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

Assessing indicators of programme coverage

Collecting specimens for assessing biomarkers

Location for collecting samples and data

Selecting laboratories to test specimens

Introduction

The overall objectives of the micronutrient survey describe the populations to be included, as well as the micronutrients and programme process indicators to be assessed (see Module 1, Planning and designing a micronutrient survey). The subsequent steps determine the type of samples and specimens required, and how they will be collected, transported, stored and analysed. Development of recommendations concerning most biomarkers 1 and food nutrients requires analysis in a laboratory setting with specialized equipment and training. These are described in more detail in Module 3: Biomarker selection and specimen handling.

Decisions made during the planning process will influence the survey outcome, protocol development, draft budget, and equipment and supplies needed. Some points to consider:

  • program coverage indicators will require knowledge of national and large-scale nutrition interventions, and may reflect a national nutrition policy;
  • the selection of indicators will be based on the feasibility of collecting required food samples and biological specimens, maintaining a cold chain if required, access to appropriate laboratory capacity either in the country or internationally, and available budget; and
  • the survey scope may need to be adjusted, depending on the cost of collecting, transporting, and analysing the samples and specimens required to assess the chosen indicator(s).

Module 3: Biomarker selection and specimen handling describes the options and main factors to consider in making these decisions.

Ordering equipment and supplies is an important determinant of the survey timeline, as described further in Module 9, Survey equipment and supplies and should be done well in advance of the survey. At the same time, if this is done too early there is a risk of exceeding expiration dates on the supplies purchased (for example, cuvettes for a portable photometer).

  1. In this context, a biomarker is a measurable indicator of micronutrient or related health status. 

Analysis of Food Samples

Food collection, testing, labelling, replacement

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Comprehensive lab supply list

List contains the specifications of laboratory supplies and the contact details of suppliers

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Equipment and Supplies List (more complex worksheet)

Detailed spreadsheet enables the user to calculate a rough cost of the supplies and tests needed for a survey

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Ferritin storage and handling guidelines

Document instructs how to properly store and handle blood for ferritin analysis

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Folate - specimen processing for WB hemolysate

Document instructs how to collect and process whole blood to prepare hemolysate for folate analysis

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HemoCue Hb Testing QC form

Quality control form used by phlebotomists to test the operation of the HemoCue prior to going into the field each day

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Lot screening for elemental analysis

Document provides instructions on how to screen lots of supplies used for elemental analysis

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MNP questionnaire template

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Minimum quality assessment system for low-resource setting

Document provides useful information for laboratories in low-resource settings about the minimum components of quality assurance

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Overview of MRDR ppt

Instructions on dosing vitamin A2 and blood collection

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Overview of cold chain logistics

Presentation to provide an overview of cold chain logistics in the field

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Overview of malaria testing presentation

Presentation instructs on how to test for malaria in the field

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Overview of specimen collection, processing, testing - Text

Presentation providing instructions on the collection, testing, and processing of specimens in the field

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QC pool preparation characterization and tracking

Document instructs laboratories on how to prepare, characterize, and use bench quality control pools

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Quality assessment system

Document provides useful information for laboratories in low-resource settings about the minimum components of quality assurance

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Questionnaire for laboratory evaluation

Document can be used by survey coordinators and external quality control programs to assess the capacity and needs of laboratories engaged in the biological assessment of micronutrients

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Serum and plasma preparation instructions

Document providing instructions on how to process blood to obtain serum and plasma

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Stool sample collection instructions

Document instructs on how to collect a stool specimen

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Universal precautions - ppt

Presentation to provide an overview of safety and use of universal precautions in the field

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Urinary iodine ammonium persulfate method

Document instructs on how to perform the urinary iodine ammonium persulfate method

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Vitamin A storage and handling guidelines

Document instructs on how to properly store and handle blood for vitamin A analysis

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Vitamin C specimen processing for serum

Document instructs on how to properly store and handle blood for vitamin C analysis

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Specimen field collection and processing manual

Manual used by phlebotomists and laboratory staff to provide a detailed explanation of specimen collection, processing, and transport

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HemoCue 201 instruction manual

Document provides the procedure for measuring hemoglobin using the HemoCue analyzer

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HemoCue 301 instruction manual

Document provides the procedure for measuring hemoglobin using the HemoCue analyzer

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HemoCue Hb Testing instructions

Document instructs on how to use the HemoCue

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HemoCue Hb Testing ppt

Presentation instructs on how to use the HemoCue

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Packaging/ shipping specimens using dry ice poster

Document instructs on how to package and ship specimens using dry ice

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