National Micronutrient and Anthropometric Nutrition Survey Somalia 2009 Funded by Financially and technically supported by TABLE OF CONTENTS 1.0 INTRODUCTION ................................................................................................................................................... 10 1.1 Micronutrient Status ............................................................................................................................................. 12 2.0 SURVEY PURPOSE AND OBJECTIVES ................................................................................................................... 14 2.1 Study Purpose ...................................................................................................................................................... 14 2.2 Survey Objectives ................................................................................................................................................ 14 3.0 METHODS .......................................................................................................................................................... 15 3.1 Sampling .............................................................................................................................................................. 15 3.2 Target Population ................................................................................................................................................. 17 3.3 Sample Size ......................................................................................................................................................... 18 3.4 Data Collection ..................................................................................................................................................... 20 3.5 Questionnaires ..................................................................................................................................................... 22 3.7 Mid Upper Arm Circumference (MUAC) .............................................................................................................. 24 3.8 Clinical assessment ............................................................................................................................................. 26 3.9 Biological Sample collection ................................................................................................................................ 26 3.9.1 Sample labelling ................................................................................................................................................ 26 3.9.2 Blood Collection ................................................................................................................................................ 27 3.9.3 Dried Blood Spot Processing ............................................................................................................................ 27 3.9.4 Serum Samples ................................................................................................................................................. 28 3.9.5 Urine Samples ................................................................................................................................................... 28 3.9.6 Salt sample collection ....................................................................................................................................... 29 3.10 Biochemical Measurements ............................................................................................................................... 29 3.10.1 Haemoglobin ................................................................................................................................................... 29 3.10.2 ELISA (Enzyme-Linked Immunosorbent Assays) ........................................................................................... 31 3.10.3 Urinary iodine .................................................................................................................................................. 34 3.10.4 Rapid salt iodine testing .................................................................................................................................. 36 3.11 Data Analysis ..................................................................................................................................................... 36 3.12 Calculation of Population Weights ..................................................................................................................... 37 3.13 Ethical approval .................................................................................................................................................. 37 4.0 RESULTS ........................................................................................................................................................... 39 4.1 Household characteristics .................................................................................................................................... 39 4.1.1 Household Characteristics ................................................................................................................................ 42 4.1.2 Main Source of Household Income ................................................................................................................... 46 4.1.3 Water ................................................................................................................................................................. 49 4.1.4 Dietary intake .................................................................................................................................................... 52 4.1.5 Salt household iodisation .................................................................................................................................. 55 4.2 Children 0-59 months ........................................................................................................................................... 56 4.2.1 Prevalence of acute malnutrition in 6-59 Months .............................................................................................. 56 4.2.2 Prevalence of acute malnutrition by age group ................................................................................................ 58 4.2.3 Prevalence of Acute Malnutrition based on MUAC ........................................................................................... 59 4.2.4 Infant Anthropometry 0-5 months ..................................................................................................................... 59 4.2.4.1 Prevalence of acute malnutrition in Infants .................................................................................................... 59 4.2.4 Anaemia in Children 6-59 months ..................................................................................................................... 63 4.2.5 Serum Transferrin Receptor (sTfR) .................................................................................................................. 64 4.2.6 Prevalence of Vitamin A deficiency ................................................................................................................... 66 4.2.7 CRP Distribution ................................................................................................................................................ 68 4.2.8 Indicators of Morbidity and Infant and Young Child Feeding Practices ............................................................ 68 4.2.9 Breast feeding practice ..................................................................................................................................... 70 4.2.10 Feeding during Diarrhoea ............................................................................................................................... 71 4.2.11 Immunisation coverage ................................................................................................................................... 72 4.3 Women of Reproductive Age ............................................................................................................................... 73 4.3.1 Characteristics of the Women Sampled in the Assessment ............................................................................. 73 4.3.2 Body Mass index (BMI) ..................................................................................................................................... 74 4.3.3 Education background ...................................................................................................................................... 77 4.3.4 Consumption of Tea .......................................................................................................................................... 78 4.3.5 Food frequency questionnaire .......................................................................................................................... 80 4.3.6 Immunisation ..................................................................................................................................................... 81 4.3.7 Goitre prevalence .............................................................................................................................................. 81 4.3.8 Urinary iodine concentration in non pregnant women .....................................................................................