Number of people who were nutritionally assessed and received nutrition counseling and therapeutic or supplementary food
How to use this indicator
This indicator can used by vulnerable children (VC), key population (KP), and HIV programs to track nutritional support provided to those vulnerable to, affected by, or who test positive for HIV. Nutritional assessment from anthropometric measurement provides the necessary information to identify those at higher risk of mortality and for whom nutrition counseling and therapeutic or supplementary feeding support is required. These data provide information on the nutritional status of people living with and at risk of acquiring HIV and should inform strategies to address nutritional care and support needs.
Although this indicator is typically reported solely for people living with HIV, it is essential for programs to consider those affected by HIV as well for nutritional assessment and support. This indicator is also typically split into three separate indicators: nutrition assessment, nutrition counseling, and provision of therapeutic or supplementary food. Although this indicator requires tracking all the above information, combining it into one indicator helps ensure adequate nutrition support service provision to those identified as malnourished.
Nutritional assessment is an essential component of care and treatment for HIV-infected and affected people; it allows monitoring of individual nutritional status and enables health workers to understand dietary habits, nutritional problems, and gauge progress. All assessments should be followed by nutrition counseling. Both should occur regularly to ensure that beneficiaries are aware of feasible dietary actions to maintain the nutritional status of themselves and their families. Nutritional status is of particular importance for those living with HIV and on treatment, because some antiretrovirals should be taken with food and others do not metabolize as well with food. The WHO recommendations state that optimal ART requires a balanced diet and good nutrition to ensure effect. Therapeutic food should be provided to those found to be severely malnourished, and supplementary food products should be provided for those found to be moderately malnourished. Programs should track provision of food products to detail scale and coverage of food security services.
Numerator
Number of people who received a nutritional assessment, nutritional counseling, and therapeutic or supplementary food, based on their level of malnutrition (moderate or severe), at any point during the reporting period
Note: Number of households is alternative language for this indicator, especially for vulnerable children programs, but tracking the number of people is ideal given the potential for variation of nutritional intake among the various members in each household (e.g., boy infants being fed more food than girl infants).
Unit of measure
Number
Calculation
Sum results across reporting period
Method of measurement
To be counted for this indicator, beneficiaries must have received a nutrition assessment, followed by nutrition counseling, and then provided with therapeutic or supplementary food. Every person who received these three services at least once during the reporting period should be counted.
For those who are not pregnant, or who are within six months postpartum and above the age of 18, BMI is the suggested method of anthropometric measurement, which is calculated by dividing weight in kilograms by height in meters squared (BMI= kg/m2). For children ages 5–18 who are not pregnant, BMI-for-age z-score is the recommended method.
Measuring middle-upper arm circumference of the left upper arm (MUAC), is recommended for children ages 6–59 months. (See the related indicator here for more information on calculating MUAC.) MUAC can also be used to assess pregnant and lactating women (up to six months) and people who are not pregnant (or are postpartum) whose height and weight cannot be measured (because equipment is not available or the person cannot stand). Equipment necessary for measurement may include MUAC measurement tapes, stadiometers/height-measuring devices, and recumbent length devices.
It is recommended that community workers be equipped with MUAC tapes, ready-to-use therapeutic foods (RUTF), and scales. Community workers should refer moderately malnourished children, lactating mothers with infants under six months of age with middle-upper arm circumference less than 21 cm, and pregnant women with middle-upper arm circumference less than 21 cm to link them to an appropriate supplementary feeding program for screening and treatment before medical complications arise.
If a community worker is unable to conduct the nutrition assessment, counseling, and/or provide food, they can ask this question directly to determine the number of people in the household who received the three components from another source, when they follow-up post-referral to ensure completed referral. Referrals should not be counted in this indicator, because it measures service uptake.
Note that an alternative for MUAC, if a community worker does not have adequate tools or training, is the adapted FANTA hunger scale from the MEASURE Evaluation Orphans and vulnerable children (OVC) toolkit. With consent from the caregiver, a community worker can ask the caregiver the following questions in relation to their children ages 0–9, and directly to a child age 10 or above, to assess food security, following consent of the caregiver. This is an indicator of nutritional status and a step in the theory of change for malnutrition.
|
1 |
In the past four weeks, did you have to eat a smaller meal than you felt you needed because there was not enough food? |
Yes No |
1 2 |
If No: 3 |
|---|---|---|---|---|
| 2 |
If yes – How many times did this happen? Read out responses. |
Rarely (1–2 times in past 4 weeks) Sometimes (3–10 times in past 4 weeks) Often (more than 10 times in past 4 weeks) |
1
2
3 |
|
| 3 | In the past four weeks, did you have to skip a meal because there was not enough food? |
Yes No |
1 2 |
If No: 5 |
| 4 |
If yes – How many times did this happen? Read out responses. |
Rarely (1–2 times in past 4 weeks) Sometimes (3–10 times in past 4 weeks) Often (more than 10 times in past 4 weeks) |
1
2
3 |
|
| 5 | In the past four weeks did you go to sleep at night hungry because there was not enough food to eat? |
Yes No |
1 2 |
If No: 7 |
| 6 |
If yes – How many times did this happen? Read out responses. |
Rarely (1–2 times in past 4 weeks) Sometimes (3–10 times in past 4 weeks) Often (more than 10 times in past 4 weeks) |
1
2
3 |
|
| 7 | In the past four weeks did you go a whole day and night without eating anything because there was not enough food to eat? |
Yes No |
1 2 |
If No: 9 |
| 8 |
If yes – How many times did this happen? Read out responses. |
Rarely (1–2 times in past 4 weeks) Sometimes (3–10 times in past 4 weeks) Often (more than 10 times in past 4 weeks) |
1
2
3 |
Data source
These data are often found in one of the following forms: OVC program child/adult status, vulnerable child, and service provision tools which track nutrition and growth scores, nutrition and growth status, and whether food and nutrition services were received by OVC and their families. Community workers are asked to complete this information at the household level as they conduct case management, but they use forms that also track referrals and follow-ups required for nutrition education, counseling, and food. Key population programs usually track nutritional information, counseling, and support provided during behavior change communication and outreach activities and corresponding forms. HIV programs collect information on the number of people living with HIV (including pregnant women) provided with nutritional assessments, nutritional counseling, nutritional services, and referral for malnutrition.
Data source
Disaggregation
- Age (<1 year, 1–4 years, 5–9 years, 10–14 years, and 15–19 years for children; 20–24 years, 25–49 years, and 50+ years for adults)
- Sex
- Pregnancy/lactation status
- Key population type (sex workers, transgender people, men who have sex with men, people who inject drugs)
- Service delivery modality
- Nutritional status (severe acute malnutrition [SAM], moderate acute malnutrition [MAM])
- HIV status
Data quality considerations
This indicator, by itself, cannot track coverage of nutrition assessment and counseling, but it supports better understanding of coverage of all three services. Additionally, this indicator does not track the quality of assessment and counseling provided. Quality assurance and supportive supervision strategies should be put in place at the community level to ensure quality provision of these services. It is recommended that the country provide guidelines on the advised anthropometric measurements, by age and demographic, to be implemented universally throughout the country, to ensure comparability of data between programs. This indicator does not incorporate the impact of food support, quality of the foods, duration of food support, or adherence or dropout rates of food programs. The overall number reported for this indicator should be equal to the sum of the numbers of people in each disaggregation type. Only one type of age disaggregation should be used throughout, and overlap should be avoided.
Reporting frequency
Community workers should collect this information regularly, but they should monitor progress monthly with support from their supervisors. The indicator should be reported on a semiannual basis.
Data element
Nutritional assessment, counseling, and food received
Category
Vulnerable Children, Home-Based Care, Key Populations, Prevention of Mother-to-Child Transmission
Related content
CORE Group Essential Nutrition Actions
References
OVC Survey Toolkit. (2017, June 13). Retrieved from https://www.measureevaluation.org/our-work/ovc/ovc-program-evaluation-tool-kit
Tang, A., Quick, T., Chung, M., & Wanke, C. (2015). Nutrition Assessment, Counseling, and Support (NACS) interventions to improve health-related outcomes in people living with HIV/AIDS: A systematic review of the literature. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4397900/
Interpretation of Mid-Upper Arm Circumference MUAC indicators. (n.d.). Retrieved from http://motherchildnutrition.org/early-malnutrition-detection/detection-referral-children-with-acute-malnutrition/interpretation-of-muac-indicators.html
The United Nations Children’s Fund. (n.d.). Lesson list assessment mini-lesson 3.1.3. Retrieved from https://www.unicef.org/nutrition/training/3.1.3/6.html
World Health Organization. (2010). AIDS treatment, nutrition and food supplements. Retrieved from http://www.who.int/3by5/mediacentre/fsFood/en/
