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AED's
PROFILES
Jump to: Calculators
PROFILES is a process for nutrition policy analysis and advocacy that uses spreadsheet models to estimate the functional consequences of malnutrition in terms that policy makers understand and care about. Nutritional problems addressed include suboptimal infant feeding practices, protein-energy malnutrition as represented by underweight, stunting, iron deficiency, vitamin A deficiency and iodine deficiency. Using local demographic, economic and nutrition data, the consequences of these problems are quantified in terms of work productivity, health and survival and the implications for economic development, education and the health sector are emphasized.
The PROFILES process, which has been used in over 20 countries worldwide since 1992, involves more than just showing the spreadsheet models to an assembled group. The process typically includes the following steps: 1) identification of a country's nutrition policy reform priorities; 2) use of the spreadsheet models to quantify the potential gains in health, survival and economic productivity expected from feasible improvements in nutrition; 3) development of a long term strategy for policy dialogue that uses the country-specific estimates of gains to argue for increased investment in key nutrition interventions; and 4) preparation of computer-based and other policy communication tools to advance these arguments. These activities typically occur during a 2-week workshop involving 10-15 local experts and 1-3 PROFILES facilitators.
Children's Nutrition
Model: Lives Saved by Nutritional Improvement
Over ten million children under five years of age die each year in developing countries. Malnutrition as an underlying cause is associated with about 60% of these deaths. To underscore the importance of nutrition in child survival efforts, the FANTA project funded the development of a model to quantify the effects of improvements in nutritional status, measured as weight-for-age, on child mortality. The model is based on work conducted by Cornell researchers David Pelletier and Ed Frongillo in which they determined that improvements in child nutritional status over the past three decades have contributed significantly to improvements in child survival, even taking into consideration socio-economic and policy changes during this same period (download their report "Changes in child survival are strongly associated with changes in malnutrition in developing countries," 2003). More information on the model can be found at AED's PROFILES website.
Women's Nutrition Models
To strengthen efforts to improve the nutritional status of women, the FANTA project supported the development of several additional models that describe the functional outcomes of women's nutritional status. These models are based on new epidemiological evidence from the literature and include the effects of iron deficiency anemia among women on work productivity, maternal mortality and perinatal mortality; and the effects of vitamin A deficiency on maternal mortality. A description of each of these models and the evidence base that supports them is given below:
Anemia and work productivity: Iron is needed to make hemoglobin, the oxygen-carrying component of the blood. Because of the importance of oxygen for the brain and muscles to function, even mild anemia can cause fatigue and reduce work capacity, sometimes with dire economic consequences for women, their households and the national economy. The PROFILES model is based on a review of an extensive literature by Horton and Ross (2003), who estimate that iron deficiency in anemic adults results in a 5% reduction in work productivity and an additional 12% reduction in heavy manual labor.
Anemia and maternal mortality: Iron deficiency has been implicated, through its contribution to anemia, as an important factor contributing to maternal death. In a recent effort to quantify this contribution, Stoltzfus et al. (2003) draw on their meta-analysis of six studies to suggest a 20% reduction in maternal mortality for every 1 g/dL increase in hemoglobin during pregnancy. PROFILES uses this coefficient and the algorithm also suggested by Stoltzfus et al. to calculate maternal deaths averted by a reduction in anemia as a function of the associated increase in mean hemoglobin.
Anemia and perinatal mortality: Using similar methods, Stoltzfus et al. (2003) also conducted a meta-analysis of 10 studies that provide evidence on the association between anemia during pregnancy and perinatal death, concluding that for every 1 g/dL increase in hemoglobin during pregnancy there is a 28% reduction in perinatal mortality in sub-Saharan Africa (where falciparum malaria is endemic) and a 16% reduction in other regions. PROFILES uses these coefficients to calculate the number of perinatal deaths that could be averted by a reduction in anemia during pregnancy.
Vitamin A deficiency and maternal mortality: In a placebo-controlled trial in Nepal, in which pregnant women were supplemented weekly with 10,000 IU of vitamin A, women receiving the supplement were 40% less likely to die than those receiving the placebo (West et al. 1999). Until these results are replicated for other populations, it is not known what effect supplementation is likely to have elsewhere. However, secondary analysis of data from the same study revealed a strong correlation between maternal nightblindness and the risk of death (Christian et al. 2000). Unlike the population level effect of supplementation documented by West et al. (1999), which is likely to vary depending on the prevalence of vitamin A deficiency (VAD), the individual vitamin A deficient (or nightblind) mother is likely to have the same increased vulnerability regardless of the VAD prevalence. In Nepal, women in the placebo group who were not nightblind in pregnancy had a 0.26 risk of mortality (95% CI: 0.13-0.55) in comparison with placebo group women who developed nightblindness. This translates into a relative risk of death for nightblind pregnant women of 3.85 (1/0.26) compared to with non-nightblind women. This increased risk among nightblind women was considerably reduced in the group supplemented with vitamin A. PROFILES uses these results to estimate the maternal deaths attributable to vitamin A deficiency as a function of the proportion of women who report nightblindness for at least one week during pregnancy.
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CALCULATORS
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