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IYCF Knowledge, Attitude and Practice Survey

Kohat District, KP Province, Pakistan

Action Against Hunger|ACF International

Nutrition

IYCF KAP Survey

Pakistan

September 2014

ACF IYCF KAP Survey in Kohat district of KP Province, Pakistan, September 2014

Acknowledgements

This survey was made possible by the efforts and hard work of many individuals both

inside and outside ACF International. The team would like to acknowledge and thank the

Khyber Pakhtunkhwa (KP) province department of health nutrition cell and Kohat district

for their involvement and continued support.

This survey could not have been completed without the commitment and hard work of ACF

International capital office and Peshawar field office management team, logistics,

administration, and Program Quality and Accountability (PQA) department of Peshawar

and Kohat. The team would also like to recognize Maureen Gallagher, the Nutrition &

Health Advisor at HQ New York, who supported the ACF team in Pakistan in all technical

aspects of this KAP assessment, Mr. Shahid Fazal, country Head of the Nutrition

Department who has been instrumental in the assessment, and, the survey team

(supervisor, data analyst, team leaders, and enumerators) who put all their efforts to

produce quality data.

Our heartfelt appreciation goes to the community elders who authorized entry into

community settlements, the opinion leaders, other senior members of the communities,

and to the mothers and caretakers of children who gave their time to our survey team.

The mothers and caretakers of the Khyber Pakhtunkhwa province made this survey

possible by responding to the questions raised by the survey team.

Statement on Copyright

© Action Against Hunger | ACF - International

Unless otherwise indicated, reproduction is authorised on condition that the source is credited. If reproduction or use of texts and visual materials (sound, images, software, etc.) is subject to prior authorization, such authorization will render null and void the above-mentioned general authorization and will clearly indicate any restrictions on use.


Table of Contents

1. Executive Summary ........................................................................................... 5

2. Background ..................................................................................................... 7

3. Survey Objectives ............................................................................................. 8

3.1 General objective ....................................................................................... 8

3.2 Specific Objectives ..................................................................................... 8

4. Methodology .................................................................................................... 9

4.1 Study area ................................................................................................ 9

4.2 Study period .............................................................................................. 9

4.3 Study design .............................................................................................. 9

4.4 Study population ........................................................................................ 9

4.5 Sample size ............................................................................................... 9

4.6 Sampling procedures ................................................................................. 10

4.6.1 Cluster selection: ................................................................................. 10

4.6.2 Household selection: ............................................................................. 10

4.6.3 Children selection: ................................................................................ 10

4.6.4 Data to be collected .............................................................................. 10

4.6.5 Survey Tool ......................................................................................... 10

5. Organization of the survey ................................................................................ 10

5.1 Meeting with the Province and District authorities ........................................... 10

5.2 Data collectors recruitment and training ........................................................ 11

5.3 Team work in the field ............................................................................... 11

5.4 Data Quality ............................................................................................ 11

5.5 Ethical considerations ................................................................................ 11

5.6 Data entry, analysis, reporting ..................................................................... 11

6. Result .......................................................................................................... 11

6.1 Demographic characteristics of sampled children ............................................. 11

6.2 Demographic characteristics of mothers/caretakers of sampled children ............... 12

6.3 Infant and young child feeding knowledge and attitude ..................................... 13

6.4 Infant and Young Child Feeding Practices ....................................................... 15

6.5 Food Security and livelihood ....................................................................... 18

6.6 Water, Sanitation and Hygiene ..................................................................... 19

6.7 Health .................................................................................................... 20

7. Discussion ..................................................................................................... 21

8. Conclusion .................................................................................................... 21

9. Recommendations ........................................................................................... 24

6. Annexes ....................................................................................................... 26

Annex 1: Survey schedule ...................................................................................... 26

Annex 2: Selected clusters/Villages for IYCF KAP Survey ............................................... 27

Annex 3: The main IYCF indicators collected and the source of data ................................. 28

Annex 4: Comparison of the results with national and regional figures .............................. 30


ACRONYMS and ABREVIATIONS

ACF Action Contre La Faim/ Action Against Hunger

CMAM Community Based Management of Acute Malnutrition

DHO District Health Office

DoH Department of Health

EBF Early Breastfeeding

EIBF Early Initiation of Breastfeeding

ENA Emergency Nutrition Assessment

FGD Focus Group Discussion

FSL Food Security and Livelihood

HQ Head Quarter

IDP Internally Displaced People

IYCF Infant and Young Child Feeding

IVAP Internally Vulnerability Assessment & Profiling

KAP Knowledge, Attitude and Practice

KP Khyber Pakhtunkhwa

NRSP National Rural Support Program

TICF Time of Initiation of Complimentary Feeding

UC Union Council

WHO World Health Organization

WASH Water, Sanitation, and Hygiene


1. Executive Summary

Kohat district is located 180km from Islamabad and 65km from Peshawar (the provincial

capital). ACF International supports the Department of Health (DoH) in Community

Management of Acute Malnutrition (CMAM) in 5 Union Councils (UCs) with funds from the

Humanitarian Aid and Civil Protection department of the European Commission (ECHO).

This two year ECHO project integrates food security and livelihoods (FSL), Infant and

young child feeding (IYCF) and nutrition education, as well as Water, Sanitation and

Hygiene (WASH) activities.

This study was commissioned by ECHO to understand the impact of ACF’s efforts in the

Kohat District and to evaluate the successes and/or shortcomings of ACF’s current Infant

and Young Child Feeding (IYCF) program. A baseline survey was carried out in September

of 2013 in 5 UCs in the Kohat district where ACF would begin its IYCF project integrated

along side the CMAM program. The baseline survey assessed the communities Knowledge,

Attitudes, and Practices (KAP) on IYCF. In September of 2014, a follow-up survey was

conducted to monitor and evaluate the programs progress. The results of the follow-up

survey will assist ACF in identifying the strengths and weaknesses of the IYCF programs

and enable ACF to effectively tailor the program accordingly.

The results from the 2013 and 2014 surveys underscore that most of the IYCF practices

remain below the national average1, but that progress has been made between 2013 and

2014 in addressing some of the IYCF practices. The main findings are outlined below:

Information about IYCF practices; early initiation of breastfeeding (EIBF), early breastfeeding (EBF), and time of initiation of complimentary food (TICF), originate from similar sources. Within the surveyed communities, there has been a significant increase, (14 percent), in hearing messages from IYCF promoters from 2013 to 2014. There has also been a 5-7 percent increase in people hearing IYCF practice messages at community events.

There has been little change in when mothers/caretakers believe that breastfeeding should begin after a child is born. In 2013, 59.6 percent of mothers/caretakers believed that breastfeeding should be started immediately after the child is born. This increased by only 1.5 percent in 2014 to 61.1 percent. Of note, there was a 14 percent increase in women hearing messages about EIBF from 2013 to 2014.

In 2013, nearly half, (45.7 percent), of the mothers/caretakers knew that a child should be exclusively breastfed for the first six months of his/her life. This increased by almost 20 percent in 2014, to 64 percent of mothers/caretakers.

In 2014, there was a 16 percent increase in the mothers/caretakers knowledge of the appropriate age, (6 months), of initiating complementary food, from 47.3 percent in 2013 to 63 percent in 2014.

In 2013 and 2014, the most common contact persons for IYCF information in the

surveyed community were nurses/dispensers and family/friends.

1NNS Pakistan, 2011


The proportion of children 0-23 months who were put to the breast within one hour

of birth dropped by 9 percent from 2013 to 2014. However, there was a 3 percent

increase in the women putting their child to their breast within 3 hours of birth.

There was a 6 percent increase in the number of women not breastfeeding within the first 24 hours of giving birth from 2013 to 2014.

The proportion of infants aged 0-5 months who are exclusively breastfed increased from 81 percent in 2013 to 94 percent in 2014.

Appropriate introduction of solid, semisolid, or soft foods was 86 percent in 2014 up from 69 percent in 2013. This indicates that children aged 6 to 9 months are given complementary feeding as per the WHO recommendation.

There was almost no change in the number of food groups consumed among children aged 6-23 months between 2013 and 2014.

There was a 2 percent drop from 2013 to 2014 for the number of children 6-23 months who were fed appropriately, based on the recommended IYCF practices, (18 percent to 16 percent, respectively).

The proportion of children aged 0-23 months who received iron-rich food or iron-fortified food (specially designed for infants and young children, or that is fortified in the home) remains low. Only 18 percent of all children surveyed under the age of two years had received iron rich food in 2014, a 7 percent decrease from the year before.

The number of mothers/caretakers feeding their child from a bottle decreased by 6 percent from 45 percent in 2013 to 39 percent in 2014.


1. Background

The 24 districts making up the Khyber Pakhtunkhwa (KP) province are: Chitral, Upper Dir,

Lower Dir, Swat, Kohistan, Shangla, Batagram, Buner, Manshera, Malakand, Maradan,

Swabi, Haripur, Abottabad, Charasadda, Peshawar, Nowshera, Kohat, Hangu, Karak,

Bannu, LakkiMarawat, Tank, and DI Khan.

Kohat district is sub-divided into 33 Union Councils (UCs) and is bordered by Peshawar

district in the north, Hangu and Kurak in the south, Nowshera in the east, and Oarkzai

Agency in the west.

Figure 1: Map of Kohat District and ACF nutrition program implementation union council, August 2013

Kohat is the 14th most highly populated district of KP. It has a total population of

1,043,850 and under five population of 177,455 (17%)2. Military operations in Bajur district

and insurgency activity throughout 2011 caused a significant number of displaced to Kohat

District. The majority of Internally Displaced People (IDP) stays with host communities,

stretching the capacity of households who employ distress mechanisms to overcome the

additional strain. During 2012 Kohat received part of the newly displaced population from

Khyber Agency, thus the pressure on traditional livelihoods in combination with structural

vulnerabilities has had the effect of reducing the overall quality of life and resilience for

the region. Kohat has very little Water, Sanitation, and Hygiene (WASH)

infrastructure/services. Based on the Internal Vulnerability Assessment and Profiling

(IVAP) statistics, Kohat hosts the fourth largest population of IDPs in KP, with 20,913

2District Health Office


families. As of March 2014, 22 percent of the IDPs currently residing in Kohat did not want

to return to their area of origin.3

ACF International supports the Department of Health (DoH) in Community Management of

Acute Malnutrition (CMAM) in 5 UCs with funds from the Humanitarian Aid and Civil

Protection department of the European Commission (ECHO). This two-year ECHO project

integrates food security and livelihoods (FSL), infant and young child feeding practices

(IYCF) and nutrition education as well as Water, Sanitation, and Hygiene (WASH) activities.

The current program is designed to ensure the provision of lifesaving nutrition services for

acutely malnourished children, pregnant and lactating women in camps and off-camps; to

prevent poor nutritional outcome through rigorous promotion of optimal infant feeding

practices, proper hygiene/sanitation and improved maternal nutrition; micronutrient

supplementation and nutrition education on locally available foods; the setting up of a

robust reporting and information system and monitoring mechanism; and an emphasis on

capacity development of health care providers for all target areas to be implemented in

partnership with the DoH and provincial nutrition cells in KP & FATA.

In the backdrop of this and as a follow-up to the efforts implemented in Kohat district,

there was a need to determine the programs impact through an assessment of knowledge,

attitude and practices of the community with regards to IYCF practices.

2. Survey Objectives

2.1 General objectives

The main objective of the surveys was to KAP of IYCF practices of the population of Kohat

district located in the KP province. The baseline survey conducted in 2013 established a

benchmark for the program’s implementation while the follow-up survey conducted in

2014, assessed the impact of the program thus far.

2.2 Specific Objectives

To assess the programs impact on IYCF practices from baseline, September 2013, to one year after implementation, September 2014 through quantitative data obtained using WHO4 IYCF indicators

To compare the types of food consumed by children aged 6-23 months with in the 24 hours prior to the survey, and hence estimate the food diversity within the last 24 hours

To assess factors related to IYCF practices and identify areas of improvement and/or regression from 2013 to 2014

To evaluate ACF’s program impact on IYCF practices thus far and make programmatic changes as needed

3Internally Displaced Person Vulnerability and Assessment Profiling (IVAP), March 2014 4Indicators for the assessment of infant and young child feeding practice, WHO 2010


3. Methodology

3.1 Study area The survey was conducted in 5 UCs of Kohat District (Urban 4, Urban 6, Jerma, Bilitang,

and Kahrimatto) where ACF was implementing its IYCF Program (See Figure 1).

3.2 Study period The baseline survey was conducted from September 5th-9th, 2013 and the follow-up survey

was carried out from September 20th-26th, 2014.

3.3 Study design The 2013 and 2014 surveys were cross sectional studies with two-stage cluster sampling

using the 'WHO model for vaccination survey'. Villages are considered as the smallest

geographical unit (clusters). The 2013 and 2014 surveys were not part of a longitudinal

study, and, therefore, did not enlist the same participants.

Focus Group Discussions (FGD) were conducted in every selected village. FGDs were carried out with pregnant and lactating women and mothers who had children less than two years of age.

3.4 Study population 1. Mothers with children under two years of age were interviewed in order to estimate

IYCF practices. Relevant information was gathered from this population in all selected

villages.

2. Households: Household food security and WASH IYCF related questions were asked in

selected households in the selected villages.

3.5 Sample size The sample size was derived using the formula:

𝑁 = 2 ⌈t2(p × q)

𝑑2⌉

The parameters used for the calculation are listed in Table 1:

Table 1: Parameters used in calculation of sample size calculation IYCF KAP.

Parameter Definition

Value

N Sample size:

𝑁 = 2 ⌈t2(p × q)

𝑑2⌉

𝑁 = 2 ⌈1.962(0.5 × 0.5)

0.12⌉

=192.08 rounded up to 210

t Error risk. t=1.96 at 95% confidence interval

p Expected prevalence Used 50% corresponding to p=0.5 as proportion

q 1-p Thus q=1-0.5=0.5


d Degree of accuracy (10% for ACF KAP survey) and given as 0.1 proportion

The sample size was estimated at 192 households and rounded up to 210 to account for a

10 percent non-response rate. This came down to 30 clusters of 7 people each (WHO

Model5 used for vaccination surveys).

3.6 Sampling procedures

3.6.1 Cluster selection: Each village in the district was considered as a cluster and the clusters to be sampled were

selected with probability proportionate to size (PPS). All villages of the district along with

their respective populations were entered into Emergency Nutrition Assessment software

(ENA); the software automatically selected the number of clusters to be included in the

study.

3.6.2 Household selection: Sample households were selected using simple random sampling. This household selection

method was chosen for its objectivity, ease of monitoring, and transparency. Preliminary

contact with local village leaders was made to prepare household lists in each village.

Enumerators used a random number table to select the households from the sampling

frame (household list).

3.6.3 Children selection: Within selected households, all children under the age of two years were included in the

survey.

3.6.4 Data to be collected: The survey collected information regarding food security and livelihoods (FSL), infant and

young child feeding (IYCF) and nutrition education, and Water, Sanitation and Hygiene

(WASH) activities.

3.6.5 Survey Tools: The age of the children was assessed using a local events calendar prepared with the local

community. The data collection formats were adapted from the WHO 2010 guideline for

the assessment of infant and young child feeding practices6. All the survey tools were

translated to the local language, pretested, and improved to strengthen data collection.

4. Organization of the survey

4.1 Meeting with the Province and District authorities

Before the survey was conducted relevant provincial and district sector offices were

briefed about the background, purpose, objectives, and methods for the survey and their

cooperation secured. The authorities were requested to officially inform the communities

(villages) where the assessment took place. Relevant sectors were invited to supervise the

training and data collection and recruit additional data collectors as needed.

5 The Expanded Program on immunization (EPI) method 6 Assessment of IYCF guideline 2010, WHO


4.2 Data collectors recruitment and training Five teams of three people each (two female and one male), one team leader and two

data collectors collected the data.

Prior to the data collection, two days of training was given to the enumerators and team

leaders on data collection procedures, interviewing, and assessment of child age. The data

collection forms and questionnaires were pilot tested in villages not selected to be part of

the larger survey, to ensure that the interviewers and respondents understood the

questions and that interviewers followed protocol.

4.3 Team work in the field Team leaders with a wealth of experience, guided the teams. The team leaders were

responsible for the overall quality of activities and teams performance. Additionally, a

survey manager and supervisors from ACF, representatives from the DHO, and the

provincial health department closely supervised the teams throughout the survey.

4.4 Data Quality Each questionnaire and data sheet were checked each night prior to data entry. The data

was entered on a daily basis and missing data identified. Based on the results, supervisors

provided feedback to the enumerators every day before enumerators departed to the next

day of data collection.

5.3 Ethical considerations

All relevant provincial and district stakeholders were informed of the study objectives,

methods, and their roles and their permission sought. Verbal consent was sought from

caretakers of the children and household heads for voluntary participation in the survey.

The identity of the participants was kept anonymous. Those who did not wish to

participate in the survey were respected for their decision. All the information collected

was treated strictly confidential.

5.4 Data entry, analysis, reporting

Data entry and analysis were done using Small Stata version 12.0 for Mac and Microsoft

Excel for Mac, version 14.4.6, 2011.

6. Results

6.1 Demographic characteristics of sampled children

In 2013, 214 households were interviewed, compared to 211 in 2014. The demographics of

the sampled children remained relatively unchanged between 2013 and 2014. In 2013, 185

children were sampled, 92 male and 93 female, comparatively, in 2014, 199 children were

sampled, 103 male, and 86 female. The average age of children surveyed was 11.4 months

in 2013 and 10.6 months in 2014.


Table 2: Demographic characteristics of surveyed children, September 2013 and September 2014, Kohat District.

2013 n 2013 % 2014 n 2014 %

Sex

Male 92 49.3% 103 54.5%

Female 93 50.3% 86 45.5%

Age (months)

0 - 5 44 23.8% 51 26.98%

6 - 8 26 14.1% 25 13.23%

9 - 11 22 11.9% 25 13.23%

12 - 17 48 25.9% 49 25.93%

18 - 23 45 24.3% 39 20.63%

6.2 Demographic characteristics of mothers/caretakers of sampled children

The demographic characteristics of mothers/caretakers of sampled children remained

relatively unchanged from 2013 to 2014. There was a 5 percent increase in the number of

women/caretakers receiving no formal education or Madarsa, 62.1 percent in 2013, to

67.2 percent in 2014. In 2013, 37 percent of women/caretakers were able to read and

write. This decreased to 33 percent in 2014.

Table 3: Background characteristics of mothers/caretakers Kohat district, September 2013 and 2014

2013 n 2013 % 2014 n 2014 %

Education status (2013,N=214; 2014, N=191)

No education 133 62.1 127 67.2%

Formal education/"Madarsa" 81 37.9 62 32.8%

Highest grade in formal education or "Madarsa" (2013, N=81; 2014, N=62)

Primary 30 37.0% 19 30.6%

Middle 14 17.3% 13 21.0%

Metrics 14 17.3% 22 35.5%

Bachelor 9 11.1% 7 11.3%

Master 7 8.6% 1 1.6%

"Madrasa" 7 8.6% 0 0%

Marital status (2013, N=214; 2014, N=189)

Married or living with their partner 214 100% 188 99.5%

Widowed 0 0 1 .5%


6.3 Infant and Young Child Feeding Knowledge and Attitudes

6.3.1 Early Initiation of Breastfeeding (EIBF) There was a 4 percent increase between 2013 and 2014 in the number of women who had

ever breastfed their child, 72 percent, to 76 percent, respectively. In 2013, 59.6 percent,

of mothers/caretakers felt that breastfeeding should be started immediately after the

child is born compared to 61.1 percent in 2014. There was no significant difference,

(p=.265), in the time it took after birth for women to begin breastfeeding from 2013 to

2014. In 2014, 82 percent of mothers reported that they heard a message about early

initiation of breastfeeding, a 12 percent increase from 2013. This increase is in large part

due to IYCF promoters, which increased from 0 percent to 14 percent in 2014.

Places where EIBF messages were heard

2013* 2014*

Figure 2: Common places where messages about exclusive breastfeeding were heard, September 2013

compared to September 2014, Kohat district, *not shown: 2013, Community Mobilizer, 0%, IYCF Promoter, 0%;

2014, Community Leader, 0%

Time of pregnancy and delivery are very common contact times to pass information to

mothers/caretakers about EIBF. In 2013, there was an 8 percent decrease in mothers

hearing the message at birth, from 67 percent to 59 percent. Alternatively, there was a 20

percent increase, 31 to 51 percent of mothers hearing the message at delivery between

2013 and 2014, respectively. Home visits and health facility visits remain adequate

channels of information with 51 percent, (7 percent decrease from 2013) of mothers

receiving breastfeeding messages during a health facility visit and 43 percent, (up from 40

percent in 2013), during home visits. Of note, there was a 4 percent increase in mothers

hearing the message at community events.

6.3.2 Exclusive Breastfeeding (EBF) In 2013, nearly half of the mothers/caretakers, (45.7 percent), knew that a child should

be exclusively breastfed for the first six months of his/her life. This increased by almost

20 percent in 2014 to 64 percent. There was no significant difference in how long a

mother believed her baby should receive breast milk between 2013 and 2014, (p=.78).


Figure 3. Number of month’s women/caretakers think they should exclusively breastfed their child for, September 2013 compared to September 2014, Kohat District.

There was a 23 percent increase in the number of women/caretakers who heard the

message about appropriate exclusive breastfeeding, 51 percent to 74 percent, 2013 to

2014, respectively; of those who have heard the message 14 percent of them had heard it

from an IYCF promoter, a 14 percent increase from 2013. In 2014, the most common

contact points for women to hear the EBF message were during pregnancy 58.8 percent

(72.2 percent in 2013), and at delivery, 30 percent, (a 16 percent increase from 2013).

6.3.3 Timely initiation of Complementary Feeding (TICF) From 2013 to 2014, there was a 16 percent increase in the knowledge of the appropriate

age to initiate complimentary feeding, 47 percent to 63 percent. Additionally, 14 percent

more mothers had received the message about complimentary feeding in 2014, 84

percent, compared to 2013, 60 percent. Similar to messages about EIBF and EBF, the most

common source of TICF information was from a health facility or home. There is an overall

trend from 2013 to 2014 of messages increasingly being heard at home or community

events.

Figure 4: Source/place of child feeding information, Kohat District, September 2013 compared to September

2014.

0

50

100

150

200

250

1 3 4 5 6 7 8 9 10 12 18 24 30

# o

f R

esp

on

de

nts

Months

# of months women believe they should EBF

2014

2013

58

1

40

1

65

3

32

0

59

4

37

0

51

5

43

1

46

7

46

1

42.5

7.5

50

0 0

10

20

30

40

50

60

70

Health Facility Community Event Home Other

Sources of Messages

2013 EIBF 2013 EBF 2013 TICF 2014 EIBF 2014 EBF 2014 TICF


6.4 Infant and Young Child Feeding Practices

6.4.1 Initiation of breastfeeding within one hour of birth

Sixty-two percent of the interviewed women in 2014, reported starting breastfeeding

within three hours of giving birth compared to 59 percent in 2013 (Figure 5). Of note,

there was a 6 percent increase in the number of women not breastfeeding within the first

24 hours of giving birth, 25 percent in 2013, to 31 percent in 2014. There was a

statistically significant difference in the time women thought breastfeeding should be

initiated between 2013 and 2014, (p=.041), with more women believing it should begin

later in 2014 compared to 2013.

Figure 5: Time of initiation of breastfeeding September 2013 compared to September 2014, Kohat district

6.4.2 Exclusive breastfeeding

It is recommended that children should be exclusively fed breast milk during the first six

months, as it provides all the necessary nutrients for the infants’ growth and protects the

child from illness. Compared to 2013, there was a 13 percent increase in the number of

mothers of children aged 0-5 months exclusively breastfeeding their child 24 hours

preceding the study, from 81 percent in 2013 to 94 percent in 2014. There was a

significant difference in the number of times a woman breastfed her child in the 24 hours

prior to the study between 2013 and 2014, (p=.035), (with women breastfeeding their

child more in 2014.)

Breast milk in the first three days of birth, colostrum, contains antibodies and nutrients

required to support the newborn during this period. In 2013, in the surveyed community,

one out of five mothers (n=35) disposed of the colostrum, comparatively, in 2014, one out

of every four mothers, (n=46) disposed of the colostrum.

6.4.3 Minimum dietary diversity

0 1 2 3 4 5 6 7 8 9 10 11 12 ≥24

2014 30 22 6 3 1 1 2 1 1 1 0 0 1 31

2013 39 2 11 7 3 3 1 1 1 0 1 0 6 25

0

10

20

30

40

50

60

70

80

Pe

rce

nta

gae

Time to Initiate Breastfeeding


There was almost no change between 2013 and 2014 and the number of food groups

consumed among children aged 6-23 months. (See Figure 6)

Figure 6: Dietary diversity of children 6-23 months, September 2013 compared to September 2014, Kohat

District

There is little change in the percentage of children who consumed foods from each food

group between 2013 and 2014. (See Figure 7). Of note, legumes, flesh foods, and eggs are

rarely consumed compared to grains/roots, dairy products, and Vitamin A rich fruits.

There is also a 7 percent increase in other fruits consumed, as well as a 19 percent

decrease in the amount of eggs consumed.

Figure 7: Percentage of children who consumed items from each food group in the previous 24 hours, September, 2013 compared to September 2014, Kohat District

6.4.4 Minimum meal frequency

The WHO recommends that breastfed children consume solid, semi-solid, or soft foods at

least twice a day between the ages of 6-8 months and at least 3 times a day between the

0

5

10

15

20

25

30

35

0 1 2 3 4

Pe

rce

nta

ge

Food Groups Consumed

2013

2014

0

20

40

60

80

100

Grains/Roots Legumes/Nuts Dairy Flesh Foods Egg Vit. A Fruits Other Fruits

Pe

rce

nta

ge

Children who Consumed Foods from each Food Group

2013

2014


ages of 9-23 months7. In Kohat District, between 2013 and 2014, there was a 9 percent

increase of children aged 6-23 months who met this requirement (2013, 68 percent; 2014,

77 percent)

6.4.5 Minimum acceptable diet

Children 6-23 months are considered to have an acceptable diet when they are breastfed

or are given milk, have the appropriate food diversity score, and have the minimum

required number of meals per day. In the studied population, although meal frequency

was moderate8, the number of food groups consumed was not (less than four). In 2013,

only 18.4 percent of children aged 6-23 months were consuming the minimum acceptable

diet, this number decreased to 16 percent in 2014.

6.4.6 Consumption of Iron-rich foods

Iron-rich foods include flesh foods (meat and organ) and fish. In 2013, around 25 percent

of children aged 6-23 months consumed flesh/fish foods the day preceding the study, this

number dropped to 18 percent in 2014.

6.4.7 Consumption of Vitamin A rich fruits and vegetables

Vitamin A is an essential micronutrient for the immune system. Severe Vitamin A

deficiency can cause eye damage, increase the severity of infections such as measles and

pneumonia in children and slows recovery. Vitamin A is found in breast milk, liver, eggs,

mangos, papayas, carrots, and dark green vegetables. In 2013, in the surveyed community

only half of children aged 6–23 months, had consumed vitamin A rich fruits and vegetables

the day preceding the study compared to a little over one-third of children in 2014.

6.4.8 Children ever breastfed, continuation of breastfeeding at one and two years old

In 2014, 98 percent of children had been breastfed at some point, a 3 percent increase

from 2013. In 2013, 72 percent of surveyed children were being breastfed at the time of

the survey, compared to 62 percent in 2014. Of those mothers who were not currently

breastfeeding in 2014 (38 percent, n=34), there were three main reasons, the mother was

ill/weak (26 percent), there was not enough milk (37 percent), or the mother became

pregnant again (35 percent). (Figure 8). There was not a significant difference in the age

in which mothers planned to breastfeed their child until, between 2013 and 2014, (p=.62).

7 http://www.who.int/mediacentre/factsheets/fs342/en/index.html 8The recommended food frequency is 2 or more times per day for children 6-8 months and 3 or more times per day. Moderate= >50% of the subject practicing the behavior.


Reasons for Breastfeeding Cessation

2013 2014

Figure 8: Reasons for cessation of breast-feeding before child reaches age of 23 months, September2013

compared to September 2014, Kohat district

6.4.9 Timely introduction of solid, semi-solid or soft foods and complementary food

The two indicators denote the same features but they refer to different age groups: 6-8

months and 6-9 months respectively. Breast milk can adequately fulfill the needs of a

newborn up to 6 months, but after six months they need additional food supplement. In

the surveyed community, 14 percent of children were not started with complementary

food at 6–9 months old in 2014, a 15 percent drop from 2013. There was a significant

difference in the age in which mothers introduced complimentary food between 2013 and

2014, (p=.001). Appropriate introduction of solid, semisolid, or soft foods was 86 percent

in 2014 up from 69 percent in 2013.

6.4.10 Bottle feeding

Feeding young children using a bottle is common in the survey community. There was a 6

percent decrease in the number of children being fed with a bottle from 2013, to 2014, 45

percent, to 39 percent, respectively.

6.5 Food Security and livelihood

The population of the surveyed community remained relatively unchanged between 2013

and 2014. In 2013, 91.3 percent of the households (HHs) were residents of the district,

while 8.7 percent were Internally Displaced Persons (IDPs), compared to 98 percent and 2

percent, respectively. All of the IDPs were displaced between 2008 and 2009. Among the

211 surveyed HHs, 93 percent of them were male-headed households, a 3 percent drop

from 2013.

Almost all of the respondents in 2014, 92 percent, replied that they do not have enough

food stored for the next three months, a 10 percent increase from 2013. 85 percent of the

households plan to buy their food for the next three months’ consumption, an increase of

15 percent from 2013.


The most common income generating activities in the surveyed villages for 2013 and 2014

are daily work and salaried positions. Of note, there was a 9 percent decrease in the

surveyed community who sell their crop production as a source of income. Income

generating activates in the “Other” category include, sale of live stock, sale of livestock

products, sale of fruit, coffee, and sugarcane, sale of handicrafts, loans, and sale of relief

food. (Figure 8)

Figure 9. Household income of the Kohat District, September 2013 and 2014.

In 2013, nearly half of the surveyed communities reported that the physical condition of

their livestock was poor, in 2014; this was greatly reduced to about one fifth of those

surveyed. The most common reason for poor livestock condition was attributed to lack of

grazing in both 2013 and 2014.

Land cultivation continues to be common in the surveyed community, with most of those

surveyed having cultivated their land by at least 50 percent in 2014, consistent with 2013

findings.

Agricultural support from the National Rural Support Program (NRSP) has increased in the

surveyed community from 2013. One third reported receiving agricultural support, with

almost all reporting receiving seeds.

6.6 Water, Sanitation, and Hygiene

Focus Group Discussions

Focus group discussions carried out in 2013 and, again in 2014, revealed an increase in

communities receiving water from “relatively improved sources”9. In 2014, almost all

participants received their water from protected springs and wells, or piped water. A

small number of participants reported using "unsafe sources"10 like surface water, river,

unprotected springs and wells. A large proportion of those surveyed in 2014, reported

9Relatively improved source, which does not necessarily mean the water is tested or treated. 10 Unsafe source indicates a relatively unsafeness than the content of the water in these sources.

05

10152025303540455055

CropProduction

SmallBusiness

Remittance Salary Daily Work Other

Household Income

2013

2014


having a water source within 30 minutes of walking, this is consistent with those surveyed

in 2013.

In 2014, about one third of participants mentioned experiencing a shortage of drinking

water during the three months prior to the survey. The most common reasons were the

source became dry and/or the source became contaminated. These results are consistent

with those from 2013.

Household Interview Surveys

From the household interviews conducted in 2013 and 2014, there has been relatively no

change (91.3 percent in 2013, to 90.3 percent in 2014) in the surveyed communities

treating their drinking water. (The surveyed communities do not boil, filter, or treat their

water with chemicals). The hand washing practices of the communities in 2014 were

highest before eating, (91 percent), after going to the toilet, (81 percent), and before

preparing or cooking food, (81 percent). The surveyed communities had the lowest hand

washing practices in terms of before feeding a child, (40 percent) and after cleaning a

child’s bottom, (39 percent). The 2013 hand washing practices were not adequately

obtained and cannot be used for comparison. (See Figure 10).

Figure 10. The hand washing practices from the household survey, September 2014, Kohat District.

In 2013, only 59 of the households, (28.6 percent), practiced appropriate disposal of

children feces, this remained the same in 2014. However, there was a 7 percent increase

in those surveyed depositing the feces in the latrine immediately after defecation

between 2013 and 2014. This resulted in a 7 percent decrease of those scattering the

child’s feces around the compound. The remaining households either disposed of the feces

with other rubbish/trash or scattered it around their compound.

81%

51%

91%

40%

81%

39%

Before Preparing/Cooking

Before Serving Food

Before Eating

Before Feeding Children

After Going to Toilet

After Cleaning Child's Bottom

2014 Handwashing Practices


6.7 Health

During the three months before the survey conducted in 2014, a few of the communities

reported occurrence of disease outbreaks. The most common disease outbreak reported

was Acute Watery Diarrhea (AWD). These findings are similar to those in 2013.

In 2013 and 2014, most of the village’s vaccination campaigns occurred in August. The

most common vaccination given to children was Oral Polio Vaccine (OPV) with Vitamin A

being the second most common.

As in 2013, there was no report of unusual outmigration from all surveyed villages in 2014.

7. Discussion

Focus group discussions carried out in the surveyed communities revealed significant

beliefs and behaviors that shape IYCF practices. In the surveyed communities, there was a

range of times for when women began breastfeeding their child after birth. Many

respondents began breastfeeding right after birth, while a few mentioned beginning two

to three hours after birth. One respondent stated,

People in this community begin breastfeeding 2 to 3 days after the child is born.

In the surveyed communities, it was common for women to breastfeed their child

exclusively for 6 months and after 6 months introduce complimentary foods. Women

mentioned continuing breastfeeding until the child was 2 years old. Within the

communities, beliefs shaped which complimentary food were introduced. One mother

stated,

For a baby 0 to 12 months, we don't feed the baby hard, bitter, or cold food items as it will cause chest infections. For a baby aged 13 to 23 months, we don't feed them yogurt or oily food items.

Another mother stated,

From 6 months on, we don't feed the baby hard food items. The baby can get [diarrhea] if we feed them such items.

Malnutrition was occasionally sited as an issue within the surveyed communities.

Malnutrition was frequently attributed to poverty and lack of food. Additionally, a few

respondents noted that malnutrition was due to people’s lack of knowledge regarding

proper nutrition and viable food sources for nutrition rich-foods. One respondent stated,

Malnutrition is common in this district. Its main cause is poverty.

Another respondent stated,

Malnutrition is common in this district. We believe it’s because babies don't eat vegetables and they mostly eat snacks from the market which are unhealthy.

In the surveyed communities many respondents mentioned following IYCF practice advice

from their elders. A few respondents mentioned hearing IYCF messages elsewhere such as

ACF, educated females in their community, and/or doctors. However, women most often


stated that their elders, mothers, and mother-in-laws, influenced their IYCF practices the

most. One respondent stated,

We are not interested in getting information about IYCF practices as we follow what our elders tell us to do.

A few women mentioned having difficulty learning and/or hearing about IYCF practices. The most common barriers to hearing about IYCF practices were inability to leave the house without permission, lack of media, and long distances to hospitals. The focus group discussions revealed key behaviors and beliefs within the surveyed communities that drive IYCF practices. These are to be considered in the recommendations in order to further strengthen the IYCF programming in the intervetions area.

8. Conclusion

The primary objective of the 2014 survey was to monitor and evaluate the progress of

ACF’s IYCF program in five UCs in the Kohat district. The 2014 survey results were

compared to the baseline survey undertaken in 2013. The results underscore that most

IYCF practices remain below the national average11, but that progress is being made.

Information about child feeding practices; EIBF, EBF, and TICF, originate from similar sources. Within the survey communities, there has been a significant increase, (14 percent), in hearing messages form IYCF promoters from 2013 to 2014. There has also been a 5-7 percent increase in people hearing child feeding practice messages at community events.

There has been little change in when mothers/caretakers believe that breastfeeding should begin after a child is born. In 2013, 59.6 percent of mothers/caretakers believed that breastfeeding should be started immediately after the child is born. This increased by only 1.5 percent in 2014 to 61.1 percent. Of note, there was a 14 percent increase in women hearing a message about EIBF from 2013 to 2014.

In 2013, nearly half, (45.7 percent), of the mothers/caretakers knew that a child should be exclusively breastfed for the first six months of his/her life. This increased by almost 20 percent in 2014, to 64 percent of mothers/caretakers.

In 2014, there was a 16 percent increase in the mothers/caretakers knowledge of the appropriate age, (6 months), of initiating complementary food, from 47.3 percent in 2013 to 63 percent in 2014.

In 2013 and 2014, the most common contact persons for child feeding information in the surveyed community were nurses/dispensers and family/friends.

The proportion of children 0 to 23 months who were put to the breast within one hour of birth dropped by 9 percent from 2013 to 2014. However, there was a 3

11NNS Pakistan, 2011


percent increase in the women putting their child to their breast within 3 hours of birth.

There was a 6 percent increase in the number of women not breastfeeding within the first 24 hours of giving birth from 2013 to 2014.

The proportion of infants aged 0-5 months who are exclusively breastfed increased from 81 percent in 2013 to 94 percent in 2014.

Appropriate introduction of solid, semisolid, or soft foods was 86 percent in 2014 up from 69 percent in 2013. This indicates that children aged 6 to 9 months are given complementary feeding as per the WHO recommendation.

There was almost no change between 2013 and 2014 with regards to the number of food groups consumed among children aged 6-23 months.

There was a 2 percent drop from 2013 to 2014 for the number of children 6-23 months who were fed appropriately, based on the recommended IYCF practices, (18 percent to 16 percent, respectively).

The proportion of children aged 0-23 months who received iron-rich food or iron-fortified food (specially designed for infants and young children, or that is fortified in the home) remains low. Only 18 percent of all children surveyed under the age of two years had received iron rich food in 2014, a 7 percent decrease from the year before.

The number of mothers/caretakers feeding their child from a bottle decreased by 6 percent from 45 percent in 2013 to 39 percent in 2014.

The majority of respondents, in 2014, 92 percent, replied they did not have enough food in store for the coming three months. This is a 10 percent increase from 2013. Eighty-five percent of the households plan to buy their food for the next three months’ consumption, an increase of 15 percent from 2013.

In 2013, nearly half of the surveyed community reported that the physical condition of their livestock was poor, in 2014; this was greatly reduced to about one fifth of those surveyed. The most common reason for poor livestock condition was attributed to lack of grazing in both 2013 and 2014.

Agricultural support from the National Rural Support Program (NRSP) has increased in the surveyed community from 2013. One third reported receiving agricultural support, with almost all reporting receiving seeds.

In 2014, almost all participants received their water from protected springs and wells, or piped water. A small number of participants reported using "unsafe sources"12 like surface water, river, unprotected springs and wells.

From the household interviews conducted in 2013 and 2014, there has been relatively no change (91.3% in 2013, to 90.3% in 2014) in the communities treating their drinking water.

12 Unsafe source indicates a relatively unsafeness than the content of the water in these sources.


A large proportion of those surveyed in 2014, reported having a water source within 30 minutes of walking, consistent with those surveyed in 2013.

In 2014, about one third of participants mentioned experiencing a shortage of drinking water during the three months prior to the survey. The most common reasons were the source became dry and/or the sources became contaminated. These results are consistent with those from 2013.

The hand washing practices of the community in 2014 were highest before eating, (91 percent), after going to the toilet, (81 percent), and before preparing or cooking food, (81 percent). The survey community had the lowest hand washing practices, before feeding a child, (40 percent) and after cleaning a child’s bottom, (39 percent)

In 2013, only 59 of the households, (28.6 percent), practiced appropriate disposal of children feces, this remained the same in 2014. However, there was a 7 percent increase in those surveyed depositing the feces in the latrine immediately after between 2013 and 2014.

During the three months before the survey conducted in 2014, a few of the communities reported occurrence of disease outbreaks. The most common disease outbreak reported was Acute Watery Diarrhea (AWD). These findings are similar to those in 2013.

9. Recommendations 9.1 Infant and Young Child Feeding (IYCF)

There have been significant strides made in IYCF practices from 2013 to 2014 in the Kohat

District. However, most IYCF practices remain below the national average and require

further efforts on behalf of ACF to improve IYCF practices in the region. Below are

recommendations that address each area discussed above.

Early Initiation of Breastfeeding, Early Breastfeeding, Time of Initiation of

Complimentary Foods

o Continue messaging efforts for pregnant women but increase the scope of these

messages to include elders

o As per the FGDs, elders are the main influencers in IYCF

practices/decisions

o Increase messaging on importance of breastfeeding vs. bottle feeding

o Increase messaging on EIBF

o Dispel any beliefs or behaviors that might be associated with delaying

EIBF by addressing them head on

o Identify barriers to EIBF, EBF, and TICF

o An increase in the number of women hearing the message is not being

directly translated into action—it is imperative to determine the gap

between knowing and doing

o Identify enablers that can be used in promoting translation of

messaging into practice.


Diet Diversification: employ qualitative research methods (in-depth interviews,

focus groups, and observations)

o Determine current diets/eating habits

o Explore available food options within the community

o Identify barriers to diet diversification

o Explore cultural beliefs and attitudes about food/diet

Once the team has completed the qualitative research methods and analyzed the

current diet diversification field, the team should create nutritional health

behavioral change campaigns.

9.2 Food Security and Livelihood (FSL)

Continued Agricultural Support from the National Rural Support Program, (NRSP)

o Currently, 92 percent of the community relies on the market for food.

Diversifying the livelihood of the community can improve income-generating

sources, which can lead to a self-sustaining community.

9.3 Water Sanitation and Hygiene

A comprehensive behavior change communication program should be designed to

advocate and address the following issues in the study community:

o Appropriate time of hand washing, highlighting; after cleaning a child’s

bottom and before feeding children.

o Appropriate disposal of children’s feces and the dangers with improper

disposal

o Importance of drinking from safe water sources, and treating water before

drinking

9.4 Health

Appropriate integrated disease surveillance program should be designed/strengthened to control the outbreak of epidemics in the community.

Increased vaccination of children in the community; Oral Polio Vaccine, (OPV), and measles


7. Annexes

Annex 1. Survey schedule Activities Time frame 2013

Time Frame 2014

Travel to Kohat and Preparation for KAP

survey enumerators training

September 2 September 15

Training of KAP Survey enumerators in Kohat September 3-4 September 18-19

Data collection September 5-9 September 20-26

Finalize data entering and cleaning September 10-12 November 25-December

1

Data Analysis, preliminary report writing and

validation of preliminary report

September 13-October 2 December 1-12

KAP Survey final report writing and validation October 2-16 December 12-23


Annex 2. Selected clusters/Villages for IYCF KAP Survey

S/N UC name Village name HH size Cluster name

Remark

1 Urban 4

Gulshanabad 211 1

Jangalkhel 273 2

Sector 9 196 3

Sector 6 280 4

Gate # 4/ phase 2 284 5

Gate # 1 252 6

Sector # 4 366 7

Charbagh 200 RC

2 Urban 6

Rehman Baba Town St-1 82 8

Koi banda 179 9

Merozai 646 10

ShaibAbada 115 11

Noor elahi colony 100 12

DalBinzadi 107 13

Akbar Aabad 93 14

Shahed Banda 362 15

Baqizai 469 16

Peshawari Banda 91 17

3 Jarma

Islamkot 53 18

Zara meela 839 19,20

Jarma 173 21

4 Bilitang BilitangDhokJata 108

22


KandyaliBala 353 23

KandyaliPayan 339 24

Gulmeer 88 25

Khotari 177 RC

Lokhari 206 26

Iqra colony 91 27

5 Khairmatoo

Dheribanda 218 RC

Khairmatoo 601 28,29

Ahmad ShujaMohalla 212 RC

Orzkzai Banda 265 30

Annex 3: The main IYCF indicators collected and the source of data13.

S/N

Description

Definition

Sampling

universe

Source of

information

(Respondent)

1 Early initiation of

breastfeeding

Proportion of children born in the last 24

months who were put to the breast within

one hour of birth

Children aged

0- 23 months

who are alive

at the time of

the study

Child’s

mother/caretaker

2 Children ever

breastfed

Proportion of children born in the last 24

months who were ever breastfed

3 Exclusive

breastfeeding

during the first 6

months

Proportion of infants aged 0-5 months who

are exclusively breastfed

Children aged

0- 23 months

who are alive

at the time of

the study

Child’s

mother/caretaker

4 Continued

breastfeeding at

one year of age

Proportion of children aged 12 – 15 months

who are breastfed

5 Timely

introduction of

solid, semisolid

or soft foods

Proportion of infants aged 6 – 8 months who

receive solid, semi-solid or soft foods

6 Minimum dietary

diversity score


who receive foods from four or more food

groups

13Guide for the Assessment of IYCF Practices, WHO, 2010.


7 Minimum meal

frequency

Proportion of breastfed and non-breastfed

children aged 6 – 23 months who receive

solid, semi-solid, or soft foods in

accordance to the minimum number of

prescribed times or more

8 Minimum

acceptable diet


who receive a minimum acceptable diet

(apart from breast milk)

9 Consumption of

Colostrum

Proportion of live born that received only

Colostrum the first three days of birth


Annex 4: Comparison of the results with national and regional figures, percentages

S/N Description Kohat district

201314

Kohat

District

2014

KP

Province15 Pakistan16

1 Early initiation of breastfeeding 39.4 30 74.3 40.5

2 Exclusive breastfeeding during the first 6 months 66 61 47.0 12.9

3 Continued breastfeeding at one year of age 73.3 52 87.4 77.3

4 Continued breastfeeding at two years of age 26.9 - 58.3 54.3

5 Timely introduction of solid, semisolid or soft

foods 69.2

77 35.3 51.3

6 Minimum dietary diversity score 21 21 2.7 3.0

7 Minimum meal frequency 68 77 45.0 56.4

8 Minimum acceptable diet 18 16 5.6 7.3

9 Consumption of Colostrum 20 25 - -

10 Children ever breastfed 95.1 98 - -

14ACF IYCF KAP Survey, Kohat district, September 2013 15National nutrition survey, Pakistan, 2011 16ibid


Annex 5. Kohat District IYCF KAP Survey IYCF questionnaire, September 2013

UC ____________________ Village Name ____________________________ Cluster

No ____

Team No ____ Date: /09/2013 House #______ HH elder's name_______

Contact # of HH elder____

Section 1: Background of the mother/caretaker

101 Are you able to read or write a simple sentence?

کيا آپ کوئی بهی آسان سا جملہ لکه يا پڑھ

سکتی ہيں؟

Yes……….1

No……….2

102 Did you ever attend formal school/Madrasa ?

کياآپکبهياسکولميںپڑھيہيں؟

Yes……….1

No……….2

Skip to 104

103 If yes, what is the highest grade you completed?

اگرہاں،توکہاںتکپڑھيہيں؟

1. Primary

2. Middle

3. matric interme

4. Bachelor

5. Master

6. Madrasa

104 What is your current marital status?

آپکيازدواجيحيثيتکياھے؟

Single 1

Married 2

Divorced/Separated 3

Widowed 4

Section 2: Background of the child

201 What is the name of your youngest child?

کا ںام کيا ہے؟ ےبچآپ کے

202 Sex of Child

جںس؟

Boy………..1

Girl………. 2

203

What is the age of your child?

کی عمر کيا ہے ؟ ےبچآپ کے [____|____] MONTHS


Section 3: IYCF practice questions

301

Have you ever breastfed [NAME]?

کو آپںے کبهی ماں کا دودھ پاليہ ےبچاس

ہے؟

Yes…………….1

No..…………...2

Skip to 308

302 How long after birth did you first put [NAME] to the breast?

کو ےبچپيدائش کی کتںی دير آپ ںے اس

ماں کا دودھ پاليہ؟If less than 1 hour or “immediately”, record “00” hours. If less than 24 hours, record hours. Otherwise, record days.

Immediately……...………00

Hours……....…….________

Days..……..……. ________

Don’t Know……………...98

Never breastfed..…………99

303

Are you still breastfeeding [NAME]?

کو ماں کا دودھ ےبچکيا آپ اب بهی اس

پالتی ہيں؟

Yes…………….1

No..…………...2

Skip to 307

304 Why did you stop breastfeeding [NAME]?

کو ماں کا دودھ پالںا کيون ےبچآپںے اس

بںد کرديا؟

(Only one main answer)

Mother ill/weak….…………….…01

Child ill/weak….…………………02

Nipple/breast problem……………03

Not enough milk…………………04

Mother working………………….05

Child refused…………….……….06

Weaning age/age to stop…………07

Became pregnant………….……..08

Started using contraception………09

Other……….…………………….10

Other (Specify__________________

For all responses skip to 307

305

Up to what age do you intend to breastfeed [NAME]?

کو ماں کا دودھ ےبچکس عمر تک آپ اس

پالئوگی؟

Months _________

Don’t Know…………..…98


306

How many times did you breastfeed [NAME], between sunrise yesterday and sunrise today?

کل صبح سورج اُبهرںے سے آج صبح

ںے ےبچسورج اُبهرںے تک کتںی بار اِس

ماں کا دودھ پيا ہے؟If response is not numeric, probe for a numeric response

Number _________

Don’t Know…………..…98

307 Did you squeeze out and throw away the first milk (colostrum)?

پيدائشکےفورںبعدںکلںےواالماںکاپہالدودھ

کياآپںےپهيںکدياتها؟

Yes…………….1

No..…………...2

308 Did [NAME] drink anything from a bottle between sunrise yesterday and sunrise today?


ںے بوتل ےبچسورج اُبهرںے تک کيا اِس

ميں کوئی چيز پی ھے؟

Yes……………..1

No……………..2

Don’t Know……8

309

Did you introduce liquids or foods (semi-solid or solid) other than breast milk to the baby?

کو ماں کے دودھ کے ےبچکيا آپںےاپںے

عالوه کوئی اور

ہلکيياںرمغذاکهالئيہے؟

Yes……………..1

No……………..2

Don’t Know……8

Skip to 401

310 At what age did you first introduce?

کسعمرميںکهالںہشروعکيا؟

Months _________

Don’t know…………..…98

Not yet started………………99

311 How many times did you feed [NAME] solid and/or semi-solid food between sunrise yesterday and sunrise today?


کو کتںی دفعہ ےبچسورج اُبهرںے تک اِس

ہلکی يا ںرم غذا کهالئی؟If response is not numeric, probe for a numeric response

Number of feedings of solids and/or semi-solid foods

_________

Don’t know…………..…98

Section 4: Message recall: Time of Initiation of Breast Feeding

401

How long after birth do you think a baby should start breastfeeding?

آپ کے خيال ميں پيدائش کے کتںی دير بعد

کو ماں کا دودھ پيںا چاھيے؟ ےبچ

If it less than an hour, circle immediately

Immediately………..…………………00

Hours……………………….________

Days.………………………. ________

Don’t Know……………..……….98


402

Did you hear a message to put your baby on the breast immediately after birth?

کيا آپںے يہ مشوره سںا تها کہ پيدائش کے

کو ماں کا دوده پالئيں؟ ےبچفورن بعد

Yes……………1

No……………..2

Can’t remember…….8

Skip to 501

Skip to 501

403

From whom did you hear this message?

کسسےسںاتهايہمشوره؟

M=Mentioned NM= Not mentioned

M NM

a.) Dispenser/Nurse………..….1 2

b.) Lady Health Volunteer....1 2

c.) Community mobilizer.......1 2

d.) IYCF Promoter.................1 2

e.) Family/friend…………..…...1 2

f.) Radio/TV………………..........1 2

g.) Community leader………1 2

h.) Other…………………….….....1 2

Other (specify) _____________


404

When did you hear these messages? During:

کبآپںےيہمشورھسںاتها؟

دوراِن؟


M NM

a.) Pregnancy……………….1 2

b.) Delivery……………………1 2

c.) Post natal...................1 2

d.) Sick child contacts………1 2

e.) Well child contacts……. .1 2

f.) Immunizations…………..…1 2

g.) Other……….……..….…1 2

Other (specify) _______________

405

Where did you hear these messages

کہاںپہسںاتهايہمشوره؟


M NM

a.) Health facility…………..….1 2

b.) Community event………….1 2

c.) Home………………………1 2

d.) Other………………………1 2

Other (specify) ________________

Section 5: Message recall: Exclusive Breast Feeding


501 For how long do you think a baby should receive only breast milk and nothing else?

کو صرف ماں کا دودھ ےبچکس عمر تک

ہی پالںا چاہيے

اسکےعالوھکچهبهيںهيں؟

Enter age in months:__________

Don’t know…….98

502

Did you hear a message to feed your baby only breast milk for the first six months of life, not even giving water?

کيا آپںے يہ مشوره سںا تها کہ پيدائش سے

کو صرف ماں کا دودھ ےبچچه ماه تک

پالئيں، يہاں تک کہ پاںی بهی ںہ پالئيں؟

Yes…….………1

No……………..2


Skip to 601

Skip to 601

503




M NM



c.) Community moblizer.......1 2

d.) IYCF Promoter.................1 2


f.) Radio/TV………………..........1 2

g.) Community leader…………1 2

h.) Other…………………….….....1 2

Other (specify) ______________


504

When or how did you hear these messages? During:

کباورکيسےآپںےيہمشورھسںاتها؟

دوراِن؟


M NM


b.) Delivery……………………1 2

c.) Post natal...................1 2




g.) Other……….……..….…1 2

Other (specify) ________________

505

Where did you hear these messages?



M NM



c.) Home………………………1 2

d.) Other………………………1 2

Section 6: Message recall: Timely initiation of Complementary Feeding

601

How long after birth do you think a baby should start to receive semi-

solid and solid foods? آپ کے خيال ميں

کو ےبچپيدائش کے کتںے عرصے بعد

ہلکی يا ںرم غذا کهالںی چاہيے؟

Age in Months ______________


602

Did you hear a message on introducing complementary foods at six months of age, such as soft porridge 2-3 times per day?

کيا آپںے يہ مشوره سںا تها کہ چه ماه کی

کو ںرم غذا ديںا شروع ےبچعمر سے

کريں

جيسا کہ

ںرم

(khichrri)

ٹائم روزاںہ ؟ 2_3 کهچںی

Yes……………1

No……………..2


Skip to 701

Skip to 701

603




M NM



c.) Community mobilizer.......1 2

d.) IYCF Promoter.................1 2


f.) Radio/TV………………..........1 2

g.) Community leader…………1 2

h.) Other…………………….….....1 2

Other (specify) _______________


604

When or how did you hear these messages? During:

کباورکيسےآپںےيہمشورھسںاتها؟

دوراِن؟


M NM


b.) Delivery……………………1 2

c.) Post natal...................1 2




g.) Other……….……..….…1 2

Other (specify) ________________

605

Where did you hear these messages?



M NM



c.) Home………………………1 2

d.) Other………………………1 2

Other (specify) ________________

Section 7: Dietary diversity and meal frequency

701

Next I would like to ask you about some liquids and food that (NAME) may have had

yesterday during the day or at night. ںے ےبچدوسرا ميں يہ پوچهںا چاہوںگا کہ آپ کے اِس

کل دن اور رات کے دوران ہلکی يا ںرم غذا ميں کون کون سی چيزيں کهائی يا پی تهيں؟

Yes No DK


A- Porridge کهچںی، bread ڈبل روٹی ,

riceچاَول, noodlesسوئياں, or other foods made from grains

1 2 8

B- White potatoes سفيد آلو , white yams مولی , manioc, cassava, or any other foods made from roots

1 2 8

C- Any foods made from beans, peas

lentils ,مٹر داليں , nuts موںگ پهلی , or seeds بيج

1 2 8

D- Milk such as tinned, powdered, or fresh animal milk?

1 2 8

E- Cheese پںير , yogurt دہی , or other milk products

1 2 8

F- Infant formula 1 2 8

G- Any meat such as Mutton and Beef, chicken مرغی کا گوشت , or duck

Liver ,بطخ کا گوشت جگر , kidney گرده , heart دل , or other organ meats

1 2 8

H- Fresh or dried fish سوکهی مچهلی , shellfish سمںدری مچهلی , or seafood

سمںدری مچهلی

1 2 8

I- Eggs اںڈا 1 2 8

J- Ripe mangoes پکی آم , ripe papayas پکا پپيتا , or lemon ليموں Guava

1 2 8

K-Anadarko green leafyvegetables

ہرے رںگ کی يا پتوں والی سبزياں 1 2 8

L- Pumpkin کدو , carrots گاجر, squash کدو, or sweet potatoes سفيد that are yellow or orange insideگاجر

1 2 8

M- Foods made with red palm oil, red palm nut, or red palm nut pulp sauce

1 2 8

N- Any other fruits or vegetables-7 1 2 8


Kohat District IYCF KAP SurveyHH FSL and WASH Questionnaire, September 2013

UC: ______________________ Village: __________________ _________Cluster number: __ __ Team number: _____ Household number____________ Date: /09/2013

NO QUESTIONS AND FILTERS ANSWERS & CODES SKIP

Food security and livelihood questions

101

What is the status of the household?

آپکی موجوده رہائش کس قسم کی ہے؟

1--------------------------Resident-----------------------------→ 2--------------------------IDP-------------------------------------→

103 Q102

102

Since how long have you been displaced?

کتںےعرصےسےآپںقلمکاںيکيےہوئےہو؟

____/____/_______ (DD/MM/YYYY)

103

What is the gender of the head of the household?

گهرکاسربراھکوںہے؟مردياعورت؟1 ------------- Male 2 -----------Female

104

What were the sources of income of the household during the last 3 months?

ماھکےدوراںآپکےگهرکيآمدںيکےذرائعکوںسےتهے؟ 3پچهلے

(Circle all options mentioned) ASK HER TO RANK ACCORDING TO IMPORTANCE

Methods Applied Rank

Methods Applied Rank

1 Sales of crop production 9 BISP work

2 Sales of live stocks 10 Loan

3 Sales of Livestock products 11 Remittance

4 Sales of fruit, Coffee, and sugarcane

12 Salary

5 Sales of Firewood and charcoal

13 Sale of relief food

6 Sales of hand craft 14 No Income source

7 Sales of fattened animals 15 Daily Work (out of BISP


work)

8 Small business 98 Other (specify) _________

105

Does this household have food in the store, which is sufficient to feed the family for the next 03 months?

3کياآپکےگهرميںاتںاراشںموجودہےجواگلے

ماھتکآپکےگهروالوںکےليےکافيہو؟

1-------------------- Yes 2 ------------------------- No

No →Q105

106

If no food in store now, what will be your main source of food for the

NEXT 3 months (expectation)? اگر

ماه ميں آ پکی 3راشن ںاکافيہے تو اگلے

آمدںی کا اہم ذريعہ کيا ہوگا ) اُميد کيا ہے( ؟

(Circle all options mentioned) ASK HER TO RANK THEM ACCORDING TO PRIORITY

Sources Rank

1 Own production

2 Bought

3 Borrowed

4 BISP

5 Relief food (GFD)

98 Other (specify

107

What is your coping mechanism at stress time? (Whenever they face food shortage) (Circle 3 most important)

تںگدستييادباؤکےوقتآپکيتدابيرکياہوتيہيں؟

) جب کبهی آ پکو خوراک کی قلت کا سامںہ

ہو؟

0---None 13--Borrowing 1---Sale of productive animals 14---Sale of Relief food 2---Sale of more animals 15---Stress not experienced 3---Sale of plough animals 16---Eating wild food 4---Reduce family size 17---Safety Net 5---Reduce number of meals/size 18---Consume seed 6---Sale of farming tools 19---Rent farm land 7---Petty trade 20---Sale of personal asset (jewellery) 8---Migration for labour/food 21--social service credit 9----Sale charcoal/firewood 22---Credit from mosque 10---Sale of poles 23---Sale of labour 11---Rent pack animals 24--Other specify (_________) 12---Remittance

WASH related Questions

108

What is done to the water before households’ members drink it?

گهرکےافرادپاںيپيںےسےپهلےپاںيکوکياکرتےہ

يں؟

1----Nothing 6--------Chlorination/Pur 2----Boiling 7------- Use herbs 3----Filtering with a cloth 8--------put it out in the sun 4----Local sand filter 9--------Others (Specify) 5----Letting it settle

109

When do you usually wash your hands during the day (Record ALL answers given)

0-------------------Never

1-------------------Before preparing food/ cooking

2--------------------Before serving food


Do not read answers.

عامطورپرآپدںميںکسوقتہاتهدھوتےہيں؟

3--------------------Before eating

4--------------------Before feeding children

5-------------------After going to toilet/defecation

6--------------------After cleaning child's bottom

7--------------------After vulvae hygiene

98----------------------------------------Other (specify

110

What is done with children/baby faeces?

بچوںکےپاخاںےکےساتهآپکياکرتےہيں؟

1 = Thrown out with normal rubbish/trash

2 = Deposited immediately in a latrine

3 = Scattered around the compound/house

4 = Given to domestic animals to clear/eat

5 = Buried 6 = Other

(specify________________)

iycf knowledge, attitude and practice survey kohat ... · uc union council who world health...

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