Report of Nutritional Survey Conducted in Damot Weyde Wereda, Welayita, North Omo, Ethiopia. 14th - 19th April 2000 Survey Conducted By Concern Worldwide With Assistance From WONTTA And The Ministry Of Health Nutritionists: Mary Corbett, MSc Victor Ferreira, MSc Assisted by: WONTTA (local NGO) Atto Woranna Dunda Yohannes Wodajo Assisted by: Yohannes Bade, MOH Compiled By: Mary Corbett Date: 2nd of May 2000. Table of Contents 1. Background 3 2. Nutritional Assessment and Survey - March 2000 3 2.1 Nutritional Survey Methodology 4 2.2 Sample Size and Composition 4 2.3 Breakdown by Age 4 2.4 Questionnaire 4 3. Survey Findings 5 3.1 Nutritional Survey 5 3.2 Nutritional Survey Table 5 3.3 Morbidity and Mortality 6 3.4 EPI Coverage 7 3.5 Mother's Nutritional Status 7 3.6 Household Food Security 7 4. Main Findings Summary 8 5. Current Priorities and Recommendations 8 6. Appendix 1 Survey Questionnaire 9 7. Appendix 2 Kebeles Surveyed 10 2 1. Background: Concern Worldwide worked in Damot Weyde Wereda, Welayita, North Omo Zone since 1984, starting with emergency relief in response to the ’84 famine. Following this programme rehabilitation interventions in health, water and agriculture were implemented with large-scale Food for Work activities being carried out to improve secondary roads and assist terracing on eroded hillsides. The programme developed into an integrated rural development programme operated in co-ordination with the local line Ministries until the end of 1998. CONCERN withdrew from the area in 1998, in line with government policy under which NGO’s were expected to work in an area for a maximum of five years before handing over programmes to the local authorities/local NGOs. The region of Welayita, which is south west of Addis has been identified for a number of years as a food insecure area. Over the last few decades it has suffered many crises, with consequent high mortality. The most recent serious food security problems occurred in 1994- 1995, following a failure of “Sapa Rains” . This led to a complete sweet potato crop failure, which, in turn, led to “famine conditions”. (Both sweet potato and green maize are important foods, in particular, to fill the “hunger gap”.) The precarious food insecurity in this area is caused by a combination of factors, high population density, with higher than the average family size (7-8 per household) small land holdings and serious soil erosion. Furthermore, reliance on rain fed agriculture adds to the already fragile situation. Three consecutive poor harvests (the main harvest) and failure of the recent Belg rains has led to the present food security crisis in this area which has also suffered three consecutive sweet potato failures. Presently the potato crops in the ground have dried up and are rotting. ‘Green maize’ is usually harvested here in June/July but this crop has not been planted this year and therefore will not be available. In normal conditions, Ethiopia has two main planting seasons. The Meher, is the main planting season, with planting in April/May and a harvest in November. The Belg rains in February/March are particularly important for the highlands as, at this time, crops such as millet, groundnuts and haricot beans are planted. This latter rain is also important to the midlands and lowlands as it moistens the land for tilling/preparation for cultivation in the main season. These rains are also vital for the pasturelands, as following months of little or no rain, it not only helps grass growth, providing grazing for livestock, but it also helps prevent bush fires. 2. Nutritional Assessment and Survey - March 2000 Concern Worldwide conducted a rapid nutritional assessment between 29th and 31st March to identify needs. On this assessment, informal interviews were conducted with different stakeholders, including Wereda authorities, elders, health personnel and local community members. The main outcome indicated that a large percentage of the community had no harvest, had no crops growing and were eating only one meal a day (mainly ensette - a nutritionally poor food). On visiting the Ministry of Health clinic at Bedessa (built by Concern) over a hundred children had gathered for a supplementary food ration which was being supplied by the health authorities. At least five children presented with Kwashiorkor (severe malnutrition), while many others were very visibly thin. It was evident that there was a need to conduct a nutritional survey, to collect baseline data on the present situation. 3 2.1 Nutritional Survey Methodology: To collect accurate representational data on the entire Wereda, it was deemed necessary to conduct a thirty cluster, randomly selected sample survey based on WHO standard guidelines. From forty-eight Kebeles in the wereda, thirty kebeles ) which included a representation of low, medium and high land were randomly selected for the survey (see Appendix 2 for list of Kebeles). Official kebele populations numbers were obtained from the local authorities and the probability of cluster selection was proportional to population size. Sampling of children was random using the technique of spinning a pen at the center of the Kebele for the direction of the survey and then randomly selecting a number to chose the first household. From this first household, the next closest house was identified and so on, until reaching the end of the Kebele, where upon the team returned to the center of the Kebele and restarted the process until the correct number of children were measured. Only one child per household was selected but where there was more than one child under five years in the household a further random selection was made. A one-day training was conducted with the three identified survey teams prior to the survey. Two international nutritionists supervised the survey. 2.2 Sample Size and Composition: A total of 960 children under 5 years, from thirty clusters, were weighed and measured. For accuracy children less than 85cms in length were measured lying down rather than standing. All children ³ 60cms (approximately six months) and £ 110cm (five years) in height were measured. Height measurements were recorded to the nearest 0.5cms while weights were measured to the nearest 10gms (0.1kg). Age, sex and presence/absence of oedema were recorded. Mother’s MUAC (Mid Upper Arm Circumference) was also recorded. As shown on table below there was a small percentage of children under 12 months in the survey, with the largest groups between the ages of two and four years. The composition consisted of 51.8% females (495 children) and 48.2% males (460 children). 2.3 Breakdown by Age: Age group % 0f total survey 6 - 11 months 3.7% 12 - 23 months 14.9% 24 - 35 months 29.6% 36 - 47 months 33.3% 48 – 59 months 18.5% 2.4 Questionnaire: During the nutritional survey a household food security/mortality/morbidity questionnaire was conducted with the mother of each fifth child measured. A total of one hundred and eighty questionnaires were completed, identifying family size, number of meals taken the previous day to the survey, what type of food and also where the household food was obtained. Information was also collected on vaccination coverage and illnesses (see Appendix 1 for questionnaire). 4 3. Survey Findings: 3.1 Nutritional Survey: Levels of acute malnutrition were calculated using Epi-info v6.04. Weight for height Z- scores were used to determine wasting, an indicator of acute malnutrition in children, as it calculates whether the child is too thin for a given height. Mean weight for height was recorded at – 1.28 (95% CI: -1.39, -1.17) indicating a mean weight for height at 87.2%. In the survey, the combination of moderate and severe malnutrition, known as global malnutrition, is 25.6% and, of this, 4.3 % of children are severely malnourished, at less than 70% weight for height. Height for Age gives us a more accurate picture of chronic poor nutrition as it measures stunting. Unfortunately, as many parents couldn’t give an accurate age for their children, it was difficult to collect accurate data for this measurement in the present circumstances pertaining in Welayita. From the survey, the level of stunting in Damot Weyde is assessed as below that of the national average at 35.1% but as stated above it is difficult to know if the recording of age is accurate. (It is easier to get accurate ages when doing a “road to health” programme, where date of birth is recorded and monthly updates are maintained). The combined wasting and stunting is recorded at 49.9%, which is an indication of both chronic and acute nutritional status. With these results, Concern Worldwide considers it is imperative that a nutritional intervention is commenced as soon as possible. 3.2 Nutritional Results Table: Z-Score Z-Score Combination Between < - 3 or (Global) -3 and < -2 oedema Moderate Severe Global malnutrition malnutrition malnutrition Weight/Height 21.3% 4.3% 25.6% (Wasting) CI: 22.9 - CI: 3.2 - 5.9 CI: 22.9 – 28.5 28.5 Moderate Severe Combined stunting stunting Height for age (H/A) 19.7% 15.4 35.1% (Stunting) Moderate Severe wasting & wasting & stunting stunting Weight for Age (W/A) 31.7% 18.2% 49.9% (Combined wasting & stunting) 5 (In this graph, the curve on the right shows a normal distribution of weight for height with fifty percent of the population at either side of Zero, the median weight for height. The curve on the left is a representation of the nutritional status in Damot Weyde, which indicates a major shift to the left. Only a very small proportion of the population, about 5%, is between zero and +1.