Dr. Manisha tharaney, senior technical advisor, nutrition, ALIVE & THRIVE
DR. YEWELSEW ABEBE, TECHNICAL DIRECTOR, IYCF/NUTRITION, ALIVE & THRIVE ETHIOPIA
Alive & Thrive recently released results from its first five years in Ethiopia, where infant and young child feeding programs reached an estimated two million mothers of children under two. As in Bangladesh and Viet Nam, we found that a comprehensive approach led to rapid improvements in feeding practices.
The prevalence of exclusive breastfeeding—already at high levels—increased to more than 80 percent in program areas. We also saw promising gains in complementary feeding practices. More children started receiving appropriate complementary foods at around six months of age and the percentage of children eating a diverse diet, while still extremely low, doubled in just four years.
We now know that significant progress can happen in a short period of time, but it is clear that more work is needed to accelerate complementary feeding results. After six months of age, many of Ethiopia’s children are not getting the nutrition they need to ensure healthy growth and development. The diversity of complementary foods remains particularly low, with only 12 percent of young children in Alive & Thrive program areas eating foods from at least four of the seven food groups recommended by the World Health Organization.
At Alive & Thrive, our goal is to adopt a multisectoral approach and work closely with partners to make even greater gains in feeding behaviors—especially in complementary feeding. Equipped with data and learning from our first five years, we’ve embarked on a new phase of our program in Ethiopia. We are working closely with the Federal Ministry of Health, the Ministry of Agriculture, Save the Children, Concern Worldwide, UNICEF, and community-based partners to reach more households and sustain changes in child feeding behaviors that will lead to healthier, more productive futures.
So, how can we support a greater change?
One way is to make more frequent contacts with mothers and families through multiple behavior change approaches. Our results show that the more ways in which mothers were exposed to feeding messages, the more likely they were to sustain behavior changes. Our refined program will reach mothers and families six to 15 times during the 1,000 day period (from conception through age two) and reinforce messages in a variety of ways including interpersonal counseling, community gatherings, complementary feeding demonstrations, peer support group meetings, and radio spots. In addition to targeting mothers, these interventions will also reach fathers and grandmothers, who are especially important decision-makers within the household.
Another way to accelerate progress is to increase coverage to reach more families at home through Ethiopia’s health and agriculture extension workers and health and household development army volunteers. The health extension workers train the volunteers, who are key to reaching households more frequently because they have greater opportunities to make home visits and discuss feeding issues with their neighbors. Yet our data revealed gaps in the training of volunteers by health extension workers and a need to improve the linkages between the health extension workers and volunteers. We are working closely with the Federal Ministry of Health to strengthen the connection between the two cadres and build the capacity of the volunteers to provide counseling and messages during home visits.
In addition, more timely and age-appropriate messages can potentially make a difference in changing behaviors. Our refined approach will aim to deliver the right message at the right time in a child’s development. That means providing interpersonal support and using local radio to reinforce messages at every stage—from exclusive breastfeeding throughout the first six months to continuing breastfeeding and adding a variety of nutritious complementary foods starting at six months through two years of age.
Together with our partners, we expect our programs to reach approximately one million more mothers of children under two over the next two years. But our goal is to ensure that children’s diets continue to improve and better feeding practices are sustained well into the future. From the outset, we have worked closely with Ethiopia’s government and local partners to build the capacity of health workers, agriculture extension workers, and volunteers and to ensure that effective programs are scaled up.
With the recent launch of a new flagship government program, Comprehensive and Integrated Community Based Nutrition, Ethiopia will begin scaling up evidence-based infant and young child programs. By building on what is working and adapting proven approaches, Ethiopian stakeholders and global and local partners will be able to increase progress and make a long-term impact on the health and well-being of Ethiopia’s children and communities.
For more information, please view our Ethiopia approach and results brief.
Photos: Desta Kebede | Alive & Thrive