New Sampling Methods for Surveying Nutritional Status

Megan Deitchler FANTA Project June 4, 2007

Presentation Outline
Traditional Approach to Assess Nutritional Status in Emergencies Work to Date on New Sampling Methods Comparison of New Sampling Methods with Traditional Approach

Data Priorities in Emergencies
Statistically representative data on the status of a situation are usually necessary before resources can be directed to the area Reliable data are needed rapidly – to allow agencies to make appropriate decisions about interventions and the level and type of aid to provide Often times recurrent assessments are mandated (quarterly, e.g.) – either by national government or donor agencies Data on GAM among children 6-59 mo is a key indicator used to measure the severity of a situation

4. 5. 2.The Traditional Approach 30x30 Cluster Survey # Clusters: 30 # Observations per Cluster: 30 Total Sample Size: 900 How to Collect 30x30 Cluster Data: 1. Obtain a complete sample frame Conduct Population Proportionate to Size (PPS) for cluster selection Establish the random start point within a cluster Administer questionnaire based on demographics of HH Sample next nearest HH until data are collected for 30 HHs and 30 Children in the Cluster REPEAT STEPS 3-5 in 29 OTHER CLUSTERS SELECTED BY PPS . 3.

The Traditional Approach Challenge Conventional 30x30 cluster surveys are time and resource intensive – this poses a challenge. when rapid and appropriate humanitarian response is essential for effective targeting of scarce resources to communities most in need. particularly in emergency situations. .

Result 1. 33x6 LQAS Design 2.New Sampling Methods Objective To develop a statistically representative assessment method allowing for rapid collection and analysis of data. 67x3 LQAS Design .

Development of Designs 2. Harvard Validation and PostHoc Correction Formula 5. Field Manual FANTA OFDA GH . SC-US 4. Mellon Grant GH and Ethiopia Mission Andrew W. OSU FANTA.New Sampling Methods: 33x6 and 67x3 Design Completed and Forthcoming Work 1. CRS. Sudan Field Validation Collaborators FANTA. Ethiopia Field Test 3. Simulation FANTA. CRS. Mellon Grant OFDA GH SC-US private funds GH FANTA. OSU Funded By USAID/GH Andrew W.

67x3 Design Accuracy Precision for child. Sudan .and HH-level indicators using data from a field validation in West Darfur.Comparison of Traditional and New Sampling Methods 30x30 Design. 33x6 Design.

Vocabulary .

Comparison of Results: Child-Level GAM 30 25 Prevalence 20 15 10 5 0 Design 30x30 33x6 67x3 Source: Deitchler et al. In Submission with IJE 2007 .

In Submission with IJE 2007 .Comparison of Results: Child-Level Low MUAC 30 25 Prevalence 20 15 10 5 0 Design 30x30 33x6 67x3 Source: Deitchler et al.

Comparison of Results: Child-Level Stunting 50 40 Prevalence 30 20 10 0 Design 30x30 33x6 67x3 Source: Deitchler et al. In Submission with IJE 2007 .

Comparison of Results: Child-Level Underweight 50 40 Prevalence 30 20 10 0 Design 30x30 33x6 67x3 Source: Deitchler et al. In Submission with IJE 2007 .

In Submission with IJE 2007 .Comparison of Results: HH-Level Access to Safe Drinking Water 80 Prevalence 60 40 20 0 Design 30x30 33x6 67x3 Source: Deitchler et al.

In Submission with IJE 2007 .Comparison of Results: HH-Level Access to Latrine 90 80 70 60 50 40 30 20 10 0 Prevalence 30x30 33x6 67x3 Design Source: Deitchler et al.

In Submission with IJE 2007 .Comparison of Results: HH-Level Bednet Ownership 90 80 70 60 50 40 30 20 10 0 Prevalence 30x30 67x3 33x6 Design Source: Deitchler et al.

Comparison of Results: HH-Level HH Food Shortage 90 80 70 60 50 40 30 20 10 0 Prevalence 30x30 33x6 67x3 Design Source: Deitchler et al. In Submission with IJE 2007 .

and is designated by “p”. The intra cluster correlation coefficient is often referred to as rho. .Vocabulary Intra Cluster Correlation A measure of how similar the responses are within clusters for an outcome of interest.

the more data (clusters) must be collected to precisely capture the variability that exists across the entire assessment area. .Why Do The LQAS Designs Work? Inherent to cluster sampling is the possibility for intra cluster correlation. The greater the intra cluster correlation.

Vocabulary Design Effect A measure of the extent to which a cluster design has diminished ability to precisely measure an indicator. as compared to a simple random sample of the same size. DE=1 + p (m-1). where m=# obs per cluster .

284 1.422 1.058 .351 1.364 1.953 0.151 1.Comparison of Design Effects Indicator GAM Low MUAC Stunting Underweight 30x30 1.006 67x3 0.285 33x6 0.955 1.804 1.831 0.

791 3.075 33x6 5.421 3.179 15.271 3.168 .Comparison of Design Effects Indicator Safe Water Latrine Access Bed-net Ownership HH Food Shortage 30x30 27.609 67x3 2.924 1.651 11.402 12.202 2.955 2.

Vocabulary .

5.4 +/.1.2.3 33x6 +/.3.0 +/.2.4 .4 +/.3.6 +/.6.1 +/.9 67x3 +/.2.6.3.Comparison of CI Widths (in ppt) Indicator GAM Low MUAC Stunting Underweight 30x30 +/.4 +/.5 +/.3.3 +/.5.9 +/.

12.Comparison of CI Widths (in ppt) Indicator Safe Water Latrine Access Bed-net Ownership HH Food Shortage 30x30 +/.10.9.7 +/.7 +/.8 +/.9 .0 +/.11.4 67x3 +/.6 +/.11.16.17.8 +/.12.9 +/.12.9 +/.9.9.11.0 +/.3 33x6 +/.

Underlying Principles of LQAS LQAS analysis methods can be used to assess binary outcomes Allows for hypothesis testing of an indicator against threshold prevalence levels Statistical principles of the method are based on cumulative probabilities of binomials Decision rules are used to judge whether the threshold prevalence of an indicator has been reached Requires observations be independently and randomly selected (SRS) .

20% prevalence of secondary interest Useful if 95% CI overlaps with a threshold level necessary for decision making about response . upper thresholds) of primary interest.e.Why Call the Methods LQAS Designs? The 33x6 and 67x3 designs allow for LQAS hypothesis tests of GAM prevalence because the designs approximate a SRS for assessment of GAM 10% and 15% prevalence levels (i.

151 1.955 1.804 1.953 0.058 .006 67x3 0.285 33x6 0.Comparison of Design Effects Indicator GAM Low MUAC Stunting Underweight 30x30 1.351 1.422 1.364 1.831 0.284 1.

Time and Cost Comparison 30x30 Time 30.17 team-days Cost 4606 US $ 1232 US $ 1630 US $ Source: Deitchler et al. In Submission with IJE 2007 .00 team-days 33x6 8.25 team-days 67x3 11.

malaria). Note: the 67x3 design provides more narrow CIs than the 30x30 design for child-level indicators with high intra-cluster correlation (eg. 33x6 and 67x3 designs provide reasonably precise results for HH-level indicators (notable exception is mortality). diarrhea. Note: the 67x3 design provides more narrow CIs than the 30x30 design for all HH-level indicators tested. VAC suppl.Summary of Main Points 33x6 and 67x3 designs provide accurate results for childand HH-level indicators 33x6 and 67x3 designs provide reasonably precise results for child-level indicators. .. with a CI only slightly wider than that of a 30x30 design for most indicators.

reliable assessment data in food insecure areas . time.Summary of Main Points 33x6 and 67x3 designs allow for LQAS hypothesis testing of GAM threshold prevalence levels (using cumulative binomial probabilities) 33x6 and 67x3 designs offer substantial benefit over 30x30 cluster design in terms of sample size. and cost required for data collection 33x6 and 67x3 design are statistically appropriate alternatives for purpose of obtaining rapid.

fantaproject.org .org Megan Deitchler mdeitchl@aed.For More Information FANTA website http://www.

Infectious Diseases and Nutrition of the Bureau for Global Health at the US Agency for International Development (USAID). under terms of Cooperative Agreement No HRN-A-0098-00046-00. and the Office of Health. Food and Nutrition Technical Assistance (FANTA) Project by the Office of Foreign Disaster Assistance (OFDA) of the Bureau for Democracy. The opinions expressed herein are those of the author and do not necessarily reflect the views of USAID.Acknowledgments Financial support for this study was provided to the Academy for Educational Development (AED). . Conflict and Humanitarian Assistance.

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