Concern Worldwide is a non-governmental, international, humanitarian organization dedicated to the reduction of suffering and working towards the ultimate elimination of extreme poverty in the world’s poorest countries.
Terms of Reference
KAP (Knowledge, Attitude and Practice) Survey for IYCF Pilot Strategies in the Urban Slums of Nairobi and Kisumu, Kenya.
1. Introduction
Evidence from a baseline survey showed that infant and young child feeding practices in the slums of both Nairobi and Kisumu are suboptimal and that this is clearly contributing to the high caseload of malnutrition.
From the findings of this survey, less than 45% of infants aged 0-5 months were exclusively breastfed the previous day and less than 56% were breastfed within one hour of birth.
While feeding frequency among children aged 6 - 23 months was fairly good, diet quality was less optimal, with children eating an average of only 3.8 food categories (of a total of 8) the previous day.
Dietary diversity of children between 6 and 23 months was limited with intake of animal source foods (apart from fish in Kisumu) and fruits particularly low. This raises concern about risks of micronutrient deficiencies in this population.
Maternal nutrition knowledge, a key focus of Malezi Bora, Kenya’s nationwide child health weeks, was low with most mothers (>60%) unable to name any Vitamin A rich food sources or fortified foods.
Furthermore, focus group discussions revealed important misconceptions around breastfeeding and HIV. It was widely reported by FGD respondents that while exclusive breastfeeding was a way for HIV+ mothers to protect their children, breast milk alone was not sufficient for the children of HIV- mothers.
These infants, it was reported, required water to quench their thirst. These commonly held perceptions about breast milk’s adequacy need to be addressed as current beliefs will lead to a high frequency of mixed feeding for both HIV exposed and non-exposed children.
Moreover, anecdotal evidence suggests that health workers have difficulties in counselling HIV+ mothers to exclusively breastfeed due the perceived risk of HIV transmission through breast milk.
One key nutrition service which has not received the attention it deserves in the current nutrition projects being implemented in the urban slums is infant and young child feeding (IYCF). While training of health care providers on IYCF in health facilities with Integrated Management of Acute Malnutrition (IMAM) services has been conducted, this has not been exhaustive.
In addition at health facility level, provision of IYCF service is largely limited to routine health education messaging at MCH clinics which have limited coverage and depth and do not afford an opportunity for one on one counselling to mothers.
At community level promotion of optimal IYCF practice is severely lacking except during the bi-annual Malezi Bora campaigns. Attendance during these Malezi Bora campaigns has continued to be low both in the slums of Nairobi and Kisumu.
Indeed from the baseline assessment it was shown that while 75% of mothers had heard of Malezi Bora by name or were generally aware of a child and maternal health campaign, only 37% who were aware of it had attended the last campaign.
The primary reasons for non-attendance were lack of information about the campaign and maternal time constraints. Thus there is clear need to increase the promotion of optimal IYCF practices at community level to ensure implementation of the practices by the caregivers.
2. Strategies
To address the very poor IYCF practices in Nairobi and Kisumu slums, Concern Worldwide (CWW) undertook an operations research project to pilot alternative methodologies for community promotion of proper feeding and caring practices. The pilots were undertaken in 3 large slums, two in Nairobi and one in Kisumu from February 2010.
The first strategy implemented in Korogocho is the standard community counselling and support (mother support groups) as prescribed by the MoH. Thirteen groups were formed in nine villages and met on a weekly basis. Topics covered were standard IYCF practices (with the aid of the IYCF counselling cards by UNICEF/Ministry of Health) as well as social barriers to those practices such as socio-economic pressures.
The support groups were facilitated by CHWs but have transitioned to mother-to-mother support groups.
The second strategy in Mukuru Kwa Njenga, Nairobi, was a revision of the standard method using a Trial of Improved Practices (TIPs) formative research approach to identify gaps in the current tools available for IYCF counselling.
The objective was to investigate feasibility and acceptability of standard IYCF messages and use this information to modify the content of messages (BUT NOT THE PRACTICE) and communication on how to implement the practices.
Modification of the approach included two key areas where further tools were needed: expression of breast milk and dietary diversity. Additional counselling cards were then created to facilitate informal group discussions with target groups, and breast models made from socks and cotton wool created for hands-on demonstrations.
The third strategy targeted 10 existing women’s groups in Nyalenda A and B in Kisumu. Some tools for community mobilisation and behaviour change were used though not implemented in full. Sessions were facilitated by community mobilisers with the objective of being led by active group members once trained.
Most groups are in the stage of creating ‘action plans’ and have implemented activities in the community such as giving IYCF messages door-to-door, targeting other groups such as mothers of young children and chamas (clubs), and producing messages for the radio.
3. Purpose of the Endline Assessment
The purpose of the assessment is to evaluate and compare the three strategies in terms of impact on knowledge, attitudes and practices of target communities AND process of implementation.
It will also determine which strategy or part of a strategy is feasible in terms of roll out by health staff (including CHWs) and community involvement in order for Concern to scale-up the most effective approach to promote better child feeding.
The participants are the Consultant, Concern staff, partner staff, Community Health Workers and community members. This assessment will include a KAP survey in the three target populations to determine the community level impact of the three strategies through comparison with baseline data collected in Feb 2010 as well as a review of implementation challenges and success of the three strategies.
4. Objectives of the Assessment
The objectives of this consultancy are:
Terms of Reference
KAP (Knowledge, Attitude and Practice) Survey for IYCF Pilot Strategies in the Urban Slums of Nairobi and Kisumu, Kenya.
1. Introduction
Evidence from a baseline survey showed that infant and young child feeding practices in the slums of both Nairobi and Kisumu are suboptimal and that this is clearly contributing to the high caseload of malnutrition.
From the findings of this survey, less than 45% of infants aged 0-5 months were exclusively breastfed the previous day and less than 56% were breastfed within one hour of birth.
While feeding frequency among children aged 6 - 23 months was fairly good, diet quality was less optimal, with children eating an average of only 3.8 food categories (of a total of 8) the previous day.
Dietary diversity of children between 6 and 23 months was limited with intake of animal source foods (apart from fish in Kisumu) and fruits particularly low. This raises concern about risks of micronutrient deficiencies in this population.
Maternal nutrition knowledge, a key focus of Malezi Bora, Kenya’s nationwide child health weeks, was low with most mothers (>60%) unable to name any Vitamin A rich food sources or fortified foods.
Furthermore, focus group discussions revealed important misconceptions around breastfeeding and HIV. It was widely reported by FGD respondents that while exclusive breastfeeding was a way for HIV+ mothers to protect their children, breast milk alone was not sufficient for the children of HIV- mothers.
These infants, it was reported, required water to quench their thirst. These commonly held perceptions about breast milk’s adequacy need to be addressed as current beliefs will lead to a high frequency of mixed feeding for both HIV exposed and non-exposed children.
Moreover, anecdotal evidence suggests that health workers have difficulties in counselling HIV+ mothers to exclusively breastfeed due the perceived risk of HIV transmission through breast milk.
One key nutrition service which has not received the attention it deserves in the current nutrition projects being implemented in the urban slums is infant and young child feeding (IYCF). While training of health care providers on IYCF in health facilities with Integrated Management of Acute Malnutrition (IMAM) services has been conducted, this has not been exhaustive.
In addition at health facility level, provision of IYCF service is largely limited to routine health education messaging at MCH clinics which have limited coverage and depth and do not afford an opportunity for one on one counselling to mothers.
At community level promotion of optimal IYCF practice is severely lacking except during the bi-annual Malezi Bora campaigns. Attendance during these Malezi Bora campaigns has continued to be low both in the slums of Nairobi and Kisumu.
Indeed from the baseline assessment it was shown that while 75% of mothers had heard of Malezi Bora by name or were generally aware of a child and maternal health campaign, only 37% who were aware of it had attended the last campaign.
The primary reasons for non-attendance were lack of information about the campaign and maternal time constraints. Thus there is clear need to increase the promotion of optimal IYCF practices at community level to ensure implementation of the practices by the caregivers.
2. Strategies
To address the very poor IYCF practices in Nairobi and Kisumu slums, Concern Worldwide (CWW) undertook an operations research project to pilot alternative methodologies for community promotion of proper feeding and caring practices. The pilots were undertaken in 3 large slums, two in Nairobi and one in Kisumu from February 2010.
The first strategy implemented in Korogocho is the standard community counselling and support (mother support groups) as prescribed by the MoH. Thirteen groups were formed in nine villages and met on a weekly basis. Topics covered were standard IYCF practices (with the aid of the IYCF counselling cards by UNICEF/Ministry of Health) as well as social barriers to those practices such as socio-economic pressures.
The support groups were facilitated by CHWs but have transitioned to mother-to-mother support groups.
The second strategy in Mukuru Kwa Njenga, Nairobi, was a revision of the standard method using a Trial of Improved Practices (TIPs) formative research approach to identify gaps in the current tools available for IYCF counselling.
The objective was to investigate feasibility and acceptability of standard IYCF messages and use this information to modify the content of messages (BUT NOT THE PRACTICE) and communication on how to implement the practices.
Modification of the approach included two key areas where further tools were needed: expression of breast milk and dietary diversity. Additional counselling cards were then created to facilitate informal group discussions with target groups, and breast models made from socks and cotton wool created for hands-on demonstrations.
The third strategy targeted 10 existing women’s groups in Nyalenda A and B in Kisumu. Some tools for community mobilisation and behaviour change were used though not implemented in full. Sessions were facilitated by community mobilisers with the objective of being led by active group members once trained.
Most groups are in the stage of creating ‘action plans’ and have implemented activities in the community such as giving IYCF messages door-to-door, targeting other groups such as mothers of young children and chamas (clubs), and producing messages for the radio.
3. Purpose of the Endline Assessment
The purpose of the assessment is to evaluate and compare the three strategies in terms of impact on knowledge, attitudes and practices of target communities AND process of implementation.
It will also determine which strategy or part of a strategy is feasible in terms of roll out by health staff (including CHWs) and community involvement in order for Concern to scale-up the most effective approach to promote better child feeding.
The participants are the Consultant, Concern staff, partner staff, Community Health Workers and community members. This assessment will include a KAP survey in the three target populations to determine the community level impact of the three strategies through comparison with baseline data collected in Feb 2010 as well as a review of implementation challenges and success of the three strategies.
4. Objectives of the Assessment
The objectives of this consultancy are:
- To assess the process of implementing the three strategies, what barriers and facilitating factors were encountered and lessons learned for scale-up, to assess outcome to date of the three strategies through a KAP survey and comparison to the baseline assessment carried out in Feb 2010.
- To compare the process and results of the three strategies tried for promotion of IYCF in Korogocho, Mukuru kwa Njenga and Nyalenda.
- To recommend the most feasible strategy (s) to improve IYCF at community level and could be integrated into the MoH system & structures.
5. Expected Outputs
A report detailing a complete analysis and report on the findings of IYCF strategies in the 3 areas. Including recommendations on how well the most feasible strategy (s) could be adopted
Prepare and present a power point presentation on the findings summary
6. Qualifications
A report detailing a complete analysis and report on the findings of IYCF strategies in the 3 areas. Including recommendations on how well the most feasible strategy (s) could be adopted
Prepare and present a power point presentation on the findings summary
6. Qualifications
- Fluent in English and Kiswahili
- Previous experience implementing IYCF programme in urban settings desirable
- Previous experience evaluating programmes in urban settings
- Previous experience conducting KAP surveys
- Basic statistical and data management skills
- Understanding of child feeding, nutrition, health, and larger public health issues in the context of informal settlements.
The evaluation will be conducted in Nairobi (Mukuru kwa Njenga & Korogocho) and Kisumu (Nyalenda) for 15 days from 1st July to 31st July 2011.
Concern has a Code of Conduct and a Programme Participant Protection protection of programme participants from abuse and exploitation.
Interested parties should apply to the following email address: nairobi.hr@concern.net
The closing date for application is Monday, 20 June 2011.
Only short-listed applications will be given further consideration
Nutrition KAP Survey - Terms of Reference
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