Developing and evaluating food-based dietary guidelines and a healthy eating index for Ethiopia

Dr. Namukolo Covic

Dr. Jeanne de Vries Dr. Inge Brouwer

Dr. Laura TrijsburgMr. Tesfaye Hailu

Mr. Dawit Alemayehu

How FBDGs development began ?

• RESULT 3.2: HEALTHY LIFESTYLES AND NUTRITION PROMOTED

• Operational research priorities (2016-2020)• Health and nutrition interaction

Ethiopian Food-Based Dietary Guidelines development is one of the agendas in the national nutrition program

Major gaps in diet quality:• Very low diet diversity• Inadequate Vit A, Zn &

protein intakeKey knowledge gap: Dietary patterns in various settings

Consumer:• Changing purchasing power• Large heterogeneity of

consumersKey knowledge gap: Consumer behavior & preference

Food environment:• Fluctuating and increasing

price of the most nutritious food groups

• Large difference b/n urban & rural settings

Key knowledge gap: intervention effects on food environment

Drivers of food system change:• Urbanization, population growth,

economic & agricultural growth, education, infrastructure investments, climate change & land degradation, institutional innovations, multi-sectoral polices & programs

Key knowledge gap: Synergies & trade-offs b/n drivers & net effect on diets & food systems

Food supply system:• Agriculture production focused

on staples but increasing attention to diversification

• Mainly short value chains, except for cereals & export crops

• New focus on food transformation

Key knowledge gap: Food storage, effect of food transformation, subnational food flows & across value chains

Overview of trends in diet quality & related food systems components in Ethiopia

...How FBDGs development began ?

Ethiopian diets

Very little/no consumption of ASFs

Low intake of protein-rich sources including legumes (~18%; EPHI,2013)

Very low consumption of fruits & vegetables (38% of women; EPHI, 2013)

Inadequate intakese.g. Vit A= 82%

Zn = 50 % (EPHI, 2013)

Food-borne illnesses are prevalent,but no precise estimates

DDS ~1-2 (EPHI, 2013)

RQ: How do diets change in time and space? Regional heterogeneity of diets? Important to develop dietary guidelines

Dietary habit can be affected

Urbanization Economic growth Lifestyle changePopulation growth Climate change

Why FBDGs and HEI?• Educational tool

• Help consumers make informed choices.

• A policy tool• Available, accessible and affordable• To set standards for foods• To guide the food industry

• Training• Dieticians, nutritionists, health and education professionals

• Healthy Eating Index• Dietary intervention programs• To check adherence of the population• Diet and disease relationship study• Assess diet quality of individuals

Key elements of FBDGs

2. Mutli-sectoral working group

FBDGs Technical Working Group has 30 members from 22 organizations

3. Science-based and practical - Methodological framework of the FBDGs Development and evaluation of Et-HEI

Dietary guidelinesDevelopment of technical

recommendations dietary

patterns and food in relation

to health

Translate into reference

diet with the aid of

computer modelling

Food-Based Dietary

Guidelines, Food Guide

and Recommendations

for Consumer

Required data

• Cost of foods - prices of the foods• Consumer behaviour - food

preference, cultural and behaviouralinformation

• Food composition table -composition of nutrient content infood

• Consumption data• Portion size - Information on

consumption unit portion sizes offoods

Review topics

• Top diseases and relation with diet• Dietary gap analysis • Availability, accessibility and

seasonality of foods • Consumer preference• Effective behavioral change

communication

Consultations

• Advisors - external expert on nutrition, health,

sustainability and behavior, health professionals

and consumers

• Criteria for consolidations - Foods inside and

outside the food guide

• Conditions - for healthy and sustainable diets

4. Compatible with food supply

Country level dietary gap assessment usingEthiopian FBDGs

• Estimate the national food supply• FAO food balance sheet data• The national reports

• Estimate the national food demand• The food groups and serving sizes determined

in the FBDGs

• 2019 population census

health, agriculture, trade and industry

policy.

5. Cultural appropriateness

Validate Ethiopian Food-Based Dietary Guidelines: Qualitative study

• Cultural appropriateness and acceptability• Focus group discussion (FGD)

• Consumer understanding and practicality of the messages• Key informant interview (KII)

• Target population: High-level nutrition experts , frontlinecommunity health extension workers, communityrepresentative (women of reproductive age).

6. Promote behavioural change (SBCC materials)

Steps for developing Ethiopian FBDGs

Commitment andleadership

Planning and Sensitization

SituationAnalysis/

Evidence review

FBDG Objectives

Development and Testing of messages

Promotion : education material, communication plan, publication, launch

Implementation

Monitoring and evaluation

Development oftechnical

recommendations

Revision

MSPC & TWG

Correction, Adjustment and

Validation

Adjustment of technical recommendations

1st

P

H

A

S

E

2nd

P

H

A

S

E

Diet Modelling

Ameseginalew !Thank you !

In 2020 Ethiopia will have the first context

specific Food-Based Dietary Guidelines