Anthropometric Nutrition Survey Children from 6 to 59 months And Infant and Young Child Feeding Practices study Children from 0 to 23 months Final Report Chal and Rustaq districts Takhar province, Afghanistan From the 24 th of June to the 2 nd of July 2011 Funded by UNICEF Islamic Republic of Afghanistan ACKNOWLEDGEMENT This anthropometric nutrition survey and Infant and Young Child Feeding study could be undertaken in Chal and Rustaq districts, Takhar province through funding by UNICEF. The coordinator of this project was Ms Brigitte Tonon, ACF health - nutrition coordinator supported by Mr. Tariq Khan, ACF nutrition program manager and Dr Asef Ghyasi, CAF nutrition and community development manager. This work would not have been possible without the dedicated efforts of the nutrition community in Afghanistan. We would like to thank: • The Ministry of Public Health, particularly the Public Nutrition Department, for their collaboration in this project; • The Nutrition Cluster body for their support; • The community representatives of the surveyed villages who have supported the nutrition survey teams during the data field collection; • The community members in the surveyed villages for welcoming and supporting the nutrition survey teams during the field work ; • The numerous Non Governmental Organizations and United Nations agencies for sharing information on the general situation in Takhar province and particularly in the selected districts; • The entire ACF and CAF Teams for their great support in this project. 2 Anthropometric nutrition survey and Infant and Young Child Feeding Practices study Chal and Rustaq districts, Takhar province – Afghanistan – June 2011 LIST OF ABBREVIATIONS ACF Action Contre la Faim BPHS Basic Package of Health Services CAF Care for Afghan Families CHW Community Health Worker CI Confidence Interval CMAM Community Management of Acute Malnutrition CSO Censes Statistics Office ENA Emergency Nutrition Assessment GAM Global Acute Malnutrition HF Health Facility HH Household HMIS Health Management Information System IYCF Infant and Young Child Feeding MAM Moderate Acute Malnutrition MoPH Ministry of Public Health Mths Months MUAC Mid Upper Arm Circumference N Sample size NCHS National Centre for Health Statistics NGO Non Governmental Organization NRVA National Risk and Vulnerability Assessment OCHA Office for the Coordination of Humanitarian Affairs OTP Out-patient Therapeutic Program RC Reserve Cluster SAM Severe Acute Malnutrition SMART Standardized Monitoring and Assessment of Relief and Transitions TFU Therapeutic Feeding Unit U5 Under Five UN United Nations UNHCR United Nation High Commissioner for Refugees UNICEF United Nation Children’s Fund WFP World Food Program W/H Weight for Height index WHO World Health Organization 3 Anthropometric nutrition survey and Infant and Young Child Feeding Practices study Chal and Rustaq districts, Takhar province – Afghanistan – June 2011 TABLE OF CONTENTS EXECUTIVE SUMMARY ................................................................................................................................ 5 1. INTRODUCTION .................................................................................................................................. 10 1.1. Agencies .................................................................................................................................... 10 1.2. Surveyed area............................................................................................................................ 10 1.3. Population data - Demography .................................................................................................. 11 1.4. Climate and geography.............................................................................................................. 11 1.5. Administrative organisation........................................................................................................ 11 1.6. Economic – Food security situation ........................................................................................... 12 1.7. Water and sanitation situation.................................................................................................... 12 1.8. Health situation and interventions.............................................................................................. 13 1.9. Nutrition intervention.................................................................................................................. 13 1.10. Humanitarian intervention.......................................................................................................... 14 2. SURVEY GOALS AND OBJECTIVES .................................................................................................. 15 3. METHODOLOGY.................................................................................................................................. 16 3.1. Sampling strategy: sampling design and sample size calculation.............................................. 16 3.2. First stage sampling: cluster selection ....................................................................................... 19 3.3. Final stage sampling: Selection of households and children...................................................... 20 3.4. Data collected and measurement techniques ............................................................................ 22 3.5. Definition of nutritional status of children 6-59 months:.............................................................. 23 3.6. IYCF indicators .......................................................................................................................... 25 3.7. Training and supervision............................................................................................................ 26 3.8. Data analysis ............................................................................................................................. 27 4. RESULTS ............................................................................................................................................. 28 4.1. Nutritional status of children 6-59 months (according to WHO standards 2006)........................ 28 4.2. Anthropometric results: Pregnant/Lactating women (based on MUAC criterion) ....................... 34 4.3. Measles vaccination coverage................................................................................................... 35 4.4. Vitamin A supplementation coverage......................................................................................... 35 4.5. IYCF study ................................................................................................................................. 36 5. DISCUSSION........................................................................................................................................ 45 5.1. Constraints and biases .............................................................................................................. 45 5.2. Acute malnutrition – Children 6-59 months old ......................................................................... 46 5.3. Chronic malnutrition – Children 6-59 months old ...................................................................... 47 5.4. Malnutrition risk - Pregnant/Lactating women............................................................................ 48 5.5. Causal analysis.......................................................................................................................... 49 6. CONCLUSION...................................................................................................................................... 50 7. RECOMMENDATIONS......................................................................................................................... 51 8. REFERENCES ..................................................................................................................................... 53 9. ANNEXES............................................................................................................................................. 54 9.1. Annex 1: Map of Takhar province, Afghanistan (Source: MoPH) ............................................... 54 9.2. Annex 2: 3 Ws (Who is doing What and Where), Takhar province, Afghanistan, September 2011 (Source: OCHA) ........................................................................................................................................ 55 9.3. Annex 3: Cluster selection, Chal and Rustaq districts, Takhar province, Afghanistan, June 2011 57 9.4. Annex 4: Selection of cluster with Probability Proportional to Population Size (PPS) ................ 58 9.5. Annex 5: Household selection sheet – SMART Training Package – Version 2011 ........................ 60 9.6. Annex 6: Anthropometric survey – children 6-59 months old and if age not know 65-110 cm, Chal and Rustaq districts, Takhar province, Afghanistan, June 2011 ....................................................... 61 9.7. Annex 7: Local event calendar, Chal and Rustaq districts, Takhar province, Afghanistan, June 2011 62 9.8. Annex 8: IYCF study – children 0-23 months old, Chal and Rustaq districts, Takhar province, Afghanistan, June 2011 ............................................................................................................................ 63 9.9. Annex 9: Skip patterns - IYCF study – children 0-23 months old, Chal and Rustaq districts, Takhar