1
|
Beal T, White JM, Arsenault JE, Okronipa H, Hinnouho GM, Morris SS. Comprehensive Nutrient Gap Assessment (CONGA): A method for identifying the public health significance of nutrient gaps. Nutr Rev 2021; 79:4-15. [PMID: 33693909 PMCID: PMC7947985 DOI: 10.1093/nutrit/nuaa140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Identifying dietary nutrient gaps and interpreting their public health significance are essential for improving poor diets and reducing malnutrition. Evidence indicative of the burden of nutrient deficiencies and inadequate nutrient intake or availability exists in many countries yet is often misinterpreted or underused in decision-making. Clear guidance is lacking on how to synthesize and interpret the relevant evidence, which comes in many forms. To fill this methodological gap, an approach called Comprehensive Nutrient Gap Assessment was created to enable use of existing evidence to assess the public health significance of nutrient gaps and identify evidence gaps. Comprehensive Nutrient Gap Assessment requires ≥ 2 experts in nutritional assessment but does not require primary data collection or secondary quantitative data analysis. It can be implemented relatively quickly with low costs, for specific countries and subnational regions, and updated on the basis of new data with minimal effort. The findings from a Comprehensive Nutrient Gap Assessment are easily interpretable by nontechnical decision makers yet include clear justification for technical audiences.
Collapse
Affiliation(s)
- Ty Beal
- Global Alliance for Improved Nutrition, Washington, DC, USA
- Department of Environmental Science and Policy, University of California, Davis, California, USA
| | | | - Joanne E Arsenault
- Institute for Global Nutrition, University of California, Davis, Davis, California, USA
- Intake, Center for Dietary Assessment, FHI Solutions, Washington, DC, USA
| | - Harriet Okronipa
- Institute for Global Nutrition, University of California , Davis, Davis, California, USA
- Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, USA
| | - Guy-Marino Hinnouho
- Institute for Global Nutrition , University of California , Davis, Davis, California, USA
- Helen Keller International, New York, New York, USA
| | | |
Collapse
|
2
|
Hoffman DJ. Nutrients in Complementary Feeding Protect Against Wasting, but Not Stunting: Results from a Multi-Country Longitudinal Cohort Study. J Nutr 2021; 151:5-6. [PMID: 33245106 DOI: 10.1093/jn/nxaa334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 01/07/2023] Open
Affiliation(s)
- Daniel J Hoffman
- Department of Nutritional Sciences, Program in International Nutrition; New Jersey Institute for Food, Nutrition, and Health, Center for Childhood Nutrition Research; Rutgers, the State University of New Jersey, New Brunswick, NJ, USA
| |
Collapse
|
3
|
Bose I, Baldi G, Kiess L, de Pee S. The "Fill the Nutrient Gap" analysis: An approach to strengthen nutrition situation analysis and decision making towards multisectoral policies and systems change. MATERNAL AND CHILD NUTRITION 2019; 15:e12793. [PMID: 30698364 PMCID: PMC6767452 DOI: 10.1111/mcn.12793] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 01/06/2019] [Accepted: 01/08/2019] [Indexed: 11/30/2022]
Abstract
Improved nutrition situation analysis can increase the understanding of the likely magnitude and main causes of the nutrient gap among a particular target group, for example, children under 2 or pregnant and lactating women, in a particular context. The World Food Programme, with input from University of California Davis, International Food Policy Research Institute, Epicentre, Harvard University, Mahidol University, Save the Children, and UNICEF, has developed a framework for strengthened nutrition situation analysis and decision making called the "Fill the Nutrient Gap" (FNG), which aims to support identification of strategies to increase availability, access, and choice of nutritious foods, to ultimately improve nutrient intake. The FNG engages stakeholders from different sectors throughout the analytical process to provide input and discuss findings to collectively identify and prioritize context-specific strategies. The FNG analysis contributes to better understanding the nutrition situation because it (a) focuses on the dietary intake side of the malnutrition framework and analyses in-depth the nutrient intake of different target groups; (b) linear programming is used in combination with review of secondary data to characterize barriers to nutrient intake, in particular to understand the availability, cost and affordability of nutritious diets for households and target groups with higher nutritional needs, and model potential interventions to improve them; (c) it links the nutrition situation analysis to decision making by providing an evidence base for decision makers to inform their strategies; (d) it facilitates multisectoral discussion on barriers to nutrient intake and enables a prioritization of context-specific strategies (both nutrition specific and sensitive) to improve the nutrition situation across food, health, and social protection systems.
Collapse
Affiliation(s)
- Indira Bose
- Nutrition Division, World Food Programme, Rome, Italy
| | - Giulia Baldi
- Nutrition Division, World Food Programme, Rome, Italy
| | - Lynnda Kiess
- Nutrition Division, World Food Programme, Rome, Italy
| | - Saskia de Pee
- Nutrition Division, World Food Programme, Rome, Italy.,Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.,Human Nutrition, Wageningen University, Wageningen, The Netherlands
| |
Collapse
|
4
|
Ahoya B, Kavle JA, Straubinger S, Gathi CM. Accelerating progress for complementary feeding in Kenya: Key government actions and the way forward. MATERNAL & CHILD NUTRITION 2019; 15 Suppl 1:e12723. [PMID: 30748122 PMCID: PMC6594063 DOI: 10.1111/mcn.12723] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/03/2018] [Accepted: 10/05/2018] [Indexed: 01/01/2023]
Abstract
Optimal complementary feeding practices, a critical component of infant and young child feeding, has been demonstrated to prevent micronutrient deficiencies, stunting, overweight, and obesity. In Kenya, while impressive gains have been made in exclusive breastfeeding, progress in complementary feeding has been slow, and the country has failed to meet targets. Recent 2014 Kenya Demographic and Health Survey reveal that only 22% of Kenyan children, 6-23 months, met criteria for a minimum acceptable diet. This case study describes key actions for complementary feeding put in place by the Kenya Ministry of Health as well as approaches for improving and monitoring complementary feeding within existing health platforms. Experience from USAID's Maternal and Child Survival Program and Ministry of Health on development of 23 complementary feeding recipes through application of a national guide for recipe development and Trials of Improved Practices is described. Challenges in how to prepare, modify, and cook foods, including meat, for young children 6-23 months of age was relayed by mothers. Addressing cultural beliefs around complementary feeding meant providing reassurance to mothers that young children are developmentally able to digest fruit and vegetables and ready to consume animal-source protein. Through the Baby Friendly Community Initiative platform, cooking demonstrations and key hygiene actions were integrated with complementary feeding messages. Future programming for complementary feeding should consider development of context specific counselling messages on consumption of animal source foods, strengthen production and use of local foods through agriculture-nutrition linkages, and include complementary indicators through routine health monitoring systems to track progress.
Collapse
Affiliation(s)
- Brenda Ahoya
- USAID's Maternal and Child Survival Program/PATHKisumuKenya
| | - Justine A. Kavle
- USAID's Maternal and Child Survival Program/PATHWashingtonDistrict of ColumbiaUSA
| | - Sarah Straubinger
- USAID's Maternal and Child Survival Program/PATHWashingtonDistrict of ColumbiaUSA
| | | |
Collapse
|
5
|
Untoro J, Childs R, Bose I, Winichagoon P, Rudert C, Hall A, de Pee S. Tools to improve planning, implementation, monitoring, and evaluation of complementary feeding programmes. MATERNAL AND CHILD NUTRITION 2018; 13 Suppl 2. [PMID: 29032631 DOI: 10.1111/mcn.12438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 11/30/2022]
Abstract
Adequate nutrient intake is a prerequisite for achieving good nutrition status. Suboptimal complementary feeding practices are a main risk factor for stunting. The need for systematic and user-friendly tools to guide the planning, implementation, monitoring, and evaluation of dietary interventions for children aged 6-23 months has been recognized. This paper describes five tools, namely, ProPAN, Optifood, Cost of the Diet, Fill the Nutrient Gap, and Monitoring Results for Equity System that can be used in different combinations to improve situation analysis, planning, implementation, monitoring, or evaluation approaches for complementary feeding in a particular context. ProPAN helps with development of strategies and activities designed to change the behaviours of the target population. Optifood provides guidance for developing food-based recommendations. The Cost of the Diet can provide insight on economic barriers to accessing a nutritious and balanced diet. The Fill the Nutrient Gap facilitates formulation of context-specific policies and programmatic approaches to improve nutrient intake, through a multistakeholder process that uses insights from linear programming and secondary data. The Monitoring Results for Equity System helps with analysis of gaps, constraints, and determinants of complementary feeding interventions and adoption of recommended practices especially in the most vulnerable and deprived populations. These tools, and support for their use, are readily available and can be used either alone and/or complementarily throughout the programme cycle to improve infant and young child-feeding programmes at subnational and national levels.
Collapse
Affiliation(s)
- Juliawati Untoro
- United Nations Children's Fund, Eastern and Southern Africa Regional Office, Nairobi, Kenya
| | | | - Indira Bose
- Nutrition Division, World Food Programme, Rome, Italy
| | | | - Christiane Rudert
- United Nations Children's Fund, East Asia Pacific Regional Office, Bangkok, Thailand
| | | | - Saskia de Pee
- Nutrition Division, World Food Programme, Rome, Italy
| |
Collapse
|
6
|
Bégin F, Aguayo VM. First foods: Why improving young children's diets matter. MATERNAL AND CHILD NUTRITION 2018; 13 Suppl 2. [PMID: 29032619 DOI: 10.1111/mcn.12528] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/04/2017] [Accepted: 09/05/2017] [Indexed: 02/06/2023]
Abstract
Globally, only 52% of children aged 6-23 months meet the minimum meal frequency and a mere 29% meet the minimum dietary diversity, with large disparities across and within regions. With most of the stunting occurring during the first thousand days-from conception to age 2 years-improving complementary feeding in children 6-23 months old is an urgent priority. With this evidence in mind, UNICEF collaborated with the governments of India and Maharashtra to convene a global meeting in Mumbai, India, under the theme: First Foods: A Global Meeting to Accelerate Progress on Complementary Feeding in Young Children (November 17-18, 2015). The global meeting provided a platform that aimed to (a) synthesize the biological and implementation science on complementary feeding; (b) review the practice and experience in improving access to nutritious complementary foods and good complementary feeding practices; and (c) consolidate a strong evidence base that can inform the development of strategies and approaches to improve complementary feeding that are fit to context. This overview paper summarizes the rationale on why improving complementary foods and feeding for infants and young children matters and what it takes to improve them. It builds on the papers presented at the First Foods Global Meeting and those commissioned as a follow on to it.
Collapse
Affiliation(s)
- France Bégin
- Nutrition Section, Programme Division, United Nations Children's Fund (UNICEF), New York, New York, USA
| | - Víctor M Aguayo
- Nutrition Section, Programme Division, United Nations Children's Fund (UNICEF), New York, New York, USA
| |
Collapse
|