Gender Nutrition Methods Workshop- 2013

1. Addressing women and children’s
nutrition – measures of food intake
and nutritional status
Gina Kennedy and Jody Harris
Bioversity International and IFPRI
6 December, 2013

2. National
economic
growth
National
nutrition
profile
Environmental
contaminants
or vectors
Food market environment
Agricultural Production
Household assets and livelihoods
Food
production &
gathering
Health
environment
Individual diet
Food prices
and
availability
Natural resources
Production
diversity
diversity
Target nutrient
consumption
Processing
& storage
Target food
consumption
Food Household
Food access
expenditure security
food
Agricultural Consumption
income / Expenditure
Health care
Non-food
expenditure
Women’s
Women’s Empowerment
empowerment in Ag Index
Household
Enabling
environment
Caring capacity
& practices
Diet
Health status
Infant and
young child
feeding
Time use
Female energy
expenditure
Nutrition and health knowledge
Child
nutrition
outcomes
Anthropometry /
biomarkers
Mother’s
nutrition
outcomes
Energy
expenditure
Individual
Knowledge /
attitudes

3. Commonly used individual indicators
Indicator
Relationship to Food Security
Examples of Commonly used
indicators
Individual Dietary Diversity and
Frequency
Ability of the diet of the diet to meet energy
and micronutrient needs
Individual Dietary Diversity Score (IDDS)
Minimum Dietary Diversity (MDD)
% Consuming target foods
% Meeting Requirements for Nutrients
Knowledge and attitudes
Provides important information on barriers
or optimizers related to dietary practices
Knowledge on nutritious foods
Attitudes toward good/bad foods for
children
Anthropometry
Outcome indicators of multiple factors
Stunting, Underweight Wasting
Body Mass Index
Desirable “ Do No Harm” Indicators
Provides important desirable information
often related to “ do no harm”
Breastfeeding
Minimum meal Frequency
Women’s energy expenditure

4. Individual dietary intakes
• FOOD and DIET are THE KEY areas for agnutrition pathway
• Womens’ dietary diversity
• Infant and young child dietary diversity
(Minimum Dietary Diversity)
• 24 hour recall/Food frequency

5. Rationale for development of individual dietary diversity
Quantitative dietary assessment cumbersome and
difficult
 need for a simple proxy of intake
Objective of dietary diversity
provide tools to produce relevant and dietary intake
information related to diet particularly at
decentralized level
the collection of information on diet is meant to
complement other indicators related to food security,
health and nutritional status; thereby forming a suite
of relevant indicators

6. INDIVIDUAL DIETARY DIVERSITY
SCORES
• Sum of food groups consumed over
the past 24 hours
–Women’s Dietary Diversity Score
–Minimum Dietary Diversity of children
6-23 months of age

7. Dietary Diversity Scores: Snapshot of Increasing Diversification
1 2 3 4 5

8. Method of data collection –
Women’s dietary diversity
• Use open recall questionnaire form
• When open recall is finished go through food
group list and mark “1” next to food groups
consumed
• For any blank food group ask respondent if any
food from this group was consumed the previous
day. Mark “1” for yes and “0” for no
• Use tabulation sheet or computer program for
WDD 9* food groups

9. Dietary Diversity (open)
“Please describe the foods (meals and snacks)
that you ate yesterday during the day and
night, whether at home or outside the home.
Start with the first food eaten in the morning.
After the respondent tells you about the first thing they had to
eat of drink, ask about what they ate or drank next. Write
down all food and drinks mentioned by the respondent. When
the respondent has finished, probe for meals and snacks not
mentioned. If they had tea or coffee ask if there was milk or
sugar added. Ask the respondent to mention the ingredients of
any mixed dishes.

11. Food Group
1
Starchy Staples
2
Dark green leafy vegetables
3
Other vitamin A rich vegetables and
fruits
4
Other fruits and vegetables
5
Organ meat
6
Eggs
7
Meat and Fish and other seafood
8
Legumes, nuts and seeds
9
DDS record “1” yes
“0” no
Milk and milk products
Sum above for WDDS
Oils and fats
Sweets, candy , sugar
Spices, condiments
Alcoholic beverages

12. Calculation of WDDS
• Sum the total number of food groups out of nine
consumed during the 24 hour recall period
• Score range 0-9
• Calculate average WDDS
• Analyze frequency of food group consumption
• CAN MODIFY TOOL FOR TARGET FOODS

13. Guidelines Available
• English
• French
• Spanish
http://www.fao.org/docrep/014/i1
983e/i1983e00.pdf

14. Minimum Dietary Diversity (MDD)
• The indicator is meant to reflect the quality of
the complementary food diet of infants and
young children 6-23 months of age

15. Data collection for MDD
• A standardized questionnaire can be
downloaded from WHO (IYCF) indicators
• Data collected on children 6-23 months of age
• Could be disaggregated by boys/girls
• Breastfeeding status and child age also need to
be collected for correct calculation of the
indicator

16. Calculating MDD

17. Strengths of DD measures
• Simple to administer
• Quick to analyze
• Have undergone robust validation as
proxy indicators for micronutrient
adequacy of the diet

18. DD measures recently recommended
Masset, Haddad Cornelius & Isaza-Castro, 2012
Review of effectiveness of agriculture interventions that
aim to improve nutritional status of children
“Indices of diversity of the diet should be used to assess
the effect on production and dietary composition”
Headey and Ecker, 2012
“dietary diversity indicators have substantial scope to add
more value to food security measurement, especially if
they can be refined and improved, rendered more
comparable across populations and measured more
frequently over time”

19. Dietary diversity tools are useful in programmes and
initiatives where a primary or secondary objective is to
improve the diet of the beneficiary population
• Agriculture, Fishery, Forestry programmes
▫ Crop diversification/integration
▫ Promotion of indigenous plant and animal foods
• Cross-cutting issues
• Food security and nutrition programmes
▫
▫
▫
▫
Sustainable livelihood support and diversification
Programmes in HIV affected areas
Food-based nutrition programmes
Nutrition education
The cost will be marginal !
▫ Gender
▫ HIV/AIDS
▫ Right to Food

20. Quantitative food intake
(target nutrient consumption and
women’s energy intakes)
• Quantitative 24 hour recalls can be used to
assess intakes of energy, protein, fat and
micronutrients
▫ Requires high level skills in training, supervision
of data collection and analysis
▫ Special equipment (weighing scales, recipes, food
composition tables)

21. Additional Infant and young child
indicators
• These and fall under “ Do no harm” principle
• Minimum meal frequency
• Breastfeeding
• SEE WHO GUIDELINES

22. Additional indicators for IYCF

23. Anthropometry in children and adults
Children
• STUNTING: height-for-age < -2 standard deviations of the WHO Child
Growth Standards Median (chronic malnutrition)
• WASTHING: weight-for-height < -2 standard deviations of the WHO
Child Growth Standards Median (acute malnutrition)
• UNDERWEIGHT: weight-for-age < -2 standard deviations of the WHO
Child Growth Standards Median (global malnutrition)
Adults
Body Mass Index (BMI)
• Requires specialized training of enumerators
• Special equipment, height board/ weighing scales

25. Anthropometric data can be obtained from:
- WHO GLOBAL DATABASE
- http://www.who.int/nutgrowthdb/en/
- National nutrition surveys
- Nutritional monitoring/surveillance
- (e.g. IFAD, WFP monitoring systems)
- Demographpic and Health and (DHS) and Multiple
Indicator Cluster (MICS) surveys

26. Biochemical indicators
• To assess if the program actually changed
micronutrient status of the population a
biochemical marker such as serum retinol or
hemoglobin can be used
▫ REQUIRES BLOOD SAMPLE AND ADDITIONAL
LEVELS OF ETHICAL CLEARANCE

27. EXAMPLES OF KAP INDICATORS
Short to medium term indicators
Knowledge
Attitudes
Practices
Percent of mothers who can
identify three local foods
rich in vitamin A
Example
Percent of mothers who
think eggs are a good
source of food for children
Example
Percent of children 6-23
Example
months fed an iron-rich
food source the previous
day

28. Food Insecurity Scales and Seasonality
• Household Food Insecurity Access Scale
(HFIAS)
• Household Hunger Scale (HHS)
• Coping Strategies Index (CSI) and Reduced CSI
• Others (ECLSA and FIES)
• Months of Inadequate HH food provisioning

29. Additional indicators of interest
• Child morbidity (see DHS for example
questions)
• Water and sanitation sources
• Socio-economic indicators
▫ Some form of wealth index
• Level of education (men and women)
• Literacy (men and women)

30. Aquaculture - Nutrition Linkages
Bangladesh: Case Study
Shakuntala Haraksingh Thilsted
Senior Nutrition Scientist

31. Bangladesh has made great strides in
aquaculture in the past 25 years
Focus on:
•
•
•
•
Production and productivity
Large fish
Men in aquaculture
Household income

32. Nutrition sensitive household pond aquaculture
Production Technology:
• Polyculture of Carps (large fish)
and Nutrient-rich Small Fish,
carried out by both men and
women
Focus on:
• Partial Frequent Harvesting of
Small Amounts of Small Fish
• Household Consumption,
especially in Women and Young
Children
• Sale of Carps for Household
Income
• Additional Diversification
strategies

33. Small Fish
Irreplaceable Animal-source
Food
Rich Source of Multiple Nutrients
Animal Protein
Essential Fats
Essential Micronutrients:
Minerals and Vitamins
Common Food eaten with Rice
Adds Flavour and Taste to the Meal
Improves Diet Diversity
Enhances Mineral Bioavailability from
Foods in the Meal
Cooked with Vegetables, Oil and Spices,
further Improving Diet Diversity, Adding
Nutrients and Growth-promoting
Substances
Processed (dried), Stored - Prolonging
Duration of Consumption, Reaching
Non-fish Producing Areas

34. Promotion of Orange Fleshed Sweet Potato
(OFSP)
• Suitable for small areas homestead gardens and dykes
• Requires minimal labour,
fertilizer and pesticides; grows
well in marginal soils
• Leaves and roots are
consumed
• Valuable in times of food
scarcity and natural disasters
• Vines are easily preserved by
households for planting in
subsequent season

35. M/E Indicators
• Increased production
• Increase Consumption of Target Food (Small fish) – Quantity, Frequency
and by Target Groups (Women and young children)
• Men and women in decision-making and work load sharing in production
• Women’s work load
• Intra-household food allocation
• Men’s purchase of foods (Knowledge and Practices)

36. Zero Sum Game? Gender and Work Load
Is it embarrassing for a man to help with
household work?
100%
90%
80%
70%
60%
Strongly Disagree
50%
Disagree
40%
Agree
Strongly Agree
30%
20%
10%
0%
Husband
Wife
Mother-in-law
Helen Keller International (HKI) 2012

37. HH Food
security
CRP / Indicator
1.1 Dryland Systems
*
*
*
*
1.2 Humidtropics
*
*
*
*
3.4 RTB
3.7 L&F
4 A4NH
*
1.3 AAS
*
3.2 Maize
3.5 Grain Legumes
*
3.6 Dryland Cereals
*
*
*
*
*
*
Other
‘Do no harm’
Anthropometry /
biomarkers
Target nutrient
consumption
IDDS
Target food
consumption
Knowledge /
attitudes
Women’s
empowerment
Production
diversity
37
*
*
3.3 GRiSP
*

38. 38
How to choose indicators…?
• Which pathway(s) is your program trying to address?
• Which of the boxes along that pathway (or any
intermediate steps not adequately captured there) can
you feasibly measure?(As many as possible!)
• What (preferably validated) tools and metrics exist to
measure each of these?
• In what way will each of these need to be adapted to your
particular context (without losing the validity of the tool)?
• How does the totality of your indicators build a picture of
how your agriculture program is affecting food and
diets/nutrition?