TECHNICAL PROTOCOL FOR SMART NUTRITION SURVEY Rubkona County, Northern Liech State SUBMITTED TO: Nutrition Information Working Group (NIWG) STUDY AREA: Rubkona County, Northern Liech State STUDY PERIOD: 14-24th May 2018 IMPLEMENTING AGENCY: CARE Table of Contents 1.0 Background information .......................................................................................................................................... 3 1.1 Introduction ........................................................................................................................................................ 3 1.2 Purpose of the survey ......................................................................................................................................... 3 1.3 Survey objectives ................................................................................................................................................. 3 1.4 Specific objectives ............................................................................................................................................... 4 2.0 Survey timing ........................................................................................................................................................... 4 2.1 Survey area .......................................................................................................................................................... 4 3.0 METHODOLOGY ....................................................................................................................................................... 4 3.1 Study Design ........................................................................................................................................................ 4 3.2 Survey Target Population .................................................................................................................................... 4 3.3Sample Size Determination .................................................................................................................................. 4 3.3.1SAMPLING PROSEDURE ................................................................................................................................ 5 3.3.2 First stage sampling – cluster selection ....................................................................................................... 5 3.3.3. Second stage sampling– Household selection ............................................................................................ 6 3.3.4 Selection of children .................................................................................................................................... 6 3.4 Survey team and training ......................................................................................................................................... 6 3.5 CASE DEFINITIONS OF THE VARIABLES .................................................................................................................... 6 3.5.1 Anthropometry survey ................................................................................................................................. 6 4.0Data quality control .............................................................................................................................................. 8 4.1 Data entry and analysis............................................................................................................................................ 8 Table 2: Anthropometry and Mortality Sample Size ..................................................................................................... 5 Table 3: Proposed Survey Timeline ............................................................................................................................... 8 Appendix 1: Survey questionnaires ............................................................................................................................... 9 1.0 Background information CARE South Sudan is a subsidiary of CARE International, a leading humanitarian and development agency fighting global poverty around the world. CARE’s operations in South Sudan dates back to the early 1980s, focusing on emergency and disaster relief to the conflict affected populations. Currently, CARE South Sudan works in three States, Unity, Jonglei and Upper Nile States, addressing both humanitarian and recovery/development needs. In development/recovery programming, CARE South Sudan focuses on four broad areas namely governance and sustainable integrated livelihoods (Food security, health and Nutrition, WASH, protection of civilians and peace building) focusing on women and youth. Rubkona County which was targeted for the Nutrition SMART Survey is made up of ten administrative Payams (Rubkona, Budang, Norlamwel, Ngop, Kaljak, Dhor Bor, Wathjak, Nhialdiu, Panhiany and Bentiu). It is situated in northern part of South Sudan in the newly created state of Northern Liech. The county's population is estimated at 100,236 according to 2008 Sudan census. However majority of the inhabitants had been displaced across the county with some moving to Bentiu PoCs due to the protracted strife in the area that had started in December 2013. 1.1 Introduction CARE Emergency Nutrition Project Unity State aims to provide 60% of malnourished children and women nutritional therapies and contribute to 10% reduction in Global Acute Malnutrition rate in four counties in Unity State through health facility based Outpatient Therapeutic Program (OTPs) and supplementary feeding programme. One of the Project key activities is to conduct annual nutrition surveys/ assessment in project service delivery locations in order to monitor /determine the general nutritional status among the under-five children, boys and girls, pregnant and lactating mothers. The Standardized Monitoring and Assessment of Relief and Transition (SMART) survey conducted in May 2017 by CARE in Rubkona County determined a GAM prevalence rate of 17.4% (12.9-23.0 95% CI), and a SAM rate of 3.9% (2.1-7.3 95% C.I). This level of malnutrition was classified as critical according to WHO 2006 classification. 1.2 Purpose of the survey The main purpose of conducting the SMART surveys is to determine the prevalence of acute malnutrition among the population in the survey area in order to allow comparison to prior year surveys. The survey is expected to provide robust data, in line with the recommendations and methodology developed by the national nutrition cluster in South Sudan. The result of the surveys will inform the program progress towards the project outcome as well as form a basis for adjusting the modalities of implementation of nutrition program in the county as will be necessary. 1.3 Survey objectives The overall objective is to determine the prevalence of acute malnutrition among children aged 6 to 59 months, estimate retrospective mortality rate of the population as well as to assess the food security situation and Infant and young children feeding practice (IYCF) in the county. 1.4 Specific objectives • To determine prevalence of Global and Severe Acute Malnutrition (GAM and SAM) among children aged 6 to 59 months in the County. • To determine retrospective crude mortality rates (CMR) and under five mortality rates (U5MR) • To estimate the coverage of measles vaccination (9-59 months), Vitamin A supplementation (6- 59 months) and deworming (12-59 months). • To determine the morbidity and health seeking behaviors in the county. • To determine infant and young child feeding practices • To assess the current household food security situation of the county • To assess the hygiene practices and access to water and sanitation. 2.0 Survey timing The surveys will be conducted from 14– 24th May 2018, inclusive of coordination with authorities, training and data collection. 2.1 Survey area The survey will be carried out in all payams in Rubkona County. The smallest geographical unit (village) in the County will be considered as a cluster. When on the ground if there are areas that are not accessible due to security and population movement/displacements they will be removed from the sampling frame. 3.0 METHODOLOGY 3.1 Study Design A cross-sectional two-stage cluster sampling following SMART methodology will be adopted. The first stage will involve selection of the clusters. The villages will be considered as the smallest geographical unit (clusters) in the host community while in the comp block/zone will be considered as the smallest geographical unit. Household1 will be considered as the basic sampling unit. The second stage will involve selection of households. 3.2 Survey Target Population The target population for this survey will be the children aged 6–59 months for the anthropometric and the health questionnaire, respondents will be the mothers or caregivers of the children. The household heads will be the respondents for individual mortality questionnaires which will include all members of the household. The sampling frame will contain only the list of villages considered secure and accessible. Only selected households will be surveyed. 3.3Sample Size Determination Emergency Nutrition Assessment (ENA) for SMART software updated version 9th July 2015 will be used for sample size calculation. The purpose of the sample calculation is to get a sample having the optimal units so that results are reliable; with reasonable precision. The sample size calculation takes into consideration the