Presented by

Elliot Vhurumuku – Regional VAM (Senior Food Security Advisor), WFP Regional Bureau for East and Central Africa

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

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

15 – 17 November 2017, Brussels, Belgium

Presentation outline

Introduction & Assessment Process

Sampling Issues

Key lessons learnt Summary

Analysis Considerations

IntroductionAcknowledgement 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)

https://www.wfp.org/content/technical-guidance-joint-approach-nutrition-and-food-security-assessment-janfsa

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

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

The Joint assessment process

1. Preparatory Phase

2. Data collection

3. Post-data collection

4. Dissemination

1b. Sample Design (Nutrition and food security)

1c. Development of joint data collection tools

1d. Securing Equipment (anthropometric measurement & vehicles)

1e. Enumerators training

2a. Field data collection 2b. Data quality control

3a. Data entry

3b. Data cleaning

3.c Data analysis and interpretation

4.b Report writing

Lessons learned

4.a Presentation of preliminary findings

4.c Distribution of report and plan coordinated response

1a. Concept note

1f. Field test instruments and refine

Data quality control

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

JOINT SAMPLING CONSIDERATION

1. Set and agree on the Objectives

FINAL Sample size for JANFSA

4. In each stratum, Pick the highest sample size between (2)

and (3)

3. Calculate Food security sample size (HHs) using

key outcome indicators

2. Conversion children’s sample HH sample

1. In each stratum, calculate children’s

sample size in each stratum

0. Define strata

In the event of financial constraints, a discussion over acceptable precision ranges must take

place

Core Indicators for Joint nutrition and food security

Co

re In

dic

ato

rs

Household level Individual 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

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

Anthropometry of children 6-59 months:

Weight for Height, Weight for Age, and Height for Age

MUAC

Bilateral oedema

Anthropometry of PLW: MUAC

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)

Optional Indicators

Op

tio

nal

Ind

icat

ors

Household level Individual level

Market/financial opportunities: Distance

Access credit

Debt

Food Insecurity Experience Scale:

Food insecurity experience scale

Shocks:

HH affected by main shocks

Nutritional status of women in the reproductive age

(15-49 years): BMI

MAUC

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 12-59 months)

Hand washing: Hand washing practices of the primary care giver

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

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.

Linkage Analysis example

Household level Individual level

HH food consumption is associated with wasting and stunting?

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)}?

HH coping strategies are associated with wasting and stunting?

Children consumption (MMF, MDD, MAD, iron rich food) is related to household wealth?

HH food share expenditure is associated with wasting and stunting?

Children consumption (MMF, MDD, MAD, iron rich food) is related to education of primary caregiver?

HH food security status is associated with wasting and stunting?

Care practices (IYCF) is associated with wasting and stunting?

Introduction of complementary feeding at the age of 6 to 8 months is related to HH food security?

Child nutritional status is associated with disease?

Examples of results generatedExample of Linkage between Food Security and Nutrition

Nutrition

indicators

Children status

in household

Food

Secure

Mild

food

secur

e

Modera

te food

insecure

Severe

food

insecur

e

Chi-

Squar

e

P

value

Wasting

None 93 91 92.1 86.8

At least one

child 7 9 7.9 13.2 5.918 0.116

Stunting

None 78.1 71 71.7 77.1

One child 17.6 21.7 22.4 16 11.974 0.063

Two or more

children 4.3 7.4 5.9 6.9

Underweight

None 83.6 77 77.9 75.7

One child 14 17.1 18.1 16.7 15.1180.019

*

Two or more

children2.4 5.9 3.9 7.6

MUAC

None 95.4 91 92.7 91.7

At least one

child 4.6 9 7.3 8.3 7.797

0.050

*

*statically significance [X2=15.118, P=0.019 <0.05] and [X2=7.797, P=0.05 =0.05].

Example of association of nutrition at household level

Wasting Stunting Underweight MUAC

I. Food Share of Total Expenditure, Shocks, and Coping Strategies

CSI

Food expenditure share

Number of income sources

Number of coping strategies

Number of shocks experienced by the Household

II. Demographics

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

III. Household Socio-economic Characteristics

Wealth quintal

Toilet facility

Safe drinking water

Land size category in hectares

TLU ownership- total livestock

Significantly associated

Examples of results generatedCausal Models to Address Interactions Conceptual Framework for the analysis of

malnutrition filled

Nutritional Status

Mortality

Health Status/

Disease

Individual Food

Intake

Household

Food AccessHealth and Hygiene ConditionsCare /Health

Practices

HH Food Production, Gifts, Exchange, Cash Earnings, Loans, Savings, Transfers

• Global Acute Malnutrition = 5,5% • Chronic Malnutrition = 48,8%• Underweight = 25,8%

• Impact - fever:. 51%• Impact - IRA: 45%• Impact - diarrhea: 25%• Fever + diarrhea + IRA: 12%

• 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%

• 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%

• 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%

Natural Physical Human

Economic Social Capital/

Assets

• Acreage: 0.5 ha/household• Density: 310 inhabitants per km2

• Drought and recurring water deficit• Other shocks: floods,• Recent and frequent displacement

• 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

• Subjective poverty: 65%• Economic growth rate : 4%• Population growth rate: 3%• Average inflation rate: 10%• Food balance sheet: Deficit 51%

Challenges of combining nutrition and food security assessments and analysis

Sample size & Precision Level of precision for nutrition indicators higher than what is needed for

food security indicators Increased sample size and resources.

Timing Timing of the assessment taking seasonality issues, national surveys and

information requirements.

Training Longer training days for interviewers and anthropometric measures.

Specialized expertise Higher level of expertise required when compared to separate assessments.

Analysis Agreement on the analysis plan required at the planning stage (same team

all along).

Interview length Interview entails administration of child questionnaire and a household

questionnaire sequentially. Administration time from 40-60 minutes.

Data management 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.

Coordination Planning for a joint assessment requires greater coordination which can be

challenging.

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

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

Thank you!