Somalia

2016 Somali Infant and Young Child Nutrition Assessment: Infant and young child nutrition practices, barriers and facilitators

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EXECUTIVE SUMMARY

Background

This report presents estimates of, and provides context for, infant and young child nutrition (IYCN) practices in Somalia, based on the results of an assessment conducted across the country between December 2015 and February 2016. The understanding of IYCN practices in Somalia, including what encourages and hinders them, is imperative to inform policy and programming, as well as for evaluative purposes. The link between poor infant and young child nutrition, malnutrition, morbidity and mortality is well documented. Recent analysis indicates suboptimal breastfeeding practices, including low rates of exclusive breastfeeding, contribute to 11.6 per cent of deaths among children aged below five. The introduction of complementary foods is also important when children reach six months, in addition to nutrients they continue to obtain from breast milk.

In 2009, a national micronutrient and anthropometric nutrition survey conducted by the Food Security and Nutrition Analysis Unit (FSNAU), in conjunction with the University College of London, assessed IYCN practices in Somalia. Unfortunately, the indicators measured were limited in scope and their definition was not consistent with IYCN indicators, which were developed and recommended by the World Health Organization (WHO) the following year.

Objectives of the 2016 Somalia IYCN survey

  1. To understand current IYCN practices for children aged 0-23 months

  2. To explore knowledge, attitudes and beliefs related to IYCN practices in Somalia

  3. To identify barriers to, and facilitators (or drivers) of, recommended IYCN practices

  4. To provide recommendations to policy makers and IYCN programmers that help improve current IYCN practices among mothers in Somalia

Methodological approaches

The assessment was a cross-sectional survey using both quantitative and qualitative methods of data collection. The target population were mothers or caregivers in households with children aged up to 23 months. In Somaliland, 30 clusters were covered; in Puntland, 25 clusters; and in regions of Central South Somalia, 35 clusters. From each cluster, 30 households were randomly sampled, while ensuring a predetermined number of mothers of children in the following age groups were enumerated: 0-5 months, 6-8 months, 9-11 months, 12-15 months, 16-19 months and 20-23 months. The primary source of information was a household survey, designed using a WHO 2010 standard questionnaire modified to include aspects of knowledge attitude and practices. The tool was used to collect data on child level indicators, which included: if the child was ever breastfed; the timely initiation of breastfeeding; exclusive breastfeeding; predominant breastfeeding; continued breastfeeding at one year; continued breastfeeding at two years; length of breastfeeding; age-appropriate breast feeding; the introduction of solid, semi-solid or soft foods; minimum dietary diversity; minimum meal frequency; minimum acceptable diet; consumption of iron-rich foods; bottle feeding; the child feeding index; and maternal micronutrient supplementation.

Focus group discussions (among mothers and fathers) and key informants’ interviews (for grandmothers, community leaders, religious leaders, health workers and traditional birth attendants) were used to collect maternal and community IYCN knowledge and attitudes.

Conclusions

Somalia has high rates of breastfeeding, with 98.2 per cent of children 0-23 months included in the survey having received breast milk a day before the survey. The country has made exponential progress in the timely initiation of breastfeeding and exclusive breastfeeding, when compared to the previous micronutrient survey of 2009 and the multi-indicator cluster survey of 2011; three out of 10 children were exclusively breastfed and up to eight in 10 children were put to the breast within an hour of birth. However, more than half of the mothers did not continue to breastfeed for the first one year of their child’s life, with rates reducing drastically to 15 per cent as the child reaches two years. By the age of six to eight months, 8 out of 10 Somali children had been introduced to solid, semi-solid or soft foods. Providing the recommended number of meals, and ensuring those meals contain at least four food groups (as per the minimum acceptable diet) as well as iron-rich foods, is still a challenge in most parts of Somalia. Bottle feeding, which is not a recommended practice, was found to be common among around half of the mothers who participated in the survey. Various factors impact whether sound IYCN practices are implemented, such as cultural beliefs, and are identified within this report.