INTEGRATED HEALTH AND NUTRITION SMART SURVEY GREATER MOYALE DISTRICT 06th-11thJune 2011 Final report Concern Worldwide, KENYA Kabura Ndegwa Consultant M.Sc Public Health Nutrition – Email: [email protected] ACKNOWLEDGEMENTS I take this opportunity to thank UNICEF and Concern Worldwide through Moyale Nutrition Programme, for providing me the opportunity to conduct this nutrition survey. I am grateful to the National Nutrition Coordinator, Nutrition Project Manager, Assistant Nutrition Project Manager, Survey and Surveillance Officer and Logistics Officer for their assistance and support. This report has been compiled with valuable input from many individuals and agencies, notably, Ministry of Health, ALRMP, KFSSG, World Vision and CIFA Kenya. Special thanks are expressed to the Survey supervisors (Concern; World Vision; UNICEF), data entry assistants and members of the survey teams for their tireless efforts to ensure that the survey was a success. I am also indebted to the district administrators, local leaders and community members who willingly participated in the survey and provided the information needed. Kabura Ndegwa (Ms.) Nutrition Consultant 1 TABLE OF CONTENTS ACKNOWLEDGEMENTS .............................................................................................................................. 1 EXECUTIVE SUMMARY ............................................................................................................................... 7 1.0 INTRODUCTION ................................................................................................................................... 11 1.1 Background Information.................................................................................................................... 11 1.1.1 Livelihoods ............................................................................................................................... 11 1.1.2 Current Climatic Conditions and Food Security ................................................................. 12 1.1.3 Food Distribution ..................................................................................................................... 12 1.1.4 Health ....................................................................................................................................... 12 1.1.5 Water Access and Availability ............................................................................................... 12 1.1.6 Nutrition .................................................................................................................................... 13 1.2 SURVEY OBJECTIVES .......................................................................................................................... 13 2.0 METHODOLOGY .................................................................................................................................. 14 2.1 General Approach .............................................................................................................................. 14 2.2 Sampling Methodology and Sample Size .......................................................................................... 14 2.3 Data collection Tools and Variables Measured ................................................................................. 15 2.4 Training and Supervision ................................................................................................................... 15 2.5 Data Entry and Analysis ..................................................................................................................... 15 2.6 Nutritional Status Cut-off Points ....................................................................................................... 15 3.0 RESULTS AND DISCUSSIONS ...................................................................................................... 17 3.1 Household Demographic Characteristics .......................................................................................... 17 3.2 Distribution by Age and Sex .............................................................................................................. 17 3.3 Nutritional Status of Children 6-59 Months ...................................................................................... 17 3.4 Prevalence of Global Acute Malnutrition by WFH Z-scores (WHO Standards) ................................. 17 3.5 Prevalence of acute Malnutrition (Weight-for-Height z-Scores) by Age Groups .............................. 18 3.6 Prevalence of Acute Malnutrition based on the % of the Median .................................................... 19 3.7 Prevalence of Acute Malnutrition by MUAC ..................................................................................... 19 3.8 Prevalence of Underweight by Weight-for-Age Z-scores (WHO-GS) ................................................ 19 3.9 Prevalence of Stunting by Height-for-Age (HFA) Z-scores (WHO-GS) ............................................... 20 4.0 Mortality Results ............................................................................................................................... 20 4.1 Children’s Morbidity .......................................................................................................................... 21 4.2 Health Seeking Behaviour by Mothers/Caregivers for the Sick Children .......................................... 21 4.3 Vaccination Results ............................................................................................................................ 21 4.5 Vitamin A Supplementation/ Deworming ......................................................................................... 22 2 4.6 Therapeutic Zinc Supplementation for Diarrhoea Management ...................................................... 22 4.7 PROGRAMME COVERAGE.................................................................................................................. 23 5.0 Primary Child Caregiver Indicators ........................................................................................................ 24 5.1 Adult Nutritional Status ..................................................................................................................... 24 5.2 Micronutrient Supplementation for Caretakers ............................................................................... 25 6.0 FOOD UTILIZATION ............................................................................................................................. 25 6.1 Infant and Young Child Feeding (IYCF) and Care Practices ................................................................ 25 7.0 ITN Utilization, Hygiene and Sanitation ................................................................................................. 28 7.1 Insecticide Treated Mosquito Nets (ITN) Holding Rates and Utilization ........................................... 28 7.2 Water, Sanitation and Hygiene Practices .......................................................................................... 28 7.3 Hand-washing .................................................................................................................................... 29 7.4 Environmental Sanitation .................................................................................................................. 29 8.0 Household Food Security Indicators ..................................................................................................... 29 8.1 Household Food Consumption, Dietary Diversity and Coping Strategies ......................................... 29 8.2 Food Aid ............................................................................................................................................. 31 8.3 Sources/Use of Income and Wealth Ranking .................................................................................... 31 9.0 DISCUSSION ........................................................................................................................................ 33 9.1 Nutritional Status .............................................................................................................................. 33 9.2 Mortality ............................................................................................................................................ 33 9.3 Causes of Malnutrition ...................................................................................................................... 33 10. CONCLUSION ....................................................................................................................................... 36 11. RECOMMENDATIONS ......................................................................................................................... 36 APPENDIX 1: PLAUSIBILITY REPORT ..................................................................................................... 39 APPENDIX 2: CLUSTER ALLOCATION LIST ............................................................................................ 40 APPENDIX 4: QUESTIONNAIRES ............................................................................................................. 41 3 List of Tables Table 1: Abbreviations ................................................................................................................................................ 6 Table 2: Summary of Findings ................................................................................................................................