Annex 1 Mycnsia Baseline Survey Report PDF

Baseline Survey for the Maternal and Young
Child Security Initiative (MYCNSIA) in Lao

People’s Democratic Republic, 2012
National Institute of Public Health

Department of Hygiene & Health Promotion, Ministry of Health
UNICEF/Laos, European Union
With technical assistance from the Global Center for Integrated Health
of Women, Adolescents, and Children/University of Washington
Report of the Baseline Survey for the Maternal and
Young Child Security Initiative (EU-UNICEF
MYCNSIA) in Lao PDR, 2012
TABLE OF CONTENTS
List of Tables .....................................................................................................................................iv

Executive Summary...........................................................................................................................vi
Section 1 Introduction: Background on Nutritional Status and Infant and Young Child Feeding .........1
1.1. General background...................................................................................................................... 1
1.2. First 1,000 Days ............................................................................................................................. 1
1.3. Nutritional Status .......................................................................................................................... 1
1.4. Infant and Young Child Feeding .................................................................................................... 3
1.5. Description of EU-UNICEF MYCNSIA Program and IYCF Interventions ......................................... 3
Section 2 Methodology ...................................................................................................................7
2.1. Objectives for the baseline survey ................................................................................................ 7
2.2. Background of LSIS and EU-UNICEF MYCNSIA surveys ................................................................. 7
2.3. Sampling design ............................................................................................................................ 8
2.4. Field team composition ................................................................................................................ 9
2.5. Core indicators ............................................................................................................................ 10
a) Nutritional status ........................................................................................................................ 10
b) Anemia ........................................................................................................................................ 11
c) Infant and young child feeding (IYCF) ......................................................................................... 11
d) Inputs (coverage of key program interventions) ........................................................................ 13
2.6. Data entry and data analysis ....................................................................................................... 14
Section 3 Basic Demographics .......................................................................................................15
Section 4 Infant and Young Child Feeding Practices (Children 0-35 months) ...................................17
4.1. Breastfeeding Practices - Early initiation of breastfeeding......................................................... 17
4.2. Exclusive and Predominant breastfeeding (children under 6 months of age) ........................... 18
4.3. Continued breastfeeding at 1 year and 2 years of age ............................................................... 19
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4.4. Age-appropriate breastfeeding (0-23 months of age) ................................................................ 20
4.5. Bottle feeding (0-23 months of age) ........................................................................................... 21
4.6. Introduction of Solid, semi-solid or soft foods ........................................................................... 22
4.7. Minimum Dietary Diversity (MDD) ............................................................................................. 24
4.8. Minimum Meal Frequency .......................................................................................................... 27
4.9. Minimum Acceptable Diet (6-23 months) .................................................................................. 29
4.10. Consumption of Iron Rich Foods ............................................................................................. 30
4.11. Key Findings ............................................................................................................................ 32
Section 5 Nutritional Status ..........................................................................................................35
5.1. Key Findings ................................................................................................................................ 38
Section 6 Anemia .........................................................................................................................39
6.1. Childhood Anemia....................................................................................................................... 39
6.2. Maternal Anemia ........................................................................................................................ 41
6.3. Key Findings ................................................................................................................................ 42
Section 7: IYCF Programs and Interventions ......................................................................................44
7.1. Interventions targeted to mothers ............................................................................................. 44
7.2. Interventions targeted to children.............................................................................................. 47
7.3. Key Findings ................................................................................................................................ 53
Section 8: Feeding Program for Children with Acute Undernutrition ..................................................56
8.1. Screening and enrollment in feeding programs ......................................................................... 56
8.2. Receipt of Supplementary and Therapeutic Foods..................................................................... 59
8.3. Key Findings ................................................................................................................................ 62
Section 9: Food Security ...................................................................................................................64
9.1. Receipt of Conditional Food/Cash Grants and Frequency of Food Consumption in Last Week. 72
9.2. Household Food Consumption in Last Week and Food Sources ................................................ 64
9.3. Coping Strategies to manage Food insecurity ............................................................................ 72
9.4. Seasonality of Food Insecurity .................................................................................................... 76
9.5. Key Findings ................................................................................................................................ 78
Section 10: WASH ............................................................................................................................80
10.1. Key Findings ............................................................................................................................ 83
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LIST OF TABLES
Figure 1.1. Map of Lao PDR and area of EU-UNICEF MYCNSIA programs ............................................ 4
Figure 1.2. Conceptual Framework for EU-UNICEF MYCNSIA .............................................................. 6
Figure 4.1. Infant feeding practices by age ......................................................................................... 24
Figure 4.2. Consumption of foods by age (in the prior day) .............................................................. 26
Figure 9.1. Patterns of Food Consumption – Average days of consumption by FCS score ................ 66
Figure 9.2. Patterns of Food Consumption – Weekly consumption by FCS score .............................. 67
Figure 9.3. Seasonality of Food Insecurity .......................................................................................... 78
Table 2.1. Key Variables in the LSIS and EU-UNICEF MYCNSIA Surveys .............................................. 8
Table 2.2. Linking between EU-UNICEF MYCNSIA and LSIS files ......................................................... 9
Table 2.3. Severity of Stunting at Population level ........................................................................... 11
Table 2.4. WHO Reference Levels for Hemoglobin as Indicator of Anemia ...................................... 11
Table 2.5. IYCF Indicators, Definitions, and Survey source ............................................................... 12
Table 2.6. Recommended Nutrient Intake (RNI) of each Micronutrient per dose for Children 6-59
Months Old, included in MixMe ....................................................................................... 13
Table 3.1. Basic Demographic Profile of Children, age 0-59.9 months of age, weighted sample sizes)
.......................................................................................................................................... 15
Table 3.2. Demographic Profile of Merged data – by Province......................................................... 16
Table 4.1. Early Initiation of Breastfeeding ....................................................................................... 17
Table 4.2. Breastfeeding patterns for children.................................................................................. 19
Table 4.3. Age-appropriate breastfeeding ........................................................................................ 21
Table 4.4 . Bottle feeding ................................................................................................................... 22
Table 4.5. Infants age 6-8 months who received solid, semi-solid or soft foods during the previous
day..................................................................................................................................... 23
Table 4.6. Dietary Diversity: Children 6-23 months who received the minimum daily dietary
diversity of food groups during previous day ................................................................... 25
Table 4.7. Minimum meal frequency: Children age 6-23 months fed solid, semi-solid, or soft foods
(and milk feeds for non-breastfeeding children) the minimum number of times or more
during the previous day, by breastfeeding status ............................................................ 28
Table 4.8. Minimum acceptable diet - Percentage children age 6-23 months who received
minimum dietary diversity and fed the minimum number of times, according to
breastfeeding status ......................................................................................................... 30
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Table 4.9 . Iron-rich Foods - Percentage of children 6-23 months fed iron-rich foods, special iron-
fortified foods, and foods fortified at home with iron (MIXME) during previous day ..... 31
Table 5.1. Nutritional Status – Weight for age (Ages 0-59 months) ................................................. 35
Table 5.2. Nutritional Status – Height for age (Ages 0-59 months) .................................................. 36
Table 5.3. Nutritional Status – Weight for height (Ages 0-59 months) ............................................ 37
Table 6.1. Prevalence of Anemia in Children (Aged 6 - 59 months) ................................................. 39
Table 6.2. Prevalence of Anemia in Children (Aged 6 – 35 months) ................................................ 40
Table 6.3. Prevalence of Anemia among Pregnant or Lactating Women.......................................... 42
Table 7.1. Women Currently Pregnant or Lactating - Receiving Supplementation .......................... 45
Table 7.2. Women Currently Pregnant or Lactating - Receiving Supplementation – by status of
health service delivery ...................................................................................................... 46
Table 7.3. MixME Knowledge and Consumption .............................................................................. 48
Table 7.4. MixME Knowledge - Number of Sachets to Consume ...................................................... 49
Table 7.5. MixME Knowledge – Reasons for providing MixMe amongst respondent who had
provided MixMe to their children..................................................................................... 50
Table 7.6. Observed Negative Effects of MixME Consumption......................................................... 52
Table 7.7. Observed Positive Effects of MixME Consumption .......................................................... 55
Table 8.1 . Screening and Enrollment in Feeding Programs ............................................................... 57
Table 8.2. Supplementary and Therapeutic Foods ............................................................................ 60
Table 8.3 . Supplementary and Therapeutic Foods ............................................................................ 61
Table 9.1. Household Food Security – Food Consumption Score ..................................................... 65
Table 9.2. Household Food Consumption –Mean Weekly Consumption ......................................... 69
Table 9.3. Household Food Consumption – % Consumption in last week and Source of food items
.......................................................................................................................................... 70
Table 9.4. Household Food Consumption – % Consumption in last week and Source of food items
(con’t) ............................................................................................................................... 71
Table 9.5. Household Food Security – Receipt of Cash/Food in last six months............................... 73
Table 9.6. Food Insecurity and Coping Strategies ............................................................................. 75
Table 9.7. Seasonality of Food Insecurity .......................................................................................... 77
Table 10.1. Percentage of household population by drinking water and sanitation ladders ............. 81
Table 10.2. Disposal of child feces ....................................................................................................... 82
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EXECUTIVE SUMMARY
The objective of the EU-UNICEF MYCNSIA survey was to provide robust baseline estimates on key
indicators of health and nutritional status, as well as of current participation in IYCF and nutrition
interventions for women and children in the three target provinces (Attapeu, Saravane and Sekong) in
Lao People's Democratic Republic. The EU-UNICEF MYCNSIA baseline combined data from two different
sources, the National Lao Social Indicator Survey (LSIS) and a supplementary EU-UNICEF MYCNSIA ‘add-
on’ survey, both conducted between October 2011 and February 2012. The survey provides critical
baseline estimates of key IYCF practices, as well as key determinants of adherence and participation in
maternal, infant and child nutrition interventions. These data help to inform the strategy of the EU-
UNICEF MYCNSIA Program and provide benchmarks to track progress.
More than half of the mothers in the EU-UNICEF MYCNSIA provinces initiated breastfeeding within one
hour of delivery (51.7%), while the proportion of infants under 6 months of age exclusive breastfeeding
was slightly lower (36.5%) than the national average (40.4%). Saravane had the lowest proportion of
mothers who exclusively breastfed their infants (28.0 %), while Sekong had the highest (62.3%). Only
40.1% of children less than two years of age from the EU-UNICEF MYCNSIA provinces were appropriately
breastfed, based on WHO criteria. Just over half of the children received solid, semi-solid or soft foods
in the EU-UNICEF MYCNSIA provinces (51.7%) at six months of age, although only 10.3% children
consumed a diet with adequate diversity.
The prevalence of undernutrition was higher in EU-UNICEF MYCNSIA Provinces than the country as a
whole: 40.8% underweight, 53.8% stunting, 8.7% wasting - compared to national figures of 26.6%, 44.2%
and 5.9% respectively. The prevalence of stunting peaked among children at age 24 months and did not
increase significantly, suggesting that the factors leading to chronic undernutrition take place prior to
birth and in the first two years of life. Anemia prevalence among children 6-35 months of age was
41.7%, while the prevalence of anemia for children aged 6-59 months was 33.8%. While almost two-
thirds of children 6-11 months were anemic (62.8%), the levels were considerably lower for older
children. The survey revealed 33.0% of pregnant and lactating mothers to be anemic.
The survey suggested that there was some penetration of messages and awareness about the
importance and safety of MixMe (micronutrient powders sprinkled on porridge and other cereals) as a
safe product for children, although in-depth understanding of the MixMe was weak. Overall, 60% of
caregivers had heard of MixME. Of those who had heard of MixME, 53.4% had received it and about
two-thirds correctly identified one MixME sachet as the proper dose to consume daily. More than half of
caregivers did not know the reasons for giving MixME to their children. Over 30% of caregivers reported
that no negative effects were observed among children consuming MixME.
The EU-UNICEF MYCNSIA survey results highlighted inconsistencies in the screening and targeting of
eligible undernourished children for enrollment in feeding programs, and revealed specific areas to
target for improvement. Overall, 37.3% of children were assessed and screened for malnutrition in the
previous four months. Attapeu reported the highest screening coverage of the three provinces, with
more than half of children screened (57.7%)... Low use of MUAC tapes in the younger children under 12
months of age (44.4%) compared to children 24-35 months of age (82.6%) suggests an operational
bottleneck that should be addressed. Only 31.3% of moderately wasted children, the target group, were
enrolled in a supplementary feeding program. Of children moderately wasted, over half (58.6%) were
not enrolled in any program, while one-third (33.5%) of severely wasted children were not enrolled in
any program.
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The EU-UNICEF MYCNSIA used several key indicators to capture key dimensions in household food
insecurity, including Food consumption scores (FCS), Coping strategy index (CSI), and seasonality of food
shortages. The overall mean FCS was 48.3 (S.D. 16.4), with 5.1% of households classified as having poor
food security (FCS < 21), 17.1% with borderline food security (FCS 21.5-35) and 77.8% with acceptable
food security (FCS > 35). Sekong had a much higher percentage of households classified with poor food
security (14.0%) and borderline (30.2%) than the other two. Rice was consumed daily in all provinces,
and across all levels of food insecurity from poor to acceptable. However, the relative proportion of
meat and fish consumption was reduced among those households with poor food security. Less than
one in ten households (9.6%) received cash or food to attend a health facility in the past 6 months.
Overall, a quarter of households reported having inadequate food or money to buy food in the past
month (24.0%), which closely tracked the proportion of households classified with a high CSI (28.3%).
The most common strategies for coping with food shortages reported by households was to limit the
portion size at meal times (49.8%), followed by borrowing food or receiving help from friends or
relatives (41.4%), or reducing the number of meals eaten (40.2%). Over half of all households in the
survey (51.4%) reported to have inadequate food to meet their families’ needs at some point in the
previous 12 months. The months with the highest proportion of households reporting food shortage
were September (73.9%), August (64.8%) and October (54.2%). The months with the lowest frequency
of food shortage were January (7.4%), February (8.2%) and December (8.9%).
Less than one in eight households used both an improved drinking water source and adequate
sanitation facilities (12.4%). Nearly 4 in 10 households used an unimproved source of drinking water,
putting them at high risk of exposure to water-borne pathogens. There was very low use of improved
sanitation, with only 15.2% of all households having access to and using facilities to dispose of feces.
Over the next few years, a series of innovative interventions will be strengthened and accelerated to
improve the nutritional well-being of mothers, infants and children as part of the EU-UNICEF MYCNSIA
program. It is anticipated that an endline survey will be carried out in order to assess the progress and
performance of the program. Changes and improvements will be measured using the initial benchmarks
provided in this baseline report.
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SECTION 1 INTRODUCTION: BACKGROUND ON NUTRITIONAL STATUS AND INFANT AND
YOUNG CHILD FEEDING
1.1. General background

This report presents data from the Maternal and Young Child Security in Asia (EU-UNICEF MYCNSIA)
Baseline Survey in Lao People’s Democratic Republic (Lao PDR). The baseline survey combines data
collected from the Lao Social Indicator Survey LSIS (MICS/DHS) carried out in 2011-12 by the
Ministry of Health (MoH) and Lao Statistics Bureau (LSB), together with supplemental data
collected as part of an ‘add-on’ survey in three Provinces targeted for the implementation of the
EU-UNICEF MYCNSIA Program. Taken together, the data from these two sources provide robust
estimates of the current nutritional status, infant and young child feeding (IYCF) practices and other
critical characteristics to reflect the baseline condition in the three EU-UNICEF MYCNSIA Provinces.
1.2. First 1,000 Days
A major focus of the EU-UNICEF MYCNSIA Project is to develop and implement innovative
interventions to improve maternal and child nutrition during the greatest period of vulnerability;
namely, the ‘first 1,000 days’ of life from conception, through pregnancy, infancy and early
childhood for the first two years of a child’s life. This early period in life is critical for healthy
cognitive, mental, and physical development. Adequate nutrition during this period helps ensure
proper development and plays a significant role in lifelong health outcomes. Inadequate nutrition
during these first months can result in irreversible damage, limiting the ability of a child to achieve
his or her full potential. These adverse outcomes, which can begin before birth, may include
delayed neurological and cognitive development, reduced mental capacity, reduced school
performance and working capacity, and overall increased susceptibility to infections and diseases.
An undernourished child has an increased risk of dying from diarrhea, measles, malaria and
pneumonia. The first 1,000 days is often called the ‘window of opportunity’ because of the
profound effect nutritional practices can have on the developing child and that damage sustained
during this period is often permanent 1.
1.3. Nutritional Status
Undernutrition has long been a major public health burden in Lao PDR, disproportionately affecting
women and children. Weight at birth is a proxy for both maternal health and an infant’s future
health. In the developing world, low birth weight (less than 2500 grams) is generally a result of
poor maternal health and nutrition, which stems from poor nutrition during pregnancy, as well as
poor nutritional status prior to becoming pregnant. Children born with a low birth weight (LBW)
face many immediate and long-term health challenges. These include an increased risk of child
mortality, as well as an increased likelihood of developing diabetes and heart disease later in life 2.
1
J. Bryce, D. Coitinho, I. Darnton-Hill, et al, for the Maternal and Child Undernutrition Study Group.
“Maternal and child undernutrition: Effective action at national level”. Lancet (2008) 371:510–26
2
Victora, C.G., Adair, L., Fali, C. et al. Maternal and child undernutrition: consequences for adult
health and human capital. Lancet (2008) 371(9609): 340–357.
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In Lao PDR, 15% of infants are born with a LBW 3. This problem is greatest in the south where one in
five infants is born with LBW, as compared to 13% in the north (LSIS, 2012). Interventions focused
on improving maternal health and nutrition can lead to better birth outcomes, and decrease the
prevalence of LBW, helping to ensure that infants start life with the full potential to achieve their
optimal state of well-being.
Although data from 2006 to 2011 shows that the prevalence of undernutrition has declined, the
progress is not on track for achieving the nutrition-related target of Millennium Development Goal
1, particularly as the population continues to grow at a fast pace. The prevalence of stunting, based
on WHO growth standards, throughout the country is high with an estimated prevalence of 44%
among children under five years of age, indicating widespread chronic undernutrition (LSIS, 2012).
Overall, the prevalence of stunting has declined slightly from 48% in 2006, but striking variations
are seen across provinces (UNICEF, 2013). The highest proportion of stunting is found among
children from Sekong where more than six out of ten children are stunted (LSIS, 2012).
Throughout the country, the prevalence of underweight is 27% (LSIS, 2012), which is a small decline
from the level observed in 2006 (31%) (MICS3 & NNS, 2006). Children from southern provinces
have higher levels of underweight than those from central and northern Lao PDR. Sekong has the
highest prevalence of underweight children, with nearly half of the children under five being
underweight (46.0%).
Data from 2012 showed that the overall proportion of children with wasting was 5.9%, holding
steady from 2006 figures of 7.4% (MICS3 & NNS, 2006) which indicates little improvement in acute
malnutrition. Although the highest level of wasting was found in Luangnamtha, a northern
province, Attapeu had the second highest level of wasting in the country with a prevalence of
10.6% (LSIS, 2012). Again, southern provinces had higher prevalence of wasting in comparison to
central and northern areas. Stunting and underweight disproportionately affect children of
mothers with lower educational levels and poorer wealth status. When improvements in nutrition
are stratified by wealth quintile, most progress in nutrition is seen to have occurred among the
wealthier groups with little change in the poorer quintiles (LSIS, 2012). The high prevalence of
undernutrition among these poor communities during the first two years of life confirms the
importance of focusing interventions on the early period of life.
Anemia is the most common nutritional deficiency worldwide and predominately found in middle
and low income countries 4. For pregnant women, infants, and adolescents in developing countries,
the main cause of anemia is iron deficiency 5. The latest data on anemia in Lao PDR are from the
2006 MICS survey. The prevalence of anaemia in children under five at that time was 41% ((MICS3
& NNS, 2006). Data on the prevalence of anemia for children were not available until the EU-
3
Ministry of Health and Lao Statistics Bureau. “2012. Lao Social Indicator Survey 2011-12, Final
Report.” Vientiane, Lao PDR: Ministry of Health and Lao Statistics Bureau
4
McLean E, Cogswell M, Egli I, Wojdyla D, de Benoist B. Worldwide prevalence of anaemia, WHO
Vitamin and Mineral Nutrition Information System, 1993-2005. Public Health Nutr. 2009
Apr;12(4):444-54.
5
World Health Organization. Prevention and control of iron-deficiency anaemia in women and
children. Report of the UNICEF/WHO regional consultation, Geneva, Switzerland, 3-5 February
1999.

UNICEF MYCNSIA baseline survey (presented in this report). A high burden of anaemia represents a
severe public health problem and one in which interventions focused on increasing iron-rich food
consumption during the first years of life can have a significant impact (WHO, 2001).
1.4. Infant and Young Child Feeding
At the core of the EU-UNICEF MYCNSIA program is an improvement in infant and young child
feeding practices (IYCF). Both exclusive and early initiation of breastfeeding promotes the health of
an infant, and these are recognized as some of the most cost-effective interventions to reduce the
overall burden of disease in a population. During the first few months of life, breast milk provides
all of the nutrients necessary for development. Infants who are exclusively breastfed through six
months of age have lower mortality from childhood illnesses such as pneumonia and diarrhea, and
rebound quicker from periods of sickness 6 7 8 9. Colostrum, the first milk expressed after delivery, is
rich in nutrients and antibodies. The high concentration of nutrients and antibodies found in
colostrum enables delivery in a low-volume form, which is essential because of the small size of a
newborn’s digestive system. Early initiation of breastfeeding, which the WHO defines as within one
hour of birth, guarantees that newborns receive this nutrient-rich liquid (WHO, 2001). Adherence
to this practice ensures that maternal antibodies are passed to the infant protecting the newborn
from illnesses and reducing infant mortality. Early initiation of breastfeeding has also been linked to
longer duration of breastfeeding.
In Lao PDR, both exclusive and early initiation of breastfeeding practices have shown some recent
improvement. In the five-year period between 2006 and 2011, there has been an increase from 26
to 40% in exclusive breastfeeding and from 30 to 39% in early initiation of breastfeeding (UNICEF,
2013). While this trend is positive, the use of infant formula more than tripled during the same
time, which is particularly worrisome given that formula-fed infants are two times more likely to
suffer from diarrhea (LSIS, 2012). Continued breastfeeding at both one year and two years of age
has declined in the period between 2006 and2011. In 2006, 82% of children were still breastfeeding
at one year of age, but this number had fallen to 73% by 2011 (UNICEF, 2013). For children two
years of age, there was a decline from 48 to 40% of these children who were still breastfeeding
(UNICEF, 2013). This report provides updates to these figures and elaborates on some of the
factors that influence IYCF practices in the three EU-UNICEF MYCNSIA Provinces.
1.5. Description of EU-UNICEF MYCNSIA Program and IYCF Interventions
The European Union (EU) is supporting the Maternal and Young Child Nutrition Security in Asia (EU-
UNICEF MYCNSIA) Program in five countries: Bangladesh, Indonesia, Lao PDR, Nepal, and the
Philippines. The four-year EU-UNICEF MYCNSIA was initiated in Lao PDR in 2011 and aims to
6
R. Feachem & M. Koblinsky. “Interventions for the control of diarrhoeal diseases among young
children.” Bull WHO (1984) 62(2) : 271-91
7
C. Victoria et al. “Evidence for protection by breast-feeding against infant deaths from infectious
diseases in Brazil.” Lancet (1987) 8(8554) 319-22
8
S. Arifeen, R.E. Black, G. Antelman, A. Baqui, L. Caulfield, and S. Becker. “Exclusive breastfeeding
reduces acute respiratory infection and diarrhea deaths among infants in Dhaka slums”. Pediatrics.
(2001) 108(4) 67-71.
9
C.J. Chantry, C.R. Howard and P. Auinger. “Full breastfeeding duration and associated decrease in
respiratory tract infection in US children.” Pediatrics. (2006) 117(2); 425-432.

strengthen the National Plan of Action for Nutrition (NPAN) to improve child survival, growth and
development through nutrition security interventions.
Figure 1.1: Map of Lao PDR and area of EU-UNICEF MYCNSIA programs
In July 2011, the Ministry of Health
(MoH) endorsed the EU-UNICEF
MYCNSIA Program, which was
subsequently followed by several
high-level policy meetings, which put
in place a number of important
regulatory decisions. In that same
year, guidelines for the treatment of
diarrhea with zinc and ORS were
incorporated into National IYCF
Guidelines. As of May, 2012, National
IYCF Guidelines were finalized and
submitted to the MoH for approval,
and later that year , a first draft of
the IYCF community-based package
was completed including
implementation guidelines, training
modules, supervision and monitoring
tools, and suggested communication
materials for village-level workers.
The package was developed in
collaboration with government and
nongovernmental organizations and
also contains recommendations for maternal nutrition and water, sanitation and hygiene (WASH)
practices. In this context, UNICEF continues to advocate for a legal framework on the marketing of
breast-milk substitutes in Lao PDR.
The EU-UNICEF MYCNSIA is being implemented in three provinces located in southern Lao PDR that
have a high burden of undernutrition, namely Attapeu, Saravane and Sekong (see Figure 1). These
provinces are located in a part of the country that is rugged and remote, and marked by poor road
infrastructure. Saravane shares a border with Thailand on its western side and almost half of the
province is covered by natural forest. Attapeu shares its borders with both Cambodia and Vietnam.
Sekong borders Vietnam to the west and encompasses several sizeable mountains throughout the
region. The smallest province by population and the second smallest by area, Sekong, is the most
ethnically diverse in the country and also, one of the poorest 10.
The EU-UNICEF MYCNSIA Program focuses on a life-cycle approach, targeting the ‘Window of
Opportunity’, from pregnancy to 24 months, and intends to reduce stunting among children and
reduce anemia among young children and women of reproductive age. The initiative is organized
around four areas of action, or ‘pillars”:
10
Epprecht, M., Minot, N., Dewina, R., Messerli, P., and Heinimann, A. (2008). The Geography of
Poverty and Inequality in the Lao PDR. Geographica Bernensia, Bern.

Pillar 1: Up-stream Policy and Nutrition Security Awareness
Pillar 2: Capacity Building
Pillar 3: Data Analysis and Knowledge Sharing
Pillar 4: Scaling Up Interventions
Within each of these Pillars, there are a number of planned activities and anticipated outputs (EU-
UNICEF MYCNSIA, 2010). The focus of the baseline survey was to provide estimates on the status of
many of these outputs. For example, the survey provides estimates on the current status of health
workers training to support IYCF, Micronutrient powder (MNP) distribution, and treatment of
diarrhea that are within Pillar 2. This survey itself represents a major deliverable against Pillar 3,
while the ongoing tracking of interventions that are being scaled up for Pillar 4 include key
performance indicators of program coverage for IYCF activities, Vitamin A capsules and deworming
distribution.
Figure 1.2 illustrates the conceptual model that constitutes the framework for the EU-UNICEF
MYCNSIA program. As depicted in the model, child malnutrition stems from many different factors
categorized by proximity of their impact on the nutritional status of an individual child. The
immediate causes which directly affect child malnutrition result from poor dietary intake among
mothers and children, and high incidence and severity of maternal and child infections. Underlying
causes of child malnutrition take place at the community level and encompass food security,
medical and environmental health services, and infrastructure improvements including roads in
rural areas and poverty reduction as part of social protection programs. High impact interventions
are available to address these causes, such as the promotion of infant and young child feeding
practices, nutritional supplementation, and the treatment of infectious diseases, which if delivered
at scale will reduce rates of stunting and young child mortality 11. In order to have a significant and
sustainable impact on child nutrition, ‘nutrition-specific’ interventions should be complimented by
‘nutrition-sensitive’ interventions, such as maternal and childcare practices, and increased access
and use of adequate toilets and improved hygiene. The EU-UNICEF MYCNSIA takes a broad view
and encompasses many of these interventions and approaches in developing a long-term strategy
to eliminate chronic undernutrition.
The baseline survey provides estimates against several key determinants of stunting depicting in
this conceptual model. Section 4 provides data on the key infant and young child feeding practices,
their prevalence and characteristics of mothers and children implementing appropriate IYCF
behaviors. Sections 5 and 6 present data on the current status of undernutrition among children
below 5 years of age, and the prevalence of anemia among both children and mothers. Section 7
offers a comprehensive description of the current reach and participation of EU-UNICEF MYCNSIA
interventions, beginning with those targeting women during pregnancy followed by activities
focused on the complimentary feeding period of children above six months of age. Section 8
describes the supplementary and therapeutic feeding programs in place to manage cases of acute
11
Bhutta ZA, Ahmed T, Black RE, et al. What works? Interventions for maternal and child undernutrition and
survival. Lancet (2008) 371(9610):417-40

undernutrition, while Section 9 summarizes the status of household food availability and food
security in the three EU-UNICEF MYCNSIA Provinces. Finally, Section 10 provides data on the
current status of water, sanitation and hygiene.
Figure 1.2. Conceptual Framework for EU-UNICEF MYCNSIA
A main focus of EU-UNICEF MYCNSIA is on the promotion of Infant and Young Child Feeding
practices. UNICEF and the Government of Lao PDR have adopted a phased intervention approach,
where communication messages are initially focused on a few selected behaviors at a given time.
To date, extensive trainings for health staff and community health workers have been undertaken
in order to increase knowledge and skills for the promotion of exclusive breastfeeding in the three
EU-UNICEF MYCNSIA provinces. Public media has also been used to transmit breastfeeding
messages, and in coordination with this campaign, the Lao Women’s Union (LWU) has conducted
breastfeeding outreach programs reaching an estimated 50% of the population.
In addition to breastfeeding promotion, health staff from Saravane and Attapeu have been trained
on multiple micronutrient supplementation of young children and diarrhea management with ORS
and zinc. Training has been provided to community health workers on MIXME distribution to help
with the delivery and monitoring of MNP. Furthermore, in Sekong not only were health staff
trained to identify, treat and manage severely malnourished children, managers also received
specific training to strengthen skills in monitoring and to provide supervisory support of the health
staff and volunteers.
Activities planned for 2013 include the implementation of the IYCF community-based package to
promote efforts to improve nutrition through the initiation of home-visits and small group
education sessions facilitated by LWU and health providers during health outreach visits. Although
breastfeeding is widespread throughout Lao PDR, the prevalence of exclusive and early initiation of
breastfeeding is below target levels. Mother Support Groups (MSG) are poised to commence in
which monthly meetings will provide feeding and care practice information to mothers with
specific support and education of caregivers on breastfeeding and complementary feeding
practices. UNICEF has created targets to reach 80 percent of caregivers with behavior change
messages focused on maternal, infant and young child nutrition, as well as hand washing and
hygiene practices, immunization and deworming.

SECTION 2 METHODOLOGY
2.1. Objectives for the baseline survey

The objective of the EU-UNICEF MYCNSIA survey, which was designed as a tag-on survey to the
Lao Social Indicator Survey (LSIS), was to provide robust baseline estimates on key indicators of
health and nutritional status, as well as of current participation in IYCF and nutrition interventions
for women and children in the target provinces (Attapeu, Saravane and Sekong).
Specific objectives were to:
• determine the prevalence of stunting among children under five in the target
provinces
• determine the prevalence of anemia among children under five and women 15-49
years in the target provinces
• provide estimates of infant and young child feeding practices for children 6-23 months
in the target provinces
• provide estimates of maternal diet and iron supplementation in pregnant and
lactating women
• apply the baseline information for eventual assessment of the impact of the EU-UNICEF
MYCNSIA interventions
2.2. Background of LSIS and EU-UNICEF MYCNSIA surveys
The EU-UNICEF MYCNSIA baseline combined data from two different sources, the National Lao
Social Indicator Survey (LSIS) and the supplementary EU-UNICEF MYCNSIA ‘add-on’ survey
conducted in three provinces, both conducted in October 2011 to February 2012. The LSIS was
implemented by the Ministry of Health and the Lao Statistical Bureau with support from UNICEF,
UNFPA, and multiple donors. The survey was based on the design of the Multiple Indicator Cluster
Survey (MICS), the Demographic and Health Survey (DHS) and the Lao Reproductive Health Survey
(LRHS). In the past, both the MICS and LRHS had been conducted at similar times and resulted in
inconsistent national figures. As such, the LSIS was an effort to coordinate and focus resources in
order to develop a single set of national figures for key social and health indicators. The LSIS was
conducted in all 17 provinces of the country, including Vientiane Capital. Four questionnaires were
developed for the survey in order to generate data for households, individual women (15-49 years),
individual men (15-49 years) and finally, for children under five years of age.
The Maternal and Young Child Nutrition Security Initiative in Asia (EU-UNICEF MYCNSIA) special
survey was designed as an ‘add-on’ to the LSIS and provided additional detail relevant to the EU-
UNICEF MYCNSIA Program for three target provinces. The EU-UNICEF MYCNSIA component was
designed by the National Institute of Public Health (NIOPH) and UNICEF in collaboration with the
MoH and Lao Statistical Bureau, and was conducted by provincial and district health departments
of the respective provinces at the same time as the LSIS. Although the LSIS collected some data on
IYCF practices, information that is more detailed was gathered as part of the EU-UNICEF MYCNSIA
special survey with a focus on the types of food eaten by children 6-23 months of age in order to
provide estimates of dietary diversity. Critical data were also collected on the knowledge and
practices of caregivers regarding complementary feeding and the use of both supplementary and
therapeutic foods for the management of acute undernutrition. The survey also gathered data on
maternal diet and meal frequency for women currently pregnant or lactating. In addition, a
household questionnaire focused on issues of food security. Finally, hemoglobin levels were
measured for a subsample of children 6 months to 5 years of age, and women 15-49 years.
The LSIS and EU-UNICEF MYCNSIA surveys were combined for the three target Provinces to provide
a comprehensive assessment of factors with direct relevance to the EU-UNICEF MYCNSIA Program.
Table 2.1 outlines the key variables in the EU-UNICEF MYCNSIA baseline and their source.
Table 2.1. Key Variables in the LSIS and EU-UNICEF MYCNSIA Surveys
Survey Questionnaire Categories Region
LSIS Children − Breastfeeding ALL 17 Provinces

survey (0-59 months) − Childcare during illness
− Immunization
− Anthropometry
Women − Maternal and Newborn health
(15-49 years) − Early initiation of breastfeeding
− Child illness symptoms
Household − Socio-demographic
− Water and sanitation (sources of water
and latrine type)
− Dwelling/environmental characteristics
− Use of mosquito net
− Salt Iodization
EU- Children − Dietary diversity 3 EU-UNICEF
UNICEF (0-35 months) − Iron-fortified food consumption MYCNSIA
MYCNSIA − Supplementary food consumption Provinces only:
survey − Participation in feeding program
− MNP (MIXME) Attapeu,
Saravane and
Pregnant and Lactating − Maternal Diet
Sekong
Women − Supplementary food consumption
− Vitamin A and deworming
− Iron-folate supplementation
Household − Food Security and Household food
consumption
− Knowledge:
− Exclusive breastfeeding
− Complementary feeding
− Hand washing and use of soap
Subsample of Children − Hemoglobin
(6-59 months)
and Women
(15-49 years)
2.3. Sampling design

The LSIS sample frame was designed to derive statistically robust and independent estimates for
each province in the country. Census cluster areas within each province were selected
systematically using a square root allocation method. Cluster numbers were then adjusted to attain
a minimum of 50 clusters in each province and a maximum of 75 in the largest provinces. Within
each cluster, households were listed and a systematic sample of 20 households selected. There
were a total of 1,220 households enumerated in Saravane and 1,000 households in both Sekong

and Attapeu. Statistical weights were developed in order to adjust for household size, cluster
size, and the total population of the individual provinces, which assured that aggregate estimates
were representative of the population at the provincial level.
The EU-UNICEF MYCNSIA sample was based on the LSIS selected sample so that the same
households were enumerated using both sets of data collection instruments. All districts and
clusters from Attapeu and Sekong provinces were included in both the LSIS and the EU-UNICEF
MYCNSIA, and the same households from each cluster were interviewed. In Saravane,
oversampling took place in Taoi, Tumlan, Saravane and Samoi where additional households were
sampled that were not included as part of the LSIS survey. In these additional areas, EU-UNICEF
MYCNSIA teams implemented a condensed version of the LSIS survey together with the EU-UNICEF
MYCNSIA instruments. Unfortunately, because the original LSIS survey was abbreviated, it was
impossible to link a number of critical household level variables for all cases.
A series of merged data files were created for households, mothers and children which combined
indicators from both surveys (for children between 6 and 35 months of age). To adjust for sampling
and merging differences between Provinces, an additional set of statistical weights was developed
for the merged data files. Table 2.2 provides an overview of the sample characteristics of the EU-
UNICEF MYCNSIA Baseline, including the unweighted sample sizes from the two data sources. The
total number of households used in this baseline study derived from the LSIS was 3,220, which
included 4,076 mothers and 2,291 children between 0 and 59.9 months of age. The total number of
households that could be linked between LSIS and the EU-UNICEF MYCNSIA was 2,952, which
included 1,156 mothers with children between 6-35 months of age and 1,352 children aged 6-35
months of age. The percentage of linked records between the EU-UNICEF MYCNSIA and the LSIS by
Province was quite high, with the exception of households from Saravane, of which only 78% could
be linked.
Table 2.2. Linking between EU-UNICEF MYCNSIA and LSIS files (unweighted sample sizes*)
Households Mothers Children

EU- LSIS Linked % LSIS Linked % LSIS Linked %
UNICEF With
MYCNSIA With child Age 6- Age 6-
child 6-
Province All All % All 6-35.9 % LSIS1 35.9 35.9 %
35.9
months months months
months
Saravane 1,220 953 78 1,566 523 475 91 845 550 547 99

Sekong 1,000 1,000 100 1,427 412 402 98 881 512 501 98
Attapeu 1,000 999 100 1,083 298 279 94 565 310 304 98
3,220 2,952 4,076 1,156 2,291 1,352

* See Section 3 for the weighted sample sizes for children and Section 9 for the weighted sample sizes for households
2.4. Field team composition

Details on the core LSIS field team management are available in the LSIS Report. Four additional
field teams were organized by the National Institute of Public Health for the EU-UNICEF MYCNSIA
‘add-on’, with one field team assigned to each province and two assigned to the larger province of
Saravane. Each team was composed of four individuals with specific roles: supervisor, team leader,
interviewer, and laboratory technician. Field team members were recruited from the NIOPH, the
Hygiene and Prevention Department, and local staff from target provinces. The University of Health

Sciences provided laboratory technicians. The supervisors monitored team operations, resolved
issues that arose in the field and reviewed all completed questionnaires while in the field.
Laboratory technicians performed the collection and analysis of blood samples for hemoglobin
determination. Supervisors, teams leaders and interviewers all conducted face-to-face interviews.
Both sets of surveys were completed in the three provinces between October 2011 and February
2012. Prior to survey collection, meetings with local authorities (heads of villages), parents, village
health volunteers, and health center staff were coordinated to explain study objectives and to
encourage community participation.
The EU-UNICEF MYCNSIA questionnaire was pretested on 30 mothers/caregivers at a hospital
located in Vientiane. EU-UNICEF MYCNSIA field supervisors attended a three-day training of
trainers workshop facilitated by a consultant from UNICEF’s Regional Office in Bangkok. Trainers
then facilitated a three-day workshop in September 2011 to train EU-UNICEF MYCNSIA
enumerators who were responsible for conducting the fieldwork. Training consisted of two days in
the classroom and one day in the field. Scores from a pre- and post-test verified that key
interviewing protocols were understood by field workers.
The LSIS survey teams conducted all anthropometric measurements. Individuals were trained in
proper measurement protocols by a UNICEF consultant in August 2011. A pre- and post-test
assessment was completed by individuals who attended training to ensure essential
anthropometry measurement concepts and practices were understood by trainees. Measurements
were performed twice in the field by two workers using standardized WHO procedures.
2.5. Core indicators
a) Nutritional status
The primary indicators of nutritional status were based on anthropometric measures of growth.
Three anthropometric indices were used to gauge the nutrition status of the population, which
included underweight, stunting and wasting. These were calculated based on measures of weight
and height/recumbent length, which were measured following standard techniques. Weight was
recorded to the nearest 0.1 kg, while length and height were recorded in centimeters to the
nearest 0.1 cm. Anthropometric indices were compared to the new WHO international reference
population and children that fell more than two standard deviations below the median of the
reference were classified as moderately or severely undernourished by different indicators, while
those that fell more than three standard deviations below the median of the reference were
classified as being severely undernourished by the respective indicators.
Stunting is a measure of low height-for-age and reflects chronic undernutrition and recurrent or
chronic illness. A reduction in the prevalence of stunting is the main outcome indicator of MYCNISA
as this indicator reflects an improvement in long-term nutrition. Wasting is a measure of low
weight-for-height and results from acute nutrition deficiency, often exacerbated by recent
infection. Underweight status is a measure low weight-for-age and can be the result of either acute
or chronic undernutrition, or both.
The WHO established criteria for the severity of population undernutrition based on the
percentage of stunting, wasting and underweight are shown in Table 2.3.
10 | P a g e Report of the Lao PDR MYCNSIA Baseline Survey

Table 2.3. Severity of Undernutrition at Population level
Underweight < 10%: Low prevalence
10-19%: Medium prevalence
20-29%: High prevalence
≥ 30%: Very high prevalence
Stunting < 20%: Low prevalence
20-29%: Medium prevalence
30-39%: High prevalence
≥ 40%: Very high prevalence
Wasting < 5%: Acceptable
5-9%: Poor
10-14%: Serious
≥15%: Critical
b) Anemia
Anemia was assessed by measuring hemoglobin concentration in the blood using a portable
battery-operated HemoCue 301 Hemoglobin Photometer by trained laboratory technicians. Blood
collection followed standardized finger-prick blood sample procedures.
The WHO reference levels for anemia as measured by hemoglobin are listed in Table 2.4 for
children and women that were used in this report. Hemoglobin levels were adjusted for smoking
status among the women in the EU-UNICEF MYCNSIA study by subtracting by 0.03 g/dL, according
to WHO guidelines.
Table 2.4. WHO Reference Levels for Hemoglobin as Indicator of Anemia±
Anemia Severity
Population Anemia Mild* Moderate Severe
g/dL g/dL g/dL g/dL
Children 6-59 months of age < 11.0 10.0 - 10.9 7.0 – 9.9 < 7.0
Non-pregnant women < 12.0 11.0 – 11.9 8.0 – 10.9 < 8.0
(over 14 years of age)
Pregnant women < 11.0 10.0 – 10.9 7.0 – 9.9 < 7.0
* "Mild" is a misnomer: iron deficiency is already advanced by the time anaemia is detected. The deficiency has consequences even
when no anaemia is clinically apparent.
±
Ref: Adapted from WHO. Hemoglobin concentrations for the diagnosis of anemia and assessment of severity. Vitamin and Mineral
Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.1)
(http://www.who.int/vmnis/indicators/haemoglobin.pdf, accessed May 1 2013.
c) Infant and young child feeding (IYCF)
Infant and young child feeding (IYCF) indicators were established in 2007 by the World Health
Organization as a means of measuring status and tracking progress of efforts to encourage and
promote appropriate feeding practices. These indicators were developed over a five-year period in
order to establish simple, valid and reliable tools to measure breastfeeding and complementary
feeding practices in children 0-23 months of age. Prior to the establishment of standardized IYCF
indicators, consensus on appropriate feeding practices for children under two years of age did not
exist. Table 2.5 describes the IYCF indicators included in the EU-UNICEF MYCNSIA baseline and
designates the survey tool used to collect information for each indicator. The LSIS provided results
regarding breastfeeding practices and indicators were estimated for the complete national sample.
The EU-UNICEF MYCNSIA survey focused on complementary feeding practices for children 6-23

months of age, as further illustrated in Table 2.5. IYCF indicators marked with an asterisk in the
table were calculated with EU-UNICEF MYCNSIA data, while the others were collected as part of the
LSIS. These indicators are of special interest because they provide results on feeding practices
previously unmeasured in Lao PDR. More details on the calculation of the different indicators is
presented in section 4.
Table 2.5. IYCF Indicators, Definitions, and Survey source
1. Early initiation of breastfeeding
Proportion of children born in the last 24 months who were put to the breast within one hour of
birth.
2. Children ever breastfed
Proportion of children born in the last 24 months who were ever breastfed. - at any point in the
child’s life, irrespective of the time of initiation or duration.
3. Exclusive breastfeeding under 6 months
Proportion of infants 0-5 months of age who are fed exclusively with breast milk. No other drink or
fluids are provided, including water.
4. Predominant breastfeeding under 6 months
Proportion of infants 0-5 months of age who are predominately breastfed. These children also
consume some other foods or drink, but their main source of consumption is breastmilk.
5. Age-appropriate breastfeeding
Proportion of children 0-23 months who are appropriately breastfed. This indicator differs for
children under 6 months of age (breastfed in previous day) and for children 6-23 months of age
(received breastmilk, along with solid- semi-solid or soft foods on the previous day).
6. Continued breastfeeding at 1 year
Proportion of children 12-15 months of age who are fed breast milk.
7. Continued breastfeeding at 2 years
Proportion of children 20-23 months of age who are fed breast milk.
8. Bottle feeding
Proportion of children 0-23 months of age who are fed with a bottle.
9. Introduction of solid, semi-solid or soft foods
Proportion of infants 6-8 months of age who receive solid, semi-solid or soft foods.
10. Minimum dietary diversity **
Proportion of children 6-23 months of age who receive food from 4 or more food groups. The 7
foods groups used for tabulation of this indicator are: 1) grains, roots and tubers, 2) legumes and
nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ
meats), 5) eggs, 6) vitamin-A rich fruits and vegetables, and 7) other fruits and vegetables
11. Minimum meal frequency
Proportion of breastfed and non-breastfed children 6-23 months of age who receive solid, semi-
solid, or soft foods (but also including milk feeds for non-breastfed children) the minimum number
of times or more.
12. Minimum acceptable diet **

Proportion of children 6-23 months of age who receive a minimum acceptable diet (apart from
breast milk).
13. Consumption of iron-rich or iron-fortified foods **

Proportion of children 6-23 months of age who receive an iron-rich food or iron-fortified food that is
specially designed for infants and young children, or that is fortified in the home.
** Indicators measured from the EU-UNICEF MYCNSIA add-on survey.

d) Inputs (coverage of key program interventions)
The survey provided data on the current status of key interventions and their coverage in the three
EU-UNICEF MYCNSIA Provinces. The survey collected data on the coverage of a number of nutrition
intervention being implemented as part of the EU-UNICEF MYCNSIA program targeting women and
young children. These include the provision of deworming treatment, Vitamin A and other
nutritional supplements for children aged 6-59 months of age, as well as weekly iron and folate
supplementation for non-pregnant women.
An additional key program input assessed was the knowledge and use of micronutrient powders
(MNP). MNPs have gained widespread interest as a means of improving the vitamin and mineral
content of the diet for children in the weaning period. They are a major component of the IYCF
strategy of the EU-UNICEF MYCNSIA Program. As children deficient in iron are often deficient in
other micronutrients, the provision of this multi-micronutrient supplement not only helps with iron
absorption but also improves overall the overall diet. The local brand of MNPs, MixMe, contains 15
essential vitamins and minerals, as in Table 2.6. Each 1-gram sachet of MixMe provides the daily-
recommended nutrient intake (RNI) of these 15 vitamins and minerals for children between 6
months and 5 years of age.
Table 2.6. Recommended Nutrient Intake (RNI) of each Micronutrient per dose for Children 6-59
Months Old, included in MixMe
Micronutrients Children (6-59
months)
Vitamin A μg RE 400
Vitamin D μg 5
Vitamin E mg 5
Vitamin C mg 30
Thiamine (vitamin B1) mg 0.5
Riboflavin (vitamin B2) mg 0.5
Niacin (vitamin B3) mg 6
Vitamin B6 (pyridoxine) mg 0.5
Vitamin B12 (cobalamine) μg 0.9
Folate μg 150.0
Iron mg 10.0
Zinc mg 4.1
Copper mg 0.56
Selenium μg 17.0
Iodine μg 90.0
MixMe is distributed at health clinics and by nutrition screening staff. Children determined to be
adequately nourished (i.e. not moderately or severely malnourished) by Mid-Upper Arm
Circumference (MUAC) tape are given MixMe for consumption in the home. A total of 120 sachets
per child per year are distributed within a schedule that provides for 60 every 6 months. More
specifically 60 sachets are distributed within a 2-month period followed by a hiatus of 4 months,
which is repeated every six month. Consumption of MixMe is expected to reduce rates of anemia
by 30-40%.
As alluded to in Section 1.5, this survey was not a true baseline. Given the public health priority to
initiate important nutritional and health interventions in a timely manner, several interventions
had already been initiated and underway at the time of the enumeration, so that estimates of
coverage are confounded by the timing and duration of exposure.

In addition, the initial introduction of the EU-UNICEF MYCNSIA activities met with several
challenges, including delays in the distribution of nutrition supplies in the three EU-UNICEF
MYCNSIA target provinces. These delays caused gaps in service delivery for the management of
acute malnutrition and iron-folate supplementation of pregnant and postpartum mothers during
the first quarter of 2012, and influence results from this survey. UNICEF has since provided
assistance to the MoH with both technical and financial services in the forecasting and
procurement of nutrition supplies in order to prevent similar distribution interruptions from
occurring in the future.
2.6. Data entry and data analysis
Data entry was completed in March 2012 and analyzed using Statistical Package for Social Sciences
(SPSS) version 19. Frequencies were run to describe the basic characteristics of each variable of
interest and to ensure that data were collected from each individual. Missing data were coded as
missing and excluded from analysis.
Key outcome variables as described above were stratified by multiple covariates to capture
significant differences between groups with special attention to identify inequalities between sub-
groups of the population. Frequencies for each program coverage and outcome variable were
stratified by sex, age, province, residence, rural area, maternal education, wealth index quintile,
and ethnicity, language, and Religion. Bivariate analyses including chi square tests were performed
to determine significant differences for outcomes.

SECTION 3 BASIC DEMOGRAPHICS
Table 3.1 describes the overall demographic characteristics of the children included in the EU-
UNICEF MYCNSIA baseline. After applying sample weights derived from the national LSIS frame, a
total of 1,408 children from the LSIS survey were assessed in the three EU-UNICEF MYCNSIA
Provinces. Of these children, 11.3% were under 6 months of age, 8.3% between 6 and 11 months of
age, and approximately 20% in each of the additional one-year age groups. A total of 1,354 children
enumerated in the LSIS survey also had information that could be linked with the EU-UNICEF
MYCNSIA-specific add-on survey, which focused enumeration on children between 6 and 35
months of age. Of these children, 16.9% were between six and 11 months of age, 41.3 % were
between 12 and 23 months of age and 41.7% between 24 and 35 months of age. No significant
differences in the age distribution of children were noted by province, with Saravane contributing
about two-thirds of the children to the total sample, due its dense and large population. This
feature should be considered when assessing the aggregate figures, since the characteristics of
Saravane heavily influence the overall totals.
Table 3.1 Basic Demographic Profile of Children, age 0-59.9 months of age, weighted sample sizes)
LSIS Data Merged Data
% Count % Count
EU-UNICEF MYCNSIA 1408 1354
Provinces
Age Groups - 6 0-5.9 11.3 158
months 6-11.9 8.3 118 16.9 229
12-23.9 19.4 273 41.3 560
24-35.9 20.1 283 41.7 565
36-47.9 20.8 293
48-59.9 20.1 283
Sex Male 51.5 725 50.0 674
Female 48.5 682 50.0 675
Province Saravane 65.6 923 66.9 907
Sekong 19.1 269 18.4 250
Attapeu 15.3 216 14.6 198
Residence Urban 9.6 135 14.4 103
Rural 90.4 1272 85.6 614
Rural area ..Rural with road 94.1 1197 90.0 552
..Rural without road 5.9 75 10.0 61
Wealth index Poorest 43.6 614 47.4 340
quintile Second 25.5 359 26.3 189
Middle 18.0 253 15.9 114
Fourth 9.2 130 6.9 50
Richest 3.7 52 3.5 25
Mother’s education None 42.3 595 43.0 308
Primary 44.9 632 43.0 309
Secondary and above 12.9 181 14.0 100
Language Lao-Tai 42.9 597 26.1 185
Mon-Khmer 57.1 795 73.9 524
Ethnicity Lao 42.0 589 25.8 184
Other 58.0 815 74.2 530
Religion Buddhist 53.2 739 37.0 262
Animist 46.8 649 63.0 446

The EU-UNICEF MYCNSIA baseline sample comes from predominately rural areas. Each Province
had a significantly higher proportion of households in rural areas but in Saravane, this difference
was most pronounced (Table 3.2). The rural population sampled from Saravane was higher than
others (97.8%), although all of these areas were accessible by road. In contrast, the proportion of
rural households in Sekong and Attapeu were 77.6% and 79.0%, respectively, although there were
a high percentage of areas without roads.
Table 3.2 Demographic Profile of Merged data – by Province
Province
Saravane Sekong Attapeu
% N % N % N
EU-UNICEF MYCNSIA Provinces 907 18.4 250 14.6 198
Age 6-11.9 16.7 151 18.0 45 16.8 33
Groups 12-23.9 41.2 374 42.9 107 39.9 79
24-35.9 42.1 382 39.1 98 43.3 86
Sex Male 49.4 448 51.9 130 49.6 98
Female 50.6 459 48.1 120 50.4 100
Area Urban 2.2 6 22.4 56 21.0 41
Rural with road 97.8 263 55.8 139 75.6 150
Rural without road 0.0 0 21.9 55 3.5 7
Wealth Poorest 52.0 140 49.6 124 38.4 76
quintile Second 28.9 78 24.9 62 24.8 49
Middle 15.3 41 14.9 37 17.8 35
Fourth 3.1 8 8.0 20 10.7 21
Richest 0.7 2 2.6 6 8.2 16
Mother’s None 59.7 161 32.4 81 33.7 67
education Primary 32.9 89 53.3 133 43.8 87
Secondary and 7.4 20 14.3 36 22.4 44
above
Language Lao-Tai 35.8 94 10.3 26 33.2 66
Mon-Khmer 64.2 168 89.7 224 66.8 132
Ethnicity Lao 35.1 94 10.0 25 33.2 66
Other 64.9 173 90.0 225 66.8 132
Religion Buddhist 41.6 109 19.8 49 52.4 104
Animist 58.4 153 80.2 199 47.6 94
The levels of maternal education varied by Province. Attapeu had the highest proportion of
mother’s with a secondary or higher level of education (22.4%). Most mothers in Sekong reported a
primary level of education (53.3%). Saravane had the highest proportion of mother’s with no
education (59.7%).
Not only did Saravane have the lowest levels of maternal education, it also was the poorest of the
three provinces. When wealth was compared across provinces (by national standards), 52.0% of
Saravane households fell in the poorest wealth quintile and only 0.7% in the richest, compared to
Attapeu where 38.4% were in the poorest quintile and 8.2% were in the richest. Comparing wealth
from the three provinces to wealth quintiles generated from wealth scores from the national
sample, it was apparent that the households in the three EU-UNICEF MYCNSIA provinces are
much poorer than the general population. Overall, there were 47.2% of households who were
classified as being in the poorest quintile, while only 3.5% of households were categorized in the
wealthiest quintile.

SECTION 4 INFANT AND YOUNG CHILD FEEDING PRACTICES (CHILDREN 0-35 MONTHS)
This section presents results from data on infant and young child feeding (IYCF) practices for
Laotian children in the three EU-UNICEF MYCNSIA Provinces. Based on WHO and UNICEF
guidelines, children should be exclusively breastfed until they are 6 months of age, followed by the
timely introduction of adequate, safe and appropriate complimentary foods with continued
breastfeeding until 2 years of age.
4.1. Breastfeeding Practices - Early initiation of breastfeeding
The WHO recommends that breastfeeding be initiated within the first hour of birth, based on
evidence of benefit to both the mother and her child, association with longer duration of
breastfeeding, and increased neonatal survival. Table 4.1 shows the proportion of children in the
two years who were breastfed within one hour of birth and within one day of birth, and the
percentage who received a prelacteal feed.
Table 4.1 Early Initiation of Breastfeeding
% who were first breastfed: Total # last-
born children in
% received a the two years
Within one Within one prelacteal preceding the
hour of birth day of birth feed survey
National 39.1 70.5 33.6 4,306
EU-UNICEF MYCNSIA 51.7 72.9 27.6 543
Provinces
Province Saravane 54.5 74.3 23.9 361
Sekong 44.0 70.2 12.8 99
Attapeu 48.7 69.8 61.4 83
Residence Urban 52.9 78.3 25.0 58
Rural 51.6 72.2 27.9 485
Rural area .. with road 52.7 72.5 28.6 458
.. without road 32.5 67.4 17.1 27
Received antenatal care Yes 61.8 82.6 30.1 261
No 44.4 66.9 26.6 269
Assistance at Skilled attendant 65.6 87.6 25.2 153
delivery Traditional birth attendant 48.1 67.5 48.0 119
Other 46.4 68.5 22.5 234
No one/Missing 39.9 56.7 4.4 37
Place of delivery Public health facility 66.3 85.3 23.9 136
Home 48.8 70.7 33.5 342
Other/Missing 35.7 57.4 4.7 63
Maternal Age 15-19 51.1 67.7 32.5 62
20-24 48.6 76.4 27.9 164
25-29 58.5 75.4 25.8 132
30-34 53.0 73.2 24.9 94
35+ 46.8 66.2 29.2 92
Mother’s education None 51.0 70.8 21.4 200
Primary 51.1 72.2 29.3 260
Secondary and above 54.6 80.0 33.8 77
Wealth index Poorest 44.8 67.7 23.5 223
quintile Second 50.7 72.3 31.2 137
Middle 59.6 77.3 27.5 106
Fourth 63.8 80.5 30.2 59
Richest 59.3 90.1 44.5 18

The EU-UNICEF MYCNSIA Provinces showed a higher adherence to WHO recommendations for
early initiation of breastfeeding than the national average (51.7% and 39.1%, respectively). The
data also showed that 72.9% of the mothers in the EU-UNICEF MYCNSIA provinces reported
breastfeeding within one day as compared to the national average of 70.5%. High levels of early
initiation of breastfeeding were noted among mothers who received antenatal care, delivered with
the assistance of a skilled attendant, delivered at a facility, and who possessed higher education
and wealth.
Prelacteal feeds are those foods and fluids fed to newborns before breastfeeding is established
usually on the first day of life. Feeding prelacteals to a newborn are typically in the context of a
ritual, or belief that prelacteals are a necessary, with little knowledge of the dietary value of the
nutrient and antibody-rich colostrum. WHO recommends avoiding any prelacteal feeds, as other
liquids are suboptimal in comparison to breastmilk and will quickly fill a newborn’s small stomach,
thus interfering with breastfeeding.
A slightly lower percentage of mothers in the EU-UNICEF MYCNSIA Provinces were found to be
feeding newborns prelacteal feeds (27.6%) as compared to the national level (33.6%), although
there were important differences between Provinces. More than six out of ten mothers in Attapeu
(61.4%) reported giving their child a prelacteal feed, which is 2.5 times higher than in Saravane
(23.9%) and almost 5 times higher than in Sekong (12.8%). Receipt of antenatal care did not
significantly alter rates of prelacteal feeds. However, when a traditional birth attendant (TBA) was
present at birth, the likelihood of prelacteal feeding was twice as high when compared to a skilled
attendant at birth. These differences in prelacteal feeding practices highlight the strong influence
of appropriate infant feeding counseling at time of delivery. Consequently, targeting TBAs with
IYCF information has the potential to greatly reduce prelacteal feeding practices.
Mothers with higher levels of education practiced prelacteal feeding at higher proportions than
mothers with less or even no education, while wealthier mothers practiced prelacteal feeding more
commonly than poorer mothers.
While early initiation of breastfeeding was low in Laos, the proportions of mothers ever
breastfeeding throughout Lao PDR was very high as more than 95% of mothers both nationally and
within the EU-UNICEF MYCNSIA Provinces reported to have ever breastfed their child, with very
little variation. Much of this breastfeeding however, was not exclusive, as the next section will
describe.
4.2. Exclusive and Predominant breastfeeding (children under 6 months of age)
Exclusive breastfeeding is recommended by WHO for children under 6 months of age. Children
exclusively breastfed receive no foods or other liquids apart from breast milk, although oral
rehydration solution (ORS), vitamins, minerals and medicines in drops and syrups are allowed.

Table 4.2 Breastfeeding patterns for children
Children 0-5 months Children 12-15 months Children 20-23 months
% % Breastfed % Breastfed
% Predomin (Continued (Continued
Exclusively antly breastfeeding breastfeeding
breastfed breastfed N at 1 year) N at 2 years) N
National 40.4 68.3 1182 73.0 758 40.0 668
EU-UNICEF MYCNSIA 36.5 59.7 158 80.4 107 66.6 104
Provinces
Sex Male 32.5 52.5 62 77.8 54 69.6 52
Female 39.1 64.4 96 83.1 52 63.7 52
Province Saravane 28.0 53.3 102 74.5 63 69.1 75
Sekong 62.3 78.4 27 89.2 27 58.2 16
Attapeu 42.5 65.1 29 91.7 17 61.1 14
Residence Urban 45.1 67.3 14 71.3 14 41.4 12
Rural 35.7 59.0 144 81.7 93 69.8 93
Rural areas ..with road 33.2 56.9 134 80.5 86 69.0 88
..without road 69.1 86.6 10 97.5 7 86.2 4
Mother's None 41.8 64.5 57 90.8 37 83.0 35
education Primary 31.7 56.0 79 76.5 53 64.4 56
Secondary and 40.4 60.7 22 69.0 16 30.3 12
above
Wealth Poorest 44.9 63.9 59 93.4 46 80.6 36
index Second 27.7 61.7 48 82.3 23 73.4 27
quintile Middle 35.5 56.6 35 56.1 16 55.5 28
Fourth 25.6 42.4 11 78.6 17 41.1 9
Richest 51.3 51.3 6 33.1 5 31.7 4
Ethnicity Lao 29.1 48.3 74 61.5 40 59.9 52
Other 43.0 69.7 85 91.6 66 73.5 52
Language Lao-Tai 28.7 47.7 75 62.6 41 59.9 52
Mon-Khmer 42.8 70.2 83 92.9 63 74.4 50
Religion Buddhist 28.0 49.2 93 65.5 48 59.9 67
Animist 47.7 74.3 64 92.3 57 76.6 34
As shown in Table 4.2 the prevalence of exclusive breastfeeding in the EU-UNICEF MYCNSIA
Provinces was slightly lower (36.5%) than the national average (40.4%). However, considerable
variation in exclusive breastfeeding was noted by province with Saravane showing the lowest
prevalence (28.0 %), while Sekong had the highest (62.3%). Children living in rural areas with a road
were less likely to be exclusively breastfeeding (33.2%) than those living in rural areas without
access to a road (69.1%), which may reflect access to infant formula. Households reporting their
religion to be Animists, showed a higher percentage of exclusively breastfeeding than those
practicing Buddhism.
The proportion of children under six months of age who were predominately breastfed was 59.7%
in the EU-UNICEF MYCNSIA provinces, which was lower than the national average (68.3%). Of the
three EU-UNICEF MYCNSIA provinces, Sekong not only had the highest rates of exclusive
breastfeeding, but also had the highest rate of predominately breastfeeding (78.4%). Interestingly,
the poorest and the wealthiest quintile groups demonstrated higher rates of exclusive
breastfeeding, although the sample sizes were small for each group.
4.3. Continued breastfeeding at 1 year and 2 years of age
Continued breastfeeding is encouraged beyond six months of age as it provides 50% or more of the
daily caloric needs for children between 6-11 months of age, and about a third of the dietary
energy requirements for children in the second year of life. Please note that these indicators are
calculated only for a sub-set of children in defined age ranges, so the sample size is quite small for
these estimates. Eight out of ten children were still breastfeeding at one year of age in the EU-
UNICEF MYCNSIA Provinces (80.4%), compared to the national average of 73.4% (Table 4.2). Higher
continued breastfeeding rates at one year of age were noted among the poorer households with
lower maternal educational levels, while the lower breastfeeding prevalence found to be among
wealthy households and those with high maternal education levels. The prevalence of continued
breastfeeding at one year of age was lower among Lao household heads, and those practicing
Buddhism.
At two years of age, the continued breastfeeding prevalence in the EU-UNICEF MYCNSIA was higher
(66.6%) in comparison to national figures (40.0%). Seven out of ten rural mothers continued to
breastfeed their children at 2 years of age (69.8%), whereas only 41.4% of urban mothers followed
these practices. Lower wealth and lower maternal education levels were associated with higher
proportions of children breastfeeding at two years. As above, ethnicity, language, and religion
showed some variation in patterns of continued breastfeeding, pointing to some areas for targeted
communication.
4.4. Age-appropriate breastfeeding (0-23 months of age)
The WHO recommends that breastfed children receive complementary foods starting at 6 months
of age. The age-appropriate breastfeeding indicator is a summary measure that combines the
proportion of young children under 6 months of age who are exclusively breastfeeding, with the
proportion of children between 6-23 months of age who are breastfed, and given solid, semi-solid
or soft foods. Table 4.3 shows that while only 40.1% of children below two years of age from the
EU-UNICEF MYCNSIA provinces were appropriately breastfed, it was slightly higher than national
estimates of 36.7%.
In Saravane, almost half of children under two years of age satisfied guidelines for age-appropriate
breastfeeding (42.9%), while 36.5% and 32.6% of children from Sekong and Attapeu had age-
appropriate breastfeeding, respectively. This higher prevalence in Saravane stems largely from the
higher rates of children aged 6-23 months who are being appropriately fed breast milk and solid
foods, since the prevalence of exclusive breastfeeding among infants under 6 months of age were
actually lowest in this Province. Rural children and those from poorer households met age-
appropriate breastfeeding requirements at higher proportions than children from urban and
wealthier households.

Table 4.3 Age-appropriate breastfeeding
Children age 0-5 Children age 6-23
months months Children age 0-23 months
% Currently
breastfeeding
and receiving
% Solid, semi-
Exclusively solid or soft % Appropriately
breastfed N foods N breastfed N
National 40.4 1,182 35.4 3,266 36.7 4,448
EU-UNICEF MYCNSIA Provinces 36.5 158 41.6 391 40.1 549
Sex Male 32.5 62 40.6 202 38.7 264
Female 39.1 96 42.6 189 41.4 286
Province Saravane 28.0 102 48.6 263 42.9 365
Sekong 62.3 27 27.1 74 36.5 101
Attapeu 42.5 29 27.3 54 32.6 83
Residence Urban 45.1 14 29.7 49 33.1 63
Rural 35.7 144 43.3 342 41.0 486
Rural area .. with road 33.2 134 43.9 324 40.8 458
.. without road 69.1 10 32.9 18 45.8 28
Mother's None 41.8 57 45.8 141 44.6 198
education Primary 31.7 79 39.0 189 36.8 268
Secondary and 40.4 22 40.0 61 40.1 83
above
Wealth index Poorest 44.9 59 43.8 162 44.1 221
quintile Second 27.7 48 45.1 91 39.1 139
Middle 35.5 35 45.8 71 42.4 107
Fourth 25.6 11 29.9 52 29.2 62
Richest 51.3 6 16.8 15 26.3 20
Ethnicity Lao 29.1 74 36.0 172 33.9 245
Other 43.0 85 46.0 217 45.1 302
Language Lao-Tai 28.7 75 35.8 174 33.7 249
Mon-Khmer 42.8 83 46.7 210 45.6 293
Religion Buddhist 28.0 93 37.4 219 34.6 312
Animist 47.7 64 46.5 166 46.9 230
4.5. Bottle feeding (0-23 months of age)

Bottle feeding has a number of adverse effects, not the least of which is that it is an alternative to
breastfeeding, may lead to nipple confusion, and may interfere with breast suckling. For children
above 6 months of age, any liquid provided to children should be fed with a cup rather than a
bottle. Bacteria may also grow on the nipples of bottles and safety of their use is influenced by the
sanitation practices of caregivers that fill these bottles. Consequently, bottle feeding has been
associated with increased rates of diarrhea.

Table 4.4 Bottle feeding
% of children age
0-23 months fed
with a bottle with a # of children age 0-
nipple [1] 23 months:
National 17.5 4,448
EU-UNICEF MYCNSIA Provinces 9.2 549
Sex Male 11.2 264
Female 7.4 286
Age 0-5 months 6.0 158
6-11 months 9.9 118
12-23 months 10.8 273
Province Saravane 9.6 365
Sekong 7.0 101
Attapeu 10.4 83
Residence Urban 28.2 63
Rural 6.8 486
Rural area ..Rural with road 7.2 458
..Rural without road .0 28
Mother's education None 2.3 198
Primary 10.9 268
Secondary or above 20.4 83
Wealth index quintile - Poorest 2.2 221
National Second 4.7 139
Middle 11.3 107
Fourth 27.7 62
Richest 48.2 20
Can you Ethnicity Lao 15.8 245
Other 4.0 302
Language Lao-Tai 15.9 249
Mon-Khmer 3.8 293
Religion Buddhist 13.7 312
Animist 3.5 230
As shown in Table 4.4 only 9.2% of the children in the EU-UNICEF MYCNSIA provinces were fed with
a bottle with a nipple, which was almost half of the national estimate (17.5%). For the older
children, a small increase is observed in the proportion that was bottle fed, although by 12-23
months of age only 10.8% were using bottles. The proportion of children from urban areas fed with
a bottle with a nipple was more than four times that of rural children. With higher wealth and
mother’s education levels, the proportion of children fed with bottles increased, starting from less
than 3% in the lowest categories and approaching 50% in the highest categories. A much higher
percentage of children from Lao ethnic families’ bottle fed (15.8%) than other ethnic groups (4.0%).
4.6. Introduction of Solid, semi-solid or soft foods
Table 4.5 shows the proportion of infants 6-8 months receiving solid, semi-solid or soft foods. This
indicator is defined for a narrow age range and captures the important transition period between
exclusive breastfeeding to complementary feeding. Children 6 months and older no longer receive
adequate nutrition from breast milk alone, and the introduction of solid, semi-solid, and soft foods
through complementary feeding is advised.

Table 4.5 Infants age 6-8 months who received solid, semi-solid or soft foods during the previous day
Currently breastfeeding All
% receiving % receiving
solid, semi- n solid, semi- n
solid or soft (6-8 solid or soft (6-8
foods months) foods months)
National 49.6 473 52.3 538
EU-UNICEF MYCNSIA Provinces 50.9 67 51.7 69
Sex Male 50.0 42 50.9 43
Female 52.4 25 52.9 26
Province Saravane 60.1 44 60.8 45
Sekong 30.0 11 30.3 12
Attapeu 36.0 12 38.5 12
Residence Urban 43.3 7 46.4 8
Rural 51.7 61 52.3 61
Rural area … with road 53.7 58 54.3 59
… without road 6.6 3 6.6 3
Mother's None 43.6 27 45.2 27
education Primary 48.7 27 49.9 27
Secondary and 68.5 12 66.8 13
above
Wealth index Poorest 57.1 31 57.1 31
quintile Second 32.5 18 32.5 18
Middle 66.5 12 66.5 12
Fourth 49.9 5 56.9 7
Richest 30.8 2 36.4 2
Current guidelines recommend that the indicator for the introduction of solid, semi-solid or soft
foods be stratified by breastfeeding status. However, as seen in Table 4.5, of the 69 children
between 6 and 8 months of age in the 3 EU-UNICEF MYCNSIA provinces, only two children were not
breastfeeding so the indicator is best interpreted using all children (last column in Table 4.5). The
proportion of children in this age group receiving solid, semi-solid or soft foods in the EU-UNICEF
MYCNSIA provinces (51.7%) was similar to national figures (52.3%).
The sample size for this indicator is small so caution should be taken in interpreting these stratified
results, but by province, differences were observed. Saravane had twice the proportion of young
children introduced to foods at an appropriate age (60.8%) than Sekong (30.3%). Young children
with higher educated mothers were introduced to foods at an appropriate age at a higher
proportion (66.8%) than those from less educated mothers (45.2%). A less clear relationship was
observed by wealth, and again, must be viewed with caution because of the small sample.
The age at which complementary foods are introduced enables an overall assessment of feeding
practices by age. Figure 4.1 provides a graphical representation of the proportion of children with
different feeding practices at different ages from birth through 23 months. The dark blue area
represents the proportion of children exclusively breastfeeding by age, and shows a marked decline
within the first six months of life. It is noteworthy that there is a very high percentage of very young
children who are provided with both breast milk and complimentary foods, but most of this was
reported to be broths or soups. The orange area indicates those children who are no longer
breastfeeding at all, the percentage of which begins to increase in the second half of the first year
and continues to increase, as children get older.

Figure 4.1. Infant feeding practices by age
100%
Not receiving any breast milk
Breast milk and complementary foods
Breast milk and other milk/formula
Breast milk and non-milk liquids
80% Breast milk and plain water only
Exclusively breastfed
60%
40%
20%
0%
0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 24+
4.7. Minimum Dietary Diversity (MDD)

Consumption of a wide variety of foods is important to assure that a young child is able to meet
their nutrient and energy requirements required for healthy growth and development. The
Minimum Dietary Diversity (MDD) indicator has been developed to serve as a proxy for an
adequate intake of micronutrient-dense foods. Table 4.6 presents the consumption frequency of
foods among children 6-23 months of age from the following seven food groups:
1. Grains, roots and tubers
2. Legumes and nuts
3. Dairy products (milk, yogurt, cheese)
4. Flesh foods (meat, fish, poultry and liver/organ meats)
5. Eggs
6. Vitamin-A rich fruits and vegetables
7. Other fruits and vegetables
Each caregiver was interviewed about their child food consumption on the previous day. The
consumption of a particular food group does not capture information on the quantity of food
consumed, so this measure is not a robust measure of the actual nutrient composition of the diet.

Table 4.6. Dietary Diversity: Children 6-23 months who received the minimum daily dietary diversity of
food groups during previous day
Children 6-23 months who received minimum daily dietary diversity of food groups
prior day
% receiving % Vit A %
Minimum % Grains % % rich Other
Dietary /roots Legumes Flesh fruits fruits
Diversity /tubers /nuts % Dairy foods % Eggs /veg /veg N
EU-UNICEF MYCNSIA 10.3 92.8 0.7 49.6 70.3 4.5 19.9 6.3 788
Provinces
Sex Male 9.8 93.6 0.5 45.9 68.5 4.5 20.2 6.6 392
Female 10.8 92.0 0.9 53.3 72.1 4.5 19.6 6.0 396
Age (months) 6-8.9 1.1 73.6 0.4 60.4 39.0 1.7 4.1 1.0 139
9-11.9 10.4 90.4 0.9 50.6 63.6 5.0 22.6 5.8 89
12-17.9 8.4 97.3 0.4 50.1 75.0 4.1 18.5 6.3 298
18-23.9 17.4 98.7 1.2 43.1 83.8 6.3 29.0 9.3 262
Sex Male 9.8 93.6 0.5 45.9 68.5 4.5 20.2 6.6 392
Female 10.8 92.0 0.9 53.3 72.1 4.5 19.6 6.0 396
Province Saravane 9.2 92.9 0.5 61.3 77.1 3.1 15.8 6.6 525
Sekong 12.5 92.7 0.0 19.8 45.3 7.5 35.4 8.1 151
Attapeu 12.8 92.6 2.7 35.1 72.1 7.2 18.3 2.8 111
Residence Urban 32.4 91.2 4.6 56.2 77.7 19.8 47.2 12.5 66
Rural 9.9 94.7 0.8 13.9 59.9 5.7 25.9 10.5 340
Rural area .. with road 11.0 94.8 0.9 14.7 63.3 6.4 25.6 10.7 302
.. without 1.7 94.2 0.0 6.9 32.9 .0 28.5 9.1 37
road
Other children Yes 2.2 90.4 0.9 68.9 70.3 1.2 7.3 4.9 154
6-35 months No 12.3 93.4 0.7 45.0 70.3 5.3 23.0 6.7 634
Mother's None 13.3 92.0 0.5 10.5 61.4 5.0 25.7 15.3 155
education Primary 9.7 96.9 1.7 19.4 61.6 7.5 31.1 7.8 193
Secondary or 27.8 91.0 2.9 53.5 70.8 17.9 33.5 9.2 58
above
Wealth index Poorest 6.1 94.8 0.0 8.9 54.8 4.1 28.9 10.6 189
quintile Second 11.0 93.9 0.8 12.4 65.4 5.5 25.4 8.3 104
Middle 26.7 94.1 5.5 35.8 68.8 16.0 34.8 16.0 65
Fourth 27.1 90.6 1.6 58.4 80.2 13.9 30.9 6.7 33
Richest 41.6 96.4 6.0 82.7 82.6 28.2 36.8 18.2 15
Ethnicity Lao 18.4 95.1 3.3 36.4 81.3 16.5 31.1 3.5 106
Other 12.0 93.8 0.7 15.0 56.3 5.1 29.0 13.6 297
Language Lao-Tai 18.3 95.2 3.3 36.2 80.8 16.4 30.9 3.5 107
Mon-Khmer 11.7 93.6 0.8 14.9 55.7 5.0 28.3 13.6 292
Religion Buddhist 16.5 93.4 2.3 31.9 77.2 12.5 27.6 5.1 152
Animist 11.9 94.5 0.9 14.4 53.5 5.3 30.9 13.0 248
Meeting the minimum requirement of the MDD (at least four of the seven foods groups)
indicates a high likelihood of the consumption of at least one animal food source, and at least one
fruit or vegetable in addition to staple foods. Overall, only 10.3% of children consumed a diet
meeting the requirement of a MDD. Among children 6-8 months of age, as these infants transition
from exclusive breastfeeding to complementary feeding, very few consumed a diet that met MDD
criteria (1.1%), while older children, aged 18-23 months had the highest percentage who consumed
the minimum number of food groups (17.4%). Children from urban areas were three times more
likely to meet the MDD (32.4%) than children living in rural areas (9.9%). There was a direct
relationship between wealth and MDD. As wealth increased so did the proportion of children
meeting MDD. Only 6.1% of children from the poorest households met the MDD, while 26.7% of
children from the middle income quintile and 41.6% of children from the richest households met
MDD. Mothers from the highest education level had the highest proportion of children meeting
MDD (27.8%) relative to only 13.3% of children from mothers with no education. There were

interesting associations between the MDD and ethnicity, language and religion of the households,
suggesting a possible cultural dimension to dietary practice.
In addition to an overall index of diversity, these data provide useful information about food
consumption patterns of the population in the EU-UNICEF MYCNSIA provinces. The most commonly
consumed food group from the seven food categories was grains/roots/tubers (92.8%), although
there was a considerably lower percentage of children in the youngest age group, 6-8 months
consuming staple foods (71.1%) than older children (> 95%).
Figure 4.2. Consumption of foods by age (in the prior day)
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23
Age (months)
Grains, roots, tubers Dairy products
Flesh foods (meat, fish) Vitamin A rich fruits/vegetables
Eggs Other fruits/vegetables
Legumes and nuts
Interestingly, flesh foods were the second most commonly consumed food group in the EU-UNICEF
MYCNSIA provinces, which were consumed by 70.3% of children on the previous day. Animal
source foods are important in that they provide the most bioavailable sources of iron and vitamin A
in the diet. There were important differences between provinces, with children in Sekong much
less likely to consume flesh foods (45.3%) than in Saravane or Attapeu. The youngest children were
considerably less likely to consume flesh foods (39.0%) than older children, with the highest
percentage noted amongst children 18-23 months of age (83.8%)
Overall, just about half of the children consumed a food item from the dairy group on the previous
day, making it the third most commonly consumed food category. An inverse relationship was
noted with age, as the highest percentage of children consuming dairy was among the younger
children (60.4%) and as age increased dairy consumption decreased. Less than one out of ten
children from the poorest households ate a dairy food whereas more than eight in ten children
from the richest households ate from the dairy food group.

Vitamin-A rich fruits and vegetables were consumed by only one of every five children (19.9%).
Younger children were much less likely to consume these foods (4.1%) than older children, aged
18-23 months (29.0%). Children in Sekong were twice as likely to consume vitamin A rich foods
(35.4%) than in the other two Provinces.
A very small percentage of children reported consuming eggs the previous day (4.5%), although
children from the richest households were almost seven times more likely to consume eggs than
children from the poorest households.
4.8. Minimum Meal Frequency
An additional measure of dietary adequacy is the minimum meal frequency (MMF) calculated as
the proportion of breastfed and non-breastfed children 6-23 months of age who receive solid,
semi-solid or soft foods (also including milk feeds for non-breastfed children) the minimum number
of times daily. These meals reflect the energy intake from foods other than breast milk, and include
both meals and snacks. For breastfed children, the minimum number of meals consumed varies
with age, as children 6-8 months require two times a day, while children 9-23 months require three
meals a day. For non-breastfed children the minimum number of meals per day is four and does
not vary by age.
Table 4.7 presents data showing that 41.5% of all children in EU-UNICEF MYCNSIA provinces met
their MMF for their age and breastfeeding status, which was slightly lower than the national
average (43.0%). There were large differences in MMF estimates between province, with Sekong
having a much lower MMF than the other two provinces for both breastfed and non-breastfed
children (9.4% and 21.1%, respectively). In Saravane, 53.7% of breastfed children met the MMF
criteria, while 45.6% of non-breastfed children met the MMF. Not surprisingly, there was a positive
association between wealth and MMF, with children from the poorest households having a lower
MMF (36.4%) than among the children from the wealthiest households (60.3%), but note that for
non-breastfed children, wealth was an even more profound determinant of MMF.

Table 4.7: Minimum meal frequency : Children age 6-23 months fed solid, semi-solid, or soft foods
(and milk feeds for non-breastfeeding children) the minimum number of times or more
during the previous day, by breastfeeding status
Currently breastfeeding Currently not breastfeeding All
% receiving
solid, semi- % receiving
solid and soft solid, semi-
foods the % solid and soft # % with
minimum # children receiving foods or milk children minimum # children
number of age 6-23 at least 2 feeds 4 times age 6-23 meal age 6-23
times months milk feeds or more months frequency months
National 36.6 2,187 51.2 55.9 1,079 43.0 3,266
EU-UNICEF MYCNSIA 41.6 303 33.0 40.8 87 41.5 391
Provinces
Sex Male 43.5 158 31.0 43.0 44 43.4 202
Female 39.6 145 35.0 38.7 44 39.4 189
Age 6-8 months 46.9 67 100.0 100.0 2 48.2 69
9-11 months 33.3 43 82.1 85.1 6 39.8 49
12-17 months 34.8 106 41.5 47.9 33 37.9 139
18-23 months 49.9 88 17.7 27.5 46 42.2 134
Province Saravane 53.7 201 28.8 45.6 61 51.8 263
Sekong 9.4 59 33.7 21.1 15 11.7 74
Attapeu 29.4 43 55.1 41.0 11 31.9 54
Residence Urban 31.9 32 63.9 58.8 17 41.2 49
Rural 42.8 271 25.5 36.5 70 41.5 342
Rural area .. with road 45.1 255 26.0 37.2 69 43.4 324
.. without 7.4 17 0.0 0.0 1 6.9 18
road
Mother's None 42.0 123 12.4 18.6 18 39.0 141
education Primary 39.0 141 29.1 42.9 48 40.0 189
Secondary 49.7 40 59.1 54.8 21 51.5 61
and above
Wealth Poorest 38.4 142 1.5 22.7 20 36.4 162
index Second 42.7 77 19.8 26.7 14 40.3 91
quintile Middle 51.1 47 29.4 28.2 24 43.5 71
Fourth 41.4 31 57.4 65.2 21 51.1 52
Richest 31.4 7 81.6 84.2 8 60.3 15
Ethnicity Lao 51.1 108 39.4 50.4 64 50.9 172
Other 36.8 193 15.8 14.9 24 34.4 217
Language Lao-Tai 50.7 109 40.3 51.2 65 50.9 174
Mon-Khmer 37.0 188 12.8 11.8 22 34.4 210
Religion Buddhist 46.9 146 37.5 47.3 73 47.0 219
Animist 36.1 151 10.7 8.7 15 33.7 166
Children not currently breastfeeding from rural areas were less likely to receive at least two milk
feeds (25.5%) compared to children from urban areas (63.9%), but again the samples sizes are
small, so these stratified results are not robust. Wealth was also associated with frequency of milk
feeding for non-breastfeeding children, as 1.5% of non-breastfed children from the poorest
households received at least two milk feeds while over 80% from the wealthiest households
received at least two milk feeds.
Ethnic Lao and children from Lao-Tai speaking households had better outcomes for this measure,
as did Buddhist families. Results for non-breastfeeding children showed the largest variation
between groups. The percent of non-breastfeeding children receiving solid, semi-solid and soft
foods or milk feeds four or more times was 50.4% for Lao-Tai speakers and 11.8% for Mon-Khmer
speakers. Similar differences for ethnicity were observed. Those practicing Animist religion
reported 8.7% of non-breastfeeding children meeting this guideline while almost half of Buddhist

children received the required number of feedings. Overall, about a one-and-a- half fold difference
exists between ethnicity, language and Religion in meeting the requirements of MMF.
4.9. Minimum Acceptable Diet (6-23 months)
A robust, summary IYCF indicator is the Minimum Acceptable Diet (MAD) that is a composite of
minimum dietary diversity and minimum meal frequency. The MAD measures the proportion of
children, aged 6-23 months of age meeting both the MDD and MMF and helps track the quality and
quantity (frequency) of the diet in the complementary feeding period. Breastfed children that score
positively for both component indicators, MDD and MMF, will score positively for this parameter.
Classification for non-breastfed children is more complicated in that the dietary diversity is
calculated using a six food group score (that excludes dairy) instead of the previous seven food
group score. Milk feeds are separately calculated for non-breastfed children in this indicator and by
excluding them in the dietary diversity calculation, it prevents double-counting. Table 4.8 provides
estimates of the proportion of children meeting the requirement of a MAD, both for breastfeeding
children and those not breastfeeding.
Only 5.1% of children from the EU-UNICEF MYCNSIA provinces consumed diet meeting the MAD
criteria, which was slightly higher for breastfeeding children than those currently not
breastfeeding. The numbers of non-breastfed children are small so it is difficult to derive robust
conclusions, but among breastfeeding children, the MAD increased with the age of children,
following the same patterns seen for the individual components; MMF and MDD. For children,
aged 18-23 months who were still breastfeeding, 12.7% consumed a MAD. There were some
variations by Province, and Saravane had the highest proportion of children achieving a MAD
(6.6%), more than ten times higher than in Sekong, where only 0.7% of children consumed a MAD.
Children from mothers with the lowest education had the highest MAD scores.

Table 4.8 : Minimum acceptable diet - Percentage children age 6-23 months who received minimum
dietary diversity and fed the minimum number of times, according to breastfeeding status
Currently breastfeeding Currently not breastfeeding All
% %
% % receiving receiving
receiving % fed receive solid min % fed % fed
solid % min minimum at least foods or dietary minimum minimum
foods min dietary acceptable 2 milk milk min diversity acceptable acceptable
frequency diversity diet N feeds frequency (excl milk) diet N diet N
EU-UNICEF MYCNSIA 43.1 8.2 5.4 654 31.8 28.9 6.9 3.6 134 5.1 788
Provinces
Sex Male 43.7 8.1 5.3 324 29.4 37.3 5.3 4.3 68 5.1 392
Female 42.6 8.3 5.4 330 34.4 20.3 8.6 3.0 66 5.0 396
Age 6-8.9 35.7 1.1 0.0 134 100.0 100.0 0.0 .0 5 0.0 139
(months) 9-11.9 28.7 8.8 4.7 84 35.4 75.8 13.0 13.0 5 5.2 89
12-17.9 39.1 7.1 3.3 258 31.5 18.1 1.0 1.0 40 3.0 298
18-23.9 61.3 14.9 12.7 178 28.0 27.1 9.7 4.5 84 10.1 262
Province Saravane 55.3 8.0 7.2 445 25.2 27.9 5.0 3.6 80 6.6 525
Sekong 9.8 8.6 0.0 121 31.4 19.5 14.6 3.7 30 0.7 151
Attapeu 27.6 8.9 3.7 88 54.6 43.9 3.7 3.7 24 3.7 111
Residence Urban 25.1 27.8 3.1 45 67.8 51.4 17.9 6.0 22 4.0 66
Rural 36.2 8.2 5.6 291 21.9 15.1 5.1 1.4 49 5.1 340
Rural Area ..with road 40.2 9.1 6.4 256 23.3 16.1 5.5 1.5 46 5.6 302
..without 6.0 1.9 0.0 34 0.0 0.0 0.0 0.0 3 0.0 37
road
Mother's None 36.5 13.2 7.1 138 8.2 10.3 8.3 4.2 17 6.8 155
education - Primary 33.6 7.8 4.1 159 31.6 19.0 4.7 2.6 34 3.8 193
Secondary 32.9 15.2 3.6 38 68.2 53.4 17.6 2.1 19 3.1 57
and above
Wealth Poorest 32.4 6.7 3.9 172 3.9 .0 .0 0.0 17 3.5 189
index Second 36.6 11.5 5.4 90 15.6 9.9 4.9 0.0 14 4.7 104
quintile Middle 46.0 19.1 12.5 46 41.9 28.9 17.4 5.8 19 10.5 65
Fourth 23.4 19.4 0.0 21 68.9 51.7 11.9 0.0 12 0.0 33
Richest 26.8 25.8 6.8 7 79.8 69.7 11.8 11.8 7 9.4 15
Ethnicity Lao 49.2 7.8 2.0 70 52.9 40.0 9.5 4.4 36 2.8 106
Other 31.1 11.8 6.2 263 18.2 11.9 8.6 1.2 34 5.6 297
Language Lao-Tai 48.8 7.7 2.0 71 52.9 40.0 9.5 4.4 36 2.8 107
Mon- 31.2 11.4 6.3 259 18.8 12.3 8.9 1.2 33 5.7 292
Khmer
Religion Buddhist 45.0 9.2 2.7 107 48.3 34.7 10.2 4.4 45 3.2 152
Animist 29.0 11.7 6.7 223 14.1 11.4 7.1 0.0 25 6.0 248
4.10. Consumption of Iron Rich Foods

The adequacy of iron in the diet was measured by the proportion of children 6-23 months of age
who received an iron-rich or iron-fortified food that is especially designed for infants and young
children, or one that is fortified at home. In this classification, iron-rich foods come only from flesh
foods, or animal sources. Additional sources of iron included specially designed iron-fortified foods
such as Rice-Soya Blend (RSB), Corn-Soya Blend (CSB), Eezeepaste/Plumpynut, Nutributter, and iron
fortified infant/toddler formula, some of which are provided only to children who meet some
screening criteria, e.g. classified as wasted or with low MUAC (see also Section 8). The third
component of the indicator are iron fortified MNPs (MixMe).
Overall, three out of four children between the ages of 6 and 23 months of age consumed at least
one of these three iron products, whether iron-rich food or fortified (75.5%). The youngest children
were the least likely to consume any of these foods, and overall, their consumption of iron sources
was 43.4%, half that of the oldest children (87.6%). Less than half of children in Sekong consumed
iron-rich or iron-fortified foods, while consumption in Saravane and Attapeu was much higher, with

more than 80% of children consuming iron sources in their diets, a finding that was consistent for
all three ‘categories’.
Table 4.9 Iron-rich Foods - Percentage of children 6-23 months fed iron-rich foods, special iron-
fortified foods, and foods fortified at home with iron (MIXME) during previous day
% % receiving TOTAL - %
receiving % receiving special home iron- receiving any iron
iron-rich designed iron- fortified food rich/fortified
foods fortified foods (MIXME) foods n
Total 70.3 40.0 23.7 75.5 788
Sex Male 68.5 38.6 26.0 72.9 392
Female 72.1 41.4 21.4 78.1 396
Age 6-8 months 39.0 9.6 3.3 43.4 139
9-11 months 63.6 26.4 11.5 70.5 89
12-17 months 75.0 47.9 30.2 81.4 298
18-23 months 83.8 51.9 31.0 87.6 262
Province Saravane 77.1 45.5 26.9 82.1 525
Sekong 45.3 11.4 6.4 47.7 151
Attapeu 72.1 52.8 31.7 82.5 111
Residence Urban 77.7 35.9 11.4 84.8 66
Rural 59.9 32.5 21.6 66.1 340
Rural area .. with road 63.3 35.6 23.5 70.0 302
.. without 32.9 7.2 7.2 35.3 37
road
Mother's None 61.4 34.1 18.5 68.3 155
education Primary 61.6 31.6 23.4 66.5 193
Secondary 70.8 35.0 12.0 80.5 57
and above
Wealth index Poorest 54.8 26.6 16.6 61.5 189
quintile Second 65.4 34.9 25.8 71.4 104
Middle 68.8 37.8 25.4 72.5 65
Fourth 80.2 43.4 11.9 90.1 33
Richest 82.6 59.2 17.0 91.7 15
Ethnicity Lao 81.3 44.3 18.1 87.0 106
Other 56.3 29.3 20.8 63.0 297
Language Lao-Tai 80.8 44.1 18.0 86.4 107
Mon-Khmer 55.7 28.7 20.1 62.5 292
Religion Buddhist 77.2 42.4 20.1 83.5 152
Animist 53.5 28.1 20.3 60.0 248
Children from urban residences, from higher educated mothers, and from wealthier households
had higher consumption of iron-rich food and iron-fortified foods.
Iron-rich foods (animal foods) were consumed by 7 in 10 children. Again, it was the younger
children who had the lowest levels of consumption (39.0%) in comparison to older children
(83.8%). Less than half of children from Sekong ate iron rich foods whereas 72.1% of children from
Attapeu and 77.1% of children from Saravane reported animal food consumption. Almost 60% of
children from rural areas ate iron-rich foods but 77.7% from urban areas consumed iron-rich foods.
Those living without road access ate iron-rich foods at half the rates of those living in rural areas
with roads. Small differences were observed by education level but because of the small sample
size for the most educated mothers interpretation should be done with caution. Slightly more than
half of the children from the poorest wealth quintile ate iron-rich foods and 82.6% of those from
the richest quintile consumed iron-rich foods. Ethnic Lao, Lao-Tai speakers and Buddhist followers
reported higher frequencies of iron-rich food consumption than their counterparts.
Iron-fortified foods were consumed less frequently. Overall, 40% of children consumed a food
fortified with iron in the previous day. Less than 10% of children 6-8 months and more than 50% of

children 18-23 months consumed an iron-fortified food. More than half of the children in Attapeu
(52.8%) and less than half in Saravane (45.5%) consumed iron-fortified foods. Sekong lagged behind
these numbers with a consumption frequency of 11.4%, which was expected since neither
Sprinkles nor RUTF were provided during the time of the survey. Little variation between urban and
rural residences was noted but a large difference existed between rural residences with and
without roads. There was a fivefold difference, with rural areas with roads, having much higher
levels of iron-fortified food consumption was observed in comparison to rural areas without roads
(35.6% vs. 7.2%) perhaps a reflection of access. Level of maternal education did not affect iron-
fortified consumption levels. More than twice the proportion of children from the wealthiest
families consumed iron-fortified foods than children from the poorest families. Differences by
ethnicity, language and household head exist. Ethnic Lao, Lao-Tai speakers and Buddhists were 1.5
times more likely to consume iron-fortified foods than their counterparts.
Less than a quarter of children reported MixME consumption during the previous day (23.7%). Age
was associated with MixME consumption patterns. Very few young children, aged 6-8 months
consumed MixME (3.3%) whereas over 30% of children 18-23 months of age consumed MixME.
Consumption levels for Saravane and Attapeu were much higher than Sekong, 26.9%, 31.7% and
6.4%, respectively. Rural households consumed MixME at almost double the rate of urban
households, although rural areas without roads consumed MixME at three times lower the
proportion of those with roads. Mother’s education level did not seem to affect MixME
consumption, although the most educated mother’s had children with the lowest consumption.
Wealth also did not play a major role in MixME consumption and neither did ethnicity, language or
Religion. More data on MixMe are presented in Section 7.
4.11. Key Findings
1. Early initiation of breastfeeding and prelacteal feeding
• More than half of the mothers from the EU-UNICEF MYCNSIA Provinces initiated
breastfeeding within one hour of delivery (National levels 39.7%). One in three children
received a prelacteal feeding, which was slightly lower than national levels. In Attapeu, six
in ten children were given a prelacteal feed. Mothers assisted in delivery by a traditional
birth attendant practiced prelacteal feeding at twice the levels of mothers assisted by
skilled birth attendants.
2. Exclusive and predominant breastfeeding (0-5 months)
• More than 95% of mothers had breastfed their child. Exclusive breastfeeding in the EU-
UNICEF MYCNSIA Provinces (36.5%) was slightly lower than the national average (40.4%).
Saravane had the lowest proportion of mothers that exclusively breastfed (28.0 %) and
Sekong the highest (62.3%). The poorest and the wealthiest quintile groups demonstrated
the highest rates of exclusive breastfeeding. Nearly 60% of children 0-5 months were
predominately breastfed. Almost 80% of children were predominately breastfed in Sekong
and 65.1% in Attapeu.
3. Continued breastfeeding at 1 year and 2 years of age (12-15 months, 20-23 months)
• 80% of children were breastfed at one year. Higher breastfeeding rates at one year of age
were noted among the poorer households with lower maternal educational levels. Overall
two out of three children were breastfed at 2 years of age. Seven out of ten rural mothers
continued to breastfeed at 2 years whereas 41.4% of urban mothers followed these
practices. Lower wealth and lower maternal education levels were associated with higher
proportions of children breastfeeding at two years.

4. Age-appropriate breastfeeding (0-23 months)
• Only 40.1% of children under two years of age from the EU-UNICEF MYCNSIA provinces
were appropriately breastfed, slightly higher than the national estimate of 35.4%. In
Saravane, almost half of children under two years of age appropriately breastfeed (48.6%),
while 27.1% and 27.3% of children from Sekong and Attapeu had age-appropriate
breastfeeding, respectively. Rural children and those from poorer households met age-
appropriate breastfeeding requirements at higher proportions than children from urban
and wealthier households.
5. Bottle feeding (0-23 months)
• Only 9.2% of the children in the EU-UNICEF MYCNSIA provinces were fed with a bottle with
a nipple, almost half of the national estimate (17.5%). The proportion of children from
urban areas fed with a bottle with a nipple was more than four times that of rural children.
With higher wealth and mother’s education levels, the proportion of children fed with
bottles increased, starting from less than 3% in the lowest categories and approaching 50%
in the highest categories.
6. Introduction of solid, semi-solid or soft foods (6-8 months)
• Just over half of the children received solid, semi-solid or soft foods in the EU-UNICEF
MYCNSIA provinces (51.7%), similar to national levels (52.3%). Please note the small
sample size, but by province, Saravane had twice the proportion of young children
introduced to foods at an appropriate age (60.8%) than Sekong (30.3%). Young children
with higher educated mothers were introduced to foods at an appropriate age at a higher
proportion (66.8%) than those from less educated mothers (45.2%).
7. Dietary Diversity (6-23 months)
• Overall, only 10.3% children consumed a diet with adequate diversity. For children 6-8
months, very few (1.1%) consumed a diet that met minimum dietary diversity
requirements. Children 18-23 months had the highest percentages (17.4%) of consuming
food from the minimum number of groups. Children from urban areas were three times
more likely to meet the MDD (32.4%) than children living in rural areas (9.9%). As wealth
increased so did the proportion of children meeting MDD. Only 6.1% of children from the
poorest households met MDD, while 26.7% of children from the middle income quintile
and 41.6% of children from the richest households met MDD. Mothers from the highest
education level had the highest proportion of children meeting MDD (27.8%) relative to
only 13.3% of children from mothers with no education.
8. Minimum Meal Frequency (6-23 months)
• 41.5% of children met the minimum meal frequency for their age and breastfeeding
status, which was slightly lower than the national average (43%). Sekong had a much
lower MMF than the other two provinces for both breastfed and non-breastfed children
(9.4% and 21.1%, respectively). In Saravane, 53.7% of breastfed children met the minimum
meal frequency and 45.6% of non-breastfed children met the MMF. A positive association
between wealth and MMF existed, with children from the poorest households having a
much lower MMF (36.4%) than among the children from the wealthiest households
(60.3%).
9. Minimum Acceptable Diet (6-23 months)
• Only 5.1% of children from the EU-UNICEF MYCNSIA provinces consumed a minimum
acceptable diet (MAD). Older children received MAD at higher levels than younger

children. For children, aged 18-23 months who were still breastfeeding, 12.7% consumed a
MAD. Saravane had the highest proportion of children reaching MAD (6.6%), more than ten
times higher than in Sekong, where only 0.7% of children consumed a MAD. Children from
mothers with the lowest education had the highest MAD scores.
10. Consumption of Iron Rich Foods (6-23 months)
• Overall, 75.5% of children consumed an iron-rich or iron-fortified food (in the previous
day). The youngest children were least likely to consume these foods (43.4%), half that of
the oldest children (87.6%). Less than half of children in Sekong consumed iron-rich or iron-
fortified foods, while consumption in Saravane and Attapeu was more than 80%. Children
from urban residences, from higher educated mothers, and from wealthier households had
higher consumption of iron-rich food and iron-fortified foods.

SECTION 5 NUTRITIONAL STATUS
Anthropometry is widely employed to serve as a proxy of nutritional status of populations, as well

as the overall health of individuals. For children under five years of age, it is used to assess physical
growth, and based on comparisons to international growth references, can help to estimate the
magnitude of both acute and chronic undernutrition.
The prevalence of undernutrition in the three EU-UNICEF MYCNSIA Provinces was considerably
higher than national figures for all three anthropometric indicators (Tables 5.1-5.3). The prevalence
of underweight children in EU-UNICEF MYCNSIA Provinces (40.8%) was considerably higher than
the national average (26.6%) , while the prevalence of severe underweight (13.2%) was almost
twice as high as observed nationally (7.2%). More than half of the children from the EU-UNICEF
MYCNSIA Provinces were stunted (53.2%); while the prevalence of chronic undernutrition at the
national level was 44.2%. There were a higher percentage of children suffering from wasting in EU-
UNICEF MYCNSIA Provinces (8.7%) than the national prevalence (5.9%).
Table 5.1 Nutritional Status – Weight for age (Ages 0-59 months)
Weight for Weight Weight for Weight for
age: for age: age: age:
% < -2 SD % < -3 SD Mean (SD) n
National 26.6 7.2 -1.30 10,814
EU-UNICEF MYCNSIA Provinces 40.8 13.2 -1.70 1,369
Sex Male 40.6 11.6 -1.70 706
Female 41.0 15.0 -1.70 663
Province Saravane 41.2 13.8 -1.70 906
Sekong 46.0 14.9 -1.90 258
Attapeu 32.0 8.5 -1.50 204
Residence Urban 19.3 2.7 -1.20 129
Rural 43.0 14.3 -1.80 1,240
Age 0-5.9 16.4 5.6 -0.90 148
Groups - 6-11.9 27.6 5.6 -1.30 116
months 12-23.9 43.5 12.8 -1.70 266
24-35.9 46.4 18.0 -1.90 274
36-47.9 48.2 15.0 -2.00 289
48-59.9 43.3 14.2 -1.90 276
Wealth Poorest 51.9 17.9 -2.00 594
index Second 41.6 15.3 -1.60 356
quintile Middle 29.0 5.3 -1.50 246
Fourth 19.7 5.7 -1.30 123
Richest 12.2 0.4 -0.90 50
Mother's None 49.9 19.8 -1.90 583
education Primary 37.6 9.5 -1.60 613
Secondary and 21.5 4.3 -1.30 174
above
Ethnicity Lao 34.6 10.0 -1.50 571
Other 45.0 15.6 -1.80 794
Language Lao-Tai 34.2 10.0 -1.50 579
Mon-Khmer 45.5 15.8 -1.90 774
Religion Buddhist 35.7 10.2 -1.60 719
Animist 46.9 16.5 -1.90 631

Table 5.2 Nutritional Status – Height for age (Ages 0-59 months)
Height for Height for Height for Height for
age: age: age: age:
% < -2 SD % < -3 SD Mean (SD) n
National 44.2 18.8 -1.80 10,618
EU-UNICEF MYCNSIA Provinces 53.8 26.6 -2.10 1,337
Sex Male 56.6 27.7 -2.20 690
Female 50.7 25.4 -2.10 647
Province Saravane 54.4 26.9 -2.10 882
Sekong 62.7 36.8 -2.50 252
Attapeu 39.7 12.7 -1.60 203
Residence Urban 34.1 12.3 -1.60 128
Rural 55.8 28.1 -2.20 1,209
Age 0-5.9 21.8 7.7 -1.00 140
Groups - 6-11.9 29.5 11.4 -1.40 116
months 12-23.9 52.0 20.5 -2.10 256
24-35.9 60.2 31.5 -2.40 267
36-47.9 64.4 34.3 -2.50 284
48-59.9 64.6 35.7 -2.40 274
Wealth Poorest 64.9 38.2 -2.50 584
index Second 50.8 23.8 -1.90 341
quintile Middle 48.8 15.6 -1.80 241
Fourth 32.7 9.0 -1.50 120
Richest 18.2 5.8 -1.20 50
Mother’s None 61.0 35.9 -2.40 567
education Primary 52.3 23.0 -2.00 598
Secondary and 35.0 8.3 -1.50 172
above
Ethnicity Lao 45.6 17.9 -1.80 566
Other 59.7 33.0 -2.30 768
Language Lao-Tai 45.4 17.9 -1.80 573
Mon-Khmer 60.0 33.3 -2.30 748
Religion Buddhist 46.9 19.1 -1.80 709
Animist 62.3 35.6 -2.40 609
The prevalence of stunting amongst children under 6 months of age was 21.8%, indicating that
growth faltering had already taken place prior to birth and reflects poor overall maternal
nutritional status. The prevalence of stunting was higher among children, 6-11.9 months of age
(29.5%) but then rose sharply for children in the second year of life to 52.0%, and then rose only
moderately again in the next two years of life. This confirms the fact that the major impact on
growth faltering occurs prior to birth and then in the first two years of life.
Nutritional status varied by province. Sekong had the highest prevalence of underweight and
stunted children, with more than six out of ten children in Sekong stunted (62.7%), indicating long-
term chronic undernutrition. Almost half of the children in Sekong were underweight (46.0%). The
prevalence of underweight and stunting in Attapeu were both below the national average (and the
other two EU-UNICEF MYCNSIA Provinces), but had the highest prevalence of wasting amongst the
three EU-UNICEF MYCNSIA Provinces. Over 10% of children from Attapeu were wasted, compared
to 5.9% nationally. Saravane had a higher prevalence for all indicators: underweight (41.2%),
stunting (54.4%) and wasting (8.6%) in comparison to national figures.

When nutritional status was further stratified, children from rural areas had much higher levels of
underweight than urban children (43.0% vs. 19.2%, respectively), as well as stunting (55.8% to
34.1%), as well as wasting (9.1% to 4.5%). The prevalence of severe underweight among children
from rural areas was five times higher than children from urban areas (14.3 vs. 2.7%). The
prevalence of severe wasting among children from rural areas was twice as high as that of children
from urban areas. Rural children were also more likely to be severely stunted (28.1%) than urban
children (12.3%).
Table 5.3 Nutritional Status – Weight for height (Ages 0-59 months)
Weight for Weight for Weight for Weight for Weight for
height: height: height: height: height:
% < -2 SD % < -3 SD % > +2 SD Mean (SD) n
National 5.9 1.4 2.0 -0.40 10,671
EU-UNICEF MYCNSIA Provinces 8.7 1.6 1.3 -0.70 1,349
Sex Male 9.4 1.0 0.9 -0.70 693
Female 7.9 2.2 1.7 -0.70 656
Province Saravane 8.6 1.6 1.3 -0.70 887
Sekong 7.3 1.1 1.7 -0.50 257
Attapeu 10.6 1.9 0.8 -0.80 205
Residence Urban 4.5 0.8 2.9 -0.40 129
Rural 9.1 1.6 1.1 -0.70 1,220
Age Groups - 0-5.9 8.3 4.2 6.4 -0.20 140
months 6-11.9 7.9 0.3 0.3 -0.60 116
12-23.9 11.6 2.3 1.0 -1.00 261
24-35.9 11.9 2.2 0.3 -0.80 270
36-47.9 7.4 0.6 0.2 -0.70 287
48-59.9 4.5 0.4 1.5 -0.60 274
Wealth index Poorest 10.3 1.2 1.0 -0.70 591
quintile Second 10.8 3.0 1.7 -0.80 348
Middle 5.5 1.0 1.2 -0.60 241
Fourth 2.7 0.6 0.8 -0.50 119
Richest 4.1 0.4 3.4 -0.20 50
Mother’s None 9.6 2.4 1.3 -0.80 576
education Primary 8.6 1.0 1.2 -0.70 603
Secondary and above 5.5 0.6 1.6 -0.50 170
Ethnicity Lao 9.0 2.0 0.7 -0.70 565
Other 8.5 1.2 1.7 -0.60 781
Language Lao-Tai 8.9 2.0 0.7 -0.70 572
Mon-Khmer 8.4 1.3 1.6 -0.70 762
Religion Buddhist 8.8 1.6 0.8 -0.70 710
Animist 8.7 1.5 1.8 -0.60 620
Wealth was associated with each anthropometric indicator. As wealth increased, the prevalence of
underweight, stunting and wasting was lower. The strongest association with wealth was observed
with underweight and stunting. More than half of the children surveyed from the poorest wealth
quintile were underweight (51.9%) while the prevalence of underweight among children from the
richest wealth quintile was 12.2%. Stunting by wealth quintile showed a similar pattern. Almost two
out of three (64.9%) children from the poorest wealth quintile were stunted, while less than two
out of ten children from the richest wealth quintile were stunted (18.2%). For wasting, the
prevalence among the poorest children was higher than among children from wealthier
households, but the association was not as clear.
Mother’s education level was strongly related to nutritional status. Children with the least
educated mothers had the highest prevalence of underweight, stunting and wasting, confirming
observations from many other studies. About half of children from mothers with no education
were underweight, this figure reduced to 21.5% for children from mothers with secondary and
higher education. For stunted children, having a mother with no education almost doubled the
prevalence in comparison to more educated mothers 61.0% and 35.0%, respectively. Wasted
children from mothers with no education had a prevalence of 9.6% (2.4% - severe wasted),
whereas children with more educated mothers only had a prevalence of 5.5% (0.6%- severe
wasted).
5.1. Key Findings
• The prevalence of undernutrition is higher in EU-UNICEF MYCNSIA Provinces than the country
as a whole: underweight 40.8% vs. 26.6%, stunting 53.8% vs. 44.2%, wasting 8.7% vs. 5.9%.
Sekong has highest prevalence of underweight and stunting, 42.6% and 62.7%, respectively.
Wasting is highest in Attapeu 10.6%.
• Age-specific prevalence of stunting and underweight increases sharply for children in the first
and second half year of life and then in the second year of life. By the time children are 24
months of age, the prevalence of stunting plateaus and does not increase significantly,
suggesting that the factors which lead to chronic undernutrition take place prior to birth and
then in the first two years of life.
• Rural areas have higher prevalence in underweight, stunting and wasting than urban areas, for
underweight and wasting it is double the proportion. Poorer children and those with less
educated mothers have the highest frequencies of underweight, stunting and wasting.

SECTION 6 ANEMIA
Iron-deficiency anemia is the most prevalent micronutrient deficiency in the world. It is associated
with low birth weight, reduced resistance to infection, poor cognitive development and lower work
capacity. Children 6-24 months and pregnant and postpartum women are generally the most
affected groups. Anemic women have increased risk of maternal and perinatal mortality and
morbidity.
Serum hemoglobin was collected from 2,263 children and 1,395 pregnant or lactating women in
the EU-UNICEF MYCNSIA provinces. The data for the oldest children were not linked to
corresponding individual and household characteristics such as residence and wealth level due to
the survey design, although the data do provide estimates on anemia prevalence for a large
sample.
6.1. Childhood Anemia
Overall 34.4% of children, aged 6-59 months, were anemic with large variation by age as shown in
Table 6.1. Almost two thirds of all children aged 6-11 months were anemic (62.8%) as were over
half of the children between 12 and 23 months of age (51.7%). Anemia prevalence reduced to a
quarter for children aged 24-59 months. In subsequent tables, key factors associated with anemia
for children between 6 and 35 months of age are presented.
Table 6.1. Prevalence of Anemia in Children (Aged 6 - 59 months)
Child anemia
Anemia Hb Standard
(Hb <= 10.9 g/dL) (Mean) Deviation
Count % g/dL
EU-UNICEF MYCNSIA Provinces 2,263 34.4 11.41 ±1.39
Age Groups 6-11.9 223 62.8 10.63 1.16
(months) 12-23.9 555 51.7 10.91 1.20
24-35.9 550 25.1 11.66 1.09
36-59.9 935 22.9 11.75 1.33
Table 6.2 presents anemia results for the 1,328 children ages 6-35 months whose records were
linked for individual and household characteristics from the survey. Overall, the prevalence of
anemia for children 6-35 months was 41.7% in the EU-UNICEF MYCNSIA provinces that is a level
designated to be of ‘severe’ public health significance using WHO classification of 40% or higher,
although rates for the women and older children are lower. 12 Differences in the aggregate anemia
12
WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral
Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.1)
(http://www.who.int/vmnis/indicators/haemoglobin.pdf, accessed May 1 2013.

prevalence between these two subsets of children are a function of the different sub-sets of
younger and older children in each sample.
When results for are examined by province, Saravane and Sekong had similar anemia prevalence
levels, 45.4% and 44.2%, respectively, while Sekong had a lower prevalence of 30.9%. Slight
differences between the type of residence existed with a lower proportion of children from urban
areas suffering from anemia than rural children, 35.1% and 37.5%, although surprisingly, children
from rural areas without roads had the lowest prevalence of all residence sub-groups (22.4%).
These results should be interpreted with caution because of the small sample size of children from
rural areas without roads.
Table 6.2. Prevalence of Anemia in Children (Aged 6 – 35 months)
Child anemia
Anemia Standard
(Hb<=10.9 gm/dL) Hb (Mean) Deviation
Count % g/dL
EU-UNICEF MYCNSIA Provinces 1,328 41.7 11.17 ± 1.22
Age Groups 6-11.9 223 62.8 10.63 1.16
(months) 12-23.9 555 51.7 10.91 1.20
24-35.9 550 25.1 11.66 1.09
Sex Male 679 42.8 11.20 1.26
Female 681 42.3 11.15 1.18
Province Saravane 908 45.4 11.10 1.17
Sekong 259 30.9 11.51 1.37
Attapeu 193 44.2 11.06 1.20
Area Urban 102 35.1 11.14 1.64
Rural 623 37.5 11.28 1.22
Rural with road 556 39.4 11.22 1.21
Rural without road 68 22.4 11.74 1.22
Wealth index Poorest 347 36.8 11.34 1.27
quintile Second 188 38.1 11.18 1.15
Middle 117 42.5 11.06 1.33
Fourth 50 38.2 11.25 1.10
Richest 23 22.7 11.67 1.25
Mother's None 312 43.3 11.19 1.17
education Primary 313 33.7 11.29 1.26
Secondary and above 99 33.1 11.37 1.38
Language Lao-Tai 189 37.9 11.13 1.24
Mon-Khmer 529 37.7 11.30 1.24
Ethnicity Lao 188 37.7 11.14 1.25
Other 534 37.5 11.31 1.23
Religion Buddhist 263 40.4 11.11 1.15
Animist 452 35.8 11.35 1.28
Wealth was not significantly associated with anemia status. Children from the poorest, second,
middle and fourth wealth quintile had similar prevalence of anemia. Children from the richest
quintile did indicate a lower level of anemia but, again, interpretation should be done with caution
because of the small number of children.
Maternal education appeared to be an important factor associated with childhood anemia.
Children of the least educated mothers had the highest prevalence of anemia (43.3%), while those
children with more educated mothers (primary and secondary and above) had lower levels of one
in three (33.7% and 33.1%, respectively).

No differences were observed in childhood anemia status by language group or ethnicity of
household head. A slightly higher prevalence of anemia was found among children in Buddhist
households (40.4%) as compared to Animist households (35.8%).
6.2. Maternal Anemia
Table 6.3 describes anemia results for 1,395 pregnant and lactating women 15-49 years of age.
Overall, a high prevalence of anemia was observed (33.0%). The overall age pattern for anemia
prevalence is not clear, as women 30-34 years displayed the lowest prevalence (18.2%) and women
25-29 years of age as well as those 35 years and older showing higher prevalence (46.3% and 37.9%
respectively). However, when examining the severity-specific rates of anemia it is clear that the
older mothers have a higher prevalence of severe anemia. There does not appear to be age trends
for the prevalence of moderate and mild anemia in these mothers.
Provincially wide variation exists. Both Saravane and Attapeu have very high prevalence of 40.8%
(mean Hb 11.5 g/dL) and 29.7%, respectively. In contrast, 9.6% of women aged 15-49 years in
Sekong were anemic, which was still considered to be of mild public health significance according
to WHO classification.
Greater than a third of women from rural areas are anemic (34.8%) whereas a little over a tenth of
urban mothers are anemic (12.7%). Interestingly, women from rural residences without roads had
anemia levels similar to women from urban areas, although the sample size is small for women
from rural areas without roads so care should be taken when interpreting these figures.
Lower maternal education appears to be associated with higher anemia prevalence. Mothers with
a no education or primary level education had an anemia prevalence of 35.2% and 34.9%
respectively. Those with secondary and higher levels of education had a 13.2% prevalence of
anemia and mean Hb of 12.6 ±1.4 g/dL.
The relationship between wealth and anemia is unclear. Women from the three lowest wealth
quintiles have similar high prevalence levels of overall anemia (28.0% to 40.4%) as well as severe
anemia. The top two wealth quintiles show reduced levels of anemia prevalence as well as higher
mean Hb (11.9±1.6 g/dL and 12.1±1.2 g/dL) but due to the small samples sizes for these groups
figures are not robust.

Table 6.3. Prevalence of Anemia among Pregnant or Lactating Women
Mean
Hemoglob % Any % Anemia severity
in g/dL Anemia N
Mild
(Mean ± Severe Moderate (10-10.9
SD) (<11 g/dL) (<7 g/dL) (7-9.9 g/dL) g/dL)
EU-UNICEF MYCNSIA Provinces 11.8 ± 1.9 33.0 1.8 12.0 19.2 1,395
Maternal Age 15-19 12.2 ± 1.6 16.8 0.0 10.2 6.6 142
years 20-24 11.9 ± 1.9 33.8 0.3 11.3 22.2 430
25-29 11.5 ± 1.6 46.3 0.0 15.6 30.7 345
30-34 12.2 ± 1.7 18.2 2.0 4.8 11.4 253
35+ 11.3 ± 2.2 37.9 8.5 16.9 12.5 226
Province Saravane 11.5 ± 2.0 40.8 2.8 15.3 22.8 873
Sekong 12.9 ± 1.4 9.6 0.0 2.4 7.2 268
Attapeu 11.5 ± 1.4 29.7 0.5 10.2 19.0 254
Residence Urban 12.3 ± 1.4 12.7 0.0 8.0 4.6 117
Rural 11.8 ± 1.9 34.8 2.0 12.3 20.5 1279
..Rural with road 11.7 ± 1.9 36.3 2.1 12.9 21.3 1196
..Rural without road 12.7 ± 1.6 12.0 0.0 3.7 8.3 83
Mother's None 11.7 ± 1.8 35.2 1.5 13.1 20.6 711
education Primary 11.8 ± 2.0 34.9 2.8 12.5 19.6 544
Secondary and 12.6 ± 1.4 13.2 0.0 4.1 9.1 136
higher
Wealth index Poorest 11.9 ± 1.9 34.7 0.7 14.1 19.9 735
quintile Second 11.7 ± 1.7 28.0 4.3 6.6 17.1 353
Middle 11.5 ± 2.0 40.4 2.4 12.6 25.3 211
Fourth 11.9 ± 1.6 24.4 0.0 17.4 7.0 67
Richest 12.2 ± 1.2 14.8 0.0 4.7 10.1 29
Ethnicity Lao 11.8 ± 1.6 41.1 1.0 8.3 31.8 392
Other 11.8 ± 2.0 30.1 2.2 13.5 14.4 993
Language Lao-Tai 11.8 ± 1.6 41.0 1.0 8.3 31.7 393
Mon-Khmer 11.7 ± 2.0 30.2 2.2 13.3 14.7 970
Religion Buddhist 11.7 ± 1.7 41.7 1.8 11.2 28.7 530
Animist 11.9 ± 2.0 26.6 1.9 11.0 13.7 840
Ethnicity and language of household head showed almost little variation in maternal anemia levels.
Difference by religion was observed with those practicing Buddhism displaying higher levels of
anemia in comparison to Animists, 41.7% and 26.6%, respectively although this difference appears
to be driven by a higher number of mothers who are mildly anemic (28.7% versus 13.7%), and the
mean Hb levels in these two populations are similar.
6.3. Key Findings
• Anemia prevalence for children 6-35 months was of severe public health significance at 41.7%.
Anemia prevalence for children 6-59 months is 33.8%.
• Great variation by age exists. While almost two-thirds of children 6-11 months are anemic
(62.8%), a little over one-half of children 12-23 months are anemic (51.7%) and a quarter of
children 24-59 months (25.1%) are anemic.
• Child anemia levels vary by province with Saravane and Attapeu showing similar prevalence and
Sekong much lower proportions, 45.4%, 44.2% and 30.9%, respectively.

• Wealth, language group, and ethnicity of household head do not seem to be related to child
anemia levels, whereas a relationship with maternal education and religion seem to exist.
• This survey revealed 33.0% of pregnant and lactating mothers to be anemic. No clear linear
trends in overall anemia was observed by maternal age, with mothers of ages 30-34 years
having the lowest prevalence (18.2%) and women 25-29 the highest prevalence (46.3%).
However, when examining the prevalence of severe anemia (Hb < 7 g/dL), an increasing
prevalence of severe anemia with older maternal age is observed so that mothers who are 35
years and older had the highest rates of severe anemia (8.5%).
• Both Saravane and Attapeu provinces have prevalence levels of maternal anemia at 40.8% and
29.7%, respectively. Approximately a tenth of mothers in Sekong were anemic (9.6%).
• The most educated women had lower anemia prevalence and higher mean hemoglobin levels.
Those with secondary and higher levels of education had a 13.2% prevalence of anemia (mean
Hb 12.6±1.4 g/dL) compared to mothers with a primary level education for whom the
prevalence of 34.9% (Hb 11.8 ±2.0 g/dL and those with no education were anemic at levels of
35.2% (Hb 11.7 ± 1.8 g/dL).

SECTION 7: IYCF PROGRAMS AND INTERVENTIONS
The EU-UNICEF MYCNSIA Program includes a number of critical interventions targeted to mothers
and young children, including iron-folate supplementation and antenatal counseling to pregnant
women, IYCF counseling for caregivers, and micronutrient powder (MNP) distribution for children
6-35 months. This section provides an overview of the coverage and some key determinants of
coverage of these important interventions.
7.1. Interventions targeted to mothers
Beginning as early in the 1,000 day window of opportunity, the improvement of nutrition can help
to assure the development of a healthy newborn and set the stage for optimal health through
childhood. Table 7.1 provides an overview of critical interventions provided to women during
pregnancy. The percentage of mothers reporting having been seen by a health worker in their
previous or current pregnancy was 45.4%. About the same proportion (42.9%) indicated that they
had received some antenatal care.
The levels of ANC receipt were similar by age of the mother and by Province. However, there was
much higher contact with the health system during pregnancy for mothers living in urban areas
than rural areas (82.2% vs. 39.2% for ANC visits) while only one in ten mothers in rural areas
without roads had been seen by a health worker (11.4%) or received ANC during their last
pregnancy (9.6%). There was a clear association between health worker coverage and ANC services
with wealth and level of education. Poorer women and those with no education were much less
likely to have a contact with a health worker or receive ANC services, and in turn, less chance to get
critical information on nutrition and proper feeding practices.

Table 7.1 Women Currently Pregnant or Lactating - Receiving Supplementation
Seen by Received
Health antenatal Received Given or bought
Worker care Supplementary iron folate tablet
Current/Last Foods last current/last
pregnancy pregnancy pregnancy N
EU-UNICEF MYCNSIA Provinces 45.4 42.9 12.9 44.5 1,395
Maternal 15-19 43.0 46.5 14.8 53.7 142
Age 20-24 49.0 44.8 15.6 48.2 430
(years) 25-29 43.3 39.7 8.3 36.6 345
30-34 52.2 52.6 12.1 51.0 253
35+ 35.5 31.1 14.9 38.3 226
Province Saravane 41.8 42.5 9.8 44.5 873
Sekong 40.4 37.4 2.0 33.6 268
Attapeu 62.6 50.0 34.0 55.8 254
Residence Urban 80.4 82.2 16.1 80.3 117
Rural 42.1 39.2 12.6 41.0 1279
Rural .. with road 44.2 41.4 12.9 43.1 1196
.. without road 11.4 9.6 8.3 11.4 83
Mother's None 31.1 27.2 8.1 29.6 711
education Primary 54.7 50.0 16.7 51.0 544
Secondary and higher 78.4 91.0 20.5 89.2 136
Wealth Poorest 33.1 33.6 10.9 33.5 735
index Second 39.5 31.4 11.8 36.7 353
quintile Middle 77.5 75.8 16.9 73.6 211
Fourth 89.9 74.9 15.9 77.9 67
Richest 83.7 100.0 35.6 100.0 29
Ethnicity Lao 57.1 52.9 17.1 61.1 392
Other 40.4 38.3 11.5 37.9 993
Language Lao-Tai 57.0 52.8 17.0 60.9 393
Mon-Khmer 39.1 37.4 11.2 37.1 970
Religion Buddhist 59.2 55.6 15.7 58.1 530
Animist 35.5 33.1 10.8 37.5 840
Two important nutritional interventions provided during pregnancy include the provision of
supplementary food and iron-folate tables (IFS) as a dietary supplement. While the coverage of
mothers with supplementary foods was low overall (12.9%), it was significantly higher in Attapeu
(34.0%) than in either Saravane (9.8%) or Sekong (2.0%), and there were disparities by urban/rural
location, wealth and level of maternal education. There was a similar coverage of pregnancy
women with IFS as ANC visits, and not surprisingly, there were consistent variation in IFS coverage
with key covariate as observed with the ANC. This association is examined in greater detail in Table
7.2.

Table 7.2 Women Currently Pregnant or Lactating - Receiving Supplementation – by status of health
service delivery
Seen by Received Given or bought
Health antenatal Received iron folate
Worker care Supplementary tablet
Current/Last Foods last current/last
pregnancy pregnancy pregnancy N
Seen by Health Yes 86.4 21.8 80.6 621
worker current/last No 7.2 5.2 11.3 748
pregnancy
Received antenatal Yes 91.1 19.7 81.6 584
care No 11.1 7.3 13.7 776
Place of delivery Home 38.7 33.5 13.9 35.1 860
Health center 100.0 97.8 57.0 76.0 43
Hospital 85.1 91.4 9.0 81.0 240
Assistance at delivery No one 19.7 17.0 1.7 41.4 94
Relative/friend 30.8 24.9 8.4 30.3 650
TBA 52.7 49.2 23.0 45.2 261
Nurse/midwife 81.5 81.5 15.7 81.2 64
Doctor 85.7 91.6 16.1 78.4 239
There are a number of important observations in Table 7.2, which are not surprising, but confirm
expectations. For example, there was almost a nine fold increased likelihood that a mother would
receive ante-natal services if she was seen by a health worker, and a similarly higher probability
to be given iron folate supplements. There was a close correspondence between whether a
woman was seen by a health worker during her last pregnancy and the place of her subsequent
delivery and the type of person who provided assistance during delivery. Women who were seen
by a health worker during the pregnancy and had ante-natal services provided were more likely to
have access to and utilize the assistance of more ‘skilled’ services at the time of delivery. Indeed, in
section 4, it was noted that access to these workers was associated with adoption of appropriate
feeding practices, including the early initiation and exclusive breastfeeding. A critical component
of the EU-UNICEF MYCNSIA is the promotion of these appropriate breastfeeding practices, and
these data provide some indication of which cadre of workers is most likely to provide information
that will lead caregivers to embrace such actions.

7.2. Interventions targeted to children
Beyond the first six months of age, when children require additional foods in their diets other than
breastmilk, the availability of vitamins and minerals is often compromised. The typical weaning
diet in Laos is based primarily on rice porridge, and the EU-UNICEF MYCNSIA Program aims to
promote the consumption of iron-rich food sources to meet the physiological needs in this critical
period. An additional intervention to enhance the nutritional content of the diet in the early
weaning period is MixME, a food fortification powder intended for home use by caregivers (as
described in Section 2.5). The distribution of MixMe is accompanied by counseling on the
frequency of consumption, its benefits and the importance of continued use. In the early stages of
the EU-UNICEF MYCNSIA, there were some inconsistencies with the distribution of MixME by
Province. 13
There are several key program components that need to be in place for the effective coverage and
implementation of MixMe. The initial demand for MixMe depends on the communication
messages provided by health workers, and the subsequent behavior change requiring caregivers to
incorporate it into complementary feeding practices. The first step to inducing this behavior change
requires that caregivers be aware of MixMe and have access to ample supply. Table 7.3 provides an
overview of caregiver knowledge about MixMe and its use. There has been reasonable penetration
of messages about MixMe as noted by the fact that some 61.6% of all caregivers in the EU-UNICEF
MYCNSIA Provinces had heard of MixMe, with higher percentages in both Saravane (71.5%) and
Attapeu (67.1%) than in Sekong (21.7%). These findings are in line with programmatic coverage.
Saravane’ s MixME program began in 2010 and it is the only province that has had uninterrupted
coverage. Attapeu’ s MixME program also began in 2010 but was discontinued in 2012. There is no
systematic MixME program in place in Sekong. Caregiver awareness in this province most likely
stems from recollection of the onetime distribution in 2009 or cross fertilization from other
provinces. Mothers of older children were more likely to have heard about MixMe than mothers of
younger children, although there were no dramatic differences in knowledge by residence,
maternal education level or even wealth. This suggests that the communication channels have
been effective in disseminating messages across different sub-groups and reaching the more
vulnerable mothers.
13
In Sekong, MixME was provided as a onetime emergency response following the flooding in September 2009. At that
time, 30 MixME sachets were provided to each child between 6-59 months of age (beyond the intended target age range
of 6-23 months of age). Following this, no additional MixME sachets were supplied in Sekong prior to the MYCNSIA
baseline survey in 2011. Both Attapeu and Saravane began distributing MixME in 2010, although MixME delivery was
halted in Attapeu in 2012 because the WFP planned to distribute Plumpydoz. These specific characteristics in the
implementation need to be considered in the interpretation of the MixMe coverage data presented in the next few
sections.

Table 7.3 MixME Knowledge and Consumption
Of those # sachets received last Of those
heard time who
about 60- Received
% Ever MIXME, % <29 30-59 90 MIXME, %
Heard of Ever Ever % fed
MIXME Received Consumed MIXME in
(n=1293) (n=793) % % % (n=422) last day n
EU-UNICEF MYCNSIA Provinces 61.6 53.4 5.8 77.4 16.8 92.3 31.4 1,349
Sex Male 59.7 54.4 8.4 80.7 10.9 92.2 32.3 674
Female 63.5 52.3 3.3 74.2 22.6 92.5 30.5 675
Age 6-8 months 39.7 11.5 .0 100.0 0.0 74.7 3.3 139
9-11 months 52.8 23.5 28.6 46.2 25.2 73.1 11.5 89
12-17 months 65.4 46.0 7.8 74.6 17.5 97.0 30.2 298
18-23 months 63.6 49.3 5.6 86.8 7.6 87.2 31.0 262
24-35 months 65.2 69.6 4.2 76.1 19.7 93.7 42.2 561
Province Saravane 71.5 51.1 2.1 85.5 12.3 98.0 36.5 904
Sekong 21.7 47.5 29.2 52.5 18.3 82.2 10.3 248
Attapeu 67.1 66.7 12.7 54.7 32.6 74.4 34.0 196
Residence Urban 39.6 64.4 28.6 57.3 14.0 65.9 16.4 103
Rural 46.2 68.5 9.6 65.5 24.9 88.2 28.3 610
Rural area .. with road 50.3 68.3 9.9 65.1 25.0 89.4 31.0 549
.. without road 10.2 74.9 .0 79.5 20.5 40.4 4.4 61
Mother's None 44.8 72.9 13.7 65.0 21.4 90.2 28.7 307
education Primary 44.6 66.2 8.0 66.8 25.2 81.8 26.0 308
Secondary and above 47.9 59.9 19.8 55.1 25.1 81.7 22.5 99
Wealth Poorest 35.8 74.4 15.1 63.4 21.5 88.4 22.0 337
quintile Second 53.1 63.3 4.0 75.7 20.4 84.7 32.5 189
Middle 55.0 67.4 9.3 56.1 34.6 91.2 33.3 114
Fourth 49.7 52.2 27.9 65.5 6.6 56.9 20.1 50
Richest 53.5 78.1 28.0 36.6 35.4 74.0 29.1 25
Ethnicity Lao 56.7 67.2 10.6 69.8 19.6 78.1 27.2 184
Other 41.4 68.7 12.7 62.1 25.2 88.7 26.6 527
Language Lao-Tai 56.5 67.2 10.6 69.8 19.6 78.1 27.1 185
Mon-Khmer 41.2 68.2 13.0 61.2 25.8 88.4 26.2 521
Religion Buddhist 56.9 64.3 9.1 66.6 24.3 81.0 26.5 262
Animist 39.3 71.0 14.3 62.8 22.9 88.8 27.3 443
Weight-for- Not wasted 62.2 53.4 5.6 80.7 13.7 92.4 32.1 1142
Height Moderately wasted 55.4 57.7 6.2 54.0 39.9 90.0 30.3 140
(Wasting) Severely wasted 67.9 43.0 19.0 67.6 13.5 100.0 21.3 31
Of those that had heard of MixME, about half had received it (53.4%). Attapeu had the highest
proportion of children receiving MixME amongst caregivers who had heard about it (66.7%), while
about half of the caregivers in both Saravane and Sekong who had heard of MixME received it
(51.1% and 47.5%, respectively).
Younger children received MixME at much lower levels than older children among mothers who
had heard of MixMe. Only one in ten children, 6-8 months received MixME (11.5%), while almost
seven out of ten children, aged 24-35 months received MixME (69.6%), reinforcing a pattern seen
with food consumption. A high proportion of children classified with either moderate or severe
wasting (based on anthropometry) were just as likely to receive MixME as those who were not
wasted, which is incongruent with local guidelines to target MixME distribution to children with
adequate nutritional status. Wasted children should receive therapeutic foods specially formulated
to deal with their poor nutritional status (Section 8).

Of children who received MixME, most received enough sachets to last more than a month, with
more than three fourths reported receiving 30-59 sachets (77.4%). Of those that received MixME,
most consumed it (92.3%).
It is important to ascertain if consumption guidelines and knowledge of MixME consumption
benefits are being adequately conveyed to caregivers. Table 7.4 presents some data on caregiver
knowledge of the proper used of MixME. This information was collected amongst caregivers that
had reported hearing of and receiving MixME. One sachet of MixME should be consumed per child
per day according to WHO guidelines. Overall, 63.6% of caregivers correctly identified this number,
but almost one-quarter of caregivers believed children should consume more than one MixME
sachet in a day. Knowledge of proper consumption decreases with decreasing age. Only one in ten
(10.8%) caregivers with children 6-8 months knew the correct number of MixME sachets for daily
consumption whereas 70.9% of caregivers with the oldest children identified the correct number.
Almost 90% of caregivers with children 6-8 months incorrectly indicated that they should provide
two sachets of MixME for daily consumption.
Table 7.4 MixME Knowledge - Number of Sachets to Consume
How many sachets should be taken/day
1 2 3 >3
% % % %
EU-UNICEF MYCNSIA Provinces 63.6 23.1 9.8 3.4
Sex Male 59.0 24.8 11.7 4.6
Female 68.2 21.5 8.1 2.3
Age 6-8 months 10.8 89.2 .0 .0
9-11 months 40.4 20.2 39.4 .0
12-17 months 55.4 28.2 12.0 4.4
18-23 months 57.2 29.6 9.1 4.1
24-35 months 70.9 17.8 8.3 3.0
Province Saravane 65.7 21.9 9.5 2.9
Sekong 48.4 22.7 19.6 9.3
Attapeu 58.3 28.9 8.6 4.2
Knowledge of MixME consumption benefits amongst caregivers is necessary to encourage

complementary feeding behavior changes. A myriad of positive outcomes result from MixME
consumption and caregivers that can list these benefits are more likely to adhere to MixME
consumption guidelines (Table 7.5).

Table 7.5 MixME Knowledge – Reasons for providing MixMe amongst respondent who had provided
MixMe to their children
Make
% Ever For brain child
Heard of develop active/ Increase Reduce Don't
MIXME ment strong appetite anaemia know n
EU-UNICEF MYCNSIA 61.6 11.3 38.9 31.0 5.1 53.7 1349
Provinces
Sex Male 59.7 8.8 36.2 26.9 3.4 57.2 674
Female 63.5 13.8 41.6 35.0 6.7 50.3 675
Age 6-8 39.7 0.0 23.4 34.2 0.0 65.8 139
(months) 9-11 52.8 10.2 41.2 44.6 0.0 25.8 89
12-17 65.4 11.3 46.1 35.0 3.4 51.5 298
18-23 63.6 13.5 37.2 27.0 5.4 59.4 262
24-35 65.2 10.9 36.9 30.1 5.9 53.5 561
Province Saravane 71.5 11.6 35.0 31.4 5.7 58.9 904
Sekong 21.7 11.1 41.5 25.1 3.8 40.6 248
Attapeu 67.1 10.2 57.0 30.8 2.6 33.0 196
Residence Urban 39.6 18.2 45.8 25.7 5.1 34.5 103
Rural 46.2 4.0 42.1 30.0 1.0 41.7 610
Rural area .. with road 50.3 4.1 41.4 29.2 1.0 42.2 549
.. without 10.2 0.0 100.0 100.0 0.0 0.0 61
road
Mother’s None 44.8 3.9 29.0 25.1 0.9 53.6 307
education Primary 44.6 5.3 57.1 34.8 0.0 28.2 308
Secondary 47.9 11.1 43.9 28.7 7.4 36.8 99
and above
Wealth Poorest 35.8 1.3 29.2 29.1 0.0 48.8 337
quintile Second 53.1 0.0 53.3 23.3 0.0 39.5 189
Middle 55.0 14.4 47.5 31.3 2.0 34.9 114
Fourth 49.7 0.0 50.9 54.6 0.0 34.3 50
Richest 53.5 43.3 67.2 43.6 23.4 10.4 25
Ethnicity Lao 56.7 10.1 68.0 52.0 5.0 9.7 184
Other 41.4 3.6 32.5 20.9 0.0 53.2 527
Language Lao-Tai 56.5 10.1 68.0 52.0 5.0 9.7 185
Mon- 41.2 3.7 33.4 19.6 0.0 53.7 521
Khmer
Religion Buddhist 56.9 6.9 61.4 50.3 3.4 18.3 262
Animist 39.3 4.4 29.2 15.0 0.0 56.9 443
Weight-for- Not wasted 62.2 10.0 36.4 28.6 5.0 56.1 1142
Height Moderately 55.4 26.0 59.7 45.0 7.7 40.2 140
wasted
Severely 67.9 0.0 0.0 53.3 0.0 46.7 31
wasted
Over half of caregivers who had heard about MixMe and provided it to their child, reported that
they did not know the reasons why (53.7%), that reflects the limited exposure to communication.
It is essential that caregivers understand the benefits their child will receive from MixME
consumption and thereby feel compelled to adhere to consumption guidelines. Caregivers with
children 6-8 months were most likely not to know of any of the benefits of MixME (65.8%).
Mothers with the lowest education level were least likely to know reasons to give MixME to their
child; while only 36.8% of mothers with a higher level of education had no knowledge of the
benefits.

Overall, the most common reason reported for consumption of MixME was to make children
active/strong (38.9%) followed closely by increasing appetite (31.0%). Very few respondents linked
MixME consumption with brain development (11.3%) and even fewer indicated that it could reduce
anemia (5.1%). For mothers of children 6-8 months, there were no positive responses linking
MixMe to anemia reduction.
Respondents from Saravane didn’t know reasons for MixME consumption more than those from
Sekong and Attapeu. This is troubling because Saravane has had the longest continually running
MixME program of the three Provinces.
Table 7.6 shows the negative effects observed by caregivers of child MixME consumption. This was
an open-ended question where interviewers did not provide examples of answers and only asked
to caregivers who had heard of MixMe and had provided MixMe to their child. Overall, very few
caregivers identified any negative effects observed in their children, and in fact, the most common
response from caregivers was that they ‘did not know of any negative effects’ (53.5%). Nearly one
in three caregivers reported that ‘no negative effects were observed’, which is a different response
from not knowing negative effects. This response greatly varies by Province. In Saravane, a much
lower percentage of caregivers reported no negative effects observed (22.6%), while in Sekong half
of the caregivers (50.1%) and in Attapeu, over seven out of ten caregivers reported this (70.3%).
Caregivers of children, aged 9-11 months responded ‘no negative effects’ with the greatest
frequency (49.0%). The most common reported observed negative effect of MixME consumption
was increased appetite (4.2%). Interestingly, over a quarter of caregivers of children 9-11 months
observed an increased appetite, which is much higher than caregivers of children from other age
categories. MixME is known to encourage appetite and this observed of an increase in children 9-
11 months as something negative may indicate where communication messages may need to be
refined. Loose stool or diarrhea was the second most frequently observed negative effect of MixME
consumption (2.7%), while in Sekong, this negative effort was reported much more frequently
(17.4% ) than other Provinces.

Table 7.6 Observed Negative Effects of MixME Consumption
Loose No
% Ever Black stool/ Increased negative Do not
Consumed stool diarrhea Vomiting appetite effects know n
EU-UNICEF MYCNSIA 30.2 0.5 2.7 0.4 4.2 31.8 53.5 1349
Provinces
Sex Male 29.8 0.9 1.3 0.0 4.0 31.4 54.5 674
Female 30.5 0.0 4.0 0.8 4.3 32.3 52.5 675
Age 6-8 3.4 0.0 0.0 0.0 0.0 34.2 65.8 139
(months) 9-11 9.1 0.0 0.0 0.0 25.2 49.0 25.8 89
12-17 28.9 0.0 4.3 0.0 3.4 35.7 50.3 298
18-23 27.3 1.0 5.2 0.0 3.2 29.5 48.7 262
24-35 42.2 0.5 1.4 0.7 4.1 30.5 57.0 561
Sekong 8.5 0.0 17.4 3.6 7.1 50.1 18.3 248
Attapeu 33.0 1.7 1.6 1.3 7.1 70.3 23.0 196
Residence Urban 16.3 6.2 10.2 4.7 15.1 33.3 43.0 103
Rural 27.9 0.4 1.8 0.5 6.9 47.9 42.1 610
Rural area .. with road 30.8 0.5 1.8 0.5 7.0 47.3 42.6 549
.. without 3.1 0.0 0.0 0.0 0.0 100.0 0.0 61
road
Mother's None 29.5 0.9 2.6 0.0 5.9 27.7 62.4 307
education - Primary 23.9 0.0 3.5 2.1 9.6 64.8 19.9 308
Secondary 23.5 4.7 0.0 0.0 7.9 54.4 42.4 99
and above
Wealth index Poorest 23.6 0.0 0.0 0.0 5.5 41.6 54.5 337
quintile – Second 28.5 0.0 4.5 0.0 12.6 48.4 32.4 189
National Middle 33.8 1.9 6.2 1.9 1.3 53.5 33.3 114
Fourth 13.8 14.7 0.0 0.0 14.7 48.4 51.6 50
Richest 30.9 0.0 0.0 11.2 21.3 44.0 23.5 25
Ethnicity Lao 29.4 0.0 2.1 1.7 13.2 63.2 17.8 184
Other 25.2 1.4 2.8 0.6 5.6 40.0 51.7 527
Language Lao-Tai 29.2 0.0 2.1 1.7 13.2 63.2 17.8 185
Mon-Khmer 24.8 1.4 2.9 0.6 5.7 39.3 52.2 521
Animist 24.8 1.7 3.5 0.7 5.6 37.3 54.9 443
Height Moderately 28.8 0.0 0.0 0.0 6.3 49.5 28.9 140
wasted
Severely 25.1 0.0 13.5 0.0 0.0 14.3 72.2 31
wasted
There were many variations in observed negative effects reported across many groups. Children
from the richest wealth quintile observed an increased appetite four times more often than those
from the poorest wealth quintile. Urban caregivers observed more negative effects of MixME
consumption in comparison to their rural counterparts. Black stool, loose stool/diarrhea, vomiting
and increased appetite were listed more frequency by urban caregivers than in rural areas.
Finally, Table 7.7 lists the positive effects observed by caregivers of children who had consumed
MixME. Again, this was an open-ended question where interviewers did not provide examples of
answers, as was the case for observed negative effects. About half of the caregivers with children
that consumed MixME reported not observing any positive benefit. Over half of the respondents

from Saravane stated not knowing any observed benefits. In Attapeu less than one in three
reported similarly. Caregivers from Lao ethnic and language groups again did not observe any
benefits, but as discussed with results of observed negative effects, this may be a result of a
difference in messaging amongst ethnic groups.
Overall, only 5% of caregivers indicated that no positive effects were observed after their child
consumed MixME, a result that is different from not knowing observed positive effects. Urban
caregivers responded with much higher frequencies than rural caregivers to observing no positive
effects after child consumption of MixME. Caregivers with children 6-8 months reported the
lowest frequencies of observed positive effects. Responses by other age groups varied in
frequencies of observed positive effects.
The most common answer for observed positive effects, apart from not knowing, was that MixME
increased appetite, which was reported by one in three caregivers. Caregivers of 9-11 month old
children responded that MixME consumption increased their child’s appetite at the highest levels
(45.4%). Over half of the children that had consumed MixME from the richest wealth quintile and
those with a Lao ethnic household head responded that MixME consumption increased appetite,
half the level of the poorest and minority ethnic group.
Nearly one in three caregivers indicated that MixME increased their child’s energy or activity level
making it the second most reported outcome. This was followed by makes child healthy (24.2%),
makes child stronger (20.9%) and makes child less sick (11.9%).
Improved physical growth (3.4%) was the least observed positive effect overall, followed closely by
mental development/smarter (5.3%). Although mother’s with the highest education and from the
richest wealth quintile chose this response at higher frequencies than those from lower education
and wealth quintiles.
Caregivers of severely wasted children observed an increase in appetite and made their child less
sick and moderately and non-wasted children but reported lower levels for all other outcomes.
7.3. Key Findings
• Overall, 60% of caregivers had heard of MixME, but there were variations by Province
(Saravane 71.5%, Sekong 21.7%, and Attapeu 67.1%). Awareness of MixME was highest for
older, rural and wealthier children. Of those that had heard of MixME, 53.4% received it.
Older children receive MixME more often than younger children. Amongst those who received
it, MixME was widely consumed, overall 92.3% (Saravane 98.0%, Sekong 82.2%, Attapeu
74.4%).
• Among those who ever received MixMe, 63.6% of caregivers correctly identified one MixME
sachet as the proper dose to consume daily. Almost one-quarter of caregivers believed
children should consume more than one MixME sachet in a day. Knowledge of proper
consumption decreases with decreasing age. 89.2% of caregivers with children 6-8 months
incorrectly recalled two sachets for daily consumption.
• More than half of caregivers did not know the reasons for giving MixME to their children.
Overall the most common reason reported for giving MixME was to make child active/strong
(38.9%) followed closely by increasing appetite (31.0%). Very few respondents recalled that
MixME consumption helped with brain development (11.3%) and even fewer recalled it
reduced anemia (5.1%).

• Over 30% of caregivers reported that no negative effects were observed with child
consumption of MixME. Few caregivers identified negative effects. The most common
reported observed negative effect of MixME consumption was increased appetite, 4.2%.
• Overall, 49.2% of caregivers with children that consumed MixME reported not knowing any
positive effect. Only 5% reported that there were no observed positive effects. The most
reported positive effect of MixME consumption by caregivers was that it increased their child’s
appetite (33.3%), followed by increased their child’s energy/ activity level (31.8%), makes child
healthy (24.2%), makes child stronger (20.9%), makes child less sick (11.9%). Mental
development (5.3%) and improved physical growth (3.4%) were less frequently identified by
caregivers.

Table 7.7 Observed Positive Effects of MixME Consumption
Increased Mental Makes Makes Improved NO
% Ever Increased energy/ development/ Less child child physical positive Don't
Consume appetite activity smarter sick healthy stronger growth effects Know Total
EU-UNICEF MYCNSIA Provinces 30.2 33.3 31.8 5.3 11.9 24.2 20.9 3.4 5.0 49.2 1349
Sex Male 29.8 31.0 30.5 5.4 13.7 25.6 24.3 3.4 2.1 53.0 674
Female 30.5 35.7 33.1 5.1 10.1 22.8 17.5 3.3 7.8 45.4 675
Age 6-8 3.4 23.4 23.4 0.0 0.0 10.8 .0 .0 .0 65.8 139
(months) 9-11 9.1 45.4 41.2 0.0 0.0 24.4 .0 .0 10.2 25.8 89
12-17 28.9 35.6 36.8 0.0 18.3 30.8 27.8 4.6 5.5 46.1 298
18-23 27.3 20.8 29.9 6.6 9.2 18.7 19.9 1.5 6.5 53.2 262
24-35 42.2 36.2 30.3 7.1 10.9 23.6 19.7 3.7 4.2 49.6 561
Province Saravane 35.6 30.9 30.6 5.9 14.3 26.9 23.0 2.8 3.8 54.3 904
Sekong 8.5 34.9 26.9 7.1 7.3 20.4 24.3 7.3 8.4 33.8 248
Attapeu 33.0 44.4 39.1 1.7 1.7 12.6 9.4 4.7 9.8 29.2 196
Residence Urban 16.3 24.2 22.0 0.0 4.2 19.1 9.4 9.6 22.0 37.3 103
Rural 27.9 34.2 28.8 2.1 3.3 17.5 10.3 1.8 2.6 39.4 610
Rural area ..Rural w/ road 30.8 33.5 27.9 2.1 3.3 17.7 10.5 1.8 2.7 39.8 549
..Rural no road 3.1 100.0 100.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 61
Mother's None 29.5 25.2 23.8 1.8 4.6 10.5 4.0 0.0 1.8 51.9 307
education - Primary 23.9 42.3 33.1 1.5 3.1 26.5 14.6 2.9 4.6 26.8 308
categories Secondary and 23.5 32.8 27.5 3.1 0.0 15.3 18.4 10.5 14.1 33.7 99
above
Wealth index Poorest 23.6 27.6 24.5 0.0 2.0 12.6 7.8 1.4 2.0 46.4 337
quintile - Second 28.5 40.7 24.4 0.0 0.0 21.6 7.0 0.0 2.1 39.9 189
National Middle 33.8 29.2 38.5 6.8 8.8 16.6 14.9 2.9 7.5 30.2 114
Fourth 13.8 39.8 30.0 9.7 15.9 9.8 .0 0.0 14.7 35.8 50
Richest 30.9 52.7 33.3 0.0 0.0 55.5 44.0 33.3 22.4 11.2 25
Ethnicity Lao 29.4 50.1 35.8 3.7 6.1 35.1 23.4 9.2 3.3 9.6 184
Other 25.2 26.7 25.1 1.1 2.3 11.0 5.1 0.0 5.0 50.6 527
Language Lao-Tai 29.2 50.1 35.8 3.7 6.1 35.1 23.4 9.2 3.3 9.6 185
Mon-Khmer 24.8 27.5 24.0 1.2 2.4 11.3 5.3 0.0 5.2 51.1 521
Religion Buddhist 29.4 48.9 42.5 2.5 4.2 31.1 19.7 6.3 2.2 18.8 262
Animist 24.8 22.3 18.1 1.4 2.8 8.4 3.7 0.0 6.2 53.4 443
Weight-for- Not wasted 30.6 30.1 29.9 4.7 11.5 23.4 19.9 1.9 4.9 53.3 1142
Height Moderately 28.8 44.4 52.3 10.6 7.7 24.9 30.4 17.8 7.7 23.2 140
wasted
Severely wasted 25.1 67.6 0.0 0.0 14.3 0.0 0.0 0.0 0.0 32.4 31

SECTION 8: FEEDING PROGRAM FOR CHILDREN WITH ACUTE UNDERNUTRITION
In addition to efforts to prevent undernutrition and reduce the conditions that lead to chronic
undernutrition, the EU-UNICEF MYCNSIA Program supports the implementation of supplementary and
therapeutic feeding programs to address short term acute undernutrition. These programs are managed
by multiple agencies through Lao PDR. Children are screened for acute undernutrition by community
health workers (CHW) and volunteers that have been trained to use mid-upper arm circumference
(MUAC) tapes, which provide easily interpreted results based on the color of the tape to classify children
as severely or moderately undernourished, or adequately nourished. Worker confidence in the ability to
properly use and interpret the MUAC is critical to assure effective screening and targeted of resources
to those most in need. Children identified by MUAC tape as undernourished receive specially formulated
foods with high concentrations of micronutrients.
8.1. Screening and enrollment in feeding programs
Table 8.1 describes the status of screening and enrollment in feeding programs for children 6-35 months
of age in the EU-UNICEF MYCNSIA Provinces. Overall, 37.3% of children were screened for malnutrition
in the previous four months. This is lower than the planned rate where at least 70% of children less than
five years are assessed for acute malnutrition on a monthly basis (Implementation Plan for Community
Management of Acute Malnutrition in Southern Laos, 2011). Baseline data shows that both children
living in urban and rural areas are being screened at similar levels, although those in rural areas with no
road were significantly less likely to have been screened (9.6%). Wide variations were seen between the
three provinces. Attapeu reported the highest screening coverage of the three provinces, with more
than half of children screened (57.7%). Levels in Saravane and Sekong were much lower, 38.8% and
16.0%, respectively. Overall the community health workers used a MUAC tape almost 80% of the time.
In both Attapeu and Saravane, the use of MUAC by health workers was well over 80%, but in Sekong, 1
in ten CHW’s used a MUAC tape (10.9%).
A strong relationship was noted between age and the likelihood of being screened, with older children
more often screened than younger children. Only 20.4% of children 6-8 months reported being seen in
the past four months to determine eligibility for feeding program while children 18-35 months were
twice as likely to be screened (41.0%). Older children were also much more likely to be screened with a
MUAC tape in comparison to younger children, 82.6% and 44.4%, respectively. The very low use of
MUAC tapes in the younger children suggests an operational bottleneck that should be addressed, or
may have been an artifact of the survey design as these children would have not been screen four
months prior to the survey as they were not eligible (by age).
Results from use of the MUAC tape identified 9.0% of children as severely malnourished, 43.2% as
moderately malnourished, and 45.7% as having adequate growth. Only 2.0% of screened children
received no verbal result from the worker. The highest proportion of severely malnourished children
was among children between 18-23 months and most of these children were from Saravane. Severely
malnourished children were characterized as being from rural residences, the bottom two wealth
quintiles, and ethnic and language minority groups. Most of these children were from families that
practiced Animist religion.
Girls were more likely to be moderately malnourished children than boys, 54.4% and 31.9%,
respectively. The highest prevalence of moderately malnourished children was among children 6-8
months and those from the bottom wealth quintile and lowest maternal education bracket.

Table 8.1 Screening and Enrollment in Feeding Programs
% seen by The color of the result of measurement % Enrolled in
CHW/ % Enrolled in Therapeutic % No Feeding % Not
volunteer last Yellow Supplementary Feeding program in enrolled
4 months to Red (Severe (moderate Green (child was Worker did feeding Outpatient area, so not in any TOTAL
determine % CHW/ malnutrition) malnutrition) okay) not say program program enrolled program N
eligibility for volunteer
feeding used
program MUAC tape % % % %
EU-UNICEF MYCNSIA 37.3 79.1 9.0 43.2 45.7 2.0 18.3 3.8 8.3 69.6 1349
Provinces
Sex Male 39.3 75.5 7.8 31.9 56.8 3.6 15.7 3.9 7.4 72.8 674
Female 35.3 83.2 10.1 54.4 34.9 0.5 20.9 3.7 9.3 66.4 675
Age 6-8 months 20.4 44.4 0.0 80.4 19.6 0.0 4.8 0.0 10.4 85.3 139
9-11 months 23.0 63.4 0.0 38.6 61.4 0.0 11.8 1.0 14.5 72.8 89
12-17 months 39.3 78.4 10.6 46.6 42.8 0.0 18.3 5.6 7.0 69.3 298
18-23 months 41.0 84.8 12.3 51.6 36.2 0.0 27.3 2.8 7.0 63.1 262
24-35 months 41.0 82.6 7.6 36.1 52.0 4.2 18.5 4.7 8.1 68.4 561
Province Saravane 38.8 82.0 11.5 45.2 42.1 1.2 20.9 5.2 4.7 68.8 904
Sekong 16.0 10.9 0.0 0.0 0.0 0.0 1.2 0.8 23.1 76.0 248
Attapeu 57.7 94.2 2.6 38.5 54.8 4.1 27.7 1.0 6.3 65.0 196
Residence Urban 37.8 53.2 0.0 38.2 50.9 10.9 9.8 1.6 27.2 61.4 103
Rural 38.7 74.3 7.5 42.4 48.6 1.5 18.3 6.8 8.1 67.3 610
..Rural with road 42.0 74.7 7.6 43.3 47.6 1.5 20.3 7.6 8.7 63.7 549
..Rural without road 9.6 58.4 0.0 0.0 100.0 0.0 0.0 0.0 2.1 100.0 61
Mother's None 41.0 70.3 4.0 52.6 40.1 3.3 19.2 9.8 5.6 65.9 307
education Primary 37.1 75.2 11.0 39.4 48.0 1.6 16.7 3.4 13.0 67.3 308
Secondary & above 35.8 62.5 0.0 19.6 76.1 4.3 11.7 2.6 20.4 65.3 99
Wealth Poorest 34.4 74.7 6.1 52.0 38.7 3.2 16.4 8.6 6.1 69.6 337
index Second 43.0 70.2 13.0 33.3 53.7 0.0 17.2 4.1 10.5 68.2 189
quintile - Middle 48.4 67.9 0.0 40.7 51.5 7.7 19.7 5.3 15.1 60.6 114
National Fourth 34.3 58.0 0.0 34.5 65.5 0.0 18.3 1.4 19.8 60.5 50
Richest 26.3 89.4 0.0 17.3 82.7 0.0 10.5 0.0 40.0 49.4 25
Ethnicity Lao 35.7 87.3 0.0 45.2 52.3 2.5 20.3 5.8 12.9 61.4 184
Other 39.8 66.3 9.1 40.6 47.6 2.7 16.0 6.2 10.2 68.0 527
Language Lao-Tai 35.6 87.3 0.0 45.2 52.3 2.5 20.2 5.8 12.8 61.6 185
Mon-Khmer 39.6 65.7 8.3 39.7 49.1 2.8 16.2 5.6 10.2 68.4 521
Religion Buddhist 38.4 82.4 1.1 36.7 59.2 3.1 18.7 4.9 12.5 64.2 262
Animist 38.0 67.6 10.8 46.0 40.8 2.4 16.5 6.9 9.8 67.4 443
Weight-for- Not wasted 36.9 76.9 5.9 42.4 49.9 1.8 16.2 3.4 8.9 71.5 1142
Height Moderately wasted 40.1 93.5 17.1 54.2 26.7 2.0 31.3 4.0 6.1 58.6 140
Severely wasted 51.0 91.2 27.9 48.3 13.9 9.9 48.5 18.0 1.4 33.5 31

Inconsistencies between the classification with MUAC tape and wasting status as determined by weight
and height measurements is worrisome. MUAC tape identified only 27.9% of severely wasted children as
severely malnourished, and incorrectly identified 17.1% of moderately wasted and 5.9% of non-wasted
children as severely malnourished. 54.2% of moderately wasted children were correctly identified to be
moderately malnourished by MUAC tape while 48.3% of severely wasted and 42.2% of non-wasted
children were incorrectly classified by MUAC tape as moderately malnourished. Most concerning was
the 13.9% of severely wasted and 26.7% of moderately wasted children were erroneously determined to
be adequately nourished by MUAC tape. The highest proportion of children that received no verbal
result after screening was the sub-group of children with severe wasting (9.9%). It should be noted that
children identified in the past 4 months by MUAC prior to the survey period may have improved during
the survey. Furthermore, new cases may have been identified during the survey that may have been
missed out in the screening given the coverage is always a challenge. Indeed, there are studies
conducted in SE Asia reflecting discrepancies between W/H and MUAC and the need for better criteria
for admission and discharge in feeding programs.
At the time of the baseline survey the World Food Program (WFP) managed the supplementary feeding
program in Lao PDR. Supplementary feeding programs are targeted to moderately malnourished
children. The EU-UNICEF MYCNSIA survey followed the devastating 2009 flooding in Sekong and families
suffered from increased food insecurity as a result of the flooding. WFP provided rice-soy blend (RSB+)
and rice for families.
At the time of the survey, 18.3% of children 6-35 months were enrolled in a supplementary feeding
program in the last four months. Attapeu had the highest enrollment (27.7%) for supplementary feeding
program, Saravane’ s enrollment was slightly lower (20.9%) and Sekong’ s was significantly lower (1.2%),
signifying the fact the there was no supplementary feeding program yet in place in Sekong. Children
from rural areas were enrolled at levels twice that of urban children (18.3% to 9.8%), but there were no
children enrolled from rural areas with no road access. Children of uneducated mothers had the highest
proportion of enrollment (19.2%). Only 31.3% of moderately wasted children, the target group, were
enrolled in a supplementary feeding program. Almost half of severely wasted were enrolled in a
supplementary feeding program, while 16.2% of children who were measured and found to not be
wasted were somehow enrolled for supplementary feeding. This discrepancy in enrollment of eligible
children highlights the need for improved targeting of at-risk children.
In 2011, UNICEF managed the outpatient/therapeutic program for children identified as severely
malnourished. Overall 8.3% of children were enrolled in a therapeutic or outpatient program at the time
of the baseline survey. Children from Saravane had the highest enrollment in such programs (5.2%).
Only 18% of severely wasted children, the target group, were enrolled in these programs. Poor, rural
children, with mothers of low education, characterize the majority of those enrolled in
outpatient/therapeutic programs. A total of 4.0% moderately wasted and 3.4% non-wasted children
were enrolled in these programs. Overall, severely wasted children reported the highest levels of
enrollment in either a supplementary or therapeutic feeding program that was followed by the
enrollment of moderately wasted children.
Only 8.3% of mother/caregivers (children) reported that a feeding program was not available in their
area. Almost a quarter of mother/caregivers (children) from Sekong reported similarly, 4.7% in Saravane
and 6.3% in Attapeu. Urban children and those from educated mothers and wealthier households
reported higher frequencies of programs being unavailable in their area. Only 1.4% of mother/caregivers
of severely wasted and 6.1% of moderately wasted children reported that a feeding program was
unavailable in their area.

Almost 70% of children are not enrolled in any program. Sekong had the lowest enrollment level, three-
quarters of children reported not participating in any program, although it should be noted that
therapeutic and supplementary feeding programs are in place only for those who are acutely
malnourished. Hence, children who are not acutely malnourished will not be enrolled. Children 6-8
months reported the lowest enrollment of all ages. Of children moderately wasted, over half (58.6%)
were not enrolled in any program and one in three (33.5%) of severely wasted children were not
enrolled in any program. 71.5% of non-wasted children are not enrolled in a program which translates
into about one-third of non-wasted children receiving services for which they do not meet eligibility
requirements. These inconsistencies with eligible children not receiving appropriate services
underscores the need for better targeting of children’s’ wasted status to ensure that the most
disadvantaged receive support and that the use of the resources are optimized.
8.2. Receipt of Supplementary and Therapeutic Foods

In 2011, Community Management of Acute Malnutrition (CMAM) was fully implemented in Lao PDR.
Three organizations work in collaboration to manage children suffering from acute malnutrition. The
WHO worked with inpatient individuals, providing F75, F100 and Plumpynut to patients admitted in the
hospital with acute malnutrition with complications. UNICEF oversees the outpatient program,
monitoring and screening children. Eezeepaste is provided by UNICEF to acutely malnourished children.
The WFP implemented supplementary feeding programs including the provision of RSBplus that is rice-
soya blend with added micronutrients.
Specific fortified foods are provided to children in Lao PDR based on nutritional status. Rice-Soya blend
(RSB) or Corn-Soya blend (CSB) powders are provided to children identified as moderately malnourished.
Eezeepaste and Plumpunut are provided to severely malnourished children. MIXME is the home based
fortification product provided to children 6-24 months who have adequate nutrition status. Plumpydoz
is a ready-to-use supplementary product in some Provinces, but was distributed in the target Provinces
at the time of the baseline survey. . Table 8.2 describes the consumption pattern of supplementary and
therapeutic foods for children 6-35 months. Overall, MixME is the most commonly consumed fortified
food by children 6-35 months. One in three children reported consuming MixME that is intended to
supplement the diets of children with adequate growth status. Corn-Soya blend in the second most
consumed fortified food (14.3%) followed by Eezeepaste/Plumpynut (13.1%), and Rice-Soya blend (
9.0%). Less than 1% of children reported consuming Plumpydoz or Nutributter. Iron fortified infant and
toddler formula was consumed by 3.4% of children.
Age was associated with consumption of fortified foods. Excluding formula in which children 9-11
months report the highest consumption, children 6-8 months old report the lowest consumption
patterns of fortified foods and children 12-35 months the highest. Sekong had the lowest reported
consumption of supplemental and therapeutic foods. When formula is excluded, rural residents
consume fortified foods at higher levels than urban dwellers. This trend is also observed for children
from lower educated mothers. Consumption levels vary by wealth index.
Rice-Soya blend (RSB) powder is targeted for children identified as moderately malnourished, but where
RSB+ was not available, WFP provided CSB so coverage rates may be affected by availability. . Within the
three provinces, 9.0% of children 6-35 months receive RSB powder. Children 18-23 months had the
highest consumption level (12.5%). Slightly over 10% of children from Saravane and Attapeu consume
RSB. In Sekong less than 1% consumes RSB. Rural residents reported consumption of RSB at almost two
times the proportion of urban residents (14.1% vs. 7.9%). Additional characteristics of children that
consumed RSB were that they were from the wealthiest households and the least educated mothers.

Severely wasted children consume RSB at 3 times the level of moderately wasted children and almost 2
times the level of non-wasted children. Those determined moderately malnourished by MUAC tape
have the highest proportion of RSB consumption (28.1%) followed by those identified as severely
malnourished (23.0%), which is the target group. 10% of children determined fine by MUAC tape
reported RSB consumption.
Table 8.2 Supplementary and Therapeutic Foods
% Received Received Iron
Rice-Soya % Received % Received % fortified
Blend Corn-Soya Eezee paste Received % Received infant/toddler Received TOTAL
powder Blend /Plumpynut Plumpydoz Nutributter formula MixMe N
EU-UNICEF MYCNSIA 9.0 14.3 13.1 0.7 0.9 3.4 31.4 1,349
Provinces
Sex Male 9.2 12.7 12.0 0.1 0.5 3.2 32.3 674
Female 8.8 16.0 14.3 1.3 1.3 3.6 30.5 675
Age 6-8 months 1.6 5.3 0.8 0.8 0.8 4.0 3.3 139
9-11 months 6.6 8.1 4.7 0.0 0.0 10.0 11.5 89
12-17 months 9.8 14.4 17.7 0.3 0.8 2.1 30.2 298
18-23 months 12.5 23.7 15.9 0.5 1.1 3.0 31.0 262
24-35 months 9.1 13.1 13.7 1.1 1.0 3.1 42.2 561
Sekong 0.6 1.6 0.0 0.0 0.3 5.5 10.3 248
Attapeu 12.7 30.3 5.1 0.9 2.9 7.4 34.0 196
Residence Urban 7.9 11.7 2.6 0.0 0.0 22.6 16.4 103
Rural 14.1 15.4 6.9 0.6 1.5 1.9 28.3 610
Rural area ..Rural with road 15.4 16.9 7.7 0.7 1.7 2.1 31.0 549
..Rural without 2.9 2.9 0.0 0.0 0.0 0.0 4.4 61
road
Mother's None 16.6 16.8 6.6 0.2 0.8 0.7 28.7 307
education Primary 10.7 13.8 6.6 0.6 1.8 4.9 26.0 308
Secondary and 10.8 12.8 4.4 1.1 1.1 16.7 22.5 99
above
Wealth Poorest 14.6 16.1 6.1 0.2 1.0 0.9 22.0 337
index Second 12.5 12.2 8.6 0.9 1.8 2.1 32.5 189
quintile - Middle 8.6 15.9 5.3 0.0 1.4 4.3 33.3 114
National Fourth 12.7 11.9 1.9 0.0 0.0 21.5 20.1 50
Richest 21.2 21.2 4.2 4.2 4.2 46.1 29.1 25
Ethnicity Lao 15.1 14.2 9.1 0.8 1.0 11.1 27.2 184
Other 12.6 15.2 5.3 0.4 1.4 2.6 26.6 527
Language Lao-Tai 15.1 14.2 9.1 0.8 1.0 11.1 27.1 185
Mon-Khmer 12.3 15.4 4.9 0.4 1.4 2.6 26.2 521
Animist 13.9 15.1 5.8 0.2 1.2 1.7 27.3 443
Corn-Soya blend (CSB), also targeted for moderately malnourished children, is more widely consumed
than RSB. Overall respondents reported consuming CSB 1.5 times the proportion of RSB (14.3%). Almost
a quarter (23.7%) of children 18-23 months consumed RSB. In Attapeu, almost 1 in 3 (30.3%) children
consume CSB. About half as many children reported CSB consumption in Saravane (14.3%) and only
1.6% of children consume CSB in Sekong. Moderately wasted children, which are the target group,
reported higher levels of consumption (23.4%) in comparison to moderately wasted and non-wasted
children. Almost two-thirds of children determined severely malnourished by MUAC tape consumed CSB
and only one in two moderately malnourished children reported consumption. 20.5% of children
determine adequately nourished and 15.4% of children that did not receive a result consumed RSB.
Eezeepaste and Plumpynut are intended for severely malnourished children. Overall, 13.1% of children
consume it. Saravane reported more than three times higher proportions of Eezeepaste and Plumpynut
consumption than Sekong and Attapeu. No children in Sekong, which as the highest prevalence of
underweight and stunted children, reported Eezeepaste and Plumpynut consumption. Both poorer and
rural children reported higher levels of consumption than other children. Severely wasted children
reported higher frequencies of consumption (22.2%). More than half of moderately malnourished
children (determined by MUAC) reported consumption. Only 44.3% of children determined severely
malnourished and 16.8% of children identified as adequately nourished consumed Eezeepaste or
Plumpynut.
Table 8.3 Supplementary and Therapeutic Foods
%
Received
Rice- Received Iron
Soya % Received % Received % fortified
Blend Corn-Soya Eezee paste Received % Received infant/toddler Received TOTAL
powder Blend /Plumpynut Plumpydoz Nutributter formula MixMe N
Height Moderately wasted 5.5 23.4 17.0 0.3 0.5 0.8 30.3 140
Severely wasted 17.7 14.0 22.2 0.0 0.0 4.7 21.3 31
The color of the Red (Severe 23.0 64.8 44.3 2.7 5.0 14.8 64.5 30
result of malnutrition)
measurement Yellow (moderate 28.1 49.0 53.9 2.4 3.7 3.4 41.7 143
malnutrition)
Green (child was 10.5 20.5 16.8 0.8 0.8 6.2 57.9 151
okay)
Worker did not say 0.0 15.4 0.0 0.0 0.0 0.0 56.0 7
Less than 1% of children reported consuming Plumpydoz of Nutributter. Those from the wealthiest
quintile and determined severely malnourished by MUAC tape reported slightly elevated consumption
frequencies.
MixME is intended for children that have not been identified as malnourished. More than twice as many
children consumed MixME than any other fortified food. As already described, but presented here for
completeness, MixME was consumed by less than 1 in 3 children (31.4%) overall. Caretakers reported
that over half (56.0%) of children consuming MixME were screened by a CHW/volunteer that did not
report the results of the MUAC tape. This exposes a lost opportunity for screeners to inform caretakers
about the nutritional status of their child and the reasons for and benefits of MixME consumption. Of
those identified as severely malnourished by MUAC tape 64.5% reported consumption and 41.7% of
those moderately malnourished. Of the targeted children (those with adequate nutrition) 57.9%
consume MixME. By anthropometry, 21.3% of severely wasted and 30.3% of moderately wasted
children consumed MixME. For those children who were not classified as wasted, which are the target
group, 32.1% consumed MixME.
Overall, iron fortified infant or toddler formula is consumed by a small percentage (3.4%) of the children
from the three provinces, although significant variation is observed across multiple covariates. Attapeu
had the highest formula level (7.4%), followed by Sekong (5.5%) and Saravane (1.9%). Children from
urban areas receive formula at higher levels (22.6%) than children from rural residences (1.9%).
Mother’s education level is associated with consumption patterns of children receiving formula.
Mothers with a secondary or higher education level provide formula significantly more (16.7%) than
mothers with no education (0.7%). Almost half of the children from the richest wealth quintile receive
formula (46.1%), whereas less than 1% of those from the poorest wealth quintile receive formula.
Children determined severely malnourished by MUAC tape received formula at more than twice the
level of children determined adequately nourished and more than four times that of moderately
malnourished children.

8.3. Key Findings
Screening
• The EU-UNICEF MYCNSIA survey results highlight inconsistencies in the screening and targeting of
eligible undernourished children for enrollment in feeding programs. Overall, 37.3% of children
were screened for malnutrition in the previous four months. Attapeu reported the highest screening
coverage of the three provinces, with more than half of children screened (57.7%). Levels in
Saravane and Sekong were much lower, 38.8% and 16.0%, respectively.
• Low use of MUAC tapes in the younger children (44.4% compared to 82.6% for children 24-35
months) suggests an operational bottleneck that should be addressed.
• Inconsistencies between the classification with MUAC tape and wasting status as determined by
weight and height measurements are worrisome. The data showed that 13.9% of severely wasted
and 26.7% of moderately wasted children were erroneously determined to be adequately
nourished by MUAC tape.
Enrollment
• Only 31.3% of moderately wasted children, the target group, were enrolled in a supplementary
feeding program. Almost half of severely wasted were enrolled in a supplementary feeding
program, while 16.2% of children who were measured and found to not be wasted were somehow
enrolled for supplementary feeding. This discrepancy in enrollment of eligible children highlights
the need for improved targeting of at-risk children.
• Almost a quarter of children from Sekong reported that a feeding program was not available in
their region.
• Of children moderately wasted, over half (58.6%) were not enrolled in any program and one in
three (33.5%) of severely wasted children were not enrolled in any program. Approximately one-
third of non-wasted children were receiving services for which they do not meet eligibility
requirements. These inconsistencies with eligible children not receiving appropriate services
underscores the need for better targeting of children’s’ wasted status to ensure that the most
disadvantaged receive support and that the use of the resources are optimized.
Receipt of Supplementary/Therapeutic Foods
• One in three children reported consuming MixME that is intended to supplement the diets of
children with adequate growth status. Corn-Soya blend in the second most consumed fortified food
(14.3%) followed by Eezeepaste/Plumpynut (13.1%), and Rice-Soya blend( 9.0%). Less than 1% of
children reported consuming Plumpydoz or Nutributter. Iron fortified infant and toddler formula
was consumed by 3.4% of children.
• RSB consumption - (RSB) powder is targeted for children identified as moderately malnourished.
o Severely wasted children consume RSB at 3 times the level of moderately wasted children
and almost 2 times the level of non-wasted children.
o Those determined to be moderately malnourished by MUAC tape had the highest
proportion of RSB consumption followed by those identified as severely malnourished
(23.0%), which is the target group. 10% of children determined fine by MUAC tape reported
RSB consumption.
• CSB consumption - Overall respondents reported consuming CSB 1.5 times the proportion of RSB
(14.3%).

o In Attapeu, almost 1 in 3 (30.3%) children consume CSB. About half as many children
reported CSB consumption in Saravane (14.3%) and only 1.6% of children consume CSB in
Sekong.
o Moderately wasted children, which are the target group, reported higher levels of
consumption (23.4%) in comparison to moderately wasted and non-wasted children.
o Almost two-thirds of children determined severely malnourished by MUAC tape consumed
CSB and only one in two moderately malnourished children reported consumption.
• Eezeepaste and Plumpynut are intended for severely malnourished children. Overall, 13.1% of
children consumed it.
o Saravane reported more than three times higher proportions of Eezeepaste and Plumpynut
consumption than Sekong and Attapeu.
o No children in Sekong, which is home to the highest prevalence of underweight and stunted
children, reported Eezeepaste and Plumpynut consumption.
o Severely wasted children reported higher frequencies of consumption (22.2%).
o Only 44.3% of children determined severely malnourished and 16.8% of children identified
as adequately nourished consumed Eezeepaste or Plumpynut.
• Less than 1% of children reported consuming Plumpydoz or Nutributter.
• MixME is intended for children that have not been identified as malnourished. MixME was
consumed by less than 1 in 3 children (31.4%) overall.
o Caretakers reported that over half (56.0%) of children consuming MixME were screened by
a CHW/volunteer that did not report the results of the MUAC tape. This exposes a lost
opportunity for screeners to inform caretakers about the nutritional status of their child and
the reasons for and benefits of MixME consumption.
o Of those identified as severely malnourished by MUAC tape 64.5% reported consumption
and 41.7% of those moderately malnourished. Of the targeted children (those with
adequate nutrition) 57.9% consume MixME. By anthropometry, 21.3% of severely wasted
and 30.3% of moderately wasted children consumed MixME. For those children who were
not classified as wasted, which are the target group, 32.1% consumed MixME.
Consumption of formula
• Overall, iron fortified infant or toddler formula is consumed by a small percentage (3.4%) of the
children from the three provinces, although significant variation is observed across multiple
covariates. Attapeu had the highest formula level (7.4%), followed by Sekong (5.5%) and Saravane
(1.9%).
• Almost half of the children from the richest wealth quintile receive formula (46.1%), whereas less
than 1% of those from the poorest wealth quintile receive formula.
• Children determined severely malnourished by MUAC tape received formula at more than twice the
level of children determined adequately nourished and more than four times that of moderately
malnourished children.

SECTION 9: FOOD SECURITY
A major determinant of chronic undernutrition is poor dietary intake, which is related to overall food
availability and consumption. The EU-UNICEF MYCNSIA survey collected information about food
consumption and food insecurity from 2,031 households: 1,413 households from Saravane, 283
households from Sekong, and 335 households from Attapeu (weighted sample). The following section
provides estimates on household food consumption, and the sources of foods consumed in the past
week, food shortages, coping strategies in the previous month, and the seasonality of food shortages
during the past year. Two sets of indicators were employed to characterize the household’s food
security. The first, based on the ‘food consumption score’ is an objective parameter based on the
consumption of different food items, their frequency and nutritional value, while the second indicator is
a more subjective expression provided by the respondents themselves regarding household food
security, and where relevant, strategies to cope with food shortages.
9.1. Household Food Consumption in Last Week and Food Sources
Table 9.1 provides the overall Food Consumption Score (FCS) for the thee EU-UNICEF MYCNSIA
provinces. The FCS was calculated according to the World Food Program, Vulnerability Analysis and
Mapping Branch (ODAV), and provides a standardized indicator of food consumption that enables
comparisons to be made between different countries and settings.
The FCS is a composite score based on dietary diversity, food frequency, and relative nutritional
importance of different food groups. The FCS is based on household 7-day food frequency data. These
data are weighted based on nutrient density values assigned to each of the foods in each group. The
FCS derived from the EU-UNICEF MYCNSIA was internally validated generating food consumption
clusters through Cluster Analysis and Principal Component Analysis. Thresholds for the FCS have been
developed by the World Food Program to characterize the overall diet of households as either poor (FCS
< 21), borderline (21.5-35) or acceptable (FCS > 35).
The overall mean FCS was 48.3 (S.D. 16.4). Of the over 2,000 households enumerated in the EU-UNICEF
MYCNSIA Provinces, 5.1% were classified as having a poor diet, 17.1% with borderline and 77.8% with
acceptable household food security. This compares to some 87.3% of all households classified as having
an acceptable diet for the country as a whole, and only 2.1% with poor and 10.6% with borderline FCS. 14
As such, the three EU-UNICEF MYCNSIA Provinces had less household food security than the country as
a whole, but some of the patterns and disparities within the EU-UNICEF MYCNSIA Provinces were of
particular note. Of the three EU-UNICEF MYCNSIA Provinces, Sekong had a much higher percentage of
households classified with poor food security (14.0%) and borderline (30.2%) than the other two.
Households in rural areas, and especially those without access to roads had very poor food consumption
scores, likely a reflection of limited access. Neither the household size nor the number of children under
five years of age were associated with the overall food consumption scores. However, the educational
status of the head of household and household wealth were both significantly related to food security.
14
World Food Program. Comprehensive Food Security and Vulnerability Analysis (CFSVA). December, 2007.

Table 9.1 Household Food Security – Food Consumption Score
Food Consumption Score Categories
Total
Borderline Less than
House-
Mean Poor (%FCS 21.5- Acceptable Acceptable holds
FCS SD (% FCS<21) 35) (% FCS >35) (% =<35)
MYNSIA Provinces 48.3 16.4 5.1 17.1 77.8 22.2 2,031
Province Saravane 47.7 14.4 4.0 16.0 80.0 20.0 1,413
Sekong 41.7 18.4 13.8 30.3 55.8 44.2 283
Attapeu 57.4 19.5 2.4 10.5 87.1 12.9 335
Residence Urban 61.4 21.4 2.0 10.5 87.4 12.6 166
Rural 45.1 16.4 6.5 24.9 68.6 31.4 950
..Rural with road 45.8 16.3 5.0 24.7 70.3 29.7 883
..Rural without 36.3 16.4 25.9 27.5 46.7 53.3 67
road
No. Household <4 51.9 18.6 4.0 15.7 80.4 19.6 518
members 5-6 49.1 16.9 4.7 17.0 78.3 21.7 585
7-8 45.8 15.4 5.8 20.7 73.5 26.5 498
9> 46.6 13.5 5.9 14.4 79.7 20.3 428
No. children < 5yr 0 50.7 17.2 4.9 14.9 80.2 19.8 837
1 48.1 16.4 5.5 16.3 78.2 21.8 611
2+ 45.5 14.8 4.9 20.9 74.2 25.8 584
Education of None 41.5 15.2 8.6 30.3 61.1 38.9 304
Household head Primary 45.6 16.5 6.4 23.6 70.0 30.0 533
Secondary 56.3 18.5 3.0 9.1 87.9 12.1 142
Post-secondary 62.4 20.8 1.1 9.2 89.7 10.3 117
Wealth index Poorest 39.6 13.7 9.2 33.0 57.8 42.2 450
quintile Second 44.4 15.2 7.6 23.9 68.5 31.5 276
Middle 52.4 15.5 1.5 12.0 86.5 13.5 197
Fourth 64.0 17.9 .5 2.9 96.6 3.4 105
Richest 75.1 17.2 .0 .5 99.5 .5 67
Ethnicity of Lao 57.5 18.5 1.4 9.3 89.3 10.7 384
household head Other 42.6 15.9 8.4 28.6 63.0 37.0 709
Language group of Lao-Tai 57.5 18.5 1.4 9.4 89.2 10.8 386
household head Mon-Khmer 42.2 15.8 8.6 29.4 62.0 38.0 689
Religion of Buddhist 55.7 18.5 1.8 11.6 86.7 13.3 519
household head Animist 40.8 14.9 9.8 30.8 59.5 40.5 568

Limited education among household heads and low levels of household wealth were both factors
associated with low food consumption scores. Only 61% of all of households whose head had no
education and only 57% of the poorest households were classified as having acceptable food security,
considerably lower than other sub-groups. There seemed to be a general association between food
security and ethnicity, language and religion in which non-Laotian headed households that did not
practice Buddhism were much more likely to have compromised food consumption. These observations
were further elucidated when examining the average consumption of specific food groups as in the next
section (Figures 9.1 and 9.2).
Figure 9.1. Patterns of Food Consumption – Average days of consumption by FCS score
7
6 Poor (< 21)
Borderline (21.5-35)
Number of Days
5
4 Acceptable (> 35)
3
2
1
0
Food group
Figure 9.1 provides a graphical representation of the average frequency of consumption of food groups
by FCS categories, while Figure 9.2 presents the weekly consumption data as stacked area graphs to
depict the relative consumption of food items by individual Food Consumption Score. For those
households with a FCS 50 or above, the relative frequency of vegetables and meat is fairly stable, while
the frequency of consumption of fruits, milk, pulses, oil and sugar continue to increase. The diversity of
foods consumed among HH with FCS <35 is much more limited with little fruit and meats; as the diet
consists primarily of staple rice and vegetables.

Figure 9.2. Patterns of Food Consumption – Weekly consumption by FCS score
60
Poor Borderline Acceptable FCS Sugar
Oil
FCS FCS
Milk
50 Fruit
FCS= 21 FCS= 35 Pulse
Household Weekly Consumption of Food Items
Vegetables
Meats and Fish
40
30
20
10
96.5
99.5
110
105.5
14
18
21
24
27
30
33
36
39
42
45
48
51
54
57
60
63
66
69
72
75
78
81
84
87
90
93
Food Consumption Score
Tables 9.2 – 9.4 provide additional information on the foods consumed by households in the last week
and the sources of these foods. Among the 2,031 households surveyed, the daily household
consumption of rice was universal and showed no variation between groups. It was grown by nearly all
households (94.7%). Vegetables were the second most commonly consumed food group by households
(86.5%) with 81.6% of these households growing the vegetables they consumed. Only 11.9% of
households purchased vegetables and 6.5% gathered them in the wild. The third most commonly
consumed food group was fish (79.8%). It was observed that most households that consumed fish
caught their own fish (81.1%) and 14.2% of households purchased their fish. Fruit and meat, the fourth
and fifth most commonly consumed group were consumed in similar frequencies, 56.4% and 56.2%,
respectively.
Fruit was grown two-thirds of the time and purchased the remaining one-third. The meat that was
consumed was purchased by most households (48.0%), hunted by 35.5% and raised by 16.5%.
Lentils/tofu was consumed by 37.9% of households in the last week, which were grown by 72.3% of the
households and purchased by the rest. Eggs were the least commonly consumed group with only 29% of
households reporting to have consumed eggs in the last week. Of the households that did consume
eggs, 55.1% raised their own eggs and 44.9% purchased eggs.
Households in Saravane reported a slightly higher frequency in consumption of vegetable/fruit and
slightly lower frequency in consuming milk, sugar and oil/butter than the other provinces. Sekong
households reported higher frequencies of consuming corn/tuber and sugar group. Attapeu showed
households consuming fish/aquatic animal and meat more frequently.
Urban households reported higher daily frequency of consuming fish, meat, egg, pulses, milk, and sugar
and oil/butter. Households from rural residences without roads reported a considerably higher
frequency of consumption of corn/tubers with lower daily food consumption all other food items.
With increasing numbers of household members and children under 5, the frequency of consuming
eggs, milk, sugar and oil, but these were the least consumed food groups. The frequency of corn/tuber
consumption was higher among larger households and where there were a larger number of children
under 5 years of age. Higher education and greater wealth were both associated with more frequent
consumption of all foods expect for rice that was constant and corn/tubers that decreased. Clear
increases in the frequency of consuming egg, milk, sugar and oil/butter groups were observed between
the wealthier and poorest households. Frequency of meat consumption is also related to wealth and a
three-fold difference between the least and most educated households.
Sources of food differed by province. Households from Saravane were more likely to grow, raise, or hunt
their own food sources as compared to purchase them as compared to the other two provinces.
Overall, Attapeu households were more likely to purchase their food than Sekong or Saravane.
Only 1.3% of households reported receiving rice or corn aid in the previous week. Food aid availability
appeared to be occurring in Attapeu province where a slightly higher frequency of households reported
receiving aid (3.5%) compared to 0.8% for Saravane and Sekong. Characteristics of households that
tended to receive corn or rice food aid included urban dwelling, small household size, few children less
than 5 years of age, higher education, higher wealth quintile, and ethnic Lao, Lao-Tai speaker and
Buddhist religion. Although the absolute levels of food aid coverage are very low, the fact that those
less vulnerable were not beneficiaries is of some concern.

Table 9.2 Household Food Consumption –Mean Weekly Consumption
Staple Pulse Vegetables Fruit Meats and Fish Milk Sugar Oil Total
Mean Mean Mean Mean Mean Mean Mean Mean House-
days SD days SD days SD days SD days SD days SD days SD days SD holds
EU-UNICEF MYCNSIA Provinces 7.0 0.1 1.1 1.8 5.1 2.2 1.7 2.1 5.3 2.3 0.5 1.6 1.2 2.1 1.2 2.3 2,031
Province Saravane 7.0 0.0 1.2 1.8 5.0 2.1 1.5 1.9 5.4 2.2 0.3 1.2 0.8 1.7 0.9 2.0 1,413
Sekong 7.0 0.1 0.6 1.3 4.9 2.5 1.6 2.0 4.0 2.6 0.5 1.5 1.6 2.5 1.4 2.3 283
Attapeu 7.0 0.2 0.9 1.7 6.0 1.9 2.4 2.5 5.9 2.0 1.5 2.6 2.6 2.6 2.6 2.7 335
Residence Urban 7.0 0.1 1.2 1.8 5.6 2.0 2.9 2.5 6.0 1.9 2.1 2.8 3.4 2.9 3.1 2.8 166
Rural 7.0 0.2 0.6 1.4 5.1 2.2 1.7 2.1 4.8 2.5 0.5 1.5 1.1 2.0 1.5 2.4 950
. ..Rural w/road 7.0 0.2 0.7 1.4 5.2 2.2 1.8 2.1 4.8 2.4 0.5 1.5 1.1 1.9 1.5 2.4 883
..Rural no road 7.0 0.0 0.1 .5 4.6 2.9 1.2 2.0 3.5 2.8 0.3 1.1 1.3 2.3 .7 1.7 67
No. <4 7.0 0.2 1.1 1.8 5.3 2.1 2.1 2.3 5.5 2.3 0.9 2.1 1.7 2.4 1.5 2.5 518
Household 5-6 7.0 0.0 1.1 1.9 5.3 2.2 1.8 2.1 5.3 2.4 0.6 1.7 1.4 2.3 1.4 2.4 585
members 7-8 7.0 0.1 0.9 1.7 4.9 2.2 1.4 2.0 5.1 2.4 0.3 1.2 1.0 1.9 1.1 2.2 498
9> 7.0 0.0 1.1 1.7 5.1 2.2 1.4 1.8 5.4 2.3 0.2 1.0 0.7 1.7 .8 1.8 428
No. children 0 7.0 0.1 1.1 1.8 5.3 2.1 1.9 2.2 5.5 2.3 0.7 1.8 1.6 2.3 1.4 2.3 837
< 5yr 1 7.0 0.0 1.1 1.8 5.1 2.2 1.8 2.1 5.2 2.4 0.5 1.6 1.1 2.0 1.3 2.3 611
2+ 7.0 0.2 1.0 1.7 5.0 2.2 1.2 1.7 5.1 2.3 0.3 1.2 0.8 1.8 1.0 2.1 584
Education of None 7.0 0.2 0.5 1.1 5.0 2.3 1.7 2.1 4.3 2.6 0.3 1.2 0.9 1.8 1.4 2.4 304
Household Primary 7.0 0.1 0.6 1.4 5.2 2.2 1.7 2.1 4.8 2.4 0.6 1.6 1.2 2.1 1.4 2.4 533
head Secondary 7.0 0.0 1.3 2.0 5.6 2.0 2.3 2.2 5.8 2.0 1.2 2.3 2.3 2.5 2.3 2.6 142
Post-secondary 7.0 0.1 1.2 1.9 5.6 2.0 3.1 2.5 6.1 1.8 2.1 2.8 3.3 2.8 3.4 2.7 117
Wealth Poorest 7.0 0.2 0.5 1.2 5.0 2.4 1.4 1.9 4.1 2.6 0.2 0.8 0.5 1.5 1.3 2.4 450
index Second 7.0 0.0 0.6 1.5 5.0 2.3 1.7 2.0 4.7 2.5 0.4 1.4 1.2 1.9 1.3 2.2 276
quintile Middle 7.0 0.0 0.7 1.4 5.6 1.9 2.1 2.1 5.7 2.0 0.9 1.9 2.1 2.4 1.9 2.4 197
Fourth 7.0 0.1 1.2 1.7 5.7 1.9 3.2 2.4 6.4 1.4 2.2 2.8 3.4 2.7 2.9 2.6 105
Richest 7.0 0.0 2.0 2.2 6.1 1.7 4.2 2.3 6.9 .6 3.3 2.9 4.3 2.6 4.3 2.4 67
Ethnicity Lao 7.0 0.0 1.1 1.7 5.4 2.1 2.6 2.4 6.0 1.8 1.4 2.4 2.5 2.6 2.0 2.6 384
Other 7.0 0.2 0.5 1.3 5.1 2.3 1.6 2.0 4.4 2.5 0.4 1.3 0.9 1.9 1.6 2.5 709
Language Lao-Tai 7.0 0.0 1.1 1.7 5.4 2.1 2.6 2.4 6.0 1.8 1.4 2.4 2.5 2.6 2.0 2.6 386
Mon-Khmer 7.0 0.2 0.5 1.3 5.1 2.3 1.6 2.0 4.3 2.5 0.4 1.3 0.9 1.9 1.6 2.5 689
Religion Buddhist 7.0 0.0 1.0 1.7 5.5 2.0 2.4 2.4 5.9 1.9 1.3 2.3 2.3 2.6 1.9 2.5 519
Animist 7.0 0.2 0.5 1.2 5.0 2.3 1.5 1.9 4.1 2.6 0.3 1.1 0.8 1.8 1.6 2.5 568

Table 9.3 Household Food Consumption – % Consumption in last week and Source of food items
% Rice Lentils/Tofu Vegetable Fruit

Received Consu
any rice or Consume med
corn aid in Consumed d last Consumed Gathered last Gathered
last week last week Grown Purchased week Grown Purchased last week Grown Purchased in wild week Grown Purchased in wild
EU-UNICEF MYCNSIA 1.3 100.0 94.7 5.3 37.9 72.3 27.7 86.5 81.6 11.9 6.5 56.4 65.8 31.3 2.9 2,031
Provinces
Province Saravane 0.8 100.0 98.2 1.8 42.0 81.4 18.6 84.7 85.9 7.1 7.0 55.6 71.2 26.0 2.8 1,413
Sekong 0.8 99.7 87.7 12.3 22.9 58.4 41.6 86.6 83.7 13.2 3.2 51.7 67.3 30.3 2.5 283
Attapeu 3.5 100.0 84.5 15.5 32.7 27.0 73.0 94.8 62.2 30.6 7.2 64.6 43.9 52.3 3.8 335
Residence Urban 3.3 100.0 56.5 43.5 42.3 13.6 86.4 94.2 44.3 52.7 2.9 79.8 29.2 70.1 .7 166
Rural 1.4 99.9 97.2 2.8 24.8 65.3 34.7 86.8 78.1 9.4 12.5 59.6 70.9 26.2 2.9 950
. ..Rural w/road 1.5 100.0 97.0 3.0 26.2 66.0 34.0 87.7 77.2 9.7 13.1 61.5 70.0 27.1 2.9 883
..Rural no road .6 99.0 99.4 .6 6.7 33.7 66.3 75.7 91.8 4.7 3.5 36.2 90.4 6.4 3.2 67
No. <4 1.7 100.0 88.8 11.2 42.3 57.9 42.1 89.0 72.6 21.5 5.9 62.6 56.4 40.7 2.9 518
Household 5-6 1.1 99.9 93.7 6.3 36.4 68.8 31.2 87.7 80.2 13.2 6.6 58.9 61.7 34.4 3.9 585
members 7-8 1.3 99.9 97.6 2.4 34.7 83.0 17.0 86.7 86.2 6.8 7.0 51.9 70.9 27.6 1.5 498
9> .9 100.0 98.8 1.2 39.5 82.4 17.6 82.6 88.2 5.5 6.3 52.0 77.6 19.2 3.1 428
No. 0 1.4 100.0 93.1 6.9 41.3 65.3 34.7 88.6 78.8 16.6 4.6 61.6 57.2 40.2 2.6 837
children < 1 1.8 99.9 94.9 5.1 37.7 72.4 27.6 87.1 82.2 11.2 6.7 60.1 68.5 29.4 2.1 611
5yr 2+ .6 99.9 96.8 3.2 33.8 83.1 16.9 83.2 84.9 6.2 8.9 45.8 76.2 19.3 4.5 584
Education None .9 99.9 97.6 2.4 18.8 79.3 20.7 83.7 73.6 8.2 18.2 57.3 79.8 17.0 3.2 304
of Primary 1.4 99.9 94.7 5.3 25.3 64.5 35.5 86.4 80.7 10.1 9.2 59.1 71.0 26.4 2.7 533
Household Secondary 2.8 100.0 85.7 14.3 44.0 42.8 57.2 94.2 63.7 28.5 7.8 71.2 41.9 55.5 2.7 142
head Post- 4.4 100.0 64.3 35.7 42.9 11.2 88.8 94.9 51.0 47.1 1.9 83.4 27.4 72.2 .5 117
secondary
Wealth Poorest 1.2 99.8 97.9 2.1 18.7 90.9 9.1 83.8 79.5 2.8 17.8 48.7 85.8 9.3 4.9 450
index Second 1.1 100.0 96.2 3.8 23.2 67.9 32.1 82.6 81.5 9.6 8.9 60.7 78.8 19.2 2.0 276
quintile Middle 2.2 100.0 90.4 9.6 33.3 51.1 48.9 94.9 75.2 19.1 5.7 72.1 53.0 45.6 1.4 197
Fourth 3.4 100.0 76.1 23.9 45.0 18.9 81.1 97.2 56.9 41.0 2.1 88.5 29.0 69.9 1.1 105
Richest 4.0 100.0 50.2 49.8 64.2 4.8 95.2 97.1 25.5 73.0 1.5 96.0 17.6 81.7 .7 67
Ethnicity Lao 2.6 100.0 83.0 17.0 41.1 32.6 67.4 92.4 61.5 32.9 5.5 75.4 43.0 54.8 2.2 384
Other 1.3 99.9 95.4 4.6 20.6 74.7 25.3 85.0 79.5 7.1 13.4 56.1 76.4 20.8 2.7 709
Language Lao-Tai 2.6 100.0 83.0 17.0 41.2 32.9 67.1 92.4 61.7 32.8 5.5 75.3 42.9 54.9 2.2 386
Mon-Khmer 1.2 99.9 95.5 4.5 20.2 75.5 24.5 84.7 79.7 6.8 13.5 55.5 77.3 19.9 2.8 689
Religion Buddhist 2.1 100.0 85.5 14.5 38.0 37.5 62.5 92.9 66.2 28.0 5.8 72.9 47.8 49.9 2.3 519
Animist 1.5 99.8 96.3 3.7 19.1 81.3 18.7 83.0 79.7 5.1 15.2 54.4 80.1 17.1 2.7 568

Table 9.4 Household Food Consumption – % Consumption in last week and Source of food items (con’t)
Fish Meat Egg
Consumed Consumed Consumed
n
last week Farmed Purchased Fished last week Livestock Purchased Hunted last week Farmed Purchased
EU-UNICEF MYCNSIA Provinces 79.8 4.7 14.2 81.1 56.2 16.5 48.0 35.5 29.0 55.1 44.9 2,031
Province Saravane 81.9 4.8 5.5 89.7 56.1 16.6 39.7 43.7 24.6 69.6 30.4 1,413
Sekong 62.3 6.0 32.1 61.9 58.2 15.7 58.1 26.1 30.6 33.1 66.9 283
Attapeu 85.6 3.6 41.4 54.9 55.0 16.5 73.4 10.1 48.3 34.0 66.0 335
Residence Urban 84.6 8.0 72.5 19.5 74.4 6.0 90.1 3.8 59.4 11.2 88.8 166
Rural 76.3 5.2 15.2 79.7 49.0 25.1 51.4 23.5 30.1 57.4 42.6 950
. ..Rural w/road 78.0 5.4 15.5 79.1 49.1 24.5 53.8 21.7 31.0 56.6 43.4 883
..Rural no road 55.0 .9 9.7 89.4 47.9 33.0 19.1 47.8 18.8 75.0 25.0 67
No. Household <4 80.7 6.5 22.1 71.5 50.7 14.3 66.1 19.7 39.8 43.1 56.9 518
members 5-6 77.2 3.1 18.7 78.3 60.2 15.9 49.0 35.1 26.6 47.0 53.0 585
7-8 82.7 5.8 10.1 84.1 54.2 13.9 45.7 40.5 25.8 64.8 35.2 498
9> 78.8 3.7 5.1 91.2 59.6 22.5 30.0 47.5 24.7 76.1 23.9 428
No. children < 5yr 0 81.4 5.5 20.6 74.0 53.1 17.4 57.4 25.2 37.7 54.0 46.0 837
1 78.8 5.2 14.5 80.2 57.8 18.2 49.1 32.6 25.1 47.3 52.7 611
2+ 78.8 3.2 5.4 91.4 59.1 13.5 34.5 52.0 21.8 67.1 32.9 584
Education of None 72.5 4.6 10.8 84.6 39.8 20.1 49.7 30.2 18.3 60.3 39.7 304
Household head Primary 75.9 5.5 17.4 77.1 52.7 25.7 50.4 23.9 30.6 54.1 45.9 533
Secondary 85.3 8.5 40.0 51.6 66.4 16.2 75.3 8.6 58.8 41.2 58.8 142
Post-secondary 86.8 5.8 65.9 28.3 76.8 11.9 86.0 2.1 62.1 15.6 84.4 117
Wealth index Poorest 69.6 2.3 5.4 92.3 38.2 26.6 34.8 38.6 16.8 76.8 23.2 450
quintile Second 74.2 6.5 15.1 78.4 49.7 25.4 49.9 24.8 32.0 61.3 38.7 276
Middle 85.1 8.5 31.9 59.6 66.8 19.1 69.8 11.1 45.2 36.3 63.7 197
Fourth 92.1 10.3 57.8 32.0 81.4 16.7 80.2 3.1 62.2 25.1 74.9 105
Richest 95.4 5.5 79.6 14.8 88.4 6.2 93.8 .0 84.3 13.8 86.2 67
Ethnicity Lao 88.6 7.0 39.0 53.9 63.9 18.2 72.6 9.2 54.5 35.2 64.8 384
Other 71.5 4.9 15.6 79.5 47.6 22.3 50.9 26.8 23.9 56.3 43.7 709
Language Lao-Tai 88.7 7.0 38.9 54.1 63.9 18.2 72.6 9.2 54.4 35.1 64.9 386
Mon-Khmer 70.8 5.1 15.8 79.1 47.0 21.5 50.4 28.0 22.8 53.7 46.3 689
Religion Buddhist 87.5 7.0 34.8 58.2 61.3 17.9 71.8 10.3 50.3 36.4 63.6 519
Animist 68.0 4.5 13.3 82.2 46.5 24.7 45.1 30.1 20.5 63.1 36.9 568

Urban households were more likely to have consumed each food item in the last week in comparison to
the rural households. As expected urban households purchased foods most commonly while the
majority of rural households grew or caught their own food. Among urban households the most
commonly grown food was rice (56.9%) followed by vegetables (44.3%). The majority of urban
households purchased their meat and eggs (90.1% and 88.8% respectively). With regards to food
purchasing behavior for rural households the most frequently purchased foods were meat and eggs
were also (51.4% and 42.6%, respectively).
As the household size increased, the weekly consumption of food groups decreased, and farming
became the most common source of the plant-based foods. Larger households were more likely to rely
on hunting than purchasing of their meat. These same trends are observed for the number of children
under 5 in a household. Higher educated households were more likely to have consumed each type of
food item in the last week than the less educated households. The higher educated the household is the
more likely they are to purchase food for consumption.
9.2 Receipt of Conditional Food/Cash Grants and Frequency of Food Consumption in Last Week.
Table 9.5 describes the household receipt of cash or food to whether households attended a health
facility in the previous 6 months. Overall, less than one in ten households received cash or food to
attend a health facility in the previous 6 months (9.6%). Saravane reported the highest proportions of
households receiving cash or food to attend a health facility, with Attapeu second, and Sekong the least
(12.3%, 4.8% and 1.1%, respectively).
Rural households had twice as likely to receive cash or food to attend a health facility than urban
households (8.8% vs. 3.9%). Of the rural households, those with access to roads were 4 times more likely
to have received conditional cash/food aid than those rural residences without roads (9.3% versus 2.3%)
which may suggest that targeted is not as effective in reaching the most vulnerable when looking at
place of residence.
As would be expected, larger households and households with a greater number of young children
reported having received food or cash grants in the last 6 months. The largest households (9 or more
members) reporting having receiving cash/food grants more often (13.5%) as compared to smaller
households (5.3%). The number of children under 5 years of age in a household was also related to the
likelihood of cash grants. Only 4% of households with no children under-five years of age received
conditional food/cash grants, while at least 13% of households with 1 or more young children reported
having received such grants.
Those with lower educational and wealth levels were more likely to receive food/cash grants.
Households of non-Lao ethnicity, Mon-Khmer language, and Animist religion reported higher somewhat
levels of having received food or cash grants to attend a health facility compared to ethnic Lao, Lao-Tai
speakers and Buddhist respondents. Households categorized with poor food security were less likely
to receive cash or food aid (2.1%) than those categorized with borderline (10.3%) or acceptable (9.9%)
food consumption scores, suggesting that there are clearly opportunities for more effective targeting.

Table 9.5 Household Food Security – Receipt of Cash/Food in last six months
% received
cash/food
to attend health
facility in last 6
months n
EU-UNICEF MYCNSIA Provinces 9.6 2,031
Province Saravane 12.3 1,413
Sekong 1.1 283
Attapeu 4.8 335
Residence Urban 3.9 166
Rural 8.8 950
. .. with road 9.3 883
.. without road 2.3 67
Number Household <4 persons 5.3 518
members 5-6 9.0 585
7-8 10.7 498
9> 13.5 428
Number children 0 children 4.0 837
< 5 yrs. age 1 13.2 611
2+ 13.0 584
Education of Household None 11.7 304
head Primary 7.7 533
Secondary 5.2 142
Post-secondary 2.5 117
Wealth index quintile Poorest 12.6 450
Second 4.5 276
Middle 5.7 197
Fourth 3.7 105
Richest 3.9 67
Ethnicity Lao 4.8 384
Other 9.6 709
Language Lao-Tai 4.7 386
Mon-Khmer 9.3 689
Religion Buddhist 4.6 519
Animist 10.9 568
Food consumption score Poor 2.1 97
Borderline 10.3 321
Acceptable 9.9 1470

9.3. Coping Strategies to manage Food insecurity
An additional metric, the Coping Strategies Index (CSI) was derived as a rapid assessment of household
food insecurity based on strategies used to cope with reduced food availability. The reduced version of
the CSI was calculated for the EU-UNICEF MYCNSIA to be able to compare food security across the
different social and geographical contexts in the provinces of Laos. The standard five coping behaviors
as shown in Table 9.6 were weighted and combined to develop the CSI according to the field manual
developed by the World Food Program and Care International.
Overall the mean CSI followed a pattern consistent with the more subjective indicator of ‘households
reporting to have inadequate food or money to purchase food’ (also presented in Table 9.6). The
overall percentage of households with a high coping index (CSI > 12) was 28.3%, while 23.2% of
households reported that they had inadequate food or money to purchase food. By province, Attapeu
had the lowest level of food insecurity based on both indicators, while Sekong consistently had the
highest level of food insecurity with 55.5% of households having CSI scores >12, and 49.6% of
households reporting inadequate food or money to purchase foods. As was seen with the FCS, almost
seven of every ten households in rural areas with no access to roads had elevated CSI and self-reported
food insecurity.
The poorer, less educated households were much more likely to report that they suffer from food
insecurity then their wealthier, educated counterparts, with 47.7% of the poorest groups suffering from
food insecurity compared to 3.0% of the richest households, and 44.5% of the households with no
education compared to 9.5% of households with highest education levels which reported to be food
insecure.
Ethnicity, language group and religion of household head showed roughly the same magnitude of
association. Ethnic Lao, Lao-Tai speakers and those of Buddhist religion had less food insecurity as
compared to other groups.
Table 9.6 lists the coping strategies employed by households in the past month. The most common
strategy overall was to limit portion sizes at mealtimes (49.3%). The second most common coping
strategy was to borrow food or receiving help from friends or relatives (40.8%) , followed by reducing
the number of meals eaten (39.6%), restricting consumption by adults so small children could eat
(37.9%), and consuming less preferred or less expensive foods (36.7%).

Table 9.6 Food Insecurity and Coping Strategies
Coping
% with % Household practicing Coping Strategies Strategies
1
inadequate Index (CSI)
food, or Consumed
Borrowed Restricted
inadequate less Limited Reduced Total HH
food, or consumption
money to preferred, portion number Mean % HH
help from by adults so
buy food in less size at of meals CSI CSI>12
friend/relat small children
past month expensive mealtimes eaten
ives could eat
foods
EU-UNICEF MYCNSIA
23.2 36.7 40.8 49.3 37.9 39.6 7.6 28.3 2,031
Provinces
Province Saravane 16.9 19.3 35.4 48.2 33.2 31.0 7.5 21.3 1,413
Sekong 49.6 50.8 69.8 69.3 68.2 69.7 10.5 55.5 283
Attapeu 28.9 62.8 10.2 21.1 3.6 16.3 3.6 5.1 335
Residence Urban 16.6 65.5 47.6 51.4 40.1 42.2 8.7 29.3 166
Rural 38.2 43.2 50.6 59.8 44.8 47.5 9.2 35.2 950
. ..Rural with 35.8 40.8 48.4 58.0 40.7 42.7 9.0 30.4 883
road
..Rural 68.3 59.7 65.3 72.3 72.4 80.0 10.7 68.0 67
without
road
No. <4 20.6 34.9 39.3 38.7 24.4 29.1 6.1 20.4 518
Household 5-6 24.4 39.0 44.2 49.5 42.5 39.9 7.9 27.2 585
members 7-8 23.8 32.9 40.1 54.5 33.5 42.8 7.1 28.1 498
9> 23.7 39.8 38.2 52.6 49.0 45.0 9.3 37.2 428
No. children 0 20.0 32.3 36.7 44.6 23.7 32.8 6.0 19.3 837
< 5yr 1 23.5 43.8 39.4 50.3 45.6 41.4 8.5 32.6 611
2+ 26.9 34.6 46.0 52.8 44.5 44.5 8.4 33.0 584
Education of None 44.5 45.9 60.2 64.0 45.2 50.6 9.1 36.5 304
Household Primary 38.8 42.2 45.5 59.9 46.8 49.0 9.6 36.1 533
head Secondary 27.8 53.1 42.5 42.7 31.6 28.7 7.4 25.8 142
Post- 9.5 47.5 55.6 51.3 39.6 39.4 8.2 25.0 117
secondary
Wealth Poorest 47.7 42.6 55.8 67.7 51.4 60.2 9.8 40.9 450
index Second 42.8 45.5 51.2 53.5 37.7 35.3 8.2 28.4 276
quintile Middle 22.8 46.6 27.3 40.9 35.7 27.0 9.2 29.1 197
Fourth 12.6 65.3 41.6 38.9 28.7 22.7 8.8 20.1 105
Richest 3.0 49.5 25.3 59.9 25.3 9.3 4.5 9.3 67
Ethnicity Lao 24.5 39.2 47.1 56.0 37.8 30.5 9.2 25.6 384
Other 41.9 46.5 51.4 60.2 46.5 52.3 9.1 37.7 709
Language Lao-Tai 24.6 39.4 47.5 55.8 37.8 30.5 9.2 25.7 386
Mon- 43.0 46.4 51.3 60.3 46.6 52.4 9.1 37.7 689
Khmer
Animist 45.8 46.8 51.7 63.7 49.4 56.4 9.6 40.8 568
Province-level variations in coping strategies was observed, with most households in Attapeu reporting
using the strategy of consuming less preferred or less expensive foods to deal with food shortages
(63.2%). Although consuming less preferred or less expensive foods was the coping strategy of choice in
Attapeu, it was the least often reported method in both Saravane (19.3%) and Sekong (50.8%).
Urban households tended to consume less preferred or less expensive foods more frequently during
periods of food shortages (65.5%) while rural households limited portion size at mealtime more

frequently (59.8%). When rural households were examined more closely, those without roads employed
reducing the number of meals eaten (80.0%) most commonly.
As the number of household members increased the tactic of restricting consumption by adults so small
children could eat is employed more frequently, from a quarter of small households (4 or fewer
members) to half of the larger households (9 or more members). A similar trend in coping strategies was
also observed by number of children under 5 in a household.
Both the poorest and wealthiest households limited portion size at mealtimes as the main strategy for
dealing with inadequate food or inadequate money to buy food. Wealth status did influence the practice
of reducing number of meals eating in a day, with 60.2% of the poorest households reported using that
strategy, and only 9.3% of the wealthiest practicing reducing number of meals eaten. Six in ten of the
poorest households employed this tactic while only one in ten of the wealthiest households reported
similarly. By ethnicity, language group, and religion of household head, the most common approach for
food shortages was to limit the portion size at mealtimes.
9.4. Seasonality of Food Insecurity
The weather of Lao PDR is marked by a wet and dry monsoon climate typical of Southeast Asia. The
monsoon arrives between May and July and lasts until November. A dry period from November until
May follows the monsoon. These seasons affect farming and food availability throughout the year. The
last months of the rainy season, from August to October is typically a ‘lean season’ when the new
harvest is still ripening in the field, and past rice stores have run low.
Table 9.7 and Figure 9.2 shows the seasonality and prevalence of food insecurity in the past year, as self-
reported by households. More than half (51.4%) of families surveyed reported to have had inadequate
food to meet their families’ needs at some point during the past 12 months. This was about twice as
high as the proportion reporting inadequate food security in the previous month. Provincial differences
were noted with Sekong having the highest prevalence of food insecurity at some point in the past year
(63.4%), followed by Attapeu (51.9%) and Saravane (49.0%).
Seasonality of food insecurities showed that the month with the highest proportions of food shortages
was September (73.9%) followed by August (64.8%) and October (54.2%). Conversely, months which had
the lowest frequencies for food shortages were January (7.4%), February (8.2%) and December (8.9%).
These data are presented in Figure 9.3. Attapeu reported slight differences in seasonality of food
shortages in comparison to national figures. October and November were the months that residents
from Attapeu reported the highest food insecurities.
Rural households reported higher frequencies of food shortages in comparison to rural households,
66.7% and 29.2%, respectively. Of rural residences, higher proportions of food insecurities were
reported amongst those without roads in comparison to those with roads, 80.2% and 65.6%,
respectively.

Table 9.7 Seasonality of Food Insecurity
Food Month with Household Food Insecurity

Insecurity (%) N
during House-
specific holds
months
Nov Dec Jan Feb Mar April May June July Aug Sept Oct
MYNCSIA Provinces 51.4 16.0 8.9 7.4 8.2 14.2 27.0 35.8 41.5 50.7 64.8% 73.9% 54.2 2,031
Province Saravane 49.0 13.0 6.1 5.8 9.1 15.3 28.9 37.6 43.4 53.1 70.3 83.0 60.9 1,413
Sekong 63.4 8.9 4.8 12.3 8.2 13.4 22.4 40.6 59.0 71.3 80.8 80.5 42.4 283
Attapeu 51.9 37.4 25.6 9.3 4.6 9.8 24.0 22.5 13.3 17.1 22.3 25.4 37.9 335
Residence Urban 29.2 17.2 4.8 4.7 6.0 9.3 16.2 20.6 25.6 35.5 49.0 55.5 35.3 166
Rural 66.7 16.1 10.1 10.5 11.8 19.4 31.6 39.7 45.3 52.2 65.1 68.8 36.3 950
. .w/ road 65.6 17.2 9.8 9.9 11.9 19.4 31.4 37.8 42.5 49.3 63.5 67.6 36.3 883
no road 80.2 5.4 13.0 16.9 10.8 20.3 34.3 59.2 74.6 82.2 82.9 80.8 35.3 67
No. <4 43.2 18.8 12.8 9.1 9.7 16.4 29.8 33.6 41.3 48.7 57.4 63.6 53.7 518
Household 5-6 51.7 16.6 11.1 6.8 8.7 12.7 24.4 34.4 40.7 50.1 62.8 72.4 52.4 585
members 7-8 55.0 16.4 6.5 8.3 8.0 16.0 29.3 39.8 46.4 56.7 72.1 80.4 58.1 498
9> 55.6 12.6 5.7 5.9 6.8 12.1 25.5 34.9 37.1 46.3 64.7 76.3 52.5 428
No. 0 46.1 21.0 11.5 8.0 9.9 15.3 28.8 34.0 40.9 48.5 61.5 71.9 56.3 837
children < 1 50.6 14.9 8.4 7.4 6.6 11.9 23.6 32.7 42.4 54.1 65.6 73.2 52.0 611
5yr 2+ 59.0 12.0 6.6 6.9 8.0 15.0 28.3 40.4 41.3 50.0 67.3 76.3 54.2 584
Education None 72.6 16.3 8.8 9.8 14.9 25.1 37.4 48.5 54.3 62.1 73.1 73.5 38.1 304
of Primary 65.7 16.0 10.0 11.4 11.3 17.6 30.3 36.8 43.2 50.8 64.1 67.1 36.7 533
Household Secondary 46.1 22.8 14.1 9.4 5.2 12.2 23.5 27.7 23.3 27.3 39.2 43.5 36.8 142
head Post- 23.3 14.0 8.8 6.1 9.1 14.0 21.4 21.4 30.3 40.2 51.6 68.2 28.4 117
secondary
Wealth Poorest 80.6 13.2 8.5 14.1 16.7 22.7 34.9 47.7 58.1 67.1 76.4 77.0 36.5 450
index Second 65.2 19.8 9.3 7.5 7.3 18.2 31.0 32.9 33.0 39.6 56.8 62.7 38.2 276
quintile Middle 46.6 19.5 16.1 4.0 4.0 13.6 25.5 24.4 20.4 26.7 41.0 43.3 33.7 197
Fourth 25.8 33.8 12.6 5.2 3.4 3.6 12.5 17.8 18.4 15.7 29.9 42.6 45.1 105
Richest 4.8 1.0 19.8 1.0 1.0 10.9 30.8 20.9 39.5 28.1 27.5 39.1 12.6 67
Ethnicity Lao 44.3 23.7 15.5 6.7 5.5 10.9 21.5 24.4 22.8 28.3 49.2 63.7 39.6 384
Other 69.3 14.4 8.1 11.7 13.9 22.2 35.0 44.0 51.5 59.5 68.9 67.8 35.9 709
Language Lao-Tai 44.4 23.8 15.4 6.7 5.5 10.9 21.4 24.5 22.9 28.3 49.1 63.6 39.9 386
Mon- 69.4 14.6 8.3 12.0 14.2 22.5 35.7 44.9 52.1 59.7 68.8 67.3 36.0 689
Khmer
Religion Buddhist 45.5 22.2 14.5 7.5 8.6 14.6 24.1 24.6 23.9 28.7 45.8 58.9 41.5 519
Animist 73.9 13.9 7.6 12.2 13.6 22.2 35.8 46.4 55.1 64.0 73.6 71.6 34.4 568
As the number of household members increased so did the prevalence of food insecurity. Less than half
of the households with 4 or fewer members reported food shortages (43.2%). When household
members increased to 9 or more, the food shortage prevalence rose to 55.6%. Similar trends were
observed by number of children under 5 in the household. Families with no children suffered from food
insecurities less than families with two or more children under 5, 46.1% and 59.0%, respectively.
As education increased, the likely of a household reporting inadequate food decreased. Almost three
out of four households with no education reported to have had food insecurity at some point in the
previous year (72.6%), while less than a quarter (23.3%) of the most educated households indicated that
they suffered from food shortages.
Large differences in the seasonality of food insecurity by wealth were noted with less than 4% of the
wealthiest households suffering from food insecurity, while eight of every ten of the poorest households
endured inadequate food supply during the last year.
Ethnicity, language group and religion of household head influenced the extent of food insecurity during
the lean season. Ethnic Lao and Lao-Tai speakers had lower levels of food insecurity during the ‘lean
season’ than other ethnic and language groups. Household heads identified as Animist had higher
prevalence of inadequate food supplies than Buddhists, 73.9% and 45.5%, respectively.
Figure 9.3. Seasonality of Food Insecurity
90%
80%
70%
60%
All
50%
Saravane
40% Sekong
30% Attapeu
20%
10%
0%
Nov Dec Jan Feb Mar April May June July Aug Sept Oct
9.5. Key Findings

Household Food Consumption in Last Week and Food Sources
• The overall mean Food Consumption Score was 48.3 (S.D. 16.4), with 5.1% of households classified
as having poor food security, 17.1% with borderline and 77.8% with acceptable food security.
These objective estimates of household food security closely paralleled more subjective metrics of
household perception of inadequate food consumption. Of the three EU-UNICEF MYCNSIA
Provinces, Sekong had a much higher percentage of households classified with poor food security
(14.0%) and borderline (30.2%) than the other two.
• Rice was universally consumed daily. On average, fish or aquatic animals were eaten 3.7 days in a
week, fruit and vegetables 3.1 days and meat 1.5 days per week.
• Higher wealth, maternal education, fewer household members urban residence Lao, Lao-Tai
speakers and Buddhist followers were all related to increased consumption of most foods except
for rice, which held steady and corns/tubers which was lower. In addition, these groups tended to
purchase food more commonly than growing or raising food.
Receipt of Conditional Food/Cash Grants

• A total of 9.6% of households received cash or food to attend a health facility in the past 6
months. Saravane had highest levels, followed by Attapeu and Sekong (12.3%, 4.8% and 1.1%,
respectively). Rural households received cash or food to attend a health facility at levels twice that
of urban households and of the rural households those with roads had levels more than 4 times
that of rural residences without roads.

• Only 1.3% of households reported receiving rice or corn aid, it appears to be distributed to
households that are in the least need of aid. Characteristics of households receiving aid are: urban,
small in member size and with few children under 5 years of age, the most educated, in the top
wealth quintile, and ethnic Lao, Lao-Tai speakers and followers of Buddhism. These are also
characteristics of the groups with the highest food consumption and purchasing power.
• Overall, a quarter (24.0%) of households reported having inadequate food or money to buy food
in the past month. Great variations provincially were reported. One in two households in Sekong
met this definition, one in three from Attapeu, and 17.7% in Saravane.
• Households from rural areas had insufficient food or money to buy food in the last month more
than double that of urban households. Ethnic Lao, Lao-Tai speakers and those of Buddhist religion
had better outcomes and suffered from food shortages less than 1.5 times that of their
counterparts.
Coping Strategies to manage Food Insecurity
• The most common coping strategy for coping with food shortages was limiting the portion size at
meal times (49.8%), followed by borrowing food or receiving help from friends or relatives
(41.4%), reducing the number of meals eaten (40.2%), restricting consumption by adults so small
children could eat (38.6%), and consuming less preferred or less expensive foods (37.4%).
• In Attapeu, consuming less preferred or less expensive foods was the most commonly employed
strategy of dealing with food shortages (63.2%). Urban households consumed less preferred or less
expensive foods more frequently during periods of food shortages while rural households limited
portion size at mealtime. When rural households were examined more closely those without roads
employed reducing the number of meals eaten (80.2%) most commonly.
• Both the poorest and wealthiest households limited portion size at mealtimes as the main strategy
for dealing with inadequate food or inadequate money to buy food.
Seasonality of Food Insecurity
• A total of 51.4% of households had inadequate food to meet their families’ needs during the past
12 months. Sekong had the highest prevalence of food insecurity (63.4%), followed by Attapeu
(51.9%) and Saravane (49.0%). The months with the highest proportions of food shortages were
September (73.9%), August (64.8%) and October (54.2%). Months which had the lowest
frequencies for food shortages were January (7.4%), February (8.2%) and December (8.9%).
• Rural households reported higher frequencies of food shortages in comparison to urban
households, 66.7% and 29.2%, respectively.

SECTION 10: WASH
Access and use of safe water, appropriate sanitation and good hygiene practices have a profound effect
in nutrition. This is not only because of the direct prevention of diarrhea, but there are broader
implications in supporting the flora of the GI system that may actually reduce the risk of infection
exposure. 15 Table 10.1 provides an overview of the sources of water and sanitation facilities in the EU-
UNICEF MYCNSIA Provinces. Overall, only 12.4% of households used both an improved drinking water
source and improved sanitation. Over half of the EU-UNICEF MYCNSIA households used an improved
drinking water source other than water piped into their dwelling, plot or yard; only 7.5% used piped
water as their drinking source. Nearly 4 in 10 (38.2%) used an unimproved source of drinking water.
The percentages of households using improved sanitation were actually lower than those for safe water.
Only 15.2% use improved sanitation. Open defecation was the most common practice (81.7%) followed
by unimproved sanitation facilities, (2.4%) and shared improved facilities (0 .7%). There was much
variation in the combined rates for improved drinking water sources and improved sanitation for
Sekong, Attapeu and Saravane. (33.3%, 25.7% and 5.0%, respectively).
Sekong ranked highest for both improved drinking water and improved sanitation (75.8% and 37.6%,
respectively). Over a quarter of households in Sekong received their drinking water from piped sources,
which was higher than Saravane and Attapeu (1.7% and 16.1%, respectively). Attapeu ranked second for
both improved drinking water and sanitation (61.8% and 35.8%, respectively). Overall, Saravane fell
closely behind the other provinces in improved drinking water (59.0%), although this figure is composed
mostly of other improved drinking water sources since water is piped to so few households (1.7%).
Access to improved sanitation in Saravane was exceptionally low (5.7%) and most households practice
open defecation (93.5%). Open defecation levels in Sekong and Attapeu were much lower (50.3% and
58.2%, respectively).
As expected urban households had higher levels of improved drinking water and sanitation in
comparison to rural households (59.8% and 13.3%). Urban households received piped water at over 10
times the level of rural households and received other improved water sources more than twice that of
rural households. Rural households openly defecated at levels more than 3 times that of urban
residences. Improved sanitation was almost 4 times more likely at an urban residence than a rural
residence.
When improved drinking water sources and improved sanitation levels are combined and examined by
education status, quite a bit of variation was observed. Less than 10% of households whose mothers had
no education met these guidelines. As education increased, the access to improved drinking water
sources and improved sanitation also increased. Over half the households with post-secondary (non
tertiary) education reported access to improved drinking water sources and improved sanitation and
almost 80% of households with higher educational attainment. The most educated households received
15
Smith LE, Stoltzfus RJ, Prendergast A . Food chain mycotoxin exposures, gut health, and impaired growth: a
conceptual framework. Advances in Nutrtion (2012) Jul 1;3(4):526-31
.

piped water at more than 16 times the level of the least educated households and only 9.0% of the most
educated households had access to unimproved drinking water, the least educated had the highest
levels of unimproved water (36.7%). Over 80% of the least educated households practice open
defecation, whereas less than 10% of the most educated practice similar sanitation practices.
Table 10.1. Percentage of household population by drinking water and sanitation ladders
Percentage of household population using:
Improved drinking
water Unimproved sanitation Improved
Piped into drinking
dwelling, Unimproved Shared water sources
plot or Other drinking Improved improved Unimproved Open and improved
yard improved water sanitation facilities facilities defecation sanitation n
EU-UNICEF MYCNSIA 7.5 54.2 38.2 15.2 0.7 2.4 81.7 12.4 2,031
Provinces
Province Saravane 1.7 57.3 41.0 5.9 0.3 0.4 93.5 5.0 1,413
Sekong 26.6 49.2 24.2 37.6 2.9 9.2 50.3 33.3 283
Attapeu 16.1 45.7 38.2 35.8 0.8 5.2 58.2 25.7 335
Residence Urban 60.3 22.2 17.5 68.3 4.4 5.2 22.0 59.8 166
Rural 5.6 57.7 36.7 17.9 0.8 3.8 77.6 13.3 950
Area ..Rural w/ 6.0 57.9 36.1 18.3 0.8 3.3 77.6 13.6 883
road
..Rural no o.0 55.8 44.2 12.7 0.0 10.0 77.3 9.2 67
road
Education None 4.4 58.9 36.7 12.8 0.7 3.2 83.3 9.1 304
of Primary 8.2 56.2 35.6 19.5 1.0 4.8 74.8 14.4 533
household Lower 23.2 44.3 32.5 41.2 2.4 4.9 51.5 33.6 109
head secondary
Upper 34.4 51.0 14.5 47.5 1.4 6.2 44.8 43.2 33
secondary
Post- 42.0 38.3 19.7 61.8 2.6 1.4 34.2 52.3 81
secondary
Higher 71.1 19.8 9.1 83.3 5.6 3.0 8.1 77.9 35
Wealth Poorest 1.0 56.1 42.9 4.2 0.2 3.4 92.2 2.6 450
index Second 6.6 57.5 35.9 21.7 1.6 5.9 70.8 15.9 276
quintile Middle 20.7 54.9 24.4 34.3 1.8 4.8 59.1 25.6 197
Fourth 40.9 42.5 16.6 68.7 3.7 3.4 24.3 54.7 105
Richest 69.0 26.7 4.3 96.1 2.5 0.0 1.4 91.7 67
Ethnicity Lao 23.6 45.9 30.5 34.9 2.0 2.5 60.6 29.3 384
Other 8.8 56.8 34.4 20.8 1.0 4.9 73.3 15.7 709
Language Lao-Tai 23.6 46.0 30.4 34.9 2.0 2.5 60.6 29.3 386
Mon-Khmer 8.8 56.1 35.1 19.4 1.0 5.1 74.5 14.2 689
Animist 6.7 56.5 36.8 19.0 1.0 5.4 74.5 14.2 568
Wealth status showed similar trends in access to water and sanitation as education levels, but with even
greater variation between poorest and richest households. Combined levels of improved drinking water
sources and improved sanitation had a large range, with the poorest reporting levels of 2.6% and the
richest groups 91.7%. Improved sanitation levels showed the most striking differences, with less than 5%
of the poorest households having improved sanitation and over 95% of the richest having improved
sanitation. The poorest households practiced open defecation 92.2% while the richest only 1.4%
practiced the same.
Ethnic Lao, Lao-Tai speakers, and Buddhists had access to improved drinking water and sanitation at
about 2 times the level of other ethnic groups, Mon-Khmer speakers and those that practice Animism.
The former groups received piped water at almost three times the level of their counterparts.

Table 10.2 shows the method of feces disposal for the households of 1,384 children 0-2 years of age.
Overall, only 5.4% of children disposed of feces safely, while 82.9% of the children left feces in the open.
A small number of households reported disposing feces by rinsing in a toilet, a drain or ditch, or
throwing them into the garbage (2.7%, 0.6%, 0.7%). Almost 10% of households buried feces while 2.8%
of children used a toilet/latrine. Use of improved, unimproved and open defecation sanitation methods
was not associated with the level of feces left in the open (78.3%, 83.5% and 84.5%, respectively) or in
the percentages of households that disposed of feces safely (5.4%, 4.2%, and 5.5%).
Differences by province exist. A very low proportion of households in Saravane disposed of feces safely,
followed by Attapeu and Sekong (1.6%, 10.9%, 14.2%). Similarly, Saravane had the highest levels of feces
that were left in the open compared to Attapeu and Sekong (87.0%, 72.7% and 76.0%, respectively).
Sekong had the highest proportion of children that used a toilet or latrine (7.9%). Attapeu had the
highest levels of feces that were thrown into the garbage and buried (4.3% and 10.7%, respectively).
Urban households safely disposed of feces at almost 6 times the level of rural households (30.5% and
5.2%, respectively). Feces were left in the open by half of the urban households while 84.0% of rural
residences followed a similar behavior. Children used a toilet or latrine at levels much higher in urban
residences as opposed to rural. Only 2.4% of rural residences without roads safely disposed of feces and
95.9% left child feces in the open.
Table 10.2. Disposal of child's feces
Place of disposal of child's feces Percentage of
children
Child Put / Put / whose last Number of
used Rinsed into Rinsed Thrown into stools were children
toilet / toilet or into drain garbage Left in the disposed of age 0-2
latrine latrine or ditch (solid waste) Buried open Other safely years
Total 2.8 2.7 0.6 0.7 9.9 82.9 0.4 5.4 1,384
Type of Improved 2.8 2.7 1.2 1.4 13.2 78.3 0.4 5.4 360
sanitation Unimproved 4.6 0.0 0.0 1.4 9.2 83.5 1.3 4.2 69
facility Open 2.7 2.9 0.5 0.4 8.7 84.5 0.3 5.5 956
defecation
Province Saravane 1.0 0.7 0.5 0.0 10.5 87.0 0.4 1.6 920
Sekong 7.9 7.3 1.3 0.6 6.9 76.0 0.0 14.2 268
Attapeu 4.6 6.4 0.5 4.3 10.7 72.7 0.9 10.9 197
Residence Urban 17.8 13.3 2.6 5.0 11.5 49.0 0.8 30.5 107
Rural 2.2 3.3 0.5 0.7 8.6 84.0 0.7 5.2 634
Rural area ..Rural with 2.1 3.6 0.5 0.8 9.5 82.7 0.7 5.6 564
road
..Rural 2.7 0.0 0.0 0.0 0.0 95.9 1.4 2.4 70
without road
Education of None 1.1 0.7 0.4 0.0 3.0 94.1 0.7 1.7 321
Household Primary 4.3 5.4 0.9 1.7 12.2 75.5 0.0 9.2 317
head Secondary 15.2 15.0 1.0 3.7 15.4 45.3 4.4 28.8 74
Post- 17.3 17.4 3.3 6.6 23.7 31.8 0.0 33.8 29
secondary
Wealth Poorest 0.9 1.1 0.7 0.5 3.8 91.9 1.1 1.8 356
index Second 3.8 2.9 0.4 0.5 11.4 81.0 0.0 6.7 192
quintile - Middle 4.7 7.3 0.6 1.7 17.9 67.1 .7 11.5 118
National Fourth 17.5 18.0 1.5 7.8 14.4 38.9 2.0 34.2 50
Richest 33.0 32.1 3.8 6.1 9.1 15.9 0.0 61.3 25
Ethnicity Lao 9.0 6.5 0.9 3.6 17.2 61.3 1.4 14.8 191
Other 2.9 4.2 0.8 0.5 6.2 84.9 0.5 6.8 547
Language Lao-Tai 9.0 6.5 0.9 3.6 17.1 61.4 1.4 14.8 192
Mon-Khmer 2.9 3.8 0.8 0.5 6.1 85.5 0.5 6.4 541
Animist 1.9 4.2 0.7 0.6 5.4 86.6 0.6 5.9 460

There were variations in fecal disposal by education status. Households whose mothers had no
education had low levels of safe disposal of feces (1.7%), and were most inclined to leave feces
in the open (94.1%), whereas just over a third of the most educated households safely disposed
of feces (33.8%) and were much less likely to leave feces in the open (31.8%). Wealth was an
even more discriminating factor in fecal disposal patterns. Nearly one in three children from the
wealthiest households used a toilet or latrine for feces disposal, while only 1% of children from
the poorest households used toilets. The children from the wealthiest households were least
likely to leave feces out in the open (15.9%) but did safely dispose of feces often (61.3%). In
contrast, the corresponding percentages for these two indicators amongst the poorest
households were 91.9% and 1.8% respectively.
Ethnic Lao, Lao-Tai speakers and Buddhist followers had better practices for feces disposal.
These groups buried feces at levels almost 3 times of other groups. Overall these groups safely
disposed of feces at twice the level of other groups.
There were also data on the main sources of both improved and unimproved drinking water
(Table not shown). Six in ten households had access to improved sources of drinking water
(61.8%). Most improved sources of drinking water were from tube wells or boreholes (38.6%).
Protected springs were the second most common improved drinking water sources followed by
public tap or standpipe (7.0% and 4.8%, respectively). Bottled water was the fourth most
common improved drinking water source, followed by drinking water piped into dwelling, piped
into compound (plot or yard), water from a protected well, rainwater collection and water piped
to a neighbor (4.4%, 3.0%, 1.8%, 1.6%, 0.5%, and 0.1% respectively). The most common
unimproved sources of drinking water were from surface water (river, stream, dam, lake, pond,
canal, irrigation channel) (20.9%). Surface water was followed by unprotected well, unprotected
spring and bottled water (13.5%, 3.7%, and 0.1%, respectively).
Three-quarters of households in Sekong had access to improved sources of drinking water,
whereas 59.0% in Saravane and 61.8% in Attapeu reported the same. In Sekong a quarter of
households received water from a protected spring, which was the most common improved
source of drinking water. Only 4% relied on protected springs in Saravane and Attapeu. Piped
water was more common in Sekong. In Attapeu bottled water was more heavily relied on for
drinking water (12.7%) than in Saravane (1.9%) and Sekong (7.0%). Public tap/standpipe was
more common in Saravane (6.4%) in relation to Sekong (1.8%) and Attapeu (0.6%).
The most common source of unimproved drinking water in Saravane and Sekong was surface
water whereas in Attapeu it is unprotected wells (23.4%, 16.2% and 18.8%, respectively).
Unprotected wells were the second most common source of drinking water in Saravane (14%).
10.1. Key Findings
• Access and use of safe water, appropriate sanitation and good hygiene practices have a profound
effect in nutrition. Overall, less than one in eight households used both an improved drinking
water source and improved sanitation facilities.
• Over half of the EU-UNICEF MYCNSIA households used an improved drinking water source other
than water piped into their dwelling, plot or yard; while only 7.5% used piped water as their
drinking source. Nearly 4 in 10 households used an unimproved source of drinking water,
reflecting a high risk of transmission of water-borne pathogens.

• There was very low use of improved sanitation, with only 15.2% of all households having access
to and using such facilities to dispose of feces. There was much variation in the combined rates for
improved drinking water sources and improved sanitation for Sekong, Attapeu and Saravane.
(33.3%, 25.7% and 5.0%, respectively).
• There is clearly a strong association between wealth, education and WASH, whereby the wealthiest
households were much more likely to have access to improved drinking water and sanitation. As
the EU-UNICEF MYCNSIA Program recognizes the importance of suitable WASH facilities, an
important intervention to track will be an increased access and awareness amongst all segments of
the population with improved facilities.

ANNEX 1. MYCNSIA SUPPLEMENTARY BASELINE QUESTIONNAIRES

Version 16 October 2013
MYCNSIA SUPPLEMENTARY BASELINE QUESTIONNAIRES for
Children Under 3
Pregnant and Lactating Women
Other Questions
Haemoglobin (HemoCue Test)
Before beginning the questionnaire, answer the questions on this page based and determine which
supplementary questionnaires you will need and how many you will need:
QC1. Do you have No ………………………….. 0 No form No HemoCue

children above 6
months and under 3 1 ......……………………….. 1 1 UT forms Send to
years old? 2 …..…………………………. 2 2 UT forms HemoCue
≤3 ……………….…………. 3 <3 UT forms
Circle answer
QC2. Do you have No ………………………….. 0 No forms No HemoCue
children between 3 – 5
years old?
1 ......……………………….. 1 1 HB form
Send to
2 …..…………………………. 2 1 HB form
HemoCue Test ONLY HemoCue
≤3 ……………….…………. 3 <2 HB forms
EACH
Circle answer
HOUSEHOLD
QC3. Are there any No ………………………….. 0 No form No HemoCue
MUST DO
pregnant or lactating
OQ FORM
women in this 1 ......……………………….. 1 1 PW forms
Send to
household? 2 …..…………………………. 2 2 PW forms
HemoCue
≤3 ……………….…………. 3 <3 PW forms
Circle answer
QC4. Are there any No ………………………….. 0 No form No HemoCue
women aged 15 – 49
years old are there in
your household? 1 ......……………………….. 1 1 HB form Send to
2 …..…………………………. 2 1 HB form HemoCue
HemoCue Test ONLY ≤3 ……………….…………. 3 <2 HB forms
Circle answer
86
MYCNSIA Questionnaire for Children Under 3

UNDER-THREE CHILD INFORMATION PANEL UT
This questionnaire is to be administered to all mothers or caretakers who were enumerated as part of LSIS with a
child that lives with them and is under the age of 3 years (see LSIS Household Listing form.
A separate questionnaire should be used for each eligible child.
Information to be copied from LSIS enumerated questionnaire
UF1. Cluster number: UF2. Household number:
-------- ------ ------ ------ ------ ------ ------
UF3. Child’s name: UF4. Child’s line number:
Name ___ ___
UF5. Mother’s / Caretaker’s name: UF6. Mother’s / Caretaker’s line number: ___ ___
Name ___ ___
UF7. LSIS Interviewer name and number: UF8. Day / Month / Year of LSIS interview:
Name .......................................... ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___
UT1. Child birthdate (from AG1 on LSIS) UT2. Age of child (from AG2 UT3. Child Sex
on LSIS)
___ ___ / ___ ___ / ___ ___ ___ ___ Male Female
D D M M Y Y Y Y Months _____________
MYCNSIA Baseline Survey Interview information
UT4. MYCNSIA Interviewer name and number: UT5. Day / Month / Year of MYCNSIA interview:
Name .......................................... ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___
Repeat greeting if not already read to this respondent:

WE ARE FROM DEPARTMENT OF STATISTICS AND MINISTRY OF HEALTH. WE ARE WORKING ON A PROJECT CONCERNED WITH FAMILY HEALTH AND
NUTRITION. I WOULD LIKE TO TALK TO YOU ABOUT (name)’S HEALTH AND WELL-BEING. THE INTERVIEW WILL TAKE ABOUT 30 MINUTES. ALL THE
INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND YOUR ANSWERS WILL NEVER BE SHARED WITH ANYONE OTHER THAN OUR PROJECT
TEAM.
MAY I START NOW?

 Yes, permission is given  Go to UT6 to record the time and then begin the interview.
 No, permission is not given  Complete UT3. Discuss this result with your supervisor
UT6. Result of interview for children under 3 Completed .................................................................... 01

Not at home .................................................................. 02
Refused ......................................................................... 03
Codes refer to mother/caretaker. Partly completed........................................................... 04
Incapacitated ................................................................ 05
Other (specify) ________________________________ 96
UT7. Field verified by (Name and number): UT8. Data entry clerk (Name and number):
Name __________________________ ___ ___ ___ Name ________________________________ ___ ___
UT9. Record the time Hour and minutes ..................................__ __ : __ __
87
COMPLEMENTARY FEEDING AND MICRONUTRIENT POWDERS CF

CF1. Please describe everything that (CHILD'S NAME) ate yesterday during the day or night, whether at home or
outside the home.
a) Think about when (CHILD'S NAME) first woke up yesterday. Did (CHILD'S NAME) eat anything at that time? If yes:
Please tell me everything (CHILD'S NAME) ate at that time. Probe: Anything else? Until respondent says nothing
else. If no, continue to Question b).
b) What did (CHILD'S NAME) do after that? Did (CHILD'S NAME) eat anything at that time?
If yes: Please tell me everything (CHILD'S NAME) ate at that time. Probe: Anything else? Until respondent says
nothing else.
Repeat question b) above until respondent says the child went to sleep until the next day.
If respondent mentions mixed dishes like a PORRIDGE, sauce or stew, Probe:
c) What ingredients were in that (MIXED DISH)? Probe: Anything else? Until respondent says nothing else.
As the respondent recalls foods, underline the corresponding food and write and circle ‘1’ in the column next to the
food group. If the food is not listed in any of the food groups below, write the food in the box labeled ‘other foods’. If
foods are used in small amounts for seasoning or as a condiment, include them under the condiments food group.
Once the respondent finishes recalling foods eaten, read each food group where ‘1’ was not circled, ask the following
question and Circle ‘1’ if respondent says yes, ‘2’ if no and ‘8’ if don’t know:
Please write down first all the foods that the respondent mentions – sometimes the respondent may talk fast so please
list as many food items as you can. This can be cross-checked later by the Team Leader or Supervisor at a later stage.
88
Coding Categories
Questions and filters (you are able to underline more than one)
Yes No DK
1 2 8
DO NOT READ THE FOODS LISTED
CF1A Sticky rice (white or brown), roasted rice, rice, pre-chewed rice, rice noodles, maize, 1 2 8
porridge, or other foods made from grains
CF1B Pumpkin, carrots, squash, sweet potatoes that are yellow or orange inside 1 2 8
CF1C White or purple colored foods from roots such as white yams, purple yams, yam bean, 1 2 8
cassava, white radish, white potato, or any other white or purple coloured food from roots
CF1D Any dark green leafy vegetables such as Pak Choi, swamp cabbage, morning glory, sweet 1 2 8
potato leaves, Chinese kale
CF1E Leucanea (bean), common pea 1 2 8
CF1F Ripe orange fleshed mangoes, ripe orange fleshed papayas 1 2 8
CF1G Any other fruits or vegetables 1 2 8
CF1H Liver, brain, lung, heart, gizzard, kidney, of any animal 1 2 8
CF1I Intestine of any animal 1 2 8
Any meat, such as beef (fresh or dry), buffalo, pork, goat, chicken, goose, duck, sausage, 1 2 8
blood sausage, sour sausage
CF1K Eggs from chicken, duck, turtle or other animals 1 2 8

CF1L Fresh, fermented or dried fish, swamp eel, squid, shrimp (fresh or dry), crab, granulated 1 2 8
ark, clam, snail, frog
CF1M Any wild animals such as lizard, frog, rat, rabbit, wild bird, small bird 1 2 8
CF1N Insects or grubs such as silk worm pupa, cricket, weaver ant, any eggs, water insects 1 2 8
CF1O Any foods made from beans, peas, lentils, nuts, or seeds including tofu 1 2 8
CF1P Milk, cheese, yogurt or other milk products 1 2 8
CF1Q Any oil, pork fat, or butter or foods made with any of these 1 2 8
CF1R Any sugary foods such as chocolates, sweets, candies, pastries, cakes, or biscuits 1 2 8
Condiments for flavor, such as, herbs, or fish powder, fish sauce 1 2 8
CF1T OTHER FOODS: Write down any other foods in this box that respondent mentioned but are not on the list
above
Go back and check the number of foods listed on the previous page is the same as the number of different
foods on this page.
89
CF2. Now I would like to ask you about some particular foods (CHILD’S NAME) may eat, even if it is combined
with other foods.
No. Yes No DK
Questions and filters
1 2 8
CF2A RSB (Rice-Soya Blend powder) 1 2 8
CF2B CSB (Corn-Soya Blend) 1 2 8
CF2C EEZEEPASTE/PLUMPYNUT 1 2 8
CF2D PLUMPYDOZ 1 2 8
CF2E NUTRIBUTTER 1 2 8
CF2F Iron fortified infant/toddler formulas available in the local setting (such as CERELAC)? 1 2 8
Show pictures of fortified infant formula available in the survey area.
CF2G MIXME 1 2 8
Yes ...................................................................... 1 IF 1, GO TO CF4

CF3. In the past 4 months, was (CHILD'S NAME) seen
No ....................................................................... 2 IF 2, SKIP TO CF6
by a health worker/village health volunteer to
determine eligibility for a feeding program?
DK ....................................................................... 8 IF 8, SKIP TO CF6
Yes ...................................................................... 1 IF 1, GO TO CF5
CF4. Did the health worker/village health volunteer
No ....................................................................... 2 IF 2, SKIP TO CF6
use the MUAC tape and say that (CHILD'S NAME) was
malnourished?
DK ....................................................................... 8 IF 8, SKIP TO CF6
Show MUAC tape commonly used

Red (Severe malnutrition) ................................. 1
CF5. Do you remember the color of the result/what
Yellow (moderate malnutrition) ........................ 2
the health worker said about (CHILD'S NAME)?
Green (child was okay) ...................................... 3
Worker did not say ............................................. 4
DK ....................................................................... 8
No feeding program in the area ......................... 0
CF6. Is (CHILD'S NAME) enrolled in feeding program in
the last 4 months?
Supplementary Feeding Program....................... 1
Therapeutic Feeding Program / Outpatient

Did they participate in a Supplementary Feeding
Therapeutic Program ......................................... 2
Program – receive Rice Soya Blend, Corn Soya
Blend) or a Therapeutic Feeding Program or
Not enrolled in any programs ............................ 3
Outpatient Therapeutic Program - receive Plumpy
Nut, EEZEEPASTE, F75 Milk, F100 Milk)
Show pictures card
90
Yes ...................................................................... 1
CF7. Have you heard of MixMe or Sprinkles or
No ...................................................................... 2 IF 2, SKIP TO UT10
vitamin and mineral mix?
DK ....................................................................... 8
IF 8, SKIP TO UT10
Show common types of micronutrient powders
available in survey area.
Yes ...................................................................... 1 IF 1, GO TO CF9
CF8. Have you ever received MIXME for
No ...................................................................... 2 IF 2, SKIP TO UT10
(child's name)?
DK ....................................................................... 8
IF 8, SKIP TO UT10
Show common types of micronutrient powders
available in survey area.
1 Box (30 sachets)

CF9. How many sachets did you receive the last
2 Boxes (60 sachets)
time you received MIXME?
3 Boxes (90 sachets)
Record number of sachets………__ __ sachets
Yes ...................................................................... 1
CF9.1 Has (child's name) ever consumed any
No ...................................................................... 2 IF 2, SKIP TO UT10
mixme sachets?
DK ....................................................................... 8
Record number of sachets………__ __ sachets

CF9.2 How many sachets should you use in one
day?
Reason: Code 1
CF9.3 What did you hear were the reasons that
you should give your child MixME? (Open For brain development 1
question with multiple answers. Do not READ
any answers. You can record more than one Make child active/strong 1
answer. Circle 1 against the reasons given)
Increase appetite 1
Reduce anaemia 1
Not told reasons to give MixMe 1
Do not know, was told reasons but can’t 1

remember
1
Other (specify)
_______________________________
______________________________
DK…………………………………………………………… 8
Reason: Code 1
CF9.4 What positive effects did you observe in
your child after using MixMe? (Open question Increased appetite 1
with multiple answers. Do not READ any
answers. You can record more than one Increased energy and activity 1
91
answer. Circle 1 against the reasons given) Mental development/Makes child 1

clever/smarter
Less sick 1
Makes child healthy 1
Makes child stronger 1
Improved/faster physical growth 1
No positive effects 1
1
Other (specify)
_______________________________
_______
DK…………………………………………………………… 8
Reason: Code 1
CF9.5 What negative effects did you observe in
your child after using MixMe? (Open question
Black stool 1
with multiple answers. Do not READ any
answers. You can record more than one
Loose stool/diarrhea 1
answer. Circle 1 against the reasons given)
Constipation 1
Vomiting 1
Nausea 1
Increased appetite 1
No negative effects 1
1
Other (specify)
_______________________________
_______
DK…(no reason given)
Yes ...................................................................... 1 IF YES, COMPLETE

UT10. Do you have any other children above 6
THIS ANOTHER FORM
months or under 3 years old?
FOR EACH ADDITIONAL
CHILD
No ...................................................................... 2 IF NO, GO TO UT11

UT11. Are you currently pregnant or lactating?
THE NEXT FORM FOR
PREGNANT AND
LACTATING WOMEN
92
IF NO, SKIP THE NEXT

No ...................................................................... 2 FORM AND GO TO THE
‘OTHER
QUESTIONS’ FORM
UT12. Record the time HOUR AND MINUTES __ __ : __ __
93
MYCNSIA Questionnaire for Pregnant and Lactating Women

WOMAN’S INFORMATION PANEL WM
This questionnaire is to be administered to all women identified as being currently pregnant or lactating in LSIS. See
question CP1 on LSIS WM questionnaire. A separate questionnaire should be used for each eligible woman in each
household.
Information to be copied from LSIS enumerated questionnaire

WM1. Cluster number: WM2. Household number:
------- ------ ------ ------ ------ ------ ------
WM3. Woman’s name: WM4. Woman’s line number:
............................................................................... ------ ------
WM5. LSIS Interviewer name and number: WM6. Day / Month / Year of LSIS interview:
Name _______________________ No.___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___
WB1. Woman’s birthdate (Question WB1 from LSIS)
WB2. Age of pregnant woman (Question WB2 from LSIS)
___ ___ / ___ ___ / ___ ___ ___ ___
Years _____________
D D M M Y Y Y Y
MYCNSIA Baseline Survey Interview information

PW1. MYCNSIA Interviewer name and number: PW2. Day / Month / Year of MYCNSIA interview:
Name .......................................... ___ ___ ___ ___ ___ / ___ ___ / ___ ___ ___ ___
REPEAT GREETING IF NOT ALREADY READ TO THIS WOMAN:

WE ARE FROM DEPARTMENT OF STATISTICS AND MINISTRY OF HEATH. WE ARE WORKING ON A PROJECT CONCERNED WITH
FAMILY HEALTH AND NUTRITION. I WOULD LIKE TO TALK TO YOU ABOUT THESE SUBJECTS. THE INTERVIEW WILL TAKE ABOUT 15
MINUTES. ALL THE INFORMATION WE OBTAIN WILL REMAIN STRICTLY CONFIDENTIAL AND YOUR ANSWERS WILL NEVER BE SHARED
WITH ANYONE OTHER THAN OUR PROJECT TEAM.
MAY I START NOW?

 YES, PERMISSION IS GIVEN  GO TO PW5 TO RECORD THE TIME AND THEN BEGIN THE INTERVIEW.
 NO, PERMISSION IS NOT GIVEN  COMPLETE PW3. DISCUSS THIS RESULT WITH YOUR SUPERVISOR
PW3. Result of woman’s interview Completed .................................................................... 01

Not at home .................................................................. 02
Refused ......................................................................... 03
Partly completed........................................................... 04
Incapacitated ................................................................ 05
Other (specify) ________________________________ 96
PW4. Field verifier by (Name and number): WM9. Data entry clerk (Name and number):
Name__________________ ___ ___ ___ Name ________________________________ ___ ___
PW5. Record the time Hour and minutes .................................. __ __ : __ __
94
MATERNAL DIET MD
MD1. YESTERDAY DURING THE DAY OR NIGHT, DID YOU DRINK/EAT (FOOD GROUP ITEMS)?
No.
Questions and filters (Circle the corresponding code and you can underline more than one Coding
answer) Catego
ries
DO NOT READ THE ANSWERS
Always start with: ‘Yesterday did you eat….’
MD1A Any offal items? Probe: ‘such as?’ 1 2 8
Liver, brain, lung, heart, gizzard, kidney, of any animal

MD1B The Intestine of any animal? 1 2 8
MD1C Any kind of meat? Probe: ‘such as?’ 1 2 8
Any meat, such as beef (fresh or dry), buffalo, pork, goat, chicken, goose, duck, sausage,
blood sausage, sour sausage
MD1D Any kind of eggs? Probe: ‘such as?’ 1 2 8
Eggs from chicken, duck, turtle or other animals

MD1E Any kind of fish or aquatic animals? Probe: ‘such as?’ 1 2 8
Fresh, fermented or dried fish, swamp eel, squid, shrimp (fresh or dry), crab, granulated ark,
clam, snail, frog, water insects
MD1F Any kind of wild animals? Probe: ‘such as?’ 1 2 8
Lizard, rat, rabbit, wild bird

MD1G Any kind of insects or grubs? Probe: ‘such as?’ 1 2 8
Silk worm pupa, cricket, weaver ant, ant egg, small bird
MD1H Any kind of dairy products? Probe: ‘such as?’ 1 2 8
Cheese, yogurt, or other milk products

MD1J Other foods that came from an animal. (Write down other foods the respondent names that come from an
animal.)
95
1 meal …………………………………………………… 1
MD1K. Yesterday, during the day and
night, how many meals did you eat? 2 meals …………………………………………………. 2
3 meals …………………………………………………. 3
Circle the corresponding answer. 4 meals …………………………………………………. 4
5 meals …………………………………………………. 5
>5 meals ……………………………………………….. 6
DK …………………………………………………………. 8 IF 8, GO TO MD2
96
MD2. Did you receive any Rice Soya Blend, Yes ...................................................................... 1
Corn Soya Blend, NUTRIBUTTER (given No ....................................................................... 2
in SFP for pregnant women) since you
became pregnant or during your most DK ....................................................................... 8
recent pregnancy in last 2 years?
Show pictures of products.

MD3. During your current pregnancy or Yes ...................................................................... 1
most recent pregnancy in the past 2 No ....................................................................... 2
years (if lactating), did you see a health
worker/village health volunteer DK ....................................................................... 8
most recent pregnancy in the past 2 No ....................................................................... 2 IF 2, SKIP TO MD7
years, were you given or did you buy
any iron folate tablets? DK ....................................................................... 8 IF 8, SKIP TO MD7
(Show sample of available tablets)
most recent pregnancy, did you take No ....................................................................... 2 IF 2, SKIP TO MD7
any iron folate tablets?
DK ....................................................................... 8 IF 8, SKIP TO MD7
MD6. During the whole pregnancy, for
how many days did you take the iron Days ........................................................ __ __ __
folate tablets?
If answer not numeric, probe for approx DK ....................................................................... 8

number of days they took them
MD7. For how many days should a
pregnant woman take iron folate Days ........................................................ __ __ __
tablets or syrup during her entire
pregnancy? DK ..................................................................... 88
If answer is not numeric, probe for

approximate number of days

PW6. Are there any other women in your
THIS ANOTHER FORM
household who are pregnant or
FOR EACH ADDITIONAL
lactating?
WOMAN
IF NO, GO TO PW7
No ....................................................................... 2
PW7. Record the time HOUR AND MINUTES __ __ : __ __
97
OTHER QUESTIONS OQ
This section is for ALL HOUSEHOLDS completing the MYCNSIA related questionnaires.
One form per household.
OQ0. Record the time HOUR AND MINUTES __ __ : __ __
OQ1. HAVE YOU OR ANYONE IN YOUR FAMILY RECEIVED CASH OR FOOD Yes .............................................................1
(EG. RICE) TO ATTEND A HEALTH FACILITY IN THE LAST 6 MONTHS? No..............................................................2
DK ..............................................................8
OQ2. How many days in the past week (last 7 days) did your household eat the following foods?
OQ3. What is the source of this food for each item mentioned?
a) Home grown crop or livestock production e) Borrowed

b) Purchased food f) Food aid
c) Forest products g) Exchanged/barter
d) Hunting/fishing h) Gift from family/relatives
PLACE A, B, C, D, E, F, G OR H FOR EACH FOOD LISTED BY THE RESPONDENT FOR QUESTION OQ3, OR PLACE 0 IN THE BOX IF THE FOOD ITEM WAS
NOT EATEN OVER THE LAST 7 DAYS.
No. of days No. of days eaten in small OQ3.

eaten (out of amounts during the last (FOOD
last 7 days) 7 days SOURC
E)
st
Questions and Filters (<1 tablespoon/ person/ 1 2
day – very small amount) mai
n
OQ2A. Rice (sticky rice, white rice)
OQ2B. Maize / Corn

OQ2C. Cassava
OQ2D. Other roots of tubers (potatoes, yam)
OQ2E. Pulses/Lentils/Tofu/Bean Curd
OQ2F. Vegetables (green leafy, carrot, pumpkin…)
OQ2G. Bamboo shoots / mushrooms
OQ2H. Fruits
OQ2I. Fish, fish paste
OQ2J. Other aquatic animals (crab, snail, shrimp…)
OQ2K. Meat (beef, pork, chicken)
OQ2L. Wild animals
OQ2M. Eggs
98
OQ2N. Milk
OQ2O. Sugar
OQ2P. Oil/Butter
99
OQ4. In the past month, did you not have enough food or Yes …………………………………….1 IF 1, GO TO
money to buy food? NEXT
QUESTION
No ……………………………………. 2 IF 2, SKIP TO
OQ6
OQ5. In the past month, how often have you used any of the strategies when you did not have enough food or money
to buy food?
Circle the number corresponding to the answer Frequency (Coding Categories)
1 = DAILY 2 = 3-6 DAYS/ 3 = 1-2 4 = <1/WK

WK TIMES/WK OR NEVER
OQ5A. Rely on less preferred and less expensive foods? 1 2 3 4
OQ5B. Borrow food, or rely on help from a friend or

1 2 3 4
relative?
OQ5C. Limit portion size at mealtimes? 1 2 3 4
OQ5D. Restrict consumption by adults in order for small

1 2 3 4
children to eat?
OQ5E. Reduce the number of meals eaten in a day? 1 2 3 4
Yes ………………………………………….1 IF 1, GO TO
OQ6. Now I would like to ask you about your household’s
NEXT
food supply during different months of the year. Think
QUESTION
back over the last 12 months, did you ever not have
No ………………………………………….2 IF 2, SKIP TO
enough food to meet your family’s needs?
OQ8
OQ7. IF YES, WHICH WERE THE MONTHS IN THE PAST Month of the Year (1)
12 MONTHS DURING WHICH YOU DID NOT HAVE
ENOUGH FOOD TO MEET YOUR FAMILY’S NEEDS? September (9) 1
August (8) 1
DO NOT READ THE LIST OF MONTHS ALOUD.
July (7) 1
CIRCLE (1) IF THE RESPONDENT IDENTIFIES
THE MONTH(S) AS THE ONES IN WHICH THE June (6) 1
HOUSHOLD DID NOT HAVE ENOUGH FOOD TO
MEET THEIR NEEDS. May (5) 1
YOU MAY CIRCLE MORE THAN 1 ANSWER. April (4) 1
March (3) 1
February (2) 1
January (1) 1
100
December (12) 1
November (11) 1
October (10) 1
101
OQ8. How soon after birth should you give a child

anything to drink other than breastmilk? Days after birth …………………….1 __ __
Probe: BY DRINK WE MEAN ANY LIQUID INCLUDING WATER, CLEAR Weeks after birth …………………2 __ __
BROTH, JUICE, ETC
Months after birth ……………….3 __ __
Fill in one line only. Circle the appropriate time frame
(days, weeks or months) and write in the answer DK ………………………… ……………8
OQ9. How soon after birth should you give a child their
first foods to eat? Days after birth …………………….1 __ __
Probe: BY FOODS WE MEAN ANY SOLID, SEMI-SOLID OR SOFT FOOD Weeks after birth …………………2 __ __
LIKE PORRIDGE, STICKY RICE, RICE, ETC
Months after birth ……………….3 __ __
Fill in one line only. Circle the appropriate time frame
(days, weeks or months) and write in the answer DK …………………………..……………8
102
Vitamin A and Deworming
OQ10. Have you ever received Vitamin A in last Yes .................................................................. 1

6 months?
No ................................................................... 2
Show vitamin A such as:
DK ................................................................... 8
ampoules/capsules/liquid.
OQ11. Have you ever taken deworming tablets Yes .................................................................. 1

in last 6 months?
No ................................................................... 2
Show deworming tablets
DK ................................................................... 8
OQ12. TODAY, DO YOU HAVE SOAP OR DETERGENT AT

THE PLACE WHERE YOU WASH YOUR HANDS? Yes ............................................................ 1
No ............................................................. 2
OQ13. DO YOU HAVE ANY CHILDREN BETWEEN 3 – 5 Yes ............................................................ 1 IF 1, WOMAN AND
YEARS OLD? CHILD GO TO
HEMOCUE TEST
No ............................................................. 2 IF 2, WOMAN ONLY

FOR HEMOCUE TEST
HOUR AND MINUTES __ __ : __ __

OQ14. Record the time
103
HAEMOGLOBIN (HemoCue Test) HB
HB1. This HemoCue Test is for

• ALL women between the ages of 15 – 49 years old.
• ALL children over 6 months and under 5 years old.
If more than 2 children or more than 2 women, use additional sheet(s).
NO. INFO CHILD 1 CHILD 2 WOMAN 1 WOMAN 2
HB1A LINE NUMBER

(UF4 OR _____ _____ _____ _____ _____ _____ _____ _____
WM4)
HB1B name
(UF3 or _______________ ______________ _______________ ________________
WM3)
HB1C Age in Not required Not required

months
____________ ____________
(UF11) months months
HB1D Is child  yes- Eligible;  yes- Eligible; go Not required – All Not required – All
above 6 to HB2 women are eligible women are eligible
go to HB2
months of
age?
 No – not
 No – not eligible
eligible
HB1E LINE NUMBER NOT REQUIRED NOT REQUIRED

OF
RESPONSIBLE
CAREGIVER _____ _____ _____ _____
(UF6)
104
Read to each one of the caretaker and/or woman the following:
AS PART OF THIS SURVEY, WE ARE ASKING PEOPLE TO TAKE AN ANEMIA TEST. ANEMIA IS A SERIOUS HEALTH PROBLEM THAT
USUALLY RESULTS FROM POOR NUTRITION, INFECTION, OR CHRONIC DISEASE. THIS SURVEY WILL ASSIST THE GOVERNMENT TO
DEVELOP PROGRAMS TO PREVENT AND TREAT ANEMIA. WE ASK THAT SOME PEOPLE YOUR HOUSEHOLD GIVE A FEW DROPS OF
BLOOD FROM A FINGER. THE EQUIPMENT USED TO TAKE THE BLOOD IS CLEAN AND COMPLETELY SAFE. IT HAS NEVER BEEN USED
BEFORE AND WILL BE THROWN AWAY AFTER EACH TEST. THE BLOOD WILL BE TESTED FOR ANEMIA IMMEDIATELY, AND THE
RESULT WILL BE TOLD TO YOU RIGHT AWAY. IF THE RESULT INDICATES THAT YOU ARE ANEMIC, THEN YOU WILL BE REFERRED TO A
HEALTH CLINIC. THE RESULT WILL BE KEPT STRICTLY CONFIDENTIAL AND WILL NOT BE SHARED WITH ANYONE OTHER THAN
MEMBERS OF OUR SURVEY TEAM.
DO YOU HAVE ANY QUESTIONS?
YOU CAN SAY YES TO THE TEST, OR YOU CAN SAY NO. IT IS UP TO YOU TO DECIDE.
105
HB1F.
Ask caregiver from HB1E – WILL YOU ALLOW

[READ NAME(S) OF ELIGIBLE CHILDREN AS PER YES ……………………………………………… 1 1HB2
HB1B] TO PARTICIPATE IN THE ANAEMIA TEST?
NO ………………………………………………. 2 2THANK AND END
HB1G.
Ask the woman – DO YOU AGREE TO

PARTICIPATE IN THE ANAEMIA TEST? YES ……………………………………………… 1 1HB2
NO ………………………………………………. 2 2THANK AND END
When HB1 is complete and you have permission from the caregiver of the child and/or the woman, please
ask them to sign in the boxes for HB2.
CHILD 1 CHILD 2 WOMAN 1 WOMAN 2
HB2 CIRCLE THE GRANTED……………1 GRANTED……………1 GRANTED……………1 GRANTED……………1

APPROPRIATE
CODE AND SIGN
YOUR NAME SIGN____________ SIGN___________ SIGN__________ SIGN___________
REFUSED…………….2 REFUSED…………….2 REFUSED…………….2 REFUSED…………….2

NOT ELIGIBLE……….3 NOT ELIGIBLE……….3 NOT ELIGIBLE……….3 NOT ELIGIBLE……….3
HB3 RECORD HB G/DL G/DL G/DL G/DL

LEVEL HERE
 .  .  .  .
NOT PRESENT….001 NOT PRESENT….001 NOT PRESENT….001 NOT PRESENT….001
REFUSED………..002 REFUSED………..002 REFUSED………..002 REFUSED………..002
OTHER……….…..003 OTHER……….…..003 OTHER……….…..003 OTHER……….…..003
HB4 REFERRED TO
HEALTH
CENTRE?
YES………………….1 YES………….……...1 YES……………..…..1 YES……………..…..1
(CIRCLE
ANSWER HERE) NOT REQUIRED……2 NOT REQUIRED……2 NOT REQUIRED……2 NOT REQUIRED……2
GO TO WHB1 GO TO WHB1
WHB1. (WOMEN ONLY)
DO YOU CURRENTLY SMOKE (TOBACCO, CIGARETTES, OR Yes............................................................. 1 END
OTHER LEAVES)? No ............................................................. 2 COMPLETE
CHECK BOX
PLEASE CIRCLE (1) OR (2)
106
Before completing the interview, ensure that you have ticked all the empty un-shaded boxes with your
Team Leader.
Characteristics Under 3 Women and Other HemoCue Test

Questionnaire Questionnaire
Women Other
Children 6m - <35.9m
36 - <59.9m
Women, 15-49 Pregnant/Lactating

years
Non-pregnant/non-
lactating
END OF EU QUESTIONNAIRE
IF THERE IS ANY ADDITIONAL INFORMATION, PLEASE FILL IN THE BOXES ON THE FOLLOWING PAGE
ONCE YOU ARE READY TO COMPLETE THIS PART OF THE INTERVIEW PLEASE SUBMIT YOUR QUESTIONNAIRE TO THE
TEAM LEADER FOR VERIFICATION SIGNATURE AND SAFE STORAGE
107
Interviewer’s Observations
Observations of other MYCNSIA interviewer – cross check
Supervisor’s Observations
108
109

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Baseline Survey for the Maternal and Young

Child Security Initiative (MYCNSIA) in Lao

National Institute of Public Health

List of Tables .....................................................................................................................................iv

iii | P a g e Report of the Lao PDR MYCNSIA Baseline Survey

iv | P a g e Report of the Lao PDR MYCNSIA Baseline Survey

v|P a g e Report of the Lao PDR MYCNSIA Baseline Survey

vi | P a g e Report of the Lao PDR MYCNSIA Baseline Survey

vii | P a g e Report of the Lao PDR MYCNSIA Baseline Survey

1.1. General background

1|P a g e Report of the Lao PDR MYCNSIA Baseline Survey

2|P a g e Report of the Lao PDR MYCNSIA Baseline Survey

3|P a g e Report of the Lao PDR MYCNSIA Baseline Survey

4|P a g e Report of the Lao PDR MYCNSIA Baseline Survey

5|P a g e Report of the Lao PDR MYCNSIA Baseline Survey

6|P a g e Report of the Lao PDR MYCNSIA Baseline Survey

2.1. Objectives for the baseline survey

Survey Questionnaire Categories Region

LSIS Children − Breastfeeding ALL 17 Provinces

2.3. Sampling design

8|P a g e Report of the Lao PDR MYCNSIA Baseline Survey

Households Mothers Children

Saravane 1,220 953 78 1,566 523 475 91 845 550 547 99

3,220 2,952 4,076 1,156 2,291 1,352

2.4. Field team composition

9|P a g e Report of the Lao PDR MYCNSIA Baseline Survey

10 | P a g e Report of the Lao PDR MYCNSIA Baseline Survey

c) Infant and young child feeding (IYCF)

11 | P a g e Report of the Lao PDR MYCNSIA Baseline Survey

12. Minimum acceptable diet **

13. Consumption of iron-rich or iron-fortified foods **

** Indicators measured from the EU-UNICEF MYCNSIA add-on survey.

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4.5. Bottle feeding (0-23 months of age)

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4.7. Minimum Dietary Diversity (MDD)

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4.10. Consumption of Iron Rich Foods

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Anthropometry is widely employed to serve as a proxy of nutritional status of populations, as well

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UT9. Record the time Hour and minutes .................................. :

Record number of sachets……… sachets