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Nutrition

Multiple Indicator Cluster Surveys Data dissemination and further analysis workshop. Nutrition. Overview of presentation. Nutritional status Breastfeeding Micronutrients Vitamin A Iodized salt Low birthweight. reflects a child’s total body mass. cumulative deficient growth .

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Nutrition

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  1. Multiple Indicator Cluster SurveysData dissemination and further analysis workshop Nutrition

  2. Overview of presentation • Nutritional status • Breastfeeding • Micronutrients • Vitamin A • Iodized salt • Low birthweight

  3. reflects a child’s total body mass cumulative deficient growth recent nutritional deficiency • Undernutrition indicators refer to children whose z-scores fall below -2 SDs (moderately and severely) and -3 SDs from the median of the reference population • International reference population: • Note that the WHO Child Growth Standards is used for these calculations • Not comparable to the NCHS/CDC/WHO reference –refer to appendix

  4. Key data considerations • Note that if height and weight data are missing for more than 10% of children under-five, caution should be exercised in the interpretation of the results. • Accurate age reporting is also an essential component of anthropometric indicators (underweight and stunting) • Do not attempt to do any trend analysis with the wasting indicator due to seasonality of wasting prevalence

  5. MICS4 country example

  6. Breastfeeding

  7. Background • Several documents provide guidance on indicators for assessing infant and young child feeding practices

  8. Continuum of feeding practices Infant and young child feeding patterns from birth to two years * Excluding China, due to lack of data.Source: UNICEF global databases 2010, from MICS, DHS and other national surveys.

  9. Note denominator = women surveyed having a live birth within the 2 years prior to the survey

  10. only breastmilk (exceptions for medicine, vitamins) breastmilk, water, non-milk liquids Indicators based on current status (24 hour recall period) The prevalence of exclusively breastfed children should be less than or equal to the prevalence of children who are predominantly breastfed.

  11. According to the 2010 Chad MICS, only 3% of children <6 months are exclusively breastfed. What’s going on?

  12. Figure 4. Répartition en pourcentage des enfants de moins de 2 ans par type d'alimentation,  par tranche d'âge,Tchad, 2010

  13. MICS4 Survey Design Workshop

  14. Assess appropriate breastfeeding practices throughout recommended period of birth to age 2 years of age NEW!

  15. Children should start receiving food at 6 months of age New standard indicator – not comparable to previous indicator on complementary feeding NEW!

  16. Appropriate number of meals varies according to child’s age and breastfeeding status NEW!

  17. Things to think about • “Current status approach” is used to calculate indicators – asks about feeding status within 24 hours of the survey. • Precision of indicators poor - The number of children in age ranges of interest (< 6 mos , 6-9 mos, 12-15 mos, 20-23 mos) are likely to be small, and therefore the precision of indicators may lower than that of others • While exclusive breastfeeding among infants remains uncommon in some countries, exclusive breastfeeding patterns are often similar for boys and girls and across household residence area and wealth quintile

  18. MicronutrientsVitamin A and Salt Iodization

  19. Either recorded in health book/ vaccination card or mother’s report Proxy measure of recommended 2 doses per year • Not all countries have Vitamin A programmes • While there may be some expectation of vitamin A deficiency in poor and rural areas, keep in mind that these are also the areas specifically targeted by campaigns.

  20. Things to remember • Survey data for vitamin A tend to be underreported as a result of - Timing: data collection may precede campaign - Recall error - Mothers’ don’t know if infant received supplement - Often not recorded on child health card • May be discrepancies between data obtained through household surveys and those obtained from National Immunization Days and routine service statistics

  21. MICS4 Country Example

  22. Take note of % households in which salt tested 15+ PPM is international standard

  23. MICS4 Country Example

  24. Low Birth Weight

  25. Methodological Issues • Percentage of births NOT weighed How can we measure low birth weight when high proportion of children not weighted????? *: Excluding China Note: Regional averages of births not weighed are not available for Latin America and Caribbean, East Asia and Pacific and Central and Eastern Europe/Commonwealth of Independent States (CEE/CIS), due to lack of data.Source: UNICEF global databases 2010, from MICS, DHS and other national surveys.

  26. Methodological Issues In MICS,two items in the questionnaire are used to estimate low birth weight based on an adjustment procedure was proposed by Boerma and colleagues (1996) . • Mother’s recall of the child’s size at birth (i.e. very small, smaller than average, larger than average, very large) • Mother’s recall of the child’s weight or the weight recorded on a health card if the child was weighed at birth

  27. Methodological Issues • Adjustment Procedure

  28. Methodological Issues • Heaping of Birth Weight, Tanzania 1999

  29. Methodological Issues Adjustment steps • 25 percent of children reported as weighing exactly 2500 grams are treated as weighing less than 2500 grams to adjust for heaping on 2500 grams -- this is based on empirical distributions from DHS surveys • Tabulate children’s size by their weight for those weighed at birth to obtain proportion of births in each size category who weighed <2,500 grams • Multiply this proportion by the total number of children in size category to obtain estimated number of children by size category with low birth weight • Sum the estimated number of children in each size category with low birth weight in order to obtain the total number of low birth weight children • Divide by the total number of live births to obtain the percentage with low birth weight

  30. Example from Gambia MICS4 Survey Design Workshop

  31. Methodological Issues • Effect of Adjustment

  32. Some ideas for further analyses • Undernutrition is the result of a combination of factors: lack of food in terms of quantity and quality; inadequate water, sanitation and health services; and suboptimal care and feeding practices . Until improvements are made in these three aspects of nutrition, progress will be limited. • As such, there is a desperate need to further understand and document relationships between WASH and undernutrition. • Examine associations between early initiation of breastfeeding and skilled attendants at delivery or antenatal care with a skilled professional

  33. Thank you!

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