introduction to nutrition assesments 1

8/2/2019 Introduction to Nutrition Assesments 1

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Objectives of this presentation

To introduce the various Nutrition

assessment methodologies.

To summarise the various steps involvedin conducting a individual nutrition

assessments and community survey in a

given population


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Defining a survey? Surveys give varied information on specific topic

depending on the objectives e.g. to determine themalnutrition prevalence rate and mortality in apopulation.

Surveys collect information at single point in time.

Surveys are done when baseline data (or midterm,end line etc.) is needed to supplement existing or nonexisting surveillance data.

Factors that trigger health and nutrition surveysinclude:1. Food security

2. Economic, weather, harvest predictions

3. Political turmoil

4. Health centre, hospital data


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Strengths and weakness of surveysStrengths

If procedures are followed,surveys can give reasonablyaccurate estimate ofprevalence of health conditionin population.

Can be replicated to evaluatehealth outcomes.

Can be done when other datacollection systems (e.g.

surveillance) not feasible.

Weaknesses

Difficult to assess

cause/effect.

Difficult to answer why

questions.

Surveys are expensive

and time consuming


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Limitations of surveys

Surveys should not be interpreted in isolation.

There has to be contextual data that prompted

the survey.

Cannot be used solely to decide how and whichprograms to implement. information collected

must be triangulated and used appropriately.

Cannot give reasons why events occur or why

things are the way they are, incidence or trends.


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Surveys should therefore be Be done by a well trained team.

Provide information that is reliable and give an accuratepicture.

Use standard methods for collecting information.

Be used with simple questionnaires and easy-to-usecomputer software for analysis and reporting gives credibilityatlthough surveys can be analysed manually also.

Be available in time to be useful for the intervention- nutritionsurveys results should be released within 2- 4 weeks assituation can change completely within 3 months.

Based on the findings, results should be discussed with thecommunity surveyed and if need be, lead to action.


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Surveillance

Many people refer to "nutrition surveillance"

when they actually mean repeated surveys. However WHO, defines surveillance assystematic ongoing collection, collation, andanalysis of data and the timely dissemination of

information to those who need to know so thataction can be taken-.

The most common form of surveillance iscollection of data from routine growth monitoring

programmes in maternal-child health or primarycare clinics.


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Steps in conducting a Survey

It is important that the survey team members and the community leaders

from the population being surveyed understand the big picture of doing

the survey.

Each step impact on each other. Each step is as important as the other.


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What is SMART?This is a Simplified, standardized survey

methodology in a package easy for emergency

situations.

S-Standardized

M-Monitoring

A-Assessment

R-Relief

T-Transitions

SMARTs main goal is to make Nutrition, andmortality surveys as easy as possible for the field

staff and as reliable as possible for the decision-

makers.


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SMART addresses issues of common interest to

many organizations. SMART gives very specific, measurable, accurate,

information in the right format, to the right people at

the right time, especially in relief and transition

contexts.

It is a very standardized survey methodology

covering data collection, analysis and reporting

among organizations conducting nutrition surveys.

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Advantages of SMART SMART is easy and user-friendly, Easy to understand and

apply.

Once trained, country staff could be self-sufficient and notrequire external assistance to do the work.

Analysis done by one computer program only. SMART dataentry and analysis are enclosed inonly one package withone accompanying software called ENA.

The SMART method isnot really new: It is based onmany established manuals and guidelines.

SMART is open for upgrading based on research,experience and current best practises.


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Limitations of SMART

The food secutiry component in SMART is

under development although food security iskey in interprating nutrition survey results.

Although many organisations including

UNICEF have accepted and are usingSMART, it is yet to be agreed or approved

that it is the best practice.


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In measuring nutritional status of a given population,

children 6 months to 5 years old and mortality are the keyindicators used.

Why measure nutritional status under-5?

Children in this age group are closely linked with high

risk of death, especially in times of crisis. They are still in growth period and particularly

vulnerable to disease and food shortage

Considered to be the most sensitive to nutritional

stress compared to other age groups Their results are used to draw conclusions on whole

population.

How to assess nutritional status


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Why measure mortality?

It is the most critical indicator of a populationsimproving and deteriorating health status.

Type of information to which donors and relief agencies

most readily respond to.

******************* There are acceptable international standards for

interpreting mortality and nutrition prevalence.

In general, if nutritional status of children under 5 is

improving and mortality rates are decreasing or gettingback to international standards, most of the humanitarian

assistance support systems are probably working.


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Steps in doing surveys

Step 1~ Decide whether or not to do a

survey

Decision is made and implemented in

conjunction and collaboration with

government, partner agencies and donors.

Key points to consider: Results will be crucial for decision making

Results will lead to action

Access of affected population


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Overall objective.

E.g. To determine the prevalence of various forms of

malnutrition among the refugees in a given population,at a defined point in time.

Specific objectives. E.g.

1. To evaluate the nutritional status of children aged 6 to

59 months amongst the Somali refuges in xxxxxdistrict.

2. To estimate retrospective crude and under fivemortality rates amongst the refugees in these districts.

3. To understand the underlying causes of malnutrition in

the targeted population.4. To determine the prevalence of anaemia amongst

children under fives amongst the targeted population.

5. To make recommendations for the next programme.

Step 2: Define objectives


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Step 3: Define geographic area and population

group to be surveyed Confine survey to area in which you intend to implement a program.

Considering homogeneity, the area should corresponds to one or moreadministrative areas (E.g. a district, location).

Areas difficult to access because of insecurity or other factors like verydifficult infrastructure could be left out of the survey but must be reported.

Nutritional survey:

Anthropometric measurements and edema assessments amongchildren aged 6-59 months.

Other ages groups depending on the specific agenda: sometimespregnant and lactating women.

Mortality survey:

Crude death rate (CDR) assessed for entire population. Age specific mortality rate e.g under 5 mortality rate, infant mortality

rates.


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Step 4: Meeting community leaders and

local authorities

Meeting the targeted community leaders and localauthorities before starting a survey is essential to agree on

dates, objectives and how results will be used.

Obtain:

Map of area Population figures

Information on security and access

Letters of permission


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Step 5: Determine actual home visiting

timings With the help of community leaders and local authorities,

agree on times when people are likely to be present athome.

Events to avoid include market days local celebrations

food distribution days vaccination campaigns

assign adequate time for preparation, literature review,

training, pilot testing, community mobilization, datacollection, analysis and reporting.


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Step 6: Selecting sampling methods Sampling methods use standard method of selecting the subjects

that is designed to eliminate bias and get a representative sample.

Every child in the entire targeted population should have an equalchance of being surveyed Sampling is based on the way households are distributed and the

population size to be surveyed There are 3 commonly used methods:

1. Simple random sampling

2. Systematic random sampling

3. Cluster sampling Exhaustive survey are occasionally done on very small

populations (less than 1000 people), where every household canbe visited.

1. Simple or systematic random sampling is used. When a list of every household or individual is available. Where the houses are arranged in a systematic way

2. Cluster sampling, the most commonly used, when households aredistributed in an unstructured way that does not easily allow all thehouseholds to be listed or numbered.


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Systematic random sampling continued...


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Cluster sampling


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Cluster sampling is in two stages:

1. Stage 1: Whole population divided into smaller geographical

areas that the population size is known e.g.villages

andClusters are then randomly selected from these units.

2. Stage 2: households are chosen at random from within eachcluster area or village.

Though larger villages are more likely to be selected tocontain a cluster (or more) than smaller villages, theindividual households within the larger village are less likelyto be sampled than a household from a small village. Theseeffects balance each other so that each household in thewhole population has an equal chance of being selected.


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Sample size: Thirty clusters of thirty children has largely been used, giving a sample

size of 900 children.. However with the SMART methodology, smaller sample sizes can be

calculated accurately based on:1. Precision: the higher the precision the more the sample size.2. Prevalence: What are the expected malnutrition prevalence and death

rate?3. Precision: The longer the recall period the more precise the estimate of

mortality.

4. Design Effect (if the survey is to use cluster sampling).5. Recall period- for the Mortality.

These factors are entered into Nutrisurvey to calculate both nutrition andmortality sample size.

Use this routinely to calculate the sample size instead of using the samesample size for all surveys as the factors above may change.

This reduces the cost and time and eases logistics compared to the 30 X30 methodology while ensuring the use the minimum sample size thatgives adequate results so that the teams are not stressed


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Step 7: Gather available

information

Population characteristics and figures.

Previous surveys and assessments.

Health statistics.

Food security information.

Situation reports (security and political

situation).

Maps, and anthropological, ethnic and

linguistic information.


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Step 8: Decide on additional data Each additional data collected may limit accuracy of

whole dataset and prolongs survey.

Need to consider if information can be collected moreefficiently in other ways.

Additional information must be quickly and reliablyobtainable during a short visit to the household.


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Step 9: Obtaining and preparing

equipment, supplies and survey materials

Measuring material, scales and height

boards are in good condition.

Transport, fuel, paper, pens, notebooks, per

diem.

Copies of questionnaires, forms for referral

of malnourished children, etc.


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SURVEY SUPERVISOR

TEAM 1 TEAM 2 TEAM 3

TEAM LEADER

TEAM 4 ++

MEASURER 1 MEASURER 2

INTERVIEWER(mortality)

orCOMMUNITY MEMBE

Step 10: Selecting survey teams


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Step 11: Training survey team members Teams can be made of 3- 4 people depending on

availability and other logistical factors like if they are to betransported.

Adequate formal training of the survey team members

before the survey is essential.

The same training for each team member is done to

ensure standardization of methods.

Supervisor must continually reinforce good practice,

identify and correct errors and prevent declining

measurement standards.


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Managing the survey Have a supervisor who has overall responsibility for survey

planning and implementation.

Important not to overwork survey teams.

Together with the supervisor, ensure quality of data collectedthrough:

1. Checking with data entry on daily basis.

2. Organize daily wrap-up sessions.

3. Keep record of all important point with team leader.

4. Double-check edema cases.

introduction to nutrition assesments 1

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