11

Draft Communication for Draft Communication for Behavioral Impact Strategy to Behavioral Impact Strategy to

Promote IYCF/Complementary Promote IYCF/Complementary Feeding in CambodiaFeeding in Cambodia

Draft Communication for Draft Communication for Behavioral Impact Behavioral Impact

Strategy to Promote Strategy to Promote IYCF /IYCF /Complementary FeedingComplementary Feeding

inin Cambodia Cambodia

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Research on IYCF Research on IYCF complementary feeding complementary feeding

Infant and young child feeding practices Infant and young child feeding practices research research in Cambodia 2006 in Cambodia 2006

Comprehensive review of feeding practices in Comprehensive review of feeding practices in children from 6 months and also explored children from 6 months and also explored some of the some of the barriers for mothersbarriers for mothers to providing to providing appropriate complementary foods.appropriate complementary foods.

Areas highlighted for future BCC interventions Areas highlighted for future BCC interventions included addressing included addressing poor qualitypoor quality Borbor Borbor introduced at introduced at inappropriate timesinappropriate times with active with active feeding and improved feeding and improved variety and quantitiesvariety and quantities. .

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Research location and Research location and participantsparticipants Research conducted by NNP with SBK Research conducted by NNP with SBK

Research and Development and partnersResearch and Development and partners 5 provinces of Stung Treng, Kratie, Prey Veng, 5 provinces of Stung Treng, Kratie, Prey Veng,

Kampot, and Battambang were selected Kampot, and Battambang were selected purposefully to be representative of the main purposefully to be representative of the main geographic regions of the country.geographic regions of the country.

A total of 110 mothers with children aged 0- 23 A total of 110 mothers with children aged 0- 23 months old were interviewed regarding infant months old were interviewed regarding infant and young child feeding practices. and young child feeding practices.

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Main Findings Main Findings For the 6-11 months oldFor the 6-11 months old

Infants were fed watery Infants were fed watery boborbobor, not energy or nutrient , not energy or nutrient densedense

Infants were fed only soup liquid with riceInfants were fed only soup liquid with rice There was inadequate amount, frequency and variety There was inadequate amount, frequency and variety

in the diet of the young childrenin the diet of the young children

For the 12-23 months old For the 12-23 months old Delayed introduction of family foods, not enough Delayed introduction of family foods, not enough

variety in the dietvariety in the diet Inadequate amount, frequency and variety in the diet of Inadequate amount, frequency and variety in the diet of

the young childrenthe young children Child eats by him/herself or with older siblings and Child eats by him/herself or with older siblings and

does not finish meal does not finish meal

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Outline of the COMBI process Outline of the COMBI process

1.1. Overall Goal Overall Goal 2.2. Expected Behavioural Results/ ObjectiveExpected Behavioural Results/ Objective

3.3. SMACK SMACK (Situation Market Analysis for (Situation Market Analysis for

Communication Keys)Communication Keys)

4. Overall Strategy4. Overall Strategy 5. COMBI Plan of Action5. COMBI Plan of Action 6. COMBI Programme Management 6. COMBI Programme Management 7. Monitoring and Evaluation7. Monitoring and Evaluation 8.8. Implementation Plan Implementation Plan 9.9. Budget Budget

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1.Overall Goal 1.Overall Goal

To improve the feeding practices of To improve the feeding practices of infants and young children, by increasing infants and young children, by increasing knowledge and supporting behaviour knowledge and supporting behaviour changes to encourage appropriate changes to encourage appropriate feeding practices (timely, consistency, feeding practices (timely, consistency, quantity, quality, frequency, hygiene and quantity, quality, frequency, hygiene and active feeding) active feeding)

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2.Behavioural Objective2.Behavioural Objective1.1. Timely :Timely :

Start complementary feeding when the child is 6 months of age and continue Start complementary feeding when the child is 6 months of age and continue breastfeeding to two years and beyondbreastfeeding to two years and beyond

cab;epþImpþl;GahabEnßmdl;kumarenAGayueBj cab;epþImpþl;GahabEnßmdl;kumarenAGayueBj 6Ex ehIybnþbMe)AkUn6Ex ehIybnþbMe)AkUnedayTwkedaHmþayrhUt ya:gtic[)an2qñaM edayTwkedaHmþayrhUt ya:gtic[)an2qñaM b¤elIsBIenH .b¤elIsBIenH .

22 Consistency and quality of food: Consistency and quality of food: Give Bobor that is thick and has meat, fish, egg, vegetables and oil from Give Bobor that is thick and has meat, fish, egg, vegetables and oil from complete 6 months. Start each time with 2 spoons and gradually increase complete 6 months. Start each time with 2 spoons and gradually increase quantity to a full bowel 3 times per day to one year of age. quantity to a full bowel 3 times per day to one year of age.

pþl;bbrxab;EdlmanlayRtI su‘t sac; bEnø pþl;bbrxab;EdlmanlayRtI su‘t sac; bEnø nigEfmxøaj; b¤eRbgpg edaycab;epþImnigEfmxøaj; b¤eRbgpg edaycab;epþIm

enAGayueBj6Ex pþl;2søabRBakñúg1eBl² enAGayueBj6Ex pþl;2søabRBakñúg1eBl² ehIybegáInbnþicmþg² rhUtdl;eBjehIybegáInbnþicmþg² rhUtdl;eBj

mYycancgÁwH 3dgkñúg1éf¶ mYycancgÁwH 3dgkñúg1éf¶ enAeBlkumarGayu)an1qñaM.enAeBlkumarGayu)an1qñaM.

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33 Hygiene:Hygiene: Wash hands and cooking equipment with soap before preparation of Bobor Wash hands and cooking equipment with soap before preparation of Bobor

and before feeding. and before feeding.

lagsMGatéd lagsMGatéd nigsMPar³pÞH)aynigsMPar³pÞH)ayCamYysab‘U CamYysab‘U muneBlcMGinGahar nig muneBlcMGinGahar nig muneBlbBa©úkGahardl;kUn .muneBlbBa©úkGahardl;kUn .

44 Active feeding: Active feeding: Feed children with lots of encouragement and patience actively feeding and allowing enough Feed children with lots of encouragement and patience actively feeding and allowing enough

time for feeding.time for feeding.

pþl;GaharbEnßmedayGt;Fµt; pþl;GaharbEnßmedayGt;Fµt; CYyelIkTwkcitþkumar [jaMGaharCYyelIkTwkcitþkumar [jaMGahar

¬pþl;edayskmµ ¬pþl;edayskmµ nigcMNayeBl[)anRKb;rKan;¦.nigcMNayeBl[)anRKb;rKan;¦.

2.Behavioural Objective2.Behavioural Objective

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Behavioural Objectives that Behavioural Objectives that should be part of the strategy?should be part of the strategy?

Sick children Sick children

Children over one year Children over one year Almost 63% not meeting energy requirements Still critical age for growth and development

Snacks as part of healthy diet for children Snacks as part of healthy diet for children less than and over one year.less than and over one year. Helps to meet energy and nutrient deficit

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Time frame and Time frame and implementation choices implementation choices

Use two behavioural objectives per year and Use two behavioural objectives per year and build on the following year?build on the following year?

Which ones should be prioritized for the first and Which ones should be prioritized for the first and second year?second year?

BCC activities should be for one year with BCC activities should be for one year with messages continued through replacing old messages continued through replacing old practices with new behaviour and reinforcing practices with new behaviour and reinforcing messages through routine IYCF counseling?messages through routine IYCF counseling?

Year one and two introduce new objectives and Year one and two introduce new objectives and in year 3 and 4 revise the changes and reinforce in year 3 and 4 revise the changes and reinforce the same messages again. the same messages again.

--

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Expected outcomes - what Expected outcomes - what should our targets be?should our targets be?

What will we use as a baseline for many of the What will we use as a baseline for many of the behavioural objectives?behavioural objectives?

CDHS information on breastfeeding and types of CDHS information on breastfeeding and types of foods in complementary feeding from 2005?foods in complementary feeding from 2005?

What should the yearly targets be? Should they be What should the yearly targets be? Should they be set?set?

In this way we will have possibly ….. to In this way we will have possibly ….. to X % by 2009 ( Y % by 2010 and Z % by X % by 2009 ( Y % by 2010 and Z % by

2011/2012 )2011/2012 )- By end of 2012 ....% start complementary feeding - By end of 2012 ....% start complementary feeding

from age 6 months, timely , quality, consistency, from age 6 months, timely , quality, consistency, hygiene, active feedinghygiene, active feeding

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Cost vs. Value CalculationCost vs. Value Calculation Field observations and conversations suggests Field observations and conversations suggests

that individuals will follow-through with the that individuals will follow-through with the recommended behaviour if in their recommended behaviour if in their cost vs. cost vs. valuevalue calculation calculation

it is worth it to invest the effort and bear the it is worth it to invest the effort and bear the “cost” in carrying out the behaviour in relation “cost” in carrying out the behaviour in relation to to the value of what they receive in …the value of what they receive in …

in relation to what other “competition” (is in the in relation to what other “competition” (is in the environment or “market place.”) environment or “market place.”)

3. SMACK 3. SMACK (Situation Market (Situation Market Analysis for communication Analysis for communication keys) keys)

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Timely :Start complementary feeding when the Timely :Start complementary feeding when the child is 6 months of age and continue child is 6 months of age and continue breastfeeding to two years and beyondbreastfeeding to two years and beyond

We have no information on the We have no information on the motivators or barriers to starting timely motivators or barriers to starting timely complementary feeding. complementary feeding.

The only intervention in the research was The only intervention in the research was attempting to encourage mothers to attempting to encourage mothers to express breastmilk but this was difficult express breastmilk but this was difficult for mothers to do and not seen as for mothers to do and not seen as possible the mothers needed a lot of possible the mothers needed a lot of education and counsellingeducation and counselling

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Consistency and quality of food: Give Bobor that Consistency and quality of food: Give Bobor that is thick and has meat, fish, egg, vegetables and is thick and has meat, fish, egg, vegetables and oil from complete 6 months. Start each time oil from complete 6 months. Start each time with 2 spoons and gradually increase quantity to with 2 spoons and gradually increase quantity to a full bowel 3 times per day to one year of age.a full bowel 3 times per day to one year of age.

Obstacles for Behavioural ChangeObstacles for Behavioural ChangeResources Resources Buying meatsBuying meats or fish is or fish is expensive and expensive and mothermother doesn’t have enough doesn’t have enough

money.money. Its common practice in the villages to eat 2 main meals in a day, Its common practice in the villages to eat 2 main meals in a day,

normally just lunch and dinnernormally just lunch and dinner Sometimes family is eating dry food like fried fish with no Sometimes family is eating dry food like fried fish with no

vegetables, vegetables, If mother goes to the field, its not possible to achieve.If mother goes to the field, its not possible to achieve.

Child HealthChild Health Children are too small and risk of choking on enriched Borbor.Children are too small and risk of choking on enriched Borbor. Think some vegetables/foods cause Think some vegetables/foods cause diarrhoea/sickness diarrhoea/sickness

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Hygiene: Wash hands and cooking Hygiene: Wash hands and cooking equipment with soap before equipment with soap before

preparation of Bobor and before preparation of Bobor and before feeding.feeding.

Unhygienic feeding behaviours such as not Unhygienic feeding behaviours such as not washing the hands before feeding the child or washing the hands before feeding the child or preparing food, using unclean utensils and not preparing food, using unclean utensils and not washing the vegetables or fruits was observed washing the vegetables or fruits was observed during the trial. In addition only aduring the trial. In addition only a minority of minority of homes had latrineshomes had latrines..

We have no information on the motivators or We have no information on the motivators or barriers to improving hygienic practices from barriers to improving hygienic practices from this research. this research.

? Other research in Cambodia? Other research in Cambodia

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Active feeding: Feed children with lots Active feeding: Feed children with lots of encouragement and patience of encouragement and patience actively feeding and allowing enough actively feeding and allowing enough time for feeding.time for feeding.

General findings on feeding practicesGeneral findings on feeding practices When to feed child: 79% give food when When to feed child: 79% give food when

cry or express hunger, only 12% have cry or express hunger, only 12% have fixed schedule for feeding.fixed schedule for feeding.

48% of mothers said full “when the child 48% of mothers said full “when the child stops eating or spits out the food” or when stops eating or spits out the food” or when they ask for water (10%) and start to play they ask for water (10%) and start to play or stop crying (11%or stop crying (11%).).

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Active feeding: Feed children with lots Active feeding: Feed children with lots of encouragement and patience of encouragement and patience actively feeding and allowing enough actively feeding and allowing enough time for feeding.time for feeding.

Obstacles for Behavioural ChangeObstacles for Behavioural Change

When child becomes sick they eat very little.When child becomes sick they eat very little. Mothers working in the field. Mothers working in the field. If child spits out food it was assumed they didn’t like it If child spits out food it was assumed they didn’t like it

or was full.or was full. Child vomits after food so mother afraid to force the Child vomits after food so mother afraid to force the

child as small stomach.child as small stomach. Mothers think that quantities/bowel of food is too much Mothers think that quantities/bowel of food is too much

for their children to eat "I was afraid that when he ate for their children to eat "I was afraid that when he ate more, his stomach would get big and burst because my more, his stomach would get big and burst because my child is still small"child is still small"

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4. Overall Strategy 4. Overall Strategy Behavioural Objectives (after Behavioural Objectives (after SMACK )SMACK )

Communication strategy Communication strategy 1 1 -Administrative mobilization/Public Relations :-Administrative mobilization/Public Relations :

2-Community Mobilization2-Community Mobilization

3.Advertising and promotion 3.Advertising and promotion

4.Personal Selling 4.Personal Selling

5.Point-of-Service promotion5.Point-of-Service promotion

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5.COMBI Plan of Action . 5.COMBI Plan of Action .

1. Administrative mobilization1. Administrative mobilization

/Public Relations/Public Relations

2.Community Mobilization 2.Community Mobilization

3.Advertising3.Advertising

4.Personal Selling4.Personal Selling

5.Point-of-Service promotion5.Point-of-Service promotion

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MessagesMessages The messages need to address both the The messages need to address both the

Head (logic) and Heart (emotional) Head (logic) and Heart (emotional) dimension of the Cost vs. Value dimension of the Cost vs. Value calculation. calculation.

On the value side, On the value side, -……………………-……………………

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1- 1- pþl;bbrxab; Edlmansac;s‘utbEnø pþl;bbrxab; Edlmansac;s‘utbEnø xøøøaj dl;kUnGñk cab;BIGayu xøøøaj dl;kUnGñk cab;BIGayu 6ExeLIgeTA edIm,I[kUnrbs;Gñk 6ExeLIgeTA edIm,I[kUnrbs;Gñk lUtlas; mMamYn R)aCa¶ evogév nig lUtlas; mMamYn R)aCa¶ evogév nig QñHCMgW .QñHCMgW .

2¦ 2¦ cab;epþImpþl;GaharbEnßm[)anRKbcab;epþImpþl;GaharbEnßm[)anRKb;RKan;RtwmRtUv nigeTogTat; ;RKan;RtwmRtUv nigeTogTat; dl;kUnGñkcab;BIGyu6ExeLIgeTAedIdl;kUnGñkcab;BIGyu6ExeLIgeTAedIm,IkaBarCm¶WeRkHRkin m,IkaBarCm¶WeRkHRkin sÁmsÁaMg nigesøksøaMg. sÁmsÁaMg nigesøksøaMg.

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3>mþay 3>mþay nigGñkEfTaMkumarRKb;rUbRtUvlagéd nigGñkEfTaMkumarRKb;rUbRtUvlagéd nigsMPar³pÞH)ayCamYysab‘U nigsMPar³pÞH)ayCamYysab‘U muneBlcMGinGahar nig muneBlcMGinGahar nig muneBlbBa©úkGahardl;kUn muneBlbBa©úkGahardl;kUn edIm,IkarBarkUnGñk BICMgWrakrUs edIm,IkarBarkUnGñk BICMgWrakrUs nigCMgWqøgepSg² nigedIm,IcMeNjR)ak; nigCMgWqøgepSg² nigedIm,IcMeNjR)ak; nigeBlevla.nigeBlevla.

4>bBa©úkGaharbEnßmdl;kUnGñkedayk4>bBa©úkGaharbEnßmdl;kUnGñkedaykþIRsLaj; GMNt; nigelIkTwkcitþkUn þIRsLaj; GMNt; nigelIkTwkcitþkUn [jaM)anRKb;RKan; [jaM)anRKb;RKan; edIm,ICYykUnGñk[lUtlas;)anledIm,ICYykUnGñk[lUtlas;)anl

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Communication ActionsCommunication Actions

- Design a new logo, Gingle, Slogan and Design a new logo, Gingle, Slogan and branding them for branding them for

the recommended behaviour. the recommended behaviour.

- To be used on all materials dealing with To be used on all materials dealing with this plan. this plan.

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1 -Administrative mobilization/Public 1 -Administrative mobilization/Public Relations :Relations :

-Memos-Memos-partnership session -partnership session

-staff meeting ,radio /TV ,news -staff meeting ,radio /TV ,news papers, papers, -community meeting/discussion etc-community meeting/discussion etc

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2-Community Mobilization :2-Community Mobilization :

-Community meeting and events-Community meeting and events

-Mass media-Mass media

-traditional media-traditional media

- Concert …- Concert …

- with supporting materials- with supporting materials

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3.Advertising and promotion :3.Advertising and promotion :-Selecting an “advertising agency”, -Selecting an “advertising agency”, - Confirm agreement on style of advertising- Confirm agreement on style of advertising - Develop content of the advertisements for radio, - Develop content of the advertisements for radio,

television, with reference to the behavioural television, with reference to the behavioural themes .themes .

-News papers-News papers-Billboards -Billboards -Banners-Banners-Flipcharts, leaflets, booklets, Flyers , cap, -Flipcharts, leaflets, booklets, Flyers , cap,

stickers, brochures, banners, T-shirts…stickers, brochures, banners, T-shirts…

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Plan IPC and other communication activities at communityPlan IPC and other communication activities at community level with PHD &OD (by NNP and partners)level with PHD &OD (by NNP and partners)

Develop training materialsDevelop training materials (by NNP and partners ) (by NNP and partners ) conducting training need assessment conducting training need assessment develop appropriate training curriculum develop appropriate training curriculum

for training of trainer to PHD and OD staff for training of trainer to PHD and OD staff for step down training to health centre staff and MSG.for step down training to health centre staff and MSG.

Conduct training of trainerConduct training of trainer to PHD and OD staff to targets to PHD and OD staff to targets provinces (by NNP and partners )provinces (by NNP and partners )

Conduct step down trainingConduct step down training to HC staff & MSG to HC staff & MSG (by PHD and OD with support from NNP and partners)(by PHD and OD with support from NNP and partners)

4.Personal Selling :4.Personal Selling :

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- Mother support group , VHSG, and others - Mother support group , VHSG, and others volunteers.volunteers.

education at village or home to mothers and education at village or home to mothers and caretakerscaretakers

… … with supporting materials e.g.Print with supporting materials e.g.Print materials …,TV/Radio spot .., which covers materials …,TV/Radio spot .., which covers the behavioural theme to caretakersthe behavioural theme to caretakers

- Mother is most important decision maker for - Mother is most important decision maker for deciding what foods to give to the child and deciding what foods to give to the child and when both parents work the grandmother often when both parents work the grandmother often becomes the caretaker.becomes the caretaker.

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5.Point-of-Service5.Point-of-Service promotionpromotion

- Display posters in the waiting area, which - Display posters in the waiting area, which messages similar to those of TV/radio messages similar to those of TV/radio spots.spots.

- Billboards - Billboards

- Banners- Banners

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6. COMBI Programme 6. COMBI Programme Management Management . .

NNP and partnersNNP and partners

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A-MonitoringA-Monitoring

Random check by NNP and partner for the Random check by NNP and partner for the activities carried out by PHD, OD and MSG.activities carried out by PHD, OD and MSG.

Random check by PHD and OD for the Random check by PHD and OD for the activities implemented by health centre.activities implemented by health centre.

Field observations and KAP SVField observations and KAP SV Small tracking surveys of mass media Small tracking surveys of mass media

activities twice a year (mid year and end activities twice a year (mid year and end year) in the targeted provinces. year) in the targeted provinces.

7.Monitoring & Evaluation7.Monitoring & Evaluation

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Conduct a final KAP( knowledge ,attitude ,practice) Conduct a final KAP( knowledge ,attitude ,practice) surveys on CF surveys on CF by NNP and partners to targeted provinces and by NNP and partners to targeted provinces and

other provinces. other provinces. Mothers ,care givers target group Mothers ,care givers target group ……

B-EvaluationB-Evaluation

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8- Implementation Plan8- Implementation Plan

4 year Duration4 year Duration From 2009 -2012From 2009 -2012 Implementers & Partners:Implementers & Partners:

NNP and NGOs , IOs, UNsNNP and NGOs , IOs, UNs PHDs, PHPUs, ODs, HCs, MSG in targeted PHDs, PHPUs, ODs, HCs, MSG in targeted

- Media- Media

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Operational PlanOperational Plan

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9.Budget :9.Budget :

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Next steps for IYCF BCC Next steps for IYCF BCC strategystrategy

1.1. Finalize messages and field testFinalize messages and field test2.2. Develop operational plan and budget Develop operational plan and budget

requests with all involved partnersrequests with all involved partners3.3. Share the strategy, operational plan and Share the strategy, operational plan and

field tested messages with N TWGfield tested messages with N TWG4.4. Develop materials as identified in the Develop materials as identified in the

strategystrategy5.5. Disseminate/broadcast/use the new Disseminate/broadcast/use the new

materialsmaterials