Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States

A Review of USAID-Sponsored Activities

Committee on International Nutrition

Food and Nutrition Board

Board on International Health

Institute of Medicine

Lindsay H. Allen and Christopher P. Howson, Editors

NATIONAL ACADEMY PRESS
Washington, D.C.
1994



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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States A Review of USAID-Sponsored Activities Committee on International Nutrition Food and Nutrition Board Board on International Health Institute of Medicine Lindsay H. Allen and Christopher P. Howson, Editors NATIONAL ACADEMY PRESS Washington, D.C. 1994

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities National Academy Press 2101 Constitution Avenue, N.W.Washington, D.C.20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. This study was supported by the U.S. Agency for International Development under the terms of Grant No. HRN-5110-G-00-3043-00. The opinions expressed herein do not necessarily reflect those of the U.S. Agency for International Development. Additional copies of this report are available in limited quantities from: Food and Nutrition Board Institute of Medicine 2101 Constitution Avenue, N.W. Washington, DC 20418 Copyright 1994 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities COMMITTEE ON INTERNATIONAL NUTRITION LINDSAY H. ALLEN (Chair), Department of Nutrition, University of California, Davis, California KENNETH H. BROWN, Department of Nutrition, University of California, Davis, California JEAN-PIERRE HABICHT, Division of Nutritional Sciences, Cornell University, Ithaca, New York EILEEN T. KENNEDY, U.S. Department of Agriculture, Food and Consumer Services, Washington, D.C. JOANNE LESLIE, University of California-Los Angeles School of Public Health and Pacific Institute for Women's Health, Los Angeles, California GILBERT A. LEVEILLE, Research and Technical Services, Nabisco Food Group, East Hanover, New Jersey Liaisons to the Committee ADELINE WYNANTE PATTERSON (Board on International Health), Caribbean Food and Nutrition Institute, Kingston, Jamaica ALFRED SOMMER (Food and Nutrition Board), * School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland Staff CHRISTOPHER P. HOWSON, Project Director SUSAN M. KNASIAK, Project Assistant SUSAN M. WYATT, Administrative and Financial Associate * Member, Institute of Medicine

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities FOOD AND NUTRITION BOARD JANET C. KING (Chair), Department of Nutritional Sciences, University of California, Berkeley, California EDWIN L. BIERMAN (Vice Chair), * University of Washington School of Medicine, Seattle, Washington JOHN W. ERDMAN, JR. (Vice Chair), Division of Nutritional Sciences, University of Illinois, Urbana, Illinois CUTBERTO GARZA (Vice Chair), Division of Nutritional Sciences, Cornell University, Ithaca, New York PERRY L. ADKISSON, † Department of Entomology, Texas A&M University, College Station, Texas LINDSAY H. ALLEN, Department of Nutrition, University of California, Davis, California DENNIS M. BIER, Children's Nutrition Research Center, Houston, Texas FERGUS M. CLYDESDALE, Department of Food Science and Nutrition, University of Massachusetts, Amherst, Massachusetts HECTOR F. DeLUCA, † Department of Biochemistry, University of Wisconsin, Madison, Wisconsin MICHAEL P. DOYLE, Department of Food Science and Technology, University of Georgia, Griffin, Georgia JOHANNA T. DWYER, Frances Stern Nutrition Center, New England Medical Center Hospital, Boston, Massachusetts SCOTT M. GRUNDY, University of Texas Southwestern Medical Center, Dallas, Texas K. MICHAEL HAMBIDGE, Center for Human Nutrition, University of Colorado Health Sciences Center, Denver, Colorado LAURENCE N. KOLONEL, Cancer Center of Hawaii and University of Hawaii, Honolulu, Hawaii SANFORD A. MILLER, Graduate School of Biomedical Sciences, University of Texas Health Science Center, San Antonio, Texas ALFRED SOMMER, * School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland VERNON R. YOUNG, † School of Science, Massachusetts Institute of Technology, Cambridge, Massachusetts STEVE L. TAYLOR (Ex Officio), Department of Food Sciences and Technology, University of Nebraska, Lincoln, Nebraska ARTHUR H. RUBENSTEIN (Institute of Medicine Liaison), * Department of Medicine, The University of Chicago, Chicago, Illinois * Member, Institute of Medicine † National, Academy of Science

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities Staff ALLISON A. YATES, Director (from July 1994) BERNADETTE M. MARRIOTT, Acting Director (January–June 1994) CATHERINE E. WOTEKI, Director (through December 1993) GAIL A. SPEARS, Interim Administrative Assistant MARCIA S. LEWIS, Administrative Assistant SUSAN M. WYATT, Administrative and Financial Associate

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities BOARD ON INTERNATIONAL HEALTH WILLIAM H. FOEGE (Chair), * Carter Center, Emory University, Atlanta, Georgia DEAN JAMISON (Cochair), The World Bank, Washington, D.C. DAVID E. BELL, Harvard Center for Population and Development Studies, Cambridge, Massachusetts JAN E. G. BLANPAIN, * School of Public Health, Leuven University, Leuven, Belgium MARGARET CATLEY-CARLSON, Population Council, New York, New York RICHARD G. A. FEACHEM, London School of Hygiene and Tropical Medicine, London, England JULIO FRENK, * National Institute of Public Health, Cuernavaca, Mexico ADETOKUNBO O. LUCAS, * Harvard School of Public Health, Boston, Massachusetts W. HENRY MOSLEY, Institute for International Programs, School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland ADELINE WYNANTE PATTERSON, Caribbean Food and Nutrition Institute, Kingston, Jamaica DAVID P. RALL, * National Institute of Environmental Health Sciences, Washington, D.C. TIMOTHY ROTHERMEL, Division for Global and Interregional Programmes, United Nations Development Programme, New York, New York NOEL S. WEISS, * Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle, Washington BARBARA L. WOLFE, Departments of Economics and Preventive Medicine, University of Wisconsin, Madison, Wisconsin BERNARD N. FIELDS (Institute of Medicine Liaison), * † Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston, Massachusetts DONALD A. B. LINDBERG (Acting Institute of Medicine Liaison), * National Library of Medicine, National Institutes of Health, Bethesda, Maryland FREDERICK C. ROBBINS (Ex Officio), * † Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio * Member, Institute of Medicine † Member, National Academy of Sciences

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities Staff CHRISTOPHER P. HOWSON, Director DEE SUTTON, Project Assistant SUSAN M. WYATT, Administrative and Financial Associate

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities This page in the original is blank.

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities Preface ◆ ◆ ◆ ◆ ◆ Over the past 2 years, there has been growing awareness of the potential value for the U.S. Agency for International Development (USAID) to have a standing capability in the Institute of Medicine (IOM) for a more flexible, less costly response to agency needs in the areas of nutrition, food, and health science policy. With support from USAID, the IOM responded in October 1993 by establishing the Committee on International Nutrition (CIN) under the aegis of the Food and Nutrition Board (FNB) and the Board on International Health (BIH). The CIN's mandate is to answer questions of current interest and concern, evaluate current nutrition activities undertaken by the agency, and make recommendations for future activities based on this review. Topics are chosen through systematic consultation with the Office of Nutrition in USAID's Bureau for Research and Development. Representing the areas of human nutrition, maternal and child health, epidemiology, economics, and program design and evaluation, the committee's six members will convene three times to produce brief reports that review specific programs, research projects, or project designs. With an initial project life of 18 months, the study is designed to be flexible (e.g., capable of responding to specific nutrition concerns that arise abruptly) and to provide quick turnaround, with the time from meeting date to document availability being 2 months. This report derives from the first meeting of the CIN, which was held on 14–15 April 1994. The purpose of the meeting, whose topic was requested by USAID's Offices of Nutrition and of Democratic Initiatives and Health and Humanitarian Resources (DIHHR), was to review the findings of selected USAID-sponsored nutrition surveys and related surveillance activities in the

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities Newly Independent States (NIS), to assess the nutritional status of populations at risk, to recommend to USAID future survey-surveillance activities to be undertaken in the NIS, and to recommend how the findings could be applied operationally to develop health and nutrition delivery programs to respond to problems in nutritional status in populations at risk. For further background information and details on USAID's request to CIN, see the memoranda to the committee from Samuel Kahn, USAID Office of Nutrition, and Julie Klement, USAID DIHHR, respectively, in Appendix A. CHARGE TO THE COMMITTEE During its two-day meeting, the CIN reviewed the findings of five nutrition surveys and related surveillance activities conducted in Russia and the NIS by a variety of organizations, including the U.S. government, universities, and private voluntary organizations (PVOs). These five activities, whose materials were provided by USAID's DIHHR in advance of the meeting, included the Russian Longitudinal Monitoring Survey (RLMS); the Cooperative for American Relief Everywhere (CARE) Pensioner Surveys; the CARE Under-Two-Years-of-Age Survey conducted in urban and rural Russia; the Anemia Prevalence Survey in Uzbekistan; and the Health/Nutrition Early Warning System conducted in Russia, Kyrgyzstan, Uzbekistan, and Armenia. In addition to these five activities, the committee also reviewed the following background information provided to it by USAID: Centers for Disease Control and Prevention (CDC) trip reports and USAID Country Health Profiles for Armenia, Azerbaijan, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Russia, Tajikistan, Turkmenistan, Ukraine, and Uzbekistan. These materials are described in chapter 2. USAID representatives were invited to attend the first day of the meeting to answer questions about specific projects and to provide additional background as needed. The following USAID representatives attended: Samuel G. Kahn and Andrew Swidorski, Office of Nutrition; Kathleen McDonald, Molly Mort, and Petra Reyes, Office of Democratic Initiatives and Health and Humanitarian Resources; and Dennis Culkin, Office of Emergency and Humanitarian Assistance. The CIN thanks these individuals for their important contributions to its review. On the second day of the meeting, the CIN met in Executive Session to discuss the reviewed projects in depth and to address the following three questions posed to it by USAID: Question 1: On the basis of the projects reviewed, what can be said about the nutritional status and identification of potential issues of at-risk populations in Russia, such as pensioners, women, and children?

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities Question 2: What indicators and methodologies would be adequate (minimal safety net) and optimal for conducting nutrition monitoring systems in the NIS? Question 3: How can USAID apply the current findings programmatically? ORGANIZATION OF THE REPORT The report contains five chapters and two appendices. chapter 1 provides a brief executive summary of the report. chapter 2 offers a detailed description of the five surveys and surveillance activities examined by the committee. Each is reviewed with respect to the project's purpose, characteristics of the population(s) examined, the study methods employed, the quality of the study methods, and the major findings. The additional background information provided to the CIN also is described. chapter 3 describes the assumptions that guided the committee's review and comments on the activities examined. chapter 4 presents the findings and conclusions for each of the three questions that the CIN was asked to address. Each is answered in the broader context of the indicators and methodologies used in the surveys, including how the results can be interpreted and what indicators and methods might be used in future studies. chapter 5 provides general recommendations about the future content and conduct of USAID nutrition surveys and surveillance activities. Although the CIN was not asked specifically to address this issue, it offers these recommendations in the hopes that they may be useful to USAID in its future work in the NIS. Appendix A contains the two USAID memoranda outlining the specific charge for this first CIN meeting. Appendix B offers recommendations for improving the study methods of each of the five survey and surveillance activities reviewed. ACKNOWLEDGMENTS The committee gives special thanks to the USAID staff who graciously made themselves available for questions during the Open Session on 14 April. The committee would also like to express its appreciation to the IOM staff who facilitated the work of the CIN: Christopher P. Howson, study director; Susan M. Wyatt, financial associate; Michael Edington, editor; Judy Grumstrup-Scott, copy editor; Claudia Carl, administrative associate; and Gail Spears, administrative assistant. The committee especially thanks Susan M. Knasiak, project assistant, for her assistance in conducting the first meeting and for her valuable editorial advice in preparing the report draft. Finally, the committee thanks Richard G. Seifman, USAID; Polly Harrison, IOM; and Catherine Woteki, formerly of the FNB, for their vision and hard work in realizing this project and Allison A.

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Nutrition Surveys and Surveillance Activities in Russia and the Newly Independent States: A Review of USAID-Sponsored Activities Yates and Bernadette M. Marriott, FNB, for their useful editorial advice and support of the CIN's activities. Lindsay H. Allen, Chair Committee on International Nutrition