Training Course on: Assessment of Nutritional Status 18-22 December 2011 Dhaka

1. 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

2. Four decades of remarkable growth • Poverty declined from 75% in 1971 to 31.5% in 2010 • Between 2005-2010GDP 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 Page 2

3. 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 Page 3

4. Trends in maternal and child under-nutrition Page 4

5. Slow spread of these developments into nutrition Page 5

6. 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 Page 6

7. 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. Page 7

8. 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 Page 8

9. 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 Page 9

10. Nutritional indicators for needs assessment Page 10

11. 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) Page 11

12. 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 Page 12

13. CNS and BDHS Child Nutrition Survey Demographic and Health Survey 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. • 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 Page 13

14. Child nutrition 1995-96: comparing different data sources Page 14

15. Child nutrition 1999-2000: comparing different data sources Page 15

16. Child nutrition 2005: comparing different data sources Page 16

17. 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 Page 17

18. 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, 1991-92, 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 Page 18

19. 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 non-income dimension • Asks direct questions on food security • Food Security and Nutritional Surveillance Project (FSNSP) • Collects food security data on a seasonal basis Page 19

20. Bangladesh Integrated Household Survey2011-2012 • 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 Page 20

21. Anticipated nutrition-related outputs fromBIHS 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 Page 21

22. 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? Page 22

23. 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 Page 23

24. 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. Page 24

25. 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. Page 25

26. 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 Page 26

27. Thank you! Page 27

28. AGRICULTURE – NUTRITION - HEALTH HEALTH & NUTRITION BENEFITS AGRICULTURE THROUGH: AGRICULTURE BENEFITS NUTRITION + HEALTH THROUGH: Productivity Agriculture Livelihoods Income Risk taking Employment Education Nutrition Food security Cognition Dietary diversity Endurance Gender equity Physical strength Health AGRICULTURE POSES RISKS: Water-related diseases Food-borne diseases Zoonotic diseases

29. Figure 1. CRP4 Conceptual Framework Health Prevention , Control of Ag- Associated Diseases Component 3 Enhancing Nutrition along the Value Chain Component 1 • Integrated Programs and Policies • Component 4 Biofortification Component 2 Nutrition Agriculture Social Behavior Change and Communications All components Availability, access, intake of nutritious, safe foods Knowledge of nutrition, food safety Labor productivity Income and gender equity Risk of AAD RESULT: A better nourished, healthier population, esp.mothers and children < 2

30. Example: A Nutrition-Sensitive Value Chain for Beans (Uganda) Activities to Enhance Nutrition Value Chain Steps Field trials with new varieties Soil & terrain analysis; trainings Inputs into production Production Technologies to  losses (insects) Nutrient retention analysis Post-harvest handling/storage, processing Testing sequencing + duration of different processing techniques (nutrient retention, anti-nutrients) Analysis of main market channels, Drivers of market decisions, Presence of nutrient-enhanced foods Marketing Increased availability of, access to, and demand for NUTRITIOUS BEANS Consumer surveys Cooking trainings, Education, Behavior chance communications Source: Adapted from Mazur et al. 2009. Pulses CRSP

31. 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