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Integrated Nutrition and Mortality SMART Survey Final Report Sar e Pul Province, Afghanistan 6th to 15th April 2021 Survey Led by: Dr. Muhammad Khalid “Zakir”, SMART Program Manager Authors: NUT-Surveillance Department, Action Against Hunger Afghanistan AFGHANISTAN Technically supported by: Global SMART team, AAH Canada and Technical Advisor, AAH France Funded by: Action Against Hunger | Action Contre La Faim A non-governmental, non-political, and non-religious organization Acknowledgments Action Against Hunger would like to thank all the stakeholders and partners who provided support to the SMART Assessment teams in all districts of Sar e Pul province: This survey would not have been possible without the financial support provided by European Union Humanitarian Aid (ECHO). Ministry of Public Health (MoPH), especially the M&EHIS Directorate, Public Nutrition Directorate (PND), AIM-Working Group, Afghanistan Nutrition Cluster, and the Nutrition Small Scale Surveys Steering Committee for their support, review, and validation of the survey protocol. Sar e Pul Provincial Public Health Directorate (PPHD) for their support and authorization; special thanks go to Dr. Noor Ahmad Ishaqzi Sar e Pul public health director and Dr. Ghulam Habib Stanekzai SEHATMANDI Project Manager for all the facilitation and assistance they have provided for smoothly implementing of this assessment. All community members for welcoming and supporting the survey teams during the data collection process. Special appreciation to the survey teams for making the survey a reality. Action Against Hunger team at Kabul and Paris for technical and operational Supports. Bijoy Sarker, SMART Regional Advisor - Asia, and Action Against Hunger Canada for technical support, review and validation of the report. Statement on Copyright © Action Against Hunger Action Against Hunger is a non-governmental, non-political, and non-religious organization. Unless otherwise indicated, reproduction is authorized on the condition that the source is credited. If reproduction or use of texts and visual materials (sound, images, software, etc.) is subject to prior authorization, such authorization was render null and void the above- mentioned general authorization and will clearly indicate any restrictions on use. The content of this document is the responsibility of the authors and does not necessarily reflect the views of Action Against Hunger and GAC. 2 Abbreviation ACF/AAH Action Contre la Faim / Action Against Hunger AIM-TWG Assessment and Information Management Technical Working Group AOGs Armed Opposition Groups ARI Acute Respiratory Infection BHC Basic Health Centre BPHS Basic Package of Health Services BSU Basic Sampling Unit CBA Child-Bearing Age CDR Crude Death Rate CHC Comprehensive Health Centre CI Confidence Interval DEFF Design Effect DH District Hospital DP Desired precision ENA Emergency Nutrition Assessment EPHS Essential Public Health Services EPI Expanded Program on Immunization FHH Family Health House GAM Global Acute Malnutrition HAZ Height for Age Z-score HF Health Facilities HHs Households IDPs Internally Displaced People IEC Information Education and Communication IMNCH Integrated Maternal New born and Child Health IPC Integrated Food Insecurity Phase Classification IPC Infection Prevention and Control IPD-SAM Inpatient Department for Severe Acute Malnutrition IYCF Infant and young Child Feeding MCH Mother and Child Health M&EHIS Monitoring and Evaluation - Health Information System MHT Mobile Health Team MM Millimetres MoPH Ministry of Public Health MUAC Mid-Upper Arm Circumference MW Mean Weight NGO Non-Governmental Organization NSIA National Statistics and Information Authorities NSSSSC Nutrition Small Scale Surveys Steering Committee OPD-MAM Outpatient Department for Moderate Acute Malnutrition OPD-SAM Outpatient Department for Severe Acute Malnutrition OW Observed Weight PH Provincial Hospital PHC Prison Health Center PHC Primary Health Care 3 PLW Pregnant and Lactating Women PND Public Nutrition Directorate PNO Public Nutrition Officer PPHD Provincial Public Health Directorate PPS Probability Proportional to Size PSU Primary Sampling Unit RC Reserve Cluster RUSF Ready to Use Supplementary Food RUTF Ready to Use Therapeutic Food SAF Solidarity for Afghan Family SAM Severe Acute Malnutrition SD Standard Deviation SHC Sub Health Center SMART Standardized Monitoring and Assessment of Relief and Transitions U5DR Under-five Death Rate UNICEF United Nations Children’s Fund UN-OCHA United Nations Office for the Coordination of Humanitarian Assistance W/H Weight for Height WASH Water, Sanitation and Hygiene WAZ Weight for Age Z-Score WFP World Food Program WHO World Health Organization WHZ Weight for Height Z-score Table of Contents Acknowledgments .................................................................................................................................... 2 Abbreviation .............................................................................................................................................. 3 1. Executive summary ............................................................................................................................................... 8 2. Introduction ......................................................................................................................................................... 10 2.1. Geographical area .................................................................................................................. 10 2.2. Health and Nutrition Services ............................................................................................. 10 2.3. Food Security .......................................................................................................................... 11 2.4. Description of the survey area ............................................................................................ 11 2.5. COVID situation in Sar e Pul ................................................................................................ 12 2.6. Survey Justification ........................................................................................................................ 12 3. Survey objectives ................................................................................................................................................ 13 3.1. General objective ............................................................................................................................ 13 3.2. Specific objectives .......................................................................................................................... 13 4. Methodology ....................................................................................................................................................... 13 4.1. Survey Design Considerations during Covid-19 pandemic ........................................... 13 4.2. Geographic target area and population group ................................................................. 14 4 4.3. Survey period .......................................................................................................................... 14 4.4. Survey design .......................................................................................................................... 14 4.5. Sample Size .............................................................................................................................. 15 4.6. Sampling Methodology ......................................................................................................... 17 4.6.1. First stage sampling (Selection of the clusters) ................................................................ 17 4.6.2. Second Stage Sampling (Selection of Households) ......................................................... 18 4.7. Field Procedures ..................................................................................................................... 19 4.8. Household inclusion and exclusion criteria ....................................................................... 20 5. Health and Safety Measures During the Survey Implementation ........................................................... 21 5. Indicators: Definition, Calculation, and Interpretation .............................................................................. 23 6.1. Overview of Indicators .......................................................................................................... 23 6.2. Anthropometric, Health, and Immunization Indicators .................................................. 24 6.3. Chronic and Acute Malnutrition .......................................................................................... 25 6.4. Combined GAM ...................................................................................................................... 26 6.5. Chronic malnutrition .............................................................................................................. 26 6.6. Underweight............................................................................................................................ 26 6.7. The proportion of acutely malnourished children enrolled in or referred to a Program 27 6.8. Malnutrition prevalence among women 15-49 years based on MUAC criterion ..... 27 6.9. Measles Both Doses Coverage ............................................................................................ 27 6.10.
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