1 NUTRITION ANTHROPOMETRIC SURVEY Final report Battagram, Balakot and Mansehra Districts Pakistan 10th April to 13th May 2006 Funded by: Action Contre la Faim 2 ACKNOWLEDGMENTS Action Against Hunger would like to thank UNICEF for providing equipment for the surveys and the MoH for the ongoing support of the nutrition program. ACF-USA is also extremely grateful to the supervisors, measurers and Lady Health Workers (LHW’s) from the supplementary feeding program for their assistance. Final thanks go to the supervisors and measurers that participated in the surveys, and the community members for their cooperation and hospitality. Action Against Hunger, Nutrition Survey: North West Frontier Province, Pakistan, April/May 2006 3 LIST OF ABBREVIATIONS AAH Action Against Hunger AJK Azad Jammu and Kashmir Province ARI Acute respiratory infection BHU Basic health unit CI Confidence interval CMR Crude mortality rate DHQ District headquarter EPI Extended Programme of Immunization ERRA Earthquake Rehabilitation and Reconstruction Authority GAM Global acute malnutrition LHW Lady health worker MoH Ministry of Health MUAC Mid upper arm circumference NCHS National Centre of Health Statistics NWFP North West Frontier Province PKR Pakistani rupees RHC Regional health centre SAM Severe acute malnutrition SFC Supplementary feeding centre SFP Supplementary feeding programme TB Tuberculosis TFC Therapeutic feeding centre THQ Tertiary headquarter TMA Tehsil Municipal Authority U5MR Under-5 mortality rate WESNET Water, Environment and Sanitation Network WSB Wheat soya blend Action Against Hunger, Nutrition Survey: North West Frontier Province, Pakistan, April/May 2006 4 TABLE OF CONTENTS .I. INTRODUCTION.............................................................................................................................................................. 6 .I.1. CONTEXT ....................................................................................................................................................................... 6 .I.2. SECURITY AND POPULATION MOVEMENT ...................................................................................................................... 7 .I.3. ACCESS TO, AND AVAILABILITY OF FOOD...................................................................................................................... 8 .I.4. WATER AND SANITATION............................................................................................................................................... 9 .I.5. HEALTH AND CHILD CARE PRACTICES........................................................................................................................... 9 .I.5.1. The Health Care Systems ....................................................................................................................................... 9 .I.5.2. Morbidity and Mortality....................................................................................................................................... 10 .I.5.3. Childcare Practices.............................................................................................................................................. 11 .I.6. MALNUTRITION............................................................................................................................................................ 11 .I.7. THE SURVEY AREA ...................................................................................................................................................... 12 .I.7.1. Battagram............................................................................................................................................................. 12 .I.7.2. Balakot ................................................................................................................................................................. 12 .I.7.3. Mansehra.............................................................................................................................................................. 13 .II. OBJECTIVES................................................................................................................................................................. 14 .III. METHODOLOGY ....................................................................................................................................................... 14 .III.1. SAMPLING ................................................................................................................................................................. 14 .III.1.1. The Survey Area................................................................................................................................................. 14 .III.1.2. Population Data ................................................................................................................................................ 15 .III.1.3. Sample Size........................................................................................................................................................ 15 .III.1.4. Cluster Selection................................................................................................................................................ 15 .III.1.5. Household Selection .......................................................................................................................................... 16 .III.1.6. Selection of Subjects .......................................................................................................................................... 16 .III.2. DATA COLLECTION AND MEASUREMENT TECHNIQUES ............................................................................................. 16 .III.2.1. The 6 to 59 months old Age Group.................................................................................................................... 16 .III.2.2. The Household................................................................................................................................................... 17 .III.2.3. The Survey Team ............................................................................................................................................... 18 .III.2.4. Data Collection and Entry................................................................................................................................. 18 .III.3. INDICATORS AND FORMULAE .................................................................................................................................... 18 .III.3.1. Acute Malnutrition............................................................................................................................................. 18 .III.3.2. Mid-Upper Arm Circumference (MUAC).......................................................................................................... 19 .III.3.3. Mortality............................................................................................................................................................ 19 .III.3.4. Measles Vaccination Coverage ......................................................................................................................... 19 .IV. RESULTS ...................................................................................................................................................................... 20 .IV.1. NUTRITION ................................................................................................................................................................ 20 .IV.1.1. Battagram tehsil................................................................................................................................................. 20 .IV.1.2. Balakot tehsil ..................................................................................................................................................... 24 .IV.1.3. Mansehra tehsil.................................................................................................................................................. 27 .IV.2. MORTALITY .............................................................................................................................................................. 31 .IV.2.1. Battargam .......................................................................................................................................................... 31 .IV.2.2. Balakot............................................................................................................................................................... 31 .IV.2.3. Mansehra ........................................................................................................................................................... 31 .IV.3. MEASLES VACCINATION COVERAGE......................................................................................................................... 32 .IV.4. RESIDENTIAL STATUS AND HOUSEHOLD SIZE ........................................................................................................... 32 .V. DISCUSSION.................................................................................................................................................................. 32 .V.1. PREVALENCE OF MALNUTRITION ..............................................................................................................................