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
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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
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Trends in maternal and child under-nutrition
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Slow spread of these developments into
nutrition
Prevalence of maternal and child undernutrition
Childhood anemia (HKI, NSP
2006)
Anthropometric indicators
(BDHS 2007)
100
90
80
70
60
50
40
30
20
10
0
50
45
40
35
30
25
20
15
10
5
0
6-11 mo
12-23 mo
24-35 mo
35-47 mo
48-59 mo
Child age groups
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Stunting
Underweight
Wasting
Women with low
BMI
Women <145 cms
tall
Anthropometric
indicators
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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
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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.
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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
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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
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Nutritional indicators for needs assessment
Anthropometric indicators
Application
1. Proportion of children with haz<-2
2. Proportion of children with whz<-2
3. Proportion of adolescents and adults
with low (high) Body Mass Index
(BMI)
5. Prevalence of low mid-upper arm
circumference (MUAC) in children,
6 - 59 months
Prevalence of stunting
Prevalence of wasting
Prevalence of thinness (obesity)
Protein-energy malnutrition, low muscle
mass, risk of death
Laboratory indicators
6. Prevalence of low serum retinol in
preschool children
7. Prevalence of low hemoglobin in
preschool or school-age children
8. Prevalence of low hemoglobin in nonlactating, non-pregnant women
9. Prevalence of low hemoglobin in men
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Vitamin A deficiency
Prevalence of anemia
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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)
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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
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CNS and BDHS
Child Nutrition Survey
•
•
•
•
Demographic and Health
Survey
Nationally representative. Same
•
households as HIES but with at least
one child, < 60 months available
Collects data on nutritional status of •
children 0-59 months by age,
gender, location, season, region
etc. Prior to 2005, sample included
children 6-71 months.
Nutrition status can be related to
different indicators of household food
security
•
From 2005, the CNS is re-named as
Mother and Child Nutrition Survey
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Nationally representative. DHS 2004
and 2007 used the 2001 Population
Census as the sampling frame.
Focus is on demographics -fertility,
use of family planning methods,
infant and child mortality, maternal
and child health, HIV/AIDS. On the
nutrition front, it collects data on
infant feeding and nutritional status
of women and children.
Sample includes children < 60
months, women 10-49 years and
men 15-54 years.
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Child nutrition 1995-96: comparing different
data sources
45
40.440.4
40
36.5
35
31.7
30
31.3
29.2
27.5 27
25.5
25.3
25
INFS
21.3
BBS
18.9
20
DHS
15.214.7
14.3
15
12.3
10.4
10
3.9
5
2.3 2.5
0
Moderate
Stunting
Severe
Stunting
Moderate
wasting
Severe
wasting
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Moderate
underwt
Severe
underwt
MUAC<12.5
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Child nutrition 1999-2000: comparing
different data sources
45
CNS
DHS
40
38.5
34.8
33.1
35
32.3
30
NSP
29.8
27.4
26.4
25
19
20
18.3
16.28
15
12.612.9
11.7
10.6
9.2
10
9.09
6.5
5
2.67
1.1 1.1
0
Moderate
Stunting
Severe
Stunting
Moderate
wasting
Severe
wasting
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Moderate
underwt
Severe
underwt
MUAC<12.5
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Child nutrition 2005: comparing different
data sources
45
42
40
34.7
35
CNS
DHS
30.5
30
NNP (baseline)
27
26.3
25
19.6
20
16.7
13.8
12.8
15
11.611.2
10
5
1.3 0.7
0
Moderate
Stunting
Severe Moderate
Stunting wasting
Severe
wasting
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Moderate Severe
underwt underwt
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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
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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, 199192, 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
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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 nonincome dimension
• Asks direct questions on food security
• Food Security and Nutritional Surveillance
Project (FSNSP)
• Collects food security data on a seasonal basis
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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
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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
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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?
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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
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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.
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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.
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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
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Thank you!
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AGRICULTURE – NUTRITION - HEALTH
HEALTH & NUTRITION
BENEFITS AGRICULTURE THROUGH:
Productivity
Risk taking
Education
Cognition
AGRICULTURE BENEFITS
NUTRITION + HEALTH THROUGH:
Agriculture
Nutrition
Endurance
Physical strength
Health
Livelihoods
Income
Employment
Food security
Dietary diversity
Gender equity
AGRICULTURE POSES
RISKS:
Water-related diseases
Food-borne diseases
Zoonotic diseases
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Figure 1. CRP4 Conceptual Framework
Health
Enhancing
Nutrition along
the Value
Chain
Prevention ,
Control of AgAssociated
Diseases
Integrated
Programs and
Policies
Component 1
Component 3
Component 4
Biofortification
Component 2
Nutrition
Agriculture
Social Behavior Change and
Communications
All components
Availability,
access,
intake
of nutritious,
safe foods
Labor
productivity
Risk of AAD
Income and
gender
equity
Knowledge
of nutrition,
food safety
RESULT: A better nourished, healthier population, esp.mothers and children < 2
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Example: A Nutrition-Sensitive Value Chain for
Beans (Uganda)
Value Chain Steps
Inputs into production
Activities to Enhance Nutrition
Field trials with new varieties
Soil & terrain analysis; trainings
Production
Technologies to  losses (insects)
Nutrient retention analysis
Post-harvest
handling/storage, processing
Testing sequencing + duration of
different processing techniques
(nutrient retention, anti-nutrients)
Marketing
Analysis of main market channels,
Drivers of market decisions,
Presence of nutrient-enhanced foods
Increased availability of,
access to, and demand for
NUTRITIOUS BEANS
Consumer surveys
Cooking trainings, Education,
Behavior chance communications
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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
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