Final Report Anthropometric Nutrition And Retrospective Mortality Survey Saptari District, Nepal 12-24 June 2013 Jorunn Smith 1 Contents Contents .......................................................................................................................................... 2 Table of figures ............................................................................................................................... 4 Acknowledgements ...................................................................................................................... 6 Acronyms ........................................................................................................................................ 7 Executive summary ......................................................................................................................... 9 Introduction .................................................................................................................................. 9 Objective of survey ....................................................................................................................... 9 Methodology ................................................................................................................................ 9 Main results .................................................................................................................................. 9 1. Introduction ............................................................................................................................. 12 1.1. Context ........................................................................................................................... 12 1.1.1. Description of survey area ........................................................................................... 12 1.1.2. Demography and Climate ............................................................................................ 13 1.1.3. Education and literacy ................................................................................................. 14 1.1.4. Economy, livelihoods and food security ....................................................................... 14 1.1.5. Water and sanitation .................................................................................................... 16 1.1.6. Health .......................................................................................................................... 16 1.1.7. Nutrition ....................................................................................................................... 17 1.1.8. Relief and intervention ................................................................................................. 19 2. Survey objectives .................................................................................................................... 19 2.1. General objective ............................................................................................................ 20 2.2. Specific objectives ........................................................................................................... 20 3. Survey methodology ............................................................................................................... 20 3.1. Type of survey................................................................................................................. 20 3.2. Population surveyed ........................................................................................................ 21 3.3. Sampling method ............................................................................................................ 21 3.4. Household and individual selection ................................................................................. 24 3.4.1. Household selection .................................................................................................... 24 3.4.2. Individual selection: ..................................................................................................... 25 3.4.3. Special cases: ............................................................................................................. 25 3.5. Data collected ................................................................................................................. 26 3.5.1. Data linked to anthropometry ....................................................................................... 26 3.5.2. Data linked to health .................................................................................................... 27 3.5.3. Data linked to Infant and Young Child Feeding practices ............................................. 27 3.5.4. Data linked to Diversity Dietary Score .......................................................................... 28 3.5.5. Data linked to retrospective mortality survey ................................................................ 28 3.6. Indicators and cut-off points used .................................................................................... 28 3.6.1. Weight for height index ................................................................................................ 28 3.6.2. Height for age index ..................................................................................................... 29 3.6.3. Weight for age index .................................................................................................... 30 3.6.4. MUAC index ................................................................................................................ 30 3.6.5. Morbidity ...................................................................................................................... 30 3.6.6. Exclusive breastfeeding ............................................................................................... 31 3.6.7. Continued breastfeeding .............................................................................................. 31 3.6.8. Complementary feeding ............................................................................................... 31 3.6.9. Meal frequency ............................................................................................................ 32 3.6.10. Dietary Diversity Score (DDS) .................................................................................. 32 3.6.11. Retrospective mortality rate ...................................................................................... 33 3.7. Training and supervision ................................................................................................. 34 3.8. Ethical considerations ..................................................................................................... 34 4. Results .................................................................................................................................... 34 4.1. Sample description .......................................................................................................... 34 2 4.2. Anthropometric results .................................................................................................... 36 4.2.1. Prevalence of acute malnutrition expressed in Z-score ................................................ 36 4.2.2. Prevalence of acute malnutrition expressed by MUAC ................................................ 38 4.2.3. Prevalence of chronic malnutrition (stunting) ............................................................... 39 4.2.4. Prevalence of underweight .......................................................................................... 40 4.3. Morbidity ......................................................................................................................... 41 4.3.1. Prevalence of reported illness in children 6-59 months ................................................ 41 4.3.2. Results for health care seeking practices ..................................................................... 42 4.3.3. Relationship between acute malnutrition and morbidity ............................................... 43 4.4. Breastfeeding and feeding practices ............................................................................... 43 4.4.1. Breastfeeding practices ............................................................................................... 43 4.4.2. Feeding practices ........................................................................................................ 44 4.5. Diet Diversity Score ......................................................................................................... 44 4.5.1. Results at household level (HDDS): ............................................................................. 45 4.5.2. Results at individual level (IDDS): ................................................................................ 45 4.6. Demographic data/characteristics of households ............................................................ 47 4.7. Retrospective mortality rate ............................................................................................. 48 4.7.1. Cause of death in persons aged five years or more ..................................................... 48 4.7.2. Cause of death in children aged less than five years ................................................... 48 5. Limitations .............................................................................................................................