Mother, Infant and Young Child Nutrition & Malnutrition - Feeding practices including micronutrient deficiencies prevention, control of wasting, stunting and underweight Mother, Infant and Young Child Nutrition & Malnutrition


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Planning, Monitoring & Evaluation
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Planning, Monitoring and Evaluation

Introduction
Indicators
Means of Data Collection
Use and Presentation of Data

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Home  »  Information Management Systems  »  Planning, Monitoring and Evaluation  »  Indicators (baseline, impact, output and performance)

Setting up and managing a Comprehensive Information Management System

Planning, Monitoring and Evaluation


Indicators (baseline, impact, output and performance)

  • Indicators should be set according to the SMART criteria: Specific to the objective; Measurable either quantitatively or qualitatively; Available at an acceptable cost; Relevant to the information needs of decision-makers; and Time-bound so that users know when to expect the objective or target to be achieved.
     
  • Baseline indicators should come from officially recognized sources of information such as the national Demographic Health Survey (DHS), the Multiple Indicator Cluster Survey (MICS) or the Health and Nutrition Survey. Targets need to be established and agreed against these baseline indicators. The classification of baseline indicators according to age, gender, rural, urban, literate and illiterate divides can help highlight significant disparities and the setting of targets that aim to close the gaps.

    The contribution towards the achievement of the Millennium Development Goals (MDG) and related Targets should also be acknowledged.
     
  • Impact indicators are linked to objectives and are expected to be achieved in the medium-long term. They should be based on objectives outlined in the national nutrition policy. The following are examples of impact indicators (clinical and biological) in the nutrition area:
     
    • Percentage of stunted children under three years (or under five years).
       
    • Percentage of wasted children under three years (or under five years).
       
    • Percentage of under-weight under three years (or under five years).
       
    • Percentage of low birth weight infants.
       
    • Percentage of micronutrient deficiency disorders - Vitamin A Deficiency and Iron Deficiency Anaemia in pre-school and school children and pregnant women, median urinary iodine level in school children and goitre prevalence.
       
    • Percentage of malnutrition (BMI) for women of reproductive age (15-49 yrs).
       
    • Incidence of diseases that have an impact on nutrition (Malaria, diarrhoea, ARI, and HIV/AIDS).
       
  • Output indicators complement impact indicators and are linked to results. They monitor the immediate products and services delivered to beneficiaries and can be used to justify short-term resource allocation decisions. The following are examples of output indicators in the nutrition area:
     
    • Percentage of children 0-6 months exclusively breastfed.
       
    • Percentage of infants that were breastfed within one hour after delivery.
       
    • Percentage of children 6-24 months still breastfeeding.
       
    • Percentage of children 6-24 months receiving appropriate complementary feeding as defined by FADUA criteria: Frequency, Amount, Density (energy), Use of food (variety) and Active feeding.
       
    • Percentage of sick children 6-24 months receiving appropriate complementary feeding as defined by "continuation" during and "increasing" after illnesses.
       
    • Percentage of children (6-34 months or 6-59 months) receiving Vitamin A Supplementation every six months (100,000 IU for children 6-12 months and 200,000 IU for children > 12 months).
       
    • Percentage of postnatal women receiving Vitamin A supplementation (200,000 IU) within 8 weeks after delivery.
       
    • Percentage of children (6-24 months) receiving daily Iron supplementation (12.5 mg iron + 50 µg folic acid daily) from 6 to12 months (prevalence of anaemia less than 40%) or from 6 to 24 months (prevalence of anaemia more than 40%).
       
    • Percentage of children with Low-Birth-Weight (<2500 g) receiving daily Iron supplementation (12.5 mg iron + 50 µg folic acid daily) from 2 up to 24 months.
       
    • Percentage of children (12-34 months or 12-59 months) receiving de-worming (Albendazole 1 to < 2 years 200 mg and > 2 years 400 mg or Mebendazole 1 to < 2 years 250 mg and > 2 years 500 mg) every six months.
       
    • Use of iodised salt.
       
    • Percentage of pregnant women receiving Iron supplementation (60 mg iron + 400 µg folic acid daily) for six months (and continuing for three months after delivery).
       
    • Percentage of pregnant and lactating women receiving adequate nutrition as defined by frequency and variety.
       
  • Performance indicators are linked to activities. To increase ownership of the process, key stakeholders like frontline service providers and communities should be involved in the setting of targets. Performance indicators need to be part of quality assurance through continuous education and/or on-the-job support supervision. Possible approaches to measure performance indicators include pre-post tests, focus group discussions and observations.

    The following are examples of performance indicators for preventive nutrition:
     
    • Percentage of community service providers with knowledge of key nutrition messages and actions at critical stages in the life cycle of women and children.
       
    • Percentage of community and facility-based service providers with skills on Behavioural Change Communication (BCC).
       
    • Percentage of children under 3 years (or under 5 years) being weighed monthly and with their growth plotted in the card.
       
    • Percentage of caregivers with knowledge of key nutrition behaviours and practices at critical stages in the life cycle of women and children.
       
    • Percentage of caregivers with knowledge of local recipes to support home-based recovery of sick children during and after illness.
       
    • Percentage of health facilities with no stock of Iron-Folic Acid (IFA) and Vitamin A.
       
    • Percentage of pregnant women receiving the recommended IFA supplementation (quantity and duration) based on recorded data.
       
    • Type and coverage of community-based BCC initiatives (e.g. drama, school events, care-groups, cooking sessions, radio programs, etc.).
       
    • Type and coverage of community-based initiatives to promote food diversification looking at production, processing, preparation and preservation of available resources.

    The following are performance indicators for management of acute malnutrition:

    • Recovery rate
       
    • Death rate
       
    • Defaulter rate
       
    • Weight gain
       
    • Length of stay
       
    • Coverage

All the above data should be available from routine monitoring systems.

Reference values have been developed by Sphere Project against which the functioning of individual programs can be interpreted. They give an indication of what might be considered an "acceptable" or "alarming" performance under average conditions where other programs are also functioning.

Reference values for SAM management ©Sphere project


Indicators
 

Acceptable

Alarming
Recovery rate > 75% < 50%
Death rate < 10% (<5% preferable) > 15%
Defaulter rate < 15% > 25%
Weight gain >= 8 g/kg/day < 8 g/kg/day
Length of stay < 4 weeks > 6 weeks
Coverage > 50% in rural areas
> 70% in urban areas
> 90% in a camp situation
< 40%

Acceptable benchmarks for out-patient programs would be:

Rate of weight gain - more than 4g/kg/day.

Length of stay - less than 60 days.

 

Reference values for MAM management ©Sphere project


Indicators
 

Acceptable

Alarming
Recovery rate > 75% < 50%
Death rate < 3 % (<5% preferable) > 5%
Defaulter rate < 15% > 25%
Coverage > 50% in rural areas
> 70% in urban areas
> 90% in a camp situation
< 40%

It is essential that Non Response also be included in the SFP Indicator rates to ensure correct
statistical response

The SMART methodology is an improved survey method based on the two most vital, basic public health indicators to assess the severity of a humanitarian crisis: nutritional status of children under-five and mortality rate of the population.



26 January, 2014
 


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