SMART SURVEY 2019
Hurungwe Mt. Darwin
Kariba Shamva
Murehwa Binga
Epworth
Buhera
Bikita
Mberengwa Mangwe
Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe March 2019 ZIMBABWE N 11 Selected Districts
Hurungwe • Bikita Mt. Darwin
Kariba Shamva • Binga
Murehwa • Buhera Binga
Epworth • Epworth
• Hurungwe
• Kariba Buhera
• Mangwe Bikita
• Mberengwa Mberengwa Mangwe • Mt Darwin
• Shamva
Selected districts
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe TTableable ofof ConConttenentsts
Foreword i
Acronyms and Abbrevia ons ii
Acknowledgements iv
Food and Nutri on Security Context 1
Ra onale 3
Objec ves 4
Methodology 5
Selec on of Enumera on Areas and Households 6
Ques onnaire Design and Enumerator Training 7
Data Collec on 8
Data Management and Analysis 9
Household and Children Demographics 10
Infant and Young Child Feeding Prac ces 22 Table of Contents Food For fica on and Micronutrient Supplementa on 32 Childhood Illness 41
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe TTableable ofof ConConttenentsts
Child Anthropometry 47
Water, Sanita on and Hygiene (WASH) 55
Conclusions and Recommenda ons 64
Report Wri ng Team 66
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe FFororeewworordd
Food and Nutri on Security (FNS) remain a major priority for na onal development in Zimbabwe. The mul -causal nature of FNS requires constant monitoring and evalua on according to season and place. Zimbabwe is experiencing a devasta ng El Nino since the 2015/16 agricultural season and the situa on is expected to worsen in 2019. Different districts will be affected differently by the same hazard, shock or crisis. Nutri on crisis may have a rapid or slow onset and as such need to be monitored regularly, par cularly following any significant changes in the primary determinants of under nutri on, dietary intake and diseases occurrence. The priority objec ve of the rapid nutri on assessment was to update the nutri on situa on data in 11 problema c districts and domains in the country.
In fulfilment of the Food and Nutri on Security Policy Commitment Six, which calls for the provision of mely food and nutri on security informa on; the Ministry of Health and Child Care in collabora on with its Partners embarked on Emergency Nutri on Assessment using the SMART methodology. This was following the poor food security projec ons by the January 2019 Lean Season Assessment , the cholera outbreaks reported in the country and the general price increases for basic foods and commodi es.
The results for the survey indicate that the rates of acute malnutri on have not changed significantly from the levels reported in the 2018 Na onal Nutri on Survey. However the contribu ng factors to acute malnutri on especially feeding and caring and prac ces, water sanita on and hygiene show a declining trend and need con nuous monitoring and strengthening for the country to maintain the prevalence of acute malnutri on within acceptable levels.
Major General Dr. G. Gwinji (Rtd) Permanent Secretary for Health
i SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe AcrAcrononymsyms andand AbbrAbbreeviavia ons ons
• EA Enumera on Area
• EBF Exclusive Breast Feeding
• ENA Emergency Nutri on Assessment
• GAM Global Acute Malnutri on
• IYCF Infant and Young Child Feeding
• MAD Minimum Acceptable Diet
• MAM Moderate Acute Malnutri on
• MDD Minimum Dietary Diversity
• MMF Minimum Meal Frequency
• MNP Micronutrient Powders
• MUAC Mid Upper Arm Circumference
• NNS Na onal Nutri on Survey
• RDC Rural District Council
• SAM Severe Acute Malnutri on
• SFP Supplementary Feeding Program
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe ii AcrAcrononymsyms andand AbbrAbbreeviavia ons ons
• SMART Standardised Monitoring and Assessment of Relief and Transi on
• UNICEF United Na on Children’s Fund
• VAS Vitamin A Supplementa on
• WASH Water, Sanita on and Hygiene
• WHA World Health Assembly
• WHO World Health Organisa on
• ZIMVAC Zimbabwe Vulnerability Assessment Commi ee
• ZIMSTAT Zimbabwe Na onal Sta s cs Agency
iii SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe AcknoAcknowledgwledgemenementsts
The technical and financial support received from the following is greatly appreciated:
• Adven st Development and Relief Agency (ADRA)
• Bikita Rural District Council
• City of Harare
• Ministry of Labour and Social Welfare
• Ministry of Local Government, Public Works and Na onal Housing
• Save the Children
• United Na ons Children’s Fund (UNICEF)
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe iv FFoodood andand Nutri onNutri on SecuritySecurity ConContteextxt
• The 2019 ZIMVAC Lean Season Assessment es mated that 51% of the rural popula on (4.5 million people) and 40.6% of the urbanites (3 million people) would be food insecure and in need of assistance during the peak hunger period (January to March 2019)
• The propor on of households with poor food consump on scores increased from 20% in 2018 to 31.9% in 2019
• The agricultural season was characterised by late rains; which were poorly distributed as well as high prices of key agricultural inputs such as seed, fer lisers and herbicides (ZIMVAC Lean Season Assessments 2019).
• The total area under maize decreased by 7% during the 2018/19 season compared to the 2017/18 agricultural season and the crop condi on was generally fair to poor (Crop and livestock assessment Round 1 2018/19).
• As of February 2019, the year on year food and non- alcoholic beverages infla on prone to transitory shocks stood at 69.8% whilst the non-food infla on rate was 54.3% (ZimStat Consumer Price Index 2019)
1 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe FFoodood andand Nutri onNutri on SecuritySecurity ConContteextxt
• Food insecurity is one of the three main underlying causes of malnutri on
• Nutri on security requires consump on of healthy foods, good health and care especially for women and children under five.
• Na onal Nutri on Survey of 2018 reported poor Infant and Young Child Feeding prac ces and only 4% of children 6-23 months received a minimum acceptable diet
• Na onal Global Acute Malnutri on (GAM) was at 2.5%; within acceptable range and stun ng stood at 26.2% with inter-district variances for both indicators
• Declining food security and health indicators typically is a good indica on that rates of acute malnutri on will also rise over me
• Zimbabwe has experienced a concerning degrada on in both determinants
• As food insecurity and rates of diarrheal disease increase progressively, rates of malnutri on are likely to follow a similar trajectory
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 2 RaRa onale onale
An Emergency nutri on assessment was conducted in 10 rural districts of Zimbabwe and Epworth iden fied using the following criteria:
• Rela vely higher GAM compared to the na onal average as described by the Na onal Survey of 2018; the highest GAM of 4.8% was reported in Kariba against a Na onal average of 2.5%
• Higher administra ve data on Severe Acute Malnutri on (SAM) admissions (DHIS 2) for the 10 districts compared to other districts in the same Province
• Cholera outbreaks in Shamva, Mt Darwin, Buhera and Epworth districts between September and December 2018 which resulted in 55 deaths and 10,202 suspected and confirmed cases na onally
• General price increases of basic food commodi es likely to affect access to food by women and children
• A devasta ng El Nino since the 2015/16 agricultural season; six of the selected districts are currently in IPC phase 3 and two are in IPC phase 4 (Buhera and Binga)
• The assessment was also meant to provide a data source for secondary IPC Acute Malnutri on Analysis
3 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe Objec vObjec veses
Overall Objec ve • To determine the current nutri on status of children 0 to 59 months in 11 hotspot areas (10 rural districts and Epworth) across 8 provinces
Specific Objec ves • To update the prevalence of global, moderate and severe acute malnutri on in 11 hotspot areas which was last reported in February 2018
• To es mate prevalence of chronic malnutri on among children aged 6 to 59 months
• To assess vitamin A supplementa on coverage among children aged 6 to 59 months
• To determine core IYCF and WASH prac ces for children 0-23 months
• To determine coverage of the Na onal Food For fica on program in the 11 hotspot districts
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 4 MeMethodologythodology
Study design • This was a cross sec onal study conducted across 10 districts and Epworth from 8 rural Provinces
Study popula on • All households that resided in the10 rural districts and Epworth. All the households in the districts had an equal chance of selec on
Sample Size • A sample size of 240 households expected to give an es mate of 119 children per district was calculated using ENA for SMART so ware based on the parameters shown in the table below: Table 1: Parameters used in sample size calcula on
Es mated Prevalence of GAM 5%
+- Desired precision 5% Design Effect 1.5 Children to be included 119 Average HH size 4.2
Percentage of children under -5 15% Percentage of non-response Households 3% Households to be included 217
5 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe Selec onSelec on ofof EnumerEnumeraa on on ArAreaseas andand HouseholdsHouseholds
• A total of 30 Enumera on Areas were randomly selected in each district using the ZIMSTAT master sample
• Eight households randomly selected were included per EA using simple random sampling a er segmenta on to yield 240 households per district
• Villages were randomly selected from within the target EAs.
• Where EAs and villages were very big, they were segmented
• Segments were randomly selected for data collec on.
• Households were visited at least twice before the teams le the EA
• Households were not replaced
• The assessment u lised the Standardised Monitoring and Assessment of Relief and Transi ons (SMART) approach
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 6 QuesQues onnair onnairee DesignDesign andand EnumerEnumeraattoror TTrrainingaining
• The standard SMART data collec on tool was adapted to include contextual indicators on Water Sanita on and Hygiene (WASH), childhood illness, Infant and Young Child Feeding (IYCF), growth monitoring and food for fica on
• The ques onnaire was loaded on an electronic pla orm; KOBO Collect
• The SMART training package was adapted and a 5 day Enumerator training conducted at a central venue from the 13th to the 17th of February 2019
• Competent enumerators and anthropometrists were selected from the MoHCC at district level
• A standardiza on test for anthropometry was conducted in collabora on with the City of Harare Health Department to enhance consistency of measurements
• A pilot test was conducted over a day in a rural field se ng and feedback was incorporated into the data collec on tool before data collec on
7 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe DaDattaa Collec onCollec on
• Data collec on was conducted over 10 days from the 19th to the 28th of February 2019 by 2 teams per districts; 2 Enumerators and 2 Anthropometrists
• Data was collected using hand-held electronic mobile devices that were linked to a central server.
• Data was automa cally transferred to the central server daily or whenever the device had connec on to internet
• Children 6-59 months had their heights, weights, oedema and MUAC assessed for the es ma on of GAM basing on WHO 2006 growth standards
• Verbal consent was obtained from all caregivers and respondents and confiden ality was assured
• Children who displayed signs of illness were immediately referred to the nearest health facility
• All oedema cases were verified and confirmed by the Provincial supervisory team
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 8 DaDattaa ManagManagemenementt andand AnalyAnalysissis
• The electronic ques onnaire had in-built restric ons to enhance quality and avoid outliers for certain variables for example date of birth, weight and height
• ENA for SMART was used for flag checks on anthropometry datasets
• Each Team of Enumerators was supervised by a Provincial Nutri onist in collabora on with a Na onal Supervisor
• Data Analysis was done using ENA for SMART v.2011,SPSS v.16 and STATA v.13
9 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 10
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof ChildrChildrenen AssessedAssessed bbyy SeSexx
100 90
80 45.6 48.2 47.8 47.1 47.0 46.2 51.1 51.7 51.1 48.2 48.6 en (%) 70 53.4 60 50 40
30 54.4 53.8 opor on of Childr 52.9 53.1 46.6 51.8 52.2 48.9 48.3 48.9 51.8 51.4
Pr 20 10 0
Boys Girls
The average propor on of the assessed children was 51.4% boys as to 48.6% girls and there was almost a similar trend across most districts
11 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe NumberNumber ofof ChildrChildrenen AssessedAssessed bbyy AgAgee
District <6month 6 -23 month 24 -59 month Total Bikita 11 36 86 133 Binga 17 47 102 166 Buhera 17 62 126 205 Epworth 18 56 117 191 Hurungwe 27 71 115 213 Kariba 28 60 129 217 Mangwe 17 43 111 171 Mberengwa 16 56 110 182 Mt Darwin 13 52 111 176 Murehwa 13 44 76 133 Shamva 24 46 96 166 Average 201 573 1179 1,953
An Average of 1, 953 children were assessed during the assessment
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 12 PPrrooppoorr oonn ooff CChhiillddrreenn AAsssseesssseedd bbyy CChhiilldd LLiivviinngg AArrrraannggeemmeenntt
Percentage of Percentage of children who live children who live Percentage of children not living with of children Live with mother and with father and both parents whose with not with father not with mother father or District both Total mother parent Both Both Father Father is Mother Mother Father is Mother living s parents parents alive dead is alive is dead alive alive status are alive are dead unknown Bikita 66.1 15.7 2.5 2.5 0.0 10.7 0.0 0.0 0.0 2.5 121 Binga 49.7 34.7 1.4 1.4 0.0 8.8 0.7 0.0 0.0 3.4 147 Buhera 67.6 10.1 1.6 2.7 0.5 12.8 2.1 1.6 0.5 0.5 188 Epworth 79.6 11.4 1.8 0.6 0.0 4.2 0.6 0.0 0.0 1.8 167 Hurungwe 79.7 10.4 1.1 1.7 0.0 4.4 1.1 0.6 0.0 1.1 182 Kariba 73.8 12.8 4.8 2.1 0.5 4.8 0.0 0.5 0.0 0.5 187 Mangwe 31.6 41.5 2.0 0.0 0.0 11.8 0.0 2.0 0.0 11.2 152 Mberengw a 68.1 19.6 1.2 1.8 0.0 8.6 0.0 0.6 0.0 0.0 163 Mt Darwin 77.2 9.5 1.9 1.9 0.0 7.6 0.0 0.6 0.0 1.3 158 Murehwa 60.5 16.8 0.8 2.5 0.0 15.1 0.8 2.5 0.8 0.0 119 Shamva 74.7 9.9 2.1 2.8 0.0 4.9 1.4 0.0 0.0 4.2 142 Average 66.9 17.1 2.0 1.8 0.1 8.3 0.6 0.8 0.1 2.3 1726 The average propor on of children assessed by orphan hood with father dead is 2.0% with Kariba recording the highest propor on(4.8%).
13 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof ChildrChildrenen AssessedAssessed bbyy MotherMother’’ss ;; CarCaregivegiverers’s’ andand FFaathertherss AgAgee
<20 Years 20-39 Years 40-59 Years 60+ Years <20 Years 20-39 Years 40-59 Years Total 60+ Years Total Caregiver’s age 6.7 71.5 16.9 4.9 1921 Care giver’s age 6.7 71.5 16.9 4.9 1921
Mother's age 7.5 83.7 8.1 0.8 1906 Mother's age 7.5 83.7 8.1 0.8 1906 Father's age 0.3 67.7 27.5 4.6 1836 Father's age 0.3 67.7 27.5 4.6 1836
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 14 PrPropor onopor on ofof ChildrChildrenen AssessedAssessed bbyy MotherMother’’ss AgAgee
100 4.9 6.1 8.2 7.3 3.6 11.2 8.8 6.2 10.4 8.1 90 9.2 11.2 80
en (%) 70 60 82.7 84.0 79.9 50 89.4 77.8 93.0 79.9 81.5 84.7 90.0 80.5 83.7 40 30 opor on of Childr
Pr 20 10 9.3 9.2 8.7 7.5 13.0 7.3 9.1 7.5 0 3.8 2.2 6.5 3.8
Below 20 20 -39 40+
Overally the highest propor on of the assessed children's mothers were in the 20 -39 age group (83.7%) followed by 40 – 59 age group (8.1%) Mangwe had the highest propor on of mothers less than 20 years (13%) followed by Binga (9.3%)
15 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof ChildrChildrenen AssessedAssessed bbyy FFaatherther’’ss AgAgee
100 2.0 1.1 1.2 3.6 1.1 1.8 2.4 1.8 3.2 2.0 90 0.6 19.2 0.0 24.0 27.8 25.5 31.5 32.2 29.9 27.5 80 27.0 18.5
en (%) 25.5 41.6 70 60 50
40 73.7 78.4 68.7 69.9 71.0 66.0 68.8 67.7 opor on of Childr 30 65.1 61.8 65.4
Pr 53.9 20 10 0
<20 20-39 40-59 60+
The average propor on of children assessed by fathers age was highest in the 20 – 39 age group (67.7%) and it was also observed that there are elderly men above the age of 60 (1.8%) who had children below the age of five
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 16 PrPropor onopor on ofof ChildrChildrenen AssessedAssessed bbyy CarCaregivegiverer’’ss AgAgee
100 1.6 1 1.2 8.4 2.4 4.4 1.9 6.7 2.3 4.6 4.4 12 12 90 16.3 16.6 19.5 12.1 17.1 15.1 18.7 18.9 16.9 80 23.6 70 20.7 en (%) 60 50 78 70.7 82.4 75.4 71.9 71.4 40 75.8 62.8 72.6 73.5 71.5 51.5 30
opor on of Childr 20 Pr 10 8.5 8.3 9.1 8.9 7.9 0 3.8 3.8 6 5.6 7 3 6.7
<20 20-39 40-59 60+
The average propor on of children assessed by caregivers ‘ age were highest in the 20 -39 age group (71.5%) followed by 40 – 59 age group(16.9%) . Of note is the propor on of the elderly (4.4%) who are also principle care givers of the children under five. Mangwe (16.6%) had the highest propor on of children being taken care of by elderly caregivers
17 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof HouseholdHousehold HeadsHeads bbyy AgAgee
100 8.8 90 16.9 15.0 15.8 27.7 27.0 23.4 25.8 24.6 80 38.2 38.2 34.2 39.1 70 30.8 34.3 34.6 60 39.7 40.4 38.3 50 38.7 44.0 39.0 40 39.0 41.6 30 45.5 51.7 50.4 52.5 20 36.6 36.7 opor on of Household Head (%) 33.6 33.8 28.6 26.8 Pr 10 22.8 20.2 0 0 3.3 0 0.4 0 0.8 0 0.4 0.4 0 0 0.5
<20 20-39 40-59 60+ Years
Most of the house holds head were in the 40-59 years (38.3%) and 20-39 years (36.7%) age groups . Binga had the highest propor on (3.3%) of house holds head under 20years.
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 18 EEducducaa on on ofof HouseholdHousehold HeadHead inin HouseholdsHouseholds withwith ChildrChildrenen UnderUnder FivFivee
100 13.6 90 17.6 30.0 80 33.6 24.2 32.9 34.6 33.6 36.9 35.4 70 40.7 44.6 60 69.7
50 37.1 61.8 46.7 40 38.8 45.2 44.6 39.8 56.7 56.2 30 41.5 20 40.5 31.7
opor on of Household Heads 22.3 10 20.4 20.3 Pr 17.4 17.2 18.0 17.5 6.7 10.4 6.7 0 2.9
None Primary Secondary Higher educa on Don’t know
The surveyed households with children under five had at least 81.4% household heads who have a ained primary level and above
19 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe EEducducaa on on ofof MotherMother ofof ChildrChildrenen UnderUnder FivFivee
100 0.5 0.5 0.5 0.0 3.0 0.6 2.7 0.0 7.8 0.0 2.3 1.6 90 18.5 17.8 28.6 28.2 28.7 80 36.2 35.5 35.3 en (%) 44.7 44.6 70 44.7 60 66.8 50.5 50 53.7 40 58.3 58.2 70.1 52.1 59.2 56.8 opor on of Childr 30 47.7 46.9
Pr 45.8 20 25.0 31.3 10 25.9 12.6 11.2 10.2 0 3.8 4.1 4.3 4.1 1.7 6.2 0.6
None Primary Secondary Higher educa on Don’t know
The average assessed households with children under five had at least 89% mothers who have a ained primary level and above Kariba (31.3%) and Binga (25.%) districts had the highest propor on of mothers who have not a ained any level of educa on
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 20 PrPropor onopor on ofof HouseHouse holdsholds HeadHead bbyy SeSexx
100 90 80 41.3 70 62.6 63.1 72.6 74.0 72.3 75.8 72.4 60 83.9 84.6 82.5 84.6 50 40 30 58.7 20 37.4 36.9 opor on of House holds Head (%) 27.4 26.1 27.7 24.2 27.6 Pr 10 16.1 15.4 17.5 15.4 0
Female Male
The majority of the house holds were male headed (72.4%) The trend is similar across all districts save for Binga which had 58.7% of the households being female headed.
21 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe Infant and Young Child Feeding Prac ces
22
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe DeDefini onsfini ons
Exclusive breas eeding • Exclusive breas eeding means giving a baby only breast milk, and no other liquids or solids, not even water. Drops or syrups consis ng of vitamins, mineral supplements or medicines (including ORS) are permi ed. (WHO, 2012)
Prelacteal feeds • These are foods other than breast milk given to children within 3 days of birth
23 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe SummarSummaryy ofof BrBreaseas eedingeeding PrPrac cesac ces
Prelacteal feeding 11.6
Bo le feeding 4.7
Ini a on of breas eeding 78.6
Ever breas ed 0-23 months 98.8
Exclusive breas eeding <6months 60
0 20 40 60 80 100
• About 60% of children less than 6 months were exclusively breas ed and this surpassed the World Health Assembly (WHA) target of 50%.
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 24 PrPropor onopor on ofof ChildrChildrenen 0-230-23 MonMonthsths EEvverer BrBreaseas eded
100 100 100 96.2 100 99 98.9 96.7 100 96.9 100 100 98.8 90 80 en (%) 70 60 50 40
opor on of childr 30 Pr 20 10 0
• Breas eeding was prac sed across all the 11 districts with more than 96% of children being breas ed at some point in me of their life • In six out of eleven districts 100% of the children were breasted at some point of their life
25 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof ChildrChildrenen BrBreaseas eded WithinWithin 11 hourhour ofof BirthBirth
100 96.6 91.4 87.2 86.6 84.7 78.6 73 73 en(%) 80 67.2 71.1 69 66.7 60 40
opor on of childr 20 Pr 0
• The average number of children ini ated on breas eeding within the first hour of birth was 78.6% • Mangwe and Shamva are the districts that surpassed the na onal target of 90% for children ini ated on breas eeding within the first hour of birth. • Murehwa, Binga and Kariba had the least propor on of children ini ated on breas eeding within the first our which was less 70%
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 26 PrPropor onopor on ofof ChildrChildrenen givgivenen FFoodsoods OtherOther thanthan BrBreaseastt milkmilk WithinWithin 33 DaDayyss ofof BirthBirth
100 90
en(%) 80 70 60 50 40
opor on of childr 30 25.3 24.6 Pr 18.4 18.2 20 8.1 12.3 11.6 10 2.1 3.3 2.8 2.9 0
• Binga has no children introduced to prelacteal feeds within 3 days of birth
• Buhera (25.3%) and Mt Darwin (24.6%) had highest propor on of children introduced to prelacteal feeds within 3 days of birth
27 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe CommonCommon PrPrelactelactealeal FFeedseeds InIntrtroducedoduced WithinWithin 33 DaDayyss ofof BirthBirth
Cooking oil 2.7
Mahewu 0.4
Thin porridge 1.4
Tea or infusions 0.6
ORS or Sugar-salt solu on 0.1
Sweetened water or juice 1.0
Plain Water 7.4
Tinned, powdered, or fresh… 1.4
• Water, cooking oil, thin porridge, nned, powdered of fresh or infant formula and sweetened water or juice were the most common foods used as prelactael feeds
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 28 PrPropor onopor on ofof ChildrChildrenen FFeded frfromom aa Bo leBo le withwith aa TTeaeatt
100 90
en (%) 80 70 60 50 40 30 opor on of childr
Pr 20 10.5 6.2 5.7 10 4.3 3.1 5.1 5.4 3.1 1.1 3.3 5.6 4.7 0
• Murehwa (10.5%) had highest propor on of children fed using a bo le with a teat. • Other districts with high figures are Mt Darwin (6.2%), Shamva (5.7%), Mberengwa (5.6%), Epworth (5.4%) and Buhera (5.1%). • Kariba (1.1%) had the least propor on of children fed from a bo le with a teat
29 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe ComplemenComplementtararyy FFeedingeeding
• Minimum dietary diversity (MDD) is defined as receiving foods from at least 5 of 8 food groups: 1) breastmilk, 2) grains, roots and tubers, 3) legumes and nuts, 4) dairy products (milk, infant formula, yogurt, cheese), 5) flesh foods (meat, fish, poultry and liver/organ meats), 6) eggs, 7) vitamin-A rich fruits and vegetables, and 8) other fruits and vegetables.
• Minimum meal frequency (MMF) among currently breas eeding children is defined as children who also received solid, semi-solid, or so foods 2 mes or more daily for children age 6-8 months and 3 mes or more daily for children age 9-23 months. For non-breas eeding children age 6-23 months it is defined as receiving solid, semi-solid or so foods, or milk feeds, at least 4 mes.
• The minimum acceptable diet (MAD) for breas ed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while for non-breas ed children further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without coun ng milk feeds. (UNICEF/WHO 2017)
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 30 ComplemenComplementtararyy FFeedingeeding PrPrac cesac ces fforor ChildrChildrenen 6-236-23 MonMonthsths
Minimum Meal Minimum Dietary Minimum Acceptable District frequency Diversity Diet Bikita 48.5 3.0 3.0 Binga 22.7 2.3 0.0 Buhera 47.5 1.7 0.0 Epworth 63.0 14.8 11.1 Hurungwe 64.3 7.1 5.7 Kariba 35.1 1.8 1.8 Mangwe 83.3 0.0 0.0 Mberengwa 85.2 27.8 27.8 Mount Darwin 47.9 25.0 20.8 Murehwa 52.3 2.3 2.3 Shamva 51.2 9.8 9.8 Average 54.8 9.1 7.8
• The average minimum acceptable diet for the 11 district was7.8% while the average minimum dietary diversity was 9.1% and the minimum meal frequency was 54.8%.
• Districts with high minimum acceptable diets were Mberegwa (27.8%) and Mt Darwin (20.8%).
31 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe Food For fica on and Micronutrient Supplementa on
32
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe FFoodood FFor ficor ficaa on on
• Food For fica on is the process of adding minute levels of vitamins and minerals to foods, regardless of whether the micronutrient was present or not in that food.
• This is done to address micronutrient deficiencies.
• In line with the Zimbabwe Na onal Food For fica on Programme, the country made industrial for fica on mandatory for sugar, cooking oil, maize meal and wheat flour.
• This was an addi on to mandatory salt iodiza on which commenced in the early 1990s.
• Mandatory industrial food for fica on for the four food vehicles was ini ated on the 1st of July 2017.
• In this report the presence of a na onal food for fica on logo on a food item iden fied in the household was a proxy used to indicate that the food item was for fied.
IFIED FO RT O O D F
Na onal Food For fica on Logo
33 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe AccessAccess ttoo FFor fiedor fied SugSugarar Propor on of households with sugar available Propor on of households using sugar with for fica on logo
100 100 98 92 93 94 96 94 90 89 92 90 90 90 85 90 82 82 80 78 79 80 70 66 70 66 64 64 60 59 60 50 48 50 40 40 33 30 30 30 20 20 opor on of households (%) opor on of households (%)
Pr 10 Pr 10 0 0 a e a a e a a a a e a a e a a a e e v v w w win win ag ag orth orth ariba ariba eh eh Bing Bikit Bing er Bikit w er w K engw K engw v Buher v Buher Sham Sham A Ep Mangw Ep A Mangw Mur Mur Hurungw Hurungw Mt Dar Mt Dar Mber Mber
• Binga (33%) and Kariba (30%) had the lowest propor on of children living in households with sugar • Of those households with access to sugar, an average of 90% had access to for fied sugar with the na onal food for fica on logo, with the least recorded in Mangwe (66%) • Access to for fied sugar with a local food for fica on logo was almost universal in Mberengwa (98%) and Mt Darwin (96%)
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 34 AccessAccess ttoo FFor fiedor fied Mealie-MealMealie-Meal
Propor on of households who purchased Propor on of households using mealie-meal mealie-meal with for fica on logo
100 100 90 90 80 80 70 70 68 67 63 60 60 53 50 50 40 40 38 36 40 37 32 30 30 26 27 30 26 19 20 20 opor on of households (%) opor on of households (%) 20 14 20 Pr Pr 10 8 4 6 10 7 7 0 0 e a e a a e a a a a e a a e a a a e v v w w ag win win orth ag orth ariba er ariba eh Bing Bikit eh Bing Bikit w w K v er engw K engw Buher Buher v Sham A Sham Ep Mangw Ep Mangw A Mur Mur Hurungw Mt Dar Hurungw Mt Dar Mber Mber
• Only in Epworth does the na onal food for fica on logo has poten al of reaching more than half of households (63%) • Murehwa(4%) and Shamva (6.%) had the lowest propor on of households who purchased mealie-meal. • Bikita and Shamva had no households that purchased mealie-meal with logo whilst Epworth (68.%) and Mt Darwin (67%) had the highest households purchasing for fied mealie meal with the na onal food for fica on logo
35 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe AccessAccess ttoo FFor fiedor fied WheaWheatt FlourFlour Propor on of households who purchased Propor on of households using wheat flour wheat flour with for fica on logo
100 100 99 99 100 99 96 97 95 100 90 93 93 90 90 84 80 80 70 70 59 60 60 56 50 50 45 40 40 35 33 30 30 26 28 29 27 23 20 20 17 opor on of households(%) opor on of households (%)
Pr 10 Pr 10 0 0 a e a a e a a a e a e a a e a a a v e w v win w ag win orth ag orth ariba eh Bing er Bikit ariba w eh Bing Bikit K engw w v er K Buher engw Sham Buher v A Ep Sham Mangw Ep Mangw A Mur Hurungw Mur Mt Dar Hurungw Mt Dar Mber Mber
• Mangwe (59.%) had the least propor on of households who had purchased flour and all had no na onal for fica on logo. • On average, 33.% of the households were using purchased wheat flour with na onal for fica on logo. • In Hurungwe among households that purchased wheat flour, no household was accessing for fied flour with a na onal food for fica on logo
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 36 AccessAccess ttoo FFor fiedor fied CookingCooking oiloil
Propor on of households purchasing Propor on of households using cooking oil cooking oil with for fica on logo
100 100 98 98 100 95 96 93 95 90 89 90 80 80 78 74 73 70 70 70 66 63 60 60 56 54 52 55 54 50 50 50
40 40 35 30 30 30 30
20 opor on of households(%) opor on of households(%) 20 17 Pr Pr 10 10 0 0 a e a a e a a a e a e a a e a a a e v v w w win ag win ag orth orth ariba ariba eh Bing er Bikit eh Bing er Bikit w w K engw K v engw v Buher Buher Sham Sham A A Ep Mangw Ep Mangw Mur Mur Hurungw Mt Dar Hurungw Mt Dar Mber Mber
• There is poten al to reach more than two-thirds of the households with for fied cooking oil in all the 11 districts. • Of the households that had cooking oil, an average of 89% of the households reported to have purchased. • About half of the households were using purchased cooking oil with a na onal food for fica on logo, • Kariba, Hurungwe, Mangwe and Shamva had less than 50% of Households purchasing cooking oil with the na onal food for fica on logo.
37 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof ChildrChildrenen GivGivenen FFoodood withwith MicrMicronutrienonutrientt PPoowwderderss
100
s (%) 90 80 70 en MNP 60 en giv 50 46 39 40 36 30 26 23 21 20 20 17 11
opor on of childr 10 3 4
Pr 0 0
• On average, 20% of the children had consumed food with MNPs within 7 days prior to the survey • Mangwe (46%) had the highest propor on of children who consumed food with MNPs. • In Hurungwe the progamme of MNP supplementa on had not started and Kariba started during the fourth quarter of 2017. Four of the districts started the program in April 2018 and 4 in November 2018
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 38 VitVitaminamin AA SupplemenSupplementtaa on on CoCovvereragagee
Percentage of children 6-11 months who Percentage of children 12-59 months who received one dose in the past 12 months received two doses in the past 12 months
100 100
90 88 88 90
80 80 70 70 70
65 amin A (%) amin A (%) 60 61 60 56 60 en Vit en Vit 53 52 50 46 50 46 en giv en giv
40 36 40 35 31 32 30 30 24 24 22 24 18 18 20 20 opor on of childr opor on of childr Pr Pr 10 10 10
0 0
• Vitamin A coverage for children 6-11months was higher than that for 12 – 59months for all the districts except Mangwe • Binga and Hurungwe had a coverage of 88% surpassing the vitamin A supplementa on target of 80%
39 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe VitVitaminamin AA SupplemenSupplementtaa on on fforor ChildrChildrenen 6-596-59 MonMonthsths
100 90 80 69.7 70 en(%) 61.2 60 50 44.3 46 44.2 42.4 41 43.8 40 37.3 37.5 35.1 30
opor on of childr 20.4
Pr 20 10 0
Na onal Vit A Target • Binga (69.7%) and Hurungwe (61.2%) had the highest propor on of children that had received the recommended dose of Vitamin A for a year and Bikita (20.4%) had the least • All the districts had Vitamin A coverage lower than the target of 80%.
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 40 Childhood Illness
41
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof ChildrChildrenen 6-596-59 MonMonthsths whowho hadhad DiarrhoeaDiarrhoea inin thethe PPasastt 22 WWeekeekss
100 90 80 en(%) 70 60 50 40
opor on of childr 30 25.0 23.4 22.5 Pr 18.1 19.6 20 14.0 16.9 12.2 10.5 11.0 10.9 12.0 10 0
• The district with the highest propor on of children with diarrhoea was Buhera (25%) which was above the average of 16.9% • Mangwe had the least propor on of children with diarrhoea at 10.5%
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 42 PrPropor onopor on ofof ChildrChildrenen 6-596-59 MonMonthsths whowho hadhad FFeevverer inin thethe PPasastt 22 WWeekeekss
100 90 80 en(%) 70 60 50 38.1 40 35.1 opor on of childr 30 26.3 Pr 23.5 20.7 19.6 22.1 20 16.7 15.1 15.6 11.8 10.6 10 0
• Highest propor on of children who had fever in the previous 2 weeks was recorded in Kariba (38.1%) and the least( 10.6%) was recorded in Murehwa .
43 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof ChildrChildrenen 6-596-59 MonMonthsths whowho hadhad CoughCough inin thethe PPasastt 22 WWeekeekss
100 90 80 en(%) 70 60 50 40 36.1 37.7 35.1 31.9 opor on of childr 30 26.3 27.7 27.8 Pr 22.7 22.6 21.3 19 20 17.4 10 0
• Kariba and Buhera had the highest propor on of children who had a cough in the previous 2 weeks, recording 37.7 % and 36.1% respec vely. • The least propor on was found in Murehwa (17.4%)
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 44 FFeedingeeding PrPrac cesac ces DuringDuring IllnessIllness
100 90 80
en(%) 70 60 50 39.1 40 34.4 31.6 opor on of childr 29.7 29.3 29.4 30.6 28.4
Pr 30 26.4 20 10 5.9 6.4 3.5 3.9 3.2 4.2 0 Much less Somewhat Less About the same More Nothing to eat
Fever Diarrhoea Cough
• Generally children who were suffering from diarrhoea and fever were offered less food than those suffering from cough. • Children who were suffering from diarrhoea (4.2%), fever (5.9%) and cough(6.4%) were given nothing to eat during illness.
45 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe FFeedingeeding PrPrac cesac ces DuringDuring IllnessIllness
100 90 80 en(%) 70 60 50 42.8 40 33.2 opor on of childr 30 29.7 28.0 Pr 22.4 22.8 22.2 20.9 19.8 21.7 19.1 20 14.8 10 0.9 0 0.3 0.8 Much less Somewhat Less About the same More Nothing to drink
Fever Diarrhoea Cough
• About 28.0% of the children suffering from fever, 33.2% from diarrhoea and 42.8% from cough were given about the same amount of liquids to drink during illness.
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 46 Child Anthropometry
47
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof ChildrChildrenen WWeighedeighed inin thethe PPasastt 3030 DaDayyss
100 90
en(%) 80 70 66 60 7.5 55.2 50 7.2 40.1 40.2 35.2 35 34.5 37.2 40 4.2 33.1 26.6 6.6 17.7 6.8 27.2 4.2 7.9
opor on of childr 30 58.5 6.3
Pr 14.9 10.6 48 7.6 20 35.9 28.6 30.3 29.3 5 22.5 28.2 26.8 10 16 19.6 9.9 0
Yes, confirmed on card Yes, on recall
• Binga ( 66%) and Mangwe (55.2%) had the highest propor on of children who had been weighed in the previous 30 days . • Bikita district recorded the least propor on( 14,9%) of children who had been weighed in the previous 30 days .
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 48 PrPropor onopor on ofof ChildrChildrenen 6-596-59 MonMonthsths MeasurMeasureded HeighHeightt inin PPasastt 3030 dadayyss
100 90 en(%) 80 70 60 51.3 46.2 50 7.9 40 5.4 32.3 30.8 27.6 27.7 27.5 30 3 21.1 19.2 4.4 17.7 4.3 20.2 4.2 5.2 43.4 opor on of childr 20 40.8 4.9 7.4 8 29.3 4.3 6.3 Pr 10 26.4 23.3 23.5 22.3 3.3 11.2 13.4 13.9 16.2 0 4.1
Yes, confirmed on card Yes, on recall
• Generally all the 11 districts had less than 50% of the children reported(confirma on by the child health card) to have been taken height measurements in the previous 30 days .
• The least number of children taken height was recorded in Bikita district(7.4%).
49 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof ChildrChildrenen 6-596-59 MonMonthsths withwith MUMUAACC MeasurMeasureded inin thethe PPasastt 3030 DaDayyss
100 90 80 en(%) 70 63.2
60 8.8 48.7 50 36.9 7.9 40 33.7 32.1 31.8 31.9 29.5 opor on of childr 26.6 30 15 2.5 Pr 54.4 6 9.8 8.3 18 19.7 6.3 20 14.9 40.8 10.8 3.6 7 29.4 10 25.8 21.9 23.9 23.2 23.8 5 11.7 14.4 12.7 0 5.8
Yes, confirmed on card Yes, on recall
A total of 10 out of 11 districts recorded less than 50% of the children who were measured MUAC in the last 30 days Only 1 district, Binga recorded 63.2% of the children to have been measured MUAC in the last 30 days .
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 50 PrPropor onopor on ofof ChildrChildrenen withwith AcutAcutee Malnutri onMalnutri on bbyy DisDistricttrict (WHO(WHO StStandarandards)ds)
10 9 8 en(%) 7 6 5.5 4.5 5 4.2 3.8 4 0.7 3.3 1.9
opor on of childr 1.3 2.6 3 5.5 Pr 2.1 1.3 1.7 1.8 0.7 2 3.5 1.2 0.8 2.6 0.6 2.5 0.9 1 0.5 2.1 2 1.9 0.8 1.1 1.2 0.9 0 0.5
MAM SAM • Global Acute Malnutri on (GAM) ranged from 0.5 % to 5.5 %.
• Majority of the districts had a prevalence of Global Acute Malnutri on of less than 5% except for Shamva which recorded 5.5%.
51 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof ChildrChildrenen withwith StunStun ng ng
100 90 80 en(%) 70 60 50 33.8 40 31 32 31.3 27.7 28 27.9 25.5 25.1 24.6 24.2 opor on of childr 30 23.6
Pr 22.3 20 20.9 19.6 24.8 26 22.6 20.5 16 18.6 17.6 20.6 14.8 10 11.5 8.4 8.7 9.4 0 7.6 6.9 7.5 6.8 4 6.2 6 7.4
Severe Stun ng Moderate Stun ng
• All 11 districts had high stun ng rates of above 20%.
• The highest was Epworth with 33.8% and the least was Bikita with 23.6%.
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 52 PrPropor onopor on ofof UnderUnderwweigheightt ChildrChildrenen
30 25
en(%) 20.1 20 15.2 14.1 15 8.6 10.8 10.4 13.0 7.5 11.1 8.6 17.5 10 6.8 7.5 13.8 7.4 9.9 12.5 9 8.9 opor on of childr 5 5 5.9 5.7 8 7.3 Pr 3.7 3.1 0 2.5 1.4 1.6 1.1 0.6 1.4 1.3 2.6 1.6 1.9
Severe Underweight Moderate underweight
• Moderate underweight was above 5% in all the districts with Murehwa having a high propor on of 17.5%. • Severe underweight was below 5% in all the districts. • The highest prevalence of underweight amongst children was in Murehwa district at 20.1% and least in Hurungwe at 6.8%.
53 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof OvOvererwweigheightt ChildrChildrenen
10 9 8 7 6.6
en(%) 5.7 6 5.3 5.3 5 5
4 3.5 3.3 4.4 3 6.6 2.1 4.4 5.3 5.3 opor on of childr 1.4 2.8 Pr 2 1.2 2.9 1.6 0.6 0.8 1 0.6 1.4 1.3 0.8 0 0.5 0.6 0.6 0.6 0.7 0.4
Severe Overweight Moderate Overweight
• The prevalence of overweight was high in Bikita district at 6.6% and least in Kariba district at 0.6%.
• A total of 6 out 11 districts recorded 0% severe overweight.
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 54 Water, Sanita on and Hygiene (WASH)
55
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe LadderLadder fforor DrinkingDrinking WWaatterer SerServicesvices
Service level Defini on Safely Managed Drinking water from an improved water source that islocated on premises, available when needed and freefrom faecal and priority chemical contamina on Basic drinking water Basic drinking water services are definedas drinking water from an improved source, provided collec on me is not more than 30minutes for a roundtrip including queuing.
Limited drinking water services Limited water services are defined as drinking water from an improved source, where collec on me exceeds 30 minutes for a roundtrip including queuing. Unimproved water sources Drinking water from an unprotected dug well or unprotected spring.
Surface Water sources Drinking water directly from a river, dam, lake, pond, stream, canal or irriga on channel.
Note : Improved” drinking water sources are further defined by the quality of the water they produce, and are protected from fecal contamina on by the nature of their construc on or through an interven on to protect from outside contamina on. Such sources include: piped water into dwelling, plot, or yard; public tap/standpipe; tube well/borehole; protected dug well; protected spring; or rainwater collec on. This category now include packaged and delivered water, considering that both can poten ally deliver safe water.
Source: UNICEF and WHO
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 56 AccessAccess ttoo DrinkingDrinking WWaatterer
100 0.0 5.0 2.5 0.8 10.8 5.8 15.4 11.9 13.6 90 10.8 13.3 29.4 28.3 31.3 80 8.3 30.3 11.5 37.3 43.4 25.0 12.4 16.7 70 1.3 9.6 0.9 60 9.2 29.1 3.1 14.9 11.7 22.3 28.2 10.3 17.5 50 40.8 60.6 28.6 31.1 72.9 40 19.8 43.3 30 47.5 opor on of households (%) 35.3 44.9
Pr 43.3 20 44.6 26.4 29.4 28.6 28.5 10 15.4 11.6 5.0 8.7 7.1 0 0.0 0.0 2.1 2.6
Safely managed Basic Limited Unimproved Surface water • Buhera district (29.4%) had the highest propor on of households drinking water from water sources that were located on premises though tests for feacal and chemical contamina on of these water sources were not carried out. • Binga district (43.4%) had the highest propor on of households drinking water from surface water sources such as dams and rivers. On average only 69.8% households from the assessed districts were drinking water from Improved water 57 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe PrPropor onopor on ofof HouseHouse holdsholds whowho trtreaeatt DrinkingDrinking wwaatterer
100 90 80 70 60 50 40 30 20 13.5 opor on of households (%) 12.7 13.1 7.9 9.7 7.8 Pr 10 5.3 5.4 2.8 5.3 3.9 0
• The propor on of households that treat their drinking water was between 2.8% and 13.5% with Murehwa having the highest and Hurungwe the least.
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 58 TTypeype ofof WWaatterer TTrreaeatmentmentt
Type of Water Treatment District Boil Add bleach or Let stand and se le Add water treatment chlorine (Jik) (sedimenta on) tablet Bikita 1.7 1.7 0.0 0.8 Binga 2.9 0.0 0.4 0.0 Buhera 8.4 2.9 0.0 2.1 Epworth 4.2 3.4 0.0 0.0 Hurungwe 4.2 0.0 0.0 0.0 Kariba 7.5 0.0 0.0 0.8 Mangwe 5.2 0.0 0.0 0.0 Mberengwa 5.0 0.4 0.0 0.8 Mt Darwin 6.2 5.7 0.4 3.5 Murehwa 6.1 3.5 0.0 6.1 Shamva 0.8 1.7 0.0 5.0 Average 4.7 1.8 0.1 1.7
• The most common type of water treatment was boiling (4.7%) and the least was sedimenta on (0.1%)
59 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe SanitSanitaa on on LadderLadder
SERVICE LEVEL DEFINITION SAFELY MANAGED Use of improved facili es that are not shared with other households and where excreta are safely disposed of in situ or transported and treated offsite BASIC Use of improved facili es that are not shared with other households LIMITED Use of improved facili es shared between two or more households UNIMPROVED Use of pit latrines without a slab or pla orm, hanging latrines or bucket latrines OPEN DEFECATION Disposal of human faeces in fields, forests, bushes or with solid waste
Note: improved facili es include flush/pour flush to piped sewer systems, sep c tanks or pit latrines; ven lated improved pit latrines, compos ng toilets or pit latrines with slabs
Source: UNICEF and WHO
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 60 PrPropor onopor on ofof HouseHouse holdhold bbyy LeLevvelel ofof SanitSanitaa on on SerServicesvices
100 1.3 1.7 16.3 90 18.8 24.1 17.9 32.8 28.8 35.3 29.9 80 39.8 13.7 56.7 70 61.8 28.8 1.7 14.9 74.4 5.0 8.2 0.8 28.3 8.4 60 2.5 8.3 22.9 50 7.9 22.7 14.0 21.3 5.0 40 2.1 27.1 30 20.0 58.8 50.6 46.9 0.4 47.1 45.2 51.2 20 12.8 37.8 35.8 34.9 23.3 opor on of households (%) 10 12.4 18.3
Pr 0 2.9 0.0 1.7 2.1 0.0 2.6 5.0 0.0 1.8 0.8 4.7
Safely managed Basic Limited Unimproved Open defaca on
• On average, one in three households use improved sanitary facili es and Epworth district had the highest propor on of households using safely managed sanita on facili es(34.9%). • Binga district had the highest propor on of households prac cing open defaca on. • On average 29.9%households from the assessed districts were prac cing open defaca on.
61 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe HyHygienegiene LadderLadder
SERVICE LEVEL DEFINITION
BASIC Availability of a handwashing facility on premises with soap and water
LIMITED Availability of a handwashing facility on premises without soap and water
NO FACILITY No handwashing facility on premises
Source: UNICEF and WHO
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 62 PrPropor onopor on ofof HouseHouse holdhold bbyy HandHand WWashingashing FFacili esacili es
100 90 80 70
60 81.5 87.7 91.2 92.9 92.5 92.3 90.9 93.3 92.2 50 97.9 97.9 95.6 40 opor on of households (%)
Pr 30 20 5.5 10 5.7 13.0 4.2 4.1 4.2 5.4 3.9 5.0 4.1 1.7 1.7 4.6 2.9 3.9 5.0 6.6 3.9 3.7 0 0.4 0.4 2.1 0.4 1.7
Basic Limited No facility • About 92.2% of households across the 11 assessed districts had no hand washing facili es. • Buhera district had the highest propor on of households with basic hand washing facili es. • Mount Darwin district had the highest propor on of households with limited hand washing facili es 63 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe ConclusionsConclusions andand RRececommendaommenda ons ons
• The prevalence of GAM across the 11 domains ranged between 0.5%-5.5% .A total of 3 districts had GAM above 4 % namely Binga, Epworth and Shamva. The Ministry of Health and Child Care needs to strengthen iden fica on and referral of children with acute malnutri on for treatment in these 3 districts.
• The monthly coverage of growth monitoring ranged from 7.4%-51.3% for height, 14.9%-66.0% for weight and 10.8%-63.2% for MUAC across the 11 domains. Therefore there is need to improve community and health centre based growth monitoring in the all districts.
• All the assessed eleven domains had high stun ng levels above the acceptable global threshold of 20%. The Government of Zimbabwe need to scale up high impact nutri on interven ons.
• The propor on of children mee ng the minimum acceptable diet was very low ranging from 0% to 28%. There is need to strengthen community based nutri on specific and sensi ve interven ons to improve the nutri on outcomes.
• The vitamin A supplementa on coverage for children 6-59 months was very low ranging from 20.4% to 69.7%. There is need to strengthen community based vitamin A supplementa on
• The coverage for micronutrient powders distribu on was below 50% across all the 11 districts. There is need to increase resource alloca on at sub na onal level for advocacy and programme logis cs
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 64 ConclusionsConclusions andand RRececommendaommenda ons ons
• Three districts namely Binga, Kariba and Mangwe had a high propor on of households that are fetching drinking water from surface sources and the same districts including Buhera, Bikita, Mberengwa and Murehwa have high propor on of households prac cing Open Defeca on. Therefore there is need to capacitate communi es on the importance of hygiene through various pla orms such as Par cipatory Health and Hygiene Educa on (PHHE) services priori sing districts with low water and sanita on coverages
• There is need to design behavior- change interven ons and by-laws that enforce the construc on of appropriate sanita on facili es at each household and installa on of community piped water schemes from the Zambezi river.
• They were no hand washing facili es at most households. WASH ac vi es should be mainstreamed into all departments and social gatherings.
• There is need for the Ministry of Health and Child Care to con nue engaging stakeholders par cularly producers of maize meal and wheat flour on the need to comply with the food for fica on legisla on.
• The majority of children across the 11 domains were not fed appropriately during illness. The Ministry of Health and Child Care need to improve on IYCF counselling and educa on for caregivers during childhood illness.
65 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe RReporteport WWri ngri ng TTeameam
Name Organisa on Email
Bonzo Nesbert Ministry of Health and Child Care bonzo [email protected]
Chafanza Elizabeth M Ministry of Health and Child Care [email protected]
Chagwena Dexter Ministry of Health and Child Care [email protected]
Chibanda Godfrey Ministry of Health and Child Care [email protected]
Chigumbu Walter Ministry of Health and Child Care – PMD Mash West [email protected]
Chineka Annastancia UNICEF [email protected]
Gwamanda Nyasha Ministry of Health and Child Care – PMD Mash East [email protected]
Kambarami Tinashe C Ministry of Health and Child Care [email protected]
Katuruza Elizabeth Ministry of Health and Child Care–PMD Mat North [email protected] Kundodyiwa Greenfield Ministry of Health and Child Care [email protected]
Machaka Ruth Ministry of Health and Child Care – PMD Mash Central rumachaka78@gmail
Mahefu Musa Ministry of Health and Child Care – PMD Midlands [email protected]
Makanganise Vakai Ministry of Health and Child Care [email protected]
Makenga Lenin F Ministry of Health and Child Care - PMD Mash Central [email protected]
Manyengawana Killian Ministry of Health and Child Care [email protected]
SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe 66 RReporteport WWri ngri ng TTeameam
Name Organisa on Email
Mazarura Innocent Ministry of Health and Child Care - PMD Mat South [email protected]
Moyo Zanele Ministry of Health and Child Care –PMD Masvingo [email protected]
Mwashaireni Thembani C Ministry of Health and Child Care [email protected]
Nemaramba Mildred Ministry of Health and Child Care [email protected]
Njovo Handrea Ministry of Health and Child Care [email protected]
Nyadzayo Tasiana Ministry of Health and Child Care [email protected]
Nyathi Craig UNICEF [email protected]
Tshuma Annabel Fungai Ministry of Health and Child Care – PMD Mat South [email protected]
67 SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe SMART SURVEY 2019 Results of The Emergency Nutrition Assessment in 11 Selected Districts, Zimbabwe