A field test of three LQAS designs to assess the prevalence of acute malnutrition

Background: The conventional method for assessing the prevalence of Global Acute Malnutrition (GAM) in emergency settings is the 30 × 30 cluster-survey. This study describes alternative approaches: three Lot Quality Assurance Sampling (LQAS) designs to assess GAM. The LQAS designs were field-tested and their results compared with those from a 30 × 30 cluster-survey. Methods: Computer simulations confirmed that small clusters instead of a simple random sample could be used for LQAS assessments of GAM. Three LQAS designs were developed (33 × 6, 67 × 3, Sequential design) to assess GAM thresholds of 10, 15 and 20%. The designs were field-tested simultaneously with a 30 × 30 cluster-survey in Siraro, Ethiopia during June 2003. Using a nested study design, anthropometric, morbidity and vaccination data were collected on all children 6-59 months in sampled households. Hypothesis tests about GAM thresholds were conducted for each LQAS design. Point estimates were obtained for the 30 × 30 cluster-survey and the 33 × 6 and 67 × 3 LQAS designs. Results: Hypothesis tests showed GAM as ≥10% for the 33 × 6 design and GAM as ≥10% for the 67 × 3 and Sequential designs. Point estimates for the 33 × 6 and 67 × 3 designs were similar to those of the 30 × 30 cluster-survey for GAM (6.7%, CI × 3.2-10.2%; 8.2%, CI = 4.3-12.1%, 7.4%, CI = 4.8-9.9%) and all other indicators. The CIs for the LQAS designs were only slightly wider than the CIs for the 30 × 30 cluster-survey; yet the LQAS designs required substantially less time to administer. Conclusions: The LQAS designs provide statistically appropriate alternatives to the more time-consuming 30 × 30 cluster-survey. However, additional field-testing is needed using independent samples rather than a nested study design.