Information on the dietary intake and nutritional status of individuals in a population is essential for monitoring trends in these indicators over time and in response to political and environmental changes, as a means of identifying groups for intervention, and to assess the impact of interventions on nutritional status of the population. Although dietary intake and simple anthropometric measurements, such as weight and height, have often been the focus of health and nutrition surveys, it is essential that other indicators of nutritional status such as micronutrient deficiencies also be documented because they continue to be important public health problems in most developing countries. Furthermore, as discussed previously, information on factors that are direct (e.g., the prevalence of infections) and indirect (e.g., maternal education and family socioeconomic status) causes of nutritional problems increases the usefulness of nutritional surveillance information for policymakers.
Many nutritional surveillance systems have dealt with this daunting list of indicators by focusing efforts on specific high-risk groups—a logical decision in light of limited resources. Thus, more information is available for children younger than 5 years of age and women of reproductive age than for olden children, adolescents, adult men, and older adults. With the increasing prevalence of overweight and obesity, particularly in school-age children and adults, this strategy may need to be modified. Although not evident in all developing countries, this paradox is particularly striking in some middle-income Latin American countries, such as Mexico and Chile, but is also documented in India and many other countries.
The coexistence of malnutrition and "over-" nutrition represents an important challenge to all those involved in nutritional surveillance. For funders, the population groups being monitored may need to be expanded, with important cost implications; malnutrition in children and pregnant and lactating women has not disappeared in developing countries with the increase in overweight and obesity. For those involved in data collection, these additional nutritional problems imply the development and validation of new instruments to measure causes of overweight and obesity (e.g., physical activity). For policymakers, the burden lies in the need for policies and programs that respond to two extremes of nutrition problems, often occurring in the same communities and even households. For example, programs designed to improve dietary intake in household members at risk for nutritional deficiencies
(e.g., children younger than 2 years of age) should not cause an increase in energy intake among those members of the household at risk for overweight and obesity (e.g., school-aged children). Thus, program evaluations must be designed to detect both desirable and unexpected or undesirable outcomes.
The choice of which indicators are most appropriate for monitoring the nutritional status and dietary intake of the population depends on the country context and the specific objective of the surveillance system. For example, in countries where food shortages are common, indicators that are particularly sensitive to change, such as the prevalence and severity of malnutrition in children younger than 5 years of age, should be used. If the objective is to determine the impact of improving the nutritional status of a population in which stunting and anemia are the principal problems, then the prevalence of these should obviously be monitored.
Information on the intake and nutritional status of individuals is available from a variety of sources in developing countries. We present a description of the types of information available for children younger than 5 years of age (Table 1) and adults (Table 2) from a variety of information sources. Much of this information is obtained from large-scale multination health and nutrition surveys and from databases maintained by international organization, such as FAO and the World Health Organization (WHO). A number of countries conduct periodic nationally representative health and nutrition surveys, and information may also be available from smaller scale health and nutrition surveys and from routine growth monitoring and promotion programs. The following sections provide a brief discussion of each of these types of information in the developing country context.
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