{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T11:43:55Z","timestamp":1775821435687,"version":"3.50.1"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T00:00:00Z","timestamp":1755043200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp;amp; Child Nutrition"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>This study characterizes the sample size and precision for infant and young child feeding (IYCF) indicators evaluated in surveys conducted in refugee settings, characterized by sample sizes enabling timely information to inform humanitarian response. We analyzed surveys provided by the United Nations High Commissioner for Refugees conducted from 2013 to 2019. For eight IYCF indicators recommended in the current global guidance, we assessed achieved sample sizes and precision by evaluating the half\u2010width of 95% confidence intervals (HWCIs) by survey design. Among cluster surveys, we characterized the intraclass correlation coefficients (ICCs) and design effects. Final analysis included 203 surveys from refugee settings in 15 countries. Ever breastfed and bottle feeding indicators were the most precise (median HWCI: 3.1% and 3.6%) due to inclusion of all children 0\u201323 months resulting in relatively large sample sizes and estimates of prevalence close to 100% and 0%, respectively. Exclusive breastfeeding under 6 months and the introduction of solid foods (6\u20138 months) had the lowest precision (median HWCI estimates: 12.6% and 18.2%). In cluster surveys, early initiation of breastfeeding and flesh food consumption stood out with markedly higher design effects (median estimates: 2.63 and 2.17) driven by relatively larger sample sizes and high ICCs (median estimates: 0.31 and 0.27); all other indicators had median design effects &lt;\u20091.3. Evidence on expected variation in precision and heterogeneity by indicator can help design surveys with samples that allow for the rapid collection of data sufficient to inform emergency responses. High caution is needed when interpreting estimates of exclusive breastfeeding and introduction of solid foods in past surveys given lower precision.<\/jats:p>","DOI":"10.1111\/mcn.70078","type":"journal-article","created":{"date-parts":[[2025,8,13]],"date-time":"2025-08-13T22:40:17Z","timestamp":1755124817000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Precision and Sample Sizes Achieved for Infant and Young Child Feeding Indicators Evaluated in Anthropometry Assessments: A Secondary Analysis of Population\u2010Representative Surveys in Refugee Settings"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4191-5931","authenticated-orcid":false,"given":"Eva","family":"Leidman","sequence":"first","affiliation":[{"name":"Center for Global Health, Centers for Disease Control and Prevention Division of Global Health Protection Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5106-4157","authenticated-orcid":false,"given":"Behzad","family":"Kianian","sequence":"additional","affiliation":[{"name":"Center for Global Health, Centers for Disease Control and Prevention Division of Global Health Protection Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oleg","family":"Bilukha","sequence":"additional","affiliation":[{"name":"Center for Global Health, Centers for Disease Control and Prevention Division of Global Health Protection Atlanta Georgia USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,13]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.2307\/2685469"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/jssam\/smv024"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1201\/9781420080674"},{"key":"e_1_2_12_5_1","volume-title":"Survey Sampling","author":"Kish L.","year":"1995"},{"key":"e_1_2_12_6_1","first-page":"193","article-title":"Confidence Intervals for Proportions With Small Expected Number of Positive Counts Estimated From Survey Data","volume":"24","author":"Korn E. L.","year":"1998","journal-title":"Survey Methodology"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v009.i08"},{"key":"e_1_2_12_8_1","unstructured":"R Core Team.2020.R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing.https:\/\/www.R-project.org\/."},{"key":"e_1_2_12_9_1","unstructured":"Standardized Monitoring and Assessment of Relief and Transitions (SMART). 2020. \u201cSmart and Rapid Smart Technology.\u201dhttps:\/\/smartmethodology.org\/survey-planning-tools\/smart-methodology\/."},{"key":"e_1_2_12_10_1","doi-asserted-by":"crossref","unstructured":"Summers A. andO. O.Bilukha. 2018. \u201cSuboptimal Infant and Young Child Feeding Practices Among Internally Displaced Persons During Conflict in Eastern Ukraine.\u201dPublic Health Nutrition21 no. 5: 917\u2013926.","DOI":"10.1017\/S1368980017003421"},{"key":"e_1_2_12_11_1","unstructured":"The Centers for Disease Control and Prevention.2022. \u201cInfant and Young Child Feeding in Emergencies Toolkit.\u201dhttps:\/\/www.cdc.gov\/nutrition\/emergencies-infant-feeding\/downloads\/IYCF-E-Toolkit-H.pdf."},{"key":"e_1_2_12_12_1","unstructured":"The DHS Program.2020. DHS Model Questionnaire \u2010 Phase 8 (English French).https:\/\/dhsprogram.com\/publications\/publication-dhsq8-dhs-questionnaires-and-manuals.cfm."},{"key":"e_1_2_12_13_1","unstructured":"The IFE Core Group. 2017. \u201cInfant and Young Child Feeding in Emergencies: Operational Guidance for Emergency Relief Staff and Programme Managers.\u201d Version 3.0.https:\/\/www.unhcr.org\/45f6cd022.pdf."},{"key":"e_1_2_12_14_1","unstructured":"UNICEF Data. 2017. \u201cRegional Classifications.\u201dhttps:\/\/data.unicef.org\/regionalclassifications\/."},{"key":"e_1_2_12_15_1","unstructured":"UNHCR. n.d. \u201cStandardized Expanded Nutrition Survey.\u201d Accessed November 21 2022.https:\/\/sens.unhcr.org\/."},{"key":"e_1_2_12_16_1","unstructured":"UNICEF.2023. \u201cMultiple Indicator Cluster Surveys Tools.\u201d Accessed November 21 2022.https:\/\/mics.unicef.org\/tools."},{"key":"e_1_2_12_17_1","unstructured":"United Nations High Commissioner for Refugees. 2018.UNHCR Standardised Expanded Nutrition Survey (SENS) Guidelines for Refugee Populations. Module 4: Infant and Young Child Feeding (IYCF). A Practical Step\u2010by\u2010Step Guide Vol.3.https:\/\/sens.unhcr.org\/introduction\/module-3-iycf\/."},{"key":"e_1_2_12_18_1","unstructured":"United Nations High Commissioner for Refugees. 2013.UNHCR Standardised Expanded Nutrition Survey (SENS) Guidelines for Refugee Populations. Module 3: Infant and Young Child Feeding (IYCF). A Practical Step\u2010by\u2010Step Guide Vol.2.https:\/\/sens.unhcr.org\/introduction\/modules-and-tools-v2\/."},{"key":"e_1_2_12_19_1","unstructured":"World Health Organization. 1991. \u201cIndicators for Assessing Breast\u2010Feeding Practices: Report of an Informal Meeting.\u201d Geneva Switzerland June 11\u201312. World Health Organization."},{"key":"e_1_2_12_20_1","volume-title":"Report of the Expert Consultation of the Optimal Duration of Exclusive Breastfeeding.\u201d Geneva, Switzerland, March 28\u201330","author":"World Health Organization","year":"2001"},{"key":"e_1_2_12_21_1","unstructured":"World Health Organization. 2001b. \u201cResolution WHA54. 2\u2010Infant and Young Child Nutrition.\u201d InProceedings of the Fifty\u2010Fourth World Health Assembly 28\u201330. World Health Organization."},{"key":"e_1_2_12_22_1","volume-title":"Indicators for Assessing Infant and Young Child Feeding Practices: Definitions and Measurement Methods: Part 1: Definition","author":"World Health Organization","year":"2008"},{"key":"e_1_2_12_23_1","volume-title":"Indicators for Assessing Infant and Young Child Feeding Practices: Definitions and Measurement Methods. Part 2: Measurement","author":"World Health Organization","year":"2010"},{"key":"e_1_2_12_24_1","volume-title":"Indicators for Assessing Infant and Young Child Feeding Practices: Definitions and Measurement Methods","author":"World Health Organization, and United Nations Children's Fund (UNICEF)","year":"2021"}],"container-title":["Maternal &amp; Child Nutrition"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.70078","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/mcn.70078","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/mcn.70078","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T10:44:17Z","timestamp":1775817857000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/mcn.70078"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,13]]},"references-count":23,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/mcn.70078"],"URL":"https:\/\/doi.org\/10.1111\/mcn.70078","archive":["Portico"],"relation":{},"ISSN":["1740-8695","1740-8709"],"issn-type":[{"value":"1740-8695","type":"print"},{"value":"1740-8709","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,13]]},"assertion":[{"value":"2025-01-09","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-09","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70078"}}