Abstract
BackgroundRepresentative surveys collecting weight, height and MUAC are used to estimate the prevalence of acute malnutrition. The results are then used to assess the scale of malnutrition in a population and type of nutritional intervention required. There have been changes in methodology over recent decades; the objective of this study was to determine if these have resulted in higher quality surveys.MethodsIn order to examine the change in reliability of such surveys we have analysed the statistical distributions of the derived anthropometric parameters from 1843 surveys conducted by 19 agencies between 1986 and 2015.ResultsWith the introduction of standardised guidelines and software by 2003 and their more general application from 2007 the mean standard deviation, kurtosis and skewness of the parameters used to assess nutritional status have each moved to now approximate the distribution of the WHO standards when the exclusion of outliers from analysis is based upon SMART flagging procedure. Where WHO flags, that only exclude data incompatible with life, are used the quality of anthropometric surveys has improved and the results now approach those seen with SMART flags and the WHO standards distribution. Agencies vary in their uptake and adherence to standard guidelines. Those agencies that fully implement the guidelines achieve the most consistently reliable results.ConclusionsStandard methods should be universally used to produce reliable data and tests of data quality and SMART type flagging procedures should be applied and reported to ensure that the data are credible and therefore inform appropriate intervention. Use of SMART guidelines has coincided with reliable anthropometric data since 2007.
Highlights
Representative surveys collecting weight, height and mid-upper arm circumference (MUAC) are used to estimate the prevalence of acute malnutrition
Over the past 30 years, it has become increasingly common to use a single round of anthropometric measurements from a representative sample of children, aged 6–59 months, to assess a population’s nutritional state, in areas thought to be under nutritional stress
As the different agencies trained, implemented and became familiar with SMART there was a reduction in the mean standard deviation (SD) of their surveys to be close to the expected SD of 1.0Z of the World Health Organisation (WHO) standards
Summary
Representative surveys collecting weight, height and MUAC are used to estimate the prevalence of acute malnutrition. Over the past 30 years, it has become increasingly common to use a single round of anthropometric measurements from a representative sample of children, aged 6–59 months, to assess a population’s nutritional state, in areas thought to be under nutritional stress. These cross-sectional, population-based surveys are used to estimate the prevalence of acute malnutrition, poor growth attainment, and mortality rates as fundamental health indicators. They can be interpreted with contextual information to plan and implement. The data enable governments and United Nations (UN) agencies to properly coordinate the overall response and allows donors to allocate funds appropriately and effectively
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