1. Improving Complementary Feeding Practices in Afghanistan Initial Results of TIPS in Afghanistan By Charlotte Dufour FAO & Ministry of Agriculture, Afghanistan Picture removed…

2. The nutritional situation Very high mortality: 26% children die before age 5 +/- 50% of chronic malnutrition 6-10% acute malnutrition in 6-59 m 9-16% acute malnutrition in 6-29 m High rates of MDDs (MOPH, 2003) –Iron deficiency: 70% of children (38% anemic) and 48% of women (25% anemic) –Vitamin A (night blindness): 20% women –Vitamin C: up to 10% in some areas; scurvy epidemics 2002 & 2003 Picture removed…

3. Causes of malnutrition Underlying Causes: –low diet diversity –improper feeding practices –poor hygiene & access to health services Basic causes: –Destroyed economic, natural, physical and social capital –Limited access to land & water –Low level of education –Poor condition of women –Many consequent pregnancies –High unemployment –Conflict and lack of governance –Etc. Picture removed…

4. Common Breastfeeding Problems Ritual foods given at birth Mothers breastmilk insufficient (link to mothers mental health) Cease breastfeeding when child is sick, or mother sick Cease breastfeeding when pregnant

5. Complementary Feeding Problems Early or Late introduction of complementary foods Do not prepare separate foods for children Family dish is often not energy-dense (e.g. watery soup) Low consumption of vegetables, fruits, and animal foods Low meal frequency Poor food hygiene Food beliefs restrict consumption of some foods

6. Mothers feeding patterns Family diet is often poor in fruits, vegetables, meat Several consequent pregnancies Mothers do not increase the number of meals when pregnant or lactating Food beliefs restrict consumption of certain foods Picture removed…

7. TIPS Methodology: Objectives To identify & document current feeding practices (good & bad) To understand reasons for the practices To identify factors that can motivate households to change To identify how far households are prepared to change and constraints to change In Afghanistan: to develop a manual of improved recipes and feeding practices, adapted to various regions

8. TIPS Approach Test in real home situation, in average households with average resources Consultative process / negotiation, where families have a choice Move from ideal recommendation to practical recommendation Step by step process / interim target Picture removed…

9. TIPS process Preparatory phase: -List common problems and prepare counselling guide -Identify locations and age groups -Train teams Implementation phase: -Cooking demonstration & selection of households -Assessment visit -Counselling Visit -Follow-up visit Evaluation and analysis (workshop): –summarise findings –discussion with all concerned / consensus –identify issues for further investigation –develop plan for wider dissemination of well-tested recommendations including recipes Picture removed…

10. TIPS in Afghanistan Collection of information on food availability, seasonality and beliefs Mission by Charity Dirorimwe: -field visit -training of staff -Development of improved recipes Field work in 3 provinces and in Kabul (2 villages) Bamyan Herat Badakshan Kabul

11. Constraints to TIPS implementation No trained nutritionists need strong supervision Food seasonality need 2 rounds Difficult access in winter Difficult to cover diversity of entire country Picture removed…

12. Despite constraints, positive initial results Confirmed lack of knowledge as cause of (preventable) malnutrition Very high interest of mothers Kids love the recipes! Mothers change their cooking and purchasing patterns The story of Nazeer Ahmad Picture removed…

13. Constraints to change Limited access to diverse foods Low income Mothers willing to improve their childs diet but not their own (too poor) Contradictory advice from doctors (esp. About breastfeeding)

14. Next steps Summarize findings in workshop Prepare manual of improved recipes and feeding practices Integrate cooking demonstrations as part of: -Literacy classes -Agricultural projects -Health education in clinics -Breastfeeding counselling (collaboration with UNICEF) Need to improve training of nutrition educators on participatory techniques Picture removed…