Roy 10b comparative analysis and applications of nutritional assessment
Dr. SK RoyMBBS, M.Sc. Nutr (London), Dip-in-Biotech(UNU), PhD(London), FRCP (Edin)
Nutritional status To define theindicators nutritionalwhether the problem of theindividual is targetedwell-nourished population,or nutritional statusundernourished is measured
• Define needs, opportunities andNutritional Need Assessment of constraints, and prioritize solutionsthe Community Evaluate of • Evaluate programme impact and nutrition improve efficiency. programmes • Influence decision making in strategic planning, policy formulation and resource allocation.Policy change and sustainability • Raise community awareness and participation to maximize long-term impact.
Nutritional status assessments measureAssessment Analysis Anthropometric Biochemical or physiological characteristics. These assessments Action combined with the analysis of underlying causes will result in appropriate action. Triple A Cycle (Source –UNICEF)
Incorporating nutritional objectives- into development policies and programmes. Household food security Protecting consumers through improved food quality and safety. Preventing and managing infectious diseases Promoting breastfeeding Promoting appropriate diets and healthy lifestyles Assessing, analyzing and monitoring nutrition situations
Health And family Food & planning Supplementation Agriculture Prgrammes for Vulnerable groups Food security EPI, IMCI. NutritionalAgricultural production Surveys (BDHS,NNP Food Safety baseline ) Nutritional services Law Commerce andenforcing Finance agency Market StabilizationFood Safety At Control of Food priceconsumer level Import Export Balance Penalization
Different anthropometricalindicesWeightHeightMid upper armcircumferencesSkin fold thicknessDemi-span or armspanKnee height Sitting heightSkin fold thicknessHead circumference
It is precise and accurate It uses standardized technique It is suitable for large sample sizes, such as representative population samples Inexpensive equipment and skills can be learnt quickly.
Large population Clinic Based based surveys Done by Health CareBangladesh professionals Demographic and Health survey 2007 Example: Maternal and child health care ClinicNational Nutrition Survey –Baseline Survey 2004
National surveyswhich are periodically conducted at national level (BDHS-2007, NNP 2004) Small-scale surveyswhich are carried out at local level to gather nutrition information within the shortest time possible.MDGF Baseline Survey Conducted In Bhola And Borguna (WFP/UNICEF/ FAO)
Biochemical testing contribute to diagnosing micronutrient deficiencies. The most common deficiencies are:• Iron• vitamin A, and• Iodine During emergencies: scurvy Beri-Beri (vitamin B 1 deficiency) pellagra (vitamin B 3 deficiency).
Example : National Nutritional survey 2004 Haemoglobin level among adolescent girls Table salt iodine level Urinary iodine excretion Prevalence of stool parasite
Information on food intake may help to better understand the causes of malnutrition and can also be used as a proxy for nutritional outcome.
Food intake or consumption surveys assess the types and amounts of food eaten. This can be represented in terms of daily energy and nutrient intake per person. May involve weighing amounts of food eaten or using dietary recall.Difficulties: labour-intensive time consuming and costly. Dietary recall are more dependent on memory. The analysis of food intake surveys requires high level of skills the use of specific software availability of a food composition table.
Advantages: provide invaluable information on quantities, diet quality and on whether energy and nutrient intake are being met. This type of assessment is undertaken in stable contexts where more information is needed about dietary causes of malnutrition.
Dietary diversity (DD) scores is a proxy of nutritional quality of the diet. The DD scores consists of a simple count of the number of food groups consumed by an individual or a household over a given period of time. The assumption is that the higher the score, the better the quality of the diet. Assessing DD is useful to evaluate the impact of a wide range of programmes on dietary quality. Examples are livelihoods and crop diversification, nutrition education, school and homestead gardens.
These assessments may be carried out in stable situations where there is a known problem of lack of dietary diversity and where efforts to improve agricultural diversification in order to improve diet have been ongoing for many years. The DD assessment can also be used in emergency contexts, where shock can adversely impact the quality of the diet.
Carried out at food distribution sites camp situations, e.g. among refugees in order to ensure that food distribution systems are operating optimally to help identify any risk of nutrition problems, especially micronutrient deficiency diseases.
Where camp populations are dependent on long-term food aid, FBM is critical, especially where the ration diversity is limited and where there is an absence of micronutrient rich foods in the ration, e.g. fortified Corn Soy Blend. Computer programmes to calculate micronutrient content of food rations are available.