Transform Nutrition has produced a Guidance note for donors and national government based on our 6 years of research on Frontline Health Workers:
pivots for mass behaviour change
Partners
The Transform Nutrition research programme consortium is made up of five member organisations, each with a distinct role. As the primary donor, the Department for International Development is also a key partner.
Behavioral change for Improved Nutrition among Pastoralists in Ethiopia
Pastoralists in Ethiopia
Ethiopia is one of the countries who managed to meet the nutrition target of MDG 1 by reducing the rate of stunting from 58% in 2000 to 40% in 2014 and wasting from 12% in 2000 to 9% in 2014.[1] Currently, the country is working towards the nutrition targets of SDG2. As of 2016, 38% of children in Ethiopia are chronically malnourished and 10% are acutely malnourished. [2]
However, the picture in pastoral areas like Somali Region of Ethiopia shows that the under-served and hard to reach segments of the population of the country need tailored ways to address the still prevailing situation of undernutrition. In Somali Region of Ethiopia, the prevalence of stunting (chronic malnutrition) is 27.4% as of 2016. In addition, the region has the highest proportion of children with acute malnutrition from all regions of Ethiopia having 22.7% wasting rate. Somali Region also has the highest prevalence of anaemia in children with a rate of 82.6% as compared to the national prevalence of 56%. Moreover, 12.8% of children in Somali region have severe anaemia. The highest prevalence of anaemia in women is also seen in Somali Region with 59% prevalence compared to 23% nationally. [3]
Nutrition sensitive interventions by VSF-Suisse in Ethiopia
To contribute to addressing the need to nutrition interventions in pastoral areas as Somali Region of Ethiopia, VSF-Suisse has implemented different nutrition sensitive interventions in the region. Linking agricultural and livestock interventions to community-based nutrition has been a flagship activity of the VSF-Suisse (and of the Ethiopia Programme in particular). Owing to the fact that the nutrition needs of under-served communities cannot be addressed by direct nutrition interventions alone, VSF-Suisse had nutrition sensitive livestock based interventions where animal source foods sourced from local markets like meat and milk were availed to households hosting children recurrently affected by acute malnutrition and recurrently admitted to therapeutic feeding centers. These interventions have proven to show changes on the availability of animal source foods at the household level.
To showcase one of these interventions in Kebriderhar and Shilabo Woredas of Somali region of Ethiopia in 2013, where 9 milking goats were provided to households hosting children affected by recurrent malnutrition, change was observed in the targeted households in terms of acute malnutrition, measured through MUAC (Mid-Upper Arm Circumference). A decreased percentage of children with MUAC <11cm from 33% before the intervention to 0% at 4 months after the provision of milking goats was observed. The percentage of children with MUAC for age <-3 SD, showing signs of acute malnutrition, had decreased from 56.8% before the intervention to 12.3% after the intervention.
Availing Animal Source Food was not Sufficient
In the intervention mentioned above, even though change was observed on one of the nutrition indicator of the targeted children, MUAC for age, it was noteworthy to observe that after they were provided with milking goats, none of the mothers were breastfeeding (from 12% before the intervention). This was one of the signals that availing animal source foods for households does not necessarily ensure the improvement of the overall nutrition situation and optimal nutrition practices. The main lesson drawn was that nutrition sensitive interventions are beyond linking specific livestock relief interventions with nutrition outcomes. This ignited the idea of thinking on optimal behavioral change communication interventions which suits pastoral areas like Somali Region of Ethiopia. The option lies on whether to integrate the conventional nutrition education or IEC/BCC interventions to our nutrition sensitive interventions or to look for other sustainable means of channeling our important message on optimal maternal, infant and young child nutrition practices.
Pastoral Community Platforms
Among the rural pastoral communities of Ethiopia’s Somali Regional State, VSF-Suisse has used the community platforms of Pastoral Field Schools (PFS) and Village Community Banks (VICOBAs) to improve communities’ resilience to recurring episodes of drought and other emergencies. The PFS approach is an adaptation of the interactive Farmer Field Schools (FFS) approach developed by the UN-FAO in Indonesia in 1989. They are groups of community members who meet periodically to pool their observations on livestock production and on rangeland management and to experiment new production systems. VICOBAs, meanwhile, comprise groups of mainly women who are trained and then meet regularly to organise collective saving and loans for times of emergency or crisis.
Given that both of these pastoral community platforms are now integrated features of their communities, they have shown to have tremendous cumulative benefit by equipping them with critical nutrition-related messages.
The BCIN-Action Research
The action research entitled ‘Behavioral Change for Improved Nutrition among pastoralists in Ethiopia’ (BCIN) thus intended to bridge the knowledge gaps by providing the scientific evidence on the outcome of integrating Behavioral Change Communication (BCC) interventions into the routine activities of the existing pastoral platforms, the PFS and VICOBA groups.
BCIN was a quasi-experimental research conducted in two pastoralist districts, Moyale and Mubarek of Somali Region of Ethiopia. The action research evaluated both intervention communities and comparison communities where the intervention did not take place with the aim of appraising the impact of channeled messages on key nutrition practices. In line with this, a total of 942 mothers having children 0-23 months were interviewed, 471 of them were in each study leg.
As a result, the number of mothers who heard about exclusive breastfeeding, optimal young child feeding practices, food safety and personal hygiene through the PFS and VICOBA were higher for the intervention communities compared to the comparison communities.
One of the main findings of the action research shows that exclusive breast feeding, food safety and hygiene are influenced by the mother’s age, educational status, income, and prior information on the issues. It is also observed that 85.5% of the mothers in the intervention groups reported receiving the information through the community platforms compared to 14.2% from other sources. Also, the action research found out that pastoral- community platforms have potential for channeling messages on key maternal, infant and young-child nutrition practices.
[1] MDG report of Ethiopia, 2014
[2] Ethiopian Demographic Health Survey, 2016
[3] Ethiopian Demographic Health Survey, 2016
Agriculture for improved nutrition and health
Our project partners Egerton University, Kenya convened a workshop Agro-biodiversity and Dietary diversity for optimal nutrition and health on Tuesday 22nd August, 2017 at the ARC Hotel Egerton University, Kenya. Forty-Five participants from academia, Ministry of Health, Ministry of Agriculture and NGOs working on Agriculture, nutrition and health gathered together with representative from County Government to discuss the important issue of tackling malnutrition and links between agriculture and Nutrition. See workshop report.
They have also written a blog Agriculture for improved nutrition and health
Transform Nutrition Learning Journey: Tomaida Msiska, EU Delegation, Malawi
When I was growing up in Malawi we tended to link marasmus and kwashiorkor to bewitching – we never linked it to malnutrition. However, I gradually learnt more about food groups at secondary school and University. I started to become more interested in the topic when I was working as Food Security and Nutrition Research Assistant alongside nutritionist in the Area Based Child Survival Development Programme at UNICEF. After a stint as a Government Economist I decided to study the subject and I completed a Masters in Medical Science Human Nutrition in 1997. However, it wasn’t until 17 years later that I would eventually take on a role where I could put this knowledge into practice.
I had been working on diversification of agricultural incomes, marketing and food security issues at the EU Delegation in Malawi for 10 years when in the framework of the 2012 London GlobalHunger Event,the EU made a global commitment to tackling undernutrition. We needed to realign our country programming and because of my background I had an opportunity to take on a lead role. However, after so long without practicing nutrition I really needed to reconnect with the issues and refresh my knowledge so I enrolled in the Transform Nutrition Short Course in 2014.
That one week was very helpful. They approached nutrition from a holistic perspective and presented it as a medical issue as well as a developmental issue. This made me more equipped to engage with stakeholders across the board, instead of looking at it from just one perspective.
The key outcome from the course was a realisation that we needed to carry out a mapping exercise in the nutrition sector in Malawi so that our planning and programming could be informed by what is already happening within the sector. We were able to get all the key development partners and the Government to rally behind this idea and as a result of the mapping, we have now developed a holistic multi-sectoral integrated Four Pillar Approach to addressing nutritional issues that scales up successful previous and existing initiatives and provide a platform for discussion between the different partners.
In July 2015 the Government through the National Nutrition Committee adopted the Four Pillars Approach, and now all partners supporting the government use this framework to coordinate and structure their programs in the countryto ensure the national objectives will be achieved.
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The Four Pillar Approach Pillar 1: Agriculture for food and nutrition security and improved maternal, infant and young child care and feeding Pillar 2: Health – primary health care, therapeutic care, support and treatment and WATSAN: Pillar 3: Integration of behavioural change and communication for optimal maternal and young child feeding and care (knowledge, attitudes and practices) among communities, learners, professional and frontline workers through nutrition education Pillar 4: Governance, human capacity building, research, monitoring & evaluation and fortification. |
We have also developed Afikepo, an EU programme to take forward and support the Four Pillar Approach. It translates from the local language as ‘let the children develop to their full potential’ and it has become a moto of some sorts for nutrition programming in Malawi.
Therefore, I took lessons from the 2014 course and applied them in Malawi, which now has the second largest EU nutrition programme in the World. However, I have also enrolled in the 2017 Transform Nutrition Short Course so I can build on my experiences, gain more insights and further improve our programmes and approaches in the country.
New approaches to accountability in nutrition
Getting governments and others to step up to the challenges of undernutrition requires concerted efforts to build commitment, increase responsiveness and to hold these actors to account for their progress or its lack. For the past six years Transform Nutrition has been at the forefront of research and conceptual development on accountability and nutrition. This brief New approaches to accountability in nutrition describes the research, tools and approaches developed by the consortium to build, monitor and increase commitment, responsiveness and accountability in nutrition
A malnutrition mobile app randomised trial in Wajir, Kenya
A mobile health application developed to help with Integrated Management of Acute Malnutrition (IMAM) which enables health workers and volunteers to identify and initiate treatment for children with acute malnutrition before they become seriously ill,was evaluated in 40 health facilities in Wajir Kenya. A research brief is now available Preliminary findings from a malnutrition mobile app randomised trial in Wajir, Kenya which summarises the findings.
Back to the storyboard
by Stuart Gillespie
What knowledge is needed to ride a bike? Is it enough to have a manual? Of course not… you need to get on the bike, fall off, get back on again… and eventually you’ll figure it out. The manual may provide information on “what” to do, but knowledge of “how” to do it is tacit knowledge that can only be acquired from experience. This important distinction was made in “The Concept of Mind” (1949) by Gilbert Ryle, a British philosopher – between “knowing that” and “knowing how”. In nutrition, as in many development arenas, we have a wealth of knowledge products (guidelines, toolkits, checklists) that focus on “what to do” but not enough documented experience of attempts (some successful) of how to do it. [Read more…]
This Is How Aid Saves Lives
Ethiopia’s Productive Safety Net Programme
A new Transform Nutrition discussion paper is now out The impact of Ethiopia’s Productive Safety Net Programme on the nutritional status of children: 2008–2012. Ethiopia’s Productive Safety Net Programme (PSNP) is a large-scale social protection intervention aimed at improving food security and stabilizing asset levels. In this paper, we examine the impact of the PSNP on children’s nutritional status over the period 2008–2012 and these findings, along with work by other researchers, have informed revisions to the PSNP.
A mobile health application to manage acute malnutrition
Community based Management of Acute Malnutrition (CMAM) is a proven high-impact and cost-effective approach in the treatment of acute malnutrition in developing countries. However, success is limited if treatment protocols are not followed, record keeping and data management is poor and reliable data is not available in time for decision makers.
There is strong evidence that mobile device based (mHealth) applications can improve frontline health workers’ ability to apply CMAM treatment protocols more effectively and to improve the provision of supply chain management. A new Transform Nutrition working paper is now available A mobile health application to manage acute malnutrition Lessons from developing and piloting the app in five countries which we hope will inform future mobile health projects.
