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Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
Sanghvi 9 linking dietary intakes with nutritional assessment
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Sanghvi 9 linking dietary intakes with nutritional assessment

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  • 1. 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 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.
  • 2. 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
  • 3. 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
  • 4. Indicators – Country Investment PlanKey Indicators Baseline (‘07-’10) Final ‘15-’16)Overall goal:% People undernourished 27 17.5% Child stunting 43 25% Child underweight 41 33Outcome/impact:Food availability (food supplies) (rice supply & share)Food access (income) - Poverty rate < 2022 kcals/day 40 24 - Poverty rate < 1805 kcals/day 19.5 14Food utilization - Minimum acceptable 42 56 complementary feeding (quantity & quality of CF 6-23 m) Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 5. Uses of data for policy & programs• 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, evaluate past 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
  • 6. METHODS OF ASSESSING FOOD SECURITY& NUTRITION & THEIR USE Method Use Trends analysis Research into Evaluation causes(1 ) FAO: DES/CV Main use: global and Not very useful except Not very usefuldietary energy supply regional level; always for broad inter-country(coefficient of variation) under-estimates trends(2) Household income Useful: national and Can be useful Usefuland expenditure survey subnational level(3) Food consumption/ Useful: now available at Main use Main use the national level, thusindividual intake (24- very useful, captureshour) intra-HH food distrib.(4) Anthropometry Useful at all levels, but Useful for physical Useful but should also(mother, child weight & for physical malnutrition malnutrition not food have food securityheight) and not food security security indicators(5) Qualitative method Useful: national and Useful Useful(food habits) subnational level
  • 7. Questions that can be addressed by different methods Method Use Trends analysis Causal analysis Evaluation(1 ) FAO: DES/CV Is the supply of food in Is the cause of food Are food supplydietary energy supply terms of calories/ insecurity & policies/programs(coefficient of variation) energy improving to undernutrition due to working? Impact of meet needs, if overall food supply? climate change/ equitably distributed? disasters on supplies?(2) Household income Are no. of food secure Is the cause of Are programs workingand expenditure survey HH (in energy and problems due to low to reach the poor? nutrients) improving? expenditures on food?(3) Food consumption/ Are mothers and young Is the problem food Are programs for children consuming availability/access or women and youngindividual intake (24-hr) more adequate diets? dietary habits? children working?(4) Anthropometry Is nutritional status No Does the program(mother/child wt, ht) improving? improve nutrition of mothers & children?(5) Qualitative method Are food habits Are habits a barrier? Does the program(food habits, frequency) improving? improve food habits?
  • 8. How we present and interpret data makes a difference: examples Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 9. Trends in food intake (gms/capita/day) All Urban Rural1991-92 886 938 8781995-96 914 931 9112005 949 952 9462010 1000 985 1005•Intakes improving faster in rural areas,•Averages hide disparities among economic groups Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 10. Food available in grams per head per day 1050 1000 950 All Urban 900 Rural 850 800 1991-92 1995-96 2005 2010 Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 11. Diversity:-National supplies -Household level - Child’s diet -Women’s dietModule 5: Program and Policy Application, Tina Sanghvi PhD
  • 12. Trends in food content adequacy (gms/capita/day)Food Recom. 2005 2010 TrendRice 390 440 416Wheat 100 12 26Vegetables 225 220 236Pulses 30 14 14Oil 20 16 21Fish 45 42 49Meat/eggs 34 20 25 Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 13. Content of food basket: improving diversity 500 450 400 350 Rice 300 Wheat 250 Vegetables 200 Pulses 150 100 Oil 50 Fish 0 Meat/eggs 2005 2010 Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 14. Content of food basket: gaps in diversity 500 450 400 350 Recom. 300 250 2005 200 150 2010 100 50 0 Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 15. 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
  • 16. Why improving food security does not necessarily remove undernutrition Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 17. A&T Baseline: Stunting is High Even in Food Secure Households Bivariate 55 53.29 50 49.88 45 46.39 47.32 47.07 44.52 40 39.28 35 PERCENT STUNTED 35.38 30 Food secure 25 Mildly food insecure 20 22.99 23.14 Moderate food insecure 19.18 Severely food insecure 15 13.88 10 5 0 Vietnam Bangladesh Ethiopia+ p < 0.10, * p < 0.05, ** p < 0.01, *** p < 0.001 Module 5: Program and Policy Application, Tina Sanghvi PhD Ruel; A&T Partners Meeting, Hanoi 9/27/2011
  • 18. Factors that determine nutritional status Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 19. Adequate Complementary Feeding100 90 By Wealth Quintiles By Age Groups 80 70 60 58 50 47 44 48 48 40 38 38 36 30 20 16 10 0 Lowest Second Middle Fourth Highest 6-8m 9-11m 12-17m 18-23m BDHS 2007
  • 20. Quality of Children’s Diets (BDHS, 2007) Meat, Fish, Poultry and Eggs Consumed (< 24 h) 100 90 80 71 75 70 64 60 48 50 40 34 30 24 20 10 10 0 0 2 0 Age <2 m 2-3 m 4-5 m 6-7m 8-9m 10- 12- 16- 20- 24- 11m 15m 19m 23m 35m
  • 21. 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• Pre-disposing factors: maternal undernutrition seasonal food/income shortages, migration, illness outbreaks, hygiene/sanitation, emergencies• Importance of under 2’s Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 22. Illustration of association between dietary adequacy and anthropometryPrevalence of % with % with Total underunder inadequate adequate or adequatenutrition diet diet nutrition% <-2SDs 20 10 30% > -2SDs 0 70 70Total sample 20 80 100 Note: 10% have adequate diets but are still undernourished due to other causes Source : Mason, 2002 in “Measurement and Assessment of Food Deprivation and Undernutrition”, FAO
  • 23. New focus on under 2 yr age group• Most rapid decline in nutritional status• Damage is largely not reversible• Affects child growth + adult chronic diseases• Affects brain development/learning as well as physical development• All national nutrition indicators focus on young children, to improve MDG 1 have to prevent under 2 decline in nutrition Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 24. Goal: To reduce undernutrition, improve IYCF Maximum decline at 3 to 15 months – period of IYCF 0.5Length-for-age Z-score EBF Complementary Feeding 0 ------- --------------------------- -0.5 Boys WHO Girls WHO Growth of girls/ boys Boys NCHS Girls NCHS NCHS/WHO standards -1 -1.5 -2 -2.5 1 3 5 7 9 11 13 15 17 19 21 23 25 Age (mo) Growth data: Kuntal K. Saha et al, Food Nutr Bull. 2009; 30: 137-44 ICDDRB Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 25. CF Provides Adequate Energy & Nutrients Energy Required & Amount From Breastmilk & CF 1000 900 800 BF + CFCalories per day 700 550 Exclusive BF 600 300 Compl. Food 500 200 400 Breastmilk 300 200 100 0 0-2 3-6 7-8 9-11 12-23 Age in months ½ Bati ½ Bati 1 Bati •At least 4 types Recommended diet: 2 times 3 times 3 times •Hygienically Daily + Daily + Daily+ prepared Module 5: Program and Policy Application, Tina Sanghvi PhD Bati = 250 ml
  • 26. Indicators – Country Investment PlanKey Indicators Baseline (‘07-’10) Final ‘15-’16)Overall goal:% People undernourished 27 17.5% Child stunting 43 25% Child underweight 41 33Outcome/impact:Food availability (food supplies) (rice supply & share)Food access (income) - Poverty rate < 2022 kcals/day 40 24 - Poverty rate < 1805 kcals/day 19.5 14Food utilization - Minimum acceptable 42 56 complementary feeding (quantity & quality of CF 6-23 m) Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 27. Minimum acceptable diet for under 2’s• 3 conditions must be met: – Breastfeeding – Meal frequency as per age (2 to 3 times plus snacks) – At least 4 different categories of food Analysis should be used to focus BCC messages, how to deal with HH food availability, mothers’ time constraints etc. Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 28. 100 Gaps in feeding 90 80 Median EBF 1.8 m 68 70 60 58 50 48 47 43 43 43 40 36 30 20 16 10 0 Breastfeeding Complementary Feeding BDHS 2007, WHO (HKI 2006) Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 29. Main messages• What is needed to ensure food security & nutrition results: – Food availability - Food access - Food utilization – Behavior change communications to promote specific dietary & health habits• Disaggregated analysis of trends, causes & evaluations to design relevant interventions• Equity: rational use of foods to reach the disadvantaged & high risk ages; targeted nutrition Module 5: Program and Policy Application, Tina Sanghvi PhD
  • 30. Conclusion• Understanding what indicators & assessment methods to use in policy & programs is key• Food & dietary adequacy (total energy & diversity) is a necessary, but not sufficient condition for good nutrition• Interpreting and presenting data in an accurate and relevant manner is essential• Assessments that do not lead to actions are meaningless Module 5: Program and Policy Application, Tina Sanghvi PhD

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