Dear Anonymous,

The MDD-W is a distal indicator which should be measured after at equal or > 6months period.

I'd not be so doctrinaire about timing for the collection of indicators particularly when indicators are likely to be subject to seasonal variation and may be vulnerable to all sorts of shock. This is the case with dietary diversity. You may want to pick the lean season or do frequent small surveys (even monthly surveys for a surveillance system).

An indicator such as MDD-W may also be useful when assessing targeting of (e.g.) fortifiction programs. For example see here, here, and here. In this case timing may not be so important although you might want to apply HDDS or WDDS and define "at-risk" as have DDS below a median.

The Fanta-III MDD-W guideline available here might be useful.

I feel that there is little value describing an indicator as "distal" without specifying what it is distal from. MDD-W is not "distal" (e.g.) from diet or from micronutrient intake.

Now to the original question ... my recent experience has been in assessing large-scale fortification programs and targeted IYCF programs. The lessons here (see some of the references given above) are that program design is very important and that programs cane easily fail to achieve coverage in at-risk groups. This sort of targeting failure is common in programming. I have seen IYCF counselling programs (along the UNICEF peer-to-peer model) achieve results within a year.

I hope this is of some use. Sorry not to be of more help.

From the CGIAR research program published by (Gelli et.al, 2015), it provides a clear framework on the project duration needed to improve dietary diversity-IDDS/MDD-W. In it you will find the use of "distal" as earlier suggested.

Perhaps, you might want to have a read at , https://a4nh.cgiar.org/files/2012/07/Value_chains_and_nutrition_A_framework_to_support_the_identification_design_and_evaluation_of_interventions.pdf

Hope you find this additive to the previously shared information.

I have to ask what is MDD-W "distal" from and is MDD-W really "distal" by nature?

Perhaps I am missing the meaning of "distal" which I take to mean "far from a central point or origin". It has a clear spatial meaning in anatomy and dentistry but, I think, not such a clear meaning in other fields unless the "origin", context, and dimensions (e.g. distance, time) are specified.

In the CGIAR report you reference I do think that MDD-W might be well-described as "distal" in space and time from many households for an agricultural intervention. In other interventions (e.g. kitchen gardens, food banks, distributions, voucher schemes, cash-transfers, IYCF promotion) it will be less "distal" and more "proximal". It seems reasonable to think that "proximal" intervention may have more rapid and more local results than "distal" interventions.

Am I missing something important here?

Hello Mark!

I suggest we take this bilateral, you are indeed missing an important point of "distal" meaning the time when one can actually measure the MDD-W change, from the first measurement.

For Anonymous, can you look at the reference which I provided and perhaps get back to the forum with a revised question.

What a lot of fancy terms! I am not sure what "take this bilateral" means. I suspect "multilateral" might be better as there will be different "answers" for different applications / interventions.

Not all effects will be "distal" in time (or space) from an intervention. That will depend upon the intervention. Being a bit "silly" for a moment ... let us imagine (1) that my neighbour has a poor diet, (2) their house burns down, (3) I take them in and share my table (I am good like that), and (4) I have a good diet. In this case MDD-W, which is based on a 24 hour recall, will improve after only 24 hours. I put the "silly" in quotes because the example is not so very far from (e.g.) fresh food vouchers. It is very far (maybe 1000s of miles and some years) from an agriculture intervention.

To answer the original question we need some context (e.g. where and doing what?).

Oh it was fancy indeed - By bilateral l had meant discussing between me and you outside this fora.

Let's hope Anonymous, can come in and clarify the matter here.