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North East Nigeria – Emergency Survey

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North East Nigeria – Emergency Survey NIGERIA FINAL REPORT Nutrition in Emergency NUTRITION AND FOOD SECURITY SURVEILLANCE : NORTH EAST NIGERIA – EMERGENCY SURVEY NOVEMBER, 2016 0 Executive Summary The Boko Haram conflict was declared to be a state of emergency at the beginning of 2012 by the government of Nigeria. In May 2013, the area under the state of emergency was extended to include all of Adamawa, Borno and Yobe states in Northeastern Nigeria. The insurgency and political violence has caused mass population displacement. According to the International Organization of Migration’s (IOM) October 2016 report, there were 1,392,927, 170,070 and 124,706 internally displaced persons (IDPs) in Borno, Adamawa and Yobe states respectively. Conflict and resulting mass displacement often results in increased prevalence of acute malnutrition and mortality. The most recent state level estimates of global acute malnutrition are from the National Nutrition and Health Survey (July to September 2015) which found 10.9% (8.6, 13.7 95% CI) in Yobe, 11.5% (8.8, 14.9 95% CI) in Borno, and 7.1% (5.0, 10.1 95% CI) in Adamawa. These state level estimates excluded areas of Borno that were inaccessible due to security. Additionally, more recent data, collected since the declaration of the nutrition emergency in April 2016, suggest an increase in prevalence of acute malnutrition in some areas of N.E. Nigeria. Small scale SMART surveys conducted in the local government areas (LGAs) of Jere,Kaga,Konduga, and Monguno town between April and August 2016 documented prevalence of global acute malnutrition (GAM) ranging from 13.0-27.3%. Additionally, screening data collected by NGOs and United Nations Children's Fund (UNICEF)- supported teams in Yobe and Borno states included assessments of IDPs with the proportion of children with global acute malnutrition [as identified by mid-upper arm circumference (MUAC) and/or oedema] reported to be over 80%. These initial assessments provide an indication of increasing levels of acute malnutrition. However, there remained many areas of the emergency states with no information to inform the ongoing response. Given the severe situation suggested by the small-scale surveys and screening data, as well as increased access to newly liberated areas since the emergency declaration, surveys were organized with the primary objective of providing representative estimates for prevalence of acute malnutrition among children (by weight-for-height and MUAC), as well as mortality rate in N. E. Nigeria to inform the ongoing emergency response. Information on nutritional status of women, prevalence of common child health morbidities, access to health services and health status among children, infant feeding, and household water and sanitation were also collected as part of the surveys. These surveys were carried out by the National Bureau of Statistics (NBS) in coordination with the National Population Commission (NPC), the Federal Ministry of Health (FMOH), and the Nigeria Nutrition in Emergency Working Group (NiEWG). Financial support was provided by the Government of Nigeria, United Nations Children’s Fund (UNICEF), and the United Nations Central Emergency Response Fund (CERF). Technical support was provided by the Centers for Disease Control and Prevention (CDC) and UNICEF through NBS. Methods We conducted cross-sectional household surveys using a two-stage cluster sampling design consistent with the SMART methodology. The survey area consisted of 65 LGAs within the three states of Adamawa, Borno and Yobe. The 65 LGAs were divided into 10 domains: 2 in Adamawa (North and South), 3 in Yobe (North, Central and South) and 5 in Borno state (North, South, Central, East, and MMC/Jere). Domains were created considering livelihood zones, geographic proximity and socio-cultural homogeneity.[1] Results are representative at the level of the II domain, groupings of LGAs. Clusters were selected using probability proportional to size (PPS) sampling. The primary sampling unit (PSU) for Yobe and Adamawa domains were based on Enumeration Areas (EAs) from the 2006 census frame. Estimated populations for each EA are 2016 populations projected from the 2006 census. Given recent large scale population movement in Borno, an updated sampling frame was built using boundaries and population estimates from the September- October 2016 polio campaign microplan and September 13 IOM Displacement Tracking Matrix (DTM) report .[2] Sample size was calculated to ensure adequate precision for estimates of global acute malnutrition (GAM) and crude mortality rate (CMR). A sample of 600 households, 30 clusters of 20 households, was selected per domain. Within selected clusters, all households were listed and selected using systematic random sampling. Enumerators received a five day training including a full standardization and field test. Results Data collection took place between October 17 and November 11, 2016. Two of the domains in Borno (North and East) were determined by state level actors to be inaccessible at the time of this survey. Within the eight domains, 13 of the originally selected clusters were either inaccessible or vacant at the time of data collection including: 2 in North Adamawa, 1 in South Adamawa, 3 in Central Borno, 2 in MMC/Jere, 2 in Central Yobe, 2 in Southern Yobe, and 1 in Northern Yobe. Inaccessible clusters in Central Borno were replaced with all reserve clusters selected a priori as per SMART guidelines. Prevalence of GAM was 11.4% in Yobe, 11.3% in Borno, and 5.6% in Adamawa. Prevalence of GAM exceeded the WHO Crisis Classification threshold for “serious” (10%) in 5 domains: Central Borno, MMC/Jere, Northern Yobe, Central Yobe, and Southern Yobe. Prevalence of GAM was highest in Northern Yobe both as assessed by weight-for-height and/or odema (14.3%), and as assessed by MUAC (10.5%). Both crude and under-five mortality rates were highest in Central Yobe, 0.63 (0.39-1.01 95% CI) and 2.06 (1.24-3.38 95% CI), respectively. The under-five mortality rate in Central Yobe exceeds the emergency threshold of 2 deaths in children under five / 10,000 children under five / day. By domain, crude mortality rate ranged from 0.26-0.63 total deaths / 10,000 people / day. Under five mortality rate ranged from 0.68 to 2.06 deaths in children under five / 10,000 children under five / day. The crude mortality rate (CMR) did not exceed the emergency threshold of 1 death/10,000 persons / day in any of the domains. Overall, data quality for the survey data was high. With respect to anthropometry data, all domains had less than 3.0% of values excluded as outliers (SMART flags). Standard deviation for Weight-for-Height Z-scores for all surveys fell within an acceptable range (0.8-1.2). Data quality was “excellent” in 4 domains (North Adamawa, Central Borno, MMC/Jere, and Central Yobe) and “acceptable” in the remaining 4 domains (South Adamawa, South Borno, South Yobe, North Yobe) according to SMART classifications. III Figure 0.1: Prevalence of global acute malnutrition based on weight-for-height z-scores (and/or oedema), children 0-59 months in NE Nigeria IV Table 0.1: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema), children 0-59 months in NE Nigeria Southern Northern Southern Central MMC/ Jere Northern Central Yobe Southern Adamawa Adamawa Borno Borno Yobe Yobe n = 547 n = 530 n = 527 n = 499 n = 446 n = 547 n = 564 n = 572 Prevalence of global (32) 5.9 % (28) 5.3 % (47) 8.9 % (58) 11.6 % (58) 13.0 % (78) 14.3 % (58) 10.3 % (61) 10.7 % malnutrition (<-2 z- (3.8 - 9.0 (3.1 - 8.8 (6.7 - 11.7 (8.8 - 15.2 (10.2 - 16.4 (10.6 - 18.9 (7.3 - 14.2 (8.3 - 13.6 score and/or oedema) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) Prevalence of (30) 5.5 % (23) 4.3 % (41) 7.8 % (55) 11.0 % (52) 11.7 % (69) 12.6 % (46) 8.2 % (52) 9.1 % moderate malnutrition (3.5 - 8.4 (2.6 - 7.3 (5.6 - 10.7 (8.3 - 14.6 (8.8 - 15.3 (9.4 - 16.8 (5.6 - 11.7 (7.3 - 11.3 (<-2 z-score and >=-3 z- 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) score, no oedema) Prevalence of severe (2) 0.4 % (5) 0.9 % (6) 1.1 % (3) 0.6 % (6) 1.3 % (9) 1.6 % (12) 2.1 % (9) 1.6 % malnutrition (<-3 z- (0.1 - 1.5 (0.3 - 2.6 (0.5 - 2.8 (0.2 - 1.8 (0.6 - 2.9 (0.7 - 3.9 (1.1 - 4.2 (0.8 - 3.0 score and/or oedema) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) V Figure 0.2: Prevalence of acute malnutrition based on MUAC cut off's (and/or oedema), children 6-59 months in NE Nigeria VI Table 0.2: Prevalence of acute malnutrition based on MUAC cut off's (and/or oedema), children 6-59 months in NE Nigeria Southern Northern Southern Central MMC/ Jere Northern Central Yobe Southern Adamawa Adamawa Borno Borno Yobe Yobe n = 491 n = 491 n = 482 n = 451 n = 430 n = 495 n = 511 n = 530 Prevalence of global (20) 4.1 % (14) 2.9 % (20) 4.1 % (34) 7.5 % (14) 3.3 % (52) 10.5 % (34) 6.7 % (39) 7.4 % malnutrition (<-2 z- (2.5 – 6.5 (1.5 - 5.2 (2.3 - 7.4 (4.5 - 12.3 (1.8 - 5.7 (7.1 - 15.3 (4.2 - 10.3 (5.4 - 10.0 score and/or oedema) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) Prevalence of (17) 3.5 % (11) 2.2 % (13) 2.7 % (26) 5.8 % (12) 2.8 % (40) 8.1 % (18) 3.5 % (33) 6.2 % moderate malnutrition (2.0 - 6.0 (1.2 - 4.2 (1.6 - 4.5 (3.3 - 9.9 (1.6 - 4.9 (5.5 - 11.7 (2.3 - 5.4 (4.5 - 8.6 (<-2 z-score and >=-3 z- 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) 95% C.I.) score, no oedema) Prevalence of severe (4) 0.6 % (3) 0.6 % (7) 1.5 % (8) 1.8 % (2) 0.5 % (12) 2.4 % (16) 3.1 % (6)
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