Qualitative Assessment of Feeding Practices Related to Vitamin A Deficiency and Anemia in Pregnant and Lactating Women and Children

Abstract

• Name: Qualitative Assessment of Feeding Practices Related to Vitamin A Deficiency and Anemia in Pregnant and Lactating Women and Children
• Purpose: The instruments are used to facilitate systematic collection of qualitative information to understand the existing knowledge, attitudes, beliefs and feeding practices related to vitamin A deficiency and anemia in pregnant and lactating women and in children.
• Type of Design: Descriptive, cross-sectional
• Sample Size: Data collection is usually made in a convenience sample of families and women in such a way as to cover major geographic (health districts) and ecological areas.
• Where Used: Nicaragua. Locally adapted versions used in Bolivia and Ecuador

To survey tool

Basic Information

Name: Qualitative Assessment of Feeding Practices Related to Vitamin A Deficiency and Anemia in Pregnant and Lactating Women and Children

Origin: Prototype instruments developed, field-tested and used by OMNI, the University of Nicaragua and the Ministry of Health (MOH) in Nicaragua in Managua.

Source: OMNI/Nicaragua, MOH, University of Nicaragua.

Basic Description: The instruments provide specific guidelines for collection of qualitative information through in-depth interviews with pregnant and lactating women and mothers of children under 36 months of age, and with influential persons in the community (fathers, grand-mothers with grandsons under 36 months, community health workers, traditional birth attendants, nursing aides), as well as for trials of improved practices (TIPS) with mothers on feeding children aimed at increasing consumption of vitamin A and iron rich foods. The following information is collected:

• From pregnant and lactating women: demographic and family information; perceptions regarding feeding during pregnancy; knowledge of vitamin A and iron rich foods availability and source of food supplies to the family; food frequency in the previous 24 hours, with emphasis on milk and dairy products, legumes, green leafy vegetables, fruits and meats.
• From mothers of children 6-11 months: current child's health; mother's perceptions regarding child's feeding and health; knowledge of vitamin A and iron rich foods; availability and source of food supplies; food frequency in the previous 24 ours, with emphasis on milk and dairy products, legumes, green leafy vegetables, fruits and meats.
• From mothers and grand-mothers of children 12-35 months, fathers, community health workers and nursing aids: perceptions regarding child's feeding and health; knowledge of vitamin A and iron rich foods; availability and source of food supplies, and (from mothers only) food frequency in the previous 24 hours, with emphasis on milk and dairy products, legumes, green leafy vegetables, fruits and meats; and knowledge and experience on the use of vitamin A supplements.
• Guidelines are provided for household visits to plan and evaluate trials of improved feeding practices (TIPS) of pregnant and lactating women, and children; this includes information to be collected during initial visits to women and children, identification of potentially improved practices, and final information on the results of attempts to implement the proposed improved feeding practices.

Country Applications: Nicaragua. Locally adapted versions used in Bolivia and Ecuador.

Languages: Spanish.

Technical Scope: Formative qualitative research on knowledge, attitudes and practices, and feasibility of changing feeding practices to increase consumption of vitamin A and iron sources.

Purpose: To gather qualitative information from pregnant and lactating women, mothers of children 6-35 months, fathers, grand-mothers, community health workers and nursing aids, as part of IEC-oriented formative research on knowledge, attitudes and feeding practices related to vitamin A deficiency and anemia.

Design: Descriptive, cross-sectional

Frequency of Administration: At the program design/planning stage.

Key Users of Information

Primary Users: Vitamin A deficiency and anemia prevention and control program planners and implementers, particularly those responsible for development and implementation of IEC plans.

Secondary Users: NGOs/PVOs, community development agencies and projects.

Objectives and Scope of Tool

Objective: To gather qualitative information on knowledge, attitudes, beliefs and practices of the population regarding feeding children under 36 months of age, pregnant and lactating women, as related to vitamin A deficiency and anemia. Data are used to understand feeding behavior and identify feasible changes in feeding practices to increase consumption of vitamin A and iron rich foods.

Scope: The tools are used to collect and analyze qualitative information on feeding practices related to vitamin A deficiency and anemia, as well as to develop, implement and evaluate the results of household trials of improved feeding practices aimed at increasing consumption of vitamin A and iron rich foods by women and children.

Key Monitoring Needs and Evaluation Questions Tool Seeks to Address

The following questions are answered:

• Prevalent knowledge of pregnant and lactating women and of mothers of children under 36 months of age, as well as fathers, grand-mothers, community health workers and nursing aides, regarding vitamin A deficiency and anemia, and the role of feeding.
• Existing attitudes and beliefs of women regarding vitamin A deficiency and anemia, and improved feeding practices.
• Most prevalent feeding practices of pregnant and lactating women and of mothers of children less than 36 months, as related to vitamin A deficiency and anemia ?
• Most powerful forces and actors influencing feeding practices by pregnant and lactating women and mother of children under 36 months in the community ?
• Positive factors as well as major barriers to changing feeding practices of pregnant women and children as related to vitamin A deficiency and anemia ?

Key Indicators

Qualitative indicators are used and summary statements made based on examination and interpretation of the qualitative information collected through in-depth interviews to assess knowledge, attitudes and feeding practices related to vitamin A deficiency and anemia in children. General conclusions are made on women and other people's knowledge of the relationship between their own feeding practices (and their children's feeding) and vitamin A deficiency and anemia, as well as on their attitudes and beliefs regarding changing feeding practices. The results of the household trials of improved practices (TIPS) are used to assess feasibility of increasing micronutrient intake through changes in specific types of behavior that would improve feeding practices of pregnant women, lactating women and children. Potentially achievable behavior changes are then targeted by IEC plans in order to improve consumption of vitamin A and iron rich foods.

Research Design

As with most qualitative research, the design calls for convenience samples of women. Sample sizes are adjusted to the resources available. The sample used in Nicaragua included four health districts, four municipalities (one per district), and 48 women for in-depth interviews (12 pregnant, 12 lactating, 12 with children 6-11 months and 12 with children 12-35 months), as well as 8 grandmothers, 8 fathers, 8 community health workers or traditional birth attendants, and 4 nursing aids, for a total of 76 in-depth interviews.

Implementation

Detailed planning and preparation of the fieldwork is critical. Preparation includes field-testing of the instruments in a small group of women, and proper training of interviewers. To the extent possible, experienced interviewers should be chosen. When properly trained and/or experienced personnel use the instruments, data collection is relatively straightforward. The number of interviewers and the duration of the field operation vary contingent upon sample size (number of persons to be interviewed and number of TIPs implemented). A full in-depth interview takes approximately one hour. Recommended duration of the TIPs is at least one week, and it is often limited by time and resource constraints. Interviews are made at households, except for those of nursing aids or other formal health care personnel. It is often advantageous to make as much use as possible of local health services for identification of women to be interviewed.

Analysis

Data analysis is relatively simple using a category analysis system with summary matrices for qualitative information. Dummy tables to facilitate systematic examination of the information collected are provided. Interpretation and use of the information for IEC development and implementation requires expertise and experience in qualitative methods of IEC formative research, and special skills in behavior problem identification and communications. Although local capacity on IEC formative research and program development is growing in developing countries, there is often a need for outside technical assistance.

Reporting

A detailed report is produced primarily for use by the IEC planning team. The report summarizes the results of the qualitative research, highlights major conclusions regarding problem areas, desirable behavioral changes, positive forces and major barriers to desirable changes in feeding practices. The report also describes how the findings will be used in the design of educational messages and materials, and in selecting the most appropriate communication channels.

Dissemination of Results

The result of IEC formative research is not systematically disseminated beyond the primary technical audience using the findings for IEC program planning.

Manuals and Guidelines

Detailed manual and guidelines for use of the instruments are available in Spanish.

References

MINSA/UNAN/OMNI. Alimentacion de los niños y niñas menores de 36 meses de edad, embarazadas y lactantes, con énfasis en alimentos ricos en vitamina A y hierro. Un Estudio Cualitativo en Cuatro Departamentos de Nicaragua, 1997.