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Maternal, Infant, and Young Child Nutrition 

and Family Planning Integration 

ASSESSMENT REPORT

Bondo District, Kenya 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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Table of Contents  

Introduction ................................................................................................................... 4 Background ............................................................................................................. 4 Assessment purpose and objectives ........................................................................ 5

Methods .......................................................................................................................... 6

Design ..................................................................................................................... 6 Sampling ................................................................................................................. 7 Tools and Logistics ................................................................................................. 7 Analysis ................................................................................................................... 7

Findings .......................................................................................................................... 8

Maternal, Infant and Young Child Nutrition .......................................................... 8 Family Planning .................................................................................................... 10 Communication Channels ..................................................................................... 13 Roles of Service Providers .................................................................................... 14 Integrated Service Delivery .................................................................................. 15

Conclusions and Recommendations .......................................................................... 17

 

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ACKNOWLEDGMENTS

The MCHIP team would like to thank the Ministry of Public Health and Sanitation (MOPHS) for their valuable support and collaboration throughout process of conducting the assessment. We are indebted to many individuals in Bondo District for their support and contribution to the assessment. Specifically, we would like to acknowledge the following individuals and thank them for their efforts and assistance. Without their support, this work would not have been possible.

Assessment Team: Rose Mulindi, M&E Program Officer (MCHIP/Kenya) Joygrace Muthoni, Program Officer (MCHIP/Kenya) Judith Kimiywe, Nutrition Advisor (MCHIP/Kenya) Grace Gichohi, Program Officer (Division of Nutrition/MOPHS) Damaris Mwanzia, Program Officer (Division of Reproductive Health/MOPHS) Jullie Odongo, District Reproductive Health Coordinator (Bondo District) Nelly Irangi, District Nutritionist (Bondo District) Maxwel Awuondo, District Public Health Officer (Bondo District) Rita Opondo, Data Collection Assistant (Bondo District) Millicent Odongo, Data Collection Assistant (Bondo District) MCHIP Technical Support Team (Washington, DC): Chelsea Cooper, Behavior Change Communication Advisor Elaine Charurat, Senior Program Officer Catharine McKaig, Family Planning Team Leader Rae Galloway, Nutrition Team Leader Holly Blanchard, Senior Reproductive Health Advisor Kiersten Israel-Ballard, Technical Officer, Maternal and Child Health/Nutrition Leah Elliott, Family Planning/Reproductive Health Technical Advisor We would also like to extend our gratitude to community members in the Bondo District assessment sites who agreed to share their time, experiences and perspectives. This report was made possible by the generous support of the American people through the United States Agency for International Development (USAID), under the terms of the Leader with Associates Cooperative Agreement GHS-A-00-08-00002-00. The contents are the responsibility of the Maternal and Child Health Integrated Program (MCHIP) and do not necessarily reflect the views of USAID or the United States Government. MCHIP is the USAID Bureau for Global Health’s flagship maternal, neonatal and child health (MNCH) program. MCHIP supports programming in maternal, newborn and child health, immunization, family planning, malaria and HIV/AIDS, and strongly encourages opportunities for integration. Cross-cutting technical areas include water, sanitation, hygiene, urban health and health systems strengthening.

 

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I. Introduction

a) Background

Interventions in maternal, infant, and young child nutrition (MIYCN) and family planning (FP) can be mutually beneficial for mothers and their children. For example, exclusive breastfeeding (EBF) in the first six months after birth not only protects the infant from becoming malnourished but also meets the mother’s contraceptive needs if she practices the lactational amenorrhea method (LAM). There is growing recognition that MIYCN and FP are closely intertwined health needs and that interventions in these areas can have synergistic effects on maternal and child health. In the Lancet Child Survival series, EBF during the first 6 months and continuing to breastfeed through 12 months were rated as the number one intervention for preventing child mortalities1. Analyses of DHS data and other studies have shown that short birth intervals and high fertility rates increase the risk of perinatal adverse events and maternal and young child malnutrition2. It is also important to note that EBF for the first 6 months is consistent with WHO’s infant feeding recommendations for prevention of maternal to child transmission of HIV3. Thus, integrated service delivery can result in a win-win for MIYCN, FP and HIV outcomes. Although the critical linkages between MIYCN and FP are recognized, nutrition programs generally do not include messages about the when, what, and how of modern methods of contraception. Maternal health and FP providers may also not provide enough information about maternal and infant nutrition. Harmonizing counseling and services for MIYCN and FP throughout the continuum from before pregnancy to early childhood can help to improve outcomes. The Kenya Ministry of Public Health and Sanitation, Department of Family Health through the Divisions of Nutrition and Reproductive Health, with support from the USAID-funded Maternal and Child Health Integrated Program (MCHIP), is initiating a demonstration program which will facilitate the integration of MIYCN with FP services. The main objective of this initiative is to enhance and strengthen evidence-based high impact nutrition and FP interventions that will ensure increased maternal and child survival, through pregnancy spacing and better nutrition practices. MIYCN-FP integration will strengthen service delivery and increase utilization of both services. The entry points for MIYCN-FP integration is at both the facility level (where MIYCN and FP messages will be routinely incorporated within antenatal and postnatal care visits at the MCH clinic) and at the community level through provision of health education on MIYCN-FP by community health workers and through existing community activities. Activities will begin on a demonstration basis in Bondo District of Nyanza Province, with potential for scale-up to other regions.

                                                            1 Jones G. et al. How many child deaths can we prevent this year? (Child Survival Series) The Lancet 2003 Vol. 362. 2 Rutstein, S.O. (2008) Further Evidence of the Effects of Preceding Birth Intervals on Neonatal, Infant, and Under‐Five‐Years Mortality and Nutritional Status in Developing Countries: Evidence from the Demographic and Health Surveys DHS Working Papers, Macro International, Demographic and Health Research. Division, Calverton, MD. 3 World Health Organization Infant Feeding Guidelines 2010.  World Health Organization, 2010. 

 

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Bondo District in Nyanza province has maternal and child health indicators that fall below the national average. Maternal and under 5 mortality rates are high, as is stunting and HIV prevalence. See the table below:

Bondo District4 Kenya (National)5

Maternal mortality ratio 620/100,000 488/100,000

Under 5 mortality ratio 208/1,000 74/1,000

HIV prevalence among adults age 15-49

23.6 6.3

% of live births receiving assistance at delivery from a trained health professional

30 44

% of children 12-23 months fully vaccinated

83.16 77

% of children stunted (moderate or severe)

56 35

Contraceptive Prevalence Rate

37% (Nyanza Province, DHS 2008)

46%

Total Fertility Rate 5.4 (Nyanza Province, DHS 2008)

4.6

Birth to pregnancy intervals < 14 months

27% (Nyanza Province, DHS 2008)

22.6%

b) Assessment Purpose and Objectives

An assessment was conducted in six health facilities in Bondo District during June 27-July 1, 2011 in order to gather information to inform program design, and development of messages and materials for the MIYCN/FP integration activity (See schedule in Appendix 1). The assessment aimed to generate useful information on current MIYCN and FP practices; enablers, barriers, and perceived benefits of key MIYCN and FP behaviors; health systems and structures; communication channels; and perceptions and ideas related to integrated MIYCN and FP service delivery. Findings from this assessment will generate insights which will be critical for informing the message and materials development process and program design.

 

 

 

                                                            4 Bondo District AOP5, 2009/2010 5 2008‐2009 Kenya DHS 6 Kenya National Health Information System.  http://hiskenya.org/.  Accessed May 2011.  

 

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II. Methods

a) Design

Bondo District is comprised of three divisions – Maranda, Usigu, and Nyangoma. In order to ensure adequate representation of responses, two facilities were selected from each division as focus sites for the assessment with assistance from the District Health Management Team. The facilities were located in rural sites, and were a representation of the small, medium and large volume facilities within the district. The ethnic groups within the area were very homogenous with most belonging to the Luo community. The assessment covered six health facilities as per the locations indicated below:

Division Facility Location

Maranda Division Bondo District Hospital Bondo Township

Kapiyo Dispensary South West Sakwa

Usigu Division Usigu Dispensary Central Yimbo

Got Agulu Sub-District Hospital West Yimbo

Nyangoma Division Nyangoma Dispensary Central Sakwa

Mabinju Dispensary South Sakwa

From each facility and catchment area, the assessment team interviewed community health workers (CHWs), mothers who had given birth in the past two years (who were already at the health facility for services), and service providers, and held one FGD which was conducted with a mixed group of mothers, partners, and CHWs. A mixed group approach for the FGDs was selected in order to ensure that a broad range of community beliefs, myths and misconceptions, as well as actual practices were adequately captured.

# Participants

Interviews

Mothers 32 CHWs 28 Service Providers 14 Clinical Officers 1 Nurses 12 Nutritionist 1

FGDs (mix of mothers, partners, CHWs)

6 total FGDs with an average of 10-12 pax per FGD

 

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b) Sampling

The assessment team purposively identified facility level health providers, CHWs, and women with children less than one year who were already visiting selected health facilities for services for interviews. The team aimed to identify approximately two facility level service providers, five CHWs, and five mothers per site for these interviews. The team also purposively identified mothers of children less than one year, partners, and CHWs for participation in focus group discussions (FGDs), with the aim of having one FGD per site, and approximately 10 participants in each FGD. c) Tools and Logistics

The assessment team was comprised of representatives from the Ministry of Public Health and Sanitation’s Division of Nutrition, Division of Reproductive Health, and Division of Public Health, MCHIP staff, and two data collectors who were fluent in the local language. MCHIP hosted a one day orientation to the assessment tools and data collection strategy for all assessment team members. The assessment tools were pretested at the Bondo District Hospital and necessary changes were made to the questionnaires prior to initiating the actual assessment activities. These field tested questionnaires were then used to guide interviews and FGDs. Semi-structured questionnaires were used for the FGDs, and structured questionnaires were used to guide the interviews. The guides included questions about enablers, barriers, and perceived benefits of MIYCN and FP services, and health facility systems and structures. (Final versions of the tools can be found in Appendix 2.) The FGDs and interviews lasted between 45 and 90 minutes, on average. Verbal informed consent was obtained from all respondents. Participants were assured that the findings presented in the assessment report would be anonymous, with no participant names appearing in the final report or any presentations related to this assessment. During each FGD and interview, each member of the assessment team was responsible for specific tasks: one for facilitation, one for transcription, and one for observation. Assessment questions were asked in English, Swahili and Dholuo depending on the language of choice of each respondent. At the end of each day, the assessment team met as a group, discussed observations, reviewed notes and identified preliminary findings. Throughout the process, assessment instruments were reviewed and refined with the aim of eliciting only the most essential information and to eliminate potential areas of repetition. At the end of each day, the assessment team reviewed the tools and data collected to improve question comprehension and identify gaps that needed to be filled by further probing in specific areas. d) Analysis

Data entry clerks entered the data from the structured questionnaires into EpiData. The data was then exported and analyzed using IBM SPSS Statistics. All qualitative responses from the structured

 

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questionnaires were recoded and also exported to SPSS. Graphs and charts were then produced using Microsoft Excel. The information from the FGDs was sorted to consolidate the responses per question for all of the FGDs. The variety of responses was then reviewed to identify common themes and key insights. This analysis was guided by an experienced qualitative researcher. Data was securely stored and only accessible to the assessment team. No individual identifiers were recorded.

III. Findings

Assessment findings are grouped by category: maternal, infant and young child nutrition; FP; communication channels; roles of providers; and integrated service delivery. In each category, summary findings related to current practices, service delivery mechanisms, barriers, perceived benefits, and enablers are detailed.

a) Maternal, Infant and Young Child Nutrition

i) Current practices

Respondents were asked about current practices in Bondo District related to breastfeeding (including immediate and exclusive breastfeeding), introduction of complementary foods, and other dietary practices for pregnant and postpartum women and their children.

Exclusive Breastfeeding

Many respondents mentioned during the FGDs and interviews that women in Bondo generally do not breastfeed exclusively for the first 6 months. Respondents mentioned that most women exclusively breastfeed for only two months at most. This is the time when women are often “allowed” by the family to stay home and recover from delivery. After the two month period, they are expected to resume normal duties, which often requires them to leave their children at home. During the period after women resume other work, mothers-in-law or other care givers will often feed the child other foods. Many respondents also mentioned that it is common for water to be given to the infant as soon as the child is born. It is believed by some that water helps to “clean the child’s stomach.”

Community health workers were asked whether they totally agree, agree slightly, or disagree with the following statement: “Mothers in Bondo usually start feeding infants other foods besides breast milk before 6 months.” Twenty of 28 CHWs totally agreed, five agreed slightly, and only three totally disagreed.

 

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Transition to Supplemental and Complementary Foods

Respondents mentioned during the focus group discussions that the most frequent first liquids given to an infant in addition to breast milk are: porridge (sometimes enriched with soya, cowpeas, groundnuts, omena), enriched flour, water (often with sugar and salt), fruit juice and soups (usually from fish, meat and vegetables). First solids given to the infant included: mashed potatoes, rice, avocado, beans, ugali, and soaked fish. Responses regarding the time at which first solids are introduced varied greatly, and were highly dependent on the individual mothers. Some infants were fed on solid foods as early as three months and others waited as long as eight months. Respondents mentioned that at one year, infants often consume fluids such as milk (both breast milk and cows’ milk), porridge, water, fruit juices, soups from fish, meat and vegetables along with mashed feeds, and at one and a half years the infant consumes much of the same foods as what the family eats.

During the interviews, CHWs were asked when other foods (other than breast milk) should be introduced into an infant’s diet. The majority (22 of 28) said they should be introduced at 6 months, whereas five suggested between 6 months and 1 year, and one said less than 6 months.

ii) Perceived benefits of recommended practices

Perceived benefits of immediate and exclusive breastfeeding mentioned by mothers most frequently included protection from disease for the baby, cost savings (from not having to purchase formula or other foods), and the convenience and ready availability of breast milk. One mother mentioned, “A mother can forget how to breastfeed if she does not breastfeed immediately,” referring to the idea that mothers may face difficulty maintaining breastfeeding if they do not initiate breastfeeding immediately after delivery.

A clear majority of CHWs (23 of 28) cited the most important benefit of exclusive breastfeeding as “it protects the baby from infectious disease,” followed by 14 of 28 stating that “it can help the child remain healthy for longer.”

Among mothers, it was generally reported that EBF is not a common occurrence. Most did not understand how the mother’s milk would be enough for a child for six months. Mothers were, however, asked about what could or did motivate them to breastfeed exclusively. The most common response was counseling from health providers, followed by counseling from CHWs. Mothers also mentioned that they felt motivated to practice EBF because they knew it would help keep their infant protected from diseases.

iii) Perceived barriers to recommended practices

Barriers to exclusive breastfeeding (EBF) mentioned during focus groups and interviews included perceptions that:

EBF can cause maternal weight loss

 

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EBF is associated with HIV/AIDS

EBF can make breasts lose shape and cause husband to stray

EBF will make the child reluctant to feed on other foods when the time comes

EBF is seen to be expensive as mother needs extra foods in order to have enough milk

Responsibilities outside the home can prevent women from breastfeeding exclusively

EBF can decrease libido and be used as an opportunity to avoid sex

Breast milk does not provide sufficient nutrients for the infant

Colostrum is not good for the infant

EBF can be linked to negative health conditions for the infant (“hero” and “nyawiwo”)

During the FGDs, participants said that partners often think that mothers use EBF as an opportunity to avoid sex. A male participant in one of the focus group discussions mentioned, “Husbands do not support EBF as it interferes with sexual activity.” Partner and family support was identified as a critical barrier to exclusive breastfeeding for the first six months. During interviews, CHWs overwhelmingly said that both spouses and other family members are unsupportive of exclusive breastfeeding. When asked whether they totally agree, slightly agree, slightly disagree or totally disagree, eighteen of 28 CHWs said that they “totally disagree” that spouses support EBF (with only 7 agreeing slightly, and 2 totally agreeing). Findings were similar regarding support from other family members for EBF. Seventeen of 28 CHWs “totally disagreed” that other family members support EBF (with only 8 agreeing slightly, and none totally agreeing).

 

 

 

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b) Family Planning

i) Current behaviors

Fifteen of the 32 mothers who were interviewed reported that they are currently using an FP method (10 reported using injectables and 3 reported using implants). Of the 17 respondents who reported that they are not currently using an FP method, 10 stated that they “have wanted to use a FP method since the last pregnancy.” Reasons cited for not wanting to use an FP method include fear of side effects, perceptions of limited risk of pregnancy due to current breastfeeding status, and one respondent mentioned that she is currently pregnant so she does not need to use FP.

Twenty two of the 32 mothers said that they came to the health facility after the birth of the last baby. Eighteen of those 22 mothers said that they were referred for FP when they returned to the health facility (14 of those 18 mothers reported following up on that referral and using FP services). It is important to note that while 14 of those had followed up on the referral for FP, 15 had reported actually using an FP method. This may be due to some mothers seeking family planning methods without having been referred, or from an outside distributor.

 

When asked about preferred methods of FP, most mothers reportedly preferred injectables. Other preferred methods included tubal ligation, condoms, implants, and “natural family planning methods” (such as the Standard Days method). One male respondent mentioned, “Tubal ligation is for widows who do not want more children.”

ii) Perceived benefits of recommended practices

Benefits of FP mentioned by mothers in the FGDs included the ability to provide sufficient care and attention for each child, as well as economic benefits. One mother said that with FP, you can have fewer children and “you can feed children well even on a small income.” Other respondents also mentioned that FP can help allow all children in a family go to school. One mother said, “When you have spaced the children, by the time the next one is born, the one before is in school so you do not have to worry.”

   

32 Postpartum Mothers 

22 came to 

health 

facility after 

infant’s 

birth 

 

18 referred for 

family planning 

during facility 

visit 

14 

followed 

up on FP 

referral 

 

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Perceived benefits of FP mentioned by CHWs included that it allows mothers sufficient time to recover and regain energy, allows mother to get involved in income generating activities to help provide for the family, allows families to provide enough care and attention for each infant, and it allows infants to breastfeed longer. CHWs also most frequently mentioned the ideal amount of time to wait before another pregnancy is 5 years (16 of 28). None of the CHWs responded that it was ideal for a woman to wait less than 2 years. It is important to note, however, that in Nyanza Province, more than 27% of all women aged 15–49 with non-first births in the last five years had conceived at 14 months or less after their last delivery7.

When asked what motivated them to seek FP services, mothers most frequently cited community talks (health education and discussion sessions conducted within the community by the CHWs) (19 of 32), individual education on FP by service providers at the facility (13 of 32), and talks led by the community chief at the baraza (9 of 32), a meeting called by the chief where all community members are invited.

iii) Perceived barriers to recommended practices

Perceived barriers to use of FP during the postpartum period mentioned by mothers focused primarily on perceived side effects and lack of partner support. Side effects mentioned by respondents included infertility, loss of libido or abnormal increase in libido, dysmenorrhea, multiparity, and infants being born with large heads.

The most frequently mentioned barriers to seeking FP services for postpartum women cited by CHWs included lack of spousal support (23 of 28) and fear of hormonal side effects (16 of 28). Other factors mentioned included religious beliefs (5 of 28) and lack of information about FP (5 of 28).

23

16

5 53 3 2 1

Lack ofspousalsupport

Fear ofhormonalside effects

Lack ofinformation

aboutservices

Religiousbeliefs

Culturalbeliefs

Lack ofeducation

Distance tofacility

Lack oftransport

Barriers to Seeking FP Services for Postpartum Women (as mentioned by CHWs, n=28, multiple responses per CHW allowed)

Number of Respondents

 

                                                            7 2008-2009 Kenya DHS 

 

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LAM

When asked about the lactational amenorrhea method (LAM) of FP, none of the CHWs knew all three LAM criteria. Eight of 28 CHWs mentioned “mother’s menstrual flow not returned” and only two mentioned “baby is exclusively breastfed.” None of the CHWs mentioned that the baby should be less than six months of age. Seventeen of the 28 CHWs did not know any of the three LAM criteria.

When service providers at the health facilities were asked about the LAM criteria, they most frequently cited “baby is exclusively breastfed” (11 of 14), followed by “mother’s menstrual flow has not returned” (6 of 14) and “baby must be less than 6 months old” (6 of 14). Six of the fourteen service providers were able to mention all three criteria.

c) Communication Channels

Mothers were asked which communication channels they find most trustworthy for transmission of health messages. Respondents most commonly mentioned that they found facility providers “extremely trustworthy” or “very trustworthy,” followed by spouses and mothers. The sources of information categorized most often as “extremely untrustworthy” or “not trustworthy” were female friends, followed by TV messages and mothers-in-law.

Extremely untrustworthy Or Not Trustworthy

Moderately Trustworthy

Very Trustworthy or Extremely trustworthy

No response

Facility Provider 1 2 29 0

Radio Messages 7 9 16 0

TV Messages 11 4 17 0

MoH billboard messages

9 4 19 0

CHW 7 4 21 0

Mother 3 1 26 2

Mother-in-Law 11 4 17 0

Other relatives 7 9 15 1

Female Friends 12 4 16 0

Spouse 1 3 26 2

 

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d) Roles of Service Providers

i) Community health workers

CHWs were asked about the roles they play in provision of maternal and child health services. They were asked to identify which services they are responsible for providing (CHWs could provide multiple responses). Of the 28 CHWs interviewed:

17 counsel mothers on child nutrition 12 counsel mothers on child nutrition AND maternal nutrition 7 do FP counseling (2 of these report counseling on LAM) 2 conduct distribution of FP methods: (condoms, pills) 25 report offering referrals for FP during home visits

Only four of the 28 CHWs reported that they currently counsel on BOTH nutrition and FP.

With regard to FP service provision, CHWs report most frequently counseling on injectables, pills, and condoms. Of 28 CHWs, six had not received any training on FP. Only 12 reported having received FP training in the last 10 years. Twenty three of the 28 CHWs had received training on infant and young child nutrition in the last 10 years (one had received training longer ago than 10 years, and two did not remember whether they had received training).

ii) Facility-level service providers Of the 14 service providers interviewed, 12 were nurses, one was a nutritionist, and one was a clinical officer. Nurses at health clinics in Bondo are often expected to “wear many hats” and are often responsible for everything from giving health talks, providing FP services, and conducting growth monitoring. In most small facilities there may only be one health provider. This provider will therefore offer both FP and nutrition services. Providers in larger facilities have the privilege of having a nutritionist at hand and will therefore offer only FP within the FP clinic. Facility-level service providers were asked about their main responsibilities at the health facility. Responses can be found in the graph on the following page.

 

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1211 11

10 10 109

87

Main Responsibilities at Health Facility(as mentioned by service providers, n=14)

Main Responsibilities at Health Facility

When asked about key services offered during postnatal care, 12 of 14 service providers reported counseling women on the importance of practicing EBF for the first 6 months, two reported counseling on LAM, and nine reported counseling on the importance of using FP to prevent unintended pregnancies.

 

e) Integrated Service Delivery

i) Perceived benefits of integrated service delivery

Respondents cited a number of potential benefits for linked or combined delivery of FP and MIYCN services. Facility-level service providers mentioned “saving time” as the most important benefit for service providers and clients. Twelve of 14 service providers cited that reduced work burden is an advantage of integrated service delivery for the provider. All 14 service providers said that a benefit of integrated service delivery for the clients is that it would save time for the mother. Service providers also mentioned reduced overall work burden on the provider (10 of 14) and less wait time for clients (9 of 14) as secondary benefits.

 

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7

10

12

effective provision of services

reduces work burden on providers

saves time for providers

Perceived Advantages of FP and Nutrition Integration  for Provider 

(as mentioned by providers, n=14, multiple responses per provider allowed)

Number of responses

14

9

4

4

2

1

Saves time for mother

Reduces waiting time

Holistic approach for the mother

Improve mother's health

Improves  mother's knowledge

Prevents  unwanted & unintended pregnancies

Advantages of FP and Nutrition  Integration  for Mothers 

(as mentioned by providers, n=14, 

multiple responses per provider allowed)

Number of respondents

ii) Perceived barriers to integrated service delivery

Service providers reported a number of challenges to integrated service delivery, including lack of staff time to take on additional responsibilities (8 of 14), lack of space in the facility (6/14), staff shortages (5/14), and lack of knowledge by the provider to provide both services (4/14).

 

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iii) Recommendations for integrated MIYCN and FP service delivery

Facility-level service providers had a number of recommendations for promoting integrated FP and MIYCN services. The majority of service providers thought that integrated service delivery could best occur through provision of training and capacity building for health workers (12 of 14), adding an additional nutritionist at the facility (9 of 14), and provision of nutrition training for all service providers at the facility (8 of14). Several FGD participants also suggested that FP and nutrition counseling and growth monitoring could be done in the same place, potentially in the same room by the same provider. One mother mentioned“You can explain your problems or needs for FP and nutrition to the same provider instead of making another line. Then you only go to look for another provider to receive the service.” It was also suggested through the FGDs that group talk sessions could address both MIYCN and FP education in the same session. Another set of suggestions that emerged from the focus group discussions was the importance of community level activities, such as integrated counselling messages provided by CHWs, local radio (such as “Radio Ramogi”) and other media channels (although assessment findings did reveal media as being less trustworthy than other communication channels), and promotion of “champions” to advocate for FP and MIYCN within target communities. One mother mentioned that if champions are used, “they must have healthy children” in order to be trusted by community members.

IV) Conclusions and Recommendations

This assessment gleaned information related to service delivery structures, attitudes and practices of service providers and clients at six health facilities and catchment areas in Bondo District. Information related to current practices, service delivery structures, barriers, enablers, and perceived benefits of maternal, infant and young child nutrition and FP will be critical in informing the design of a strategy to promote integration of MIYCN and FP in Kenya. Key themes that emerged frequently through this assessment and which will be critical for the MIYCN-FP integration message and materials development process include the following:

FP benefits and motivators: Benefits of FP mentioned most frequently by mothers focused on the ability to provide sufficient care and attention for each child, and economic benefits for the family. Implications: Messages to encourage FP uptake among postpartum women should include these key points, which are primary motivators for postpartum women in Bondo District. Messages around healthy timing and spacing of pregnancies (HTSP) should be emphasized.

Benefits of infant and young child nutrition: Mothers in Bondo generally do not practice EBF for 6 months. Benefits of immediate and exclusive breastfeeding cited most by mothers focused primarily on protection from disease for the baby, cost savings (from not having to purchase formula or other foods), and the convenience and ready availability of breast milk.

 

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Implications: Messages to encourage exclusive breastfeeding should reinforce the importance of exclusive breastfeeding for the full 6 months, and should cite the benefits mentioned by postpartum women.

Miscommunication and misconceptions: It was clear from the assessment that there are a

number of misconceptions related to exclusive breastfeeding and FP. There also appears to be a lack of clear understanding about recommended practices, especially surrounding breastfeeding, introduction of complementary foods, and HIV/AIDS. Implications: A clear, easy to follow feeding program is needed for mothers to follow when transitioning from one type of feed to another. Clear information about the benefits of FP, and options for postpartum women (including LAM) will also be important.

Partner and family support: Partner support was found to be a critical barrier to both FP uptake and EBF. Partners often feel that EBF can affect the woman’s libido and interfere with sexual activity. Family members are also often reportedly not supportive of exclusive breastfeeding for the full 6 months. Spouses and women’s mothers were mentioned as being among the most trustworthy people in a postpartum woman’s life (only second to facility health providers). Implications: Health education should address linkages between sexual activity and breastfeeding. It will be critical for messages and activities to be targeted specifically to partners and family members (who postpartum women trust most, and who have significant influence on postpartum women’s behaviors) to help build support for desired FP and MIYCN practices.

LAM: The assessment revealed a lack of knowledge about the three LAM criteria both among CHWs and facility health providers. Health workers at both levels also do not appear to be routinely counselling on LAM. Implication: Training and capacity building for service providers and CHWs on LAM and other linkages between maternal, infant and young child nutrition and FP (including that LAM as a natural method without side effects) will be critical to ensuring that clear and accurate information is routinely communicated to women.

Maternal Nutrition: There appears to be a gap in maternal nutrition messages and services

provided at community and facility levels. Implication: It is critical that maternal nutrition messages and services be routinely incorporated during ANC and postnatal visits, and at the community level through CHW outreach activities. Messages around maternal nutrition may be most accepted if the benefits for both the mother and the infant are emphasized.

Integrated Service Delivery: Health providers and clients seemed to realize the potential

benefits of integrating MIYCN and FP services. Facility providers mentioned that this type of integrated approach would save time for both the providers and clients over the long run. Respondents also had a number of suggestions related to MIYCN-FP integration activities, such as delivering both services in one room, having CHWs discuss both issues at the community level, and having MIYCN and FP champions to advocate in the community. Implications: To build buy-in among health staff, it is recommended that trainers/supervisors

 

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emphasize the potential result of saving time for both the clients and the providers, as this was a benefit most frequently cited by the providers themselves. It is also recommended that the aforementioned respondent suggestions for MIYCN-FP program design be considered, in addition to incorporation of MIYCN-FP messages within mothers support groups at the community level.

Findings from this assessment will be used to guide the development of a strategy for integration of MIYCN and FP services, along with supporting messages and materials. A message and materials development workshop is scheduled for August 2011. Following the workshop, the team will move forward with pre-testing and finalization of materials, and orientation of health workers.

 

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APPENDIX 1: Assessment Schedule

Day Date Facility

Sunday 26 June Team Arrives in Kisumu

Monday 27 June Bondo- Orientation of data teams

Tuesday 28 June Bondo D.H.

Wednesday 29 June Usigu, Got Agulu

Thursday 30 June Mabinju, Nyangoma

Friday 1 July Kapiyo

Saturday 2 July Travel back to NBI

 

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APPENDIX 2: Assessment Tools

Mothers Exit Interview  

Hello my name is ________. I am here under the auspices of the Ministries of Health. Thank you 

for allowing me to visit with you today. I would like to ask you some questions that will better 

allow us to understand how family planning and young child nutrition services are being 

provided at facilities within this area. This interview will take about 10 minutes. Please be 

assured that your name will not be recorded and any other identifying information provided by 

yourself will be kept strictly confidential. Your participation in this survey is voluntary and you 

will not be penalized b facility staff or anyone else in any way whether you decide to participate 

or not. You can refuse to answer any questions and you may also stop the interview at any time. 

May I continue?  

Yes =Continue with interview   _____________________  

signature/mark of respondent 

No = Thank respondent and END.  

 

01. Interviewer name    

02. Date of Interview 

03. Facility/Village name    

04. Facility Level National Hospital ................................... 1 Provincial Hospital ................................. 2 District Hospital ...................................... 3 Dispensary .............................................. 4 Health Centre ......................................... 5 Other specify .......................................... 6 

05. Questionnaire Number   

       

 

 

 

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Q No.

Question Answer Skip pattern

A. DEMOGRAPHIC INFORMATION A1. How old are you? Write in

A2 What is the highest level of schooling that you attained?

None .................................................1 Primary (Incomplete) .........................2 Primary (complete) ............................3 Secondary (incomplete) .....................4 Secondary (complete) ........................5 High school .......................................6 Intermediate college/polytechnic .......7 University ...........................................8 Other (specify) ......................... 10

A3. What is your marital status?

Single (never married) .......................1 Divorced/widowed/separated .............2 Cohabiting .........................................3 Married (monogamous) .....................4 Married (polygamous) ........................5

A4 What is your current occupation?

Student .................................... 1 Housewife ................................ 2 Self employed .......................... 3 Employed (casual) ................... 4 Employed (permanent) ............ 5 Unemployed............................. 6 Other (specify) ......................... 7

A5. How many children do you have and how old are they?

Write in Total Number of Children____ Ages of Children____________________

A.6 When did you give birth to your last born child? Note the month and year the last child was born

Write in Month ________________ Year _________________

If last born child is more than 2 years old - END

A7 Are you currently pregnant? If yes, how many months along are you?

Yes ........................................... 1 No ............................................. 2 If Yes, write in how many months_________

 

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B. BACKGROUND ON INDIVIDUAL BREASTFEEDING PRACTICE B1. Have you ever

received any messages at the facility about how to feed your baby?

Yes ............................................................... 1 No ................................................................ 2

If NO go to B4

B2. How often have you received these messages?

Every time I come to the ANC clinic ............................... 1 During Labor and Delivery care ....................................... 2 Every time I come to the PNC clinic ............................... 3 Every time I bring my baby to the facility for growth monitoring or well baby visit .......................................................................... 4 Every time I bring my infant for immunization ................. 5 Every time I bring my baby for treatment ........................ 6 Only once ......................................................................... 7 At a few visits ................................................................... 8 Rarely .............................................................................. 9 Never ............................................................................... 10 Other(specify) .................................................................. 11

Continue

B3a. What messages have you ever received from the facility on how to feed your baby? PROBE AND CIRCLE ALL RELEVANT ANSWERS

To breastfeed exclusively for six months ...................................... 1 To breastfeed child on demand for the first six months ................. 2 To give formula before six months ................................................. 3 To give formula after six months .................................................... 4 To breastfeed exclusively for four months ..................................... 5 Continue to breastfeed after six months and at the same time give complementary foods .................................................................... 6 Start giving food at six months ....................................................... 7 To start weaning with easily digestible foods ................................. 8 To feed the child 2-3 meals per day from months 6-8 ................... 9 To feed the child 3-4 meals per day from months 9-23 ................. 10 To give the child plenty of fluids ..................................................... 11 To give child plenty of fluids in cases of diarrhea and vomiting .... 12 Other (write in) ............................................................................... 13

B3b. What were you told exclusive breastfeeding is?

Write in

B4. Where else APART FROM THE FACILITY, do you get messages on how to feed your baby? PROBE AND CIRCLE ALL RELEVANT ANSWERS

From the radio ............................................................ 1 From TV programs and advertisements ..................... 2 From Billboards by MOH ........................................... 3 From posters by MOH ................................................ 4 From CHWs ................................................................ 5 From my mother in law .............................................. 6 From my mother ......................................................... 7 From other relatives ................................................... 8 From other female friends ........................................... 9 From my spouse ......................................................... 10 Other(specify) ............................................................. 11

 

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B5. What messages have you received from sources AWAY FROM THE FACILITY on how to feed your baby?

To breastfeed exclusively for six months ...................................... 1 To breastfeed child on demand for the first six months ................. 2 To give formula before six months ................................................. 3 To give formula after six months .................................................... 4 To breastfeed exclusively for four months ..................................... 5 Continue to breastfeed after six months and at the same time give complementary foods .................................................................... 6 Start giving food at six months ....................................................... 7 To start weaning with easily digestible foods ................................. 8 To feed the child 2-3 meals per day from months 6-8 ................... 9 To feed the child 3-4 meals per day from months 9-23 ................. 10 To give the child plenty of fluidsin case of diarrhea ....................... 11 To give child plenty of fluids in cases of diarrhea and vomiting .... 12 Other (write in) ............................................................................... 13

B6. I want you to rate the messages on FP you receive in terms of trust where 1 is extremely untrustworthy and 5 extremely trustworthy.

1 Extremely

untrustworthy(Haiaminiki

hata kidogo)

2 Not

trustworthy (Haiaminiki)

3 Just

trustworthy(Inaaminka

kidogo)

4 Very

Trustworthy (Inaaminika

zaidi)

5 Extremely

Trustworthy(Inaaminika

kabisa)

Tick as appropriate

B6a Facility Provider B6b Radio B6c TV B6d Billboards by MOH B6e Posters by MOH B6f CHWs B6g Mother in Law B6h Mother B6i Other relatives B6j Female friends B6k Spouse B6l Other

 

FOR MOTHERS WITH BABIES SIX MONTHS AND BELOW ASK QUESTIONS C1 AND C2 AND THEN SKIP TO RELEVANT QUESTION

FOR MOTHERS WITH BABIES OF MORE THAN SIX MONTHS BUT LESS THAN TWO YEARS START AT C3.

Question Answers Skip Pattern

C(i.) FOR MOTHERS WITH BABIES AGED SIX MONTHS AND BELOW

 

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C1. Are you currently EXCLUSIVELY breastfeeding your child? Explain that medicines and vitamins and mineral supplements are excluded.

Yes .............................................................. 1 No ................................................................ 2

If NO: Go to C7

C2. What or who motivated you to breastfeed exclusively? PROBE AND CIRCLE ALL RELEVANT ANSWERS

Was told by a provider ..................................................... 1 Heard a message on the radio ........................................ 2 Heard a message on TV ................................................. 3 Saw a message on a billboard ........................................ 4 Saw a message on a facility poster ................................. 5 I have a lot of milk ........................................................... 6 I cannot afford to give my child anything else ................. 7 Was told by mother in law ............................................... 8 Was told by my mother .................................................... 9 Was told by other relative ................................................ 10 Was told by friend ............................................................ 11 Was advised by spouse/partner ..................................... 12 I am always at home ....................................................... 13 I am able to store the breast milk safely .......................... 14 Was counseled by a CHW .............................................. 15 Was told by a neighbor ................................................... 16 Heard that my baby will be free from diseases ............... 17 Other (specify) ................................................................. 18

Skip to D1

C(ii.) FOR MOTHERS WITH BABIES OVER SIX MONTHS OLD C3. Did you at any point

exclusively breastfeed your baby?

Yes .............................................................. 1 No ................................................................ 2

IF NO GO TO C5

C4. IF YES: For how long did you exclusively breastfeed your child?

Less than one month ................................... 1 One month ................................................... 2 Two months ................................................. 3 Three months ............................................. 4 Four months ................................................ 5 Five months ................................................. 6 Six months ................................................... 7

GO TO C6

 

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C5. IF NO What made you introduce other foods (food or liquids, including water) to your baby’s diet before SIX months were up? Mark all that apply

Was advised by provider to stop ................................................. 1 Lack of lactation .......................................................................... 2 Child refused to suckle ................................................................ 3 Was advised by mother in law .................................................... 4 Was advised by my mother to .................................................... 5 Was advised by other family members ....................................... 6 Was advised by friends ............................................................... 7 My husband is unfaithful so I fear my baby might fall sick .......... 8 I felt my child was not satisfied with breast milk alone ................ 9 I am unable to express the milk ................................................... 10 Felt that my breast milk is not safe for my baby .......................... 11 No reason given .......................................................................... 12 Did not feel my child was getting enough nutrition ...................... 13 Was advised by a CHW .............................................................. 14 Other .......................................................................................... 15

GO TO C7

C6. IF CHILD BREASTFED EXCLUSIVELY FOR SIX MONTHS ASK What or who motivated you to breastfeed exclusively for six months? Mark all that apply

Was told by a provider ................................................ 1 Heard a message on the radio ................................... 2 Heard a message on TV ............................................ 3 Saw an article on the internet ..................................... 4 I have a lot of milk ...................................................... 5 I cannot afford to give my child anything else ............ 6 Was told by mother in law .......................................... 7 Was told by my mother ............................................... 8 Was told by other relative ........................................... 9 Was told by friend ....................................................... 10 I am always at home .................................................. 11 I am able to store the breast milk safely ..................... 12 Was counseled by a CHW ......................................... 13 Other (specify) ............................................................ 14

C7. Do you still breast feed your child?

Yes .............................................................. 1 No ................................................................ 2

IF NO GO TO C9

C8. IF YES: Why do you continue breastfeeding your child?

Breast milk is cheap and free ..................................... 1 Was encouraged by provider ..................................... 2 Was encouraged by mother in law ............................. 3 Was encouraged by my mother ................................. 4 Was encouraged by my spouse ................................ 5 Was encouraged by other relatives ............................ 6 Was encouraged by my friends ................................. 7 I still have a lot of milk ............................................... 8 Breast milk is good for my baby at any age ............... 9 Keeps baby healthy .................................................... 10 Keeps me from getting pregnant ................................ 11 Other .......................................................................... 12

Go to D1

 

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C9. IF NOT: Why did you stop breastfeeding your child?

Was advised by provider to stop ................................................. 1 Lack of lactation/My milk dried up ............................................... 2 Child refused to suckle ................................................................ 3 Was advised by mother in law .................................................... 4 Was advised by my mother ....................................................... 5 Was advised by other family members ....................................... 6 Was advised by friends ............................................................... 7 My husband is unfaithful so I fear my baby might fall sick .......... 8 I felt my child was not satisfied with breast milk alone ................ 9 Feel that my breast milk is not safe for my baby ....................... 10 No reason given ........................................................................ 11 Did not feel my child was getting enough nutrition .................... 12 I am pregnant so do not feel I should continue ......................... 13 I have to go back to work .......................................................... 14 Was advised by CHW ............................................................... 15 Other ........................................................................................ 16

D. ......................................................... FP AND FEEDING PRACTICES INTEGRATION ASK ALL MOTHERS

D1. Are you planning to have another baby?

Yes ........................................................... 1 No .............................................................. 2 Not decided .............................................. 3

NO OR NOT DECIDED GO TO QD3

D2. IF YES: When do you hope to have another child?

I am already expectant ............................. 1 In the next one year ................................... 2 Within the next two years .......................... 3 Within the next three years ........................ 4 More than 3 years from now ..................... 5 Not decided/Don’t know .......................... 6 Other (specify) ........................................... 7

D3a. Did you return/come to the facility after the delivery of your last baby?

Yes ............................................................ 1 No ............................................................... 2

If NO go to D11

D3b IF YES: Did you return for yourself or did you bring your baby or both?

Came for myself ........................................ 1 Came for my baby ...................................... 2 Came for both myself and my baby ............ 3

D4. When you returned to the facility for either your child or yourself did any of the providers refer you for Family Planning services?

Yes ........................................................... 1 No .............................................................. 2

IF NO Go to D10

 

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D5. IF YES: Where or who were you referred to for FP services?

Other provider at the facility ...................... 1 Other department at the facility ................. 2 CHW .......................................................... 3 Other facility .............................................. 4 Other (specify) ........................................... 5

Continue

D5a. Did you follow up on the FP referral?

Yes ........................................................... 1 No .............................................................. 2

D5b. IF NOT: Why did you follow up on the FP referral?

Facility where I was referred is too far away ......................... 1 Facility where I was referred is too expensive ...................... 2 Did not have time to go to the facility where I was referred ... 3 Do not like the facility where I was referred .......................... 4 Did not want my husband to know about my using an FP method 5 Do not trust the providers at the facility where I was referred 6 My religion does not allow me to use a method .................... 7 My husband does not want me to use a method ................... 8 Other .................................................................................... 9

D6. When you went to the clinic for services for your child, did the provider speak to you about any methods of FP?

Yes ........................................................... 1 No .............................................................. 2

D7 Have you ever heard about LAM/Using breastfeeding to prevent pregnancy?

Yes ........................................................... 1 No .............................................................. 2

IF NO Go to D10

D8. What messages were you given for LAM to be effective?

The mother’s menstrual flow should not have returned....1 The baby is fully or nearly fully breastfed and is fed often, day and night………………………………………………….2 The baby should be than six months old………………….3 All of the above………………………………………………..4 Other (specify)…………………………………………………5

D9. Did the provider discuss LAM as a way of delaying your next pregnancy immediately after delivery?

Yes ........................................................... 1 No .............................................................. 2

D10. What other messages have you received about FP and or birth spacing after you had your baby?

I should use an FPmethod if I do not want to have another baby 1 It is important to space the birth of my babies ............................. 2 FP will help me have a baby when I am ready to have one ........ 3 Spacing of my children will improve their health ......................... 4 Spacing of my children will ensure they grow well (are taller)……………………………………………………………..5 Spacing of my children will help improve MY health ................... 6 Side effects FP methods ............................................................ 7 Other ........................................................................................... 8

 

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D11. Do you know of any CHW who provides FP counseling/methods to women in your community?

Yes .................................................................................... 1 No ...................................................................................... 2

D12. Are you currently using any FP method?

Yes .................................................................................... 1 No ...................................................................................... 2

If NO; go to D15

D13. IF YES: What method are you using?

Pills ................................................................................... 1 Injectables ........................................................................ 2 Norplant ............................................................................ 3 Jadelle ............................................................................... 4 IUCD .................................................................................. 5 Diaphragms ....................................................................... 6 Natural FP ......................................................................... 7 Condoms ........................................................................... 8 LAM ................................................................................... 9 Vasectomy ........................................................................ 10 Tubal Ligation .................................................................... 11 Emergency Contraceptives ............................................... 12 Other (specify) ................................................................... 13

D14. Where did you receive the initial counseling for the FP method you are using?

From a provider at this facility ........................................... 1 From a provider at another facility ..................................... 2 CHW .................................................................................. 3 From friends ..................................................................... 4 From spouse/partner ........................................................ 5 From other family member ............................................... 6 Other (specify) ................................................................... 7

D15. IF NO: Have you ever wanted to use an FP method since your last pregnancy?

Yes .................................................................................... 1 No ...................................................................................... 2 Not decided ....................................................................... 3

If YES go to D16 If NO go to D17

D16. IF YES: What has stopped you from getting an FP method?

Do not have the time to line up at the FP clinic ................. 1 Afraid to ask ...................................................................... 2 No-one has ever asked me if I want a method .................. 3 Do not know enough about FP to ask for a method .......... 4 My spouse does not want me to use any method ............. 5 My religion does not allow me to use any method ........... 6 My husband lives far away ................................................ 7 Do not like the side effects ............................................... 8 Other (specify) ................................................................... 9

Go to D18

 

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D17. IF NO: Why do you not want to use an FP method?

Still want to have more children ........................................ 1 Afraid of the side-effects of FP methods ........................... 2 Feel I am too young to use FP methods ........................... 3 Believe that FP methods are only for married couples ...... 4 I am breastfeeding so not at risk of getting pregnant..5 Other(specify) .................................................................... 6

D18. In your opinion when is the best time after having one baby to have another?

It does not matter .............................................................. 1 Immediately after ............................................................... 2 One year after .................................................................. 3 Two years later ................................................................. 4 More than two years later .................................................. 5 Other (specify) ................................................................... 6 Don’t know ........................................................................ 7

D19. In your opinion what are the benefits of spacing babies FOR THE MOTHER?

Mother has adequate time for recovery ............................. 1 Mother has ample time to care for her baby ...................... 2 Mother can bond better with the baby ............................... 3 Mother has more time to care for the rest of the family ..... 4 Mother has less financial stress ....................................... 5 It is good for the mother’s health………………………6 Other (specify) ................................................................... 7 Don’t know ......................................................................... 8

D20. In your opinion what are the benefits of proper birth spacing FOR THE BABY?

Baby has healthy birth weight .......................................... 1 Baby develops well as mother can give a lot of attention .. 2 Baby is born healthier as mother has had time to recover 3 Baby is better prepared to begin school ............................ 4 Children properly spaced perform better in school ............ 5 The baby forms a better bond with the mother .................. 6 The baby will grow taller………………………………..7 Other (specify) ................................................................... 8 Don’t know ........................................................................ 9

D21. Would you want to receive FP information at the MCH clinic?

Yes .................................................................................... 1 No ...................................................................................... 2

D22. Please give reasons for your answer above.

Write in

E. Do you have any questions or comments concerning IYCN and FP? _______________________________________________________________________

THANK RESPONDENT AND CLOSE INTERVIEW

 

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SERVICEPROVIDERSQUESTIONNAIRE 

Hello my name is ________. I am here under the auspices of the Ministries of Health. Thank you for allowing me to visit with you today. I would like to ask you some questions that will better allow us to understand how family planning and young child nutrition services are being provided within this area. This interview will take about 10 minutes. Please be assured that your name will not be recorded and any other identifying information provided by yourself will be kept strictly confidential. Your participation in this survey is voluntary and you will not be penalized by anyone else in any way whether you decide to participate or not. You can refuse to answer any questions and you may also stop the interview at any time. May I continue?

Yes =Continue with interview _____________________

signature/mark of respondent

No = Thank respondent and END.

01. Interviewer(write in)

02. Date of Interview (write in)

03. Facility Name (write in )

04. Facility Level

National Hospital ............................... 1 Provincial Hospital ............................ 2 District Hospital ................................. 3 Health Centre .................................... 4 Dispensary ........................................ 5 Other specify ..................................... 6

05. Questionnaire Number

Q No.

Question Answer Skip pattern

A1. What is your current cadre? Physician/Doctor ................................................ 1 Clinical Officer .................................................... 2 Registered Nurse .............................................. 3 Enrolled Nurse ................................................... 4 Nutritionist .......................................................... 5 CHW .................................................................... 6 Other (specify) ..................................................... 7

B. .................................................... SP’S RESPONSIBILITIES AND TRAINING B1. Have you ever received any Yes ............................................................ 1 If NO Go

 

 

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Q No.

Question Answer Skip pattern

training on Family Planning? No ............................................................... 2 to B6 B2. How long did the most recent

training last? Write in:

B3. Was this training pre-service or in-service training?

Pre-service ................................................. 1 In-service .................................................... 2

B4. Which year did you receive this most recent training?

Write in:

B5. Who provided the training? GOK ........................................................... 1 NGO ........................................................... 2 FBO ............................................................ 3 CBO ............................................................ 4 OJT from other CHW .................................. 5 OJT from facility provider ........................... 6 Other (specify) ............................................ 7

B6. Have you ever received any training on nutrition for Infant and Young Child Nutrition?

Yes ............................................................ 1 No ............................................................... 2

If NO go to C1

B7. How long did the most recent training last?

Write in:

B8. Was this training pre-service or in-service training?

Pre-service ................................................. 1 In-service .................................................... 2

B9. In which year did you receive the most recent training?

Write in:

B10. Who provided this training? GOK ........................................................... 1 NGO ........................................................... 2 FBO ............................................................ 3 CBO ............................................................ 4 OJT from other CHW .................................. 5 OJT from facility provider ........................... 6

C.............................................................. RESPONSIBILITIES AND DUTIES AS FP PROVIDER

C1. What are your main responsibilities at the health facility? Circle all that apply

Growth monitoring .............................................. 1 Nutrition education ............................................. 2 Health talks ......................................................... 3 Child immunization ............................................. 4 Maternal immunization ....................................... 5 Provision of FP services ...................................... 6 Provision of PNC services .................................. 7 Provision of ANC services .................................. 8 Delivery services ................................................. 9 Other (specify) ..................................................... 10

C2. On average, how many family planning clients do you see each day?

Write in

C3. On average, how long does Write in

 

 

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Q No.

Question Answer Skip pattern

each of your family planning counselling sessions usually last?

C4. Do you have job aids to guide your FP and nutrition counselling sessions?

Yes ............................................................... 1 No .................................................................. 2

If No go to C8

C5. IF YES: Which job aids are these? Circle all that apply

FP Checklist ........................................................ 1 FP method Flip chart ........................................... 2 Eligibility criteria .................................................... 3 FP Guidelines ...................................................... 4 MEG cards ........................................................... 5 Nutrition counselling cards for PLWAS ................ 6

C6. Who supplies the job aids? GOK .............................................................. 1 NGO .............................................................. 2 FBO ............................................................... 3 CBO ............................................................... 4 Other (specify) ............................................... 5

C7. Do you give health education on FP to clients seeking maternal, new born, and child health services?

Yes ............................................................... 1 No .................................................................. 2 Don’t know/Not sure ..................................... 3

If NO go to D1

C8. How long do the group sessions last?

Less than one hour ........................................ 1 Between one and two hours .......................... 2 Between two and three hours ....................... 3 Between three and four hours ....................... 4 More than four hours ..................................... 5 Do not provide group sessions ..................... 6

C9. Who usually attends the group sessions at the facility? Circle all possible answers

Mothers ........................................................ 1 Spouses ........................................................ 2 Community leaders ...................................... 3 Religious leaders ........................................... 4 Youth ............................................................. 5 Not sure/Don’t know ..................................... 6 Other(specify) ................................................ 7

C10. What topics are covered during the group sessions at the facility?

FP methods .................................................. 1 Maternal nutrition .......................................... 2 Young child nutrition ..................................... 3 Infant nutrition ............................................... 4 EBF .............................................................. 5 LAM ............................................................... 6 Myths surrounding Breastfeeding ................. 7 Myths surrounding FP ................................... 8 Management of post rape ............................ 9 Other (specify) ............................................... 10

 

 

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Q No.

Question Answer Skip pattern

Q

No. Question Answer Skip

pattern D. ...................................................... FAMILY PLANNING AND EBF

D1. When women deliver AT THE FACILITY what messages are they given? Circle all that apply

Come for PNC after 2 weeks ....................................... 1 Bring infant to facility for immunization after six weeks .................................................................................... 2 Danger signs for mother ............................................. 3 Danger signs for the infant ......................................... 4 In case of danger signs bring infant to any facility immediately ................................................................. 5 In case of danger signs take child to main/district facility .................................................................................... 6 On conclusion of immunizations bring child for growth monitoring until child is 5 yrs old ................................. 7 Practice EBF for 6 months ......................................... 8 Continue breastfeeding after six months and give adequate complementary foods .................................. 9 Children need more diverse food/meals than adults ... 10 Messages on LAM ....................................................... 11 Use of FP methods to prevent unplanned pregnancy . 12 HIV testing .................................................................. 13 Receive a vitamin A capsule within four weeks of delivery ........................................................................ 14 Ensure a balanced diet for good health and good quality milk .............................................................................. 15 Other (specify) ............................................................. 16

D2. When women deliver AT HOME do MOST of them come to the facility WITHIN 48 HRS?

Yes ................................................................ 1 No .................................................................. 2 Don’t know/not sure ....................................... 3

If YES go to D4

D3. IF NO to D2 When do MOST women who DELIVER AT HOME come to the facility for postpartum care?

Within the first week but after 48 hours ....................... 1 After the first week but within the second week .......... 2 After the second week but within the third week ......... 3 After the third week but within the fourth week ............ 4 After the fourth week but within the fifth week ............ 5 After the fifth week but within the sixth week .............. 6 After the sixth week ..................................................... 7 Other(specify) ............................................................. 8 Don’t know ................................................................... 0

Continue

 

 

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Q No.

Question Answer Skip pattern

D4. What messages do the women WHO DELIVER AT HOME receive WHEN THEY COME TO THE FACILITY? Circle all that apply

Come for PNC after 2 weeks ....................................... 1 Bring infant to facility for immunization after six weeks .................................................................................... 2 Danger signs for mother ............................................. 3 Danger signs for the infant ......................................... 4 In case of danger signs bring infant to any facility immediately ................................................................. 5 In case of danger signs take child to main/district facility .................................................................................... 6 On conclusion of immunizations bring child for growth monitoring until child is 5 yrs old ................................. 7 Practice EBF for 6 months ......................................... 8 Continue breastfeeding even after introducing complementary feeding ............................................... 9 Children need more meals than adults ........................ 10 Messages on LAM ....................................................... 11 Use of FP methods to prevent unplanned pregnancy . 12 HIV testing .................................................................. 13 Receive a vitamin A capsule four weeks after delivery 14 Ensure a balanced diet for good health and good quality milk .............................................................................. 15 Other (specify) ............................................................. 16

D5. Who of the following are generally supportive of using family planning? Circle all that apply

Mother in Law ........................................................ 1 Woman’s Mother ................................................... 2 Woman’s Grandmother ......................................... 3 Husband ................................................................ 4 Religious Leaders (excluding Catholic and Independent churches ) .............................................................. 5 Grandmother ......................................................... 6 Partners/Spouses .................................................. 7 CHWs .................................................................... 8 Health workers at the facility ................................. 9 Female Friends of the mother .............................. 10 Male friends of the mother .................................... 11 Youth .................................................................... 12 Others(specify) ...................................................... 13

 

 

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Q No.

Question Answer Skip pattern

D6. In your opinion what strategies are most successful in motivating mothers with children under 2 years to adopt FP?

Group counselling ................................................ 1 Individual counselling ........................................... 2 Provision of educational material .......................... 3 Educational material ............................................. 4 Demand creation for services through health education .............................................................................. 5 Use CHWs to spread the message ...................... 6 Use CHWs to distribute certain methods ............. 7 Support for family planning from religious and community leaders Other .................................................................... 8

E. ............................................................... NUTRITION AND FAMILY PLANNING SERVICES

E1. Is there a nutritionist at this facility?

Yes ........................................................................ 1 No .......................................................................... 2

If YES go to E3

E2. IF NO at E1: Who in the facility is responsible for counselling clients on maternal and infant nutrition?

Doctor .................................................................... 1 Clinical Officer ...................................................... 2 Nurse .................................................................... 3 Other (specify) ....................................................... 4 No one ................................................................... 0

Continue

E3. When do you start counselling mothers on nutrition?

When mother first comes to facility for ANC ................ 1 When mother comes in for delivery ............................ 2 After mother has been discharged from maternity ..... 3 When mother brings baby for immunization ............... 4 Does not occur ........................................................... 0

E4. Which FP methods do you usually COUNSEL mothers on?

Pills ......................................................... 1

Injectables .............................................. 2

Implanon ................................................. 3

Jadelle ..................................................... 4

IUCD ........................................................ 5

Diaphragms ............................................. 6

Natural FP ............................................... 7

Condoms ................................................. 8

LAM ......................................................... 9

Vasectomy .............................................. 10

Tubal Ligation .......................................... 11

Emergency Contraceptives ..................... 12

None ............................................................ 20

 

 

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Q No.

Question Answer Skip pattern

E5. What FP methods ARE AVAILABLE for you to offer to clients at this facility?

Pills ......................................................... 1

Injectables .............................................. 2

Implanon ................................................. 3

Jadelle ..................................................... 4

IUCD ........................................................ 5

Diaphragms ............................................. 6

Natural FP ............................................... 7

Condoms ................................................. 8

LAM ......................................................... 9

Vasectomy .............................................. 10

Tubal Ligation .......................................... 11

Emergency Contraceptives ..................... 12

None ............................................................ 20

E6. For which FP methods do you usually REFER MOTHERS TO OTHER FACILITIES?

Pills ......................................................... 1

Injectables .............................................. 2

Implanon ................................................. 3

Jadelle ..................................................... 4

IUCD ........................................................ 5

Diaphragms ............................................. 6

Natural FP ............................................... 7

Condoms ................................................. 8

LAM ......................................................... 9

Vasectomy .............................................. 10

Tubal Ligation .......................................... 11

Emergency Contraceptives ..................... 12

None ............................................................ 20

E7. Do you counsel your clients on LAM?

Yes ....................................................................... 1 No .......................................................................... 2 Just mention LAM ................................................. 3

IF NO Go to E13

E8. IF YES: What are the three conditions that must be in place for a client to be eligible for LAM?

The mother’s menstrual flow has not returned ........... 1 The baby is exclusively or almost exclusively breastfed .................................................................................... 2 The baby must be less than six months old ............... 3 Don’t know ................................................................... 5

 

 

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Q No.

Question Answer Skip pattern

E9. What messages do you share with the women you counsel about LAM? Circle all that apply

It is a temporary FP method ........................................ 1 Can be effective for up to six months after childbirth . 2 Requires breastfeeding often, day and night .............. 3 Encourages the best breastfeeding patterns ............... 4 Has health benefits for both mother and child ............ 5 The effectiveness depends on the user ...................... 6 LAM depends on how much the woman breastfeeds the baby ............................................................................. .................................................................................... 7 Does not offer protection against HIV and other STDs 8 The method has no side effects ................................. 9 Change to another method once the woman’s menses returns ........................................................................ 10 Other (specify) ............................................................. 11

E10. What messages do you share with clients about moving from LAM to another method of FP? Circle all that apply

None ...................................................................... 1 LAM is just a gateway to other FP methods ......... 2 See provider for alternative once any of the three conditions are no longer met ................................. 3 Use other FP method as soon as she is no longer using LAM. ...................................................................... 4 Choose FP methods that are safe for a breastfeeding mother ................................................................... 5 Continue to breastfeed baby even after using other FP methods ................................................................. 6 Other (specify) ........................................................ 7

Go to E14

E11. IF NO: Why do you not counsel mothers on LAM?

Do not believe it works ........................................... 1 Do not understand how it works ............................. 2 Do not have the time .............................................. 3 Most mothers are not supportive of LAM ............... 4

F. MIYCN/FP INTEGRATION F1. Do providers usually counsel

mothers on bothEBF and FP at the same time?

Yes ............................................................................ 1 No .............................................................................. 2 Not always ................................................................ 3

F2.. Would you be able to confidently counsel mothers both on IYCF and FP at the same time?

Yes ............................................................................ 1 No .............................................................................. 2 Not sure ..................................................................... 3

F3. What is your reason for your answer above?

Mothers need the service ........................................... 1 I know the importance of both services ...................... 2 I have the knowledge, skills and tools ....................... 3 FP is important to mothers ......................................... 4 Nutrition is important for mothers and their children .... 5 Other (specify) ............................................................. 6

 

 

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Q No.

Question Answer Skip pattern

F4. State challenges that might be faced in incorporating family planning messages and FP referrals in nutrition counselling?

Lack of staff time ....................................................... 1 Lack of space ............................................................ 2 Poor provider attitudes .............................................. 3 Resistance from mothers .......................................... 4 Staff shortages ......................................................... 5 High turnover of trained staff ..................................... 6 Lack of knowledge by provider .................................. 7 Other(specify) ............................................................ 8

F5. State the advantages of incorporating family planning messages and FP referrals in nutrition counselling FOR HEALTH CARE WORKERS?

Saves time for provider .............................................. 1 Reduce work burden on providers .............................. 2 Effective provision of services .................................... 3 Other (specify) ............................................................. 4

F6. State the advantages of incorporating family planning messages and FP referrals in nutrition counselling for THE MOTHERS?

Holistic approach for the mother ................................ 1 Saves time for mother ................................................ 2 Will improve mothers health ....................................... 3 Reduces waiting time ................................................. 4 Prevent unwanted pregnancies .................................. 5 Improves mothers’ knowledge ..................................... 6 Other .......................................................................... 7

F7. Do you have any other ideas for improved integration of services and reduction of missed opportunities for promoting maternal and infant/young child health?

Additional nutritionists at facility .................................. 1 All providers should be receive training on nutrition ... 2 Ensure privacy ............................................................. 3 Avail commodities, equipment and supplies ............. 4 Capacity building for health workers ........................... 5 Supply nutritional supplements ................................... 6 Other (specify) ............................................................. 7

06. Do you have any further comments about MIYCN/FP integration? _________________________________________________________________________

THANK RESPONDENT

 

 

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MIYCN/FP Integration Needs Assessment Tool

Recruitment Questionnaire—Community Health Workers

Hello my name is ________. I am here under the auspices of the Ministries of Health. Thank you for allowing me to visit with you today. I would like to ask you some questions that will better allow us to understand how family planning and young child nutrition services are being provided within this area. This interview will take about 20 minutes. Please be assured that your name will not be recorded and any other identifying information provided by yourself will be kept strictly confidential. Your participation in this survey is voluntary and you will not be penalized by anyone else in any way whether you decide to participate or not. You can refuse to answer any questions and you may also stop the interview at any time. May I continue?

Yes =Continue with interview _____________________

signature/mark of respondent

No = Thank respondent and END.

Interviewer (write in)

Date of Interview (write in)

Facility/Community Group Name

Facility Level National Hospital ............................... 1 Provincial Hospital ............................ 2 District Hospital ................................. 3 Dispensary ........................................ 4 Health Centre .................................... 5 Other specify ..................................... 6

District Write in

Location

Questionnaire Number

 

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Q No.

Question Answer Skip pattern

C. DEMOGRAPHIC INFORMATION A1. How old are you? Write in

A2 What is your highest level of schooling that you attained?

None .............................................................. 1 Primary (Incomplete) ...................................... 2 Primary (complete) ......................................... 3 Secondary (incomplete) .................................. 4 Secondary (complete) .................................... 5 High school .................................................... 6 Intermediate college/polytechnic .................... 7 University ........................................................ 8 Other (specify) ................................................ 10

A3. What is your marital status?

Single (never married) ............. 1 Divorced/widowed/separated .. 2 Cohabiting .............................. 3 Married (monogamous) ........... 4 Married (polygamous) .............. 5

A4 What is your current cadre?

Community Health Worker ........................ 1 Community Extension Health Worker ........ 2 Community Based Distributor .................... 3 Facility Based distributor ........................... 4 Other (specify) ............................................ 5

D. ......................................................... CHW’’S RESPONSIBILITIES AND TRAINING

B1. Have you received any training on Family Planning?

Yes ........................................................... 1 No .............................................................. 2

If NO skip to B5

B2. Which year(s) did you receive this training?

Write in answer: 1___________2________3________ 4________

B3 How long was the last training?

Write in answer: 1___________2________3________ 4________

B4. Who provided the training? Write in training number

GOK ............................................................. 1______ NGO ............................................................ 2______ FBO ............................................................. 3 ______ CBO ............................................................. 4______ OJT from other CHW ................................... 5______ OJT from facility provider .. 6_______

B5. Have you ever received any training on

Yes ........................................................... 1 No .............................................................. 2

If NO skip to B8

 

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Q No.

Question Answer Skip pattern

nutrition for Infant and Young Child Nutrition?

B5. In which year(s) did you receive this training?

Write in answer:___________

B6 How long was the last training?

Write in answer:___________

B7. Who provided this training?

GOK ........................................................... 1 NGO .......................................................... 2 FBO ........................................................... 3 CBO ........................................................... 4 OJT from other CHW ................................. 5 OJT from facility provider ........................... 6 Other (specify) ........................................... 7

B8. What are your main responsibilities during household visits? Circle all that apply

Counselling families on WASH activities ................... 1 Counselling mothers on child nutrition ........................ 2 Follow-up visits for families with HIV+ individuals.3 Follow-up for TB defaulters ....................................... 4 Follow-up for ARV defaulters ..................................... 5 FP counselling ............................................................ 6 FP distribution ............................................................. 7 Follow up of children with nutrition problems ............. 8 Counsel mothers on maternal nutrition ...................... 9 Deworming of children ............................................... 10 Hospital referral .......................................................... 11 Other (specify) ............................................................ 12

B9. Approximately how long do each of your home visits usually last?

Less than one hour ................................... 1 About One hour ........................................ 2 Between one hour and two hours ............. 3 Between two and three hours ................... 4 Between three and four hours .................. 5 Between four and five hours ..................... 6 Between five and six hours ....................... 7 Between six and seven hours ................... 8 Between seven and eight hours ................ 9 More than eight hours ................................ 10

 

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Q No.

Question Answer Skip pattern

B10. What are the key health topics you COUNSEL families on? Circle all that apply

WASH ........................................................................ 1 FP ............................................................................... 2 Infant and Young Child nutrition ................................. 3 General family nutrition .............................................. 4 Maternal nutrition ....................................................... 5 HIV/AIDS nutrition....................................................... 6 Drug adherence schedule in HIV ................................ 7 Drug adherence in TB................................................. 8 Facility delivery to pregnant mothers ......................... 9 Facility revisit for postpartum mothers ....................... 10 Child immunization .................................................... 11 Other (specify) ............................................................ 12

B11. Are there any job aids/counselling cards that you use to guide home visits?

Yes ........................................................... 1 No .............................................................. 2

If NO skip to B21

B12. If yes, which job aids/counselling cards Ask to see them? (note whether any IYCF job aids have FP included or vice versa)

I make my own .......................................... 1 Other(specify name of tool and who gave it to them) 2

B13.. Where do you receive the job aids from?

GOK ........................................................... 1 NGO .......................................................... 2 FBO ........................................................... 3 CBO ........................................................... 4 From the facility where I am based ........... 5 I make my own........................................... 6 Other (specify) ........................................... 7

B14. Do you experience any difficulties obtaining and using the necessary job aids for counselling

Yes ........................................................... 1 No .............................................................. 2

 

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Q No.

Question Answer Skip pattern

mothers? B15 Have you been

trained on how to use your job aides?

Yes ........................................................... 1 No .............................................................. 2

B16. IF YES: What difficulties do you experience? Circle all that apply

Job aids do not always arrive in time ............................. 1 Job aids are sometimes outdated ................................... 2 Language used is unfamiliar to me ................................. 3 The job aids are always in English ................................ 4 Writing is not always clear .............................................. 5 Providers are not always willing to give me the job aids 6 Have to travel far to get the job aids .............................. 7 If I am not available, the job aids are not received by anyone ........................................................................................ 8 Translating to local language ......................................... 8 Other (specify) ................................................................ 9

B17. Do you find the job aids helpful?

Yes ........................................................... 1 No .............................................................. 2

B18. Which ones do you find to be helpful?

Write in

B19. Which ones are not helpful?

Write in

B20. What changes could be made to make them more useful? Circle all that apply

Translate to local language ....................... 1 Ensure that they are always legible .......... 2 Pictures should be clearer ......................... 3 Ensure they are up to date ....................... 4 Other (specify) ........................................... 5

B21 Are there additional job aids you wish you had? If so, which ones?

Write in

B22. Are there any educational materials that you give to the families?

Yes ........................................................... 1 No .............................................................. 2

 

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Q No.

Question Answer Skip pattern

B23. IF YES: What materials do you usually give to the families you visit?

LIST:

B24. Are these educational materials always in a language that mothers can understand?

Yes ........................................................... 1 No .............................................................. 2

Continue for all

E. .......................................................... INFORMATION ON FAMILY PLANNING C1. Do you usually

offer family planning commodities during the home visits?

Yes ............................................................ 1 No .............................................................. 2

If NO skip to C3

C2. What FP planning commodities do you offer during home visits?

Pills ............................................................ 1 Male Condoms .......................................... 2 Female condoms ...................................... 3 ECP ........................................................... 4

C3. Do you provide referral for FP during your home visits?

Yes ............................................................ 1 No .............................................................. 2

C4. What are some of the barriers that cause mothers not to go to the health facility to seek CHILD HEALTH SERVICES Circle all that apply

Distance to facility ....................................................... 1 Cost of services at facilities ....................................... 2 Time that facilities open ............................................... 3 Lack of transport ......................................................... 4 Poor Provider attitudes ............................................... 5 Lack of information about services ............................ 6 Cultural beliefs ............................................................ 7 Religious beliefs .......................................................... 8 Home responsibilities .................................................. 9 Lack of spousal support .............................................. 10 Lack of support from other family members ................ 11 Lack of Education ........................................................ 12 Child immunization defaulters ..................................... 13 Other (specify) ............................................................. 14

 

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Q No.

Question Answer Skip pattern

C5. What are the KEY barriers that prevent women in Bondo from using FP methods? Circle all that apply 

Distance to facility ..................................................... 1 Cost of services at facilities ..................................... 2 Time that facilities open ............................................. 3 Lack of transport ....................................................... 4 Poor Provider attitudes ............................................. 5 Lack of information about services .......................... 6 Cultural beliefs .......................................................... 7 Religious beliefs ....................................................... 8 Home responsibilities ................................................ 9 Lack of spousal support ............................................ 10 Lack of support from other family members .............. 11 Lack of education ..................................................... 12 Fear of side effects of hormonal methods ................ 13 Other (specify) ........................................................... 14

If cultural beliefs not mentioned skip to C7

C6. IF CHW mentions cultural beliefs ASK: What beliefs are these?

Write in

C7. IN YOUR OPINION what are the advantages of birth spacing? Circle all that apply 

Less chance of premature births ............................... 1 Good development of baby ....................................... 2 Mother will be more energetic .................................... 3 Mother enjoys good health ....................................... 4 Mother has time to bond with baby ............................ 5 Mother can feed better ............................................. 6 Future babies will be healthier .................................. 7 Current baby will grow well and be tall ...................... 8 Children are better fed .............................................. 9 Family has more time to bond with the child .............. 10 Parents have time for themselves ............................ 11 Less financial stress .................................................. 12 Mother is better able to work ..................................... 13 Less stress on the land as mother has fewer children ................................................................................... 14 Mother has time for other activities ........................... 15 Other (specify) ........................................................... 16

 

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Q No.

Question Answer Skip pattern

C8. What can motivate the women you serve to go to the facility to seek CHILD HEALTH SERVICES?

Community talks ................................................. 1 Chief talks at the “baraza”.................................... 2 Spousal support .................................................. 3 Church talks ........................................................ 4 Education on child health..................................... 5 IEC materials ...................................................... 6 Post information in shopping places ................... 7 Education on importance of immunization ........... 8 Drama groups ..................................................... 9 Other (support) .................................................... 10 Don’t know .......................................................... 0

C9. What can motivate the mothers you serve to SEEK FP SERVICES?

Community talks ................................................. 1 Chief talks at the “baraza”.................................... 2 Village barazas organized by CHWs ................... 3 Spousal support .................................................. 4 Church talks ........................................................ 5 Talks at workplaces ............................................ 6 Talks during women’s groups .............................. 7 Individual education on FP .................................. 8 Group education on FP ....................................... 9 IEC materials ...................................................... 10 Other (support) .................................................... 11

C10. In your opinion, what is the ideal amount of time a woman should wait after delivery before getting pregnant again?

It does not matter ................................................ 1 Less than one year .............................................. 2 Between one year and two years ........................ 3 Two years ........................................................... 4 Three years ........................................................ 5 Four years .......................................................... 6 Five years ........................................................... 7 More than five years ............................................ 8 Other (specify) ..................................................... 9 Don’t know ........................................................... 0

If 4 AND 5 mentioned continue if not skip to C12

 

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Q No.

Question Answer Skip pattern

C11. What is the reason for your answer above? Circle all that apply

Mother has time to recover from delivery .................. 1 Mother has time to regain her energy ........................... 2 Baby receives enough attention from mother .............. 3 Mother has time to bond with the baby ......................... 4 Child is well fed by mother ........................................... 5 Child receives enough attention from mother .............. 6 Child is able to breastfeed for longer ........................... 7 Mother can get involved in income generating activities 9 Child has time to develop properly .............................. 10 Other (specify) .............................................................. 11

C12. What are the benefits of exclusive breastfeeding? Circle all that apply

Natural milk designed for your baby ...................... 1 Protects baby from infections and diseases .......... 2 Causes child to remain healthy for longer ............ 3 Causes milk to be available whenever and wherever the baby needs feeding ....................................................... 4 Breast milk is always at the right temperature ...... 5 Delays return to fertility .......................................... 6 Makes mother have a lot of milk ........................... 7 Children not exclusively breastfed are more susceptible to illnesses ................................................................ 8 Formula is too expensive ....................................... 9 Other (specify) ....................................................... 10

F. ............................................................ BREASTFEEDING AND FAMILY PLANNNING

Question Answer Skip Pattern

D1. What methods of FP are you aware of? Circle all that apply

Pills .............................................................. 1

Injectables ................................................... 2

Implanon ...................................................... 3

Jadelle .......................................................... 4

IUCD ............................................................. 5

Diaphragms .................................................. 6

Natural FP .................................................... 7

Condoms ...................................................... 8

LAM .............................................................. 9

Vasectomy ................................................... 10

Tubal Ligation ............................................... 11

Emergency Contraceptives .......................... 12 None ............................................................ 20 Other – (Explain)

 

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Q No.

Question Answer Skip pattern

D2. Which FP methods do you usually counsel mothers on? Circle all that apply

Pills ......................................................... 1

Injectables .............................................. 2

Implanon ................................................. 3

Jadelle ..................................................... 4

IUCD ........................................................ 5

Diaphragms ............................................. 6

Natural FP ............................................... 7

Condoms ................................................. 8

LAM ......................................................... 9

Vasectomy .............................................. 10

Tubal Ligation .......................................... 11

Emergency Contraceptives ..................... 12

None ............................................................ 20

If LAM mentioned skip to D4

D3. IF LAM NOT MENTIONED Do you know of the LAM method of Family Planning?

Yes ....................................................................... 1 No .......................................................................... 2

If NO skip to E1

D4. Do you counsel your clients on LAM?

Yes ....................................................................... 1 No .......................................................................... 2

D5.. IF YES: What are the three conditions for LAM to be used? Circle all that apply

The mother’s menstrual flow has not returned ..... 1 The baby is exclusively or almost exclusively breastfed .............................................................................. 2 The baby must be less than six months old ......... 3 Don’t know ............................................................. 4 Other (specify)

If respondent answered NO to D5 skip to D8

D6. What messages do you share with the women you visit about LAM?

It is a temporary FP method .............................................. 1 Can be effective for up to six months after childbirth ....... 2 Requires breastfeeding often, day and night .................... 3 Encourages the best breastfeeding patterns ..................... 4 Has health benefits for both mother and child .................. 5 The effectiveness depends on the user ............................ 6 LAM depends on how much the woman breastfeeds the baby .......................................................................................... 7 Does not offer protection against HIV and other STDs ..... 8 The method has no side effects ....................................... 9 Other (specify) ................................................................... 10

 

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Q No.

Question Answer Skip pattern

D7. What messages do you share with women about transitioning to a modern FP method after LAM?

None ................................................................................. 1 LAM is just a gateway to other FP methods .................... 2 See provider for alternative once any of the three conditions are no longer met ............................................................. 3 Start other FP method before she stops using LAM. ....... .......................................................................................... 4 Methods that are safe for a breastfeeding mother ........... 5 Continue to breastfeed baby even after using other methods Other (specify) ................................................................... 6

D8. IF NO: Why do you not counsel mothers on LAM?

Do not believe it works ...................................................... 1 Do not understand how it works ........................................ 2 Do not have the time ......................................................... 3 Mothers are not supportive of LAM……………………4 Other (specify)

G. ................................................................................ FACTS AND MYTHS ABOUT FP AND BREASTFEEDING

READ TO RESPONDENT I want you to tell me whether you agree with any of the following statements; where 1 is TOTALLY DISAGREE, and 4 is TOTALLY AGREE. If you have NO OPINION or YOU ARE NOT SURE OF THE ANSWER then it is a 5.

Totally Disagree

1

Disagree Slightly

2

Agree Slightly

3

Totally Agree

4

No Opinion

5

E1. Mothers in Bondo believe they are protected from getting pregnant if they breastfeed in the first six months

E2. Mothers in Bondo believe that they are protected from getting pregnant again for as long as they are breastfeeding

E3. Mothers in Bondo believe they are safe from getting pregnant as long as their menstrual flow has not returned

E4. Mothers in Bondo frequently start feeding their infants on other feeds before six months are up.

 

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Q No.

Question Answer Skip pattern

E5. Mothers in Bondo believe that breast milk alone is enough for the baby for the first six months of the baby’s life

E6. Mothers in Bondo are the ones who decide when to introduce supplementary feeds for the new born baby.

Totally Disagree

1

Disagree Slightly

2

Agree Slightly

3

Totally Agree

4

No Opinion

5

E7. Grandmothers in Bondo are ones who decide when to introduce supplementary feeds for the new born baby.

E8. A good diet can cause a mother to have enough milk to feed her baby

E9. A protein rich diet can cause a mother to improve her milk production

E10. Mothers in Bondo have no problems accessing food in order to ensure proper nutrition during breastfeeding

E11. Spouses actively support mothers in practicing exclusive breastfeeding

E12. Other family members actively support mothers in practicing exclusive breastfeeding

E13. Mothers in this area know the importance of colostrum and how it benefits the baby.

 

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Q No.

Question Answer Skip pattern

E14 Mothers in Bondo feel that young infants need water in addition to breastfeeding on hot sunny days to avoid dehydration.

Question Answers Skip pattern

H. ................................................................................. COMPLEMENTARY FEEDING PRACTICES

F1. IN YOUR OPINION: At what age should other foods be introduced to the child’s diet?

Immediately after birth ....................................................... 1 Less than one month after birth ........................................ 2 When child is one month old ............................................ 3 When child is between one and two months old .............. 4 When child is between two and three months old ............ 5 When child is between three and four months old ............ 6 When child is between four and five months old .............. 7 When child is between five and six months old ................. 8 When the child is six months old………………………9 When child is older than six months but less than one year 10 Does not matter ................................................................ 11 It depends on the needs of the child ................................. 12 Other(specify) ................................................................... 13

F2. IN YOUR OPINION: what should be introduced first to the child’s diet?

Fluids(water, fruit juice) .................................................... 1 Semi solid foods (porridge, enriched porridge) ................ 2 Mashed foodstuffs ........................................................... 3 Unmashed foodstuffs ........................................................ 4 Other .................................................................................. 5

F3. IN YOUR OPINION When should this food be introduced?

Immediately after birth ....................................................... 1 Less than one month after birth ........................................ 2 When child is one month old ............................................ 3 When child is between one and two months old ............. 4 When child is between two and three months old ............ 5 When child is between three and four months old ............ 6 When child is between four and five months old .............. 7 When child is between five and six months old ................. 8 When the child is six months old………………………9 When child is older than six months but less than one year 10 Does not matter ................................................................ 11 It depends on the needs of the child ................................. 12 Other(specify) ................................................................... 13

 

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Q No.

Question Answer Skip pattern

F4. IN YOUR OPINION What should be introduced second to the child’s diet?

Fluids(water, fruit juice) .................................................... 1 Semi solid foods (porridge, enriched porridge) ................ 2 Mashed foodstuffs ........................................................... 3 Unmashed foodstuffs ........................................................ 4 Other .................................................................................. 5

F5. IN YOUR OPINION When is the child ready to eat what the rest of the family is eating?

Immediately after birth ....................................................... 1 When child is one month old ............................................ 2 When child is between one and two months old ............. 3 When child is between two and three months old ............ 4 When child is between three and four months old ............ 5 When child is between four and five months old .............. 6 When child is between five and six months old ................. 7 When the child is six months old………………………8 When child is older than six months but less than one year 9 When the child is one year old…………………………10 Older than one year but less than two years .................... 11 When first tooth shows ..................................................... 12 Does not matter ................................................................ 13

F6. IN YOUR OPINION What is most commonly used to enrich the porridge given the child?

Milk .................................................................................... 1 Fruits ................................................................................. 2 Groundnuts ........................................................................ 3 Fish .................................................................................... 4 Vegetables ......................................................................... 5 Oil ...................................................................................... 6 Beans ................................................................................ 7 Nothing ............................................................................. 8 Other (specify) .................................................................. 9

THINKING OF THE MOTHERS YOU SERVE F6. At what age do

MOST MOTHERS introduce other foods to the child’s diet?

Immediately after birth ....................................................... 1 Less than one month after birth ........................................ 2 When child is one month old ............................................ 3 When child is between one and two months old ............. 4 When child is between two and three months old ............ 5 When child is between three and four months old ............ 6 When child is between four and five months old .............. 7 When child is between five and six months old ................. 8 When child is six months old ............................................. 9 When child is older than six months but less than one year 10 When the child is one year old .......................................... 11 Does not matter ................................................................ 12 It depends on the needs of the child ................................. 13 Other(specify) ................................................................... 14

 

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Q No.

Question Answer Skip pattern

F7. What do the mothers introduce FIRST to the child’s diet?

Fluids(water, fruit juice) .................................................... 1 Semi solid foods (porridge, enriched porridge) ................ 2 Mashed foodstuffs ........................................................... 3 Unmashed foodstuffs ........................................................ 4 Other (specify) ................................................................... 5

F8. What do the mothers introduce SECOND to the child’s diet?

Fluids(water, fruit juice) .................................................... 1 Semi solid foods (porridge, enriched porridge) ................ 2 Mashed foodstuffs ........................................................... 3 Unmashed foodstuffs ........................................................ 4 Other .................................................................................. 5

F9. When do most children start to eat what the rest of the family is eating?

Immediately after birth ....................................................... 1 When child is one month old ............................................ 2 When child is between one and two months old ............. 3 When child is between two and three months old ............ 4 When child is between three and four months old ............ 5 When child is between four and five months old .............. 6 When child is between five and six months old ................. 7 When child is six months old ............................................. 8 When child is older than six months but less than one year 9 When child is one year old ................................................ 10 Older than one year but less than two years .................... 11 When first tooth shows ..................................................... 12 Does not matter ................................................................ 13

F10. ASK ONLY IF PORRIDGE IS MENTIONED What do most mothers commonly use to enrich the porridge given their child?

Milk .................................................................................... 1 Fruits ................................................................................. 2 Groundnuts ........................................................................ 3 Fish .................................................................................... 4 Vegetables ......................................................................... 5 Oil ...................................................................................... 6 Beans ................................................................................ 7 Nothing ............................................................................. 8 Other (specify) .................................................................. 9

I. ................................................................................... CHALLENGES IN NUTRITION AND FAMILY PLANNING

G1. What are the most common challenges related to infant and young child nutrition in this community ?

Lack of adequate foodstuffs ............................................. 1 Lack of time to prepare meals .......................................... 2 Lack of time to feed children .............................................. 3 Ignorance ........................................................................... 4 Family disagreements ...................................................... 5 Inability to provide balanced meals .................................. 6 Lack of kitchen gardens .................................................... 7 Other(specify) .................................................................... 8

 

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G2. What are the most commonchallenges related to maternal nutrition?

Ignorance .......................................................................... 1 Distance to Health facility ................................................. 2 Poverty levels are high/Financial instability ....................... 3 Time to prepare meals ....................................................... 4 Inability to provide balanced meals .................................. 5 Lack of kitchen gardens .................................................... 6 Other (specify) ................................................................... 7

G3. What are the most common challenges related to birth spacing?

Encourage community health organization for counselling 1 Ignorance .......................................................................... 2 Religion ............................................................................. 3 Family disagreements ...................................................... 4 Male are idle ..................................................................... 5 Lack of spousal support .................................................... 6 Lack of FP commodities .................................................... 7 Poverty levels are high/Financial instability ....................... 8 Other(specify) .................................................................... 9

G4. What role could the COMMUNITY play in enhancing family planning?

Proper advice during barazas ........................................... 1 Community mobilization activities ..................................... 2 Community education ........................................................ 3 Community posters ........................................................... 4 Have mobile services ....................................................... 5 Other (specify) ................................................................... 6

G5. Do you feel you can give messages on BOTH FP and Infant and young child nutrition during home visits?

Yes ................................................................................... 1 No ...................................................................................... 2 Not sure ............................................................................ 3

G6. IF NO OR NOT SURE: What is the best way to pass these messages?

At the facility ...................................................................... 1 During barazas .................................................................. 2 Over the mass media ........................................................ 3 Don’t know ........................................................................ 4 Other (specify ) .................................................................. 5

G7. What is the best way to motivate mothers to adopt healthier practices?

By home visits .................................................................. 1 At the facility ...................................................................... 2 During barazas .................................................................. 3 Over the mass media ........................................................ 4 Don’t know ......................................................................... 5 Other (specify) ................................................................... 6

G8. Do you see any opportunities for promoting maternal and infant/young child health that are currently being missed? ________________________________________________________________________

G9. Do you have any ideas for how we can reduce these missed opportunities?

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