RAPID SMART METHODOLOGY GNC Meeting, September th, 2014

What is Rapid SMART? To RAPIDLY measure the nutritional status:  Emergency programming  Limited time/access for data collection 2 A standardised and simplified field survey methodology which produces a snapshot of the current situation on the ground.

Rapid SMART Feasibility  Geographic area is clearly delimited (village, camps, settlements, urban slums, etc.) AND;  The target population is at maximum homogenous (shares the same living conditions, agro-ecological zone, etc.) Results are valid only after its representativeness, accuracy and precision are evaluated 3

 Indicators:  Advised to only measure anthropometry (mortality for the case of South Sudan).  Sample size:  Fixed sample sizes are used depending on the scope of the survey.  Time for data collection:  Should not take more than 1 week.  Data quality checks:  Still uses ENA for SMART for the Plausibility Check. 4 Key differences

 ONE settlement to assess (1 camp, 1 block of houses in city, 1 village etc.) and:  Population is less than 200 households  Exhaustive assessment of all eligible children.  Population is above 200 households  Select a random sample of children using simple or systematic random sampling  A sample size of 150 children would be enough to gather relatively meaningful prevalence.  Assume DEFF=1; Convert # children to # households Sample size: One Settlement

Expected GAMSample sizePrecision 20%150 children+/- 6.4% 15%150 children+/- 5.7% 10%150 children+/- 4.8% 5%150 children+/- 3.5%

 Cluster sampling must be used. At least 25 Clusters must be selected using PPS.  A sample size of 200 households (25 Clusters x 8 households) would be enough to gather relatively meaningful prevalence.  Assume DEFF=1.5; Convert # children to # households Sample size: > 1 Settlement Expected GAMSample sizePrecision 20%200 children+/- 7.1% 15%200 children+/- 6.3% 10%200 children+/- 5.3% 5%200 children+/- 3.9%

 4-5 Teams comprising of 2 surveyors with 3 days for training if a standardization test is needed.  Inclusion of children based on age:  Age of children between 6-59 months determined by official documents or events calendar.  Variables: Age, Sex, MUAC, Edema, weight and height  1 week maximum to complete a Rapid SMART  Even shorter if 2 Clusters per day can be done.  Same recommendations for Reserve Clusters. 8 Data Collection

Pilot Tests – only with MUAC 9 CountryInclusion Criteria Clusters Planned Second Stage Sampling Additional Variables 1Afghanistan Age (6-59 months)25 Simple or SystematicNone 2Afghanistan Height (65 to 110)25 Simple or SystematicNone 3India Height25SystematicNone 4India Height (60 to 110)25SystematicNone 5India Height (60 to 110)25SystematicNone 6Madagascar Height (60 to 110)25Modified EPI Measles Vaccination, Vitamin A, Sickness 7Myanmar Height25Modified EPINone 8Myanmar Height23Modified EPINone

Rapid SMARTSMART Design 201 children 97 households 25 clusters x 8 households 575 children 570 households Desired precision (±3%), design effect (1.7), prevalence (7.9%) 30 clusters x 18 households Achieved 329 children surveyed Visited 396 households 473 children surveyed Both estimated average household size: (9.7), children U5 ( 15.6) Non Response (8%)  A SMART survey and a Rapid SMART were conducted concurrently in Kabul, Afghanistan in November 2012  Independent selection of the sample. SMART vs. Rapid SMART

Similar Sampling Procedures Rapid SMARTSMART SMART two-stage cluster sampling method Selected 25 clusters using PPS method Simple random sampling where household listing could be done quickly i.e. ≤50 households Systematic sampling for clusters where listing was not feasible SMART two-stage cluster sampling method Selected 30 using PPS method 3 clusters inaccessible; used reserve clusters (3 of 4 accessible) Simple random sampling where household listing could be done quickly i.e. ≤50 households Systematic sampling for clusters where listing was not feasible

Variables Included Rapid SMARTSMART Age Sex MUAC Bilateral oedema Age Sex MUAC Bilateral oedema Weight Height Vitamin A Measles vaccination Mortality (census)

Time / Logistics Required Rapid SMARTSMART Training: 1-day training session (Nov. 26) Data collection: 2-day data collection (Nov ) Staffing 5 teams x 2 people each Training: 5-day training Data collection: 5-day data collection (Nov ) Staffing 6 teams x 4 people each  Rapid SMART completed in 3 days

Representativeness Rapid SMARTSMART Sample Sex Ratio Age Ratio: 6-29 months to months  Sex ratio for sampling was very similar for SMART and Rapid SMART  Age ratio for Rapid SMART was imbalanced  Underrepresentation of age group of 6 to 29 months.

Survey Results GAM Rapid SMARTSMART MUAC (6-59 months)4.6% ( )5.4% ( ) MUAC ( cm)4.3% ( )4.3% ( ) SAM MUAC (6-59 months)0.4% ( )0.7% ( ) MUAC ( cm)0.3% ( )0.5% ( ) The GAM and SAM prevalence estimates from the Rapid SMART are similar to the findings of the SMART survey Non-significant differences in confidence intervals

Case of South Sudan  Based on the IPC workshop outcome and analysis in May 2014 recommendation Urgently work with relevant agencies and clusters to ensure that nutrition, mortality and morbidity data needed for the IPC are being consistently collected. Standardized validation process with ACF and CDC.  Why Rapid SMART?  Sustained conflict in the target Counties  Constrained Humanitarian access (flooding, security, Limited time, Logistics challenges…) 16

 Based on the IPC, certain counties were prioritized.  3 rounds of surveys in Leer, Mayendit and Fashoda during July, Sept and Nov  Anthropometry:  250 households (25 Clusters x 10 households).  Mortality:  420 households (30 Clusters x 14 households). Survey Design: With Mortality

Round 1 Rapid SMART Results CountyDateSettlementClusters Planned 2 nd stage sampling Modules Covered LeerJune 24-29Rural25SystematicAnthropometry MayenditJuly 15-27Rural25SystematicAnthropometry FashodaAug 9-19Rural25SystematicAnthropometry & Mortality 18 CountyChildren (Measured) Plausibility Score GAM Results Leer42513% 34.1% ( ,95 % CI) Mayendit4109% 16.9% ( ,95 % CI)

Round 2 Rapid SMART  Expected / tentative SET planning:  Leer round 2 from 5th to 12th of Sept  Mayendit round 2 from 17th to 23rd of Sept  Fashoda round 2 form 8th to 16th of Oct 19

20 ACF-CA: SMART Project Convenor The SMART Project at ACF-CA, a core member of the GNC, in collaboration with the SMART Technical Advisory Group and Centers for Disease Control and Prevention (CDC Atlanta) establishes and maintains:  New training curriculums of field tools for survey managers and surveyors  Newly re-vamped SMART website.  Partnerships with other agencies in trainings & survey support.