Tag Archives: anthropometry

Anthropometry: Height and Weight

Module 8 takes note of other measurements as well. These include height or length (if a child is < 85 cm, measuring their length provides a more accurate measurement) and weight. Since the focus of FoF is to eliminate “hidden hunger”, these measurements provide us with a lot of information about the nutritional status of the women and children we’re meeting. A woman or child may look healthy enough – their bones won’t be visible, or their bellies won’t be swollen (indicators of Marasmus and Kwashiorkor, both of which are types of severe acute malnutrition, or SAM). However, when we have their height/length, weight and age, we can use this information to compare them to healthy individuals of the same age and gender to get a better picture of their health.

There are three indicators that we use:

  1. Height/length for age – when we know a person’s height and their age, we can compare them to the average height for a healthy individual of the same age and gender. If the person is significantly short for his or her age, we call this stunting. It is a sign of chronic malnutrition.
  2. Weight for height – we can use an adult’s weight and height to calculate their body mass index, or BMI. A healthy BMI is anywhere from 18.5-24.9. Anything below 18.5 means a person is malnourished. In children, we compare their weight to the weight of a healthy reference child of the same height. If the child is significantly lighter than the reference child, we call this wasting, which indicates acute malnutrition.
  3. Weight for age – when we know a person’s weight and their age, we can compare them to the average weight for their age and gender group. If the person is light for his or her age, he/she is considered to be underweight.

Here are some pictures from the field.

 

Anthropometry: MUAC

Module 8 of the survey is Anthropometry and Hemoglobin. One of the measurements we take is the mid-upper arm circumference (aka the MUAC). The MUAC is generally regarded as an accurate assessment of nutritional status in adults and children. Also, it’s easy to do in the field.

There are two steps to taking a MUAC measurement. The first involves measuring the length of the upper arm to determine the mid-point of the upper arm. The second is to wrap a band around that point to measure the circumference.

The band tells us two things:

  1. The MUAC in centimetres, and
  2. What degree of malnutrition an individual has, if any. This is possible because the band is divided into three coloured segments that indicate whether an individual is well-nourished (green), suffering from moderate acute malnutrition (MAM) (yellow), or suffering from severe acute malnutrition (SAM) (red).  In children, these divisions are based on how many standard deviations a person’s MUAC is from the mean, which is 13.0 cm. In adults, the cutoffs are 18.5 cm for moderate undernutrition, and < 16.5 cm for severe undernutrition.

Here are some pictures that demonstrate the process. Enjoy!

 

Baseline: Day 15

My how baseline has flown! Tonight is our last night in Prey Veng. Tomorrow morning we will go to one more village and then head back to Phnom Penh. I managed to get some videos of women and children at the anthropometry station today, but I’m far too exhausted to edit and post them tonight. They should be up by the weekend. For now I’ll leave you with a picture of a treat we had yesterday.

Fresh coconut water!

Baseline: The Survey

My apologies for not posting over the past few days. The posts I’ve planned for the next week take longer to write as they involve some research.

Anyways, to recap: I’ve discussed how we picked the households for FoF and what it’s like to be out in the field. I’ve also briefly mentioned what the purpose of our project is: to improve household food security and the nutritional status of women and children in rural Cambodia by combining HFP and aquaculture (it says so on the site’s banner). The word baseline keeps popping up – in post titles, categories, my writing. But what IS baseline? What are we trying to measure, and how are we measuring it? These are the questions I’ll be answering in my next few posts.

All 900 houses are completing a one-hour survey during baseline. The enumerators have a set of questions they work through, as well as a guide that explains how to record answers. When all of the questions have been answers, the women and any of their children under the age of 5 make their way to the anthropometry station to be measured and pricked. This process will be repeated after the intervention (ie after the farms and fish ponds have been established) during what is called the endline survey.

Half of the women are also completing 24-hour recalls and providing blood samples. I’ll discuss this another day.

Going back to the survey – what are we asking the women? What information do we hope to obtain from their answers?

The survey is divided into 8 modules: Household Information, Water and Sanitation, Homestead Food Production (subcategory: animal raising), Food Consumption, Mother’s Nutrition and Health, Knowledge and Attitudes, Household Food Security, and Measurements and Hemoglobin. The first 7 modules contain questions asked during the interview, and the last module is filled in by the enumerators trained in anthropometry and hemoglobin analysis.

Module 1: Household information

Here we try to ascertain the main characteristics of the household. We want to know how many people live in the house, the highest level of education obtained by the mother and father, annual income, who makes decisions about income, health care, and other important issues (mother, father, both?), what material goods the house has, and what materials the house is made out of. These questions provide a detailed picture of the family’s socioeconomic status.

Module 2: Water and Sanitation

We want to learn about the family’s hygiene (how often they use soap, where they go to the bathroom), and whether or not they have decent access to clean water.

Module 3: Homestead Food Production

We are trying to establish what kind of food, if any, people grow for their own use and to sell. This includes gardens, fishponds, and animal raising. This helps us gain insight into a variety of things, such as what food is available in a household, how familiar people are with HFP and aquaculture, what kind of income they make.

Module 4: Food Consumption

The most direct way of assessing nutritional status. We want to know what people eat, and how often. Because of our interest in aquaculture, we want to get as specific as possible when discussing fish. Therefore we ask people if they consume 10 common species of fish (5 big, 5 small), and we also leave room for any species not on the list. To help with this section, all enumerators carry a fish atlas with them, which has pictures of 36 fish common in Cambodia for easy identification of species consumed. We also want to know what nutrients they are or aren’t getting. Our questions specifically ask about dark, leafy greens (iron), fruit and vegetables with orange insides (vitamin A), grains (carbohydrates), organ meats (iron, protein), animal protein and oil, fat, and butter (dietary fat). Finally, we want to know where their food comes from (home, market, gift).

Module 5: Mother’s Nutrition and Health

The purpose of this section is to look at anemia and pregnancy. We ask if/when women have taken iron tablets, and we write down their current pregnancy status (not pregnant, or pregnant and how many months along they are). We also have a question about night blindness during pregnancy, as night blindness is a strong indicator of vitamin A deficiency.

Module 6: Knowledge and Attitudes – This is where we assess what women know about proper nutrition for themselves and their children. We ask how much they think they should feed their children, when they should introduce solid food, and if they can identify which foods are good sources of certain nutrients such as vitamin A and iron.

Module 7: Household Food Security – The last module in our survey tries to determine how food secure a household is by asking women if they worry about getting enough food for their family, or the right kinds of food, and whether or not they sometimes have to skip meals or eat famine foods (foods that make you feel full but don’t provide a decent amount of nutrients).

Hopefully this provides some insight into the kind of data we are collecting during baseline and why we care about this information. I’m going to try to film videos in the field tomorrow. Between my iPhone, laptop, and camera, I should be able to get some footage. Wish me luck!

Test Survey

Preparations are underway as the countdown to the baseline survey continues. Yesterday morning we checked off one of the most important “to-do”s on our pre-baseline checklist: the test survey. After a week of training, our enumerators had the opportunity to put their new skills to use. This also gave us a chance to work out any “bugs” in the survey.

The day began bright and early, as two vans carrying 20+ people departed from HKI’s office in Phnom Penh to head to the province of Kampong Chhnang. Although FoF is taking place in the province of Prey Veng, Kampong Chhnang is closer to Phnom Penh, and was thus better suited for a day trip.

Our first stop was at the Longvek Health Center, where we picked up iron and folic acid tablets to distribute to the households we were going to visit.

Outside the Longvek Health Center, our first stop in Kampong Chhnang.

Our next stop was at the home of the village chief. We informed him of our plans to meet with different households and ask them questions about nutrition and health. He directed us to the house of the village health volunteer, who would be able to assist us in identifying suitable households to visit.

The final stop for our van was at the house of the village health volunteer. The second van went to the next village to find more households to survey. Outside of the volunteer’s house, the enumerators set up stations to conduct anthropometric measurements and blood analyses. Then the volunteer took us to different houses to meet with women and their families. As an incentive, every woman who agreed to speak with us received a bag of detergent.

Bags of the detergent we distributed as an incentive to participate in the test survey.

The first house we visited was the home of a husband and wife whose three daughters were present. Two of the daughters lived in adjacent houses, while one still lived at home. We interviewed the two daughters who had young children.

The enumerator going through his list of questions with a mother and her child.

As the enumerator worked his way through the survey, I had time to observe the family’s home. Houses in Kampong Chhnang are very different from houses in Vancouver! The houses are all raised so that the “house” part is actually the second story. Underneath the house is the area where most family activity occurs. There are cots, tables, and chairs underneath, taking advantage of the shade the raised portion of the house provides. The cooking is done in a separate area nearby on the property. The kitchen I observed consisted of a cupboard and a heat source. Most families eat from the same pot. This particular family also raised chickens who roamed the yard freely.

The kitchen, separate from the rest of the house.

The kitchen at the daughter's house, which was behind the parents' house.

Chickens that the family raises on its property.

The question portion of the test survey went fairly smoothly. One of the challenges was that the infant wanted breast milk before his nap. However, women aren’t comfortable breastfeeding in front of strange men. Unfortunately, it was hard to find enough female enumerators who are able to leave their homes for the 2+ weeks of baseline, so the majority of our enumerators are men.

The final portion of the test survey involved bringing the women and their children to the village health volunteer’s house to get measurements and blood. First the women were weighed, their height was measured, and their mid-upper arm circumference (MUAC) was recorded.

Recording a mother's weight

...her height

...and her MUAC.

Then their children went through the same process. Most of the small children cried when they were placed on the length board! It must have looked like a scary contraption to them.

Recording a girl's weight

...her length (she was not happy)

...and her MUAC.

Finally, the women and children had their fingers pricked. A drop of blood was placed on a slide that was fed to a machine to analyze the hemoglobin content of the sample. Based on the results, many women were given iron and folic acid tablets.

Pricking the mother's finger to draw blood.

Analyzing the blood sample.

The day concluded back at the HKI office in Phnom Penh. Everyone gathered to discuss their experiences and raise any questions or concerns. A few questions were further clarified on the survey, but overall the results of the test survey were encouraging. Our enumerators are now confident and prepared to head to Prey Veng for baseline next Wednesday!