Kerri Wazny, Monitoring & Evaluation Specialist
While weight and height might seem like simple measurements to take, curious, active babies make taking these measurements very challenging.
Just one week into starting as The Power of Nutrition’s Monitoring and Evaluation Specialist and I was on a flight to Rwanda to observe anthropometric training for a baseline survey. While I thought this might be a bit of a ‘baptism by fire,’ I was excited to witness one of our biggest programmes first-hand, and to meet our World Bank partners in-person so soon after starting. Thankfully, I was with Jeffrey Misomali, The Power of Nutrition’s programme manager for Rwanda, and could benefit from his extensive knowledge and experience.
We spent the first day observing the enumerators, the staff who will be conducting the anthropometric (weight and height) measurements, as they received training. They asked full and incisive questions, practiced measuring each other’s height, and used Styrofoam blocks as babies to practice on the length boards. On the second day, women and babies from neighbouring communities came in, which gave the enumerators some real-life training.
As it turns out, the active babies weren’t the only challenge.
Taking their mother’s measurements may have seemed straightforward, but the team discovered that the women’s hairstyles can also impede the team’s ability to measure their height accurately. Adaptive problem solving, creative thinking, and polling friends led the team to devise a solution: perhaps we could use a chopstick for women to thread through their hairstyles, then create a separate entry in the form for women who had their height measured, chopstick included (the computer can automatically subtract the length of the chopstick).
The enumerators were incredibly good with the children. While at times they were some tears and there was a symphony of screams, you could see how much they loved children, and the children really warmed up to them instantly.
The enumerators used some tricks to get the children to stand tall and still to have their height measured, such as pretending to take a photo and asking the children to smile for it. As a reward, each child was given a biscuit for participating – maybe not the most nutritious, but they definitely deserved a treat (though fruit would be better).
These measures are not only essential for our programme, but for tracking children’s growth so that an intervention is possible if a child isn’t growing properly (for example, if he or she is too thin for his/her age or isn’t growing tall enough).
We are partnering with the World Bank and the Government of Rwanda to deliver this programme. It aims to increase awareness among health workers and parents on the importance of improving children’s growth and their nutrition. Specific interventions include monitoring children’s growth, providing nutrition interventions in pregnant and lactating women and young children (such as supplements when needed), increasing antenatal care visits, improving treatment of children who are not growing properly, improving access to sanitation (such as clean water and latrines), improving knowledge of early child development, and providing cash transfers to low-income families.
This baseline survey will tell us the nutritional status of women and children across Rwanda, in both areas that are receiving the interventions and those that are not. By knowing the nutritional status prior to the programme beginning, we will be able to see whether the programme improves the nutritional status after it is operational. Follow-up surveys at the mid-line and end-line of the programme are planned, which will tell us whether, and by how much, the programme has been able to improve nutrition in young children.
We were also able to visit two rural health facilities on our trip. Babies who are born with low birth weight are at an increased risk of stunting in childhood, among other negative health consequences. However, there is limited, reliable measurements on the prevalence of low birth weight. Time of measurement (such as whether babies are measured immediately after birth, or before or after breastfeeding), can impact the reliability or comparability of this indicator.
We were fortunate to observe the procedures to measure birth weight at two maternity wards. While neither had women in active labour (this is not something that can be predicted), we saw a baby only a few hours old being weighed. We were also able to ask questions about both health facilities’ data management systems, which can help us design future interventions.
Far from being a baptism of fire, this was a trip that allowed me to learn a lot about Rwanda, a country that has come far despite adversity and a devasting history. I am also looking forward to the future surveys, to see the results of a great, multi-component, multi-sectoral programme that has a very comprehensive evaluation.
Contact Kerri at firstname.lastname@example.org