Lessons Learnt in Joint Nutrition and Food Security Assessments and Analysis (JANFSA)

Transcription

1 Lessons Learnt in Joint Nutrition and Food Security Assessments and Analysis (JANFSA) JRC-IFPRI workshop on Quantitative Methods for Integrated Food and Nutrition Security Measurements Presented by Elliot Vhurumuku Regional VAM (Senior Food Security Advisor), WFP Regional Bureau for East and Central Africa Authors: Elliot Vhurumuku, Sergio Regi, Jo Jacobsen, Cyprian Ouma, Patrick Codjia and Stien Gijsel Reviewers: Mara Nyawo, Louise Mwirigi, John Ntambi, Ismail Kassim, Hermann Ouedraogo, Sara Gari- Sanchis, Claudia Ah Poe and Byron Poncesegura Contributors: Isabel Nirina, Erik Kenefick, Kathryn Ogden, Bradley A. Woodruff, Michael O hiarlaite, Lynnda Kiess, Katrien Ghoos and Noel Zagre November 2017, Brussels, Belgium

2 Presentation outline Introduction & Assessment Process Sampling Issues Analysis Considerations Key lessons learnt Summary

3 Introduction Acknowledgement of the interrelationship between food security and nutritional status, has always been there Despite the linkages food and nutrition assessments have more often been carried out in parallel to meet programme information needs Food security situation and direct measurement of the nutritional anthropometric status done separately cannot adequately explain IF food security or other aggravating factors are underlying causes of malnutrition WHY the disassociation? Technical issues - such as the size of the sample required to obtain reliable household food security information compared with the one needed for precise estimates of malnutrition rates were considered different, Timing issues and agencies mandates and expertise HENCE The need for a joint methodology that meets the information needs and standards of both nutrition and food security sectors (set of minimum indicators)- led to the Technical Guidance for the Joint Approach to Nutrition and Food Security Assessments (JANFSA)

4 Why the Joint assessments and analysis? Linkage of food security and nutrition Greater understanding of the linkages (if any) between food security and nutrition. Comprehensive collection and analysis of intra-households food distribution and utilization in relation to care and feeding practices. Advocacy Powerful advocacy tool in both the planning phase of the assessment and the implementation of any joint programme. Cost Comparative reduction in costs of logistics, training, transportation and human resources (pooling resources). Coordination and planning Combined food security and nutrition results allow more precise targeting, greater clarity in roles and responsibility. Responses to malnutrition have sometimes been food centric without addressing underlying causes Capacity Technical and planning discussions, as well as the assessment results themselves, can act as a means of broadening the capacity of practitioners who normally only work in one of the sectors. Conceptual Framework The UNICEF conceptual framework for determinants of child and maternal malnutrition adapted by WFP to include food security is operationalized

5 Basis of the design of JANFSA The framework used as a basis for the joint assessments Can also use the Lancet series on maternal health and child nutrition 2013

6 The Joint assessment process 2a. Field data collection 2b. Data quality control 1f. Field test instruments and refine 1e. Enumerators training 1d. Securing Equipment (anthropometric measurement & vehicles) 1c. Development of joint data collection tools 1. Preparatory Phase 2. Data collection 3. Post-data collection Data quality control 3a. Data entry 3b. Data cleaning 1b. Sample Design (Nutrition and food security) 4. Dissemination 3.c Data analysis and interpretation 1a. Concept note Lessons learned 4.c Distribution of report and plan coordinated response 4.b Report writing 4.a Presentation of preliminary findings

7 JOINT SAMPLING CONSIDERATION 1. Set and agree on the Objectives 2. Decide on key indicators (food security and nutrition) 3. Estimate prevalence of key indicators 4. Decide on precision required 5. Calculate initial sample size using Nutrition and food security calculators 6. Adjust for individual non-response 7. Adjust for eligible members 8. Adjust for household non-response Final sample size

8 FINAL Sample size for JANFSA 0. Define strata 1. In each stratum, calculate children s sample size in each stratum 2. Conversion children s sample HH sample 3. Calculate Food security sample size (HHs) using key outcome indicators 4. In each stratum, Pick the highest sample size between (2) and (3) In the event of financial constraints, a discussion over acceptable precision ranges must take place

9 Core Indicators Core Indicators for Joint nutrition and food security Household level Demographics: Educational level of head of the HH and primary caregiver Sex of the head of the HH and marital status Age of HH members and size of the HH Vulnerable HH members including OVC, disabled and chronical ill/plhiv Individual level Anthropometry of children 6-59 months: Weight for Height, Weight for Age, and Height for Age MUAC Bilateral oedema Anthropometry of PLW: MUAC HH consumption: Food Consumption Score(-Nutrition) Household dietary diversity Share of Food Expenditure Coping strategies: Livelihood coping Water and sanitation: Access to improve water source Access to improve sanitation Income: Livelihood activities Crop and livestock Morbidity in children 6-59 months: Diarrhea ARI Fever Core IYCF indicators: Minimum dietary diversity (6-23 months) Minimum meal frequency (6-23 months) Minimum acceptable diet (6-23 months) Consumption of iron-rich foods (6-23 months) Women s consumption: Minimum dietary diversity for women (15-49 years)

10 Optional Indicators Optional Indicators Household level Market/financial opportunities: Distance Access credit Debt Individual level Nutritional status of women in the reproductive age (15-49 years): BMI MAUC Food Insecurity Experience Scale: Food insecurity experience scale Shocks: HH affected by main shocks Core IYCF indicators: Early initiation of breastfeeding Exclusive breastfeeding under 6 months Continuous breastfeeding at 1 year Introduction of complementary foods (6-8 months) Micronutrient deficiency: Vitamin A supplementation (children 6-59 month) Folic acid/iron supplementation (PLW) Access to health services: Vaccinations (children aged 9-59 months) and deworming (children aged months) Hand washing: Hand washing practices of the primary care giver

11 Data Analysis Analysis plan defined available after objectives and finalization of data collection tools The scripts for the analysis of household/individual data can be created using trial data sets for a quick turn around of the analysis and report Creation of 2 different datasets (FS and Nutrition) with unique HH identifier (HHID) for both Data cleaning standard rules used for FS and Nutrition (never delete the data) Separate analysis Food Security (e.g. SPSS or Strata) and Nutrition (e.g. ENA or SPSS) initially ENA dataset merged into SPSS for joint analysis on relation between key determinants and prevalence of outcome indicators. Weights for the household to be created and used if PPS was not used in sample design

12 Assessing Nutrition and Food Security Linkages Cross tabulation and difference tests (Chi-square or non-parametric tests for few number of cases, within categorical/ordinal variables) Bivariate correlation and Analysis of Variance (ANOVA) between continuous variables, for example between household diet diversity score (HDDS) and children s dietary diversity score (IDDS) Multivariate analysis depending on the results of bivariate analysis, appropriate multivariate analyses will explore the strength of association between various independent variables.

13 Linkage Analysis example Household level HH food consumption is associated with wasting and stunting? HH coping strategies are associated with wasting and stunting? HH food share expenditure is associated with wasting and stunting? HH food security status is associated with wasting and stunting? Introduction of complementary feeding at the age of 6 to 8 months is related to HH food security? Individual level Children consumption {(Minimum Meal Frequency (MMF), Minimum Dietary Diversity (MDD), Minimum Acceptable Diet (MAD), iron rich food)} is related to household consumption {(Dietary Diversity (DD), Food Consumption Score_Nutrition) and primary care giver (MDD-W)}? Children consumption (MMF, MDD, MAD, iron rich food) is related to household wealth? Children consumption (MMF, MDD, MAD, iron rich food) is related to education of primary caregiver? Care practices (IYCF) is associated with wasting and stunting? Child nutritional status is associated with disease?

14 Nutrition indicators Wasting Stunting Examples of results generated Example of Linkage between Food Security and Nutrition Underweight Children status in household Food Secure Mild food secur e Modera te food insecure Severe food insecur e Chi- Squar e P value None At least one child None One child Two or more children None One child * Two or more children None MUAC At least one child * *statically significance [X 2 =15.118, P=0.019 <0.05] and [X 2 =7.797, P=0.05 =0.05]. I. Food Share of Total Expenditure, Shocks, and Coping Strategies II. Demographics Example of association of nutrition at household level CSI Food expenditure share Number of income sources Number of coping strategies Number of shocks experienced by the Household Household size Number of Children under five Illness oh head of household Household head education level Age of head of household Sex of head of household Wealth quintal III. Household Toilet facility Socio-economic Safe drinking water Characteristics Land size category in hectares TLU ownership- total livestock Significantly associated Wasting Stunting Underweight MUAC

15 Examples of results generated Causal Models to Address Interactions Conceptual Framework for the analysis of malnutrition filled Global Acute Malnutrition = 5,5% Chronic Malnutrition = 48,8% Underweight = 25,8% Nutritional Status Mortality Breastfeeding exclusive 0-5 months: 64% food supplement/6-8 months: 77% diversification food/6-23 months 23% minimum number of meals/6-23 months 23% dietary intake acceptable/6-23 months 9% early breastfeeding initiation 88% Individual Food Intake Health Status/ Disease Impact - fever:. 51% Impact - IRA: 45% Impact - diarrhea: 25% Fever + diarrhea + IRA: 12% Food Insecure *: 9% Cons. Not acceptable: 11% Score of food diversity: 2.8 Number of meals/day: 1.8 HH with unstable income: 74% Coping strategy Index: 11.8 Strategy of emergency: 8% Farming: 90% Production: 178 kg/head Agricultural workforce: 1794FBU/day Coverage of agricultural prod. 3.1 month Household agri. without livestock 26% Price way bean (Avr): 1300FBU/kg Price means maize (Avr): 719FBU/kg Acreage: 0.5 ha/household Density: 310 inhabitants per km 2 Drought and recurring water deficit Other shocks: floods, Recent and frequent displacement Household Food Access Care /Health Practices HH Food Production, Gifts, Exchange, Cash Earnings, Loans, Savings, Transfers Natural Physical Human Economic Social Capital/ Assets Health and Hygiene Conditions Diarrhea without treatment: 31% Has not slept under mosquito net: 47% Participation in the nutrition program: 6% (Verified) VAR : 65% coverage Vitamin A - postpartum women: 30% Deworming - pregnant women: 31% Mother without education or primary level:88% Does not have access to safe water : 80% Subjective poverty: 65% Economic growth rate : 4% Population growth rate: 3% Average inflation rate: 10% Food balance sheet: Deficit 51%

16 Challenges of combining nutrition and food security assessments and analysis Sample size & Precision Timing Training Specialized expertise Level of precision for nutrition indicators higher than what is needed for food security indicators Increased sample size and resources. Timing of the assessment taking seasonality issues, national surveys and information requirements. Longer training days for interviewers and anthropometric measures. Higher level of expertise required when compared to separate assessments. Analysis Interview length Data management Coordination Agreement on the analysis plan required at the planning stage (same team all along). Interview entails administration of child questionnaire and a household questionnaire sequentially. Administration time from minutes. The requirement to link household and child datasets before analysis may require higher levels of data management expertise than single surveys at household or child level. Planning for a joint assessment requires greater coordination which can be challenging.

17 Key learnings 1. Inter-agency collaboration and coordinated planning 2. Survey design, tools development 3. Training and data collection 4. Data entry, analysis and results interpretation 5. Reporting and dissemination

18 Summary- Joint Approach in Nutrition and Food Security Assessments (JANFSA) Meet the information needs by adopting standardized best practices in Food security & nutrition surveys Optimize the use of financial and human resources available Highlight on areas for which important and mutual actions are required: planning, survey design, technical assistance requirement, data analysis, etc. Bring onboard adequate expertise on both dimensions & enhance cross-fertilization at all levels Enhance a joint analysis and response Some areas may require further (development) such as results validation, report writing, and dissemination

19 Thank you!