UNHCR standardised nutrition survey guidelines and training
By Melody Tondeur and Andrew Seal
Melody Tondeur is an ENN Consultant and one of the team members implementing the Anaemia Control, Prevention and Reduction Project, a collaborative work between the UNHCR and ENN.
Andrew Seal is Lecturer at UCL Centre for International Health and Nutrition and a senior technical advisor to the ENN on the UNHCR/ENN Anaemia Control, Prevention and Reduction Project.
Nutritional outcomes continue to be of concern in most refugee contexts. UNHCR recommends the measurement of anthropometric status, anaemia and other associated indicators (including water, sanitation and hygiene (WASH) and mosquito net coverage) on an annual basis in order to monitor situations and to react in a timely manner to any deterioration.
A 2009 review of UNHCR nutrition surveys worldwide highlighted a lack of standardisation in methodologies, in the type of information collected and in data presentation.
In order to measure trends over time in the same region, as well as across regions and populations, surveys need to be replicable and the same definitions, geographic boundaries, and methodologies need to be used from year to year. To help overcome these challenges, UNHCR encourages the adoption of the internationally recognised SMART1 methods for survey design and anthropometric measurements.
However, surveys conducted by UNHCR and its partners typically collect data on a much wider set of indicators to allow for the monitoring of programme performance and key risk factors for malnutrition. UNHCR has also been introducing a number of innovative interventions to control and reduce anaemia in refugee populations, including the use of micronutrient powders and lipid-based nutrient supplements, and strengthening existing efforts on malaria control and deworming. The need to monitor progress with these interventions, as well as collect data for other key indicators, resulted in an initiative to develop the UNHCR Standardised Nutrition Survey Guidelines (SNSG). This work was undertaken in collaboration with ENN and UCL, with modules on the measurement of anaemia, WASH, antimalarial bed nets, food security, and IYCF being developed over a period of two years.
Dadaab nutrition surveys, August-September 2011
The UNHCR survey guidelines are divided into two main sections. Section 1 is a quick reference guide in the form of a Fact Sheet, focusing on the key practical steps involved in a standardised nutrition survey. Section 2 contains the standardised survey modules outlining the information to follow for training, data collection, analysis and reporting, and focuses on the recommended core indicators. The guidelines can be used as a reference document for designing and implementing a nutrition survey or as a tool for training survey workers on conducting the standardised nutrition survey.
The guidelines are designed to cover most emergencies and all stable, protracted camp situations (except urban settings). In the future, these guidelines will be updated and improved as lessons are learnt on their application and usefulness, and the field of survey methodology evolves.
A number of tools are available to assist at each step of the survey process. For example, there are spreadsheets for supplies planning and producing trend graphs. All the tools and guideline documents can be downloaded from: http://www.unhcr.org or from http://info.refugee-nutrition.net
These guidelines are designed specifically for camp settings, however they can be adapted to other contexts. Comments and questions can be directed to: HQPHN@unhcr.org
Training on survey guidelines
UNHCR and ENN in collaboration with the Centres for Disease Control and Prevention (CDC) implemented two 8-day long regional training workshops in Kenya (Naivasha, October 2010) and Hungary (Budapest, UNHCR training centre, May 2011) for key nutrition technical staff and UNHCR’s implementing partners.
The workshop objectives were to:
- Improve the quality and reliability of nutrition survey data collected in refugee operations.
- Establish standardised data collection, analysis and reporting for refugee operations.
- Build capacity of technical staff from UNHCR and implementing partners for conducting standardised nutritional surveys.
The expected training outcomes were that participants know how to use the SMART tools appropriately and how to assess anaemia, WASH and mosquito net coverage indicators, are able to use standard methods to implement nutritional surveys, gather reliable data, and analyse and report on results, and can identify areas of improvement for nutritional survey implementation among refugee populations.
Candidates were prioritised based on criteria using a questionnaire developed by Action Contre la Faim Canada (ACF-Ca) and adapted by ENN and UNHCR that included experience in nutrition surveys, training, data collation, report writing and working in refugee populations. A total of 29 participants from 13 countries from UNHCR offices, six non-governmental organisations (NGOs) and one government agency were selected.
The training covered SMART (SMART Standardised Training Package), Epi Info (and the ENA/Epi Info hybrid software) and the UNHCR Standardised Nutrition Survey Guidelines (SNSG). Evening sessions were offered on a daily basis and covered the day’s topics.
Participants were evaluated on the SMART component of the training only, using the SMART Standardised Training Package tests. The post-test was more complex than the pre-test (more information on the SMART methodology concepts and the ENA software) that limits interpretation. Results suggest the SMART knowledge of the group either stayed at a similar level or increased slightly. A formal evaluation of the rest of the training was not conducted. Instead informal evaluations were conducted at various points during the training. Daily evaluations completed by participants helped to refine the agenda and review the training experience. Daily quizzes helped to assess individual and group lesson learning and knowledge retention, and allowed participants to identify areas of weakness to work on.
Based on daily evaluations and an end of training focus group discussion, the level of overall satisfaction with the training was found to be high. Participants felt they had acquired knowledge, but would have liked more time and practical exercises on those sessions which were considered technically complex, e.g. on sample size and sampling, plausibility check, report writing, analysis with ENA and Epi-Info, the mortality survey and the standardisation test. In the Budapest training, participants felt that infant and young child feeding (IYCF) should be added as a topic in future similar training events. A survey module on IYCF is currently being finalised (Dec 2011). A posttraining assignment was sent to participants from the Budapest training and is currently being analysed (Dec 2011).
Follow-up is needed to ensure that trainees apply what they have learned. This has since been pursued in refugee camps in Algeria, Ethiopia and Kenya in 2011 where the ENN has provided technical support and capacity building for the implementation of the standardised nutrition surveys.
For more information, contact Caroline Wilkinson or Allison Oman, email: HQPHN@unhcr.org
1Standardised Monitoring and Assessment of Relief and Transitions. http://www.smartmethodology.org
More like this
Research on the Prevention and Reduction of Anaemia and Micronutrient Deficiencies in Refugee Populations
Donor: UNHCR Collaborators: UCL Institute for Global Health ENN Project Lead: Carmel Dolan Timeframe: 2009 - 2013 Background During 2009, UNHCR commenced the...
FEX: People in aid
UNHCR standardised nutrition survey guidelines and training regional training in Budapest, May 2011 (see news piece). Participants in the UNHCR Operational Guidance workshop...
TERMS OF REFERENCE
CONSULTANT, NUTRITION SURVEY COORDINATOR
EXPERIENCED IN NUTRITION SURVEYS AND SMART METHODOLOGY
TERMS OF REFERENCE
CONSULTANT, NUTRITION SURVEY COORDINATOR
EXPERIENCED IN NUTRITION SURVEYS AND SMART METHODOLOGY
SUDAN – WHITE...
Interview with Mélody Tondeur and Sarah Style The following is based on a face to face interview conducted by Carmel Dolan (ENN) with Mélody Tondeur and Sarah Style, two team...
Mothers and caregivers taking part in an MNP demonstration session during acceptability tests in a refugee camp in Algeria This article summarises UNHCR's 'Operational...
By Ellen Cecilie Andresen, Mélody Tondeur, and Caroline Wilkinson Since 2011, Ellen Cecilie Andresen has been a nutritionist with the Public Health Section at UNHCR...
Following the Darfur conflict of 2003-2004, refugees from Sudan are found in Eastern Chad and are settled, among others, in 12 camps. As soon as they...
FEX: Monitoring and evaluation of programmes in unstable populations: Experiences with the UNHCR Global SENS Database
By Melody Tondeur, Caroline Wilkinson, Valerie Gatchell, Tanya Khara and Mark Myatt View this article as a pdf Lisez cet article en français ici Mélody Tondeur...
FEX: UNHCR Technical Workshop on the Operational Guidance on the use of Special Nutritional Products
By Sarah Style and Andrew Seal Sarah Style is an ENN consultant working on the UNHCR/ENN Anaemia Control, Prevention and Reduction Project. Andy Seal is a lecturer and...
Nutrition Survey Co-ordinator Jordan - UNHCR
Dates of consultancy: from 03/04/2016 to 24 /06/2016
Duty Station: Amman and for the report...
Donor: UNHCR Collaborators: The ENN/ IGH ENN Project lead: Carmel Dolan Timeframe: 2013 Background Between 2010 and 2013, the ENN in partnership with the UCL Institute...
By Timo Luege, Caroline Wilkinson and Maeve de France Timo Luege is an independent, humanitarian communications and advocacy consultant based in Berlin, Germany. Timo has...
By Doris Mwendwa, James Njiru and Jacob Korir Doris Mwendwa is the current National MIYCN Deputy Programme Manager and has been working with ACF-USA Kenya Mission for the past...
By Najwa Rizkallah Najwa Rizkallah was Nutrition Specialist with UNICEF Lebanon until September 2014, having led the nutrition in emergencies programme in Lebanon for Syrian...
FEX: A small-quantity, lipid-based nutrient supplement to reduce anaemia and stunting among refugees in the Horn of Africa
Research snapshot1 Stunting and micronutrient malnutrition are persistent public health problems in refugee populations. As one approach to address these issues, UNHCR and its...
By Susana Moreno, Brigitt Olagivel and Elisa Dominguez Susana Moreno Romero is the Nutrition Programme Manager for Acción contra el Hambre (ACH) (Action Against Hunger -...
The ENN will undertake technical projects, including the development of nutrition guidance, where the project will significantly contribute to knowledge to support programming...
FEX: UNHCR experiences of enabling continuity of acute malnutrition care in the East, Horn of Africa and Great Lakes region
View this article as a pdf By Naser Mohmand Naser Mohmand is currently working with UNHCR as Senior Regional Nutrition and Food Security Officer in the East, Horn of Africa...
FEX: ENN update
View this article as a pdf Field Exchange Special issue on wasting in South Asia Asia is home to half of the world's wasted children (25.9 million) and severely wasted...
Reference this page
Melody Tondeur and Andrew Seal (2012). UNHCR standardised nutrition survey guidelines and training. Field Exchange 42, January 2012. p56. www.ennonline.net/fex/42/standardised