Naher mannan pe1 exercise on nutritional indicators for needs assessment

Food Security and Nutritional Indicators for
Needs Assessment – Collating Information

Firdousi Naher
International Food Policy Research Institute

TRAINING COURSE ON:
ASSESSMENT OF NUTRITIONAL STATUS
18-22 DECEMBER 2011
DHAKA

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 schooling

INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE Page 2

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
basket

Trends in maternal and child under-nutrition


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 indicators


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 diversity

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.

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 security


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
assessment


Nutritional indicators for needs assessment
Anthropometric indicators Application

1. Proportion of children with haz<-2 Prevalence of stunting
2. Proportion of children with whz<-2 Prevalence of wasting
3. 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 months
Laboratory indicators
6. Prevalence of low serum retinol in
Vitamin A deficiency
preschool children
7. Prevalence of low hemoglobin in
preschool or school-age children
Prevalence of anemia
8. Prevalence of low hemoglobin in non-
lactating, non-pregnant women
9. Prevalence of low hemoglobin in men

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)


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
IPHN


CNS and BDHS
Child 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.


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

0


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
0


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 underwt


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 location


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 sanitation


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 basis


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

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 linkages


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?


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 status


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.


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.


Needs assessment process for project
implementation
1. Collate nutritional data from as many different
population-based sources as possible
2. The information should be arranged by indicator,
age group studied, and year of collection
3. 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 population


Thank you!

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 equity
Physical strength
Health AGRICULTURE POSES
RISKS:
Water-related diseases
Food-borne diseases
Zoonotic diseases
INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE

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

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 of
handling/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 surveys
of, access to, and demand for Cooking trainings, Education,
NUTRITIOUS BEANS Behavior chance communications

Source: Adapted from Mazur et al. 2009. Pulses CRSP

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
partners

Naher mannan pe1 exercise on nutritional indicators for needs assessment

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