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IFE RAPID ASSESSMENTS (Sector specific rapid assessments) Common challenges

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IFE RAPID ASSESSMENTS (Sector specific rapid assessments) Common challenges & potential solutions Ali Maclaine Consultant Public Health Nutritionist – PowerPoint PPT presentation

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Title: IFE RAPID ASSESSMENTS (Sector specific rapid assessments) Common challenges


1
IFE RAPID ASSESSMENTS (Sector specific rapid
assessments) Common challenges potential
solutions
Ali Maclaine
Consultant Public Health Nutritionist IFE
Regional Meeting, Bali, Indonesia 10-13 March,
2008
2
IFE Assessments in general What are main
questions / issues people face?
  • When should an assessment be done?
  • What type of assessment should be done at that
    time?
  • What is the correct methodology?
  • What questions should be asked?
  • What is the correct way to ask them?

3
(No Transcript)
4
IFE SSRA The problem
  • NO set guidelines on how to do IFE SSRAs in rapid
    onset emergencies.
  • No generic tools
  • Everyone tackles same questions / issues /
    problems
  • People doing it wrong / could do it better
  • 2002 paper on IFE indicators suggested
    review..
  • (Marie McGrath et al. Infant feeding indicators
    for use in emergencies an analysis of current
    recommendations and practice. Pub Health Nut
    2002, 5(3) 365-372)

5
IFE SSRA
First question people worry about is? What am I
going to do? Should be What are the
objectives?
6

IFE SSRA Main objectives
  • Related to assessing CHANGE due to the crisis
  • Reduction / Increase in exclusive breastfeeding
  • Mothers stopping breastfeeding early
  • Reduction / increase in mothers mix feeding
    (breast formula)
  • Earlier / later introduction of complementary
    foods
  • Poorer / better complementary foods being used
  • WHY there a change e.g. breastfeeding myths,
    donations
  • Information used for programming, advocacy, etc.

7
IFE SSRA What is the correct methodology?
  • - Qualitative / Quantitative / mix?
  • FGDs / Key informants / Household visits /
    Transect walk one best or mix?
  • Sampling method Cluster fixated but convenience
    more appropriate purposive sampling
  • Numbers needed to make outcome significant, are
    numbers feasible?
  • Anthropometry included (lt 6 months?)?

8
IFE SSRA What questions should be asked? How
should questions be phrased?
  • IYCF standard core indicators
  • Early initiation of breastfeeding
  • Exclusive breastfeeding under 6 months
  • Continued breastfeeding at 1 year
  • Timely complementary food (New guidelines
    Introduction of solid, semi-solid or soft foods)
  • Minimum dietary diversity (i)
  • Minimum meal frequency (ii)
  • Minimum acceptable diet (composed of (i) (ii))
  • Consumption of iron-rich or iron-fortified foods
  • Are they all relevant and needed in IFE SSRA?
  • How should they be asked in a crisis? (24hr
    recall v. quick question when trying to get
    rapid over-view)

9
IFE SSRA What OTHER questions are essential for
an IFE SSRA?
  • Main objective of SSRA to assess CHANGE
  • Type
  • Level (to some extent)
  • Reason

Need to determine the key questions required to
assess change Establish best phrasing of
question
10
IFE SSRA
ASSESSING ARTIFICIAL FEEDING IN
EMERGENCIES
  • Need to assess the extent nature of artificial
    feeding in emergencies
  • BUT NO agreed guidelines on what data is key,
    or correct phrasing of questions to get the
    best information in a SSRA
  • Due to high risk related to donations (BMS, milk
    powder, bottles/teats) need to assess their
    impact

What is the key data? What is best phrasing of
questions?
Need to determine the key questions required to
get required detail. Establish best
phrasing of question
11
IFE SSRA ASSESSING COMPLEMENTARY FEEDING IN
EMERGENCIES
  • Need to assess need for complementary food aid
  • Local foods, fortified foods, micronutrient
    sprinkles
  • Need to assess impact

What are the key questions? What is best
phrasing of questions?
12
IFE SSRA PROGRAMMING DECISIONS
  • Need to establish what is required to support
    appropriate IFE in the area
  • Need to establish acceptability and requirement
    of specific interventions e.g. wet nursing,
    breastfeeding support groups, etc

What are the key questions? What is best
phrasing of questions?
13
So how are IFE sector specific rapid assessments
being done?
14
BANGLADESH Cyclone hit 15th November
2007 Districts 30 Sub-districts 200 Unions
1,950 Population affected 8.9 mill Families
affected 2 mill. DeathsDeaths 3363 3363
15
Photos credit Ali Maclaine, 2007
16
Save the Children
  • SC great history in IFE
  • One of first agencies to actively look into the
    issue.
  • Always seeking to attain best practice in the
    field in terms of IFE.
  • Should be commended
  • NOT an example of a bad IFE rapid assessment, but
    a regional example in order to look at the common
    challenges and issues.

17
Save the Children Alliance - Bangladesh
  • Rapid IFE assessment to
  • determine whether infants and young children were
    vulnerable to increased morbidity and mortality
    due to poor IYCF practices..
  • develop strategies to promote optimal feeding
    practices for the emergency areas

18
The objectives were
  • To establish an overview of IYCF patterns
    pre-cyclone in the assessment area (14 unions)
  • 2. To determine whether there had been changes in
    these patterns post-cyclone
  • 3. To establish the reasons for these changes
  • 4. To identify ways to promote and support
    optimal IYCF practices for
  • the breastfeeding infant
  • the mix-fed infant
  • the non-breastfed infant, and
  • the complementary-fed child.

19
Available capacity for assessment
  • SC health and nutrition staff IYCF experience
  • Capability to assess all 14 unions in 2 days
  • SC support
  • Bangladesh Breastfeeding Foundation and Dr.
    Khurshid Talukder, Consultant Paediatrician and
    Research Co-ordinator, Centre for Woman and Child
    Health

20
Method (Also looked at secondary data)
  • Focus Group Discussions (FGD) with caregivers of
    children aged 0-24 months (half of group infants
    lt6 months)
  • Key informant interviews with (i) Government or
    NGO health workers (ii) Traders
  • Transect walks
  • Household interviews with
  • mothers with infants lt6 months exclusively
    breastfeeding,
  • mothers with infants lt6 months who were being
    mixed fed or not being breastfed at all
  • mothers/caregivers with infants 6 months who
    were being complementary fed
  • Additional unstructured rapid assessments

21
Results led to
  • SC revising its health and nutrition messages
    given as part of the emergency programming.
  • SC further engaging with its partner agencies in
    IFE at the local and national level.
  • Provided qualitative data to the nutrition
    cluster and other agencies as to IFE situation.
  • Bangla translation of the Operational Guidance.

22
What could have been done better.
23
Time flies past
  • Early assessment by SC missed out IFE
  • Due to unavoidable delays assessment not started
    until 28th Dec (5 weeks)
  • So not initial rapid assessment or full
    assessment (MSS)..

24
Having IFE designated support throughout
  • The IFE SC designated person became unavailable
    important to have a nutrition person sensitive to
    IFE issues and local knowledge.
  • (Lucky to have BBF to help Breastfeeding
    counsellors, trainers, translators, etc!!!)

25
Having agreed tools in advance
  • Tools changed during translation
  • To fit with national IYCF strategies
  • To include other issues
  • To fit with local context
  • Some IFE questions removed / changed

26
Greater time
  • Only a week on the ground
  • Team busy
  • Added time pressure Long journeys teams had to
    get back to the field in daylight

27
Hence
  • No time to discuss issues / decide on questions
    needed and the way to ask them
  • Training of field workers had to start before
    team met to finalise assessment tool
  • Quick discussion make changes to tools straight
    into Bangla
  • No time to fully discuss changes with assessment
    team or field test new forms
  • No time to back translate to ensure changes made
    were correct

28
Language Challenges
  • Mixed feeding is not a Bangla term and is not
    well understood
  • Childs milk could cover infant formula, tinned
    milk, child powdered milk or any milk (e.g. cows
    milk, milk powder, milk in cartons) that is drunk
    by a child whether suitable or not
  • Concerns translated as issues then
    interpreted by assessors/interviewees as asking
    about their knowledge of appropriate IYCF

29
Challenges caused by misunderstanding (found
during analysis)
  • The terms less and more were sometimes
    interpreted as earlier and later
  • e.g. Since the cyclone are infants being given
    complementary foods earlier, later or at the
    normal time? Was answered as later when checked
    mother meant giving it later during the day..
  • A question such as Are less mothers
    breastfeeding? was sometimes interpreted as Are
    mothers producing less milk?

30
Challenges of assessment method
  • FGDs were not always free ranging conversations -
    each mother was asked about her experience on the
    issue.

31
Challenges with the rapid assessment tool
  • Long
  • Amalgamating qualitative data from different
    tools takes time
  • Questions not phrased the right way
  • Some important questions missed out
  • It could be done better.

32
Overview. What is needed?
  • Determine best method of conducting IFE SSRA.
  • Review of sampling strategies for infants and
    determine agreed numbers for acceptability of
    results
  • Need to agree
  • what data is key
  • the best method of phrasing questions in SSRAs
    to obtain reliable information with a useful
    level of detail
  • Need to field test
  • Bring it together to form SSRA guidelines and
    useable assessment tools based on best
    practice.
  • Tools need pre-emergency country review
    translation

33
  • Your Experiences Thoughts?

Conducting IFE SSRA In Bangladesh, Post-cyclone
Sidr
Thank you.
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