Indicators to monitor the implementation of the ...

1 22/10/2010 Indicators to monitor the implementation of the comprehensive implementation planDefinition Rationale for the choicePrimary DataSecondary DataRemarks1) Biological outcome Incidence of low birthweightWeight at birth of < 2500 grams ( pounds) At population level, the proportion of infants with a low birth weight is an indicator of a multifaceted public health problem that includes long-term maternal malnutrition, ill health, laborious work and poor health care in National Surveys- DHS - MICS- UNICEF (ChildInfo)A very important indicator that is difficult to collect in populations with low hospital delivery of underweight children below five years of ageWeight-for-age < 2 standard deviations (SD) of the WHO Child Growth Standards medianEvidence has shown that the mortality risk of children who are even mildly underweight is increased, and severely underweight children are at even greater National Surveys- DHS - MICS- Surveillance systems- WGDCGM- UNICEF (ChildInfo)

2 This is the most commonly collected growth index yet it is a composite one that does not distinguish between acute and chronic of stunted children below five years of age Height-for-age < 2 standard deviations (SD) of the WHO Child Growth Standards medianStunting is the result of long-term nutritional deprivation and often results in delayed mental development, poor school performance and reduced intellectual National Surveys- DHS - MICS- Surveillance systems- WGDCGM- UNICEF (ChildInfo)Height has been measured in all recent of wasted children below five years of age Weight-for-height < 2 standard deviations (SD) of the WHO Child Growth Standards medianWasting in children is a reflection of acute undernutrition, usually as a consequence of insufficient food intake and/ or a high incidence of infectious diseases, especially diarrhoea.

3 - National Surveys- DHS - MICS- Surveillance systems- WGDCGM- UNICEF (ChildInfo)This is a sensitive index of short-term events ( famines, ).Proportion of overweight children below five years of age Weight-for-height > +2 standard deviations (SD) of the WHO Child Growth Standards medianChildhood overweight is associated with a higher probability of overweight in adulthood, which can lead to a variety of disabilities and diseases, such as diabetes and cardiovascular diseases. - National Surveys- DHS - MICS- Surveillance systems- WGDCGMA relevant indicator given the double burden of malnutrition in children under 5 and obtained at no extra cost in nutrition surveys that measure weight and of thin school-age children and adolescents (5-19 years)Degrees of thinness categorized on the basis of Body-mass Index (BMI):- Thinness: BMI for age < 2 standard deviations (SD) of the WHO 2007 Reference median- Severe thinness.

4 BMI for age < 3 standard deviations (SD) of the WHO 2007 Reference medianAdolescent thinness is sensitive to short-term changes and should therefore be included in annual surveillance protocols in areas where the condition is prevalent or where timely warning systems relate to undernutrition caused by excessive dieting and eating disorder, including anorexia nervosa, and in populations with high HIV seropositive prevalence. - National Surveys- DHS - Surveillance systems- GDGSCAIn emergency situations, immediate action is required to identify those at greatest risk of death from starvation ( pregnant or lactating adolescents).

5 Also thin or undernourished adolescents identified in PHC or public health settings could be given nutritional guidance or referred for further evaluationProportion of overweight school-age children and adolescents (5-19 years)Overweight: BMI for age >+1 standard deviations (SD) of the WHO 2007 Reference median (equivalent to BMI 25 kg/m2 at 19 years)Obesity: BMI for age >+2 standard deviations (SD) of the WHO 2007 Reference median (equivalent to BMI 30 kg/m2 at 19 years)Childhood obesity is associated with a higher probability of obesity in adulthood, which can lead to a variety of disabilities and diseases, such as diabetes and cardiovascular diseases.

6 - National Surveys- DHS - Surveillance systems- GDGSCAThis is an important indicator to monitor given increasing rates of overweight and obesity in both developed and developing of thin women of reproductive ageDegrees of thinness categorized on the basis of Body-mass Index (BMI)BMI - = mild thinness BMI - = moderate thinnessBMI < = severe thinnessThe nutrition and health of adults are of particular importance as they are the age group that is primarily responsible for the economic support of the National Surveys- DHS - Surveillance systems- GDBMIP roportion of overweight and obese adults BMI = overweightBMI = obesityOverweight and obesity are major determinants of many noncommunicable diseases, including non-insulin-dependent diabetes mellitus, coronary heart disease and stroke, and increases the risks for several types of cancer, gallbladder disease.

7 Musculoskeletal disorders and respiratory symptoms. They have a high cost not only in terms of premature death and health care but also in terms of disability and a diminished quality of life. - National Surveys- DHS - Surveillance systems- GDBMIThe list of Indicators is only presented as an initial proposal for consideration by Member States. Not all these Indicators have been fully evaluated by WHO for feasibility of data collection, limitations in interpretation, usefulness for monitoring and evaluating evidence-informed nutritioninterventions considering the life-cycle approach to health and nutrition. The selection of adoption of these suggested Indicators should consider in-country' stakeholders engagement, understanding of the integrated nutrition and health programmes, the focus of the efforts and maturity of the programmes roll-out, the data availability.

8 And mostly the users needs for data to improve implementation or delivering of nutrition actions through effective policies and of 622/10/2010 Indicators to monitor the implementation of the comprehensive implementation planDefinition Rationale for the choicePrimary DataSecondary DataRemarksThe list of Indicators is only presented as an initial proposal for consideration by Member States. Not all these Indicators have been fully evaluated by WHO for feasibility of data collection, limitations in interpretation, usefulness for monitoring and evaluating evidence-informed nutritioninterventions considering the life-cycle approach to health and nutrition.

9 The selection of adoption of these suggested Indicators should consider in-country' stakeholders engagement, understanding of the integrated nutrition and health programmes, the focus of the efforts and maturity of the programmes roll-out, the data availability, and mostly the users needs for data to improve implementation or delivering of nutrition actions through effective policies and of children below five yeasr of age with Hb concentration of <11 g/dLChildren 6-59 mons with Hb < 11 g/dL at sea levelAnaemia is associated with increased risks of child National Surveys- Local studies- DHS - MICS- VMNISThe finger-prick blood sample test to measure Hb concentration is easy to do in the field.

10 Cost of equipment may be of adolescent girls with Hb concentration of <12 g/dL- Pregnant women with Hb < 11 g/dL at sea level- Non-pregnant women (age 15+ yrs) as Hb < 12 g/dL at sea levelAnaemia is associated with increased risks of maternal mortality. Iron-deficiency anaemia is the most prevalent micronutrient deficiency that reduces the work capacity of individuals and entire populations, with serious consequences for the economy and national National Surveys- Local studies- DHS - MICS- VMNISThe finger-prick blood sample test is easy to administer in the field. The test could be easily integrated in regular health or prenatal visit to capture all women in reproductive ages.