RAPID SMART

METHODOLOGY

GNC Meeting, September 16-18th, 2014

What is Rapid SMART?

To RAPIDLY measure the nutritional status:

Emergency programming

Limited time/access for data collection

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A standardised and simplified field survey methodology which produces a snapshot of the current situation on the ground.

Rapid SMART Feasibility

Geographic area is clearly delimited (village, camps, settlements, urban slums, etc.) AND;

The target population is at maximum homogenous (shares the same living conditions, agro-ecological zone, etc.)

Results are valid only after its representativeness, accuracy and precision are evaluated

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Indicators: Advised to only measure anthropometry

(mortality for the case of South Sudan). Sample size:

Fixed sample sizes are used depending on the scope of the survey.

Time for data collection: Should not take more than 1 week.

Data quality checks: Still uses ENA for SMART for the Plausibility

Check.

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Key differences

ONE settlement to assess (1 camp, 1 block of houses in city, 1 village etc.) and:

Population is less than 200 households Exhaustive assessment of all eligible children.

Population is above 200 households Select a random sample of children using simple or

systematic random sampling A sample size of 150 children would be enough to gather

relatively meaningful prevalence. Assume DEFF=1; Convert # children to # households

Sample size: One Settlement

Sample size: One Settlement

Expected GAM Sample size Precision

20% 150 children +/- 6.4%15% 150 children +/- 5.7%10% 150 children +/- 4.8%5% 150 children +/- 3.5%

Cluster sampling must be used. At least 25 Clusters must be selected using PPS.

A sample size of 200 households (25 Clusters x 8 households) would be enough to gather relatively meaningful prevalence.

Assume DEFF=1.5; Convert # children to # households

Sample size: > 1 Settlement

Expected GAM Sample size Precision

20% 200 children +/- 7.1%15% 200 children +/- 6.3%10% 200 children +/- 5.3%5% 200 children +/- 3.9%

4-5 Teams comprising of 2 surveyors with 3 days for training if a standardization test is needed.

Inclusion of children based on age: Age of children between 6-59 months determined by

official documents or events calendar. Variables: Age, Sex, MUAC, Edema, weight

and height

1 week maximum to complete a Rapid SMART Even shorter if 2 Clusters per day can be done. Same recommendations for Reserve Clusters.

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Data Collection

Pilot Tests – only with MUAC9

Country Inclusion Criteria

Clusters

Planned

Second Stage

Sampling

Additional Variables

1 Afghanistan Age (6-59 months) 25

Simple or Systematic None

2 Afghanistan Height (65 to 110) 25

Simple or Systematic None

3 India Height 25 Systematic None4 India Height

(60 to 110) 25 Systematic None5 India Height

(60 to 110) 25 Systematic None6 Madagascar

Height(60 to 110) 25

Modified EPI

Measles Vaccination, Vitamin A, Sickness

7 MyanmarHeight 25

Modified EPI None

8 MyanmarHeight 23

Modified EPI None

Rapid SMART SMART

Design • 201 children • 97

households• 25 clusters x

8 households

• 575 children • 570 households

• Desired precision (±3%), design effect (1.7), prevalence (7.9%)

• 30 clusters x 18 households

Achieved

• 329 children surveyed

• Visited 396 households • 473 children surveyed

Both estimated average household size: (9.7), children U5 ( 15.6) Non Response (8%)

A SMART survey and a Rapid SMART were conducted concurrently in Kabul, Afghanistan in November 2012

Independent selection of the sample.

SMART vs. Rapid SMART

Similar Sampling Procedures

Rapid SMART SMART

• SMART two-stage cluster sampling method

• Selected 25 clusters using PPS method

• Simple random sampling where household listing could be done quickly i.e. ≤50 households

• Systematic sampling for clusters where listing was not feasible

• SMART two-stage cluster sampling method

• Selected 30 using PPS method• 3 clusters inaccessible;

used reserve clusters (3 of 4 accessible)

• Simple random sampling where household listing could be done quickly i.e. ≤50 households

• Systematic sampling for clusters where listing was not feasible

Variables Included

Rapid SMART SMART

• Age• Sex• MUAC • Bilateral oedema

• Age• Sex• MUAC • Bilateral oedema• Weight• Height• Vitamin A• Measles vaccination• Mortality (census)

Time / Logistics Required

Rapid SMART SMART

• Training:• 1-day training

session (Nov. 26)• Data collection:

• 2-day data collection • (Nov. 27-28)

• Staffing• 5 teams x 2 people

each

• Training: • 5-day training

• Data collection: • 5-day data collection • (Nov. 18-22)

• Staffing• 6 teams x 4 people

each

Rapid SMART completed in 3 days

Representativeness

Rapid SMART

SMART

Sample Sex Ratio 0.91 1.0

Age Ratio:6-29 months to 30-59 months

0.63 0.94 Sex ratio for sampling was very similar for

SMART and Rapid SMART

Age ratio for Rapid SMART was imbalanced Underrepresentation of age group of 6 to 29

months.

Survey Results

GAM

Rapid SMART SMART MUAC (6-59 months) 4.6% (2.5-8.5) 5.4% (3.8-8.5)

MUAC (65-110 cm) 4.3% (2.5-7.2) 4.3% (2.6-7.3)

SAMMUAC (6-59 months) 0.4% (0.1-2.8) 0.7% (0.1-3.2)

MUAC (65-110 cm) 0.3% (0.0-2.3) 0.5% (0.1-2.1)

• The GAM and SAM prevalence estimates from the Rapid SMART are similar to the findings of the SMART survey

• Non-significant differences in confidence intervals

Case of South Sudan

Based on the IPC workshop outcome and analysis in May 2014 recommendation

Urgently work with relevant agencies and clusters to ensure that nutrition, mortality and morbidity data needed for the IPC are being consistently collected.

Standardized validation process with ACF and CDC.

Why Rapid SMART? Sustained conflict in the target Counties Constrained Humanitarian access (flooding,

security, Limited time, Logistics challenges…)

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Based on the IPC, certain counties were prioritized.

3 rounds of surveys in Leer, Mayendit and Fashoda during July, Sept and Nov 2014.

Anthropometry: 250 households (25 Clusters x 10 households). Mortality: 420 households (30 Clusters x 14 households).

Survey Design: With Mortality

Round 1 Rapid SMART Results

County Date Settlement

Clusters Planned

2nd stage sampling

Modules Covered

Leer June 24-29 Rural 25 Systematic

Anthropometry

Mayendit July 15-27 Rural 25 Systematic

Anthropometry

Fashoda Aug 9-19 Rural 25 Systematic

Anthropometry & Mortality

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County Children (Measured)

Plausibility Score

GAM Results

Leer 425 13% 34.1%(28.0-40.6,95 % CI)

Mayendit 410 9% 16.9%(13.4-21.0,95 % CI)

Round 2 Rapid SMART

Expected / tentative SET planning: Leer round 2 from 5th to 12th of Sept Mayendit round 2 from 17th to 23rd of Sept Fashoda round 2 form 8th to 16th of Oct

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ACF-CA: SMART Project ConvenorThe SMART Project at ACF-CA, a core member of the GNC, in collaboration with the SMART Technical Advisory Group and Centers for Disease Control and Prevention (CDC Atlanta) establishes and maintains:

New training curriculums of field tools for survey managers and surveyors

Newly re-vamped SMART www.smartmethodology.org website.

Partnerships with other agencies in trainings & survey support.