Minimum Dietary Diversity for Women
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MINIMUM DIETARY DIVERSITY FOR WOMEN An updated guide for measurement: from collection to action MINIMUM DIETARY DIVERSITY FOR WOMEN An updated guide for measurement: from collection to action Food and Agriculture Organization of the United Nations Rome, 2021 Required citation: FAO. 2021. Minimum dietary diversity for women. Rome. https://doi.org/10.4060/cb3434en The designations employed and the presentation of material in this information product do not imply the expression of any opinion whatsoever on the part of the Food and Agriculture Organization of the United Nations (FAO) concerning the legal or development status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or products of manufacturers, whether or not these have been patented, does not imply that these have been endorsed or recommended by FAO in preference to others of a similar nature that are not mentioned. ISBN 978-92-5-133993-0 © FAO, 2021 Some rights reserved. This work is made available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo/legalcode). Under the terms of this licence, this work may be copied, redistributed and adapted for non-commercial purposes, provided that the work is appropriately cited. In any use of this work, there should be no suggestion that FAO endorses any specific organization, products or services. The use of the FAO logo is not permitted. If the work is adapted, then it must be licensed under the same or equivalent Creative Commons licence. If a translation of this work is created, it must include the following disclaimer along with the required citation: “This translation was not created by the Food and Agriculture Organization of the United Nations (FAO). FAO is not responsible for the content or accuracy of this translation. The original [Language] edition shall be the authoritative edition.” Disputes arising under the licence that cannot be settled amicably will be resolved by mediation and arbitration as described in Article 8 of the licence except as otherwise provided herein. The applicable mediation rules will be the mediation rules of the World Intellectual Property Organization http://www.wipo.int/amc/en/mediation/rules and any arbitration will be conducted in accordance with the Arbitration Rules of the United Nations Commission on International Trade Law (UNCITRAL). Third-party materials. Users wishing to reuse material from this work that is attributed to a third party, such as tables, figures or images, are responsible for determining whether permission is needed for that reuse and for obtaining permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. Sales, rights and licensing. FAO information products are available on the FAO website (www.fao.org/publications) and can be purchased through [email protected]. Requests for commercial use should be submitted via: www.fao.org/contact-us/ licence-request. Queries regarding rights and licensing should be submitted to: [email protected]. Contents Acknowledgements vii Abbreviations and acronyms ix Scope of the guide xi PART 1. THE INDICATOR: FROM COLLECTION TO ACTION 1 Section 1. Introduction 3 1.1. Definition of the indicator 5 1.2. Background 6 1.3. Appropriate uses 9 1.4. Methodological approaches 12 Section 2. The ten food groups 13 2.1. Selection of the food groups 16 2.2. Food group descriptions 17 2.3. Additional food groups 29 2.4. Mixed dishes and food items with multiple ingredients 36 Section 3. Data collection tools 41 3.1. Elaboration of locally adapted food lists 43 3.2. Translation and adaptation 48 3.3. Adapting survey tools for computer-assisted personal interviewing 50 3.4. Selection of the data collection method 51 3.5. List-based method 57 3.6. Open-recall method 62 Section 4. Analysis, presentation and interpretation 67 4.1. Constructing the indicator 69 4.2. Data processing and management 71 4.3. Presentation and interpretation of results 71 Section 5. From collection to action 79 5.1. Practical uses for the indicator of minimum dietary diversity for women 82 iii PART 2: STEPS FOR FIELD OPERATIONS 89 Section 1. Preparing to collect data 91 1.1. Assemble a multi-disciplinary team 84 1.2. Liaise with local authorities to obtain approvals 96 1.3. Procure equipment and prepare the enumerator kits 98 1.4. Sampling and sample size calculation 99 Section 2. Capacity-development 105 2.1. Recruitment and selection of enumerators and supervisors 107 2.2. Topics to cover during the training 108 2.3. Training protocol 109 Conclusion 115 References 116 Appendices 127 Appendix 1. Additional examples of food items for MDD-W 129 Appendix 2. Comparing MDD-W and other food group diversity indicators 143 Appendix 3. Example Technical Specifications for Tablet and Powerbank 146 used in the FAO MDD-W study Appendix 4. Frequently encountered challenges and proposed solutions 148 for list-based and open recall methods Appendix 5. Sample extensive food lists from the FAO MDD-W study for use 150 in both list-based and open recall adapted tools. Appendix 6. Examples list-based and open recall questionnare in 156 Open Data Kit application Appendix 7. List of country team members 158 iv Figures 1. Steps in the development of an extensive food list and the 47 corresponding support tools 2. Comparison of the two proxy methods for data collection: preparation 52 of the questionnaire, length of food list, interview protocol and recording of responses 3. Main considerations when selecting the data collection methodology 53 for the MDD-W indicator 4. Diagram of study design 55 5. Possible options for open recall interview protocol 63 6. Percent of WRA achieving MDD-W during the previous day or night, by region 72 7. Percent of WRA achieving MDD-W during the previous day or night, 73 by food system typology 8. Mean (Standard Deviation) food group diversity score during the previous 73 day or night, by region 9. Percent of WRA by food group diversity scores during the previous 74 day or night, by region 10. Percent of WRA by food group diversity scores, during the previous day or night 74 11. Median (interquartile range) food group diversity score for WRA during 75 the previous day or night, by wealth quintiles 12. Percent of consumption of food groups by WRA, during the previous day or night 75 13. Percent of WRA who reported consumption of unhealthy food groups 76 during the previous day or night, based on age group 14. Simple pathways to women’s dietary diversity 82 15. Integrating MDD-W into national nutrition information systems 83 16. Uses for MDD-W in programme evaluation: Entry points in the project cycle 83 17. Proportion of women reaching MDD-W 87 v Tables 1. Appropriate and inappropriate uses of the MDD-Windicator 10 2. Sample of an extensive food list 44 3. Advantages and disadvantages of list-based and open recall methods 54 4. Example of a grid structure 65 5. Aggregation of subdivided food groups for MDD-W 69 6. Percent of WRA achieving MDD-W, during the previous day or night, 76 according to urban/rural residence and wealth quintile 7. Percent of WRA in hypothetical countries where food is consumed from various 77 food groups the day before data collection, when above or below MDD-W 8. Potential composition of the team to investigate MDD-W 95 9. Checklist of equipment and supplies required by each enumerator 98 10. Target areas for capacity-development 108 Boxes 1. Why focus on women? 11 2. Subdivision of the ten food groups 16 3. The issue of quantity – how much is enough to count towards food group diversity? 21 4 Criteria for defining foods and liquids as sources of vitamin A 27 5. Mixed dishes: examples of classifying ingredients into rows on the model 38 questionnaire 6. Food items with multiple ingredients 40 7. Programming the adapted survey into the chosen application 50 8. Overview of the two data collection methods 51 9. Summary of the multi-country study in Cambodia, Ethiopia, and Zambia 55 on MDD-W 10. List-based: using computer-assisted personal interviewing for MDD-W 62 11. Open recall: using computer-assisted personal interviewing 66 12. Setting targets for MDD-W 86 13. Snapshot of preparatory steps involved and their objectives 93 14. Deciding on the software and hardware 99 15. Optional suggested exercises to assist understanding of food group 112 classification and 15 g 16. Capacity-development using tablets and the data collection application 113 vi Acknowledgements The present updated guide builds on the work completed by the team that wrote the 2016 edition Minimum Dietary Diversity for Women: A Guide for Measurement. At the global level, revision and writing was led by Maria Antonia Tuazon, Ji Yen Alexandra Tung and Isabela Fleury Sattamini (Food and Agriculture Organization of the United Nations – FAO, Rome), who also led study design, project coordination and implementation of the multi-country study that provided the scientific basis for the update. The team from Ghent University, Kingdom of Belgium: Giles Hanley- Cook, Carl Lachat and Patrick Kolsteren supported the design of the study, and managed and conducted statistical analysis. Boran Altincicek supervised the design, adaptation and use of electronic data collection tools. Mary Arimond, Terri Ballard, Estefania Custodio (European Commission Joint Research Centre/Instituto de Salud Carlos III), Gina Kennedy (USAID), Yves Martin Prével (Institut de Recherche pour le Développement, IRD), Markolf Maczek (GIZ) and Pattanee Winichagoon (Mahidol University, Kingdom of Thailand) were part of the project’s Technical Advisory Group (TAG).