SAMBURU CENTRAL DISTRICT SMART NUTRITION SURVEY REPORT (Final Report) Conducted by: World Vision Kenya and Ministry of Public Health and Sanitation Services With Support from UNICEF February 2013 Submitted to: World Vision Kenya Country Office Report compiled by: Martin Meme Consultant Nutritionist Department of Foods, Nutrition & Dietetics Kenyatta University P.O. Box 43844 (00100) Nairobi Cell: 0722-306607 Email: [email protected] 2 ACKNOWLEDGEMENTS I most sincerely thank World Vision Kenya for according me the opportunity to undertake this survey in Samburu Central district. Successful implementation of the survey was made possible through the input of a number of people. I most gratefully appreciate the useful technical input from Daniel Muhinja, the Nutrition Information Working Group (NIWG) and Moragwa Oirere. The Samburu Senior IPA Manager (Charles Kasura), the Samburu Nutrition Programme Manager (Peter Wangai), Judith Muango, Lilian Kagwiria and Alfred Karisa (Samburu Project Officers - Nutrition), Koros Geoffrey (Project Officer - WASH), Josphat Lenguris (Samburu Deputy Public Health Nutritionist) and Humprey Mosomi (Samburu County Nutrition Support Officer - UNICEF) all played crucial roles during training, logistical coordination and field data collection supervision. The field and data entry teams are appreciated for collecting quality data and data entry, respectively. Special thanks go to the entire Samburu Central district community members for sparing time to provide the required information during household visits and FGDs. 3 TABLE OF CONTENTS ACKNOWLEDGEMENTS................................................................................................ 2 TABLE OF CONTENTS............................................................................................ 3 ACRONYMS AND ABBREVIATIONS………………………………………………………. 5 EXECUTIVE SUMMARY ……………………………………………………………………... 6 1.0 INTRODUCTION …………………………………………………………………………... 11 1.1 Background and Rationale………………………………………................................... 11 1.2 Objectives …………………………………………………………………………………... 11 2.0 METHODOLOGY ……………………………………………………………………......... 13 2.1 Geographic Target Area and Population Group……………………………………....... 13 2.2 Type of Survey............................................................................................................ 13 2.3 Sampling Methodology and Sample Size ……………………………………………… 13 2.4 Data Collection Tools and Variables Measured.......................................................... 14 2.4.1 The Household Questionnaire................................................................................. 14 2.4.2 Child (6-59 months old)............................................................................................ 14 2.4.3 Child (6-23 months old)............................................................................................ 14 2.4.4 Child (<6 months old).............................................................................................. 14 2.4.5 FGD guide............................................................................................................... 14 2.5 Training and Supervision………………………………………………………………… 14 2.6 Data Entry and Analysis.............................................................................................. 14 2.7 Nutritional Status Cut-off Points.................................................................................. 15 2.7.1 Weight-for-height (WFH) and MUAC – Wasting…………………............................. 15 2.7.2 Weight-for-age (WFA) – Underweight ……………………………………………........ 15 2.7.3 Height-for-age (HFA) – Stunting ……………………………………………………….. 15 2.7.4 Maternal MUAC ………………………………………………………………………….. 15 2.8 Data Quality Control.................................................................................................... 15 3.0 RESULTS AND DISCUSSIONS ………………………………………………………... 17 3.1 General Characteristics of Study Population and Households ……………................ 17 3.2 Nutritional Status of Children 6-59 Months ……………………………………………... 17 3.2.1 Prevalence of Global Acute Malnutrition by WFH z-scores..................................... 17 3.2.2 Prevalence of Acute malnutrition by MUAC............................................................. 18 3.2.3 Prevalence of Underweight by WFA z-scores……………….................................... 19 3.2.4 Prevalence of Stunting by HFA z-scores…………................................................... 19 3.3 Maternal Nutritional Status and Maternal Health Care ………………………………... 19 3.4 Infant and Young Child Feeding (IYCF) Practices and Care…………………............ 20 3.4.1 Breastfeeding Practices ……………………………………………............................. 20 3.4.2 Complementary Feeding Practices ……………....................................................... 20 3.4.3 Child Immunization…………………………………………………………................... 21 3.4.4 Vitamin A Supplementation, Deworming and Zinc in Diarrhoeal Management....... 22 3.4.5 Child Morbidity and Health-Seeking Behaviour ...................................................... 22 3.5 Water, Sanitation and Hygiene (WASH) practices..................................................... 22 3.6 Household Food Security Indicators .......................................................................... 23 3.6.1 Income and Food Sources ...................................................................................... 23 3.6.2 Household Meal Frequency .................................................................................... 23 4.0 CONCLUSIONS AND RECOMMENDATIONS ………………………………………... 25 4.1 Conclusions .............................................................................................................. 25 4.2 Recommendations..................................................................................................... 26 4 LIST OF TABLES Table 1: Summary of main survey findings..................................................................... 6 Table 2: Age and sex distribution of sample children …………………………………….. 17 Table 3: Prevalence of acute malnutrition by weight-for-height (WHO-GS)................... 17 Table 4: Child nutritional status based on MUAC…........................................................ 18 Table 5: Prevalence of underweight by weight-for-height z-scores (WHO-GS)………... 19 Table 6: Prevalence of stunting by height-for-age z-scores (WHO-GS)……….............. 19 Table 7: Adult nutritional status by MUAC …………………………………………............ 20 Table 8: Breastfeeding practices..................................................................................... 20 Table 9: Complementary feeding practices..................................................................... 21 Table 10: Vitamin A supplementation, deworming & zinc in diarrhoeal management.... 22 Table 11: Sources and treatment of drinking water........................................................ 23 Table 12: Frequency of meals………………………………............................................. 24 LIST OF FIGURES Figure 1: Overall prevalence of GAM by child age................…………………………….. 18 Figure 2: Distribution of W/H Z-scores for sampled children........................................... 18 Figure 3: Wasting by MUAC and child age ………………………………………………... 19 Figure 4: Food groups taken by children in the previous 24 hours................................. 21 Figure 5: Immunization, vitamin A supplementation and deworming coverage ……….. 21 Figure 6: Child morbidity................................................................................................. 22 Figure 7: Main sources of household income................................................................. 23 LIST OF APPENDICES Appendix 1: Survey clusters........................................................................................... 27 Appendix 2: Child age chart............................................................................................ 27 Appendix 3: Referral form............................................................................................... 27 Appendix 4: Movement plan........................................................................................... 27 Appendix 5: Weighted Samburu County findings.......................................................... 27 Appendix 6: Household & Anthro combined data........................................................... 27 Appendix 7: Child 6-59 months data............................................................................... 27 Appendix 8: Child 6-23 months data............................................................................... 27 Appendix 9: Child 0-5 months data................................................................................. 27 Appendix 10: Survey tool................................................................................................ 27 Appendix 11: FGD tool.................................................................................................... 27 5 ACRONYMS AND ABBREVIATIONS ARI - Acute Respiratory Infection BF - Breastfeeding CI - Confidence Interval EBF - Exclusive Breastfeeding ENA - Emergency Nutrition Assessment FGD - Focus Group Discussion GFD - General Food Distribution GAM - Global Acute Malnutrition GOK - Government of Kenya GS - Growth Standards HFA - Height-for-Age IMAM - Integrated Management of Acute Malnutrition KAP - Knowledge Attitudes and Practices KEPI - Kenya Expanded Programme on Immunization KII - Key Informant Interview MOH - Ministry of Health MUAC - Mid-Upper Arm Circumference