Food Security and Nutrition Assessment in Ibanda, Kabale, Kanungu, Nebbi and Pader districts November 2014 Re po rt By Dr. He nry Wamani Makerere University School of Public Health ii Table of content Acknowledgements ......................................................................................................................................... vii Executive summary .............................................................................................. viii Introduction and Background ................................................................................. 1 Methods ................................................................................................................ 1 Findings and discussion .......................................................................................... 2 Socio-demographic characteristics ............................................................................................................ 2 Age and sex distribution of sampled children ........................................................................................ 2 Sex, age and marital status of household head ..................................................................................... 2 Age and parity status of respondents ........................................................................................................ 3 Education status of mothers .......................................................................................................................... 4 Nutritional status of children 6-59 months ............................................................................................ 4 Trends of stunting rates for 2012 to 2014 ............................................................................................... 5 Prevalence of stunting stratified by sex among children 6-59 months ....................................... 6 Prevalence of severe stunting according to age among children 6-59 months ...................... 7 Wasting prevalence stratified by sex among children 6-59 months ............................................ 7 Mean z-score of nutrition indicators .......................................................................................................... 8 Nutrition status of mothers 15-49 years ................................................................................................. 8 BMI status of mothers ....................................................................................................................................... 8 Infant and young child feeding practices ................................................................................................. 9 Exclusive breastfeeding among children 0-5 months ......................................................................... 9 Timing of introduction of complementary feeding .............................................................................. 9 Minimum meal frequency ............................................................................................................................ 10 Minimum dietary diversity .......................................................................................................................... 10 Minimum acceptable diet ............................................................................................................................. 11 Factors significantly associated with minimum acceptable diet (MAD) ................................ 12 Use of micronutrient powders (MNP) ..................................................................................................... 12 Mothers knowledge of infant and young child feeding practices ............................................... 12 Morbidity and health care seeking practices ...................................................................................... 13 Immunization deworming and vitamin A supplementation coverage .................................... 13 Prevalence of common childhood illness among children 0-59 months .................................. 14 Safe water and sanitation coverage ........................................................................................................ 15 Safe water coverage ....................................................................................................................................... 15 Latrine coverage .............................................................................................................................................. 16 Household socioeconomic, food security and livelihood status ................................................. 16 Household socioeconomic status .............................................................................................................. 16 Household food security status .................................................................................................................. 17 Factors associated with household food security or moderate to severe hunger ............... 19 Diagrammatic description of 7-day food consumption frequencies ......................................... 22 Household sources of livelihood ................................................................................................................ 24 Household ownership of livestock ............................................................................................................ 25 Household expenditure ................................................................................................................................. 26 Gender dynamics at household level ...................................................................................................... 28 Time allocation between husbands and wives in households ...................................................... 28 Decision making, ownership and control profiles between men and women ....................... 28 Factors associated with malnutrition .................................................................................................... 30 Conclusions .......................................................................................................... 33 Recommendations ............................................................................................... 36 Appendix 1– Questionnaire ........................................................................................................................ 37 Appendix 2– ENA reports and plausibilty checks ............................................................................. 49 iii List of figures FIGURE 1: PREGNANCY AND BREASTFEEDING STATUS OF AMONG MOTHERS 15-49 YEARS ......................................... 4 FIGURE 2: TREND OF STUNTING 2012 TO 2014 ACCORDING TO DISTRICT ..................................................................... 6 FIGURE 3: STUNTING AND SEVERE STUNTING PREVALENCE ACCORDING TO SEX ............................................................. 6 FIGURE 4: PREVALENCE OF SEVERE STUNTING ACCORDING TO AGE .................................................................................. 7 FIGURE 5: PREVALENCE OF WASTING ACCORDING TO SEX .................................................................................................. 7 FIGURE 6: EXCLUSIVE BREASTFEEDING RATES ACCORDING TO DISTRICT ......................................................................... 9 FIGURE 7: PROPORTIONS OF CHILDREN 6-8 MONTHS WHO DID NOT RECEIVE COMPLEMENTARY FOOD 24 HOURS BEFORE THE ASSESSMENT, ACCORDING TO DISTRICT ............................................................................................. 10 FIGURE 8: MEAL FREQUENCY AMONG CHILDREN 6-23 ACCORDING TO DISTRICT ........................................................ 10 FIGURE 9: MINIMUM ACCEPTABLE DIETARY DIVERSITY FOR CHILDREN 6-23 MONTHS ACCORDING TO DISTRICT . 11 FIGURE 10: PROPORTION OF CHILDREN 6-23 MONTHS WHO HAD MINIMUM ACCEPTABLE DIET, ACCORDING TO DISTRICT ....................................................................................................................................................................... 12 FIGURE 11: ASSOCIATION BETWEEN CHILDREN WHO HAD MINIMUM ACCEPTABLE DIET, WITH MOTHERS’ EDUCATION ................................................................................................................................................................... 12 FIGURE 12: CORRECT RESPONSE ON QUESTIONS ASSESSING MOTHERS KNOWLEDGE ON INFANT AND YOUNG CHILD FEEDING PRACTICES AND BIRTH SPACING ................................................................................................................ 13 FIGURE 13: IMMUNIZATION, DEWORMING AND VITAMIN A SUPPLEMENTATION COVERAGE AMONG CHILDREN 12- 23 MONTHS ACCORDING TO DISTRICT .................................................................................................................... 14 FIGURE 14: TWO-WEEK PREVALENCE OF FEVER, ARI AND DIARRHEA ACCORDING TO DISTRICT ............................. 15 FIGURE 15: LATRINE COVERAGE ACCORDING TO DISTRICT ......................................................................................... 16 FIGURE 16: ASSOCIATION OF HOUSEHOLD SOCIOECONOMIC STATUS AND CHILDHOOD MALNUTRITION .................. 17 FIGURE 17: FOOD SECURITY STATUS OF HOUSEHOLDS BASED ON FOOD CONSUMPTION SCORES ACCORDING TO DISTRICT ......................................................................................................................................................................