Transcript TITLE PAGE
Emergency
Immediate
Pre-Crisis
Response Phase
Increasing depth
Preparedness
data collection
Beyond the
Immediate Response
Tracking
Mulit-sectoral
Rapid
Assessment
(qualitative &
secondary
quantitative)
Sector-specific rapid
assessments
Early warning systems
Surveillance
Multi-sectoral survey
Follow-up survey:
Health/Nutr/
Food/WASH/etc
(probability sample):
Health/Nutr/
Food/WASH/etc
Periodic surveys
In-depth sector studies
Existing research/studies
(quantitative/qualitative)
Preparedness Monitoring
Sudden
onset
Performance Monitoring
1 wk
6-8 wks
3-6 mo
1 year
Measurement of Infant and Young Child
Feeding Behaviors
Mary S Lung’aho
for
CARE: March 2008
Emergency
Immediate
Pre-Crisis
Response Phase
Increasing depth
Preparedness
data collection
Beyond the
Immediate Response
Tracking
Mulit-sectoral
Rapid
Assessment
(qualitative &
secondary
quantitative)
Sector-specific rapid
assessments
Early warning systems
Surveillance
Multi-sectoral survey
Follow-up survey:
Health/Nutr/
Food/WASH/etc
(probability sample):
Health/Nutr/
Food/WASH/etc
Periodic surveys
In-depth sector studies
Existing research/studies
(quantitative/qualitative)
Preparedness Monitoring
Sudden
onset
Performance Monitoring
1 wk
6-8 wks
3-6 mo
1 year
Why Use a Standard Methodology?
Camp: Exclusive Breast Feeding Rates
100%
80%
60%
52.0%
36.7%
40%
32.5%
24.1%
27.4%
20%
4.1%
0%
2004
2005
2006
2007
Collecting Data to Calculate IYCF Practices Indicators?
As part of multi-pronged data collection strategy.
Examples:
POPULATION LEVEL
• NOT for Initial Rapid Assessment (‘finger in the air’)
• Comprehensive Assessment: if no suitable secondary data are
available (to create Baseline against which to assess program
impact)
• Periodic (annual) Rapid Assessment Surveys: track trends
• Endline surveys (to measure impact)
PROGRAM LEVEL
• Special studies of program interventions
Recommended IYCF Practices Indicators
WHO 2007/2008
WHO 1991
•
Timely initiation of
breastfeeding (0-11.9 months)*
•
CORE Indicators
•
Exclusive breastfeeding rate
(0-5.9 months)**
Early initiation of
breastfeeding (0-23.9 months)
•
•
Continued breastfeeding at:
1 year (12-15.9 months);
2 years (20-23.9 months)
Exclusive breastfeeding under
6 months
•
Continued breastfeeding at 1
year
•
Timely complementary feeding
rate (6-9.9 months)
•
•
Bottle-feeding Rate (0-11.9
months)
Introduction of solid, semisolid or soft foods (6-8.9
months)
•
Minimum dietary diversity
*Not included on original list
•
Minimum meal frequency
** Updated
•
Minimum acceptable diet
OPTIONAL Indicators
Other Indicators
from Same Questions
•
Ever breastfed; currently breastfeeding; no breastmilk (past 24
hours)
•
Consumption of infant formula (past 24 hours)
•
Milk feeding frequency for non-breastfed children*
•
Bottle-use*
•
Consumption from individual food groups (food groups used to
construct the dietary diversity indicator) in past 24 hours
-- grains, roots and tubers
-- legumes and nuts
-- dairy products (milk, cheese and yogurt)
-- flesh foods (meat, fish, poultry and liver/organ meats)
-- eggs
--vit-A rich fruits and vegetables
-- other fruits and vegetables
Key Information Needed
• Child’s Age: calculated from
-- Date of Interview
-- Date of Birth
• Child’s Gender
• Still breastfeeding
• List of fluids given child in past 24 hours: Yes or No
• List of foods given child in past 24 hours: Yes or No
• Frequency of feeding solids, semi-solids or soft food in past
24 hours
• Bottle use: optional
Age in Completed Months
Days
Breastfeeding Indicators related to Age
< 1 month
0-30 days
Exclusive Breastfeeding Rate (EBR) Predominant Breastfeeding
Rate (PBR) Full/Partial/Token Breastfeeding
1 month
31-61 days
2 months
62-91 days
3 months
92-122 days
4 months
123-152 days
5 months
153-182 days
6 months
183-213 days
7 months
214-243 days
8 months
244-274 days
9 months
275-304 days
10 months
305-335 days
11 months
336-365 days
12 months
366-395 days
13 months
396-426 days
14 months
427-456 days
15 months
457-487 days
16 months
488-517 days
17 months
518-547 days
18 months
548-578 days
19 months
579-608 days
20 months
609-639 days
21 months
640-669 days
22 months
670-700 days
23 months
701-730 days
24 months
731-760 days
25 months
761-791 days
26 months
792-821 days
27 months
822-852 days
Timely Complementary Feeding Rate
Continued Breastfeeding at 12 Months
Continued Breastfeeding at 24 Months
Use of Data
Information on Early Feeding Practices
Early feeding practices: responses from mothers of infants 0-11
months
100%
80%
63%
67%
60%
48%
40%
20%
0%
Breastfed within one hour of Birth
Gave colostrum
Did not give prelacteal feeds
Use of Data
Disaggregation by Residence
Feeding practices for infants 0-5 months
by area of residence
100%
80%
37%
47%
60%
4%
1%
19%
40%
20%
23%
40%
28%
0%
Urban
Excl BF
Rural
BF + water
BF + oth liq
BF + solids
Use of Data
Methodology Allows Flexibility in Analysis
Continued breastfeeding
by age group
100%
98%
88%
80%
60%
48%
40%
20%
0%
6-11 mos
(Example data from Zimbabwe DHS+ 1999)
12-17 mos
18-23 mos
Use of Data
Feeding Practice Categories
Feeding practices for infants 0-5 months
32%
44%
22%
2%
Excl BF
BF + water
BF + oth liq
BF + solids
New Recommended Indicators:
Percent of infants and children fed
with selected “good practices”
100%
90%
80%
60%
40%
28%
22%
20%
8%
8%
High dietary
diversity
Best practice
0%
Exclusive
breasfeeding
Continued
breasfeeding
(Example data Mali DHS+ 2001)
Minimum
recommended
frequency of
feeding
Feeding Practices Over Time
Infant Feeding Practices by Age
Exclusively breastfed
Breastmilk and non-milk liquids
Breastmilk and complementary foods
Breastmilk and plain w ater only
Breastmilk and other milk/formula
Not receiving any breastmilk
100%
Percentage
80%
60%
40%
20%
0%
0-1
2-3
4-5
6-7
8-9 0-11 2-13 4-15 6-17 8-19 0-21 2-23
1
1
1
1
1
2
2
Age groups in m onths
+
24
A Step-by-Step Guide:
How to Measure Infant and Young Child Feeding
Practices in Emergencies
•
Sampling: stand-alone survey or piggy-backed onto
nutrition/anthropometry survey
•
Sample Questionnaire for adaptation
•
Data entry screens
•
Checking and cleaning data
•
Analyzing infant and young child feeding data
-- age calculation
-- syntax for calculating IYCF practices indicators
-- practice data files
•
Reporting
-- producing and interpreting tables and bar graphs
-- creating and interpreting figures
-- sample reports and report card
The IYCF Assessment Process:
Assessment Objectives
Initial Rapid Assessment (often a multi-sectoral rapid assessment):
•
Provides a rapid overview of the situation related to IYCF in order to
identify the immediate impacts of the crisis and estimate the needs of
the affected population for assistance (funding and personnel) in the
first weeks following the crisis
•
Timing: as soon as possible(within days) after acute onset emergency
Comprehensive (in-depth) Assessment (sector-specific):
•
A more thorough analysis that provides information to more thoroughly
assess the situation, to inform program development, determine resource
requirements, and disseminate additional information to the international
community. Often includes:
Sector-specific rapid assessment
Survey data (can be single-sector or multi-sectoral: nutritional,
anthropometry, IYCF practices, other data): to document baseline
Timing: as soon as appropriate resources and experience are available (13 weeks)
IYCF Assessment Process
Key information (Ops Guidance)
Initial Rapid Assessment (often multi-sectoral):
•
Demographic profile. Are the following groups under or overrepresented: infants, pg women, orphans/unaccompanied children?
•
Feeding practices pre-crisis; any observable changes. Observed and precrisis approaches to feeding orphaned infants (including acceptability of
wet-nursing).
•
Reported problems (by population, by health staff) feeding infants and
young children (including BF difficulties, poor access to infant
complementary foods)
•
Conspicuous availability of BMS, milk products, bottles and teats in
population or commodity pipeline
•
Who is available to provide immediate assistance?
•
[Situation related to mortality, morbidity, nutritional status of
infants/young children]
•
[Security risks to women and children]
IYCF Assessment Process
Additional information (Ops Guidance)
Comprehensive Assessment: obtain information on the following
• Food situation
-- Nutritional adequacy of food ration; availability of appropriate foods for infant
complementary feeding (in general ration; in targeted feeding programmes)
-- Food situation for pregnant and lactating women
• Health environment
-- water quantity and quality, fuel, sanitation, housing, facilities for food
preparation and cooking
-- support offered by health facilities providing antenatal, delivery, postnatal and
child care
• Care environment
-- feeding: feeding techniques (cup, bottle, management and use; methods of
encouraging complementary feeding); any factors disrupting breastfeeding
-- capacity of potential support givers (BF mothers, trained HWs, trained IYCF
counsellors, experienced women from community)
-- identify key decision-makers at HH, community and local health facility level
-- identify cultural barriers to relactation, expressing BM or wet-nursing
IYCF Assessment Process
Additional information (Ops Guidance)
Comprehensive Assessment: information from surveys
• Population statistics: numbers of accompanied and unaccompanied
infants and young children <24 months (data stratified by age: 05 months, 6-11 months, 12-23 months), children aged 24-59
months (2-5 years), pregnant and lactating women
• Morbidity and mortality of infants
• Infant and young child feeding practices; include