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7/29/2019 Nutritional Anthropometric and Mortality Survey Final Report Mandera Central District North Eastern Province
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NUTRITIONAL ANTHROPOMETRIC AND MORTALITY SURVEY
FINAL REPORT
MANDERA CENTRAL DISTRICT
NORTH EASTERN PROVINCE, KENYA
APRIL-MAY 2012
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Acknowledgements
Special thanks are expressed to;
CIFF/ELMA and UNICEF financial support to Save the Children Nutrition program andfor funding this survey.
Provincial administration, ALRMP, Ministry of Agriculture, Ministry of Health and DistrictDevelopment Office through their respective district focal persons for the necessaryexpertise during the entire survey period.
Survey team (supervisors, team leaders, enumerators and drivers) for their tireless efforts toensure that the survey was conducted professionally and on time.
Community members who willingly participated in the survey and provided the informationneeded.
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TABLE OF CONTENTSAcknowledgements ...................................................................................................................................................... 2
TABLE OF CONTENTS ........................................................................................................................................... 3
List of abbreviations and acronyms ........................................................................................................................... 5
Executive summary ..................................................................................................................................................... 8
Area Covered ............................................................................................................................................................. 8
Specific Objectives .................................................................................................................................................... 8Methodology .............................................................................................................................................................. 9
Main survey results .................................................................................................................................................... 9
Results summary for water, hygiene and sanitation .................. .......... ........... ........... .......... ........... .......... ........... .... 10
Recommendations ................................................................................................................................................... 11
1. Introduction ....................................................................................................................................................... 12
1.1.1 Relief Programmes currently in the area: .......... ........... .......... ........... .......... ........... ........... .......... ........... .... 13
1.1.3. Humanitarian interventions in Mandera Central district ............................................................................ 15
1.2 Specific Objectives ............................................................................................................................................ 15
2. Methodology....................................................................................................................................................... 16
2.1. Parameters used in the determination of mortality and anthropometry data (21.9% U5 population) ............... 17
2.2. Sampling procedure: selecting households and children ........... .......... ........... ........... .......... ........... .......... ........ 18
2.3. Case definitions and inclusion criteria .............................................................................................................. 18
2.3.1. Childrens data ........................................................................................................................................... 18
2.3.2. Anthropometric data: ................................................................................................................................. 18
2.4. Programme coverage ........................................................................................................................................ 19
2.5. Infant and Young Child feeding (IYCF) ........................................................................................................... 19
2.6. Mortality data ................................................................................................................................................... 20
2.7. Causes of malnutrition data .............................................................................................................................. 20
2.8. Nutritional Status Cut-off Points .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ... 20
2.8.1. Weight-for-height (WFH) and MUAC Wasting for Children ................... ........... .......... ........... .......... ... 20
2.8.2. Weight-for-age (WFA) Underweight ........... .......... ........... .......... ........... .......... ........... .......... ........... ...... 21
2.8.3. Height-for-age (HFA) Stunting.......... ........... .......... ........... .......... ........... .......... ........... .......... ........... ...... 21
2.8.4. Mid upper arm circumference (MUAC) .................................................................................................... 21
2.8.5. Mortality .................................................................................................................................................... 22
2.9. Questionnaire, training and supervision .......... .......... ........... .......... ........... .......... ........... .......... ........... .......... ... 22
2.9.1. Questionnaire .......... ........... .......... ........... .......... ........... .......... ........... ........... .......... ........... .......... ........... .... 22
2.9.2. Survey teams and supervision .................................................................................................................... 222.9.3. Training ..................................................................................................................................................... 23
2.9.4. Data analysis .............................................................................................................................................. 23
3. Results................................................................................................................................................................. 24
3.1 Anthropometric results (based on WHO standards 2006): ........... .......... ........... .......... ........... .......... ........... ...... 24
3.2. Malnutrition by MUAC .................................................................................................................................... 27
3.3. Chronic Malnutrition ........................................................................................................................................ 28
3.3.1. Prevalenceof underweight.......................................................................................................................... 28
3.3.2. Prevalence of stunting ................................................................................................................................ 28
3.4. Mortality results ................................................................................................................................................ 29
3.5. Children's morbidity ......................................................................................................................................... 29
3.5.1. Health seeking behaviour........................................................................................................................... 30
3.6 Vaccination Results ........................................................................................................................................... 30
3.6.1: OPV 1&3 and BCG for 6-59 months and measles for 9-59 months .......... .......... ........... .......... ........... ...... 303.6.2: Micronutrient supplementation and deworming ........... .......... ........... .......... ........... .......... ........... .......... ... 31
3.7 Programme coverage ......................................................................................................................................... 31
4. Discussion ............................................................................................................................................................... 32
4.1 Nutritional status ................................................................................................................................................ 32
4.1.1. Under five nutrition status ......................................................................................................................... 32
4.1.2. Caretakers nutrition status ........................................................................................................................ 33
4.2 Mortality ............................................................................................................................................................ 34
4.3 Causes of malnutrition ....................................................................................................................................... 35
4.3.1. Health status: ................................................................................................................................................. 35
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4.3.2. Infant and Young Child Feeding (IYCF) ................................................................................................... 35
4.4. Water Sanitation and hygiene ........................................................................................................................... 38
4.4.1. Main water source...................................................................................................................................... 38
4.4.2. Water treatment ......................................................................................................................................... 39
4.4.3. Handwashing practices .............................................................................................................................. 39
4.4.4. Access to toilet facilities ............................................................................................................................ 40
5. Conclusions ............................................................................................................................................................ 40
6. Recommendations and priorities.......................................................................................................................... 41
6.1. Immediate ......................................................................................................................................................... 41
6.2. Medium term .................................................................................................................................................... 41
6.3. Long term ......................................................................................................................................................... 41
7. References .............................................................................................................................................................. 42
8.1. Appendix 1 ....................................................................................................................................................... 42
8.2. Appendix 2 ....................................................................................................................................................... 42
8.3. Appendix 3 ....................................................................................................................................................... 43
8.4. Appendix 4 ....................................................................................................................................................... 43
8.6. Appendix 5 ....................................................................................................................................................... 47
LIST OF TABLES
Table 1: Results Summary ............................................................................................................................................. 9
Table 2: Main Results WASH ..................................................................................................................................... 10
Table 3: Seasonal timeline ........................................................................................................................................... 14
Table 4: Sample size calculation .................................................................................................................................... 17Table 5 : population sex pyramid .......... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ... 25
Table 6: Prevalence of malnutrition based on WHO 2006 standards .......... .......... ........... ........... .......... ........... .......... . 26
Table 7: Health seeking behaviour .............................................................................................................................. 30
Table 8: Vaccination coverage: OPV 1&3 and BCG for 6-59 months and measles for 9-59 months .......... ........... .... 30Table 9: Survey trends ................................................................................................................................................. 32
Table 10: Caretakers Nutrition Status .......................................................................................................................... 33Table 11: Proportion of children 0-23 months put to the breast within 1 hour of birth ......... ........... .......... ........... ...... 35
Table 12: proportion of children exclusively breastfed .......... .......... ........... .......... ........... ........... .......... ........... .......... . 36
Table 13: Minimum dietary diversity (n=285) ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ... 36
Table 14: Minimum meal times for breastfed children 6-8 months (n=20) .......... .......... ........... .......... ........... .......... ... 37
Table 15: Minimum meal times for breastfed children 9-23 months (n=133) ........... ........... .......... ........... .......... ........ 37
Table 16: Minimum meal times for Non breastfed children 6-23 months (n=130) .......... ........... .......... ........... .......... . 38
Table 17: Main current water sources ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... ...... 38
Table 18: Treatment given to drinking water ........... .......... ........... .......... ........... .......... ........... ........... .......... ........... .... 39
Table 19: When hands were washed........... .......... ........... .......... ........... .......... ........... ........... .......... ........... .......... ........ 39
Table 20: what was used to clean hands .......... ........... .......... ........... .......... ........... .......... ........... .......... ........... .......... ... 40
LIST OF FIGURES
No table of figures entries found.
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List of abbreviations and acronymsALRMP II - Arid Lands Resource Management Project II
AMREF - African Medical Research Foundation
APHIA -Aids Population Health Integrated Assistance Project
ASAL - Arid and Semi-Arid Lands
CDR - Crude Death Rate
COCOP - Consortium of cooperating partners
CI - Confidence Interval
CMR - Crude Mortality Rate
CSB - Corn Soya Blend
ENA - Emergency Nutrition Assessment
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EPI - Extended Programme of Immunization
GAM - Global Acute Malnutrition
GFD - General Food Distribution
HAZ - Height-for-Age Z-score
HINI - High Impact Nutrition Interventions
HSNP - Hunger Safety Net Project
KFSSG - Kenya Food Security Steering Group
L/HAZ - Length/ Height for Age Z-score
MOH - Ministry of Health
MUAC - Mid-Upper Arm Circumference
NEP - North Eastern Province
OPV - Oral Polio Vaccine
OTP - Out-patient Therapeutic Program
SAM - Severe Acute Malnutrition
SC - Stabilization Centre
SD - Standard Deviation
SFP - Supplementary Feeding Programme
SMART Standardized Monitoring and Assessment of Relief and Transitions
U5MR - Under Five-Mortality Rate
UNICEF - United Nations Childrens Fund
CIFF - Children investment Funds Foundation/
URTI - Upper Respiratory Tract Infection
WAZ - Weight-for-Age Z-score
WFP - World Food Programme
WHM - Weight for Height Median
WHO - World Health Organization
WHZ - Weight-for-Height/length Z-scores
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Executive summaryMandera Central is one of the districts that form the North Eastern Province (NEP) and is one of
the 19 districts gazetted as part of the Arid and Semi-Arid Lands of Kenya (ASAL). The district is
located in the North West horn of Kenya bordered by Mandera East District and Somalia to the
east, Mandera West District and Wajir North District to the west, Wajir District to the south and
Ethiopia to the north. The town of El Wak is the District headquarter, which administrativelyconsists of 5 divisions including El Wak, Shimbir Fatuma, Wargadud, Qalanqalesa and Kotulo.
The main livelihood activity in the district is pastoralism and being predominantly arid, the district
experiences chronic food insecurity and high incidences of malnutrition. Predictable rainy and dry
seasons can no longer be counted upon to provide adequate dry season grazing and water for
pastoral populations, whose resilience is increasingly eroded by broader economic factors in the
region. Food aid continues to be a key source of food for a majority of the population. The district
is predominantly inhabited by one clan Garre with 2 major sub clans namely
Save the Children UK (SCUK) operates in all the 5 divisions. Within the four divisions there are a
total of 7 GOK health facilities including El Wak district hospital. The projected population for the
survey area is 64,9161. The District is geographically isolated from the rest of the country with it
being characterized with poor infrastructure and thus poor access to services. The area is prone to
extreme climatic conditions characterized by successive droughts and floods leading to chronic food
insecurity. This has rendered the population reliant on food aid.
The securityin the district is volatile since the incursionof the Kenyan Army into Somalia
AreaCovered
Save the children in conjunction with the MOPHS and MOMS have been carrying out IMAM
activities in the 5 divisions of Mandera Central namely Elwak, Shimbir Fatuma, Qalanqalesa, Kotuloand Wargadud since August 2007. Nutrition surveys have been conducted in the area on the same
month (March) since 2006 in order to evaluate impact and as well serve as a surveillance system.
This survey was conducted from 26th of April to 7th May 2012.
Specific Objectives
The survey aimed at estimating the;
The prevalence of acute and chronic malnutrition in children aged 6-59 months; The nutrition status pregnant women and mothers with children
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Infant and Young Child feeding practices (children between 0-23 months). The Coverage rate of Vitamin A. supplementation and de worming; The Morbidity rates of children 6-59 months 2 weeks prior to the survey; To recommend appropriate interventions based on the survey findings;
Methodology
Two different sampling methodologies were applied. Emergency Nutrition Assessment (ENA) for
Standardized Monitoring of Relief and Transition (SMART) was used to calculate Anthropometry
and mortality samples while IYCF multi survey sampling calculator was used to calculate for IYCF
sample. Probability of Proportion to Population Size (PPS) was used to identify clusters within a
study area after collecting population data from all villages/ sub location that were considered as
clusters.
The target population for the anthropometric survey was children aged 6-59 months while that for
IYCF was children 0-24 months. The total sample size of households was arrived at by collating
both the Anthropometry, IYCF and Mortality samples. The final sample size was 574 households
from 34 clusters.
Data was collected on anthropometry, morbidity, vaccination and de-worming status, Vitamin A
supplementation, hygiene and sanitation practices, IYCF, food security and livelihoods. This data
was triangulated with feeding programme data to help in the interpretation of results.
Retrospective information on mortality was collected using the current household census method,
with a recall period of 94 days, from all households visited including those without children under
the age of five. A total of 578 households were visited and 1071 children from 6 to 59 months were
assessed for anthropometry and other indicators. The final analysis was on 1068 children afterexclusion of 3 records.
Anthropometric and mortality data were analyzed using the ENA software beta version May 2011.
IYCF data was analysis on Excel and Qualitative and quantitative data was analyzed using the
EPIINFO software.
Main survey resultsTable 1: Results Summary
Characteristic N n % ( 95%CI)
GAM (WFH
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Proportion of caretakers seeking medical care whenchild is ill
398 382 94.8%
BCG Scar
Measles immunization (card and confirmation) 1043 990 96%
OPV1 immunization (card and confirmation) 1071 1023 97%
OPV3 immunization (card and confirmation) 1071 1013 94%
Vitamin A supplementation coverage (>12 month) -1time
988 464 47%
Vitamin A supplementation coverage (>12 month) -2times
988 374 38%
Vitamin A supplementation coverage (6-11 months)- 1time
83 68 82%
Proportion of children >1 year de-wormed 1 time 752 289 38%
Proportion of children >1 year de-wormed 2 time2 752 284 37%%
Iron-folate Supplementation for pregnant mothers 155 72 46.5%
Appropriate hand-washing with soap/ash 47.5%
Proportion of children 6-59 months supplemented withZinc the last time they had diarrhoea
93 1 1.2%
IYCF Key Indicator - Timely Breast-feeding Initiation 332 286 86.1%
IYCF Key Indicator - Exclusive Breastfeeding 47 24 51%
IYCF Key Indicator - Minimum Dietary Diversity>3foods BF
155 84 54%
IYCF Key Indicator - Minimum Dietary Diversity >4foods NBF
133 47 34%
IYCF Key Indicator meal frequency 6-8 months 2times 20 14 70%
IYCF Key Indicator meal frequency 9-93 months 3times
133 92 69%
IYCF Key Indicator meal frequency 6-93 months 3times
130 60 60%
Crude mortality rate (deaths/10000/day) 0.18(0.07-0.43)
Under-five mortality rate (deaths/10000/day) 0.22(0.05-0.87)
Results summary for water, hygiene and sanitationTable 2: Main Results WASH
Sources of WaterBorehole 33.9%Unprotected well 29.1%Dam 18.3%Protected well 7.3%
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Water tap 6.3%Water tracking 4.9%WATER TREATMENTNothing 94.3%Use of chemicals 6.6%
Boiling 1.9%ACCESS TO A TOILET FACILITYYes 48.5%IF NO TOILET WHAT WAS USEDBush 78%HANDWASHING PRACTICESBefore eating food 83.2%After visiting toilet 75%After cleaning childrens bottoms 64.5%Before preparing food 66%
The prevalence of acute malnutrition in Mandera Central district is still critical with global acutemalnutrition (GAM) of 17.9% (14.9-21.4 95% C.I.) and Severe Acute Malnutrition (SAM) rate of3.4.% (2.1-5.3 95% C.I.). Compared with the survey undertaken in March of 2011 however whichindicated GAM of 27.5% (23.2-32.2.0 95% CI) and SAM of 3.4% (2.3-4.9), there is a reduction inthe level of GAM which is statistically significant(P=0.001) while there was no much change inSAM. The levels of Immunization (OPV1&3, Measles, BCG) were also within the recommendednational levels of above 80% both by card and recall. Some other HINI indicators like use of Zinc inthe management of diarrhoe, deworming and Vitamin A supplementation for the 12-59 Monthswere however not up to scale.This was also the case as regards to Hygiene and Sanitation pracices.An analysis of IYCF indicators showed that the IYCF practices are poor with high percentage ofchildren not receiving optimal infant feeding practices (with the exception of timely initiation ofbreastfeeding reported at above 80%).
Recommendations
Immediate
Continue supporting to the MOH with OJT, HINI ,supportive supervision and logisticalsupport.
Promotion of IYCF activities geared towards optimal complementary feeding and dietarydiversity e.g. kitchen gardening and cooking demostration.
Incooporating DRR in normal programming through activities like provision of health,nutrition and hygiene promotion activities to school health clubs.
Scale up of the HINI package with special focus on Zinc supplementation. As a startsensitization of health workers and supply chain management of the Zinc tablets should beadressed.
Medium term
MOH to develop a health workers retention strategy to reduce the high staffs turn over. Through SCUK WASH programmestrengthen Hygiene promotion hygiene practices to
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reduce the incidence of diarrhoeal disease including health and nutrition promotiontoeducate the community on basic WASH i.e. domestic treatment of drinking water andproper disposal of faecal waste.
Long term
Through SCUK WASH programme, Provide toilet facilities through communityparticipatory approaches coupled with awareness campaign on the importance of using suchfacilities i.e. Community Led Total Sanitation (CLTS) and Participatory Hygiene andSanitation Transformation (PHAST) approaches. This can be piloted in one division (to beagreed among all stakeholders) and depending on how it works it can be scaled up to theothers.
Need for defined linkage of nutrition sector cluster with other sectors such as WaterSanitation and Hygiene (WASH) in the longer term.
Advocacy for recruitment and retention of health workers i.e. nurses , Clinical Officers (Cos)and nutritionists in North Eastern province
Government of Kenya (GOK) to strengthen community health strategy in the ASALS tofoster empowerment of CHWs to participate in health and nutrition promotion andmanagement of minor childhood ailments.
1. Introduction
Mandera Central is one of the districts that form the North Eastern Province (NEP) and is one of
the 19 districts gazetted as part of the Arid and Semi-Arid Lands of Kenya (ASAL). The district is
located in the North West horn of Kenya bordered by Mandera East District and Somalia to theeast, Mandera West District and Wajir North District to the west, Wajir District to the south and
Ethiopia to the north. The town of El Wak is the District headquarter, which administratively
consists of 5 divisions including El Wak, Qalanqalesa, Shimbir Fatuma, Wargadud and Kotulo.
The district experiences chronic food insecurity and high incidences of malnutrition. Predictable
rainy and dry seasons can no longer be counted upon to provide adequate dry season grazing and
water for pastoral populations, whose resilience is increasingly eroded by broader economic factors
in the region. Food aid continues to be a key source of food for a majority of the population
The estimated population for the district is 63,025
2
with the people being sparsely populated.Residents are mainly from the Somali community speaking the Garre language. The main livelihood
activity in the district is pastoralism with a number of Peri-urban destitutes (PUDs) who have
dropped out of pastoralism due to loss of livestock to shocks and settled near urban centers.
2Figures obtained from the District Development Office- Mandera Central.
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The district has one main road connecting the District to other districts in the province (Wajir East
and Mandera East) and other minor roads to the divisions and to Mandera West. The roads are
however in bad condition rendering them impassible especially during the rainy season.
Save the Children UK (SCUK) operates in all the 5 divisions. Within the divisions, there are a total
of 7 GOK health facilities including El Wak district hospital. Worth to note however is that, out ofthe seven health facilities, currently 2 are not fully operational due to transfer of the skilled staff with
only CHWs left to provided minimal services.
In the course of its work, Save the children is supporting the MOMs and MOPHS in implementing
Health and Nutrition, and has also a Food security and Livelihood support projects to vulnerable
HHs in Mandera and Wajir Districts through DFID funded HSNP project. Under the health and
nutrition project there is a components of WASH mainly targeted at the health facilities by
rehabilitation of water and sanitation facilities. The projects utilize integrated approaches to address
immediate and underlying causes of malnutrition.
1.1.1 Relief Programmes currently in the area:
Kenya Red Cross: Emergency relief
SCUK: IMAM, HSNP, Health Outreach, WATSAN
COCOP/WFP : Food Aid
ADRA: Primary Health Care
AMREF: MCH/HIV/AIDS
Northern Aid: WATSAN, HIV/AIDS
Office of the President: Food Aid
DANIDA: Nomadic Clinic
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Table 3: Seasonal timeline
Short Dry Spell
(Jilaal)
Long Rainy
Reason
(Gu)
Long Dry Spell
(Hagai)
Short Rainy
Season
(Deyr)
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Migration, Conflicts,
Watering of Livestock,
Pasture Surveys,
mating season,
Livestock diseases, Calving,
Kidding
Migration,
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Pressure on boreholes Planting Labour Demand Period Conflict
1.1.3. Humanitarian interventions in Mandera Central district
Save the Children has been implementing programmes in Mandera Central district since 2007. Ourcurrent integrated approach; Nutrition, Health, Food security and Livelihoods Support programmes,
aim to address the underlying causes of malnutrition through strengthening health systems,
treatment for acute malnutrition and enhancement of house hold food security and livelihoods in
the medium term while at the same time linking these to long term livelihood strategies.
The World Food Programme (WFP) through Arid Lands Development Focus (ALDEF) has been
carrying out general food distribution (GFD) in this area. The GFD food basket provides a 75%
ration scale of 2,100Kcal/person, the daily per capita energy requirement3.
The Ministry of special programmes through the District Commissioners office occasionallysupplies food to the region and this is usually divided equally among the divisions. School feeding
programme is also available in all government schools which is run by WFP.
Other actors on the ground include:
ADRA providing health services, Kenya Red Cross society undertaking emergency relief
operations and AMREF who havebeen supporting the MoH in combating HIV /AIDS and in
matters related to reproductive health.
1.2 Specific Objectives
The survey aimed at estimating the;
The prevalence of acute and chronic malnutrition in children aged 6-59 months; The nutrition status pregnant women and mothers with children
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2. Methodology
Two different sampling methodologies were applied; Emergency Nutrition Assessment (ENA) for
Standardized Monitoring of Relief and Transition (SMART) was used to calculate Anthropometry
and mortality samples while IYCF multi survey sampling calculator was used to calculate for IYCF
sample. A 2 stage cluster sampling method with Probability of Proportion to Population Size (PPS)
was used to identify clusters within a study area after collecting population data from all villages that
were to be considered as clusters.
The required sample size was calculated on the nutritional status for children 6-59 months and onthe Crude Mortality Rate (CMR) for the household sample. Sample size for infants and young
children (0-5 months) was calculated separately using IYCF sampling calculator calculating sample
size for each of the IYCF indicators. The sample size for the survey was calculated and adjusted for
absentees and refusals using previous results of surveys conducted in the district.
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Sample size for anthropometry was calculated using the ENA for SMART methodology which gave
667 children. IYCF sample size was calculated using multiple survey sample size calculation
considering current rates of the most critical IYCF indicators to be considered (Timely initiation of
breast feeding, Exclusive breast feeding, continued breast feeding, minimum dietary diversity and
minimum meal frequency). Assumptions of 10% improvement rate were made since indicators did
not have target rate for improvements (arrived at following discussions with consultants who haveresearched on IYCF over time and through a blog on ENN). Hence, the highest from IYCF sample
size (Exclusive breast feeding) was considered which 782 are4. It was then assumed that 80% of
these children will however be captured in the overall anthropometry sample. Thus, 20% (156) of
the 782 was added to the anthropometry sample to account remaining age group making the total
sample of children 823. In order to calculate the number of households to visit in the duration of
the survey, total number of children was divided by 1.3 (number of children/household) based on
previous surveys giving rise to 633 HH.
2.1. Parameters used in the determination of mortality and anthropometry
data (21.9% U5 population)1). the estimated prevalence of malnutrition is 27.5 %5)
2) The design effect is 2 and the standard margin of error is 5% (95% CI).
3) The number of children less than 5 years per household is estimated at 1.3 6
4) The average number of persons per household is 7 and 1 mother per household.
Sample size for mortality is calculated based March 2011, survey showing death rate of
0.637/10,000/day, a desired precision of 0.4, design effect 2 non-response rate of 3% and 90 days
recall period. This was keyed in to ENA for SMART with family size of 7 and gave a sample of 3659and 539 households.
To calculate number of clusters to visit, the total sample for anthropometry and IYCF was used.
Number of households (633) was divided by number of HH to be reached per day (17) gives 37
clusters.
The table below summarizes the sample size calculation.
Table 4: Sample size calculation
Sample of
IYCF
Sample of
Anthropometry
Total
sampleofchildren
# of HH to
visit
# of HH
formortality
Final Sample
sizeconsidered
# of
children percluster
# of clusters
4Rates of IYCF indictors for the district were based on Save the Children KPC survey Sept 2011.
5malnutrition rates (2011 nutrition survey)
6From the March 2011 Mandera Central nutrition survey
7CMR rates March 2011 nutrition survey
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156 667 823 633 539 633 17 37
2.2. Sampling procedure: selecting households and childrenThe second stage sampling stage comprised of the household selection. Only the randomly sampled
villages were assessed during data collection. In the selected village, the Expanded Programme on
Immunization (EPI) method was applied in order to determine the starting point. At the center of
the village, a pen was spun to determine the starting direction. The team then moved to the
periphery along the pointed direction. At the end of the village, the pen was re-spun and a direction
obtained. Just like the first stage, the survey team moved along the pointed direction but this time
counting all households in that direction to the edge. A table of random numbers was used to
determine the first household. Mortality and anthropometric questionnaires were administered
accordingly and subsequent households determined by going to the next house to the right. In
villages with more than one cluster, the village was subdivided and the center of each subdivisiondetermined and households selected as described above. In a cluster that was sparsely populated, all
the households in the cluster were visited.
A household was defined as a group of people who lived together and shared a common cooking
pot. In polygamous families with several structures within the same compound but with different
wives having their own cooking pots, the structures were considered as separate households and
assessed separately. All children aged 6-59 in every household visited were included in the
anthropometric survey and 0-24 month category included in IYCF survey. In cases where there wasno eligible child, a household was still considered part of the sample and its mortality data were
collected. If a respondent was absent during the time of household visit, the teams left a message
and re-visited later to collect data for the missing person, with no substitution of households
allowed. The teams visited the nearest adjacent village (not among those sampled) to make up for
the required number of households if the selected village yielded a number below 22 children and 17
households, following the SMART methodology8.
2.3. Case definitions and inclusion criteria
2.3.1. Childrens data
2.3.2. Anthropometric data:
Age: the age of the child was recorded based on a combination child health cards, themothers/caretakers knowledge of the birth date and use of a calendar of events for the districtdeveloped in collaboration with the survey team.
Sex:it was recorded whether a child was male or female.
8SMART (2006): Measuring Mortality, Nutritional Status and Food Security in Crises Situations: SMART METHODOLOGY
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Bilateral oedema:normal thumb pressure was applied on the top part of both feet for 3 seconds.If pitting occurred on both feet upon release of the fingers, nutritional oedema was indicated.
Weight:the weights of children were taken with minimal or light clothing on, using UNICEF SalterScales with a threshold of 25kgs and recorded to the nearest 0.1kg.
Length/height: children were measured bareheaded and barefooted using wooden UNICEF
height boards with a precision of 0.1cm. Children under the age of two years were measured whilelying down (length) and those over two years while standing upright (height). If child age could notbe accurately determined, proxy heights were used to determine cases where height would be takenin a supine position (
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Children whose WFH indices were
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2.8.5. Mortality
The crude death rate is defined as the number of people in the total population who died between
the star of the recall period and the time of the survey. It is calculated using the following:
Crude mortality Rate (CMR) = 10,000/a*f/ (b_+f/2+d/2-c/2), where
a =number of recall days
b =number of current households residents
c =number of people who joined the HH
d =number of people who left the HH
e =number of births during recall
f =number of deaths during recall period.
The result is expressed per 10,000 people per day.Table 5: Mortality Thresholds
Total population CMR Under-five population U5MR
Alert level: 1/10,000 people/day 2/10,000 children/day
Emergency level: 2/10,000 people/day 4/10,000 children/day
2.9. Questionnaire, training and supervision
2.9.1. Questionnaire
The standard nutrition survey questionnaire as recommended in the nutrition guidelines was adapted
to include additional information on the high Impact nutrition interventions. The IYCFquestionnaire as recommended in the CARE IYCF step by step guide was used to collectinformation on IYCF.The questionnaire was developed in English and the enumerators trained on the questionnaire.During the training session, the enumerators translated the questionnaires as they would ask duringdata collection and an agreed way of asking the questions during data collection was agreed upon.The questionnaires were not translated into Somali language however; all interviews were conductedin Somali language. The questionnaire was pre-tested a day before the actual survey began and thefinal questionnaire used is annexed in the report.
2.9.2. Survey teams and supervision
The survey was executed by 5 teams each comprising of 1 team leader and 2 anthropometricmeasurers. Four of the team leaders were from Ministry of Health (MOMS/MOPHS),one from
Arid Lands Resource Management Project (ALRMP) and one from the District development Office.
The survey was led and supervised by trained staff from Save the Children UK. The anthropometric
measurers were recruited from the district and spoke the local language as well as English. The
measurers were required to be literate and at least have completed high school to participate in the
study. The team leaders were practitioners either in health, food security and nutrition and were
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sourced from the government and Save the Children. The survey was supervised by the nutrition
technical specialist from save the Children UK.
2.9.3. Training
Training for the survey teams was undertaken by Save the Children staff (the nutrition technical
specialist). The training was undertaken for 3 days and covered an introduction to nutrition andnutrition assessments, the survey objectives, anthropometric measurements, household selection
procedures, data collection and interviewing skills and the survey questionnaire. The anthropometric
standardization exercise, as recommended by the SMART methodology was undertaken with 10
children, each measurer taking measurements on each child twice. Each enumerator was closely
observed and guided by supervisors and manually given a score of competence based on performing
measurements with accuracy and precision.
After the class room training, practical field experience was conducted to pre-test the questionnaire,
take anthropometric measurements of children and caretakers, conduct interviews and fill
questionnaires; pre-testing exercise was performed on 12 households. The pre-testing exercisefacilitated some changes on the structure of the questionnaire. In addition, a team of data clerks who
were trained on the operation of ENA for SMART for the data entry and these were closely
supervised by the M&E officer from Save the Children.
2.9.4. Data analysis
Anthropometric and mortality data entry and processing was done using the ENA for SMARTsoftware Beta version May 2011 where the World Health Organization Growth Standards (WHO-GS) data cleaning and flagging procedures were used to identify outliers which enabled data cleaningas well as exclusion of discordant measurements from anthropometric analysis. The SMART/ENAsoftware generated weight-for-height, height-for-age and weight-for-age Z scores to classify them
into various nutritional status categories using WHO9
standards and cut-off points. IYCF data wasanalysed in Excel using guidance from the Infant and Young Child Feeding Practices collecting andusing data: a step- by- step guide. All the other quantitative data were entered and analysed in theEPIINFO 3.5.3 version.
9WHO 2006
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3. ResultsTable 6: Demography
Number of children 6-59 months surveyed 1071
Number of children 6-59 months analyzed 1068
Number of anthropometry data excluded using
Plausibility Check
3
Household Census:
Number of total population surveyed for mortality 3743
Number of children under five surveyed for
mortality
1071
Number of HH covered in the mortality survey 711
Number of persons who joined the household
during the recall period
63
Number of persons who left the household during
the recall period
29
Number of under five children who joined the
household during the recall period
7
Number of under five children who left the
household during the recall period
4
Number of births during the recall period 40 40
DEMOGRAPHY
Number of persons per HH 3743/600 6.23
Number of children per HH 1071/600 1.79
% of children under five in the population 28%
3.1 Anthropometric results (based on WHO standards 2006):
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Definitions of acute malnutrition should be given (for example, global acute malnutrition is definedas
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malnutrition (=-3 z-score, no oedema)
(12.0 - 17.395% C.I.)
(12.9 - 19.595% C.I.)
(9.7 - 16.795% C.I.)
Prevalence of severe malnutrition(
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3.2. Malnutrition by MUAC
Malnutrition rates by MUAC were reported atGAM of 10.1% with a SAM 1.7%Table 3.5: Prevalence of acute malnutrition based on MUAC cut offs(and/or oedema) and by sex
Table 11: prevalence of Malnutrition rates by MUAC
All n = 1071 Boys n = 548 Girls n = 523Prevalence of global malnutrition(< 125 mm and/or oedema)
(108) 10.1 %(7.7 - 13.1
95% C.I.)
(54) 9.9 %(7.1 - 13.6
95% C.I.)
(54) 10.3 %(7.6 - 13.9
95% C.I.)Prevalence of moderatemalnutrition (< 125 mm and >=115 mm, no oedema)
(90) 8.4 %(6.4 - 10.995% C.I.)
(45) 8.2 %(5.9 - 11.395% C.I.)
(45) 8.6 %(6.3 - 11.795% C.I.)
Prevalence of severe malnutrition(< 115 mm and/or oedema)
(18) 1.7 %(1.0 - 2.7 95%C.I.)
(9) 1.6 % (0.8- 3.2 95%C.I.)
(9) 1.7 % (0.8- 3.6 95%C.I.)
Table 12: Prevalence of acute malnutrition by age, based on MUAC cut offs and/or oedema
Severe wasting(< 115 mm)
Moderatewasting (>=115 mm and =125 mm )
Oedema
Age(mo)
Totalno.
No. % No. % No. % No. %
6-17 205 12 5.9 38 18.5 155 75.6 1 0.518-29 264 3 1.1 32 12.1 229 86.7 0 0.0
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30-41 256 2 0.8 12 4.7 242 94.5 0 0.042-53 236 0 0.0 8 3.4 228 96.6 0 0.054-59 110 0 0.0 1 0.9 109 99.1 0 0.0Total 1071 17 1.6 91 8.5 963 89.9 1 0.1
3.3. Chronic Malnutrition
3.3.1. Prevalenceof underweight
Table 13: Prevalence of underweight based on weight-for-age z-scores by sex
All n = 1070 Boys n = 547 Girls n = 523Prevalence of underweight (
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Prevalence of severe stunting (
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6-59months
Prevalence of reported illness 38.6%
Table 20: Symptom breakdown in the children in the two weeks prior to interview (n=398)
6-59 months
Diarrhoea 23.4%Cough 37.2%Fever 20.9%Vomiting 19.1%Other 23.4%
*it was possible for a child to report more than one illness
Acute respiratory tract infections was the most common disease reported at 37% diarrhoea, feverand vomiting came in close succession at 23.4%, 20.9% and 19.1% respectively. Of those who
reported to have been sick 83.7% reported to have sought help in the health facilities as shown inthe figure below;
3.5.1. Health seeking behaviour
Table7: Health seeking behaviour
3.6 Vaccination Results
3.6.1: OPV 1&3 and BCG for 6-59 months and measles for 9-59 months
Vaccination was reported at above the recommended EPI >80% for all the antigens as shown in inthe figure below. The same was seen in the case for BCG which was reported at 94%
Table8: Vaccination coverage: OPV 1&3 and BCG for 6-59 months and measles for 9-59 months
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Health
facility
Outreach
sites
Herbalists Other
83.7%
11.1%1.3% 1.0%
Percentage
where Assistance Was sought
Health Seeking Behaviour
Percent
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3.6.2: Micronutrient supplementation and deworming
Table 21: Micronutrients and deworming coverage
Factor Mandera Central
Vitamin Asupplementation (6-11months)
1 time 82% (68)
Vitamin Asupplementation(12months)
1 time 47% (464)
2 times 38% (374)
De-worming Childrenaged > 12 months 1 time 38% (289)
2 times 37%(284)
Iron/folatesupplementation
Pregnant women 46.5%(72)
Zinc In Diarrhoea management 1.1%(1)
From the table above, Vitamin A supplementation for the ages above 11months (Post immunizationage) were suboptimal reported at 2 times 38% this was the same for Deworming and especially so inthe Zinc supplementation in the management of diarrhoea which was only reported at 1%
3.7 Programme coverage
This information was not collected but a SQUEAC survey is scheduled for the month of Augustwhich will be used to provide information on coverage.
0% 20% 40% 60% 80% 100%
2011
2012
2011
2012
2011
2012
OPV1
OPV3
M
easles
46%
67%
48%
65%46%
67%
51%
29%
49%
29%51%
31%
3.1%
1%
2%
2%3%
1%
PERCENTAGE
FACTOR
OPV 1, 3 AND MEASLES COVERAGE
By Card
By Recall
No
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4. Discussion
4.1 Nutritional status
4.1.1. Under five nutrition status
The prevalence of Global Acute Malnutrition for Mandera Central is 17.9 % (14.9 - 21.4 95% C.I.)and Severe Acute Malnutrition at 3.5 % (2.2 - 5.4 95% C.I.).These rates indicate an improvement inthe nutrition status compared with the rates reported in a survey conducted in the district in March
2011 which showed a GAM of 27.5% (23.2-32.2 95% C.I). Further analysis with the CDC calculatorindicates an improvement in the nutrition status that is statistically significant (p=0.001). Possiblereasons for this could be better food security situation in the district following better amounts ofshort rains received in the district in October-December 2011 and as well quite a number ofmeasures that had been put in place in the district following the emergency that had affected thedistrict between April and October 2011. This included the BSFP programme, increase ofoutreaches from 15 to 25, other players providing foods like Kenya Red-cross and ADRA at theheight of the drought among others.
Table9: Survey trends
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Comparing the GAM rates by WFH with those by MUAC there seems to be a reverse trend whereas one increases the other seems to be decreasing (2010 to 2012)
4.1.2. Caretakers nutrition status
Table10: Caretakers Nutrition Status
25.1
30.9
26.327.5
17.9
0
5
10
15
20
25
30
35
2008 2009 2010 2011 2012
PERCENT
YEAR
GAM and SAM trends for MC
WHO GAM
WHO SAM
MUAC GAM
Threshold GAM
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Most of the caretakers were either pregnant or lactating(79%) of the pregnant and lactating motherstheir MUAC data was as follows;Table 22: Caretakers MUAC
CATEGORY MUAC 21
All women(15-49 years) 95(14.3%) 5969(85.7%)
PLW 28(6.4%) 419(93.6%)
4.2 Mortality
The Crude mortality rate (CMR) for this survey was 0.41 (0.22- 0.77 95% CI) and the Under 5
mortality rate (U5MR) was 0.67 (0.29-1.53 95% CI). From the results, the CMR and the under 5
Mortality rates were within the normal rates. Compared to last year the differences in the mortality
rates were not statistically significant. It is worth noting however that discussions related to death inthe district are taboo/ related.
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Currently
pregnant
B/feeding
< 6 mts
infant
B/feeding
6 24
months
Pgnt and
b/feeding
Not Pgnt
Nt
b/feeding
B/feeding
> 24
months
13.3%
6.3%
21.2%
1.6%
21.5%
0.1%
Percentage
Physiological Status
Women physiological Status
Percent
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4.3 Causes of malnutrition
The nutrition survey was undertaken during after the long rains at the end of the Month of Apriland the beginning of May. The rainfall recording in the district was ******. Malnutrition in amongstchildren in Mandera Central was affected by the following factors:
4.3.1. Health status:
4.3.1.1. Morbidity:
Morbidity rates were high with 39% of the respondents reporting to having been sick two weeksprior to the survey. The main causes of morbidity reported were; acute respiratory tract infections(37%), followed by diarrhoea (23%), fever with chills like Malaria (20.9) and Vomiting reported at19%. The disease patterns in the community were said to be typical for the season.
4.3.1.2. Vaccination, Micronutrient supplementation and De-worming coverage
The immunization coverage for BCG (95.6%), Measles (98%) and Pentavalent/OPV 3 (94%) bothby card and by recall were good and above the MOH target of 80%. These 4 vaccines are used in thesurvey as proxy for the immunization coverage at population level. The Malezi bora campaigns and
the integrated outreaches supported by Save the Children have helped improve the immunizationcoverage. These strategies should continue to be supported to keep the coverage high and shouldalso be used to improve the micronutrient supplementation coverage.
Vitamin A supplementation was suboptimal especially for the group above the age of 12 months(post immunization) reported at 38%. Deworming and Iron Folate supplementation was also lowreported at 37% and 47% respectively.
Worst however was Zinc in the management of diarrhoea which was only reported by 1.1% of allthe respondents who reported to have had diarrhoea two weeks prior to the survey. This was due totheir no being any deliberate effort in the promotion of the same and this is something that should
be done in future with the adoption of the HINI strategy.4.3.2. Infant and Young Child Feeding (IYCF)
Infant and young child feeding is a continuum of critical nutrition and health practices that beginduring pregnancy and continue through at least the first two years of life. The sharpest increase inmalnutrition occurs between 6 and 24 months of age, the time when children grow most rapidly andare introduced to other foods in addition to breast milk.Appropriate IYCF practices include timelyinitiation of breastfeeding within 1 hour of birth, exclusive breastfeeding for the first 6 months,complementary feeding after 6 months with continued breastfeeding upto 2 years, and improvedfeeding during and after illness. In this survey, the IYCF practices were considered to be sub-optimal and likely to contribute to the high malnutrition rates.
4.3.2.1. Timely initiation of breastfeeding:This relates to putting an infant to the breast within one hour of birth. Of the 332 children aged 6-23 in the survey, 286 (86%) reported to have put their infants on the breast within one hour of birthas shown in the figure below;
Table11: Proportion of children 0-23 months put to the breast within 1 hour of birth
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4.3.2.2. Exclusive Breastfeeding:Exclusive breastfeeding was reported at 51% within the recommended HINI targets of 50%. Therates were however slightly higher in girls than in boys at 55% and 48% respectively.
Table12: proportion of children exclusively breastfed
4.3.2.3. Minimum Dietary Diversity
Dietary diversity was less than optimal with the worst being minimum dietary diversity for 6-23months with only 39% reporting to eating food from more then three food groups as shown below.Table13: Minimum dietary diversity (n=285)
86.1%
10.8%2.1% 0.6% 0.3%0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
80.0%
90.0%
100.0%
Immediately
(within 1 hr)
Within first
day
Within first 3
days
After 3 days Dont Know
How soon the baby was put on the breast
Percent
51
48
55
44
46
48
50
52
54
56
0-5 Mnths Male Female
Exclusive breast feeding rates
EBF
HINI
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4.3.2.4. Minimum meal frequency
Minimum meal frequency was below the recommended HINI standards of 80%. For the group
between 6-8 months the indicators were slightly better with the feeding reported at 70%. The lowest
rates were reported for the 6-23 months non breastfed infants which was reported at 60%
Table14: Minimum meal times for breastfed children 6-8 months (n=20)
Table15: Minimum meal times for breastfed children 9-23 months (n=133)
0%
10%
20%
30%
40%
50%
60%70%
80%
90%
6-23months 3+ 6-23Males 6-23 Females
6-23 months > 3 food groups
6-23 F>3+ FGPS
70
4030
0102030405060
708090
6-8 months 2+ 6-8Males 6-8 Females
6-8 months BF fed 2 times a day
BF F>2+ Times
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Table16: Minimum meal times for Non breastfed children 6-23 months (n=130)
4.4. Water Sanitation and hygiene
4.4.1. Main water source
The main sources of water for a majority of the population were borehole(33.9%),unprotected wells
(29%), and private and public dams (18.3%). A few of the households got water from protected
wells and water taps as shown below;
Table17: Main current water sources
69
36 33
01020304050
60708090
9-23 months 3+ 9-23 Males 9-23 Females
9-23 Months breast fed children 3+ times
BF F>3+ Times
60.0%
31.0% 29.0%
0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%
6-23 months 4+ 6-23 Males 6-23 Females
Meal frequency NBF 6-23 months
NBF F>4+ Times
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4.4.2. Water treatment
Though quite a numebr of the repondednts reported to having used water for unsafe sources(around 47%), most respondent did not do anything to their drinking water (94.3%). Chemical usein water treatment was reported by around 7% of the respondents as shown in the figure below;
Table18: Treatment given to drinking water
4.4.3. Handwashing practicesAround two thirds of the respondents reported to washing hands at the most critical times.However it is worth noting that most of them used water only(85%) as shown in figure 4.11 and4.12 below;
Table19: When hands were washed
0.0%5.0%
10.0%15.0%20.0%
25.0%30.0%35.0%
6.3%
33.9%29.1%
7.3%4.9%
18.3%
Percentage
Source of Water
Main Source of Water
Percent
0.0%20.0%40.0%60.0%
80.0%100.0%
94.3%
1.9% 1.8% 6.6% 0.3%Percentage
Treatment
Water treatment
Percent
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Table20: what was used to clean hands
4.4.4. Access to toilet facilities
Only 48% of the respondents reported to having access to a toilet facility( either own orneighbours). This was mainly reported in the urban areas with the rural areas reported to usingbush.This indicates poor human waste disposal methods that have the potential to contaminate theopen water sources leading to diarrhoea and other water borne diseases.
5. Conclusions
0.0%20.0%40.0%
60.0%80.0%
100.0% 75.0% 66.6%83.2%
47.1%64.5%
10.0%
Percentage
When
When Hands were Washed
Percent
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
Water only Water &
soap
Water &
ash
Others
85.0%
47.5%
35.1%
0.4%Percentage
What was used for cleaning
What was used to clean Hands
Percent
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The prevalence of acute malnutrition in Mandera Central district is still critical with global acutemalnutrition (GAM) of 17.9% (14.9-21.4 95% C.I.) and Severe Acute Malnutrition (SAM) rate of3.4.% (2.1-5.3 95% C.I.). Compared with the survey undertaken in March of 2011 however whichindicated GAM of 27.5% (23.2-32.2.0 95% CI) and SAM of 3.4% (2.3-4.9), there is a reduction in
the level of GAM which is statistically significant(P=0.001) while there was no much change inSAM. The levels of Immunization (OPV1&3, Measles, BCG) were also within the recommendednational levels of above 80% both by card and recall. Some other HINI indicators like use of Zinc inthe management of diarrhoe, deworming and Vitamin A supplementation for the 12-59 Monthswere however not up to scale.This was also the case as regards to Hygiene and Sanitation pracices.An analysis of IYCF indicators showed that the IYCF practices are poor with high percentage ofchildren not receiving optimal infant feeding practices (with the exception of timely initiation ofbreastfeeding reported at above 80%).
6. Recommendations and priorities
6.1. Immediate Continue supporting to the MOH with OJT, HINI ,supportive supervision and logistical
support. Promotion of IYCF activities geared towards optimal complementary feeding and dietary
diversity e.g. kitchen gardening and cooking demostration. Incooporating DRR in normal programming through activities like provision of health,
nutrition and hygiene promotion activities to school health clubs. Scale up of the HINI package with special focus on Zinc supplementation. As a start
sensitization of health workers and supply chain management of the Zinc tablets should beadressed.
6.2. Medium term MOH to develop a health workers retention strategy to reduce the high staffs turn over. Through SCUK WASH programme strengthen Hygiene promotion hygiene practices to
reduce the incidence of diarrhoeal disease including health and nutrition promotiontoeducate the community on basic WASH i.e. domestic treatment of drinking water andproper disposal of faecal waste.
6.3. Long term
Through SCUK WASH programme, Provide toilet facilities through communityparticipatory approaches coupled with awareness campaign on the importance of using suchfacilities i.e. Community Led Total Sanitation (CLTS) and Participatory Hygiene and
Sanitation Transformation (PHAST) approaches. This can be piloted in one division (to beagreed among all stakeholders) and depending on how it works it can be scaled up to theothers.
Need for defined linkage of nutrition sector cluster with other sectors such as WaterSanitation and Hygiene (WASH) in the longer term.
Advocacy for recruitment and retention of health workers i.e. nurses , Clinical Officers (Cos)and nutritionists in North Eastern province
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Government of Kenya (GOK) to strengthen community health strategy in the ASALS tofoster empowerment of CHWs to participate in health and nutrition promotion andmanagement of minor childhood ailments.
7. References
The SPHERE Project Handbook (2011), Humanitarian Charter and Minimum Standards in DisasterResponse
WHO 2006 growth standards
Infant and Young Child Feeding Practices: Collecting and Using Data: A Step-by- Step Guide.Cooperative for Assistance and Relief Everywhere, Inc. (CARE). 2010.
8. Appendicies
8.1. Appendix 1
Plausibility Report
Plausability MC.rtf
8.2. Appendix 2
Assignment of Clusters
Geographical unit Population size Assigned cluster
Bulla afya 13191 "1,2"
Elwak south 33636 "3,4,RC,5,6"
Elwak town 27560 "RC,7,8"
El-adi 14574 "9,10"
Dasheng wante 5817 11
Wante 8339 12
Bore hole 11 16412 "13,14,15"
Dabacity 10203 16El-ram 8293 17
Garsesala 9566 18
Kotulo 11231 "19,20"
Lehele 2343
Kutayu 9056 21
Bojigarse 3225 RC
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Fincharo 6351 22
Fincharo 6351 23
Qalanqaleysa 7547 RC
Burmayo North 5657
Burmayo South 5129 24
Shimbir Fatuma 19590 "25,26,27"Shimbir Fatuma 19590 "28,29"
Quramadhow 9275 "30,31"
Sukela tinfa 2018
Elele 6969 32
Wargadud 23430 "33,34,35"
Wargadud East 17372 "36,37"
8.3. Appendix 3
Calendar of Events
Calender of
events.doc
8.4. Appendix 4
Result Tables for NCHS growth reference 1977
Table 3.2: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema)and by sex
All n = 1071 Boys n = 548 Girls n = 523Prevalence of global malnutrition(
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Severe wasting(= -3and = -2z score)
Oedema
Age(mo) Totalno. No. % No. % No. % No. %
6-17 205 6 2.9 25 12.2 173 84.4 1 0.518-29 264 3 1.1 38 14.4 223 84.5 0 0.030-41 256 1 0.4 41 16.0 214 83.6 0 0.042-53 236 5 2.1 44 18.6 187 79.2 0 0.054-59 110 0 0.0 23 20.9 87 79.1 0 0.0Total 1071 15 1.4 171 16.0 884 82.5 1 0.1
Table 3.4: Distribution of acute malnutrition and oedema based on weight-for-height z-scores
=-3 z-score
Oedema present Marasmic kwashiorkor No. 0(0.0 %)
Kwashiorkor No. 1 (0.1 %)
Oedema absent Marasmic No. 15 (1.4 %) Not severely malnourishedNo. 1055 (98.5 %)
Table 3.5: Prevalence of acute malnutrition based on MUAC cut offs (and/or oedema) and by sex
All n = 1071 Boys n = 548 Girls n = 523
Prevalence of global malnutrition(< 125 mm and/or oedema)
(108) 10.1 %(7.7 - 13.195% C.I.)
(54) 9.9 %(7.1 - 13.695% C.I.)
(54) 10.3 %(7.6 - 13.995% C.I.)
Prevalence of moderatemalnutrition (< 125 mm and >=115 mm, no oedema)
(90) 8.4 %(6.4 - 10.995% C.I.)
(45) 8.2 %(5.9 - 11.395% C.I.)
(45) 8.6 %(6.3 - 11.795% C.I.)
Prevalence of severe malnutrition(< 115 mm and/or oedema)
(18) 1.7 %(1.0 - 2.7 95%C.I.)
(9) 1.6 % (0.8- 3.2 95%C.I.)
(9) 1.7 % (0.8- 3.6 95%C.I.)
Table 3.6: Prevalence of acute malnutrition by age, based on MUAC cut offs and/or oedema
Severe wasting(< 115 mm)
Moderatewasting (>=115 mm and =125 mm )
Oedema
Age Total No. % No. % No. % No. %
7/29/2019 Nutritional Anthropometric and Mortality Survey Final Report Mandera Central District North Eastern Province
44/46
44
(mo) no.6-17 205 12 5.9 38 18.5 155 75.6 1 0.518-29 264 3 1.1 32 12.1 229 86.7 0 0.030-41 256 2 0.8 12 4.7 242 94.5 0 0.042-53 236 0 0.0 8 3.4 228 96.6 0 0.0
54-59 110 0 0.0 1 0.9 109 99.1 0 0.0Total 1071 17 1.6 91 8.5 963 89.9 1 0.1
Table 3.5: Prevalence of acute malnutrition based on the percentage of the median and/or oedema
n = 1071Prevalence of global acutemalnutrition (
7/29/2019 Nutritional Anthropometric and Mortality Survey Final Report Mandera Central District North Eastern Province
45/46
45
3 z-score) 95% C.I.) 95% C.I.) 95% C.I.)Prevalence of severe underweight(
7/29/2019 Nutritional Anthropometric and Mortality Survey Final Report Mandera Central District North Eastern Province
46/46
42-53 236 7 3.0 28 11.9 201 85.254-59 110 1 0.9 7 6.4 102 92.7Total 1070 69 6.4 155 14.5 846 79.1
Table 3.11: Mean z-scores, Design Effects and excluded subjects
Indicator n Mean z-scores SD
DesignEffect (z-score < -2)
z-scores notavailable*
z-scores outof range
Weight-for-Height
1070
-1.150.94 1.53 1 0
Weight-for-Age 1070
-1.590.93 2.03 1 0
Height-for-Age 1070
-1.041.25 3.48 0 1
* contains for WHZ and WAZ the children with oedema.
8.6. Appendix 5
Questionnaires
Survey
Questionnaire clus
Survey
Questionnaire hou