IMPROVING NUTRITION OUTCOMES THROUGH OPTIMIZING AGRICULTURAL INVESTMENT HOUSEHOLD FACILITATION MANUAL FOR ATONU FIELD ASSISTANTS ETHIOPIA

Transcription

1 IMPROVING NUTRITION OUTCOMES THROUGH OPTIMIZING AGRICULTURAL INVESTMENT HOUSEHOLD FACILITATION MANUAL FOR ATONU FIELD ASSISTANTS ETHIOPIA

2 How to use this counseling package This flip chart is a series of Themes designed with illustrations to be used by field staff/volunteers to communicate to mothers, fathers and caregivers with children under 2 years old on best nutritional practices for improved child and family wellbeing. The illustration page should face the caregiver while the message side should face the field staff. The flip chart will be used during group meetings and home visits. Use the following steps with the caregiver to encourage them to adopt the required practices: Greet the caregiver and build rapport. Ask open ended questions about the child s age and the wellbeing of the child and caregiver. Listen actively to the progress and concerns of the caregiver about the child. Use helpful non-verbal communication such as: make eye contact, listen closely, remove barriers, take time, touch as appropriate. Identify the main issues causing the problem and help the caregiver decide which problems to work on. Remember to Praise what the mother is doing right. Identify feeding difficulty, if any and its cause and avoid being judgmental. Discuss possible ways to overcome difficulties. Discuss with the caregiver the available feasible options to overcome the problem. Recommend and negotiate for doable solutions with the caregiver who should choose which option to take. Caregiver Agrees to try the chosen action and demonstrates understanding of the action. Make an Appointment for follow-up with the caregiver to assess progress on the agreed option. Use responses and gestures to show you are interested and repeat back what the mother/father says to ensure understanding.

3 CONTENTS THEME 1: FAMILY NUTRITION 1 Session #1: What happens when families do not eat well? 2 Session #2: Why we need to eat well 8 Session #3: Hygiene and sanitation in handling and storing food 11 THEME 3: MATERNAL, INFANT AND YOUNG CHILD FEEDING Session #9: Session #10: Maternal nutrition: nutrition before, during and after pregnancy Infant and young child feeding THEME 2 : DIET DIVERSITY 20 Session #4: The food groups: animal source food 21 THEME 4: WOMEN EMPOWERMENT AND MALE ENGAGEMENT 49 Session #5: The food groups: Oils and fats 25 Session #6: The food groups: Fruits and vegetables 27 Session #7: The food groups: Staples and legumes 29 Session #8: Chicken and eggs in family nutrition 32

4 THEME I FAMILY NUTRITION Session #1: What happens when families do not eat well? Session #2: Why we need to eat well Session #3: Hygiene and sanitation in handling and storing food 1

5 SESSION THEME 11 WHY FAMILY NUTRITION NUTRITION MATTERS Session #1: What happens when families do not eat well? OBJECTIVES To influence households changes in eating habits Promote food safety, hygiene and sanitation measures at household level To influence household income and budgets for nutritious food KEY MESSAGES: 1. Families that do not eat the right food in the right quantities become under nourished because their bodies are not getting the nutrients to function well a. Children growth is poor b. Families have less energy to do farm work or any other work c Their immune system becomes weak and they become sick often d. Undernourished pregnant women give birth to a low birth weight child who begins life poorly e. Eating too much food than the body requires result in the body becoming obese 2. A poor diet does not contain all the right food in right quantities; this diet does not meet family nutrition needs 3. A good diet is the one that supplies our body with the right nutrients in right amounts. A good diet is formed from diverse food sources THEME OBJECTIVES: By the end of this theme, families should be able to: Mention the consequences of poor nutrition Identify a poor diet Explain how they can achieve a good diet HOW TO FACILITATE THIS THEME: Before the session begins: Welcome all the participants make greetings Introduce yourself Ask participants to introduce themselves Explain why you are meeting them and how long will the session take Facilitation requirements Time required: 45 minutes Teaching and Learning Resources: Counselling cards with poorly nourished family members, malnourished children, and vicious circle of malnutrition for farmers, plates of a poor meal and a balanced meal, food group poster FACILITATION METHODS: DISCUSSION QUESTIONS: What are the consequences of a poor diet? Give participants posters to identify the cycle of malnutrition and the poster with different forms of malnourished children How can you identify a poor diet? Show participants pictures of poor meals and ask them what is wrong with that diet. Take note of their answers and comment with right answers What can you do to achieve a good diet? Put the participants in groups to discuss how they can achieve a good diet. This exercise should be approximately 5 minutes Discuss and comment on their responses and show them the six food group chart. Discuss each food group and explain the importance of the food sources 2 ACTION: DISCUSS AND AGREE WITH FAMILIES SOME OF THE FOLLOWING POSITIVE STEPS TO TAKE: Eat the right amount of nutritious food in the right quantities (not too little and not too much) from the 6 food groups Plan for a nutritious diet everyday by committing income to purchase nutritious food that you do not have from your farm Husband and wife should budget for nutritious food every month to avoid a poor diet Reserve enough food from your harvest to meet food requirements through-out the growing season CONCLUSION OF THE THEME: Ask participants what they have learnt in this session Ask them how this knowledge will help them at household level

6 THEME 1 FAMILY NUTRITION SESSION #1: WHAT HAPPENS WHEN FAMILIES DO NOT EAT WELL? The four children are of the same age but with different nutritional status. Child C is the only healthy child. Child A Child B Child C Child D Wasted yes no no no Stunted no yes no no Underweight yes yes no no Obese no no no yes Normal no no yes no NOTE: All these children may also be micronutrient deficient 3

7 THEME 1 FAMILY NUTRITION SESSION #1: WHAT HAPPENS WHEN FAMILIES DO NOT EAT WELL? A poorly nourished pregnant woman is likely to give birth to an underweight baby who grows up as a weaker adolescent and likely to give birth to an underweight baby in future. A well-nourished pregnant woman will give birth to a healthy baby who grows up as a healthy adolescent and likely to give birth to a health baby in the future. 4

8 THEME 1 FAMILY NUTRITION SESSION #1: WHAT HAPPENS WHEN FAMILIES DO NOT EAT WELL? INADEQUATE FOOD AVAILABILITY ADEQUATE FOOD AVAILABILITY 5

9 THEME 1 FAMILY NUTRITION SESSION #1: WHAT HAPPENS WHEN FAMILIES DO NOT EAT WELL? A plate with 2 food groups: INjera(staple) and lentils(legume) can be improved if more food groups are included A plate with 5 food groups: Injera (staple) chicken (animal source food), vegetables, lentils and fruits 6

10 THEME 1 FAMILY NUTRITION SESSION #1: WHAT HAPPENS WHEN FAMILIES DO NOT EAT WELL? Fruits Oils and fat Vegetables Animal source foods Legumes and nuts Staples 7

11 SESSION 1 WHY THEME NUTRITION 1 MATTERS FAMILY NUTRITION Session #2: Why we need to eat well OBJECTIVES To influence households changes in eating habits Promote food safety, hygiene and sanitation measures at household level To influence household income and budgets for nutritious food THEME OBJECTIVES: By the end of this theme, families should be able to: Explain why families need to eat well Plan, budget and prepare good family meals Explain factors that affect attainment of good nutrition HOW TO FACILITATE THIS THEME: Before the session begins: Welcome all the participants and exchange greetings Ask them what they had eaten the previous day (fill the session monitoring form) and hold a discussion on why they ate what they ate Explain why you are meeting them and how long will the session take Explain that they will do a meal plan which will be cooked in the next session Facilitation requirements Time required: 60 minutes for the discussion Teaching and Learning Resources: Counselling cards and posters KEY MESSAGES: 1. Families need to eat a nutritious diet for the following reasons: a. Children grow healthy, have a good start in life and are active in school. It supports physical growth and intellectual development. b. A nutritious diet provides energy to perform work. c. Nutritious diet protects the body from illnesses and repairs the body. 2. One food does not provide all the nutrients required by the body. Only a variety of foods can provide nutrients to perform all the functions of a body. 3. Families should plan nutritious meals from the six food groups. Ensure that by the end of the day, the family has eaten from the six food groups. 4. When farmers sell extra farm produce, husband and wife should plan and budget their income to buy other nutritious food that they did not grow on the farm. DISCUSSION QUESTIONS: Why do families need to eat well (ask questions and discuss each answer given). Use posters of well fed and active families to emphasise importance of good diet Conduct exercise on how to budget and make good family meals by putting participants in groups and asking them to fill the blank meal planning tool, use the six food group chart as a reference for food groups) and discuss the meal plans from each group Discuss what would make families achieve good nutrition at household level? 8 ACTION: DISCUSS AND AGREE WITH FAMILIES SOME OF THE FOLLOWING POSITIVE STEPS TO TAKE: Eat the right amount of nutritious food in the right quantities (not too little and not too much) from the 6 food groups Plan for a nutritious diet everyday by committing income to purchase nutritious food that you do not have from your farm Feed their children nutritious food like chicken and eggs for proper growth and strong immune system Maintain good hygiene for food, water and themselves CONCLUSION OF THE THEME: Ask participants what they have learnt in this session Ask participants what they identified as the easy and difficult tasks in budgeting for a nutritious diet Which foods would be easy or difficult to get and how they would find alternatives Negotiate with participants to bring the food they had planned for the next session cookery demonstrations Ask the participants how this knowledge will help them at household level

12 THEME 1 FAMILY NUTRITION SESSION #2: WHY WE NEED TO EAT WELL Fruits Oils and fat Vegetables Animal source foods Legumes and nuts Good nutrition means well-nourished children who are active in class and are not absent because of sicknesses that result from poor nutrition. Staples Each day eat from the six food groups. If you did not grow or have some food, buy nutritious food from the market. 9

13 THEME 1 FAMILY NUTRITION SESSION #2: WHY WE NEED TO EAT WELL Food provides energy to farm 10

14 SESSION 1 THEME 1 WHY NUTRITION FAMILY MATTERS NUTRITION Session #3A: Hygiene and sanitation in handling and storing food OBJECTIVES To influence households changes in eating habits. Promote food safety, hygiene and sanitation measures at household level. To influence household income and budgets for nutritious food. KEY MESSAGES: Germs get into our food through many ways Wash hands to avoid introducing germs into food Treat drinking water Keep food and water safe and covered using well covered containers or utensils THEME OBJECTIVES: By the end of this theme, families should be able to: Mention the consequences of poor hygiene and sanitation Identify hygiene and sanitation practises around the home including food and water handling and storing Explain how families can achieve good hygiene and sanitation at household level HOW TO FACILITATE THIS THEME: Before the session begins: Welcome all the participants and exchange greetings. Collect all the food items brought by families and put them in a safe place Explain that the session will have a cookery demonstration at the end Explain why you are meeting them and how long will the session take FACILITATION REQUIREMENTS Time required: 45 minutes for discussions and 30 minutes for cookery session Teaching and Learning Resources: Counselling cards with hygiene and sanitation illustration, points for hand washing and food group poster Facilitation methods: Question and answer, discussion DISCUSSION QUESTIONS: Ask participants what is poor hygiene and sanitation Ask what are the consequences of poor hygiene and sanitation and take note of their answer Refer to the posters on hygiene and sanitation and discuss each picture what it is trying to communicate Present a case study of hygiene and sanitation and ask participants to stop you every time the character in the case study practised poor hygiene and sanitation and point out the poor practise What can you do to achieve good hygiene and sanitation in the home? Ask participants to role play good hygiene and sanitation practises that they would do in the home CASE STUDY: Mrs. Worde gets up early. She goes to the toilet * then she prepares baby s food and feeds the baby. She cleans the baby and washes herself. She gives food from yesterday which is not *warmed to the family. She goes to the farm to work. She works for hours on the farm and once she makes a break on the farm and stops work * to feed the baby again. At midday she * feeds the baby. Then she prepares * a meal for her other children. She puts the food in the plate and does not *cover it, the chickens that are passing by eats from the uncovered food plates. She calls her children to come and eat. The children who are coming from play ground * eat the food without washing hands. Participants should point out the poor hygiene practise Mrs Worde made. Discuss with the participants the right practises Mrs Worde was supposed to take in this story. 11

15 SESSION 1 THEME 1 WHY NUTRITION FAMILY MATTERS NUTRITION Session #3A: Hygiene and sanitation in handling and storing food ACTION: DISCUSS AND AGREE WITH FAMILIES SOME OF THE FOLLOWING POSITIVE STEPS TO TAKE: Wash hands after coming from the toilet, changing baby nappies, doing farm work Wash hands before preparing food, before feeding the baby, wash babies hand before feeding him/her, wash hands before eating the food Cover the food to avoid vectors Treat drinking water Use the toilet at all times and not the bush COOKERY SESSION 1. Organise farmers into groups according to the meal they planned at the last session 2. Discuss with them the food items they will cook, what food group they belong to 3. Ask them to cook their food considering hygiene and good cooking methods 4. Observe the processes of food preparation and hygiene care 5. Discuss with participants the food types they cooked and how important each prepared food is 6. Discuss the critical hygiene measures they observed during cookery session CONCLUSION OF THE THEME: Ask participants what they have learnt in this session Ask them how this knowledge will help them at household level What would be easy to practise and what would be difficult to practise and why? 12

16 THEME 1 FAMILY NUTRITION SESSION #3A: HYGIENE AND SANITATION IN HANDLING AND STORING FOOD Use the toilet at all time and wash hands after using the toilet Cover the food at all times to keep away vectors which are disease carries like rats and flies 13

17 THEME 1 FAMILY NUTRITION SESSION #3A: HYGIENE AND SANITATION IN HANDLING AND STORING FOOD WHEN TO WASH HANDS Wash hands after changing baby nappy, disposing baby feces and after using the toilet 14 Wash hands before preparing food, feeding the baby and eating food

18 THEME 1 FAMILY NUTRITION SESSION #3A: HYGIENE AND SANITATION IN HANDLING AND STORING FOOD HOW TO PREVENT FOOD AND WATER CONTAMINATION Always use the toilet and NOT the bush. Open defecation will spread disease causing germs Ways through which germs are carried include the hands if not washed, the flies, through farm crops and open water spaces The germs will get into food. To avoid this, wash your hands always, cover the food and treat drinking water Ensure that the child's food and play area is protected to avoid diarrhea and other diseases 15

19 THEME 1 FAMILY NUTRITION SESSION #3A: HYGIENE AND SANITATION IN HANDLING AND STORING FOOD Do not leave the water uncovered, germs may get into the water Always cover your water to avoid contamination Treat your drinking water if from unprotected sources 16

20 THEME 1 FAMILY NUTRITION SESSION #3A: HYGIENE AND SANITATION IN HANDLING AND STORING FOOD STEPS TO THOROUGH HAND WASHING Rinse your hands with warm water suitable for drinking. Dry your hands in the air or on a clean, hygienic cloth 17

21 SESSION THEME 11 WHY FAMILY NUTRITION NUTRITION MATTERS Session #3B: Food safety measures in agriculture production SESSION OBJECTIVES To influence households changes in eating habits. Promote food safety, hygiene and sanitation measures at Household level To influence Household income and budgets for nutritious food KEY MESSAGES: Chicken feed should be free of contamination just like human food should be safe for consumption Wash hands with soap after feeding your chicken or after handling them Wash fruits and vegetables before consuming, Make sure the children play areas is free of chicken droppings Always cover your food once cooked to avoid chicken eating from your uncovered plates- chickens can be carriers of germs on their beaks Take good handling care of fresh produce like milk, vegetables and fruits to avoid exposing them to contamination THEME OBJECTIVES: By the end of this theme, families should be able to: Identify practises in Agriculture value chains that can affect food safety Explain measures to be taken to ensure food safety in agriculture value chains Discuss potential practises in chicken and vegetable production that would affect food safety FACILITATION REQUIREMENTS Time required: 45 minutes for discussions Teaching and Learning Resources: Counselling cards with food safety pictures and illustrations Facilitation methods: Question and Answer, discussion, role play CONCLUSION OF THE THEME: Ask participants what they have learnt in this session Ask them how this knowledge will help them at household level What would be easy to practise and what would be difficult to practise and why HOW TO FACILITATE THIS THEME: Before the session begins: Welcome all the participants, make greetings Explain that the session is building on hygiene and sanitation Explain why you are meeting them and how long will the session take DISCUSSION QUESTIONS: Ask participants what are the possible contamination points when breeding chickens and producing vegetables. Ask participants to identify food safety issues that can arise from agriculture produce handling, processing and utilisation. Look at the food safety issues in agriculture value chains that farmers deal with 18

22 THEME 1 FAMILY NUTRITION SESSION #3B: FOOD SAFETY MEASURES IN AGRICULTURE PRODUCTION 19

23 THEME 2 DIET DIVERSITY Session #4: The food groups: Animal source food Session #5: The food groups: Oils and fats Session #6: The food groups: Fruits and vegetables Session #7: The food groups: Staples and legumes Session #8: Chicken and eggs in family nutrition 1

24 SESSION 1 WHY THEME NUTRITION 2 DIET MATTERS DIVERSITY Session #4: The food groups: animal source food OBJECTIVES Support households achieve diet diversity Influence changes in food access habits Influence changes in food utilisation Households ability to minimise food wastage KEY MESSAGES: There are diverse food found in our village, both from our farms and our local market Animal source foods are among the six food groups responsible for building our bodies and for growth. A good diet is the one that supplies our body with the right nutrients in right amounts. A good diet is formed from diverse food sources. A good diet contains animal source food. THEME OBJECTIVES: By the end of this theme, families should be able to: Identify the food available in their areas Mention the animal source food found in their area Explain the importance of animal source food for nutrition Jointly plan a nutritious diet for their families using animal source food as a focal food HOW TO FACILITATE THIS THEME: Before the session begins: Welcome all the participants and exchange greetings. Collect the food items they have brought and keep them in a safe place Explain why you are meeting them and how long will the session take Explain that after 45 minutes of discussion, the participants will be involved in cooking a nutritious meal with emphasis on animal source food FACILITATION REQUIREMENTS Time required: 45 minutes discussions and 40 minutes cookery Teaching and Learning Resources: Counselling cards with pictures of the six food group, animal source food images and blank meal planning calendar Facilitation methods: Question and answer anddiscussion DISCUSSION QUESTIONS: Ask participants to mention the food grown in their area and found in their market, record the foods and ask participants to help you classify the food according to each group Ask participants to mention the animal source foods found in their homes and in the market, list the animal source food Ask participants why they need to consume animal source foods Comment on their responses by explaining the importance of animal source food, show them the picture of growth cycle, emphasising the role of protein for human growth and body development Ask the participants to work as a household and plan the weekly food by costing only those food that are not found in their home 21 ACTION: DISCUSS AND AGREE WITH FAMILIES SOME OF THE FOLLOWING POSITIVE STEPS TO TAKE: Eat the right amount of nutritious food in the right quantities (not too little and not too much) from the 6 food groups Plan for a nutritious diet everyday by committing income to purchase nutritious food that they do not have from their farm, including animal source food Husband and wife commit to include animal source food especially chicken and eggs in the family meals and especially in infant diet Reserve enough food from the harvest to meet food requirements through-out the growing season CONCLUSION OF THE THEME: Ask participants what they have learnt in this session Ask them how this knowledge will help them at household level Explain that the next session will have a cookery demonstration to prepare all food found in their area Explain to participants that in-order to make a nutritious meal in the next session, they will need to bring any nutritious food from the meal plan they just made

25 THEME 2 DIET DIVERSITY Session #4: The food groups: animal source food NEXT SESSION: Next session is on diet diversity, focusing on Oil and Fat source food. Ask participants to bring any food found in their home or community by showing them the six food group chart, discuss with them what food they can afford to bring and that which is in season. Explain that they will learn about Fat and oils source food and by the end of the session they will prepare nutritious food that includes fats and oils. Explain to them that the next session will involve cookery demonstration and therefore they need to bring all the requirements for conducting cookery demonstration including firewood and utensils. COOKERY SESSION Discuss with them the food items they will cook, what food group they belong to. Ask them to cook their food considering hygiene and good cooking methods. Observe the process of food preparation and hygiene. Discuss with participants the importance of animal source foods they cooked and how important it is for their children. 22

26 THEME 2 DIET DIVERSITY SESSION #4: THE FOOD GROUPS: ANIMAL SOURCE FOOD Fruits Oils and fat Vegetables Animal source foods Legumes and nuts Staples 23

27 THEME 2 DIET DIVERSITY SESSION #4: THE FOOD GROUPS: ANIMAL SOURCE FOOD Animal source food builds bodies and are responsible for growth Eggs Organ meat Milk Meat Chicken Animal source food supply the body with protein for growth and development. This is the example of how we move from one stage of growth to the next 24

28 SESSION THEME 21 WHY DIET NUTRITION DIVERSITY MATTERS Session #5: The food groups: oils and fats OBJECTIVES Support households achieve diet diversity Influence changes in food access habits Influence changes in food utilisation Households ability to minimise food wastage KEY MESSAGES: Fats provide the body with a good source of energy, they also help with many body functions as well as support other nutrients function well. Fats are to be consumed in small quantities. Add fats in your children s food every day. THEME OBJECTIVES: By the end of this theme, families should be able to: Identify the food available in their areas. Mention the Oil and fat food sources found in their area. Explain the importance of fats and oil source foods for nutrition. Jointly plan a nutritious diet for their families that include oils and fats food. HOW TO FACILITATE THIS THEME: Before the session begins: Welcome all the participants make greetings Collect the food items brought by the households Explain why you are meeting them and how long will the session take FACILITATION REQUIREMENTS Time required: Discussion time: 45 minutes and cookery demonstration time: 30 minutes Teaching and Learning Resources: Six food group charts, posters of oils and fat foods and flipcharts Facilitation methods: Question and answer, discussion and group work DISCUSSION QUESTIONS: Ask participants to mention the foods that are sources of oils and fats in their area. Ask participants to mention the oil and fat foods that they consumed last night if any. Ask participants how they access oil and fat foods. DISCUSS WITH FAMILIES SOME OF THE FOLLOWING POSITIVE STEPS TO TAKE: To buy fats and oils source foods to include in their meals. To include fats and oils in their infants diet. To grow foods that are good sources of fats and oils like nuts. CONCLUSION OF THE THEME: Ask participants what they have learnt in this session. Ask them how this knowledge will help them at household level. Explain that the next session will have a cookery demonstration to prepare all food found in their area. Explain to participants that in-order to make a nutritious meal in the next session, they will need to bring any nutritious food from the meal plan they just made. 25

29 THEME 2 DIET DIVERSITY SESSION #5: THE FOOD GROUPS: OILS AND FATS Coconut Cooking oil Avocado Groundnuts Sunflower seeds Pumpkin seeds Fat from meat 26

30 SESSION THEME 21 WHY DIET NUTRITION DIVERSITY MATTERS Session #6: The food groups: Fruits and vegetables OBJECTIVES Support Households achieve diet diversity Influence changes in food access habits Influence changes in food utilisation Households ability to minimise food wastage KEY MESSAGES: Fruits and vegetables provide vitamins and minerals that are necessary for protection of the body against infection and for proper metabolism. Fruits and vegetables should be consumed everyday by the family. Add fruits and vegetables to your child s food everyday. THEME OBJECTIVES: By the end of this theme, families should be able to: Identify the food available in their areas Mention the fruits and vegetables found in their area Explain the importance of vegetables for nutrition Explain the importance of fruits for nutrition Jointly plan a nutritious diet for their families that include fruits and vegetables HOW TO FACILITATE THIS THEME: Before the session begins: Welcome all the participants make greetings Collect the food items brought by the households Explain why you are meeting them and how long will the session take FACILITATION REQUIREMENTS Time required: Discussion time: 45 minutes and Cookery demonstration time: 30 minutes Teaching and Learning Resources: Six food group charts, posters of common fruits and vegetables in the area and flipcharts Facilitation methods: Question and Answer, discussion, group work DISCUSSION QUESTIONS: Ask participants to mention the common fruits in their area Ask participants to mention the common vegetables in their area Ask participants to mention the fruits and vegetables that they consumed the previous day if any and if they did not eat any, ask why? Discuss their responses and discuss ways of increasing consumption of fruits and vegetables Ask participants how they access fruits and vegetables Ask participants if they have a vegetable garden or any fruit trees Discuss how they can access fruits and vegetables all year round Ask participants the importance of fruits and vegetables in their diet, what can they do to eat fruits and vegetables every day? DISCUSS WITH FAMILIES SOME OF THE FOLLOWING POSITIVE STEPS TO TAKE: To include fruits and vegetables in their meals every day To preserve fruits and vegetables when they are plenty in season for use in the time when they are out of season To include fruits and vegetables in their infants diet. To grow vegetables and fruits in their backyard garden CONCLUSION OF THE THEME: Ask participants what they have learnt in this session. Ask them how this knowledge will help them at household level Explain that the next session will have a cookery demonstration on how vegetables and fruits can be used in the diet and to demonstrate how to preserve vegetables Explain to participants that in-order to make a nutritious meal using fruits and vegetables in the next session, they will need to bring any nutritious food from the food group circle and fruits and vegetables will be the main ingredients 27

31 THEME 2 DIET DIVERSITY SESSION #4: THE FOOD GROUPS: FRUITS AND VEGETABLES Fruits Vegetables Grapes Sweet potato Green leafy vegetables Brocolli Cabbage Banana Pineapple Onion Okra Guava Mango Kale Chinese cabbage Orange Pawpaw Pumpkin Carrots Avocado Watermelon Peas Tomato Squash 28

32 SESSION THEME 21 WHY DIET NUTRITION DIVERSITY MATTERS Session #7: The food groups: Staples and legumes OBJECTIVES Support Households achieve diet diversity Influence changes in food access habits Influence changes in food utilisation Households ability to minimise food wastage KEY MESSAGES: Staple foods like tuff, wheat, rice, potatoes, sorghum etc are a good source of energy. Legume foods are among the six food groups responsible for building our bodies and for growth. A good diet is the one that supplies our body with the right nutrients in right amounts. A good diet is formed from diverse food sources. A meal should contain at least four food groups. And by the end of the day, make sure you have eaten from all the food groups THEME OBJECTIVES: By the end of this theme, families should be able to: Mention the staple foods (cereals, tubers, roots) found and grown in their area Mention the legumes found and grown in their area Explain the importance of staples for nutrition Explain the importance of legumes for nutrition Jointly plan a nutritious diet for their families using staples and legume food found in their area HOW TO FACILITATE THIS THEME: Before the session begins: Welcome all the participants and exchange greetings Collect the food items they have brought and keep them in a safe place Explain why you are meeting them and how long will the session take Explain that after 45 minutes of discussion, the participant will be involved in cooking a nutritious meal with emphasis on fruits and vegetables FACILITATION REQUIREMENTS Time required: 45 minutes discussions and 40 minutes cookery Teaching and Learning Resources: Counselling cards with pictures of the six food group, poster images of staples, poster images of legumes commonly grown and consumed in Ethiopia and blank meal planning calendar Facilitation methods: Question and answer, discussion and practical sessionsgroup work DISCUSSION QUESTIONS: Ask participants to mention the staple foods that they have in the home and found on the market Ask participants to mention the legume foods found in their homes and in the market, list the legumes Ask participants why they need to consume staples and why consumes legumes. Comment on their responses by explaining the importance of these food groups separately, show them the posters of legumes and posters of staples emphasising the role of staples as energy for the body and legumes as protein for human growth and body development Ask the participants to work as a household(husband and wife) and plan the weekly meals by costing only those food that are not found in their home 29 DISCUSS AND AGREE WITH FAMILIES SOME OF THE FOLLOWING POSITIVE STEPS TO TAKE: Eat the right amount of nutritious food in the right quantities (not too little and not too much) from the 6 food groups Plan for a nutritious diet everyday by committing income to purchase nutritious food that are not from their farm, including legumes and staples Husband and wife commit to include legumes in the family meals and especially in infant diet Reserve enough food from their harvest to meet food requirements through-out the the year CONCLUSION OF THE THEME: Ask participants what they have learnt in this session. Ask them how this knowledge will help them at household level Explain that the next session will have a cookery demonstration to prepare staple based food with legumes and other foods including fruits and vegetables Explain to participants that in-order to make a balanced nutritious meal in the next session, they will need to bring any nutritious food from the meal plan they just made

33 THEME 2 DIET DIVERSITY Session #7: The food groups: Staples and legumes NEXT SESSION: Next session is on diet diversity, focusing on chicken and eggs. Ask participants to bring any food found in their home or community by showing them the six food group chart, discuss with them what food they can afford to bring from the staples and legumes plus any fruits and vegetables and that which is in season or available on the market Explain to them that the next session will involve cookery demonstration focusing of chicken and eggs in the diet and therefore they need to bring all the requirements for conducting cookery demonstration including firewood and utensils Purchase the chicken and eggs incase farmers can t afford them (consult your sub-regional coordinator) COOKERY SESSION Discuss with them the food items they will prepare, in this case fruits and vegetables which were planned for in the last session Ask them to prepare their food considering hygiene and good cooking methods. Observe the process of food preparation and hygiene Discuss with participants as a reminder, the importance of fruits and vegetables they prepared and how important it is for their children 30

34 THEME 2 DIET DIVERSITY SESSION #7: THE FOOD GROUPS: STAPLES AND LEGUMES Staples Legumes Maize Rice Beans lentils Potatoes Wheat chickpeas beans Barley pulses peas Millet Te ff Groundnuts 31

35 SESSION THEME 21 WHY DIET NUTRITION DIVERSITY MATTERS Session #8: Chicken and eggs in family nutrition OBJECTIVES This session is a practical focussing on households learning how to prepare different recipes using eggs and chicken meat as key ingredients. The farmer households should bring chicken piece and eggs to the session. Various recipes will be developed for all family members and especially for children. Field assistant should discuss the following points: KEY POINTS ON CHICKEN AND EGGS IN THE DIET 1. Eggs are a good source of protein which is for growth. 2. An egg Is rich in fat which is source of energy. 3. An egg contains good amounts of minerals like calcium, iron, vitamin A and D and also thiamine and riboflavin. These minerals and vitamins are essential for normal body functioning. 4. Chicken meat is a good source of protein which is good for growth. As a refresher, go back on the importance of animal source food in your resource book and refresh the memory of the farmers. COOKERY SESSIONS: Recipes on chicken and eggs: 45 minutes In this session, explore the different ways of making chicken meat and eggs consumed by infants and by the whole family, not only during festivals. 32

36 THEME 2 DIET DIVERSITY SESSION #8: CHICKEN AND EGGS IN FAMILY NUTRITION 33

37 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING Session #9: Maternal nutrition: Nutrition before, during and after pregnancy Session #10: Infant and young child feeding 1

38 SESSION THEME 31 MATERNAL WHY NUTRITION INFANT AND MATTERS YOUNG CHILD FEEDING Session #9: Maternal nutrition: Nutrition before, during and after pregnancy OBJECTIVES Influence family feeding practises especially for infants and women of reproductive age Promote positive child care practises among farming families THEME OBJECTIVES: By the end of this theme, families should be able to: Explain the factors that contribute to poor nutrition among women. Explain why women of reproductive age need good nutrition. Link good nutrition for women to health, child development and growth. HOW TO FACILITATE THIS THEME: Before the session begins: Welcome all the participants and exchange greetings. Collect the food items they have brought and keep them in a safe place. Explain why you are meeting them and how long will the session take. FACILITATION REQUIREMENTS Time required: 45 minutes discussions Teaching and Learning Resources: Counselling cards Facilitation methods: Question and answer, discussion and practical sessions. DISCUSSION QUESTIONS: 1. What causes maternal malnutrition? 2. Key nutritional considerations before, during and after pregnancy. 3. Role of husband before, during and after pregnancy DISCUSS AND AGREE WITH FAMILIES SOME OF THE FOLLOWING POSITIVE STEPS TO TAKE: 1. Husbands agree to source nutritious food for their wives in-order to meet the demanding nutritional requirements of the woman before, during and after pregnancy. 2. Families agree to allow a pregnant and lactating woman enough rest for their body to recover. 3. To support their wives with other chores to allow the wife take care of the baby. CONCLUSION OF THE THEME: Ask participants what they have learnt in this session. Ask them how this knowledge will help them at household level. Explain that the next session will have a cookery demonstration to prepare meals for women before, during and after pregnancy. Therefore using the 6 food group chart, they should do a meal plan of what they will cook. Explain to participants that in-order to make a nutritious meal in the next session, they will need to bring any nutritious food from the meal plan they just made. KEY MESSAGES: 1. Maternal malnutrition results from low intake of food due to poor production on the farm, unavailability of food on the market, lack of money to purchase nutritious food. 2. Poor health care will lead to disease which will prevent woman s body from absorbing nutrients. 3. Before pregnancy, The future mother should have good nutrition status, she should eat a variety of nutritious and safe food every day, from all the food groups. She should have a health check-up, right immunisations, family planning education, reproductive health and child care information from the health worker. A well nourished mother-to-be will give birth to a full term child and a poorly nourished underweight mother is likely to give birth to a low birthweight and malformed baby. 4. During pregnancy Eat a variety of foods, and an extra health snack(nuts, fruit etc) in between meals. Chicken and eggs are good sources of nutrients that support the growth of the growing baby, a pregnant mother need good nutrition for the growing baby. Poor nutrition will result into a poorly developed baby. Get enough rest, drink plenty of clean and safe water. Remind farming families to balance farm work and reproductive responsibilities- attended antenatal clinics where they will get all relevant information for a health pregnancy (deworming, anaemia treatments etc.) 5. During lactation: Lactating woman has increased demands on her food intake as she has to breast feed the baby. Therefore she should eat right amount of diverse and nutritious food to meet her own nutritional needs as well as the breastfeeding baby. 35

39 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #9: MATERNAL NUTRITION: BEFORE, DURING AND AFTER PREGNANCY Health counselling during pregnancy Pregnant woman being supported by husband to eat a well balance meal. The husband has a role to play in ensuring that his pregnant wife is well nourished and healthy. 36

40 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #9: MATERNAL NUTRITION: BEFORE, DURING AND AFTER PREGNANCY Lactating woman should eat right amount of diverse and nutritious food to meet her own nutritional needs as well as the breastfeeding baby. 37

41 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #9: MATERNAL INFANT AND YOUNG CHILD FEEDING WHAT FARMERS NEED TO KNOW: Women in general, need additional nutrients because of menstruation, pregnancy and lactation Pregnant mothers need extra and nutritious food to cover the nutritional needs for the growing baby in the womb TIPS FOR PREGNANT WOMAN To overcome nausea and heartburn, the food should be taken in small portions and more frequently. Eat only nutritious foods Pregnant women require more iron/folic acid. They should take more iron/folic acid rich foods such as meat, liver, eggs, beans Since food alone is not enough to provide adequate iron/folic acid during pregnancy, pregnant women should take iron/folic acid tablets Women should eat well between pregnancies so they rebuild their bodies stores of nutrients Legumes and nuts Staples Animal source foods Vegetables Oils and fat Fruits 38

42 SESSION THEME 31 MATERNAL WHY NUTRITION INFANT AND YOUNG CHILD MATTERS FEEDING Session #10: Infant and young child feeding OBJECTIVES This theme covers nutrition requirements for infants from birth to five years. It discusses the right food to give to infants after six months, quantities, frequency of feeding and consistency of the food. The aim is to promote dietary diversity in infants and ensure that proper child care and feeding practises are adhered to by the caretakers. The theme covers infant and young child feeding from birth to five years. SESSION OBJECTIVES: Influence family feeding practises especially for infants and women of reproductive age Promote positive child care practises among farming families THEME OBJECTIVES: By the end of this theme, families should be able to: Explain the factors that contribute to poor nutrition among infants Describe the feeding patterns for infants and the requirements for achieving good nutrition for infants FACILITATION REQUIREMENTS Time required: 45 minutes discussions, and 40 minutes for cookery session Teaching and Learning Resources: Counselling cards Facilitation methods: Question and answer, discussion and practical sessions HOW TO FACILITATE THIS THEME: This theme is long and cannot be covered as one lesson, therefore it will be divided into 4 lessons Session one will cover infant feeding from 0-6 months and 6-9 months. The second session will cover 9-12 months and 12-24months The other two sessions will cover cookery sessions to develop recipes for infants in the 4 age categories Before Part one of theme the session begins: Welcome all the participants and exchange greetings Collect the food items they have brought and keep them in a safe place Explain why you are meeting them and how long will the session take KEY HYGIENE CONSIDERATIONS IN INFANT FEEDING 1. Wash your hands with soap and running water before preparing food and before feeding your baby 2. Wash your child s hands with soap and running water before he or she eats 3. Wash your hands with soap and running, clean and safe water after using the latrine or cleaning your baby s bottom 4. Feed your child using clean hands, clean utensils and clean cups. Do not use feeding bottles since if poorly cleaned, they may cause your child to get diarrhoea 5. Wash all utensils with soap in clean and safe water 6. Always give freshly prepared foods to your child 7. Make sure the child s play area is free of animal droppings at all times DISCUSSION POINTS: 1. Discuss exclusive breast feeding briefly and refer them to nearest health facility for more information 2. Ask mother at what age did they introduce complementary food to their babies 3. Ask mothers why they introduced the particular food to the child 39

43 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #10: INFANT AND YOUNG CHILD FEEDING KEY CONSIDERATIONS FOR INFANTS FROM 0-6 MONTHS Breast milk provides all the nutrients required by infants from 0-6 months, nothing else is needed. If you give food or drink other than breast milk, there is a risk of diarrhea and other complications which may lead to sickness and death, therefore breast feed infants exclusively until the age of six months. Even with demanding agriculture activities, mothers should exclusively breast feed. Ensure the mothers consult the health staff on appropriate breast feeding. Introducing food before completion of 6 months will lead to illness and other complications Exclusively breast feed your baby 40

44 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #10: INFANT AND YOUNG CHILD FEEDING AFTER 6 MONTHS TO 11 MONTHS Message 1: Start feeding your child complementary food when he or she is finished six months. A good complementary food for infants is soft porridge. Feed the child one small coffee cup of porridge two times per day (for children 6-8 months), or three times per day (for children 9-11 months), in addition to breastmilk. Porridge can be made from various cereals and pulses. When preparing, mix 3 handfuls of cereal and 1 handful of pulses to increase the nutritious content. Thicker porridge has denser nutrient content. As the child grows older, pay attention to their capacity to swallow and accordingly thicken the porridge. Eventually it should be thick enough to feed with your thumb. Because thin gruel will not satisfy your child s hunger, it may lead to improper growth and undernourishment. At six months a child needs more energy and nutirents than what breastmilk alone can provide Mothers and fathers should not wait until the infant is older than six months to begin feeding complementary foods Timely introduction of complementary foods is essential to the good health and development of the child 41

45 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #10: INFANT AND YOUNG CHILD FEEDING FROM 6 MONTHS TO 11 MONTHS Message 2: Fathers, support your wife by providing eggs, milk, vegetables, or fruits for your baby s food. Message 3: Add a variety of foods to your child s porridge to ensure it is nutritious. Adding in dried meat, eggs, milk, oil, vegetables, and fruit is useful for your child s growth and strength. If possible, use milk instead of water to prepare the porridge. (You may also give the child cow s milk to drink, but this should not replace the child s complementary food.) Mash the food types that you will add to fortify the porridge so that your child can easily swallow the food. It is very beneficial to your child s health to eat animal products (meat, liver, fish, and eggs). Ripe and yellow-coloured fruits (mango, papaya) and vegetables (carrots) are good sources of Vitamin A. Dark green vegetables (collard greens/kale) and pulses are sources of nutrients such as iron. Add oil or butter to the complementary food that is prepared. Use iodised salt while preparing the porridge. Fathers have a special role to play in the family by ensuring the health and good nutrition of their babies Fathers may consider a variety of ways to aquire special foods, including investing in household livestock or small crops for the child to consume, or selling products to get income to buy these foods Fathers may also support mothers by ensuring their access to household funds to buy such foods for the baby 42

46 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #10: INFANT AND YOUNG CHILD FEEDING FROM 6 MONTHS TO 11 MONTHS Message 4: Wash your hands with soap and water before preparing food and feeding the baby. To prevent diarrhoea and other diseases, never prepare food or feed your baby without washing your hands with soap and water. The child s food should be prepared in a clean environment. Touching food with unclean hands may cause food to spoil. Dishes used to eat food all have to be clean. Feed your child using cups. It is easy to keep cups clean. Do not use bottles because they are difficult to clean and may cause diarrhoea. It is necessary to store infants food in a clean place to prevent diarrhoea and the spread of contagious diseases. 43

47 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #10: INFANT AND YOUNG CHILD FEEDING FROM 6 MONTHS TO 11 MONTHS Message 5: Between meals and breastfeeding, also give the child one or two snacks such as pieces of fruit, soft cooked vegetables, or fried bread. FROM 6 MONTHS TO 11 MONTHS Message 6: Continue breastfeeding your child. Breast milk is an important source of food and can provide about half of the energy requirements of a child between 6 and 11 months of age Because infants stomachs are small, they connot eat much at one sitting. Therfore, it is neccesary to feed them small servings frequently Give mashed soft fruits or mashed cooked vegetbles, for example: half of a mango, a small avocado, or a small sweet potato. Other snacks might inculde fresh bread, fried potatoes, etc. Give these small pieces of food at least once or twice a day as a snack Breastfeed whenever the child would like, day or night, at least 8 times a day Breast milk is an important source of food and can provide about half of the energy requirements of a chld between 6 and 11 months of age 44

48 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #10: INFANT AND YOUNG CHILD FEEDING FROM 6 MONTHS TO 11 MONTHS Message 5: Between meals and breastfeeding, also give the child one or two snacks such as pieces of fruit, soft cooked vegetables, or fried bread. How much does a 6 to 8 month old infant eat every day? Two small coffee cups of cooked, soft porridge. Feed the child one small coffee cup of poridge at each sitting. One small coffee cup of milk, either added to the porridge or given seperately For snacks, give two to three spoonfuls of mashed fruits or mashed cooked vegetables Continue breastfeeding on demand How much does a 9 to 11 month old infant eat every day? Three small coffee cups of cooked, soft porridge. Feed the child one small coffee cup of porridge at each sitting One small coffee cup of milk, either added to the porridge or given seperately For snacks, give mashed soft fruits or mashed cooked vegetables, for example: half of a mango, a small avocado, or a small sweet potato Continue breastfeeding on demand 45

49 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #10: INFANT AND YOUNG CHILD FEEDING FROM 12 TO 23 MONTHS Message 1: Infants from the age of 12 to 23 months may eat from the same food that the family eats 3 to 4 times a day and should be given one or two snacks. An infant months can safely chew cooked meat that is cut into small pieces. Meat is an important source of nutrients for developing children Because infants stomachs are small, they cannot eat a lot at one sitting. Therefore, frequent small feedings are necessary You can give snacks multiple times. This can be small pieces of ripe papaya, mango, avocado, bananas and other fruits and vegetables, fresh bread, fried potatoes, sweet potatoes, pita, etc. It is necessary to store the prepared foods carefully to prevent diarrhoea and other contagious illnesses Don t forget to wash your hands with soap before preparing food and feeding your child to prevent diarrhoea and other contagious illnesses Message 2: As your infant grows older, increasing the infant s food portions and varieties of food will help provide the nutrition your child needs. The child months old may begin eating from the family s food Food given to the child should include various types including milk, eggs, meat, vegetables and fruits Feed the child one coffee cup of food (porridge or family food) 3 to 4 times per day, in addition to breastmilk How much does a 12 to 23 month old infant eat every day? Four small coffee cups of porridge and family s food. Feed the child one small coffee cup of food at each sitting Two small coffee cup of milk, either added to the food or given separately For snackks, give mashed soft fruits or mashed cooked vegetable, for example: half of a mango, a small avocado, or a small sweet potato Continued breastfeeding on demand Alternate the type of food and its preparation every day It is necessary to encourage your child to eat more as your child grows older 46

50 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #10: INFANT AND YOUNG CHILD FEEDING FROM 12 TO 23 MONTHS Message 3: Feed your child with love, patience and happiness so that your child finishes their meal and can grow properly. Because infants cannot eat and finish meals on their own, you will need to keep feeding the infant until the meal is finished Because new foods will be unfamiliar, feed the infant patiently, soothingly, and with playfulness Let the infant have his or her own plate so that the amount they have consumed is known Forcing the child to eat will cause the child to hate food Persistently encourage your child to finish his or her food but be gentle and loving How much does a 12 to 23 month old infant eat every day? Four small coffee cups of porridge and family s food. Feed the child one small coffee cup of food at each sitting Two small coffee cups of milk, either added tot he food or given separately For snacks, give mashed soft fruits or mashed cooked vegatables, for example: half of a mango, a small avocado, or a small sweet potato Continued breastfeeding on demand 47

51 THEME 3 MATERNAL INFANT AND YOUNG CHILD FEEDING SESSION #10: INFANT AND YOUNG CHILD FEEDING SICK CHILD Families and children in difficult circumstances require special attention and practical support. Wherever possible, mothers and babies should remain together and get the support they need to exercise the most appropriate feeding option available. Breastfeeding remains the preferred mode of infant feeding in almost all difficult situations including for low-birth-weight or premature infants; HIV-infected mothers; adolescent mothers; infants and young children who are malnourished; and families suffering the consequences of complex emergencies. Complementary feeding should also begin at six months and continue until 24 months in such circumstances. Message 1: During an illness, feed your child breast milk and complementary food frequently to recovery. Message 2: As soon as your child begins to recuperate from the illness, feed your child an additional meal for two weeks, in addition to what your child used to eat previously. It is necessary to give plenty of breast milk and complementary food to infants who are just recovering from an illness so that their strength and normal weight gain returns Feed your child one extra meal for two weeks after the illness If the child s appetite remains low due to the illness, it is necessary to provide extra attention and encouragement to eat complementary food Message 3: Before preparing food and feeding your child, it is necessary to wash your hands with soap. This will prevent diarrhoea and other transmittable diseases. Touching food with unclean hands may cause food to spoil Dishes used to eat food all have to be clean Feed your child using cups. Do not use bottles because of the risk that it may cause diarrhoea. It is necessary to store infants food in a clean place to prevent diarrhoea and the spread of contagious diseases Message 4: Make sure your child takes Vitamin A when he or she is six months old. Because your child needs to take Vitamin A every six months (or twice a year) starting from six months until the age of five, go to a health facility or consult your health extension worker Vitamin A is good for your child s eyesight and immunity Message 5: Use iodized salt when preparing food for the family, as it will improve your family s health. When using iodised salt, salt your food after the food is already cooked, as iodine depletes if cooked for a long time Use a container with a lid to store iodized salt, as this prevents the depletion of the iodine over time Pregnant mothers especially should use iodized salt so that the newly born child is healthy 48

52 THEME 4 WOMEN EMPOWERMENT AND MALE ENGAGEMENT 49