Nutritional surveillance and intervention.pptx

It is a ppt prepared on nutritional surveillance and intervention

1. Nutritional surveillance and intervention 8/3/2016 1

2. Nutritional Surveillance 8/3/2016 2

3. Surveillance F rom French “ surveiller”: is to watch over with great attention T erm from infectious disease epidemiology adopted for nutrition at 1974 World Food Conference 8/3/2016 3

4. Nutritional Surveillance System organized to monitor the food & nutrition situation of a country/region within a country on a continuous & regular basis Concerned with data on populations , not individuals On going data collection; regular & timely collection , analysis & repotting of nutrition-relevant data ICN (1992) called for the international agencies to establish a global nutritional surveillance system National systems are needed Information from the national systems must be compatible; allow international comparisons 8/3/2016 4

5. Nutritional Surveillance… M ethods Active surveillance : done by the group running the program Advantage: Takes time & other resources Limitations: More reliable & in accordance with the need Passive surveillance : data collected indirectly from on going programs Strength: Lesser cost, time, personnel Limitations: Data less reliable & less relevant to the program Sentinel surveillance 8/3/2016 5

6. Nutritional Surveillance…… Objectives of nutritional surveillance Describe the nutritional status of the population, particularly those at risk Analyze cases & associated factors Promote government decisions on nutritional emergencies & national planning Prediction of future nutritional problems Monitoring & evaluation of nutrition programs 8/3/2016 6

7. Applications of Nutritional Surveillance Early warning & intervention Policy and program Planning Monitoring and Evaluation A dvocacy 8/3/2016 7

8. 1. Timely warning & intervention To prevent short term critical reductions in food consumption to identify problems in the food systems Information distributed to decision makers 8/3/2016 8

9. The Early warning signs(EWS) The Early Warning (EW) system is designed to provide assessments of food prospects within the country & to detect (as early as possible) the likelihood of deterioration in food security or, in worse case scenarios, impending disaster . This includes data on : Crop assessments Epidemic outbreaks Nutritional status of vulnerable groups livestock conditions Impact of precipitation on crops & livestock Market situation Magnitude of food shortages & measures taken for mitigation. 8/3/2016 9

10. Food Balance Sheets Divided by 365 8/3/2016 10

11. Role of Early Warning Systems in Decision Making Processes It is of little use to look at an EWS in isolation from their use in the decision making process To be effective : it must be able to trigger a timely response/intervening before the point of destitution is reached , to protect livelihoods before lives are threatened. In other words, the EW/response system must be geared to protect future capacity to subsist as well as able to ensure current consumption. Thus, the EWS must be sensitive to changes in food security status before famine threatens & able to detect localized pockets of acute food stress. 8/3/2016 11

12. The timing of response in the downward spiral of famine. Source: Buchanan-Smith & Davies 1995 8/3/2016 12

13. Factors Affecting the Take-up of Early Warning Information Ownership of Early Warning Information A Clear & Consistent Early Warning Message Interpreting Early Warning Information **The challenge is how to translate early warning data into food aid requirements 8/3/2016 13

14. Application cont’d 2. Policy & program planning Provide continuous analysis , integration, and interpretation of data from multiple sources, ensuring a systematic flow of sectoral information . Demographic and Health Surveys (DHS) Multiple Indicator Cluster Survey (MICS) National Nutrition Surveys WHO/FAO Projections Assess policies & programs and supports high-level decision making Enhance nutritional effects of development policies 8/3/2016 14

15. 3. Monitoring & evaluation Political and managerial decision-makers are interested in the outcomes and effects of food and nutrition programs To rationalize & maximize effectiveness of Food & nutrition programs by measuring performance 8/3/2016 15

16. 4. Advocacy To assess &/ or monitor indicators related to nutritional status by advocates Basis for directing funds towards particular nutritional problems advocates seek to increase the flow of resources to support food and nutrition activities that will allow them to achieve their goals. helps advocates set priorities for dealing with problems and serves as evidence to support those advocates' claims . Policy or program proposals made by the advocates will be strengthened and a favorable outcome is more likely. 8/3/2016 16

17. The basic steps in carrying out/Designing nutritional surveillance system Scope Assessment Implementation Impact 1. Problem identification including desired impact of action taken 10. Actual impact Intervention 2. Proposed policies & intervention strategies 9. Intervention enacted based on decision Decision 3. Potential decisions regarding policies & interventions 8. Decision (s) made based on information Information 4. Information needed to aid in decision making 7. Data analysis: the transformation in to Information Data 5. Data needed to generate information 6. Data collection action 8/3/2016 17

18. Of all the steps involved in designing a surveillance system: Indicator selection and conversion of surveillance data into policy information are the most crucial. 8/3/2016 18

19. Information Levels of information A. Ecology M eteorology , land, water, vegetation Demography Infrastructure -transport, communications, services B. Resources & production products: livestock , food imports/exports/stocks, fuel C. Income & consumption market data, income, food consumption D. Health status nutritional status, disease patterns 8/3/2016 19

20. I nformation for nutrition surveillance must be : population based D ecision and action oriented Sensitive Accurate Relevant timely readily accessible communicated effectively 8/3/2016 20

21. Indicators of nutritional surveillance The indicators can be Measures of resources (eg, farming systems or access to services) outcomes (eg, nutritional status, morbidity, or mortality) factors that link resources to outcomes (eg, food production , food intake, or household expenditures) 8/3/2016 21

22. Characteristics of indicators The indicators should be: relevant sensitive specific cost-effective appropriate for trends analysis For action-oriented NS systems , cutoff points and action-triggeri ng levels must be chosen to determine how extensive the problem being assessed must be before society demands that action be taken. It is determined by: Available resources cost effectiveness political awareness 8/3/2016 22

23. Cut-off points and trigger levels Cut-off point: a value that marks the boundary of acceptability (e.g . < -2SD W/A) Trigger level: percent of observations below a cut-off point required to initiate action (e.g. % children < 5 y with W/A < -2SD greater than 10% ) Need to use the most sensitive indicators (in terms of triggering action) that are feasible 8/3/2016 23

24. Indicators used in nutrition monitoring Food crises Food stocks (food balance sheets) Production patterns Market prices Fall In body weights Rainfall pattern Household food security Employment levels Market prices Changes in real income & purchasing power Dietary energy supply Poverty rate (percentage living on less than a $1 a day) 8/3/2016 24

25. Indicators … Prevalence of malnutrition(PEM) Wt/age, wt/ht, ht/age Preschool stunting (low height for age) Preschool underweight (low weight for age) Preschool wasting (low weight for height ) BMI, BMI/age Over nutrition Under nutrition Children’s growth Infectious disease rates Food intake relative to need 8/3/2016 25

26. Indicators … Caring capacity Maternal education Literacy rates Maternal employment Public expenditure Breast feeding(duration & percentage) 8/3/2016 26

27. Indicators … Malnutrition-infection complex Incidence of diarrhea EPI coverage availability of clean water 8/3/2016 27

28. Indicators for measuring water and sanitation-related program performance: Percentage of children under <36 months with diarrhea in the last two weeks Quantity of water used per capita per day Percentage of child caregivers and food preparers with appropriate hand washing behavior Percentage of population using hygienic sanitation facilities 8/3/2016 28

29. Indicators … Micronutrient deficiencies Iron deficiency Clinical signs Pallor Tiredness Breathlessness Headaches Hemoglobin Vitamin A Deficiency Indicators Clinical signs Night blindness Bitot’s spot Corneal xerosis Keratomalacia Blood assays 8/3/2016 29

30. Micronutrient indicators… IDD Indicators Clinical signs (goiter and cretinism) Urinary assays cretinism Context where used Clinical signs are monitored in stable contexts in areas where iodine deficiency disease is endemic Zinc deficiency Calcium deficiency 8/3/2016 30

31. Challenges of nutrition surveillance systems Sustainability? Institutional issues? Linking information to action ? 8/3/2016 31

32. Nutritional intervention Aim is to reduce malnutrition and its consequences Intervening effectively to improve nutrition requires understanding the causes of malnutrition (UNICEF Framework) 8/3/2016 32

33. I ntervention… Can Be implemented at different levels households Community regional National International 8/3/2016 33

34. Should Combine different approaches like: Bottom up – Triple A Cycle Top-down Supplementation programs Fortification Food relief programs Interventions… 8/3/2016 34

35. The ‘TRIPLE A’ Cycle Surveillance should be followed by intervention action in a cyclic manner Assessment of the nutrition Situation of A country or A region Action based on analysis & available resources Analysis of the cause of nutritional Problems 8/3/2016 35

36. Should Be fully integrated!!! Strategies that tackle only immediate causes of malnutrition need to be Repeated often to have sustainable effect and should be Enhanced by activities which address the underlying or basic cause of malnutrition I nterventions… 8/3/2016 36

37. Nut-Specific VS Nut-Sensitive 37 Working only on nutrition-specific interventions is like scratching the tip of the ‘ice burg” 8/3/2016

38. Con’t… Proven Nut-specific and Nut-sensitive interventions Benefits ‘’during the life course’’ Reduce childhood mortality and morbidity Obesity and NCDs Increase Cognitive, motor, socio emotional development School performance and learning capacity Adult stature Work capacity and productivity 8/3/2016 38

39. Evidence-based interventions to address under nutrition Breastfeeding promotion reduce Deaths by 9.1% at 36 months of age Appropriate complementary feeding More effective at reducing stunting Supplementation with vitamin A and zinc Could reduce deaths in children by about 10% Appropriate management of severe acute malnutrition Reduce deaths due to SAM by 55% 39 8/3/2016

40. The 2013 Lancet’s Series on Maternal and Child nutrition Re-evaluate The problems of maternal and child under nutrition Growing problems of overweight and obesity for women and children in low-income and middle-income (LMIC) Many of these countries are said to have the ‘’double burden of malnutrition’’ 8/3/2016 40

41. Con’t… 8/3/2016 41 New evidence also strengthens the case for a continued focus on the crucial 1000 day window during pregnancy and the first 2 years of life It also shows the importance of intervening early in pregnancy and even before conception Because many women do not access nutrition-promoting services until month 5 or 6 month of pregnancy

42. Con’t… 8/3/2016 42 Growing interest in adolescent health as an entry point to improve the health of women and children Maternal overweight and obesity are associated with maternal morbidity, preterm birth, and increased infant mortality

43. proven interventions: Recent evidences Nutrition-specific interventions across the lifecycle Address the immediate determinants of fetal and child nutrition If 10 proven nutrition-specific interventions were scaled-up from existing population coverage to 90% Nearly 15% of deaths of children younger than 5 years could be reduced Prevalence of stunting could be reduced by 20.3 % Severe wasting by 61.4% 43 8/3/2016

44. Con’t… The top 10 Identified Nutrition specific interventions Maternal dietary supplementation Micronutrient supplementation or fortification Breastfeeding and complementary feeding Dietary supplementation for children Adolescent health preconception nutrition 8/3/2016 44

45. Con’t… Dietary diversification Treatment of severe acute malnutrition Disease prevention and management Nutrition interventions in emergencies 8/3/2016 45

46. Con’t… 8/3/2016 46 The maximum effect on reduction of mortality is noted with: Management of acute malnutrition infant and young child nutrition package Promotion of breastfeeding Promotion of complementary feeding Micronutrient supplementation

47. Key proven practices, services and policy interventions throughout the life cycle 8/3/2016 47

48. Nutrition-sensitive interventions and programmes An approach that tackles the underlying determinants of under nutrition by promoting: Agriculture and food security Access to and consumption of nutritious foods Improving social protection and care practices Ensuring access to health care 8/3/2016 48

49. Nutrition sensitive interventions... Developmental / Livelihoods Approaches Are systems approaches that addresses the root/underline causes of development failure 8/3/2016 49

50. Long term strategies Poverty Reduction Improved Child Nutrition Enhanced Human Resource Social Sector Investments Increased productivity Economic Growth 8/3/2016 50

51. Con’t… Delivery platforms/ Channel's for nutrition-specific interventions potentially increasing their scale, coverage, and effectiveness Helps to reach the needy ( nutritionally vulnerable) and poor segment of the community 8/3/2016 51

52. Example's Nutrition sensitive interventions Food fortification Food price subsidies Homestead food production to increase dietary diversity Improved water sources, sanitation practices (e.g. appropriate hand washing) to reduce disease Conditional cash transfer programs to increase income, other income generation schemes 8/3/2016 52

53. Con’t… Rearing livestock Gender-based programs-women empowerment Food-for-work programs-social safety net School feeding programs, efforts to keep girls in school Nutrition education in schools 8/3/2016 53

54. 8/3/2016 54

55. Nutrition interventions in Emergencies Aims at reduction of excess mortality that results during the first few weeks to months It involves provision of : Food Shelter( if displaced) Program to control diarrheal diseases Epidemiological surveillance system Training of community health workers Curative care unit Coordination of operational partners Locating a situation on the food security/famine continuum helps identify the most appropriate type of intervention. 8/3/2016 55

56. Proven Nutritional Interventions in Emergency The major focus is on : General food distributions(GFD) Selective feeding Programs Supplementary feeding program(SFP) Therapeutic feeding(TFP) 8/3/2016 56

57. General Food Distribution(GFD) The aim of GFD is to cover the immediate basic food needs of a population in order to eliminate the need for survival strategies which may result in long-term negative consequences to human dignity, household viability, livelihood security & the environment Ideally a standard general ration is provided in order to satisfy the full nutritional needs of the affected population. In a population affected by an emergency, the general ration should be calculated in such a manner as to meet the population’s minimum energy, protein, fat & micronutrient requirements for light physical activity. May not provide rations that satisfy the full nutritional needs of the population 8/3/2016 57

58. Example of recommended ration 8/3/2016 58

59. Ration composition should give consideration to micronutrient deficiencies Commodity Risk Possible solution Maize Pellagra( vitamin B3 deficiency) Nuts,beans, whole grain cereals, meat, fish, eggs, milk Polished rice Beriberi (Vitamin B1 deficiency) Parboiled rice, whole grains, ground nut, legumes, meat, fish, egg, milk No fresh fruit or vegetables Scurvy (vitamin C deficiency) Onions, cabbage, canned tomato paste, vitamin c tablets 8/3/2016 59

60. Selective Feeding Programs Supplementary Feeding Programs (SFP) targets the most nutritionally vulnerable groups Therapeutic feeding programss(TFP) those in need of nutritional rehabilitation 8/3/2016 60

61. Supplementary Feeding Programs Targeted SFP Supplementary food is restricted to only those individuals identified as the most malnourished or most nutritionally vulnerable/at risk during nutritional emergencies Includes pregnant women, lactating mothers & young children under 5 years of age. The main objective is to prevent the moderately malnourished from becoming severely malnourished & consequently, reduce the prevalence of severe acute malnutrition & associated mortality. 8/3/2016 61

62. Blanket SFP Supplementary food is distributed as a temporary measure to all vulnerable members of a population at-risk of becoming malnourished without identifying the most malnourished. The general objective of a blanket SFP is to prevent widespread malnutrition & mortality. Supplementary Feeding Programs 8/3/2016 62

63. Therapeutic Feeding Program Provide a rehabilitative diet together with medical treatment for diseases & complications associated with the presence of severe acute malnutrition. The specific aim is to reduce mortality among acutely severely malnourished individuals & to restore health through rehabilitating them. Administered through the following venues: Therapeutic Feeding Center (TFC) Nutrition Rehabilitation Unit ( NRU) at a hospital or health facility Community-Based Therapeutic Care (CTC/OTP) program 8/3/2016 63

64. TFCs Traditionally, the management of SAM in emergencies includes setting up TFCs the focus has been on the attainment of acceptable minimum standards of mortality Recovery and clinical outcomes in TFCs managed by experienced agencies has been positive 8/3/2016 64

65. critical limitations of TFCS D ifficult to establish expensive to operate very limited coverage D o not build on the capacity of the community and can undermine traditional coping strategies Mothers or caregivers are often required to stay longer in the TFC which has tremendous opportunity costs and disrupts family life. lead to the spread of cross infection , an important cause of increased morbidity and mortality in an already weakened population. 8/3/2016 65

66. Community Therapeutic Care (CTC) is a new approach to managing acute malnutrition in emergencies and beyond. provide rapid, effective , low cost assistance that is least disruptive to affected communities builds a foundation to link relief and development interventions for long-term solutions to food insecurity and threats to public health. aims to treat the majority of the severely malnourished at home build local capacity to better manage care of acutely malnourished children, and address repeated cycles of relief and recovery . 8/3/2016 66

67. Emergency Nutritional intervention 8/3/2016 67

68. Classification Tool for Implementation of Selective Feeding Programs(Ethiopian Guideline ) 8/3/2016 68

69. Cont.. GAM: percentage of child population (6-59 months) with WFH z score < -2 and/or manifesting bilateral oedema. SAM: percentage of child population (6-59 months) with WFH z score < -3 and/or manifesting bilateral oedema. 8/3/2016 69

70. Aggravating Factors: Poor household food availability & accessibility, general food ration below mean energy requirement Crude mortality rate >1 per 10,000 per day Epidemic of measles, whooping cough (pertussis), cholera, shigella & other important communicable diseases High prevalence of respiratory or diarrheal diseases High prevalence of HIV/AIDS Outbreaks of diseases (malaria, etc.) Low levels of measles vaccination & vitamin A supplementation Inadequate safe water supplies & sanitation Inadequate shelter War & conflict, civil strife, migration & displacement 8/3/2016 70

71. Admission and Discharge Criteria for TFP 8/3/2016 71