Nutritional Assessment Methods

Demographic Analysis

• Demography is the study of population characteristics, including population size, growth, and age structure.
• Factors that influence population change include fertility, mortality, migration, marriage, and social mobility.

Population Characteristics

• Include size, density, composition (age, sex, ethnicity, marital status, education, occupation), geographic distribution, population growth, and urbanization.
• Population growth rate is the percentage change in population size over a year.

Malaysia Population Profile

• Age and sex distribution for 1990, 2000, 2010, 2020, and 2050 show a changing population structure.
• The total fertility rate, age at first marriage, proportion ever married, and life expectancy at birth are important demographic indicators.

Factors Leading to Changes in Population Characteristics

• Fertility indicators include total fertility rate, age at first marriage, and proportion ever married.
• Mortality indicators include life expectancy at birth, crude death rate, maternal mortality ratio, and infant, toddler, and under-five mortality rates.
• Migration indicators include internal and international migration.

Socio-Economic Consequences of Changes

• Changes in population size, growth rate, and age structure affect economic development, health outcomes, mobility, and disease.
• Nutrition and demographic changes are interconnected, with good nutrition reducing maternal, neonatal, and child mortality.

Nutrition Assessment Methods

• Direct methods include anthropometric, biochemical, clinical, and dietary evaluation methods.
• Indirect methods include ecological variables, economic factors, and vital health statistics.

Vital Statistics

• Dependency ratio measures the proportion of a population composed of dependents (too young or too old to work).
• Child dependency ratio (young-age index) and aged dependency ratio (old-age index) are components of the dependency ratio.

Fertility Indicators

• Crude Birth Rate (CBR) is a measure of fertility, with a CBR of >30 per 1000 indicating a high fertility rate.
• Total fertility rate is a better measure of fertility than CBR.

Demography and Population Profiles

• A population profile is a descriptive summary of a population's characteristics, including demographic, socioeconomic, and health-related factors.
• Demography is the study of population characteristics, including size, structure, distribution, and growth.

Indirect Indicators of Nutritional Status

• Vital statistics are records of births, deaths, and disease occurrences, used to estimate nutritional status.
• Examples of indirect indicators include:
  • Birth weight and length
  • Infant mortality rates
  • Prevalence of micronutrient deficiencies
  • Mortality rates by age and sex

Calculating Disease Burden

• Incidence: the number of new cases of a disease occurring in a population over a specific time period.
• Prevalence: the total number of cases of a disease existing in a population at a specific point in time.
• Burden of disease: the total impact of a disease on a population, measured in terms of mortality, morbidity, and disability-adjusted life years (DALYs).
• Techniques to calculate incidence, prevalence, and burden of disease include:
  • Cohort studies
  • Case-control studies
  • Cross-sectional studies

Quantitative and Qualitative Methods

• Quantitative methods involve objective, numerical measurements, such as surveys and experiments.
• Qualitative methods involve subjective, non-numerical data collection, such as focus groups and interviews.
• The choice of method depends on the research question, available resources, and the level of precision required.

Qualitative Methods in Nutritional Status Assessment

• Qualitative methods are used to gather in-depth information on people's attitudes, beliefs, and behaviors related to nutrition.
• Examples of qualitative methods include:
  • Focus groups
  • In-depth interviews
  • Observations
  • Content analysis

Focus Groups in Nutrition Surveys

• Focus groups are small, facilitated discussions with 6-12 participants, used to gather qualitative data on specific topics.
• In nutrition surveys, focus groups can be used to:
  • Identify dietary patterns and habits
  • Understand food choices and preferences
  • Explore attitudes towards nutrition and health

Basic Techniques for Demographic Analysis and Sociologic Analysis

• Sociological Research Methods:
  • Definition: The science that interprets the meaning of social action
  • Studies human social behavior, especially the origins, organization, institutions, and development of human society

Sociological Research Methods – Quantitative vs. Qualitative Methods

• Quantitative Methods:
  • Approach social phenomena through quantifiable evidence
  • Rely on statistical analysis to create valid and reliable general claims
  • Seek to uncover universal principles
  • Designed around the ability to infer from a sample to a larger population
• Qualitative Methods:
  • Emphasize understanding social phenomena through direct observation, communication with participants, or analysis of texts
  • Fundamentally an interpretive effort that is context-dependent
  • Designed around the ability to interpret a phenomenon from an insider and outsider perspective
  • May stress contextual and subjective accuracy over generality

Sociological Research Methods – Strengths and Weaknesses

• Quantitative Methods:
  • Strengths: Statistical analysis allows for generalization to some extent
  • Weaknesses: Difficulty in choosing an adequate number of samples that represent the population
• Qualitative Methods:
  • Strengths: Different methodologies can be used to execute research
  • Weaknesses: Subjectivity, difficulty in replicating results, and built-in researcher bias

Sociological Research Methods – Types

• Quantitative Methods:
  • Anthropometric measurements
  • Biochemical determinations
  • Dietary intake assessment
  • Physical activity assessment
• Qualitative Methods:
  • In-depth interviews
  • Focus group discussions
  • Document study
  • Field research (participant observation)

Qualitative Methods

• Used to study aspects of nutritional status that cannot be measured quantitatively (e.g. psychosocial aspects, family dynamics)
• Techniques:
  • In-depth interviews
  • Focus group discussions
  • Observations
  • Document study
  • Field research (participant observation)

Focus Group Discussion (FGD)

• Definition: A carefully planned discussion to obtain perceptions of a defined area of interest
• Six "W"s:
  • What: Carefully planned discussion
  • Where: Non-threatening environment
  • Who: 7-10 people with common characteristics
  • Why: Determine feelings, perceptions, beliefs, and attitudes
  • When: Before, during, or after a program
  • How: Conducted by a trained interviewer (moderator, facilitator)

FGD Session

• Systematic notification procedures:
  1. Set meeting times for interviews
  2. Contact potential participants by phone or in person
  3. Send personalized invitations
  4. Phone participants the day before the meeting
• Facilitator's role:
  • Lead the group
  • Formulate questions
  • React neutrally to comments
  • Avoid expressing personal opinions
  • Encourage participation
• Recorder/Observation role:
  • Takes notes during the discussion
  • Observes group dynamics, level of participation, and distractions
  • Notes personal impressions and observations
  • May participate in the FGD session### Data Analysis
• When analyzing focus group data, consider the following factors:
  • Words used by respondents
  • Context of the responses
  • Internal consistency of the responses
  • Frequency or extensiveness of comments
  • Intensity of the comments
  • Specificity of responses
• The goal is to find the big ideas or key themes that emerge from the data

References

• Num SF, Basic Techniques for Demographic Analysis and Sociologic Analysis - Lecture Slides, 2015
• Khor GL, Basic Techniques for Demographic Analysis and Sociologic Analysis - Lecture Slides, 2013
• Zalilah MS, Khor GL, Sarina S, et al, The relationship between household income and dietary intakes of 1-10 year old urban Malaysian, Nutr Res Pract, 2015;9(3):278-287
• Department of Statistics, 2022

Is this an adequate summary? Did we or have we missed anything?