Guiding Principles for Rapid Nutrition Assessments

Guiding Principles For Rapid Nutrition Assessments-Free PDF

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ABBREVIATIONS,1 BACKGROUND,2 OBJECTIVES,3 IMPLEMENTING STRATEGY. 3 1 Criteria,3 3 Activities,3 4 Reporting and Decision Making. 3 5 Rapid Response Strategies,4 METHODOLOGY AND ACTIVITIES. 4 1 Selection of Geographical Areas,4 2 Assessment Implementation. 4 3 Key Informant Interviews,4 4 Focus Groups,4 5 Transect Walk.
4 6 Screening,5 REPORTING,5 1 Report Structure,5 2 Report Summary Table. Form No 1 Key Informant Interviews,Form No 2 Checklist for Focus Group Discussions. Form No 3 Checklist for Transect Walks,Form No 4 Screening Data Collection. ABBREVIATIONS,ARI Acute Respiratory Infection,BoA Bureau of Agriculture. DPPA Disaster Prevention and Preparedness Agency,DPPB Disaster Prevention and Preparedness Bureau.
DPT3 Diptheria Pertusis Tetanus,ENCU Emergency Nutrition Coordination Unit. EPI Expanded Programme on Immunisation,EW Early Warning. EWU Early Warning Unit,FGD Focus Group Discussion,GRP General Ration Programme. MoH Ministry of Health,MoWR Ministry of Water and Resources. MUAC Mid Upper Arm Circumference,NGO Non Governmental Organisation.
PA Peasant Association,UN United Nations,RA Rapid Assessment. SFP Supplementary Food Programme,STI Sexually Transmitted Illness. TB Tuberculosis,TFP Therapeutic Feeding Programme,WFH Weight For Height Index. WHZ Weight For Height Index in Z scores,1 BACKGROUND. The use of Rapid Assessments RA is not new to Ethiopia as governmental and non governmental. organisations NGOs including the Disaster Preparedness and Prevention Agency have been conducting. them for some time RA is a useful tool when the situation is deemed critical based on information generated. by Early Warning Systems and when time and or resources do not allow for a standard emergency nutrition. assessment to take place, Rapid Nutrition Assessments can be undertaken as part of initial assessments to obtain an overview of the.
nutritional situation and determine areas and population groups affected by an emergency It is also. reasonable to recommend and implement nutrition interventions temporarily based on RA results However. the RA should not be taken as a substitute for the standard nutrition assessment Once an appropriate. intervention has been identified a standard emergency nutrition assessment should be conducted. simultaneously with implementation, In this document Nutrition Rapid Assessments refer to the collection of a combination of quantitative and. qualitative information on the immediate and underlying causes of malnutrition Health Food Security Water. and Sanitation etc including quantification of the outcome i e acute malnutrition In order to standardise the. methodology for Rapid Nutrition Assessments the Emergency Nutrition Coordination Unit DPPA has. developed the present guiding principles,2 OBJECTIVES. To verify whether flagged areas of concern by Early Warning EW reports are actually hot spots. To assess whether there is a need for a standard emergency nutrition assessment. To trigger an immediate response where acute needs are identified in specific areas or population. 3 IMPLEMENTING STRATEGY,3 1 Criteria, Rapid nutrition assessments are triggered on the basis of secondary data information generated by Early. Warning Systems from the DPPA at Woreda Zonal or Regional level UN agencies and NGOs which show a. decline in food security and or unusual increase in mortality malnutrition disease outbreak and or. displacement of people, The team undertaking a rapid nutrition assessment will ideally be interagency and interdisciplinary Given the. inherent time constraints of RAs and in order to ensure high quality data team members who will be taking. anthropometric measurements must have prior and extensive experience in measurement techniques and. testing for oedema,3 3 Activities, Rapid nutrition assessments include key informant interviews focus group discussions transect walks and.
anthropometric measurements of children 6 59 months. 3 4 Reporting and Decision Making, Data collected during the RA must be summarised throughout the field visit Upon completion of the RA. preliminary data will be presented at an oral debriefing session with the EW committee at the Woreda level. Initial results preliminary data are to be presented during the debriefing while recommendations are to be. finalised at a later stage following discussions with Regional authorities Results must be presented in a. written format to the ENCU DPPA and should be shared with the EW department at Zonal and Regional levels. See recommended report format in section 6 2 If during the debriefing session it is mutually decided that. the results exceed the capacity at the Woreda level external assistance may be required. The decision making authority on the choice and implementation of appropriate interventions vary from. situation to situation and from place to place Decisions can normally be made at Federal or Regional and to a. lesser extent at Woreda level However as interventions involve allocation of resources which is usually done. at Federal level the Federal DPPA MoH or MoWR depending on the type of interventions may be the. appropriate decision makers on the need for and type of intervention However this should not exclude the. Regional and or Woreda offices from the decision making process or mandate In conclusion it is necessary. that the decision on the need for intervention as well as the types of interventions to be implemented be. handled on a case by case basis,3 5 Rapid Response Strategies. As part of the initial debriefing joint agreements must be made when life saving interventions are deemed. necessary based on the results of the RA and the overall evaluation of the area assessed The following. points must be considered when determining the appropriate intervention. If the capacity staff expertise to follow National guidelines facilities supplies etc of the local. facilities is overwhelmed by the high prevalence of acute malnutrition capacity building of existing. facilities or interventions by non governmental agencies will be required for implementation. Consideration of other aggravating factors in the assessed area i e Health Food Security Socio. Economic Status Water and Sanitation etc,4 METHODOLOGY. 4 1 Selection of Geographical Areas, The selection of the localities to be assessed within the woreda of interest is based on purposive sampling i e. the worst affected Kebele are selected for the assessment The process of selecting worst affected Kebele is. undertaken in conjunction with the Woreda Typically Kebeles have been categorized by the Woreda. Administration into three categories worst affected close monitoring and normal However to date there is no. standardised procedures and criteria for categorization of Kebeles Though a number of indicators are taken. into account i e crop production livestock condition market prices there is no pre determined benchmarks. for each indicator Thus categorization of Kebele is rather subjective and prone to bias It is therefore. recommended to randomly select three Kebeles from those categorized as the worst affected The purposive. sampling followed by a random sampling allows for the team to assess a subset of Kebeles deemed most. affected by the current crisis, Note with purposive sampling specific localities are deliberately selected because they represent a certain.
situation rather than the situation of the whole area Therefore the assessment findings are not representative. of and cannot be extrapolated to the whole area,4 2 Assessment Implementation. The following activities are expected to be implemented during a rapid assessment. Meet Woreda officials, Request for designation of volunteers to assist in translation and with other RA activities. Carry out Key Informant interviews with Woreda officials. Randomly select three Kebeles, Carry out key Informant Interviews with Kebele officials. Request for information of the community for anthropometry for following days by Kebele officials. Carry out Focus groups discussions,Carry out transect walk. Carry out anthropometric measurements, Depending on the number of teams ideally two teams it is anticipated that the full RA will take 3 days.
4 3 Key Informant Interviews, Key Informant interviews should be carried out with as many of the following persons as possible Heads of. Woreda Administration Woreda Health Bureau Rural Development Agriculture Water Bureau DPPB and the. Kebele chairperson representative staff from health facility if exists These officials will be able to provide. specific information used in forming an overview and establishing a background of the situation in the Kebele. It may be appropriate to undertake other interviews with elders church leaders officials education health or. other members of the community that can give specific information that is relevant to the assessment. 4 4 Focus Groups, In the selected Kebele Focus Group Discussions FGD are carried out to gather qualitative information. reflecting community perception and perspective of the overall health food security and nutritional situation in. the area Each group typically consists of 8 12 homogenous by sex participants selected from the village. When in the village you should request volunteers to participate in the focus group generally people are. happy to volunteer The facilitator should introduce the focus group and assure participants that they can. speak freely on any number of issues that they may be facing. Central to the facilitator s role is the ability to passively guide the discussion and foster a dialogue He she. should be able to facilitate the discussion from a neutral position while the translator should also be someone. with no vested interest in the results of the focus group discussion. With these guidelines in mind the checklist is prepared to assist in facilitating the focus group discussion and. should not be used as a series of questions asked to the group The list is prepared in a question format and. a question may occasionally be used to stimulate further discussion but should not be systematically worked. through as this would undermine the nature of the discussion. 4 5 Transect Walk, In the same selected Kebele Transect Walks must be carried out This involves visual observation of the. prevailing conditions in the Kebele and households It is imperative that the team ask permission to enter. randomly selected households while walking from one end of the village to the other Time must be taken at. the end of the day one to complete the summary form one form completed per Kebele visited Use Form No. 4 6 Screening,Indicators, The Mid Upper Arm Circumference MUAC is recommended considering that it is the rapid assessment tool. par excellence it is quick simple and cheap The presence of nutritional bilateral oedema is also assessed. Note one has to bear in mind that there is a number of limitations associated with the use of MUAC to. determine the rate of malnutrition as an alternative of Weight for Height This includes the lack of agreed. reference value for moderate malnutrition the use of a single cut off point to classify children aged 6 59. months the poor correlation between MUAC and WFH in some population groups Based on available data. from nutrition surveys undertaken in non pastoralist populations of Ethiopia a MUAC cut off of 125 mm is. expected to provide similar estimate of malnutrition as a WHZ below 2 z scores It is however anticipated. that there would be a great discrepancy between the two estimates in pastoralist populations Data from. previous surveys conducted in Somali region showed that MUAC underestimated consistently malnutrition. rates as compared to WHZ, The MUAC cut off points recommended are 110 mm for severe malnutrition1 and 125 mm for moderate.
malnutrition The case definitions for acute malnutrition are as follows. Severe Acute Malnutrition MUAC 110 mm and or presence of bilateral oedema. Moderate Acute Malnutrition 110 mm MUAC 125 mm, Global Acute Malnutrition MUAC 125 mm and or presence of bilateral oedema. MUAC values and presence of oedema are recorded in the data collection form Form No 4 At a later stage. the prevalence rates are calculated with the following steps. 1 determine the number of children with oedema A, 2 determine the number of children with MUAC 110 mm but without oedema B. 3 determine the number of children with 110 mm MUAC 125 mm but without oedema C. 4 severe acute malnutrition will be A B,5 global acute malnutrition will be A B C. 6 calculate the rates of malnutrition, Target population children from 6 to 59 months or 65 to 110 cm of length height. Sampling of children, Children should be selected by using the house to house method This method should be strictly followed to.
avoid child selection bias When children are gathered at a central location for measurement some of the. children are inevitably missed out Younger or older children might be preferably brought while. sick malnourished children might be brought or left at home Therefore calling children in the centre of a. locality can result in significant bias in child selection and in turn results in over or under estimation of. malnutrition bearing in mind that it is not possible to determine the direction of the bias. Two methods of sampling are proposed according to the population size or number of. assessment to take place Rapid Nutrition Assessments can be undertaken as part of initial assessments to obtain an overview of the nutritional situation and determine areas and population groups affected by an emergency It is also reasonable to recommend and implement nutrition interventions temporarily based on RA results However

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