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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 previous 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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