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Field Article
A child being weighed during the DRC survey.
GPS assisted
coverage
survey in DRC
By David Rizzi
David Rizzi graduated in Pharmacy and later
took an MSc in Development at the Rome
University La Sapienza, Italy. He holds a second
MSc in Public Health Nutrition from the LSHTM
in UK. He has been volunteering and working
for NGOs in Tanzania, Palestine, Angola, Tchad,
Burundi, Uganda and DRC, mainly focusing on
nutrition survey and therapeutic feeding
programmes in emergency contexts.
The author would like to thank Jean-Laurent
Martin, GIS officer at OCHA in Goma for his
valuable assistance with GPS and maps, and
the ECHO office in Goma for their financial
support. The author also acknowledges the
COOPI field staff and the Binza’s population for
making this work possible.
A child being measured
during a survey in DRC.
D Rizzi, DRC, 2008
D Rizzi, DRC, 2008
This article describes a modification of the
centric systematic area sampling method using
GPS, to overcome field constraints related to
mapping and active case finding.
COOPI is an Italian non-governmental
organisation (NGO) that has worked in
the Democratic Republic of the Congo
(DRC) since 1970. Its main sectors of
intervention nowadays are health, nutrition,
psychosocial care and water/sanitation. As a
leading NGO in the nutrition sector in eastern
DRC, COOPI was asked by the Ministry of
Health and UNICEF to run a pilot phase of a
Community-based Therapeutic Care (CTC)
programme in Bunia (Ituri) and to provide technical
assistance in the preparation of the national
CTC protocol.
In late 2007, ECHO (European Commission
Humanitarian Office) funded COOPI to provide
nutritional care (or support) to Binza’s population
(over 100,000 people) in North Kivu
province. The target population included many
returnees who were subject to a high degree of
insecurity, due to national army and rebel
groups’ dispute and conflict over the area.
Displacements were frequent due to continuous
attacks and pillaging by the warring factions. The
intervention goals were to:
• Provide technical, logistic and financial
assistance to a local NGO (BDOM 1 ) who was
already running two therapeutic feeding
centres (TFC) and ten SFC Supplementary
Feeding Centres
• Set up a CTC programme to replace the
classical centre-based approach, This would
involve training of BDOM and provincial
health personnel, rehabilitation of SFC tents,
and establish Stabilisation Centres (SC) in
two hospitals, transport of food and non-food
items and supervision of activities until the
programme was fully integrated into existing
services.
By January 2009, the traditional inpatient therapeutic
programmes have progressively been
replaced by CTC programmes throughout the
country. In 2008, the national CTC protocol had
been validated by health authorities, international
organisations and NGOs, and was awaiting
final approval and publication. The COOPI
CTC programme in Binza started in January 2008
and included two SC and ten SFC/OTP
(Outpatient Therapeutic Programmes). All the
health centres in the zone hosted a SFC/OTP
providing good geographical coverage of the
zone. After seven months, 652 severely malnourished
children had been admitted (averaging 93
per month); the cure rate was above 90% and
mortality less than 2%. An anthropometric and
coverage survey was undertaken at this point to
monitor the progress of malnutrition rates and
programme coverage. The anthropometric
survey showed a significant fall in most indicators
of malnutrition (see Table 1) compared to the
previous survey conducted in November 2007.
However, it was not possible to infer that this
was due to the COOPI intervention or the new
CTC approach: seasonality effect, improvement
in security, food aid and better crops were likely
to have been at least partly responsible for this
positive trend.
There were no baseline data available on
coverage of the therapeutic feeding programme
so that the CTC programme coverage survey
was, to the best of our knowledge, the first
assessment of this type in the whole province.
Coverage survey methodology and
constraints
The coverage survey was undertaken in July
2008. The CSAS methodology (centric systematic
area sampling), which is based on active
case-finding, was used 2 . The first step in the
implementation of this methodology consisted
of drawing or overlaying a grid on a map of the
area under investigation. The communities
closest to the centre of each square were then
the first to be surveyed.
Constraint 1: Lack of a detailed map of
villages
No detailed map of the health zone was available
for Binza and recent population movement
had resulted in many villages being abandoned.
When this problem occurred in previous
surveys, a ‘blank’ map had been given to
all the field teams so that on the day of data
collection, they could locate the village closest
to the centre of the square by means of a landmark
shown on the map, e.g. river, hills,
villages, etc. This method proved to be very
time consuming, inaccurate and ultimately,
prone to bias; the teams would hurry through
this first phase in order to maximise time for
the data collection itself. Moreover, where
maps didn’t show any physical landmarks or
no landmarks were present, the task proved
even more difficult.
Constraint 2: Absentees at the time of
measurement
In previous coverage surveys, another problem
was that many children were absent when the
team visited the household. Children under 5
years of age are usually taken to the field with
their mothers early in the morning and come
back at sunset. Where this occurred, an
appointment, whenever possible, would be
made and a second visit arranged to measure
the absent children at a later stage.
Moreover, the active case-finding approach
needs the assistance of carers, key informants
and local authorities to identify suspected
malnourished children and those children
enrolled in a programme. However, when
those people were contacted on the day of data
collection, many complained about not having
had sufficient notice to think about the children
to include in the survey (and to inform them).
This process further reduced the time that
COOPI field teams had for data collection.
A new strategy
A two-phase modified methodology was therefore
designed to address these problems. In the
first phase, Global Positioning System (GPS)
receivers were used to select the target villages
and key informants were informed about the
survey and asked to assist in case finding. In
the second phase, the teams focused solely on
anthropometric data collection.
Phase 1: GPS aided village selection and
preliminary actions
The best map available was kindly provided by
the Office for Coordination of Humanitarian
Affairs (OCHA) office in Goma. A physical
map with a 1:50,000 scale showing the main
1
BDOM (Bureau de Développement des Oeuvres Médicales)
is part of the CARITAS association.
2
Myatt M, Teshome F, et al. (2005). A field trial of a survey
method for estimating the coverage of selective feeding
programmes. WHO Bulletin 2005; 83(1): 20-26.
3
Although doable on the field through simple calculation,
free online tools are available for such conversion:
http://www.fcc.gov/mb/audio/bickel/DDDMMSS-decimal.html
(accessed on January, 5 2009)
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