ASSESSMENT ON INTERNALLY DISPLACED

PERSONS (IDP) STATUS IN KHYBER PAKHTUNKHWA AND

FEDERALLY ADMINISTERED TRIBAL AREAS

Nutrition Cluster

Submitted to UNOCHA

KP Nutrition Cluster

Aien Khan

2

1. INTRODUCTION 1.1 Background

The current existing displacement of caseload is estimated about one million IDPs (159,609

families; 957,654 individuals – 54 per cent men/46 per cent women),1who fled between

2008 to 2013 due to insecurity related to armed non-state entities, security operations and

sectarian violence in various Agencies of FATA. Almost four cent of this population is living in

the three IDP camps, including 4,682 IDP families in Jalozai (KP), 1,157 families in Togh Sarai

(KP)and 732 in New Durrani (FATA) IDP camps. The remaining 96 per cent are residing in

host communities, mostly in the adjoining districts in KP and safer areas in FATA. So far

517,133 Children displaced and over 1 million in IDPs in KP and FATA. As of may 20 2014,

824 registered families returned to Tirah Valley, Khyber Agency in the on-going Phase II of

Tirah IDPs return, which started on 7 May 2014.2

1.2 The rational for theIDP Assessment

This assessment was planned in response to OCHA request to carry outIDP assessment by

the respective clusters on the Internally Displaced persons (IDP) within Khyber Pakhtunkhwa

(KP) and Federally Administered tribal areas (FATA).The main objective of the assessment is

to identify and estimate the humanitarian needs of the IDPs community and prepare

response based on the facts in the targeted areas. Thus, theassessment wasdesignedbased

on UNHCR IDP official figure that was shared to the clusters during the technical working

group meeting. This assessment was believed to fill the lack of updated information on IDP

status and provide basis for IDP humanitarian response planning in areas of Nutrition and

other sectors through: Promote a shared vision of needs and priorities; Establish the priority

needs from an integrated perspective and use resources more efficiently; Obtain a more

comprehensive picture of needs for better guide donor funding; Allow clusters to analyze

and decide on the most appropriate strategies to support IDPs; Serve as a foundation for

planning for IDP response; and Reduce duplication of effort and promote inter-cluster

learning.

Therefore, the nutrition cluster decided to coordinate with implementing partners (IPs) in order to conduct the assessment in their own operational area using simple random sampling. Almost all who are renting the house are living within the host community. In terms of place origin, the IDPs came from different parts of the province. The highest origin was reported from Alihera for Kurram agency followed by Tirah, slaarzai for other districts. This assessment was conducted in DI Khan, Hangu, Nowshera, Khot,Kurram, Nowshera, Peshawar,Tank of KP districts, Bajour, Mohmand, Kurram agencies of FATA and three camps Jalozai in Nowshera, Togh Sarai in Hangu, New Durrani in Kurram camps in KP and FATA.

1UNHCRIDP statistics as of 30 April 2014 2 Situation Report Complex Emergency in KP and FATA Monthly Sitrep # 29

3

1.3 Objectives of the Study

The cluster developed tool and harmonize it to come up simple tool for IDP assessment. The

assessment specifically will look into;

The prevalence of malnutrition among children aged 6-59 months in the IDP households.

Determine of measles coverage and illness among children in the IDP population

Assess the Infant and young child feeding practice among the IDP population

2. METHODOLOGY

2.1 Sample size calculation

Simple random sampling was used as indicated on Table1. The sample size for nutrition

cluster was derived using the formula:

𝑁 = D ⌈t2(p×q)

𝑑2⌉ The parameters are tabulated as follows:

Table 1: Parameters used in calculation of sample size calculation IDP assessment

Parameter Definition value

N Sample size:

𝑁 = 2 ⌈t2(p × q)

𝑑2⌉

𝑁 = ⌈1.962(0.5 × 0.5)

0.052⌉

=384.16 rounded up to 384

t Error risk. t=1.96 at 95% confidence interval

p Expected prevalence Used 50% corresponding to p=0.5 as proportion

q 1-p Thus q=1-0.5=0.5

d Degree of accuracy (5% for each survey) and given as 0.05 proportion

D Design effect 1 because we are using random sampling

Simple random sampling is always used for small populations that contain more than 1000 sampling units (or households). The assessment team was requested to prepare the list of IDP households up on arrival in each selected village for purpose of sampling.

Table 2. IDP sampling by district with in KP/FATA

S/N

District Total population

Total under five @ 12.1%

Total IDPs

Total Returnees

OCHA IDPs Sample

OCHA Sample Returnees

Actual Sample 3

1 Peshawar 2,020,463 244476 71469 382 384 2 DI Khan 705,403 85354 25331 378 384 3 Kohat 554,750 67125 21670 377 384 4 Tank 360,539 43625 11684 372 384 5 Nowshera 671,328 81231 9304 369 384 6 Hangu 373,520 45196 1205 291 384 7 Kurram 649,287 78564 9770 10263 370 370 384 8 Khyber 973,330 117773 2082 6187 324 362 384 9 SWA 574,270 69487 ??? 1900 320 384 10 Bajaur 1124141 136021 ??? 559 228 384 11 Mohmand 627,120 75882 ??? 186 126 384 8,634,151 1044732

3 Sample was taken at confidence interval (CI) of 95%, desired precision of 5% if the prevalence of malnutrition is 50%

4

Figure 1: ENA Random Number Generator

Since in most contexts the number of basic sampling units (BSU) is large, simple random

sampling procedure was conducted by numbering each basic sampling unit i.e IDP

households and then choosing the desired number IDPs households randomly using the

random number table as presented on Figure 2Error! Reference source not found..

Assessment was then be taken based on these IDP households only. For instance we have

71469 IDP households in Peshawar and our total sample is 382 (OCHA sample). Therefore, in

order to select 386 IDP households randomly in Peshawar the team usedrandom table

generated from ENA software as follow.

2.2 Sampling procedure

Option 1:Using simple random sampling methodology.

In order to select the specific IDPs Households from village after listing that is 386 IDP households from the total IDP list in each district, the following optionwas given to the team

o Number each of the 71469 IDPs of Peshawar from 1 to 71469.

o Enter 1 in the box named Range from and 71469 in the box named To (Figure 1Error! Reference source not found.).

o Enter the number of IDPs you need for your sample (386) in the box named Numbers.

o Click on the Generate Table button.

o A word file will open displaying the 386numbers selected randomly (Figure 2).

5

2.3.Data Analysis, Management and Process

2.3.1Data quality management and clearance

One day a partner meeting was organized by nutrition cluster and the pretest of the questioner

was carried out with partners. The review and daily editing of the questionnaires was carried

out on daily basis by the district supervisors in order to identify errors, omissions and

inconsistencies. This quality checking was not done daily after data collection and feedbacks

wasnot given before the next data collection measure as a result the anthropometric data

quality was affected. That means the consistency of data wasn’t assessed by plausibility check

on digit preference in height and weight measurements, overall sex ratio, and standard

deviation for weight for height. Therefore, the analysis of this report was based on the MUAC

finding.

2.3.2Data Analysis SPSS version 16 was used for data cleaning, outliers checking and analysis of contextual or

non-anthropometric data analysis. Moreover, anthropometry Data entry and analysis was

done using ENA for SMART software.

2.3.3 Ethical Considerations

Clearance for the assessment was collected from the respective mandated offices and verbal

consents were obtained from each assessment participants. The participants were briefed

about the objectives and importance of the assessment before the commencement of

interviews and all interviews was conducted in areas where the privacy of the study

participants was maintained.

Figure 2: List of random IDP numbers in a Word document generated by

ENA software

6

3. RESULT

3.1 Resident status of the IDP household

According the findings 4,576 IDP households were visited both within the host community

of eight districts and three camps. The mean household size was 7.27 +3.75 standard

deviation. A total of 3549 children were visited in the assessment and 52.2% of them were

male. The majority of the IDPs in the host community of Hangu, Kohat, Nowshera, Peshawar

and Tank are living within rented houses whereas the IDPs in the camps reported they have

been living within the camp. The situation in Bajour, Mohmand and Kurram is different

where the majority IDPs live in their own house.

Figure 3: percentage of IDPs by types of resident

Out of the total 4574 households, 41.1% are living in rented house while 24.3% and 25.9%

of them were living in IDP camps and own house respectively.

Figure 4: Resident status of in the overall respondents

9.4 11.2 14.1 14.6

6.9 4.1

11.814.9 13.0

6.5 4.3

14.6 9.1 7.6

18.9

7.612.1

8.8 10.6

15.4 12.8

4.46.0

13.6

25.0

9.26.2 7.4

33.3 35.131.6

0.05.0

10.015.020.025.030.035.040.0

Housing conditiong of IDPs

Rented house Living with relatives Owner of the house

In IDP camp Linear (Living with relatives)

41.10%

8.70%

25.90%

24.30%

Resident status of IDPs households

Rented house Living with relatives Owner of the house In IDP Camp

7

3.2 The number of children per household

Except in Hangu and Togh Sarai camp in Hangu where more than 75 of the households

reported they haveonly1 to 2 children, the rest of the IDPs households in the other districts

reported they have more than 3 to 4 more children.

Figure 5: Number of children per household

3.4 IDP Household Income source Casual labor and skilled labor are accounting for 50 %of the income source for IDPs population

Figure 6: The source of income for households

40% 29% 25%

78% 86%

26% 32% 32% 26% 27% 21% 18%

50%

29% 30%

18% 6%

31% 28% 35%25% 27% 30% 43%

10%

24%16%

2%

22% 24%24%

23% 26% 28%27%

11%15%

1%7%

12% 7%15% 13% 15%

12%1% 9% 1% 8% 12%

1% 1% 3% 3% 4%

0%

20%

40%

60%

80%

100%

120%

The number of children in Household

1 to 2 3 to 4 5 to 6 7 to 8 9 to 10 more than 10

0.4

4.3

3.2

2.8

1.7

42.2

16.7

9.1

1.3

5.7

12.5

0.0 5.0 10.0 15.0 20.0 25.0 30.0 35.0 40.0 45.0

No income

Sale of crops

Sale of livestock and animals

Sale of Natural Resources

Sale of Food Aid

Casual labour

Skilled Labour

Salaried work

Petty trading

Family support

Other

Source of income%

8

3.5 Frequency of meal in 24 hours.

The majority of the households consumed three times except in Tank where 73.3 of the

households consumed food twice a day.

Figure 7: Meal frequency in 24 hours recall

3.6 Assistances received 52.8 % of the IDP households mainly from host community didn’t receive any form of

assistance in the past three months. Most households who reported they received FGD for

the last three month, they have also confirmed they received supplementary food in

addition.

Table 3 Type of assistance by District District None GFD Supplementary

food Seeds and tools

Cash assitance

Total

Kurram Camp 100 0 0 0 370

Bajour 96.8 2.6 1.0 0.8 0.3 386

DI Khan 49.7 19.7 28.9 1.3 0.3 380

Hangu 76.8 10.9 8.0 2.1 2.1 375

Hangu Camp 3.6 90.3 5.9 0.0 0.3 390

Jalozai IDPs Camp 21.2 61.0 1.0 0.0 16.8 387

Khot 60.8 21.9 14.1 2.7 0.5 375

Kurram 55.5 36.1 5.7 1.6 1.1 366

Mohmand 1 89.8 1.2 3.7 3.0 2.2 403

Nowshera 48.9 40.8 7.9 1.3 1.1 380

Peshawar 55.1 30.8 9.2 1.8 3.1 390

Tank 76.2 17.9 0.3 0.5 5.1 374

Total 2420 1645 327 58 126 4576

46.4

53.4

10.9 5.4 3.716.3 12.6 9.7 4.5

20.3

73.3

100.0

50.543.4

71.784.6

48.2

79.5 82.5

64.675.8

66.4

26.7

3.1 3.217.4

10.0

48.2

4.3 4.9

25.719.7

13.30.0

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Meal frequncy in 24 hurs

2 times 3 times 4 times

9

3.7 Donation of Infant feeding supplies

Out of the total households, 83.3% of the total households reported there was no donation of infant feeding supplies Table 4: Types of infant feeding donation District No

distribution %

Bottles %

Dry milk

%

Infant formula

%

Liquid milk

%

Teats %

Dont know

%

Others %

Kurram Camp 100 0 0 0 0 0 0 0 370

Bajour 94.6 0.8 2.8 0 0.3 0.5 0.5 0.5 386

DI Khan 81.1 0.3 0 0 0.3 0.3 2.4 15.8 380

Hangu 83.5 0 2.1 6.4 0.5 0 3.5 4 375

Hangu Camp 21.3 0 39.7 18.5 5.4 0 2.8 12.3 390

Jalozai IDPs Camp

98.7 0.5 0.3 0 0 0 0.52 0 387

Khot 84.5 0.27 1.3 2.1 0 0 2.9 8.8 375

Kurram 93.7 1.09 0 2.2 0.55 0 1.6 0.82 366

Mohmand 1 78.7 2.7 5.5 2.2 1.2 0.0 5.7 4.0 403

Nowshera 88.7 0.5 0 0 0.5 0.0 1.8 8.4 380

Peshawar 81.5 0 3.8 1.0 0.5 0 1.0 12.1 390

Tank 84.0 0 0.53 0 0 0 14.7 0.8 374

Total 3767 24 219 125 36 3 143 259 4576

3.8 Shock faced

The price of food commodities is reported as the primary challenge for IDP households followed by insecurity. Figure 8: Shocked faced by IDP households

None, 105, 2%

Insecurity, 784, 17%

Food too expensive, 1770, 39%

Lack of free access, 192, 4%

Livestock disease, 154, 3%

Floods, 41, 1%

Human sickness, 490, 11%

IDP living with HH, 91, 2%late food

distribution, 192, 4%

Social event, 115, 3%

Delay of rains, 34, 1%

weeds or Pest, 27, 1%Others, 525, 12%

10

3.2 Infant and young child feeding practice 3.2.1 Ever breast feeding

The ever breastfeeding coverage is higher as expected for all the districts and camps.

Table 5: Ever breast feeding Districts No Yes %

Kurram Camp 0 265 100.0 265

Bajour 0 234 100.0 234

DI Khan 0 262 100.0 262

Hangu 0 282 100.0 282

Hangu Camp 2 253 99.2 255

Jalozai IDPs Camp 2 176 98.9 178

Kohat 3 252 98.8 255

Kurram 0 246 100.0 246

Mohmand 1 12 246 95.3 258

Nowshera 1 243 99.6 244

Peshawar 2 291 99.3 293

Tank 0 366 100.0 366

22 3116 3138

3.2.2 Initiation of breastfeeding More than half (56.7%) of the mothers initiated breastfeeding within one hour as per the

recommendation.

Table 6: Initiation of breastfeeding among mothers of children under two years Districts Immediately

in 1 hr % In first

day % After first

day % Total under

two children

Kurram Camp 223 84.2 42 15.8 0 0.0 265

Bajour 78 33.6 111 47.8 43 18.5 232

DI Khan 143 54.6 75 28.6 44 16.8 262

Hangu 83 29.4 111 39.4 88 31.2 282

Hangu Camp 58 22.7 98 38.4 99 38.8 255

Jalozai IDPs Camp 153 86.0 17 9.6 8 4.5 178

Kohat 101 39.6 62 24.3 92 36.1 255

Kurram 168 68.3 55 22.4 23 9.3 246

Mohmand 1 100 38.8 63 24.4 95 36.8 258

Nowshera 148 60.7 45 18.4 51 20.9 244

Peshawar 177 60.4 48 16.4 68 23.2 293

Tank 346 94.5 14 3.8 6 1.6 366

1778 56.7 741.0 23.6 617.0 19.7 3136

3.2.3 Colostrum feeding The colostrum feeding was reported highest in Hangu(68.6%) and Jalozai(62.9%)camps whereas New Durrani camp in Kurram shows the lowest of all surveyed areas.

11

Table 7: Colostrum feeding District No % yes % Total under Two

Kurram Camp 157 59.2 108 40.8 265

Bajour 151 64.5 83 35.5 234

DI Khan 133 50.8 129 49.2 262

Hangu 141 50.0 141 50.0 282

Hangu Camp 80 31.4 175 68.6 255

Jalozai IDPs Camp 66 37.1 112 62.9 178

Kohat 122 47.8 133 52.2 255

Kurram 117 47.6 129 52.4 246

Mohmand 1 111 43.0 147 57.0 258

Nowshera 131 53.7 113 46.3 244

Peshawar 165 56.3 128 43.7 293

Tank 216 59.0 150 41.0 366

1433 45.7 1705 54.3 3138

3.2.3 Continued breast feeding two years Similarly, the camps have shown higher proportion of continued breastfeeding.

Table 8:Continue breastfeeding Districts No Yes

Kurram Camp 20 7.55 245 92.5 265

Bajour 63 26.92 171 73.1 234

DI Khan 62 23.66 200 76.3 262

Hangu 61 21.63 221 78.4 282

Hangu Camp 37 14.51 218 85.5 255

Jalozai IDPs Camp 14 7.87 164 92.1 178

Kohat 56 21.96 199 78.0 255

Kurram 28 11.38 218 88.6 246

Mohmand 1 72 27.91 186 72.1 258

Nowshera 56 22.95 188 77.0 244

Peshawar 38 12.97 255 87.0 293

Tank 60 16.39 306 83.6 366

567 18.07 2571 81.9 3138

The analyses for continued breastfeeding at 1 year also showed higher level of children are still breastfed.

12

Table 9: Continued breastfeeding at age 1 year. No % Yes %

Kurram Camp 0 0.0 42 100.0 42

Bajour 8 20.0 32 80.0 40

DI Khan 9 19.1 38 80.9 47

Hangu 4 10.5 34 89.5 38

Hangu Camp 0 0.0 35 100.0 35

Jalozai IDPs Camp 4 16.0 21 84.0 25

Kohat 13 29.5 31 70.5 44

Kurram 7 14.9 40 85.1 47

Mohmand 1 7 15.2 39 84.8 46

Nowshera 4 11.4 31 88.6 35

Peshawar 10 18.5 44 81.5 54

Tank 4 6.3 60 93.8 64

70 13.5 447 86.5 517

3.2.4 Exclusive breast feeding at age 6 months

The overall exclusive rate was at 45.9% whereas the highest was reported in Tank district at

70.6 even though the number of children in the Tank district sample was found very few.

Table 10: The exclusive breast feeding none

other than

breast Milk

EBF Powder or

animal milk

Cereals based diet

Plain water

Fruit Juice

sugar water

Vegetables

Green tea

Total

Kurram Camp 56 50.0 0 54 0 0 0 0 2 112

Bajour 20 40.0 14 0 3 0 0 1 12 50

DI Khan 19 48.7 6 0 1 0 0 0 13 39

Hangu 25 26.0 7 0 12 0 34 0 18 96

Hangu Camp 17 17.5 3 0 14 1 52 1 9 97

JalozaiCamp 26 59.1 2 10 1 0 0 0 5 44

Khot 21 48.8 3 6 2 2 4 0 5 43

Kurram 24 55.8 1 8 0 0 0 0 10 43

Mohmand 1 37 62.7 9 4 3 0 0 4 2 59

Nowshera 38 64.4 9 1 0 1 1 1 8 59

Peshawar 30 61.2 8 0 0 1 0 1 9 49

Tank 12 70.6 1 0 1 0 0 0 3 17

325 45.9 63 83 37 5 91 8 96 708

13

3.2.6 Child Feeding during Diarrhea The large proportion (56.68%) of mothers’ provided less or same feeding amount for their

children during diarrhea against the recommendation of more feeding. Only 14.5 of the

mothers reported more feeding was given to the children during diarrhea.

Table 11: Child feeding practice during illness Nothing was

given less than

usual same as

usual More than

usual Never had diarrhoea

Kurram Camp 0 0 43.2 0 56.8 229

Bajour 20.9 12.4 37.8 9.8 19.1 225

DI Khan 16.9 25.10 46.7 7.06 4.3 255

Hangu 5.5 19.9 48.9 18.75 7.0 272

Hangu Camp 3.3 27.5 47.5 20.9 0.8 244

Jalozai IDPs Camp 17.0 28.5 24.2 26.1 4.2 165

Khot 16.9 0.3 29.8 7.3 15.3 248

Kurram 17.9 19.7 44.4 3.0 15.0 234

Mohmand 1 32.0 32.0 26.4 7.2 2.4 250

Nowshera 14.5 13.7 56.0 12.4 3.4 234

Peshawar 25.5 28.4 28.0 5.0 13.1 282

Tank 8.6 5.8 16.3 45.4 23.8 361

Total 442 595 1105 435 422 2999

3.3 Child Nutrition, immunization and Morbidity status 3.3.1 Sex pyramid of the children

The Bajour sex male to female ratio reveled there was biases in selection of the children.

Figure 10: Sex pyramid by district

47.3

74.3

45.9

50.8

50.8

48.0

50.5

52.9

53.7

52.3

51.2

48.2

52.2

52.7

25.7

54.1

49.2

49.2

52.0

49.5

47.1

46.3

47.7

48.8

51.8

47.8

0.0 20.0 40.0 60.0 80.0 100.0 120.0

KURRAM CAMP

BAJOUR

DI KHAN

HANGU

HANGU CAMP

JALOZAI IDPS CAMP

KHOT

KURRAM

MOHMAND 1

NOWSHERA

PESHAWAR

TANK

Children sex

Male Female

14

3.3.2 Nutritional service

Quite number of children 382 were severely and moderately malnourished however the

service provision wasn’t able to address these children.

Table 12: Beneficiaries by program and gap

In OTP program

In SFP treated by the program

malnourished not in program

Kurram Camp 0 0 83 39

Bajour 5 1 0 78

DI Khan 4 14 0 6

Hangu 6 7 5 20

Hangu Camp 4 32 4 4

JalozaiCamp 5 26 38 6

Khot 17 45 3 19

Kurram 13 23 5 51

Mohmand 1 3 5 0 31

Nowshera 7 7 2 7

Peshawar 19 36 13 13

Tank 46 53 1 108

129 249 154 382

3.3.3 Child morbidity

As the red part of the char highlights the percentage of sick children for past two weeks was very high. Except in Hangu district where the percentage of sick children was reported low at 20.8% as compared to the rest of the areas, almost half of the study children were sick two weeks prior to the assessment with the highest reported figure at 72.8% in Kohat district. Diarrhea is the first major cause of sickness followed by fever and cough respectively.

60.0 52.346.1 75.7

39.119.4 23.7

46.2 41.7 47.929.7

56.4 44.7

40.046.4 48.9

20.8

54.8

38.0

72.852.7 58.3

46.3 68.743.0 49.4

0.0

20.0

40.0

60.0

80.0

100.0

120.0

Child Morbidty

No Yes

15

Table 12 Type of illness Not

Sick fever Cough Diarrhea Skin

Infections Eye

infections Other

Kurram Camp 222 25 35 36 12 5 0

Bajour 202 65 46 53 7 6 2

DI Khan 175 69 21 77 4 2 13

Hangu 284 45 9 19 3 0 2

Hangu Camp 166 112 20 81 11 2 4

JalozaiCamp 75 41 17 75 8 2 4

Khot 89 113 38 98 10 2 11

Kurram 169 42 30 86 18 14 3

Mohmand 1 168 75 41 79 25 4 11

Nowshera 182 68 22 62 9 3 11

Peshawar 116 74 28 142 5 0 18

Tank 211 49 39 45 9 12 7

2059 778 346 853 121 52 86

3.3.4 Child Nutritional status results for MUAC

Table 13. The prevalence of Malnutrition using MUAC and analyzed using ENA software. Prevalence of global acute malnutrition: MUAC < 125 mm or edema

Prevalence of moderate acute malnutrition: MUAC < 125 and MUAC >= 115 mm

Prevalence of severe acute malnutrition : MUAC < 115 mm or edema

All (3422): (635) 18.6% (16.7-19.2 95% CI) Boys (1794): (311) 17.3% (15.2-18.6 95% CI) Girls (1628): (324) 19.9% (17.3-21.0 95% CI)

All (3422): (454) 13.3% (11.7-13.9 95% CI) Boys (1794): (228) 12.7% (10.9-13.9 95% CI) Girls (1628): (226) 13.9% (11.8-15.0 95% CI

All (3422): (181) 5.3% (4.4- 5.9 95% CI) Boys (1794): (83) 4.6% (3.6- 5.5 95% CI) Girls (1628): (98) 6.0% ( 4.8- 7.0 95% CI)

3.3.5 Measles vaccination coverage Measles vaccination was the lowest in Mohmand followed by DI Khan, Tank and Hangu. No % Yes with EPI

with card % Yes recall %

Kurram Camp 1 0.4 170 68.5 77 31.0 248

Bajour 37 14.5 333 130.1 0 0.0 256

DI Khan 177 73.8 109 45.4 32 13.3 240

Hangu 151 62.4 88 36.4 78 32.2 242

Hangu Camp 24 10.0 182 75.8 173 72.1 240

Jalozai Camp 9 3.6 108 43.0 97 38.6 251

Kohat 144 55.8 168 65.1 26 10.1 258

Kurram 65 28.8 181 80.1 41 18.1 226

Mohmand 1 225 88.6 129 50.8 44 17.3 254

Nowshera 98 38.7 235 92.9 5 2.0 253

Peshawar 104 41.4 212 84.5 24 9.6 251

Tank 143 64.4 83 37.4 39 17.6 222

1178 40.1 1998 67.9 636 21.6 2941

*167 of the children were found under nine months.

16

4. Conclusion and recommendation

The prevalence both Severe and moderate acute malnutrition is at critical level even though

MUAC is sensitive measurement and it is a proxy indicative deepening on the type of

population measured.Therefore, the nutrition cluster response need to consider the

following recommendations.

In addition to the high SAM prevalence in this assessment there has always been

high rate of MAM with low coverage of SFP interventions attributes to the high rate

of SAM beneficiaries. It is therefore necessary to have an SFP to run a long side the

already existing OTPs to avert the situation where children deteriorate to severe

malnutrition.

Close follow up of the nutrition situation and giving special attention to areas with

very high SAM and GAM rates and possibly increasing outreach sites to cater for the

IDPs household that travel from far areas for OTP services.

Up scaling the nutrition interventions in the most affected areas. Community

mobilization activities to be increased and continued creation of community

awareness of malnutrition since some cases seem to be reporting at a later stage

when the child is extremely malnourished and in some cases getting a child in the

community with MUAC less than 10cm. Furthermore, most households are food

insecure as reflected by overreliance on food aid and food purchase in the face of

high market food prices hence need for initiation of SFP to run alongside the

operational OTP.

There is need for continued and more intensive health and nutrition education

focusing on: importance appropriate IYCF feeding practices with special focus on the

value and duration of exclusive breastfeeding and the importance of timely

introduction of complementary feeding, dietary diversity and appropriate frequency

of feeding;

Promote income generation on households and community level to increase market

dynamics and service provision, and households’ purchasing power. Establish and

promote an active hunger safety net facilitated through cash or in kind, to support

vulnerable households during the cultivation period to prevent depletion of

productive assets or consumption of seed material;

Explore the possibility of shelter provision for the IDPs as the majority are living in

the rented household.

Promote immunization activities and prevention of communicable disease that

directly impact the nutritional status of children