1. Kakuma Nutrition Survey November 2012 Training Day 2

2. Today’s schedule  Recap day 1  Team roles  Household visits  Household member listing  Food security section  WASH section  Anaemia section  Mosquito net section  Sampling procedure  Survey logistics (to come later)

3. Team roles WEIGHT HEIGHT ASSISTANT MEASURER HB CHILD IYCF WOMAN WASH MALARIA FOOD SECURITY Team of 5 One team leader (not phone holder)

4. Team household visits MALARIA FOOD SECURITY CHILD IYCF Household questions Individual questions WOMAN CHILD IYCF WOMAN WASH MALARIA FOOD SECURITY WASH CHILD IYCF + equipment

5. Household member listing  To keep track of household members  Name, age, gender  Use birth certificates, events calendar and other relevant documents  Tick off when household member has been investigated

6. Food security  To investigate: Access to food distribution and duration of the general food ration Use of negative coping strategies Level of household dietary diversity  Logistics: Interview the person who is most involved in food preparation in the household Really important to word questions exactly as they are written – even if you have to repeat it When was the last full (i.e. completed) cycle of the GFD ration?

7. Food security – key information  Ask about ALL foods eaten and beverage consumed, inside or outside house, during previous day and night by ANY member of the HH Includes all meals and snacks All foods in mixed dishes should be recalled individually (apart from e.g. bread and other basic foods)  Foods consumed by only one member of the household and not by the others are still recorded.  No need to set minimum quantities for foods (e.g. small piece of meat)

8. Food security – common errors  Respondents feel embarrassed to answer questions  Respondents do not understand the questions or the information is too difficult to report  Confusion around the cycle being discussed  Respondent is uncomfortable with questions on coping strategies Take the time to be clear, patient and reaffirm the confidentiality of the survey

9. Food security  Role play exercise 1 In individual teams with a coordinator Please practice the dietary recall questionnaire and recording answers  Role play exercise 2 Two paired interview teams Please go through the questionnaire according to scenarios given by the coordinator

10. Food security – training test 1. When was the first day of the general food distribution we are investigating? 2. What do you do if the respondent says that they lost their ration card? 3. What do you do if the respondent says that they don’t know how long the ration lasted. 4. If only one member of the household used a negative coping strategy over the last month, should I write ‘yes’ as a response option? 5. Who should the respondent be for the dietary recall? 6. When asking about all foods eaten and beverages consumed inside the home, what is the recall period to use? 7.In the dietary recall, do all meals and snacks count? 8. If a certain food was only consumed by one household member, should it be recorded on the questionnaire? 9. Should foods consumed outside the home that were not prepared in the home be included? 10. Is there a need to set a minimum quantity of food below which foods are not considered?

11. Food security – training test ANSWERS 1. When was the first day of the general food distribution we are investigating? Answer: Add date for the recall. 2. What do you do if the respondent says that they lost their ration card? Answer: Record it as lost in FS2. 3. What do you do if the respondent says that they don’t know how long the ration lasted. Answer: Probe and explain the question in a different way. 4. If only one member of the household used a negative coping strategy over the last month, should I write ‘yes’ as a response option? Answer: Yes 5. Who should the respondent be for the dietary recall? Answer: The main caregiver responsible for cooking the meals in the household 6. When asking about all foods eaten and beverages consumed inside the home, what is the recall period to use? Answer: 24 hours or yesterday during the day and at night. 7. In the dietary recall, do all meals and snacks count? Answer: Yes 8. If a certain food was only consumed by one household member, should it be recorded on the questionnaire? Answer: Yes 9. Should foods consumed outside the home that were not prepared in the home be included? Answer: Yes 10. Is there a need to set a minimum quantity of food below which foods are not considered? Answer: No

12. WASH  Objective: To investigate water and sanitation activities  Use of an adequate quantity of water  Access to an improved drinking water source  Safe excreta disposal practices  Logistics: Interview the mothers or the main caretaker of young children (and look at the facilities yourself if necessary) Please ask questions exactly as written! Take care to be polite when asking where drinking water is stored  Administered to the household even if there is no child for the nutrition survey Every household to be surveyed for WASH

13. WASH – on the spot question  What is the capacity of the following? ABC D (Big and small one)

14. WASH: Answers 15 litres A B C D 200 litres 15 litres 10 litres Large: 20 litres Small: 10litres

15. WASH – role play  Role play 1 Coordinator = respondent Teams to ask questions to the respondent  Role play 2 Take in turns between teams to be the respondent and the surveyor Take notes on potential problem areas and give feedback to your colleagues

16. Anaemia  6-59 and non- pregnant women (including lactating)  Referrals for severely anaemic cases 6-59: <7.0 g/dl Women: <8.0 g/dl

17. BELOW: HemoCue Hb 301 Analyser, microcuvettes, carry case, and safety lancets HemoCue

18. Anaemia – most common errors Not setting up properly Removing microcuvette from container with fingers wet with alcohol Underfilling the microcuvette Mixing alcohol with blood drop Shallow finger puncture Obstructing blood flow ‘Milking’ the finger Using the 1 st drop of blood Air bubbles in microcuvette ‘Topping off’ the microcuvette Blood on outside of microcuvette Inadequate placement of the microcuvette Not referring the severely anaemic subjects according to local treatment standards

19. BREAK

20. Referral exercise – 15 mins  Exercise

21. Mosquito net  Objective: To assess the level of ownership and utilisation of mosquito nets amongst all household members, including children under 5 and pregnant women  Logistics: Interview the head of household (male or female) or a responsible adult in absence Make a list of the number of mosquito nets available for sleeping under and the household members who normally sleep there. The type of mosquito net (LLIN, conventional) is determined by observation of the net and its brand name and manufacturer on the tag.

22. These are some of the tags you might see. In addition you might see: SUPANET NETTO others?

23. Mosquito - Questions 1 What do you do if a respondent will not allow you into their house to see their mosquito nets? 2 What do you do if the number of mosquito nets the respondent reports does not equal the number of mosquito nets found in their household? 3 What do you do if you find mosquito nets in the household that are still in their packaging? 4 How do you identify a mosquito net as an LLIN or NOT? 5 Are mosquito nets that are being used for another purpose: fencing, fishing, covering their plants; considered for inclusion in total number of mosquito nets in the household? Yes or No 6 Are households that do not have any mosquito nets included in this survey? Yes or No 7 What do you do if there are more than 4 mosquito nets found in a household?. 8 What key information can you provide to the household on mosquito net use before moving on to the next household?

24. Mosquito – Answers (1) 1 What do you do if a respondent will not allow you into their house to see their mosquito nets? Answer: Ask the respondent to bring the nets outside for you to look at. 2 What do you do if the number of mosquito nets the respondent reports does not equal the number of mosquito nets found in their household? Answer: Probe to see the additional nets if the number seen is less than the number reported. Adjust the number of mosquito nets reported if additional nets are found when in the household. 3 What do you do if you find mosquito nets in the household that are still in their packaging? Answer: These nets should be considered as mosquito nets that can be slept under and should be counted in the total number of mosquito nets in the household that can be slept under (questions M1-M6) 4 How do you identify a mosquito net as an LLIN or NOT? Answer: Find the manufacturers TAG on the mosquito net and record the brand name and manufacturer’s information. CompareSupervisors will compare this to the WHOPES listing of approved LLINs.

25. Mosquito – Answers (2) 5 Are mosquito nets that are being used for another purpose: fencing, fishing, covering their plants; considered for inclusion in total number of mosquito nets in the household? Answer: NO, because they cannot be used for sleeping under. 6 Are households that do not have any mosquito nets included in this survey? Answer: Yes 7 What do you do if there are more than 4 mosquito nets found in a household?. Answer: Use a supplementary mosquito net questionnaire. 8 What key information can you provide to the household on mosquito net use before moving on to the next household? Answer: Repair your nets if there are holes. Hang and use your net every night. Pregnant women and children under 5 are the most at risk of illness and death. Provide a leaflet if available.

26. SAMPLING

27. Review of sampling procedure  Two stage cluster sampling X blocks are preselected as clusters Within each block, X households will be randomly selected by survey team on the day of data collection  Sampling EPI method Path method Household list etc

28. Sampling procedure - EPI method X = 5 houses Cluster Location 1 2 3 4 5

29. EPI method Randomly select one house to start at by lottery Choose others by proximity; visit every house to the LEFT until sample household number is reached

30. Sampling procedure – path method  After arrival in block, walk around the edge of the block while counting all the roads leading into the block. Give each road a number: 1, 2, 3, etc.  When you are back at where you started you randomly select one of the roads leading into the block. For this, put number notes in a container and randomly pick one note.  Start where the selected road number starts at the edge of the block. Walk into the block counting every household on both sides of the road and give them a number. When road ends, randomly select one number using same method as before.  Start your survey at the selected household number.  For the next households, always choose the nearest door to your LEFT when exiting the current household.