Anthropometric nutrition survey Children from 6 to 59 months Pregnant – Lactating women And Infant and Young Child Feeding Practices study Children from 0 to 23 months Final Report Saighan, Yakawlang and Panjab districts Bamyan province, Afghanistan From the 23 rd up to the 31 st 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 Saighan, Yakawlang and Panjab districts, Bamyan province with funding from 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 Saber Safi HMIS/Technical manager. This work would not have been possible without the dedicated efforts of the nutrition community and the local population in Afghanistan. We would like to thank: • The Ministry of Public Health and 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 field data 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 Bamyan province and particularly in the selected districts; • The entire ACF and AADA Teams for their great support in this project. 2 Anthropometric nutrition survey and Infant and Young Child Feeding Practices study Saighan, Yakawlang and Panjab districts, Bamyan province – Afghanistan – July 2011 LIST OF ABBREVIATIONS AAADA Agency for Assistance and Development of Afghanistan ACF Action Contre la Faim AKF Agha Khan Foundation BPHS Basic Package of Health Services CHC Comprehensive Health Centre CI Confidence Interval CMAM Community Management of Acute Malnutrition CSO Censes Statistics Office ENA Emergency Nutrition Assessment GAM Global Acute Malnutrition 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 Saighan, Yakawlang and Panjab districts, Bamyan province – Afghanistan – July 2011 TABLE OF CONTENTS EXECUTIVE SUMMARY ................................................................................................................................ 5 1. INTRODUCTION .................................................................................................................................. 10 1.1. Agencies .................................................................................................................................... 10 1.2. Surveyed area............................................................................................................................ 11 1.3. Population data – Demography ................................................................................................. 11 1.4. Geography – Climate ................................................................................................................. 11 1.5. Administrative organisation........................................................................................................ 12 1.6. Economic – Food security situation ........................................................................................... 12 1.7. Water and sanitation situation.................................................................................................... 13 1.8. Health situation and intervention................................................................................................ 13 1.9. Nutrition intervention.................................................................................................................. 14 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............................................................................................ 20 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: .................................................................. 24 3.6 IYCF indicators ............................................................................................................................... 25 3.7 Training and supervision................................................................................................................. 27 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 – Children 9-59 months............................................................. 35 4.4. Vitamin A supplementation coverage – Children 6-59 months .................................................. 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............................................................................ 48 5.4 Nutritional risk - Pregnant/Lactating women ................................................................................... 49 5.5 Causal analysis............................................................................................................................... 49 6. CONCLUSION...................................................................................................................................... 52 7. RECOMMENDATIONS......................................................................................................................... 53 8. REFERENCES ..................................................................................................................................... 54 9. ANNEXES............................................................................................................................................. 55 9.1 Annex 1: Map of Bamyan province, Afghanistan (Source: MoPH) ................................................. 55 9.2 Annex 2: 3 Ws (Who is doing What and Where), Bamyan province, April 2011 (Source: OCHA).. 56 9.3 Annex 3: Cluster selection, Saygan, Yakawlang and Panjab districts, Bamyan province, Afghanistan, July 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, Bamyan province, Afghanistan, July 2011 ................................................................................................ 61 9.7 Annex 7: Local event calendar, Bamyan province, Afghanistan, July 2011.................................... 62 9.8 Annex 8: IYCF study – children 0-23 months old, Bamyan, Afghanistan, July 2011 ...................... 63 9.9 Annex 9: Skip patterns - IYCF study – children 0-23 months old, Bamyan province, Afghanistan,