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Sage Organization
In partnership with UNFAO/FSNAU
And the Somalia Nutrition Cluster
Funded by the
COMMON HUMANITARIAN FUND
Training Report No. 1
May 2, 2013
The Standardized Monitoring and Assessment of Relief and Transitions
(SMART) Survey Methodology
Somali Nutrition Cluster partners
UN OCHA/FAO Somalia Conference Room.
March 21-28, 2013
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2 ACKNOWLEDGEMENTS
Sage acknowledges the Common Humanitarian Fund (CFH) for funding the SMART training
in addition to other scheduled initiatives.
The support from Leo Matunga the Nutrition Cluster Coordinator in identifying participants
for the training and in reviewing the draft report jointly with Komberero Chirenda is
acknowledged. Special thanks to Penina Muli and UNFAO’s Monicah Magu for facilitating
access to the training venue.
Sage appreciates the expertise and commitment of Elijah Odundo the SMART Methodology
Training Consultant, for undertaking a rigorous training, and presenting the draft report. We
would also like to thank UNFAO/FSNAU’s nutrition team: Tom Oguta, Joseph Waweru,
Mohamed Borle and Abukar Yusuf for co-facilitation, and experience sharing.
We are grateful to CDC for availing SMART training modules and tools which were used in
the training.
We are indebted to Dr. Yeri Kombe, Director: Center for Public Health Research - Kenya
Medical and Research Institute, who provided us with anthropometric equipment for the
practical sessions.
We are thankful to the management of the Great Star Academy in Kibera-Nairobi for
allowing us to undertake a practical session on anthropometry and the standardization test, in
the institution; and to the caregivers of the children who were measured.
Sage further acknowledges the commitment and focused attention of the participants who
attended the rigorous six day training.
Sage organization management team acknowledges the administrative role played by Sherry
Makeba, an intern at the agency which contributed to the successful accomplishment of the
SMART Methodology Training.
To all of you we say,
Mahadsanid.
On behalf of Sage Organization
Ahono Busili
Technical Advisor
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3 TABLE OF CONTENT
ACKNOWLEDGEMENTS ....................................................................................................... 2
TABLES ..................................................................................................................................... 4
ACRONYMS ............................................................................................................................. 5
INTRODUCTION ...................................................................................................................... 6
Purpose and objectives ........................................................................................................... 7
1. SCOPE OF TRAINING ...................................................................................................... 9
2. TRAINING: METHODS AND ACTIVITIES ................................................................. 12
Session timing ...................................................................................................................... 12
Adequate coverage of subject material ................................................................................ 12
Target group/Trainees participation ..................................................................................... 12
Training Materials ................................................................................................................ 12
3. ANALYSIS OF THE TRAINING EFECTIVENESS ...................................................... 14
4. LIMITATIONS AND CHALLENGES ............................................................................... 16
5. RECOMMENDATIONS .................................................................................................. 16
6. APPENDICES .................................................................................................................. 17
Appendix 6.1. Participants at SMART METHODOLOGY training workshop . ................ 17
Appendix 6.2. Knowledge assessment: Day 1 .................................................................... 17
Appendix 6.3: Group work ................................................................................................... 18
Appendix 6.4. Knowledge assessment: Day 3 ..................................................................... 18
Appendix 6.5: Survey Managers Post-Training Assessment ............................................... 19
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4
TABLES
Table 1: Training content ........................................................................................................... 9
Table 2: Summary of analysis of training effectiveness .......................................................... 14
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ACRONYMS
CDC Center for Disease Control
ENA Emergency Nutrition Assessment
EPI-INFO Epidemiological Information
HH Household
KEMRI Kenya Medical Research Institute
MUAC Mid Upper Arm Circumference
FSNAU Food Security and Nutrition Analysis Unit
OCHA Office for the Coordination of Humanitarian Assistance
SAGE Sage organization
SMART The Standardized Monitoring and Assessment of Relief and Transitions
UN United Nations
UNFAO United Nations Food and Agriculture Organization
WHZ Weight for Height Z Scores
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6
INTRODUCTION This report presents a summary of results from the SMART Methodology Training that targeted
Nutrition cluster members. The training was held between 21st and 28th March 2013. The workshop
was organized by SAGE organization, delivered through a consultant, and co-facilitated by SMART
trained FSNAU staff.
In summary, SAGE was able to achieve its training project goals of providing a training to the Somali
nutrition partners as well as their staffs with transferable skills on SMART methodology. More
specifically, SAGE organization met the principal project objective of helping build the capacity of
nutrition cluster members in planning, collecting and analyzing data, particularly, nutrition data using
ENA for SMART and EPI-ENA and report on nutrition and mortality data in a standardized manner
through the use of SMART methodology.
An end-of-workshop evaluation assessment indicated that participants who attended the training
consistently to the end managed to acquire knowledge and build confidence in the SMART. The
components of the training agenda were delivered in a timely fashion, allowing a good mix of theory
and practical lessons that allowed effective delivery of the training.
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7 Purpose and objectives
Purpose
The purpose of conducting the SMART methodology training was to equip a core group of nutrition
cluster members with knowledge and skills to undertake and/or interpret nutrition survey’s findings.
According to SAGE, a clear understanding of key evidence from nutrition surveys is cornerstone to
appropriate nutrition response.
Objectives
The main objective of the training was to equip the participants with transferable skills for conducting
nutrition surveys using the SMART methodology and analyze nutrition data using ENA for SMART
and EPI-INFO analysis tools.
SAGE anticipates that the trained members will be able to mentor staff within their organizations on
nutrition research based on the SMART methodology.
Participants objectives/expectations
Below is a summary of participants’ expectations from the training workshop.
To increase capacity in conducting nutrition surveys.
To obtain a certificate of SMART methodology training
To gain knowledge on how to conduct a nutrition survey and how to analyse the data to
determine malnutrition rates in a specific group
To learn more about SMART methodology
To interpret ENA results
To learn SMART sampling techniques, particularly for selection of HHs
To understand analysis of data using ENA and EPI-INFO.
Understanding sampling procedures
To carry out a nutrition survey :Specifically: Planning a survey,: Training a survey team on
data collection, Data entry using ENA software, Data analysis, Results interpretation and
Report writing.
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8 Training participants
Selection of participants was done jointly by the Nutrition Cluster Coordinator and SAGE
Organization. The selection criteria constituted, professional background, experience in conducting or
participating in a nutrition survey, and demonstrated basic understanding of research.
The selected participants represented five international and six local non-governmental organizations.
The list of participants is provided in Appendix 6.1.
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9 1. SCOPE OF TRAINING The training on SMART methodology was intended to provide the participants with transferable skills
in conducting
i. nutrition surveys
ii. mortality surveys
The training also expounded on nutrition and mortality data analysis and other non-anthropometric
indicators such as household food consumption and morbidity data. Data interpretation and report
writing were addressed. It therefore covered the fundamental areas which formed the training content
as illustrated in the summary below table:
Table 1: Training content
Day Topics covered Module Objectives Materials provided & Other day activities
Day 1 Introduction &
presentation of training
contents and teaching
methods
Over view of Nutrition
and Mortality surveys
Presentation of participants
SMART training program
Structure of the training
Learning and teaching
methods
What the SMART initiative
offers
Introduction to SMART methodology Workshop
.ppt
1. Pre- test evaluation was done: Tested participants
knowledge of various issues as pertains the
training content (Pre-Training Evaluation
test –embedded)
- Software installation s(ENA, EPI-ENA version
3.5.3 and EPI-INFO version 7.0)
Day 2 Sampling in nutrition and
mortality surveys using
ENA-for-SMART
(planning)
Sample size calculation
Decide when and how to apply
each sampling method.
Understand which factors
influence sample size.
Use these factors to determine
sample size appropriately with
ENA software.
1. Sampling in Nutrition surveys.ppt
2. Sample size calculation.ppt
Group discussions and presentation –Tested
participants understanding of sampling concept
and the methodologies.
Day 1_Knowledge assessment (embedded)
Day 1_Knowledge assessment
Group work
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Day 3
Survey field procedures.
List the daily verifications to do
before leaving to the survey
area.
Choose the most appropriate
method for household selection
and apply it properly.
Enumerate the basic procedures
to follow once on the field and
before leaving it.
Manage the most common
special cases that might be
encountered on the field.
Survey field procedures.ppt
Day 4 Anthropometrics &
Fundamental concepts in
Nutrition
Techniques in
anthropometric
measurements
Introduction to ENA and
entering data into ENA
software
Apply the appropriate
anthropometric measurements
procedures for children 6-59
months.
Build and use an events calendar
to estimate the age of children
from 6 to 59 months.
Use the weight for height
reference tables to determine the
nutritional status of measured
children.
Use ENA Data Entry
Anthropometry screen
appropriately.
Explain the different graphs and
results shown on the ENA
Anthropometry Results screen
Anthropometry overview_suchdev.ppsx
Anthropometry.ppt
Day_3 Knowledge assesment
Day 5 Standardization
Identify the objectives and
the principles of the
standardization test.
Describe the procedures for
the standardization test.
Enter the data of the
standardization test into
ENA.
Interpret the results and
decide on the appropriate
solutions.
-Visited a Great Star Kindergarten in Kibera area
of Nairobi where we conducted standardization on
10 children
Day 6
Plausibility check for
Anthropometry
Interpret the different parts
of the plausibility report.
Use parts of the plausibility
check for the supervision of
teams during data collection.
Use the evaluation done by the
plausibility report to make
2. Post- test evaluation was done: Tested participants
knowledge of the modules covered during
the training
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Interpretation of Results and
Reporting
objective and informed
judgment about the quality of
your survey.
Identify the factors to
consider for the interpretation
of survey results.
List the essential elements for
a complete survey report.
3. Case study: The participants were given a take
away case study for purposes of reinforcing
the training messages.
4. Awarding of certificates to 10 participants.
As illustrated above, the workshop was split in different subject modules and was delivered in a mix of
theory, practical and group sessions depending on whether it was knowledge or skills transfer that
needed to be achieved.
The practical sessions for anthropometrics were done during the standardization test session which
was done at Great Star Academy in Kibera area of Nairobi.
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2. TRAINING: METHODS AND ACTIVITIES
Session timing
There was adequate time to deliver the subject content that was conducive to learning, providing
ample opportunity for feedback, discussion and practice. However, key1 modules such as Sampling ,
Plausibility Check for Anthropometry data and Standardization test were accorded slightly more time
than the other modules. Unfortunately data analysis using ENA and EPI-ENA which was of key
interest to the participants, did not get adequate time as was cited by the participants.
Adequate coverage of subject material
Given the systematically developed timetable, the subject material, were very well covered.
The participants felt that materials and training provided more than adequate details and very intense.
Target group/Trainees participation
All participants were required to take an active part in the workshop. Apart from the standardization
test which required practicals in the field and analysis sessions that required every participant to
practice from his or her computer, the sessions on sampling and survey planning, involved group
work and presentations which allowed the facilitator to assess the participants level of understanding
of the fundamental concepts. Through the group work and presentations, every participant was given
a chance to share his/her understanding of the concepts.
The workshop was an interactive and participatory style seminar, where participants were required to
work in groups. In addition to group work, the facilitator conducted knowledge assessment test every
morning to evaluate the participants understanding of the concepts. This allowed the facilitator to
filter out some areas that needed further emphasis.
Training Materials
During the training, the participants were provided with relevant reading materials for reference and
all the necessary softcopies of the training modules. Data files were also made available for analysis
1 Sampling, Plausibility check for Anthropometry and Standardization are robust topics in SMART training and
require more hours and emphasis.
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13 session using ENA and EPI-ENA softwares. In addition, the facilitators provided the data analysis
software (ENA for SMART, EPI-INFO version 3.5.3 and 7.0 and EPI-ENA) for installation on
participants computers. It is important to note that these soft wares can be freely downloaded from
CDC and SMART/Nutrisurvey websites.
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14 3. ANALYSIS OF THE TRAINING EFECTIVENESS Table 2: Summary of analysis of training effectiveness
Day Analysis of training effectiveness based on the Evaluations
Day 1 The objective of the pre-test evaluation was to assess the participants back ground and prior
understanding of course content.
33% (4 out of the 12) participants who took the test had some past experience with
SMART guidelines and had important understanding of fundamental nutrition concepts
and were more keen on sharpening their data analysis skills. The 4 scored above 40% in
the pre-test.
Another 25% (3 had no experience with SMART guidelines but had good understanding
of key nutrition concepts-had undergone some training in Nutrition or by experience.
These scored between 15% and< 40% in the pre-test.
The remaining 42 % had no experience with SMART guidelines and had very little
understanding of fundamental nutrition concepts.
The evaluation which tested the participants level of exposure to the SMART
methodology and use of ENA and EPIINFO software prior to the training indicated the
group had little knowledge and therefore the training was needful. (see embedded Pre-
Training Evaluation results)
Given that this group was very heterogeneous in their exposure and understanding of
the training content, it therefore meant that the group work was going to be highly
beneficial as this allowed sharing of practical experience for learning purposes.
Day 1 evaluation: The analysis illustrated that the concepts were adequately understood.
Facilitator provided the powerpoint materials for reference.
Day 2 Through group discussion and class presentations evaluation results of the teams showed that
the sampling techniques were well understood, albeit a little challenges. Emphasis was
therefore laid on the aspects that were a bit unclear such as HH selection, use of replacement
clusters, rationale of different types of sampling techniques.
Day 3
Day 4 Sessions on anthropometric measurements were conducted using visual demonstrations. The
participants appreciated the techniques and their understanding were further evaluated during
the standardization test exercise.
Day 5 Standardization test exercise was done among children of between 12 to 48 months at a
children’s centre in Kibera. This activity enabled the participants to practice anthropometric
techniques as well learn the dynamics of conducting standardization test.
Day 6 Out of the 12 participants who were present at the start, 10 stayed till the end and took part in
the post-training test. The final evaluation illustrated the participants had developed some level
of understanding with reference to the use of anthropometric tools and SMART methodology.
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Pre & Post training results
During and post-training monitoring and evaluation
The following tools were used to monitor and evaluate whether project objectives were met
and were used both during and after the SMART workshop:
Pre and post Post-training evaluation to assess participants understanding of concepts.
Trivia to provoke discussion on certain fundamental issues.
Daily knowledge assessment to assess participants understanding of the sessions
Group work during the training and revision sessions to help gauge learning transfer
and any necessary adjustments.
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16 4. LIMITATIONS AND CHALLENGES
During the workshop, the facilitator/participants encountered a few challenges that impeded
the ability to deliver the training as effectively as planned. These included:
The attendance of was not steady with between 3 and 4 participants being absent and
hence missing certain sessions due to demand on their time, illness and in some cases
due to explained absence.
3 participants joined a day after the training had started. One cited lack of
communication, while two who had been on the waiting list were co-opted in the last
minute after three previously selected candidates failed to show-up.
Epi-ENA Software installation problem was encountered on computers of three
participants. This hindered their effective practice in using EPI-ENA.
Two participants had serious challenges with their computer operating systems which
affected their ability to concentrate on their work during class.
5. RECOMMENDATIONS The facilitator recommends that the following needs to be done to help the participants in the
realization of their expectations after undergoing the SMART training:
- Continued technical support in the planning of the survey and use of ENA and should
be involved in the upcoming nutrition and mortality surveys in Somalia.
- Continued sharing of information, pertaining to updates and changes in the SMART
methodology. Sage Organization and its network of facilitators are willing to maintain
a network with the participants regarding new updates.
- Further training, e.g. refresher training and support for the nutrition cluster members
and other partners that could benefit from the training.
- A practical research study augmented with follow up training on Data management
and analysis would enhance the effectiveness of the SMART training.
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17 6. APPENDICES
Appendix 6.1. Participants at SMART METHODOLOGY training workshop
in Nairobi, March 2013.
No. Name Agency Email Address Cellphone no.
1 Halima Ahmed AMCCO [email protected] 0705352265
2 Abdi Moge SAF [email protected] 0722700991
3 Abdi Gedi Mohamed DIAL [email protected] 0727649464
4 Mohamed Sheikh
Ahmed
COSV [email protected] 0729611929
5 Adan Mohamed
Ahmed
ARDI [email protected] 0728343020
6 Ali Abdullahi Abdi Hardo/Oxfam
Novib
[email protected] 0728343020
7 Everlyne Adhiambo Cafdaro [email protected]
0721498706
8 Sherry M. Wawire Sage [email protected] 0722477293
9 Onesmus Muinde
Klungu
Save the
Children
[email protected] 0733577378
10 Aweys Mohamed
Abdille
Sage [email protected] 0712888934
11 Jennifer Wema Adere World Vision [email protected] 0722860022
12 Matilda Kirui Jubaland Charity
Center (JCC)
[email protected] 0721665362
Appendix 6.2. Knowledge assessment: Day 1
1. List and briefly explain the difference between surveillance, surveys and Rapid
assessments.6 mks
2. Your organization is planning to conduct a nutrition and mortality survey amongst the
under 5 population in Lower Juba. As the person in charge, you are tasked to prepare a
questionnaire. You are also interested in estimating the EPI coverage in the area since
your organization also conducts health interventions
Using the above information
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18 I. Write down the at least 3 objectives for your survey (3 mks)
II. What are the 3 main components of an objective (3 mks)
III. Design a small questionnaire listing the key variables that you will need to meet
your objectives (DO NOT CONSIDER MORTALITY VARIABLES) (13 mks)
3. When designing a questionnaire what are the key factors to consider (list at least 5)
(5 mks)
Appendix 6.3: Group work
GROUP A
Part A
Writing questions: Is anything wrong with the following questions?
1) Many people think that eating red meat is bad for your health. Do you like to eat red
meat? ___ Yes ___ No
2) Please list all foods you have eaten in the past 3 days. __________________
3) When you last had a respiratory infection, did aerosolized particulate matter
exacerbate your symptomatology? ___ Yes ___ No
4) Can you read and write? ___ Yes ___ No
5.Compared to your friends, do you exercise More than most ____
Similar to most _____ Less than most ____
Part B
List some of the factors to consider when designing questions/questionnaire
GROUP B
Your boss informs you of the need to conduct an Anthropometric survey in an area where you
conduct health and nutrition interventions and tasks you to design an appropriate survey
questionnaire for the survey. In the last few weeks a partner agency sent a mail raising
concerns about some outbreak of an unknown disease in the area. Your agency provides
health interventions in the area.
Design an appropriate questionnaire.
Appendix 6.4. Knowledge assessment: Day 3
1. You arrive to a village(selected cluster) and you find that it is too large (more than
250HH), so you decide to do segmentation. Village leader was able to identify 3 parts.
Their approximate sizes in HH number are 95 HH for part A, 60 HH for part B and 120
HH for part C. Explain how you would proceed to select your households.(6 MKS)
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19 2. TRUE or FALSE: Segmentation allows dividing the cluster into smaller equal or unequal
parts in order to use one of the recommended households selection methods. (1MK)
3. When is it possible to use systematic random sampling within clusters? (1 MK)
4. Name 6 items you need to check before leaving for the field (6 MKS)
5. What is the advantage of using z-score when expressing nutrition indicators (1 mk)
a. It is easier to understand and explain by the survey manager
b. It is more valid statistically
c. It is easier to calculate with calculator
d. All these answers are correct
6. What 3 mistakes can be made when measuring a child’s length ( 3mks)
7. What 3 mistakes can be made when measuring MUAC (3 mks)
Appendix 6.5: Survey Managers Post-Training Assessment
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