Naher mannan pe1 exercise on nutritional indicators for needs assessment


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Naher mannan pe1 exercise on nutritional indicators for needs assessment

  1. 1. Food Security and Nutritional Indicators forNeeds Assessment – Collating Information Firdousi Naher International Food Policy Research Institute TRAINING COURSE ON: ASSESSMENT OF NUTRITIONAL STATUS 18-22 DECEMBER 2011 DHAKA
  2. 2. Four decades of remarkable growth • Poverty declined from 75% in 1971 to 31.5% in 2010 • Between 2005-2010 GDP per capita grew at 6.19% • Appreciable reduction in non-income welfare indicators: population growth rates have halved lowered infant and child mortality expanded immunisation coverage improved water and sanitation augmented life expectancy increased net primary enrolment ratio eliminated gender gap in schoolingINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 2
  3. 3. Similar developments in the food economy• Dramatic increase in rice production leading to closing the gap between rice availability and rice requirement• In the past decade, 84% of the increase in production has been brought about through increased yield; 16% through area expansion• Broadened consumption basketINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 3
  4. 4. Trends in maternal and child under-nutritionINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 4
  5. 5. Slow spread of these developments into nutrition Prevalence of maternal and child undernutrition Childhood anemia (HKI, NSP Anthropometric indicators 2006) (BDHS 2007) 100 50 90 45 80 40 70 35 Stunting 6-11 mo 30 60 12-23 mo 25 Underweight 50 24-35 mo 20 Wasting 40 35-47 mo 15 Women with low 30 10 BMI 20 48-59 mo Women <145 cms 5 tall 10 0 0 Anthropometric Child age groups indicatorsINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 5
  6. 6. Why has nutrition eluded the progress in food, agriculture and health? • Certain expectations of policy makers often leave nutrition out of lead policy • Stagnated consumption patterns • Achieving food security through focus on both input and output market have not always complemented each other • Need for strong of institutional arrangements for coordination • Need for greater priority in nutrition initiatives • Need to strengthen development administration • Need for more gender sensitive policies aimed at greater empowerment of women • Greater awareness needed on dietary diversityINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 6
  7. 7. 3 Types of Food and Nutrition Insecurity• First, there are those chronically food-insecure – about 28 million Bangladeshis – who cannot purchase enough rice or wheat to meet energy requirements.• Second, those who normally meet energy requirements, but run the very real risk of loosing access to food – due to shocks – are also food insecure.• Third, a large percentage of the population is food-insecure due to diet quality rather than diet quantity.INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 7
  8. 8. What is nutritional assessment?• Measurements of body size, body composition or body function to diagnose nutrient deficiency or deficiencies• Measures derived from nutritional assessments may be viewed as biological manifestation of nutrition securityINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 8
  9. 9. Why is nutritional assessment important?• Helps identify geographic locations most in need of development projects• Useful input into project formulation through needs assessment• For monitoring and evaluation of projects since human welfare impact of the project can be directly measured through nutritional assessmentINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 9
  10. 10. Nutritional indicators for needs assessmentAnthropometric indicators Application1. Proportion of children with haz<-2 Prevalence of stunting2. Proportion of children with whz<-2 Prevalence of wasting3. Proportion of adolescents and adults Prevalence of thinness (obesity) with low (high) Body Mass Index (BMI)5. Prevalence of low mid-upper arm Protein-energy malnutrition, low muscle circumference (MUAC) in children, mass, risk of death 6 - 59 monthsLaboratory indicators6. Prevalence of low serum retinol in Vitamin A deficiency preschool children7. Prevalence of low hemoglobin in preschool or school-age children Prevalence of anemia8. Prevalence of low hemoglobin in non- lactating, non-pregnant women9. Prevalence of low hemoglobin in men INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 10
  11. 11. Different sources of data on nutrition• Bangladesh National Nutrition Survey • 1962-64, 1975-76, 1981-82, 1995-96 • Done by the Institute of Nutrition and Food Science (INFS) under the University of Dhaka• Demographic and Health Survey • 1993-94, 1996-97, 1999-2000, 2004, 2007 • Done by the National Institute of Population Research and Training (NIPORT) under the MoHFW• Child Nutrition Survey • 1985-86, 1989-90, 1992, 1995-96, 2000, 2005 • Done by the Bangladesh Bureau of Statistics (BBS)INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 11
  12. 12. Nutrition data sources ………………..cont’d•Food Security and Nutritional Surveillance Project (FSNSP) • 2010 in 3 rounds so as to provide seasonal data on maternal care and malnutrition and child care and malnutrition • Done by Helen Keller International (HKI) in collaboration with BRAC University and BBS•National Nutrition Program (Baseline Survey) • 2004 • Done by ICDDR,B in collaboration with NIPORT and IPHNINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 12
  13. 13. CNS and BDHSChild Nutrition Survey Demographic and Health Survey• Nationally representative. Same • Nationally representative. DHS 2004 households as HIES but with at least and 2007 used the 2001 Population one child, < 60 months available Census as the sampling frame.• Collects data on nutritional status of • Focus is on demographics -fertility, children 0-59 months by age, use of family planning methods, gender, location, season, region infant and child mortality, maternal etc. Prior to 2005, sample included and child health, HIV/AIDS. On the children 6-71 months. nutrition front, it collects data on• Nutrition status can be related to infant feeding and nutritional status different indicators of household food of women and children. security • Sample includes children < 60• From 2005, the CNS is re-named as months, women 10-49 years and Mother and Child Nutrition Survey men 15-54 years.INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 13
  14. 14. Child nutrition 1995-96: comparing different data sources 45 40.4 40.4 40 36.5 35 31.7 31.3 29.2 30 27.5 27 25.3 25.5 25 21.3 20 18.9 15.2 14.7 14.3 INFS 15 12.3 10.4 BBS 10 DHS 5 3.9 2.3 2.5 0INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 14
  15. 15. Child nutrition 1999-2000: comparing different data sources 45 CNS DHS NSP 40 38.5 34.8 35 33.1 32.3 29.8 30 27.4 26.4 25 20 19 18.3 16.28 15 12.9 12.6 11.7 10.6 9.2 9.09 10 6.5 5 2.67 1.1 1.1 0INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 15
  16. 16. Child nutrition 2005: comparing different data sources 45 42 40 34.7 35 CNS 30.5 DHS 30 27 NNP (baseline) 26.3 25 19.6 20 16.7 15 13.8 12.8 11.6 11.2 10 5 1.3 0.7 0 Moderate Severe Moderate Severe Moderate Severe Stunting Stunting wasting wasting underwt underwtINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 16
  17. 17. Probable reasons for data discrepancy among sources• Inaccuracy in age reporting due to lack of birth record• Age group studied• Time of data collection• Definition of locationINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 17
  18. 18. Sources of data on food security• Household Income and Expenditure Survey (HIES) • Done by BBS • 1973-74, 1981-82, 1983-84, 1985-86, 1988-89, 1991- 92, 1995-96, 2000, 2005, 2010 • Among others, provides information on: •Household income and expenditure •Daily per capita intake of different food items hh food security •Average calorie and protein intake Other related data on food security include: • health status • child immunization • pre- and post-natal care • participation in social safety nets • housing, water and sanitationINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 18
  19. 19. Sources of data on food security…….cont’d• Welfare Monitoring Survey • Conducted for the first time in 2009 • Records data on standard of living indicators on non- income dimension • Asks direct questions on food security• Food Security and Nutritional Surveillance Project (FSNSP) • Collects food security data on a seasonal basisINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 19
  20. 20. Bangladesh Integrated Household Survey 2011-2012• Nationally representative survey being conducted by IFPRI to yield integrated hh data for policy analyses• 6500 households; survey completion in April 2012• Detailed information on food security – captures both hh as well as intra-hh food consumption and also food frequency• Detailed plot-level data on agriculture• Detailed nutrition module, including anthropometry, IYCF, micronutrient consumption, exposure to national IYCF communications campaign, use of health and nutrition services INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 20
  21. 21. Anticipated nutrition-related outputs from BIHS data• National food and nutrition profile disaggregated by division: gender differentiated analysis• Status paper on SUN and SPRING interventions• Nationally representative findings on exposure to national IYCF media campaign• Analytic papers on • Determinants of use of nutrition-related services • Women’s assets and child nutrition • Household food security and child diets/child nutrition • Agriculture and nutrition linkagesINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 21
  22. 22. Different units of analyses• Food security indicators are mostly collected at the household level or community level while• Nutrition indicators are collected for individual and infant-mother pairs So how do we integrate these two indicators?INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 22
  23. 23. Integrating data on food security and nutrition security• Food security indicators may be used in conjunction with health and care practice indicators for possible cause of malnutrition • For e.g. link between income and expenditure (food security indicators) and health (diarrhea) with malnutrition• Agriculture productivity or homestead food production can be linked with nutrition status• Diversification of agriculture production can be linked to nutrition statusINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 23
  24. 24. Integrating data on food security and nutrition security……cont’d• Assessment to improve health and nutrition programming may be used to obtain food security related information, particularly on food consumption and infant feeding practices• Household’s perception of its own food security standing and nutrition status of children in the household• Household’s energy and protein intake and the nutrition status.INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 24
  25. 25. Best practice to integrate food security and nutrition for program assessment• Standardized questionnaires and checklists should be used in repeat surveys while nutritional status should continue to be collected at the individual level.• Food consumption data (24-hour recall, 7-day recall) must complemented with data on market availability and food prices so as to link the availability, access and utilization components more rigorously.INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 25
  26. 26. Needs assessment process for project implementation1. Collate nutritional data from as many different population-based sources as possible2. The information should be arranged by indicator, age group studied, and year of collection3. Conflicting evidence from different sources should be carefully reviewed with the help of local experts to identify the source of the discrepancy.4. Subsequently, it may be helpful to rank the different problems identified according to their frequency in the populationINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 26
  28. 28. AGRICULTURE – NUTRITION - HEALTH HEALTH & NUTRITION AGRICULTURE BENEFITS BENEFITS AGRICULTURE THROUGH: NUTRITION + HEALTH THROUGH: Productivity Livelihoods Agriculture Income Risk taking Employment Education Food security Cognition Nutrition Dietary diversity Endurance Gender equityPhysical strength Health AGRICULTURE POSES RISKS: Water-related diseases Food-borne diseases Zoonotic diseases INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
  29. 29. Figure 1. CRP4 Conceptual Framework Health Enhancing Nutrition along Prevention , the Value Control of Ag- Chain Integrated Associated Component 1 Programs and Diseases Policies Component 3 Component 4 Biofortification Component 2 Nutrition Agriculture Social Behavior Change and Communications All components Availability, access, intak Labor Knowledge e Income and of nutrition, productivity Risk of AAD of nutritious, gender food safety safe foods equity RESULT: A better nourished, healthier population, esp.mothers and children < 2 INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
  30. 30. Example: A Nutrition-Sensitive Value Chain for Beans (Uganda) Value Chain Steps Activities to Enhance Nutrition Field trials with new varieties Inputs into production Soil & terrain analysis; trainings Production Technologies to  losses (insects) Nutrient retention analysis Post-harvest Testing sequencing + duration ofhandling/storage, processing different processing techniques (nutrient retention, anti-nutrients) Analysis of main market channels, Marketing Drivers of market decisions, Presence of nutrient-enhanced foods Increased availability Consumer surveysof, access to, and demand for Cooking trainings, Education, NUTRITIOUS BEANS Behavior chance communicationsINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Source: Adapted from Mazur et al. 2009. Pulses CRSP
  31. 31. Conclusions Agriculture alone will not improve nutrition fast enough We have opportunities and examples of success on how to bridge the agriculture-nutrition divide We have challenges Our biggest challenge AND opportunity is to work together - cross-sectorally (how?) We need to do much better at documenting successes – and failures; we need the evidence for advocacy, to stimulate investments In Bangladesh we have a momentum, new initiatives, committed government and donors, experienced NGOs, strong research community and partnersINTERNATIONAL FOOD POLICY RESEARCH INSTITUTE