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Preliminary Report Integrated Survey Dadu District, Sindh Province

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Preliminary Report Integrated Survey Dadu District, Sindh Province December 2012 Preliminary report Integrated Survey Dadu District, Sindh province, Pakistan .I. Context Sindh province of Pakistan is bordered to the west by the Indus River and Baluchistan, to the north by Punjab, to the east by the Indian states of Gujarat and Rajasthan and to the south by the Arabian Sea. The capital of the province is Karachi, Pakistan's largest city and financial hub. The 23 districts making up the Sindh province are: Kambar Shahdadkot, Larkana, Shikarpur, Ghotki, Sukkur, Khairpur, Khashmore, Nau Shahro Feroze, Jacobad, Badin, Shaheed Benazir Abad (Nawabshah), Thatta, Jamshoro Sanghar, Matiari, Dadu, Tando allay Yar, Tando Mohammad Khan, Hyderabad, Mirpurkhas, Umerkot, Tharparket, Sanghar and Karachi. Dadu district (Figure 1) has four Talukas namely Dadu, Khaipur Nathan Shah (K.N.Shah), Mehar and Johi1. The district is bordered by the following districts - Naushero Feroze in the East, Khirthar Range in the West, Kambar Ali Khan and Warah districts in the north, and Thalo Bula Khan in the South. The district is estimated at 7866 square kilometers. There are 52 Union Councils (UCs) in Dadu district2. Figure 1: Map showing Nutrition survey areas in Dadu district 1 Pakistan emergency situational analysis, District Dadu; iMMAP Pakistan, November 2012 2 Dadu district comprises Talukas of Mehar, Khairpur Nathan Shah (KN Shah), Dadu and Johi. The union councils (UCs) for Mehar Taluka are Radhan, Mangwani, Bothro, Shah Punjo and Kolachi; K.N.Shah are Khaipur Nathan Shah, Sita Road, Kakar, Mitho Babar, Kande Chuki, Thalho, Burira, Gozo and Chhore Qamber and Nau Goth. Dadu Taluka has Pat (Rural), Allahabad, Makhdoom, Sial, Pipri, Mian Yar Muhammad Kalhoro and Khudabad. Johi Taluka has Johi (Urban), Drigh Bala, Tando Rahim Khan (at Wahi Pandhi), Phulji, Pat Gul Muhammad, Chhinni and Sawro. 2 In Dadu district, ACF International and Merlin International Non-Governmental Organizations (INGOs) are the organizations that implement targeted nutrition interventions (Community Management of Acute Malnutrition-CMAM) in various UCs since 2011. The broad situation of the nutritional status in Pakistan is well reported in the 2011 Pakistan National Nutrition Survey (NNS) which indicates that malnutrition rates are unacceptably high and reports around 57% of the 30,000 households surveyed nationally face food insecurity3. The report indicates a Global Acute Malnutrition (GAM) rate of 17.5% and a Severe Acute Malnutrition (SAM) rate of 6.6% among children under-five years in Sindh province. In addition, the prevalence of chronic malnutrition (stunting) and underweight has been critically high among under five (U5) children in Sindh, with stunting and underweight rates of 49.8%, and 40.5% respectively3. Health experts have noted that the increasing rate of chronic and acute malnutrition in the country is primarily due to poverty, high illiteracy rate among mothers and lack of government commitment towards ensuring food security to each and every citizen. Part of the challenge has been as a result of inherent inadequate practices in infant feeding practices and access to “right” foods4. In regard to infant and young child nutrition (IYCN), NNS 2011 survey results, also revealed that across Pakistan only 40.5% of mothers had initiated breastfeeding within one hour of birth, and 47.9% started to introduce semi-solid foods to their children before the recommended period of 6 months of age. Further to this, only 4.6% of women provided a minimum diversified diet for their children aged 6-23 months. Micronutrient deficiencies are also widespread in Sindh province, with more than 60% of women reported anemic, and 49.5% of women reported having zinc deficiency. The UNICEF report on evaluation of CMAM4 notes that even though Pakistan has achieved high coverage for some nutrition interventions such as Vitamin A supplementation and salt iodization, huge gaps exist in terms of coverage of essential health and nutrition services and the country ranks low in many nutrition indicators. After the 2010 Pakistan monsoon floods hit, the ACF-CA/UNICEF Flood Affected Nutrition Survey (FANS) conducted in October/November 2010 showed GAM rate of 22.9% and a SAM rate of 6.1%5 in Southern Sindh province. ACF also, conducted other nutrition surveys in Dadu district in the periods; October- November 2007, June 2008, and October 2011. The design of the nutrition surveys varied (although all based on SMART methodology) and were conducted at different seasons of the year, so that results are not strictly comparable. However they are important in giving a picture of the evolution of nutrition situation of Dadu district at various points in time throughout a five-year period and are summarized in Table 9 in the results section of this report. These trends show that GAM rates have been above the World Health Organization's (WHO) 15% emergency threshold even before the 2010 floods. Pakistan has a government strategy to address malnutrition, as laid out in the Pakistan Integrated Nutrition Strategy (PINS), a multi-sectoral strategy that has been developed in 2011. PINS recognizes the nutritional problem, particularly high GAM and stunting rates and defines clear short term, medium term, and long term interventions and targets by using the immediate, underlying, and basic interventions. The implementation of the strategy recommends a National and Provincial Multi-sectoral Nutrition Board, creation of a simple Nutrition Information System and an intersectoral working group. The intersectoral working group will be made up of the 5-6 nutrition-related sectors that provide technical input to the Nutrition Board, and that mainstreams nutrition into all development and humanitarian projects. 3 National Nutrition Survey of Pakistan. Department of pediatrics and child health, Aga Khan University, Pakistan, Pakistan Medical Research Council (PMRC), Nutrition Wing, Cabinet Division, Government of Pakistan. Supported by Unicef Pakistan. Nov 2011. 4 Evaluation of community management of acute malnutrition (CMAM); Pakistan country case study, UNICEF, July 2012 5Flood Affected Nutrition Surveys, Sindh Province, October-November 2010, Unicef, ACF-CA, Department of Health of Pakistan 3 A coordinating body of nutrition-oriented donors was envisaged and would function as a donor pool where agencies and organizations developing nutrition related projects or programs for funding can submit proposals to be taken up by interested donors in a coordinated way6. An operational plan for PINS has been published with key nutrition interventions7. In addition, there has been a recent plan by the Ministry of Health (MoH) to start implementation of nutrition activities through the Pakistani People Health care Initiative (PPHI) in 4 districts while supporting national NGOs to continue implementing in 11 districts in Sindh. ACF has supported integration of CMAM activities to the health system’s Basic Health Units (BHUs) activities from September 2011 up to date (December 2012). In this endeavor, ACF supports one Nutrition Stabilization Centre (SC) and 9 Supplementary Feeding (SFP)/ Outpatient Therapeutic Program (OTP) Sites8. Supplies for treatment of malnutrition are provided by UNICEF and WFP. Merlin International has also supported emergency treatment of malnutrition in 12 OTP/SFP sites9 in Dadu District. Children with SAM and Moderate Acute Malnutrition (MAM) under the age of five and Pregnant and Lactating Women (PLW) are the beneficiaries. To ensure sustainability in treatment of malnutrition in the district, ACF’s nutrition program has also built the capacity of the District Health Office (DHO) staff in CMAM. This has mainly been done through trainings delivered to health care providers, Lady Health Workers (LHWs), Community Health Workers (CHWs) and Community Nutrition Volunteers (CNVs). Between September 2011 and December 2012, a total of 3,910 SAM and 9,671 MAM children, as well as 4,451 MAM PLW’s were treated and recovered in the CMAM program. Also, 185 SAM cases with medical complications recovered in the stabilization center at Mehar Hospital. In order to continue monitoring the nutritional situation in Dadu district, and to inform program actions in future nutrition intervention in the district, ACF implemented a nutrition survey in Dadu in December 2012. .II. Objectives The survey was guided by the following objectives: • To determine the prevalence of acute malnutrition among 6-59 months old children; • To estimate crude and under-five mortality rates; • To investigate household food security and food consumption practice; • To estimate morbidity rates of children below five years; • To determine the Infant and Young Child Feeding Practices (IYCF) among children 0-23 months of age; • To determine the proportion of households with access to safe water and sanitation; • To give appropriate recommendations for intervention programs in the district. 6 Pakistan Integrated Nutrition Strategy (PINS) operational plan (July 2011-Dec 2012) 7 Scaling Up a Set of Direct Nutrition Interventions: Four Key elements: CMAM, Infant and young child feeding and hygiene, multi micro nutrient supplementation and deworming, food fortification, access to safe water and sanitation. PINS Operational Plan; July –December 2012 8 Mounder (Mounder UC), Bahawalpur (Bahawalpur UC), Kamal Khan (Kamal Khan UC), Qasbo (Torre UC), Bughio (Bughio UC), Essa Khan (Buttra UC), Dogar (Pariya UC), Nao Goth (Nao Goth UC) and Mangwani (Magwani UC) BHU/OTP sites distributed in the Talukas of Dadu, K.N. Shah, Johi and Mehar
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