ND 202 LEC.pdf

LESSON 1: DEFINITION OF TERMS RELATED TO 2. Provide baseline data planning and evaluation of NUTRITIONAL ASSESSMENT programs. 3. Help identify...

LESSON 1: DEFINITION OF TERMS RELATED TO 2. Provide baseline data planning and evaluation of NUTRITIONAL ASSESSMENT programs. 3. Help identify the responsibilities of the public health Definition of Terms system at all administrative levels. 1. Nutritional Assessment - The interpretation of information obtained from ** an assessment should be done first as evidence if the dietary, biochemical, anthropometric, and clinical program is necessary studies. - The information is used to determine the health status Types of Nutritional Assessment Systems if individuals or groups as influenced by their intake 1. Nutritional Survey (also known as cross-sectional survey) and utilization of nutrients - Establishes baseline nutritional data and/or determine - The process through which the nutritional health of an the overall nutritional status of the population; identify individual is evaluated, specific nutrient needs is and define population sub- groups at risk of chronic estimated and plans for nutrition intervention are malnutrition and less likely to identify acute malnutrition. determined. - Information obtained are used to allocate resources to ** used to evaluate the nutritional status of an individual or the population groups identified in need and to formulate group of people policies to improve the overall nutrition of the ** will be the basis on making the diagnosis on a nutritional population. problem, then will be used to make an intervention or program - Ex. Philippine National Nutrition Survey or Expanded policies in order to eradicate malnutrition or any nutritional National Nutrition Survey problem found **conducted at a one time shot 2. Nutritional Status - The condition of the body resulting from intake, 2. Nutrition Surveillance absorption, and utilization of food. - Continuous monitoring of the nutritional status of - Refers to severe, moderate, normal, mild, overweight, selected population groups to assess change over time. and obese for the weight measurement and either - Data are collected, analyzed and utilized for an extended normal, tall or stunted height period of time. Also, can identify the possible causes of malnutrition and hence, can be used to formulate and Under nourishment - poor intake of food initiate intervention measures at the population or Over nourishment - over intake of food subpopulation level. - Objectives include the promotion of decisions by 3. Community Assessment governments concerning priorities and disposal of - Paints a picture of the health of the community, its resources, formulation of predictions on the basis of ecology, and the factors influencing the way its people current trends, and evaluation of the effectiveness of live. nutrition programs. - It is the most practical method of obtaining an - Can be done on selected individuals, but the term overview of the nutritional status of a given "monitoring" is used. community. ** has an extended period of time, ex. group of people is 4. Nutritionally–at-risk groups assessed for months or years, better for accuracy - Refers to certain segments of the population which by virtue is age, physiologic status, occupation, or 3. Nutrition Screening geographic location, become more susceptible to - Identifies malnourished individuals needing interventions; nutritional disorders. can be done at the individual or specific population groups at risk. Reasons for Assessing the Nutritional Status - Compares an individual measurement with 1. In the Individual predetermined risk levels or cut-off points To establish the nature and etiology of the problem in order to provide the appropriate treatment and prevent Factors Affecting the Selection of the Design of Nutritional re-occurrence of the problem. Assessment System 2. In the community 1. Study Objectives To establish the extent and distribution of the problem Study objectives should be the major basis for and to determine the associated environmental factors in order selecting the design of the assessment system and the to provide appropriate health and nutrition services and measurement or indices. facilitate the implementation of preventive programs. 2. Sampling Protocol Necessary to avoid systematic bias in the sample Purposes of Nutritional Assessment selection, and to ensure that the sample is random and 1. Define nutritional problems that need attention; as an representative of the target population. Better to used integral part of situational analysis, it is the first step in probability sampling than non-probability sampling methods. the nutrition program planning and management cycle. 1 3. Validity How many are affected by the problem? Describes the adequacy with which any measurement Why does the problem exist? or index reflects the nutritional parameter of interest. What are the available resources in the area? 4. Precision ** if all of these are answered you can say that the assessment The degree to which repeated measurements of the is completed same variable give the same value. Also referred to as reproducibility. Does not influence the mean or median value. These steps are listed in sequence but the process is iterative It can be calculated as coefficient of variation. and circular than linear: CV = Standard Deviation x 100% mean 1. Justification and definition of the objective of the assessment 5. Random Measurement Errors 2. Preliminary appraisal and reconnaissance Caused by an insensitive instrument or variations in 3. Setting up a team the measuring and recording technique. Reduces the precision 4. Analysis of the causes of malnutrition in the population of a measurement by increasing the variability about the mean. 5. Consistency appraisal May occur when the same examiner repeats the 6. Assembly of existing data measurements (within, or intra-examiner error) 7. Data analysis and interpretation 8. Presentation of the results 6. Accuracy A term best used in a restricted statistical sense to Generalized Scheme for the Development of a Nutritional describe the extent to which the measurement is close to the Deficiency true value. It is possible that a measurement can be precise but at the same time inaccurate a situation which, occurs when Stage Depletion Method(s) used there is a systematic bias in the measurements. 7. Systematic measurement Errors or Bias 1 Dietary inadequacy Dietary Arise in any nutritional assessments methods that reduces the accuracy of a measurement by altering the mean 2 Decreased level in reserved tissue Biochemical store or median value. Bias cannot be removed by subsequent statistical analysis thus, it must be reduced and if possible 3 Decreased level in body fluids Biochemical eliminate all sources of systematic errors in the design of the nutritional assessment system. 4 Decreased functional level in Biochemical/Anthrop tissues ometric 8. Sensitivity The sensitivity of an index refers to the extent to 5 Decreased activity in nutrient- Biochemical which it reflects nutritional status or predicts changes in dependent enzyme nutriture. Sensitive indicates shows large changes as a result of only small changes in NS and as a result, have the ability to 6 Functional Change Behavioral/Physiolog identify and classify those persons within a population who are ical genuinely malnourished. 7 Clinical symptoms Clinical 9. Specificity The sensitivity of an index refers to the ability of the 8 Anatomical Sign Clinical index to identify and classify those persons who are genuinely well-nourished. Methods used in Nutritional Assessment Additional Factors affecting the design of Nutritional Direct Method Assessment Systems 1. Clinical Examination Respondent Burden 2. Biochemical Examination Equipment and Personnel Requirements 3. Anthropometry Field Survey and Data Processing Costs Indirect Method 1. Dietary Methods/Food Consumption Studies ** mas nahirapan respondent = high respondent burden 2. Studies affect nutritional Status = Vital Statistics, Food mas nahirapan measurer = low respondent burden Production, Health Data 3. Studies on non-nutritional variables = Birth order episodes of Steps in Conducting a Nutritional Assessments infectious diseases in early life In conducting nutritional assessment, a set of questions are answered: Direct Nutritional Assessment Methods Anthropometric Measurements Who are the malnourished? Measurement of different physical dimensions and gross What malnutrition problems exist? composition of the body Where are the malnourished? Varies with age (infantometer vs regular weighing scales) 2  Differs based on physiological and degree of nutritional LESSON 2: THE NATIONAL NUTRITION SURVEY status Essential component of clinical examination NATIONAL NUTRITION SURVEY Used to evaluate both under and over nutrition Provides information on past nutritional history which Department of Science and Technology -Food and cannot be obtained using other NSA techniques Nutrition Research Institute (DOST-FNRI) - the premier Research and Development Institute of the government in Clinical Assessment food, and nutrition and other S & T services. Medical history and physical examination - to detect signs and symptoms associated with malnutrition Legal Basis Essential feature of all nutritional surveys Executive Order 128 Section 22 Simple and most practical method of measuring The FNRI is mandated to undertake research that defines the nutritional status citizenry’s nutritional status, with reference particularly to the Utilizes physical signs, known to be associated with malnutrition problem, its causes and effects, and identify malnutrition and vitamins and micronutrients lack. alternative solutions to them; Functional Assessment Executive Order 352 Recommended to be part of a complete nutrition The national nutrition survey is a designated statistical activity assessment that will generate critical data for decision-making of the Recent consensus criteria for identification of government and the private sector. malnutrition include functional assessment Manual muscle testing and computed tomography scan Designated Statistical Activities assessment of lean tissue are other tods that show The National Nutrition Survey (NNS) is a promise in correlating functional and nutrition comprehensive survey conducted every five years assessments since 1978 and the latest of which is in 2013. In-between the five-year period, the Updating Survey Dietary Assessment of Nutritional Status of Children and Other First stage of malnutrition is identified using this method Population Groups is conducted every 2 to 3 years to Dietary intake of one or more nutrients is not optimal rapidly assess thenutrition situation of Filipinos. during malnutrition state due to change of nutrients in the diet Historical Background Indirect Nutritional Assessment Methods Ecological Factors Assessment Malnutrition and its integrational consequences are the end result of many interacting ecological factors Ecological information will complete the nutrition assessment Ecological factors are easier and more economical to collect Inclusion of ecological assessment, enables planner appreciate the real causes of malnutrition and are able to plan appropriate programs/intervention ○ Ecological variables e.g. crop production ○ Economic factors e.g. per capita income ○ Vital Health Statistics e.g. fertility index The range of information that can be included as "ecological variables" can be very extensive to be able to support the interpretation of the nutritional status Key is to select relevant information that can be most Survey Components easily and economically obtained Anthropometry Ecological variables collected should yield useful Biochemical information as specific as possible to be able to guide the Dietary planning actions Clinical & Health The comprehensiveness of the data to be collected Socio-Economic should depend on the purpose of the assessment Government Program Food Security Maternal Infant & Young Child Feeding 3 components in 1978 NNS 10 components in 2013 NNS 3 Sample Size 1978 NNS ➡ 2013 NNS Clinical and Health 2,800 Households 42,310 Households - Assesses the prevalence of elevated blood pressure, high 17,667 Individuals 181,384 Individuals fasting blood glucose and dyslipidemia, as well a behavioral risk factors such as smoking, alcohol consumption, physical Method of Data Collection inactivity and unhealthy diet. - Questionnaires - Measurement of blood pressure, collection of blood and - Surveys face-to-face interview - Interviews - Electronic Data Collection System Dietary - In person observation - Determines the quality and quantity of food and nutrient intakes of households and individual member of the sample Information Dissemination households. - website, infographic, seminars, reports, presentations - One-day food weighing (household) and 24-hour food recall *main target audience are policy makers & government (individual) institutions Food Security - Assesses food security at the household and individual level THE EXPANDED NATIONAL NUTRITION SURVEY (ENNS) as well as coping mechanisms and strategies. - face-to-face interview Rationale: Generation of National Nutrition Data Government Program Participation There is a need to generate Nutrition and Health Data - Assesses household’s and member’s participation in selected Annually at the National Level to cover key health and nutrition and related government programs. nutrition indicators and serve as basis for monitoring - face-to-face interview national programs Global commitment on health and nutrition Socio-Economic Characteristics of Households/ Individuals - Includes the education and occupation of the household Generation of local level data members, their type of housing unit, type of wall, roof and There is a clamor from the local government units ownership of different types appliances (LGUs), Congress, and other stakeholders for a local - face-to-face interview data estimates to be used for their development plan. There is a need to generate nutrition and health data Infant and Young Child Feeding for all provinces and Highly Urbanized Cities (HUCs) - Updates information on the feeding practices of Filipino Children 0-23 months old and other related factors affecting Adoption of New Master Sample feeding practices. Adopted the new Master Sample (MS) of the - face-to-face interview Philippine Statistics Authority (PSA) which will cover all 117 provinces and HUCs. Maternal Health and Nutrition ○ the sample households increased to fourfold - Determines health and nutrition of mothers with children 0-3 from the 2013 and 2015 surveys, thus could years old, their health-seeking behaviors and care giving not conduct the survey in a year. practices. In 2018, FNRI initiated a 3-year survey called the - face-to-face interview rolling survey and termed as ENNS (2018-2020) Who collects the data? General Objective Trained professionals: To provide empirical data on the nutritional and health status - Nutritionist-dietitians of Filipinos for planning nutrition and development programs, - Medical technologist and for timely policy decisions at the national and - Nurses provincial/HUC levels. - Other allied health professionals What and How are the data collected? Uses of Survey Results METHOD: Actual data collection To address nutrition problems by crafting policies and Anthropometry interventions - Measurement of physical growth (weight and height) and ○ Micronutrient Supplementation body composition (mid upper arm, waist and hip ○ Philippine Food Fortification Act of 2000 (R.A. circumferences) ○ 8976) - Measures the prevalence of underweight, underheight, ○ Asin Law (R.A. 8172) thinness, overweight and obesity ○ Republic Act No. 10351 (Sin Tax Law) ○ School Feeding Law Biochemical ○ The First 100 days Law - Assesses prevalence of Vitamin A Deficiency, Iron Deficiency ○ National Policies on Infant and Young Anemia and other nutrient deficiencies. Children (A.O.No.2005-0014) - Collection of blood and urine samples 4  For planning, targeting and implementing nutrition Sorsogon Northern Samar Mountain City of Tagulg and related intervention programs, goals and Province commitment Aklan Zamboanga Del Abra Quezon City ○ Sustainable Development Goal (SDG) Norte ○ Philippine Development Plan (PDP) ○ Philippine Plan of Action (PPAN) Sampling Design of the 2018 ENNS ○ The Food Fortification Program - 2013 Master Sample (PSA) Sampling domains: ** Monitor and evaluate the impact of nutrition intervention 81 provinces, 33 HUCs, 3 other areas (Pateros, Isabela City, programs Cotabato City **Tool in advocacy for policy Response to Sustainable Development Goals ( specifically 2 & 3) ○ 2 - Zero Hunger ○ 3 - Good Health & Well-being 2018 EXPANDED NATIONAL NUTRITION SURVEY Methodology Why did we change the design of the NNS? Provide Province and HUC Level estimates for local planning of specific and sensitive interventions. Response Rates for 2018 ENNS Provide reliable National Level Estimates annually Level Eligible Response Response Rate What is the Survey Design of the 2018 NNS? ROLLING SURVEY for 3 YEARS Household 52,285 45,957 87.9% 40 Provinces & HUCs for 2018 Individuals 196,332 159,926 81.5% 40 Provinces & HUCs for 2019 37 Provinces & HUCs for 2020 Target coverage per sampling domain is 1,536 households PSA Board Resolution No. 06 - Approving and Adopting the Survey Design of the Expanded National Nutrition Survey How did we select the provinces and HUCs to be included in the 2018 ENNS? Provinces and HUCs covered in the 2018 ENNS Cagayan Capiz Isabela City Maguindanao Valley Isabela llollo Province Cagayan De Butuan City Oro City Nueva Vizcaya llollo City Camiguin Oriental Mindoro Profile of Households Olongapo City Mandaue City Davao City City of Las Piñas Household Size ○ 5 members and below - 71.9% Zambales Siquijor Davao City of Makati Occidental ○ More than 5 members - 28.1% Place of Residence Bulacan Eastern Samar Sultan Kudarat City of ○ Rural - 48.5% Mandaluyong ○ Urban - 51.5% Laguna Tacloban City Caloocan City City of Manila Profile Of Household Heads Sex Camarines Western Samar Bagulo City City of San Juan ○ Male - 76.2% Norte ○ Female - 23.8% 5  Highest Educational Attainment ○ No education - 1.9% ○ Elementary Level - 31.6% ○ Secondary level - 43.7% ○ College level - 22.4% ○ Others - 0.3% Civil Status ○ Single - 6.7% ○ Married - 61.3% ○ Widowed - 14.5% ○ Separated - 4.1% ○ Common Law/Living in - 13.3% Engaged in Agriculture - 20.7% 2018 ENNS Population Groups 0 - 23 months - 4.4% 24 - 71 months - 10.8% 71 - 120 months - 10.2% >10-19 years - 17,7 % 20 - 59 years - 45.9% 50 years and over - 8.9% Women of Reproductive Age Pregnant Women - 3.8% ○ Adult - 4.2% ○ Teenage - 2.0% Lactating Mothers - 10.6% ○ Adult - 3.4% Teenage - 12.2% Non-Pregnant Women/Non-Lactating Mother - 85.6% ○ Adult - 94.6% ○ Teenage - 83.7% Sex Male - 47. 7% Female - 52.3% Ethnicity Indigenous People/IPs - 4.7% 6