NUTRITIONAL ANTHROPOMETRIC SURVEY Final Report Rawalpindi City Pakistan
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NUTRITIONAL ANTHROPOMETRIC SURVEY Final report Rawalpindi City Pakistan 4th to 16th June 2007 TABLE OF CONTENTS 1. EXECUTIVE SUMMARY ...............................................................................................................4 2. INTRODUCTION ...........................................................................................................................7 2.1 Structures of Power..................................................................................................................7 2.2 Demography ............................................................................................................................8 2.3 Migration Features ...................................................................................................................9 2.4 Rawalpindi Demographic Features ..........................................................................................9 2.5 Access to Infrastructures........................................................................................................11 2.5.1 Health facilities ..............................................................................................................11 2.5.2 Educational Facilities.....................................................................................................11 2.5.3 Water and Sanitation Facilities ......................................................................................11 2.6 Morbidity and Mortality ...........................................................................................................12 2.7 Childcare Practices ................................................................................................................12 2.8 Malnutrition ............................................................................................................................12 3. SURVEY OBJECTIVES...............................................................................................................12 4. METHODOLOGY ........................................................................................................................13 4.1. Selection of Survey Area within Rawalpindi City................................................................13 4.2. Survey Methodology ..........................................................................................................16 4.3. Sample size and sampling procedure for anthropometric and mortality data .....................16 4.3.1. Sample size for anthropometric data .............................................................................16 4.3.2. Sample Size for Household and Mortality Data .............................................................17 4.3.3. Selection of Clusters......................................................................................................17 4.3.4. Selection of Households and Children...........................................................................17 4.4. Key informant Interviews and secondary data collection....................................................18 4.5. Data collection and measurement techniques ...................................................................19 4.5.1. Anthropometric data ......................................................................................................19 4.5.2. Household and Mortality Data .......................................................................................19 4.6. Training and supervision....................................................................................................20 4.7. Data analysis .....................................................................................................................20 4.8. Indicators and Formulae ....................................................................................................21 4.8.1. Acute Malnutrition..........................................................................................................21 4.8.2. Chronic Malnutrition.......................................................................................................21 4.8.3. Mortality.........................................................................................................................21 5. FIELD WORK ..............................................................................................................................22 6. RESULTS....................................................................................................................................22 6.1. Anthropometric results.......................................................................................................22 6.1.1. Age and sex distribution of the sample population.........................................................22 6.1.2. Anthropometric analysis (based on Z-scores)................................................................23 6.1.3. Anthropometric analysis (based on Percentage of the Median).....................................24 6.1.4. Anthropometric analysis (comparison of Z-score and Percentage of Median) ...............25 6.1.5. Anthropometric analyses – Risk of Mortality: Children’s MUAC.....................................25 6.2. Visited Households’ description .........................................................................................26 6.3. Results of retrospective mortality survey............................................................................27 6.4. Results of Key Informant Interviews and Secondary Data .................................................27 6.4.1. National and District Level Key Informant Interviews.....................................................27 6.4.2. Union Council Level Key Informant Interviews...............................................................28 6.4.3. Secondary Data Collection ............................................................................................29 7. DISCUSSION AND RECOMMENDATIONS................................................................................29 8. ACKNOWLEDGEMENTS............................................................................................................31 9. APPENDICES .............................................................................................................................32 Action Against Hunger, Nutrition Survey: Rawalpindi City, Pakistan June 2007 2 List of Acronyms AAH Action Against Hunger ACF Action Contre la Faim ADB Asian Development Bank CI Confidence Interval DCO District Coordination Officer EDO Executive District Officers GAM Global Acute Malnutrition HFA Height for Age IDP Internally Displaced Person KG Kilogram LHW Lady Health Worker MUAC Mid Upper Arm Circumference NCHS National Center for Health Statistics NGO Non Governmental Organizations NWFP North Western Frontier Province SMART Standardized Monitoring and Assessment of Relief and Transitions TB Tuberculosis UC Union Council WASA Water and Sanitation Agency WFH Weight for Height WHO World Health Organization Action Against Hunger, Nutrition Survey: Rawalpindi City, Pakistan June 2007 3 1. EXECUTIVE SUMMARY Rawalpindi is located in Punjab Province, North-East Pakistan, in the close vicinity of Islamabad. Rawal city has an estimated population of about 1 million in 20071. Four union councils out of 46 within Rawalpindi City were chosen for a joint nutritional and food security survey based on an analysis of indicators for vulnerability which included density, minority population, secure tenure, housing conditions, water and sanitation, impact of natural disaster, accessibility to food markets and sustainable employment. It was felt that these four union councils were the most vulnerable out of the 46 and relatively homogeneous in regards to their vulnerabilities. The union councils are Dhok Hassou North Union Council 5, Fauji Colony Union Council 8, Mohallah Eidgah Union Council 16 and Pirwadhai Union Council 7. Dhok Hassou North is located in the northern part of Rawalpindi, across the road defining the administrative boundary between Rawalpindi and Islamabad. One of the specificities of Dhok Hassou is that it encompasses a large population from Pathan origin (these are Pashto speakers versus the native district Punjabi speakers). The Pathan populations living in Dhok Hassou North are from longstanding in-migrations. Such a significant proportion of Pathans in this union council is related to economic opportunities. Wholesale or retail markets are strongly handled by Pathans, notably involved in the nearby Sabzi Mandi (vegetable and fruits wholesale market). Men are mainly daily- wage workers. The estimated population in 2007 is 18,503. Dhok Hassou North is bordered by Lai Nulla River on its Eastern, Southern and Western part, increasing its exposure to flooding during the monsoon period. Fauji Colony Union Council 8 had to face an influx of population following the eviction of Afghan refugees from a nearby camp. About 30,000 people lived in this informal settlement and had no choice than move in September 2005. They were requested to return to Afghanistan but part of them are said to have stayed in the neighboring union councils for economic reasons: Consequences of migrations since the eighties are mainly related to the pressure on facilities and resources (accommodation, water, sanitation). Similarly to Dhok Hassou, Pathan communities also constitute a large proportion of the population of Fauji Colony. About 72% are longstanding residents (27% natives from