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Paul B. Spiegel, MD, MPH; Peter Salama, MBBS, MPH; Susan Maloney, MD, MSc; Albertien van der Veen, MSc

JAMA. 2004;292:613-618.

Context  During 1999 and 2000, approximately 10 million people were affected by famine in Ethiopia. Results of nutrition assessments and surveys conducted by humanitarian organizations were used by donors and government agencies to determine needs for food aid and to make other decisions on geographic allocation of limited resources; however, accurate results might have been hampered by methodological errors.

Objectives  To identify common methodological errors in nutrition assessments and surveys and to provide practical recommendations for improvement.

Design and Setting  Nutrition assessments and surveys (n = 125) conducted by 14 nongovernmental organizations (NGOs) in 54 woredas (districts) in Ethiopia from May 1, 1999, through July 31, 2000. Surveys were ranked as valid and precise according to 5 criteria: use of population proportional to size sampling, sample size, number of clusters, number of children per cluster, and use of weight-for-height index.

Main Outcome Measures  Number and proportion of surveys that used standard, internationally accepted methods and reported valid and precise results.

Results  Fifty-eight of the 125 surveys (46%) were not intended to be standard 30 x 30 cluster surveys. Of the remaining 67 surveys, 6 (9%) met predetermined criteria for validity and precision. All 67 used the anthropometric index of weight-for-height, with 58 (87%) reporting z scores. Fifty-four (81%) used nonrandom sampling without consideration of population size and 6 (9%) had sample sizes of fewer than 500 persons.

Conclusions  Major methodological errors were identified among 30 x 30 cluster surveys designed to measure acute malnutrition prevalence in Ethiopia during the famine of 1999-2000. Donor agencies and NGOs should be educated about the need for improved quality of nutrition assessments and their essential role in directing allocation of scarce food resources.

Author Affiliations: International Emergency and Refugee Health Branch, Division of Emergency and Environmental Health Services, National Center for Environmental Health (Drs Spiegel and Salama) and Division of Global Migration and Quarantine (Dr Maloney), US Centers for Disease Control and Prevention, Atlanta, Ga; and Office of the Regional Humanitarian Emergency Coordinator, World Health Organization, Addis Ababa, Ethiopia (Mr van der Veen).

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