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To estimate a sample size for a proportion in a single cross-sectional survey, three numbers are needed: 1. Estimate of the expected proportion (p !. "esired level of absolute precision (d #. Estimated design effect (DEFF The sample size formula is:

($orstein %, &ullivan '(, )arvanta *, +egin ,. Indicators and methods for cross-sectional surveys of vitamin and mineral status of populations. (icronutrient *nitiative (-tta.a and /enters for "isease /ontrol and )revention (0tlanta , (ay !112, pg !3 . *f the expected proportion p for an indicator is not 4no.n, usually the value of 1.5 (or 516 is used because it produces the largest sample size (for a given values of d and DEFF . *f the proportion is expected to be bet.een t.o values, select the value closest to 1.5. size calculation. The level of absolute precision d specifies the .idth of the confidence interval, e.g., 71.1# (i.e., 7#6 , 71.15 (i.e., 756 or 71.11 (i.e., 7116 . ,or example, if the proportion estimated .ere 816, .ould a precision of 7116 (i.e., 356 confidence limits of #16 and 516 be acceptable9 *f not, .ould a narro.er confidence interval (#56, 856 , i.e., precision of 756, be acceptable9 The selection of a value for d (the desired absolute precision may depend on the expected proportion and the purpose of the survey. /ommon values for d are ,or example, if the proportion is thought to be bet.een 1.15 and 1.#1, use 1.#1 for the sample

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usually around 756 for estimated proportions in the range of !16-:16, and around 7#6 for less common or very common events (;!16 or <:16 . The sample size re=uired for a cluster survey is almost al.ays larger than that re=uired for surveys using simple random sampling because of the design effect ( DEFF . *f the prevalence of a particular indicator is similar in each cluster, the DEFF .ill be around one, .hich means the variability is the same as .ould have been .ith simple random sampling methods. The greater the clusters differ from one another, the larger the DEFF. 0s the "E,, increases the sample size must be increased to maintain a desired level of precision. 0fter a survey has been completed and the data analyzed, any calculated proportion is an estimate of the proportion in the .hole population. $enerally a confidence interval is calculated to present a range of values .ithin .hich the true proportion is li4ely to be captured. ,or example, if the proportion is 816 and the lo.er and upper 356 confidence limits are #16 and 516, respectively, the interpretation .ould be that the true proportion in the population most li4ely lies some.here bet.een #16 and 516. This means that it .ould be very unli4ely for the true population proportion to be belo. #16 and very unli4ely for it to be greater than 516. Experience from surveys of anemia, vitamin 0 deficiency, and iodine deficiency .ith around #1 individuals sampled in each of #1 clusters have "E,,s in the range of 1.5 to #. *f more than #1 individuals are sampled per cluster, the "E,, is usually larger> if fe.er than #1 individuals are sampled per cluster, the "E,, is usually smaller. &le sizes for different 4ey indicators, based on estimated prevalence levels, design effects, confidence levels, and precision are presented in Table 1. )lease note that these are only estimates and the actual sample size re=uired for an individual country survey .ill vary. 0s an example, the sample size calculation to assess vitamin 0 capsule coverage, assuming p ? 1.5, d ? .15, and DEFF ? !:

n=

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Table 1 Examples of sample size calculations for 4ey micronutrient indicators Micronutrient/Indicators/Group Expected revalence/ !overage "p# "$# %bsolute recision "d# "$# &esign Effect DEFF Sample Sizea

Indicators based on individuals '%& and capsule coverage @o. &erum retinol in preschool children Aitamin 0 capsule coverage I&% and supplementation coverage 0nemia *ron deficiency anemia *ron tablet coverage in appropriate group(s I&& @o. urinary iodine Indicators based on households Couseholds using vitamin 0 fortified product Couseholds using iron fortified product(s Couseholds using iodized salt

a

&le sizes are calculated for each strata based on 356 confidence intervals ( ? 1.15 , expected prevalenceDcoverage levels closest to 516, desired absolute precision, and estimated design effect

&le sizes are al.ays rounded up, so the sample size from the above example .ould be 2B3. *n some settings, a different precision value andDor different expected "E,, value may be appropriate. ,or example, if the prevalence of anemia is thought to be B16, this .ould indicate that anemia is a severe problem in the population> it could be decided that a precision of 7116 .ould be ade=uate because any anemia prevalence estimate in a population <816 is considered to indicate a severe anemia problem, so a very precise estimate may not be necessary. -n the other hand, if the proportion is very lo. or very high, for example, if the proportion of households using iodized salt is thought to be 3!6, it some situations it may be desired to have greater precision than 756, perhaps 7!.56. *n general, .hen performing sample size calculations or using sample size tables, careful consideration should be given to the values used in the calculation.

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