The Kuwait nutrition surveillance system (KNSS): an example for the region

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1 The Kuwait nutrition surveillance system (KNSS): an example for the region First Regional Nutrition Conference Nutrition Challenges in the East Mediterranean Region 28, 29 March, 2011 Dr Mona AlSumaie, IBCLC Community Nutrition Supervisory Food & Nutrition Administration MOH/KUWAIT

2 Background The Kuwait nutrition surveillance system (KNSS) is a nation-wide Nutrition Surveillance system which was established in 1995 with consultation provided by CDC, through WHO/EMRO. The KNSS is funded by Kuwait MOH and coordinated by the Community Nutrition Supervisory under the Food and Nutrition Administration. The system is simple, sustainable and tailored to the needs of the country.

3 The overall objectives of the KNSS Its main objective is to monitor health and nutritional status of the Kuwaiti population, to supply a reliable and sustainable data on the nutritional status of people at the national and international levels, to show trends, and to enable local comparisons between the governorates, raise awareness about nutritional problems, provide guidance to health related local intervention programs.

4 Methods The KNSS is run by about 25 nutritionally trained staff, responsible for data-collection, data-entry, data-cleaning, anaysis and reporting. The KNSS covers all 6 governorates targeting Kuwaiti nationality children, adolescents and adults. The country population consists of about 33% nationals and the remaining 67% are expatriates. The KNSS is designed as a sentinel data collection operation with "convenience" or "purposive" sampling (consisting of subjects who agree to participate). To derive the sample size the standard cluster survey sample calculation approach is applied.

5 Sample Size in 2010 KNSS Age group Males Females Total < 5 years years years < 20 years years Total

6 Population group scope Age Sex Geographic coverage Indicators Data sources sentinel sites Methods of collection Preschool children (2 - <60m) M+F 6 governorates Anthropometry, IDA :(Hb), infant feeding practices. 2 Health Centers & 2 Kindergartens from each governorate By finger prick: - -Hb (Hem Cue) Questionnaire: Face to face interview School children (6 <20y) Adults (20- >60y) M F M F All governorates 6 9 Y Y Y No governorate level estimates Anthropometry, IDA :(Hb) Anthropometry, IDA :(Hb) Dietary habits: (vegetables & fruits) Smoking Physical activity 2 government schools from each level & governorate Health Centers, Medical Council & Authority for Social Security -Date of birth from school files By finger prick: -Hb (Hem Cue) Questionnaire: Face to face interview By finger prick: - -Hb (Hem Cue) -Blood glucose (Glucotrend) -Cholesterol (Accutrend GCT)

7 There are one or two sentinel sites in each governorate. The sentinel centers are in places that are easily accessible to Kuwaiti people, providing services to a reasonable number of the target population and they are satisfactorily prepared and equipped.

8 MOH/ EMRO/ WHO Food & Nutrition Administration Capital Hawally Farwania Medical Council Ahmadi Jahra Mubarak AlKabeer Public Authority Social Security

9 The KNSS interventions are: Nutritional advice and education materials for all age groups, which usually take place during the face-toface interviews, including: Breastfeeding & complementary feeding counselling for mothers; Healthy life style education for mothers and other adults.

10 Instruments of data collection:

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17 The data are collected throughout the year. People are always asked for their consent to participate, which is rarely refused. Every two weeks the completed forms are taken to the Food and Nutrition Administration office, to enter the data into a database system (recently into SPSS file directly). The teams check their own data-entry then additional checks are performed to ensure a clean and complete data set by the supervisors.

18 For the analysis of annual KNSS rounds, the data from all the 6 governorates are pooled by a senior nutritionist who conducts the analysis, using WHO Anthro and SPSS 11.

19 KNSS RESULTS

20 Kuwait Nutrition Surveillance [2010] Anemia Among Kuwaiti Population % <5 yrs 5-9 yrs yrs yrs >=20 Age Male Female

21 Kuwait Nutrition Surveillance Anemia Among Kuwaiti Adults ( ) % Years Male Female

22 Kuwait Nutrition Surveillance [2010] Obesity Among Kuwaiti Population % <5 yrs 5-9yrs yrs yrs >=20 Age Male Female

23 The annual report Kuwait Nutrition Surveillance System [KNSS] Annual Report 2010 Preface The State of Kuwait has established and running a nation-wide Nutrition Surveillance system with consultation provided through WHO/EMRO &CDC. It is run by Community Nutrition Supervisory of Food and Nutrition Administration of Ministry of Health since 2001 until now. List of Participants: Dr. Nawal Al-Hamad: Director of Food and Nutrition Administration Dr. Mona Al-Sumaie: Head of the Community Nutrition Supervisory, Management & Reporting Ms. Prasanna Prakash: Nutritionist, Data Management, Analysis & Reporting Ms. Fahima Al-Anazi: Head of Research Unit, management Ms. Nawal Al-Dalmani Assistant Dieticians, Data management Editing Field workers for data collection and entry Ms. Entisar Al-Haifi Ms. Najat Al-Anazi Ms. Mariam Al-Aazmi Ms. Tahani Al-Sarawi Ms. Badrya Al-Marshid Ms. Dalal Al-Fadli Ms. Safa Al-Khalaf Ms. Klolod Mohammed Ms. Fatin Bo-Hamad Ms. Eida Al-Husainy Ms. Amna Jamaan Ms. Fadila Muhammed Ms. Amani Awad Ms. Halima Abbas Ms. Tahani Al-Motairi Ms. Amna Jamal Ms. Dalal Al Anazi Ms. Seham Al-Motairi Ms. Badrya Al-Heila Data Entry: Data Collection: Ms.Maha Al-Azmi Mr. Fahad Al Diferi Ms.Nidal Sinan Mr. Awad

24 The Trends & Annual Report

25 The annual report is issued and disseminated to the concerned parties. The data are reported to MOH which uses the information for policy changes, and to help guiding and shaping public health programs. The results are forwarded to the WHO database managers and the results can be accessed via the WHO website of the Nutrition Landscape Information System (NLIS which also provides other countries nutrition profiles.

26 Options for the future Based on recommendations made by the EMRO, and on suggestions from WHO consultations, in line with the National Health Policy, there are options to strengthen the existing system, fill gaps, and expand nutrition surveillance in Kuwait.

27 Modification of the existing Nutrition Data Collection System Reporting system could be modified through updating country data yearly, locally through the MOH website for better dissemination of results. To enhance the dissemination of the annual report locally we will present it all interested parties (governmental and private). It will also allow to engage the stakeholders in the evaluation and further planning of the KNSS. One outcome of the meeting could be to formulate a goal that should be reached by the end of next year in order to give further motivation to the KNSS staff.

28 Requirements to achieve these targets KNSS staff at all sentinel health centres should be offered retraining and provided with continuous support. The sampling method should be modified to include all residents of Kuwait and not only Kuwaiti nationals. This will overcome the limitation in the KNSS design and make the results nationally representative and directly comparable to other country estimates.

29 Conclusion The system is simple, sustainable and tailored to the needs of the country and within the health care system. Recruiting staff from outside the centers to run the surveillance could be one of the main factors that allowed sustainability of the KNSS. KNSS provides useful information on trends which can alert the health authorities and trigger policy changes. KNSS can act as an example for the region.

30 Dr Mona AlSumaie, IBCLC Community Nutrition Supervisory Food & Nutrition Administration MOH/KUWAIT