Measurement and Interpretation TRAINING COURSE ON ASSESSMENT OF NUTRITIONAL STATUS, National Food Policy Capacity Strengthening Programme (NFPCSP) 21 December 2011 Presentation by: Nusha Choudhury, WFP
Measuring Dietary Diversity The gold standard to measure dietary diversity Costly is through measuring Requires various food items Technical Time consumed by an expertise consuming individual or a household in energy or kilocalorie terms. Alternate/Proxy IndicatorsHousehold/Individual Food ConsumptionDiet Diversity Score/FCSScore/HDDS/IDDS
Household & Individual Diet Diversity Score (HDDS/IDDS) Measures no. of different food groups consumed over a given reference period i.e. 24 hours/1 day (FANTA/USAID). HDD is also a proxy for hh’s socio economic status. Whereas IDD is purely a proxy measure of an individual’s quality of diet. 12 Food Groups in HDD, 8 Food Groups in IDD (Children), (Score: 0-12) (Score: 0-8) 1. Cereals Roots and tubers 1. Grains, roots or tubers 2. Vegetables 2. Vitamin A-rich plant foods 3. Fruits 3. Other fruits or vegetables 4. Meat, poultry, offal 5. Eggs 4. Meat, poultry, fish, seafood 6. Fish and seafood 5. Eggs 7. Pulses/legumes/nuts 6. Pulses/legumes/nuts 8. Milk and milk products 7. Milk and milk products 9. Oils/ fats 8. Foods cooked in oil/fat 10. Sugar/honey 11. Miscellaneous
General Rules for HDD & IDD Data Collection Data should be collected during the food shortage period of the year. Recall period is 24 hours. The 24 hour recall period has to be a normal/usual food consumption day for the household/individual. Generally for HDD food items consumed outside the house should not be included, unless it is a common practice for majority of the household members.
HDDS Calculation Step 1: Assign 1 if the food group/item consumed; 0 not consumed. Sum all the scores for various food groups. Sum will be between 0-12. Step 2: The average HDDS for the sample population Sum HDDS Total no. of households Setting HDDS Threshold: Option 1: From a baseline survey take the HDDS for the richest income tercile (33%). Option 2: From a baseline survey take HDDS of the upper tercile (33%) of diet diversity.
Food Consumption ScoreFCS is a frequency weighted diet diversity score for ahousehold or an individual over past 7 days. Here the scoreis calculated using the frequency of consumption ofdifferent food groups by (WFP). Key features of FCS Total 9 food groups are considered. Consumption frequency by various food groups are recorded over 7 days recall basis. Consumption less than 10 grams/1tea spoon are not considered. Each food groups are assigned weights based on their micro and macro nutrient content.
Food Groups & Weights in FCS Food groups Weight FOOD ITEMS (examples) (definitive) (definitive) Rice, wheat, maize , maize porridge, sorghum, millet pasta, bread and other cereals1 Main staples 2 Cassava, potatoes and sweet potatoes, other tubers, plantains2 Beans. Peas, groundnuts and cashew nuts Pulses 33 Vegetables, relish and leaves Vegetables 14 Fruits Fruit 15 Beef, goat, poultry, pork, eggs and fish Meat and fish 46 Milk yogurt and other diary Milk 47 Sugar and sugar products Sugar 0.58 Oils, fats and butter Oil 0.5 spices, salt, fish power, small amounts of milk for9 Condiments 0 tea.
FCS Calculation Group all the food items into specific food groups. Sum all the consumption frequencies of food items of the same group, and recode the value of each group above 7 as 7. Multiply the value obtained for each food group by its weight and creates new weighted food group scores. Sum the weighed food group scores, thus creating the food consumption score (FCS). Using the appropriate thresholds (see below), recode the variable food consumption score, from a continuous variable to a categorical variable. FCS Profiles 0-21 Poor 21.5-35 Borderline > 35 Acceptable
Bangladesh Specific FCS Given the importance of oil and fish in the diet of the Bangladeshi people, the general thresholds were elevated. As a result, FCS thresholds were revised for Bangladesh (HFSNA 2009): Poor consumption (≤28), Borderline Consumption (>28 and ≤42), Acceptable Consumption (>42), An additional threshold was introduce to distinguish the acceptable households between acceptable low (43-52) and acceptable high (>52).
Diet Composition by Food Consumption Score in Bangladesh Sugar, Molasses (gur)Cumulative no. of days of consumption 56 Fruits Milk&Milk product 49 Pulses (mansur, kesari, etc) Meats&Fish 42 Vegetables Edible oil 35 Cereals&Tubers 28 21 14 7 0 0 29 43 53 Poor BorderlineAcceptable Acceptable high low Food Consumption Score
Comparative Advantages of the Two Scores HDD has more food groups FCS records frequency of than FCS therefore prevents consumption which under reporting. prevents over reporting. Short recall periods are more 7 days recall period provides reliable. a habitual food Easy to collect, enumerators consumption. do not need extensive training . Disregards small quantities More suitable for rapid of consumption which over assessments during rates the consumption. emergencies. Suitable for in depth food A child IDD module is security assessment. available.
Research findings on the two scores Gina Kennedy et al. conducted a study in Burkina Faso, Lao PDR, N. Uganda and found correlation between HDDS & FCS were significant in all three countries. The best correspondence identified based in this study FCS ≤ 21 corresponded to HDDS between 2 & 3. FCS ≤ 35 corresponded to HDDS slightly higher than 3. FCS and HDD demonstrated similar strength of correlation with other food security indicators.IFPRI research found that combination of frequency anddiversity in FCS correlates better with household energy intakethan only diet diversity (based on three countries)Another IFPRI research revealed that weighted FCS do not haveadded advantage over un weighted FCS in terms of relationshipto energy intake, unless they are locally adjusted.
Research findings on linkagebetween FCS & anthropometric measures P <0.05 P <0.001 P <0.000 P <0.000HFSNA 2009
Precautionary messages Both the FCS and HDDS are proxy indicators of food consumption and are not interchangeable. The choice of the methods will depend on objective and depth of the surveys. None of these measures are directly synonymous of food insecurity, they are rather one of the indicators of food insecurity. To identify the food insecure and vulnerable the diet diversity scores/groups should be used in combination with food security access indicators like income, expenditure, asset, HFIAS etc.