DISSEMINATION WORKSHOP

Damasak and LGA Preliminary Results

July 2017 Background - Damasak Map • Damasak, the headquarters of is located near the confluence of the Yobe River and Komadugu Gana River adjoining the border with Niger. • According to the military commandant, Damasak became accessible to the general public as of 26th December 2016, and as of 26 February 2017, 10,100 households (approx. 65,000 individuals) in Damasak had been assisted by International Committee of Red Cross (ICRC)- registration for food distribution purpose. • No prior nutritional and mortality survey data available for these areas Background – Kukawa LGA

• The Local Government Area (LGA) of Kukawa covers roughly 5,125 square kilometers and is located in Northeast of Borno State along the Nigerian border with Chad, 180 km from by road. • No prior baseline nutrition and mortality data was available for these targeted areas to understand nutritional situation. Objectives of the survey

Overall objective was to determine nutritional status amongst children aged 6-59 months of age and set a baseline. Specific objectives include: • To determine the prevalence of undernutrition (acute malnutrition, underweight and stunting) among children 6-59 months old • To estimate the prevalence of common childhood illnesses among children 0-59 months based on two-week recall • To assess under-nutrition rates among women of reproductive age (15-49y) using MUAC measurements Survey Methodology

SURVEY AREA • Damasak Survey was conducted into Damasak and Zanna Umorti wards – comprising 79 communities/villages • Kukawa survey was conducted into Baga, Kauwa and Kukawa town -comprising 175 communities Therefore, the results are only representative of the wards covered by the survey and can not be extrapolated for other areas not covered by the survey.

TARGETED POPULATION • All eligible children aged 6-59months present in the household • All eligible women between 15-49 years old Survey Methodology - Sampling

Rapid SMART methodology with two stage cluster sampling was used to conduct the surveys.

FIRST STAGE: SELECTION OF CLUSTERs A cluster was defined as a community/village. Therefore, all the villages/communities were listed with their total population. • 30 clusters were selected randomly using ENA for SMART software

SECOND STAGE- SELECTION OF HOUSEHOLD • All households’ list were updated for the selected clusters • 14 households in each cluster were randomly selected using simple random sampling. Organization of the Survey

• Officials from State Primary Healthcare Development Agency (SPHCDA) at the LGA level were engaged • Trained AAH Enumerators from the host communities were recruited and trained • AAH Surveillance Specialist was overall providing technical support, supervision during data collection. An additional nutrition research fellow was also providing technical support to kukawa survey team during data collection • Each survey team comprised of 1 team leader and 2 trained enumerators. Meaurers were selected based on standardization test results during the training • Pilot survey was conducted prior to data collection of each survey to make sure that survey teams understand appropriately the household selection process, enumeration and measurements appropriately. Organization of the Survey Cont…

• The survey activities were undertaken as follows:

Main Activity When Training of the survey team 5th – 8th July 2017 Data collection Damasak, Mobbar LGA 13th – 18th July 2017

Data collection Kukawa LGA 13th -19th July 2017 Data Analysis and reporting 24th July- 22nd August 2017 Data Validation by Nutrition Information 23rd-26th August 2017 Working Group Dissemination 28th August 2017 Survey Results Survey data quality- Plausibility check

Criteria Damasak, Mobbar LGA Kukawa LGA Flagged data 0 (0.0%) Excellent 0 (0.9%) Excellent Overall Sex ratio 4 (p=0.001) Acceptable 0 (p=6.70) Excellent Age ratio(6-29 vs 30-59) 0 (p=0.912) Excellent 0 (p=0.421) Excellent Digit preference score - weight 0 (4) Excellent 4 (18) Acceptable Digit preference score - Height 2 (11) Good 4 (20) Acceptable Digit preference score - MUAC 2 (10) Good 4 (15) Acceptable Standard Dev WHZ 5 (1.14) Good 5 (1.11) Good Skewness WHZ 0 (-0.15) Excellent 0 (-0.09) Excellent Kurtosis WHZ 1 (-0.24) Good 0 (-0.06) Excellent Poisson distribution WHZ-2 0 (p=0.114) Excellent 3 (p=0.009) Acceptable OVERALL SCORE 14% : Good 20% : Acceptable Prevalence of Acute Malnutrition (WHZ)

Damasak Kukawa n = 488 n=445

Prevalence of global malnutrition (67) 13.7 % (60) 13.5 %

(<-2 z-score and/or oedema) (10.9 - 17.1 95% C.I.) (9.8 - 18.2 95% C.I.)

Prevalence of moderate malnutrition (50) 10.2 % (42) 9.4 %

(<-2 z-score and >=-3 z-score, no (7.8 - 13.3 95% C.I.) (6.9 - 12.8 95% C.I.) oedema)

Prevalence of severe malnutrition (17) 3.5 % (18) 4.0 %

(<-3 z-score and/or oedema) (2.2 - 5.4 95% C.I.) (2.2 - 7.3 95% C.I.)

The prevalence of oedema was (1) 0.2 % in Mobbar and (3) 0.7 in Kukawa Prevalence of Acute Malnutrition (MUAC)

Damasak Kukawa n = 488 n = 444 Prevalence of global malnutrition (31) 6.4 % (27) 6.1 % (< 125 mm and/or oedema) (4.7 - 8.5 95% C.I.) (3.5 - 10.2 95% C.I.) Prevalence of moderate (22) 4.5 % (21) 4.7 % malnutrition (< 125 mm and >= 115 mm, no (3.1 - 6.5 95% C.I.) (2.6 - 8.3 95% C.I.) oedema) Prevalence of severe malnutrition (9) 1.8 % (6) 1.4 % (< 115 mm and/or oedema) (0.9 - 3.6 95% C.I.) (0.5 - 3.8 95% C.I.)

The prevalence of oedema was (1) 0.2 % in Mobbar and (3) 0.7 in Kukawa Prevalence of Stunting (HAZ)

Damasak Kukawa n = 488 n = 445 Prevalence of stunting (170) 34.8 % (175) 39.3 %

(<-2 z-score) (29.7 - 40.3 95% C.I.) (34.9 - 43.9 95% C.I.)

Prevalence of moderate (117) 24.0 % (103) 23.1 % stunting

(<-2 z-score and >=-3 z- (19.7 - 28.9 95% C.I.) (19.2 - 27.7 95% C.I.) score) Prevalence of severe (53) 10.9 % (72) 16.2 % stunting (<-3 z-score) (8.3 - 14.1 95% C.I.) (13.3 - 19.6 95% C.I.) Prevalence of Underweight (WAZ)

Damasak Kukawa n = 487 n = 442 Prevalence of underweight (125) 25.7 % (135) 30.5 %

(<-2 z-score) (21.0 - 31.0 95% C.I.) (25.7 - 35.9 95% C.I.)

Prevalence of moderate (107) 22.0 % (113) 25.6 % underweight

(<-2 z-score and >=-3 z- (17.8 - 26.9 95% C.I.) (21.1 - 30.6 95% C.I.) score)

Prevalence of severe (18) 3.7 % (22) 5.0 % underweight

(<-3 z-score) (2.3 - 5.8 95% C.I.) (3.4 - 7.3 95% C.I.) Maternal Malnutrition in Damasak (MUAC)

Maternal MUAC (n) % <21cm 21-23 cm >23 cm

Pregnant (n=53) (1) 1.9 (6) 11.3 (46) 86.8

Breastfeeding (n=131) (2) 1.5 (20) 15.3 (109) 83.2

Women of Reproductive Age (15-49 (2) 0.5 (22) 5.6 (367) 93.9 years) (N=391)

<21cm= Malnourished; 21-23 cm=At risk; >23 cm=Normal

• Majority of women (93.9%), regardless of pregnant or breastfeeding status, have MUAC measurements within a normal range Maternal Malnutrition (MUAC) in Kukawa

Maternal MUAC (n) % Total (n=325) <21cm 21-23 cm >23 cm

Pregnant (n=56) (1) 0.31 (2) 0.62 (53) 16.31

Breastfeeding (n=104) (6) 1.85 (16) 4.92 (82) 25.23

Women of Reproductive Age (15-49 (7) 2.15 (15) 4.62 (143) 44.0 years) (n=165) *all cell% above add to 100% <21cm= Malnourished; 21-23 cm=At risk; >23 cm=Normal

• Majority of women (85.5%), regardless of pregnant or breastfeeding status, have MUAC measurements within a normal range Common Childhood Illness among 0-59m old (2 weeks prior survey)

Damasak Kukawa Sample size 519 459 Proportion of sick children (n=112) 21.6 (n=101) 21.6 Fever (57) 50.9 (52) 51.5 Cough (10) 8.9 (9) 8.9 Diarrhea (32) 28.6 (27) 26.7 Illnesses recorded (%) Skin Infections (7) 6.3 (8) 7.9 Eye Infections (2) 1.8 (4) 4.0 Other (4) 3.6 (1) 1.0 Yes (109) 97.3 (98) 97.0 Sought treatment (%) No (3) 2.7 (3) 3.0 Immunization Services-Damasak Vitamin A Deworming Measles Vac Polio Vac (N=488) (N=437) (n=459) (n=518) 6-59 12-59 9-59 0-59 Yes (any source) (399) 81.8 (334) 76.4 (368) 81.2 (404) 80.0

Yes, maternal recall (32) 6.6 (18) 4.1 (24) 5.2 (30) 5.8 Yes, from records (363) 74.4 (316) 72.3 (344) 74.9 (374) 72.2 No (81) 16.6 (70) 16.0 (78) 17.0 (110) 21.2 Don’t know (12) 2.5 (33) 7.6 (13) 2.8 (4) 0.8 Immunization Services-Kukawa

Measles Polio Vitamin A Deworming Vaccination Vaccination (n=444) (n=411) (n=444) (n=455) Yes (any source) (273) 61.5 (250) 60.8 (236) 75.7 (432) 95.0

Yes, maternal recall (200) 45.1 (176) 42.8 (194) 43.7 (270) 59.3 Yes, from records (73) 16.4 (74) 18.0 (142) 32.0 (162) 35.6 No (133) 30.0 (123) 29.9 (75) 16.9 (22) 4.8 Don’t know (38) 8.5 (38) 9.3 (33) 7.4 (1) 0.2 Recommendations for Damasak

Immediate Nutrition interventions: 1. Scale-up and continue implementation of the community management of acute malnutrition (CMAM) program. 1. Particularly increase coverage of SAM treatment through HF 2. Addition of SFP programs for acutely malnourished children and PLWs 2. Implement blanket supplementary feeding for all children under two and pregnant and lactating women to prevent further deterioration of the under nutrition situation 3. Establish stabilization centre for ensuring inpatient treatment services for severely malnourished children with medical complications in Damasak town. 4. Establish community based health interventions for increased coverage of basic primary health care services including SAM in hard to reach areas Recommendations for Damasak cont..

Medium term nutrition interventions -

• Promote GMP through health facilities and develop routine nutrition and health surveillance system based on health facility data – complemented by nutrition & mortality surveillance data. • Support should be provided to the General Hospital and primary health care facilities in Damasak town to make healthcare services more accessible to the larger community • Food security and livelihood programming to address the vicious cycle of undernutrition and adapted to the population needs across different seasons Recommendations for Kukawa

1. Implement full scale Community Based Management of Acute Malnutrition program in the areas for treatment of acute malnutrition  Establish stabilization centre in Kukawa LGA to ensure treatment of medically complicated SAM cases identified at hospital/referred from outpatient therapeutic programs  Strengthen the existing treatment programs to increase the access and coverage of treatment services 2. Implement Blanket Supplementary Feeding Program or food safety net programs for children aged 6-23m; pregnant and lactating women.  Strengthen the BSFP/GFP/Safety net programs to ensure nutritional adequacy and continuity of the support during the crisis, for identified vulnerable groups  Continuity and transition of such food assistance programs (BSFP/GFD) shall be done based on continuous monitoring of undernutrition situation and gradual establishment of full scale CMAM programs Recommendations for Kukawa Cont…

3. Ensure/support provision of routine immunization services in PHC and mobile clinics in Kukawa LGA. 4. Scale up programs promoting essential nutrition actions focusing on Infant and Young Child Feeding in Emergencies 5. Scale up micronutrient supplementation for children in line with international protocol and standards 6. Further integrated food security, nutrition, WaSH assessments to identify gaps and underlying causes of under-nutrition for developing context specific multisectoral programs to tackle undernutrition. Thank You All !!!!

Questions and comments are welcome…..