Nutritional surveillance

The status of a population over a period of time. A continuing surveillance system in the prone to
disaster (e.g. drought) area will greatly facilitate assessments in any future disaster. It will also
indicate when sup- plementary feeding may be phased out, and subsequently relapse into
malnutrition. Surveillance involves the systematic collection and analysis of :

 data from periodic nutritional surveys

 results of periodic screening .
 reports from supplementary and therapeutic feeding centres and health clinics
 morbidity and mortality data.

Information on food distributions and on developments in such areas as agricul- tural production
and employment among the affected populations should also be collected and considered in
parallel with nutritional data

Priodic nutritional surveys

A comparison of nutritional survey results obtained at different times will show trends in the
nutritional status of a population. However, valid comparison re- quires the use of standardized
survey methods and sampling techniques (see Annex 4).
Baseline data indicating the usual nutritional status of the population are important as a basis for
comparison, but may not always be available at the beginning of an emergency. Compa can re in
evaluation of the effectiveness of food and nutrition relief operations. A mea- sure of variance
(SD or standard error of the mean) of each successive survey is therefore desirable, so that the
statistical significance of apparent differences between populations, or within the same
population over time, can be assessed.

risons between data from successive surveys veal whether nutritional status is worsening or
improving, and can help Comparisons between several sets of measurements taken at different
times from the same community must be interpreted with caution. Many severely malnourished
children die in nutritional emergencies, leaving fewer children to be counted as malnourished in
later surveys. A declining malnutrition rate may thus be due to a high death rate among the
severely malnourished rather than to any improvement in the nutritional situation. Similarly,
improvements in nutritional conditions in spite of an inefficient food relief programme might be
the result of seasonal or economic factors.

The findings of a series of surveys should always be compared with mortality data gathered
between survey dates and with other available information (such as morbidity data, especially in
epidemics) relevant to health and socioeconomic conditions .

Periodic screenings

Body measurement data collected during periodic screenings of vulnerable groups (for eligibility
for special food assistance) can be used to produce "nutritional profiles" of the populations
screened. These profiles may indicate whether the proportion of malnourished individuals is
changing, and in what way. However, even small differences in the procedure used during
screening may result in different groups of people attending. A screening held early in the
morning is likely to attract a different group from a screening held at midday, because peo- ple
are engaged in different activities. Resulting variations can be large and can give rise to
erroneous conclusions. Moreover, if only a part of the population is screened it is unlikely to be
representative of the whole population.

Systematic checking of indicators other than body measurements during screen- ing can also
provide useful data, provided that they are interpreted with due care. Data may include oedema
rates and signs of specific mineral and vitamin deficiencies. Because organization of screening
sessions is likely to take up con- siderable amounts of time, several such indicators should be
checked during each session whenever possible.

Records from supplementary and therapeutic feeding centres and health clinics

Data collected weekly at selective feeding centres, fixed health facilities, and maternal and child
health centres- such as the number of individuals attend- ing for health care or nutritional relief
and the nature of their problems- can give a rough idea of change in the nutritional health of the
affected population and particular vulnerable groups. Such data should be used with caution:
they are not wholly representative, although they can provide an indication of changes that may
be occurring in the overall population. They do, however, give a good picture of which members
of the population feel they need nutritional attention, for whatever reason, and are physically able
to attend nutrition clinics (e.g. live within walking distance).

Local auxiliary personnel can be recruited and trained to gather data for the surveillance of
simple signs and symptoms of malnutrition at village or camp level. Training might be organized
as follows:

1 day : major signs of PEM (wasting, oedema) investigation of anaemia and night
blindness diagnosis of major eye lesions due to vitamin A deficiency clinical signs of
other mineral and vitamin deficiencies organizing the collection of information
 1 day : practice in measuring weight (and/or arm circumference) and height, and
recording, analysing, interpreting, and reporting results
 1 day : field test; a simple survey - data collection, analysis, presentation.

Health surveillance

Apart from the strictly nutritional data gathered by surveillance, there is both an initial and a
continuing need for health information of a broader nature. In emergencies affecting large and
stable populations much of this information may already be available, but for newly created
communities, such as those of refu- gees and displaced persons, a broad needs assessment is
generally required followed by the establishment of a new health information system.
The initial assessment must first establish the population that is affected-the number of people
and their location and living conditions. This is necessary both for the proper planning of rations
and other services and facilities, and for calcu- lating mortality rate, which is an important
indicator of the adequacy of any rehabilitation programme. Methods of assessment include the
following:

 Ideally,census or registration of individuals on arrival in a location. This is not always

feasible, and information requires periodic updating.
 Aerial photography combined with household surveys to estimate the average number of
people and their age distribution (in 5-year brackets) per house shelter
 Mapping of camps and estimation of total population by identifying zones of high,
medium, and low density, and counting the people in several squares (e.g. 100 m x 100
m) in each zone.
 In an immunization programme, counting the number of children under 5 years of age
immunized. Estimating the percentage coverage in the community lows the number of
children under 5 years and-by extrapolation-the total population to be estimated.