How can we better capture food away from Home? Lessons from India's linking person-level meal and household-level food data.

Despite acknowledged shortcomings, household consumption and expenditure surveys (HCES) are increasingly being used to proxy food consumption because they are relatively more available and affordable than surveys using more precise dietary assessment methods. One of the most common, significant sources of HCES measurement error is their under-estimation of food away from home (FAFH). In 2011, India's National Survey Sample Organization introduced revisions in its HCES questionnaire that included replacing "cooked meals"-the single item in the food consumption module designed to capture FAFH at the household level-with five more detailed and explicitly FAFH sub-categories.

Iron+folic acid distribution and consumption through antenatal care: identifying barriers across countries.

Objective: The prevalence of maternal anaemia remains unacceptably high in developing countries. At the same time, the percentage of women who consume one or more Fe+folic acid (IFA) tablets during pregnancy remains persistently low. The objective of the present study was to identify where, within antenatal care (ANC) programmes, pregnant women falter in obtaining and consuming an ideal minimum of 180 IFA tablets.

Assessing alternative industrial fortification portfolios: a Bangladesh case study.

Background: Approximately 1.2 million disability-adjusted life years (DALYs) are lost annually in Bangladesh due to deficiencies of vitamin A, iron, and zinc.

Objective: To provide evidence on the coverage, costs, and cost-effectiveness of alternative fortification interventions to inform nutrition policy-making in Bangladesh.

Micronutrient program costs: sources of variations and noncomparabilities.

Background: Micronutrient interventions are contributing to substantial reductions in global morbidity and mortality. As the diversity and coverage of these interventions expand, it is increasingly important to understand their distinct roles and contributions, and the resources they require. To date, comparing program resource use has been hampered by several noncomparabilities in cost studies relating to diverse intervention activities and service delivery pathways, along with differences in methodological approaches.

Food crop production, nutrient availability, and nutrient intakes in Bangladesh: exploring the agriculture-nutrition nexus with the 2010 Household Income and Expenditure Survey.

Background: Systematic collection of national agricultural data has been neglected in many low- and middle-income countries for the past 20 years. Commonly conducted nationally representative household surveys collect substantial quantities of highly underutilized food crop production data.

Objective: To demonstrate the potential usefulness of commonly available household survey databases for analyzing the agriculture-nutrition nexus.

Managing the vitamin A program portfolio: a case study of Zambia, 2013-2042.

Background: Micronutrient deficiencies continue to constitute a major burden of disease, particularly in Africa and South Asia. Programs to address micronutrient deficiencies have been increasing in number, type, and scale in recent years, creating an ever-growing need to understand their combined coverage levels, costs, and impacts so as to more effectively combat deficiencies, avoid putting individuals at risk for excess intakes, and ensure the efficient use of public health resources.

Objective: To analyze combinations of the two current programs--sugar fortification and Child Health Week (CHW)--together with four prospective programs--vegetable oil fortification, wheat flour fortification, maize meal fortification, and biofortified vitamin A maize--to identify Zambia's optimal vitamin A portfolio.

An analysis of the costs of Uganda's Child Days Plus: do low costs reveal an efficient program or an underfinanced one?

Background: Twice annually, Uganda implements Child Days Plus (CDP), a month-long outreach activity that distributes vitamin A capsules to preschool children and deworms children 6 months to 14 years old. Introduced initially as a temporary, interim strategy, CDP is now a decade old.

Objective: To assess how well CDP is implemented using an activity-based cost analysis.

Estimating the impact of vitamin A-fortified vegetable oil in Bangladesh in the absence of dietary assessment data.

Objective: Vitamin A deficiency is a serious health problem in Bangladesh. The 2011-12 Bangladesh Micronutrient Survey found 76·8% of children of pre-school age were vitamin A deficient. In the absence of nationally representative, individual dietary assessment data, we use an alternative--household income and expenditure survey data--to estimate the potential impact of the introduction of vitamin A-fortified vegetable oil in Bangladesh.

Policy implications of using a household consumption and expenditures survey versus an observed-weighed food record survey to design a food fortification program.

Background: Observed-Weighed Food Record Surveys (OWFR) are regarded as the most precise dietary assessment methodology, despite their recognized shortcomings, which include limited availability, high cost, small samples with uncertain external validity that rarely include all household members, Hawthorne effects, and using only 1 or 2 days to identify "usual intake." Although Household Consumption and Expenditures Surveys (HCES) also have significant limitations, they are increasingly being used to inform nutrition policy

Objective: To investigate differences in fortification simulations based on OWFR and HCES from Bangladesh.

Methods: The pre- and postfortification nutrient intake levels from the two surveys were compared.

Assessing Zambia's industrial fortification options: getting beyond changes in prevalence and cost-effectiveness.

Background. Since fortification of sugar with vitamin A was mandated in 1998, Zambia's fortification program has not changed, while the country remains plagued by high rates ofmicronutrient deficiencies. Objective.

Identifying zambia's industrial fortification options: toward overcoming the food and nutrition information gap-induced impasse.

Background: Zambia was a pioneer when it started fortifying sugar with vitamin A in 1998. Micronutrient deficiencies-especially among young children-have changed little over the past decade. In 2008 an initiative to introduce fortified flours was halted when last-hour questions about the program could not be answered.

Relative costs of 24-hour recall and Household Consumption and Expenditures Surveys for nutrition analysis.

Background: The technical and resource demands of the most precise dietary assessment methods, 24-hour recall and observed-weighed food records, have proven impractical for most low- and middle-income countries, leaving nutrition policymakers with a woefully inadequate evidence base and compromising nutrition program effectiveness.

Objective: To better understand the relative costs of informing food and nutrition policy-making using two different data sources: 24-hour recall survey data and Household Consumption and Expenditures Survey (HCES) data.

Methods: A comparative analysis of the costs of designing, implementing, and analyzing a 24-hour recall survey and the cost of secondary analysis of HCES data.

Maize flour fortification in Africa: markets, feasibility, coverage, and costs.

The economic feasibility of maize flour and maize meal fortification in Kenya, Uganda, and Zambia is assessed using information about the maize milling industry, households' purchases and consumption levels of maize flour, and the incremental cost and estimated price impacts of fortification. Premix costs comprise the overwhelming share of incremental fortification costs and vary by 50% in Kenya and by more than 100% across the three countries. The estimated incremental cost of maize flour fortification per metric ton varies from $3.

Child Health Week in Zambia: costs, efficiency, coverage and a reassessment of need.

Child Health Weeks (CHWs) are semi-annual, campaign-style, facility- and outreach-based events that provide a package of high-impact nutrition and health services to under-five children. Since 1999, 30% of the 85 countries that regularly implement campaign-style vitamin A supplementation programmes have transformed their programmes into CHW. Using data drawn from districts' budget, expenditures and salary documents, UNICEF's CHW planning and budgeting tool and a special purposive survey, an economic analysis of the June 2010 CHW's provision of measles, vitamin A and deworming was conducted using activity-based costing combined with an ingredients approach.

Still waiting for Godot? Improving Household Consumption and Expenditures Surveys (HCES) to enable more evidence-based nutrition policies.

Background: The constrained evidence base of food and nutrition policy-making compromises nutrition programs. Nutrition policy-making must do better than relying exclusively on Food and Agriculture Organization Food Balance Sheets. The strategy of relying on observed-weighed food record or 24-hour recall surveys has not proven practical either; they remain few in number, generally not nationally representative, and of dubious external validity.

Estimating micronutrient intakes from Household Consumption and Expenditures Surveys (HCES): an example from Bangladesh.

Background: Globally, there is a scarcity of national food consumption data that could help to assess food patterns and nutrient intakes of population groups. Estimates of food consumption patterns and apparent intakes of energy and nutrients could be obtained from national Household Consumption and Expenditures Surveys (HCES).

Objective: To use the HCES conducted in Bangladesh in 2005 (HIES2005) to estimate apparent intakes of vitamin A, iron, and zinc.

Comparison of estimates of the nutrient density of the diet of women and children in Uganda by Household Consumption and Expenditures Surveys (HCES) and 24-hour recall.

Background: Individual dietary intake data are important for informing national nutrition policy but are rarely available. National Household Consumption and Expenditures Surveys (HCES) may be an alternative method, but there is no evidence to assess their relative performance.

Objective: To compare HCES-based estimates of the nutrient density of foods consumed by Ugandan women (15 to 49 years of age) and children (24 to 59 months of age) with estimates based on 24-hour recall.

Household Consumption and Expenditures Surveys (HCES): a primer for food and nutrition analysts in low- and middle-income countries.

Background: The dearth of 24-hour recall and observed-weighed food record data--what most nutritionists regard as the gold standard source of food consumption data-has long been an obstacle to evidence-based food and nutrition policy. There have been a steadily growing number of studies using household food acquisition and consumption data from a variety of multipurpose, nationally representative household surveys as a proxy measure to overcome this fundamental information gap.

Objective: To describe the key characteristics of these increasingly available Household Consumption and Expenditures Surveys (HCES) in order to help familiarize food and nutrition analysts with the strengths and shortcomings of these data and thus encourage their use in low- and middle-income countries; and to identify common shortcomings that can be readily addressed in the near term in a country-by-country approach, as new HCES are fielded, thereby beginning a process of improving the potential of these surveys as sources of useful data for better understanding food- and nutrition-related issues.

A program needs-driven approach to selecting dietary assessment methods for decision-making in food fortification programs.

Background: Dietary assessment data are essential for designing, monitoring, and evaluating food fortification and other food-based nutrition programs. Planners and managers must understand the validity, usefulness, and cost tradeoffs of employing alternative dietary assessment methods, but little guidance exists.

Objective: To identify and apply criteria to assess the tradeoffs of using alternative dietary methods for meeting fortification programming needs.

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh.

This study assessed the cost-effectiveness of adding the community-based management of severe acute malnutrition (CMAM) to a community-based health and nutrition programme delivered by community health workers (CHWs) in southern Bangladesh. The cost-effectiveness of this model of treatment for severe acute malnutrition (SAM) was compared with the cost-effectiveness of the 'standard of care' for SAM (i.e.

Indian social safety net programs as platforms for introducing wheat flour fortification: a case study of Gujarat, India.

Background: Micronutrient deficiencies exact an enormous health burden on India. The release of the National Family Health Survey results--showing the relatively wealthy state of Gujarat having deficiency levels exceeding national averages--prompted Gujarat officials to introduce fortified wheat flour in their social safety net programs (SSNPs).

Objective: To provide a case study of the introduction of fortified wheat flour in Gujarat's Public Distribution System (PDS), Integrated Child Development Scheme (ICDS), and Mid-Day Meal (MDM) Programme to assess the coverage, costs, impact, and cost-effectiveness of the initiative.

Recommendations for improving Guatemala's food fortification program based on household income and expenditure survey (HIES) data.

Background: Fortification offers great potential for reducing the enormous disease burden of micronutrient deficiencies. The lack of information on food consumption patterns has been a major impediment to the development of fortification programs. In some countries, the absence of this information has been an obstacle to the introduction of fortification.

Vitamin A fortification in Uganda: comparing the feasibility, coverage, costs, and cost-effectiveness of fortifying vegetable oil and sugar.

Background: Twenty-eight percent of Ugandan preschool children suffer from vitamin A deficiency. With vitamin A supplementation covering only a third of children under 5 years of age, fortification is essential to reduce their vitamin A deficiency-related disease burden. At present, the only widely consumed food in Uganda that is fortified with vitamin A is vegetable oil.

A strategic approach to the unfinished fortification agenda: feasibility, costs, and cost-effectiveness analysis of fortification programs in 48 countries.

Background: Food fortification is a promising strategy for combating micronutrient deficiencies, which plague one-third of the world's population. Which foods to fortify, with which micronutrients, and in which countries remain essential questions that to date have not been addressed at the global level.

Objective: To provide a tool for international agencies to identify and organize the next phase of the unfinished global fortification agenda by prioritizing roughly 250 potential interventions in 48 priority countries.

Household income and expenditure surveys: a tool for accelerating the development of evidence-based fortification programs.

Background: One-third of the world's population suffers from micronutrient deficiencies due primarily to inadequate dietary intake. Food fortification is often touted as the most promising short- to medium-term strategy for combating these deficiencies. Despite its appealing characteristics, progress in fortification has been slow.