This article is part of a series on Methods for Health Surveys in Difficult Settings, edited by Oleg Bilukha (Centers for Disease Control), Kristof Bostoen (London School of Hygiene and Tropical Medicine), Francesco Checchi (London School of Hygiene and Tropical Medicine), Bridget Fenn (London School of Hygiene and Tropical Medicine), Oliver Morgan (London School of Hygiene and Tropical Medicine) and Anne-Marie ter Veen (London School of Hygiene and Tropical Medicine).

Analytic perspective

A review of methodology and analysis of nutrition and mortality surveys conducted in humanitarian emergencies from October 1993 to April 2004

Claudine Prudhon¹ and Paul B Spiegel²

¹  United Nations Standing Committee on Nutrition, c/o World Health Organization, 20 Avenue Appia, CH 1211, Geneva 27, Switzerland

²  United Nations High Commissioner for Refugees, PO Box 2500, CH 1211, Genève 2 Dépôt, Switzerland

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Emerging Themes in Epidemiology 2007, 4:10doi:10.1186/1742-7622-4-10

Published:	1 June 2007

Abstract

Background

Malnutrition prevalence and mortality rates are increasingly used as essential indicators to assess the severity of a crisis, to follow trends, and to guide decision-making, including allocation of funds. Although consensus has slowly developed on the methodology to accurately measure these indicators, errors in the application of the survey methodology and analysis have persisted. The aim of this study was to identify common methodological weaknesses in nutrition and mortality surveys and to provide practical recommendations for improvement.

Methods

Nutrition (N = 368) and crude mortality rate (CMR; N = 158) surveys conducted by 33 non-governmental organisations and United Nations agencies in 17 countries from October 1993 to April 2004 were analysed for sampling validity, precision, quality of measurement and calculation according to several criteria.

Results

One hundred and thirty (35.3%) nutrition surveys and 5 (3.2%) CMR surveys met the criteria for quality. Quality of surveys varied significantly depending on the agency. The proportion of nutrition surveys that met criteria for quality rose significantly from 1993 to 2004; there was no improvement for mortality surveys during this period.

Conclusion

Significant errors and imprecision in the methodology and reporting of nutrition and mortality surveys were identified. While there was an improvement in the quality of nutrition surveys over the years, the quality of mortality surveys remained poor. Recent initiatives aimed at standardising nutrition and mortality survey quality should be strengthened. There are still a number of methodological issues in nutrition and mortality surveys in humanitarian emergencies that need further study.