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Micronutrient Survey
Manual & Toolkit

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Micronutrients, commonly known as vitamins and minerals, are essential in small amounts for proper growth and development. Micronutrient deficiencies can lead to impaired physiological development and socioeconomic achievement. Preventing deficiencies requires that people have access to enough food and an appropriately diverse diet. Certain population groups, especially women and children, are at greater risk of deficiencies. Populations that are deficient in one micronutrient are often vulnerable to deficiencies in others, thus interventions to address different micronutrient deficiencies frequently use the same delivery mechanism.

Surveys to assess micronutrient status provide a basis for policy makers and programme implementers to understand variations among different population groups, to assess where micronutrient deficiencies exist, to evaluate the impact of interventions to improve micronutrient status, and to gather the evidence needed to improve programming.

The Manual

This manual contains modules covering all aspects of a cross-sectional micronutrient survey, from planning through implementation to analysing, reporting, disseminating and using the data. The main audience for the manual is programme managers responsible for the design and implementation of a micronutrient survey. Others involved in specific aspects of survey planning and implementation should also find certain procedures and tools useful.

The manual focuses on cross-sectional cluster surveys, which are designed to provide estimates of the prevalence or population status of selected micronutrients. The surveys also provide information on relevant health indicators and estimates of intervention coverage. The manual has limited information about simple random sample surveys, since that method usually only applies to small-scale micronutrient surveys in concentrated populations, for example refugee camps.

Designing and implementing large, population-based micronutrient surveys is a complex and costly activity. Because there is often a programmatic need to study the status of several micronutrients within the same population group, and because most of the costs are incurred during field work (transportation, accommodation, allowances, maintenance of a cold chain for specimens, and other logistical issues) it is common practice to include multiple micronutrients in one single survey. The present manual is written from that perspective.

This manual emphasizes the use of indicators recommended by the World Health Organization (WHO) and other internationally recognized agencies for assessing vitamin and mineral status, for classifying deficiencies at the individual and population levels, for defining public health problems and for monitoring progress toward preventing and eliminating micronutrient deficiencies. Other indicators that may be useful for specific research studies but that are not suitable for large cross-sectional surveys are not included in this manual. It is important to recognize that recommended methods to assess the micronutrient status of a population change frequently. The information contained in this manual is current at the time of publication and will be updated when appropriate to reflect changes.

Where possible, this manual has drawn from existing survey resources, including the Multiple Indicator Cluster Surveys (MICS) and the Demographic and Health Surveys (DHS). The manual is organized as a series of stand-alone modules for each of the key aspects to be considered when planning and implementing a micronutrient survey, and when carrying out data management, analysis and reporting. The modules are available individually on line and have been assembled in this manual. The manual may be used in its entirety for planning a micronutrient survey, or individual modules may be referred to as needed. Each module discusses specific considerations and is designed to guide the user through these at every step in the process.

The manual is complemented by an online toolkit that provides additional resources, including standardized tools and examples of how they have been used in the field. Links to relevant tools are provided throughout this manual.

The following table provides a short description of each module. Programme managers, responsible for designing and implementing micronutrient surveys, should read and become familiar with every module. In addition, as suggested on the table, certain specialists will find specific modules most useful.

Table of Contents

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Module 1: Planning and designing a micronutrient survey

Describes key considerations necessary for planning and implementing a micronutrient survey. Specifically, it describes defining the scope and objectives for the survey, and navigating the next steps of protocol development and ethical approval.

Target: Programme manager, Survey coordinator, Steering committee, Technical committee

Module 2: Indicators of programme coverage, specimen selection, management and analysis

Describes how to select biological specimens for different population groups and food samples for surveillance and evaluation of fortification programmes.

Target: Programme manager, Technical committee, Data coordinator, central data team, field, laboratory and management staff

Module 3: Biomarker selection and specimen handling

Describes the specific biomarkers, the type of specimen to collect, and analytical methods required for various micronutrients and related health indicators. There is ample information on laboratory methods and the correct interpretation of micronutrient biomarkers.

Target: Programme manager, laboratory coordinator, Regional laboratory supervisor field, laboratory and management staff

Module 4: Survey design

Focuses on how various design factors would complement certain survey objectives. For example, is it necessary to have national or sub-national estimates for the chosen indicators? Could the survey objectives be met if the data collection was nested within another ongoing survey? These factors, along with periodicity of data collection and mode of data collection are discussed.

Target: Programme manager, Technical committee, Survey statistician

Module 5: Sample size

Describes how to calculate appropriate sample sizes for key indicators among population groups of interest with adequate precision. The survey objectives must be taken into consideration and balanced with the available budget. There are examples of sample size calculations that account for stratification, clustering, and non-response.

Target: Programme manager, Technical committee, Survey statistician

Module 6: Selecting clusters

“Clusters” is the most common term used to describe the primary sampling units (PSUs) that are selected for sampling in micronutrient surveys. This module explains methods for and provides examples of selecting clusters, using probability proportional to size (PPS), simple random sampling (SRS), and systematic sampling (SS).

Target: Programme manager, Technical committee, Survey statistician

Module 7: Selecting households and participants

Reviews the general principles of household mapping and listing, and outlines the responsibilities of listing and mapping personnel. There are examples on how to (1) map clusters and households, (2) segment primary sampling units, (3) select households in a cluster and (4) identify and select eligible individuals in selected households.

Target: Programme manager, Survey statistician

Module 8: Survey supervision and personnel

Outlines survey oversight and staffing. This module describes the personnel needs for micronutrient surveys, from the overarching organizational structure to the field team composition. There are suggestions for field team recruitment as well as for the roles of the subcommittees overseeing the coordination of the survey.

Target: Programme manager, Survey coordinator, household listing and mapping team, Field coordinator, regional supervisors

Module 9: Survey equipment and supplies

Provides detailed information and links to tools to help plan for specific survey supply and equipment needs. Since equipment and supplies may not be readily available and can take a while to procure, it is important to determine the needs for data collection and laboratory assessment early in the planning phase of the survey.

Target: Programme manager, Survey coordinator, Steering committee, Technical committee, Field coordinator, Laboratory coordinator, regional supervisors

Module 10: Budget and timeline

Provides an example of micronutrient survey budgets and timelines.

Target: Programme manager, Survey coordinator, Technical committee, Laboratory coordinator, Field coordinator

Module 11: Data collection tools, field manual, and database

Describes the development of data collection tools such as questionnaires, and discusses the survey database. Early planning on database development can enable file checking throughout data collection, which would lead to higher quality survey data. This module also covers informed consent and accurate determination of a child’s age

Target: Programme manager, Survey coordinator, Steering committee, Technical committee, budget and finance subcommittee, Laboratory coordinator

Module 12: Training and pilot testing

Discusses how to develop training agendas and conduct the pilot testing for micronutrient surveys.

Target: Programme manager, Technical committee, Field coordinator, Data coordinator, central data team, regional supervisors

Module 13: Field logistics

Outlines the complexities of data collection in the field and provides suggestions for effective communication, efficient movement of supplies, staff and specimens throughout the survey. If the survey requires a cold chain then proper mapping, planning and budgeting prior to data collection is necessary. The requirements for cold chain can be underestimated.

Target: Programme manager, Technical committee, Deputy coordinator, Field coordinator, Laboratory coordinator, regional supervisors

Module 14: Data entry, cleaning and processing

Describes the steps necessary after data collection to come to a complete database for the survey. It also discusses outlier variables and dichotomizing continuous variables for reporting prevalence estimates in the final report.

Target: Programme manager, Technical committee, Deputy coordinator, Field coordinator, Data coordinator, central data team, Laboratory coordinator, regional supervisors

Module 15: Data analysis

Focuses on appropriate reporting of estimates collected by the survey. Specifically, it addresses the use of complex survey design parameters such as cluster, strata and weighting variables.

Target: Programme manager, Data coordinator, central data team, regional supervisors

Module 16: Survey reports and dissemination

Provides considerations for disseminating the new information generated from the micronutrient survey. Examples include an executive summary or key indicator report, the full survey report, protocol papers or scientific manuscripts.

Target: Programme manager, Technical committee, Data coordinator, Database managers and data processing staff

The Micronutrient Survey Manual & Toolkit is a collaboration of: