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Pochalla County Anthropometric and Mortality Survey February – March, 2014 International Medical Corps (IMC) Pochalla County. Background Pochalla County is located in the eastern part of Jonglei State, bordering Ethiopia The current population of Pochalla County is estimated as 76,131 (former United Sudan Household Census of 2008 [Sudan 2008]) Much of its territory is located between two rivers, Akobo to the east and Oboth to the west International Medical Corps has been present in South Sudan since 1994, and working in Pochalla County since January 2009 IMC has supported eight health facilities in Pochalla County in delivery of the Basic Package of Health Services (BPHS) and invested in building the capacity of the County Health Department (CHD) Map of Pochalla County Rationale of the Survey No nutrition survey has been conducted in the past 1 year despite the county having been on the spotlight over insecurity and floods A rapid nutrition assessment conducted in July had revealed that out of 684 children who were screened 78 were moderately while 22 were severely malnourished based on MUAC cut-offs In mid-October, the Relief and rehabilitation commission in Pochalla did raise a concern that close to 6000 people were affected by hunger due to poor harvest and flooding. Most of them migrating to Ethiopia, in search of food Overall Objective The overall goal of this assessment was to establish the extent and the severity of acute malnutrition and determine the retrospective mortality rate in Pochalla County Specific Objectives • To estimate the prevalence of malnutrition among the population aged 6- 59 months • To estimate the crude and under-five mortality rates in Pochalla County • To identify factors influencing the nutrition status of children aged 6-59 months in the County • To estimate the prevalence of some common child illnesses (suspected measles, diarrhea, febrile and respiratory illnesses) • To estimate the coverage of measles vaccination and Vitamin A supplementation status among children aged 6-59 months • To assess the infant and young child feeding (IYCF) and care practices among mothers with children aged 0-23 months. • To assess the households’ water, sanitation and hygiene practices (WASH) and Food Security and livelihood (FSL) situation. Survey Methodology Survey Design The survey applied a two-stage cluster sampling adopting the SMART Methodology Stage 1 was selection of clusters using PPS while stage 2 was selecting of households using Simple Random Sampling Sample Size The sample size for this survey was 540 Households to provide 416 children 6-59 Months. There were 36 cluster which were sampled Survey Methodology Data Collection Six teams of three collected the data in six days i.e. 17th – 22nd February, 2013 The teams under-went a three days training including the standardization test and piloting Data Entry and Analysis Anthropometric data was entered and analyzed in ENA while the other sets of data were entered and analyzed in SPSS RESULTS Plausibility Results Value Comment Missing/Flagged data 1.6% Excellent Overall Sex ratio 1.1 Excellent Overall Age distribution 0.86 Excellent Dig preference score - weight 2 Good Dig preference score - height 2 Good Dig preference score - MUAC 2 Good Standard Dev WHZ 1.07 Excellent Skewness WHZ 0.07 Excellent Kurtosis WHZ -0.10 Excellent Poisson dist WHZ-2 p=0.131 Excellent Overall 6% Excellent Household Characteristics Characteristics Value Clusters/villages covered 36 Total HHs covered 535 Total population 2965 Average HH Size 5.5 HH status (Resident) 98.3% (n=526) HH status (IDP) 0.4% (n=2) HH Status (Returnee) 1.3% (n=7) Male headed HH 58.5% (n=313) Female Headed 41.5% (n=222) Malnutrition Rates by WFH and/or Oedema All Boys Girls n = 501 n = 255 n = 246 Prevalence of global malnutrition (31) 6.2 % (16) 6.3 % (15) 6.1 % (<-2 z-score and/or oedema) [4.1 ↔ 9.3 95% [3.8 ↔10.2 95% [3.3 ↔ 11.1 95% C.I.] C.I.] C.I.] Prevalence of moderate (24) 4.8 % (12) 4.7 % (12) 4.9 % malnutrition [3.1 ↔ 7.4 95% [2.9 ↔ 7.7 95% [2.4 ↔ 9.5 95% (<-2 z-score and >=-3 z-score, no C.I.] C.I.] C.I.] oedema) Prevalence of severe malnutrition (7) 1.4 % (4) 1.6 % (3) 1.2 % (<-3 z-score and/or oedema) [0.6 ↔ 3.4 95% [0.5 ↔ 5.1 95% [0.4 ↔ 3.7 95% C.I.] C.I.] C.I.] Malnutrition Rates by MUAC and/or Oedema All Boys Girls n = 509 n = 261 n = 248 Prevalence of global malnutrition ( 18) 3.5% ( 6) 2.3% ( 12) 4.8% (<125 mm and/or oedema) [ 2.0↔ 6.1 95% [ 0.7 ↔7.6 95% [ 2.5↔ 9.3 95% C.I.] C.I.] C.I.] Prevalence of moderate ( 16) 3.1% ( 6) 2.3% ( 10) 4.0% malnutrition [ 1.7 ↔5.6 95% [ 0.7 ↔7.6 95% [ 2.0↔ 8.1 95% (<125 mm and >=115 mm z-score, C.I.] C.I.] C.I.] no oedema) Prevalence of severe malnutrition ( 2) 0.4% ( 0) 0.0% ( 2) 0.8% (<115and/or oedema) [ 0.1 ↔1.6 95% ( 0.0 ↔0.0 95% [ 0.2↔ 3.3 95% C.I.] C.I.) C.I.] Prevalence of Stunting All Boys Girls n = 500 n = 254 n = 246 Prevalence of stunting (41) 8.2 % (27) 10.6 % (14) 5.7 % (<-2 z-score) [5.8 ↔ 11.4 [6.9 ↔ 16.0 [3.5 ↔ 9.2 95% C.I.] 95% C.I.] 95% C.I.] Prevalence of moderate stunting (39) 7.8 % (25) 9.8 % (14) 5.7 % (<-2 z-score and >=-3 z-score) [5.6 ↔ 10.8 [6.4 ↔ 14.8 [3.5 ↔ 9.2 95% C.I.] 95% C.I.] 95% C.I.] Prevalence of severe stunting (2) 0.4 % (2) 0.8 % (0) 0.0 % (<-3 z-score) [0.1 ↔ 1.6 [0.2 ↔ 3.1 [0.0 ↔ 0.0 95% C.I.] 95% C.I.] 95% C.I.] Prevalence of Underweight All Boys Girls n = 508 n = 260 n = 248 Prevalence of underweight (29) 5.7 % (17) 6.5 % (12) 4.8 % (<-2 z-score) [3.9 ↔ 8.3 [3.7 ↔ 11.4 [2.8 ↔ 8.3 95% C.I.] 95% C.I.] 95% C.I.] Prevalence of moderate underweight (27) 5.3 % (16) 6.2 % (11) 4.4 % (<-2 z-score and >=-3 z-score) [3.5 ↔8.0 [3.3 ↔ 11.1 [2.4 ↔ 7.9 95% C.I.] 95% C.I.] 95% C.I.] Prevalence of severe underweight (2) 0.4 % (1) 0.4 % (1) 0.4 % (<-3 z-score) [0.1 ↔1.6 [0.1 ↔2.9 [0.1 ↔ 2.9 95% C.I.] 95% C.I.] 95% C.I.] Interpretation of Results (WHO Classification) Index Stunting <- 2 SD % Wasting <- 2 SD % Underweight <- 2 SD % Low < 20% <5% <10% Medium [20↔29%] [5 ↔ 9% ] [10 ↔19% ] 26.8% [23.6 ↔ 30.3] 6.2% [4.1 ↔ 9.3] 16.0% [13.1 ↔-19.3] High [30↔ 39%] [10↔14%] [20↔29%] Alarming/ ≥ 40% ≥ 15% ≥ 30% Critical The Prevalence of Global Acute Malnutrition in Pochalla was classified as medium The prevalence of stunting and underweight were classified as low WHO Classification of Malnutrition with Corrective Action GAM W/H Z Score Interpretation Corrective Proposed Action < 5% Acceptable - 5 - 9.9% Poor Supplementary Feeding Selective Supplementary Feeding of the 10 - 14.9% Serious Malnourished Population is High Priority Selective Supplementary Feeding of the Malnourished Population is High Priority >=15% Critical Additional Food to all Children and Vulnerable Groups Improve Basic Food Supply Since the GAM rate is classified as poor, then it is recommended that the supplementary feeding should be implemented in Pochalla County this should be both Supplementary Feeding Program (SFP) and Blanket Supplementary Feeding Program (BSFP) Mortality Rates Value Crude Death Rate 0.43 (0.171↔.08) Under-Five Mortality Rate 0.37 [0.05↔2.75 ] Both the Crude and Under-Five Mortality Rates were found to be low (: <2 – Low; 2 - <4 – Medium; 4 and above – Emergency) The leading causes of mortality in Pochalla were: Suspected measles (8.3%, n=1) Fever (16.7%, n=2) Pneumonia (8.3%, n=1) Unknown causes (25.0%, n=4). IYCF Results Minimum Dietary Diversity 23.5% Minimum Meal Frequecy 30.2% Timely Complementary Feeding 44.1% Exclusive Breastfeeding Rate 47.8% Continued Breastfeeding at 2 Yrs (20-23 Months) 95.7% Continued Breastfeeding at 1 Yr (12-15 Months) 100.0% Timely Initiation to Breastfeeding 92.6% 0.0% 20.0% 40.0% 60.0% 80.0% 100.0% 120.0% The breastfeeding practices were high in the Pochalla County. This is demonstrated by the high continued breastfeeding rates both at 1 and 2 years and also the high timely initiation to breastfeeding. However, EBF was still low at 47.8% Feeding practices among the 6 – 23 children was found to be poor which is demonstrated by the low minimum meal diversity and the minimum meal frequency Children Morbidity IYCF Results n N Proportion Morbidity 223 509 43.8% Fever 102 45.7% Cough 112 50.2% Diarrhoea 68 30.5% 223 Skin Infection 3 1.3% Eye Infection 15 6.7% Health Seeking Behavior (PHCC/PHCU) 215 96.4% High morbidity rates in Pochalla County at 43.8% Leading causes of morbidity include: Coughing (50.2%), Fever (45.7%), and Diarrhoea (30.5%) The health seeking behavior in the county was commendable at 96.4% with the PHCC/PHCU being the preferred Service Delivery Points Immunization 99.0% 96.1% 100.0% 90.0% n=468 80.0% n=504 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% Vitamin A Supplementation Measles Vaccination The Vitamin A Supplementation was high at 99.0% (n=504) The measles vaccination was high at 96.1% (n=468) with 61.2% being confirmed by cards and the other 34.9% through recall The high immunization rates were attributed to the monthly immunizations through the expanded program of immunization (EPI) outreaches Water and Hygiene Indicator n N Percent Borehole 378 70.7% Main Source of Drinking Water Open Shallow Well 19 535 3.6% River/Stream 138 25.8% < 30 Minutes 263 49.2% 30 Min - < 1 Hr 108 20.2% Time Taken to Fetch Water 1 Hr - < 2 HRs 122 535 22.8% 2Hrs - < 4 Hrs 40 7.5% Over 4 Hrs 2 0.4% Food Security Indicator Percent n Sale of Natural Resources 20.6% 110 Major Sources of Income Family Support 20.4% 108 Brewing 16.8% 90 Own Production 73.6% 394 Main Sources of Food Work-for-Food 6.9% 37 Purchase from Market 6.5% 35 Yes 88.5% 454 Cultivated in Last Season No 11.5% 81 Insecurity 88.2% 472 Major Shocks Expensive Food 71.8% 384 Limited Access/Movement 49.5% 265 Short Term Recommendations Conclusion Recommendations By Who Poor Nutrition Situation Introduction of the supplementary feeding programmes i.e.
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