Understanding Mortality and Anthropometry Methods in Public Health Research

1. Research • Do NOT change current methods unless new methods have been tested. • MR method - prior birth history • CMR v <5MR • other data: 30-35yr children, Mother:child ratio, demographic profile etc. • Anthro - calculation from mean/ GIS • other data: MUAC vs anthro (mort risk)

2. CMR - why? • Most basic public health indicator - should have some idea of CMR in all populations • Need to assess overall severity of population stress • to inform resource allocation • documentation/ advocacy • calibration of surveillance data/ triangulation • urgency of intervention

3. CMR - When? • Best obtained with surveillance methods • use survey if no reliable data from other sources • Co-ordination of timing with other agencies • At same time as anthro survey • seasonality/ peak

4. CMR - How? • By surveillance methods where possible (with calibration) • No evidence based basis for choice of a particular method at the moment • Current household method most often used - other methods should be chosen where they are thought to have advantages • need to assess prior birth history method as it appears to be the most promising method • 3 month recall where possible.

5. CMR - Who? • Scale - each agency has different purpose for survey. National to micro scale. • To large a scale averages out pockets: to small a scale misses pockets and is not generalisable- difficult to use data to inform where there is a problem. • Commend areas based upon characteristic likely to be important determinant - Agroeconomic zones, tribal/ethnic areas, etc. and not necessarily administrative districts • CANNOT in general be used to decide where to set up a program - this comes from other information

6. Anthro - why? • Need to assess overall severity of nutritional stress in population. • to inform resource allocation • documentation/ advocacy • urgency of intervention

7. Anthro - When? • Need to design feeding programs • when surveillance /program data shows that there is a problem • when program “coverage” likely to have changed. • Seasonality/ peak and trough • Co-ordination of timing with other agencies

8. Anthro - How? • Systematic random sample where feasible otherwise cluster sampling • 30x30 clusters unless data to inform assumptions and expertise available • use systematic random or random for cluster choice if feasible and convenient. Otherwise start - chose person from crowd and go to his/her house to start; then EPI-n with bottle spin after each house. • Take ALL children in house • use houses with no children for CMR/demographic other data collection.

9. Anthro - Who? • As with Mortality rates - each agency has different purpose for survey. National to micro scale. • To large a scale averages out pockets: to small a scale misses pockets and is not generalisable- difficult to use data to inform where there is a problem. • Commend areas based upon characteristic likely to be important determinant - Agroeconomic zones, tribal/ethnic areas, etc. and not necessarily administrative districts • CANNOT in general be used to decide where to set up a program - this comes from other information

10. Anthro - Who? 2 • From program data - e.g. map admissions to TFC - new arrivals - anecdotal information. • Assess with anthro survey (area often security delimited) • secure areas likely to be best