast feeding, dietary diversity, minimum accessible diet, bottle feeding,timely initiation of complementary feeding and hand washing practices), hence behavioural change communication should be designed to advocate and address the following issues in the study community:

o Early initiation of breast feeding, initiation of breast feeding within one hours of giving birth

o Continuation of breast feeding up to the age of two years o Diversifying dietary diet o Consumption of iron rich foods, vitamin A rich foods and animal proteins o to address the myths about child feeding o Hand washing during five points (before cooking food, before feeding

children, before eating food, after going to toilet and after cleaning child's bottom.

Only a few children had consumed animal proteins (25%). An integrated program is

mandatory to improve dietary diversity and consumption of dairy products. Programs


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which incorporate food vouchers, income generating activities, nutrition should be implemented and advocated.

The dietary diversity and minimum acceptable diet is very low. Further effort should

be made in the new project to improve the dietary diversity and minimum acceptable diet by considering livelihood diversification strategies.

Forty five percent (45%) of mothers use bottle feeding in the study area. Attention

should be given to reducing bottle feeding by incorporating and focusing on the disadvantages of bottle feeding as part of the behavioural change communication (BCC) strategy.

It is essential to do a further barrier analysis to identify the reasons for the poor

practices (like bottle feeding, inappropriate feeding during pregnancy, etc).

9.2 Food Security and Livelihood (FSL)

The main source of income for the coming three months is either money secured from salary or remittance. In addition to this, two third of the community are planning to get their food from the market. This indicates a communities reliance of food from the market more than its own production. Diversifying the livelihood of the community is vital to improve the income generating sources which can lead to resilience.

Nearly half of the surveyed communities reported that physical condition of their livestock was poor or very poor at the time of the survey. The main reasons being lack of grazing, lack of veterinary service and livestock disease. Only one village has received any agriculture related support in the past three months. ACF can intervene in one or more of the following areas to improve the livestock physical condition which has a direct or indirect link with alleviating malnutrition.

9.3 Water Sanitation and Hygiene

Efforts should be made to advocate and enhance use of safe water source, piped water, protected spring/well.

Awareness creation sessions should be done to the general community about WASH, particularly about appropriate time of hand washing, appropriate disposal of child faeces, and treatment of water before drinking.

Water sources which are broken and dirty should be repaired and cleaned/treated.

9.4 Health

Appropriate integrated disease surveillance program should bedesigned/strengthened to control the outbreak of epidemics in the community.


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6. Annexes

Annex 1. Survey schedule

S/N Activities Time frame

Remark

1 Travel to Kohat and Preparation for KAP survey

enumerators training September 2, 2013 1 day

2 Training of KAP Survey enumerators in Kohat September 3-4, 2013 2 days

3 Data collection September 5-9, 2013 5 days

4 Finalize data entering and cleaning September 10-12, 2013 2 days

5 Data Analysis, preliminary report writing and

validation of preliminary report September 13-October 2, 2013 14 days

6 KAP Survey final report writing and validation October 2-16, 2013 14 days


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Annex 2. Selected clusters/Villages for IYCF KAP Survey

S/N UC name Village name HH size Cluster name Remark

1 Urban 4

Gulshanabad 211 1 Jangalkhel 273 2 Sector 9 196 3 Sector 6 280 4 Gate # 4/ phase 2 284 5 Gate # 1 252 6 Sector # 4 366 7 Charbagh 200 RC

2 Urban 6

Rehman Baba Town St-1 82 8 Koi banda 179 9 Merozai 646 10 ShaibAbada 115 11 Noor elahi colony 100 12 DalBinzadi 107 13 Akbar Aabad 93 14 Shahed Banda 362 15 Baqizai 469 16 Peshawari Banda 91 17

3 Jarma

Islamkot 53 18 Zara meela 839 19,20 Jarma 173 21

4 Bilitang BilitangDhokJata 108 22


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KandyaliBala 353 23 KandyaliPayan 339 24 Gul meer 88 25 Khotari 177 RC Lokhari 206 26 Iqra colony 91 27

5 Khairmatoo

Dheribanda 218 RC Khairmatoo 601 28,29 Ahmad ShujaMohalla 212 RC Orzkzai Banda 265 30

Annex 3: The main IYCF indicators collected and the source of data17.

S/N

Description

Definition

Sampling universe

Source of information

(Respondent)

1 Early initiation of breastfeeding

Proportion of children born in the last 24 months who were put to the breast within one hour of birth

Children aged 0- 23 months who are alive at the time of

the study

Child’s mother/caretaker

2 Children ever breastfed

Proportion of children born in the last 24 months who were ever breastfed

3 Exclusive breastfeeding during the first 6 months

Proportion of infants aged 0-5 months who are exclusively breastfed

Children aged 0- 23 months who are alive at the time of the study

Child’s mother/caretaker

4 Continued breastfeeding at one year of age

Proportion of children aged 12 – 15 months who are breastfed

5 Timely introduction of solid, semisolid or soft foods

Proportion of infants aged 6 – 8 months who receive solid, semi-solid or soft foods

6 Minimum dietary diversity score

Proportion of children aged 6 – 23 months who receive foods from four or more food groups

17Guide for the Assessment of IYCF Practices, WHO, 2010.


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7 Minimum meal frequency

Proportion of breastfed and non-breastfed children aged 6 – 23 months who receive solid, semi-solid, or soft foods in accordance to the minimum number of prescribed times or more

8 Minimum acceptable diet

Proportion of children aged 6 – 23 months who receive a minimum acceptable diet (apart from breast milk)

9 Consumption of Colostrum

Proportion of live born that received only Colostrum the first three days of birth


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Annex 4: Comparison of the results with national and regional figures

S/N Description Kohat

district18 KP

Province19 Pakistan20

1 Early initiation of breastfeeding 39.4 74.3 40.5

2 Exclusive breastfeeding during the first 6 months 66 47.0 12.9

3 Continued breastfeeding at one year of age 73.3 87.4 77.3

4 Continued breastfeeding at two years of age 26.9 58.3 54.3

5 Timely introduction of solid, semisolid or soft foods

69.2 35.3 51.3

6 Minimum dietary diversity score 21 2.7 3.0

7 Minimum meal frequency 68 45.0 56.4

8 Minimum acceptable diet 18 5.6 7.3

9 Consumption of Colostrums 80 - -

10 Children ever breastfed 95.1 - -

18ACF IYCF KAP Survey, Kohat district, September 2013 19National nutrition survey, Pakistan, 2011 20ibid


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Annex 5. Kohat District IYCF KAP Survey IYCF questionnaire, September 2013

UC ____________________ Village Name ____________________________ Cluster No ____

Team No ____ Date: /09/2013 House #______ HH elder's name_______

Contact # of HH elder____

Section 1: Background of the mother/caretaker

101 Are you able to read or write a simple sentence?

هھھھآآسانن سا جملہہ لکهھ يیا پڑ یکيیا آآپپ کوئی بهھ سکتی ہيیں؟

Yes……….1

No……….2

102 Did you ever attend formal school/Madrasa ?

ہيیں؟ هھھھیڑکيیا آآپپ کبهھی ااسکولل ميیں پ

Yes……….1

No……….2

Skip to 104

103 If yes, what is the highest grade you completed?

هھھھی ہيیں؟ڑر ہاںں٬، تو کہاںں تک پگاا

1. primary

2. middle

3. matric interme

4. bachlor

5. mASTER

6. Madrasa

104 What is your current marital status?

حيیثيیت کيیا هھھھے؟آآپپ کی ااززددووااجی

Single 1

Married 2

Divorced/Separated 3

Widowed 4

Section 2: Background of the child

201 What is the name of your youngest child?

کا نامم کيیا ہے؟ ےچبآآپپ کے

202 Sex of Child جنس؟

Boy………..1

Girl………. 2

203

What is the age of your child?

کی عمر کيیا ہے ؟ ےچبآآپپ کے [____|____] MONTHS

Section 3: IYCF practice questions


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301

Have you ever breastfed [NAME]? کو آآپنے کبهھی ماںں کا ددووددهھھھ ےچبااسس

پاليیہہ ہے؟

Yes…………….1

No..…………...2

Skip to 308

302 How long after birth did you first put [NAME] to the breast?

کو ےچبپيیداائش کی کتنی دديیر آآپپ نے ااسس ماںں کا ددووددهھھھ پاليیہہ؟

If less than 1 hour or “immediately”, record “00” hours. If less than 24 hours, record hours. Otherwise, record days.

Immediately……...………00

Hours……....…….________

Days..……..……. ________

Don’t Know……………...98

Never breastfed..…………99

303

Are you still breastfeeding [NAME]?

کو ماںں کا ددووددهھھھ ےچبکيیا آآپپ اابب بهھی ااسس پالتی ہيیں؟

Yes…………….1

No..…………...2

Skip to 307

304 Why did you stop breastfeeding [NAME]?

کو ماںں کا ددووددهھھھ پالنا کيیونن ےچبآآپنے ااسس بند کردديیا؟

(Only one main answer)

Mother ill/weak….…………….…01

Child ill/weak….…………………02

Nipple/breast problem……………03

Not enough milk…………………04

Mother working………………….05

Child refused…………….……….06

Weaning age/age to stop…………07

Became pregnant………….……..08

Started using contraception………09

Other……….…………………….10

Other (Specify__________________

For all responses skip to 307

305

Up to what age do you intend to breastfeed [NAME]?

کو ماںں کا ےچبکس عمر تک آآپپ ااسس ددووددهھھھ پالئوگی؟

Months _________

Don’t Know…………..…98

306

How many times did you breastfeed [NAME], between sunrise yesterday and sunrise today? کل صبح سوررجج ااُبهھرنے سے آآجج صبح

ےچبسوررجج ااُبهھرنے تک کتنی بارر ااسِس نے ماںں کا ددووددهھھھ پيیا ہے؟

If response is not numeric, probe for a numeric response

Number _________

Don’t Know…………..…98


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307 Did you squeeze out and throw away the first milk (colostrum)? پيیداائش کے فوررنن بعد نکلنے ووااال ماںں کا

پہال ددووددهھھھ کيیا آآپنے پهھيینک دديیا تهھا؟

Yes…………….1

No..…………...2

308 Did [NAME] drink anything from a bottle between sunrise yesterday and sunrise today? کل صبح سوررجج ااُبهھرنے سے آآجج صبح

نے بوتل ےچبسوررجج ااُبهھرنے تک کيیا ااِسس ميیں کوئی چيیز پی هھھھے؟

Yes……………..1

No……………..2

Don’t Know……8

309

Did you introduce liquids or foods (semi-solid or solid) other than breast milk to the baby?

کو ماںں کے ددووددهھھھ کے ےچبکيیا آآپنےااپنے عالووهه کوئی ااوورر

ہلکی يیا نرمم غذاا کهھالئی ہے؟

Yes……………..1

No……………..2

Don’t Know……8

Skip to 401

310 At what age did you first introduce? کس عمر ميیں کهھال نہہ شرووعع کيیا؟

Months _________

Don’t know…………..…98

Not yet started………………99

311 How many times did you feed [NAME] solid and/or semi-solid food between sunrise yesterday and sunrise today? کل صبح سوررجج ااُبهھرنے سے آآجج صبح

کو کتنی ےچبرنے تک ااسِس سوررجج ااُبهھ ددفعہہ ہلکی يیا نرمم غذاا کهھالئی؟

If response is not numeric, probe for a numeric response

Number of feedings of solids and/or semi-solid foods _________

Don’t know…………..…98

Section 4: Message recall: Time of Initiation of Breast Feeding

401

How long after birth do you think a baby should start breastfeeding?

آآپپ کے خيیالل ميیں پيیداائش کے کتنی دديیر کو ماںں کا ددووددهھھھ پيینا چاهھھھيیے؟ ےچببعد

If it less than an hour, circle immediately

Immediately………..…………………00

Hours……………………….________

Days.………………………. ________

Don’t Know……………..……….98

402

Did you hear a message to put your baby on the breast immediately after birth?

کيیا آآپنے يیہہ مشوررهه سنا تهھا کہہ پيیداائش کے کو ماںں کا ددووددهه پالئيیں؟ ےچبفوررنن بعد

Yes……………1

No……………..2

Can’t remember…….8

Skip to 501

Skip to 501


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403

From whom did you hear this message?

کس سے سنا تهھا يیہہ مشوررهه؟

M=Mentioned NM= Not mentioned

M NM

a.) Dispenser/Nurse………..….1 2

b.) Lady Health Volunteer....1 2

c.) Community mobilizer.......1 2

d.) IYCF Promoter.................1 2

e.) Family/friend…………..…...1 2

f.) Radio/TV………………..........1 2

g.) Community leader………1 2

h.) Other…………………….….....1 2

Other (specify) _____________

404

When did you hear these messages? During:

کب آآپنے يیہہ مشوررهه سنا تهھا؟

ددوورراانِن ؟


M NM

a.) Pregnancy……………….1 2

b.) Delivery……………………1 2

c.) Post natal...................1 2

d.) Sick child contacts………1 2

e.) Well child contacts……. .1 2

f.) Immunizations…………..…1 2

g.) Other……….……..….…1 2

Other (specify) _______________

405

Where did you hear these messages

کہاںں پہہ سنا تهھا يیہہ مشوررهه؟


M NM

a.) Health facility…………..….1 2

b.) Community event………….1 2

c.) Home………………………1 2

d.) Other………………………1 2

Other (specify) ________________

Section 5: Message recall: Exclusive Breast Feeding


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501 For how long do you think a baby should receive only breast milk and nothing else?

کو صرفف ماںں کا ےچبکس عمر تک ددووددهھھھ ہی پالنا چاہيیے

ااسس کے عالووهه کچهھ بهھی نهھيیں؟

Enter age in months:__________

Don’t know…….98

502

Did you hear a message to feed your baby only breast milk for the first six months of life, not even giving water?

کيیا آآپنے يیہہ مشوررهه سنا تهھا کہہ پيیداائش کو صرفف ماںں کا ےچبسے چهھ ماهه تک

ددووددهھھھ پالئيیں٬، يیہاںں تک کہہ پانی بهھی نہہ پالئيیں؟

Yes…….………1

No……………..2


Skip to 601

Skip to 601

503




M NM



c.) Community moblizer.......1 2

d.) IYCF Promoter.................1 2


f.) Radio/TV………………..........1 2

g.) Community leader…………1 2

h.) Other…………………….….....1 2

Other (specify) ______________


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504

When or how did you hear these messages? During:

کب ااوورر کيیسے آآپنے يیہہ مشوررهه سنا تهھا؟

ددوورراانِن ؟


M NM


b.) Delivery……………………1 2

c.) Post natal...................1 2




g.) Other……….……..….…1 2

Other (specify) ________________

505

Where did you hear these messages?



M NM



c.) Home………………………1 2

d.) Other………………………1 2

Section 6: Message recall: Timely initiation of Complementary Feeding

601

How long after birth do you think a baby should start to receive semi-solid and solid foods? آآپپ کے خيیالل ميیں

کو ےچبپيیداائش کے کتنے عرصے بعد ہلکی يیا نرمم غذاا کهھالنی چاہيیے؟

Age in Months ______________


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602

Did you hear a message on introducing complementary foods at six months of age, such as soft porridge 2-3 times per day?

کيیا آآپنے يیہہ مشوررهه سنا تهھا کہہ چهھ ماهه کی کو نرمم غذاا دديینا شرووعع ےچبعمر سے

کريیں

جيیسا کہہ

نرمم

(khichrri)

ڻٹائم ررووززاانہہ ؟ 2_3 کهھچنی

Yes……………1

No……………..2


Skip to 701

Skip to 701

603




M NM



c.) Community mobilizer.......1 2

d.) IYCF Promoter.................1 2


f.) Radio/TV………………..........1 2

g.) Community leader…………1 2

h.) Other…………………….….....1 2

Other (specify) _______________


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604

When or how did you hear these messages? During:

کب ااوورر کيیسے آآپنے يیہہ مشوررهه سنا تهھا؟

ددوورراانِن؟


M NM


b.) Delivery……………………1 2

c.) Post natal...................1 2




g.) Other……….……..….…1 2

Other (specify) ________________

605

Where did you hear these messages?



M NM



c.) Home………………………1 2

d.) Other………………………1 2

Other (specify) ________________

Section 7: Dietary diversity and meal frequency

701

Next I would like to ask you about some liquids and food that (NAME) may have had yesterday during the day or at night. نے کل ددنن ااوورر ررااتت ےچبددووسراا ميیں يیہہ پوچهھنا چاہونگا کہہ آآپپ کے ااسِس کے ددوورراانن ہلکی يیا نرمم غذاا ميیں کونن کونن سی چيیزيیں کهھائی يیا پی تهھيیں؟ Yes No DK

A- Porridge کهھچنی٬، bread ڈڈبل ررووڻٹی , riceچاوَولل, noodlesسوئيیاںں, or other foods made from grains

1 2 8

B- White potatoes سفيید آآلو , white yams manioc, cassava, or any other ,مولی foods made from roots

1 2 8

C- Any foods made from beans, peas lentils ,مڻٹر ددااليیں , nuts مونگ پهھلی , or seeds بيیج

1 2 8

D- Milk such as tinned, powdered, or fresh animal milk?

1 2 8

E- Cheese پنيیر , yogurt ددہی , or other milk products

1 2 8


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F- Infant formula 1 2 8

G- Any meat such as Mutton and Beef, chicken مرغی کا گوشت , or duck بطخ کا Liver ,گوشت جگر , kidney گرددهه , heart ددلل , or other organ meats

1 2 8

H- Fresh or dried fish سوکهھی مچهھلی , shellfish سمندرریی مچهھلی , or seafood سمندرریی مچهھلی

1 2 8

I- Eggs اانڈاا 1 2 8

J- Ripe mangoes پکی آآمم , ripe papayas or lemon ,پکا پپيیتا ليیموںں Guava

1 2 8

K-Anydark green leafyvegetables ہرےے ررنگ کی يیا پتوںں وواالی سبزيیاںں

1 2 8

L- Pumpkin کدوو , carrots گاجر , squash کدوو, or sweet potatoes سفيید گاجرthat are yellow or orange inside

1 2 8

M- Foods made with red palm oil, red palm nut, or red palm nut pulp sauce

1 2 8

N- Any other fruits or vegetables-7 1 2 8


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Kohat District IYCF KAP SurveyHH FSL and WASH Questionnaire, September 2013

UC: ______________________ Village: __________________ _________Cluster number: __ __ Team number: _____ Household number____________ Date: /09/2013

NO QUESTIONS AND FILTERS ANSWERS & CODES SKIP Food security and livelihood questions

101 What is the status of the household?

ے؟ہائش کس قسم کی ہآآپکی موجوددهه رر1--------------------------Resident-----------------------------→ 2--------------------------IDP-------------------------------------→

103 Q102

102 Since how long have you been displaced? کتنے عرصے سے آآپپ نقل مکا نی کيیے ہوئے

ہو؟

____/____/_______ (DD/MM/YYYY)

103 What is the gender of the head of the household? گهھر کا سربرااهھھھ کونن ہے؟ مردد يیا عوررتت؟

1 ------------- Male 2 -----------Female

104 What were the sources of income of the household during the last 3 months? ماهه کے ددوورراانن آآ پکے گهھر کی آآمدنی کے ذذ رراا ئع کونسے تهھے ؟ 3پچهھلے

(Circle all options mentioned) ASK HER TO RANK ACCORDING TO IMPORTANCE

Methods Applied Rank Methods Applied Rank

1 Sales of crop production 9 BISP work

2 Sales of live stocks 10 Loan

3 Sales of Livestock products 11 Remittance

4 Sales of fruit, Coffee, and sugarcane

12 Salary

5 Sales of Firewood and charcoal

13 Sale of relief food

6 Sales of hand craft 14 No Income source

7 Sales of fattened animals 15 Daily Work (out of BISP work)

8 Small business 98 Other (specify) _________

105 Does this household have food in the store which is sufficient to feed the family for the next 03 months? کيیا آآ پپ کے گهھر ميیں ااتنا ررااشن موجودد ہے

ماهه تک آآپکے گهھر وواالوںں کے 3جو ااگلے ليیے کافی ہو؟

1-------------------- Yes 2 ------------------------- No

No →Q105


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106 If no food in store now, what will be your main source of food for the NEXT 3 months (expectation)? ے يیہااگر ررااشن ناکاف

م ذذرريیعہہ ہماهه ميیں آآ پکی آآمدنی کا اا 3تو ااگلے ااُميید کيیا ہے) ؟ وگا (ہکيیا

(Circle all options mentioned) ASK HER TO RANK THEM ACCORDING TO PRIORITY

Sources Rank 1 Own production

2 Bought 3 Borrowed 4 BISP 5 Relief food (GFD)

98 Other (specify

107 What is your coping mechanism at stress time? (whenever they face food shortage) (circle 3 most important )

تنگدستی يیا ددباؤؤ کے ووقت آآپپ کی تداابيیر کيیا ہوتی ہيیں؟

( جب کبهھی آآ پکو خوررااکک کی قلت کا سامنہہ ہو؟

0---None 13--Borrowing 1---Sale of productive animals 14---Sale of Relief food 2---Sale of more animals 15---Stress not experienced 3---Sale of plough animals 16---Eating wild food 4---Reduce family size 17---Safety Net 5---Reduce number of meals/size 18---Consume seed 6---Sale of farming tools 19---Rent farm land 7---Petty trade 20---Sale of personal asset (jewellery) 8---Migration for labour/food 21--social service credit 9----Sale charcoal/firewood 22---Credit from mosque 10---Sale of poles 23---Sale of labour 11---Rent pack animals 24--Otherspecify(_________) 12---Remittance

WASH related Questions

108 What is done to the water before households’ members drink it?

گهھر کے اافراادد پا نی پيینے سے پهھلے پا نی کو کيیا کرتے ہيیں؟

1----Nothing 6--------Chlorination/Pur 2----Boiling 7------- Use herbs 3----Filtering with a cloth 8--------put it out in the sun 4----Local sand filter 9--------Others(Specify) 5----Letting it settle

109 When do you usually wash your hands during the day (record ALL answers given) Do not read answers. عامم ططورر پر آآ پپ ددنن ميیں کس ووقت ہاتهھ ددهھھھوتے

ہيیں ؟

0-------------------Never 1-------------------Before preparing food/ cooking 2--------------------Before serving food 3--------------------Before eating 4--------------------Before feeding children 5-------------------After going to toilet/defecation 6--------------------After cleaning child's bottom 7--------------------After vulvae hygiene 98----------------------------------------Other (specify

110 What is done with children/baby faeces?

بچوںں کے پاخانے کے سا تهھ آآ پپ کيیا کرتے ہيیں ؟

1 = Thrown out with normal rubbish/trash 2 = Deposited immediately in a latrine 3 = Scattered around the compound/house 4 = Given to domestic animals to clear/eat 5 = Buried 6 = Other (specify________________)

IYCF KAP Survey - Action Against Hunger · 3.1 General objective ... ACF IYCF KAP Survey in Kohat district of KP ... The survey collected information regarding IYCF knowledge, attitude

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