1. ACCELERATING NUTRITION IMPROVEMENT (ANI) APPLICATION OF FOOD BASED APPROACH TO IMPROVE COMPLEMENTARY FEEDING
MINISTRY OF HEALTH

2. Of all children under five in Uganda
BACKGROUND
Of all children under five in Uganda
One third are stunted
14% are underweight
5% are wasted,
Prevalence peaks during the complementary feeding (CF) period.
Poor infant and child (IYC) nutrition indicators are linked to high rates of infection and mortality rates

3. BACKGROUND
- IYCF including breastfeeding and complementary feeding is not optimal
63% of children are exclusively breastfed for the first 6 months.
- 5.8% of children aged 6-23 months receive minimum acceptable diet.
12.8% of children aged 6-23 months receive minimum dietary diversity.
NB: Nationally over a third of Uganda children aged 6-23 months had low dietary diversity rising to well over half in the Western Region by 55%

4. WHO-ANI PROJECT
In 2012 World Health Organization received funding from the Canadian International Development Agency (CIDA)/DFATD entitled “ANI- Accelerating Nutrition Improvements” to support 11 countries in Sub-Saharan with aim of reducing stunting among under 5 children.
The countries include: Uganda, Burkina Faso, Rwanda, Ethiopia, United Republic of Tanzania, Zimbabwe, Mali, Senegal, Mozambique, Sierra Leone, and Zambia.

5. WHO-ANI PROJECT FOR UGANDA
The project is in in line with Uganda Nutrition Action Plan (UNAP) strategy to reduce malnutrition.
Aimed at improving infant and young child feeding practices through
increasing consumption of nutritious foods and adequate complementary feeding,
improving nutrition knowledge and practices, especially in the “critical window” of conception through 23 months.

6. THE PROJECT OBJECTIVES FOR UGANDA
General Objective:
Reduce stunting among children under 5 years.
Specific Objectives:
Support the scaling-up of evidence-informed nutrition actions focusing on improvement of complementary feeding of children 6-23 months by use of a Food Based approach.
Strengthen nutrition surveillance systems in collaboration with government national Health Information Management Systems (HMIS).

7. PROJECT’S INTERVENTION DISTRICTS
MASINDI
NAMUTUMBA
HOIMA
LUUKA
KIBAALE
IGANGA

8. Development of the Food based recommendations – Process in ANI Uganda4.
Developing and rolling out SBCC strategy 3.
Testing for feasibility through TIPs 2.
Optimizing complementary food recipes 1.
Generating evidence through surveys

9. GENERATING EVIDENCE THROUGH SURVEYS
Awareness on nutrition problems
Capacity to implement nutrition actions
Nutrition interventions coverage
- Landscape analysis
- Mapping
Barriers and facilitators
Influencers IYCF practices
Feasible and effective channels that can be to promote IYCF practices
KAP study on IYCF practices
Dietary patterns,
Dietary adequacy in terms of nutrients
Nutritional status including hemoglobin level
Adequacy of current feeding practices
Cost and seasonality of principle food sources for child feeding
Food based pattern survey
DISTRICT
COMMUNITY
HOUSEHOLD

10. Nutritional Status of children (6-23 months)
District
Stunting
Underweight
Wasting
Iganga
25.3
14.8
2.9
Namutumba
26.6
11.4
4.1
Luuka
31.7
15.8
3.7
Hoima
29.5
7.7
1.3
Masindi
21.9
7.0
2.0
Kibaale
38.9
16.1
5.2
Total
28.9
12.6
3.1
UDHS, 2011–National
27.2
15.7
8.3
UDHS, 2011–Eastern
20.6
8.5
UDHS, 2011-Western
35.8
17.6
4.8

11. Prevalence of Anemia in Children (6-23 months)
Background characteristic
Any anemia
(<11.0 g/dl)
Mild anemia ( g/dl)
Moderate anemia ( g/dl)
Severe anemia
(<7.0 g/dl)
Number of children
Overall
81.0
27.7
47.6
5.1
1,407
Districts
Iganga
89.3
25.1
57.8
26.4
422
Namutumba
83.8
18.4
58.7
29.0
179
Luuka
91.0
24.8
57.1
9.0
210
Total Eastern region
88.5
23.6
7.2
811
UDHS, 2011
67.0
27.9
38.1
3.1
419
Hoima
69.6
31.6
34.2
3.8
237
Masindi
69.0
36.1
32.3
0.6
155
Kibaale
68.6
32.8
33.8
2.0
204
Total Western region
69.1
33.2
26.9
2.3
596
UDHS, 2011, Western
48.8
26.0
14.9
2.2
285
UDHS 2011, National
62.3
25.2
34.4
2.8
759

12. IYCF Practices Initiation of breast feeding within one hour of birth
Background characteristic
Initiation of breast feeding within one hour of birth
Exclusive breastfeeding
Timely start of complementary foods from age 6 months
Minimum Meal Frequency
District
Iganga 65 62 46
52.7
Namutumba
57.4 56 44
48.4
Luuka
61.1 54 43
47.1
Hoima
45.4 74 50
46.6
Masindi
44.2 73
51.6
Kibaale
55.9 69 51
44.9
UDHS 2011
52.5 63 67
44.8

13. KEY FINDINGS FROM THE KAP SURVEY
BF and complementary practices do not meet the ideal practices for most of the IYFC indicators assessed
Less than a third meet their daily energy requirement and less than 10% met their daily intake of key nutrients,
Very low consumption of iron rich foods, iron supplements and deworming medications, low consumption of animal source foods
Limited exposure to health messages related to IYFC

14. BARRIERS TO OPTIMAL IYCF PRACTICES –KAP
Limited knowledge in IYCF
Early initiation, Importance of colostrum, When and what complementary feeding to start with, Recommended number of meals per day, Nutrient and energy dense foods, How to increase feeds during and after illness
Myths and misconceptions such as
First thick yellow milk is dirty , pre-lacteal feeds strengthen the digestive system , Breast milk does not satisfy a child less than 6 months, When the baby eats solid food, it doesn’t need breastfeeding, Thicker foods constipate children
Variety of foods is limited
Selling of most food by households

15. 2. Optimizing complementary food recipes
Using Optifood : A software program that uses linear programing and mathematical optimisation to generate the nutritionally best diet for specific populations and test food based recommendations.
using specific criteria such as locally available foods; dietary patterns; cost.
Optifood can select the best diets from a range of possible combinations up to 1000 combinations
The software identifies the lowest-cost combination of local foods that will meet or come as close as possible to meeting nutrient needs of specific target groups and local diets.

16. Optifood Food Composition Table
1- Primary source: HarvestPlus FCT for Eastern and Central Uganda (Hotz et al., 2012.
2-United States Dietary Association (USDA)
Rationale
Updated regularly
Relatively few missing data
Reliable in terms of quality Data for raw and cooked forms for many foods

17. HOW OPTIFOOD WAS USED
Identified nutrients whose requirements are difficult to meet using locally available foods (problem nutrients)
Identified the best local food sources of multiple nutrient problem nutrients
Formulated food-based recommendations (FBRs) for specific target groups
Combined and tested FBRs (dietary patterns, cost, nutritional adequacy)
Identified the lowest cost, nutritionally best diet, given local food availability and usual dietary patterns

18. OUTPUTS The target groups for which recipes were developed
6-8, 9-11, and months-old breastfed children and months Non breastfed children from Eastern Uganda
6-8, 9-11, months-old breastfed children and 12-23months Non- breastfed children from Western Uganda
NB: Recipes for 8 different groups in total.

19. 3. Testing for feasibility of recipes through TIPs:
Tested feasibility and acceptability of the FBR (recipes) developed using household trials in the two regions. What is easier to implement for mothers and families, which is more difficult and motivations for their use
The results informed modifications to the recipes in terms of food promoted, preparation, frequency, serving size and seasonality of access.
The recipes trial results used to inform the development of the SBCC strategy, incorporating motivations to putting the recipes into practice and barriers and facilitators to implementation and potential strategies for overcoming these barriers

20. RECIPES FOR CHILDREN IN THE EASTERN AND WESTERN REGIONS

21. 4. Developing and rolling out SBCC strategy:
Based on the optimized and tested complementary feeding recipes and the KAP survey, SBCC materials - flip charts, posters of recipes, radio spots - were generated to achieve behavior change and strategies developed to reach the care givers through influential stakeholders within health facilities, communities and through media.
The SBCC strategy with food based messages is tailored to the specific context of the targeted population.

22. SBCC strategy and communication channels
Capacity building on DHIS2
Supportive supervision
Development of the recipes
Development of the SBCC strategy
Development of the IEC materials
Monitoring and reporting
Orientation of stakeholders
Orientation of science teachers
Radio programs
Management of malnutrition
Recording and reporting
BCC on IYCF
Health activation
Cooking demonstration
Growth Monitoring and Promotion
Community dialogues
Food fairs
National level
Districts
Health facility
Community
Recipes

23. SUSTAINABILITY:
The intervention is in line with UNAP strategy and MOH priority areas.
All nutrition stakeholders were involved through out the steps including; surveys, capacity building to gather and utilize local data to design effective, targeted interventions.
Health systems were strengthened following the structures in place.
Recipes are based on locally available foods

24. ACKNOWLEDGEMENTS WHO Uganda, AFRO and HQ Staff
Steering Committee (Nutrition Working Group)
Ministry of Health- Nutrition Unit
REACH
Mwanamugimu Nutrition Team
IBFAN Team
Service for Generations (SFG) International Study Team
Communication for Development Foundation Uganda Team / Feed the Children Uganda
District Local Governments, Communities in all the six ANI districts.

25. Appropriate Breastfeeding and Complementary Feeding is Key

26. FOR GOD AND MY COUNTRY Thank you for your attention