Rapid nutritional assessments in emergencies Presented by Dr. Amani Elsayed
objectives • To diagnose the problem and determine its extent • To identify groups at high risk • To estimate the numbers of people needing assistance • To act as a baseline for monitoring and evaluation of the situation.
Planning the survey • • • • • •
First step is collecting data about : Demography Mortality & morbidity Previous nutritional status Socioeconomic situation Communications
Check list for implementing a survey Which population is to be assessed (country, region, ethnic group, etc.)? 2. What is the smallest unit to be assessed (camp, village, district)? 3. Is there a need to analyze subgroups (by sex, age, ethnicity)? 4. Which sampling method will be used (systematic, cluster)? 5. Which age groups ( 6-59 month, month 60100cm, 100cm 60-11-cm)? 60-11-cm 6. What will be the sample size?
Which indicators will be used (weight-forheight, oedema)? 8. What personnel, equipment, transport, number of teams, and resources will be needed? 9. Workload: how many children (cluster) per day per team? 10. Has a training schedule for field workers been prepared? 11. Who will conduct the training? Where? 12. Who will supervise the teams during the survey?
Will data be analyzed by hand and/or by computer? 14. Are computers and operators available? 15. Who is responsible for the logistics (e.g. transport, equipment, accommodation, information for target population, etc.)? 16. Who is responsible for report writing and interpretation of findings 17. Who is responsible for taking action on the reportâ€™s finding?
Selection of survey subjects • The target group for the survey are children (males & females ) age 6 - 59 months or height 60 – 100 cm why ? • In emergencies the only indicator to be used is weight for height
â€˘ In food emergencies ; older children ,pregnant and lactating women & elderly are considered as high risk group â€˘ The indicator is body mass index (kg/m 2 )
Sample selection â€˘ systematic random sampling: Used when: â€˘ population is concentrated in an organized or structured urban setting or in a refugee camp â€˘ total number of households is less than 10 000. 000
The recommended sample size is 450 children number of house holds to be visited )= 450/ (A x P A= average household size of persons P=average proportion of children of the right age/height in a population
example â€˘ If the average household size=6 persons &the proportion of children under 5 = 0,15 â€˘ number of house holds to be visited = 450/ ( 6 x 0,15 ) = 500
sampling interval â€˘ Sampling interval k = â€˘ Total no of household in the camp/ no of household required for the survey Eg 9000/500 = 18 Thus every 18th house hold is to be visited
Cluster sampling Is usual method for : • Large population • Scattered over a large area • Newly established camps (no of patient is roughly stimulated)
• The recommended sample size is 900 children (30 x 30) Steps: • Dived the area on a map into equal sections • Each section have at least 300 inhabitant
• A systematic sample of 30 clusters is drawn from a list of all sections • Cluster interval k= total no of sections/30 • Eg : if no of sections is 183 • The cluster interval =183/30 =6
Survey methodology • Weight for height is the only indicator • Boys and girls are treated separately • The data to be collected are weight, sex, oedema and age. - The assessment is limited to PEM
The standard deviation (z-score ) of a distribution is a measure of the width of the distribution around the mean. Children with weight for height -2 sd (-2 z_ score ) below the median of reference are called seriously or acutely malnourished
â€˘ -3 Z_scores below the median All children are critically ill and malnourished â€˘ Cases of oedema are counted as sever malnutrion.