Ministry of Health / Kurdistan Region of Iraq Nutrition Anthropometric and Mortality Survey among Internally Displaced Populations in Erbil and Sulaimaniyah Governorates – Kurdistan Region of Iraq (November 2014) November 2014 I Acknowledgements The Departments of nutrition of Directorate of health in Erbil and Sulaimaniyah would like to take the opportunity to acknowledge the efforts of individuals and organizations involved in the successful implementation of this survey. We would like to acknowledge UNICEF Regional and Country Office for the financial and technical support for conducting this survey as part of the strong collaboration and partnership with the Kurdistan Ministry of health. We are deeply appreciative for the helpful contributions of various individuals and organizations on the design of the survey, its implementation, data analysis and report review. Special appreciations are expressed to survey team (supervisors, team leaders, enumerators, and drivers) for their tireless efforts to ensure that the survey was conducted professionally and on time. A special thanks to mothers caregivers and the whole community for the voluntary participation in this survey and response to the interviewers. 2 Table of contents Table of Contents Acknowledgements ......................................................................................................................................... 2 .......................................................................................................................................................................... 2 Table of contents ............................................................................................................................................. 3 List of Tables and Figures .............................................................................................................................. 4 Acronyms and abbreviations ......................................................................................................................... 5 Executive Summary .......................................................................................................................................... 6 The CMR in Erbil was 0.09 death (0.02 – 0.39; 95% CI) per 10,000 people per day while it is 0.0 death per 10,000 children per day. The situation is the same in Sulaimaniyah. According to the Sphere project, the CMR and U5MR emergency thresholds are 0.3 and 0.5 respectively for Middle East countries. These figures demonstrate that the level of malnutrition is in within the acceptable range in both provinces. ...... 7 I. Introduction ............................................................................................................................................ 8 1.1. Survey Objectives .......................................................................................................................... 9 II. Methodology ....................................................................................................................................... 9 2.1. Survey area .................................................................................................................................... 9 2.2. Sample size ................................................................................................................................... 10 2.3. Sampling procedure: selecting clusters, households and children .......................................... 10 2.4. Inclusion criteria and case definitions ....................................................................................... 11 2.5. Training and supervision ............................................................................................................ 12 3 2.6. Data collection ............................................................................................................................. 13 2.7. Data analysis ................................................................................................................................ 14 III. Results ............................................................................................................................................... 14 3.1. Anthropometric results (based on WHO standards 2006): ..................................................... 14 Anthropometric data were collected among 678 children in Erbil and 665 in Sulaimaniyah. Among these, 17 children (10 from Erbil and 7 from Sulaimaniyah) were excluded in the analysis as the one or more of the measurements (weight, height or age) were out of range. .......................................................................... 14 a) Prevalence of Global Acute Malnutrition (GAM); wasting ........................................................ 16 b) Prevalence of underweight ........................................................................................................... 18 c) Prevalence of chronic malnutrition (Stunting) ........................................................................... 20 d) Prevalence of overweight based on WHZ .................................................................................... 21 3.2. Retrospective mortality results .................................................................................................. 22 3.3. Households socio-economic characteristics ............................................................................... 22 3.4. Infant and young child feeding practices .................................................................................. 23 3.5. Vitamin A supplementation and immunization ........................................................................ 24 3.6. Prevalence of child morbidity .................................................................................................... 25 3.7. Household food Security ............................................................................................................. 25 3.8. Water access and hygiene ........................................................................................................... 26 IV. Discussion ......................................................................................................................................... 26 V. Conclusions ....................................................................................................................................... 28 VI. Recommendations ............................................................................................................................. 28 VII. References ......................................................................................................................................... 29 VIII-Annexes .................................................................................................................................................. 31 Annex 1: Calendar of events .................................................................................................................... 31 Annex 2: Plausibility Report .................................................................................................................... 32 Annex 3: Standardization test ................................................................................................................. 59 Annex 4: Assignment of clusters .............................................................................................................. 64 List of Tables and Figures Table 1: The sample size calculation parameters ........................................................ 10 Table 2: Anthropometric and mortality indicators definition .................................... 11 Table 3-a: Distribution of age and sex of sample in Erbil ........................................... 15 Table 4: Household food security ................................................................................. 25 Table 55: Access to safe water and household hygiene ............................................... 26 4 Figure 1-a: Distribution of the sample (678 children) within the target districts in Erbil ........................................................................................................................ 14 Acronyms and abbreviations ARI Acute Respiratory Infection BMS Breastmilk Substitutes C4D Communication for Development CI Confidence Interval CMAM Community Management of Acute Malnutrition CMR Crude Mortality Rate DoH Directorate of Health DTM Displacement Tracking Matrix ENA Emergency Nutrition Assessment EPI Extended Program on Immunization GAM Global Acute Malnutrition HAZ Height-for-Age Z score IDP Internally Displaced Population IMCI Integrated Management of Childhood Diseases IOM International Organization for Migration IYCF infant and Young Child feeding Practices KRI Kurdistan Region of Iraq MAM Moderate Acute Malnutrition MICS Multiple Indicator Cluster Survey MUAC Mid Upper Arm Circumference 5 SAM Severe Acute Malnutrition SD Standard Deviation SMART Standardized Monitoring of Relief and Transitions SPSS Statistical Package for Social Sciences U5MR under five Mortality Rate UNICEF United Nations Children's Fund WASH Water Sanitation and Hygiene WAZ Weigh-for-Age Zscore WHO World Health Organization WHZ Weight-for-height Zscore Executive Summary The Departments of nutrition of Erbil and Sulaimaniyah - Directorate of preventive health affairs in collaboration with UNICEF carried out a nutrition survey in the districts of Erbil,Shaqlawa ,Barzan