Transcript Assessment of Nutritional status (Lecture 8)

Measurement and Interpretation
TRAINING COURSE ON ASSESSMENT OF NUTRITIONAL
STATUS,
National Food Policy Capacity Strengthening Programme
(NFPCSP)
21 December 2011
Presentation by: Nusha Choudhury, WFP
Measuring Dietary Diversity
Costly
Time
consuming
The gold standard to
measure dietary diversity
is through measuring
various food items
consumed by an
individual or a household
in energy or kilocalorie
terms.
Requires
Technical
expertise
Alternate/Proxy Indicators
Household/Individual
Diet Diversity
Score/HDDS/IDDS
Food Consumption
Score/FCS
Household & Individual Diet Diversity Score
(HDDS/IDDS)
 Measures no. of different food groups consumed over a given
reference period i.e. 24 hours/1 day (FANTA/USAID).
 HDD is also a proxy for hh’s socio economic status. Whereas IDD
is purely a proxy measure of an individual’s quality of diet.
12 Food Groups in HDD,
(Score: 0-12)
1. Cereals Roots and tubers
2. Vegetables
3. Fruits
4. Meat, poultry, offal
5. Eggs
6. Fish and seafood
7. Pulses/legumes/nuts
8. Milk and milk products
9. Oils/ fats
10. Sugar/honey
11. Miscellaneous
8 Food Groups in IDD (Children),
(Score: 0-8)
1. Grains, roots or tubers
2.
3.
4.
5.
6.
7.
8.
Vitamin A-rich plant foods
Other fruits or vegetables
Meat, poultry, fish, seafood
Eggs
Pulses/legumes/nuts
Milk and milk products
Foods cooked in oil/fat
General Rules for HDD & IDD Data
Collection
 Data should be collected during the food shortage
period of the year.
 Recall period is 24 hours.
 The 24 hour recall period has to be a
normal/usual food consumption day for the
household/individual.
 Generally for HDD food items consumed outside
the house should not be included, unless it is a
common practice for majority of the household
members.
HDDS Calculation
 Step 1: Assign 1 if the food group/item consumed; 0
not consumed. Sum all the scores for various food
groups. Sum will be between 0-12.
 Step 2: The average HDDS for the sample population
Sum HDDS
Total no. of households
Setting HDDS Threshold:
Option 1: From a baseline survey take the HDDS for the
richest income tercile (33%).
Option 2: From a baseline survey take HDDS of the upper
tercile (33%) of diet diversity.
Food Consumption Score
FCS is a frequency weighted diet diversity score for a
household or an individual over past 7 days. Here the score
is calculated using the frequency of consumption of
different food groups by (WFP).
Key features of FCS
 Total 9 food groups are considered.
 Consumption frequency by various food groups are
recorded over 7 days recall basis.
 Consumption less than 10 grams/1tea spoon are not
considered.
 Each food groups are assigned weights based on their
micro and macro nutrient content.
Food Groups & Weights in FCS
FOOD ITEMS (examples)
1
Rice, wheat, maize , maize porridge, sorghum,
millet pasta, bread and other cereals
Cassava, potatoes and sweet potatoes, other
tubers, plantains
2 Beans. Peas, groundnuts and cashew nuts
3 Vegetables, relish and leaves
4 Fruits
5 Beef, goat, poultry, pork, eggs and fish
6 Milk yogurt and other diary
7 Sugar and sugar products
8 Oils, fats and butter
9
spices, salt, fish power, small amounts of milk for
tea.
Food groups
Weight
(definitive) (definitive)
Main staples
2
Pulses
3
Vegetables
1
Fruit
1
Meat and fish
4
Milk
4
Sugar
0.5
Oil
0.5
Condiments
0
FCS Calculation
 Group all the food items into specific food groups.
 Sum all the consumption frequencies of food items of the
same group, and recode the value of each group above 7 as 7.
 Multiply the value obtained for each food group by its weight
and creates new weighted food group scores.
 Sum the weighed food group scores, thus creating the food
consumption score (FCS).
 Using the appropriate thresholds (see below), recode the
variable food consumption score, from a continuous
variable to a categorical variable. FCS
Profiles
0-21
Poor
21.5-35 Borderline
> 35
Acceptable
Bangladesh Specific FCS
 Given the importance of oil and fish in the diet of the
Bangladeshi people, the general thresholds were
elevated. As a result, FCS thresholds were revised for
Bangladesh (HFSNA 2009):
Poor consumption (≤28),
Borderline Consumption (>28 and ≤42),
Acceptable Consumption (>42),
An additional threshold was introduce to
distinguish the acceptable households between
acceptable low (43-52) and acceptable high (>52).
Sugar, Molasses (gur)
Fruits
Milk&Milk product
Pulses (mansur, kesari, etc)
Meats&Fish
Vegetables
Edible oil
Cereals&Tubers
56
49
42
35
28
21
14
7
53
29
Poor
43
0
0
Cumulative no. of days of consumption
Diet Composition by Food
Consumption Score in Bangladesh
BorderlineAcceptable
low
Acceptable high
Food Consumption Score
Comparative Advantages of the
Two Scores
 HDD has more food groups




than FCS therefore prevents
under reporting.
Short recall periods are more
reliable.
Easy to collect, enumerators
do not need extensive
training .
More suitable for rapid
assessments during
emergencies.
A child IDD module is
available.
 FCS records frequency of
consumption which
prevents over reporting.
 7 days recall period provides
a habitual food
consumption.
 Disregards small quantities
of consumption which over
rates the consumption.
 Suitable for in depth food
security assessment.
Research findings on the two scores
 Gina Kennedy et al. conducted a study in Burkina Faso, Lao
PDR, N. Uganda and found correlation between HDDS & FCS
were significant in all three countries.
 The best correspondence identified based in this study
 FCS ≤ 21 corresponded to HDDS between 2 & 3.
 FCS ≤ 35 corresponded to HDDS slightly higher than 3.
 FCS and HDD demonstrated similar strength of correlation
with other food security indicators.
IFPRI research found that combination of frequency and
diversity in FCS correlates better with household energy intake
than only diet diversity (based on three countries)
Another IFPRI research revealed that weighted FCS do not have
added advantage over un weighted FCS in terms of relationship
to energy intake, unless they are locally adjusted.
Research findings on linkage
between FCS & anthropometric
measures
P <0.05
HFSNA 2009
P <0.001
P <0.000
P <0.000
Precautionary messages
 Both the FCS and HDDS are proxy indicators of food consumption
and are not interchangeable.
 The choice of the methods will depend on objective and depth of the
surveys.
 None of these measures are directly synonymous of food insecurity,
they are rather one of the indicators of food insecurity.
 To identify the food insecure and vulnerable the diet diversity
scores/groups should be used in combination with food security
access indicators like income, expenditure, asset, HFIAS etc.
Thank you!
?&A