An assessment of the causes of malnutrition in Ethiopia: A ...

4.7. Care Indicators and the Monitoring and Evaluation of the National
Nutrition Strategy
4.7.1. Indicators of caring capacity and their assessment
Indicators are variables that enable measurement of changes. Better caring practices
have different aspects to be measured. Care has the simplest and yet the most valid and
reliable methods and indicators to measure hygienic practices, child feeding practices, and
caregiver-child interaction during feeding.
4.7.1.1. Indicators of nutritional care (child feeding practices)
Child feeding is a multidimensional concept and feeding practices are age specific
and change rapidly with age (Table 4.6). It is difficult to combine these dimensions.
Secondly, appropriate child feeding practices are defined within narrow age ranges.
Therefore, key feeding practices within a continuum of child feeding are used as an indicator
of nutritional care practices (Arimond & Ruel 2002 & 2003). There is a need to create a child
feeding summary index to avoid bias that results due to the co-existence of both good and bad
nutritional care practices in the same household on the one hand, and the clustering of
nutritional care practices on the other.
Basically, optimally fed infants and young children should be recipients of all the key
nutritional care activities mentioned in the above table for their age category. If one of them is
not fulfilled, the child will be identified as sub-optimally fed. The data can be collected using
24-hour recall or repeated visit methods. At the population level, the following indicators can
be used for assessing nutritional care practices.
• Rate of timely initiation of breastfeeding.
• Exclusive breastfeeding rate.
• Rate of timely complementary feeding.
• Rate of continued feeding during diarrheal episodes.
• Rate of increased feeding after diarrhea.
Optional indicators include:
• Rate of continued breastfeeding at 12 months.
Table 4.6: The continuum of child feeding.
0- 6 months 6-9 months 9-12 months 12-24 months
• Initiate breastfeeding
soon after birth.
• Continue
breastfeeding.
• Continue
breastfeeding.
• Continue
breastfeeding.
• Avoid prelacteal
feeds. Feed
colostrum.
• Exclusively breastfeed
(no teas, water,
other milks).
• Avoid bottle-feeding.
• Gradually introduce a
variety of
complementary foods,
including animal
foods.
• Feed complementary
foods 2 to 3 times a
day + snacks.
• Increase amount,
variety, and frequency
of complementary
foods, including
animal-source foods.
• Feed complementary
foods 3 to 4 times a
day + snacks.
• Continue to give
variety of foods and
gradually complete
the transition to the
family diet.
• Feed complementary
foods 3 to 4 times a
day + snacks.
• Avoid bottle-feeding.
• Avoid bottle-feeding.
• Avoid bottle-feeding.
Source: Ruel & Menon 2003
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