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The procedures described in this manual are for assessing natural food sources of vitamin A and their effect on vitamin A deficiency in communities. The purpose of the assessment is to assist health personnel in developing programs at various levels to address vitamin A deficiency. Important outcomes of the research are suggestions for vitamin A interventions and policies, including recommendations for homecare messages for healthcare workers to employ when working with mothers. Using emic data, suggestions can be made for messages on vitamin A-rich food, and why this food should be consumed, and treatment for the stages of nutritional blindness. Conclusions about the various sources for vitamin A in the food system and information on perceptions and beliefs surrounding vitamin A-rich and staple food that can constrain or enhance intake, as well as food consumption patterns and behaviors, are the most important aspects of the report. Another outcome is the identification of and explanations for health-seeking behavior for the signs and symptoms of xerophthalmia.
The information in the assessment report should be presented in a clear and concise way. At the same time, it is critical to preserve the emic approach, including local terminology and cultural meanings attached to both the food that you have chosen to study and the signs, symptoms, and treatment for vitamin A deficiency diseases. Be sure to avoid direct conversion of local terms or concepts into Western (biomedical) terminology, as original meanings and concepts may be lost.
Organization of the Assessment Report
The team manager will determine the degree of detail required in the report and the amount of summary data to attach. This will depend on the intended reader(s) of the report and whether or not they are interested in the process of the assessment as well as the conclusions. The length of reports from this assessment can vary from ten to fifty pages, or more. This should be decided before writing the report.
The report should include the following sections:
1. Table of Contents.
2. Executive Summary. The executive summary should be no longer than three pages, highlighting key findings from the assessment. This summary should direct the reader to important sections of the report which warrant further attention. If any unusual findings or surprises were uncovered during the study, they should be mentioned in the executive summary.
3. Introduction. This section includes a description of the area in which the study was conducted along with a discussion of the study population and community resources. Important elements of the background data gathered are presented, with special note of existing information on the vitamin A situation in the area. Highlight the seriousness of the vitamin A problem, if known, and the need for intervention.
4. Procedures Followed. Summarize the procedures followed, which are contained in the data-gathering sections of this manual. You may choose to justify the use of this focused, somewhat rapid ethnographic assessment, because of the value of the results uncovered. See Appendix 11 for notes to asist with this section.
5. Questions and Answers Addressed in the Assessment. Each of the questions presented in Section I-A should be stated and answered. An assessment of how the results can be applied through vitamin A improvement interventions to the specific community and to locations beyond the research area should be made clear.
Since the report will be used by a variety of people from a range of backgrounds, these assessment findings need to be presented in a clear, succinct way. Because you are using a basic emic approach (see Glossary), it is also important that the richness of the data be preserved. The report therefore will include tables which capture the descriptive data, and summaries examining and explaining both the quantitative and qualitative data can be incorporated in the answers to these questions.
The summary tables and tabulations found at the end of each research procedure, as well as the field notes you have gathered from key-informant interviews, should be reviewed and thoroughly analyzed before responding to the questions. Results from all the data-gathering procedures (Sections II and IV of this manual) should be evaluated and integrated, providing the basis for answering the research questions. In order to give thorough and accurate responses, most questions require that you use data from various sources, including results from different procedures and findings from the interview and observation field notes. It also may be effective to use excerpts from in-depth interviews that capture local beliefs or illustrate practices.
6. Discussion and Recommendations. This section includes interpretation of all data from the assessment procedure and the identification of factors that constrain or enhance consumption or vitamin A-rich food, particularly among women and children. This section should clearly point to ways in which diets can be modified to improve vitamin A status in the context of the local ecology and culture. It includes discussion of factors affecting the intake and/or content of vitamin A-rich food such as cost, seasonality, food distribution, and preparation and preservation techniques. Try to be succinct and to the point when describing these key issues.
A critical aspect to the data analysis, answering the assessment questions, and the discussion, is the identification and evaluation of intragroup variation. Remember that you are interested in locating general tendencies within the population that have implications for program planning and can help to facilitate the development and application of interventions. At the same time avoid distorting or ignoring differences in responses in order to illuminate trends that could be useful for programmatic purposes. Although you will be able to identify some evidence showing intragroup variation, the samples of open-ended and of structured interviews are too small to allow the researcher to form exact conclusions about all community beliefs and behaviors. You will need to make item-by-item judgments as to when and to what extent variation is important and should be incorporated into the report. Include tables and text from the interviews to substantiate your results and show the way in which you reached your conclusions and developed generalizations. The degree to which you justify and back up your conclusions will vary according to each question and the way that it is addressed in the assessment procedure.
An optional inclusion to the report could be a diagram showing how the various food sources fit into the overall dietary scheme. You may want to attempt to illustrate characteristics or qualities of the foods that affect intake, particularly among the principle target age/gender groups.
7. Appendices. Appendices are added that include the research methods and other materials used that were relevant to the research, which may be helpful to the reader of the report. These can include a list of the food items contained in the Community Food System Data Tables and perhaps the Tables themselves, a list of attributes of foods recognized by the community, a list of the government offices/officials/other professionals who participated in the assessment, maps of the area, and summary tables from the assessment procedures. Appendices in this report will assist the reader in understanding the results and show where further information might be found.
There should not be so many appendices as to the report to make it too bulky for easy distribution. It is important that the report be distributed, read, and considered by a wide range of policy makers and program planners.
The synthesis and presentation of the study results is a creative act involving both judgment and interpretation. The final product should reflect the input of the supervisors, team manager, and field assistants who participated in the study, and members of the Health Ministry and other key officials at the local and national levels. To assure that the final report is sufficiently accurate and thorough, it is critical that the assessment supervisor facilitate effective and continuous communication among these individuals.