Measurement of Infant and Young Child Feeding Behaviors Mary S Lung’aho for CARE: March 2008

Why Use a Standard Methodology?

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 1991 Timely initiation of breastfeeding ( months)* Exclusive breastfeeding rate (0-5.9 months)** Continued breastfeeding at: 1 year ( months); 2 years ( months) Timely complementary feeding rate (6-9.9 months) Bottle-feeding Rate ( months) *Not included on original list ** Updated WHO 2007/2008 CORE Indicators Early initiation of breastfeeding ( months) Exclusive breastfeeding under 6 months Continued breastfeeding at 1 year Introduction of solid, semi- solid or soft foods (6-8.9 months) Minimum dietary diversity Minimum meal frequency 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 MonthsDaysBreastfeeding Indicators related to Age < 1 month0-30 daysExclusive Breastfeeding Rate (EBR) Predominant Breastfeeding Rate (PBR) Full/Partial/Token Breastfeeding 1 month31-61 days 2 months62-91 days 3 months days 4 months days 5 months days 6 months daysTimely Complementary Feeding Rate 7 months days 8 months days 9 months days 10 months days 11 months days 12 months daysContinued Breastfeeding at 12 Months 13 months days 14 months days 15 months days 16 months days 17 months days 18 months days 19 months days 20 months daysContinued Breastfeeding at 24 Months 21 months days 22 months days 23 months days 24 months days 25 months days 26 months days 27 months days

Use of Data Information on Early Feeding Practices

Use of Data Disaggregation by Residence

Use of Data Methodology Allows Flexibility in Analysis

Use of Data Feeding Practice Categories

New Recommended Indicators: Percent of infants and children fed with selected “good practices”

Feeding Practices Over Time

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 c ard

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 (1- 3 weeks)

IYCF Assessment Process Key information (Ops Guidance) Initial Rapid Assessment (often multi-sectoral): Demographic profile. Are the following groups under or over- represented: infants, pg women, orphans/unaccompanied children? Feeding practices pre-crisis; any observable changes. Observed and pre- crisis 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: 0- 5 months, 6-11 months, months), children aged months (2-5 years), pregnant and lactating women Morbidity and mortality of infants Infant and young child feeding practices; include