Indonesia: Improving Weaning Practices



The Weaning Project in Indonesia (Proyek Pola Makanan Pendamping ASI or PMPA) was a pilot effort to examine the role that enhanced communication could play in strengthening the impact of the national nutrition program (UPGK) to improve child feeding practices at home. The purpose of the project was to help reduce infant mortality through improvements in the nutritional status of infants and young children by assisting in the development of an infant feeding policy. The project utilized existing programs to promote low-cost, sustainable solutions to problems faced in feeding the weaning-age child in different ecological and socio-economic situations.

The project developed and tested a methodology to assess weaning practices and explore alternatives that could be applied in existing programs. The project also produced information and analysis on weaning practices, the variables affecting these practices and the potential for changing detrimental practices. Province-specific strategies were formulated, implemented and evaluation in East Java and Nusa Tenggara.

The assessment phase—qualitative research

Manoff managed a formative field study in several semi-urban and rural villages with mixed ethnic groups, combining market, anthropological and nutritional investigation techniques to assess and document current nutritional status and feeding practices and trends and the causes for them:
  • Literature and statistical reviews, focus group discussions and in-depth ethnographic interviews with households and key informants helped identify problems
  • Food availability, household income, mothers' time use and work as well as family/community access to media were examined
  • Household trials explored families' ability and willingness to change practices, while focus groups obtained reactions to the most successful trial concepts and behaviors from those who did not participate in the trials
  • A series of thirteen recommendations resulted from the assessment

Targeted communication/competency-based training

Staff established a pilot project that focused on the creation, dissemination and evaluation of education and communication material. Five streams of information were identified by audience target and were implemented:
  1. Administrative
  2. Providers
  3. Community Leaders
  4. Warung Operators (shopkeepers)
  5. Radio
They were chosen because they reflected the most influential information sources for mothers and community members.

Materials included training packages on healthy weaning practices targeting health providers such as community health workers and TBAs, community leaders, women's groups and shopkeepers. A special module on the development of communication skills was created for health center staff.

Educational materials, such as counseling cards and cassettes, were developed and disseminated. All of the material were pre-tested and revised. Supportive educational material for the media on healthy weaning, such as radio spots, program jingles and newspaper supplements were also developed and disseminated.

Cassettes were produced for use by community and religious groups to encourage the discussion of weaning concepts. Special posters and recipe leaflets were created for shopkeepers.

Results

The evaluation compared baseline knowledge, practices, dietary intake and nutrition status before and after the project by using mother and provider surveys. Participants were selected at random and interviewed by locally trained enumerators.

The evaluation showed a high degree of improvement in knowledge and practices among the providers and mothers, which led to an improvement in healthier weaning practices with the young child.