Household Consumption And Expenditures Surveys Research Articles

More efficient use of household consumption and expenditure surveys (HCES) to inform food security1

Household Consumption and Expenditure Surveys (HCES) collect comprehensive information on households’ consumption and can provide a range of analyses on access to food. They are key to estimating poverty (SDG 1.2.1) and Prevalence of Undernourishment (SDG 2.1.1). Before the food data becomes meaningful for analysis, it needs extensive preparation. While NSOs are responsible for poverty statistics and typically prepare the data for this purpose, it is often organizations or researchers that use the data for food security. Although the preparation of the data for these two purposes has a lot in common, they rely on different traditions and guidelines. This paper presents results from an ongoing project that aims to bridge the gap between these two processes. The project’s goal is that NSOs take the lead in preparing the HCES food data for all uses. An expected result is that the food security statistics will be available at the same time as the other main outputs from the survey and can be used for planning for improved food security. The project includes preparing a guideline for NSOs and others (endorsed by the United Nations’ Statistical Commission in 2024), building capacity in NSOs, and using results in a regional context.

Impact of Socio-Economic Factors on Nutrition Efficiency: An Application of Data Envelopment Analysis.

BackgroundPaying particular attention to sustainable food consumption in low-income households is essential for increasing human health. Due to the growing population globally, this concept will likely become more serious soon.MethodsFollowing the importance of optimizing food consumption for sustainability, in this study, a novel methodology is introduced for calculating nutrient intake efficiency and determining choices of food in different locations. The impact of socio-economic factors on nutrition efficiency is assessed. Data Envelopment Analysis (DEA) as a well-known linear programming (LP) and a Tobit model are used to achieve the goals. Household Consumption and Expenditure Surveys (HCESs) of 30,000 rural and urban Iranian households in all provinces in 2016 are analyzed. A Nutrient Efficiency Map (NEM) of Iran was depicted by GIS software.ResultsThe results showed that many townships had nutrient efficiency scores of less than 70%. Northeast townships had the lowest scores, with an efficiency score of less than 50%. Overall, townships have lower efficiency in the North (seaside cities), East (desert cities), and North East (isolated cities) when compared with other areas.ConclusionTherefore, it is suggestible that the government should modify the support policies and the protection packages based on social, geographical, and cultural status.

Quantifying fish catches and fish consumption in the Amazon Basin

Abstract The Amazon Basin is the largest in the world and for many of its inhabitants fishing is a crucially important source of food and income. However, the benefits derived from mostly informal, part time, seasonal, and subsistence-based activities such as fishing are largely invisible to policy-makers, and addressing the threats to aquatic habitats, ecosystem functioning, and fisheries is frequently given low priority in national development agendas. To estimate the total extraction of fish in the Amazon Basin, we reviewed various publications and databases with quantitative data related to the landings, trade, and consumption of fish. We estimated the total landings to be between 422,000 and 473,000 t yr-1 in live weight, near to previous estimates. Almost 75%, however, represented landings in the Brazilian part of the basin, and there is a very large margin of uncertainty given that, among other issues, there are no recent official statistics on commercial landings. Conversely, landings in Bolivia, Colombia, and Ecuador seem to be considerably higher than previously thought. In all Amazonian countries, from 50% up to almost 100% of the fishing takes place for personal consumption, implying that it is not recorded in official landing statistics. Available time series data indicate that fish consumption in Brazil, as well as commercial fish landings in Peru and Colombia, have declined in recent years. Local case studies, national household consumption and expenditure surveys (HCES), and market surveys, all have their benefits and drawbacks. Some minor modifications of HCES procedures could considerably improve their usefulness for estimating fish landings in the Amazon Basin. To improve such estimates, we propose that local case studies be used to calibrate HCES data, thus combining the high precision of local case studies with the wide coverage and representativity of HCES data

Household-level consumption data can be redistributed for individual-level Optifood diet modeling: analysis from four countries.

A barrier to using Optifood linear programming (LP), which identifies nutrient gaps and supports population‐specific food‐based recommendation (FBR) development, is the requirement for dietary intake data. We investigated whether Household Consumption and Expenditure Surveys (HCESs) could be used instead of individual‐level 24‐h recalls (24HRs). The 24HR data from 12‐ to 23‐month‐old breastfeeding children in rural Kenya, Uganda, Guatemala, and Bangladesh were paired with HCES food consumption data from similar areas (n = 8) and time periods. HCES food intakes (g/week) were estimated using adult male equivalents, adjusted for breastfeeding. Paired HCES‐ and 24HR‐defined LP inputs and outputs were compared using percentage agreement. Mean overall percentage agreements were 42%, 63%, and 80%, for food, food subgroup, and food‐group model parameters, respectively. HCES food lists were on average 1.3 times longer than 24HR. Similar nutrient gaps (77–100% agreement), food sources of nutrients (71–100% agreement), and FBRs (80–100% agreement) were identified. The results suggest that HCES data can be used in Optifood analyses for 12‐ to 23‐month‐old children, despite recognized challenges of using it to estimate dietary intakes of young children compared with older age groups. Further analyses, however, are required for different age groups and locations to confirm expectations that it would perform equally well.

Using Household Surveys and Other Secondary Data to Assess the Need for and Impacts of Micronutrient Interventions (FS01-03-19)

ObjectivesGiven the scarcity of nationally-representative dietary intake data in most low- and middle-income countries, our objective was to compare estimates of micronutrient (MN) intake and predicted MN intervention effectiveness generated using household consumption and expenditure surveys (HCES) and other secondary data vs individual-level 24-hr dietary recalls (24HR), focusing on vitamin A (VA) in children and iron in women of reproductive age (WRA). MethodsWe calculated “apparent” food consumption using HCES data from Cameroon and applied the adult male equivalent method to estimate individual-level food intake. For children, intake was matched with food composition data to calculate VA intake, inadequate intake, and, combined with Demographic and Health Survey (DHS) data, effective coverage (shift from inadequate to adequate intake) of VA interventions. For WRA, we combined DHS data with HCES estimates of fortifiable food intake to predict cases of iron deficiency anemia averted. Results were compared to those generated by modeling data from a national 24HR survey. ResultsMean apparent VA intake among children 6–59 mo from HCES data was similar to 24HR estimates for non-breastfed children (206 vs 215 μg RAE/d) and followed the same sub-national pattern (highest in the South macro-region, followed by the cities, and lowest in the North). Prevalence of inadequate intake was also similar (64% vs 59% nationally). Both data sources predicted effective coverage was highest for VA supplements, micronutrient powders, and oil fortification (Fig. 1).Preventive iron supplements to WRA was predicted to avert a relatively high proportion of anemia based on both the 24HR (24–62% of cases of anemia averted in the cities, 15–26% in the North, and 12–57% in the South) and secondary data (28–60%, 17–37%, and 27–56%). Iron-fortified wheat flour (60 ppm) and bouillon cubes (600 ppm) were predicted to avert few cases of anemia among WRA (<7% and <3%, respectively) in all macro regions. ConclusionsWhere dietary intake data are unavailable, secondary data may be useful for identifying effective MN interventions. Challenges include uncertainty about intrahousehold food distribution, MN intake from breastmilk, and combining multiple secondary data sources. Funding SourcesThis study is based on research funded by a grant to UC Davis from the Bill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs▪

Using Household Surveys and Other Secondary Data to Assess the Need for and Impacts of Micronutrient Interventions (FS01-03-19)

ObjectivesGiven the scarcity of nationally-representative dietary intake data in most low- and middle-income countries, our objective was to compare estimates of micronutrient (MN) intake and predicted MN intervention effectiveness generated using household consumption and expenditure surveys (HCES) and other secondary data vs individual-level 24-hr dietary recalls (24HR), focusing on vitamin A (VA) in children and iron in women of reproductive age (WRA). MethodsWe calculated “apparent” food consumption using HCES data from Cameroon and applied the adult male equivalent method to estimate individual-level food intake. For children, intake was matched with food composition data to calculate VA intake, inadequate intake, and, combined with Demographic and Health Survey (DHS) data, effective coverage (shift from inadequate to adequate intake) of VA interventions. For WRA, we combined DHS data with HCES estimates of fortifiable food intake to predict cases of iron deficiency anemia averted. Results were compared to those generated by modeling data from a national 24HR survey. ResultsMean apparent VA intake among children 6–59 mo from HCES data was similar to 24HR estimates for non-breastfed children (206 vs 215 μg RAE/d) and followed the same sub-national pattern (highest in the South macro-region, followed by the cities, and lowest in the North). Prevalence of inadequate intake was also similar (64% vs 59% nationally). Both data sources predicted effective coverage was highest for VA supplements, micronutrient powders, and oil fortification (Fig. 1).Preventive iron supplements to WRA was predicted to avert a relatively high proportion of anemia based on both the 24HR (24–62% of cases of anemia averted in the cities, 15–26% in the North, and 12–57% in the South) and secondary data (28–60%, 17–37%, and 27–56%). Iron-fortified wheat flour (60 ppm) and bouillon cubes (600 ppm) were predicted to avert few cases of anemia among WRA (< 7% and < 3%, respectively) in all macro regions. ConclusionsWhere dietary intake data are unavailable, secondary data may be useful for identifying effective MN interventions. Challenges include uncertainty about intrahousehold food distribution, MN intake from breastmilk, and combining multiple secondary data sources. Funding SourcesThis study is based on research funded by a grant to UC Davis from the Bill & Melinda Gates Foundation. Supporting Tables, Images and/or Graphs▪

Estimating trends in prevalence of undernourishment: advantages of using HCES over the FAO approach in a case study from Cameroon

Global and national food security policies require a good knowledge of trends in prevalence of undernourishment (PoU). Progress towards the Sustainable Development Goals might be difficult to assess if trends in undernourishment are not correctly estimated. However, methods of estimating PoU are still subject to debate. FAO Food Balance Sheets are used to measure food availability and undernourishment at country level. The aim of this paper is to compare trends in PoU using the FAO approach to that using Household Consumption and Expenditure Surveys (HCES). We used FAO Food Balance Sheets and parameters, and two nationwide representative Cameroonian Household Surveys (ECAM), conducted by the National Institute of Statistics (INS) in 2001 and 2007. Our findings, based on ECAM, show that 38% and 24% of the population were undernourished in 2001 and 2007, respectively. FAO estimates were 29% in 2001 and 17% in 2007. Both approaches showed a downward trend in PoU, but ECAM results showed a greater decrease. Using ECAM enabled disaggregation of trends in PoU by area of residence and region. This, in turn, will enable better targeting of vulnerable areas and disadvantaged segments of the population. The North and Far-North regions of the country were facing major food insecurity problems at the time of the surveys.

Getting the food list 'right': an approach for the development of nutrition-relevant food lists for household consumption and expenditure surveys.

The present paper aimed to demonstrate how 24 h dietary recall data can be used to generate a nutrition-relevant food list for household consumption and expenditure surveys (HCES) using contribution analysis and stepwise regression. The analysis used data from the 2011/12 Bangladesh Integrated Household Survey (BIHS), which is nationally representative of rural Bangladesh. A total of 325 primary sampling units (PSU=village) were surveyed through a two-stage stratified sampling approach. The household food consumption module used for the analysis consisted of a 24 h open dietary recall in which the female member in charge of preparing and serving food was asked about foods and quantities consumed by the whole household. Rural Bangladesh.ParticipantsA total of 6500 households. The original 24 h open dietary recall data in the BIHS were comprised of 288 individual foods that were grouped into ninety-four similar food groups. Contribution analysis and stepwise regression were based on nutrients of public health interest in Bangladesh (energy, protein, fat, Fe, Zn, vitamin A). These steps revealed that a list of fifty-nine food items captures approximately 90 % of the total intake and up to 90 % of the between-person variation for the key nutrients based on the diets of the population. The study illustrates how 24 h open dietary recall data can be used to generate a country-specific nutrition-relevant food list that could be integrated into an HCES consumption module to enable more accurate and comprehensive household-level food and nutrient analyses.

Food counts. Measuring food consumption and expenditures in household consumption and expenditure surveys (HCES). Introduction to the special issue

This introductory paper presents the results of an international multi-disciplinary research project on the measurement of food consumption in national household surveys. Food consumption data from household surveys are possibly the single most important source of information on poverty, food security, and nutrition outcomes at national, sub-national and household level, and contribute building blocks to global efforts to monitor progress towards the major international development goals.The paper synthesizes case studies from a diverse set of developing and OECD countries, looking at some of the main outstanding research issues as identified by a recent international assessment of 100 existing national household surveys (Smith et al., 2014). The project mobilized expertise from different disciplines (statistics, economics, food security, nutrition) to work towards enhancing our understanding of how to improve the quality and availability of food consumption and expenditure data, while making them more valuable for a diverse set of users. The individual studies summarized in this paper analyze, both theoretically and empirically, how different surveys design options affect the quality of the data being collected and, in turn, the implications for statistical inference and policy analysis.The conclusions and recommendations derived from this collection of studies will be instrumental in advancing the methodological agenda for the collection of household level food data, and will provide national statistical offices and survey practitioners worldwide with practical insights for survey design, while providing poverty, food and nutrition policymakers with greater understanding of these issues, as well as improved tools for and better guidance in policy formulation.

Filling a dietary data gap? Validation of the adult male equivalent method of estimating individual nutrient intakes from household-level data in Ethiopia and Bangladesh

Many researchers use data from Household Consumption and Expenditure Surveys (HCES) to estimate individual food and nutrient intake when individual dietary data are not available. They assume that food is allocated within households according to members’ proportional energy requirements relative to an adult male (called an adult male equivalent, or AME). This study sought to validate AME-based estimates of individual consumption of calories, protein, iron, and animal source protein (ASP) across 10 age-sex categories, using data from Bangladesh and Ethiopia containing both household and individual-level consumption data. The study also assessed the accuracy of adjusting for meal partakers and physical activity levels (PAL), and compared energy-weighted AMEs to nutrient-specific AME predictions.Energy AME-based predictions of nutrient intake were generally accurate within ten percentage points of individually reported intakes, but were less accurate for infants 6–23months and children in Bangladesh than for other demographic groups. AME predictions were more accurate: (1) in Ethiopia than in Bangladesh, (2) for predicting intake of the three nutrients rather than ASP, (3) for estimating nutrient intake rather than adequacy, (4) using energy-weighted AMEs rather than nutrient specific weights, and (5) using moderate PAL for youth and adults rather than high PAL. Adjusting for meal partakers did not consistently improve the AME-based predictions. Energy based AME estimates from household data can produce a useful proxy of average intake for certain population subgroups, however individually measured dietary assessment remains the best approach to identify groups at risk of nutrient inadequacy.

Can household-based food consumption surveys be used to make inferences about nutrient intakes and inadequacies? A Bangladesh case study

Household Consumption and Expenditures Surveys (HCES) are increasingly being used to make inferences about individual food consumption, despite the fact that they collect food data at only the household level. Usually the analysis assumes that the household’s food is distributed among its members in direct proportion to each member’s share of the household’s total energy requirements; what is referred to as the adult male equivalent (AME) approach. Using the 2011–2012 Bangladesh Integrated Household Survey—which collected consumption data for all members of rural households using combined 24-hour recall (24HR) and food weighing methods—this study directly compared probability-based average estimates of intakes, intake gaps, and the prevalence of inadequacies as estimated by the 24HR and those calculated using the AME approach for energy and each of four micronutrients: vitamin A, iron, zinc, and calcium.At the population level, for iron, vitamin A, and calcium, more than 97% of all individuals had the same estimated prevalence of adequate or inadequate nutrient intakes using 24HR and AME-based estimates. In the case of energy and zinc, roughly 77 and 83% of the sample population had identical adequacy statuses, respectively. The magnitude of inadequacies (the nutrient gaps) differed by 8 percentage points for energy and less than 3 percentage points for the four micronutrients. Disaggregating intakes and inadequacies by age groups revealed that the vast majority of variance between the two methods was highly concentrated in the first few years of life. Children 3years of age and younger constituted 7.5% of the population but had 13.1% of the inconsistencies in intake adequacy status. 54% of children 3 and under had at least one pair of inconsistent prevalence estimates. While there are important differences in the levels of estimated energy and micronutrient intakes using 24HR and the AME-based estimates for children 3 and under, the results are remarkably comparable for the rest of the population.

How can we better capture food away from Home? Lessons from India’s linking person-level meal and household-level food data

Despite acknowledged shortcomings, household consumption and expenditure surveys (HCES) are increasingly being used to proxy food consumption because they are relatively more available and affordable than surveys using more precise dietary assessment methods. One of the most common, significant sources of HCES measurement error is their under-estimation of food away from home (FAFH). In 2011, India’s National Survey Sample Organization introduced revisions in its HCES questionnaire that included replacing “cooked meals”—the single item in the food consumption module designed to capture FAFH at the household level—with five more detailed and explicitly FAFH sub-categories. The survey also contained a section with seven, household member-specific questions about meal patterns during the reference period and included three sources of meals away from home (MAFH) that overlapped three of the new FAFH categories.By providing a conceptual framework with which to organize and consider each household member’s meal pattern throughout the reference period, and breaking down the recalling (or estimating) process into household member-specific responses, we assume the MAFH approach makes the key respondent’s task less memory- and arithmetically-demanding, and thus more accurate than the FAFH household level approach. We use the MAFH estimates as a reference point, and approximate one portion of FAFH measurement error as the differences in MAFH and FAFH estimates. The MAFH estimates reveal marked heterogeneity in intra-household meal patterns, reflecting the complexity of the HCES’s key informant task of reporting household level data, and underscoring its importance as a source of measurement error.We find the household level-based estimates of FAFH increase from just 60.4% of the individual-based estimates in the round prior to the questionnaire modifications to 96.7% after the changes. We conclude that the MFAH-FAFH linked approach substantially reduced FAFH measurement error in India. The approach has wider applicability in global efforts to improve HCES.

National food security assessment through the analysis of food consumption data from Household Consumption and Expenditure Surveys: The case of Brazil’s Pesquisa de Orçamento Familiares 2008/09

By analyzing the food consumption data from the 2008/09 Pesquisa de Orçamentos Familiares in Brazil, we demonstrate that failing to account for food consumed for free at school may significantly distort the assessment of the distribution of food consumption among households and therefore the assessment of the extent of food insecurity in the country. The results of our analysis enabled a revision of the FAO estimate of the Prevalence of Undernourishment in Brazil and provide useful suggestions for better design of food consumption modules to be included in Household Consumption and Expenditure Surveys (HCES). Additionally, we identify areas for further research on food consumption data to improve national food security assessments.

Identification of optimal investments

Biofortification is regarded as a complement to supplementation, industrial fortification and dietary diversification in the fight against micronutrient deficiencies. It is important therefore to first identify areas where biofortification may have high impact and prioritize these areas for more in-depth analysis. HarvestPlus has developed the Biofortification Prioritization Index (BPI), which ranks countries globally according to their suitability for investment in biofortification interventions. HarvestPlus is also conducting ex ante micronutrient intervention portfolio analyses, designed to simulate the implementation and impact of a biofortification program in countries which have been identified as suitable candidates for investment. Micronutrient intervention portfolio studies offer the ability to distinguish production, consumption and inadequate micronutrient intake at a more disaggregated level and offer a complementary design and planning tool to simulate the implementation of biofortification and examine its potential impact and cost-effectiveness among different approaches. In addition, these studies are designed to examine multiple interventions within a country, to better understand biofortification’s role in reducing micronutrient deficiency when considered among a suite of interventions. This case study of Zambia demonstrates how these tools can be used to assess the potential impact of biofortification, quantify its cost-effectiveness and examine how it interacts with and complements other interventions. Given the long-term nature of biofortification as an intervention investment, future analyses should continue to incorporate various scenarios including continued investment in sustainable development and the effects of climate change which are likely to condition the impact of biofortification and other interventions. Keywords: Biofortification, Biofortification Priority Index (BPI), Cost-effectiveness, Household Consumption and Expenditure Surveys (HCES)

Getting the Food List “Right”: Leveraging Household Consumption and Expenditure Surveys for Food Security and Nutrition

BackgroundThere is growing interest in leveraging the consumption data collected in Household Consumption and Expenditure Surveys (HCES) to inform food and nutrition policies. However many HCES food lists lack sufficient detail on food items and necessary disaggregation of food groups to construct indicators of interest, including dietary quality indicators and estimates of household‐level nutrient adequacy.ObjectiveThis research explored whether and how changes to the food list could result in significant benefits for those interested in using HCES for food security and nutrition related analyses. Using two unique nationally representative datasets from Bangladesh, this analysis sought to determine the most parsimonious set of food list items needed to derive a core set of maximally accurate food security and nutrition indicators while balancing concerns about cost, respondent burden, and trade‐offs with data needs for poverty estimation.MethodsFood security and nutrition indicators constructed from the food consumption module of the 2011–2012 Bangladesh Integrated Household Survey (BIHS) were compared to the same indicators constructed from the ‘gold standard’ 24‐hour recall module in the same data set. The recommended food list from the gold standard BIHS was then compared to the 2010–2011 Bangladesh Household Income and Expenditure Survey (B‐HIES) food list to quantify the accuracy of food security and nutrition indicators. The 2013 Bangladesh Nutrient Database was linked to both the BIHS and B‐HIES to construct indicators of nutrient adequacy. Sensitivity and specificity analyses were conducted in order to determine how well the indicators from the consumption module compared to those from the 24‐hour recall, allowing for assessment of accuracy and precision with different configurations of the food list. Bland‐Altman plots were used to assess the degree of agreement between indicators derived from each data source.ResultsIndicators were compared across the 24‐hour recall and the household food consumption module in both the BIHS and the B‐HIES. The indicators that were evaluated included 1) energy adequacy; 2) macronutrient adequacy (fat, protein, carbohydrate, alcohol); 3) micronutrient adequacy (vitamin A, calcium, folate, iron, and zinc); 4) percentage of calories from individual foods and food groups; 5) quantities consumed of individual foods and food groups including animal source foods, select processed foods, staple and non‐staple foods; and 6) dietary diversity.ConclusionFindings from this research contribute to guidance and recommendations for National Statistics Offices and the international community to enable the development of food lists that serve multiple purposes, including poverty estimation and the derivation of key food security and nutrition metrics.Support or Funding InformationFunding: This research was conducted as part of the International Dietary Data Expansion (INDDEX) Project, which is implemented by Tufts University's Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy with funding from the Bill &amp; Melinda Gates Foundation.

Monitoring population diet quality and nutrition status with household consumption and expenditure surveys: suggestions for a Bangladesh baseline

Increasing understanding of nutrition and the changing nature of malnutrition have increased interest in diet quality. Owing largely to the apparent lack of national and sub-national level data about diet and diet quality, however, we have little knowledge about dietary patterns, and little understanding of how agriculture, trade, food industry and health policy may be used to improve diet quality. This paper reviews the growing use of household consumption and expenditure surveys (HCES)— multi-purpose surveys that are routinely conducted in roughly 120 countries—to address this dietary information gap. By virtue of their being household-based and sub-nationally representative, HCES can get beyond the limitations of the long-standing, traditional data source used to inform food policy—FAO Food Balance Sheets –to provide an understanding of sub-national and household level food consumption patterns. To date, nutritionists have had little knowledge about or involvement with HCES. The confluence of a constellation of factors has now created an opportunity for familiarizing nutritionists with HCES. This paper provides an introduction to and overview of HCES, a description of the activities spawning this opportunity and a case study of Bangladesh. The paper demonstrates how HCES may be used to calculate baseline indicators, which may be used to articulate specific goals and targets, assess progress, identify gaps and prioritize actions, and thereby provide a platform for increasing accountability and commitment to improving nutrition.

The great Indian calorie debate: Explaining rising undernourishment during India’s rapid economic growth

The prevalence of undernourishment in India – the percent of people consuming insufficient calories to meet their energy requirements – has been rising steadily since the mid 1980s. Paradoxically, this period has been one of robust poverty reduction and rapid economic growth. The reasons for the apparent reductions in calorie consumption underlying increased undernourishment have been the subject of intense debate both within India and internationally. This paper critically reviews this debate, finding that is has taken place outside of the context of India’s recent nutrition and epidemiological transitions, which appear to have brought with them increased, not decreased, food consumption. The debate has also taken place under the unchallenged assumption that the data on which the conflicting trends are based, collected as part of the country’s Household Consumption and Expenditure Surveys (HCESs), are reliable. The paper provides supporting literature and empirical evidence that a probable key source of the calorie decline is incomplete collection of data on food consumed away from peoples’ homes, which is widespread and rapidly increasing. Complete measurement of this food source in the HCESs of all developing countries is vital for accurate measurement of both undernourishment and poverty – and for resolving the Indian calorie debate.

Policy Implications of Using a Household Consumption and Expenditures Survey versus an Observed-Weighed Food Record Survey to Design a Food Fortification Program

Observed-Weighed Food Record Surveys (OWFR) are regarded as the most precise dietary assessment methodology, despite their recognized shortcomings, which include limited availability, high cost, small samples with uncertain external validity that rarely include all household members, Hawthorne effects, and using only 1 or 2 days to identify "usual intake." Although Household Consumption and Expenditures Surveys (HCES) also have significant limitations, they are increasingly being used to inform nutrition policy To investigate differences in fortification simulations based on OWFR and HCES from Bangladesh. The pre- and postfortification nutrient intake levels from the two surveys were compared. The total population-based rank orderings of oil, wheat flour, and sugar coverage were identical for the two surveys. OWFR found differences in women's and children's coverage rates and average quantities consumed for all three foods that were not detected by HCES. Guided by the Food Fortification Formulator, we found that these differences did not result in differences in recommended fortification levels. Differences were found, however, in estimated impacts: although both surveys found that oil would be effective in reducing the prevalence of inadequate vitamin A intake among both subpopulations, only OWFR also found that sugar and wheat flour fortification would significantly reduce inadequate vitamin A intake among children. Despite the less precise measure of food consumption from HCES, the two surveys provide similar guidance for designing a fortification program. The external validity of these findings is limited. With relatively minor modifications, the precision of HCES in dietary assessment and the use ofHCES in fortification programming could be strengthened.

The Great Indian Calorie Debate: Explaining Rising Undernourishment during India's Rapid Economic Growth

SummaryThe prevalence of undernourishment in India – the percent of people consuming insufficient calories to meet their energy requirements – has been rising steadily since the mid‐1980s. Paradoxically, this period has been one of robust poverty reduction and rapid economic growth. The reasons for the apparent reductions in calorie consumption underlying increased undernourishment have been the subject of intense debate both within India and internationally. This paper critically reviews this debate, finding that is has taken place outside of the context of India's recent nutrition and epidemiological transitions, which appear to have brought with them increased, not decreased, food consumption. The debate has also taken place under the unchallenged assumption that the data on which the conflicting trends are based, collected as part of the country's Household Consumption and Expenditure Surveys (HCESs), are reliable. The paper provides supporting literature and empirical evidence that one key factor driving the measured calorie decline is incomplete collection of data on food consumed away from peoples’ homes, which is widespread and rapidly increasing. The India example shows that complete measurement of this food source in the HCESs of all countries is vital for accurate measurement of undernourishment and, indeed, poverty at national, regional and global levels.

Validation of Dietary Applications of Household Consumption and Expenditures Surveys (HCES) against a 24-Hour Recall Method in Uganda

The benefits of food fortification depend on the proportion of the population that uses the fortified food (coverage), the amount of the food being consumed, and the additional content of micronutrients in the food. Coverage and amounts consumed can be determined by 24-hour recall or Food Frequency Questionnaires (FFQs). However, these methods are rarely applied. Secondary analysis of data from Household Consumption and Expenditures Surveys (HCES) can be used for these purposes; however, such data analysis has not been validated. To compare the results of HCES and 24-hour recall for estimating the consumption profile of potential fortification vehicles in Uganda. Food intake estimates for 24- to 59-month-old children and 15- to 49-year-old women derived from a one-day 24-hour recall carried out in Uganda (Kampala, North, and Southwest) were compared with data from two HCES (2006, nationwide, and 2008, coupled with the 24-hour recall). The analyzed foods were vegetable oil, sugar, wheat flour, maize flour, and rice. Food consumption estimates calculated from HCES may be less accurate than estimates derived by 24-hour recall. Nevertheless, the HCES results are sensitive enough to differentiate consumption patterns among population strata. In Uganda, HCES predicted proportion of the population that consumes the foods, and approximated intakes of main food vehicles by the "observed" consumers (those who reported using the foods), although estimates for the latter were lower for wheat flour and rice. HCES data offer the basic information needed to provide a rationale for, and help design, food fortification programs. Individual intake surveys are still needed, however, to assess intrahousehold use of foods.