OpenIDEO is an open innovation platform. Join our global community to solve big challenges for social good. Sign Up / Login or Learn more

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

Written by

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.

144 comments

Join the conversation:

Comment
Spam
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.

Spam
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

Spam
Photo of Jéssica Casagrande
Team

Hey team! What a amazing idea! Why not give to the families seed so they can grow their own vegetables? Some of them grows really fast and the diet would be more balanced and cheap!

Spam
Photo of International Youth Empowerment Network
Team

Hey Jessica! Thank you for your kind feedback. Yes, we are planning on supporting the families with vegetable and fruit farming. With our agronomist, we are planning a demonstration this week to inspire the families to grow vegetables and fruits. We have set up mushroom, vegetable and chicken demos within our centre to use to practically train the families. We are hoping we can negotiate for land within some slums to help the community run urban vegetable and fruit farming too but this will take some time to establish as we build community trust.

Spam
Photo of Bettina Fliegel
Team

Hi all!
How about introducing sack gardening if there is a problem with land acquisition?
https://openideo.com/challenge/zero-to-five/research/sack-gardening-micro-farms-provide-nutrition-in-kenyan-slums
https://openideo.com/challenge/zero-to-five/ideas/lessons-from-grandmother-how-to-feed-my-child

Spam
Photo of International Youth Empowerment Network
Team

Hi Bettina!

Thank you for sharing the links. We plan to support them with Tyre, sack, bottle, etc gardening for now. The idea of the bigger land is for them to collectively work together and use the plot to teach others later on.

Spam
Photo of Taz Fear
Team

Hi All

Fantastic to hear that you plan to empower families and communities to become self-sustaining and grow their own food. Not only will this address the children and families nutritional needs and add seasonal variety to their diet but it can be done in a really cost-effective way from planting the seeds to crushing the plant. You have really considered the small detail to deliver as much cost reduction within families and communities as you can.

Can I just ask if any tools will be needed for home and community gardening and if so, will these be given out on loan or will you suggest common household items that can be used for gardening as an alternative?

Good luck!

Kindest regards

Tara Fear

Spam
Photo of International Youth Empowerment Network
Team

Thank you very much Taz,
About the tools, we are not giving any households new tools for gardening but rather they will use the available tools they already have. Remember it will be home gardening where they will use the available small land in their backyard or sack gardens as well as any other container that can hold soil to grow these vegetables.

Regards
Racheal Natumanya
community nutritionist-YEN

Spam
Photo of Afzal Habib
Team

Congratulations on being selected as a TOP IDEA! We @Kidogo are very excited to see how your project plays out and what menus are developed at the end of the day to balance nutrition and affordability for parents in East Africa.

In fact, we'd love to meet up with your team if you are in Nairobi anytime soon... we feed the children who attend our early childhood centres 2 meals per day (plus a snack) and would love to collaborate on our menu planning!

Feel free to reach out and connect! Congratulations again team!

Spam
Photo of International Youth Empowerment Network
Team

Hello Habib. Thank you for reaching out to us. We are more than happy to collaborate. Besides this idea, we are also running sustainable school feeding project which helps schools to better plan balanced meals and teach children gardening for increased school food productivity but for making learning fun.

We are based out in Kampala, Uganda. We are happy to have skype call. Please let's connect via email: yenuganda@gmail.com and get started with the conversation.

Spam
Photo of Bettina Fliegel
Team

Hi all.
Would be great to learn a bit from what you are currently doing at Kidago!
What age are the children in the Kidago day care centers? What are the meals and snacks you provide? are they prepared on site? do the centers have refrigerators on site?

IYEN - In what community are you running the school feeding project? Is it one of the communities where you will be doing the 2 Legumes, One Cereal project? Are these the same families? It would be a very comprehensive family program if these projects were running side by side.

Exciting to hear about this potential collaboration and cross cultural learning experience everyone!

Spam
Photo of Isadora Dantas
Team

Great idea! Information is the start of improvement. By teaching the mothers and so the entire family better ways to use their legumes and cereal could develop their creativity and open their mind to help them find different solutions to other problems in life besides feeding.

Spam
Photo of International Youth Empowerment Network
Team

Thank you Dantas for the encouragement.

Spam
Photo of Bettina Fliegel
Team

Congratulations IYEN and team! Exciting news. Looking forward to hearing what you have planned as next steps!
Bettina

Spam
Photo of International Youth Empowerment Network
Team

Thanks Bettina. We are working on the plan and will share it soonest. Congratulations.

Spam
Photo of International Youth Empowerment Network
Team

Congratulations team for having made it through! Let's continue with the commitment and move to the impact phase with more determination! Special thanks to Bettina, Richard and other members of this community for having actively guided us throughout. We are sure this is victory for children, men, women and leaders in low income areas in Kampala and Central Uganda whose dreams lie in balance because of acute malnutrition and stunting plus other preventable childhood illnesses!

Spam
Photo of Ayman Hanafi
Team

Hello team. Brilliant idea, if achievable. Early nutrition is vital for healthy bodies and being able to fight infections. Getting the fathers involved, providing them with the necessary cultivation skills to provide freshly grown foods for their families would be awesome. Thank you all.

Spam
Photo of International Youth Empowerment Network
Team

Thanks Ayman for appreciation. The idea is liked by the community and yesterday we had the mothers and fathers we worked with during the first prototype teach other community members about preparing these meals. We had an opportunity of Urban TV filming the demonstration and will air it on TV today as means of creating more awareness among caretakers (We will share the link once the feature is played on TV).

The mothers and fathers from the community liked the idea and continued to commit to using it to prepare meals for their children. Unlike the first day, this time they prepared multi-mix of rice, dodo (amaranthus), groundnut and beans. Children from the community enjoyed the meal and were left wanting more!

Spam
Photo of Bettina Fliegel
Team

Wow! That is so exciting that a local TV group filmed a demo. Would love to watch it!
(The link above is for a segment 3 weeks ago when I click on it. Can you check?
Does the segment have a name that we can search with?)

Spam
Photo of International Youth Empowerment Network
Team

Hello Bettina! They were to show the feature on TV yesterday night but unfortunately it was pushed forward to next Saturday. We will share the link and the footage once they are ready. Yes, we are excited about this partnership and could be a great way to get more caretakers doing something better regarding how they care for their children in Uganda.

Spam
Photo of Julian Marembo
Team

Nice work Team! I have one serious concern. Does the sauce for each meal strictly be a mixture of legumes? What are we really trying to achieve by mixing the two legumes?

In a country where people can hardly afford one meal a day, I think it's asking for too much to have a mixture. Most families have a large stock of one cereal, mostly maize or millet flour depending on the region. Therefore, in my opinion, it would be better if we advocated for change in sauce for each meal. Say if they eat peas at lunch, then they will have beans for supper. That way, the two legumes one cereal design still holds, is more practical and affordable for Ugandan families. Tell me what you think.

Spam
Photo of International Youth Empowerment Network
Team

Dear Julian! Appreciation for your feedback. As nutritionists and programmers we shared the same concerns as you do before we conducted this research and held prototype with the communities here. Actually we are trying to be very realistic in our approach and avoid making mistakes that technocrats have made before of imagining what works or what is needed and imposing it to clients. Yes, our research indicated communities worried about the cost of two legumes but when we demonstrated the quantities needed to make a daily mean for children, they realized it is affordable. If you follow the content of the idea and how it has evolved you realized the conversation we had with Dr Bettina last week concluded we will encourage those who can obtain one legume to make use of it but we will help them understand how to blend it to improve nutrient content. In short we are getting out there with an open mind and will learn from positive deviance too.
Note, we are promoting preparing meals for lunch and supper at once to save fuel and time for these mothers. Also note the meals will not be predominantly legumes day in day out, blending is key component to ensure balancing nutrients and taste is promoted.

I guess we are partly frustrated by the fact health experts keep talking of minimum acceptable diet, dietary diversity and frequency without digging deep to understand if they are achievable or not. Hence, we want to promote what is achievable and affordable as entry point to achieve minimum dietary diversity.

Please let's know what other thoughts you have in this regard.

Spam
Photo of International Youth Empowerment Network
Team

We are having partner engagement with engageSPARK https://start.engagespark.com/ for using their platform for mobile technology for sending out campaign messages and monitoring uptake of the education.

Spam
Photo of International Youth Empowerment Network
Team

We have uploaded draft daily menu for children 6 months to 2 years. Please check it out. Thanks!

Spam
Photo of The Mediae Company
Team

This is really useful. I think we need to have a conversation when we know we are going into production and fine-tune key information points to be included in programmes. Both Shamba Shape Up and Makutano Junction are broadcast in Uganda as well as Kenya, so the key information will be communicated in both countries.

Spam
Photo of International Youth Empowerment Network
Team

This would be awesome! Let's hope for the best. Thanks!

Spam
Photo of Bettina Fliegel
Team

Can you put up a comparison menu? A menu of what children 6 mo to 2 years are generally eating currently in the community you are working in?

What kind of juice are you recommending? Is it store bought or home made? If store bought is it expensive?

Spam
Photo of International Youth Empowerment Network
Team

Thank you Bettina the comparison menu is soon going to be uploaded. About the juice, we are recommending the home made since we are encouraging the households to have backyard gardens for fruits and vegetables but the juice sold in the store, 500ml goes for $.25.

Spam
Photo of International Youth Empowerment Network
Team

Hi Bettina! Thanks for the feedback. We have provided comparison menu based on the information we obtained from our research. We are recommending home made fresh juice. Thanks!

Spam
Photo of Bettina Fliegel
Team

Great! So easy to scan and compare!
When you present the 2 Legumes/One Cereal menu to end users will you include estimated costs based on your research? (sorry if this was already mentioned. I do not recall)

Spam
Photo of International Youth Empowerment Network
Team

Yes Bettina, it will include the cost. We are still working on it.

Spam
Photo of The Mediae Company
Team

This is so practical and really helpful. Thank you!

Spam
Photo of The Mediae Company
Team

I think we need to be in contact when we get to pre programme production stage so we can include vital information that you have identified, with regards to nutrition. I would think this will be sometime later this month/early February.

Spam
Photo of International Youth Empowerment Network
Team

Okay, we look forward to that time! One question: I understand you in Kenya and us in Uganda. How we will work out this partnership and which audience are we targeting?

Spam
Photo of International Youth Empowerment Network
Team

Hello colleagues, based on the feedback from Bettina we have uploaded updated videos of the prototype. We have uploaded document providing details of the prototype, insights we picked and how we made use of them to improve our idea (see attachment #1). Many thanks for continued feedback.

Spam
Photo of Bettina Fliegel
Team

The feedback and insights from the prototype is great! Awesome that you are adjusting the program at each stage based on learnings. I was reading up on makene. Interesting question that the mother asked regarding which was more nutritious, eating it whole or in powder form. Seems that parents have questions and that you are giving them a forum to ask them! From what I read makene is very nutritious. Have you considered visuals such as posters which illustrate the benefits of each of the complementary foods you are proposing?

I think it is great to aim for the top - 2 legumes and 1 cereal, however in the case that they cannot do it for whatever reason, adding 1 legume will also benefit their children. Can you incorporate this into your messaging? The same for the complementary feeding? "Whatever you can do is great? Small steps are great."

The communication campaign - Have you discussed the messaging with any mothers? Most mothers are doing the best that they can. They want the best for their children. You mentioned this in relation to how the fathers were so responsive to the food preparation demonstrations etc. Will mothers get the message that if they are not doing this they are "bad"? How about asking your own mothers what they think?
Thoughts?

Spam
Photo of International Youth Empowerment Network
Team

Thanks Bettina. Yes, Racheal is drafting guide with visuals illustrating the benefits of different complementary foods. This "Whatever you can do is great? Small steps are great" and we will incorporate it into the messages.

No we are yet to discuss messaging with the mothers as we focused the prototype on cooking. We are set to use positive framing and avoid negative one like 'bad' as it discourages mothers from adopting the required behaviours.

Spam
Photo of Bettina Fliegel
Team

Hi all. I did not think you would use a negative message or word. What I am wondering is if by stating "a good mother does........" some mothers might interpret this as being judged if they are not doing it, are not able to do it.
Does this make sense?

Spam
Photo of International Youth Empowerment Network
Team

Sorry Bettina for the confusion. Given your suggestions, we triangulate the proposed messages and get the feedback from the mothers on what they think of them.

Spam
Photo of Bettina Fliegel
Team

Hi everyone. No confusion - well maybe there was some - sometimes it is hard to understand everything on a screen.
It might be interesting to speak to mothers of different generations. They might have different perspectives. Older more experienced moms and grandmoms may have some insights into what motivated them over the years in regards to parenting, what guidance they had, who provided it, what they chose to follow and why. They may remember an advertising campaign that resonated with them and why.
Thoughts?

Spam
Photo of International Youth Empowerment Network
Team

Good advice. We will look into it when we are ready to test the draft messages. Thanks!

Spam
Photo of immy carols
Team

the idea is appreciable, I await its upshot!

Spam
Photo of International Youth Empowerment Network
Team

Thanks Immy!

Spam
Photo of David Citrin
Team

Great post and updates IYEN, have enjoyed following this. Particularly your user maps and the implementation research results you posted. I noticed respondents shared that there were often foods they would introduce as complementary, but socio-economic conditions are putative barriers here. Do you have M&E in place to track the up-take of these legume meals by user, which you could later stratify according to variable such as SES? I know that where I've conducted research dietary transition is interwoven into changing livelihood conditions. For example, as foodways become increasingly intertwined with cash, critical forms of exchange related to basic subsistence can take on new monetized forms. Here 'unconditional legume transfer' might be one way to think about this intervention. What are some other changing social and economic contexts that families in Kampala and Central Uganda where you work that might account for a shift in what people come to see as "good foods"?

Also, a listserv that may be of use for gathering continued feedback about your project is the Society for the Anthropology of Food and Nutrition (SAFN): http://foodanthro.com/2014/12/02/safn-at-aaa-2014-in-dc/

Spam
Photo of International Youth Empowerment Network
Team

Thanks David for the continued technical feedback. Yes our M&E plan has indicators for tracking uptake of the legumes but had not including stratification by SES beyond sex. Let's update this to include SES in the definitions of the indicators.
What we are seeing now days in Kampala and Central Uganda is the shift towards more convenient, quick to fix and less fuel consuming food stuff.

Thanks for the listserve. Let's explore how to engage with them. Do you have any suggestions of how we can engage with them now without being members?

Spam
Photo of David Citrin
Team

I imagine there may be a link to sign up on that site? to write the list, one posts to: SAFN@listserv.uic.edu, you might catch the moderator's attention there. In general, a very friendly/open email forum where folks regularly solicit advice on readings/resources, methodological frameworks, etc. An invitation to explore your idea on OpenIDEO and offer feedback would be welcome I'm sure! Thanks again, and will check in again soon!

Spam
Photo of International Youth Empowerment Network
Team

Thanks David. We have sent the e-mail inviting them to provide their technical feedback to help us refine the idea.

Spam
Photo of OpenIDEO
Team

Congrats on being the Featured Contribution of our Refinement phase (first feature of 2015!)

Spam
Photo of International Youth Empowerment Network
Team

Thank you OpenIDEO for featuring our contribution.

Spam
Photo of Maurizio Bricola
Team

Dear Alex, how are you? I hope this message finds you well. Thanks again for offering to test our prototypes with your community and consider to presenting it to your strategic partner. In the case you and YEN are still interested in giving a try to the labels we are designing, see my comment here: https://openideo.com/challenge/zero-to-five/ideas/modular-packaging-for-joyful-families-and-happy-children#c-daadf663bdd014fdba6fda243f0a36b3
please let me know, we can send you either a pdf, and you can then print the labels and then glue them to the pots, or the labels printed (if we had the sizes of your packaging).

I was reading your awesome post and I was impressed to read that "The average amount of money spent [on food] on each child per week is UGX. 29,000 (USD. 11). "
How many children on average? If we count 3 it comes 33 USD per week, if we add 2 parents it goes up to 55/60 USD, if we divide that for 7 is something like 8 USD per day. On the supermarket here I can buy 250grs of the most affordable white rice for 99cts, with 1.39euro I buy 1Kg of potatoes, with 89cts 400gr fresh tomatoes, with another 89cts about 500gr broccolis, with 1.20 I buy six eggs and with 1euro I can buy about 200grs of groundnuts. All this summed up makes it 6.36 euro (6.36*1.22 = 7.76 USD).

Cheers

Spam
Photo of International Youth Empowerment Network
Team

Hi Maurizio! Please send the pdf and we can print and glue the labels on the boxes!

Thanks for the computations.

Spam
Photo of Maurizio Bricola
Team

Dear YEN most welcome and thank you for your assistance. As soon as we are ready we will send the files to you. Thanks again!
Cheers

Spam
Photo of Maurizio Bricola
Team

Dear YEN we have the labels you can download them at the below links:

https://d3gxp3iknbs7bs.cloudfront.net/attachments/6eadd24f-6c6d-4003-b572-4e7feb967243.pdf

https://d3gxp3iknbs7bs.cloudfront.net/attachments/901c47f9-1fe7-4577-b6df-776135ec9a61.pdf

https://d3gxp3iknbs7bs.cloudfront.net/attachments/d9f89ede-2262-47b7-9d74-f03a4096bb39.pdf

https://d3gxp3iknbs7bs.cloudfront.net/attachments/4a4e7c4b-d6d7-41f3-9f77-a44dbe97688a.pdf

It would be great if you could make a short video about the parents-children interaction and capture few parents' impressions.
We are really curious and excited to know how it will go, please consider to invite as observers the private company you were thinking to collaborate with so they might buy-in from the start.
Thanks a million!
Cheers

Spam
Photo of Bettina Fliegel
Team

So exciting!!!

Spam
Photo of Maurizio Bricola
Team

Hi a small update, we have also the labels for the pots' covers you can find them here: https://d3gxp3iknbs7bs.cloudfront.net/attachments/a4ee4325-6e51-4d02-aa9c-5903bd6885aa.pdf

The language is English and Chichewa in this case, feel free to translated in your own.

It would be lovely to hear if you have been able to use the labels. Thanks!
Cheers

Spam
Photo of Bettina Fliegel
Team

Hi all! Great updates and iterations based on your field research.

Regarding your plan to teach and inform -
You mentioned earlier in your postings/I believe it was a comment from Alex - that there is geographical location in Uganda where families are currently feeding children legumes - Was it Northern Uganda? Would it be possible to make a journey there to see what they are doing and how they are doing it? Or to contact someone in that region - ??? Not sure where to start in that case.....What is the local knowledge there that allows them to do this as a community? Finding best practices within the communities will help you to build a program that the community will sustain, engaging locals so that they can come up with their own solutions, through your facilitation and guidance.
Check out this article which describes a nutrition project in Vietnam. It is a case study on malnutrition there in which outsiders found a group of local families which had healthy, normal weight children. It mentions that they were doing things differently than other families and some of those things were thought to be wrong by the majority of the population. Some of the things they were doing are things you plan to initiate.
Once they found these "positive deviants" within these communities they then organized the community to learn from what they found. This effort included cooking with neighbors, practicing, reinforcing behaviour change. It is fascinating and I think can help you think about next steps on the local level.
http://opinionator.blogs.nytimes.com/2013/02/27/when-deviants-do-good/

What do you mean when you mention recipes? Small children can eat the food plain. One thing I would add is that I often told moms with small babies/infants that they can mix two foods together if the child did not really adjust to the taste of one food initially. Perhaps mixing a vegetable into the mashed beans, or cereal, will work better than giving the vegetable alone. Also with infants it is often the textures of foods that they are not familiar with that they initially reject. Encouraging a parent to wait a few weeks and try again is a great approach.

Regarding the prepared foods - Some prepared foods are very high in sodium content. What are the additives/ingredients in the products you are speaking of?

Involvement of fathers - Great idea. Can the key influencers of men in this community join your campaign in some way to help elicit this?

The campaign itself and messaging - I will read through the PDF files and post feedback on that. What visuals do you plan to include? In the US we have the "food pyramid" and "plate" which is a visual using colors. It might be very helpful to have a visual of a plate? bowl? whatever families use to feed their small children from - that is subdivided by color. So a circle with 4 parts - one white/light yellow for the cereal/day, two brown/tan/red for the beans - and one portion green or green plus bright yellow/organge - whatever colors the fruits are there. Something simple that shows parents what to aim for in terms of how to proportion these food groups each day for the young children. (How to divide this will be based on your plan - seems like 1 cereal/ 2 legumes and ? if you are including the vegs/fruits / day. I think you are based on the above.) Anyway - a strong simple colorful visual can be very helpful.

SOME REFERENCES:
Things to think about and use as references for inspiration.

http://kidshealth.org/parent/nutrition_center/healthy_eating/myplate.html#cat20738 (written for parents)

http://kidshealth.org/kid/nutrition/food/pyramid.html#cat20738 (written for chldren)

http://www.choosemyplate.gov/kids/index.html

A poster on eating ... "When Money Is Tight" -
http://www.choosemyplate.gov/budget/downloads/EatRightWhenMoneysTight.pdf

positivedeviance.org
http://www.ssireview.org/articles/entry/design_thinking_for_social_innovation (article on Social Innovation in Design - design thinking and also references the case study in Vietnam/positive deviants - Meena shared this article with me during the Women's Safety Challenge.... passing it on!)

Will be in touch!

Spam
Photo of International Youth Empowerment Network
Team

Thank you Bettina. These are great insights. Here is our feedback:

Yes, northern parts of Uganda depend a lot on meals that contain mixtures of two legumes and cereals. Unfortunately, we currently do not have resources to facilitate our travel to the region. However, we have consulted with few friends from the north who are living in Kampala to share insights on preparing such food. We have included the commonly used recipes in northern Uganda in our draft recipes so we are covered for now. Since there are many northerners living in Kampala and other parts of central region, we will engage them more in later stage.

By recipe, we mean a stepwise description of how to prepare complementary foods for children of age six months to two years using list of food ingredients such as beans, peas, maize flour, vegetables, etc.

Yes, we are promoting blending or mixing vegetables to beans/groundnut and one cereal rather than giving it directly to children alone.

There are no additives in this instant bean sauce that we have proposed to promote among caretakers. It simply contains pre-cooked beans, groundnut and salt.

We learnt that men consider local council I chairpersons as influential to them. We have included Local council I chairpersons in the campaign.

We are planning to design simple coloured ‘complementary feed plate’ as teaching aid and cue to action for mothers and caretakers to provide right proportion of vegetables, fruits, grains/cereals and protein to children of age six months to two years. The design will take into consideration the local context so that we do not just adapt the American or European guide.

Yes, have taken positive deviance into consideration. We will identify community mothers who are already preparing blends of complementary foods we intend to promote and use them to teach others.

Spam
Photo of Bettina Fliegel
Team

Hi all. The photos are great.
The amount of food being prepared seems to be a lot. What is the common practice? If most women do not have refrigeration is food prepared in such large amounts daily?
Can women organize together and share cooking and food prep responsibilities? Sharing what they cook with each other? Taking turns as a time saving measure?

As you are onsite doing food prep and cooking demos this is a great opportunity to include WASH teachings. Will you include this in your efforts locally?
Excited to see the visuals you come up with as a teaching tool - re: "the plate". Of course local context is everything! Will you be working with local designers? How about menu plans that include general pricing? Any plans to create visuals of these?

As you identify women who are already preparing blends of complementary foods, or are using legumes in ways that are more efficient/easier to manage in terms of food prep time it would be great to learn more/hear their stories here.

Great follow up.

Spam
Photo of Bettina Fliegel
Team

Hi.
What language is being spoken in in the video? Is it possible to post a translation here in a comment so that we can understand the conversation? I would love to know what the questions were that parents were asking, in addition to the teachings etc.
Did this group of parents taste the blends? feed any of it to their children?
Will your promotional materials be bilingual?

(Part of the video is sideways. Any chance you can fix that?)

Spam
Photo of International Youth Empowerment Network
Team

Hi Bettina!

We used Luganda, the main local language spoken in Kampala and Central Uganda. We are putting together report that provides details of the discussions we had in the prototype.

Here are some of the questions the mothers and fathers asked:

1. How do you know if food is enough for the child?
2. How much do the precooked beans cost?
3. Which silver fish is more nutritious; the powdered one or the whole one?
4. How can we get the beans ready in the short time?
5. Can posho get ready when it is just steamed minus mingling?
6. How many servings are in one pack of precooked beans?
7. How much does the two legume one cereal cost?

Spam
Photo of Bettina Fliegel
Team

The parents are asking great questions! Are you creating an outline of your presentations as you do this prototyping ? keeping notes on what seems to be effective in terms of how you deliver the information and the demonstrations?

How are you determining what indicators to measure as you roll out this project?

Spam
Photo of International Youth Empowerment Network
Team

Hello Bettina. Thanks for the continued technical feedback. We are including WASH in the intervention. We have drafted indicators based on international WHO recommendations for complementary feeding. We have M&E members on the team who have worked with the nutritionists to draft this.

We have adjusted the video but it has failed to upload for the last two days. We will keep trying.

We are keeping notes from the prototype and are using them to refine the idea and user experience map.

We used locally popular techniques of using the palm to estimate amount of food sufficient for the child. This amount you see appears too much because it was simply for the demonstration. If you look at the photos, you will see Ronald holding food on his palm; he was demonstrating to mothers and fathers on how to measure sufficient food for their children.

By promoting steaming, we want mothers and caretakers to prepare food which is sufficient for lunch and supper so that they do not have to cook more than twice a day. So the trick is to use boxes/small saucepan with tight cover which can remain covered in the local steamer on small amount of fire to keep it warm until it is time to serve the child to eat again. This way they do not need to refrigerate the food.

We have Michael and Racheal who are part of our design team so they will support design the visuals and menus. However, we appreciate getting any links to US designers who are familiar with this kind of menu and my plate design to support if possible. Yes, we are trying to get prices that could go along with the menus.

Depending on resource availability, we plan to capture video stories and demonstrations from mothers who are already using this food preparation techniques. The videos could be shown to other mothers and caretakers as way of promoting the practice locally.

Thanks!

Spam
Photo of Bettina Fliegel
Team

Great insight on using one's palm to measure portion size for small children! (Washing hands with soap and clean water is so important! great that you are including WASH teachings.)

What is M & E?

I see you changed the title of the project. How did the group decide on the phrase "smart children" for the campaign? Was this something that came out of research?

Spam
Photo of International Youth Empowerment Network
Team

Hello Bettina. The palm is used mainly for raw food before it is washed as estimate of the right quantity for mothers who may not have spoons, jugs and cups. We do encourage washing hands before handling food as a must for mothers and other caretakers involved (see photos for example). Here is an extract of how palm is used to estimate ingredients for making multimixes or blends of complementary food:

-1 palm of dry beans (90g)
- 1 fist of mukene (60g)
- 3 fingers of matooke (300-500g)
- 1 pinch of salt
- ½ mug of water (250ml)

Mothers we interviewed desired to have successful children who perform well in school. Hence, we associated the title with emotional motivation mothers referred to..they want to have smart children and would do anything to achieve it.

M&E is monitoring and evaluation.

Thanks for the feedback!

Spam
Photo of Betul Salman
Team

great idea! i love it. how about maybe developing the idea of instead limiting it to 6 months to 2 year old expanding it to more older age? going to maybe up to 5 or 6 year old, i think they can still benefit form the cereal meal. so making this meal from 6 months to 5 year olds.

Spam
Photo of International Youth Empowerment Network
Team

Hello Salman. Appreciation for your feedback. Whereas the challenge is focused on children zero to five years, we are trying to design an idea which addresses the most critical period when greatest malnutrition and failure to thrive occurs in children. Our theory as backed up by current evidence and programming is that if we have mothers and caretakers adequately provide complementary feeding, WASH and stimulation to children at this age group 6 months to 2 years, we can prevent stunting and wasting in older age 3-5 years. The caretakers will be encouraged to feed older children well though. We will also promote exclusive breastfeeding as indicated in our draft indicators but main focus will remain 6-23 months.

Thanks!

Spam
Photo of Laura Schwecherl
Team

Thank you for this thoughtful and inspiring idea! It's great that you're taking advantage of what Uganda already offers in regards to their local crops.

Could you go a bit in depth about how you plan on educating mothers around the concept of preparing and providing these meals for their kids? Will it be fed through a CHW program?

Spam
Photo of Scott Halliday
Team

I enjoyed reading about your idea here- your incorporation of dialogue and discussion with your community is great to see.

To build off of Laura's comment above, who would be your implementing partners for your idea? I see that you mention the Village Health Team and the local council leaders... do you have any partners at the central level of Uganda?

As you begin to implement your project, what does success look like? Have you thought about indicators for monitoring and evaluation?

I'm looking forward to seeing your idea develop!

Spam
Photo of International Youth Empowerment Network
Team

Thanks Laura and Scott for your feedback. Yes, CHWs aka VHTs are part of the partners for implementation and monitoring of this project. They were reported as being influential to mothers during our research. Scott, we will partner with Ministry of Health centrally and at the local government with district health office. It is a requirement that we engage MoH in these kind of interventions.

Yes, Scott we have thought about indicators--impact, outcome and output indicators. We are reviewing the draft logframe that we hope to share with the community next week or earlier.

Thanks!

Spam
Photo of Laura Schwecherl
Team

Looking forward to seeing the indicators!

Spam
Photo of International Youth Empowerment Network
Team

Hi Laura. We have uploaded the draft M&E plan which includes key indicators. Thanks for your feedback in advance!

Spam
Photo of International Youth Empowerment Network
Team

We have uploaded photos from the prototyping of preparing blend of two legumes, a cereal and vegetables. The video and the user experience map have been uploaded too! Looking forward to your feedback!

Spam
Photo of International Youth Empowerment Network
Team

We have updated the idea: provided key learnings and insights from the implementation research; attached key findings from implementation research and the discussion guide used. Thanks for your continued feedback and collaboration!

Spam
Photo of International Youth Empowerment Network
Team

Today we visited Peak Value Industries Limited to pursue potential partnership for provision of instant blended beans and groundnut sauce to potentially solve the challenge of time and fuel that mothers highlighted in our research during idea phase. They are happy to make smaller packs for us but we are set to test the blend with mothers first. We obtained samples to use for the trial. We are putting down the documentation to this effect and will share shortly. Please check out the photos of the project in the main body of this idea!

Spam
Photo of Ines Bernal
Team

Nice pictures, they are inspiring.
I've been following your idea for a long time and I'm happy to see it reached the refinement.
You're doing really good job here.
Promoting a cheap, healthy and complete meal is fantastic.

Spam
Photo of International Youth Empowerment Network
Team

Thanks Bernal for your kind feedback!

Spam
Photo of International Youth Empowerment Network
Team

Hi Bettina! Could you be having any feedback on the updates we have shared so far? We miss your great insights!

Spam
Photo of Bettina Fliegel
Team

Hi all. Thank you for reaching out! I apologize for not writing sooner, although I have been checking some of your updates. I was busy and then away, just back yesterday. I will review everything this weekend and give feedback!

Spam
Photo of International Youth Empowerment Network
Team

We have responded to the questions asked by OpenIDEO designers in New York and Shanghai. See attachment #2 in the main idea!

Spam
Photo of Ghana Health and Education Initiative
Team

IYEN,
Thanks for this interesting idea- it is really wonderful to read through the insights you have collected from the community thus far.
We have identified complimentary feeding as a critical element of our Mother Mentors program (https://openideo.com/challenge/zero-to-five/refinement/mother-mentors-for-child-development), and I was hoping we could get your advice:
1. Do you have or know of a nutritional guide for complimentary feeding using locally available ingredients (I know this will vary tremendously by site, but I think rice, cassava etc. are common staples)? We have a nutritionist partner in the district administration, but it would be good to have ideas and materials for him, if something like this exists.
2. So far in our assessments, time (having to prepare separate food) and money (even using locally available foods, nutritious ones are out of the reach of families financially) are the biggest barriers for mothers providing nutritious foods for their children. We are beginning a literature review and hope to find organizations that have addressed this issue with these barriers in mind. Do you have insights and/or leads?

Also, OpenIDEO asked us a great question that was a wonderful exercise for us to think through and write down: what have you learned from your previous programming experience that you hope to apply with this program?

Thanks very much!

Spam
Photo of International Youth Empowerment Network
Team

Thank you GHEI for reaching out to us! There are WHO, UNICEF and customized country specific guidelines for complementary feeding. We suspect Ghana MoH has them already. Consider checking them out: http://www.who.int/mediacentre/factsheets/fs342/en/

Then based on the findings you obtained from the mothers and other targeted beneficiaries, you may consider doing trials of improved practices for complementary feeding based on the local context just like we are trying to do now.

There are now of agencies that have implemented IYCN in Ghana including MI, IYCN and SPRING that you could reach out to. You could check: www.spring-nutrition.org for resources around complementary feeding and the current approaches used. Our advice though is to use implementation research to inform the intervention because each situation is unique. We understand you intend to use mentor mothers to implement the intervention. Based on our own nutrition experience, they are good platform but you still need to contextualize,

We are mainly nutritionists and have been running community and facility based maternal and child nutrition interventions. We have learnt: how less attractive nutrition is to mothers and other beneficiaries and the need to design appealing strategies to entice clients to take nutrition seriously. Hence, we are leaning more towards applying behavioural economics (emotion-based approaches) and business models to promote complementary feeding.

YEN as an organization is young but the promoters are experienced in what we are trying to do. Thanks!

Spam
Photo of Diini Omar
Team

This is campaign excellent program for family who are low income for supplying healthier and high quality balancing foods through the stipulation of blended legumes and cereal for children 6-23 months. Particular the areas needs more help. As the above information that you will use interpersonal communication through Village Health Team members, local council leaders and mothers to influence knowledge, attitudes and practices on preparing and feeding children nutrient dense foods four times every day is great way to go to get involve the community and children. But my only concern is how the caretaker was not happy and complaining of how expensive the food is and also the hustles to feed the children therefore if the food is expensive how would you manage to get the quality food for the children?
Good luck! Diini

Spam
Photo of International Youth Empowerment Network
Team

Thanks Dini! Our aim is to help mothers blend locally available foods to make better diets. During the village meetings we will explore further the issue of costs of complementary foods and will continue interacting with the mothers to better understand how best they can use what is affordable to make good combinations of foods for their children. We do not have all the answers but the community has most of them. We will catalyse the process of improvement of use of what is available!

Spam
Photo of Masheyat Chowdhury
Team

Love this idea, well done! Also think about what sort of food is most available in the area to save importing costs.

Spam
Photo of International Youth Empowerment Network
Team

Thanks Masheyat! We conducted discussions with mothers and fathers during the idea phase and found the following foods as being locally available: Rice, Irish potatoes, Sweet potatoes, Beans, Groundnut, Silver fish, Cassava, Matooke, Maize.
Our idea is to help mothers to better make use of the available foods and prepare diverse complementary foods..

Spam
Photo of International Youth Empowerment Network
Team

We have updated the summary of the idea and included the draft creative brief for the campaign. Thanks!

Spam
Photo of Meena Kadri
Team

Nice one – looking forward to seeing how you create the 'shiver factor' :^)

Spam
Photo of International Youth Empowerment Network
Team

Thanks Meena! We will do our best.

Spam
Photo of OpenIDEO
Team

Congratulations on making the Zero to Five Refinement list, International Youth Empowerment Network! We have loved watching all of the hard work, research and collaborative efforts you have made over the course of the challenge so far and are excited to see this idea continue to evolve. Check out tips for Refinement http://ideo.pn/0to5-tips-refine

Spam
Photo of Chioma Ume
Team

IDEO designers in New York and Shanghai reviewed your idea and have shared their feedback. Here are some things they suggest your team consider during Refinement:

IDENTIFY BARRIERS TO ADOPTION

- It appears that most mothers and caretakers value the shorter less complex preparation process of existing meals over a pure vegetable meal. What are the actual proposed processes to be suggested that are time-sensitive and easy to execute and sustain?

-If education is the biggest hurdle, what ways can you reach these families? What tangential ways can you introduce the idea into the discussion? What locations can your message be shown, healthcare facilities, schools, community centers, or markets?

THINK ABOUT YOUR AUDIENCE AND BEHAVIOR CHANGE

- This project has a lot of great user and field research and has been synthesized into themes, however consider looking into the greater underlining learnings.

- What is behind the content that you collected? Much of the research is observational, which is a great place to start, but dive back in and look for the “whys” and hints to help change behavior or perceptions.

- Think not just about targeting the caregivers, but about the whole family. How can you speak to kids, fathers, grandparents? What message or medium would work to reach them? Kids love stories or games.

DEVELOP A WORKING PROTOTYPE

-You have a broad direction in terms of a solution, suggest you focus on creating and iterating an actual meal solution or campaign (whichever your idea focuses on) to try in the field so that you can get necessary consumer feedback.

- You might get inspiration from packaged food companies or cooking authors who specialize in healthy meals that are tasty and easy to source and prepare.

- What are the existing best-in-class real-world references or points of inspiration out there around you that can inspire and inform your iterative design process and thinking?

Spam
Photo of International Youth Empowerment Network
Team

Hi Chioma! Thank you for the feedback from OpenIDEO designers. The team met with Amplify Country Manager and other members whose ideas sailed through to refinement from Uganda. The discussions from Zulu, representative of Amplify program and DFID were great and helped us think through the idea more critically. We are working on a creative brief for the campaign, organizing members of Sebowa zone for the prototype, scheduled meeting with precooked food processing plant and working on illustrations for complementary recipes through our Nutrition Studio team.
We will provide response to the feedback shortly.

Thanks!

Spam
Photo of An Old Friend
Team

Congratulations team!

Spam
Photo of Yee Ting (Christy) Chan
Team

love your idea! this idea would work well with local people using local resource.
when you said: "educate and help our mothers understand how they can prepare such dishes and serve them to their children"
who will go educate and help?? instead people getting there to do it, how about a handy tool like a book with illustrated instructions?

Spam
Photo of An Old Friend
Team

Yes, we would like to educate them. Illustrated instructions would be great.Do you have any leads on working with us on this? Thanks!

Spam
Photo of An Old Friend
Team

Today evening I walked into Quality Shopping village supermarket in Namugongo. While doing my shopping I came across instant beans and groundnut sauce. I was curious to try it at home. Well, it takes only three minutes of boiling to get it ready into porridge like sauce.

Looking back at the worries caretakers have on fuel and time requirements to prepare Two legumes and a cereal, I think partnering with industries as this one that processes and packages these instant beans and groundnut sauce is potentially useful!

Spam
Photo of International Youth Empowerment Network
Team

Kenya and Uganda on Tuesday launched a 30-month project to market precooked beans in the formal market in order to boost nutrition and income status for the citizens. Director General of Kenya Agriculture and Livestock Research Organization said, “Value addition of beans will stimulate increased consumption by the urban population. We anticipate increased trade and involvement of private sector in beans production across east Africa.” The project is funded by Canadian International Development Research Center and Australian Center for International Agriculture Research.

http://www.coastweek.com/3748-agriculture-05.htm

Spam
Photo of Michael Lwin
Team

Very interesting idea. Have you focus group tested this at all yet? As in, taste may be a factor, so perhaps cooking up a simple-to-prepare, tasty recipe may help.

Spam
Photo of International Youth Empowerment Network
Team

Thanks Michael. The team is yet to conduct focus group discussions. We will keep the issue of taste in mind as we do small trials with the community.

Spam
Photo of Meena Kadri
Team

We look forward to hearing how the focus groups go. Do add insights from these as your idea evolves further – we're excited to hear what you learn!

Spam
Photo of Bettina Fliegel
Team

Hi all.
I am curious to learn what solid foods are given to infants in Myanmar and Uganda - from age 6 months on.
In the USA we start with rice cereal, which is fortified with Iron, mixed with breast milk or formula. Once the baby is accustomed to taking this - then vegetables, fruits, and later on meats. The foods are cooked and mashed.
Are any vegetables and fruits given to children in this age group - 6 mo to 23 months?

One thing that may be interesting to learn is how parents are preparing these foods - I have read varying things regarding preparation of fruits and vegetables and availability and/or loss of micronutrients. To the nutritionists on the IYEN team - what is your understanding of this?

It would be helpful when thinking about ideas for this challenge to know what the feeding practices are in your respective countries - and what the limitations are. Thanks.
Bettina

Spam
Photo of International Youth Empowerment Network
Team

Thanks Bettina for the interest in the matter, however, in Uganda, from 6-8 months, we usually give diluted cow's milk and thin porridge as the start complementary foods and as the infant grows up, we gradually introduce soft and mashed local foods reason being, they are relatively readily available compared to commercial formula and cereals which are quite expensive for most mothers to buy. Cow's milk per say is not so rich in iron yet it is the most commonly used, and because of this, we encourage mothers to breast feed up to the age of at least two years such that these infants continue to get some iron from breast milk.

For fruits and vegetables we give soft fruits like pawpaw, sweet banana, avocado and the other soft fruits and vegetables, we can also give fresh fruit juices but unsweetened.

Spam
Photo of An Old Friend
Team

Actually giving young children 6-11 months fruits and vegetables is not usual practice in Uganda. Starch based complementary foods with more of legumes are commonest staples given to children of this age group!

Spam
Photo of Bettina Fliegel
Team

Thanks for the clarification Alex.
So I have some questions. If these fruits and vegetables are freely available why aren't they given to infants? In the US we mix foods - cereal plus fruit or veggie, veggie and meat, veggie and beans etc. Is this done for infants in Uganda or is it just cereals in general? It seems that if legumes are available that they would be using them already. Is there a reason that this has not been done in the past?
What new teaching will need to be done to encourage this change?
How are most foods cooked? Are they boiled? steamed? fried? Will you include any discussion on food preparation in your intervention?

Your post above about complementary feeding is very interesting and important. Are any of the fruits listed by your colleagues above rich in Vit C?
If so can the parents feed that with the beans in order to make the iron more bioavailable?

What ideas do you have in terms of behavior change?
One thing I tell parents in practice regarding healthy eating is to make the plate colorful. In general there is much white food (rice, pasta, bread) and beans/meats on the plates of children I work with. "Making the plate colorful brings in all those fruits, veggies, and decreases the carbohydrates which are in excess." This is as a way to combat obesity but also overall good nutrition.

I am looking forward to what ideas you try out with the families and excited to hear about the learnings!

Spam
Photo of Meena Kadri
Team

Great insights and questions, Bettina!

Spam
Photo of Bettina Fliegel
Team

Thanks Meena! I am really interested in this idea. I think it has a lot of potential. I am not too convinced that one needs recipes - just basic mashed food, happy infant, and parent. I am trying to get the full picture of what the common practice is in Uganda in order to contribute to the idea!

Spam
Photo of An Old Friend
Team

Hi Bettina! I am summarizing some of the statistics on complementary feeding practices herein:

My re-analysis of Uganda Demographic Health Survey of 2011 reveals over two thirds of Ugandan children 6-23 months receive inadequate complementary feeding. The proportion with receiving minimum acceptable diet was 26.3%, minimum dietary diversity (58.2%) and minimum meal frequency (38.1%).

Specifically the following statistics show the percentage of children who receive different food groups: milk/cheese/yoghurt (26.9%); grains/roots/tubers (63.0%), vitamin A rich fruits and vegetables (33.0%), other fruits and vegetables (19.3%), eggs(6.3%), meat/fish/poultry/organ meat (22.4%), legume and nuts (39.0%) and food made of oil/butter/fat (21.8%). Blood haemoglobin levels were affected by the intake of legumes (p<0.001); oil/butter/fat (p=0.0045); dietary diversity (p=0.008). The consumption of milk/yoghurt/cheese, and legumes/nuts as complementary foods predicted child anaemia in 2006 and 2011.

Children who did not consume foods made of grain/roots/tubers were 2.3 times more likely to be stunted while children breastfed beyond 10 months were 1.4 times more likely to be stunted in 2006. Children who were breastfed beyond 10 months were 1.7 times more likely to be stunted in 2011.

There was reduction in legume production in 2010/2011 and could have contributed to the drop in consumption of legumes from 42% in 2006 to 39% in 2011.

I have lots of more information on complementary feeding in Uganda as it is the topic of PhD dissertation.

Let me know what else I can get to help you get a comprehensive picture.

Many thanks,
Alex

Spam
Photo of Bettina Fliegel
Team

Hi Alex. Wow, lot's of interesting info!
What I am curious about is what factors into these numbers.

Why aren't families feeding their children under 2 y/o legumes currently?
Do they not have them available in the villages? Can they not afford them? Is it not culturally acceptable? Do parents themselves eat legumes in these communities? Each answer will need a different approach to overcome I would think. (I would ask these questions about feeding practices with fruits/veggies and eggs as well.) Do families have gardens in these villages? Are there community gardens?

Would love to hear what the families report and what your group is thinking in terms of practical solutions and motivational influences to bring this idea to life.

One thing that is confusing in your statistics is that you mention that breastfeeding beyond 10 months had increased chance of stunted growth. Why?

Spam
Photo of An Old Friend
Team

Hi Bettina! I am sharing more statistics to help us understand what we are dealing with here. But first let me explain the stunting and duration of breastfeeding scenario. There is evidence of reverse causal relationship between stunting and duration of breastfeeding. Mothers whose children are already stunted tend to breastfeed them longer as they often lack sufficient complementary food to give them. So it is not the duration of breastfeeding increasing the risk to stunting. This is the case in Uganda too!

"Uganda has generally had adequate dietary energy supply for its population over the years. However, supply of adequate protein-especially animal based protein, is a challenge. Nationally almost half (48%) of Ugandans are food energy deficient and the proportion is relatively similar across regions (Eastern 43%, Kampala 46%, Western 46% and Central 46%) , although it spikes at 59% in northern Uganda. Notably, more urbanites (49%) than rural dwellers (47%) are energy deficient (UBOS and WFP, 2013). As expected Ugandans derive 69% of their daily calories from staples: plantains (matooke), cassava, maize and sweet potatoes (UBOS and WFP, 2013). Almost half (45%) of these calories are derived from cereals, roots and tubers (FAO, IFAD and WFP, 2013). The highly staple based diets are complemented by ground nut, beans, sorghum, millet, Irish potatoes, peas, simsim and green leafy vegetables in all regions of the country. Dependency on staples is much higher in rural (71%) than urban (59%) parts of the country. Regional differences in dependency on staple foods is observed: people from Eastern and Western regions are the most staple dependent with households deriving on average around three quarters of their energy from staples in both regions (UBOS and WFP, 2013). The poorer the household, the more likely it is to be staple dependent and obtain more than three quarters of its energy from staples. On a scale of 7 days, average Ugandans eat cereals every day, vegetables six days a week and pulses four times a week. Fruits, animal protein (meat/fish) and milk are consumed twice a week, though less frequently in Northern and Western Uganda (UBOS and WFP, 2013). On the other hand, there has been 7.3 percentage point decrease in the proportion of Ugandans with unacceptable food consumption between 2009 and 2010 (20.3 % in 2010 and 27.6% in 2009) (WFP and UBOS, 2013). More rural dwellers (21.5%) than urban dwellers (20.3%) have unacceptable food consumption. People from Western Uganda have higher food consumption scores than those from other regions with fewer than 3% of households having poor food consumption and 14.6% borderline (UBOS and WFP, 2013). The households with borderline food consumption scores reportedly have more varied diet with more pulses, vegetables and sugars, but like those with poor food consumption, barely any animal proteins, milk or fruits. Overall, the comparison of the 2009 and 2010 analysis indicates that all food groups are being consumed slightly more frequently except beans (UBOS and WFP, 2013). Low dietary diversity remains a key problem especially in western Uganda where over half (55%) low dietary diversity compared to over a third of all Ugandans. Overall the western region has the lowest dietary diversity score and is highly dependent on staples for energy in spite of it having lower prevalence of households with inadequate food consumption. On the contrary the northern region has the worst energy deficiency, poverty and higher share of expenditure on food (UBOS and WFP, 2013)".

Spam
Photo of An Old Friend
Team

Here are additional statistics on food production in Uganda:

"Uganda grows 17 major food crops: cereals (maize,millet, sorghum, rice); root crops (cassava, sweet potatoes, Irish potatoes); pulses (beans, cow peas, field peas, pigeon peas); and oil crops (groundnuts, soya beans, simsim), plantain bananas (food, beer, sweet types) (UBOS, 2013). UBOS projected the total area planted in 2012 for food crops as 5,729,000 Ha which was an increment of 2% compared to 2011. Cereals occupied 30.2% of total area planted for major crops while root crops occupied 23.7%, pulses 13.3%, plantains 16.8% and oil crops 16.0%. Maize with 62.6%, cassava 64.0%, beans 88.4% and groundnuts 46.6% occupied the largest proportions of area planted within their broad crop categories. Compared to 2011, there was a general increase (between 1 and 5%) in the area planted for all crops except plantains (UBOS, 2013). Production estimates for 2012, indicate that maize with 7.2%, Irish potatoes (3%), cassava (3%), sweet potatoes (3.5%), and pigeon peas (2.1%) are the crops which registered increments in production while the rest of the crops recorded declines in production as compared to 2011 (UBOS, 2013).

Uganda Census of Agriculture (UCA) data of 2008/09 reported that Eastern region led in the production of finger millet (106,838 tonnes), maize (1,108,554 tonnes), rice (128,195 tonnes), sweet potatoes (847,140 tonnes) and cassava (1,061,186 tonnes). On the other hand, Northern region led in the production of sorghum (177,088 tonnes), field peas (10,428 tonnes), pigeon peas (11,031 tonnes), groundnuts (83,182 tonnes), soya beans (15,727 tonnes) and simsim (93,562 tonnes) while the Western region led in the production of banana-all types (2,883,648 tonnes) and beans (411,945 tonnes).
The cereals grown in Uganda is sold, consumed or stored. The biggest proportion of maize produced (40.5%) and rice (54.5%) is sold out. On the other hand, most of the finger millet (37.7%) and sorghum (46.9%) is consumed by the households".

Spam
Photo of Bettina Fliegel
Team

HI Alex. Thank you. Lots of stats to absorb.

I see the challenge as being able to take the stats and translate them into a clear campaign and approach to teaching/education for parents.
Your provocation to the community above about being concerned about parents not having enough fruit to feed their kids daily and also that legumes do not have enough micronutrients for the daily requirements for their children -
From my point of view if you are promoting improved nutrition for young children I would:
1) Work with what I have available - This is what you are proposing by advocating for 2 legumes/ day.
2) Educate on how to best utilize what is available
3) From what you wrote above it seems that fruits and veggies are also available but it is not common practice to feed them to young children. (Do you know why?)

Is the 2 Legumes Proposal a national campaign? Or an educational campaign to be done locally? Both?
If it is something that includes an education component :
Can you advocate for best practices in a parenting group/village forum, or in home visits by community health workers? The issue being maximize information and resources - How can we use what is available in the best possible way?
ex: Beans + Vit C - The info would be secondary to the primary campaign.
Simply - "Beans are a healthy food for small children. Giving your child beans everyday will help them grow and develop. On days when you have fruit at home feeding them beans and fruit together can have added benefits. Vits in beans can become more available to your baby's body when you feed them fruit at the same time. So when you do have fruit make a meal out of it! On days when you do not have fruit - no problem. Beans are always a healthy choice for a growing baby!" ( Is your concern that the parents will see this as absolute and therefore not give beans at all? )
Another approach if you are targeting communities on a larger scale is to use visuals. Visuals of 2 Legumes + Cereal and support visuals with beneficial food combinations?? can this work??
Information can help parents make informed decisions on what to grow, buy and how to feed their small children.

Parents may not always have fruit, and legumes may not be a sufficient source of micronutrients. Can we maximize the potential of what is available to parents through education? A diet of cereal and diluted cow's milk for small children does not meet their nutritional needs. If other foods are available how can we encourage parents to use them? What is currently standing in their way?
Information?
Access?
Cultural feeding practices which may be difficult to change? What ideas does your team have about this?

Ultimately the idea for this project might be only to tackle the problem of lack of protein in the diet of young children. It might be a public health campaign only on that issue. Focusing on this problem by adding two legumes might be a huge challenge itself. What is your team thinking?

Spam
Photo of Bettina Fliegel
Team

Also in relation to your provocation to the community above - If beans do not have sufficient micronutrients are you proposing advocating for feeding an increased variety of foods?

Spam
Photo of Nataliia Pavlovskaia
Team

Hi Alex! It`s great u have found the statistics. I guess, this is from this report: http://documents.wfp.org/stellent/groups/public/documents/ena/wfp256989.pdf ? My team is also concerned about the kids` nutrition and especially vegetables in their diet. We are trying to propose a way to motivate children eat vegetables, does your project includes some special ways of motivation? From the idea description I have understood, that mixing vegetables with other food that is more tasty for children overcomes this issue?

Spam
Photo of An Old Friend
Team

Hi Nataliia! I think Racheal and Josephine will camp in some of the villages and do some TIPs during the refinement phase to taste out some of the plausible practices with mothers and children. Like Racheal's My Little Clean hands, I think the issue of eating vegetables by children needs being instilled to them in early childhood so they grow knowing it is important to eat vegetables. I know some areas like Eastern Uganda, Northern, Westnile where vegetables constitute a good portion of the family diet. Children automatically grow enjoying them!

Where are you testing your idea from?

Thanks, Alex!

Spam
Photo of Nataliia Pavlovskaia
Team

True, vegetables should be a part of daily meal from the very first steps of the child and so it could become a habit. But the point is which exactly vegetables these are. For example, mashed potato is usually quite easy to make children eat, whereas, broccoli and carrots, that contains more vitamins and no starch, are more difficult to make kids eat.

Spam
Photo of International Youth Empowerment Network
Team

Hi Zulu and team, we have summarized findings from prototype discussions in the three villages. Thanks for your input. Let's know if there is anything we can update! Thanks YEN team!

Spam
Photo of International Youth Empowerment Network
Team

We have posted findings from three different villages. We look forward to getting your feedback. Bettina and other team mates, we addressed most of the issues you raised earlier. Thanks to Racheal, Shakira, Sheila and Josephine for the great job well done.

Thanks!

Spam
Photo of Bettina Fliegel
Team

Hi all!
Am excited to see the updates and will get back online in the next days to do so. Today it is Thanksgiving in my corner of the world and I would like to share the sentiment with all - Happy Thanksgiving!

Spam
Photo of Richard Zulu
Team

I have read the findings from your visit to three villages, this is great work. I would suggest that rather than posting the whole interview, you summary where you went, the kind of people you interacted with and the insights you developed. That way, you will keep the post short for other people to read. Great work

Spam
Photo of An Old Friend
Team

Thank you sir! Our intention was to have detailed research findings for a couple of days then we clean it up by summarizing up what we got from the three villages.

Spam
Photo of wekesa zab
Team

Alex .. Zulu is from outbox hub - Kampala .. Happy to connect .. Kindly reach out and have a long chat with him on existing gaps in our work..
<----- Jus a proposition for the team ..
Excited to be part of the team :)..

Jioni njema ..

Spam
Photo of An Old Friend
Team

Thanks Wekesa. I have tried connecting to Zulu about Innovation Centre and Pop Up Bus. Waiting for some feedback!

Spam
Photo of International Youth Empowerment Network
Team

During discussions with mothers in Balintuma yesterday, I was surprised that one mother actually gives her 2 months old baby silver fish soup and juice! She boils the soup and sieves it then gives it to her baby using a bottle and her reason was that it boosts the child's immunity and makes the baby grow stronger and faster. She further explains that if she was working and leaving her baby with a maid, this baby would be taking juice and cow’s milk already!

Spam
Photo of International Youth Empowerment Network
Team

So on average a mother spends about UGX. 35,000 (USD.14) a week to feed a child mainly on animal milk and starchy food. It seems there are more complications in promoting use of what we think are cheaper alternatives to animal food stuff for children. It is not just an issue of money, mothers have poverty of time, food storage facilities, complementary food preparation.

Please check out the research updates and share your thoughts with the team!

Spam
Photo of An Old Friend
Team

I wonder what the findings would be like in Northern and Eastern Uganda where the diet is predominantly legume based? I also wonder if the findings would be any different between urban and rural settings?

Spam
Photo of International Youth Empowerment Network
Team

We have drafted user experience map: see the main write up.

We are having some heated up debate among the team members on whether we should promote consumption of legumes and nuts especially beans as means of increasing intake of micronutrients such as iron. We know beans have high levels of non-haem iron and evidence shows they are consumed highly in Uganda. We know intake of foods high in non-haem iron should be accompanied by intake of vitamin C rich fruits and vegetables or animal source foods including soup in order to increase its absorption. We are concerned about the ability of caretakers to give fruits to their children daily.

Finally, we know we have to promote intake of micronutrients and not just protein and energy. We think legumes have some good micronutrients but they are not sufficient to meet dietary requirements of children 6-23 on daily basis.

Let's know what your thoughts on this!

Spam
Photo of Chioma Ume
Team

Hi guys,

I'm impressed to see your idea evolving and that your team is challenging some of your initial assumptions. I will keep my eye out for people with nutritional expertise in the challenge - maybe they will have some advice to share with you. It's an important question to consider the other resources that are needed to ensure that your idea will serve the community that you hope it will - this is a key part of human centered design - so thank you so much for sharing your learnings and struggle with us. Maybe your idea will end up pivoting in an unexpected direction - please continue to keep us posted - and calling out for feedback!

Spam
Photo of Richard Zulu
Team

Did you manage to develop more insights to help with the debate? Further to Chioma's feedback, I believe you will have to gather more data within the community to inform your debate. That is the only way of justifying your assumptions. The insights developed will help you.

Spam
Photo of International Youth Empowerment Network
Team

Hi Chioma! Yes, we had our first focus groups with mothers within the slum section of Sebowa zone today. The mothers perceive the preparation and feeding their children on two legumes and a cereal based as important in ensuring the children get the diverse nutrients needed for proper growth. They also think it would be good to add fruits and vegetables.Greatest fear is their ability to buy two legumes as they do not have much money. The mothers often feed their children of age 6-23 months what the adults eat as they fear the children could develop preferential tastes for foods they cannot afford.

They also called for more training on how best they can make mixes of such complementary foods. This I believe addresses some of the issues raised by Dr. Bettina. We will do additional data collection two to triangulate these findings.

Thank you for the continued feedback!

Spam
Photo of Bettina Fliegel
Team

Excited to hear that the parents are open to new food combinations. As to cost, I would educate on what the different types of food provide in terms of nutrition in practical terms and let parents know that whatever they can manage is great. Even one legume is ok, as currently they are using none. Some times will be leaner than others but with knowledge they can use their financial resources in the best possible way.
Thanks for the updates!

Spam
Photo of International Youth Empowerment Network
Team

Thanks community for your feedback on this idea. We had our first focus group with mothers of children 6-23 months today in one of the slum areas within Kiwatule. Please do check out the key insights within the main section of the idea. We look forward to receiving more feedback from you!

Spam
Photo of Yujun Zhang
Team

Actually, I hate to read this aspect of news because I feel sad when I know some children who cannot get their deserved food. However, I hope the world is getting better, especially the world of children.

Spam
Photo of Bettina Fliegel
Team

Very timely IDEA for this challenge IYEN! I just read that the UN has proclaimed the year 2016 as the International Year of the Pulses (Pulses are Legumes.) -- There will be much info and gatherings to highlight the benefits of these foods for nutrition, sustainability etc. See links.

http://www.iyop.net/en/
http://articles.economictimes.indiatimes.com/2014-01-10/news/46067741_1_grains-association-pravin-dongre-india-pulses
http://www.usdrybeans.com/2014/01/united-nations-proclaims-2016-the-international-year-of-pulses/

Spam
Photo of An Old Friend
Team

Thank you Bettina for sharing this important information.

Spam
Photo of Bettina Fliegel
Team

It seems that your idea can build on the momentum of what is being planned going forward!

Spam
Photo of David Citrin
Team

Thank you for this post. Great to see the promotion of locally available foods as a part of moving communities that know hunger back to a more expectable state of wellness. So easy for an intervention like food aid to enter the mix here (when the only tool you have is a hammer, everything looks like a nail)! I agree that families and communities have local/historical foods cultivated in place that can nourish and satisfy. Have you considered a cookbook or something similar, as Adriana suggested below. Not so much a cookbook for recipes to be replicated, but one that benefits you describe above, teach about changing agricultural practices + dietary patterns (often a result of changing political economies and growing inequalities); almost a reclamation of local foods. Great post, thanks again

Spam
Photo of Adriana U
Team

I want to contribute a little bit with this incredible Idea.

You tell us:

"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."

And thinking about it, maybe it is a good opportunity not only to bring the oportunity to the mothers to learn cooking and about nutrition, for children also.

Why not combine both aspects, and create a book who mix the topic about the feeding habits and the children educational development?

This book can be a simple book with two aspects: Learning about the food (With pictures or drawings), how is it writted and about how to cook it:

Per each recipe, different ingredients and each ingredient with a photo/draw and it's spell. Mother and children will learn together and it's going to be a stronger relation between them, a learn/learn relation.

Hope you like the idea!

Thank you :)

http://oi62.tinypic.com/2z8ykj6.jpg

Spam
Photo of OpenIDEO
Team

Congrats on this post being today's Featured Contribution!

Spam
Photo of Josephine Murungi
Team

using locally available foods to keep children healthy. I think it is a step in the right direction

Spam
Photo of An Old Friend
Team

I like very simple and doable actions that do not require parents or caretakers to drastically change their habits. As change agents and professionals some times we ought to get more realistic as to what we require caretakers to undertake. This idea is simple, affordable and generally acceptable. Reliance of external support is often not sustainable in communities. This idea is one step towards addressing gaps in complementary feeding interventions.
Multimixes of locally available foods could be the way to go!

http://www.oxfordjournals.org/our_journals/tropej/online/module%20on%20multimixes_29012008.pdf

Spam
Photo of An Old Friend
Team

In this research, the authors acknowledge high quality protein can
be provided by properly mixing some cereals or legumes (e.g.: rice and beans) and adding cheap animal protein like eggs and silver fish. These are all staples in developing countries like Uganda...

Spam
Photo of An Old Friend
Team

"Away to improve the protein quality of complementary foods is
to add legumes (beans, peas, etc) to cereals (rice, maize, quinoa, wheat, millet, sorghum, etc). The quality of protein is not as good as that in foods of animal origin, but legumes contain those amino acids that are less plentiful in cereals. Hence a mixture of the two makes a balanced form of protein"

http://www.oxfordjournals.org/our_journals/tropej/online/module%20on%20multimixes_29012008.pdf

Spam
Photo of An Old Friend
Team

Even codex guidelines on processing complementary foods recognize the need to have multimixes of cereals with legumes and/or pulses:
www.codexalimentarius.org/input/download/standards/.../CXG_008e.pdf

Spam
Photo of Charlotte
Team

I love that you are taking the local context into consideration with this project, and planning your programming around what foods are common and popular in this region.
Why do you think families are not already eating the food you propose will be better for their health?
It seems this program will be successful if you are able to create a change in behavior for these families - Check out this great resource focused on community based nutritional focused behavior change - https://www.k4health.org/toolkits/pc-nutrition/hearth-nutrition-guide-community-based-approach-nutritional-rehabilitation-and

Spam
Photo of International Youth Empowerment Network
Team

Hi Charlotte! Thank you for the encouragement and for the resource. The families are already eating those foods but the concern is around their ability to mix the legumes and cereals in the right proportions to help reach the desired value. We will learn more insights as we interact with the communities.

Thanks!