ROUND-4 EMERGENCY NUTRITION ASSESSMENT FINAL REPORT NAYAPARA & KUTUPALONG REGISTERED ROHINGYA REFUGEE CAMPS AND MAKESHIFT SETTLEMENTS COX’S BAZAR, BANGLADESH 25th September - 23rd October, 2019 1 ACKNOWLEDGMENTS The Round 4 Emergency Nutrition Assessment was conducted from September 25th to October 23rd, 2019 in Cox’s Bazar, Bangladesh by multiple Nutrition Sector partners. In collaboration with the Government of Bangladesh, Institute of Public Health Nutrition (IPHN), Ministry of Health and Family Welfare (MoHFW) through the Cox’s Bazar District Civil Surgeon’s Office and Office of the Refugee Relief and Repatriation Commissioner the Round 4 Assessment was led by Action Against Hunger (ACF Bangladesh) with additional technical support from Action Against Hunger Canada SMART Team. The Assessment was funded by the United Nations High Commissioner for Refugees (UNHCR), the World Food Programme (WFP), the United Nations Children’s Fund (UNICEF) and Swedish International Development Cooperation Agency (SIDA). Opinions expressed in this report may not reflect the official opinion of these organizations. Additional supervisory and field support was provided by Action Against Hunger, World Food Programme, Save the Children International (SCI), Care Bangladesh and the Social Assistance and Rehabilitation for the Physically Vulnerable (SARPV). 2 Action Against Hunger would like to thank the following agencies and individuals for their support in making this assessment a reality: The people surveyed for their availability and flexibility, without which the results of this assessment could not have been possible. Family members and their measured children are warmly thanked for their cooperation and for welcoming survey teams into their homes for data collection. Respective camp focal of Nutrition Sector partners for coordinating with Camp In-Charge (CIC) and site management about this assessment as well as dedicating one Community nutrition volunteer from the selected sub- blocks to ensure smooth running of survey activities in the camp. The community nutrition volunteers and community leaders for their collaboration in identifying survey areas and households during data collection. International Organization for Migration for providing the Needs and Population Monitoring estimates which contributed to high-quality sampling. UNHCR for providing population data and supporting sampling for the registered camps and providing HB testing kits. AAH, TAI and UNHCR field staff for creating awareness among refugees living in Kutupalong and Nayapara Registered Camp that led successful implementation of round 4 SMART surveys. Action Against Hunger MEAL team for providing technical support for necessary adjustment of KoBo questionnaire and managing the organization of mortality data set for ENA software. Action Against Hunger Canada SMART Initiative for providing technical support on data analysis, report writing and review. The survey teams who made the assessment possible through their professionalism and dedication in the field. Assessment Coordinators: Md Lalan Miah, Program Manager-Nutrition Surveillance , Action Against Hunger, Bangladesh Martin N Njoroge, Head of Department- Nutrition Surveillance, Action Against Hunger, Bangladesh Technical support: The Nutrition Assessment Technical Working Group, Cox’s Bazar Bijoy Sarker, SMART Regional Advisor- Asia, Action Against Hunger Canada Brigitte Tonon, Regional Health and Nutrition Advisor Asia, Action Against Hunger France Jogie Abucejo Agbogan, Health and Nutrition Head of Department, Action Against Hunger Bangladesh 3 TABLE OF CONTENTS Contents ACKNOWLEDGMENTS ............................................................................................................................................. 2 TABLE OF CONTENTS .............................................................................................................................................. 4 LIST OF TABLES......................................................................................................................................................... 7 LIST OF FIGURES ..................................................................................................................................................... 10 ACRONYMS .............................................................................................................................................................. 12 EXECUTIVE SUMMARY ......................................................................................................................................... 14 1. BACKGROUND ................................................................................................................................................ 17 1.1 CONTEXT ........................................................................................................................................................ 17 1.1.1 Geography and Demography ..................................................................................................................... 17 1.1.2 Displacement and the Camps ..................................................................................................................... 18 1.1.3 Health and Nutrition Situation ................................................................................................................... 19 1.1.4 Nutrition Programming and other Interventions in the Camps ................................................................. 20 1.2 SURVEY JUSTIFICATION ..................................................................................................................................... 21 1.3 SURVEY OBJECTIVES .......................................................................................................................................... 21 2. METHODOLOGY ............................................................................................................................................. 23 2.1 TYPE OF SURVEY AND TARGET POPULATION ..................................................................................................... 23 2.2 SAMPLE SIZE CALCULATION .............................................................................................................................. 24 2.3 SAMPLING .......................................................................................................................................................... 26 2.3.1 Makeshift and Informal Settlements (Two Stage Cluster Sampling) .......................................................... 26 2.3.2 Kutupalong and Nayapara Refugee Camps (Simple Random Sampling) .................................................. 28 2.3.3 Selection of Individuals in Survey .............................................................................................................. 28 2.4 COLLECTED VARIABLES ..................................................................................................................................... 29 2.4.1 Anthropometry ........................................................................................................................................... 29 2.4.2 Anaemia, Antenatal care, Iron-Folic Acid ................................................................................................. 30 2.4.3 Morbidity, Vitamin A and MNP Supplementation...................................................................................... 30 2.4.4 Receipt of Rations ...................................................................................................................................... 30 2.4.5 Retrospective Mortality .............................................................................................................................. 31 2.5 QUESTIONNAIRE, TRAINING, AND SUPERVISION................................................................................................. 31 2.5.1 Questionnaire ............................................................................................................................................. 31 2.5.2 Training ..................................................................................................................................................... 31 2.5.3 Survey Teams and Supervision .................................................................................................................. 32 2.6 DATA MANAGEMENT ......................................................................................................................................... 33 2.7 ETHICAL CONSIDERATIONS ................................................................................................................................ 33 3. RESULTS ................................................................................................................................................................ 34 3.1 RESULTS OF ROUND 4 MAKESHIFT SETTLEMENTS (MS) .................................................................................... 35 3.1.1 MS Sample ................................................................................................................................................. 35 3.1.2 MS Demography ........................................................................................................................................ 35 3.1.3 MS Data Quality .......................................................................................................................................