Methods of nutrition surveillance in low-income countries

Background In 1974 a joint FAO/UNICEF/WHO Expert Committee met to develop methods for nutrition surveillance. There has been much interest and activity in this topic since then, however there is a lack of guidance for practitioners and confusion exists around the terminology of nutrition surveillance. In this paper we propose a classification of data collection activities, consider the technical issues for each category, and examine the potential applications and challenges related to information and communication technology. Analysis There are three major approaches used to collect primary data for nutrition surveillance: repeated cross-sectional surveys; community-based sentinel monitoring; and the collection of data in schools. There are three major sources of secondary data for surveillance: from feeding centres, health facilities, and community-based data collection, including mass screening for malnutrition in children. Surveillance systems involving repeated surveys are suitable for monitoring and comparing national trends and for planning and policy development. To plan at a local level, surveys at district level or in programme implementation areas are ideal, but given the usually high cost of primary data collection, data obtained from health systems are more appropriate provided they are interpreted with caution and with contextual information. For early warning, data from health systems and sentinel site assessments may be valuable, if consistent in their methods of collection and any systematic bias is deemed to be steady. For evaluation purposes, surveillance systems can only give plausible evidence of whether a programme is effective. However the implementation of programmes can be monitored as long as data are collected on process indicators such as access to, and use of, services. Surveillance systems also have an important role to provide information that can be used for advocacy and for promoting accountability for actions or lack of actions, including service delivery. Conclusion This paper identifies issues that affect the collection of nutrition surveillance data, and proposes definitions of terms to differentiate between diverse sources of data of variable accuracy and validity. Increased interest in nutrition globally has resulted in high level commitments to reduce and prevent undernutrition. This review helps to address the need for accurate and regular data to convert these commitments into practice

The nutritional status of children in Bhutan: results from the 2008 National nutrition survey and trends over time

<p>Abstract</p> <p>Background</p> <p>There are few reports on the nutritional status of Bhutanese children. The objective of this paper is to summarize results from the 2008 National Nutrition Survey and to describe progress achieved during the last two decades.</p> <p>Methods</p> <p>A cross-sectional survey of 2376 children aged 6 to 59 months was conducted during November-December 2008 to provide national and regional estimates. A multi-stage cluster sampling method was applied and 40 gewogs/thromdes were selected from each region (Western, Central, Eastern). Guidelines on how to measure length/height and weight followed WHO standardized procedures. Data were analysed for consistency and validation using the software WHO Anthro and the WHO SPSS macro. Underweight, stunting, overweight, wasting and thinness were defined based on the WHO Child Growth Standards. Data from 1986-88 and 1999 national surveys were reanalysed using the WHO standards to describe trends in nutritional status.</p> <p>Results</p> <p>Nationally, 34.9% Bhutanese preschool children are stunted and 10.4% are underweight. Wasting is 4.7%, with severe wasting close to 2% in rural areas, while overweight affects 4.4% of preschool children. While underweight rates are similar across regions, wasting is substantially more prevalent in the Western region and stunting in the Eastern region. Stunting shows a steep rise during the first two years of life, as high as 40%, and levels off thereafter, while wasting is greatest among children aged 6-24 months and subsequently decreases. The prevalence of stunting fell from 60.9% in 1986-88 to 34.9% in 2008, and underweight declined from 34.0% to 10.4% during same period. The percentage of wasted children dropped from 5.2% in 1986-88 to 2.5% in 1999 but then increased to 4.7% in 2008.</p> <p>Conclusions</p> <p>There have been major improvements in the nutritional status of Bhutanese children over the past two decades, however, linear growth retardation remains a significant concern. Early identification of growth faltering is essential for improving the effectiveness of public health programs to prevent stunting. Similarly, wasting rates indicate the need for a system to identify children with severe malnutrition in the isolated communities so that they can receive appropriate care.</p

Multi‐response optimization of extrusion conditions of grain amaranth flour by response surface methodology

The study was designed to optimize extrusion processing conditions for production of instant grain amaranth flour for complementary feeding. Multi-response criteria using response surface methodology and desirability function analysis were employed during the study. The central composite rotatable design (CCRD) was used to determine the level of processing variables and to generate the experimental runs. The process parameters tested included extrusion temperature (110–158°C), screw speed (40–52 Hz), and feed moisture content (11%–16%), while response variable was protein digestibility, sensory acceptability, water absorption index, water solubility index, bulk density, and viscosity. Data obtained from extrusion were analyzed using response surface methodology. Data were fitted to a second-order polynomial model, and the dependent variables expressed as a function of the independent variables. Analysis of variance (ANOVA) revealed that extrusion parameters had significant linear, quadratic, and interactive effects on the responses. Numerical optimization indicated that the optimum extrusion parameters were extrusion temperature of 150°C, extrusion speed (screw speed) of 50 Hz, and feed moisture content of 14.41%. The responses predicted for optimization resulted in protein digestibility 81.87%, water absorption index 1.92, water solubility index 0.55, bulk density 0.59 gm/L, viscosity 174.56 cP (14.55 RVU), and sensory acceptability score of 6.69, with 71% desirability