Gaps, Barriers and Opportunities Related to Infant and Young Child Feeding Content (IYCF) Across CARE Staff (Regional Outreach officer, Block Coordinator, Health Sub Center Meeting Facilitators) and Auxiliary Nurse Midwife in Bihar, India Open Access

Jivani, Saiza Firoz (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/j098zb27w?locale=en
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Abstract

Introduction: In Bihar, child under nutrition is a major public health concern as, 56% are stunted, 27% are wasted, and 56% are underweight. Timely initiation and age appropriate complementary feeding helps ensure proper growth and development of children. Although improving complementary feeding amongst children between the ages 6 and 24 months is critical to improve child nutrition, progress has been slow. CARE-India has launched an Integrated Family Health Initiative (IFHI) program (2011-present) to improve maternal and child health in Bihar. One of the aims of this program is to improve the capacity of community Front Line Workers (FLW) through enhanced training and job aids to facilitate effective IYCF counseling for families.

Objective: This study aimed to assess gaps, barriers and opportunities related to IFHI program to improve child nutrition in Bihar.

Methods: 44 in-depth interviews were conducted with CARE members, including Regional Outreach Officers, Block Coordinators and Health Sub Center Facilitators, Auxiliary Nurse Midwives, FLWs and beneficiaries to gain individual perspectives of IYCF content and program delivery related to complementary feeding in Bihar, India. The data were analyzed using systematic coding and thematic analysis approach.

Results: Numerous gaps and barriers are observed in the delivery and practice of IYCF recommendations. The barriers include poverty, certain cultural and religious practices, misconceptions on feeding practices, discrepancy in knowledge of complementary feeding among CARE staff and FLWs, lack of use of job aid kit, and lack of motivation among FLWs. Also, at the HSC meetings, lack of available infrastructure and resources pose barriers to effectively communicate complementary feeding messages to the FLWs.

Discussion: Complementary feeding was introduced at the HSC meetings 6 months prior to conducting the interviews, and in a short time, awareness about complementary feeding counseling had spread across CARE staff, ANMs and FLWs. However, several gaps remain to be filled to improve the effectiveness of complementary feeding training and counseling. Recommendations to improve the CARE IFHI program include emphasizing the importance of the job aid kit, explaining the long term benefits of complementary feeding, passing consistent and well defined messages to all program implementers, and providing incentives to FLWs.

Table of Contents

TABLE OF CONTENTS
CHAPTER I - INTRODUCTION AND LITERATURE REVIEW ...........................1
Rationale .......................................................................................1
Purpose of the Study .......................................................................4
Research Question ...........................................................................5
Objectives .....................................................................................5
CARE IFHI Program Background ..........................................................6
Significance of the Study ................................................................12
CHAPTER II - METHODS ..................................................................13
Study Design ................................................................................13
Timeline .......................................................................................13
Selection of Research Sites .............................................................14
Study Population and Sample Size ....................................................15
Design Research Tools ....................................................................18
Identification and Recruitment of Participants .....................................18
Data Analysis ...............................................................................20
CHAPTER III - RESULTS ..................................................................21
OBJECTIVE 1 ................................................................................21
OBJECTIVE 2 ................................................................................27
OBJECTIVE 3 ................................................................................46
OBJECTIVE 4 ................................................................................51
Chapter IV - DISCUSSION ...............................................................78
Lack of Prioritization to Complementary Feeding...................................78
Prevention is better than Cure .........................................................79
Immediate Results .........................................................................80
Communicated Message .................................................................81
HSC Meetings ..............................................................................82
ANM Leading HSC Meetings ............................................................83
Job Aids ......................................................................................84
Content Delivery to Households .......................................................87
Lack of Motivation ........................................................................87
Vegetarian and Non-Vegetarian Food ...............................................88
Annaprasana ...............................................................................88
Hand Washing .............................................................................89
Self-Sustainability ........................................................................90
Future Studies .............................................................................91
Research Limitations .....................................................................93
Research Strengths ......................................................................94
Conclusion ................................................................................. 95
REFERENCES ...............................................................................99
APPENDICES ..............................................................................102
Tool 1: In-Depth Interview Guide for ROO and BC .............................102
Tool 2: In-Depth Interview Guide for HSC Facilitator .........................112
Tool 3: In-Depth Interview Guide for ANM .......................................120
Tool 4: In-Depth Interview Guide for FLWs (AWW and ASHA) .............133
Tool 5: In-Depth Interview Guide for Households (HH)........................144

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