An interesting finding

The workshop I taught in Ethiopia was participatory, and in the middle of it we went to the field to collect data for 2 days. We interviewed mothers of positive deviant (PD) children (WAZ>-1 for you nutrition techies out there!) and mothers of children that were at least moderately malnourished (WAZ<-2). A positive "deviant" child is a child that for some "unexplained" reason is growing well, or relatively well, in the midst of a village of malnourished children. Our research interviews were focused on discovering those "unexplained" reasons, at least as they pertain to child feeding practices, child care and health seeking practices, and psychosocial factors. One of our most surprising findings was that children that were currently breastfeeding were MORE LIKELY to be MALNOURISHED! WHAT! Isn't breastfeeding supposed to be good for babies?

But when we looked at this result in the context of the families we interviewed and the breastfeeding practices of the area it made more sense. The international recommendations are for children to breastfeed until age 2 (unless the mother is HIV+ and then recommended to exclusively BF only until the baby is 6 months). The average age of our subjects was 33 months (range 12-59m), and 78% of the malnourished kids were BF, while only 47% of the PD kids were BF. So that's alot of older toddlers nursing. As we discussed this phenomenon we discovered that there were also several "older" kids that were ONLY nursing, and not eating any solid foods or hardly any solids! OK, now that's a major problem! Our assessment was that there was a severe mismanagement of breastfeeding going on, for reasons we could only guess why (lack of knowledge, lack of foods to offer for complementary feeding, believing breastmilk was enough, etc). So the plan of action is to start with getting correct information about breastfeeding and introduction of complementary foods out there. Whew! What a crazy situation!

Back by popular demand

I got back from Ethiopia last Saturday. It was a great trip - the food was wonderful! I really got the hang of scooping up the stew-like wats with pieces of the injera bread. Did you know that Ethiopians saying the Lord's Prayer pray "give us this day our daily injera...?" Pretty cool! I also loved the coffee. The traditional macciato of concentrated coffee poured into steamed milk. So yum! Reminded me of Peruvian style coffee. I got to attend a coffee ceremony (basically a group of people hanging out and making coffee) and they let me roast the beans. I had to consistently push back and forth with a metal tool (kind of like sauteeing) the beans on a hot sheet of metal over a coal fire until they turned a dark roasted brown color. A little tricky in the dark (the electrical power was often out)! Fortunately the true coffee bean roaster was looking over my shoulder to make sure I didn't burn them. Traditionally they crush the beans in a mortar and pestle contraption but this shop actually had an electric grinder (the power went back on). And then they boil the coffee grounds and water together in a clay pitcher over the coal fire and place it on your table when it's ready. Then a lady of the table (they chose me again for this role)pours it into the tiny cups (about 3 oz). I managed to pour at least an ounce on the table too (oops!)

Ethiopia- here I come!

It's hard to believe that in one week from today I'll be in Addis Ababa, Ethiopia! I'm headed out there to train local FH staff in a workshop called Local Determinants of Malnutrition. Over the course of 8 days we'll learn the ins and out of a questionnaire our DC Health Director (Tom) designed, use it to conduct interviews and collect data, look for significant variables that may be factors related to malnutrition or positive deviance, and then make an action plan to apply what we learn to upcoming health program activities. Last week I was a bit more apprehensive because I still hadn't mastered the statistical analysis program that we'll be using (and that I need to be explaining!). But after an internet session with Tom (he only works virtually in DC) my "confidence (interval)" rose considerably! (How's that for cheesy!) It's exciting and timely material as Ethiopia will be starting a new Child Survival program if the grant gets approved. I just hope that they will be able to understand my American accent, that I'll remember to speak SLOWLY, and that I can understand their accent as well!