Nutritional Assessment Refugee Settlement in Nakivale, Uganda - Case Study Example

Running head: Nutritional Assessment Nutritional Assessment Refugee Settlement in Nakivale: South-Western Uganda Measurements to conduct In nutritional assessment this paper seeks to determine whether individuals from Nakivale camp are receiving all the food sources adequately to satisfy their energy requirements and help the fight off any diseases that might arise. According to De Onis (2000 p.1272) A nutrition assessment is an in-depth analysis of both objective and subjective information related to an individual's food and nutrient intake, lifestyle, and medical history. There is not one specific single parameter that functions as the only and best parameter to discover malnourished patients or individuals with risk for malnutrition. There is no golden set-standard; because of this we always use more parameters to constitute a representation of the nutritional status of a patient. Assessment of a population at risk seeks to establish the degree and type of malnutrition present, and other resources for example water and sanitation so as to be able to relieve the situation. Special attention should be given to vulnerable groups such as children less than 5 years of age, pregnant and lactating women and the elderly. Furthermore there is a need to asses the environment and infrastructure in which the affected population resides in. This is important in establishing the underlying causes of the problems. Such assessments are vital in determining the origin and severity of the nutritional crises. The process consists of two phases both involve information gathering that use interviews, group discussions, observations and surveys. The first stage involves a general evaluation to obtain a global; picture of the problem this includes: Determining the causes of the specific crisis (war, famine ,natural disasters) The number of refugees and their economic status The environmental conditions The existence and organization of food distribution activities. The efforts of local and international aid bodies to provide assistance. The second phase comprises of four activities: Data collection Problem analysis Reporting Follow-up. It is worth noting that when carrying out a nutritional assessment, accurate techniques. One such technique is the use of anthropometrics. This is generally the purposive measurements of body muscle and fat. They are used to evaluate individuals, to measure growth in the young, and to assess weight loss or gain in the grown-up individuals. Weight and height are some of the most commonly used anthropometric measurements, together with skin fold measurements of several areas of the body (Bilukha O. (2008 p.5). This will include components such as: 1) body measurements: weight, height , left mid upper arm circumference 2) other indices: Age , bilateral edema Indicators of malnutrition will include: Weight/age (underweight) Height/age (chronic stunted growth) Height/weight (wasting) Pitting bilateral edema (kwashiorkor) Jahn et al (2008 p.3) points out that certain tables have been formulated to compare weight and height in order to provide a reference for an individual's health status. The Metropolitan Life Insurance Company revised height and weight tables in 1942, so as to relate weight to disease and mortality. Deitchler et al (2007 p.862), concur that to determine percentage body fat, skinfold measurements are vital measurements which can be obtained by using skin-fold calipers. Most often, triceps and subscapular skin-folds are recorded. Measurements are then compared to referenced data and to previous measurements of the individual, if available. Precise measuring takes practice, and comparison measurements are most dependable if done by the same technician each time. According to the American College of Sports Medicine, when performed by a trained, skilled tester, skinfold measurements of body fat are up to 98% accurate. Qualitative analysis Here a questionnaire should be used to asses the number of meals eaten in a day and by listing the various food items consumed. Who to measure' The nutritional assessment will be done during the November to December period therefore the study will encompass all the refugees residing in the camp during that period. Category:'male/female Population'Age-groups: ''''''''' 0-5 yrs'''' 6-17yrs'''' 18yrs< For such a population, a single-stage cluster sampling method is recommended this is according to Shears et al (1985 p.315), with cluster units of unequal size (the households will be of unequal size); the households should be the listing units. The list of houses in each zone constituted the sampling frame. A complete sample will be carried out, i.e. a hut-to-hut interviewing procedure for all the huts will be effected according to the random cluster sample. New arrivals will not be included in the analysis however their population will be recorded Validation In order to validate the methodology used, a validation exercise will be carried out an expert team. A random sample of the assessment will be conducted by the interviewers within a time space of four-weeks prior to the actual research. The validation will involve both a test-retest method. Spiegel et al (2001 p.234) How to sample population' The camp's population has to be first estimated. The study will be conducted in the refugee Settlement, using quantitative and qualitative methods of data collection. A cluster sampling technique will be used to establish the demographics of the camp population based on country of origin and age-groups. The anthropometrical testing techniques to determine nutritional levels will then be carried out randomly for each group set however testing will be done based on age-group differences. Clustering will be done in 6 major groups namely group A-Democratic Republic of Congo, Rwanda, C-Ethiopia, D-Somalia, E-Kenya and F-Eritrea. Grandesso F, et al (2004 p. 1491) describes the sampling procedure as follows, the first phase of the assessment exercise, an immediate appraisal of population size is vital to provide relief workers with the necessary data to plan. While a head count leading to a registration of the refugees is the most appropriate method of obtaining information on population size and composition, such an exercise can often be extremely difficult to undertake. It is now accepted that as preparations for a census are underway, other plans may be necessary in order to swiftly approximate numbers. There are several approaches that can be used; mass screening of all age-groups, aerial photography and using Satellite Geographic Systems GPS. All these methods have benefits and disadvantages which must be well thought-out on a case by case basis. In the past decade an approach based on area sampling in camps has been developed and enhanced. There are two specific stages. The first requires the camp to be mapped by registering all of its coordinates. In the second stage the total camp population is determined by counting the population settled in a limited number of square blocks of known surface area and by extrapolating average population calculated per block to the total camp surface. A recent study analyzed data from six refugee camps in Africa and Asia (1992 to 94), where populations were quickly estimated within the initial days of arrival using an area sampling methodology. After measuring all external limits, surface areas were computed. In five camps, the average population per square block was attained using blocks measuring 25 by 25 meters and for another camp with blocks 100 by 100 square meters. In three camps, different population density zones were characterized. The principal goal of the study was to verify whether population estimates could be obtained rapidly using the method and to identify methodological strengths and weaknesses. (Young et al 2004 p. 206).The study resolved that the area sampling method was a competent technique in providing population estimates within a short period. The validity of the method could however only be fully assessed in Liboi camp for Somali refugees (in Kenya) where a manual head count was conducted a few weeks after the assessment approximated the camp population at 45,000 refugees as compared to the 43,000 figure obtained through the area sampling method. The study also had constraints with the sampling method. For example, there are concerns related to selection of the population density zones and to the number of square blocks needed. Stratification per density zone is mainly used as a way to boost accuracy. Ideally, a single population density zone could be measured if the sample comprised of an adequate number of square blocks (breaking up the camp in smaller, countable areas). Though, the number of square blocks sampled varied between different camp experiences and was driven by working conditions and logistical constraints. References Bern C, and Nathanial L. 1995 Is mid-upper-arm circumference a useful tool for screening in emergency settings' Lancet publishers, Philadelphia Bilukha O.2008 Old and new cluster designs in emergency field surveys: in search of a one-fits-all solution. Emerg publishers. p 5- 7. Deitchler M, Valadez J, Egge K, Fernandez S, Hennigan M. A field test of three LQAS designs to assess the prevalence of acute malnutrition. 2007 Baltimore Epidemiol Inc. 858-64. De Onis M, 2000. Measuring nutritional status in relation to mortality. Bull World Health Organazation.vol; 78 no10 pp1271-4. De Onis M, and Frongillo R. 2004 Methodology for estimating regional and global trends of child malnutrition. Epidemiol. Inc. vol 6 pp1260-70. 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