Module 2: Anthropometry and Health – Standardised Expanded Nutrition Survey

OBJECTIVES

Target groups

The standard target group to routinely include in an anthropometric assessment in refugee contexts is children aged 6-59 months. When justified, other age groups are sometimes also included.
Children aged 9-59 months will be assessed for measles vaccination (or other context-specific target group e.g. 9-23 months).
Children aged 6-59 months will be assessed for vitamin A supplementation in the last six months, diarrhoea in the last two weeks and current enrolment into the targeted supplementary and therapeutic (OTP/SC) nutrition programmes.
If there is a BSFP in place, BSFP coverage should be assessed in the context-specific target age group (i.e. 6-23 months, 6-35 months or 6-59 months, pregnant women and/or lactating women with an infant
under 6 months).

Primary 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 (or context-specific target group e.g. 9-23 months).
To determine the coverage of vitamin A supplementation 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.

Secondary objectives

To determine the enrolment into the targeted supplementary (TSFP) and therapeutic (OTP/SC) nutrition programmes for children aged 6-59 months.
To determine the coverage of the blanket supplementary feeding programme (BSFP) for children aged 6-23/6-35/6-59 months. (SENS recommendation: include this indicator in all contexts where a BSFP is in place for young children).
To determine the coverage of deworming (soil-transmitted helminth control) with mebendazole or albendazole in the last six months among young children (include context specific target age group, 12-59m/24-59m). (SENS recommendation: include this indicator only if a deworming campaign was done in the last six months in pre-school children at the same time as a vaccination campaign and/ or a vitamin A campaign using drugs for intestinal worms, namely mebendazole or albendazole, and if results are needed for programme monitoring purposes).
To determine the coverage of the blanket supplementary feeding programme (BSFP) for pregnant women and lactating women with an infant less than 6 months aged 15-49 years. (SENS recommendation: include this indicator in all contexts where a BSFP is in place for pregnant and lactating women with an infant less than 6 months).

KEY MESSAGES

Data on the prevalence of acute malnutrition (based on weight-for-height and / or oedema) and stunting (based on height-for-age) among children aged 6-59 months is essential to collect in refugee settings for monitoring purposes. When justified, other age groups are sometimes also included.
Data on the coverage of measles vaccination, the coverage of vitamin A supplementation in the last six months and the two-week period prevalence of diarrhoea in young children is essential to collect in
refugee settings for monitoring purposes.
Data on the enrolment in nutrition programmes (targeted supplementary (TSFP), therapeutic (OTP/SC) and/or blanket (BSFP) where they exist) are recommended to be collected in SENS surveys conducted in refugee contexts.
When justified, additional objectives on the coverage of deworming in the last six months and use of oral rehydration salts (ORS) and zinc during diarrhoea episodes in young children, and on the prevalence
of MUAC malnutrition in women (non-pregnant, non-lactating and/or pregnant and lactating) can be collected.
A standard questionnaire should be used for the collection of the SENS indicators.
Providing good quality training to survey teams, supervising them well and checking the quality of the data they are collecting on a daily basis will help ensure that data are reliable.
Standard methods have been developed for collecting, analysing and presenting anthropometric data in reports (refer to SMART initiative documentation). Standardising this process helps to maintain the
quality, reliability and usability of SENS survey data.
The prevalence of stunting (height-for-age) and underweight (weight-for-age) should be presented as part of the survey report but should be interpreted with caution where reliable age data is not available (as is the case in many refugee situations).
There are standard ways of reporting anthropometric, measles vaccination, vitamin A supplementation, diarrhoea, nutrition programme enrolment and deworming results that should be followed in all SENS survey reports produced in refugee contexts.

CAUTION!

There will be targeted supplementary (TSFP) and therapeutic (OTP/SC) nutrition programmes in most refugee settings to treat acutely malnourished children. A SENS survey is a good opportunity to ask about enrolment of the surveyed children into the nutrition programmes running in the area for the treatment of acute malnutrition. This will only provide a rough estimation of the coverage of such programmes but may point out to some major problems that can be addressed following the survey. However coverage surveys as opposed to SENS surveys are the best way to determine the coverage of these types of nutrition programmes due to the small sample size of acutely malnourished children found during nutrition surveys. This is why this objective should always be worded as a secondary objective.
The systematic inclusion of infants aged 0-5 months in SENS survey is not currently recommended by UNHCR for the following main reasons: (1) The accurate weight measurement of infants 0-5 months
requires an infant scale with a higher precision (+/-10g) than those most commonly used during nutrition surveys (+/- 100g); (2) If a meaningful, precise estimate of infant malnutrition is needed for programmatic purposes, sample size requirements can be difficult to meet; (3) Interpretation of malnutrition results among children aged 6-59 months and 0-59 months are often wrongly used interchangeably and compared; and (4) Reporting malnutrition results among children aged 6-59 months is currently the norm in refugee settings and emergencies. However, in certain circumstances, where there may be particular concerns over the nutritional status of infants 0-5 months old, these infants may also be included in the anthropometric assessment if proper scales are used, specialised training is provided for measuring infants’ length (e.g. a cloth needs to be used below the knees of infants during length measurement) and sample size requirements are met. MUAC in infants 0-5 months is increasingly being measured and may be a more feasible option to include in a SENS survey.

Downloads

Module 2