Abstract

PIP: Nutritional surveillance is an essential instrument for the detection of nutrition problems, for the formation of policy and for the planning and evaluation of action programs for both development and emergency situations. Without an adequate surveillance system at both the national and local levels, health may progressively deteriorate without detection, or disasters may recur without prior warning. The objectives of nutritional surveillance are to describe the population's nutritional status, with particular reference to at risk subgroups; to elucidate causal relationships to permit selection of preventive measures; to promote governmental decisions which will meet the needs of both normal development and emergencies; to predict the evolution of nutritional problems based on an assessment of current trends; and to monitor nutrition programs and evaluate their effectiveness. Prior to implementing a nutrition surveillance system, an initial assessment should be conducted to determine the type, extent, and timing of the nutritional problems; to identify and describe groups at risk; to assess the reasons for the presence of malnutrition; and to identify existing data sources that could be useful to the system. This qualitative information can be based on data from analogous countries, spot surveys, community studies, hospital reports, and routinely collected data. Indicator selection should reflect causal relationships and predict populations at risk and timing of interventions. Selection of agricultural and socioeconomic indicators should be based on the type of food supply system: pastoral subsistence, settled subsistence farming, market economy or mixed. The ratio of available food supplies and access to food supplies can be used as a global indicator for international comparisons and for determining the size of the population at risk. Health and dietary indicators should be clearly related to the prevalence of symptomatic ill health. Data sources should be complementary to cover the broad range of needed information and can include: government statistical and meteorological agencies, health systems, and agricultural systems. The institutional structure for the surveillance system is determined by the decision making points for immediate action and long range planning. A centralized unit for technical assistance and data interpretation may be necessary. The initiative for developing the system must come from a sufficiently high level to ensure that action follows. Several steps are involved in system planning and implementation: determine sample design and units for surveillance, design the report format and construct the questionnaire, determine methods for data collection, implement field operations including training personnel and supervising data quality, securing equipment and supplies, arranging for data transmittal, and develop a timely data processing system. A draft surveillance plan, containing all the implementation steps, with details of timing, manpower, funding, and alternative strategies should be prepared. Surveillance systems should be among a nation's priorities. To enhance their effectiveness, additional research is needed on causal relationships, the significance of available health indicators and operations management.