Nutritional Status Assessmentthrough Household Income and Expenditure Survey (HIES), Child and Mother Nutrition Survey (CMNS), and Multiple Indicator Cluster Survey (MICS) By Dipankar Roy, PhD Bangladesh Bureau of Statistics 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 Food Policy Capacity Strengthening Programme (NFPCSP) . The NFPCSP is jointlyimplemented 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.
Introduction• The Bangladesh Bureau of Statistics (BBS) has a long history of conducting Child Nutrition Surveys (CNS) to determine the nutritional status of children in Bangladesh• Five such surveys were conducted every 3-5 years between 1985 and 2000• Child and Mother Nutrition Survey 2005• Child and Mother Nutrition Survey 2011-12 is on process
Method of Data Collection• A questionnaire was designed to record data on several indicators• Direct interview method taking some measurements• Logistics – UNISCALE – Stadiometer – MUAC tape – HemoCue Photometer
Data Processing• Data entry was done through IMPS software• Validation was confirmed using Epi-Info• Data were analyzed with SPSS
Data Interpretation• Mean• Standard deviation• Z-score• Confidence interval
Data Availability• Food Security-Nutritional Surveillance Project (EU-BRAC-HKI-BBS) – State of Food Security & Nutrition in Bangladesh 2010• BBS has been doing PEC of the survey
Conclusions• Malnutrition is difficult to address because it has numerous causes including – immediate (inadequate dietary intake, diseases…) – underlying (food insecurity, lack of maternal and child caring practices, unhealthy environment, poor health services…) – basic (poverty and inequality in the society)• A multi-sectoral approach is crucial, because the multiple causes of malnutrition require a coordinated response from multiple sectors
Data Combination• Anthropometric measurements combined with various socio-economic, health and sanitary variables are an effective way to assess nutritional status of children
Introduction• Bangladesh Bureau of Statistics has been conducting HES since 1973-74• Thereafter surveys were conducted in 1974-75, 1975-76, 1976-77, 1977-78, 1978-79, 1981-82, 1983-84, 1985-86, 1988-89, 1991-92, 1995-96, 2000, 2005 (HES became HIES in 2000)• The 15th round of HIES, the latest one, was conducted in 2010
Objectives• Obtaining estimates on household income, expenditure, and consumption• Determining poverty lines and estimating poverty and inequality measures• Providing information about living standards and nutritional status of the population• Determining weights for consumer price indices
Measurement of Poverty Line• Direct Calorie Intake (DCI) method• Food Energy Intake (FEI) method• Cost of Basic Need (CBN) method (since 1995-96)• In DCI method, only calorie intake is considered. There are three types of poverty a) Absolute poverty: the threshold is <=2122 k. calorie; b) Hardcore poverty: the threshold is <=1805 k. calorie; and c) Ultra poverty: the threshold is <=1600 k. calorie.
Measurement of Poverty Line (2)• In DCI method, only calorie intake is considered.• In FEI method, per capita expenditure is taking into account with calorie intake.• In this case food basket is dynamic while in CBN method fixed bundle is considered.• There are two poverty lines in poverty measurement such as lower poverty line and upper poverty line.• However, BBS refers upper poverty line and CBN method to estimate poverty officially.
Measurement of Poverty Line (3) Quantity per capita Price per kg.Item Calorie (K. cal.) Value per day (gm.) (in TK.)Rice (Coarse) 397 1389 17.50 6.95Wheat 40 136 18.62 0.74Pulses 40 136 46.37 1.85Milk 58 36 15.71 0.91Oil 20 180 67.55 1.35Meat 12 14 109.03 1.31Potato 27 24 8.46 0.23Vegetables 150 65 8.50 1.28Fish 48 66 72.75 3.49Sugar 20 66 38.30 0.77Fruits 20 10 28.46 0.57Total 832 2122 19.45 FPL = 583.45
Measurement of Poverty Line (4)• Pricing of the food bundle yields the food poverty line and 16 food poverty lines are constructed for 16 strata.• Computing two non-food allowances (lower & upper) for non-food consumption.• Lower non-food allowance is obtained by taking the median amount spent for non-food items whose per capita total expenditure is close to the food poverty line.
Measurement of Poverty Line (5)• Upper non-food allowance is obtained by taking the median amount spent for non-food items whose per capita food expenditure is close to the food poverty line.• Adding lower and upper non-food allowances to food poverty line yield lower poverty line and upper poverty line respectively.
Average per capita daily calorie intake (k.cal)
Average per capita daily protein intake (grams)
Introduction• The Bangladesh Bureau of Statistics has been conducting the Multiple Indicator Cluster Survey (MICS) since 1993.• The objective of the MICS 2009 was to provide disaggregated data on children and women at the national and subnational levels• The survey was the first attempt ever in Bangladesh by a national household survey to collect data at the sub- district level for a number of key social sector indicators covering the education, environment, health and child protection sectors
Data Availability in MICS• MUAC• Timely initiation of breastfeeding, exclusive breastfeeding• Colostrum given• Infant feeding patterns• Adequately fed infants• Iodized salt consumption• Vitamin A administration Lecture X: Title of the Presentation -Name of Presenter
REACH Initiatives• REACH (Renewed Efforts against Child Hunger and under nutrition) is an interagency (UNICEF, WFP, WHO, and FAO) UN initiative that assists governments in countries with high burdens of child and maternal under nutrition to implement, and to mobilize resources for, food and nutrition security programs.
Introduction• The REACH initiative has selected Satkhira District in Southern Bangladesh as the first demonstration area• Prior to initiating REACH-supported activities in Satkhira District, there is a clear need to carry out a district-wide food security and nutrition survey that encompasses the key indicators under the initiative
Objectives• The purpose of the Satkhira baseline survey is to assess the nutrition and food security characteristics of the population of young children (0-59 months), their mothers, and pregnant women in Satkhira before REACH implementation
Field and Data• REACH has commissioned Helen Keller International (HKI) to conduct a baseline survey in consultation/coordination with the Bangladesh Bureau of Statistics (BBS) that will provide robust household food security and nutrition data that is statistically representative for the district