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Nutritional Assessment on Flood-Affected Populations Kamber-Shahdadkot and Dadu Districts, Sindh Province

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Nutritional Assessment on Flood-Affected Populations Kamber-Shahdadkot and Dadu Districts, Sindh Province FINAL REPORT Nutritional Assessment on Flood-Affected Populations Kamber-Shahdadkot and Dadu Districts, Sindh Province, Pakistan November 2007 Anna Bosch i Masgrau Nutritionist Action Against Hunger (ACF-USA) Table of contents Acknowledgments 3 List of acronyms 4 Executive summary 5 1. Introduction 9 1.1 Floods and massive population displacement 10 1.2 Health 10 1.3 Food security 11 1.4 Water and Sanitation 12 1.5 Nutrition 12 1.6 Aid response 13 1.7 Programs initiated by ACF in floods affected areas 13 2. Objectives of the survey 14 3. Methodology 14 3.1 Population Data 14 3.2 Sample size and cluster selection 15 3.3 Households and children selection 15 3.4 Data collection and measurement techniques 16 3.4.1 Anthropometric data 16 3.4.2 Household and Mortality Data 17 3.5 Indicators and Formulas used 17 3.5.1 Acute Malnutrition 17 3.5.2 Mortality 18 3.5.3 Measles Vaccination Coverage 18 3.6 Training and supervision 19 3.7 Data analysis 19 4. Results 19 4.1 Kamber-Shahdadkot survey 19 4.1.1 Anthropometric results 19 4.1.2 Mortality 22 4.1.3 Immunization coverage 22 4.2 Dadu survey 23 4.2.1 Anthropometric results 23 4.2.2 Mortality 26 4.2.3 Vaccination Results 26 5. Discussion 26 6. Recommendations 27 Appendixes 28 2/32 Acknowledgments Action Against Hunger thanks the Health Executive District Officer of Dadu and Kamber-Shahdadkot, as well as the Nazims of the Union Councils surveyed, for their assistance and collaboration. Action Against Hunger would like to thank Action Aid, HOPE, as well as the local NGO Pirbhat Women Development Society, NDS and YST for their assistance in conducting the survey and gathering information. Action Against Hunger is also extremely grateful to the community members for their cooperation and hospitality. Final thanks go to Thamina Laghari and Sajjad Hussain and the whole Nutrition Team, as well as all the members of Action Against Hunger’s Larkana base, especially to Faisal. 3/32 List of acronyms ACF Action Contre la Faim / Action Against Hunger ARI Acute respiratory infection BCG Bacillus Calmette-Guérin, a vaccine for tuberculosis BHC Basic Health Centers CI Confidence interval CDR Crude death rate CTC Community-based therapeutic care DHQ District Head Quarter Hospitals DTP Diphtheria, Tetanus, and Pertussis EDO Executive District Officer GAM Global acute malnutrition GD Government Dispensaries HepA Hepatitis A HepB Hepatitis B IDP Internally displaced person Kcal Kilocalories LHW Lady Health worker MHC Mother and Child Health MoH Minister of Health MUAC Mid upper arm circumference NDS NGO Development Society NCHS National Centre of Health Statistics NGO Non governmental organization OPD Out door patient department OTP Outpatient Therapeutic Programme PKR Pakistani rupees Pol Poliomyelitis RHC Rural Health Centre RUTF Ready-to-use therapeutic food SAM Severe acute malnutrition SC Stabilization centre SD Standard deviation SFP Supplementary Feeding Programme SMART Standardized Monitoring and Assessment of Relief and Transitions TFC Therapeutic feeding center THQ Taluka Headquarters Hospital UC Union Council YST Young Samaji Tanzeem 4/32 Executive summary Context The Sindh is one of the four provinces of Pakistan, located on the Southeastern corner of the country. Its capital is Karachi. The Sindh is bounded by the Thar Desert to the East, the Kirthar Mountains to the West, and the Arabian Sea in the South. Its center is crossed by the Indus River, around which the soil is fertile. It is the third largest Province of Pakistan, stretching about 579 km from north to south, and 442 km (extreme) or 281 km (average) from east to west, with a total acreage of 140,915 km².The province is subdivided into 23 districts, further subdivided into numerous Talukas and local governments. The total population of the Province is estimated between 50 to 54 millions inhabitants (1.1 million in Kamber-Shahdadkot and 1.7 million on Dadu)1. According to Pakistan Demographics 2003, 48.7% of the population lives in urban context. The Sindh Province is a major centre of economic activity in Pakistan and has a highly diversified economy, ranging from heavy industry and finance centered in and around Karachi, to a substantial agricultural base along the Indus. The main crops are cotton, rice, wheat, sugar cane, bananas, and mangoes. Land ownership is very uneven in the area: most of the land is owned by a small number of important landlords. Floods In 2007, heavy monsoon rains coupled with the landfall of Cyclone Yemyin on 26th June led to extensive flooding in Northern Sindh. Although the cyclone-associated rainfalls affected first the Balochistan Province, they drained then through the Indus River, and ultimately the Arabian Sea. Kamber-Shahdadkot and Dadu Districts were the most acutely affected. Because the floods were the result of breaches on the FPB rather than direct flows, water levels rose relatively slowly in the two districts, and the local population had time to escape from their villages and seek shelter on higher ground (frequently along elevated roadways) or in nearby towns. More than 100,0002 people were displaced by the floods in Kamber-Shahdadkot and Dadu or stranded in villages built on the tops of hills and completely surrounded by water. Rationale of the surveys The nutrition situation of the affected population was not documented. The only data available come from a countrywide nutrition survey, the MICS, implemented by UNICEF in 2001-2002, and targeting children from 0 to 59 months.The results for global acute malnutrition rates were 38% weight-for-age, 36.8% height-for-age and 13.1% weight-for-height in Z-score analysis (reference NCHS). Nevertheless, it can be expected that the nutritional status of the target population has deteriorated due to agriculture is the main resource of this people and the fields have been widely destroyed by the floods. Humanitarian assistance started one week after the floods by the Government, international and local NGO: food and tent distributions were implemented, water and sanitation programs and distribution of money. During the month of August, flood waters started to recede, allowing some of the displaced people to return home. Most of the aid stopped by September/October, at the end of the emergency phase. However, the flood crisis is not over: households will continue to face difficulties in the coming months, as their principal livelihood source – agriculture production– was destroyed during the floods. Flood affected population of Kamber-Shahdadkot and Dadu districts were chosen for a joint nutritional and food security survey. The Food Security Assessment was conducted in September 2007 and the results show that the food security situation of flood-affected households is precarious at best and is expected to deteriorate further in the coming months. 1 Population as per census of 1998 2 Approximately 10% of the total population of Kamber-Shahdadkot and 20% of the total population of Dadu 5/32 This Nutrition Assessment is the second part of this project that will provide a better understanding of the current food security and nutrition situation of these areas in order to make recommendations about potential interventions. Methodology To ensure the validity of the results, after analysis of both districts, it was decided to conduct 2 nutrition surveys (one in each district), to ensure the principle of homogeneity in each of the areas surveyed. Indeed, the Food security assessment carried out in September revealed that Kamber-Shahdadkot is more vulnerable than Dadu3. For both surveys, a cluster sampling was chosen. The SMART protocol was applied in the training, planning, collection and analysis of both anthropometric and mortality data. 4 teams composed of 3 members each, completed the field work. There was a least a female surveyor in each team. They attended theoretical and practical training, from October 25th to 29th, 2007. Kamber-Shahdadkot The survey was conducted from October 31st to November 9th, 2007. 805 children between 6 and 59 months were measured. After cleaning, the data of 27 of them were discarded of the analysis. The following results are based on the data of 778 children. Table 1: Results summary, Kamber-Shahdadkot survey, November 2007 INDEX INDICATOR RESULTS4 Global Acute Malnutrition 16.7% W/H< -2 z and/or oedema (12.9% - 20.5%) Z- scores Severe Acute Malnutrition 2.2% W/H < -3 z and/or oedema (1.2% - 3.2%) NCHS Global Acute Malnutrition 9.5% W/H < 80% and/or oedema (6.9% - 12.2%) % Median Severe Acute Malnutrition 0.4% W/H < 70% and/or oedema (0.0% - 0.8%) Global Acute Malnutrition 18.7% W/H< -2 z and/or oedema (15.0% - 22.3%) Z-scores Severe Acute Malnutrition 4.1% W/H < -3 z and/or oedema (2.6% - 5.6%) WHO Global Acute Malnutrition 6.0% W/H < 80% and/or oedema (4.3% - 7.8%) % Median Severe Acute Malnutrition 0.3% W/H < 70% and/or oedema (0.0% - 0.6%) Total crude retrospective mortality (last 3 months) /10,000/day 0.37 (0.11-0.63) Under five crude retrospective mortality /10,000/day 1.27 (0.35-2.19) By card 2.0% Measles immunization coverage According to caretaker5 73.3% (children ≥ 9months old) Not immunized 16.1% Do not know 8.6% 3 “Villages in Dadu District tend to be built on higher ground, and fewer were completely destroyed by the floods. As a result, in most cases food stocks were saved and fewer livestock lost. In addition, income sources tend to be more diverse in Dadu District, with a higher percentage of households involved in handicrafts and casual labor. While a majority of households in both districts will not be able to plant in the next planting for 2007, more households will be able to plant in Dadu District (37%) than in Kamber-Shahdadkot District (28%).
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