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Promoting Local Nutrition Solutions

Our idea is a nutrition campaign in Kampala and Central Uganda tackling increasing childhood stunting and wasting by helping mothers and caretakers through food demonstrations and health education to make a two legume—one cereal blend for their children from 6 months to 2 years—the most critical age for child growth faltering due to malnutrition. The campaign shall engage the Village Health Team members, local council leaders, mothers and fathers to influence knowledge, attitudes and practices on preparing and feeding children with a two legume—one cereal blend. We will use megaphones, radio, SMS and video to reach mothers and caretakers. We will partner with a local industry producing pre-cooked bean sauce to time and fuel constraints

Photo of International Youth Empowerment Network

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Key learnings and insights from the implementation research (Updated Dec.30)
 
  • Mothers seem to have a wrong perception that they cannot feed children variety of the usual family diet. This could be an issue of not having sufficient knowledge and skills to make balanced complementary meals for their children out of available family foods. Mothers would love to feed their children on a variety  of good quality food such as milk, eggs, Irish potatoes, fish, beef[soup], avocado, pawpaw, pumpkin, margarine, soya porridge, etc. so that they grow into smarter children and adults in future. However, mothers complained of how expensive it is for them to acquire such food for children—they cannot afford to buy for instance milk, eggs, beef, fruits and vegetables so they settle for what they can afford such as cassava, sweet potatoes, rice, posho, beans.  The food for children could actually be cheaper but because it is often bought as family food it appears expensive for the mothers. Hence, these mothers could benefit from training on how to plan and budget for complementary food for children. They could also benefit from home gardening where they are trained how to grow own fresh vegetables using the available space within their compounds.
 
  • Mothers are concerned about how expensive it is to feed children and they provided an estimated cost of UGX. 29,000 (USD.11) as weekly expense on food for children. The recipes we intend to develop and promote among mothers and caretakers shall be affordable for all mothers and caretakers and within UGX. 29,000 or less per week.
 
  • We should attempt to show mothers better methods of preparing food that are cost effective and save time. This includes steaming food, precooked bean and groundnut sauce, teaching them hygiene so they avoid cross contamination of the food. The mothers have attempted to cook food (such as beans and peas) in large quantities in order to save their time and fuel but because they do not have storage facilities and/or do not know how to keep it safe, the cooked food gets spoilt.
 
  • Some mothers reported their children not liking to eat food especially vegetables. This could be as result of mothers lacking the skills to actively engage children so that they can enjoy their complementary foods and eat it freely without being forced. Our project will train mothers and caretakers about active feeding and interacting with children as they eat so that the children enjoy the right amount of safe and nutrient dense food the right number of times each day.
 
  • Mothers have faith in VHTs at community level and health workers at health facility level. Thus passing information about nutrition through these VHTs at community level and health workers in health centres would ensure that it is got and followed. 
 
  • Mothers consider consulting fathers about feeding and health of the children so it would be wise to empower fathers with nutrition information and skills (such as interacting and playing with their children, setting up and maintaining vegetable gardens) so that they can support the mothers.
 
  • Mothers feed their children of age 6 months to 2 years twice or thrice a day according to the meal schedule of the whole family. Given that children of this age group need special complementary food that is given to them more frequently up to four times a day, we propose to sensitize mothers and caretakers about the right frequency of feeding children a day.
 
  • There is no special preparation of food for the children mostly because mothers and caretakers don’t have the knowledge on how best to prepare balanced meals for children of age 6 months to 2 years. Children eat on the food prepared for the rest of the family; this might result in children not eating enough, not eating on time, and eating fewer times because usually the rest of the family has lunch and supper. We propose to work with VHTs to teach mothers and caretakers about the correct complementary feeding recipes and to conduct cooking and food demonstrations at community level for mothers and caretakers.
 
  • Mothers and caretakers would love to prepare a blend of two legumes and a cereal for their children but they complain that it takes a lot of time and fuel to do it. We will teach them how to use appropriate techniques that save time and fuel such as soaking the beans and peeling off the testa, grinding or pounding beans before cooking, adding salt to beans to reduce cooking time, energy saving stoves, use of pre-cooked blends of beans and groundnut.
 
  • Men/fathers are seen as being less involved in child care in most places in Uganda. Whereas this is seen as the case, the leaders interviewed expressed concern about the worsening child care practices currently. This showed fathers could have a great role in child nutrition if only they are directly engaged in the programs. The men in peri-urban and rural areas give their spouses money for purchasing food and the spouses prioritize what food to buy out of the money given. The priority does not include fruits and vegetables. For this campaign, we propose to directly involve fathers as active stakeholders to support child nutrition by doing what is appropriate and interesting to them such as supervising feeding of children, maintaining hygiene and sanitation, actively interacting and playing with the children, vegetable gardening, helping mothers better budget for complementary foods, etc.




Justification for carrying out the intervention in Central and Kampala regions:
  • We are focussing on the central region which is ought to be the host of the capital city Kampala and also one of the richest regions in Uganda. Despite that, the rates of stunting are at 32.5%, 36%, 13.5% in Central 1, Central 2, Kampala respectively and wasting levels are 5.8%, 5.3%, 4.4% in Central 1, Central 2, Kampala respectively which are slightly higher than the national average of 33.4% and 4.7% respectively. This is brought about by the poor complementary feeding practices characterised by mainly offering only one food type (Irish potatoes or light porridge) to the children, this is also worsened by the poor caring capacities of the parents who are mostly working away from homes and leave the children in the hands of the housemaids. 

 

Synthesis of interactions with caretakers in the villages of Sebowa, Balintuma and Kiwologoma in Kiwatule parish, Kampala district and Kira parish, Wakiso district
  • See the attachment for the findings from the interviews and discussions conducted in October-November 2014 
  • See attachment for the research tool used to collect data.

 
Lots of cereals and legumes, very little of animal based diets: 
  • We want to help address the challenge of mothers and caregivers failing to provide high quality protein and micronutrient rich diets for their rapidly growing children of age 6 months and above.
  • Diets of Ugandan children like other developing countries are predominantly plant based with very limited animal sources.
  • Despite the fact that mothers and caretakers cannot afford animal based diets for their children, program planners continue to tell caretakers to add animal based diets for the children. This is not practical for over 90 percent of the population in developing countries with low incomes.
  • Research shows that by adding two legumes to a cereal based diet, one can highly improve the quality of food given to children by completing the amino acid profile of these foods; cereals are deficient in lysine and tryptophan, but provide adequate amounts of methionine and cysteine; yet the amino acid profile of leguminous seeds is considered a rich source of lysine but it is quite deficient in methionine and cysteine, so, combining cereals and leguminous seeds can increase the quality of protein in children’s food.
  • As change agents we need to get more practical in how we want to support caretakers to address the issue of inappropriate complementary feeding especially dietary diversity.
 
We want to get everyone acting and to use what they have to make sure each child enjoys quality meals each day:
  • We have more than 50 different food stuffs in Uganda, which when used appropriately can greatly improve the quality of diet for the rapidly growing children of age 6-23 months
  • Supporting caretakers obtain the necessary knowledge, skills and attitudes would make a difference in how these readily available foods could be better used for improved quality of diets for chuldren
  • By making each caretaker know they can achieve quality diet by appropriately mixing up one cereal and two legumes to provide a wholesome meal to their children, we will create a mass of charged country women and men determined to use abundantly available cereals and legumes to help their children thrive
  • All we need to do is to educate and help our mothers understand how they can prepare such dishes and serve them to their children using the available local resources.
  • This is a low cost, less demanding and possibly highly acceptable intervention across the country.
  • Mothers and caregivers need to understand that they don’t need to read a lot about nutrition or even get over whelmed with the new feeding habits for them to provide the best for their children.
  • In Uganda we learn our feeding practices from mom, dad, grandma or grandpa.We don’t even need to import apples from New Zealand, cucumber from Canada for us to get the vitamins and minerals, we just need to cook the beans, mix them with groundnut paste and the child with rice or millet bread at least twice a day  and the child will grow so healthy throughout childhood and remain a productive citizen at adulthood.

Why this idea will succeed:
  • Uganda is blessed by nature and is very rich with different kinds of legumes and cereals.
  • Parents and caretakers are all concerned about how best to provide their children with high quality and affordable diets. Hence, they would welcome this idea with open arms.
  • World Health Organization, development partners, Ministry of Health, districts and community members are now focused on promoting complementary feeding practices for their children. Therefore, there is already an opportunity to pitch the campaign.
  • Mass media is also already charged and are looking for marketable ideas to sell to their readers or digital audience.
  • Overall, because this intervention uses what is already available, is very specific and cuts across the country,the likelihood of it being taken up and succeeding is very high.

Who will benefit from this idea and where are they located?

Mothers and caretakers for children of 6 months to 2 years; village health teams and health workers as they will not have many cases of undernourished children to manage and will use their time for other productive activities; entire community and ministry of health (Updated Dec.29)

How could you test this idea in a quick and low-cost way right now?

We will hold discussions and interviews with parents, health workers, community volunteers, local leaders and other influencers in communities to answer the questions we have outlined above. This will be used to help us understand how best to support caretakers to use two legumes and one cereal meals for their children. Following the interviews with the mothers, fathers, village health teams and local leaders, we will hold recipe development and cooking demonstration prototype with mothers and fathers in Sebowa zone to help us refine findings obtained from the interviews. We will collaborate with parents and other community members to prioritize actions to get every parent giving their children of age 6 months up to 2 years complementary diets based on at least two legumes and a cereal at least three times a day. Lastly, we will actively monitor uptake of the practice, learn from it, adapt and improve the strategy used (updated Dec.29).

What kind of help would you need to make your idea real?

We welcome technical support from this community and are also open to partnerships to make the idea real.

Is this an idea that you or your organization would like to take forward?

  • Yes. I am ready and interested in testing this idea and making it real in my community.

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Photo of Caitlin O'Donnell
Team

Hi!! I am currently working in Kampala for an organization called Suubi House. It works with families with special needs kids hoping to support them, educate them, and improve their quality of life. This Saturday we are hosting a "family fun day" and one of the components of the schedule is teaching the parents and caretakers about nutrition. I came across your project and loved that you figured out a nutritionally complete diet that can work for their availability and budget. Do you have any teaching resources? I'd love to get more information about your project and hear about how you are implementing it! If you'd like, you can contact me at caitymo@vt.edu.

Photo of Bettina Fliegel
Team

Hi Caitlin.
It would be great if you can connect with YEN on the ground! I was one of their virtual team mates on this project. You can learn more about the ongoing project from this link, posted on the Impact page of this challenge: https://challenges.openideo.com/challenge/zero-to-five/impact/when-spiders-unite-they-can-tie-down-a-lion

Bettina

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