Impact Data - Alive & Thrive (A&T) in Ethiopia
"Results indicate that the more ways mothers were exposed to feeding messages - through home visits, village gatherings, and radio spots - the more likely they were to sustain changes in feeding practices."
In Ethiopia, chronic food insecurity, poor infant and young child feeding (IYCF) practices, and high rates of infectious diseases persist, leading to high rates of malnutrition. Forty-four percent of Ethiopia's children under 5 years of age are stunted (Ethiopia Demographic and Health Surveys (EDHS), 2011). In this country of 92 million people, malnutrition contributes to over half of all child deaths, the majority occurring in children under 2 years of age. In late 2009, Alive & Thrive, or A&T, (see Related Summaries, below) initiated activities to support the Government of Ethiopia in reducing death, illness, and malnutrition caused by poor breastfeeding and complementary feeding practices. For change to happen, A&T had to address widespread and limited recognition of the long-term consequences of stunting and find ways to reach mothers and their families in a large and diverse country with multiple languages, overextended health workers, and limited media reach. Community-based and mass media activities were concentrated in the 4 most populous regions: Tigray, Amhara, Oromia, and Southern Nations, Nationalities, and Peoples (SNNP).
A baseline and an endline survey were conducted in 2010 and 2014 respectively. A sentinel study was conducted in March 2012.
- The 2010 baseline survey conducted in Tigray and SNNP region found relatively high rates of exclusive breastfeeding (72 percent). By the time of the 2014 endline survey, the rate had increased to more than 80 percent in project areas.
- The proportion of children who met minimum dietary diversity and minimum adequate diet, while still extremely low, doubled in the programme evaluation areas (from 6 to 15 percent and from 5 to 12 percent, respectively) between 2010 and 2014. In addition, minimum meal frequency increased by more than 20 percentage points (from 46 to 70 percent). These gains were achieved despite high levels of food insecurity in A&T's intervention areas.
- Nearly 30 percent of the women surveyed in a sentinel site surveillance in December 2012 had participated in a food demonstration of an enriched porridge in the past 6 months, and of these women, nearly three-fourths reported trying at home what had been demonstrated.
In the March 2012 sentinel survey, about two-thirds of mothers reported that their husbands were involved to some extent in IYCF. By November 2013, the rate had increased to 76 percent, and almost 80 percent of mothers reported discussing child feeding with their husbands.
About 2 million mothers of children under 2 reached by either interpersonal communication and/or radio. By mid-2012, close to half the mothers of children under 2 in the programme evaluation areas remembered a message on IYCF delivered by a health extension worker or volunteer during a home visit. This represents about 1.5 million mothers across 295 intervention woredas (districts). During this same period, an estimated 960,000 women heard the programme's radio spots.
The partners suggested that communities set targets for the number of families practicing the 7 excellent feeding actions communicated by A&T's Smart and Strong family campaign (see the first linked resource in the Source, section, below) and hold public events to recognise their achievement. Some organisations introduced the 7 IYCF actions in primary schools, often through school clubs. A&T developed community conversation guides, an orientation session for community leaders, 9 lessons for schools, and small cards with the 7 IYCF actions for fathers and school children.
The IYCF counseling tool and reminder card for families are used in government health programmes and by numerous civil society organisations. An IYCF module is now included in the Ministry of Health's training materials used nationwide to provide refresher training to all health extension workers (HEWs). More than 33,000 HEWs in Ethiopia have or will receive training on complementary feeding as part of the government's integrated refresher training.
A&T developed messages and a video tailored to national-level policymakers, emphasising the economic benefits of investing in nutrition and the impact on national development. A&T staff actively supported the Government of Ethiopia in updating the National Nutrition Programme (NNP) for 2013-2015 and supported regional events to launch the NNP. In October 2013, the Government of Ethiopia and A&T co-hosted a national forum to explore approaches for the design, implementation, and evaluation of stunting reduction programmes. Advocacy activities included raising awareness through stunting reduction workshops for health officials and staff, leaders of other sectors, journalists, and parliamentarians at sub-national levels. Some of the workshops were organised by regional women's associations whose leaders had participated in advocacy training on IYCF.
The 2008 NNP was revised in 2013 to focus on a lifecycle approach with emphasis on the first 1,000 days, stunting reduction, and a multiple sector approach. The new plan notes an improved policy landscape for nutrition since the 2008 plan. Stunting reduction is one of the goals of the country's Growth and Transformation Plan.
In 2014, A&T transitioned to a new phase of activities in Ethiopia (mid 2014 to mid 2017). A&T is applying its comprehensive framework to support the National Nutrition Program and its multiple sector approach at the national level and operationalising the framework in the Amhara region. To sustain behaviour change at the household level, the programme will emphasise frequent interpersonal contacts between caregivers and frontline workers at critical points during a child's first 2 years. A&T will also contribute to the integration of IYCF in the Productive Safety Net Program. Click here to learn more.
"Alive & Thrive's Approach and Results in Ethiopia: Improving Child Feeding Practices to Prevent Malnutrition" [PDF], August 24 2015 - sent via email from Alive & Thrive to The Communication Initiative on September 24 2015; and "In Ethiopia, Rapid Improvements in Child Feeding Behaviors Are Possible", by Dr. Manisha Tharaney and Dr. Yewelsew Abebe, Less Guess blog, July 20 2015, and A&T Ethiopia website - both accessed on March 10 2016. Image credit: Desta Kebede | Alive & Thrive
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