Home-based Consultancy: Systematic review; the nutritional status of adolescents and children (7-18 years old) and the existing policies and programs to address their nutritional problems, in Eastern Europe and Central Asia (ECA)
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1. Background The study will be a cross sectional descriptive systematic review, which aims to review existingliterature, policies and strategies, as well as existing data and evidence and provide relevant analysisand findings on estimated prevalence of all forms of micronutrient deficiencies (Anemia and Iron,Vitamin A, Vitamin D and Zinc deficiencies); over-weight and obesity and unhealthy dietary patterns among children and adolescents (boys and girls) aged 7-18.
The demand for this study comes for the need to obtainevidence to inform the planning and lead the direction of ECARO in regards with adolescent andschool age nutrition agenda.
Malnutrition in various forms persist and co-exist in various proportions with noticeable differencesbetween countries in the region. Based on a report published by FAO in 2016, 20 percent (or 44.6million) of women of reproductive age in the ECA region are anemic. EU-28 and European CIScountries, SEE and Central Asia- Caucasus, respectively accounted for 25.9, 7.7 and 7.7 millionanemic women in the region. Unfortunately, the prevalence of anemia increased across all the subregionsbetween 2005 and 2016 (including Europe), except for the Central Asian countries whichcould be related to absence of large scale flour fortification programs in Europe. Though we haveno direct data from adolescent girls, one can expect the same trend among adolescent girls.
More than 55 percent of adults in Europe and Central Asia region are overweight or obese thesimilar trends can be seen among children. The number of overweight under-5-year-old children inECA region have increased from 2.1 to 4.5 million from 2000 to 2017 (over 100% increase which isthe greatest increase globally). Based on the estimations the number of overweight children greatlyoutweighs the number of children who are stunted or suffer from wasting (except for Tajikistan). Atthe same time, millions of young children are anemic, or suffer from iodine, zinc, or vitamin A andD deficiencies. The regional prevalence of Iron Deficiency Anemia is estimated at 20-40%. And perthe global map of micronutrient deficiencies (Zinc, Iron, Vitamin A and Iodine), still the magnitudeof the problem in CIS and parts of CEE is at moderate level. Though we have no systematicanalysis over the trends of malnutrition among school age and adolescents boys and girls.
The regional average for use of iodized salt is at 61 per cent (of which 51 per cent adequatelyiodized). Only 15 out of 22 countries in the Region have reached the 90% target. Infant and youngchild feeding practices are poor across the Region, with a 26% rate of Exclusive Breast Feeding(during the 6 months of life) ranking the poorest region globally. The prevalence of stunting inchildren under age of five years is estimated as is 12.5* in Central Asia (from 1.1 to 26.7%) and theprevalence of wasting at 3.8% (from 0.2 to 10.0%). In ECA malnutrition in all its forms, and diet-related NCDs affect peoples’ health, productivity, anddevelopment potential on individuals, households and countries. The data shows that the nutritionalstatus of children has improved, still in several countries (Tajikistan, Uzbekistan, Kyrgyzstan andTurkmenistan as well as Caucasus countries; Azerbaijan and Armenia) and some few CEE countries, out of every 10 children 1 to 3 are stunted. Poor nutrition among 7-18-year-old children and adolescents not only imposes major delays to their development and productivity but also can be a major risk factor for early development of non-communicable diseases (NCDs) and a main contributor to high DALY (Disability Adjusted Life Years) values in the region, especially in countries of Eastern Europe with rapid rise in income levels over the last two decades. This’s while not much information is available on the nutritional status of the adolescents as well as the existing national policies and programs which are aiming at addressing this public health problem. Majority of the data are focused on early ages of life and some are outdated or sporadic without validity checks.
To fill this gap and to ultimately make evidence informed advocacy, policy and programingdecisions regarding the major nutritional problems of the adolescent and school age children, asystematic review of all existing valid sources of information such as published studies, nationalsurveys and etc on the nutritional status of the adolescents (including micronutrient deficiencies aswell as over-weight and obesity, and under-nutrition) and the existing policies and programs inECA region is planned.
The existing data are from very scattered and outdated sources, not systematized, clustered andstatistically processed. In light of our recent funding from GTF for nutrition for 2018-21 for schoolage nutrition and adolescent (around 1.5 million to the nutrition of school age children andadolescents) in ECAR, having a sound understanding of the existing deprivation and bottlenecks aswell as existing programs and policies is crucial for the regional office to plan its road map for thenext few years. For the 8 countries in Central Asia and Caucasus, the study will be considered as thefirst multi-country evidence generation for nutrition policy advocacy and programming in thecontext of Regional Nutrition Partnership Platform. In addition, the study will contribute inidentifying and applying the most relevant gender lens in nutrition programming in the region.
2. Objective The overall aim of this study is to obtain an updated evidence base on the holistic nutritional statusof the adolescents and school age girls and boys and the existing national policies, programs andstrategies to prevent or to address them.
To update the estimated prevalence of all forms of micronutrient deficiencies (Anemia andIron, Vitamin A, Vitamin D and Zinc deficiencies) as well as over-weight and obesity andunhealthy dietary patterns specifically among adolescents (boys and girls) in ECA countries;
To define and plot the trends of all forms of malnutrition as well as dietary patterns (whichare specified under objective 1 for the period for which data is available;
To map the national policies, programs and strategies which are aiming at addressing thenutritional problems among adolescents and school age children in ECA countries withspecial focus on below elements; o School based programs for promotion of healthy nutrition, including programs forprevention of obesity o National level micronutrient supplementations o National regulations on marketing of food for children and adolescents
To identify and map the potential inequities in nutritional health of adolescents (boys andgirls) (between sub-regions, between countries, within countries between different localities or marginalized groups, between boys and girls, age groups, socio-economical groups (to the extent available) o To derive a focused conclusion on adolescent girls nutritional deprivations
To identify the information gaps on the nutritional status of adolescents and school agechildren (boys and girls) and the existing policies, programs and strategies,
To propose evidence based recommendations to improve the nutritional status ofadolescents and women/mothers;
3. Methodology and Technical Approach After identifying the review team, an analytic framework will be developed, key questions based onthe review’s objectives will be formulated, inclusion/exclusion criteria for existing literature, will beagreed upon and search terms based on different clusters of countries will be set. Consequently, theliterature search will be launched for each country cluster, the data from the eligible resources will beextracted and summarized.
Ultimately the sub-national and where available the national prevalence of all forms of malnutritionwill be estimated and a malnutrition index using data on all forms of malnutrition will be calculatedand will be used for mapping of adolescents’ nutritional problems across the region. The choice ofcountries will be made based on relevance and the availability of the first quick round of search onexisting sources of data. The preference is to include all countries in the region.
The same approach will be applied for reviewing the existing national policies, regulations. programsand strategies. A thorough research will be made to identify and understand the content of all existingnational policies, programs and strategies aiming at improving the nutritional status of the adolescentswith specific focus on prevention of micronutrient deficiencies and prevention and management of over-weight and obesity.
Based on above review for every micronutrient, and every form of malnutrition (over-weight andobesity and stunting), the countries will be categorized into High, medium and low priority/ riskcountries by tabulating the level of severity of the nutritional problems in a regional scale versus thesituation of the preventive strategies/ programs. For every country, an adolescent and school agechildren nutritional profile in 2 pages will be developed, which includes all the extracted informationon estimation of micronutrients deficiencies and other forms of malnutrition as well as the existingpolicies, program and strategies and the relevant maps.
Lastly the knowledge gap around the nutritional problems of adolescents and school age children, aswell as the gaps in policies, programs and strategies to address the priority problems will be identifiedand prioritized and a set of main recommendations to improve the nutritional status of adolescentsand women in ECAR will be proposed.
4. Activities, Deliverables, Indicators, Timeframe, and Schedule of Payment
N.B. All reports and presentations should be submitted in English
5. Management and Organization
5.1. Management: The consultant will work under the direct supervision of UNICEF ECAROHealth and Nutrition Specialist in consultation with adolescent and gender team. 5.2. Travel: No travels are forecasted, ad hoc trips if authorized will be covered by UNICEF as perthe regulations 5.3. The Consultant will be responsible for organizing and coordinating all meetings with thecounterparts as required.
6.Terms of payment
The consultancy fee shall be paid upon above matrix andupon approval of relevant deliverables by UNICEF.
7. Conditions of Work This is a home-based consultancy. The consultant shall use his/her own facilities to manage the work. In case there is a presence of UNICEF office in the city where consultant is based and if the circumstancesdemand other than home-based working modality, the consultant shall be allowed to make use of available UNICEF office space, computer andinternet facilities with prior notification and arrangement with the supervisor and UNICEFAdmin/ICT. The provision of these facilities by UNICEF shall be subject to their availability.
8. Qualifications The consultancy should possess the following qualifications: • Experts with post-graduate degree in nutrition, or public health Nutrition, and nutritionepidemiology, epidemiology • Minimum 10 years of working experience in designing and implementing similar studiesand systematic reviews; • Experience of undertaking similar reviews for nutritional status of children and adolescents • Previous working experience with UNICEF/UN is an asset • Fluency in English both written and verbal is essential • Knowledge of Russian language is an asset
9. Application requirements
Applicants should apply online with completion/submit ion of the below items:
- Duly completed online profile or fully completed P11 form.
- Proposed methodology to run the systematic review (max. 700 words)
- Fully completed online questionnaire
- Daily fee and a lump sum fee in USD
Applications which do not have mentioned above documents will not be considered further.Only shortlisted candidates will be contacted.
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Only shortlisted candidates will be contacted and advance to the next stage of the selection process.
UNICEF is committed to diversity and inclusion within its workforce, and encourages qualified female and male candidates from all national, religious and ethnic backgrounds, including persons living with disabilities, to apply to become a part of our organization. To apply, click on the following link http://www.unicef.org/about/employ/?job=518396