A cross-sectional survey was conducted to collect data between May and August 2014. The survey was designed to provide IYCF and baseline indicators on a representative sample of households in the study area.
This study was conducted in two districts of Thatta and Sujawal in Sindh, Pakistan. These districts are administratively subdivided into nine Talukas and 55 union councils (UCs) with a population of 1.5 million. More than 88% of the population in Thatta and Sujawal has access to improved sources of drinking water. Sixty eight percent have access to electricity and 31% of households own some agriculture land. Finished floors are present in 35% of households, roofing in 36% and walls in 40% of households .
The study participants for this survey were the mothers of children aged less than two years who lived in the study area for more than six months. In the case of having two or more mothers with children under-two years of age in the household, we selected the one with younger child.
Sample size for this study was calculated using comparison of two sequential surveys approach. This design was used to assess the impact of intervention over time as discussed in Micronutrient Initiative (MI) and Center for Disease Control (CDC) manual . Sample size calculation considered the prevalence of stunting in Sindh at 55% (NNS 2011) and design effect of 1.5. Total sample size was 2166 per survey to detect 10% difference in stunting. With a power of 80% and a significance level of 5%, the sample size was inflated by 10% for non-response.
A two-staged cluster sampling technique was used to select households for interviews. In the first stage, the sample size was divided in 29 UCs using a Proportion to Population Size (PPS) design. In the second stage, the villages and households with children under-two years of age were randomly selected for interview on baseline and IYCF indicators.
Sixteen data collectors, four team leaders, two desk editors and two field supervisors were trained and involved in baseline data collection. Senior faculty and staff belonging to the Department of Paediatrics and Child Health, Aga Khan University arranged the five day training. Three days were dedicated to didactic training of staff, one day was spent on field pilot testing and one day for a short refresher that included problems and irregularities found during the pilot testing.
A standard questionnaire on IYCF practices recommended by WHO was used to collect information from mothers with children aged between 0 and 23 months. The information collected included IYCF practices and socioeconomic characteristics. The questionnaire was initially designed in English, with subsequent translation to Sindhi by a senior project team staff that was well versed in both languages. It was then translated back in English. An independent review of the questionnaire was done eventually to check for any inconsistencies.
Definition of variables used in the study
Early initiation of breastfeeding
Children born in the last 24 months who received breast milk within one hour of birth.
Infants 0–5 months of age who received only breast milk and nothing else: no other milk, food, drink, not even water during the previous day.
Continued breastfeeding at one year
Children 12–15 months of age who received breast milk during the previous day.
Introduction of solid, semi-solid or soft foods
Infants 6–8 months of age who received solid, semi-solid or soft foods during the previous day.
Minimum dietary diversity
Children 6–23 months of age who received foods from four or more food groups during the previous day.
Minimum meal frequency
Breastfed and non-breastfed children 6–23 months of age who receive solid, semi-solid, or soft foods (but also including milk feeds for non-breastfed children) the minimum number of times or more during the previous day.
Minimum acceptable diet
Children 6–23 months of age who receive a minimum acceptable diet (apart from breast milk) during the previous day.
Consumption of iron-rich or iron-fortified foods
Children 6–23 months of age who received an iron-rich food or a food that was specially designed for infants and young children and was fortified with iron, or a food that was fortified in the home with a product that included iron during the previous day.
Continued breastfeeding at two years
Children 20–23 months of age who received breast milk during the previous day.
Infants 0–5 months of age who received only breast milk during the previous day, and children 6–23 months of age who received breast milk, as well as solid, semi-solid or soft foods, during the previous day.
Predominant breastfeeding under six months
Infants 0–5 months of age who received breast milk as the predominant source of nourishment during the previous day.
Taluka or Tehsil is second administrative level after district in all provinces of Pakistan.
Union council is lowest administrative unit in Pakistan with a population between 25,000 to 70,000.
Paper based data was entered on predefined data entry screens using Microsoft visual fox pro version 9.0. STATA version 12 was used for data analysis. Frequencies and percentages were calculated for categorical variables. Multivariable analysis was used for the impact of each variable by odds ratio with 95% CI and p - value <0.05 being considered statistically significant. Initiation of breastfeeding, EFB, minimum dietary diversity, minimum acceptable diet and age appropriate breastfeeding were defined as binary variables. We tested bivariate analysis for factors associated with all outcome variables. The p - value <0.25 in the bivariate was used for inclusion in the multivariable logistic regression model. Factors that were insignificant at the multivariable model were excluded after careful assessment of confounders. The final model was selected on the basis of theoretical and statistical significance of predictors. Clusters were adjusted to take sampling design into account.
Wealth indexes were based on the principal component analysis using household assets, household ownership status, materials used for the roof, floor and wall of the house, number of rooms, fuel for cooking, main source of drinking water and toilet facility. Wealth scores were divided into five parts to make wealth quintile: poorest, poor, middle, rich and richest .