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Women's Dietary Diversity Indicator [message #1716] Tue, 01 April 2014 18:42 Go to next message
mdeitchl
Messages: 1
Registered: March 2014
Member
The USAID funded Food and Nutrition Technical Assistance III Project (FANTA) would like to highlight the need for an indicator of women's dietary diversity to be collected by and reported in the DHS.

1. Why is the information needed:

The quality of the diet of women of reproductive age is a key nutrition issue, which has important implications for the health and well-being of women of reproductive age; and, which, among pregnant and lactating women has important consequences for the health, nutrition and development of infants and young children. The quality of women's diet is thus an important feature of global efforts to address optimal health and nutrition during the first 1000 days.

2.a. What questions will elicit this information:

To collect an indicator of women's dietary diversity would require questions similar to those required for collecting the dietary diversity indicator for children. This would require only asking a short set of questions related to women's food group consumption in the past 24 hours. These questions could be collected by adding an additional column to questions 558i-558u so that there would be an area to record the 24 hour food group recall data for the mother of the child under 24 months in addition to the food group recall data that is already being collected for her child under 24 months.

It would be recommended to add a few more food groups to the set of questions currently listed in this 24 hour food group recall section of the questionnaire, such as: "condiments for flavor, such as chilies, spices, herbs, or fish powder", "grubs, snails or insects", "foods made with red palm oil, red palm nut, or red palm nut pulp sauce". In addition, we recommend disaggregating question 558g into "beans and peas" and "nuts and seeds"; question 558i into "grains and grain products" and "all other starchy staples"; and question 558n into "other fruits" and "other vegetables" to better capture data for the women's dietary diversity indicator.

2.b. Validation of the indicator:

There has been a substantial amount of research undertaken to help develop and validate an indicator of women's dietary diversity. From 2005-2010, FANTA, with funding from USAID, undertook, in collaboration with IFPRI and a number of other institutions, a multi-year research initiative to develop and validate a simple indicator to reflect the micronutrient adequacy of women's diets.

As a result of this research, several large USAID funded programs, such as Feed the Future and the Title II Development Food Assistance Programs, adopted a women's dietary diversity indicator in their M&E results frameworks. The women's dietary diversity indicator is now collected in the baseline/final evaluations for these programs.

More recently, FAO has funded a follow-on validation research initiative in an effort to further explore and strengthen the evidence for the validity of such a simple indicator of women's diets. This work is in its last stages of completion and the results will help to inform how best to tabulate (ie. the most appropriate cut-off to use for) an indicator women's dietary diversity.

3. How will the resulting information be used:

Collection of a women's dietary diversity indicator in the DHS would not only help to further advocate for the importance of the quality of women's diets, but would also provide a means for tracking and monitoring progress across countries in improving the quality of women's diets. In addition, given that the women's dietary diversity indicator is now collected in the baseline/final evaluations for the USAID Feed the Future and Title II Development Food Assistance Programs, national level tracking information such as that which could be provided by inclusion of the indicator in the DHS could be very beneficial for these USAID programs in way of secondary data.

4. What is the priority of the suggested additions compared with what is already in the questionnaire:

The addition of questions on women's dietary diversity will not obviate the needs for other questions that are currently included in the questionnaire, as no questions on women's dietary diversity are currently included in the questionnaire. However, there are other questions in the nutrition section (not related to women's dietary diversity), which we would suggest could be deleted (see DELETIONS below).

5. If suggesting more than one addition, what is the priority among the suggested additions:

N/A

6. Should the additional data be collected in all countries:

Yes, information on women's dietary diversity should be collected in all countries to support global advocacy, monitoring and tracking information related to women's nutrition issues.

DELETIONS: Q446 "In the first two months after delivery, did you receive a Vitamin A dose like (this/any of these)?"

1. Why can this information be removed:

Post-partum Vitamin A supplementation for women is no longer recommended by the World Health Organization.


Re: Women's Dietary Diversity Indicator [message #1796 is a reply to message #1716] Thu, 03 April 2014 11:46 Go to previous messageGo to next message
marimond
Messages: 2
Registered: March 2014
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We are writing to strongly support the proposals put forward by PAHO/WHO and HKI, and by the FANTA Project.

Previous rounds of the DHS have provided critical information on infant diet quality; in the context of urbanization and rapid nutrition transition throughout the developing world, the additional response options on infant/young child consumption of sugar-sweetened beverages and energy-dense, nutrient poor snacks are urgently needed to provide information for global tracking and to inform national programs.

PAHO/WHO/HKI have provided specific and field-tested options. We suggest a modification to one of their specific proposals, to expand the wording of the proposed question for soda to include all sugar-sweetened beverages. Precise wording would benefit from a continued consultation process prior to finalization of the new DHS core questionnaire, but it could be along the lines of:

• "Any sweet drinks, such as juice drinks, tea with sugar, or soft drinks/soda/fizzy drinks?"

In many areas, "juice drinks" and sweet tea provide much more added sugar to infant diets than do soft drinks/sodas.

There is also an urgent need to fill an information void about the quality of women's diets, globally. Recent reviews (1-2) have documented many gaps between micronutrient intakes and needs, and analytic work previously published (3) and on-going (as mentioned by FANTA) show consistent associations between simple proxy indicators of food group consumption and the micronutrient adequacy of women's diets, at population level. Dietary diversity indicators have been incorporated in the results framework of on-going USAID-funded projects; in addition, global advocacy initiatives to address the entire "1000 Days" are now calling explicitly for dietary diversity indicators to track women's diet quality ( http://thousanddays.org/wp-content/uploads/2013/09/Nutrition -in-the-Post-2015-Agenda-Technical-Brief.pdf). DHS data on food group consumption by adult women would also be useful to national governments aiming to track adherence to national food-based dietary guidelines.

Finally, we also strongly support the WHO/PAHO/HKI proposal to add a simple and field-tested question to provide information on threats to the International Code of Marketing of Breast-milk Substitutes.

Mary Arimond, Analyst, and
Kathryn G. Dewey, Director, Program in International and Community Nutrition
University of California, Davis

1. Torheim LE et al. Women in resource-poor settings are at risk of inadequate intakes of multiple micronutrients. J Nutr. 2010 Nov;140(11):2051S-8S.

2. Lee SE et al. Dietary intakes of women during pregnancy in low- and middle-income countries. Public Health Nutr. 2013 Aug;16(8):1340-53.

3. Arimond M et al. Simple food group diversity indicators predict micronutrient adequacy of women's diets in 5 diverse, resource-poor settings. J Nutr. 2010 Nov;140(11):2059S-69S.

Re: Women's Dietary Diversity Indicator [message #1801 is a reply to message #1796] Thu, 03 April 2014 12:35 Go to previous messageGo to next message
terriballard
Messages: 1
Registered: April 2014
Location: Rome Italy
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I would like to enthusiastically endorse the suggestion by the FANTA III project to include a measure of women's dietary diversity in the DHS, and am in agreement with Mary Arimond's suggestion on rewording for the food group composed of sugary beverages.

At FAO (Food and Agriculture Organization of the UN), we have included women's dietary diversity in surveys and have endorsed its use in nutrition surveillance systems for a number of years. The adequate diet of women of reproductive age is key to interrupting the intergenerational phenomenon of malnutrition by reducing the probability of low birth weights and other negative birth outcomes. Likewise, women whose diet is sufficient in nutrients and micronutrients will be in a better situation to provide care of their children as well as carrying out all the other duties they are responsible for.

Having a baseline of women's dietary diversity from a nationally representative sample from DHS will provide a benchmark to programs to improve nutrition through agriculture and health.

Thank you for this opportunity to express my opinion on inclusion of a tool for measuring women's dietary diversity in the DHS.

Terri Ballard

http://www.fao.org/fileadmin/user_upload/wa_workshop/docs/FA O-guidelines-dietary-diversity2011.pdf



Terri Ballard DrPH
Food and nutrition security specialist
FAO
Statistics Division
Rome, Italy
Re: Women's Dietary Diversity Indicator [message #1806 is a reply to message #1716] Thu, 03 April 2014 13:08 Go to previous messageGo to next message
annalartey is currently offline  annalartey
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Registered: April 2014
Location: Rome
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We fully endorse the inclusion of this indicator in the DHS. This is a simple easy to collect tool to assess diet quality. With all the Agriculture nutrition interventions on-going, this indicator would be helpful measure of impact.

Re: Women's Dietary Diversity Indicator [message #1813 is a reply to message #1716] Thu, 03 April 2014 17:14 Go to previous messageGo to next message
AHerforth is currently offline  AHerforth
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Registered: April 2014
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I strongly support the addition of a women's dietary diversity indicator to the DHS Woman's Questionnaire.

ONE: Indicators of diet quality are basic data that are, to date, missing in the world's ability to identify causes of malnutrition.

As understanding of nutrition and malnutrition causality has developed over the last several decades, indicators related to nutrition have evolved dramatically. For example, in the 1970s-80s, malnutrition prevalence used to be estimated from food availability data. The DHS has led the way in collecting the most-used nutrition indicators around the world, including anthropometry, micronutrient-related indicators, and indicators of health care access and sanitation, and care practices. The one nutrition area missing is around dietary causes of malnutrition. With existing data largely supplied by DHS, it is possible to identify "health" and "care" causes of malnutrition, but not "food" or dietary causes. Indicators of dietary quality are critically needed to fill that gap.

At a time when the triple burden of malnutrition undernutrition, micronutrient deficiencies, and obesity and NCDS exists in all regions and income levels, it is almost unbelievable that the world collects no globally-comparable indicators of diet quality, which is a key factor in all these forms of malnutrition. While indicators of young child diet quality ARE collected, these are, in fact, primarily reflective of care practices, and not reflective of diets in the general population.

TWO: It is difficult to imagine where else, besides DHS, globally-comparable indicators of diet quality could be collected.

In the absence of dietary indicators collected in DHS, the next step is to explore HCES. The tremendous downsides of having to use HCES rather than DHS is that are (1) indicators of dietary quality cannot really be assessed from household-level data, but rather require individual-level data. Few HCES collect any individual-level data. (2) Methodology in HCES between surveys and countries varies widely, making the data currently incomparable between countries.

There is really no substitute for the comparability and quality of data collected by DHS. (MICS also does not collect any indicator of dietary quality.)

THREE: There is strong, explicit demand for a women's diet diversity indicator from the nutrition community

As a part of the post-MDG discussions, the nutrition community has come to consensus around the need to collect indicators of diet quality (see sources below). The Women's Diet Diversity Score is the most developed indicator currently available that represents a diverse, nutritionally adequate diet.

Current consensus statements from the nutrition and food security communities specify an indicator of women's dietary diversity as a key desired indicator in the post-2015 development framework. The irony of this suggestion is that the data are not currently collected. Data from a globally-comparable source are strongly needed to fulfill the nutrition community's vision for necessary indicators to track progress on nutrition.

Call to Action: Nutrition in the Post-2015 Development Agenda: http://thousanddays.org/wp-content/uploads/2013/09/Nutrition -in-the-Post-2015-Agenda-Key-Messages.pdf
A Key message of this consensus statement, developed by the post-2015 working groups of the SUN Civil Society Network and of the Road to Rio Nutrition Advocacy Group, is: "Food security needs to be measured with indicators and targets that ensure action and accountability toward access to adequate nutritious food. Access to a range of diverse foods, reflected in dietary quality, is core to adequate food for all."

Proposed Nutrition Goals, Targets & Indicators for the Post-2015 Development Agenda: http://thousanddays.org/wp-content/uploads/2013/09/Nutrition -in-the-Post-2015-Agenda-Technical-Brief.pdf
Includes a goal to: "Increase access to adequate nutritious diets, as measured by a dietary diversity indicator, to all adolescent girls and women of reproductive age"

Bill & Melinda Gates Foundation "Sustainable Agriculture, Food Security, and Nutrition in the post-2015 Framework": https://docs.gatesfoundation.org/documents/Post%202015%20Foo d%20Security%20Discussion%20Paper.pdf
Includes a target: "Dietary diversity: Reduce percentage of women 15-49 years of age who are consuming less than the recommended number of food groups."

The Agriculture-Nutrition Community of Practice has produced a consensus statement: http://unscn.org/files/Agriculture-Nutrition-CoP/Agriculture -Nutrition_Key_recommendations.pdf
This includes a Key Recommendation: "Monitor dietary consumption and access to safe, diverse, and nutritious foods. The data could include food prices of diverse foods, and dietary consumption indicators for vulnerable groups."

The Ag2Nut CoP has recently held discussions on how to operationalize this recommendation: http://www.spring-nutrition.org/events/ag2nut-community-call -what-needed-global-monitoring-access-adequate-nutritious-fo od
As a part of this discussion, one practitioner noted that at country level, SUN Focal points reported getting their data about nutrition all from DHS. They noted an absence of data possible to use for nutrition-sensitive agriculture interventions, such as those with an aim of improving dietary diversity. If DHS were to collect data on dietary diversity, SUN countries that have committed to nutrition-sensitive agriculture approaches would be able to use at least one indicator of dietary quality as a target or benchmark tracking progress.


Thank you for the opportunity to comment.
Anna Herforth, PhD
Independent Consultant; Visiting Fellow, Cornell University; and Agriculture-Nutrition Community of Practice co-leader

[Updated on: Thu, 03 April 2014 17:15]

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Re: Women's Dietary Diversity Indicator [message #1818 is a reply to message #1813] Thu, 03 April 2014 17:54 Go to previous messageGo to next message
DWiesmann is currently offline  DWiesmann
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I fully support the proposal by FANTA-III to add a set of questions to the DHS Woman's Questionnaire that is suitable for constructing a women's dietary diversity indicator. As Anna Herforth rightly pointed out, the DHS provide extremely useful data on health factors, caring practices, and nutritional outcomes, but for a full analysis of the causes of malnutrition, indicators of diet quality/food consumption are required as well. Including a woman's dietary diversity indicator in the DHS would be an important step towards overcoming the current constraints of the DHS data sets when it comes to analyzing the pathways leading to malnutrition.

Doris Wiesmann, PhD
Food Security & Nutrition Specialist
Independent Consultant, Germany
Re: Women's Dietary Diversity Indicator [message #1852 is a reply to message #1796] Fri, 04 April 2014 10:16 Go to previous messageGo to next message
catherine.leclercq
Messages: 1
Registered: April 2014
Location: Rome
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I am writing to strongly support the proposals put forward by FANTA to collect information on the diversity of the diet through the Dietary Diversity Score assessed at individual level in women. This will be useful for surveillance purpose and also for comparison purpose when assessing the impact of interventions in different sectors.


Catherine Leclercq, PhD
Nutrition Officer

Nutrition Assessment & Nutrient Requirements Group
Nutrition Division (ESN)
Food and Agricultural Organization of the United Nations
Viale Terme di Caracalla
00153 Rome
Italy
Re: Women's Dietary Diversity Indicator [message #1861 is a reply to message #1716] Fri, 04 April 2014 11:01 Go to previous messageGo to next message
twilliam is currently offline  twilliam
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Registered: March 2014
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The USAID-funded Strenghtening Partnerships, Results and Innovations in Nutrition Globally (SPRING) Project strongly endorses FANTA's proposal to add questions for an indicator for women's dietary diversity. The indicator will help fill an important gap in knowledge on women's nutrition related to diet.

Tim Williams
Senior Strategic Information Advisor
SPRING Project
Arlington, VA, USA
Re: Women's Dietary Diversity Indicator [message #1869 is a reply to message #1716] Fri, 04 April 2014 14:18 Go to previous messageGo to next message
agnes guyon
Messages: 3
Registered: April 2014
Location: USA
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I fully endorse FANTA's proposal and comments from other colleagues to add questions for an indicator for women's dietary diversity. The indicator will help fill an important gap in knowledge on women's nutrition related to diet.


The quality of the diet of women of reproductive age is a key nutrition issue, which has important implications for the health and well-being of women of reproductive age; and, which, among pregnant and lactating women has important consequences for the health, nutrition and development of infants and young children.

Re: Women's Dietary Diversity Indicator [message #1925 is a reply to message #1716] Wed, 09 April 2014 16:05 Go to previous messageGo to next message
Marie Ruel is currently offline  Marie Ruel
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Registered: April 2014
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On behalf of the International Food Policy Research Institute (IFPRI) and the CGIAR, I would like to indicate my strong support for including questions in the DHS surveys that would allow the computation of the women's dietary diversity indicator. This indicator is increasingly recommended as an indicator to track progress in improving nutrition through agriculture and other nutrition-sensitive programs. It is also the only indicator currently available that has been validated and shown to accurately reflect the micronutrient adequacy of the diet (an important dimension of diet quality) of women in developing countries. The regular collection of data on women's dietary diversity is critically important for development practitioners, program implementers and policy makers to measure the impact of their investments and track progress in improving access not only to adequate quantity of food but also adequate quality for all, and most importantly for nutritionally vulnerable women from the developing world.

Marie Ruel
Director,
Poverty, Health and Nutrition Division
International Food Policy Research Institute (IFPRI)

[Updated on: Wed, 09 April 2014 16:07]

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Re: Women's Dietary Diversity Indicator [message #1927 is a reply to message #1716] Wed, 09 April 2014 16:22 Go to previous messageGo to next message
ellenpiwoz
Messages: 2
Registered: March 2014
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The Bill & Melinda Gates Foundation strongly supports the recommendation from FANTA III. We would like to underscore the following points from other posts, namely:

Indicators of diet quality are basic data that are, to date, missing in the world's ability to identify causes of malnutrition. It is difficult to imagine where else, besides DHS, globally-comparable indicators of diet quality could be collected. There is strong, explicit demand for a women's diet diversity indicator from the nutrition community (please refer to the paper below as one example).

Women's dietary diversity is increasingly recommended as an indicator to track progress in improving nutrition through agriculture and other nutrition-sensitive programs. It is also the only indicator currently available that has been validated and shown to accurately reflect the micronutrient adequacy of the diet (an important dimension of diet quality) of women in developing countries. The regular collection of data on women's dietary diversity is critically important for development practitioners, program implementers and policy makers to measure the impact of their investments and track progress in improving access not only to adequate quantity of food but also adequate quality for all, and most importantly for nutritionally vulnerable women from the developing world.

Ref: Bill & Melinda Gates Foundation "Sustainable Agriculture, Food Security, and Nutrition in the post-2015 Framework": https://docs.gatesfoundation.org/documents/Post%202015%20Foo d%20Security%20Discussion%20Paper.pdf

Ellen G. Piwoz
Senior Program Officer, Nutrition
Re: Women's Dietary Diversity Indicator [message #1990 is a reply to message #1716] Fri, 11 April 2014 17:33 Go to previous message
eskoufias@worldbank.org is currently offline  eskoufias@worldbank.org
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Registered: April 2014
Location: Washington, DC
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The World Bank Group supports the recommendations for deletions, revisions, and additions, posted above by FANTA. Contributed by Leslie Elder, Health, Nutrition & Population, HD.

Regards


Emmanuel Skoufias
Lead Economist
Poverty, Gender and Equity Group
Poverty Reduction and Economic Management
The World Bank
eskoufias@worldbank.org
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