Table 1.
Proposed indicators for a core set of effective nutrition interventions delivered through the health system, by phase along the continuum of care
| Intervention | Data availability (core DHS 7 and/or MICS 6) | Potential indicator definition |
| Preconception* | ||
| Iron supplementation (W) | No | Percentage of non-pregnant women ages 15–49 who received ANY iron containing supplements in the last X months |
| Folic acid supplementation (L, W) | No | Percentage of non-pregnant women ages 15–49 who received ANY folic acid containing supplements in the last X months |
| Pregnancy | ||
| Any nutrition counselling during pregnancy (W) | No | Percentage of women who received ANY information by ANY provider about diet or physical activity during pregnancy |
| Nutrition counselling during pregnancy (specific content) (W) | No | Percentage of women who received information on the following topics during pregnancy: physical activity, diet (quality and quantity), micronutrients, breast feeding, other |
| Balanced energy protein supplementation (L, W) | No | Percentage of women meeting criteria for need that received any food or macronutrient supplements during pregnancy |
| Iron–folic acid supplementation (IFA) (L, W) | Yes, DHS 7. Questions do not distinguish composition of supplement beyond ‘iron containing’. Long period for maternal recall is a concern for validity | Percentage of women who received any IFA during pregnancy |
| Multiple micronutrient (MMN) supplementation (L) | No. They may qualify as ‘iron-containing’ supplement in DHS 7 but there is no way to distinguish it was a MMN supplement. | Percentage of women who received any MMN supplements during pregnancy |
| Calcium supplementation for pregnant women with low calcium intakes (L, W) | No | Percentage of women with low calcium intakes who received any calcium supplements during pregnancy |
| Vitamin A supplementation (low dose for populations with high prevalence of deficiency) (W) | No | Percentage of women in populations at risk of deficiency who received any low-dose vitamin A supplements during pregnancy |
| Deworming for populations where pregnant women have a 20% or higher prevalence of infection with hookworm or T. trichiura infection AND a 40% or higher prevalence of anaemia (W) | Yes, DHS 7. Concern that women may not be able to recall differences between drugs provided for deworming, IPTp or iron and IFA supplements | Percentage of women in targeted areas who received any albendazole during pregnancy |
| Around delivery/postnatal | ||
| Delayed cord clamping (W) | No | Percentage of women whose cord was clamped at 2 min after birth |
| Support for early initiation of breast feeding (L, W) | Yes, DHS 7 and MICS 6. Survey questions are included in the postnatal care module so time period is limited to any time in the first 2 days after childbirth | Percentage of women who were assisted by a provider to put the infant to the breast in the first hour after childbirth |
| Iron supplementation (lactating women) (W) | No | Percentage of lactating women who received any iron-containing supplement within 6 months after childbirth |
| Childhood prevention and promotion | ||
| Support for exclusive and continued breast feeding (L, W) |
Yes, DHS 7 and MICS 6. Survey questions are included in the postnatal care module so time period is limited to any time in the first 2 days after childbirth. Support may be needed later on during infancy | Percentage of women with a child 0–6 months of age who received advice/information from a healthcare provider or community worker within 1 month after childbirth; and/or percentage of women with a child 0–6 months of age who were observed breast feeding by a health provider or community. Additional time periods after childbirth may be added depending on country/context-specific services |
| Counselling for exclusive and continued breast feeding (L, W) | Yes, DHS 7 and MICS 6. Survey questions are included in the postnatal care module so time period is limited to any time in the first 2 days after childbirth. Information/counselling may be needed later on during infancy | Percentage of women with a child 0–6 months of age who received information/counselling about exclusive breast feeding from a health provider or community worker in the last 6 months |
| Counselling for complementary feeding (L, W) | No | Percentage of women with a child 6–24 months of age who received information from a provider about key components of complementary feeding within the previous X months, including timing of introduction of semisolid and solid foods, diet diversity and other local messages? |
| Food supplementation for complementary feeding in food-insecure populations (L, W) | Yes, DHS 7. Questions ask only about ready-to-use supplemental foods with 7-day recall period. Questions are not currently located with the IYCF practice questions | Percentage of children 6–23 months of age from food-insecure populations who received any food supplements in the last X months |
| Iron supplementation in a population where children of 6–59 months have 20% or higher prevalence of anaemia (W) | No | Percentage of children (6–59 months) in a selected population who received any iron supplements in the X days before the survey Percentage of children (6–59 months) in a selected population who received at least X doses of iron supplements in the X days before the survey |
| Vitamin A supplementation (high dose)† (L, W) | Yes, DHS 7. Questions ask about a single dose in the previous 6 months | Percentage of children (6–59 months) who received a high-dose vitamin A supplement in the 6 months preceding the survey |
| Multiple micronutrient powders (MNP for anaemia) in a population where children of this age have 20% or higher prevalence of anaemia (L, W) | Yes, DHS 7. Questions use a 7-day recall period, which is limited to current consumption | Percentage of children (6–59 months) in a selected population who received any MNP in the last X days prior to the survey Percentage of children (6–59 months) in a selected population who received at least N doses of MNP in the last X days prior to the survey |
| Preventive zinc supplementation (L) | No | Percentage of children (6–59 months) who received any preventive zinc supplementation in the X days before the survey |
| Childhood treatment | ||
| Management of severe acute malnutrition (SAM) (L, W) |
Yes, DHS 7. Questions ask only about ready-to-use therapeutic foods with 7-day recall period. Challenge is on identifying the appropriate population of children (the denominator) | Percentage of children 6–59 months of age who are identified as having SAM that received treatment (a special food supplement) |
| Management of moderate acute malnutrition (MAM) (L, W) | Yes, DHS 7. Questions ask only about ready-to-use supplemental foods with 7-day recall period. Challenge is on identifying the appropriate population of children (the denominator) | Percentage of children 6–59 months of age who are identified as having MAM that received treatment (a special food supplement) |
| Zinc supplementation with oral rehydration salts (ORS) for children with diarrhoea (L, W) | Yes, DHS 7 and MICS 6. Both survey programmes use an aided recall of receipt of zinc | Percentage of children who received zinc and ORS for an episode of diarrhoea in the 2 weeks before the survey |
*‘The preconception phase’ includes interventions delivered during the time period prior to a first pregnancy and interpregnancy intervals as well as interventions provided to women of reproductive age and adolescent girls (ages 10–14) who do not eventually or ever become pregnant.
†Unicef includes in its databases the following indicator which is based upon a combination of survey and administrative data: percentage of children ages 6–59 months who received two doses of vitamin A during the calendar year.
DHS, Demographic and Health Survey; IPTp, Intermittent preventive treatment in pregnancy; IYCF, infant and young child feeding; L, Included in the Lancet Maternal and Child Nutrition Series, 2013; MICS, Multiple Indicator Cluster Survey; W, recommended by WHO.