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South Bor County UPPER NILE (JONGLEI STATE)

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South Bor County UPPER NILE (JONGLEI STATE) South Sudan NUTRITIONAL ANTHROPOMETRIC SURVEY CHILDREN UNDER 5 YEARS OLD Padak (Athoac Region) South Bor County UPPER NILE (JONGLEI STATE) 19th - 29th May 2002 Henry Sebuliba -Nutritionist Bertha Ocholla -Nutritionist Action Against Hunger – USA (ACF-USA) South Sudan 32 SUMMARY ………………………………………………………………………………3 ACKNOWLEDGEMENTS ……………………………………………………………...9 INTRODUCTION ………………………………………………………………………11 OBJECTIVES …………………………………………………………………………...13 METHODOLOGY …………………………………………………………………...…14 1. TYPE OF SURVEY AND SAMPLE SIZE………………………………….…14 2. SAMPLING METHODOLOGY………………………………………………..14 3. COLLECTED DATA ...…………………………………………………………14 4. INDICATORS, GUIDELINES AND FORMULAS USED .……………….…15 4.1. Acute Malnutrition …………………..…….……………………………….15 4.2. Mortality……………………………………………………………………..16 5. FIELDWORK……………………………………………………………....……17 6. DATA ANALYSIS ………………………………………………………………17 RESULTS ……………………………………………………………………………..…..18 1. DISTRIBUTION BY AGE AND SEX ……………………………………….……...18 2. ANTHROPOMETRIC ANALYSIS ………………………………………..…..…...20 2.1. Acute Malnutrition .……………………………………………………..………...20 ¾ Distribution of malnutrition Z- Score……….…………… ………….……..…...20 ¾ Distribution of malnutrition in percentage of the median ………….……..…….23 2.2. Risk of mortality: Children’s MUAC ……………………………….………. …. 24 2.3. Adult malnutrition: Caretakers’ MUAC ……………………….….………..…….25 3. MEASLES VACCINATION COVERAGE …………………………………….….25 4. HOUSEHOLD STATUS AND CARETAKER INFORMATION ..………..……..25 5. RETROSPECTIVE MORTALITY SURVEY……………………………………...25 5.1. MORTALITY RATE ……………………………………………………..…….25 5.2. CAUSES OF MORTALITY …………………………………………………....26 DISCUSSION-RECOMMENDATIONS ……………………………………………….27 APPENDIX ……………………………………………………………………………….30 2 SUMMARY 1. OBJECTIVES General objectives of the survey were: To evaluate the nutritional status of children aged 6 to 59 months To evaluate the measles immunisation coverage of children aged 9 to 59 months To evaluate the nutritional status of caretakers using the MUAC To estimate the crude and under-five mortality rates To assess the extent of household movement Specific objectives are: To identify groups at higher risk to malnutrition: age group and sex 2. METHODOLOGY The survey was conducted from 19th to 29th May 2002 in Padak Athoac region South Bor County, Jonglei State, Central Upper Nile region. A two-stage cluster sampling methodology was employed (30 clusters of 30 children each). Resultantly, the final sample size was composed of 900 children aged 6-59months. (With a height of 65 cm – 115cm). The first sampling frame consisted of all villages that are found in Baidit and Jalle Payams. However in this survey, three villages namely; Jalle, Anakdiar and Pathunol were not included because they were not easily accessible. Constraints encountered in the field • Physical accessibility to villages located on the other side (west) of the Nile was difficult, requiring a 2 hours boat ride. This could not be undertaken. • Training had to be done through a local person acting as an interpreter, and it was realised, on occasion, that he conveyed a different message. 2 3. RESULTS Age Indicator RESULT* Group 6-59 Global Acute Z-score 37.7% [33.1 – 42.4%] N= Malnutrition 900 Severe Acute 6.6% [4.5 – 9.4%] Malnutrition % median Global Acute 25.8% [21.8 – 30.2%] Acute Malnutrition Malnutrition Severe Acute 2.8% [1.8 – 4.2%] Malnutrition 6-29 Z-score Global Acute 36.9% [30.1 – 44.2%] N= Malnutrition 393 Severe Acute 7.4% [4.2 – 12.3%] Malnutrition % median Global Acute 25.8% [21.8 – 30.2%] Malnutrition Severe Acute 2.8% [1.5 – 4.9%] Malnutrition Oedema 0.6% [5 Children] Mother’s <185mm Malnourished 0.4% MUAC 185 – 219mm ‘At risk’ 27% >=220mm ‘Well nourished’ 72.5% Under Five retrospective 1.7 /10 000 /day mortality♠ Crude retrospective mortality♠ 0.6 /10 000 /day Measles immunization coverage 81.2% *: Expressed over a 95% confidence interval ♠: Over three months preceding the survey (Temporary evacuation of Medair in February from Baidit was used as a reference point). 2 4. DISCUSSION The prevalence of acute malnutrition for children aged 6 to 59 months as manifested in this survey is alarmingly high1 and it exists at a global rate of 37.7% according to the z-score index. The results also reveal very high prevalence of severe acute malnutrition at a rate of 6.6%. This implies, for every 100 children, seven children are vulnerable to mortality resulting malnutrition. Further analysis of survey results, reveals that statistical comparative analysis of malnutrition rates between children aged 6 to 29 and 30 to 59 months, indicate no significant difference (P>0.05). This implies that malnourished children in our sample are evenly distributed in both age groups. This scenario, points to a worrying nutrition state of this population considering that nutritional insecurity is not only limited to younger children but also the older children are equally at risk. Z-score index distribution analysis, reveals that a considerable proportion of children (31%) in the surveyed sample are moderately under- nourished (-2SD =<WFH>-3SD), while 28% of those who appear to be “adequately nourished” are at the borderline (distributed between –2SD and –1SD). In the event of a lengthy period of a hunger gap, the borderline children are likely to slip into a moderate state while the moderate slip into a severe state, adding to an already difficult situation. Thus the need to address the problem before it deteriorates further. MUAC results, further reveals that 6.2% of the under-five population are identified to be “at high risk of mortality due to malnutrition” while 42.4% are at moderate risk. As regards the caretakers, 27% are chronically energy deficient. In consideration of mothers’ roles at household level in this community, this poor nutritional state is likely to affect quality of childcare provided by the mothers as well as their ability to effectively ensure household food security. This is a matter of concern in view of the prevailing hunger gap. According to this survey, crude and under five retrospective mortality rates are low and below emergency levels. The main presumed causes of death were respiratory tract infections (45%) followed by diarrhoea diseases (27.3%) amongst the under five’s while in the above five population, respiratory tract infections again featured as the highest causes of mortality. Bor County was reported food secure by the ANA 2001/2 because of improved crop production, restocking process and improved access to trade and markets. However a 5% food deficit in poor households was predicted this year for the period of May –July. Consequently, food aid interventions for this region were planned and channelled through food for work micro projects starting in January this year4. With the exception of the registered returnees, who are still receiving food aid (3000 beneficiaries in May 2002), the last food distribution in this place occurred in July last year. 3980 beneficiaries were targeted with a 50% food ration meant to cover two months. However at the time of the survey, the food security situation of this population appeared threatened. From observations and discussions, non-pastoral communities settled far from the Nile and its tributaries appeared to be most hit since they possess no livestock and have little access to 1 WHO classification of wasting prevalence 4 WFP-TSU Southern Sudan 2 fish. Although the consumption of wild foods had increased at the time of the survey, it seemed not to be sufficient. In addition, although the population had access to markets, it was noticed that little or no grain was available to potential buyers. During the survey, it was reported that individuals with the grain were withdrawing it from the market for own consumption. In addition, there was an unexpected influx of population (returnees) into the area last year. Though some of them were registered and accounted for, discussions with the people on the ground revealed that, a considerable number came in unregistered. These unregistered self-returnees, as well as the Murle population that came after the peace agreement appear to have had an immense impact on the overall availability of food in the population. (A lot of grain was exchanged for cattle from the Murles who are traditionally nomadic and exchange / sell animals for grain). In addition, discussions with individuals in this community revealed that Athoac region received the second rains late (normally they are received in October), this appears to have led to reduced grass availability for cattle and thus decreased milk production. The late and finally excessive second rains, at a critical moment led to flooding of low lands and caused reduced grain harvest also. (As result, Amul is said to have been extremely affected). In addition to the hunger gap there are aggravating factors that have a strong likelihood of contributing to the deterioration of the nutritional status. These include poor child weaning practises (Children are only breast fed till they are 2-3 years), raw milk consumption (this is potentially dangerous because of raw milk borne infections associated with animal ill health). Differential intra-household food distribution, inadequate personnel and environmental hygiene, poor health care seeking practises, absence of affective preventive health services, are problems, among others, that are likely to impact negatively on the nutritional status of the population2. Medair provides primary health care services through 1 PHCC and 9 PHCUs. At the time of the survey, 23 TB patients were reportedly
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