SANAAG REGION NUTRITION SURVEY REPORT Revised version September 2002 1 Table of Contents TABLE OF CONTENTS .......................................................................................................................2 ACKNOWLEDGEMENTS ...................................................................................................................3 1 EXECUTIVE SUMMARY...........................................................................................................4 2 SUMMARY OF FINDINGS ........................................................................................................5 3 BACKGROUND INFORMATION.............................................................................................6 3.1 HEALTH CONTEXT.......................................................................................................................6 3.3 FOOD SECURITY CHARACTERISTICS ............................................................................................7 4 SURVEY OBJECTIVES..............................................................................................................8 5 METHODOLOGY .......................................................................................................................8 5.1 SAMPLING METHODOLOGY .........................................................................................................8 5.2 SAMPLE SIZE ...............................................................................................................................9 5.3 TRAINING OF ENUMERATORS AND PRE-TESTING ........................................................................9 5.4 DATA COLLECTION AND ANALYSIS.............................................................................................9 6 PRESENTATION OF THE SURVEY RESULTS.....................................................................9 6.1 DEMOGRAPHIC CHARACTERISTICS OF STUDY HOUSEHOLDS ......................................................9 6.2 DISTRIBUTION OF CHILDREN BY AGE AND SEX ..........................................................................11 6.3 DISTRIBUTION ACCORDING TO WEIGHT/HEIGHT INDEX IN Z-SCORE OR OEDEMA .......................11 6.5 INDICATORS ..............................................................................................................................12 6.6 INTERPRETIVE ANALYSIS ..........................................................................................................12 6.7 ANALYSIS OF RISK FACTORS.....................................................................................................13 7 ANALYSIS OF FINDINGS .......................................................................................................13 8 RECOMMENDATIONS............................................................................................................14 REFERENCES .....................................................................................................................................14 ANNEX 1: POPULATION ESTIMATES..........................................................................................15 ANNEX 2: LOCAL CALENDAR.......................................................................................................19 2 Acknowledgements UNICEF wishes to thank the Sanaag Regional Health Office, which was instrumental in conducting this survey, as was the Erigavo Branch of the Somaliland Red Crescent Society by availing both office space and communication equipment to the survey team. UNICEF is also grateful to FSAU for participating in the planning, implementation and data analysis of this study. Special thanks is due to the mothers and caregivers that took time off their busy schedules to respond to the questionnaires and allowing their children to undergo anthropometric measurements. Last but not least the enumerators and supervisors who participated in the gathering of data are acknowledged. June 08, 2002 3 1 Executive Summary UNICEF, in collaboration with FSAU and the Sanaag Regional Health Office of MOHL conducted a nutrition survey in Sanaag region in May 2002. The main objective of the survey was to determine the nutritional status of children aged 6 – 59 months in Sanaag region. Moreover, the study aimed at understanding the factors influencing the nutritional status of children in these areas. Using the two-stage random cluster sampling methodology, a total of 900 children between ages 6-59 months were examined. Nutritional status assessments were based on weight and height measurements. Information relating to diarrhoea and ARI incidence two weeks prior to the survey, vitamin A supplementation and measles vaccination status of the children were also collected. 1.1 Nutrition Data analysed in EPI Info for nutritional status suggests a global acute malnutrition rate of 13.7 per cent (using <-2 z score and/or oedema) and a severe malnutrition rate of 5.0 per cent (<-3 z score and/or oedema) while oedema alone was 3.3 per cent. 1.2 Immunization Information collected on immunization during the survey indicates that only about 19 per cent of the children had been immunized against measles, out of which only about 4 per cent had been vaccinated within the six months prior to the survey. An overwhelming 81 per cent had not been immunized at all against measles. Vitamin A supplementation during the past six months stood at just under 46 per cent. 1.3 Child diseases About 18 per cent of the children had diarrhoea while close to 38 per cent suffered from acute respiratory infections during the two weeks prior to the survey. When asked if they seek assistance when a child is sick, the majority of households (more than 92 per cent) replied in the affirmative. While the majority of these (44.5 per cent) reported that they seek assistance from private clinics/pharmacies, an equally significant number (38.2) reported use of traditional healer when a child falls ill. 1.4 Household characteristics It appears that 26 per cent of the households interviewed are female headed. Just over 66 per cent reported purchases as their main source of food, while sales of animals and animal products was the main cited source of income with about 37 per cent of households. 1.5 Water and environmental sanitation The main source of drinking water for the surveyed households was open wells (about 42 per cent). About 37 per cent of interviewed households reported the pit latrine as their sanitation facility, whereas slightly more than 62 per cent were reported as not having one. 4 2 Summary of findings Indicator Percentage Number of boys in the sample 52.6 Number of girls in the sample 47.4 Global acute malnutrition according to Weight For Height Index in Z-Score or presence of oedema 13.7 Severe acute malnutrition according to Weight For Height Index in Z-Score or presence of oedema 5.0 Severe malnutrition according to oedema only 3.3 Proportion of children with diarrhoea in two weeks prior to the survey 18.2 Proportion of children with ARI in two weeks prior to the survey 37.7 Proportion of children supplemented with Vitamin A in six months prior to the survey 45.6 Proportion of children immunised against Measles 19.2 Proportion of female-headed households 26.0 Proportion of households with open wells as the main source of drinking water 44.2 Proportion of households with pit latrines as sanitation facility 37.1 Proportion of households seeking assistance when child is sick 92.5 Proportion of households seeking assistance from private clinic/pharmacay 44.5 Proportion of households seeking assistance from traditional healer 38.2 5 3 Background information Sanaag region shares borders with Puntland (Northeast Somalia) on the east and the Red Berbera Ceerigaabo AWDAL Sea on the north. The region’s Borama SANAG Burao GALBEED population is approximately Gar Adag Hargeisa 210,000 persons. Of this TOGDHEERCaynabo population, approximately 16 SOOL percent are rural-sedentary and 58 percent rural-nomadic. Most The boundaries and names on these maps do not imply official endorsement or acceptance by people in the region engage in the United Nations animal husbandry, with only a limited number involved in small-scale subsistence farming, fishery, frankincense production and urban-based commercial activities. The region has a land mass that makes up about 35 percent of total land area of Somaliland, making it the broadest region. Geographically, Sanaag has four zones: the coastal area, the mountain range, the gypsumlkarst deposit plateau and the Sool Haud plateau. The latter is rich in pasture and has better quality of water. Except for the elevated area of Erigavo district, where rainfall records indicate an annual average of up to 500 mm, most areas in Sanaag have rains that generally do not exceeded 150 mm. Recently, the region has received a large number of displaced people fleeing from the instability in Puntland. The majority of the displaced settled in Dhahar and Badhan districts, while a significant number also settled inside Erigavo town. 3.1 Health context Sanaag region has got one regional hospital, five mother/child health centers and 25 health posts. In collaboration with MOHL, UNICEF supports with the provision of drugs/medical supplies and staff training to all health facilities in the region. IFRC/SRCS supports and manages the Kulmiye mother/child health center inside Erigavo town. Also, IFRCS/SRCS trains first aid volunteers who can assist in emergencies and the implementation of mass immunization campaigns. The regional hospital,