May Im'p13 Clifford Wokveha, M.D
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. ..... ....... •· ·• •. ~TRITION sirk~~~ kEPORT- ~1AYJ993 NUTRITION SURVEYS SOFALA AND TETE PROVINCES CAIA DISTRICT - CAIA SEDE - SENA CHEMBA DISTRICT - C~ASEDE MUTARARA DISTRICT - MUTARARA - INHANGOMA May iM'P13 Clifford Wokveha, M.D. Terry Andrews, M.D. Veronique Kollhoff, M.D. INTERNATIONAL ADDRESS: &111 WESl HUN11NGTON DR!VE.IMONROYlA, CALIFOR.'-llA 9101! 18181 357-7979/CAB•E WORVIS/TELEX.: 67-5341 GRAEME. IRVINE, PRESIDENT WORLD TVISION INTERNATIONAL MOZAMBIQUE RELIEF PROGRAMME AV. PAULO SAMUEL KA.NKHOMBA 1170, MAPUTO P. O. BOX 2U1. MAPUTO MOZAMBIQUE TELEPHONE 42 29 22/U 03 It TELEX 6-124 WORV. MO TELEFAX 42 IHi MAP/COMM/141/FY93-L June 08. 1993 Sidney Bliss USA ID Maputo SUB: lWI'RITION SURVEY RESULTS- ZAMBEZI CORRIDOR Dear Sidney, We are pleased to forward to you the results of the nutrition surveys carried out during the month of May in Caia Sede, Murraca, Sena (Caia District), Chemba Sede (Chemba district), Mutarara and Inhangoma <Mutarara district), where WV food and non food items have been and continues to be airlifted with funding made available from OFDA. Though food is no longer being airlifted to Mutarara, as it is now accessible by road, it was included in the survey. The nutritional surveys in the above six sites were carried out in accordance with donor requirements. Though the results are not that alarming, the conditions could rapidly deteriorate if assistance to the above sites should cease. The surveys were undertaken by the WV Health team. If you have any questions, please let us know and we will be more than happy to respond. Thank you. Walte Middleton Commodities Manager cc: John Yale, WVM cc: Leland Brenneman, WVRD/DC cc: Rich Moseanko, WVIO cc: Dr. Terry Andrews, WVM cc: Joe Seigle/Milton Amayum, WVRD cc: Phillip Clarke, WFP, Maputo 100.1.10 '\ / TABLE OF CONTENTS INTRODUCTION 1 SURVEY OBJECTIVES 1 TARGET POPULATION 2 METHODS 2 A. TYPE OF SURVEY SYSTEM USED B. SAMPLE SIZES/PREDICTED RA TES OF MALNUTRITION C. VARIABLES MEASURED D. PERSONNEL E. DATA ANALYSIS RESULTS 4 A. DISTRIBUTION OF CHILDREN ACCORDING TO GENDER B. RA TE OF GLOBAL ACUTE MALNUTRITION (MOH) C. RA TE OF GLOBAL ACUTE MALNUTRITION (WHO) D. RA TE OF SEVERE ACUTE MALNUTRITION COMPARISON WITH PREVIOUS SURVEYS 7 DISCUSSION/CONCLUSIONS 8 INTRODUCTION World Vision Emergency Response has been airlifting food and seeds to the vil1ages of Caia, Murrai;a, Mutarara and Inhangoma s_ince October 1991. Sena and Chemba were adde<l in May 1992. The government of Mozambique initially requested aid to these areas because they were severely affected by draught and war. Food stores were all but non-existent and villagers were scavaging for roots and green mangoes to survive. The airlifted food and seeds did much to improve food stores, as evidenced by comparative nutrition surveys carried out by WV in November 1991 and April 1992. Malnutrition levels in these 6 villages remained relatively stable through August 1992, at which time an influx of refugees from Renamo controlled wnes began. After the signing of the peace accord, migration of villagers in search of food increased dramatically with refugees pouring in from Renamo zones as well as the neighboring countries of Malawi and Zimbabwe. Airlift site populations increased 10 and 20 - fold during this period. Overcrowding combined with draught and lack of seeds led to a markerl increase in levels of malnutrition in all sites. A WV survey c6nducted in November 1992 showed global acute malnutrition ranging from 11 % to 35% by MOH standards. Severe malnutrition ranged from 2% to 15%. Since November, World Vision has increased amounts of airlifted food, seeds and tools. 6 feeding centers were opened - one in each airlift site to treat the severely malnourished who might not be strong enough to benefit from distributed food and seeds. Over the past 6 months, nearly all sites experienced meas1es epidemics, spread primarily by recent arrivals to airlift sites; cholera and dysentery epidemics were also widespread during the rainy season, spreading all the more easily because of overcrowding from the refugee influx. World Vision worked together with the MOH of Zambezia, Tete and Sofala provinces and Medecins Sans Frontieres to vaccinate against measles and transport supplies for the treatment of cholera. At present, no cases of cholera have been reported in the sites since March 1993 and measles cases are much fewer. The following nutritional surveys in the six sites of Caia, Murra\a, Sena, Chemba, Mutarara and Inhangoma were carried out in accordance with donor requirements for biannual nutrition surveillance in WV airlift sites. OBJECTIVES The objectives of this survey were to: 1. Confirm reported populations currently existing in airlift sites. 2. Evaluate the nutritional state of populations currently benefitting from airlifted seeds and food, using both Ministry of Health (MOH) and World Health Organization (WHO) standards. 3. Mobilize parents of malnourished children encountered during the survey to receive help at the intensive therapeutic feeding centers. i l 1 TARGET POPULATION Children aged 6 months to 5 years were evaluated. When mothers were unsure of childrens' ages, the criteria of 55 cm to 115 cm (height) was used. The following are population estimates based on numbers given by the administrator, and confirmed lists of returnees for each village at the time of the survey: VILLAGE F.STIMATED ESTIMATED NO. NO. OF CHILDREN % OF 0-5 YR POPULATION 0-5 YR OLDS* SURVEYED OLDS SURVEYED Caia 38,420 7,864 539 7.0% Murra~ 9,789 1,958 568 29.0% Sena 27,300 5,460 495 9.1% Chemba 7,509 1,502 479 31.9% Inhangoma 5,146 1,029 496 48.2% Mutarara 6,925 1,385 448 32.3% * 0 - 5 yr olds were estimated to be approximately 20% of the population (according to WHO standards for developing countries) :METHODS A. TYPE OF SURVEY SYSTEM USED: (1) the sample size was determined according to the expected prevalence of malnutrition and precision desired using the following formula: n = 1.962 *(p)*(l-p) d2 where n is population number; p = expected prevalence; d is desired precision. (2)-The World Health Organization system of 30 random clusters was used for villages with population~ greater than 10,000: Sena (May 4 - 6) Caia (May 22 - 26) (3) For villages with less than 10,000 population, as systematic random sampling method was used: the number of houses was estimated based on population (average of 4.5 people per household) or basec on a village house count prior to implementing the survey; this number was divided by the desired sample size to determine the sample interval in terms of houses. Mutarara (May 7 - 11) Chemba (May 12 - 14) Inhangoma (May 15 - 18) Murra~ (May 19 - 21) 2 B. SAl\fPLE SIZF..S I PREDICTED RA TES OF MAL!\'UTRITION: Sample sizes were initially determi11ed using predicted rate of malnutrition and level of precision desired. The number of children surveyed in most villages was actually more than initially planned due to the efficiency of the survey team. In the case of Chemba and Inhangoma, the numbers actually surveyed were less than planned because the populations of these villages were small and not enough children could be found. The number of children surveyed in Chemba and Inhangoma was 32% and 48% respectively however, giving a very accurate result in spite of the lower number~. Caia = 539 _ (expected malnutrition = 15%) - cluster size = 18 children Sena = 495 (expected malnutrition = 25%) - cluster size = 17 children Mutarara = 448 (expected malnutrition rate = 10%) Inhangoma = 496 (expected malnutrition rate = 30%) Chemba = 479 - (expected malnutrition rate = 20%) Murra~ = 568 (expected malnutrition rate = 15%) Expected rates of malnutrition were predicted using the results of the November 1992 survey in the same villages. Desired precision was between 2 % and 4 % , depending on rates of malnutrition predicted. C. VARIABLFS MEASURED: 1. Anthropometric measurements collected for all 6 month - 5 year-olds included their weight (with precision level of 100 grams) and height (with a precision of 0.5 cm). 2. The edema of kwashiorkor was evaluated using the following criteria: a depression created by pressing a finger against the anterior base of both legs must remain after the finger has been removed. 3. The child's gender and length or residence in the village was also measured. D. PERSONNEL: Four WV Health Mozambican Nurses spent 20 days in the Zambezia Valley: two of these were well versed in the techniques of height/weight calculations and measurements, while the other two received intensive training with a brief practical prior to beginning. In each vil1age, Ministry of Health nurses or health aids assisted. The teams were led by a medical doctor from Nigeria, Clifford Wokveha, with two years experience in medical work in Mozambique. Six community chosen literate volunteers from each village were briefly trained on how to implement the questionnaire and record answers. Data was analyzed by Veronique Kollhoff, R.N. and Theresa Andrews, M.D. E. DATA ANALYSIS: A formal analysis of all heights and weights was conducted using the NCHS standard height/weight charts. Weight was compared with length for children with heights 55-70 cm; weight was compared with stature ir children with heights from 71-115 cm as children of this height were measured in the upright (standing~ position. Weight-for-height was analyzed according to the following criteria: 1. Percentile: Children whose weights fell below the 3n1 percentile of the mean weight for height were classified as acutely malnourished. Though this is not the currently recommended classification of WHO, it is the classification used by the Mozambican MOH. The percentile analysis was conducted so that the information gathered would be useful to the MOH, as they will compare malnutrition rates in these sites with other districts in other parts of the country.