Republic of Yemen Ministry of Public Health and Population

SMART survey report for Nutritional Status and Mortality Sanaa Governorate, Yemen 14 April-5 May 2018

Implementing partner: Ministry of Public Health and Population, Sana'a Governorate Health Office and Central Statistical Organization, funded by UNICEF

Acknowledgements

The Ministry of Public Health and Population of Yemen, represented by the Public Health and Population Office in Sana'a, Acknowledge the cooperation with the UNICEF country office in Yemen and the UNICEF Sana'a hub in addition to the various stakeholders in the region for implementing the SMART survey. The UNICEF country office in Yemen provided technical support, using the SMART methodology while the Ministry of Public Health and Population and the Public Health and Population Offices in Taiz-Al- Mahweet provided a survey director and his assistants. The data collectors and team leaders were also provided by the Public Health and Population Office in Sana'a Governorate. for The data entry team, it was provided by the Public Health and Population Offices (Sana'a) and the Nutrition Department at the Ministry. The protocol was finalized by the Nutrition department of the Ministry of Public Health and Population with technical support provided by UNICEF. UNICEF Economic Cooperation provided technical assistance, particularly with regard to daily quality verification, data analysis and reporting. The Office of Public Health and Population of Sana'a Governorate was informed of the organizational and logistical arrangements for the survey and ensured smooth operation. UNICEF provided financial support to the nutrition survey under a grant from the United Nations Central Emergency Response Fund (UNICEF YCO);

The contribution of local authorities to ensuring the security of survey teams during fieldwork and in providing task facilitation is appreciated. These data could not be obtained without the cooperation and support of assessed communities, particularly mothers and caregivers, to respond to interviews. Their participation and cooperation are greatly appreciated. The Ministry of Public Health and Population and UNICEF express their sincere appreciation to the entire survey team for the high level of the commitment and diligence demonstrated during all stages of the evaluation to ensure the high quality of the data collected and the successful completion of this process.

Acronyms BF Breast feeding CDR Crude Death Rate CI Confidence Interval CSI Coping Strategy Index CSO Central Statistics Office DEFF Design Effect DF Degree of Freedom DHS International Health & Demographic Survey EFSNA Emergency Food Security and Nutrition Assessment ENA for Emergency Nutrition Assessment for Standardized Monitoring & Assessment SMART of Relief & Transitions FCS Food Consumption Score GAM Global Acute Malnutrition GHO General Health Office HAZ Height for Age Z-Score HDDS Household Dietary Diversity Score HH Household IYCF Infant and Young Children Feeding MAD Minimum Acceptable Diet MAM Moderate Acute Malnutrition MDD Minimum Dietary Diversity MMF Minimum Meal Frequency MoPHP Ministry of Public Health and Population MUAC Mid-Upper Arm Circumference SAM Severe Acute Malnutrition SD Standard Deviation U5MR Under Five Mortality Rate U6 Months Under six months UNICEF United Nations Children's Emergency Fund WASH Water, Sanitation and Hygiene WAZ Weight for Age Z-Score WFP World Food Programme WHZ Weight for Height Z-Score SMART Standardized Monitoring and Assessment of Relief and Transitions ENA Program Emergency Nutrition Assessment software program PPS, Proportionate probability sample SRS Systematic random sample IDP Internally displaced person NA Not available

Table of content Page content 1. Executive Summary 6 2. Introduction 8 2.1. An overview of Sanaa governorate background. 8 2.2. Justification of the survey 9

3. Methodology 10 3.1 Setting 10 3.2 Study and sampling design 11 3.3 Household Selection Strategy (the second stage) 13 3.4 Data Collection Process 14 3.5 Measurement Standardization and Quality Control 15 3.6 Data Entry and Analysis 15 4. Assessment Results 17 4.1 Demographic Characteristics 17 4.2 Household Characteristics 18 4.3 Household income status 19 4.4 Monthly expenditure 19 4.5 Water, Sanitation and Hygiene 20 4.6 Household Food Security 21 4.7 coping strategies 22 4.8 Child Nutrition 22 4.8.1 Distribution by age and sex of U5 children 23 4.8.2 Wasting (WHZ) Indicators 24 4.8.3 Underweight (WAZ) Indicator 26 4.8.4 Stunting (HAZ) Indicators 28 4.8.5 Change in Nutrition status between 2016 and 2018 30 4.9 Child Morbidity and Immunization 32 4.10 Infant and Young Child Feeding (IYCF) Practices 32 4.11 Vitamin A supplementation and child vaccination 33 4.12 Child Mortality 34 4.13 Mid-Upper Arm Circumference (MUAC) Measurement for Women 35 36 4.14 Associations of the nutritional status

5.Recommendations 38 6. References 38 7. Annexes 39

List of Tables:

Table (1) Key indicators of the nutritional survey in Sana'a Governorate Table (2): districts of Dry and Temperate zone. Table (3): references for calculating sample size Table (4): Parameters used in the Sample Size Determination Table (5): field work schedule for both zones. Table (6) Survey demographics results. Table (7): The basic data for the head of the household, the social situation and the educational level of the HH care giver in the dry and temperate zones. Table (8): Impact of the crisis on household income in the dry and temperate layers. Table (9) The median monthly expenditure of households in Yemeni riyals is distributed on the basis of coping strategies. Table (10) Water and environmental sanitation indicators in the dry and temperate zones Table (11): Food consumption classification Table (12) average coping strategies for dry and temperate zone. Table (13): Results of plausibility check on anthropometric measurement Table (14): Distribution of U5 children by age group, gender in dry zone Table (15): Distribution of U5 children by age group, gender in Temperate zone Table (16): prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex in Sanaa Dry zone Table (17): Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex in Sanaa Temperate zone. Table (18): Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex in Sanaa governorate Table (19): Prevalence of underweight based on weight-for-age z-scores by sex in Dry zone Table (20): Prevalence of underweight based on weight-for-age z-scores by sex Temperate zone Table (21): Prevalence of underweight based on weight-for-age z-scores by sex in Sanaa governorate Table (22): Prevalence of stunting based on height-for-age z-scores and by sex Dry zone Table (23): Prevalence of stunting based on height-for-age z-scores and by sex Temperate zone. Table (24): Prevalence of stunting based on height-for-age z-scores and by sex in Sanaa governorate Table (25): Mean z-scores, Design Effects and excluded subjects Dry zone Table (26): Mean z-scores, Design Effects and excluded subjects Temperate zone Table (27): Prevalence of child Morbidity (2-week recall period) in Dry and Temperate zone. Table (28): IYCF indicator Table (29): Vitamin A supplementation and child vaccination Table (30): Death rates in the two survey strata of Sanaa Governorate. Table (31): Acute malnutrition among women at child bearing age Table (32): Associations of acute malnutrition (by WHZ) Table (33): Associations of acute malnutrition (by MUAC) Table (34): Associations of acute malnutrition (by combined) List of Figures Figure (1): Map of the governorates of Republic of Yemen Figure (2): Sana’a Governorate map shows the two survey zones Figure (3): Observed distribution of population by age and sex for Dry (Left) and Temperate zones (Right) Figure (4): Observed distribution (WHZ) for Dry zone (Left) and Temperate zone (Right) in comparison to normal reference population distribution as per the WHO standards Figure( 1) : Observed distribution (WAZ) for Dry zone (Left) and Temperate zone (Right) Figure (6): Observed distribution (HAZ) for Dry zone (Left) and Temperate zone(Right) Figure (7): Changes in malnutrition levels in Dry zone between May-June 2016 and April-May 2018 Figure (8): Changes in malnutrition levels in Temperate zone between May-June 2016 and April-May 2018 Figure (9): Complementary feeding practice in children aged 6 to 23 months in both zone.

1. Executive Summary introduction A SMART survey was conducted during 14April to 5 May 2018 in the two ecological zones of Sana’a governorate (details about districts in each zone are shown on the methodology section). A total of 1029 HHs were surveyed and a variety of house characteristics were collected. Data were also collected from 1054 U5 children and 1727 women on the reproductive age 15-49 years. Rationale of the Survey 1. Updating existing data to determine the current nutritional and health status. 2 - measuring the impact of intervention programs located in the survey area. 3 - the need for continuous data because Yemen is in emergency Goals and Objectives Assessment of the current nutritional status, total mortality and under-five mortality in Sana'a governorate, and to identify the nutritional status correlation with health indicators, dietary and health practices. This involved providing anthropometric data along with mortality rates of the survey population using the SMART methodology. Methodology SMART survey is a two-staged cluster cross sectional study were the first stage was the selection of clusters, with the clusters being selected using the probability proportional to population size (PPS). The methods used, including sampling design and sample size determination, were following SMART approach. through the updated list of villages and neighborhoods (the updated sample framework) for the survey and (ENA) program was used for clusters. Anthropometric data, two-week retrospective morbidity and retrospective mortality data was collected. Results Table (1) Key indicators of the nutritional survey in Sana'a Governorate

Indicators Dry zone Temperate zone

Wasting (WHZ) Global 5.6 % 7.0 % Wasting (WHZ) severe 0.2 % 0.8 % Underweight (WAZ) Global 34.4 % 38.5 % Underweight (WAZ) severe 7.9 % 9.0 % Stunting (HAZ) Global 60.3 % 51.6 %

Stunting (HAZ) severe 21.7 % 15.4 % Edema 0.0 % 0.0 %

U5DR per 10,000 per day 0.71 0.78 CDR per 10,000 per day 0.35 0.21 Exclusive breastfeeding < 6 months 20.8% 8.5% Proportion of children with diarrhea 43.5% 34.3% within 2 weeks prior to assessment (6- 59 months Proportion of children with Cough 35.4% 34.9% Breathing Difficulty (ARI) within 2 weeks prior to assessment (6-59 months) Proportion of children with Fever within 2 weeks prior to assessment (6-59 54.7% 47% months) Children immunized against measles (9- 71.1% 68.8% 59 months) Children who have received 3 doses of 74.4% 71.2% polio vaccine (6-59 months) Children reported to have received 19.5% 29.3% Vitamin A supplementation in the last 6 months (6-59 months) Acute malnutrition among women 15.7% 11,1% (WFP Yemen Classification)Global Acute malnutrition among women 0.5% 0.4% (WFP Yemen Classification)severe

Conclusion and recommendations  As part of health and nutrition services, urgent need to scale up of CMAM services (OTP). The out-patient therapeutic program should be scaled up in the area and increase its coverage by setting up the program in high priority areas to address the severely malnourished children as a priority.  Integrate basic water, sanitation & health (WASH) approach for the interventions being implemented in Sanaa governorate.  Community screening of under-fives and active case finding and defaulter tracing should be adopted by the community linked at the primary healthcare centers.  Strengthen the community referral system for malnourished children and pregnant and lactating women with a special focus on the inaccessible communities.

2.Introduction 2.1 An overview of Sanaa governorate background. The Governorate of Sana'a is one of the governorates which had been established earlier with currently sixteen districts. it is located in the center of the western part of the Republic of Yemen, bordered to the north by the governorate of Amran and Al-Jawf, from the south by Marib and Al-Baida governorate, from the east by Marib governorate and from the west by Al- Mahweet and Al-Hodeidah. The Governorate covers an area of (11864) km², population density is 77 per km². Population The total population of the governorate is 1,247,000,distributed as 97.2% for rural areas and 2.8% for urban areas. The governorate's population represent 4.9% of the total Yemen. The mean age of the population is 21.9 years and the median age is 15.3 years. Administrative division: The governorate consists of (16) sixteen districts and (146) Ozla , (2177) villages[1113 villages in the dry zone and 1064 villages in the temperate zone] , (5387) Mahela [ 2670 in the dry zone, and 2717 in the temperate zone], and Two secondary cities. Climate and terrain : The topography of Sana'a Governorate consists of a number of mountainous highlands, Mostly located in the western districts. Also there are a number of valleys such as Wadi Al Khard in the District of Arhab, Wadi Rayyan and Wadi Nashmi in the District of Saaffan, and Wadi Gail Asaad Kamel in the District of Sinhan and Bani Bahloul. The average annual temperature is 18 ° C and the average temperature in summer and in winter is 22 ° C and 12 ° C respectively.

Agricultural activity: Agriculture is the main activity of the population of Sana'a Governorate. The most important agricultural crops are coffee, cereals, fruits and vegetables of various kinds. In addition to livestock grazing and beekeeping. Industrial and Mineral Activity: The industrial activity in the province is limited to a number of industrial establishments such as plastics, pharmaceuticals, disinfectants, fodder and keratin. Information indicates the presence of certain minerals in the territory of the governorate such as zinc, silver, lead, basalt rocks and volcanic materials which (Alaschoria and Alberleight).

Figure (1): Map of the governorates of Republic of Yemen

2.2 Justification of the survey: 1. Updating existing data to determine the current nutritional and health status. 2 - measuring the impact of intervention programs located in the survey area. 3 - the need for continuous data because Yemen is in emergency. General Survey objectives Assessment of the current nutritional status, total mortality and under-five mortality in Sana'a governorate, and to identify the nutritional status correlation with health indicators , dietary and health practices. Specific survey objectives: 1.The prevalence of acute malnutrition (wasting), chronic malnutrition (stunting) from (6 - 59 months) and underweight among children (0 - 59 months) in dry and temperate zones in Sana'a governorate 2. Evaluation of the prevalence of exclusive breastfeeding among children under 6 months, continuation of breastfeeding to one year and two years, complementary feeding practices among children (6-23 months) in both zones in Sana'a Governorate. 3. Assessment of the morbidity of children (0-59 months) through the determination of the prevalence of diarrhea, pneumonia and fever in the dry and temperate zones in Sana'a Governorate 4. Determine the coverage of third dose of polio and pentavalent vaccine in children (6 - 59 months), coverage of measles vaccination among children (9 - 59 months) and coverage with vitamin A supplementation during the 6 months preceding the survey among children from (6 - 59 months) in dry and temperate zones in Sana'a Governorate 5. Estimate the level of acute malnutrition (wasting) among women of childbearing age of 15_49 years in dry and temperate zones in Sana'a Governorate. 6. Determination of food consumption in the 7 days prior to the survey in dry and temperate zones in Sana'a governorate 7. Estimation of the coping strategies index for households in the dry and temperate zones in Sana'a Governorate 8. Estimation of household measures for a range of severe coping strategies, crisis and emergency in the dry and temperate zones in Sana'a Governorate. 9. Estimating the percentage of families who lost their source of income as a result of the crisis and the current conflict in the dry and temperate zones in Sana'a Governorate 10. Estimation of the average monthly household expenditure for families in the dry and temperate zones in Sana'a Governorate 11. Assessment of the educational level of caregivers for families in the dry and temperate zones in Sana'a governorate 12. Evaluation of the main source of drinking water for households, classification of the quality of the water source and cleanliness of the drinking water storage point in the dry and temperate zones in Sana'a Governorate 13. Assessment of the type of latrines and the classification of the quality of sanitary facilities in the dry and temperate zones in Sana'a Governorate 14. Evaluation of the practice of the family caregiver to wash hands with soap and water (or soap substitutes) after defecation and before eating in the dry and temperate zones in Sana'a governorate. 15. Estimation of the total mortality rate and mortality of children under five in the dry and temperate zones in Sana'a Governorate 3. Methodology 3.1 Setting The survey was conducted during 14April to 5 May 2018 in the two ecological zones of Sana’a governorate, the Dry zone and the Temperate zone. The distribution of districts in the two zones are as following:

Table (2): districts of Dry and Temperate zone. No. Dry zone Temperate zone 1 Bani Dhabian Jehanah 2 Al Haymah Al Dakheliah Al Teyal 3 Sa’fan Khawlan, 4 Manakhah Nehm 5 Al Haymah Al Kharijiah Bani Matar 6 Hamdan 7 Arhab 8 Bani Hoshaish 9 Bilad Al Roos 10 Sanhan & Bani Bahlul 11 Al Hesn All unsafe areas have been excluded from the frame before the selection of clusters in both zones. the excluded areas were distributed in the annexes (1,2):

Figure (2): Sana’a Governorate map shows the two survey zones

3.2 Study and sampling design The following assumptions (based on a given context) were used to calculate the sample size in the number of children, after which they were converted to a number of households for the survey. The first survey of SMART methodology was conducted in Sana'a governorate in May-June 20161 .The following references results were:

Table (3): references for calculating sample size. reference Dry zone Temperate zone SMART Global acute severe acute Global acute severe acute survey May- malnutrition rate malnutrition rate malnutrition rate malnutrition rate June 2016 16% 3% 8.4% 1.1% Demographic Sanaa governorate Survey for Global acute malnutrition rate severe acute malnutrition rate Family 14% 4.8% Health in 2013 2

According to the Emergency Food Security and Nutrition Assessment in November 2016 3, 79.7% of the households in Sana'a Governorate are food insecure. This is almost double compared to the results of the Comprehensive Food Security Survey 20144 indicating that the food insecurity rate is 41.3%, according to food security indicators, The Classification of Integrated Food Security and Nutrition of the governorate was classified in phase 3 (crisis). The sample size was calculated using the parameters as shown in Table (4). The sample size was calculated based on achieving statistical significance for anthropometric and mortality objectives. Thus, the highest number from each of the two objectives was selected. All calculations were made using the ENA Smart Survey Program (date of issue July 9, 2015). the references used for parameters are Smart Survey May- June 20161, Central Statistic organization5 , Estimation of EPI6 , EFSNA 20163.

Table (4): Parameters used in the Sample Size Determination Determinants of anthropometric Dry zone Temperate zone measurement Prevalence of expected sever 21.1 %[ GAM 16 (12-21.1)] 10.7 %[ GAM (6.5-10.7)] acute malnutrition Required accuracy± 4 % 3.5 % Design Effect(DEFF) 1.7 1.5

Children required for surveying 740 489 Average household size 7 8.2

Percentage of children under 5 18 % 18 % years of age Percentage of non-responsive 3 % 3 % families

Households required for surveying 672 380

Mortality determinants

Expected crude death 0.33 0.33 rate/10000/day(CDR)

Relative desired precision (d) per 0.3 0.3 10000/day Design Effect (DEFF) 1.5 1.5

Recall periods in days 151.5 145 (the Prophet's birthday (the Prophet's birthday 30/11/2017) 30/11/2017) Population covered in the survey 1518 1588 Average household size 7 8.2 Percentage of non-responsive 3% 3% families

Households required in the survey 224 199

In view of the calculations in the tables above, the sample size calculated for the anthropometric measurements of the dry zone 740 and the 489 temperate zone. The calculated sample sizes for HHs in the two zones of Dry and Temperate were 672 and 380 respectively. Selection of clusters: SMART survey is a two-staged cluster cross sectional study were the first stage was the selection of clusters. The methods used, including sampling design and sample size determination, were following SMART approach. through the updated list of villages and neighborhoods (the updated sample framework) for the survey and (ENA) program was used for clusters. In this survey the cluster in rural areas is the village - and in urban areas is neighborhoods. Sample framework: The sample framework did not include conflict areas, while IDPs living with host communities were not excluded. For displaced families who do not live with the host (displaced communities) were very few. Due to the unpredictability of the dynamics of conflict and crises and the sudden and rapid changes in the situation, the framework was updated during the training week. The source of the sample frame used in this survey was Sana’a Governorate Health Office. The frame contains a list of villages with a projection of population that was made based on the CSO 2004 Census5. in the dry zone there were 1113 villages (clusters) and in the temperate zone 1064 villages (clusters). the list of clusters is attached in annexes (3,4). The survey was taken place in Dry zone covering 42 clusters and in temperate zone covering 30 clusters according to ENA method, and the number of households in each cluster was calculated as16 households in the dry zone and 13 households in the temperate zone.

During the field work, the team of Temperate zone came into the fact that the number of children under the age of five did not match with the number of children required for the survey. According to the protocol, the number of children required was 489 children based on the estimates of the national program for expanded immunization(EPI)6 indicated that the number of children under the age of five from the total Population is 18%, however surveying the temperate zone in 30 cluster the number of children been measured was 376 children. This number did not reach the minimum number of children required, 80%, as a result the team had to survey the extra clusters which are 4 clusters. The total number of children surveyed in the 34 clusters was 443, representing 90.5% of the total number of children required. 3.3 Household Selection Strategy (the second stage) Rural areas In clusters (villages) with a population of 80 households or less, updated list of these HH was established by team leader with a support from village leaders or key informants in the village and a simple random sample was applied to select the required number of households. Division: In the case of large clusters, segmentation was made, then one segment was selected using PPS, and within selected segment, HHs were selected using SRS. urban areas - Each selected neighborhood was divided into residential blocks, and the randomly selected block / blocks was considered cluster / clusters. - Supervisors conducted the urban division before the teams collected data. This process included the construction of a preliminary map of buildings in the block, and estimates of the cumulative number of households was applied. - simple random sampling used in the household selection process. The operating room in Sana'a provided daily survey teams with supplies, lists for households and random numbers. At the end of the day, these models were received with completed questionnaires and a daily cluster report to the operating room. EPI method was not used in this survey. Fieldwork:

Table (5): field work schedule for both zones. activity Dry zone Temperate zone Recruited field teams six field teams six field teams Preparation and training six days six days Collecting of data seven days five days (Friday for two zones was leave)

Survey teams The survey team consists of a survey manager, a logistics officer, 4 field supervisors, 4 data entry operators and six field teams. Each field team consists of a team leader (male) and three female researchers. Each team has a car with driver and manual. Annex(8) The survey manager, supported by supervisors, trained the teams for six days before starting the data collection phase. The training consisted of anthropometry, filling of questionnaire, field procedures and standardization exercise followed by field pilot before data collection phase. 3.4 Data Collection Process During the data collection, each supervisor of the 4 supervisors assisted the manager in overseeing the data collection process in the field and assisted in the verification of data in the survey operating room. Each supervisor had a car and a driver to cover a team or two teams maximum per day. Verbal consent from the selected HH to participate was obtained after the head of household had a brief survey overview from the survey team. The questionnaire comprised of 1) background demographics; 2) education of household caregiver; 3) household income; 4) WASH indicators; 5) household food consumption and coping strategies; 6) child vaccination and vitamin A supplementation; 6) child anthropometry; 7) child morbidity; 8) IYCF practices; 9) woman MUAC; and 10) crude and U5 mortality. (Annex 5). Retrospective mortality data were collected from all randomly selected HHs, irrespective of presence or absence of children aged 6-59 months. A recall period of 151 and 145 days prior to the survey was used in Dry and Temperate zones respectively. Annex (9)

3.5 Measurement Standardization and Quality Control To ensure high quality measurement, the survey teams had gone through a meticulous practical training prior to the survey covering all areas related to the field work including standardization test of the data collectors. Data quality was ensured through (1) monitoring of fieldwork by field technical supervisors; (2) crosschecking of filled questionnaires on a daily basis, recording of observations and daily de- briefing and discussion; (3) confirmation of measles, severe malnutrition especially edema cases and death cases by supervisors; (4) daily entry of anthropometric data; (5) doing the plausibility check in daily basis for the overall quality scoring and identification each team quality using 10 scoring criteria (statistical tests), plus ensuring each team was given feedback on the quality of previous day’s data before the start of a new day; (6) daily equipment calibration, (7) additional check done at the data entry level to enable entry only of relevant possible responses and measurements; (8) continuous capacity building of team leaders of good practices.(9)Clear job descriptions were provided to field teams before commencing the data collection in order to ensuring appropriate guidance in completing the assigned tasks.(10) Field team head was reviewing the filed questionnaires and verify the accuracy of the details before the team was leaving the cluster site, thus minimizing possibility of incomplete data (missing variables) and outlier data. The overall plausibility scores were 5% (excellent) for both zones (Annexes 6,7): 3.6 Data Entry and Analysis The data in the filled questionnaires and mortality forms were entered into an Excel spread sheet created for the purpose of this survey. The spreadsheet contained all required self-check formulas as well as converting dates from Hijri to Gregorian. The data entry was verified by random selection of 10% of the questionnaires (households). The data entered were considered valid after being verified and more than 95% of the selected records were accurate. The anthropometrical data then were copied to ENA for SMART for interpretation to z scores as well as creation of the final plausibility check report and results of nutritional anthropometry status tables and curves for acute malnutrition (wasting), chronic malnutrition (stunting) and undernutrition. Similarly, the data of mortality were transferred to ENA for the analysis purposes and getting out the final death results with population pyramid. Household variables and the remaining child-related variables (Vaccination, vitamin A supplementation, feeding practices and morbidity) were analyzed using epi Info Version 7.2.2.6. The anthropometry indices (z-scores) for Weight for Height (wasting), Height for Age (stunting) and Weight for Age (underweight) were generated and compared with WHO 2006 Growth Standards. Children/cases with extreme z-score values were flagged and investigated and appropriately excluded in the final analysis if deviating from the observed mean (SMART flags). In epi info, frequencies and cross-tabulations were used to give percentages, means and standard deviations in the descriptive analysis and presentation of general household and child characteristics. Significances was defined as (P<0.05). The classification the nutritional status using the above indices as well as MUAC was made following the WHO classification. With regard to acute malnutrition, an additional calculation was performed for the purposes of showing the prevalence of GAM and SAM, which combine the cutoff thresholds for weight for height and MUAC, taking into account the presence of bilateral edema, this is for the programmatic planning. For IYCF indicators related to breast feeding and complementary feeding, the WHO guidelines on assessing infant and young child feeding practices were used. For the calculation of the value for Minimum Dietary Diversity (MDD), a 7 food group score variable was created. The 7 foods groups used for calculation are 1) grains, roots and tubers; 2) legumes and nuts; 3) dairy products (milk, yogurt, cheese); 4) flesh foods (meat, fish, poultry and liver/organ meats); 5) eggs; 6) vitamin-A rich fruits and vegetables; 7) other fruits and vegetables. Another indicator is the minimum meal frequency (MMF) which is measuring the child consumption for solid, semi-solid, or soft foods. Minimum acceptable diet (MAD) is combining both MDD and MMF. The methods and analysis for the MDD, MMF and MAD were based as recommended by the WHO. The classification of MUAC of Women is not made based on the global one but based on that WFP is using for Yemen CFSS 2011 & CFSS 2014 7. Woman is considered severely wasted if her MUAC is below 21.3 cm, moderately wasted if her MUAC is equal or more than 21.3 cm and below 22.2 cm, and of normal MUAC if the measurement is not less than 22.2 cm. For sources of drink water indicators, the sources listed in the classification were classified to improved and unimproved sources. Improved drinking water sources are: 1) Water pipelines extended into the house; 2) Water pipelines extended to the backyard of the house; 3) Protected open well; 4) Sealed tank for rainwater harvesting; and 5) Protected spring water. Unimproved sources are: 1) Unprotected open well; 2) Unsealed tank for rainwater harvesting; and 3) Unprotected ground water (wadi, spring running water, etc.). Other sources in the questionnaires are not classified as either improved or unimproved including water trucking, community water points and bottled water. Sanitation was also classified as improved and unimproved based on the type of latrine. Improved latrines are flush/pour flush latrine and simple covered pit latrine, while unimproved latrines include open pit latrine and defecation in open (in fields, etc.). Food consumption scores (FCS) were calculated based on the consumption during the last 7 days from the 8 food groups following WFP guidelines. The classification of FCS is not made following the global WFP one but based on the WFP Yemen way as the following: - Below of equal to 28: Poor food consumption - Above 28 to 42: Border line food consumption - Above 42: Acceptable food consumption

The reduced copping strategy index rCSI scoring was done following WFP guidelines. It made depending on practicing of a list of 11copping strategies. The extended list of coping strategies in this surveys was used to determine HHs who are practicing no coping strategies, stress coping strategies, crisis coping strategies and emergency coping strategies during the last 30 days as shown below: Stress coping strategies: Selling HHs assets/belongings (furniture, jewelry, clothes, etc.) Buying food by credit or pawning Spending from saving Borrowing money Crisis coping strategies: Selling of production assets or transport means (sewing machine, car or motorcycle, etc.) Consuming the stock of seeds that is reserved for the coming season Withdraw children out of school Reduce spending on education and health (including drugs) Emergency coping strategies: Selling the house or land Begging Selling the last female of cattle, the household has Surveying equipment A – Anthropometric measuring equipment The following three materials will be used to take anthropometric measurements of the child: 1. Electronic scale of mother and child manufacturing SECA Article No. UNICEF Supply Catalog, S0141021 2. Height board 130 cm made of wood Item number UNICEF Supply Catalog, S0114530 3. Mid-upper arm circumference tape measure UNICEF Supply (MUAC) 4. The wooden piece to place scale on it. B-Equipment used for additional indicators A white tape to measure the MUAC of women of childbearing age between 15-49 years in the sample household. UNICEF Supply (MUAC). The questionnaire is the only tool that will be used for additional indicators 4.Assessment Results 4.1 Demographic characteristics The information is as summarized in the table below

Table (6) Survey demographics results. No. Parameters Dry Sanaa zone Temperate Sanaa zone 1 Total number of households 586 443 2 Total number of absent HH 2(0.3%) 9(2%) 3 Non response HH 2(0.3%) 2(0.5%) 4 HH IDP 1(0.2%) 0 5 HH IDP with resident 1(0.2%) 0 6 HH with full questioner 582 432 7 Average household size 6.8 7.4

8 HH has children under 5 346 272 9 HH has children under 6months 70 45 10 Total population of under 5 607 441 11 HH has women at reproductive 537 416 age 49 -15 12 No. children U5 610 444 13 No. children U6 months 73 48 14 No. children 6-59 months 537 396 15 % of under-five population 18.1 17.5

16 No. women at reproductive age 902 825 49 -15 17 No. of clusters 42 34 18 Birth rate 0.77 1.19 19 In-migration Rate (Joined) 20.25 25.72

20 Out-migration Rate (Left) 26.79 29.04

4.2 Household Characteristics The heads of HH are mainly males in both zones, and the caregivers are females in both zones. majority of HHs are married and living with their spouses. Illiteracy of caregivers is still serious issue particularly in Dry zone with 84 %.

Table (7): The basic data for the head of the household, the social situation and the educational level of the HH care giver in the dry and temperate zones.

Background indicter Dry Temperate N %(95%CI) N %(95%CI) The gender of household head

MAN 559 96.21(94.33-97.5) 418 96.8(94.6-98.1)

WOMAN 22 3.79(2.51-5.8) 14 3.2(1.9-5.4) The gender of household care giver WOMAN 569 97.8(96.2-98.7) 416 96.3 (94.1-97.7)

MAN 13 2.2(1.3-3.8) 16 3.7(2.3-5.9) Marital status of household head

Married 541 93(90-94.8) 395 91.4(88.4-93.7)

Widow 34 5.8(4.2-8.1) 31 7.2(5.1-10)

Divorced 2 0.3(0.1-1.2) 1 0.2(0.04-1.3)

Single 4 0.7(0.3-1.8-) 2 0.5(0.1-1.7) Education level of household caregiver Illiterate 488 84(80.8-86.7) 267 61.95 (57.3-66.4)

Can read and write 53 9.1(7-11.7) 97 13.3 (10.5-16.6) Basic education 21 3.6(2.4-5.5) 43 9.98(7.5-13.2) Secondary education 12 2.1(1.2-3.6) 19 4.41 (2.8-6.8) Higher education (university, college or institute 7 1.2(0.6-2.5) 5 1.2(0.5-2.7)

4.3 Household income status Table (8) shows that 94% of households lost their sources of income in part or in total during the current crisis (Since March 2015) in the dry zone is the highest compared to the temperate zone, where 85% of households have lost their income in part or in total, a high percentage compared with other governorates.

Table (8) Impact of the crisis on household income in the dry and temperate zones Dry Temperate N %(95%CI) N %(95%CI) The impact on household income Regular salary or income has not been affected 34 6(4-8) 57 13(10-17) Salary or income partially or totally lost 545 94(92-96) 386 85(82-88) DON’T KNOW 1 0.2(1-0) 7 2(1-3)

4.4 Monthly expenditure The median monthly expenditure per year is 30000 and 33000 Rials in Dry and Temperate zone respectively. In both zones the surveyed HH are adopting the stress coping strategy mostly.

Table (9) The median monthly expenditure of households in Yemeni riyals is distributed on the basis of coping strategies.

Dry Median(±SD) Monthly expenditure per year in Yemeni riyals (number = 30000(39903.9) 586) Average monthly expenditure based on coping strategies(Within 30 days) Crisis (72) 30000 (20723.5)

Emergency (11) 23000 (115076.8)

No Coping Strategy (191) 30000 (41204.7)

Stress (308) 33500 (37386.8)

Temperate Median(±SD) Monthly expenditure per year in Yemeni riyals (number = 33000(61282.2) 443 ) Average monthly expenditure based on coping strategies(Within 30 days) Crisis (61 ) 37000 (32894) Emergency(9) 40000(32175.7) No Coping Strategy(174) 32000(55988.8) Stress(188) 33500(73423.9)

4.5 Water, Sanitation and Hygiene Table (10) shows that in temperate zone, more than a third of households rely slightly on the artesian wells with 28% as the main source, followed by the index of water projects connected to houses by 26.7%, and the percentage of household dependency on water tanks is 20.4% and unprotected water is 9%. The sources of the collection of protected rain water represent 3.5% followed by the public tap water point by 2.6%. The dry zone was found to be the most dependable on unsafe water by 21.3%, as the main source of drinking followed by unprotected spring by 17.7% and protected spring 12.7% followed by the source of drinking public tap - community water point of 10.5% followed by piped water for houses by 8.4%. It was found that the use of improved drinking water sources is 61% more than the use of non- improved drinking water by 39% while the water is treated before drinking by 14.2% and drinking water stored in soft containers by 77.1% in the temperate zone. The dry zone found that the use of improved drinking water sources was 30.5% less than the use of not improved drinking water by 69.6% while the water is treated before drinking by 20.6% and the drinking water stored in soft containers by 60.8%. In addition, 26.7% of household’s caregivers reported washing hands with soap and water or (soap substitute) after toilet, while 36.9% of them reported washing before eating in temperate zone. As for the dry zone, 20.1% of the household’s caregivers said that they wash hands with soap and water (soap substitutes) after the toilet, while 33.5% of them said that they washed before eating.

Table (10) Water and environmental sanitation indicators in the dry and temperate zones

Dry Temperate N %(95%CI) N %(95%CI) The main household drinking water main source Artesian well 35 6 (4.4-8.3) 121 28.1(24-32.5) Bottled water 1 0.2(0.03-0.97) 1 0.2 (0.04-1.3) House connected piped water 49 8.4 (6.4-10.9) 115 26.7(22.7-31.05) Other 7 1.2 (0.6-2.5) 8 1.9(0.9-3.6) Protected rainwater harvesting 10 1.7 (0.9-3.1) 15 3.5(2.1-5.7) Protected spring 74 12.7 (10.3-15.7) 2 0.7(0.1-1.7) Protected well 7 1.2 (0.6-2.5) 10 2.3 (1.3-4.2) Public tap/ Community point/ Sabeel 61 10.5 (8.3-13.3) 11 2.6(1.4-4.5) Unprotected rainwater harvesting 26 4.5(3-6.5) NA NA Unprotected spring 103 17.7 (14.9-21) 19 4.4 (2.8-6.8) Unprotected surface water (Wadi, springs, etc.) 43 7.4 (5.5-9.8) 2 0.5(0.1-1.7) Unprotected well 124 21.3 (18.2-24.9) 39 9 (6.7-12.1) Water tanker 41 7 (5.2-9.4) 88 20.4 (16.9-24.5) Category of the main household drinking water main source Improved 175 30.5 (26.5 -34) 263 61(58.3-65.5) Unimproved 406 69.6 (66 -73.5) 168 39(34.5-34.7) Treatment of water before 119 20.6 )17.5- 24) 61 14.2 (11.2-17.8) drinking (n=431 ,579) Clean drinking water 350 60.8 (56.7-64.8) 333 77.1(72.9-80.8) storage(n=432 ,576) The main facility for defecation Composting toilet 48 8.2 (6.3-10.8) 19 4.4 (2.8-6.8) Defecation in open (in fields, etc.) 133 22.9 (19.6-26.4) 23 5.3 (3.6-7.9) Flush to DK 2 0.3 (0.1-1.2) 1 0.2 (0-1.3) Flush to open drain 246 42.3 (38.3-46.3) 139 32.2 (27.9-36.7) Flush to piped sewer system 13 2.2 (1.3-3.8) 2 0.5 (0.1-1.7) Flush to pit latrine 17 2.9 (1.8-4.6) 12 2.8 (1.6-4.8) Flush to septic tank 101 17.4 (14.5-20.6) 204 47.2 (42.6-51.9) Pit latrine with slab 6 1 (0.5-2.2) 14 3.2 (1.9-5.4) Pit latrine without slab/ open pit 11 1.9 (1.1-3.4) 16 3.7 (2.3-5.9) Ventilated improved pit latrine 4 0.7 (0.3-1.8) 2 0.5 (0.1-1.7) The type of latrine Improved 189 32.47(36.38-28.80) 253 58.56(63.11-53.86) Unimproved 393 67.53(71.20-63.62) 179 41.44(46.14-36.89) Hand washing practice by household caretaker

After the toilet (n=431 ,582) 117 20.10(23.55-17.05) 115 26.68(31.05-22.73)

Before meal(n=431 ,582) 195 33.5(37.4-29.8) 159 36.89(41.54-32.47)

4.6 Household food security Food consumption was calculated based on the food consumption ratings during the last 7 days of the survey day for eight (8) groups and were classified using WFP (Yemen) thresholds. As shown in the table below, 79.7% were classified as having acceptable food security while 14.3% were food insecure in the temperate zone. The dry zone (76.6%) were classified as having an acceptable food security, slightly below the temperate zone, while 15.6% were food insecure.

Table (11): Food consumption classification

Food consumption classification Dry Temperate N %(95%CI) N %(95%CI) Household food consumption(WFP

Yemen classification) 330 76.6(73-97.9) Acceptable 330 79.7(75.6- 83.3) 88 15.6(12.8-18.8) borderline 59 14.3(11.2-17.9) 44 7.8(5.9-10.3) Poor 25 6(4.1-8.8)

4.7 coping strategies coping strategies were measured using the coping Strategy Index (CSI). The average coping strategy during the last 7 days for the survey day in the Temperate zone was 3.253, which is close to the dry zone 3.597. The highest average index of the CSI was for those who exercised a crisis strategy in the last 30 days of survey in the temperate zone (6.017), followed by those who exercised the stress strategy of (3.54). in the dry zone, the table showed the highest average index of the coping strategy for those who implemented the coping strategy of emergency (13) was followed by those who exercised the coping strategy during the crisis, (6.5) as shown in table below.

Table (12) average coping strategies for dry and temperate zone. Coping Strategy Index(CSI) Dry Temperate Mean(+SD) Mean(+SD) Coping strategy index(CSI) in 7 days(n=580,431) 3.597(7.7911) 3.253(7.87) CSI means based on category of coping strategy (in 30 days) No coping strategy (n=191,173) 2.0628 (5.89) 2.0694(8.496) Stress coping strategy (n=306,188) 3.5392(6.7221) 3.5372(6.24) Crisis coping strategy(n=72,61) 6.4722(11.4584) 6.0164(10.07) Emergency coping strategy (n=9,11) 13(18.56) 1.333(4) CSI means based on food consumption(WFP Yemen classification) Acceptable (n= 330,432) 2.5301(5.86) 2.203(5.26) borderline (n=58 ,86) 7.8605(12.4) 5.7414(8.9982) Poor (n= 25 ,44) 6.66(10.41) 12(19.814) 4.8 Child Nutrition To determine the nutritional status of a child under five of age, a nutritional indicators were used namely WHZ, WAZ, HAZ and MUAC of children according to the WHO 2006 nutrition standards. in order to calculate these indicators a comprehensive Anthropometric measurements had been taken by the data collectors at the field (based on WHO standards 2006). ENA software was used to calculate these indicators. SMART flags: WHZ -3 to 3; HAZ -3 to 3; WAZ -3 to 3 from the observed mean used to exclude extreme values. For each indicator, GAM, MAM and SAM were also calculated for male and female children and within each age group Definitions of acute malnutrition should be given (for example, global acute malnutrition is defined as <-2 z scores weight-for-height and/or oedema, severe acute malnutrition is defined as <-3z scores weight-for-height and/or oedema)

Results of plausibility check on anthropometric measurement were indicating excellent score. Annex (6,7) plausibility check on anthropometric results

Table (13): Results of plausibility check on anthropometric measurement Dry Temperate The overall data quality 5 % excellent 5 % excellent standard deviation (SD) for 0.88 0.90 WHZ Design effect for WHZ <-2 1.01 1.05 poison distribution score p=0.515(no pockets of p=0.387 (no pockets of malnutrition from the survey malnutrition from the survey area) area)

4.8.1 Distribution by age and sex of U5 children

The ages of the children were determined based on birth or immunization card details and/or supported with events calendar (developed by the survey teams during the training), agriculture and fishing seasons, as well as national and local events (Annex 9: Events Calendar). This is as shown in the tables below which shows a normal distribution of the total sampled age groups of U5 children and represent boys and girls quite fairly in Dry zone while slightly in favor of boys in Temperate zone.

Table (14): Distribution of U5 children by age group, gender in dry zone. Boys Girls Total Ratio AGE (mo) no. % no. % no. % Boy: girl 0-5 43 58.9 30 41 73 12 1.4 6-17 57 42.5 77 57.5 134 25.0 0.7 18-29 60 49.6 61 50.4 121 22.5 1.0 30-41 82 53.6 71 46.4 153 28.5 1.2 42-53 50 48.1 54 51.9 104 19.4 0.9 54-59 12 48.0 13 52.0 25 4.7 0.9 Total 304 49.8 306 50.1 610 100.0 1.0

Table (15): Distribution of U5 children by age group, gender in Temperate zone. Boys Girls Total Ratio

AGE (mo) no. % no. % no. % Boy: girl

0-5 25 52 23 48 48 10.8 1.0

6-17 46 55.4 37 44.6 83 21.0 1.2

18-29 50 52.1 46 47.9 96 24.2 1.1

30-41 53 49.5 54 50.5 107 27.0 1.0

42-53 54 60.7 35 39.3 89 22.5 1.5

54-59 10 47.6 11 52.4 21 5.3 0.9

Total 238 53.6 206 46.4 444 100.0 1.2

The population pyramids of the two zones are shown in Figure (3). Obviously, the populations are young and approximately more than 90% less than 50 years either males or females.

Figure (3): Observed distribution of population by age and sex for Dry (Left) and Temperate zones (Right)

4.8.2 Wasting (WHZ) Indicators The prevalence rates were produced according to WHO 2006 growth standards by ENA for SMART package. According to the results, the prevalence of Global Acute Malnutrition (GAM) was 5.6 % (3.9 - 8.0 95% C.I.) and 7.0 % (4.7 - 10.3 95% C.I.) in Dry and Temperate zones respectively. it is classified as poor (5-10%). female children are significantly more vulnerable to wasting than male children in Dry zones than in Temperate. Table (16) prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex in Sanaa Dry zone

All Boys Girls n = 532 n = 258 n = 274 Prevalence of global malnutrition (30) 5.6 % (11) 4.3 % (19) 6.9 % (<-2 z-score and/or oedema) (3.9 - 8.0 95% (2.3 - 7.7 95% (4.6 - 10.3 95% C.I.) C.I.) C.I.) Prevalence of moderate malnutrition (29) 5.5 % (10) 3.9 % (19) 6.9 % (<-2 z-score and >=-3 z-score, no (3.8 - 7.8 95% (2.0 - 7.4 95% (4.6 - 10.3 95% C.I.) oedema) C.I.) C.I.) Prevalence of severe malnutrition (1) 0.2 % (1) 0.4 % (0) 0.0 % (<-3 z-score and/or oedema) (0.0 - 1.4 95% (0.1 - 2.8 95% (0.0 - 0.0 95% C.I.) C.I.) C.I.) The prevalence of oedema is 0.0 %

Table (17): Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex in Sanaa Temperate zone. All Boys Girls n = 385 n = 206 n = 179

Prevalence of global malnutrition (27) 7.0 % (15) 7.3 % (12) 6.7 % (<-2 z-score and/or oedema) (4.7 - 10.3 (4.4 - 11.8 95% (4.0 - 11.0 95% 95% C.I.) C.I.) C.I.)

Prevalence of moderate malnutrition (24) 6.2 % (13) 6.3 % (11) 6.1 % (<-2 z-score and >=-3 z-score, no (4.0 - 9.6 95% (3.7 - 10.5 95% (3.5 - 10.6 95% oedema) C.I.) C.I.) C.I.)

Prevalence of severe malnutrition (3) 0.8 % (2) 1.0 % (1) 0.6 % (<-3 z-score and/or oedema) (0.3 - 2.4 95% (0.2 - 4.0 95% (0.1 - 4.1 95% C.I.) C.I.) C.I.)

The prevalence of oedema is 0.0 %

Figure (4) depicts the WFH z-score distribution curve of the survey sample relative to the WHO- Gaussian curve. The findings indicate a skewed slightly to the left of the sample curve which indicates poor nutrition status of the sampled population in comparison to the reference population. The standard deviation SD for WHZ was 0.88 in Dry, 0.9 in Temperate zone (which lies within the acceptable range (0.8 – 1.2), indicating representativeness in the sample selection.

Figure (4): Observed distribution (WHZ) for Dry zone (Left) and Temperate zone (Right) in comparison to normal reference population distribution as per the WHO standards

Table (18): Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex in Sanaa governorate.

All Boys Girls n = 917 n = 464 n = 453

Prevalence of global malnutrition (57) 6.2 % (26) 5.6 % (31) 6.8 % (<-2 z-score and/or oedema) (4.7 - 8.3 95% C.I.) (3.8 - 8.2 95% C.I.) (4.8 - 9.7 95% C.I.)

Prevalence of moderate malnutrition (53) 5.8 % (23) 5.0 % (30) 6.6 % (<-2 z-score and >=-3 z-score, no (4.3 - 7.8 95% C.I.) (3.3 - 7.5 95% C.I.) (4.6 - 9.4 95% C.I.) oedema)

Prevalence of severe malnutrition (4) 0.4 % (3) 0.6 % (1) 0.2 % (<-3 z-score and/or oedema) (0.2 - 1.1 95% C.I.) (0.2 - 2.0 95% C.I.) (0.0 - 1.6 95% C.I.)

4.8.3 Underweight (WAZ) Indicator The prevalence of underweight by GAM in Dry and Temperate zones is high and exceeding the critical international standard threshold (≥30%). It is almost equal in both sex in both zones.

Table (19): Prevalence of underweight based on weight-for-age z-scores by sex in Dry zone

All Boys Girls n = 604 n = 301 n = 303 Prevalence of underweight (208) 34.4 % (105) 34.9 % (103) 34.0 % (<-2 z-score) (28.6 - 40.8 95% (27.1 - 43.6 95% (27.8 - 40.8 95% C.I.) C.I.) C.I.) Prevalence of moderate underweight (160) 26.5 % (76) 25.2 % (84) 27.7 % (<-2 z-score and >=-3 z-score) (22.3 - 31.2 95% (19.7 - 31.7 95% (22.6 - 33.5 95% C.I.) C.I.) C.I.) Prevalence of severe underweight (48) 7.9 % (29) 9.6 % (19) 6.3 % (<-3 z-score) (5.5 - 11.3 95% (6.0 - 15.1 95% (4.1 - 9.6 95% C.I.) C.I.) C.I.) Table (20): Prevalence of underweight based on weight-for-age z-scores by sex Temperate zone

All Boys Girls n = 434 n = 232 n = 202

Prevalence of underweight (167) 38.5 % (89) 38.4 % (78) 38.6 %

(<-2 z-score) (32.9 - 44.4 (32.3 - 44.8 (31.1 - 46.7 95% C.I.) 95% C.I.) 95% C.I.)

Prevalence of moderate underweight (128) 29.5 % (70) 30.2 % (58) 28.7 %

(<-2 z-score and >=-3 z-score) (24.3 - 35.3 (24.1 - 37.1 (21.6 - 37.0 95% C.I.) 95% C.I.) 95% C.I.)

Prevalence of severe underweight (39) 9.0 % (19) 8.2 % (20) 9.9 %

(<-3 z-score) (6.6 - 12.2 95% (5.1 - 12.9 95% (6.7 - 14.3 95% C.I.) C.I.) C.I.)

In Figure (5) shows how much the growth standards of children of each zone are diverging away from the international growth standards.

Figure( 2) : Observed distribution (WAZ) for Dry zone (Left) and Temperate zone (Right)

Table (21): Prevalence of underweight based on weight-for-age z-scores by sex in Sanaa governorate

All Boys Girls

n = 1037 n = 532 n = 505

Prevalence of underweight (375) 36.2 % (194) 36.5 % (181) 35.8 %

(<-2 z-score) (31.8 - 40.7 (31.3 - 41.9 (30.8 - 41.3 95% C.I.) 95% C.I.) 95% C.I.)

Prevalence of moderate underweight (288) 27.8 % (146) 27.4 % (142) 28.1 %

(<-2 z-score and >=-3 z-score) (24.2 - 31.6 (23.3 - 32.0 (23.4 - 33.4 95% C.I.) 95% C.I.) 95% C.I.)

Prevalence of severe underweight (87) 8.4 % (48) 9.0 % (39) 7.7 %

(<-3 z-score) (6.5 - 10.7 95% (6.5 - 12.4 95% (6.0 - 9.8 95% C.I.) C.I.) C.I.)

4.8.4 Stunting (HAZ) Indicators Stunting is an indicator of chronic (long-term) malnutrition which is mainly due to long term food deprivation, micronutrient deficiencies, recurrent illnesses and other factors which interrupt normal growth. Findings indicated an overall global chronic malnutrition prevalence of 60.3 % (53.9 - 66.3 95% C.I.), 51.6 % (44.4 - 58.7 95% C.I.) in Dry and Temperate respectively. Furthermore, the stunting prevalence of male children is higher than female children in Dry zone and almost equal in Temperate zone.

Table (22): Prevalence of stunting based on height-for-age z-scores and by sex Dry zone

All Boys Girls n = 526 n = 258 n = 268 Prevalence of stunting (317) 60.3 % (162) 62.8 % (155) 57.8 % (<-2 z-score) (53.9 - 66.3 (55.1 - 69.9 (50.1 - 65.2 95% C.I.) 95% C.I.) 95% C.I.) Prevalence of moderate stunting (203) 38.6 % (96) 37.2 % (107) 39.9 % (<-2 z-score and >=-3 z-score) (33.7 - 43.8 (29.9 - 45.2 (34.2 - 46.0 95% C.I.) 95% C.I.) 95% C.I.) Prevalence of severe stunting (114) 21.7 % (66) 25.6 % (48) 17.9 % (<-3 z-score) (16.7 - 27.6 (18.4 - 34.4 (12.6 - 24.8 95% C.I.) 95% C.I.) 95% C.I.)

Table (23): Prevalence of stunting based on height-for-age z-scores and by sex Temperate zone. All Boys Girls

n = 382 n = 206 n = 176

Prevalence of stunting (197) 51.6 % (106) 51.5 % (91) 51.7 %

(<-2 z-score) (44.4 - 58.7 (43.6 - 59.3 95% C.I.) (42.2 - 61.1 95% C.I.) 95% C.I.)

Prevalence of moderate stunting (138) 36.1 % (75) 36.4 % (63) 35.8 %

(<-2 z-score and >=-3 z-score) (30.5 - 42.2 (29.8 - 43.6 95% C.I.) (28.2 - 44.2 95% C.I.) 95% C.I.)

Prevalence of severe stunting (59) 15.4 % (31) 15.0 % (28) 15.9 %

(<-3 z-score) (11.7 - 20.1 (10.0 - 22.1 95% C.I.) (11.1 - 22.3 95% C.I.) 95% C.I.)

In Figure (6) shows the deviations of HAZ scores from the population international reference.

Figure (6): Observed distribution (HAZ) for Dry zone (Left) and Temperate zone(Right)

Table (24): Prevalence of stunting based on height-for-age z-scores and by sex in Sanaa governorate.

All Boys Girls n = 912 n = 464 n = 448

Prevalence of stunting (516) 56.6 % (268) 57.8 % (248) 55.4 % (<-2 z-score) (51.7 - 61.3 (52.7 - 62.7 (49.1 - 61.4 95% 95% C.I.) 95% C.I.) C.I.)

Prevalence of moderate stunting (341) 37.4 % (171) 36.9 % (170) 37.9 % (<-2 z-score and >=-3 z-score) (33.4 - 41.6 (31.4 - 42.7 (33.1 - 43.0 95% 95% C.I.) 95% C.I.) C.I.)

Prevalence of severe stunting (175) 19.2 % (97) 20.9 % (78) 17.4 % (<-3 z-score) (15.9 - 23.0 (16.1 - 26.7 (13.8 - 21.7 95% 95% C.I.) 95% C.I.) C.I.)

4.8.5 Change in Nutrition status between 2016 and 2018 When studying the GAM rates by WHZ results from 2016 to 2018 it shows decrease in both zones however, is only significant in Dry zone (p=0.0001 in Dry and p=0.433 in Temperate). While GAM rates by MUAC in Temperate zone increases slightly, but decreases in Dry zones. For Underweight (p=0.00in both) and stunting (p=0.02 in temperate) in both zones it increases from 2016 to 2018.this indicate that malnutrition is still a chronic issue in Sanaa governorate.

Figure (7). Changes in malnutrition levels in Dry strata between May-June 2016 and April-May 2018

underweight GAM by WHZ GAM by MUAC stunting 25 60 18 50 60.4 16 20 60.35 14 40 13.8 34.4 16 12 30 60.3 60.3 15 10 20 60.25 8 10 10 7.3 60.2 60.2 6 0 3 4 60.15 5 5.6 -10 2 60.1 -20 0 0 May-June 2016 April-May 2018 60.05 May-June April-May May-June April-May May-June April-May 2016 2018 2016 2018 2016 2018

Figure (8). Changes in malnutrition levels in Temperate zone between May-June 2016 and April-May 2018 GAM by WHZ GAM by MUAC Underweight stunting 10 7 70 60 9 60 8.4 6 50 8 5.7 50 7 7 5 40 38.5 40 6 4.6 30 5 4 30 20 4 3 10 3 20 1.1 2 2 0 10 1 -10 1 -20 0 0 May-June Apr-18 -30 0 May-June Apr-18 2016 May-June 2016 April-2018 May-June 2016 Apr-18 2016

In tables below, indicates the mean z-scores, design effects and excluded subjects in each zone and for each malnutrition indicator.

Table (25): Mean z-scores, Design Effects and excluded subjects Dry zone Indicator n Mean z-scores ± Design Effect (z- z-scores not z-scores out of SD score < -2) available* range)exclude subjects) 0-59 months Weight-for-Age 604 -1.61±0.96 2.48 5 1 6-59 months Weight-for-Height 532 -0.59±0.88 1.01 4 1

Height-for-Age 526 -2.22±1.07 2.08 4 7 * contains for WHZ and WAZ the children with edema Table (26): Mean z-scores, Design Effects and excluded subjects Temperate zone Indicator n Mean z-scores ± Design Effect (z- z-scores not z-scores out of SD score < -2) available* range 0-59 months Weight-for-Age 434 -1.64±1.00 1.50 9 1 6-59 months Weight-for-Height 385 -0.66±0.90 1.05 8 3

Height-for-Age 382 -2.04±1.06 1.93 8 6 * contains for WHZ and WAZ the children with edema.

4.9 Child Morbidity and Immunization In the survey, morbidity data was collected among children 6-59 months (two-week recall) to assess the occurrence of main diseases. Results showed that Half of children were reportedly sick of fever in both zones 54% ,47% in Dry and Temperate zone respectively.

Table (27): Prevalence of child Morbidity (2-week recall period) in Dry and Temperate zone.

Dry zone Temperate zone Frequency(%) 95%CI Frequency( 95%CI %) Cough 214 (35.4%) 31.7-39.3 152(34.9%) 30.6-39.5 Breathing Difficulty Diarrhea 260(43.5%) 39.6-47.5 149(34.3%) 29.9-38.8

Fever 330(54.7%) 50.7-58.7 203(47%) 42.3-51.7

4.10 Infant and Young Child Feeding (IYCF) Practices Among children from 0 to 23 months, 70.2%, 60.9% in Dry and Temperate respectively were breastfed exclusively during the night before the survey, while exclusive breastfeeding for children under 6 months was 20.8% in Dry zone which is higher than the national indicator. However, it was only 8.5% in Temporal zone and it is lower than the national indicator. Almost 20% of children continues to breastfeed for up to two years in both zones. It is also found that feeding practices for young children are inappropriate. Although more than half of breastfed and breastfeeding children between the ages of 6-23 months have the appropriate number of meals, only 23%,38.8% of children in this age group receive the various acceptable diets (consisting of 4 or more food groups) in Dry and Temperate zones respectively. Minimum Acceptable Diet levels are low at 9.1%,20% in Dry and Temperate zones respectively.

Figure (9). Complementary feeding practice in children aged 6 to 23 months in both zone.

Complementary feeding practice in children aged 6-23 months

80% 73.5% 70% 66.3% 60% 50% 38.8% 40% 30% 23% 20.0% 20% 9.1% 10% 0% Minimum Minimum Minimum dietary meal acceptable diversity frequency diet Dry zone Temperate zone

Table (28): IYCF indicator Dry zone Temperate zone Indicator N)%) 95% CI N(%) 95% CI Breastfed yesterday 188(72.3) 66.4%-77.7% 109)60.9( 53.3%-68.1% Exclusive breastfeeding 15(20.8) 12.2%-32% 4)8.5( 2.4%-20.4% Continued breastfeeding at 1 year 28(65.1) 49.1%-79% 13)52( 31.3%-72.2% Continued breastfeeding at 2 years 6(20) 7.7%-38.6% 7)20.6( 8.7%-37.9%

Minimum dietary diversity 44)23( 17.3%-29.7% 52)38.8( 30.5%- 47.6%

Minimum meal frequency 124(66.3) 59.1%-73% 97(73.5) 65.1%-80.8% Minimum acceptable diet 17(9.1) 5.4%-14.2% 26)20( 13.5%- 27.9%

4.11 Vitamin A supplementation and child vaccination Immunization coverage in Dry zone either for measles or polio (3 doses) by card and recall is higher than Temperate zone. In addition, children are also the lowest in receiving vitamin A supplementation in the last six months prior to assessment especially in the Dry zone.

Table (29): Vitamin A supplementation and child vaccination Dry zone Temperate zone Indicator N(%) % (95% CI) N(.l’\%) % (95% CI) Vitamin A supplementation within 16.4%- the last 6 months (for children aged 6 104(19.5) 113 (29.3) 25%-34% 23.1% to 59 months) Routine polio vaccination (by card) 15.9%- among children aged 3 months and 101(19) 128 (33.2) 28.7%-38% 22.5% above Routine polio vaccination (by recall) 51.2%- among children aged 3 months and 295(55.5) 147 (38.1) 33.4%-43% 59.6% above Routine polio vaccination (by card and recall) among children aged 3 396(74.4) 70.6%-78% 275 (71.2) 66.5%-75.5% months and above Measles vaccination (by card) among 14.8%- 89(17.9) 108 (30) 25.5%-34.9% children aged 9 months and above 21.5% Measles vaccination (by recall) 48.9%- among children aged 9 months and 265(53.3) 140 (38.9) 34%-44% 57.7% above Measles vaccination (by card and recall) among children aged 9 354(71.1) 67%-74.9% 248 (68.8) 64%-73.5% months and above

4.12 Child Mortality The results of the survey showed that the total crude death rate was 0.35and 0.21 per 10,000 populations / day during the period of recall 151.5 and 145 days (since the anniversary of the birth of the Prophet 2018) in Dry and Temperate zone respectively, while the children under five years mortality rate was 0.71and 0.78 per 10,000 / day in Dry and Temperate zone respectively. Table (30): Death rates in the two survey strata of Sanaa Governorate. Dry zone Temperate zone Death Rate (95% Design Death Rate (95% Design Effect CI) Effect CI) Overall (CDR) 0.35 (0.19-0.64) 1.24 0.21 (0.11-0.41) 1.11

Sex Male 0.38 (0.17-0.87) 1.16 0.29 (0.13-0.66) 1.10

Female 0.31 (0.12-0.78) 1.27 0.12 (0.04-0.38) 1.00

Years 0 – 4 yrs 0.71 (0.27-1.84) 1.00 0.78(0.27-2.20) 1.33 (U5DR)

5 – 11 yrs 0 1.00 0 1.00 12 – 17 yrs 0.17 (0.02 - 1.28) 1.00 0 1.00 18-49 yrs 0.22 (0.07-0.68) 1.00 0 1.00 50-64 yrs 0 1.00 1.00 (0.32-3.05) 1.00 65-120 yrs 3.05 (1.04-8.60) 1.41 1.00 (0.23-4.12) 1.02

4.13 Mid-Upper Arm Circumference (MUAC) Measurement for Women Women malnutrition can lead to increased susceptibility to infections, slow recovery from illness, and increase the risk of adverse pregnancy outcomes which in turn increases the risk of malnutrition for herself and her baby. Women of reproductive age (15-49 years) and pregnant & lactating women were included in the survey analysis where MUAC measurements were taken. The cut-off less than 22.2 cm for women to assess their MUAC nutritional status were used. The mid-upper arm circumference index for women of childbearing age (15-49) in the survey indicated that more than a quarter of lactating and pregnant women suffer from global acute malnutrition (32.9,33.6%)in Dry and Temperate respectively, while severe acute malnutrition was less than quarter in lactating and pregnant women (19.2, 22.2%) in both zones respectively. Table )31). Acute malnutrition among women at child bearing age Indicator Dry Temperate Global acute Severe acute Global acute Severe acute malnutrition malnutrition malnutrition malnutrition N (%) (95% CI) N (%) (95% N (%) (95% CI) N (%) (95% CI) CI) Women at child bearing age (15 – 49 years) 135(15.7)(13.4-18.3) 4(0.5)(0.2-1.2) 84(11,1)(9-13.6) 3(0.4)(0.14-1.2) Lactating mothers 20(19.2)(12.2- 56(32.9)(25.9-40.6) 1(0.6)(0-3.2) 28.1) 0 Pregnant women 20(22.2)(14.1- 37(33.6)(24.9-43.3) 0 32.2) 0 Neither lactating nor pregnant 42(7.3)(5.4-9.7) 3(0.5)(0.2-1.5) 44(7.9)(5.9-10.4) 3(0.5)(0.2-1.6) 4.14 Associations of the nutritional status Acute malnutrition In Sanaa governorate, severe acute malnutrition (wasting) according to the weight-for-height index was associated with diarrhea in children in Temperate zone, where the statistical significance was p= 0.03 which is less than 0.05, as shown in table (32) It was also found that acute malnutrition (wasting) according to the index of MUAC has relation to diarrhea in children in both zones, where the statistical significant test was p= 0.004 and 0.009 in Dry and Temperate zones respectively and it is less than 0.05 as the table (33) showed. And when studying acute malnutrition using combined indices (WFH and MUAC), there found a relation to diarrhoea in children in Temperate zone, where the statistical significant test was p= 0.002 as shown in table (34). study the relationship between children malnutrition status and some of the HHs important characteristics, food security, and type of source of water had no statistical significant

Table (32). Associations of acute malnutrition (by WHZ) Indicator Acute Statistical Acute Statistical test malnutrition test malnutrition (by (by WHZ) WHZ) N(%) N% Dry temperate Diarrhea (n=525) OR=1.02 Diarrhea (n=382) OR=2.4 95% CI (0.5- 95% CI (1.1-5.4) Yes (n=225) 13(5.8) Yes (n=135) 15(11.1) 2.1) X2=4.3 No (n=300) 17(5.7) X2=0.003 No (n=247) 12(4.9) P=0.03 P=0.95 fever (n=530) OR=1.4 fever (n=382) OR=1.7 95% CI (0.9- 95% CI (0.7-3.9) Yes (n=289) 19(6.6) Yes (n=192) 17(8.9) 3.1) X2=0.6 X2=1.4 No (n=241) 11(4.6) P=0.4 No (n=190) 10(5.3) P=0.2

Cough, breathing OR=0.9 Cough, breathing OR=0.4 difficulties n= 95% CI (0.4- difficulties n= 95% CI (0.1-0.9) 10(5.2) 5(3.6) (531) 1.9) X2=0.02 (382) X2=3.4 20(5.9) P=0.9 22(9.1) P=0.06 Yes (n=193) Yes (n=141)

No (n=338) No (n=241) Table (33): Associations of acute malnutrition (by MUAC) Indicator Acute Statistical test Acute Statistical test malnutrition malnutrition (by (by MUAC) MUAC N(%) N% Indicator Acute Statistical test Acute Statistical test malnutrition malnutrition (by (by MUAC) MUAC N(%) N% Dry temperate Diarrhea (n=525) OR=2.8 Diarrhea OR=3.4 95% CI (1.4- (n=386) 95% CI (1.4-8.4) Yes (n=224) 25(11.2) 14(10.2) 5.6) X2=8 X2=6.8 Yes (n=137) No (n=301) 13(4.3) P=0.004 8(3.2) P=0.009 No (n=249) fever (n=530) OR=1.7 fever (n=386) OR=2.2 95% CI (0.9- 95% CI (0.9-5.5) Yes (n=289) 26(9.0) Yes (n=195) 15(7.7) 3.5) X2=2 X2=2.2 No (n=241) 13(5.4) P=0.6 No (n=191) 7(3.7) P=0.1

Cough, breathing OR=0.9 Cough, OR=0.6 difficulties n= 95% CI (0.4- breathing 95% CI (0.2-1.6) 13(6.7) 6(4.2) (531) 1.7) X2=0.05 difficulties n= X2=0.6 26(7.7) P=0.8 (386) 16(6.6) P=0,5 Yes (n=193)

Yes (n=143) No (n=338) No (n=243) Table (34): Associations of acute malnutrition (by combined) Indicator Acute Statistical test Acute Statistical test malnutrition malnutrition (by (by combined) combined) N(%) N% Dry temperate Diarrhea (n=526) OR=1.7 Diarrhea OR=2.9 95% CI (1.0- (n=386) 95% CI (1.5-5.8) Yes (n=225) 30(13.3) 23(16.8) 3.0) X2=3 X2=9.3 Yes (n=137) No (n=301) 25(8.3) P=0.08 16(6.4) P=0.002 No (n=249) fever (n=531) OR=1.6 fever (n=386) OR=1.6 95% CI (0.9- 95% CI (0.8-3.2) Yes (n=289) 36(12.5) Yes (n=195) 24(12.3) 2.8) X2=2 X2=1.6 No (n=242) 20(8,3) P=0.1 No (n=191) 15(7.8) P=0.2

Cough, breathing OR=0.7 Cough, breathing OR=0.6 difficulties n= 95% CI (0.4- difficulties n= 95% CI (0.3-1.2) 16(8.3) 10(7) (532) 1.2) X2=1.3 (386) X2=1.9 40(11.8) P=0.2 29(11.9) P=0.2 Yes (n=193) Yes (n=143)

No (n=339) No (n=243)

5-Recommendations

 Strengthen a minimum services package in coverage of integrated health and nutrition services at the primary health care centers. A coordinated approach with a focus on maternal, infant and young child nutrition should be adopted, with a special focus on infant and young child feeding practices IYCF and maternal nutrition programmes (IMCI + nutrition)  As part of health and nutrition services, urgent need to scale up of CMAM services (OTP). The out-patient therapeutic program should be scaled up in the area and increase its coverage by setting up the program in high priority areas to address the severely malnourished children as a priority.  Integrate basic water, sanitation & health (WASH) approach for the interventions being implemented in Sanaa governorate.  Community screening of under-fives and active case finding and defaulter tracing should be adopted by the community linked at the primary healthcare centers.  Strengthen the community referral system for malnourished children and pregnant and lactating women with a special focus on the inaccessible communities.  Expansion of a Blanket Supplementary Feeding Program for children 6-59 months which suffer of moderately malnourished children as evidenced by the survey results. Pregnant and lactating women should also be considering for nutritional supplementation  Increased advocacy efforts for the acute malnutrition treatment or related emergency nutrition response at the national level.  rehabilitation of the exiting primary health care centers in order to improve an integrated health and nutrition implementation which should be strengthened by joint supervision by the MOPH and partners

6-References:

1-SMART methodology was conducted in Sana'a governorate in May-June 2016 2-Demographic Survey for Family Health in 2013 3-Emergency Food Security and Nutrition Assessment in November. EFSNA 2016 4- Comprehensive Food Security Survey 2014 5- Central Statistic organization 6- Estimation of EPI 7- Comprehensive Food Security Survey (CFSS)2011,2014 Annex(1)Area excluded from Dry zone

رمز المحافظة المحافظة رمز ال مديرية المديرية رمز العزلة العزلة رمز الحي الحي رمز المدينة/القرية المدينة/القرية

23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 1 بين الحمام 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 101 الناع 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 102 الصفيراء 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 103 الخليف 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 104 الشوالن 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 105 قرض 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 106 المعلق 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 107 وادي شاهر 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 108 علكم 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 109 اثيبه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 110 الخالف 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 111 االفيراع 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 112 نعمان االعلى 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 113 زعالن 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 114 الكيحل 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 115 الضويلع 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 116 الفرحة 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 117 الحمدات 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 118 قلت 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 119 نسالء 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 120 المنترى 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 121 العوسجي االعلى 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 122 الكوله الحمراء 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 123 السمره 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 124 الفدفدة 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 125 االحوال 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 126 السرين 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 127 الكوله 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 128 نعمان االسفل 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 129 الشويحط 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 130 الجالحب 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 131 رحب 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 132 نونا 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 133 جبل صغير 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 134 الحزم 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 135 حميد 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 136 كولة العرفط 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 137 الصدور 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 138 فرثع 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 139 الحفاه السفلى 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 140 خليف الذهب 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 141 دعام 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 142 العرام 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 143 العارضه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 144 رشوم 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 145 صودر 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 146 المسياب 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 147 القلعه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 148 الكميش 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 149 االواس 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 150 الشرطه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 151 الحجفه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 152 ذوين 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 153 الدجيرة 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 154 المقهل 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 155 نبعه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 156 الوقيطين 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 157 الجنافير 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 158 الضيه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 159 السفيت 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 160 العسيله 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 161 الحريض 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 162 الثجي 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 163 حبابض 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 164 حضيه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 165 توان 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 166 العقاد 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 167 نون 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 168 عرشا 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 169 الشواك 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 170 عقله 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 171 عرس االعلى 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 172 عرس االسفل 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 173 شوحط 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 174 وعل 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 175 الحرجه لبخ 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 176 الرصفه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 177 درع 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 178 قراءو 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 179 الخدره 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 180 خليف القبه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 181 الروضه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 182 الذراع 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 183 القمله 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 184 العرفط 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 185 صيفاء 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 186 الشريه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 187 الخبه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 188 القصر 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 189 الحد 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 190 الروضه العرقين 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 191 الزيده 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 192 السود 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 193 الحمر 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 195 الباقم 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 196 الخدروج 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 197 الجراول 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 198 مرتفعات شاهر 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 199 بالساء 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 200 السوس 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 201 الشرز 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 202 النشفه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 203 وادي الالل 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 204 المسينخ 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 205 الزغن 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 206 شروب 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 207 وادي عروسة 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 208 محجب السفلى 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 209 القابلة 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 211 تحت النقيل 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 212 وناء 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 213 الفجوه 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 214 الجحيله 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 215 الحفاه العليا 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 216 موقع 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 219 امشان على سالم 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 220 ترسم 23 صنعاء 14 بني ضبيان 21 بني ضبيان 0 221 رحب عشره Annex(2)Area excluded from Temperate zone

رمز المحافظة المحافظة رمز ال مديرية المديرية رمز العزلة العزلة رمز الحي الحي رمز المدينة/القرية المدينة/القرية

23 صنعاء 3 نهم 21 عيال صياد 0 101 جبل العوران 23 صنعاء 3 نهم 21 عيال صياد 0 102 بهمان 23 صنعاء 3 نهم 21 عيال صياد 0 103 الجبيله 23 صنعاء 3 نهم 21 عيال صياد 0 104 ثومه 23 صنعاء 3 نهم 21 عيال صياد 0 105 المحاجر 23 صنعاء 3 نهم 21 عيال صياد 0 106 هجرة المكته 23 صنعاء 3 نهم 21 عيال صياد 0 107 خلقه السفلى 23 صنعاء 3 نهم 21 عيال صياد 0 108 الهياثم 23 صنعاء 3 نهم 21 عيال صياد 0 109 خلقه العليا 23 صنعاء 3 نهم 21 عيال صياد 0 110 حجر المصياد 23 صنعاء 3 نهم 21 عيال صياد 0 111 بيت حمران 23 صنعاء 3 نهم 21 عيال صياد 0 112 ظريمه 23 صنعاء 3 نهم 21 عيال صياد 0 113 الجرف 23 صنعاء 3 نهم 21 عيال صياد 0 114 الغيظه 23 صنعاء 3 نهم 21 عيال صياد 0 115 المعمل 23 صنعاء 3 نهم 21 عيال صياد 0 116 جبل القاريه 23 صنعاء 3 نهم 21 عيال صياد 0 117 حوره العليا 23 صنعاء 3 نهم 22 عيال منصور 1 عيال منصور 1 بيت العذري 23 صنعاء 3 نهم 22 عيال منصور 0 101 المجهله 23 صنعاء 3 نهم 22 عيال منصور 0 102 بني شيبان 23 صنعاء 3 نهم 22 عيال منصور 0 103 بني معصار 23 صنعاء 3 نهم 22 عيال منصور 0 104 جبل القاريه 23 صنعاء 3 نهم 22 عيال منصور 0 105 الوقشه 23 صنعاء 3 نهم 23 الحنشات 0 101 عصر 23 صنعاء 3 نهم 23 الحنشات 0 102 بيت عاصم 23 صنعاء 3 نهم 23 الحنشات 0 103 العصرات 23 صنعاء 3 نهم 23 الحنشات 0 104 قوبره 23 صنعاء 3 نهم 23 الحنشات 0 105 المعادي 23 صنعاء 3 نهم 23 الحنشات 0 106 غول علي 23 صنعاء 3 نهم 23 الحنشات 0 107 بني فراص 23 صنعاء 3 نهم 23 الحنشات 0 108 بني ناجى 23 صنعاء 3 نهم 23 الحنشات 0 109 العقران 23 صنعاء 3 نهم 23 الحنشات 0 110 وادى لصف 23 صنعاء 3 نهم 23 الحنشات 0 111 المجاوحه 23 صنعاء 3 نهم 23 الحنشات 0 112 جبل يام 23 صنعاء 3 نهم 23 الحنشات 0 113 الخارد 23 صنعاء 3 نهم 23 الحنشات 0 114 البهدلي 23 صنعاء 3 نهم 23 الحنشات 0 115 بني سارى 23 صنعاء 3 نهم 23 الحنشات 0 116 ضبوعه 23 صنعاء 3 نهم 23 الحنشات 0 117 هران 23 صنعاء 3 نهم 23 الحنشات 0 118 النجاد 23 صنعاء 3 نهم 23 الحنشات 0 119 بيت شبانه 23 صنعاء 3 نهم 23 الحنشات 0 120 بني شلغف 23 صنعاء 3 نهم 23 الحنشات 0 121 بني قطران 23 صنعاء 3 نهم 23 الحنشات 0 122 الحرشفه 23 صنعاء 3 نهم 23 الحنشات 0 123 مزدان 23 صنعاء 3 نهم 23 الحنشات 0 124 البثيعه 23 صنعاء 3 نهم 23 الحنشات 0 125 الوقيط 23 صنعاء 3 نهم 23 الحنشات 0 126 بني شكوان 23 صنعاء 3 نهم 23 الحنشات 0 127 مدفون 23 صنعاء 3 نهم 24 عيال غفير 0 101 ثاجر 23 صنعاء 3 نهم 24 عيال غفير 0 102 بيت عرامان 23 صنعاء 3 نهم 24 عيال غفير 0 103 النخيله 23 صنعاء 3 نهم 24 عيال غفير 0 104 الثميلة 23 صنعاء 3 نهم 24 عيال غفير 0 105 الحنيكه 23 صنعاء 3 نهم 24 عيال غفير 0 106 بني صبر 23 صنعاء 3 نهم 24 عيال غفير 0 107 الحضن 23 صنعاء 3 نهم 24 عيال غفير 0 108 كيم 23 صنعاء 3 نهم 24 عيال غفير 0 109 الجشاء 23 صنعاء 3 نهم 24 عيال غفير 0 110 هيناء 23 صنعاء 3 نهم 24 عيال غفير 0 111 النمصه 23 صنعاء 3 نهم 24 عيال غفير 0 112 الحقل 23 صنعاء 3 نهم 24 عيال غفير 0 113 الذراع 23 صنعاء 3 نهم 24 عيال غفير 0 114 جبل يام 23 صنعاء 3 نهم 24 عيال غفير 0 115 البزه 23 صنعاء 3 نهم 24 عيال غفير 0 116 الضبيعه 23 صنعاء 3 نهم 24 عيال غفير 0 117 وادى نمله 23 صنعاء 3 نهم 24 عيال غفير 0 118 جبل صلب 23 صنعاء 3 نهم 24 عيال غفير 0 119 ال سعد 23 صنعاء 3 نهم 24 عيال غفير 0 120 ال خريص 23 صنعاء 3 نهم 24 عيال غفير 0 121 النعيمات 23 صنعاء 3 نهم 24 عيال غفير 0 122 الشريه 23 صنعاء 3 نهم 24 عيال غفير 0 123 العبادل 23 صنعاء 3 نهم 24 عيال غفير 0 124 شيحان 23 صنعاء 3 نهم 24 عيال غفير 0 125 القريه 23 صنعاء 3 نهم 24 عيال غفير 0 126 ديره 23 صنعاء 3 نهم 24 عيال غفير 0 127 بران 23 صنعاء 3 نهم 24 عيال غفير 0 128 ال سكان 23 صنعاء 3 نهم 24 عيال غفير 0 129 المدفون 23 صنعاء 3 نهم 25 مرهبة 0 101 قطبين 23 صنعاء 3 نهم 25 مرهبة 0 102 حقه بنى غالب 23 صنعاء 3 نهم 25 مرهبة 0 103 عيال حسين 23 صنعاء 3 نهم 25 مرهبة 0 104 غوله الحنشات 23 صنعاء 3 نهم 25 مرهبة 0 105 االشراف 23 صنعاء 3 نهم 25 مرهبة 0 106 بني صاع 23 صنعاء 3 نهم 25 مرهبة 0 107 وادي محلي 23 صنعاء 3 نهم 25 مرهبة 0 108 عيال محمد 23 صنعاء 12 خوالن 22 حباب آل حنتش 0 101 سبيتين 23 صنعاء 12 خوالن 22 حباب آل حنتش 0 102 الحاجب 23 صنعاء 12 خوالن 22 حباب آل حنتش 0 104 الوتده 23 صنعاء 12 خوالن 22 حباب آل حنتش 0 106 الخليوات الحسيني 23 صنعاء 12 خوالن 22 حباب آل حنتش 0 107 فرعه 23 صنعاء 12 خوالن 22 حباب آل حنتش 0 108 الرميش 23 صنعاء 12 خوالن 22 حباب آل حنتش 0 109 اميمه 23 صنعاء 12 خوالن 24 المكير اللغباء 0 101 وسا المكير 23 صنعاء 12 خوالن 24 المكير اللغباء 0 102 المكير االعلى 23 صنعاء 12 خوالن 24 المكير اللغباء 0 103 المكير االسفل 23 صنعاء 12 خوالن 24 المكير اللغباء 0 104 المجاعير 23 صنعاء 12 خوالن 24 المكير اللغباء 0 105 المجزعه 23 صنعاء 12 خوالن 24 المكير اللغباء 0 106 الغدير 23 صنعاء 12 خوالن 24 المكير اللغباء 0 107 فرع المجزعه 23 صنعاء 12 خوالن 24 المكير اللغباء 0 108 مروح المكير 23 صنعاء 12 خوالن 24 المكير اللغباء 0 109 كريشه

Annex (3) Table of clusters of Dry zone

رمز المحافظة المحافظة رمز المديرية المديرية رمز العزلة العزلة رمز الحي الحي رمز المدينة/القرية المدينة/القرية عدد األسر Cluster

23 صنعاء 8 الحيمه الداخليه 21 الحدب 0 103 بيت ذره 49 595 1 23 صنعاء 8 الحيمه الداخليه 21 الحدب 0 122 دار البرك 174 1706 2 23 صنعاء 8 الحيمه الداخليه 22 بني عمرو 0 110 نعام 86 731 3 23 صنعاء 8 الحيمه الداخليه 23 بني السياغ 0 111 يعر 141 1961 4 23 صنعاء 8 الحيمه الداخليه 24 االحبوب 0 102 باعر 39 557 5 23 صنعاء 8 الحيمه الداخليه 24 االحبوب 0 116 بيت الكبش 67 746 6 23 صنعاء 8 الحيمه الداخليه 24 االحبوب 0 131 بيت الشعيبي 69 876 7 23 صنعاء 8 الحيمه الداخليه 26 بني مهلهل 0 103 ذوله 21 271 8 23 صنعاء 8 الحيمه الداخليه 26 بني مهلهل 0 131 الزواهره 28 360 9 23 صنعاء 8 الحيمه الداخليه 27 بالد القبائل 0 117 الصوبات 91 1750 10 23 صنعاء 8 الحيمه الداخليه 27 بالد القبائل 0 139 جبل مطرد 32 459 11 23 صنعاء 8 الحيمه الداخليه 28 بني النمري 0 115 الجلب 115 1424 12 23 صنعاء 8 الحيمه الداخليه 28 بني النمري 0 125 بيت اليسرى 81 980 13 23 صنعاء 8 الحيمه الداخليه 29 بني يوسف 0 114 بني احمد 26 304 14 23 صنعاء 8 الحيمه الداخليه 30 بني الحذيفي 0 111 وادي دايان 59 548 15 23 صنعاء 8 الحيمه الداخليه 30 بني الحذيفي 0 133 بيت البوص الزكريه 29 286 16 23 صنعاء 9 الحيمه الخارجيه 23 االعروش 0 104 السواده 24 233 17 23 صنعاء 9 الحيمه الخارجيه 30 يادع 0 106 المالوي 41 423 18 23 صنعاء 9 الحيمه الخارجيه 31 بني سليمان 0 114 بيت الرميم 55 756 19 23 صنعاء 9 الحيمه الخارجيه 33 المخالف 0 113 بيت غوبر 84 1033 20 23 صنعاء 9 الحيمه الخارجيه 35 بيت ابن مهدي 0 101 بيت ابن مهدي 33 363 21 23 صنعاء 9 الحيمه الخارجيه 36 بني بجير 0 126 الكديه 40 299 22 23 صنعاء 9 الحيمه الخارجيه 41 السدس 0 105 الشريفه 15 131 23 23 صنعاء 9 الحيمه الخارجيه 45 بيت الجريدي 0 101 السلعي 26 263 24 23 صنعاء 9 الحيمه الخارجيه 49 ضابي سهام 0 101 الغفر 90 834 25 23 صنعاء 10 مناخة 21 مناخة 1 مناخة 1 مناخة العليا 171 1676 26 23 صنعاء 10 مناخة 25 بني اسحاق 0 104 بني اسحاق 60 534 27 23 صنعاء 10 مناخة 27 االغمور 0 102 االجالب 69 851 28 23 صنعاء 10 مناخة 28 السدس وبني عطاء0 103 بني مرح 146 1640 29 23 صنعاء 10 مناخة 29 بني خطاب 0 126 اهتن 13 202 30 23 صنعاء 10 مناخة 31 المغارب السفلى 0 106 القبال 28 305 31 23 صنعاء 10 مناخة 32 حصبان 0 128 النقيل 35 526 32 23 صنعاء 10 مناخة 33 لهاب 0 111 شيبة 35 313 33 23 صنعاء 10 مناخة 36 بني مقاتل 0 103 الرياع 28 255 34 23 صنعاء 10 مناخة 37 هوزان 0 101 هجرة الحصن 286 3665 35 23 صنعاء 10 مناخة 38 مسار 0 103 بيت شمران 175 1937 36 23 صنعاء 10 مناخة 38 مسار 0 114 القدم 114 1225 37 23 صنعاء 11 صعفان 21 متوح 0 111 الهجره 24 274 38 23 صنعاء 11 صعفان 23 بني جربن 0 103 الزبيه 131 1124 39 23 صنعاء 11 صعفان 25 بني اسحاق 0 101 المسيل 77 728 40 23 صنعاء 11 صعفان 26 بني عراف 0 106 الجميمه 87 956 41 23 صنعاء 11 صعفان 28 الطرف 0 103 دهو الدار 214 1664 42 23 صنعاء 9 الحيمه الخارجيه 27 الجحادب 0 109 شمسان RC 293 20 23 صنعاء 10 مناخة 21 مناخة 1 مناخة 1 دار الجالس RC 612 57 23 صنعاء 10 مناخة 23 بني حسن وحسين 0 118 المحراس RC 210 18 23 صنعاء 10 مناخة 33 لهاب 0 128 الجذوة RC 322 36 23 صنعاء 11 صعفان 27 مدول 0 102 الرحبه RC 801 97

Annex (4) Table of clusters of Temperate zone

اجمالي المحافظة المديرية العزلة المدينة/القرية عدد األسر الذكور األناث اجمالي 2004 العناقيد 2017 صنعاء همدان ربع همدان حصن الراس 77 328 303 631 987 1 صنعاء همدان وادعه الحطاب 273 1139 1137 2276 3562 2 صنعاء همدان وادعه العره العليا 272 1022 973 1995 3122 3 صنعاء همدان بني مكرم ضروان 340 1513 1423 2936 4595 4 صنعاء أرحب بني على حق الهيج 46 205 194 399 624 5 صنعاء أرحب شاكر بيت سواء 38 132 144 276 432 6 صنعاء أرحب بني سليمان بيت هارون 32 149 151 300 469 7 صنعاء أرحب هزم يحيص 334 1463 1448 2911 4556 8 صنعاء بنى حشيش عيال مالك بنى يزيد 79 301 323 624 977 9 صنعاء بنى حشيش صرف الملكه 409 1816 1669 3485 5454 10 صنعاء بنى حشيش عضران بيت النخيف 212 1010 953 1963 3072 11 صنعاء بنى حشيش الشرفه بنى داود 99 410 429 839 1313 12 صنعاء سنحان وبني بهلول الحمس العدني جوب 269 1028 1085 2113 3307 13 صنعاء سنحان وبني بهلول صرفةودجة دجة 200 679 621 1300 2034 14 صنعاء سنحان وبني بهلول الربع الغربي المحاقرة 260 1032 1001 2033 3182 15 صنعاء سنحان وبني بهلول الربع الغربي بئر الهذيل 139 529 486 1015 1588 16 صنعاء سنحان وبني بهلول الفروات دار عمر 116 451 421 872 1365 17 صنعاء بالد الروس ربع العبس الجار 224 734 680 1414 2213 18 صنعاء بالد الروس ربع اوالد حسن عافش 154 671 657 1328 2078 19 صنعاء بنى مطر ديان رهم العليا 207 780 819 1599 2502 20 صنعاء بنى مطر جنب الحمراء 20 63 60 123 192 21 صنعاء بنى مطر شهاب االسفل ريد 133 637 522 1159 1814 22 صنعاء بنى مطر الحدب نقبه 27 128 133 261 408 23 صنعاء خوالن االعروش السرو 78 429 392 821 1285 24 صنعاء خوالن بني شداد وادي مالحه 116 536 493 1029 1610 25 صنعاء الطيال بني جبر االجرف 10 91 100 191 299 26 صنعاء الطيال جبل ال لوز شوبان 173 655 668 1323 2070 27 صنعاء الحصن اليمانية العليا الهجره 10 53 49 102 160 28 صنعاء جحانه اليمانية السفلى المصنعه 136 500 493 993 1554 29 صنعاء جحانه حضر اسل 184 1125 949 2074 3246 30

صنعاء همدان ربع همدان المنقب RC 3449 2204 1077 1127 234 صنعاء أرحب شعب بيت مهدي RC 466 298 139 159 43 صنعاء بنى مطر البرويه قوبه RC 380 243 117 126 31 صنعاء الحصن اليمانية العليا النوابه RC 1042 666 331 335 73

Annex 5: Sana’a Governorate Nutrition Survey Questionnaire, April-May 2018

Annex (6): Assessment Quality Check of Dry zone

Plausibility check for: Sanaa DH April-May 2018

Standard/Reference used for z-score calculation: WHO standards 2006 (If it is not mentioned, flagged data is included in the evaluation. Some parts of this plausibility report are more for advanced users and can be skipped for a standard evaluation)

Overall data quality

Criteria Flags* Unit Excel. Good Accept Problematic Score

Flagged data Incl % 0-2.5 >2.5-5.0 >5.0-7.5 >7.5 (% of out of range subjects) 0 5 10 20 0 (0.2 %)

Overall Sex ratio Incl p >0.1 >0.05 >0.001 <=0.001 (Significant chi square) 0 2 4 10 0 (p=0.517)

Age ratio(6-29 vs 30-59) Incl p >0.1 >0.05 >0.001 <=0.001 (Significant chi square) 0 2 4 10 0 (p=0.474)

Dig pref score - weight Incl # 0-7 8-12 13-20 > 20 0 2 4 10 0 (3)

Dig pref score - height Incl # 0-7 8-12 13-20 > 20 0 2 4 10 0 (7)

Dig pref score - MUAC Incl # 0-7 8-12 13-20 > 20 0 2 4 10 0 (4)

Standard Dev WHZ Excl SD <1.1 <1.15 <1.20 >=1.20 . and and and or . Excl SD >0.9 >0.85 >0.80 <=0.80 0 5 10 20 5 (0.88)

Skewness WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6 0 1 3 5 0 (-0.02)

Kurtosis WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6 0 1 3 5 0 (-0.05)

Poisson dist WHZ-2 Excl p >0.05 >0.01 >0.001 <=0.001 0 1 3 5 0 (p=0.515)

OVERALL SCORE WHZ = 0-9 10-14 15-24 >25 5 %

The overall score of this survey is 5 %, this is excellent.

Annex (7): Assessment Quality Check of Temperate zone

Plausibility check for: Sanaa TH April 2018

Standard/Reference used for z-score calculation: WHO standards 2006 (If it is not mentioned, flagged data is included in the evaluation. Some parts of this plausibility report are more for advanced users and can be skipped for a standard evaluation)

Overall data quality

Criteria Flags* Unit Excel. Good Accept Problematic Score

Flagged data Incl % 0-2.5 >2.5-5.0 >5.0-7.5 >7.5 (% of out of range subjects) 0 5 10 20 0 (0.8 %)

Overall Sex ratio Incl p >0.1 >0.05 >0.001 <=0.001 (Significant chi square) 0 2 4 10 0 (p=0.132)

Age ratio(6-29 vs 30-59) Incl p >0.1 >0.05 >0.001 <=0.001 (Significant chi square) 0 2 4 10 0 (p=0.766)

Dig pref score - weight Incl # 0-7 8-12 13-20 > 20 0 2 4 10 0 (6)

Dig pref score - height Incl # 0-7 8-12 13-20 > 20 0 2 4 10 0 (7)

Dig pref score - MUAC Incl # 0-7 8-12 13-20 > 20 0 2 4 10 0 (6)

Standard Dev WHZ Excl SD <1.1 <1.15 <1.20 >=1.20 . and and and or . Excl SD >0.9 >0.85 >0.80 <=0.80 0 5 10 20 5 (0.90)

Skewness WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6 0 1 3 5 0 (-0.10)

Kurtosis WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6 0 1 3 5 0 (-0.19)

Poisson dist WHZ-2 Excl p >0.05 >0.01 >0.001 <=0.001 0 1 3 5 0 (p=0.387)

OVERALL SCORE WHZ = 0-9 10-14 15-24 >25 5 %

The overall score of this survey is 5 %, this is excellent.

Annex (8) survey teams of Sanaa SMART survey المهمة االسم م التلفون التلفون التلفون مدير المسح عارف محمد عوفان 1 777475495 736656165 المدير احمد شرف الدين 1 773430060 اللوجستي موفق عبد الصمد الهتاري 1 770642753

أحمد محمد أحمد مرزوق 2 773752034 770461263

المشرفين محمد أحمد أحمد الشاحذي 3 777651234

إبراهيم عبداللطيف الشوكاني 4 773793669

1 أمل حسين محمد دريب 770631137 محمد يحيى علي الشامي فريق 1 2 زمزم محمد أحمد القفاش 772068555

777339910 3 أحالم علي أحمد هاجر 777908823

1 صفية حمود الحاج 774086663 فريق 2 مجاهد محمد صالح الرميم 2 ليلى ناجي الحماطي 773608848 777127201 3 سبأ غالب محمد عايض 773232981

1 ليدا محمد محمد المساري 777986522 عيسى سلطان االثوري فريق 3 2 فاطمة ناصر أحمد حاجب 77269029

775901221 3 عفاف غانم عبدهللا جالس 770411459

1 أسماء داحش الشرير 775155232 يحيى محمد غالب العقار أفراح حسين صالح فريق 4 2 777494791 الحماني 773232682 3 أمة هللا قاسم قاسم 770010613

إبراهيم عبدالرحمن شرف 1 سارة يحيى محمد مساوى 775080821 فريق 5 الدين 2 ريم علي المالكي 775943017

777738881 3 فاتن حسين الحجاجي 771993709

1 بدور يحيى الصادق 773132176 فتحي عبدهللا عبده خليل صفاء عبدالرحمن فريق6 2 773962980 الحظرمي 771695592 3 نظمية صالح جبران 770664657

عبدهللا علي عبدهللا معوضة 1 774142256

عبدهللا علي محمد حمزة 2 777014693

اإلدخال

حفظ هللا علي غالب السياغي 3 777503633

فريق سلطان عقالن قايد النجار 4 777206686

ا ا ا ا ا evet calendar ا(Annex (9

ل ل ل ل ل ل

ا

ل

ع ع ع ع ع ع

م م م م م م

ش

ر ر ر ر ر ر

ه

ا ا ا ا ا ا

ل ل ل ل ل ل

ر

ا

م م م م م م

ل

ق ق ق ق ق ق

م

ر ر ر ر ر ر الشهر ي 2013 2014 2015 2016 2017 2018

ال الميالدي ب ب ب ب ب ب

د

( ( ( ( ( (

ش ش ش ش ش ش

ه ه ه ه ه ه

ي

ر ر ر ر ر ر

) ) ) ) ) ) تفج ري كلية ال رشطة 7 يناير 3 15 27 39 51 يناير يناير هروب عبدربه منصور فرياير 2 14 26 38 50 فرياير اىل عدن 21 فرياير مارس 1 13 25 بداية العدوان 26 مارس 37 49 مارس االرساء والمعراج 23 قصف جبل عطان 20 ابريل بداية المسح 21 ابريل 0 12 24 36 48 ابريل ابريل ابريل االرساء والمعراج 15 مايو ذكرى عيد الوحدة 22 االرساء والمعراج 4 مايو ذكرى عيد الوحدة 22 ذكرى عيد الوحدة 22 ذكرى عيد الوحدة 22 مايو مايو 11 ذكرى عيد الوحدة 22 23 35 مايو 47 59 مايو مايو مايو بداية رمضان 26 مايو مايو االرساء والمعراج 26 مايو تفج ري جبل نقم 12 مايو االرساء والمعراج 5 يونيو عيد الفطر 25 يونيو 10 بداية رمضان 6 يونيو 22 بداية رمضان 17 يونيو 34 بداية رمضان 28 يونيو 46 58 يونيو يونيو عيد الفطر 17 يوليو يوليو 9 عيد الفطر 6 يوليو 21 33 عيد الفطر 28 يوليو 45 بداية رمضان 8 يوليو 57 يوليو أغسط أغسطس 8 20 32 44 عيد الفطر 7 أغسطس 56 س عيد األضىح 1 سبتم ري بداية السنة الهجرية دخول انصار هللا صنعاء عيد األضىح 12 سبتم ري عيد األضىح 23 سبتم ري سبتم ري 1439 ف 21 سبتم ري 7 19 31 21 سبتم ري 43 ذكرى ثورة 26 سبتم ري 55 سبتم ري ي ذكرى ثورة 26 سبتم ري ذكرى ثورة 26 سبتم ري ذكرى ثورة 26 سبتم ري ذكرى ثورة 26 سبتم ري عاشوراء 30 سبتم ري ذكرى ثورة 14 أكتوبر بداية السنة الهجرية

1438 ف 2 أكتوبر ذكرى ثورة 14 أكتوبر عيد األضىح 4 أكتوبر ي ذكرى ثورة 14 أكتوبر حملة الشلل األخ رية قصف الصالة الك ريى بداية السنة الهجرية ذكرى ثورة 14 أكتوبر أكتوبر 6 18 30 42 عيد األضىح 14 54 أكتوبر وال ت شاركت فيها قاعة العزاء 8 أكتوبر 1437 ف 14 أكتوبر بداية السنة الهجرية ي ي أكتوبر التغذية 24 أكتوبر عاشوراء 11 أكتوبر عاشوراء 23 أكتوبر 1436 يف 24 أكتوبر 2017 ذكرى ثورة 14 أكتوبر االعصار شباال عىل بداية السنة الهجرية

سقطرى والسواحل عاشوراء 2 نوفم ري 1435 ف 4 نوفم ري نوفم ري عيد الجالء 30 نوفم ري 5 عيد الجالء 30 نوفم ري 17 29 41 ي 53 نوفم ري ال رشقية 5 نوفم ري عيد الجالء 30 نوفم ري عاشوراء 13 نوفم ري عيد الجالء 30 نوفم ري عيد الجالء 30 نوفم ري مقتل عىل عبدهللا صالح ي الهجوم عىل مجمع ديسم ري وعارف الزوكا 4 ديسم ري 4 16 28 40 52 ديسم ري العرض 5 ديسم ري 2017 ي

ا

ا

ا

ا

ا

ا

ل

ل

ل

ل

ل

ل

ع

ع

ع

ع

ع

ع

م

م

م

م

م

م

ر

ر

ر

ر

ر

ر

ا

ا

ا

ا

ا

ا

ل

ل

ل

ل

ل

ل

م

م

م

م

م

م

ق

ق

ق

ق

ق الشهر ق الشهر

ر

ر

ر

ر

ر 1439 1438 1437 1436 1435 1434 ر

ب

ب

ب

ب

ب الهجري ب الهجري

(

(

(

(

(

(

ش

ش

ش

ش

ش

ش

ه

ه

ه

ه

ه

ه

ر

ر

ر

ر

ر

ر

)

)

)

)

)

)

محرم ذكرى ثورة 26 سبتم ري عاشوراء 10 محرم ذكرى ثورة 14 أكتوبر ف عاشوراء 10 محرم عاشوراء 10 محرم محرم ي يف 6 محرم ذكرى ثورة 14 أكتوبر يف 1 محرم عيد الجالء 30 نوفم ري يف عاشوراء 10 محرم 13 محرم عاشوراء 10 محرم 27 محرم 53.2 41.6 30.0 18.4 6.8 ذكرى ثورة 14 أكتوبر يف قصف الصالة الك ريى االعصار شباال عىل 24 محرم قاعة العزاء 8 أكتوبر سقطرى والسواحل ال رشقية 23 محرم

صفر حملة الشلل األخ رية عيد الجالء 30 نوفم ري يف عيد الجالء 30 نوفم ري يف صفر

وال يت شاركت فيها 5.8 17.4 18 صفر 29.0 8 صفر 40.7 52.3 التغذية 4 صفر 1439هـ ر ربيع أول عيد الجالء 30 نوفم ري يف عيد الجالء 30 نوفم ري يف تفج ري كلية الشطة 17 ربيع أول 12 ربيع أول 1 ربيع أول ربيع أول 51.3 39.7 28.1 16.5 4.8 مقتل ع يىل صالح وعارف الزوكا 16ربيع اول 1439

ربيع ثان ربيع ثان ي 3.9 15.5 27.1 38.7 50.3 ي جمادي هروب عبدربه منصور جمادي أول 49.4 37.8 26.1 14.5 2.9 أول اىل عدن 3 جمادي أول

جمادي ثا ين بداية العدوان 6 جمادي جمادي ثا ين 48.4 36.8 25.2 13.6 1.9 ثا ين قصف جبل عطان 12 رجب االرساء والمعراج 27 االرساء والمعراج 27 االرساء والمعراج 27 ذكرى عيد الوحدة )22 ذكرى عيد الوحدة )22 رجب رجب رجب رجب مايو( 23 رجب مايو( 13 رجب 59.0 47.4 35.8 24.2 12.6 1.0 االرساء والمعراج 27 رجب االرساء والمعراج 27 رجب

شعبان بداية المسح 5 شعبان ذكرى عيد الوحدة )22 ذكرى عيد الوحدة )22 ذكرى عيد الوحدة )22 شعبان 1-0 مايو( 26 شعبان 11.6 مايو( 15 شعبان 23.2 مايو( 4 شعبان 34.8 46.5 58.1

رمضان شهر مضان شهر مضان شهر مضان شهر مضان شهر مضان رمضان 57.1 45.5 33.9 22.3 10.6 شوال عيد الفطر 1 شوال عيد الفطر 1 شوال عيد الفطر 1 شوال عيد الفطر 1 شوال عيد الفطر 1 شوال شوال 56.1 44.5 32.9 21.3 9.7

ذو القعدة دخول انصار هللا صنعاء ذكرى ثورة 26 سبتم ري يف ذو القعدة 8.7 20.3 31.9 27 ذو القعدة 43.6 22 ذي القعدة 55.2

ذو الحجة عيد األضىح 10 ذو عيد األضىح 10 ذو عيد األضىح 10 ذو ذكرى ثورة 26 سبتم ري يف الهجوم عىل مجمع ذو الحجة

الحجة الحجة الحجة 2 ذي الحجة العر يض 5 ديسم ري 7.7 ذكرى ثورة 26 سبتم ري 19.4 ذكرى ثورة 26 سبتم ري 31.0 عيد األضىح 10 ذو 42.6 عيد األضىح 10 ذو 54.2

ف 24 ذي الحجة ف 13 ذي الحجة الحجة الحجة ي ي ذكرى ثورة 14 أكتوبر يف ذكرى ثورة 14 أكتوبر يف 20 ذو الحجة 10 ذو الحجة