Menu ENN Search
Language: English Fran├žais

SMART HHs Sampling

This question was posted the Assessment and Surveillance forum area and has 10 replies.

» Post a reply

Sameh Al-Awlaqi

Public Health and Nutrition Consultant

Normal user

23 Oct 2015, 17:05

Dear Colleagues, We are planning to conduct a SMART survey in one area in Sudan. This area is a mixture of IDPs camps and host communities with no specific arrangement of HHs or streets. The estimated population is around 102,000.There is no accurate mapping and it will take time to count all HHs within each of the 34 clusters if we wanted to use systematic random sampling method. What is the best method to select segments and HHs in this case? My colleagues from Ministry of health use " the spinning pen" technique in SMART surveys by going to the center of the cluster, spin a pen, go with the direction of that pen to the end of the cluster, spin it again, record all HHs on their left and right, then randomly select one as a start to interview and continue until finishing their target households.They are saying it is a good one for their context. I know this method has been used in the past for some nutrition assessments but I am not sure if it is the right one to be used here in SMART given the challenges mentioned above. Thanks! Sameh

Anonymous 81

Public Health Nutritionist

Normal user

25 Oct 2015, 18:33

Dear Sameh, I can see two questions from your post. The first is how to deal if the survey population is mixture of IDPS and host communities. Are you assuming both are the same condition? As you stated, it seems there is no clear map of the villages or enumeration areas. This issue is everywhere. If you managed stage I (listing of geographic area and selection of clusters), in the next stage, the villagers can assist you to locate their own catchment. Regarding the selection of HH method at stage II, given the SMART guideline, I would advise you to use either random or systematic sampling method. Now days, modified EPI method is not advisable. What you need is just listing households regardless of HH size or whether or not there are children under five. Then you select the required HHs using either random or systematic

Sameh Al-Awlaqi

Public Health and Nutrition Consultant

Normal user

26 Oct 2015, 07:02

Join ANH and ENN on 24th for a practical workshop (online) exploring the knowledge and actions at the intersections between food systems and climate change for improved nutrition and well-being.

In the workshop, we will explore:

  • Key evidence gaps from recent systematic work in this arena
  • Gaps and potential solutions, exemplified by the African Population and Health Research Center's research on climate change impacts on women & children's nutrition & mental health in Eastern African drylands
  • A live demonstration of how to use an interactive Evidence and Gap Map on this topic to answer questions and strengthen your work
  • Ways for the nutrition, food systems and climate communities to gain momentum towards better population and planetary outcomes in research and practice.

Register at:

Anonymous 81

Public Health Nutritionist

Normal user

26 Oct 2015, 08:25

Dear Colleagues,

We are excited to share with you a new update of our IYCF-E repository. Below we share with you an outline of some highlights of recently published papers.

You can use the interactive dashboard feature to search by keyword and filter by publication type (such as reviews, original research, editorials), countries of interest, and selected topic areas. Users can view or download a PDF version by following the link at the top left of the dashboard.

Since our last update in January 2024, we have added 12 NEW publications to our scientific repository related to IYCF in emergency settings (168 total). In addition to several international reviews, this update describes recent findings and ongoing research from Bangladesh, Botswana, Burkina Faso, Indonesia, Iran, Kenya, Malaysia, Nigeria, Portugal, Somaliland, South Africa, Switzerland, Thailand, the Netherlands, the United States, and Türkiye.

Click here to view the updated repository

Several new publications offer guidance for protecting IYCF and nutrition in humanitarian settings, including reviews of current guidelines to identify gaps. This update offers new guidance related to the safety of breastfeeding after exposure to chemical and biological agents used in modern warfare, including safety considerations during treatment and practical guidance for breastmilk testing, monitoring symptoms, safe use of expressed breastmilk, and the minimum amount of time before breastfeeding can safely resume. Other guidelines mention strategies to support breastfeeding, safe alternatives to breastfeeding, facilitating relactation and induced lactation, and complementary feeding in emergency settings. Another review describes facilitators and barriers to wet nursing, contemporary attitudes and beliefs, and strategies to facilitate and support wet nursing in emergencies. Researchers highlighted gaps in current literature, including a lack of practical guidance for small and vulnerable newborns, wet nursing, and strengthening health systems in humanitarian settings.

Other researchers examine the impacts natural disasters and climate change on IYCF. One study describes changes in maternity care and breastfeeding practices following hurricanes Irma and Maria in Puerto Rico, highlighting the important role of healthcare workers in supporting breastfeeding following childbirth, especially when regular breastfeeding and other postnatal services are interrupted. One commentary describes three stages of protecting nutrition following a natural disaster, with specific recommendations for each stage. Another article explores the impact of climate change on breastfeeding, emphasizing the need for region-specific climate action plans that incorporate IYCF.

New publications on IYCF in displaced families include the first known report of successful adoptive breastfeeding in a refugee camp, the impact of financial assistance on child stunting among Syrian refugees in Türkiye, and strategies to reduce the high prevalence of diarrheal illness among young children living in internally displaced camps in Somaliland. Another study explored IYCF knowledge, attitudes, beliefs, practices among refugee, migrant, and asylum seekers in Portugal, noting key differences in IYCF practices between migrant and the host populations and highlighting the need for universal breastfeeding support in hospital settings.

If you know anyone who would benefit from these updates, please direct them to this link to sign up for our email listserv. We aim to publish updates every 3 months – look for our next update in July 2024.

The IYCF-E Repository Team

Mark Myatt

Frequent user

26 Oct 2015, 12:14

The "spin the bottle" EPI-derived technique seems to work OK for anthropometry surveys. It does not work well for some indicators. There is a tendency for loss of sampling variation leading to high design effects. You can fix this (to some extent) by having more smaller clusters. The issue is loss of sampling variation not bias. There are alternative within-cluster sampling methods. I find the newer SMART approaches rather impractical. Modification of the EPI method (EPI3 and EPI5) in which the EPI method is used to sample the first HH with subsequent HHs selected by spinning the bottle again and taking the third (or fifth) HH in the indicated direction works well for many indicators. Such methods assume a simple community structure. You may want to use the within-cluster sampling methods used in RAM and RAM-OP type surveys. There is a manual for RAM-OP here. This method can sample from simple and complicated communities. I hope this helps.

Sameh Al-Awlaqi

Public Health and Nutrition Consultant

Normal user

26 Oct 2015, 12:39

Many thanks Mark for you reply, I will read the the RAM-OP manual and will revert back should I have any questions. Thanks again, Regards,Sameh

Bradley A. Woodruff


Technical expert

26 Oct 2015, 18:05

In fact, there are many ways to randomly select an unbiased sample of sampling units, but the EPI "spin-the-pen" technique is not one of them. One of the presentations in the original SMART workshop in 2002 explained why (see However, nothing is perfect, and sampling, like life itself, requires compromise between correctness and expediency. My preference in a specific situation is to initially consider the most correct sampling technique possible and be willing to expend some energy and resources to use this method. The most statistically and epidemiologically correct method is listing all sampling units and using simple random selection to choose among them. If this is impossible or logistically too demanding, select a feasible, albeit perhaps less correct, method with the full understanding of potential effects on sampling error and bias. The really important point is that, regardless of SMART or any other standard recommendations, you must choose the most appropriate sampling strategy for a specific situation, and this requires knowledge and experience. No cookbook can tell you how to sample in every situation. There are several sources which describe the process of selecting the most correct and feasible sampling method: 1. A Manual: Measuring and Interpreting Malnutrition and Mortality (see: 2. Gary T. Henry. Practical Sampling. SAGE Publications, Applied Social Reseach Methods Series Volume 21. 1990. 3. The presentation at the SMART workshop cited above.

Kemal J. Tunne

Emergency project coordinator

Normal user

26 Oct 2015, 18:33

Thanks every one I learn a lot from the manual RAM-OP its better to follow the guidelines for perfect sampling

Anonymous 310

Normal user

7 Nov 2015, 09:58

As others pointed out, the EPI method is not advisable for sampling. If the ‘clusters’ are already selected (assuming at village level), then the list of the HHs at the sampled cluster often done using the villagers and local knowledge in most context in south sudan (the survey team doesn’t necessary need to move around the entire village to list the HHs). So, active involvement of the local people at the ground during the planning stage is very important. If the selected cluster (village), is large or the HHs dispersed as you described, then 'segmentation' can be done (assuming the village has >than 100 HHs). At the end, you will end up of using either random or systematic sampling to select the required HHs in the sampled cluster. I understand the challenges in some circumstances, but we should do our utmost to avoid sampling error/bias during the planning stage.

RAM-OP method applies different methodology for selection of clusters/PSUs at Stage One (not PPS)

Blessing Mureverwi


Normal user

7 Nov 2015, 10:01

Spot on!

Kennedy Musumba

SMART Program Manager

Normal user

17 Nov 2015, 11:41

During the second stage sampling, it is advisable to liaise with the village leaders/authorities to come up with an updated list of households per cluster (sampling frame) dependent of your household definition and subsequently apply simple random or systematic random sampling.

In cases where clusters are large (approximate more than 100 households), Segmentation is applied based on PPS followed by either simple random or systematic random sampling. Further detailed information can be obtained from;
1.Module 3-Sampling
2. Sampling for SMART, Pgs. 26-32 (Complementary Tools &Resources, download Handouts)

It is important to note that EPI method /pen spinning is not as highly recommended because of its limitation of introducing selection bias.

If you have any problem posting a response, please contact the moderator at

Back to top

» Post a reply