http://www.a4nh.cgiar.org/

1. How Can We Understand Nutrition Impacts?
Jody Harris
A4NH value chains for nutrition meeting, IFPRI, June 2013
Nutritional status is determined by food, health and care. The agriculture sector could conceivably be asked to be
accountable for stages along the causal pathway as far as food production and consumption (diets), but this sector alone
cannot be wholly accountable for nutrition; generally a package of interventions covering all three domains (according
to context) would be necessary to have an impact on nutrition. The agriculture sector should however ensure (monitor)
to ‘do no harm’ in terms of health- for instance an environment free of contaminants- and care- for instance women’s
time for childcare; the sector should also be aware of the continuum of nutrition from under- to over-nutrition, and its
role in the production of excess calories in a changing and urbanizing world.
The value chain projects presented at the meeting were very varied, so it is difficult to give prescriptions on nutrition
indicators; most important will be to think through the aims, context, and duration of the project, as well as sampling
issues such as available sample size, before deciding on what to measure. Below is a general synopsis of nutrition
indicators, and initial thoughts on what each of the nutrition-sensitive value chain projects might like to consider (note:
This is not a final recommendation for what the projects should measure; rather just thoughts provoked by the
meeting).
Dietary diversity is a useful measure of diet quality in individuals (see Mary Arimond’s presentation), and can be used as
part of formative work to understand local diets; as part of an impact evaluation to assess changes in diets attributed to
the intervention; and as an adjunct to studies looking at the impact of single foods in order to assess that food’s place in
the overall diet, or to check for displacement of other food groups (‘do no harm’). Several projects presented will also
want to look in detail at consumption of the target food that the value chain is promoting. Most projects will also want
to look at ‘knowledge’, broadly defined; what exactly is assessed here will depend on the individual project, but could
include awareness of the nutritional properties of the food group or of nutrition in general, attitudes to different foods,
thoughts on certification or safety, etc. Anthropometry will generally not be useful in value chain studies promoting a
single food or food group and not addressing the health and care determinants of nutrition; value chain projects which
are part of a broader package of interventions addressing these, or which have the potential sample sizes, duration and
impact pathways to address nutritional status could consider anthropometry. Some projects would be better assessing
biomarkers for specific nutrients included in food products, or markers of infection, depending on the aims of the study.
The table below gives an overview of indicators the different projects might like to consider.
In summary, most projects presented target a single food or food group, rather than a person’s diet, but assessment of
dietary diversity is useful to assess the project’s contribution to the diversity (and therefore quality) of the diet; this is a
relatively fast, easy and cheap method that has been validated in children under 2 (7 food groups) and older children
and women (16 food groups). Projects targeting a single food should also measure consumption of this food. Most
projects would also want to measure the ‘knowledge’ relevant to its particular aims. Anthropometry did not seem useful
or feasible in the projects as presented, at least at this seed-funded stage. Note that all indicators of diet and nutrition
are collected at individual level; value chains have to reach the consumer to address nutrition issues.
DNH: Do No Harm