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Somalia Nutrition Smart Survey Final Report Badhan

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Somalia Nutrition Smart Survey Final Report Badhan CARE INTERNATIONAL – SOMALIA NUTRITION SMART SURVEY FINAL REPORT BADHAN DISTRICT, SANAG REGION, SOMALIA OCTOBER 2019 ACKNOWLEDGMENT CARE Somalia would like to pleasantly acknowledge the support of everyone who was involved in successful execution of the SMART survey in Badhan District, Sanaag Region. The following played a key role; ▪ OFDA for their financial support to carry out the SMART survey ▪ Ministry of Health for their help in survey planning, coordination and implementation ▪ Community leaders for good reception and provision of household lists for their villages ▪ Parents and caretakers for availing their children for assessment as well as for providing other relevant data for the study ▪ Somalia Cluster’s Assessment and Information Management Working Group for their technical review and validation of the survey protocol and results. ▪ Care Somalia staff for the management of personnel, logistics planning and field implementation of the survey ▪ Field supervisors and data collectors for their hard work and dedication during data collection Report compiled by: Epistat Research Consultants i TABLE OF CONTENTS ACKNOWLEDGMENT ................................................................................ I LIST OF TABLES .................................................................................... III LIST OF FIGURES .................................................................................. IV LIST OF ANNEXES .................................................................................. IV ACRONYMS AND ABBREVIATIONS ................................................................ V EXECUTIVE SUMMARY ............................................................................. VI 1.0 INTRODUCTION ................................................................................ 1 1.1 Background .................................................................................. 1 1.2 Health and nutrition situation ............................................................ 2 1.3 Justification of the survey ................................................................ 2 1.4 Survey objectives ........................................................................... 3 1.4.1 Specific Objectives .................................................................... 3 1.5 Survey location and timing ................................................................ 3 2.0 METHODOLOGY ................................................................................ 4 2.1 Study design ................................................................................. 4 2.2 Target group ................................................................................ 4 2.3 Data and data collection methods ....................................................... 4 2.4 Sample size determination ................................................................ 5 2.4.1 Anthropometry sample size .......................................................... 5 2.4.2 Summary of sampling methods ...................................................... 6 2.5 Organization of the survey ................................................................ 6 2.5.1 Recruitment and Composition of survey teams ................................... 6 2.5.2 Training of the survey teams ........................................................ 7 2.5.3 Field Data Collection ................................................................. 7 2.6 Data Management .......................................................................... 7 2.6.1 Data Quality Control .................................................................. 7 2.6.2 Data Collection Tools ................................................................. 8 2.6.3 Data Entry and Analysis .............................................................. 8 3.0 RESULTS- BADHAN DISTRICT ................................................................. 9 3.1 Anthropometric Results.................................................................... 9 3.1.1 Distribution by age and sex .......................................................... 9 3.1.2 Prevalence of Wasting (WHZ) ...................................................... 10 ii 3.1.3 Prevalence of Acute Malnutrition by MUAC ...................................... 12 3.1.4 Prevalence of Underweight (WAZ) ................................................ 14 3.1.5 Prevalence of Stunting (HAZ) ...................................................... 15 3.1.6 Mean z-scores, Design Effects and excluded subjects ......................... 16 3.2 Child morbidity and immunization coverage ......................................... 16 3.2.1. Child Morbidity ..................................................................... 16 3.2.2 Health seeking behaviour .......................................................... 17 3.2.3 Child immunization, vitamin a supplementation, and deworming ........... 18 4.0 CONCLUSION ................................................................................. 20 5.0 RECOMMENDATIONS ......................................................................... 21 6.0 ANNEXES ...................................................................................... 22 LIST OF TABLES Table 1: Summary of Main Survey Results ..................................................... vi Table 2: Survey target group ..................................................................... 4 Table 3: Data and collection methods .......................................................... 4 Table 4: Sample size determination ............................................................ 5 Table 5: Summary of survey completeness .................................................... 9 Table 6: Distribution of age and sex of sample ............................................... 9 Table 7: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex ............................................................................. 11 Table 8: Distribution of acute malnutrition and oedema based on weight-for-height z- scores .............................................................................................. 12 Table 9: Prevalence of acute malnutrition by age, based on weight-for-height z-scores and/or oedema ................................................................................... 12 Table 10: Prevalence of acute malnutrition based on MUAC cut off's (and/or oedema) and by sex......................................................................................... 13 Table 11: Prevalence of underweight based on weight-for-age z-scores by sex ....... 14 Table 12: Prevalence of stunting based on height-for-age z-scores and by sex ........ 15 Table 13: Mean z-scores, Design Effects and excluded subjects ......................... 16 iii LIST OF FIGURES Figure 1: Badhan Seasonal Calendar ............................................................ 3 Figure 1: Age and sex pyramid ................................................................. 10 Figure 2: Distribution of WHZ z-scores for the surveyed population ..................... 11 Figure 3: Prevalence of acute malnutrition by age, based on MUAC cut offs and/or edema ............................................................................................. 14 Figure 4: Common illnesses reported ......................................................... 17 Figure 5: Health seeking behavior ............................................................. 17 Figure 6: Vitamin A Supplementation, Deworming and measles vaccination ........... 19 LIST OF ANNEXES Annex 1: List of sampled clusters ............................................................. 22 Annex 2: Badhan District Plausibility report ................................................. 23 Annex 3: Badhan District Standardization test report ...................................... 24 Annex 4: Badhan District calendar of events, 2019 ......................................... 27 iv ACRONYMS AND ABBREVIATIONS AIMWG Assessment and Information Management Working Group CHW Community Health Worker CI Confidence Interval CMAM Community Management of Acute Malnutrition DEFF Design Effect ENA Emergency Nutrition Assessment FSNAU Food Security and Nutrition Analysis Unit GAM Global Acute Malnutrition HAZ Height for Age Z-score HH/s Household/s IDPs Internally Displaced Persons IMCI Integrated Management of Childhood Illnesses IPC Integrated Phase Classification IYCF Infant and Young Child Feeding KAP Knowledge, Attitudes and Practices LCL Lower Confidence Limit MIYCN Maternal, Infant and Young Child Nutrition MOH Ministry of Health MUAC Mid Upper Arm Circumference ODK Open Data Kit OFDA Office of Foreign Disaster Assistance OTP Outpatient Therapeutic Programme. PPS Probability proportional to size SAM Severe Acute Malnutrition SD Standard Deviation Standardized Monitoring and Assessment of Relief and SMART Transitions TEM Technical Error of Measurement TSFP Targeted Supplementary Feeding Program UCL Upper Confidence Limit VAS Vitamin A Supplementation WASH Water, Sanitation and Hygiene WAZ Weight for Age Z-Score WHO World Health Organization WHZ Weight for Height Z- Score v EXECUTIVE SUMMARY CARE has been providing emergency relief and lifesaving assistance to the Somali people since 1981. Since then, its programs have evolved to include water and sanitation, Food security and livelihood, Nutrition and Education. CARE Somalia is currently operational in the northern regions of Puntland and Somaliland1.
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