Funded by:
IYCF Knowledge, Attitude and Practice Survey
Kohat District, KP Province, Pakistan
Action Against Hunger|ACF International
Nutrition
IYCF KAP Survey
Pakistan
September 2014
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 2
Acknowledgements
This survey was made possible by the efforts and hard work of many individuals both
inside and outside ACF International. The team would like to acknowledge and thank the
Khyber Pakhtunkhwa (KP) province department of health nutrition cell and Kohat district
for their involvement and continued support.
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. The team would also like to recognize Maureen Gallagher, the Nutrition &
Health Advisor at HQ New York, who supported the ACF team in Pakistan in all technical
aspects of this KAP assessment, Mr. Shahid Fazal, country Head of the Nutrition
Department who has been instrumental in the assessment, and, the survey team
(supervisor, data analyst, team leaders, and enumerators) who put all their efforts to
produce quality data.
Our heartfelt appreciation goes to the community elders who authorized entry into
community settlements, the opinion leaders, other senior members of the communities,
and to the mothers and caretakers of children who gave their time to our survey team.
The mothers and caretakers of the Khyber Pakhtunkhwa province made this survey
possible by responding to the questions raised by the survey team.
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ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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Table of Contents
1. Executive Summary ........................................................................................... 5
2. Background ..................................................................................................... 7
3. Survey Objectives ............................................................................................. 8
3.1 General objective ....................................................................................... 8
3.2 Specific Objectives ..................................................................................... 8
4. Methodology .................................................................................................... 9
4.1 Study area ................................................................................................ 9
4.2 Study period .............................................................................................. 9
4.3 Study design .............................................................................................. 9
4.4 Study population ........................................................................................ 9
4.5 Sample size ............................................................................................... 9
4.6 Sampling procedures ................................................................................. 10
4.6.1 Cluster selection: ................................................................................. 10
4.6.2 Household selection: ............................................................................. 10
4.6.3 Children selection: ................................................................................ 10
4.6.4 Data to be collected .............................................................................. 10
4.6.5 Survey Tool ......................................................................................... 10
5. Organization of the survey ................................................................................ 10
5.1 Meeting with the Province and District authorities ........................................... 10
5.2 Data collectors recruitment and training ........................................................ 11
5.3 Team work in the field ............................................................................... 11
5.4 Data Quality ............................................................................................ 11
5.5 Ethical considerations ................................................................................ 11
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 ....................................................... 15
6.5 Food Security and livelihood ....................................................................... 18
6.6 Water, Sanitation and Hygiene ..................................................................... 19
6.7 Health .................................................................................................... 20
7. Discussion ..................................................................................................... 21
8. Conclusion .................................................................................................... 21
9. Recommendations ........................................................................................... 24
6. Annexes ....................................................................................................... 26
Annex 1: Survey schedule ...................................................................................... 26
Annex 2: Selected clusters/Villages for IYCF KAP Survey ............................................... 27
Annex 3: The main IYCF indicators collected and the source of data ................................. 28
Annex 4: Comparison of the results with national and regional figures .............................. 30
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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ACRONYMS and ABREVIATIONS
ACF Action Contre La Faim/ Action Against Hunger
CMAM Community Based Management of Acute Malnutrition
DHO District Health Office
DoH Department of Health
EBF Early Breastfeeding
EIBF Early Initiation of Breastfeeding
ENA Emergency Nutrition Assessment
FGD Focus Group Discussion
FSL Food Security and Livelihood
HQ Head Quarter
IDP Internally Displaced People
IYCF Infant and Young Child Feeding
IVAP Internally Vulnerability Assessment & Profiling
KAP Knowledge, Attitude and Practice
KP Khyber Pakhtunkhwa
NRSP National Rural Support Program
TICF Time of Initiation of Complimentary Feeding
UC Union Council
WHO World Health Organization
WASH Water, Sanitation, and Hygiene
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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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 two 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 study was commissioned by ECHO to understand the impact of ACF’s efforts in the
Kohat District and to evaluate the successes and/or shortcomings of ACF’s current Infant
and Young Child Feeding (IYCF) program. A baseline survey was carried out in September
of 2013 in 5 UCs in the Kohat district where ACF would begin its IYCF project integrated
along side the CMAM program. The baseline survey assessed the communities Knowledge,
Attitudes, and Practices (KAP) on IYCF. In September of 2014, a follow-up survey was
conducted to monitor and evaluate the programs progress. The results of the follow-up
survey will assist ACF in identifying the strengths and weaknesses of the IYCF programs
and enable ACF to effectively tailor the program accordingly.
The results from the 2013 and 2014 surveys underscore that most of the IYCF practices
remain below the national average1, but that progress has been made between 2013 and
2014 in addressing some of the IYCF practices. The main findings are outlined below:
Information about IYCF practices; early initiation of breastfeeding (EIBF), early breastfeeding (EBF), and time of initiation of complimentary food (TICF), originate from similar sources. Within the surveyed communities, there has been a significant increase, (14 percent), in hearing messages from IYCF promoters from 2013 to 2014. There has also been a 5-7 percent increase in people hearing IYCF practice messages at community events.
There has been little change in when mothers/caretakers believe that breastfeeding should begin after a child is born. In 2013, 59.6 percent of mothers/caretakers believed that breastfeeding should be started immediately after the child is born. This increased by only 1.5 percent in 2014 to 61.1 percent. Of note, there was a 14 percent increase in women hearing messages about EIBF from 2013 to 2014.
In 2013, nearly half, (45.7 percent), of the mothers/caretakers knew that a child should be exclusively breastfed for the first six months of his/her life. This increased by almost 20 percent in 2014, to 64 percent of mothers/caretakers.
In 2014, there was a 16 percent increase in the mothers/caretakers knowledge of the appropriate age, (6 months), of initiating complementary food, from 47.3 percent in 2013 to 63 percent in 2014.
In 2013 and 2014, the most common contact persons for IYCF information in the
surveyed community were nurses/dispensers and family/friends.
1NNS Pakistan, 2011
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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The proportion of children 0-23 months who were put to the breast within one hour
of birth dropped by 9 percent from 2013 to 2014. However, there was a 3 percent
increase in the women putting their child to their breast within 3 hours of birth.
There was a 6 percent increase in the number of women not breastfeeding within the first 24 hours of giving birth from 2013 to 2014.
The proportion of infants aged 0-5 months who are exclusively breastfed increased from 81 percent in 2013 to 94 percent in 2014.
Appropriate introduction of solid, semisolid, or soft foods was 86 percent in 2014 up from 69 percent in 2013. This indicates that children aged 6 to 9 months are given complementary feeding as per the WHO recommendation.
There was almost no change in the number of food groups consumed among children aged 6-23 months between 2013 and 2014.
There was a 2 percent drop from 2013 to 2014 for the number of children 6-23 months who were fed appropriately, based on the recommended IYCF practices, (18 percent to 16 percent, respectively).
The proportion of children aged 0-23 months who received iron-rich food or iron-fortified food (specially designed for infants and young children, or that is fortified in the home) remains low. Only 18 percent of all children surveyed under the age of two years had received iron rich food in 2014, a 7 percent decrease from the year before.
The number of mothers/caretakers feeding their child from a bottle decreased by 6 percent from 45 percent in 2013 to 39 percent in 2014.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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1. Background
The 24 districts making up the Khyber Pakhtunkhwa (KP) province are: Chitral, Upper Dir,
Lower Dir, Swat, Kohistan, Shangla, Batagram, Buner, Manshera, Malakand, Maradan,
Swabi, Haripur, Abottabad, Charasadda, Peshawar, Nowshera, Kohat, Hangu, Karak,
Bannu, LakkiMarawat, Tank, and DI Khan.
Kohat district is sub-divided into 33 Union Councils (UCs) and 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: 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 operations in Bajur district
and insurgency activity throughout 2011 caused a significant number of displaced to Kohat
District. The majority of Internally Displaced People (IDP) stays with host communities,
stretching the capacity of households who employ distress mechanisms to overcome the
additional strain. During 2012 Kohat 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)
infrastructure/services. Based on the Internal Vulnerability Assessment and Profiling
(IVAP) statistics, Kohat hosts the fourth largest population of IDPs in KP, with 20,913
2District Health Office
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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families. As of March 2014, 22 percent of the IDPs currently residing in Kohat did not want
to return to their area of origin.3
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 two-year ECHO project
integrates food security and livelihoods (FSL), infant and young child feeding practices
(IYCF) and nutrition education as well as Water, Sanitation, and Hygiene (WASH) activities.
The current program 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; the 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 backdrop of this and as a follow-up to the efforts implemented in Kohat district,
there was a need to determine the programs impact through an assessment of knowledge,
attitude and practices of the community with regards to IYCF practices.
2. Survey Objectives
2.1 General objectives
The main objective of the surveys was to KAP of IYCF practices of the population of Kohat
district located in the KP province. The baseline survey conducted in 2013 established a
benchmark for the program’s implementation while the follow-up survey conducted in
2014, assessed the impact of the program thus far.
2.2 Specific Objectives
To assess the programs impact on IYCF practices from baseline, September 2013, to one year after implementation, September 2014 through quantitative data obtained using WHO4 IYCF indicators
To compare the types of food consumed by children aged 6-23 months with in the 24 hours prior to the survey, and hence estimate the food diversity within the last 24 hours
To assess factors related to IYCF practices and identify areas of improvement and/or regression from 2013 to 2014
To evaluate ACF’s program impact on IYCF practices thus far and make programmatic changes as needed
3Internally Displaced Person Vulnerability and Assessment Profiling (IVAP), March 2014 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 2014
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3. Methodology
3.1 Study area The survey was conducted in 5 UCs of Kohat District (Urban 4, Urban 6, Jerma, Bilitang,
and Kahrimatto) where ACF was implementing its IYCF Program (See Figure 1).
3.2 Study period The baseline survey was conducted from September 5th-9th, 2013 and the follow-up survey
was carried out from September 20th-26th, 2014.
3.3 Study design The 2013 and 2014 surveys were cross sectional studies with two-stage cluster sampling
using the 'WHO model for vaccination survey'. Villages are considered as the smallest
geographical unit (clusters). The 2013 and 2014 surveys were not part of a longitudinal
study, and, therefore, did not enlist the same participants.
Focus Group Discussions (FGD) were conducted in every selected village. FGDs were carried out with pregnant and lactating women and mothers who had children less than two years of age.
3.4 Study population 1. Mothers with children under two years of age were interviewed in order to estimate
IYCF practices. Relevant information was gathered from this population in all selected
villages.
2. Households: Household food security and WASH IYCF related questions were asked in
selected households in the selected villages.
3.5 Sample size The sample size was derived using the formula:
𝑁 = 2 ⌈t2(p × q)
𝑑2⌉
The parameters used for the calculation are listed in Table 1:
Table 1: Parameters used in calculation of sample size calculation IYCF KAP.
Parameter Definition
Value
N Sample size:
𝑁 = 2 ⌈t2(p × q)
𝑑2⌉
𝑁 = 2 ⌈1.962(0.5 × 0.5)
0.12⌉
=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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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d Degree of accuracy (10% for ACF KAP survey) and given as 0.1 proportion
The sample size was estimated at 192 households and rounded up to 210 to account for a
10 percent non-response rate. This came down to 30 clusters of 7 people each (WHO
Model5 used for vaccination surveys).
3.6 Sampling procedures
3.6.1 Cluster selection: Each village in the district was considered as a cluster and the clusters to be sampled were
selected with probability proportionate to size (PPS). All villages of the district along with
their respective populations were entered into Emergency Nutrition Assessment software
(ENA); the software automatically selected the number of clusters to be included in the
study.
3.6.2 Household selection: Sample households were selected using simple random sampling. This household selection
method was chosen for its objectivity, ease of monitoring, and transparency. Preliminary
contact with local village leaders was made to prepare household lists in each village.
Enumerators used a random number table to select the households from the sampling
frame (household list).
3.6.3 Children selection: Within selected households, all children under the age of two years were included in the
survey.
3.6.4 Data to be collected: The survey collected information regarding food security and livelihoods (FSL), infant and
young child feeding (IYCF) and nutrition education, and Water, Sanitation and Hygiene
(WASH) activities.
3.6.5 Survey Tools: The age of the children was assessed using a local events calendar prepared with the local
community. The data collection formats were adapted from the WHO 2010 guideline for
the assessment of infant and young child feeding practices6. All the survey tools were
translated to the local language, pretested, and improved to strengthen data collection.
4. Organization of the survey
4.1 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 as needed.
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 2014
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4.2 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.
Prior to the data collection, two days of training was given to 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 understood the
questions and that interviewers followed protocol.
4.3 Team work in the field Team leaders with a wealth of experience, guided the teams. The team leaders were
responsible for the overall quality of activities and teams performance. Additionally, a
survey manager and supervisors from ACF, representatives from the DHO, and the
provincial health department closely supervised the teams throughout the survey.
4.4 Data Quality Each questionnaire and data sheet were checked each night prior to data entry. The data
was entered on a daily basis and missing data identified. Based on the results, supervisors
provided feedback to the enumerators every day before enumerators departed to the next
day of data collection.
5.3 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
caretakers of the children and household heads for voluntary participation in the survey.
The identity of the participants was kept anonymous. Those who did not wish to
participate in the survey were respected for their decision. All the information collected
was treated strictly confidential.
5.4 Data entry, analysis, reporting
Data entry and analysis were done using Small Stata version 12.0 for Mac and Microsoft
Excel for Mac, version 14.4.6, 2011.
6. Results
6.1 Demographic characteristics of sampled children
In 2013, 214 households were interviewed, compared to 211 in 2014. The demographics of
the sampled children remained relatively unchanged between 2013 and 2014. In 2013, 185
children were sampled, 92 male and 93 female, comparatively, in 2014, 199 children were
sampled, 103 male, and 86 female. The average age of children surveyed was 11.4 months
in 2013 and 10.6 months in 2014.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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Table 2: Demographic characteristics of surveyed children, September 2013 and September 2014, Kohat District.
2013 n 2013 % 2014 n 2014 %
Sex
Male 92 49.3% 103 54.5%
Female 93 50.3% 86 45.5%
Age (months)
0 - 5 44 23.8% 51 26.98%
6 - 8 26 14.1% 25 13.23%
9 - 11 22 11.9% 25 13.23%
12 - 17 48 25.9% 49 25.93%
18 - 23 45 24.3% 39 20.63%
6.2 Demographic characteristics of mothers/caretakers of sampled children
The demographic characteristics of mothers/caretakers of sampled children remained
relatively unchanged from 2013 to 2014. There was a 5 percent increase in the number of
women/caretakers receiving no formal education or Madarsa, 62.1 percent in 2013, to
67.2 percent in 2014. In 2013, 37 percent of women/caretakers were able to read and
write. This decreased to 33 percent in 2014.
Table 3: Background characteristics of mothers/caretakers Kohat district, September 2013 and 2014
2013 n 2013 % 2014 n 2014 %
Education status (2013,N=214; 2014, N=191)
No education 133 62.1 127 67.2%
Formal education/"Madarsa" 81 37.9 62 32.8%
Highest grade in formal education or "Madarsa" (2013, N=81; 2014, N=62)
Primary 30 37.0% 19 30.6%
Middle 14 17.3% 13 21.0%
Metrics 14 17.3% 22 35.5%
Bachelor 9 11.1% 7 11.3%
Master 7 8.6% 1 1.6%
"Madrasa" 7 8.6% 0 0%
Marital status (2013, N=214; 2014, N=189)
Married or living with their partner 214 100% 188 99.5%
Widowed 0 0 1 .5%
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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6.3 Infant and Young Child Feeding Knowledge and Attitudes
6.3.1 Early Initiation of Breastfeeding (EIBF) There was a 4 percent increase between 2013 and 2014 in the number of women who had
ever breastfed their child, 72 percent, to 76 percent, respectively. In 2013, 59.6 percent,
of mothers/caretakers felt that breastfeeding should be started immediately after the
child is born compared to 61.1 percent in 2014. There was no significant difference,
(p=.265), in the time it took after birth for women to begin breastfeeding from 2013 to
2014. In 2014, 82 percent of mothers reported that they heard a message about early
initiation of breastfeeding, a 12 percent increase from 2013. This increase is in large part
due to IYCF promoters, which increased from 0 percent to 14 percent in 2014.
Places where EIBF messages were heard
2013* 2014*
Figure 2: Common places where messages about exclusive breastfeeding were heard, September 2013
compared to September 2014, Kohat district, *not shown: 2013, Community Mobilizer, 0%, IYCF Promoter, 0%;
2014, Community Leader, 0%
Time of pregnancy and delivery are very common contact times to pass information to
mothers/caretakers about EIBF. In 2013, there was an 8 percent decrease in mothers
hearing the message at birth, from 67 percent to 59 percent. Alternatively, there was a 20
percent increase, 31 to 51 percent of mothers hearing the message at delivery between
2013 and 2014, respectively. Home visits and health facility visits remain adequate
channels of information with 51 percent, (7 percent decrease from 2013) of mothers
receiving breastfeeding messages during a health facility visit and 43 percent, (up from 40
percent in 2013), during home visits. Of note, there was a 4 percent increase in mothers
hearing the message at community events.
6.3.2 Exclusive Breastfeeding (EBF) In 2013, nearly half of the mothers/caretakers, (45.7 percent), knew that a child should
be exclusively breastfed for the first six months of his/her life. This increased by almost
20 percent in 2014 to 64 percent. There was no significant difference in how long a
mother believed her baby should receive breast milk between 2013 and 2014, (p=.78).
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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Figure 3. Number of month’s women/caretakers think they should exclusively breastfed their child for, September 2013 compared to September 2014, Kohat District.
There was a 23 percent increase in the number of women/caretakers who heard the
message about appropriate exclusive breastfeeding, 51 percent to 74 percent, 2013 to
2014, respectively; of those who have heard the message 14 percent of them had heard it
from an IYCF promoter, a 14 percent increase from 2013. In 2014, the most common
contact points for women to hear the EBF message were during pregnancy 58.8 percent
(72.2 percent in 2013), and at delivery, 30 percent, (a 16 percent increase from 2013).
6.3.3 Timely initiation of Complementary Feeding (TICF) From 2013 to 2014, there was a 16 percent increase in the knowledge of the appropriate
age to initiate complimentary feeding, 47 percent to 63 percent. Additionally, 14 percent
more mothers had received the message about complimentary feeding in 2014, 84
percent, compared to 2013, 60 percent. Similar to messages about EIBF and EBF, the most
common source of TICF information was from a health facility or home. There is an overall
trend from 2013 to 2014 of messages increasingly being heard at home or community
events.
Figure 4: Source/place of child feeding information, Kohat District, September 2013 compared to September
2014.
0
50
100
150
200
250
1 3 4 5 6 7 8 9 10 12 18 24 30
# o
f R
esp
on
de
nts
Months
# of months women believe they should EBF
2014
2013
58
1
40
1
65
3
32
0
59
4
37
0
51
5
43
1
46
7
46
1
42.5
7.5
50
0 0
10
20
30
40
50
60
70
Health Facility Community Event Home Other
Sources of Messages
2013 EIBF 2013 EBF 2013 TICF 2014 EIBF 2014 EBF 2014 TICF
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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6.4 Infant and Young Child Feeding Practices
6.4.1 Initiation of breastfeeding within one hour of birth
Sixty-two percent of the interviewed women in 2014, reported starting breastfeeding
within three hours of giving birth compared to 59 percent in 2013 (Figure 5). Of note,
there was a 6 percent increase in the number of women not breastfeeding within the first
24 hours of giving birth, 25 percent in 2013, to 31 percent in 2014. There was a
statistically significant difference in the time women thought breastfeeding should be
initiated between 2013 and 2014, (p=.041), with more women believing it should begin
later in 2014 compared to 2013.
Figure 5: Time of initiation of breastfeeding September 2013 compared to September 2014, Kohat district
6.4.2 Exclusive breastfeeding
It is recommended that children should be exclusively fed breast milk during the first six
months, as it provides all the necessary nutrients for the infants’ growth and protects the
child from illness. Compared to 2013, there was a 13 percent increase in the number of
mothers of children aged 0-5 months exclusively breastfeeding their child 24 hours
preceding the study, from 81 percent in 2013 to 94 percent in 2014. There was a
significant difference in the number of times a woman breastfed her child in the 24 hours
prior to the study between 2013 and 2014, (p=.035), (with women breastfeeding their
child more in 2014.)
Breast milk in the first three days of birth, colostrum, contains antibodies and nutrients
required to support the newborn during this period. In 2013, in the surveyed community,
one out of five mothers (n=35) disposed of the colostrum, comparatively, in 2014, one out
of every four mothers, (n=46) disposed of the colostrum.
6.4.3 Minimum dietary diversity
0 1 2 3 4 5 6 7 8 9 10 11 12 ≥24
2014 30 22 6 3 1 1 2 1 1 1 0 0 1 31
2013 39 2 11 7 3 3 1 1 1 0 1 0 6 25
0
10
20
30
40
50
60
70
80
Pe
rce
nta
gae
Time to Initiate Breastfeeding
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 16
There was almost no change between 2013 and 2014 and the number of food groups
consumed among children aged 6-23 months. (See Figure 6)
Figure 6: Dietary diversity of children 6-23 months, September 2013 compared to September 2014, Kohat
District
There is little change in the percentage of children who consumed foods from each food
group between 2013 and 2014. (See Figure 7). Of note, legumes, flesh foods, and eggs are
rarely consumed compared to grains/roots, dairy products, and Vitamin A rich fruits.
There is also a 7 percent increase in other fruits consumed, as well as a 19 percent
decrease in the amount of eggs consumed.
Figure 7: Percentage of children who consumed items from each food group in the previous 24 hours, September, 2013 compared to September 2014, Kohat District
6.4.4 Minimum meal frequency
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
0
5
10
15
20
25
30
35
0 1 2 3 4
Pe
rce
nta
ge
Food Groups Consumed
2013
2014
0
20
40
60
80
100
Grains/Roots Legumes/Nuts Dairy Flesh Foods Egg Vit. A Fruits Other Fruits
Pe
rce
nta
ge
Children who Consumed Foods from each Food Group
2013
2014
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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ages of 9-23 months7. In Kohat District, between 2013 and 2014, there was a 9 percent
increase of children aged 6-23 months who met this requirement (2013, 68 percent; 2014,
77 percent)
6.4.5 Minimum acceptable diet
Children 6-23 months are considered to have 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 moderate8, the number of food groups consumed was not (less than four). In 2013,
only 18.4 percent of children aged 6-23 months were consuming the minimum acceptable
diet, this number decreased to 16 percent in 2014.
6.4.6 Consumption of Iron-rich foods
Iron-rich foods include flesh foods (meat and organ) and fish. In 2013, around 25 percent
of children aged 6-23 months consumed flesh/fish foods the day preceding the study, this
number dropped to 18 percent in 2014.
6.4.7 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, eggs,
mangos, papayas, carrots, and dark green vegetables. In 2013, in the surveyed community
only half of children aged 6–23 months, had consumed vitamin A rich fruits and vegetables
the day preceding the study compared to a little over one-third of children in 2014.
6.4.8 Children ever breastfed, continuation of breastfeeding at one and two years old
In 2014, 98 percent of children had been breastfed at some point, a 3 percent increase
from 2013. In 2013, 72 percent of surveyed children were being breastfed at the time of
the survey, compared to 62 percent in 2014. Of those mothers who were not currently
breastfeeding in 2014 (38 percent, n=34), there were three main reasons, the mother was
ill/weak (26 percent), there was not enough milk (37 percent), or the mother became
pregnant again (35 percent). (Figure 8). There was not a significant difference in the age
in which mothers planned to breastfeed their child until, between 2013 and 2014, (p=.62).
7 http://www.who.int/mediacentre/factsheets/fs342/en/index.html 8The 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.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 18
Reasons for Breastfeeding Cessation
2013 2014
Figure 8: Reasons for cessation of breast-feeding before child reaches age of 23 months, September2013
compared to September 2014, Kohat district
6.4.9 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 fulfill the needs of a
newborn up to 6 months, but after six months they need additional food supplement. In
the surveyed community, 14 percent of children were not started with complementary
food at 6–9 months old in 2014, a 15 percent drop from 2013. There was a significant
difference in the age in which mothers introduced complimentary food between 2013 and
2014, (p=.001). Appropriate introduction of solid, semisolid, or soft foods was 86 percent
in 2014 up from 69 percent in 2013.
6.4.10 Bottle feeding
Feeding young children using a bottle is common in the survey community. There was a 6
percent decrease in the number of children being fed with a bottle from 2013, to 2014, 45
percent, to 39 percent, respectively.
6.5 Food Security and livelihood
The population of the surveyed community remained relatively unchanged between 2013
and 2014. In 2013, 91.3 percent of the households (HHs) were residents of the district,
while 8.7 percent were Internally Displaced Persons (IDPs), compared to 98 percent and 2
percent, respectively. All of the IDPs were displaced between 2008 and 2009. Among the
211 surveyed HHs, 93 percent of them were male-headed households, a 3 percent drop
from 2013.
Almost all of the respondents in 2014, 92 percent, replied that they do not have enough
food stored for the next three months, a 10 percent increase from 2013. 85 percent of the
households plan to buy their food for the next three months’ consumption, an increase of
15 percent from 2013.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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The most common income generating activities in the surveyed villages for 2013 and 2014
are daily work and salaried positions. Of note, there was a 9 percent decrease in the
surveyed community who sell their crop production as a source of income. Income
generating activates in the “Other” category include, sale of live stock, sale of livestock
products, sale of fruit, coffee, and sugarcane, sale of handicrafts, loans, and sale of relief
food. (Figure 8)
Figure 9. Household income of the Kohat District, September 2013 and 2014.
In 2013, nearly half of the surveyed communities reported that the physical condition of
their livestock was poor, in 2014; this was greatly reduced to about one fifth of those
surveyed. The most common reason for poor livestock condition was attributed to lack of
grazing in both 2013 and 2014.
Land cultivation continues to be common in the surveyed community, with most of those
surveyed having cultivated their land by at least 50 percent in 2014, consistent with 2013
findings.
Agricultural support from the National Rural Support Program (NRSP) has increased in the
surveyed community from 2013. One third reported receiving agricultural support, with
almost all reporting receiving seeds.
6.6 Water, Sanitation, and Hygiene
Focus Group Discussions
Focus group discussions carried out in 2013 and, again in 2014, revealed an increase in
communities receiving water from “relatively improved sources”9. In 2014, almost all
participants received their water from protected springs and wells, or piped water. A
small number of participants reported using "unsafe sources"10 like surface water, river,
unprotected springs and wells. A large proportion of those surveyed in 2014, reported
9Relatively improved source, which does not necessarily mean the water is tested or treated. 10 Unsafe source indicates a relatively unsafeness than the content of the water in these sources.
05
10152025303540455055
CropProduction
SmallBusiness
Remittance Salary Daily Work Other
Household Income
2013
2014
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 20
having a water source within 30 minutes of walking, this is consistent with those surveyed
in 2013.
In 2014, about one third of participants mentioned experiencing a shortage of drinking
water during the three months prior to the survey. The most common reasons were the
source became dry and/or the source became contaminated. These results are consistent
with those from 2013.
Household Interview Surveys
From the household interviews conducted in 2013 and 2014, there has been relatively no
change (91.3 percent in 2013, to 90.3 percent in 2014) in the surveyed communities
treating their drinking water. (The surveyed communities do not boil, filter, or treat their
water with chemicals). The hand washing practices of the communities in 2014 were
highest before eating, (91 percent), after going to the toilet, (81 percent), and before
preparing or cooking food, (81 percent). The surveyed communities had the lowest hand
washing practices in terms of before feeding a child, (40 percent) and after cleaning a
child’s bottom, (39 percent). The 2013 hand washing practices were not adequately
obtained and cannot be used for comparison. (See Figure 10).
Figure 10. The hand washing practices from the household survey, September 2014, Kohat District.
In 2013, only 59 of the households, (28.6 percent), practiced appropriate disposal of
children feces, this remained the same in 2014. However, there was a 7 percent increase
in those surveyed depositing the feces in the latrine immediately after defecation
between 2013 and 2014. This resulted in a 7 percent decrease of those scattering the
child’s feces around the compound. The remaining households either disposed of the feces
with other rubbish/trash or scattered it around their compound.
81%
51%
91%
40%
81%
39%
Before Preparing/Cooking
Before Serving Food
Before Eating
Before Feeding Children
After Going to Toilet
After Cleaning Child's Bottom
2014 Handwashing Practices
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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6.7 Health
During the three months before the survey conducted in 2014, a few of the communities
reported occurrence of disease outbreaks. The most common disease outbreak reported
was Acute Watery Diarrhea (AWD). These findings are similar to those in 2013.
In 2013 and 2014, most of the village’s vaccination campaigns occurred in August. The
most common vaccination given to children was Oral Polio Vaccine (OPV) with Vitamin A
being the second most common.
As in 2013, there was no report of unusual outmigration from all surveyed villages in 2014.
7. Discussion
Focus group discussions carried out in the surveyed communities revealed significant
beliefs and behaviors that shape IYCF practices. In the surveyed communities, there was a
range of times for when women began breastfeeding their child after birth. Many
respondents began breastfeeding right after birth, while a few mentioned beginning two
to three hours after birth. One respondent stated,
People in this community begin breastfeeding 2 to 3 days after the child is born.
In the surveyed communities, it was common for women to breastfeed their child
exclusively for 6 months and after 6 months introduce complimentary foods. Women
mentioned continuing breastfeeding until the child was 2 years old. Within the
communities, beliefs shaped which complimentary food were introduced. One mother
stated,
For a baby 0 to 12 months, we don't feed the baby hard, bitter, or cold food items as it will cause chest infections. For a baby aged 13 to 23 months, we don't feed them yogurt or oily food items.
Another mother stated,
From 6 months on, we don't feed the baby hard food items. The baby can get [diarrhea] if we feed them such items.
Malnutrition was occasionally sited as an issue within the surveyed communities.
Malnutrition was frequently attributed to poverty and lack of food. Additionally, a few
respondents noted that malnutrition was due to people’s lack of knowledge regarding
proper nutrition and viable food sources for nutrition rich-foods. One respondent stated,
Malnutrition is common in this district. Its main cause is poverty.
Another respondent stated,
Malnutrition is common in this district. We believe it’s because babies don't eat vegetables and they mostly eat snacks from the market which are unhealthy.
In the surveyed communities many respondents mentioned following IYCF practice advice
from their elders. A few respondents mentioned hearing IYCF messages elsewhere such as
ACF, educated females in their community, and/or doctors. However, women most often
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 22
stated that their elders, mothers, and mother-in-laws, influenced their IYCF practices the
most. One respondent stated,
We are not interested in getting information about IYCF practices as we follow what our elders tell us to do.
A few women mentioned having difficulty learning and/or hearing about IYCF practices. The most common barriers to hearing about IYCF practices were inability to leave the house without permission, lack of media, and long distances to hospitals. The focus group discussions revealed key behaviors and beliefs within the surveyed communities that drive IYCF practices. These are to be considered in the recommendations in order to further strengthen the IYCF programming in the intervetions area.
8. Conclusion
The primary objective of the 2014 survey was to monitor and evaluate the progress of
ACF’s IYCF program in five UCs in the Kohat district. The 2014 survey results were
compared to the baseline survey undertaken in 2013. The results underscore that most
IYCF practices remain below the national average11, but that progress is being made.
Information about child feeding practices; EIBF, EBF, and TICF, originate from similar sources. Within the survey communities, there has been a significant increase, (14 percent), in hearing messages form IYCF promoters from 2013 to 2014. There has also been a 5-7 percent increase in people hearing child feeding practice messages at community events.
There has been little change in when mothers/caretakers believe that breastfeeding should begin after a child is born. In 2013, 59.6 percent of mothers/caretakers believed that breastfeeding should be started immediately after the child is born. This increased by only 1.5 percent in 2014 to 61.1 percent. Of note, there was a 14 percent increase in women hearing a message about EIBF from 2013 to 2014.
In 2013, nearly half, (45.7 percent), of the mothers/caretakers knew that a child should be exclusively breastfed for the first six months of his/her life. This increased by almost 20 percent in 2014, to 64 percent of mothers/caretakers.
In 2014, there was a 16 percent increase in the mothers/caretakers knowledge of the appropriate age, (6 months), of initiating complementary food, from 47.3 percent in 2013 to 63 percent in 2014.
In 2013 and 2014, the most common contact persons for child feeding information in the surveyed community were nurses/dispensers and family/friends.
The proportion of children 0 to 23 months who were put to the breast within one hour of birth dropped by 9 percent from 2013 to 2014. However, there was a 3
11NNS Pakistan, 2011
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 23
percent increase in the women putting their child to their breast within 3 hours of birth.
There was a 6 percent increase in the number of women not breastfeeding within the first 24 hours of giving birth from 2013 to 2014.
The proportion of infants aged 0-5 months who are exclusively breastfed increased from 81 percent in 2013 to 94 percent in 2014.
Appropriate introduction of solid, semisolid, or soft foods was 86 percent in 2014 up from 69 percent in 2013. This indicates that children aged 6 to 9 months are given complementary feeding as per the WHO recommendation.
There was almost no change between 2013 and 2014 with regards to the number of food groups consumed among children aged 6-23 months.
There was a 2 percent drop from 2013 to 2014 for the number of children 6-23 months who were fed appropriately, based on the recommended IYCF practices, (18 percent to 16 percent, respectively).
The proportion of children aged 0-23 months who received iron-rich food or iron-fortified food (specially designed for infants and young children, or that is fortified in the home) remains low. Only 18 percent of all children surveyed under the age of two years had received iron rich food in 2014, a 7 percent decrease from the year before.
The number of mothers/caretakers feeding their child from a bottle decreased by 6 percent from 45 percent in 2013 to 39 percent in 2014.
The majority of respondents, in 2014, 92 percent, replied they did not have enough food in store for the coming three months. This is a 10 percent increase from 2013. Eighty-five percent of the households plan to buy their food for the next three months’ consumption, an increase of 15 percent from 2013.
In 2013, nearly half of the surveyed community reported that the physical condition of their livestock was poor, in 2014; this was greatly reduced to about one fifth of those surveyed. The most common reason for poor livestock condition was attributed to lack of grazing in both 2013 and 2014.
Agricultural support from the National Rural Support Program (NRSP) has increased in the surveyed community from 2013. One third reported receiving agricultural support, with almost all reporting receiving seeds.
In 2014, almost all participants received their water from protected springs and wells, or piped water. A small number of participants reported using "unsafe sources"12 like surface water, river, unprotected springs and wells.
From the household interviews conducted in 2013 and 2014, there has been relatively no change (91.3% in 2013, to 90.3% in 2014) in the communities treating their drinking water.
12 Unsafe source indicates a relatively unsafeness than the content of the water in these sources.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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A large proportion of those surveyed in 2014, reported having a water source within 30 minutes of walking, consistent with those surveyed in 2013.
In 2014, about one third of participants mentioned experiencing a shortage of drinking water during the three months prior to the survey. The most common reasons were the source became dry and/or the sources became contaminated. These results are consistent with those from 2013.
The hand washing practices of the community in 2014 were highest before eating, (91 percent), after going to the toilet, (81 percent), and before preparing or cooking food, (81 percent). The survey community had the lowest hand washing practices, before feeding a child, (40 percent) and after cleaning a child’s bottom, (39 percent)
In 2013, only 59 of the households, (28.6 percent), practiced appropriate disposal of children feces, this remained the same in 2014. However, there was a 7 percent increase in those surveyed depositing the feces in the latrine immediately after between 2013 and 2014.
During the three months before the survey conducted in 2014, a few of the communities reported occurrence of disease outbreaks. The most common disease outbreak reported was Acute Watery Diarrhea (AWD). These findings are similar to those in 2013.
9. Recommendations 9.1 Infant and Young Child Feeding (IYCF)
There have been significant strides made in IYCF practices from 2013 to 2014 in the Kohat
District. However, most IYCF practices remain below the national average and require
further efforts on behalf of ACF to improve IYCF practices in the region. Below are
recommendations that address each area discussed above.
Early Initiation of Breastfeeding, Early Breastfeeding, Time of Initiation of
Complimentary Foods
o Continue messaging efforts for pregnant women but increase the scope of these
messages to include elders
o As per the FGDs, elders are the main influencers in IYCF
practices/decisions
o Increase messaging on importance of breastfeeding vs. bottle feeding
o Increase messaging on EIBF
o Dispel any beliefs or behaviors that might be associated with delaying
EIBF by addressing them head on
o Identify barriers to EIBF, EBF, and TICF
o An increase in the number of women hearing the message is not being
directly translated into action—it is imperative to determine the gap
between knowing and doing
o Identify enablers that can be used in promoting translation of
messaging into practice.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 25
Diet Diversification: employ qualitative research methods (in-depth interviews,
focus groups, and observations)
o Determine current diets/eating habits
o Explore available food options within the community
o Identify barriers to diet diversification
o Explore cultural beliefs and attitudes about food/diet
Once the team has completed the qualitative research methods and analyzed the
current diet diversification field, the team should create nutritional health
behavioral change campaigns.
9.2 Food Security and Livelihood (FSL)
Continued Agricultural Support from the National Rural Support Program, (NRSP)
o Currently, 92 percent of the community relies on the market for food.
Diversifying the livelihood of the community can improve income-generating
sources, which can lead to a self-sustaining community.
9.3 Water Sanitation and Hygiene
A comprehensive behavior change communication program should be designed to
advocate and address the following issues in the study community:
o Appropriate time of hand washing, highlighting; after cleaning a child’s
bottom and before feeding children.
o Appropriate disposal of children’s feces and the dangers with improper
disposal
o Importance of drinking from safe water sources, and treating water before
drinking
9.4 Health
Appropriate integrated disease surveillance program should be designed/strengthened to control the outbreak of epidemics in the community.
Increased vaccination of children in the community; Oral Polio Vaccine, (OPV), and measles
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 26
7. Annexes
Annex 1. Survey schedule Activities Time frame 2013
Time Frame 2014
Travel to Kohat and Preparation for KAP
survey enumerators training
September 2 September 15
Training of KAP Survey enumerators in Kohat September 3-4 September 18-19
Data collection September 5-9 September 20-26
Finalize data entering and cleaning September 10-12 November 25-December
1
Data Analysis, preliminary report writing and
validation of preliminary report
September 13-October 2 December 1-12
KAP Survey final report writing and validation October 2-16 December 12-23
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 27
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 2014
Page 28
KandyaliBala 353 23
KandyaliPayan 339 24
Gulmeer 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 data13.
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
13Guide for the Assessment of IYCF Practices, WHO, 2010.
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 29
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 2014
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Annex 4: Comparison of the results with national and regional figures, percentages
S/N Description Kohat district
201314
Kohat
District
2014
KP
Province15 Pakistan16
1 Early initiation of breastfeeding 39.4 30 74.3 40.5
2 Exclusive breastfeeding during the first 6 months 66 61 47.0 12.9
3 Continued breastfeeding at one year of age 73.3 52 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
77 35.3 51.3
6 Minimum dietary diversity score 21 21 2.7 3.0
7 Minimum meal frequency 68 77 45.0 56.4
8 Minimum acceptable diet 18 16 5.6 7.3
9 Consumption of Colostrum 20 25 - -
10 Children ever breastfed 95.1 98 - -
14ACF IYCF KAP Survey, Kohat district, September 2013 15National nutrition survey, Pakistan, 2011 16ibid
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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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?
کيا آپ کوئی بهی آسان سا جملہ لکه يا پڑھ
سکتی ہيں؟
Yes……….1
No……….2
102 Did you ever attend formal school/Madrasa ?
کياآپکبهياسکولميںپڑھيہيں؟
Yes……….1
No……….2
Skip to 104
103 If yes, what is the highest grade you completed?
اگرہاں،توکہاںتکپڑھيہيں؟
1. Primary
2. Middle
3. matric interme
4. Bachelor
5. Master
6. Madrasa
104 What is your current marital status?
آپکيازدواجيحيثيتکياھے؟
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 ںام کيا ہے؟ ےبچآپ کے
202 Sex of Child
جںس؟
Boy………..1
Girl………. 2
203
What is the age of your child?
کی عمر کيا ہے ؟ ےبچآپ کے [____|____] MONTHS
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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Section 3: IYCF practice questions
301
Have you ever breastfed [NAME]?
کو آپںے کبهی ماں کا دودھ پاليہ ےبچاس
ہے؟
Yes…………….1
No..…………...2
Skip to 308
302 How long after birth did you first put [NAME] to the breast?
کو ےبچپيدائش کی کتںی دير آپ ںے اس
ماں کا دودھ پاليہ؟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 ےبچکيا آپ اب بهی اس
پالتی ہيں؟
Yes…………….1
No..…………...2
Skip to 307
304 Why did you stop breastfeeding [NAME]?
کو ماں کا دودھ پالںا کيون ےبچآپںے اس
بںد 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 دودھ ےبچکس عمر تک آپ اس
پالئوگی؟
Months _________
Don’t Know…………..…98
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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306
How many times did you breastfeed [NAME], between sunrise yesterday and sunrise today?
کل صبح سورج اُبهرںے سے آج صبح
ںے ےبچسورج اُبهرںے تک کتںی بار اِس
ماں کا دودھ پيا ہے؟If response is not numeric, probe for a numeric response
Number _________
Don’t Know…………..…98
307 Did you squeeze out and throw away the first milk (colostrum)?
پيدائشکےفورںبعدںکلںےواالماںکاپہالدودھ
کياآپںےپهيںکدياتها؟
Yes…………….1
No..…………...2
308 Did [NAME] drink anything from a bottle between sunrise yesterday and sunrise today?
کل صبح سورج اُبهرںے سے آج صبح
ںے بوتل ےبچسورج اُبهرںے 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 ےبچکيا آپںےاپںے
عالوه کوئی اور
ہلکيياںرمغذاکهالئيہے؟
Yes……………..1
No……………..2
Don’t Know……8
Skip to 401
310 At what age did you first introduce?
کسعمرميںکهالںہشروعکيا؟
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 اُبهرںے سے آج صبح
کو کتںی دفعہ ےبچسورج اُبهرںے تک اِس
ہلکی يا ںرم غذا کهالئی؟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 کتںی دير بعد
کو ماں کا دودھ پيںا چاھيے؟ ےبچ
If it less than an hour, circle immediately
Immediately………..…………………00
Hours……………………….________
Days.………………………. ________
Don’t Know……………..……….98
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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402
Did you hear a message to put your baby on the breast immediately after birth?
کيا آپںے يہ مشوره سںا تها کہ پيدائش کے
کو ماں کا دوده پالئيں؟ ےبچفورن بعد
Yes……………1
No……………..2
Can’t remember…….8
Skip to 501
Skip to 501
403
From whom did you hear this message?
کسسےسںاتهايہمشوره؟
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 2014
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404
When did you hear these messages? During:
کبآپںےيہمشورھسںاتها؟
دوراِن؟
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
کہاںپہسںاتهايہمشوره؟
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 2014
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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 دودھ ےبچکس عمر تک
ہی پالںا چاہيے
اسکےعالوھکچهبهيںهيں؟
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 آپںے يہ مشوره سںا تها کہ پيدائش سے
کو صرف ماں کا دودھ ےبچچه ماه تک
پالئيں، يہاں تک کہ پاںی بهی ںہ پالئيں؟
Yes…….………1
No……………..2
Can’t remember…….8
Skip to 601
Skip to 601
503
From whom did you hear this message?
کسسےسںاتهايہمشوره؟
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 2014
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504
When or how did you hear these messages? During:
کباورکيسےآپںےيہمشورھسںاتها؟
دوراِن؟
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?
کہاںپہسںاتهايہمشوره؟
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 ےبچپيدائش کے کتںے عرصے بعد
ہلکی يا ںرم غذا کهالںی چاہيے؟
Age in Months ______________
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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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 آپںے يہ مشوره سںا تها کہ چه ماه کی
کو ںرم غذا ديںا شروع ےبچعمر سے
کريں
جيسا کہ
ںرم
(khichrri)
ٹائم روزاںہ ؟ 2_3 کهچںی
Yes……………1
No……………..2
Can’t remember…….8
Skip to 701
Skip to 701
603
From whom did you hear this message?
کسسےسںاتهايہمشوره؟
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 2014
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604
When or how did you hear these messages? During:
کباورکيسےآپںےيہمشورھسںاتها؟
دوراِن؟
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?
کہاںپہسںاتهايہمشوره؟
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. ںے ےبچدوسرا ميں يہ پوچهںا چاہوںگا کہ آپ کے اِس
کل دن اور رات کے دوران ہلکی يا ںرم غذا ميں کون کون سی چيزيں کهائی يا پی تهيں؟
Yes No DK
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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A- Porridge کهچںی، bread ڈبل روٹی ,
riceچاَول, noodlesسوئياں, or other foods made from grains
1 2 8
B- White potatoes سفيد آلو , white yams مولی , manioc, cassava, or any other foods made from roots
1 2 8
C- Any foods made from beans, peas
lentils ,مٹر داليں , nuts موںگ پهلی , or seeds بيج
1 2 8
D- Milk such as tinned, powdered, or fresh animal milk?
1 2 8
E- Cheese پںير , yogurt دہی , or other milk products
1 2 8
F- Infant formula 1 2 8
G- Any meat such as Mutton and Beef, chicken مرغی کا گوشت , or duck
Liver ,بطخ کا گوشت جگر , kidney گرده , heart دل , or other organ meats
1 2 8
H- Fresh or dried fish سوکهی مچهلی , shellfish سمںدری مچهلی , or seafood
سمںدری مچهلی
1 2 8
I- Eggs اںڈا 1 2 8
J- Ripe mangoes پکی آم , ripe papayas پکا پپيتا , or lemon ليموں Guava
1 2 8
K-Anadarko green leafyvegetables
ہرے رںگ کی يا پتوں والی سبزياں 1 2 8
L- Pumpkin کدو , carrots گاجر, squash کدو, or sweet potatoes سفيد that are yellow or orange insideگاجر
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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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Kohat District IYCF KAP SurveyHH FSL and WASH Questionnaire, September 2013
UC: ______________________ Village: __________________ _________Cluster number: __ __ Team number: _____ Household number____________ Date: /09/2013
NO QUESTIONS AND FILTERS ANSWERS & CODES SKIP
Food security and livelihood questions
101
What is the status of the household?
آپکی موجوده رہائش کس قسم کی ہے؟
1--------------------------Resident-----------------------------→ 2--------------------------IDP-------------------------------------→
103 Q102
102
Since how long have you been displaced?
کتںےعرصےسےآپںقلمکاںيکيےہوئےہو؟
____/____/_______ (DD/MM/YYYY)
103
What is the gender of the head of the household?
گهرکاسربراھکوںہے؟مردياعورت؟1 ------------- Male 2 -----------Female
104
What were the sources of income of the household during the last 3 months?
ماھکےدوراںآپکےگهرکيآمدںيکےذرائعکوںسےتهے؟ 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
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
Page 42
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?
3کياآپکےگهرميںاتںاراشںموجودہےجواگلے
ماھتکآپکےگهروالوںکےليےکافيہو؟
1-------------------- Yes 2 ------------------------- No
No →Q105
106
If no food in store now, what will be your main source of food for the
NEXT 3 months (expectation)? اگر
ماه ميں آ پکی 3راشن ںاکافيہے تو اگلے
آمدںی کا اہم ذريعہ کيا ہوگا ) اُميد کيا ہے( ؟
(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)
تںگدستييادباؤکےوقتآپکيتدابيرکياہوتيہيں؟
) جب کبهی آ پکو خوراک کی قلت کا سامںہ
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--Other specify (_________) 12---Remittance
WASH related Questions
108
What is done to the water before households’ members drink it?
گهرکےافرادپاںيپيںےسےپهلےپاںيکوکياکرتےہ
يں؟
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)
0-------------------Never
1-------------------Before preparing food/ cooking
2--------------------Before serving food
ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014
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Do not read answers.
عامطورپرآپدںميںکسوقتہاتهدھوتےہيں؟
3--------------------Before eating
4--------------------Before feeding children
5-------------------After going to toilet/defecation
6--------------------After cleaning child's bottom
7--------------------After vulvae hygiene
98----------------------------------------Other (specify
110
What is done with children/baby faeces?
بچوںکےپاخاںےکےساتهآپکياکرتےہيں؟
1 = Thrown out with normal rubbish/trash
2 = Deposited immediately in a latrine
3 = Scattered around the compound/house
4 = Given to domestic animals to clear/eat
5 = Buried 6 = Other
(specify________________)