Multi Sectoral Issues in Nutritional Assessment with Examples from

Health Sectors

Dr. SK RoyMBBS, M.Sc. Nutr (London),

Dip-in-Biotech(UNU), PhD(London), FRCP (Edin)

Nutritional Status Assessment

Nutritional status indicators whether the individual is well-nourished or undernourished

To define the nutritional problem of the targeted population, nutritional statusis measured

Nutritiona

l Nee

d Assessment of

the Communi

ty

•Define needs, opportunities and constraints, and prioritize solutions

Evaluate of

nutrition

programm

es

•Evaluate programme impact and improve efficiency.

Policy change and

sustainability

•Influence decision making in strategic planning, policy formulation and resource allocation.

•Raise community awareness and participation to maximize long-term impact.

Nutritional Assessment

Nutritional status assessment

Triple A Cycle (Source –UNICEF)

Analysis

Action

Assessment

Nutritional status assessments measure

Anthropometric Biochemical or physiological characteristics.

These assessmentscombined with the analysis of underlying

causes will result in appropriate action.

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

Issues in Nutritional Assessment

Food &AgricultureFood security

Agricultural productionFood Safety

HealthAnd family planning

Supplementation Prgrammes for Vulnerable groups

EPI, IMCI. Nutritional Surveys (BDHS,NNP baseline )Nutritional services

Law enforcing agency

Food Safety At consumer level

Penalization

Commerce and Finance

Market StabilizationControl of Food price

Import Export Balance

Multi sectoral contribution in Nutritional Assessment

Methods of Nutritional Assessment

Different anthropometrical indicesWeightHeightMid upper arm circumferencesSkin fold thicknessDemi-span or armspanKnee height Sitting height Skin fold thickness Head 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.

Advantages of Anthropometry in Nutritional Assessment

Uses of Anthropometrical Methods

Large population based surveys

Bangladesh Demographic and Health survey 2007

National Nutrition Survey –Baseline Survey 2004

Clinic Based

Done by Health Care professionals

Example: Maternal and child health care Clinic

National surveys

which are periodically conducted at national level (BDHS-2007, NNP 2004)

Small-scale surveys which 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)

Use of Anthropometrical Assessment

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).

Biochemical testing for Nutritional Assessment

Example : National Nutritional survey 2004

Haemoglobin level among adolescent girls

Table salt iodine level

Urinary iodine excretion

Prevalence of stool parasite

Biochemical testing for Nutritional Assessment

Information on food intake may help to better understand the causes of malnutrition

and can also be used as a proxy for nutritional

outcome.

Indirect correlates of Nutritional Status

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.

Food Intake Surveys

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.

Food Intake Surveys

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.

DIETARY DIVERSITY SCORES

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.

DIETARY DIVERSITY SCORES

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.

FOOD BASKET MONITORING (FBM)

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.

FOOD BASKET MONITORING (FBM)

THANK YOU VERY MUCH