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«Minimum Dietary Diversity for Women A Guide to Measurement Minimum Dietary Diversity for Women A Guide to Measurement Published by the Food and ...»

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S. Sweets As with category “R”, there is no consensus and no standard approach to data collection on “sweets”, but there is interest in capturing descriptive information on consumption. This category includes highly processed commercial products but also a variety of locally produced and processed snacks and “street foods”.

Include all food items with a high content of different sweetening agents (e.g. sugar, corn syrup, other

syrup, honey, molasses or jaggery), such as:

• Baklava • Biscuits (sweet) • Cakes • Candies (hard candies, toffees, “milk toffees” or candies made with sweetened condensed milk, any other candies) • Chocolates • Coconut candies and sweet biscuits, and other sweetened coconut snacks • Cookies • Frozen custard/frozen yoghurt • Fruit canned in sugar syrup • Fruit “gummy” candies, fruit “leathers” • Ice cream • Halwa • Honey • Jam • Marmalade • Pastries (sweet, fried or baked) • Pie • Sesame seed candies • Sweetened condensed milk • Any other sweets T. Sugar-sweetened beverages

This category includes all sugar-sweetened beverages, with any/all other ingredients. Examples include:

• Chocolate drinks, fortified and unfortified, both pre-packaged fluid drinks and powders • Coffee with sugar • “Energy drinks” • Fruit drinks, sweetened fruit juices • Malt drinks, fortified and unfortified • Soft drinks/sodas/carbonated or “fizzy drinks”, including colas, fruit flavours and other flavours • Tea with sugar • Any other drink sweetened with sugar, corn syrup, honey or other sweetener Note: Include sweet drinks here even if they have some dairy content.

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Note: The next and final two categories are REQUIRED food categories.

U. Condiments and seasonings This category includes all minor ingredients in mixed dishes, which primarily provide flavour and would be consumed in very small amounts in any individual serving of the dish. It includes items added at any stage of cooking or when serving food (e.g. garnishes sprinkled on top of a dish to add flavour or visual appeal).

It is not possible to provide a complete listing of such items globally, but the examples listed here

should help guide users in populating this category:

• Bean paste, fermented bean paste • Bouillon cubes, flavour cubes • Chili peppers (hot) • Chives • Dried soup seasoning packets • Fish powder • Fish sauce • Garlic • Ginger root • Horseradish • Herbs, dried and fresh, all types • Ketchup (“catsup”) • Lemon or lime or other juice, added to “bring up flavour” of mixed dishes • Monosodium glutamate (MSG) and flavour products made with MSG • Mustard • Pepper sauce • Seeds or seed pastes, when used to flavour or garnish a dish (see list of seeds in “Nuts and seeds”, group “D”) • Soy sauce, tamari • Spices, dried and fresh, all types • Sugar, when added to flavour a mixed dish • Tomato paste • Any other seasoning or flavouring added during cooking • Any garnish added at the end of cooking or when serving (e.g. grated cheese, grated vegetable, seeds or legumes)

62 Appendix 2

V. Other beverages and foods This miscellaneous category includes all food and beverage items not in groups “A”–“U”. When survey designers choose not to include any or all of the six optional categories (categories “O”–“T”), then examples from those categories should also be listed in the questionnaire row in this category, so that enumerators know where to mark those foods (e.g. insects, fats and oil, savoury snacks, sweets and sugar-sweetened beverages).

Items always categorised here include:

• Alcohol, all types • Chutney or pickle (British) • Clear broth, soup broth • Coffee, with or without milk, if unsweetened • Herbal beverages/infusions • Olives • Pickled cucumbers • Tea, with or without milk, if unsweetened • Any other food or beverage not included in previous groups/categories Note: Olives and pickles are listed here because they are usually consumed in small quantities, to the side of or to accent main dishes. Even if eaten in larger quantities, because olives and pickles are usually high in sodium, they are not similar to other fruits and vegetables. Chutney or pickle (British) is also eaten to the side or as a garnish. All these items could also be classified as “Condiments or seasonings” if that is a better fit locally. In either case, they should not be classified into an MDD-W food group.

Classification challenges Table A2-1 presents some food classification challenges. While there are no perfect solutions to some challenges, standardisation in classification can help ensure comparability between surveys, and in general we recommend a standard approach to these difficult choices. Three types of items present challenges or uncertainties: items that are unusual for a group (e.g. several high-fat fruits), items that contain multiple ingredients but that are considered a single food (e.g. bread) and items that are often consumed in small quantities.

The classification decisions in this table follow two principles. When necessary:

• Err on the side of not falsely inflating food group diversity • Err on the side of simplicity when a single ingredient usually dominates in a food or is most likely to dominate in lower-cost versions of the food

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This food is not part of any of the MDD-W groups, so this classification choice does not affect the indicator. In some a areas (particularly poor rural areas), coconut milk may be the predominant fat source in the diet, and there may be an interest in including this in the “Other oils and fats” category. In other areas, particularly where coconut milk is typically made very thin with water, it is more appropriate to consider in the “Condiments and seasonings” category.

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Appendix 3. Alternative method for collecting information on food groups consumed – the list-based method The Minimum Dietary Diversity for Women of Reproductive Age (MDD-W) guide to measurement details how to collect food group dietary diversity information from women of reproductive age (WRA) in a survey using an open recall. This appendix describes an alternative method for gathering information about foods consumed when it is not practical to carry out an open recall.

The open recall elicits information by guiding the respondent through an “open recall” of foods and beverages consumed the previous day and night. The recall is organized by time (starting the previous morning) and is intuitive for respondents.

The alternative “list-based” method instead asks the respondent to report if she has consumed any foods during the previous day and night from each of the food categories. The enumerator reads out loud a list of example food items for each category (as written in the “description/examples” column of the questionnaire). The respondent must mentally shift back and forth in time and mentally “decompose” mixed dishes to respond correctly when lists of foods, in groups, are read to her.

Additional advantages and disadvantages of the open recall and list-based methods are described in detail in Section 1 of this guide (see Table 2 on page 7).

In summary, the open recall makes fewer cognitive demands on the respondent and for this reason may result in more accurate recalls. However, correct administration of an open recall requires more enumerator capacity and training. The time required for administering each type of questionnaire varies depending on the complexity of the local diet. The open recall tends to be less tedious for enumerators and respondents.

The alternative MDD-W model questionnaire to use for the list-based method is shown below, along with suggested enumerator instructions and text to read to the respondent.

Order of food groups/categories Note that the order of the food group categories in this version differs from the MDD-W model questionnaire presented in Section 3 of this guide. This is to avoid the situation where a respondent replies “yes” to the roots and tubers question when she has in fact consumed a vitamin A-rich orange- or yellow-fleshed sweet potato. By placing the “special” category of orange-fleshed roots, tubers and vegetables before the general category of roots and tubers, this problem is avoided. The other vegetable categories are also moved up in the sequence to avoid a gap in time before querying about “other” vegetables. This aims to avoid the possibility of double-counting items like carrots and orange-flesh sweet potatoes (i.e. having the respondent say “yes” for both categories when only one item, such as carrot, was consumed).

Changing the number of rows on the list-based questionnaire In the list-based method, unlike in the open recall, responses and the resulting “count” of food groups are influenced by the total number of categories and by the choices made in disaggregating categories. In general, the larger the number of questions (rows) on a list-based questionnaire, the larger the number of “yes” responses, which in some cases leads to a higher count among the ten MDD-W food groups.

Ideally if users wish to compare across time or space, the list-based questionnaires should remain the same/have the same number of questions. However, it is allowable to add questions to capture information about one or several specific, targeted food items, but additions should be few and made thoughtfully to avoid biases in responses and in the constructed indicator.

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Other steps in questionnaire adaptation Please note that the steps described in Section 4 for adapting the food lists should also be taken when using the list-based method.

MDD-W alternative questionnaire using a list-based data collection method Enumerator instructions Begin by reading the introductory portion of the questionnaire slowly, emphasising that the question concerns what the woman drank or ate yesterday during both the day and night. Then ask about each of the food group categories and provide examples of foods belonging to them in the order that they appear in the questionnaire. Mark ‘1’ for “yes” if any item in a category was consumed and “no” if the woman reports she did not consume items in the category.

The following script can be included on the questionnaire or on a job aid/guidance sheet to be carried by the enumerator.

To be read to the respondent:

Now I’d like to ask you about foods and drinks that you ate or drank yesterday during the day or night, whether you ate it at home or anywhere else.

I am interested in whether you had the food items I will mention even if they were combined with other foods. For example, if you had a soup made with carrots, potatoes and meat, you should reply “yes” for each of these ingredients when I read you the list. However, if you consumed only the broth of a soup, but not the meat or vegetable, do not say “yes” for the meat or vegetable.

As I ask you about foods and drinks, please think of foods and drinks you had as snacks or small meals as well as during any main meals. Please also remember foods you may have eaten while preparing meals or preparing food for others.

Please do not include any food used in a small amount for seasoning or condiments (like chilies, spices, herbs or fish powder). I will ask you about those foods separately.

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If rows O, P, Q, R, S and/or T are not included, examples for the “Other beverages and foods” a category must be expanded to include these types of items.

The final two rows (“Condiments and seasonings” and “Other beverages and foods”) should always be included on the questionnaire.

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Only the first 14 rows used to calculate the MDD-W are listed here. Questionnaires for both indicators (IYCF a MDD and MDD-W) may include other optional foods/groups, and the MDD-W questionnaire has two more required categories (“Condiments and seasonings” and “Other beverages and foods”).

Food groups names as listed in: World Health Organization (WHO). 2008. Indicators for assessing infant and b young child feeding practices. Part I: Definitions. Geneva, WHO.

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9 789251 091531 I5486E/1/03.16

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