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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

Show footnotes

1Standardised Monitoring and Assessment of Relief and Transitions. http://www.smartmethodology.org

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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

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