1.  Body stature of schoolchildren

The easiest and most reliable way of assessing the nutritional situation of a community is by taking a particular body measurement.  Many studies have shown that children who grow up under poor conditions suffer from an inadequate food intake and repeated infectious diseases that lead to body growth failures. This growth faltering process can be observed in the long term and becomes increasingly irreversible after the age of one and a half years. The age related height (h/a) of a preschool child is internationally recognized as a very appropriate indicator for the nutritional situation and the underlying situation leading to poverty.

Although strong genetic disposition influences anthropometric data in individuals, this phenomena disappears when observations are taken of a population (Of course, populations exist with strong genetic differences in body measurements, such as pygmies. Nevertheless these are rare exception that are not discussed here). The observation of anthropometric indices in children figures most prominently as an indicator of the nutritional situation of a community, as the nutrient requirements are highest and diseases appear most frequently while a child is growing, and thus problems in provision for this group become apparent at a particularly early stage.

It has become internationally accepted that a population is indicated as stunted if more than 2.5% of their individuals have a ht/age index less than the standard deviation of -2 (-2s) in comparison to the reference population. The worse the nutritional situation and the poorer the community, the higher is the prevalence of stunting in children.

Because it would not be possible to assemble enough pre-school children on the one day visit, and because their age determination would be more difficult,  the prevalence of stunting among the children in the community should be estimated from the anthropometric data collected from children in the first grade in the local school.  Additionally the assessment of age related height will be more accurate in the school children, because birth certificates normally are required for school entry.

Furthermore, differences in prevalence of stunting between boys and girls should be identified. These analyses can be carried out by the NutriSurvey software (Individual part/anthropometry in children).

 

2.  Data processing

In addition to the Survey Forms (SF),  Analysis Forms (AF) are available in Appendix 3.  These forms help standardize and structure processing the collected data.

The analysis forms enable

• the visualizing of the seasonality in the survey region.
  They present temperature changes, the rhythm in cultivation of the major crops and livestock farming, food price fluctuations, and the availability of food at the household level throughout the year. The workloads of women, the incidence of illnesses and the nutritional status during the course of a year are also recorded. So, for example, times of abundance or acute deficiency in food availability, and the seasonality of illnesses and risks of malnutrition, as well as whether, and when, the workload of women or men would allow further income generating activities can directly be identified.

• a comparison of national and regional data of the agriculture, health status, and economic, educational and demographic data of the region.
  In this way, it is also possible to find out the deficits and acute malnutrition, high rates of birth/mortality, increased unemployment and migration, etc. which justify the future project region.

 

3.  Reliability

Reliability should be established by the abundance of primary and secondary data. In regard to this, RAN is not aimed at obtaining quantitatively assured data. However, by surveying variables from different government sectors at the national and provincial/district level, as well as at non-government organizations, information is obtained from a wider base and does not depend on a few subjective opinions.

At the community level, it is important to obtain the most comprehensive picture of the prevailing situation possible by interviewing different community leaders and the future target groups, as well as from observations by the specialists themselves.

 

4.  Ranking of indicators - variables

The selected indicators identify the population of a future project region, define the population in comparison to national standards, and provide indications of their state of nutrition.

Table 2.  Variable-Indicator Table

Variable	Indicator	Information content
Population density	No. of population/km2	Population pressure Population distribution
Population growth	Birth rate/death rate	Health/nutrition status Hygienic conditions Medical care
Ethnic groups	% of local population	Influence on agricultural and consumer habits Distribution of food within family, taboos
Religious groups	% of local population	Influence on agricultural and consumer habits Distribution of food within family, taboos
Formal Education	Illiteracy (%, m/f) Primary school graduates (%, m/f) Secondary school graduates/further education (%, m/f) Primary school attendance rate (m/f) Primary school dropout rate (m/f)	Influence from school education of parents on  nutritional status of children Income levels of parents Child labor Selection of communication strategies
Informal Education	Spoken, written language	Influence on possibilities and strategies for communication Obstacles to literacy (for men/women)
Climate	Temperature (days of frost/month) Rainfall (mm/month) Dry weather (weeks) Flooding (weeks)	Agricultural production Food production Food prices Availability of food at the household level Illnesses Nutritional status
Agricultural cultivation structure	% arable land % cash crops % subsistence culture Agricultural yield/ha Agricultural self-sufficiency (%) Agricultural imports (%) Livestock farming (livestock/ha) Land owner right Women in agricultural work (%	Food production Division of labor Sources of income Food prices Availability of food at the household level Nutritional status
Agricultural extension services	Agricultural advisors (technicians/region, m/f, Agricultural promoters/community, m/f)	Agricultural production Food production Food storage/availability at the household level
Illnesses	Preschool children (< 5 years) Schoolchildren (5 - 14 years) Mothers Endemic illnesses among entire population	Health status Nutritional status Hygienic conditions Health care/immunization coverage
Health infrastructure	Hospitals (beds/capita) Health centers/capita Health posts/capita Doctors/capita Nurses/capita Health assistants/capita	Preventative/curative health care Health status Nutritional status
Traditional health services	Healers (% use by population) Traditional midwives (% use by population)	Health status Nutritional status
Preventative health services	Mother/child advisory service/center Nutrition advisory service/center Family planning/center Supplementary feeding program/center Feeding program/center%	Health status Nutritional status Birth rate
Family Planning	Families Contraceptives used	Child spacing
Employment	Economic activities (m/f) Unemployment rate % of women in employment Migration rate Seasonal migration rate Income/capita Minimum wage (m/f) Credit Time spent at work (m/f) Seasonality	Sources of income, earnings Time and physical burden on men/ women
Living conditions	Building materials used Bedrooms/family members Water/electricity supply Sanitary facilities Location of kitchen (inside/outside house) Food storage Luxury goods	Health status Nutritional status Social status Family income Health status Nutritional status Hygienic conditions Availability of food in the household
Anthropometric measurements	Body stature of schoolchildren (6-9 years)	Nutritional status
Nutritional practices	Breast-feeding/weaning practices Infant supplementary feeding Staple foods % of daily supply Seasonality Special foods Prestige of foods Distribution of food within family Food taboos	Nutritional status Health status
Poverty perception	% poverty Causes of poverty	Relative poverty

 

5.  Presentation of findings

5.1. Final information for relevant institutions

The findings of RAN should be presented and discussed with relevant institutions and decision makers regarding the nutritional and poverty situation of a potential target population. In particular, the following items should be considered (detailed explanation see below point 5.3):

• Description of the situation by sectors;

• Description of the situation from the community point of view;

• Result of anthropometric measurements;

• Point of view of policy makers (national, regional, and local);

• Proposal of project purpose.

5.2. Final report

The report on the nutritional and poverty-related situation of a potential target population should contain the following points:

• Overall political and socioeconomic conditions

• Description of the situation by sectors

• Selection of the project location

• Description of the situation from the community point of view

• Point of view of policy makers (national, regional, and local)

• Result of anthropometric measurements

• Proposal for project purpose
     - Problem tree
     - Analysis of resources
     - Analysis of alternatives

• Proposals for baseline survey and in depth cause analysis

• Summary

5.3. Items included in oral and written information

a. Description of the situation by sectors

Initially a general overview of the national situation and of particularly needy areas should be formulated on the basis of the obtained demographic data and statistics on agriculture and health.  Questions asked explicitly of government representatives from government sectors and NGOs concerning the existence of deprived regions should also be used as further criteria for the selection of a province/district and the communities to be investigated (AF-2 to AF-6).

b. Description of the situation from the community point of view

In describing the situation from the point of view of the community, overriding consideration should be given to how the community views its situation, which problems it identifies, and how it assigns priority to them (obtained by individual interviews and the different group discussions in the villages).

Through group discussions, among others, the surveyors obtained gender specific information about food production systems and other income generating activities of the community members, their work loads and responsibilities towards their families and the community. They also have gained insight into the situation of women, one of the highest risk groups, their social status, and the opportunities to provide the basis needs for their families. The supply of food and the seasonal availability of food on the household level are important  indicators of the nutritional conditions of the inhabitants. Nutritional habits and taboos provide further indicators of the nutritional status, and thereby also influence the health status of children and infants, in particular, as well as of mothers.

Information on the most frequent illnesses, community health care, school attendance rate of children, and living conditions are further indicators which help to determine the poverty level of the population and the social structure. In doing so, it is necessary to take into account ethnic background and religious beliefs: (SF-1 to SF-9; AF-1 and AF-7).

c. Point of view of policy makers (national, regional, and local)

The rapid assessment includes interviews with policy makers from the different governmental sectors, as well as with planning authorities, depending on the assessment area (rural/urban) on the national, regional and local levels. At the end of the mission an initial analysis of the assessment should take place, be summarized and discussed with the relevant organizations. These initial and final discussions will help to determine the framework for the future project/program.

d. Result on anthropometric measurements

To get a first, objective impression on the nutritional situation in each of the selected communities, the body stature of schoolchildren (first grade of school) should be measured and the prevalence of stunting described. It should also be explored whether stunting differs between genders.

e. Proposal of project/program purpose

The project/program purpose describes the intended impacts or the anticipated goals of the project/program as a precisely stated condition. The project/program purpose contributes to achieving the overall goal.

Taking the first 4 points above into consideration the project/program purpose should be defined. A tool for analyzing the existing problems and for identifying and discussing potential alternative solutions is the building of a 'problem tree' (hierarchy of problems), which can afterwards be transformed into a hierarchy of objectives. The set of objectives is then analyzed and suitable alternatives for the future project/program are recommended.

f. Proposal of problem tree

To analyze the major existing problems a "problem tree" should be built, which tackles the problems at their roots - their cause and looking at their effect.  In the problem tree, the problems apparent in a province or district should be visualized collectively. In doing so, equal consideration should be given to information from the individuals and communities as to the data provided by each government sector. The problem tree provides a description of the situation from the point of view of the surveyors.

The major causes of poverty and poor nutritional conditions are described in the following problem tree (Diagram 1). This problem tree presents only some factors and describes the related causes only for one branch. The analysis thus attempts to extract typical perspectives of the situation which in reality is very complex. These characteristics then become tangible and can be analyzed and worked on by the team of specialists.

Diagram 1.    Problem tree for undernutrition

(Example)

The impact of one specific problem on the overall living conditions depends strongly on the characteristics of the existing situation (ecological, cultural, economic, political etc. conditions) and therefore the problem tree should illustrate some "typical" relations. The assessment team should concentrate on the visualization of the main problems which later are transformed into an objectives tree, indicating potential alternatives.

g. Analysis of alternatives

In the analysis of alternatives, possible intervention measures for improvement of the current situation of the population are discussed.  Interventions should be planned, initiated and maintained as self help activities in order to sustain future measures. Furthermore it is  indispensable for the future program that the measures considered are those directly aiding the improvement of the nutritional condition of the target population.

The chief criterion when evaluating and selecting alternatives is whether the project/program is expedient and realistic.

h. Selection criteria to define a nutrition intervention project/strategy

The following criteria are important in defining the project/strategy:

 1.   Resources available
 2.   Problem awareness of the target groups
 3.   Probability of achieving objectives
 4.   Political feasibility
 5.   Capacity of local institutions to manage the nutritional intervention program
 6.   Self-help potential
 7.   Sustainability
 8.   Cost-benefit ratio
 9.   Time horizon
10.  Social risks

i. Proposals for baseline survey and in depth cause analysis

As mentioned earlier, RAN cannot substitute the baseline survey.  For this reason, a statistically reliable nutritional survey should be conducted during the first months of a newly undertaken project, and especially before the beginning of large scale intervention measures in the project region.

Nevertheless, RAN can be used to draw up proposals as to what areas should be given particular emphasis in the baseline survey, and where it is necessary to carry out in depth cause analysis in addition to the baseline survey. With help of the Fact-Hypotheses-Matrix, which shows the hypothetical as well as the verified cause-impact relationships, it is possible to draw valuable conclusions about what information is still needed.

j. Summary

WHY                the project/program should be carried out

WHAT              the project/program is expected to achieve

HOW                it is going to achieve these results

WHICH             external factors are crucial for the success of the project/program

HOW                the success of the project/program can be assessed

WHERE            the data can be required to assess the success

WHAT              the project/program will cost

 

6.  Monitoring and checking of RAN

RAN requires the collection of much information within a short time. There is always the possibility that due to the specific conditions of the process of project finding it is not possible to collect all information which is desired. However, in this case it is necessary to show what information is lacking and to explain the reason for information gaps.

Table 4 gives an overview of the situation of data collection and analysis which can be used by the specialists involved in the project investigation and by those at the responsible headquarters. The check list contains only those parts of the rapid assessment which are written down/visualized, and which are part of the reporting to Headquarters. The specialist team should indicate whether or not each activity has been fulfilled, if not should explain the reason.  The responsible individuals at headquarters then has the opportunity to monitor data collection and analysis, and the recommendations of the specialist team.

Examples for monitoring:

1. respective survey forms have been adapted to the existing situation and filled out,

2. the situation is described from the point of view of the different sectors (e.g. health, agriculture) on national, regional and local level.