Endline Survey Report - RICOD · Endline Survey Based on the above stated interventions, JBC and...

RURAL INSTITUTION FOR COMMUNITY DEVELOPMENT (RICOD)

2016

Endline Survey Report A comparison study of Baseline and Endline findings

of Improving Mother and Child Nutrition Project

Ram Hari Ghimire & Honey Gurung

B A J R A B A R A H I - 1 0 , L A L I T P U R N E P A L

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Background

The Rural Institution for Community Development (RICOD) is a non-governmental social

organization working with children, youth and women in Nepal. RICOD was registered at the

Lalitpur District Administration Office and became affiliated with the Social Welfare Council in

1994. RICOD was established with the fundamental aim of establishing an equitable society for

peace, justice and development. RICOD works by organizing and empowering focal groups

through participatory processes to fulfill their rights.

Jana Bhawana Campus (JBC) was established in 1991 and situated at Bajrabarahi Municipality-

10, Pyangaun, Lalitpur, Nepal. JBC is a Community College led by renowned academicians,

educationalists and professionals. It has been running MBS, BBS, BA and B. Ed programmes

under Tribhuvan University. Prioritizing research oriented learning methodologies and

improving students in research work, it has a Research Management Cell (RMC) which has been

conducting multidimensional research work through the faculty and the students.

Two-thirds of Lalitpur district is rural with scattered settlements. The five project VDCs

(Dalchoki, Nallu, Bhardeu, Chaughare and Lele) are located in the central/southern part of the

district. The total population of the area is 23,137, and most of the people are of Tamang ethnic

group. Marriage takes place at a young age followed by early pregnancy resulting in poor health

and nutritional status of both mother and child, because many young mothers lack the physical

maturity and child care knowledge needed to bring up healthy children.

To identify the nutrition status of women and children, RICOD conducted a baseline survey in

2013 through Improving Mother and Child Nutrition project. Although there has been no formal

study done on the nutritional status of men in the area, it is seen that men are less likely to be at

risk of malnutrition because they control the income of the household. The possibility of

malnutrition among men in the district is far less. Therefore, the survey was focused on the

assessment of the nutritional status of women and children. The main focus of this assessment

was to find the changes seen in the nutrition status of women and children from 2013 to 2016.

1. Statement of Problem

RICOD is a pioneering institute for community development programmes in Lalitpur district

with the aim of establishing an equitable society through a participatory process for a dignified

coexistence of the focal group (women and children) who have remained deprived of control

over facilities and services. As per RICOD’s objectives, it started a project to improve the health

status of mothers and children.

Different studies have shown the health status of women and children of Lalitpur district to be

significantly low. Similarly, the health situations of these five VDCs have been poor. So, to

make the people in these VDCs more aware of health and nutrition issues, RICOD decided to

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initiate an effective intervention in health and nutrition issues. General observation, literature

review and baseline survey of 2013 identified the needs leading to the development of the

project. Thus, the project “Improving Mother and Child Nutrition” started in 2013.

RICOD implemented the project between 2013 and 2016, and JBC as a third party independently

in coordination of RICOD monitored the project’s endline survey in 2016.

2. Objective of The Survey The organizational vision, mission goals and objectives are clearly laid down in the project

“Improving Mother and Child Health Nutrition.” The main objective of the end line survey is

"To know the impact/outcomes of improving mother and child nutrition project (2013-2016)"

supported by Canadian Foodgrains Bank and Mennonite Central Committee.

The specific objectives are;

➢ To find out and increase knowledge of nutritional health status in the target groups.

➢ To evaluate and improve the availability of nutritious food in the target area.

➢ To access and increase the practice of ANC, PNC and institutional delivery in the target

area.

➢ To find out and improve the nutritional status of target groups through height, weight,

MUAC and BMI measurement.

➢ To improve the situation of women’s empowerment in the target area.

To achieve above stated objectives, the following interventions are conducted.

❖ 10 sessions nutrition training

❖ Kitchen Garden training

❖ Income Generating Grant (IGG) support

❖ Day snacks to Early Childhood Development (ECD) center

❖ Baseline Survey

❖ Endline Survey

Based on the above stated interventions, JBC and RICOD jointly conducted an end line survey in

November 2016. Thus, the expected output of the intervention was a comprehensive research

based project impact evaluation report.

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3. Methodology The survey was done in all the five VDCs of Dalchoki, Chaughare, Bhardeu, Nallu and Lele in

November, 2016. The target group was trained women, and the sample size was 202 which is

30% of the total target group. The assessment was completely based on field surveys. To conduct

the end line survey, Jana Bhawana campus team and RICOD team were jointly mobilized.

JBC issued a notice to the students of BA 2nd year and 3rd year to select the team members. The

team members were selected from a written test, interview and presentation. From the entire

participant students, 11 students from Jana Bhawana Campus were selected as enumerators.

The organization conducted a two-day workshop to orient the students of JBC, and RICOD staff

and peer educators. To complete the specific task, the capacity building workshop was conducted

in the second week of November for two days at Anadaban Training Center, Lele where 19

people participated. During the training the endline questionnaire was also discussed and revised.

Five groups were divided and a survey plan was also prepared. The detailed plan is attached in

annex-1. At the end of the workshop survey questionnaires were revised and finalized.

Enumerator groups were formed for each VDC and the group leaders of the survey of each group

were chosen.

The survey team consisted of one coordinator, two supervisors, and 19 enumerators (11 from

JBC and 8 from RICOD details in annex-2. The team was supervised and mobilized by the

Executive Director of RICOD Mr. Ramhari Ghimire; Campus Chief, Mr. Shivaraj Sanjel, and

JBC, RMC Coordinator, Dr. Bharat Prasad Badal. Mr. Shankar Sigdel and Miss. Honey Gurung

were regularly monitoring the team in the field.

30% of trained women respondents were chosen for the interview by lottery method.

The height, weight data of children was entered in Emergency Nutrition Assessment (ENA)

program on the same date of measurement, and other data were entered into the Statistical

Package for Social Sciences (SPSS) version 16 at the end of the completion of data collection.

Data analysis was done descriptively using mean, standard deviation, range and the proportions.

The tools and techniques used for the survey to collect the data were:

a) Questionnaire to the respondents

b) Focus Group Discussion (FGD) with Income generating Groups (IGG), Facilitators and

teachers of Early Childhood Development (ECD) and male members of targeted

households.

c) Nutritional Status of children through measurement of height and weight.

d) Collection of case stories.

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4. Data Analysis

Socio-Economic status of Respondents Table 1: Status of Respondents

Target Respondents BS (N=366) ES (N=202)

Pregnant women 10.38% 9.41%

Women who had recently delivered a child (within 45

days)

0% 2.97%

Mothers having children U 5 Years 89.62% 87.62%

Total 100% 100%

Source: Baseline Survey (BS) 2013 & End line survey (ES) 2016

Findings: In relation to the status of respondents, table 1 depicts that in both surveys (baseline

and end line), targeted respondents were pregnant women, women who had recently delivered a

child, and mothers having children U 5. In the baseline survey, respondents who had delivered a

child (after 45 days of delivery) were merged with women having children U 5 years. The

majority of respondents were women having children U 5 years, which is approximately 88% of

the total respondents in both the surveys.

The number of respondents has decreased as compared to baseline survey because many women

have migrated to the city after the earthquake. And also the pregnancy rates of the mothers have

become low as they have started to gain knowledge on birth spacing and benefits of having fewer

children.

Table 2: Age Group of Respondents

Age Group BS (N=366) ES (N=202)

16-20 years 17.5% 7.39%

21-25 years 39.9% 36.1%

26-30 years 24.6% 34.2%

31-35 years 13.1% 12.9%

36-40 years 3.0% 6.93%

41-45 years 1.9% 1.98%

45-50 years 0 0.5%

Total 100% 100%


Findings: Regarding the age groups of respondents in the baseline survey, table 2 illustrates that

the highest percentage of respondents was in the age group of 21-25 years and the lowest

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percentage of respondents was in the age group of 41-45 years. The minimum age of the

respondents was 17 years, and maximum age was 44 years with an average age of 25.7±5.45

years. In the endline survey, the highest percentage of respondents was again in the age group of

21-25 years, and the lowest percentage of respondents was in the age group of 45-50 years. The

minimum age of the respondents was 17 years, and maximum age was 46 years.

Table 3: Educational Status of Respondents

Level of Education BS (N=366) ES (N=202)

Illiterate 23.77% 7.43%

Literate 27.05% 34.2%

Primary level passed 27.87% 30.7%

Secondary level passed 10.93% 19.3%

Higher secondary level passed 7.38% 5.45%

Bachelor's degree or more 3.00% 2.92%

Total 100% 100%


Findings: With regards to the educational status of the respondents of the baseline survey, table

3 shows that slightly above one fifth of the respondents were illiterate, and the highest

percentage of the respondents attained literate level and primary level of education. In the end

line survey, the table illustrates that the illiterate level decreased by 16.34% to 7.43% from

23.77% in the baseline survey. In contrast to baseline survey, the end line survey depicts that the

highest percentage of respondents were at the literate level of education. The literacy rate among

targeted women has significantly increased from baseline to endline.

Table 4: Mother consuming three groups of food

% of mother consuming

three groups of food

Dalchoki

BS=18

ES=22

Chaughare

BS=22

ES=19

Bhardeu

BS=18

ES=25

Nallu

BS=31

ES=24

Lele

BS=66

ES=56

Total

BS=155

ES=146

Baseline 58.06% 44.0% 35.3% 49.2% 38.00% 42.30%

End line 81.48% 50.0% 80.65% 85.70% 71.79% 72.28%

Achievement 23.42% 6.0% 45.35% 36.5% 33.79% 29.98%


Findings: Relating to mothers consuming three types of food, table 4 depicts that in the baseline

survey, 44.3% of mothers consumed three types of food in the survey area comprising of 58.06%

in Dalchoki, 44.0% in Chaughare, 35.3% in Bhardeu, 49.2% in Nallu, and 38.0% in Lele. In an

endline survey, 72.28% mother consumed three types of food comprising of 81.48% in Dalchoki,

and 50% in Chaughare, 80.65% in Bhardeu, 85.7% in Nallu and 71.79% in Lele. Here, the

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improvement of mothers consuming three types of food is significantly high. But in the case of

Chaughare, it could not drastically increase the consumption rate because the households are

damaged more in Chaughare due to the earthquake than in other VDCs. So, the people are still

living in temporary shelters in their kitchen garden leading to an imbalance in their diet.

The above table shows a significant increment in mothers' consuming three types of food. After

the intervention of the project through nutrition trainings to women and male members, kitchen

garden training and Income Generating Grants, the mothers have started understanding the

importance of each food group and been able to put into practice the knowledge gained. This

change in behavior as observed in the community through project intervention will continue

ensuring healthy women in the community.

Table 5: Children Consuming Three groups of Food

Consuming three

types of food

Dalchoki

BS= 23

ES=17

Chaughare

BS=46

ES=14

Bhardeu

BS=42

ES=17

Nallu

BS=57

ES=19

Lele

BS= 160

ES=39

Total

BS=328

ES=106

Baseline 34.78% 30.43% 33.33% 24.56% 40.63% 36.28%

End line 62.96% 36.84% 54.84% 67.86% 50% 52.48%

Achievements 28.18% 6.41% 21.51% 43.3% 9.37% 16.2%

Source: Baseline Survey (BS) 2013 and Endline survey (ES) 2016

Findings: Table 5 related to children consuming three types of food, shows that Nallu has the

highest number of children consuming 3 types of food a day i.e. 67.86% and Chaughare has the

lowest number of children consuming 3 types a food a day, i.e., 36.84%. Whereas 62.96% in

Dalchoki, 54.84% in Bhardeu and 50% in Lele. In average 52.48% of mothers feed their young

children three types of food. The project had a target of achieving 66% in mothers feeding their

children three types of food. But the result was less than the target due to their shelters in the

kitchen gardens after the earthquake destroyed their houses which have not seen reconstruction

to date.

Table 6: Women that use antenatal Check-up

ANC attendance Dalchoki

BS=31

ES=27

Chaughare

BS=50

ES=38

Bhardeu

BS=51

ES=31

Nallu

BS=63

ES=28

Lele

BS=171

ES=78

Total

BS=366

ES=202

Baseline (Yes) 26(83.9%) 41(82%) 47(92.2%) 58(92.1%) 164(95.9%) 336(91.8%)

Endline (Yes) 27(100%) 37(97.37%) 31(100%) 28(100%) 74(94.87%) 197(97.52%)

Achievement 16.1 15.37 7.8 7.9 1.03 5.72


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Findings: With regard to women using antenatal check-up, table 6 shows that in the baseline

survey overall 91.8% of women visited health facilities for antenatal check-up covering 95.9% of

the respondents in Lele, 92.2% in Bhardeu, 92.1% in Nallu, 83.9% in Dalchoki and 82% in

Chaughare VDCs. Whereas the end line report shows that overall 97.52% of women

accomplished antenatal check-ups covering 100% in Dalchoki, Bhardeu and Nallu, 97.37% in

Chaughare VDCs, which is significant improvement over the baseline of women who went for

antenatal checkup. Only in Lele the percentage went down slightly with the finding at endline at

94.87%, it was because the health post was damaged and not all women had access to ANC

check-up. The result of antenatal checkups seemed satisfactory in Dalchoki, Bhardeu and Nallu

VDC. This demonstrates mothers being more concerned about their health.

Table 7 (a): Antenatal Checkup by time

Times

ANC

attaine

d

Dalchoki

Chaughare

Bhardeu

Nallu

Lele

Total

BS

(n=26)

ES

(n=27)

BS

(n=41)

ES

(n=37)

BS

(n=47)

ES

(n=31)

BS

(n=58)

ES

(n=28)

BS

(n=164)

ES

(n=74)

BS

(n=336)

ES

(n=197)

One 0% 1.30% 0% 2.54% 12.8% 0% 0% 6.16% 1.8% 1.0% 2.7% 2.2%

Two 11.5% 0% 19.5% 1.88% 4.3% 2.56% 4% 1.46% 5.3% 0% 7.7% 1.18%

Three 15.4% 3.70% 22% 5.68% 36.2% 2.84% 35.1% 5.82% 7% 4.0% 18.8% 4.39%

Four or

More 73.1% 95.00% 58.5% 89.9% 46.77% 94.6% 57.8% 86.6% 84.7% 95.0% 70.8% 92.23%

Source: Baseline Survey (BS) 2013 & Endline survey (ES) 2016

Findings: Table no 7 demonstrates the findings of both surveys regarding the number of times

women attended antenatal checkups. As per the recommendation of WHO, a pregnant woman

should go to four antenatal checkups (during 4, 6, 8 and 9 months of pregnancy). Overall,

antenatal checkups for four or more times have increased from 70.8% to 92.23 %.

The percentage of women attending four or more checkups was 95% in Lele, 94.6% in Bhardeu,

95% in Dalchoki, 89.9% in Chaughare and 86.6% in Nallu. It was found that the antenatal

checkups as recommended by WHO had increased in four years’ time.

Table 8: Place of delivery

Place of delivery

% Place

of

delivery

Dalchoki Chaughare Bhardeu Nallu Lele Total

BS

n=23

ES

n=23

BS

n=46

ES

n=38

BS

n=42

ES

n=31

BS

n=57

ES

n=27

BS

n=160

ES

n=77

BS

n=328

ES

n=196

Home 69.6% 17.14% 78.3% 40% 64.3% 17.14% 71.9% 18.57% 16.9% 7.14% 44.8% 20%

Health

Institution

30.4% 82.86% 21.7% 60% 35.7% 82.86% 28.1% 81.43% 83.1% 92.86% 55.2%

80%

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Total 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100%


Findings: Regarding the place used for delivery, table 8 reveals that in the baseline survey 147

(44.8%) mothers delivered their babies at home including 78.3% in Chaughare, 71.9% in Nallu,

69.6% in Dalchoki, 64.3% in Bhardeu and 16.9% in Lele VDCs. In the endline survey 20 % of

mothers surveyed delivered their babies at home with 40% in Chaughare, 18.57% in Nallu,

17.14% in Dalchoki, 17.14% in Bhardeu and 7.14% in Lele VDCs. This demonstrates a decrease

in the number of women delivering their babies at home (and, therefore, an increase in deliveries

at the health institutions) from the baseline survey to the endline survey. The project intends to

increase the institutional delivery with the implementation of sessions on the importance of

institutional delivery. Additionally, working in a collaborative way with the local health

institutions (HIs) to increase deliveries in the HIs and mobilization of Female Community Health

Volunteers supported the project in achieving the increase in number. Nevertheless, the increase

in number may be less than expected since some health institutions were damaged in the

earthquake, forcing deliveries at home.

Table 9: Postnatal check up Practices

PNC check-ups Dalchoki

BS=23

ES=23

Chaughare

BS=46

ES=38

Bhardeu

BS=42

ES=31

Nallu

BS=57

ES=27

Lele

BS=160

ES=77

Total

BS=328

ES=196

Baseline (Yes) 8(34.8%) 24(52.2%) 17(40.5%) 30(52.6%) 115(71.9%) 194

(59.1%)

Endline (Yes) 10(43.48%) 22(57.89%) 21(67.74%) 19(70.37%) 71(92.21%) 143(72.96

%)

Achievements 8.68 5.69 27.24 17.77 20.31 13.86

Source: Baseline survey (BS) 2013 & Endline survey (ES) 2016

Findings: In the case of postnatal check-up, table 9 shows that in the baseline survey report, a

total of 59.1% mothers went for post-natal check-ups while the endline survey report shows that

a total of 72.96% of mothers went for post-natal check-ups which is a slight increase over the

baseline. This is due to an improved awareness among mothers on health issues.

Table 10: Postnatal checkup by time

Times

PNC

attendi

ng

Dalchoki

Chaughare

Bhardeu

Nallu

Lele

Total

BS

(n=8)

ES

(n=10)

BS

(n=24)

ES

(n=22)

BS

(n=17)

ES

(n=21)

BS

(n=30)

ES

(n=19)

BS

(n=115)

ES

(n=71)

BS

(n=194)

ES

(n=143)

One 75% 30% 79.2% 52.10% 70.6% 61.90% 63.3% 57.89% 71.3% 20% 70.6% 37.06%

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Two 25% 30% 12.5% 9.13% 11.8% 23.80% 30% 15.79% 25.2% 24.28% 23.3% 25.87%

Three

or More

0% 40% 8.4% 8.69% 17.7% 14.28% 6.7% 26.32% 3.5% 55.71% 6.1% 37.05%


Findings: With regards to postnatal checkup by time, in the baseline survey, table 10

demonstrates the frequency of PNC done by women. In the baseline survey the percentage of

PNC check-up just once was 70.6%. Likewise, a total of 23.3% of women went for two PNC

check-ups. In total 4.6% of the respondents managed to make three PNC visits. Finally, only

1.5% of them made four or more PNC visits involving 5.9% of respondents in Bhardeu and 4.2%

of respondents in Chaughare VDCs.

In the endline survey, 37.06% of the respondents went for only one PNC. Likewise, a total of

25.87% of women made two PNC visits. In total 21.67% of the respondents managed to take

three PNC visits. Finally, 15.38% of the women made four or more PNC visits. This information

shows that women attending three, four or more post-natal checkups have moderately increased

in the end line over the baseline survey. The number of women attending three or more post natal

check-ups has moderately increased in the end line compared to the baseline survey. This is due

to the importance of post-natal check-ups in mothers' nutrition training.

Table 11: Perception of women in household decision making process

% of women who think their involvement for

decision making is need

perception of

women on food

purchases

perception of

women on

agriculture plan

BS (n=366) 31.7% 35.8%

ES (n=202) 39.1% 84.2%

Achievement 7.4% 48.4%


Findings: The above table interprets that the perception of women on household decision in both

food purchase and agricultural plan has slightly increased as compared to the baseline. In the

context of Nepal, the household decisions are made by the male members of the family but after

the intervention of the project, the data revealed that women are starting to perceive that they

have equal responsibility in household decisions.

Table 12: Availability of kitchen garden

Availability of

kitchen garden

Dalchoki

BS=25

ES=26

Chaughare

BS=40

ES=37

Bhardeu

BS=44

ES=30

Nallu

BS=56

ES=27

Lele

BS=151

ES= 72

Total

BS=316

ES=192

BS 80.6% 80% 86.3% 88.9% 88.3% 86.3%

ES 96.29% 97.37% 96.77% 96.43% 92.30% 95.04%

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Achievements 15.69% 17.37% 10.47% 7.53% 4.0% 8.74%


Findings: Table 12 illustrates that the availability of Kitchen Garden has increased from 86.3%

at the baseline survey to 95.04% in the end line survey. This is due to the running of the kitchen

garden training with its emphasis on locally available vegetables. Additionally, support with seed

and agriculture materials during the project period also contributed to this. Farmers were given

technical support during the four year project period.

Table 13: Using Kitchen Garden production

Using

of

kitchen

gardeni

ng

product

ion

Dalchoki

Chaughare

Bhardeu

Nallu

Lele

Total

BS

(n=25)

ES

(n=26)

BS

(n=40)

ES

(n=37)

BS

(n=44)

ES

(n=30)

BS

(n=56)

ES

(n=27)

BS

(n=151)

ES

(n=72)

BS

(n=316)

ES

(n=192)

Self-

consum

ption

only

76% 34.62% 77.5% 37.84% 93.2% 46.67% 94.6% 100% 96.7% 51.39% 91.8% 52.60%

Selling

only 16% 0% 2.5% 0.027% 4.5% 0.10% 0% 0% 0% 0% 2.2% 0.02%

Both 8% 65.38% 20% 59.46% 2.3% 43.33% 5.4% 0% 3.3% 48.1% 6.0% 45.31%


Findings: Table 13 shows the use of kitchen garden production for different purposes. In the

baseline survey, overall 91.8% of the respondents used kitchen garden production only for

household consumption incorporating 96.7% of respondents in Lele, 94.6% in Nallu, 93.2% in

Bhardeu, 77.5% in Chughare and 76% in Dalchoki VDCs. In contrast, only 2.2% of the women

utilized kitchen garden production only for selling, encompassing 16% of respondents in

Dalchoki, 4.5% in Bhardeu and 2.5% in Chaughare. Again, in total 6% made use of the kitchen

garden production for the purpose of both household consumption and selling which included

20% of respondents in Chaughare, 8% in Dalchoki, 5.4% in Nallu, 3.3% in Lele and 2.3% in

Bhardeu VDCs.

The endline survey shows a change in the use of kitchen garden production. Overall 52.60% of

the respondents used kitchen garden production for household consumption incorporating

51.39% of respondents in Lele, 100% in Nallu, 46.67% in Bhardeu, 37.84% in Chughare and

34.61 in Dalchoki VDCs. Only 0.02% of the women utilized kitchen garden production for

selling, which included 0.10% of respondents in Bhardeu and 0.027% in Chaughare. Again, in

total 45.31% made use of the kitchen garden production for the purpose of both household

consumption and selling, involving 48.1% of respondents in Lele, 43.33% in Bhardeu, 59.46% in

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Chaughare, and 65.38% in Dalchoki VDCs. The use of kitchen garden production for both

household consumption and selling has significantly increased from 6% to 45.31%.

The consumption of kitchen garden products has increased as compared to the baseline survey

due to the intervention made by way of kitchen garden training, therefore, more people have

been able to sell their production as well as use for household consumption.

Table 14: Mothers’ understanding about three groups of food

% of Mothers’

understanding of three

groups of food

Dalchoki

BS=31

ES=27

Chaughare

BS=50

ES=38

Bhardeu

BS=51

ES=31

Nallu

BS=63

ES=28

Lele

BS=171

ES=78

Total

BS=366

ES= 202

Baseline (n=366) 9.7% 6% 0% 3.2% 6.4% 5.2%

End line (n=202) 92.59% 15.79% 61.29% 82.14% 97.43% 73.8%

Achievements 82.89 9.79 61.29 78.94 91.03 68.6


Findings: Table 14 illustrates an improvement in mothers’ understanding of three types of food.

In the baseline survey, mother’s understanding about three types of food was only 5.2% and in

the endline survey, it has increased to 73.8 %. In relation to Chaughare VDC, the number of

women with knowledge of three food groups is quite less as compared to other VDCs, it is

because most of the women dropped out the nutrition sessions due to their domestic problems

(male members in the family did not support them in attending the nutrition sessions).

Table 15: Mothers’ understanding about “Sarbottam Pitho.”

% of Mothers’

understanding

sarbottam pitho

Dalchoki

BS=31

ES=27

Chaughare

BS=50

ES=38

Bhardeu

BS=51

ES=31

Nallu

BS=63

ES=28

Lele

BS=171

ES=78

Total

BS=366

ES= 202

Baseline (n=366) 58.10% 44.00% 39.20% 36.50% 56.10% 48.90%

End line (n=202) 88.89% 65.79% 83.87% 82.14% 100% 87.13%

Achievements 30.79% 21.79% 44.67% 45.64% 43.9% 38.23%


Findings: As per table 15, mothers’ understanding about Sarbottom Pitho has significantly

increased from the baseline average of 48.9% to 83.17% at endline. Almost all the women have

gained knowledge about supplementary food i.e. super flour to children under 5 years of age,

through nutrition sessions.

Table 16: Mothers’ understanding about “Posilo Jaulo.”

% Mother's

understanding of

posipo jaulo

Dalchoki

BS=31

ES=27

Chaughare

BS=50

ES=38

Bhardeu

BS=51

ES=31

Nallu

BS=63

ES=28

Lele

BS=171

ES=78

Total

BS=366

ES= 202

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Baseline (n=366) 25.8% 6% 9.8% 12.7% 22.8% 17.2%

Endline (n=202) 85.18% 68.42% 87.09% 92.86% 100% 89.11%

Achievements 59.38 62.42 77.29 80.16 78.2 71.91


Findings: Table 16 shows that mothers’ understanding about “Posilo Jaulo” has significantly

increased from 17.2% at baseline to 89.11% at endline. The practical demonstration of posilo

jaulo "rice porridge" in nutrition sessions made mothers more knowledgeable about this

supplementary food than about super flour.

Table 17: Household consuming three groups of food

% of household

consuming three

types of food

Dalchoki

BS=31

ES=27

Chaughare

BS=50

ES=38

Bhardeu

BS=51

ES=31

Nallu

BS=63

ES=28

Lele

BS=171

ES=78

Total

BS=366

ES= 202

Baseline (n=366) 58.06% 44.00% 35.30% 49.20% 38.00% 42.30%

Endline (n=202) 89.60% 87.55% 90.86% 87.74% 88.86% 88.9%

Achievements 31.54 43.55 55.56 38.54 50.86 46.6%


Findings: The average percentage of households consuming three groups of food increased from

42.3% at baseline to 88.9% at endline. It was found that the nutrition training increased the

knowledge and practice of household consuming three groups of food.

Table 18: Child weighed within one month

% of under 5 years

children weighing

last month

Dalchoki

BS=23

ES=23

Chaughare

BS=46

ES=38

Bhardeu

BS=42

ES=30

Nallu

BS=57

ES=27

Lele

BS=160

ES=76

Total

BS=328

ES=194

Baseline (n=328) 26.1% 15.2% 16.7% 21.4% 40% 29.3%

End line (n=194) 56.5% 60.5% 60% 51.85% 81.58% 67%

Achievements 30.4 45.3 43.3 30.45 41.58 37.7


Findings: The above table shows an increase in mothers' understanding about the importance of

child weighing (i.e. growth monitoring) in a regular/ monthly basis.

Table 19: Prevalence of underweight based on weight-for-age z-scores by sex

% of underweight children

(Weigh for height)

Baseline (n=336) End Line (n=186)

Boys

n = 190

Girls

n = 146

Total

n = 336 Boys

n = 92

Girls

n = 94

All

n = 186

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Prevalence of underweight 25.8 % 28.1 % 26.8 % 19.6 %

18.1 %

18.8 %

Prevalence of moderate underweight 21.6 % 22.6 % 22.0 % 12.0 %

13.8 %

12.9 %

Source: Baseline Survey 2013 and Endline survey 2016

Findings: The above table shows that the percentage of moderately underweight children under 5

have considerably decreased from 22 % at baseline to 12.9 %. This is due to the active

participation of mothers in nutrition trainings making them aware about healthy eating habits.

Focus Group Discussion (FGD)

A) Male Members:

With the aim of finding the involvement of male members in household activities, inclusion of

female members in decision making, sense of responsibility toward their family members,

knowledge on nutritional foods they give their children and the health status of their family

members, the survey team conducted focus group discussions with the male members in the five

VDCs and had the following response.

In the issue of involving women in decision making, all the participants said that women should

be involved in decision making because most of the household activities are carried out by them

including managing food for children and taking care of children.

In relation to their knowledge on nutritional food and its need to women, most of the participants

said that nutritional food meant three types of food (i.e. carbohydrate, protein and vitamin). They

also said that they eat three types of food regularly. Only a few participants indicated that they

knew about nutritional food without being able to categorize them while a small number of

participants knew nothing about nutritional food. Most of the participants felt that women were

physically weak because they had given birth and needed nutritional food. Only a few of them

thought that women needed nutritional food without any information or reason to support this

claim.

In relation to the issue of children’s need on nutritional food, most of the participants responded

that the children needed nutritional food because it helped their physical and mental growth and

development. In relation to feeding their children most of the respondents said that it was the

mothers who fed their children. A few of them said that whoever was available in the house fed

the children and in average, they fed their children around 3 to 5 times a day.

Following the discussion on their knowledge on nutrition and child care, most of the participants

stated that men should also know about nutrition and child care because men also have to feed

their children and to avoid malnutrition in their children.

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Finally, talking about the health status of mothers and children; and their work in improving their

health, most of them said that the health status of mothers and children had improved as

compared to the time before the project intervention, because of adequate use of health facilities

and their awareness about nutrition and sanitation. Only a few of them have seen a few cases of

poor mother and child health in their VDCs. In order to overcome this most of them suggested

conducting more awareness program in health and sanitation.

B) Income generating Groups (IGG):

Focus Group Discussions were carried out with income generating groups in the five VDCs of

Dalchoki, Nallu, Bhardeu, Chaughare and Lele which are located in the central/southern part of

Lalitpur district. These discussions were focused on finding out how the community people used

the grant they received from RICOD and whether this grant supported them to enhance their

standard of living, whether it helped them improve their children’s health. The outcomes are

stated below.

In relation to the question on the grant that they received, most of the participants responded that

they had invested the grant in ways that would enhance the quality of life and was sustainable,

i.e., by buying goats and buffalos they became more self-reliant. A few of them invested the

grant money in agriculture/cultivation and expanding their businesses.

Most of the participants responded that because of the earnings from the self-sustaining activities

like raising goats, buffalos and their business supported them in meeting their household

expenses, like, children’s school fees, daytime snacks for them & school uniforms, a few of the

respondents had spent their earning on religious activities whereas a few of the participants

responded that they had been able increase their savings in cooperatives as a result of their

earnings.

Finally, to the question on improvement in children’s nutrition health, all the participants

responded that as a result of their earnings from the income generating activities they were able

to purchase nutritional food for their children which improved the children’s health. Last and the

most important response was that all the participants had become economically independent.

C) Early Childhood Development (ECD) teachers:

Focus Group Discussion was conducted with the ECD teachers of the five VDCS of Lalitpur

District. The main focus of this programme was to know the impact of lunch facility provided to

the children and their plan on providing lunch facilities after the completion of the project.

General outcomes of the lunch facilities and its impacts are given below.

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All the participant schools are running ECD classes. In average, Bhardeu and Nallu have the

same number of children attending ECD classes, i.e., 25 to 30. Whereas, Chaughare, Lele and

Dalchoki have the same number of children attending ECD classes, i.e., 20 to 25. In relation to

the question of student’s regular attendance, most of the participants said that the reason behind

their regular attendance was the provision of lunch and parents’ awareness regarding school

education. All the participants responded that children would not carry lunch with them because

of the provision of day snack which is supported by the school.

In relation to the question of changes they had seen in children because of lunch facility, most of

the participants said that there were plenty of changes like: that they found the children to be

energetic, enthusiastic to learn and healthier as a result of getting nutritious and hygienic food.

Some of the participants said that they were regular in their classes. A few of the participants

responded that it helped them to prevent malnutrition.

Finally, to the question of managing lunch facility after the completion of this project, most of

the participants said that they were planning to request the guardians/parents to manage lunch for

their children. Some of them were planning to request RICOD to continue with this project, a

few of them were planning to request the school management committee to manage and make

arrangements for food. And a very few of them responded that they were undecided as to what

their next steps would be.

Case Studies:

Case Study I: Upliftment of health and economic status through Kitchen gardening

My name is Kalpana Lama. I live with my family in Bhardeu VDC ward no. 5, Kunnekali tole.

I have seven members in the family including myself. They are my father-in-law, mother-in-

law, husband, son and two daughters. Agriculture is our main occupation. We own four

“ropanies” of land where we used to grow routine crops like rice, maize, etc. But after hearing

about the Improving Mother and Child Nutrition Project (IMNCP) by RICOD, I got an

opportunity to join a Mother’s Group where we used to discuss about mother and child health,

monthly saving and credit investment, agriculture and other issues in the community. Besides,

helping us with knowledge in nutrition and support in income generation, these meetings

helped to increase harmony in our society.

I participated in kitchen garden training which helped us with the introduction of the latest

agriculture technologies and with material support like water sprayer, drum, and ten different

vegetable seeds to increase agriculture productivity. Before this programme, I didn’t have the

practice of vegetable farming, but now my family members and I consume different types of

vegetables in each meal and at the same time I have been able to sell these vegetables in the

market. This has resulted in improving our economic as well as health status. The organization

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taught us to prepare organic fertilizer by using locally available herbs and cow dung. I have

two cows, four goats and ten chickens, which is my additional source of income for my family.

I prepare organic fertilizer by mixing cow dung and local herbs. Now, I have totally stopped

using chemical fertilizers. This project has taught me and my family about nutrition and the

immense effect of vegetable production.

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Case Study II: Nutrition training changed the perception and eventually upgraded me and my

child’s nutritional health

My name is Srijana Syangtan. I live in Dalchoki VDC ward # 8, Lalitpur, Nepal. I live with ten

family members. My mother-in-law, sister-in-law, five nephews, my husband and my son. I

was very interested in studies since my childhood. Later, my parents (mother and father) went

abroad (Gulf Country) for their earnings. I used to live with my elder brother, but he too went

to Kathmandu when I was just 15 years old. At that time, I was in class 8. I had no guardian to

give me guidance in my studies or life in general. Eventually, I eloped with a boy who was at

the intermediate level his studies. This happened because I had no guidance and was influenced

easily by my friends and at the same time I used to feel very lonely. In the initial stages of my

marriage, our relation was good, but later we were not getting along with each other.

It was during this time I met Sushmita (the field facilitator in Dalchoki) who was the employee

of RICOD. She inspired me to participate in all the ten sessions of nutrition training given by

RICOD though I met her in the fifth session of the training. I started to participate from the

fifth session training because in the beginning my husband did not want me to participate in the

mothers' nutrition training. I was able to attend only after she started convincing my husband to

allow me to participate in the nutrition sessions. And one day Sushmita made time for me to

informally talk about the first four sessions I had missed and its importance on mother and

child nutrition. I didn’t know about risks of delivering babies at home, but I delivered the child

at the health institution. I gave birth to a son in the health post and started eating green leafy

vegetables during lactating period as Sushmita suggested. Additionally, I immunized my child

and got more concious about exclusive breastfeeding, and I regularly monitored the growth of

my child. I gradually provided my knowledge on nutrition to my husband and he became

convinced and now encourages me to eat nutritious food during lactating period.

One year later, I told Sushmita about my interest in studies. For this also she was able to

convince my husband to allow me to continue with my studies. Then, she admitted me in a

nearby school in class 8 and managed all the needed stationery. I was very happy to continue

my studies with the support of the teachers in the school. No sooner had I been admitted to

class 8, I appeared in the final examination and was upgraded to class 9. Gradually, my

husband started supporting me for my studies though it was not acceptable to the other

members of my family. I wasn’t able to manage my time for class as my husband had to work

for the whole day, and I had to look after the baby and other household activities. Now, I’m in

class 10 and not regular in class. My husband has just gone abroad, and our baby is 1 and a half

year old. He weighs 12 kg. And that is the normal weight for the child. This is because the

nutrition sessions helped me to track the growth of my child and gave knowledge on

complementary feeding practice to the child.

Finally, I realized that we have to have knowledge on nutrition and its importance to our

health. Later I realized that knowledge is a crucial factor in improving one’s health. I also hope

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to complete my higher studies. I’m very thankful to Sushmita and RICOD for showing the way

and making my life easy.

5. CONCLUSION:

The project was launched for the improvement of the health status of women and children.

From the baseline survey to the endline survey, effective programme activities on health status

have been carried out i.e. 10 nutrition sessions training, Kitchen Garden training, Income

generating Grant support, day snacks to Early Childhood Development center. The overall

result reveals that the interventions have had a significant impact. The availability of nutritious

food is also increasing due to the training on kitchen gardens and support for income

generation. The overall outcome reveals that the respondents are aware in health related issues

i.e. ANC, PNC, place of delivery, etc.

The literacy level has significantly increased from the time of the baseline survey to the

endline survey. The practice of ANC in newly married young women is very high as

compared to other age groups. So, young literate women are highly conscious. But the lack of

infrastructure, absence of human resources in health institutions, lack of road and

transportation facilities directly affect the increase in post-natal check-up.

The situation of women’s empowerment in the target area has increased with regards to

decision making practice and the knowledge on mother and child to consume three types of

food for nutrition and use of kitchen garden products. Women’s practice and knowledge about

Sarbottam Pitho (super flour) and Posilo Jaulo (rice porridge) is higher from baseline to

endline.

Following the intervention of the project, a very few children have severe malnutrition.

All in all, most of the targeted groups of five VDCs have been fully covered, and the result

overall shows a significant improvement in the areas the project intended.

6. Recommendation:

✓ Frequent meeting with school management committees and parents should be done to

manage day snacks.

✓ Regular advocacy with VDC should be done to allocate budget for day snacks support to

ECD center.

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✓ The practice of giving all three types of foods to children is considerably low. To address

this, the same intervention program regarding the production and use of all three types of

food items is to be encouraged.

✓ Despite an increment in health institution deliveries, more advocacy and mobilization of

FCHVs (Female Community Health Volunteers) is highly suggested.

✓ Mobilization of FCHV in each mothers' group monthly meeting to demonstrate on the

importance of three food groups is highly suggested.

✓ Awareness programme for the male members of the family on the importance of post natal

checkups is required so that men help their wives who have delivered recently to visit health

institutions. (Such as- carrying a woman who has recently delivered on a stretcher or call for

help).

✓ A program to encourage women’s decision making on food purchase and agriculture plan is

highly recommended.

Annex-1

SN Name Role for Survey Institution

1 Bharat Prasad Badal, Ph. D Survey Coordinator Jana Bhawana Campus

2 Shankar Sigdel M.Phil Supervisor Jana Bhawana Campus

3 Honey Gurung Supervisor RICOD (Improving

Mother and Child Nutrition

Project)

4 Sujan Lama, Susmita Dulal,

Nawaraj Ghimire, Dinesh Dahal,

Durga Tamang,(FFs) Ganesh Pd.

Bhatta (TSS), Bikash Ghimire (PE),

Anistha Dahal (PE)

Enumerator RICOD

5 Pratik Silwal, Kopila Humagain,

Anamika Nagarkoti, Samita

Dangol, Nirmala Nagarkoti, Merry

Lama, Yashoda Kunwar, Renuka

Timalsina, Karuna Ghimire, Bimala

Baniya & Amita Nagarkoti

Enumerator JBC

6 Mr. Shiva Raj Sanjel, Campus

Chief, Jana Bhawana Campus

Monitoring JBC

7 Mr. Ram Hari Ghimire, Executive

Director, RICOD

Monitoring RICOD

FFs- Field facilitators, TSS- Technical Support Staff, PE – Peer Educator

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Annex-2

SN. Activities Date

1 Team selection meetings November 1st week

2 Training, questionnaire orientation and finalization November 2nd week

3 Field survey November 2nd & 3rd week

4 Data Entry and analysis November 3rd & 4th week

5 Report writing 1st draft December 1st week

6 Report finalization February 4th week

7 Report printing and publication March 3rd week

8 Report dissemination March 4th week

***

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