1. Project GCP/BGD/037/MUL
National Food Policy Capacity Strengthening Programme (NFPCSP)
Training Workshop on
FOOD SECURITY CONCEPTS, BASIC FACTS & MEASUREMENT ISSUES
25 June – 07 July, 2011
Topic: Analytical Approaches for Food security
Sub-topic 2c : Analytics 3: Food Utilization
Lecture : Food Utilization/Nutrition
By
Mohammad Abdul Mannan, PhD
Nutrition Advisor, NFPCSP-FAO

2. OUTLINE OF THE PRESENTATION
Background
Conceptual framework
Nutrition and health status
Food consumption and nutrition situation
Seasonality and disaster
Linkage with different sectors
Concluding
Way forward

3. Food security – An evolving concept
 In the 50s and 60s: Food security = self sufficiency in major staples
 After World Food Conference of 1974:Food Security = Access to
sufficient food
 World Food Summit of 1996:“Food security exists when all people, at
all times, have physical and economic access tosufficient, safe and
nutritious food to meet their dietary needs and food preferences for an
active and healthy life”.
 Food Security is part of Nutrition Security
 The concept of Nutrition security — ensuring access to food that is
nutritious as well as sufficient — is increasingly being used to
stress the importance of the quality of food for people of all ages

4. What is Nutrition?
Nutrition is the science
and practice of
consuming and utilizing
foods. It is the study of
nutrients in food, how
the body uses
nutrients, and the
relationship between
diet, health and disease.

5. Why nutrition is important?
 Foundation to development contributing to MDG’s
 Economic benefit
 LBW perpetuates the intergenerational cycle of
undernutrition and disease
 Economic growth alone unlikely to yield Nutrition
results

6. Conceptual framework for analyzing the causes of
malnutrition
Outcomes Malnutrition,
death & disability
Immediate Inadequate
causes Disease
dietary intake
Underlying
causes at Inadequate maternal Poor water,
Insufficient access to sanitation &
household / & child CARE
FOOD inadequate HEALTH
family level practices
services
Quantity and quality of actual resources –
human, economic & organisational - and the way they are controlled
Basic causes at
societal level
Potential resources: environment, technology, people
UNICEF

7. The food and agriculture sector and nutrition
Narrowing the “nutrition gap”
the gap between what foods are available and what foods are needed
for a healthy diet
 Diets are often low in quantity, quality and variety
(hunger and micro-nutrient deficiencies)
 Increased production of staple foods is not sufficient
 Need to ensure local availability and access of the right mix of
foods in all seasons
 Consumers must be informed
 Collaboration must be established with : (a) social protection
programmes to support the poorest and (b) with health &
multi sectors/programmes

8. Undernourishment in 2010, by Region (millions)
Total: 925 million
19
37 Developed Countries
53
Near East and North
Africa
Latina America and the
578
Caribbean
239 Sub-Saharan Africa
Asia and the Pacific
Source: FAO, 2010

9. Undernourishment: FAO estimates
• Proportion of undernourished population remains the largest in South Asia
• Between 1990-92 and 2005-07,prevalence of undernourished decreased in Bangladesh
by 11%, the largest decline in South Asia
Country Undernourished Undernourished Proportion (%) Proportion (%)
(millions) (millions) of population of population
in 1991-93 in 2005-07 undernourished undernourished
in 1991-93 in 2005-07
Bangladesh 44.4 41.7 38 27
India 172.4 237.7 20 21
Nepal 4.2 4.5 21 16
Pakistan 29.6 43.4 25 26
Sri Lanka 4.8 3.8 28 19
Total South Asia 255.4 331.1 22 22
Source: SOFI
,2010

10. CONTEXT : Bangladesh continues to have the highest Cer DES - 80%

11. Undernourishment trends
Undernutrition trends among <5 children in Bangladesh
80
65.8 68.3
70
60 64.6 57.4
64.2
51
50
51.4 47.8
Percent
43 44.6
48.3
40 43.1
42.4 41
30
20 16.7 16.6
14.4
12 12.7 17
13
10
1989/90 1992 1995 2000 2005 2007 2009
Underweight <5 Stunting <5
Wasting <5 MDG target for underweight
Source: 1990-2005 CMNS; 2007 BDHS; 2009 HFSNA

12. FOOD CONSUMPTION SITUATION
•Significant + correlations between DES Cer% and child MN rates
Association between DES Cereal% and
% stunting in U-5 children (n = 20, p = 0.000)
55
50
45
% Stunting
40
35
30
25 y = 0.7634x - 17.671
20
15 R2 = 0.5154
10
5
0
35 40 45 50 55 60 65 70 75 80 85
DES Cereal%
Source: Authors' own calculation from FAO RAP 2007

13. RELATIONSHIPS WITHIN THE FS FRAMEWORK

14. Nutritional and health status
This „vicious cycle‟ is known as the “malnutrition-infection cycle”:
Weight loss, growth faltering and reduced
INADEQUATE
leads to immunity, which lower the body’s ability to
DIETARY INTAKE
resist infection.
this causes
this results in
Loss of appetite, malabsorption of Longer, more severe and
nutrients, altered metabolism and leads to more frequent disease
increased nutrient needs. episodes.

15. Nutritional and health status
Nutrition and health are closely linked:
NUTRITIONAL STATUS
disease contributes to malnutrition
HEALTH STATUS
while malnutrition makes an individual more
susceptible to disease.
This can eventually lead to severe
malnutrition and death.

16. FOOD CONSUMPTION SITUATION
•Increase in consumption of vegetables by 20% (157g); potato by 50% (63g)
Consumption trend of non-rice foods in Bangladesh
180
160
140
120
100
80
60
40
20
0
1991-92 1995-96 2000 2005
Meat and Egg Milk Fish Potato Fruits Vegetables
Source: Adapted from BBS-HES/HIES, 1991-2005

17. FOOD CONSUMPTION SITUATION
•DEI Cer % decreased from 80 % to 73 % in the last 10 years
•FAO recommendation contribution of cereals to DEI optimally 60%
•Prospects by 2020
Decline in percent dietary energy intake (DEI) from
cereals in Bangladesh (1991-2005)(BBS HIES) and
projection up to 2020
National Rural Urban
85
80.3 79.7
80 77.1
79.6 75.2
78.5
DEI cereal (%)
75
72.2 75.6 69
70 72.9
69.2 68.5 65
65
66.7 60
60
55
1991-92 1995-96 2000 2005 2010 2015 2020
Source: Authors’ own calculations

18. Population with access to improved water
source and sanitation
water Sanitation
97
100 92
87
90 85 84 83
81 82
80
77
80 73
70
59
60 52
50
%
39
40
30
20
10
0
Bangladesh Nepal Maldives India Sri Lanka Bhutan Thailand
Source: WHO SEARO, 2007 Selected Asian Countries

19. Source of hazards
in the food chain
Vehicle
emission
Crops
Processing
Agricultural
practices
Livestock Cooking
Retail
Landfills
Storage
Seafood
Industrial emissions
and effluents Distribution

20. Household drinking water source and treatment prior to drinking
99.4
96.5 97.1
100
90
80
70
% of households
60 Improved source
50
Non-improved source
40
% of appropriate water treatment
30 prior to drinking
20.3
20
6.7
10 3.5 2.9 2.8
0.5
0
Urban Rural Total
Source: BDHS, 2007

21. Population Pyramid - Bangladesh

22. Health services
Health services delivery includes-
 Maternal, Neonatal and Child Health
 Communicable disease control
 TB and Leprosy control
 HIV/AIDS prevention and control
Non communicable disease control including
 Emergency preparedness programme and climate change,
 Hospital based emergency obstretic care,
Health education and promotion,
 Hospital services at upazila, district, and tertiary level, and
Alternative medical care.

23. NUTRITION SITUATION
•% Decline in BMI (< 18.5) in women over the last decade 53 % to 26%
•Emerging concern of double burden- prevalence of overweight (BMI > 23)
Maternal Nutrition Status
60%
52%
50% 45%
38%
40%
32% 33%
30% 26%
20% 25%
17% 16%
10% 12%
9%
6%
0%
BDHS BDHS BDHS CMNS BDHS FSNSP
1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
CED (BMI<18.5) Overweight (BMI>23.0)

25. Stunting and Underweight
• Indicators for under five children remain alarming despite improvements
• Nutrition outcomes highly susceptible to variability of food prices
70%
Trends in stunting and underweight (<-2 sd, children 6 to 59 months)
60% 64%
60% Stunting Underweight
58%
54% 55%
50%
50% 51% 50%
47%
49% 48%
45%
49% 49% 47% • Slight increment in 2007
40% 45%
43% 41% 41% 42% (underweight) and 2008
39% and 2009 (stunting).
37% 37%
30% 32%
• Evidences of impact of the
20% food crisis of 2007 and
2008 in reverting the
10% positive trend
0%
NSP NSP NSP NSP NSP NSP CMNS NSP* BDHS* HFSNA*HFSNA* FSNSP*
1-3, 8, 9 3-8 11-12 1 1-4 Months of the survey
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

26. NUTRITION SITUATION
•3 fold increase in % of UW among 6-12 month infants
•Faulty weaning and feeding behaviour along with infectious disease are critical factors
Child Malnutrition by age in months - 5 month moving
average
70%
60%
50%
40%
30%
20%
10%
0%
0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57
Stunting Wasting Underweight

27. % children 6-59 months receiving Vitamin A supplementation
94 97
two doses of vitamin A during
100
90 85 82
80
calander year
70
60 50
50
40
30
20
10
0
1995 2000 2005 2007 2008
Year

28. NUTRITION SITUATION
•Night blindness almost non existent, prevalence below 0.1% in 2006;
•Attributed to blend of actions VAC distribution with EPI and food based
strategies
•VAD is still high, 30% among women and children
Decline in nightblindness among under-5
children in Bangladesh, 1962-2005
4.5 4.1
4 3.6
3.5
3
Percent
2.5
2 1.78
1.5 1
1 0.6
0.3 0.2 0.2
0.5
0
1962-64 1982 1989 1995 1997 1999 2002 2005
Source: HKI, 2006

31. NUTRITION SITUATION
•Success due to USI initiated in 1994-95; marked annual decline of 3.48%;
•Physiological iodine deficiency still exists around 36%
Change in goitre prevalence among women
and children in Bangladesh, 1962-2005
Children Women
Total goitre rate (%)
60 55.6
50
40 49.9
32.7
30 24.2
20 26
11.7
10 17.2
6.2
0
1962-64 1993 1999 2004-5
Source :Yusuf et al, 2008

34. Food safety in horticulture :
Bangladesh Results- Survey (fruit ripening)
JACKFRUIT RIPENING, BHALUKA, MYMENSINGH
Source: Hassan et al,2010, BAU

35. Consumers’ perception on quality and safety
40
37
35 34
Dhaka (N=500)
30 Mymensingh (N=500)
26
25
% of consumers
Consumers’ willingness to pay
more for purchasing safe fruits
20 and vegetables
15
15 12
10
6
6
5 2
0 0 0
Up to 2% Up to 5% Up to 10%
Up to 20% Up to 50%

36. Framework on access to
education, credit, and health care

37. From farm to table, table to farm: a new
agricultural paradigm (Rouse and Davis, 2004)

38. AGRICULTURE-NUTRITION LINKAGES
•Horticulture technology models from DAE show a wide range and quantity of fruits
•Can be produced over a 10 year period at HH level
•Fruits rich in vitamins and minerals; contribute to food security and dietary diversity
An example of a small mixed orchard intercropped with vegetables
Source: DAE, MoA: GoB/FAO/UNDP Integrated Horticulture and Nutrition Development (BGD/97/041) 2000 -2006

39. AGRICULTURE-NUTRITION LINKAGES
•Vitamin A supply from fruits/HH/d and per capita noted to be adequate
•Provides substantial part of the RDA for micronutrients at HH and
individual levels
•Papaya and drumstick leaves : furnish 97% of the RDA for Vitamin A
Vitamin A supply /person/d (mcg)
10000
8000 Mango
6000 Papaya
4000
2000 Drumstick leaves
0
Ye 1
Ye 2
Ye 3
Ye 4
Ye 5
Ye 6
Ye 7
Ye 8
Ye 9
10
ar
ar
ar
ar
ar
ar
ar
ar
ar
ar
Ye
Source: Report on Food based Nutrition Strategies for Bangladesh, Integrated Horticulture and Nutrition Development Project,
FAO/GoB/UNDP, 2000 -2006

40. DESIRABLE DIETARY PATTERN
•Current national average cereal intake 469 g/person/d (rice 449g) contributing to
70% DEI as against the optimal FAO/WHO norm of 55% -60%
•Need to reduce cereal intake and increase non-cereal foods
•Need to increase calorie intake
Current intake of rice (g) and total energy kcal
(HIES 2005) as against desired intake in
Bangladesh
Current intake Desired intake
2500 2238 2350
2000
1500
930 1050
1000 469 448
375 350
500
0
Cereal, g Rice, g Total, g Kcal
Source: FPMU, MoFDM, MoA, MoH&FW, NFPCSP Expert Consultation, August 2007

41. DESIRABLE DIETARY PATTERN
Desirable food basket total energy intake set at 2350 kcal and % energy from cereals
proposed at 55%; absolute terms 375 g(350 g rice + 25g wheat & other cereals) some
77 g less than present intake (rice low by 90g and wheat up by 13g)
Desirable intake of non-rice foods vs current
intake in Bangladesh
Current intake Desired intake
250
200
200 180
g/capita/day
157
150
96 100
100 60
75
63 60
55
44 40
35 32 33
50 2125
14 15 15 16 8
18 18 20
5
0
g
to
t
sh
l
at
ilk
ur
es
es
t
s
ui
oi
es
ea
Eg
od
ta
he
Fi
Fr
r/g
M
ls
ic
bl
ng
M
Po
fo
Pu
Sp
W
ta
ga
ki
al
ge
oo
Su
m
Ve
C
ni
A
Source: FPMU, MoFDM, MoA, MoH&FW, NFPCSP Expert Consultation, August 2007

42. Thresholds for assessing nutritional status in emergency
situation
Severity of Prevalence of Mean weight
malnutrition wasting for height
• Starting point
(% below Z-score for
median – interpretation,
2SD) rather than
the sole
basis…
Acceptable < 5% > -0.40 • Thresholds
vary
Poor 5–9% -0.40 to -0.69
Serious 10–14% -0.70 to -0.99
Critical > 15% < -1.00

43. Adaptation of Health sector: Community action for malnutrition
amidst climate change
Climate change through nutrition intervention Actions needed
and mainstreaming nutrition • Review evidence of relationship
consideration in food, agriculture and
health sectors: among nutrition, health and climate
change
• Increase vector borne diseases like
malaria and dengue fever due to global • Establish community based
warming and climate change nutrition program
• Increase depletion of nutrients, minerals • Deliver integrated package of
and reserves due to diarrhoea – because health and nutrition
of increased flooding and drainage • Home gardening, poultry
congestion
rearing, fisheries development
• Increase heat strokes –further aggravated
by shortages of drinking water • Food storage and processing
• Increase malnutrition, morbidity, mortality technologies
suffering and loss of productivity • Population planning at community
• Reduce the capacity of individuals to level
adapt to climate change

44. Feeding programmes: decision making frameworks
Food availability at household level Unsatisfactory situation: improve general
<2100 kcal/day rations
Malnutrition rate 15% or more or 10- Serious situation:
14% with aggravating factors General rations, supplementary feeding for all
members of vulnerable groups, therapeutic
feeding
Malnutrition rate 10-14% or Risky situation:
5-9% with aggravating factors No general rations, but supplementary feeding
targeted to malnourished individuals, therapeutic
feeding for severely malnourished
Malnutrition rate under 10% with no Acceptable situation:
aggravating factors No need for population interventions
Attention to malnourished individuals through
regular community services

45. Malnutrition and Mortality – can we review rates in order to
diagnose food crises, health crises and famines that kill?
1.8
1.6
1.4
Crude Mortality Rate
1.2
1
0.8
0.6
0.4
0.2
0
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00%
Prevalence of Acute Malnutrition

46. The Country Investment Plan
 Responding to L’Aquila Initiative and
in line with the 5 Rome Principles, the
CIP was Approved on 14 June 2010
following the Bangladesh Food Security
Forum.
 Translates the policy frameworks in a
comprehensive set of 12 priority
investment programmes and aims at
• convergence and alignment of
domestic and external funding
• mobilizing additional resources:
Bangladesh qualified as first Asian
country receiving a grant under the
Global for US $ 52.5 million
The revised CIP, based on extensive consultation, incorporates over 400
projects of which 146 ongoing (for US$ 3.036 billion) and 262 in pipeline
(for US$ 4.945 billion of which US$ 3.299 billion are priority).

47. Concluding Remarks
 Bangladesh is an exemplary case of a consistent long term effort to put in place
a comprehensive policy framework for food security and nutrition
 HPNSDP is ready for implementation
 This framework provides a platform for
 Dialogue among government, civil society and development partners
 Alignment, coordination and harmonization of interventions
 Within the FS framework, CIP is the tool for prioritizing, enhancing effectiveness
and scaling up food security investments
 Food security is critical to nutrition security – ensuring access to safe and
nutritious food – emphasis on quality of food
 A conducive institutional setting and continued commitment of all partners are
needed to sustain the implementation and monitoring process in the
medium/long term

48. Way Forward
 Global/regional/national commitment to mobilize the
necessary resources to address the problem decisively.
 Improve capacity building and awareness raising on food and
nutrition security at household level
 Integrate /strengthen nutritional considerations into
agriculture, food and health policies and interventions to
improve food security and nutrition
 Establishing information and surveillance systems that are
critical for developing evidence-based food security and
nutrition policies.
 Sustain involvement of multiple actors –
strengthen/establish community based and national
mechanisms for nutrition

49. THANK YOU FOR YOUR KIND ATTENTION !