Model nutrition assessment report

(based on the Save the Children Fund emergency nutrition assessment handbook)

Report of Nutrition and Mortality in (region, camp etc) of

(country) during (date to date).

(Date of report)

(Name of responsible authors)

Summary of the report (one to two pages only)

· area surveyed
· date of survey
· methodology employed
· main anthropometric results (prevalence of global and severe acute malnutrition in
terms of z-scores and/or oedema and 95 per cent confidence intervals)
GAM: #02-03 % (#02-04 - #02-05 95% C.I.)
SAM : #02-11 % (#02-12 - #02-13 95% C.I.)
· mortality rates (CMR and U5MR and 95 per cent confidence intervals)
CMR: #09-01 (95% CI)
U5MR: #09-02 (95% CI)
· other important results (vaccination rates etc)
· explanation of the causes of malnutrition in the area
· recommendations.

1. Introduction

Description of survey area

· survey area
· name of village/district/region/country
· name of nearest large town/city — administrative centre.

Population data
· number of people living in survey area
· population density
· ethnic group.

Geography of area
· town/camp/rural, etc

1
 · altitude/mountainous/flat, etc
· total area (hectares).

Way in which people live

· information on food economy if available
· agriculturalists/pastoralists/agro-pastoralists/refugees/merchants, etc
· type of land farmed or animals kept.

Any important political/security information

· if refugees, how long have they been there?
· any instability in the area?

Services available
· health
· education
· markets, roads.

Assistance received by the population

· relief programmes in area
· number of people on food aid, etc
· other initiatives.

1.2 Survey Objectives

For example,
· estimate the prevalence of acute malnutrition
· estimate retrospective mortality rates
· understand the causes of malnutrition
· (estimate the coverage of a feeding programme)
· make recommendations for a programme.

2. Methodology

2.1 Survey Methodology

General approach
· type of sampling (for example, 3030 cluster)
· age of children measured
· number of children measured
· number of households visited for the mortality survey
· date of survey.

2.2 Sampling procedure and sample size for anthropometric data

How did you choose the children?
· What sampling methodology did you chose? Why?
· How did you calculate the sample size? (show the sample size calculation)
· What population figures did you get and from whom (for example, village level
population figures from district council)?
· How did you calculate the sampling interval? (for example, the cumulative population
was calculated and a sampling interval determined)
· How did you assign the clusters? (for example, 30 clusters were randomly selected by
assigning probability proportional to population size)

2
 · Did you alter the method from the standard method at all (for example, because of
insecurity, etc)?
· Describe any changes to the selection of the clusters during the survey.

2.3 Sampling procedure and sample size for the mortality data
· What sampling methodology did you chose? Why?
· How did you calculate the sample size? (show the sample size calculation)
· Did you alter the method from the standard method at all (for example, because of
insecurity, etc)?
· Describe any changes to the selection of the clusters during the survey.

2.4 Selection of households and children

How did you choose the households and children within a cluster?
· Where was the starting place? (Middle of the villages? Or did you randomly chose a
village within a district and start in the middle of the village?)
· How did you choose the direction to follow? (spin a pen?)
· Did you walk to the end of the village/district and count the houses?
· How did you choose subsequent houses?

How did you choose children within the houses?

· Did you measure all children aged 6-59 months in the houses selected?
· If age was unknown, how did you decide whether or not to measure children?
· What happened when a child was away?
· Did you measure all children in the last house?

2.5 Training and supervision

Training
· Who was trained?
· Who did the training?
· What did the training cover (survey design, anthropometric measurements, signs and
symptoms of malnutrition, data collection and interview skills)?
· Did the survey teams measure children and compare their results? (inter-observer
error)?

Pilot survey
· Was there a practice/pilot survey?
· Who supervised the teams during the practice survey?
· Were data collection forms piloted during the practice survey and changes made to
them if necessary?

Supervision during the survey

· Who supervised the teams (a nutritionist, a nurse or someone else)?
· How many times did the supervisor visit the teams?
· Who were the team leaders, were they experienced?

2.6 Data collected

2.5.1 Children’s data

Anthropometric data
· age (proxy heights used for age)
· weight (type of scales used, precision of measurement)

3
 · height (type of height board used, how children were measured (standing-up/lying
down/both), precision of measurement)
· oedema (how did you define oedema?).

Retrospective morbidity of children

· Who did you ask about the children’s illnesses?
· Over how long were questions about illness asked?
· How did you define illness if you used a questionnaire?

Vaccination status and coverage

· How did you check for vaccinations?
· Did you look at MCH cards?

Programme coverage
· How did you assess this?
· What did you do if you found a malnourished child who was not registered?

2.6.2 Mortality data

Retrospective mortality (under five and total population)
· What type of questionnaire/recall method did use to estimate mortality rates?
· In which households did you use the mortality questionnaires?
· Over how long did you estimate mortality (number of months)? How long was the
recall period?
· Did you categorise deaths by age?
· Did you record cause of death? How did you define causes?

2.6.3 Causes data

Secondary data on the causes of malnutrition
· What sources did you get your secondary data from?

Primary data on the causes of malnutrition

· How were the key informant and focus group discussion topics developed?
· Were the questionnaires adjusted after the practice survey?
· What kind of data did you collect in the key informant questionnaires?
· Who did you ask the questions to (community leaders, women, etc)?
· Did you visit any Government officials? Who? For what information? Any other
NGOs?
· What observations were made?
· Did you use a household questionnaire?
· How were the household questionnaires developed?
· Were the questionnaires adjusted after the practice survey?
· What kind of data did you collect in the household questionnaires?
· Who did you ask the questions to (how many households, which people in the
household)?

2.7 Data analysis

· How did you analyse the data? (qualitative and quantitative)
· What type of computer programme did you use or did you do it by hand?

4
3. Results

3.1 Anthropometric results: children

Definitions of acute malnutrition should be given (for example, global acute malnutrition is
defined as <-2 z scores weight-for-height and/or oedema, severe acute malnutrition is defined as <-
3z scores weight-for-height and/or oedema)

Table 3.1: Distribution of age and sex of sample

Boys Girls Total Ratio

no. % no. % no. % Boy:girl
#age01 #01-01 #01-02 #01-03 #01-04 #01-05 #01-06 #01-07
months
#age02 #01-08 #01-09 #01-10 #01-11 #01-12 #01-13 #01-14
months
#age03 #01-15 #01-16 #01-17 #01-18 #01-19 #01-20 #01-21
months
#age04 #01-22 #01-23 #01-24 #01-25 #01-26 #01-27 #01-28
months
#age05 #01-29 #01-30 #01-31 #01-32 #01-33 #01-34 #01-35
months
Total #01-36 #01-37 #01-38 #01-39 #01-40 #01-41 #01-42

Figure 3.1: Population age and sex pyramid

Error: Reference source not found

Table 3.2: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema)
and by sex

All Boys Girls

n = #02-01 n = #04-01 n = #05-01
Prevalence of global malnutrition (#02-02) #02- (#04-02) #04- (#05-02) #05-
(<-2 z-score and/or oedema) 03 % 03 % 03 %
(#02-04 - #02- (#04-04 - #04- (#05-04 - #05-
05 95% C.I.) 05 95% C.I.) 05 95% C.I.)
Prevalence of moderate malnutrition (#02-06) #02- (#04-06) #04- (#05-06) #05-
(<-2 z-score and >=-3 z-score, no 07 % 07 % 07 %
oedema) (#02-08 - #02- (#04-08 - #04- (#05-08 - #05-
09 95% C.I.) 09 95% C.I.) 09 95% C.I.)
Prevalence of severe malnutrition (#02-10) #02- (#04-10) #04- (#05-10) #05-
(<-3 z-score and/or oedema) 11 % 11 % 11 %
(#02-12 - #02- (#04-12 - #04- (#05-12 - #05-
13 95% C.I.) 13 95% C.I.) 13 95% C.I.)
The prevalence of oedema is #02-14 %

5
Table 3.3: Prevalence of acute malnutrition by age based on weight-for-height z-scores and/or
oedema

Severe wasting Moderate Normal Oedema

(<-3 z-score) wasting (> = -2 z score)
(>= -3 and <-2 z-
score )
Age Total No. % No. % No. % No. %
(mths) no.
#age01 #03- #03-02 #03-03 #03-04 #03-05 #03-06 #03-07 #03-08 #03-09
01
#age02 #03- #03-11 #03-12 #03-13 #03-14 #03-15 #03-16 #03-17 #03-18
10
#age03 #03- #03-20 #03-21 #03-22 #03-23 #03-24 #03-25 #03-26 #03-27
19
#age04 #03- #03-29 #03-30 #03-31 #03-32 #03-33 #03-34 #03-35 #03-36
28
#age05 #03- #03-38 #03-39 #03-40 #03-41 #03-42 #03-43 #03-44 #03-45
37
Total #03- #03-47 #03-48 #03-49 #03-50 #03-51 #03-52 #03-53 #03-54
46

Table 3.4: Distribution of acute malnutrition and oedema based on weight-for-height z-scores

<-3 z-score >=-3 z-score

Oedema present Marasmic kwashiorkor Kwashiorkor
No. #06-01 No. #06-03
(#06-02 %) (#06-04 %)
Oedema absent Marasmic Normal
No. #06-05 No. #06-07
(#06-06 %) (#06-08 %)

Table 3.5: Prevalence of acute malnutrition based on the percentage of the median and/or oedema

n = #07-01
Prevalence of global acute malnutrition (#07-02) #07-03 %
(<80% and/or oedema) (#07-04 - #07-05
95% C.I.)
Prevalence of moderate acute malnutrition (#07-06) #07-07 %
(<80% and >= 70%, no oedema) (#07-08 - #07-09
95% C.I.)
Prevalence of severe acute malnutrition (#07-10) #07-11 %
(<70% and/or oedema) (#07-12 - #07-13
95% C.I.)

Table 3.6: Prevalence of malnutrition by age, based on weight-for-height percentage of the

median and oedema

Severe wasting Moderate Normal Oedema

(<70% median) wasting (> =80%
(>=70% and median)
<80% median)

6
 Age Total No. % No. % No. % No. %
(mths) no.
#age01 #08- #08-02 #08-03 #08-04 #08-05 #08-06 #08-07 #08-08 #08-09
01
#age02 #08- #08-11 #08-12 #08-13 #08-14 #08-15 #08-16 #08-17 #08-18
10
#age03 #08- #08-20 #08-21 #08-22 #08-23 #08-24 #08-25 #08-26 #08-27
19
#age04 #08- #08-29 #08-30 #08-31 #08-32 #08-33 #08-34 #08-35 #08-36
28
#age05 #08- #08-38 #08-39 #08-40 #08-41 #08-42 #08-43 #08-44 #08-45
37
Total #08- #08-47 #08-48 #08-49 #08-50 #08-51 #08-52 #08-53 #08-54
46

3.2 Mortality results (retrospective over x months/days prior to interview)

Table 3.8: Mortality rates

CMR (total deaths/10,000 people / day): #09-01 (95% CI)

U5MR (deaths in children under five/10,000 children under five / day): #09-02 (95% CI)

Report the main causes of death as given by the MoH and the community leaders.

The mean household size is calculated as … (mode =, range )

3.3 Children’s morbidity

If you have collected data on children’s morbidity using a household questionnaire then you
should present in the format shown below.

Table 3.9: Prevalence of reported illness in children in the two weeks prior to interview (n=)

6-59 months
Prevalence of reported illness %

Table 3.10: Symptom breakdown in the children in the two weeks prior to interview (n=)

6-59 months
Diarrhoea %
Cough %
Fever %
Measles %
Other %

3.4 Vaccination Results

Table 3.11: Vaccination coverage: BCG for 6-59 months and measles for 9-59 months

BCG Measles Measles

7
 n= (with card) (with card or confirmation from
n= mother)
n=
YES (No.) % (No.) % (No.) %
(95% C.I.) (95% C.I.) (95% C.I.)

3.5 Programme coverage

Programme type
Supplementary feeding programme coverage %
(95% C.I.)
Therapeutic feeding programme coverage %
(95% C.I.)
Data on the causes of malnutrition (other than those above)
· Leave this for the discussion

4. Discussion

4.1 Nutritional status

· discuss sample sex ratio — any bias? If so, explain why you think there is bias
· prevalence of acute malnutrition
· if previous survey results are available, how do these results compare to before, or to
other areas nearby?
· how does the prevalence compare to national benchmarks of malnutrition?
· Is the prevalence of malnutrition typical or not?
4.2 Mortality

· Do you suspect any bias in the findings?

· Mortality rates
· if previous survey results are available, how do these results compare to before, or to
other areas nearby?
· How do the rates compare to benchmarks?
· Is the mortality rate typical or not?

4.3 Causes of malnutrition

· What are the major acute causes of malnutrition and where possible the causes of
mortality (taking into account causes already addressed by other interventions)?
Consider immediate, underlying and basic causes.
· What are the prospects for the coming months? Will the situation get better or worse
(refer to seasonal changes etc)
· Who is worst affected?
· What are the chronic causes of malnutrition?
· What does the community recommend?
· Does the story fit together? If not what are the unanswered questions
· A diagram to show the causal framework of malnutrition may be useful.

4.4 Programme coverage

· rate of coverage for any SFP/TFC programmes
· explanation for rates (good/bad/why)

8
 · given the prevalence of malnutrition found, how many children should be enrolled?

5. Conclusions

û overall conclusions on the severity of the situation and the urgency of the response
required

6. Recommendations and priorities

Remember to prioritise recommendations and try to give a time when action would be appropriate
(e.g, immediate, medium term or longer term).

Future nutrition monitoring

· is it necessary to carry out another nutrition survey in this area in the near future?
Who should do it? Should there be any changes to the survey methodology? When
should the survey take place?
· should there be food security indicator monitoring in this area? Who should do it?

7. References

List all secondary sources to which you have referred in the text.

8. Acknowledgements

1. List all government departments, International agencies, International NGOs, National NGOs
and other organisations that supported or participated in the survey. (All involved in planning the
survey and those organisations or individuals who have provided staff, vehicles, equipment,
logistics).
2. List donors and other sources of funds
3. List the individuals involved in the survey
Supervisor/Manager:
Consultants/ Trainers/ Advisors/ analysists:
Logistics/administration:
Team members:
Translators:
Drivers:
Others
4. (Optional) List those who gave permission/ authorisation and otherwise supported the survey in
a non-participatory way.

9. Appendicies

Appendix 1.

Table of villages used for cluster sampling, with their population sizes and those selected to
contain a cluster.

Appendix 2.
Table of results of training exercise

Appendix 3

9
Maps of area

Appendix 4
Questionnaires

10