Good caring practices to child will contribute a lot in his/her growth and development especially physical growth, psychosocial and psychological development.Parents and other care givers should be close to the child so as to monitor child’s development. Love and affection are essential ingredients for a child’s growth and development. However, childcare in Tanzania
Behaviour challenges and needs for change.
Behaviour changes is not, however simply an issue of providing caregivers with correct information. Certain conditions and enabling factors that cut across sectors must exist for changes to be effective and sustainable. They include social support systems, reduced workload and time saving from higher labour productivity and access to financial and productive resources. The practices of caretakers and families at home and community are critical to preventing infant and child morbidity and mortality. Caretakers should practice behaviors that will prevent infant and childhood health problems before they arise. In order to change the nutritional status of populations, it is critical to change the behavior of caretakers, families, and communities. When care is sought at health facilities, health workers play an important role in providing essential services. They need to be trained to provide appropriate nutritional management and counseling for both sick and children (UNICEF: 2004).
Table 5.1
Initiator of breastfeeding Process
[In-depth interview N=60]
| Incidence of malnutrition | Low incidence area | Middle incidence area | High incidence area | Total % | |||
| Researched areas | Bora n=10 | Temeke n=10 | Sabasaba n=10 | Mzinga n=10 | Makuka n=10 | Kibondemaji n=10 | |
| Mother | 7 | 8 | 6 | 5 | 3 | 4 | 55 |
| Child | 3 | 2 | 4 | 5 | 7 | 6 | 45 |
During in-depth interview with mothers who breast feed their children when asked who initiate breastfeeding, the mother or a baby, response were as follows; Majority of women (55%) in low and middle incidence areas revealed that, mother is the who initiate breastfeeding process while 45% of mothers in high incidence area are Mzinga and Sabasaba wards depicted that the child is the one who initiate breastfeeding (Table 5.1). This variation may be due to difference in education level among mothers, since most of mothers in low and middle incidence areas seem to have higher level of education than women in high incidence areas. Women from Bora added “we let the child to breastfeed until when she/he is satisfied”.
Most mothers in Makuka and Kibondemaji wards mentioned that, “A child is the one who initiate breastfeeding because if the child is not crying it is an indication of feeling hungry then there is no need to breastfeed. We frequently let the child decide when he or she wants to eat or is fed up.” This might be a cause of poor nutrition status to majority of children in these areas thus high incidence rate of malnutrition. Therefore, women especially in Makuka and Kibondemaji wards should be encouraged to breastfed and gave food to their children on demand instead of waiting until the child feels hungry.
Constraints to Behaviour Change in Child Care and Feeding Practices
There are many constraints or issues that reduce likelihood of families adopting better child feeding behaviors which can be classified as environmental or attitudinal constraints. Environmental factors include the unavailability or seasonal variation in the accessibility of certain foods, the need to work outside home, a scarcity of cooking fuel or inadequate reception of information about child feeding given by health care workers. Attitudes that prevent improvements in child feeding are numerous. They will vary by culture, but certain issues are common.
Unavailability or seasonal variation in the accessibility of certain foods.
Seasonal variation in the accessibility of certain foods contributes to food insecurity in some families as result children would lack adequate and variety of food to nourish their body. Thus some families wish to provide adequate and balanced diets to their children but they fail due to seasonal variation or poor access to such food. This is one of the constraints which were stated by majority of families during quantitative data collection which was conducted at particular time in Temeke municipality. It was observed that mothers of children less than five years when asked to list the type of foods they normally use. The response was as follows;
“We normally ate all foods which are available for example this is a season for pawpaw thus we ate pawpaw every day and I hope our children get enough vitamins. But there was a problem of getting other types of fruits like mangoes, and its price is very high so only few people can afford to purchase. Also peas are scarcity nowadays due to off-season. [Mother from one household visited in Sigara Street
“We ate a lot of vegetables this time because majority of people have planted and now it is the time for harvest. Even in the market its price is reasonable everyone can afford but during the off season we real suffer. We had plenty of cassava and sweet potatoes because it was its season”. [Mother from Ungindoni- Mji mwema ward]
“We had access to almost all types of foods in the market the problem was money for purchasing such foods. Otherwise we ate what we managed to buy. [Mother’s from Bora streets FGD]
Low Income
Low income was observed to be a major constrain for improving child care and feeding practices in five surveyed streets in Temeke Municipality Bora Street
Makuka
“It is difficult for us to provide quality care for our children due to low income. They have to eat what we have. However, they sometimes lack important services such as hospital services, education and other social needs [Key informants].
Kibondemaji A
“We do not have money for buying nutritious foods for our children” [Mothers with children under 2 years, FGD]. On the other hand, key informants from this street also stated that major problem for majority of the community was low income. “This is a burden to most of us sometimes we failed to meet some basic needs. It is not because we do not like, no! II was due to poverty” [Key informants]
Mzinga and Sabasaba
“Our families have low income thus we failed to buy enough food for our children. Majority of us are housewives and we do not have any income generating activity where we can depend as a source of money. We spend what we got from our husbands.”
Temeke
“Sometimes we failed to give our children nutritious foods as you know life has ups and downs. So when we had enough money, we purchased good foods for our children”.
Bora
No constraints were reported by mothers from Bora Street
This constraint was also observed during in-depth interview with mothers of children under two years old, were: “I do not have money to buy special foods for my child even when she is sick” [Kibondemaji, Makuka and Sabasaba]. “I do not have enough money to buy some important foods for my child such as milk and lishe flour. My child used to eat maize porridge most of the time, which was the reason for his sickness [Bora]. “I gave her normal foods but if I had enough money I could prepare nutritious food for her.[Mzinga]. “It was real difficult for me to buy special food for my child during sickness due to lack of money” [Temeke].
Constraints in Provision of Complementary Foods
Table 5.2 shows constraints in the provision of complementary foods to infants in Bora, Temeke, Mzinga, Sabasaba, Makuka and Kibondemaji.
Table 5.2
Constraints in Provision of Complementary Foods [N = 75]
 Researched Area | Bora [n = 10] | Temeke [n = 15] | Mzinga [n =13] | Sabasaba [n =12 ] | Makuka [n = 15] | Kibondemaji [n = 10] |
 Incidence of malnutrition | Low incidence areas | Middle incidence areas | High incidence areas | |||
| Low Income | | ü | ü | ü | ü | ü |
| Food acceptability | | | | | ü | |
| Poor information on choice of foods | | ü | | | | |
| idleness and negligence | | ü | | | | |
| No constraints reported | ü | | | | | |
The result obtained from the research showed that the major constraint in provision of complementary feeding was low income, this was mentioned by women from Mzinga, Temeke Kibondemaji and Makuka streets, and thus they failed to afford to buy food. Not only that but also the other constraints mentioned by the mothers in Temeke were idleness, negligence, and poor information on choice of foods. Table 5.2 summarizes the results, while Box 5.1
Hygiene Practices
It is, important that all foods prepared for young infants are handled in a way that they are free from germs. Some considerations while preparing food for infants are: hands should be washed with soap and water before handling the food as germs that can not been seen in dirty hands can be passed on to the food. Utensils used should be scrubbed, washed well, dried and kept covered. Cooking kills most germs. The foods prepared for infants should be cooked properly so as to destroy harmful bacteria present if any. After cooking, handle the food as little as possible and keep it in a covered container from dust and flies. Cooked food should not be kept for more than two hours in hot climate unless there is a facility to store them at refrigeration temperature. The hand both mother and child should be washed before feeding the child (Kant Singh: 2006).
Table 5.3
Constraints to good hygiene practices
[N=75]
| Researched Area | Bora [n = 10] | Temeke [n = 15] | Mzinga [n =13] | Sabasaba [n =12 ] | Makuka [n = 15] | Kibondemaji [n = 10] |
| Incidence of malnutrition | Low incidence areas | Middle incidence areas | High incidence areas | |||
| Mother’s negligence | ü | ü | | | | ü |
| Feeding the child dirty foods | ü | | | | | |
| Income Poverty | ü | ü | ü | ü | ü | |
| Work load to mothers | ü | ü | | | | |
| Having sexual intercourse with a man apart from a husband | | | | | | ü |
| Feeding the child leftovers | | | | | | ü |
| Diseases | | | ü | | | ü |
| Idleness of the parent | | | | ü | ü | |
| Ignorance | | | | ü | | |
| Unclean environment | | ü | ü | ü | ü | ü |
Table 5.3 provides the brief summary constraints of good hygiene practices faced by the women. The major constraint was the income poverty and unclean environment in terms of food preparation up to consumption facing women at Sabasaba, Makuka, Temeke, Bora and Kibondemaji. Also Mother’s negligence from women at Bora, Temeke and Kibondemaji as they ignore a certain type of food and women workload in the household responsibility for the women at Bora and Temeke. Women at Mzinga faced the constraints like child diseases when the teeth start to appear and most of the baby taking any thing to scrub their teeth. Ignorance and the idleness of the parent were the constraints of the women at Sabasaba while those women from Kibondemaji said that having sexual intercourse with a man apart from a husband, feeding the baby leftovers and child diseases influence them in maintaining good health. Mothers at Makuka were idle most of the time as they had older children to assist them with household activities.
Results from Transect walk in all six streets in Temeke Municipality showed that, environment were not clean, areas surrounding the houses were dirty, there were a lot of solid wastes around the houses and there were no dustbins or specific area for wastes disposal. For example in Makuka and Kibondemaji and Sabasaba garbage damp was near to houses and a lot of insects such as houseflies and cockroaches roamed about. A fowl and pungent smell emanated from the garbage dump. This was a health hazard for children as they sometimes played around the garbage dump or spent time to collect scraps.
With regards to household cleanliness it was observed that, some utensils were not washed they were just kept outside the house, toilets were not clean and were of poor quality, pit latrines were not closed and they were very close to the house, dirty clothes were scattered over the place. This was similarly observed in Sabasaba and Mzinga streets since they had no specific areas for solids waste disposal. Water for domestic use was not safe as shallow water wells were dug near the toilets and there were long grasses around the house which cause mosquito breeding.
During structured and unstructured observations children were seen eating left over food with tea while sitting on the dirty ground playing with the food and then consuming it. Generally personal hygiene was poor.
Women’s Heavy workload
In addition to the time spent caring or managing the care of their children, women from Temeke Municipal reported that women are responsible for key household tasks (fetching water, preparing foods, etc) and other productive and ruminative activities. Information from women during focus group discussion yields several interesting insights about the relationship between women’s workload and child care. Women from Bora, Kibondemaji A and Temeke streets stated that they had heavy workload which demanded more time for household tasks which limited their time to proper care for their children including good hygiene practice, (refer to Table 5.2). This hindered woman to practices better child care and feeding practices as she will try to accomplish all tasks per day some will not be done effectively (UNICEF: 1998).
On the other hand, women from Makuka, Mzinga and Sabasaba streets did mention that they do not have enough time to feed their children due to low income and many responsibilities. The strain was most visible physically as a result of the work burdens they carry and the children they bear, breastfeed and care for (URT & UNICEF: 1990).
The need to work outside home
During in-depth interview it was observed that, a substantial number (31%) of mothers with children-under 24 months were not involved in economic activities. Most of them said they were housewives or that they spent most of their time at home. On the other hand the majority of the mothers were involved in economic activities which occupy them quite a long time with 43% of them consuming from 5 to 12 hours. A relatively smaller number of mothers (18%) claimed to use more than 12 hours. The implication was that mothers hardly have time to breastfeed their children properly and for those whose ages permitted to provide them with appropriate complementary foods. Mothers who are overloaded with work are likely to have less time to spend for caring young children. Thus, their children are likely to suffer from poor nutrition.
It was observed in focus group discussion with Extension and Community workers at Kibondemaji Street Bora Street
Poor accessibility to clean and safe water
The available water in Temeke municipality is inadequate both in terms of quality and quantity. Besides, the majority of municipal residents have no access to piped water and, as a result, rely mostly on bore holes and shallow-wells which are unfortunately untreated and thus, unsafe (Temeke Env. Profile: 2005). Results from Formative research conducted on September this year (2006) in seven streets in Temeke Municipal had revealed the same. During structured and un-structured observation when research participants were required to observe the accessibility to clean and safe water for domestic use, the results were; majority of people (57%) had access to water from wells for domestic use. This comprised people with high income of Temeke Street Mzinga Street Kibondemaji Street
The distance and time taken to fetch water was a major factor of poor nutrition status of children in high incidence areas of Kibondemaji streets. In general 95% of people in high incidence of malnutrition areas of Makuka and Kibondemaji spent twice as much time as residents from low incidence of malnutrition of Bora Street
Table 5.4
Accessibility to clean and safe water for domestic use
[N=60]
| Researched Area | Bora [n =10] | Temeke [n = 10] | Mzinga [n =10] | Sabasaba [n =10 ] | Makuka [n = 10] | Kibondemaji [n = 10] | Total | Total in % |
| incidence of malnutrition | Low incidence areas | Middle incidence areas | High incidence areas | |||||
| Tap | 9 | 1 | 2 | 6 | 3 | 0 | 21 | 35% |
| Shallow wells | 1 | 7 | 7 | 4 | 7 | 8 | 34 | 57% |
| River | 0 | 0 | 1 | 0 | 0 | 1 | 2 | 3.0% |
| Bought | 0 | 2 | 0 | 0 | 0 | 1 | 3 | 5% |
During focus group discussion it was found that, majority of people use water from deep wells and river for their domestic use including cooking foods, washing clothes and boiling water for drinking. In Kibondemaji some people had good access to clean and safe water from taps but they have to buy; others fetch unsafe water from wells for their domestic use.
Poor access to Health Services
There are number of obstacles in accessing health services, including health care charges and other “unofficial” costs; long distances to the location of services, unaffordable transport systems, poor quality of care and poorly implemented exemption and waiver schemes meant to protect the most vulnerable and poor people. Although maternal and child health immunisation services are exempted, other services for example if the child is sick with malaria, the cost of malaria drugs has to be borne by the parents, most often by poor mothers. Moreover, women lack control and decision making power over, the use of resources in the household this makes it more difficult for them to access medical services (URT [MOH]: 2003). Children may not be treated properly when they become sick because many families do not have access to health facilities, or, even if they do, do not seek care regularly.
Cost of treatment was ranked as the most serious problem in the health sector with key informants from Makuka, Bora and Temeke streets stated it to be a “serious problem”. During focus group discussion with key informants from different wards in Temeke municipality, it was observed, as shown in box 5.4
Unhealthy Environment and Poor Hygiene Practice
Results from structured and un-structured observation in all seven streets in Temeke Municipality
Some utensils were not washed they were just kept outside the house, toilets were not clean despite of being of poor quality, pit latrines were not closed and they are very close to the house in medium and high incidence areas of malnutrition. This was similarly observed in medium incidence areas of Mzinga and Sabasaba streets since they had no specific areas for solids waste disposal and water for domestic use was not safe as shallow wells were constructed near the toilets. Generally personal hygiene was not practiced. For example, hand washing before and after eating was found to be common in areas with low and medium incidence of malnutrition. This habit was practiced in high incidence of areas malnutrition of Makuka and Kibondemaji streets such as after defecation or after attending a child who had defecated, as shown in. Table 5.5 summarizes these results.
Table 5.5
Condition of hygiene in households
[N = 60]
| Researched Area | Bora [n = 10] | Temeke [n = 10] | Mzinga [n =10] | Sabasaba [n =10 ] | Makuka [n = 10] | Kibondemaji [n = 10] |
| Incidence of malnutrition | Low incidence areas | Middle incidence areas | High incidence areas | |||
| Long grasses around the house | | ü | ü | ü | ü | ü |
| Areas surrounding the houses were dirty | ü | ü | | | ü | ü |
| No dustbins or specific area for wastes disposal | ü | | ü | ü | ü | ü |
| A garbage damper was near by houses | | | | ü | ü | ü |
| Dirty clothes were scattered over the place | | | | | | ü |
| Shallow wells were constructed near the toilets | | | ü | ü | ü | |
| Toilets were not clean and were not closed | | | ü | ü | ü | ü |
| Poor personal hygiene | ü | ü | ü | ü | ü | ü |
| Poor storage of cooking utensils | | | | ü | | ü |
| Poor disposal of animal faeces. | | | | ü | ü | ü |
| Poor food storage | | | | ü | ü | ü |
| Total | 3 | 3 | 5 | 9 | 9 | 9 |
During in-depth interview it was observed that less than 13% of all respondents (60) dispose properly child’s waste in a latrine or wash their hands with soap after child’s defecation. Refer to table 5.14 of chapter four in this report.
Inadequate knowledge on how to feed the child nutritious foods
Inadequate knowledge on how to prepare and feed the child nutritious food was observed to be a factor which caused malnutrition to children in researched areas. Box 5.5
Taboos and Superstition in Food Consumption
Traditions and cultural believes on caring practices sometimes are good and contributed to good nutrition. But some traditional and cultural practices have contributed more to erosion of good child caring practices thus malnutrition and inappropriate caring practices. Some people refuse to consume certain types of food due to local believes and their taboos. This may contribute to nutrient deficiencies which resulted to several nutrition problems such as, anaemia to pregnant women, toxaemia, premature birth, neural tube defect to infant, low-birth weight and other neurological defect to infants. For example in some culture pregnant women are restricted to eat certain types of foods such as eggs, fish and offal’s (TFNC/UNICEF: 2003). Results from research stipulated difference answers from mothers with children, less than 2 years during focus group discussion.
In the focus group discussion, it was pointed out that, pregnant women’s food had some taboos, some of the mentioned taboos were, and “Pregnant mothers were not allowed to eat offal’s because of belief that the umbilical cord of their babies will be larger than normal. Also they were restricted to eat eggs because children will be born without hairs. Moreover they are not allowed to eat some body parts of slaughtered animals like head of cows and sheep believing that baby born would have flue. Fish were also restricted since baby would be lazy” [Mzinga]. For Sabasaba Street
Motivations for Improving Child Feeding Practices
Motivation is critical for effective communication strategies and messages, formative research must not neglect these issues. Motivation may also include personal beliefs about benefits or personal aspirations, or it may reflect the influence of others who are important sources of information or support. In the following sections are possible motivations and influences.
Hopes and dreams for the child
This includes what parents aspired from their children in the future. Almost all societies value children and that wished to see children grow to be healthy, intelligent and productive adults. Results from table 5.6 shows that, there is no significant difference between mothers of well and undernourished children on aspirations. They all reported that offering some vision of future to their children through providing good education could be an important motivator for us in improving feeding practices”. In addition women from Bora, Temeke, Makuka and Kibondemaji said “We also hope our children will grow well and healthy, since we believed that a healthy, well nourished child will do better in school”. It is very interesting as all mothers despite of having different income levels but they are aspired to feed their children through proper allocation of little resource they have. However these future goals need to be tailored to the culture.
Table 5.6
Hopes and Dreams for children
| | Bora | Temeke | Mzinga | Sabasaba | Makuka | Kibondemaji |
| Our children will grow well and healthily | ü | ü | | | ü | ü |
| They will get education | ü | ü | ü | ü | ü | ü |
Parents’ images on themselves and their roles in caring for the child
The role of caring for children is the responsibility of both parents. By so doing women workload will be reduced and mother can have enough time for caring. However, in African culture caring for children remained to be women’s role. In the focus group discussion with elderly women when asked what responsibilities parents have to their children, responses were as presented in box 5.6
Less Illness and Related Costs
A well nourished child would be health with less illness. In structured and un-structured observation, researchers observed great difference between children from Bora and that of Kibondemaji. During observation they found children of Bora playing in safe grounds in their home, well dressed, they were healthy, and they were given balanced diets. The situation was different in Kibondemaji when observers found many children played outside their house, half dressed, and majority did not put on shoes. They also found sick child who was given medicine soon after wake up, that child was weak, not dressed but was dressed after noticing that visitors coming to the house.
Obstacles that Prevent activities Planned for Improving Child care and Feeding Practices
During focus group discussion with key informants, they stated that the following obstacles which they face in their streets. Problem of poor economic status was not stated by people from Bora and Temeke because they are high income earners comparatively. It was also observed in low income areas of Makuka and Kibondemaji streets and in medium income area of Sabasaba streets. Poor access to clean and safe water was stated by all people interviewed despite of others having high income of Temeke Street Mzinga Street
Table 5.7
Obstacles that existed in the streets
| Incidence of malnutrition | Low incidence area | Middle incidence area | High incidence area | |||
| Bora | Temeke | Sabasaba | Mzinga | Makuka | Kibondemaji A | |
| Poor economic status | | | ü | | ü | ü |
| Lack of nutrition knowledge | ü | ü | ü | ü | ü | ü |
| Inadequate number of schools | ü | ü | | | | |
| Problem of electricity | ü | | | | | |
| Poor transport system | ü | | | | | ü |
| High hospital cost | ü | ü | | ü | ü | ü |
| Problem of water | | ü | | ü | ü | ü |
| Superstition and belief | | | ü | | ü | |
| Inadequate school facilities | | ü | | | | |
| Presence of private schools | | ü | | | | |
| Houses are overcrowded | | | | | ü | ü |
| Poor access to market | | | | | ü | |
| Distance Health facilities | | | | | ü | |
| Lack of specific area for solid waste | | | ü | | | |
The results showed that there was no significance different in nutrition knowledge about child feeding in areas with people having high income of Bora and Temeke, medium income earners of Sabasaba and Mzinga streets and low income earners of Makuka and Kibondemaji.
Despite of having high income, people from Temeke complained to have inadequate schools facilities for their children. They revealed that, this is the burden for few parents who send their children in government’s schools, while well-off people enroll their children in private schools. Low and high income earners seem to have specific area for solid waste disposal compared to medium income earners (Sabasaba). Overcrowded of household was observed in areas of low income earners (Makuka & Kibondemaji) as compared to high (Bora & Temeke) and medium income earners (Sabasaba & Mzinga). This is very dangerous if people do not practice good hygiene as it may result to several epidemic diseases. Hideous beliefs were observed to be an obstacle for community development in medium income earners area (Sabasaba) and low income earners (Makuka). These results are summarized in table 5.7
In the focus group discussion, the obstacles to planned activities were reported as follows:
“We are facing a problem of capital for supporting our small projects like vegetable gardening, local chicken keeping and money for running small business” [Bora].
“Poor economic status to majority of people is a major obstacle even if they will be given education. If they do not have anything in their pockets and there is no support from anywhere else it will be wastage of time” [Kibondemaji A].
“There is no cooperation between community members and us (their leaders). You may find that we call people for meetings to discuss issues which might bring development in this street, but only a few respond. So how can we achieve development in nutritional issues?”[Mzinga]
“We have a plan on establishing dispensaries in our area since existing services are inadequate. But we failed due to funds. We have tried finding donors and we got TASAF. So we now expect something from them and UNICEF too” [Sabasaba]
“Home visits are one of our planned activities in order to follow up problems. But due to inadequate funds we can not manage” [Temeke]
“There are several activities we planned to do but due to financial constraint we failed to accomplish them. We had planned to provide nutrition and family planning education to community members especially women but we are not capable. Also we have tried to find some loans for digging toilets and dug wells in some areas where people had problems” [Makuka]
It was further reported by WEOs, VHW, CORPS, Extension and Community Workers in the focus group discussion that, obstacles which prevent development of activities planned to improve child care and feeding practices in some parts of Temeke Municipality, included lack of capital to run small projects such as vegetable gardens, poultry keeping, small entrepreneurial activities, digging of toilets and wells, family planning and nutrition education, home visits, small business, expansion of schools, establishment of dispensaries and lack of cooperation between community members and leaders.
The findings have revealed that there are several opportunities in Temeke Municipality
Table 5.8
Opportunities for Improving Child Care
[N=35]
| Response | High Income earners | Middle Income earners | Low Income earners | Total | |||
| Bora n=7 | Temeke n=6 | Sabasaba n=4 | Mzinga n=6 | Makuka n=6 | Kibondemaji n=6 | ||
| Private dispensaries | ü | ü | | | | ü | 3 |
| MCH-clinics | ü | ü | | | | ü | 3 |
| Centre for counseling about children’s right | | | | | | ü | 1 |
| Schools (nursery, primary & secondary) | ü | ü | ü | ü | ü | ü | 6 |
| Good access to tap water | ü | | ü | | | | 1 |
| Play grounds | ü | | | | | | 1 |
| Arts groups | ü | | ü | | | | 2 |
| Entrepreneurship groups | ü | | | | ü | | 1 |
| Fishing activities | | | ü | | ü | | 2 |
| Small business | | ü | ü | ü | ü | | 4 |
| Cooking oil industry | | | | | ü | | 1 |
| Good access to market | | ü | ü | ü | ü | | 3 |
| Government hospital | | ü | | | | | 1 |
| CBOs | | | ü | | | | 1 |
Moreover high income earners of Bora Street Temeke Municipality
Ability to conduct some small business activities helped people to increase their income and meet some of their basic needs. This was observed in all areas where people had high income such as Temeke Street Makuka street
Being near to the ocean, residents with medium income such as of Sabasaba and low income earners of Makuka have advantage of doing fishing. They got enough fish for food and for sell and obtain income to meet their basic needs including clothes, cost for treatments, and for buying other goods and services. From fish children can obtain protein, fat and minerals such as Calcium and Iron which helps to strengthen their bones and teeth. Incidence of malnutrition in Makuka might be caused by improper use of fish for foods as majority would like to get money thus selling a big amount and little is left for consumption.
During focus group discussion with WEOs, VHW, CORPS, Extension and Community Workers stated that, the presence of special people in their communities was observed to be an opportunity for them to share and solve some problems in low level of the household to community levels, instead of waiting for top officials to solve problems. The officials included people like religious leaders, traditional doctors and other experts. These people helped to sensitize the society in different aspects including nutrition. For example, it was observed in one of the high incidence areas of malnutrition of Makuka Street
Support from special people in the community
“We have a habit to invite experts in this street where they teach and advice mothers especially those who are not employed on nutrition matters such as importance of attending clinics during pregnancy, how to plan and prepare balanced diets to their families and others. This helped much and some women had changed you can find them buying green vegetable and fruits for their family members especially children” [Mzinga].
When asked how many Extension and Community health workers are present in their streets and how they assist them in nutrition issues response were are follows; there were many extension and health workers in areas were people had high income of Bora and Temeke streets compared to low income earning areas of Makuka and Kibondemaji streets. Those experts offered advices to mothers on how to feed children nutritious foods as well as good child care practices.
It appears that those people are not responsible or community members do not know the important of those people. The responsibilities of health workers in medium incidence of malnutrition areas of Sabasaba and Mzinga provided home visits and advice on good nutrition to their children and encouraged women to attend clinic regularly were among the responsibilities of health workers. When women from Kibondemaji Street
Table 5.9
Number of extension and community health workers and
Their assistance on nutrition related issues [N = 36]
 Researched areas | Bora n=6 | Temeke n=6 | Sabasaba n=6 | Mzinga n=6 | Makuka n=6 | Kibondemaji n=6 |
 Incidence of malnutrition | Low incidence of malnutrition | Middle incidence of malnutrition | High incidence of malnutrition | |||
 Number of extension and health workers present | 5 | 4 | 4 | 2 | 4 | 0 |
| Kind of assistance obtained from extension and health workers | ||||||
| Nutrition advice including child care practices | ü | | | | | |
| They don’t assist | | ü | | | ü | |
| Gave women advice and instruction on how to feed their children, encourages women to attend clinic regularly. | | | ü | | | |
| Home visits and advice on good nutrition to their children | | | | ü | | |
| No support but clinical assistants advice them | | | | | | ü |
From the in-depth interview when mothers with children less than two years asked to explain how different stakeholders can do as an opportunity to improve child care and feeding practices their response were: Mothers from all seven streets revealed that, “we would like get advice on proper ways of feeding our children. As it may help to improve feeding styles thus good nutrition status to children”. On the other hand, women with high income status of Bora and Temeke and low income (Makuka) requested, family planning and nutrition education should be provided to all of women.
Few women with high income of Temeke and low income of Makuka sighted that, “we would like to have frequency discussions with our leaders so that they could understand our family problems and look together for proper and appropriate solutions”. Majority of women with middle and low income wishes to get donation of materials such as mosquito nets, ngao and lishe flour from donors. Free hospital services for mothers and children and to improve health services facilities were revealed by women with low income of Makuka and Kibondemaji streets and also some mothers with high income Temeke, Tables 5.8 summarize these results.
Table 5.10
Support from stakeholders to improve nutrition status of children.
[N=60]
| Researched areas | Bora n=10 | Temeke n=10 | Mzinga n=10 | Sabasaba n=10 | Kibondemaji A n=10 | Makuka n=10 |
| Level of income. | High income earners | Middle income earners | Low income earners | |||
| Response | ü | ü | ü | ü | ü | ü |
| Advice on proper ways of feeding the children | ||||||
| Family plan and nutrition education should be provided | ü | ü | | | | ü |
| To have frequency discussions with mothers so as to understand their family problems | | ü | | | | ü |
| Free hospital services for mothers and children and to improve health services facilities s | | ü | | | ü | ü |
| Donation of materials such as mosquito nets, ngao and lishe flour | | | ü | ü | ü | ü |
| Capital for income generating activities for women | | | ü | | | ü |
| Other support including aids from NGO’s and CBOs. | | | ü | | ü | ü |
[Extracted from a Report by GAD Consult, titled “Formative Research on Child Nutrition and Care Practices in Temeke Municipality” GAD Consult, January 2007]
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