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Kakuma Nutrition Survey November 2012. Training Day 1. Today’s schedule. Introduction of coordinators, supervisors, and survey team members Overview of the survey Survey objectives Survey schedule Survey teams Roles and responsibilities Skills for good interviewing Malnutrition

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Kakuma nutrition survey november 2012

Kakuma Nutrition SurveyNovember 2012

Training Day 1

Today s schedule
Today’s schedule

  • Introduction of coordinators, supervisors, and survey team members

  • Overview of the survey

  • Survey objectives

  • Survey schedule

  • Survey teams

    • Roles and responsibilities

  • Skills for good interviewing

  • Malnutrition

  • Anthropometry

  • 6-59 months section

  • IYCF section

Snapshot question
Snapshot question

  • What is a nutrition survey?

Definition of a survey
Definition of a survey

  • Collection of data from a specific population at a single point in time.

  • Allows for:

    • Providing data on prevalence

    • Providing information on the actual situation

    • Gathering diverse data

Objectives of a survey
Objectives of a survey

  • Evaluate scope and severity of a humanitarian crisis

  • Determine needs of a new programme

  • Advocacy

  • Evaluate already existing programmes

Kakuma nutrition survey objectives
Kakuma nutrition survey objectives

Among the refugee population residing in Kakuma camp this survey aims to

  • estimate the prevalence of malnutrition among children 6-59 months;

  • estimate anaemia levels among children 6-59 months and women of reproductive age (non-pregnant);

  • estimate period prevalence of diarrhoea in last 2 weeks among children 6-59 months;

  • assess coverage of measles vaccination in children 9-59 months;

  • assess coverage of vitamin A supplementation and deworming in last 6 months in children 6-59 months;

  • assess IYCF practices among children 0-23 months;

  • assess global coverage and use of mosquito nets;

  • investigate household food security;

  • assess water, sanitation and hygiene situation;

  • estimate coverage of the selective feeding programme.

Snapshot question1
Snapshot question

  • What are the characteristics of a good nutrition survey?

A nutrition survey should
A nutrition survey should:

  • Be conducted by a competent team

  • Have clear and precise objectives

  • Provide reliable data and a clear image of situation

  • Be relatively simple to execute

  • Use standard methods to collect data

  • Use simple, robust questionnaires and software

  • Results are available on time to be able to intervene and react

Team roles
Team roles

















Team of 5

One team leader – any of the above roles (except HH questionnaire)

Snapshot question2
Snapshot question

  • How would you define a household?

Snapshot question3
Snapshot question

  • How would you define a household?

  • A group of people who live together and routinely eat of the same pot.

Kakuma nutrition survey components
Kakuma nutrition survey components

  • Measurements

    • Anthropometry

    • Anaemia

  • Questionnaires

    • Household questionnaires

      • WASH

      • Mosquito net

      • Food security

    • Individual questionnaires

      • Women

      • Children 6-59

      • Children 0-23

  • Other:

    • HH enumeration

      • Cluster control sheet

      • HH listing form (paper record of Hb, anthro etc.)

Skills for good interviewing
Skills for good interviewing

  • SMART video

  • Translation

Children 6 59 objectives
Children 6-59: Objectives

  • To measure the prevalence of acute malnutrition in children aged 6-59 months.

  • To measure the prevalence of stunting in children aged 6-59 months.

  • To determine the coverage of measles vaccination among children aged 9-59 months.

  • To determine the coverage of vitamin A supplementation and deworming in the last six months among children aged 6-59 months.

  • To determine the two-week period prevalence of diarrhoea among children aged 6-59 months.

Main indicator acute malnutrition
Main indicator: acute malnutrition

  • Marasmus

    • Excessive thinness, “wasting””

    • Low weight compared to height/length

    • Resulting from a recent or rapid weight loss or incapacity to gain weight

    • Reversible through improvements of life conditions

  • Kwashiorkor

    • Presence of bilateral oedema

    • Weight and appearance can be quite normal

    • Often following weaning, and 18m – 2.5y

    • Causes remain uncertain

Marasmus signs and synptoms
Marasmus: signs and synptoms

  • Severe weight deficiencies and growth problems

  • Deterioration of adipose and muscular tissue

  • Growth retardation

  • Behavioural problems

  • Infections and diarrhea

  • Anorexia

  • Hypoglycemia

  • Hypothermia

Kwashiorkor signs and symptoms
Kwashiorkor: signs and symptoms

  • Bilateral edema

  • Eyebrow and nail alterations

  • Hepatic hypertrophy

  • Variable weight for height deficiency

  • Moon face

  • Behavioural problems: children who are sad, fearful, closed onto themselves

  • Hair may be depigmented and broken

  • Oropharyngeal mucous atrophy

Intervention cut offs and benchmarks
Intervention cut-offs and benchmarks

Classification of malnutrition (WHO 2000)

Introduction to equipment
Introduction to equipment

  • Height board

  • Scales

  • MUAC tape

Children spot question
Children - spot question

  • What is anthropometry?

Children answer
Children - answer

  • Anthropometry: anthropometry is the study and technique of human body measurement. It is used to measure and monitor the nutritional status of an individual or population group.

Snapshot question4
Snapshot question

  • Why are the 6-59 months the most targeted population in anthropometric surveys?

Children 6 59 months
Children 6-59 months

  • Nutrition status indicates severity of situation in whole population

  • In growth period

  • Particularly vulnerable to disease and food shortage

  • Considered to be most vulnerable to nutritional stress

  • Easier to measure

    • Equipment less bulky

    • Possible to undress them when taking measurements

  • Generally at home

  • Stakeholders are used to this type of data and appropriate response

  • Lots of expertise in surveys for this age group

  • Anthropometric indicators and measures are internationally recognised

Kakuma nutrition survey november 2012



  • Questionnaire and pencil on clipboard on floor

  • Assistant on knees

  • Measurer on knees

  • Hands cupped over child’s ears; head against base of board

  • Assistant’s arms comfortably straight

  • Line of sight of child right angle to board

  • Child flat on board

  • Hands on knees or shins; legs straight

  • Feet flat against footpiece

Kakuma nutrition survey november 2012



  • Questionnaire on floor

  • Assistant on knees

  • Measurer on knee

  • Right hand on shins, heels against back and base of board

  • Left hand on knees; knees together and against board

  • Heel against board

  • Calf against board

  • Line of sight right angle to board

  • Hand placed on chin

  • Shoulders level

  • Hands at side

  • Head, back of shoulders and bottom against board

  • Headpiece rested firmly on head

Kakuma nutrition survey november 2012

Measurement of weight with electronic scale


  • Ensure weight at zero before mother steps on scales

  • Mother steps on; centrally placed feet

  • Measurer puts weight of scales to ZERO

  • Mother handed baby

  • Weight measured

  • If child able to stand straight and understand instructions not to move while on the scale, child can stand on the scale by himself or herself.

Kakuma nutrition survey november 2012



  • Locate tip of shoulder and tip of elbow

  • Place tape at tip of shoulder

  • Pull tape past tip of bent elbow

  • Mark midpoint

  • Don’t pull tape too tight or too loose; gently touching all round

Diagnosing oedema
Diagnosing oedema


Moderate thumb pressure

Tops of feet or just above the ankle – inside of leg

Pressure for 3 seconds

If Oedema: a pitting remains for at least a few seconds

If both feet have oedema child can be recorded as so

Exercise find the errors

Exercise:Find the errors

Children 6 59months
Children 6-59months

  • Talk through questionnaire

Children tips to note
Children – tips to note

  • Always measure the weight before the height as children often get agitated with height measurements. 

  • If there is more than one eligible child in the household, measure the less ‘difficult’ child first.

  • Explain the procedure to the mother and ask the mother’s authorisation to undress the child.

  • To avoid the scales wobbling when placed on uneven ground, they should be stood on a flat wooden board. The height/length boards can be laid flat and used for this purpose.  

Plausibility checks
Plausibility checks

Digit preference

And much more!

Kakuma nutrition survey november 2012

  • 0-23 months

    • Infant = <12m

    • Child = 12m+

  • Measures breastfeeding practices

    • Initiation of breastfeeding

    • Exclusive breastfeeding for <6m

    • Continued breastfeeding at 1 and 2 years

    • Introduction of solid, semi-solid or soft foods

    • Consumption iron rich foods

    • Bottle feeding children 0-23m

Kakuma nutrition survey november 2012

  • Interviews with the mother or main caregiver

  • TIPS!

    • Invest time in the assessment of AGE

      • Don’t round up or down

      • Don’t complete on a child of 24 months

    • Ask questions exactly as written

      • E.g. ‘yesterday, during the day or at night’ for 24 hour recall

    • Clear broth – it’s a water based liquid

    • Use local brand names for products

Women 15 49 years
Women 15-49 years

  • Anaemia for non-pregnant

    • Including lactating

  • Pregnancy

    • ANC enrollment

    • Receiving Iron-Folate