NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016
RAPID ASSSESSMENTS REPRESENTATIVE SURVEYS
Key Questions in Multisector RNAs – ANNEXE B
Transect Walks – ANNEXE C
Focus Group Discussions – ANNEXE D
Rapid IYCF Assessment Questionnaires – ANNEXE E
Remember to always do a secondary data review first
IYCF-E ASSESSMENT GUIDANCE: SUMMARY SHEET
PRIORITY INDICATORS
1. Early initiation of breastfeeding
2. Exclusive breastfeeding under 6 months
3. Not breastfed
4. Continued breastfeeding at one year
5. Continued breastfeeding at two years
6. Minimum Acceptable Diet
Do…
Conduct IYCF surveys representative of the
population whenever possible
Choose subjects as randomly as possible, even when
the aim is not to be representative
Include a budget for IYCF assessments in proposals
and plan IYCF assessments in advance
Take into account ethical considerations;
Use standard indicators and questionnaires;
Test questionnaires and translation;
Train interviewers adequately;
Use IYCF assessment results to inform response
planning;
Develop a dissemination plan to ensure all relevant
stakeholders, including the community, have access
to the results as is appropriate.
Exhaustive or random sampled household surveys
Inclusion in multi-sector needs assessments
USE STANDARDISED TOOLS &
METHODOLOGIES VALIDATED BY THE
NUTRITION SECTOR AS MUCH AS
POSSIBLE
SHARE ASSESSMENT PLANS & RESULTS
WITH THE IYCF-E & ASSESSMENT TWG
FOR VALIDATION
Don’t….
Conduct an assessment without proper planning
Conduct an assessment without informing the
Nutrition Sector
Develop a questionnaire before listing the
indicators/information that are of interest to you
and developing and analysis plan;
Invent your own questions when standard questions
already exist;
Include questions that will not be of use for
programme planning;
Use a questionnaire that is too long;
Lose site of the objective of your assessment
Use non random sampling methodologies when it is
possible to do otherwise;
Insufficiently train assessment staff;
Have too many assessment teams;
Put assessment participants or staff at risk.
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

ASSESSMENT GUIDANCE
INFANT & YOUNG CHILD FEEDING in EMERGENCIES

Contents

WHO is this guidance for?..........................................................................................................................3

What is the purpose of this document?.....................................................................................................3
WHY should I conduct an IYCF assessment as part of the emergency response?......................................3
WHEN should I conduct an IYCF assessment?............................................................................................3
WHO is the target population?...................................................................................................................3
WHERE should I conduct an IYCF assessment?...........................................................................................3
WHAT methodology should be used?........................................................................................................3
Integration of IYCF within multi-sectoral rapid assessments......................................................................4
Rapid Assessments: choosing participants as randomly as possible...........................................................5
Representative Surveys..............................................................................................................................5
Which INDICATORS should be measured?..................................................................................................5
Integration of IYCF within anthropometric surveys....................................................................................6
KAP Surveys................................................................................................................................................7
Barrier Analyses..........................................................................................................................................7
Conducting interviews................................................................................................................................7
Ethical Considerations................................................................................................................................7
Assessment Team Composition..................................................................................................................7
Assessment Team Training.........................................................................................................................8
Data Analysis – Software............................................................................................................................8
Interpreting Results....................................................................................................................................8
Budgeting...................................................................................................................................................8
External support for assessments...............................................................................................................9

This guidance has been adapted from the “Fact Sheet on IYCF Practices Assessment in Emergencies”
developed by Claudine Prudhon for the Tech RRT http://techrrt.org/
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

WHO is this guidance for?

For anyone planning a multisectoral or nutrition assessment as part of the humanitarian response.

What is the purpose of this document?

The purpose of this fact sheet is to outline the basic principles of infant & young child feeding assessments in
emergencies and to suggest a standardised manner in which they should be conducted, resulting in
comparable, usable results and a common understanding.

This document will be linked to assessment tools (validated by the IYCF-E TWG) and point to resources with
more detailed guidance. This document does not cover monitoring.

WHY should I conduct an IYCF assessment as part of the emergency response?

IYCF-E assessments should be conducted to:

 Assess the impact the current crisis in North Easter Nigeria has had on IYCF practices
 Determine who is most affected or at risk in regards to IYCF practices (vulnerable groups)
 Determine the need for an IYCF-E intervention and identify the most effective measures and
programming methods needed to protect or improve IYCF practices.
 Gather information to inform advocacy and support resource mobilisation
 Establish baseline IYCF data
 Contribute to an evaluation of programme effective by measuring the evolution of IYCF practices
through comparing initiation and follow on assessments.

WHEN should I conduct an IYCF assessment?

 When entering new areas of operation
 In the event of a change in the situation which might affect IYCF practices
 Periodically, during the implementation of an IYCF-E programme, to evaluate response effectiveness

Note that different types of assessments will be appropriate for different phases of the response.

WHO is the target population?

Caregivers of children 0 – 23 months affected by the emergency.

WHERE should I conduct an IYCF assessment?

IYCF assessments can be conducted in various areas, such as wards, LGAs, IDP camps or livelihood zones 1. It
is recommended to conduct assessments in areas that are thought to be homogeneous (the same/similar) in
terms of IYCF practices will enable the design of a response that will benefit the most people in the area.

WHAT methodology should be used?

Standardised methodologies & tools agreed upon by the IYCF-E TWG in collaboration with the Assessment
TWG should be used as much as possible to allow for comparability and ensure quality. It is recommended
all assessment plans are shared with the IYCF-E TWG for validation prior to commencing any assessment.

1
Livelihoods can play a role on IYCF practices by influencing food security, availability and affordability of specific foods
and care practices.
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

Prior to any assessment: secondary data review

Secondary data reviews should always be carried out to obtain general information about the
situation and avoid collecting primary data if information already exists. Consider:

 MICS survey 2011

 Nigeria DHS Survey 2013
 Health & Nutrition Survey (using SMART) 2014-
 Assessments carried out by other NGOs – refer to the Nutrition Sector’s survey database

When entering new areas of operation: rapid assessment

At this stage of the response, it is recommended to carry out rapid IYCF-E assessments to give a rough
indication of the IYCF situation and generate quick information to start programming.

1. Upon arrival, carry out direct observation of the situation through a Transect Walk
2. Administer Rapid IYCF Assessment Questionnaires to a convenient sample2 of the population.
3. To obtain qualitative information to inform programming, conduct Focus Group Discussions.

When resources and the situation allow: representative (in-depth) assessment

Whenever possible, preferred methods for IYCF assessments are exhaustive or random-sampled surveys that
are representative of the population.

 Household survey using a representative sample

 Focus Group Discussions before the survey (to understand the IYCF environment and better define
indicators) and/or during or after the survey (to put survey results into perspective).

In the event of a change in the situation which might affect IYCF practices: rapid assessment
followed by representative survey if indicated

To evaluate response effectiveness: representative survey

IYCF assessments can also be used as opportunities to evaluate the coverage of ongoing IYCF programmes.
For example, you could ask if the caregiver has participated in any group counselling sessions or received any
facility-based one-on-one counselling depending on the type of services offered.

Integration of IYCF within multi-sectoral rapid assessments

Assessment of IYCF practices should be included in multi-sectoral rapid assessments

Questions to include:

 Problems feeding infants & young children

 Complementary feeding
 Questions related to distributions / donations of BMS
 Care for non-breastfed infants

Suggested questions can be found in ANNEXE C

2
Easily accessible population – choose caregivers as randomly as possible.
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

Rapid Assessments: choosing participants as randomly as possible

Although the purpose of a rapid assessment is not to be representative of the population, caregivers
included in the assessment should be chosen randomly as much as possible.

In a village or camp: go to the centre of the village / camp, toss a pen in the air, follow the direction of the
pen to the outside edge of the village / camp. Measure all eligible subjects in households to the right of the
line in the direction of the pen until the required number of subjects is attained. If the required number of
subjects is not attained by the time you reach the edge of the village or camp, throw the pen again and
repeat the process by in a new direction.

Snowball sampling: When you have identified a family with children 0 – 23 months, ask the caregivers you
are interviewing to direct you to another family where there are children 0 – 23 months, and so on. This
method can decrease the representativeness of the sample. For example, families might point you to
families they know so you might interview mostly families of the same wealth group.

The subjects included in the assessment should preferably be well scattered within the targeted area that
you plan to assess. In urban settings, such as a town, include different districts. In LGAs, include several
different wards. In wards, include different villages. For each district, or village, repeat the process described
above.

As far as possible, take into account socio-economic disparities. Including both more and less affluent parts
of an area will give an overall picture, while focusing on underprivileged districts will reflect the situation of
the more vulnerable families.

Representative Surveys

Whenever possible, it is recommended to conduct a household survey (interviewing caregivers of children 0-

23 months) that is representative of the population of concern because it gives more robust data on the
situation and allows comparison with subsequent surveys and surveys conducted in other locations or by
other partners

The sampling methods to conduct a representative IYCF survey are the same as for anthropometric surveys,
such as SMART: exhaustive surveys and random-sampled surveys, such as simple random sampling,
systematic sampling and cluster sampling.

The sample size needed should be calculated according to the objectives of the survey, the likely levels of
the principal indicators you want to measure (determined from available data) and the precision desired.
Sample size will be calculated differently if the objective of the survey is to assess the situation (one-off
survey) or if it is to evaluate the difference between two surveys, for example to assess any change in IYCF
after programme implementation (see CARE guidelines and sample size calculation sheet in section 21
below).

Which INDICATORS should be measured?

It is strongly recommended to use standard indicators which have been internationally or nationally agreed
because they have been validated and allow for comparison.
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

Priority indicators of interest for the emergency response include:

1. Early initiation of breastfeeding

2. Exclusive breastfeeding under 6 months
3. Continued breastfeeding at one year
4. Continued breastfeeding at two years
5. Minimum Acceptable Diet

Depending on the objective of the assessment, other indicators of interest can include:

 Reasons for difficulties with breastfeeding, if any

 Origin of Breastmilk Substitutes, if used
 Source of water for preparing BMS, if used
 Bottle / Cup Feeding

In additional to IYCF indicators, you will need to record general information such as location, age and sex.

It is especially important to determine age with accuracy as age will determine which children are included in
the survey and whose data are used to calculate specific indicators.

Integration of IYCF within anthropometric surveys

Measures of IYCF practices can be added to planned anthropometric surveys to obtain an initial rough
appraisal of the IYCF situation. However, precision will be generally low. It is recommended to stick to
essential questions only to avoid the survey being too long. A suggested format is annexed to this
document. <-- to be developed & added

For further information, UNHCR has developed a module for the integration of IYCF assessments with
anthropometric surveys with sampling and sample size based the requirements for anthropometric survey.

Alternatively, to integrate IYCF and anthropometric assessment and ensure precision is sufficient, use the
methodology developed for anthropometric surveys but at the same time:

 Expand the target group to include 0 – 6 month children 3

 Increase the sample size of children 0 – 23 months 4

In practice, this means that in households surveyed for the anthropometric measurements, 0-6 months
children will be also surveyed and that households with children 0-6 months but no older children will also
be included in the IYCF assessment. As the sample size of children 0-23 months for the IYCF assessment will
be higher than that for the anthropometric assessment, a higher number of households will be included in
the IYCF survey.

3
In households surveyed for anthropometric measurements, 0 – 6 month children will also be surveyed. Households with children 0
– 6 months but no older children should also be included in the IYCF assessment.

4
As the sample size of children 0-23 months for the IYCF assessment will be higher than that for the anthropometric assessment, a
higher number of households will be included in the IYCF survey.
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

KAP Surveys
Depending on the objectives of the assessment and resources available, adding questions about knowledge
and attitudes towards IYCF can provide interesting information for designing a programme.

KAP surveys can also be used to monitor the effect of a programme on attitudes, practices and knowledge of
the target population by comparing baseline and end line surveys.

IYCF KAP assessments can be combined with KAP surveys for other sectors, such as WASH or Health, but
limitations for target population, sample size and length of questionnaire will apply.

Barrier Analyses

KAP surveys can be followed up by Barrier Analyses to further explore the facilitators and barriers to key IYCF
behaviours. Key IYCF behaviours (e.g. exclusive breastfeeding) can be further investigated using this method.
Barrier analyses can:

 Assess determinants of behaviour change as it relates to IYCF practices

 Provide additional qualitative information on IYCF practices and beliefs
 Serve to adapt programme activities to better target key IYCF behaviours.

Conducting interviews
 Ask the questions as they are written to guarantee reliable measurement
 Carry out translation and back translation of the questionnaire in advance to ensure standardisation
and reliability. Standard translations for terms such as exclusive breastfeeding may not exist in the
language the interview is to be conducted in: it is important to gain consensus on the translation.
 Pilot questionnaires and agree upon any modifications with all surveyors to standardise.
 Choose surveyors according to the context. Consider whether female caregivers will feel
comfortable talking to male surveyors about IYCF practices. Take into account religion or ethnicity if
relevant --< add contextualised guidance here.
 Surveyors should be well selected and trained so that they have an empathic attitude towards the
responded, can explain well the purpose of the assessment, can explain some questions that the
respondents might not understand and can interpret ten answers in a standardised fashion.

Ethical Considerations
 Informed consent of the respondent is always needed before starting any interview.
 Nigeria – any sign off / ethical committee procedures?
 Inform communities and local authorities, including the ministry of health, about the assessment.
 An assessment has always some cost. You should ensure that the results of the assessment will
provide benefits in informing the response. This does not mean that the results of the assessment
will automatically lead to more humanitarian aid but that the assessment will have a significant
added value for the design of the response.
 Consider ethical principles when designing and carrying out assessments

Assessment Team Composition

Overall survey coordinator – to design assessment methodology, calculate sample size, train and supervise
teams, analyse data and write report.
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

Data entry can be done by the survey coordinator or by data entry clerks, depending on the size of the
survey.

1 – 2 interviewers, fluent in Kanuri / Hausa, per team.

Aim for four (4) teams - this may vary according to staff availability and duration allowed for the survey. It is
recommended to limit the number of teams to six (6) at a maximum.

Assessment Team Training

Allocate a sufficient number of days for training. A typical IYCF assessment training could take 3 -4 days
(including a field test) and up to 6 days if SMART anthropometry is included (including field and
standardisation tests)

Training objectives are to review roles & responsibilities of each team member, provide sufficient time to
practice implementing the questionnaire (role play and field test) and ensure that teams can follow proper
procedures when selecting households to maintain a representative sample.

Training topics should include: training overview, survey teams, questionnaire, event calendar, field
procedures, segmentation and random number table (if required for assessment), household selection
method (simple/systematic), special cases and field test.

Training modules, materials and training modalities will be standardised through the IYCF-E TWG

Data Analysis – Software

There is no specific software for IYCF data analysis. Any statistical software can be used, such as Excel,
EpiInfo or Stata. Resources exist which give guidance on calculating indicators using Excel or EpiInfo and on
reporting format.

Interpreting Results
Take into account special circumstances, such as seasonality, that might affect availability and affordability of
some foods as well as care practices.

IYCF assessment results form just one part of the formative research required to inform programme design.
While important, data from assessments should be complemented with additional information such as
availability, affordability and price of nutrient-dense foods or barrier analyses aimed at identifying barriers
and enablers for designing SBCC programmes.

Budgeting

IYCF assessment budgets should include:

 Staff costs (salary, per diem, accommodation costs and other expenses)
 Translation costs
 Logistics e.g. transportation, communications, security
 Materials: stationary, computer with analysis software, questionnaire hard copies or tablets to enter
data. Voice recorders for FGDs or key informant interviews.
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

External support for assessments

Technical Support Cell: This cell is composed of NGO and UN staff who can provide remote technical
guidance on IYCF surveys and assessments, such as methodology, questionnaire, data analysis,
interpretation, and identification of external resources if needed. Contact: iycfe.tech.cell@gmail.com

En-net: this forum allows you to ask questions on IYCF assessments that will be answered by your peers and
sector experts www.en-net.org

Tech RRT: This mechanism allows for the deployment of technical experts for up to 6 weeks. They can be
requested and deployed to any organisation as long as their assignment will benefit the entire humanitarian
nutrition response in the country. Experts in IYCF-E, Assessments & SBCC can be requested to assist with
assessment planning, design and implementation. http://techrrt.org/
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

ANNEXE A - FURTHER READING

 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

Methodology for surveys Main

representative of the
population, including CARE (2010) Infant and Young Child Feeding- Collecting and
sampling and sample size Using Data: A Step-by-Step Guide.

CARE (2010) Sample size calculation spreadsheet

UNHCR (2013) Standardised Expanded Nutrition Survey (SENS)

guidelines – Pre Module: Survey steps and sample.

Additional

MSF (2002) A guide to using qualitative research.

DFID and Evidence for Action (2007) Introduction to qualitative

research methodology.

IYCF-E Tool Kit, in References, Determine the needs.

Methodology for rapid IYCF-E Tool Kit, in Core tool kit, Key Implementation Resources,
assessments and References, Determine the needs.

MSF (2002) A guide to using qualitative research.

DFID and Evidence for Action (2007) Introduction to qualitative

research methodology.

Indicators, questionnaires Main

and data collection
WHO/UNICEF (2010) Indicators for assessing infant and young
child feeding practice- Part 1 Definition

WHO/UNICEF (2010) Indicators for assessing infant and young

child feeding practice- Part 2 Measurement

CARE (2010) Infant and Young Child Feeding- Collecting and

Using Data: A Step-by-Step Guide.

CARE (2010) Generic IYCF questionnaire.

UNHCR (2013) Standardised Expanded

Nutrition Survey (SENS) guidelines - Module 3: Infant and Young
Child Feeding

Additional
NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

SMART Survey Enumerator and accompanying slides can be

adapted for an IYCF assessment.

FAO (2014) Guidelines for

assessing nutrition-related
Knowledge, Attitudes and Practices.

Havard University (2007) Tip sheet on question wording.

MSF (2002) A guide to using qualitative research.

DFID and Evidence for Action (2007) Introduction to qualitative

research methodology.

IYCF-E Tool Kit, in Core tool kit, Key Implementation Resources,

and References, Determine the needs.
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

Indicators calculation and Main

data entry, analysis and
report writing WHO/UNICEF (2010) Indicators for assessing infant and young
child feeding practice- Part 2 Measurement

CARE (2010) Infant and Young Child Feeding- Collecting and

Using Data: A Step-by-Step Guide.

CARE (2010) Excel data entry sheet

CARE (2010) Excel report card template

CARE (2010) Chi-square test calculation

UNHCR (2013) EpiInfo data entry and analysis in Standardised

Expanded Nutrition Survey (SENS) guidelines - Module 3: Infant
and Young Child Feeding

Additional

MSF (2002) A guide to using qualitative research.

DFID and Evidence for Action (2007) Introduction to qualitative

research methodology.

IYCF-E Tool Kit, in References, Determine the needs.

KAP Surveys Guidelines for assessing nutrition-related Knowledge Attitudes and

Practices

Barrier Analysis FSN Network Barrier Analysis Questionnaires

CORE Group - A Practical Guide to Conducting Barrier Analysis

Ethical issues CDC Distinguishing Public Health Research and Public Health Non
research.

LSHTM Ethical issues in data collection in The use of

epidemiological tools in conflict-affected populations.

UNHCR (2013) Approaching community and households and

informed consent forms in Standardised Expanded Nutrition Survey
(SENS) guidelines – Pre Module: Survey steps and sample.
 NUTRITION SECTOR – NIGERIA EMERGENCY RESPONSE – NOVEMBER 2016

ANNEXE B – KEY QUESTIONS FOR MULTISECTORAL RAPID NEEDS ASSESSMENT

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ANNEXE C – TRANSECT WALKS

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ANNEXE D – FOCUS GROUP DISCUSSIONS

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ANNEXE E – RAPID ASSESSMENT QUESTIONNAIRE

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