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Nutrition
Q: If malnutrition exists, should you always recommend interventions to improve food security?
A: No. It is possible that malnutrition among a particular group may be not be caused by food insecurity, but by other factors such as disease outbreaks (e.g. measles, diarrhea or malaria), or by poor caring practices (non-exclusive breastfeeding, early weaning of children). Food security interventions may have no impact on malnutrition in such cases. It is therefore necessary to understand the causes of malnutrition before drawing conclusions about appropriate interventions. Furthermore, we should look beyond the immediate causes and even the underlying causes. For example, in many situations, poor caring practices may not be the result of lack of knowledge of good caring by mothers, but rather be caused by wealth-related factors, such as an inability to afford to diverse diet or a lack of time for breastfeeding because of heavy workloads. Alternatively, in some populations malnutrition among younger children may be due to unequal intra-household distribution of the food.
Q: Why not just add some questions to the household nutrition survey about food security to make the links?
A: Such questions, if well chosen, can indeed show statistical relationships between nutritional status of children and household food security. Choosing the right food security indicators, however, can be difficult. Some common indicators are not always used appropriately (e.g. “food stocks in the household” is not an appropriate indicator where the household economy is heavily based on income and food purchases), while others are very difficult to collect accurately in a short questionnaire (e.g. income levels). Questions around household wealth, probably related to asset holdings, are probably the easiest to include in a nutrition survey. A more qualitative type of HEA would add value by (a) indicating the most relevant questions to include in the survey, and (b) providing more contextual information that would allow statistical relationships between nutrition and food security or wealth to be explained rather than just described.
