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SC (UK) Nutrition Survey 22-26 Nov'00 Fik Zone Somali National Regional State Page 1 of 14 SC

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SC (UK) Nutrition Survey 22-26 Nov'00 Fik Zone Somali National Regional State Page 1 of 14 SC SC (UK) Nutritional Survey 22-26 November 2000 Fik Zone, Somali National Regional State 1. EXECUTIVE SUMMARY The Somali Region has been severely affected by drought since early 2000. SC (UK) has been active in four woredas in Fik zone since May 2000, providing emergency assistance to those most affected by the drought. An anthropometric and food security assessment was carried out in the four woredas of Fik Zone between 21 and 26 November 2000 to assess the nutritional status of the population and determine programme activities. A total of 1829 children were seen in two thirty by thirty cluster surveys. The results showed a decline in acute malnutrition as compared with previous surveys conducted in April and July in Fik Zone. Fig 1: Prevalence of Acute malnutrition in Fik Zone Anthropometrical Measurement Fik and Segeg and Hamero Dihun Global Acute Malnutrition (GAM) <80% 12.2% 15.5% Severe Wasting < 70% ) 0.1% 0.8 % Mean Weight for Height % 88.43% 87.0% Z Scores global acute malnutrition <-2.0 17.2 % 24.2 % Z Scores severe acute malnutrition <-3.0 1.6% 2.3% Median weigh-for-height <80% 12.2% 15.5% Median weight-for-height <70% 0.2% 0.8% No oedema was recorded. · The prevalence of acute malnutrition is above the internationally accepted norms, although rates have decreased compared to surveys conducted earlier in the year. · Reported mortality rates have fallen from 20-25 per week in May-June’00 to 3-5 per week in November. · The food security situation appears to be improving. Pastoralists that migrated out of Fik Zone during the worst of the drought have been returning over the last couple of months with herds of camels and cattle. The condition of the livestock has improved with the increased availability of water and pasture. · Access to clean drinking water and health services are now thought to be the key factors affecting nutritional status rather than lack of access to food. Current leading health problems include malaria, TB, measles and diarrhea. The lack of functioning health facilities in the Zone is having a negative impact on the health status of the population. · Despite the overall improvements in food security in 2000, the nutritional situation continues to be fragile, particularly for the under-five population who is more vulnerable to the poor health environment. Close monitoring of the food security and nutritional status of the population are required as it remains to be seen what effect the livestock ban and closure of supplementary feeding programmes will have in the Region. BACKGROUND SC (UK) experience in Somali Region (Region 5) dates back to the early 1970’s, when nutritional surveillance in the area began. Since 1994, activities have focused on rehabilitation and development, mainly in education, water, agriculture, restocking and veterinary projects but also maintaining food security surveillance and emergency response capacity. In 1998, for example, SC (UK) distributed 55,000 mt of food aid in Region 5. In response to the acute food crisis caused by three successive years of drought, SC (UK) started emergency relief interventions in Somali Region in May 2000. These included: SC (UK) Nutrition Survey 22-26 Nov’00 Fik Zone Somali National Regional State Page 1 of 14 · The provision of 7,770 mt of wheat grain as a general ration for Degahabour, Gode and Fik Zones. · Blanket supplementary distributions to the entire under five populations and their mothers in four woredas in Fik Zone. · Targeted supplementary feeding programmes in Fik and Hamero Woredas for moderately malnourished children. · Three therapeutic feeding centres for severely malnourished children in Fik, Hamero and Gasangas Woredas. · Distribution of blankets and plastic sheeting to the most vulnerable populations in Fik Zone. 2. OBJECTIVES 2.1 To assess rates of global and severe acute malnutrition among children aged between 6 and 60 months in four Woredas in Fik Zone. 2.2 To collect socio-economic information to assist in the analysis of the nutritional data and to assess the food security situation in the Zone. 2.3 To review programme activities based upon the results of the survey. 3. METHODOLOGY Selection of sample · Two two-stage cluster sample surveys were conducted. The first survey covered Fik and Hamero woredas and the second covered Segeg and Dihun woredas. A total of 915 children were seen in Fik and Hamero and 914 in Segeg and Dihun, giving a total of 1829 children. · Fik and Hamero woredas and Segeg and Dihun woredas were grouped together as factors such as ecological conditions, accessibility to pasture, relief distributions and clan relations were very similar within each grouping. · Clusters were selected in each survey using population proportion to size techniques. Population estimates were based on distribution lists used and verified over the previous months during SC(UK) food distributions. The selection criteria for the villages chosen included a minimum of fifty households per settlement, accessibility and security considerations. Note that this method did not result in an entirely random selection of children being measured. However, key informants have indicated that the results presented below are representative of the population as a whole and samples based on population sizes were taken from urban, peri-urban and rural communities across the four woredas. · From the central point of each selected cluster, a random direction was picked by spinning a pen to determine the direction and selection of individual households3. Anthropometric Measurements · Weight was recorded with the minimum clothing to the nearest 0.1kg, using 25kg Salter Scale. The scale was checked after every 7-10 children were weighed with a stone of a known weight. · All children were measured lying down. Length was measured to the nearest 0.5cm. One centimetre was subtracted from the length of children who were greater than 85cm in length during analysis of data to compensate for increased recumbent length measurement4. This allowed the data to be compared to the reference standards that use height data. The range of children selected was 70cm - 110cm. 3 ‘Selection of Children in the Clusters’ p58 MSF Nutrition Guidelines 1995 4 As recommended by WHO (Physical Status: the use and interpretation of anthropometry, WHO Technical report series, 1995 SC (UK) Nutrition Survey 22-26 Nov’00 Fik Zone Somali National Regional State Page 2 of 14 · Data collected included age, sex, weight, height, presence of oedema, measles and polio vaccination and inclusion in SC (UK) targeted and blanket feeding programmes. · Nutritional oedema was defined by the presence of bilateral oedema. This was detected by applying normal thumb pressure to the feet for three seconds. If the shallow pit remained when the thumb was lifted on both feet, nutritional oedema was confirmed. · Results for weight for height were compared against Reference Population Table of the NCHS/CDC/WHO 1982. · Data was collected by four teams of four people, each including a team leader, data recorder and two measuring assistants. · EPI INFO 6 and Excel Software were used to analyse the results of the survey. 4.3 Collection of Socio-Economic Data Information, covering issues of food-security, rainfall, condition of livestock, mortality and morbidity, was gathered through discussions with key informants, typically three to four community leaders in the form of group discussion based upon a questionnaire (Annex 4). All team leaders have had training and experience in participatory rural appraisal techniques. Where possible, women from the community were also involved. Information was crossed checked with secondary sources from other agencies and by observations made by SC (UK) staff. 4. RESULTS 5.1 The sample population Ratio of Females to Males Fik and Hamero: 432 Female: 483 Male 47.2%: 52.8% Segeg and Dihun: 466 Female: 448 Male 51%: 49% 5.2 The prevalence of acute malnutrition Figures 1 and 2 show the prevalence of global, moderate and severe acute malnutrition in the two surveys. The prevalence of severe acute malnutrition in both surveys is low. There were no cases of oedema in either sample. The estimated prevalence of moderate acute malnutrition was higher in Segeg and Dihun (14.8% <80%WFH) than in Fik and Hamero (12.0% <80%WFH). The graphs showing the distribution of weight-for-height z scores in both surveys (annex 1 and 2) indicate that the population's weight-for-height has shifted to the left in comparison to the reference population. This implies that the population has lower weight for height than the reference population. Fig 2: Summary of prevalence of acute malnutrition (Weight for Height percent of the median) Indicator Fik and Segeg and Hamero Dihun Total no. of children 915 914 Prevalence of moderate acute malnutrition 70- 80% 12.0% 14.8% Confidence interval 9.0-15.0% 12.0-17.6% Prevalence of severe acute malnutrition <70% 0.2% 0.8% Confidence interval 95% 0.0-0.5% 0.3-1.3% Global Acute Malnutrition (GAM) <80% 12.2% 15.5% Confidence interval 95% 9.2-15.2% 12.7-18.4% Mean Weight for Height % 88.43% 87.0% SC (UK) Nutrition Survey 22-26 Nov’00 Fik Zone Somali National Regional State Page 3 of 14 Fig 3: Summary of prevalence of acute malnutrition (Weight for Height Z score) Indicator Fik and Segeg and Hamero Dihun Total no. of children 915 914 Prevalence of moderate acute malnutrition -3z - <-2z 15.5% 21.9% Confidence interval 12.1-18.9% 18.6-25.2% Prevalence of severe acute malnutrition <-3z 1.7% 2.3% Confidence interval 95% 0.7-2.8 1.4-3.2% Global Acute Malnutrition (GAM) <-2z 17.2% 24.2% Confidence interval 95% 13.4-21.1% 20.7-27.7% Mean Weight for Height % 88.43% 87.0% As is usual in anthropometric surveys, the results presented as z scores show higher levels of acute malnutrition than percentage of the median values.
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