Despite all efforts undertaken both nationally and internationally, poor nutritional status is still a fundamental cause of disease and shortened life-span. Most people are aware that many factors are either directly or indirectly responsible for undernutrition, including insecure food supply, lack of basic education, inadequate health services, deteriorated environment, low income, and inadequate empowerment. The factors contributing to malnutrition vary from community to community. However, poverty is nearly always an underlying factor.
To improve the nutritional status and improve living conditions in communities, it is necessary to determine the nature, magnitude and causes of malnutrition. Anthropometric indices are internationally accepted as nutrition key indicators of populations. Additionally, they have been recommended repeatedly as a suitable key indicator for poverty as well. The use of anthropometric indicators is based on the extensively observed phenomena that a growing child who lacks an adequate intake of food and is repeatedly ill, does not have the body height corresponding to its genetic potential. Furthermore, inadequate food availability, caring capacity, basic education, health systems, housing and environmental conditions have been proven to be underlying causes of inadequate food intake and repeated episodes of diseases. As a result, communities that are not able to satisfy their basic needs adequately generate higher proportions of individuals with inadequate anthropometric indices.
The quality of intervention strategies is closely linked with the quality of the assessment of the situation. Planning methods for interventions, such as ZOPP (Objective-Oriented Project Planning), triple A (Assessment - Analysis - Action) or PMC (project management cycle), provide a structure for gathering and analyzing data that can be used subsequently in monitoring the impact of an intervention. Therefore, if an objective of an intervention or program/project is to raise the nutritional and living standards, appropriate and realistic indicators must be established.
Appropriate planning requires both quantitative and qualitative information. To measure the impact of nutrition-oriented programs/projects, i.e. self-standing nutritional programs/projects and nutrition-related programs/projects, it is necessary to collect quantitative information. Therefore, projects/programs must start with a baseline survey, and such survey must be repeated periodically.
Self-standing nutrition projects/programs
are directly targeted for an improvement of the nutritional situation of
the population. Nutrition-related programs/projects may belong to
the agricultural sector (in terms of producing, processing and storing
of food; food hygiene and quality control as well as regional development
in rural areas), health care, nutritional security, urban
development and urban planning. These programs/projects have
objectives related to the particular subject, but the improvement of the
nutritional situation is stated as an overall objective or positive
impact in program/project planning. Therefore, the program/project
should be evaluated as to whether its impact on the nutritional situation
is positive, neutral, or negative.
This document is not a text book which teaches the inexperienced reader how to organize and implement a nutrition survey. Certainly, there is information available in the guidelines with which some readers are very familiar. However, the pertinent chapter should be read to ensure that the survey is carried out using a consistent standardized method.
This publication has the following structure:
The following individual activities are part of the process of a baseline survey:
To illustrate this even more vividly: if, while collecting data on 500 children, only one case of eye abnormality caused by vitamin A deficiency is discovered - in which case the sampling is indisputably too small to derive a scientifically supportable conclusion concerning this (health) problem - vitamin A deficiency should nevertheless be considered in project planning. This potential cause-effect relationship must then be followed up in greater detail no later than during the first implementation phase of a project or program (orientation phase).
During the assessment of the nutritional situation of a community, a baseline survey provides information about the nutritional problems in individuals. Therefore if, for example, a child is identified as undernourished, the child must be sent to the nearest available health service for further examination. Before commencing a survey, arrangements must be made with the local health service. Many surveys have shown that both communities and health services have been extremely cooperative in adopting such an arrangement.
The objective of a nutrition survey is not only to obtain information on the nutritional situation of a community in a survey area, but this information should be fed back to serve the needs of individuals in the community.
A nutrition survey takes place in 5 steps:
1.3 Target group of the guidelines
As explained before a nutrition survey
has several objectives and the guidelines is a tool to reach these objectives
adequately. However, it cannot be expected that all there is to know about
carrying out a survey can be taught by means of a handbook. It is only
able to set guidelines and standardize procedures. These guidelines have
therefore been written for an experienced community or public
health nutrition specialists who possess already a basic knowledge
in nutritional epidemiology and practical experiences in survey technic.
It is designed so that the user can extract the relevant sections corresponding
to the project types, phase and needs.
1.4 Types of surveys
There are four types of nutrition surveys; each is important for a different type of project or a different phase of a project.
Both types of surveys are suitable
for a pre-feasibility study for the assessment of the nutritional situation.
One of these two types of surveys should be used for identification of
the project during the planning phase.
- Felt needs by the community
- Demographic data of the households
- Socioeconomic factors
- Signs of malnutrition and disease
- Nutrition and health practices.
A project starts with a project idea and ends when its main objective has been achieved. This objective, or objectives should be planned jointly by all involved parties including the community. The project lifetime can be subdivided into phases, such as identification, conceptualization and implementation. The baseline survey is an instrument for the development of a project strategy.
Figure 1. Project Cycle for nutrition-
and poverty-oriented projects/programs
|Project indentification||¯||Pre-feasibility study (e.g. RAN)|
|Decision about project purpose|
|Poject design (conceptualization)||¯||Baseline survey and participatory planning (e.g. ZOPP)|
|Decision about projects strategy|
|Project implementation||¯||Follow-up survey and participatory planning (e.g. ZOPP)|
|Decision about project strategy adjustment|
|Project redesign and implementation||¯||Follow-up survey and participatory planning (e.g. ZOPP)|
|Desired project impact|
RAN: Rapid Assessment on Nutrition
for Community-Based Poverty Alleviation Projects/Programs
ZOPP: Ziel-Orientierte Projekt-Plannung (objective-oriented project planning)