Promoting integrated nutrition and WASH practices to contribute in reduction of stunting

Summary:

Childhood stunting is the consequence of maternal and child inadequate dietary intake (poor maternal diet, inadequate infant and young child feeding practices), repeated bouts of infections and/or combination of both. Underlying these immediate causes are socio-economic factors including poverty, food insecurity, inadequate care of mothers and children and poor availability and quality of water, sanitation, hygiene. To tackle immediate behavioral causes of stunting and to improve WASH and nutrition awareness and practices, an integrated Nutrition & WASH SBCC strategy was developed and implemented in the 3 targeted districts of Pakistan. Community structures were strengthened by forming peer support groups like Mother to Mother Support Groups and Father to Father Support Groups for two-way communication and sustainability. Integrated WASH & Nutrition SBCC training module for community health workers was rolled out at village level. By the conclusion of 3 year' program awareness around WASH and Nutrition key practices improved with positive trend in feeding & hygiene behavior, since outreach workers reached to community for both sector' messages, resulting in cost effectiveness, efficiency and combine behavioral changes were obtained with less resources invested. Engagement of specific audiences, including mothers, fathers and other influencer groups like mothers-in-law, grandmothers and village elders, on the desired WASH & nutrition practices needed for stunting reduction was a unique experience in Pakistan. Participatory Video Most Significant Change (PVMSC) technique was applied to qualitatively assess the impact of SBCC along with traditional KAP survey-need a couple of sentences on results.

Background/Objectives:

An evidence-based Nutrition & WASH SBCC strategy was developed and implemented to contribute to stunting reduction programme. A combination of community engagement and mass media approaches SMS Capacity development of front-line workers and community platforms were undertaken. The objective of the SBCC strategy was to encourage communities, especially mothers, caregivers of children and fathers to adopt positive practices such as exclusive breastfeeding, complementary feeding, hand washing with soap, using a SBCC package. Qualitative evaluation through PVMSC was to understand the effectiveness of the integrated programing through empowering beneficiaries by providing a platform for sharing most significant changes they have experienced.

Description of Intervention and/or Methods/Design:

Formative research & behavioural analysis were conducted to understand the contributing factors for stunting, and to prioritize key behaviours for a focused SBCC intervention. The research sought to understand modalities of engagement of outreach workers and available channels through which target groups can be reached. The findings informed the development of the SBCC approach and accompanying communication products. In addition, baseline/end-line KAP surveys were conducted to assess the impact of SBCC intervention. The model mother' approach used participatory dialogue to encourage mothers to adopt desired behaviors by simplifying actions, while at the same time, encouraging fathers to on taking care of the child with weekly contacts with household. The SBCC package comprised of a toolkit, posters, games, stories and demonstrations to evoke emotional responses from mothers was developed in the local language for use at household & community levels. PVMSC technique and KAP were used to assess the impact.

Results/Lessons Learned:

The results of the KAP surveys show improvement in key IYCF practices, such as a significant increase in the prevalence of exclusive breastfeeding (by 15 percentage points). Qualitative Impact Assessment of SBCC, which was unique experience for UNICEF Pakistan, revealed direct and indirect impacts of the SBCC efforts on the mothers' perceptions along with shedding light on the mothers' priorities, needs, fears, motivations, misconceptions and societal pressures. Exclusive breastfeeding for children below 6 months of age was considered the most significant change by 26% of the story tellers, followed by use of the Iron Folic Acid (IFA) tablets by 25%. Regular hand washing, use of toilets, and maintaining household cleanliness were the third most frequently perceived changes at 11%. This shows the integrated nutrition and WASH SBCC efforts, along with the other initiatives, had an impact at changing attitudes and perceptions with respect to the desired behaviors.

Discussion/Implications for the Field:

Having an integrated WASH & Nutrition SBCC interventions was a unique experience and helped in minimizing duplication of resources and time. Integrated SBCC Package is now being adopted by the Government in the respective province and is being rolled out through Government resources. PVMSC methodology not only enabled the collection of insights regarding impact, but also provided a valuable platform for mothers to share their experiences, advise others, and gain recognition as well as dispelling myths around nutrition and child care. This can be good to replicate in future interventions.

Abstract submitted by:

Saba Shuja - UNICEF
Ziggy Kugedera - UNICEF
Deepa Risal Pokharel - UNICEF