Proxy measures of household food consumption for food security assessment and surveillance: comparison of the household dietary diversity and food consumption scores.

OBJECTIVE: To provide an overview of the household dietary diversity score and the food consumption score, two indicators used for food security assessment and surveillance, and compare their performance in food security assessments in three countries. DESIGN: Cross-sectional cluster sampling design using an interview-administered structured questionnaire on household food security, including household-level food group consumption measured over 1 d and 7 d. SETTING: Survey data are from Burkina Faso, Lao People's Democratic Republic (Lao PDR) and northern Uganda. SUBJECTS: Households in Burkina Faso (n 3640), Lao PDR (n 3913) and northern Uganda (n 1956). RESULTS: Spearman's correlation coefficients between the scores were 0·73 in Burkina Faso, 0·65 in Lao PDR and 0·53 in northern Uganda. Prevalence-adjusted kappa coefficients showed substantial strength of agreement in two countries. The proportion of agreement between the two scores ranged from 85 % in Lao PDR to 65 % in northern Uganda. Dietary profiles based on food group consumption using score tertiles were comparable. Rankings of the most food-insecure areas within a country corresponded well in northern Uganda and Burkina Faso but not in Lao PDR. Both indicators showed moderate correlations with other proxy measures of food security. CONCLUSIONS: The comparative study highlights the similarities and differences between the food consumption and household dietary diversity scores. Similar classification of the most food-insecure areas within sub-national levels was obtained. The choice of indicator for food security assessment and surveillance will vary depending on user needs.

School-based iron and folic acid supplementation for adolescent girls: findings from Manica Province, Mozambique.

BACKGROUND: The 1997 Demographic and Health Survey in Mozambique shows that 47% of girls 15 to 19 years old living in Manica province (west-central Mozambique) are pregnant or have already had a child. A recent survey also shows that 45% of girls 10 to 18 years old attending school are anemic. Strategies are needed to build iron stores before pregnancy and to control seasonal and chronic iron deficiency and anemia in school-aged girls. OBJECTIVE: To assess the program effectiveness of two school-based weekly iron and folic acid (IFA) supplementation regimes (5-month supplementation vs. 8-month supplementation) in girls 10 to 18 years old attending school in Manica province. METHODS: Twelve schools were included in the study. Schools were ordered by descending mean hemoglobin concentration, and assigned alternately to study group 5 (six schools; 5-month supplementation) or study group 8 (six schools; 8-month supplementation). In both study groups, the weekly supplement contained 60 mg of elemental iron and 400 microg of folic acid. All girls received a single dose of mebendazol (500 mg) twice--once at the beginning of the study (T0) and once six months later (T6). Supplementation was implemented and supervised by the teachers of the schools included in the study. Between T0 and T3, girls in study group 8 received IFA supplements weekly whereas girls in study group 5 did not. Between T3 and T8, all girls in both groups received weekly IFA supplements. RESULTS: At T0, mean hemoglobin concentration and anemia prevalence were comparable in study groups 8 and 5 (125.3 +/- 12.6 g/L vs. 123.8 +/- 12.8 g/L; 28% vs. 29%, respectively). At T3, the mean hemoglobin concentration in study group 8 was significantly higher (126.3 +/- 14.3 g/L vs. 121.5 g/dL +/- 11.9 g/L, p < .001) and the prevalence of anemia was lower (28% vs. 35%, p = .076) than in study group 5. At T8, after an additional 5-month supplementation period in both study groups, mean hemoglobin concentration and anemia prevalence in study groups 8 and 5 were not significantly different (126.5 +/- 12.6 g/L vs. 124.9 +/- 12.3 g/L; 23% vs. 27%, respectively). CONCLUSION: In Manica Province, school-based weekly IFA supplementation is a feasible and effective intervention to prevent seasonal drops in hemoglobin concentration and increases in anemia prevalence. Short supplementation periods can have an important impact on girls' hematological status. However, the size of girls' hematological response in this study was significantly lower that that observed in studies with similar population groups, initial anemia prevalence, supplement dosing, and/or supplementation regime.