Model Nutrition Assessment Report
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SMART Survey Report, Idleb Governorate, Syria Physicians Across Continents-Turkey August 2017 Contents List of Acronyms ............................................................................................................... 3 Acknowledgements .......................................................................................................... 4 Executive summary .......................................................................................................... 5 1. Introduction ................................................................................................................... 7 2. Survey Objective .......................................................................................................... 7 3. Methodology ................................................................................................................. 8 3.1 Sample size .......................................................................................................................................... 8 3.2 Sampling procedure: selecting clusters ........................................................................................... 9 3.3 Sampling procedure: selecting households and children ............................................................ 10 3.4 Case definitions and inclusion criteria ............................................................................................ 11 3.5 Questionnaire, training and supervision ......................................................................................... 12 3.6 Data entry and analysis .................................................................................................................... 13 3.7 Characteristic of the sample ............................................................................................................ 13 4. Results ....................................................................................................................... 15 4.1 Anthropometric results (based on WHO standards 2006): ......................................................... 15 4.1.1 Prevalence of acute malnutrition based on weight-for-height z-scores ............. 15 4.1.2 Prevalence of acute malnutrition based on MUAC cut offs (and / or edema): .. 17 4.1.3: Prevalence of underweight based on weight-for-age z-score (WAZ) ................ 18 4.1.4: Prevalence of stunting based on height-for-age z-score (HAZ) ......................... 19 4.1.5: Prevalence of overweight based on weight for height z-score (HAZ) ............... 20 4.2 Anaemia results: ................................................................................................................................ 22 4.3 Separated children result: ................................................................................................................ 22 5. Discussion .................................................................................................................. 23 6. Recommendations and priorities ................................................................................. 24 7. Appendices ................................................................................................................. 25 List of Acronyms CDC Centers for Disease Control and Prevention CCCM Camp Coordination and Camp Management CI Confidence Interval ENA Emergency Nutrition Assessment GAM Global Acute Malnutrition HAZ Height-for-Age Z-Scores HFA Height-for-Age IDP Internally Displaced People IYCF Infant and Young Child Feeding IYCF-E Infant and Young Child Feeding in Emergencies MAM Moderate Acute Malnutrition MUAC Mid-Upper Arm Circumference NGO Non-Governmental Organization NPM Need and Population Monitoring PAC Physicians Across Continents PPS Probability Proportional to Size PSU Primary Sampling Unit RC Reserve Cluster SAM Severe Acute Malnutrition SD Standard Deviation SMART Standardized Monitoring and Assessment of Relief and Transitions WAZ Weight-for-Age Z-Scores WFA Weight-for-Age WFH Weight-for-Height WHO World Health Organization WHZ Weight-for-Height Z-Scores Acknowledgements We thank the United Nations Children's Fund (UNICEF) for support and funding for this survey and Physicians Across Continents – Turkey (PAC-Turkey for their planning and implementation Executive summary After six years of war and deterioration of Health and nutrition services in Syria, there was a need to determine the nutrition situation. Physicians Across Continents (PAC) in coordination with Nutrition cluster conduct a Standardized Monitoring and Assessment of Relief and Transitions (SMART) survey in Idleb governorate in June 2014. However, after the Survey there were major changes in the situation. There were new accessible areas. These areas had been accessible from Turkey after being under the opposition’s control. There were a huge number of Internally Displaced People (IDPs) coming from other besieged areas (Aleppo, Madaiya, Dariya) and due to these changes, we planned to conduct a new SMART survey in Idleb governorate to determine the current nutrition status. Idleb governorate is located in north of Syria and contains Host community and IDPs, most of them are Muslim, This survey was conducted between 10 to14 July 2017. Thirty clusters from Idleb governorate had been surveyed. These clusters has been selected randomly to represent all Idleb communities. Need and Population Monitoring (NPM) and CCCM data was used to estimate the population size. After we selected the clusters we used Simple or Systematic random sampling methods to select the Households in each cluster. The main objective of the survey was to determine the Global Acute Malnutrition (GAM) prevalence in Idleb governorate.578 children 6 – 59 month from 411 Household (HH) were included in the survey. All selected clusters had been visited and no reserved cluster had been used. Table 1 below summarizes Major nutrition related findings. Table 1: Summary of key indicators Prevalence of acute malnutrition based on weight-height (n) % CI z-scores1 Prevalence of global acute malnutrition 12 2.2 1.2- 4.2 95% C.I. (WFH <-2 z-score and/or edema) Prevalence of moderate acute malnutrition 10 1.7 0.8 – 3.6 95% C.I. (WFH <-2 z-score and >=-3 z-score, no edema) Prevalence of severe acute malnutrition 3 0.5 0.2 – 1.6 95% C.I. (WFH <-3 z-score and/or edema) Prevalence of acute malnutrition based on MUAC Prevalence of global malnutrition (< 125 mm and/or oedema) 11 1.9 0.8 – 4.6 95% C.I. Prevalence of moderate malnutrition 9 1.6 0.6 – 3.8 95% C.I. (< 125 mm and >= 115 mm, no oedema) Prevalence of severe malnutrition (< 115 mm and/or oedema) 2 0.3 0.1 – 1.5 95% C.I. Prevalence of underweight based on weight-for-age z- scores1 Prevalence of underweight (WFA <-2 z-score) 38 6.6 3.9 – 10.9 95% C.I. Prevalence of moderate underweight 26 4.5 2.7 – 7.4 95% C.I. (WFA <-2 z-score and >=-3 z-score) Prevalence of severe underweight (WFA <-3 z-score) 12 2.1 0.9 – 4.8 95% C.I. Prevalence of stunting based on height-for-age z-scores1 Prevalence of stunting (HFA <-2 z-score) 82 14.2 10.2 – 19.5 95% C.I. Prevalence of moderate stunting 54 9.4 6.6 – 13.1 95% C.I. (HFA <-2 z-score and >=-3 z-score) Prevalence of severe stunting (HFA <-3 z-score) 28 4.9 2.6 – 8.9 95% C.I. Prevalence of overweight based on weight for height cut- offs1 Prevalence of overweight (WHZ > 2) 9 1.6 0.8 – 2.9 95% C.I. Prevalence of severe overweight (WHZ > 3) 3 0.5 0.2 – 1.6 95% C.I. 1 Based on WHO Child Growth Standards (2006) 1. Introduction The survey had been conducted in Idleb governorate in Syria. Idleb Governorate has 5 Districts which is further divided in to 25 sub Districts. Idleb has a total population of 1,895,676. IDPS leave in a mixed settlement with the host community. The majority of the population are Muslim Sunni. The population of Idleb are mainly dependant on agriculture with some pastoralist community. The survey was conducted in all communities of Idleb governorate. With the exception of Kafariya and Foaa Communities. These two communities were not accessible). A total of 739 Communities and camps were included in the sampling frame. The communities were mix of urban, rural and camps. Humanitarian assistance: All Communities in Idleb Governorate are accessible. A number of Humanitarian organizations operate in the area. Rural Eastern part of the Governorate has relatively less accessible than the other parts. Health and nutrition services coverage is not uniform with some rural communities having poor access. Access to food and market is good. However, there is some rise in price of food items. (Inflation) 2. Survey Objective The Overall objective of the SMART assessment was to estimate the current prevalence of acute malnutrition among children 6-59 months of age in Idleb Governorate. Specific Objectives • Assess the prevalence of GAM in children 6- 59 months of age in Idleb governorate. • Assess the prevalence of stunting in children 6 – 59 months of age in Idleb governorate. • Assess the prevalence of anaemia in children 6 – 59 months of age in Idleb governorate. • Compare the prevalence of GAM using MUAC and using Weight / Height Z-score to see the sensitivity of MUAC. 3. Methodology This survey used standard two-stage cluster sampling based on probability proportion to size (PPS). The assessment was conducted following the Standardised Monitoring and Assessment of Relief and Transitions (SMART) methodology, a fast, standardized and simplified method meant to ensure household/everyone in a target population has the same chance