Nutrition Indicators
Nutrition indicators
There are a wide range of indicators related to Nutrition in the broadest sense. Some are specific to the Nutrition Impact and others are related to outcomes along the causal pathway. These are arranged related to the Immediate and Underlying and Basic causes of Malnutrition – the UNICEF framework that we have used throughout.
When there isn’t a recognised indicator, it is possible to make up a new one using a participatory exercise… see the Indicator Fabricator lesson Activity: Indicator Fabricator lesson Activity: Indicator Fabricator
Many of these indicators will be beyond the scope of most small Permaculture projects. I have highlighted the ones that might be of greatest use with a *
Some publications and websites list multiple indicators and review them:
Data4Diets: Food Security Indicators | INDDEX Project (tufts.edu)
References mentioned in the table:
FAO (2014). Guidelines for Measuring Individual and Household Dietary Diversity https://www.fao.org/3/i1983e/i1983e.pdf.
FAO and FANTA (2016). Minimum Dietary Diversity for Women: a guide to measurement http://www.fao.org/3/a-i5486e.pdf
Kennedy, G. and M. Dop (2013). Guidelines for Measuring Household and Individual Dietary diversity. , Food and Agriculture Organization of the United Nations.
Lachat, C., J. E. Raneri, K. W. Smith, P. Kolsteren, P. Van Damme, K. Verzelen, D. Penafiel, W. Vanhove, G. Kennedy, D. Hunter, F. O. Odhiambo, G. Ntandou-Bouzitou, B. De Baets, D. Ratnasekera, H. T. Ky, R. Remans and C. Termote (2018). “Dietary species richness as a measure of food biodiversity and nutritional quality of diets https://www.pnas.org/content/115/1/127.” Proceedings of the National Academy of Sciences 115(1): 127-132.
Save the Children. (2017). “Cost of Diet tool.” from http://www.savethechildren.org.uk/resources/online-library/the-cost-of-the-diet.
WHO (2010). Indicators for assessing infant and young child feeding practices. Part 2: measurement https://www.who.int/nutrition/publications/infantfeeding/9789241599290/en/.
Measuring | Indicator | Using | When to use | Organisation developed indicator/ website |
1. NUTRITIONAL STATUS | ||||
Nutritional status in adults | Adult Body Mass Index (BMI) | (Weight in kg/ ht in m squared)
Cut offs are 18.5 for underweight; 25 for overweight; 30 for obesity |
Where adult malnutrition is a problem (either overweight or underweight)
|
World Health Organisation (WHO) |
Nutritional status in children: chronic | Child stunting under 5 years | Height for age (height in cm; age in months) assessed against standard charts | Where chronic malnutrition in children is a problem | WHO
|
Nutritional status in children: acute | Child Wasting under 5 years | Weight for Height (Weight in kg, height in cm) against standard charts | Where acute malnutrition in children is a problem | WHO |
Nutritional status in children: acute | Child wasting 0 to 5 or older | Mid Upper Arm Circumference in mm against standard cut-offs | An easy way to monitor acute malnutrition in children | WHO |
2. MORTALITY | ||||
Crude mortality | Crude mortality | Part of a malnutrition survey | This will only be relevant where the project covers a large population | Crude Mortality Rate | IndiKit |
Under 5 mortality rate | Mortality in children under 5 years | Part of a malnutrition survey | This will only be relevant where the project covers a large population | Crude Mortality Rate | IndiKit |
3. DIET | ||||
Infant and Young Child Feeding practices (0 to 2 year old child) | Breastfeeding Exclusive (0 to 6 months)
Minimum Acceptable Diet (0-2yr) Minimum Dietary Diversity (0 to 2yr) * |
Survey of carer of child < 2 years | Children under 2 yrs are particularly vulnerable to malnutrition so these IYCF indicators are useful to assess | WHO
(WHO 2010) and Data4Diets: Food Security Indicators | INDDEX Project (tufts.edu) |
Infant and Young Child Feeding | Qualitative assessments * | Question guide developed for either Key Informants or FGD | An initial assessment or one-off | Ad hoc |
Diet | Individual Dietary Diversity Score
(individual) IDDS * |
A household survey or a food diary. 24 hour recall. The consumption of any foods from a list of 10 food groups for over 5yrs old or 7 food groups for under 5 years. | Most PC projects | FAO
(Kennedy and Dop 2013) |
Diet | Minimum Dietary Diversity for Women
MDDW |
A women’s survey.
Recording number of food groups consumed within 24 hour period out of 10 |
To assess womens dietary diversity | (FAO and FANTA 2016) |
Diet | Global Dietary Quality Score
GDQS |
23 food groups with a maximum score of 49 | To score dietary diversity accounting for over and under nutrition | INTAKE
The Global Diet Quality Score: Data Collection Options and Tabulation Guidance | intake |
Diet | Dietary Species Richness
DSR |
A food diary | Relates to improvements in on farm production diversity | (Lachat, Raneri et al. 2018) |
Diet | Food Frequencies | 7 day or 30 day recall of foods consumed- survey | This relates to foods introduced or emphasised to find out if they are consumed. | |
Diet quality | Diet Quality metric | 5 minute questionnaire | integrates diet and FIES | Gallup |
Diet | Diet 24 hours | A tablet or mobile based platform under development | INDEX24
Tufts/ INDEX project |
|
4. HEALTH and DISEASE | ||||
Health Status | Prevalence of diarrhoea, cough or fever in the past 14 days * | Survey of carer of child 6 months to 5 years | Where health education or other health activities are included | |
Knowledge about Nutrition and Health | Knowledge about particular practices | KAP (Knowledge Attitude Practice) survey | Where education activities are included | |
5. HOUSEHOLD FOOD SECURITY | ||||
Economic Access to food at household level | Household Dietary Diversity | Household survey- consumption by any member of the household | This relates to variety of foods available in the household and also links to food production and purchases. | FAO
(FAO 2014) |
Food Security | Food Insecurity Experience Scale (FIES) * | A household survey
8 questions |
Where food insecurity is or has been a problem in the project area | www.fao.org/in-action/ voices-of-the-hungry/en/#.V8WB6Ft96Uk
|
Seasonal Food Security | Months of Adequate Household Food Provisioning | A household survey | Where seasonal food insecurity is or has been a problem in the project area | |
6. CARING PRACTICES | ||||
Infant and Young Child Feeding practices (0 to 2 year old child) | Breastfeeding Exclusive (0 to 6 months)
|
Survey of carer of child < 2 years | Breastfeeding is most closely related to care | WHO |
Hygiene practices | Appropriate handwashing | Household survey | Related to Caring Practices | |
7. Health and Sanitation Environment | ||||
Access to clean water | Household protected water source available/ accessible * | Household survey and observations | Where water supply is improved | |
Access to adequate sanitation | Household access to latrine or compost toilet * | Household survey and observations | Where sanitation is improved | |
· Food production and food systems
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On-farm diversity of production (food groups) | Crop Nutritional Functional Richness * | Inventory of crops grown categorised into 10 food groups over 1 year | Most PC projects that support agricultural production. This indicator relates closely to dietary diversity | |
The total production in terms of nutrition | Nutritional Yield per ha | Number of people fed per Ha for all nutrient requirements | Where agricultural production provides local diets | ‘Nutrition Per Acre’ – A New Measure of Farming Success — The A Team Foundation |
On-farm diversity of production (Agro-biodiversity) | Crop Species Richness | Inventory of all crops grown in 1 year | Most PC projects that support agricultural production. This indicator relates to Dietary Species Richness
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On-farm diversity of production (Agrobiodiversity)
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Functional Diversity | The Capacity of the environment to produce nutritionally balanced diets
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Market access to foods | Availability of foods in markets | Market survey | This relates to urban projects and also rural projects to assess whole access to foods consumed. | |
Market affordability | Cost of foods in markets | Market survey | Affordability is important dimension of food security where purchases are large part of food sources. | Save the Children: Cost of Diet tool (Save the Children 2017) |
· Gender issues | ||||
Womens time use and labour | Womens time and labour in 24 hours * | Time use diary by women. Or FGD | relates to care for children and drudgery of work and health of women | |
Womens Empowerment in Agriculture – Abbreviated | 6 Dimensions of empowerment | Womens survey | (i) Input in productive decisions (ii) Ownership of assets, (iii) Access to credit (iv), Control over use of income, (v) Group membership, (vi) Workload. | |
Mens time use and labour | Mens time and labour in 24 hours | Time use diary by men. Or FGD | Relates to drudgery and health of men | |
Womens asset ownership | Women’s assets | Women’s survey | Relates to empowerment of women and equality | |
Womens income | Increase in womens income over the past year | Women’s survey | Relates to empowerment of women and equality | |