SMART survey

Badin district,

Sindh Province, Pakistan

November 2014

Title: SMART survey Preliminary Report Place: Badin District of Sindh Province, Pakistan Funded By: ECHO (PEFSA-V) By: Muhammad Ali, Action Against Hunger / ACF International

ACF SMART Survey executive summary, Badin district, Sindh Province, Pakistan, Oct-Nov 2014

1. Introduction

Badin district is located in Sindh province. It is divided into 5 Talukas Badin, Talhar, Matli, Tando Bago and shaheed Fazil Rahu. All five Talukas are sub-divided into 49 Union councils (UCs). The district is bordered with Thatta, Sujawal, Tando Allahyar, Hyderbad, Tando Muhammad Khan, Mirpur Khas and TharParker district.

The bulk of Population i.e 83% resides in rural areas with farming as main source of livelihood. The district produces about 50 % of total production of crude oil of Pakistan but remains one of the poorest districts of Sindh. Recent history shows that it has remained in the grip of disasters in one form or another. Cyclone, heavy rains, droughts and floods have followed each other with short intervals.

2. Objectives

The overall objective of the nutrition survey was to measure the extent and severity of acute malnutrition in children aged 6 to 59 months and their caregivers (pregnant and lactating women). The specific objectives for Badin District were:

 To estimate the prevalence of acute and chronic malnutrition among children 6-59 months of age;  To estimate crude and under five mortality rates;  To estimate the prevalence of maternal malnutrition among pregnant and lactating women;  To assess morbidity and immunization coverage among 6-59 months children;  To give appropriate recommendations for intervention programs in district.

3. Methodology

Study area: The survey was conducted in all 49 union councils of Badin District of Sindh Province.

Study design: The survey was a cross sectional study with two-stage cluster sampling using Standardized Monitoring of Relief and Transition (SMART) methodology. Villages are considered as the smallest geographical unit (clusters).

Study population:  Children 6–59 months old: Anthropometric measurements and oedema was measured from children 6-59 months old in the sampled household in all selected villages.  MUAC measurement of Pregnant and Lactating Women (PLW) was taken to estimate the malnutrition prevalence in PLW in all selected villages. Lactating: Mothers of children under 6 months of age. Pregnant: in third trimester and visible pregnancy

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ACF SMART Survey executive summary, Badin district, Sindh Province, Pakistan, Oct-Nov 2014

Sample size: Emergency Nutrition Assessment (ENA) for SMART software delta version (Nov 10th, 2014 version) was used for sample size calculation.

4. Preliminary results

For the sake of timely presentation of survey results, Table 1 summarizes preliminary findings with regards to nutrition and health indicators. The final report will contain the full analysis and will be completed within one month.

A total of 621 children aged 6-59 months were assessed for their nutritional status through anthropometric measurements from 502 sampled households. The data quality analysis is presented in annex 2 (plausibility check summary).

Table 1: Summary of Nutrition and Health indicator results, Badin District, Sindh Province, Oct-Nov 2014

Results presented in brackets are expressed with 95.0% confidence interval (CI)

Index Indicators Badin Result (%) Global Acute Malnutrition (GAM) 18.3 Weight for height< -2 z and/or oedema (14.5 - 22.9) WHZ- scores Severe Acute Malnutrition (SAM) 3.7 Weight for height < -3 z and/or oedema (2.1 - 6.4 Stunting 54.5 HAZ- scores WHO 2006 Height for age <-2 z-score (48.9 - 60.1) Underweight 45.5 WAZ-scores Weight for age <-2 z-score (41.1 - 50.1 Global Acute Malnutrition 9.8 MUAC <125 mm or oedema (7.4 - 13.0) MUAC Severe Acute Malnutrition 3.9 MUAC <115 mm or oedema (<115mm) (2.5 - 6.0) The final report will be available in the coming weeks

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Annex 1: Sample size calculation for nutrition status using ENA for SMART software (Nov10th, 2014 version)

U5 Sample size Sample Clusters (13HHs/ Estimated GAM Precision DEFF Av. HH size Contingency Population Children size HHs Cluster)

23% 5% 1.5 14.8% 7 5% 444 502 39

Annex 2: Plausibility check summary, Badin District

Missing/ Digit pref. Digit pref. Standard Poisson Overall sex Overall age Skewness Kurtosis Overall CRITERIA flagged score score Digit pref. deviation distribution ration distribution WHZ WHZ score WHZ data Weight Height score WHZ WHZ Height

SCORE 0 (0.6 %) 0 (p=0.100) 0 (p=0.518) 0 (2) 0 (2) 0 (4) 0 (0.99) 1 (-0.20) 0 (0.10) 3 (p=0.002) 4%

Interpretation Excellent Excellent Excellent Excellent Excellent Excellent Excellent Good Excellent Acceptable Excellent