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South Sudan NUTRITIONAL ANTHROPOMETRIC SURVEY CHILDREN UNDER 5 YEARS OLD LANKIEN AND TUT PAYAMS, NYIROL COUNTY JONGLEI STATE 16TH AUGUST – 12TH SEPTEMBER 2007 Edward Kutondo- Survey Program Manager Imelda .V. Awino – Nutritionist Simon Tut Gony- Program Assisstant 2 ACKNOWLEDGMENTS ACF-USA acknowledges the support, commitment and cooperation of the following institutions and persons, who enabled the team to successfully actualize survey objectives: ª Office of United States Foreign Disaster Assistance (OFDA) for funding the survey; ª The Sudan Relief and Rehabilitation Commission (SSSRRC) Nyirol County for availing relevant data and ensuring smooth flow of activities; ª The entire survey team for their hard work, team spirit, commitment and endurance despite the difficult terrain; ª South Sudan Ministry of Health in Jonglei State, MSF-OCA, Sudan Red Crescent, Cush Community Relief International for availing staff for capacity building; ª Parents, caretakers and the local authority for their cooperation. 3 TABLE OF CONTENTS .I. EXECUTIVE SUMMARY................................................................................................................................4 .II. INTRODUCTION .........................................................................................................................................10 .III. OBJECTIVES .............................................................................................................................................11 .IV. METHODOLOGY.......................................................................................................................................11 .IV.1. Type of Survey and Sample Size .......................................................................................................11 .IV.2. Sampling Methodology .......................................................................................................................11 .IV.3. Data Collection....................................................................................................................................12 .IV.4. Indicators, Guidelines, and Formula’s Used.......................................................................................13 .IV.4.1. Acute Malnutrition........................................................................................................................13 .IV.4.2. Mortality .......................................................................................................................................13 .IV.5. Field Work...........................................................................................................................................14 .IV.6. Data Analysis ......................................................................................................................................15 .V. RESULTS OF THE QUALITATIVE ASSESSMENT ..................................................................................15 .V.1. Socio- demographic Characteristics of the Respondents....................................................................15 .V.2. Food Security.......................................................................................................................................17 .V.3. Health...................................................................................................................................................20 .V.4. Water and Sanitation ...........................................................................................................................22 .V.5. Maternal and Child care practices .......................................................................................................24 .V.6. Education .............................................................................................................................................24 .V.7. Actions Taken by NGO’s and other partners.......................................................................................25 .VI. RESULTS OF THE ANTHROPOMETRIC SURVEY.................................................................................26 .VI.1. Distribution by Age and Sex................................................................................................................26 .VI.2. Anthropometrics Analysis ...................................................................................................................27 .VI.2.1. Acute Malnutrition, Children 0-59 months of Age........................................................................27 .VI.2.2. Risk of Mortality: Children’s MUAC .............................................................................................28 .VI.3. Measles Vaccination Coverage ..........................................................................................................29 .VI.4. Household Status................................................................................................................................29 .VI.5. Composition of the Households..........................................................................................................29 .VII. RESULTS OF THE RETROSPECTIVE MORTALITY SURVEY..............................................................29 .VII.1. Mortality Rate.....................................................................................................................................29 .VIII. CONCLUSION .........................................................................................................................................30 .IX. RECOMMENDATIONS..............................................................................................................................31 .X. APPENDIX ..................................................................................................................................................32 .X.1. Sample Size and Cluster Determination..............................................................................................32 .X.2. Anthropometric Survey Questionnaire.................................................................................................33 .X.3. Household enumeration data collection form for a death rate calculation survey (one sheet/household)..........................................................................................................................................34 .X.4. Enumeration data collection form for a death rate calculation survey (one sheet/cluster)..................35 .X.5. Calendar of events in Lankien and Tut payams, Nyirol County, Jonglei State....................................36 .X.6. Food market prices- Lankien and Tut payams, Nyirol County.............................................................37 .X.7. The map of Lankien and Tut payams, Nyirol County ..........................................................................38 4 .I. EXECUTIVE SUMMARY Introduction Nyirol County in Northern Jonglei State borders Akobo County to the South East, Wuror County to the South, Ayod County to the West and Khorfulus- Atar County to the North West. It is composed of 8 payams namely Lankien, Tut, Pultruk, Waat, Nyanbor, Chuil, Pading and Keeth. The county’s population is estimated at 108,9541. The main denizens of the Nyirol County are the Lou Nuer of the Goatbal clan sub divided into two main sub clans namely the Cienglang and Ciengnyarkuach2. Their main source of livelihood is agro-pastoralism, though crop farming, employment and petty trade are gaining prominence. Lankien and Tut payams, locally referred to as ”Thol payams” are characterized by a low lying flat terrain. The area, classified under Eastern flood plain zone, is covered by clay soil with portions of sandy soil. This topography predisposes the area to flooding during the rain season. The vegetative cover comprises of thorny trees such as Acacia senegali and Desert dates species. The seasonal streams like Thol cut across the payams during the rain season. There are no permanent rivers in the area. According to FEWSNET April 2007, the hunger gap season was likely to be severe in some livelihood zones such as the northern parts of the Western Flood Plains and the Eastern Flood Plains (Nyirol, amongst other counties in Jonglei State) where structural food deficits are normally acute. Food security in Nyirol County is further weighed down by the poor harvest caused by floods and civil insecurity due to disarmament in the year 2006. Flooding was reported in most parts of Upper Nile and Jonglei states between June and July 2007. Such was the case in Nyirol County where the local authority reported flooding and displacement of 9,4533 persons within the county. This was reported to have worsened in July 2007 when people were displaced, farms destroyed and market access cut prompting the local authority to seek for help from the government, national and international agencies4. ACF-USA undertook a nutritional survey in Nyirol County in Lankien and Pultruk payams in July 2002. Above emergency GAM and SAM rates of 28.4% [24.3% - 33.0%] and 4.3% [2.7% - 6.8%] respectively (expressed in z-scores, NCHS reference, with 95% of confidence interval) were unveiled. No nutritional survey was since implemented. In view of potential food insecurity, negative effects of floods and civil insecurity impact on livelihoods, ACF- USA deemed it necessary to undertake a nutrition survey in Nyirol County. Objectives To evaluate the nutritional status of children aged 6 to 59 months; To estimate the measles
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