Implementing a Tablet- Based Baseline Survey for Nutritional Assessment and InterventionProject Improving dietary diversity through introduction of NUTRI-FOOD BASKET in tribal households of Adilabad, Mancherial and Komaram Bheem-Asifabad districts of Telangana. 2017-2018

A collaborative project with Government of Telangana, through the Commissioner of Health & Family Welfare, NHM-Tribal Health and ICRISAT

GoalTo transition tribal households from nutrient deficient diets to diverse nutritional foods.

Target beneficiariesPregnant womenLactating mothersAdolescent girlsChildren aged between 3 and 5.

LocationTribal households of Adilabad, Mancherial and Komaram Bheem-Asifabad districts of Telangana. Villages were selected from Utnoor, Tiryani and Kasipet mandals of the three districts.

AdilabadMancherial

Komaram Bheem-Asifabad

Photo: GD Nageswara Rao, ICRISAT

UtnoorTiryani

Kasipet

Adilabad district, Telangana

A multi-dimensional baseline surveyThe baseline survey was carried out for all respondents. A tablet-based survey was implemented by trained enumerators well versed with the local language and conditions. The survey adopts a holistic approach to capture the nutritional and health status of the respondents and covers multi-sectoral pathways towards maternal and child health.

Utnoor mandal

Total sample surveyed

40

30

20

10

0

Total sample for intervention

Tiriyani mandal Kasipet mandal

Figure 1. Percentage of sample distribution by selected locations.

Components of the survey:a. Verbal informed consent

It is necessary to introduce the household to the survey and obtain the consent of all prospective respondents (Figure 2). If a prospective respondent in a household is, for example,. a pregnant woman, it has been ensured that the enumerators obtain a verbal consent before interviewing her. This serves as a starting point to establish rapport with the households and respondents.

Figure 2. The consent form is read out to the respondents for their agreement.

b. Household identification and demographic details

This information was collected at the household level and includes data on the socio-economic status of the household. The data will help in characterizing the respondents and their households based on key socio-economic variables.

Sample sizeThe total sample for the intervention includes 5069 respondents. The baseline survey was implemented for a total of 5643 respondents so that the loss in sample size can be accounted for. Details of the total sample distribution by type of respondent are given in Figure 1 and Table 1, respectively.

Table 1. Details of the sample size for the Nutri-Food Basket study.Sample Adolescent girls Children (3-5 years) Lactating mothers Pregnant women Total

Total sample surveyed

Sample identified for intervention

Total sample surveyed

Sample identified for intervention

Total sample surveyed

Sample identified for intervention

Total sample surveyed

Sample identified for intervention

Total sample surveyed

Sample identified for intervention

Total sample 1408 1332 2622 2423 888 792 725 522 5643 5069

Total sample percentage 25 24 46 43 16 14 13 9 100 90

Photo: Padmaja R, ICRISAT

Figure 3. Dwellings in Tiryani mandal, Komaram Bheem-Asifabad district, Telangana.

Figure 5. Trained enumerators recording anthropometric and haemoglobin measurements of the respondents.

Figure 4. Assessing the dietary diversity of sample respondents.

d. Nutritional and health status

This information was collected from each respondent.It includes measurements of weight (kgs); height (cms), mid-upper arm circumference (cms) and haemoglobin count (gms/dl) (Figure 4 and 5). Standardized non-invasive equipment and instruments were used to take these measurements. Information was also collected on any existing chronic diseases, physical disability, and episodes of sickness during the 7 days preceding the data collection date.

c. Dwelling characteristics

Information on the type of house, type of roof, type of cooking fuel used and its source, drinking water source and who gets the water and sanitation status of the household was collected (Figure 3).

Photos: Swathi G, ICRISAT

Photo: Swathi G, ICRISAT

Photos: GD Nageswara Rao, ICRISAT

Understanding the dietary diversity of the respondents

Dietary diversity metrics offer a timely, cost-effective and logistically easy way of assessing household or individual nutritional outcomes. With the recent emphasis on improved maternal and child nutrition outcomes, focusing on dietary diversity offers one way of identifying nutrition outcomes. It measures the quality and diversity of the diets consumed by the people.

This is important for micronutrient deficiencies (like iron) that are often the result of inadequate dietary intake. In India, the high rates of anemia have been attributed to a diet that is heavily concentrated on starchy staples like rice and wheat relative to iron rich foods like leafy vegetables and meat, fish or poultry products (Figure 6).

Figure 7. Training enumerators on the protocols to be followed in the baseline survey, Adilabad district.

Figure 6. Balanced nutrition.

A standardized dietary diversity protocol was adopted to include the following:a. General information on the respondents and their statusb. A 2-day recall plus market day recall for foods consumed that include:

i. Source of the food’s ingredients ii. Who consumed itiii. Food eaten outside, if any iv. Frequency of consumption.

This provides information on households’ access to foods from different sources.

ICRISAT is a member of the CGIAR System OrganizationAbout ICRISAT: www.icrisat.orgICRISAT’s scientific information: EXPLOREit.icrisat.org

Photo: Swathi G, ICRISAT

Photo: Swathi G, ICRISAT Photo: GD Nageswara Rao, ICRISATPhoto: Padmaja R, ICRISAT

Nov 2017

TrainingA 4-day capacity building program conducted by a team of six ICRISAT-AIP members to implement the baseline survey (Figure 7) included the following:1. Baseline survey protocols were converted into

a tablet-compatible questionnaire using CSPro software.

2. All the questions and instruments were translated into Telugu, the local language.

3. 24 enumerators (12 male and 12 female) from Utnoor, Kasipet and Tiryani mandals were trained in data collection using tablets.

4. The enumerators were trained in: a. Taking informed consentb. Collecting socio-economic datac. Collecting dietary diversity data d. Asking probing questions for data validation

5. In addition to this, the enumerators were also trained ona. Taking anthropometric measurements using

SECA instruments b. Using Pulse CO-Oximeter to record

haemoglobin levels, oxygen, pulse rate and perfusion index.

End line surveyThe end line survey will be carried out for all the respondents after 9 months of project implementation. This will be a simple survey that focuses on the nutritional and health status of the respondents. Additional information will be collected depending on the intervention process.