Integrated Nutrition Survey in 4 Upazila Satkhira District January 2014 Acknowledgments ACF would like to thank Satkhira District, Upazila and Union Authorities for their support and collaborations during the planning and implementation of the nutrition survey and the continuous and on-going nutrition activities in waterlogging affected areas of Satkhira District. ACF would also like to thank Shushilan management and staff for their support in the implementation of the nutrition survey. ACF would like to thank the European Commission’s Humanitarian Aid department for providing funds for the SMART Nutrition Survey in waterlogging affected areas of Satkhira district. Finally, ACF would like to especially thank all of the enumerators and team leaders who participated in the survey. Table of content Acknowledgments .................................................................................................................................... i Table of content ....................................................................................................................................... i Abbreviations .......................................................................................................................................... v Executive Summary ................................................................................................................................. 1 Introduction ............................................................................................................................................ 6 Specific Survey Objectives ................................................................................................................... 7 Methodology ........................................................................................................................................... 8 Survey Area ......................................................................................................................................... 8 Type of Survey ..................................................................................................................................... 8 Primary Sampling Unit - PSU ............................................................................................................... 8 Sampling size ....................................................................................................................................... 9 Sampling Technique ............................................................................................................................ 9 Training and supervision ..................................................................................................................... 9 Questionnaire ................................................................................................................................... 10 Indicators, Classifications and Thresholds ............................................................................................ 12 Nutritional indices and status ........................................................................................................... 12 Results ................................................................................................................................................... 15 Nutrition ................................................................................................................................................ 16 Wasting - Weight-for- Height ........................................................................................................... 16 Middle Upper Arm Circumference - MUAC ...................................................................................... 18 Underweight- Weight-for-age ........................................................................................................... 20 Stunting - Height-for-age .................................................................................................................. 20 Child Health ........................................................................................................................................... 22 Young Infant and Child Feeding Practices ............................................................................................. 24 Individual Dietary Diversity Score ..................................................................................................... 24 Continued Breastfeeding for children 6 to 23 months ..................................................................... 25 Minimum Meal Frequency for children aged 6 to 23 months .......................................................... 25 Acceptable Diet for children aged 6 to 23 months ........................................................................... 25 Child Care Practices ............................................................................................................................... 26 Early initiation to breastfeeding ....................................................................................................... 26 Exclusive breastfeeding duration ...................................................................................................... 26 Responsive Feeding and Interaction ................................................................................................. 27 Care of Pregnant and Lactating Woman ............................................................................................... 28 Caregiver / mother information ........................................................................................................ 28 Care during Pregnancy and Lactation ............................................................................................... 29 Caregiver Workload .......................................................................................................................... 30 Integrated SMART Survey Satkhira 2014 i Food Security ........................................................................................................................................ 32 Household Food Insecurity Access Score (HFIAS) ............................................................................. 32 Household Dietary Diversity Score (HDDS) ....................................................................................... 33 Main Source of income ..................................................................................................................... 36 Income .............................................................................................................................................. 38 Household Expenditure..................................................................................................................... 40 Water, Sanitation and Hygiene ............................................................................................................. 42 Water sources ................................................................................................................................... 42 Sanitation Facility .............................................................................................................................. 43 Hygiene ............................................................................................................................................. 45 Discussion.............................................................................................................................................. 47 Conclusion ............................................................................................................................................. 54 Recommendations ................................................................................................................................ 56 Annex1: Calendar of Local Events ......................................................................................................... 57 Annex 2. Plausibility check for: Satkhira Nutrition Integrated Survey Feb- 2014 ................................. 59 Annex 3. Nutrition Indicator results based on NCHS growth reference 1977 ...................................... 60 Annex 4: Overview of Results ............................................................................................................... 61 Integrated SMART Survey Satkhira 2014 ii Tables Table 1: Summary Table of Results ......................................................................................................... 5 Table 2: Classification of acute malnutrition using z-scores (WHO, 2006) ........................................... 12 Table 3: Acute under nutrition thresholds ............................................................................................ 12 Table 4: Classification of acute malnutrition using MUAC ................................................................... 13 Table 5: Classification of chronic under nutrition and underweight using z-scores (WHO, 2006) ....... 13 Table 6: Classification of prevalence ranges of low height-for-age and low weight-for-age for children under 5 years of age ............................................................................................................................. 13 Table 7: Household Food Insecurity Scale ............................................................................................ 14 Table 8: Overview of the survey respondent per result section ..........................................................