ecological assessment

• Ecological factors for nutritional assessment

  • Demographic information
  • Socioeconomic stratification
  • Health statistics resources: Morbidity and Mortality
  • Local health resources
  • Dental health
  • Cultural factors
  • Community political organization
  • Housing
  • Food supply
  • School nutrition programs
  • Social welfare programs
  • Transportation
  • Education
  • Occupational data
  • Geography and environment
  • Other community aspects
• Demographic information

  • Population by age
  • Ethnicity
  • Sex
  • Population density
  • Birth rates
  • Deaths
• Socioeconomic stratification


  • Economic status: income, employment, % below poverty
  • Education levels
  • Age and gender
  • Race & ethnicity
  • Social factors: homelessness, immigration status, family composition, TANF utilization
• Vital statistics


  • Obtained from the community, health care professionals, and surveillance network
  • Analysis of morbidity and mortality data can be used in estimating the prevalence of the disease in the community and identifying the high-risk groups
  • Program managers could use vital statistic to evaluate the strategies periodically, then revise their program, accordingly
• Mortality rate


  • Age-specific mortality rates
  • Cause specific mortality rates
  • Death rate
  • Maternal mortality rate (MMR)
  • Infant mortality rate (IMR)
  • Neonatal mortality rate
  • Perinatal mortality rate
  • Stillbirth rate
• Morbidity rate


  • Morbidity relates to types and varieties of diseases one faces or experiences affecting the day-to-day activity
  • Incidence – number of new cases
  • Prevalence – number of existing cases
• Community health status


  • Causes of mortality
  • Hospital discharge data
  • Disease prevalence data
  • Food borne illness reports
  • Years of potential life lost
  • Infant mortality
• Local health resources


  • Number of available physicians, dentists, public health nutritionists, public health nurses, midwives, school nurses, health educators, social service workers, nurse practitioners, and other health workers
• Cultural factors


  • Food preferences and eating habits, marketplace, shopping pattern
• Community political organization


  • Community power structure
  • Political and administrative responsibilities
• Housing


  • Indicator of social or environmental deprivation
  • Family's ability to utilize foodstuffs is directly related to the adequacy of kitchen facilities
  • Measure crowding
  • Sanitation
• Food supply


  • Foods that are available
  • Patterns of purchase if not consumption
  • Assessment of the local marketplace-supermarkets
  • Food cost
  • Food supply
  • Nutrition resources
• Food standards


  • Compliance with local or state food standards, including fortification requirements
  • Effectiveness of any local consumer protection agencies in protecting the food buyer
• School nutrition and health


  • Concern with obesity and other nutritional problems
  • Programs for pregnant and/or married adolescents, especially in terms of nutritional counselling
• Social welfare programs


  • Population Receiving Assistance
  • Eligibility standards
• Transportation facilities


  • Accessibility affects the availability of foodstuffs
  • Mobility of individuals has a direct bearing on their ability to obtain food, nutritional counseling, or to visit health of educational facilities
• Education


  • Nutritional service, educational, and assistance programs must be oriented to the education, literacy, and cultural levels of the community
• Geography


  • Soil type and other factors related to agricultural production
• Other community aspects

  • Community Awareness
  • Disaster Planning
  • Public Institutions
• Community resources & service utilization

  • What resources are available?
  • To what extent are people using them?
  • Sources of Information: Citizens, Service providers, Existing data, Interviews, Surveys
• Methods of data collection

  • Primary data: Surveys, Focus Group Discussions (FGD), Key Informant Surveys (KI), Participatory Rural Appraisal (PRA)
  • Secondary data: Desk reviews
• First studies of nutritional status and food intake in developing countries conducted before WW II
• 1950s and 1960s: studies on the nutrition problems of people in development countries; comprehensive nutrition surveys done
• 1970s: rapid but less precise procedures for assessing nutrition situation, its causes, and trends emerged
• Community


  Any group sharing something in common
• Community nutrition


  • An area of nutrition that focused on the promotion of good health and the primary prevention of diet-related illness
  • Emphasis is on maintenance of health in the whole population, although it will also include working with high-risk groups and other subgroups within the population
  • The community rather than the individual is the focus of interest
  • Includes nutritional surveillance; epidemiological studies of diet; and the development, implementation, and evaluation of dietary recommendations and goals
• Mechanisms leading to malnutrition were unclear
• Rapid but less precise procedures for assessing nutrition situation, its causes, and trends emerged

  1970s
• Community nutrition (public health nutrition)

  An area of nutrition that focused on the promotion of good health and the primary prevention of diet-related illness
• Community nutrition


  • Emphasis is on maintenance of health in the whole population, although it will also include working with high-risk groups and other subgroups within the population
  • The community rather than the individual is the focus of interest
  • A community may be any group of individuals, for example, the population of a town or country, or the residents of an old people's home
• Community nutrition assessment


  A practical method of obtaining an overview of the nutritional status of a given community
• Community nutritional assessment (CNA)

  • Paints a picture of the health of the community, its ecology, and the factors influencing the way its people
  • Cannot be made in isolation from either decisions previously made about future action or the subsequent steps in the planning cycle
  • Data such as demographic, epidemiologic, cultural, and geographic are utilized
• It is necessary to examine the community as a whole in order to determine how the quality of life relates to the nutritional status of the community
• Nutritional assessment is justified only when taken as a preliminary step to further action; a step in a planning process
• Malnutrition is caused by a combination of factors, e.g., low income, illiteracy, unhealthy environment and that all these factors affect each other differently according to the particular situation
• The health sector (or for that matter, any other sector) alone will not solve the nutritional problems of the population
• An analysis of causes is a prerequisite to any decision-making
• Causal model


  An ordered set of causal hypotheses linked together in a rational, hierarchical manner
• Building a causal model is an essential step to give a global view of nutrition and its determinants and help in the choice and interpretation of data
• Methodological assumptions

  • Objectives of the assessment must be clearly defined at the outset
  • An assessment does not only consist of collecting data and describing a situation; it is also an explanation and an identification of trends
  • Deadlines and financial constraints restrict the choice of data to be collected
  • Maximum use of existing data is the rule: large surveys are often unnecessary
  • Important to break down the data, e.g., age group, region, ethnicity
  • A nutritional assessment is the responsibility of an inter-disciplinary team
  • Decisions will have to be made in all cases