MICS4 Survey Design Workshop Multiple Indicator Cluster Surveys Survey Design Workshop Questionnaire for Children Under Five: Anthropometry

MICS4 Survey Design Workshop Background One-third of global child deaths attributable to malnutrition Millennium Development Goal (MDG) Goal 1: Eradicate extreme poverty and hunger Target 1C: Halve, between 1990 and 2015, the proportion of people who suffer from hunger Indicator 1.8: Prevalence of underweight children under-five years of age World Fit for Children Goal: Between , reduction of child malnutrition among children under 5 years by at least one third

MICS4 Survey Design Workshop Anthropometry Data Requirements –Height –Weight –Sex (male or female) –Age in months

MICS4 Survey Design Workshop Child Nutritional Status Indicators Compared against the international reference population, proportion (%) under fives who are # 2.1a & 2.1b - Underweight (low weight-for-age, <-2 SD) and severely underweight (<-3 SD) # 2.2a & 2.2b - Stunted (low height-for-age, <-2 SD) and severely stunted (<-3 SD) # 2.3a & 2.3b - Wasted (low weight-for-height, <-2 SD) and severely wasted (<-3 SD)

MICS4 Survey Design Workshop International Reference Population The WHO Child Growth Standards (2006) Currently recommended The NCHS/WHO/CDC reference population (1978) Previously used The change in reference population will not affect the way we measure, just the way we analyze and report.

MICS4 Survey Design Workshop Anthropometry Module Purpose Assess prevalence of malnutrition in children under 5 years Eligibility All children under 5 years Data collection Each team will have a dedicated measurer, special equipment

MICS4 Survey Design Workshop Equipment Weight scales: Seca 874 U electronic scale 150 kilo capacity, precision of 100 grams Height/length boards: Wooden child measuring board (UNICEF supply catalogue) 130 centimeter capacity

MICS4 Survey Design Workshop Personnel Measurer (one per team) Assistant (all field staff trained) Training Classroom Clinic, daycare, nursery Field practice Standardization exercise Good training & practice ensure high quality data!

MICS4 Survey Design Workshop Weight measurement Remove clothing, underpants okay Weighing children If child cannot stand, mother holds child If child can stand, stands on scale Do weigh children with missing limbs or cast, but do not record result (just note in margin)

MICS4 Survey Design Workshop Height measurement, part 1 Height versus length measurement Lying down: <2 years (if age unknown, <85 cm) Standing up: >2 years (if age unknown, >85 cm) Other considerations If child has a physical deformity, measure but do not record result; note in margin Beware of hairstyles that affect measurement -- undo

MICS4 Survey Design Workshop Height measurement, part 2 Be quick and calm! Start with older children Clear area Safety – both hands to guide/support child, pen and questionnaire on ground

MICS4 Survey Design Workshop

Other issues Timing: Take measurements after under-five questionnaire interview Equipment: New equipment is recommended; ensure that old equipment is field-ready before use Proper care of equipment is essential for accurate results Each team should have cleaning fluid, paper towels

MICS4 Survey Design Workshop Oedema Retention of fluid in the tissues of the body; sign of kwashiorkor, a form of severe acute malnutrition Oedema new in MICS4; only include if appropriate Calculation of indicators will not change

MICS4 Survey Design Workshop Prepared by: Holly Newby Statistics and Monitoring Section UNICEF/New York