CHAPTER THREE
Indicators by sector

IRD/B. Maire

This chapter contains the indicators most often presented in the literature but usually scattered in many different publications. They are grouped by sectoral field. It must be emphasised that the list does not claim to be exhaustive. The following criteria were used to develop it:

The indicators have been proposed for monitoring achievement of the Millennium Development Goals (see Introduction), identified in the tables by MDG1-8.
The indicators are frequently collected and analyzed by administrative services or by major information systems on a routine basis. In particular, they are found among the indicators of the fifteen information fields corresponding to the conceptual framework adopted by the Inter-Agency Working Group on Food Insecurity and Vulnerability Information and Mapping Systems (IAWG/FIVIMS), identified as such (FIVIMS). They also include indicators approved by the Committee on World Food Security, at its 26th and 27th Sessions and used in the yearly evaluations of world food security, identified as such (CFS). Other indicators derive from information systems of other agencies of the United Nations (WHO and World Bank in particular), the OECD or statistics of ministerial departments of States. It must be noted that the choice or formulation of these indicators steadily evolves over time.
Next, the indicators are recommended by expert bodies in a given specific sector, such as indicators of nutritional anthropometry of children (WHO) or of adults (FAO, IDECG) Vitamin A deficiency (IVACG) or iodine deficiency (ICCIDD), iron deficiency anemia (INACG) etc. They represent the indicators which can be used to characterise a given problem, in agreement with the groups of international experts who have examined the problem.
Finally, indicators that are mainly used in more specific studies, or in certain more sophisticated information systems. Since their value has, however, been clearly demonstrated, they are accepted here as potential indicators. Among them, some are recent and have not yet been widely used; considered innovative by some authors, they have been included because they offer information hitherto lacking.

This list of indicators, which is long but not exhaustive, cannot be used in its entirety! It is intended to help choose indicators, on the basis of a conceptual framework of a specific situation and needs under consideration. The list is not organized strictly in order of importance, because specific situations will call for an ad-hoc choice of indicators.

In line with the conceptual framework of causes of malnutrition and mortality, the major divisions adopted here are nutritional status, food security, caring capacity, health and demographics, and fundamental socio-economic and agro-ecological indicators.

Since the order followed is a function of the conceptual framework of the causes of malnutrition and mortality, the list begins with the principal indicators of nutritional status. Logically, indicators of mortality ought to follow; however, for reasons of simplification, the general demographic indicators, including those of mortality, have been left together and appear further down the list.

The indicators relating to nutritional and food problems are obviously more highly developed.

The same indicators may be found at different levels, if they appear useful in the analysis of the situation for different sectors.

Finally, it should be noted that indicators may be revised at variable intervals by expert committees; therefore it is useful to consult a specialist in the sector under consideration to know if improvements or validation have taken place since this document was written and also in order to be aware of limits of interpretation of the indicators.

Nutritional status

Indicators in this field - as well as procedures for data collection, analysis and interpretation - are now standardized. While this standardization is widely followed for anthropometry, it is still viewed as somewhat new for micronutrients.

The lists are more complete or more detailed for some aspects than for others, depending on the groups of experts who have studied them, and the type of programmes that might be implemented.

The terms "percentage", "frequency", "incidence", "prevalence" or "rate" are used in different situations. A rate refers to the ratio between two quantities, generally expressed as "percent" or "per thousand". A frequency refers to a proportion of individuals in a statistical sample who show a given characteristic. Two frequencies are distinguished in the health sector, both expressed as percentages: prevalence, which represents the frequency - either immediate or during a given period - of a sickness or event; and incidence, which represents the frequency of new cases alone for the period in question.

Anthropometry^[9]

TABLE 1
Anthropometric indicators

INDICATORS	REFERENCE CUT-OFF VALUE	USED BY
Preschool children (0-59 months)
% of newborns with a low birthweight	<2500 g	FIVIMS
% of newborns with a birthweight lower than normal	<10th centile or <-2 Z-scores of the local reference if it exists	FIVIMS
% of children 0-59 months with a low weight-for-age index (underweight), overall and by age group (see Table 2)	<-2 Z-scores of the reference (possibly also consider the severe form <-3 Z-scores)	MDG 1 FIVIMS CFS
% of children 0-59 months with a low weight-for-height index (wasting), overall and by age group (see Table 2)	<-2 Z-scores of the reference (possibly also consider the severe form <-3 Z-scores)
% of children 0-59 months with a low height-for-age index (stunting), overall and by age group (see Table 2)	<-2 Z-scores of the reference (possibly also consider the severe form <-3 Z-scores)
Preschool children (0-59 months)
% of children 0-59 months with a high weight-for-height index (overweight), overall and by age group	>+2 Z-scores of the reference
Average weight-for-age index in Z-scores, overall and by age group
Average weight-for-height index in Z-scores, overall and by age group
Average height-for-age index in Z-scores, overall and by age group
School-age children (6-10 years)
% of children with a low height-for-age index (stunting) on entering primary school	< -2 Z-scores of the reference
% of children with a high weight-for-height index (overweight)	> +2 Z-scores of the reference
Adolescents (11-18 years)
% of adolescents with a low height-for-age index (stunting)	<-2 Z-scores or <3^rd centile of the reference
% of adolescents with a low Body Mass Index (BMI) for age	< 5^th centile of the reference
% of adolescents with a high BMI for age (overweight and obesity)	> 85^th centile of the reference
Adults (18 years)
% of adults with a low BMI (wasting or chronic energy deficiency)	<18.5 kg/m² (possibly consider also the secondary cut-off of <17.0 and <16.0)	FIVIMS
% of adults with a high BMI	25.0 (overweight) and 30.0 (obesity)
Average BMI	a national average between 21 and 23 is regarded as desirable
% of pregnant women with a low weight gain during pregnancy	<1 kg/month (from the 3^rd month of pregnancy)
% of women with a low weight	<45 kg
% of women of small stature	<145 cm
% of families with at least one adult with a low BMI
% of families with at least one overweight adult

TABLE 2
WHO classification for assessing severity of malnutrition in the population of children 0-59 months of age

INDICATOR	PREVALENCE
	low	medium	high	very high
underweight (% with weight-for-age <-2 Z-scores)	<10	10-19	20-29	³30
wasting (% with weight-for-height <-2 Z-scores)	<5	5-9	10-14	³15
stunting (% with height-for-age <-2 Z-scores)	<20	20-29	30-39	³40

Micronutrients

TABLE 3
Iodine deficiency^[10]

PREVALENCE INDICATORS	VULNERABLE GROUPS	CUT-OFF VALUE	USED BY
Total goitre rate (or of different stages of goitre) in the population or in groups at risk (see Table 6)	total population school age children (6-12 years) pregnant (and/or breast-feeding) women in pre-natal care centres	Grade 1 and grade 2	FIVIMS
% of cretinism	total population
% of individuals with a low urinary iodine level	target population school age children (6-12 years)	<100 µg/L (deficiency low to severe) or <50 µg/L (severe and moderate deficiency)
Median urinary iodine in µg/L (see Table 6)	school age children
Median serum thyroglobulin concentration (ng/mL)	children and adults
% of individuals with a high level of thyroid stimulating hormone (or TSH) in whole blood	newborns	> 5 mIU/L
INDICATORS OF RISK
Water iodine content
Soil iodine content
Amount of goitrogens consumed in the usual diet
INDICATORS FOR ASSESSING PROGRESS AND EFFECTIVENESS OF PROGRAMMES
% of population (or of households) consuming adequately iodized salt (iodine content 15 parts per million) (goal > 90%)			CFS FIVIMS
Proportion of the population with urinary iodine <100 µg/L (goal to be reached <50%), and <50 µg/L (goal <20%)
Achieving at least 8 out of 10 of the programme indicators specified (WHO, 2001a)
% of population at risk covered by some form of intervention
% of the population covered by iodized oil distribution
% of the population covered by iodized salt distribution (or marketing)
Amounts of iodized salt produced, exported, imported
Price of iodized and non-iodized salt
Iodine content of salt at manufacturing level
Iodine content of salt at wholesale/retail level
Iodine content of salt at household level
Preference of consumers for iodized salt
Rate of abortion (number of women who have aborted/number of pregnant women over a given period) (‰)
Rate of stillbirth (number of stillborn infants/total number of deliveries) (‰)
Infant mortality rate (see Table 13)
Underfive mortality rate (see Table 13)
% of newborns with a low birthweight (see Table 1)			FIVIMS
School dropout rate
Repetition rate of classes (see Table 21)

The clinical indicators of iodine deficiency (goitre) are useful for an initial assessment or long-term monitoring of programme impact. The biological indicators (urinary iodine) are more sensitive to change in iodine intake and therefore more useful for short-term evaluation of programme impact. TSH concentration in newborns is a sensitive marker of iodine status but interpretation is difficult. The measurement of thyroglobulin is costly and its usefulness is still debated.

TABLE 4
Vitamin A deficiency^[11]

PREVALENCE INDICATORS	VULNERABLE GROUPS	CUT-OFF VALUES	USED BY
% of individuals affected by clinical signs of vitamin A deficiency (see Table 6)	pregnant women and women with a previous pregnancy that ended in a live birth in the past 3 years children 2-5 years	night blindness (XN) night blindness (XN) or Bitot spots (X1B)	IVACG CFS
% of individuals with a low serum retinol measured by HPLC (see Table 6)	children 2-5 years	<20 µg/dL (0.70 µmol/L)	IVACG
% of individuals whose relative dose response test (RDR) or modified test MRDR is abnormal	children 3-6 years	³20% (RDR) ³0.06% (MRDR)
% of individuals with abnormal 30-day serum response test	children 3-6 years	³20%
% of individuals with a low breastmilk retinol level	breastfeeding women	£1.05 µmol/L
% of individuals with abnormal conjunctival impression cytology	children 3-6 years
Underfive mortality rate (see Tables 3, 6 and 13)
INDICATORS OF RISK
% of breastfed children with a low dietary intake of vitamin A	6-12 months 12-24 months	<950 µg RE*/week (breastmilk excluded) <1450 µg RE/week (breastmilk excluded)
% of weaned children with a low dietary intake of vitamin A	weaned children	<2450 µg RE/week
% of individuals with a low daily fat intake	children pregnant or lactating women	<5 g fat/day <20 g fat/day
% of individuals and/or families with a low intake of vitamin A-rich foods	children 1-6 years and women of 15-45 years families	<50% of recommended daily vitamin A intake, or <3 times/week
GENERAL INDICATORS OF RISK
Availability of green leafy vegetables in markets (approximate quantity per season, unit cost, size of population served by the market)
Frequency and duration of periods of seasonal food shortage
Frequency, duration and severity of drought
Periods of overlap of seasonal food shortages with rise of infectious diseases
Availability of vitamin A-rich foods in markets (food groups)
Qualitative indicators of attitudes and beliefs towards vitamin A-rich foods
% of children no longer breastfed before 6 months
% of preschool children not vaccinated against measles
% of malnourished preschool children (wasting and stunting, see Table 1)
% of newborns with a low birthweight (see Table 1)			FIVIMS
Mortality rate from measles (see Table 13)
Prevalence of parasitic infections (ascaris)
Prevalence of diarrhea in preschool children during the previous 15 days
Prevalence of episodes of fever in preschool children during the previous 15 days
INDICATORS FOR MONITORING PROGRESS OF PROGRAMMES
% of the population covered by some form of intervention
% of children 6-59 months who received a high-dose vitamin A supplement during the last 6 months
% of mothers who received a high-dose vitamin A supplement before their infant reached 8 weeks of age
% of the population with access to foods fortified with vitamin A
% of families growing foods rich in provitamin A carotenoids in a home garden
% of schools with a garden growing foods rich in provitamin A carotenoids

* RE: retinol equivalent

TABLE 5
Iron deficiency^[12]

PREVALENCE INDICATORS	VULNERABLE GROUPS	CUT-OFFS	USED BY
Anemia:
- % of individuals with a hemoglobin concentration lower than the norm for sex age and physiological status (see Table 6)	children 6-59 months, and pregnant women	<110 g/L	FIVIMS
	children 5-11 years	<115 g/L
	adolescents 12-14 years and non-pregnant women >15 years	<120 g/L
	men >15 years	<130 g/L
	severe anemia (all groups)	<70 g/L
- % of individuals with a hematocrit level lower than the norm for sex, age and physiological status (see Table 6)	children 6-59 months and pregnant women	<33%
	children 5-11 years	<34%
	adolescents 12-14 years and non-pregnant women >15 years	<36%
	men >15 years	<39%
% of individuals with a low transferrin saturation coefficient	children < 5 years	<12%
	children 5-10 years	<14%
	adults	<16%
% of individuals with a low serum ferritin	children <5 years	<12 mg/L
% of individuals with a low serum ferritin	children >5 years	<15 mg/L
% of individuals with a high zinc protoporphyrin	children <5 years	>70 µg/dL
% of individuals with a high zinc protoporphyrin	>5 years	>80 µg/dL
INDICATORS OF RISK
Frequency of consumption of iron-rich foods, or inhibitors and enhancers of iron absorption during pregnancy, breastfeeding and complementary feeding
Qualitative indicators of beliefs and attitudes towards iron-rich foods and their relationship to health
Prevalence of parasitic infections (in particular hookworm, schistosomiasis, malaria)
INDICATORS FOR ASSESSING PROGRESS OF PROGRAMMES
% of the population at risk covered by some form of intervention
% of pregnant women and children < 5 years (groups at risk) covered by distribution of iron tablets
Iron content of fortified foods (at industry, wholesale and retail level)
Availability of iron-rich or iron-fortified foods in markets (list of foods, quantities available per season, size of the population served by the market)
% of the population with access to (and/or consuming) iron-fortified foods
Average price of iron-rich and iron-fortified foods

TABLE 6
Epidemiological criteria for assessing the importance of micro-nutrient deficiencies in the population

DEFICIENCY	POPULATION GROUP	INDICATOR	SITUATION OF DEFICIENCY
DEFICIENCY	POPULATION GROUP	INDICATOR	mild	moderate	severe
Iron	all groups	Anemia (%)	5.0-19.9	20.0-39.9	40.0
Iodine	children 6-12 years	Total goitre rate (%)	5.0-19.9	20.0-29.9	30.0
Iodine	children 6-12 years	Median urinary iodine (mg/L)	50-99	20-49	<20
Vitamin A	pregnant women	Night blindness, XN (%)	>5
	children 2-5 years	Night blindness, XN (or Bitot spots X1B) (%)	>1 (ou >0,5)
	children 2-5 years	Low serum retinol (%)	>15
	children <5 years	Mortality (‰)	>50 (ou 20-50†)

† indicates a problem could exist and that additional investigations are necessary

Food security

The four key elements of food security are: availability of food, access to sufficient food, stability of food supplies and cultural acceptability.

The very general concept of food security may be analyzed at various levels - national, regional, household or individual level. Examining different levels is often crucial because food security at one level does not necessarily imply security at other levels. Hence the very wide diversity and heterogeneity of indicators. A clear conceptual framework, such as that proposed by IAWG/FIVIMS, is therefore particularly important in order to make a relevant choice (see FIVIMS, 2002).

The indicators corresponding to the first three major categories, namely food availability, access to food and stability of supplies have here been grouped together; the fourth (acceptability) requires specific qualitative surveys for which defining standardized indicators is more difficult.

Food availability

The FAOSTAT database is the source of information on food availability at national level with the largest geographical coverage. Moreover, it provides complete series of yearly data since 1961 (FAO).

TABLE 7
Food availability

INDICATORS		USED BY
National food balance statistics (FAO)^[13]
Prevalence of undernourishment		CFS
For FAO (2003), the following percentages serve to assess progress achieved:		FIVIMS
	- <2.5% ‘extremely low’	MDG1
	- 2.5-<5% ‘very low’
	- 5-<20% ‘moderately low’
	- 20-<35% ‘moderately high’’
	³35% ‘very high‘
Number of people undernourished		CFS
Dietary energy supply (DES) in kcal/day per person		CFS FIVIMS
DES per person represented by staple foods
Share of cereals, roots and tubers in total DES as % (a high % indicates a low diversity of the food supply)		FIVIMS
Availability of cereals per person		FIVIMS
Total protein availability per person		FIVIMS
Availability of protein of animal origin per person		FIVIMS
Availability of fat per person		FIVIMS
Availability of fruit and vegetables per person
Production, utilization of foods, trade and stock changes of basic staples		CFS FIVIMS
Agricultural production per person
Food production per person, overall and by food group (staples, meat, milk, etc.)
Net food imports (by food group)
Quantity of food products used as livestock feed and seeds and for industrial processing
Production, cropped areas and yields
Food production index		FIVIMS
Export price movements for wheat, maize and rice		CFS FIVIMS
Ratio of supply over demand for the five major grain exporters		CFS FIVIMS
Rate of self-sufficiency in staples (for each staple, % of energy needs covered in consumption by domestic production)
Production, cropped areas and yields
% of land devoted to main staples
% of land devoted to export crops
Ratio of total harvested area/cultivated area
Yields per hectare for major staples, including cereals		FIVIMS
Yield discrepancies (real vs potential)
Growth in cereal yields		FIVIMS
Growth in staple food yields, by commodity		FIVIMS
Agricultural production per agricultural worker
Monetary value of agricultural production per family in agriculture
Quantity of staples produced per person in rural areas
% of the population owning 90% of land
% of total cultivated area (either regional or local) belonging to small farmers (defined as those whose land holdings are in the lower 40% of the distribution at national level)
% of the population with access to secure land tenure		MDG7
% of arable land that is irrigated
Cultivated area using improved techniques (in number of hectares)
Distribution of farmers by main crops
Ratio of time spent by women in production of food crops (by type of crop)/other crops
% of land allotted to women for food production
Number of extension workers per 1000 farms
% of women among extension workers
% of food production marketed by type of crop
Means of production at household level
Distribution of farmer households according to number of hectares per person
% of households with an area per person lower than the norm
Distribution of households according to size of herds owned
Distribution of households according to the number of draught animals or transport animals
% of households using agricultural inputs
Price of inputs (seeds, fertilizers, organic fertilizers, insecticides, livestock inputs)
% of households with a water source for farming (per season)
Means of production at household level
% of households with access to communal woods
% of households owning a home garden (see Table 4)
% of households with small livestock (poultry, sheep, pigs, rabbits, fish farming)
Transport cost of staples per season
Volume of agricultural production transported by households to markets

Access to food and food consumption at household level

The problem here is primarily one of financial accessibility, where food security, poverty and undernutrition are closely linked.

TABLE 8
Access to food by households

INDICATORS	USED BY
Prices and income
Gross National Product (GNP) and Gross Domestic Product (GDP) in US$ per person	CFS FIVIMS
GNP per person at Purchasing Power Parity	CFS FIVIMS
Average household income (mainly in urban areas) and as % of the legal minimum wage	FIVIMS
Share of national income by percentile of population	FIVIMS
Food price indices (staples, imported products) on local markets	CFS FIVIMS
Ratio food prices/minimum wage
Average cost of the household food basket as % of the legal minimum wage (food basket = foods that comprise the population’s usual diet and which adequately cover minimum energy requirements of all individuals, at the lowest cost)
% of household income spent on food (or % of household food expenditure in relation to total expenditure)	CFS FIVIMS
% of households spending 70% of their income (or total expenditure) on food
Elasticity of food consumption in relation to income, per decile of income (variation of food consumption per food and per macro- and micronutrient)
Elasticity of food consumption in relation to price of foods
Ratio of food price index/general price index
Price of livestock on the hoof at local markets
Poverty
% of population living on less than 1 US$ a day	MDG1 CFS FIVIMS
% of population below the national poverty line	CFS FIVIMS
Poverty gap ratio	MDG1 FIVIMS
Share of poorest quintile of national consumption	MDG1
Distribution of households by income (or total expenditure) level per person	FIVIMS
% of private income received by the poorest 40%
Gini coefficient of household income distribution (% of national income received by the poorest 40%)	CFS FIVIMS
% of the population with income (or expenditure) below the level of absolute poverty (level below which minimum food of adequate nutritional quality and essential non-food goods are not economically accessible; or level corresponding to 40% of median family income adjusted after tax and transfer)
Foster-Greer-Thorbecke’s measure of the severity/inequality of poverty (mean of squared proportionate poverty gaps)	FIVIMS
% of households whose consumption expenditure is lower than the cost of the household food basket
Infrastructure
Market density (number of markets per unit area)	FIVIMS
Density of road network (roads mileage per unit area)	FIVIMS
Paved roads as % of total road mileage	FIVIMS
Living standards of households
Cash crop sale as a % of total household income
Wages by economic activity (in real US$/year) or level of average and minimum agricultural and urban wages	FIVIMS
Distribution of households by wealth index as defined by the community
Ratio of agricultural/urban wages
Rate of unemployment, or rate of employment of the population of working age (in %)	FIVIMS
% of dwellings with electricity
% of households according to type and quantity of possessions, including essential goods (table, chairs, cooking utensils, household equipment, radio, bicycle, livestock, agricultural and professional equipment and specific equipment for given crops)
Living standards of households
% of households with access to credit (and/or to help from relatives)
% of households with access to food aid or assistance programmes or to ration stores
% of households with access to public works programmes or "food for work/cash for work" programmes
Level of public expenditure on food subsidies
Level of remittances linked to food subsidies
Ratio of the above two amounts
Distribution of dwellings by fuel/energy source for heating and cooking (electricity, gas, coal, wood, etc.)
Level of average rent in urban areas
Quantity, regularity and frequency of food transfers in and out of households
% of households belonging to a family or community mutual assistance network
% of households according to number, gender, age and duration of leave of migrants
% of migrants according to age, sex, period, duration of leave and place of migration, in the total population
% of households by ratio of economic dependence (number of working members/number of non-working members)
% of households according to the number of different sources of income
% of households in which the only working member is a woman
% of households according to level of education of members of working age
% of households according to health status of members representing an economic support for the family (number of days of permanent or temporary disability)
Food consumption
Distribution of households by score of food diversity (number of food groups consumed) and by score of food variety (number of foods consumed)
Number of meals eaten in a day	FIVIMS
% of households consuming less than 2 meals per day
% of households according to quality of their diet as assessed by school children

Stability of food supplies

TABLE 9
Stability of food supplies

INDICATORS	USED BY
Index of variability of food production	CFS FIVIMS
Cereal import dependency ratio	FIVIMS
Cereal self-provisioning capacity, in months	FIVIMS
Maximum coefficient of variation of food availability (yield or production) between geographical areas, social groups and years
Coefficient of variation of per capita DES over a given period
Variability of food prices	CFS FIVIMS
Number of storage sites and storage capacity in areas of food production deficit
% of households owning adequate storage facilities for crops (protection against pests and weather conditions)
% of harvests lost during storage
Duration of household food stocks (in months, assessed just after harvest)
% of households owning cooking, processing and storage equipment
Frequency of publication or broadcast of market information	FIVIMS

^[9] The international references for the standardised indicators are to be found in: WHO, 1983; WHO, 1995; Shetty & James, 1993.
^[10] Consult: WHO, UNICEF & ICCIDD, 1994 and WHO, 2001a.
^[11] For prevalence indicators, refer to: IVACG, 2002, supplemented by WHO, 1996b. For ocular cytology, refer to McLaren & Frigg, 2002; Chowdhury et al., 1996. The recommended intake refers to a FAO/WHO expert consultation (FAO & WHO, 2002).
^[12] See: WHO, 2001 b.
^[13] See: FAO/SOFI (2004) and FAOSTAT database at: http://apps.fao.org/faostat/collections?version=ext&hasbulk=0&subset=nutrition.

CHAPTER THREE Indicators by sector