Nutrition

CHOICES project aims to improves household behaviors and practices for children at risk of dietary deficiency and hygiene related diseases. Poor child nutrition practices is addressed through awareness as a broader outreach activity including education in groups and village wide campaigns. Height-weight-age based growth monitoring will be conducted in collaboration with government health providers and malnourished children from 0-5 years will be identified. Nutrition rehabilitation and education sessions is conducted with parents and caregivers to accelerate physical growth as well as be an awareness raising platform for identification of nutritious locally available food options using PD HEARTH program methods. Positive feeding practices during migration or when children are under the supervision of other caretakers is also addressed.  

CHOICES project also promotes the use of fortified nutritional supplements and foods where available. This includes supporting the Ministry of Health in rolling out regular distribution of SPRINKLES children’s vitamin and micronutrient supplements with the Provincial Health Department as well as promoting nutritionally fortified/concentrated foods available by local producers. 

Household hygiene and sanitation’s impact on child health is addressed by supporting reduction of risks to children through promotion and support of sanitary latrines. Ensuring families have an effective, sustainable means to regularly access safe water is a priority. Hardware support is specifically targeted at families which do not otherwise have means of access to needed technology.

Activities listed below are expected to result in four outputs, grouped together as follows:

6,000 Female and 3,150 male parents and caregivers of girls and boys under 6 trained in child nutrition and feeding practices. 

Activities: RC facilitators are provided with a series of specific child nutrition key messages to utilize in assessment and behavior change discussions in their village groups. Groups use participatory activities to identify and understand the root causes and influencing factors of both child and adult malnutrition, such as irregular meals, food selection choices, child care during migration, and the impacts of poor sanitation and hygiene on children. Home visits by facilitators are made to reach out to vulnerable families that do not regularly participate including growth monitoring of children and assessments of feeding practices. Sustainable options for improving behaviors are learned including balanced diets and food preparation by differing ages, child growth monitoring, household hygiene as well as sources and accessing appropriate foods and food preparation – especially for young children. Groups also are facilitated to meet with Health Center staff to discuss the services provided at the local health centers that support both maternal and infant/child nutrition. 

The project is facilitating the training and roll-out of the Ministry of Health micro-nutrient supplementation program “Sprinkles” which is being piloted in 10 operational districts around the country and ADRA has supported in two other provinces. Households with limited means to supply proper child diets are encouraged to join livelihood improvement interventions. 

2,000 malnourished children identified and rehabilitated through  PD/HEARTH/NERP sessions.

Activities: Following the anthropometric baseline survey and Reflect Circle establishment, growth monitoring is being conducted to identify at risk malnourished children 6 months to 5 years (-2 SD and below on 2006 WHO scale) are identified and included in a nutrition rehabilitation program facilitated through their local REFLECT groups. Experiences from ADRA’s former current SMILE and Nutrition for All projects has been used to inform this process. The Hearth Nutrition positive deviance methodology is used to identify locally appropriate foods to improve the dietary balance of family members’ consumption. This methodology emphasizes the use of local knowledge, skills and food resources to counter malnutrition, especially among young children and will be conducted and documented in all villages. By highlighting positive examples of families providing good nutrition and health for their families, households with less capacity can realize that it is important to provide nutritious diets for their children and learn how to do this using locally available food and resources. Group cooking, child feeding sessions and the instruction in the appropriate use of micro-nutrient supplements is organized at the village level for at least 2 - 10 day periods of time for specific rehabilitation and growth recovery and behavior change sessions.  These are followed up with growth and diet monitoring at home by Reflect Circle Facilitators.

820 households with improved access to sanitation resources.

Activities: REFLECT Circle sessions are being facilitated on household sanitation and parents and caregivers will identify and plan locally appropriate options for their homes safe sanitation practices. Household use of latrines is in high demand and the project supports the broader communities towards having sustainable options in all homes. The ADRA New Zealand supported Bakan WASH project (begun in late 2013) supports some of these needs in the existing 30 villages while the CHOICES project provides expanded support in the 30 new villages starting in year 3. Poor households are eligible for a subsidization voucher to access supplies from existing WASH hardware suppliers who have contracted with ADRA to maintain quality control standards. Sanitation promotion in local schools will be conducted starting in YR 3 and 4 along with working with school administrators to address ongoing challenges to maintaining functional latrines with water supplies at schools.

1,100 households with improved access to safe drinking water

Activities: REFLECT Circle sessions are being facilitated on ensuring safe drinking water for all household members. Parents and caregivers identify and plan locally appropriate options for water purification, storage, and access. The best current locally available technology is the locally made “ceramic” filter (the filter pot is produced from local red clay and fired like a brick) and this will be promoted. The Bakan WASH project supports the existing 30 villages while the CHOICES project provides expanded support in 30 new villages. Households are eligible for a graded subsidization voucher (based on economic status) to access filters from the project and WASH hardware suppliers are established in local communities to carry these products and replacement parts. Vouchers are also available for materials for ring wells in locations where water supply remains a limiting factor to both general water supply and sanitation. Clean drinking water awareness campaigns is promoted on a community wide basis as well as in schools along with sanitation.