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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
Page 2
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.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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
SMART Standard Monitoring and Assessment of Relief and Transition
WHO World Health Organization
WASH Water Sanitation and Hygiene
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 5
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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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.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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2. Background
The 24 districts making up the Khyber Pakhtunkhwa (KP) province are: Chitral, Upper Dir,
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 8
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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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:
⌈ ( )
⌉
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:
⌈ ( )
⌉
⌈ ( )
⌉
=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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 10
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 11
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)
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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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).
0
10
20
30
40
50
60
70
80
perc
enta
ge
Sources of EBF messages
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 14
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
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 17
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, 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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 20
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 21
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.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 22
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 23
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 24
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.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 25
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 26
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 27
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.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 28
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
Page 29
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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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?
ھآسان سا جملہ لکه يا پڑ یکيا آپ کوئی به
سکتی ہيں؟
Yes……….1
No……….2
102 Did you ever attend formal school/Madrasa ?
ہيں؟ ھیڑکيا آپ کبهی اسکول ميں پ
Yes……….1
No……….2
Skip to 104
103 If yes, what is the highest grade you completed?
ھی ہيں؟ڑر ہاں، تو کہاں تک پگا
1. primary
2. middle
3. matric interme
4. bachlor
5. mASTER
6. Madrasa
104 What is your current marital status?
حيثيت کيا ھے؟آپ کی ازدواجی
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 نام کيا ہے؟ ےچبآپ کے
202 Sex of Child
جنس؟
Boy………..1
Girl………. 2
203
What is the age of your child?
کی عمر کيا ہے ؟ ےچبآپ کے [____|____] MONTHS
Section 3: IYCF practice questions
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301
Have you ever breastfed [NAME]?
کو آپنے کبهی ماں کا دودھ ےچباس
پلايہ ہے؟
Yes…………….1
No..…………...2
Skip to 308
302 How long after birth did you first put [NAME] to the breast?
کو ےچبپيدائش کی کتنی دير آپ نے اس
ماں کا دودھ پلايہ؟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 ماں کا دودھ ےچبکيا آپ اب بهی اس
پلاتی ہيں؟
Yes…………….1
No..…………...2
Skip to 307
304 Why did you stop breastfeeding [NAME]?
کو ماں کا دودھ پلانا کيون ےچبآپنے اس
بند کرديا؟ (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 ماں کا ےچبکس عمر تک آپ اس
دودھ پلائوگی؟
Months _________
Don’t Know…………..…98
306
How many times did you breastfeed [NAME], between sunrise yesterday and sunrise today?
کل صبح سورج ابُهرنے سے آج صبح
ےچبسورج ابُهرنے تک کتنی بار اسِ نے ماں کا دودھ پيا 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)?
پيدائش کے فورن بعد نکلنے والا ماں کا
پہلا دودھ
کيا آپنے پهينک ديا تها؟
Yes…………….1
No..…………...2
308 Did [NAME] drink anything from a bottle between sunrise yesterday and sunrise today?
کل صبح سورج ابُهرنے سے آج صبح
نے بوتل ےچبسورج ابُهرنے تک کيا اِس
ميں کوئی چيز پی ھے؟
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 ماں کے دودھ کے ےچبکيا آپنےاپنے
علاوه کوئی اور
ہلکی يا نرم غذا کهلائی ہے؟
Yes……………..1
No……………..2
Don’t Know……8
Skip to 401
310 At what age did you first introduce?
کس عمر ميں کهلا نہ شروع کيا؟
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 سورج ابُهرنے سے آج صبح
کو کتنی ےچبرنے تک اسِ سورج ابُه
دفعہ ہلکی يا نرم غذا کهلائی؟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?
آپ کے خيال ميں پيدائش کے کتنی دير
کو ماں کا دودھ پينا چاھيے؟ 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?
کيا آپنے يہ مشوره سنا تها کہ پيدائش کے
کو ماں کا دوده پلائيں؟ ےچبفورن بعد
Yes……………1
No……………..2
Can’t remember…….8
Skip to 501
Skip to 501
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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403
From whom did you hear this message?
کس سے سنا تها يہ مشوره؟
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 آپنے يہ مشوره سنا تها؟
دورانِ ؟
M=Mentioned NM= Not mentioned
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
کہاں پہ سنا تها يہ مشوره؟
M=Mentioned NM= Not mentioned
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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501 For how long do you think a baby should receive only breast milk and nothing else?
کو صرف ماں کا ےچبکس عمر تک
دودھ ہی پلانا چاہيے
اس کے علاوه کچه بهی نهيں؟
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?
کيا آپنے يہ مشوره سنا تها کہ پيدائش
کو صرف ماں کا ےچبسے چه ماه تک
دودھ پلائيں، يہاں تک کہ پانی بهی نہ
پلائيں؟
Yes…….………1
No……………..2
Can’t remember…….8
Skip to 601
Skip to 601
503
From whom did you hear this message?
کس سے سنا تها يہ مشوره؟
M=Mentioned NM= Not mentioned
M NM
a.) Dispenser/Nurse………..….1 2
b.) Lady Health Volunteer....1 2
c.) Community moblizer.......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) ______________
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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504
When or how did you hear these messages? During:
کب اور کيسے آپنے يہ مشوره سنا تها؟
دورانِ ؟
M=Mentioned NM= Not mentioned
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) ________________
505
Where did you hear these messages?
کہاں پہ سنا تها يہ مشوره؟
M=Mentioned NM= Not mentioned
M NM
a.) Health facility…………..….1 2
b.) Community event………….1 2
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? آپ کے خيال ميں
کو ےچبپيدائش کے کتنے عرصے بعد
ہلکی يا نرم غذا کهلانی چاہيے؟
Age in Months ______________
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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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?
کيا آپنے يہ مشوره سنا تها کہ چه ماه کی
کو نرم غذا دينا شروع ےچبعمر سے
کريں
جيسا کہ
نرم
(khichrri)
ٹائم روزانہ ؟ 2_3 کهچنی
Yes……………1
No……………..2
Can’t remember…….8
Skip to 701
Skip to 701
603
From whom did you hear this message?
کس سے سنا تها يہ مشوره؟
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) _______________
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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604
When or how did you hear these messages? During:
کب اور کيسے آپنے يہ مشوره سنا تها؟
دورانِ؟
M=Mentioned NM= Not mentioned
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) ________________
605
Where did you hear these messages?
کہاں پہ سنا تها يہ مشوره؟
M=Mentioned NM= Not mentioned
M NM
a.) Health facility…………..….1 2
b.) Community event………….1 2
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 دن اور رات ےچبدوسرا ميں يہ پوچهنا چاہونگا کہ آپ کے اس
کے دوران ہلکی يا نرم غذا ميں کون کون سی چيزيں کهائی يا پی تهيں؟
Yes No DK
A- Porridge کهچنی، bread ڈبل روٹی ,
riceچاوَل, noodlesسوئياں, or other foods
made from grains
1 2 8
B- White potatoes سفيد آلو , white yams
manioc, cassava, or any other ,مولی
foods made from roots
1 2 8
C- Any foods made from beans, peas
lentils ,مٹر داليں , nuts مونگ پهلی , or
seeds بيج
1 2 8
D- Milk such as tinned, powdered, or
fresh animal milk? 1 2 8
E- Cheese پنير , yogurt دہی , or other
milk products 1 2 8
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2013
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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 گرده , heart دل
, or other organ meats
1 2 8
H- Fresh or dried fish سوکهی مچهلی ,
shellfish سمندری مچهلی , or seafood
سمندری مچهلی
1 2 8
I- Eggs انڈا 1 2 8
J- Ripe mangoes پکی آم , ripe papayas
or lemon ,پکا پپيتا ليموں Guava 1 2 8
K-Anydark green leafyvegetables ہرے
رنگ کی يا پتوں والی سبزياں 1 2 8
L- Pumpkin کدو , carrots گاجر ,
squash کدو, or sweet potatoes سفيد گاجر
that 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
103 What is the gender of the head of the household?
گهر کا سربراھ کون ہے؟ مرد يا عورت؟
1 ------------- Male 2 -----------Female
104 What were the sources of income of the household during the last 3 months?
ماه کے دوران آ پکے گهر کی آمدنی کے ذ را ئع کونسے تهے ؟ 3پچهلے (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?
کيا آ پ کے گهر ميں اتنا راشن موجود ہے
ماه تک آپکے گهر والوں کے 3جو اگلے
ليے 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 يہاگر راشن ناکاف
م ذريعہ ہماه ميں آ پکی آمدنی کا ا 3تو اگلے
امُيد کيا ہے( ؟ وگا )ہکيا
(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 يا دباؤ کے وقت آپ کی تدابير کيا
ہوتی ہيں؟
) جب کبهی آ پکو خوراک کی قلت کا سامنہ
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?
گهر کے افراد پا نی پينے سے پهلے پا نی کو
کيا کرتے ہيں؟
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.