Indicators of nutritional status of women after food supplementation
queries regarding indicators Bhawana Sharma 16.03.2000
queries regarding indicators Wisam Al-Timimi 19.03.2000
queries regarding indicators George Beaton 16.03.2000
Re[2]: queries regarding indicators Wisam Al-Timimi 19.03.2000
LBW David Morley 20.03.2000
Measurements David Morley 20.03.2000
Re: queries regarding indicators Barbara Reed 20.03.2000
Re: queries regarding indicators patricia haggerty 20.03.2000
Re: queries regarding indicators Marti J. van Liere 21.03.2000

From: Bhawana Sharma,

Date : 16.03.2000

Subject : queries regarding indicators


Dear Sir / Madam

We are planning to implement a program in one of the hilly districts of Nepal main objectives of the program are;

. supplement fortified foods for six months before delivery and six months after delivery.
. Raising awareness among community people regarding the uses of existing health facilities
. Raising awareness how to meet dietary needs

. Increase in regular clinic attendance
. Hemoglobin levels
. Nutrition awareness
. Consumption of supplement

I would like to request you to suggest me for the following queries;

  1. To assess the nutritional status of mothers what will be the other effective and feasible indicators ?
  2. As there will be three stages of women i.e., pregnant, delivery and lactation what indicator will be most appropriate despite of changing stages of women ?

If you could response these queries it will be great help to design the project. Hope to get your response soon. Thanks.



Bhawana Sharma

Date: Sun, 19 Mar 2000 17:13:39 -0800

From: (Wisam Al-Timimi)

Subject: Re: queries regarding indicators


Dear colleagues

1-The incidence of low birth weight infants.

2-The serum Iron and Iron binding capacity ,Blood film and blood indices MCH,MCHC and other indices if possible (if this applicable & feasible ) (( probably automation will be of great help ))coulter counter .

3-The Vaccination coverage rate, especially Tetanus toxoid coverage, and other Primary health care service coverage..

I hope this may cover your questions.

Best regards


Dr. Al-Timimi Wisam


From : George Beaton,

Date : 16.03.2000

Subject : Re: queries regarding indicators


A couple of things for you to think about in the design of your study.

There is ample evidence that food supplements are shared and that change in intake of the target individual may be comprised of other foods that become available because supplemental food was introduced into the household. To look at dietary effects you will have to monitor total food intake, not just supplement intake.

You speak of the fact that the women will be in different physiologic stages. You do not mention whether you are designing cross-sectional or longitudinal observations (i.e. whether individual women will be followed over time) This would have important bearing on how you deal with the "stages" during data analysis.

Whichever field design you choose, you will have to control for expected changes/differences with physiologic stage. Thus, for example, in tracking hemoglobin levels, age (in adolescents) and stage of pregnancy have expected physiologic shifts in Hb level - descriptions of expected changes are now available and can be used during analysis.

Good luck with your program.

George Beaton



9 Silverview Drive, Willowdale, Ontario, Canada M2M 2B2

Date: Sun, 19 Mar 2000 16:53:30 -0800

From: (Wisam Al-Timimi)

Subject: Re[2]: queries regarding indicators


Dear colleagues

We already aware of the points mentioned down here ,we study the issue to support a national survey in collaboration with MOH to determine the level of Anemia in secondary school students during November this year ,but the survey protocol is not yet finalized (the door is still open for further modification ) .

Best regards


Dr. Wisam Al-Timimi


Date: Mon, 20 Mar 2000 11:40:38 +0000

From: David Morley <>


Colleagues, Dr Al-Timimi Wisam mentions Low birth weight. Weighing new born babies may not be possible. An alternative is a piece of nonstrtch string with knots 30 cm apart. If when placed around the chest at nipple level the knots overlap then the baby is almost certainly LBW. Correlation between chest circumfernce and Birth Weight is high. David

David Morley


David Morley,Emeritus Professor of Tropical Child Health, University of London.

Tel: & Fax. 44 (0) 1582 712199.

Preferred Address; 51 Eastmoor Park, Harpenden, AL5 1BN. UK.

Date: Mon, 20 Mar 2000 11:43:22 +0000

From: David Morley <>

Subject: Measurements


Dear Bhawana Sharma, Teaching Aids at Low Cost (TALC) is attempting to provide low cost measuring equipment which can be used by families and communities. This material is in various stages of development:

1.Insertion tape for measuring under fives arm circumference can be coloured like the Shakir strip.Also a longer tape can measure chest head abdominal circumference.

2. Direct Recording Scale, when used by mothers and the community they come to understand the meaning of a line graph [which has been the reason for failure of growth monitoring] Among the Maasai in East Africa there is evidence they will take action, in giving extra food when they see faltering. Weight charts supplied as national charts with a few exceptions do not fit

3 A height or length [Stadiometer or Infantometer] just becoming available need slight DIY 'carpentry' skill to erect.

4.The Weight for Height 'Nabarro' wall chart which help to distinguish weight loss and stunting when the age is not known.

5. A thermospot this is a black disc which is stuck in the newborns axilla as long as the temperature is over 35.5 the disc changes colour to a smiling face. Studies in Nepal certainly in hospitals show that hypothermia in the newborn is common.

6. The "Zeal" multi use crystal clinical thermometer 7. Fundal height tape, available in 3-6 months this will allow the fundal height to be measured and easily plotted on a kchart. Probably availble in 3 - 6 months.

Let me know if you or other ngonutters need additional information on any of these.



David Morley,Emeritus Professor of Tropical Child Health, University of London.

Tel: & Fax. 44 (0) 1582 712199.

Preferred Address; 51 Eastmoor Park, Harpenden, AL5 1BN. UK.

Date: Mon, 20 Mar 2000 19:28:44 +0000

From: "Barbara Reed" <>

Subject: Re: queries regarding indicators


Consider MUAC as an indicator of women's nutritional status. It is comparable across all three reproductive states (pregnant, lactating, neither pregnant nor lactating), and is responsive to interventions of short duration.

However, assuming that you are longitudinally tracking the nutritional status of beneficiaries, it may be too much to expect to see an improved MUAC during the year because the woman is pregnant and lactating -- unless the level of supplementation is such that it plus other food provides all of the additional energy demands of reproduction plus makes up any deficits in the household diet. It may be more realistic to hope that the woman maintains the same MUAC, i.e., that she is protected against depletion during reproduction. If the woman is already malnourished a better time for building her up is between lactation and the next pregnancy. Because MUAC is responsive to change, when making comparisons, seasonal changes that affect dietary intake should be considered.

Because you say your objectives are "intergenerational", in addition to monitoring the nutritional status of women, are you also examining the nutritional status of their infants, particularly their girls?

Child-level indicators to consider would be:

- birthweight (which can be influenced by the pre-delivery supplementation)

- H/A or W/A of children at 6 mos, and if can follow them longer, at 12 mos and 2 yrs


Barbara A. Reed

MCH Emergency Specialist

Fanta Project/ Academy for Educational Development (202) 884 8011

Date: Mon, 20 Mar 2000 16:49:36 +0000

From: "patricia haggerty" <>

Subject: Re: queries regarding indicators


For the study in Nepal,

In addition to the indicators suggested by George Beaton, another indicator of the effectiveness of the intervention will be birth weights of the babies. While not directly measuring the nutritional status of the mothers, this will be a reflection of improved maternal nutrition during pregnancy.

Of course, you should have an appropriate control group that does not receive the same intervention, so you can attribute changes in any of the indicators to the intervention.

Beyond looking at immediate effects of the intervention on maternal heath/nutrition -- which one would expect to be positive -- have you addressed the question of sustainability? What happens when the supplements are no longer available, and the intervention goes away? If your ultimate goal is combatting intergenerational effects of malnutrition, then long term strategies are needed. Raising awareness of diet and health facilities is just the tip of the iceberg. Community awareness needs to translate into commitment which eventually builds capability. At these levels, there are also indicators you could measure.

Patricia Haggerty

Date: Tue, 21 Mar 2000 17:58:33 +0000

From: "M.v.Liere" <>

Subject: Re: queries regarding indicators


Dear Sir / Madam,

Studies by Prof. Dr. Jane Kusin et al. in Indonesia (East Java Pregnancy Study) have shown that there is partitioning of extra energy (supplementary feeding to pregnant women), depending on the nutritional status of the woman. Pre-pregnant weight and BMI determine the maternal response to reproductive outcomes.

With BMI < 17 the preference is for the mother, she gets the extra energy; with BMI 17-18,5 the extra energy is shared between mother, fetus and breast milk production;

with BMI>18,5 the extra energy benefits fetus or breast milk production.

For evaluating the effect of your supplementation you might want to look both at maternal (difference in pre- and post-pregnant weight) and child outcome (average birth weight, percentage of low birth weight) as compared to baseline data or a control group.

I am very interested to know more about this intervention, the implementing organisation etc.

Best regards,

Marti J. van Liere


Kusin JA, Kardjati S (eds), (1994). Maternal and Child nutrition in Madura, Indonesia. Amsterdam, KIT. ISBN : 90-6832-086-6

Kusin JA, Kardjati S, Renqvist UH (1994). Maternal body mass index: the functional significance during reproduction. Eur. J. Clin. Nutr. 48 suppl.3: S56-S67.

Kardjati S, Kusin JA, Schofield WM, With C de (1990). Energy supplementation in the last trimester of pregnancy in East Java, Indonesia: effect on maternal anthropometry. Am. J. Clin Nutr 52: 987-994.

Kardjati S, Kusin JA, With C de (1988). Energy supplementation in the last trimester of pregnancy in East Java : effect on birthweight. Br. J. Obstetrics and Gynaecology 95: 783-794


Marti J. van Liere (PhD), nutritionist

Department of Health Care and Disease Control Royal Tropical Institute (KIT)

Maurits kade 63, PO Box 95001, 1090 HA Amsterdam

phone : +31 20 5688 497, fax : +31 20 5688 444