Republic of Yemen Ministry of Public Health and Population Central Statistical Organization Report on the Nutritional Situation and Mortality Survey Al Jawf Governorate, Yemen From 19 to 25 April 2018 1 Acknowledgment The Ministry of Public Health and Population in Yemen, represented by the Public Health and Population Office in the Al Jawf governorate and in cooperation with the UNICEF country office in Yemen and the UNICEF branch in Sana’a, acknowledges the contribution of different stakeholders in this survey. The UNICEF country office in Yemen provided technical support, using the SMART methodology, while the survey manager and his assistants from the Ministry of Public Health and Population and the Public Health and Population Offices in Amran and Taiz were also relied on. The surveyors and team heads were provided by the Public Health and Population Office in the Al Jawf governorate. The data entry team was provided by the Public Health and Population Office in Amran and the Nutrition Department in the Ministry. The survey protocol was prepared, and other changes were made to it, through cooperation between the Ministry of Public Health and Population and the Central Statistical Organization, with technical support from UNICEF. The Organization for Economic Cooperation and Development provided UNICEF with technical assistance, especially with regards to daily quality checks, data analysis, and report writing. The Building Foundation for Development provided technical and logistical support through extensive coordination with the local authorities in the Al Jawf governorate, as well as through their choice of the survey team and providing extensive training for them. The Building Foundation for Development was also responsible for regular follow-up with the survey teams out in the field and providing logistical and technical support for these teams, as well as preparing the initial draft of the survey report. The Public Health and Population Office in the Al Jawf governorate was informed of the organizational and logistical arrangements for the survey in order to ensure that the process went along smoothly. UNICEF provided financial support to the nutrition survey within the scope of a grant from the United Nations Central Emergency Response Fund (UNICEF YCO), and this support is greatly appreciated. The contributions of the local authorities in ensuring the security of the survey teams during their field working, and in facilitating their work, is also appreciated. It would not have been possible to get this data without the cooperation and support of the communities that were assessed, especially the mothers and caregivers who responded to the interviews. Their participation and cooperation is greatly appreciated. The Ministry of Public Health and Population, the Central Statistical Organization, the Building Foundation for Development, and UNICEF express their thanks and appreciation to the survey team for their high level of commitment and effort during all of the stages of the assessment to ensure the high quality of the data that was collected and that this process is successful. 2 Table of Contents Acknowledgment .......................................................................................................................................... 2 Table of Contents .......................................................................................................................................... 3 Index of Tables ............................................................................................................................................. 5 List of English Abbreviations and Their Definitions .................................................................................... 7 Introduction ................................................................................................................................................... 9 Survey Objectives ....................................................................................................................................... 11 Methodology ............................................................................................................................................... 12 Sample Size and Sampling Design ............................................................................................................. 12 Sample Frame Description .......................................................................................................................... 13 Survey Community and Data Collection Procedures.................................................................................. 14 Monitoring Measurements and Quality Control ......................................................................................... 15 Data Entry and Analysis ............................................................................................................................. 15 Results and Discussion ............................................................................................................................... 19 Household Characteristics ...................................................................................................................... 20 Household Income Characteristics ......................................................................................................... 21 Water, Sanitation, and Hygiene .............................................................................................................. 22 Household Food Security ....................................................................................................................... 24 Average Coping Strategies ..................................................................................................................... 24 Child Nutrition ............................................................................................................................................ 25 Severe Malnutrition – Wasting – WHZ Indicator .................................................................................. 25 Severe Malnutrition by Mid-Upper Arm Circumference (MUAC) ........................................................ 27 Acute Malnutrition (Wasting) Using a Mix of the WHZ and MUAC Indicators: .................................. 28 Malnutrition (Underweight) ................................................................................................................... 30 Chronic Malnutrition (Stunting) – HAZ Indicator ................................................................................. 32 Standard Deviations of the Mean, the Effect of the Design, and Abnormal Values (Extremes) ............ 33 Infant and Young Children Feeding (IYCF) .......................................................................................... 34 Child Morbidity ...................................................................................................................................... 34 Vitamin A Supplements and Child Vaccination ..................................................................................... 35 Nutrition of Women of Reproductive Age (15 to 49 years old) ............................................................. 36 Mortality Rate ......................................................................................................................................... 36 Nutritional Status Factors ....................................................................................................................... 38 Child Nutrition and Its Relationship to Mother Nutrition ...................................................................... 42 Recommendations ....................................................................................................................................... 44 References ................................................................................................................................................... 46 Annexes ...................................................................................................................................................... 47 3 Annex 1: Malnutrition Survey Questionnaire – Al Jawf Governorate – April 2018 .............................. 47 Annex 2: Malnutrition Survey Team – Al Jawf Governorate – April 2018 ........................................... 66 Annex 3: Timetable – Al Jawf Governorate – April 2018 ..................................................................... 68 Annex 4: Table to determine the ages of children using the Gregorian and Hijri calendars – Al Jawf Governorate – April 2018 ....................................................................................................................... 76 Annex 5: Credibility Check for the Al Jawf Survey – April 2018 ......................................................... 79 Annex 6: Report on the child measurement sessions to evaluate the team during the Al Jawf Survey – April 2018 ............................................................................................................................................... 80 Annex 7: The clusters chosen for the nutrition and mortality survey – Al Jawf Governorate – April 2018 ........................................................................................................................................................ 81 Sample Selection Decision Tree – Al Jawf Survey – April 2018 ........................................................... 83