Kurgan Teppe and Kulyab Zones, Khatlon Region of Tajikistan
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Food Security Survey in Supplementary Feeding Center Caretakers – Kurgan Teppe and Kulyab zones, Khatlon region of Tajikistan August/September 2005 Acknowledgements Action Against Hunger (AAH) would like to thank all the people who helped make this survey possible. In particular, we would like to extend our gratitude to the caregivers who participated actively in this survey. 1. Executive summary 1.1. AAH background Action Against Hunger has been implementing integrated programs in Tajikistan since 1998. The targeted region is Khatlon Oblast, which has the highest rates of poverty, food insecurity, migration and female- headed households in the country. With very limited food supplies and low incomes, all segments of Tajikistan’s population were estimated to consume nutritionally inadequate diets in 2001. This situation is expected to persist over the next decade1. As a consequence, Action Against Hunger has been working to improve the food security of the most vulnerable households through the implementation of various programs: health and nutrition programs focus on the immediate causes of malnutrition in children between 6 and 59 months through detection and treatment activities, whereas food security and irrigation / water sanitation programs were focus on the prevention of malnutrition by targeting the underlying causes. According to the National Nutrition Survey 2003 (NNS 03), conducted by a consortium of NGOs with the lead of Action Against Hunger, the Global Acute Malnutrition (GAM) rate in Kulyab zones was 7.1% and the Severe Acute Malnutrition (SAM) rate was 1.4%. In 2004 the NNS showed an increase in the number of malnourished children, with a 9.9% GAM rate and a 1.6% SAM rate in Kulyab area2. In the Kurgan Teppe zone the NNS 03 showed a GAM rate of 5.4% and a SAM of 0.9%. The following year, the NNS indicated a GAM of 11.1% and a SAM of 3.1%. The goal of this survey, conducted among Supplementary Feeding Centers (SFC) caregivers, is two- fold: on the one hand to better understand the underlying causes for the persisting high rates of malnutrition with a view to adapt AAH programs accordingly, and on the other hand to establish a base-line profile of SFC caretakers for future food security activities. Supplementary feeding centers are designed to provide moderately malnourished patients with a food supplementation corresponding to their physiological needs3 This supplementation is given either as wet rations (ready-to-eat) or dry rations (take home). In the case of dry rations, nutritional values are doubled to allow for the fact that they will probably be shared with the family. In Tajikistan AAH distributes dry rations in SFCs spread over 14 districts within Khatlon Oblast. The dry ration consists of porridge (wheat flour, oil, and sugar) which the beneficiaries cook at home. Caregivers come with their malnourished child once a week to the SFC, at which point the children have their anthropometrical measurements taken and receive vitamin A, folic acid, iron supplementation, as well as their porridge ration. Such visits ensure that a clear picture of their evolution within the program is available. Health education is also a very important part of each SFC visit. The admission into the SFC program is based on the following criteria: Children from 6 to 59 months W-H index between 70 % and 79 % of the median and/or MUAC between 110 and 119 mm Table 1: Criteria of Admission to SFC Program 1.2. Main findings Family information ¾ The survey revealed that 89% and 90% (Kurgan Teppe zone and Kulyab zone respectively) of primary caregivers at the SFC are mothers. Their ages varied from 19-46 years old, with the average for both Kurgan Teppe and Kulyab zones being 29. 1 US Department of Agriculture, Economic Research Service Food Security Assessment/GFA-13/March 2002 2 National Nutrition Survey 2003 and 2004 3 Golden MHN, Briend A, Grellety Y. (1995). Report of meeting in supplementary feeding programmes with particular reference to refugee populations. Eur. J. Clin. Nutr.; 49, 137-45. Malnourished child profile ¾ The average age of the children assessed was 16 months. ¾ 69% of caretakers in Kurgan Teppe and 79% in Kulyab declared that their child was being admitted for the first time. Surprisingly, in Kurgan Teppe 19.5% of mothers claimed it was their third time in the SFC. This means that 20-30% of the children in the SFC program relapsed at least once, thus demonstrating that malnutrition is a chronic problem in Khatlon Oblast. ¾ Amongst caregivers, 74% in Kurgan Teppe and 61% in Kulyab claimed that malnutrition was caused by health problems. In Kulyab another 31% of caregivers thought that malnutrition was the result of food problems (access and use). However, less than 2% declared that malnutrition was linked to poor hygiene practices. This indicates a poor level of understanding regarding the causes of malnutrition. Motivation to come to SFC ¾ 47% of surveyed caregivers in Kurgan Teppe zone claimed that they were referred to the SFC by the doctors and nurses of the village, and only 5% by the ACF screening teams. Although this may indicate a poor level of performance in the screening teams (which in turn would warrant a refresher course for the teams), this may also be due to a more efficient and implanted system of health structures in Kurgan Teppe. Comparatively, in Kulyab doctors and nurses sent only 30% of the surveyed caregivers, whereas screening teams sent 34%. In both regions a sizeable proportion of caretakers were motivated by friends and neighbors to come to the program. This indicates that both information regarding the program and positive word-of-mouth are wide-spread and facilitating the program. Health ¾ 59.5% of children admitted to SFC in Kurgan Teppe zone stated they had had diarrhea during the past month. In Kulyab, 53% made the same claim. ¾ For the children who were ill, 91% sought treatment and 9% did not in Kurgan Teppe. In Kulyab 70% of ill children were treated and 30% were not. ¾ For those who did not seek treatment, the primary reason given was that treatment was not available or that it was too expensive. All these results point towards the prevalence of water-born diseases and problems of availability and accessibility to medical care in Kulyab. Water ¾ According to the caretakers interviewed, the main sources of water for villages in Kurgan Teppe zone are irrigation channels (21%) and river/stream (41%). For Kulyab zone, water piped outside the house (29%) and piped directly into the house (25%) were the most common sources. ¾ More than 90% of caregivers interviewed during the survey said they were boiling water for drinking purposes. However only 77% of mothers in Kurgan Teppe zone and 31% in Kulyab zone used boiled water in food preparation. Once again, results point towards high risks of water-born diseases and poor hygiene practices, which may represent a danger to health and facilitate the incidence of malnutrition. Land and livestock access ¾ About 91% of caregivers interviewed claimed to have access to agricultural land in Kurgan Teppe, compared to only 48% in Kulyab zone. The majority of caregivers have private kitchen gardens with an average size of 0.12 hectare of land per household. They use these gardens mainly to grow staple foods and vegetables. ¾ 76% of families in Kurgan Teppe reported owning livestock while only 41% did in Kulyab. ¾ In both areas the most commonly kept livestock in the households were chickens (47% Kurgan Teppe; 17% Kulyab) and cattle (58% Kurgan Teppe; 31% Kulyab). Household food consumption ¾ 87% of surveyed caregivers in Kurgan Teppe zone and 75% in Kulyab zone responded that they prepared enough food to feed the entire family. ¾ Bread, tea, cooking oil, and potatoes were the most commonly consumed foods and are accessible to most people in the surveyed districts. ¾ 83% of families surveyed in Kurgan Teppe zone and 81% in Kulyab found it necessary to reduce their food intake at some point during the year. The most commonly reported periods of food reduction were the winter months, from February to May. The main reason evoked for food reduction was financial constraints (58.5% Kurgan Teppe; 82% Kulyab). Although food consumption seems to be satisfying in terms of quantity, food quality and variety may be insufficient. Furthermore, the seasonality of food scarcity must be with compared the seasonal fluctuations of SFC/TFC admission figures in order to establish whether there is a correlation (see recommendations). Child food consumption ¾ 99% of the surveyed children were breastfed from birth. ¾ From the interviewed caregivers, 41% in Kurgan Teppe zone and 65% in Kulyab zone introduced other liquid/foods at the age of 4-6 months. ¾ The most commonly given liquid/foods are tea/water with sugar (27% Kurgan Teppe; 32% Kulyab). ¾ 32% of the interviewed caregivers in Kurgan Teppe zone and 35% in Kulyab zone stopped breastfeeding when their child was less than 6 months old. ¾ Apart from sweetened tea/water, for the last three days children had reportedly consumed mostly staple foods (56% Kurgan Teppe; 40% Kulyab). 1.3. Main recommendations From the survey, the following recommendations can be made regarding nutrition: 1. Improved availability and access to adequate health structures must be ensured in remote areas, especially in Kulyab. 2. Health and nutrition education focusing on personal and general hygienic practices should be reinforced. Development and supply of training materials such as brochures, flip charts, exercise books by Ministry of Health, Ministry of Education and Republican Healthy life Center is highly recommended. 3. The identification and prevention of acute malnutrition must be reinforced, ideally by public structures and communities. Specifically, screening activities must be strengthened, especially in Kurgan Teppe, 4.