Module 5: Nutritional assessment in policy and programmatic application By Tina G. Sanghvi, PhD Senior Country Director Alive & Thrive, FHI360 Training on Assessment of Nutritional Status 18-22 December 2011 Date : 22 December 2011, Venue: FPMU Meeting Room The Training is organized by the National National Food Policy Capacity Strengthening Programme (NFPCSP) . The NFPCSP is jointly implemented by the Food Planning and Monitoring Unit (FPMU), Ministry of Food and Disaster Management and Food and Agriculture Organization of the United Nations (FAO) with the financial support of the EU and USAID.
30
Embed
Sanghvi 9 linking dietary intakes with nutritional assessment
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
Module 5: Nutritional assessment in policy and programmatic application
By
Tina G. Sanghvi, PhD Senior Country Director Alive & Thrive, FHI360Training on Assessment of Nutritional Status 18-22 December 2011
Date : 22 December 2011, Venue: FPMU Meeting Room
The Training is organized by the National National Food Policy Capacity Strengthening Programme (NFPCSP) . The NFPCSP is jointly implemented by the Food Planning and Monitoring Unit (FPMU), Ministry of Food and Disaster Management and Food and Agriculture
Organization of the United Nations (FAO) with the financial support of the EU and USAID.
Acknowledgements
• M. Ruel, IFPRI. Nutrition and economic growth A&T Partners’ Meeting Hanoi, September 2011
• Lalita Bhattacharjee, FSNSP Dissemination Workshop. December 13 December 13, 2011.
• Mahbub Hossain, BRAC. FSNSP Dissemination Workshop. December 13, 2011
• John B. Mason. Keynote paper: Measuring hunger and malnutrition.FAO Symposium 2002
• IFPRI. Alive & Thrive Baseline Survey 2011.• Haider, Sanghvi et al. Alive & Thrive Formative Research
on IYCF. 2009.
Module 5: Program and Policy Application, Tina Sanghvi PhD
Session Overview
• Uses of data for policy & programs
– Examples
• Why dietary adequacy does not always equal nutritional status
– Examples
Module 5: Program and Policy Application, Tina Sanghvi PhD
Indicators – Country Investment Plan
Module 5: Program and Policy Application, Tina Sanghvi PhD
• How food & nutrition assessments are used:– Define trends to trigger action– Identify causes to design interventions– Monitor & evaluate effects of programs & policies
• Choice of indicators & interpretation are keyExample: In Bangladesh, food and poverty trends
have improved. Fertility & mortality rates have declined but malnutrition is stagnant. This is triggering actions to find out the causes, evaluatepast programs and strengthen nutrition interventions, e.g. CIP, NFP, POA, National Nutrition Service to evaluate their future effects
Module 5: Program and Policy Application, Tina Sanghvi PhD
METHODS OF ASSESSING FOOD SECURITY& NUTRITION & THEIR USE
Method UseTrends analysis Research into
causesEvaluation
(1 ) FAO: DES/CV
dietary energy supply Main use: global and
regional level; always
under-estimates
Not very useful except
for broad inter-country
trends
Not very useful
(coefficient of variation)
(2) Household income
and expenditure survey
Useful: national and
subnational level
Can be useful Useful
(3) Food consumption/ Useful: now available at
the national level, thus
very useful, captures
intra-HH food distrib.
Main use Main use
individual intake (24-
hour)
(4) Anthropometry
(mother, child weight &
height)
Useful at all levels, but
for physical malnutrition
and not food security
Useful for physical
malnutrition not food
security
Useful but should also have food security indicators
(5) Qualitative method
(food habits)
Useful: national and
subnational level
Useful Useful
Questions that can be addressed by different methods
Are food supply policies/programs working? Impact of climate change/ disasters on supplies?
(coefficient of variation)
(2) Household income
and expenditure survey
Are no. of food secure
HH (in energy and
nutrients) improving?
Is the cause of
problems due to low
expenditures on food?
Are programs working to reach the poor?
(3) Food consumption/ Are mothers and young
children consuming
more adequate diets?
Is the problem food
availability/access or
dietary habits?
Are programs for women and young children working?individual intake (24-hr)
(4) Anthropometry
(mother/child wt, ht)
Is nutritional status
improving?
No Does the program improve nutrition of mothers & children?
(5) Qualitative method
(food habits, frequency)
Are food habits
improving?
Are habits a barrier? Does the program improve food habits?
How we present and interpret data makes a difference: examples
Module 5: Program and Policy Application, Tina Sanghvi PhD
Trends in food intake (gms/capita/day)
All Urban Rural
1991-92 886 938 878
1995-96 914 931 911
2005 949 952 946
2010 1000 985 1005
Module 5: Program and Policy Application, Tina Sanghvi PhD
•Intakes improving faster in rural areas,•Averages hide disparities among economic groups
Food available in grams per head per day
800
850
900
950
1000
1050
1991-92 1995-96 2005 2010
All
Urban
Rural
Module 5: Program and Policy Application, Tina Sanghvi PhD
Diversity:-National supplies-Household level
- Child’s diet-Women’s diet
Module 5: Program and Policy Application, Tina Sanghvi PhD
Trends in food content adequacy (gms/capita/day)
Food Recom. 2005 2010 Trend
Rice 390 440 416
Wheat 100 12 26
Vegetables 225 220 236
Pulses 30 14 14
Oil 20 16 21
Fish 45 42 49
Meat/eggs 34 20 25
Module 5: Program and Policy Application, Tina Sanghvi PhD
Content of food basket: improving diversity
0
50
100
150
200
250
300
350
400
450
500
2005 2010
Rice
Wheat
Vegetables
Pulses
Oil
Fish
Meat/eggs
Module 5: Program and Policy Application, Tina Sanghvi PhD
Content of food basket: gaps in diversity
0
50
100
150
200
250
300
350
400
450
500
Recom.
2005
2010
Module 5: Program and Policy Application, Tina Sanghvi PhD
Dietary intake assessment is key
• RAP –low cost, primary method for collecting dietary data (locally available /commonly consumed foods, dietary habits, behaviour)
• Household surveys – provide data on foods consumed by HH not individuals
• Point to which foods are major contributors to nutrients of particular concern ( identify vulnerability/at risk of dietary deficiency - e.g lack of animal foods; no fresh vegetables/fruits, lack of DGLV/YOV–lack of vit. C & A in diet)
• Food record and 24 hr recall methods of choice for estimating mean intakes; quantitative dietary intake methods to obtain individual nutrient intakes
• Take measurements for each individual on at least 2 non-consecutive days to obtain intra-individual variation
Module 5: Program and Policy Application, Tina Sanghvi PhD
Why improving food security does not necessarily remove undernutrition
Module 5: Program and Policy Application, Tina Sanghvi PhD
Ruel; A&T Partners' Meeting, Hanoi 9/27/2011
13.88
35.38
39.28
19.18
46.3944.52
22.99
47.32 47.07
23.14
53.29
49.88
0
5
10
15
20
25
30
35
40
45
50
55
Vietnam Bangladesh Ethiopia
PER
CEN
T ST
UN
TED
+ p < 0.10, * p < 0.05, ** p < 0.01, *** p < 0.001
A&T Baseline: Stunting is High Even in Food Secure Households
Bivariate
Food secure
Mildly food insecure
Moderate food insecure
Severely food insecure
Module 5: Program and Policy Application, Tina Sanghvi PhD
Factors that determine nutritional status
Module 5: Program and Policy Application, Tina Sanghvi PhD
Adequate Complementary Feeding
38 3847 44 48
16
36
4858
0
10
20
30
40
50
60
70
80
90
100
Lowest Second Middle Fourth Highest 6-8m 9-11m 12-17m 18-23m
By Wealth Quintiles By Age Groups
BDHS 2007
Quality of Children’s Diets (BDHS, 2007)
0 0 210
24
34
48
6471
75
0
10
20
30
40
50
60
70
80
90
100
Age <2 m 2-3 m 4-5 m 6-7m 8-9m 10-11m
12-15m
16-19m
20-23m
24-35m
Meat, Fish, Poultry and Eggs Consumed (< 24 h)
Why is nutrition not improving?• Knowledge: do people know what foods they should
consume by age, sex, occupation, physiological status?
• Do families have the resources/motivation to convert knowledge to practice
• If food intakes (energy and nutrients) are adequate, could there be intervening factors e.g. illness