Integrated Nutrition Survey in Habiganj district of Bangladesh, October 2015. Photo: Training of Survey enumerators Conducted by: Supported by: 1 | P a g e Executive Summary Habiganj is one of the under developed (110,000) and underweight (96,000). Food district, emerged as a zila in 1984, with security and livelihoods: Around 98% of around 2 million population and among the the surveyed households were working districts of highest poverty rate. Main every day. Almost half (44.9%) of the sources of income are Agriculture 42.26%, family’s main income sources were Agriculture labourer 20.55 non-agricultural dependent on unskilled/skilled daily labourer 4.64%, industry 1.7%, commerce labour, rickshaw pulling and fishing. 8.2%, service 4.69% and others 13.42%. Estimated 53.5% of the households Habiganj has also disaster vulnerabilities surveyed were purchasing staple foods for like frequent occurrences of flooding, pre- daily consumption with more than 90% monsoon flooding, river erosion, cyclones who were purchasing fish, legumes & etc. Every year flooding affects the rice pulse, meats & eggs and fruits. Overall, production, limits the working opportunities food consumption was very high with among farmers leaving households with 86.7% of the households with acceptable food insecurity across 8 Upazilas of the food consumption scores in past week. district. Floods also affect embankments, Although the diet was mostly dominant by roads and sanitation facilities every year. fish, vegetables and staples with very low Objective: To determine current consumption of meat & eggs, milk and nutritional status of children aged 6-59 dairy products, legumes & pulses. Dietary months, food security, water and consumption among reproductive aged sanitation situation of Habiganj District. women showed that around 55.5% women Methodology: Two-staged cluster had acceptable level (minimum 5 or above sampling recommended by SMART food groups) of diversity in last 24 hours. survey methodology was applied to Further analysis revealed that 98.9% of conduct the survey. At first stage, list of the women had vitamin A rich foods villages (smallest administrative unit) with (mostly from plant sources) and 92.6% population was entered into ENA to select had iron rich food in last 24 hours. Food estimated number of clusters applying insecurity situation was better reflected in PPS method. In second stage, all the finding of coping strategy index scores households from selected clusters were which explored that more than half of the updated to generate sampling frame. The households (57.8%) were adapting with list of households was then used to select medium or high level of coping strategy estimated number of households per scores. Among the coping strategies cluster using simple random sampling adapted by families, 49.3% households technique. Results: Nutrition: Global were depending on loan from relatives for acute malnutrition in Habiganj district was food, 49.4% eat less than necessary, 13.9% (10.3 – 18.5 95% C.I.) with a 42.5% households’ elder ate less to allow severe acute malnutrition rate of 0.7% younger to eat more and strikingly 29% (0.2-2.0 95%C.I.). The district hosts a total households reduced their meals to cope of 34,500 acutely malnourished children up with household food shortage. Water with around 1500 severely malnourished and Sanitation: Around 99.4% children who are in needs of immediate households had access to improved life-saving treatment for their recovery and drinking water sources (98.3% of them growth. Stunting and underweight rate accessing through tube wells: shared - were 43.7% (37.2-50.4, 95% C.I.) and 59.9% & household-37.4%). About 74,3% 39.0 % (32.6-45.8 95% C.I.) respectively of the surveyed households had access to in the district. The district has significantly improved sanitation facilities. Discussion exceeded WHO thresholds for nutritional and Conclusion: Nutrition situation in emergency with high burden of stunting Habiganj district was found to be at 2 | P a g e serious level (13.9%) with aggravating 3) Design and implement micronutrient factors (such as food insecurity at supplementation for children less than 5 household level, disaster prone areas, years and PLWs pocket areas with very high rate of morbidity). The population high rate of chronic undernutrition were adapting to poverty and food 4) Reinforce Growth Monitoring & insecurity by reducing consumption of food Promotion activities in health facilities both in terms of quality and quantity. There focusing on identifying growth failure and is high risk of deterioration in nutritional promotion of age appropriate IYCF status of this population which is predicted practices by the high proportion of households 5) Design and implement community coping with restricting adult’s food based interventions for promoting Infant (43.6%), reducing meals (30%), eating and young child feeding practices less than necessary foods (52%) and targeting 1000days families (considering borrowing or taking loan of food (49.6%). high rates of stunting & underweight rates) The district with high burden of chronic including essential nutrition actions undernutrition needs to put in place at 6) Design and implement integrated food scale promotion of preventive security-livelihoods and nutrition interventions focussing on essential interventions targeting vulnerable families nutrition actions. To complement to these (who are adapting with negative coping community based nutrition specific mechanism) for improved quality and interventions, livestock interventions to quantity of food consumption in the district. promote animal food production and increased consumption is important in the 7) Support vulnerable families to ensure context. Reviewing all nutrition actors in low cost sanitary latrine facilities and its the district and its interventions to identify utilization at household level gaps and appropriate strategies to 8) Sensitizing and mobilizing government address high burden of undernutrition and non-government stakeholders at could be helpful for improved coverage district level for targeting families at risk of and outcomes. undernutrition for district level Recommendations: 1) Implement programming (nutrition sensitive) through therapeutic feeding program for severely the district multi-sectoral coordination malnourished children in the Upazila platform. Health Complex and District Hospital. 9) Facilitate Capacity Gap Analysis of the 2) Identify Upazilas with high rates of existing health system for identifying undernutrition and implement targeted specific gaps related to nutrition service supplementary feeding program for delivery (in line with NNS) and define moderately malnourished children in the appropriate strategies for reinforcement of district the health system’s capacity. 3 | P a g e Acknowledgement Action Contre la Faim would like to acknowledge and express gratitude to the following organization for their support, collaboration and contribution: - Institute of Public Health and Nutrition for their support and cooperation in planning and coordination with District Health, Family Planning and Administrative authorities in Habiganj District. - Health and Family Planning staff at district, Upazila and community level for their active support in generating the sampling frame for selected clusters during the survey. - District and Upazila administration office, local representatives’ office - Food and Agriculture Organization, IPC unit, for their support and collaboration in conducting the training for survey supervisors, reviewing the report and inputs in additional indicators’ analysis - Concern Worldwide for their extended support in recruitment of local enumerators, support for effective coordination with district authorities. - UNICEF for funding the nutrition survey and reviewing reports for Habiganj District ACF would like to acknowledge the community representatives and community people who have actively participated in the survey process for successful completion of the survey. Finally, ACF is thankful to all of the survey enumerators, team leaders and supervisors for their tremendous efforts to successfully complete the survey in the district. 4 | P a g e Acronyms ACF Action Contre la Faim ARI Acute Respiratory Infection CI Confidence Interval CMAM Community Management of Acute Malnutrition FCS Food Consumption Score FSL Food Security and Livelihoods GAM Global Acute Malnutrition HAZ Height-for-Age z-score HH Household MoH Ministry of Health MAM Moderate acute malnutrition MUAC Mid-Upper-Arm-Circumference NGO Non-Governmental Organization SAM Severe Acute Malnutrition SD Standard Deviation SFP Supplementary Feeding Programme SMART Standardized Monitoring and Assessment of Relief and Transition WaSH Water, Sanitation and Hygiene WAZ Weight-for-Age z-score WHO World Health Organization WHZ Weight-for-Height z-score 5 | P a g e Table of Contents Executive Summary .......................................................................................................... 2 Acknowledgement ............................................................................................................ 4 Acronyms ......................................................................................................................... 5 Table of Contents ............................................................................................................. 6 Introduction ......................................................................................................................