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Ministry of Health Nutritional MINISTRY OF HEALTH NUTRITIONAL ANTHROPOMETRIC SURVEY CHILDREN UNDER FIVE YEARS OF AGE INFORMAL SETTLEMENTS IN KAMPALA CITY JUNE 29th- 18th JULY 2009 ACKNOWLEDGEMENTS Action against Hunger – Uganda Mission would like to acknowledge the support from the following: ª UNICEF for offering the financial support to undertake the survey; ª Ministry of Health-Kampala, Kampala Central division, Kawempe division and Nakawa division offices for providing vital information to facilitate planning and survey implementation; ª Action against Hunger – Uganda Mission management, administration and logistics team for their assistance in preparing and conducting the survey. Special thanks go to ACF – USA and Kutondo Edward for further broadening our understanding of SMART Methodology, coordination and ensuring training and survey objectives are met; ª Namulumba Eva Rose, Tadria Sophie, Nakitto Peace, Oluka Samuel, Bukusuba John, Opule Nicholas, Mabingo Jonathan, Ndahura Nicholas Bari, Nabuule Elizabeth Claire, Kuziga Fiona, Agaba Edgar, Apolot Pauline, Wakou Betty, Ahimbisibwe Emmanuel, Dr. Jacinta Sabiiti, Albert K Lule, Gerald Onyango, Samalie Bananuka, Esther Wamono, Rebecca Mirembe, Muhumuza Richard, Rwegyema Twaha, Dr. Mugisha Jennifer, Mateeba Tim and Nabunya Victoria for their endurance, dedication and team spirit in ensuring quality in actualization of survey objectives; ª The parents and caretakers for providing valuable information by patiently taking their time to be interviewed and allowing their children to be measured. - 2 - TABLE OF CONTENTS .I. EXECUTIVE SUMMARY ............................................................................................................. - 4 - .II. INTRODUCTION ........................................................................................................................ - 7 - .III. OBJECTIVES ............................................................................................................................ - 7 - .IV. METHODOLOGY ...................................................................................................................... - 7 - .IV.1. Type of Survey and Sample Size ....................................................................................... - 7 - .IV.2. Sampling Methodology ....................................................................................................... - 8 - .IV.3. Data Collection ................................................................................................................... - 9 - .IV.4. Indicators, Guidelines, and Formula Used ....................................................................... - 10 - .IV.4.1. Acute Malnutrition ..................................................................................................... - 10 - .IV.4.2. Mortality .................................................................................................................... - 11 - .IV.5. Field Work ........................................................................................................................ - 12 - .IV.6. Data Analysis ................................................................................................................... - 12 - .V. RESULTS OF THE QUALITATIVE ASSESSMENT ................................................................ - 13 - .V.1. Socio- demographic Characteristics of the Respondents .................................................. - 13 - .V.2. Food Security .................................................................................................................... - 14 - .V.3. Health ............................................................................................................................... - 15 - .V.4. Water and Sanitation ......................................................................................................... - 16 - .V.5. Child care practices ........................................................................................................... - 16 - .V.6. Organizations providing health and nutrition services ....................................................... - 17 - .VI. RESULTS OF THE ANTHROPOMETRIC SURVEY ............................................................... - 18 - .VI.1. Distribution by Age and Sex ............................................................................................. - 18 - .VI.2. Anthropometrics Analysis ................................................................................................. - 19 - .VI.2.1. Acute Malnutrition defined in Weight for Height ........................................................ - 19 - .VI.2.2. Risk of Mortality: Children’s MUAC ........................................................................... - 21 - .VI.3. Measles Vaccination Coverage ........................................................................................ - 21 - .VI.4. Composition of the households ........................................................................................ - 22 - .VI.5. Stunting ............................................................................................................................ - 22 - .VI.6. Underweight ..................................................................................................................... - 22 - .VII. RESULTS OF THE RETROSPECTIVE MORTALITY SURVEY ............................................ - 22 - .VIII. CONCLUSION ...................................................................................................................... - 23 - .IX. RECOMMENDATIONS ........................................................................................................... - 25 - .X. APPENDIX ............................................................................................................................... - 26 - .X.1. Sample Size and Cluster Determination ............................................................................ - 26 - .X.2. Anthropometric data collection form for children 6-59 months ........................................... - 27 - .X.3. Household nutrition security data form .............................................................................. - 28 - .X.4. Household enumeration data collection form for a death rate calculation survey (one sheet/household) ............................................................................................................... - 29 - .X.5. Enumeration data collection form for a death rate calculation survey (one sheet/cluster) ............................................................................................................................. - 30 - .X.6. Map of surveyed informal settlements in Kampala ............................................................ - 31 - .X.7. Prevalence of acute malnutrition by age (UDHS classification) based on WFH z- scores and/or oedema ............................................................................................................... - 32 - - 3 - .I. EXECUTIVE SUMMARY The feeding of infants and young children is crucial in determining the health, nutrition, survival, growth and development of the individual. Nutrition is a key element of the child’s right to health as stipulated in the Convention on the Rights of the Child (CRC, 1989). According to Uganda Participatory Poverty Assessment Project, UPPAP, (2000), about 30% of Kampala’s population lives in informal settlements commonly known as slums which cover about 10% of the total area of Kampala with an average density of 14,112 people per square kilometer. Unfortunately both the number of slum dwellers and the area covered are on the increase and this is a challenge for the urban authorities. The living conditions of slum dwellers impacts on the service availability and overall health conditions of the children under five at the household level. According to Uganda Demographic Health Survey, UDHS, (2006), stunting in Uganda was at 38%, wasting was at 6% and underweight at 16% among children under five. These rates of malnutrition contribute to over half of the high infant mortality rate of 76 deaths per 1000 live births. In Kampala district, the malnutrition rates stood at 3.7% for wasting, 8.1% stunting and 2.6% underweight based on WHO standards (2006). However, there is no consolidated data on the prevalence and infant mortality rates of children under five in informal settlements. Therefore the study was to investigate the nutritional anthropometric status of children 6-59 months in the informal settlements. Justification Following a four day training on the National Nutritional Survey Guidelines based on SMART methodology, participants needed hands on practice to appreciate and gain experience on data collection, analysis and reporting. More still, the survey was also aimed at filling the knowledge gap on the paucity of data regarding informal settlements in Kampala. Objectives ♦ To assess the nutritional status of children aged between 6 and 59 months. ♦ To estimate the mortality rate in the slum areas of Kampala. ♦ To determine the measles immunization coverage in children of age 9-59 months. ♦ To determine the incidence of common diseases (diarrhea, malaria, measles and ARI) among children two weeks prior to the assessment. ♦ To assess the factors influencing the nutrition situation of the community. Methodology Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology was utilized in the implementation of the nutritional anthropometric
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