DOI: 10.3886/e108684v3-99420
title: Assessment of nutritional status of children of pastoralists in a humanitarian setting: A Cross-sectional Standardized Monitoring and Assessment of Relief and Transitions Survey

description: The AVSI Foundation in collaboration with the South Sudan Nutrition Cluster conducted a SMART nutrition and mortality survey covering all the eight Payams of the former Ikwoto County in the former Eastern Equitoria State. The main objective of the survey was to assess the current prevalence of acute malnutrition and retrospective mortality rates in the County. The Standardized Methodology for Assessment in Relief and Transitions (SMART) which applies a two-stage cluster sampling was used. A total of 623 children aged 6-59 months from 532 households in 36 clusters were sampled for anthropometric measurements. The mortality assessment was conducted concurrently in all 532 households. Additional information on Infant and Young Child Feeding practices (IYCF) was collected in the 532 households visited to provide more insight into possible risk factors associated with the high acute malnutrition prevalence. The prevalence of Global Acute Malnutrition (GAM) defined as Weight-for-Height &lt;-2 Z scores and/or oedema for the County was 10.3% (7.9 - 13.3 95% C.I.) and the severe acute malnutrition (SAM) prevalence defined as Weight-for-Height &lt;-3 Z scores and/or oedema was 1.6% (0.9 - 3.1 95% C.I.) The GAM and SAM prevalence indicated a serious nutrition situation according to WHO classification. Two edema cases were identified during the assessment. The crude mortality rate (CMR) and under five mortality rate (U5MR) were 1.79 (1.32 – 2.42 95% C.I). and 1.24 (0.47-3.21 95% C.I.) respectively. The CMR rate was above the WHO emergency thresholds of 1/10,000/day. The U5MR was below the WHO emergency threshold of 2/10,000/day and was therefore classified as ‘Alert’. Most deaths were due to illness (73.8%). Information on infant and young child feeding (IYCF) practices was collected. The proportion of children exclusively breast fed to the age of 6 months was (78%) which was lower than the WHO recommended standard of &gt;80%. Another 76.2% of children (0-23.9 months) were initiated to breastfeeding within one hour after delivery. Introduction of solid, semi-solid or soft foods among children aged 6 to 8.9 months was low (51.5%). Findings indicated suboptimal IYCF practices.
description: Response Rates: Survey contains a total of 96% response rate on average on all questions
description: <b>1.1 Sampling methodology</b> <br>The survey applied a two-stage cluster sampling based on the SMART methodology with clusters being selected using probability proportional to population size (PPS). <br><b><br>2.4.1 First stage sampling</b> <br>The first stage involved the assignment of the smallest sampling unit called clusters which in this case were villages. A sampling frame for clusters was prepared with assistance from the County Health Department and the survey enumerators because they were familiar with the area. All accessible villages along with their respective populations were entered into the ENA for SMART software. Random selection of clusters from the total number of villages in the County was done using the planning screen of ENA for SMART software based on probability proportional to population size (PPS). Clusters were defined as villages within Bomas in all the Payams of the County. A total of 36 clusters were selected from the sampling frame generated from the list of all villages in the County. <br><b><br>2.4.2 Second stage sampling</b> <br>Simple random sampling was used to select 15 households per cluster to be surveyed. The household heads in the villages were listed with the support of the village Chiefs. Once a complete list of household heads was obtained, enumerators used ENA generated random numbers tables to select the households from the sampling frame (household list). 2.4.3 Number of households per cluster The number of households to be completed per day was determined according to the time the team could spend in the field excluding transportation, other procedures and break times. The details below were taken into consideration when performing this calculation based on the given context: 1. Departure from office at 8:00 am and back at 6:00 pm. 2. Average travel time (to and from the field): 3 hours. 3. Duration for initial introduction and selection of households: 1 hour. 4. Breaks: 1 lunch break of 1hour. The above considerations gave an average of 5 hours of working time in each cluster. If on average teams spent 10 minutes in each HH and 10 min traveling from one HH to another, each team could comfortably reach 15 HH per day. One day in each area (cluster) was assumed. The total number of households in the sample was then divided by the number of households to be completed in one day to determine the number of clusters to be included in the survey. 528 HH/15 HH per day = 35.2 clusters (when rounded up gives 36 clusters). Based on this calculation 36 clusters were selected to be included in the survey. All the selected clusters were surveyed and no replacements were done.
description: Children of pastoralists in South Sudan. Smallest Geographic Unit: Payam (Villages)
description: face-to-face interview;