Emergency Infant and Young Child Feeding Survey Donetsk

Emergency Infant and Young Child Feeding Survey Donetsk City – Makiivka – Horlivka – Shartarsk - Khartzisk Eastern Ukraine November – December 2015

INTRODUCTION

KEY OBJECTIVES • Enhance understanding of IYCF practices • Inform the evidence base for appropriately intervening to protect, promote & support safe & appropriate IYCF for children <2 years of age • Identify information gaps & needs

METHODOLOGY Location • Non government controlled Donetsk region Primary subjects • Infants & young children <24 months of age Tools • Household questionnaire - + MUAC measures (children 6 -23 months) o Face-to-face interviews with 250 primary caregivers o MUAC measures of 176 children 6 -23 months Sampling • 33 HHs randomly selected from NGO household list. 217 HHs through snowball sampling Survey team • 4 people (following a 2 -day training with practicum + data quality control measures); data analysis manager; coordinator/nutrition specialist Data cleaning and Analysis • Excel + STATA

Map of assessment locations

RESULTS

Household demographics • 250 households participated in the survey o Mean household size: 3. 88 (SD=1. 09) people, very similar across all locations o Mean number of children per household under 2 -years: 1. 06 (SD=0. 24). o Mean number of children aged 2 to 5 -years: 0. 21 (SD=0. 45) o No one was employed in 12. 8% of households o (See Table 1: HH characteristics) o Majority (53. 9%) living in original residence without displacement; 41. 1% living in original residence after returning from displacement, highest in Donetsk City (67. 7%). (See Fig 1: Dwellings) • 257 children <2 years were included in the survey sample (as of the 250 households who participated, 7 had two children under the age of 2 years including: 81 infants aged 0 -5 months; 79 children 6 -11 months; 97 children 12 -23 months. A total of 125 girls and 132 boys (See Fig 2: Age and sex distribution)

Table 1: Household characteristics Region Household characteristic (%) All Donetsk City Makiivka Horlivka Khartzisk Shakhtersk Number of caregivers interviewed (n=250) Number of Mothers (n) Fathers Grandmothers Aunt Children sampled (n) Households with more than one child aged under 2 -years (n) 231 6 10 3 257 85 6 8 2 104 (40. 5%) 39 0 0 0 41 (16. 0%) 40 0 41 (16. 0%) 37 0 2 1 40 (15. 6%) 30 0 31 (12. 1%) 7 4 1 1 0 1 29. 3 (6. 3) 29. 9 (6. 3) 27. 9 (4. 3) 29. 4 (5. 7) 30. 3 (8. 1) 27. 8 (6. 2) Incomplete secondary school 1. 2 1 2. 4 0 0 3. 2 Complete secondary school 11. 7 12. 5 12. 2 7. 3 10 16. 1 Professional secondary education 31. 5 28. 8 24. 4 43. 9 35 29 Incomplete higher education 9. 7 5. 8 9. 8 17. 1 15 6. 5 Complete higher education or above 45. 9 51. 2 31. 7 40 45. 2 1. 6 (0. 73) 1. 6 (0. 7) 1. 5 (0. 8) 1. 6 (0. 7) 1. 7 (0. 8) 10. 6 58. 1 35. 5 6. 5 22 46. 9 50 3. 1 9. 8 16. 2 67. 6 16. 2 7. 5 51. 4 48. 6 0 19. 4 32 68 0 Average of mother/primary caregiver (years) (Ẋ (SD)) Education level of mother/primary caregiver Average number of alive children to mother (Ẋ (SD)) Monthly Household Income (RUB) No one employed <7000 -14000 >14000 12. 8 45. 5 48. 7 5. 8

Fig 1: Percentage of households (n=250) who completed the HHQ in each type of dwelling, by assessment location Shakhtersk 25. 8 67. 7 Khartzisk 50 Horlivka 45 61 Makiivka 36. 6 68. 3 Donetsk 0 10 20 30 50 60 Percentage (%) 70 80 5 0 0 2. 4 0 26. 9 40 0 2. 4 0 0 29. 3 64. 4 6. 5 1 3. 8 90 100 Original residence without displacement Original residence after returning from displacement With relatives Renting Collective Center

Fig 2: Age of all children (n=257) in the survey sample, by sex 120 100 Female Number of children 80 44 60 41 40 40 53 20 40 39 0 -5 6 -11 Age (months) 0 12 -24 Male

Registration & Humanitarian Assistance • Registration at polyclinics and for assistance was high o 96. 4% (241/250) of sampled children were registered at a polyclinic o 94. 0% (235/250) of sample households registered for assistance • 10. 0% (25/250) of sample households registered as displaced (See Table 2: Registration status)

Table 2: Registration status & assistance of households (n=250), self-reported, by assessment location Registration status (% (n)) All Donetsk City Makiivka Region Horlivka Khartzisk Shakhtersk Child registered at Polyclinic 96. 4 (241) 96. 0 (97) 94. 9 (37) 95. 0 (38) 97. 5 (39) 100 (30) Household registered as displaced 10. 0 (25) 5. 9 (6) 5. 1 (2) 22. 5 (9) 7. 5 (3) 16. 7% (5) Ministry of Social Policy (%) 60. 0 (15) 83. 3 (5) 50 (1) 22. 2 (2) 100 (3) 80 (4) Migration Service (%) 76. 0 (19) 66. 7 (4) 100 (2) 77. 8 (7) 100 (3) 60 (3) 0 (0) 0 (0) 16. 0 (4) 16. 7 (1) 0 (0) 33. 3 (3) 0 (0) 0 (0) Household registered for assistance 94% (235) 91. 1% (92) 100% (39) 90% (36) 100% (40) 93. 3% (28) Ministry of Social Policy (%) 59. 1 (139) 54. 3 (50) 79. 5 (31) 36. 1 (13) 87. 5 (35) 35. 7 (10) State Emergency Service (%) 0. 4 (1) 0 (0) 2. 5 (1) 0 (0) 93. 6 (220) 93. 5 (86) 100 (39) 100 (36) 90 (36) 82. 1 (23) 0. 9 (2) 2. 2 (2) 0 (0) State Emergency Service (%) Humanitarian Organisation (%) Other (%)

Assistance received Since January 2014: • 6. 4% of mothers had received cash or voucher assistance • 58. 0% food assistance • 23. 2% non-food assistance • 90. 0% baby-food assistance (See Fig 3: Assistance since January 2014 by location) Infant formula had been received by 23. 7% of HHQ infants under 6 months old; 17. 9% infants 6 -11 months old and 9. 8 % of infants 12 -23 months Since May 2015: HHQ respondents had received food assistance 4. 76 times on average, and last received baby-food assistance on average 1. 2 month prior to the survey, in all assessment areas (See Table 3: Frequency of baby food assistance)

Fig 3: Assistance received by households since January 2014 (n= 250), by assessment location 100 Donetsk 90 Makiivka 80 Horlivka Percentage (%) 70 60 Khartzisk 50 Shakhtersk 40 30 20 10 0 Cash/ voucher assistance Food assistance Non-food assistance Baby food assistance

Table 3: Percentage of households (n=250) completing the HHQ receiving baby-food assistance by frequency group since May 2015, by assessment location & type of accommodation Frequency All 0 1 -2 3 -4 5 -6 7 -8 Mean 0. 9 21. 0 17. 4 40. 1 20. 5 Location Donetsk City 1. 2 12. 8 11. 6 43. 1 31. 4 5. 33 Makiivka 0. 0 26. 4 18. 4 42. 1 13. 2 4. 47 Horlivka 0. 0 26. 1 41. 6 22. 3 0. 0 3. 08 Khartzisk 2. 7 27. 0 5. 4 43. 2 21. 6 4. 65 Shakhtersk 0. 0 11. 1 33. 3 48. 1 22. 2 5. 04 Type of accommodation Without displacement 0. 0 24. 0 15. 1 36. 8 24. 1 Returned from displacement 1. 3 16. 9 19. 5 45. 8 16. 9 Displaced with relatives 0. 0 60. 0 40. 0 20. 0 Displaced in rented 0. 0 20. 0 Displaced in collective centre 25. 0 0. 0 50. 0

IYCF Practices (1) Some key findings • More than two-thirds of infants < 6 months not exclusively breastfed • Mean age for those who have stopped breastfeeding is low (6. 83 months) • Less than half the children continue breastfeeding at 1 year • Age appropriate breastfeeding met by just over half the children • Formula feeding alone given to 14. 8% of infants <6 months of age • Infant formula introduced early, at the average of 3. 3 months • Bottle feeding is common; practised by approx. two-thirds of children 0 -23 months • Water &/or herbal tea are commonly given to infants 4 -5 months of age; mean age of introduction is 2. 19 months • More than half of the infants <6 months are predominantly breastfeeding

IYCF Practices (2) … Key findings • Breastfeeding on a schedule is practiced by over half of the caregivers currently breastfeeding • Soft, semi-solid and solid foods are commonly received before the recommended age of 6 months (by 36. 4% of infants 4 months & 76. 5% of infants 5 months of age • Most frequently consumed complementary foods are bread/noodles/ vermicelli/ crackers, fruit, porridge • Just over half of the children 6 -23 months reach the minimum dietary diversity; • Almost three-quarters of children 6 -23 months reach the minimum meal frequency • Stress from the conflict was the main reason given for stopping breastfeeding (See Table 4: Summary of primary feeding indicators. Also see: Tables 5, 6, 7, 8, 9; Figures 4, 5, 6, 7, 8, 9, 10, 11)

Table 4: Summary of primary IYCF Indicators Feeding indicators n/N % [95% CI] MICS 2012 * Eastern Ukraine (%) Ever breastfed (N=children 0 -23 mo) 235/257 91. 4 [88. 0, 95. 0] 96. 7 Early initiation of breastfeeding, within 1 hour of birth) (N=children 0 -23 mo) 184/257 78. 3 [76. 1, 81. 5] 61. 5 Early initiation of breastfeeding (within 24 hours of birth (N=children 0 -23 mo) 36/257 15. 3 [11. 3, 16. 7] 83. 0 Exclusive breastfeeding (N=children <6 mo) 25/81 30. 9 [27. 5, 33. 5] 21. 3 Predominant breastfeeding (N=children <6 mo) 42/81 51. 9 [49. 1, 54. 4] 47. 5 Continued breastfeeding at 1 year (N=children 12 -15 mo) 15/31 48. 4 [46. 1, 51. 4] 33. 4 Continued breastfeeding at 2 years (N=children 20 -23 mo) 5/39 12. 8 [10. 6, 14. 4] 31. 1 138/257 53. 7 [49. 0, 56. 5] 22. 3 Receiving solid, semi-solid, or soft foods at 6 -8 mo 30/30 100. % Minimum dietary diversity (N=children 6 -23 mo)** 96/176 54. 5 [50. 2, 58. 4] Minimum meal frequency (N=children 6 -23 mo) 130/176 73. 9 [71. 3, 76. 5] (N) 95 6. 83 mo. [5. 5] 138/257 53. 7 [48. 6, 56. 4] Age-appropriate breastfeeding (N=children 0 -23 mo) Age stopped breastfeeding, (mean (x SD)) Breastfeed on a schedule (N=children 0 -23 mo currently breastfeeding) 67. 2**

Table 5: Percentage of children demonstrating specified breastfeeding practices 15. 2 7. 1 92. 1 106 77. 4 18. 3 4. 3 92. 3 41 72. 2 16. 7 11. 1 97. 5 41 97. 4 2. 6 0 87. 5 40 77. 1 17. 1 5. 7 90. 0 31 67. 7 14. 8 18. 5 78. 3 15. 3 [76. 1, [11. 3, 81. 5] 16. 7] 6. 4 [4. 3, 7. 6] 91. 4 257 [88. 0, 95. 0] Average stopped breastfeeding (months) ((Ẋ (SD)) 7. 0 (5. 24) 3. 5 (3. 06) 7. 2 (3. 68) 9. 5 (5. 79) 6. 3 (6. 70) 6. 83 (5. 47) Number of children 023 months (n) 77. 7 Age appropriate breastfeeding a (%) 125 Number of children 2023 months (n) 92. 6 7. 4 (5. 81) 6. 2 (4. 79) Breastfed at 2 years (%) 5. 9 Number of children 1215 months (n) 14. 4 Breastfed at 1 year (%) Total (% [95% CI]) 79. 7 Of children 12 -15 Of children 20 -23 Of children 0 -23 months Number of children 0 -5 months (n) Shakhtersk 132 Initiation of breastfeeding (hours) (%) Of children 0 -5 months Predominantly breastfed (%) Khartzisk 91. 5 Of children ever breastfed Exclusively breastfed (%) Horlivka >24 Makiivka 1 -24 Location Donetsk City <1 Female Number of children 0 -23 months (n) Sex Male Ever breastfed (%) 36. 1 60. 0 40 46. 7 18 11. 1 22 53. 9 75 33. 3 64. 3 41 61. 2 13 25. 0 17 48. 8 61 47. 4 48. 3 18 50. 0 15 25. 0 18 46. 8 106 38. 5 58. 5 13 75. 0 4 - 3 58. 3 41 8. 00 92. 0 25 100 3 0. 0 4 42. 1 41 80. 0 20. 0 12 100 6 0. 0 6 44. 0 40 20. 0 80. 0 9 - 2 0. 0 7 30. 4 31 81 48. 4 [46. 1, 51. 4] 31 12. 8 [10. 6, 14. 4] 39 53. 7 [49. 0, 56. 5] 257 30. 9 51. 9 [27. 5, [49. 1, 54. 4] 33. 5]

Table 6: Non-breast milk liquid feeding Formula introduction, age in months (mean (x SD)) (N) 151 3. 28 mo. [3. 2] Artificial feeding alone (children <6 mo) (% [95% CI] ) 12/81 14. 8 [13. 6, 15. 9] Mixed feeding –breastfeeding + infant formula (children <6 months) 11/81 13. 6 [10. 9, 15. 3] Bottle feeding (children 0 -23 mo) (% [95% CI] ) 174/257 67. 7 [63. 5, 72. 4] Water &/or tea (herbal tea) introduction, age in months (mean (x. SD)) (N) 226 2. 19 (2. 2)

Figure 4: Opinion of HHQ respondents (n=250) as to what age a child should be breastfed to and the number of infants breastfed yesterday, by mother/ primary caregiver’s education level 100 Complete higher education or above 90 Incomplete higher education 80 Perceentage (%) 70 Professional secondary education 60 Complete secondary school 50 40 Incomplete secondary school 30 Infants breastfed yesterday 20 10 0 <6 6 -11 Age (months) 12 -18 19 -36

Figure 5: Opinion of HHQ respondents (n=250) as to what age a child should be breastfed to & the number of infants breastfed yesterday, by household income level 100 Infants breastfed yesterday 90 80 No one employed Percentage (%) 70 60 < 7. 000 50 7. 000 – 14. 000 40 30 > 14. 000 RUB 20 10 0 <6 6 -11 Age (months) 12 -18 19 -36

Figure 6: Percentage of infants who were breastfed yesterday (the previous 24 hours) (n=135) by assessment location and age 70. 0 Donetsk 60. 0 Makiivka Percentage (%) 50. 0 Horlivka Khartzisk 40. 0 Shakhtersk 30. 0 20. 0 10. 0 0 -5 6 -11 Age group (months) 12 -18 19 -23

Figure 7: Area graph of breast feeding practices by age & percentage of children (n=257) 120% 100% Exclusive breastfeeding Breastfed & water 80% Breastfed & other milk Breastfed & non-milks 60% Breastfed & foods 40% Not breastfed 20% 22 -23 20 -21 18 -19 16 -17 Age group (months) 14 -15 12 -13 10 -11 8 -9 6 -7 4 -5 2 -3 0 -1 0%

Figure 8: Reasons for stopping breastfeeding prior to the survey, for mothers who ever breastfed 16% 26% Conflict stress Other stress Insufficient food for mother 11% Work schedule Attachment problems Use of other liquids in bottle Out of milk 4% Medical reasons Child stopped 6% Other 6% 4% 11% Other: pregnancy, mother’s decision, child’s age, no mother 16%

Table 7: Percentage of children with infant feeding practices & average of introduction of food for infants of HHQs (n=257) Receiving solid, semisolid or soft foods at 4 months (n=11) (%) Receiving solid, semisolid or soft foods at 5 months (n=16) (%) Receiving solid, semisolid or soft foods at 6 -8 months (n=26) (%) Of children 6 -23 months: Minimum meal frequency (n=130) (%) All All Breastfed Not breastfed Sex Male 34. 0 62. 5 100. 0 76. 0 97. 9 95. 4 6. 6 (4. 32) 5. 9 (4. 63) 6. 8 (4. 34) Female 42. 0 55. 6 100. 0 72. 4 98. 0 90. 4 5. 9 (4. 59) 5. 9 (4. 45) 5. 6 (4. 19) Location Donetsk City 25. 0 33. 3 100. 0 91. 1 95. 8 86. 7 5. 5 (5. 69) 5. 5 (5. 16) 5. 5 (5. 65) Makiivka 0. 0 100. 0 85. 7 97. 3 100. 0 94. 3 5. 3 (5. 56) 5. 5 (5. 54) 5. 4 (5. 39) Horlivka 0. 0 71. 4 100. 0 96. 0 100. 0 93. 3 6. 6 (1. 53) 6. 4 (1. 55) 1. 6 (1. 69) Khartzisk 0. 0 33. 3 75. 0 98. 4 100. 0 97. 6 3. 6 (5. 67) 5. 5 (1. 81) 3. 4 (3. 56) Shakhtersk 0. 0 66. 7 100. 0 97. 5 100. 0 94. 5 3. 4 (5. 66) 5. 6 (5. 63) Total (% [95% CI]) 36. 4 [34. 3, 39. 1] 76. 5 [72. 4, 83. 7] 100 73. 9 97. 9 [71. 3, [95. 3, 76. 5] 98. 7] 92. 9 [89. 5, 95. 9] 6. 6 (5. 08) 5. 9 (4. 70) 6. 6 (4. 72) Average for introduction of foods (months) (n=209) (mean - SD)

Figure 9: Percentage of children of each month of age demonstrating different feeding practices 100 90 Receiving hard, semi-soft or soft foods 80 70 Breastfeeding Percentge (%) 60 Exclusively breastfeeding 50 40 30 20 10 0 0 2 4 6 8 10 12 14 Age of child (months) 16 18 20 22

Figure 10: The average of introduction of complementary foods by mother’s age The average of introduction of complementary foods by mother’s 9 8 7 Child’s age (months) 6 5 4 3 2 1 0 <20 20 -29 30 -40 Mother/ Primary caregivers age (years) >40

51. 0 % 42 35 97. 7 % 81. 4 % 50 40 98. 0 % 78. 4 % 13 -18 mo 19 -23 m 2 46. 7 % % 31 0 13 7 9 17 23. 3 % 30. 0 % 56. 7 % 23 26 28 20 14 46. 9 % 53. 1 % 57. 1 % 40. 8 % 20 24 11 46. 5 % 55. 8 % 22 7 43. 3% 23. 3 % 17 21 63. 3. 0% 34. 7% 42. 9 % % 25 0 6 27 58. 1. 0% 14. 0% 62. 8 % % 37 2 72. 5 3. 9 % % 5 30 19 9. 8% 58. 8 % 37. 3 % 7 6 6 0 0 2 . 0% 25. 9 % 22. 2 % . 0% 7 19 21 11 0 14 6 63. 3 % 70. 0 % 36. 7 % . 0% 46. 7 % 20. 0 % 14 29 40 27 1 38 11 36 7 0 28. 6 % 59. 2 % 81. 6 % 22. 4 % 73. 5 % 14. 3 % . 0% 21 17 14 15 42 10 42 15 1 25. 6 % 48. 8 % 39. 5 % 32. 6 % 34. 9 % 97. 7 % 23. 3 % 97. 7 % 5 25 11 19 7 48 16 44 21. 6 % 37. 3 % 13. 7 % 94. 1 % 31. 4 % 86. 3 % 22. 2 3. 7% % 7 2 23. 3 6. 7% 23. 3 % % 43. 1 9. 8% 49. 0 % % 55. 1 2. 0% 77. 6 % % 17 2 39 39. 5 4. 7% 90. 7 % % 27 2 50 52. 9 3. 9% 98. 0 % % Other 89. 8 % 14 0 Sweets 25 11. 1 % 1 Bread, noodles, vermicelli 44 9 -12 mo . 0% Eggs 43. 3 % . 0% 22. 2. 0% 25. 9% 11. 1 % % Meat, chicken, fish 66. 7 % 6 Peas or beans 13 3 Vegetable homemade 20 6 -8 mo 0 Fruits 33. 3 % 0 baby fruit or vegetable 81. 5 % 3 other homemade porridge 7 Buckwheat porridge Infant formula 0 Semolina Soda drinks 6 Infant commercial porridge Fruit or vegetable juice 9 Cottage cheese Tea or herbal tea 22 Sour milk drinks Water 4 -5 mo Animal milk Months Table 8: Percentage of children 4 -23 months (n=204) reported to consume the specified foods in the 24 hours prior to the HHQ, by age group 3 0 0 . 0% 2 0 7. 4% 11. 1 % 22 73. 3 6. 7% % . 0% 34. 9 2. 3% % 26 1 51. 0 2. 0% %

ba er at W l t ab ea le So juic e da d In ri fa nt nks fo rm ul An a i So ma l ur m milk In ilk fa C d nt co otta rink ge s m m ch er cia ees e l p or rid Bu ge S ot ck em he w ol he r h in om at a em por ba r by ade idge p fr o ui t o rrid g r v eg e et Ve ab ge le ta bl Fr e ui ho m ts em Pe ad as e M ea or b t, ea ch n i c ke s Br ea n, fi d, sh n oo dl Eg es gs , v er m ice lli Sw ee ts Ot he r et eg r v er r h a o Te t o ui Fr Figure 11: Percentage of children 4 -23 months (n=204) reported to consume the specified foods in the 24 hours prior to the HHQ, by age group 500. 0% 450. 0% 400. 0% 350. 0% 300. 0% 250. 0% 4 -5 months 200. 0% 6 -8 months 9 -12 months 150. 0% 13 -18 months 19 -23 months 100. 0% 50. 0%

Iron and Protein-containing Foods Iron-rich foods Of children aged 6 -23 months of age: • In the 24 hours prior to the interview – 81. 5% had consumed homemade meat – 5. 2% had consumed commercial meat puree • Average frequency of consumption was 2. 7 times in the previous 7 days (range 0 to 7 times) Eggs • In the 24 hours prior to the interview – 24. 9% had consumed eggs • Average frequency of egg consumption was 1. 5 times in the last 7 days (range 0 to 7 times) • No eggs had been received through food assistance Dairy products Of children aged 6 -23 months of age: • In the 24 hours prior to the interview – 49. 1% had consumed dairy products • Average frequency of consumption was 2. 8 times in the previous 7 days (range 0 to 7 times) • Commercial meat puree had been received in aid by 4. 4% of households (See Fig #: 24 -hour recall of foods given, 4 -23 months of age; Table 10: Baby food assistance)

Table 9: Dietary diversity of infants aged 6 -23 months (n=176) Dietary diversity ((Ẋ (SD)) Minimum dietary diversity (%) Male 3. 1 (3. 01) 52. 2 Female 3. 4 (2. 98) 56. 8 6 -8 3. 2 (3. 04) 53. 3 9 -11 3. 0 (3. 04) 50 12 -18 3. 3 (3. 01) 55. 4 19 -23 3. 5 (2. 98) 58. 8 3. 1 (3. 01) 51. 8 3. 2 (3. 05) 53. 8 3. 2 (3. 09) 53. 3 3. 4 (3. 02) 57. 1 4. 0 (2. 89) 66. 7 3. 32 (2. 89) 54. 5 [95%CI=50. 2, 58. 4] Sex Age (months) Location Donetsk City Makiivka Horlivka Khartzisk Shakhtersk Total

Baby food assistance • Baby food that households had received in aid include: porridge (commercial; for home-made); commercial fruit/veg puree; fruit/veg juice; commercial meat puree; infant formula (See Table 10) • Infant formula had been received in aid by 23. 7% of HHQ infants under 6 months old; 17. 9% infants 6 -11 months old and 9. 8 % of infants 12 -23 months • The primary baby food provider was reported to be the Rinat Akhmetov Foundation

Table 10: Analysis of food patterns in infants 6 -23 months old (n=173) & baby-food assistance given to households (n=235) Food Group Consumed in the last Average weekly 24 hours (%) consumption (Ẋ(SD)) Average introduced (months) (Ẋ(SD)) Households receiving item in aid (%) Bread, noodles, vermicelli, crackers 83. 2 5. 0 (10. 7) 8. 3 (12. 9) 0. 0 Commercial porridge 35. 3 2. 0 (2. 59) 5. 6 (2. 51) 42. 1 Homemade porridge 31. 2 3. 0 (2. 73) 7. 3 (8. 03) 79. 1 Cheese 46. 8 1. 8 (1. 98) 6. 9 (2. 17) 0. 0 Animal milk/ sour milk 49. 1 2. 5 (2. 72) 8. 1 (8. 33) 0. 0 Commercial baby fruit/ veg puree 40. 5 2. 1 (2. 24) 5. 6 (7. 18) 42. 1 Vegetables 47. 4 2. 9 (2. 50) 6. 6 (6. 06) 0. 0 Fruits 87. 3 4. 0 (2. 90) 6. 1 (2. 11) 0. 0 Eggs 24. 9 1. 5 (1. 49) 7. 1 (2. 29) 0. 0 Potato 69. 9 2. 7 (2. 18) 6. 3 (1. 99) 0. 0 Peas and beans 2. 9 0. 2 (0. 48) 8. 5 (4. 93) 0. 0 Animal-source meat foods 81. 5 2. 1 (2. 13) 7. 6 (7. 46) 0. 0 Commercial meat puree jars 5. 2 - 5. 6 (7. 18) 4. 4 Sugary foods 28. 9 - - 0. 0 Tea or herbal tea 65. 3 - 2. 2 (2. 18) 0. 0 Fruit/ veg juice 61. 8 (2. 86) 5. 9 (7. 08) 39. 6 Other liquids (including soft drinks) 2. 3 2. 1 (1. 4) 4. 7 (1. 73) 0. 0 Commercial infant formula 23. 7 3. 2 (3. 33) 3. 3 (3. 40) 44. 2

Safe water access and Soap use • All households have access to running water • 99. 2% have access to facilities to boil water • Bottled water is the main water source used for preparing drinks (66. 8%) and food (63. 6%) • Soap was used by 96. 4% of HHs >10 x in the 48 hours before the survey, primarily for cleaning various parts of the body (See Tables 11, 12 and Figure 12)

Table 11: Percentage of households (n=250) with access to running water, facilities to boil water and the sources of water used for preparing children’s food and drink Region All Donetsk Makiivka Horlivka Khartzisk Shakhtersk Access to running water 100 100 100 Facilities to boil water 99. 2 99 97. 4 100 100 Main source of water used for preparing drinks Bottled 68. 8 80. 2 53. 8 95. 0 65. 0 20. 0 Tap 28. 4 17. 8 41. 0 5. 0 35. 0 70. 0 Well 2. 0 0. 0 5. 1 0. 0 10. 0 - - - 0. 8 2. 0 0. 0 65. 3 53. 8 92. 5 65. 0 30. 0 Water pump Othera Main source of water for preparing food Bottled 63. 6 Tap 33. 6 32. 7 41. 0 7. 5 35. 0 60. 0 Well 2. 0 0. 0 5. 1 0. 0 10. 0 - - - 0. 8 0. 0 Water pump Otherb a Other: boiled, filtered, don’t give; b Other: boiled, filtered, don’t give

Table 12: Frequency of soap use in the 48 hours prior to the survey Region Soap use (number of times) All in the last 48 hours 0 -4 - Donetsk - Makiivka - Horlivka - Khartzisk - Shakhtersk - 5 -10 3. 6 3. 0 5. 1 0. 0 5. 0 6. 7 10> 96. 4 97. 0 94. 9 100 95. 0 93. 3

Figure 12: Frequency for different uses of soap in the last two days by 250 HHQ respondents 300 250 Frequency (n) 200 150 100 50 0 After Hands after Before defecating cleaning child feeding child Before eating Own body preparing food Child's body Child's bottom Child's hands Clothes

Acute Malnutrition • 175 children had a normal MUAC measure (>125 mm) • 1 child (aged 9 months) had a MUAC of 120 mm (classified as moderate acute malnutrition • No child was assessed as having severe acute malnutrition (See Table 13) • MUAC ranged from 120 -210 mm with a mean of 161 mm (SD= 14. 78) Table 13: MUAC measures (n=176) infants 6 -23 months MUAC (mm) N= 176 <115 115 -124 >125 N % (95% CI) 0 (0) 0 1 0. 6 [. 04, 0. 1] 175 99. 4 [98. 3, 99. 7]

CONCLUSION

Key issues • Non-exclusive breastfeeding of infants <6 months - Tea, water, fruit/ vegetable juice, infant formula received before 6 months - Complementary foods consumed by infants aged 4 -5 months • Breastfeeding continuation at one year is low • Bottle use common • Stress related to the conflict limiting breastfeeding duration • Protein-containing complementary foods weekly frequency of consumption is low • Minimum dietary diversity is low, indicting concern for micronutrient deficiencies • Malnutrition, assessed through MUAC, not a major problem; 1 child with moderate acute malnutrition

Promotion and support required for: • Exclusive breastfeeding (infants <6 months) – reduction in use of infant formula (alone; mixed feeding) and use of teas and water • Use of cups, not bottles, for non-breast milk liquid feeds • Continued breastfeeding to 2 years • Age appropriate introduction of complementary foods • Increased dietary diversity / micronutrient intake (children 6 -23 months) • Psychosocial support for maternal stress combined with breastfeeding counselling (Recommendations will be elaborated on in the Final Report document)

THANK YOU