World Neighbors, Inc.
Community of Practice:
The central Andes of Bolivia have the highest infant mortality rate (around 167 per thousand births) in the hemisphere. In order to eradicate this, fortified foods are given away in rural areas to complement children’s diets, and fortified oil is given to lactating mothers with children under five years old. Although these actions have short-term benefits, they encourage dependence and teach people that they are unable to fulfill their own needs.The project seeks to implement a systematic process of action learning in food security and nutrition that will target children aged 0 through 5 years and their mothers, i.e. the most vulnerable population in the Andes. Nutrition will be defined as the entry point to holistically tackle household food security.Specifically, the project will research the impact of factors such as child infectious diseases, hygiene, lactation practices, food balances, beliefs pertaining child feeding and gender inequalities that affect nutrition as much as food availability. Based on this information, the communities and the project will design and implement comprehensive interventions to strengthen nutrition. The methods and lessons learned in the process will be shared widely as evidence-based inputs for the implementation of “zero malnutrition” national government strategies in the municipalities of the target area.
Document the local knowledge of families in communities in respect to the food they produce and identify how this knowledge is transmitted.Have critical reflection on the advantages, disadvantages, opportunities and limitation of the tools used in accompanying communities in the definition of problems as well as possible solutions associated with malnutrition.To evaluate the changes in behavior of the families in the communities in terms of nutrition and agriculture applying participative tools.
Outputs and Outcomes:
This project hoped that the farmers would be inspired to monitor their child’s growth as way of ensuring long term sustainability of the intervention. A 1-year ex-post survey reveals that 15 out of 29 families are doing so. Parents mentioned that this number was not higher because of poor understanding of numbers (probably referring to difficulties in the understanding of basic math underlying the measurement process ─ i.e. illiteracy is the main cause for this situation) and lack of time. However, they also stated that it is important to do this monitoring by using data provided by health personnel. Depending how you look at it 50% adoption of this practice is impressive.
According to end-line survey results of 80% of project participants (n=124), 100% of parents said they had changed their opinion about the importance of inter-family support for improving child feeding; 50% of the parents said it was important in order to share work and the other half said it is important for family feeding; 65% of women report that their husbands have improved their support in the home over the past year, an ex-poste survey in 2014 (n=30 families of who had previously been interviewed and participated in 50% of project activities) showed that had increased to 80%.
Even though there weren’t any workshops in inter-family support in 2014, we can see that the parents continue to improve on this front. However, the sample went from 124 to 30 families so this might account for the improved percentages. According to the 2010 baseline survey 38% of families didn’t buy any nutritious food (n=120), in 2013 that percentage went to 14% (n=124.) 89% are consuming vegetables with vitamin A in 2013 compared to 73% in 2010 — that increased to 100% in ex-post survey in 2014 (n=51), meat consumption went from 43% to 80%, oil from 79% to 91%, although dairy stayed the same and average dietary diversity stayed the same. Two mid-terms participatory food frequency analysis in 2011 and 2012 revealed that 48% of the families were diversifying their food sources, especially the communities at lower altitudes. The results around legume consumption are less notable mostly because the baseline was done during a different season when there were more available then the end-line. However, the consumption of lupin went from 16% to 23%. The increase in consumption of meat, oil and vegetables with vitamin A was also reported in food frequency surveys with mothers of children under two.
According to a survey (n=60) after project intervention 68% of fathers knew that complementary feeding should not begin before 6 months of age; 96% knew that it should be consistent and diverse; and 79% knew it should be frequent. In a 2014 ex-poste survey (n=30) the knowledge about complementary feeding among both mothers and fathers had dropped by 15%. Across the board, knowledge seemed to have fallen but practices continue.
Upon reflection the team thought this decrease is due to parents who no longer have small children, but underscores the necessity of constantly re-learning and reminding. To that end a workshop on organizational strengthening revealed that two of the four communities were committed to strengthening the role of existing health personnel; the other two would include this objective in their 2015 work plan. All families expressed the desire to have this objective within the community in order not to neglect or forget what they learned and achieved through this project. Significant gains were seen in the four communities on breastfeeding practices after project interventions. In 2013 65% of mother mothers with children under 1 (n=24), initiated breastfeeding within half an hour after birth compared to 37% of the sample in 2010. 82% of these mothers breastfed exclusively during the first six months of life in 2013 versus 13% in 2010. Likewise, 75% frequently nursed a child under 1 year of age in 2013 vs. 19% in 2010. Over 80% of fathers surveyed in 2013 (n=60) knew about proper nursing practices. In an ex-post survey in 2014, after a year without project interventions on breastfeeding, parental knowledge (both mothers and fathers n=48) only increased 3.5% and the good breastfeeding practices increased 20% (n=14).