SMART nutrition assessment report Report of Nutrition and Mortality in Jawzjan province of Afghanistan from 12th to 22nd of April 2012. (28th April 2012) Óscar Serrano Oria, Nutrition ERP, SCUK Dr. Mohammad Akbar Sabawoon, Senior Nutrition Manager, SC Afghanistan TABLE OF CONTENTS ACRONYMS .................................................................................... 3 Executive summary .......................................................................... 4 1. Introduction ............................................................................... 5 1.1 Survey Objectives ....................................................................... 6 2. Methodology ............................................................................... 7 2.1 Sample size ............................................................................... 7 2.2 Sampling procedure: selecting clusters .............................................. 9 2.3 Sampling procedure: selecting households and children .......................... 9 2.4 Case definitions and inclusion criteria ............................................. 10 2.5 Questionnaire, training and supervision ........................................... 11 2.6 Data analysis ........................................................................... 12 2.6 Limitations of the Survey ............................................................ 13 3. Results .................................................................................... 14 3.1 Anthropometric results (based on WHO standards 2006): ....................... 14 3.2 Mortality results (retrospective over x months/days prior to interview) ..... 18 3.3 Children’s morbidity .................................................................. 18 3.4 Vaccination Results ................................................................... 19 4. Discussion ................................................................................ 19 4.1 Nutritional status ...................................................................... 19 4.2 Mortality ................................................................................ 20 4.3 Causes of malnutrition ............................................................... 20 4.4 Vaccination ............................................................................. 21 5. Conclusions .............................................................................. 21 6. Recommendations and priorities ..................................................... 21 7. References ............................................................................... 21 8. Acknowledgements ..................................................................... 22 9. Appendices .............................................................................. 23 ACRONYMS AFCO Afghanistan Country Office AM Acute malnutrition AMS Afghanistan Mortality Survey C.I. Confidence Interval CMAM Community Management of Acute malnutrition CMR Crude Death Rate DEFF Design Effect ENA Emergency Nutrition Assessment EPI Short name ERP Emergency Response Personnel GAM Global Acute Malnutrition HH Household HHS LQAS Household Survey using Lot Quality Assuring Sampling km2 Square Kilometres MoPH Ministry of Public Health MUAC Middle Upper Arm Circumference NCHS National Center for Health Statistics NRVA National Risk and Vulnerability Assessment PPS Probability Proportional to Size RC Reserve Cluster SAM Severe Acute malnutrition SC Save the Children SCUK Save the Children UK SD Standard Deviation SMART Standardized Monitoring and Assessment of Relief and Transitions U5MR Under 5 Mortality Rate WFP World Food Program WHO World Health Organisation Executive summary • The survey was performed in the Jawzjan Province, covering all the districts except QushTepa and Darzab, due to serious security constraints. Also some villages were excluded in the other districts for security reasons. The target population were residents, both rural and urban, being children 6-59 months of age the target for the Nutrition survey, and the whole population for the mortality part. • The dates of data collection for the survey range from the 12th to the 22nd of April • The methodology used on this survey was the Random Cluster Survey approach. Sampling was done using PPS (probability proportional to size) in 3 stages. The sample size was calculated with the software ENA 2011 based in national population averages and HH size). It was 903 children for the Nutrition survey and 4455 people for the mortality component, which resulted in a total of 880 HH to be visited. • Main anthropometric results (prevalence of global and severe acute malnutrition in terms of z-scores and/or oedema and 95% confidence intervals) GAM: 2,8 % (1,7 - 4,5 95% C.I.) SAM : 0,9 % (0,4 - 2,2 95% C.I.) • Prevalence of stunting (<-2 z-score) 42.7% • mortality rates (CMR and U5MR and 95% confidence intervals) CMR: 0,14 (0,05-0,36)(95% CI) U5MR: 0,11 (0,02-0,83) (95% CI) • Measles vaccination rates Not vaccinated: 53.65 % Vaccinated, with proof: 23.23 %, Vaccinated without documented proof: 23.12 % • Prevalence of Diarrhoea in the last 2 weeks: 3.7 % Discussion of results • The AM rates in the Jawzjan province are low, below the alert threshold, as an acceptable situation. No emergency interventions are required but support to the Public health implementers in order to spread capacity on diagnosis and treatment is recommendable due to the food insecurity in the area. • The rates of stunting are very high. Looking to the consequences of chronic malnutrition, some interventions should be prioritized to address it. • Rates on measles vaccination are substandard. Recommendations: 1. Continuation of the actual support to the present facilities, and expansion of the capacity for treatment of SAM in the rest of the districts. 2. Close monitoring of the trends in the Nutrition Surveillance system in place 3. Prioritization of interventions to reduce stunting including promotion of optimal IYCF, micronutrient-rich foods and appropriate supplementation and improving maternal health and nutrition. 4. Advocacy and support for a measles vaccination campaign ASAP 5. Perform another SMART survey within 1 year from now, including FSL component. 1. Introduction Geographic description of survey area • Country: Afghanistan Province: Jawzjan Districts: Aqcha, Fayzabad, Khamyab, Khanaqa, Khwaja Du Koh, Mangajak, Mardyan, Qarqin and Shibirghan districts, excluding Qush Tepa and Darzab districts due to serious security constraints1, as well as certain populations in the other districts for the same reason. (See annex 7 for details on the excluded areas) • The survey was performed among the resident population, both rural and urban. No IDP or refugees are known to live in the area. • The surface area of the province is 14660 km2, with a 29.6 % of mountainous land 2 and the rest is flat. Description of the population • The total population of the province is estimated, by the last HHS LQAS survey on 518676 individuals (December 2011), of which, removed all the excluded areas, the total number of people living in survey area is 403104 people. • The population is totally resident • The major livelihoods in the area are agriculture and pastoralist and Handicraft (carpet weaving, Mat weaving, etc.) and small business (shopkeepers). 1Security risks affect both expatriate and national staff, and so far, it’s categorized as a no-go area for humanitarian relief. 2http://jawzjan.afghanistan.af/en/page/2877 1. Introduction Geographic description of survey area • Country: Afghanistan Province: Jawzjan Districts: Aqcha, Fayzabad, Khamyab, Khanaqa, Khwaja Du Koh, Mangajak, Mardyan, Qarqin and Shibirghan districts, excluding Qush Tepa and Darzab districts due to serious security constraints1, as well as certain populations in the other districts for the same reason. (See annex 7 for details on the excluded areas) • The survey was performed among the resident population, both rural and urban. No IDP or refugees are known to live in the area. • The surface area of the province is 14660 km2, with a 29.6 % of mountainous land and the rest is flat.2 Description of the population • The total population of the province is estimated, by the last HHS LQAS survey on 518676 individuals (December 2011), of which, removed all the excluded areas, the total number of people living in survey area is 403104 people. • The population is totally resident • The major livelihoods in the area are agriculture and pastoralist and Handicraft (carpet weaving, Mat weaving, etc.) and small business (shopkeepers). 1Security risks affect both expatriate and national staff, and so far, it’s categorized as a no-go area for humanitarian relief. 2http://jawzjan.afghanistan.af/en/page/2877 Services and humanitarian assistance • Relief programmes in area: Save the children is implementing CFW project funded by ECHO, Tearfund is implementing Cash for Voucher project funded by WFP, Action Aid is also implementing a CFT project in Mordian district, WFP implements blanket distribution of Plumpy doz through BPHS implementer BDN. Also some WASH interventions are being implemented by Tearfund in Sheberghan and Aqcha districts. • Number of people on food aid: Save the Children covering 2700 individuals (500 unconditional and 2200 conditional or CFW) through CFW funded by ECHO, Action Aid is covering 999 beneficiaries through Cash for Training - CFT, TearFund is covering 3010 individuals through CFV, 1750 through CFW and 5392 through WASH project at 6 schools,