ATHROPOMETRIC AND MORTALITY SURVEY
TAITA-TAVETA COUNTY (VOI, MWATATE, WUNDANYI AND TAVETA
DISTRITCS)
KENYA
FINAL REPORT
JULY 2011
Onesmus Muinde Nutrition Consultant [email protected]
Survey done by World Vision in collaboration with Ministry of Health of Health and ARIDLANDS
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ACKNOWLEDGMENTS
We would like to acknowledge the following:
ꢀ UNICEF for funding the survey report ꢀ World Vision Kenya for proving transport and logistical support ꢀ Provincial administration in Taita-Taveta County , for their guidance to ensure smooth flow of the survey,
ꢀ Ministries of Medical services and Public Health and ARID lands for their participation in the survey.
ꢀ The local surveyors for their resolute efforts, in contributing towards fulfilment of the survey objectives,
ꢀ Final but not least, appreciation goes to caretakers, local authorities, and community leaders without whose cooperation and assistance the survey objectives could not have been realized.
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Table of content
ACKNOWLEDGMENTS.............................................................................................................1 Table of content............................................................................................................................2 List of Tables..................................................................................................................................4 List of Figures ................................................................................................................................4 List of Maps....................................................................................................................................4 List of Pictures...............................................................................................................................4 EXECUTIVE SUMMARY.............................................................................................................5
2.0 INTRODUCTION .................................................................................................................... 10 2.1 FOOD SECURITY..................................................................................................................... 11 2.3 HEALTH AND NUTRITION .................................................................................................... 11
3.1 METHODOLOGY ................................................................................................................12
3.1 Type of Survey and Sample Size................................................................................................. 12 3.2 Sample Size Calculation ............................................................................................................. 12 3.3 Data Collection ......................................................................................................................... 13 3.4 Indicators, Guidelines, and Formula’s Used................................................................................ 13 3.4. 1 Acute Malnutrition................................................................................................................. 13 3.4.2 Stunting................................................................................................................................... 14 3.4.3 Underweight........................................................................................................................... 14 3.4.4 Mortality................................................................................................................................. 15 3.4.5 IYC Indicators......................................................................................................................... 16 3.4.5 Health, food security and water and sanitation data................................................................ 17 3.5 Data quality control assurance................................................................................................... 17 3.6 Field Work................................................................................................................................ 17 3.7 Data Analysis............................................................................................................................. 17 3.8 Challenges faced during survey.................................................................................................. 17
4.0 RESULTS AND DISCUSSION...........................................................................................18
4.1 Health and nutrition status ........................................................................................................ 18 4.1 .1 Distribution by Age and Sex .................................................................................................. 18
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4.1.2 Distribution of Acute malnutrition by Z-scores ...................................................................... 19
4.1.3 Distribution of acute malnutrition in percentage of median..................................................... 20 4.1.4. Distribution of Underweight in Z scores Taita-Taveta July 2011 (WHO reference............... 21 4.1.5 Distribution of stunting in Z scores Tiatia -Taveta (WHO reference)..................................... 21 4.1.6 Risk of mortality: children MUAC and mothers/care takers MUAC........................................ 22
4.1.7 Vaccination coverage and Vitamin A supplementation............................................................. 22 4.19 Mortality.................................................................................................................................. 23 4.1.8 Breastfeeding and complementary feeding............................................................................... 23 4.1.9 Child morbidity and treatment seeking ................................................................................... 24 4.1.10 Mosquito net coverage.......................................................................................................... 25 4.2 Water and Sanitation................................................................................................................. 25 4.2.1 Water source and use ............................................................................................................ 25 4.2.2 Hand washing practice and Latrine ownership......................................................................... 25 4.3 Food security............................................................................................................................. 25
5.0 CONCLUSIONS AND RECOMMENDATIONS.............................................................27
5.1 Health and Nutrition ................................................................................................................. 27 5.2 Water and Sanitation................................................................................................................. 28 5.3 Food Security ............................................................................................................................ 28
6.0 ANNEXES..............................................................................................................................30
Annex 1: Assignment of clusters Taita-Taveta County.................................................................... 30 Annex 2: Anthropometric and Health survey data form................................................................ 33 Annex 3: Calendar of events........................................................................................................... 34 Annex 4: Household mortality form................................................................................................ 35 Annex 5. Infant and young Child feeding questionnaire................................................................ 36 Annex 6: Water and Sanitation questionnaire.............................................................................. 37 Annex 7: Food security questionnaire........................................................................................... 38 Annex 8: Plausibility checks .......................................................................................................... 40
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List ofTables
Table 1: Summary results .................................................................................................................. 6
Table 2. Distribution of age and sex Taita-Taveta July 2011............................................................ 18 Table 3. Weight for height distribution by age Taita-Taveta in Z-scores (WHO reference)............. 19 Table 4. Weight for height versus Oedema Taita-Taveta in Z scores (WHO reference)................. 19 Table 5 Global and Severe Acute Malnutrition in Z score Taita-Taveta, July 2011........................... 20 Table 6: Distribution of Weight/Height by age in percentage of median (NCHS)............................. 20 Table 7: Global and Severe Acute Malnutrition in percentage of Medium Taita-Taveta July 2011..... 20 Table 8: Prevalence of underweight based on Weight-for age Z scores........................................... 21 Table 9: Prevalence of stunting by age based on height-for-age Z scores......................................... 21
Table 10: Child MUAC distribution Taita-Taveta , July 2011............................................................ 22
Table 11: Measles vaccination coverage Taita-Taveta, July 2011....................................................... 22
Table 12 Vitamin A coverage........................................................................................................... 22 Table 13: DPT 3 coverage ............................................................................................................... 23 Table 13: Mortality results............................................................................................................... 23
Table 14: Disease patterns in the last two weeks before the survey................................................ 25
List of Figures
Figure 1: Distribution by Age and sex Taita-Taveta July 2011 .......................................................... 18
Figure 2: Weight for height distribution Taita-Taveta July 2011 ....................................................... 19
Figure 3: Breastfeeding indicators, Taita-Taveta, July 2011............................................................... 24
Figure 4: Introduction of complementary foods in Taita-Taveta July 2011........................................ 24
Figure 5. House hold food diversity Taita-Taveta, July 2011 ....................................................... 27
List of Maps
Map 1: Taita-Taveta County.......................................................................................................... 10
List of Pictures
Picture 1: Maize in Kishushe location, Wundanyi July 2011......................................................... 26
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EXECUTIVE SUMMARY
Taita Taveta County is in Coast Province and is situated to the southwest. It borders Tana River, Kitui and Makueni Districts to the north, Kwale and Kilifi Districts to the east, Kajiado District to the northwest and the Republic of Tanzania to the south and southwest. The County lies between 2° 46’ South and 4° 10’ south and longitudes 37° 36’ east and 30°14’ east. However, the County has recently been divided into Voi, Wundanyi, Taita, and Taveta districts
Taita Taveta is classified as a semi arid district. Out of the total area of 17,128.3 Km2 covered by the district, 10,680.7 km2 or 62 per cent is occupied by Tsavo East and West National parks, 4,100.7 km2 or 24 per cent is range land suitable for ranching and dry land farming, while only 2,055.4 km2 or 12 per cent is available for rain-fed agriculture. Of the 2,055.4 km2 arable land, 1,774.5 km2 or 74 per cent is low potential agriculture land, receiving an annual mean rainfall of 650mm.
It is estimated that in the larger Taita Taveta County has a population size of 284,657. The area experiences extreme food shortages which have contributed to high malnutrition rates, including acute malnutrition among children. In the recently conducted Short Rains Assessments, Taita Taveta has been classified as borderline food insecure and currently one of the districts under watch following the La Nina phenomenon. The district is predominantly agro pastoralist and marginal mixed livelihood zones and thus highly vulnerable to food insecurity during the drought seasons.
In order to guide programming in the district, a nutrition survey is in need. The survey will provide not only nutrition information, but also those related to WASH, health and food security.
SURVEY OBJECTIVES
The specific objectives of this survey were to:-
1. Assess the prevalence of acute and chronic malnutrition in children aged 6-59 months. 2. Assess the prevalence of malnutrition in pregnant women and mothers 3. Assess Infant and young feeding practices. 4. Estimate coverage for SFP, OTP, measles and DPT 3 vaccination and vitamin A. 5. Estimate morbidity rates in children 6-59 months 6. Estimate crude and under five mortality rate. 7. Assess Household food security levels/situation
Methodology
Standardized Method for Relief and Transition (SMART) was used for planning, training and data collection for the nutrition survey. The Survey enumerators were trained for 4 days, standardization test was done to select the data recorders and pilot was done to make sure that enumerators are equipped with the necessary skills for data collection.
Using prevalence of 7 %, precision of 3 and design effect of 2, a sample size of 556 children was obtained. In the mortality session, an estimated prevalence of 0.2, a desired precision of 0.2 and a design effect of 2 resulted in a sample size 3,312 with a recall period of 112 days. A total of 828 households were sampled for the survey and a total of 40 clusters were selected for the survey.
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At the second stage, a selection of the households to be visited within each cluster was done. Simple random method was used to select the households, the village elders gave the list of the households in a given village, using table of random numbers the households were selected. In cases where the villages had huge number of households, segmentation was done; the population was subdivided in to equal segments and one segment was selected using table of random numbers, the household were then listed, and the required households selected from the list by simple random method.
In each selected household, all children aged 6-59 months were included. If there was more than one wife (care taker) in the household1, each wife was considered separately regardless of whether they were cooking together. If there were no children in a household, the house remained a part of the “sample” that contributed zero children to the nutritional part of the survey. The household was recorded on the nutritional data sheet as having no eligible children.
Nutrition, mortality and vaccination coverage, IYCF and Water and Sanitation results
A total of 561children were measured, one records were excluded from anthropometric data analysis.
Table 1: Summary results
Anthropometric and Mortality data results
Global Acute Malnutrition (GAM) (<-2 z-score and/or oedema) Severe Acute Malnutrition (SAM) (<-3 z-score and/or oedema) Global Acute Malnutrition (GAM) (<-2 z-score and/or oedema) Severe Acute Malnutrition (SAM) (<-3 z-score and/or oedema)
5.5% [3.7- 8.1] 0.9% [0.3- 2.5] 5.3% [3.6- 7.9] 0.5% [0.1- 2.3]
Child Nutrition Status W/H
(WHO)- Z scores (561)
Child Nutrition status W/H
(NCHS)- Z-scores(561)
Prevalence of global acute malnutrition (<80% and/or oedema) Prevalence of severe acute malnutrition 0.2 %[0.0 – 1.3] (<70% and/or oedema)
2.5 % [1.4 – 4.6]
Child Nutrition status W/H
(NCHS)- percentage of the median (561)
Prevalence of stunting (<-2 z-score) Prevalence of severe stunting (<-3 z-score)
27.8% [23.9-32.1]
Child Nutrition Status H/A
- (WHO)- Z scores (561)
- 6.6% [4.7-9.2]
Prevalence of stunting (<-2 z-score) Prevalence of severe stunting (<-3 z-score)
21.7% [18.2-25.8] 3.2% [2.0-5.2]
Child Nutrition Status H/A
(NCHS)- Z scores (561)
12.8% [10.1-16.2]
Prevalence of underweight (<-2 z-score) Prevalence of severe underweight (<-3 z-score)
Child Nutrition Status W/A
(WHO)- Z scores (561)
1.6% [0.8- 3.2]
20.0% [16.1-24.5]
Child Nutrition Status W/A
(NCHS)- Z scores (561)
Prevalence of underweight (<-2 z-score)
1 A household refers to a caretaker and his/her children
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Prevalence of severe underweight (<-3 z-score)
2.0% [ 1.0- 3.9]
Crude Death rate/10,000/day 0-5 Death rate/10,000/day SAM (<115 mm)
0.27[0.16-0.45] 0.30[0.07-1.20] 0.4%
Mortality
- Child MUAC (598)
- GAM (<125mm)
- 2.2%
- At risk ( >125-<134 mm)
- 10.5%
Maternal nutrition status (lactating Malnourished < 21.0 cm and pregnant mothers)
0.7%
Vaccination coverage, Vitamin A and Iron supplementation
- Card
- 81.0%
16.4%
2.4%
Measles coverage ≥ 9 months
(538)
According to mother
Not Immunized
83.6% 15.7%
0.7%
Card
DPT3 (560)
According to mother
Not immunized
Vitamin A coverage (last 6 months) (560)
64.1% 35.9%
Received Not received
65.5% 34.5% 63.9% 36.1%
Vitamin A coverage (6-11) Last 6 months (58)
Received Not received Received Not received
Vitamin A coverage (12-59) Last 6 months (502)
84.9% 13.7%
1.4%
Yes No
Don’t Know
Mother Iron supplementation (last pregnancy)
Morbidity for the last 2 weeks
- Child Illness in the last 2 weeks
- Yes
No
53.0% 47.0%
Fever Cough
Watery Diarrhoea
31.0% 54.8%
6.2%
Type of Illness
Blood Diarrhoea
Others (vomiting, skin infection, eye problem, wound, stomach ache, ring worms )
1.6% 6.5%
Yes No
Don’t Know
51.4% 47.5%
1.1%
De-Worming
- ORS
- 46.7%
13.3%
6.7%
Homemade sugar salt solution Another homemade liquid
Zinc
Treatment Sought for diarrhoea
6.7%
Other drugs nothing
13.3% 13.3% 87.0% 13.0%
Child Slept under mosquito net last night
Yes No
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Infant and young child feeding practice2
Given colostrums
Exclusive breastfeeding
0-23 Months (n=278)
0-5 Months (n=90)
75.9% 51.1%
Early Initiation of breast feeding
- 0- 23 Months(n=278)
- 67.6%
Continued breastfeeding at 1year
12-15 Months (n=42)
6-8 Months (n=26)
85.7% 92.6%
Introduction of solid, semi-solid or soft foods
Minimum diet diversity
Minimum meal frequency Minimum Acceptable diet
Child ever breastfed
6-23 Months (n=188) 6-23 Months (n=188) 6-23 Months (n=188) 0-23 months (n=278)
2.7%
93.1%
2.7%
94.2%
- 48.6%
- Continued breastfeeding at 2years
20-23 months (n=37)
Water and Sanitation
Bore hole River
Protected shallow well Household connection Unprotected shallow well
Open shallow well
5.8%
14.4%
1.1%
75.3%
2.9%
Main water source
0.4%
Length from Water Source
House hold water
<30 minutes
>=30 minutes
72.4% 27.6%
Minimum Maximum Average
7 litres
200 litre
59.2 litres
Nothing Boiling
Chlorination
60.4% 19.2% 20.5%
Water Treatment
Latrine Hole
Designated Open Area
96.4%
1.6% 0.4% 1.6%
Toilet Use
Undesignated Area
2
As per Indicators for assessing infant and young child feeding practices Part 3 Country profiles
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House hold food consumption
Own Production
Purchases
Gifts
18.0% 79.0%
0.2%
Main Source of food consumed in the Household
- Food Aid
- 2.5%
- Borrowed
- 0.2%
One meal Two meals
Three meals and above
0.2%
12.6% 87.1%
Number of meals normally eaten per day
One meal Two meals
Three meals and above
0.7%
14.5% 84.8%
Number of meals eaten the day preceding the survey
Household dietary diversity score
Average HDDS
6.4
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2.0 INTRODUCTION
Taita Taveta County is in Coast Province and is situated to the southwest. It borders Tana River, Kitui and Makueni Districts to the north, Kwale and Kilifi Districts to the east, Kajiado District to the northwest and the Republic of Tanzania to th e south and southwest. The County lies between 2° 46’ South and 4° 10’ south and longitudes 37° 36’ east and 30°14’ east. However, the County has recently been divided into Voi, Wundanyi, Taita, and Taveta districts
Map 1: Taita-Taveta County.
Taita Taveta is classified as a semi arid district. Out of the total area of 17,128.3 Km2 covered by the district, 10,680.7 km2 or 62 per cent is occupied by Tsavo East and West National parks, 4,100.7 km2 or 24 per cent is range land suitable for ranching and dry land farming, while only 2,055.4 km2 or 12 per cent is available for rain-fed agriculture. Of the 2,055.4 km2 arable land, 1,774.5 km2 or 74 per cent is low potential agriculture land, receiving an annual mean rainfall of 650mm.