1. Background - IMCF Improving the dietary intakes and nutritional status of infants and young children through improved food security and complementary feeding counselling IMCF Baseline Preliminary Results Preah Vihear and Otdar Meanchey 10.09. 07.10.2012 Anika Reinbott(PhDStudent), Judith Kuchenbecker (PhDStudent) Dr. Irmgard Jordan, Prof. Dr. Michael Krawinkel Poor nutritional status in early infancy: morbidity, delayed motor and mental development, mortality Lack of knowledge on age-appropriate infant and young child feeding practices using locally available foods 2 1.Background - IMCF baseline objectives To determine the nutritional status of mothers and children under two years of age with a focus on child growth, particularly stunting, and micronutrient status especially iron and vitamin A status. To collect data on the knowledge of mothers/caregivers on child health care and feeding practices. To understand living conditions, socioeconomic indicators and dietary diversity of households. 2. Methods Cross-sectional nutrition baseline survey in 2 districts in Preah Vihear 4 districts in Otdar Meanchey Study population: mothers/primary caregivers and children< 2 years Random selection of villages on commune level proportional-to-population-size Random selection of participants on village level 3 4 1
2. Methods Study site: Preah Vihear 2. Methods Study site: Otdar Meanchey IMCF Baseline Results - Anika Reinbott - 12.02.2013 5 6 2. Methods - Indicators Interview with standardized questionnaire Socio-economic status, Sanitation, Hygiene, access to health facilities, Breastfeeding and complementary feeding practices, Dietary Diversity Score (Household and individual level), Child health, Household Hunger Scale Anthropometric measurements (parents and child) Motor milestones (child) Haemoglobin levels (mother and child) Blood plasma for iron and vitamin A status (child) - participants Households Children N 1028 1028 Details of N 992 mothers 36 caregivers 572 male 456 female Age Mean 27 years 11.6 Age Minimum 17 years 5 days Age - Maximum 48 years 731 days/23 Mean No. of members per household 5.16 Mainincomesource Ever attended school 67% Able to read 54% Saleof agricult. products(71.6%) 7 8 2
Ownership of agricultural land and homegarden (N =1028) homegarden usage (N= 713) 7% 93% 29% 71% 30.6% 63% 6% no agricultural land no homegarden homegarden no homegarden not growing vegetables growing vegetables 9 10 cooking place, access to health facilities, sanitation facilities cooking places Indicator in % Cooking place (N= 1032) Nearest health facility (N= 1025) Sanitation facilities (N= 1028) Source of drinking water (N= 1028) in the house 78.8 in a seperate building 11.4 outdoors 9.8 < 1 hour 87.3 1 to 3 hours 12.4 3 hours to half a day 0.3 improved 18.7 unimproved 81.3 protected 86.6 unprotected 13.4 11 12 3
- Household Wealth water stored covered withalid protected water source Wealth index was calculated using PCA Inclusion criteria for variables: frequency distribution >5% and <95% Variables included: number of people per room used for sleeping material of the floor sanitation facility drinking water source size of land owned ownership of certain possessions 13 IMCF Baseline Results - Anika Reinbott - 12.02.2013 14 - Household Dietary Diversity (N = 1028) 25% 2 episodes of illness: fever, diarrhoea, ARI among children under2 (N= 1028) 7 6 65.2 15% 1 5 4 3 37.2 46.2 5% 2 1 2 3 4 5 6 7 8 9 10 11 12 Household Dietary Diversity Score fever in past 2 weeks diarrhoea in past 2 weeks ARI in past 2 weeks 15 16 4
- Prevalence of diarrhoea and mothers /caregivers knowledge Respondent s knowledge of diarrhoea causes and prevention in% Knew at least one causes of diarrhoea 66.4 Causes named: - Contaminated food, water, hands Knew at least one way to prevent diarrhoea 70.0 Ways of prevention named: - boiling/filtering water for drinking - Covering food and water supplies - Washing hands -exclusive breastfeeding under 6 of age (N = 224) 10 9 8 7 6 5 4 3 2 1 93.5 89.5 69.8 0 to 1 2 to 3 4 to 5 IMCF Baseline Results - Anika Reinbott - 12.02.2013 17 IMCF Baseline Results - Anika Reinbott - 12.02.2013 18 - breastfeeding(who indicators) infant and young child feeding indicators (WHO) Indicator in % n N Breastfeeding(< 6 ) Exclusive Predominant Poor Early initiation of breastfeeding (0 23 ) Still being breastfed (0 23 ) Continued breastfeeding at 1 year (12-15 ) 83.0 2.2 14.7 186 5 33 224 82.4 847 1028 84.8 872 1028 93.0 173 186 Bottle feeding(< 6 ) 10.2 23 225 Indicator In % n N Minimum Dietary Diversity(6-23 ) 43.9 352 801 Minimum Meal Frequency(6-23 ) 69.9 540 773 Minimum Acceptable Diet(6-23 ) 28.3 226 798 Infantswho receive solid, semi-solid and soft foods (6-8 ) 93.9 153 163 19 20 5
Child Dietary DiversityScore -6 to 23 of age (N = 799) 3 25% 2 15% 1 5% 1. Grains, cereals, tubers (97%) 2. Flesh foods (meat and fish) (75%) 3. Other fruits/vegetables (5) 4. Vitamin A rich fruits/ vegetables (45%) Nutritional Status ofchildren0 to 23 Z-Score < -3SD < -2SD N Height-for-age (stunting) 3.6 21.4 1026 Weight-for-height (wasting) 1.1 8.5 1028 0 1 2 3 4 5 6 7 Child Dietary Diversity Score Weight-for-age (underweight) 2.8 19.8 1028 21 22 -Stunting(-2SD) prevalencesper agegroup(n = 1026) 4 35% 3 25% 2 15% 1 5% 0 to 1 month 2 to 3 4 to 5 6 to 8 9 to 11 12 to 17 18 to 23 on stunting compared with CDHS 2010 -Prevalenceofstuntingamong children0 to23 5 45% 4 35% 3 25% 2 15% 1 5% < 6 6-8 9 to 11 IMCF 2012 CDHS 2010 12 to 17 18 to 23 23 24 6
- Deworming and Vitamin A supplementation - Anaemia among children and non-pregnant mothers Percentage of children under 2 who received vitamin A: 76.9 (N = 1016) deworming: 34.4 (N = 1012) children3 to23 (N = 929) 39% 61% 3 31% no anemia severe anemia (Hb < 7g/dl) moderate anemia (Hb 7-9.9 g/dl) mild anemia (Hb 10.0-10.9 g/dl) non-pregnant mothers(n = 976) 71% 29% 2% 27% no anemia moderate anemia (Hb 7-9.9 g/dl) mild anemia (Hb 10.0-11.9 g/dl) 25 26 4. Outlook 5. Registration and funding Nutrition Education Intervention on IYCF Qualitative Survey Training of Trainers Cooking demonstrations Nutrition education in Farmer Field Schools etc German Clinical Trial Register (DRKS) https://drks-neu.uniklinik-freiburg.de/drks_web/setlocale_en.do The research was conducted within the IMCF Project of FAO: http://www.fao.org/ag/humannutrition/nutritioneducation/70106/en/ which is funded by Baseline (cross-sectional) Impact Survey (cross-sectional) 2012 2013 2014 Justus-Liebig University Research; FAO MALIS Implementation of activities 27 28 7
IMCF Project Team Malawi Cambodia Food security Project FAO/FICA MALIS Research Institutions PhD students FAO Headquarters Rome, Italy JLU Giessen, Germany Bunda College of Agriculture DrB Mtimuni Dr C Masangano Ms J Kuchenbecker Ms G Chiutsi Phiri Mahidol University & NNP DrO Kevanna Dr P Winichagoon Dr G Charoonruk Ms Anika Reinbott Mr M Khun Ms E Muehlhoff, Dr G Kennedy and Ms T Jeremias Prof. MB Krawinkel, MD, Dr I Jordan, Dr J Herrmann Thank you for your attention. 29 30 8