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Nutrition Module: 13. Nutrition Information System

Session 13  Nutrition Information System

Introduction

In the previous study sessions you learned about the different methods of assessing nutritional status as well as determining indicators for malnutrition, micronutrient deficiencies of public health importance in Ethiopia and food security issues. In this study session, you will be introduced to the nutrition information system (NIS) and sources of data that can be used to generate useful nutritional indicators. You will also learn about the service generated data sources and the key nutritional indicators that can be calculated at local level and at national level. Much of this data will be generated by the routine community-based nutrition interventions that you are participating in as a Health Extension Practitioner.

Learning Outcomes for Study Session 13

When you have studied this session, you should be able to:

13.1  Define and use correctly all of the key words printed in bold. (SAQ 13.2)

13.2  List key indicators for the nutrition information system. (SAQ 13.2)

13.3  Explain why nutrition information needs to be reported regularly and promptly in Ethiopia. (SAQs 13.1 and 13.2)

13.4  Identify routine data sources and the types of indicators that can be obtained from each data source. (SAQs 13.3 and 13.4)

13.5  List the type of data you need to record and report regularly to generate these indicators at local and national level. (SAQs 13.3, 13.4 and 13.5)

13.1  Nutrition information system (NIS)

As a Health Extension Practitioner, you deliver a range of services to the community and record your activities for the purpose of reporting. These routine service records can be used to generate important data for the nutrition information system (NIS). This is a system of continuous collection, analysis and interpretation of nutrition-related data for making timely and effective decisions to improve the nutritional health of the population. Any good NIS will consist of the following features:

  • The ability to detect and prevent malnutrition epidemics during times of insecurity
  • The ability to collect and process information easily so that information can be available promptly to various levels of government administration and the local community for making policy decisions and developing intervention programmes
  • As far as possible, it uses data and information already available from the routine service returns at the local level
  • It is designed so that the information can be collected and processed by frontline health workers (such as Health Extension Practitioners) in the community
  • It serves as a monitoring mechanism for higher level government administrators (regional and federal levels) so that information can be communicated to them timely way without creating additional reporting arrangements.

The NIS facilitates prompt action and should be able to show trends (situations over a period of time) in nutrition in the country. The NIS has to function as a timely warning and intervention system (TWIS) and a system for linking problem-prone areas (community, woreda, regional and federal levels), with higher authorities at woreda and federal levels. It should also provide indicators that can serve as early detection mechanisms together with data of food crises from other sectors. Finally, an effective NIS should guide prompt action to cope with deterioration of the nutritional status of vulnerable people in the population, particularly among poor households, as well as children and mothers.

Generating relevant data is an important part of your role and helps to signal possible food shortages or the determination of the nutrition status of people in your community.

The NIS is aimed primarily at using data generated by the different programmes to help the decision-making process for mobilising resources in a targeted and appropriate way. As a frontline health worker, you can make use of the data generated by the system, together with other early warning signs diagnosed by the agricultural and other relevant sectors on food shortages or problems, in order to hasten timely interventions at all levels. The data you generate in your work (for example, the weight of infants in your community) is part of the overall information system and therefore has vital importance in helping to address nutrition problems and protect the people you work with in your community.

As a Health Extension Practitioner, you’re the one at the community level to have first-hand information indicating people's wellbeing. If you use data effectively you can communicate information about a problem as fast as possible to the next level above you which in turn can forward crucial information to the highest decision-making level. Authorities at the Federal Ministry of Health use the information to monitor nutrition problems both at local and national levels. You should pass data onto the level above your Health Post as quickly as possible to enable effective decision making. Information is power, and having the right kind of information available at the right time enables the authorities to make effective decisions about how to address the nutritional needs of communities.

Data on different forms of malnutrition is essential to track the trends and variation of the nutritional status of a vulnerable population over time. It helps in assessment of the impact of the community-based nutrition interventions and progress towards achievement of the Millennium Development Goals. Data can be presented in different ways and draw attention to key messages. For example, look at Figure 13.1, which shows you the prevalence of chronic malnutrition (stunting) in African countries. You can see from the data that the prevalence in Ethiopia is among the highest.

Graph showing the prevalence of stunting in children under five
Figure 13.1   Prevalence of stunting in children under five, in selected African countries. (Source: AED/Linkages, 2006)

Pause for a moment and think about your experience of using data generated by the routine services you are running. How have you used the data that you are generating, for example from therapeutic feeding programmes or child health days?

Other data you have to collect is on the coverage of essential community based nutrition services such as de-worming, vitamin A supplementation, and iodised salt coverage. This can be collected during nutrition interaction programmes or when you visit households (see Figure 13.2). The accuracy and reliability of all the data that is generated at the Health Post level is crucial.

Health Extension Practitioner collecting data
Figure 13.2  Health Extension Practitioner collecting data from the household. (Photo: UNICEF Ethiopia/Indrias Getachew

13.2  Objectives of the NIS in Ethiopia

A major objective of the NIS is to use nutrition data to support timely warnings for short-term prevention, preparedness and response. One aim is to increase the use of data generated from routine community based nutrition interventions, and link these data to an early warning system (EWS) at woreda and regional levels for early warning purposes.

The following are additional key objectives of the NIS in Ethiopia:

  • To support timely warnings of possible household food insecurity
  • To provide accurate and reliable information on trends
  • To provide inputs into management decisions, planning and monitoring of nutrition programmes.

Activity 13.1  The importance of routine service generated data

As you have read, generating accurate data and communicating this in a timely way is an important part of your job. Read the questions below and think carefully about your responses before reading the answer that follows.

  • a.What kind of information from the routine data can be used to show household food insecurity?
  • b.Why is accurate and reliable information important?
  • c.How can information inform the planning of nutrition programs?
Answer
  • a.The percentage of children with severe acute malnutrition (SAM) in a community is a good example of data that can be used to detect household food insecurity and indicate the severity of the situation. According to the national emergency nutrition intervention guideline, if there is more than 5% of children under five with in a community, there is a need to initiate different interventions to address this problem.

  • b.Information is therefore needed for effective decision making. To enable you and your manager to make effective decisions, the information you collect needs to be accurate, relevant and communicated in a timely way.

  • c.Reliable information generated from the routine services can also help you to plan essential interventions at the community level. For example; using information about your community’s needs to access important supplies including vitamin A capsules, de-worming tablets and bed nets.

13.3  Why Ethiopia has an NIS

Ethiopia is one of the most disaster-prone countries in the world. Famines and food shortages brought on by drought have been a major problem through the years, and to a lesser extent there have also been problems triggered by flood, pests and livestock diseases. The recorded history of famine and food shortages in the country goes back hundreds of years, with considerable loss of human life and the destruction of property. In addition to climate, the roots of Ethiopia’s vulnerability to disaster are in its subsistence economy. About 80% of the population remain subsistence farmers, with another 10% being pastoral nomads.

Currently, the food and nutrition information system is being compiled, analysed and used for decision-making by the Disaster Risk Management and Food Security Sector (DRMFSS). The creation of the DRMFSS has created a capacity for prior awareness of the need for disaster preparedness, encompassing, among other things, the ability to provide advance warnings and to develop response mechanisms based on an effective early decision making system.

However, despite the high prevalence of undernutrition and the history of nutrition crises in Ethiopia, nutrition indicators that can be used for effective decision-making are not routinely reviewed for early warning. To fill this information gap, using selected nutrition indicators from routine health programmes is a practical alternative.

  • Why is an NIS so important for Ethiopia?

  • Ethiopia is a country where there is food insecurity and considerable vulnerability of households to seasonal food shortages. Availability of reliable information that can assist in early recognition of the problem for timely intervention is highly important.

Now that you have read about the NIS and its relevance to Ethiopia, you are going to look at the critical indicators and their data sources that come from the routine services that you deliver in the community.

13.4  Critical indicators and data sources for the NIS in Ethiopia

One of the most important sources of data for the NIS is the routine service data that you record. The following basic information is needed in order to track the nutrition situation in Ethiopia:

  • Micronutrient coverage (vitamin A, iodine, iron)
  • Growth of children under two years (growth monitoring coverage)
  • Prevalence of acute malnutrition (severe acute malnutrition and moderate acute malnutrition)
  • Birth weight
  • Maternal nutritional status during pregnancy and lactation.

13.4.1  Sources of data for the NIS

Nutrition information can be generated from active surveillance activities (e.g. pocket surveys) which require an active data search. One of the major disadvantages of an active data generation strategy is that it is very costly. Secondly, it is difficult to develop uniform indicators that can detect progress in the common nutrition success indicators at national levels because the data from the active surveillance usually come from small studies which are not representative of the different regions.

The alternative is using data from the routine service records such as growth monitoring records. The data you record and report from community-based nutrition activities, child health days and therapeutic feeding programmes could be used to generate uniform indicators for looking at trends in indicators of certain nutrition situations. This allows comparisons over time across all regions of the country (either by yearly or seasonal variation). So your role in providing accurate and clear information is very important (Figure 13.3).

Health Extension Worker in her Health Post
Figure 13.3  Health Extension Worker in her Health Post in rural SNNPR (Photo: Basiro Davey)

Box 13.1 sets out the kinds of data you would collect from community-based nutrition (CBN) programmes and therapeutic feeding programmes (TFP) and what indicators can be drawn from the data of community level and how the data might be used nationally.

Interpreting changes in nutrition indicators requires an understanding of the normal levels of undernutrition in the community, as well as agricultural, economic, health, and other factors. As you run your routine CBN services, the data generated as a result of these services could be useful in calculating key nutritional indicators that can support effective decision making.

Box 13.1  Routine service data to estimate nutrition status of a community
Data (collect and record monthly)IndicatorNational relevance
CBNTotal number of children under two years old with weight for age <-2 and >-3SD Prevalence of moderate underweightGrowth performance
Total number of children under two years old with weight for age <-3SDPrevalence of severe underweightGrowth performance
TFPNumber of children who were admittedBaseline information
Number of children (and percentage of total) who stopped attending the programme‘Defaulter’ rateTake up of the programme; enables community and regional comparisons
Number (and percentage) of children who failed to recover fullyTreatment failureInforms continuing improvement in programme design
Number of children (and percentage) who diedMortality rateProgress towards MDGs; informs national strategy for community nutrition interventions

The information in Box 13.1 is just an example of the kind of data collection you’ll be expected to carry out. As you’ve read in the other study sessions in this Module, you will be collecting a range of measurements (height, length, MUAC) and other information (e.g. vitamin A coverage, de-worming coverage, households screen or iodised salt use) that together help to provide a detailed picture of the nutritional status of your community.

  • Why is it important to have an NIS?

  • As long as data is recorded accurately and communicated in a timely way, it provides a source of information (indicators) that will help create appropriate and effective solutions to address the nutritional needs in communities.

Indicators are useful for community programme planning to establish priorities for problems, set goals, formulate plans of action and implement, monitor, and evaluate community efforts aimed at achieving the Millennium Development Goals (MDGs). Each village then can determine its requirements and plan for further action, based on the indicators generated, that will best address its particular nutritional needs.

13.5  The triple A cycle approach

The NIS should be a continuous (cyclic) process which is undertaken regularly using the principle of the triple A cycle used in CBN, which you learned about in Study Session 11 of this Module. Information generated by the NIS can be use for decision making from your local community level to the national level. As you will remember from Study Session 11, the triple A cycle has:

  • An assessment aspect involving service generated data recording and timely reporting
  • Analysis and interpretation of the data based on the national guidelines and procedure
  • An action component which involves decision making and implementation using the information, which in turn will automatically be followed by another assessment.

This is illustrated in Figure 13.4, which shows how each element of the cycle is connected to the other.

Using the triple A cycle in nutritional surveillance
Figure 13.4  Using the triple A cycle in nutritional surveillance.

The data you record as part of routine programmes is a critical element of nutrition intervention programmes and therefore needs to be recorded accurately and reported in a timely way. Figure 13.5 illustrates how data collection informs decision making through the different level, right up to the Federal Ministry of Health.

5  How local data informs national decision-making
Figure 13.5  How local data informs national decision-making.

13.6  Conclusion

In this Module you’ve learned about the basics: food, diet and nutrients, and the different nutritional requirements throughout the human lifecycle. You have looked at nutritional problems of public health importance in Ethiopia and the role you can play as a Health Extension Practitioner in identifying and recording nutrition problems in your community and how can you advise and support the individuals you work with to find effective nutrition solutions. As you’ve learned, the nutrition information you generate at the kebele level can be used to monitor nutrition indicators and to inform decision making at different levels.

Summary of Study Session 13

In Study Session 13 you have learned that:

  1. A nutrition information system (NIS) is a system of continuous collection and interpretation of nutrition-related data to enable timely decision making for improving the nutrition situation of the population.
  2. A good NIS should enable early detection of food insecurity, be promptly available for making policy decisions and developing action programmes.
  3. It should utilise data and information already available from the routine service returns. As a Health Extension Practitioner you are in the ideal position to collect and process information about your community.
  4. The NIS should target nutrition indicators based on the essential nutrition action components. These indicators are useful to assess progress towards achieving the Millennium Development Goals and assessing programme performance in particular. Nutritional indicators also help in planning community-based nutrition intervention programmes.
  5. Key nutrition indicators can be generated from community-based nutrition, therapeutic feeding programmes and child health days.
  6. The power of information for decision making relies on accurate data and information being communicated in a timely way. As a Health Extension Practitioner you need to maintain the quality of all information generated from a community-based nutrition programme and timely reporting.
  7. You can make use of the data generated from the routine services you deliver in the community for assessing progress and for planning interventions.

Self-Assessment Questions (SAQs) for Study Session 13

Now that you have completed the study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers on your Study Diary and discuss them with your Tutor at the next study support meeting. You can check your answers with the Note on the Self-Assessment Questions at the end of the Module.

SAQ 13.1 (tests Learning Outcome 13.3)

Why is the routine service data you collect regularly so important?

Answer

The routine service data you collect is important because it can be fed into Ethiopia’s NIS. It will also help you understand the nutrition situation in your community and help you to make local decisions.

SAQ 13.2 (tests Learning Outcomes 13.1, 13.2 and 13.3)

What is the NIS and how does it contribute to solving Ethiopia’s food problems?

Answer

The NIS is a system of continuous collection, analysis and interpretation of data about nutrition. It can be used to detect malnutrition epidemics, identify trends, make decisions about interventions and monitor programmes.

SAQ 13.3 (tests Learning Outcomes 13.4 and 13.5)

When and how, during your work in the community, can you gather information about key nutrition indicators?

Answer

You can gather data from a number of sources including from the community-based nutrition programme, the therapeutic feeding programme and community health days.

SAQ 13.4 (test Learning Outcomes 13.4 and 13.5)

  • a.What kind of indicators can be generated during child health days?
  • b.How can this data be useful for the NIS?
Answer
  • a.The data you record at child health days can tell you the prevalence of severe underweight children in your community and can also be used by the NIS to measure national growth performance.
  • b.SAM data can be used by NIS as an emergency warning sign, the percentage with MAM can show the effects of supplementary programmes and all the information will add generally to information about trends and seasonality. Community Health Days can generate indicators related to the prevalence of SAM and MAM, de-worming coverage, vitamin A coverage, and iodised salt coverage.

SAQ 13.5 (tests Learning Outcome 13.5)

Summarise the kinds of data you need to record and report regularly.

Answer

You should regularly record data related to the weight of children, the success of the therapeutic feeding programme, the numbers of pregnant and lactating women. You also need to record information about children under five and treatments they have received.