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Al Jawaldeh A, El Hajj Hassan O, Qureshi AB, Zerbo FC, Alahnoumy S, Bozo M, Al-Halaika M, Al-Dakheel MH, Alhamdan L, Mujib SA, El Ammari L, Aguenaou H, Alqaoud N, Almaamari S, Alshamkhi S, Dureab F. Qualitative Review of National Nutrition Surveillance Systems in the Eastern Mediterranean Region. Nutrients 2023; 15:3689. [PMID: 37686721 PMCID: PMC10490415 DOI: 10.3390/nu15173689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 09/10/2023] Open
Abstract
The World Food Conference in 1974 emphasized the significance of establishing global nutrition surveillance to monitor and address nutritional challenges effectively. However, many countries, especially in the EMRO region, continue to encounter substantial difficulties in regularly generating disaggregated data on nutrition. The current study aimed to review the existing nutrition surveillance systems in the region and to identify their strengths and weaknesses, as well as the challenges they face in functioning optimally. METHODS This study focused on the functional nutrition surveillance systems in eight Arab countries; namely Kuwait, Morocco, Oman, Palestine, Saudi Arabia, Sudan, Syria, and Yemen. The study's analysis involved utilizing primary data collected from both published and unpublished reports. Additionally, a structured checklist was employed to gather information from all countries involved in the study. Furthermore, interviews were conducted with the EMRO offices to gain deeper insights into the challenges, if any, that these nutrition surveillance systems face in functioning optimally. RESULTS All countries use health facilities as a basic source of data for their nutrition surveillance, some countries triangulate their nutrition surveillance reports with data from other sources of information such as community or school surveys. Identified nutrition surveillance approaches are closely split between those who operate in stable settings and use routine health information systems (Morocco, Saudi Arabia, Oman, and Kuwait) and other countries that operate in fragile settings; for example, Yemen, Syria, Palestine, and Sudan struggle to provide early warning reports for rapid nutritional responses. CONCLUSIONS Nutrition surveillance systems that utilize existing health information systems are the most sustained in the EMRO region. However, by integrating data from multiple sources, such as health facilities, surveys, and population censuses, countries can provide a holistic view of the nutritional situation, enhance their response to any emergency, and can leverage the infrastructure and resources already in place for health data collection and reporting. Collaboration between countries in the region through sharing experiences and success stories is important in order to reach a standardized system that can be implemented in different settings.
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Affiliation(s)
- Ayoub Al Jawaldeh
- World Health Organization (WHO), Regional Office for the Eastern Mediterranean, Cairo 7608, Egypt
| | - Ola El Hajj Hassan
- Heidelberg Institute of Global Health, Hospital University Heidelberg, 69120 Heidelberg, Germany
| | | | | | | | - Mahmoud Bozo
- World Health Organization (WHO), Damascus 3946, Syria
| | - Mousa Al-Halaika
- Nutrition Department, Ministry of Health, Ramallah 4284, Palestine
| | | | - Lamya Alhamdan
- Nutrition Department, Ministry of Health, Riyadh 11176, Saudi Arabia
| | | | - Laila El Ammari
- Nutrition Department, Ministry of Health, Rabat 335, Morocco
| | - Hassan Aguenaou
- Joint Research Unit in Nutrition and Food, RDC-Nutrition AFRA/IAEA, Ibn Tofaïl University-CNESTEN, Rabat-Kénitra 242, Morocco
| | - Nawal Alqaoud
- Food and Nutrition Administration, Ministry of Health, Kuwait City 13001, Kuwait
| | | | | | - Fekri Dureab
- Heidelberg Institute of Global Health, Hospital University Heidelberg, 69120 Heidelberg, Germany
- Institute of Research for International Assistance, Akkon Hochschule, 12099 Berlin, Germany
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Ricci JMS, Romito ALZ, Silva SAD, Carioca AAF, Lourenço BH. Food intake markers in Sisvan: temporal trends in coverage and integration with e-SUS APS, Brazil 2015-2019. CIENCIA & SAUDE COLETIVA 2023. [DOI: 10.1590/1413-81232023283.10552022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Abstract The aim of the present study was to estimate the population coverage of recording food intake markers in Brazil’s Food and Nutrition Surveillance System (Sisvan) and mean annual percent change (APC) in coverage according to the system used for data entry (e-SUS APS and Sisvan Web). We conducted an ecological time series study of the period 2015-2019. The data were stratified into region and age group. APC in coverage was calculated using Prais-Winsten regression and the correlation between APC and HDI, GDP per capita and primary healthcare coverage was assessed using Spearman’s correlation coefficient. Population coverage of recording food intake markers at national level was 0.92% in 2019. Mean APC in coverage throughout the period was 45.63%. The region and age group with the highest coverage rate were the Northeast (4.08%; APC=45.76%, p<0.01) and children aged 2-4 years (3.03%; APC=34.62%, p<0.01), respectively. There was an upward trend in data entry using e-SUS APS, to the detriment of Sisvan Web. There was a positive correlation between APC in coverage using e-SUS APS and HDI and GDP per capita in some age groups. Population coverage of recording Sisvan food intake markers remains low across the country. The e-SUS APS has the potential to be an important strategy for expanding food and nutrition surveillance.
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Ricci JMS, Romito ALZ, Silva SAD, Carioca AAF, Lourenço BH. Food intake markers in Sisvan: temporal trends in coverage and integration with e-SUS APS, Brazil 2015-2019. CIENCIA & SAUDE COLETIVA 2023; 28:921-934. [PMID: 36888874 DOI: 10.1590/1413-81232023283.10552022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 09/03/2022] [Indexed: 03/08/2023] Open
Abstract
The aim of the present study was to estimate the population coverage of recording food intake markers in Brazil's Food and Nutrition Surveillance System (Sisvan) and mean annual percent change (APC) in coverage according to the system used for data entry (e-SUS APS and Sisvan Web). We conducted an ecological time series study of the period 2015-2019. The data were stratified into region and age group. APC in coverage was calculated using Prais-Winsten regression and the correlation between APC and HDI, GDP per capita and primary healthcare coverage was assessed using Spearman's correlation coefficient. Population coverage of recording food intake markers at national level was 0.92% in 2019. Mean APC in coverage throughout the period was 45.63%. The region and age group with the highest coverage rate were the Northeast (4.08%; APC=45.76%, p<0.01) and children aged 2-4 years (3.03%; APC=34.62%, p<0.01), respectively. There was an upward trend in data entry using e-SUS APS, to the detriment of Sisvan Web. There was a positive correlation between APC in coverage using e-SUS APS and HDI and GDP per capita in some age groups. Population coverage of recording Sisvan food intake markers remains low across the country. The e-SUS APS has the potential to be an important strategy for expanding food and nutrition surveillance.
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Affiliation(s)
- Joanna Manzano Strabeli Ricci
- Programa de Pós-Graduação Nutrição em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo (USP). Av. Dr. Arnaldo 715, Cerqueira César. 01246-904 São Paulo SP Brasil.
| | | | - Sara Araújo da Silva
- Coordenação-Geral de Alimentação e Nutrição, Ministério da Saúde. Brasília DF Brasil
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Checchi F, Frison S, Warsame A, Abebe KT, Achen J, Ategbo EA, Ayoya MA, Kassim I, Ndiaye B, Nyawo M. Can we predict the burden of acute malnutrition in crisis-affected countries? Findings from Somalia and South Sudan. BMC Nutr 2022; 8:92. [PMID: 36038942 PMCID: PMC9421106 DOI: 10.1186/s40795-022-00563-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Sample surveys are the mainstay of surveillance for acute malnutrition in settings affected by crises but are burdensome and have limited geographical coverage due to insecurity and other access issues. As a possible complement to surveys, we explored a statistical approach to predict the prevalent burden of acute malnutrition for small population strata in two crisis-affected countries, Somalia (2014-2018) and South Sudan (2015-2018). METHODS For each country, we sourced datasets generated by humanitarian actors or other entities on insecurity, displacement, food insecurity, access to services, epidemic occurrence and other factors on the causal pathway to malnutrition. We merged these with datasets of sample household anthropometric surveys done at administrative level 3 (district, county) as part of nutritional surveillance, and, for each of several outcomes including binary and continuous indices based on either weight-for-height or middle-upper-arm circumference, fitted and evaluated the predictive performance of generalised linear models and, as an alternative, machine learning random forests. RESULTS We developed models based on 85 ground surveys in Somalia and 175 in South Sudan. Livelihood type, armed conflict intensity, measles incidence, vegetation index and water price were important predictors in Somalia, and livelihood, measles incidence, rainfall and terms of trade (purchasing power) in South Sudan. However, both generalised linear models and random forests had low performance for both binary and continuous anthropometric outcomes. CONCLUSIONS Predictive models had disappointing performance and are not usable for action. The range of data used and their quality probably limited our analysis. The predictive approach remains theoretically attractive and deserves further evaluation with larger datasets across multiple settings.
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Affiliation(s)
- Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
| | - Séverine Frison
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Abdihamid Warsame
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Kiross Tefera Abebe
- United Nations Children's Fund, South Sudan Country Office, Juba, South Sudan
| | - Jasinta Achen
- United Nations Children's Fund, Somalia Country Office, Mogadishu, Somalia
| | - Eric Alain Ategbo
- United Nations Children's Fund, South Sudan Country Office, Juba, South Sudan
| | - Mohamed Ag Ayoya
- United Nations Children's Fund, Somalia Country Office, Mogadishu, Somalia
| | - Ismail Kassim
- United Nations Children's Fund, South Sudan Country Office, Juba, South Sudan
| | - Biram Ndiaye
- United Nations Children's Fund, Somalia Country Office, Mogadishu, Somalia
| | - Mara Nyawo
- East and Southern Africa Regional Office, United Nations Children's Fund, Nairobi, Kenya
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Gonçalves IDSA, Donateli CP, Cotta RMM, Moreira TR, da Costa GD. Perception of the Food and Nutrition Surveillance System in the Zona da Mata Mineira region of Brazil: A qualitative approach. Sci Prog 2021; 104:368504211043365. [PMID: 34665070 PMCID: PMC10450770 DOI: 10.1177/00368504211043365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This work is a qualitative exploratory survey that aims to identify healthcare workers and skilled professionals' perceptions of the Food and Nutrition Surveillance System in the Zona da Mata Mineira region of Brazil. Data analysis was carried out through content analysis; testimonials were extracted from semi-structured interviews via the qualitative data processing software Interface de R pour lês Analyses Multidimensionnelles de Textes et de Questionnaires version 0.7 alpha 2. A total of 41 people were interviewed, including primary healthcare center coordinators, and technical consultants at the Food and Nutrition Surveillance System, as well as nutritionists and data entry clerks. The issues most mentioned during interviews were related to lack of anthropometric equipment, absence of transportation, and inadequate facilities. Regarding the work process, professionals identified scarce training and nonuse of the data collected for healthcare decision-making as factors that compromise desired system outcomes. System qualities were also recognized, especially the mapping of main nutritional issues in the region. The participants reported the need for greater efforts to raise awareness of the importance of Food and Nutrition Surveillance actions at all levels of the public healthcare system. They also highlighted the need for human resources training, higher quality data recording, and suitable facilities. Investments in the entire system are essential to strengthen the information-decision-making-action triad, which would result in the improvement of users' health indicators.
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Affiliation(s)
- Irene da Silva Araújo Gonçalves
- Programa de Pós-Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde/CCBII, Universidade Federal de Viçosa – UFV, Brasil
| | - Cíntia Pereira Donateli
- Programa de Pós-Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde/CCBII, Universidade Federal de Viçosa – UFV, Brasil
| | - Rosangela Minardi Mitre Cotta
- Programa de Pós-Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde/CCBII, Universidade Federal de Viçosa – UFV, Brasil
| | | | - Glauce Dias da Costa
- Programa de Pós-Graduação em Ciência da Nutrição, Departamento de Nutrição e Saúde/CCBII, Universidade Federal de Viçosa – UFV, Brasil
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Rippin HL, Hutchinson J, Jewell J, Breda JJ, Cade JE. Assessing diet in European populations using national dietary surveys. Proc Nutr Soc 2020; 79:1-11. [PMID: 31969200 DOI: 10.1017/s0029665119001174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The WHO encourages countries to conduct national dietary surveys (NDS) to inform preventative policies targeting malnutrition and noncommunicable diseases. Previous reviews have found inadequate nutrient intakes and survey provision across Europe. This research is the first to provide an updated review of NDS provision within the whole WHO European Region, across the lifecourse, with reference to disadvantaged groups, obesity and nutrients of concern. Over a third of WHO European countries, mainly Central and Eastern European countries (CEEC), had no identifiable NDS. Where countries reported nutrient intakes, poor WHO recommended nutrient intake attainment was Europe-wide across the lifecourse, particularly in CEEC. Lower educated individuals had poorer diet quality. However, heterogeneity in age group sampled, dietary assessment method, nutrient composition database and under-reporting hindered inter-country comparisons. Average population trans fatty acid intakes below WHO recommended limits may hide inequalities in disadvantaged groups; legislative bans may help alleviate this. There were few associations between NDS-derived consumed food portion size (FPS) and BMI. However, consumed FPS was greater than on-pack serving-size in the majority of foods studied. This review illustrates how NDS can generate information on diet, nutrient intakes and the food environment. However, to enable valid inter-country comparisons, countries should be encouraged to conduct and report harmonised NDS, particularly in the age groups sampled, dietary assessment methodology, nutrient range, underpinning food composition database and treatment of under-reporters. This will aid effective, coordinated policy development that can have a real impact on dietary improvement, on a population and subgroup level, throughout Europe.
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Affiliation(s)
- Holly L Rippin
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, LeedsLS2 9JT, UK
| | - Jayne Hutchinson
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, LeedsLS2 9JT, UK
| | - Jo Jewell
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, UN City, Marmorvej 51, 21000Copenhagen, Denmark
| | - Joao J Breda
- Division of Noncommunicable Diseases and Promoting Health through the Life-Course, World Health Organization Regional Office for Europe, UN City, Marmorvej 51, 21000Copenhagen, Denmark
| | - Janet E Cade
- Nutritional Epidemiology Group, School of Food Science and Nutrition, University of Leeds, LeedsLS2 9JT, UK
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Rhodes EC, Hennink M, Jefferds MED, Williams AM, Suchdev PS, Mapango C, Nyirenda E, Mshali G, Tripp K. Integrating micronutrient status assessment into the 2015-2016 Malawi Demographic and Health Survey: A qualitative evaluation. MATERNAL AND CHILD NUTRITION 2019; 15 Suppl 1:e12734. [PMID: 30748109 DOI: 10.1111/mcn.12734] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 12/14/2022]
Abstract
Demand for national-level micronutrient status data continues to grow, yet little is known about the implementation of different approaches for collecting these data. We conducted an evaluation of the process of linking the 2015-2016 Malawi Demographic and Health Survey (MDHS) and 2015-2016 Malawi Micronutrient Survey (MNS). We conducted 24 in-depth interviews with stakeholders from the Malawi government and international agencies and field staff. Interview questions explored perceptions of what worked and what was challenging during three phases of implementation: preparation; data collection; and data analysis, reporting, and dissemination. Data were analysed using thematic analysis. Results showed that there was strong government interest to integrate the MDHS and MNS. Perceived benefits included potential cost savings and lower respondent burden. However, government and international agency stakeholders did not view the linkage of the surveys to be a fully integrated approach. The lack of full integration produced challenges throughout implementation, such as complex field logistics and duplication in nutrition indicators assessed and reported. Some stakeholders believed integration was not attainable primarily due to timing. The MDHS and MNS were originally designed as stand-alone surveys, and planning for each survey was at an advanced stage once the government sought to integrate the surveys. Additionally, the MNS could not be incorporated as a module within the MDHS given the complexity of the MNS data collection and short timeframe for planning. These findings can inform decisions about implementing the next MNS and may be transferable to other countries that are conducting micronutrient surveys to address data gaps.
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Affiliation(s)
- Elizabeth C Rhodes
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, USA
| | - Monique Hennink
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Maria Elena D Jefferds
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anne M Williams
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Parminder S Suchdev
- Nutrition and Health Sciences Program, Laney Graduate School, Emory University, Atlanta, Georgia, USA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA.,Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Carine Mapango
- Division of Laboratory Sciences, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eunice Nyirenda
- Demography Section, National Statistical Office of Malawi, Zomba, Malawi
| | - Glory Mshali
- Demography Section, National Statistical Office of Malawi, Zomba, Malawi
| | - Katie Tripp
- Division of Nutrition, Physical Activity and Obesity, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Gicevic S, Kremic E, Fung TT, Rosner B, Sabanovic E, Willett WC. Feasibility and sustainability of dietary surveillance, Bosnia and Herzegovina. Bull World Health Organ 2019; 97:349-357. [PMID: 31551631 PMCID: PMC6747026 DOI: 10.2471/blt.18.227108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 02/19/2019] [Accepted: 02/28/2019] [Indexed: 11/27/2022] Open
Abstract
National dietary surveillance systems are necessary for monitoring people’s intake of foods and nutrients associated with health and disease, and for implementing national and global dietary goals. However, these systems do not exist in many low- and middle-income countries. The development of a model of dietary surveillance for Bosnia and Herzegovina, described here, provides insights into the feasibility and sustainability of dietary surveillance systems in resource-constrained settings and illustrates the challenges involved. In 2016, a year-long dietary survey was initiated in collaboration with the country’s Institute for Statistics using a subsample of households that participated in the 2015 national Household Budget Survey. Interviewers collected lifestyle, anthropometric and health data and participants answered two 24-hour dietary recall questionnaires. The survey included a representative sample of 853 participants and was performed efficiently by a small team of highly motivated, well-trained staff. Conducting a high-quality dietary survey was found to be feasible despite constrained resources. In addition, the ability to link dietary intake and regular household survey data provided an effective way of associating dietary variables with socioeconomic determinants of health. This dietary survey, the first conducted by an official institution in Bosnia and Herzegovina, represents an important starting point for building a sustainable nutritional surveillance system for the country. The cost–effective, low-burden approach to dietary surveillance described here could be applied in other low- and middle-income countries, many of which already carry out regular economic surveys.
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Affiliation(s)
- Selma Gicevic
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, Massachusetts, MA 02115, United States of America (USA)
| | - Emir Kremic
- Institute for Statistics of the Federation of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Teresa T Fung
- Department of Nutrition, Simmons University, Boston, USA
| | - Bernard Rosner
- Department of Medicine, Brigham and Women's Hospital, Boston, USA
| | - Edin Sabanovic
- Agency for Statistics of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Walter C Willett
- Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Ave, Boston, Massachusetts, MA 02115, United States of America (USA)
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Mugomeri E. Identifying Imperatives for an Effective Nutrition Surveillance Policy Framework for Maternal and Child Health in Lesotho. Food Nutr Bull 2018; 39:608-620. [PMID: 30477342 DOI: 10.1177/0379572118806708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surveillance of nutrition indicators is critical for informing nutrition policies and programs. The failure by many sub-Saharan countries to maintain functional surveillance systems for maternal and child health (MCH) hampers their capacity to achieve the 2030 Sustainable Development Goals relevant for MCH. The nutrition surveillance system (NSS) for MCH in the southern African country of Lesotho is no exception to this problem despite the country having some of the highest maternal and child mortality ratios globally. OBJECTIVE The study reviewed Lesotho's quantitative nutrition surveillance data and qualitatively analyzed the structure and functionality of Lesotho's NSS to identify imperatives for an effective nutrition surveillance policy framework for MCH in the country. METHODS Descriptive quantitative analyses were based on NSS data and nationally representative Lesotho Demographic and Health Survey (LDHS) data while qualitative analysis on data obtained through interviews with purposefully selected key informants working in the NSS of Lesotho was based on grounded theory. RESULTS Nutrition surveillance system data were inconsistently compiled across Lesotho's 10 districts, while LDHS data suggested that stunting, maternal anemia, child overweight, and low birth weight remain high. Challenges with the NSS were linked to poor coordination of the NSS due to an indistinct organogram of nutrition offices and poor cooperation among stakeholders in the NSS. CONCLUSIONS To improve the NSS in Lesotho, the most critical imperative is to capacitate the Food & Nutrition Coordinating Office which in turn should create distinct nutrition offices yet with adequate cooperation and clear benchmarks for monitoring and evaluation of the NSS.
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Affiliation(s)
- Eltony Mugomeri
- 1 Department of Pharmacy, Faculty of Health Sciences, National University of Lesotho, Maseru, Lesotho
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Gillespie S, Hoddinott J, Nisbett N, Arifeen S, van den Bold M. Evidence to Action: Highlights From Transform Nutrition Research (2012-2017). Food Nutr Bull 2018; 39:335-360. [PMID: 30079765 DOI: 10.1177/0379572118788155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Transform Nutrition ( Transform) research consortium (2012-2017), led by the International Food Policy Research Institute, sought to generate evidence to inform and inspire action to address undernutrition in 4 high-burden countries (India, Bangladesh, Kenya, and Ethiopia) and globally. OBJECTIVE Within the context of the literature, this synthesis article brings together core findings of Transform, highlighting priorities for future research. METHODS This article uses a narrative approach to synthesize diverse study findings that collectively address Transform's three primary research questions: (1) How can nutrition-specific interventions be appropriately designed, implemented, scaled, and sustained in different settings?; (2) How can the nutritional impact of social protection and agriculture be improved?; and (3) How can enabling environments be promoted so as to use existing political and economic resources more effectively? RESULTS Highlights of Transform include (1) improved understanding of the relative effectiveness of different combinations of nutrition-specific interventions and the ways in which they can be scaled for maximal impact; (2) evidence that shows that social protection and agriculture need to be explicitly linked to nutrition in order to contribute to stunting reduction; (3) identification of key components of "enabling environments" for nutrition and how they can be cultivated/sustained; (4) research that examines ways in which leaders emerge and operate to change the political and policy landscape in different settings; and (5) "stories of change" that provide in-depth contextual knowledge of how transformative change has been driven in countries that have made inroads in reducing malnutrition. The conclusion highlights the contributions of the consortium and provides recommendations for future research.
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Affiliation(s)
- Stuart Gillespie
- 1 International Food Policy Research Institute (IFPRI), Washington, DC, USA
| | - John Hoddinott
- 2 Cornell College of Human Ecology, Cornell University, Ithaca, NY, USA
| | - Nicholas Nisbett
- 3 Institute of Development Studies (IDS), Library Road, Brighton, UK
| | - Shams Arifeen
- 4 International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR, B), Dhaka, Bangladesh
| | - Mara van den Bold
- 1 International Food Policy Research Institute (IFPRI), Washington, DC, USA
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Frison S, Kerac M, Checchi F, Nicholas J. A novel, efficient method for estimating the prevalence of acute malnutrition in resource-constrained and crisis-affected settings: A simulation study. PLoS One 2017; 12:e0186328. [PMID: 29091927 PMCID: PMC5665500 DOI: 10.1371/journal.pone.0186328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 09/28/2017] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The assessment of the prevalence of acute malnutrition in children under five is widely used for the detection of emergencies, planning interventions, advocacy, and monitoring and evaluation. This study examined PROBIT Methods which convert parameters (mean and standard deviation (SD)) of a normally distributed variable to a cumulative probability below any cut-off to estimate acute malnutrition in children under five using Middle-Upper Arm Circumference (MUAC). METHODS We assessed the performance of: PROBIT Method I, with mean MUAC from the survey sample and MUAC SD from a database of previous surveys; and PROBIT Method II, with mean and SD of MUAC observed in the survey sample. Specifically, we generated sub-samples from 852 survey datasets, simulating 100 surveys for eight sample sizes. Overall the methods were tested on 681 600 simulated surveys. RESULTS PROBIT methods relying on sample sizes as small as 50 had better performance than the classic method for estimating and classifying the prevalence of acute malnutrition. They had better precision in the estimation of acute malnutrition for all sample sizes and better coverage for smaller sample sizes, while having relatively little bias. They classified situations accurately for a threshold of 5% acute malnutrition. Both PROBIT methods had similar outcomes. CONCLUSIONS PROBIT Methods have a clear advantage in the assessment of acute malnutrition prevalence based on MUAC, compared to the classic method. Their use would require much lower sample sizes, thus enable great time and resource savings and permit timely and/or locally relevant prevalence estimates of acute malnutrition for a swift and well-targeted response.
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Affiliation(s)
- Severine Frison
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Marko Kerac
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Francesco Checchi
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
| | - Jennifer Nicholas
- Department of Population Health, London School of Hygiene and Tropical Medicine (LSHTM), London, United Kingdom
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Brindle E, Lillis L, Barney R, Hess SY, Wessells KR, Ouédraogo CT, Stinca S, Kalnoky M, Peck R, Tyler A, Lyman C, Boyle DS. Simultaneous assessment of iodine, iron, vitamin A, malarial antigenemia, and inflammation status biomarkers via a multiplex immunoassay method on a population of pregnant women from Niger. PLoS One 2017; 12:e0185868. [PMID: 28982133 PMCID: PMC5628875 DOI: 10.1371/journal.pone.0185868] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 09/20/2017] [Indexed: 11/24/2022] Open
Abstract
Deficiencies of vitamin A, iron, and iodine are major public health concerns in many low- and middle-income countries, but information on their status in populations is often lacking due to high costs and logistical challenges associated with assessing micronutrient status. Accurate, user-friendly, and low-cost analytical tools are needed to allow large-scale population surveys on micronutrient status. We present the expansion of a 7-plex protein microarray tool for the simultaneous measurement of up to seven biomarkers with relevance to the assessment of the key micronutrients iron, iodine, and vitamin A, and inflammation and malaria biomarkers: α-1-acid glycoprotein, C-reactive protein, ferritin, retinol binding protein 4, soluble transferrin receptor, thyroglobulin, and histidine-rich protein II. Assay performance was assessed using international reference standards and then verified by comparing the multiplexed and conventional immunoassay results on a training panel of plasma samples collected from US adults. These data were used to assign nominal concentrations to the calibrators of the assay to further improve performance which was then assessed by interrogating plasma samples from a cohort of pregnant women from Niger. The correlation between assays for each biomarker measured from this cohort was typically good, with the exception of thyroglobulin, and the sensitivity ranged from 74% to 93%, and specificity from 81% to 98%. The 7-Plex micronutrient assay has the potential for use as an affordable tool for population surveillance of vitamin A, iron, and iodine deficiencies as well as falciparum malarial parasitemia infectivity and inflammation. The assay is easy-to-use, requires minimal sample volume, and is scalable, rapid, and accurate—needing only a low-cost reader and basic equipment present in most reference laboratory settings and so may be employed by low and middle income countries for micronutrient surveillance to inform on status in key populations. Micronutrient deficiencies including iron, iodine, and vitamin A affect a significant portion of the world’s population. Efforts to assess the prevalence of these deficiencies in vulnerable populations are challenging, partly due to measurement tools that are inadequate for assessing multiple micronutrients in large-scale population surveys. We have developed a 7-plex immunoassay for the simultaneous measurement of seven biomarkers relevant to assessing iodine, iron, and vitamin A status, inflammation and Plasmodium falciparum parasitemia by measuring levels of thyroglobulin, ferritin, soluble transferrin receptor, retinol binding protein 4, α-1-acid glycoprotein, C-reactive protein, and histidine-rich protein II. This 7-plex immunoassay technique has potential as a rapid and effective tool for use in large-scale surveys and assessments of nutrition intervention programs in low- and middle-income countries.
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Affiliation(s)
- Eleanor Brindle
- Center for Studies in Demography and Ecology, University of Washington, Seattle, WA, United States of America
| | | | | | - Sonja Y. Hess
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
| | - K. Ryan Wessells
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
| | - Césaire T. Ouédraogo
- Program in International and Community Nutrition, Department of Nutrition, University of California, Davis, CA, United States of America
- Helen Keller International, Niamey, Niger
| | - Sara Stinca
- Laboratory of Human Nutrition, Swiss Federal Institute of Technology, Zurich, Switzerland
| | | | - Roger Peck
- PATH, Seattle, WA, United States of America
| | - Abby Tyler
- Quansys Biosciences, Logan, Utah, United States of America
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Tuffrey V, Hall A. Methods of nutrition surveillance in low-income countries. Emerg Themes Epidemiol 2016; 13:4. [PMID: 26997966 PMCID: PMC4797352 DOI: 10.1186/s12982-016-0045-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 03/05/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In 1974 a joint FAO/UNICEF/WHO Expert Committee met to develop methods for nutrition surveillance. There has been much interest and activity in this topic since then, however there is a lack of guidance for practitioners and confusion exists around the terminology of nutrition surveillance. In this paper we propose a classification of data collection activities, consider the technical issues for each category, and examine the potential applications and challenges related to information and communication technology. ANALYSIS There are three major approaches used to collect primary data for nutrition surveillance: repeated cross-sectional surveys; community-based sentinel monitoring; and the collection of data in schools. There are three major sources of secondary data for surveillance: from feeding centres, health facilities, and community-based data collection, including mass screening for malnutrition in children. Surveillance systems involving repeated surveys are suitable for monitoring and comparing national trends and for planning and policy development. To plan at a local level, surveys at district level or in programme implementation areas are ideal, but given the usually high cost of primary data collection, data obtained from health systems are more appropriate provided they are interpreted with caution and with contextual information. For early warning, data from health systems and sentinel site assessments may be valuable, if consistent in their methods of collection and any systematic bias is deemed to be steady. For evaluation purposes, surveillance systems can only give plausible evidence of whether a programme is effective. However the implementation of programmes can be monitored as long as data are collected on process indicators such as access to, and use of, services. Surveillance systems also have an important role to provide information that can be used for advocacy and for promoting accountability for actions or lack of actions, including service delivery. CONCLUSION This paper identifies issues that affect the collection of nutrition surveillance data, and proposes definitions of terms to differentiate between diverse sources of data of variable accuracy and validity. Increased interest in nutrition globally has resulted in high level commitments to reduce and prevent undernutrition. This review helps to address the need for accurate and regular data to convert these commitments into practice.
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Affiliation(s)
- Veronica Tuffrey
- />Faculty of Science and Technology, University of Westminster, 115 New Cavendish Street, London, W1W 6UW UK
| | - Andrew Hall
- />Save the Children, 1 St John’s Lane, London, EC1M 4AR UK
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