ICTworks

Before the COVID-19 pandemic, UNICEF, the World Health Organization, and the World Bank estimated that 47 million children younger than 5 years were moderately or severely wasted, one of several measures of malnutrition. As a result, these children are at increased risk of morbidity and mortality, potentially throughout their lives.

The Standing Together for Nutrition consortium, as reported by Heady et al., estimates that there could be a 14.3% increase in this number (6.7 million) due to increased food insecurity and decreased access to child health and nutrition services as a result of COVID-19.

At the same time, the number of people considered overweight or obese has increased dramatically – more than tripling since 1975 – as has the prevalence of nutrition-related non-communicable diseases such as cardiovascular diseases, diabetes, musculoskeletal disorders, and some cancers.

Digital health has the potential to improve health outcomes through better nutrition by:

• reaching clients with information about nutrition practices
• supporting providers during nutrition service delivery
• helping strengthen health system interventions, such as fine-tuning the supply chain for supplemental foods.

This is particularly true today, in the face of the global COVID-19 pandemic.

A Review of 53 ICT4Nutrition Solutions

USAID Advancing Nutrition, the Agency’s flagship multi-sectoral nutrition project, has a new report, Digital Tools for Nutrition Service Delivery, that explores how 53 digital solutions have supported or are supporting health and agriculture providers to deliver nutrition services in low- and middle-income countries. It has 34 tools from 25 countries in Africa and 19 tools from 10 countries in Asia active between 2015 and today.

Facility-level health workers, community-based health workers, and their supervisors use the 53 ICT4Nutrition tools to support nutrition assessment and growth monitoring and promotion, nutrition counseling or promotion, and treatment or management of malnutrition. This review found:

• 25 tools aid in the promotion of infant and young child feeding.
• 28 support the assessment of nutritional status of adults and children.
• 13 tools are used for the treatment of sick children, often as part of a larger package of services, such as Integrated Management of Childhood Illnesses (IMCI) or the Integrated Community Case Management of childhood illnesses (iCCM).
• 4 tools are used for Community Management of Acute Malnutrition (CMAM).
• 1 tool follows the Management of At-risk Mothers and Infants (MAMI) protocol.
• 2 tools provide support for early childhood developed (ECD) or responsive care and early leaning counseling.

Comprehensive Digital Solutions for Nutrition

Most of the digital tools we reviewed were designed to support a package of health services (primarily maternal, newborn, and child health-related) that integrates nutrition services. For example, upSCALE, developed by the Malaria Consortium and partners, is a mobile tool that guides community health workers (CHWs) in Mozambique through:

• provision of iCCM services for children aged 2–59 months
• family planning services
• antenatal and postpartum care
• well-child visits
• treatment of malaria and diarrhea
• assessment of nutritional status
• referral of those with acute malnutrition
• health promotion activities and treatment follow-up.

Nutrition-Specific Digital Tools

Of the 53 solutions we surveyed, 21 digital tools are stand-alone nutrition tools specifically and solely for nutrition. For example, World Vision’s Community-Based Management of Acute Malnutrition (CMAM) digital tool was designed for nurses and doctors to collect the following data on clients’ nutritional status:

• mid-upper arm circumference (MUAC), height, weight, age, and bilateral pitting edema
• Z-score calculations and suggested treatment pathways: counseling only, provision of supplementary feeding, enrollment in an outpatient therapeutic program, or referral to inpatient treatment.

Another nutrition-specific tool is the Integrated Child Development Services–Common Application Software (ICDS-CAS) job aid and supervision tool for community health (Anganwadi) workers who are a part of the Government of India’s ICDS program and their supervisors. The tool contains eight modules:

• home visit scheduler to remind health workers when to visit clients at home
• tracker for attendance at daily complementary nutrition sessions
• growth monitoring for each child, tracking weight and height
• notation of take-home rations
• listing of children due for follow-up visits
• Anganwadi management module for overview of activities and clients
• monthly progress report that aggregates data from other modules for submission.

The growth monitoring module of the tool improves data quality by auto-calculating the nutritional status of a child and plotting growth charts when Anganwadi workers enter a child’s weight. Videos in the tool support Anganwadi workers in counseling beneficiaries on nutrition practices.

Next: Application Guidance Package

As indicated in our report, Digital Tools for Nutrition Service Delivery, we identified several important gaps:

• Understanding the specific indicators collected and behaviors promoted by ICT4Nutrition tools.
• Evidence of the acceptability, usability, and/or effectiveness of these tools for reducing malnutrition, increasing the adoption of optimal nutrition behaviors, and/or improving the quality of nutrition services in line with global standard.
• Guidance and templates for ICT4Nutrition tools for to facilitate the creation of digital tools for various contexts that align with global guidance.
• Expansion of ICT4Nutrition to more countries and additional nutrition services (e.g., breastfeeding counseling and support, promotion of responsive care and early leaning, adolescent nutrition services)..

To address these needs, USAID Advancing Nutrition is conducting a deeper dive review into selected tools and building on the latest global guidance to develop an Application Guidance Package for digitizing growth monitoring and promotion (GMP) services and supervision.

The Application Guidance Package will help governments, non-governmental organizations, and programmers to more rapidly develop GMP service applications for their context.

We welcome collaboration with the wider nutrition and digital health communities to ensure that all digital tools targeting nutrition service delivery are designed to achieve the greatest possible health outcomes.

Leona Rosenblum is the Deputy Director for the Center for Digital Health at JSI.