Case Study : Application of

Simple Spatial Sampling Method (S3M) Niger National CMAM coverage and IYCF practices survey

October 2011 to February 2012

Step 1 : Find a map

The first step in a S3M survey is to find a map of the survey area.

For a survey over a very large area such as for five regions of Niger, it will be practical and useful to have instead:

A small-scale map of the entire survey area. This map does not need to show the location of all towns and villages in the survey area.

A collection of larger scale maps of each of the five regions of Niger showing the locations of all towns and villages.

The small-scale map will be useful for identifying initial sampling locations.

The large-scale maps will be useful for identifying the precise location of sampling points and for selecting the communities to be sampled.

Small-scale map of five regions of Niger

Large-scale map of Maradi region

Step 2: Decide area represented by sampling point

The easiest way of thinking about this is as a function of the intended maximum distance (d) of any community from the nearest sampling point.

What value of d to use?

The value of d should be small enough that homogeneity of the area defined can be assumed.

For the Niger survey, a d of 15 km was judged to be small enough to assume homogeneity.

This will mean that no child will live more than 15 km away from a sampling point.

The distance between each sampling point is:

The area of the △ area formed: 292 km2

The area of the ⬡ area formed: 584 km2

Step 2 : Draw a grid over the maps

The next step is to draw a grid over the maps. The size of the grid is determined by the distance (d) decided in Step 2. In this case, d = 15 km.

The grid is rectangular.

The width of the grid in the east-west (x) direction is calculated using

The height of the grid in the north-south (y) direction can be calculated using

For the case of the Niger survey with d = 15 km:

Small-scale map with 22.5 x 13 km grid

Large-scale map of Maradi region with 22.5 x 13 km grid

Niger survey technical team composed of representatives from the Nutrition Department, Institute of National Statistics and UNICEF drawing grids on a large-scale map of Dosso region (above) and Tillaberi region (right).

Step 4 : Create an even spread of sampling points

Sampling points are located at the intersections of the rectangular grid in a staggered fashion. Alternate intersections of the grid are used such as that shown below:

Identified sampling points based on small-scale map

Corresponding sampling points for Maradi region

Survey technical team identifying and labelling sampling points on large scale map of Tillaberi making sure that sample points go right to the edge (or even over the edge) of the survey area.

Step 5 : Select communities to sample

Select the communities closest to the sampling points identified in Step 4.

About three (3) communities per sampling point were selected.

The position of the sampling point was moved into the middle of the three (3) communities selected.

Moving sampling points based on location of selected villages / communities

Step 6 : Label each sampling point

Gave each sampling point a unique identifying label:

The label may be a number or a name.

The label must be unique.

The label was used to identify which community belongs to which sampling point.

The label was used when collecting, organising, and analysing data.

Sampling points labeled and triangles drawn

Step 7 : Within-community sampling

Two within-community sampling strategies were used to select a sample from the selected communities

Coverage Survey – active and adaptive case finding was done in most communities selected. Door- to-door screening was used were in very small rural communities and in urban communities.

IYCF practices – QTR + EPI3, a variant of standard EPI within-community household sampling method

The first step in the method, QTR, divides the community into four (quarters hence QTR) areas each of which have roughly equal volumes.

The second step utilises the standard EPI strategy to select the first household in each of the quarters and selecting the third nearest house in a random direction (third nearest house hence EPI3).

EPI3

Survey Implementation

Step 1 : Identify and train supervisors

Thirty persons were initially hired as surveyors and underwent training phase for the survey.

After training, 20 trainees were retained and seven (7) teams were formed.

The training of surveyors was done through learning-by-doing approach.

Some classroom sessions conducted but on-the-job training was given emphasis during this phase.

There was no separate training period per se as the survey started alongside the training phase.

However, the training phase of the survey was done slower to allow for the surveyors to be trained and learn the survey skills and process.

Step 2: Identify the region to start the survey

The training phase was conducted in Dosso region because it had the least number of sampling points.

The smallest region was chosen to begin with so that the teams can be closely supervised during the training

It also allowed for end-of-day debriefs of the teams with the lead trainer and surveyors (right).

Step 3: Adjust, adapt, revise and re-train

The survey mechanics were adjusted as appropriate during the early stages based on learnings from the training phase

Adapted and refined the case-finding question for active and adaptive case finding (right)

Shifted from EPI3 to QTR + EPI3 approach

Door-to-door approach added as a sampling method for very small villages

Team structure and hierarchy changed based on optimal team composition based on surveyor dynamics

Re-training and refresher training for surveyors done routinely

Mind-mapping exercise with surveyors to refine the case-finding question for active and adaptive case finding

Step 4: Segmentation of regions

Segmentation done similar to that described in the SLEAC session

Regions segmented into 7 by route accessible by road. Each segment assigned to 1 team

List of sampling communities in each segment listed and provided to the team covering that segment

Teams started out in the farthest sampling point in the segment and then worked their way back to the regional capital

Above: Technical team segmenting and planning routes for Dosso region.

Top and bottom right: Technical team members explaining to team leader the route and providing the list of sampling points and communities within that route.

Step 5: Select the next region and continue the survey

The choice of the next region to survey was made based on the following principle:

Results

Barriers to service uptake and access - Maradi

Barriers to service uptake and access – Maradi region

Service problems

Difficulties / challenges faced by mother or caregiver

Screening and referral problems

Lack of awareness of programme and how it works

Lack of knowledge about malnutrition

Rejection

Access issues

Others

0 50 100 150 200 250

ICFI : Infant and Child Feeding Index

Based on an index devised by Mary Arimond and Marie Ruel of the International Food Policy Research Institute for the 2000 DHS survey of Ethiopia and developed by FANTA as a KPC2000+ indicator :

Age-group (months)

6 - 9 9 - 12 13 - 36 36 +

Value Score Value Score Value Score Value Score

Breastfed(24 Hours)

Yes + 2 Yes + 2 Yes + 1 Yes + 0

Food groups(24 Hours)

1

≥ 2

+ 1

+ 2

1 or 2

≥ 3

+ 1

+ 2

2 or 3

≥ 4

+ 1

+ 2

3 or 4

≥ 5

+ 2

+ 3

Meals(24 Hours)

1

≥ 2

+ 1

+ 2

1 or 2

≥ 3

+ 1

+ 2

2

3

≥ 4

+ 1

+ 2

+ 3

2

3

≥ 4

+ 1

+ 2

+ 3

The ICFI score is a measure of appropriate child feeding practices …

ICFI = Breastfeeding + Dietary diversity +Meal frequency… using age-speci,c weighting for each item.

All children are scored 0 – 6 … results presented as a numerical summary (e.g. median) or in a histogram.

Requires only simple and standardised question sets and small sample sizes.

Learnings from S3M pilot

S3M produces:

high resolution maps of indicator of interest over very wide area

S3M can:

serve as a base mapping method for the assessment of other indicators

infant and young child feeding (IYCF)

prevalence of childhood illnesses

water, sanitation and hygiene (WASH)

other typical indicators assessed through standard large-scale surveys like the Multiple Indicator Cluster Survey (MICS)