L M Neufeld and L Tolentino, National Institute of Public Health, Cuernavaca, Mexico
© 2005 Elsevier Ltd. All rights reserved.
Nutritional surveillance was defined in the previous article as a system established to continuously monitor the dietary intake and nutritional status of a population or selected population groups using a variety of data collection methods, with the ultimate goal of having a direct impact on actions to improve the situation. The challenges to meet this goal in developing countries are many, and they differ from those of more industrialized countries for a number of reasons. First, in most developing countries the prevalence of problems related to nutritional deficiency is higher than in industrialized countries and the prevalence varies greatly within and between regions and countries. Second, continuous national monitoring (e.g., through the health care system) is not well established in many countries and resources in many countries are scarce. Finally, during the past decade there has been a dramatic increase in the prevalence of overweight and obesity and their related morbidities. Together, the problems related to under- and overnutrition present unique challenges to national and international policymakers and heighten the need for nutritional surveillance systems that are able to provide useful information to policymakers.
To date, the major shortfall of nutritional surveillance has been the link between the data collected and its use in policy and programs, particularly in developing countries, where the need for nutrition interventions is great. Health and nutrition policies and programs should use information from nutritional surveillance systems to identify needs of specific populations within regions and countries and to help design appropriate interventions that address the relevant causes of these problems. This implies an open communication between those involved in data collection and those who would ultimately use the information. Unfortunately, the number of concrete examples in which this link has resulted in nutritional surveillance information being directly used to influence policy is still limited.
The responsibility for making nutritional surveillance action-oriented lies with all parties involved— donors, agencies or researchers involved in data collection and analysis, and policymakers. In many developing countries, the lack of existing information systems and limited local resources implies that external funds, often from donor agencies, will be required for surveillance activities. At all stages of planning, those responsible for data collection should interact directly with policymakers to ensure that the information is collected, analyzed, and presented in a way that is meaningful to them. Once data on the nutrition situation become available, policymakers should seek technical assistance from experts in the field to assist with the design of interventions with high potential for impact. Evaluation of policy and programs is essential to complete the cycle and permit new assessments and analyses based on these outcomes. This again implies the need for external funds in many cases. Researchers or national or international agencies may need to become advocates to promote dialogue with policymakers and to convince donors of the importance of this process.
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