using household consumption and expenditure surveys...

HarvestPlus c/o IFPRI2033 K Street, NW • Washington, DC 20006-1002 USATel: 202-862-5600 • Fax: 202-467-4439HarvestPlus@cgiar.org • www.HarvestPlus.org

Using Household Consumption and

Expenditure Surveys (HCES)

for Nutrition Policymaking

John L (Jack) Fiedler, PhD

Poverty, Health and Nutrition Division / SPRING

International Food Policy Research Institute

Washington DC

Email: J.Fiedler@cgiar.org

Presentation Outline

• Introduction to HCES

• The allure of HCES

• Uses of HCES: Large scale (national or sub-national level), diagnostics, planning and monitoring

• Common HCES limitations

• Overcoming the limitations

– In reactive mode: Improving HCES as a secondary data source

– Getting proactive: The unique potential for nutritionists and other food and nutrition experts to help improve HCES

• The multiagency agenda for strengthening HCES

Household Consumption and

Expenditure Surveys (HCES)

• Large , multi-purpose, routine household surveys: ~5yr

• Representative at subnational (regional or state) level

• Detailed information

on household food

acquisition and

consumption

• Already routinely conducted and paid for in 116 countries

• Incremental cost of analyzing the nutrient content of an already-existing HCES: ~$25,000

• Cost of a 24HR survey (8,500 HHs) $2.3 million(Source: Fiedler, Martin-Prevel & Moursi, Food Nutr Bull 4(3), 2013)

HCES: A rich source of data

1. Food is reported as a mixture of consumption of own production, purchases & received as in-kind/gift

2. Household composition: Number of members, age, gender,

3. Housing characteristics (water, sanitation)

4. Non-food expenditures, assets and employment

5. Common, but not universal modules include:

Agriculture: Amount of land owned, cultivated, types of crops planted, inputs, production levels and disposition

Health and health care use (VAS, iron supplementation)

Social program participation

ttps://openknowledge.worldbank.org/handle/10986/18091

HCES-A Tool for Assessing…

Diet and Dietary Patterns

100%93% 97%

48%

23%

38%

87%

63%

38%

99%

52%

74%

Percent of Households Consuming Each Food Group, Bangladesh

HCES-A Tool for Assessing…

Regional Variations

54% 53%

20%15% 14% 12%

8% 6%2%

23%

Percent of Households Purchasing Some Fortifiable Maize Meal

HCES-A Tool for Assessing…

The Agriculture-Nutrition Nexus

Energy Calcium Vitamin A Iron Zinc

Food Crop Kcal mg ug RAE mg mg

1 Patal/Perbol (carrot) 46 37 934.7 0.3 0.3

2 White gourd/ Pumpkin 12 10 172.1 0.4 0.1

3 Puisak/Spinach 81 659 294.3 12.8 2.0

4 Other vegetables 161 280 402.1 5.6 1.7

5 Melon/ Bangi 12 3 20.7 0.1 0.0

6 Ripe papaya 8 5 10.7 0.0 0.0

7 Green chili 16 6 19.6 0.4 0.1

8 Tomato 17 9 38.5 0.2 0.2

9 Mango 12 2 7.2 0.0 0.0

10 Guava 9 2 4.2 0.0 0.0

11 Ladies' finger (okra) 33 86 20.2 0.9 0.6

12 Other fruits 86 23 20.6 0.5 0.5

13 Jack fruit 30 11 4.8 0.2 0.1

14 Maize 36 1 3.7 0.2 0.2

Nutrient Availability per Area Planted by Crop, Bangladesh 2010

Nutrients per Day per Decimal*

Key Food Sources of Zinc in Nigeria (% EAR)

HCES-A Tool for Assessing….

Key Sources of Nutrients

Monthly Fluctuations in Sweet Potato Consumption, Uganda

HCES-a Tool for Assessing…

Seasonality

134

148

115145

173212

259

308

243

162

112129

May June July Aug Sept Oct Nov Dec Jan Feb Mar Apr

Sweet Potato Apparently Consumedby Ugandan Households

Gra

ms

pe

r d

ay p

er

ho

use

ho

lds

Seasonality of Food Rich in

Vitamin ASeasonality of food rich in Vitamin A (orange) and potentially bio/fortified

with Vitamin A (yellow)

Average kg apparently consumed per AME per day, by month

HCES-a Tool for Assessing…

Multiple Intervention Portfolios

64.3%

31.3%

4.3% 0.1%Participation in 3 Social Programs, Gujarat

Participates in NoneParticipates in 1 ProgramParticipates in 2 ProgramParticipates in 3 Program

Program Participation Status Number Percent

No Program Participation 39,816,263 64.2%

Program Coverage: By type 22,154,782 35.8%

1 PDS-Only 15,058,007 24.3%

2 ICDS-Only 947,581 1.5%

3 MDM-Only 3,407,902 5.5%

4 PDS & ICDS 307,144 0.5%

5 PDS & MDM 2,263,787 3.7%

6 ICDS & MDM 120,621 0.2%

7 PDS & ICDS & MDM 49,740 0.1%

TOTAL 61,971,045 100.0%

HCES-a Tool for Assessing…

Selection of Fortification Vehicles

82 80 77 73 73 70 6660 59

45

2317

6 6

0102030405060708090

Per

cen

t

Figure 2. Percent of Zambian Households Purchasing Potential Fortification Portfolios

S: SugarO: Vegetable OilM: MaizeMM: Maize MealW: Wheat Flour

Percent of Zambian Households PurchasingAlternative Fortification Portfolios

Designing Fortification Portfolios

18

1

4

20

23

5

24

Oil WFE Sugar Oil + WFE Oil + Sugar Sugar +WFE

Oil + WFE +Sugar

Percentage Point Reduction in the Prevalence of

Inadequate Vitamin A Intake, Bangladesh

WFE: Wheat Flour Equivalents. The wheat flour content of flour-based foods:

white bread=60%, flat bread=75%, biscuits=60%, noodles=90%, cakes 55%

Requires Quantifying Food Consumption and Nutrient Intakes

HCES are Heterogenous:

Generalizations are Hazardous

• A mixture of consumption and purchases/acquisition

• Recall period: 3 days to 12 months

• Completeness of food data– Food sources: purchases, own production, gifts

• Food lists vary– Number of items: 20 to 500+

– Specificity: From commodity-like to processed or prepared meals

• Food consumed away from home inadequately covered

• Units of measurement may be unstandardized and vary by locality (e.g., bunch, cluster, heap, pile)

• Artifacts of country-specific design and implementation (e.g., seasonality)

Addressing HCES Shortcomings to

Estimate Apparent Nutrient Intakes1. Units of measurement may be unstandardized and vary

by locality (e.g., bunch, cluster, heap, pile)

a. Clarify and standardize local units of measure using a community level questionnaire, if available

2. Develop a proxy for “usual intake”

a. HCES is generally a mixture of food acquisition & consumption (often labeled “available food)

b. Assume all food consumed or acquired during the recall period is consumed during the recall period

c. Assume there are no food stocks, waste

HCES Limitations

d. Calculate household total apparent consumption of each food item

e. Match food items with items listed in country-specific Food Composition Table (FCT)

• Food items may not be specific enough to enable unambiguously matching to a Food Composition Table (FCT) entry—making nutrient intake estimation imprecise (e.g., “Other vegetables”)

f. Sum nutrient content across all foods (apparent nutrient intake)

Estimating Apparent Nutrient Intakes

g. Estimate the Estimated Average Requirement (EAR) of all household members

h. Compare “apparent nutrient intake” to Estimated Average Requirement (EAR) to determine apparent nutrient intake adequacy

i. Use the cutpoint method for vitamin A and zinc.

– If apparent nutrient intake:≥ EAR: Apparent intake is adequate

< EAR: Apparent intake is inadequate

j. Use the probability method for iron – IOM 2006 has tables reporting probabilities of adequacy

for specific, age-, gender- and bioavailability adjusted EARs

Estimating Apparent Nutrient Intakes

• To go from household to individual nutrient adequacy estimates

– Need to assume how the household’s food is distributed among its members

• For example:

– Assume food is distributed in direct proportion to household member’s share of the household’s total Adult Male Consumption Equivalents (ACEs) to take into account household’s size, age and gender composition.

Improving HCES: In Proactive Mode

• The experiences and skills of nutritionists make them uniquely qualified to make significant contributions to improving HCES’s by helping to improve areas that are commonly problematic:

– Standardizing units of measurement

– Having the “best” recall period (to estimate usual intake)

– Better capturing food away from home

– Improve the food item list

Nutritionists can Help Strengthen HCES

• By helping to ensure that a “nationally-relevant” Food Composition Table (FCT) is being used to inform decisions about the composition and length of the HCES food list

• Ensure that the food item categories in the HCES are closely matched to the FCT entries to enhance precision and reliability

Nutritionists can help improve

the HCES food list. Does it….

• Capture the most commonly consumed foods?

• Capture the important sources of micronutrients?

• Identify specific food items as opposed to groups?

• Specify the food’s form or how it is prepared?

Food Item NameServing

g

Edible

Portion

Water

g

Energy

Kcal

Iron

mg

Zinc

mg

Vit A

RAE

rice 100 100% 13.5 345.5 1.95 1.4 0

chira (unhusked rice) 100 100% 13.3 346 1 0.9 0

khoi (popped rice, lawa) 100 100% 5.8 392 1.49 3 0

muri (puffed rice ) 100 100% 5.8 392 1.49 3 0

other rice products 100 100% 12.63 354.67 2.05 3 0

wheat / atta ( wheat flour) 100 100% 12.8 346 3.63 2.7 0

maida (wheat flour) 100 100% 10.59 354 3.63 0.62 0

suji, rawa (semolina) 100 100% 12.67 360 3.63 1.05 0

sewai, noodles 100 100% 11.91 364 0.7 0.74 0

jowar & its products 100 100% 11.9 349 4.1 1.6 0

Portion of the 2010 Bangladesh

HIES food list.

Nutritionists can Help Develop an

“Appropriate” Food List

• The length and composition of the food item list has been shown to be an important determinant of the accuracy of food consumption reporting.

– Is it too short? Short, overly aggregated food lists result in under-reporting of food consumption.

– Is it too long? Highly detailed, lengthy lists are not the answer either: they may contribute to:

• over-reporting of food consumption,

• add to interviewer and interviewee fatigue,

• increase the possibility that the household will refuse to participate in the survey or

• prematurely terminate the interview

Nutritionists can help by…

• Identifying when more detailed food types are unnecessary because they do not result in significant differences in estimated nutrient intakes

• As needed, conduct limited 24 Hour Recall surveys to help address specific issues and complement HCES

Engaging in a Proactive Process

• Identify the timing of and participate in the National Statistical Office (NSO) HCES project cycle

• Engage the NSO at the beginning of the cycle

– Help review existing questionnaires and guidelines

– Sensitize field supervisors and interviewers

– Review data processing routines and guidelines

– Review and assess FCT and propose FCT-HCES food list matchings

– Identify methods for estimating intra-household distribution of food

The recently established platform

for strengthening HCES

• World Bank-FAO-International Household Survey Network-UN Statistical Commission: Inter-Agency Working Group

• 2013 assessment of the precision and relevance of 115 countries’ HCES

• Recent release of ADePT Food Security Module: free software will facilitate processing HCES & producing food security indicators http://openknowledge.worldbank.org/handle/10986/18091

• 2014 Agenda (Shared with Several National Statistical Offices)– Direct comparisons of 24 hour recall and HCES data

– Including pregnancy, lactating, breastfeeding status

– Methods for improving the food list

– Standardizing quantitative reporting units

– Better capturing processed foods & food consumed away from home

The Challenge

How good can we make HCES?