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Nutrition

Multiple Indicator Cluster Surveys Data Interpretation, Further Analysis and Dissemination Workshop. Nutrition. Overview of presentation. Low birth weight Nutritional status Breastfeeding and dietary intake Iodized salt. Low Birth Weight. Methodological Issues.

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Nutrition

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  1. Multiple Indicator Cluster SurveysData Interpretation, Further Analysis and Dissemination Workshop Nutrition

  2. Overview of presentation Low birth weight Nutritional status Breastfeeding and dietary intake Iodized salt

  3. Low Birth Weight

  4. 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.

  5. 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 subjective assessment 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

  6. Methodological Issues • Adjustment Procedure

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

  8. 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 2,500 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

  9. Methodological Issues Adjustment steps (cont’d) 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

  10. Example from Gambia

  11. Methodological Issues • Effect of Adjustment

  12. Nutritional status

  13. 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

  14. 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

  15. MICS4 country example

  16. Breastfeeding and Dietary Intake

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

  18. Continuum of feeding practices Birth 2 years and beyond Percent * Excludes China

  19. Note: Denominator = women surveyed having a live birth within the 2 years prior to the survey

  20. Breastmilk, water, non-milk liquids Only breastmilk (exceptions for medicine, vitamins) • 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.

  21. MICS4 country example According to the 2010 Chad MICS, only 3% of children <6 months are exclusively breastfed. What’s going on?

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

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

  24. Children age 0-5 months who are exclusively breastfed and children age 6-23 months who are currently breastfed and receiving any solid, semi-solid or soft foods (at least one food item). • Assess appropriate breastfeeding practices throughout recommended period of birth to age 2 years of age

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

  26. Minimum dietary diversity: Receiving foods from at least 4 of 7 food groups: Grains, roots and tubers Legumes and nuts Dairy products (milk, yogurt, cheese) Flesh foods (meat, fish, poultry and liver/organ meats) Eggs Vitamin-A rich fruits & vegetables Other fruits &vegetables. Recent addition to MICS

  27. Minimum meal frequency Calculation depends on age of child and breastfeeding status Recent addition to MICS

  28. Minimum acceptable diet: Receiving the minimum dietary diversity and the minimum meal frequency Recent addition to MICS

  29. 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

  30. Salt Iodization

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

  32. MICS4 Country Example

  33. Some ideas for further analyses • Undernutrition is the result of a combination of factors: lack of food in terms of quantity & quality; inadequate water, sanitation & health services; and suboptimal care and feeding practices. • Possible to look at relationships between • WASH and undernutrition. • Early initiation of breastfeeding and skilled attendance at delivery or antenatal care with a skilled professional • Create an infant feeding continuum

  34. Thank you! Holly’s daughter!

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