Nutritional Anthropometric and Mortality Survey Final Report Mandera Central District North Eastern...

7/29/2019 Nutritional Anthropometric and Mortality Survey Final Report Mandera Central District North Eastern Province

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NUTRITIONAL ANTHROPOMETRIC AND MORTALITY SURVEY

FINAL REPORT

MANDERA CENTRAL DISTRICT

NORTH EASTERN PROVINCE, KENYA

APRIL-MAY 2012


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Acknowledgements

Special thanks are expressed to;

CIFF/ELMA and UNICEF financial support to Save the Children Nutrition program andfor funding this survey.

Provincial administration, ALRMP, Ministry of Agriculture, Ministry of Health and DistrictDevelopment Office through their respective district focal persons for the necessaryexpertise during the entire survey period.

Survey team (supervisors, team leaders, enumerators and drivers) for their tireless efforts toensure that the survey was conducted professionally and on time.

Community members who willingly participated in the survey and provided the informationneeded.


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TABLE OF CONTENTSAcknowledgements ...................................................................................................................................................... 2

TABLE OF CONTENTS ........................................................................................................................................... 3

List of abbreviations and acronyms ........................................................................................................................... 5

Executive summary ..................................................................................................................................................... 8

Area Covered ............................................................................................................................................................. 8

Specific Objectives .................................................................................................................................................... 8Methodology .............................................................................................................................................................. 9

Main survey results .................................................................................................................................................... 9

Results summary for water, hygiene and sanitation .................. .......... ........... ........... .......... ........... .......... ........... .... 10

Recommendations ................................................................................................................................................... 11

1. Introduction ....................................................................................................................................................... 12

1.1.1 Relief Programmes currently in the area: .......... ........... .......... ........... .......... ........... ........... .......... ........... .... 13

1.1.3. Humanitarian interventions in Mandera Central district ............................................................................ 15

1.2 Specific Objectives ............................................................................................................................................ 15

2. Methodology....................................................................................................................................................... 16

2.1. Parameters used in the determination of mortality and anthropometry data (21.9% U5 population) ............... 17

2.2. Sampling procedure: selecting households and children ........... .......... ........... ........... .......... ........... .......... ........ 18

2.3. Case definitions and inclusion criteria .............................................................................................................. 18

2.3.1. Childrens data ........................................................................................................................................... 18

2.3.2. Anthropometric data: ................................................................................................................................. 18

2.4. Programme coverage ........................................................................................................................................ 19

2.5. Infant and Young Child feeding (IYCF) ........................................................................................................... 19

2.6. Mortality data ................................................................................................................................................... 20

2.7. Causes of malnutrition data .............................................................................................................................. 20

2.8. Nutritional Status Cut-off Points .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ... 20

2.8.1. Weight-for-height (WFH) and MUAC Wasting for Children ................... ........... .......... ........... .......... ... 20

2.8.2. Weight-for-age (WFA) Underweight ........... .......... ........... .......... ........... .......... ........... .......... ........... ...... 21

2.8.3. Height-for-age (HFA) Stunting.......... ........... .......... ........... .......... ........... .......... ........... .......... ........... ...... 21

2.8.4. Mid upper arm circumference (MUAC) .................................................................................................... 21

2.8.5. Mortality .................................................................................................................................................... 22

2.9. Questionnaire, training and supervision .......... .......... ........... .......... ........... .......... ........... .......... ........... .......... ... 22

2.9.1. Questionnaire .......... ........... .......... ........... .......... ........... .......... ........... ........... .......... ........... .......... ........... .... 22

2.9.2. Survey teams and supervision .................................................................................................................... 222.9.3. Training ..................................................................................................................................................... 23

2.9.4. Data analysis .............................................................................................................................................. 23

3. Results................................................................................................................................................................. 24

3.1 Anthropometric results (based on WHO standards 2006): ........... .......... ........... .......... ........... .......... ........... ...... 24

3.2. Malnutrition by MUAC .................................................................................................................................... 27

3.3. Chronic Malnutrition ........................................................................................................................................ 28

3.3.1. Prevalenceof underweight.......................................................................................................................... 28

3.3.2. Prevalence of stunting ................................................................................................................................ 28

3.4. Mortality results ................................................................................................................................................ 29

3.5. Children's morbidity ......................................................................................................................................... 29

3.5.1. Health seeking behaviour........................................................................................................................... 30

3.6 Vaccination Results ........................................................................................................................................... 30

3.6.1: OPV 1&3 and BCG for 6-59 months and measles for 9-59 months .......... .......... ........... .......... ........... ...... 303.6.2: Micronutrient supplementation and deworming ........... .......... ........... .......... ........... .......... ........... .......... ... 31

3.7 Programme coverage ......................................................................................................................................... 31

4. Discussion ............................................................................................................................................................... 32

4.1 Nutritional status ................................................................................................................................................ 32

4.1.1. Under five nutrition status ......................................................................................................................... 32

4.1.2. Caretakers nutrition status ........................................................................................................................ 33

4.2 Mortality ............................................................................................................................................................ 34

4.3 Causes of malnutrition ....................................................................................................................................... 35

4.3.1. Health status: ................................................................................................................................................. 35


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4.3.2. Infant and Young Child Feeding (IYCF) ................................................................................................... 35

4.4. Water Sanitation and hygiene ........................................................................................................................... 38

4.4.1. Main water source...................................................................................................................................... 38

4.4.2. Water treatment ......................................................................................................................................... 39

4.4.3. Handwashing practices .............................................................................................................................. 39

4.4.4. Access to toilet facilities ............................................................................................................................ 40

5. Conclusions ............................................................................................................................................................ 40

6. Recommendations and priorities.......................................................................................................................... 41

6.1. Immediate ......................................................................................................................................................... 41

6.2. Medium term .................................................................................................................................................... 41

6.3. Long term ......................................................................................................................................................... 41

7. References .............................................................................................................................................................. 42

8.1. Appendix 1 ....................................................................................................................................................... 42

8.2. Appendix 2 ....................................................................................................................................................... 42

8.3. Appendix 3 ....................................................................................................................................................... 43

8.4. Appendix 4 ....................................................................................................................................................... 43

8.6. Appendix 5 ....................................................................................................................................................... 47

LIST OF TABLES

Table 1: Results Summary ............................................................................................................................................. 9

Table 2: Main Results WASH ..................................................................................................................................... 10

Table 3: Seasonal timeline ........................................................................................................................................... 14

Table 4: Sample size calculation .................................................................................................................................... 17Table 5 : population sex pyramid .......... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ... 25

Table 6: Prevalence of malnutrition based on WHO 2006 standards .......... .......... ........... ........... .......... ........... .......... . 26

Table 7: Health seeking behaviour .............................................................................................................................. 30

Table 8: Vaccination coverage: OPV 1&3 and BCG for 6-59 months and measles for 9-59 months .......... ........... .... 30Table 9: Survey trends ................................................................................................................................................. 32

Table 10: Caretakers Nutrition Status .......................................................................................................................... 33Table 11: Proportion of children 0-23 months put to the breast within 1 hour of birth ......... ........... .......... ........... ...... 35

Table 12: proportion of children exclusively breastfed .......... .......... ........... .......... ........... ........... .......... ........... .......... . 36

Table 13: Minimum dietary diversity (n=285) ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ... 36

Table 14: Minimum meal times for breastfed children 6-8 months (n=20) .......... .......... ........... .......... ........... .......... ... 37

Table 15: Minimum meal times for breastfed children 9-23 months (n=133) ........... ........... .......... ........... .......... ........ 37

Table 16: Minimum meal times for Non breastfed children 6-23 months (n=130) .......... ........... .......... ........... .......... . 38

Table 17: Main current water sources ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... ...... 38

Table 18: Treatment given to drinking water ........... .......... ........... .......... ........... .......... ........... ........... .......... ........... .... 39

Table 19: When hands were washed........... .......... ........... .......... ........... .......... ........... ........... .......... ........... .......... ........ 39

Table 20: what was used to clean hands .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ... 40

LIST OF FIGURES

No table of figures entries found.


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List of abbreviations and acronymsALRMP II - Arid Lands Resource Management Project II

AMREF - African Medical Research Foundation

APHIA -Aids Population Health Integrated Assistance Project

ASAL - Arid and Semi-Arid Lands

CDR - Crude Death Rate

COCOP - Consortium of cooperating partners

CI - Confidence Interval

CMR - Crude Mortality Rate

CSB - Corn Soya Blend

ENA - Emergency Nutrition Assessment


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EPI - Extended Programme of Immunization

GAM - Global Acute Malnutrition

GFD - General Food Distribution

HAZ - Height-for-Age Z-score

HINI - High Impact Nutrition Interventions

HSNP - Hunger Safety Net Project

KFSSG - Kenya Food Security Steering Group

L/HAZ - Length/ Height for Age Z-score

MOH - Ministry of Health

MUAC - Mid-Upper Arm Circumference

NEP - North Eastern Province

OPV - Oral Polio Vaccine

OTP - Out-patient Therapeutic Program

SAM - Severe Acute Malnutrition

SC - Stabilization Centre

SD - Standard Deviation

SFP - Supplementary Feeding Programme

SMART Standardized Monitoring and Assessment of Relief and Transitions

U5MR - Under Five-Mortality Rate

UNICEF - United Nations Childrens Fund

CIFF - Children investment Funds Foundation/

URTI - Upper Respiratory Tract Infection

WAZ - Weight-for-Age Z-score

WFP - World Food Programme

WHM - Weight for Height Median

WHO - World Health Organization

WHZ - Weight-for-Height/length Z-scores


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Executive summaryMandera Central is one of the districts that form the North Eastern Province (NEP) and is one of

the 19 districts gazetted as part of the Arid and Semi-Arid Lands of Kenya (ASAL). The district is

located in the North West horn of Kenya bordered by Mandera East District and Somalia to the

east, Mandera West District and Wajir North District to the west, Wajir District to the south and

Ethiopia to the north. The town of El Wak is the District headquarter, which administrativelyconsists of 5 divisions including El Wak, Shimbir Fatuma, Wargadud, Qalanqalesa and Kotulo.

The main livelihood activity in the district is pastoralism and being predominantly arid, the district

experiences chronic food insecurity and high incidences of malnutrition. Predictable rainy and dry

seasons can no longer be counted upon to provide adequate dry season grazing and water for

pastoral populations, whose resilience is increasingly eroded by broader economic factors in the

region. Food aid continues to be a key source of food for a majority of the population. The district

is predominantly inhabited by one clan Garre with 2 major sub clans namely

Save the Children UK (SCUK) operates in all the 5 divisions. Within the four divisions there are a

total of 7 GOK health facilities including El Wak district hospital. The projected population for the

survey area is 64,9161. The District is geographically isolated from the rest of the country with it

being characterized with poor infrastructure and thus poor access to services. The area is prone to

extreme climatic conditions characterized by successive droughts and floods leading to chronic food

insecurity. This has rendered the population reliant on food aid.

The securityin the district is volatile since the incursionof the Kenyan Army into Somalia

AreaCovered

Save the children in conjunction with the MOPHS and MOMS have been carrying out IMAM

activities in the 5 divisions of Mandera Central namely Elwak, Shimbir Fatuma, Qalanqalesa, Kotuloand Wargadud since August 2007. Nutrition surveys have been conducted in the area on the same

month (March) since 2006 in order to evaluate impact and as well serve as a surveillance system.

This survey was conducted from 26th of April to 7th May 2012.

Specific Objectives

The survey aimed at estimating the;

The prevalence of acute and chronic malnutrition in children aged 6-59 months; The nutrition status pregnant women and mothers with children


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Infant and Young Child feeding practices (children between 0-23 months). The Coverage rate of Vitamin A. supplementation and de worming; The Morbidity rates of children 6-59 months 2 weeks prior to the survey; To recommend appropriate interventions based on the survey findings;

Methodology

Two different sampling methodologies were applied. Emergency Nutrition Assessment (ENA) for

Standardized Monitoring of Relief and Transition (SMART) was used to calculate Anthropometry

and mortality samples while IYCF multi survey sampling calculator was used to calculate for IYCF

sample. Probability of Proportion to Population Size (PPS) was used to identify clusters within a

study area after collecting population data from all villages/ sub location that were considered as

clusters.

The target population for the anthropometric survey was children aged 6-59 months while that for

IYCF was children 0-24 months. The total sample size of households was arrived at by collating

both the Anthropometry, IYCF and Mortality samples. The final sample size was 574 households

from 34 clusters.

Data was collected on anthropometry, morbidity, vaccination and de-worming status, Vitamin A

supplementation, hygiene and sanitation practices, IYCF, food security and livelihoods. This data

was triangulated with feeding programme data to help in the interpretation of results.

Retrospective information on mortality was collected using the current household census method,

with a recall period of 94 days, from all households visited including those without children under

the age of five. A total of 578 households were visited and 1071 children from 6 to 59 months were

assessed for anthropometry and other indicators. The final analysis was on 1068 children afterexclusion of 3 records.

Anthropometric and mortality data were analyzed using the ENA software beta version May 2011.

IYCF data was analysis on Excel and Qualitative and quantitative data was analyzed using the

EPIINFO software.

Main survey resultsTable 1: Results Summary

Characteristic N n % ( 95%CI)

GAM (WFH


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Proportion of caretakers seeking medical care whenchild is ill

398 382 94.8%

BCG Scar

Measles immunization (card and confirmation) 1043 990 96%

OPV1 immunization (card and confirmation) 1071 1023 97%

OPV3 immunization (card and confirmation) 1071 1013 94%

Vitamin A supplementation coverage (>12 month) -1time

988 464 47%

Vitamin A supplementation coverage (>12 month) -2times

988 374 38%

Vitamin A supplementation coverage (6-11 months)- 1time

83 68 82%

Proportion of children >1 year de-wormed 1 time 752 289 38%

Proportion of children >1 year de-wormed 2 time2 752 284 37%%

Iron-folate Supplementation for pregnant mothers 155 72 46.5%

Appropriate hand-washing with soap/ash 47.5%

Proportion of children 6-59 months supplemented withZinc the last time they had diarrhoea

93 1 1.2%

IYCF Key Indicator - Timely Breast-feeding Initiation 332 286 86.1%

IYCF Key Indicator - Exclusive Breastfeeding 47 24 51%

IYCF Key Indicator - Minimum Dietary Diversity>3foods BF

155 84 54%

IYCF Key Indicator - Minimum Dietary Diversity >4foods NBF

133 47 34%

IYCF Key Indicator meal frequency 6-8 months 2times 20 14 70%

IYCF Key Indicator meal frequency 9-93 months 3times

133 92 69%

IYCF Key Indicator meal frequency 6-93 months 3times

130 60 60%

Crude mortality rate (deaths/10000/day) 0.18(0.07-0.43)

Under-five mortality rate (deaths/10000/day) 0.22(0.05-0.87)

Results summary for water, hygiene and sanitationTable 2: Main Results WASH

Sources of WaterBorehole 33.9%Unprotected well 29.1%Dam 18.3%Protected well 7.3%


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Water tap 6.3%Water tracking 4.9%WATER TREATMENTNothing 94.3%Use of chemicals 6.6%

Boiling 1.9%ACCESS TO A TOILET FACILITYYes 48.5%IF NO TOILET WHAT WAS USEDBush 78%HANDWASHING PRACTICESBefore eating food 83.2%After visiting toilet 75%After cleaning childrens bottoms 64.5%Before preparing food 66%

The prevalence of acute malnutrition in Mandera Central district is still critical with global acutemalnutrition (GAM) of 17.9% (14.9-21.4 95% C.I.) and Severe Acute Malnutrition (SAM) rate of3.4.% (2.1-5.3 95% C.I.). Compared with the survey undertaken in March of 2011 however whichindicated GAM of 27.5% (23.2-32.2.0 95% CI) and SAM of 3.4% (2.3-4.9), there is a reduction inthe level of GAM which is statistically significant(P=0.001) while there was no much change inSAM. The levels of Immunization (OPV1&3, Measles, BCG) were also within the recommendednational levels of above 80% both by card and recall. Some other HINI indicators like use of Zinc inthe management of diarrhoe, deworming and Vitamin A supplementation for the 12-59 Monthswere however not up to scale.This was also the case as regards to Hygiene and Sanitation pracices.An analysis of IYCF indicators showed that the IYCF practices are poor with high percentage ofchildren not receiving optimal infant feeding practices (with the exception of timely initiation ofbreastfeeding reported at above 80%).

Recommendations

Immediate

Continue supporting to the MOH with OJT, HINI ,supportive supervision and logisticalsupport.

Promotion of IYCF activities geared towards optimal complementary feeding and dietarydiversity e.g. kitchen gardening and cooking demostration.

Incooporating DRR in normal programming through activities like provision of health,nutrition and hygiene promotion activities to school health clubs.

Scale up of the HINI package with special focus on Zinc supplementation. As a startsensitization of health workers and supply chain management of the Zinc tablets should beadressed.

Medium term

MOH to develop a health workers retention strategy to reduce the high staffs turn over. Through SCUK WASH programmestrengthen Hygiene promotion hygiene practices to


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reduce the incidence of diarrhoeal disease including health and nutrition promotiontoeducate the community on basic WASH i.e. domestic treatment of drinking water andproper disposal of faecal waste.

Long term

Through SCUK WASH programme, Provide toilet facilities through communityparticipatory approaches coupled with awareness campaign on the importance of using suchfacilities i.e. Community Led Total Sanitation (CLTS) and Participatory Hygiene andSanitation Transformation (PHAST) approaches. This can be piloted in one division (to beagreed among all stakeholders) and depending on how it works it can be scaled up to theothers.

Need for defined linkage of nutrition sector cluster with other sectors such as WaterSanitation and Hygiene (WASH) in the longer term.

Advocacy for recruitment and retention of health workers i.e. nurses , Clinical Officers (Cos)and nutritionists in North Eastern province

Government of Kenya (GOK) to strengthen community health strategy in the ASALS tofoster empowerment of CHWs to participate in health and nutrition promotion andmanagement of minor childhood ailments.

1. Introduction

Mandera Central is one of the districts that form the North Eastern Province (NEP) and is one of

the 19 districts gazetted as part of the Arid and Semi-Arid Lands of Kenya (ASAL). The district is

located in the North West horn of Kenya bordered by Mandera East District and Somalia to theeast, Mandera West District and Wajir North District to the west, Wajir District to the south and

Ethiopia to the north. The town of El Wak is the District headquarter, which administratively

consists of 5 divisions including El Wak, Qalanqalesa, Shimbir Fatuma, Wargadud and Kotulo.

The district experiences chronic food insecurity and high incidences of malnutrition. Predictable

rainy and dry seasons can no longer be counted upon to provide adequate dry season grazing and

water for pastoral populations, whose resilience is increasingly eroded by broader economic factors

in the region. Food aid continues to be a key source of food for a majority of the population

The estimated population for the district is 63,025

2

with the people being sparsely populated.Residents are mainly from the Somali community speaking the Garre language. The main livelihood

activity in the district is pastoralism with a number of Peri-urban destitutes (PUDs) who have

dropped out of pastoralism due to loss of livestock to shocks and settled near urban centers.

2Figures obtained from the District Development Office- Mandera Central.


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The district has one main road connecting the District to other districts in the province (Wajir East

and Mandera East) and other minor roads to the divisions and to Mandera West. The roads are

however in bad condition rendering them impassible especially during the rainy season.

Save the Children UK (SCUK) operates in all the 5 divisions. Within the divisions, there are a total

of 7 GOK health facilities including El Wak district hospital. Worth to note however is that, out ofthe seven health facilities, currently 2 are not fully operational due to transfer of the skilled staff with

only CHWs left to provided minimal services.

In the course of its work, Save the children is supporting the MOMs and MOPHS in implementing

Health and Nutrition, and has also a Food security and Livelihood support projects to vulnerable

HHs in Mandera and Wajir Districts through DFID funded HSNP project. Under the health and

nutrition project there is a components of WASH mainly targeted at the health facilities by

rehabilitation of water and sanitation facilities. The projects utilize integrated approaches to address

immediate and underlying causes of malnutrition.

1.1.1 Relief Programmes currently in the area:

Kenya Red Cross: Emergency relief

SCUK: IMAM, HSNP, Health Outreach, WATSAN

COCOP/WFP : Food Aid

ADRA: Primary Health Care

AMREF: MCH/HIV/AIDS

Northern Aid: WATSAN, HIV/AIDS

Office of the President: Food Aid

DANIDA: Nomadic Clinic


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Table 3: Seasonal timeline

Short Dry Spell

(Jilaal)

Long Rainy

Reason

(Gu)

Long Dry Spell

(Hagai)

Short Rainy

Season

(Deyr)

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

Migration, Conflicts,

Watering of Livestock,

Pasture Surveys,

mating season,

Livestock diseases, Calving,

Kidding

Migration,


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Pressure on boreholes Planting Labour Demand Period Conflict

1.1.3. Humanitarian interventions in Mandera Central district

Save the Children has been implementing programmes in Mandera Central district since 2007. Ourcurrent integrated approach; Nutrition, Health, Food security and Livelihoods Support programmes,

aim to address the underlying causes of malnutrition through strengthening health systems,

treatment for acute malnutrition and enhancement of house hold food security and livelihoods in

the medium term while at the same time linking these to long term livelihood strategies.

The World Food Programme (WFP) through Arid Lands Development Focus (ALDEF) has been

carrying out general food distribution (GFD) in this area. The GFD food basket provides a 75%

ration scale of 2,100Kcal/person, the daily per capita energy requirement3.

The Ministry of special programmes through the District Commissioners office occasionallysupplies food to the region and this is usually divided equally among the divisions. School feeding

programme is also available in all government schools which is run by WFP.

Other actors on the ground include:

ADRA providing health services, Kenya Red Cross society undertaking emergency relief

operations and AMREF who havebeen supporting the MoH in combating HIV /AIDS and in

matters related to reproductive health.

1.2 Specific Objectives

The survey aimed at estimating the;

The prevalence of acute and chronic malnutrition in children aged 6-59 months; The nutrition status pregnant women and mothers with children


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2. Methodology

Two different sampling methodologies were applied; Emergency Nutrition Assessment (ENA) for

Standardized Monitoring of Relief and Transition (SMART) was used to calculate Anthropometry

and mortality samples while IYCF multi survey sampling calculator was used to calculate for IYCF

sample. A 2 stage cluster sampling method with Probability of Proportion to Population Size (PPS)

was used to identify clusters within a study area after collecting population data from all villages that

were to be considered as clusters.

The required sample size was calculated on the nutritional status for children 6-59 months and onthe Crude Mortality Rate (CMR) for the household sample. Sample size for infants and young

children (0-5 months) was calculated separately using IYCF sampling calculator calculating sample

size for each of the IYCF indicators. The sample size for the survey was calculated and adjusted for

absentees and refusals using previous results of surveys conducted in the district.


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Sample size for anthropometry was calculated using the ENA for SMART methodology which gave

667 children. IYCF sample size was calculated using multiple survey sample size calculation

considering current rates of the most critical IYCF indicators to be considered (Timely initiation of

breast feeding, Exclusive breast feeding, continued breast feeding, minimum dietary diversity and

minimum meal frequency). Assumptions of 10% improvement rate were made since indicators did

not have target rate for improvements (arrived at following discussions with consultants who haveresearched on IYCF over time and through a blog on ENN). Hence, the highest from IYCF sample

size (Exclusive breast feeding) was considered which 782 are4. It was then assumed that 80% of

these children will however be captured in the overall anthropometry sample. Thus, 20% (156) of

the 782 was added to the anthropometry sample to account remaining age group making the total

sample of children 823. In order to calculate the number of households to visit in the duration of

the survey, total number of children was divided by 1.3 (number of children/household) based on

previous surveys giving rise to 633 HH.

2.1. Parameters used in the determination of mortality and anthropometry

data (21.9% U5 population)1). the estimated prevalence of malnutrition is 27.5 %5)

2) The design effect is 2 and the standard margin of error is 5% (95% CI).

3) The number of children less than 5 years per household is estimated at 1.3 6

4) The average number of persons per household is 7 and 1 mother per household.

Sample size for mortality is calculated based March 2011, survey showing death rate of

0.637/10,000/day, a desired precision of 0.4, design effect 2 non-response rate of 3% and 90 days

recall period. This was keyed in to ENA for SMART with family size of 7 and gave a sample of 3659and 539 households.

To calculate number of clusters to visit, the total sample for anthropometry and IYCF was used.

Number of households (633) was divided by number of HH to be reached per day (17) gives 37

clusters.

The table below summarizes the sample size calculation.

Table 4: Sample size calculation

Sample of

IYCF

Sample of

Anthropometry

Total

sampleofchildren

# of HH to

visit

# of HH

formortality

Final Sample

sizeconsidered

# of

children percluster

# of clusters

4Rates of IYCF indictors for the district were based on Save the Children KPC survey Sept 2011.

5malnutrition rates (2011 nutrition survey)

6From the March 2011 Mandera Central nutrition survey

7CMR rates March 2011 nutrition survey


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156 667 823 633 539 633 17 37

2.2. Sampling procedure: selecting households and childrenThe second stage sampling stage comprised of the household selection. Only the randomly sampled

villages were assessed during data collection. In the selected village, the Expanded Programme on

Immunization (EPI) method was applied in order to determine the starting point. At the center of

the village, a pen was spun to determine the starting direction. The team then moved to the

periphery along the pointed direction. At the end of the village, the pen was re-spun and a direction

obtained. Just like the first stage, the survey team moved along the pointed direction but this time

counting all households in that direction to the edge. A table of random numbers was used to

determine the first household. Mortality and anthropometric questionnaires were administered

accordingly and subsequent households determined by going to the next house to the right. In

villages with more than one cluster, the village was subdivided and the center of each subdivisiondetermined and households selected as described above. In a cluster that was sparsely populated, all

the households in the cluster were visited.

A household was defined as a group of people who lived together and shared a common cooking

pot. In polygamous families with several structures within the same compound but with different

wives having their own cooking pots, the structures were considered as separate households and

assessed separately. All children aged 6-59 in every household visited were included in the

anthropometric survey and 0-24 month category included in IYCF survey. In cases where there wasno eligible child, a household was still considered part of the sample and its mortality data were

collected. If a respondent was absent during the time of household visit, the teams left a message

and re-visited later to collect data for the missing person, with no substitution of households

allowed. The teams visited the nearest adjacent village (not among those sampled) to make up for

the required number of households if the selected village yielded a number below 22 children and 17

households, following the SMART methodology8.

2.3. Case definitions and inclusion criteria

2.3.1. Childrens data

2.3.2. Anthropometric data:

Age: the age of the child was recorded based on a combination child health cards, themothers/caretakers knowledge of the birth date and use of a calendar of events for the districtdeveloped in collaboration with the survey team.

Sex:it was recorded whether a child was male or female.

8SMART (2006): Measuring Mortality, Nutritional Status and Food Security in Crises Situations: SMART METHODOLOGY


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Bilateral oedema:normal thumb pressure was applied on the top part of both feet for 3 seconds.If pitting occurred on both feet upon release of the fingers, nutritional oedema was indicated.

Weight:the weights of children were taken with minimal or light clothing on, using UNICEF SalterScales with a threshold of 25kgs and recorded to the nearest 0.1kg.

Length/height: children were measured bareheaded and barefooted using wooden UNICEF

height boards with a precision of 0.1cm. Children under the age of two years were measured whilelying down (length) and those over two years while standing upright (height). If child age could notbe accurately determined, proxy heights were used to determine cases where height would be takenin a supine position (


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Children whose WFH indices were


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2.8.5. Mortality

The crude death rate is defined as the number of people in the total population who died between

the star of the recall period and the time of the survey. It is calculated using the following:

Crude mortality Rate (CMR) = 10,000/a*f/ (b_+f/2+d/2-c/2), where

a =number of recall days

b =number of current households residents

c =number of people who joined the HH

d =number of people who left the HH

e =number of births during recall

f =number of deaths during recall period.

The result is expressed per 10,000 people per day.Table 5: Mortality Thresholds

Total population CMR Under-five population U5MR

Alert level: 1/10,000 people/day 2/10,000 children/day

Emergency level: 2/10,000 people/day 4/10,000 children/day

2.9. Questionnaire, training and supervision

2.9.1. Questionnaire

The standard nutrition survey questionnaire as recommended in the nutrition guidelines was adapted

to include additional information on the high Impact nutrition interventions. The IYCFquestionnaire as recommended in the CARE IYCF step by step guide was used to collectinformation on IYCF.The questionnaire was developed in English and the enumerators trained on the questionnaire.During the training session, the enumerators translated the questionnaires as they would ask duringdata collection and an agreed way of asking the questions during data collection was agreed upon.The questionnaires were not translated into Somali language however; all interviews were conductedin Somali language. The questionnaire was pre-tested a day before the actual survey began and thefinal questionnaire used is annexed in the report.

2.9.2. Survey teams and supervision

The survey was executed by 5 teams each comprising of 1 team leader and 2 anthropometricmeasurers. Four of the team leaders were from Ministry of Health (MOMS/MOPHS),one from

Arid Lands Resource Management Project (ALRMP) and one from the District development Office.

The survey was led and supervised by trained staff from Save the Children UK. The anthropometric

measurers were recruited from the district and spoke the local language as well as English. The

measurers were required to be literate and at least have completed high school to participate in the

study. The team leaders were practitioners either in health, food security and nutrition and were


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sourced from the government and Save the Children. The survey was supervised by the nutrition

technical specialist from save the Children UK.

2.9.3. Training

Training for the survey teams was undertaken by Save the Children staff (the nutrition technical

specialist). The training was undertaken for 3 days and covered an introduction to nutrition andnutrition assessments, the survey objectives, anthropometric measurements, household selection

procedures, data collection and interviewing skills and the survey questionnaire. The anthropometric

standardization exercise, as recommended by the SMART methodology was undertaken with 10

children, each measurer taking measurements on each child twice. Each enumerator was closely

observed and guided by supervisors and manually given a score of competence based on performing

measurements with accuracy and precision.

After the class room training, practical field experience was conducted to pre-test the questionnaire,

take anthropometric measurements of children and caretakers, conduct interviews and fill

questionnaires; pre-testing exercise was performed on 12 households. The pre-testing exercisefacilitated some changes on the structure of the questionnaire. In addition, a team of data clerks who

were trained on the operation of ENA for SMART for the data entry and these were closely

supervised by the M&E officer from Save the Children.

2.9.4. Data analysis

Anthropometric and mortality data entry and processing was done using the ENA for SMARTsoftware Beta version May 2011 where the World Health Organization Growth Standards (WHO-GS) data cleaning and flagging procedures were used to identify outliers which enabled data cleaningas well as exclusion of discordant measurements from anthropometric analysis. The SMART/ENAsoftware generated weight-for-height, height-for-age and weight-for-age Z scores to classify them

into various nutritional status categories using WHO9

standards and cut-off points. IYCF data wasanalysed in Excel using guidance from the Infant and Young Child Feeding Practices collecting andusing data: a step- by- step guide. All the other quantitative data were entered and analysed in theEPIINFO 3.5.3 version.

9WHO 2006


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3. ResultsTable 6: Demography

Number of children 6-59 months surveyed 1071

Number of children 6-59 months analyzed 1068

Number of anthropometry data excluded using

Plausibility Check

3

Household Census:

Number of total population surveyed for mortality 3743

Number of children under five surveyed for

mortality

1071

Number of HH covered in the mortality survey 711

Number of persons who joined the household

during the recall period

63

Number of persons who left the household during

the recall period

29

Number of under five children who joined the

household during the recall period

7

Number of under five children who left the

household during the recall period

4

Number of births during the recall period 40 40

DEMOGRAPHY

Number of persons per HH 3743/600 6.23

Number of children per HH 1071/600 1.79

% of children under five in the population 28%

3.1 Anthropometric results (based on WHO standards 2006):


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Definitions of acute malnutrition should be given (for example, global acute malnutrition is definedas


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malnutrition (=-3 z-score, no oedema)

(12.0 - 17.395% C.I.)

(12.9 - 19.595% C.I.)

(9.7 - 16.795% C.I.)

Prevalence of severe malnutrition(


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3.2. Malnutrition by MUAC

Malnutrition rates by MUAC were reported atGAM of 10.1% with a SAM 1.7%Table 3.5: Prevalence of acute malnutrition based on MUAC cut offs(and/or oedema) and by sex

Table 11: prevalence of Malnutrition rates by MUAC

All n = 1071 Boys n = 548 Girls n = 523Prevalence of global malnutrition(< 125 mm and/or oedema)

(108) 10.1 %(7.7 - 13.1

95% C.I.)

(54) 9.9 %(7.1 - 13.6

95% C.I.)

(54) 10.3 %(7.6 - 13.9

95% C.I.)Prevalence of moderatemalnutrition (< 125 mm and >=115 mm, no oedema)

(90) 8.4 %(6.4 - 10.995% C.I.)

(45) 8.2 %(5.9 - 11.395% C.I.)

(45) 8.6 %(6.3 - 11.795% C.I.)

Prevalence of severe malnutrition(< 115 mm and/or oedema)

(18) 1.7 %(1.0 - 2.7 95%C.I.)

(9) 1.6 % (0.8- 3.2 95%C.I.)

(9) 1.7 % (0.8- 3.6 95%C.I.)

Table 12: Prevalence of acute malnutrition by age, based on MUAC cut offs and/or oedema

Severe wasting(< 115 mm)

Moderatewasting (>=115 mm and =125 mm )

Oedema

Age(mo)

Totalno.

No. % No. % No. % No. %

6-17 205 12 5.9 38 18.5 155 75.6 1 0.518-29 264 3 1.1 32 12.1 229 86.7 0 0.0


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30-41 256 2 0.8 12 4.7 242 94.5 0 0.042-53 236 0 0.0 8 3.4 228 96.6 0 0.054-59 110 0 0.0 1 0.9 109 99.1 0 0.0Total 1071 17 1.6 91 8.5 963 89.9 1 0.1

3.3. Chronic Malnutrition

3.3.1. Prevalenceof underweight

Table 13: Prevalence of underweight based on weight-for-age z-scores by sex

All n = 1070 Boys n = 547 Girls n = 523Prevalence of underweight (


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Prevalence of severe stunting (


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6-59months

Prevalence of reported illness 38.6%

Table 20: Symptom breakdown in the children in the two weeks prior to interview (n=398)

6-59 months

Diarrhoea 23.4%Cough 37.2%Fever 20.9%Vomiting 19.1%Other 23.4%

*it was possible for a child to report more than one illness

Acute respiratory tract infections was the most common disease reported at 37% diarrhoea, feverand vomiting came in close succession at 23.4%, 20.9% and 19.1% respectively. Of those who

reported to have been sick 83.7% reported to have sought help in the health facilities as shown inthe figure below;

3.5.1. Health seeking behaviour

Table7: Health seeking behaviour

3.6 Vaccination Results

3.6.1: OPV 1&3 and BCG for 6-59 months and measles for 9-59 months

Vaccination was reported at above the recommended EPI >80% for all the antigens as shown in inthe figure below. The same was seen in the case for BCG which was reported at 94%

Table8: Vaccination coverage: OPV 1&3 and BCG for 6-59 months and measles for 9-59 months

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Health

facility

Outreach

sites

Herbalists Other

83.7%

11.1%1.3% 1.0%

Percentage

where Assistance Was sought

Health Seeking Behaviour

Percent


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3.6.2: Micronutrient supplementation and deworming

Table 21: Micronutrients and deworming coverage

Factor Mandera Central

Vitamin Asupplementation (6-11months)

1 time 82% (68)

Vitamin Asupplementation(12months)

1 time 47% (464)

2 times 38% (374)

De-worming Childrenaged > 12 months 1 time 38% (289)

2 times 37%(284)

Iron/folatesupplementation

Pregnant women 46.5%(72)

Zinc In Diarrhoea management 1.1%(1)

From the table above, Vitamin A supplementation for the ages above 11months (Post immunizationage) were suboptimal reported at 2 times 38% this was the same for Deworming and especially so inthe Zinc supplementation in the management of diarrhoea which was only reported at 1%

3.7 Programme coverage

This information was not collected but a SQUEAC survey is scheduled for the month of Augustwhich will be used to provide information on coverage.

0% 20% 40% 60% 80% 100%

2011

2012

2011

2012

2011

2012

OPV1

OPV3

M

easles

46%

67%

48%

65%46%

67%

51%

29%

49%

29%51%

31%

3.1%

1%

2%

2%3%

1%

PERCENTAGE

FACTOR

OPV 1, 3 AND MEASLES COVERAGE

By Card

By Recall

No


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4. Discussion

4.1 Nutritional status

4.1.1. Under five nutrition status

The prevalence of Global Acute Malnutrition for Mandera Central is 17.9 % (14.9 - 21.4 95% C.I.)and Severe Acute Malnutrition at 3.5 % (2.2 - 5.4 95% C.I.).These rates indicate an improvement inthe nutrition status compared with the rates reported in a survey conducted in the district in March

2011 which showed a GAM of 27.5% (23.2-32.2 95% C.I). Further analysis with the CDC calculatorindicates an improvement in the nutrition status that is statistically significant (p=0.001). Possiblereasons for this could be better food security situation in the district following better amounts ofshort rains received in the district in October-December 2011 and as well quite a number ofmeasures that had been put in place in the district following the emergency that had affected thedistrict between April and October 2011. This included the BSFP programme, increase ofoutreaches from 15 to 25, other players providing foods like Kenya Red-cross and ADRA at theheight of the drought among others.

Table9: Survey trends


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Comparing the GAM rates by WFH with those by MUAC there seems to be a reverse trend whereas one increases the other seems to be decreasing (2010 to 2012)

4.1.2. Caretakers nutrition status

Table10: Caretakers Nutrition Status

25.1

30.9

26.327.5

17.9

0

5

10

15

20

25

30

35

2008 2009 2010 2011 2012

PERCENT

YEAR

GAM and SAM trends for MC

WHO GAM

WHO SAM

MUAC GAM

Threshold GAM


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Most of the caretakers were either pregnant or lactating(79%) of the pregnant and lactating motherstheir MUAC data was as follows;Table 22: Caretakers MUAC

CATEGORY MUAC 21

All women(15-49 years) 95(14.3%) 5969(85.7%)

PLW 28(6.4%) 419(93.6%)

4.2 Mortality

The Crude mortality rate (CMR) for this survey was 0.41 (0.22- 0.77 95% CI) and the Under 5

mortality rate (U5MR) was 0.67 (0.29-1.53 95% CI). From the results, the CMR and the under 5

Mortality rates were within the normal rates. Compared to last year the differences in the mortality

rates were not statistically significant. It is worth noting however that discussions related to death inthe district are taboo/ related.

0.0%

5.0%

10.0%

15.0%

20.0%

25.0%

Currently

pregnant

B/feeding

< 6 mts

infant

B/feeding

6 24

months

Pgnt and

b/feeding

Not Pgnt

Nt

b/feeding

B/feeding

> 24

months

13.3%

6.3%

21.2%

1.6%

21.5%

0.1%

Percentage

Physiological Status

Women physiological Status

Percent


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4.3 Causes of malnutrition

The nutrition survey was undertaken during after the long rains at the end of the Month of Apriland the beginning of May. The rainfall recording in the district was ******. Malnutrition in amongstchildren in Mandera Central was affected by the following factors:

4.3.1. Health status:

4.3.1.1. Morbidity:

Morbidity rates were high with 39% of the respondents reporting to having been sick two weeksprior to the survey. The main causes of morbidity reported were; acute respiratory tract infections(37%), followed by diarrhoea (23%), fever with chills like Malaria (20.9) and Vomiting reported at19%. The disease patterns in the community were said to be typical for the season.

4.3.1.2. Vaccination, Micronutrient supplementation and De-worming coverage

The immunization coverage for BCG (95.6%), Measles (98%) and Pentavalent/OPV 3 (94%) bothby card and by recall were good and above the MOH target of 80%. These 4 vaccines are used in thesurvey as proxy for the immunization coverage at population level. The Malezi bora campaigns and

the integrated outreaches supported by Save the Children have helped improve the immunizationcoverage. These strategies should continue to be supported to keep the coverage high and shouldalso be used to improve the micronutrient supplementation coverage.

Vitamin A supplementation was suboptimal especially for the group above the age of 12 months(post immunization) reported at 38%. Deworming and Iron Folate supplementation was also lowreported at 37% and 47% respectively.

Worst however was Zinc in the management of diarrhoea which was only reported by 1.1% of allthe respondents who reported to have had diarrhoea two weeks prior to the survey. This was due totheir no being any deliberate effort in the promotion of the same and this is something that should

be done in future with the adoption of the HINI strategy.4.3.2. Infant and Young Child Feeding (IYCF)

Infant and young child feeding is a continuum of critical nutrition and health practices that beginduring pregnancy and continue through at least the first two years of life. The sharpest increase inmalnutrition occurs between 6 and 24 months of age, the time when children grow most rapidly andare introduced to other foods in addition to breast milk.Appropriate IYCF practices include timelyinitiation of breastfeeding within 1 hour of birth, exclusive breastfeeding for the first 6 months,complementary feeding after 6 months with continued breastfeeding upto 2 years, and improvedfeeding during and after illness. In this survey, the IYCF practices were considered to be sub-optimal and likely to contribute to the high malnutrition rates.

4.3.2.1. Timely initiation of breastfeeding:This relates to putting an infant to the breast within one hour of birth. Of the 332 children aged 6-23 in the survey, 286 (86%) reported to have put their infants on the breast within one hour of birthas shown in the figure below;

Table11: Proportion of children 0-23 months put to the breast within 1 hour of birth


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4.3.2.2. Exclusive Breastfeeding:Exclusive breastfeeding was reported at 51% within the recommended HINI targets of 50%. Therates were however slightly higher in girls than in boys at 55% and 48% respectively.

Table12: proportion of children exclusively breastfed

4.3.2.3. Minimum Dietary Diversity

Dietary diversity was less than optimal with the worst being minimum dietary diversity for 6-23months with only 39% reporting to eating food from more then three food groups as shown below.Table13: Minimum dietary diversity (n=285)

86.1%

10.8%2.1% 0.6% 0.3%0.0%

10.0%

20.0%

30.0%

40.0%

50.0%

60.0%

70.0%

80.0%

90.0%

100.0%

Immediately

(within 1 hr)

Within first

day

Within first 3

days

After 3 days Dont Know

How soon the baby was put on the breast

Percent

51

48

55

44

46

48

50

52

54

56

0-5 Mnths Male Female

Exclusive breast feeding rates

EBF

HINI


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4.3.2.4. Minimum meal frequency

Minimum meal frequency was below the recommended HINI standards of 80%. For the group

between 6-8 months the indicators were slightly better with the feeding reported at 70%. The lowest

rates were reported for the 6-23 months non breastfed infants which was reported at 60%

Table14: Minimum meal times for breastfed children 6-8 months (n=20)

Table15: Minimum meal times for breastfed children 9-23 months (n=133)

0%

10%

20%

30%

40%

50%

60%70%

80%

90%

6-23months 3+ 6-23Males 6-23 Females

6-23 months > 3 food groups

6-23 F>3+ FGPS

70

4030

0102030405060

708090

6-8 months 2+ 6-8Males 6-8 Females

6-8 months BF fed 2 times a day

BF F>2+ Times


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Table16: Minimum meal times for Non breastfed children 6-23 months (n=130)

4.4. Water Sanitation and hygiene

4.4.1. Main water source

The main sources of water for a majority of the population were borehole(33.9%),unprotected wells

(29%), and private and public dams (18.3%). A few of the households got water from protected

wells and water taps as shown below;

Table17: Main current water sources

69

36 33

01020304050

60708090

9-23 months 3+ 9-23 Males 9-23 Females

9-23 Months breast fed children 3+ times

BF F>3+ Times

60.0%

31.0% 29.0%

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%

6-23 months 4+ 6-23 Males 6-23 Females

Meal frequency NBF 6-23 months

NBF F>4+ Times


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4.4.2. Water treatment

Though quite a numebr of the repondednts reported to having used water for unsafe sources(around 47%), most respondent did not do anything to their drinking water (94.3%). Chemical usein water treatment was reported by around 7% of the respondents as shown in the figure below;

Table18: Treatment given to drinking water

4.4.3. Handwashing practicesAround two thirds of the respondents reported to washing hands at the most critical times.However it is worth noting that most of them used water only(85%) as shown in figure 4.11 and4.12 below;

Table19: When hands were washed

0.0%5.0%

10.0%15.0%20.0%

25.0%30.0%35.0%

6.3%

33.9%29.1%

7.3%4.9%

18.3%

Percentage

Source of Water

Main Source of Water

Percent

0.0%20.0%40.0%60.0%

80.0%100.0%

94.3%

1.9% 1.8% 6.6% 0.3%Percentage

Treatment

Water treatment

Percent


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Table20: what was used to clean hands

4.4.4. Access to toilet facilities

Only 48% of the respondents reported to having access to a toilet facility( either own orneighbours). This was mainly reported in the urban areas with the rural areas reported to usingbush.This indicates poor human waste disposal methods that have the potential to contaminate theopen water sources leading to diarrhoea and other water borne diseases.

5. Conclusions

0.0%20.0%40.0%

60.0%80.0%

100.0% 75.0% 66.6%83.2%

47.1%64.5%

10.0%

Percentage

When

When Hands were Washed

Percent

0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Water only Water &

soap

Water &

ash

Others

85.0%

47.5%

35.1%

0.4%Percentage

What was used for cleaning

What was used to clean Hands

Percent


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The prevalence of acute malnutrition in Mandera Central district is still critical with global acutemalnutrition (GAM) of 17.9% (14.9-21.4 95% C.I.) and Severe Acute Malnutrition (SAM) rate of3.4.% (2.1-5.3 95% C.I.). Compared with the survey undertaken in March of 2011 however whichindicated GAM of 27.5% (23.2-32.2.0 95% CI) and SAM of 3.4% (2.3-4.9), there is a reduction in

the level of GAM which is statistically significant(P=0.001) while there was no much change inSAM. The levels of Immunization (OPV1&3, Measles, BCG) were also within the recommendednational levels of above 80% both by card and recall. Some other HINI indicators like use of Zinc inthe management of diarrhoe, deworming and Vitamin A supplementation for the 12-59 Monthswere however not up to scale.This was also the case as regards to Hygiene and Sanitation pracices.An analysis of IYCF indicators showed that the IYCF practices are poor with high percentage ofchildren not receiving optimal infant feeding practices (with the exception of timely initiation ofbreastfeeding reported at above 80%).

6. Recommendations and priorities

6.1. Immediate Continue supporting to the MOH with OJT, HINI ,supportive supervision and logistical

support. Promotion of IYCF activities geared towards optimal complementary feeding and dietary

diversity e.g. kitchen gardening and cooking demostration. Incooporating DRR in normal programming through activities like provision of health,

nutrition and hygiene promotion activities to school health clubs. Scale up of the HINI package with special focus on Zinc supplementation. As a start

sensitization of health workers and supply chain management of the Zinc tablets should beadressed.

6.2. Medium term MOH to develop a health workers retention strategy to reduce the high staffs turn over. Through SCUK WASH programme strengthen Hygiene promotion hygiene practices to

reduce the incidence of diarrhoeal disease including health and nutrition promotiontoeducate the community on basic WASH i.e. domestic treatment of drinking water andproper disposal of faecal waste.

6.3. Long term

Through SCUK WASH programme, Provide toilet facilities through communityparticipatory approaches coupled with awareness campaign on the importance of using suchfacilities i.e. Community Led Total Sanitation (CLTS) and Participatory Hygiene and

Sanitation Transformation (PHAST) approaches. This can be piloted in one division (to beagreed among all stakeholders) and depending on how it works it can be scaled up to theothers.

Need for defined linkage of nutrition sector cluster with other sectors such as WaterSanitation and Hygiene (WASH) in the longer term.

Advocacy for recruitment and retention of health workers i.e. nurses , Clinical Officers (Cos)and nutritionists in North Eastern province


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Government of Kenya (GOK) to strengthen community health strategy in the ASALS tofoster empowerment of CHWs to participate in health and nutrition promotion andmanagement of minor childhood ailments.

7. References

The SPHERE Project Handbook (2011), Humanitarian Charter and Minimum Standards in DisasterResponse

WHO 2006 growth standards

Infant and Young Child Feeding Practices: Collecting and Using Data: A Step-by- Step Guide.Cooperative for Assistance and Relief Everywhere, Inc. (CARE). 2010.

8. Appendicies

8.1. Appendix 1

Plausibility Report

Plausability MC.rtf

8.2. Appendix 2

Assignment of Clusters

Geographical unit Population size Assigned cluster

Bulla afya 13191 "1,2"

Elwak south 33636 "3,4,RC,5,6"

Elwak town 27560 "RC,7,8"

El-adi 14574 "9,10"

Dasheng wante 5817 11

Wante 8339 12

Bore hole 11 16412 "13,14,15"

Dabacity 10203 16El-ram 8293 17

Garsesala 9566 18

Kotulo 11231 "19,20"

Lehele 2343

Kutayu 9056 21

Bojigarse 3225 RC


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Fincharo 6351 22

Fincharo 6351 23

Qalanqaleysa 7547 RC

Burmayo North 5657

Burmayo South 5129 24

Shimbir Fatuma 19590 "25,26,27"Shimbir Fatuma 19590 "28,29"

Quramadhow 9275 "30,31"

Sukela tinfa 2018

Elele 6969 32

Wargadud 23430 "33,34,35"

Wargadud East 17372 "36,37"

8.3. Appendix 3

Calendar of Events

Calender of

events.doc

8.4. Appendix 4

Result Tables for NCHS growth reference 1977

Table 3.2: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema)and by sex

All n = 1071 Boys n = 548 Girls n = 523Prevalence of global malnutrition(


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Severe wasting(= -3and = -2z score)

Oedema

Age(mo) Totalno. No. % No. % No. % No. %

6-17 205 6 2.9 25 12.2 173 84.4 1 0.518-29 264 3 1.1 38 14.4 223 84.5 0 0.030-41 256 1 0.4 41 16.0 214 83.6 0 0.042-53 236 5 2.1 44 18.6 187 79.2 0 0.054-59 110 0 0.0 23 20.9 87 79.1 0 0.0Total 1071 15 1.4 171 16.0 884 82.5 1 0.1

Table 3.4: Distribution of acute malnutrition and oedema based on weight-for-height z-scores

=-3 z-score

Oedema present Marasmic kwashiorkor No. 0(0.0 %)

Kwashiorkor No. 1 (0.1 %)

Oedema absent Marasmic No. 15 (1.4 %) Not severely malnourishedNo. 1055 (98.5 %)

Table 3.5: Prevalence of acute malnutrition based on MUAC cut offs (and/or oedema) and by sex

All n = 1071 Boys n = 548 Girls n = 523

Prevalence of global malnutrition(< 125 mm and/or oedema)

(108) 10.1 %(7.7 - 13.195% C.I.)

(54) 9.9 %(7.1 - 13.695% C.I.)

(54) 10.3 %(7.6 - 13.995% C.I.)

Prevalence of moderatemalnutrition (< 125 mm and >=115 mm, no oedema)

(90) 8.4 %(6.4 - 10.995% C.I.)

(45) 8.2 %(5.9 - 11.395% C.I.)

(45) 8.6 %(6.3 - 11.795% C.I.)

Prevalence of severe malnutrition(< 115 mm and/or oedema)

(18) 1.7 %(1.0 - 2.7 95%C.I.)

(9) 1.6 % (0.8- 3.2 95%C.I.)

(9) 1.7 % (0.8- 3.6 95%C.I.)

Table 3.6: Prevalence of acute malnutrition by age, based on MUAC cut offs and/or oedema

Severe wasting(< 115 mm)

Moderatewasting (>=115 mm and =125 mm )

Oedema

Age Total No. % No. % No. % No. %


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(mo) no.6-17 205 12 5.9 38 18.5 155 75.6 1 0.518-29 264 3 1.1 32 12.1 229 86.7 0 0.030-41 256 2 0.8 12 4.7 242 94.5 0 0.042-53 236 0 0.0 8 3.4 228 96.6 0 0.0

54-59 110 0 0.0 1 0.9 109 99.1 0 0.0Total 1071 17 1.6 91 8.5 963 89.9 1 0.1

Table 3.5: Prevalence of acute malnutrition based on the percentage of the median and/or oedema

n = 1071Prevalence of global acutemalnutrition (


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3 z-score) 95% C.I.) 95% C.I.) 95% C.I.)Prevalence of severe underweight(


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42-53 236 7 3.0 28 11.9 201 85.254-59 110 1 0.9 7 6.4 102 92.7Total 1070 69 6.4 155 14.5 846 79.1

Table 3.11: Mean z-scores, Design Effects and excluded subjects

Indicator n Mean z-scores SD

DesignEffect (z-score < -2)

z-scores notavailable*

z-scores outof range

Weight-for-Height

1070

-1.150.94 1.53 1 0

Weight-for-Age 1070

-1.590.93 2.03 1 0

Height-for-Age 1070

-1.041.25 3.48 0 1

* contains for WHZ and WAZ the children with oedema.

8.6. Appendix 5

Questionnaires

Survey

Questionnaire clus

Survey

Questionnaire hou

Nutritional Anthropometric and Mortality Survey Final Report Mandera Central District North Eastern...

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Transcript of Nutritional Anthropometric and Mortality Survey Final Report Mandera Central District North Eastern...