purposes of nutrition information systems: using data for decisions on policies and programmes

Purposes of nutrition information systems:using data for decisions on policies and programmesCtown1.ppt

Topics in course presentations (JM)

Purposes of nutrition information systems: using information for decisions on policies and programmes

Experience in nutrition information systems in the region

Principles of nutritional data analysis

Getting suitable data: national surveys; area level surveys; reporting systems; sentinel systems (clinics/programmes, sample sites)

Interpreting data: emergencies; descriptive long term trends (for planning); for causality and intervention decisions

Interpretation of data for decisions.

Purposes of nutrition information systems: using information for decisions on policies and programmes

What are they (systems and purposes)?Common sources (outcome data)Causes of malnutrition, & what can we measure?What sort of interventions affect causes of malnutrition?Questions asked to guide programme decisionsFramework for answering questions with data analysis

Surveillance: to watch over ... to make decisions that will lead to improvements in populations ...

Surveillance cycle

Decide on action

Monitor

Evaluate

Detect new

problems

Take action

(Implement)

Data

Observation

http://www.undp.org/mdg/goallist.shtml

MDG Targets and Indicators

Eradicate extreme poverty and hunger INCLUDEPICTURE "http://www.undp.org/mdg/images/br-icons/Brazil1English.jpg" \* MERGEFORMATINET

Goal 1.

Target 1: Reduce by half the proportion of people living on less than a dollar a day

1. Proportion of Population Below $1 (PPP) per Day (World Bank)

2. Poverty Gap Ratio, $1 per day (World Bank)

3. Share of Poorest Quintile in National Income or Consumption (World Bank)

Target 2: Reduce by half the proportion of people who suffer from hunger

4. Prevalence of Underweight Children Under Five Years of Age (UNICEF)

5. Proportion of the Population below Minimum Level of Dietary Energy Consumption (FAO)

Uses of information can be distinguished into: long-term planning and policy-making programme monitoring and evaluation timely warning to pre-empt and mitigate crises

Usual sources of data are: repeated large-scale surveys (e.g. natl, DHS, MICS) area level surveys (e.g. 30 by 30) reporting systems using data from clinics, screeening, programmes sentinels systems, from sites (e.g. clinics) or special surveys

Source

Long-term planning

Program monitoring and evaluation

Timely warning to prevent crises

A. Repeated national surveys

Yes, main use

Possible but rare as process data limited and design not ideal

No, too infrequent and too long lag

B. Area level surveys

Not usually, but some potential with further analysis

Possible but rare as process data limited, design not ideal, and external validity may be unclear.

Main use, together with other data (e.g. prices)

C. Reporting systems

Not usually, as less reliable than A.

Potential use for process monitoring if lag can be reduced.

Potential main use if lag can be minimized.

D. Sentinel systems

Potential: e.g. Zimbabwe

Potential for evaluation if carefully designed.

Potentially important use

Fitting systems together and deciding prioritiesSee case studies (presentation 2) for more details

System/

Data source

Eth

Ken

Som

Uga

Bots

Les

Mal

Moz

Nam

S A

Zam

Zim

A. Repeated natl surveys

(# 90 on)

Y

(6 )

Y

(4)

?

Y

(2)

Y

(1)

Y

(3)

Y

(4)

Y

(3)

Y

(2)

?

Y

(3)

Y

(4)

B. Area level

Surveys

(ad hoc) # 2000 on

399

163

107

100

-

-

2/~30

N

-

2/32

N

C. Reporting systems

Clinics

(Y)

Chanis

Thru HMIS

Y (food distrn points)

Y?

Selected clinics

Proposed

Thru DHIS

Screening

EOS twice yrly

Progs

CBNP

D. Sentinel

Systems

Survey

F-up asst surveys

ALRMP

In FSAU

Y

Site

Proposed

In FSAU

Proposed

Inadequate

dietary intake

Disease

Malnutrition

and death

Inadequate

access to food

Inadequate care

for mothers and

children

Insufficient health

services and

un-

healthy

environ-

ment

I na d e q u a t e e d u c a t i o n

Potential

resources

Political and ideological superstructure

Economic structure

Formal and non-

formal institutions

Outcomes

Immediate

causes

Underlying

causes

Basic

causes

Source:

Redrawn from UNICEF, 1990 [39]

Figure 1.8.

Conceptual framework for the causes of malnutrition

in society

Better health and nutrition

Some key variables

for HPN program

planning

Outcomes

Intermediate

outcomes

Difficult to measure

Commonly measured

Mortality

Nutritional status

Anthropometry

Morbidity

Fertility

Immunization

Ante-natal care

Health services

Caring practices

Diet

Contraceptive prevalence rate

Type of malnutrition

Micronutrient

General (=protein-energy)

Vitamin A (VAD)

Acute (food crisis)

Chronic

Iron (anemia)

Iodine

(I deficiencydisorders: IDDs)

Groups affected

Community-based

Vertical

Emergency

Interventions

By socio-economic status

By biological status

By area/location

"PUBLIC NUTRITION

includes the following activities:

an understanding and a raising of awareness of the nature,

causes and consequences of nutrition problems in society;

epidemiology, including monitoring, surveillance, and evaluation;

nutritional requirements and dietary guidelines for populations;

programs and interventions: their design, planning, management, and evaluation;

community nutrition and community based programs;

public education, especially nutrition education for behavioral

change;

timely warning and prevention and mitigation of emergencies, including use of emergency food aid;

advocacy and linkage with, for example, population and environmental concerns;

public policies relevant to nutrition in several sectors, for example, economic development, health, agriculture, and education.

Source: letter to Am J Clin Nutr, March 1996,63399-400, Mason, Habicht, Greaves, Jonsson, Kevany, Martorell, and Rogers.

What would it take

to eliminate malnutrition?

Economic growth, jobs, improved income distribution

Education, especially for women

Reduced fertility, family planning

Nutrition in health services, schools

Community-based programs including nutrition

Low

Higher

Nutrition

influence

purposes of nutrition information systems: using data for decisions on policies and programmes

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