day 1 session 5 harris and kennedy_ indicators
DESCRIPTION
Gender Nutrition Methods Workshop- 2013TRANSCRIPT
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
Health environment
Natural resources
Food market environment
Nutrition and health knowledge
Food accessFood
expenditure
Non-food
expenditure
Diet Child
nutrition
outcomes
Ho
use
ho
ld a
sset
s an
d liv
elih
oo
ds
Health status
Mother’s
nutrition
outcomes
Health care
Women’s
empowerment
National
nutrition
profile
Agricultural
income
Caring capacity
& practices
Female energy
expenditure
Food
production &
gathering
National
economic
growth
IndividualHousehold
Enabling environment
Processing
& storage
Agri
cult
ura
l P
roduct
ion
Production diversity
Household food security
Knowledge / attitudes
Target food consumption
Individual diet diversity
Target nutrient consumption
Anthropometry / biomarkers
Infant and young child
feeding
Environmental contaminants
or vectors
Food prices and
availability
Women’s Empowerment
in Ag Index
Consumption / Expenditure
Energy expenditureTime use
Commonly used individual indicatorsIndicator 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
Individual dietary intakes
• FOOD and DIET are THE KEY areas for ag-nutrition pathway
• Womens’ dietary diversity
• Infant and young child dietary diversity (Minimum Dietary Diversity)
• 24 hour recall/Food frequency
Quantitative dietary assessment cumbersome and difficult need for a simple proxy of intake
Objective of dietary diversityprovide 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
Rationale for development of individual dietary diversity
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
Dietary Diversity Scores: Snapshot of Increasing Diversification
1 2 3 4 5
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
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.
Food Group DDS record “1” yes “0” no
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 Milk and milk products
Sum above for WDDS
Oils and fats
Sweets, candy , sugar
Spices, condiments
Alcoholic beverages
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
Guidelines Available
• English
• French
• Spanish
http://www.fao.org/docrep/014/i1983e/i1983e00.pdf
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
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
Calculating MDD
Strengths of DD measures
• Simple to administer
• Quick to analyze
• Have undergone robust validation as proxy indicators for micronutrient adequacy of the diet
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”
• Agriculture, Fishery, Forestry programmes▫ Crop diversification/integration
▫ Promotion of indigenous plant and animal foods
• Food security and nutrition programmes▫ Sustainable livelihood support and diversification
▫ Programmes in HIV affected areas
▫ Food-based nutrition programmes
▫ Nutrition education
• Cross-cutting issues▫ Gender
▫ HIV/AIDS
▫ Right to Food
Dietary diversity tools are useful in programmes and initiatives where a primary or secondary objective is to
improve the diet of the beneficiary population
The cost will be marginal !
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)
Additional Infant and young child
indicators• These and fall under “ Do no harm” principle
• Minimum meal frequency
• Breastfeeding
• SEE WHO GUIDELINES
Additional indicators for IYCF
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
Anthropometric data can be obtained from:
- WHO GLOBAL DATABASE
- http://www.who.int/nutgrowthdb/en/
- National nutrition surveys
- Nutritional monitoring/surveillance
- (e.g. IFAD, WFP monitoring systems)
- Demographpic and Health and (DHS) and Multiple Indicator Cluster (MICS) surveys
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
EXAMPLES OF KAP INDICATORS
Short to medium term indicators
Example
Example
Example
Percent of mothers who can identify three local foods rich in vitamin A
Percent of mothers who think eggs are a good source of food for children
KnowledgeAttitudesPractices
Percent of children 6-23 months fed an iron-rich food source the previous day
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
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)
Aquaculture - Nutrition Linkages
Bangladesh: Case Study
Shakuntala Haraksingh Thilsted
Senior Nutrition Scientist
Bangladesh has made great strides in
aquaculture in the past 25 years
Focus on:
• Production and productivity
• Large fish
• Men in aquaculture
• Household income
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
Small FishIrreplaceable 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
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
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)
Zero Sum Game? Gender and Work Load
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Husband Wife Mother-in-law
Is it embarrassing for a man to help with household work?
Strongly Disagree
Disagree
Agree
Strongly Agree
Helen Keller International (HKI) 2012
CRP / Indicator
Pro
du
ctio
n
div
ers
ity
HH
Fo
od
se
cu
rity
Wo
men
’s
emp
ow
erm
ent
Kn
ow
led
ge
/
att
itu
des
Ta
rge
t fo
od
co
nsu
mp
tio
n
IDD
S
Targ
et nutr
ient
co
nsu
mp
tio
n
Anth
ropom
etr
y /
bio
ma
rke
rs
‘Do n
o h
arm
’
Oth
er
1.1 Dryland Systems * * * *
1.2 Humidtropics * * * *
1.3 AAS * *
3.2 Maize *
3.3 GRiSP
3.4 RTB * *
3.5 Grain Legumes *
3.6 Dryland Cereals * *
3.7 L&F * *
4 A4NH \ * *
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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?
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