MICS4 Survey Design Workshop Multiple Indicator Cluster Surveys Survey Design Workshop Questionnaire for Children Under Five: Breastfeeding

MICS4 Survey Design Workshop WHO/UNICEF Feeding Recommendations Exclusive breastfeeding for first six months Continued breastfeeding up to two years and beyond Safe, appropriate and adequate complementary foods beginning at six months Frequency of complementary feeding: –Breastfed: 2 times per day for 6-8 month olds; 3 times per day for 9-23 month olds; –Non-breastfed: 4 times per day for 6 – 23 months

MICS4 Survey Design Workshop Background information Indicators: Revised set of global indicators (2008) MICS4 adapted accordingly (a few exceptions flagged later) Module: All (living) children <5 years Current status --24 hours preceding interview

MICS4 Survey Design Workshop Caretakers are asked about the following for each child under five –Whether child was ever and is currently breastfed –Was the child was fed and liquids or foods in the preceding 24 hours –Types of liquids –Types of milk products and number of times consumed –Number of times non-liquid foods Breastfeeding Module

MICS4 Survey Design Workshop Infant and young child feeding (IYCF) indicators in MICS Exclusive breastfeeding (< 6 months) Continued breastfeeding (at one year and at two years) Predominant breastfeeding (<6 months) Duration of breastfeeding Bottle feeding Introduction of solid, semi-solid or soft foods Minimum meal frequency (for breastfed children and for non-breastfed children) Age-appropriate breastfeeding Milk feeding frequency for non-breastfed children Note that early initiation of breastfeeding and children ever breastfed calculated from Maternal and Newborn Health Module

MICS4 Survey Design Workshop Exclusive breastfeeding (<6 months) # 2.6: Proportion of infants 0–5 months of age who are fed exclusively with breast milk –Includes breast milk from bottle, wet nurse –Includes vitamins, medicines, ORS –Based on previous 24 hours –Related indicator: # 2.9: Predominant breastfeeding under 6 months

MICS4 Survey Design Workshop Continued breastfeeding # 2.7: At one year: Proportion of children 12–15 months of age who are fed breast milk # 2.8: At two years: Proportion of children months of age who are fed breast milk –Includes breast milk from bottle, wet nurse –Related indicator: Duration of breastfeeding

MICS4 Survey Design Workshop Introduction of solids, semi-solid or soft foods # 2.12: Proportion of infants 6–8 months of age who receive solid, semi-solid or soft foods –Substituted for timely introduction of complementary foods –Based on all infants age 6-8 months –Narrow age range = larger confidence intervals –Related indicator: Bottle feeding

MICS4 Survey Design Workshop Minimum meal frequency # 2.13: Proportion of breastfed and non-breastfed children 6–23 months of age who receive solid, semi- solid, or soft foods the minimum number of times or more –Two separate indicators (proxy for energy intake) –For non-breastfed children includes milk feeds –Minimum number of times varies by age, breastfeeding status

MICS4 Survey Design Workshop Other indicators # 2.14: Age-appropriate breastfeeding –Proportion of children 0–23 months of age who are appropriately breastfed <6 months exclusively breastfed 6-23 months breasfed and consuming foods # 2.15: Milk feeding frequency for non-breastfed children –Proportion of non-breastfed children 6–23 months of age who receive at least 2 milk feedings

MICS4 Survey Design Workshop Methodological issues Local adaptation of liquids necessary (including appropriate local terms) MICS does not include questions on dietary diversity –Minimum dietary diversity –Minimum acceptable diet –Consumption of iron-rich or iron-fortified foods

Infant feeding area graph example MICS4 Survey Design Workshop

Infant feeding area graph example MICS4 Survey Design Workshop

Prepared by: Holly Newby Statistics and Monitoring Section UNICEF/New York