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Introduction

Nutritional Assessment and its related database is the overall assessment of nutritional requirements of a particular set of people based on their various characteristics such as geographical and ecological. Nutritional assessment gives a thorough overview of the nutritional patterns that are prevalent in the region and its requirement for improvement. The following report on the Nutritional Baseline Assessment of the Dominican Republic includes an overview of the current scenario of nutritional status as per the standards of different organisations concerned with the same. The following write up also includes through explanation of different types of tools and methodologies involved in the nutritional assessment of any region or a particular country.

The main deciding points of Nutritional assessment are the analysis of Anthropometric details, Micronutrient status, maternal care practices, infant and young child feeding and potential determinants of under nutrition including reasons for diseases occurrence and its prevalence. Dominican Republic is a Caribbean country with a major population suffering from various diseases. As per the recent 2015 report of International Food Policy Research Institute (IFPRI) on the nutritional profile of the country Dominican Republic, the citizens suffer a very high amount of nutritional deficiency. The county is in a major state of reform and needs proper attention from all the aspects to develop the current scenario of apathy.

Assessment through various toolkits such as Anthropometric statuses and Micronutrient deficiency statuses are crucial in developing the overall data collection plan for the assessment of the same. Though the government of the country has taken measures to improve the current situation through various kinds of Policies and health guidelines it still needs a lot of work to standardize the aspect in terms of global average. The following reports also include various analysis and findings based on the collection of data on different scales. The write up concludes by mentioning of different actions as per the analysis and findings suggests.

Development of Data Collection Plan

Data Collection plan in the given context is a detailed document explaining the nutritional situation of Dominican Republic. The planning of data collection requires many a points which can contribute to the better understanding of the situation of the same in the country. Dominican Republic being a Caribbean and a not so developed country needs a proper assessment of the nutritional assessment. The country is in a vulnerable situation and has exposure to much disease such as Chikungunya, Tetanus, Malaria, Typhoid, Hepatitis A and the now epidemic fearing Zika (Outreach 360, 2019).Hence the country is in a dire need of nutritional awareness as well as nutritional precaution.

Nutritional Assessment requires the assessment of many an areas. The major ones include Anthropometric Status, Micronutrient Deficiency, Infant and Young Child Feeding, Maternal Care Practices. The study methods for the same are given below.

Anthropometric Status: Anthropometric measurements of a person is concerned with the measurement of the different dimensions of body including bone, muscle, quantity of Adipose tissue, Body Mass Index(BMI), height weight and waist circumference. As per the Centre for Disease Control and Prevention, the main methodologies for assessment of the same are required under normal assessment of nutritional baseline. As per the views of Vinué (2017), height and body weights are measured normally to give a proper overview of presence of any nutritional deficiency. BMI or the Body Mass Index is used to categorize the population under overweight, normal weight and underweight. The use of measurement of Adipose Tissue is done to determine the quantity of fat cells present in the body. The major equipments used for the same are Digital weight scale, Portable scales, Stadiometer, Skin fold Calipers, Knee Calipers and Head Circumference Tape.

Micronutrient Deficiency Status: Malnutrition and Undernutrition in the population occurs majorly due to the deficiency of Micronutrients status. Micronutrients deficiencies mainly include lack of essential vitamins and minerals in the body causing stunted growth and other problems. The same can be measured by different methodologies. Deficiency of Vitamin A, Anaemia and zinc deficiency are some of the common problems in the area. The measurements and assessment for the same can be done through different tools. One of the major procedures for the same is the “Estimated Average Requirement” or EAR( Our World In Data, 2019).

This methods give a perfect analysis of the nutritional patterns and eating habits in the society. However, the data collection should be done in varied levels across all the levels of the society of or the region. Lower income families and homeless children suffer more from micronutrients deficiency hence the same requires to be noticed. The equipments used in the process include a proper Nutrient Meter and Water Quality Testing Kit among others. Apart from that, equipments required for different testing’s also required.

Infant and Young Child Feeding: Early development of child is very important and the same can be done only by the proper assessment of fulfilment of Nutritional requirements of the children. The process will mainly include Breastfeeding methods. As per the World Health Organisation, the young and infant child needs various data analysis on the patterns of Breastfeeding prevalent in the country. This includes exclusive Breastfeeding rates and duration of Breastfeeding. The other nutritional requirement of the infants and maternal care can be accessed through the availability of children friendly and maternity hospitals as well.

Maternal Care Practices: Maternal care practices regarding nutritional baseline assessment mainly includes rate of healthy and hygienic practices in the women of reproductive age and expectant mothers. The practices include rates of Sexually Transmitted Diseases. The sampling size should also include women of all stature and regions of the country to get a correct perspective of the situation.

Associated Determinants: Associated determinants of health include assessment of various factors such as disease prevalence and health care accessibility. Socio economic factors also come into picture for the assessment of the same. The sample size should include people of all ages.

Steps of Data Collection Plan

Purpose: Baseline Nutritional Assessment of Dominican Republic

Data needs to be collected			Operational Definition and Procedures
Data type	Measure Type (Continuous/ Discrete)	Methods for measurement	Related factors to record	Sampling Notes	Place of record
Assessment of anthropometric status (Anthropometric status is the collection of overall height, weight and BMI in the concerned persons)	Depends on the sample size. Continuous in small sample size Discrete in nature if measured in a large population	Individual measurement is required for the measurement of different body dimensions.	The equipments used in the process should be used accurately to prevent any type of erroneous calculation and misrepresentation of facts.	Random and Cluster sampling method should be used as the process needs individualistic data	Schools and Workplace areas as they contain the majority of the population
Micronutrient Deficiency status (Micronutrient Deficiency is referred to as the nutritional deficiency of important accessory nutrients in the body)	Discrete. As the sample size includes people from all stature, the collection method for the data is based on average results only. Individualistic Measure is not possible	Methods include Estimated Average Requirement as average outputs are sufficient to determine the pattern of the condition.	The measurement for differents types of tests requires a lot of equipments that needs to be well maintained during the sample collection procedure.	The process requires Systematic Sampling as health indicators of all the parts of societies are need to be accessed and the data collection process involves average output measurement.	Areas with different class of people and of myriad ages are needs to be selected for non erroneous procedure completion.
Infant and Young Child Feeding (Infant and Young child Feeding is concerned with the nutritional fulfilment of the children and includes Breastfeeding majorly).	Discrete data sampling as the sampling size is larger.	Analysis and application of various methods such as Exclusive Breastfeeding rate and bottle feeding patterns	The data collection method requires assessment of the entire societal group including lower income groups. The assessment and data collection size should include women of all the regions.	The process requires Quota as well as systematic sampling.	Maternity care homes and children friendly assignment.
Maternal care Practices (Maternal care Practices mainly includes health care practices and health hygiene practices)	Discrete data. Sampling method should include region wise surveys.	Assessment and analysis should include various conditions include pre natal, ante partum and post natal care mothers.	Sample size should include women of all regions and expectant as well as mothers under postnatal care.	Strategic sampling is required in this case.	Maternity care homes.
Associate potential determinants of undernutrition. (Associated reasons for undernutrition in the people can be the prevalence of disease under which the country suffers a lot.)	Discrete data type.	Assessment should include disease prevalence areas.	Equipments majorly include the all type of tastings.	Quota as well as strategic sampling is required.	Health care centres

Table 1: Data collection plan

(Source: Based on views of Maliszewski et al.2017)

Analysis and Findings

Dominican Republic is a Caribbean country with a population of almost 10,649,000 (GHDx, 2019). The country faces many a health issues. The top most three diseases prevalent in the country are Schistosomiasis, HIV/AIDS and Malaria (The Borgen Project, 2019). For the nutritional assessment of the country, baseline analysis needs to be done to get a proper overview of the nutritional scenario in the country. The baseline analysis covers all the major points as mentioned in the above paragraphs.

Underweight People: For the measurement of Anthropometric Data, the baseline research included weight and height measurements of the concerned persons. The data collection also included BMI index as it was concerned with the identification of obesity which can cause many diseases (ScienceDirect, 2019). The findings suggested that people do suffer from malnutrition in the country especially in the shock and natural calamities prone regions of Haiti and other regions. Prevalence of underweight children under five years in the country as founded in the survey was almost 4%. The given data when compared to the recent 2015 survey reports of International Food Policy Research Institute (IFPRI), found that people suffering from obesity are nil in the country. However, a majority of people suffer from underweight problem and malnutrition (International Food Policy Research Institute, 2019).

Reason for Underweight people: Dominican Republic is a tropical country with vulnerability to natural calamities such as cyclones and earthquakes. This causes the country a to become a malnutrition hub and causes underweight among the citizens, majorly in expectant mothers.

Low Maternal Health Hygiene: Another finding through the data collection process regarding maternal care practices showed that a major population suffers from the Sexually Transmitted Diseases , the topmost being HIV/AIDS. The prevalence of the disease in the country is very high (Maliszewski et al. 2017). The micronutrient survey conducted in a cluster sample and anthropometric findings revealed ill developed maternal care facilities in the survey. The findings when compared to the report of World Health Organisation show that the major causes of maternal death are hemorrhage and obstructed labour (World Health Organisation, 2019). In the recent years the causes also include transmission of HIV among the expectant mothers putting the whole question on health accessibility as well as health facilities.

Reason for low Maternal Hygiene: The studies reveal that the major reason for such a condition is the gender determinants and low gender equality ratio in the country. A major of the women undergo multiple pregnancies by the age of 18, which consequently reduces the stature of Maternal Health.

Micronutrient Deficiency prevalence: The survey conducted about the micronutrient deficiency gives the analysis that situation is severe and has affected people of all ages in the country. The situation has arised due to less maternal hygiene causing problems in the children form a very early age. As per the views of Bazzano et al. (2017), the young and child infants should be breastfed properly to ensure safe and sound health. The recent findings of World Health Organisation suggest that the county lags a lot in the same. Rate of Exclusive Breastfeeding among children under six months of age is continuously deteriorating. The rates were around 8% in the year 2009-10 and have reduced to 5% in the year 2014 (World Health Organisation, 2019). The figures itself reflects the severity of the situation.

Reason for Micronutrient Deficiency Prevalence and Low Breastfeeding: The responsibility of the same can be attributed again to the gender determinant gradient in the country causing a nutritional gap, initiating the disease and its related conditions.

Prevalence of Abdominal disease and Non-communicable disease: The major diseases causing condition in the country is the food and water contaminated conditions, especially diarrhea, cholera and Schistosomiasis. The other non communicable diseases prevalence in the country is very high as found in the baseline survey. The findings suggest that the country is not highly immune to the non communicable disease. The occurrence of Malaria and Cholera is the major reason of diminished health quality of the country. Another major reason behind the outbreak of Zika Virus in the country can again be attributed to the mosquito prevalence and contaminated food and water. As per the Food and Agriculture Organizations of the United Nations, the food based dietary guidelines ensure the coverage and consumption of non contaminated food so as to reduce the cases of food and water contaminated diseases.

Reason for increased cases of Food and Water contaminated Diseases: The major reason behind the ill developed medical immunity of the country causing the increased rates of Non-communicable diseases in the country can be attributed to the geographical and demographical regions of the co8untry. As per the views of Cramer et al. (2017), the climatic conditions and the geographical reasons contribute a lot under the rising issues of the food and water related diseases.The country usually face a lot of episodes of Natural calamities, mainly Tsunami and different types of cyclones, increasing the vulnerability of the country towards disease rising incidents.

Priorities for Action

From the above discussed baseline analysis of the nutritional condition of the Caribbean Country with a tropical climate, the Dominican Republic, the major challenges that arises are the rising cases of Sexually Transmitted Diseases affecting the overall maternal health and the newborns as well.

Action for the issue: The major issue of increased cases of sexually transmitted diseases needs proper awareness among the cases. The increased childbearing incidences of women fewer than 18 are also cause for the increment in such cases. In order to improve the situation, gender inequality should be reduced.

Another important issue that needs proper attention is the micronutrient deficiency cases in the country. The current scenario of micronutrient deficiency will cause the people getting mo0re affected with various diseases as the immunity response of the body reduces due to lack of Nutrition.

Action for the issue: As the major reason behind the micronutrient deficiency is the haphazard health system as well as geographical regions of the country, the best action for the same is the precautions for the food and drinking water safety along with awareness on micronutrients importance among the citizens of the country. These actions will ensure reduction in the cases and an improved situation as well.

Reference List

Bazzano, A. N., Kaji, A., Felker-Kantor, E., Bazzano, L. A., & Potts, K. S. (2017). Qualitative studies of infant and young child feeding in lower-income countries: A systematic review and synthesis of dietary patterns. Nutrients, 9(10), 1140. Retrieved on April 8,2019 Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5691756/

Centre for Disease Control and Prevention (2019) Anthropometry Procedures Manual Retreived on April 7, 2019 Retrieved from https://www.cdc.gov/nchs/data/nhanes/nhanes_07_08/manual_an.pdf

Cramer, L., Huyer, S., Lavado, A., Loboguerrero, A. M., Martínez Barón, D., Nyasimi, M., … & Wijk, M. T. V. (2017). Methods Proposed to Evaluate the Potential Impact of Climate Change on Food and Nutrition Security in Central America and the Dominican Republic. Retrieved on April 4,2019 Retrieved from https://cgspace.cgiar.org/bitstream/handle/10568/80948/WP196_EN.pdf

Derose, K. P., Payán, D. D., Fulcar, M. A., Terrero, S., Acevedo, R., Farías, H., & Palar, K. (2017). Factors contributing to food insecurity among women living with HIV in the Dominican Republic: A qualitative study. PloS one, 12(7), e0181568. Retrieved on April 7, 2019 Retrieved from https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0181568

GHDx (2019) Dominican Republic Multiple Indicator Cluster Survey 2014 Retrieved on April 7,2019 Retrieved from http://ghdx.healthdata.org/record/dominican-republic-multiple-indicator-cluster-survey-2014

Government of New Zealand (2019) Body Size Technical Report Measurements and classifications in the 2006/07 New Zealand Health Survey Retrieved on April 5, 2019 Retrieved from http://www.moh.govt.nz/NoteBook/nbbooks.nsf/0/DD99C7ECDD5729F7CC25748D000C0AE7/$file/body-size-tecnical-report-08.pdf

Maliszewski, G., Enriquez, M., Cheng, A. L., Logan, P., & Watts, J. (2017). Development and feasibility of a community‐partnered nutrition intervention targeting rural migrant communities in the Dominican Republic. Public Health Nursing, 34(4), 343-347. Retrieved on April 5,2019 Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1111/phn.12322

Our World in Data (2019) Micronutrient Deficiency Retrieved on April 6,2019 Retrieved from https://ourworldindata.org/micronutrient-deficiency

Outreach360 (2019) Medical Precautions – Dominican Republic Retrieved on April 6, 2019 Retrieved from https://outreach360.org/guide/dr/medicalprecautions/

ScienceDirect (2019) Anthropometric Data Retrieved on April 3, 2019 Retrieved from https://www.sciencedirect.com/topics/engineering/anthropometric-data

The Borgen Project (2019) Three of the Most Common Diseases in the Dominican Republic Retrieved on April 7, 2019 Retrieved from https://borgenproject.org/common-diseases-in-the-dominican-republic/

Vinué, G. (2017). Anthropometry: An R package for analysis of anthropometric data. Journal of Statistical Software, 77(6), 1-39. Retrieved on April 7, 2019 Retrieved from https://cran.fhcrc.org/web/packages/Anthropometry/vignettes/Anthropometry.pdf

World Health Organization (2019) Infant and Young Child Feeding A tool for assessing national practices, policies and programmes Retrieved on April 8,2019 Retrieved from https://www.who.int/nutrition/publications/inf_assess_nnpp_eng.pdf

World Health Organization (2019) Vitamin and Mineral Nutrition Information System (VMNIS) Retrieved on April 6,2019 Retrieved from https://www.who.int/vmnis/toolkit/logic_model/en/