INTEGRATED SURVEY MERU NORTH DISTRICT, JULY 2013 INTEGRATED SURVEY MERU NORTH DISTRICT JULY 2013 FUNDED BY: UNICEF Report compiled by: Francis Wambua ACKNOWLEDGEMENT The survey team would like to express their sincere thanks to all who made it possible given the numerous challenges faced. In particular, the team would like to thank ACF- Kenya and UNICEF for the financial and technical support for the survey. In particular, special thanks go to Mr. Francis Wambua (the Survey co-ordinator), Mr. Samuel Murage (monitoring and evaluation officer), Ms. Grace Gichohi (Program officer – food security), Francis Odhiambo (UoN) and Mr. Michael Mwongera (NDMA) for their leadership role during planning, training, data collection and data cleaning, Analysis and report compilation. Special acknowledgment goes to the Health Team led by Dr. James Gitonga (County Health Coordinator), Lucy Njagi (acting county Nutrition officer) for their role in the planning, coordination and field supervision of survey teams. The invaluable work by Hellen Ringera during data entry and analysis is highly acknowledged. Sincere gratitude also goes to the entire survey team composed of the health staff and Field monitors from Meru North district who tirelessly participated for the entire data collection exercise. TABLE OF CONTENTS ACKNOWLEDGEMENT ...................................................................................................................................... 2 LIST OF TABLES ............................................................................................................................................... 3 LIST OF FIGURES ............................................................................................................................................. 4 ABBREVIATIONS ............................................................................................................................................... 5 1. EXECUTIVE SUMMARY ............................................................................................................................. 6 1.1 OBJECTIVES ........................................................................................................................................... 6 1.2 METHODOLOGY .................................................................................................................................... 6 1.3 RESULTS ................................................................................................................................................ 6 2. INTRODUCTION ........................................................................................................................................ 8 2.1 RATIONALE FOR THE SURVEY ............................................................................................................. 8 3. OBJECTIVES ............................................................................................................................................. 8 4. METHODOLOGY ....................................................................................................................................... 8 4.1 GEOGRAPHIC TARGET AREA AND POPULATION GROUP ................................................................. 8 4.2 SURVEY DESIGN .................................................................................................................................... 9 4.3 SAMPLING PROCEDURE: SELECTING HOUSEHOLDS AND CHILDREN .............................................. 9 4.4 SELECTION OF SURVEY TEAM, TRAINING AND PRETESTING OF QUESTIONNAIRE ....................... 9 4.5 VARIABLES COLLECTED ..................................................................................................................... 10 4.6 DATA ANALYSIS ................................................................................................................................... 11 5. RESULTS ..................................................................................................................................................... 13 5.1 DEMOGRAPHIC CHARACTERISTIC OF HOUSEHOLDS ...................................................................... 13 5.2 HEALTH AND NUTRITION ................................................................................................................... 13 5.2.1 Distribution by Age and sex .................................................................................................... 13 5.2.3 Nutritional status of under five children ............................................................................... 14 5.2.4 Mortality results (retrospective over 96 days prior to interview) .................................... 16 5.2.5 Maternal nutrition ...................................................................................................................... 16 5.2.6 Immunization coverage ............................................................................................................. 16 Figure 4: Immunization coverage ...................................................................................................... 17 5.2.7 Vitamin A Supplementation and De worming Coverage ...................................................... 17 5.2.8 Child Morbidity and Health Seeking Behaviour ..................................................................... 17 5.3 INFANT AND YOUNG CHILD FEEDING PRACTICES .......................................................................... 18 5.3.1 Breastfeeding Practices ............................................................................................................ 18 5.3.2 Complementary Feeding and Meal Frequency ...................................................................... 18 5.4 WATER, SANITATION AND HYGIENE ................................................................................................ 19 5.4.1 Household Water Access and Sanitation ................................................................................ 19 5.4.2 Access to Toilet and Hand washing practices ....................................................................... 20 5.5 FOOD SECURITY AND LIVELIHOODS ................................................................................................. 20 5.5.1 Main Livelihood Activities ......................................................................................................... 20 5.5.2 Main source of income .............................................................................................................. 21 5.5.3 Main sources of food .................................................................................................................. 21 5.5.4 Household Dietary Diversity ..................................................................................................... 21 LIST OF TABLES Table 1: Summary of survey findings ............................................................ 6 Table 2: Household demographic characteristics ............................................. 13 Table 3: Distribution of age and sex of sample ................................................ 13 Table 4: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex ............................................................................... 14 Table 5: Prevalence of acute malnutrition based on MUAC cut off's (and/or oedema) and by sex........................................................................................... 14 Table 6: Prevalence of underweight based on weight-for-age z-scores by sex ........... 15 Table 7: Prevalence of stunting based on height-for-age z-scores and by sex ............ 15 Table 8: Mortality rates ........................................................................... 16 Table 9: Vitamin A and deworming coverage .................................................. 17 Table 10: Morbidity and health seeking behaviour ........................................... 18 Table 11: Recommendations ..................................................................... 22 LIST OF FIGURES Figure 1: Population by livelihood ................................................................ 8 Figure 2: Underweight prevalence by age category .......................................... 15 Figure 3: Stunting rates by age category ....................................................... 16 Figure 4: Immunization coverage ................................................................ 17 Figure 5: Individual Dietary Diversity ........................................................... 19 Figure 6: Main water sources ..................................................................... 19 Figure 7: Hand washing at critical moments ................................................... 20 Figure 8: Livelihood activities ................................................................... 21 Figure 9: Household Dietary Diversity .......................................................... 21 ABBREVIATIONS ARI Acute Respiratory Infection CI Confidence Interval ENA Emergency Nutrition Assessment FAO Food and Agriculture Organization GAM Global Acute Malnutrition GOK Government of Kenya GS Growth Standards HFA Height-for-Age IMAM Integrated Management of Acute Malnutrition ITN Insecticide Treated Nets EPI Expanded Programme on Immunization MOH Ministry of Health MUAC Mid-Upper Arm Circumference OPV Oral Polio Vaccine PPS Probability Proportional to Population Size SAM Severe Acute Malnutrition NDMA National Drought