5

Considerations for Future Activities

◆ ◆ ◆ ◆ ◆

This chapter provides suggestions for the future content and conduct of USAID nutrition surveys and surveillance activities. The committee offers these in the hopes that they will be of use to USAID in its future work in the NIS.

  • To the extent that there are ongoing changes in the NIS that threaten market and household food security and the quality of the food supply, the food and nutrition situation in the NIS should continue to be monitored. Suggested minimal and optimal measures have been described in the report.

  • In future surveys and surveillance activities, attention should be paid to obtaining qualitative information prior to study design.

  • Study methods, content, and analysis should be designed with the outcome in mind: enhanced decision making, particularly by health policymakers in the NIS. These activities should be designed considering the ethnic and sociocultural characteristics of their target populations and in consultation with national/regional/local decision makers, key informants, frontline service staff, researchers, and others with an interest in these activities. More attention should be paid to tailoring monitoring systems accordingly.

The committee believes that the three previous suggestions will help minimize problems that have occurred in some past surveys. These problems have resulted, in many cases, in a relatively small amount of available information useful for decision making, a lack of useful current information, and an uneven quality across surveys.



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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities 5 Considerations for Future Activities ◆ ◆ ◆ ◆ ◆ This chapter provides suggestions for the future content and conduct of USAID nutrition surveys and surveillance activities. The committee offers these in the hopes that they will be of use to USAID in its future work in the NIS. To the extent that there are ongoing changes in the NIS that threaten market and household food security and the quality of the food supply, the food and nutrition situation in the NIS should continue to be monitored. Suggested minimal and optimal measures have been described in the report. In future surveys and surveillance activities, attention should be paid to obtaining qualitative information prior to study design. Study methods, content, and analysis should be designed with the outcome in mind: enhanced decision making, particularly by health policymakers in the NIS. These activities should be designed considering the ethnic and sociocultural characteristics of their target populations and in consultation with national/regional/local decision makers, key informants, frontline service staff, researchers, and others with an interest in these activities. More attention should be paid to tailoring monitoring systems accordingly. The committee believes that the three previous suggestions will help minimize problems that have occurred in some past surveys. These problems have resulted, in many cases, in a relatively small amount of available information useful for decision making, a lack of useful current information, and an uneven quality across surveys.

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities ADDITIONAL AREAS TO PURSUE Assistance should be provided to implement food fortification programs in order to reduce the problems of rickets, goiter, and anemia, to the extent that these problems are documented. Evidence of decreasing iodine intake or increased rates of goiter or rickets should be viewed as an emergency. In some areas or population groups, there may be a need to investigate further the causes of anemia, including the potential role of environmental pollution. To reduce the prevalence of micronutrient deficiencies in the population, a combination of assistance from the FDA to establish standards for processed food composition and micronutrient fortification and from the private food-processing industry in techniques for food fortification would be extremely desirable in ensuring that the food-processing sector makes as rapid and widespread a contribution as possible. Additional opportunities for joint participation in, and coordination of, activities with other bilateral and multilateral organizations should be explored and defined. Evaluation of the situation in the NIS differs from the assessment of a chronically malnourished population, which is the more usual situation, and for which accepted survey methods have been developed. There is, therefore, a need to develop new methods to detect “hunger ” in generally (or previously) well-nourished populations such as most of those in the NIS. Declines in nutritional status in such populations, especially in the short-term, may be more difficult to detect reliably than a simple determination of nutritional status at a given point in time. The committee suggests that USAID consider the formation of an advisory group, whose function would be to expand upon, coordinate and advise on the many qualitative activities described in the report; coordinate and, perhaps, standardize future survey and surveillance activities; and help interpret, disseminate, and follow up on results and on surveillance activities in general. Emergency feeding in the form of direct feeding programs should be based on evidence of food shortage, rather than a lack of purchasing power. One exception is the careful targeting of vulnerable groups who consume a relatively small proportion of the food supply. These vulnerable groups may differ from those usually targeted in developing countries. Based on evidence that women of reproductive age have a high risk of morbidity and mortality due to a high prevalence of anemia and high rates of abortion, consideration should be given to ways of increasing nutrient supplementation to this group (perhaps through UNICEF), as well as enhancing access to contraceptive technology. In no document was consideration given to food rationing. If food availability is scarce, this programmatic action may be helpful. Any decision of

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities this type should be made by the appropriate policymakers in the NIS, taking into account the serious political implications. SPECIFIC SUGGESTIONS REGARDING ON-GOING NUTRITION SURVEYS The RLMS is potentially a very informative survey. The CIN's recommendations on how to proceed with the RLMS are provided in Appendix B and are summarized as follows: The first recommendation for the RLMS is to identify focused policy questions that the current protocol was intended to address and the specific data that are required to answer these questions. This task should involve decision makers from USAID and appropriate counterparts in the NIS. Dummy tables can then be drawn up and analyses produced as soon as possible. This process will enable all parties to review the usefulness and timeliness of data collection. It is also recommended that a solid scientific review of the RLMS be undertaken after the above analyses are available. The committee did not have the necessary information or time to perform this service. The review will take experts several days to accomplish. Based on the former two activities and qualitative evidence of food insecurity in Russia, USAID and NIS counterparts will be able to develop a core group of essential indicators for monitoring the ongoing effects of economic reforms. These indicators should take priority in collection and analysis and be sustainable within the current Russian infrastructure. The purpose of collecting additional data needs to be articulated and justified. Finally, due to the rapid decline in meat, fish, dairy product, vegetable, and fruit consumption in 49,000 Russian families between 1991 and 1992 reported in the Goskomstat survey (Volgarev, 1992), a detailed evaluation of the methodology and the suitability of the data for surveillance should be undertaken.

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