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

4. Why Use a Standard Methodology?

5. 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

6. Recommended IYCF Practices Indicators WHO 1991 Timely initiation of breastfeeding (0-11.9 months)* Exclusive breastfeeding rate (0-5.9 months)** Continued breastfeeding at: 1 year (12-15.9 months); 2 years (20-23.9 months) Timely complementary feeding rate (6-9.9 months) Bottle-feeding Rate (0-11.9 months) *Not included on original list ** Updated WHO 2007/2008 CORE Indicators Early initiation of breastfeeding (0-23.9 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

7. 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

8. 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

9. 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 months92-122 days 4 months123-152 days 5 months153-182 days 6 months183-213 daysTimely Complementary Feeding Rate 7 months214-243 days 8 months244-274 days 9 months275-304 days 10 months305-335 days 11 months336-365 days 12 months366-395 daysContinued Breastfeeding at 12 Months 13 months396-426 days 14 months427-456 days 15 months457-487 days 16 months488-517 days 17 months518-547 days 18 months548-578 days 19 months579-608 days 20 months609-639 daysContinued Breastfeeding at 24 Months 21 months640-669 days 22 months670-700 days 23 months701-730 days 24 months731-760 days 25 months761-791 days 26 months792-821 days 27 months822-852 days

10. Use of Data Information on Early Feeding Practices

11. Use of Data Disaggregation by Residence

12. Use of Data Methodology Allows Flexibility in Analysis

13. Use of Data Feeding Practice Categories

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

15. Feeding Practices Over Time

16. 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

17. 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)

18. 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]

19. 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

20. 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, 12-23 months), children aged 24-59 months (2-5 years), pregnant and lactating women Morbidity and mortality of infants Infant and young child feeding practices; include