1. Food and Nutrition Surveillance and Response in Emergencies
Session 11
Nutritional Assessment and Analyses

2. Main Nutritional Assessment Methods
Anthropometry: wt, ht, MUAC, (mainly for <5yrs since they are sensitive to factors influencing nutritional status-illness/ food
Biochemical Methods
Clinical Assessment
Dietary Methods

3. Nutritional Surveillance
Is the process of monitoring changes in the nutritional status of a population over a period of time.
Nutrition surveillance involves Data collection, processing, Analyses, Interpretation and Communication

4. Purpose of nutritional Surveillance
Nutrition data is a vital indicator for the overall health and welfare of populations especially where regular demographic and health surveys are lacking.
Surveillance data is critical for making decisions that will assist in improved nutrition outcomes of a population e.g. when to start or phase out a nutrition intervention such as supplementary feeding program.
Nutrition data can be used in crisis mitigation especially as an early warning indicator to respond to threats such as droughts or disease outbreaks.

5. Data collected assists in providing baseline information on nutrition, socio-economic factors, demographic characteristics, food security and cultural aspects of a population
Information is important for decision making on program planning, management, monitoring and evaluation

6. Type of data Quantitative: numeric
Qualitative: Narrative (to supplement the quantitative data) – FGD, formal (in-depth) and informal interviews of key informants, case studies, observation,

7. Principle Users
Communities involved in the design, planning and management of nutrition related programs
Government authorities and Non Governmental Organizations supporting food security, health and nutrition related programs

8. Food Aid agencies e.g. WFP, CARE
Donors
Industries addressing nutrition and health related issues

9. Nutrition Surveillance in Somalia by FSAU utilizes diverse range of information sources to develop an efficient and effective nutrition surveillance system. These are, nutrition surveys, health facilities, rapid assessment, and sentinel sites.

10. A nutritional survey is a method by which information is obtained concerning the nutritional status of a population or a subgroup. Such information is collected by asking nutrition related questions in an interview to a representative sample of the population.

11. Steps in conducting survey
Planning the survey
Administering the survey: partner contacts, training and tool pre-testing, data collection, data management, report and presentation (quality control maintained in all steps).

12. Planning Survey
A review of the existing information related to the anticipated survey area
Identify survey goals and objectives:
Identify survey indicators
Selecting survey methodology
Select survey sample

13. Survey plan (cont’) Liaising with partners: roles & responsibilities
Data collection tools and instrument
Pre-testing the tools
Data collection
NB: quality control ensured at all levels

14. Typical survey designs include:
Longitudinal survey: data is collected for the same population over a long period of time. Longitudinal studies are useful in establishing trends over a long period of time
Cross-sectional surveys: This is one of the commonly used survey designs that looks into population issues at a given point in time.
In emergency: Cross sectional survey mainly used.

15. Sampling methods are: Two Stage Cluster sampling Random sampling
Systematic sampling
Stratified sampling

16. When to conduct Survey
At the beginning of a nutrition project cycle to provide baseline information for program formulation
During initial phase of emergency situation to measure nutritional status and plan a short term response
During the course of the nutrition program to assess and monitor the impact

17. monitor progress (regular monitoring of the situation)
At the end of the project circle to evaluate its extent and impact
Any other time deemed necessary to establish a baseline.

18. Type of info. in surveys Demographic – HH details, residential status
Socio-economic issues: income, food source, coping strategies, water source, hygiene
Anthropometric measurements
Intervention coverage
Morbidity
Food consumption
Mortality

19. Quality control measures
Thorough training of staff plus pre-testing of tools (interpretation of the questionnaires, if necessary)
Standardization tests- Intra-personal/ interpersonal errors
Close monitoring of the field work by qualified persons
Cross-checking of the field questionnaires for anomaly daily
Daily review of enumerator experiences and problems
Progress review per plan and by checklist
Data cleaning: collection, entry,
Integrity of equipments: maintain accuracy using known weights

20. Health Facility
Summary of anthropometric measurements of <5yrs, morbidity and EPI from MCH collected
The MCH are located in vast vulnerable area
Data collected from it serve as early indicator in case of crises.
HF data indicates trends in malnutrition rates over a period of time
N.B. Data from HF is not representative of the entire population and it’s biased since only the sick or those who can access the health facility are assessed

21. Key issues in site based surveillance
Importance of carrying out surveillance
Anthropometric data- quality of data/integrity of equipment and staff quality
Recording and interpreting measurements
Clinical diagnosis: obvious micronutrient deficiency- VAD, anaemia, IDD
Causes of malnutrition

22. Rapid Assessment Mainly carried out on ad hoc bases. Useful when:
When nutrition information are fast needed
When resources of carrying out Nutrition survey are limited.
MUAC is usually used. Additional methods include: FGD, Key informant interview, observation (transect walks), seasonal calendars and Case study.

23. Steps in planning a rapid assessment
Define objectives (who to assess-children, women, why),
Determine target site/area/population
Develop appropriate method of data collection: representative
Staff identification and training (involve the existing authority)
Materials and equipment

24. Type of information MUAC measurements: adults (women), <5yr
Food availability and accessibility
Water sources
Common diseases- how are recent trends
Access to health services/ other interventions
Livestock and population movement- destinations/ origin of emigrants
Type of food consumed/freq. of feeding
Security situation