Types of Surveillance Systems

Nutrition Landscape Information System (NLiS)

Public health surveillance
Daily iron and folic acid supplementation is currently recommended by WHO as part of antenatal care to reduce the risk of low birth weight, maternal anaemia and iron deficiency. These individuals are trained sufficiently in nutrition practice to demonstrate defined competencies and to meet certification or registration requirements of national or global nutrition or dietetics professional organizations. This indicator is the percentage of children aged 6—23 months who receive a minimum acceptable diet. Poverty reduction strategy papers. Recommended Dietary Allowances, revised Inevitably, such large-scale concentration changes the nutritional content of food, saving certain nutrients while removing others.

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Global Antimicrobial Resistance Surveillance System (GLASS)

Registries are a type of surveillance system used for particular conditions, such as cancer and birth defects. They are often established at a state level to collect information about persons diagnosed with the conditions. This information can be used to improve prevention programs. Public health laboratory data is another source of surveillance data which routinely conduct tests for viruses, bacteria, and other pathogens. Laboratory serotyping provides information about cases that are likely to be linked to a common source.

For this reason, serotypes are useful for detecting local, state, or national outbreaks Swaminathan In , more than 40, isolates from the US were reported through this system Center of Disease Control and Prevention Other laboratory system that plays an important role in surveillance is PulseNet, developed by the CDC and the Association of Public Health Laboratories to monitor foodborne illness outbreaks.

This system enables public health laboratories across the US to compare pulsed-field gel electrophoresis PFGE patterns of bacteria isolated from ill persons and determine whether they are similar.

This allows scientists to determine whether an outbreak is occurring, even at geographically distant locations, and can decrease the time required to identify outbreaks of food borne illness and their causes Center of Disease Control and Prevention Having this variety of surveillance systems, public health practitioners have abroad sources of data ready to be analyzed and distributed at local, state, and national levels for public health action.

However, these surveillance systems might increase with the range of health-related events that are associated with public health action and are under surveillance. This issue highlights the importance of having different methods of collecting data and the usefulness that these data means in public health actions including guiding prevention strategies and targeting resources, detecting disease outbreaks of local, national, and international significance, and evaluating public health control measures.

Therefore, knowing where to look for different types of data can save valuable time and resources. If you want to know how to make extra money, search for: I know one interesting method of earning money, I think you will like it.

Creating a Program Rationale. Saturated fats have all of the carbon atoms in their fatty acid chains bonded to hydrogen atoms, whereas unsaturated fats have some of these carbon atoms double-bonded , so their molecules have relatively fewer hydrogen atoms than a saturated fatty acid of the same length. Unsaturated fats may be further classified as monounsaturated one double-bond or polyunsaturated many double-bonds.

Furthermore, depending on the location of the double-bond in the fatty acid chain, unsaturated fatty acids are classified as omega-3 or omega-6 fatty acids.

Trans fats are a type of unsaturated fat with trans -isomer bonds; these are rare in nature and in foods from natural sources; they are typically created in an industrial process called partial hydrogenation.

There are nine kilocalories in each gram of fat. Fatty acids such as conjugated linoleic acid , catalpic acid, eleostearic acid and punicic acid , in addition to providing energy, represent potent immune modulatory molecules.

Saturated fats typically from animal sources have been a staple in many world cultures for millennia. Saturated and some trans fats are typically solid at room temperature such as butter or lard , while unsaturated fats are typically liquids such as olive oil or flaxseed oil.

Trans fats are very rare in nature, and have been shown to be highly detrimental to human health, but have properties useful in the food processing industry, such as rancidity resistance.

Most fatty acids are non-essential, meaning the body can produce them as needed, generally from other fatty acids and always by expending energy to do so. However, in humans, at least two fatty acids are essential and must be included in the diet.

An appropriate balance of essential fatty acids— omega-3 and omega-6 fatty acids —seems also important for health, although definitive experimental demonstration has been elusive. Both of these "omega" long-chain polyunsaturated fatty acids are substrates for a class of eicosanoids known as prostaglandins , which have roles throughout the human body.

They are hormones , in some respects. The omega-3 eicosapentaenoic acid EPA , which can be made in the human body from the omega-3 essential fatty acid alpha-linolenic acid ALA , or taken in through marine food sources, serves as a building block for series 3 prostaglandins e. The omega-6 dihomo-gamma-linolenic acid DGLA serves as a building block for series 1 prostaglandins e. An appropriately balanced intake of omega-3 and omega-6 partly determines the relative production of different prostaglandins, which is one reason why a balance between omega-3 and omega-6 is believed important for cardiovascular health.

In industrialized societies, people typically consume large amounts of processed vegetable oils, which have reduced amounts of the essential fatty acids along with too much of omega-6 fatty acids relative to omega-3 fatty acids. Moreover, the conversion desaturation of DGLA to AA is controlled by the enzyme deltadesaturase , which in turn is controlled by hormones such as insulin up-regulation and glucagon down-regulation.

The amount and type of carbohydrates consumed, along with some types of amino acid, can influence processes involving insulin, glucagon, and other hormones; therefore, the ratio of omega-3 versus omega-6 has wide effects on general health, and specific effects on immune function and inflammation , and mitosis i. Proteins are structural materials in much of the animal body e. They also form the enzymes that control chemical reactions throughout the body. Each protein molecule is composed of amino acids , which are characterized by inclusion of nitrogen and sometimes sulphur these components are responsible for the distinctive smell of burning protein, such as the keratin in hair.

The body requires amino acids to produce new proteins protein retention and to replace damaged proteins maintenance. As there is no protein or amino acid storage provision, amino acids must be present in the diet.

Excess amino acids are discarded, typically in the urine. For all animals, some amino acids are essential an animal cannot produce them internally and some are non-essential the animal can produce them from other nitrogen-containing compounds. About twenty amino acids are found in the human body, and about ten of these are essential and, therefore, must be included in the diet. A diet that contains adequate amounts of amino acids especially those that are essential is particularly important in some situations: A complete protein source contains all the essential amino acids; an incomplete protein source lacks one or more of the essential amino acids.

It is possible with protein combinations of two incomplete protein sources e. However, complementary sources of protein do not need to be eaten at the same meal to be used together by the body. Water is excreted from the body in multiple forms; including urine and feces , sweating , and by water vapour in the exhaled breath.

Therefore, it is necessary to adequately rehydrate to replace lost fluids. Early recommendations for the quantity of water required for maintenance of good health suggested that 6—8 glasses of water daily is the minimum to maintain proper hydration. Most of this quantity is contained in prepared foods. For healthful hydration, the current EFSA guidelines recommend total water intakes of 2. These reference values include water from drinking water, other beverages, and from food. The EFSA panel also determined intakes for different populations.

Recommended intake volumes in the elderly are the same as for adults as despite lower energy consumption, the water requirement of this group is increased due to a reduction in renal concentrating capacity. Dehydration and over-hydration - too little and too much water, respectively - can have harmful consequences. Drinking too much water is one of the possible causes of hyponatremia , i. Pure ethanol provides 7 calories per gram.

For distilled spirits , a standard serving in the United States is 1. A 5 ounce serving of wine contains to calories. A 12 ounce serving of beer contains 95 to calories. Alcoholic beverages are considered empty calorie foods because other than calories, these contribute no essential nutrients.

The micronutrients are minerals , vitamins , and others. Dietary minerals are inorganic chemical elements required by living organisms, [70] other than the four elements carbon , hydrogen , nitrogen , and oxygen that are present in nearly all organic molecules. The term "mineral" is archaic, since the intent is to describe simply the less common elements in the diet.

Some are heavier than the four just mentioned, including several metals , which often occur as ions in the body. Some dietitians recommend that these be supplied from foods in which they occur naturally, or at least as complex compounds, or sometimes even from natural inorganic sources such as calcium carbonate from ground oyster shells.

Some minerals are absorbed much more readily in the ionic forms found in such sources. On the other hand, minerals are often artificially added to the diet as supplements; the most famous is likely iodine in iodized salt which prevents goiter.

Many elements are essential in relative quantity; they are usually called "bulk minerals". Some are structural, but many play a role as electrolytes. Many elements are required in trace amounts, usually because they play a catalytic role in enzymes. Vitamins are essential nutrients, [70] necessary in the diet for good health. Vitamin D is an exception, as it can be synthesized in the skin in the presence of UVB radiation , and many animal species can synthesize vitamin C.

Vitamin deficiencies may result in disease conditions, including goitre , scurvy , osteoporosis , impaired immune system, disorders of cell metabolism, certain forms of cancer, symptoms of premature aging, and poor psychological health , among many others. Phytochemicals such as polyphenols are compounds produced naturally in plants phyto means "plant" in Greek. In general, the term is used to refer to compounds which do not appear to be nutritionally essential and yet may have positive impacts on health.

To date, there is no conclusive evidence in humans that polyphenols or other non-nutrient compounds from plants have health benefit effects. While initial studies sought to reveal if nutrient antioxidant supplements might promote health, one meta-analysis concluded that supplementation with vitamins A and E and beta-carotene did not convey any benefits and may in fact increase risk of death.

Vitamin C and selenium supplements did not impact mortality rate. Health effects of non-nutrient phytochemicals such as polyphenols were not assessed in this review. Animal intestines contain a large population of gut flora. In humans, the four dominant phyla are Firmicutes , Bacteroidetes , Actinobacteria , and Proteobacteria. Bacteria in the large intestine perform many important functions for humans, including breaking down and aiding in the absorption of fermentable fiber, stimulating cell growth, repressing the growth of harmful bacteria, training the immune system to respond only to pathogens, producing vitamin B 12 , and defending against some infectious diseases.

There is not yet a scientific consensus as to health benefits accruing from probiotics or prebiotics. Carnivore and herbivore diets are contrasting, with basic nitrogen and carbon proportions vary for their particular foods. Many herbivores rely on bacterial fermentation to create digestible nutrients from indigestible plant cellulose, while obligate carnivores must eat animal meats to obtain certain vitamins or nutrients their bodies cannot otherwise synthesize.

Plant nutrition is the study of the chemical elements that are necessary for plant growth. Some elements are directly involved in plant metabolism. However, this principle does not account for the so-called beneficial elements, whose presence, while not required, has clear positive effects on plant growth. A nutrient that is able to limit plant growth according to Liebig's law of the minimum is considered an essential plant nutrient if the plant cannot complete its full life cycle without it.

There are 16 essential plant soil nutrients, besides the three major elemental nutrients carbon and oxygen that are obtained by photosynthetic plants from carbon dioxide in air, and hydrogen , which is obtained from water.

Plants uptake essential elements from the soil through their roots and from the air consisting of mainly nitrogen and oxygen through their leaves. Green plants obtain their carbohydrate supply from the carbon dioxide in the air by the process of photosynthesis. Carbon and oxygen are absorbed from the air, while other nutrients are absorbed from the soil.

These hydrogen ions displace cations attached to negatively charged soil particles so that the cations are available for uptake by the root. In the leaves, stomata open to take in carbon dioxide and expel oxygen.

The carbon dioxide molecules are used as the carbon source in photosynthesis. Although nitrogen is plentiful in the Earth's atmosphere, very few plants can use this directly. Most plants, therefore, require nitrogen compounds to be present in the soil in which they grow.

This is made possible by the fact that largely inert atmospheric nitrogen is changed in a nitrogen fixation process to biologically usable forms in the soil by bacteria.

Plant nutrition is a difficult subject to understand completely, partially because of the variation between different plants and even between different species or individuals of a given clone. Elements present at low levels may cause deficiency symptoms, and toxicity is possible at levels that are too high.

Furthermore, deficiency of one element may present as symptoms of toxicity from another element, and vice versa. Canada's Food Guide is an example of a government-run nutrition program. Produced by Health Canada , the guide advises food quantities, provides education on balanced nutrition, and promotes physical activity in accordance with government-mandated nutrient needs.

Like other nutrition programs around the world, Canada's Food Guide divides nutrition into four main food groups: Dietary and physical activity guidelines from the USDA are presented in the concept of MyPlate , which superseded the food pyramid , which replaced the Four Food Groups. Department of Health and Human Services provides a sample week-long menu that fulfills the nutritional recommendations of the government.

Governmental organisations have been working on nutrition literacy interventions in non-primary health care settings to address the nutrition information problem in the U. The FNP has developed a series of tools to help families participating in the Food Stamp Program stretch their food dollar and form healthful eating habits including nutrition education.

It is designed to assist limited-resource audiences in acquiring the knowledge, skills, attitudes, and changed behavior necessary for nutritionally sound diets, and to contribute to their personal development and the improvement of the total family diet and nutritional well-being. Launched in , this program promotes lifelong healthful eating patterns and physically active lifestyles for children and their families. It is an interactive educational program designed to help prevent childhood obesity through classroom activities that teach children healthful eating habits and physical exercise.

Nutrition is taught in schools in many countries. In England and Wales , the Personal and Social Education and Food Technology curricula include nutrition, stressing the importance of a balanced diet and teaching how to read nutrition labels on packaging.

In many schools, a Nutrition class will fall within the Family and Consumer Science or Health departments. In some American schools, students are required to take a certain number of FCS or Health related classes. Nutrition is offered at many schools, and, if it is not a class of its own, nutrition is included in other FCS or Health classes such as: In many Nutrition classes, students learn about the food groups, the food pyramid, Daily Recommended Allowances, calories, vitamins, minerals, malnutrition, physical activity, healthful food choices, portion sizes, and how to live a healthy life.

In the US, Registered dietitian nutritionists RDs or RDNs [89] are health professionals qualified to provide safe, evidence-based dietary advice which includes a review of what is eaten, a thorough review of nutritional health, and a personalized nutritional treatment plan. They also provide preventive and therapeutic programs at work places, schools and similar institutions. Certified Clinical Nutritionists or CCNs, are trained health professionals who also offer dietary advice on the role of nutrition in chronic disease, including possible prevention or remediation by addressing nutritional deficiencies before resorting to drugs.

These Board Certified Nutritionists typically specialize in obesity and chronic disease. In order to become board certified, potential CNS candidate must pass an examination, much like Registered Dieticians. This exam covers specific domains within the health sphere including; Clinical Intervention and Human Health. The study found that health literacy increases with education and people living below the level of poverty have lower health literacy than those above it. Another study examining the health and nutrition literacy status of residents of the lower Mississippi Delta found that 52 percent of participants had a high likelihood of limited literacy skills.

For example, only 12 percent of study participants identified the My Pyramid graphic two years after it had been launched by the USDA. The study also found significant relationships between nutrition literacy and income level and nutrition literacy and educational attainment [93] further delineating priorities for the region. Among these problems are the lack of information about food choices, a lack of understanding of nutritional information and its application to individual circumstances, limited or difficult access to healthful foods, and a range of cultural influences and socioeconomic constraints such as low levels of education and high levels of poverty that decrease opportunities for healthful eating and living.

The links between low health literacy and poor health outcomes has been widely documented [94] and there is evidence that some interventions to improve health literacy have produced successful results in the primary care setting. More must be done to further our understanding of nutrition literacy specific interventions in non-primary care settings [93] in order to achieve better health outcomes.

Malnutrition refers to insufficient, excessive, or imbalanced consumption of nutrients by an organism. In developed countries, the diseases of malnutrition are most often associated with nutritional imbalances or excessive consumption. In developing countries, malnutrition is more likely to be caused by poor access to a range of nutritious foods or inadequate knowledge.

The aim was to boost nutrition and livelihoods by producing a product that women could make and sell, and which would be accepted by the local community because of its local heritage. Although under- and over-nutrition are often viewed as human problems, pet animals can be under- or overfed by their owners, domesticated animals can be undernourished for macro- and micro-nutrients, affecting growth and health, and wild animals can be undernourished to the point of starvation and death.

Nutritionism is the view that excessive reliance on food science and the study of nutrition can lead to poor nutrition and to ill health. It was originally credited to Gyorgy Scrinis , [96] and was popularized by Michael Pollan. Since nutrients are invisible, policy makers rely on nutrition experts to advise on food choices. Because science has an incomplete understanding of how food affects the human body, Pollan argues, nutritionism can be blamed for many of the health problems relating to diet in the Western World today.

ULs are set a safe fraction below amounts shown to cause health problems. ULs are part of Dietary Reference Intakes. When too much of one or more nutrients is present in the diet to the exclusion of the proper amount of other nutrients, the diet is said to be unbalanced.

High calorie food ingredients such as vegetable oils, sugar and alcohol are referred to as "empty calories" because they displace from the diet foods that also contain protein, vitamins, minerals and fiber. Research indicates that improving the awareness of nutritious meal choices and establishing long-term habits of healthy eating have a positive effect on cognitive and spatial memory capacity, with potential to increase a student's ability to process and retain academic information.

A strong nutrition component in a PRSP means that the government considers nutrition a priority for poverty reduction and national development. A weak nutrition component in the document does not necessarily imply that no government department is working to improve nutrition ; however, unless such efforts are mentioned in strategy documents like PRSPs, they may not be sufficiently sustainable or be scaled-up to adequately address nutrition problems in the country.

Basing such action in frameworks for overall development contributes to ensuring the accountability of relevant government departments. Sources and further reading. Poverty reduction strategy papers. Assessing countries' commitment to accelerate nutrition action demonstrated in poverty reduction strategy paper, UNDAF and through nutrition governance.

SCN News , , Shekar M, Lee Y-K. Mainstreaming nutrition in poverty reduction strategy papers: What does it take? A review of the early experience. Health, Nutrition and Population Discussion Paper, Landscape analysis on countries' readiness to accelerate action in nutrition , This indicator is a description of the strengths and weaknesses of various aspects of nutrition governance in countries.

The following 10 elements or characteristics are used to assess and describe the strength of nutrition governance: These elements were identified by countries as key elements for successful development and implementation of national nutrition policies and strategies during a review of the progress of countries in implementing the World Declaration and Plan of Action for Nutrition adopted by the International Conference on Nutrition, the first intergovernmental conference on nutrition Nishida et al.

The components of the composite indicator have been identified by countries as important for determining the completeness of national nutrition plans and policies Nishida, Mutru, Imperial Laue , For instance, a national nutrition plan and policy was considered to provide the political basis for initiating action. In many countries, official government endorsement or adoption of a national nutrition plan or policy facilitated its implementation.

The role of an intersectoral coordinating committee in implementing national nutrition plans and policies was also considered crucial, although the nature i.

Another important element was considered to be regular surveys and other means of collecting data on nutrition. A periodically updated national nutrition information system and routinely collected data on food and nutrition were considered important for evaluating the effectiveness of national nutrition plans and policies and identifying subsequent actions. Strategies for effective and sustainable national nutrition plans and policies.

Modern aspects of nutrition , present knowledge and future perspective. Basel , Karger Forum for Nutrition 56 , This indicates whether a government has adopted legislation to monitor and enforce the International Code of Marketing of Breast-milk Substitutes, which helps create an environment that enables mothers to make the best possible feeding choice, based on impartial information and free of commercial influences, and to be fully supported in doing so.

This indicator is defined on the basis of whether a government has adopted legislation for effective national implementation and monitoring of the International Code of Marketing of Breast-milk Substitutes.

The Code is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats. The Code aims to contribute "to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution" Article 1.

Improper marketing and promotion of food products that compete with breastfeeding often negatively affect the choice and ability of a mother to breastfeed her infant optimally. The Code was formulated in response to the realization that such marketing resulted in poor infant feeding practices, which negatively affect the growth, health and development of children and are a major cause of mortality in infants and young children.

Breastfeeding practices worldwide are not yet optimal, in both developing and developed countries, especially for exclusive breastfeeding under 6 months of age. In addition to the risks posed by the lack of the protective qualities of breast milk, breast-milk substitutes and feeding bottles are associated with a high risk for contamination that can lead to life-threatening infections in young infants.

Infant formula is not a sterile product, and it may carry germs that can cause fatal illnesses. Artificial feeding is expensive, requires clean water, the ability of the mother or caregiver to read and comply with mixing instructions and a minimum standard of overall household hygiene. These factors are not present in many households in the world. Frequently asked questions , These indicators provide information on national policies for legal entitlement to maternity protection, including leave from work during pregnancy and after birth, as well breastfeeding entitlements after return to work.

Since the International Labour Organization ILO was founded in , international labour standards have been established to provide maternity protection for women workers. Key elements of maternity protection include: The right to cash benefits during absence for maternity leave is intended to ensure that the woman can maintain herself and her child in proper conditions of health and with a suitable standard of living. The source of benefits is important due to potential discrimination in the labour market if employers have to bear the full costs.

The right to continue breastfeeding a child after returning to work is important since duration of leave entitlements generally is shorter than the WHO recommended duration of exclusive and continued breastfeeding. A composite indicator on maternity protection is included as a policy environment and capacity indicator in the core set of indicators for the Global Nutrition Monitoring Framework.

It currently uses the ILO classification of compliance with Convention on three key provisions leave duration, remuneration and source of cash benefits , but an alternative method taking into account higher standards as stated in Recommendation as well as breastfeeding entitlements is under development.

The ILO periodically publishes information on the above key indicators, including the assessment of compliance with Convention No. However, an alternative method is under development which may use a scale to indicate the degree of compliance is under development. This method will also take into account higher standards for leave duration and remuneration in Recommendation , as well as breastfeeding entitlements within both the Convention and Recommendation.

Pregnancy and maternity are potentially vulnerable time for working women and their families. Expectant and nursing mothers require special protection to prevent any potential adverse effects for them and their infants. They need adequate time to give birth, to recover from delivery process, and to nurse their children. At the same time, they also require income security and protection to ensure that they will not suffer from income loss or lose their job because of pregnancy or maternity leave.

Such protection not only ensures a woman's equal access and right to employment, it also ensures economic sustainability for the well-being of the family. Returning to work after maternity leave has been identified as a significant cause for never starting breastfeeding, early cessation of breastfeeding and lack of exclusive breastfeeding.

In most low- and middle-income countries, paid maternity leave is limited to formal sector employment or is not always provided in practice. The ILO estimates that more than million women lack economic security around childbirth with adverse effects on the health, nutrition and well-being of mothers and their children. Maternity cash benefits for workers in the informal economy.

Rollins et al Why invest, and what it will take to improve breastfeeding practices? Database of national labour, social security and related human rights legislation. The legislative data are collected by ILO through periodical reviews of national labour and social security legislation and secondary sources, such as the International Social Security Association and International Network on Leave Policies and Research; as well as consultations with ILO experts in regional and national ILO offices around the world.

The composite indicator on maternity protection included in the Global Nutrition Monitoring Framework is currently defined as whether the country has maternity protection laws or regulations in place compliant with the provisions for leave duration, remuneration and source of cash benefits in Convention Documentation for the maternity protection database http: Degree training in nutrition exists.

What does the indicator tell us? This indicator reflects the capacity of a country to train professionals in nutrition in terms of having national higher education institutions offering training in nutrition.

This indicator is defined as the existence of higher education institutions offering training in nutrition in the country. Higher education training institutions include universities and other schools offering graduate and post-graduate degrees in nutrition or dietetics, including public health nutrition, community nutrition, food and nutrition policy, clinical nutrition, nutrition science and epidemiology.

Trained nutrition professionals work at facilities including health facilities as well as at population and community levels and may influence nutrition policies, and designing and implementation of nutrition intervention programmes at various levels. They also play an important role in training of other health and non-health cadres to plan and deliver nutrition interventions in various settings.

It is recognized that availability, within a country, of sufficient workforce with appropriate training in nutrition will lead to better outcomes for country-specific nutrition and health concerns. A competency framework for global public health nutrition workforce development: World Public Health Nutrition Association.

Registering as Registered Nutritionist. Building systemic capacity for nutrition: Nutrition is part of medical curricula. This indicator reflects the inclusion of maternal, infant and young child nutrition in pre-service training of health personnel.

This indicator is defined as the existence of pre-service training in maternal, infant and young child nutrition for health personnel. The survey investigates training in three key areas of maternal, infant and young child nutrition, namely growth monitoring and promotion, breastfeeding and complementary feeding, and management of severe or moderate acute malnutrition.

The first two of these three training topics are relevant for all forms of malnutrition, whereas the third topic only pertains to undernutrition. Training on other topics e. Adequate training of health professionals is essential to ensure that nutrition activities are included in their regular health care activities.

Nutrition counseling training changes physician behavior and improves caregiver knowledge acquisition. Nutrition Journal ; Trained nutrition professionals density. The focus of the nutrition professional indicator is on individuals trained to pursue a nutrition professional career, described in most countries as dieticians or nutritionists including nutrition scientists, nutritional epidemiologists and public health nutritionists. These individuals are trained sufficiently in nutrition practice to demonstrate defined competencies and to meet certification or registration requirements of national or global nutrition or dietetics professional organizations.

Dieticians and nutritionists may complete the same training and perform the same functions in some countries but not others. This indicator is defined as the number of trained nutrition professionals per , population in the country in a specified year. Validation of the indicator has shown that it can predict several maternal, infant and young child nutrition outcomes. Global nutrition monitoring framework: Density of nurses and midwi ves.

Nurse and midwife density indicates whether nurses and midwifery personnel are available to address the health care needs of a given population. It is the number of nursing and midwifery personnel and density per 10 population. These personnel include professional nurses, professional midwives, auxiliary nurses, auxiliary midwives, enrolled nurses, enrolled midwives and other personnel, such as dental nurses and primary care nurses. Traditional attendants are not counted here but as community or traditional health workers.

There is no gold standard for a sufficient health workforce to address the health care needs of a given population. It has been estimated, however, that countries with fewer than 25 health-care professionals counting only physicians, nurses and midwives per 10 population fail to achieve adequate coverage rates for selected primary health care interventions that are priorities in the Millennium Development Goals.

The World Health Report Working together for health. The World Health Report papers. G ross domestic product per capita and annual growth rate. GDP per capita purchasing power parity is the GDP divided by the midyear population, where GDP is the total value of goods and services for final use produced by resident producers in an economy, regardless of the allocation to domestic and foreign claims.

It does not include deductions for depreciation of physical capital or depletion and degradation of natural resources. Purchasing power parity indicates the rate of exchange that accounts for price differences across countries, allowing international comparisons of real output and incomes.

Purchasing power parity rates allow standard comparisons of real prices among countries, just as conventional price indexes allow comparisons of real values over time; use of normal exchange rates could result in over - or undervaluation of purchasing power.

GDP per capita annual growth rate is defined as the least squares annual growth rate, calculated from constant price GDP per capita in local currency units.

Higher income is usually associated with lower rates of mal nutrition. Improving income however, reduces mal nutrition to only a small degree World Bank On the basis of the correlation between growth and nutrition , it is estimated that a sustained per capita economic growth of 2.

These estimates suggest that countries cannot depend on economic growth alone to reduce mal nutrition within an acceptable time. Repositioning nutrition as central to development. A strategy for large-scale action , Human solidarity in a divided world , Official development assistance received net disbursements as a percentage of Gross Domestic Product GDP is a measure of the flow of aid, private capital and debt in comparison with the value of goods and services produced within the country.

This indicator is official development assistance received as a percentage of the GDP. Net official development assistance consists of grants or loans to countries or territories from the official sector, with the main objective of promoting economic development and welfare, at concessional financial terms.

GDP is the total value of final goods and services produced within a country's borders in a year, regardless of ownership. When official development assistance makes up a large proportion of the GDP, a country is highly aid dependent, with the risk of unpredictable aid and donor-driven aid programmes. This can affect the resources allocated to nutrition , which are often not a donor priority in the sector-wide aid strategies promoted by the Paris Declaration Paris Declaration on Aid Effectiveness: This indicator identifies countries with low income and food inadequacy.

A country is classified by the UN Food and Agriculture Organization FAO as 'low-income food-deficit' for analytical purposes on the basis of low income and food inadequacy, and the status is agreed by the country itself. The classification applies to countries that have a per capita income below the ceiling used by the World Bank to determine eligibility for International Development Association assistance and for year terms determined by the International Bank for Reconstruction and Development, applied to countries included in World Bank categories I and II.

The second criterion is based on the net i. Trade volumes of a broad range of basic foodstuffs cereals, roots and tubers, pulses, oilseeds and oils other than tree crop oils, meat and dairy products are converted and aggregated by the calorie content of individual commodities.

The third criterion, which is self-exclusion, is applied when countries that meet the above two criteria specifically request to be excluded from the low-income food-deficit category. In order to avoid too frequent changes of low-income food-deficit status, usually reflecting short-term, exogenous shocks, an additional factor is taken into consideration.

This factor, called 'persistence of position', postpones the 'exit' of a country from the list even if it does not meet the low-income or the food-deficit criterion, until the change in its status is verified for 3 consecutive years. In other words, a country is taken off the list in the fourth year after confirming a sustained improvement in its position.

During these 3 years, the country is considered to be in a transitional phase. The rationale behind the low-income food-deficit classification is that being both food deficit and having a low income at the same time means that the country lacks the resources not only to import food but also to produce sufficient amounts domestically.

It is the combination of these two factors that makes these countries both food insecure and susceptible to domestic and external shocks, which could affect the nutrition al status of vulnerable populations.

The low-income food-deficit list is intended to capture this aspect of the food problem. In comparison with countries in other classifications commonly used for analytical and operational purposes, e.

Committee on World Food Security. Rome , June Averaged aggregate governance indicators. The world governance indicators of the World Bank Institute define governance as the traditions and institutions by which authority in a country is exercised. This includes the process by which governments are selected, monitored and replaced; the capacity of the government to formulate and implement sound policies effectively; and the respect of citizens and the state for the institutions that govern economic and social interactions among them.

The world governance indicators measure six broad definitions of governance, capturing the key elements of this definition: The averaged aggregate governance indicators in the NLIS country profile represent the aggregated average of the six world governance indicators.

The indicators represent the views of thousands of stakeholders worldwide, including respondents to household and firm surveys and experts from nongovernmental organizations, public sector agencies and providers of commercial business information.

The NLIS averaged aggregate governance indicators are calculated from the average of the z scores a measure of standard deviations away from the mean of the six world governance indicators. Each of the six indicators are expressed as the standard normal units, ranging from around The higher the score a country has, the better the assessment has it received regarding the six governance elements. Policy-makers, civil society groups, aid donors and scholars around the world increasingly agree that good governance affects development.

This consensus has emerged from a proliferation of empirical measures of institutional quality and governance, the investment climate and research World Bank Institute, For nutrition , the importance of good governance is reflected in the UNICEF conceptual framework of factors in the "control and management of resources influenced by political and ideological structures in society'' Jonsson Good governance is also recognized by countries themselves in the Voluntary Guidelines to support the progressive realization of the right to adequate food in the context of national food security FAO as an essential factor for sustained economic growth, sustainable development, the eradication of poverty and hunger and the realization of all human rights, including the right to adequate food.

Voluntary guidelines to support the progressive realization of the right to adequate food in the context of national food security , Towards an improved strategy for nutrition surveillance. Food and Nutrition Bulletin , United Nations Standing Committee on Nutrition.

The fifth report on the world nutrition situation: The Worldwide Governance Indicators: Methodology and Analytical Issues September Gender inequality index GII. The Gender Inequality Index is a composite measure reflecting inequality in achievements between women and men in three dimensions: It varies between zero when women and men fare equally and one when men or women fare poorly compared to the other in all dimensions. The Gender Inequality Index is designed to reveal the extent to which national human development achievements are eroded by gender inequality, and to provide empirical foundations for policy analysis and advocacy efforts.

Low status restricts women's opportunities and freedom, giving them less interaction with others and fewer opportunities for independent behaviour, restricting the transmission of new knowledge and damaging their self-esteem and expression. It is a particularly important determinant of two resources for care: Low status restricts women's capacity to act in their own and their children's best interests.

There is a demonstrated association between women's status and malnutrition in children. Human Development Report Gender and Human Development. Challenges for the 21st century: Gender Parity Index in primary level enrolment. This indicator of gender equality is also an indicator of Millennium Development Goal 3: The ratio of girls to boys, the gender parity index, in primary education is the ratio of the number of female students enrolled at the primary level of education to the number of male students.

To standardize the effects of the population structure of the appropriate age groups, the gross enrolment ratio for each level of education is used. The gross enrolment ratio is the number of students enrolled in primary, secondary and tertiary education, regardless of age, as a percentage of the population of official school age for the three levels.

There is a demonstrated association between women's status and mal nutrition in children. United Nations Statistics Division. Millennium Development Goals indicators. Promote gender equality and empower women. Eliminate gender disparity in primary and secondary education, preferably by , and in all levels of education no later than The global hunger index is a means of monitoring whether countries are achieving the hunger-related Millennium Development Goals.

It can be used for international ranking. The global hunger index captures three dimensions of hunger: Accordingly, the index includes three equally weighted indicators: In order to identify countries that are notably better or worse off with regard to hunger and undernutrition than would be expected from their gross national income per capita, a regression analysis is made of the global hunger index on gross national income per capita.

Countries are ranked on a point scale, with 0 and being the best and worst possible scores, respectively. Hunger is one of the world's major problems and therefore one of its most important challenges. Hunger and undernourishment form a vicious circle, which is often 'passed on' from generation to generation: The children of impoverished parents are often born underweight and are less resistant to disease; they grow up under conditions that impair their intellectual capacity for the whole of their life.

As of , FAO estimates that 1. This is the highest number since , the earliest year for which comparable statistics are available. The factors that contribute to a high global hunger index are: Countries with high hunger indexes are overwhelmingly low- or low- to middle-income countries with high levels of poverty.

Sub-Saharan Africa and South Asia are the regions with the highest global hunger indexes and the highest poverty rates. These have been major causes of widespread poverty and food insecurity in most countries with high global hunger indexes. The 15 countries with the highest global hunger indexes were consistently rated by the 'Freedom House Index' as non-free or partially free with regard to political rights and civil liberties in the period Low women's status is an important contributor to child malnutrition, which in turn accounts for high global hunger indexes for South Asian countries.

Well-designed, well-implemented health and nutrition services can reduce child malnutrition substantially. Many of the countries with high global hunger indexes, especially in South Asia, do not have effective health and nutrition services that reach the most vulnerable age groups pre-pregnancy through 2 years of age.

International Food Policy Research Institute. International Food Policy Research Institute,

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