Category Archives: Project Information

Body Image Tool

One of the most interesting tools that we used in the gender survey was the Body Image of Men and Women. The objective of the tool was to illustrate the different behavioral expectations for men and women, how they were learned, and to identify the consequences for people who do not follow them. This was done in separate groups of men and women; the men discussed the behavioral expectations for men and the women discussed the behavioral expectations for women.

I was fortunate to observe the focus group discussion of the women for this tool. First, we had the participants draw a picture of an ideal woman, which depicted how she was expected to look, dress and stand. Then as a group, the participants brainstormed the important qualities that an ideal woman should have and wrote them around the drawing.

An ideal woman is expected to dress modestly and neatly, and stands with her feet close together.

This tool illustrated the very different behavioral expectations for men and women. A man is expected to be strong and to be responsible for the family’s income, while it is important for a woman to be a good housewife and a good caretaker of the children.

Our participants came up with 13 qualities that an ideal woman should have such as politeness and docility, patience, respect for her husband and respect for the elders. She needs to be a good housewife who does not leave the house. And she is responsible for the wellbeing of the children and the management of all the household assets such as the income earned by the husband, the cows, and the pigs.

After drawing, we discussed the importance of each of the qualities and the consequences for those who did not live up to the expectations. These behavioral expectations were learned from a young age from their parents, older siblings and teachers. When these expectations were not met, the people in the community would say that she was a bad woman and won’t befriend her. Also, it will only affect her family’s wellbeing if she was unable to fulfil her responsibilities. For instance, if she wasn’t patient with her husband when he picked a fight with her when he was drunk, then the conflict will not end and this is not good for her family, especially the children. She will also get into trouble with her husband if she did not do the household tasks or manage the assets well.

The women found some rules to be hard to follow such as always being patient with their husbands, especially when they were drunk, or staying at home all the time because they needed to have relationships with their neighbours who were also a great information source.

This tool has made them realized that there had been behavioral changes in the community that diverged from the traditional rules. Even though the women believed that these expectations had their merits, they had noted some positive changes that had taken place. The women reason and question other people more now and they are allowed to leave the house for income-earning, such as working in the factories in Phnom Penh.  They saw these changes as positive because they increased the family’s income and improved their livelihoods.

In addition to improving nutrition, the objective of Fish on Farms is also to improve livelihoods by empowering women. The information gathered through this process is important for our project because we can use this to study the problems that are faced by the women in the community such as domestic violence, and the roles of women in decision-making and income management.

Introduction

 

My name is Pardis Lakzadeh and Im a graduate from the Faculty of Integrated Sciences in the area of Human Nutrition and Immunology. My focus was on understanding the impact of Nutrition on overall health and more specifically the relationship between nutrients and the immune system. I was first introduced to this area of research in FNH 355 International Nutrition, taught by Judy McLean herself! I was immediately taken in by the complexity of the problems surrounding nutrition globally, and was very impressed with the innovative solutions offered. This new found interest motivated me to follow up this course with FNH 455 Applied International Nutrition, and it was here that I first learned about Fish on Farms. I knew immediately that I would like to be involved and here I am 6 months later. Over the next few months together with Hellene Sarin I will be updating the blog posts and twitter account, to keep you updated on the exciting progress of Fish on Farms.

My name is Hellene Sarin and I will be working with Pardis Lakzadeh over the next few months. I am from Phnom Penh, and a fourth year student majoring in Natural Resources Conservation in the Faculty of Forestry at UBC. Building on my experience from last summer in Cambodia where I was involved in the research evaluation of a voucher program for reproductive health, through qualitative research that has a strong focus on gender analysis with FoF, I hope to gain a better understanding of the problems that surround nutrition issues in a developing country. I am also really excited to learn more about Participatory Rural Appraisal tools throughout the project and how the integration of aquaculture into homestead food production works to improve nutrition and livelihood of the people.

Baseline Gender Analysis

Tomorrow the Baseline Participatory Gender Analysis of Fish on Farms will begin. The purpose of this is to gain a better understanding of the role gender plays in mixed-farm livelihood systems. This process involves a number of Participatory Rural Appraisal (PRA) tools to collect the data. A participatory process is particularly important as it involves the community participants, who will be the agents of change,  to be engaged as co-investigators. The information gained here will be used to inform a “Gender Aware” behaviour change for the project.

More specifically the tools we will be looking at are:

1) Historical timeline of gender changes – to understand how gender roles have changed in recent years, what factors have made them change, and what community members think about these changes.

2) Bodymap (image of ideal husband/wife) – to illustrate behavioral expectations and images for men/women, and to identify the consequences for people who do not follow it.

3) Market and extension access – to understand different agriculture and aquaculture institutions and services in the community to which men and women have access.

4) Gender division of labour – to view how household management tasks are divided among household members, to understand men’s and women’s views about what constitutes “work’’ and to demonstrate a tool that will help community members assess their situation.

5) Fish preference ranking – to better understand categories and species of fish that men and women prefer for consumption and marketing. And to identify any food taboos associated with different fish species and to explore decisions to sell or to consume fish products.

6) Asset control and management – to understand how men, women, and elders have ownership and decision-making control over critical livelihood assets, and to understand how men and women define “control” over asset-related decisions.

7) Seasonal calendar matrix – to understand seasonal and gender patterns related to the production, sale and consumption of agriculture and horticulture products, and how decisions about sales and consumption are made.

8) Financial management and meanings of income controlto understand the diversity of sources of income from men, women, and other family members, and how different family members are involved in managing, saving, and making decisions about income.

9) Nutrition and coping strategies – to understand the relationship between food and health/well-being; how people try to maintain good health for the family; and how they cope when food supplies are low.

10) Key informant interview – to better understand community leadership opinions on gender issues, opportunities, and priorities in the community.

The implementing staff, comprising of the HKI and NGO field staff officers, were trained over the past week to administer the research exercises. The training was focused on conveying the concept and purpose behind each tool and questionnaire guide. Each tool was reviewed and practiced separately, through team work and participatory learning.

Since the quality of the research is dependent on the responses given, special emphasis was put on asking “probing questions”.  This style of questioning is of particular importance, since oftentimes there is a lot that we can learn by simply questioning the responses given, such as “why is that important?” Or “What happened as a result?”

With these skills at hand, the implementing staff are now equipped to facilitate an open dialogue to gain insight into the role gender plays in these communities. Over the next seven days the research will be paced to allow for a full day of data analysis in between each data collection day. This method allows for critical reflection of the findings and minimizes loss of detail.

Stay tuned for more on the Baseline Gender Analysis from our new students in the field (and authors of this post), Pardis Lakzadeh and Hellene Sarin!

Pond Construction

Pond construction has begun!

After many weeks spent in conference rooms and on field visits with the Fish on Farms aquaculture experts, the innovative fishpond design has been finalized and the first fishponds have been dug.

At the heart of the Fish on Farms project, is the novel approach to increase micronutrient intake by increasing household access to large and small fish species. Fish is one of the most commonly consumed animal source foods in Cambodia so the ability to increase access to fish and fish products should have a direct impact on family nutrition.

Currently, fishpond construction is underway throughout the four “Operational Districts” encompassing the FoF study area. Due to the difficult terrain, approximately 20% of the ponds are being dug by hand. Four excavation teams – locally hired construction companies with access to the necessary machinery – will dig the remaining 260 ponds over the coming weeks. Specially trained aquaculture experts from Helen Keller International and the local NGO are supervising the construction.

The design of the fishpond is key to the success of the project: the walls of the pond are sloped to ensure structural stability while maximizing the surface area of the water; the ponds are to be dug at least 10 meters from the household water source in order to prevent contamination of drinking water; and the site for the ponds must not be obstructed by large trees, so that the pond is exposed to sunlight and can maintain the correct nutrient balance.

It has been a particularly dry monsoon season in Prey Veng this year, which has allowed us to begin construction so late in the season. We’re hoping for a few more dry weeks until all 330 ponds are dug, followed by a few months of heavy rain to fill the ponds with water.

The aquaculture team is now working to determine the best ways to stock the ponds, and is sourcing fish fry and fingerlings. Striking a balance between the small nutrient-dense fish, which are most commonly eaten in poor, rural areas like those in Prey Veng province, and the large, valuable fish that can be sold in the market is an important consideration. More on that soon!

Blood Analysis: Part 2

Picking up from where we left off…

Once the blood arrived at the NIPHL from the field via the Blood Taxi, one of two things happened.

1. For the blood collected in the 4.5 mL tubes containing the EDTA:  a complete blood count (CBC) was conducted. This provides information on the total number of red blood cells, hemoglobin, white blood cells, and platelets present in a person’s bloodstream. The red portion undergoes gel electrophoresis  for hemoglobinopathy testing. This separates proteins in the blood so that the amount and type of hemoglobin can be determined. Low levels of hemoglobin indicate anemia.

2. For the blood collected in the 7 mL trace element free tube: the samples were prepped and sent to UBC. Researchers at UBC will be performing a serum analysis to trace ferritin, vitamin B12, folate, serum retinol (vitamin A) and carotenoids (another form of Vitamin A), and zinc. The data collected should provide us with a clear picture of how much iron, vitamin A, vitamin B12, folate, and zinc was present in a woman’s diet before and after we introduced HFP and aquaculture. These biochemical indicators will allow us to quantify some of the results of our intervention.

Here are some pictures I took in the lab:

Blood Analysis: Part 1

 As promised, I wrote about the “5Ws” of our blood collection: who, what, when, where, and why. I even threw in the “how”. Today’s post focuses on what happened in the field.

One of the most important (and expensive!) components of FoF is the blood collection and subsequent analysis. This process provides us with concrete evidence that there are more (or less) nutrients in a person’s body by looking at biochemical indicators of nutritional status. Obtaining this information is what sets FoF apart from previous homestead food production interventions.

During baseline blood was collected from 450 women. We will collect samples from the same 450 women during endline for a paired analysis. While we considered collecting blood from children as well, it was decided this would be too traumatic. Plus, we had other less-invasive methods available to assess whether or not children were anemic (finger-pricking to measure hemoglobin).

When we arrived in each village, a random lottery was held. Each house was assigned a number (1-10) and slips of paper with those numbers were randomly selected. In the end, we selected 5 women from each village. Women were given an ID number and asked to report to their local Health Center the day after our visit to their village.

The morning of collection, the local Village Health Volunteer (VHV) came with the women and their children to the Health Center. The VHV was responsible for making sure everyone who agreed to provide samples was present. Most mornings everyone was at the Health Center by 7:30 am, as they had to fast for a minimum of 3 hours before providing samples. When all the women assembled, they were briefed by Mr. Tee from HKI.

One at a time, the women entered a room where a technician was working. The technician drew 3 vials of blood. After, the women were given a sarong as a thank you for their participation.

Two of the vials collected were 4.5 mL test tubes containing Ethylenediaminetetraacetic acid(EDTA), which is an anticoagulant, that prevents blood from clotting. They were then packed on ice and transported via a car we dubbed the “Blood Taxi” to the National Institute of Public Health Laboratories (NIPHL) in Phnom Penh for further processing.

The third tube collected was a 7 mL trace element free tube. It was centrifuged in the field. This separated the blood into 3 components: the serum plasma, the buffy coat (most of the white blood cells and platelets), and the erythrocytes (red blood cells). The serum was packed on ice and sent to the NIPHL, where samples were stored at -70 degrees Celcius until the end of baseline.

Some pictures:

Check back tomorrow to find out what happened once the blood arrived at the NIPHL.

World Breastfeeding Week

This week is the 20th World Breastfeeding Week, an initiative started by the WHO (World Health Organization) and UNICEF (United Nations Children’s Fund) to promote breastfeeding, especially in developing countries. While New York City Mayor Bloomberg’s breastfeeding initiative, which was appropriately announced this week, has ignited a heated debate in Western media about a mother’s right to choose formula or breastfeeding, the situation is quite different in developing countries. (To read about Latch On NYC, check out the press release here.)

The benefits of breast milk cannot be overstated in developing countries (and developed too).

  • Breast milk is the only source of Immunoglobulin A, an antibody required to protect newborns from illness.
  • It is a guaranteed source of clean water.
  • Despite a mother’s nutritional status, it will always retain the proper balance of fat, protein, and other nutrients necessary to promote healthy growth in babies and infants, whereas mothers may end up watering down formula to make their supply last longer. Additionally, the fat and protein in breast milk are more easily absorbed than the nutrients in formula, and breast milk is easier for the baby’s sensitive gastrointestinal tract to handle.
  • The iron in breast milk is more readily absorbed than the iron in cow’s milk or formula (50% versus 10%).
  • It’s free!

There are numerous benefits to the mother as well, but I’m only focusing on the nutritional and immunological benefits to children right now.

Formula companies may send representatives to developing countries to promote their product and distribute free samples to new mothers, even though this has been declared illegal by the WHO in a document referred to as “The Code” (The International Code of Marketing of Breast-Milk Substitutes – you can read it here). The problem is that once the mothers go home, they often cannot afford to buy more formula, but they are no longer producing enough milk since they have been feeding their babies formula. In 2012, most (if not all) formula companies ignore The Code; hence the need for World Breastfeeding Week.

Cambodia has the highest rate of mortality for children under 5 in Southeast Asia due to malnutrition and associated illnesses (such as diarrhea and respiratory infections). This is why nutrition education is an important component of FoF. Our baseline survey’s module on knowledge and attitudes should help us identify what information women are lacking so that we can provide them with the tools to help their children. We will also be incorporating the country’s current complementary feeding strategy, which educates parents on how and when to start adding nutritious foods to a breast milk diet. The Phnom Penh Post published an informative article about this two months ago (you can find it here). The WHO recommends that women should breastfeed exclusively until 6 months of age, and then start introducing foods while continuing to breastfeed until their child is at least 2 years old.

The theme of this year’s World Breastfeeding Week in Cambodia is “Baby needs mom made, not man made“. This slogan has been printed on t-shirts and banners to promote the message. In addition, there will be a round-table discussion on the dangers of bottle feeding, a radio call-in program for women to ask questions related to bottle feeding, press releases in local papers and TV spots promoting this year’s theme.

For more information about World Breastfeeding Week, check out the World Breastfeeding Website.

Anthropometry: Height and Weight

Module 8 takes note of other measurements as well. These include height or length (if a child is < 85 cm, measuring their length provides a more accurate measurement) and weight. Since the focus of FoF is to eliminate “hidden hunger”, these measurements provide us with a lot of information about the nutritional status of the women and children we’re meeting. A woman or child may look healthy enough – their bones won’t be visible, or their bellies won’t be swollen (indicators of Marasmus and Kwashiorkor, both of which are types of severe acute malnutrition, or SAM). However, when we have their height/length, weight and age, we can use this information to compare them to healthy individuals of the same age and gender to get a better picture of their health.

There are three indicators that we use:

  1. Height/length for age – when we know a person’s height and their age, we can compare them to the average height for a healthy individual of the same age and gender. If the person is significantly short for his or her age, we call this stunting. It is a sign of chronic malnutrition.
  2. Weight for height – we can use an adult’s weight and height to calculate their body mass index, or BMI. A healthy BMI is anywhere from 18.5-24.9. Anything below 18.5 means a person is malnourished. In children, we compare their weight to the weight of a healthy reference child of the same height. If the child is significantly lighter than the reference child, we call this wasting, which indicates acute malnutrition.
  3. Weight for age – when we know a person’s weight and their age, we can compare them to the average weight for their age and gender group. If the person is light for his or her age, he/she is considered to be underweight.

Here are some pictures from the field.

 

Anthropometry: MUAC

Module 8 of the survey is Anthropometry and Hemoglobin. One of the measurements we take is the mid-upper arm circumference (aka the MUAC). The MUAC is generally regarded as an accurate assessment of nutritional status in adults and children. Also, it’s easy to do in the field.

There are two steps to taking a MUAC measurement. The first involves measuring the length of the upper arm to determine the mid-point of the upper arm. The second is to wrap a band around that point to measure the circumference.

The band tells us two things:

  1. The MUAC in centimetres, and
  2. What degree of malnutrition an individual has, if any. This is possible because the band is divided into three coloured segments that indicate whether an individual is well-nourished (green), suffering from moderate acute malnutrition (MAM) (yellow), or suffering from severe acute malnutrition (SAM) (red).  In children, these divisions are based on how many standard deviations a person’s MUAC is from the mean, which is 13.0 cm. In adults, the cutoffs are 18.5 cm for moderate undernutrition, and < 16.5 cm for severe undernutrition.

Here are some pictures that demonstrate the process. Enjoy!

 

Baseline: Day 14 (VMF)

This afternoon our anthropometry and hemoglobin analysis stations were set up at the home of a Village Model Farm (VMF). I was really excited because I hadn’t seen a VMF yet, AND because our VMF concept just received press as of yesterday! (Click here to read an article about FoF in the New Agriculturalist) I had the chance to speak with the VMF representative in the village of Svay Trai, and thought I would share what I learned on the blog.

The backstory: Sophal Eab used to be a wedding stylist, but when her children were old enough to attend school, she needed a job that required less travel. When the opportunity to have the VMF in her village arose, she took it. Until her farm is up and running, she sells corn for income. She purchases 500 ears of corn for $40 USD from her local market (160,000 Riel at 320 Riel/ear). She then boils all of the corn and sells it from a stand in front of her house for 500 Riel per ear (sometimes she has to sell it for less if it’s not good quality corn). Taking the cost of fuel into account, she makes roughly 100 Riel per ear, leaving her with a profit margin of anywhere from  50,000 Riel ($12.5 USD) per day to 100,000 Riel ($25 USD) per day depending on the quality of the corn available at the market.

Sophal's corn stand.

A happy customer!

Making the most of leftovers.

Sophal has already impressed FoF with her dedication. Within one month she has raised the height of the land on her property to better support the beds needed to grow fruit and vegetables. She purchased wire and sourced local bamboo to make a fence to keep animals off of her farm. She also bought mango seeds so she could start growing mangoes. Luckily, she already had a fishpond, but she is considering expanding it. FoF will provide her with other seeds for her farm and fingerlings (small fish) for her pond. For now, all she knows is that she has to grow a variety of fruit and vegetables and follow the guidelines given to her by HKI and FoF, but she is looking forward to her training. She hopes to grow enough of her own corn so that she can increase the profit margin of her corn stand by not having to purchase corn from the market.

The back of Sophal's farm.

Facing Sophal's house from the back of the farm.

The fishpond that was already at Sophal's house.

The new fence is working out quite well!

The VMF will play a very important role in FoF. Each village will have a VMF, and the VMFs in the aquaculture villages will also have a fishpond. The VMF representative will be a woman who receives training and inputs as part of our intervention. She will learn about homestead food production (HFP), aquaculture, and sustainable agricultural practices. There will be a marketing component to her training that will include information on how to plan the planting and harvesting of crops according to the seasons (of which there are 2 here – wet and dry), how to price crops, how to pick a good market to sell her produce, and how to form a marketing group to share information with VMF representatives from other villages. For instance, the marketing group may discourage women from growing morning glory (a common leafy green vegetable here) because it can be grown anywhere and with little input, so it doesn’t fetch a good price at the market. There will also be gender-specific training, as one of our goals is to empower women by improving both their health and their opportunities for income. The VMF representative will teach the FoF households in her village how to use their new farms and fishponds. Her knowledge will be e a local resource for other households in the village. She will be monitored every 4 months by FoF to see how her farm, her fishpond, and her “students” (the other FoF households in her village) are doing.

There is also a nutrition education component of our project that is being carried out by Village Health Volunteers (VHVs). The details, however, are another story for another day.