ACCELERATING NUTRITION IMPROVEMENT ACCELERATING NUTRITION IMPROVEMENT (ANI)(ANI)

APPLICATION OF FOOD BASED APPROACH TO APPLICATION OF FOOD BASED APPROACH TO IMPROVE COMPLEMENTARY FEEDING IMPROVE COMPLEMENTARY FEEDING

MINISTRY OF HEALTH

BACKGROUNDBACKGROUND

•Of all children under five in Uganda• One third are stunted• 14% are underweight • 5% are wasted,

•Prevalence peaks during the complementary feeding (CF) period.•Poor infant and child (IYC) nutrition indicators are linked to high rates of infection and mortality rates

BACKGROUNDBACKGROUND

- - IYCF including breastfeeding and complementary feeding is not optimal

– 63% 63% of children are exclusively breastfed for the first 6 monthsof children are exclusively breastfed for the first 6 months..

- 5.8% of children aged 6-23 months receive minimum acceptable diet.- 12.8% of children aged 6-23 months receive minimum dietary diversity.

NB: Nationally over a third of Uganda children aged 6-23 months had low dietary diversity rising to well over half in the Western Region by 55%

WHO-ANI PROJECT WHO-ANI PROJECT

In 2012 World Health Organization received funding

from the Canadian International Development Agency (CIDA)/DFATD entitled “ANI- Accelerating Nutrition Improvements” to support 11 countries in Sub-Saharan with aim of reducing stunting among under 5 children.

The countries include: Uganda, Burkina Faso, Rwanda, Ethiopia, United Republic of Tanzania, Zimbabwe, Mali, Senegal, Mozambique, Sierra Leone, and Zambia.

WHO-ANI PROJECT FOR UGANDA WHO-ANI PROJECT FOR UGANDA

The project is in in line with Uganda Nutrition Action Plan (UNAP) strategy to reduce malnutrition.

Aimed at improving infant and young child feeding practices through – increasing consumption of nutritious foods and adequate

complementary feeding,

– improving nutrition knowledge and practices, especially in the

“critical window” of conception through 23 months.

General Objective:•Reduce stunting among children under 5 years.Specific Objectives:•Support the scaling-up of evidence-informed nutrition actions focusing on improvement of complementary feeding of children 6-23 months by use of a Food Based approach.•Strengthen nutrition surveillance systems in collaboration with government national Health Information Management Systems (HMIS).

THE PROJECT OBJECTIVES FOR UGANDA THE PROJECT OBJECTIVES FOR UGANDA

PROJECT’S INTERVENTION DISTRICTS MASINDI

HOIMA

KIBAALE

NAMUTUMBA

LUUKA

IGANGA

Development of the Food based recommendations – Process in ANI Uganda

Development of the Food based recommendations – Process in ANI Uganda

DISTRICT

COMMUNITY

HOUSEHOLD

GENERATING EVIDENCE THROUGH SURVEYS

District StuntingUnderweig

ht WastingIganga 25.3 14.8 2.9Namutumba 26.6 11.4 4.1Luuka 31.7 15.8 3.7Hoima 29.5 7.7 1.3Masindi 21.9 7.0 2.0Kibaale 38.9 16.1 5.2

Total 28.9 12.6 3.1UDHS, 2011–National 27.2 15.7 8.3UDHS, 2011–Eastern 20.6 11.4 8.5UDHS, 2011-Western 35.8 17.6 4.8

Nutritional Status of children (6-23 months)

10

Background characteristic

Any anemia(<11.0 g/dl)

Mild anemia(10.0-10.9

g/dl)

Moderate anemia(7.0-9.9

g/dl)

Severeanemia(<7.0 g/dl)

Number of

children

Overall 81.0 27.7 47.6 5.1 1,407DistrictsIganga 89.3 25.1 57.8 26.4 422Namutumba 83.8 18.4 58.7 29.0 179Luuka 91.0 24.8 57.1 9.0 210

Total Eastern region

88.5

23.6 57.8

7.2

811

UDHS, 2011 67.0 27.9 38.1 3.1 419

Hoima 69.6 31.6 34.2 3.8 237Masindi 69.0 36.1 32.3 0.6 155Kibaale 68.6 32.8 33.8 2.0 204

Total Western region

69.1

33.2 26.9

2.3 596UDHS, 2011,

Western 48.8 26.0 14.9 2.2 285UDHS 2011,

National 62.3 25.2 34.4 2.8 759

Prevalence of Anemia in Children (6-23 months)

11

Background characteristic

Initiation of breast

feeding within one

hour of birth

Exclusive breastfeeding

Timely start of

complementary foods

from age 6 months

Minimum Meal

Frequency

DistrictIganga 65 62 46 52.7Namutumba

57.4 56 44 48.4

Luuka 61.1 54 43 47.1Hoima 45.4 74 50 46.6Masindi 44.2 73 54 51.6Kibaale 55.9 69 51 44.9UDHS 2011 52.5 63 67 44.8

IYCF Practices

12

KEY FINDINGS FROM THE KAP SURVEYKEY FINDINGS FROM THE KAP SURVEY BF and complementary practices do not meet the

ideal practices for most of the IYFC indicators assessed

Less than a third meet their daily energy requirement and less than 10% met their daily intake of key nutrients,

Very low consumption of iron rich foods, iron supplements and deworming medications, low consumption of animal source foods

Limited exposure to health messages related to IYFC

BARRIERS TO OPTIMAL IYCF PRACTICES –KAP –KAP Limited knowledge in IYCF– Early initiation, Importance of colostrum, When and what

complementary feeding to start with, Recommended number of meals per day, Nutrient and energy dense foods, How to increase feeds during and after illness

Myths and misconceptions such as – First thick yellow milk is dirty , pre-lacteal feeds strengthen the

digestive system , Breast milk does not satisfy a child less than 6 months, When the baby eats solid food, it doesn’t need breastfeeding, Thicker foods constipate children

Variety of foods is limited Selling of most food by households

2. Optimizing complementary food recipes

• Using Optifood : A software program that uses linear programing and mathematical optimisation to generate the nutritionally best diet for specific populations and test food based recommendations.

– using specific criteria such as locally available foods; dietary patterns; cost.

• Optifood can select the best diets from a range of possible combinations up to 1000 combinations

• The software identifies the lowest-cost combination of local foods that will meet or come as close as possible to meeting nutrient needs of specific target groups and local diets.

Optifood Food Composition Table

1- Primary source: HarvestPlus FCT for Eastern and Central Uganda (Hotz et al., 2012.2-United States Dietary Association (USDA) •Rationale

– Updated regularly– Relatively few missing data– Reliable in terms of quality Data for raw and cooked

forms for many foods

HOW OPTIFOOD WAS USED• Identified nutrients whose requirements are difficult to meet

using locally available foods (problem nutrients) • Identified the best local food sources of multiple nutrient

problem nutrients

• Formulated food-based recommendations (FBRs) for specific target groups

• Combined and tested FBRs (dietary patterns, cost, nutritional adequacy)

• Identified the lowest cost, nutritionally best diet, given local food availability and usual dietary patterns

The target groups for which recipes were

developed • 6-8, 9-11, and 12-23 months-old breastfed children

and 12-23 months Non breastfed children from Eastern Uganda

• 6-8, 9-11, 12-23 months-old breastfed children and 12-23months Non- breastfed children from Western Uganda

• NB: Recipes for 8 different groups in total.

OUTPUTS

3. Testing for feasibility of recipes

through TIPs:

• Tested feasibility and acceptability of the FBR (recipes) developed using household trials in the two regions. What is easier to implement for mothers and families, which is more difficult and motivations for their use

• The results informed modifications to the recipes in terms of food promoted, preparation, frequency, serving size and seasonality of access.

• The recipes trial results used to inform the development of the SBCC strategy, incorporating motivations to putting the recipes into practice and barriers and facilitators to implementation and potential strategies for overcoming these barriers

RECIPES FOR CHILDREN IN THE EASTERN AND WESTERN REGIONS

4. Developing and rolling out SBCC strategy:

• Based on the optimized and tested complementary feeding recipes and the KAP survey, SBCC materials - flip charts, posters of recipes, radio spots - were generated to achieve behavior change and strategies developed to reach the care givers through influential stakeholders within health facilities, communities and through media.

• The SBCC strategy with food based messages is tailored to the specific context of the targeted population.

SBCC strategy and communication channels

• The intervention is in line with UNAP strategy and MOH priority areas.

• All nutrition stakeholders were involved through out the steps including; surveys, capacity building to gather and utilize local data to design effective, targeted interventions.

• Health systems were strengthened following the structures in place.

• Recipes are based on locally available foods

SUSTAINABILITY:

• WHO Uganda, AFRO and HQ Staff• Steering Committee (Nutrition Working Group)• Ministry of Health- Nutrition Unit• REACH• Mwanamugimu Nutrition Team• IBFAN Team• Service for Generations (SFG) International Study Team• Communication for Development Foundation Uganda

Team / Feed the Children Uganda• District Local Governments, Communities in all the six ANI

districts.

ACKNOWLEDGEMENTS

Appropriate Breastfeeding and Complementary Feeding is Key

FOR GOD AND MY COUNTRYFOR GOD AND MY COUNTRY

Thank you for your attentionThank you for your attention