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Nutrition and Mortality Survey

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Nutrition and Mortality Survey NUTRITION AND MORTALITY SURVEY Tharparkar, Sanghar and Kamber Shahdadkhot districts of Sindh Province, Pakistan 18-25 March, 2014 1 TABLE OF CONTENT TABLE OF CONTENT ................................................................................................................................... 2 ABBREVIATIONS ........................................................................................................................................... 3 EXECUTIVE SUMMARY ............................................................................................................................... 4 1. Introduction ................................................................................................................................................ 6 2. Objective of the Study ............................................................................................................................... 6 3. Methodology .............................................................................................................................................. 7 3.1 Study area ......................................................................................................................................... 7 3.2 Study population .............................................................................................................................. 7 3.3 Study design ...................................................................................................................................... 8 3.3.1 Sample size determination: ............................................................................................................ 8 3.3.2 Cluster determination and selection .............................................................................................. 8 3.4 Sampling Procedure......................................................................................................................... 8 3.5 Data Collection .............................................................................................................................. 9 3.5.1 Anthropometric measurements ...................................................................................................... 9 3.5.2 Mortality data ................................................................................................................................ 9 3.5.3 Morbidity data ............................................................................................................................... 9 3.5.4 Vaccination - Measles and BCG .................................................................................................. 10 3.5.5 Vitamin A supplementations ........................................................................................................ 10 3.5.6 Contextual factors ........................................................................................................................ 10 3.6 Survey management....................................................................................................................... 10 3.6.1 Coordination of the survey........................................................................................................... 10 3.6.2 Recruitment and Training of Enumerators .................................................................................. 10 3.7 Data analysis and Reporting .................................................................................................... 10 3.7.1 Data Analysis ............................................................................................................................... 10 3.7.2 Preliminary result and final report .............................................................................................. 10 4. RESULTS ................................................................................................................................................ 11 4.1 Sex and age distribution children 6 to 59 months ........................................................................ 11 4.2 Anthropometric results (WHO 2006) .......................................................................................... 11 4.3 Mortality results (retrospective over x months/days prior to interview) ..................................... 16 4.4 Child morbidity ............................................................................................................................ 16 4.5 Vitamin A Supplementation and Vaccination status ................................................................... 17 4.6 Household (HH) Characteristics .................................................................................................. 18 5. Discussion ................................................................................................................................................ 21 5.1 Nutritional status .............................................................................................................................. 21 5.2 Mortality .......................................................................................................................................... 22 5.3 Morbidity and coverage public health intervention ......................................................................... 23 5.4 Water, sanitation and Hygiene (WASH) ......................................................................................... 23 5.5 Household Food security ................................................................................................................. 24 6. Recommendations and priorities.............................................................................................................. 25 7. APPENDICES ......................................................................................................................................... 26 7.1 Assignment of clusters ..................................................................................................................... 26 7.2 Questionnaires.................................................................................................................................. 29 2 ABBREVIATIONS ARI Acute Respiratory infection BCG Bacillus Calmette–Guérin CMAM Community Management of Acute Malnutrition CDC center for disease control CI confidence Interval CMR Crude Mortality rate DHO District Health Office DHS Demographic Health Survey EBF Exclusive Breastfeeding ENA Emergency Nutrition assessment (ENA/SMART) GAM Global Acute malnutrition HFA Height for Age HH Household IP Implementing partner IYCF Infant and young child feeding MUAC Mid-Upper Arm Circumference NNS National Nutrition Survey PPS Probability Proportional to Size SMART Standardized Monitoring and Assessment of Relief and Transitions UC Union Council UNICEF United Nations Children’s Fund WASH Water Sanitation and Hygiene WFA Weight-for-Age WFH Weight-for-Height WHO World Health Organization 3 EXECUTIVE SUMMARY Through UNICEF technical and ECHO financial support, three SMART Nutrition and mortality surveys were conducted in Tharparkar, Sanghar and Kamber Shahdadkot districts of Sindh, Pakistan. The overall objective of the nutrition surveys were to measure the extent and severity of acute malnutrition in children aged 6-59 months in the above mentioned districts. The data collection was managed by implementing partners; HANDS, Shifa Foundation, and NDS through coordination from provincial nutrition cell. The survey for Tharparkar and Sanghar were conducted between 19th and 25th whereas for Kamber Shahdadkot between 18th and 24th March 2014. Provincial nutrition cell in coordination with District health office (DHO) and the implementing partners (IPs) in the respected district were responsible to manage the survey. UNICEF was responsible to provide technical support throughout the assessment including design the questionnaire, providing the training for enumerators, analyzing the data and supporting the report writing. The survey design was descriptive cross-sectional survey, two-stage cluster sampling. In stage one, in each district total of 35 clusters or villages were selected randomly from the list of all villages in the respected districts. In stage two, from each clusters, total of 15 houses were randomly selected using random table number. A total of 630 children in Tharparkar, 511 in Sanghar, and 693 children in Kamber Shahdadkot were assessed. The major findings are summarized below FINDINGS The survey findings indicate that the prevalence of global acute malnutrition (GAM) of 22.7% in Tharparkar, 16.0% in Sanghar, and 13.8% in Kamber Shahdadkot. According to World Health Organization (WHO) classification of severity of acute malnutrition in a community, the rate in Tharparkar and Sanghar is classify as critical whereas for Kamber Shahdadkot it is under the classification of serious. According to WHO threshold for chronic malnutrition, the level of stunting all three surveys was found very high; 45.9% in Tharparkar, 53.4% in Sanghar and 48.4% in Kamber Shahdadkot. The crude (CMR) and under-five mortality rates (U5MR) in Tharparkar and Sanghar were almost within the acceptable range for South Asia region. The CMR and U5MR for Tharparkar was 0.2 and 0.9 deaths/10,000 people/day respectively whereas in Sanghar CMR was 0.22 and U5MR 0.64 /10,000 people/day. However, the CMR and U5MR in Kamber was 0.45 and 2.45 deaths/10,000 people/day which was above emergency threshold levels of the
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