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Day 1 Session 5 Harris and Kennedy_ Indicators


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Gender Nutrition Methods Workshop- 2013

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Day 1 Session 5 Harris and Kennedy_ Indicators

  1. 1. Addressing women and children’s nutrition – measures of food intake and nutritional status Gina Kennedy and Jody Harris Bioversity International and IFPRI 6 December, 2013
  2. 2. National economic growth National nutrition profile Environmental contaminants or vectors Food market environment Agricultural Production Household assets and livelihoods Food production & gathering Health environment Individual diet Food prices and availability Natural resources Production diversity diversity Target nutrient consumption Processing & storage Target food consumption Food Household Food access expenditure security food Agricultural Consumption income / Expenditure Health care Non-food expenditure Women’s Women’s Empowerment empowerment in Ag Index Household Enabling environment Caring capacity & practices Diet Health status Infant and young child feeding Time use Female energy expenditure Nutrition and health knowledge Child nutrition outcomes Anthropometry / biomarkers Mother’s nutrition outcomes Energy expenditure Individual Knowledge / attitudes
  3. 3. Commonly used individual indicators Indicator Relationship to Food Security Examples of Commonly used indicators Individual Dietary Diversity and Frequency Ability of the diet of the diet to meet energy and micronutrient needs Individual Dietary Diversity Score (IDDS) Minimum Dietary Diversity (MDD) % Consuming target foods % Meeting Requirements for Nutrients Knowledge and attitudes Provides important information on barriers or optimizers related to dietary practices Knowledge on nutritious foods Attitudes toward good/bad foods for children Anthropometry Outcome indicators of multiple factors Stunting, Underweight Wasting Body Mass Index Desirable “ Do No Harm” Indicators Provides important desirable information often related to “ do no harm” Breastfeeding Minimum meal Frequency Women’s energy expenditure
  4. 4. Individual dietary intakes • FOOD and DIET are THE KEY areas for agnutrition pathway • Womens’ dietary diversity • Infant and young child dietary diversity (Minimum Dietary Diversity) • 24 hour recall/Food frequency
  5. 5. Rationale for development of individual dietary diversity Quantitative dietary assessment cumbersome and difficult  need for a simple proxy of intake Objective of dietary diversity provide tools to produce relevant and dietary intake information related to diet particularly at decentralized level the collection of information on diet is meant to complement other indicators related to food security, health and nutritional status; thereby forming a suite of relevant indicators
  6. 6. INDIVIDUAL DIETARY DIVERSITY SCORES • Sum of food groups consumed over the past 24 hours –Women’s Dietary Diversity Score –Minimum Dietary Diversity of children 6-23 months of age
  7. 7. Dietary Diversity Scores: Snapshot of Increasing Diversification 1 2 3 4 5
  8. 8. Method of data collection – Women’s dietary diversity • Use open recall questionnaire form • When open recall is finished go through food group list and mark “1” next to food groups consumed • For any blank food group ask respondent if any food from this group was consumed the previous day. Mark “1” for yes and “0” for no • Use tabulation sheet or computer program for WDD 9* food groups
  9. 9. Dietary Diversity (open) “Please describe the foods (meals and snacks) that you ate yesterday during the day and night, whether at home or outside the home. Start with the first food eaten in the morning. After the respondent tells you about the first thing they had to eat of drink, ask about what they ate or drank next. Write down all food and drinks mentioned by the respondent. When the respondent has finished, probe for meals and snacks not mentioned. If they had tea or coffee ask if there was milk or sugar added. Ask the respondent to mention the ingredients of any mixed dishes.
  10. 10. Food Group 1 Starchy Staples 2 Dark green leafy vegetables 3 Other vitamin A rich vegetables and fruits 4 Other fruits and vegetables 5 Organ meat 6 Eggs 7 Meat and Fish and other seafood 8 Legumes, nuts and seeds 9 DDS record “1” yes “0” no Milk and milk products Sum above for WDDS Oils and fats Sweets, candy , sugar Spices, condiments Alcoholic beverages
  11. 11. Calculation of WDDS • Sum the total number of food groups out of nine consumed during the 24 hour recall period • Score range 0-9 • Calculate average WDDS • Analyze frequency of food group consumption • CAN MODIFY TOOL FOR TARGET FOODS
  12. 12. Guidelines Available • English • French • Spanish 983e/i1983e00.pdf
  13. 13. Minimum Dietary Diversity (MDD) • The indicator is meant to reflect the quality of the complementary food diet of infants and young children 6-23 months of age
  14. 14. Data collection for MDD • A standardized questionnaire can be downloaded from WHO (IYCF) indicators • Data collected on children 6-23 months of age • Could be disaggregated by boys/girls • Breastfeeding status and child age also need to be collected for correct calculation of the indicator
  15. 15. Calculating MDD
  16. 16. Strengths of DD measures • Simple to administer • Quick to analyze • Have undergone robust validation as proxy indicators for micronutrient adequacy of the diet
  17. 17. DD measures recently recommended Masset, Haddad Cornelius & Isaza-Castro, 2012 Review of effectiveness of agriculture interventions that aim to improve nutritional status of children “Indices of diversity of the diet should be used to assess the effect on production and dietary composition” Headey and Ecker, 2012 “dietary diversity indicators have substantial scope to add more value to food security measurement, especially if they can be refined and improved, rendered more comparable across populations and measured more frequently over time”
  18. 18. Dietary diversity tools are useful in programmes and initiatives where a primary or secondary objective is to improve the diet of the beneficiary population • Agriculture, Fishery, Forestry programmes ▫ Crop diversification/integration ▫ Promotion of indigenous plant and animal foods • Cross-cutting issues • Food security and nutrition programmes ▫ ▫ ▫ ▫ Sustainable livelihood support and diversification Programmes in HIV affected areas Food-based nutrition programmes Nutrition education The cost will be marginal ! ▫ Gender ▫ HIV/AIDS ▫ Right to Food
  19. 19. Quantitative food intake (target nutrient consumption and women’s energy intakes) • Quantitative 24 hour recalls can be used to assess intakes of energy, protein, fat and micronutrients ▫ Requires high level skills in training, supervision of data collection and analysis ▫ Special equipment (weighing scales, recipes, food composition tables)
  20. 20. Additional Infant and young child indicators • These and fall under “ Do no harm” principle • Minimum meal frequency • Breastfeeding • SEE WHO GUIDELINES
  21. 21. Additional indicators for IYCF
  22. 22. Anthropometry in children and adults Children • STUNTING: height-for-age < -2 standard deviations of the WHO Child Growth Standards Median (chronic malnutrition) • WASTHING: weight-for-height < -2 standard deviations of the WHO Child Growth Standards Median (acute malnutrition) • UNDERWEIGHT: weight-for-age < -2 standard deviations of the WHO Child Growth Standards Median (global malnutrition) Adults Body Mass Index (BMI) • Requires specialized training of enumerators • Special equipment, height board/ weighing scales
  23. 23. Anthropometric data can be obtained from: - WHO GLOBAL DATABASE - - National nutrition surveys - Nutritional monitoring/surveillance - (e.g. IFAD, WFP monitoring systems) - Demographpic and Health and (DHS) and Multiple Indicator Cluster (MICS) surveys
  24. 24. Biochemical indicators • To assess if the program actually changed micronutrient status of the population a biochemical marker such as serum retinol or hemoglobin can be used ▫ REQUIRES BLOOD SAMPLE AND ADDITIONAL LEVELS OF ETHICAL CLEARANCE
  25. 25. EXAMPLES OF KAP INDICATORS Short to medium term indicators Knowledge Attitudes Practices Percent of mothers who can identify three local foods rich in vitamin A Example Percent of mothers who think eggs are a good source of food for children Example Percent of children 6-23 Example months fed an iron-rich food source the previous day
  26. 26. Food Insecurity Scales and Seasonality • Household Food Insecurity Access Scale (HFIAS) • Household Hunger Scale (HHS) • Coping Strategies Index (CSI) and Reduced CSI • Others (ECLSA and FIES) • Months of Inadequate HH food provisioning
  27. 27. Additional indicators of interest • Child morbidity (see DHS for example questions) • Water and sanitation sources • Socio-economic indicators ▫ Some form of wealth index • Level of education (men and women) • Literacy (men and women)
  28. 28. Aquaculture - Nutrition Linkages Bangladesh: Case Study Shakuntala Haraksingh Thilsted Senior Nutrition Scientist
  29. 29. Bangladesh has made great strides in aquaculture in the past 25 years Focus on: • • • • Production and productivity Large fish Men in aquaculture Household income
  30. 30. Nutrition sensitive household pond aquaculture Production Technology: • Polyculture of Carps (large fish) and Nutrient-rich Small Fish, carried out by both men and women Focus on: • Partial Frequent Harvesting of Small Amounts of Small Fish • Household Consumption, especially in Women and Young Children • Sale of Carps for Household Income • Additional Diversification strategies
  31. 31. Small Fish Irreplaceable Animal-source Food Rich Source of Multiple Nutrients Animal Protein Essential Fats Essential Micronutrients: Minerals and Vitamins Common Food eaten with Rice Adds Flavour and Taste to the Meal Improves Diet Diversity Enhances Mineral Bioavailability from Foods in the Meal Cooked with Vegetables, Oil and Spices, further Improving Diet Diversity, Adding Nutrients and Growth-promoting Substances Processed (dried), Stored - Prolonging Duration of Consumption, Reaching Non-fish Producing Areas
  32. 32. Promotion of Orange Fleshed Sweet Potato (OFSP) • Suitable for small areas homestead gardens and dykes • Requires minimal labour, fertilizer and pesticides; grows well in marginal soils • Leaves and roots are consumed • Valuable in times of food scarcity and natural disasters • Vines are easily preserved by households for planting in subsequent season
  33. 33. M/E Indicators • Increased production • Increase Consumption of Target Food (Small fish) – Quantity, Frequency and by Target Groups (Women and young children) • Men and women in decision-making and work load sharing in production • Women’s work load • Intra-household food allocation • Men’s purchase of foods (Knowledge and Practices)
  34. 34. Zero Sum Game? Gender and Work Load Is it embarrassing for a man to help with household work? 100% 90% 80% 70% 60% Strongly Disagree 50% Disagree 40% Agree Strongly Agree 30% 20% 10% 0% Husband Wife Mother-in-law Helen Keller International (HKI) 2012
  35. 35. HH Food security CRP / Indicator 1.1 Dryland Systems * * * * 1.2 Humidtropics * * * * 3.4 RTB 3.7 L&F 4 A4NH * 1.3 AAS * 3.2 Maize 3.5 Grain Legumes * 3.6 Dryland Cereals * * * * * * Other ‘Do no harm’ Anthropometry / biomarkers Target nutrient consumption IDDS Target food consumption Knowledge / attitudes Women’s empowerment Production diversity 37 * * 3.3 GRiSP *
  36. 36. 38 How to choose indicators…? • Which pathway(s) is your program trying to address? • Which of the boxes along that pathway (or any intermediate steps not adequately captured there) can you feasibly measure?(As many as possible!) • What (preferably validated) tools and metrics exist to measure each of these? • In what way will each of these need to be adapted to your particular context (without losing the validity of the tool)? • How does the totality of your indicators build a picture of how your agriculture program is affecting food and diets/nutrition?