Previous - Next
A. Users and purpose
B. Goals
C. Program benefits
D. Using this manual
This manual is intended for
experienced health professionals interested in food-related
public health problems. It describes a protocol developed to
understand natural food sources of vitamin A: their availability
and use, cultural beliefs surrounding their use, and community
perceptions about food and vitamin A deficiency.
The purpose
of the assessment described in this manual is to provide
essential information for program planning aimed at increasing
consumption of vitamin A-rich food among populations at risk for
deficiency. It gives careful and complete guidance that can be
followed by researchers not generally familiar with ethnographic
approaches to data-gathering. There are several steps to the
protocol which incorporate techniques in public health,
anthropology, and field-based nutrition. Not all steps will be
equally important to all readers or situations where the protocol
is implemented. Thus, it is intended that these guidelines can be
adapted to provide necessary information in a wide variety or
settings.
Steps in the protocol are
intended to achieve the following interrelated goals within a
local community food system:
1. Identify significant sources of preformed vitamin A and carotene-rich food in the context of the local food system.
2. Describe patterns of food consumption especially for vitamin A-containing food, particularly with respect to infants, young children, and women of reproductive age.
3. Identify cultural beliefs that influence food choice and consumption patterns.
4. Identify cultural, ecological and socioeconomic factors that constrain or facilitate consumption of vitamin A.
5. Describe the community explanations and understandings of vitamin A deficiency diseases and symptoms.
For each step, the manual defines research questions to be addressed, and guidance on how to collect field data on the forms which are provided. The entire protocol can be completed by a field team of three in a period of six to eight weeks.
As outlined in many policy-relevant documents, food-based interventions are best seen as one component of a multi-stranded strategy to reduce vitamin A deficiency. Together with other types of interventions (such as vitamin A supplement distribution and food fortification with vitamin A, improving consumption patterns of local food resources containing vitamin A can help reduce the burden of morbidity and mortality associated with inadequate intake of this essential nutrient. Food-based interventions are viewed as those most likely to be sustained, provided the culture and ecology of the vitamin A-containing foods are addressed in programs based in agriculture, food processing, social marketing, and public health education.
It is understood that food carries many nutrients, and that when communities are at risk for vitamin A deficiency, they may be at risk for other nutrient deficiencies as well. The scientific issues of nutrient composition of food as consumed, and of dietary evaluation of those vulnerable to vitamin A deficiency, are particularly complex for vitamin A. While some steps in the protocol can contribute to knowledge of general food use and nutrition, others are specific to issues of vitamin A in food, and the cultural context of the use of these food sources. To understand vitamin A in food as consumed in communities vulnerable to deficiency, the complex issues are broken down into component parts, and each is addressed in turn-this is a particular strength of the protocol.
The
assessment will give several perspectives on dietary change, some
of which will be specific to vitamin A nutrition. Understanding
the elements of food availability, food choice and consumption
patterns will set the stage for understanding how consumption of
vitamin A-rich food can be improved. For example, steps in the
protocol will help to define the food history of the area,
migration patterns of the people, where and how food items no
longer used to a great extent can still be harvested, and ability
to access food available in markets. This information together
with cultural food beliefs and practices is especially important
in programs based in agriculture, public health, social
marketing, and nutrition education.
This manual is intended for
distribution to national and regional ministries and NGOs for
decisions on implementing the protocol in local areas. Following
the assessment described here, recommendations for effective
strategies in a variety of sectors can be defined to improve
vitamin A nutrition in vulnerable groups. The activities
resulting from this research will be directly applicable to the
community in which the research is conducted. However, adaptation
to broader regions is possible with program planning and
development. While national health planners and vitamin A
programs obviously cannot conduct the ethnographic protocol in
every ethnic group and region in a country, the local
circumstances so described by the protocol give essential
rationale for program guidelines and activities.
Ultimately,
programs to improve community food use and nutritional status for
vitamin A are more likely to be effective and sustainable when
local circumstances are considered with credible and useful data,
and when the program is implemented locally.
This manual is to assist in
the definition of the assessment, the organization of the
protocol, the guidance of how to complete the procedures of data
collection and analysis, and the preparation of the report. The
Table of Contents clearly shows how to find each of these components.
Part One describes the protocol: the questions addressed, the design and timing, and the actual steps to complete before and during the fieldwork phase. Before field work begins, the steps to complete are site selection, background research, and document review on the historical, ecological, and cultural setting for the food system. Field activities include key-informant interviews, creating family food lists, market surveys, creating food system data tables, conducting structured interviews with mother-respondents, and six research modules to define food use and cultural beliefs among the mothers. Guidance on interpreting results and preparing the assessment report is also provided here.
Part Two describes how to manage the project, and contains several sections on how to complete some of the procedures. It gives guidance on selecting personnel, providing translation, and general administration preparation. Also provided are "how to" sections needed to complete the research steps. For example, how to complete the family food list and select key foods from it for more detailed study; how to identify food plant and animal species and search for their nutrient content; and how to use a computer to manage the data.
Thirteen appendices give a variety of useful information to assist data collection, management and interpretation. Examples from the five field test sites are given in this section, and a glossary of terms is presented.
In each step, the forms for use in data collection are provided. These are on separate pages and can be copied so there are enough for each step of the protocol by members of the research team and for each respondent.
Inside the
front and back covers of the manual, photographs describing the
eye signs of clinical vitamin A deficiency are given in order to
complete research Module 6 with mother-respondents.