Standardized Expanded Nutrition Survey 2019 - Kenya

Abstract
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The UNHCR Standardized Expanded Nutrition Surveys (SENS) provide regular nutrition data that plays a key role in delivering effective and timely interventions to ensure good nutritional outcomes among populations affected by forced displacement. UNHCR conducted an annual SENS nutrition surveys in Kakuma refugee camp and Kalobeyei Refugee Settlement. At the time of the survey, the camp was hosting 186,515 refugees originating from 20 countries, comprised of 53.3% (99,320) males and 46.7% (87,195) females. These represented 148,295 from Kakuma and 38,220 from Kalobeyei and originating from 20 nationalities. The number of children under 5 years of age is currently estimated to be 20,468 from Kakuma and 7,576 from Kalobeyei or 15% of the total population. Women of reproductive age were 32,373 from Kakuma and 7,643 from Kalobeyei. According to the United Nations High Commission for Refugees (UNHCR) HIS database (Nov 2018), the main countries of origin are currently South Sudan, 57.8 %, and Somalia, 33.6 %, with the remaining percent originating from various countries in the region including Democratic republic of Congo (6.5%), Ethiopia (5.6%), and Burundi (5.4%) among others. Data collection started on the 27th November of 2019 in Kakuma and 8th of December of 2019 in Kalobeyei settlement. The overall aim of this survey was to assess the general nutrition and health status of refugee population and formulate workable recommendations for appropriate nutritional and public health interventions.

Geographic coverage
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Kakuma Refugee Camp and Kalobeyei Refugee Settlement in Turkana County, Kenya

Analysis unit
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Children 0-23 months
Children 6-59 months
Women 15-49 years
Households

Universe
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Children 0-59 months Women 15-49 years Refugee households

Kind of data
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Sample survey data [ssd]

Sampling procedure
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A two-stage cluster survey with probability proportion to size sampling was employed in this survey. Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology to collect and analyse data on child anthropometry and UNHCR's Standardised Expanded Nutrition Survey (SENS) Guidelines for Refugee Populations was used to guide data collection for other indicators. The same households sampled by SMART were used in all indicators. Anaemia sample was drawn from the SMART sample size, as recommended by the UNHCR Standardised Expanded Nutrition Survey (SENS) Guidelines.

For each of the indicators used, households and individuals were sampled as follows:
Household-level indicators:
- WASH: every household
- Food Security: every other household
- Mosquito net: every other household

Individual-level indicators:
- Children 0-59 months: all eligible children in all households were assessed (based on the above calculations)
- Women 15-49: all eligible women in every other household were assessed.

The sample size for children, 6-59 months, was calculated using ENA for SMART software (9th, July 2015) according to UNHCR SENS guidelines (version 2 (2013). The calculation was based on the expected prevalence of global acute malnutrition (GAM) in children, 6-59 months. A precision of 3.5; a design effect (DEFF) of 1.5 for Kakuma and 1 for Kalobeyei; an average household size of 6.6 in Kakuma and 5.2 in Kalobeyei; and percentage of children under the age of five was estimated at 19.5% in Kakuma and 14.9% in Kalobeyei, using the UNHCR ProGres data, November 2019.

A two-stage cluster survey was conducted using the Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology to collect and analyse data on child anthropometry. Information on other indicators was collected and analysed using UNHCR's Standardised Expanded Nutrition Survey (SENS) Guidelines for Refugee Populations (Version 2 2013) (see www.sens.unhcr.org). ENA for SMART selects the clusters (blocks), once done a team was sent to a block to label the households numerically with indelible pens. Population density varies across the blocks at Kakuma. If a block contained 100 households or less, all households in the block were marked. If a Block contained more than 100 households then the team walked around the block to identify a path that divided the block into approximately two halves. One portion of the block was selected randomly. In the selected segment of the block the team proceeded to number all households from the first to the last. If there was more than one household in a particular compound, this was indicated at the entrance of the compound (e.g., 2019 SENS HH1). The numbering and labelling were done two days prior to commencement of the survey. If there was more than one household in a particular compound, this was indicated at the entrance of the compound (e.g., HH1-HH6). The numbering and labelling were done three days prior to commencement of the survey.

Mode of data collection
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Face-to-face [f2f]

Research instrument
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1) Children 6-59 months (SENS Modules 1-2): Anthropometric status, oedema, enrolment in selective feeding programmes and blanket feeding programmes (CSB++), immunisation (measles), vitamin A supplementation in last six months, de-worming, morbidity from diarrhoea in past two weeks, haemoglobin assessment.

2) Children 0-23 months (SENS Module 3): Questions on infant and young children feeding practices.

3) Women 15-49 years (SENS Module 2): Pregnancy status, coverage of iron-folic acid pills and post-natal vitamin A supplementation, MUAC measurements for pregnant and lactating women (PLW), and haemoglobin assessment for non-pregnant women.

4) Food Security (SENS Module 4): Access and use of the general food ration (GFR), coping mechanisms when the GFR ran out ahead of time and household food dietary diversity using the food consumption score.

摘要
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联合国难民署标准化扩展营养调查（SENS）提供定期的营养数据，这些数据在确保因被迫流离失所而受到影响的人群获得良好的营养结果方面发挥着关键作用。联合国难民署在卡库马难民营和卡洛比耶伊难民营进行了年度SENS营养调查。调查时，难民营接待了来自20个国家的186,515名难民，其中男性占53.3%（99,320人），女性占46.7%（87,195人）。这些难民中，来自卡库马的有148,295人，来自卡洛比耶伊的有38,220人，分别来自20个民族。目前估计5岁以下儿童的数量为卡库马的20,468人，卡洛比耶伊的7,576人，占总人口的15%。育龄妇女为卡库马的32,373人，卡洛比耶伊的7,643人。根据联合国难民署（UNHCR）卫生信息系统（HIS）数据库（2018年11月），主要来源国目前为南苏丹（57.8%），索马里（33.6%），其余百分比来自该地区包括刚果民主共和国（6.5%）、埃塞俄比亚（5.6%）和布隆迪（5.4%）等其他国家。数据收集始于2019年11月27日的卡库马，以及2019年12月8日的卡洛比耶伊定居点。本次调查的总体目标是评估难民人群的总体营养和健康状况，并制定切实可行的营养和公共卫生干预措施的建议。
地理覆盖范围
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肯尼亚图尔卡纳县卡库马难民营和卡洛比耶伊难民营
分析单元
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0-23个月大的儿童
6-59个月大的儿童
15-49岁的妇女
家庭

总体
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0-59个月大的儿童
15-49岁的妇女
难民家庭

数据类型
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样本调查数据 [ssd]
抽样程序
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本调查采用了两阶段集群抽样，采用与规模成比例的概率抽样。使用标准化救援和过渡监测与评估（SMART）方法收集和分析儿童人体测量学数据，并采用联合国难民署标准化扩展营养调查（SENS）指南（难民人群，版本2（2013年）指导数据收集的其他指标。SMART抽样调查的家庭用于所有指标。根据联合国难民署标准化扩展营养调查（SENS）指南的建议，贫血样本从SMART样本量中抽取。
对于每个使用的指标，家庭和个人按以下方式进行抽样：
家庭层面的指标：
- 卫生与水：每个家庭
- 食物安全：每两个家庭中有一个
- 蚊帐：每两个家庭中有一个
个人层面的指标：
- 0-59个月大的儿童：评估所有家庭中符合条件的儿童（根据上述计算）
- 15-49岁的妇女：评估每个家庭中每两个符合条件的妇女。
儿童6-59个月的样本量是根据SMART软件的ENA（2015年7月9日）根据联合国难民署SENS指南（版本2（2013年）计算的。计算基于6-59个月大儿童全球急性营养不良（GAM）的预期患病率。卡库马的精度为3.5；设计效应（DEFF）为1.5，卡洛比耶伊为1；卡库马的平均家庭规模为6.6，卡洛比耶伊为5.2；使用联合国难民署ProGres数据，卡库马五岁以下儿童的比例估计为19.5%，卡洛比耶伊为14.9%。
使用标准化救援和过渡监测与评估（SMART）方法进行了两阶段集群调查，以收集和分析儿童人体测量学数据。其他指标的信息收集和分析使用联合国难民署标准化扩展营养调查（SENS）指南（难民人群，版本2 2013）（见www.sens.unhcr.org）。ENA for SMART选择集群（区块），完成后，一个团队被派往一个区块，用不可擦墨水笔对该区块的家庭进行编号。卡库马各区块的人口密度不同。如果一个区块包含100个家庭或更少，则对该区块的所有家庭进行标记。如果一个区块包含超过100个家庭，则团队在该区块周围行走以确定一条将区块大致分为两半的路径。选择区块的一半。在所选区块的片段中，团队继续从第一个到最后一个对家庭进行编号。如果有多个家庭在一个特定的院落中，则在该院落的入口处标明（例如，2019 SENS HH1）。编号和标记在调查开始前两天完成。如果有多个家庭在一个特定的院落中，则在该院落的入口处标明（例如，HH1-HH6）。编号和标记在调查开始前三天完成。
数据收集方式
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面对面 [f2f]
研究工具
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1) 6-59个月大的儿童（SENS模块1-2）：人体测量学状况，水肿，选择性喂养计划（CSB++）和毯子喂养计划（CSB++）的登记，免疫接种（麻疹），过去六个月内维生素A补充剂，驱虫，过去两周内腹泻的发病率，血红蛋白评估。
2) 0-23个月大的儿童（SENS模块3）：关于婴儿和幼儿喂养实践的提问。
3) 15-49岁的妇女（SENS模块2）：怀孕状况，铁叶酸片覆盖率和产后维生素A补充剂，孕产妇（PLW）的MUAC测量，以及非孕妇女的血红蛋白评估。
4) 食物安全（SENS模块4）：一般食品配给（GFR）的获取和使用，GFR提前用完时的应对机制，以及家庭食物饮食多样性使用食物消费评分。