NOURISH PROJECT MID-TERM SURVEY REPORT Cooperative Agreement No: AID-442-A-14-00006 March 2018 Photo by Igor Dashevskiy NOURISH Mid-term Survey Report ii | P a g e March 2018 NOURISH Project Save the Children No. 5, Street 242, Sangkat Chaktomuk Daun Penh, Phnom Penh, Cambodia Disclaimer: This document is made possible by the generous support of the American people through the United States Agency for International Development (USAID) under Cooperative Agreement No. AID-442-A-14-00006. The contents are the responsibility of Save the Children and do not necessarily reflect the views of USAID or the United States Government. Led by Save the Children, NOURISH is implemented in Cambodia in partnership with five local and international partners: Operations Enfants du Cambodge, Partners in Compassion, SNV, The Manoff Group, and Wathnakpheap. NOURISH Mid-term Survey Report iii | P a g e EXECUTIVE SUMMARY Background: This document reports the findings of the United States Agency for International Development (USAID) and United States Presidential Initiative Feed the Future (FTF)-supported NOURISH Project cross-sectional mid-term evaluation. The NOURISH Project seeks to reduce the proportion of children in Cambodia who are stunted and to begin to break the intergenerational malnutrition cycle and halt productivity losses. NOURISH works to accelerate stunting reduction by focusing directly on the causal factors of chronic malnutrition specific to Cambodia: lack of access to diverse and quality food, lack of adequate feeding and care practices and unsanitary environments. Survey Design and Methodology: The mid-term evaluation captures data on the nutritional status of children and behaviors related to the three pillars of the project’s approach to integrated nutrition: health, water, sanitation and hygiene (WASH) and agriculture. The sampling frame was caregivers of children under five years in the NOURISH Project area. This differs from the baseline survey, which included data on the nutritional status of both women of reproductive age and children under five. Where possible, findings from this mid-term are compared to those at baseline. At end-line in December 2018, a more comprehensive survey will be done that will allow comparison of impact and outcome for both women of reproductive age and children between baseline and end-line. The end-line survey will also compare findings among caregivers of children between mid-term and end-line. The survey received approval from the National Ethical Committee for Health Research in Cambodia in 2015 and the Save the Children Ethical Review Board in 2015 and 2017. All procedures followed ethical standards to ensure that participation was informed and voluntary, while maintaining confidentiality at all stages. Selected through a competitive bid process, the local consulting firm SBK Cambodia collected the mid-term data in November 2017. The cross-sectional survey sampled respondents from 90 villages across the NOURISH Project target area that were randomly selected from those that had NOURISH interventions during June 2014 – September 2016. They were selected from villages across three project-supported provinces of Battambang, Pursat and Siem Reap to reach a sample of 700 respondents – all of which were caregivers/mothers of children under five. Mid-term survey data collection was done using tablets with the help of Kobo toolbox software. Field data collection took place in November 2017 in all three provinces following a 2-day training of the data collectors. The survey used a multi-stage cluster methodology using communes and villages: 30 communes were randomly selected from the three provinces, proportionate to population size. From these communes, 90 villages were randomly selected again based on the population distribution. Data were sampled to represent the full project area and are not for province-specific disaggregation. Respondents were randomly selected from household lists managed by Village Chiefs. The sample size was calculated for 95% confidence intervals on key variables. The total sample of 755 mothers/caregivers of children aged 0- 59 months exceeded the planned number of 700. To properly capture data on child feeding the survey purposely oversampled children under six months of age. As a result, following standard Cambodia Demographic and Health Survey (CDHS) methodology anthropometric data of children 0-59 months were weighted to reflect the normal distribution of ages in the population of children under five years. Data collection tools utilized validated CDHS questions and Feed the Future guidance, combined into the following modules: Mother and Other Children Caregiver Questionnaire Modules  Demographic characteristics  Anthropometry of children 0- 59 months  Child care  Infant and Young Child feeding  Water, hygiene and sanitation (WASH)  Homestead agriculture  Exposure, participation and motivation following “Grow Together” stunting prevention campaign NOURISH Mid-term Survey Report iv | P a g e Data were entered and analyzed in SPSS except anthropometric data on weights and heights. Anthropometric data were entered and analyzed in WHO’s Anthro software and then exported into SPSS 23.0 for combined analysis1. In line what is rapidly becoming the standard of practice due to the time and costs savings and error reduction associated with their use, data was collected on tablets and was later checked and cleaned. Mid-term Surveys Summary Results: NOURISH 2017 mid-term survey demonstrated progress made across many areas of project interventions measured by key standard output indicators in health/nutrition, WASH and agriculture. Having its main focus on chronic malnutrition, the survey also revealed significant change in its core impact indicator: prevalence of stunting among children under five decreased from 34.3% at 2015 NOURISH baseline to 28.6% at 2017 NOURISH mid-term. There was no change in undernutrition and wasting prevalence, which was surprising given the reduction in stunting and will be further explored. Indicators NOURISH 2015 Baseline (N=764) NOURISH 2017 Mid-term (N=755) Prevalence of stunted children under 5 years of age* 34.3% 28.6% Prevalence of exclusive breastfeeding of children under 6 months 77.8% 78% Prevalence of children 6-23 months receiving a minimum acceptable diet 25.5% 26.5% % of children age 9-11 months who received enriched solid, semi￾solid, or soft foods with frequency in the last 24 hours* 46.3% 73% % of households (with children under 5) using an improved latrine*** 37% 59% % of households (with children under 5) practicing correct use of recommended household water treatment technologies*** 66.1% [71.9% with bottled water] 77.2% [85.8 with bottled water] % of households (with children under 5) with soap and water at a hand washing station used by family members*** 67.9% 89.8% % of caregivers of children under 2 years disposing of infant stool appropriately*** 59.5% 82.2% Home gardens with nutrient-rich vegetables among households with children under 5* 49.5% 58.4% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01children by integrating health and nutrition, WASH and agriculture interventions for the benefit of Cambodia ***Statistical significance at 0.1% level, P<0.001 While the mid-term survey findings show some promising results, they also highlight the need for continued efforts to improve nutrition of children. 1 http://www.who.int/nutgrowthdb/software/en/ NOURISH Mid-term Survey Report v | P a g e ACKNOWLEDGEMENTS The mid-term survey design, analysis and reporting was led by Math Srales, Monitoring and Evaluation (M&E) Specialist of NOURISH/Save the Children with support from Carolyn O’Donnell, Save the Children Nutrition Advisor and Caroline Blair, Consultant, who assisted with the design of the analysis plan for the exposure section of the report, and wrote the final study report. The NOURISH baseline survey required the coordinated efforts of many people. Special words of appreciation go to SBK Research and Development, the consulting company contracted by Save the Children to conduct the survey. We express our thanks to SBK team leaders, interviewers, and management team for actively participating in the training and survey revisions, facilitating evaluation discussions with local leaders, coordinating administrative and logistical aspects of the survey fieldwork and diligently cleaning all of the data and creating output tables. In addition, the survey team extends its gratitude to all those who were involved in the survey including:  Larry Dershem, Save the Children US M&E Advisor, for technical guidance and input into sampling, comments on questionnaire drafts, valuable comments on this report and steadfast support;  Khaim Sophornn, SNV WASH Specialist for training data collectors on WASH indicators;  Sunetra Lala, SNV WASH Sector Lead for the review of the WASH portion of the report;  Lisa Sherburne and Melissa Antal, The Manoff Group for the review of the report with a special focus on the SBCC Campaign exposure section of the report. Our thanks are also extended to NOURISH finance staff and provincial teams for strong support to arrange for and support data collection, organize logistics and many other aspects of the survey. We also thank Provincial Departments of Health and Provincial Departments of Rural Development, Operational Districts, Village Chiefs and Village Health Support Groups (VHSG) for supporting the survey planning and implementation. Last but certainly not least, to the caregivers who graciously gave of their time, knowledge, and energy by participating in the survey, we thank you. Without this participation and commitment to well-nourished children, the mid-term survey would not have been possible. NOURISH Mid-term Survey Report vi | P a g e ACRONYMS ANC Antenatal Care BFCI Baby Friendly Community Initiative BMI Body Mass Index CARD Council for Agricultural and Rural Development CCT Conditional Cash Transfer CDHS Cambodia Demographic and Health Survey CLTS Community Led Total Sanitation ECCD Early Childhood Care and Development FTF Feed the Future GMP Growth Monitoring and Promotion IDA Iron Deficiency Anemia JMP Joint Monitoring Programme for Water Supply and Sanitation M&E Monitoring and Evaluation MAFF Ministry of Agriculture, Forestry and Fisheries MOH Ministry of Health MRD Ministry of Rural Development NECHR National Ethics Committee for Health Research ODF Open Defecation Free PHD Provincial Health Department RUA Royal University of Agriculture SAM Severe Acute Malnutrition SBCC Social and Behavior Change Communication SBK SBK Research and Development Consulting Firm SD Standard Deviation UNICEF United Nations Children’s Fund USAID United States Agency for International Development VHSG Village Health Support Group VIP Ventilated Improved Pit latrine WASH Water, Sanitation and Hygiene WHO World Health Organization WRA Women of Reproductive Age NOURISH Mid-term Survey Report vii | P a g e TABLE OF CONTENT EXECUTIVE SUMMARY ..................................................................................................... iii ACKNOWLEDGEMENTS................................................................................................... iv ACRONYMS..................................................................................................................... vi TABLE OF CONTENT ...................................................................................................... vii INTRODUCTION .............................................................................................................. 1 Nutrition Situation in Cambodia ............................................................................................... 1 Summary of Factors that Drive Nutritional Status ..................................................................... 2 Overview of the NOURISH Project.......................................................................................... 3 METHODOLOGY .............................................................................................................. 6 Sampling.................................................................................................................................. 6 Data Collection and Analysis.................................................................................................... 7 Ethical Considerations.............................................................................................................. 8 Limitations............................................................................................................................... 9 FINDINGS ....................................................................................................................... 10 Socio-Demographic Characteristics........................................................................................ 10 Health and Nutrition.............................................................................................................. 13 Water, Sanitation and Hygiene (WASH) ................................................................................. 22 Agriculture ............................................................................................................................ 26 Exposure, Participation and Motivation to Take Actions .......................................................... 27 FINDINGS AND RECOMMENDATIONS ............................................................................ 31 ANNEX I: Data Collection Protocol .................................................................................... 34 ANNEX II: NOURISH Villages Selection by Provinces, Districts, Communes.............................. 38 ANNEX III: Data Tables..................................................................................................... 40 ANNEX IV: Questionnaire ................................................................................................. 86 NOURISH Mid-term Survey Report 1 | P a g e INTRODUCTION Nutrition Situation in Cambodia Despite steady economic growth in Cambodia since the mid-1990s, and some positive trends, malnutrition remains high. Malnutrition has serious human development and economic consequences. Stunting, the most common form of malnutrition in Cambodia, undermines children’s health, impacts children’s cognitive development, and reduces lifetime earnings. Cambodia’s Council for Agricultural and Rural Development (CARD) and UNICEF estimate that stunting alone costs approximately USD $120 million annually in lost gross domestic product.2 The 2014 Cambodia Demographic and Health Survey (CDHS) found that 14% of women of reproductive age (WRA, 15-49 years) were underweight; young women 15-19 years of age have the highest underweight prevalence (28%).3 Among those births for which the mother was able to report the baby’s weight, 8% of children had a low birthweight under 2.5 kg. Approximately half of women was anemic; 45% of WRA and 53.2% of pregnant women had anemia.4 The causes of anemia in Cambodia include genetic hemoglobin disorder and iron deficiency anemia.5 Nearly one in three (32.4%) children under the age of five is chronically malnourished, or stunted. Stunting is highest in rural areas (34.3%) and in children of families in the poorest quintile (42%). Although not as high as stunting, one in four children (24%) under five years is underweight and one in 10 children (10%) is wasted with low weight-for-height. Two percent of children under five years has severe acute malnutrition (SAM) or severely low weight-for-height. See Figure 1. Over half (56%) of children 6 to 59 months of age is anemic and 66% is iodine deficient.6 2 Bagriansky J., et al. The economic consequences of malnutrition in Cambodia, more than 400 million US dollar lost annually. Asia Pac J Clin Nutr 2014;23(4):524-531. 3National Institute of Statistics, Directorate General for Health, and ICF International, 2015. Cambodia Demographic and Health Survey 2014. Phnom Penh, Cambodia, and Rockville, Maryland, USA: National Institute of Statistics, Directorate General for Health, and ICF International. 4 CDHS 2014. 5 Karakochuk C., et al. Genetic Hemoglobin Disorders Rather Than Iron Deficiency Are a Major Predictor of Hemoglobin Concentration in Women of Reproductive Age in Rural Prey Veng, Cambodia. The Journal of Nutrition: Community and International Nutrition. 2015. 6 CDHS 2014. Figure 1 Trends in Child Malnutrition in Cambodia NOURISH Mid-term Survey Report 2 | P a g e Summary of Factors that Drive Nutritional Status Determinants of undernutrition are multi-faceted. Immediate causes of undernutrition are inadequate dietary intake and diseases. Underlying causes are multi-sectoral encompassing maternal and infant and young child feeding and care; health services; water, sanitation and hygiene (WASH) environment and practices and a lack of sustainable household food security.7 Health and Nutrition: Health service utilization during pregnancy and childbirth have shown significant improvement since 2000. The 2014 CDHS found that 73.9% of rural women who had a live birth in the past five years had at least four antenatal care (ANC) visits; 77.5% of rural women start ANC in the first trimester. Through ANC services, nearly all women (96%) reported taking iron supplements and 76% reported completing the course of 90 or more tablets during pregnancy. Nearly all (95%) pregnant women were weighed and 72% received deworming as part of ANC. Most births (83%) were in a health facility. Child health service access and utilization have also improved. CDHS 2014 found that 73% of children age 12-23 months was fully immunized and 70% of children 6-59 months received Vitamin A supplements in the past six months. Sixty-five percent of children under six months was exclusively breastfed overall; children in rural areas, poor households and with mothers with lower education were significantly more likely to be exclusively breastfed and to breastfeed longer. However, only 30% of children 6-23 months received a minimum acceptable diet, meaning that the child received the minimum feeding frequency and minimum dietary diversity, as appropriate for her or his age.8 Rural and the poorest children were two and four times less likely to receive the minimum acceptable diet, respectively. Secondary analysis of the Cambodia DHS show that children who ate animal source foods were less likely to be stunted. 9,10 Water, Sanitation and Hygiene (WASH): CDHS 2014 (which sampled households with women of reproductive age and children under five) found that 67% of rural households used an appropriate method of water treatment, primarily boiling (55%) or filtering (17%). Nationally, 39.7% of rural households had an improved latrine, 9% used a shared latrine, 1% had an unimproved latrine and 50.4% openly defecate. Over two-thirds (70.6%) of households with children under five years reported disposing infant’s feces hygienically. 11 Most rural households (77%) had a place for handwashing (although not a designated separate handwashing station) with water and soap. Agriculture: Despite improvements in household food access and food consumption, the poor quality of diet remains the main factor responsible for undernutrition in Cambodia.12 The vast majority of dietary energy comes from white rice. Food security constraints include low agricultural productivity and diversification, limited access to and unsustainable use of resources, landlessness, and insufficient employment and income opportunities, especially in rural areas. The risk of maternal underweight and child malnutrition increases as food insecurity increases. Efforts to improve household food security are recommended to improve nutritional status.13 Multi-sectoral approaches are needed to address malnutrition including interventions to improve WASH; increase access to more diverse food for women and children; address suboptimal infant and young child feeding practices; and support social protection initiatives.14 7 USAID Multi-Sectoral Nutrition Strategy 2014-2025. USAID. Washington, DC, 2014. 8 CHDS 2014. 9 Ikeda, N. et al. Determinants of reduced child stunting in Cambodia: analysis of pooled data from three Demographic and Health Surveys. Bulletin of the World Health Organization 2013; 91:341-349. 10 Consumption of animal source foods and dietary diversity reduce stunting in children in Cambodia. Darapheak et al. International Archives of Medicine 2013, 6:29 11 CDHS 2014. 12 Cambodia ‐ Food and Nutrition Security Profiles 2015. Association of Southeast Asian Nations, EU, FAO, UNICEF WFP, WHO. 13 McDonald, CM et al. Household food insecurity and dietary diversity as correlates of maternal and child undernutrition in rural Cambodia. European Journal of Clinical Nutrition (2014), 1–5 14 Chaparro, C.; Oot, L.; and Sethuraman, K. 2014. Cambodia Nutrition Profile. Washington, DC: FHI 360/FANTA. NOURISH Mid-term Survey Report 3 | P a g e Overview of the NOURISH Project NOURISH, an integrated nutrition project funded by the United States Agency for International Development (USAID) and the US Presidential Initiative Feed the Future (FTF), aims to reduce the proportion of children in Cambodia who are stunted and to begin to break the intergenerational malnutrition cycle and halt productivity losses due to poorer cognition and reduced schooling. NOURISH works to accelerate stunting reduction by focusing directly on the causal factors of chronic malnutrition specific to Cambodia: lack of access to diverse and quality food, inadequate feeding and care practices and unsanitary environments. The NOURISH Project is implemented by Save the Children in partnership with local and international organizations: SNV, The Manoff Group, Operation Enfants du Cambodge, Partners in Compassion and Wathnakpheap over the course of five years from June 6, 2014 to June 5, 2019. In pursuit of its goal, NOURISH offers a comprehensive integrated approach through three components and four objectives: Three Components 1) Promotion of nutrition, child development, sanitation and hygiene improvement through innovative approaches. 2) WASH and nutrition product marketing. 3) WASH and nutrition Social and Behavior Change Communication. Four Strategic Objectives 1) Improve community delivery platforms to support improved nutrition. 2) Create demand for health, WASH, and agriculture practices, services, and products. 3) Expand supply of agriculture and WASH products using the private sector. 4) Enhance capacity of sub-national government and civil society for integrated nutrition programming. Core project activities related to each strategic objective are expected to lead to targeted outcomes that improve stunting and anemia in three project-supported provinces. NOURISH uses a multi￾sectorial approach to improve the nutritional status of women and children through integrating health/nutrition, WASH and agriculture interventions to maximize the potential impact.  Health/Nutrition: To strengthen care practices for the “first 1,000 days” families (families with pregnant women and children under two), NOURISH works primarily at the community level to improve maternal and child diets and feeding practices. NOURISH places special emphasis on complementary feeding and appropriate care-seeking behaviors through the MOH’s Baby￾Friendly Community Initiative (BFCI) and “first 1,000 days” Conditional Cash Transfer activity.  WASH: To improve access to safe drinking water at the point of use, and improve sanitation and hygiene, NOURISH works with both the public and private sectors, as well as the local NGO community and aligns closely with the government’s national WASH strategy and action plan. NOURISH develops the capacity of local bodies to create demand for sanitation at the village level and supports the private sector to promote a market-based approach for improved supply chains. To ensure safe drinking water at the point of use and improved sanitation, NOURISH fosters promotion of water filters and latrines by the private sector. Vouchers serve as additional incentives to expand sanitation demand to “first 1,000 days” ID poor families.  Agriculture: To improve access and availability of diverse quality foods for women and children year-round, NOURISH focuses on home micro-gardens and the consumption of small fish, as well as other nutritious foods from value chains. This includes promoting the purchase of nutrient-dense foods and building the capacity of provincial agriculture partners to support poor food-insecure women-farmers. NOURISH links “first 1,000 days” families with agriculture resources. NOURISH Mid-term Survey Report 4 | P a g e To successfully implement project activities and ensure they are sustainable over time, NOURISH engages with central and sub-national government counterparts across three sectors and respective line ministries: Ministry of Health (MOH), Ministry of Rural Development (MRD) and Ministry of Agriculture, Fisheries, and Forestry (MAFF) as well as the Council for Agriculture and Rural Development (CARD). Cooperation with the Royal Government of Cambodia is guided by the following policies and strategies:  National Strategy for Food Security and Nutrition (2014-2018): The Strategy identifies priority actions over 4 dimensions of Food Security and Nutrition: availability; access; use and utilization of food; and stability of these dimensions through three strategies: improve access to food, community nutrition in the first 1,000 Days and multi-sectoral efforts, and social protection to reduce the vulnerability of food insecure households and their exposure to risks.  National Fast Track Road Map for Improving Nutrition (2014-2020): This scales up a core package of nutrition-specific interventions for first 1,000 days with 5 core components on nutrition counseling in pregnancy, treatment of severe acute malnutrition, micronutrient supplementation and behavior change communication. Three components aim to create an enabling environment, including reducing financial barriers to services and multi-sectoral engagement in nutrition.  National Strategy for Rural Water Supply, Sanitation and Hygiene (2011-2025): The Strategy has been translated into an Action Plan to achieve targets such as complete rural sanitation coverage by 2025 and improved hygiene behaviors by 2025.  Gender Mainstreaming Policy and Strategic Framework in Agriculture (2016-2020): The Gender Mainstreaming framework guides women farmer’s empowerment and capacity strengthening of the agriculture line ministry and extension workers to support women farmers to reach gender equity.  Policy and Strategic Framework on Childhood Development and Protection in the Agriculture Sector (2016-2020): This policy aims to foster better conditions for childhood development and protection, to prevent child labour in the agriculture sector and to protect them from hazards like using agrochemicals. Over the life of the project, NOURISH is expected to reach more than 600,000 people in 565 villages across Battambang, Pursat, and Siem Reap provinces. The interventions are designed to be introduced in a phased manner. Following initial project mobilization in 2014, all project activities were introduced in133 villages in 2015, growing to reach a total of 306 villages by the end of September 2016, and reaching the target of 565 village by September 2017. All villages were identified using selection criteria that focused primarily on the identification of villages where the level of poverty is greater than 30% according to the latest available data from the Ministry of Planning (MOP). In addition, all project communes with respective villages were randomly pre￾assigned to receive three types of project interventions in order to allow for a separate independent evaluation team to answer impact evaluation questions related to stunting prevention: (1) nutrition only; (2) sanitation/hygiene only; and (3) nutrition and sanitation/hygiene combined. See Table 1 below for a brief description of the interventions. Table 1 Brief Description of NOURISH Intervention Types Defined by Impact Evaluation Team Sanitation/Hygiene interventions  Community-led Total Sanitation (CLST)  Supply-side support  Social and Behavior Change Communications (SBCC) “Grow Together” integrated stunting prevention campaign* Nutrition interventions  Community nutrition (community growth monitoring, caregiver groups, and home visits)  SBCC “Grow Together” campaign*  Conditional Cash Transfer  Integrated vouchers NOURISH Mid-term Survey Report 5 | P a g e Nutrition and sanitation/hygiene interventions combined  Community-led Total Sanitation (CLST)  Supply-side support  Community nutrition (community growth monitoring, caregiver groups, and home visits)  SBCC “Grow Together” campaign*  Conditional Cash Transfer  Integrated vouchers * “Grow Together” focuses on 13 core behaviors promoted via a series of TV spots, print materials including: posters and stickers; length mats; children’s books; fish powder preparation instructions; food basket inserts; advocacy kits; community dialogue dashboards; SME marketing materials as well as branded collaterals. “Grow Together” materials and tools are distinctively and consistently integrated into all community activities led by NOURISH-trained Community Agents, caregiver group facilitators, local leaders, and participating SMEs including Village Fairs, group education sessions, CLTS, and Community Dialogues. This impact evaluation is separate and in addition to the NOURISH baseline, mid-term and end-line effort. See Annex 2 for the list of villages according to the interventions. NOURISH Mid-term Survey Report 6 | P a g e METHODOLOGY The cross-sectional mid-term survey aims to document any changes in levels of behaviors and environmental factors since baseline, to assess project performance through comparison of the two data points. An end-line survey will be conducted in November 2018 to measure changes over the project life. The mid-term evaluation also provides a first data point to measure “Grow Together”, an integrated stunting prevention SBCC campaign, exposure and participation in other NOURISH activities. Sampling The NOURISH Project implementation area is inclusive of 565 of the poorest villages in three provinces: Battambang, Pursat and Siem Reap. Project communes have a poverty rate of 30% or higher according to Ministry of Planning 2013 data. Table 2 Population of Sampled Respondents, by Province Province 0-5 months 6-59 months 15-49 year old Total % Battambang 1,722 6,064 52,295 60,081 44% Pursat 396 1,331 10,059 11,786 9% Siem Reap 1,966 6,075 57,766 65,807 48% Total 4,084 13,470 120,120 137,674 100% Sampling was done using a random, cluster sampling approach proportionate to population size. First, a Probability Proportional to Size (PPS) method was used to select 30 communes for sampling by province: 13 in Battambang, 14 in Siem Reap and 3 in Pursat. Respondent data was collected from a randomly selected sample of households with children under five years using village household lists maintained by Village Chiefs from 90 villages, selected from among the 284 villages in 58 sanitation/hygiene and nutrition combined and nutrition only communes where implementation started in NOURISH year 1 and 2 based according to coverage. Respondents were the primary caregivers (mothers, grandmothers, aunts and fathers) of children under five years. Respondents were randomly selected from the household lists. All possible respondents in the village were interviewed in order to reach the sample required. See Figure 2. Figure 2 NOURISH Mid-term Sample Selection Process in three Project-supported Provinces of Battambang, Pursat and Siem Reap NOURISH Mid-term Survey Report 7 | P a g e Table 3 Planned Sample Size by Respondent Category Respondent Category Population Size (CDB 2013) Data Source for Sample Calculation* Sample Size Planned Sample Size Actual Children under 6 months 11,537 65% exclusive breastfeeding (CDHS 2014 Analysis) 384 213 Children 6-59 months 50,277 32.4% stunting (CDHS 2014 Analysis) 334 541 *The indicators selected for sample calculation were based on two criteria: the highest level outcome indicator for the specific respondent category or in the case of children under 6 months, the most relevant indicator required to collect. **Sample size calculation was done when the preliminary CDHS 2014 data were available but before the full CDHS 2014 report was released. The preliminary CDHS 2014 included stunting. Data Collection and Analysis Mid-term Survey. The survey was cross-sectional in nature in order to examine the prevalence of key indicators among the defined project target population at a single point in time and the relationship between these indicators and socio-demographic characteristics. The survey not only provided a second data point for major project indicators, but also included a first analysis of exposure and participation to the “Grow Together” campaign, analyzing associations between these and the project’s outcome and impact indicators. NOURISH will conduct an end-line survey during the last year of the project implementation in November 2018 to assess changes over the life of the project. This will similarly be cross-sectional survey to collect information on key indicators at a single point in time. Longitudinal or panel data will not be collected (over multiple periods of time with the same persons.) NOURISH developed the data collection tools and questionnaires using validated questions in the Cambodia Demographic and Health Survey (CDHS) questionnaires and Feed the Future survey modules.15 The questionnaires were translated from English to Khmer and back-translated to ensure comprehension and accuracy of translation. Prior to training the interviewers, selected surveyors and NOURISH staff pre-tested the questionnaire for language, understanding, skip patterns, as well as time, and then finalized tools for the field data collection. The questionnaires were prepared and tested in November 2017. The data was purposely collected in November both at mid-term and baseline, since due to seasonal factors, people are most likely to be in their villages at this time, the time immediately after the harvest. Ethical clearance approval was received from the Save the Children Ethical Review Board in June 2017. The final number of persons sampled was 755, more than the planned number of 700. Following a competitive bidding process for the survey, NOURISH selected the SBK Research and Development consulting firm to conduct the survey. SBK selected 15 experienced interviewers to collect the household survey data: SBK interviewers collected data in November 2017. Data collectors worked in 3 teams; each comprising five data collectors and one supervisor. All research assistants and supervisors are university graduates. Training of Interviewers. The NOURISH M&E Specialist, WASH Specialist, Nutrition Coordinator, and SBK jointly oriented15 interviewers during a two-day training on key principles of interviewing and practiced in the field to identify households, select respondents and conduct interviews using the questionnaires that were loaded on tablets. The NOURISH WASH Specialist introduced the water, sanitation and hygiene (WASH) variables and definitions, taught the WASH section in the questionnaire, and provided guidance on how to collect data through observation. 15 Feed the Future M&E Guidance Series. Volume 8: Population-Based Survey Instrument for Feed the Future Zone of Influence Indicators with Revised WEAI Module, October 2012 NOURISH Mid-term Survey Report 8 | P a g e NOURISH M&E Specialist covered health topics and skills. NOURISH Nutrition Coordinator covered skills in anthropometry. Their training included classroom-based learning and field practice to ensure that weights and heights were measured, read and recorded correctly, following training detailed in the FANTA Guide.16 Data Quality and Management. SBK hired and supervised data collectors. Each team of data collectors had one supervisor attached to the team throughout data collection. Additional supervisors from SBK and the NOURISH project M&E Specialist provided spot checks. To ensure the quality of anthropometric data, scales were re-calibrated in each village prior to weighing. Weights and length measures were taken two times per child. Additionally, children were weighed with minimal clothing. Each household was given a unique identifier code based on the Commune, Village, the type of respondent (W = women of reproductive age; C = caregiver; H = household head) and the number of the interview. The code was comprised of the first letter of the Province, first letter of the Commune, first letter of the Village, and the number of the interview. The data were analyzed in SPSS 23.0. The NOURISH M&E Specialist conducted spot checks on data cleaning, coding and entry. Because data was collected on tablets on not on paper forms, the data was cleaned and checked, but not re￾entered. In order to ensure a good comparison of baseline and mid-term data, both sets were merged, cleaned and checked. Children’s anthropometric data were analyzed in WHO’s Anthro software and then transferred to SPSS. Data analysis for the remaining data was done in SPSS. Data analysis required weighting of children’s anthropometric data. Due to the need to sample a large number of caregivers of children under six months old to capture practices related to breastfeeding, coupled with constraints to sample as many children each of the other age groups, the sample resulted in “oversampling” of caregivers of younger age groups of children, a common survey challenge. Thus, in order for the sample to be representative of the population of children 0-59 months, the analysis required re￾balancing or correction to reflect the older age groups by using a weighting procedure. Weighting of the data was done in SPSS. Regarding the analysis of data on exposure to the “Grow Together” campaign and participation, in light of the very high levels found, it was not possible to accurately compare those exposed to those not exposed across all indicators.17 We were, however able to compare differences in key indicators by exposure to specific types of material and for key high level indicators (section VII). Ethical Considerations In keeping USAID’s policy (22 CFR Part 225), NOURISH received approval to conduct research in compliance with US federal standards for human subject research with review. The mid-term survey was approved by the internal Save the Children Ethics Review Committee (ERC). Participation in the survey was voluntary. Prior to participation, potential respondents were informed that they had no obligation to participate and would face no penalty or consequence if they chose not to. If they agreed, respondents were informed that they were free to withdraw at any time, again with no penalty or consequence. For all minors under the age of 18 years, the primary caregiver was asked for consent. Confidentiality was ensured during all stages. No names or other identifying characteristics of individual caregivers and children were written on the forms which are being kept in a locked cabinet and will be destroyed after one year. Finally, findings are reported by the total sample rather than by any unit such as village or commune which further protects confidentiality. 16 Cogill, Bruce. 2003. Anthropometric Indicators Measurement Guide. Washington, DC: Food and Nutrition Technical Assistance (FANTA) Project, FHI 360 17 Defined as seeing at least one of 13 materials, or having seen at least one of 3 TV spots, or having participated in at least one of 8 types of NOURISH activities. Full exposure and participation was defined as having met the criteria for each of the three questions. NOURISH Mid-term Survey Report 9 | P a g e Limitations Potential limitations of the survey include response bias and recall bias. There are many reasons why people may provide less-than-truthful responses to questions, i.e., socially desirable answers and recall bias. The survey attempted to reduce this potential bias by providing respondents with clear information about why they were interviewed and ensuring them that their responses would have no bearing on their participation or lack of participation in in the project or other services, and that they would never be identified individually or by name in any reports. In addition, to confirm answers on self-reported behaviors, interviewers observed the environment when possible (relevant for WASH and agriculture topics). Another limitation to the analysis and interpretation is the sample size which was calculated to be representative of all three provinces combined. Therefore, the sample is not intended to disaggregate and compare data by provinces. Although these data are shown in Annex III, apparent differences cannot be taken as statistically significant. Additionally, the sample of this survey was primary caregivers of children under 5 (who may or may not have been the children’s mothers) not the entire community. However, WASH interventions are designed to reach all households for maximum health impact; reaching only “first 1,000 day” households will not provide the impact from WASH interventions as anticipated from reaching all households. National reporting and project monitoring systems are designed at whole of community level. Therefore, this survey can be used for NOURISH Project comparison at baseline and mid-term (and eventually at end-line), and compared to CDHS, but cannot fully be compared to national WASH data. Additional information on the mid-term survey protocol is found in Annex I. Another limitation include the fact that the data collection was completed by different agencies/teams at baseline and mid-term. Although the entire data collection process was generally overseen and supervised by NOURISH staff and the same questionnaires were used, two survey teams may have cause slight differences in how data collectors asked certain questions, especially around dietary recall and caregiving practices. Additionally, the sampling frame used for baseline and midterm limits comparability. Women of reproductive age and pregnant women were sampled at baseline but not midterm, so any indicators relevant to that area cannot be compared. The stratification of age groups among children under five was different between the two surveys which impacted comparison of results, especially as results became further disaggregated by age or other factors. Though NOURISH used weighting to limit this effect on key indicators it is still important to note it as a limitation throughout the results. We also believe that there were a few outliers in the baseline data points, which we were unable to explain or confirm at mid-term. Examples include baseline data points on underweight and protein consumption of children 6-23 months that were surprisingly low/high compared to the 2014 CDHS and may have been a subject to data collection error. NOURISH Mid-term Survey Report 10 | P a g e FINDINGS Socio-Demographic Characteristics This section provides information (1) on the general characteristics of the primary caregivers - mothers and others caregivers - of children under five (0-59 months) surveyed at NOURISH mid￾term as well as (2) draws conclusions on the general comparability of both baseline and mid-term respondents. The survey spanned 90 villages across the NOURISH Project target areas in three provinces: Battambang, Pursat and Siem Reap. Highlights of the findings are shown in this section; data not shown, and detailed data tables are included in Annex III. The survey sampled 755 primary caregivers18 of children under 59 months. The distribution by province was proportionate to population size: 41.2% in Battambang (n=311), 45.6% in Siem Reap (n=344) and 13.2% in Pursat (n=100). See Figure 3. The ages of respondents at mid-term ranged from 17 to 72 with a mean age of 31.5 years compared to 28.6 at baseline. Similar to baseline, marriage among mid-term respondents was almost universal, with 99% reporting having ever been married. The age distribution of children under the care of respondents is shown in Figure 4. The age distribution differed between the two data points, especially among 0-5 months and 24-59 months sub-group category based on the availability of the respondents at the household at the time of the survey data collection efforts. To compensate for this, where appropriate (e.g. stunting prevalence, wasting prevalence, underweight prevalence, and minimum acceptable diet), the data was weighted during analysis in accordance with the standard method used in demographic and health surveys. Over 87% of respondents surveyed at mid-term had ever attended school; of these 64% reported that their highest level of education was primary school, 22% went to lower secondary school, and 8% attended high school. None received high level education. At baseline, the educational profile of respondents was similar. Eighty-two percent had ever attended school, of which 59% reported that 18 The survey interviewed the child’s primary caregiver whether the caregiver is the mother or not. Throughout the report, the designation of the caregiver is used as mother when questions were asked only for the mother (ie. related to maternal health and breastfeeding) and parent/other caregiver when encompassing all types of primary caregivers. Figure 3 Distribution of Respondents Interviewed at NOURISH 2017 Mid-term, by Province NOURISH Mid-term Survey Report 11 | P a g e their highest level of education was primary school, 26% went to lower secondary school, 11% went to high school (P<0.01). Overall husband’s level of the educational attainment was similar in both groups: with 84% and 87% attending any school at baseline and mid-term, respectively. More specifically, husbands’ education levels at baseline were as follows: 51% had completed primary school, 30% had attended lower secondary school, and 15% attended high school or received high level education. This distribution differed slightly at mid-term, where it was reported that 63% of husbands had completed primary school, 23% had attended lower secondary, and 11% had attended high school or higher education (P<0.01). When asked about a primary occupation at mid-term, women reported the following occupations: almost 51% said they were farmers, 28% said they were daily laborers, and 5% responded that they stayed at home with children [Figure 5]. At baseline, 43% of women listed farmer as their primary occupation, 23% said they were daily laborers, and 21% said they stayed at home with children (P<0.001). The difference in the percent of women saying they stayed home with children is unclear. Figure 4 Age Distribution of Children under Care of Respondents at NOURISH 2015 Baseline vs NOURISH 2017 Mid-term Figure 5 Primary Occupation of Caregivers Interviewed at 2015 NOURISH Baseline and 2017 NOURISH Mid-term NOURISH Mid-term Survey Report 12 | P a g e Currently married caregivers interviewed at mid-term reported their husband’s ages which ranged from 18-83 years with a mean age of 33.7 years. Currently married women reported their husbands’ highest level of education: 63% said their husbands completed primary school, 23% said that their husband attended secondary school, and 11% reported that their husband went to high school or university. The range of husbands’ ages found at baseline was smaller 18-70 years, or a 52 year range compared to a 65 year range at mid-term. The mean age of husbands at baseline was 31 years, close to the mean at mid-term. These differences could be result of the larger age range, with older Cambodians tending to have had less schooling. Forty-four percent of currently married women husbands’ are farmers [Figure 6], as opposed to 61% at baseline. At mid-term, 26% of husbands were reported to be engaged in construction work, up from 11% at baseline. Just over 61% of respondents reported that their husbands worked in their home village, down from over 81% at baseline. Sixty-five percent said that their husbands worked in Cambodia, while 24% said their husband worked in Thailand, contrasting with 41% and 55% at baseline, respectively. All changes were statistically significant to P<0.001. These findings, taken together, suggest that between baseline and mid-term, opportunities for non-farm employment, mainly in construction and other daily labor (10.5%) have increased. Twenty-six percent of respondents surveyed at mid-term had a current Identification (ID) Poor Card 1 or 2 issued by the Ministry of Planning (observed), while 3% reported having one but were not able to produce it/show to the interviewer. Another 7% had expired cards (observed) that were observed Combining observed and not observed cards, 29.5% of those surveyed at mid-term had an Identification (ID) Poor Card, representing a very slight increase over baseline, when the figure was 28.6% (P<0.01). These findings are similar to the national Ministry of Planning statistics for rural population demonstrating a slight increase in the proportion of ID poor 1 and 2 from 19.5% in 2014 to 21% in 2016. Forty-four percent of caregivers at mid-term had a savings bank account, a substantial increase from baseline when only 6% reported having one (P<0.001). This increase is mirrored in the finding that at mid-term, almost 50% of caregivers was enrolled in the conditional cash transfer (CCT) initiative that assists pregnant women and caregivers of children under two to open a bank account with a participating micro-finance institution, compared with only 15% at baseline (P<0.001), suggesting that NOURISH’s efforts to increase CCT participation and financial inclusion in the modern cash economy have seen some success. Figure 6 Husband’s Primary Occupation at 2015 NOURISH Baseline vs 2017 NOURISH Mid-Term NOURISH Mid-term Survey Report 13 | P a g e In addition, NOURISH researchers demonstrate a substantial increase of observed birth certificates for children in target areas between baseline (59.8%) and mid-term (84.9%) (p<0.001), likely due to the reported increase in CCT enrolment (14.9% and 49.5%, respectively) and to a child’s birth certificate being a requirement for this enrolment. These changes in respondents’ socio-demographic characteristics at mid-term were expected as a result of targeted project interventions, and do not influence the comparability of two samples at baseline and mid-term. Health and Nutrition This section provides information on child feeding and other health and hygiene practices including dietary intake among children under 5 years collected at NOURISH mid-term. Included in this section are child care practices, such as exclusive breastfeeding during the first six months of life and complementary feeding and diet diversity for children under 24 months. The height and weight of all children under 59 months were measured. Highlights of the findings are shown in this section; data not shown and detailed data tables are included in Annex III. Child Health and Nutrition Stunting (low height-for-age) is a result of chronic malnutrition. Stunting is difficult to reverse after age two, and linear growth deficits in the “first 1,000 days” have severe short- and long-term health and functional consequences, including poor cognition and educational performance, low adult wages and lost productivity.19 Stunted girls grow up to have higher risk of childbirth complications and low birth weight babies. Stunting prevalence is one of the core NOURISH indicators collected at baseline for the comparison at mid-term and end-line as a means to demonstrate project progress and impact. The prevalence of stunting20, reflecting chronic malnutrition, in all children under the age of five surveyed at NOURISH baseline was 34.3%.21 At mid-term, measured stunting had 19 2016 WHO; Childhood Stunting: a Global Perspective. Maternal and Child Nutrition (2016). 12, pp 12-26. 20 Stunting measures the percent of children 0-59 months who are stunted, as defined by a height for age Z score of <-2 SD. Children with a height for age Z score <-2 and >= -3 are classified as moderately stunted. Children with a height for age Z score <-3 are classified as severely stunted. The numerator for this indicator is the total number of children 0-59 months surveyed with a height for age Z score <-2 SD. The denominator is the total number of children 0-59 months surveyed with height-for-age Z score data. 21 Data analysis required weighting of children’s anthropometric data; results are ‘weighted’ to re-balance to reflect the prevalence in the population of children up to 59 months, in order to correct for oversampling of children under six months (required to collect data on exclusive breastfeeding) and under-sampling of children 48-59 months. Figure 7 Difference in the Socio-Demographic Characteristics at 2015 NOURISH Baseline vs 2017 NOURISH Mid-term NOURISH Mid-term Survey Report 14 | P a g e declined significantly (p<0.05) to 28.6% in this same group. Both data points were weighted. We recognize that the data from both baseline and midterm surveys are not statistically comparable to the 2014 CDHS given the differences in geographic scope and the size of the sample, but we included it as a point of reference for the national nutrition context. See Figure 8. The prevalence of underweight22 (weighted data), reflecting a combination of chronic and acute malnutrition in children 0-59 months, was 16.9% at NOURISH baseline, which is substantially lower than CDHS 2014 rural findings of 25.4%. At mid-term, this figure was recorded at 18.3% - this change is not statistically significant. The baseline underweight data may have been an outlier or incorrect as we did not expect to see a figure so well below the national CDHS data, especially before NOURISH project implementation. While this is an increase from baseline it is still well below the national CDHS data, further analysis will be conducted at end-line. The prevalence of wasting23 in children 0-59 months at NOURISH baseline (weighted data) was 8.4%, lower than 2014 CDHS 2014 findings of 9.9% wasting in rural Cambodia. At mid-term, this figure remained unchanged, at 8.5%. The proportion of children found to have severely low weight￾for-height (weight-for-height Z-score -3 SD), or severe acute malnutrition (SAM), was 3% compared to 2.4% in CDHS 2014 data for rural children. Due to the small sample size, with only 64 cases on wasting in the mid-term, researchers do not feel these data have sufficient power to be informative, and are certainly not comparable to the 2014 CDHS. The fact that stunting showed significant improvement while underweight and wasting did not warrants further investigation by the project into household and community practices that may be affecting these results as well as deeper analysis at end-line. Quality of data collection and the sampling frame will both be closely controlled to ensure quality comparable data at end-line. 22 Underweight is a low weight-for-age measurement that is a reflection of acute malnutrition. This indicator measures the percent of children 0-59 months who are acutely underweight, as defined by a weight-for-age Z-score <-2 SD. The numerator for the indicator is the total number of children 0-59 months in the sample with a weight-for-age Z-score <-2. The denominator is the total number of children 0- 59 months in the sample with weight-for-age Z-score data. 23 Wasting is a low weight-for-height measurement that is a reflection of acute malnutrition. This indicator measures the percent of children 0-59 months who are acutely underweight, as defined by a weight-for-height Z score <-2 SD. The numerator is the total number of children 0-59 months in the sample with a weight-for-height Z-score <-2. The denominator is the number of children 0-59 months in the sample with weight-for-height Z-score data. Figure 8 Stunting Prevalence among Children under Five at 2015 NOURISH Baseline vs 207 NOURISH Mid-term NOURISH Mid-term Survey Report 15 | P a g e Thirty-one percent of caregivers interviewed at baseline reported taking the child 0 – 59 months to the health facility within the month of the survey or the previous month, while 34% reported visiting a health facility in the past two to three months. Another 27.4% reported that the child last visited a health facility within the past four months or longer than six months ago (9.8% went in the last four to six months and 17.6% went over six months ago) [Figure 9]. At mid-term, 44.5% reported taking the child to the health facility within the month of the survey or the previous month (an increase of 13.4%, p<0.001), but fewer (12.3%) reported taking the child in the last 2-3 months. Remembering and reporting the exact time frame remains a challenge for the respondents interviewed at both baseline and mid-term and researchers rightfully acknowledge limitation of this data point. Child monthly growth monitoring and promotion (GMP) during first 23 months is a key behavior promoted by the NOURISH Project due to the importance of tracking growth to take corrective actions in growth faltering before malnutrition is set. At baseline, among children 0-23 months who visited a health facility, 86% of caregivers reported that the child was vaccinated during the last visit. In addition, nearly equal proportions of caregivers said that the child was weighed/received GMP (46.9%), received medicine (46.8%) and intravenous (IV) fluids (44.3%); and 21.8% received counseling. At mid-term, the reasons a child was taken to a health center were somewhat different. Fewer reported that the recent visit had been taken for vaccination (83.7%, n=407) although this proportion is still high (total sample n=486), and receive IV fluids from 44.3% to 2.9%. Combining the numbers for GMP and weighing reported by caregivers, at mid-term and baseline, the percentage of children taken to a health facility increased to 67.3% from 46.9%. Weighing is key part of GMP and many respondents refer to GMP as weighing of the children. See Figure 10. Further data analysis not only demonstrated more frequent visits to the healthcare facilities for children 0-23 months, but also showed that the proportion of children who received GMP/was weighed this month or last month nearly doubled at mid-term (30%, n=147) compared to the baseline (15%, n=103) demonstrating an increase in regular growth monitoring of children whether through project GMP or facility based weighing. Anecdotal evidence suggests that mothers are now asking health workers to weigh their child at each health facility visit as a result of community-based NOURISH activities (CCT Process Review 2017). Because participating in GMP and weighing are behaviors promoted by NOURISH, this suggests that the interventions are influencing change. Figure 9 Timing of Child’s (0-59 months) Most Recent Health Facility Visit at 2015 NOURISH Baseline vs 2017 NOURISH Mid-term NOURISH Mid-term Survey Report 16 | P a g e Infant and Young Child Feeding Infants Birth to Five Months. Nearly all children, 96% and 95% respectively, surveyed at NOURISH baseline and mid-term were breastfed at some point of time. Exclusive breastfeeding when the infant only receives breast milk without any additional food or drink, not even water, is a WHO recommended practice. Exclusive breastfeeding for the first six months is the optimal way of feeding infants. Among children under six months, the number was already high, at 77.8% being exclusively breastfed at baseline. This number did not change between baseline and mid-term, remaining at about 78%. The proportion of children with continued breastfeeding at 2 years of age remained essentially unchanged: with 32.5% at baseline and 33.3% at mid-term. These figures were not unexpected based on already high breastfeeding data at baseline and the existing cultural inclination in Khmer women in rural areas to practice exclusive and continued breastfeeding. However, given the current trend in Cambodia of reduced breastfeeding practices, the maintenance of both figures at such levels may indicate a positive effect of the project interventions. At baseline, among children under six months of age breastfeeding, the average number of breastfeeding sessions per day ranged from 1 to 35 with a mean of 10.5 times per day. At mid-term the average number of breastfeeding sessions per day remained nearly unchanged: it ranged from 2 to 60 with a mean of 9.9 times per day. In the past 24 hours, 34.4% of the caregivers of children 0-5 months reported breastfeeding 11 or more times, 45.5% fed six to 10 times and 20.1% fed less than five times at baseline. There is a change in the number of times children were breastfed at midterm: 20.1% reported feeding 11 or more times, 35.6% fed six to 10 times and 44.3% fed less than five times at NOURISH mid-term. The average length of a breastfeeding session ranged from under one minute to one hour with a mean of 12.9 minutes at baseline to three to 30 minutes with a mean of 11.3 minutes at mid-term. In addition, among those children who were ever breastfeed, prelacteal feeding in the first 3 days of life dropped from 12.8% at baseline to 6.8% at mid-term. Reported consumption of other milk in the past 24 hours also went down from 7.7% at baseline to none at mid-term, whereas the use Vitamin drops and medicine increased from 4% at baseline to 11.7% at mid-term. Figure 10 Health Services Child (0-23 months) Received on Most Recent Visit at 2015 Baseline vs 2017 Mid-term NOURISH Mid-term Survey Report 17 | P a g e Table 4 Breastfeeding Practices at NOURISH 2015 Baseline and NOURISH 2017 Mid-term Indicators 2014 CDHS 2015 NOURISH Baseline 2017 NOURISH Midterm N % N % Ever Breastfed 96% 722 96% 452 94.8 Exclusively Breastfed until 6 months 65% 298 77.8% 184 78% Continued breastfeeding at two years 37% 24 32.5% 12 33.3% Pre-lacteal feed in the first 3 days of life among children 0-5 months 28% 48 12.8% 16 6.8% Other milks (non-formula) consumption among children 0-5 months in the past 24 hours -- 29 7.7% 0 0% Children Six to 23 Months. The globally standardized minimum acceptable diet (MAD) 24 indicator assesses the percentage of children 6-23 months who consumed the minimum dietary diversity and the minimum meal frequency during the previous day. For breastfed children, the minimum meal frequency is solid or semi-solid food at least twice a day for infants 6-8 months and at least three times a day for children 9-23 months. A non-breastfed 6-8 month old child should eat soft or semi-solid food 3 times a day and a non-breastfed 9-23 month old child should eat semi-solid food four times a day. NOURISH utilized the validated Feed the Future food recall to collect data. Each component of this indicator is presented below, concluding with the composite indicator results. [1] Breastmilk or other milk: At baseline 55% percent of children 6-23 months continued to breastfeed; whereas, at midterm, 66% of children 6-23 months continued to breastfeed. The prevalence of breastfeeding to children 6-8 month olds was 81%, while children 9-11 months old slightly decreased to 78% and continued to decrease to 54% for children 12-23 months. [II] Number of Food Groups: At baseline, the number of food groups consumed by children in the last day and night ranged from 0 to 7 with a mean of 3.5 groups. The proportion of children who ate four or more food groups increased with age: 34.5% of 6-8 months olds, 57.5% of 9-11 months olds, and 51.6% of 12-23 months old children consumed four or more food groups in the previous day. At midterm, the number of food consumed by children in the last day and night ranged from 0 to 7 with a mean of 3.52 groups. The proportion of children who ate four or more food groups decreased with age: 52.1% of children aged 6-8 months, 50% of 9-11 months, and 44.7% of 12-23 months. At baseline, 50% of children 6-23 months were consuming four or more food group compared to 48% at mid-term. All changes are not statistically significant. 24 MAD is defined as: [I] Breast milk or two or more feedings of formula; fresh, tinned, or powdered animal milk; or yogurt; and [II] Foods from four or more of the following groups: (1) Infant formula, milk other than breast milk, cheese or yogurt, or other milk products; (2) Foods made from grains, roots, and tubers, including porridge and fortified baby food from grains; (3) Vitamin A-rich fruits and vegetables (and red palm oil); (4) Other fruits and vegetables; (5) Eggs; (6) Meat, poultry, fish, and shellfish (and organ meats); and (7) Legumes and nuts. [III] The minimum number of recommended meals per day, according to age and breastfeeding status. NOURISH Mid-term Survey Report 18 | P a g e Figure 12 describes the most commonly reported foods given to children in the past 24 hours at baseline were grains (95%), foods from animal origin (75%), breastmilk (55%) and orange Vitamin A￾rich fruits and vegetables (54%). Fewer children ate other fruits and vegetables (42%), eggs (34%), dairy products (27%) as well as beans or nuts (23%). A change was found at mid-term. While grains were still the most commonly reported at 97%, vitamin A rich fruits and vegetables were the second most cited food group reported at 76% as given to children in the past 24 hours. This was followed by breastmilk (66%), foods from animal origin (51%), eggs (44%), other fruits and vegetable (39%), and finally by beans, nuts, and seeds (25%) and dairy (20%). The researchers would like to acknowledge a very high proportion of caregivers (75%) reported to provide foods of animal origin to children 6-23 months at baseline compared to the national average of 49.6% reported in the 2014 CDHS. Such high figure may be attributable to the less experienced data collectors at baseline not properly capturing food consumed by children compared to a smaller more experienced group of data collectors in mid-term. It may be partially related to change in understanding that the food should be in the child’s bowl rather than the family bowl (i.e., not in the soup broth). Caregivers now have better understanding of correct definition where broth does not count as animal source food. Alternatively it may imply that caregivers now prioritize fish and fish powder over dairy or other animal source foods as these were heavily promoted by the project and well received by the community. The project will investigate this further through monitoring at end￾line as it works to improve dietary diversity over the remainder of implementation. Not counted above, but important to understand the full scope of children’s dietary practices, are sweets and packaged snacks. At baseline in the past day, 42.5% of caregivers of children 6-23 months reported providing their children a sugary food such as sweets or biscuits and 30.1% had a packaged snack food (i.e., chips). At midterm sugary foods in the past 24 hours increased slightly to 46%, while packaged snack food decreased significantly to 16%. Special efforts at the community level where made by the NOURISH interventions to reduce consumption of packaged snack food by small children. Figure 11 Diet Diversity among Children 6-23 months at 2015 NOURISH Baseline vs 2017 NOURISH Mid-term NOURISH Mid-term Survey Report 19 | P a g e The survey also asked specifically about small fish consumption given its importance to children’s nutrition as a source of protein, lipids, micronutrients and other nutrients in Cambodia. On average 18.1% of children under two had small fish of any type, including small fish powder, in the past 24 hours at baseline compared to 25% at mid-term. The change in consumptions was similar for children under five: 17.7% of children consumed small fish, including small fish powder, at baseline compared to 24.8% at midterm. [III] Number of meals per day: At baseline 95.9% of breastfed children were fed with the recommended frequency (at least twice a day when 6-8 months and at least three times a day when 9-23 months), but only 60.6% of non-breastfed children were fed with the minimum frequency (four or more times a day). Total minimum meal frequency among all children 6-23 months was 79% at baseline. These numbers declined at mid-term with 85% of breastfed children and 52% of non￾breastfed children receiving minimum meal frequency or a total of 73% among all children 6-23 months. It is important to note that the sample sizes of the smaller subsets by age and breastfeeding Figure 13 Consumption of Small Fish, Including Small Fish Powder, at NOURISH 2015 Baseline vs NOURISH 2017 Mid-term Figure 12 Food Consumption of Children 6-23 Months in the Past 24 hours at NOURISH 2015 Baseline vs NOURISH 2017 Mid-term NOURISH Mid-term Survey Report 20 | P a g e status were quite different at baseline and mid-term and in two cases these differences may have pulled down the general total. Children age 6-8 months who were not breastfed decreased from 80% at baseline (n=10) to 27% (n=26) and children 9-23 who were breastfed decreased from 94% at baseline (n=32) to 82% at mid-term (n=105), while the other groupings remained stable. Overall 25.5% of children 6-23 months received a minimum acceptable diet in the past 24 hours at baseline compared to 26.5% at mid-term. [Figure 14]. In comparison, CDHS 2014 found that 30% of breastfeeding children 6-23 had a minimum acceptable diet. In Cambodia, stunting sharply increases around 9 months of age. Stunting is not treatable, but preventable. Prevention requires targeted efforts during the introduction to the complementary feeding period, after six months. At NOURISH baseline, 46.3% of children 9-11 months old ate enriched food (vegetables and animal source foods) with recommended frequency in the past day compared to 73% at mid-term. With a calculated Confidence Interval (CI) of 59% to 86%, this change is significant. Figure 15 Consumption of Enriched Solid, Semi-Solid or Soft-Foods with Frequency in the Past 24 hours by Children 9-11 Months at 2015 NOURISH Baseline vs. 2017 NOURISH Mid-term Figure 14 Minimum Acceptable Diet among Children 6-23 months at NOURISH 2015 Baseline and NOURISH 2017 Mid-term NOURISH Mid-term Survey Report 21 | P a g e According to UNICEF, more fluids, breastfeeding, continued feeding (and selective use of antibiotics) reduce the duration and severity of diarrheal episodes and lower their incidence. At baseline, respondents were asked if their child had ever had diarrhea, to which 62.4% responded yes. However, at mid-term the question was modified to whether or not the child had had diarrhea in the last two weeks (14.4% yes) to be more in line with the DHS questionnaire, so the results cannot be compared directly between baseline and mid-term data points. Of the respondents at mid-term who said their child had suffered from diarrhea in the last two weeks a large increase in the percentage who gave their child more to drink was recorded, from 33.2% at baseline to 58.7% at mid-term, a positive improvement. Another 28.4% of respondents said they gave the child about the same amount to drink during diarrhea as before the episode, a small decrease from the 35.3% recorded at baseline. This is not a concern in light of the increase seen in those who gave more to drink (as recommended in cases of diarrhea). When asked how much was given to drink during the week after the diarrhea, the findings were also encouraging: 46.8% said they gave the child more to drink, an additional 4.6% said they gave them much more, and 33% answered that they gave the child about the same amount to drink. Table 6 below provides more details and a comparison of baseline and mid-term findings for drink offered to children during and following an episode of diarrhea. Table 6 Amount of Drinks Offered to Children 6-59 Months with Diarrhea by Caregivers Variable While with diarrhea The week after diarrhea 2015 NOURISH Baseline 2017 NOURISH Mid-term 2015 NOURISH Baseline 2017 NOURISH Mid-term Gave child more to drink 33.2 58.7*** 22.8 46.8*** Gave child much more to drink 5.3 2.8 2.8 4.6 Gave child about the same amount to drink 35.3 28.4*** 51.6 33.0*** Gave child somewhat less 11.5 8.3 6.6 2.8 Gave child much less 1.1 0.0 0.4 0.0 Stopped or never gave 4.5 1.8 6.2 1.8 Don’t know 9.2 0.0 9.6 11.0 TOTAL 100 % 100% 100% 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Regarding food, there was little change between baseline and mid-term, with the numbers of respondents saying that when their child had diarrhea they fed them about the same amount of food, more, or much more being 42.3% at baseline compared to 45% at mid-term. However, it is a concern that 31.2 % of respondents at mid-term said they did not give their children food while they had diarrhea, compared to 22.6% at baseline. This situation should be monitored by program staff to determine what steps should be taken by the project. NOURISH Mid-term Survey Report 22 | P a g e Table 7 Amount of Food Offered to Children 6-59 Months with Diarrhea by Caregivers Variable While with diarrhea The week after diarrhea 2015 NOURISH Baseline 2017 NOURISH Mid-term 2015 NOURISH Baseline 2017 NOURISH Mid-term Gave child more to eat 14.3 14.7 15.4 16.5 Gave child much more to eat 1.6 0.9 0.7 0.9 Gave child about the same amount to eat 26.4 29.4 41.7 31.2 Gave child somewhat less 20.0 21.1 9.7 13.8 Gave child much less 5.2 2.8 0.5 0.9 Stopped or never gave 23.1 31.2* 22.3 22.9 Don’t know 9.4 0.0 9.7 13.8 TOTAL 100% 100% 100% 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 The percent of respondents saying their child had a fever in the last two weeks prior to survey fell markedly between baseline and mid-term from 55.8% to 29.1%. A fever is not an illness. However, the presence of fever is a primary manifestation of an underlying condition, such as malaria and other acute infections in children. Fever in children comes with accompanying symptoms such as lethargy, fussiness, poor appetite, vomiting and diarrhea. Fever and other infections can contribute to high levels of malnutrition and mortality among children under five in Cambodia. The vicious cycle exists: infection increases the risk of malnutrition, and moderate malnutrition weakens every part of the immune system making children more prone to infections. The reasons for the decline in the incidence of fever are unclear, although it may be partially attributable to the WASH-specific interventions by NOURISH starting to result in change. Among respondents at mid-term reporting that their child had suffered a fever in the last two weeks, 53.1% of respondents at mid-term said that during the illness the child was given more or much more to drink, while another 25.9% reported giving the child about the same amount to drink as usual. This shows an improvement from baseline, when during the most recent fever, only 28.9% of children had more to drink, while 40.7% had the same amount as usual. Slightly over 18% said they gave the child slightly less, and only 2.7% reported not giving liquids. At mid-term, in the week after fever, 44.1% reported offering their child aged 6-59 months more or much more to drink; another 36.8% said they gave as much as usual. In the week after fever, 25.9% of children was fed more and 34.5% was fed the same amount as usual; 12.3% of children were fed less than usual. Overall, at baseline, only 16.1% of children 6-59 months with fever was given increased fluids and continued feeding (i.e., more, the same amount as usual, or somewhat less). Water, Sanitation and Hygiene (WASH) This section provides information on water, sanitation and hygiene (WASH). Highlights of the findings are shown in this section; data not shown and detailed data tables are included in Annex III. NOURISH Mid-term Survey Report 23 | P a g e Drinking Water Treatment The mid-term survey analyzed the percent of respondents who practice correct use of recommended household water treatment technologies. According to the USAID, households are considered to be correctly practicing water treatment technologies if the following conditions are met for any of the treatment options:  Chlorination: an enumerator carrying out the chlorine residual test obtains positive results (CT+);  Filtration: enumerators are able to see the filter and verify that water is in the filter’s bottom container or comes out of the filter’s tap (Filter +);  Solar disinfection: the enumerator is able to see that bottles filled with water are exposed to the sun and self-reports indicate that bottles are exposed to the sun for at least six hours per day of exposure (SODIS+) on sunny days and up to two days on cloudy days;  Boiling: study participants report that boiling occurred until water comes to a rolling boil and the same container where water is boiled is used to store boiled water (BOIL+). At NOURISH mid-term, 77.2% of respondents said they followed “recommended water treatment practices” as defined by USAID indicator25 guidelines: 41.7% boil and 35.5% filter water before drinking, with no chlorination or solar disinfection – both of which are not being promoted by the NOURISH project. These numbers show an increase over baseline at 66.1% overall, with 52.5% for boiling and 13.6% for filtering (significance 0=0.000). An additional 8.6% reported buying bottled water26 [Figure 16], a slight increase from 5.8% at baseline. It appears that between the baseline and mid-term, in NOURISH’s intervention areas, there was a transition from boiling water to using a filtration system, – most likely as a result of NOURISH’s work that not only promotes the correct treatment of drinking water, but also works with the private sector that promotes and distributes locally made water filters with and/or without vouchers requiring a co-payment from beneficiaries. Access to safe drinking water has shown to have a strong relationship with stunting and wasting. Seeing so much improvement on the use of the recommended water treatment practices is a sign that the project is moving in the right direction. 25 The numerator for this indicator is the number of households with children under five that properly treat drinking water through chlorination, filtration, solar disinfection or boiling. The denominator for this indicator is the number of households visited in the survey. 26 According to the Joint Monitoring Report: “Bottled water is considered to be improved only when the household uses water from an improved source for cooking and personal hygiene. Where this information is not available, bottled water is classified on a case-by-case basis. In some countries, bottled water is the best quality water available.” Figure 16 Treatment of the Drinking Water by Respondents at NOURISH 2015 Baseline and NOURISH 2017 Mid-term NOURISH Mid-term Survey Report 24 | P a g e Importantly, on observation by the mid-term researchers of the presence of a water treatment device at households reporting having one, almost all (99.6%) were found to be present; this compares favorably to the number found at baseline, which was at 89.6%. At baseline, 30.8% of caregivers of children under five reported cleaning their filters weekly, while at mid-term the figure more than doubled to 79.5%. Interviewers at NOURISH mid-term and baseline also observed filters of those who filtered water before drinking: out of those 7.5% of the filters did not look clear at mid-term, a significant decrease from 15.7% (p<0.05) at baseline. Sanitation Caregivers of children under five interviewed at NOURISH baseline and mid-term were asked to allow the interviewer to observe their toilet facilities. A toilet facility is classified as “improved” if it is not shared by other households and if it effectively separates human waste from human contact: flush or pour flush into a piped sewer system, septic tank, or pit latrine; ventilated improved pit (VIP) latrines; pit latrines with a slab; and composting toilets, as defined by the Joint Monitoring Programme (JMP) for Water Supply and Sanitation of WHO and UNICEF. Table 9 Household Sanitation Facilities Variables 2015 NOURISH Baseline (N=764) 2017 NOURISH Mid-term (N=754) N % N % Improved latrine, not shared 278 37%*** 442 59%*** Improved latrine, share 117 16% 113 15% Unimproved facility 2 0% 2 0% Shared 37 5% 99 13% Open defecation 309 41%*** 99 13%*** Other 9 1% 0 0% TOTAL 752 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Thirteen percent of caregivers of children under five interviewed at mid-term reported openly defecating demonstrating a remarkable improvement compared to 41% at baseline. Proportion of respondents having ‘an improved not shared toilet’ also increased significantly from 37% at baseline to 59% at mid-term, and another 15% reported sharing a latrine with another family compared to only 16% at baseline (p<0.001). For purposes of comparison, 2014 CDHS which sampled households of women reproductive age and caregivers of children under five, found that 39.7% of rural households had an improved, not shared, facility. Hygiene: Handwashing Interviewers at NOURISH mid-term observed an increase in the number of households having water at a handwashing station, from 89.8% at baseline to 99.3% at mid-term (p<0.001). Out of these, interviewers observed at mid-term that 89.8% of persons interviewed had a station with water and soap compared to 67.9% (p<0.001) at baseline. These findings suggest an increase in the uptake of the handwashing practices promoted by NOURISH. Of those with a handwashing station, the NOURISH Mid-term Survey Report 25 | P a g e interviewers observed an increase in the presence of tippy taps with soap. At baseline, these were observed at 37.6% of households, while at mid-term they were observed at 71.7% (p<0.001) of households. Also, the percentage of households that had no separate handwashing station declined from 38.7% to 15.5% (p<0.001) between baseline and mid-term, suggesting that the target communities have acted on behavior change messages disseminated by NOURISH. Proximity to the latrine is a facilitating factor in handwashing after defecation, one of the key critical times when handwashing is promoted. Thirty-four percent of households had a handwashing station with soap or other cleansing agent within 10 meters of a latrine at mid-term, up from 25% at baseline, suggesting a positive program outcome, although this must continue to be monitored and the planned end-line survey will provide more evidence of this outcome for both types of households: with women of reproductive age and children under five. Hygiene: Household Environment of Caregivers Following standard definition used by Cambodian DHS27 and NOURISH’s focus on the “first 1,000 days” households for stunting prevention, eighty-two percent of caregivers of children under two reported disposing children’s stools hygienically within past 24 hours at mid-term: 25.7% put infant feces into a latrine, 37% bury – not necessarily promoted by the NOURISH project - and 19.5% of children use latrine compared to only 59.5% at baseline. In comparison, 2014 CDHS found that 70.5% of all rural households disposed of infant’s stools safely. See Figure 18. At mid-term, NOURISH researchers also observed whether or not there was feces around the household or in the compound. Compared to 39% at baseline, feces (not specified whether animal or human) were observed in over 57% of households with children under five. More specifically, interviewers observed a small amount (1-2 piles) in 36.4% of the cases, and more than 2 piles in the remaining 21.3%. Improvement is clearly needed in this front and should be emphasized as the project moves forward. 27 As defined by the Cambodia Demographic and Health Survey 2014. Figure 17 Core Hygiene Practices (Observed) Among Caregivers of Children under 5 at 2015 NOURISH Baseline vs 2017 Midterm NOURISH Mid-term Survey Report 26 | P a g e Agriculture This section provides information on questions collected at baseline and mid-term related to homestead food production, focusing on nutritious vegetables. As part of the nutrition-sensitive agriculture efforts for “first 1,000 days” families, NOURISH promotes certain types of nutritious vegetables which are locally available, need minimal water and are hardy enough to grow in small spaces year-round: amaranth, moringa, and yard-long bean. Pumpkin and sweet potato are also encouraged as locally acceptable complementary food for young children and snacks for pregnant women. Highlights of the findings are shown in this section. Similar to baseline, all respondents interviewed at mid-term were asked whether they grow fruit and/or vegetables at home. Interviewers requested to observe the garden. At mid-term, nearly nine out of ten 86.9% (n=655) caregivers of children under five had active home gardens compared to 81% (n=615) at baseline. Figure 19 Homestead production of Nutrient-rich Vegetables at 2015 NOURISH Baseline v 2017 NOURISH Mid-term Figure 18 Hygienic Disposal of Infant Feces by Caregivers of Children under 2 at 2015 NOURISH Baseline vs 2017 NOURISH Mid-term NOURISH Mid-term Survey Report 27 | P a g e Overall 58.4% (n=441) grow at least one of five local high-nutrient vegetables promoted by NOURISH for pregnant/lactating women and young children at mid-term compared to 49.5% (n=379). At baseline, 27% grew amaranth, 19.5% grew moringa and 12% raised yard-long beans. Additionally, 26% grew pumpkin and 25.7% grew sweet potato. As illustrated in Figure 19, with the exception of sweet potatoes, there has been an increase of the proportion of families reporting the cultivation of the recommended amaranth, moringa and pumpkin, yard-long beans. Substantial changes are seen for moringa and pumpkin: both are core ingredients in the recipes that include small fish powder. Of those who grow at least one of NOURISH-promoted high-nutrient vegetables at home gardens as observed at both baseline and mid-term, nearly all (99%) said that the family eats the vegetables. Exposure, Participation and Motivation to Take Actions In March 2016, the NOURISH Project launched “Grow Together”, a groundbreaking multi-faceted Social and Behavior Change Communication (SBCC) Campaign. The campaign focuses on thirteen key stunting prevention behaviors spanning health/nutrition, WASH, and agriculture to stimulate relevant actions for children to grow and reach their full potential. With “first 1,000 days” families at its core, the campaign was designed to improve nutrition during pregnancy through better diet and antenatal care. For children, the campaign promotes monthly nutrition services (GMP), exclusive breastfeeding for the first 6 months and continued breastfeeding up to 2 years, along with optimal feeding for children from 6-23 months. The campaign also promotes drinking clean water, construction of improved latrines, washing hands with soap at critical times as well as separating animals from small children and properly disposing of infant feces. To boost food and nutrition security, the campaign calls for local innovations to increase access to nutritious foods year-round by setting up water-saving micro-gardens, collecting nutritious food (especially, but not limited to, small rice field fish) around the home and fields, and safely preserving and storing small fish for children and pregnant women. The “Grow Together” campaign strategy outlined key creative concepts based on formative research with the potential audiences. A series of formative research studies and concept testing revealed core values and emotional triggers of caring, warm families and unified communities where everyone works together in hope and joy around child growth and development. All creative elements grew from these findings. The campaign tagline ‘grow together’ has profound meaning in Khmer and yet can be interpreted in a personal way by each of its targeted audiences. Its logo of a village with a rising sun behind and interlocked helping hands as fertile fields evokes feelings of the future everyone desires where families and communities unite and everyone plays their role for children to grow well. The ‘young rice’ green and golden yellow colors signify growth and prosperity to rural Cambodian communities. The “Grow Together” campaign was designed to reach audiences at all levels from provincial leaders and rural caregivers of children under five. Media and materials were carefully selected for their ability to reach each audience with a frequency and authority appropriate for the messaging. The campaign’s media plan included three television spots, “soundbites”, advocacy materials for local leaders, and more than 20 tools and print materials carrying the same “look and feel” to ensure immediate links to the core values and the motivations to take action. Key to the media plan were NOURISH-empowered “Grow Together” ambassadors—Village Health Support Group members, agriculture extension workers and WASH focal persons. These change agents were to bring just-in￾time tailored and practical support to the communities and families they serve. The mid-term survey aimed to document interim levels for each key NOURISH indicator in order to assess whether the interventions implemented during the first two years have started to show some progress. The mid-term survey was also designed to provide a first data point to measure the effect of the “Grow Together” integrated stunting prevention SBCC campaign. Exposure to the Campaign, participation in NOURISH activities as well as motivations to take actions were measured. NOURISH Mid-term Survey Report 28 | P a g e At mid-term, the interviewers showed respondents each of the core 12 print “Grow Together” materials developed by the NOURISH project and asked which, if any, they had seen before. The same process was done for the 3 TV spots produced by the project. The respondents were then asked, without prompting, if they had participated in NOURISH activities at the community level (e.g. “first 1,000 days” village fair for CCT beneficiaries, home visit by village health support group member for a “first 1,000 days” family, vouchers, Community Dialogue, CLTS, Community GMP, group education session by caregiver group facilitators, home garden learning by District Agriculture Officers/Agriculture Extension Workers, etc). Exposure to the “Grow Together” campaign was defined as having seen at least one print material, or having seen at least one TV spot. Participation was defined as having attended at least one NOURISH community-level activity with “Grow Together” messages and materials incorporated. Overall, exposure to the “Grow Together” campaign was found to be high ranging from 81% who reported seeing at least one TV spot to 88% who say at least one print material. Nearly 76% of all respondents interviewed were able to recognize “Grow Together” campaign logo. Participation in community activities ranged from the highest of 77% for community GMP to 33% for vouchers offered to CCT beneficiaries for water filters, food baskets and latrines with respective co￾payments. See Figure 20. Village fairs with 51% reported attendance were not designed to reach all children under five in the communities, but were intended to cover only CCT beneficiaries who came to open a bank account or receive a payment for the CCT condition(s) met. The high level of participation in community GMP is a positive sign that NOURISH activities are reaching its intended audience. Additional analysis on the exposure and participation will be performed following end-line survey in November 2018 to focus more specifically on the “first 1,000 days” households: pregnant women and caregivers of children under 2 to more accurately portray if the Campaign was able to reach its target audience. Among all respondents interviewed, 69% reported seeing “Fish Power” TV spot, followed by “Building a Latrine” TV spot at 61% and a foundation “Grow Together” TV spot at 53%. When it comes to the “Grow Together” print materials, a poster with 13 core stunting prevention behaviors Figure 20 Exposure to the “Grow Together” Campaign and Participation in NOURISH Community activities by Caregivers of Children under Five at 2017 NOURISH Mid-term NOURISH Mid-term Survey Report 29 | P a g e was reported seeing the most at 77%, followed by the fish powder making poster at 67% and food basket insert at 65%. See Figure 21 for more information on the exposure to other print materials. Respondents were asked whether after having seen materials or having taken part in an activity, they were motivated to do something, and if so, what in particular. Nearly nine out of ten respondents (88%) in general felt motivated to take action. More specifically, many respondents felt motivated to take more than one action corresponding to the complexity of the “Grow Together” campaign focusing on 13 core stunting prevention behaviors: from 70% for “washing hands with soap” to 26% for “breastfeeding longer” and “feeding children more food”. Many of the motivations already translated into tangible actions. Although it is too early to evaluate the entire “Grow Together” campaign, the interim analysis of the baseline and mid-term data indicate some progress. More specifically, the analysis showed positive and substantial changes in seven out of 13 core stunting prevention behaviors: from GMP for children 0-23 months to drinking clean water, building an improved latrine, handwashing practices, safe disposal of infant feces, making Figure 21 “Grow Together” TV spots and Print Materials Seen by Caregivers of Children under Five, at 2017 NOURISH Mid-term Figure 22 Respondents Reported Feeling Motivated to Take Actions Following Exposure to “Grow Together” NOURISH Mid-term Survey Report 30 | P a g e of nutrient-rich home gardens and consumption of small fish, including small fish powder, among children 0-23 months. Antenatal care, dietary practices of pregnant and lactating women as well as separation of animals from children were not evaluated; whereas, active stages of the “Grow Together” campaign with more direct focus on diet diversity for children 0-23 months is scheduled to start in March 2018. According to NOURISH estimates, as of March 2018 nearly $432,000 was invested in the development and roll out of the “Grow Together” campaign in direct expenses, including air time on two national TV channels. It represents about 3% of the entire NOURISH project budget. In the effort to identify minimum effective package of the Campaign interventions, the differences in campaign components/channels and participation (TV vs print media vs interpersonal communication at the community level) were further analyzed in connection to the overall campaign goal of stunting reduction. No differences were found. Further analysis revealed that 59% (N=444) of respondents interviewed received high dose explosure to the “Grow Together” Campaign. High dose exposure was defined as seeing four or more “Grow Together” print materials, one or more “Grow Together” TV spots and participating in at least 3 NOURISH community-level activities. In many instances, those who received high dose exposure where more likely to practice key stunting prevention behaviors. For example, 74% of such respondents reported providing enriched food with proper frequency to children 9-11 months in the past 24 hours; 95% treated their drinking water through boiling or filtering, and 89% offered their children 6-23 months small fish, including small fish powder. Due to the high level of exposure to any Campaign materials (print and TV) and high level of participation at NOURISH community activities measured at mid-term, it was not possible to make additional comparisons between the relative effects of various components of the “Grow Together” campaign due to the low number of cases among those not exposed. At mid-term, the activities seem to have contributed to a small increase in key behaviors and at least to have prevented worsening of the baseline situation in all behaviors. Progress must continue to be monitored over time; the planned end-line survey and independent impact evaluation will provide additional evidence regarding the project’s performance and impact on malnutrition. Figure 23 Changes in the core “Grow Together” Stunting Prevention Behaviors Evaluated at NOURISH 2015 Baseline vs NOURISH 2017 Mid-term NOURISH Mid-term Survey Report 31 | P a g e DISCUSSIONS AND RECOMMENDATIONS With a few exceptions, social-demographic characteristics of the respondents interviewed at both baseline and mid-term were found to be similar in age, educational attainment, marital status, etc. Migration is a key feature of life in the project-supported areas, with men often moving outside the village or country (usually to Thailand) to earn a living; and this trend further increased at mid-term. Forty-four percent of currently married women’s husbands were reported to be farmers at mid￾term, as opposed to 61% at baseline. At mid-term, 26% of husbands were reported to be engaged in construction work, up from 11% at baseline. Just over 61% of respondents reported that their husbands worked in their home village, down from over 81% at baseline. Sixty-five percent said that their husbands worked in Cambodia, while 24% said their husband worked in Thailand, contrasting with 55% and 41% at baseline, respectively. All changes were statistically significant. These findings, taken together suggest that between baseline and mid-term, opportunities for non-farm employment, mainly in construction and other daily labor (10.5%) have increased, making work outside Cambodia and outside the village somewhat more necessary. It will be interesting to see if this trend continues over the next few years, as it could possibly influence homestead resources as well as how they are distributed. Forty-four percent of caregivers had a savings bank account, a substantial increase from baseline when only 6% reported having one. At mid-term, 50% of caregivers were enrolled in the conditional cash transfer (CCT) initiative that assists pregnant women and caregivers of children under two to open a bank account with a participating micro-finance institution. This compares favorably with only 15% at baseline, suggesting that NOURISH’s efforts to increase CCT participation and financial inclusion have seen some success. With more access to financial services (e.g. savings bank accounts) women’s bargaining power increases as they are equipped with the tools that help them earn and maintain a living. Additionally, international evidence shows women are more likely to save, allocate, and invest money in order to be protected against unexpected expenses – healthcare and food insecurity, and in their children’s education; giving an opportunity for a better livelihood to the next generation.28 In addition, there is a substantial increase in having children’s birth certificates from baseline (59.8%) and mid-term (84.9%), likely due to the reported increase in CCT enrolment and to a child’s birth certificate being a requirement for this enrolment. Birth registration is recognized as an essential means of protecting a child’s right to identity, as well as ensuring realization of his/her fundamental rights. More specifically, data for births are essential for the Royal Government of Cambodia for planning of services for populations, setting priorities, formulating essential national strategies and making decision about resource allocation at national and subnational level.29 Despite recent declines in urban Cambodia, breastfeeding practices remain high in rural NOURISH￾supported areas. In this survey, “ever breastfeeding” was nearly universal, 78% were exclusively breastfed for six months while continuous breastfeeding until the age of two was practiced by 33% of the respondents showing no change, while breaking the pattern in the negative optimal breastfeeding trend characteristic to the entire county. Also positive trends, pre-lacteal feeding and “other milk” consumption among children 0-5 months in the past 24 hours were both substantially less frequently practiced, changing from 12.8% at baseline to 6.8% at mid-term for pre-lacteal feed, and from 7.7% to none for milk. In addition, at NOURISH baseline, 25.5% of children 6-23 months were fed a minimum acceptable diet in the past 24 hours compared to 26.5% at mid-term. This change is not statistically significant (CI from 20.8% to 32.3%) and largely due to lack of improvement in dietary diversity. Additional interventions, including introduction of the last TV spot on diet diversity supported by a series of comprehensive community level activities will be introduced by the project in March 2018. 28 www.worldbank.org/en/news/feature/2015/08/05/empowering-women-through-financial-inclusion Accessed March 2018. 29 https://www.unicef.org/cambodia/9-_Issue_Briefs_Birth_Registration.pdf Accessed March 2018. NOURISH Mid-term Survey Report 32 | P a g e While overall minimum acceptable diet remained unaffected, significant changes are reported in key complementary feeding practices, including the consumption of enriched food with proper frequency among children 9-11 months which increased from 46.3% at baseline to 73% at mid-term (CI from 59% to 89%). Also, significantly fewer caregivers fed children 6-23 months packaged snacks, down from 31% at baseline to 16% at mid-term. Special efforts at the community level were made by the NOURISH interventions to reduce consumption of packaged snack food by small children. In addition, 18.1% of children 6-23 months had small fish of any type, including small fish powder, in the past 24 hours at baseline compared to 25% at mid-term. Further analysis revealed that substantially more respondents (89%) who received “high dose” explosure to the “Grow Together” campaign materials and messages offered their children 6-23 months small fish, including small fish powder. As stunting sharply increases around nine months of age, additional stunting prevention efforts were incorporated into project activities to correctly introduce complementary foods at this important period. As noted above, the baseline survey found that less than half (46%) of children 9-11 months old ate a diverse diet needed for micronutrient adequacy supporting growth and development (including vegetables and animal source foods) with recommended frequency in the last 24 hours compared to 73% at mid-term. This positive change will be further reinforced by the project efforts at the community level with the support from VHSGs, health workers and District Agriculture Officers. The percentage of children under two taken to a health facility for weighing/GMP rose between baseline and mid-term from 46.9% to 67.3%, doubling the increase in the proportion of children who reportedly came for GMP in the past month from 15% at baseline to 30% at mid-term. NOURISH will strive to maintain and increase this level. There appear to have been improvements regarding correct drink-giving practices when a child has diarrhea or fever. However, there was little change between baseline and mid-term regarding food given to children with diarrhea or with fever, an issue which the project needs to address as it continues to promote both correct feeding practices for children with illness and recovering from illness. The percent of respondents saying their child had a fever in the last two weeks fell between baseline and mid-term from 55.8% to 29.1%. The reason for this substantial decline is unclear, although it may be that WASH-specific interventions being done by NOURISH are starting to result in change. A marked increase was found in the percentage of households with soap and water at a handwashing device used by family members between baseline and mid-term, from 67.9% to 89.8%. Another increase in correct water treatment (filtering and boiling) was also reported, from 66.1% at baseline to 77.2% at mid-term. In sanitation, the proportion of respondents having an improved not shared toilet also increased significantly from 37% at baseline to 59% at mid-term; and 13% percent of respondents at mid-term reported “openly defecating” demonstrating a large improvement compared to 42% at baseline. Such progress is also indicative of the strong collaboration of the project with the Ministry of Rural Development and Provincial Departments of Rural Development. In agriculture, at mid-term nearly nine out of ten (87%) caregivers of children under five had active home gardens compared to 81% at baseline. Similarly, 58% grow at least one of five local high￾nutrient vegetables promoted by NOURISH for pregnant/lactating women and young children at mid-term compared to 50% at baseline. Consumption of small fish, including fish powder, by children under two also increased from 18.1% at baseline to 25% at mid-term – a change strongly connected to the “Grow Together” campaign. NOURISH will continue to sustain the progress made and to intensify its efforts with great level of commitment and support from the Gender Mainstreaming and Child Protection Support Unit at the Ministry of Agriculture, Forestry, Fishery and Provincial Departments of Agriculture in all three project-supported provinces. The “Grow Together” Campaign, while only in place for under two years, is showing some promise. Both exposure to the Campaign’s print and other mass media materials and participation in the community-level activities is high – greater than 80% among all caregivers of children under two interviewed at baseline. Respondents exposed to the materials and activities reported feeling NOURISH Mid-term Survey Report 33 | P a g e motivated to take action on one or more of the 13 key stunting prevention behaviors promoted by the project. Many motivations already translated into actions: from more children attending GMP and families building latrines to offering small fish powder to the small children. The project will continue to monitor progress and address identified areas for improvement. In particular, community efforts will be aimed at ‘convergence’ of activities for each “first 1,000 days family”, so that each family has the opportunity to participate in all possible activities intended for that family. In addition, the project will aim to increase the intensity of participation. The planned end-line survey and the ongoing routine monitoring of data will inform the evidence base and future project implementation strategies. When it comes to the core project malnutrition impact indicators, chronic malnutrition, or stunting, in children mirrored 2014 CDHS rural findings at baseline, but appears to have improved between NOURISH 2015 baseline and NOURISH 2017 mid-term. The mid-term survey found a significant decrease in the percentage of children under 5 years old who were stunted, from 34.3% to 28.6% (p<0.05). 30 The percentage of children found to be underweight or wasted remained unchanged. The discrepancy between improvement in stunting but not underweight and wasting warrants further investigation. At baseline, 17% of children under five years was underweight compared to 24% nationally and 18% at mid-term. At both baseline and mid-term 8% of children under five years was wasted, with low weight-for-height, compared to 10% in CDHS 2014. None of these changes are significant. While the mid-term survey findings show some promising results, they also highlight the need for continued efforts to improve children’s nutrition by integrating health and nutrition, WASH and agriculture interventions for the benefit of children in the “first 1,000 days”. 30 Data analysis required weighting of children’s anthropometric data; results are ‘weighted’ to re-balance to reflect the prevalence in the population of children up to 59 months, in order to correct for oversampling of children under six months (required to collect data on exclusive breastfeeding) and under-sampling of children 48-59 months. NOURISH Mid-term Survey Report 34 | P a g e ANNEX I: Data Collection Protocol Data Collection and Analysis Baseline, Mid-term and End-line The baseline survey was cross-sectional to examine the prevalence of key indicators among the defined project target population at a single point in time, as well as the relationship between these indicators and socio-demographic characteristics. The cross-sectional data will be used for programming targeting purposes and to compare to the endline survey at the end of the project. The mid-term was smaller in scope and only surveyed caregivers of children under five. The endline survey will similarly be cross-sectional to collect information on key indicators at a single point in time. Longitudinal or panel data will not be collected. Instruments The questionnaires were developed by NOURISH based on validated questions of the CDHS and Feed the Future modules. 31 Questionnaires included sections on, anthropometry and interview questions including: background characteristics (e.g. age, family structure, work), knowledge and attitudes towards related contextual issues such as perceptions of food for children, care practices and women’s confidence, and behaviors on diet/feeding, and sanitation and hygiene. At mid-term, questions on exposure to materials and participation in NOURISH-organized activities were asked, and an analysis of the association between exposure and key indicators (prevalence of stunting, underweight, and wasting) was done to help assess the impact of the communication campaign carried out in project years one and two. An analysis of the relationship between exposure to the campaign and motivation to adopt one or more of the 13 promoted behaviors was also done. The analysis will be repeated at endline. Indicator Instrument HemoCue Measures Prevalence of anemia among women of reproductive age and pregnant women Women of reproductive age(not at mid-term) Prevalence of anemia among children 6-59 months Caregiver of children under 5(not at mid-term) Anthropometric Measures Prevalence of underweight women Women of reproductive age (not at mid-term) Prevalence of stunted children <5 Caregiver of children under 5 Prevalence of wasted children <5 Caregiver of children under 5 Prevalence of underweight children <5 Caregiver of children under 5 Questionnaires 31 Feed the Future M&E Guidance Series. Volume 8: Population-Based Survey Instrument for Feed the Future Zone of Influence Indicators with Revised WEAI Module, October 2012 NOURISH Mid-term Survey Report 35 | P a g e Indicator Instrument Women’s Dietary Diversity: Mean number of food groups consumed by women of reproductive age Women of reproductive age(not at mid-term) Prevalence of exclusive breastfeeding of children under 6 months Caregiver of children under 5 % of children age 9-11 months who received enriched food with frequency in the last 24 hours Caregiver of children under 5 Prevalence of children 6-23 months receiving a minimum acceptable diet Caregiver of children under 5 % parents/caregivers of children 0-23 months providing age￾appropriate stimulation of children Caregiver of children under 5 % children <5 who had diarrhea in prior 2 weeks Caregiver of children under 5 % of households in the target area using an improved latrine Caregiver of children under 5 % of households practicing correct use of recommended HH water treatment technologies Caregiver of children under 5 % of households with soap and water at a hand washing station commonly used by family members Caregiver of children under 5 % of caregivers disposing of feces appropriately Caregiver of children under 5 Prior to training the interviewers, selected surveyors and NOURISH staff piloted the questionnaire for language, understanding, skip patterns, as well as time, and then corrected. Training of Researchers At mid-term, the SBK Cambodia and the NOURISH M&E Unit trained the data collectors. The two￾day training included key principles of interviewing, practice using each questionnaire, and practice in the field to identify households, select respondents and conduct interviews using the questionnaires and record the answers. Experienced interviewers weighed and measured women and children to ensure that weights and heights were read and recorded correctly and consistently across locations, following training detailed in the FANTA Guide.32 Data Collection The interviews were conducted at each respondent’s home in a location of their choice. All efforts were made to find a private and quiet place for the interview, away from other people. Prior to data collection, the interviewers obtained verbal consent from the respondent or caregiver of the child. This was done by reading the consent form aloud which explained the purpose and process of the study and clarified that participation was voluntary with no penalties for refusing to participate. If the woman agreed, she was asked to sign or provide a thumbprint as a sign of consent. 32 Cogill, Bruce. 2003. Anthropometric Indicators Measurement Guide. Washington, DC: Food and Nutrition Technical Assistance (FANTA) Project, FHI 360. NOURISH Mid-term Survey Report 36 | P a g e Children were weighed with minimal clothes. Children were weighed and measured twice, following standard guidance. Children under two years were measured lying down while children over two years were measured standing up. Following the weighing and measurements, any caregiver of a child who is classified as severely malnourished was referred to the health system in collaboration with health workers. Unique Identifier Codes Each household was given a unique identifier code based on the Commune, Village, the type of respondent (W = women of reproductive age; C = caregiver; H = household head) and the number of the interview. The code was comprised of the first letter of the Province, first letter of the Commune, first letter of the Village, and the number of the interview. Data Quality and Management Anthropometrists and interviewers were trained for one week prior to the field work. The training will included time for demonstration and practice with feedback. Anthropometrists were trained using proven methods to standardize data33. At mid-term , SBK Cambodia was responsible for hiring researchers and conducting the training; NOURISH provided technical oversight of the data collectors’ training. At mid-term, SBK Cambodia Supervisors and NOURISH staff conducted spot checks on data cleaning, coding and entry. Data was entered directly on tablets to improve efficiency and accuracy. Data Analysis The data were entered into Excel and analyzed with SPSS. With the data sets that show each variable, the analysis prepared the results according to NOURISH indicators. For some indicators, analysis disaggregated the results by sex and age, as per the Performance Indicator Reference Sheets in the NOURISH Project Monitoring and Evaluation Plan. Anthropometric data was analyzed using WHO’s Anthro software. Ethical Considerations In keeping USAID’s policy (22 CFR Part 225), NOURISH received approval to conduct research in compliance with US federal standards for human subject research with review. The mid-term survey was approved by the internal Save the Children Ethics Review Committee (ERC). Informed Consent: Participation in the survey was voluntary. Prior to participation, caregivers were be informed that they have no obligation to participate and would face no penalty or consequence if they choose not to participate. If they agreed, they were informed that they were free to withdraw from the study at any time, again with no penalty or consequence. On the day of the survey, interviewers read the consent statement aloud and discussed it with the participant before consent. Consent forms will be kept in a locked cabinet in the Battambang NOURISH office for 1 year, and then destroyed. For all minors under the age of 18 years, the primary caregiver or guardian was asked for consent. For young children under five years of age, the caregiver was requested to sign (or give a thumbprint) as a sign of consent prior to their interview and the measurement of the child. 33 Cogill, Bruce. 2003. Anthropometric Indicators Measurement Guide. Washington, DC: Food and Nutrition Technical Assistance (FANTA) Project, FHI 360. NOURISH Mid-term Survey Report 37 | P a g e Confidentiality: Confidentiality was ensured during all stages of the study. Each respondent’s age and each child’s date of birth and sex was recorded, but no names or other identifying characteristics of women, individual caregivers and children. Electronic versions SPSS computer files containing these identifiers (birthdate) are password protected (both in the local data collection firm and NOURISH office). The final data set can be accessed by the NOURISH staff. If ever reported or shared, findings will be reported by province, rather than by village or commune, to further protect individual confidentiality. Respect for Respondent’s Rights: Respondents were informed of all risks and protections in the written consent form. Participants were informed of their right to withdraw from the study and to not answer any questions they do not feel comfortable answering. Respondents were also provided with contact information for a local contact should they have any further questions or concerns. NOURISH carefully assessed potential risks and benefits for respondents, and aimed to eliminate or minimize all possible risks. A potential risk is that children who are malnourished may not be identified due to human error in weighing and measuring children. To minimize the potential risk of incorrectly identifying a malnourished child, a Type II error (false negative) in which a malnourished child is classified as normal, NOURISH will use only trained and experienced anthropometrists to conduct weighing and measuring. The nutritionist on NOURISH staff will conduct a (refresher) training of experienced anthropometrists. Furthermore, the same persons will do the weighing and measuring throughout the baseline in all villages to ensure consistency. There may be minimal psychological risk that may arise from some questions that some participants may find to be sensitive. To minimise this risk, participants will be advised that they can decline to answer questions that make them uncomfortable. Additionally, participants will be assured that refusal to participate will not affect any services or care they would like to receive from the government of Cambodia or any other service provider. Families and children will benefit by receiving the weight and height screening. Any child who is under the standard weight and/or height for her/his age will be offered follow-up counseling through the regular systems established by the project- trained Village Health Support Group and health workers. Additionally, staff supported referrals to health centers or referral hospitals for any children are seriously ill or severely malnourished not growing well (-3 SD), or for any other concerns that caregivers may have. Any child from a poor family referred to a referral hospital will receive funds for transportation through the Health Equity Fund. Participants were informed that theirs and other Cambodian communities will benefit because information gained from this study will allow for more informed decision-making in programme design and service delivery. NOURISH Mid-term Survey Report 38 | P a g e ANNEX II: NOURISH Villages Selection by Provinces, Districts and Communes (2014-2017) Year 1: June 2014 – Sep 2015; Year 2: Oct 2015 – Sep 2016; Year 3: Oct 2016 – Sep 2017 Full coverage Years 4-5: October 2017 – June 2019 NOURISH Mid-term Survey Report 39 | P a g e NOURISH Mid-term Survey Report 40 | P a g e ANNEX III: Data Tables Demographics Tables Table 1: Caregiver of children 0-59 months by age category and provinces Caregiver’s age category Baseline Midterm N % N % Battambang <=20 43 13.0% 22 7.1% 21-29 161 48.8% 131 42.1% 30-39 87 26.4% 104 33.4% 40-49 17 5.2% 24 7.7% 50-59 15 4.5% 20 6.4% >60 7 2.1% 10 3.2% Total 330 100% 311 100% Siem Reap <=20 44 12.2% 30 8.7% 21-29 196 54.3% 152 44.2% 30-39 90 24.9% 120 34.9% 40-49 23 6.4% 15 4.4% 50-59 5 1.4% 11 3.2% >60 3 .8% 16 4.7% Total 361 100% 344 100% Pursat <=20 6 8.0% 5 5.0% 21-29 44 58.7% 51 51.0% 30-39 24 32.0% 33 33.0% 40-49 1 1.3% 6 6.0% 50-59 0 0.0% 3 3.0% >60 0 0.0% 2 2.0% Total 75 100% 100 100% Total All <=20 93 12.1% 57 7.5% 21-29 401 52.3% 334 44.2%*** 30-39 201 26.2% 257 34.0%*** 40-49 41 5.4% 45 6.0% 50-59 20 2.6% 34 4.5% >60 10 1.3% 28 3.7% Total 766 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 41 | P a g e Table 2: Caregiver respondents by age category and provinces Age of caregivers Baseline (N=766) Midterm (N=755) Mean 28.60 31.54 95% Confidence Interval for Mean Lower Bound 27.98 30.79 Upper Bound 29.22 32.29 Median 27.00 29.00 Variance 76.154 109.541 Std. Deviation 8.727 10.466 Minimum 16 17 Maximum 68 72 Range 52 55 Table 3: Caregiver’s marital status, by provinces Caregiver's Marital status Baseline Midterm N % N % Battambang Married 313 96.0% 292 94.2% Widowed 10 3.1% 12 3.9% Divorced 3 .9% 6 1.9% Total 326 100% 310 100% Siem Reap Married 337 94.9% 319 93.5% Widowed 10 2.8% 16 4.7% Divorced 5 1.4% 6 1.8% Don't Know 3 .8% 0 0.0% Total 355 100% 341 100% Pursat Married 69 92.0% 100 100.0% Widowed 5 6.7% 0 0.0% Divorced 1 1.3% 0 0.0% Total 75 100% 100 100% Total All Married 719 95.1% 711 94.7% Widowed 25 3.3% 28 3.7% Divorced 9 1.2% 12 1.6% Don't Know 3 .4% 0 0.0% Total 756 100% 751 100% NOURISH Mid-term Survey Report 42 | P a g e Table 4: Children’s Ages, by provinces Children's Ages Baseline Midterm N % N % Battambang 0-5m 161 48.8% 91 29.4% 6-11m 70 21.2% 39 12.6% 12-23m 79 23.9% 49 15.8% 24-35m 12 3.6% 40 12.9% 36-47m 7 2.1% 23 7.4% 48-60m 1 .3% 68 21.9% Total 330 100% 310 100% Siem Reap 0-5m 170 47.2% 104 30.2% 6-11m 93 25.8% 63 18.3% 12-23m 74 20.6% 57 16.6% 24-35m 17 4.7% 22 6.4% 36-47m 4 1.1% 32 9.3% 48-60m 2 .6% 66 19.2% Total 360 100% 344 100% Pursat 0-5m 40 54.1% 18 18.0% 6-11m 14 18.9% 23 23.0% 12-23m 19 25.7% 23 23.0% 24-35m 1 1.4% 28 28.0% 36-47m 0 0.0% 7 7.0% 48-60m 0 0.0% 1 1.0% Total 74 100% 100 100% Total All 0-5m 371 48.6% 213 28.2%*** 6-11m 177 23.2% 125 16.6%*** 12-23m 172 22.5% 129 17.1%*** 24-35m 30 3.9% 90 11.9%*** 36-47m 11 1.4% 62 8.2%*** 48-60m 3 .4% 135 17.9%*** Total 764 100% 754 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 43 | P a g e Table 5: Children’s Ages by sex, by provinces Children’s Age by gender Baseline Midterm N % N % Female 0-5m 175 48.7% 120 29.5% 6-11m 76 21.2% 70 17.2% 12-23m 84 23.4% 64 15.7% 24-35m 20 5.6% 55 13.5% 36-47m 4 1.1% 26 6.4% 48-60m 0 0.0% 72 17.7% Total 359 100% 407 100% Male 0-5m 191 49.0% 93 26.8% 6-11m 97 24.9% 55 15.9% 12-23m 84 21.5% 65 18.7% 24-35m 9 2.3% 35 10.1% 36-47m 6 1.5% 36 10.4% 48-60m 3 .8% 63 18.2% Total 390 100% 347 100% Total 0-5m 366 48.9% 213 28.2%*** 6-11m 173 23.1% 125 16.6% 12-23m 168 22.4% 129 17.1% 24-35m 29 3.9% 90 11.9%*** 36-47m 10 1.3% 62 8.2%*** 48-60m 3 .4% 135 17.9%*** Total 749 100% 754 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 6: Caregiver’s Education, by provinces Caregiver's Education Baseline Midterm N % N % Battambang Illiteracy 11 3.8% 22 7.7% Primary (1-6) 173 60.1% 186 65.0% NOURISH Mid-term Survey Report 44 | P a g e Lower Secondary (7-9) 69 24.0% 64 22.4% Upper Secondary (10-12) 31 10.8% 14 4.9% Higher 3 1.0% 0 0.0% No Answer 1 .3% 0 0.0% Total 288 100% 286 100% Siem Reap Illiteracy 10 3.6% 8 2.9% Primary (1-6) 160 57.8% 175 62.9% Lower Secondary (7-9) 71 25.6% 60 21.6% Upper Secondary (10-12) 33 11.9% 34 12.2% Higher 2 .7% 0 0.0% No Answer 1 .4% 1 .4% Total 277 100% 278 100% Pursat Illiteracy 1 1.6% 8 8.4% Primary (1-6) 35 55.6% 59 62.1% Lower Secondary (7-9) 23 36.5% 20 21.1% Upper Secondary (10-12) 4 6.3% 5 5.3% No Answer 0 0.0% 3 3.2% Total 63 100% 95 100% Total All Illiteracy 22 3.5% 38 5.8% Primary (1-6) 368 58.6% 420 63.7%** Lower Secondary (7-9) 163 26.0% 144 21.9%** Upper Secondary (10-12) 68 10.8% 53 8.0% Higher 5 .8% 0 0.0% No Answer 2 .3% 4 .6% Total 628 100% 659 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 7: Caregiver’s Husband Education, by provinces Caregiver's husband education Baseline Midterm N % N % Battambang Illiteracy 8 2.8% 8 2.8% Primary (1-6) 133 47.3% 178 63.3% Lower Secondary (7-9) 87 31.0% 68 24.2% Upper Secondary (10-12) 38 13.5% 22 7.8% NOURISH Mid-term Survey Report 45 | P a g e Higher 8 2.8% 3 1.1% No Answer 7 2.5% 2 .7% Total 281 100% 281 100% Siem Reap Illiteracy 7 2.6% 7 2.6% Primary (1-6) 152 57.1% 175 64.6% Lower Secondary (7-9) 71 26.7% 54 19.9% Upper Secondary (10-12) 30 11.3% 29 10.7% Higher 2 .8% 3 1.1% No Answer 4 1.5% 3 1.1% Total 266 100% 271 100% Pursat Illiteracy 0 0.0% 3 3.0% Primary (1-6) 25 42.4% 55 55.6% Lower Secondary (7-9) 24 40.7% 27 27.3% Upper Secondary (10-12) 10 16.9% 11 11.1% Higher 0 0.0% 3 3.0% Total 59 100% 99 100% Total All Illiteracy 15 2.5% 18 2.8% Primary (1-6) 310 51.2% 408 62.7%** Lower Secondary (7-9) 182 30.0% 149 22.9%** Upper Secondary (10-12) 78 12.9% 62 9.5% Higher 10 1.7% 9 1.4% No Answer 11 1.8% 5 .8% Total 606 100% 651 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 8: Caregiver’s Occupation, by provinces Caregiver's Occupation Baseline Midterm N % N % Battambang Other 11 3.3% 1 .3% Farmer 122 37.0% 149 47.9% Factory 2 .6% 2 .6% Retail 24 7.3% 23 7.4% Motor taxi 1 .3% 0 0.0% Construction 2 .6% 12 3.9% Teacher or official 3 .9% 5 1.6% Unemployed 3 .9% 7 2.3% Other daily labor 96 29.1% 86 27.7% NOURISH Mid-term Survey Report 46 | P a g e Housewife/ mother 66 20.0% 26 8.4% Total 330 100% 311 100% Siem Reap Other 7 1.9% 2 .6% Farmer 154 42.7% 174 50.6% Factory 0 0.0% 2 .6% Retail 22 6.1% 31 9.0% Motor taxi 0 0.0% 1 .3% Construction 1 .3% 9 2.6% Teacher or official 7 1.9% 7 2.0% Unemployed 4 1.1% 6 1.7% Other daily labor 75 20.8% 104 30.2% Housewife/ mother 89 24.7% 8 2.3% Don't know 2 .6% 0 0.0% Total 361 100% 344 100% Pursat Other 1 1.3% 1 1.0% Farmer 56 74.7% 60 60.0% Factory 1 1.3% 1 1.0% Retail 2 2.7% 8 8.0% Construction 1 1.3% 4 4.0% Teacher or official 0 0.0% 1 1.0% Other daily labor 7 9.3% 23 23.0% Housewife/ mother 7 9.3% 2 2.0% Total 75 100% 100 100% Total All Other 19 2.5% 4 .5% Farmer 332 43.3% 383 50.7%*** Factory 3 .4% 5 .7% Retail 48 6.3% 62 8.2% Motor taxi 1 .1% 1 .1% Construction 4 .5% 25 3.3%*** Teacher or official 10 1.3% 13 1.7% Unemployed 7 .9% 13 1.7% Other daily labor 178 23.2% 213 28.2%*** Housewife/ mother 162 21.1% 36 4.8%*** Don't know 2 .3% 0 0.0% Total 766 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 47 | P a g e Table 9: Husband’s age, by provinces Husband’s age Baseline (N=693) Midterm (N=731) Mean 31.38 33.71 95% Confidence Interval for Mean Lower Bound 30.71 32.97 Upper Bound 32.06 34.45 Median 29.00 31.00 Variance 81.170 103.275 Std. Deviation 9.009 10.162 Minimum 18 18 Maximum 70 83 Range 52 65 Table10: Husband’s age group, by provinces Husband's age Baseline Midterm N % N % Battambang under 20 2 0.6% 0 0.0% 20-29 153 48.9% 116 37.4% 30-39 109 34.8% 122 39.4% 40-49 22 7.0% 27 8.7% 50-59 16 5.1% 27 8.7% 60 or over 11 3.5% 11 3.5% Don't Know 0 0.0% 7 2.3% Total 313 100% 310 100% Siem Reap under 20 4 1.2% 3 0.9% 20-29 164 48.7% 130 38.1% 30-39 128 38.0% 143 41.9% 40-49 27 8.0% 32 9.4% 50-59 10 3.0% 8 2.3% 60 or over 4 1.2% 12 3.5% Don't Know 0 0.0% 13 3.8% Total 337 100% 341 100% Pursat under 20 0 0.0% 1 1.0% NOURISH Mid-term Survey Report 48 | P a g e 20-29 40 58.0% 36 36.0% 30-39 24 34.8% 47 47.0% 40-49 5 7.2% 8 8.0% 50-59 0 0.0% 7 7.0% 60 or over 0 0.0% 1 1.0% Total 69 100% 100 100% Total All under 20 6 0.8% 4 0.5% 20-29 357 49.7% 282 37.5%*** 30-39 261 36.3% 312 41.5%*** 40-49 54 7.5% 67 8.9% 50-59 26 3.6% 42 5.6% 60 or over 15 2.1% 24 3.2% Don't Know 0 0.0% 20 2.7% Total 719 100% 751 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 11: Caregiver’s husband occupation, by provinces Caregiver's husband occupation Baseline Midterm N % N % Battambang Other 26 8.3% 2 .6% Farmer 165 52.9% 154 49.7% Factory 4 1.3% 3 1.0% Retail 15 4.8% 23 7.4% Motor taxi 7 2.2% 2 .6% Construction 41 13.1% 52 16.8% Teacher or official 15 4.8% 11 3.5% Unemployed 5 1.6% 1 .3% Other daily labor 34 10.9% 48 15.5% Don't know 0 0.0% 14 4.5% Total 312 100% 310 100% Siem Reap Other 25 7.4% 5 1.5% Farmer 224 66.3% 115 33.7% Factory 5 1.5% 4 1.2% NOURISH Mid-term Survey Report 49 | P a g e Retail 9 2.7% 12 3.5% Motor taxi 3 .9% 8 2.3% Construction 30 8.9% 127 37.2% Teacher or official 20 5.9% 15 4.4% Unemployed 2 .6% 2 .6% Other daily labor 20 5.9% 26 7.6% Private company staff 0 0.0% 8 2.3% Don't know 0 0.0% 19 5.6% Total 338 100% 341 100% Pursat Other 5 7.2% 0 0.0% Farmer 49 71.0% 60 60.0% Factory 2 2.9% 2 2.0% Retail 4 5.8% 6 6.0% Motor taxi 0 0.0% 3 3.0% Construction 7 10.1% 20 20.0% Teacher or official 0 0.0% 1 1.0% Other daily labor 2 2.9% 5 5.0% Private company staff 0 0.0% 2 2.0% Don't know 0 0.0% 1 1.0% Total 69 100% 100 100% Total All Other 56 7.8% 7 0.9%*** Farmer 438 60.9% 329 43.8%*** Factory 11 1.5% 9 12.0% Retail 28 3.9% 41 5.5% Motor taxi 10 1.4% 13 1.7% Construction 78 10.8% 199 26.5%*** Teacher or official 35 4.9% 27 3.6% Unemployed 7 1.0% 3 4.0% Other daily labor 56 7.8% 79 10.5% Private company staff 0 0.0% 10 1.3% Don't know 0 0.0% 34 4.5% Total 719 100% 751 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 50 | P a g e Table 12: Caregivers’ husbands’ location of work, by provinces Caregiver's husbands' location of work Baseline Midterm N % N % Battambang In village 227 73.0% 213 68.7% Outside 84 27.0% 90 29.0% No answer 0 0.0% 7 2.3% Total 311 100% 310 100% Siem Reap In village 297 88.1% 177 51.9% Outside 40 11.9% 147 43.1% No answer 0 0.0% 17 5.0% Total 337 100% 341 100% Pursat In village 61 88.4% 69 69.0% Outside 8 11.6% 30 30.0% No answer 0 0.0% 1 1.0% Total 69 100% 100 100% Total All In village 585 81.6% 459 61.1%*** Outside 132 18.4% 267 35.6%*** No answer 0 0.0% 25 3.3% Total 717 100% 751 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 13: Among Husbands who work outside of village location, by provinces Among husbands who work outside of village Baseline Midterm N % N % Battambang Other 3 3.6% 7 7.2% In Cambodia 36 42.9% 50 51.5% Thailand 45 53.6% 34 35.1% Don't know 0 0.0% 6 6.2% Total 84 100% 97 100% NOURISH Mid-term Survey Report 51 | P a g e Siem Reap Other 1 2.6% 2 1.2% In Cambodia 14 36.8% 116 70.7% Thailand 22 57.9% 29 17.7% Don't know 1 2.6% 17 10.4% Total 38 100% 164 100% Pursat Other 0 0.0% 2 6.5% In Cambodia 3 37.5% 23 74.2% Thailand 5 62.5% 6 19.4% Don't know 8 100% 31 100% Total All Other 4 3.1% 11 3.8% In Cambodia 53 40.8% 189 64.7% Thailand 72 55.4% 69 23.6% Don't know 1 .8% 23 7.9% Total 130 100% 292 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01; ***Statistical significance at 0.1% level, P<0.001 Table 14: Among Husbands who work outside of village location, by provinces Bank Account Baseline Midterm N % N % Battambang Yes 17 5.2% 150 48.2% No 311 94.8% 161 51.8% Total 328 100% 311 100% Siem Reap Yes 25 6.9% 133 38.7% No 335 93.1% 211 61.3% Total 360 100% 344 100% Pursat Yes 4 5.3% 51 51.0% No 71 94.7% 49 49.0% Total 75 100% 100 100% Total All Yes 46 6.0% 334 44.2%*** No 717 94.0% 421 55.8% Total 763 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 52 | P a g e Table 15: Poverty Status, by Respondent Category and Province Poverty Status Baseline Midterm N % N % Battambang Yes observed 90 27.3% 103 33.1% Yes not observed 12 3.6% 19 6.1% Yes expired 17 5.2% 15 4.8% No 211 63.9% 171 55.0% Don't know 0 0.0% 3 1.0% Total 330 100% 311 100% Siem Reap Yes observed 69 19.1% 64 18.6% Yes not observed 32 8.9% 3 0.9% Yes expired 13 3.6% 33 9.6% No 246 68.1% 243 70.6% Don't know 0 0.0% 1 0.3% Total 361 100% 344 100% Pursat Yes observed 11 14.7% 31 31.0% Yes not observed 5 6.7% 3 3.0% Yes expired 0 0.0% 2 2.0% No 59 78.7% 64 64.0% Total 75 100% 100 100% Total All Yes observed 170 22.2% 198 26.2%** Yes not observed 49 6.4% 25 3.3% Yes expired 30 3.9% 50 6.6% No 516 67.4% 478 63.3%** Don't know 0 0.0% 4 0.5% Total 766 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 16: Observation of Child’s Birth Certificate, by provinces Child’s birth certificate Baseline Midterm N % N % Battambang Yes Observed 185 56.1% 248 79.7% Yes Not Observed 71 21.5% 29 9.3% No 65 19.7% 34 10.9% Don't Know 9 2.7% 0 0.0% Total 330 100% 311 100% Siem Reap NOURISH Mid-term Survey Report 53 | P a g e Yes Observed 235 65.1% 320 93.0% Yes Not Observed 68 18.8% 11 3.2% No 50 13.9% 13 3.8% Don't Know 8 2.2% 0 0.0% Total 361 100% 344 100% Pursat Yes Observed 38 50.7% 73 73.0% Yes Not Observed 21 28.0% 13 13.0% No 16 21.3% 14 14.0% Total 75 100% 100 100% Total All Yes Observed 458 59.8% 641 84.9%*** Yes Not Observed 160 20.9% 53 7.0%*** No 131 17.1% 61 8.1% Don't Know 17 2.2% 0 0.0% Total 766 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Health and Nutrition Tables Table 17: Timing of Child’s Most Recent Visit to Health Center, by provinces Timing of Child's visit to Health Center Baseline Midterm N % N % Battambang This Month 58 17.6% 47 15.1% 1Month ago 39 11.8% 83 26.7% 2-3Months ago 116 35.2% 32 10.3% 4-5months ago 37 11.2% 15 4.8% 6months ago 11 3.3% 4 1.3% Over 6months 42 12.7% 78 25.1% Don't remember/Missing 27 8.2% 52 16.7% Total 330 100% 311 100% Siem Reap This Month 67 18.6% 86 25.0% 1Month ago 56 15.5% 87 25.3% 2-3Months ago 112 31.0% 44 12.8% 4-5months ago 28 7.8% 31 9.0% 6months ago 12 3.3% 9 2.6% Over 6months 61 16.9% 66 19.2% NOURISH Mid-term Survey Report 54 | P a g e Don't remember/Missing 25 6.9% 21 6.1% Total 361 100% 344 100% Pursat This Month 9 12.0% 18 18.0% 1Month ago 9 12.0% 15 15.0% 2-3Months ago 33 44.0% 17 17.0% 4-5months ago 10 13.3% 8 8.0% 6months ago 4 5.3% 4 4.0% Over 6months 5 6.7% 36 36.0% Don't remember/Missing 5 6.7% 2 2.0% Total 75 100% 100 100% Total All This Month 134 17.5% 151 20.0% 1Month ago 104 13.6% 185 24.5%*** 2-3Months ago 261 34.1% 93 12.3%*** 4-5months ago 75 9.8% 54 7.2% 6months ago 27 3.5% 17 2.3% Over 6months 108 14.1% 180 23.8% Don't remember/Missing 57 7.4% 75 9.9% Total 766 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 18: Health Services Child (0-23 months) received on most recent visit Children 0-23m received health services* Baseline Midterm N % N % Other 24 3.5% 0 0.0% Vaccination 584 86.0% 407 83.7% Medicine 318 46.8% 224 46.1% IV 301 44.3% 14 2.9% GMP 1 0.1% 208 42.8% Weighing 318 46.8% 119 24.5% NOURISH Mid-term Survey Report 55 | P a g e Counseling 148 21.8% 112 23.0% Don't remember 17 2.5% 0 0.0% Total 679 252% 486 223% *Multiple choice Table 19: Breastfeeding practice, by provinces Ever breastfed 0-59 months Baseline Midterm N % N % Battambang Yes 318 96.7% 167 92.8% No 11 3.3% 13 7.2% Total 329 100% 180 100% Siem Reap Yes 335 95.4% 226 98.7% No 15 4.3% 3 1.3% Don't know 1 0.3% 0 0.0% Total 351 100% 229 100% Pursat Yes 69 95.8% 59 86.8% No 3 4.2% 9 13.2% Total 72 100% 68 100% Total All Yes 722 96.0% 452 94.8% No 29 3.9% 25 5.2% Don't know 1 0.3% 0 0.0% Total 752 100% 477 100% Table 20: Exclusive Breastfeeding practice, by provinces Exclusive Breastfeeding Baseline Midterm N % N % Battambang Yes 127 77.9% 81 82.7% No 36 22.1% 17 17.3% Total 163 100% 98 100% Siem Reap Yes 140 80.0% 88 76.5% No 35 20.0% 27 23.5% Total 175 100% 115 100% Pursat Yes 31 68.9% 15 65.2% No 14 31.1% 8 34.8% Total 45 100% 23 100% NOURISH Mid-term Survey Report 56 | P a g e Total All Yes 298 77.8% 184 78.0% No 85 22.2% 52 22.0% Total 383 100% 236 100% Table 21: Exclusive Breastfeeding practice, by gender Exclusive breastfeeding Baseline Midterm N % N % Female Yes 141 79.2% 100 76.3% No 37 20.8% 31 23.7% Total 178 100% 131 100% Male Yes 155 77.1% 84 80.0% No 46 22.9% 21 20.0% Total 201 100% 105 100% Total Yes 296 78.1% 184 78.0% No 83 21.9% 52 22.0% Total 379 100% 236 100% Table 22: Liquids Other than Breastmilk Given, Children 0-5 Months Liquids other than Breastmilk Baseline Midterm N % N % Battambang Prelacteal feed 24 14.6% 5 5.2% Water 18 11.0% 11 11.1% Infant formula 16 9.8% 4 4.0% Milk 15 9.1% 0 0.0% Juice 1 .6% 0 0.0% Soup broth 3 1.9% 0 0.0% Borbor 3 1.8% 1 1.0% Other liquids 3 1.8% 0 0.0% Vitamin drops or medicine 4 2.4% 12 12.1% Orasel 2 1.2% 1 1.0% Siem Reap Prelacteal feed 17 9.9% 11 9.6% Water 13 7.4% 13 11.3% Infant formula 14 7.9% 15 13.0% Milk 11 6.3% 0 0.0% Juice 0 0.0% 0 0.0% Soup broth 1 .6% 1 .9% Borbor 6 3.4% 5 4.3% NOURISH Mid-term Survey Report 57 | P a g e Other liquids 9 5.1% 0 0.0% Vitamin drops or medicine 7 4.0% 9 7.8% Orasel 3 1.7% 2 1.7% Pursat Prelacteal feed 7 17.9% 0 0.0% Water 5 12.8% 1 4.0% Infant formula 5 12.8% 1 4.0% Milk 3 7.9% 0 0.0% Juice 0 0.0% 0 0.0% Soup broth 0 0 0 0 Borbor 0 0 0 0 Other liquids 2 5.1% 1 4.0% Vitamin drops or medicine 4 10.3% 7 28.0% Orasel 0 0.0% 1 4.0% Total All Prelacteal feed 48 12.8% 16 6.8% Water 36 9.5% 25 10.5% Infant formula 35 9.2% 20 8.4% Milk 29 7.7% 0 0.0%*** Juice 1 .3% 0 0.0% Soup broth 4 1.1% 1 .4% Borbor 9 2.4% 6 2.5% Other liquids 14 3.7% 1 .4%** Vitamin drops or medicine 15 3.9% 28 11.7%*** Orasel 5 1.3% 4 1.7% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 23: Children 6-23 months Food consumption, by type of food and province. Type of food group consumption 6-23 months Baseline Midterm N % N % Battambang Food Group1: Grains, white roots and tubers, and plantains 131 95.6% 87 97.8% Food Group2: Beans, Nuts and Seeds 26 19.0% 21 22.8% Food Group3: Diary products (milk, yogurt, cheese) 47 34.3% 19 21.3% Food Group4: Animal origin (meat, fish, poultry, liver/organ meat) 100 73.0% 45 50.6% Food Group5: Eggs 46 33.6% 32 36.0% Food Group6: Vitamin A rich fruits and vegetables 71 51.8% 62 69.7% NOURISH Mid-term Survey Report 58 | P a g e Food Group7: Other fruits and vegetables 64 46.7% 36 40.4% Siem Reap Food Group1: Grains, white roots and tubers, and plantains 146 94.8% 98 96.1% Food Group2: Beans, Nuts and Seeds 40 26.0% 21 21.9% Food Group3: Diary products (milk, yogurt, cheese) 32 20.8% 20 19.6% Food Group4: Animal origin (meat, fish, poultry, liver/organ meat) 120 77.9% 50 49.0% Food Group5: Eggs 55 35.7% 49 48.0% Food Group6: Vitamin A rich fruits and vegetables 88 57.1% 80 78.4% Food Group7: Other fruits and vegetables 64 41.6% 42 41.2% Pursat Food Group1: Grains, white roots and tubers, and plantains 24 96.0% 31 100.0% Food Group2: Beans, Nuts and Seeds 6 24.0% 13 38.2% Food Group3: Diary products (milk, yogurt, cheese) 6 24.0% 6 19.4% Food Group4: Animal origin (meat, fish, poultry, liver/organ meat) 16 64.0% 19 61.3% Food Group5: Eggs 7 28.0% 17 54.8% Food Group6: Vitamin A rich fruits and vegetables 13 52.0% 5 16.1% Food Group7: Other fruits and vegetables 6 24.0% 8 25.8% Total All Food Group1: Grains, white roots and tubers, and plantains 301 95.3% 216 97.3% Food Group2: Beans, Nuts and Seeds 22 22.8% 55 24.8% Food Group3: Diary products (milk, yogurt, cheese) 85 26.9% 45 20.3%* Food Group4: Animal origin (meat, fish, poultry, liver/organ meat) 236 74.7% 114 51.4%*** Food Group5: Eggs 108 34.2% 98 44.1%* Food Group6: Vitamin A rich fruits and vegetables 171 54.1% 168 75.7%*** Food Group7: Other fruits and vegetables 134 42.4% 86 38.7% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 59 | P a g e Table 24: Fish Consumption in Past 24 Hours Any fish consumption Baseline Midterm N % N % 6-8m 19 48.7% 10 20.8% 9-11m 27 64.3% 30 60.0% 12-23m 50 67.6% 68 55.3%* 24-59m 15 57.7% 7 63.6% Total 111 38.7% 115 50.4% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 25: Fish Consumption in Past 24 Hours Small Fish Baseline Midterm N % N % 6-8m 5 12.8% 7 14.6% 9-11m 8 19.0% 17 34.0% 12-23m 16 21.3% 33 26.8%* 24-59m 3 12.0% 2 18.2% Total 32 17.7% 59 25.4% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 26: Packed snacks Packed snacks Baseline Midterm N % N % Yes 116 31.9% 39 16.4%*** No 248 68.1% 198 83.2% Don't Know 0 0 1 .4% Total 364 100% 238 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 27: Sweets Sweets Baseline Midterm N % N % Yes 161 43.9% 113 47.5% No 206 56.1% 125 52.5% Total 367 100.0% 238 100.0% NOURISH Mid-term Survey Report 60 | P a g e Table 28: Time breastfeeding by province Time breastfed Baseline Midterm N % N % Battambang < 5 times 30 21.4% 2 2.5% 5-10 times 73 52.1% 33 40.7% 11-15 times 24 17.1% 35 43.2% >15 times 13 9.3% 11 13.6% Total 140 100% 81 100% Siem Reap < 5 times 32 23.5% 9 8.2% 5-10 times 54 39.7% 53 48.2% 11-15 times 23 16.9% 34 30.9% >15 times 27 19.9% 14 12.7% Total 136 100% 110 100% Pursat < 5 times 1 2.6% 0 0.0% 5-10 times 16 42.1% 7 43.8% 11-15 times 12 31.6% 6 37.5% >15 times 9 23.7% 3 18.8% Total 38 100% 16 100% Total All < 5 times 63 20.1% 11 5.3%*** 5-10 times 143 45.5% 93 44.9%*** 11-15 times 59 18.8% 75 36.2% >15 times 49 15.6% 28 13.5% Total 314 100% 207 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 29: Duration of breastfeeding by province Duration of breastfeeding Baseline Midterm N % N % Battambang <5minutes 40 28.8% 41 50.6% 5-10minutes 45 32.4% 26 32.1% 11-15minutes 20 14.4% 5 6.2% >15minutes 34 24.5% 9 11.1% Total 139 100.0% 81 100.0% NOURISH Mid-term Survey Report 61 | P a g e Siem Reap <5minutes 60 46.2% 45 40.9% 5-10minutes 25 19.2% 43 39.1% 11-15minutes 15 11.5% 11 10.0% >15minutes 30 23.1% 11 10.0% Total 130 100.0% 110 100.0% Pursat <5minutes 4 10.5% 8 50.0% 5-10minutes 21 55.3% 3 18.8% 11-15minutes 2 5.3% 1 6.3% >15minutes 11 28.9% 4 25.0% Total 38 100.0% 16 100.0% Total All <5minutes 104 33.9% 94 45.4% 5-10minutes 91 29.6% 72 34.8%** 11-15minutes 37 12.1% 17 8.2%** >15minutes 75 24.4% 24 11.6%** Total 307 100.0% 207 100.0% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 30: Feeding Practice During and After Fever 0-5 month Olds Drink given during fever Baseline Midterm N % N % Battambang Much Less 2 1.8% 0 0.0% Somewhat Less 27 23.9% 3 16.7% About The Same 45 39.8% 4 22.2% More 31 27.4% 10 55.6% Much More 4 3.5% 0 0.0% Never gave 0 0.0% 1 5.6% Don't Know 4 3.5% 0 0.0% Total 113 100% 18 100% Siem Reap Much Less 2 1.4% 0 0.0% Somewhat Less 44 29.9% 3 12.0% About The Same 44 29.9% 4 16.0% More 38 25.9% 11 44.0% NOURISH Mid-term Survey Report 62 | P a g e Much More 7 4.8% 2 8.0% Never gave 0 0.0% 5 20.0% Don't Know 12 8.2% 0 0.0% Total 147 100% 25 100% Pursat Much Less 1 3.4% 0 0.0% Somewhat Less 7 24.1% 2 20.0% About The Same 13 44.8% 2 20.0% More 7 24.1% 5 50.0% Much More 1 3.4% 1 10.0% Total 29 100% 10 100% Total All Much Less 5 1.7% 0 0.0% Somewhat Less 78 27.0% 8 15.1%*** About The Same 102 35.3% 10 18.9%*** More 76 26.3% 26 49.1%*** Much More 12 4.2% 3 5.7% Never gave 0 0.0% 6 11.3% Don't Know 16 5.5% 0 0.0% Total 289 100% 53 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 31: Feeding Practice During and After Fever 0-5 month Olds Food given during fever Baseline Midterm N % N % Battambang Much Less 5 4.5% 0 0.0% Somewhat Less 29 25.9% 2 11.1% About The Same 36 32.1% 1 5.6% More 13 11.6% 1 5.6% Much More 1 .9% 0 0.0% Stopped 1 .9% 0 0.0% Never gave 24 21.4% 14 77.8% Don't Know 3 2.7% 0 0.0% Total 112 100% 18 100% Siem Reap Much Less 2 1.4% 1 4.0% Somewhat Less 43 29.3% 3 12.0% About The Same 37 25.2% 0 0.0% More 13 8.8% 1 4.0% Stopped 3 2.0% 0 0.0% Never gave 42 28.6% 20 80.0% Don't Know 7 4.8% 0 0.0% Total 147 100% 25 100% Pursat Much Less 8 27.6% 2 20.0% Somewhat Less 12 41.4% 2 20.0% About The Same 0 0.0% 1 10.0% NOURISH Mid-term Survey Report 63 | P a g e More 1 3.4% 0 0.0% Much More 8 27.6% 5 50.0% Total 29 100% 10 100% Total All Much Less 7 2.4% 1 1.9% Somewhat Less 80 27.8% 7 13.2%*** About The Same 85 29.5% 3 5.7%*** More 26 9.0% 3 5.7% Much More 2 .7% 0 0.0% Stopped 4 1.4% 0 0.0% Never gave 74 25.7% 39 73.6%*** Don't Know 10 3.5% 0 0.0% Total 288 100% 53 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 32: Feeding Practice During and After Fever 0-5 month Olds Drink given after fever Baseline Midterm N % N % Battambang Much Less 2 1.8% 0 0.0% Somewhat Less 2 1.8% 0 0.0% About The Same 65 58.0% 5 27.8% More 28 25.0% 6 33.3% Much More 6 5.4% 1 5.6% Never gave 6 5.4% 4 22.2% Don't Know 3 2.7% 2 11.1% Total 112 100% 18 100% Siem Reap Much Less 1 .7% 0 0.0% Somewhat Less 16 10.8% 0 0.0% About The Same 74 50.0% 7 28.0% More 34 23.0% 11 44.0% Never gave 15 10.1% 2 8.0% Don't Know 8 5.4% 5 20.0% Total 148 100% 25 100% Pursat Much Less 6 20.7% 2 20.0% Somewhat Less 20 69.0% 4 40.0% About The Same 2 6.9% 3 30.0% More 0 0.0% 1 10.0% Much More 1 3.4% 0 0.0% Total 29 100.0% 10 100.0% Total All Much Less 3 1.0% 0 0.0% Somewhat Less 24 8.3% 2 3.8% About The Same 159 55.0% 16 30.2%** More 64 22.1% 20 37.7%** NOURISH Mid-term Survey Report 64 | P a g e Much More 6 2.1% 2 3.8% Never gave 22 7.6% 6 11.3% Don't Know 11 3.8% 7 13.2% Total 288 100% 53 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 33: Feeding Practice During and After Fever 0-5 month Olds Food given week after fever Baseline Midterm N % N % Battambang Much Less 1 .9% 1 5.6% Somewhat Less 9 8.1% 1 5.6% About The Same 54 48.6% 3 16.7% More 18 16.2% 1 5.6% Much More 4 3.6% 0 0.0% Never gave 22 19.8% 8 44.4% Don't Know 3 2.7% 4 22.2% Total 111 100% 18 100% Siem Reap Somewhat Less 14 9.6% 0 0.0% About The Same 60 41.1% 3 12.0% More 18 12.3% 1 4.0% Much More 1 .7% 0 0.0% Stopped 1 .7% 0 0.0% Never gave 46 31.5% 17 68.0% Don't Know 6 4.1% 4 16.0% Total 146 100% 25 100% Pursat Somewhat Less 2 6.9% 3 30.0% About The Same 16 55.2% 3 30.0% More 3 10.3% 0 0.0% Never gave 8 27.6% 4 40.0% Total 29 100.0% 10 100.0% Total All Much Less 1 .3% 1 1.9% Somewhat Less 25 8.7% 4 7.5%*** About The Same 130 45.5% 9 17.0%*** More 39 13.6% 2 3.8% Much More 5 1.7% 0 0.0% Stopped 1 .3% 0 0.0% Never gave 76 26.6% 29 54.7%*** Don't Know 9 3.1% 8 15.1% Total 288 100% 53 100.0% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 65 | P a g e Table 34: Feeding Practice During and After Diarrhea 6-59 month Olds Drink given during diarrhea Baseline Midterm N % N % Battambang Much Less 1 1.0% 0 0.0% Somewhat Less 10 10.4% 2 9.1% About The Same 35 36.5% 8 36.4% More 31 32.3% 12 54.5% Much More 9 9.4% 0 0.0% Don't Know 10 10.4% 0 0.0% Total 96 100% 22 100% Siem Reap Much Less 2 1.2% 0 0.0% Somewhat Less 18 11.0% 3 8.8% About The Same 47 28.7% 11 32.4% More 66 40.2% 20 58.8% Much More 6 3.7% 0 0.0% Never gave 10 6.1% 0 0.0% Don't Know 15 9.1% 0 0.0% Total 164 100% 34 100% Pursat Somewhat Less 3 13.6% 0 0.0% About The Same 12 54.5% 3 27.3% More 4 18.2% 7 63.6% Much More 0 0.0% 1 9.1% Don't Know 3 13.6% 0 0.0% Total 22 100% 11 100% Total All Much Less 3 1.1% 0 0.0% Somewhat Less 31 11.0% 5 7.5% About The Same 94 33.3% 22 32.8%* * More 101 35.8% 39 58.2%* * Much More 15 5.3% 1 1.5%** Never gave 10 3.5% 0 0.0% Don't Know 28 9.9% 0 0.0% Total 282 100% 67 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 66 | P a g e Table 35: Feeding Practice During and After Diarrhea 6-59 month Olds Drink given after diarrhea Baseline Midterm N % N % Battambang Somewhat Less 5 5.3% 0 0.0% About The Same 48 50.5 % 10 45.5% More 22 23.2 % 10 45.5% Much More 6 6.3% 2 9.1% Stopped 1 1.1% 0 0.0% Never gave 2 2.1% 0 0.0% Don't Know 11 11.6 % 0 0.0% Total 95 100 % 22 100% Siem Reap Somewhat Less 10 6.2% 1 2.9% About The Same 77 47.5 % 13 38.2% More 44 27.2 % 13 38.2% Much More 3 1.9% 0 0.0% Never gave 12 7.4% 0 0.0% Don't Know 16 9.9% 7 20.6% Total 162 100 % 34 100% Pursat Somewhat Less 3 13.6 % 0 0.0% About The Same 13 59.1 % 3 27.3% More 3 13.6 % 6 54.5% Much More 0 0.0% 1 9.1% Don't Know 3 13.6 % 1 9.1% Total 22 100 % 11 100% Total All Somewhat Less 18 6.5% 1 1.5%* About The Same 138 49.5 % 26 38.8% * More 69 24.7 % 29 43.3% * Much More 9 3.2% 3 4.5% NOURISH Mid-term Survey Report 67 | P a g e Stopped 1 .4% 0 0.0% Never gave 14 5.0% 0 0.0% Don't Know 30 10.8 % 8 11.9% Total 279 100 % 67 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 36: Feeding Practice During and After Diarrhea 6-59 month Olds Food given during diarrhea Baseline Midterm N % N % Battambang Much Less 10 10.6% 2 9.1% Somewhat Less 13 13.8% 6 27.3% About The Same 20 21.3% 9 40.9% More 15 16.0% 5 22.7% Much More 4 4.3% 0 0.0% Stopped 2 2.1% 0 0.0% Never gave 19 20.2% 0 0.0% Don't Know 11 11.7% 0 0.0% Total 94 100% 22 100% Siem Reap Much Less 5 3.1% 0 0.0% Somewhat Less 36 22.2% 10 29.4% About The Same 43 26.5% 15 44.1% More 29 17.9% 7 20.6% Much More 2 1.2% 0 0.0% Never gave 30 18.5% 2 5.9% Don't Know 17 10.5% 0 0.0% Total 162 100% 34 100% Pursat Somewhat Less 6 27.3% 2 18.2% About The Same 4 18.2% 5 45.5% More 2 9.1% 3 27.3% Much More 0 0.0% 1 9.1% Never gave 7 31.8% 0 0.0% Don't Know 3 13.6% 0 0.0% Total 22 100% 11 100% Total All Much Less 15 5.4% 2 3.0% Somewhat Less 55 19.8% 18 26.9%*** About The Same 67 24.1% 29 43.3%*** NOURISH Mid-term Survey Report 68 | P a g e More 46 16.5% 15 22.4%*** Much More 6 2.2% 1 1.5% Stopped 2 .7% 0 0.0% Never gave 56 20.1% 2 3.0% Don't Know 31 11.2% 0 0.0% Total 278 100% 67 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 37: Feeding Practice During and After Diarrhea 6-59 month Olds Food given week after diarrhea Baseline Midterm N % N % Battambang Much Less 1 1.1% 0 0.0% Somewhat Less 5 5.4% 3 13.6% About The Same 37 39.8% 11 50.0% More 18 19.4% 8 36.4% Much More 2 2.2% 0 0.0% Never gave 18 19.4% 0 0.0% Don't Know 12 12.9% 0 0.0% Total 93 100% 22 100% Siem Reap Somewhat Less 16 10.1% 4 11.8% About The Same 69 43.7% 15 44.1% More 28 17.7% 7 20.6% Never gave 30 19.0% 2 5.9% Don't Know 15 9.5% 6 17.6% Total 158 100% 34 100% Pursat Somewhat Less 3 13.6% 4 36.4% About The Same 7 31.8% 3 27.3% More 2 9.1% 2 18.2% Much More 0 0.0% 1 9.1% Never gave 7 31.8% 0 0.0% Don't Know 3 13.6% 1 9.1% Total 22 100% 11 100% Total All Much Less 1 .4% 0 0.0% Somewhat Less 24 8.8% 11 16.4% About The Same 113 41.4% 29 43.3%* NOURISH Mid-term Survey Report 69 | P a g e More 48 17.6% 17 25.4%* Much More 2 .7% 1 1.5% Never gave 55 20.1% 2 3.0%* Don't Know 30 11.0% 7 10.4% Total 273 100% 67 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 38: Feeding Practice During and After Fever 6-59 month Olds Drink given during fever Baseline Midterm N % N % Battambang Much Less 2 1.8% 0 0.0% Somewhat Less 30 26.8% 10 21.3% About The Same 41 36.6% 10 21.3% More 33 29.5% 26 55.3% Much More 1 .9% 1 2.1% Don't Know 5 4.5% 0 0.0% Total 112 100% 47 100% Siem Reap Much Less 3 1.9% 0 0.0% Somewhat Less 27 16.8% 17 21.5% About The Same 81 50.3% 26 32.9% More 33 20.5% 33 41.8% Much More 10 6.2% 3 3.8% Don't Know 7 4.3% 0 0.0% Total 161 100% 79 100% Pursat Much Less 1 4.0% 0 0.0% Somewhat Less 4 16.0% 5 12.2% More 16 64.0% 11 26.8% Much More 4 16.0% 22 53.7% Don't Know 0 0.0% 3 7.3% Total 25 100% 41 100% Total All Much Less 6 2.0% 0 0.0% Somewhat Less 61 20.5% 32 19.2%*** About The Same 138 46.3% 47 28.1%*** More 70 23.5% 81 48.5% Much More 11 3.7% 7 4.2% Don't Know 12 4.0% 0 0.0% Total 298 100% 167 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 70 | P a g e Table 39: Feeding Practice During and After Fever 6-59 month Olds Drink given after fever Baseline Midterm N % N % Battambang Somewhat Less 8 7.1% 2 4.3% About The Same 67 59.8% 18 38.3% More 27 24.1% 21 44.7% Much More 1 .9% 1 2.1% Stopped 0 0.0% 1 2.1% Never gave 5 4.5% 0 0.0% Don't Know 4 3.6% 4 8.5% Total 112 100% 47 100% Siem Reap Somewhat Less 13 8.1% 2 2.5% About The Same 94 58.4% 35 44.3% More 31 19.3% 28 35.4% Much More 4 2.5% 2 2.5% Never gave 16 9.9% 0 0.0% Don't Know 3 1.9% 12 15.2% Total 161 100% 79 100% Pursat Somewhat Less 1 4.0% 2 4.9% About The Same 16 64.0% 12 29.3% More 6 24.0% 23 56.1% Never gave 2 8.0% 0 0.0% Don't Know 0 0.0% 4 9.8% Total 25 100% 41 100% Total All Somewhat Less 22 7.4% 6 3.6%*** About The Same 177 59.4% 65 38.9%*** More 64 21.5% 72 43.1% Much More 5 1.7% 3 1.8% Stopped 0 0.0% 1 .6% Never gave 23 7.7% 0 0.0% Don't Know 7 2.3% 20 12.0% Total 298 100% 167 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 71 | P a g e Table 40: Feeding Practice During and After Fever 6-59 month Olds Food given during fever Baseline Midterm N % N % Battambang Much Less 6 5.5% 1 2.1% Somewhat Less 30 27.3% 14 29.8% About The Same 27 24.5% 18 38.3% More 9 8.2% 13 27.7% Stopped 3 2.7% 0 0.0% Never gave 32 29.1% 1 2.1% Don't Know 3 2.7% 0 0.0% Total 110 100% 47 100% Siem Reap Much Less 4 2.5% 1 1.3% Somewhat Less 41 25.6% 31 39.2% About The Same 63 39.4% 31 39.2% More 17 10.6% 15 19.0% Much More 1 .6% 0 0.0% Stopped 1 .6% 0 0.0% Never gave 31 19.4% 1 1.3% Don't Know 2 1.3% 0 0.0% Total 160 100% 79 100% Pursat Much Less 2 8.3% 1 2.4% Somewhat Less 3 12.5% 20 48.8% About The Same 6 25.0% 10 24.4% More 1 4.2% 10 24.4% About The Same 12 50.0% 0 0.0% Total 24 100% 41 100% Total All Much Less 12 4.1% 3 1.8% Somewhat Less 74 25.2% 65 38.9% About The Same 96 32.7% 59 35.3%*** More 27 9.2% 38 22.8% Much ore 1 .3% 0 0.0% Stopped 4 1.4% 0 0.0% Never gave 75 25.5% 2 1.2%*** Don't Know 5 1.7% 0 0.0% Total 294 100% 167 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 72 | P a g e Table 41: Feeding Practice During and After Fever 6-59 month Olds Food given week after fever Baseline Midterm N % N % Battambang Much Less 1 .9% 0 0.0% Somewhat Less 11 10.0% 5 10.6% About The Same 38 34.5% 23 48.9% More 22 20.0% 15 31.9% Never gave 34 30.9% 0 0.0% Don't Know 4 3.6% 4 8.5% Total 110 100% 47 100% Siem Reap Somewhat Less 15 9.4% 9 11.4% About The Same 86 53.8% 31 39.2% More 27 16.9% 26 32.9% Never gave 31 19.4% 1 1.3% Don't Know 1 .6% 12 15.2% Total 160 100% 79 100% Pursat Somewhat Less 1 4.0% 9 22.0% About The Same 9 36.0% 13 31.7% More 3 12.0% 14 34.1% Never gave 11 44.0% 0 0.0% Don't Know 1 4.0% 5 12.2% Total 25 100% 41 100% Total All Much Less 1 .3% 0 0.0% Somewhat Less 27 9.2% 23 13.8% About The Same 133 45.1% 67 40.1%*** More 52 17.6% 55 32.9% Never gave 76 25.8% 1 .6%*** Don't Know 6 2.0% 21 12.6% Total 295 100% 167 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 73 | P a g e Water, Sanitation, and Hygiene (WASH) Tables Table 42: Water Treatment before Drinking, by Method and Province Water treatment before drinking Baseline Midterm N % N % Battambang Boil 196 59.4% 134 43.1% Filter 22 6.7% 100 32.2% Chlorine 1 0.3% 0 0.0% Buy drinking water 23 7.0% 34 10.9% Nothing 1 0.3% 23 7.4% Drink raw water 0 0.0% 2 0.6% Overall sample 330 100% 311 100% Siem Reap Boil 158 45.1% 122 35.5% Filter 80 22.9% 148 43.0% Chlorine 1 0.3% 0 0.0% Buy drinking water 15 4.3% 23 6.7% Nothing 4 1.1% 20 5.8% Overall sample 350 100% 344 100% Pursat Boil 42 56.0% 59 59.0% Filter 1 1.3% 20 20.0% Buy drinking water 6 8.0% 8 8.0% Nothing 0 0.0% 3 3.0% Overall sample 75 100% 100 100% Total All Boil 396 52.5% 315 41.7%*** Filter 103 13.6% 268 35.5%*** Chlorine 2 0.3% 0 0.0% Buy drinking water 44 5.8% 65 8.6% Nothing 5 0.7% 46 6.1% Drink raw water 0 0.0% 2 0.3% Total overall sample 755 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 74 | P a g e Table 43: Water Filter Cleaning, by Province Water Filter Cleaning Baseline Midterm N % N % Battambang Daily 0 0.0% 5 5.0% Weekly 9 39.1% 89 89.0% Monthly 1 4.3% 5 5.0% Every few months 1 4.3% 1 1.0% Every few day 12 52.2% 0 0.0% Total 23 100% 100 100% Siem Reap Daily 15 18.8% 18.8% 6.8% weekly 22 27.5% 27.5% 73.0% Monthly 3 3.8% 3.8% 13.5% Every few months 4 5.0% 5.0% 4.7% Every year 0 0.0% 0.0% .7% Don't remember 0 0.0% 0.0% 1.4% Every few day 35 43.8% 43.8% 0.0% Don't know 1 1.3% 1.3% 0.0% Total 80 100% 1 100% Pursat Daily 0 0.0% 4 20.0% weekly 1 100.0% 16 80.0% Total 1 100% 20 100% Total All Daily 15 14.4% 19 7.1% weekly 32 30.8% 213 79.5%*** Monthly 4 3.8% 25 9.3%*** Every few month 5 4.8% 8 3.0% Every Year 0 0.0% 1 .4% Do not remember 0 0.0% 2 .7% Every few day 47 45.2% 0 0.0% Don't know 1 1.0% 0 0.0% Total 104 100% 268 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 44: Water Filter Cleanliness, by Province (Observation) Water Filter Cleanliness (Observed) Baseline Midterm N % N % Battambang Looks clean 18 78.3% 97 97.0% Looks dirty 5 21.7% 3 3.0% Total 23 100% 100 100% NOURISH Mid-term Survey Report 75 | P a g e Siem Reap Looks clean 56 86.2% 131 88.5% Looks dirty 9 13.8% 17 11.5% Total 65 100% 148 100% Pursat Looks clean 1 100.0% 20 100.0% Total 1 100% 20 100% Total All Observed Looks clean 75 84.3% 248 92.5%* Looks dirty 14 15.7% 20 7.5% Total 89 100% 268 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 45: Type of latrine construction, by Province Type of latrine Baseline Midterm N % N % Battambang Flush to piped sewer system 44 13.3% 162 52.1% Flush to septic tank 53 16.1% 60 19.3% Flush to pit latrine 7 2.1% 0 0.0% Ventilated improved pit latrine 0 0.0% 1 0.3% Pit latrine with slab 0 0.0% 2 0.6% Pit latrine without slab/ open pit 1 0.3% 2 0.6% No facility/bush/field 98 29.7% 46 14.8% Use another person/family's latrine 17 5.2% 38 12.2% Flush to outside tank 108 32.7% 0 0.0% Don't know 2 0.6% 0 0.0% Total 330 100% 311 100% Siemreap Flush to piped sewer system 68 19.3% 227 66.0% Flush to septic tank 36 10.2% 34 9.9% Hanging toilet/hanging latrine 1 0.3% 0 0.0% No facility/bush/field 183 52.0% 32 9.3% Use another person/family's latrine 15 4.3% 51 14.8% Flush to outside tank 42 11.9% 0 0.0% Don't know 7 2.0% 0 0.0% Total 352 100% 344 100% Pursat Flush to piped sewer system 18 24.0% 54 54.0% Flush to septic tank 3 4.0% 14 14.0% NOURISH Mid-term Survey Report 76 | P a g e Flush to pit latrine 13 17.3% 1 1.0% No facility/bush/field 28 37.3% 21 21.0% Use another person/family's latrine 5 6.7% 10 10.0% Flush to outside tank 8 10.7% 0 0.0% Total 75 100% 100 100% Total All Flush to piped sewer system 130 17.2% 443 58.7%*** Flush to septic tank 92 12.2% 108 14.3% Flush to pit latrine 20 2.6% 1 0.1% Ventilated improved pit latrine 0 0.0% 1 0.1% Pit latrine with slab 0 0.0% 2 0.3% Pit latrine without slab/ open pit 1 0.1% 2 0.3% Hanging toilet/hanging latrine 1 0.1% 0 0.0% No facility/bush/field 309 40.8% 99 13.1%*** Use another person/family's latrine 37 4.9% 99 13.1%*** Flush to outside tank 158 20.9% 0 0.0%*** Don't know 9 1.2% Total 757 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 46: Latrine construction, by type of function Latrine construction by function Baseline Midterm Improved Latrine, Not Shared N % N % Flush to piped sewer system 97 13% 349 46%*** Flush to septic tank 65 9% 89 12% Flush to outside tank 101 13% 0 0%*** Flush to pit latrine 15 2% 1 0% Flush, don't know where 0 0% 0 0% Pit latrine with slab 0 0% 2 0% Ventilated improved latrine 0 0% 1 0% Total 278 37% 442 59% Shared Facility Flush to piped sewer system 31 4% 94 12%*** Flush to septic tank 27 4% 19 3% Flush to outside tank 54 7% 0 0%*** Flush to pit latrine 5 1% 0 0% NOURISH Mid-term Survey Report 77 | P a g e Flush, don't know where 0 0% 0 0% Pit latrine with slab 0 0% 0 0% Total 117 16% 113 15% Non-Improved Latrine Pit latrine without slab/ open pit 1 0% 2 0% Hanging toilet/hanging latrine 1 0% 0 0% No facility/bush/field 309 41% 99 13%*** Use another person/family's latrine 37 5% 99 13%*** Other 9 1% 0 0% Total 357 47% 200 26% Total All 752 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 47: Household handwashing place, by province Handwashing Place , by province Baseline Midterm N % N % Battambang Observed 255 77.7% 295 94.9% Not observed, not in dwelling/yard/plot 70 21.3% 16 5.1% Not observed, no permission to see 2 .6% 0 0.0% Not observed, other reason 1 .3% 0 0.0% Total 328 100% 311 100% Siem Reap Observed 259 74.6% 338 98.3% Not observed, not in dwelling/yard/plot 81 23.3% 6 1.7% Not observed, no permission to see 1 .3% 0 0.0% Not observed, other reason 6 1.7% 0 0.0% Total 347 100% 344 100% Pursat Observed 34 45.3% 100 100.0% Not observed, not in dwelling/yard/plot 35 46.7% 0 0.0% Not observed, no permission to see 1 1.3% 0 0.0% NOURISH Mid-term Survey Report 78 | P a g e Not observed, other reason 5 6.7% 0 0.0% Total 75 100% 100 100% Total All Observed 548 73.1% 733 97.1%*** Not observed, not in dwelling/yard/plot 186 24.8% 22 2.9%*** Not observed, no permission to see 4 .5% 0 0.0% Not observed, other reason 12 1.6% 0 0.0% Total 750 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 48: Separate Handwashing station, by Province Separate, Dedicated Handwashing Station Baseline Midterm N % N % Battambang Tippy Tap 29 9.9% 52 16.7% Tippy Tap with soap 131 44.6% 194 62.4% Happy Tap 2 .7% 6 1.9% Happy Tap with soap 1 .3% 3 1.0% No separate handwashing station 86 29.3% 56 18.0% Other 45 15.3% 0 0.0% Total 294 100% 311 100% Siem Reap Tippy Tap 26 8.0% 7 2.0% Tippy Tap with soap 95 29.1% 299 86.9% Happy Tap 2 .6% 0 0.0% Happy Tap with soap 4 1.2% 2 .6% No separate handwashing station 170 52.1% 36 10.5% Other 29 8.9% 0 0.0% Total 326 100% 344 100% Pursat Tippy Tap 13 18.1% 27 27.0% Tippy Tap with soap 34 47.2% 48 48.0% Happy Tap 4 5.6% 0 0.0% Happy Tap with soap 2 2.8% 0 0.0% No separate handwashing station 12 16.7% 25 25.0% Other 7 9.7% 0 0.0% Total 72 100% 100 100% NOURISH Mid-term Survey Report 79 | P a g e Total All Tippy Tap 68 9.8% 86 11.4% Tippy Tap with soap 260 37.6% 541 71.7%*** Happy Tap 8 1.2% 6 .8% Happy Tap with soap 7 1.0% 5 .7% No separate handwashing station 268 38.7% 117 15.5%*** Other 81 11.7% 0 0.0% Total 692 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 49: Child Stool Disposal by children age group, by Province Battambang Baseline Midterm Children <=2 Year Children >2-5 Year Children <=2 Year Children >2-5 Year N % N % N % N % Child used toilet or latrine 18 5.9% 1 5.0% 42 22.2% 82 67.8% Put/rinsed into toilet or latrine 49 16.0% 5 25.0% 41 21.7% 8 6.6% Put/rinsed into drain or ditch 4 1.3% 0 0.0% 3 1.6% 0 0.0% Thrown into garbage 18 5.9% 1 5.0% 16 8.5% 2 1.7% Buried 83 27.1% 5 25.0% 72 38.1% 25 20.7% Left in the open 8 2.6% 0 0.0% 14 7.4% 4 3.3% Throw to the forest 45 14.7% 5 25.0% 0 0.0% 0 0.0% Other 81 26.5% 3 15.0% 1 0.5% 0 0.0% Total 306 100% 20 100% 189 100% 121 100% Siem Reap Child used toilet or latrine 11 3.4% 0 0.0% 25 10.9% 84 73.0% Put/rinsed into toilet or latrine 47 14% 4 18.2% 79 34.5% 7 6.1% Put/rinsed into drain or ditch 4 1.2% 0 0.0% 2 0.9% 0 0.0% Thrown into garbage 2 0.6% 0 0.0% 9 3.9% 3 2.6% Buried 169 51.5% 12 55% 93 40.6% 17 14.8% Left in the open 12 3.7% 1 4.5% 15 6.6% 4 3.5% Throw to the forest 51 15.5% 3 13.6% 0 0.0% 0 0.0% Other 32 9.8% 2 9.1% 6 2.6% 0 0.0% Total 306 100% 22 100% 229 100% 115 100% Pursat Child used toilet or latrine 1 1.4% 0 0.0% 28 41.2% 15 46.9% Put/rinsed into toilet or latrine 8 11% 0 0.0% 5 7.4% 2 6.3% Thrown into garbage 0 0.0% 0 0.0% 4 5.9% 0 0.0% Buried 35 47.9% 0 0.0% 15 22.1% 8 25.0% NOURISH Mid-term Survey Report 80 | P a g e Left in the open 3 4.1% 1 100% 16 23.5% 7 21.9% Throw to the forest 24 32.9% 0 0.0% 0 0.0% 0 0.0% Other 2 2.7% 0 0.0% 0 0.0% 0 0.0% Total 73 100% 1 100% 68 100% 32 100% Total All Child used toilet or latrine 30 4.2% 1 2.3% 95 19.5%*** 181 67.5% Put/rinsed into toilet or latrine 104 15% 9 20.9% 125 25.7%*** 17 6.3% Put/rinsed into drain or ditch 8 1.1% 0 0.0% 5 1.0% 0 0.0% Thrown into garbage 20 2.8% 1 2.3% 29 6.0% 5 1.9% Buried 287 40.6% 17 40% 180 37.0%*** 50 18.7% Left in the open 23 3.3% 2 4.7% 45 9.3% 15 5.6% Throw to the forest 120 17.0% 8 19% 0 0.0% 0 0.0% Other 115 16.3% 5 12% 7 1.4% 0 0.0% Total 707 100% 43 100% 486 100% 268 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Agriculture Tables Table 50: Percentage grown food at home, by Province Grow food at home Baseline Midterm N % N % Battambang Yes Observed 274 83.8% 276 88.7% Yes Not Observed 6 1.8% 1 .3% No 47 14.4% 34 10.9% Total 327 100% 311 100% Siem Reap Yes Observed 253 71.5% 288 83.7% Yes Not Observed 27 7.6% 10 2.9% No 74 20.9% 46 13.4% Total 354 100% 344 100% Pursat Yes Observed 43 57.3% 79 79.0% Yes Not Observed 12 16.0% 1 1.0% No 20 26.7% 20 20.0% Total 75 100% 100 100% Total All Yes Observed 570 75.4% 643 85.2%*** NOURISH Mid-term Survey Report 81 | P a g e Yes Not Observed 45 6.0% 12 1.6% No 141 18.7% 100 13.2% Total 756 100% 755 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 51: Vegetables Grown at Home, by Province Use of vegetables grown Baseline Midterm N % N % Battambang Ptee (Amaranth) 105 42.2% 105 37.9% Moringa 79 31.7% 138 49.8% Pumpkin 87 34.9% 159 57.4% Sweet Potato 68 27.3% 55 19.9% Long Bean 39 15.7% 57 20.6% Siem Reap Ptee (Amaranth) 86 33.0% 87 29.2% Moringa 58 22.2% 99 33.2% Pumpkin 92 35.2% 79 26.5% Sweet Potato 80 30.7% 31 10.4% Long Bean 45 17.2% 35 11.7% Pursat Ptee (Amaranth) 18 34.0% 40 50.0% Moringa 12 22.6% 32 40.0% Pumpkin 17 32.1% 37 46.3% Sweet Potato 14 26.4% 9 11.3% Long Bean 4 7.5% 7 8.8% Multiple Answers (Baseline N=563, N=655) Table 52: Use of Vegetables Grown at Home, by Province Use of vegetables grown Baseline Midterm N % N % Battambang Eat 283 100.0% 276 99.6% Sell 41 14.5% 53 19.1% Give to family and friends 83 29.3% 111 40.1% Give to neighbors 108 38.2% 153 55.2% Give to animals 3 1.1% 28 10.1% Throw away 2 .7% 0 0.0% NOURISH Mid-term Survey Report 82 | P a g e Siem Reap Eat 284 99.6% 298 100.0% Sell 55 19.3% 36 12.1% Give to family and friends 106 37.2% 38 12.8% Give to neighbors 143 50.2% 92 30.9% Give to animals 16 5.6% 18 6.0% Throw away 4 1.4% 1 .3% Pursat Eat 50 90.9% 80 100.0% Sell 12 21.8% 9 11.3% Give to family and friends 2 3.6% 37 46.3% Give to neighbors 31 56.4% 45 56.3% Give to animals 2 3.6% 4 5.0% Throw away 1 1.8% 1 1.3% Multiple answers (Baseline N=623, Midterm N=655) Exposure, Participation and Motivation to Take Actions Table 53: TV spots seen by caregivers of children 0-59 months TV spots seen by caregivers Battambang Siem Reap Pursat N % N % N % Unified Grow Together 167 62.50% 173 70.00% 62 63.90% Latrine 198 74.20% 191 77.30% 75 77.30% Fish powder 234 87.60% 200 81.00% 88 90.70% Total 267 224% 247 228% 97 232% Multiple answers Table 54: NOURISH Growth Together Print Materials seen by caregivers of children 0-59 months Print materials Battambang Siem Reap Pursat N % N % N % Chenda story book 114 43.0% 93 31.0% 77 77.8% 5+5+3 behavior poster 223 84.2% 265 88.3% 97 98.0% Group education manual for caregivers 190 71.7% 141 47.0% 89 89.9% Fish powder curtain./poster 202 76.2% 219 73.0% 86 86.9% NOURISH Mid-term Survey Report 83 | P a g e Commitment Card 147 55.5% 217 72.3% 70 70.7% Toilet leaflet 152 57.4% 161 53.7% 70 70.7% Toilet fliptarp 163 61.5% 141 47.0% 82 82.8% CCT Fan/ fliptarp 120 45.3% 203 67.7% 43 43.4% Commitment Card 103 38.9% 122 40.7% 52 52.5% Reminder (icons) sheet 121 45.7% 191 63.7% 55 55.6% Key chain 63 23.8% 64 21.3% 24 24.2% Home visit wheel 65 24.5% 80 26.7% 21 21.2% Food basket insert 196 74.0% 225 75.0% 66 66.7% Stickers 92 34.7% 189 63.0% 43 43.4% Total 265 736.2% 300 770.3% 99 883.8% Multiple answers Table 55: NOURISH Activities joined or experienced by caregivers of children 0-59 months NOURISH Activities Battambang Siem Reap Pursat N % N % N % GMP 232 74.6% 255 74.1% 96 96.0%*** Home Visit.by VHSG 214 68.8% 179 52.0% 90 90.0%*** Garden support by Agriculture Officer 171 55.0% 140 40.7% 74 74.0%*** Caregiver education group 184 59.2% 177 51.5% 89 89.0%*** Community dialogue 168 54.0% 215 62.5% 79 79.0%*** CLTS (village meeting on OD/toilets) 202 65.0% 236 68.6% 83 83.0%** First 1,000 Days Village Fair 161 51.8% 155 45.1% 69 69.0%*** Voucher 127 40.8%** 96 27.9% 26 26.0% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 56: # times GMP joined or experienced by caregivers of children 0-59 months GMP Battambang Siem Reap Pursat N % N % N % <=5 times 145 62.5% 153 60.0% 76 79.2%** 6-10 times 39 16.8% 55 21.6%** 16 16.7% 11-15 times 20 8.6% 21 8.2% 3 3.1%** > 15 times 28 12.1% 26 10.2% 1 1.0% Total 232 100% 255 100% 96 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 NOURISH Mid-term Survey Report 84 | P a g e Table 57: # Times home visit joined or experienced by caregivers of children 0-59 months Home Visit Battambang Siem Reap Pursat N % N % N % <=5 times 203 94.9% 170 95.0% 71 78.9%*** 6-10 times 7 3.3% 9 5.0% 14 15.6% 11-15 times 3 1.4% 0 0.0% 5 5.6% > 15 times 1 0.5% 0 0.0% 0 0.0% Total 214 100% 179 100% 90 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 58: # Times home garden joined or experienced by caregivers of children 0-59 months Home garden Battambang Siem Reap Pursat N % N % N % <=5 times 170 99.4% 140 100.0% 73 98.6% 6-10 times 0 0.0% 0 0.0% 1 1.4% 11-15 times 1 0.6% 0 0.0% 0 5.6% Total 214 100% 179 100% 90 100% Table 59: # Times caregiver education group joined or experienced by caregivers of children 0-59 months Caregiver education Battambang Siem Reap Pursat N % N % N % <=5 times 177 96.2% 169 95.5% 84 94.4% 6-10 times 7 3.8% 5 2.8% 4 4.5% 11-15 times 0 0.0% 1 0.6% 1 1.1% > 15 times 0 0.0% 2 1.1% 0 0.0% Total 184 100% 177 100% 89 100% Table 60: # Times community dialogue joined or experienced by caregivers of children 0-59 months Community dialogue Battambang Siem Reap Pursat N % N % N % <=5 times 166 98.8% 204 94.9% 76 96.2% 6-10 times 2 1.2% 8 3.7% 3 3.8% 11-15 times 0 0.0% 2 0.9% 0 0.0% > 15 times 0 0.0% 1 0.5% 0 0.0% Total 168 100% 215 100% 79 100% Table 61: # Times CLTS joined or experienced by caregivers of children 0-59 months CLTS Battambang Siem Reap Pursat N % N % N % <=5 times 195 96.5% 232 98.3% 80 96.4% 6-10 times 5 2.5% 4 1.7% 2 2.4% 11-15 times 2 1.0% 0 0.0% 0 0.0% > 15 times 0 0.0% 0 0.0% 1 1.2% Total 202 100% 236 100% 83 100% NOURISH Mid-term Survey Report 85 | P a g e Table 62: # Times village fair joined or experienced by caregivers of children 0-59 months village fair Battambang Siem Reap Pursat N % N % N % <=5 times 159 98.8% 153 98.7% 65 94.2% 6-10 times 2 1.2% 2 1.3% 4 5.8% Total 161 100% 155 100% 69 100% Table 63: # Times voucher joined or experienced by caregivers of children 0-59 months Voucher Battambang Siem Reap Pursat N % N % N % 1 times 41 32.3% 41 42.7% 14 53.8%** 2 times 46 36.2% 42 43.8% 3 11.5%** 3 times 31 24.4% 9 9.4% 8 30.8% 4 times 9 7.1% 4 4.2% 1 3.8% Total 127 100% 96 100% 26 100% * Statistical significance at 5% level, p<0.05 ** Statistical significance at 1% level, p<0.01 ***Statistical significance at 0.1% level, P<0.001 Table 64: Motivation to do anything new or different by caregivers of children 0-59 months Battambang Siem Reap Pursat N % N % N % Go for health services 166 64.8% 79 24.5% 51 60.0% Take child for health services 133 52.0% 136 42.2% 62 72.9% Take child for GMP 35 13.7% 26 8.1% 7 8.2% Eat more diverse food myself 105 41.0% 90 28.0% 48 56.5% Breastfeed exclusively 115 44.9% 104 32.3% 51 60.0% Breastfeed longer 61 23.8% 90 28.0% 24 28.2% Feed child more diverse food 76 29.7% 103 32.0% 36 42.4% Feed child more food 55 21.5% 89 27.6% 31 36.5% Feed child fish powder 116 45.3% 109 33.9% 43 50.6% Make fish powder 78 30.5% 67 20.8% 32 37.6% Drink clean water 198 77.3% 178 55.3% 72 84.7% Build toilet 151 59.0% 148 46.0% 66 77.6% Wash hands with soap 185 72.3% 214 66.5% 67 78.8% Plant a home /micro / sack garden 98 38.3% 100 31.1% 26 30.6% Other 0 0.0% 17 5.3% 0 0.0% Total 256 614.1% 322 481.4% 85 724.7% Multiple answers NOURISH Mid-term Survey Report 86 | P a g e ANNEX IV: Questionnaire QUESTIONNAIRE ID#___________ CAREGIVERS OF CHILDREN 0-59 MONTHS IDENTIFICATION PROVINCE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DISTRICT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . COMMUNE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . VILLAGE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . CLUSTER NUMBER . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . HOUSEHOLD CODE . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . HOUSEHOLD VISITS DATE INTERVIEWER'S NAME AND CODE SUPERVISOR NAME AND CODE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TIME INTERVIEW STARTED TIME INTERVIEW COMPLETED Hello. My name is _______________________________________. I am working with the NOURISH Project. We are conducting a survey about nutrition in Cambodia. The information we collect will help to plan services for villages like yours. You were selected for the survey. I would like to ask you some questions. The questions usually take about 1 hour. READ THE CONSENT FORM. SIGNATURE OF INTERVIEWER: ________________________ DATE: __________________ RESPONDENT AGREES TO BE INTERVIEWED . . . . . . . . . . . . 1 RESPONDENT DOES NOT AGREE TO BE INTERVIEWED . . . . 2 END Do you have any questions? May I begin the interview now? Ask woman to bring the child’s Yellow Health Card and birth certificate, and the family ID Poor Card (if they have one) and NOURISH CCT card. NOURISH Mid-term Survey Report 87 | P a g e BASIC INFORMATION QUESTION RESPONSE 1. IN WHAT MONTH AND YEAR WERE YOU BORN? IF DON’T KNOW, KHMER MONTH AND YEAR BORN? 2. HOW OLD WERE YOU AT YOUR LAST BIRTHDAY? Gregorian Month ___________ Gregorian Year ___ ___ ___ ___ Don't Know ……………………….88 _______________________ ________ Years 3. HAVE YOU EVER ATTENDED SCHOOL? 4. WHAT IS THE HIGHEST LEVEL OF SCHOOL YOU ATTENDED? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q5 Don't Know . . . . . . . . . . . . . . . . . . .88 Illiteracy………………………………………1 Primary (1-6) . . . . . . . . . . . . . . . . .. 2 Lower Secondary (7-9) . . . . . . . . . 3 Upper Secondary (10-12)…………… 4 Higher. . . . . . . . . . . . . . . . . . . . .. . .5 No Answer. . . . . . . . . . . . . . . . . . .. 99 5. HAVE YOU EVER BEEN MARRIED? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q14 Don't Know . . . . . . . . . . . . . . . . . . . 88 6. WHAT IS YOUR MARITAL STATUS NOW? Married . . . . . . . . . . . . . . . . . . . . . . 1 Widowed. . . . . . . . . . . . . . . . . . . . . 2 Divorced . . . . . . . . . . . . . . . . . . . . . 3 No Answer . . . . . . . . . . . . . . . . . . . 99 7. DID YOUR (LAST) (HUSBAND/PARTNER) EVER ATTEND SCHOOL? 8. WHAT IS THE HIGHEST LEVEL OF SCHOOL HE ATTENDED? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q9 Don't Know . . . . . . . . . . . . . . . . . . . 88 Illiteracy……………………………………….1 Primary (1-6) . . . . . . . . . . . . . . ….. . 2 Lower Secondary (7-9) . . . . . . . . . . .3 Upper Secondary (10-12)….…….…… 4 Higher. . . . . . . . . . . . . . . . . . . . .. .. 5 No answer. . . . . . . . . . . . . . . . . . … 99 9. HOW OLD IS YOUR (LAST) (HUSBAND/PARTNER)? Under 20. . . . . . . . . . . . . . . . . . . . . . 1 20-29. . . . . . . . . . . . . . . . . . . . . . . . 2 30-39. . . . . . . . . . . . . . . . . . . . . . . . 3 40-49. . . . . . . . . . . . . . . . . . . . . . . . 4 50-59. . . . . . . . . . . . . . . . . . . . . . . . 5 60 or over . . . . . . . . . . . . . . . . . . . . 6 NOURISH Mid-term Survey Report 88 | P a g e QUESTION RESPONSE Don't Know . . . . . . . . . . . . . . . . . . . 88 Age______________________ 10. WHAT IS YOUR (HUSBAND'S) OCCUPATION? THAT IS, WHAT KIND OF WORK DOES HE MAINLY DO? Farmer . . . . . . . . . . . . . . . . . . . . …...1 Factory . . . . . . . . . . . . . . . . . . . . .. ...2 Retail . . . . . . . . . . . . . . . . . . . . . . ….3 Motor taxi……………………………………..4 Construction …………………………………5 Teacher or official………………………….6 Unemployed……………………………… …7 Other daily labor …………………………..8 Other ______________________ 00 Don't Know . . . . . . . . . . . . . . . . . . . 88 11. DOES YOUR HUSBAND WORK IN THIS VILLAGE? Yes . . . . . . . . . . . . . . . . . . . . . . . .. 1 SKIP TO Q14 No . . . . . . . . . . . . . . . . . . . . . . . .. . . 2 No answer. . . . . . . . . …. . . . . .. . . 99 12. DOES YOUR HUSBAND WORK IN CAMBODIA OR OVERSEAS? In Cambodia . . . . . . . . . . . . . . . .. .1 SKIP TO Q14 Thailand . . . . . . . . . . . . . . . . . . . . . 2 Other ______________________ 00 Don't know . . . . . . . . . …. . . . . .. 88 SKIP TO Q14 13. IF YOUR HUSBAND HAS WORKED OVERSEAS, WHEN WAS THIS? Now . . . . . . . . . . . . . . . . . .. ……….. 1 Earlier this year .. . . . . . . . . . . . .. . 2 Last year . . . . . . . . . . . . . . . . ... .. . . 3 1-3 years ago . . . . . . . . . . . . .. …. . . 4 Over 3 years ago ... . . . . …. . . . . .. . 5 Don't know . . . . . . . . . . . . … . . . ... 88 14. WHAT IS YOUR OCCUPATION? THAT IS, WHAT KIND OF WORK DO YOU MAINLY DO? Farmer . . . . . . . . . . . . . . . . . . . . …...1 Factory . . . . . . . . . . . . . . . . . . . . .. ...2 Retail . . . . . . . . . . . . . . . . . . . . . . ….3 Motor taxi……………………………………..4 Construction …………………………………5 Teacher or official………………………….6 Unemployed……………………………… …7 Other daily labor …………………………..8 Housewife/ mother ……………………….9 Other ______________________ 00 Don't Know . . . . . . . . . . . . . . . . . . . 88 15. DOES YOUR FAMILY HAVE AN ID POOR CARD? (Request to observe the card.) Yes observed. . . . . . . . . . . . . . .. . . ..1 Yes not observed . . . . . . . . . . . . …. 2 NOURISH Mid-term Survey Report 89 | P a g e QUESTION RESPONSE Yes expired . . . . . . . . . . . . …………... 3 No . . . . . . . . . . . . . . . . . . . . . . . . .. . .4 Don't know . . . . . . . . . . . . . . . .. . … 88 No answer.. . . . . . . . . . . . . . . . . .... 99 16. ARE YOU ENROLLED IN A CCT PROGRAM FOR HEALTH AND NUTRITION? (Request to observe the card.) Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't know . . . . . . . . . . . . …. . . . . . 88 NOURISH CCT Card Observed Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 17. DO YOU HAVE YOUR OWN BANK ACCOUNT, INCLUDING NOURISH CCT BANK ACCOUNT? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't know . . . . . . . . . . . . . . . . …. . 88 18. DOES YOUR HOUSEHOLD GROW ANY FOOD AT HOME FOR CONSUMPTION? Request to see the garden. Yes Observed. . . . . . . . . . . . . ….. . 1 Yes Not Observed . . . . . . . . . . ….2 No . . . . . . . . . . . . . . . . . . . . . . . . 3 SKIP TO Q23 Don't Know . . . . . . . . . . . . . . . .. . …. 88 19. IF YOUR HOUSEHOLD GROWS ANY FOOD IN THE HOME COMPOUND, WHAT DO YOU GROW? (CIRCLE ALL GROWN AT DIFFERENT TIMES OF THE YEAR.) Ptee (Amaranth) . . . . . . . . . . . . . . . . 1 Moringa. . . . . . . . . . . . . . . . . . . . . . . .2 Pumpkin . . . . . . . . . . . . . . . . . . . . . . 3 Sweet Potato . . . . . . . . . . . . . . . . . . .4 Long Bean . . . . . . . . . . . . . . . . . . . . . 5 Jackfruit. . . . . . . . . . . . . . . . . . . . . . . 6 Mango. . . . . . . . . . . . . . . . . . . . . . . . 7 Banana . . . . . . . . . . . . . . . . . . . . . . . 8 Other ______________________ 00 Don’t know . . . . . . . . . . . . . . . . . … 88 20. IF YOUR HOUSEHOLD GROWS FOOD AT HOME, WHAT DO YOU DO WITH THE PRODUCE? (Circle all answers given). Eat . . . . . . . . . . . . . . . . . . . .. . . . . 1 Sell. . . . . . . . . . . . . . . . . . . . .. . . . . 2 Give to family and friends. . . . . . . 3 Give to neighbors. . . . . . . . . . . . . .4 Give to animals . . . . . . . . . . . . . .. . 5 Throw away. . . . . . . . . . . . . . . . . . 6 Other ______________________ 00 Don’t know . . . . . . . . . . . . . . . . . . 88 [Ask only if she grows ptee, yardlong bean, moringa, or sweet potato in #19. If not, SKIP TO Q23 ] 21. HOW MUCH OF ______ THAT YOU GROW DID YOUR HOUSEHOLD EAT IN THE PAST WEEK? Bunch 1/2 kilo 1 kilo 2-5 kilos More Amaranth 1 2 3 4 5 NOURISH Mid-term Survey Report 90 | P a g e QUESTION RESPONSE Moringa 1 2 3 4 5 Sweet potato 1 2 3 4 5 Long bean 1 2 3 4 5 [Ask only if she grows ptee, yardlong bean, moringa, or sweet potato in #19.] 22. WHO EATS THE PRODUCE USUALLY? (Read answers and circle all answers given). Men . . .. . . . . . . . . . . . . . . . . . .. . .1 Women . . .. . . . . . . . . . . . . . . .. . . 2 Pregnant women. . .. . . . . . . .. ... . ..3 Children over 1 year . . . ... . .. . . ... .4 Children 1 year – 2 years. . . . . . .. ...5 Children over 2 years . . . . . . . . . ...6 Other _______________________ 00 Don’t know . . . . . . . . . . . . . . . . . . ...88 FOR THE REST OF THIS INTERVIEW WE CAN TALK ABOUT ONE CHILD [SPECIFY AGE NEEDED] WHO IS AT HOME NOW. IF YOU HAVE TWINS, PLEASE PICK ONE. WHAT IS THE CHILD’S NAME? _____________________ 23. WHAT DATE WAS {child’s name} BORN? Verify with yellow child health card. Gregorian (French) Month ___________ Gregorian (French) Year ___ ___ ___ ___ Don't Know . . . . . . . . . . . . . . . . . . . . 88 24. WHAT IS [child’s name]’S SEX? Female. . . . . . . . . . . . . . . . . . . . . . . . 1 Male…. . . . . . . . . . . . . . . . . . . . . . . . 2 25. DOES [child’s name] HAVE A BIRTH CERTIFICATE? Verify with birth certificate. Yes Observed. . . . . . . . . . . . . . . . . . . 1 Yes Not Observed . . . . . . . . . . . . . . 2 No . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Don't Know . . . . . . . . . . . . . . . . . . . . 88 NOURISH Mid-term Survey Report 91 | P a g e HYGIENE AND SANITATION QUESTION RESPONSE 26. DO YOU DO ANYTHING TO THE WATER TO MAKE IT SAFER TO DRINK? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q29 Don't Know . . . . . . . . . . . . . . . . . . . . . 88 27. WHAT DO YOU USUALLY DO TO MAKE THE WATER SAFER TO DRINK? (Confirm by observation) 28. HOW OFTEN IS THE FILTER CLEANED? (Confirm by observation) Boil . . . . . . . . . . . . . . . . . . . . . …. . . . . ..1 SKIP TO Q29 Filter . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Chlorine . . . . . . . . . . . . . . . . . . . . . . . . 3 SKIP TO Q29 Buy drinking water . . . . . . . . . . . . .. . . .4 SKIP TO Q29 Nothing . . . . . . . . . . . . . . . . . . . . . . . . 5 SKIP TO Q29 Other . . . . . . . . . . . . . . . . . . . . . . . . . . .99 SKIP TO Q29 No answer . . . . . . . . . . . . . . . . . . . . . . . 00 Based on answer above: Water treatment device observed . . . . 1 Water treatment device not observed. 2 Daily . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Weekly . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Monthly . . . . . . . . . . . . . . . . . . . . . . . . 3 Every few months. . . . . . . . . . . . . . . . . .4 Every year . . . . . . . . . . . . . . . . . . . . . . . .5 Do not remember. . . . . . . . . . . . . . . . . .9 Other __________________________99 Observed: Filter looks clean . . . . . . . . . . . . . . . . . 1 Filter looks dirty. . . . . . . . . . . . . . . . . . 2 29. WHAT KIND OF TOILET FACILITY DO MEMBERS OF YOUR HOUSEHOLD USUALLY USE? (Confirm by observation) Flush or pour flush toilet Flush to piped sewer system . . . . . . . .1 Flush to septic tank . . . . . . . . . . . . . . . 2 Flush to pit latrine . . . . . . . . . . . . . . . . 3 Flush to somewhere else . . . . . . . . . . .4 Flush, don't know where . . . . . . . . . . .5 Pit latrine Ventilated improved pit latrine .. . . . .6 Pit latrine with slab . . . . . . . . . . . . . . . 7 Pit latrine without slab/ open pit . . . 8 Composting toilet . . . . . . . . . . . . . . . . 9 Bucket toilet . . . . . . . . . . . . . . . . . . . 10 Hanging toilet/hanging latrine . . . . . 11 No facility/bush/field . . . . . . . . . . . . . 12 SKIP TO Q32 Use another person/family’s latrine…13 SKIP TO Q32 Other _________________________99 NOURISH Mid-term Survey Report 92 | P a g e QUESTION RESPONSE Answer above is confirmed by observation Observed . . . . . . . . . . . . . . . . . . . . . . .. 1 Not observed . . . . . . . . . . . . . . . . . . . . 2 30. DO YOU SHARE YOUR TOILET FACILITY WITH OTHER HOUSEHOLDS? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP Q32 Don't Know . . . . . . . . . . . . . . . . . . . . . . . 88 31. HOW MANY HOUSEHOLDS USE THIS TOILET FACILITY? Number ____ ____ ____ Don't know . . . . . 88 32. DOES THIS HOUSEHOLD OWN ANY ANIMALS (CHICKENS, DUCKS, COWS, ETC.)? Yes. . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . 1 No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 33. THE LAST TIME (child’ name) PASSED STOOLS IN THE PAST 24 HOURS, WHAT WAS DONE TO DISPOSE OF THE STOOLS? (Confirm by observation.) Child used toilet or latrine . . . . . . . . . . . . . . 1 Put/rinsed into toilet or latrine . . . . . . . . 2 Put/rinsed into drain or ditch . . . . . . . . . . 3 Thrown into garbage . . . . . . . . . . . .. . . . . . 4 Buried . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . 5 Left in the open . . . . . . . . . . . .. . . . . . . . . . 6 Other ______________________________99 Observed stools in hole, drain or ditch . .. . .…1 Did not observe stools in hole, drain or ditch..2 34. PLEASE SHOW ME WHERE MEMBERS OF YOUR HOUSEHOLD MOST OFTEN WASH THEIR HANDS. [Note: anal cleansing water inside toilet is not considered hand washing station] Observed . . . . . . .. . . . . . . . . . . . . . .. . . . ….... 1 Not observed, not in dwelling/yard/plot . ... 2 Not observed, no permission to see . . . . . . .3 Not observed, other reason . . . . . . . . . . . . . 4 35. OBSERVATION ONLY: OBSERVE PRESENCE OF WATER AT THE SPECIFIC PLACE FOR HANDWASHING. Water is available . . . . . . . . . . . . . . . . . . . . . .1 Water is not available . . . . . . . . . . . . . . . . . . 2 36. OBSERVATION ONLY: OBSERVE PRESENCE OF SOAP, DETERGENT, OR OTHER CLEANSING AGENT. Soap or detergent (bar, liquid, powder) . . . .1 Ash, mud, sand . . . . . . . . . . . . . . . . . . . . . . . . 2 None. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 37. OBSERVATION ONLY: OBSERVE HANDWASHING STATION (Circle all observed) Near to platform (feeding/eating) place. . . . 1 Within 10 meters of the toilet . . . . . . . . . . . .2 Water is protected from contamination by people and animals …..…........…........…........…........….....3 Water falls freely (not ladled by one hand). 4 38. OBSERVATION ONLY: OBSERVE PRESENCE OF A SEPARATE HANDWASHING STATION Tippy Tap …… . . . . . . . . . . . . . . . . . . . . . . . . . 1 Tippy Tap with soap . . . . . . . . . . . . . . . . . . . .2 Happy Tap . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 Happy Tap with soap . . . . . . . . . . . . . . . . . . . 4 No separate handwashing station . . . . . . . , 5 Other: _____________________________ 99 NOURISH Mid-term Survey Report 93 | P a g e QUESTION RESPONSE 39. OBSERVATION ONLY: OBSERVE WHETHER THERE IS FECES AROUND THE HOUSEHOLD OR IN THE COMPOUND? (animal or children) None…………………………………………………… 1 Small amount (1-2 piles) ……………………………2 More than 2 piles/droppings …………………… 3 40. OBSERVATION ONLY: IS THERE IS EVIDENCE OF SWEEPING IN THE COMPOUND? Observed ……………………………………………… 1 Not observed ………………………………………..…2 NOURISH Mid-term Survey Report 94 | P a g e CHILD’S ILLNESS QUESTION RESPONSE Let’s continue to talk about the same child under 2 years you told me about earlier. Let’s talk about this child’s health. 41. WHEN WAS THE LAST TIME THIS CHILD VISITED THE HEALTH CENTER? 42. WHAT SERVICES DID THE CHILD RECEIVE DURING THAT VISIT? (Circle all mentioned). _____ MONTH _____ YEAR Don't remember ………….99 Vaccination . . . . . . . . . . . . . . . . . . . . 1 Medicine…. . . . . . . . . . . . . . . . . . . .. .2 IV…………….. . . . . . . . . . . . . . . . . . . . .3 GMP… . . . . . . . . . . . . . . . . . . . . . . . . 4 Weighing … . . . . . . . . . . . . . . . . . . . . 5 Counseling. . . . . . . . . . . . . . . . . . . . . 6 Don't remember . . . . . . . . . . . . . . . .99 Other _______________________ 00 May I see the Yellow Child Health Card? 43. OBSERVATION ONLY: WHEN IS THE LAST MONTH THE CHILD’S WEIGHT WAS PLOTTED ON THE YELLOW CHILD HEALTH CARD? ________ MONTH 44. HAS (child’s name) HAD DIARRHEA IN THE PAST 2 WEEKS? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 skip to Q50 Don't Know . . . . . . . . . . . . . . . . . . .88 45. THE LAST TIME (child’s name) WAS ILL, DID YOU GET A REFERRAL TO THE PUBLIC HEALTH CENTER OR HOSPITAL? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . .88 46. NOW I WOULD LIKE TO KNOW HOW MUCH (child’s name) WAS GIVEN TO DRINK DURING THE DIARRHEA (INCLUDING BREASTMILK) If Less, probe: Was s/he given much less than usual to drink or somewhat less? Much Less. . . . . . . . . . . . . . . . .. . . . 1 Somewhat Less . . . . . . . . . . . . . . . . 2 About The Same. . . . . . . . . . . . . . 3 More. . . . . . . . . . . . . . . . . . . . . . . .. 4 Much More . . . . . . . . . . . . . . . . . . . 5 Stopped . . . . . . . . . . . . . . . . . . . . . . 6 Never gave. . . . . . . . . . . . . . . . . . . . 7 Don’t Know. . . . . . . . . . . . . . . . . . 88 47. WHEN (child’s name) HAD DIARRHEA, WAS HE/SHE GIVEN LESS THAN USUAL TO EAT, ABOUT THE SAME AMOUNT, MORE THAN USUAL, OR NOTHING TO EAT? If Less, probe: much less than usual to eat or somewhat less? Much Less. . . . . . . . . . . . . . . . .. . . . 1 Somewhat Less . . . . . . . . . . . . . . . . 2 About The Same. . . . . . . . . . . . . . 3 More. . . . . . . . . . . . . . . . . . . . . . . .. 4 Much More . . . . . . . . . . . . . . . . . . . 5 Stopped . . . . . . . . . . . . . . . . . . . . . . 6 NOURISH Mid-term Survey Report 95 | P a g e QUESTION RESPONSE Never gave. . . . . . . . . . . . . . . . . . . . 7 Don’t Know. . . . . . . . . . . . . . . . . . 88 48. DURING THE WEEK AFTER THE DIARRHEA, HOW MUCH (child’s name) WAS GIVEN TO DRINK? (INCLUDING BREASTMILK) If Less, probe: much less than usual to drink or somewhat less? Much Less. . . . . . . . . . . . . . . . .. . . . 1 Somewhat Less . . . . . . . . . . . . . . . . 2 About The Same. . . . . . . . . . . . . . 3 More. . . . . . . . . . . . . . . . . . . . . . . .. 4 Much More . . . . . . . . . . . . . . . . . . . 5 Stopped . . . . . . . . . . . . . . . . . . . . . . 6 Never Gave. . . . . . . . . . . . . . .. . . . . 7 Don’t Know. . . . . . . . . . . . . . . . . . 88 49. DURING THE WEEK AFTER THE DIARRHEA, WAS HE/SHE GIVEN LESS THAN USUAL TO EAT, ABOUT THE SAME AMOUNT, MORE THAN USUAL, OR NOTHING TO EAT? If Less, probe: much less than usual to eat or somewhat less? Much Less. . . . . . . . . . . . . . . . .. . . . 1 Somewhat Less . . . . . . . . . . . . . . . . 2 About The Same. . . . . . . . . . . . . . 3 More. . . . . . . . . . . . . . . . . . . . . . . .. 4 Much More . . . . . . . . . . . . . . . . . . . 5 Stopped . . . . . . . . . . . . . . . . . . . . . . 6 Never Gave. . . . . . . . . . . . . . . . . . . . 7 Don’t Know. . . . . . . . . . . . . . . . . . 88 50. IN THE LAST TWO WEEKS, HAS (child’s name) BEEN ILL WITH A FEVER AT ANY TIME? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . .88 51. HOW DID YOU KNOW (child’s name) HAD A FEVER? Felt head . . . . . . . . . . . . . . . . . . . . . 1 Took temperature . . . . . . . . . . . . . 2 Pharmacist diagnosed . . . . . . . . . . 3 Health center diagnosed. . . . . . . . 4 Other ______________________ 00 Don't remember. . . . . . . . . . . . . . . 99 52. NOW I WOULD LIKE TO KNOW HOW MUCH (child’s name) WAS GIVEN TO DRINK DURING THE ILLNESS? (INCLUDING BREASTMILK) If Less, probe: much less than usual to drink or somewhat less? Much Less. . . . . . . . . . . . . . . . .. . . . 1 Somewhat Less . . . . . . . . . . . . . . . . 2 About the Same. . . . . . . . . . . . . . 3 More. . . . . . . . . . . . . . . . . . . . . . . .. 4 Much More . . . . . . . . . . . . . . . . . . . 5 Stopped . . . . . . . . . . . . . . . . . . . . . . 6 Never Gave. . . . . . . . . . . . . . . . . . . .7 Don’t Know. . . . . . . . . . . . . . . . . . 88 53. DURING THE ILLNESS, WAS HE/SHE GIVEN LESS THAN USUAL TO EAT, ABOUT THE SAME AMOUNT, MORE THAN USUAL, OR NOTHING TO EAT? If Less, probe: much less than usual to eat or somewhat less? Much Less. . . . . . . . . . . . . . . . .. . . . 1 Somewhat Less . . . . . . . . . . . . . . . . 2 About the Same. . . . . . . . . . . . . . 3 NOURISH Mid-term Survey Report 96 | P a g e QUESTION RESPONSE More. . . . . . . . . . . . . . . . . . . . . . . .. 4 Much More . . . . . . . . . . . . . . . . . . . 5 Stopped . . . . . . . . . . . . . . . . . . . . . . 6 Never Gave. . . . . . . . . . . . . . . . . . . .7 Don’t Know. . . . . . . . . . . . . . . . . . 88 54. DURING THE WEEK AFTER THE ILLNESS, HOW MUCH (child’s name) WAS GIVEN TO DRINK? (INCLUDING BREASTMILK) If Less, probe: much less than usual to drink or somewhat less? Much Less…. . . . . . . . . . . . . . . . . . . 1 Somewhat Less . . . . . . . . . . . . . . 2 About The Same. . . . . . . . . . . . . . 3 More…. . . . . . . . . . . . . . . . . . . . . . . 4 Much More . . . . . . . . . . . . . . . . . . . 5 Stopped ……………….. . . . . . . . . . . . .6 Never gave....………. . . . . . . . . . . . . .7 Don’t Know…. . . . . . . . . . . . . . . . . . 88 55. DURING THE WEEK AFTER THE ILLNESS, WAS HE/SHE GIVEN LESS THAN USUAL TO EAT, ABOUT THE SAME AMOUNT, MORE THAN USUAL, OR NOTHING TO EAT? If Less, probe: much less than usual to eat or somewhat less? Much Less…. . . . . . . . . . . . . . . . . . . 1 Somewhat Less . . . . . . . . . . . . . . 2 About The Same. . . . . . . . . . . . . . 3 More…. . . . . . . . . . . . . . . . . . . . . . . 4 Much More . . . . . . . . . . . . . . . . . . . 5 Stopped ……………….. . . . . . . . . . . . .6 Never gave....………. . . . . . . . . . . . . .7 Don’t Know…. . . . . . . . . . . . . . . . . . 88 NOURISH Mid-term Survey Report 97 | P a g e CHILD’S WEIGHT AND HEIGHT Weight 1: kg __ __. __ Weight 2: kg __ __. __ Z score- to determine underweight, wasting _____ CHILDREN UNDER 24 MONTHS SHOULD BE MEASURED LYING DOWN. CHILDREN 24 MONTHS OR OLDER SHOULD BE MEASURED STANDING UP. 56. Height in cm ___ ___ ___. ___ Z score- to determine stunting, wasting _____ NOURISH Mid-term Survey Report 98 | P a g e CHILD FEEDING Check age of child:  Child birth – 5 months  Continue this module.  Child age 6-23 months  Skip to Q80.  Child age over 23 months  End Interview. QUESTION RESPONSE 57. WAS [child’s name] EVER BEEN BREASTFED? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q68 Don't Know . . . . . . . . . . . . . . . . . . . 88 58. HOW LONG AFTER BIRTH DID YOU FIRST PUT (child’s name) TO THE BREAST? IF LESS THAN 1 HOUR, RECORD ‘00' HOURS. IF LESS THAN 24 HOURS, RECORD HOURS. OTHERWISE, RECORD DAYS. Minutes ___ ___ Hours ___ ___ Days ___ ___ Don’t Know . . . . 88 59. IN THE FIRST THREE DAYS AFTER DELIVERY, WAS (child’s name) GIVEN ANYTHING OTHER THAN BREAST MILK SUCH AS CHHEU EM? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 60. IF [child’s name] WAS BREASTFED EVER, IS S/HE STILL BREASTFEEDING SOMETIMES? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q68 Don't Know . . . . . . . . . . . . . . . . . . . 88 61. WAS [child’s name] BREASTFED YESTERDAY DURING THE DAY OR AT NIGHT? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 62. IF [child’s name] BREASTFED YESTERDAY, HOW MANY TIMES? ___ ___ 63. IF [child’s name] BREASTFED YESTERDAY HOW LONG IS THE USUAL FEEDING? ____ ___ MIN Sometimes babies are fed breast milk in different ways, for example by spoon, cup, or bottle. This can happen when the mother cannot always be with her baby. Sometimes babies are breastfed by another woman or given breast milk from another woman by spoon, cup, bottle, or some other way. This can happen if a mother cannot breastfeed her own baby. 64. DID [CHILD’S NAME] CONSUME BREAST MILK IN ANY OF THESE WAYS YESTERDAY DURING THE DAY OR AT NIGHT? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 NOURISH Mid-term Survey Report 99 | P a g e QUESTION RESPONSE Next I would like to ask you about some liquids that [child’s name] may have had yesterday during the day or at night. 65. PLAIN WATER Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q70 Don't Know . . . . . . . . . . . . . . . . . . . 88 66. HOW MANY TIMES YESTERDAY DURING THE DAY OR AT NIGHT DID [child’s name] CONSUME WATER? ___ ___ 67. INFANT FORMULA Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q72 Don't Know . . . . . . . . . . . . . . . . . . . 88 68. HOW MANY TIMES YESTERDAY DURING THE DAY OR AT NIGHT DID [child’s name] CONSUME FORMULA? ___ ___ 69. DID [child’s name] HAVE ANY MILK SUCH AS TINNED CONDENSED, POWDERED, OR FRESH MILK? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q74 Don't Know . . . . . . . . . . . . . . . . . . . 88 70. HOW MANY TIMES YESTERDAY DURING THE DAY OR NIGHT DID [child’s name] CONSUME MILK? ___ ___ 71. DID [child’s name] HAVE ANY JUICE? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 72. PLAIN SOUP BROTH? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 73. BORBOR? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 74. ANY OTHER LIQUIDS? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 Now I would like to ask you about some medicines and vitamins that are sometimes given to infants. 75. WAS [child’s name] GIVEN ANY VITAMIN DROPS OR OTHER MEDICINES AS DROPS YESTERDAY DURING THE DAY OR AT NIGHT? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 76. WAS [child’s name] GIVEN ORASEL YESTERDAY DURING THE DAY OR AT NIGHT? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 Check age of child: NOURISH Mid-term Survey Report 100 | P a g e  Child birth – 5 months  End Interview.  Child age 6-23 months  Continue this module.  Child age over 23 months  End Interview. QUESTION 77. WAS [child’s name] EVER BREASTFED? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 78. PLEASE DESCRIBE EVERYTHING THAT [child’s name] ATE YESTERDAY DURING THE DAY OR NIGHT, WHETHER AT HOME OR OUTSIDE THE HOME. A) THINK ABOUT WHEN [child’s name] FIRST WOKE UP YESTERDAY. DID [child’s name] EAT ANYTHING AT THAT TIME? IF YES: Please tell me everything [child’s name] ate at that time. PROBE: Anything else? UNTIL RESPONDENT SAYS NOTHING ELSE. THEN CONTINUE TO PART B). IF NO, CONTINUE TO PART B). B) WHAT DID [child’s name] EAT NEXT? IF YES: Please tell me everything [child’s name] ate at that time. PROBE: Anything else? REPEAT UNTIL RESPONDENT SAYS NOTHING ELSE. IF RESPONDENT MENTIONS MIXED DISHES LIKE A PORRIDGE, SAUCE, OR SOUP, PROBE: C) WHAT INGREDIENTS WERE IN THAT [MIXED DISH]? PROBE: ANYTHING ELSE? UNTIL RESPONDENT SAYS NOTHING ELSE. AS THE RESPONDENT RECALLS FOODS, CIRCLE THE 1 BY THE CORRESPONDING FOOD. IF THE FOOD IS NOT LISTED IN ANY OF THE FOOD GROUPS BELOW, WRITE THE FOOD IN THE BOX LABELED ‘OTHER FOODS.’ IF FOODS ARE USED IN SMALL AMOUNTS FOR SEASONING OR AS A CONDIMENT, INCLUDE THEM UNDER THE CONDIMENTS FOOD GROUP. ONCE THE RESPONDENT FINISHES RECALLING FOODS EATEN, READ EACH FOOD GROUP WHERE ‘1’ WAS NOT ENTERED IN THE RESPONSE BOX, ASK AND ENTER ‘1’ IF RESPONDENT SAYS YES, ‘2’ IF NO, AND ‘88’ IF DON’T KNOW: NOURISH Mid-term Survey Report 101 | P a g e OTHER FOODS: PLEASE WRITE DOWN OTHER FOODS (TO THE RIGHT OF THIS BOX) THAT RESPONDENT MENTIONED BUT ARE NOT IN THE LIST BELOW. THIS WILL ALLOW THE SURVEY SUPERVISOR TO CLASSIFY THE FOOD LATER. RESPONSE CODES WRITE FOODS MENTIONED HOW MANY TIMES? Food made from grains such as rice, noodles, porridge YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Beans YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Nuts and seeds YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Pumpkin, carrots, squash, or sweet potatoes that are yellow or orange inside YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 White potatoes, white yams, or any other foods made from roots YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Any dark green leafy vegetables such as amaranth leaves, moringa, morning glory, water spinach YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Ripe mangoes, ripe papaya, jackfruit YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Any other fruits or vegetables YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Liver, kidney, heart, or other organ meats YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Flesh foods (ie meat, such as beef, pork, chicken, or duck) Yes . . . . . . .. . . . . 1 No . . . . . . . . . . . 2 Don't Know . …. . 88 Wild animals like frogs, snails, crabs, insects Yes . . . . . . .. . . . . 1 No . . . . . . . . . . . 2 Don't Know . …. . 88 Duck or chicken eggs YES . . . . . . .. . . . . 1 NOURISH Mid-term Survey Report 102 | P a g e OTHER FOODS: PLEASE WRITE DOWN OTHER FOODS (TO THE RIGHT OF THIS BOX) THAT RESPONDENT MENTIONED BUT ARE NOT IN THE LIST BELOW. THIS WILL ALLOW THE SURVEY SUPERVISOR TO CLASSIFY THE FOOD LATER. RESPONSE CODES WRITE FOODS MENTIONED HOW MANY TIMES? NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Fresh or dried fish YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Small fish, including fish powder YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Any foods made from beans, nuts, or seeds YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Cheese, yogurt, or other milk products YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Breastmilk YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Any oil, fats, or butter, or foods made with any of these YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Any sugary foods such as sweets, candies, cakes, or biscuits YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Any packaged snacks such as chips YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 Condiments for flavor, such as soy sauce, prahok YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 DON'T KNOW . . . 88 CHECK CATEGORIES all ‘no’ >> go to 78 . If at least one ‘yes’ or all ‘DK’ go to 79 79. THE LAST TIME [child’s name] DRANK WATER, DID YOU DO ANYTHING TO TREAT THE WATER? YES . . . . . . .. . . . . 1 NO . . . . . . . . . . . 2 NOURISH Mid-term Survey Report 103 | P a g e OTHER FOODS: PLEASE WRITE DOWN OTHER FOODS (TO THE RIGHT OF THIS BOX) THAT RESPONDENT MENTIONED BUT ARE NOT IN THE LIST BELOW. THIS WILL ALLOW THE SURVEY SUPERVISOR TO CLASSIFY THE FOOD LATER. RESPONSE CODES WRITE FOODS MENTIONED HOW MANY TIMES? DON'T KNOW . . . 8 80. HOW WAS THE WATER TREATED? BOIL . . . . . . . . . . .1 FILTER . . . . . . . . 2 CHLORINE . . . . . .3 BUY. . . . . . . . . . . .4 NOTHING . . . . . .5 OTHER . . . . . . . ..99 DON'T KNOW . .. 88 81. DID [child’s name] EAT ANY OTHER SOLID, SEMI-SOLID, OR SOFT FOODS YESTERDAY DURING THE DAY OR AT NIGHT? IF ‘YES’ PROBE: What kind of solid, semi-solid, or soft foods did [child’s name] eat? 1 = Yes >> go back to list and record foods eaten. Then continue. 2 = No >> Continue. 82. HOW MANY TIMES DID [child’s name] EAT SOLID, SEMI-SOLID, OR SOFT FOODS OTHER THAN LIQUIDS YESTERDAY DAY OR AT NIGHT? ___ ____ DON'T KNOW . . . 88 NOURISH Mid-term Survey Report 104 | P a g e CHILD CARE AND DEVELOPMENT Check age of child:  Child age 0-5 months  Skip to Section VII.  Child age 6-23 months  Continue with this module.  Child age 24-48 months  Continue with this module.  Child age over 48 months  End Interview. QUESTION RESPONSE 83. IN THE PAST 3 DAYS, DID YOU OR ANY HOUSEHOLD MEMBER AGE 15 OR OVER ENGAGE IN ANY OF THE FOLLOWING ACTIVITIES WITH (CHILD’S NAME): If yes, ask: WHO ENGAGED IN THIS ACTIVITY WITH (CHILD’S NAME)? Read and circle all that apply. a) TOLD STORIES TO (CHILD’S NAME)? b) SANG SONGS TO OR WITH (NAME)? c) TOOK (NAME) OUTSIDE THE HOME? d) PLAYED WITH (NAME)? e) NAMED, COUNTED OR DREW THINGS WITH (NAME)? f) SHOW OR TEACH (NAME) SOMETHING NEW? g) TALK WITH (NAME) AND ASK SIMPLE QUESTIONS? h) PRAISE (NAME) FOR WHAT S/HE IS LEARNING? i) SHOW AFFECTION TO (NAME)? j) HIT (NAME) FOR MISBEHAVING? k) CRITICIZE OR YELL AT (NAME)? Mother Father Grandmother Other Told Stories 1 2 3 4 Sang Songs 1 2 3 4 Took on outing 1 2 3 4 Played 1 2 3 4 Counted, Drew 1 2 3 4 Teach/show new 1 2 3 4 Talk/ask questions 1 2 3 4 Praise for learning 1 2 3 4 Show affection 1 2 3 4 Hit 1 2 3 4 Yell 1 2 3 4 QUESTION RESPONSE This is the final section of the interview. I will read a statement. Please tell me if you agree, somewhat agree, or disagree with each statement. 84. I KEEP TRACK OF HOW MUCH FOOD THE CHILD EATS EVERY MEAL Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 85. I RETRY NEW FOODS FOR THE YOUNG CHILD IF THEY ARE REJECTED AT FIRST Agree . . . . . . . . . . . . . . . . . . . . . . . . 1 Somewhat agree . . . . . . . . . . . . . . 2 Disagree . . . . . . . . . . . . . . . . . . . . . 3 Don't Know . . . . . . . . . . . . . . . . . . . 88 NOURISH Mid-term Survey Report 105 | P a g e EXPOSURE, PARTICIPATION, MOTIVATION QUESTION RESPONSE This is the final section of the interview. It is about your experience that you whether exposure with NOURISH or not. There are no right or wrong answers. Show Grow Together Logo 86. HAVE YOU SEEN THIS LOGO BEFORE? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Don't Know . . . . . . . . . . . . . . . . . . . 88 Show 3 TV Spots 87. HAVE YOU SEEN ANY OF THESE TV SPOTS? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q9 Don't Know . . . . . . . . . . . . . . . . . . . 88 88. IF YES, WHICH ONES? Circle all mentioned. Unified Grow Together . . . . . . . . . 1 Latrine . . . . . . . . . . . . . . . . . . . . . . . 2 Fish powder . . . . . . . . . . . . . . . . . . .3 Don't Know . . . . . . . . . . . . . . . . . . . 88 Show NOURISH Grow Together Print Materials 89. HAVE YOU SEEN ANY OF THESE MATERIALS? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP TO Q9 Don't Know . . . . . . . . . . . . . . . . . . . 88 90. IF YES, WHICH ONES? Circle all mentioned. Chenda story book . . . . . . . . . . . . . . . . . . . . . . . . .1 5+5+3 behavior poster . . . . . . . . . . . . . . . . . . . . . 2 Group education manual for caregivers. . . . . . . 3 Fish powder curtain./poster . . . . . . . . . . . . . . . . . 4 Commitment Card. . . . . . . . . . . . . . . . . . . . . . . . . 5 Toilet leaflet. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Toilet fliptarp. . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 CCT Fan/ fliptarp. . . . . . . . . . . . . . . . . . . . . . . .. . . 8 Commitment Card. . . . . . . . . . . . . . . . . . . . . . . . . 9 Reminder (icons) sheet . . . . . . . . . . . . . . . . . . . . 10 Key chain. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Home visit wheel . . . . . . . . . . . . . . . . . . . . . . . . . 12 Food basket insert. . . . . . . . . . . . . . . . . . . . . . . . .13 Stickers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Other. ________________________ ______ 99 (SPECIFY) 91. WHICH NOURISH ACTIVITIES HAVE YOU YOURSELF JOINED OR EXPERIENCED? Read one by one, circle if yes # times GMP. . . . . . . . . . . . .. . . . . . . . . . . . . .1 ______ Home Visit.by VHSG . . . . . . . . . . . . 2 ______ Garden support by Ag Officer…… . . 3 ______ NOURISH Mid-term Survey Report 106 | P a g e QUESTION RESPONSE This is the final section of the interview. It is about your experience that you whether exposure with NOURISH or not. There are no right or wrong answers. Caregiver education group . . . . . . . . 4 ______ Community dialogue. . . . .. . . . . . . . . .5 ______ CLTS (village meeting on toilets). . . . 6 ______ First 1,000 Days Village Fair . . . . . . . 7 ______ Voucher . . . . . . . . . . . . . . . . . . . . .. ..8 ______ None. . . . . . . . . . . . . . . . . . . . . . . . . 00 Don’t Know . . . . . . . . . . . . . . . . . . . 88 Other_______________________99 (SPECIFY) 92. AFTER SEEING THESE MATERIALS AND PARTICIPATING IN THESE ACTIVITIES, WERE YOU MOTIVATED TO DO ANYTHING NEW OR DIFFERENT? Yes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 No . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 2 END Don't Know . . . . . . . . . . . . . . . . . . . .. . . . . 88 END 93. IF YES, WHAT DID YOU FEEL MOTIVATED TO DO? Circle all mentioned. Go for health services. . . . . . . . . . . . . . . . ..1 Take child for health services. . . . . . . . . . . 2 Take child for GMP. . . . . . . . . . . . . . . . . . . 3 Eat more diverse food myself . . . . . . . . . . .4 Breastfeed exclusively . . . . . . . . . . . . . . . . 5 Breastfeed longer . . . . . . . . . . . . . . . . . . . . 6 Feed child more diverse food . . . . . . . . . . .7 Feed child more food . . . . . . . . . . . . . . . . . 8 Feed child fish powder. . . . . . . . . . . . . . . . .9 Make fish powder . . . . . . . . . . . . . . . . . . . .10 Drink clean water. . . . . . . . . . . . . . . . . . . . .11 Build toilet . . . . . . . . . . . . . . . . . . . . . . . . .. 12 Wash hands with soap . . . . . . . . . . . . . . .. 13 Plant a home /micro / sack garden. . . . . . 14 Don’t remember . . . . . . . . . . . . . . . . . . . . .88 Other. ___________________________ 99 (SPECIFY) 94. HOW LONG WERE YOU IN THIS VILLAGE IN THE PAST YEAR? 6 MONTHS OR LONGER . . . . . . . . . . . . . . . . ..1 LESS THAN 6 MONTHS . . . . . . . . . . . . . . . . ….2 Don’t remember. . . . . . . . . . . . . . . . ………….88 The end. Thank the respondent for her participation in the survey.