A perspective on the development and sustainability of nutrition surveillance in low-income countries

Abstract

Background: Many varied activities are encompassed by the term "nutrition(al) surveillance". Several national surveillance systems were initiated soon after the World Food Conference in 1974, but few have lasted. Most were complex, expensive, slow to produce findings, and were eventually stopped. This paper discusses why nutrition surveillance in low-income countries is so hard to sustain, and identifies the key factors in systems which have been maintained. Discussion: For nutrition surveillance activities to be sustainable, there needs to be: demand for the information; a reasonable cost as well as a cost-efficient process; speedy generation and dissemination of good quality information; secure allocation of resources from the government and/or donor; and a central, organizing institution for strong coordination of data collection, analysis, interpretation and communication. Investment in local individual and institutional capacity plus the retention of experienced staff are important. A periodic evaluation of the process should be an integral part of surveillance activities. For national systems the ideal coordinating institution should sit within a government structure separate from those with direct involvement in health or agriculture, such as a ministry of planning, as those who lead the surveillance must be independent of decision-makers but need to understand and prioritise their needs for information. The findings need to be communicated clearly and the means of presentation adapted to different audiences. To promote participation, the findings should be shared with stakeholders at all levels. Summary: This review of the development of nutrition surveillance in low-income countries over the last 40 years finds that sustainability hinges on cost, capacity development, location of the institutional base, demand for the products, and participation. These considerations are noteworthy given the pivotal role of nutrition surveillance information in national and sub-national policy-making, planning and programming. Information from nutrition surveillance also provides an increasingly important mechanism to hold governments to account and to allow progress towards international targets to be tracked.

Integrating micronutrient status assessment into the 2015–2016 Malawi Demographic and Health Survey: A qualitative evaluation

“…Altogether, more evidence on the advantages and disadvantages of different survey approaches could help to identify effective and efficient approaches for routinely collecting high‐quality, national micronutrient status data in LMICs. Such approaches are essential because historically nutrition surveillance systems in LMICs that were complex and expensive were discontinued, and a cost‐efficient process for nutrition surveillance has been identified as a key factor for sustainability (Tuffrey, ).…”

“…Providing information for decision making is a key objective of nutrition surveillance (Tuffrey, ; Tuffrey & Hall, ). In Malawi, the 2015–2016 MNS results were the basis for the government's planned response to malnutrition outlined in the 2018–2022 National Multi‐Sector Nutrition Strategic Plan, such as micronutrient supplementation (vitamin A, iron, and folic acid) and deworming through routine child health campaigns, vitamin A and iron supplementation for school‐aged children, micronutrient powders for children under 5 years and pregnant women, and integrated homestead farming to promote consumption of micronutrient rich foods (Government of Malawi, Department of Nutrition, HIV and AIDS, ).…”

“…In 2014, the Global Nutrition Report called for a “data revolution” to increase the availability of national nutrition data (International Food Policy Research Institute, ). As low‐ and middle‐income countries (LMICs) intensify action to address malnutrition, data gaps must be closed to inform policy decisions, target programs and resources, and track progress (Mei, Jefferds, Namaste, Suchdev, & Flores‐Ayala, ; Tuffrey, ; Tuffrey & Hall, ). Routinely collected data on micronutrient status and coverage of micronutrient interventions are especially lacking in many LMICs (Gernand, Schulze, Stewart, West, & Christian, ; Mei et al, ; Wirth et al, ), hindering planning and accountability for actions to improve micronutrient status, including both nutrition‐specific (e.g., micronutrient supplementation) and nutrition‐sensitive (e.g., agriculture and food security) interventions (Bhutta et al, ; Ruel & Alderman, ; Tuffrey & Hall, ).…”

“…To date, the predominant approach for assessing population micronutrient status has been to conduct stand‐alone national micronutrient status surveys, which may be hard to implement and sustain in settings where resources are stretched (Tuffrey, ). Cambodia pioneered linking micronutrient status data collection with the 2014 Cambodia Demographic and Health Survey (DHS) by using the DHS sampling frame to collect micronutrient status data from a subsample of households one to three months following the DHS (National Institute of Statistics, Directorate General for Health, & ICF International, ).…”

Methods of nutrition surveillance in low-income countries

“…Information derived from nutrition surveillance has been used in several ways: to monitor the nutrition situation; to identify factors associated with malnutrition; to inform nutrition policies and programmes; to track progress towards achieving nutrition goals; to serve as an early warning of increased nutritional risk; to assess the delivery and coverage of services; to evaluate programmes and interventions; and to detect the impact of changes in policies. The issues relating to the sustainability of nutrition surveillance activities are considered in another paper [ 3 ], whilst in this paper the methods used to collect data are reviewed.…”