SQUEAC assessments use in-community case finding methods to find acutely malnourished children during Stage 2 (small surveys and small-area surveys) and Stage 3 (likelihood survey).
There are two methods which should be chosen depending on the context:
The most appropriate method to use in rural and peri-urban settings is active and adaptive case finding.
It is Active because it actively searches for cases rather than just expecting cases to be found in a sample.
It is Adaptive because it uses information found during case-finding to inform and improve the search for cases.
This technical note provides more detail about how to develop an active and adaptive case finding technique.
Two things are needed to conduct active and adaptive case-finding in a village:
1. A case definition: a description of the children you are looking for, based on clinical and non-clinical characteristics. For example, 'children that are sick, thin, have swollen legs or feet, or have recently been sick and have not recovered fully, or are attending a feeding programme'. This should be adapted to local terminology (based on the information collected during the Stage 1 qualitative data collection), and could be supported by visual aids if and when appropriate. Markers of risk (eg. orphans, twins, single parents, neglected or abused children, households without land or livestock) can also be included in the case-finding question. It should also avoid highly stigmatised terms (eg. terms associated with poverty) as community members may be reluctant to slander their neighbours to help you find SAM cases.
The case definition should be printed out and distributed to the surveyors.
2. Key informants: Key informants should be identified in each community who can help surveyors with the identification of SAM cases. They can include (but are not limited t0): community leaders, traditional health practitioners and traditional birth attendants, Community health workers and volunteers, Mothers of SAM children. More guidance on how to go about this is available in this case finding procedure in Figure 1.
With the guidance of key informants and the case definition, surveyors can then go into the community to locate SAM cases. When they find them, the surveyors should interview the carer of the child with a simple structured questionnaire.
A template for this interview and the method for delivering it is available here.
Once they have interviewed the first carer, they should ask him or her to direct them to any other SAM cases near their home and proceed there. Sampling stops only when surveyors are sure that they have found all SAM cases in the community, including those already enrolled in the programme (see Figure 2). Sampling should not stop because they have reached a quota or met the sample size required by the survey.
A review of coverage survey methods undertaken by Epicentre in 2015 voiced concerns about the
performance of the active and adaptive case-finding (AACF) procedures that are used to find cases of severe acute malnutrition (SAM) in SQUEAC and SLEAC coverage assessments.
This report reviews data on case finding sensitivity from a number of capture-recapture studies that tested active and adaptive case-finding procedures.
Data collection can be easily conducted on smartphones using software such as "M-Health". This case study presents the results of a trial in 2016 to collect data during in-community case finding in the health district of Gourcy in Burkina Faso.
In urban areas or in camp settings, it is more appropriate to use door-to-door sampling to locate SAM children.
This is due to the multiple occupancy of compounds and buildings and to the fact that high population turnover. These settings are typified by a lack of strong extra-familial relationships, extended familial relationships, strong local kinship ties, collective loyalty, and simple (traditional) social structures. And often people do not know their neighbours well. Furthermore in these settings it may be very difficult to find useful key informants or local guides.
Surveyors should ensure that they measure all children in a household by taking a verbal household census before asking to measure children. This avoids sleeping or sick children being 'hidden' to avoid them being disturbed by the survey team.