Republic of Yemen Ministry of Public Health and Population Central Statistical Organization

Report on the Nutritional Situation and Mortality Survey

Al Jawf Governorate, Yemen

From 19 to 25 April 2018

1 Acknowledgment The Ministry of Public Health and Population in Yemen, represented by the Public Health and Population Office in the Al Jawf governorate and in cooperation with the UNICEF country office in Yemen and the UNICEF branch in Sana’a, acknowledges the contribution of different stakeholders in this survey.

The UNICEF country office in Yemen provided technical support, using the SMART methodology, while the survey manager and his assistants from the Ministry of Public Health and Population and the Public Health and Population Offices in Amran and Taiz were also relied on. The surveyors and team heads were provided by the Public Health and Population Office in the Al Jawf governorate. The data entry team was provided by the Public Health and Population Office in Amran and the Nutrition Department in the Ministry.

The survey protocol was prepared, and other changes were made to it, through cooperation between the Ministry of Public Health and Population and the Central Statistical Organization, with technical support from UNICEF. The Organization for Economic Cooperation and Development provided UNICEF with technical assistance, especially with regards to daily quality checks, data analysis, and report writing.

The Building Foundation for Development provided technical and logistical support through extensive coordination with the local authorities in the Al Jawf governorate, as well as through their choice of the survey team and providing extensive training for them. The Building Foundation for Development was also responsible for regular follow-up with the survey teams out in the field and providing logistical and technical support for these teams, as well as preparing the initial draft of the survey report.

The Public Health and Population Office in the Al Jawf governorate was informed of the organizational and logistical arrangements for the survey in order to ensure that the process went along smoothly. UNICEF provided financial support to the nutrition survey within the scope of a grant from the United Nations Central Emergency Response Fund (UNICEF YCO), and this support is greatly appreciated. The contributions of the local authorities in ensuring the security of the survey teams during their field working, and in facilitating their work, is also appreciated.

It would not have been possible to get this data without the cooperation and support of the communities that were assessed, especially the mothers and caregivers who responded to the interviews. Their participation and cooperation is greatly appreciated. The Ministry of Public Health and Population, the Central Statistical Organization, the Building Foundation for Development, and UNICEF express their thanks and appreciation to the survey team for their high level of commitment and effort during all of the stages of the assessment to ensure the high quality of the data that was collected and that this process is successful.

2 Table of Contents Acknowledgment ...... 2 Table of Contents ...... 3 Index of Tables ...... 5 List of English Abbreviations and Their Definitions ...... 7 Introduction ...... 9 Survey Objectives ...... 11 Methodology ...... 12 Sample Size and Sampling Design ...... 12 Sample Frame Description ...... 13 Survey Community and Data Collection Procedures...... 14 Monitoring Measurements and Quality Control ...... 15 Data Entry and Analysis ...... 15 Results and Discussion ...... 19 Household Characteristics ...... 20 Household Income Characteristics ...... 21 Water, Sanitation, and Hygiene ...... 22 Household Food Security ...... 24 Average Coping Strategies ...... 24 Child Nutrition ...... 25 Severe Malnutrition – Wasting – WHZ Indicator ...... 25 Severe Malnutrition by Mid-Upper Arm Circumference (MUAC) ...... 27 Acute Malnutrition (Wasting) Using a Mix of the WHZ and MUAC Indicators: ...... 28 Malnutrition (Underweight) ...... 30 Chronic Malnutrition (Stunting) – HAZ Indicator ...... 32 Standard Deviations of the Mean, the Effect of the Design, and Abnormal Values (Extremes) ...... 33 Infant and Young Children Feeding (IYCF) ...... 34 Child Morbidity ...... 34 Vitamin A Supplements and Child Vaccination ...... 35 Nutrition of Women of Reproductive Age (15 to 49 years old) ...... 36 Mortality Rate ...... 36 Nutritional Status Factors ...... 38 Child Nutrition and Its Relationship to Mother Nutrition ...... 42 Recommendations ...... 44 References ...... 46 Annexes ...... 47

3 Annex 1: Malnutrition Survey Questionnaire – Al Jawf Governorate – April 2018 ...... 47 Annex 2: Malnutrition Survey Team – Al Jawf Governorate – April 2018 ...... 66 Annex 3: Timetable – Al Jawf Governorate – April 2018 ...... 68 Annex 4: Table to determine the ages of children using the Gregorian and Hijri calendars – Al Jawf Governorate – April 2018 ...... 76 Annex 5: Credibility Check for the Al Jawf Survey – April 2018 ...... 79 Annex 6: Report on the child measurement sessions to evaluate the team during the Al Jawf Survey – April 2018 ...... 80 Annex 7: The clusters chosen for the nutrition and mortality survey – Al Jawf Governorate – April 2018 ...... 81 Sample Selection Decision Tree – Al Jawf Survey – April 2018 ...... 83

4 List of Tables

Table 1 - List of English Abbreviations and Their Definitions ...... 7 Table 2 - Sample of Children and Households in the Single Survey Group ...... 12 Table 3 - Sample of Population Required to be Included in the Single Survey Group ...... 13 Table 4 - Households, Children, and Women in the Single Survey Group ...... 19 Table 5 - Basic Data on Household Heads and the Marital Status and Education of the Household Caretakers ...... 20 Table 6 - The Effect of the Crisis on Household Income ...... 21 Table 7 - Average Monthly Spending of Households in YER Classified by Coping Strategies ...... 22 Table 8 - Water and Environmental Sanitation ...... 23 Table 9 - Categorizing Food Consumption ...... 24 Table 10 - Averages for Coping Strategies ...... 24 Table 11 - Prevalence of Acute Malnutrition Based on Weight for Height (and/or Oedema) Among Children from 6 to 59 months old (by gender) in the Al Jawf Governorate ...... 26 Table 12 - Prevalence of Acute Malnutrition by Age Group, Based on the Weight for Height Indicator (and/or Oedema) Among Children between 6 and 59 Months Old (by age group) in the Al Jawf Governorate ...... 26 Table 13 - Prevalence of Acute Malnutrition Based on MUAC Measurement (and/or Oedema) Among Children between 6 and 59 Months Old (by gender) in the Al Jawf Governorate ...... 27 Table 14 - Prevalence of Acute Malnutrition by Age Group Based on MUAC Measurement and/or Oedema Among Children between 6 and 59 Months Old (by age group) in the Al Jawf Governorate...... 28 Table 15 - Prevalence of Mixed Acute Malnutrition Based on WHZ and MUAC measurements (and/or Oedema) Among Children between 6 and 59 Months Old (by gender) in the Al Jawf Governorate ...... 28 Table 16 - Prevalence of Mixed Acute Malnutrition Based on WHZ and MUAC measurements (and/or Oedema) Among Children between 6 and 59 Months Old (by age group) in the Al Jawf Governorate .... 29 Table 17 – Prevalence of Underweight Based on Standard Deviation for Weight to Age and By Gender Among Children from 0 to 59 Months Old in the Al Jawf Governorate ...... 30 Table 18 - Prevalence of Underweight by Age Based on Standard Deviation for Weight to Age Among Children from 0 to 59 Months Old in the Al Jawf Governorate ...... 31 Table 19 – Prevalence of Stunting Based on Standard Deviation of Height for Age by Gender Among Children Between 6 and 59 Months Old in the Al Jawf Governorate ...... 32 Table 20 – Prevalence of Stunting by Age Based on Standard Deviation for the Height for Age Indicator Among Children from 6 to 59 Months Old in the Al Jawf Governorate ...... 33 Table 21 – Standard Deviations from the Mean, Design Effects, and [???] ...... 33

5 Table 22 – Infant and Young Child Feeding Indicators ...... 34 Table 23 – Morbidity of Children Under Five Years of Age Within the Two Weeks Before the Day of the Survey ...... 35 Table 24 – Vitamin A Supplements and Child Vaccination ...... 35 Table 25 – Acute Malnutrition Among Women in Reproductive Age ...... 36 Table 26 – Mortality Rates in the Al Jawf Governorate During the 144 Days Before the Survey ...... 36 Table 27 – Demographic Information Mentioned Regarding the 144-day Recall Period ...... 38 Table 28 – Factors of Acute Malnutrition (Weight for Height) ...... 38 Table 29 – Factors of Acute Malnutrition (MUAC) ...... 39 Table 30 - Factors of Acute Malnutrition (Weight for Height and MUAC) ...... 40 Table 31 - Underweight Factors...... 40

6 List of English Abbreviations and Their Definitions

Table 1 - List of English Abbreviations and Their Definitions Abbreviation Meaning BF Breastfeeding CDR Crude Death Rate CI Confidence Interval CSI Coping Strategy Index CSO Central Statistics Office DEFF Design Effect DF Degree of Freedom DHS International Health & Demographic Survey EFSNA Emergency Food Security and Nutrition Assessment ENA for Emergency Nutrition Assessment for Standardized SMART Monitoring & Assessment of Relief & Transitions FCS Food Consumption Score GAM Global Acute Malnutrition GHO General Health Office HAZ Height for Age Z-Score HDDS Household Dietary Diversity Score HH Household IYCF Infant and Young Children Feeding MAD Minimum Acceptable Diet MAM Moderate Acute Malnutrition MDD Minimum Dietary Diversity MMF Minimum Meal Frequency MoPHP Ministry of Public Health and Population MUAC Mid-Upper Arm Circumference SAM Severe Acute Malnutrition SD Standard Deviation U5MR Under Five Mortality Rate

7 UNICEF United Nations Children's Emergency Fund WASH Water, Sanitation and Hygiene WAZ Weight for Age Z-Score WFP World Food Programme WHZ Weight for Height Z-Score

8 Introduction

General Information: The Al Jawf governorate is located to the northeast of the capital, Sana’a, and it is 143 km away from it. The governorate has an area of 39,495 km2. It has 12 districts and 601 villages, and Hazm is the capital of the governorate.

The population of the governorate, according to the results of the Population and Housing Census in 2004, is 443,797 people. The population grows at an annual rate of 2.44%, with the population reaching 589,000 in 2017 based on population projections from the 2004 census.

The population of the governorate make up 2.3% of the total population of Yemen. The governorate is bordered by Sa’dah to the north, the Empty Quarter Desert to the east, parts of Mareb and Sana’a to the south, and the governorates of Jawf and Sa’dah to the west. Al Jawf is the current day area of the Minaean Kingdom (Central Statistical Organization 2004).

The number of villages in the governorate has not changed over time, but some of the residential gatherings inside the villages (mahallas) have increased. Villages are divided into residential gatherings that are called mahallas, and there are 2,080 mahallas in the governorate (Central Statistical Organization).

No SMART survey has been carried out in the governorate of Al Jawf before. According to the results of the Family Health Survey in 2013, the prevalence of global acute malnutrition is 12.1% (4.6% severe acute malnutrition). The results of the Comprehensive Food Security and Nutrition Survey in 2014 showed that the prevalence of global acute malnutrition was 13.2%, with a confidence range of 10.2 – 16. The indicators from the Emergency Food Security and Nutrition Assessment in November 2016 showed that global acute malnutrition was 11.2% with a confidence range of 8.1 – 15.4. This assessment was implemented in only 4 districts, and it is a prevalence rate that is less than the results of the previous survey.

Terrain:

9 The terrain in the Al Jawf governorate is divided into the mountainous highlands, plateaus, and expansive plains that include arable land and large valleys, as well as deserts and semi-deserts. The terrain of the Al Jawf governorate is mostly made up of plains that merge into the desert of the Empty Quarter.

Climate: The climate is moderate in the summer and cold in the winter in the interior parts and highlands, and the desert parts of the governorate are hot in the summer and moderate during winter days and cold in the evening.

Agriculture and animal husbandry are the main activities for the people of the governorate, and the governorate could become an agricultural region. The crops from the governorate make up 28% of the total agricultural production of the country. Among the most important crops that are grown are grains, vegetables, fruits, and feed, and the governorate has a desert climate. There are a diverse number of tourist landmarks in the governorate, and among the most important ones are the archeological cities like Qarnaw, Al Kharbah Al Baydha, Al Kharbah Al Sawda’a, and Baraqish.

10 Survey Objectives

Goal: Assessing the current nutritional situation, total mortality, and mortality of children under 5 years old in the governorate of Al Jawf and looking for the relationship between the nutritional situation with some health indicators and some health and nutritional practices.

Objectives: • Estimating the prevalence rate of acute malnutrition (wasting), using the weight for height indicator, among children between 6 and 59 months of age in the Al Jawf governorate • Estimating the prevalence rate of acute malnutrition (wasting), using the mid-upper arm circumference (MUAC) indicator, among children between 6 and 59 months of age in the Al Jawf governorate • Determining the prevalence rate of acute malnutrition (wasting) (through the weight for height indicator and the mid-upper arm circumference (MUAC) indicator) among children between 6 and 59 months of age in the Al Jawf governorate • Estimating the prevalence rate of chronic malnutrition (stunting) among children between 6 and 59 months of age in the Al Jawf governorate • Estimating the prevalence rate of underweight children between 0 and 59 months of age in the Al Jawf governorate. • Estimating the prevalence rate of exclusive breastfeeding between children from 0 to 6 months old, continuing breastfeeding until the age of 1 year and 2 years, and the practice of sound supplementary feeding among children from 6 to 23 months of age in the Al Jawf governorate • Estimating the Prevalence of diarrhea, acute respiratory infections, and fever among children in the Al Jawf governorate • Estimating the coverage of vaccines for the third dose of the polio vaccine and the third dose of the pentavalent vaccine among children from 6 to 59 months of age, the coverage of vaccines for measles among children from 9 to 59 months of age, the coverage of supplementary Vitamin A during the 6 months before the survey among children from 6 to 59 months old in the Al Jawf governorate. • Estimating the prevalence rate of severe acute malnutrition (wasting) among women of reproductive age (between 15 and 49 years old) in the Al Jawf governorate. • Estimating the rate of food consumption in the 7 days before the survey in the Al Jawf governorate. • Estimating the coping strategies index of the households in the Al Jawf governorate. • Assessing the households’ use of a number of intensive coping strategies, during the emergency crisis, in the Al Jawf governorate.

11 • Estimating the percentage of heads of households that have lost their means of incomes as a result of the crisis and the current conflict in Yemen. • Estimating the average monthly expenditures of households in the Al Jawf governorate. • Assessing the educational level of household caregivers in the Al Jawf governorate. • Assessing the main source of drinking water for households and assessing the quality of the water source and the cleanliness of water storage areas in the Al Jawf governorate. • Assessing the types of household latrines and classifying the quality of the sewage facilities used in the Al Jawf governorate. • Assessing the practices of household caregivers in washing hands with water and soap (or soap alternatives) after defecating and before eating in the Al Jawf governorate. • Estimating the total mortality rates and the mortality rate of children under five years old in the Al Jawf governorate since the anniversary of the Prophet’s Birthday in 2018.

Methodology

The Al Jawf governorate was assessed as a single group made up of 10 districts. The data was collected between April 19th and April 25th, 2018, after a week of training and logistic preparation. 544 households were visited during the survey, and there were no families who were absent or refused to respond. Two districts were removed from the sample, and they are the Khabb wa ash Sha'af District and the Al Ghayl district. These two districts were removed from the sample because of the ongoing conflict there.

Sample Size and Sampling Design

The following assumptions (based on a particular context) were used to calculate the size of the sample in number of children. After that, it was changed to number of households in the survey. All calculations were carried out by the ENA software for SMART (version released July 9th, 2015).

Table 2 - Sample of Children and Households in the Single Survey Group Determinants of Anthropometric Measurements Value Expected Prevalence of global acute malnutrition 16%

Required precision  4% Design effect 1.5 Children required for the survey 527 Average household size 7 Percentage of children under 5 years of age 18%

12 Percentage of refusing households (unresponsive) 3% Households required for the survey 479

Table 3 - Sample of Population Required to be Included in the Single Survey Group Mortality Determinants Value Expected mortality rate (10,000 per day) 0.22

Precision required (10,000 per day)  0.2 Design effect 1.5 Recall period (in days) 144 Population included in the survey 2,396 Average household size 7 Percentage of refusing households (unresponsive) 3% Households required for the survey 353

Looking at the calculations in the tables above, the size of the sample that was calculated for the anthropometric measurements for this survey was 479 households, which is larger than the number of households needed for mortality. This sample was taken into account for all of the anthropometric measurements, mortality, and other indicators.

Sample Frame Description

The most recent list of villages and blocks was used as the framework for the survey after the two districts of Khabb wa ash Sha'af and Al Ghayl were removed. It should be noted that displaced families were limited in the host communities before the clusters were chosen. A cluster in this survey is a village in the rural areas and a block in urban areas. In this survey, 36 clusters were chosen, in accordance with the ENA method, and the number of households in each cluster was 15. There were 6 field teams that implemented the survey in the governorate in a week, as follows: 1. The preparation and training was completed during the period from April 11th to 18th, 2018 2. The data was collected over a period of 7 days, from April 19th to 25th, 2018

Sample Collection Procedures (Second Stage) The households in the cluster were chosen using the decision tree that is mentioned in the manual, Sampling Methods and Sample Size Calculation for the SMART Methodology in June 2012 (Annex 8). The heads of the teams and community leaders listed the targeted households and choose from among them using simple random sampling for each cluster that was studied after they had been divided. (The recommended scope

13 is between 80 to 120 households for each of the villages, and this was the maximum number of households to be divided to ensure a representative sample for the targeted clusters) The survey operations room in Al Jawf would provide, on a daily basis, supplies and lists of the households and random numbers. At the end of the day, these forms would be handed over, along with the completed questionnaires and the daily cluster report, to the operations room. The random walk method for vaccination (EPI) was not used for this survey.

Survey Community and Data Collection Procedures

The survey community is made up of the following: 1) Anthropometric measurements: Children from 6 months to 59 months old 2) Mortality rate: All individuals who lived in the household (currently live in the household or have left or were born or died) during the period starting with the Prophet’s Birthday. 3) Natural breastfeeding: Children from 0 to 24 months 4) Morbidity: Children from 0 to 59 months

Estimating the age depends on details from the birth certificate or vaccination cards, and/or supported by the events list that includes events that happened in the governorate and well-known national events. (Annex 3: Events List and Annex 4: Helping Estimate Age)

Six field teams were trained, as were three data enterers (Annex 2: Nutrition Survey Team in the Al Jawf governorate, April 2018), for 7 days by the survey manager and the survey field supervisors. The training included anthropometric measurements, filling out the questionnaires, and the following field procedures after strict normative training (Annex 6: Standardization Test Report for the Nutrition Survey in the Al Jawf governorate, April 2018) and the field test before beginning the data-collection stage and among the six trained teams. The teams were chosen to complete the data-collection process over 7 days.

The households that were chosen were given a brief introduction to the survey and called to participate. A verbal agreement to participate was gotten from the participants after they got a general overview of the survey from the survey team. After they agreed, a single member of each family helped the survey team complete the questionnaire, which includes: 1) demographic characteristics, 2) gender of the head of household, 3) gender, education, and marital status of the members of the household, 4) information on household spending and income, 5) water and sanitation indicators, 6) food consumption of households and coping strategies, 7) social status, physiological status, and MUAC for women of reproductive age, 8) vaccinations and vitamin A supplements for children, 9) anthropometric measurements for children, 10) infant morbidity, 11) natural breastfeeding practices, and 12) mortality of children under the age of 5 years. (Annex 1: Questionnaire for the Nutrition Survey in the Al Jawf governorate, April 2018).

14 The mortality data was collected retroactively from all of the randomly selected households, regardless of whether there were children between 6 and 59 months of age. The recall period was from the date of the Prophet’s Birthday, or 144 days.

Monitoring Measurements and Quality Control

The survey teams got practical and focused training before the survey, and this training covered all of the fields relating to the field work, including testing the measurements of the surveyors. Controlling the quality of the data was done through the following: (1) Having the field work monitored by central and specialized supervisors (2) Conducting a review of the questionnaires that have been filled out with data, recording any comments on them, extracting the information, and discussing the results (3) Having the supervisors confirm cases of measles and acute malnutrition, especially cases of oedema and death (4) Entering the anthropometric data (body measurements) into the computer on a daily basis (5) Presenting the reasonableness check on a daily basis to determine the comprehensive quality and evaluate each team using 10 criteria for evaluation (statistical tests), in addition to ensuring that each team is given feedback on the type of data during the nightly meetings (6) Calibrating the scales and completing the daily review checklist before the teams go out into the field (7) Carrying out additional reviews and confirming the data to ensure that they are sound, reasonable, and consistent, and recording any comments in the field for review for the data enterers (8) Strengthening and building the capacity of team heads through participation and supervision of the method that the sample is taken by the central supervisors, and giving the surveyors feedback on information missing from the questionnaires after ensuring that they were completed correctly (9) Providing clear job descriptions with the tasks of the teams working out in the field during the training and before the data collection process starts in order to ensure that the teams carry out the functions that they are tasked with (10) Having the head of the field team carry out field reviews of the completed questionnaires and ensure that the data is complete, and the forms are signed before the team leaves the cluster, which will decrease the possibility of there being incomplete forms (missing variables) and the external data (cover), and the level of the reasonableness test was good at 11% (Annex 5: Report on the Credibility Check).

Data Entry and Analysis

The data on the household forms (Form 1) and deaths (Form 2) were entered into a Microsoft Excel sheet that was made specifically for this survey. This sheet includes all of the required helping formulas and also converts the dates from Hijri to Gregorian.

15 The data entry process was confirmed through a random selection of 10% of the questionnaires from the households, and the data that was entered was considered correct after they were checked and more than 95% of the selected records had accurate information.

The anthropometric measurements were copied to the ENA for SMART program to calculate the standard deviation, as well as to create a report on the final credibility check, the results of the nutritional and anthropometric condition, and the curves relating to acute malnutrition (wasting), chronic malnutrition (stunting), and acute chronic malnutrition (underweight), as well as MUAC. The mortality data was moved to the ENA program for analysis and to come up with the crude mortality indicators with the population pyramid.

The variables relating to household characteristics and the variables relating to children (vaccinations, vitamin A supplements, nutritional practices, and morbidity) were analyzed using EPI Info (commercial version) 3.5.4.

The indicators of anthropometric measurements (standard deviation) for weight for height (wasting), height for age (stunting), and weight for age (underweight) were analyzed and compared with the development criteria of the World Health Organization in 2006.

The children with extreme cases (extremes) from the standard deviation were reported and removed, as suitable, in the final analysis if the deviation from the mean was noticeable in the information from EPI Info.

Iterations and pivot tables were used to give percentage, averages, and standard deviations in the descriptive analysis and the presentation of the general characteristics of households and children. Statistical significance was defined as probability value being less than 0.05 (P < 0.05).

The nutritional status was described using the indicators mentioned above, as well as the mid-upper arm circumference indicator (MUAC), in accordance with the classification of the World Health Organization (World Health Organization 2006 and World Health Organization 2013). With regards to acute malnutrition, another calculation was carried out with the purpose of showing the Prevalence of global acute malnutrition (GAM) and severe acute malnutrition (SAM), which combine the cutting thresholds of the weight for height (WHZ) and MUAC, taking into account there being a bilateral oedema (legs and feet).

With regards to the infant and young child feeding indicators relating to natural breastfeeding and supplementary feeding, the guidelines of the World Health Organization were used to evaluate feeding practices of infants and young children (World Health Organization 2008).

16

In order to calculate the minimum dietary diversity (MDD), 7 food groups were used, and they are: 1) Grains, roots, and tubers 2) Legumes and nuts 3) Dairy products (milk, yogurt, etc.) 4) Meat (cow, goat, fish, chicken, and liver/kidneys) 5) Eggs 6) Vitamins – fruits and vegetables that are rich in Vitamin A 7) Other fruits and vegetables

These groups were used to measure another indicator, which is minimum meal frequency (MMF), which measures the children’s consumption of solid, semi-sold, and soft foods. The minimum acceptable diet indicator (MAD) is the sum of the minimum diet diversity indicator (MDD) and the minimum meal frequency indicator (MMF). The methods and analysis for the three indicators (MAD, MMF, and MDD) were based on the recommendations of the World Health Organization (2008).

The MUAC for women in reproductive age (15 to 49 years old) was not classified based on the international classification, but based on what is used by the World Food Program in Yemen (CFSS 2011 & CFSS 2014), as follows: • Women are considered to have extreme wasting if their MUAC is less than 21.3 cm. • Women are considered to have moderate wasting if their MUAC is more than 21.3 cm and less than 22.2 cm. • Women are considered to be normal if their MUAC is not less than 22.2 cm.

With regards to the sources of the drinking water indicators, the sources that were included in the classification were classified as improved sources or sources that have not been improved. The improved water sources are the following: 1) Water project that is linked to the home via water pipes 2) Artesian well 3) Protected well 4) Protected spring 5) Protected rain water collection

The sources of water that are not improved are: 1) Public faucet / communal water point / public water 2) Unprotected wells 3) Unprotected springs

17 4) Water filled from bottles (treated) 5) Surface water (table, runoff, irrigation channels, valleys, fountains, or others) 6) Unprotected rain water collection (water cisterns, ponds, wells) 7) Water trucks or other water transportation vehicles 8) Any other sources that are not classified and were not mentioned above

Sanitation facilities were classified based on the types of latrines and whether they were improved or not improved. Improved latrines are: 1) Latrines that drain into a sanitation system through pipes 2) Latrines that drain into a sewage tank 3) Latrines that drain into latrine pits 4) Latrine holes that are improved and ventilated 5) Latrine hole with boards 6) Composting latrines Latrines that are not improved include: 1) Latrines out in the open 2) Latrines that drain into unknown locations 3) Latrine holes without boards / not covered 4) Buckets 5) Hanging latrines 6) Defecating in the open (out in the fields, for example) 7) Any other sources that are not classified and were not mentioned above

The level of food consumption in the 7 days before the survey were calculated from the 8 food groups that are in accordance with the guidelines and manual of the World Food Program. The classification of the levels of food consumption were not in accordance with the global food classification of the World Food Program, they were based on a special method used in Yemen. This method is as follows: - Less than 28: weak food consumption - From 28 to 42: minimal food consumption - More than 42: acceptable food consumption

The coping strategies indicator was used in accordance with the guidelines of the World Food Program, which is based on a list of 11 coping strategies. Another expanded list of coping strategies was used for this survey to determine the households that use any coping strategies.

Severe coping strategies:

18 • Selling household assets / property (furniture, jewelry, clothes, etc.) • Buying food on credit or by pawning property • Spending savings • Borrowing money Coping strategies during the crisis: • Selling productive assets or means of transportation (sewing machine, car, motorcycle, etc.) • Using grains that were stored for the coming season • Taking children out of school • Decreasing spending on education and healthcare (including medicine) Emergency coping strategies: • Selling house or land • Begging • Selling the last of the furniture in the household

Results and Discussion

Survey Sample: The survey field teams targeted 544 households, as is clarified in Table 4. There were no absences or refusals. Data was collected from all of the 544 households, including 742 children and 989 women.

Table 4 - Households, Children, and Women in the Single Survey Group Survey Sample Households visited 544 Households absent (0.0%) 0 Households that refused (0.0%) 0 Displaced households by themselves (3.5%) 19 Displaced households with host households (residents) (0.6%) 3 Households with complete questionnaires (99.8%) 543 Households with children under 5 years of age (72%) 392 Households with children under 6 months of age (16.4%) 89 Households with a woman in reproductive age (15 to 49 years old) (95.2%) 518 Number of children under 5 years old 742 Number of children under 6 months old 94 Number of children from 6 to 59 months old 648 Number of women in reproductive age (15 to 49 years old) 989

19 Average size of household 8.1

The number of households who were visited was larger than the number of households that had visits planned, with 15 households in each cluster = 544 households. There were just three families that were IDP families who lived with host households, as is clarified in the table above.

Household Characteristics Background Indicators The survey found that 94.5% of the households that were surveyed had male heads of households, while the caretakers in 96.7% of the households were women. The survey found that 89.9% of the caretakers of the households were married.

The survey found that 83.4% of the caretakers of the households were illiterate, and they represent the vast majority of women, while 9.9% had a primary school education in the survey group, as is clarified in detail in Table 5.

Table 5 - Basic Data on Household Heads and the Marital Status and Education of the Household Caretakers Single Survey Group Background Indicators % (95% confidence n interval) Gender of Head of Household Male 513 94.5 (92.1 – 96.2) Female 30 5.5 (3.8 – 6.7) Gender of Household Caretaker Male 525 96.7 (94.7 – 98.0) Female 18 3.3 (2.0 – 5.3) Marital Status of the Household Caretaker Married 487 89.9 (86.9 – 92.2) Widowed 39 7.2 (5.2 – 9.8) Divorced 9 1.7 (0.8 – 3.2) Single 7 1.3 (0.6 – 2.8)

20 Single Survey Group Background Indicators % (95% confidence n interval) Education of Household Caretaker Illiterate 453 83.4 (80.0 – 86.4) Literate 36 6.6 (4.7 – 9.1) Primary School Education 16 2.9 (1.8 – 4.8) Secondary School Education 32 5.9 (4.1 – 8.3) Higher Education (University, College, or 6 1.1 (0.4 – 2.5) Institute)

Household Income Characteristics Table 6 shows that 84.7% of the households partially or totally lost their sources of income during the current crisis (since March 2015). These levels are much higher than they are in the Ibb governorate (in March 2017), which was at 7%, the Shabwa governorate (in January 2017) with around 32%, and the rate recorded in the Dhale governorate (in August 2016) with around 72%.

Table 6 - The Effect of the Crisis on Household Income Income Level Indicator % (95% confidence n interval) Effect on the Household Income The normal income or salary was not affected 80 (No) 14.8 (11.9 – 18.1) The income or salary was partially affected 459 (Yes) 84.7 (81.3 – 87.6) The respondents do not know 3 0.6 (0.1 – 1.7)

Monthly Spending Table 7 shows that the median monthly expenditures for the sample of the survey is 31,000 YER, which is equivalent to 70 USD (according to the average exchange rate between YER and USD during the month that the survey was implemented in). There has been an increase in spending among households that do not have coping strategies, followed by households that have emergency coping strategies. The survey found that the median expenditures in Al Jawf is less than the spending in Ibb (34,000 to 35,000 YER) from March 2017 and more than the expenditures in Raymah (25,000 to 30,000 YER) in August 2017.

21

* The average exchange rate for 1 USD in March / April was 450 YER based on market prices.

Table 7 - Average Monthly Spending of Households in YER Classified by Coping Strategies Median Expenditures Media (± Standard Deviation) Monthly spending in a year in YER (n = 542) 31,000 (23,678) Average monthly spending of households based on dependence on coping strategies (in 30 days) No coping strategies (n = 49) 42,000 (30,389) Severe coping strategies (n = 264) 32,000 (20,752) Coping strategies during the crisis (n = 204) 29,000 (25,002) Emergency coping strategies (n = 25) 33,000 (22,962)

Water, Sanitation, and Hygiene Table 8 shows that more than half of the households depend on artesian wells (55.4% of the households) as their main source of drinking water. 32.2% of the households depend on covered wells as their main source of drinking water, with 31.5% depending on unprotected wells and 0.7% on protected wells. Protected and unprotected collection of rain water makes up 8.3% (0.2 and 8.1%, respectively), followed by surface water, tables, runoffs, and irrigation channels with 2.6%, while the last source of water is water through pipes to the home, and public faucets, communal water points, and public water for a total of 1.3% that is 1.1% and 0.2% respectively.

The survey found that 57.5% of the households used improved water sources while 42.5% used unimproved water sources. 16.8% of the households treated the water before drinking it, and the drinking water was stored in clean containers in 66.1% of the households.

The survey found that defecating out in the open makes up less than a third, with 30.8%, followed by using latrines that drain into a sewage tank for more than a quarter of the households (28.9%), then defecation using latrines that drain into the open (open sewage) with 23.2%, while the rest is divided up into different percentages. Improved sanitation methods made up 44.8% based on the percentages that are shown in Table 8.

The survey also found that 13.1% of the caretakers in the households said that they wash their hands with water and soap (or soap alternatives) after using the bathrooms, while 51.2% of them said that they did this before eating.

22 Table 8 - Water and Environmental Sanitation Water and Environmental Sanitation Indicators n % (95% confidence interval) Main Source of Drinking Water: Water project that brings water to the house (public or 6 1.1 (0.4 – 2.5) private) Public faucet, communal water point, or public water 1 0.2 (0.0 – 1.2) Artesian well 301 55.4 (51.1 – 59.7) Covered well 4 0.7 (0.2 – 2) Unprotected well 171 31.5 (27.6 – 35.6) Unprotected spring 1 0.2 (0.0 – 1.2) Surface water, tables, runoff, or public water 14 2.6 (1.5 – 4.4) Protected rainwater collection 1 0.2 (0.0 – 1.2) Unprotected rainwater collection (water cisterns, ponds, 44 (8.16.0 -10.8) and wells) Classification of Household Sources of Drinking Water Improved 312 57.5 (53.2 – 61.6) Unimproved 231 42.5 (38.4 – 46.8) Treating the water before drinking it (n = 543) 91 16.8 (13.8 – 20.2) Cleanliness of the container used to store the water (n = 359 66.1 (61.9 – 70.1) 543) Sanitation Facilities (Defecation) Latrine – to a sewage tank 157 28.9 (25.2 – 33.0) Latrine – to a latrine put 39 7.2 (5.2 – 9.8) Latrine – out into the open 126 23.2 (19.8 – 27.0) A latrine hole that is improved and ventilated 46 8.5 (6.3 – 11.2) A latrine hole with boards 1 0.2 (0.0 – 1.2) A latrine hole without boards / uncovered 6 1.1 (0.4 – 2.5) Hanging latrine 1 0.2 (0.0 – 1.2) Open defecation (in the fields, etc.) 167 30.8 (26.9 – 34.9) Type of Sanitation Improved 243 44.8 (40.5 – 49.0)

23 Unimproved 300 55.2 (51 – 59.5) Caretaker Handwashing Practices After using the bathroom (n = 543) 71 13.1 (10.4 – 16.3) Before eating (n = 505) 278 51.2 (46.9 – 55.5)

Household Food Security Food consumption was calculated based on the consumption during the 7 days before the day of the survey for 8 groups, and they were categorized using the thresholds of the World Food Program (Yemen). As show in Table 9 below, 76.2% had acceptable food security, while 23.8% were suffering from a lack of food security. We found that severe lack of food security was in one of every four households in the survey area.

Table 9 - Categorizing Food Consumption Food Consumption Score (FCS) n % (95% confidence interval) As categorized by the World Food Program for Yemen Acceptable food consumption 414 76.2 (72.4 – 79.7) Minimum food consumption 123 22.7 (19.2 – 26.5) Weak food consumption 6 1.1 (0.4 – 2.5)

Average Coping Strategies Coping strategies were measured using the Coping Strategy Index (CSI), and the average CSI during the 7 days before the day of the survey in the area of the survey was 4.15. The highest average CSI for those that use emergency coping strategies during the 30 days before the survey was 8.72, followed by those that use coping strategies during the crisis with an average of 6.85, as is shown in Table 10.

Table 10 - Averages for Coping Strategies Coping Strategies Index (CSI) Average ( standard deviation) Coping strategies during the previous 7 days (n = 543) 4.15 (8.80) Average of groups using coping strategies during the previous 30 days (n = 473) Non-coping strategy (n = 49) 0.73 (3.07) Severe coping strategies (n = 264) 2.25 (5.95)

24 Coping Strategies Index (CSI) Average ( standard deviation) Coping strategies during the crisis (n = 205) 6.85 (10.92) Emergency coping strategies (n = 25) 8.72 (13.46) Average food consumption (based on the classification of the World Food Program in Yemen) Acceptable food consumption (414) 57.4 (12.7) Minimum food consumption (123) 38.7 (3.48) Weak food consumption (6) 21.41 (6.32)

Child Nutrition Severe Malnutrition – Wasting – WHZ Indicator The Prevalence of global acute malnutrition (wasting), based on the weight for height indicator, was 9.2%, or 12% among the boys and 6.2% among the girls. The severe acute malnutrition was 0.8%, and there were no cases of oedema in the area of the survey (Table 11).

According to the classification of the World Health Organization, the current level is considered “bad” because the result is outside the 5 to 9% range, meaning that the situation could become dangerous in the future.

From the chart above, it is clear that the red line, which represents the survey area, is to the left of the WHO standard (the green line).

25 As a result of there not having been a previous SMART survey implemented in the Al Jawf governorate, the Prevalence of global acute malnutrition (wasting) and severe acute malnutrition cannot be compared to the results of previous surveys that used the same methods.

These results can be compared to the results of nutrition assessments that used other methods, and this comparison shows that the result is less than the Comprehensive Food Security and Nutrition Survey in 2014, which had the prevalence rate global acute malnutrition at 13.2%, and less than the Emergency Food Security and Nutrition Assessment in November 2016, which showed that global acute malnutrition was 11.2%.

Table 11 - Prevalence of Acute Malnutrition Based on Weight for Height (and/or Oedema) Among Children from 6 to 59 months old (by gender) in the Al Jawf Governorate Acute Malnutrition Boys Girls Total n = 334 n = 307 n = 641 The prevalence rate of (40) 12.0 % (19) 6.2 % (59) 9.2 % global acute malnutrition (9.4 - 15.1 95% (4.2 - 9.1 95% C.I.) (7.2 - 11.7 95% C.I.) (GAM) C.I.) The prevalence rate of (37) 11.1 % (17) 5.5 % (54) 8.4 % moderate acute (8.5 - 14.4 95% (3.6 - 8.4 95% C.I.) (6.5 - 10.8 95% C.I.) malnutrition (MAM) C.I.) The prevalence rate of (3) 0.9 % (2) 0.7 % (5) 0.8 % severe acute malnutrition (0.3 - 2.7 95% (0.2 - 2.6 95% C.I.) (0.3 - 1.8 95% C.I.) (SAM) C.I.) The Prevalence of oedema = 0.0%

Table 12 shows that the prevalence rate of global acute malnutrition (wasting), based on the WHZ indicator, among children younger than two years old (6 to 23 months) was high compared to those between 24 and 59 months old, and this difference was not statistically significant.

Table 12 - Prevalence of Acute Malnutrition by Age Group, Based on the Weight for Height Indicator (and/or Oedema) Among Children between 6 and 59 Months Old (by age group) in the Al Jawf Governorate Severe Acute Moderate Acute Global acute Age Total Malnutrition Malnutrition Malnutrition Group Number n % n % n % 6 to 23 220 3 1.4 23 10.5 26 11.8

26 24 to 59 421 2 0.5 31 7.4 33 7.8 Total 641 5 0.8 54 8.4 59 9.2 Chi-squared test X2 =1.47 , df =1, X2 =2.74 , df =1, P= 0.225 P= 0.09

Severe Malnutrition by Mid-Upper Arm Circumference (MUAC) The prevalence rate of global acute malnutrition (wasting) according to an indicator of the MUAC being less than 12.5 cm is 5.9%, while the Prevalence of severe acute malnutrition based on a MUAC of less than 11.5 cm is 0.9%. The prevalence rate of general malnutrition among girls is 7.5%, more than 3.1%, which is the prevalence rate among boys. This difference is not statistically significant. The prevalence rate of severe acute malnutrition among girls is almost double that among the boys, and this difference is not statistically significant. Table 13 shows the details of these figures.

Table 13 - Prevalence of Acute Malnutrition Based on MUAC Measurement (and/or Oedema) Among Children between 6 and 59 Months Old (by gender) in the Al Jawf Governorate Boys Girls Total Acute Malnutrition (MUAC) n = 339 n = 308 n = 647

(23) 7.5 (38) 5.9 (15) 4.4 % % %

(5.2 - The prevalence rate of global acute malnutrition (GAM) (4.3 - 8.0 (2.4 - 7.9 10.6 95% 95% C.I.) 95% C.I.) C.I.)

(19) 6.2 (32) 4.9 (13) 3.8 % % %

The prevalence rate of moderate acute malnutrition (MAM) (4.0 - 9.4 (3.5 - 6.9 (2.2 - 6.6 95% 95% 95% C.I.) C.I.) C.I.)

(2) 0.6 % (4) 1.3 % (6) 0.9 %

(0.5 - 3.4 (0.4 - 2.3 The prevalence rate of severe acute malnutrition (SAM) (0.1 - 2.3 95% 95% 95% C.I.) C.I.) C.I.)

27 Table 14 shows that the prevalence rate of global acute malnutrition (wasting), according to MUAC measurements of less than 12.5 cm among children between 6 and 23 months of age was higher than it was for children between 24 and 59 months of age, and this difference is statistically significant, with a significance level of 0.000.

Table 14 - Prevalence of Acute Malnutrition by Age Group Based on MUAC Measurement and/or Oedema Among Children between 6 and 59 Months Old (by age group) in the Al Jawf Governorate Severe Acute Moderate Acute Global acute Age Total Malnutrition Malnutrition Malnutrition Group Number n % n % n % 6 to 23 222 6 2.7 29 13.1 35 15.8 24 to 59 425 0 0 3 0.7 3 0.7 Total 647 6 0.9 32 4.9 38 5.9

2 2 X =11.6 , df =1, X =59. 8 , df =1, Chi-squared test P= 0.001 P= 0.000

Acute Malnutrition (Wasting) Using a Mix of the WHZ and MUAC Indicators: The prevalence rate of global acute malnutrition (wasting) based on a mix of the weight for height and the mid-upper arm circumference indicators was 12.5%, while the prevalence rate of severe acute malnutrition based on the two indicators was 1.5%. The prevalence rate of global acute malnutrition among boys was 13.3%, which is higher than the rate among girls (1.6%). This difference is not statistically significant. The prevalence rate of severe acute malnutrition based on the two indicators is the same between boys and girls, and this difference is not statistically significant. Table 15 shows the details of these figures.

Table 15 - Prevalence of Mixed Acute Malnutrition Based on WHZ and MUAC measurements (and/or Oedema) Among Children between 6 and 59 Months Old (by gender) in the Al Jawf Governorate

Acute Malnutrition Based on the WHZ and MUAC Boys Girls Total Indicators n = 339 n = 308 n = 647

(45) 13.3 % (36) 11.7 % (81) 12.5 % The prevalence rate of global acute malnutrition based on the WHZ and MUAC measurements (9.9- 17.5 (8.4- 15.9 (10.1- 15.4 95% C.I) 95% C.I) 95% C.I)

(40) 11.8 % (31) 10.1 % (71) 11.0 % The prevalence rate of moderate acute malnutrition based on the WHZ and MUAC measurements (8.7 - 15.8 (7.0 - 14.1 (8.7 - 13.7 95% C.I) 95% C.I) 95% C.I)

28 (5) 1.5 % (5) 1.6 % (10) 1.5 % The prevalence rate of severe acute malnutrition based on the WHZ and MUAC measurements (0.5 - 3.6 (0.6 - 4.0 (0.8 - 2.9 95% C.I) 95% C.I) 95% C.I)

Table 16 shows that the prevalence rate of global acute malnutrition (wasting) based on the mixed indicators of WHZ and MUAC among children between 6 and 23 months of age was high compared to children between 24 and 59 months of age, and this difference is statistically significant, with a significance level of 0.000. It also shows that the prevalence rate of severe acute malnutrition based on the mixed indicators of WHZ and MUAC among the age group of children between 6 and 23 months of age was high compared to children between 24 and 59 months of age. This difference was also statistically significant and had a significance level of 0.000.

Table 16 - Prevalence of Mixed Acute Malnutrition Based on WHZ and MUAC measurements (and/or Oedema) Among Children between 6 and 59 Months Old (by age group) in the Al Jawf Governorate Severe Acute Moderate Acute Global acute Malnutrition Age Total Malnutrition Malnutrition Group Number n % n % n % 6 to 23 222 8 3.6 40 18 48 21.6 24 to 59 425 2 0.5 31 7.3 33 7.8 Total 647 10 1.5 71 11.0 81 12.5 X2 =7.4 , df =1, X2 =25.5 , df =1, Chi-squared test P= 0.006 P= 0.000

29 Malnutrition (Underweight) The prevalence rate of global acute malnutrition using the weight for age indicator is 35.7% and based on the classification of the World Health Organization, this is considered a very high Prevalence of malnutrition. The prevalence rate of severe acute malnutrition using the weight for age indicator was 9.2%, as shown in Table 17. The prevalence rate of global acute malnutrition in girls is higher than in boys, while severe acute malnutrition is higher among the boys than it is in the girls. These differences are not statistically significant.

The chart above shows that the red line, which represents the surveyed area, is to the left of the green line, which is the WHO standard, in a smooth and consistent manner. This shows that the standard deviation is less than 1 within the range of 0.8 to 1.2.

The levels of global and severe malnutrition in Al Jawf is lower than the results of the Emergency Food Security and Nutrition Assessment in 2016, which was 34.2%, and the National Health and Demographic Survey in 2013, which was 37%.

Table 17 – Prevalence of Underweight Based on Standard Deviation for Weight to Age and By Gender Among Children from 0 to 59 Months Old in the Al Jawf Governorate

Malnutrition Boys Girls Total (Underweight) n = 381 n = 347 n = 728 Prevalence of (130) 34.1 % (130) 37.4 % (260) 35.7 % underweight (28.7 - 39.9 95% C.I.) (32.1 - 43.1 95% C.I.) (31.3 - 40.3 95% C.I.) Prevalence of (94) 24.7 % (99) 28.5 % (193) 26.5 % moderate (19.7 - 30.4 95% C.I.) (24.0 - 33.6 95% C.I.) (23.2 - 30.1 95% C.I.) underweight

30 Prevalence of severe (36) 9.4 % (31) 8.9 % (67) 9.2 % underweight (7.3 - 12.2 95% C.I.) (6.2 - 12.6 95% C.I.) (7.2 - 11.6 95% C.I.)

Table 18 shows that the prevalence rate of global acute malnutrition (underweight) among children between 6 and 23 months of age is 38.1%, followed by children between 24 and 59 months of age at 36.5%. These two age groups are higher than the group between 0 and 5 months of age, at 25.9%, while the prevalence rate of severe malnutrition (underweight) among children between 6 and 23 months of age was the highest, at 9.6%. It was followed by children between 24 and 59 months of age, at 9.2%, and finally children between 0 and 5 months of age at 8.2%. These differences were not statistically significant.

Table 18 - Prevalence of Underweight by Age Based on Standard Deviation for Weight to Age Among Children from 0 to 59 Months Old in the Al Jawf Governorate Moderate Severe Underweight Global Underweight Age Total Underweight Group Number n % n % n % 0 to 5 85 7 8.2 15 17.6 22 25.9 6 to 23 218 21 9.6 62 28.4 83 38.1 24 to 59 425 39 9.2 116 27.3 155 36.5 Total 728 67 9.2 193 26.5 260 35.7 Chi-squared test X2 =0.144 , df =2, X2 =4.21 , df =2, P= 0.931 P= 0.122

31 Chronic Malnutrition (Stunting) – HAZ Indicator The spread of chronic malnutrition (stunting) based on height for age is 50.2%, exceeding the threshold of international estimates over 40% based on the classification of the World Health Organization, which considers this to mean that stunting is very prevalent. The prevalence rate of global stature deficiency among girls is 53%, higher than the rate for boys (47.8%), and this difference is not statistically significant. Severe stunting among boys has a prevalence of 20.3%, which is around the same as the rate for girls (20.2%)

These results were found from the Emergency Food Security and Nutrition Assessment in 2016, where the prevalence rate was 43.3%, less than the results of the National Health and Demographic Survey in April 2013 (57.1%).

Table 19 – Prevalence of Stunting Based on Standard Deviation of Height for Age by Gender Among Children Between 6 and 59 Months Old in the Al Jawf Governorate Chronic Malnutrition Boys Girls Total (Stunting) n = 335 n = 302 n = 637 Prevalence rate of (160) 47.8 % (160) 53.0 % (320) 50.2 % stunting (40.8 - 54.8 95% C.I.) (47.1 - 58.8 95% C.I.) (44.8 - 55.6 95% C.I.) Prevalence rate of (92) 27.5 % (99) 32.8 % (191) 30.0 % moderate stunting (22.4 - 33.2 95% C.I.) (27.9 - 38.1 95% C.I.) (26.2 - 34.0 95% C.I.) Prevalence rate of severe (68) 20.3 % (61) 20.2 % (129) 20.3 % (15.9 - 25.6 95% C.I.) (15.4 - 26.0 95% C.I.) (16.2 - 25.0 95% C.I.)

32 Table 20 shows that the prevalence rate of global chronic malnutrition (stunting) and the prevalence rate of severe malnutrition (severe stunting) among children in the age group from 24 to 59 months was high (51.9%, 22%) compared to children in the age group from 6 to 23 months. These differences were not statistically significant.

Table 20 – Prevalence of Stunting by Age Based on Standard Deviation for the Height for Age Indicator Among Children from 6 to 59 Months Old in the Al Jawf Governorate Age Total Severe Stunting Moderate Stunting Global Stunting Group Number n % n % n % 6 to 23 219 37 16.9 66 30.1 103 47 24 to 59 418 92 22 125 29.9 217 51.9

Total 637 129 20.3 191 30 320 50.2 Chi-squared test X2 =2.32 , df =1, X2 =1.37 , df =1, P= 0.127 P= 0.242

Standard Deviations of the Mean, the Effect of the Design, and Abnormal Values (Extremes) Table 21 shows that the average deviation of the z-score of the anthropometric measurement indicators is higher than 1, except for the weight for height indicator, which is less than 1. In general, there is no standard deviation that is less than 0.80 or more than 2. The design effect was 1.18 for the height for age indicator, followed by the weight for age indicator at 1.57, then finally the weight for height indicator, which equals 1.

Table 21 – Standard Deviations from the Mean, Design Effects, and ranges Indicator N Mean z-scores ± Design Effect z-scores not z-scores out of SD (z-score < -2) available range Children from 6 to 59 months of age Weight for height 641 -0.80±0.89 1.00 6 4 (WHZ) Height for age (HAZ) 637 -2.03±1.11 1.81 6 8 Children from 0 to 59 months of age Weight for age (WAZ) 728 -1.69±0.96 1.57 7 10 * Includes the WHZ and WAZ of children suffering from oedema

33

Infant and Young Children Feeding (IYCF) Among children from 0 to 23 months old, the survey showed that 64.8% had either been only breastfed or breastfed and fed through other means in the night before the survey. Exclusively breastfeeding children less than 6 months of age was at 20.2%, and this indicator is higher than the national indicator. Around one out of every two children continues natural breastfeeding until they are two years old.

The survey also shows that the practices of feeding young children are not suitable. Despite half of the children who breastfeed and are between 6 to 23 months getting the appropriate number of meals, only 39.4% of the children in this age group get an acceptably diverse nutrition (made up of 4 or more food groups). As for the accepted minimums of food, they are low (8.9%). Table 22 shows this.

Table 22 – Infant and Young Child Feeding Indicators Indicator n (95% CI) % Breastfed yesterday (n = 310) 201 (59.2-70.2) 64.8 Exclusively natural breastfeeding (n = 94) 19 (12.6-29.8) 20.2 Continuing natural breastfeeding for first year (n = 54) 30 (41.4-69.1) 55.6 Continuing natural breastfeeding until 2 years old (n = 40) 5 (4.2-26.8) 12.5 Minimum dietary diversity (MDD) (n = 216) 85 (32.8-46.2) 39.4 Minimum meal frequency (MMF) (n = 215) 100 (39.7-53.4) 46.5 Minimum acceptable diet (n = 213) 19 (5.5-13.6) 8.9

Child Morbidity Table 23 shows that the most prevalent illnesses among children under the age of five are fever, acute respiratory infections, and diarrhea, and this data is for the two weeks before the day of the interview. The prevalence rate of diarrhea is high, at 50.3%, which is near the level that it was at in March in the Ibb governorate (45%, 44%) in the eastern and western mountainous highlands, respectively, in April 2017. It is also higher than the rate in the Emergency Food Security and Nutrition Assessment in November 2016 (38.1%).

The survey found that the prevalence of acute respiratory infections was 54%, which is 3 times the rate found during the National Health and Demographic Survey in April 2013 (34.5%)

34

Table 23 – Morbidity of Children Under Five Years of Age Within the Two Weeks Before the Day of the Survey Indicator N (95% CI) % Diarrhea (n = 744) 374 (46.6- 53.9) 50.3 Acute respiratory infections (n = 744) 402 (50.4 -57.7) 54.0 Fever (n = 743) 464 (58.8-65.9) 62.4

Vitamin A Supplements and Child Vaccination The survey was implemented at the same time as the implementation of a complementary activity that gave Vitamin A to the children who were between 6 and 59 months of age. The survey showed that the covered of both types of Vitamin A in the previous six months was 39.1%, as is shown in Table 24, which is lower than the Sphere Standards. The table also shows routine vaccinations against polio (third dose) is around 44% in the surveyed area, while the total vaccination against measles for children between 9 and 59 months of age was 44.2%. There is still around 1 child out of every 3 children who were vaccinated for measles that still has a vaccination card.

Table 24 – Vitamin A Supplements and Child Vaccination Indicator N (95% CI) % Vitamin A supplements during the previous six months (for 254 (35.4 - 43.0) 39.1 children between 6 and 59 months) (n = 649) Routine vaccinations for polio (from vaccination card) for 66 (8.0 -12.81) 10.2 children who are older than 6 months (n = 650) Routine vaccinations for polio (from recall) for children who 220 (30.2-37.6) 33.8 are older than 6 months (n = 650) Routine vaccinations for polio (from the vaccination card 286 (40.2- 47.9) 44.0 and recall) for children who are older than 6 months (n = 650) Vaccination against measles (from vaccination card) for 59 (7.6-12.5) 9.8 children who are older than 9 months (n = 604) Vaccination against measles (from recall) for children who 208 (30.7-38.4) 34.4 are older than 9 months (n = 604) Vaccination against measles (from vaccination card and 267 (40.2-48.3) 44.2 recall) for children who are older than 9 months (n = 604)

35

Nutrition of Women of Reproductive Age (15 to 49 years old) The MUAC measurement indicator for women in reproductive age (15 to 49 years) shows, based on the classification of the World Food Program for Yemen, that less than a quarter of the women are suffering from acute malnutrition (wasting). There is 1 out of every 5 women who is suffering from acute malnutrition. These women are pregnant and breastfeeding (10.9% and 11.9%, respectively), while severe acute malnutrition makes up 14.6%, and they are also among the pregnant and breastfeeding women (6.6% and 8%, respectively).

Table 25 – Acute Malnutrition Among Women in Reproductive Age Global Acute Malnutrition Severe Acute Malnutrition Indicator N (%) (95% CI) N (%) (95% CI) Women in reproductive age (15 – 12 (12.4) (10.5 – 14.7) 77 (7.9) (6.3 – 9.8) 49) in general Breastfeeding mothers 24 (11.9) (7.8 – 17.2) 16 (8.0) (4.6 – 12.6) Pregnant women 15 (10.9) (6.3 – 17.4) 9 (6.6) (3.0 – 12.1) Not pregnant nor breastfeeding 82 (13.0) (10.5 – 15.9) 52 (8.2) (6.3 – 10.7)

Mortality Rate The results of the study showed that the total mortality rate is 0.3 for every 10,000 people per day during the recall period (144 days, since the Prophet’s Birthday in 2018), while the number of children who died while under 5 years old was 0.68 for every 10,000 per day. The details are clarified in Table 26.

Table 26 – Mortality Rates in the Al Jawf Governorate During the 144 Days Before the Survey Mortality Rate (95% CI) Design Effect

Crude Mortality Rate 0.30 (0.18 – 0.48) 1.09 Gender Male 0.42 (0.24 – 0.72) 1

Female 0.18 (0.09 – 0.40) 1 Age Groups Less than 5 years old 0.68 (0.34 – 1.37) 1 5 to 11 years old 0.15 (0.02 – 1.08) 1.96 12 to 17 years old 0.10 (0.01 – 0.73) 1

36 18 to 49 years old 0.17 (0.05 – 0.58) 1.46 50 to 64 years old 0.46 (0.11 – 1.87) 1 65 to 120 years old 1.47 (0.49 – 4.28) 1

Figure 1 below, the population pyramid, shows the relative distribution of individuals in the population by age group within 5 years. The data shows that the base of the pyramid is wide because of the age groups under 20 years old, and there is relative similarity and symmetry among the genders.

Figure 1 - Population Pyramid in the Al Jawf Governorate Survey

37

Table 27 – Demographic Information Mentioned Regarding the 144-day Recall Period Total number of households 540 Total number of households that have children under 5 years of age 436 Average household size 8.2 Mid Interval Population Size 4,426 Number of clusters 36 Percentage of children under 5 years of age 21.7 Number of births 1.15 Migration rate (into area) 29.06 Migration rate (out of area) 30.86

Nutritional Status Factors Acute Malnutrition Factors (Wasting) In the Al Jawf governorate, it was found that acute malnutrition (wasting), based on the weight for height indicator, has no relation to diarrhea and fever among children. The statistical significance was more than 0.05, as is clarified in Table 28.

The survey also found that acute malnutrition (wasting), based on the MUAC measurement indicator, has no relationship with diarrhea among children and the classification of the source of drinking water, with the statistical significance more than 0.05 for this as well, as is clarified in Table 29.

The survey found that acute malnutrition (wasting), based on weight for height and MUAC indicators at the same time, is correlated with diarrhea and fever among children because the statistical significance was less than 0.05, but it did not have anything to do with respiratory infections because the statistical significance was more than 0.05, as is shown in Table 30.

Table 28 – Factors of Acute Malnutrition (Weight for Height) Acute malnutrition Indicator (wasting) Statistical significance N %

Diarrhea (n = 640) X2=3.41, df=1, P=0.06 Yes (n = 328) 37 11.3

38 No (n = 312) 22 7.1

Fever (n = 639) Yes (n = 411) 43 10.5 X2=2.08, df=1, P=0.15 No (n = 228) 16 7.0

Table 29 – Factors of Acute Malnutrition (MUAC) Acute Malnutrition Indicator (Wasting) Statistical Significance N %

Diarrhea (n = 646) Yes (n = 331) 24 7.3 X2= 2.29, df=1, P= 0.12 No (n = 315) 14 4.4

Type of drinking water (n = 647) Improved (n = 383) 20 5.2 X2= 0.72, df=1, P= 0.39 Unimproved (n = 264) 18 6.8

39

Table 30 - Factors of Acute Malnutrition (Weight for Height and MUAC) Acute Malnutrition (Wasting) Indicator Statistical Significance N % Diarrhea (n = 646) Yes (n = 331) 53 16.0 X2= 7.47, df=1, P= 0.01 No (n = 315) 28 8.9

Fever (n = 645) Yes (n = 415) 61 14.7 X2= 4.86, df=1, P= 0.03 No (n = 230) 20 8.7 Acute Respiratory Infections (n = 646) Yes (n = 361) 46 12.7 X2= 0.03, df=1, P= 0.86 No (n= 285) 35 12.3

Malnutrition Factors (Underweight) The following table clarifies the relationship between underweight and sanitation and food consumption factors. The survey showed that being underweight is more prevalent among children in families that have unimproved latrines, but this result was not statistically significant because its significance level was more than 0.05. The survey also showed (see Table 31) that there is no relationship between children being underweight and the following factors: type of source of drinking water and classification of food consumption. The significance level for these factors was more than 0.05.

Table 31 - Underweight Factors Underweight Statistical Significance Indicator N %

Type of source of drinking water (n = 728) Improved (n = 434) 158 36.4 X2=0.22, df=1, P=0.64 Unimproved (n = 294) 102 34.7 Type of latrines (n = 728) Improved (n = 304) 97 31.9 X2=3.29, df=1, P=0.06 Unimproved (n = 424) 163 38.4 Classification of food consumption (n = 728) X2= 1.34, df=2, P= 0.52

40 Underweight Statistical Significance Indicator N % Acceptable food consumption (n = 550) 190 34.5 Minimum food consumption (n = 173) 68 39.3 Weak food consumption (n = 5) 2 40.0

Chronic Malnutrition Factors (Stunting) Table 32 shows the relationship between chronic malnutrition (stunting) and the type of source of drinking water. The survey found that there is no relationship between stunting and the type of source of drinking water because the significance level was more than 0.05.

Stunting Indicator Statistical Significance N %

Type of source of drinking water (n = 637) X2= 1.31, df=1, P= 0.25 Improved (n = 376) 196 52.1 Unimproved (n = 261) 124 47.5

Summary of Factors Associated with Forms of Malnutrition GAM (by GAM (by GAM (by Determinants WHZ or Underweight Stunting WHZ) MUAC) MUAC) Diarrhea ○ ○ + ○ ○ Respiratory Infection ○ ○ ○ ○ ○ Fever ○ ○ + ○ ○ Using improved sources of ○ ○ ○ ○ ○ drinking water Using improved types of ○ ○ ○ ○ ○ latrines Lack of food security (using ○ ○ ○ ○ ○ Food Security Score)

41

Child Nutrition and Its Relationship to Mother Nutrition The results show that the prevalence rate of acute malnutrition (wasting) and severe malnutrition is 11.4% and 1.4%, respectively, among children under the age of five whose mothers have acute malnutrition (wasting or underweight). These results are not statistically significant (p > 0.05).

The rate of underweight children makes up a little less than half of the children under the age of five whose mothers have severe malnutrition, and 11.5% of the children under the age of five who are severely underweight have mothers who have acute malnutrition. 21.4% of the children under the age of five have severe stunting have mothers who have acute malnutrition. Table 34 shows the details of these figures, and these results are not statistically significant. Indicator N % Statistical Significance Acute malnutrition (by WHZ)

Wasting among mothers (n = 619) Wasting (n = 70) 8 11.4 X2=0.46, df=1, P=0.49 Natural MUAC (n = 549) 49 8.9 Severe acute malnutrition (by WHZ)

Wasting among mothers (n = 619) Wasting (n = 70) 1 1.4 X2=0.008*, df=1, P=0.92 Natural MUAC (n = 549) 4 0.7 Underweight

Wasting among mothers (n = 705) Wasting (n = 78) 31 39.7 X2=0.70, df=1, P=0.40 Natural MUAC (n = 627) 219 34.9 Severe underweight

Wasting among mothers (n = 705) Wasting (n = 78) 9 11.5 X2=0.56, df=1, P=0.45 Natural MUAC (n = 627) 56 8.9 Severe Stunting

Wasting among mothers (n = 615) X2=0.15, df=1, P=0.69 Wasting (n = 70) 15 21.4

42 Indicator N % Statistical Significance Natural MUAC (n = 545) 106 19.4 * Yates

43 Recommendations

The survey found that the prevalence of global acute malnutrition (wasting) is at the lowest level of the “bad” classification based on the standards of the World Health Organization. As for the prevalence of underweight and stunting, it was “very high” in accordance with these same standards, which shows that there is a need for a comprehensive response in the short-term (to avoid deaths caused by malnutrition) and in the long-term (to improve nutrition and curb malnutrition). The different parties responsible for this issue must look into these recommendations, including the government (like the Ministry of Public Health and Population, the Health Office in the governorate and its districts, the local authorities, and the local councils) as well as the international community/donors:

Short-term Interventions: • With the increasing cases of malnutrition, there is a need to employ mobile medical staff at the second and third levels and to the health facilities to look for cases of malnutrition. They can be given urgent support by partners. • Providing services of management of acute malnutrition programs in all health facilities so that cases of severe acute malnutrition can be decreased.

Medium-term Interventions: • Strengthening the current program for community management of acute malnutrition (CMAM) by enabling community health volunteers to play an effective role in categorizing cases, referring patients, and changing behaviors at the village level, especially with regards to defecation, sanitation practices, and exclusive natural breastfeeding (IYCF). The community health volunteers, in addition to the community midwives, must play important roles in raising the level of exclusive natural breastfeeding. • Encouraging suitable practices to feed infants and young children (especially encouraging supplementary feeding practices that are suitable for children between 6 and 24 months old) and quickly including IYCF consultations in all of the services provided by permanent and mobile clinics for CMAM. • Intensive awareness-raising campaigns on nutritional practices of infants and young children through interventions to change behavior and communicative interventions in the following main fields: exclusive natural breastfeeding, continuing natural breastfeeding until two years of age, preventative measures for diarrhea, and appropriate management of acute respiratory infections among young children. • Promoting and imparting an institutional nature on capacity building of a routine nutritional status monitoring system in the government and community institutions

Long-term Interventions:

44 • Focusing on programs that increase opportunities for household breadwinners, specifically women, leading to improving their economic conditions in general and improving children’s health • Raising awareness on nutrition through schools, and this can be done by children teaching children and improving health facilities with support from donors and partners

45 References

1. Action Against Hunger, Technical Advisory Group (2012), SMART, Sampling Methods and Sample Size Calculation for the SMART Methodology, Canada 2. World Health Organization (2008). Indicators to Assess Nutrition Practices for Infants and Young Children, World Health Organization 3. World Health Organization (2010), NLIS Country Profile Indicators Interpretation Guide, World Health Organization, Geneva 4. World Health Organization (2013), Updates on the management of severe acute malnutrition in infants and children, World Health Organization, Geneva 5. World Health Organization Multi-Center Growth Reference Study Group (2006). World Health Organization Child Growth Standards: Methods and development Length/height-for-age, weight- for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and Development. World Health Organization, Geneva 6. World Health Organization, Water, Sanitation, Hygiene. http://www.who.int/water_sanitation_health/monitoring/jmp2012/key_terms/en. Accessed on 28/5/2016. 7. Food Security Analysis. (2009). Comprehensive Food Security & Vulnerability Analysis (CFSVA) Guidelines. United Nations World Food Program, Rome, Italy. 8. Maxwell, D. and Caldwell, R. (2008). The Coping Strategies Index: Field Methods Manual, Second Edition. Care, Inc. 9. World Food Program and UNICEF (2016), Emergency Food Security and Nutrition Assessment, Yemen. 10. Ministry of Public Health and Population and the Central Statistical Organization (2013), National Health and Demographic Survey, Yemen.

46 Annexes Annex 1: Malnutrition Survey Questionnaire – Al Jawf Governorate – April 2018

Questionnaire No: ______

Republic of Yemen

Ministry of Public Health and Population

Office of the Ministry of Public Health and Population in the Al Jawf Governorate

Assessing the Nutritional Situation and Mortality in the Al Jawf Governorate in April 2018

Household Questionnaire (Form 1)

First: Explain to the residents of the household (the adults) about the assessment, and introduce the entity that is carrying it out, as well as the individuals working on it (the team members), then get their verbal approval.

1. Yes Approval 2. No Move on to the next page

Is the household a resident household or a If the household is a resident household: Does refugee households or a refugee household? refugee household reside with you?

1. Residents 1. Yes If there is a refugee household that lives with the resident household, the information for both households 2. Refugees 2. No must be filled out in the questionnaire, separately, except for the mortality form, of which only one form is to be filled out for both households, and it is included with the resident household.

District Sub-District Village/Block

Household serial number according to sample Interview date Day Month Year

0 2 0 1 8

Household head name:

Team Name Signature Assessment Team Number Researcher 1 ______Researcher 2 + 3

47 Team Head

Field Supervisor

The following data from Q. 1, household data and deaths, is copied to the cluster dump form.

Number of household Number of children Number of children Number of at Number of individuals members under 5 years old under 6 months childbearing age in mortality form between 15 and 49 years

If the following apply:

1. If the household is absent during the first visit, and a second visit is needed.

2. If the woman is absent during the first visit, and a second visit is needed.

3. If the child is absent during the first visit, and a second visit is needed. *

* If the child is absent, all of the information is filled out except for the anthropometric measurements and edema, which are completed when the child is present.

Note: The data on the cover is for field and administrative use by the members of the team.

Questionnaire No: ______

To be filled out by the team head (used to enter data)

Interview date Day Month Year

0 2 0 1 8

Team #

Village / Neighborhood Code Sub-District Code

District Code Governorate Code

Assessment Print Number Cluster Number

Is the area (1) urban or (2) rural?

Household is absent after second visit (1 yes, or 2 no)

Approval (1 yes, or 2 no)

48 If no approval, move on to the next household.

Household Questionnaire Number

Resident household (1) or Refugee Household (2)

If it is a resident household, do they host a refugee household? (1 yes, or 2 no)

Refugee household serial

For Office Use

Name Day Month Year Signature

Data Enterer

Data Enterer

Reviewer

Notes:

2

Questionnaire No: ______

Q 001: Information about the household (only those that are still alive and currently reside with the household)

Number of members of the household (only those that are still alive and currently Number H001a reside with the household)

Number of children under 5 years old (only those that are still alive and currently Number H001b reside with the household)

49 Number of children younger than 6 months old (only those that are still alive and Number H001c currently reside with the household)

Number of women between 15 and 49 years old (only those that are still alive and Number H001d currently reside with the household)

Q 002: Information about the gender of the household head (the person that is responsible for the household’s livelihood)

What is the gender of the head of the household?

H002 1. Male

2. Female

Q 003 – Q 005: Information about the household caregiver (the person that is responsible for taking care of the household, especially the children)

What is the gender of the household caregiver?

H003 1. Male

2. Female

What is the marital status of the household caregiver?

1. Married

2. Widow H004 3. Divorced

4. Separated

5. Single

What is the educational level of the household caregiver?

1. Illiterate

2. Literate

H005 3. Basic education

4. Secondary school education

5. Higher education (university, college, or institute)

Questionnaire No: ______

Q 006 – Q 007: Information about the household’s income and spending

50 Has the household’s income decreased during the past 12 months?

1. Yes H006 2. No

3. I do not know

What is the average spending (expenses) for the Spending (in riyals) household, in riyals?

1. Daily spending H007 2. Weekly spending

3. Monthly spending

Totals

Q 008 – Q 013: Information about water, sanitation, and hygiene.

What is the main source of drinking water in your house? (Choose one only) Go to

1 Water project that comes that brings water to the house (government or private)

2 Public water pump / communal water source / public water

3 Artesian aquifer

4 Covered well

5 Unprotected well

6 Covered spring H008 7 Unprotected spring

8 Treated water (mineral or treated) -> H010

9 Surface water table / stream / irrigation channels

10 Collecting covered rain water

11 Collected unprotected rain water (water cisterns / pond)

12 Water trucks or carts that transport water

13 Other: ______

Do you treat the water before drinking it? Go to

1 Yes H009a 2 No -> H010

3 I do not know -> H010

H009b What is the main method of treatment that is used for drinking water? (Choose only one)

51 1 Boiling water before drinking it

2 Using chlorine

3 Filtering using a clean cloth

4 Using a ceramic or sand water filter, or a similar method (filter or distill)

5 Leaving the water to settle so that the sediment settles.

6 Using alum

7 Other: ______

Note: Make sure that there are water storage areas for drinking water:

Is the container that is being used to store the water clean (free of algae)? H010 1 Yes (there is no algae)

2 No (there is algae)

Where do they answer the call of nature (defecate)? (Choose one of the following): Verify

the facilities and practices.

Latrines – They have water for cleaning (hose or bucket) that pours into a public sewer 1 system.

2 Latrines – They have water for cleaning (hose or bucket) that pours into a septic tank.

3 Latrines – They have water for cleaning (hose or bucket) that pours into a latrine hole.

4 Latrines – They have water for cleaning (hose or bucket) that pours out into the open.

Latrines – They have water for cleaning (hose or bucket) that pours into an unknown 5 location. H011 6 Improved and ventilated latrine hole.

7 Latrine hole with boards

8 Latrine hole without boards / is uncovered

9 Compost latrine

10 Bucket

11 Hanging latrine

12 Open defecation (in the fields, for example, etc.)

13 Other: ______

Questionnaire No: ______

H012a 1. Mentioned -> If the answer to question 1 was mentioned in the previous question.

52 When do you wash your hands? H012b What do you use to wash your hands? (Record only when one or both of 2. If it was not a. Just b. With water and soap c. Water with these situations are mentioned.) mentioned, go to with (piece of soap, liquid ashes / dirt / question H013 water soap, powdered soap, pebbles / leaves soap dough)

1. Yes 1. Yes 1. Yes

2. No 2. No 2. No

A. After using the bathroom

B. Before eating

Q 013 – Q 015: Food consumption and coping strategies

Does the household eat any of the foods or H013a H013b food groups below? Has the household If the answer to the previous In the first column, the answer will be yes or eaten this in the past 7 question is yes, how many days did no (1 or 2). days? the household have this food in the past 7 days? In the second column, the answer will be the 1. Yes number of days in the last seven days. (The answer will be from 1 to 7.) 2. No

If no, move to the next choice.

A Wheat, bread, aseed, fattah, other grains (corn, thin corn, millet, barley), pastries, or any food made out of grains.

B Rice or macaroni

C Potatoes H013 D Vegetables (leafy vegetables, tomatoes, peppers, carrots, squash, etc.)

E Fruits (mangos, bananas, grapes, etc.)

F Meat (beef or goat meat), liver, kidneys, poultry

G Poultry

H Eggs

I Fish (fresh, dried, or canned)

J Legumes (beans, lentils, peas, kidney beans)

K Dairy products (milk, cheese, yogurt, etc.)

L Oils or fats (margarine, butter, vegetable oil, etc.)

53 M Sugar, sweets, honey, dried fruits (dates, raisins)

N Spices, tea, coffee

Questionnaire No: ______

During the past 7 days, has the household not Go to had enough food or money to buy the food that it needs? H014a 1 Yes

2 No -> H015

How many days, in the past 7 days, did the household have to do any of the following Number of days because it did not have enough food or money to buy the food that it needs? (Answer is from 0 to 7)

A Depending on lower quality or cheaper food.

B Borrowing food or depending on help from household and friends

C Lowering the amount of food that is served at the main meals

D Decreasing the meals of the adults in the household in order to secure food for the children

H014b E Decreasing the number of daily meals F Buying food on credit or by pawning items

G Collecting food from the brush or harvesting crops that are not ready for harvesting

H Using the seeds that are to be planted in the coming season

I Sending members of the household to eat elsewhere

J Sending members of the household to beg

K Spending a whole day without food.

Have any of the members of the household done any of the following to deal with the 0. Never scarcity of food in the previous 30 days? 1. Rarely Please fill out all of the fields as follows: 2. Sometimes (0) Never 3. Always H015 (1) Rarely (once or twice in the past 30 days) (2) Sometimes (from 3 to 10 times in the past 30 days)

(3) Always (more than 10 times in the past 30 days)

A Selling the assets or holdings of the household (furniture, jewelry, clothes, etc.)

B Buying food on credit or by pawning items because cash is not available to buy it

54 C Spending savings

D Borrowing money

E Selling productive assets, or means of transportation (sewing machines, cars, bicycles, etc.)

F Using seeds stored for the next season

G Taking children out of school

H Selling homes or real estate

I Begging

J Selling the last remaining female livestock animals that they own

K Decreasing spending on education and healthcare (including medicine)

55

Household Questionnaire No: ______

Q 016 – Q 020: MUAC of women in childbearing age (15 – 49 years old)

W016 W017 W018 W019 W020

Woman’s Woman’s Woman’s Age Marital Status: The woman is now: MUAC (cm) How much time did the woman Number First Name (in years) spend outside of the house 1. Married 1. Pregnant 88.8 = refused yesterday? 2. Widowed 2. Nursing 99.9 = absent

3. Divorced 3. Not pregnant or nursing 4. Separated

5. Single

6. If the answer is single (5), move to W019

H H M M 1 .

H H M M 2 .

H H M M 3 .

H H M M 4 .

H H M M 5 .

H H M M 6 .

56 H H M M 7 .

H H M M 8 .

H H M M 9 .

H H M M 10 .

Household Questionnaire No: ______

Q 021 – Q 023: Children’s ages (Document every child from 0 to 5 years old in the table below, starting from the oldest)

C021 C022 C023a C023b

Child’s Child’s Child’s Number of woman (mother or caregiver of the Date of birth (Hijri or Child’s age What did the mother number first name gender child, to be taken from the page with the Gregorian) (in months) say about the child’s women’s information) age? 1 = male For children from 0 to 59 months old 2 = female

DD MM YYYY 1

DD MM YYYY 2

DD MM YYYY 3

DD MM YYYY 4

57 DD MM YYYY 5

DD MM YYYY 6

DD MM YYYY 7

DD MM YYYY 8

DD MM YYYY 9

DD MM YYYY 10

Household Questionnaire No: ______

Q 024 – Q 026: Anthropometric measurements of children between 6 and 59 months old in the household (leave blank for any children younger than 6 months)

C024 C025 C026

Child’s number (copied from Child’s first name (from Child’s age (in Weight (Kilograms Height (centimeters and MUAC (centimeters and the previous page) the previous page) months) and grams) millimeters) millimeters)

(from previous 88.8 = refused 888.8 = refused 88.8 = refused page) 99.9 = absent 999.9 = absent 99.9 = absent

. . .

. . .

. . .

. . .

58 . . .

. . .

. . .

. . .

. . .

. . .

Household Questionnaire No: ______

Q 027 – Q 033: Edema, immunization, and morbidity among children between the ages of 0 and 59 months in the household (all of the children under 5 years old)

C027 C028 C029 C030 C031 C032 C033

For all children between 0 and 59 months For children 6 months old and older For children 9 months old and older

Child’s Child’s first Child’s Edema Diarrhea* Coughing or Fever in Were they Has the child For children older number name (from age (in in both during the difficulty the past given vitamin gotten the third than 9 months, was (copied from the previous months) feet past two breathing in two A during the dose of the the child given the the previous page) weeks the past two weeks past six pentavalent measles vaccine (from 1 = Yes page) weeks months? (Show vaccine (dose in the (dose in the left previous 1 = Yes 1 = Yes 2 = No sample) thigh)? hand)? page) 1 = Yes 2 = No 2 = No 8 = 1 = Yes 1 = Yes, from the 1 = Yes, from the 2 = No Refused vaccination chart vaccination chart 2 = No 9 = 2 = Yes, from 2 = Yes, from 3 = Do not Absent memory memory know 3 = Do not know 3 = Do not know

4 = Not vaccinated 4 = Not vaccinated

59

* Diarrhea: It is the increase in the number of watery diarrhea, more than usual

Household Questionnaire No: ______

Q 034 – Q 035: Record the incidents of nursing children between 0 and 24 months old within the past 24 hours (leave blank for children older than 24 months)

Child’s Child’s Child’s C034 C035 number first name age (in Did the child Record the number of times that the child nursed yesterday (0 if the child did not nurse) (copied (from the months) nurse from their from the previous C035a C035b C035c C035d C035e (from mother (nursing previous page) previous or expressed If the answer to the How many How many times did How many How many times page) page) milk) within the previous question is times did the the child drink any times did the did the child have past 24 hours? yes, how many times child have other kind of milk, child have other food that is did the child nurse, breastmilk in powdered, bottled, yogurt or a solid, semi-solid, 1 = Yes and how many times the last 24 or fresh animal yogurt drink or soft (like 2 = No were they given their hours? milk, in the last 24 in the past 24 bananas)? mother’s milk, in the hours. hours?

last 24 hours? If the answer is no, go to question C035b

60

Household Questionnaire No: ______

Q 036: Record the feeding of children between the age of 0 and 24 months during the past 24 hours (leave blank for children older than 24 months)

Child’s Child’s Child’s C036 number first name age (in Did the child eat any of the food groups below yesterday? (By yesterday, it means from the time the child woke up in the (copied (from the months) morning until they went to sleep at night) from the previous (from previous page) Give the mother time to remember, and, when she finishes, list the items below. previous page) page) 1 = Yes / 2 = No / 3 = The mother does not know

C036a C036b C036c C036d C036e C036f C036g C036h C036i

Meat: Vegetables Grains: Legumes: Any other and fruits: Liver, foods or Aseedah, Any food Any other kidney, Squash, drinks shabisah, made from fruits or heart, or carrots, (other bread, beans, vegetables Water, other sweet than rice, kidney that were with or Cheese or organs potatoes, children’s macaroni, beans, Eggs not without ice cream yellow or milk, or or any peas, Any beef mentioned sugar orange any other other food lentils, or goat in the guava milk, made from peanut meat, previous yogurt, grains. butter, or sheep Any dark part and yogurt any other meat, or green leafy Tubers: drink.) legumes poultry. vegetables

61 White Fresh, Mango or potatoes, canned, or ripe or any dried fish. papaya other tubers

Household Questionnaire No: ______

Assessing the Nutritional Situation and Deaths in Al Jawf Governorate, April 2018

Demographic Survey Form during the Period from 30 November 2017 (Form 2)

Assessment District: ______Block/Village: ______Date: ______Cluster Number: ______

Team Number: ______Household Questionnaire Number: ______Assessment Level: ______

Gender Joined the household on or Left the household on or Born on or after the Died on or after the Place Age (in Cause # Name (Male or after the anniversary of the after the anniversary of the anniversary of the birth anniversary of the birth of years) of death Female) birth of the Prophet birth of the Prophet of the Prophet of the Prophet death

Complete the list with the members of the household that currently reside with the household, then put a check mark (✓) for the household members that joined the household or were born after the anniversary of the birth of the Prophet.

1

62 2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

63 Continue on the next page

Household Questionnaire No: ______

Gender Joined the household on or Left the household on or Born on or after the Died on or after the Place Age (in Cause # Name (Male or after the anniversary of the after the anniversary of the anniversary of the birth anniversary of the birth of years) of death Female) birth of the Prophet birth of the Prophet of the Prophet of the Prophet death

Complete the list with individuals that left the household before the date of the visit, starting on or after the anniversary of the birth of the Prophet, then put a check mark (✓) for those that had joined the household or were born on or after the anniversary of the birth of the Prophet.

1 ✓

2

3

4

5

6

7

8

9

10

11

12

Gender Joined the household on or Left the household on or Born on or after the Died on or after the Place Age (in Cause # Name (Male or after the anniversary of the after the anniversary of the anniversary of the birth anniversary of the birth of years) of death Female) birth of the Prophet birth of the Prophet of the Prophet of the Prophet death

Complete the list with individuals that died before the date of the visit, starting on or after the anniversary of the birth of the Prophet, then put a check mark (✓) for those that had joined the household or were born on or after the anniversary of the birth of the Prophet.

64 1 ✓

2

3

4

5

Has there been a pregnant woman in the household since the anniversary of the birth of the 1. Yes If the answer is yes, how many pregnant Prophet? women? 2. No

Causes of Death Codes

1 = Unknown 3 = Malnutrition

2 = Accident or injury 6 = Fever

3 = Diarrhea 7 = Other (specify):

4 = Problems breathing

Places of Death Codes

1 = Current location

2 = While migrating

3 = In their last residence

4 = Other (specify):

65 Annex 2: Malnutrition Survey Team – Al Jawf Governorate – April 2018 # Name Position Phone Number 1 Adel Abdulmahmoud Muhammad Survey Manager 777263611 / Othman 730438727 2 Muhammad Taha Al Saqqaf Central Supervisor 773691108 3 Ali Ahmad Al Faqih Central Supervisor 771585348 4 Abdulmalik Abdullah Ahmad Al Central Supervisor 771229040 Qassi 5 Ahmad Yusr Abbas Central Supervisor 777748267 6 Zaid Ali Al Mushiki Central Supervisor 777706552 7 Ammar Naji Al Haloul Logistics 770652019 8 Arafat Shamsan Central Data Enterer 773906661 9 Mahfoudh Al Malahi Data Enterer 770413112 10 Abduljabbar Abu Osbo' Data Enterer 772357045 11 Yusuf Hussein Al Daba Data Enterer 771951476 12 Nayef Radman Hamdan Data Analysis and Report Writing 772111998 12 Jizailan Muhammad Jizailan Team Head 775315400 13 Ahad Muhammad Humaidan Team Head 712582425 14 Uday Naji Hamoud Haloul Team Head 774231702 15 Saleh Awadh Hadi Al Hammi Team Head 773591597 16 Aqil Ahmad Al Manahi Team Head 715513766 17 Nabil Muhammad Ali Al Kuraimi Team Head 777199515 18 Nurah Salem Hadi Saeed Surveyor 716445627 19 Surveyor 773298758 / Mudirah Abdullah Hajar 71522935 20 Khamisah Muhammad Hasan Abu Surveyor 716661981 Qar 21 Alia Hasan Salem Al Hayak Surveyor 714252669 22 Masoudah Aziz Nasser Al Qassimi Surveyor 714318574 23 Muna Naji Naji Al Ahdab Surveyor 714520911 24 Intisar Mabkhout Abdullah Qaswah Surveyor 714277612

66 # Name Position Phone Number 25 Intisar Abdoh Abdullah Darjan Surveyor 710402311 26 Ta'ah Abdullah Ja'dar Surveyor 716830833 27 Alia Ali Ali Antar Surveyor 713646192 28 Nazihah Abdoh Abo Osbo' Surveyor 773903176 29 Sumayah Hussein Al Khalasis Surveyor 771889615 30 Sumayah Abdullah Muhsin Jarad Surveyor 775540811 31 Zuhour Muhsin Ahmad Al Sawadi Surveyor 77388699 32 Azizah Aziz Nasser Al Qassimi Surveyor 775842137 33 Shaima Nasser Yahya Hatman Surveyor 771439320 34 Alia Muhammad Hasan Al Farjah Surveyor 714362729 35 Hayat Yahya Al Mahmi Surveyor 771823649

67

Annex 3: Timetable – Al Jawf Governorate – April 2018

(Months)

1439 1438 1437 1436 1435 1434

Hijri Month Hijri Month Hijri

Approximate Age Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate

Muharram Anniversary Ashura on 10 Anniversary of Ashura on 10 Ashura on 10 Muharram of September Muharram October 14 Muharram Muharram 26 Revolution Revolution on Anniversary Independence on Muharram Muharram 1 of October 14 Day, 6 Revolution Ashura on 10 November Ashura on 10 3.9 on Muharram 15.4 Muharram 26.5 37.3 30, 47.7 Muharram 13 Muharram 27 Cyclone Chapala Anniversary in Socotra and the of October 14 Eastern Coasts on Revolution on Muharram 23 Muharram 24 Safar Warehouse of Independence Independence Safar Aref Qa’l Day, November Day, Blowing up, 30, Safar 18 November Safar 27, 30, Safar 8 1439

Latest polio 2.9 14.4 25.6 36.4 46.8 campaign, which included nutrition, Safar 4, 1439

68

(Months)

1439 1438 1437 1436 1435 1434

Hijri Month Hijri Month Hijri

Approximate Age (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate Approximate Age Age Approximate Rabi’ I Independence Independence Bombing of End of Rabi’ I Day, Day, the Police schedule, November 30, November Academy, Rabi’ I 15 Rabi’ I 12 30, Rabi’ I 1 Rabi’ I 17

Killing of Ali 1.9 13.5 24.7 35.5 46.0 60.0 Saleh and Aref Al Zouka, Rabi’ I 16, 1439

Rabi’ II The war Rabi’ II Resistance between Bombing of the going into the Hasan home of Saleh 1.0 Monday 12.6 23.8 34.6 Hamoud Al 45.1 59.0 Darman, Rabi’ II Market, Rabi’ Qahm and the 15, 1437 II 16, 1438 Houthis, February 15

Jumada I Beginning of Abd Rabboh Beginning of Jumada I survey, Mansour the National Jumada I 11 0 - 1 11.6 22.9 Hadi’s escape 33.7 44.3 Dialogue 54.5 to Aden, Conference, Jumada I 3 Jumada I 7

Jumada II Beginning of Jumada II bombing by 10.6 21.9 32.8 43.4 53.6 Coalition, Jumada II 6

69

(Months)

1439 1438 1437 1436 1435 1434

Hijri Month Hijri Month Hijri

Approximate Age Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate

Rajab Isra and Isra and Mi'raj, Isra and Unification Unification Rajab Mi'raj, Rajab Rajab 27 Mi'raj, Rajab Day (May Day (May 27 27 22), Rajab 23 22), Rajab 13 9.7 21.0 31.9 Isra and 42.5 52.8 Mi'raj, Rajab Isra and 27 Mi'raj, Rajab 27

Sha’ban Unification Unification Day Unification Sha’ban Day (May (May 22), Day (May 22), Sha’ban Sha’ban 15 22), Sha’ban 26 4

8.7 20.0 Al Labnat 31.0 41.6 51.9 Military Base falling to the Houthis, Sha’ban 29, 1436

Ramadan Ramadan Ramadan Ramadan Ramadan Ramadan Ramadan

Bombing of Al Fardhah 7.7 19.1 Bridge on the 30.1 40.8 51.1 way to Sana’a, Ramadan 20, 1436

Shawwal Eid Al Fitr, Eid Al Fitr, Eid Al Fitr, Eid Al Fitr, Eid Al Fitr, Shawwal 6.8 18.2 29.2 39.9 50.2 Shawwal 1 Shawwal 1 Shawwal 1 Shawwal 1 Shawwal 1

70

(Months)

1439 1438 1437 1436 1435 1434

Hijri Month Hijri Month Hijri

Approximate Age Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate (Months) Age Approximate

Dhul Houthis September Dhul Qi’dah going into 26 Qi’dah Sana’a, Dhul Revolution Qi’dah 27 Anniversary, Dhul Qi’dah Bombing and 22 blowing up of 5.8 17.2 28.3 Hasan 39.0 49.4 Abkar’s house and the Al Ghail War, Dhul Qi’dah 20, 1435

Dhul Eid Al Adha, Eid Al Adha, Eid Al Adha, September 26 Attack on Al Dhul Hijjah Dhul Hijjah Dhul Hijjah 10 Dhul Hijjah Revolution Urdhi Hijjah 10 10 Anniversary, Complex, September 26 Dhul Hijjah 2 December 5 Revolution September 26 Anniversary, Revolution Eid Al Adha, Eid Al Adha, Dhul Hijjah 24 Anniversary, Dhul Hijjah Dhul Hijjah 4.8 16.3 27.4 38.1 48.5 Dhul Hijjah 10 10 13 October 14 October 14 Revolution Revolution Anniversary, Anniversary, Dhul Hijjah Dhul Hijjah 20 10

71 Approxim Approxim Approxim Approxim Approxim Approxim Gregoria Gregoria 2018 ate Age 2017 ate Age 2016 ate Age 2015 ate Age 2014 ate Age 2013 ate Age n Month n Month (Months) (Months) (Months) (Months) (Months) (Months)

January Beginni 0 - 1 Resistance 12 Bombing of 24 Bombing of 36 48 End of 60 January ng of the going into the home of Police Calendar, survey, the Monday Sheikh Academy, January 26 January Market, Saleh January 7 27 January 14, Darman, 2017 January 25, 2016

February 11 23 Abd 35 The war 47 59 February Rabboh between Mansour Hasan Hadi’s Hamoud Al escape to Qahm and Aden, the February Houthis, 21 February 15

March 10 22 Beginning 34 46 Beginning 58 March of the of the bombing by National the Dialogue Coalition, Conference March 26 , March 18

April Isra and 9 21 33 45 57 April Mi'raj, April 23

May Unification 8 Isra and 20 Isra and 32 Unification 44 Unification 56 May Day, May Mi'raj, May Mi'raj, May Day, May Day, May 22 4 15 22 22

Beginning Unification Unification Isra and of Day, May Day, May Mi'raj, May Ramadan, 22 22 26 May 26

72 Approxim Approxim Approxim Approxim Approxim Approxim Gregoria Gregoria 2018 ate Age 2017 ate Age 2016 ate Age 2015 ate Age 2014 ate Age 2013 ate Age n Month n Month (Months) (Months) (Months) (Months) (Months) (Months)

June Eid Al Fitr, 7 Beginning 19 Beginning 31 Beginning 43 Isra and 55 June June 25 of of of Mi'raj, June Ramadan, Ramadan, Ramadan, 5 June 6 June 17 June 28

Al Labnat Military Base falling to the Houthis, June 16, 2015

July 6 Eid Al Fitr, 18 Eid Al Fitr, 30 Eid Al Fitr, 42 Beginning 54 July July 6 July 17 July 28 of Ramadan, Bombing of July 8 the Al Fardhah Bridge on the way to Sana’a, July 7, 2015

August 5 17 29 41 Eid Al Fitr, 53 August August 7

Septemb Eid Al 4 Eid Al 16 Eid Al 28 Houthis 40 Anniversar 52 Septemb er Adha, Adha, Adha, going into y of the er September September September Sana’a, September 1 12 23 September 26 21 Revolution Hijri New Anniversar Anniversar Year y of the y of the Anniversar (1439), September September y of the September 26 26 September 21 Revolution Revolution 26 Revolution

73 Approxim Approxim Approxim Approxim Approxim Approxim Gregoria Gregoria 2018 ate Age 2017 ate Age 2016 ate Age 2015 ate Age 2014 ate Age 2013 ate Age n Month n Month (Months) (Months) (Months) (Months) (Months) (Months)

Anniversar Bombing y of the and September blowing up 26 the home of Revolution Hasan Abkar and Ashura, Al Ghail September War, 30 September 15, 2014

October Anniversar 3 Beginning 15 Anniversar 27 Eid Al 39 Anniversar 51 October y of the of 1438 y of the Adha, y of the October 14 Hijri year, October 14 October 4 October 14 Revolution October 2 Revolution Anniversar Revolution Ashura, Beginning y of the Eid Al ,October 11 of 1437 October 14 Adha حملة الشلل Anniversar Hijri year, Revolution October 14 األخيرة والتي y of the October 14 Beginning شاركت فيها October 14 Ashura, of 1436 التغذية 24 October Revolution October 23 Hijri year, 2017 October 24

Novemb Warehouse 2 Independen 14 Cyclone 26 Ashura, 38 Beginning 50 Novemb er of Aref ce Day, Chapala in November of Hijri er Qa’l November Socotra and 2 New Year, Blowing 30 the Eastern Independen 1435, up, Coasts on ce Day, November November November November 4 16, 2017 5 30 Ashura, November Independen Independen 13 ce Day, ce Day, Independen November November ce Day, 30 30 November 30

74 Approxim Approxim Approxim Approxim Approxim Approxim Gregoria Gregoria 2018 ate Age 2017 ate Age 2016 ate Age 2015 ate Age 2014 ate Age 2013 ate Age n Month n Month (Months) (Months) (Months) (Months) (Months) (Months)

Decemb Killing of 1 13 25 37 Attack on 49 Decemb er Ali Saleh Al Urdhi er and Aref Al Complex, Zouka, December December 5 4, 2017

75 Annex 4: Table to determine the ages of children using the Gregorian and Hijri calendars – Al Jawf Governorate – April 2018

Age in Years Gregorian Years Hijri Years Age in Months and Months Months Years 2018 2017 2016 2015 2014 2013 1439 1438 1437 1436 1435 1434

0 4 8

1 1 3 7

2 2 2 6

3 3 1 5

4 4 12 4

5 5 11 3

6 6 10 2

7 7 9 1 12

8 8 8 11

9 9 7 10

10 10 6 9

11 11 5 8

12 1 4 7

13 1 1 3 6

14 2 1 2 5

15 3 1 1 4

16 4 1 12 3

17 5 1 11 2

18 6 1 10 1

19 7 1 9 12

20 8 1 8 11

21 9 1 7 10

76 Age in Years Gregorian Years Hijri Years Age in Months and Months Months Years 2018 2017 2016 2015 2014 2013 1439 1438 1437 1436 1435 1434

22 10 1 6 9

23 11 1 5 8

24 2 4 7

25 1 2 3 6

26 2 2 2 5

27 3 2 1 4

28 4 2 12 3

29 5 2 11 2

30 6 2 10 1

31 7 2 9 12

32 8 2 8 11

33 9 2 7 10

34 10 2 6 9

35 11 2 5 8

36 3 4 7

37 1 3 3 6

38 2 3 2 4 + 5

39 3 3 1 3

40 4 3 12 2

41 5 3 11 1

42 6 3 10 12

43 7 3 9 11

44 8 3 8 10

77 Age in Years Gregorian Years Hijri Years Age in Months and Months Months Years 2018 2017 2016 2015 2014 2013 1439 1438 1437 1436 1435 1434

45 9 3 7 9

46 10 3 6 8

47 11 3 5 7

48 4 Month Gregorian 4 Month Hijri 6

49 1 4 1 January 3 1 Muharram 5

50 2 4 2 February 2 2 Safar 4

51 3 4 3 March 1 3 Rabi' I 3

52 4 4 4 April 12 4 Rabi' II 2

53 5 4 5 May 11 5 Jumada I 1

54 6 4 6 June 10 6 Jumada II 12

55 7 4 7 July 9 7 Rajab 11

56 8 4 8 August 8 8 Sha'ban 10

57 9 4 9 September 7 9 Ramadan 9

58 10 4 10 October 6 10 Shawwal 8

59 11 4 11 November 5 11 Dhul Qi'dah 7

60 5 12 December 4 12 Dhul Hijjah 6

78 Annex 5: Credibility Check for the Al Jawf Survey – April 2018

79 Annex 6: Report on the child measurement sessions to evaluate the team during the Al Jawf Survey – April 2018

Standardisation test results Precision Accuracy OUTCOME Weight subjects mean SD max Technical error TEM/mean Coef of reliability Bias from superv Bias from median # kg kg kg TEM (kg) TEM (%) R (%) Bias (kg) Bias (kg) result Supervisor 10 15.4 3.2 0.3 0.09 0.6 99.9 - 1.05 TEM acceptable R value good Bias reject Enumerator 1 10 15.4 3.2 0.3 0.12 0.8 99.9 -0.03 1.02 TEM poor R value good Bias reject Enumerator 2 10 14.4 5.1 10.71 3.31 22.9 58.3 -1.02 0.03 TEM reject R value reject Bias good Enumerator 3 10 15.1 3.3 1.01 0.23 1.5 99.5 -0.35 0.7 TEM reject R value good Bias reject Enumerator 4 10 15.4 3.2 0.81 0.24 1.5 99.5 -0.01 1.03 TEM reject R value good Bias reject Enumerator 5 10 15.4 3.3 0.81 0.21 1.4 99.6 -0.04 1 TEM reject R value good Bias reject Enumerator 6 10 15.5 3.2 0.3 0.09 0.6 99.9 0.05 1.09 TEM acceptable R value good Bias reject enum inter 1st 6x10 15 3.9 - 1.87 12.5 77.3 - - TEM reject R value reject enum inter 2nd 6x10 15.4 3.2 - 0.24 1.5 99.5 - - TEM poor R value good inter enum + sup 7x10 15.2 3.5 - 0.98 6.5 90 - - TEM reject R value poor TOTAL intra+inter 6x10 - - - 1.91 12.5 71.7 -0.23 0.84 TEM reject R value reject Bias reject TOTAL+ sup 7x10 - - - 1.77 11.6 74.9 - - TEM reject R value reject Height subjects mean SD max Technical error TEM/mean Coef of reliability Bias from superv Bias from median result # cm cm cm TEM (cm) TEM (%) R (%) Bias (cm) Bias (cm) Supervisor 10 103.3 10.4 0.9 0.28 0.3 99.9 - -0.19 TEM good R value good Enumerator 1 10 104.4 11.4 19 4.26 4.1 86.1 1.13 0.95 TEM reject R value reject Bias poor Enumerator 2 10 103.3 9.4 10.4 3.18 3.1 88.5 -0.02 -0.21 TEM reject R value reject Bias good Enumerator 3 10 103.2 10.5 1.1 0.44 0.4 99.8 -0.13 -0.31 TEM acceptable R value good Bias good Enumerator 4 10 233.1 313.9 900.3 338.46 145.2 -16.2 129.77 129.58 TEM reject R value reject Bias reject Enumerator 5 10 103.4 10.5 1.1 0.38 0.4 99.9 0.07 -0.12 TEM good R value good Bias good Enumerator 6 10 103.1 10.3 0.6 0.29 0.3 99.9 -0.22 -0.41 TEM good R value good Bias good enum inter 1st 6x10 146.7 188.5 - 193.14 131.7 -5 - - TEM reject R value reject enum inter 2nd 6x10 103.5 13.2 - 7.95 7.7 63.8 - - TEM reject R value reject inter enum + sup 7x10 122 125 - 93.08 64.5 39.5 - - TEM reject R value reject TOTAL intra+inter 6x10 - - - 194.37 155.4 -107.9 21.77 18.47 TEM reject R value reject Bias reject TOTAL+ sup 7x10 - - - 179.95 147.5 -107.1 - - TEM reject R value reject MUAC subjects mean SD max Technical error TEM/mean Coef of reliability Bias from superv Bias from median result # mm mm mm TEM (mm) TEM (%) R (%) Bias (mm) Bias (mm) Supervisor 10 151.4 11.8 6 2.07 1.4 96.9 - 0.4 TEM acceptable R value acceptable Bias good Enumerator 1 10 150.9 11.2 6 2.4 1.6 95.4 -0.45 -0.05 TEM acceptable R value acceptable Bias good Enumerator 2 10 154.1 12.2 4 2.13 1.4 96.9 2.75 3.15 TEM acceptable R value acceptable Bias reject Enumerator 3 10 148.2 11.3 4 1.52 1 98.2 -3.2 -2.8 TEM good R value acceptable Bias good Enumerator 4 10 153.8 11 10 3.99 2.6 87 2.4 2.8 TEM reject R value reject Bias poor Enumerator 5 10 149.1 12.3 13 4.13 2.8 88.7 -2.35 -1.95 TEM reject R value reject Bias good Enumerator 6 10 152.4 11.2 4 1.4 0.9 98.4 1.05 1.45 TEM good R value acceptable Bias acceptable enum inter 1st 6x10 151 11.5 - 3.7 2.4 89.7 - - TEM reject R value reject enum inter 2nd 6x10 151.9 11.6 - 3.65 2.4 90.1 - - TEM reject R value poor inter enum + sup 7x10 151.4 11.5 - 3.45 2.3 91.1 - - TEM reject R value poor TOTAL intra+inter 6x10 - - - 4.63 3.1 83.9 0.03 0.43 TEM reject R value reject Bias good TOTAL+ sup 7x10 - - - 4.4 2.9 85.4 - - TEM reject R value reject

80

Annex 7: The clusters chosen for the nutrition and mortality survey – Al Jawf Governorate – April 2018

Date District district Sub-district Town / Village Team # Team Head Central Supervisor

-

District District Code Sub Code Urban Status Town Village / Code # Cluster

19/04/2018 5 Al Hazm 10 Hamdan Rural 12 Al Aslat 10 1 Jizailan Muhammad Muhammad Al Saqqaf

19/04/2018 4 Al Zahir 5 Al Zahir Rural 7 Al Zahir 5 2 Uday Al Haloul Zaid Al Mushiki

19/04/2018 5 Al Hazm 8 Hamdan Urban 10 Dhamam 8 3 Saleh Al Haimi Ahmad Humaidan

19/04/2018 4 Al Zahir 6 Al Aqdah Rural 8 Al Aqdah 6 4 Nabil Al Kuraimi

19/04/2018 5 Al Hazm 9 Hamdan Rural 11 Al Maqashib 9 5 Ahmad Abbas Adel Al Absi

19/04/2018 4 Al Zahir 7 Ad'am Market Rural 9 Ad'am Market 7 6 Aqil Al Manhami Adel Al Absi

20/04/2018 9 Al Khalq 14 Al Rawdh Urban 16 Al Atiq 13 1 Jizailan Muhammad Muhammad Al Saqqaf

20/04/2018 3 Al Matammah 4 Husun Al Shinan Rural 5 Husun Al Shinan 4 2 Uday Al Haloul Zaid Al Mushiki

20/04/2018 7 Al Maslub 13 Al Maslub Rural 15 Al Aqrah 12 3 Saleh Al Haimi Muhammad Al Saqqaf

20/04/2018 6 Al Maton 11 Bin Shihab Rural 13 Farsha 11 4 Nabil Al Kuraimi Adel Al Absi

20/04/2018 9 Al Khalq 15 Al Rawdh Rural 17 Al Khalq 14 5 Ahmad Abbas Adel Al Absi

20/04/2018 3 Al Matammah 3 Hisn Bani Saeed Rural 4 Al Matraf 3 6 Aqil Al Manhami Ahmad Humaidan

21/04/2018 2 Al Humaydat 1 Al Salal Rural 1 Al Salal 1 1 Jizailan Muhammad Zaid Al Mushiki

21/04/2018 2 Al Humaydat 1 Al Salal Rural 2 Jarn Ni'mah 2 2 Uday Al Haloul Muhammad Al Saqqaf

21/04/2018 12 Kharab Al Marashi 29 Al Maranah Rural 34 Marqab 30 4 Nabil Al Kuraimi Adel Al Absi

21/04/2018 12 Kharab Al Marashi 29 Al Maranah Rural 35 Mashqab 31 5 Ahmad Abbas Adel Al Absi

21/04/2018 12 Kharab Al Marashi 30 Al Kharab Rural 36 Ghail Masih 32 6 Aqil Al Manhami Saleh Al Haimi

22/04/2018 12 Kharab Al Marashi 29 Al Maranah Rural 33 Haram Al Maranah 29 1 Jizailan Zaid Al Mushiki

22/04/2018 12 Kharab Al Marashi 30 Al Kharab Rural 37 Al Qardhah 33 2 Uday Al Haloul Ahmad Abbas

22/04/2018 12 Kharab Al Marashi 30 Al Kharab Rural 38 Al Nasb 34 4 Nabil Al Kuraimi Adel Al Absi

22/04/2018 12 Kharab Al Marashi 31 Al Sha'ara Rural 39 Al Jiljilah 35 5 Saleh Al Haimi Ahmad Humaidan

81 22/04/2018 12 Kharab Al Marashi 32 Hayjan Rural 40 Nahyan 36 6 Aqil Al Manhami Muhammad Al Saqqaf

23/04/2018 11 Rajuzah 23 Al Aridhah Rural 26 Al Tahal 23 5 Saleh Al Haimi Ahmad Abbas

23/04/2018 11 Rajuzah 22 Wadi Bani Nawf Rural 25 Qabis 22 4 Nabil Al Kuraimi Ahmad Humaidan

23/04/2018 11 Rajuzah 25 Al Khash'ah Rural 28 Wadi Al Neel 25 1 Jizailan Muhammad Zaid Al Mushiki

23/04/2018 11 Rajuzah 21 Al Sarar Rural 24 Al Badw Al Ra's 21 2 Uday Al Haloul Muhammad Al Saqqaf

23/04/2018 11 Rajuzah 24 Al Qirshah Rural 27 Al Ma'mal 24 6 Aqil Al Manhami Adel Al Absi

23/04/2018 11 Rajuzah 26 Madajir Rural 30 Al Malh 27 1 Jizailan Ahmad Abbas

24/04/2018 10 Bart Al Anan 19 Al Salah Rural 22 Al Naseef 19 5 Saleh Al Haimi Ahmad Humaidan

24/04/2018 11 Rajuzah 26 Madajir Rural 29 Madajir 26 2 Uday Al Haloul Adel Al Absi

24/04/2018 10 Bart Al Anan 18 Al Ahmad bin Kawl Rural 21 Al Ta'bar 18 4 Nabil Al Kuraimi Muhammad Al Saqqaf

24/04/2018 11 Rajuzah 27 Al Bahbahah Rural 31 Al Jareed 28 6 Aqil Al Manhami Zaid Al Mushiki

25/04/2018 10 Bart Al Anan 16 Dhu Musa Rural 18 Al Husn Jizailan 15 4 Nabil Al Kuraimi Ahmad Humaidan

25/04/2018 10 Bart Al Anan 17 Dhu Zaid Rural 19 Al Sawadah 16 2 Uday Al Haloul Ahmad Abbas

25/04/2018 10 Bart Al Anan 18 Al Ahmad bin Kawl Rural 20 Dhabibah 17 5 Saleh Al Haimi Zaid Al Mushiki

25/04/2018 10 Bart Al Anan 20 Al Daminah Rural 23 Mawsas 20 6 Aqil Al Manhami Muhammad Al Saqqaf

82 Sample Selection Decision Tree – Al Jawf Survey – April 2018

83