Nutrition and Food Security Surveillance ROUND THREE JULY TO AUGUST 2017

Transcription

1 Nutrition and Food Security Surveillance ROUND THREE JULY TO AUGUST 2017

2 Outline Summary of Survey Methodology and Results Objectives Methodology Preliminary results Discussion and Interpretation of Results in Context Conclusions and Recommendations

3 Introduction Continued concern about emergency levels of acute malnutrition given ongoing conflict and limited access in the North East. The Boko Haram conflict was declared to be a state of emergency at the beginning of 2012 by the government. The emergency is currently focused in Borno Yobe and Adamawa states. The insurgency and political violence in these states has caused population displacement, disruption in livelihoods, and acute food insecurity. According to the International Organization of Migration s (IOM) May 2017 report, there are 1,496,995, 143,209 and 108,769 internally displaced persons (IDPs) in Borno, Adamawa and Yobe states respectively.

4 ROUND 1 Justification The first round of repeated surveys were conducted in October-November, 2016 and the second round in February- March, Data from these surveys suggests that the prevalence of global acute malnutrition (GAM) declined between the first and second rounds From 11.4% ( % CI) to 8.0% ( % CI) in Yobe From 11.3% ( % CI) to 6.7% ( % CI) in Borno ROUND 2 Mortality both crude and under five was above emergency thresholds in several domains and increased in all domains

5 Survey Goal Provide high quality, population representative estimates of the nutrition, food security, and health situation in accessible areas of N.E Nigeria Note: Many areas of the population are newly liberated or still inaccessible for both programs and the survey. This round of the survey therefore cannot provide information on these areas.

6 Primary Objectives Determine all-cause mortality among the general population (crude death rate) and among children 0 to 59 months (under-five death rate); Determine the prevalence of acute malnutrition among children 0 to 59 months of age using WHZ and bilateral oedema and among children 6 to 59 months using Mid Upper Arm Circumference (MUAC); Determine the prevalence of acute malnutrition among women 15 to 49 years of age using MUAC; Determine household mosquito net ownership, universal coverage of mosquito net and utilization of mosquito net by under-five children and intermittent preventive treatment in children Measure coverage of major public health interventions such as vaccination campaigns (polio / measles), Vitamin A and deworming, Micronutrient (MNP), and MNCHW campaigns; and Determine proportion of children under five with fever and diarrhoea who received an ACT and ORS and zinc respectively.

7 Methodology Cross sectional household survey designed using SMART methodology (consistent with NNS) Sample Design State 1: Cluster Selection Probability proportional to size (PPS) method Yobe: Enumeration Areas (EAs) with projected population projected from the 2006 census provided by the National Bureau of Statistics Borno: Villages and camps with estimated populations from the February 2017 polio campaign microplan and the International Organization on Migration (IOM) Displacement Tracking Matrix (DTM) round XIII. Stage 2: Household selection Full mapping and listing of selected clusters Systematic random selection GPS verified locations

8 Domains Southern Adamawa: Demsa, Gombi, Guyuk, Lamurde, Numan, Shelleng, Yoa North, Ganye, Jada, Mayo-Belwa, Teungo, Fufore, Yola South 2. Northern Adamawa: Girie, Hong, Madagali, Maiha, Michika, Mubi North, Mubi South, Song Northern Borno: (Abadam), (Mobbar), Guzamala, Kukawa, Nganzai 4. Southern Borno: Askira/Uba, Bayo, Biu, Chibok, Haul, Kwaya Kusar, Shani 5. East Borno: (Bama), Dikwa, Gwoza, (Kala/Balge), Ngala 6. Central Borno: (Damboa), Gubio, Kaga, Konduga, Mafa, Magumeri, (Marte), Monguno 7. MCC/Jere: Maiduguri, Jere Central Yobe: Bade, Borsari, Geidam, Jakusko 9. Southern Yobe: Damaturu, Fika, Fune, Gujba, Gulani, Nangere, Potiskum, Tarmuwa 10. Northern Yobe: Karasuwa, Machina, Nguru, Yunusari, Yusufari 1 Domains where most or all settlements were inaccessible are indicates with ()s

9 Sample Size Calculation GAM Estimated prevalence of Global Acute Malnutrition (GAM) Parameters Borno Yobe Source 8.3% 9.4% Upper confidence interval of estimate from emergency surveillance (Mar 2017) Precision 3.5% 3.5% Recommended precision for prevalence 10-15% Design effect for WHZ Number of children to be included Conservative estimate from emergency surveillance (Mar 2017) Average number of persons per household Estimate from emergency surveillance (Mar 2017) Percent of under five children in total population 19.6% 21.0% Estimate from emergency surveillance (Mar 2017) Percent of non-response households 2.3% 1.9% Estimate from emergency surveillance (Mar 2017) Number of Households to be included

10 Sample Size Calculation - Mortality Parameters Borno Yobe Source Estimated prevalence of Crude Death Rate (CDR) State level estimate from emergency surveillance rounded up (Mar 2017) Precision Design effect for Crude Death Rate (CDR) State level observed DEFF from emergency surveillance rounded up (Mar 2017) Recall period in days From 1 st April (Kidnap of 18 girls in Pulka) Number of persons to be included, Number of households to interview Average number of persons per household Estimate from emergency surveillance (Mar 2017) Percent of non-response households 2.3% 1.9% Estimate from emergency surveillance (Mar 2017) Number of Households to be included

11 Training and Field Work Training of Survey Teams (3 days) 1 day theoretical training, 1 day standardization test, 1 day field test Highest performing teams retained from Round 1&2 30 Individuals re-trained Selection of 22 interviewers, 5 supervisors, and 3 coordinators based on post-test and standardization test results

12 Results

13 Final Sample Size Survey Area Number of Clusters Number of Households Number of Children 0-59m Planned Surveyed % Planned Surveyed % Planned Surveyed % Northern Yobe % % % Southern Yobe % % % Central Yobe % % % Southern Borno % % % East Borno % % % MMC/Jere % % % Northern Borno % % % Central Borno % % %

14 Inaccessible Clusters Yobe State 31 clusters of 24 households were selected per domain All clusters were accessible with the following exceptions: North Yobe: 2 clusters were inaccessible due to insecurity South Yobe: 1 cluster was vacant on arrival and 1 cluster was not located in Yobe Central Yobe: 1 cluster was inaccessible due to insecurity

15 Inaccessible Clusters Borno State 37 clusters of 24 households were selected per domain All clusters were accessible with the following exceptions: East Borno: 3 clusters were inaccessible due to insecurity MMC/Jere: 1 cluster refused participation in the survey Central Borno: 7 clusters inaccessible due to insecurity, attempts were made to visit all reserve clusters however, only 3 (of 4) were accessible North Borno: 12 clusters inaccessible due to insecurity, attempts were made to visit all reserve clusters however, only 1 (of 4) was accessible Data are presented given limited available regarding the nutritional status in Northern Borno Data are only representative of accessible areas and should be interpreted with some caution

16 Data Quality Overall data quality is good All strata except MMC & Jere had less than 5.0% of values excluded as outliers (SMART flags). Standard deviation for WHZ for all surveys fell within an acceptable range ( ) Some notable demographic differences More young children (6-29 months) sampled than older children (30-59 months) in Southern and Central Yobe Below 35% of children across all strata in Borno and Yobe had an exact birthday.

17 Data Quality Excellent Good Acceptable Problematic Domain Flagged data Sex Ratio Age Ratio Digit Preference M/F 6-23/ Weight Height MUAC SD WHZ Skewnes s WHZ Kurtosi s WHZ Poisson WHZ Northern Yobe 4.7% p= South Yobe 3.1% p= Central Yobe 3.1% p= Southern Borno 4.5% p= East Borno 3.4% p= MMC/Jere 5.4% p= North Borno 3.1% p= % Central Borno 3.5% ex -0.09ex p= % Overall

18 Results ANTHROPOMETRY AND MORTALITY

19 Prevalence (%0) Prevalence of Global Acute Malnutrition in Children 0-59 months (WHZ) Northern Yobe South Yobe Central Yobe Southern Borno East Borno MMC/Jere North Borno Central Borno Domain MAM SAM

20 Prevalence of Acute Malnutrition in Children 0-59 months (WHZ) - Yobe North Yobe n = 663 South Yobe n = 740 Central Yobe* n = 677 Prevalence of global malnutrition (<-2 z-score and/or oedema) (109) 16.4 % ( % (73) 9.9 % ( % (99) 14.6 % ( % Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema) (89) 13.4 % ( % (53) 7.2 % ( % (73) 10.8 % ( % Prevalence of severe malnutrition (<-3 z-score and/or oedema) (20) 3.0 % ( % (20) 2.7 % ( % (26) 3.8 % ( % *Prevalence includes 1 case of oedema in Central Yobe

21 Prevalence of Acute Malnutrition in Children 0-59 months (WHZ) - Borno Prevalence of global malnutrition (<-2 z-score and/or oedema) Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema) Prevalence of severe malnutrition (<-3 z-score and/or oedema) South Borno n = 874 (75) 8.6 % ( % (65) 7.4 % ( % (10) 1.1 % ( % East Borno n = 769 (80) 10.4 % ( % (66) 8.6 % ( % (14) 1.8 % ( % MMC & Jere* n = 824 (104) 12.6 % ( % (83) 10.1 % ( % (21) 2.5 % ( % North Borno n = 474 (66) 13.9 % ( % (47) 9.9 % ( % (19) 4.0 % ( % Central Borno n = 783 (105) 13.4 % ( % (81) 10.3 % ( % (24) 3.1 % ( % *Prevalence includes 1 case of oedema in MMC & Jere

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23 Prevalence of Acute Malnutrition in Children 6-59 months (MUAC)

24 Prevalence of Acute Malnutrition in Children 6-59 months (MUAC) - Yobe North Yobe n = 631 South Yobe n = 678 Central Yobe* n = 631 Prevalence of global malnutrition (MUAC < 125 mm and/or oedema) Prevalence of moderate malnutrition (MUAC < 125 and MUAC >= 115 mm, no oedema) Prevalence of severe malnutrition (<MUAC < 115 and/or oedema) (65) 10.3 % ( % (41) 6.5 % ( % (24) 3.8 % ( % (43) 6.3 % ( % (32) 4.7 % ( % (11) 1.6 % ( % (44) 7.0 % ( % (31) 4.9 % ( % (13) 2.1 % ( % *Prevalence includes 1 case of oedema in Central Yobe

25 Prevalence of Acute Malnutrition in Children 6-59 months (MUAC) - Borno Prevalence of global malnutrition (< 125 mm and/or oedema) Prevalence of moderate malnutrition (< 125 mm and >= 115 mm, no oedema) Prevalence of severe malnutrition (< 115 mm and/or oedema) South Borno n = 820 (33) 4.0 % ( % (24) 2.9 % ( % (9) 1.1 % ( % East Borno n = 735 (40) 5.4 % ( % (23) 3.1 % ( % (17) 2.3 % ( % MMC & Jere* n = 811 (48) 5.9 % ( % (29) 3.6 % ( % (19) 2.3 % ( % North Borno n = 452 (29) 6.4 % ( % (18) 4.0 % ( % (11) 2.4 % ( % Central Borno n = 742 (65) 8.8 % ( % (46) 6.2 % ( % (19) 2.6 % ( % *Prevalence includes 1 case of oedema in MMC & Jere

26 Crude and Under Five Death Rate

27 Crude and Under Five Death Rate Yobe North Yobe South Yobe Central Yobe Crude Death Rate (total deaths / 10,000 people / day) 1.31 ( ) 1.60 ( ) 0.87 ( ) Under Five Death Rate (deaths in children under five/ 10,000 children under five / day) 3.15 ( ) 4.76 ( ) 2.05 ( ) Deaths from natural causes (illness) 85.1% 88.1% 93.5%

28 Crude and Under Five Death Rate Borno South Borno East Borno MMC & Jere North Borno Central Borno Crude Death Rate (total deaths / 10,000 people / day) 0.39 ( ) 0.38 ( ) 0.43 ( ) 0.98 ( ) 0.89 ( ) Under Five Death Rate (deaths in children under five/ 10,000 children under five / day) 1.13 ( ) 1.02 ( ) 0.98 ( ) 2.39 ( ) 1.81 ( ) Deaths from natural causes (illness) 90.5% 95.0% 80.0% 82.8% 82.5%

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30 Discussion / Interpretation

31 Conclusion Survey results are of high quality and provide population representative estimates for accessible areas in the emergency states; Acute Malnutrition: Results suggest an increase in prevalence of acute malnutrition in all domains relative to the second surveillance round (March/April, 2017). This increase was significant in North and Central Yobe, MMC/Jere and Central Borno GAM prevalence suggests a critical situation in North Yobe and a serious situation in Central Yobe and 4 Borno domains (East, North, Central, MMC/Jere) An increase in acute malnutrition is consistent with seasonal trends in admissions to CMAM sites Mortality: Results suggest that mortality remains above emergency levels in several regions of Borno and Yobe CMR is above 1 deaths/10,000/day in North and South Yobe U5MR is above 2 deaths / 10,000/ day in all Yobe domains and North Borno Deaths are primarily from illness not conflict related or other injuries

32 Prevalence of Global Acute Malnutrition (%) Trends in GAM from NFSS1 to NFSS (October) 2017 (March) 2017 (July) North Yobe South Yobe Central Yobe MMC/ Jere Southern Borno Central Borno East Borno North Borno

33 Prevalence of severe acute malnurition (%) Trends in SAM from NFSS1 to NFSS (October) 2017 (March) 2017 (July) North Yobe South Yobe Central Yobe MMC/ Jere Southern Borno Central Borno East Borno North Borno

34 Seasonality Admissions data from CMAM programs suggests notable increases annually between July and September likely corresponding to increases in acute malnutrition during hunger / malaria season The current surveys were organized in July at the beginning of the hunger season Admission in February approximately 16,000 new SAM cases compared to 24,000 new SAM cases admitted in July (1.5 times increase). Seasons: Round 1 (October 2016) post-harvest Round 2 (February / March 2017 ) post-harvest

35 Seasonality Survey Data Collection

36 Trends in Mortality from NFSS1 to NFSS3 Crude Mortality Rate Under-Five-Mortality Rate Critical/ Emergency Threshold Critical/ Emergency Threshold

37 Recommendations - Overall Nutrition emergency response to be scaled up concurrent with health, WASH and food security programs across Borno and Yobe state All children with acute malnutrition should have access to treatment Ensure that there is safe drinking water and clean environment at community levels Strengthen linkages between nutrition, food security interventions and social safety net programs (Cash based transfers) Scale up humanitarian food security response beyond general food distribution and CBT to include : Promotion of adequate infant feeding practices Micronutrient supplementation Women s nutrition (particularly for pregnant and lactating women and adolescents) Strengthen and scale up Inpatient management of acute malnutrition and Community component of CMAM program for early identification, referral and treatment of cases

38 Recommendations - Overall Sustained high under five and crude mortality rate for two rounds suggest a need for increased emphasis on other common causes of mortality in children Improve treatment of common childhood illnesses by ensuring availability and accessibility to recommended treatment Continue monitoring nutrition and health situation in Borno and Yobe states using surveillance Partners with capacity to conduct rapid SMART especially in areas that were inaccessible by the NFSS R3; possibility that the populations in these areas have poorer nutrition and health outcomes Conduct further analysis and present the percentage of acutely malnourished children who were identified as cases by both Mid-upper-arm-circumference and weight-for-height Z scores.

39 Acknowledgements This survey was carried out by the National Bureau of Statistics (NBS) in coordination with the National Population Commission (NPC), the Federal Ministry of Health (FMOH), and the Nigeria Nutrition in Emergency Working Group (NiEWG). Financial support was provided by the Government of Nigeria, United Nations Children s Fund (UNICEF), and the United Nations Central Emergency Response Fund (CERF). Technical support was provided by the Centers for Disease Control and Prevention (CDC) and UNICEF through NBS.

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41 Trends in SAM from NFSS1 to NFSS3: Map

42 Prevalence of Global Acute Malnutrition (%) Comparison to NNS - GAM (August) 2013 (Sept) 2014 (May ) 2015 (July) 2016 (October) 2017 (March) 2017 (July) Borno Yobe North Yobe South Yobe Central Yobe MMC/ Jere Southern Borno Central Borno East Borno North Borno

43 Prevalence of Severe Acute Malnutrition (%) Comparison to NNS - SAM (August) 2013 (Sept) 2014 (May ) 2015 (July) 2016 (October) 2017 (March) 2017 (July) Borno Yobe North Yobe South Yobe Central Yobe MMC/ Jere Southern Borno Central Borno East Borno North Borno