Nutritional surveillance,

1. NUTRITIONAL
SURVEILLANCE
Department of Community Medicine, ISTH Irrua 18th March 2020

2. || OUTLINE
• List of Abbreviations
• Introduction
Purpose of Nutritional Surveillance
History of Nutritional Surveillance Process
of Nutritional Surveillance
Challenges of Nutritional Surveillance Systems
Establishing a Nutritional Surveillance System Examples
of Nutritional Surveillance in Nigeria Conclusion
References
2

3. I ■ LIST OF ABBREVIATIONS...!
• BMGF - Bill and Melinda Gates Foundation
• DHS - Demographic and Health Survey
• FAO - Food and Agriculture Organization
• FMOH - Federal Ministry of Health
• M1CS - Multiple Indicator Cluster Survey
• MUAC - Mid Upper Arm Circumference
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4. LIST OF ABBREVIATIONS...!
• NACA - National Agency for the Control of AIDS
• NDHS - Nigeria Demographic and Health Survey
• NPHCDA - National Primary Health Care
Development Agency
• SOML - Saving One Million Lives
• UNFPA - United Nations Population Fund
• UNICEF - United Nations Children’s Fund
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5. I || LIST OF ABBREVIATIONS..^
• USAID - United States Agency for
International Development
• WHO - World Health Organization
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6. I | INTRODUCTION...!
• Nutritional surveillance means to watch
over nutrition in order to make decisions
that lead to improvements in nutrition in
populations (Mason and Mitchell 1983)
• It involves the regular and systematic
collection of data on nutritional outcomes
and exposures.
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7. INTRODUCTION...!
• The regular and timely collection, analysis
and reporting of data on nutrition risk
factors, nutritional status and nutrition-
related diseases in the population
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8. PURPOSE OF NUTRITIONAL
■I SURVEILLANCE...i
• To monitor the nutrition situation
• To identify factors associated with malnutrition
• To inform nutrition policies and programmes
• To track progress towards achieving nutrition goals
• To serve as an early warning of increased nutritional
risk
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9. PURPOSE OF NUTRITIONAL
SURVEILLANCE...2
• To assess the delivery and coverage of
services
• To evaluate programmes and interventions
• To detect the impact of change in policies
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10. HISTORY OF NUTRITIONAL ■I
SURVEILLANCE...1
• First World Food Conference in 1974,
FAO, WHO and UNICEF were invited to
establish a global nutrition surveillance
system
• This led to national surveillance systems
being set up - about 20 countries by the
1980s
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11. HISTORY OF NUTRITIONAL
SURVEILLANCE...2
• Early nutrition surveillance systems were
primarily based on growth monitoring
data from clinics plus infrequent surveys.
• A few school census systems existed
mainly in Central America
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12. HISTORY OF NUTRITIONAL
SURVEILLANCE...3
• Today, there is substantial political
momentum to reduce the numbers of
children affected by undernutrition as
demonstrated by political and financial
commitments by national governments
and international organizations
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12

13. THE PROCESS OF NUTRITION
SURVEILLANCE
>3

14. Surveillance is a continuous process
ACTION
based on rhe
analysis and
available resources
ANALYSIS
of the causes of the
problem
The Analysis stage
aims to analyze the
causes of malnutrition
as represented in
various conceptual
frameworks such as
UNICEF
._________________
K The Assessment stage
ASSESSMENT I / x 1
■ ,>
aims to define the
of the nutritional nutritional problem in
situation in the target terms of magnitude and
distribution

15. I | DATA COLLECTION
• In nutritional surveillance, information
should be collected both on the nutritional
status of the population and on the
underlying causes of malnutrition
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16. MAJOR DETERMINANTS OF
III NUTRITIONAL STATUS...1

17. MAJOR DETERMINANTS OF
III NUTRITIONAL STATUS...2
1. Nutritional status depends on the dietary
intake of food and nutrients as well as
disease.
2. The dietary intake or food consumption of
a family or a person depends on the food
available to the family and on the nutrition
awareness in the family.
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18. MAJOR DETERMINANTS OF
NUTRITIONAL STATUS...3
3. Food availability depends:
(a) on the relation between food prices and earnings
in a market economy;
(b) on the food harvests in subsistence households;
and
(c) on both the price- wage relationship and on
production in mixed market and subsistence
households (the exact relationships between
these factorsand food availability in a mixed
household economy are not usually known and
are difficult to determine).
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19. MAJOR DETERMINANTS OF
III NUTRITIONAL STATUS..^
4. The relation between food prices and
earnings is largely influenced by imports
or food aid.
5. Local food production is influenced by
many interrelated factors, both inside and
outside the country (e.g. the weather).
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20. MAJOR DETERMINANTS OF
III NUTRITIONAL STATUS...5
6. Food utilization depends on the
physiological status of the human body
which, in turn, is influenced by the
environment, accessibility to safe water,
and the morbidity status which itself
results from inadequacies in the
environment and water and sanitation
situations.
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21. INDICATORS TO BE MONITORED...1
• Anthropometric and biochemical
indicators are used to assess nutritional
status of the population
• These indicators aim to answer the
following questions:
-Who suffers from malnutrition? (children,
elderly, mothers)
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22. Ill INDICATORS TO BE MONITORED...! -What
is the type of malnutrition? (wasting, stunting, iodine
deficiency)
—When? (recent or chronic problem) —Where?
Which areas are most affected?
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23. INDICATORS TO BE MONITORED...3 •
There are 3 primary anthropometric indices for
children under five years of age -Wasting (using
weight-for-age and MUAC) -Underweight (using
weight-for-age) -Stunting (using height-for-age)
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24. INDICATORS TO BE MONITORED...4
• Food security, health and care practice
indicators are used to analyze the causes
of the nutritional problem
- Why are people malnourished or at risk of
malnutrition?
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25. ]| METHODS OF DATA COLLECTION...!
• Large-scale national surveys
• Repeated small-scale surveys
• Clinic-based monitoring
• Sentinel site surveillance
• School census data
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26. METHODS OF DATA COLLECTION...2
• Rapid nutrition assessments
• Rapid screening based on MUAC
measurement
• Selective feeding programmes or services
statistics monitoring
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27. LARGE-SCALE NATIONAL SURVEYS...1
• Examples include Demographic and Health Surveys
(DHS). Multiple Indicator Cluster Surveys (MICS)
Advantages
• They provide valuable data to assess trends in
nutrition nationally and globally.
• Long-term trends can be observed.
• Standardized methodology
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28. LARGE-SCALE NATIONAL SURVEYS...2
Disadvantages
• Need to train and supervise large numbers of
surveyors for quality control
• High cost
• Long period between data collection and release of
findings
• Acute malnutrition could be missed because of long
period between surveys
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29. REPEATED SMALL-SCALE SURVEYS...1
• They are the most common method used in
emergencies.
• To be comparable, they should be conducted in the
same geographical area and at the same
time/season of the year.
• Repeating the surveys make them useful in
surveillance as against a single ad-hoc small-scale
survey
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30. || REPEATED SMALL-SCALE SURVEYS...2
Limitations
• Require technical expertise
• High cost
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31. I || CLINIC-BASED MONITORING
• A component of health information system
• Can be applied both in emergency and
nonemergency situations
Limitations
• Population attending clinics may not be
representative
• Captures only younger children
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32. || SENTINEL SITE SURVEILLANCE...1
• Monitoring of a set of indicators in selected
communities or service-delivery sites
• Ranges from technically sophisticated large-scale to
simple community-based monitoring of several key
indicators
• Aims to produce trends in the nutrition situation in
identified vulnerable areas in order to provide early
warning of deterioration
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33. ■ SENTINEL SITE SURVEILLANCE...!
Limitations
• Problems with analysis of data and
representativeness
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34. I SCHOOL CENSUS DATA...1
• To identify high-risk populations with poor
health, malnutrition and low
socioeconomic status
• Focuses on stunting and can provide large
coverage
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35. SCHOOL CENSUS DATA...2
Limitations
• Not useful in emergency situations
• Representativeness is determined by
school attendance
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36. RAPID NUTRITION
! || ASSESSMENTS/RAPID SCREENINGS...!
♦ They are conducted to obtain a quick
snapshot of the nutrition situation.
• Important source of information
especially at the onset of an emergency to
determine magnitude and severity of a
crisis
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37. ■ PROGRAMME/SERVICE STATISTICS •
Indicators such as admissions, cure, defaulting and case-
fatality rates provide a measure of:
- programme quality
-trends in acute malnutrition
- the most vulnerable groups
- seasonal trends
- Underlying causes of malnutrition such as
morbidity patterns
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38. Ill ANALYSIS OF DATA
• Variety of tools
• Quality control, major challenges -Accurate
estimation of age -Height/length
measurement
- Weight measurement
• How to address them
— Training and ongoing supervision
- Quality checks with specialized softwares
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39. || PRESENTATION OF DATA
• Compare current data with previous and establish
trends: numbers in isolation mean very little.
• Seasonal interpretation is also critical
• Consider underlying causes and assess predictable
changes in the nutrition situation:
- risk factors likely to result in further deterioration
- mitigating factors leading to improvement
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40. Ill INTERPRETATION OF DATA...1
• To properly understand and interpret nutritional data,
the following should be considered:
- The actual prevalence rates of acute malnutrition in relation to
thresholdsand decision making frameworks
- Trends over time and seasonality (reviewing expected seasonal
changes in nutritional status),
- The underlying causes of acute malnutrition
- The relationship between malnutrition and mortality
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41. DISSEMINATION OF DATA
• There must be timely dissemination of
information to aid appropriate responses
especially in a crisis situation.
• Can be done through national nutrition
coordination units or clusters
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42. CHALLENGES OF A NUTRITIONAL
111 SURVEILLANCE SYSTEM...1
• Sustainability and continued effectiveness
of the system
-Waning donor interest
-Change in funding priorities
- No crisis situation for a long period
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43. CHALLENGES OF A NUTRITIONAL
■■ SURVEILLANCE SYSTEM...2
• Institutionalization - Reliance on information
sources that cut across several government
ministries can pose problems
- Where the system should be located
- How it links with existing systems
- Who ultimately makes the decisions about the
analysis of the information
- Who determines the appropriate response
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44. CHALLENGES OF A NUTRITIONAL
SURVEILLANCE SYSTEM...3
* Linking information to action -Lack of
confidence in the data -Political reasons for
failing to act on surveillance information
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45. ESTABLISHING A NUTRITION
■I SURVEILLANCE SYSTEM...I
• Be clear on the objectives and what the
information will be used for (Consider the
availability of resources, staff capacity,
sustainability, environmental factorsand response
capacity).
• Review and map existing nutrition information
sources to prevent duplication and where
possible, ensure linkage or integration with
existing information systems.
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46. ESTABLISHING A NUTRITION
II SURVEILLANCE SYSTEM...2
* Define a minimum set of core indicators
that refer both to nutritional status and
provide an understanding of the
underlying causes of malnutrition.
• Design the system based on the most
appropriate methods. Several methods
may be appropriate in some contexts.
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47. ESTABLISHING A NUTRITION
SURVEILLANCE SYSTEM...3
• Ensure adequate training and supervision
of data collection (include simple quality
checks to assure reliability of data).
• Consider contextual issues when
interpreting data: seasonality, population
movement, morbidity patterns and
historical trends.
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48. ESTABLISHING A NUTRITION
■I SURVEILLANCE SYSTEM...4
• Ensure information is presented in a
timely and accessible manner to decision
makers and to the community.
• Establish triggers to determine when
more detailed nutrition assessments are
necessary.
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49. ESTABLISHING A NUTRITION
■■ SURVEILLANCE SYSTEM...5
• Consider how the information from the
surveillance system will link to action or
response.
• For longer term systems in emergency
prone areas, consider sustainability issues
from the outset.
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