Standardizing Measurements of
nutrition and mortality information
Washington D.C, October 16th, 2013
Why are nutrition surveys
Goals of a Survey
Evaluate the scope and severity of a
Determine the needs of a new
Evaluate already existing programs.
When to do a Survey?
Surveys should take place when the
data collected will answer questions
that will influence activities and
What are the differences between
nutritional surveys, nutrition
surveillance and rapid assessment?
Methods for Data Collection
Limitations of Nutrition Surveys
Cross-sectional in nature.
Provides a snapshot at a given moment of
time (not trends).
Unable to establish causality.
Provides insufficient information for causeeffect analysis.
Cross sectional survey data should be
used in conjunction with other contextual
Summary stages of a survey
What is SMART?
A standardised and simplified field survey
methodology which produces a snapshot of
the current situation on the ground.
Prior to SMART:
Many established survey manuals and
guidelines to gather this information, BUT…
Standardized methodology - timely and reliable
Simplified, clear guidance for non-epidemiologists/
statisticians to prioritize humanitarian assistance.
Addressing key issues regularly faced by field
Emphasis on representative sampling AND
information on the quality of the measurements.
Problem: No Standardisation
Data quality in disaster settings poor.
Source: Spiegel P et al, JAMA 2004
Among 67 nutrition and mortality
surveys, only 6 (9%) met all 5 eligibility
criteria (being valid and precise).
The SMART methodology was developed in
2006 by a panel of experts in epidemiology,
nutrition, food security, early warning systems
SMART was originally developed to assess
acute malnutrition and mortality in
It is now used in all settings, including
development and displaced populations.
Who uses SMART?
Today, SMART is recognised as the standard
methodology by national Ministries of Health,
donors, implementing partners such as
international NGOs and UN agencies that wish to
undertake nutrition and mortality surveys in
ALL settings (emergency, development,
SMART is also incorporated into many national
Surveys using SMART
Produce representative, accurate and precise estimates of:
Global Acute Malnutrition (GAM).
Chronic malnutrition (Stunting).
These four indicators gathered through the SMART
methodology provide the best available validated data that
can be used for effective decision making and resource
Practice MUAC measurements.
Advantages of MUAC.
Why is mortality data needed?
Benchmark the severity of a crisis.
Establish a baseline for comparison (programmatic
Provide an empirical basis for advocacy purposes.
Complement a surveillance system.
Provides information on the demography of the
What indicators to include
1.Crude Death Rate.
2.Under-5 Death Rate.
Other possible analyses:
Age-specific death rate.
Sex-specific death rate.
(Cause-specific death rate).
Mortality & Demography Questionnaire
Limitations of Mortality Data
Data is retrospective: data on deaths will be late;
deaths may have occurred months ago.
Mortality is multi-causal: it is difficult to identify
what specific programs have reduced mortality
SMART can also evaluate:
Additional indicators, including:
Anemia; water, sanitation and hygiene (WASH);
coverage of blanket programs, immunization, and
vitamin A distribution; food security contextual
The number of additional indicators is
recommended to be kept to a minimum to
ensure high quality data.
Key SMART Innovations
User-friendly software -ENA Software- that follows every
step of a SMART survey.
Flexibility in sample size calculation.
Regularly updated, clear sampling guidance based on field
experiences, research and best practices.
Rigorous standardization test and analysis.
Plausibility check to follow data quality and identify
where the problems are.
Improved census procedure for the Mortality
Increased data credibility
Rigorous standardisation of field procedures.
Data quality checks.
Standardised automated data analysis.
Consistent and reliable survey data is
collected and analysed.
ACF-CA: SMART Project Convenor
ACF-CA, a core member of the GNC, is the SMART Project
Convenor, and in collaboration with the SMART Technical
Advisory Group and Centers for Disease Control and Prevention
(CDC Atlanta) establishes and maintains:
Standardisation and translation of tools for survey managers.
The SMART www.smartmethodology.org website.
On-line technical forum.
Partnerships with other agencies in trainings & survey support.
The SMART experts at ACF-Canada
in collaboration with CDC
currently provide training and remote technical
support in SMART.