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Final Report (Conduct Formative Research for Designing BCC Framework/Strategy)
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Acronym
BCC
Behaviour Change Communication
CBAs
Community Birth Attendants
CMAM
Community Based Management of Acute Malnutrition
EC
European Commission
FGDs
Focus Group Discussions
GAM
Global Acute Malnutrition
IYCF
Infant and Young Child Feeding
LHVs
Lady Health Visitor
LHWs
Lady Health Works
M&E
Monitoring & Evaluation
MAM
Management of Acute Malnutrition
MDC
Management & Development Center
NNS
National Nutrition Survey
PHC
Primary Health Care
RHC
Rural Health Center
SAM
Sever Acute Malnutrition
SPSS
Statistical Package for Social Science
TT
Tetanus
UCs
Union Council
WHO
World Health Organization
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TABLE OF CONTENT
PREFACE ............................................................................................................................................................... 5
ACKNOWLEDGMENT ............................................................................................................................................. 6
EXECUTIVE SUMMARY .......................................................................................................................................... 7
1.
INTRODUCTION AND BACKGROUND ............................................................................................................ 9
2.
OBJECTIVES OF THE STUDY ......................................................................................................................... 12
3.
METHODOLOGY ......................................................................................................................................... 13
3.1
STEP 1: REVIEW OF SECONDARY INFORMATION................................................................................................... 13
3.2
STEP 2: FIELD CONSULTATION.......................................................................................................................... 13
3.2.1 In-depth Interviews ............................................................................................................................... 13
3.2.2 Focus Group Discussions ....................................................................................................................... 14
3.3
SAMPLE SIZE.................................................................................................................................................. 15
3.4
TRAINING ..................................................................................................................................................... 15
3.5
DATA COLLECTION ......................................................................................................................................... 15
4.
FINDINGS: CURRENT PRACTICES ................................................................................................................. 16
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
4.10
4.11
4.12
5.
IRON AND FOLIC ACID TABLETS ......................................................................................................................... 16
DIET DURING PREGNANCY................................................................................................................................ 16
PERCEPTIONS OF MEN REGARDING NUTRITION NEEDS OF WOMEN ......................................................................... 17
DIET OF SCHOOL GOING CHILDREN .................................................................................................................... 17
WORK DURING PREGNANCY ............................................................................................................................. 19
PLACE OF DELIVERY ........................................................................................................................................ 19
KNOWLEDGE AND PRACTICE ABOUT COLOSTRUM ADMINISTRATION......................................................................... 20
PRE-LACTEAL FEEDS AND SLEEP-INDUCING DRUGS ............................................................................................... 20
EXCLUSIVE BREASTFEEDING AND COMPLEMENTARY FEEDING .................................................................................. 21
USE OF IODIZED SALT ...................................................................................................................................... 22
AWARENESS ABOUT HEALTH AND HYGIENE ......................................................................................................... 22
DECISION MAKING REGARDING NUTRITION NEEDS OF MOTHERS ............................................................................ 23
DETERMINANTS OF BEHAVIOR .................................................................................................................. 24
5.1
BEHAVIOR CHANGE COMMUNICATION STRATEGY ................................................................................................. 24
5.2
IDENTIFICATION OF HIGH-RISK BEHAVIORS.......................................................................................................... 24
5.2.1
Inadequate Diet ................................................................................................................................ 24
5.2.2
Use of Ghutka ................................................................................................................................... 25
5.2.3
Use of ordinary salt .......................................................................................................................... 25
5.2.4
Pre-Lacteal Feeding .......................................................................................................................... 25
5.2.5
Sleep-Inducing Drugs ........................................................................................................................ 25
5.2.6
Early Initiation of Supplementary Feeds ........................................................................................... 25
5.2.7
Discontinuing Breastfeeding before 24 Months of Age .................................................................... 25
5.2.8
Repeated Pregnancies ...................................................................................................................... 25
5.2.9
Hand washing without soap ............................................................................................................. 25
5.3
POSITIVE BEHAVIORS TO BE PROMOTED .............................................................................................................. 26
5.3.1.
Exclusive Breastfeeding for 0-6-Month-Old Infants.......................................................................... 26
5.3.2
Optimal Complementary Feeding Practices from 6-24 Months and Continued Breastfeeding ........ 26
5.3.3.
General Perceptions about Child Health and Growth....................................................................... 27
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5.3.4
5.3.5
5.3.6
Targeting Substitute Caregivers ....................................................................................................... 27
Communication Material .................................................................................................................. 31
Other Supporting Activities............................................................................................................... 32
6.
KEY MESSAGES ........................................................................................................................................... 33
7.
IMPLEMENTATION STRATEGY .................................................................................................................... 37
7.1
7.2
7.3
7.4
7.5
Interpersonal Communication (IPC) ...................................................................................................... 37
Community Mobilization (CM) .............................................................................................................. 37
Advocacy ............................................................................................................................................... 38
Entertainment Education (EE) ............................................................................................................... 39
Mass Media .......................................................................................................................................... 41
8
MONITORING AND EVALUATION OF BCC STRATEGY .................................................................................. 42
9
RECOMMENDATIONS ................................................................................................................................. 43
10
ANNEXURE 1 .............................................................................................................................................. 44
10.1
FIELD TOOLS ................................................................................................................................................. 44
11. BIBLIOGRAPHY .............................................................................................................................................. 79
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Preface
Sindh province bears highest rate of malnutrition among children under five years of age in the
country. Child malnutrition is the key factor affecting health of children and globally more than
half of child deaths can be attributed to it1. Malnutrition also affects mental well-being of the
children2, which can cause negative and irreversible consequences for the lives of children.
Causes of malnutrition are multifarious and multisectoral that involve interventions from
individual level to family, community, institution and state level3.
The problem of malnutrition needs to be addressed and resolved as soon as possible so that
more lives of children can be saved. However, before making an intervention to reduce
malnutrition is important to know current practices, knowledge and attitude of the target
communities, bottlenecks and challenges in implementation of intervention, coordination
among related public departments and civil society organizations, and political will to eliminate
all forms of malnutrition. At organization level, it requires evidence-based behaviour change
strategy (BCC) and advocacy to educate target communities regarding nutrition among
pregnant women and children under five. At State level, it must be ensured that all the people
have access to adequate food and livelihood resources, access to health facilities and family
planning services. Negative and harmful cultural practices of administering pre-lacteals should
be discouraged and exclusive breastfeeding for six months and continued breastfeeding, along
with complementary feeding, up to 24 months after delivery, should be promoted.
The report presents a comprehensive behaviour change communication strategy to address
the issue of malnutrition. It highlights current practices of the communities, develops a BCC
strategy with key messages to be delivered among the masses, and also suggests key
communication channels to effectively deliver health education and key messages.
Dr YameenMemon
M Sajjad Abro
Ghulam QadirArbab
1
(W. L. Cheah, 2009)
(Ngalawa, 2008)
3
(S. Linnemayr, 2008)
2
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Acknowledgment
We are highly indebted to the target communities of the formative research was conducted,
who provided valuable information for designing BCC strategy to address an important issue of
the country. We are also thankful to management of Merlin for their cooperation, support and
guidance at all levels from beginning to the end. Finally, we also thank our field researchers
who collected qualitative data from 49 union councils of the district. Without their support,
this report would have been impossible.
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Executive Summary
The formative research activities utilized qualitative data research methods to collect data on
knowledge, attitude and practices of target communities regarding nutrition, nutrition needs of
pregnant women and children under five years of age in 49 Union Councils of district Thatta.
The data was collected through focus group discussions and individual interviews with mothers
of young infants, grandmothers, fathers, teachers, religious scholars and health facility staff.
Results of the formative research are summarized below with an emphasis on how they relate
to the development of the BCC program to prevent malnutrition among women and children.
Majority of women know that they should take iron and folic acid tablets during pregnancy, but
these are not available at public health facilities and women have to buy these from medical
stores.
Majority of women continued routine diet during pregnancy and did not increase food intake.
They even chewghutkaduring pregnancy and after delivery.
Children eat meals two times a day (lunch and dinner). They just have tea with biscuits in the
morning, and do not count it as a meal.
School going children know about basic hygiene. They do wash hands but not with soap as
schools do not place soaps in latrines. In most of the schools, latrines and hand pumps are not
available.
Many school going children were found to eat ghutka. Even some teachers were observed to
use ghutka during classes.
Majority of women continue to do routine work during pregnancy, whereas only a fewwomen
do less than routine work.
Most of deliveries take place at home assisted by unskilled birth attendants. Public hospitals
are said to lack adequate facilities and services and people prefer private hospitals over public
ones if they have to deliver in a hospital.
Almost all the women had administered colostrumto their babies, but many women initiate
breastfeeding one hour after delivery.
Majority of women had given pre-lacteal feeds to their babies and use of sleep-inducing drugs
was also found to be very common.
Majority of women said they continued breastfeeding along with complementary feeding up to
24 months after delivery, whereas the rest stop breastfeeding before or after eighteen months
In order to effectively implement BCC strategy, Merlin should use different methods to
mobilize communities, involve concerned stakeholders and promote key health messages. The
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methods recommended for such a strategy are: Interpersonal Communication, Community
Mobilization, Advocacy, Entertainment Education and Mass Media.
BCC framework and implementation strategy should also be closely monitored and evaluated
against set indicators so that desired results can be achieved.
It is recommended that BCC framework be carefully implemented and all the relevant
stakeholders like civil administration, health department, education department and media be
involved to discourage harmful practices and adopt positive behaviors, equip public health
facilities with staff and instruments, arrange washing facilities in schools and involve
community to endorse program objectives and support program activities.
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1.
Introduction and Background
The National Nutrition Survey 2011 indicates that in Sindh, 17.5% of children under five years
old are suffering from acute malnutrition, of which 6.6 % are severely malnourished. These
rates of acute malnutrition exceed the WHO’s emergency threshold level of 15% GAM4. These
children are ten times more susceptible to die before reaching their fifth birthday than their
healthy counterparts. The same survey also highlights that half of the children in Sindh are
stunted. These children are not only vulnerable to contracting diseases more often, but as a
consequence, will also be more impaired in their intellectual and physical development.
In Sindh, under-nutrition is a complex problem with poverty as its major underlying cause.
Poverty results in the non-availability of healthy and nutritious diets, lack of access to health
services and poor hygiene practices which cumulatively contribute to the high burden of
preventable diseases and deaths.
Being part of the low lying Indus Delta, Thatta was one of the worst flood-affected districts of
Pakistan, from devastating floods in 2010-2011. Since 1999, the district has experienced six
disasters -- a cyclone in 1999, drought in 2000, earthquake in 2001, drought and floods in 2003,
monsoon floods in 2010 and torrential rains in 2011 - all of which severely disrupted life and
food security, especially those of low income and vulnerable groups.
Merlin is present in the Sindh since 2010 and has been operating with the support of different
International donor agencies in different activities, all of which are under the Primary Health
Care (PHC) umbrella. These projects include PHC, Reproductive Health and CMAM Projects and
these were launched and implemented by Merlin with the main objective of improving the
living conditions of the most vulnerable populations and target groups including CBAs and
children under 05. The projects have been successively implemented in districts Thatta, Dadu,
Badin and Tharparkar.
At this time, Merlin is starting Food Security Thematic Programme with the funding of EC which
aims to address malnourishment in 49 targeted UCs of district Thatta. Merlin is strongly
concerned with the implementation of the project more efficiently and for achieving this
objective Merlin planned to conduct a baseline survey in the project areas in order to obtain a
baseline which eases the process of setting objectives for future.
4
(Health, 2011)
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The overall objective of the action is to improve the nutrition status of children and pregnant
women in Pakistan. The specific objective is to strengthen capacity to address the high rates of
malnutrition in Sindh Province, Pakistan. The proposed action will achieve this objective, by
addressing both acute and chronic malnutrition amongst pregnant and lactating women and
children (SAM: under 5 yrs and MAM under two years old), through the integration of
community based management of acute malnutrition (CMAM) into health services, through
improved community outreach and health education, and through Social protection driven
food security interventions to tackle the root cause of malnutrition, poverty. This action is a
natural progression from the emergency food and nutrition interventions implemented in
Thatta during the emergency flood response in 2010 and 2011 to a more sustainable mode of
development to assist the people and institutions of Thatta in their long-term recovery.
The action is structured under four results:

Management: To improve population access to nutritional care, based on a CMAM/IYCF
approach, through the district health system;

Prevention: To improve maternal and child nutritional status through increased
knowledge and appropriate practices of mothers/caregivers;

Resilience: To improve food access to children 6-18 months old, through gendersensitive social transfers (Conditional cash transfers); and

Evidence and Impact: To scale up the evidence-base of sector wide approaches which
address malnutrition, and inform and influence wider stakeholders on the impact of the
action.
The programme will be implemented with specific focus on 49 Targeted Union Councils of
District Thatta of Sindh Province of Pakistan.
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2.
Objectives of the Study
The main objective of the formative research was to use the qualitative findings in designing an
evidence-based, comprehensive and culturally appropriate BBC strategy for projects in both
townships. The formative research provides detailed information on behaviours and their
determinants, barriers, key target audiences, and possible channels of communication for BCC
activities.
The objectives of the formative research were to:
1. Acquire in-depth qualitative information on knowledge, attitudes, behaviours, beliefs and
perceptions of communities about maternal, child health and malaria, to improve uptake of
key family practices
2. Understand relevant socio-cultural, traditional, religious and economic determinants of
maternal, child health and care-seeking behaviours and to develop key messages to address
through a BCC strategy
3. Identify the target audience, key stakeholders, gate keepers, and major decision makers at
the house hold and community level to be engaged in the interventions
4. Identify common social gathering places, popular media and entertainment habits and
existing channels of communication
5. Develop themes and focused messages for IEC materials for the target audience
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3.
Methodology
In order to conduct the formative research the information was collected from both primary
and secondary sources. Primary data was collected through in-depth interviews and focus
group discussions. In order to carry out the task in an efficient and smooth manner, MDC
followed three steps given below:
3.1
Step 1: Review of Secondary Information
Review of secondary information provided us with a better, broader and clearer view of the
situation being studied. Apart from Merlin project documents, the research team also reviewed
important sources of information regarding nutrition including national nutrition
survey/strategy and current situation in Sindh Province and Pakistan and practices in other
countries. Merlin had also shared another survey regarding Knowledge, Practices and Coverage
(KPC), which was also conducted in the same district and which provided quantitative database
for the designing qualitative tools to further explore nutrition practices and attitudes of the
target communities.
3.2
Step 2: Field Consultation
Following the review of secondary information, the team held field consultations by using
following field instruments:
1) In-depth Interviews and
2) Focus Group Discussions, (See Annex B to G)
In order to have a clear understanding about the study and designing of instruments, two
meetings with Merlin Staff were held at Thatta Office and the tools, when finally prepared,
were shared with Merlin to get their approval.
Each data collection instruments has its own scope to cover as given below:
3.2.1 In-depth Interviews
In order to have an in-depth understanding about the nutrition status, in total 30 interviews
were conducted including 5 interviews with school teachers, religious scholars, Doctor, Social
Activist, LHWs/LHVs and Shop Keeper. The schools interviews covered the important aspects of
nutrition needs of children and their hygienic practices. Interviews with religious scholars
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provided understanding about their attitude towards mother and child health and nutrition.
The interviews with Social Activist provided their understanding of the current situation in rural
community and their role played in the society. The interview with doctors and health workers
focused on current status of nutrition in the district and role played by health practitioners and
their suggestions for improvement. These stakeholders play an important role in mobilizing and
influencing behaviour target communities. Husbands/fathers are also guardian of their families
and their knowledge and influence can also affect behaviour of mothers and pregnant women.
3.2.2 Focus Group Discussions
Focus Group Discussions (FGDs) provided a broader understanding about attitude and practices
of the populations in the target areas. FGDs are a good technique to collect qualitative data
involving a homogenous group of participants. FGDs not only provide required information but
also generate more knowledge by engaging persons of the similar background in a healthy
discussion. Participants were asked to reflect on the questions asked by the interviewers,
provide their own comments, listen to what the rest of the group have to say and react to their
observations. The main purpose is to elicit ideas, insights and experiences in a social context
where people stimulate each other and consider their own views along with the views of
others.
The interviewer acted as a facilitator introducing the subject, guiding the discussion, crosschecking each other comments and encouraging all members to express their opinions. One of
the main advantages of this technique is that participant interaction helps weed out false or
extreme views, thus providing a quality control mechanism. Number of the participants was
from 6 to 10. A moderator engaged the participants in a discussion whereas the note taker
recorded all the discussions on his/her note pad. At the end of the discussion, the two again sat
together to complete the narratives and fill in the data which might have been missed during
the FGD.
In all, 50 FGDs were conducted in the selected villages of 49 Union Councilsfor the baseline
survey. The FGDs were conducted with single-sex homogenous groups of people in the villages
of the target districts including women, men and lady health visitors/health attendants etc.
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3.3
Sample size
The detail on sample size for the research study is given below:
Table 1: Sample Size
S No
Tool
2
Focus Group Discussions
Total – 50
3
Interviews – Total - 30
3.4
Training
Sample Size
Target group
30 Females (mothers-in-law and women of
reproductive age (15-49 years)
16 Male (husbands, fathers-in-law, committee
members)
4 FGDs with children
5 Teachers
5 Religious scholars
5 Social activists
5 Doctor
5 LHWs/LHVs
5 Market Interview
Two days intensive training (7 & 8 December 2013) for the field staff was organized by the
MDC at Hyderabad. Representative from Merlin also participated in the training in order to
ensure that field team properly understands the project activities and objectives of the BCC
formative research study. The brief highlights of the training are given below:
3.5

The first daywas spent on an overview and the objective of the study, familiarization to
the field instruments including research guides and checklists through explaining each
question, interviewing techniques, quality and monitoring of the survey, monitoring
and the nature of potential problems arising in the field.

The second day of the training focused on mock exercise on the instruments and field
planning.
Data Collection
The data collection exercise was the most important activity of the study. During the
assignment, the data was collected at three different tiers, at community level, at institutional
(school) level and at individual level. Semi-structured interviews provided in-depth
understanding of attitude of key influencers (religious scholars, teachers, doctors, shop
keepers, social activist, and LHWs/LHVs) about mother and child health care practices. Focus
group discussions were held at community level to assess community’s attitude and response
towards the target health issue i.e. malnutrition.
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4.
Findings: Current Practices
This section provides thematic analysis of findings of the qualitative data. Quantitative data
about nutrition needs, dietary habits, and breastfeeding practices have already been presented
in a KPC survey conducted by Merlin and the reader should refer to that report for further
quantitative information. This report explores causes underlying dietary practices, lack of
access to medicines, and health facilities, use of inadequate food items, pre-lacteals and sleepinducing drugs.
4.1
Iron and Folic Acid Tablets
During focus group discussions, it was found that many women do know about and do not take
iron and folic acid tablets during pregnancy, and they may have to suffer from anaemia which
can complicate matters during pregnancy and delivery. It was also found that the women who
had taken iron and folic acid tablets, had purchased these from a medical store. This shows the
tablets are either not available at health facilities or these are available but not provided to the
pregnant women who come for antenatal check-up.
During discussions with LHWs, they had indeed confirmed that these tablets are not available
in the health facilities. One LHW complained that they have lost trust among the communities:
We haven’t received such medicines for a long time. And this has created trouble
for us. People think that these medicines are provided to the health facilities but
we don’t give these medicines to communities. We are losing our credibility.
During market survey, owners of some medical stores told that sale of iron and folic acid
tablets have increased. They also gave the same reason that health facilities no longer provide
iron and folic acid tablets to the pregnant women.
4.2
Diet during Pregnancy
Majority of women continue to eat routine diet during pregnancy and lactating period. The
reasons for increasing food intake are economic and as well as cultural and should be
addressed in every intervention on nutrition of mothers and children. One common belief
which was shared by many women during focus group discussions was that if women eat more
food during pregnancy, the baby will grow large in size and will create complications during
delivery.
During FGDs, they informed that while pregnant or after delivery, they eat simple routine food
items period such as rice, legumes, potatoes, vegetables and Rablocal diet as well.
However, being near to coastal areas, the females from Taluka Mirpur Sakro, KetiBunder and
Kharo Chan informed that they eat fish in routine almost every alternate day. In addition to
food items, the majority of females also consume Ghutko,pan and supari and some also
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reported eating mat during pregnancy. All the women were aware that ghutko is harmful to
their health but they said they are unable to leave it as they are addicted to it now.
4.3
Perceptions of Men Regarding Nutrition Needs of Women
Men seemed to be aware of nutrition needs of women and said that women should be given
good and healthy diet such as butter, milk, meat, fish and other good food items, and women
should eat more than routine diet during pregnancy. They also shared that lack of adequate
diet was the main reason for anemia among women. But they were unable to provide
adequate diet to their women because of lack of resources and financial constraints.
We hardly eat three times a day. We do not earn enough to make ends meet. We
are just surviving. Nobody has come to help us. Whatever we earn, we spend on
our household needs. We do know that women need more food during
pregnancy, but where should we get more money to buy more food?
Hassan, Jhirk
They also shared that women eat ghutka during pregnancy. All of the men in group discussions
told that ghutka was harmful for health, but everyone, men, women, and children, consumed
ghutka. They said they can’t stop women from eating ghutkabecause they themselves also
consume it.
Whenever we ask women to stop eating ghutka, they reply, “Why don’t you quit
it first? If you cannot quit it, how can we?”Nasir, Jhirk
Social activists were against sale of ghutkasat local shops. They said ghutkawas extremely
dangerous for health and can cause cancer. They said that ghutkawas also one of the main
causes of malnutrition among women and children.
If you eat ghutka, you won’t feel hungry. Ghutkakills hunger. This is the reason
why men and women do not eat adequate food. We have also talked to district
authorities to ban ghutka, but nobody listens to us.Rafiq, Thatta
Doctors considered ghutka a very dangerous thing. They said children also use ghutkawhen
they see their parents doing the same. “Children follow their parents,” said a doctor, “Parents
simply cannot ask their children to stop eating ghutkabecause they themselves us it.
4.4
Diet of School Going Children
During observations and discussions with children, it was found that they don’t bring lunch to
school because their homes are near to the school and they go to home to eat with permission
of the school teacher. Moreover, there is no trend in villages to bring lunch boxes and drinking
water with them.
The children informed that they eat twice a day i.e. lunch and dinner. They don’t count
breakfast as a meal because they just take a cup of tea with biscuit in the morning.
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Moreover, the majority of the children informed that they like sweets, Pakora, and cold drink
and if they have money and visit nearby town, they prefer to spend on these items.
They didn’t report any discrimination in feeding boys or girls. They said their parents treat boys
and girls equally and give equal amount of food to both the genders. However, they shared
that whenever there is food scarcity, their mothers eat less food and give more to children.
This was considered a main cause of weakness among women by the school going children.
School teachers also expressed concerns over the health of children. They said majority of the
students in the school do not look healthy. Though they said they do give information about
basic hygiene to children, but there are various constraints due to which these healthy advices
are not followed. One of the major issues was that the schools did not have enough funds to
purchase soaps and place in latrines for washing hands. Another issue was absence of canteens
in schools. Local vendors came to schools during break time and sold eating item to children.
The teachers did not think that these items were healthy, but they said they had no other
option.
If there was a canteen in the school, we could monitor quality of things sold to
children. We do not have enough funds to buy soaps. Many schools in this area
lack even latrines and hand pumps. How can children follow our advices?
Riaz, Mirpur Sakro
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4.5
Work during Pregnancy
Like food intake, workload also remains the same for majority of the women even after they
become pregnant. Majority of women continued to do routine work during pregnancy. Though
it is not clear whether women lift heavy loads during pregnancy, but if they continue routine
heavy work without taking adequate rest, pregnancy may result in miscarriage and pose threat
to life of the pregnant woman.
Women cried less for workload and more for food deficiency. They said they have to do all the
household work as nobody else will come to help them, but they needed adequate diet to that
they could work normally without getting weak. During focus group discussions, they also
complained that their husbands do not take their proper care during pregnancy and after
delivery.
4.6
Place of Delivery
Majority of deliveries take place at home attended by unskilled traditional birth attendants.
Compared to deliveries at public hospitals, more deliveries take place at private hospitals.
Though the number of home deliveries is quite high, it means large number of deliveries are
assisted by unskilled birth attendants. The main reason for preferring TBAs was that they were
local and enjoyed trust of the community. They were also easily available on a call.
And the reason for preferring private hospitals over public ones is mainly said to be
unavailability of appropriate tools for caesarean deliveries.
Whenever we take the delivering woman to the government hospital, they ask us
to go to a private hospital. They say they don’t have equipments for deliveries.
Khatoon, Mirpur Bathoro
Social activities also complained about inadequate facilities and services provided by public
hospitals. They said that many hospitals are under-staffed and lack required number of doctors
and nurses. But even those doctors and nurses do not come to hospitals regularly. Lady
Doctors, they said, do not go to the far off hospitals where they have been placed.
We have made many complaints about public hospitals to DHO and DC, but to no
avail. They simply say they don’t have enough resources to hire more medical
staff or buy new equipments. When we ask them to make sure doctors attend
hospital regularly, they say their staff is regular. Irfan, Thatta
The same justification about unavailability of equipmentswas also given by medical staff in
health facilities. “BHUs are not equipped to assist deliveries,” said an LHV, “Since most of the
pregnant women are anaemic, and they can’t deliver normally, we simply refer them to RHCs
or THQs. But many people can’t access these facilities in time because these are too far from
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their villages. That’s why they go to a nearby private hospital. Private hospitals are expensive,
but people have no other option at that time.”
Regarding absence of medical staff in the hospitals, a few doctors did acknowledge that many
staff members do not come to the hospital regularly. They explained that due to lack of
transportation facility, many lady doctors cannot go to far flung areas. Lady Doctors have also
some security concerns due to which they cannot move in those areas unaccompanied.
4.7
Knowledge and Practice about Colostrum Administration
Though not all the women know about benefits of colostrum, almost all of them had
administered it to their babies. This is a positive sign, and if educated about the benefits of
colostrum, all of the women in the target areas can easily adopt this practice.
A few women who said they did not administer colostrum to their babies after delivery
provided different reasons for that. Some said they did not have milk in their breasts, or
considered it harmful for the baby, whereas the others said there was no practice in the family
of giving colostrum to the baby.
It means considerable number of women initiated breastfeeding later and this has to be
discouraged and they should be advised to initiate breastfeeding as soon as possible after
delivery.
Husbands of the women seemed to know benefits of benefits of colostrum and believed that it
was a ‘natural vaccination’ for the baby. However, they could not describe how colostrum
benefited the child. But they said it was better than any milk because it was natural.
4.8
Pre-Lacteal Feeds and Sleep-Inducing Drugs
Pre-lacteal feeding is also common in the district. Commonly administered pre-lacteal feeds are
honey, butter and ghutti/dukko. These are believed to clean the stomach of the baby and keep
its body warm in winter.
In winter, a baby needs to be warm from inside. Honey keeps the baby warm.
And butter is good for stomach. If the stomach of the baby remains clean, the
baby will stay healthy.
Rani,
Keti Bandar
Another interesting and surprising finding of the formative research was use of sleep-inducing
drugs. Majority of women gave sleep-inducing drugs to their babies. Though these drugs are
not given as pre-lacteals, but women initiate these after a couple of weeks so that the babies
can sleep quietly at night.
Phenergan is the most commonly administered sleep-inducing drug among of the women in
the district. Women said that whenever they see that their baby does not sleep at night and
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keeps crying, they give this drug to the baby. This is believed to be a good practice for the
health of the baby.
If the baby sleeps well, he will remain healthy. The children, who cry a lot and do
not sleep well, will not be good adults. Moreover, crying baby also disturbs
parents at night. Zahida, KharoChaan
Another reason given by women for giving this drug to babies was related to the physical wellbeing of the mother.
Women work all the day. They have to work in lands, take care of children, clean
house, wash utensils, prepare food and do many other things. Women, therefore,
need to have a good sleep at night. If they remain awake at night, how will they
perform their duties during the day? That’s why women give Phenergan to their
babies so that they (women) could sleep well.Shahida, KharoChhaan
Husbands of the women did not take much interest in what is given to the baby. They said it
was the job of the mother to take better of the baby. Though they knew that children are given
pre-lacteal feeds and many women also give sleep-inducing drugs to children, they did not
know whether these were harmful.
We have seen all women do this. This has been a custom here. We were also
given such feeds. All our children were given such feeds. Wives and their mothers
know better what to feed the baby with. We do not interfere in these matters.
Ghulam Mustafa, Jati
4.9
Exclusive Breastfeeding and Complementary Feeding
Practice of exclusive breastfeeding is very low in the district. Some women who know about
exclusive breastfeeding for six months reside in the villages where many NGOs have launched
health interventions and conducted health education sessions. This shows communities do
remember key health messages if these are delivered by reliable persons through effective
communication channels.
The main reason given by women for not exclusively breastfeeding for six months was lack of
breast milk, weakness or early initiation of complementary feeds.
One respondent in UC Jhirk said:
I was anaemic during pregnancy. I am still weak and anaemic. I don’t have
enough milk to breastfeed the baby for more than four months.
Another said:
We usually start other feeding after four or five months. We start giving water to
the baby after two months. Some women also give tea to their babies after three
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months. Other soft feed is given to the baby after four months. This is our
tradition. We have raised all our children following this tradition.
Majority of men did not know about exclusive breastfeeding up to six months. They just said
mothers know better when to give other feed to the baby. It seems care of the baby is
considered to exclusive responsibility of women and men do not participate in child care during
initial months after delivery.
Majority of women do not breastfeed their babies, along with complementary feeding, up to
24 for months and initiate other feeds after three or four months after delivery. Breastfeeding
(exclusive breastfeeding and continued breastfeeding along with complementary feeds up to
24 months) is an important area of intervention and communities need to be educated and
sensitized about the issue that babies receive adequate diet and remain healthy.
For women who did not continue breastfeeding up to 24 months, the main reason for not
doing so was repeated pregnancy. This also shows that quiet a large number of women either
don’t do family planning or do not have access to family planning services.
Religious scholars stressed on continued breastfeeding, along with complementary feeding, up
to 24 months, as it is advised by Sunna. However, they also said that most of the women in the
district cannot do this because of inadequate diet and weakness.
Religious scholars are willing to educate masses, if they are provided adequate health
information. They said they can deliver key health messages during Friday Prayers.
4.10 Use of Iodized Salt
Lack of micronutrients also causes malnutrition. One of the micronutrients is Iodine which is
not taken by the majority of the families in the district. Through informal discussions and focus
groups discussions, it was found that communities were aware of iodized salt, but didn’t use it
because of its different taste.
Though it is slightly expensive, we can purchase it. But we don’t use it because it
has a different taste. It is not that much salty and tasty as common salt is.
Amina, Jhirk
During market survey, it was also observed that iodized salt was available in most of the shops.
But they said very few people in rural areas use such salt. It was mainly used in urban and periurban areas. They informed that people have certain beliefs about iodized salt, “Some people
believe that this salt will sterilize men. Like polio vaccine, they believe iodized salt is also a
conspiracy against Muslims.”
4.11 Awareness about Health and Hygiene
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Main reason for lack of knowledge regarding basic health care, hygiene and nutrition is lack of
access to health education. Some women had attended any health education session. These
education sessions were mainly organized by NGOs after 2010 floods.
However, almost all of the respondents do want to get health education, which is a positive
attitude and shows their willingness to attend these sessions for more reliable knowledge.
During discussions with men, they also expressed willingness to participate in such sessions,
and they realized importance of knowledge regarding mother and child care. Teachers
suggested organizing such sessions in schools as well because more children can attend and
benefit from these sessions.
4.12 Decision Making Regarding Nutrition Needs of Mothers
Though majority of women know that during pregnancy or lactating period, they need more
food and they should increase their daily food intake, but they do not seem to have power to
decide how to fulfil their nutrition needs. Majority of the respondents said the decision
regarding food is made by their husbands. Since husbands are the heads of households, only
they are supposed to make decision about everything.
However, they did not say their husbands deliberately wanted to deprive them of adequate
diet during pregnancy or lactating period. They said the main reason for inadequate diet is
poverty.
This was also asserted by women during focus group discussions:
Our husbands are not our enemies. They do love us. They know very well that no
house can run without women. They know that nobody can take better care of
children than women. But we are very poor people. We do not earn enough get
adequate food. In families where they had good sources of income, husbands
provide good food to their wives.Amina, Jhirk
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5.
Determinants of Behavior
Community’s attitude and practices about nutrition needs of pregnant women and children
under five is affected by various factors ranging from individual to community and institutional
level. Though poverty is the main factor that affects livelihood, income and social life of
communities, other factors also come to play. Lack of knowledge regarding basic health and
hygiene, lack of access to health facility, unavailability of medicines, equipments and staff at
public health facility, cultural practices of chewing gutka, giving pre-lacteal feeds and use of
sleep-inducing drugs to babies are some of the important factors that affect health and
nutrition of the pregnant women and children under five years of age.
5.1
Behavior Change Communication Strategy
Behavior change communication (BCC) is the strategic use of communication to promote
positive health outcomes, based on proven theories and models of behaviour change. BCC
employs a systematic process beginning with formative research and behaviour analysis,
followed by communication planning, implementation, and monitoring and evaluation.
Audiences are carefully segmented, messages and materials are pre-tested, and both mass
media and interpersonal channels are used to achieve defined behavioural objectives.
Achieving sustainable shifts in the key behaviours of target groups requires gaining an
understanding of what drives them: designing innovative, integrated, and multidimensional
interventions and incorporating continuous monitoring and evaluation.
5.2
Identification of High-Risk Behaviors
In order to design an effective BCC strategy, one of the key tasks was to identify of high-risk
behaviors that contribute to malnutrition among children and women in the target area. Using
qualitative and quantitative methods, following high-risks behaviors was observed and
identified:
5.2.1 Inadequate Diet
Most of the women and children eat two times a day and their diet consists of simple foods like
potatoes, rice and some vegetables. Morning meals consist of only tea with biscuits, and it is
usually not considered as a meal. Diet diversity was not found among the communities and
their foods lack proteins and fruits/vegetables rich in vitamin A.
Majority of the women continue to eat routine diet even after getting pregnant or during
lactating period. Similarly, they also continue to do routine work during pregnancy and after
delivery.
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5.2.2 Use of Ghutka
What is worse, men, women and children in the district use ghutka, which cannot only cause
cancer but also suppresses hunger. When they don’t feel hungry, they eat less food.
5.2.3 Use of ordinary salt
Iodized salt is consumed by only one-third of the communities and lack of iodine is also thought
to be responsible for malnutrition among them.
5.2.4 Pre-Lacteal Feeding
Pre-lacteal feeding is wide spread and commonly given pre-lacteal feeds are honey, butter and
ghutti. These are thought to clean baby’s stomach and keep it warm from inside.
5.2.5 Sleep-Inducing Drugs
Use of sleep-inducing drugs was also common and the drug usually given to the baby was
Phenergan. When women go outside to work and sleep at night, they give this drug to their
children so that they remained asleep and don’t in absence of their mothers or at night.
5.2.6 Early Initiation of Supplementary Feeds
Exclusive breastfeeding up to six months is done by very few women and majority of them
introduce other feeds after three or four months of delivery. Women said they become weak
and anemic and can’t exclusively breastfeed the baby for six months.
5.2.7 Discontinuing Breastfeeding before 24 Months of Age
Majority of women do not continue breastfeeding the baby for 24 months. The main reason for
discontinuing breastfeeding was said to be weakness and repeated pregnancy.
5.2.8 Repeated Pregnancies
Since family planning is not done in the communities, women have to go through repeated
pregnancies due to which they not only become weak, but also are unable to continue
breastfeeding the child for 24 months.
5.2.9 Hand washing without soap
Though men and women wash their hands before and after taking meals, after defecation, or
coming in contact with animals, majority do not wash hands with soap. Soaps are not available
in schools. Many schools lack latrines and hand pumps. Children have to defecate in open
grounds and have wash hands with pond water without soap.
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5.3
Positive Behaviors to be promoted
Pregnancy is considered a natural phenomenon and people welcome newborns with religious
and cultural rituals. There does not seem to be discrimination in providing food to children of
either sex. There are a few women in each community who take balanced diet and take good
care of themselves during pregnancy. Such women of “positive deviant behavior” should be
appreciated and promoted among other families to encourage them to follow key health
practices. Other important behavior that need to be promoted are described below.
5.3.1. Exclusive Breastfeeding for 0-6-Month-Old Infants
Breastfeeding is widely practiced in this population and appears to be on demand, at least
when mothers are physically with their infant. However, the widespread use of complementary
liquids and starchy gruels often fed with a baby bottle to very young infants raises serious
concerns about the potential displacement of breast milk, the resulting nutrient inadequacy of
the diet, and the excessive risk of contamination. The fact that positive deviant mothers—i.e.,
mothers who exclusively breastfed—were identified in the communities where the study took
place is encouraging. These mothers can be used as “role models” who have successfully
practiced exclusive breastfeeding, while sharing similar living conditions as other mothers from
the same communities. Interviews with these positive deviant mothers also helped to identify
some potentially powerful arguments as to why exclusive breastfeeding is a positive and
beneficial practice. Among other things positive deviant mothers reported were that exclusive
breastfeeding improved their infant’s health and reduced their health care costs. These ideas
can be used to design powerful and locally relevant messages to promote exclusive
breastfeeding.
The BCC strategy will have to address, for instance, the concerns that mothers have regarding
colic and the need to use teas to relieve them. Also the fact that mothers and infants have to
be separated to allow mothers to pursue their income-generating and other types of activities
away from home has to be addressed carefully because it was one of the main reasons
reported by mothers to give sleep-inducing drugs to their very young infant.
Another aspect that will need to be carefully addressed is the felt lack of energy and the
weakness reported by mothers when they “breastfeed all the time,” and their use of liquids
and foods to complement breast milk to provide them some relief.
5.3.2
Optimal Complementary Feeding Practices from 6-24 Months and
Continued Breastfeeding
Complementary foods, however, are generally low in energy- and nutrient-density, and they
include few micronutrient-rich foods such as animal products, fruits, and vegetables. The
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frequency of feeding also appears lower than recommended throughout the 6-24 months
period.
Although there appears to be no cultural barriers to feeding infants and young children animal
source foods such as eggs, fish, or meat, lack of availability and access to these foods appears
to be a major constraint.
Many factors seem responsible for the lack of “special” complementary foods in this
population. These include an apparent lack of knowledge of the specially high energy and
nutrient needs of infants and young children, the belief that children are ready to consume
family foods as early as by 12 months of age, the time constraints of caregivers to prepare
these special foods and the lack of overall resources to purchase, prepare, and store these
special foods.
The BCC program will have to find ways to overcome some of these factors because they are
likely to affect the ability of families to adopt the proposed behaviors.
5.3.3. General Perceptions about Child Health and Growth
In addition to the foregoing specific issues for the BCC program, there are also larger issues
related to perceptions about child health and growth that the program can address. The
research results suggest that families are very concerned about the vulnerability of babies and
are actively trying to protect them during the first year of life. However, after the first year
mothers and other adults interviewed did not seem to perceive that the young child is still at
serious risk of nutritional deficiency. Integrating young children into family meal patterns is a
priority for rural families, possibly due to household resource and time constraints. The
communication program will have to place a special emphasis on the need for continued
attention to feeding frequency, types of food, and related caregiving behaviors for children
between 6 and 24 months of age who are vulnerable and prone to chronic malnutrition.
5.3.4 Targeting Substitute Caregivers
Our study highlighted the importance of alternative caregivers, especially for mothers who
work outside the home on a regular basis. Substitute caregivers include fathers, grandmothers,
and older siblings, who are often given the responsibility to feed the child when the mother is
absent. Thus, it is crucial that the BCC program be directed to all family members and to other
adults who may have responsibilities for child feeding and caregiving.
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The following chart provides comprehensive strategy for BCC that need to be adopted to target behavior change.
Goals
Pregnant women
■ Balanced diet
■ Intake of micronutrients
■Avoidance of harmful
diet
Practices to Promote
■ Intake of more than routine
food
■Intake of food rich in proteins,
vitamins
■ Use of iron and folic acid tablets
■ Use of iodized salt
■ Avoidance of ghutka
Infant Feeding from 0 to 6 Months of Age
Exclusive Breastfeeding
■ Exclusive Breast Feeding ■ Early initiation of BF (EBF)
■ Feeding of colostrum
■ On demand BF round the clock
■ Prevent Bacterial
■ Avoidance of pre- and postContamination
lacteal
feeds
■ Avoidance of baby-bottles
■ exclusive Breast feeding till 6
months
Current Practices
Facilitating Conditions for
Behavior Change
Issues that Affect Capacity
for Behavior Change
Positive:
■ Majority of women take iron
and folic acid tablets
Negative:
■ Two-time meals
■ No diet diversity
■ Use of simple food that lacks
micronutrients
■ Widespread use of ghutka
■ Scarce use of iodized salt
■ Women visit health at
least once during
pregnancy and receive
counselling on various
themes including nutrition
■ Women are aware of
iron and folic acid tablets.
Even if these tablets are
not available at health
facility, they buy these
from medical store
■ Poverty and lack of
financial resources to eat
three times a day
■ Addiction to use of
Ghutka
■ Different taste of iodized
salt
Positive:
■ BF widely practiced
■ Reported to be mostly on
demand
Negative:
■ Pre-lacteals and post-lacteal
feeds widely used
■ Complementary liquids
and foods introduced at a
very young age
■ Widespread use of sleepinducing drugs
■ Experienced, successful
positive deviant mothers
(who EBF) exist in
communities
■ Positive deviant
mothers
had received information
from health workers,
NGOs,
health center staff
■ Belief that mother’s milk
is better than animal’s or
■ Water-based liquids (gripe
water) and Phenergan
given to treat colic
■ Mothers’ time and work
constraints
■ Mothers are concerned
about feeling too weak and
depleted if they EBF
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Goals
Practices to Promote
Current Practices
■ Delayed initiation of first BF
Feeding Practices for Infants and Young Children 6-24 Months of Age
Breastfeeding
■ Ensure sustained,
■ Continue to BF frequently
Positive:
frequent, on demand
and on demand for 2 years
■ Mothers traditionally
BF up to 24 months
■ Avoidance of bottle feeding
continue to BF up to 24
of age and beyond
months of age, if they remain
healthy
Negative:
■ Widespread use of Phenergan
■ Mothers may not always
BF on demand because
of need to leave home for
work or other tasks
■ Children whose mothers
are frequently absent
may not receive
sufficient nutrients from
breast milk
Complimentary Feeding
■ Provide foods to
■ Feed child special energy- and
Positive:
complement breast milk
nutrient-dense foods of
■ Mothers continue to BF
and to allow adequate
appropriate texture and
and give liquids when child has
intake ofenergy and
consistency for age
diarrhea
micronutrients
■ From 6 months on, gradually
increase amounts and quantity of Negative:
foods as child gets older
■ Complementary foods
■ Increase number of times
(CF) of low energy and
Facilitating Conditions for
Behavior Change
formula milk
■ Women’s willingness to
BF up to 24 months and
beyond, if they do not get
pregnant again, or they do
not get weak/ anemic.
Issues that Affect Capacity
for Behavior Change
■ No need for behavior
change, but continue
promotion of continued BF
up to 24 months and
beyond
Potential constraints to
frequent, on demand BF:
■ Mothers do need to leave
home
■ No cultural barriers to
feeding young children
animal foods
■ Mothers know that
eggs,
liver are good for child
■ Mothers usually feed
child
Final Report (Conduct Formative Research for Designing BCC Framework/Strategy)
■ Lack of availability and
access to food, especially
animal foods and
micronutrient-rich fruits and
vegetables
■ Overall poverty, lack of
economic resources
■ Poor access to water,
29
Goals
Practices to Promote
child is fed CF as he/she gets
older (at least 2-3 times/d for 6-8
months old; 3-4 times/day for 924 month old)
■ Feed a variety of foods
(gradually increase variety
with age); animal foods
should be eaten daily, or as
often as possible
■ Continue to BF and feed CF to
child during diarrhea;
ensure fluid replacement
Current Practices
very low nutrient-density
■ No “special”
complementary food for
child
■ Low frequency of feeding
CF, child often not fed
morning meal
■ Frequency of feeding is
low (2-3 times/day) and
does not seem to increase
with age
■ Variety of foods seems
low; animal foods
consumed infrequently
and in small amounts; low
intake of vitamin A fruits
and vegetables
Facilitating Conditions for
Behavior Change
when they are present
■ Mothers leave prepared
food for child when she
has to leave
■ Fathers seem involved
inchildcare and feeding,
and their involvement can
be increased
■ Good recognition of
importance of fluid
replacement during
diarrhea
Final Report (Conduct Formative Research for Designing BCC Framework/Strategy)
Issues that Affect Capacity
for Behavior Change
sanitation, health services
■ Time constraints of
caregivers to prepare
“special foods”
■ Lack of recognition of
importance of high feeding
frequency for young
children
■ Belief that children are
ready for family foods and
family meal patterns by 12
months of age
■ Some cultural barriers to
feeding young children
specific types of
fruits/vegetables
30
5.3.5 Communication Material
Successful behavior change communication requires the use of effective material to support
the behavior change communications initiated by the program staff. Suggestions for types of
materials that can provide added orientation to the BCC topics being discussed by program
staff include the following:

Counseling cards based on the age and health status of the child that should be used in
conjunction with individual counseling sessions;

Visual materials like posters, charts, and billboards that can be displayed in
communities, health centers, and other venues to orient program beneficiaries and
community members to various topics that are discussed at BCC program venues; and

Take-home handouts that remind caregivers of the needs of children in different age
groups, based on their health status.

Some easy audio messages which can be on air through local FM radio.
Counselling cards should primarily be designed for pregnant women and mothers of children
under five years of age. The cards should have clear and understandable pictureswith easy and
informative key messages. These can be used in individual counselling sessions and group
education sessions with women of reproductive age, in general, and pregnant and mothers, in
particular. The cards can be packed in separate sets that focus on different themes from prepregnancy, to pregnancy, to delivery, and post-partum care of mother and newborn.
Program staff should be well-trained in effectively communicating the key messages contained
in counselling cards. It is important that the key messages are translated in local language (and
local dialect of the language) with short but easy sentences. Effective delivery of message is as
important as key the message itself. The program staff should be trained in interpersonal
communication skills and how to use verbal and non-verbal communication to deliver
messages.
Visual material should be aimed for general public/target communities at larger level. Since
men are more mobile than women, and men’s literacy ratio is higher than women, these
materials should target male members of the communities and sensitize them about nutrition
needs of pregnant women and children and encourage them to play active role in providing
adequate care to their wives and children. These materials should be pasted at places where
men gather/visit more often like tea stalls, markets, Otaqs (gathering place for men in villages),
and hospitals.
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Pictorial material, nonetheless, is also important for women and such posters can be pasted, if
possible, inside houses and women’s gathering places. The suitable places would be where
education sessions are held between program staff and community members.
Visual material must be pasted onto the walls of schools so that children could also learn about
basic health and hygiene practices.Teachers should also be given trainings on health topics and
encourage to frequently deliver lectures on health to the students. Apart from that local
education department should be mobilized to ensure availability of safe drinking water,
functional latrine and hand-washing soaps in the schools.
Take-home handouts are appropriate better guidance whenever people like to consult these.
Age-specific handouts would target specific community members and would allow them to
seek information relevant to their health needs.
Television is not so common in the target communities. It is therefore recommended that key
messages should be broadcast through local FM radio. Special programs should be held on key
health days, such as breastfeeding day, hand washing day etc, around the year.
In addition to the BCC materials used for communication between program staff and program
participants, there is also a need for developing training materials that can guide and orient
program staff to the topics they will discuss. These training materials should provide sufficient
technical detail with local contextual examples that enhance the technical understanding of
program staff and, at the same time, provide them with the background necessary to
communicate well with their audiences and to address problems encountered by the families
they interact with.
5.3.6 Other Supporting Activities
The research on the impact of behavior change programs and on the mechanisms by which
maternal education affects child outcomes suggests that knowledge is often not sufficient to
ensure adequate impacts on nutrition, health, and development. Specifically, it is the
interaction of knowledge with resources that leads to the largest positive effects on child
health5. Thus, in order to maximize potential impact on child health and nutrition outcomes,
integrated programs should be implemented, which address behavior change in conjunction
with programs that increase household and caregiver access to resources like food, money, and
time. All three of these resources are critical to ensure that caregivers and families are
equipped to utilize the enhanced knowledge that can come about from a successful behavior
change communications program.
5Ruel,
M.T. and P. Menon. "Child feeding practices are associated with child nutritional status inLatin America: Innovative uses
of the demographic and health surveys." Journal of Nutrition132(6):1180-7.
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6.
Key Messages
Effective BCC strategy depends on effective key messages for behavior change. On the basis of
results of formative, a limited number of key messages have been developed to educate
communities and change their practices.
For husbands
Key Message: ensure that your pregnant wife has one additional meal every day to maintain her
strength.
Supporting messages:
• Pregnant women need to eat a variety of foods, animal products (meat, milk, eggs, etc),
pulses, grains, legumes,leafy green vegetables and fruits.
• Ripe papaya & mango, orange-fleshed sweet potatoes, carrot & pumpkin are especially good.
 Pregnant women need to eat more food than usual rather than decrease their intake.
 Pregnant women should be discouraged from eating morning tea with biscuits only. They
should, instead, regular breakfast.
For pregnant women
Key Message: When you get pregnant, visit a health facility for antenatal check-up and get
iron/folic acid tablets
Supporting Messages:
• Ask the Health Worker for iron/folic acid tablets. Also ask for de-worming tablets to be taken
during second or third trimester. If not available, get these from Merlin Site or purchase these
from local medical stores
• The six-month course of iron/ folic acid tablets can be carried over even after the birth of the
baby.
• Pregnant women have increased needs for iron.
• Iron/ folic acid pills are important to prevent anemia and will help to keep her and the new
baby healthy.
 Liver is also a good food source of iron for pregnant women.
Key Message: Make sure you get tetanus shots during pregnancy
For Fathers/heads of households
Key Message:Ensure that all family food is cooked using iodized salt so that family members remain
healthy.
Supporting Messages:
• Iodized salt is not available everywhere, but should be used when available.
• Pregnant women need to use iodized salt to ensure the health of their new baby.
• Add the iodized salt at the end of the cooking.
• When you store iodized salt, make sure that it is covered properly.
Key Message: Ensure that no one in the family, in general, and pregnant woman, in particular, use
Ghutka
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Supporting Messages:
• Ghutka is injurious to health
• Ghutka suppresses hunger and people eat less. This can lead to malnutrition and anemia
among pregnant women.
For Mothers
Key Message:Put your baby on the breast immediately after birth, even before theplacenta is
expelled, to stimulate your production of milk.
Supporting Messages:
• The first yellow milk (colostrum) helps to protect the infant from illness.
• The first yellow milk (colostrum) is the mother’s natural butter and will help to expel your
baby’s first dark stool.
• Immediate breastfeeding withinhalf an hour of birth will help to expel the placenta and
reduce post-partum bleeding.
• Pre-lacteal feeds such as sugar water, honey, ghutti, butter, are not necessary and may
interfere with establishing good breastfeeding practices during the first days of the baby’s
life.
Key Message: Feed your baby only breast milk for the first six months, not even giving water, for
the baby to grow healthy and strong.
Supporting Messages:
• Breast milk protects the baby from diarrhea and respiratory infections.
• Empty the first breast before you switch to the other for the baby to receive all nutrients and
fat from the breast milk.
• If the baby takes water or other liquids, it sucks less on the breast leading to poor growth.
• Even during very hot weather, breast milk will satisfy the baby’s thirst during the first six
months.
• If the baby takes water and other liquids, the baby will get diarrhea.
 Never use a bottle to feed your baby, as these are hard to keep clean and will cause diarrhea.
 Don’t use Phenergan. This drug is contraindicated in under 2 years of age. The long term use
of this can cause the respiratory depression & can provoke the Morbidity & Mortality.
Key Message: Breastfeed your baby on demand, at least 10 times day and night,to produce enough
milk and provide your baby enough food to grow healthy.
Supporting Messages:
• Frequent breastfeeding helps the milk to flow and ensures your baby grows well. If you think
that you don’t have enough milk, increase the breastfeeding frequency and be sure to empty
the breast before switching to the other.
• Exclusive breastfeeding until 6 months, if menses are not back, protects the mother from
getting pregnant (Lactation Amenorrhea Method – LAM).
• Ensure proper positioning and attachment so baby gets adequate breast milk and to avoid
breast problems such as sore and cracked nipples.
• Advise mothers with nipple and breast problems to seek immediate care from a Health
Worker.
• Breastfeeding increases bonding between mother and child.
For Husbands
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Key Message: Ensure that your wife who is breastfeeding has 2 extra meals day to maintain her
health and the health of the baby.
Supporting Messages:
• Breastfeeding women need to eat a wide variety of foods, particularly, animal products
(meat, milk, eggs, etc), orange/red fruits andand green leafy vegetables.
For Mothers
Key Message: Starting from 6 months of age, introduce complementary foods such as soft porridge
2-3 times a day for your baby to grow healthy and strong.
Supporting Messages:
• Porridge can be made from many different types of cereals (wheat) or tubers (e.g. potatoes),
banana, yogurt, combination of rice and milk etc
• Porridge is just right and good for the baby when it slowly falls off the spoon.
• Thicken the porridge as the baby grows older, making sure the baby is still able to swallow
easily without choking.
• Thin gruels made with water are not healthy for your baby as they do not provide enough of
the nutrients it needs to grow strong and healthy.
• When possible use milk instead of water to cook the porridge.
• Use iodized salt whenever possible to cook the porridge.
• Foods given to the child must be stored in clean/hygienic conditions to avoid diarrhea and
illness.
• Prepare small amount as per need of child & specifically use home prepared foods when child
grow.
• Continue breastfeeding to 24 months or older.
• (For Muslims) Breastfeeding up to 24 months is also mentioned in Quran.
Key Message: Continue to breastfeed your baby until two years and beyond tomake it stay strong
Supporting Messages:
• During the first and second year of life, breast milk is still an important source of nutrients for
your baby.
• After 6 months of age, continue to breastfeed your child on demand, at least eight times day
and night, until two years and beyond to maintain its strength.
• Continuing breastfeeding will protect your child from diseases such as diarrhea.
For Fathers and Mothers
Key Message: To help your baby grow and get strong, enrich your baby/child’s food with 2 to 3
differenttypes of foods (such as butter, oil, peanuts, meat, eggs, lentils, vegetables and fruits)
ateach meal.
Supporting Messages:
• Add colorful foods to enrich the food including orange/red vegetables and fruits (such as
carrots, fleshed sweet potatoes, and ripe mango), green leafy vegetables, eggs, beans,
peanuts, peas or lentils.
• Add animal foods (meat, liver, chicken, fish) whenever available, as these are make your
baby/child grow healthy and strong. If this is not possible use beans, peanuts, peas or lentils.
• Mash and soften the enrichment foods so your baby/child can easily chew and swallow the
food.
• Add butter and oil every time to the porridge.
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•
Cow’s milk can be offered to your child in addition to the enrichment foods given and can also
be used to cook instead of water.
• Continue breastfeeding until your child is 24 months or older whenever your child is hungry
or thirsty.
For Children and teachers
Key Message: Wash hands with soap before and after eating meals and after using toilet
Supporting Messages:
 Always wash hands with soap for 15 to 20 seconds
 Washing hands with soap prevents from various diseases like diarrhoea, cough, flu etc.
 Teachers should emphasize on hand washing during teaching.
 Head Masters should ensure availability of water and soap in toilets.
For Parents
Key Message: Parents must ensure that their babies received complete course of vaccination
Supporting Messages:
 Immunization prevents from deadly diseases.
 Immunized children are less prone to diseases.
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7.
Implementation Strategy
A good BCC framework depends on effective implementation strategy to achieve desired
results. In light of above BCC framework and key messages, following key steps are suggested
for implementation strategy in the target district.





7.1
Interpersonal Communication
Community Mobilization
Advocacy
Entertainment Education
Mass Media
Interpersonal Communication (IPC)
Multiple social networks, including village development committees, citizens’ groups and
community gatherings should promote child health using IPC(inter-personal communication -talking and discussing). It will be crucial to involve community leaders, volunteers, and health
workers.
Interpersonal communication should make effective use of existing social networks
orinterpersonal relationships (family, friends, acquaintances, neighbors and colleagues) that
bindpeople together to enhance the communication process. For example, youngmothers’
mothers or mothers-in-law are often key decision-makers for fertility decisions.Therefore,
counseling the young woman about the benefits of balanced diet, exclusive breastfeeding,
birth spacing etc may beineffective if her mother or mother-in-law is uninformed or opposed to
this practice. It is therefore necessary to inform and educate mothers and mothers’-in-law
about mother and child health and nutrition needs.
Health care providers should be trained to provide counseling and storytelling to promote
desirable positive key health practices.
Skills of community volunteers should be strengthened to serve as effective communication
and change agents in their communities, through counseling and other communication
activities.
Health education tool box should be produced thatincludes key health messages for nurses,
midwives and volunteers.
7.2
Community Mobilization (CM)
Communities should be invited to actively participate in planning and implementing BCC
activities to promote improved mother and child health. Community mobilization (CM) is
essential for desired practices to become “normal behavior” in the community and
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willstimulate community action by involving different groups and community stakeholders to
work together in child health. A good CM provides the following benefits:
 It increases community dialogue and collective action in which members of a
community take action as a group to solve a common problem, which leads not only to
a reduction in the prevalence of disease within the community but also to social change
that increases the collective capacity to solve new problems.
 It increases program sustainability if the individuals and communities most affected feel
ownership of the process and content of the programs.
 It emphasizes the shift from transmission of information from outside technical experts
to dialogue, debate and negotiation on issues that resonate with members of the
community.
 It emphasizes that outcomes should go beyond individual behavior to social norms,
policies, culture and the supporting environment.
 It allows people to identify all the available resources in the community.
 It can overcome and complement limitations of interpersonal communication, by
working together with local mass media in BCC interventions.
A coordinated process should be implemented for participatory planning with communities to
promote improved child health.
Community leaders should be trained and equipped with a communications tool box tailored to
their needs
The same health information should be shared in mosques (especially Friday Prayers) and other
community forums, including cultural festivals.
7.3
Advocacy
Advocacy for health is defined as a combination of individual and social actions designed to
gainpolitical commitment, policy support, social acceptance and systems support for a
particularhealth goal or program.A number of key actions are needed to influence high-level
decision makers to provide commitment, policies, and organizational support for the Merlin’s
health initiatives, including the implementation of this BCC strategy.
To facilitate CM, mobilizers (health providers, community leaders, Merlin staff) should carry
out advocacy activities at different levels in order to gain stakeholders’support of our initiatives
or programs.
Table 2: Advocacy for Program
Administrative/Government
Advocacy
Community Advocacy
Media Advocacy
To inform authorities and decision-makers of your
program and enlist their cooperation.
To elicit a commitment from community leaders and
program beneficiaries
To place a specific issue on the public agenda,
To provide legitimacy to community interventions
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To generate sufficient public pressure to ensure the
adoption of decisions or public policies that benefits the
community.
Merlin should seek endorsement from the Ministry of Health (MoH) and partners at all levels
(district health department, People’s Primary Health Initiative and NGOs working on health) to
incorporate the BCC strategy into their work plans.
Public and private mass media should be negotiated to identify mutually beneficial
opportunities for designing, producing and broadcasting creative health programming.
The program should lobby for the support of government programs outside the MOH to
promote desired health practices.
7.4
Entertainment Education (EE)
Street theater, radio dramas, school plays, songs, games, and stories can be widely used to
promote public health messages. ThisCommunication approach presents opportunities for
building on and coordinating these efforts.
Theater, storytelling, games and radio dramas can be used to promote key behaviors for
mother and child health. A soap opera for local community radio stations can be produced that
addresses key health behaviors and monthly themes on mother and child health, in general
and malnutrition among mothers and children, in particular.
A range of EE products in small group discussions and in large public gatherings, such as village
committee meetings, to keep things lively and maintain local enthusiasm and interest.Some
important elements of entertainment-education include:
 EE interventions use narratives to emotionally engage the audience in the lives of
believable characters in an entertaining way, rather than using didactic rational appeals
for behavior change.
 EE uses elements of communication and behavioral theories to reinforce and promote
specific values, attitudes, and behaviors.
 EE uses self-efficacy and modeling to promote particular behaviors. Self-efficacy refers
to a feeling of personal empowerment to perform a particular behavior. Modeling takes
place when people observe others performing a behavior either in real life or in a
drama. Characters are created to perform as role models demonstrating the feasibility
of performing the new behaviors and the real benefits obtained from those behaviors.
 EE assumes that education does not have to be boring – and that entertainment can be
educational.
 EE projects acknowledge the structural barriers to behavior change and in addition to
individual behavior, address society as a unit of change.
 New EE projects have introduced participatory approaches, seeking to empower
individuals and communities to create social change.
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7.5
Mass Media
Though majority of women in the target villages do not have access to radio, as it is used
mainly by men, but educating men through radio can also have a positive impact. Health care
providers who live in urban settings do use radio and TV and benefit from health program
broadcast on such channels.
A weekly radio program can enhance their understanding about the problem of malnutrition in
the district. Monthly public announcements can change knowledge and attitude of the target
communities.
In urban settings cable TV can play an important role. Brief videos on key health messages
should be broadcast every week to disseminate health information. Key messages can also be
imparted through slides on cable TV. The most commonly watch channel on TV should
identified and slides should be run on that channel to impart education.
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8
Monitoring and Evaluation of BCC Strategy
Like any project/program on health, BCC strategy for reducing malnutrition should also be
properly monitored and evaluated against certain indicators. On the basis of program strategy,
following indicators are suggested for monitoring and evaluation of BCC strategy:
Indicators
% of underweight children
% of children with moderate acute malnutrition
% of children with severe acute malnutrition
% of stunted children (short for their age)- chronic malnutrition
% of severely stunted children – severe chronic malnutrition
% of women who initiated barest milk within half an hour after delivery.
% of women who exclusively breastfeed their babies for six months
% of children and women receiving Vitamin Supplementation
% of families using iodized salt
% of children receiving pre or post-lacteal feeds
% of children receiving bottle feeing
% of children receiving complementary feeding at the age of six months.
% of children receiving breast feeding till the age of 2 years.
% of children receiving multi micronutrient powder
% of children receiving sleep-inducing drugs
% of women using gutka during pregnancy and post-natal period
% of women receiving ANC for at least 3 times during pregnancy
% of women taken 3 times meals during pregnancy & Lactation period.
% of women receiving iron & folic acid during pregnancy
% of women receiving counseling on balanced diet, exclusive breastfeeding and complementary diet
during Antenatal visits
% of women who can recognize a malnourished child
% of health care providers trained in interpersonal communication
Number of community volunteers trained in interpersonal communication
Number of communication tool boxes shared with health care providers and community volunteers
Number of community meetings held for health education
Number of advocacy meetings held with stakeholders
Number of public rallies held for promotion of mother and child nutrition
Number of radio programs broadcast
Number of public announcement made on Radio and Cable TV
Number of school plays held to educate children on health and hygiene
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9
Recommendations
On the basis of findings and analysis, following activities have been recommended:
Health care providers should be well-trained in interpersonal communication and Merlin
should ensure that all the women seeking antenatal care receive counselling on key issue.
It should also be ensured that all the women receive TT vaccination and all the babies complete
immunization course. All the women should have access to iron and folic acid tablets and their
use must be ensured.
Men and women should be informed about the negative and harmful effects of chewing gutka,
and its use must be discouraged. Local administration should be involved in this task to ban
gutka or make it inaccessible.
Communities should be educated to seek assistance for delivery from skilled birth attendants.
Since majority of the deliveries take place at home, mothers are unlikely to received correct
health information from untrained and unskilled traditional birth attendants.
In cases when people have to choose a hospital for delivery, they usually prefer to go to a
private hospital because public health facilities do not have adequate staff and equipments.
District health authorities should be mobilized to ensure attendance of regular staff and equip
facilities with medical instruments.
All the community members should be sensitized to make sure that newborns be immediately
breastfed after birth and colostrum should not be discarded. Instead of giving pre or postlacteal feeds, only colostrum should be given to the baby. Moreover, all the mothers should be
encouraged to exclusively breastfeed their babies up to six months. Complementary feeding
should be initiated after six months, but mothers should continue to breastfeed their babies up
to two years.
Bottle feeding should be discouraged and mothers should be educated not to give sleepinducing drugs to their babies.
All the women should be trained to prepare ORS at home and all the families should be
encouraged to use iodized salt in their food.
Education department should be involved in the program and concerned education officials
should be mobilized to provide adequate washing facilities in the schools. Teachers must be
discouraged from chewing gutka, as it can badly affect perceptions of children. Health and
hygiene education sessions should be held in schools and children should be encouraged to
follow positive health practices not just in school but wherever they go.
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10
Annexure 1
10.1 Field Tools
HOUSEHOLD QUESTIONAIRE
Form #__________
Interview Date: __________
Respondent must have below 5 years Baby
My name is _________________________. We are conducting research study on behalf of Merlin to Design
nutrition BCC Framework / Strategy in District Thatta, Sindh Province. I’m going to ask you some questions about
how you care for and feed your baby, as well as what you know about infant feeding and from where get the
information on child care. You do not have to answer any questions that you do not want to answer, and you may
end this interview at any time you want to. However, your honest answers to these questions will help us better
understand what people think, say and do about feeding and caring for their babies in this community so we can
help improve health care for everyone. We would greatly appreciate your help in responding to this survey. The
survey will take about 25 minutes to ask the questions. Are you willing to participate?
Verbal consent for interview from respondent received: Yes: _____ No:________
1. Village: ____________________________ 2. UC:______________________ 3. Taluka: _________________
Respondent Profile
1. Name of Respondent
‫انٽرويو ڏيندڙ جو نالو‬
3. Age ‫عمر‬
5. Age at first
pregnancy ‫پهرين ٻار ڄڻڻ وقت‬
‫عمر‬
11. No. of children
‫ٻارن جو تعداد‬
Boys‫ڇوڪرا‬: _______________
Girls‫ڇوڪريون‬: _____________
13. Any miscarriage
‫ڪو ٻار ضايع ٿيو‬
[ ] Yes ‫ها‬
[ ] No‫نه‬
2. Education
‫تعليم‬
4. Age at marriage ‫شادي جي‬
‫وقت عمر‬
6. No. of total pregnancies
she has till today ‫اڄ تائين‬
.‫ڪيترا دفعا پيٽ سان ٿي آهي‬
12. Ages of first and last
children ‫پهرين ۽ آخري‬
‫ٻارنجون عمرون‬
14. if yes, in 13, how many
‫جيڪڏهن ها ته ڪيترا دفعا‬
1st_______
Last _______
No‫ تعداد‬. ______
Pregnancy Period
1. Did you go to a health facility for antenatal check-up during pregnancy? ‫ڇا حمل جي دوران توهان اسپتال چيڪ‬
.‫اپ الءِ ويا هئا‬
a) Yes‫ها‬
b) No ‫نه‬
2.
Did you receive counselling on any of the following (multiple tick allowed)? ‫حمل جي دوران توهان هيٺين مان ڪهڙا‬
.‫مشورا ورتا هئا‬
a) Breastfeeding practices ‫کير پيارڻجا طريقيڪار‬
b) Hygiene ‫صفائي سٿرائي‬
c) Nutrition needs during and after pregnancy ‫حمل جي دوران يا پوءِ کاڌ خوراڪ جي ضرورت‬d) Family planning
‫ خانداني منصوبه بندي‬e) Vaccination ‫حفاظتي ٽڪا‬
f) Danger signs of pregnancy ‫حمل وقت خطري‬
‫جو عالمتون‬
g)Food rich in iron‫توانائي بخش غذا‬
h) Other‫___________________________________________ ڪو به ٻيو‬
3. Did you receive any anti tetanus injection during pregnancy? ‫ڇا حمل جي دوران توهان تشنج (جهٽڪن) کان‬
‫بچا َء جا حفاظتي ٽڪا لڳرايا‬
a)Yes‫ ها‬b)No‫نه‬
c)Don’t Know‫خبر ناهي‬
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4.
5.
6.
7.
8.
9.
Do you know about iron and folic acid tablets during pregnancy?
‫ڇا توهانکي فوالد ۽ فولڪ ايسڊ جي گورين‬
‫جي باري ۾ ڄاڻ آهي‬
a)Yes‫ ها‬b)No‫نه‬
Did you take iron and folic acid tablets during pregnancy? ‫ڇا توهان فوالد ۽ فولڪ ايسڊ جون گورين کاڌيون‬
a)Yes‫ها‬
b)No‫نه‬
If yes, from where you get the iron and folic acid tablets during pregnancy (Multiple Tick)? ِ‫جيڪڏهن ها ته پوء‬
‫توهان فوالد ۽ فولڪ ايسڊ جون گوريون ڪٿان ورتيون‬
a) LHV/LHW‫ورڪر‬/‫ ليڊي هيلٽ وزيٽر‬b) BHU ‫صحت جو بنيادي مرڪز‬
c) RHC ‫ٻهراڙي جو صحت مرڪز‬
d) Purchase from medical store on prescription‫ڊاڪتر جي تجويز تي ميڊيڪل اسٽور ٿان خريد ڪيون‬
e) Other‫_____________________________________________________________________ ڪو به ٻيو‬
How many meal (s) did you eat during your pregnancy? ‫حمل جي دوران توهان ڪيترا دفعا ماني کاڌي‬
a) Same as usual
‫عام ڏينهن جيترو‬
b) Less than usual ‫ عام ڏينهن کان گهٽ‬c)More than usual (if
this option, then answer following question) ‫ عام ڏينهن کان وڌيڪ‬d)Don’t know ‫خبر ناهي‬
If your diet is more than usual, then which food items are supplemented in addition to normal food items?
(Allow respondent to share different items) ‫جيڪڏهن توهان عام ڏينهن کان وڌيڪ کائو ٿا ته اهي ڪهڙا کاڌا آهن جيڪي توهان‬
)‫(هڪ کان وڌيڪجواب ٻڌائي سگهجن ٿا‬.‫وڌيڪ کائو ٿا‬
a)______________________________________ b)______________________________________________
c) _____________________________________ d)________________________________________________
e)_________________________________________
How much work did YOU do during pregnancy?‫حمل دوران توهان ڪيترو ڪم ڪندا آهيو‬
a) Same as usual ‫جيتري عام ڏينهن ۾‬
b) Less than routine work ‫روز مره کان گهٽ‬
c) More than routine work ‫ روز مره کان وڌيڪ‬d) Other‫_______________________ڪو به ٻيو‬
Birth Preparedness and delivery ‫ٻار جي پيدائش ۽ ويم جي تياري‬
10. Where did YOU deliver the baby? (Multiple tick)‫ٻار جي پيدائش الءِ توهان ڪٿي ويا‬
a) Home ‫ گهر‬b) Public Hospital ‫گورنمينٽ اسپتال‬
c) Private Hospital ‫پرائيوٽ اسپتال‬
d)Other ‫ڪو به‬
‫______ٻيو‬
11. Who assisted your delivery? ‫ٻار جي پيدائش ۾ توهان جي ڪنهن مدد ڪئي‬
a) TBA ‫تربيت يافته دائي‬
b)LHW ‫ ليڊي هيلٿ ورڪر‬c)Midwife ‫ دائي‬d)Nurse ‫نرس‬
e)Doctor ‫ڊاڪٽر‬
f) Other‫__________________ ڪو به ٻيو‬
Post-partum care ‫ٻار جي پيدائش کان پوءِ سار سنڀال‬
12. Do you know benefits of colostrum? ‫ ڇا توهان کي پهرين ٿڃ جي فائدن جي باري ۾ خبر آهي‬a) Yes‫ها‬
b) No‫نه‬
13. Did YOU give colostrum to the baby? ‫ڇا توهان پنهنجي ٻار کي پهرين ٿڃ پياري‬
a) Yes‫ها‬
b) No‫نه‬
14. If no, why?‫جيڪڏهن نه ته ڇو‬
a. Didn’t have milk in the breast ‫ٿڃ جو کير نه هو‬
b) It’s harmful for the baby ِ‫اهو کيرٻار جي الء‬
‫نقصانڪار آهي‬
c) No practice in the family ‫ توهان جي خاندان ۾ ناهي پياري ويندي‬d) Other ‫_________________ٻي ڪا وجهه‬
15. When did YOU first breastfeed the baby after delivery? ‫ٻار جي پيدائش کانپوءِ پهريون ڀيرو ٻار کي کير ڪڏهن پياريو‬
a) Within half an hour after delivery ‫ ٻار ڄڻڻ کانپوءِ اڌڪالڪ اندر‬b) Within one to two hours ‫ ڪالڪن‬2 ‫ يا‬1
‫اندر‬
e) Within three to six hours
‫ ڪالڪن اندر‬6‫ کان‬3 d) Within six to 24 hours ‫ ڪالڪن جي‬22 ‫ ڪالڪن کان‬6
‫ اندر‬Other ‫____________________________ ٻيو ڪو به‬
16. Did YOU give pre-lacteal feeds to your baby? (Multiple) ‫ڇا توهان ٻار کي پهرين ٿڃ کانسواءِ ڪاٻي خوراڪ يا دوا ڏني‬
a)Yes ‫ها‬
b)No ‫نه‬
17. If yes, what?‫جيڪڏهن ها ته ڇا‬
d) Honey ‫ ماکي‬b) Butter
‫مکڻ‬
c) Ghutti/dukko‫ دُڪو يا گهٽي‬d) Sleep inducing medicine ‫ننڊ جي‬
‫(دوا‬Phenergan etc.) e)Other‫_____________________________________________ٻيو ڪو به‬
18. Do you know about exclusive breastfeeding period? ‫ڇا توهانکي خبر آهي ته ٻار کي صرف ما ُء جو کير ڪيتري عمر تائين‬
‫پيارجي‬
a)Yes‫ها‬
b)No‫نه‬
19. If yes, for how many months should a baby be exclusively breastfed? ‫جيڪڏهن ها ته گهڻن مهينن تائين صرف ما ُء جو‬
‫کير پيارجي‬
a) One month‫ مهينو‬1
b)Two to three months ‫ مهينا‬3 ‫ کان‬2 c)Four to five months ‫ مهينا‬5 ‫ يا‬2
d) Six
months‫ مهينا‬6
20. For how many months did you exclusively breastfeed the baby? ‫توهان ڪيترن مهينن تائين پنهنجي ٻار کي صرف ۽‬
‫صرف ٿڃ پياري‬
a) One month‫ مهينو‬1 b)Two to three months ‫ مهينا‬3 ‫ کان‬2 c)Four to five months ‫ مهينا‬5‫ يا‬2
d) Six months 6
‫مهينا‬
21. How many times did breastfeed the baby in a day?‫توهان هڪ ڏينهن ۾ ٻار کي ڪيترا دفعا ٿڃ پياري‬
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1 to 4 times a day‫هڪ کان چار دفعا‬
b) 5 to 8 times a day‫ پنج کان اٺ دفعا‬c) 8 to 10 times a day ‫اٺ‬
‫کان ڏهه دفعا‬
d) 11 to 12 times a day‫ يارهن کان ٻارن دفعا‬e) Other ‫ٻيو ڪو‬
‫_____________________________________به‬
22. When should the baby be provided complementary diet? ‫ٻار کي ڪيتري عرصي کانپوءِ کير کان عالوه ٻي غذا کارائڻ‬
‫گهرجي‬
a) After two months
b) After four months ِ‫ مهينن کانپوء‬2 c) At six months ِ‫ مهينن کانپوء‬6
ِ‫ مهينن کانپوء‬2
23. When did YOU start complimentary diet to the baby? ‫توهان ڪيتري عرصي کانپوءِ پنهنجي ٻار کي کير کان عالوه ٻي غذا ڏيڻ‬
‫شروع ڪئي‬
a) After two months
b) After four months ِ‫ مهينن کانپوء‬2 c) At six months ِ‫ مهينن کانپوء‬6
ِ‫ مهينن کانپوء‬2
24. How long did YOU breastfeed your baby, along with complimentary diet? ‫توهان ڪيتري عرصي تائين ٻي غذا سان‬
‫گڏوگڏ ٻار کي ٿڃ پياريو‬
a) Six months ‫ مهينا‬6 b) Twelve months
)‫ مهينا (سال‬12
c) Eighteen months‫ مهينا‬11
d) Twenty four months)‫ مهينا(ٻه سال‬22
25. If not 24 months, why?‫جيڪڏهن ٻن سالن تائين ٿڃ نه ڏني ته ڇو‬
a. Did not have milk in the breasts‫ٿڃ جو کير ختم ٿي ويو‬
b) Got pregnant again ‫ٻيهر حمل ڪري کير بند ٿي‬
‫ويو‬
c) No practice in family‫ مهينه کير پيارڻ جو رواج ناهي‬22 ‫ خاندان ۾‬d) Other‫_____________ڪو به ٻيو‬
26. Which milk is good for your baby? .‫توهان جي ٻار جي الءِ ڪهڙو کير سٺو آهي‬
a. Mother‫ما ُء‬
b) Animal ‫ جانور‬c) Formula ‫پاوڊر جو کير‬
27. Did you bottle-feed your baby?.‫ڇا توهان ٻار کي کير بوتل ۾ پياريو ٿا‬
a) Yes ‫ها‬
b) No ‫نه‬
28. What do you use in bottle feeding?‫توهان بوتل ذريعي هيٺين مان ڪهڙي شئي ٻار کي پياريو ٿا‬
a. Animal Milk ‫جانور جو کير‬
b)Formula Milk ‫هٿرادو ٺهيل کير‬
c)Tea/Other drinks ‫چانهه يا ڪو‬
‫شربت‬
d. Other ‫______________________________ٻيو ڪو به‬
29. Do you know about acute diseases suffered by child? (Multiple Tick) ‫ڇا توهان ٻارن ۾ ٿيندڙ هيٺين خطرناڪ بيمارين‬
.‫جي باري ۾ ڄاڻو ٿا‬
a) Diarrhoea ‫دست‬
b) Measles ‫ اُرڙي‬c) Pneumonia
‫نمونيا‬
d) Malaria ‫مليريا‬
e) Other‫______________________________ ڪو به ٻيو‬
30. What measures are taken by you in case if your child is suffering from any of above acute disease?
(Multiple Tick)
.‫توهان جي ٻارن ۾ مٿين ڄاڻايل بيمارين جي ٿيڻ صورت ۾ توهان ڪهڙا اُپا َء وٺندا آهيو‬
a) Home remedy‫گهر ۾ ئي عالج ڪندا آهيو‬
b) Consult TBA‫تربيت يافته دائي سان رجوع ڪندا آهيو‬
c) Consult LHW/LHV‫ ليڊي هيلٿ ورڪريا وزيٽر سان رجوع ڪندا آهيو‬d) Consult a doctor‫ڊاڪٽر سان رجوع ڪندا آهيو‬
e) Other‫_______________________________________________________________ ڪو به ٻيو‬
31. Can you tell me at least three danger signs in the new-born baby? (Multiple) ‫نئين ڄاول ٻار ۾ ڪي به ٽي خطرناڪ‬
.‫نشانيون توهان ٻڌائي سگهو ٿا‬
a. The baby does not cry after delivery ‫ ٻار ڄمڻ وقت ٻار جو نه روئڻ‬b) The baby is breathing hardly ‫ٻار جو‬
‫تڪليف سان ساهه کڻڻ‬
c) The baby’s colour turns pale or blue ‫ٻار جي بدن يا چهري جو رنگ پيلو يا نيلو ٿي وڃڻ‬
d) High grade fever‫تيز بخار‬
e. Vomiting‫ الٽيون‬f)Diarrhoea‫ دست‬f) Other‫___________________________________ڪا به ٻي‬
32. How you take care of nutrition needs of a sick child? ‫توهان هڪ بيمار ٻار جي غذائي ضرورت پوري ڪرڻ الءِ ڪهڙا اپا َء‬
‫ڪندا آهيو‬
a) Use traditional practices (Specify)‫____________________________________گهريلو طور طريقا‬
b) Consult doctor for advice ‫ ڊاڪٽر جي مشوري مطابق‬c) Consult TBA for advice
‫تربيت يافته دائي جي مشوري مطابق‬
d) LHV/LHW for advice‫ ليڊي هيلٿ ورڪريا وزيٽر جي مشوري مطابق‬e)
Consult Hakeem for advice‫ حڪيم جي مشوري مطابق‬f) Other (Specify ‫________________________ڪو به ٻيو‬
33. Do you know the importance of Immunization?‫ ڇا توهان حفاظتي ٽڪن جي اهميت جي باري ۾ ڄاڻو ٿا‬a)Yes‫ ها‬b)No‫نه‬
34. Has your child been fully immunized? ‫ڇا توهانجي ٻار جو حفاظتي ٽڪن جو ڪورس ٿيل آهي‬
a)Yes‫ ها‬b)No‫ نه‬c)Don’t know‫خبر ناهي‬
a)
35. Can you recognize a malnourished child?‫ڇا توهان ٻار ۾غذائيت جي ڪمي جي نشاني کي سڃاڻي سگهو ٿا‬
a)Yes‫ ها‬b)No‫ نه‬c)Don’t know‫خبر ناهي‬
36. What to do if the child becomes malnourished?‫جيڪڏهن توهان جو ٻار غذائيت جو شڪار ٿئي ٿو ته توهان ڇا ٿا ڪندا آهيو‬
a) Home remedy‫گهر ۾ ئي عالج ڪندا آهيو‬
b) Consult TBA‫تربيت يافته دائي سان رجوع ڪندا آهيو‬
c) Consult LHW/LHV‫ ليڊي هيلٿ ورڪريا وزيٽر سان رجوع ڪندا آهيو‬d) Consult a doctor‫ڊاڪٽر سان رجوع ڪندا آهيو‬
e) Other‫__________________________________________________________________ ڪو به ٻيو‬
37. Did your child receive Vitamin A drops?‫ڇا توهان پنهنجي ٻار کي وٽامن اي جا ڦڙا پياريو ٿا‬
a) Yes‫ ها‬b) No‫نه‬
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38. Do you know about ORS? ‫ڇا توهان او ار ايس جي باري ۾ ڄاڻوٿا‬
a) Yes‫ ها‬b) No‫نه‬
39. If ‘Yes’ then, can you prepare ORS at home? ‫جيڪڏهن ها ته ڇا توهان او ار ايس پنهنجي گهر ۾ ئي تيار ڪري سگهو ٿا‬a)
Yes‫ها‬b) No‫نه‬
40. How much do you eat during breast feeding period?‫ٻار کي کير ڏيڻ جي عرصي دوران توهان ڪيترو کاڌو کائيندا آهيو‬
a) Same as usual ‫جيترو عام ڏينهن ۾‬
b) Less than usual
‫ عام ڏينهن کان گهٽ‬c) Normal ‫عام طور‬
d) More than normal ‫عام طور کان وڌيڪ‬
e) don’t know ‫خبر ناهي‬
Practice/Behaviour/Attitude ‫طور طريقا‬/‫رويا‬/‫رواج‬
41. What is your source of drinking water?‫توهان جي پيئڻ جي پاڻي جو ذريعو ڪهڙو آهي‬
a) Hand pump ‫نلڪو‬
b) Water course/Irrigation Channels‫واهه يا ڪئنال‬
c) Water Supply‫واٽر سپالئي‬
d) Other ‫____________________ڪو ٻيو‬
42. Do you treat your drinking water?
‫ڇا توهان پيئڻ جي پاڻي کي صاف ڪرڻ جو ڪو طريقو استعمال ڪيو ٿا‬
a) Yes‫ها‬
b) No‫نه‬
43. Do you use iodized salt?
‫ڇا توهان آيوڊين مليل لوڻ استعمال ڪيو ٿا‬
a) Yes‫ ها‬b) No‫نه‬
44. Where do you defecate?.‫آهيو‬
‫توهان پنهنجي حاجت پوري ڪرڻ يا ڪاڪوس ڪرڻ ڪٿي ويندا‬
Pour Flush Latrine‫پڪو ليٽرين‬
b) Pit Latrine‫ کڏ وارو ليٽرين‬c) Covered defecation Corner ‫حاجت الءِ ڍڪيل‬
‫مخصوص جڳهه‬
b) d) Uncovered defecation Corner ‫حاجت الءِ کليل مخصوص جڳهه‬
e) Open defecation ‫ حاجت الءِ کليل جڳهه‬f) Other‫__________________________________________ڪو به ٻيو‬
When do you usually wash your hands (Multiple Tick)?‫عام طور توهان ڪهڙي وقت هٿ ڌوئيندا آهيو‬
a) After waking up in the morning‫صبح سوير اٿڻ مهل‬
b) After defecation ِ‫ڪاڪوس ڪرڻ کانپوء‬
c) Before cooking ‫کاڌي پچائڻ کان پهرين‬
d) Before feeding your baby?‫ٻارن کي کارائڻ کان پهرين‬
e) After washing your baby? ِ‫ٻارکي وهنجارڻ کانپوء‬
f) After working in fields ِ‫ٻني ٻاري تان موٽڻ کانپوء‬
g) After coming in contact with livestock/animals ِ‫ مال مٿا َء جي سنڀال کانپوء‬h) Others‫________________ڪو به ٻيو‬
From where you get information about mother & child nutrition (Multiple Tick)? ‫ما َء ۽ ٻارجي غذا بابت توهان کي ڄاڻ‬
‫ڪٿان ملي ٿي‬
a) Mother ‫ ما َء‬b) Mother in law‫سس‬
c) Older women‫بزرگ عورتون‬
d) Husband ‫مڙس‬
e) Father-in-law ‫سهرو‬
g) Other family member‫گهر جو ڪو ٻيو ڀاتي‬
ُ
h) Neighbor / Friend / Relative ‫پاڙيسري مٽ مائٽ دوست‬
i) TBA‫تريبيت يافته دائي‬
j) Doctor‫ڊاڪٽر‬
k) Lady Health Visitor‫ ليڊي هيلٿ وزيٽر‬l) Radio ‫ريڊيو‬
m) TV ‫ ٽي وي‬n) Newspaper‫نيوزپيپر‬
o) Mosque/Imam/Church/Pundit‫ پنڊت‬،‫ گرجا گهر‬،‫امام‬،‫مسجد‬
p)
Other
source
‫ٻيو‬
‫ڪو‬
‫______________________ذريعو‬
Please select the best three most useful sources of information by ranking? ‫ اهم معلومات جا ذريعه ٻڌايو‬3 ‫هيٺين مان‬
‫جتان توهان معلومات وٺو ٿا‬
a) Mother ‫ ما َء‬b)Mother in law‫سس‬
c) Older women‫بزرگ عورتون‬
d) Husband ‫مڙس‬
e) Father-in-law ‫سهورو‬
f) Other family member‫گهر جو ڪو ٻيو ڀاتي‬
g) Neighbor / Friend / Relative‫پاڙيسري مٽ مائٽ‬
h) TBA‫تريبيت يافته دائي‬
i) Doctor‫ڊاڪٽر‬
j) Lady Health Visitor‫ ليڊي هيلٿ وزيٽر‬k) Radio ‫ريڊيو‬
l) TV ‫ ٽي وي‬m) Newspaper‫اخبار‬
n) Mosque/Imam/Church/Pundit‫ پنڊت‬،‫ گرجا گهر‬،‫امام‬،‫مسجد‬
o) Other source ‫___________ڪو ٻيو ذريعو‬
What information on infant and young child nutrition did you receive? ‫کيرپياڪ ۽ ان کان وڏي ٻار جي غذايت جي‬
‫باري ۾ توهان کي ڪهڙي معلومات آهي‬
a) Benefits of mother diet‫ما َء جي غذايت جا فائدا‬
b) Breast feeding practices ‫ٿڃ پيارڻ جي اهميت‬
c) Child food needs at different age‫ عمر مطابق ٻار جي خوراڪ‬d) Hygiene practices ‫صفائي سٿرائي‬
e) Other (specify)‫____________________________________________________ ڪو به ٻيو‬
Have you attended any health education session before? ‫ان کان اڳ ۾ ڇا توهان صحت بابت ڪا ٽريننگ ورتي‬
‫آهي‬a)Yes ‫ها‬b)No‫نه‬
If yes, when and where and by whom?‫جيڪڏهن ها ته ڪڏهن ڪٿي ۽ ڪنهن کان ٽريننگ ورتي‬
______________________________________________________________________________________
Will you be willing to attend health sessions on child care and nutrition needs?
‫ صفائي سٿرائي ۽ کاڌخوراڪ بابت ٽريننگ ڏني وڃي‬،‫ڇا توهان جي خواهش آهي ته توهان کي ٻار جي صحت‬
a)Yes‫ ها‬b)No‫نه‬
If ‘No’, why?‫جيڪڏهن نه ته ڇو‬
a) My husband will not allow me ‫منهنجو مڙس اجازت ڪونه ڏيندو‬
b) My mother in law will not allow me‫منهنجي سس اجازت نه ڏيندي‬
c) I don’t have time due to farming and home work ‫گهر ۽ ٻني ٻاري جي ڪم ڪارجي ڪري وقت نٿو ملي‬
d) Will not get permission due to cultural restrictions ‫معاشرتي رڪاوٽن سبب اجاز نٿي ملي‬
e) Don’t know reason ‫خبر ناهي‬
f) Other‫_______________________________ ڪو ٻيو‬
Who decides on your nutrition needs during pregnancy and lactating period?
a)
45.
46.
47.
48.
49.
50.
51.
52.
53.
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‫توهان جي حمل ۽ ٻار کي ٿڃ ڏيڻ جي عرصي دوران توهان جي کاڌ خوراڪ جي ضرورتن جو فيصلو ڪير ڪندو آهي‬
a) Mother in law‫سس‬
b) Husband‫ مڙس‬c) Self‫ پنهنجو پاڻ‬d) Other‫_____________________ ڪو ٻيو‬
54. What factors govern nutrition needs decision (Multiple tick)? ‫توهان جي خوراڪ جي ضرورت جي پورائي ڪرڻ ۾‬
‫ڪهڙي اهم رڪاوٽ آهي‬
a. Poverty ‫غربت‬
b) Low priority on balanced diet c) Low priority on female nutrition needs d)
Traditional practices ‫کاڌ خوراڪ جا رسمي طريقا‬
e) Lack of awareness ‫ڄاڻ جي گهٽتائي‬
f) Other‫______________ ڪو ٻيو‬
55. Who decides on your health needs during pregnancy and lactating period?
‫توهان جي حمل ۽ ٻار کي کير پيارڻ جي دوران توهان جي عالج الءِ ڪير فيصلو ڪندو آهي‬
a) Mother in law‫سس‬
b) Husband‫ مڙس‬c) Self‫ پنهنجو پاڻ‬d) Other‫______________________ ڪو ٻيو‬
56. What factors govern health needs decision?(Multiple tick) ‫توهانجي عالج ڪرائڻ جي ضرورت جي پورائي ڪرڻ ۾‬
‫ڪهڙي اهم رڪاو ٽ آهي‬
a) Poverty ‫غربت‬
b) Traditional practices‫رواجي طور طريقن تي ڀروسو‬
c) Lack of awareness
about the disease ‫بيمارين بابت ڄاڻ جي گهٽتائي‬
d) No health facility near the village ‫صحت جي مرڪز‬
‫جو ڳوٺ جي ويجهو نه هجڻ‬
e) Other _____________________________________________
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SCHOOL INTERVIEW
Form #__________
Interview Date: __________
My name is _________________________. We are conducting research study on behalf of Merlin to
Design nutrition BCC Framework / Strategy in District Thatta, Sindh Province. I’m going to ask you some
questions about nutrition and food facilities in your school. Your answers to these questions will help us
better understand what people think, say and do about feeding and caring for their babies in this
community so we can help improve health care for everyone. We would greatly appreciate your help in
responding to this survey. The interview will take about 25 minutes to ask the questions. Are you
willing to participate?
Verbal consent for interview from respondent received: Yes: _____ No:________
1. Principal Name: ____________________________ 2. School Level:_________________________ 3.
Village: ______________________ 2. UC: __________________ 3. Taluka: ___________________
1.
School Enrolment:
S. No.
Class
a.
Class 1
b.
Class 2
c.
Class 3
d.
Class 4
e.
Class 5
f.
Class 6
g.
Class 7
h.
Class 8
i.
Class 9
j.
Class 10
Boys
1.
Does your schools has any functional canteen / cafeteria?
2.
If, yes in above question, what facilities it has
Girls
a.Yes
Total
b.No
_________________________________________________________________________________________
_________________________________________________________________________________________
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_________________________________________________________________________________________
3.
If no – do students bring lunch boxes from their homes?
a.Yes
4.
If yes in above question, what percentage of students brings lunch boxes from their homes?
a.
b.No
Percentage b.No idea
5.
Does any Health team visit your school? (like vaccination team, LHW, MCH week team) a.Yes
b.No
6.
7.
Does anyone in your school provide nutrition, health and hygiene awareness to students? a.Yes
If yes, who organize these sessions?
b.No
a.
Health department (through LHV etc.) b.NGO Project
e.
Other_________________________________________________________________
8.
Brief highlights about the hygiene sessions organized in your schools
_________________________________________________________________________________________
c.School Staff
d.Senior Students
_________________________________________________________________________________________
_________________________________________________________________________________________
9.
Can you please share the nutrition needs of the children in school age?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
10. Does someone sell food items in the school?
a.Yes
b.No
11. Does your school has functional toilet?
a.Yes
b.No
12. If no, how students manage if the need to use toilet?
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
13. Does your school has drinking water facility
a.Yes
b.No
14. If yes, is the available water safe for drinking?
_________________________________________________________________________________________
_________________________________________________________________________________________
15. Do the children bring drinking water in bottles from their home?
a.Yes
b.No
16. If yes, how many:
___________________________________________________________________________
17. If no, why
_________________________________________________________________________________________
_________________________________________________________________________________________
________________________________________________________________________________________
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18. Will you be willing to attend health sessions on child care and nutrition needs?
a.Yes
b.No
19. If ‘No’, why?
_________________________________________________________________________________________
_________________________________________________________________________________________
________________________________________________________________________________________
20. Being a School Head what you think the general practices of community regarding taking of Nutritious food
items & supplementations during pregnancy and breast feeding of the baby?
a)
d.
Good (peoples are serious)
Poor (peoples don’t care)
b.Normal (as per routine) c.Satisfactory (pay attention somehow)
21. If ‘Poor’, why and how to bring change?
_________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
________________________________________________________________________________________
22. General remarks / observations of the interviewer:
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FOCUS GROUP DISCUSSION
Men - (husbands, fathers-in-law, committee members)
Village:
Tehsil:
Number of participants:
Date:
Start time:
Research team information
Name of Group Facilitator:
Name of note-taker:
Verbal consent obtained? Yes/No
UC:
District:
End time:
Introduction (must be completed by Facilitators before beginning the discussion)
We are conducting research study on behalf of Merlin to Design nutrition BCC Framework /
Strategy in District Thatta, Sindh Province. We are going to have a conversation about child
feeding in this community. It is important that we discuss this topic as honestly as we can so
that the appropriate interventions can be planned to improve the health status of our
children.
The discussion will take between 30 and 40 minutes depending on your interest and
participation. Any information that you provide will be kept strictly confidential and will not
be shown to other people. The information that you provide during the discussion will be
presented together with answers from other participants so that you cannot be identified.
The discussion is voluntary and you are free to choose not to answer any or all of the
questions, or to leave the discussion at any time.
List of participants
s.#
Name
1.
Age
Occupation
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12
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1. What do you know about the nutrition and
health needs of women during pregnancy?
Probe
 Probe about knowledge and practice in the
local community

Do you think women eat balanced diet
during pregnancy? Do you encourage them
to have a balanced diet?

What do you think are the causes of
anemia among pregnant women?
2. Delivery & Breast Feeding?
Probe
 Who is preferred for delivery: TBA or a
skilled birth attendant?

Do men know about benefits of breast
feeding?

Do the breast milk alone is enough for a
baby for the first six months? (What’s
opinion of men in FGD about pre-lacteal
feeds? Bottle-feeding? Formula milk? Sleep
inducing medicines?)
‫ حمل جي دوران عورتن جي صحت ۽ غذا جي ضرورتن‬.1
‫جي باري ۾ توهان ڇا ڄاڻ آهي‬
‫مقامي ماڻهن کان معلومات وٺڻ جي ڪوشش ڪريو‬
‫ڇا توهان سمجهو ٿا ته عورت کي حمل جي دوران مناسب‬
‫ ڇا توهان انهن جي همت افزائي ڪندو ته هو‬.‫کاڌو ملي ٿو‬
‫متوازن کاڌو کائن‬
‫ڇا توهان سمجهو ٿا ته حمل دوران عورتن جي رت گهٽ‬
‫ٿيڻ جا سبب ڪهڙا آهن‬



‫ ويم ۽ ٿڃ پيارڻ‬.2
‫عام دائي يا تربيت يافته‬. ِ‫ڪير مناسب آهي ويم ڪرڻ الء‬
‫دائي‬
‫ڇا توهان ماڻهن کي خبر آهي ته ٿڃ پيارڻ جا فائده ڪهڙا‬
‫آهن‬
‫ڇا فقط ما ُء جو کير ئي ٻار الءِ ڇهن مهينن تائين ڪافي‬
‫ (گڏجاڻي ۾ موجود ماڻهن کان ما ُء جي ٿڃ کان عالوه‬.‫آهي‬
‫ کير سان ٺهيل شئي‬،‫ٻي خوراڪ جهڙوڪ بوتل وارو کير‬
)‫يا ننڊ جي دوا‬
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
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3. Behavior
Probe
 What role is played by husbands in your
community during the pregnancy and
breastfeeding period?

Do you allow females to follow advices of
health practitioners during pregnancy and
breast feeding?
4. Complementary feeding knowledge and
practice
Probe
 Age when young baby be given solid
foods?

What kind of food items be given at the
age of 6 months?

What are responsibilities of father to
ensure better health of baby?

Do purchase fortified food for baby if
needed? If No, why?
‫ رويا‬.3
‫معاشري ۾ مڙس جو ڪهڙو قردار آهي جڏهن ان جي‬
‫گهرواري حمل سان هوندي آهي ۽ ٻار کي ٿڃ ڏيندي آهي‬
‫ڇا توهان پنهنجن عورتن کي اجازت ڏيندو ته حمل ۽ ٿڃ ڏيڻ‬
‫جي دوران ڊاڪٽر جي مشورن تي عمل ڪن‬


‫ کير سان گڏوگڏ ٻي خوراڪ جي بابت ڄاڻ‬.2
‫ڪيتري عمر جي ٻار کي سخت قسم جي کاڌو کارايو وڃي‬
‫ڇهن مهينن جي ٻار کي ڪهڙي قسم جا کاڌا ڏنا وڃن‬
‫والد تي ڪهڙيون ذميواريون ٿين ٿيون جنهن سان هو پنهنجي‬
‫ٻار کي بهتر خوراڪ مهيا ڪري‬
‫ڇا ضرورت وقت صحت بخش کاڌا خريد ڪري ٻار کي ڏنا‬
‫ جيڪڏهن نه ته ڇو؟‬.‫وڃن‬




5. Media habits and access to infant and ‫ صحت جي باري ننڍن ٻارن ۽ وڏن ٻارن جي غذايت جي‬.5
‫معلومات تائين رسائي‬
young child nutrition information
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
Probe
Which radio/TV program do you listen
to/watch?
‫ڪهڙا پروگرام توهان ريڊيو يا ٽي تي ٻڌندا ۽ ڏسندا آهيو‬


Do you listen any program related to child
health?
‫ڇا توهان ٻارن جي صحت جي باري ۾ ڪو پروگرام ٻڌندا‬
‫آهيو‬


How many days do you listen to radio in a
week?
What messages have you heard on
mother and child food needs?
What more information do you want to
get on child health and nutrition care?
‫هڪڙي هفتي ۾ گهڻا ڏينهن توهان ريڊيو ٻڌندا آهيو‬

‫ما ُء ۽ ٻار جي ضروري کاڌ خوراڪ وارا ڪهڙا پيغام ٻڌندا‬
‫آهيو‬

‫ٻار جي صحت ۽ غذايت جي باري ۾ وڌيڪ ڄاڻ حاصل‬
‫ڪرڻ الءِ توهان ڇا ڪندا‬



6. Child health awareness/Care
Probe
 What do you know about child care in first six
months after birth?
 From where you get information about child
care/nutrition?
 How have you used the
messages/information you heard?
Probe
 How much time do father spend with
child?
 When child is sick, what you do?
 Who decides on getting medical help
‫ ٻار جي صحت ۽ حفاظت بابت معلومات‬.6
‫ٻار جي پيدائش کان ڇهه مهينن تائين توهان کي ٻار جي‬
‫حفاظت ڪرڻ بابت ڄاڻ آهي‬
‫ٻار جي صحت ۽ حفاظت بابت توهان ڪٿان معلومات‬
‫حاصل ڪندا آهيو‬
‫جيڪي توهان پيغام ۾ معلومات ٻڌندا آهي انهي کي ڪيئن‬
‫پنهنجي زندگي ۾ ڪتب آڻيندا آهيو‬



‫ ٻار سان ان جو والد صاحب ڪيترو وقت گذاري ٿو‬
‫ جڏهن ٻار بيمار ٿي ٿو ته توهان ڇا ڪندا آهيو‬
‫ جڏهن ٻار بيمار ٿي پوي ٿو ته اسپتال وٺي وڃڻ جو‬
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‫فيصلو ڪير ڪري ٿو‬
when child is sick?
7. Will you be willing to attend health sessions
on child care and nutrition needs?
‫ ڇا توهان ٻار جي حفاظت ۽ غذايت جي ضرورتن تي مشتمل‬.7
‫صحت جي ٽريننگ وٺندا‬
Probe
 Ask if there is no any restriction from
family to participate in the training ‫ پڇو ته ٽريننگ سيشن وٺڻ الءِ توهان جي خاندان مان‬
sessions,
becoming
member
of ‫ ڪميونٽي هيلٿ جي ميمبر ۽‬،‫ڪا رڪاوٽ پيش ايندي‬
‫سي آر پي ٿيڻ ۾ ڪا رڪاوٽ پيش ايندي‬
Community Health Committee and CRP
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Interview Checklist with Social Activist/Religious
Leader/Doctor/Health Practitioners/LHV/LHWs/TBA
Name of Respondent:
Village:
Tehsil:
Date:
Start time:
Name of Interviewer:
Verbal consent obtained? Yes/No
Occupation:
UC:
District:
End time:
Introduction (must be completed by Facilitators before beginning the discussion)
We are conducting research study on behalf of Merlin to Design nutrition BCC Framework /
Strategy in District Thatta, Sindh Province. We are going to have a conversation about child
care and feeding practices and behavior of the community. It is important that we discuss this
topic as honestly as we can so that the appropriate interventions can be planned to improve
the health status of our children.
The discussion will take between 30 and 40 minutes depending on your interest and
participation. Any information that you provide will be kept strictly confidential and will not
be shown to other people. The information that you provide during the discussion will be
presented together with answers from other participants so that you cannot be identified.
The discussion is voluntary and you are free to choose not to answer any or all of the
questions, or to leave the discussion at any time.
2. How is the maternal and child health
‫ توهان جي عالئقي ۾ ما ُء ۽ ٻار جي صحت جي صورتحال‬.1
‫ڪيئن آهي‬
situation in your area?
Probe
.‫ ڇا توهان سمجهو ٿا ته اها بهتر آهي جي نه ته ڇو‬
 Do you think it is better? If no,
.‫انجي بهتري جي الءِ ڇا ڪرڻ گهرجي‬
why? What needs to be done?
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2. How about nutrition status of women
(Pregnant & Lactating) and children in this
area?
Probe
 Do you think women and men are aware of
basic hygiene and nutrition principles?
 If no, why? What to do?
 What do you think are the causes of
malnourishment among children? Anemia
among women?
‫ توهان جي هن عالئقي ۾ عورتن (حمل ۽ کير پياريندڙ) ۽‬.2
‫ٻارن جي غذايت جي صورتحال ڇا آهي‬
‫ ڇا توهان سمجهو ٿا ته مردن ۽ عورتن کي صحت ۽‬
‫صفائي ۽ غذايت بابت بنيادي اصولن جي ڄاڻ آهي‬
‫جيڪڏهن نه ته ڇو؟ ڇا ڪيو وڃي‬
‫ ٻارن ۾ غذايت جي ڪمي جي سببن جي باري ۾ توهان ڇا‬
‫ڄاڻ رکو ٿا؟ عورتن ۾ رت جي ڪمي جي باري ۾ توهان ڇا‬
‫ڄاڻ رکو ٿا‬
3. What do you think about government ‫ توهانجي ڄاڻ مطابق گورنمينٽ جون اسپتالون ما ُء ۽ ٻار‬.3
‫جي غذائي ضرورتن متعلق ڪهڙيون خدمتون ڏين ٿا؟‬
health services regarding mother and
‫ ڪهڙيون مشڪالتون آهن ۽ انهن جا ڪهڙا حل آهن؟‬
child nutrition in your area?
Probe:
 What are the challenges? What are the
possible solutions?
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4. Do you feel that the community (men & ‫ توهانجي خيال ۾ توهانجي ڳوٺ ۾ مردن ۽ عورتن کي‬.2
women) have sufficient information on ‫عورت جي حمل دوران ۽ ٻار کي کير پيارڻ دوران غذائي‬
‫ضرورتن متعلق مناسب معلومات آهي؟‬
health and nutrition of mother and child
during pregnancy and breast feeding
period?
5. Do you feel that the females get due care ‫ ڇا حمل دوران ۽ ٻار کي کير پيارڻ دوران عورتن جي‬.5
.‫غذائي ضرورتون پوريون ڪيون وڃن ٿيون‬
during pregnancy and breast feeding period?
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6. Child Care - Who decides on getting medical
help when child is sick?
‫ ننڍن ٻارن جي عالج الءِ ڪير فيصلو ڪندو آهي‬.6
7. What role is being played by social ِ‫ ٺٽي ضلعي ۾ صحت جي مسئلن کي حل ڪرڻ الء‬.7
activists/Religious Leader/ Doctors / Health ‫ ليڊي هليٿ‬/‫ ڊاڪٽر‬/‫ مذهبي اڳواڻ‬/‫سماجي ڪارڪن‬
Practitioners /LHVs/LHWs TBAs in increasing ‫ دائيون معاشري ۾ صحت جي‬/ ‫وزيٽرس ۽ ورڪرس‬
.‫باري ۾ ڄاڻ ڪهڙي طريقي سان ڦهالئي رهيا آهن‬
awareness and community mobilization to
combat the health problem in rural
community in district Thatta?
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8. How to change the behavior of community ‫ معاشري ۾ ما ُء ۽ ٻار جي صحت جي باري ۾ رويا ڪيئن‬.1
‫تبديل ڪندا‬
for better health care of women and child?
‫ ڪوشش ڪري اهڙيون تجويزون وٺو ته اها تبديلي‬
 Try to get suggestions in line with ‫ڪهڙ‬
ِ
Community
involvement,
Economic ‫ صحت جي‬،‫ جهڙوڪ؛ معاشي بهبود‬.‫طريقي سان اچي‬
‫ڄاڻ ۽ ميڊيا جي ذريعي‬
empowerment, Health awareness sessions,
Role of media etc.
General Observations of the interviewer
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‫ريمارڪس‬
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FOCUS GROUP DISCUSSION
Children
Village:
Tehsil:
Number of participants:
Date:
Start time:
Research team information
Name of Group Facilitator:
Name of note-taker:
Verbal consent obtained? Yes/No
UC:
District:
End time:
Introduction (must be completed by Facilitators before beginning the discussion)
We are conducting research study on behalf of Merlin to Design nutrition BCC Framework /
Strategy in District Thatta, Sindh Province. We are going to have a conversation about child
feeding in this community. It is important that we discuss this topic as honestly as we can so
that the appropriate interventions can be planned to improve the health status of our
children.
The discussion will take between 30 and 40 minutes depending on your interest and
participation. Any information that you provide will be kept strictly confidential and will not
be shown to other people. The information that you provide during the discussion will be
presented together with answers from other participants so that you cannot be identified.
The discussion is voluntary and you are free to choose not to answer any or all of the
questions, or to leave the discussion at any time.
List of participants
s.#
Name
Age
Occupation
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12
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3. Has anyone taught you hygiene
practices?
Probe
 Parents, School Teacher, LHV, doctor,
NGO person?
‫ صحت ۽ صفائي جي باري ۾ توهان کي ڪنهن سيکاريو آهي‬.1
‫معلوم ڪجو ته اها ڄاڻ ڪنهن ڏني جهڙوڪ‬
‫ ڊاڪٽر‬،‫ ليڊي هيلٿ وزيٽر‬،‫ اسڪول ماستر‬،‫والدين‬
‫۽ اين جي او جو ڪو ماڻهو‬
‫ ڇا توهان پنهنجا هٿ ڌوئيندا اهيو‬.2
2. Do you wash hands?
Probe
 What are the benefits of hand

‫ توهان هٿ‬،‫هٿ ڌوئڻ جا ڪهڙا فائدا آهن‬
‫ڪڏهن ڌوئيندا آهيو‬

washing? When to wash hands?
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3. Do you take lunch box while going to school?
Probe
 Probe: what kind of food items they take
and if not then, explore reasons why they
don’t take lunch box due to poverty or
else!
4. Do you think you get enough food at home?
Probe
 How many times do you eat a day? Do
you ever feel hungry even after eating
food?
 What foods do you like to eat junk foods
‫ جڏهن توهان اسڪول ويندا آهيو ته پنهنجو کاڌو کڻي‬.3
‫ويندا آهيو‬
‫ ڪهڙي قسم جو کاڌو کڻي ويندا آهيو ۽ جيڪڏهن نه‬
‫ته پوءِ ان جو سبب ڇا آهي ته اهي کاڌو ڇو کڻي‬
‫ڪونه ويندا آهن ان جو سبب غربت يا ڪو ٻيو آهي‬
‫ ڇا توهان سمجهو ٿا ته توهان کي گهر ۾ کاڌو پورو‬.2
‫ملندو آهي‬
‫ ڏينهن ۾ توهان ڪيترا دفعا ماني کائيندا آهيو ڇا‬
‫توهان کاڌي کائڻ کان پوءِ به بک محسوس ڪندا‬
‫آهيو‬
‫ توهان کي ٻاهريان ڪهڙا کاڏا پسند آهن‬
(chips, juice, biscuits, Pakoras, rusk, tea,
Papar, sweet candies, choclates) nutrition
foods (home foods, meat, milk eggs, cereals).
(Note – due to these junk foods children feel no
hungry and don’t eat on time which has negative
impact on health).
5. Have you seen malnourished child?
‫ ڇا توهان غذايت جو شڪار ٻار ڌٺو آهي‬.5
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Probe
 In your opinion, what are causes of
malnourishment among children? What
to do for malnourished children?
6. Who is given more food at home: boys or
girls? Why?
Probe
 Explore the reasons of giving the priority
and how to change this?
7. Do you feel your mother nutrition needs are
taken care? What are reasons and how to
improve this?
‫ توهان جي خيال مطابق ٻارن ۾ غذايت جي ڪمي جا‬
‫ توهان انهن ٻارن الءِ ڇا ڪندا‬.‫ڪهڙا سبب آهن‬
‫جيڪي غذايت جو شڪار آهن‬
‫ گهر ۾ ڪنهن کي وڌيڪ کاڌو ڏنو وڃي ٿو ڇوڪري يا‬.6
‫ ڇو؟‬.‫ڇوڪري کي‬
‫ اوليت جا سبب معلوم ڪيو ۽ پڇو ته انهن کي ڪيئن‬
‫تبديل ڪري سگهجي ٿو‬
‫ ڇا توهان محسوس ڪيو ٿا ته توهان جي ما ُء جي غذايت‬.7
‫جو پورو خيال رکيو وڃي ٿو؟ جيڪڏهن نه ته ڇا سبب‬
‫آهين ۽ انهن کي ڪيئن بهتر ڪري سگهجي ٿو‬
Probe
---------------------
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Interview Checklist with Social Activist/Religious
Leader/Doctor/Health Practitioners/LHV/LHWs/TBA
Name of Respondent:
Village:
Tehsil:
Date:
Start time:
Name of Interviewer:
Verbal consent obtained? Yes/No
Occupation:
UC:
District:
End time:
Introduction (must be completed by Facilitators before beginning the discussion)
We are conducting research study on behalf of Merlin to Design nutrition BCC Framework /
Strategy in District Thatta, Sindh Province. We are going to have a conversation about child
care and feeding practices and behavior of the community. It is important that we discuss this
topic as honestly as we can so that the appropriate interventions can be planned to improve
the health status of our children.
The discussion will take between 30 and 40 minutes depending on your interest and
participation. Any information that you provide will be kept strictly confidential and will not
be shown to other people. The information that you provide during the discussion will be
presented together with answers from other participants so that you cannot be identified.
The discussion is voluntary and you are free to choose not to answer any or all of the
questions, or to leave the discussion at any time.
4. How is the maternal and child health
‫ توهان جي عالئقي ۾ ما ُء ۽ ٻار جي صحت جي صورتحال‬.3
‫ڪيئن آهي‬
situation in your area?
Probe
.‫ ڇا توهان سمجهو ٿا ته اها بهتر آهي جي نه ته ڇو‬
 Do you think it is better? If no,
.‫انجي بهتري جي الءِ ڇا ڪرڻ گهرجي‬
why? What needs to be done?
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4. How about nutrition status of women
(Pregnant & Lactating) and children in this
area?
Probe
 Do you think women and men are aware of
basic hygiene and nutrition principles?
 If no, why? What to do?
 What do you think are the causes of
malnourishment among children? Anemia
among women?
‫ توهان جي هن عالئقي ۾ عورتن (حمل ۽ کير پياريندڙ) ۽‬.4
‫ٻارن جي غذايت جي صورتحال ڇا آهي‬
‫ ڇا توهان سمجهو ٿا ته مردن ۽ عورتن کي صحت ۽‬
‫صفائي ۽ غذايت بابت بنيادي اصولن جي ڄاڻ آهي‬
‫جيڪڏهن نه ته ڇو؟ ڇا ڪيو وڃي‬
‫ ٻارن ۾ غذايت جي ڪمي جي سببن جي باري ۾ توهان ڇا‬
‫ڄاڻ رکو ٿا؟ عورتن ۾ رت جي ڪمي جي باري ۾ توهان ڇا‬
‫ڄاڻ رکو ٿا‬
5. What do you think about government ‫ توهانجي ڄاڻ مطابق گورنمينٽ جون اسپتالون ما ُء ۽ ٻار‬.5
‫جي غذائي ضرورتن متعلق ڪهڙيون خدمتون ڏين ٿا؟‬
health services regarding mother and
‫ ڪهڙيون مشڪالتون آهن ۽ انهن جا ڪهڙا حل آهن؟‬
child nutrition in your area?
Probe:
 What are the challenges? What are the
possible solutions?
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6. Do you feel that the community (men & ‫ توهانجي خيال ۾ توهانجي ڳوٺ ۾ مردن ۽ عورتن کي‬.6
women) have sufficient information on ‫عورت جي حمل دوران ۽ ٻار کي کير پيارڻ دوران غذائي‬
‫ضرورتن متعلق مناسب معلومات آهي؟‬
health and nutrition of mother and child
during pregnancy and breast feeding
period?
7. Do you feel that the females get due care ‫ ڇا حمل دوران ۽ ٻار کي کير پيارڻ دوران عورتن جي‬.7
.‫غذائي ضرورتون پوريون ڪيون وڃن ٿيون‬
during pregnancy and breast feeding period?
8. Child Care - Who decides on getting medical
help when child is sick?
‫ ننڍن ٻارن جي عالج الءِ ڪير فيصلو ڪندو آهي‬.1
9. What role is being played by social ِ‫ ٺٽي ضلعي ۾ صحت جي مسئلن کي حل ڪرڻ الء‬.9
activists/Religious Leader/ Doctors / Health ‫ ليڊي هليٿ‬/‫ ڊاڪٽر‬/‫ مذهبي اڳواڻ‬/‫سماجي ڪارڪن‬
Practitioners /LHVs/LHWs TBAs in increasing ‫ دائيون معاشري ۾ صحت جي‬/ ‫وزيٽرس ۽ ورڪرس‬
.‫باري ۾ ڄاڻ ڪهڙي طريقي سان ڦهالئي رهيا آهن‬
awareness and community mobilization to
combat the health problem in rural
community in district Thatta?
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Market Survey - Interview Checklist with Retailor/wholesaler
Name of Respondent:
Village/city:
Tehsil:
Date:
Start time:
Name of Interviewer:
Verbal consent obtained? Yes/No
Type of Business:
UC:
District:
End time:
Introduction (must be completed by Facilitators before beginning the discussion)
We are conducting research study on behalf of Merlin to Design nutrition BCC Framework /
Strategy in District Thatta, Sindh Province. We are going to have a conversation about child
care and feeding practices and behavior of the community. It is important that we discuss this
topic as honestly as we can so that the appropriate interventions can be planned to improve
the health status of our children.
The discussion will take between 30 and 40 minutes depending on your interest and
participation. Any information that you provide will be kept strictly confidential and will not
be shown to other people. The information that you provide during the discussion will be
presented together with answers from other participants so that you cannot be identified.
The discussion is voluntary and you are free to choose not to answer any or all of the
questions, or to leave the discussion at any time.
5. When did you start your trading business?
6. Please list below, the important items being sold by you?
7. Please indicate the three most important products most commonly purchased by the
customers?
8. Do you sell baby food items such as infant formula, fortified food items etc.? If yes, please
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indicate their demand and sales trends. If No, why?
9. Merlin is considering the conditional cash grants to poor people to enable them to purchase
nutrient rich food items for mother and child. Will you be willing to become certified seller for
selected items? If yes, in what time you can arrange those items?
10. Have you worked before with any aid agency as their certified seller? If yes, indicate name of
org and focus area of that project? If No, will you be willing to join a nutrition based project
with provision of nutrient rich food items?
11. On an average how many customers are served by you on daily basis?
12. What type of food customer’s demand for women (during pregnancy and lactating period) and
children (during 0-24 months)? Which ones? Please share reasons?
General Comments
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FOCUS GROUP DISCUSSION
Women - (mothers-in-law and women of reproductive age (15-49 years)
Village:
Tehsil:
Number of participants:
Date:
Start time:
Research team information
Name of Group Facilitator:
Name of note-taker:
Verbal consent obtained? Yes/No
UC:
District:
End time:
Introduction (must be completed by Facilitators before beginning the discussion)
We are conducting research study on behalf of Merlin to Design nutrition BCC Framework /
Strategy in District Thatta, Sindh Province. I’m going to ask you some questions about how you
care for and feed your baby, as well as what you know about infant feeding and from where
get the information on child care.
The discussion will take between 30 and 40 minutes depending on your interest and
participation. Any information that you provide will be kept strictly confidential and will not
be shown to other people. The information that you provide during the discussion will be
presented together with answers from other participants so that you cannot be identified.
The discussion is voluntary and you are free to choose not to answer any or all of the
questions, or to leave the discussion at any time.
List of participants
s.#
Name
1.
Age
Occupation
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12
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13. How is the diet of women in this
community?
Probe
 During pregnancy, lactating period and a
common woman
 Is it usual diet? Less? More? Why?
 Do women eat gutka, chhalia, or met?
Why? Is it fine to eat these things
during pregnancy?
 Do you suppose that eating more during
pregnancy can cause problems during
delivery? How?
2. What do you think are the causes of anemia
in women during pregnancy?
Probe
 Do they really think women get anemic
during pregnancy? If yes, how?
 What do women usually do if they get
anemic? Why?
‫ توهانجي ڳوٺ ۾ عورتن جي کاڌخوراڪ ڪيئن آهي‬.1
ِ‫عام ڏينهن ۾ حمل دوران ۽ ٻار جي پيدائش کانپوء‬
‫عورت جي خوراڪ ڪيئن هوندي آهي‬
‫اها خوراڪ معمول مطابق هوندي آهي يا گهٽ وڌ‬
‫ ڇو؟‬.‫هوندي آهي‬
‫ سپاري‬،‫پان‬،‫ڇا توهان جي ڳوٺ جو عورتون گٽڪو‬
‫ڇو؟ ڇا حمل دوران هي‬.‫۽ ميٽ وغيره کائين ٿيون‬
‫شيون کائي سگهجن ٿيون‬
‫ڇا توهان سمجهو ٿا ته حمل دوران گهڻو کاڌو کائڻ‬
‫ ڪيئن؟‬.‫سان ويم ۾ تڪليف ٿيندي‬




‫ توهان جي خيال ۾ حمل دوران عورتن ۾ خون جي ڪمي‬.2
‫جا ڇا اسباب آهن‬
‫ ڇا توهان سمجهو ٿا ته حمل دوران عورتن ۾ خون‬
‫ ها ته ڪيئن؟‬.‫جي ڪمي ٿيندي آهي‬
‫ جيڪڏهن عورتن ۾ خون جي ڪمي ٿيندي آهي ته‬
‫ ۽ ڇو؟‬.‫ڇا ڪنديون آهن‬
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3. Do women give colostrum to the baby?
Probe
 Are they aware of benefits of
colostrum?
 Do women discard it? Why?
 When is the baby first breastfed after
delivery? Why?
‫ ڇا عورتون ٻار کي پنهنجو پهريون کير (پس) ڏينديون آهن‬.3
‫ ڇا عورتن کي پهرين کير جي فائدن جي خبر آهي‬
‫ ڇو؟‬.‫ ڇا عورتون پنهنجو پهريون کير ضايع ڪنديون آهن‬
‫ ويم کان پوءِ ڪيتري دير کانپوءِ ٻار کي پهريون کيرڏنو‬
‫ ڇو؟‬.‫ويندو آهي‬
4. Do they give pre-lacteal feeds to the
baby?
Probe
 What pre-lacteal feeds are given?
Why? How long are they given?
‫ ما ُء جي کير کان پهريان ڇا ٻار کي ٻي ڪا خوراڪ ڏني‬.2
‫ويندي آهي‬
‫عرصي‬
‫ڪيتري‬
‫ڇو؟‬
.‫آهي‬
‫ويندي‬
‫ڏني‬
‫خوراڪ‬
‫ ڪهڙي‬
ِ‫الء‬
‫ ڇا عورتون ڇهن مهينن تائين صرف ۽ صرف ما ُء جو‬.5
‫کيرپيارينديون آهن‬
‫ ڇا عورتن کي خبر آهي ته ڇهن مهينن تائين صرف ۽‬
‫صرف ما ُء جو کير پيارجي‬
exclusive
‫ ڇو؟‬.‫ ڪيترو ٽائيم‬
5. Do women exclusive breastfeeding?
Probe
 Do they know
breastfeeding is?
 How long? Why?
what
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6. Do women bottle-feed the baby?
Probe
 Why? How long?
7. Which salt do you use?.
Probe
 Do they know about iodized salt?
 Do they use iodized salt?
 If no – why?
 Probe if there is any perception in the
community that iodized salt is a birth
control salt
‫ڇا عورتون ٻار کي بوتل ۾ کير پيارينديون آهن‬
 ‫ ڪيتري ٽائيم تائين؟‬.‫ڇو‬




.6
‫ ڪهڙو لوڻ استعمال ڪندا آهيو‬.7
‫ڇا توهان کي آيوڊين مليل لوڻ جي خبر آهي‬
.‫ڇا توهان آيوڊين وارو لوڻ استعمال ڪندا آهيو‬
‫جي نه ته ڇونه؟‬
‫آيوڊين لوڻ جي باري ۾ ڳوٺاڻن جو ڇا تاثر آهي‬
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‫ ڇا توهان سمجهو ٿا ته ڇوڪري ۽ ڇوڪري َء جون کاڌي‬.1
8. Do you think baby boys and baby girls have
‫جون ضروريات مختلف آهن‬
different feeding needs?
Probe
‫ ڇا عورتون ڇوڪرن کي ڇوڪرين کان وڌيڪ پنهنجو‬
 Do women breastfeed & Complementary ‫ يا ڇوڪرين کي ڇوڪرن‬.‫کير يا ٻي ڪا غذا ڏينديون آهن‬
‫ ڇو؟‬.‫کان وڌيڪ ڏينديون آهن‬
feed more to boys than girls? Or more
to girls than boys? Why?
9. Have you attended any health education
session before?
Probe
 When, where and by which org
organized?
 What were key learning areas of the
sessions?
‫ ڇا توهان صحت جي باري ۾ پهرين ڪا معلوماتي تربيت‬.9
‫ورتي آهي‬
‫ ڪٿي ۽ ڪهڙي اداري جي طرفان‬،‫ ڪڏهن‬
‫ ڇا جي متعلق توهان کي ڄاڻ ملي‬
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‫ ڇا جيڪڏهن توهان کي اهڙي تربيت ڏني وڃي ته توهان ان‬.11
10. Will you attend health education
‫۾ حصو وٺندو‬
sessions, if given here?
Probe
‫ ڇو؟ ڇا توهان سمجهو ٿا ته اها توهان جي الءِ فائديمند‬
‫هوندي‬
 Why? Do you think these will be
useful?
11. Who decides on your nutrition & health
care needs during pregnancy and
lactating period?
Probe
 Do
women
understand
their
nutritional needs during pregnancy
or lactation period?
 Do husbands understand nutritional
needs of pregnant/lactating women?
12. What do you know about malnourishment
Probe
 How you recognize a malnourished child?
 What to do if the child becomes

‫ حمل دوران ۽ حمل کان پوءِ توهان جي صحت ۽ خوراڪ‬.11
‫جي باري ۾ ڪير فيصلو ڪندو آهي‬
‫ ڇا عورتن کي خبر آهي ته انهن جون حمل دوارن ۽‬
‫حمل کان پوءِ غذائي ضرورتون ڪهڙيون آهن‬
ِ‫ ڇا مڙسن کي عورتن جي حمل دوران يا حمل کان پوء‬
‫غذائي ضرورتن جي خبر آهي‬
‫ ? غذايت جي ڪمي(ڪمزوري) جي باري ۾ توهان ڇا ٿا ڄاڻو‬.12
‫توهان ڪمزور يا غذايت جي ڪمي جو شڪار ٻار کي ڪيئن‬
‫سڃاڻيندو‬
‫جيڪڏهن ٻار غذايت جي ڪمي جو شڪار يا ڪمزور ٿي‬
‫وڃي ته توهان ڇا ڪندا آهيو‬
malnourished?
‫آهيو‬
‫ڪندا‬
‫پوريون‬
‫ڪيئن‬
‫ضرورتون‬
‫اهڙي ٻار جون غذائي‬
What nutritional needs are fulfilled if a
child is malnourished?
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13. Media habits and access to child care
information
Probe
 What media sources they have access to?
Do women have access to radio, TV or any
other available media source?

Which radio/TV program do you listen
to/watch? How many hours do they listen
to/watch radio/TV?

Do you listen any program related to child
health?

What more information do you want to get
on child health and nutrition care?
‫ صحت جي باري ۾ معلومات تائين رسائي‬.13
‫ ڇا‬.‫توهان وٽ معلومات جا ڪهڙا مواصالتي ذريعا آهن‬
‫عورتون ريڊيوٻڌنديون ۽ ٽي وي ڏسنديون آهن‬
‫ريڊيو يا ٽي وي تي ڪهڙو پروگرام ٻڌنديون يا ڏسنديون‬
‫آهن ۽ ڪيترا ڪالڪ‬
‫ٻار جي صحت جي متعلق ڪو پروگرام ٻڌنديون يا‬
.‫ڏسنديون آهن‬
‫ٻار جي صحت ۽ غذا جي باري ۾ توهان کي ٻي ڪهڙي‬
‫معلومات کپي‬
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10. How to change the behavior of community ‫ معاشري ۾ ما ُء ۽ ٻار جي صحت جي باري ۾ رويا ڪيئن‬.9
‫تبديل ڪندا‬
for better health care of women and child?
‫ ڪوشش ڪري اهڙيون تجويزون وٺو ته اها تبديلي‬
 Try to get suggestions in line with ‫ڪهڙ‬
ِ
Community
involvement,
Economic ‫ صحت جي‬،‫ جهڙوڪ؛ معاشي بهبود‬.‫طريقي سان اچي‬
‫ڄاڻ ۽ ميڊيا جي ذريعي‬
empowerment, Health awareness sessions,
Role of media etc.
‫ريمارڪس‬
General Observations of the interviewer
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11. Bibliography
National Nutrition Survey. (2011).. Ministry of Health.
Ngalawa, E. W. (2008). Determinants of Child Nutrition in Malawi. South African Journal of Economics,
76(4), 628-640.
S. Linnemayr, H. A. (2008). Determinants of Malnutrition in Senegal: Household, Community Variables,
and their Interaction. Economics and Human Biology, 6(2), 252-263.
W. L. Cheah, W. W.-H. (2009). A Structural Equation Model of the Determinants of Malnutrition among
Children in Rural Kelantan, Malaysia. The International Electronic Journal of Rural and Remote
Health, 10, 1248.
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