SEMINAR PRESENTATIONS Cambodia DHS and Measure DHS+ Survey Objectives and Methodology Housing and Characteristics of the Population Fertility and its Determinants Fertility Preferences Family Planning Abortion Women’s Status Domestic Violence HIV/AIDS and Other STIs Health Status and Utilization of Health Services Infant, Child and Maternal Mortality Maternal and Child Health Infant Feeding & Childhood and Maternal Nutrition

Breastfeeding and Supplementation Nutritional Status of Children Nutritional Status of Women Micronutrient Status

Breastfeeding and its benefits Breastmilk contains all the nutrients that most babies need in the first 6 months. It is hygienic, safe and economical. Colostrum (premilk substance containing antibodies and white cells from the mother’s blood) is a key supplement for the infant’s immune system. Colostrum is produced in the first 2 to 3 days of lactation. These findings indicate that there is a large pool of potential family planning users that could be targeted for family planning counseling. To reach these potential users, a vigorous outreach programme is needed. With the onset of the decentralisation initiative focusing on the district and community levels, the approaches can include encouraging all health workers to discuss fertility preference issues and the option of family planning whenever the opportunity arises.

Breastfeeding and Supplementation Breastfeeding and complementary feeding behaviors are important predictors of infant and child nutrition, health and survival. Poor nutritional status increases the risk of illness and death. Frequent breastfeeding for long durations delays the return to ovulation, resulting in longer birth intervals and lower fertility, which is strongly related to infant and child survival. These findings indicate that there is a large pool of potential family planning users that could be targeted for family planning counseling. To reach these potential users, a vigorous outreach programme is needed. With the onset of the decentralisation initiative focusing on the district and community levels, the approaches can include encouraging all health workers to discuss fertility preference issues and the option of family planning whenever the opportunity arises.

What proportion of children are breastfed? These findings indicate that there is a large pool of potential family planning users that could be targeted for family planning counseling. To reach these potential users, a vigorous outreach programme is needed. With the onset of the decentralisation initiative focusing on the district and community levels, the approaches can include encouraging all health workers to discuss fertility preference issues and the option of family planning whenever the opportunity arises. 57% of infants are given other liquids before breast milk, a practice that exposes them to pathogens and increases their risk of infection, especially diarrheal disease.

For how long are children breastfed? Any breastfeeding: 24 months Exclusive breastfeeding: less than 1 month 99% of children under 6 months of age were breastfed at least 6 times in the 24 hours before the interview These findings indicate that there is a large pool of potential family planning users that could be targeted for family planning counseling. To reach these potential users, a vigorous outreach programme is needed. With the onset of the decentralisation initiative focusing on the district and community levels, the approaches can include encouraging all health workers to discuss fertility preference issues and the option of family planning whenever the opportunity arises.

What do children less than 4 months receive? These findings indicate that there is a large pool of potential family planning users that could be targeted for family planning counseling. To reach these potential users, a vigorous outreach programme is needed. With the onset of the decentralisation initiative focusing on the district and community levels, the approaches can include encouraging all health workers to discuss fertility preference issues and the option of family planning whenever the opportunity arises.

Supplementary feeding Whereas early supplementation feeding is not recommended because: It may expose children to pathogens It decreases an infant’s intake of breast milk And it also reduces breast milk production… However, starting at the age of 6 months, children should be receiving supplementary feeding since breastmilk alone is no longer sufficient.

What do children 6 to 9 months receive? These findings indicate that there is a large pool of potential family planning users that could be targeted for family planning counseling. To reach these potential users, a vigorous outreach programme is needed. With the onset of the decentralisation initiative focusing on the district and community levels, the approaches can include encouraging all health workers to discuss fertility preference issues and the option of family planning whenever the opportunity arises.

What about bottle-feeding? Improper sanitation (difficulty to sterilize the nipples properly) can introduce pathogens to the infant. Infant formulas (often watered down) and other types of milk do not provide comparable nutrition to breast milk for infants less than 6 months old. Therefore, bottle-feeding puts infants at a higher risk of illness, especially diarrheal disease, and malnutrition.

Use of the bottle… This practice puts these children at a higher risk of illness and malnutrition.

Breastfeeding and Supplementation Nutritional Status of Children Nutritional Status of Women Micronutrient Status

Level of malnutrition (Percent of children under age 5)

Does stunting vary by age? Percent In months

Stunting variations by mother’s education and by residence Urban 38% Rural 46% Education: No education 51% Primary 43% Secondary+ 35%

Regional variations in stunting prevalence Nationwide, 45% of children are stunted Regional variations in stunting prevalence

Breastfeeding and Supplementation Nutritional Status of Children Nutritional Status of Women Micronutrient Status

What percentage of women are malnourished? 21% of women have a BMI (Body Mass Index) below 18.5; they are considered underweight. 6% of women are shorter than 145 cm, a sign of poor nutritional status during childhood and adolescence.

Regional variations in the proportion of women with a BMI <18.5 Nationwide, 21% of women have a BMI <18.5 Regional variations in the proportion of women with a BMI <18.5

Breastfeeding and Supplementation Nutritional Status of Children Nutritional Status of Women Micronutrient Status

Iodine deficiency disorder (IDD) IDD is a major global nutrition concern. IDD can be avoided by using salt that has been fortified with iodine. Interviewers asked household respondents for a teaspoon of salt and tested it for iodine content using portable test kits provided by UNICEF. Only 12% of children live in households using adequately iodized salt.

Nationwide 12%: 23% urban 11% rural Regional variations in the proportion of children living in households with iodized salt Nationwide 12%: 23% urban 11% rural

Iron-deficiency anemia Most common micronutrient deficiency in the world. Prevalence is defined by low hemoglobin. In the CDHS, direct measurement of hemoglobin for children 6-59 months and women 15-49 years was done in 1 household in 4. Level of hemoglobin was measured by taking a drop of capillary blood from a person’s fingertips or heel.

Prevalence of anemia by age 63% 85% 78% 55%

Nationwide 63%: 57% urban 64% rural The percentage of anemic children varies greatly by region and residence Nationwide 63%: 57% urban 64% rural

Prevalence of anemia among women 58 51 50 59 62 Percent

The percentage of anemic women varies greatly by region and residence Nationwide 58%: 51% urban 59% rural The percentage of anemic women varies greatly by region and residence

Vitamin A deficiency (VAD) Vitamin A is essential for the growth and development, sight, immune function and reproduction. VAD is strongly linked to the nature of foods available and to the feeding practices. In the survey, VAD was estimated by looking at the consumption of foods rich in vitamin A in the week before the survey and in the consumption of vitamin A supplements.

Vitamin A intake among children *In the week preceding the survey ** In the 6 months preceding the survey

Main Findings 96% of children born in the last five years have been breastfed. However, only 11% were breastfed in the first hour and 24% during the first day. 14% of children under 4 months are exclusively breastfed Half of children under age 3 were breastfed until 24 months. Supplementary feeding is introduced much too early in life.

16% of children less than 36 months are bottle-fed, which can be detrimental to their health. Almost half (45%) of children are stunted (too short for their age) including 21% severely. One in five women (21%) have a BMI of less than 18.5. Around 3 in 5 children and women are anemic. Consumption of iodized salt is very low. Consumption of foods rich in vitamin-A is 76%.