weaning in nepal

A quarterly newsletter linkingdevelopment workeraround the world

A quarterly newsletter linking development workers around the world

No.52 SEPTEMBER 2002 NUTRITION

Footsteps

Breast milk continues to be an importantsource of nutrients until a child is at leasttwo years old. However, after six monthsof age, all babies need increasingamounts of additional foods, beforeeventually changing to family foodsalone. These additional foods are calledcomplementary foods. As a baby grows andbecomes more active, complementaryfoods fill the gap between the totalnutritional needs of the child and theamounts provided by breast milk.Without adequate amounts and a goodmixture of these additional foods, babieswill fail to grow properly and their

• Letters

• Bible study

• Weaning practices in Nepal

• Feeding young children

• Gardening for better nutrition

• HIV and breast-feeding

• Encouraging young children to eat

• Resources

• Asking questions

IN THIS ISSUE

immune system will become lesseffective. Common infections likediarrhoea last longer and are moresevere in malnourished children. Once achild is sick, poor appetite can lead to acycle of ever-worsening malnutritionand repeated infections that often endsin death (see diagram, page 3). Nearlytwo-thirds of all deaths in childrenaged 0–4 years are associated withmalnutrition in countries in the south– so good feeding practices are of vitalimportance to child survival.

Complementary foodsComplementary foods should be:

■ rich in energy and nutrients

■ clean and safe

■ easy to prepare

■ locally available andaffordable

■ easy and enjoyable for thechild to eat

■ not too peppery or salty.

Complementary foods may bespecially prepared foods, or be

Feeding youngchildren

by Ann Ashworth

Good food is important for good health. Children who are well fedduring the first two years of life are more likely to stay healthy forthe rest of their childhood. During the first six months of a child’slife, breast milk alone is the ideal food. It contains all the nutrientsneeded for healthy growth as well as immune factors that protectagainst common childhood infections.

Spoon sizesSpoon sizes may be different. In this issue:

1 teaspoon is equal to 5ml or 8g and issimilar in size to a soda bottle top.

1 tablespoon is equal to 15ml or 25gmand is similar in size to half of an emptyplastic film canister (1 film canister issimilar in size to 2 tablespoons).

made from mixtures of family foodswhich are modified to make them easyto eat and high in nutrients. They shouldbe given in small amounts three times aday at first, increasing to five times dailyby 12 months. Start with a few teaspoonsand gradually increase the amount andvariety. It is important to actively

Children who are well fed during thefirst two years of life are likely to stayhealthy for the rest of their childhood.

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Iron and zinc

Foods high in iron and zinc include redmeats, liver, kidneys, blood and otherkinds of offal. Egg yolks, dark green leavesand pulses are also high in iron, but thisiron is not so easily absorbed in the body.However, eating fruit rich in vitamin C (eg: oranges, papaya), at the same mealwill improve the absorption of iron.

Vitamin A can be stored in a child’s body for a few months, so encourage families to feed foods high in vitamin A as much as possible when available.

encourage a child to eat. A child leftalone may not eat enough.

When preparing these foods, make sureall utensils are clean. Spoon-feedcomplementary foods from a cup orbowl and do not use a feeding bottle.Foods should be used within two hoursof preparation if they are not kept in arefrigerator.

Keep a chart of a young child’s weight.Monitoring growth is a useful way toknow if a child is eating enough and ishealthy.

Complementary foods need to containsufficient energy, protein, minerals andvitamins to meet the nutritional needs ofthe growing child. The most difficultnutritional needs to fill are usually forenergy, iron, zinc and vitamin A.

Using staple foodsEvery community has a staple food whichis the main food eaten. This may be acereal (such as rice, wheat, maize, millet),or a root crop (such as cassava, yam,

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FO O T S T E P S 52

FootstepsISSN 0962 2861

Footsteps is a quarterly paper, linking health anddevelopment workers worldwide. Tearfund,publisher of Footsteps, hopes that it will providethe stimulus of new ideas and enthusiasm. It is away of encouraging Christians of all nations asthey work together towards creating wholeness inour communities.

Footsteps is free of charge to individuals workingto promote health and development. It is availablein English, French, Portuguese and Spanish.Donations are welcomed.

Readers are invited to contribute views, articles,letters and photos.

Editor: Isabel CarterPO Box 200, Bridgnorth, Shropshire, WV16 4WQ, UK

Tel: +44 1746 768750Fax: +44 1746 764594E-mail: [email protected]

Sub Editor: Rachel Blackman

Language Editor: Sheila Melot

Administrators: Judy Mondon, Sarah Carter

Editorial Committee: Ann Ashworth, SimonBatchelor, Mike Carter, Paul Dean, RichardFranceys, Martin Jennings, Ted Lankester, SimonLarkin, Sandra Michie, Veena O’Sullivan, NigelPoole, Alan Robinson, Rose Robinson, JoséSmith, Ian Wallace

Illustrator: Rod Mill

Design: Wingfinger Graphics, Leeds

Translation: S Boyd, L Bustamante, Dr J Cruz, S Dale-Pimentil, N Edwards, N Gemmell, R Head,M Machado, O Martin, N Mauriange, M Pereira, J Perry

Mailing List: Write, giving brief details of yourwork and stating preferred language, to:Footsteps Mailing List, PO Box 200, Bridgnorth,Shropshire, WV16 4WQ, UK.E-mail: [email protected]

Change of address: Please give us the referencenumber from your address label when informingus of a change of address.

Articles and illustrations from Footsteps may beadapted for use in training materials encouraginghealth and development provided the materialsare distributed free of charge and that credit isgiven to Footsteps, Tearfund. Permission shouldbe obtained before reprinting Footsteps material.

Opinions and views expressed in the letters andarticles do not necessarily reflect the views of theEditor or Tearfund. Technical information suppliedin Footsteps is checked as thoroughly aspossible, but we cannot accept responsibilityshould any problems occur.

Tearfund is an evangelical Christian relief anddevelopment agency working through localpartners to bring help and hope to communitiesin need around the world. Tearfund, 100 ChurchRoad, Teddington, Middlesex, TW11 8QE, UK. Tel: +44 20 8977 9144

Published by Tearfund. A company limited byguarantee. Regd in England No 994339. RegdCharity No 265464.

potato), or starchy fruits (such asplantain and breadfruit). In rural areas,families often spend much of their timegrowing, harvesting, storing and pro-cessing the staple food. In urban areasthe staple is often bought, and the choicedepends on cost. For use as comple-mentary foods, cooked staples canusually be mashed (for example, rice,noodles, cassava, potato), or softened ina small amount of liquid (for example,bread and chapati).

Porridges prepared from the staple areoften used as early complementaryfoods. However, these are usuallywatery and contain little energy and fewnutrients. Soups are also commonly usedand are watery, so have the sameproblems.

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Monitoring growth is a useful way to know if achild is eating enough and is healthy.

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The malnutrition/infection cycle. Good feedingbreaks this cycle and saves lives.

3FO O T S T E P S 52

CHILD HEALTH

■ Cook with less water and make a thicker porridge.

■ Replace some (or all) of the water with milk.

■ Add extra energy and nutrients. For example, add milkpowder, sugar, margarine or ghee to porridge. Addgroundnut or sesame seed paste to soups.

■ Toast cereal grains before grinding them for flour. Toastedflour does not thicken much, and uses less water to makeporridge.

■ Take out a mixture of the solid pieces in soups such asbeans, meat, vegetables and mash to a thick puree with thestaple food. Soften with a little margarine or oil for extraenergy. The best part of the soup is the solid foods in it.

To improve porridges and soups

Porridges are often watery withlittle energy and few nutrients.

Staple foods provide energy. Cereals alsocontain protein, but most other staplefoods have very little protein. However,staple foods are poor sources of iron,zinc, calcium and some vitamins, whichare all needed to meet the nutritionalneed of the growing child.

Useful complementaryfoodsOther foods must be eaten with thestaple food in order to fill the energy andnutritional needs. The types of foods thatfill these needs best are:

■ pulses (such as peas, beans, andgroundnuts) and oil seeds (such assesame seeds). These are good sourcesof protein. Some, such as groundnuts,bambarra, soybeans and oil seeds, arerich in fat so are also high in energy.

■ foods from animals and fish These arerich sources of many nutrients but areoften expensive. Also, some people donot eat meat because of their religiousor personal beliefs. Meat and organs(such as liver, heart, and kidneys), aswell as milk, yoghurt, cheese and eggsare good sources of protein. Foodsmade from milk and any food con-taining bones that are eaten (eg: smallfish, canned fish, or pounded driedfish) are good sources of calcium,needed to build strong bones.

■ dark green leaves and orange-colouredfruits and vegetables are all rich sourcesof vitamins A and C.

■ oils, fats (such as margarine, butter,ghee) and sugars are concentratedsources of energy. Adding oneteaspoon of oil or fat to a meal givesextra energy. Red palm oil is also veryrich in vitamin A.

Mixing complementary foods is the bestway to make certain that children getenough energy, protein and micro-nutrients for healthy growth and develop-ment. During a day, a good mixture is:

■ a staple + a pulse + an animal food + greenleaves or an orange-coloured vegetable or fruit.

Families can use all these foods to make ameal, or they can use, as examples:

■ staple + pulse + green leavesat one meal

■ staple + animal food + fruitat another meal.

Add a small amount of fat or oil to giveextra energy if none of the other foods inthe meal is energy-rich.

AnaemiaChildren need iron to produce new bloodparticularly during their first year whengrowth is fastest. Breast milk containsvery little iron, but full-term babies areborn with enough iron for their needs inthe first six months. After that, if theirneed for iron is not met, the child willbecome anaemic. Premature and lowbirth-weight babies are at higher risk ofanaemia because they are born withsmaller body stores of iron. Give themiron drops from two months, if available.

Fortified foodsFortified foods have special nutritionalingredients added by the manufacturers.For example, cereal products may befortified with iron. Salt may be fortified

with iodine. Margarine usually hasvitamins A and D added to it by themanufacturer.

Professor Ann Ashworth is a nutritionist atthe London School of Hygiene and TropicalMedicine with many years of experience inyoung child feeding.

E-mail is [email protected]

Public Health Nutrition UnitLondon School of Hygiene and Tropical Medicine49–51 Bedford Square, LondonUKWC1B 3DP

■ Discuss the age at which most childrenstart complementary foods in your area.Is this too early or too late? If so, discuss why.

■ Are foods from animals eaten in yourarea? What are they?

■ Which of these are regularly given toyoung children?

■ Can you think of ways to make moreanimal foods available for eating at home,for example, by building a fishpond, orraising rabbits, guinea pigs or poultry?

■ Dark green leaves and orange-colouredvegetables and fruits are all rich sourcesof vitamins A and C. Make a list of thoseavailable in your area. What could somefamilies do if there are some monthswhen none are available? Can you helpfamilies overcome this lack?

Discussion questions

infection

poor diseaseresistance

malnutrition

death

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LETTERS

FO O T S T E P S 52

THE EDITORFOOTSTEPSPO BOX 200BRIDGNORTH

SHROPSHIRE

WV16 4WQUK

CAHD tries to lessen the exclusion of,and negative attitudes towards, peoplewith disabilities and to break thenegative cycle which links poverty anddisability. CAHD is being piloted in Asiaby Handicap International andChristoffel Blinden Mission inpartnership with local organisations.

Jane Schofield GurungCommunity Based Rehabilitation Service (CBRS)Naya Bazaar, PO Box 293PokharaNepal

E-mail: [email protected]

For more information, contact: [email protected]: www.handicap-international.org

Training about medicinal plantsI was very interested to read the Footstepsissue on medicinal plants. Our group hasbeen interested in medicinal plants forabout 25 years. We have gradually set upa training centre and created a botanicalgarden. The garden holds 182 localvarieties of medicinal plants. We holdseminars in French for groups of 15–60

Community approachesto disabilityThank you for the excellent Footstepsissue on people with disabilities. Readersmay be interested to hear of a newapproach which bridges community-based rehabilitation and generalcommunity development work. We call this Community Approaches toHandicap and Disability (CAHD). Ithelps existing community developmentorganisations to gain awareness,knowledge and skills to include peoplewith disabilities in their existing work.

participants for training in medicinalplants and group dynamics. Please writefor details if you are interested inattending these seminars.

Hervé de LautureCADI (Centre d’Application auDéveloppement Intégré)BP6259, DakarSenegal

The Deborah MovementA group of women had a vision to gatherall the women from evangelical churchesin Burkina Faso together for intercession,evangelism and to train them using Biblestudies.

They launched the Deborah Movement.With support from various churchgroups they have organised Prayer Days to pray for the country. Half theday is used for teaching and the otherhalf for praying for the various needs inthe country.

A second day of prayer for AIDS washeld in 2002 with a particular concern forthe 200,000 orphans in the country. Thesedays have been a huge encouragementand we are now planning an inter-national conference in November.

Joanna IlboudoContact Editions, 04 BP 8463Ouagadougou 04Burkina Faso

Water for healthPeople often do not drink enough water. This results in people havinghealth problems such as stomachproblems, dizziness and dry skin. Toencourage people to drink more waterwe have tried the followingdemonstration.

■ Cut the bottom off a plastic sodabottle with a narrow neck. Half fill thebottle with a mix of gravel, sand andearth. Line up eight full glasses ofwater.

■ Explain to people that drinking wateris important for the body to get rid ofwastes. Start pouring the water fromthe glasses slowly into the bottle. Thewater looks dirty at first. If you don’tdrink enough, the body’s leftover dirtwill cause problems.

EDITORIAL

Nutrition is a huge topic and in this issue we have chosen to concentrate on one of the mostimportant stages of nutrition – the early years of life when a child learns to share in the family diet.This is a dangerous time for many young children. Two thirds of the deaths of young children aged0–4 years in Third World countries are associated with malnutrition. The types of food given and theway in which babies are encouraged to eat are so important. Healthy and well-nourished babies growinto strong children better able to fight off disease.

A recent report by UNICEF called We the Children found that in India, for example, nearly half of allchildren under three years of age suffered from malnutrition.

Ann Ashworth is a world expert in nutrition and provides many good and practical ideas. Breast-feeding always used to be the very best way to feed a baby. However, with the knowledge that the HIVvirus can be passed from mother to baby through breast-feeding, many people are unsure how toadvise mothers. We provide an update on the real risks to help people make an informed judgement.Home gardens can be used nearly everywhere, including urban areasand can really help improve the intake of vitamins and minerals.

We hope this issue provides a variety of ideas to help improvenutrition in your community. Future issues will look at holisticdevelopment, urban agriculture and pressures on the family.

■ Continue pouring the glasses into thebottle. Gradually the water willbecome clear. Each person shoulddrink at least eight glasses of water aday. This will keep their body healthyas wastes will be washed away.

Louise FongProject GraceYunnanChina

Helpful weedsI read the article about helpful weeds inFootsteps 48 with a keen interest. InNigeria, the Tiv people of Benue Statehave many local chickens. Newcastledisease constantly plagues thesechickens. Tiv people use a cheap meansof controlling this dangerous disease.


LETTERS

They use striga, a common weed ofmaize and sorghum, and find thistreatment as effective as the vaccine.

They soak the whole striga plant inwater for 10–20 minutes. Leaving theplant in the water, they give the water tothe chickens to drink. The mixtureshould be kept topped up with water.Continue treatment for one week.

Akaa Ijir, PO Box 491Makurdi 970001, Benue StateNigeria

Reflections on HIV/AIDS Statistics show clearly that unless drasticmeasures are taken immediately, theHIV/AIDS epidemic will claim half ofAfrica’s population within the next fewyears. It is estimated that over 7,000Africans are dying and about 11,000 arebeing infected with the virus everysingle day!

If HIV testing facilities and life-savingmedicines were readily available andaffordable, more people would beencouraged to go for an HIV test. Over90% of people who discover they are

Traditions and customsconcerning our foodAll cultures develop a variety of traditional beliefs and customsconcerning food. Sometimes there are foods that people eat atspecial festivals. Some foods may be avoided on particular days.Foods which are avoided in one culture may be valued in an-other. Most of these beliefs have little impact on nutrition butthere are some that have a considerable impact. For example, inmany cultures pregnant or nursing women are not supposed toeat eggs – which are a very nutritious food. Children likewisemay be prevented from eating foods which would be of real nutrit-ional benefit.

Read I Samuel 21:1-6

• Why did the priest give David the consecrated bread?

David knew that according to religious custom he should not haveeaten this bread. But without it, he and his men would not havehad the strength to continue their mission.

Read Acts 10:9-16

• Why did Peter refuse to kill and eat the animals and birds shown to him?

• What was God’s answer to Peter?

The Jewish tradition considered certain foods unclean and for Paulthese taboos were part of his life. But then God challenged him onthis. God is able to make all things clean and to change people’sway of thinking.

• What customs, traditions and taboos do you have in your own cultureconcerning food?

• Are any of them unhelpful and damaging to good nutrition?

• Should some of the taboos be challenged and if so, how could this bedone sensitively?

God is our father and we are his children, to whom he gives goodgifts. As we read in Luke 11:11-13, God freely gives his Holy Spiritand his gifts to us. He encourages us to provide good nutritiousfood to our children.

BIBLE STUDY

HIV positive try to avoid passing on thevirus to others until they die. This helpsreduce transmission of the disease.

Life-saving medicines such asNevirapine help reduce HIV/AIDSbeing passed from mother to child.However, improving child survivalwithout doing anything to prolong thelife of the mother will produce orphanswith an uncertain future.

Children who become orphans becauseof AIDS must be helped in a sustainableway, with education and training thatwill eventually make them self-sufficient. There is a danger of pouringmoney into institutions for orphans, asextended families will hand over theirtraditional responsibility of looking afterorphans. It is vital to strengthen andsupport African extended families totake care of orphans.

Dr Eben MwashaPHC Ambassadors FoundationPO Box 9618, MoshiTanzania


Weaning practicesin Nepal

Ingredients for super-flour porridge

The flour is made from:

■ Two parts pulse – soybeans are best,but other small beans, grams and peascan also be used

■ One part whole grain cereal such asmaize or rice

■ One part another whole grain cerealsuch as wheat, millet or buckwheat.

The pulses and grains need to be cleaned,roasted well (separately) and ground intofine flour (separately or together). Theflour can then be stored in an airtightcontainer for one to three months. Theflour is stirred into boiling water andcooked for a short time. The properamount and consistency of the porridgewill depend on the age and condition ofthe child. Salt should not be added,especially if the child is malnourished.

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FO O T S T E P S 52

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jaulo, so adding pulses, green leafyvegetables or fruit to these foods isencouraged.

Another traditional food which has beenshown by scientists to be very nutritious,is a porridge made from the finelyground flour of roasted cereal grains andpulses. In Nepal this is known as super-flour porridge or sarbottam pitho ko lito.

Common traditional weaning foodsinclude:

■ porridge (lito), made from roasted riceflour (occasionally maize or millet),ghee (clarified butter) and sugar

■ jaulo, made from rice and turmeric orrice and salt

■ dhiro, made from maize flour (ormillet or wheat)

■ maar, made in lowland areas bycooking rice, cracked maize andsoybeans together

■ khichari, a mix of rice, pulses andvegetables.

Some of these traditional foods are highin energy and nutrients and should beencouraged. These include maar andkhichari. Others are poor weaning foodswith little protein or nutrients, such as

In Nepal, weaning traditionally begins with the Rice FeedingCeremony (Pasne) where children receive their first meal. Theceremony is performed at five months of age for a girl and sixmonths for a boy.

Super-flour porridgeThe recipe developed out of experienceand research by Miriam Krantz, workingwith Nepalese mothers and with thefoods they grow. The NutritionProgramme of the United Mission toNepal fully supports the use of super-flour porridge and it is now promotedthroughout the country by the govern-ment as the ideal weaning food.

The flour makes full use of whateverlocal foods are most readily available.Any pulse can be used instead ofsoybeans, and combinations of any twocereal grains can be substituted for thewheat and maize.

For babies of six months of age or more,porridge made with one or twoteaspoons of super-flour given two orthree times a day is enough with breast-feeding. As the child grows, the amountof porridge used will gradually increaseuntil about 100gm (four tablespoons) ofsuper-flour is used each day – enough toprepare three feeds of porridge. Thisamount will provide most of a one tothree year old’s requirements of protein,calcium, iron and various vitamins. If a

by Sanjay Kumar Nidhi

young child is also breast-fed and eatstwo small portions of their family’s mealof dhal-bhat (pulses and rice), all theirneeds for energy and protein will be met.

The nutritional content of super-flourvaries according to the ingredients used,but analysis shows that 100gm of flourwill contain 13.5–25gm of protein and345–370 calories. Super-flour porridgedoes not supply enough vitamin A for achild’s daily need. Health workerstherefore teach mothers to add groundleafy greens or other family vegetables tothe porridge.

The nutritional value of the porridge is also improved by adding ghee(clarified butter) or other fat or vegetableoil. A recipe that meets the WHOrecommendation for severely mal-nourished children uses 30gm (oneheaped tablespoon) of super-flourcooked with 15ml (three teaspoons) of oiland made up to 150ml with water. Thisis being used for malnourished childrenin UMN Hospitals.

Advantages of super-flour■ Super-flour is a convenient and

adaptable food that stores well. Forolder children the flour can be eatendry (as sattu) or added to fresh boiledmilk or any other liquid withoutfurther cooking, since all theingredients are pre-roasted. The flourcan also be used for baking breadsand biscuits.

■ Infants like the roasted flavour.

■ Mashed vegetables and fruits can beadded to the porridge to improve thenutritional value and vary the flavour.

■ Super-flour porridge is highlyrecommended for use with severelymalnourished children.

Kamali brought her two year oldson, Arjun, to the District HealthOffice with tears in her eyes. Shebrought him there as a last resortafter he had received treatmentfrom local traditional healers. Arjunhad diarrhoea all the time, had lost hisappetite and had been constantly losing weight.

Arjun was immediately referred to the NutritionProgramme of UMN. He had severe weight loss andlooked just ‘skin and bones’. He was irritable, very slow,dehydrated and was crying all the time. It was a clear caseof severe protein energy malnutrition. Arjun’s mother,Kamali, was advised about his situation and givensuggestions for feeding him.

Three days later, UMN staff visited his home and talked with his mother about the familysituation. They discovered that she was not aware of the importance of good child feeding andhygiene practices.

The nutrition programme staff taught the mother how to prepare super-flour porridge. She wasencouraged to feed Arjun this porridge four to five times a day (fortified with ghee or oil) alongwith other food, fruits and vegetables. During later home visits, Kamali was given practicalsuggestions regarding weaning foods, feeding sick children, personal hygiene, balanced diet andnutritious local foods. The nutrition field staff alsomonitored Arjun’s weight during regular home visits.

Arjun gained weight slowly but steadily. When hereturned to the nutrition unit for a check-up visit he wasa different child – happy and full of energy. He hadgained weight, could walk easily, his appearance hadimproved and he wanted to feed himself. The clear joy inhis mother’s eyes said it all.

We hope that our experience in Nepal with homeprocessed weaning foods can be duplicated in othercountries. Sound, home-based approaches to childfeeding should be recognised and encouraged by policymakers, community leaders and public health workers.

On the road to recovery


CHILD HEALTH

Sanjay Kumar Nidhi has worked as a nutrition assessment and supportofficer in the Nutrition Programme,United Mission to Nepal. Hisaddress is Nutrition Programme,UMN, PO Box 126, Kathmandu,Nepal.


A selection of some commonand traditional weaning

foods, including porridge,dhal and half an orange P

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8 FO O T S T E P S 52

NUTRITION

Buildingfoods

Protectivefoods

Energyfoods

The three food groupsA child’s diet should include food from the three food groups:

■ Energy foods help children play and work. These are staple foodssuch as maize, rice and plantain, and oils such as vegetable oil andanimal fat, and sugar.

■ Building foods or protein help children to grow and repair the bodyafter illness. Examples are peanuts, soybeans, pigeon peas, milk,eggs, fish and meat.

■ Protective foods contain vitamins and minerals, which help the bodyto run smoothly and protect against illness. Most fruit and vegetablesare protective foods.

MealsThese recipes are examples

from around the world of meals thathave a good balance of all three food

types. Each meal meets at least one third ofa small child’s daily requirements of energy,

protein, iron and vitamins. Adapt these ideas usingyour own local foods.

Dhal, carrot and amaranthus (Asia)Cook dhal (lentils) until soft. Add a few spices to give flavour.

Add half a small carrot when the lentils are nearly cooked. Addsome amaranthus leaves and steam, or cook separately. For the

child’s meal, mash 1 rounded tablespoon of cooked lentils with thecarrot, 1 teaspoon of ghee (or oil) and a tablespoon of cooked leaves.

Serve with half a chapati and 1/4 cup milk.

Millet and bean porridge (Africa)Gather cowpea leaves (or sweet potato/pumpkin/cassava/kale leaves)and steam or boil. Make a thick porridge from millet and bean flours (3 parts millet to 1 part bean). Mix 5 tablespoons of porridge with 1 tablespoon cooked leaves and add 1 teaspoon oil, margarine or ground-nut paste. Alternatively, serve the cooked leaves separately and fry withonions and tomato for flavour.

Rice, beans and liver (Latin America)Cook rice. Boil beans with chopped onions and a few spices until soft.Add some potato and continue cooking. Steam a chicken’s liver withthe rice or cook it with the beans. For the child, mash 3 tablespoons

rice, 1 tablespoon of beans and potato, 1/2 tablespoon liver and 1teaspoon margarine.

Rice, lentils and yoghurt (Middle East)Cook rice. Boil lentils until soft. Fry some onion until brown

and add spices for flavour. Add to lentils. For the child’smeal, mix 3 rounded tablespoons cooked rice with 11/2

tablespoons lentil and onion mixture and 1 teaspoonoil. Serve with 3 tablespoons yoghurt. Serve with

half an orange to improve ironabsorption.

Mealtimes should be funMealtimes should be relaxed and enjoyable and an opportunity forthe whole family to spend time together. Don’t force children to eatin a hurry.

Use mealtimes to improve children’s development. For example:

■ Children can learn new words and concepts, foods andcolours. Talk about how the food tastes, name the utensils,foods and colours.

■ Let children touch and pick up food themselves. Thishelps to develop their co-ordination.

■ Help children feel good about themselves by givingthem praise and smiling at them.

Feedingyoung childrenBased on information from Ann Ashworth, World Neighbours,Sarah Carter, Rachel Blackman and Diane Reed


BiscuitsBiscuits can make nutritioussnacks. Here is a very easy recipe thatwill work in an oven or on top of a fire or stove.

1/2 cup sugar 1/2 cup fat Pinch of salt

2 cups wheat flour (or a mix of 1 cup wheat and 1 cupother flours such as soy or millet)

2 small spoons of a sweet spice such as nutmeg, ginger ormixed spice if available1/2 cup finely chopped nuts (pound to a paste if for small babies)

Mix all these ingredients together to make a very stiff dough with eithermilk, an egg or water.

Either roll out thinly and cut into squares about 5cm in size, or take smallspoon-sized pieces of dough and work into a round (like a chapati), againto about 5cm in size. If using an oven, cook on a tray for 15 minutes at180°. If cooking over a stove or fire, use a thick metal frying pan or sheet ofmetal. Cook very slowly over a cool heat, again for about 15 minutes, turningover once.

These biscuits may be kept in an airtight container for a few days.

Good snacksSnacks are foods eaten between meals. Nutritious snacksmay be useful to help fill the energy gap and are an easyway to give a young child extra food. Snacks should beeasy to prepare.

Good snacks provide both energy and nutrients. Examples are:

■ mashed ripe banana, paw-paw, avocado, mango andother fruits

■ yoghurt, milk, puddings made with milk

■ bread or chapati with butter, margarine, groundnutpaste (peanut butter) or honey

■ biscuits, crackers

■ cooked potatoes.

Poor snacks are high in sugar (which rots teeth)and low in nutrients. Examples are:

■ fizzy drinks (sodas)

■ ice lollies/ lollipops

■ sweets.

Encourageindependence■ Encourage children to hold their own

spoon by twelve months old. Thiscan be messy, and they will needhelp, but it makes their mealtimesmore interesting.

■ Cut up food into small pieces so thatit is easier to eat.

■ Give children their own plate orbowl.

Vegetable oilVegetable oil, as well as being auseful source of energy, helps makefood soft and tasty. Children aged6–12 months should eat twoteaspoons each day mixed into theirfood. Children aged 1–2 yearsshould eat three teaspoons per day.

Food hygieneGood hygiene when preparing food is always essential but especially when food is beingprepared for young children. Always wash hands with soap and water before handlingfood. Cooking utensils should be clean. Dry them on a drying rack.

Never cough, sneeze or smoke over food that is being prepared for eating. If you are ill,particularly with vomiting or diarrhoea, do not prepare food as you are likely to pass onyour infection. Cover cuts and sores on your hands and wear clean clothing.

Flies carry disease so food should always be covered. Some food such as milk, eggs,cooked meat, cooked rice and other cereals will spoil more quickly than other kinds of

food. Once cooked, food should not be left at normal temperatures for more than twohours.

Raw meat and fish, and uncooked vegetables with soil on them, should nevercome into contact with cooked foods. After handling these foods, wash handswell before handling cooked foods.

The San Lucas Association (SLA) in Peru works with poor farmingcommunities in the jungle area of Moyabamba. Here the main crops arerice, coffee, banana, maize and manioc (cassava). Through communitymeetings and a needs assessment with local people, high rates of infantmalnutrition and low consumption of fruits and vegetables were revealed.SLA began a gardening project in the schools of four communities,involving the teachers, pupils and parents’ associations. Many families thenestablished vegetable plots on their own land. Recently, SLA has started a community and familygardens project, working mainly with existing grass roots organisations.

The mothers chose their own leaders to coordinate groups of 15–20 women in each village. Eachwoman cultivates a small home garden near her house, ideally 10 square metres in size. SLAprovides training and support with two visits each month, as well as seeds and some hand tools.The training includes technical information on how to grow vegetables, how to maintain soilfertility, basic nutrition and how to prepare nutritionally balanced dishes with the vegetables.

The crops which have proved most successful are coriander, radish, carrot, small marrows,cabbage and tomato. SLA begin with three or four popular and nutritious vegetables. Later, asproducers improve their gardening skills, there may be surplus production for sale.

Major problems have been a lack of water in the dry season and crop losses (from pests,diseases, thieves and livestock). To help resolve the water problem, communities have used pipesto take water from nearby streams and adapted plastic drinking bottles to serve as sprinklers.SLA helps producers identify pests and trains them in using natural pesticides. Losses due tothieves and roaming livestock have been largely solved through community agreements andfencing the gardens.

San Lucas Association

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In recent years, many people’straditional diets have changed. Moreprocessed foods are now eaten. Ruralfarmers may now grow crops to sellrather than for family use. This meansthey may grow fewer crop varieties,particularly of vegetables. Wild leaves,roots and berries traditionally harvestedas food may no longer be available as aresult of deforestation and lack of accessto communal land. Because of these

trends, the diets of many poor peoplehave lost their original variety oftraditional foods and they lack enoughincome to buy a varied and adequatediet. Home gardens can help improvefamily nutrition, encourage traditionalvarieties, improve health, producemedicinal plants and save money.

Working with women is usually the keyto improving nutrition through homegardens. Pregnant and nursing mothers

Gardening for better nutrition

Small food gardens near the family home have traditionally made animportant contribution to family nutrition. Home gardens can helpprovide variety in the diet and supply vital vitamins and minerals,carbohydrates and proteins. Good nutrition helps the body to resistdisease, so home gardens help improve family health.

and young children are more likely tosuffer from malnutrition. Women alsousually prepare, process and store familyfood supplies.

Before planning such work, take time toassess local nutritional problems andconsider how these might be solved.Where lack of protein is a seriousproblem, home garden projects mayinclude the growing of high-proteincrops, such as beans of all kinds, as wellas the raising of fish, poultry and smallanimals. In situations where deficienciesof iron (anaemia) and calcium arecommon, promote vegetables with highiron and calcium content. Where vitaminA deficiency causes ill health and nightblindness among the poor, promote leafygreen vegetables and other crops, suchas sweet peppers and carrots, which arerich in vitamin A.

In urban areas there may be a small areaof land outside the home or by theroadside which could be cultivated.Otherwise herbs, tomatoes and leafycrops can be grown in tubs made fromold tyres or plastic buckets by windowsor doors and watered with waste water.

Setting up a home garden projectWe can learn a lot about how to set up ahome garden from the experience of theSan Lucas Association (SLA) in Peru.Here are some key points for success.

■ Assess local nutritional needsWhat are the main nutritional problemsin the community and how are theylinked to eating habits?

• What crops are grown? Are they usedfor income or family consumption?

• How do families budget for buyingfood?

• What are the main problems inproducing food (for example, lack ofland or labour, pest damage, lack ofskills, poor storage)?

• What are the main problems incooking and preparing food?

■ OrganisationConsider carefully how to organiseproduction – in either individual orcommunal plots and how to co-ordinatesupport.

by Ian Horne

Practical tips

■ Provide nutrition training and enjoyableparticipatory workshops wherebalanced meals are prepared.

■ Introduce new crops slowly and onlywhen they have special nutritionalbenefits.

■ Include leafy dark green vegetables asgood sources of vitamin A. Older leavestend to have higher levels of vitamin A.

■ Encourage crops rich in vitamin C, suchas citrus fruits, sweet peppers andtomatoes.

■ Promote beans, peas and lentils. Formaximum protein levels, encouragepeople to grow and eat a mixture ofbeans, peas or lentils and starchyvegetables and at each mealtime.

■ Consider promoting fish farming andthe production of chickens, rabbits orother small animals.

■ The leaves and fruits of many trees canmake a vital contribution to familynutrition. Plant them in corners of thegarden where they do not shadevegetable crops. They often havegreater drought resistance because oftheir extensive root systems.

■ Plan planting carefully so crops providefood all year round, particularly duringthe ‘lean seasons’ when vegetables andfruits are in short supply.


AGRICULTURE

■ Choose crops wellCrops should be:

• easy to grow, with short growingcycle or long cropping season

• adapted to the local climate and soil

• locally grown

• popular, with a good flavour

• pest and disease resistant.

When choosing suitable vegetables,study the diet of poor families with goodhealth. Also study the diet of olderpeople with more traditional foodcustoms.

■ Link production to good nutritionEnjoyable training on nutrition andpreparing balanced meals is vital. Localprejudices against certain foods mayneed challenging.

■ Water availabilityWhen water is scarce, other domesticneeds are likely to take priority. Improvethe water available to plants by:

• covering soil around plants with amulch of leaves or grass

• shading young plants

• removing weeds (they compete forwater)

• add manure and compost to improvewater retention.

■ Pests and diseases Provide technical help on identifyingand treating pests and diseases. Help

producers prepare organic pesticides.Distribute leaflets with clear diagrams.

■ Protect and feed the soilConsider using techniques such as covercrops to cover the soil and contourbarriers which prevent soil from beingwashed away. SLA encourages compost-making to improve soil fertility.

A few final commentsWarmikunam Cristianas Trabajaykan(WCT) works with indigenous groups innorthern Peru. They have found homegarden projects useful for empoweringwomen and developing more effectivelocal organisations. This work may leadto commercial production and the pro-cessing of garden produce to raise extraincome. Such projects contribute tobroader community development andsolidarity.

PRODAD, in Nicaragua, encouragesproducers to share part of their gardenproduce with widows, child feedingcentres and other people in need,demonstrating care and concern withinthe community.

In rural areas, landless people are oftenthe most vulnerable to malnutrition. Forhome gardens to benefit such people, wewill need to help them to have secureaccess to land.

Special thanks are due to Tearfund partnersSan Lucas Association and WarmikunamCristianas Trabajaykan (Peru), CORCRIDE(Honduras), and PRODAD (Nicaragua),who provided information for this article.

Ian Horne is a nutritionist with an interestin rural development and currently workswith Tearfund as Desk Officer for theAndean Region. He formerly worked on ahome gardens project in Mexico.

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Small home gardens can be made in almost anysituation.

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Enjoyable training onnutrition and preparingbalanced meals is vital.

options will be to breast-feed or to givereplacement feeding (such as powderedmilk). In some cities in Brazil, motherswith HIV may express their breast milkand have it made safe by heat treatmentat a breast milk bank.

Breast-feedingBabies benefit from the immune factorsin breast milk and its high nutritionalvalue. They are less likely to die fromdiarrhoea and pneumonia but they riskgetting the HIV virus. This risk is small ifthe mother:

■ breast-feeds exclusively – this meansthe mother and others in the house-hold must not give the baby water orother fluids or food

■ maintains healthy breasts throughgood breast-feeding practices, such asbreast-feeding on demand and havingthe baby correctly attached on thebreast

■ seeks help promptly for nipple orbreast problems, and for thrush in thechild’s mouth or on her nipples

■ avoids becoming infected, or re-infected, with HIV while breast-feeding

■ starts complementary feeding at sixmonths (see pages 1–3 ) and stopsbreast-feeding as soon as is practical.

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FO O T S T E P S 52

■ breast health The risk is higher ifnipples are cracked or bleed, or if thebreast is sore or inflamed (mastitis,breast abscess).

■ timing of the mother’s HIV infection Therisk of MCTC is higher if the motherbecomes infected during pregnancy orwhile breast-feeding.

■ mother’s immune status The risk isgreater if the mother’s immunity islow, for example, due to malnutritionor because she is in the advancedstages of HIV disease.

Feeding optionsMothers with HIV have a difficultchoice, especially if they live in poorconditions. Choosing not to breast-feedmay prevent some infants becominginfected with HIV but can greatlyincrease the risk of death from othercauses. UNICEF estimates that for everychild dying from HIV through breast-feeding, many more die because they arenot breast-fed.

It is important to discuss with HIV-positive mothers the feeding optionsavailable to them so they can make aninformed choice. In most situations the

Risk through breast-feedingThe risk of passing the virus throughbreast-feeding depends on:

■ breast-feeding duration The longerbreast-feeding continues, the greaterthe risk of MTCT. The risk is thoughtto be about 5% in the first six months,10% over the first 12 months, and15–20% if the baby is breast-fed for 24months.

■ pattern of breast-feeding The risk islower if the baby is fed only breastmilk.

HIV and breast-feeding

by Ann Ashworth

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The HIV virus can be passed from an HIV-infected mother to her baby.This is called mother-to-child transmission (MTCT). It can occur duringpregnancy, labour and delivery, and through breast-feeding.Antiretroviral drugs such as Nevirapine reduce the risk of MTCT.

One in every 20 babies willbecome infected if breast-fedfor six months.

Three in every 20 will becomeinfected if breast-feedingcontinues for two years.

The risks of HIV through breast-feeding


CHILD HEALTH

the child tired when fed? Is the food toospicy or difficult to eat? Does the childhave enough time to eat? Is the childgiven sweets, sodas or other snacks sothey are not hungry at mealtimes?

Then decide how to deal with theproblem. Often this means spending

Professor Ann Ashworth is a nutritionist atthe London School of Hygiene and TropicalMedicine with many years of experience inyoung child feeding.

E-mail: [email protected].

Public Health Nutrition UnitLondon School of Hygiene and Tropical Medicine49–51 Bedford SquareLondonUKWC1B 3DP

example, they may want to breast-feed atnight when it is inconvenient to preparea feed. Mixing breast-feeding with otherways of feeding is more risky intransmitting the virus than exclusivebreast-feeding.

Replacement feeding should only bechosen if it is acceptable, affordable,sustainable and safe. Mothers must betold the danger of mixing artificial andbreast-feeding. Breast-feeeding is thebest choice for HIV-negative women andfor women whose HIV status isunknown.

If parents complain that their child‘refuses to eat’, spend time discussingwhat they can do.

First, identify why the child is not eating.For example, is the child sick orunhappy? Is the child jealous of a newbaby and trying to get more attention? Is

Encouraging young children to eatby Ann Burgess

Replacement feedingThere is no risk of transmitting the virusbut there is a risk of death by losingbreast milk’s protective immunity andfrom unhygienic or incorrectly preparedfeeds. This risk is high if a mother cannotafford sufficient milk, has an untreatedwater supply, poor sanitation, scarcefuel, no fridge, feeds by bottle or ispoorly educated. In communities wherebreast-feeding is the usual practice,mothers who choose replacementfeeding will ‘stand out’ and may bealienated. Mothers may find it difficult togive only replacement feeding. For

The amount children eat depends on the food they are offered, theirappetite and how their mothers or other carers feed them.

■ Make mealtimes happy times. Encourage children by talking to them, telling them how good thefood is and how well they are eating.

■ Play games to persuade children to eat. For example, pretend to feed a doll or pet.

■ Do not hurry children. They may eat a bit, play a bit, and then eat again. Offer a few more spoonfulsat the end of a meal.

■ Feed with the rest of the family but give children their own plates so they get their share of the food.

■ Cut food into pieces that children can hold, and provide spoons for soft foods. Young children like tofeed themselves but are messy eaters. Carers must make sure the food eventually reaches the mouth.

■ Give a variety of good foods that children like. Avoid salty or spicy foods.

■ Mix foods together if a child picks out their favourite foods.

■ Make sure children are not thirsty. Thirsty children eat less. But do not fill up their stomachs with too much drink before or during the meal.

■ Feed children when they are hungry. Do not wait until children are too tired to eat.

■ Never force-feed. This increases stress and decreases appetite. If children refuse food, take it awayand offer it later. A child may really dislike a particular food. Provided they are eating a variety ofother foods do not force them to eat.

■ Give special love and attention if children are unhappy.

Encouraging sickchildren to eat

■ Make children clean and comfortablebefore feeding. For example, clean theirmouth and nose.

■ Give small meals that are easy to eat andthat children like.

■ Feed more frequently – perhaps everytwo hours.

■ Give plenty to drink, especially if a childhas diarrhoea or fever.

■ Feed them on the lap of their favouritecarer and gently encourage them to eat.

When children recover, they continue toneed loving supervision to make sure theyeat extra food and regain lost weight.

Encouraging healthy children to eat

more time at meals gently encouragingthe child to eat.

Below are some suggestions on how todo this. It is very important to supervisefeeding from the time children startcomplementary foods until they are twoto three years old, or if a child is ill.

Based on information from Child HealthDialogue Issue 9 1997, ComplementaryFeeding: family foods for breast-fedchildren (WHO 2000) and Nutrition forDeveloping Countries (Oxford UniversityPress 1992). Ann Burgess is a nutritionconsultant with many years experience inEast Africa.


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RESOURCES

FO O T S T E P S 52

BooksNewslettersTraining materials

Improving Nutrition Through Home Gardening This book isdesigned forcommunitydevelopment andextension workersin Africa. Itcontains inform-ation sheets andillustrations whichcan be used intraining sessionswith people who wantto start a personal or communal garden.The book also outlines how to improvethe quality of food production in homegardens. It shows how, when and whereto grow nutritious plants and givesrecipes for useful dishes for weaning andyoung children. The book has 282 pages,costs US $22 ( 24.55) and is availablefrom:

FAO Sales and Marketing GroupViale delle Terme di Caracalla00100 RomeItaly


How to Diagnose and Treat LeprosyThis well illustratedlearning guide isaimed at healthprofessionals whoneed to recognise,care for andprovide treatmentfor people withleprosy. It isavailable inEnglish and will shortly be available inFrench. It is available free of charge.

ILEP also have a catalogue with detailsof other useful resources about leprosy.

ILEP234 Blythe RoadLondonW14 0HJUK


Books can also be ordered on line: www.ilep.org.uk

in extension work, vaccination cam-paigns and control programmes. Thebook has 112 pages, costs 25 Australiandollars ( 14.15) and is available from:

ACIARGPO Box 1571Canberra, ACT 2601Australia


The book can also be downloaded from:www.aciar.gov.au/publications/monographs/82

Complementary FeedingFamily foods for breastfed children

A comprehensiveguide to familyfoods for breast-fed children. Thisbooklet is full ofinformation onthe use of comp-lementary foods,the nutritionalvalue of a varietyof foods andgives detailed guidance on all aspects ofcomplementary feeding. The openingarticle of this issue of Footsteps was basedon material from this book. The booklethas 52 pages and is produced by WHO.It costs US $10 ( 10) and can be orderedfrom:

WHO Marketing and DisseminationAvenue Appia, CH01211 Geneva 27Switzerland


This is the first publication in Tearfund’s new ROOTS series, aimed atsupporting partners and other organisations working in development.The Advocacy Toolkit is for anyone interested in advocacy work. It isavailable as a set of two booklets, to be worked through by groups in aworkshop setting, or during short sessions over a longer period. Thefirst booklet, Understanding advocacy, explores what advocacy is andwhy it is important. It includes group exercises and case studies fromTearfund partners. It also looks in depth at the Christian approach toadvocacy. The second booklet, Practical action in advocacy, explores how todevelop an advocacy strategy. It is well illustrated with plenty of practical ideas.

The Advocacy Toolkit costs £10 (US/ 15) for organisations able to pay. Please make chequespayable to Tearfund. One copy is available free of charge to Footsteps readers unable to pay whocould make good use of it. Please write with details to:

Resources Development, PO Box 200, Bridgnorth, Shropshire, WV15 4WQ, UK


Advocacy Toolkit

Nutritious Food for Young ChildrenA well-illustratedand simplywritten bookletfull of ideas andinformation onfeeding youngchildren. The bookhas 42 pages andcosts US $4. It isavailable from:

World Neighbours 4127 Northwest 122nd StreetOklahoma City, OK 73120-8869USA

Controlling Newcastle Disease in Village Chickens: a field manualby R Alders and P Spradbrow

Newcastle disease is a killer diseaseamong poultry, and there is still noeffective cure available. This book hasbeen produced by the Australian Centrefor International Agricultural Researchfor veterinary workers and extensionists.It describes how to diagnose Newcastledisease and how to vaccinate against it.The final chapter gives ideas on how toinclude knowledge on Newcastle disease


RESOURCES

Footstepsin Hindi and BengaliFootsteps is now available inBengali and Hindi. If youwould like to receive copiesin Bengali, please contact:

HEEDPO Box 5052NewmarketDhaka 1205Bangladesh

Health and NutritionBiblical, preventative and practical views

by Ruth Renvoize

A practical teaching course developed inNigeria for use in Bible schools andcovering all aspects of health andnutrition with a biblical basis. Availableonly from:

ACTSTCNN, PMB 2020Bukuru, Plateau StateNigeria

PILLARS (Partnership In Local LAnguageResourceS) is a new way of sharinginformation through discussion within smallgroups that has been developed by Tearfund.PILLARS guides are designed for use within community groups,broken down into 20 or so topics and with illustrations for non-literate members. These guides are easy to use and a trained leaderis not required. Each guide contains Bible studies, again designed foruse in small groups. Five guides are now available in English, withtranslations of some available in French, Spanish and Portuguese.

PILLARS guides can also be used for translation into locallanguages, either by organisations or during a series of threeworkshops with about 20 participants who initially work ontranslating and adapting their chosen guides and then begin writingand printing their own materials. There is a workbook to guidepeople through the workshop process and a CD-ROM with designlayout etc to make the design and printing process as easy aspossible. The PILLARS process has been used in Uganda in theLusoga language, southern Sudan with the Zande language, Nigeriawith the Yoruba language, Burkina Faso in the Mooré language and inMyanmar using Burmese.

The guides are on the subjects of:

■ Building the capacity of local groups (English, French, Spanish,Portuguese)

■ Improving food security (English, French)

■ Credit and loans for small businesses (English, French, Spanish,Portuguese)

■ Agroforestry (English, French)

■ Preparing for disaster (English) NEW!Each guide costs £3.50 (US $5 or 5) or the set of five is £15 (US $20 or 20) including surface postage and packing.

The workbook and the CD-ROM are £5 (US $8 or 8) each. Theworkbook is available in English, French, Spanish and Portuguese.

A complete package – which is all that isneeded to run the workshop series with fivecopies of each of two guides, plus workbook andCD-ROM costs £35 (US $50 or 50). Pleasespecify which guides are required. Participants use the guides fortranslation and adaption, working in small groups during the workshop.

Payment is by credit card or cheque in either sterling, euros or dollars made out to Tearfund. For further details or to place an order,please contact:

Tearfund Resource Development, PO Box 200, Bridgnorth, Shropshire,WV16 4WQ, UK.E-mail: [email protected]

A number of groups around the world have been piloting the PILLARSprocess. They have produced guides in various local languages which areavailable for others to buy. Here are details of the languages and relevantaddresses if you would like to contact these groups and ask for details:

Lusoga Patrick Kaluba, Cultural Research Centre, PO Box 673, Jinja,Uganda

Zande PILLARS Committee, c/o ECS Yambio Diocese, PO Box 7576,Kampala, Uganda

Burmese CSSDD – PILLARS, MBC, P O Box 506, Yangon, Myanmar

Yoruba Francis Ademola, CRUDAN, P O Box 1784, Ibadan, Oyo State,Nigeria

Mooré Contact Editions, 04BP 8462, Ouagadougou, Burkina FasoE-mail: [email protected]

✹SPECIALOFFER

Hard at work on the Burmese translation in Myanmar.

If you would like to receive copies in Hindi, please contact:

Raj KumarRainbow Christian AcademyPlot No 12Gorewada BastiNagpur – 440013India

PILLARS

There are several important types ofquestion:

■ closed questions which allowsomeone to say only yes or no

■ leading questions which tend to makethe person replying answer in acertain way – usually yes or no – andwhich may limit the informationreceived

■ ambiguous questions which are vagueand confusing so the person can’treally understand what is being asked

■ open-ended questions which allow theperson replying to give moreinformation

■ probing questions which seek todiscover more about what lies behindthe initial replies.

Practical exercise

Use this exercise to discover the differencesbetween various questions. First, decidewhat type of question each one below is.Discuss situations where this might beappropriate and when it might beinappropriate. Then suggest alternativeways of asking the same question.

■ How do you get your medicine?

■ Isn’t the new health post wonderful?

■ How do you find the school?

■ Shouldn’t you cover your water storagepot?

■ What do you do most of the time as alocal health visitor?

■ Do you take your children to bevaccinated?

■ Wouldn’t you prefer to grow improvedpotato varieties?

■ Is it true that it is difficult to findinformation on family spacing?

Common mistakes■ not listening carefully (but preparing

the next question)

■ asking too many closed or leadingquestions

■ helping the informant (often byanswering your own questions)

■ asking vague or ambiguous questions

■ failing to explore people’s answers

■ being unaware you have alreadymade your own conclusions

■ keeping the informant too long.

Participants may like to repeat the groupexercise with a different topic to see iftheir interviewing skills have improved.

Adapted from ‘Improving listening andobservation skills’ in A Trainer’s Guide forParticipatory Learning and Action, 1995,by International Institute for Environmentand Development (IIED).

E-mail: [email protected]: www.iied.org

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FO O T S T E P S 52

Published by: Tearfund, 100 Church Road,Teddington, TW11 8QE, UK

Editor: Dr Isabel Carter, PO Box 200, Bridgnorth,Shropshire, WV16 4WQ, UK

Tearfund staff spend considerable time dealingwith many thousands of funding requests that weare unable to support. This is taking them awayfrom their work of bringing good news to the poorthrough current partnerships. Please note that allfunding proposals will be rejected unless they arefrom current Tearfund partners.

There is no one correct way of askingquestions. It depends on the purpose ofthe interview. However, open, probingquestions are usually needed to discoveruseful information. These often beginwith one of the six ‘helpers’:

What? When? Where? Who? Why? How?

An interviewing exerciseDivide people into groups of three andask them to choose one to act as inter-viewer, one as informant and the other asan observer. Suggest some topics onwhich to ask questions. Here are somesuggestions:

■ healthcare for older people in the area

■ different uses for trees

■ good practice in storing householdwater supplies

■ where to obtain information on familyspacing methods

■ employment opportunities in the area

■ child vaccination.

Allow each group ten minutes to try todiscover as much as possible about theirtopic. Explain that good questioning islike peeling away the layers of an onionuntil the central core or reason is reached.Before starting, ask the group to suggest afew good probing questions. If they lackideas, suggest a few such as ‘But why?’‘Please tell me more about that?’ or‘Anything else?’

Allow each group to feed back theirfindings. Were leading questions used?What observations did each participantmake? If two groups have taken the sametopic, let one feed back after the other andcompare their findings.

How easy did they find the interviewing?How well did they keep the interviewgoing? What mistakes did people make?

All of us use questions in our daily lives. Frequently thekind of questions we ask may make important differencesto the information we can gather. Asking the wrong kindof questions will limit the information discovered.

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