BASELINE SURVEY (2019): ZAMBIA SCALING UP NUTRITION (SUN) 2.0 / FIRST 1000 MOST CRITICAL DAYS PROGRAMME (MCDP II) Final Report: 10 March 2020 This page is intentionally blank BASELINE SURVEY REPORT (2019) Zambia Scaling Up Nutrition 2.0 / First 10010000 Most Critical Days Programme (MCDP) II Submitted by: Khulisa Management Services, Inc. 4550 Montgomery Avenue, Suite 220 Bethesda, MD 20814, USA Tel: +1 (301) 951-1835 Prepared under: Scaling Up Nutrition Learning and Evaluation (SUN LE) project USAID Contract Number 72061119C00003 Prepared by: Mathews Onyango, SUN LE Chief of Party/Project Director 1 Patricia Sakala, SUN LE Strategic Information Advisor 1 John Manda, SUN LE Learning and Dissemination Advisor 4 Mulako Kabisa, SUN LE Survey Manager 2 Dr Rhoda Mofya Mukuka, Senior Research Fellow 2 Dr Raider Mgode, Head, Training and Collaboration 3 Dr Lwendo Moonzwe, Technical Specialist 4 Dr Stephanie Martin, Asst. Professor 5 Musonda Mofu, Acting Executive Director 3 Mike Mwanza, Head, Research and Planning 3 1. Khulisa Management Services 2. Indaba Agricultural Policy Research Institute (IAPRI) 3. National Food and Nutrition Commission (NFNC) 4. International Health and Development ICF 5. Department of Nutrition, University of North Carolina SUN LE: 2019 Baseline Survey of Zambia SUN 2.0 / MCDP II Page | ii Recommended Citation: USAID Scaling Up Nutrition Learning and Evaluation (SUN LE), National Food and Nutrition Commission (NFNC). 2019 Baseline Survey of the First 1000 Most Critical Days Programme (MCDP) II. 2020. Lusaka, Zambia Cover Photo: SUN LE data collector and respondent. Courtesy of SUN LE staff. SUN LE: 2019 Baseline Survey of Zambia SUN 2.0 / MCDP II Page | iii Acknowledgements This 2019 Baseline Survey of Zambia’s Scaling Up Nutrition 2.0 / First 1000 Most Critical Days Programme (MCDP) II was made possible with the generous support of the American people through the United States Agency for International Development (USAID). We also acknowledge the Government of the Republic of Zambia for infrastructural support that facilitated survey implementation. We are grateful to the National Food and Nutrition Commission (NFNC) for their leadership during the planning and execution of the survey. Technical and logistical support from the Zambia Statistics Agency, formerly known as the Central Statistics Office, and the Ministry of Health, is greatly appreciated. We further acknowledge the Monitoring, Evaluation, and Research (ME&R) Technical Working Group (TWG) for its technical review of, and input into, the baseline survey report. We are grateful to the field workers who worked tirelessly during the data collection period as well as the households that provided the information. We are grateful to the communities without whose cooperation this survey would not have been possible. SUN LE: 2019 Baseline Survey of Zambia SUN 2.0 / MCDP II Page | iv Table of Contents Executive Summary ................................................................................................................................................................................... ............................................. viiiviiiviii 111 Introduction ................................................................................................................................................................................... ..................................................................................... ........ 111 1.1 Background .............................................................................................................. 1 1.2 Baseline Survey Objectives ....................................................................................... 3 222 Methods ................................................................................................................................................................................... .......................................................................................... ............. 444 2.1 Sampling .................................................................................................................. 4 2.2 Ethical Approval ....................................................................................................... 5 2.3 Field Work ................................................................................................................ 6 2.4 Data Analysis ........................................................................................................... 8 2.5 Survey Limitations and Challenges ........................................................................... 9 333 Main Findings ................................................................................................................................................................................... .................................................................................. ............... 999 3.1 Sample Description .................................................................................................. 9 3.2 Maternal and Child Nutrition Status ....................................................................... 10 3.3 Nutritional Status of Mothers ................................................................................. 16 3.4 Dietary Intake and Access to Safe Food .................................................................. 18 3.5 Household Food and Nutrition Practices ................................................................. 29 3.6 Child Diarrhoea ...................................................................................................... 31 3.7 Family Planning Use ............................................................................................... 33 3.8 Household Water, Sanitation, and Hygiene (WASH) ................................................. 34 SUN LE: 2019 Baseline Survey of Zambia SUN 2.0 / MCDP II Page | v 3.9 Reach of Community-level Nutrition-specific Interventions ................................... 38 3.10 Stakeholder Perceptions on SUN Implementation.......................................... 41 444 Conclusions ................................................................................................................................................................................... ................................................................................... ...... 454545 555 Recommendations ................................................................................................................................................................................... ....................................... 464646 Annexes NB: Submitted as separate documents, in two volumes Volume III Annex 1 List of SUN Indicators Annex 2 Number of EAs Selected by District, Constituency, and Residence Annex 3 Indicator Data Tables Annex 4 KII Data Tables Annex 5 Indicator Definitions and Calculation Methods Volume IIIIII Annex 6 Household Survey Questionnaire Annex 7 Key Informant Interview (KII) Guide List of FigureFiguress Figure 1. Child Stunting, Underweight, and Wasting in children less than 2 years ......... x Figure 2. 30 districts for MCDP II (SUN 2.0) ................................................................. 3 Figure 3. Household Sampling Procedure .................................................................... 4 Figure 4. Sample for calculation of stunting, underweight, and wasting ..................... 11 Figure 5. Percentage of children less than 2 years of age stunted, underweight, or wasted (<2 SD) by age in months ................................................................ 11 Figure 6. Percent of children stunted, underweight and wasted by district ................. 13 Figure 7. Percent of mothers with Low BMI ................................................................ 17 Figure 8. Percent of Exclusively breastfed children by age in months ......................... 20 SUN LE: 2019 Baseline Survey of Zambia SUN 2.0 / MCDP II Page | vi Figure 9. Percent of HHs that sold/bartered safe and nutritious crops/livestock they grew/kept ................................................................................................... 26 Figure 10. Percent of households experiencing hunger by region .............................. 27 Figure 11. Households with recommended dietary diversity ....................................... 29 Figure 12. Percent of children experiencing diarrhoea in the preceding two weeks by district ........................................................................................................ 33 Figure 13. Percent of modern family planning users by methods ............................... 33 Figure 14. Types of water treatment technologies ..................................................... 35 Figure 15. Percentage of households practicing essential hygiene practices ............... 37 Figure 16. GRZ interventions to reduce stunting ........................................................ 38 Figure 17. No. nutrition-specific and -sensitive interventions (combined) received by the child ..................................................................................................... 39 SUN LE: 2019 Baseline Survey of Zambia SUN 2.0 / MCDP II Page | vii Acronyms BMI Body Mass Index CLTS Community-Led Total Sanitation EA Enumeration Area GRZ Government of the Republic of Zambia HH Household IAPRI Indaba Agricultural Policy and Research Institute IFA Iron and Folic Acid IYCF Infant and Young Child Feeding KII Key