Nutrition Surveillance- Do we collect the RIGHT information for public health?

Written by Rumbidzai Mashavave

The transition to a circular economy in the food system improves nutrition-related health outcomes. Globally nutrition imbalances are a cause for concern. Obesity has been largely dominant in middle-high income countries, while micronutrient deficiencies have been in low income countries. But currently, all forms of malnutrition exist globally. To be able to treat nutrition there is need to understand the severity and distribution of malnutrition geographically, demographically as well as the circumstances surrounding the malnutrition, such as availability and access to food, income group and so on.

The first point of call however is, having the RIGHT information on the prevalence of malnutrition from district to national level to inform interventions. Nutrition surveillance has played a role in understanding malnutrition and thus provide decision-makers with the correct information on the prevalence of obesity, for example, and appropriate actions such as policy, with the context in mind are enforced or implemented.

Academically, nutrition surveillance has been a topic of discussion since the 1980s globally according to a brief scoping exercise I took on Google Scholar. The government institutions are the owners of surveillance systems in the majority of middle income and all high income countries. While in low income countries, INGOs and NGOs fund health information systems. The Demographic Health Surveys supported by USAID, and the stratified, multistage cluster designed surveys (MICS) supported by UNICEF. These have provided secondary information for nutrition. These surveys are performed every 3, 4 years respectively which is not adequate for nutrition surveillance. Surveillance demands frequency of data collected, secondary and primary data.

Unfortunately, such nationally representative surveys are expensive and demand a lot of human resources and time, which the governments alone in low income countries cannot hold. Case studies in Africa, have seen the collapse of surveillance systems when INGOs support was withdrawn or ended with the project timeline. Reasons cited include,

  • ownership of the acquired data is not straightforward;
  • staff hired for the purposes of data collection for the surveillance systems have been reassigned, where there was more need; and
  • funding at national level is prioritized to more “pressing” issues (Just to mention a few).

Two important discussions need to be had by academics, the development sector, public sector and the private sector at local level. Firstly, on the sustainability of nutrition surveillance systems in low income countries. We have several organizations making efforts into solving malnutrition, in Zimbabwe for example, some of the information generated is so as to measure the impact of longitudinal studies/projects. Some for early warning – dominated by FEWS-NET, while the one of interest is for long term planning. How can we properly apply circular economy principles in food systems to address nutrition imbalances with respect to the local context?

Secondly, malnutrition is not treated as a public health issue in Zimbabwe, the vulnerable groups to micronutrient deficiencies are children below the age of 5 and women of reproductive age. Information on malnutrition generated is specifically on the vulnerable groups and the Zimbabwe National Nutrition Survey 2018 reported that there is scarcely any information on adolescents and adults. How then can we inform nutrition interventions with inadequate information?

Don’t get me wrong, methods of nutrition data collection, has been discussed at length and recommendations have been made. For example, the Monitoring and Assessment of Relief and Transition methods (SMART) is a well-accepted collection of best practices for the implementation of nutrition surveys. However, more considerations as elaborated above, creates the need for dialogue, discussions and action.

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