Nutritional Survey Loiyangalani

MEDAIR East Africa

George Padmore Road (off Marcus Garvey Road) P.O. Box 76575, Nairobi, Kenya

Tel/Fax (+254 – 2) 711730 Tel. 571124 Email: [email protected]

Nutritional Survey Loiyangalani

January 2001

MEDAIR MEDAIR is a relief organization dedicated to assisting populations in crisis situations, such as natural disasters and wars, in order to alleviate their suffering. Established in 1988 as a Swiss registered NGO, it has run projects in Uganda, Southern Sudan, Liberia, Iraq, Somalia, Chad, Armenia, Rwanda, Kenya, Mozambique, North Caucasus, Afghanistan and the Democratic Republic of Congo. MEDAIR attempts to identify a people group or region that is particularly hit by a crisis and meet the needs of this community by providing appropriate aid. This may be in the area of health, water and sanitation, food, household support, reconstruction or other areas of need, helping the affected group to re-establish a more sustainable way of life. Although MEDAIR assists in complex emergencies, it will endeavor to strengthen local capacities by employing and training local staff, purchasing local materials and involving the beneficiaries in the design, management and implementation of the programs. MEDAIR is a Signatory to the “Code of Conduct for the International Red Cross and Red Crescent Movement and NGO’s in Disaster Relief”.

Summary

Malnutrition

Table 1. Prevalence of acute malnutrition in Loiyangalani division expressed as Z-scores of weight for height (n=884) Z-scores Proportion (%) Confidence Interval <-2.00 31.45 (25.50-37.39) <-3.00 5.32 (2.59-8.04)

Table 2. Prevalence of acute malnutrition in Loiyangalani division expressed as percentage of the median weight for height (n=884) % of the median WFH Proportion (%) Confidence Interval · <80% of median WFH 20.25 (15.25-25.24) · <70% of median WFH 2.04 (0.72-3.35)

Table 3. Prevalence of acute malnutrition per sub-location expressed as Z-scores of WFH Location Proportion <-2.00 (%) Proportion <-3.00 (%) Loiyangalani 32.07 (29.22-34.92) 8.28 (6.04-10.51) (n=290) Moite 11.85 (11.36-12.37) 0 (n=59) Gatab 32.14 (30.36-33.93) 0 (n=112) Arapal 10.00 (9.26-10.71) 1.67 (1.50-1.84) (n=60) South Horr 24.17 (23.74-24.59) 4.17 (3.78-4.55) (n=120) Kargi 44.03 (41.02-47.04) 7.00 (6.04-7.95) (n=243)

Table 4. Prevalence of acute malnutrition per sub-location expressed as percentage of the median WFH Location Proportion <80 % Proportion <70 % Median WFH Median WFH Loiyangalani 20.69 (17.73-23.65) 3.10 (2.27-3.93) (n=290) Moite 5.08 (4.91-5.26) 0 (n=59) Gatab 16.96 (16.01-17.91) 0 (n=112) Arapal 6.67 (6.30-7.03) 0 (n=60) South Horr 15.83 (14.95-16.71) 2.50 (2.10-2.90) (n=120) Kargi 30.45 (27.92-32.99) 2.47 (1.65-3.29) (n=243)

Morbidity

Table 5. Vaccination indicators Vaccination type Coverage (n=381)1 BCG 95.01% Polio 86.35% Measles 80.05% 1. Only 43.10 % of the children had an immunisation card. Coverage percentages are given for children with a card.

Table of contents

1 Introduction 1

2 Methods 2 2.1 Study area and population 2 2.2 Statistical analysis 2

3 Results 3 3.1 Population 3 3.2 Indicators for nutritional status 3 3.3 Morbidity 5

4 Discussion and conclusions 6 4.1 Discussion 6 4.2 Conclusions 6

1 Introduction

Loiyangalani division is one of the 6 divisions in Marsabit District (Eastern Province, Kenya). Like the other divisions in Northern Kenya, Loiyangalani has experienced a period of prolonged drought, as the rains have failed for four consecutive seasons. The predominantly pastoralist commun ities in the district are facing an emergency situation as traditional coping mechanisms have failed to sustain them during the current drought. This failure is not the result of drought alone, but is the result of multiple factors, such as cattle raiding, insufficient water points near pasture, over grazing, poor livestock marketing management, lack of alternative sources of income and increasing populations around settlement points. This has lead to a significant food deficit, with resultant malnutrition, especially among the children under 5 years of age.

A nutritional survey conducted by UNICEF in Loiyangalani division in June 2000 indicated a moderate malnutrition rate of 35.2 % (< -2 Z-score) of children between 6 months and 5 years of age. The severe malnutrition rate (< -3 Z-score) was 6.7 %. A nutritional survey conducted by MEDAIR in October 2000 showed a moderate malnutrition rate of 29.0 % and a severe malnutrition rate of 3.8 %. This report presents the results of a second nutritional survey con ducted by MEDAIR in January 2001. The objective of this survey was to collect data on the nutritional status of the children between 6 months and 5 years of age as a follow up of the surveys conducted in June and October 2000.

Since July 2000, 80 % of the population has received maize, beans and oil from the relief food distribution by GoK/WFP. In addition, since July 2000 80% of all children under 5 years of age and all pregnant and lactating women have received supplementary food (UNIMIX or CSB). Theref ore, it was expected that the results of this study would show a decrease in the prevalence of malnutrition compared to the findings of the survey conducted in June and October 2000. In November a supplementary wet feeding centre was started in Gatab and in December a second supplementary feeding centre was started in Kargi. Therefore is was expected that especially in these two areas, the malnutrition rate would be lower than in June and October 2000.

2 Methods

2.1 Study area and population

This nutrition survey was conducted by MEDAIR in Loiyanagalani division of Marsabit district between 8 th-15th January 2000. A total population figure of 21,044 for the division was established from the 1999 census, as well as figures from the ongoing EMOP food dist ributions. Within these figures it was estimated that 4,209 children were below the age of 5 years. Traditionally, the population has been spread between those living in the towns, smaller sub -divisional centers, villages and nomadic peoples. Recently, due to the drought, the divisional centers have been experiencing an influx of vulnerable, while the remainder of the population has become increasingly transient, as they seek pasture lands for their livestock.

Because of the difficulty of collecting accur ate population data for a pastoralist community and the danger of exaggerated figures from relief committee registers, population figures for the different distribution centers were calculated from the ongoing GoK/WFP EMOP. A random sample of 30 clusters w as taken from these locations according to the population size of each center. Rough population figures from the chiefs, elders and relief committees were then used to select the more specific cluster locations within each distribution center. In each clus ter the mid upper arm circumference (MUAC), weight and height (WFH) of 30 children aged 6 to 59 months (65 -110 cm) was measured. In addition, information on immunization coverage and morbidity was collected. A one -day workshop on the purpose of the survey, interviewing techniques, and how to collect the anthropeometic data was conducted before the survey started. During the survey at least one of these trained people participated in each team.

2.2 Statistical analysis

The proportion (with its confidenc e interval) of malnourished children in the division and per sub location was calculated using MUAC, WFH Z -scores and percentages of the WFH median as indicators. The following cut off points were used to classify nutritional status as recommended by WHO.

Z-scores % of median MUAC · Global acute <-2.00 s.d < 80% <125 cm malnutrition · Severe acute <-3.00 SD < 70% <110 cm malnutrition

Note: Weight for height Z -scores give a more accurate picture than the percentage of median as expressions in Z -scores have a true statistical meaning, which percentage of the median does not have.

3 Results

3.1 Population

A total of 900 children were assessed. Sixteen records were excluded from the analysis, because the data was suspected to be erroneous. Of the remaining 884 children were assessed. Of the children 52.7 % were boys and 47.3% were girls. The average age was 34 months.

3.2 Indicators for nutritional status

In table 1 and 3 the malnutrition rates in Loiyangalani division are presented. A global malnutritio n rate of 31.45 % (< -2 Z-score) was found. When expressed as percentage of the median weight for height, the global malnutrition rate (<80 %) was 20.25 %. Table 5 gives the malnutrition rates when calculations are based on the MUAC measurement.

Table 1. Prevalence of acute malnutrition in Loiyangalani division expressed as Z - scores of weight for height (n=884)

Z-scores Proportion in % (confidence interval) · <-2.00 (global malnutrition) 31.45 (25.50 -37.39) · <-3.00 (severe malnutriti on) 5.32 (2.59 -8.04)

Table 2. Prevalence of acute malnutrition in Loiyangalani division expressed as Z - scores of weight for height for boys and girls

Z-scores Boys (n=466) Girls (n=418) · <-2.00 (global malnutrition) 32.19 % 30.62 % · <-3.00 (severe malnutrition) 7.08 % 3.35 %

Table 3. Prevalence of acute malnutrition in Loiyangalani division expressed as percentage of the median weight for height (n=884)

% of the median WFH Proportion in % (confidence interval) · <80% of median WFH 20.25 (15.25 -25.24) · <70% of median WFH 2.04 (0.72 -3.35)

Table 4. Prevalence of acute malnutrition in Loiyangalani division expressed as percentage of the median weight for height for boys an d girls

% of the median WFH Boys (n=466) Girls (n=418) · <80% of median WFH 20.39 % 20.10 % · <70% of median WFH 2.58 % 1.44 %

Table 5. Prevalence of acute malnutrition in Loiyangalani division (MUAC)(n=905)

MUAC Number Proportion · <125 cm 121 13.69 % · <110 cm 15 1.70 %

In table 6 and 7 the figures are presented per location. The highest prevalences (Z-scores) were found in the sub -locations Kargi and Loiyangalani. Although the figures give an indication of the situation in the differe nt sub-locations, it should be noted that it is not statistically correct to use a cluster sample as an estimate of the prevalence of malnutrition in individual locations, because the sample size in each location is too small.

Table 6. Prevalence of acute malnutrition per sub -location expressed as Z -scores of WFH

Location Proportion < -2.00 (%) Proportion < -3.00 (%) Loiyangalani 32.07 (29.22 -34.92) 8.28 (6.04-10.51) (n=290) Moite 11.85 (11.36 -12.37) 0 (n=59) Gatab 32.14 (30.36 -33.93) 0 (n=112) Arapal 10.00 (9.26 -10.71) 1.67 (1.50-1.84) (n=60) South Horr 24.17 (23.74 -24.59) 4.17 (3.78-4.55) (n=120) Kargi 44.03 (41.02 -47.04) 7.00 (6.04-7.95) (n=243)

Table 7. Prevalence of acute malnutrition per sub -location expressed in percenta ge of the median WFH

Location Proportion <80 % Proportion <70 % Median WFH Median WFH Loiyangalani 20.69 (17.73 -23.65) 3.10 (2.27-3.93) (n=290) Moite 5.08 (4.91-5.26) 0 (n=59) Gatab 16.96 (16.01 -17.91) 0 (n=112) Arapal 6.67 (6.30-7.03) 0 (n=60) South Horr 15.83 (14.95 -16.71) 2.50 (2.10-2.90) (n=120) Kargi 30.45 (27.92 -32.99) 2.47 (1.65-3.29) (n=243)

3.3 Morbidity

The immunization cards of the children were checked for tuberculosis, polio and measles immunization. Only 43.10 % of the childre n had an immunization card. The vaccination coverage for these children is given in table 8.

Table 8.Vaccination indicators Vaccination type Coverage BCG 95.01% Polio 86.35% Measles 80.05%

Mothers were asked about illnesses of the last two wee ks. The most common diseases were cold/cough ( 53.92 %), diarrhoea (32.61 %) and fever ( 26.73 %). No cases of measles were found.

4 Discussion and conclusions

4.1 Discussion The population is widespread between those living in towns, smaller sub -divisional centres, villages and n omadic people. There has been a continued influx of people into towns due to the effects of drought and insecurity. There have been recent clashed between the Samburu and Turkana in Baragoi and South Horr and families have been forced to flee into the town centres. This mostly affects the mothers, elderly and children, because the men (morans) move into the bush with the animals. The effects of the recent rains can only be felt in reserves such as Olturot, Arapal and Moite where increased grazing results i n wider availability of milk and other animal products. However, a delay in full milk production is anticipated, as it will take time until the weakened animals regain their strength. Meanwhile, access to animal products is low for people living in the mai n population centres, especially Loiyangalani. Either animals have died, or have moved far away to areas where grazing is available. It remains a concern when people migrate between distribution centres – often they fail to become regist ered in time and thu s lose their share of the relief food. This has also a bearing on the accuracy of available population figures – thus in most cases the 1999 census figures were used.

A high need for hygiene promotion remains evident throughout many areas of Loiyangalani. The incidence of skin disease (scabies, ringworms) as well as diarrhoea and vomiting is particularly high in Gatab.

After the October survey MEDAIR opened wet feeding centres in Gatab and Kargi. The effects of this service are felt in the reduction of se vere acute malnutrition. Until January, admitted children have been receiving a wet ration only – without a take-away dry ration as this was supplied in the form of UNIMIX/CSB through the general distribution system. However, the amounts thus distributed have recently been inadequate, while often CSB is shared among family members. This has led to continued re -admissions of recently discharged children who have little food to eat at home.

It was observed that in Gatab there are possibilities to grow food. It is recommended to improve the agricultural knowledge of the local community and to encourage the people to cultivate their own shamba.

4.2 Conclusions In comparison with the Octob er survey results the situation has deteriorated with increased rates of global acute malnutr ition in Loiyangalani. The severe acute malnutrition rate has risen from 3.76 % to 5.32 %