The use of epidemiological tools in conflict-affected populations: open-access educational resources for policy-makers

Table of Contents

1. Welcome
2. Introduction: Epidemiology in crises
3. Ethical issues in data collection
4. Need for epidemiologic competence
5. Surveys - Introduction
   1. What is a survey?
   2. Types of outcomes and indicators measured in a survey
   3. Reasons to do a survey
   4. Questions to ask before beginning or commissioning a survey
   5. Alternatives to conducting new surveys
   6. Limitations of surveys
   7. Valid questions to answer
   8. Formulation of goals and objectives
6. Surveys - Description of sampling methods
7. Surveys - Sampling error, bias, accuracy, precision, & sample size
8. Surveys - Resources required for surveys
9. Surveys - Critiquing survey reports
10. Surveillance - When to do surveillance
11. Surveillance - Methods
12. Surveillance - Common problems
13. Programme data
14. Rapid assessment
15. Mortality - Indicators and their measurement
16. Mortality - Data sources
17. Mortality - Interpretation and action
18. Nutrition - Introduction and background
19. Nutrition - Indicators and their measurement
20. Nutrition - Data sources
21. Nutrition - Interpretation and action
22. Health services
23. Vaccination programmes
24. Water supply, sanitation, and shelter
25. Violence
26. Presentation of results
27. Formulating conclusions and recommendations
28. Dissemination and action

Formulation of goals and objectives

(go to Outline)

The goal of a survey, when written out, ought to explain in one sentence why the survey is being done. It is a general statement. The objectives of a survey should be more detailed descriptions of what indicators and outcomes will be measured in what population. Both goals and objectives should be written down at the start of survey planning.

Below are examples of survey goals:

1

True or false? Is this a feasible goal for the survey in Mongolia? a) True b) False Yes, correct. A single survey is not the best way to gather evidence of causality. Sorry, this is not strictly true. Note the word "effects" in the goal. It implies that the survey is being done to determine if the severe weather "caused" any nutritional effects. This is again a question of causality which is not best answered by survey data collection, especially a single survey. Your answer has been saved.

After the goal of the survey is determined, you need to write clear, detailed objectives for each of the major outcomes to be measured. Each objective should include:

• The specific health or nutrition indicator or outcome to be measured,
• The target group in which it will be measured, and
• The population or geographic area in which the survey will be conducted.

Of course, the health outcomes to be measured will depend on what program questions you want to answer. You may also wish to explicitly state in the goals and/or objectives the time period during which the data will be collected and to which the conclusions will refer.

2

Which of the following outcomes would you want to measure in a survey if you want to know whether or not anaemia is a serious problem in adult women? a) Urinary iodine levels b) Shoe size c) Height d) Haemoglobin levels e) Knowledge of diarrhoea treatment Correct. Haemoglobin level is the most common measure of anaemia. To calculate the prevalence of anaemia, you must determine if each survey subject is anaemic. Incorrect. This is not a direct measure of anaemia. Haemoglobin level is the most common measure of anaemia. To calculate the prevalence of anaemia, you must determine if each survey subject is anaemic. Your answer has been saved.

3

What target group would you include in the survey if you are interested in whether or not anaemia is a serious problem in adult women? a) Children 5-14 years of age b) Adult men c) Pregnant women d) Women 15-49 years of age e) Boys 6-59 months of age f) Girls 6-59 months of age Correct. You measure anaemia in the population subgroup you are interested in, that is, women of child-bearing age. You often narrow down the survey target group to those who are most susceptible to the disease or those who might be targeted by an intervention. Incorrect. You need to measure anaemia in the population subgroup you are interested in. If you answered pregnant women, this is still not correct. Pregnant women have very different levels of anaemia from non-pregnant women, so measuring anaemia in pregnant women tell you little about non-pregnant women.Your answer has been saved.

Obviously, you must carefully define both the indicator or outcome of interest and the target group in which that indicator or outcome will be measured. You should have already defined the population in which the survey will be done. The diagram below shows the relationship among these groups

To check if your definitions are clear, ask yourself if your definition of the population and the target groups allow someone else to determine if any individual on earth is eligible to be included in your survey. For example, as above, if you are targeting women of child-bearing age (15 -49 years of age) who currently live in country X, this will exclude all women of child-bearing age living elsewhere in the world and all women older than 49 years and girls younger than 15 years of age who live in country X. This definition could be used to determine if any individual human on earth is eligible or ineligible to be included in the survey sample. If a survey report you are reading does not define the target groups and indicators and outcomes to this level of detail, perhaps the survey workers or managers themselves were a bit unclear as to whom they included in the survey and what outcome was measured in them.

4

Which of these objectives is adequate to describe a survey measuring anaemia in refugee camps in Tanzania? a) This survey will assess anaemia b) This survey will study children less than 5 years of age in all refugee camps in Tanzania c) This survey will estimate the current prevalence of anaemia in all refugee camps in Tanzania d) This survey will estimate the current prevalence of vitamin A deficiency among children less than 5 years of age in all refugee camps in Tanzania. e) This survey will estimate the current prevalence of anaemia among children less than 5 years of age. f) This survey will estimate the current prevalence of anaemia among children less than 5 years of age in all refugee camps in Tanzania. Please select an answerIncorrect. This objective is missing both the target group and the population.Incorrect. This objective is missing the health outcome to be measured.Incorrect. This objective is missing the target group in which the health outcome will be measured.Incorrect. This objective lists the wrong health outcome to be measured.Incorrect. This objective is missing the population in which the survey will be carried out.Correct. This objective contains all the essential parts of an objective.

We should not belabour the point, but having clear objectives will greatly help you with:

• Negotiations with collaborating organizations
• Writing the questionnaire
• Planning logistics and needs for supplies and equipment
• Data analysis

Not having clearly defined objectives may result in:

• Misunderstandings and bad feelings from collaborating organizations whose outcomes were left out of the survey
• Poor direction to those who are commissioned to do a survey, potentially producing survey results which do not answer the questions which the sponsoring organization needs answered
• A poor questionnaire which does not gather the data required to measure one or more important indicators or outcomes
• Lack of appropriate supplies and equipment
• Undirected and unfocused data analysis and wasted time

These are certainly qualities no one wants to have in a survey. Will you trust the results of a survey in which objectives were not clearly defined and listed in the survey report? Probably less than if specific objectives are clearly presented.