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 effect of a micronutrient powder home fortification program on anemia and cognitive outcomes among young children in rural China: a cluster randomized trial

Abstract Background Anemia early in life has been associated with delayed cognitive and motor development. The WHO recommends home fortification using multiple micronutrient powders (MNPs) containing iron as a strategy to address anemia in children under two. We evaluated the effects of a program freely distributing MNP sachets to caregivers of infants in rural China. Methods We conducted a cluster-randomized controlled trial in Shaanxi province, enrolling all children aged 6–11 months in target villages. Following a baseline survey, investigators randomly assigned each village/cluster to a control or treatment group. In the treatment group, caregivers were instructed to give MNPs daily. Follow-up was after 6, 12, and 18 months of intervention. Primary outcomes were hemoglobin concentrations and scores on the Bayley Scales of Infant Development. Results One thousand, eight hundred and-two eligible children and their caregivers were enrolled. At baseline 48% (870) of children were anemic and 29% (529) were developmentally delayed. Six hundred and-ten children (117 villages) were assigned to the control group and 1192 children (234 villages) were assigned to the treatment group. Assignment to the treatment group was associated with an improvement in hemoglobin levels (marginal effect 1.77 g/L, 95% CI 0.017–3.520, p-value = 0.048) and cognitive development (marginal effect 2.23 points, 95% CI 0.061–4.399, p-value = 0.044) after 6 months but not thereafter. There were no significant effects on motor development. Zero effects after the first 6 months were not due to low compliance, low statistical power, or changes in feeding behavior. Hemoglobin concentrations improved in both the treatment and control groups over the course of the study; however, 22% (325) of children remained anemic at endline, and 48% (721) were cognitively delayed. Conclusions Providing caregivers with MNP sachets modestly hastened improvement in hemoglobin levels that was occurring absent intervention; however, this improvement did not translate into improved developmental outcomes at endline. Trial registration ISRCTN44149146 ; prospectively registered on 15th April 2013

Survey of micro, small and medium enterprises experience of urban flooding, water supply disruption and hydroelectric load shedding during the 2015-2016 El Niño

Dataset of 195 surveys with micro, small and medium enterprises (MSMEs) in sub-Saharan Africa that explore their their experiences of urban flooding (Nairobi, Kenya, n=60), water supply disruption (Gaborone, Botswana, n=57) and disruption to electricity supplies from hydroelectric load shedding (Lusaka, Zambia, n=78) during the 2015/2016 El Niño. The surveys were conducted in August 2016 in Lusaka, in September 2016 in Nairobi, and in November 2016 in Gaborone.This research investigated the impacts of and responses to extreme drought (Botswana and Zambia) and floods (Kenya) associated with the 2015-16 El Niño (EN) and subsequent rainy season. The aim of the research was to examine micro, small and medium enterprises (MSME) experience of: water supply disruption in Botswana's capital Gaborone; flooding in Kenya’s capital Nairobi; and disruption in Zambia's capital Lusaka to electricity supply, due to reduced hydropower production. In this research we adopted a mixed methods research design, conducted in two phases: 1) Firstly, we examine the hydrological response and impact pathways of the 2015/2016 El Niño in eastern and southern Africa, focusing on Botswana, Kenya, and Zambia. To do this we present an analysis of the impact of the 2015/2016 El Niño in eastern and southern Africa, focusing on Botswana, Kenya, and Zambia, using in situ and remotely sensed time series of precipitation, river flow, and lake levels complemented by qualitative insights from interviews with key organizations in each country about awareness, impacts, and responses. This phase of the research is written up in Siderius et al., (2018). Results show that drought conditions prevailed in large parts of southern Africa, reducing runoff and contributing to unusually low lake levels in Botswana and Zambia. Key informants characterized this El Niño through record high temperatures and water supply disruption in Botswana and through hydroelectric load shedding in Zambia. Warnings of flood risk in Kenya were pronounced, but the El Niño teleconnection did not materialize as expected in 2015/2016. Extreme precipitation was limited and caused localized impacts. The hydrological impacts in southern Africa were severe and complex, strongly exacerbated by dry antecedent conditions, recent changes in exposure and sensitivity and management decisions. 2) Secondly, we contribute to a sparse literature on firm-level adaptation among micro, small and medium enterprise (MSMEs) in sub-Saharan Africa, through a near-real time assessment of MSME experience of hydrological disruption associated with the 2015/2016 El Niño in the capital regions of Botswana, Zambia and Kenya. We do this through three case studies which consider hydroelectric load shedding (Lusaka), water supply disruption (Gaborone) and flooding (Nairobi). And we consider MSME experience of this disruption in sectors making substantial contributions to livelihoods and national GDP. This focus allows us to profile impact pathways of hydrological disruption associated with a major El Niño event. But it also offers a near-real time snapshot of firm-level experience of a range of climate-related forms of hydrological and resource disruption, as well as of business adaptation behaviour during climate extremes in SSA. This research is written up in Gannon et al., (2018). Alongside complex and indirect impact pathways that influence total loss and damage, results show varying vulnerability to disruption. Nevertheless, directly after the El Niño event, MSMEs reported water supply disruption, power outages and flooding to be the leading challenge within the business environment in Botswana, Zambia and Kenya respectively. The paper calls for deeper understanding of vulnerabilities in existing water, energy and urban infrastructure – in the context of increasing urbanisation and a potentially broader range of climate variability across SSA and argues that this needs to be coupled with public provision of wider enabling conditions – including access to finance – that support private sector adaptation to extreme climate events and associated resource disruption. This paper also identifies clear opportunities to improve climate information services for MSMEs. </p