Republic of Yemen Ministry of Public Health and Population Taiz Governorate Health Office
Nutrition Survey of Taiz Governorate 2016
May 2016
Final Report
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Contents Page 1. Executive Summary 7 2.Taiz Context 9 3. Methodology 10 3.1 Setting 10 3.2 Study and sampling design 11 3.3 Sampling Procedure (The second stage) 12 3.4 Survey Population and Data Collection Process 13 3.5 Measurement Standardization and Quality Control 14 3.6 Data Entry and Analysis 15 4. Assessment Results 17 4.1 Household Characteristics 17 4.2 Food Security 21 4.3 Child Nutrition 25 4.3.1 Distribution of U5 children 25 4.3.2 Wasting (WHZ) Indicators 26 4.3.3 Oedema and WHZ Indicators 28 4.3.4 Underweight (WAZ) Indicators 29 4.3.5 Stunting (HAZ) Indicators 31 4.3.6 MUAC Indicator of Children 36 4.4 Child Morbidity and Immunization 41 4.5 Infant and Young Child Feeding (IYCF) Practices 42 4.6 Child Mortality 43 4.7 Mid-Upper Arm Circumference (MUAC) Measurement for 44 Women 4.8 Discussion and variable associations 45 5. References 48
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3 Acronyms TC: Taiz City THL: Taiz Highland TLL: Taiz Lowland HHs: Households YER: Yemeni Rial WHZ: Weight-for-height-z score WAZ: Weight-for-age-z score HAZ: Height-for-age-z score MUAC: Mid Upper Arm Circumference GAM: Global Acute Malnutrition MAM: Moderate Acute Malnutrition SAM: Severe Acute Malnutrition 95% CI: 95% Confidence Interval FT: Fisher Test SD: Standard Deviation U5: Under Five U5MR: Under Five Mortality Rate CMR: Crude Mortality Rate MDGs: Millennium Development Goals SDGs: Sustainable Development Goals BF: Breastfeeding MDD: Minimum Dietary Diversity MMF: Minimum Meal Frequency MAD: Minimum Acceptable Diet IYCF: Infant and Young Child Feeding
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List of Tables
Table 1: Key indicators of the nutritional survey of Taiz Governorate Table 2. Parameters used in the Sample Size Determination Table 3. Chronology of Activities in Taiz Governorate Table 4: Household Characteristics Table 5: Distribution of HHs Income Quintiles by zone Table 6: HHs Food Security Indicators by zone Table 7: Descriptive Statistics of Some Food Security Indicators by zone Table 8: FCHDDSIPC indicators by income quintiles and zone Table 9: FCS Classification indicator by income quintile and zone Table 10: CS Type indicator by income quintile and zone Table 11: Distribution of U5 children by age group, gender and zone Table 12: Prevalence of Wasting (WHZ) by gender and zone (6-59 months) Table 13: Prevalence of wasting by age group and zone Table 14: Distribution of WHZ and Oedema (6-59 months) Table 15: Prevalence of Underweight (WAZ) by gender and zone (6-59 months) Table 16: Prevalence of Underweight by age group and zone Table 17: Prevalence of Stunting (HAZ) by gender and zone (6-59 months) Table 18: Prevalence of Stunting by age group and zone Table 19: Prevalence of MUAC by gender and zone (6-59 months) Table 20: Prevalence of MUAC by age group (6-59 months) and zone Table 21: Mean z-scores, Design Effects and excluded subjects by zone Table 22: Child Morbidity 6-59 by gender and zone Table 23: IYCF Indicators Table 24: U5MR for all children by zone (365 days recall time) Table 25: U5MR of male children by zone Table 26: U5MR of female children by zone Table 27: Nutrition status of women aged 15-49 years measured by MUAC Table 28: Mapping the statistical significant associations between malnutrition status of children and some socio-economic and health indicators
List of Figures Figure (1): TC (WHZ) Figure (2): THL (WHZ)
5 Figure (3): TLL (WHZ) Figure (4): TC (WAZ) Figure (5): THL (WAZ) Figure (6):TLL (WAZ) Figure (7): TC (HAZ) Figure (8): THL (HAZ) Figure (9): TLL (HAZ) Figure (10): TC Population Pyramid Figure (11): THL Population Pyramid Figure (12): TLL Population Pyramid Figure (13): The malnutrition status by gender and zone Figure (14): The malnutrition status by by zone
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1. Executive Summary
A SMART survey was conducted from …. to …. 2016 in three zones namely TC, TLL and THL in Taiz Governorate (details about districts in each zone are shown on the methodology section). A total of 1458 HHs were surveyed and a variety of HH characteristics information were collected. Data were also collected from 1708 U5 children and 2338 women on the reproductive age 15- 49 years. The survey was designed and aimed at updating information about the nutritional status of children and women and more precisely: 1. To investigate some of the HHs living conditions that may – directly or indirectly – affect the nutritional status of children and women. 2. To evaluate the HHs food security situation. 3. To assess the nutritional status of U5 children and women aged 15- 49 years. 4. To assess the prevalence of infectious diseases, the immunization and Vitamin A coverage among children and follow the trends of IYCF practices. 5. To track any possible changes in U5MR trends.
A two-staged cluster cross sectional study was conducted. The methods used, including sampling design and sample size determination were following SMART approach. The WHO Growth Standards and SMART flags of (±3SD) were used to calculate the nutritional situation of U5 children1,2. A cut-off of <-2SD) was used to calculate global acute malnutrition (GAM) of all nutritional indicators of children. Further, cut-off less than 22.2 cm for women and 12.5 cm for children to assess their MUAC nutritional status were used. The key indicators of the survey are shown on Table 1.
Table 1: Key indicators of the nutritional survey in Taiz Governorate Indicators TC THL TLL Children Wasting (WHZ) Global 17.0% 14.5% 25.1% Severe 1.9% 1.7% 5.3% Underweight (WAZ) Global 38.1% 42.6% 48.8% Severe 8.9% 11.1% 15.9% Stunting (HAZ) Global 39.3% 49.4% 45.6% Severe 9.1% 16.7% 14.6% MUAC Global 8.3% 9.4% 11.7%
7 Severe 2.3% 2.1% 3.4% Oedema 0% 0% 0% U5MR per 10,000 per day 1.14 0.28 0.4 CMR per 10,000 per day 0.21 0.09 0.16 Still breastfeeding (6-24 months) 70.1% 67.3% 76.5% Exclusive breastfeeding < 6 months 25.0% 58.1% 11.9% Continued BF at 1 year (12–15 months) 87.5% 74.0% 80.4% Continued BF at 2 year (20-23 months) 50.0% 31.5% 54.7% MDD (6-23 months) 29.3% 27.5% 26.3% MMF (6-23 months) 50.9% 58.7% 55.4% MAD (6-23 months) 13.1% 13.0% 11.7% Proportion of children with diarrhoea within 2 45.1% 43.8% 27.4% weeks prior to assessment (6-59 months) Proportion of children with Cough Breathing 37.0% 36.9% 24.1% Difficulty (ARI) within 2 weeks prior to assessment (6-59 months) Proportion of children with Fever within 2 weeks 57.9% 62.3% 41.2% prior to assessment (6-59 months) Children immunized against measles (6-59 90.0% 88.6% 64.9% months) Children who have received 3 doses of polio 93.1% 91.1% 62.1% vaccine (6-59 months) Children reported to have received Vitamin A 91.2% 90.9% 77.9% supplementation in the last 6 months (6-59 months) Women Acute malnutrition among women Global 17.3% 19.0% 28.3% (WFP Yemen Classification) Severe 11.5% 12.4% 18.8% Acute malnutrition among Global 5.1% 7.7% 6.1% Pregnant women (WFP Yemen Severe 3.8% 6.7% 5.0% Classification) Acute malnutrition among Global 15.3% 21.4% 35.2% Lactating women (WFP Yemen Severe 17.9% 17.6% 36.2% Classification)
With few exceptions, the above table marks the nutritional status of children in the three zones as critical and exceeding the emergency thresholds according to WHO categorization1. In general, the U5MR,s are high but more noticeably in TC zone. Exclusive breastfeeding varied enormously from one zone to another with the highest percentage in THL. Complementary food practices indicators are – into some extent – similar in the three zones. While
8 the highest prevalence rates of diarrhea and ARI are in TC and THL, the highest prevalence of fever in THL. More than 90% in TC and 88% in THL children were measles immunized and polio vaccinated. The situation is different with the TLL children where only 64.9% and 62.1% have been immunized against measles and polio. Vitamin A coverage is lower than 95% (the recommended coverage of Sphere Standards3) in all zones and more noticeably in TLL zone. The prevalence of acute malnutrition among women is mainly concentrated in TLL zone either on general or those who still lactating. In addition, statistical significant relationships between malnutrition status and some HHs characteristics, food security indicators and prevalence of diarrhea were found but it differ from one zone to another.
Recommendations Rapid interventions should be implemented to alleviate more deterioration in the malnutrition disastrous situation in this governorate. The community-based programs should be enhanced to provide information and raise mothers awareness about the importance of breastfeeding practices and appropriate complementary feeding practices. Educate HHs about proper care and hygiene practices that could help in reducing the prevalence of infectious diseases. Efforts should be devoted to scale up the immunization and Vitamin A coverage specially in TLL zone.
2. Taiz Context
Taiz Governorate is located in the southwestern part of the Republic of Yemen, bordering the Red Sea to the west, Hodaidah and Ibb governorates to the north, Lahj to the south, and Al-Dhale governorate to the east. Its surface area is about 10462 km2. Taiz is Yemen's most populous governorate, with an estimated 3,116,000 people – 11.3% of the country's population (2016 population projection based on 2004 census4). About 81% of the population is rural while 19% is urban; 46.7% is male and 53.3% is female. Taiz's population growth rate is 2.47%. Current population density is estimated at 298 inhabitants /km2. Administratively Taiz is divided into 23 districts, 3 urban (Muzaffar, Qahera and Salah), and 20 rural (Al Taziha, Saber Al Moadm, Mashra'a and Hdnan, Al Msrakh, Jabal Habashi, Mawasit, Al Maafr, Ashammaitin, Mauza'a, Al Wazeia, Al Makha, Dhubab, Maqbana, Sharhab Al
9 Rawna, Sharhab Al Salam, Khadder, Same'a, Aselow, Hiffan and Mawiah), as shown in Figure 1. There are 1877 villages, within 329 Ozla. Apart from TC, Taiz governorate is made up of two ecological zones, namely the Mountainous Zone or Highland Zone and the Lowland Coastal Plain or just the Lowland Zone. Although the governorate is characterized by diverse economic activity, the population's characteristics and living conditions differ significantly between the two ecological zones. People in the lowland zone work mainly in fisheries, while those living in the highland area engage mostly in farming, cultivating crops such as grains, vegetables, qat and fruits as well as livestock and industry. Climate: The climate differs between the mountainous and coastal plain areas. The mountainous areas have cold winters and temperate summers, while the coastal areas have temperate winters and warm/hot summers. Precipitation: Summers are humid across Taiz governorate, due to the seasonal winds from the Indian Ocean. Average rainfall in Taiz is 737 mm, though little of it is received during winter. Annual rainfall may reach more than 1000 mm in certain locations, such as Jabal Sabir. Socio-political situation: Since May 2011 armed conflict and civil unrest have caused a significant increase in humanitarian needs in Taiz, particularly with regard to food, access to basic health care, and water, sanitation and hygiene (WASH). Insecurity is one of the primary humanitarian challenges, hindering smooth delivery of humanitarian assistance. Basic public social services are also inadequate in some areas that may not have access challenges. All recent assessments and surveys including the results of the present assessment are indicating that the malnutrition situation of children and women is deteriorating in Taiz Governorate and escalated into unprecedented levels may be in decades and therefore entailed emergency nutrition situation announcement.
3. Methodology 3.1 Setting The survey was conducted in three strata of Taiz governorate, the Taiz City, Taiz Highlands and Taiz Coastal Lowlands. Recognising that the livelihood situation in Taiz City is different than rest of the governorate, it was considered in design of this survey as a standalone survey layer.
10 Three districts were composing the Taiz City stratum, Al-Modhaffar, Al- Qaherah and Sala. Taiz Highland districts were Al-Shamaitain, Al-Selow, Al- Mesrakh, Al-Ma'afer, Al-Mawaset, Jabal Habashi, Haifan, Samea', Sharab Al- Rawna, Sharab Al-Salam, Saber Al-Mawadem, Mashra'ah Wa Hadnan, Al- Taiziah, Khadeer, Mawiah and 26 Ozlas of Maqbanah District. Taiz Coastal Lowland districts were Al-Makha, Dobab, Mawza', AlWazeiah, and 3 Ozlas of Maqbanah District. Total clash areas have been excluded from the frame before the selection of clusters. In Taiz City zone 17 zones in Al-Modhaffar, 16 zones in Al-Qaherah and 27 zones in Sala have been excluded from the frame. In Taiz Highlands, the excluded areas were distribute as the following: - Al-Taiziah District: 13 villages in Al-Rubaiee, 16 villages in Al-Hashamah and 6 villages in Hathran. - Jabal Habashi District: 11 villages in Bilad Al-Wafi. - Saber Al-Mawadem District: 6 villages in Al-Dhabab. - Al-Mesrakh District: 33 villages in Al-Aqroodh and 6 villages in Abdan. - Haifan District: 28 villages in Al-Arooq, 8 villages in Al-Aghaberah, 25 villages in Al-Aboos, 15 villages in Al-Athawer and 9 villages in Al-Ahkoom. In Taiz Coastal Lowland, excluded areas were: - AlWazeiah District: 8 villages in Al-Mashawelah, 16 villages in Al-Dharifah, 1 village in Al-Sowaida, 7 villages in Al-Bawkarah and 5 villages in Al- Ahyooq. - Dobab District: 18 villages in Bani Al-Hakam - 3.2 Study and sampling design A two-staged cluster cross sectional study was conducted. The methods used, including sampling design and sample size determination were following SMART approach. The sample size was calculated using the parameters as shown in table 2. The sample size was calculated based on achieving statistical significance for anthropometric and mortality objectives. Thus, the highest number from each of the two objectives was selected. Table 2. Parameters used in the Sample Size Determination Taiz City Taiz Highland Taiz Lowland
Anthropometry
11 Expected prevalence (p) 15 12 17.6
Relative desired precision (d) 3.8 3 3.5 Design Effect (DEFF) 1.2 1.2 1.3 Average household size 7 7.06 7.26 % of U5 in population 18.4 18.4 18.4
% Non-response 3 3 3
Mortality Estimated crude death rate (CDR) per 0.24 0.24 0.27 10000/day Relative desired precision (d) per 0.2 0.2 0.2 10000/day Design Effect (DEFF) 1.5 1.5 1.5
Recall period in days (RP) 365 365 365
Average household size 7 7.06 7.26 % Non-response 3 3 3
The sample size calculated for the three strata were higher in the anthropometry than in mortality. The calculated sample sizes for households in the three strata of Taiz City, Taiz Highland and Taiz Lowland were 394, 519 and 552 respectively. With these numbers of households, the expected numbers of undelivered children in the three strata were 443, 589 and 644 respectively. The survey has taken place in 30 clusters in each stratum. The number of households in each cluster was calculated as 14 households in Taiz city, 18 households in Taiz Highland and 19 households in Taiz Coastal Lowland. The source of the sample frame used in this survey was Taiz Governorate Health Office. The frame contains a list of villages with a projection of population that is made based on the of the CSO 2004 Census 4.
3.3 Sampling Procedure (The second stage) The survey sample consisted of 30 clusters. These clusters were selected following Probability Proportional to Size (PPS) approach using ENA software.
12 For the majority of clusters, household were selected at a cluster level using simple random sampling (SRS). This was achieved through randomly selection of the required number of households from the updated households list. In the case of large clusters, segmentation was made, then one segment was selected using PPS, and within selected segment, households were selected via SRS. In many cases, updated lists can be readily collected from village leaders who are having them for other purposes. Where household lists at a village-level were not available, team leaders were doing these lists before commencing the household section and data collection process in collaboration with villagers. The lowest and the last method used is the modified EPI random walking. It is used in settings where simple random sampling with or without segmentation are difficult to be followed such as in towns. The modified EPI random walking method is explained in the box below.
The Modified EPI methodology involved identifying the centre of the cluster/ village or the segment, where they have to spin a pen to randomly select the direction to take to the edge/periphery of the village. The team should walk to the edge of the cluster/ village. From the edge of the village, the team has to spin the pen again aiming to randomly get a direction to follow to the other extreme edge of the village. In case the pen pointed towards outside of the village, the team were to spin The modified EPI method used for selection of the pen multiple times till the households pen pointed to any of the directions towards the village. Once a new direction is obtained, the team counted Total the households along the randomly selected direction, give each household a number, and then randomly selected the first household to be interviewed from the numbered households. Same direction is followed to select the subsequent household for interview, going for next nearest household on the right side and following the selected direction, until the required minimum number of households and children had been assessed5.
13 In case the team assesses total households to the edge of the village and did not reach the required number of households, the team should repeat the process again i.e. start from the cluster/ village centre to randomly select another direction, then walk to the edge, then spin the pen again and count the households to the edge of the cluster. Then randomly pick the first household for interview, and then go the next nearest household, to the right hand side, till the required number of households were interviewed. In case of absence of members or children of the randomly selected house during the interview time, an appointment was made by the survey team to return back before leaving the cluster5.
3.4 Survey Population and Data Collection Process The survey population consisted of: 1) anthropometry: children aged 6 to 59, 2) mortality: Total people that have lived at the household (currently residing, left, born or died) over a set recall period; 3) IYCF: children 0-24 months; 4) morbidity: children 0-60 months. Age estimation was based on birth or immunization card details and/or supported with events calendar, agriculture and fishing seasons, as well as national and local events (Ref: Annex 3: Events Calendar and Annex 4: Age determination job aid). Table 3 summarises the survey activities undertaken. A qualified SMART survey team, present in Taiz Governorate participated in a two day refresher training organized by the survey manager. The training consisted of anthropometry, filling of questionnaire, and the field procedures before commencing the data collection phase. The data collection was completed over a five day period by five teams (Ref: Annex 2: Taiz Lowland Nutrition March 2016 Survey Team). Selected households were given a brief overview of the survey and invited to participate. Verbal consent to participate was obtained after the household participant heard the survey overview from the survey team. After consent was given, the survey teams assisted a member from each selected household to complete a questionnaire comprising of 1) background demographics; 2) education of household caretaker; 3) household income; 4) WASH indicators; 5) household food consumption and coping strategies; 6) child vaccination and vitamin A supplementation; 6) child anthropometry; 7) child morbidity; 8) IYCF practices; 9) woman MUAC; and 10) crude and underfive mortality. The questionnaire was the same questionnaire used in the 2015 nutrition survey
14 (Annex 1: Taiz Governorate Lowland Nutrition Survey Questionnaire). Retrospective mortality data were collected from Total randomly selected households, irrespective of presence or absence of children aged 6-59 months. A recall period of 365 days prior to the survey was used. Table 3: Chronology of Activities in Taiz Governorate
Action Period Preparation: Contacting local authority, survey team identification, 17 – 21 April 2016 trainingRefresher material training preparation of survey te ams 26 – 28 April 2016 Data collection and data entry 1 – 19 May 2016 Data cleaning and sharing ENA anthropometry and mortality 25 May 2016 findingsPreparing the first preliminary report (report of findings) Presentation of the findings and circulation the preliminary report Receiving comments The planed finalizing and circulating the final report
3.5 Measurement Standardization and Quality Control The survey teams had prior experience in rigorous standardisation tests from previous nutrition surveys. Data quality was ensured through (i) monitoring of fieldwork by field technical supervisors; (ii) crosschecking of filled questionnaires on a daily basis, recording of observations and daily de-briefing and discussion; (iii) confirmation of measles, severe malnutrition especially oedema cases and death cases by supervisors; (iv) daily entry of anthropometric data; (v) doing the plausibility check in daily basis for the overall quality scoring and identification each team quality using 10 scoring criteria (statistical tests), plus ensuring each team was given feedback on the quality of previous day’s data before the start of a new day; (v) daily equipment calibration, (vi) additional check done at the data entry level to enable entry only of relevant possible responses and measurements; (vii) continuous reinforcement of good practices. Clear job descriptions were provided to field teams before commencing the data collection in order to ensuring appropriate guidance in completing the assigned tasks. Field team head was reviewing the filed questionnaires and verify the accuracy of the details before the team was leaving the cluster site, thus minimizing possibility of incomplete data (missing variables) and outlier data. 3.6 Data Entry and Analysis The data in the filled questionnaires and mortality forms were entered into an
15 Excel spread sheet created for the purpose of this survey. The spreadsheet contained all required self-check formulas as well as converting dates from Hijri to Gregorian. The anthropometrical data then were copied to ENA for SMART for interpretation to z scores as well as creation of the final plausibility check report and results of nutritional anthropometry status tables and curves. Similarly, the data of mortality were transferred to ENA for the analysis purposes and getting out the final death results with population pyramid. Household variables and the remaining child-related variables (Vaccination, vitamin A supplementation, feeding practices and morbidity) were analysed using SPSS Version 21. The anthropometry indices (z-scores) for Weight for Height (wasting), Height for Age (stunting) and Weight for Age (underweight) were generated and compared with WHO 2006 Growth Standards 1,2. Children/cases with extreme z-score values were flagged and investigated and appropriately excluded in the final analysis if deviating from the observed mean (SMART flags). In SPSS, frequencies and cross-tabulations were used to give percentages, means and standard deviations in the descriptive analysis and presentation of general household and child characteristics. Significances was defined as (P<0.05). The classification the nutritional status using the above indices as well as MUAC was made following the WHO classification (WHO 20061) and (WHO 20137). For IYCF indicators related to breast feeding and complementary feeding, the WHO guidelines on assessing infant and young child feeding practices were used (WHO 20086). For the calculation of the value for Minimum Dietary Diversity (MDD), a 7 food group score variable was created. The 7 foods groups used for calculation are 1) grains, roots and tubers; 2) legumes and nuts; 3) dairy products (milk, yogurt, cheese); 4) flesh foods (meat, fish, poultry and liver/organ meats); 5) eggs; 6) vitamin-A rich fruits and vegetables; 7) other fruits and vegetables. Another indicator is the Minimum meal frequency (MMF) which is measuring the child consumption for solid, semi-solid, or soft foods. Minimum acceptable diet (MAD) is combining both MDD and MMF. The methods and analysis for the MDD, MMF and MAD were based as recommended by the WHO (WHO 20086).
16 The classification of MUAC of Women is not made based on the global one but based on that WFP is using for Yemen. Woman is considered severely wasted if her MUAC is below 21.3 cm, moderately wasted if her MUAC is equal or more than 21.3 cm and below 22.2 cm, and of normal MUAC if the measurement is not less than 22.2 cm. For sources of drink water indicators, the sources listed in the classification were classified to improved and unimproved sources. Improver drinking water sources are: 1) Water pipelines extended into the house; 2) Water pipelines extended to the backyard of the house; 3) Protected open well; 4) Sealed tank for rainwater harvesting; and 5) Protected spring water. Unimproved sources are: 1) Unprotected open well; 2) Unsealed tank for rainwater harvesting; and 3) Unprotected ground water (wadi, spring running water, etc.). Other sources in the questionnaires are not classified as either improved or unimproved including water trucking, community water points and bottled water8. Sanitation was also classified as improved and unimproved based on the type of latrine. Improved latrines are flush/pour flush latrine and simple covered pit latrine, while unimproved latrines include open pit latrine and defecation in open (in fields, etc.)8. Food consumption scores (FCS) were calculated based on the consumption during the last 7 days from the 8 food groups following WFP guidelines 9. The classification of FCS is not made following the global WFP one but based on the WFP Yemen way as the following: - Below of equal to 28: Poor food consumption - Above 28 to 42: Border line food consumption - Above 42: Acceptable food consumption The other way of calculation food consumption is made based of the household dietary diversity scoring (HDDS). This scoring is considering the consumption in the last 24 hours from the list of 12 food groups. The scoring is made based on FANTA, while the classification is similar to the one that IPC is using but it still under review10. The reduced copping strategy index rCSI scoring was done following WFP guidelines. It made depending on practicing of a list of five copping strategies. The extended list of coping strategies in this surveys was used to determine households who are practicing no coping strategies, stress coping strategies, crisis coping strategies and emergency coping strategies during the last 30 days as shown below:
17 Stress coping strategies: Selling households assets/belongings (furniture, jewellery, clothes, etc.) Buying food by credit or pawning Spending from saving Borrowing money Crisis coping strategies: Selling of production assets or transport means (sewing machine, car or motorcycle, etc.) Consuming the stock of seeds that is reserved for the coming season Withdraw children out of school Reduce spending on education and health (including drugs) Emergency coping strategies: Selling the house or land Begging Selling the last female of cattle the household has 4. Assessment Results
4.1 Household Characteristics
From Table 4, it is obvious that the response rates of HHs that participated in the investigation reaching almost 100%. There is no much difference among the mean HH size and also the mean number of U5 in the three surveyed zones. The heads of HH are mainly males with over 95% in and 80% of HHs are married and living with their spouses in all zones. Illiteracy is still digging deeply particularly in both zones THL and TLL with 60.7 % and 80.0%, respectively. Even in TC the illiteracy rate of 31.1% is still very high as an urban area. The daily casual work is clearly the most important source of income in all zones and more specifically in TLL zone. The other two main sources of income are coming from salaries of working with public or mix sectors and also from those who own small scale businesses. In general, the THL and TLL zones depend mainly on the daily casual work income. On the other hand, 72.7%, 53.5% and 78.7% of HHs have lost their income either partially or totally respectively. The distribution of income quintiles is different from one
18 zone to another. However, it is noticeable from Table 5 that while the income quintiles intervals of TC and THL are quite similar, the TLL income quintiles are shorter and smaller in values which reflect the fact that people of this zone are the poorest in the whole governorate. The investigated sample of HHs in TC have reported that the main source of drinking water is bottle water (73.1%) and community point (Sabeel) (18.1%). The situation is different on the other zones, while piped water is the main source of drinking water (26.3%) in the THL, the water coming from unprotected open wells (34.4%) is the main source of drinking water in TLL. The percentages of HHs having improved source of drinking water are 67.7%, 69.8% and 56.6% in TC, THL and TLL consecutively. Treatment of water before drinking is not a common practice in all zones but – on the other side – HHs are very keen to keep their water storages clean. In TC, 65.8% of HH are using flush or pour flush latrine and 33.0% using open pit latrine in their human disposal practices. The two ways of practices are also common in THL with 44.1% and 38.5%, respectively. On TLL, open pit latrine is the most used practice for human disposal with 40.8% followed by defecation in open and simple covered pit with 21%. The percentages of HHs having improved sanitation facilities are 67%, 54% and 37.2% in TC, THL and TLL respectively. The hand washing of HH caretakers after toilet is widely used practice in TC but declining sharply to reach only 42.1% in TLL. Further, the hand washing of HH caretakers before meals is surprisingly low in all zones.
Table 4: Household Characteristics Indicators TC THL TLL N % N % N % Total HHs surveyed (% of response) 421/422 99.8 552/556 99.3 485/491 98.8 Mean HH Size 6.6 7.4 7.0 Mean No. of U5 children 1.2 1.3 1.4 Gender of Man 401 95.3 526 95.3 470 96.9 Household Head Woman 20 4.7 26 4.7 15 3.1 Gender of Man 29 6.9 15 2.7 11 2.3 Household Woman 392 93.1 537 97.3 474 97.7 Caretaker Marital status of Married but living far 34 8.1 77 13.9 43 8.9 household head from spouse for ≥ 6 months
19 Married lives with spouse 364 86.4 450 81.5 419 86.4 Recalcitrant 3 0.7 ** ** 4 0.8 Single 7 1.7 1 0.2 4 0.8 Widowed 13 3.1 20 3.6 15 3.1 Divorced ** ** 4 0.7 ** ** Education level of Illiterate 131 31.1 334 60.7 388 80.0 household Read and write 86 20.4 80 14.5 45 9.3 caretaker Basic education 75 17.8 73 13.3 28 5.8 Secondary education 76 18.1 53 9.6 18 3.7 Higher education 53 12.6 10 1.8 6 1.2 Main Source of Daily casual worker 103 24.5 190 34.4 283 58.4 Income Donations 37 8.8 27 4.9 12 2.5 Own a large scale business 3 0.7 ** * ** ** Own a medium scale 7 1.7 11 2.0 4 0.8 business Own a small scale 81 19.3 70 12.7 39 8.0 business Qat cultivation/selling 10 2.4 52 9.4 10 2.1 Remittances 22 5.2 63 11.4 36 7.4 Salary for large private 30 7.1 11 2.0 2 0.4 sector employee Salary for medium or 16 3.8 16 2.9 11 2.3 small private sector employee Salary for public/mix 99 23.6 96 17.4 65 13.4 sector employee Salary for third sector 5 1.2 2 0.4 1 0.2 (NGOs) employee Social insurance 5 1.2 ** ** 3 0.6 Begging 2 0.5 6 1.1 5 1.0 Farmer working in the ** ** 5 0.9 14 2.9 family farm (not Qat) Other ** ** 3 0.5 ** ** The Impact on Salary / income has partially 201 48.4 173 32.6 296 61.1 Household been lost Income Salary / income has totaly 101 24.3 111 20.9 85 17.6 been lost Salary / ordinary income has 113 27.3 247 46.5 103 21.3 not been lost
Income Quintiles Q1 Lowest 75 20.4 80 15.7 127 30.0 Q2 Second 72 19.6 103 20.2 37 8.8 Q3 Middle 89 24.2 90 17.7 25 5.9 Q4 Fourth 59 16.0 127 25.0 149 35.2 Q5 Highest 73 19.8 109 21.4 85 20.1 Main water Bottled water 307 73.1 1 0.1 5 1.0 source for Community point (Sabeel) 76 18.1 6 1.1 ** ** drinking House connected piped ** 145 26.3 62 12.8 water House connected yard 1 0.2 25 4.5 128 26.4 piped water Unprotected surface 8 1.9 59 10.7 29 6.0
20 water (Wadi, springs, etc.) Water from covered 5 1.2 68 12.3 1 0.2 rainwater harvesting tank Water from protected ** ** 95 17.2 65 13.4 open well Water from unprotected ** ** 97 17.6 167 34.4 open well Water from protected 15 3.6 32 5.8 ** ** spring Water from uncovered 2 0.5 2 0.4 ** ** rainwater harvesting tank Water tanker 6 1.4 22 4.0 28 5.8 Main Source of Improved 21 67.7 365 69.8 256 56.6 Drinking Water Unimproved 10 32.3 158 30.2 196 43.4 Missing Values 391 33 39 Treatment of water before drinking 4 3.5 26 47 10 2.1 Cleanness of drinking water storage 405 96.2 511 92.6 401 82.7 HH latrine type Flush/pour flush latrine 277 65.8 243 44.1 77 15.9 Open pit latrine 139 32.8 212 38.4 198 40.8 Simple covered pit latrine 5 1.2 55 10.0 102 21.0 Defecation in open (in ** ** 39 7.1 104 21.4 field, etc) Other ** ** 2 0.4 4 0.8 Hand washing After the toilet 351 83.4 360 65.2 204 42.1 practice by HH Before meal 206 48.9 317 57.4 204 35.5 caretaker Sanitation Type Improved 282 67.0 298 54.3 179 37.2 Unimproved 139 33.0 251 45.7 302 62.8 ** Data not reported Table 5: Distribution of HHs Income Quintiles by zone TC Quintiles (YR) N % Q1 (≤ 16800) 75 20.4 Q2 (16800-26600) 72 19.6 Q3 (26600-40000) 89 24.2 Q4 (40000-59200) 59 16.0 Q5 (59200-360,000) 73 19.8 THL Q1 (≤ 15000) 80 15.7 Q2 (5000-25000) 103 20.2 Q3 (25000-40000) 90 17.7 Q4 (40000-70000) 127 25.0 Q5 (70000-120000) 109 21.4 TLL Q1 (≤12000) 127 30.0 Q2 (12000-20000) 37 8.8 Q3 (20000-24000) 25 5.9 Q4 (24000-45600) 149 35.2 Q5 (45600-72000) 85 20.1
21
4.2 Food Security The World Food Summit 1996 had defined food security as a situation in which all people at all times have physical and economic access to sufficient, safe and nutritious food, which meets their dietary needs and food preferences for an active and healthy life11. As a result, no single criteria is efficiently enough to measure a nation's food security situation and instead a bulk of techniques and indicators were developed and applied. Tables 6 and 7 are displaying some descriptive statistics to some of these indicators contained in the present survey. For instance, HH's that have reached the crisis stage are 9%, 8.7% and 11.5% for FCHDDSIPC and 18.1%, 18.5%, 15.0% and 15.3% for CS Type indicators in the three zones respectively. Table 6: HHs Food Security Indicators by zone Indicator TC THL TLL N % N % N % FCHDDSIPC Crisis 38 9.0 48 8.7 56 11.5 Emergency or catastrophe ** ** 1 0.2 3 0.6 Normal/Stressed 383 91.0 503 91.1 426 87.8 FCS Classification Acceptable 281 67.4 403 74.1 395 81.4 Borderline 104 24.9 83 15.3 55 11.3 Poor 32 7.7 58 10.6 35 7.2 CS Type Crisis 78 18.5 83 15.0 47 9.7 Emergency 13 3.1 49 8.9 68 14.0 No Copping Strategy 76 18.1 118 21.4 74 15.3 Stress 254 60.3 302 54.7 296 61.0 ** Data not available
Table 7: Descriptive Statistics of Some Food Security Indicators by zone Zone Indicators N Minimum Maximum Mean SD TC HDDS 421 3 12 7.2 2.1 rCSI 421 0 56 7.6 13. 5 FCScores 417 15 108 51.7 18.0 THL HDDS 552 1 12 7.3 2.1 rCSI 552 0 56 4.0 9.5 FCScores 544 14 112 55.1 19.6 TLL HDDS 485 2 11 6.4 1.71 rCSI 485 0 49 5.6 9.3 FC Scores 485 16.5 112 60.4 20.3
22 To understand – deeply - the food security indicators, it seems plausible to crosstabulate them with HHs income quintiles. For such manner, Table 8 and the subsequent two tables were calculated. Table 8, for instance comparing FCHDDSIPC indicator stages with each HHs income quintile and it can be clearly understood that: In TC and THL, HHs with income less than 40,000 YER represent 80.7% and 84.1% from those who have reached the crisis stage respectively. In TLL, HHs with income less than 45,000 YER represent 88.6% from those who have reached the crisis stage. Table 8: FCHDDSIPC indicators by income quintiles and zone FCHDDSIPC TC Income Quintiles Crisis Normal or stressed Emergency or catastrophe** Total N % n % n % Q1 ≤16800 8 10.7 67 89.3 ** ** 75 Q2 16800-26600 10 13.9 62 86.1 ** ** 72 Q3 26600-40000 7 7.9 82 92.1 ** ** 89 Q4 40000-59200 5 8.5 54 91.5 ** ** 59 Q5 59200-360000 1 1.4 72 98.6 ** ** 73 Total 31 8.4 337 98.6 ** ** 368 THL Q1 ≤15000 12 15.0 68 85.0 ** ** 80 Q2 15000- 25000 14 13.6 89 86.4 ** ** 103 Q3 25000-40000 11 12.2 79 87.8 ** ** 90 Q4 40000-70000 4 3.1 123 96.9 ** ** 127 Q5 70000-120000 3 2.8 106 97.2 ** ** 109 Total 44 8.6 465 91.4 ** ** 509 TLL Q1 ≤12000 24 18.9 102 80.3 1 0.8 127 Q2 12000-20000 3 8.1 34 91.9 0 0 37 Q3 20000-24000 0 0 25 100 0 0 25 Q4 24000-45600 12 8.1 136 91.3 1 0.7 149 Q5 45600-72000 5 5.9 80 94.1 0 0 85 Total 44 10.4 377 89.1 2 0.5 423 ** data not available
Similarly, Table 9 is comparing FCS classifications indicator stages with each HHs income quintile. The table indicates the following facts: In TC, HHs with less than 40,000 YER represent 80.3% and 92.3% from those who have reached either the borderline or poor stages respectively.
23 In THL, HHs with less than 40,000 YER represent 65.4% and 86.3% from those who have reached either the borderline or poor stages respectively. In TLL, HHs with less than 45,600 YER represent 88.1% and 100% from those who have reached either the borderline or poor stages respectively.
Table 9: FCS Classification indicator by income quintile and zone FCS Classification TC Income Quintiles Acceptable borderline Poor Total N % n % n % Q1 ≤16800 41 54.7 21 28 13 17.3 75 Q2 16800-26600 39 54.9 25 35.2 7 9.9 71 Q3 26600-40000 65 73.9 19 21.6 4 4.5 88 Q4 40000-59200 45 76.3 12 20.3 2 3.4 59 Q5 59200-360000 63 86.3 10 13.7 0 0 73 Total 253 69.1 81 23.8 26 7.1 366 THL Q1 ≤15000 44 55.7 20 25.3 15 19.0 79 Q2 15000- 25000 66 64.7 20 19.6 16 15.7 102 Q3 25000-40000 66 73.3 11 12.2 13 14.4 90 Q4 40000-70000 102 82.3 18 14.5 4 3.2 124 Q5 70000-120000 95 88.8 9 8.4 3 2.8 107 Total 373 74.3 78 15.5 51 10.2 502 TLL Q1 ≤12000 85 66.9 21 16.5 21 16.5 127 Q2 12000-20000 34 91.9 2 5.4 1 2.7 37 Q3 20000-24000 21 84.0 4 16.0 0 0 25 Q4 24000-45600 135 90.6 10 6.7 4 2.7 149 Q5 45600-72000 80 94.1 5 5.9 0 0 85 Total 355 83.9 42 9.9 26 6.2 423
Similarly, Table 10 is comparing CS type indicator stages with each HHs income quintile. Again one can easily extract the following noes: In TC, HHs with less than 40,000 YER represent 92.7% and 72.1% from those who have reached either the emergency or crisis stages respectively.
24 In THL, HHs with less than 40,000 YER represent 75% and 75.3% from those who have reached either the emergency or crisis stages respectively. In TLL, HHs with less than 45,600 YER represent 80.4% and 87.5% from those who have reached either the emergency or crisis stages respectively.
Table 10: CS Type indicator by income quintile and zone CS Type TC Income Quintiles Crisis Emergency No Copping Stress Total Strategy n % n % N % n % Q1 ≤16800 19 25.3 5 6.7 11 14.7 40 53.3 75 Q2 16800-26600 13 18.1 4 5.6 8 11.1 47 65.3 72 Q3 26600-40000 17 19.1 2 2.2 15 16.9 55 61.8 89 Q4 40000-59200 11 18.6 1 1.7 12 20.3 35 59.3 59 Q5 59200-360000 8 11 0 0 21 28.8 44 60.3 73 Total 68 18.5 12 3.3 67 18.2 221 60.1 368 THL Q1 ≤15000 11 13.8 11 13.8 13 16.3 45 56.3 80 Q2 15000- 25000 25 24.3 12 11.7 18 17.5 48 46.6 103 Q3 25000-40000 22 24.4 7 7.8 18 20.0 43 47.8 90 Q4 40000-70000 14 11.0 5 3.9 32 25.2 79 59.8 127 Q5 70000-120000 5 4.6 5 4.6 32 29.4 67 61.5 109 Total 77 15.1 40 7.9 113 22.2 282 55.4 509 TLL Q1 ≤12000 21 16.5 14 11.0 12 9.4 80 63.0 127 Q2 12000-20000 4 10.8 7 18.9 6 16.2 20 54.1 37 Q3 20000-24000 0 0 6 24.0 4 16.0 15 60.0 25 Q4 24000-45600 10 6.7 18 12.1 26 17.4 95 63.8 149 Q5 45600-72000 5 5.9 11 12.9 17 20.0 52 61.2 85 Total 40 9.5 56 13.2 65 15.4 262 61.9 423
At the end of this discussion, income is undoubtedly the main burden that facing all inhabitants of Taiz Governorate to live a dignified life.
4.3 Child Nutrition
To assess the nutritional status of U5 children in the three surveyed zones, the field survey has included measuring their weights, heights and mid upper arm circumferences. For women, only their mid upper arm circumferences were
25 measured. These measures were used to calculate the nutritional indicators; namely WHZ, WAZ, HAZ and MUAC of children and MUAC for women according to the WHO 2006 nutrition standards. ENA software was used to calculate these indicators along with some other less important indicators. SMART flags (-3,+3 Z-Scores) from the observed mean used to exclude extreme values. For each indicator, GAM, MAM and SAM were also calculated for male and female children and within each age group.
4.3.1 Distribution of U5 children As shown in Table 11, the distribution of U5 children seems equally likely to represent males and females quite fairly in all zones. However, it may be due to sampling reasons; there is some biasedness against males in most age groups of TC. Conversely, males of TLL are noticeably higher than females in both age groups 6-11 and 36-47 months. However, the sex ratio is almost one (0.99) for the whole survey in Taiz Governorate.
Table 8: Distribution of U5 children by age group, gender and zone TC Age (months) Males Females Total Ratio n % n % n % Male: Female 6-11 38 46.3 44 53.7 82 17.4 0.9 12-23 40 42.6 54 57.4 94 19.9 0.7 24-35 51 46.8 58 53.2 109 23.1 0.9 36-47 49 50.5 48 49.5 97 20.6 1.0 48-59 41 45.6 49 54.4 90 19.1 0.8 Total 219 46.4 253 53.6 472 100.0 0.9 THL Males Females Total Ratio n % n % n % Male: Female 6-11 43 47.8 47 52.2 90 13.5 0.9 12-23 92 53.5 80 46.5 172 25.7 1.1 24-35 73 51.0 70 49.0 143 21.4 1.0 36-47 65 49.2 67 50.8 132 19.8 1.0 48-59 60 45.8 71 54.2 131 19.6 0.8 Total 333 49.9 335 50.1 668 100.0 1.0 TLL Males Females Total Ratio N % n % n % Male: Female 6-11 40 58.8 28 41.2 68 11.1 1.4 12-23 72 49.0 75 51.0 147 24.1 1.0 24-35 70 46.7 80 53.3 150 24.5 0.9 36-47 81 60.4 53 39.6 134 21.9 1.5 48-59 58 51.8 54 48.2 112 18.3 1.1
26 Total 321 52.5 290 47.5 611 100.0 1.1
27 4.3.2 Wasting (WHZ) Indicators
Table 12, demonstrates the prevalence rates of wasting among children aged 6-59. These rates were produced according to WHO 2006 growth standards by ENA for SMART package. Collectively, TLL children are the most vulnerable to stunting with a prevalence rate approaching 25%. It can be easily noticed that female children are significantly less vulnerable to wasting than male children in all zones. The prevalence of wasting for the whole governorate is 18.9% that exceeds the international critical threshold (≥15%). Figures (1,2,3) show how children's WHZ scores are diverging from the WHO 2006 growth standards. It should be understood that no overweight children were found in the present survey data.
Table 12: Prevalence of Wasting by gender and zone (6-59 months) TC WHZ Total Males Females n = 464 n = 215 n = 249 n (%) 95% CI n (%) 95% CI n (%) 95% CI GAM 79 (17.0) 13.7 - 20.9 45 (20.9) 15.8 – 27.2 34 (13.7) 9.5 - 19.2 MAM 70 (15.1) 12.0 - 18.9 38 (17.7) 13.0 - 23.5 32 (12.9) 9.0 – 18.0 SAM 9 (1.9) 1.1 - 3.5 7 (3.3) 1.6 - 6.6 2 (0.8) 0.2 – 3..3 THL WHZ Total Males Females n=663 n=330 n=333 n(%) 95%CI n(%) 95%CI n(%) 95%CI GAM 96 (14.5) 10.8 - 19.2 66 (20.0) 14.7 – 26.7 30 (9.0) 6.2 - 12.9 MAM 85 (12.8) 9.6 - 16.9 59 (17.9) 12.9 - 24.3 26 (7.8) 5.4 - 11.2 SAM 11 (1.7) 0.8 - 3.4 7 (2.1) 0.9 – 5.2 4 (1.2) 0.5 - 3.2 TLL WHZ Total Males Females n=602 n=316 n=286 n(%) 95%CI n(%) 95%CI n(%) 95%CI GAM 151(25.1) 20.3 - 30.6 86 (27.2) 21.0 - 34.4 65 (22.7) 17.2 – 29.4 MAM 119(19.8) 15.9 - 24.4 68 (21.5) 16.4 - 27.7 51 (17.8) 13.3. - 23.5 SAM 32(5.3) 3.7 – 7.7 18 (5.7) 3.5 - 9.2 14 (4.9) 2.9 - 8.2
Figure (1): TC (WHZ)
28
Figure (2): THL (WHZ)
Figure (3): TLL (WHZ)
To understand whether wasting is affecting specific age group of children, Table 13 was produced. It can be noticed easily that the first two age groups are having the most vulnerable children to wasting in TC and TLL and the first three age groups in TLL.
29 Table 13: Prevalence of wasting by age group and zone TC Age (months) Total SAM MAM GAM N % n % n % 6-11 80 2 2.5 15 18.8 17 21.3 12-23 92 2 2.2 19 20.7 21 22.9 24-35 107 1 0.9 10 9.3 11 10.3 36-47 97 0 0.0 16 16.5 16 16.5 48-59 88 4 4.5 10 11.4 14 15.9 Total 464 9 1.9 70 15.1 79 17.0 THL 6-11 89 3 3.4 17 19.1 20 22.5 12-23 171 4 2.3 25 14.6 29 16.9 24-35 142 1 0.7 15 10.6 16 11.3 36-47 131 2 1.5 9 6.9 11 8.4 48-59 130 1 0.8 19 14.6 20 15.4 Total 663 11 1.7 85 12.8 96 14.5 TLL 6-11 66 6 9.1 17 25.8 23 34.8 12-23 145 10 6.9 31 21.4 41 28.3 24-35 147 5 3.4 31 21.1 36 24.5 36-47 133 5 3.8 20 15.0 25 18.8 48-59 111 6 5.4 20 18.0 26 23.4 Total 602 32 5.3 119 19.8 151 25.1
4.3.3 Oedema and WHZ Indicator Table 14, clearly indicates that Oedem – in general – is absent and only 2.6%, 1.9% and 6.2% of children have reached the marasmic stage in the three zones respectively .
Table 14: Distribution of WHZ and Oedema (6-59 months) by zone TC Oedema WHZ <-3 z-score >=-3 z-score Oedema N(%) Marasmic kwashiorkor Kwashiorkor present 0 (0.0) 0 (0.0) Oedema N(%) Marasmic Not severely absent 12 (2.6) malnourished 457 (97.4) THL Oedema N(%) Marasmic kwashiorkor Kwashiorkor present 0 (0.0) 0 (0.0) Oedema N(%) Marasmic Not severely absent 13 (1.9) malnourished 654 (98.1)
30 TLL Oedema N(%) Marasmic kwashiorkor Kwashiorkor present 0 (0.0) 0 (0.0) Oedema N(%) Marasmic Not severely absent 38 (6.2) malnourished 571 (93.8)
4.3.4 Underweight (WAZ) Indicator Table 15, casts the following important notes: Broadly, the prevalence of underweight is exclusively high in all zones and exceeding the international critical threshold (≥30%). TLL children are the most vulnerable to suffer from underweight with a prevalence rate over than 50% The male children of the three zones are the most vulnerable to suffer from underweight than female children. The total prevalence rate is 43.6% for the whole governorate. Figures (4,5,6) show how much the growth standards of children of each zone are diverging from the international growth standards.
Table 15: Prevalence of Underweight (WAZ) by gender and zone (6-59 months) TC WAZ Total Males Females N= 462 n= 214 n= 248 n (%) 95%CI n (%) 95%CI n (%) 95%CI GAM 176 (38.1) 33.0 – 43.5 86 (40.2) 32.3 – 48.6 90 (36.3) 31.3 – 41.6 MAM 135 (29.2) 24.4 – 34.5 64 (29.9) 22.4 – 38.6 71 (28.6) 23.6 – 34.2 SAM 41 (8.9) 6.5 – 12.0 22 (10.3) 6.4 – 16.0 19 (7.7) 4.9 – 11.8 THL WAZ N=664 n=329 n=335 n (%) 95%CI n (%) 95%CI n (%) 95%CI GAM 283 (42.6) 36.0 - 49.5 154 (46.8) 38.4 - 55.4 129 (38.5) 30.9 - 46.7 MAM 209 (31.5) 27.3 - 36.0 109 (33.1) 27.6 - 39.2 100 (29.9) 24.2 – 36.2 SAM 74 (11.1) 7.6 - 16.1 45 (13.7) 8.8 - 20.7 29 (8.7) 5.6 - 13.1 TLL WAZ N=609 n=320 n=289 n (%) 95%CI n (%) 95%CI n (%) 95%CI GAM 297 (48.8) 43.4 - 54.1 161 (50.3) 43.9 - 56.7 136 (47.1) 40.3 - 54.0 MAM 200 (32.8) 28.6 – 37.4 109 (34.1) 29.0 – 39.6 91 (31.5) 25.7 - 37.9 SAM 97 (15.9) 13.0 – 19.4 52 (16.3) 12.4 - 21.0 45 (15.6) 11.6 - 20.6
31 Figure (4): TC (WAZ)
Figure (5): THL
Figure (6):TLL (WAZ)
Table 16, indicates that underweight is almost affecting all age groups equally likely in the three zones with only one exception at 24-35 age group in TC.
32
Table 16: Prevalence of Underweight by age group and zone TC Age Group (Months) WAZ Total SAM MAM GAM n % n % n % 6-11 80 7 8.8 21 26.3 28 35.0 11-23 92 9 9.8 27 29.3 36 39.1 24-35 106 9 8.5 25 23.6 34 32.1 36-47 96 7 7.3 35 36.5 42 43.8 48-59 88 9 10.2 27 30.7 36 40.9 Total 462 41 8.9 135 29.2 176 38.1 THL 6-11 89 11 12.4 21 23.6 32 35.9 11-23 171 24 14.0 55 32.2 79 46.2 24-35 143 14 9.8 44 30.8 58 40.6 36-47 130 13 10.0 44 33.8 57 43.8 48-59 131 12 9.2 45 34.4 57 43.5 Total 664 74 11.1 209 31.5 283 42.6 TLL 6-11 68 14 20.6 21 30.9 35 51.5 11-23 147 29 19.7 44 29.9 73 49.7 24-35 149 25 16.8 47 31.5 72 48.3 36-47 134 12 9.0 45 33.6 57 42.5 48-59 111 17 15.3 43 38.7 60 54.1 Total 609 97 15.9 200 32.8 297 48.8
4.3.5 Stunting (HAZ) Indicators The prevalence of stunting are shown in Table 17 for all zones. From which, one can easily spot that GAM indicator has exceeded 45% in TLL and approaching 50% in THL. Further, the stunting prevalence rates of male children are significantly higher than female children in all zones. The total prevalence rate of stunting for the whole governorate is 45.4%. According to WHO (2000), the health situation of children with stunting levels exceed 40% has been classified as critical12. So, the health situation of children in this governorate is - beyond doubt - approaching very critical. Figures (7,8,9) show the deviations of HAZ scores are about 2 SD's from the population international reference.
33
Table 17: Prevalence of Stunting by gender and zone TC HAZ Total Males Females n = 463 n = 214 n = 249 n (%) 95%CI n (%) 95%CI n (%) 95%CI GAM 184 (39.7) 34.9 - 44.8 92 (43.0) 34.9 - 51.4 92 (36.9) 31.1 - 43.2 MAM 142 (30.7) 26.2 - 35.6 68 (31.8) 24.6 - 40.0 74 (29.7) 24.6 - 35.4 SAM 42 (9.1) 6.4 - 12.6 24 (11.2) 7.5 - 16.4 18 (7.2) 4.5 - 11.5 THL HAZ n=664 n=330 n=334 n (%) 95%CI n (%) 95%CI n (%) 95%CI GAM 328 (49.4) 41.9 - 56.9 172 (52.1) 44.2 - 59.9 156 (46.7) 37.5 - 56.1 MAM 217 (32.7) 27.8 - 38.0 112 (33.9) 28.0 –40.4 105 (31.4) 26.2 - 37.2 SAM 111 (16.7) 11.6 - 23.5 60 (18.2) 12.4 - 25.8 51 (15.3) 9.1 - 24.5 TLL HAZ n=603 n=317 n=286 n (%) 95%CI n (%) 95%CI n (%) 95%CI GAM 275 (45.6) 39.4 - 52.0 157 (49.5) 42.4 - 56.6 118 (41.3) 34.2 - 48.7 MAM 187 (31.0) 26.4 - 36.0 111 (35.0) 29.5 - 40.9 76 (26.6) 20.6 - 33.6 SAM 88 (14.6) 11.6 - 18.2 46 (14.5) 10.7 - 19.4 42 (14.7) 10.4 - 20.4
Figure (7): TC (HAZ)
34 Figure (8): THL (HAZ)
Figure (9): TLL (HAZ)
TC
THL
35 Evidently, stunting is affecting all age groups in all zones (Table 18).
Table 18: Prevalence of Stunting by age group and zone TC Age Group (Months) SAM MAM GAM Total n % n % n % 6-11 80 6 7.5 14 17.5 20 25.0 11-23 92 13 14.1 27 29.3 40 43.5 24-35 108 7 6.5 36 33.3 43 39.8 36-47 96 8 8.3 39 40.6 47 49.0 48-59 87 8 9.2 26 29.9 34 39.1 Total 463 42 9.1 142 30.7 184 39.7 THL 6-11 88 9 10.2 19 21.6 28 31.8 11-23 172 37 21.5 54 31.4 91 52.9 24-35 143 25 17.5 44 30.8 69 48.3 36-47 130 20 15.4 56 43.1 76 58.5 48-59 131 20 15.3 44 33.6 64 48.8 Total 664 111 16.7 217 32.7 328 49.4 TLL 6-11 67 6 9.0 24 35.8 30 44.8 11-23 146 27 18.5 41 28.1 68 46.6 24-35 148 27 18.2 43 29.1 70 47.3 36-47 132 13 9.8 43 32.6 56 42.4 48-59 110 15 13.6 36 32.7 51 46.4 Total 603 88 14.6 187 31.0 275 45.6
The population pyramids of the three zones are shown on Figures (10,11,12). Obviously, the populations are young and more than 90% less than 50 years either males or females approximately.
36
Figure (10): TC Population Pyramid
Figure (11): THL Population Pyramid
37
Figure (12): TLL Population Pyramid
4.3.6 MUAC Indicator of Children Table 19, demonstrates an increase pattern of MUAC as one goes from TC zone down to THL and TLL zones consecutively. While GAM of TC is the lowest, it is the highest in TLL. The MUAC prevalence rates of female children are higher than male children and more noticeably in TLL zone. Furthermore, total prevalence rate of MUAC is 9.9% of the children in this governorate.
Table 19: Prevalence of MUAC by gender and zone (6-59 months) TC MUAC Total Males Females n = 469 n = 218 n = 251 n (%) 95%CI n (%) 95%CI n (%) 95%CI GAM 39 (8.3) 5.5 – 12.3 16 (7.3) 4.4 – 12.0 23 (9.2) 5.5 – 14.9 MAM 28 (6.0) 3.6 – 9.8 13 (6.0) 3.2 – 10.7 15 (6.0) 3.4 – 10.3 SAM 11 (2.3) 1.3 – 4.1 3 (1.4) 0.4 – 4.4 8 (3.2) 1.5 – 6.6 THL MUAC n =667 n=332 n=335 n (%) 95%CI n (%) 95%CI n (%) 95%CI GAM 63 (9.4) 6.5 – 13.4 31 (9.3) 5.7 – 14.9 32 (9.6) 6.5 - 13.7 MAM 49 (7.3) 5.2 – 10.2 24 (7.2) 4.4 - 11.6 25 (7.5) 4.9 – 11.1
38 SAM 14 (2.1) 0.9 - 4.7 7 (2.1) 0.9 - 4.6 7 (2.1) 0.8 - 5.6 TLL MUAC n=609 n=320 n=289 n(%) 95%CI n(%) 95%CI n(%) 95%CI GAM 71 (11.7) 8.7 - 15.5 30 (9.4) 6.2 – 14.0 41 (14.2) 10.0 - 19.8 MAM 50 (8.2) 5.9 - 11.3 22 (6.9) 4.2 - 11.2 28 (9.7) 6.3 - 14.6 SAM 21 (3.4) 2.2 – 5.4 8 (2.5) 1.3 - 4.9 13 (4.5) 2.4 – 8.1
In addition, it is evident that MUAC incidence is low in general and mainly concentrated on the first two age groups namely 6-11 and 12-23 months in all zones (Table 20).
Table 20: Prevalence of MUAC by age group (6-59 months) and zone MUAC Age Group(months) TC Total SAM MAM GAM n % n % n % 6-11 81 7 8.6 15 18.5 22 27.2 12-23 94 3 3.2 9 9.6 12 12.8 24-35 109 0 0.0 3 2.8 3 2.8 36-47 97 1 1.0 0 0.0 1 1.0 48-59 88 0 0.0 1 1.1 1 1.1 Total 469 11 2.3 28 6.0 39 8.3 THL 6-11 90 6 6.7 25 27.8 31 34.4 12-23 172 7 4.1 19 11.0 26 15.1 24-35 143 0 0.0 3 2.1 3 2.1 36-47 131 1 0.8 2 1.5 3 2.3 48-59 131 0 0.0 0 0.0 0 0.0 Total 667 14 2.1 49 7.3 63 14.1 `TLL 6-11 68 10 14.7 15 22.1 25 36.8 11-23 147 10 6.8 19 12.9 29 19.7 24-35 149 1 0.7 12 8.1 13 8.7 36-47 134 0 0.0 3 2.2 3 2.2 48-59 111 0 0.0 1 0.9 1 0.9 Total 609 21 3.4 50 8.2 71 11.7
39
Table 21, indicates the mean z-scores, design effects and excluded subjects in each zone and for each malnutrition indicator.
Table 21: Mean z-scores, Design Effects and excluded subjects by zone Indicator n Mean z- Design Effect z-scores not z-scores out of range scores ± SD (z-score < -2) available* (excluded subjects) TC WHZ 464 -1.10±0.95 1.01 3 5 WAZ 462 -1.72±0.96 1.30 3 7 HAZ 463 -1.68±1.04 1.12 3 6 THL WHZ 663 -1.03±0.92 2.22 1 4 WAZ 664 -1.83±0.93 3.00 1 3 HAZ 664 -2.01±1.07 3.63 1 3 TLL WHZ 602 -1.39±0.94 2.02 2 7 WAZ 609 -2.03±0.95 1.69 2 0 HAZ 603 -1.88±1.10 2.31 2 6
Graphical summaries to all previous malnutrition indicators are shown on Figures (13,14).
40
Figure (13): The malnutrition status by gender and zone
41
Figure (14): The malnutrition status by by zone
42
4.4 Child Morbidity and Immunization In general, infectious diseases are very common in all zones. Within the last two weeks prior to the survey, Table 22 for instance, indicates the following: The prevalence of diarrhea in both TC and THL is around 45%. The prevalence of ARI is almost 37% in both TC and THL. The prevalence of fever are 57.9% and 62.3% in TC and THL respectively. The prevalence of suspected measles are 1.9% and 3% in TC and THL respectively. The prevalence of diarrhea, ARI, fever and suspected measles in TLL are the lowest in the governorate. On the other hand, immunization coverage either for measles or polio (3 doses) is the lowest in TLL. In addition, TLL children are also the lowest in receiving vitamin A supplementation in the last six months prior to assessment. This controversial situation certainly needs further investigation. Table 22: Child Morbidity 6-59 by gender and zone Indicators TC THL TLL Male Female Total Male Female Total Male Female Total n n n n n n n n N=609 % % % % % % % % Proportion of 98 113 211 164 132 296 97 73 170 children with (45.0) (44.8) (44.9) (49.2) (39.6) (44.4) (30.4) (25.2) (27.9) diarrhoea within 2 weeks prior to assessment 6-59 months Proportion of 77 97 174 113 133 246 78 69 147 children with (35.3) (38.5) (37.0) (33.9) (40.0) (36.9) (24.4) (23.8) (24.1) Cough Breathing Difficulty (ARI) within two weeks prior to assessment 6-59 months Proportion of 117 155 272 169 219 415 141 110 251 children with fever (53.7) (61.5) (57.9) (50.8) (65.8) (62.3) (44.2) (37.9) (41.2) within two weeks prior to assessment 6-59 months Measles 6-59 5 4 9 13 7 20 0 2 2 months (2.3) (1.6) (1.9) (3.9) (2.1) (3.0) (0.0) (0.7) (0.3)
43 Immunization Children (9-59 179 210 389 277 262 539 196 177 373 months) (89.5) (90.5) (90.0) (90.8) (86.5) (88.6) (65.3) (64.4) (64.9) immunised against measles Yes, by card 230 245 145
sles sles
a (53.2) (40.3) (25.2)
vaccine Yes, by 159 394 228 recall (36.8) (48.4) (39.6) Do not 3 2 9 know (0.7) (0.3) (1.6) No vaccine 40 67 193 Receiving Receiving me of was given (9.3) (11.0) (33.6) Children who have 202 231 433 304 302 606 202 177 379 received 3 doses of (93.9) (92.4) (93.1) (91.3) (90.7) (91.1) (63.1) (61.0) (62.1) polio vaccine 6-59 months Supplementation Children reported 203 221 424 303 301 604 250 225 475 to have received (94.4) (88.4) (91.2) (91.0) (90.7) (90.9) (78.1) (77.5) (77.9) vitamin A 6-59 supplementation in last 6 months
4.5 Infant and Young Child Feeding (IYCF) Practices
The World Health Assembly and the Executive Board of UNICEF endorsed the Global Strategy for IYCF in 2002. The IYCF strategy provides governments and other stakeholders with strategies and key components to improve IYCF practices13. In general, Table 23, illustrates that 70.9%, 67.3% and 76.5% of the children aged 6-24 months are still breastfeed in the three zones consecutively. These values are promising as such practice should be encouraged by all means. In addition, continued BF one year and two years indicators are also very promising. Moreover, exclusive BF< 6 months is noticeable (58.1%) in THL zone. Feeding the children 6-24 months with other than breastfeed milk is a common practice in all zones and more specifically in TLL with 42.3%. Bottle milk is also widely used practice in all zones with 34.5%, 34.9% and 61.0%, respectively. In all zones, it can be noticed that MDD, MMF and MAD are not exceeding 30%, 60% and 13.1% respectively. Table 23: IYCF Indicators Indicators TC THL TLL N % N % N % Still breastfeeding 122 70.9 171 67.3 163 76.5 Exclusive breastfeeding < 6 months 9 25.0 18 58.1 7 11.9 Continued BF at 1 year (12-15 months) 14 87.5 37 74.0 41 80.4 Continued BF at 2 year (20-23 months) 18 50.0 17 31.5 29 54.7
44 Number of feeds (other than breastfeed) No feed 24 13.9 28 11.0 29 13.6 One feed 45 26.2 59 23.1 38 17.8 Two feeds 34 19.8 41 16.1 51 23.9 Three feeds 30 17.4 58 22.7 90 42.3 Feeding 4 times and above 39 22.7 69 27.1 5 2.4 Number of milk feeds (other than breast milk) No milk feed 114 66.5 166 65.1 83 39.0 One milk feed 24 13.8 25 9.8 40 18.8 More than one milk feed 36 20.7 64 25.1 90 42.2 MDD (6-23 months) 51 29.3 70 27.5 56 26.3 MMF (6-23 months) 87 50.9 149 58.7 118 55.4 MAD (6-23 months) 22 13.1 33 13.0 25 11.7
4.6 Child Mortality One of the MDG,s is to reduce the U5MR by two thirds between 1990 and 201514. The subsequent SDG's are also asserted in its third goal the importance of supporting good health and well-being15. Recently, U5MR has been estimated in both THL and TLL of Taiz governorate by 0.71 and 0.69 per 10,000 per day respectively. The CMR of the same two zones were also estimated by as 0.27 and 0.21 per 10,000 per day 16. For the present investigation, Table 24 is showing promising improvements. While, the U5MR and CMR of both THL and TLL have been improved dramatically, the highest U5MR and CMR are clearly concentrated in TC zone.
Table 24: U5MR for all children by zone (365 days recall time) Indicators TC THL TLL U5 Total U5 Total U5 Total Total HHs surveyed 382 485 475 Total Population assessed in HHs 404 2605 526 3572 574 3371 Number who joined the HHs 786 828 504 550 660 711 Number who left the HHs 706 752 559 605 732 788 Number of births 114 114 142 142 141 141 Number of deaths 13 19 5 11 8 20 Mortality rate (per 10,000 per day) U5MR 1.14 0.28 0.40 (95%CI) (0.53-1.97) (0.12-0.65) (0.17-0.92) CMR 0.21 0.09 0.16 (95%CI) (0.13-0.33) (0.05-0.15) (0.10-0.28)
Gender has been disaggregated and a separate child mortality anlaysis was performed. This action is important to see where child mortality is concentrated. Tables 25 and 26 are displaying the child mortality rates for
45 male and female children separately. Of which, mortality rates are unequivocally concentrated on male children. Table 25: U5MR of male children by zone Indicators TC THL TLL U5 Total U5 Total U5 Total Total HHs surveyed 379 479 473 Total Population assessed in HHs 412 2592 534 3564 582 3365 Number who joined the HHs 370 390 239 256 272 291 Number who left the HHs 332 355 303 325 348 372 Number of births 55 55 67 67 77 77 Number of deaths 13 16 3 9 6 11 Mortality rate (per 10,000 per day) U5MR 0.96 0.15 0.28 (95%CI) (0.52-1.73) (0.05-0.48) (0.11-0.69) CMR 0.17 0.07 0.09 (95%CI) (0.10-0.29) (0.03-0.14) (0.05-0.17)
Table 26: U5MR of female children by zone Indicators TC THL TLL U5 Total U5 Total U5 Total Total HHs surveyed 381 484 465 Total Population assessed in HHs 435 2605 578 3572 597 3371 Number who joined the HHs 416 438 265 294 388 420 Number who left the HHs 374 397 256 279 384 416 Number of births 59 59 75 75 64 64 Number of deaths 0 3 2 2 2 9 Mortality rate (per 10,000 per day) U5MR 0.0 0.10 0.10 (95%CI) (0.0-0.0) (0.02-0.42) (0.01-0.76) CMR 0.03 0.02 0.07 (95%CI) (0.01-0.10) (0.00-0.06) (0.03-0.19)
4.7 Mid-Upper Arm Circumference (MUAC) Measurement for Women
Women are vulnerable to malnutrition because of their high nutritional requirements during pregnancy and lactation. MUAC was measured of a total of 2398 women 15 to 49 years of age; only 713 (11.3%) were found having a MUAC (SAM) less than 230 mm (Table 27). Pregnant women are less vulnerable to MUAC malnutrition than lactating women.
46 Table 27: Nutrition status of women aged 15-49 years measured by MUAC Indicator Categories TC HL LL
N % N % N %
Acute malnutrition among women GAM 158 23.0 281 29.3 274 36.4 (WFP Yemen Classification) MAM 92 13.4 190 19.8 159 21.1
SAM 66 9.6 91 9.5 115 15.3
Acute malnutrition among pregnant GAM 7 4.5 22 7.8 18 6.6 women (WFP Yemen Classification) MAM 5 5.4 16 8.4 11 6.9
SAM 2 3.1 6 6.6 7 6.1
Acute malnutrition among lactating GAM 25 15.9 61 21.7 94 34.3 women MAM 14 15.2 43 22.6 55 34.6
SAM 11 16.9 18 19.8 39 33.9
4.8 Discussion and variable associations As most of the variables in this survey are categorical, Chi-Square analysis is preferred to study the relationship between children malnutrition status and some of the HHs important characteristics, food security, child infectious diseases and IYCF indicators. For such reason, a comprehensive table that indicating only the significant relationships (y) was constructed (Table 25). From which we can easily draw the following important notes (Annex … for more details): Education of THL caretakers is of concern. Income has become the nightmare facing HHs from feeding their children properly. Type of drinking water is mainly important for both TC and THL children. Unclean drinking water storages are possibly increasing the prevalence of malnutrition in TLL. Open defecation seems the major cause behind children malnutrition in THL Further, caretakers should be advised to wash their hands after toilet. HH size seems to negatively affecting the children's health in THL and more specifically in TLL.
47 In THL, it seems that the more children U5 in the HH the more malnutrition cases among them. HDDS IPC and FCS WFP classifications declare TC and THL children to have serious food deficiencies. Diarrhoea is – doubtless – the major cause of malnutrition among THL and TLL children.
48 Indicators Table 25: Mapping the statistical significant associations between malnutrition status of children and some socio-economic and health indicators.
TC THL TLL WHZ WAZ HAZ WHZ WAZ HAZ WHZ WAZ HAZ GAM SAM GAM SAM GAM SAM GAM SAM GAM SAM GAM SAM GAM SAM GAM SAM GAM SAM Education y y y level of caretaker Lost in HH y Income Income y y y y y quintile Type of y y drinking water Cleanness of y y drinking water storage Type of latrine y y y y Open y y y y y defecation HH caretaker y y y y hand washing after toilet HH caretaker y hand washing before meal
HDDS IPC y y y classification FCS WFP y y y y y y y Classification HH size y y y y y y HH U5 y y y number Diarrhoea y y y y y y y y y ARI Fever y Breastfed yesterday MDD MMF MAD y
5. References 1. WHO Multicentre Growth Reference Study Group. (2006). WHO Child Growth Standards: Length/height-for-age, Weight-forage, Weight-for-length, Weight-for- height and Body mass index-for-age: Methods and Development. World Health Organization, Geneva.
2. WHO (1995). Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series No.854. . Geneva, World Health Organisation.
3. Sphere Project,s Handbook (2011). www.spherehandbook.org
4. Central Statistical Organization (CSO). Population Projection Based on 2004 Census. Yemen.
5. SMART, Action Against Hunger-Canada, and Technical Advisory Group. (2012) Sampling Methods and Sample Size Calculation for the SMART Methodology.
6. WHO (2008). Indicators for assessing infant and young child feeding practices, World Health Organisation.
7. WHO. (2013). Guideline: Updates on the management of severe acute malnutrition in infants and children Geneva: World Health Organization, Geneva.
8. WHO. Water Sanitation Health. http://www.who.int/water_sanitation_health/monitoring/jmp2012/key_terms/e n/.
9. WFP and Food Security Analysis Service. (2009). Comprehensive Food Security & Vulnerability Analysis Guidelines. United Nations World Food Programme, Rome, Italy.
10. Household food consumption indicator study: summary recommendations for the integrated food security phase classification acute reference table for house hold group classification. This summary brief was prepared by L.Glaeser (FANTA) , C. Hillbruner (FEWS NET), A. Mathiessen (WFP Vulnerability Analysis and Mapping [VAM]), and L. Olivera (IPC Global Support Unit [GSU]. 2015
11. WFP-UNICEF (2014). Comprehensive Food Security Survey (CFSS) of Yemen.
12. WHO (2000). The management of nutrition in major emergencies. Geneva. 13. UNICEF. Final Report of Nutrition Survey Using Smart Method in Typhoon Haiyan- affected areas of regions VI, VII and VIII. The Philippines, March 2014. 14. www.un.org/MDG's 15. www.un.org/SDG's 16. UNICEF. Nutrition Survey Report (Mountainous and Coastal Plain Ecological Zones), Taiz Governorate, Yemen, February 2012.
Annex …
51
Variable Associations
52
TC Zone Cross tabulation analysis Education Level of HH Caretaker Illiterate Can read and Basic Secondary Higher Statistical write education education education test N (%) N (%) N (%) N (%) N (%) (P-Value) Acute malnutrition 18 (14.3) 15 (15.5) 18 (21.7) 14 (15.2) 10 (16.4) 2.264 (0.687) Severe acute 4 (3.2) 3 (3.1) 2 (2.4) 2 (2.2) 1 (1.6) 3.609 malnutrition (0.891) Underweight 49 (38.9) 36 (37.1) 41 (49.4) 31 (33.7) 22 (36.1) 5.227 (0.265) Severe 8 (6.3) 8 98.2) 8 (9.6) 7 (7.6) 4 (6.6) 5.886 Underweight (0.660) Stunting 50 (39.7) 42 (43.3) 38 (45.8) 30 (32.6) 22 (36.1) 4.078 (0.396) Severe Stunting 12 (9.5) 8 (8.2) 13 (15.7) 6 (6.5) 4 (6.6) 7.847 (0.449)
Lost in household Income salary or income has not Salary or income has been partially or Statistical been lost totally lost test
N (%) N (%) (P-Value) Acute malnutrition 6.854 9 (8.3) 65 (18.9) (0.009) Severe acute 8.469 3 (2.8) 8 (2.3) malnutrition (0.014) Underweight 1.758 36 (33.0) 138 (40.1) (0.185) Severe Underweight 3.394 4 (3.7) 29 (8.4) (0.183) Stunting 0.962 38 (34.9) 138 (40.1) (0.327) Severe Stunting 1.088 8 (7.3) 33 (9.6) (0.580)
Income quintile
Lowest Second Middle Fourth Highest Statistical test N (%) N (%) N (%) N (%) N (%) (P-Value)
53 Acute malnutrition 20 (26.0) 16 (20.3) 14 (12.2) 4 (6.2) 8 (11.9) 13.847 (0.008)
Severe acute malnutrition 4(5.2) 3 (3.8) 0 (0.0) 1 (1.5) 2 (3.0) 16.913 (0.031)
Underweight 34 (44.2) 34 (43.0) 46 (40.0) 19 (29.2) 21 (31.3) 5.647 (0.227
Severe Underweight 10 (13.0) 8 (10.1) 5 (4.3) 4 (6.2) 3 (4.5) 11.113 (0.193) Stunting 31 (40.3) 44 (55.7) 38 (33.0) 25 (38.5) 25 (37.3) 10.624 (0.031)
Severe Stunting 7 (9.1) 10 (12.7) 10 (8.7) 6 (9.2) 5 (7.5) 10.949 (0.205)
Type of drinking water Improved Unimproved Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.553 (0.457) 2 (7.1) 2 (14.3) FT (0.590)
Severe acute malnutrition 2 (7.1) 2 (14.3) 0.553 (0.457)
Underweight 6.740 (0.009) 5 (17.9) 8 (57.1) FT (0.015) Severe Underweight 2 (7.1) 0 (0.0) 10.768 (0.005) Stunting 1.867 (0.172) 8 (28.6) 7 (50.0) FT (0.193) Severe Stunting 3 (10.7) 3 (21.4) 1.917 (0.384)
Cleanness of drinking water storage Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 1.683 (0.195) 69 (15.8) 6 (26.1) FT (0.241)
Severe acute malnutrition 11 (2.5) 1 (4.3) 1.686 (0.430)
Underweight 0.181 (0.671) 171 (39.2) 8 34.8 FT(0.827) Severe Underweight 33 (7.6) 2 (8.7) 0.323 (0.851) Stunting 1.862 (0.172) 176 (40.4) 6 (26.1) FT (0.196) Severe Stunting 41 (9.4) 2 (8.7) 2.079 (0.354)
54
Type of latrine Improved Unimproved Statistical test N (%) N (%) (P-Value) Acute malnutrition 1.247 (0.264) 46 (15.0) 29 (19.1) FT (0.284)
Severe acute malnutrition 7 (2.3) 5 (3.3) 1.305 (0.521)
Underweight 0.307 (0.580) 117 (38.1) 62 (40.8) FT (0.612) Severe Underweight 21 (6.8) 14 (9.2) 0.872 (0.647) Stunting 0.066 (797) 123 (40.1) 59 (38.8) FT (0.840) Severe Stunting 30 (9.8) 13 (8.6) 0.188 (0.910)
Open defecation (no open defecation in TC) no data found Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition no open defecation in TC no open defecation in TC Severe acute malnutrition no open defecation in TC no open defecation in TC Underweight no open defecation in TC no open defecation in TC Severe Underweight no open defecation in TC no open defecation in TC Stunting no open defecation in TC no open defecation in TC Severe Stunting no open defecation in TC no open defecation in TC
Household caretaker handwashing after toilet Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.301 (0.583) 62 (15.9) 13 (18.6) FT (0.599)
Severe acute malnutrition 10 (2.6) 2 (2.9) 0.306 (0.858)
Underweight 0.374 (0.541) 154 (39.6) 25 (35.7) FT (0.596)
55 Severe Underweight 29 (7.5) 6 (8.6) 0.714 (0.700) Stunting 3.697 (0.055) 147 (37.8) 35 (50.0) FT (0.063) Severe Stunting 37 (9.5) 6 (8.6) 4.910 (0.086)
Household caretaker handwashing before meal
Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 1.479 (0.224) 30 (14.1) 45 (18.3) FT (0.255)
Severe acute malnutrition 6 (2.8) 6 (2.4) 2.053 (0.358)
Underweight 0.157 (0.692) 81 (38.0) 98 (39.8) FT (0.702) Severe Underweight 15 (7.0) 20 (8.1) 0.257 (0.879) Stunting 0.459 (0.498) 88 (41.3) 94 (38.2) FT (0.505) Severe Stunting 20 (9.4) 23 (9.3) 0.536 (0.765)
HDDS IPC classification Normal or stressed Crisis Emergency or catastrophe Statistical test N (%) N (%) N (%) no data (P-Value) Acute malnutrition 1.263 (0.261) 65 (15.7) 10 (22.2) FT (0.287)
Severe acute malnutrition 11 (2.7) 1 (2.2) 1.667 (0.435)
Underweight 0.031 (0.860) 162 (39.1) 17 (37.8) FT (1.000) Severe Underweight 29 (7.0) 6 (13.3) 2.907 (0.234) Stunting 0.479 (0.489) 162 (39.1) 20 (44.4) FT (0.523) Severe Stunting 37 (8.9) 6 (13.3) 1.039 (0.595)
FCS WFP classification Poor Borderline Acceptable Statistical test N (%) N (%) N (%) (P-Value) Acute malnutrition 10 (23.8) 26 (24.1) 39 (12.9) 8.902 (0.012)
Severe acute malnutrition 3 (7.1) 3 (2.8) 6 (2.0) 11.561 (0.021)
56 Underweight 16 (38.1) 55 (50.9) 103 (34.1) 9.509 (0.009)
Severe Underweight 3 (7.1) 16 (14.8) 16 (5.3) 14.367 (0.006) Stunting 14 (33.3) 49 (45.4) 114 (37.7) 2.599 (0.273)
Severe Stunting 4 (9.5) 15 (13.9 ) 23 (7.6) 5.007 (0.287)
Household size 2 – 7 8 – 13 14 - 19 20 – 25 Statistical test N (%) N (%) N (%) N (%) (P-Value)
Acute malnutrition 50 (17.2) 22 (15.2) 3 (16.7) 0 (0.0) 1.490 (0.685)
Severe acute malnutrition 9 (3.1) 3 (2.1) 0 (0.0) 0 (0.0) 2.315 (0.889)
Underweight 110 (37.9) 59 (40.7) 9 (50.0) 1 (16.7) 2.487 (0.478)
Severe Underweight 23 (7.9) 12 (8.3) 0 (0.0) 0 (0.0) 5.545 (0.476)
Stunting 114 (39.3) 61 (42.1) 7 (38.9) 0 (0.0) 4.315 (0.229) Severe Stunting 27 (9.3) 13 (9.0) 3 (16.7) 0 (0.0) 5.914 (0.433)
Household underfive number 1-2 3 – 4 5+ Statistical test N (%) N (%) N (%) (P-Value)
Acute malnutrition 66 (17.1) 9 (13.8) 0 (0.0) 2.021 (0.364)
Severe acute malnutrition 12 (3.1) 0 (0.0) 0 (0.0) 3.718 (0.446)
Underweight 151 (39.1) 27 (41.5) 1 (12.5) 2.540 (0.281)
Severe Underweight 34 (8.8) 1 (1.5) 0 (0.0) 8.056 (0.090)
Stunting 158 (40.9) 23 (35.4) 1 (12.5) 3.224 (0.199)
Severe Stunting 34 (8.8) 9 (13.8) 0 (0.0) 6.457 (0.168)
Diarrhoea Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 3.180 (0.075) 42 (19.7) 33 (13.5) FT (0.078)
Severe acute malnutrition 8 (3.8) 4 (1.6)
57 Underweight 3.020 (0.082) 92 (43.2) 86 (35.2) FT (0.085) Severe Underweight 18 (8.5) 17 (7.0) 3.021 (0.221) Stunting 0.122 (0.726) 83 (39.0) 99 (40.6) FT (0.774) Severe Stunting 23 (10.8) 20 (8.2) 1.529 (0.466)
ARI Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.024 (0.876) 28 (16.8) 47 (16.2) FT (0.896)
Severe acute malnutrition 6 (3.6) 6 (2.1) 1.013 (0.603)
Underweight 0.036 (0.849) 66 (39.5) 112 (38.6) FT (0.921) Severe Underweight 16 (9.6) 19 (6.6) 1.437 (0.487) Stunting 2.840 (0.092) 75 (44.9) 107 (36.9) FT (0.112) Severe Stunting 17 (10.2) 26 (9.0) 2.908 (0.234)
Fever
Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 1.259 (0.262) 49 (18.0) 26 (14.1) FT (0.304)
Severe acute malnutrition 10 (3.7) 2 (1.1) 3.180 (0.204)
Underweight 3.133 (0.077) 115 (42.3) 63 (34.1) FT (0.080) Severe Underweight 26 (9.6) 9 (4.9) 4.827 (0.090) Stunting 0.106 (0.744) 110 (40.4) 72 (38.9) FT (0.771) Severe Stunting 27 (9.9) 16 (8.6) 0.236 (0.889)
Breastfed yesterday
Yes No Statistical test N (%) N (%) (P-Value)
Acute malnutrition 22 (15.5) 3 (7.3) 1.803 (0.179)
58 FT (0.209)
Severe acute malnutrition 6 (4.2) 0 (0.0) 2.457 (0.293)
Underweight 2.602 (0.107) 54 (38.0) 10 (24.4) FT (0.137) Severe Underweight 11 (7.7) 0 (0.0) 4.467 (0.107) Stunting 0.002 (0.966) 49 (34.5) 14 (34.1) FT (1.000) Severe Stunting 13 (9.2) 2 (4.9) 0.897 (0.639)
Minimum dietary diversity
Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 2.023 (0.155) 10 (20.4) 15 (12.0) FT (0.158)
Severe acute malnutrition 3 (6.1) 3 (2.4) 2.413 90.299)
Underweight 0.004 (0.950) 17 (34.7) 44 (35.2) FT (1.000) Severe Underweight 4 (8.2) 7 (5.6) 0.483 (0.786) Stunting 0.057 (0.812) 17 (34.7) 41 (32.8) FT (0.859) Severe Stunting 4 (8.2) 10 (8.0) 0.062 (0.970)
Minimum meal frequency
Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.015 (0.901) 12 (14.5) 12 (13.8) FT (1.000)
Severe acute malnutrition 3 (3.6) 3 93.4) 0.015 (0.992)
Underweight 0.067 (0.795) 28 (33.7) 31 (35.6) FT (0.872) Severe Underweight 6 (7.2) 5 (5.7) 0.339 (0.844) Stunting 0.145 (0.704) 29 (34.9) 28 (32.2) FT (0.747) Severe Stunting 7 (8.4) 7 (8.0) 0.150 (0.928)
Minimum acceptable diet
Yes No Statistical test
59 N (%) N (%) (P-Value) Acute malnutrition 3.898 (0.048) 5 (29.4) 18 (12.0) FT (0.063)
Severe acute malnutrition 1 (5.9) 5 (3.3) 4.127 (0.127)
Underweight 0.011 (0.915) 6 (35.3) 51 (34.0) FT (1.000) Severe Underweight 2 (11.8) 9 (6.0) 0.885 (0.642) Stunting 0.144 (0.704) 5 (29.4) 51 (34.0) FT (0.792) Severe Stunting 1 (5.9) 13 (8.7) 0.209 (0.901)
Severe acute malnutrition among women Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.389 (0.533) 0 (0.0) 2 (16.7) FT (1.000)
Severe acute malnutrition 0 (0.0) 1 (8.3) 0.389 (0.823)
Underweight 1.750 (0.186) 0 (0.0) 6 (50.0) FT (0.473) Severe Underweight 1.750 (0.186) 0 6 (50.0) FT (0.473) Stunting 1.750 (0.186) 0 (0.0) 6 (50.0) FT (0.473) Severe Stunting 0 (0.0) 1 (8.3) 1.750 (0.417)
THL Zone
Cross tabulation analysis Education Level of Caretaker Illiterate Can read and Basic Secondary Higher Statistical write education education education test N (%)
N (%) N (%) N (%) N (%) (P-Value) Acute 0.320 53 (14.1) 12 (13.2) 14 (14.4) 12 (15.4) 2 (18.2) malnutrition (0.989)
Severe acute 6 (1.6) 1 (1.1) 1 (1.0) 2 (2.6) 0 (0.0) 1.379
60 malnutrition (0.995)
Underweight 167 (44.3) 34 (37.4) 44 (45.4) 29 (37.2) 6 (54.5) 3.330 (0.504) Severe 10.758 42 (11.1) 13 (14.3) 9 (9.3) 4 (5.1) 3 (27.3) Underweight (0.216) Stunting 4.744 183 (48.5) 42 (46.2) 54 (55.7) 36 (46.2) 8 (72.7) (0.315) Severe Stunting 9.088 63 (16.7) 18 (19.8) 14 (14.4) 9 (11.5) 3 (27.3) (0.335)
Lost in household Income salary or income has not Salary or income has been partially or Statistical been lost totally lost test
N (%) N (%) (P-Value) Acute malnutrition 3.208 32 (11.7) 60 (16.8) (0.073) FT (0.087) Severe acute 3.312 3 (1.1) 7 (2.0) malnutrition (0.191) Underweight 0.819 111 (40.7) 158 (44.3) (0.366) FT (0.373) Severe Underweight 3.196 23 (8.4) 46 (12.9) (0.202) Stunting 0.900 128 (46.9) 181 (50.7) (0.343) FT (0.376) Severe Stunting 1.103 40 (14.7) 61 (17.1) (0.576)
Income quintile Lowest Second Middle Fourth Highest Statistical test N (%) N (%) N (%) N (%) N (%) (P-Value)
61 Acute malnutrition 14 (17.1) 17 (12.8) 18 (18.9) 20 (12.1) 17 (13.4) 1.167 (0.530)
Severe acute malnutrition 5.333 2 (2.4) 2 (1.5) 3 (3.2) 1 (0.6) 1 (0.8) (0.721)
Underweight 44 (53.7) 53 (39.8) 43 (45.3) 59 (35.8) 57 (44.9) 8.220 (0.084)
Severe Underweight 11.866 15 (18.3) 15 (11.3) 10 (10.5) 15 (9.1) 11 (8.7) (0.157)
Stunting 45 (54.9) 74 (55.6) 49 (51.6) 66 (40.0) 61 (48.0) 9.128 (0.058) Severe Stunting 17.725 21 (25.6) 22 (16.5) 12 (12.6) 26 (15.8) 16 (12.6) (0.023)
Type of drinking water Improved Unimproved Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.702 (0.402) 58 (13.6) 30 (16.1) FT (0.452)
Severe acute malnutrition 6 (1.4) 3 (1.6) 0.704 (0.703) Underweight 3.411 (0.065) 175 (40.9) 91 (48.9) FT (0.076) Severe Underweight 40 (9.3) 30 (16.1) 6.774 (0.034) Stunting 1.077 (0.299) 206 (48.1) 98 (52.7) FT (0.334) Severe Stunting 61 (14.3) 40 (21.5) 4.965 (0.084)
Cleanness of drinking water storage Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.269 (0.604) 85 (14.0) 8 (16.7) FT (0.666)
Severe acute malnutrition 9 (1.5) 1 (2.1) 0.301 (0.860)
Underweight 1.106 (0.293) 257 (42.2) 24 (50.0) FT (0.294) Severe Underweight 65 (10.7) 6 (12.5) 1.107 (0.575)
Stunting 295 (48.4) 28 (58.3) 1.742 (0.187)
62 FT (0.230)
Severe Stunting 100 (16.4) 7 (14.6) 2.811 (0.245)
Type of latrine Improved Unimproved Statistical test N (%) N (%) (P-Value) Acute malnutrition 2.712 (0.100) 41 (12.1) 52 (16.6) FT (0.117)
Severe acute malnutrition 4 (1.2) 6 (1.9) 2.787 (0.248)
Underweight 4.262 (0.039) 132 (38.8) 147 (46.8) FT (0.040) Severe Underweight 34 (10.0) 36 (11.5) 4.322 (0.115) Stunting 0.066 (0.797) 168 (49.4) 152 (48.4) FT (0.825) Severe Stunting 51 (15.0) 55 (17.5) 1.288 (0.525)
Open defecation Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 3.417 (0.065) 12 (22.6) 81 (13.4) FT (0.096)
Severe acute malnutrition 3 (5.7) 7 (1.2) 7.833 (0.020)
Underweight 7.302 (0.007) 32 (60.4) 249 (41.2) FT (0.009) Severe Underweight 14 (26.4) 57 (9.4) 16.192 (0.000) Stunting 15.966 (0.000) 40 (75.5) 283 (46.9) FT (0.000) Severe Stunting 20 (37.7) 87 (14.4) 24.550 (0.000)
Household caretaker handwashing after toilet Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 5.493 (0.019) 50 (11.8) 43 (18.5) FT (0.026)
Severe acute malnutrition 4 (0.9) 6 (2.6) 6.420 (0.040)
Underweight 167 (39.4) 114 (48.9) 5.591 (0.018)
63 FT (0.021)
Severe Underweight 39 (9.2) 32 (13.7) 6.432 (0.040) Stunting 0.527 (0.468) 204 (48.1) 119 (51.1) FT (0.514) Severe Stunting 65 (15.3) 42 (18.0) 0.933 (0.627)
Household caretaker handwashing before meal Yes No Statistical test N (%) N (%) (P-Value)
Acute malnutrition 40 (11.0) 53 (18.2) 6.905 (0.009)
Severe acute malnutrition 3 (0.8) 7 (2.4) 7.673 (0.022)
Underweight 5.751 (0.016) 141 (38.6) 140 (47.9) FT (0.017) Severe Underweight 35 (9.6) 36 (12.3) 5.781 (0.056) Stunting 0.147 (0.701) 177 (48.5) 146 (50.0) FT (0.753) Severe Stunting 59 (16.2) 48 (16.4) 0.155 (0.925)
HDDS IPC classification Normal or stressed Crisis Emergency or catastrophe Statistical test N (%) N (%) N (%) (P-Value)
Acute malnutrition 82 (13.5) 0 (0.0) 11 (22.4) 3.147 (0.207)
Severe acute malnutrition 8 (1.3) 0 (0.0) 2 (4.1) 4.232 (0.376)
Underweight 257 (42.3) 23 (46.9) 1 (100.0) 1.732 (0.421)
Severe Underweight 59 (9.7) 12 (24.5) 0 (0.0) 12.919 (0.012)
Stunting 288 (47.4) 34 (69.4) 1 (100.0) 9.769 (.008)
Severe Stunting 93 (15.3) 13 (26.5) 1 (100.0) 14.528 (0.006)
FCS WFP classification Poor Borderline Acceptable Statistical test N (%) N (%) N (%) (P-Value)
Acute malnutrition 16 (21.1) 14 (13.6) 62 (13.2) 3.331 (0.189)
Severe acute malnutrition 3 (3.9) 3 (2.9) 4 (0.9) 7.557 (0.109)
Underweight 41 (53.9) 48 (46.6) 190 (40.5) 5.444 (0.066)
Severe Underweight 13 (17.1) 17 (16.5) 40 (8.5) 11.139 (0.025)
64 Stunting 51 (67.1) 57 (55.3) 213 (45.4) 13.958 (0.001)
Severe Stunting 20 (26.3) 28 (27.2) 59 (12.6) 24.966 (0.000)
65 Household size 2 – 7 8 – 13 14 - 19 20 – 25 Statistical test N (%) N (%) N (%) N (%) (P-Value)
Acute malnutrition 40 (12.2) 39 (15.6) 11 (16.7) 3 (21.4) 2.376 (0.498)
Severe acute malnutrition 6 (1.8) 4 (1.6) 0 (0.0) 0 (0.0) 5.145 (0.525)
Underweight 148 (45.3) 105 (42.0) 22 (33.3) 6 (42.9) 3.290 (0.349)
Severe Underweight 40 (12.2) 24 (9.6) 5 (7.6) 2 (14.3) 4.130 (0.659)
Stunting 173 (52.9) 124 (49.6) 21 (31.8) 5 (35.7) 10.809 (0.013)
Severe Stunting 63 (19.3) 38 (15.2) 6 (9.1) 0 (0.0) 13.993 (0.030)
Household underfive number 1-2 3 – 4 5+ Statistical test N (%) N (%) N (%) (P-Value)
Acute malnutrition 65 (13.9) 23 (14.8) 5 (14.7) 0.095 (0.953)
Severe acute malnutrition 9 (1.9) 1 (0.6) 0 (0.0) 2.388 (0.665)
Underweight 204 (43.6) 70 (45.2) 7 (20.6) 7.325 (0.026)
Severe Underweight 54 (11.5) 16 (10.3) 1 (2.9) 7.927 (0.094) Stunting 242 (51.7) 74 (47.7) 7 (20.6) 12.447 (0.002)
Severe Stunting 78 (16.7) 28 (18.1) 1 (2.9) 13.729 (0.008)
Diarrhoea Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 8.437 (0.004) 52 (18.8) 41 (10.8) FT (0.004)
Severe acute malnutrition 9 (3.3) 1 (0.3) 13.777 (0.001)
Underweight 12.400 (0.000) 140 (50.7) 140 (36.9) FT (0.001) Severe Underweight 36 (13.0) 35 (9.2) 12.420 (0.002) Stunting 4.166 (0.041) 149 (54.0) 174 (45.9) FT (0.048) Severe Stunting 60 (21.7) 47 (12.4) 10.656 (0.005)
66 ARI Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 1.801 (0.180) 40 (16.6) 53 (12.8) FT (0.202) Severe acute malnutrition 7 (2.9) 3 (0.7) 5.311 (0.070)
Underweight 0.026 (0.873) 104 (43.2) 176 (42.5) FT (0.935) Severe Underweight 27 (11.2) 44 (10.6) 0.058 (0.972) Stunting 0.897 (0.344) 113 (46.9) 210 (50.7) FT (0.373) Severe Stunting 35 (14.5) 72 (17.4) 1.253 (0.534)
Fever Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 1.801 (0.180) 40 (16.6) 53 (12.8) FT (0.202)
Severe acute malnutrition 10 (2.4) 0 (0.0) 7.386 (0.025)
Underweight 2.746 (0.098) 185 (45.2) 95 (38.6) FT (0.103) Severe Underweight 49 (12.0) 22 (8.9) 3.097 (0.213) Stunting 0.355 (0.551) 198 (48.4) 125 (50.8) FT (0.573) Severe Stunting 67 (16.4) 40 (16.3) 0.473 (0.789)
Breastfed yesterday Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 1.596 (0.206) 41 (22.7) 11 (15.5) FT (0.230)
Severe acute malnutrition 9 (5.0) 0 (0.0) 4.003 (0.135)
Underweight 1.773 (0.183) 83 (45.9) 26 (36.6) FT (0.205) Severe Underweight 30 (16.6) 6 (8.5) 3.144 (0.208) Stunting 2.305 (0.129) 88 (48.6) 27 (38.0) FT (0.160)
67 Severe Stunting 34 (18.8) 11 (15.5) 2.340 (0.310)
Minimum dietary diversity Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 3.405 (0.065) 8 (12.7) 39 (23.8) FT (0.070)
Severe acute malnutrition 1 (1.6) 8 (4.9) 3.599 (0.165) Underweight 1.380 (0.240) 23 (36.5) 74 (45.1) FT (0.294) Severe Underweight 5 (7.9) 30 (18.3) 3.806 (0.149) Stunting 2.093 (0.148) 24 (38.1) 80 (48.8) FT (0.181) Severe Stunting 6 (9.5) 36 (22.0) 4.809 (0.090)
Minimum meal frequency Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 2.334 (0.127) 22 (17.2) 25 (25.5) FT (0.139) Severe acute malnutrition 2 (1.6) 7 (7.1) 5.074 (0.079)
Underweight 3.540 (0.060) 48 (37.5) 49 (50.0) FT (0.078) Severe Underweight 14 (10.9) 21 (21.4) 5.546 (0.062) Stunting 0.059 (0.808) 58 (45.3) 46 (46.9) FT (0.893) Severe Stunting 19 (14.8) 23 (23.5) 3.241 (0.198)
Minimum acceptable diet Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.475 (0.491) 5 (16.1) 42 (21.5) FT (0.636)
Severe acute malnutrition 1 (3.2) 8 (4.1) 0.477 (0.788)
Underweight 1.667 (0.197) 10 (32.3) 87 (44.6) FT (0.243) Severe Underweight 3 (9.7) 32 (16.4) 1.807 (0.405)
68 Stunting 1.605 (0.205) 11 (35.5) 93 (47.7) FT (0.246) Severe Stunting 3 (9.7) 39 (20.0) 2.307 (0.316)
TLL Zone
Cross tabulation analysis Education Level of Caretaker Illiterate Can read and Basic Secondary Higher Statistical write education education education test N (%)
N (%) N (%) N (%) N (%) (P-Value) Acute malnutrition 11.766 127 (27.9) 5 98.80 10 (23.80 4 (14.3) 2 (22.2) (0.019) Severe acute 12.274 27 (5.9) 1 (1.8) 2 (4.8) 1 (3.6) 0 (0.0) malnutrition (0.139) Underweight 14.219 231 (50.7) 20 (35.1) 26 (61.9) 7 (25.0) 4 (44.4) (0.007) Severe 25.739 70 (15.4) 0 (0.0) 12 (28.6) 4 (14.3) 1 (11.1) Underweight (0.001) Stunting 9.218 217 (47.6) 22 (38.6) 22 (52.4) 6 (21.4) 4 (44.4) (0.056) Severe Stunting 10.693 72 (15.8) 5 (8.8) 8 (19.0) 1 (3.6) 1 (11.1) (0.220)
Lost in household Income
salary or income has not Salary or income has been partially or Statistical been lost totally lost test
N (%) N (%) (P-Value) Acute malnutrition 0.011 32 (25.4) 116 (24.9) (0.918) FT (0.908) Severe acute 0.131 6 (4.8) 25 (5.4) malnutrition (0.937) Underweight 0.014 62 (49.2) 226 (48.6) (0.904) FT (0.920) Severe Underweight 0.173 20 (15.9) 67 (14.4) (0.917) Stunting 1.866 51 (40.5) 220 (47.3) (0.172) FT (0.190)
69 Severe Stunting 3.014 13 (10.3) 74 (15.9) (0.222)
Income quintile Lowest Second Middle Fourth Highest Statistical test N (%) N (%) N (%) N (%) N (%) (P-Value)
Acute malnutrition 31 (22.3) 12 (25.0) 8 (29.6) 52 (25.9) 30 (24.0) 0.966 (0.915)
Severe acute malnutrition 10.890 6 (4.3) 4 (8.3) 4 (14.8) 11 (5.5) 2 (1.6) (0.208)
Underweight 70 (50.4) 22 (45.8) 11 (40.7) 110 (54.7) 52 (41.6) 6.407 (0.171)
7.919 Severe Underweight 19 (13.7) 8 (16.7) 2 (7.4) 31 (15.4) 17 (13.6) (0.441) Stunting 72 (51.8) 17 (35.4) 9 (33.3) 102 (50.7) 48 (38.4) 10.521 (0.033)
Severe Stunting 11.284 23 (16.5) 5 (10.4) 2 (7.4) 35 (17.4) 14 11.2) (0.186)
Type of drinking water Improved Unimproved Statistical test N (%) N (%) (P-Value)
(P-Value) Acute malnutrition 0.095 (0.759) 76 (24.9) 60 (26.1) FT (0.764)
Severe acute malnutrition 17 (5.6) 12 (5.2) 0.207 (0.902)
Underweight 1.474 (0.225) 139 (45.6) 117 (50.9) FT (0.256) Severe Underweight 47 (15.4) 31 (13.5) 3.099 (0.212) Stunting 1.345 (0.246) 144 (47.2) 97 (42.2) FT (0.255) Severe Stunting 43 (14.1) 32 (13.9) 1.605 (0.448)
Cleanness of drinking water storage Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.618 (0.432) 128 (25.6) 20 (21.7) FT (0.513)
Severe acute malnutrition 28 (5.6) 3 (3.3) 1.057 (0.589)
70 Underweight 3.950 (0.047) 252 (50.4) 36 (39.1) FT (0.054) Severe Underweight 81 (16.2) 6 (6.5) 6.932 (0.031) Stunting 3.414 (0.065) 237 (47.4) 34 (37.0) FT (0.069) Severe Stunting 80 (16.0) 7 (7.6) 5.391 (0.067)
Type of latrine Improved Unimproved Statistical test N (%) N (%) (P-Value) Acute malnutrition 8.118 (0.004) 64 (32.0) 83 (21.3) FT (0.005)
Severe acute malnutrition 16 (8.0) 14 (3.6) 9.732 (0.008)
Underweight 0.000 (0.993) 97 (48.5) 189 8.5) FT (1.000) Severe Underweight 40 (20.0) 46 (11.8) 8.707 (0.013) Stunting 0.310 (0.578) 88 (44.0) 181 (46.4) FT (0.601) Severe Stunting 34 (17.0) 52 (13.3) 2.935 (0.231)
Open defecation
Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.085 (0.771) 30 (24.0) 118 (25.3) FT (0.817)
Severe acute malnutrition 6 (4.8) 25 (5.4) 0.104 (0.949)
Underweight 1.555 (0.212) 67 (53.6) 221 (47.3) FT (0.228) Severe Underweight 14 (11.2) 73 (15.6) 5.405 (0.067) Stunting 1.877 (0.171) 64 (51.2) 207 (44.3) FT (0.189) Severe Stunting 20 (16.0) 67 (14.3) 1.908 (0.385)
Household caretaker handwashing after toilet
Yes No Statistical test N (%) N (%) (P-Value)
71 Acute malnutrition 0.823 (0.364) 61 (23.2) 87 (26.4) FT (0.391)
Severe acute malnutrition 8 (3.0) 23 (7.0) 4.595 (0.101)
Underweight 0.025 (0.876) 127 (48.3) 161 (48.9) FT (0.934) Severe Underweight 40 (15.2) 47 (14.3) 0.203 (0.904) Stunting 0.585 (0.444) 125 (47.5) 146 (44.4) FT (0.456) Severe Stunting 38 (14.4) 49 (14.9) 0.896 (0.639)
Household caretaker handwashing before meal Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 3.919 (0.048) 43 (20.3) 105 (27.6) FT (0.048)
Severe acute malnutrition 6 (2.8) 25 (6.6) 5.524 (0.063)
Underweight 0.289 (0.591) 100 (47.2) 188 (49.5) FT (0.608) Severe Underweight 26 (12.3) 61 (16.1) 1.558 (0.459) Stunting 1.049 (0.306) 103 (48.6) 168 (44.2) FT (0.344) Severe Stunting 34 (16.0) 53 (13.9) 1.113 (0.573)
HDDS IPC classification Normal or stressed Crisis Emergency or catastrophe Statistical test N (%) N (%) N (%) (P-Value)
Acute malnutrition 132 (25.1) 16 (25.0) 0 (0.0) 0.669 (0.716)
Severe acute malnutrition 28 (5.3) 3 (4.7) 0 (0.0) 0.721 (0.949)
Underweight 250 (47.5) 36 (56.3) 2 (100.0) 3.856 (0.145)
Severe Underweight 76 (14.4) 11 (17.2) 0 (0.0) 5.642 (0.228)
Stunting 237 (45.1) 32 (50.0) 2 (100.0) 2.939 (0.230)
Severe Stunting 76 (14.4) 11 (17.2) 0 (0.0) 5.087 (0.278)
FCS WFP classification Poor Borderline Acceptable Statistical test N (%) N (%) N (%) (P-Value)
72 Acute malnutrition 6 (12.8) 15 (31.3) 127 (25.6) 4.833 (0.089)
Severe acute malnutrition 0 (0.0) 3 (6.3) 28 (5.6) 5.750 (0.219)
Underweight 25 (53.2) 23 (47.9) 240 (48.3) 0.424 (0.809)
Severe Underweight 8 (17.0) 5 (10.4) 74 (14.9) 1.281 (0.865)
Stunting 23 (48.9) 25 (52.1) 223 (44.9) 1.123 (0.570)
Severe Stunting 7 (14.9) 5 (10.4) 75 (15.1) 3.300 (0.509)
Household size 2 – 7 8 – 13 14 - 19 20 – 25 Statistical test N (%) N (%) N (%) N (%) (P-Value)
Acute malnutrition 71 (23.7) 64 (28.1) 5 (14.3) 8 (27.6) 3.677 (0.299)
Severe acute malnutrition 18 (6.0) 12 (5.3) 0(0.0) 1 (3.4) 5.812 (0.445)
Underweight 146 (48.7) 119 (52.2) 8 (22.9) 15 (22.9) 10.576 (0.014)
Severe Underweight 50 (16.7) 35 (15.4) 0 (0.0) 2 (6.9) 15.525 (0.017) Stunting 126 (42.0) 122 (53.5) 13 (37.1) 10 (34.5) 9.757 (0.021)
Severe Stunting 48 (16.0) 31 (13.6) 3 (8.6) 5 (17.2) 16.093 (0.013)
Household underfive number 1-2 3 – 4 5+ Statistical test N (%) N (%) N (%) (P-Value)
Acute malnutrition 97 (24.4) 44 (25.1) 7 (35.0) 1.137 (0.566)
Severe acute malnutrition 20 (5.0) 10 (5.7) 1 (5.0) 1.490 (0.828)
Underweight 196 (49.4) 84 (48.0) 8 (40.0) 0.711 (0.701)
Severe Underweight 61 (15.4) 25 (14.3) 1 (5.0) 1.776 (0.777) Stunting 186 (46.9) 81 (46.3) 4 (20.0) 5.557 (0.062)
Severe Stunting 60 (15.1) 26 (14.9) 1 (5.0) 5.599 (0.231)
Diarrhoea Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 8.701 (0.003) 60 (33.0) 88 (21.6) FT (0.004)
Severe acute malnutrition 16 (8.8) 15 (3.7) 10.955 (0.004)
73 Underweight 3.485 (0.062) 99 (54.4) 188 (46.1) FT (0.074) Severe Underweight 40 (22.0) 47 (11.5) 11.201 (0.004) Stunting 0.003 (0.959) 83 (45.6) 187 (45.8) FT (1.000) Severe Stunting 28 (15.4) 59 (14.5) 0.128 (0.938)
74 ARI Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.274 (0.601) 34 (23.4) 114 (25.6) FT (0.660) Severe acute malnutrition 8 (5.5) 23 (5.2) 0.444 (0.801)
Underweight 2.078 (0.149) 63 (43.4) 224 (50.3) FT (0.153) Severe Underweight 17 (11.7) 70 (15.7) 2.469 (0.291) Stunting 3.225 (0.073) 57 (39.3) 213 (47.9) FT (0.084) Severe Stunting 15 (10.3) 72 (16.2) 4.262 (0.119)
Fever Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 1.663 (0.197) 75 (27.6) 73 (23.0) FT (0.216)
Severe acute malnutrition 17 (6.3) 14 (4.4) 1.937 (0.380)
Underweight 0.047 (0.828) 131 (48.2) 156 (49.1) FT (0.869) Severe Underweight 45 (16.5) 42 (13.2) 1.904 (0.386) Stunting 0.064 (0.800) 126 (46.3) 144 (45.3) FT (0.804) Severe Stunting 39 (14.3) 48 (15.1) 0.239 (0.888)
Breastfed yesterday Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 1.495 (0.221) 82 (28.2) 9 (19.6) FT (0.284)
Severe acute malnutrition 17 (5.8) 3 (6.5) 2.063 (0.356)
Underweight 0.115 (0.735) 147 (50.5) 22 (47.8) FT (0.754) Severe Underweight 49 (16.8) 8 (17.4) 0.190 (0.909) Stunting 0.437 (0.509) 129 (44.3) 18 (39.1) FT (0.527)
75 Severe Stunting 43 (14.8) 8 (17.4) 1.221 (0.543)
Minimum dietary diversity Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.009 (0.925) 19 (25.7) 53 (26.2) FT (1.000)
Severe acute malnutrition 7 (9.5) 11 (5.4) 1.920 (0.383) Underweight 0.241 (0.624) 36 (48.6) 105 (52.0) FT (0.684) Severe Underweight 11 (14.9) 34 (16.8) 0.280 (0.869) Stunting 0.663 (0.416) 30 (40.5) 93 (46.0) FT (0.494) Severe Stunting 11 (14.9) 30 (14.9) 0.849 (0.654)
Minimum meal frequency Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.082 (0.775) 36 (25.4) 36 (26.9) FT (0.786) Severe acute malnutrition 10 (7.0) 8 (6.0) 0.378 (0.828)
Underweight 3.303 (0.069) 65 (45.8) 76 (56.7) FT (0.072) Severe Underweight 20 (14.1) 25 (18.7) 3.376 (0.185) Stunting 3.114 (0.078) 56 (39.4) 67 (50.0) FT (0.090) Severe Stunting 22 (15.5) 19 (14.2) 4.741 (0.093)
Minimum acceptable diet Yes No Statistical test N (%) N (%) (P-Value) Acute malnutrition 0.253 (0.615) 12 (29.3) 60 (25.5) FT (0.700)
Severe acute malnutrition 4 (9.8) 14 (6.0) 0.838 (0.658)
Underweight 0.995 (0.319) 18 (43.9) 123 (52.3) FT (0.398) Severe Underweight 5 (12.2) 40 (17.0) 1.138 (0.566)
76 Stunting 1.241 (0.265) 15 (36.6) 108 (46.0) FT (0.309) Severe Stunting 4 (9.8) 37 (15.7) 1.530 (0.465)
77 Annex 1: Taiz Nutrition May 2016 Survey Questionnaire
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92 Annex 2: Taiz Nutrition May 2016 Survey Team Team No Name Title 1 Sadiq Hasan al Qadasi 2 Tawfeeq Abdo Saeed Ahmed 3 Abdullah Qasim Al Haidari Team Heads 4 Abdulsalam Ghaleb Al Tabe’e 5 Abdo Abdullah Al Naser Hayat ali Mahdi Saeed 1 Enas Abdulhameed Al Hammadi Afrah Ibraheem Mohammed Waheebah Ali Mohammed Hasan 2 Tahani Mohammed Abdulwahab Fakhriah Abdullah Othman Asia Mohammed Morshed 3 Sana Ahmed Abdo Al Sabri Shareefah Sharaf Abdullah Enumerators Entidhar Abdo Mohammed Farhan 4 Wafa Abdullah Saeed Zohor Mohammed Nagi Khaled Sarah Saeed Al Atri 5 Rawdhah Mohammed Al Ameer Bushra Mosa’ad Abdo Fare’ Badriah Abdulwali Noman Reserve Najat Ahmed Ahmed Raheem Latifah Qannaf Saleh Dr. Adel Abdulmahmood Al Absi Dr. Mohammed Ali Al Faqeeh Field supervisors Abdullah Mohammed Al Qaidhi Hadhrami Hadi Naser Al-Hadhrami Ahmed Mohammed Hameed Al Sabri Sadiq Abdo Mohsen Ali Data entry Ibraheem Ali Mohammed Al Samit Nabeel Abdo Ghanim al Shami Name Title
93 Nagib Abdulbaqi Ali Survey Design and Sampling (UNICEF) Aref Mohammed Awfan Survey Logistic Manager Dr. Fahd Abdulziz Al Nadhari Survey Manager Prof. Muhammed Abdul Kareem Al-Mansoob Data Analysis and Report Writing (UNICEF)
94 Annex 3: Calendar of events الحدث تاريخ الحدث Event Event Date رأس السنة الهجرية 1 محرم من كل عام Beginning of Hijrij Year 1 Muharram يوم عاشوراء 10محرم من كل عام A’ashora Day 10 Muharram المولد النبوي 12 ربيع أول من كل عام Anniversary of the birth of the 12 RabieAwal Prophet (PUH) ذكرى اإلسراء والمعراج 27 رجب من كل عام Anniversary of Isra and Me’raj 27 Rajab الشعبانية )النصف من 15 شعبان من كل عام Ashabania Day 15 Shaban شعبان( عيد الفطر 1 شوال من كل عام Eid Al-Fitr 1 Shawal عيد األضحى 10 ذي الحجة من كل عام Eid Al-Adha 10 Dhul-Hijjah رأس السنة الميالدية 1 يناير Beginning of Gregorian Year 1 January ذكرى ثورة الشباب 11 فبراير Youth Revolution anniversary 11 Feb ذكرى جمعة الكرامة 18 مارس Dignity Friday anniversary 18 March عيد األم 21 مارس The Mother Day 21 March عيد المعلم 20 ابريل Teacher Day 20 April عيد العمال 1 مايو Labour Day 1 May ذكرى عيد الوحدة 22 مايو Unity anniversary 22 May ذكرى محرقة تعز 30 مايو Taiz holocaust anniversary 30 May
95 Annex 4: Age determination job aid
96 Annex 5: Taiz May 2016 Survey Plausibility Check
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98 Annex 6: Clusters for Taiz May 2016 Survey
I- Taiz City
Cluster Zone Ozla District 1 Al-Msla Al-Mothfr 2 Al-Mharouqat Al-Mothfr 3 Al-dhrbh Al-Mothfr 4 Wady Al-Qadhy Al-Mothfr 5 Bazrah Al-Mothfr 6 Byr Basha Al-Mothfr 7 Synh Al-Mothfr 8 Al-Nsyryh Al-Mothfr 9 Haarh Al-Masl Al-Mothfr 10 Al-Shnyni Al-Mothfr 11 Al-Souany Al-Grbyh Al-Mothfr 12 Al-Thahryh Al-Mothfr 13 Al-Rodhh Al-Shmalyh Al-Qahrh 14 Al-Msbha Al-Aaly Al-Shmaly Al-Qahrh 15 Al-Slkhanh Al-Grbyh Al-Qahrh 16 Njd Allah Akbr Al-Qahrh 17 Aosyfrh Al-Shrqyh Al-Qahrh 18 Aosyfrh Al-wsta Al-Qahrh 19 Roudhh Al-Kouthr Al-Qahrh 20 Al-dhbouah Al-Qahrh 21 Al-Tehryr Al-Asfel Al-Qahrh 22 Al-Mostshfa Al-Jmhoury Al-Qahrh 23 Al-Mojlyh Al-Qahrh 24 Al-Najdyn Salh 25 Hart Souq Al-Jomleh Salh 26 Hart Habyl Al-Thaby Salh 27 Hart Al-Radhowan Salh 28 Hart Bank Al-Tasleef Salh 29 Al-Humyra Salh 30 Hart Al-Qbh Salh Reserve Clusters 1 Al-Roudhh Al-Grbyh Al-Qahrh 2 Alajynat Al-Mothfr 3 Al-Mydan Al-Mothfr 4 Aloual Salh
99 II- Taiz Highland
Cluster Site (village or zone) Ozla District 1 Maouyh Aoujouh Alhankh 2 Maouyh Alqmahdh Qmahdh Al-Alya 3 Shrab Al-Slam Alahajour Alouashh 4 Shrab Al-Slam Ayfoua Asfl Alrysy 5 Shrab Al-Rounh Alzrary Alqhaaf 6 Shrab Al-Rounh Alraynh Alshtyn 7 Shrab Al-Rounh Alahatoub Almoudqh 8 Alshmaytyn Thbhaan Thlqyan 9 Alshmaytyn Alzaaza Alsfounh 10 Alshmaytyn Alrjaayh Dqm Al-Grab ds Bny SaydــAlmouast Q 11 12 Almouast Bny Yousf Qsha 13 Sama Sama Haourh 14 Alslou Alharybh Kzazh 15 Mshrah Ouhadnan Mshrah Alsnahaf 16 Sbralmouadm Alnjadh Alshqb 17 Almsrakh Msfr Almmshaha 18 Khdyr Khdyr Al-Slma Alahjour 19 Khdyr Alshouyfh Marh 20 Jbl Habshy Alhaql Alaraar h AladfـــJbl Habshy Albryh 21 22 Altazyh Alshabanyh Al- Alhaqala Sfla 23 Altazyh Aljndyh Al-Alya Alamaqy 24 Altazyh Alhaymh Al-Alya Shqb 25 Almaafr Aljbzyh Alanyh h Thy HbylــAlmaafr Alshaoub 26 27 Almaafr Almshaoulh Alanbouh 28 Mqbnh Bny Slaha Alkhrabh 29 Mqbnh Alashmlh Bny Aly 30 Mqbnh Alakhloud Haouysyh Reserve clusters 1 Altazyh Aljndyh Al-Sfla Alarbh 2 Alshmaytyn Dba Al-Dakhl Alslyha 3 Almsrakh Jarh Jarh 4 Maouyh Akhrq Alsakn
100 III- Taiz Lowland
Cluster Site (village or zone) Ozla District 1 Al-Amoudy Al-Mkha Al-Mkha 2 Al-Arouk Al-Mkha Al-Mkha 3 Al-Haly Al-Mkha Al-Mkha 4 Alghrafy Almshalhah Al-Mkha 5 Althoubany Almshalhah Al-Mkha 6 Alblyly Almshalhah Al-Mkha 7 Ykhtl Alzhari Al-Mkha 8 Alzhari Alzhari Al-Mkha 9 Noubh Amer Alzhari Al-Mkha 10 Alshathlyh Alzhari Al-Mkha 11 Almaamrh Aljomah Al-Mkha 12 Alshbarh Aljomah Al-Mkha 13 Jaashy Aljomah Al-Mkha 14 Hadhyh Aljomah Al-Mkha 15 Alkdhah Bny Al-Hakm Thoubab 16 Aldoush Bny Al-Hakm Thoubab 17 Alrouaa Bny Al-Hakm Thoubab 18 Mouzaa Mouzaa Mouzaa 19 Alhad Mouzaa Mouzaa 20 Alhajafyh Mouzaa Mouzaa 21 Almeqysa Al-Ahmoul Mouzaa 22 Alouhyz Al-Ahmoul Mouzaa 23 Alarysh Al-Awashgeh Mouzaa 24 Alaqmeh Al-Awashgeh Mouzaa 25 Al-Souyda Al-Souyda Al-Wazayh 26 Altbybh Alhabybh Magbanh 27 Alarf Alhabybh Magbanh 28 Alsoufyh Alhabybh Magbanh 29 Alghrg Akhdoua Asfl Magbanh 30 Boumyh Brashh Magbanh Reserve clusters 1 Almnasyb Aljomah Al-Mkha 2 Alashyrh Almshalhah Al-Mkha 3 Alaoura Akhdoua Asfl Magbanh 4 Alhamly Al-Ahmoul Mouza
101 Annex 7: The data collection daily plan Day Team Stratum Cluster 01/05/2016 1 Taiz City 6 01/05/2016 2 Taiz City 9 01/05/2016 3 Taiz City 4 01/05/2016 4 Taiz City 20 01/05/2016 5 Taiz City 16 03/05/2016 1 Taiz City 22 03/05/2016 2 Taiz City 8 03/05/2016 3 Taiz City 2 03/05/2016 4 Taiz City 17 03/05/2016 5 Taiz City 5 04/05/2016 1 Taiz City 26 04/05/2016 2 Taiz City 23 04/05/2016 3 Taiz City 18 04/05/2016 4 Taiz City 14 04/05/2016 5 Taiz City 12 05/05/2016 1 Taiz City 28 05/05/2016 2 Taiz City 10 05/05/2016 3 Taiz City 1 05/05/2016 4 Taiz City 27 05/05/2016 5 Taiz City 19 06/05/2016 1 Taiz City 3 06/05/2016 2 Taiz City 13 06/05/2016 3 Taiz City 15 06/05/2016 4 Taiz City 11 06/05/2016 5 Taiz City 7 07/05/2016 1 Taiz Highland 30 07/05/2016 2 Taiz Highland 15 07/05/2016 3 Taiz Highland 22 07/05/2016 4 Taiz Highland 6 07/05/2016 5 Taiz City 21 08/05/2016 2 Taiz Highland 16 08/05/2016 3 Taiz City 24 08/05/2016 4 Taiz Highland 28 08/05/2016 1 Taiz Lowland 30 09/05/2016 2 Taiz Highland 17 10/05/2016 2 Taiz Highland 20 10/05/2016 4 Taiz Highland 4 11/05/2016 2 Taiz Highland 21 11/05/2016 3 Taiz Highland 1 11/05/2016 4 Taiz Highland 3 12/05/2016 2 Taiz Highland 25 12/05/2016 3 Taiz Highland 2 12/05/2016 4 Taiz Highland 7 13/05/2016 2 Taiz Highland 27 13/05/2016 4 Taiz Highland 5 08/05/2016 5 Taiz Lowland 24 14/05/2016 2 Taiz Highland 26 09/05/2016 1 Taiz Lowland 10 14/05/2016 3 Taiz Highland 14 09/05/2016 4 Taiz Lowland 26
102 Day Team Stratum Cluster 14/05/2016 4 Taiz Highland 29 09/05/2016 5 Taiz Lowland 16 15/05/2016 2 Taiz Highland 12 10/05/2016 1 Taiz Lowland 8 15/05/2016 3 Taiz Highland 19 10/05/2016 5 Taiz Lowland 17 11/05/2016 1 Taiz Lowland 14 11/05/2016 5 Taiz Lowland 1 12/05/2016 1 Taiz Lowland 7 12/05/2016 5 Taiz Lowland 2 13/05/2016 1 Taiz Lowland 23 13/05/2016 5 Taiz Lowland 18 14/05/2016 1 Taiz Lowland 12 14/05/2016 5 Taiz Lowland 15 15/05/2016 1 Taiz Lowland 9 15/05/2016 4 Taiz Lowland 29 15/05/2016 5 Taiz Lowland 6 16/05/2016 1 Taiz Lowland 21 10/05/2016 3 Taiz City 25 13/05/2016 3 Taiz City 29 09/05/2016 3 Taiz City 30 16/05/2016 2 Taiz Highland 11 16/05/2016 3 Taiz Highland 18 17/05/2016 2 Taiz Highland 10 17/05/2016 3 Taiz Highland 13 18/05/2016 2 Taiz Highland 9 18/05/2016 3 Taiz Highland 24 19/05/2016 2 Taiz Highland 8 19/05/2016 3 Taiz Highland 23 16/05/2016 4 Taiz Lowland 20 16/05/2016 5 Taiz Lowland 3 17/05/2016 1 Taiz Lowland 22 17/05/2016 4 Taiz Lowland 27 17/05/2016 5 Taiz Lowland 4 18/05/2016 1 Taiz Lowland 11 18/05/2016 4 Taiz Lowland 28 18/05/2016 5 Taiz Lowland 5 19/05/2016 4 Taiz Lowland 25 19/05/2016 5 Taiz Lowland 19 19/05/2016 1 Taiz Lowland 13
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Ministry of Public Health and Population Primary Health Care Sector Family Health General Directorate Nutrition Department
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