Concern Worldwide/South Sudan Programme Terms of Reference for Consultant to carry out nutritional survey in Aweil North and West Counties, Northern Bahr el Ghazal State, South Sudan Background and Rational Concern Worldwide has been working in Aweil West and North counties since May 1998 in the fields of food security, relief, nutrition interventions and more recently water/ sanitation, education and health. Althought the water/sanitation and education program was closed by the end of 2010. In March 2003, Concern initiated a Community-based Therapeutic Care (CTC) project in Aweil West and North, with support from Valid International, following elevated levels of malnutrition resulting from a very poor harvest the previous year. The Community-based Management of Acute Malnutrition (CMAM, formally known as CTC) response has continued, but it's main components - supplementary feeding for moderate acute malnutrition (SFP); outpatient therapeutic programme (OTP) for children with uncomplicated severe acute malnutrition; inpatient therapeutic programme (ITP or Stabilization Centre) for children with complicated severe acute malnutrition and community mobilisation - have been largely integrated into the broader primary health care programme that Concern began implementing in 2007. The aim of the broader health and nutrition programme is to support the local health office to deliver basic health and nutrition services through its existing health structures. It is currently implemented through 9 Primary Health Care Units (PHCUs) and 2 Primary Health Care Centres (PHCCs) in Aweil West. In Aweil North, the programme is implementing emergency nutrition project after scaling its operation at the end of 2009. Concern Worldwide also works with the local authorities to improve food security and has until recently worked in the area of water and sanitation and education. Anthropometric surveys using the 30x30 cluster methodology have been conducted each year, except 2007, during February/March (start of the hunger gap) and September-November (generally harvest time/ post-harvest) to help monitor the overall situation and malnutrition rates. No survey was carried out in 2007 due to an outbreak of meningitis in February and programme reorientation in September. These surveys have consistently shown levels of global and severe acute malnutrition (GAM and SAM) above the emergency threshold of 15%, with a SAM generally around 2% (and in 2003/ 2004 SAM prevalence of above 4% was seen). The only exception has been two post-harvest surveys in November 2003 and November 2005 when the GAM reduced to around 12%. The post-harvest survey conducted in November 2009 revealed a 17% GAM prevalence (WFH < -2 Z-scores and/ or oedema, Confidence Interval of 14.7-19.6%) and 3% SAM prevalence (WFH <3 Z-scores and/or oedema, CI of 2.0-4.3%) using NCHS reference. This worrying result has necessitated a scale-up of the CMAM nutrition response, including reactivating in Aweil North. Two nutrition surveys were conducted in May/June 2010 - one in Aweil West and one in Aweil North. The nutrition survey results shown marked increased in the levels of acute malnutrition among children 6 - 59 months in the two counties. The prevalence of GAM in Aweil West was 25.7 percent (95% CI: 21.0 - 30.3) and prevalence of SAM was 5.6 percent (95% CI: 3.8 - 7.3) based on comparison with the WHO Growth Standards. The level of GAM found in Aweil North was 23.6 percent (95% CI: 19.5 - 27.8), while the level of SAM was 6.0 percent (95% CI: 3.9 - 8.1). Although the methodology for these surveys differed from previous assessments, these figures suggest a marked increase in the levels of acute malnutrition among children 6-59 months in these areas - the November 2009 survey for both counties found GAM and SAM levels of 17.6 percent and 3.7 percent, respectively. Unfortunately we had to cancel the November 2010 survey due to security issues and lack of human resources. However, a nutritional survey is planned for March 2011 - to help provide an up-to-date picture of the nutrition situation in Aweil West & North Counties. The results of the survey will be used to better direct and monitor the nutrition response across Aweil West & North Counties. As such, the questionnaire for the survey will include key knowledge, practice and coverage of health service (KPC) indicators related to maternal and child health, in addition to anthropometric measurements. To the degree possible, the survey will also monitor a selection of key indicators that have been measured in past surveys. (These baseline and past indicators/ questions are currently being compiled and will be shared with the consultant for inclusion in the final questionnaire at the start of the consultant's contract). Objectives The proposed nutrition survey has the following objectives: 1. To determine the prevalence of global and severe acute malnutrition among children aged 6 to 59 months 2. To estimate both under-five and crude retrospective death rates in the three months prior to the survey 3. To assess the recent morbidity patterns among children 6- 59 months 4. To establish immunization coverage for BCG, Measles and DPT 3 among children 6-59 months 5. To estimate coverage of key health services, including vitamin A supplementation, de-worming, therapeutic treatment for SAM and supplementary feeding for moderate acute malnutrition 6. To determine the nutritional status of mother and/or primary caretaker of the surveyed children 6-59 months 7. To determine carers' knowledge and practice regarding infant and young child feeding 8. To determine carers' knowledge and practice regarding the prevention of and care-seeking for malaria, diarrhoea, pneumonia and HIV & AIDS 9. To establish the source of drinking water and water management at household level and presence and use of latrines 10. To provide additional qualitative information on the likely causes of undernutrition and barriers to optimal child health and nutrition practices in the area (e.g. through focus group discussions) 11. To assess trends in nutrition status based on repeated surveys 12. To formulate and provide practical and sustainable intervention based on the survey findings to improve the nutrition status of the population. Duties and Responsibilities of the Consultant The consultant will, in coordination with the Concern South Sudan team: ? Develop and design survey tools using the SMART methodology. This includes preparation of data collection forms in line with international standards and that incorporate all relevant indicators/ questions, including standard anthropometric measurements for children (and MUAC for mothers), and all KPC questions outlined above and to be finalised by the Concern team. ? Be responsible for preparation for the surveys in the two counties, including review of population statistics, calculating the sample size, selecting, clusters, developing an efficient survey schedule ? Coordinate with UNICEF who are working towards using a consolidated survey process and data collection for South Sudan. ? Train the survey teams (including pre-testing questionnaire) in collaboration with Concern and County Health staff ? Assume overall responsibility for implementation of the two surveys, including daily supervision of survey teams, daily data quality assurance ? Supervise data entry (via assigned data entry staff) and assure data entry quality ? Be responsible for data cleaning and analysis using anthropometric software (SMART, EPI INFO, EPINUT and others as needed) for the core anthropometric and additional KPC indicators, including analysis using both NCHS and WHO 2006 Growth Standards ? Write and submit a comprehensive report outlining the findings and recommendations for each survey ? Lead the synthesis and sharing of findings during meetings and discussions with and Concern relevant field team members. Other relevant stakeholders could be included if time allow Expected outputs The expected outputs of the nutritional survey are: ? Two final survey reports: Consultant submits the two draft reports (Aweil North and Aweil West) for review to the CD, ACDP, Nutrition Advisor, Health and Nutrition PM and Nutrition Coordinator. Based on the feedback, the Consultant submits the final reports to Concern. ? Feedback on findings: The Consultant gives a briefing on the findings of the preliminary findings from surveys to Concern & MOH staff in Aweil before leaving Sudan. Concern will: ? Pay for economy class return flight from the consultant's country to Sudan ? Support/facilitate visa/ travel permits for South Sudan ? Facilitate/ provide all in-country transport for the consultant ? Recruit survey team with adequate skills to carry out surveys ? Provide accommodation in Sudan and if in transit from Nairobi Location and Duration The consultant should arrive in Nyamlel on the 11th March 2011. Recruitment for survey participants to have been conducted before the arrival of the consultant and the training should start immediately. It should take a maximum of 21 days including the training, survey, data entry and preliminary report. It is envisaged that the final report will be available 14 days after the submission of the preliminary report. Tentative Schedule Pre-departure - 2 days of work to be completed - Review draft and finalise survey questionnaires - Provide clear, detailed list for Concern South Sudan team of all inputs - human, technical, logistical - necessary to carry out the survey - Review population statistics provided by Concern team to ensure they are adequate to select cluster 11th March (Friday) (arrive in Juba on the 10th March) Arrive in Aweil. Plan survey schedule with Health/Nutrition Team. Note: number of travel days depends on where the consultant is travelling from - up to 2 days of travel if coming from Europe/ US). Can usually be 1 day from Nairobi 14th - 18th March (Mon-Fri) Train survey team, including pre-testing survey questionnaire and revising/ finalising survey questionnaire based on pre-test 19th of March (sat) Further prep/ finalising logistics/ forms 20th of March (Sun) Rest 21st - 28th March (Mon - Mon) Teams move to field; data collection, recording forms collected on a rolling basis, data quality check by supervisors/ consultant; data entry started 29th March Teams hand in final data sheets; review of data and discussions /debriefing with Concern team 29th March - 2nd April Continued data entry, cleaning and analysis and report writing 6th April Draft reports given to Concern for comments, feedback in country 13th April Concern team sends final comments/ feedback to the Consultant 27th April Final reports incorporating Concern feedback submitted to Concern South Sudan Country Director . Report Format As with all population assessments it is imperative that the results are available to Concern and operational partners as soon as possible. The report from the nutrition survey will be presented in English and will include at minimum: Introduction and details of the study population, study design (survey site, sample, design, and sample size and data collection methods), results (to include regression analysis for quantitative data), discussion, conclusions/recommendations, and references. As mentioned above the consultant will conduct debriefing meetings with Concern field team, this could include other relevant stakeholders. The final report to follow within one (1) week after receipt of comments by consultant. Women candidates are highly encouraged to apply. Interested candidates who meet the above requirements should send their applications and Curriculum Vitae (CV) to the address below or hand delivery to our office not later than 22 February 2011. Mailing address address; Human Resources Manager, Concern Worldwide South Sudan Program, Po Box 104, Hai Negley, Juba Southern Sudan. Email: Sarthak.pal@concern.net with copy to geraldine.mccrossan@concern.net, mireille.ndikumageng@concern.net, pradip.sanyal@concern.net, fanuel.inyangala@concern.net, and Charlotte.Kakebeeke@concern.net