Rapid Nutritional Assessment (RNA) on Flood-Affected Populations In
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Rapid Nutritional Assessment (RNA) on Flood-Affected Populations In Awsi-Rasu and Gabi-Rasu IDP Sites Afar Region (13th – 18th October 2020) Date of report: 25th October 2020 Joint Government and Humanitarian Partners Joint Regional Assessment Team Afar Regional Health Bureau and DPFSPCO, WFP Samara, Afar_ Ethiopia Introduction According to the Afar Regional and NGO Joint Rapid Nutrition Assessment, the majority of IDPs (Internally Displaced Persons) are identified in Aysaita district (9,377 people). The demographic profile suggests that 54% of the displaced population are children, of which 7.9% are five (5) years old or younger. Although one-fourth of the IDPs (21%) live in host communities, there are still the majority of the IDPs (79%) that have settled in formal and informal sites, and sites/camp like settlements. In Aysaita district, 4 of these IDP sites have been identified. Figure 1: Location of Assessment Woredas Map-flood affected areas in Afar Aysaita Afambo A scre ening exercise was conducted in the 3 Internally displaced people sites (IDP) in selected areas of Aysaita district between 13th and 15th October2020. While all screenings were conducted in the government managed sites/settlements, there were also some IDP out of the formal sites screened. Please note that IDP site in the newly accessible area/sultan-Alimirah was not captured by the Joint Regional Government and humanitarian partners assessment-RNA mission. RNA Joint Assessment Team Composition, Awsi-Rasu Team No. List of Team Organization Role Remarks 1 KEDIR LAALE DPFPCO/ENCU ENCU Coordinator 2 NUR MOHAMMED DPFSPCO/WFP TSFP Coordinator 3 SELAMAWIT HAILU PIE Health and Nutrition Supervisor 4 MOHAMMED ABAGEZ RHB Nutrition Focal Person 5 HASSAN SCI CMAM -Supervisor 6 AYDAHIS ALI ABH/UNICEF Zonal Monitor 2. Objective The main purpose of conducting the rapid nutrition assessment is to assess nutrition situation, particularly to know the total number of children and PLW affected/displaced as well as the proportion of malnourished individuals over the total number of IDP sites and health status of the worst affected flooding Woredas of Awsi-Rasu and Gabi-Rasu in order to verify whether flagged areas of concern obtained from the Regional early warning reports are actually affected and displaced population/areas and to see the need for conducting a standard emergency nutrition survey and trigger an immediate response. 2.1 Specific Objective a) To estimate nutritional status of children 6-59 months of age using Middle Upper Arm Circumference (MUAC) and Oedema in the selected flood affected Woredas of Afar Region; b) To estimate nutritional status of Pregnant and Lactating Women (PLW) using MUAC measurement. c) To assess morbidity status of children aged 6-59 months; d) To assess the level of food insecurity situation of the affected /displaced population and identify possible foreseen scenarios including main aggravating factors; e) To assess environmental sanitation situation of the community in the affected Woredas, IDPs. 3. Methodology A total of six oriented health workers and three food security officers were deployed per each Woreda/IDP sites and over a three-day period conducted rapid nutrition assessment in all children aged 6 to 59 months and PLW using Mid Upper Arm Circumference (MUAC) tapes, children were also assessed for nutritional oedema. The assessment was employed by using the National Emergency Nutrition Coordination Unit /Disaster Prevention and Preparedness Agency (ENCU/DPPA, 2006) guideline. A purposive and two stage simple random sampling methods was used to determine IDPs and villages to carry out the assessment. The RNA exercise had purposively targeted in selected flood affected Woredas in Awsi-Rasu and Gabi-Rasu Woredas of the region. In this case, Aysaita and Afambo Woredas in Awsi-Rasu, and Amibara and Gewane Woredas in Gabi-Rasu was selected for the purpose this RNA assessment exercise. Three out of total IDP sites were identified as worst affected areas, and selected using the purposive sampling technique per each sampled Woreda. As summarized in table 1 below, Focus Group discussion (FGD), Key Informant Interview (KII), MUAC screening and Transect walk were the main activities undertook to collect both primary and secondary data. Table1: RNA main activities at Woreda and IDPs levels Study Location Major Activities Participants Woreda Briefing & planning meeting with - Woreda Health and Pastoral & Rural Woredas Officials in the 1st day of Development Offices, and Water resources Office; and Woreda Administrators 4 KII Kebele Briefing & planning meeting HEW, Health Officer and kebele Administrator (flood affected) 3 KII IDP Site 2 FGD Men and Women Groups 1 MUAC Screening Children 6-59 months old and PLW (15-49 years aged) 1 Transect Walk The entire IDP sites per each Woreda Woreda Level: 3 KIIs were conducted with focal persons from Woreda health, pastoral and rural development offices and Woreda Administrator per a Woreda. 3 KII was conducted with flood affected Kebele administrators, and health extension workers. IDPs Level: Two FGDs with voluntary participants of young and elderly groups of men and women, drawn from the community, were parallel and independently conducted to gather qualitative information reflecting community perception and perspective of the overall health, nutrition and food security situation of the communities in the affected IDP/Woreda. In order to determine the nutritional status of children aged 6 - 59 months, nutritional assessments using MUAC and identification of oedema and PLW at household level (IDP sites) will be employed per sampled IDP/kebele. In some cases, if parents are not in a position to determine the exact age of the child, height are used as proxy indicator of age. Locally made measuring sticks were used to determine the height of the child. Children between 65 and 110 cm were included in the screening process. MUAC screening and oedema identification of children 6-59 months was carried out by the team moving from house to house and from one edge to the other end of the village/IDP sites to minimize bias. Thus, a total of 100 children per each IDP site/sub-kebele were measured using MUAC; and a minimum of 300 children and PLW were screened for their nutritional status in the three selected IDP sites per a Woreda. All children under five who are detected as severely malnourished were immediately referred to the nearby health facility using the referral slip form. Parallel to the MUAC and oedema measurement, physical observation of each IDP/village to assess various conditions of the flood affected community such as water, livestock, sanitation, hygiene were carried out using transect walks. MUAC are registered according to the cut off points recommended by ENCU/DPPA (2006) guideline for malnutrition as outlined in the following table: Table 2: U5 Children MUAC screening results presentation format Indicator Category/ Nutritional Status Number Percentage Oedema = A Kwashiorkor A (A/N)*100 MUAC < 115 mm = B Severe Acute Malnutrition (SAM) B (B/N)*100 115≤ MUAC < 125 = C Moderate Acute Malnutrition (MAM) C (C/N)*100 MUAC ≥ 125 = D Normal D (D/N)*100 Total N Severe Acute Malnutrition (SAM) A+B (A+B)/N*100 Global Acute Malnutrition (GAM) A+B+C (A+B+C)/N*100 Classification of MUAC malnutrition in children 6-59 months (based WHO Classification 2007) MUAC reading classification Severity <125 mm Moderate and severe (Orange & Red MUAC) ≥115 mm and <125 mm Moderate (Orange MUAC) ---- MAM <115 mm Severe (Red MUAC) ---- SAM Oedema Severe Awsi-Rasu Team-01_Arado IDP Site 15th October2020 4. Results Screening results with proportions of SAM and MAM Children (6-59 months aged) assessed in the four selected flood-affected Woredas of Awsi-Rasu and Gabi-Rasu using MUAC measurement are summarized in Table 4.1; Table 4.1: Proportions of SAM and MAM Children (6-59 months) in Awsi-Rasu, October 2020 Awsi-Rasu Number of IDP sites assessed: 6 AYSAITA AFAMBO Number of % Number of % MUAC Category Children Children MUAC ≥ 125mm no oedema (Green MUAC) 201 50.3 128 59.5 MUAC < 125 mm no oedema (Orange & Red MUAC) 199 49.8 87 40.5 MUAC ≥ 115 mm & < 125 mm no oedema (Orange MUAC) 95 23.8 58 27.0 MUAC < 115 mm and/or oedema (Red MUAC) 104 26.0 29 13.5 Total children screened 400 100.0 215 100.0 Fig1: Proportions of SAM and MAM by age, based on Fig2: Proportions of SAM and MAM by age, based on MUAC cut off's in Aysaita Woreda, October 2020 MUAC cut off's in Afambo Woreda, October 2020 Table 4.2: Proportions of SAM and MAM Children (6-59 months) in Gabi-Rasu, October 2020 Gabi-Rasu Number of IDP sites assessed: 6 AMIBARA GEWANE Number of % Number of % MUAC Category Children Children MUAC ≥ 125mm no oedema (Green MUAC) 200 66.7 205 68.3 MUAC < 125 mm no oedema (Orange & Red MUAC) 100 33.3 95 31.7 MUAC ≥ 115 mm & < 125 mm no oedema (Orange MUAC) 65 21.7 59 19.7 MUAC < 115 mm and/or oedema (Red MUAC) 35 11.7 36 12.0 Total children screened 300 100.0 300 100.0 Fig3: Proportions of SAM and MAM by age, based on MUAC Fig4: Proportions of SAM and MAM by age, based on cut off's in Amibara Woreda, October 2020 MUAC cut off's in Gewane Woreda, October 2020 As indicated in the figures above, a higher proportion of the children aged 6 - 17 months were more severely malnourished based on MUAC (<125mm) than the older children aged (30-59) months in all assessed Woredas IDPs IDP sites. Table 4.3: Screening results with proportions of SAM and MAM children by Sex and IDP sites Oedema (Severely MUAC <11.5 cm MUAC 11.5 cm & <12.5 cm MUAC >=12.5 cm SAM MAM No.