By Marijke de Graaf
In my previous blog I focused on measuring the Food Security Situation at household level. In this blog I will elaborate on methods to measure the situation at individual level.
Nutrition is an important aspect of overall food security and goes beyond availability at local level and access at household level. Nutrition security is defined by adequate utilization of food at individual level. Together with infants and young children, adolescent girls and women of reproductive age are the most vulnerable for under nutrition. It can be assumed that once the nutrition situation of these individuals has been improved the nutritional status of all household members has improved.
The nutritional status of a woman before and during pregnancy has a direct impact on the development and nutritional status of her baby. Malnutrition before and during pregnancy increases the risk of low birth weight and under nutrition during infancy. The role and importance of women goes beyond infant and child nutrition. Women have their own right to adequate food and to be free from hunger. In addition it is important to recognize that they make up 43% of the overall agricultural workforce , and in many societies they have the main responsibility for the production, processing and preparation of food for home consumption. However, women often have weaker access to productive resources, services, markets and food and are therefore more likely than men to be malnourished.
To define the nutritional status of individuals so-called anthropometric measurements, such as weight and height, can be used. The level of anemia, vitamin A and Iodine deficiency are also important indicators for the nutrition status and are normally determined through blood tests. These indicators form part of National Demographic and Health Surveys , which are managed by the public sector. The results of these surveys are publically available for almost every country, normally providing averages from national to district level. These surveys provide an important source of secondary data for problem and/or context analyses during the design and preparation phase of project interventions. However possibilities to use these data for measurement of impact of specific project interventions is limited given the aggregation of the data as well as the limited frequency of the surveys and the usual delay in publication of the results.
Given the complexity of taking anthropometric measurements as well as defining levels of vitamin A and hemoglobin (iron) in the blood, in general it is not feasible to include this type of indicators in the monitoring mechanism of food and nutrition security projects. That’s why actors like FAO and the USAID supported FANTA project have worked on simple indicators for global use in assessing the quality (micronutrient adequacy) of diets and appropriateness of feeding practices. The increased attention for nutrition-sensitive interventions – are further boosting the use of and experiences with these indicators.
In answer to the abovementioned demand, the Dietary Diversity Score has been developed and validated. In resource-poor environments, low quality monotonous diets are the norm. When grain- or tuber-based staple foods dominate and diets lack vegetables, fruits and animal-source foods, the risk for micronutrient deficiencies is high. In these settings the diversity of all foods consumed, i.e. dietary diversity, is a useful indicator for overall diet quality.
To measure the diversity of foods consumed the available foods have to be classified into a number of pre-defined food groups. The number of food groups may vary depending on the context and specifications of the research. In July 2014 an international expert meeting defined the Minimum Dietary Diversity for Women (MDD-W), based on the following ten food groups.
The benchmark for assessing the quality of diets of adolescent girls and women of reproductive age has been set at five out of these ten pre-defined food groups. Persons consuming foods from five or more of the 10 food groups on a daily basis have a greater likelihood of meeting their micronutrient needs than those consuming foods from fewer food groups. Depending on the context and the character of the research one could amplify the number of food groups.
The dietary diversity questionnaire
From experiences we know that one should take into account the following do’s and don’ts in order to effectively collect reliable data for a dietary diversity score:
- Apply a so-called 24-hour recall questionnaire during a face-2-face interview, asking the respondent what he or she consumed the day before, covering a period of 24 hours including morning, afternoon, evening and night. It was found that in general respondents are able to recall quite accurately what they consumed the day before. Going further back in time will reduce the reliability of the provided information.
- It is recommended not to plan a survey directly after an unusual day, e.g. a national Holiday as this will result in data which does not reflect the respondent’s usual diet.
- Phrase the questions in an open way. Don’t ask whether the respondent consumed starchy staple foods yesterday; rather ask whether the respondent had breakfast yesterday. If confirmative ask what the respondent consumed for breakfast, registering the food groups included. It might be necessary to check the ingredients used for the dishes that are mentioned. For this the enumerator needs basic knowledge about nutrition and food preparation, as well as good interviewing skills. This is to prevent ‘false positive answers’ based on leading questions. Besides breakfast the enumerator should check whether the respondent had lunch, dinner and snacks between meals and/or after dinner.
- Foods that are mentioned should only be included if a minimum amount of 15 grams/millilitres or more has been consumed.
- In case the dietary diversity score forms part of a baseline in combination with a mid-term and or end-term evaluation to measure impact of interventions it is recommended to apply the questionnaires in the lean period of the year. It is even more important to make sure that all surveys are applied during the same period of the calendar year, to exclude the impact of seasonal influences.
Applying a Dietary Diversity Score is slightly more time consuming than the HFIAS and, as mentioned before, requires a solid level of food and nutrition knowledge among the interviewers. We have experienced that it is worth the investment as the combination of HFIAS and DDS provides a solid and valuable source of information for designing, monitoring as well as evaluating FNS programs. In blog # 4 and # 5 more information will be provided on the use of AKVO FLOW, a web- and mobile device based tool for data collection, that can be used effectively for both HFIAS and DDS.