Five types of methods are used for assessing the extent of hunger and malnutrition, each having different applications and comparative advantages in terms of uses for advocacy, policy analysis and decisions, and research. Three of these, the FAO method, household income and expenditure surveys (HIES) and food intake surveys (FIS), estimate dietary intake and try to relate this to energy needs, of which physical activity is the largest single component yet the least measurable. The fourth assesses perceptions of hunger and behavioural response (qualitative methods), and the fifth measures physical effects on growth and thinness (anthropometry). Not only is there no absolute measure (or "gold standard"), but these methods assess different aspects of hunger and dimensions of its effects on health, suffering, behaviour and economics. None the less, triangulating on trends in "hunger" is a reasonable goal and is the underlying intent of the internationally agreed upon obligation to accelerate the reduction in the numbers of people affected.
In principle, the ways ahead are suggested as: shifting towards trend assessment based on patterns of related indicators that capture different dimensions of hunger; estimating global and regional trends every few years with the current FAO methods, with more detailed assessments in selected ("sentinel") countries through household and individual surveys; developing qualitative methods in the local contexts and starting to use these as modules in other surveys; using small- scale studies for policy and causality research; and balancing resource allocations based on required outputs and decision needs.
The associations between income, dietary energy intake and anthropometry can be understood from national data and point the way to interpreting trends. The prevalence of child underweight differs by income bands. Within countries, the relationship of child underweight prevalence with income appears to be non-linear. This is consistent with child malnutrition being caused by a number of interacting factors, several of which may need to improve before an impact is seen on child growth. Across countries, greater variation is seen with location than with income. In South Asia, child growth responds much faster to increasing income or food availability - in line with the high incidence of low birth weight and related intergenerational effects. Patterns of within-country indicator trends can be interpreted in relation to food, health and nutritional factors. To this, there is a need to add diet quality, derived from food supply estimates, surveys of food availability and intake, and clinical and biochemical measurements. Combating hunger to promote health and productivity clearly includes adequacy in micronutrients to prevent anaemia and retarded child development, to improve resistance to disease and to bring other benefits.
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Measuring hunger and malnutrition
