Chapter9

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Nutrition indicators for development: Priority and intervention efforts

Ma. Patrocinio E. de Guzman and Wilma L. Molano

Nutrition indicators are commonly used to measure the progress of development programmes and projects. They are used by planners and policy makers to establish baseline values, to focus attention on the problems of nutrition, and to identify development projects for nutritionally at-risk groups of the population. The selection and identification of nutrition indicators should be based on precise criteria: measurability, appropriateness, comprehensiveness, relevance, sensitivity, and impact orientation. The Philippines used five nutrition indicators in the update of the Philippine Development Plan, 1990-1992: percentage of preschool children with weight less than 75% of the standard weight for age, percentage of schoolchildren 7-10 years old with height less than 90% of standard height for age, percentage of schoolchildren 7-10 years old with weight less than 75% of standard weight for age, per capita energy intake, and percentage of households with energy intake less than 100% adequacy. These indicators were selected on the basis of their sensitivity, simplicity, and usefulness in appraising the effects of nutritional interventions and the ease of data collection.

Nutrition indicators for development

Efforts to correct malnutrition have traditionally relied on direct nutrition intervention programmes. However, limited success and the high costs of these programmes have restricted their use. Although they may be effective in preventing selected nutritional problems, the overall problem of energy and protein deficiencies among large population segments can be solved only through economic and social development. Failure to consider nutritional goals explicitly in development plans, strategies, projects, and policies may worsen the overall nutrition situation, despite improvements made by direct intervention programmes.

Including nutritional goals in development plans and strategies requires knowing the true condition of an individual, community, or country on the basis of information derived from nutrition indicators. These indicators should be available to planners for establishing baseline values and for focusing their attention on the problems affecting a population. With such data the planners and policy makers can identify development programmes and projects that will benefit the less fortunate, and monitor the progress of development projects in meeting this aim.

Selecting indicators

Nutrition indicators should be selected and identified on the basis of an organized and precise set of criteria.

The United Nations Research Institute for Social Development has presented the following five criteria [1] which can be used by any country:

The availability or obtainability of acceptable data. This might seem quite obvious, but much effort has been spent in elaborating theoretical lists of ideal indicators for which reliable statistics cannot be found and for which no feasible method of data collection is offered or evident.
Validity. An indicator should make sense conceptually by virtue of its composition, structure, and performance. That is, its value should be consistent with other data and with common sense. If it measures factors other than those intended (even if the unintended factors have an important impact), it will be of little value.
Comparability of operational and theoretical definitions. Different operations to measure the same object, even with the same basic indicator, often yield different data for the same area or population at the same period. In some cases differences due to different operations may not be so great as to require discarding the data, but in other cases some data may have to be suppressed in order for the indicator to be used; otherwise, comparability may be compromised far beyond what is acceptable. For example, measurements of height made with different types of instruments can result in unreliable data; this may be suspected especially when percentages of stunting over the years appear questionable.
Degree of association or correlation of a particular indicator with other development indicators. In principle, socio-economic indicators should be well correlated with one another.
Balance among sectors and generally between socioeconomic and nutrition indicators. This criterion is relevant when overall measurement of development covering both social and economic sectors is a goal. This means avoiding unnecessary overlap and undue proliferation of indicators.

Another set of criteria for selecting critical key indicators was used in the 1987 Economic and Social Impact Analysis and Women in Development (ESIA/WID) project in the Philippines [2]:

Measurability. The indicator must be capable of being expressed in terms of quantitative measures.
Appropriateness. The indicator must be capable of measuring a specific attribute or characteristic for the purpose of determining the extent to which an objective has been obtained.
Comprehensiveness. The indicator should incorporate as much information on a given area of concern as feasible.
Relevance. The indicator should be responsive and relevant in its attempt to monitor existing policy objectives.
Sensitivity. The indicator should reflect actual changes in absolute levels or trends related to the aspects of conditions implicit in the goals or areas of concern.
Impact orientation. The key indicator measures final impact/outcome rather than inputs.

In the ESIA/WID project, indicators were categorized into two groups: key indicators, which meet all the six criteria given above, and supportive indicators, which satisfy the criteria on measurability and appropriateness.

The following five steps, which have been identified for selecting indicators relevant for analysing economic development, could be adopted in selecting nutrition indicators for any development effort: (1) compilation of initial variables after review of published statistical series, (2) elimination of those with insufficient data or conspicuous defects or that do not distinguish between developed and developing countries, (3) a second reduction of variables based on duplication, (4) a third reduction to a reservoir of indicators, and (5) a final selection of a set of core indicators.

FAO Indicators

In 1983 Dr. R. U. Quereshi, regional Food Policy and Nutrition Officer of the FAO Regional Office for Asia and the Pacific, convened a consultation of nutrition experts from the region which identified the following four nutritional measurements as indicators for development [3]: birth weights, heights and weights of children, dietary scores, and affordability of a survival ration. The corresponding variables were birth weights, weights for heights of children at age of school entry (i.e., at 6-7 years of age), 24-hour recall of food intake during the final year of primary school, and the cost of 1,600 kcal from the staple cereal, represented as a proportion of the average daily income in various regions of the country.

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