You are on page 1of 31

Summary of Nutrition Baseline Surveys for the BMZ financed Global

Programme Food and Nutrition Security and Enhanced Resilience


Gina Kennedy, Gudrun Keding, Esther Evang, Lars Scheerer, Giulia Rota Nodari
16 September 2016

Table of contents
Survey methods
Country overview
Definitions of Key Indicators
Results

Key indicators
Availability and access to food
Water, Sanitation and Health
Care practices and MAD
Dietary intake of women and children
Preliminary Logistic regression results

Conclusions
Recommendations
2

Bioversity International\S. Collins

Survey methods

Sample size needed was calculated at


n=347, sample size of the NBS ranged
from 396-487 with the exception of India
(n=803)

Data from 4700 women-child pairs

Selection criteria: Respondents were


women (15-49 yrs) who also had at least
one child (6-23 months)
Bioversity International\J. Lauderdale

Country overview: Africa

Ethiopia

Mali

GDP per capita* (World Bank,


2015): 744.3
Human Development Index
(UNDP, 2014): 0.419
Prevalence of stunting (UNICEF,
2013): 39%

Kenya

Burkina Faso

GDP per capita* (World Bank,


2015): 619.1
Human Development Index
(UNDP, 2014): 0.442
Prevalence of stunting (UNICEF,
2013): 44%

GDP per capita* (World Bank,


2015): 613
Human Development Index
(UNDP, 2014): 0.402
Prevalence of stunting (UNICEF,
2013):33%

Zambia

Togo

GDP per capita* (World Bank,


2015): 1376.7
Human Development Index
(UNDP, 2014): 0.548
Prevalence of stunting (UNICEF,
2013): 35%

GDP per capita* (World Bank, 2015):


548
Human Development Index (UNDP,
2014): 0.484
Prevalence of stunting (UNICEF,
2013): 30%

Benin

GDP per capita* (World Bank,


2015): 779.1
Human Development Index
(UNDP, 2014): 0.480
Prevalence of stunting (UNICEF,
2013): 45%

GDP per capita* (World Bank,


2015): 1307.8
Human Development Index
(UNDP, 2014): 0.586
Prevalence of stunting (UNICEF,
2013):46%

Malawi

GDP per capita* (World Bank,


2015): 381.4
Human Development Index
(UNDP, 2014): 0.445
Prevalence of stunting (UNICEF,
2013): 48%

*current US$

Country overview: Asia

India

GDP per capita* (World Bank,


2015): 1581.6
Human Development Index
(UNDP, 2014): 0.609
Prevalence of stunting (UNICEF,
2013): 48%

Cambodia

GDP per capita* (World Bank,


2015): 1158.7
Human Development Index
(UNDP, 2014): 0.555
Prevalence of stunting (UNICEF,
2013): 41%

*current US$
5

Definitions of Key Indicators of the Program


Individual Dietary Diversity Score Women of Reproductive age IDDS-W - and Minimum Dietary Diversity Women of reproductive
age - MDD-W
Minimum Acceptable Diet - MAD (6-23 months of age)
MDD (Minimum Dietary Diversity)
MMF (Minimum Meal Frequency)

Food Insecurity Experience Scale-Household - FIES-H

Definitions of Key Indicators


Individual Dietary Diversity Score and MDD-W
IDDS-W: is the sum of ten food groups consumed
over the past 24 hours by women 15-49 years of
age.
MDD-W: is the proportion of women 15-49 years of
age who consumed food items from at least 5 out of
10 defined food groups the previous day or night.
Interpretation: Higher prevalence of MDD-W is a
proxy for better micronutrient adequacy among
women of reproductive age in the population
Photo credit: Klaus Wohlmann

Definitions of Key Indicators


Food groups for women

Grains, white roots/tubers, plantains

Eggs

Pulses (beans, peas and lentils)

Dark green leafy vegetables

Nuts and seeds

Other vitamin A-rich fruits &

Dairy
Meat, poultry and fish

vegetables
Other vegetables
Other fruits

Definitions of Key Indicators


Minimum Acceptable Diet (MAD)
Minimum Dietary Diversity (MDD)
Minimum Meal Frequency (MMF)
Minimum acceptable diet (MAD): Proportion of children 6-23 months of age who receive a minimum
acceptable diet which is a composite indicator of minimum dietary diversity and minimum meal frequency
during the previous day
Minimum dietary diversity (MDD): Proportion of children 6-23 months of age who receive foods from 4
or more food groups out of seven
Interpretation: proxy for adequate micronutrient-density of foods and liquids other than breast milk
Minimum meal frequency (MMF): Proportion of breastfed and non-breastfed children 6-23 months of
age who receive solid, semi-solid, or soft foods (but also including milk feeds for non-breastfed children)
the minimum number of times or more.
Source, WHO, 2008
Interpretation: proxy for energy intake from foods other than breast milk
9

Definitions of Key Indicators

Food Insecurity Experience Scale-H (FIES-H)


Prevalence of Experienced Food Insecurity at moderate or severe levels (FImod+sev)
Prevalence of Experienced Food Insecurity at severe levels (FIsev)
Interpretation: estimates of the proportion of the population facing difficulties in
accessing food, at levels of moderate and severe food insecurity During the last 4 weeks, was there a time when:
1.
You or others in your household worried you would run out of food because of a lack of money or other resources?
2.
You or others in your household were unable to eat healthy and nutritious food because of a lack of money or other resources?
3.
You or others in your household ate only a few kinds of foods because of a lack of money or other resources?
4.
You or others in your household had to skip a meal because there was not enough money or other resources to get food?
5.
You or others in your household ate less than you thought you should because of a lack of money or other resources?
6.
Your household ran out of food because of a lack of money or other resources?
7.
You or others in your household were hungry but did not eat because there was not enough money or other resources for
food?
8.
You or others in your household went without eating for a whole day because of a lack of money or other resources?
10

Source: FAO, Voices of the Hungry, 2016

Results according to the UNICEF Framework


Nutritional Status
(Prevalence of stunting, underweight, overweight
and micronutrient deficiencies)

Food Intake

Health Status

MAD (MDD and MMF) in children 6-23 mo

Prevalence of diarrhea

MDD-W of women 15-49 years

Availability and access to food


Land access. Crop diversity,
Home gardening, Livestock keeping, Access to fruit trees
Prevalence of moderate and severe food insecurity (FIES-H)

Care Environment
Access to nutrition counselling

Presence of soap in household,Use of soap for hand-

Knowledge about prevention of

washing, Access to improved sanitation facility, Access to

malnutrition

improved water

Education
11

Health Services and WASH

Womens education level

Results: Presentation of the Nutrition Baseline Survey


results
In order to summarize visually
different percentages across
the ten countries, a dashboard
categorization was used.
Red: Very Poor
Yellow: Poor
Green: Better

12

0-32%

Very low/poor

33-66%

Low

67-100%

Better

The inverse percentages used for Food


Insecurity as increasing percentage
reflects a worse situation

Results: Summary of Key Indicators of the Program


Country

FIES-H

MAD

MDD-W

Kenya

87

15

12

Malawi

86

34

27

Mali

55

11

Togo

55

33

28

Zambia

41

34

57

Benin

32

26

34

Cambodia

24

41

53

Ethiopia

23

19

Burkina Faso

22

38

38

India

18

18

20

FIES-H here refers to moderately and severely food insecure


Numbers represent %

Many patterns are consistent


(Kenya, Togo, Zambia, Benin)
Households experience of
moderate and severe food
insecurity is relatively low in
Ethiopia and India, however MAD
and MDD very low.

14

Results: Female education


Benin

Some
school

20%

Burkina
Cambodia Ethiopia
Faso
33.6%

90.4%

45%

India

Kenya

Malawi

Mali

Togo

Zambia

51%

100%

87%

33.6%

56%

69%

Very large range across countries in female education (20-100%)


According to MDG for sub-Saharan Africa in 2000, 60% of all children were enrolled in
primary school (MDG report of the United Nations, 2015). 5 out of 8 project sites in Africa are
below this benchmark.

Keep the level of education in mind when designing and implementing interventions

Results: Availability and access to food - access to land


Burkina
Cambodia Ethiopia
Faso

Benin
Access to
land for
agriculture

97%

81%

85%

95%

India

Kenya

Malawi

Mali

Togo

Zambia

71.5%

21%

90%

78%

92%

99%

Access to land for agriculture is OK for all countries except Kenya.


Kenya reports a low access to land; it should be noted that the survey area in Kenya
represents an area where the population is mainly pastoral and practice a nomadic lifestyle.

Keep the level of access to land in mind for agriculture interventions, especially INDIA
and KENYA
15

Results: Availability and access to food - Main crops grown


(% of households growing the crop)
Benin

Burkina
Faso

Cambodia

Ethiopia

India

Kenya

Malawi

Mali

Togo

Zambia

Maize
94

Maize
97

Rice
95

Maize
70

Wheat
93

Maize
88

Maize
91

Rice
88

Maize
98

Maize
100

Sorghum
75

Millet
78

Cassava
15

Teff
60

Mustard
66

Maize
19

Manioc
94

Groundnuts
67

Soya
76

Groundnuts
63

Beans
8

Barley
50

Sesame
56

Soya
20

Millet
19

Beans
66

Sunflower
57

Yams
77

Red sorghum
61

Legumes
43

Bengal
gram
55

Rice
20

Groundnuts
58

Legumes Groundnuts
74
45

Red circles indicate potentially interesting crops for


diversifying diet of women and children
16

17

Comparison of production and consumption


Countries with
red circle
indicate more
attention to
consumption of
own production
needed

Results: Availability and access to food - households with


home gardens, access to fruit and livestock
India, Kenya and Togo
twenty percent or fewer
hh had home gardens.
1/3 of hh or fewer with
access to fruit in
Ethiopia, India, Kenya
and Mali
Fifty percent or more of
all hh keep livestock,
except Malawi
Photo: Kuldeep Singh Jadon

18

Results: Availability and access to food - food insecurity


experience scale (FIES-Household)
Country
Kenya
Malawi
Mali
Togo
Zambia
Benin
Cambodia
Ethiopia
Burkina Faso
India
19

FImod+sev (%)
86.6
86.1
54.8
54.6
41.4
31.7
23.8
22.7
21.9
17.7

FIsev (%)
46.5
35.8
29.7
2.5
10
12.8
0.09
0.8
4.7
8.4

Prevalence rates are


representative of project area
(not national).
Within the surveyed areas
food insecurity is greatest in
Kenya, followed by Malawi,
Mali and Togo.
Results from Ethiopia are
better than expected given
one of the lowest MDD-W and
MAD.

Results: Health - drinking water and sanitation


West Africa

East Africa

Asia

Southern Africa

100

100

100

100

90

90

90

90

80

80

80

80

70

70

70

70

60

60

60

60

50

50

50

50

40

40

40

40

30

30

30

30

20

20

20

20

10

10

10

10

Ethiopia

Kenya

Access to improved sanitation


Access to improved water Wet
season
Access to improved water Dry
season

Benin

Burkina
Faso

Mali

Togo

Malawi

Zambia

2015 MDG targets


for sub-Saharan
Africa 74% access
to safe water and
62% access to safe
sanitation.
Water goal met in at
least one season for
six project areas in
Africa.

Cambodia

India

Sanitation in nearly
every project area is
very far away from
goal.

Results: Care - Maternal knowledge compared to prevalence of


MAD
What should we do to prevent malnutrition in
children?

21

Gap between knowledge and


practice is high in Kenya and
Ethiopia. WHY? Research on
barriers (economic, culture,
gender) needed
Knowledge and practice are
similar for other countries, so
behavior change communication
a plausible strategy.

Results: Dietary Intake Women (15-49 years)


Country

IDDS-W

MDD-W (%)*

Ethiopia

3.1

Kenya

3.2

12

Mali

3.2

India

3.6

20

Malawi

3.9

27

Togo

3.9

28

Benin

4.1

34

Burkina
Faso

4.2

38

Cambodia

4.6

53

Zambia

4.7

57

22

The IDDS-W ranged from 3.1 (0.9)


(Ethiopia) to 4.7 (1.3) (Zambia) with
percent of women achieving MDD
ranging from 6.8 % in Ethiopia to 57 %
in Zambia.
The relationship between IDDS
and MDD-W is very consistent.
Could recalculate your target
IDDS now (add 0.5 to the
baseline)

Results: Dietary intake children 6-23 months


Mali

MAD
MDD
MMF

Kenya

Ethiopia

India

Benin Togo Malawi Zambia

Burkina
Cambodia
Faso

11

15

17

18

26

33

34

34

38

41

27

22

19

23

33

43

43

55

50

47

57

71

66

58

67

71

70

77

63

93

MMF higher than MDD for all countries, focus needed on diversification.
Important to also disaggregate results by breastfeeding and age
Results are presented for full sample not by breastfed/non-breastfed as >75% of children breastfed yesterday

Results: Preliminary testing of hypotheses


Hypothesis 1: Womens dietary diversity, measured by the Individual Dietary
Diversity Score Women (IDDS-W) or Minimum Dietary Diversity Women (MDD-W),
is higher for households with a more diverse agricultural production pattern and a
better knowledge of adequate nutrition.
Hypothesis 2: Children aged 6-23 months are more likely to receive a minimum
acceptable diet (MAD) the more diverse the households agricultural production and
the higher the households level of nutrition knowledge.

24

Results: Preliminary testing of hypotheses IDDS-W and MDD-W


In 9 out of 10 country models at least one and max. three agricultural variables have
a causal positive effect on women's dietary diversity:
(crop diversity, home garden, access to fruit/fruit production in homestead, yearround vegetable production, vegetable diversity, fruit diversity)
Nutrition counselling was significant in some but not all countries
Other significant predictors are very country specific and do not occur consistently
amongst countries
(secondary education, geographical location, ethnicity, income score)

Results: Preliminary testing of hypotheses: Minimum acceptable


diet
In 5 out of 10 country models at least one and max. two agricultural variables
have causal positive effect on infants MAD (vegetable diversity, crop diversity,
home garden)
In some country models under 5 child clinic visits positively and significantly
influence MAD
Within countries district was also often a significant predictor

Results seem to confirm the programs hypotheses of relationships between


agriculture production and particularly womens dietary diversity.

For Minimum acceptable diet, have a close look at MDD and MMF across age groups
and breastfeeding status

Conclusions
1.

The project sites represent vulnerable areas and are appropriate sites for the proposed
interventions.

2.

The chosen key indicators of IDDS-W and MAD match well with the program intervention
packages in most countries.

3.

There are plausible impact pathways to achieve the objectives of the program given the
combination of interventions in most countries.

4.

Note: Those countries focusing on sanitation and hygiene will need to think how to measure
change as no change in MAD or IDDS-W is expected based on improvements in sanitation
and hygiene

27

Recommendations for the program


General

Try to assess level and intensity of participation in interventions (see RAIN impact evaluation)

Availability and access to food

Own production was a big focus of the NBS but market and market access was not, more
exploration of market access and food availability in markets could be undertaken at mid-term

Seasonal fluctuations in food availability should be further explored and addressed when
designing interventions

Divergence between access to fruit and vegetables and consumption should be explored
using qualitative methods (see supplementary slides)

28

Recommendations for the program


Gender

All projects should undertake qualitative research with women and men of different age groups
to understand food and nutrition security dynamics within the household:

Who controls the income that determines what food is purchased?


Who decides what food to grown in the homegarden? (mother in law/older female in HH, male
member of hh, or mother of the young child?)
Who decides on a daily basis the food prepared for the family (mother in law/older female, male
member of hh, or mother of the young child)
Who decides on a daily basis the food prepared for the child (6-23 months) ?* there could be a
difference between decision making for family and young child
Who decides if it is OK to feed the child a new food (e.g. fruit, vegetable, egg)

29

Recommendations for the program


Care

Country specific qualitative data collection is needed to understand divergence in knowledge


and practice of dietary diversity for children in Ethiopia and Kenya

Most knowledge questions were based on maternal recall of general topics, the uptake of
program specific messaging should be tested

Assess different channels of communication for uptake of messages

Health/WASH

Advocate especially access to sanitation

30

Thank you
Gina Kennedy
g.kennedy@cgiar.org

www.bioversityinternational.org/subscribe
@BioversityInt