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To include children consuming RUTF in IYCF indicator results or not?

This question was posted the Infant and young child feeding interventions forum area and has 3 replies.

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Philip McKinney

Nutrition Survey & Research Advisor (Concern)

Normal user

2 Nov 2020, 14:20

Dear all

Having tried a quick search of this forum and other sites I remain with the question stated:

When assessing dietary intake and presenting the results of Minimum Meal Frequency (MMF), Minimum Dietary Diversity (MDD), and Minimum Acceptable Diet (MAD) should I be excluding children that consume RUTF?

The filter used is "did the child consume RUTF in the last day or night?"

The assumption is that children that are supposed to be consuming RUTF should only be consuming RUTF and don't reflect a typical dietary pattern / consumption profile, disrupting the results.

I can imagine that in emergencies more children would be consuming RUTF - with a greater impact on the results.  However, this may well be much less in normal situations.

I (we) would be greatful for any thoughts on this and others approach to the idea of excluding children that have consumed RUTF from the MMF, MAD and MDD indicators.  Perhaps there is already some guidance on this (the current ones make no mention of such, other than RUTF in the context of iron rich food).

Thanks, in advance, for your thoughts.

Regards

Phil

Alessandro Iellamo

Save the Children UK

Normal user

2 Nov 2020, 14:51

Thanks Phil

excellent question...now I am not working directly on watsting/CMAM programmes, RUTF is provided to SAM children wout complications and this may be in the range of 1, 2 or maye 3, 4% 5% of the total population of 6 to 59 months, generally the majority of the children suffers from Moderate Acute Malnutrition where MAD, MDD etc, are very relevant; In general even if that s 5% or so, that represents less than 10% of the chidren 6 to 23 months  that may be receiving RUTF in severe crisis. 

In general I would agree we need to ensure that in the MDD, MAD estimation, we dont include children that are actually enrolled in the CMAM programme, for the reasons you have stated..(usually sometimes we also include a question where we asked the respondent if the the food the chidl is consuming is routine/regular or not (we do that to capture seasonalities, events, religious moments, and we may include also if children were sick for example) all of this indicators are based on a 24hr recall, hence very sensitive to certain situations ...

sorry, just sharing few thoughts, and looking froward additional relevant thoughts on this important question

regards 

Mark Manary

Washington University School of Medicine

Frequent user

2 Nov 2020, 14:55

Phillip;

I imagine that the question about consuming RUTF is so you can exclude children with SAM from your dietary diversity scoring.  Excluding these SAM children is appropriate, in that these children do not need to consume other foods to receive a complete diet, but they did not obtain this complete diet from their habitual foods.

I also imagine some children that do not have SAM consume RUTF, and you want to include those in your surveys.  So you could modify the question

Is this child diagnosed with SAM and currently receives RUTF?

Mark Manary

Philip McKinney

Nutrition Survey & Research Advisor (Concern)

Normal user

2 Nov 2020, 15:42

Dear Mark / Alessandro 

Firstly, thanks for such a speedy response.

Alessandro: we will take a look at the % of our surveys for which children consuming RUTF represent and see if we're seeing the same things as you are.  It's definitely something we've been considering, particularly in terms of any impact that we might see if we remove the filter.  And please, an open thought process is a most welcome way to scope out the question and have others bring related interesting points to the table.  The issue of introducing seasonality into a questionnaire may complicate things a little?  Although I can see where you're going with that.   Perhaps seasonal diets could be more usefully investigated with focus groups?

Mark: yes the notion that children with severe acute malnutrition should be consuming only RUTF is exactly what we intended to address with this filter.  This definitely gets me thinking about how we can filter this with what data we would already collect in the questionnaire (anthropometry etc.).  As a standalone tool (the IYCF indicators) it would be a useful filter question.  Perhaps alternatively this would be two questions:

  1. Is the child currently attending a treatment programme for SAM?
    • the issue of diagnosed and attending could be two seperate things.  Attendance would reflect the availability of RUTF but a diagnosis of SAM may not capture the final days of treatment prior to discharge.
    • the question could be even more specific?
      • Diagnosis of SAM
      • Attendance at a health facility to collect RUTF in the last x weeks (x = the locally applicable schedule)
  2. Did the child consume RUTF in the previous day or night?
    • and the consumption would reflect supply and reflect access to RUTF (if no - because of defaulting, something wrong with the supply chain at the health facility, or something else)

I still think we should still enumerate the diet of these children.  As this might help us understand adherence to the feeding protocol and could be welcome research data on duration of treatment etc.  The main concern presented here for doing this is time.  However, how many children in our samples this represents is still to be assessed.

Mark/Alessandro:

Is there room for some offical guidance on how to address this (questionnaire / analysis / reporting) in our surveys conrtaining IYCF indicators?  Or is the impact of not addressing it (i.e. enumerating and analysing data from all eligible children) minimal in any given survey?

Thanks again

Phil

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