Nutrition and Food Security Surveillance ROUND TWO FEBRUARY TO MARCH 2017

Transcription

1 Nutrition and Food Security Surveillance ROUND TWO FEBRUARY TO MARCH 2017

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

3 Justification Continued concern about emergency levels of acute malnutrition given ongoing conflict and limited access in the North East. Small scale surveys also continue to show areas with elevated prevalence of acute malnutrition Source: FEWSNET, November 2016

4 Justification First (November) round of surveys suggest improvements in acute malnutrition from reported highs in summer 2016: GAM exceeded the WHO Crisis Classification threshold for serious (10%) in 5 domains: Central Borno, MMC/Jere, Northern Yobe, Central Yobe, and Southern Yobe. The under-five mortality rate in Central Yobe exceeds the emergency threshold of 2 deaths in children under five / 10,000 children under five / day.

5 Justification Round two consistent with trends in small-scale surveys However, areas of high prevalence and areas of limited access remain Need to continue to monitor the situation Data from ACF Monguno LGA, Borno suggests decline in GAM from 27.3% to 9.4% between Aug and Nov, 2016

6 Justification Interest in impact of scale up of humanitarian interventions in the North East. Between the first and second round: Ongoing polio campaigns Large scale measles campaign in the North East (including Vitamin A) Scale up of BSFP and CMAM services Source: UNICEF January 2017

7 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.

8 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; Assess the current state of food security using a measure of dietary diversity among women 15 to 49 years of age; and Assess infant and young child feeding practices among children 0 to 23 months including initiation of breastfeeding, exclusive breastfeeding, continuation of breastfeeding, and introduction of complementary foods; and Measure coverage of major public health interventions such as vaccination campaigns (polio / measles), Vitamin A and deworming, CSB, and MNCHW campaigns; and Determine access to key health services, use of improved hygiene facilities, and indicators of child health status.

9 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

10 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 9a. Damaturu, Fika, Fune, Nangere, Potiskum, Tarmuwa 9b. Gujba, Gulani 10. Northern Yobe: Karasuwa, Machina, Nguru, Yunusari, Yusufari 1

11 Additional Small Areas Additional small-area surveys were planned in small areas selected purposefully Selected due to high number of displaced persons, high number of admissions into treatment centers, and/or area that has become newly accessible Accessible areas of Ngala LGA (Ngala Ward, Gamboru A/B/C), Borno Konduga Ward in Konduga LGA, Borno Old Maiduguri Ward, MMC LGA, Borno Methodology for these small areas was the same as surveillance domains However shorter questionnaires were conducted: only anthropometry among children under five, vaccination coverage, and mortality Surveys were done independently (in addition) to standard surveillance domains

12 Representativeness Yobe No wards excluded a priori Borno: Inaccessible areas were excluded a priori Determined from February polio campaign In the 4 surveyed domains: 55% of villages were accessible representing 68% of the population of these domains

13 Sample Size Calculation GAM Parameters Borno Yobe Source Estimated prevalence of Global Acute Malnutrition (GAM) 13.0% 13.3% Upper confidence interval of estimate from emergency surveillance (Nov 2016) 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 (Nov 2016) Average number of persons per household Estimate from emergency surveillance (Nov 2016) Percent of under five children in total population 15.6% 18.0% Estimate from emergency surveillance (Nov 2016) Percent of non-response households 2.3% 1.9% Estimate from emergency surveillance (Nov 2016) Number of Households to be included

14 Sample Size Calculation - Mortality Parameters Borno Yobe Source Estimated prevalence of Crude Death Rate (CDR) Precision State level estimate from emergency surveillance rounded up (Nov 2016) Design effect for Crude Death Rate (CDR) State level observed DEFF from emergency surveillance rounded up (Nov 2016) Recall period in days From Eid-al-Adha Number of persons to be included, Number of households to interview Average number of persons per household Estimate from emergency surveillance (Nov 2016) Percent of non-response households 2.3% 1.9% Estimate from emergency surveillance (Nov 2016) Number of Households to be included

15 Training and Field Work Training of Survey Teams (4 days) 2 days theoretical training, 1 day standardization test, 1 day field test Highest performing teams retained from Round 1 30 Individuals re-trained Selection of 22 interviewers, 5 supervisors, and 3 coordinators based on post-test and standardization test results

16 Results

17 Final Sample Size Survey Area Number of Clusters Number of Households Number of Children 0-59m Planned Surveyed % Planned Surveyed % Planned Surveyed % Northern Borno % % % Southern Borno % % % Central Borno % % % MMC/Jere % % % Central Yobe % % % Southern Yobe % % % Gujba Gulani % % % Damaturu, Fika, Fune, Nangere, Potiskum, Tarmuwa % % % Northern Yobe % % %

18 Final Sample Size Survey Area Number of Clusters Number of Households Number of Children 0-59m Planned Surveyed % Planned Surveyed % Planned Surveyed % Konduga Ward % % % Old Maiduguri % % % Ngala LGA % % %

19 Inaccessible Clusters 31 clusters of 20 households were selected per domain All clusters were accessible with the following exceptions: Yobe Gujba and Gulani: 4 clusters in Gujba were inaccessible and 2 were vacant on arrival. 1 cluster in Gulani was also vacant on arrival reserve clusters selected a priori used Northern Yobe: 4 clusters were inaccessible and 2 were vacant on arrival reserve clusters selected a priori used Borno: MMC/Jere: 1 cluster was vacant on arrival Southern Borno: 1 cluster was inaccessible Northern Borno: (See next slide) reserve clusters selected a priori used

20 Caution in North Borno Interpretation Only 20 of the selected clusters in North Borno were accessible 3 clusters were vacant 7 clusters (and 2 reserve clusters) were inaccessible 2 clusters completely refused Data are presented given limited available regarding the nutritional status in Northern Borno However, data are only representative of accessible areas and should be interpreted with some caution

21 Data Quality Overall data quality is high All strata but Southern Borno had less than 2.5% of values excluded as outliers (SMART flags) Standard deviation for WHZ for all surveys fell within an acceptable range ( ) Moderate rounding of height Some notable demographic differences More males than females in Central Borno and Northern Yobe More younger children (6-29mo) than older children (30-59 mo) in Southern Yobe

22 South Yobe Data Quality Excellent Good Acceptable Problematic Flagged Data Sex Ratio Age Ratio Digit Preference M/F 6-23/30-59 Weight Height MUAC SD WHZ Skewness WHZ Kurtosis WHZ Poisson WHZ 1 Northern Borno 1.5% Southern Borno 2.6% p< Central Borno 1.5% P= MMC/Jere 1.5% p= Central Yobe 1.8% p< b 9a Gujba Gulani 1.0% p= Other LGAs 1.7% p= Northern Yobe 1.1% p= Overall

23 Data Quality Excellent Good Acceptable Problematic Flagged Data Sex Ratio Age Ratio Digit Preference M/F 6-23/30-59 Weight Height MUAC SD WHZ Skewness WHZ Kurtosis WHZ Poisson WHZ Overall Konduga Ward 1.4% P= Old Maiduguri 0.5% p= Ngala LGA 0.8% P=

24 Results ANTHROPOMETRY AND MORTALITY

25 Prevalence (%) Prevalence of Global Acute Malnutrition in Children 0-59 months (WHZ) Northern Yobe South Yobe (A) South Yobe (B) Central Yobe MMC/Jere Southern Borno North Borno Central Borno Old Maiduguri Konduga Ngala MAM SAM

26 Prevalence of Acute Malnutrition in Children 0-59 months (WHZ) - Yobe Northern Yobe n = 627 South Yobe (A) n = 701 South Yobe (B) n = 588 Central Yobe n = 762 Prevalence of global malnutrition (<-2 z-score and/or oedema) (54) 8.6% ( % CI) (53) 7.6% ( % CI) (55) 9.4% ( % CI) (62) 8.1% ( % CI) Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema) (48) 7.7% ( % CI) (48) 6.8% ( % CI) (48) 8.2% ( % CI) (55) 7.2% ( % CI) Prevalence of severe malnutrition (<-3 z-score and/or oedema)* (6) 1.0% ( % CI) (5) 0.7% ( % CI) (7) 1.2% ( % CI) (7) 0.9% ( % CI) *No cases of oedema were identified in any of the domains

27 Prevalence of Acute Malnutrition in Children 0-59 months (WHZ) - Borno MMC/Jere n = 652 Southern Borno n = 605 North Borno n = 329 Central Borno n = 512 Prevalence of global malnutrition (<-2 z-score and/or oedema) (42) 6.4% ( % CI) (39)6.4% ( % CI) (27)8.2% ( % CI) (40)7.8% ( % CI) Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema) (37)5.7% ( % CI) (34) 5.6% ( % CI) (24) 7.3% ( % CI) (34) 6.6% ( % CI) Prevalence of severe malnutrition (<-3 z-score and/or oedema)* ( 5) 0.8% ( % CI) (5) 0.8% ( % CI) (3) 0.9% ( % CI) (6) 1.2% ( % CI) *No cases of oedema were identified in any of the domains

28 Prevalence of Acute Malnutrition in Children 0-59 months (WHZ) Borno (Small area surveys) Old Maiduguri n = 603 Konduga n = 546 Ngala n = 485 Prevalence of global malnutrition (<-2 z-score and/or oedema) (59) 9.8% ( % CI) (48)8.8% ( % CI) (27) 5.6% ( % CI) Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema) (46) 7.6% ( % CI) (40) 7.3% ( % CI) (24) 4.9% ( % CI) Prevalence of severe malnutrition (<-3 z-score and/or oedema)* (13) 2.2% ( % CI) (8) 1.5% ( % CI) (3) 0.6% ( % CI) *No cases of oedema were identified in any of the domains

29 Prevalence (%) Prevalence of Acute Malnutrition in Children 6-59 months (MUAC) Northern Yobe South Yobe (A) South Yobe (B) Central Yobe MMC/Jere Southern Borno North Borno Central Borno Old Maiduguri Konduga Ngala mm <115mm

30 Prevalence of Acute Malnutrition in Children 6-59 months (MUAC) - Yobe Northern Yobe n = 563 South Yobe (A) n = 623 South Yobe (B) n = 529 Central Yobe n = 717 Prevalence of global malnutrition (MUAC < 125 mm and/or oedema) (33) 5.9% ( % CI) (33) 5.3% ( % CI) (47) 8.9% ( % CI) (40) 5.6% ( % CI) Prevalence of moderate malnutrition (MUAC < 125 and MUAC >= 115 mm, no oedema) Prevalence of severe malnutrition (<MUAC < 115 and/or oedema)* (21) 3.7% ( % CI) (12) 2.1% ( % CI) (25) 4.0% ( % CI) ( 8) 1.3% ( % CI) (34) 6.4% ( % CI) (13) 2.5% ( % CI) (27) 3.8% ( % CI) (13) 1.8% ( % CI) *No cases of oedema were identified in any of the domains

31 Prevalence of Acute Malnutrition in Children 6-59 months (MUAC) - Borno MMC/Jere n = 602 Southern Borno n = 559 North Borno n = 300 Central Borno n = 460 Prevalence of global malnutrition (MUAC < 125 mm and/or oedema) (25) 4.2% ( % CI) (29) 5.2% ( % CI) (23) 7.7% ( % CI) (22) 4.8% ( % CI) Prevalence of moderate malnutrition (MUAC < 125 and MUAC >= 115 mm, no oedema) (19) 3.2% ( % CI) (18) 3.2% ( % CI) (11) 3.7% ( % CI) (19) 4.1% ( % CI) Prevalence of severe malnutrition (<MUAC < 115 and/or oedema)* ( 6) 1.0% ( % CI) (11) 2.0% ( % CI) (12) 4.0% ( % CI) (3) 0.7% ( % CI) *No cases of oedema were identified in any of the domains

32 Prevalence of Acute Malnutrition in Children 6-59 months (MUAC) Borno (Small area surveys) Old Maiduguri n = 565 Konduga n = 505 Ngala n = 439 Prevalence of global malnutrition (MUAC < 125 mm and/or oedema) (28) 5.0% ( % CI) (22) 4.4% ( % CI) (9) 2.1% ( % CI) Prevalence of moderate malnutrition (MUAC < 125 and MUAC >= 115 mm, no oedema) (21) 3.7% ( % CI) (21) 4.2% ( % CI) (7) 1.6% ( % CI) Prevalence of severe malnutrition (<MUAC < 115 and/or oedema)* (7) 1.2% ( % CI) (1) 0.2% ( % CI) (2) 0.5% ( % CI) *No cases of oedema were identified in any of the domains

33 Deaths per 10,000/Day Crude and Under Five Death Rate Northern Yobe South Yobe (A) South Yobe (B) Central Yobe MMC/Jere Southern Borno North Borno Central Borno Old Maiduguri Konduga Ngala CMR U5MR

34 Crude and Under Five Death Rate Yobe Northern Yobe n = 637 South Yobe (A) n = 696 South Yobe (B) n = 562 Central Yobe n = 780 Crude Death Rate (total deaths / 10,000 people / day) 1.02 ( % CI) 0.92 ( % CI) 0.89 ( % CI) 1.14 ( % CI) Under Five Death Rate (deaths in children under five/ 10,000 children under five / day) 2.63 ( % CI) 2.28 ( % CI) 1.73 ( % CI) 2.49 ( % CI)

35 Crude and Under Five Death Rate Borno MMC/Jere n = 641 Southern Borno n = 598 North Borno n = 332 Central Borno n = 505 Crude Death Rate (total deaths / 10,000 people / day) 0.85 ( % CI) 0.56 ( % CI) 1.35 ( % CI) 1.36 ( % CI) Under Five Death Rate (deaths in children under five/ 10,000 children under five / day) 1.45 ( % CI) 1.96 ( % CI) 2.22 ( % CI) 2.60 ( % CI)

36 Crude and Under Five Death Rate Borno (Small area surveys) Old Maiduguri n = 598 Konduga n = 537 Ngala n = 493 Crude Death Rate (total deaths / 10,000 people / day) 1.58 ( % CI) 1.04 ( % CI) 1.56 ( % CI) Under Five Death Rate (deaths in children under five/ 10,000 children under five / day) 3.24 ( % CI) 1.87 ( % CI) 4.16 ( % CI)

37 Results NUTRITION WOMEN AGED YEARS

38 Prevalence of Acute Malnutrition in Women aged years by MUAC, by Age and State years N=1038 Age Group years N=3951 Borno N=2371 State Yobe N= mm < 214 mm 221 mm < 214 mm 221 mm < 214 mm 221 mm < 214 mm Prevalence [95% Confidence Interval] [22.4,31.5] [11.9,18.3] [5.5,8.1] [2.4,3.8] [7.9,11.5] [3.9,6.5] [10.5,13.6] [5.2,7.7]

39 Prevalence of Acute Malnutrition in Women aged years by MUAC, Borno State Domain Prevalence [95% Confidence Interval] Northern Borno N= 364 Southern Borno N=727 Central Borno N=525 MMC/Jere N= mm < 214mm 221mm < 214mm 221mm < 214mm 221mm < 214mm [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]

40 Prevalence of Acute Malnutrition in Women aged years by MUAC, Yobe State Domain Central Yobe N=718 Southern Yobe (9a) N=738 Southern Yobe (9b) N=580 Northern Yobe N= mm < 214mm 221mm < 214mm 221mm < 214mm 221mm < 214mm Prevalence [95% Confidence Interval] [ ] [ ] [ ] [ ] [ ] [ ] [ ] [ ]

41 Dietary Diversity among Women aged 15-49, by Age Group and State Percent Meeting Minimum Dietary Diversity for Women of Reproductive Age (MDD-W)* Percent Consuming Iron Rich Foods Yesterday Age Group State years N= years N=3078 Borno N=1768 Yobe N=1984 % [95% CI] % [95% CI] %[95% CI] %[95% CI] 36.5 [31.1,42.4] 50.2 [44.1,56.3] 35.7 [32.3,39.4] 47.6 [43.2,52.1] 41.6 [36.5,47.0] 53.1 [47.0,59.1] 31.2 [26.8,36.0] 40.2 [34.9,45.7] Consuming Vitamin A Rich Foods Yesterday 67.8 [61.9,73.3] 64.8 [60.5,68.9] 62.3 [56.7,67.6] 70.5 [65.7,75.0] Mean number of food groups consumed yesterday (of 10) 4.1 [3.9,4.3] 4.1 [4.0,4.2] 4.2 [4.1,4.4] 3.9 [3.7,4.0]

42 Dietary Diversity among Women aged by Domain, Borno State Percent Meeting Minimum Dietary Diversity for Women of Reproductive Age (MDD-W)* Percent Consuming Iron Rich Foods Yesterday Consuming Vitamin A Rich Foods Yesterday Mean number of food groups consumed yesterday (of 10) Northern Borno Southern Borno Central Borno MMC/Jere N= N=427 N=535 % [95% CI] % [95% CI] %[95% CI] %[95% CI] 33.8 [23.7,45.6] 53.8 [41.0,66.2] 61.5 [49.3,72.5] 4.0 [3.7,4.2] 49.4 [40.1,58.7] 56.4 [45.7,66.5] 61.8 [53.4,69.6] 4.5 [4.2,4.7] 34.9 [25.8,45.1] 48.0 [37.3,58.9] 62.9 [50.7,73.6] 4.1 [3.8,4.3] 39.5 [31.4,48.1] 53.0 [43.1,62.6] 62.4 [52.7,71.1] 4.1 [3.9,4.4]

43 Dietary Diversity among Women aged by Domain, Yobe State Percent Meeting Minimum Dietary Diversity for Women of Reproductive Age (MDD-W)* Percent Consuming Iron Rich Foods Yesterday Central Yobe Southern Yobe (9a) Southern Yobe (9b) Northern Yobe N=519 N=530 N=477 N=458 % [95% CI] % [95% CI] %[95% CI] %[95% CI] 27.0 [19.7,35.8] 38.3 [27.2,50.7] 40.1 [32.0,48.8] 46.2 [38.2,54.4] 29.5 [21.3,39.2] 31.6 [23.9,40.3] 19.7 [13.3,28.2] 34.3 [23.8,46.6] Consuming Vitamin A Rich Foods Yesterday 74.9 [67.2,81.4] 65.7 [56.4,74.0] 76.9 [66.2,85.0] 71.5 [62.4,79.2] Mean number of food groups consumed yesterday (of 10) 3.8 [3.4,4.1] 4.2 [3.9,4.4] 3.4 [3.2,3.7] 3.8 [3.5,4.1]

44 Results NUTRITION INFANT AND YOUNG CHILD FEEDING

45 Dietary Diversity among Children aged 6-23 months, by Sex and State Percent achieving minimum 4.6 dietary diversity a [3.0,7.1] Percent achieving minimum 8.3 meal frequency b [6.4,10.6] Percent achieving minimum 0.6 acceptable diet c [0.2,1.7] Sex State Male Female Borno Yobe N=192 N=165 N=667 N=865 % [95% CI] % [95% CI] % [95% CI] % [95% CI] 2.6 [1.5,4.3] 6.4 [4.6,8.8] 0.2 [0.0,1.2] 3.8 [2.2,6.3] 7.3 [5.2,10.3] 0.4 [0.1,1.7] 3.5 [2.2,5.7] 7.4 [5.4,10.0] 0.4 [0.1,1.3] a Minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-a rich fruits and vegetables, and 7) other fruits and vegetables. b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times. c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while it for non-breastfed children further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without counting milk feeds.

46 Dietary Diversity among Children aged 6-23 months by Domain, Borno State Domain Northern Borno Southern Borno Central Borno MCC & Jere N=104 N=193 N=164 N=206 % [95% CI] % [95% CI] % [95% CI] % [95% CI] Percent achieving minimum dietary diversity a 2.4 [0.4,13.4] 4.1 [1.7,9.3] 2.5 [0.8,7.3] Percent achieving minimum meal frequency b [3.3,17.0] [7.2,17.5] [2.9,10.2] Percent achieving minimum acceptable diet c [1.9,9.2] 5.3 [2.5,11.1] 1 [0.2,3.9] a Minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-a rich fruits and vegetables, and 7) other fruits and vegetables. b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times. c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while it for non-breastfed children further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without counting milk feeds.

47 Dietary Diversity among Children aged 6-23 months by Domain, Yobe State Percent achieving minimum 2.2 dietary diversity a [0.9,5.4] Percent achieving minimum 4.3 meal frequency b [2.4,7.7] Percent achieving minimum 0 acceptable diet c Domain Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) N=253 N=230 N=193 N=189 % [95% CI] % [95% CI] % [95% CI] % [95% CI] 5.6 [2.8,11.0] 10.4 [6.5,16.4] 0.9 [0.2,3.2] 1.3 [0.3,5.0] 5.7 [3.1,10.1] 4.4 [1.8,10.1] 7.9 [4.1,14.9] 0.5 [0.1,3.7] a Minimum dietary diversity is defined as receiving foods from at least 4 of 7 food groups: 1) Grains, roots and tubers, 2) legumes and nuts, 3) dairy products (milk, yogurt, cheese), 4) flesh foods (meat, fish, poultry and liver/organ meats), 5) eggs, 6) vitamin-a rich fruits and vegetables, and 7) other fruits and vegetables. b Minimum meal frequency among currently breastfeeding children is defined as children who also received solid, semi-solid, or soft foods 2 times or more daily for children age 6-8 months and 3 times or more daily for children age 9-23 months. For non-breastfeeding children age 6-23 months it is defined as receiving solid, semi-solid or soft foods, or milk feeds, at least 4 times. c The minimum acceptable diet for breastfed children age 6-23 months is defined as receiving the minimum dietary diversity and the minimum meal frequency, while it for non-breastfed children further requires at least 2 milk feedings and that the minimum dietary diversity is achieved without counting milk feeds. 0

48 Ever breastfed and initiation of breastfeeding among children aged 0-59 months, by sex and state Sex State Male Female Borno Yobe N=923 N=946 N=834 N=1035 % [95% CI] % [95% CI] % [95% CI] % [95% CI] Percentage who were ever breastfed 89.8 [87.2,92.0] 92.8 [90.6,94.5] 94.4 [91.9,96.1] 88.8 [85.5,91.4] Percentage who were first breastfed Within one hour of birth 26.8 [22.2,31.9] Within one day of birth 72.4 [67.3,76.9] 31.1 [26.3,36.3] 68.4 [63.2,73.2] 33.2 [26.5,40.5] 66.3 [58.9,72.9] 25.3 [20.2,31.1] 73.9 [68.2,79.0]

49 Ever breastfed and initiation of breastfeeding among children aged 0-59 months, by age Age in months N=486 N=530 N=853 % [95% CI] % [95% CI] % [95% CI] Percentage who were ever breastfed 95.1 [92.4,96.9] 96.7 [94.6,98.0] 86.5 [82.9,89.4] Percentage who were first breastfed Within one hour of birth Within one day of birth 36.6 [30.8,42.8] 63.0 [56.8,68.8] 30.2 [25.0,36.0] 69.0 [63.2,74.2] 23.9 [19.3,29.2] 75.3 [70.0,79.9]

50 Ever breastfed and initiation of breastfeeding among children aged 0-59 months by domain, Borno State Domain Northern Borno Southern Borno Central Borno MCC & Jere N=128 N=241 N=212 N=253 % [95% CI] % [95% CI] % [95% CI] % [95% CI] Percentage who were ever breastfed 92.1 [86.0,95.6] 93.4 [88.1,96.4] 94.6 [89.5,97.3] 95.1 [90.5,97.6] Percentage who were first breastfed Within one hour of birth Within one day of birth 26.6 [13.5,45.6] 72.7 [53.5,86.0] 38.2 [25.1,53.2] 61.8 [46.8,74.9] 33.5 [22.8,46.2] 65.6 [53.1,76.2] 29.6 [20.2,41.2] 69.6 [58.0,79.1]

51 Ever breastfed and initiation of breastfeeding among children aged 0-59 months by domain, Yobe State Percentage who were ever breastfed Central Yobe Domain Southern Yobe (A) Northern Yobe Southern Yobe (B) N=284 N=275 N=240 N=236 % [95% CI] % [95% CI] % [95% CI] % [95% CI] 91 [84.4,95.0] 85.4 [79.0,90.1] 90.6 [85.8,93.8] 93.3 [87.8,96.4] Percentage who were first breastfed Within one hour of birth Within one day of birth 16.9 [9.9,27.3] 81.7 [71.8,88.7] 32.7 [23.2,43.9] 67.3 [56.1,76.8] 18.8 [11.1,29.9] 79.6 [68.6,87.4] 35.2 [23.3,49.2] 64.8 [50.8,76.7]

52 Exclusive and Predominant Breastfeeding among Children 0-5 months, by Sex & State Percent exclusively breastfed Sex State Male Female Borno Yobe N=241 N=270 N=221 N=290 % [95% CI] % [95% CI] % [95% CI] % [95% CI] 29.8 [23.3,37.3] 29.1 [23.3,35.6] 19.9 [13.7,28.1] 37.0 [29.8,44.8] Percent predominantly breastfed a 93.8 [89.5,96.4] 95.4 [91.2,97.6] 93.5 [87.6,96.7] 95.5 [92.4,97.4] a Predominantly breastfed includes children currently breastfeeding who are either exclusively breastfed or receiving plain water and non-milk liquids only

53 Exclusive and Predominant Breastfeeding among Children 0-5 months by Domain, Borno State Percent exclusively breastfed Domain Northern Borno Southern Borno Central Borno MCC & Jere N=35 N=65 N=61 N=60 % [95% CI] % [95% CI] % [95% CI] % [95% CI] 20.0 [7.3,44.4] Percent predominantly breastfed* [22.5,50.8] 95.4 [82.0,98.9] 13.1 [6.7,24.1] 93.4 [80.5,98.0] 11.7 [3.7,31.1] 91.7 [79.2,96.9] a Predominantly breastfed includes children currently breastfeeding who are either exclusively breastfed or receiving plain water and non-milk liquids only

54 Exclusive and Predominant Breastfeeding among Children 0-5 months by Domain, Yobe State Percent exclusively breastfed Percent predominantly breastfed* Domain Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) N=62 N=92 N=72 N=64 % [95% CI] % [95% CI] % [95% CI] % [95% CI] [21.4,49.0] [29.5,54.2] [24.1,53.2] [11.0,34.4] 91.9 [82.8,96.4] 97.8 [92.2,99.4] 94.4 [83.9,98.2] 95.3 [87.3,98.4] a Predominantly breastfed includes children currently breastfeeding who are either exclusively breastfed or receiving plain water and non-milk liquids only

55 Continued Breastfeeding at One and Two Years of Age, by Sex and State Sex State Male Female Borno Yobe % [95% CI] % [95% CI] % [95% CI] % [95% CI] Continued breastfeeding at 1 year (12-15 months) 86.8 [79.2,91.9] 88.4 [82.2,92.7] 87.6 [80.3,92.4] 87.6 [79.7,92.7] Number of children months Continued breastfeeding at 2 years (20-23 months) 27.1 [20.2,35.3] 16.8 [10.9,24.9] 20.0 [13.3,29.1] 24.0 [17.4,32.0] Number of children months

56 Continued Breastfeeding at One and Two Years of Age by Domain, Borno State Domain* Northern Borno Southern Borno Central Borno MCC & Jere % [95% CI] % [95% CI] % [95% CI] % [95% CI] Continued breastfeeding at 1 year (12-15 months) [73.3,95.1] 92.7 [80.4,97.5] 83.3 [68.8,91.9] Number of children months Continued breastfeeding at 2 years (20-23 months) 33.3 [16.3,56.2] 20.7 [10.0,37.9] 28.6 [13.4,50.8] 15.8 [7.4,30.6] Number of children months * Data should be interpreted with a note of caution given small sample size of children in age range

57 Continued Breastfeeding at One and Two Years of Age by Domain, Yobe State Domain Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) % [95% CI] % [95% CI] % [95% CI] % [95% CI] Continued breastfeeding at 1 year (12-15 months) 88.3 [77.4,94.4] 87.9 [69.2,95.9] 84 [66.7,93.2] 92.9 [75.4,98.2] Number of children months Continued breastfeeding at 2 years (20-23 months) 22.4 [11.5,39.3] 26.3 [16.0,40.0] 21.4 [10.0,40.2] 27.3 [15.4,43.5] Number of children months

58 Percentage of infants age 6-8 months who received solid, semi- solid, or soft foods during the previous day, by sex and state Sex State Male Female Borno Yobe % [95% CI] % [95% CI] % [95% CI] % [95% CI] Percent receiving solid, semi-solid or soft foods 52.3 [41.5,62.9] 49.9 [40.3,59.6] 57.9 [46.1,68.9] 44.8 [35.1,55.0] Number of children age 6-8 months

59 Percentage of infants age 6-8 months who received solid, semi-solid, or soft foods during the previous day by domain, Borno State Domain* Northern Borno Southern Borno Central Borno MCC & Jere % [95% CI] % [95% CI] % [95% CI] % [95% CI] Percent receiving solid, semi-solid or soft foods 58.6 [31.3,81.5] 77.8 [54.9,91.0] 40.7 [23.6,60.5] 55.6 [36.8,72.8] Number of children age 6-8 months * Data should be interpreted with a note of caution given small sample size of children in age range

60 Percentage of infants age 6-8 months who received solid, semi-solid, or soft foods during the previous day by domain, Yobe State Domain* Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) % [95% CI] % [95% CI] % [95% CI] % [95% CI] Percent receiving solid, semi-solid or soft foods 37.2 [22.7,54.4] 51.4 [32.6,69.7] 41.4 [23.2,62.2] 50 [35.7,64.3] Number of children age 6-8 months * Data should be interpreted with a note of caution given small sample size of children in age range

61 Results VACCINATION RATES MEASLES AND POLIO

62 Percentage of children aged months vaccinated against measles, by state Borno Measles Vaccination (Total) a 80.3 [74.9,84.8] State Yobe % [95% CI] % [95% CI] 65.0 [57.4,71.8] Measles Vaccination (Vaccination Card Seen) 33.8 [27.1,41.1] 34.7 [28.4,41.6] Number of children age months a Total includes vaccination as verified by vaccination card or by self-report from a caregiver

63 Percentage of children aged months vaccinated against measles by domain, Borno State Domain Northern Borno Southern Borno Central Borno MCC & Jere % [95% CI] % [95% CI] % [95% CI] % [95% CI] Measles Vaccination (Total) a 73.3 [52.6,87.2] 76.9 [64.2,86.1] 78.9 [66.1,87.7] 83.9 [77.3,88.9] Measles Vaccination (Vaccination Card Seen) 48.6 [28.6,69.0] 42.3 [29.7,56.1] 36.8 [23.8,52.0] 25.1 [16.5,36.4] Number of children age months a Total includes vaccination as verified by vaccination card or by self-report from a caregiver

64 Percentage of children aged months vaccinated against measles by domain, Yobe State Measles Vaccination (Total) a 67.1 [52.4,79.1] Measles Vaccination (Vaccination Card Seen) Number of children age months Domain Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) % [95% CI] % [95% CI] % [95% CI] % [95% CI] 38.3 [25.3,53.2] 65.3 [52.8,75.9] 30.2 [21.8,40.0] 67.1 [50.3,80.5] 43.5 [29.3,58.9] 49.9 [35.1,64.7] 19.3 [10.8,32.0] a Total includes vaccination as verified by vaccination card or by self-report from a caregiver

65 Percentage of children aged months vaccinated against measles, by age category and state Children aged months Measles Vaccination (Total) Measles Vaccination (Vaccination Card Seen) State Borno Yobe % [95% CI] % [95% CI] [70.5,83.0] [51.9,67.8] [24.6,39.4] [28.1,44.2] Children aged months Number of children age months Measles Vaccination (Total) Measles Vaccination (Vaccination Card Seen) Number of children age months [76.0,85.8] 34.5 [27.5,42.2] 66.7 [59.0,73.6] 34.3 [28.0,41.3]

66 Percentage of children aged months vaccinated against measles, by age category and domain, Borno State Children aged months Children aged months Domain Northern Borno Southern Borno Central Borno MCC & Jere % [95% CI] % [95% CI] % [95% CI] % [95% CI] Measles Vaccination (Total) [63.7,93.7] [62.5,87.5] [56.0,84.0] [71.2,86.4] Measles Vaccination (Vaccination Card Seen) [31.1,76.2] [31.0,60.3] [19.8,48.8] [11.3,29.0] Number of children age months Measles Vaccination (Total) Measles Vaccination (Vaccination Card Seen) 70.4 [48.8,85.6] 46.9 [27.3,67.5] 76.8 [63.8,86.1] 41.3 [28.3,55.5] 81.2 [68.4,89.6] 38.3 [24.4,54.3] 85.3 [79.0,89.9] 27.3 [17.7,39.4] Number of children age months

67 Percentage of children aged months vaccinated against measles, by age category and domain, Yobe State Children aged months Children aged months Measles Vaccination (Total) Measles Vaccination (Vaccination Card Seen) Domain Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) % [95% CI] % [95% CI] % [95% CI] % [95% CI] [49.2,77.5] 35.4 [21.5,52.2] [43.3,70.0] 33.8 [21.5,48.7] [47.5,78.2] 47.6 [32.7,63.0] [31.3,63.2] 15.9 [9.5,25.6] Number of children age months Measles Vaccination (Total) Measles Vaccination (Vaccination Card Seen) 68.0 [53.0,80.0] 39.4 [26.1,54.3] 68.4 [55.7,78.9] 28.8 [21.0,38.0] 68.1 [50.6,81.7] 42.1 [27.4,58.4] 50.9 [35.5,66.0] 20.3 [11.0,34.6] Number of children age months

68 Percentage of children aged 0-59 months vaccinated against polio, by state Borno State Yobe % [95% CI] % [95% CI] Polio Vaccination (Total) a 95.1 [92.8,96.7] 86.6 [82.3,90.0] Polio Vaccination (Vaccination Card Seen) 15.2 [10.9,20.8] 11.8 [8.2,16.6] Number of children age 0-59 months a Total includes vaccination as verified by vaccination card or by self-report from a caregiver

69 Percentage of children aged 0-59 months vaccinated against polio by domain, Borno State Domain Northern Borno Southern Borno Central Borno MCC & Jere % [95% CI] % [95% CI] % [95% CI] % [95% CI] Polio Vaccination (Total) 94.9 [90.0,97.5] 97.1 [95.4,98.2] 93.5 [86.9,96.9] 94.4 [89.7,97.1] Polio Vaccination (Vaccination Card Seen) 13.4 [3.9,37.2] 18.4 [10.6,30.0] 22 [11.3,38.4] 9.3 [5.3,16.0] Number of children age 0-59 months

70 Percentage of children aged 0-59 months vaccinated against polio by domain, Yobe State Domain Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) % [95% CI] % [95% CI] % [95% CI] % [95% CI] Polio Vaccination (Total) 92.7 [87.9,95.7] 82.4 [73.1,89.0] 88.2 [77.7,94.2] 79.9 [69.1,87.6] Polio Vaccination (Vaccination Card Seen) 9.0 [3.4,21.8] 14.1 [9.1,21.4] 11.3 [4.5,25.4] 12.2 [6.1,23.1] Number of children age 0-59 months

71 Percentage of children aged 0-59 months vaccinated against polio, by state and age category Children aged 0-5 months State Borno Yobe % [95% CI] % [95% CI] Polio Vaccination (Total) 69.8 [61.6,76.8] 48.2 [39.4,57.1] Polio Vaccination (Vaccination Card Seen) 18.2 [11.7,27.1] 7.8 [4.6,12.8] Number of children age 0-5 months Children aged 6-23 months Polio Vaccination (Total) 96.1 [92.1,98.1] 89.4 [84.4,92.9] Polio Vaccination (Vaccination Card Seen) 14.6 [9.9,21.0] 11.4 [7.5,16.9] Number of children age 6-23 months Children aged months Polio Vaccination (Total) 98.9 [97.0,99.6] 92.3 [88.0,95.1] Polio Vaccination (Vaccination Card Seen) 15.0 [10.5,20.9] 12.8 [8.8,18.1] Number of children age months

72 Percentage of children aged 0-59 months vaccinated against polio, by domain and age category, Borno State Children aged 0-5 months Domain Northern Borno Southern Borno Central Borno MCC & Jere % [95% CI] % [95% CI] % [95% CI] % [95% CI] Polio Vaccination (Total) 60.0 [32.7,82.2] 76.9 [65.9,85.2] 68.9 [54.1,80.6] 65.0 [48.9,78.3] Polio Vaccination (Vaccination Card Seen) 8.6 [1.9,30.9] 15.4 [6.8,31.2] 24.6 [10.9,46.4] 16.7 [8.0,31.6] Number of children age 0-5 months Children aged 6-23 months Polio Vaccination (Total) 98.1 [92.7,99.5] 99.5 [96.2,99.9] 93.9 [78.0,98.5] 94.7 [88.1,97.7] Polio Vaccination (Vaccination Card Seen) 10.6 [2.5,35.1] 19.7 [11.0,32.7] 22.6 [10.5,42.0] 6.8 [3.2,13.7] Number of children age 6-23 months Children aged months Polio Vaccination (Total) 99.5 [96.4,99.9] 99.5 [96.3,99.9] 98.3 [91.7,99.7] 98.8 [93.9,99.8] Polio Vaccination (Vaccination Card Seen) 15.8 [4.4,43.6] 18.3 [10.2,30.7] 21.1 [10.6,37.6] 9.5 [5.0,17.2] Number of children age months

73 Percentage of children aged 0-59 months vaccinated against polio, by domain and age category, Yobe State Children aged 0-5 months Domain Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) % [95% CI] % [95% CI] % [95% CI] % [95% CI] Polio Vaccination (Total) 50.0 [34.7,65.3] 53.3 [38.9,67.1] 41.7 [25.4,59.9] 32.8 [19.1,50.2] Polio Vaccination (Vaccination Card Seen) 6.5 [1.5,23.2] 9.8 [4.9,18.5] 5.6 [1.6,17.4] 6.3 [1.5,22.9] Number of children age 0-5 months Children aged 6-23 months Polio Vaccination (Total) 96.0 [92.2,98.0] 83.9 [71.9,91.4] 94.3 [86.2,97.8] 78.8 [65.0,88.2] Polio Vaccination (Vaccination Card Seen) 8.3 [3.1,20.3] 13.5 [7.2,23.8] 11.9 [4.9,26.1] 11.6 [5.5,22.9] Number of children age 6-23 months Children aged months Polio Vaccination (Total) 96.6 [90.4,98.8] 88.3 [78.7,93.9] 94.1 [80.5,98.4] 89.2 [78.6,94.9] Polio Vaccination (Vaccination Card Seen) 9.7 [3.6,23.3] 15.5 [10.0,23.2] 12.1 [4.5,28.6] 13.7 [6.7,25.7] Number of children age months

74 Number of doses of polio vaccination received among children 0-59 months, by state State Borno Yobe % [95% CI] % [95% CI] Zero Doses 4.9 [3.3,7.2] 13.1 [9.7,17.4] One Dose 2.0 [1.4,3.1] 6.5 [5.0,8.6] Two Doses 7.9 [6.2,10.0] 12.3 [10.1,14.8] Three or More Doses 84.0 [80.1,87.3] 66.6 [61.3,71.5] Unknown Number of Doses 1.2 [0.6,2.4] 1.5 [0.9,2.7] Number of Children 0-59 months Among children who reported receipt of zero doses, percent reporting displacement in the past year 25.4 [12.5,44.7] 4.1 [2.1,7.9] Number of children with zero doses

75 Number of doses of polio vaccination received among children 0-59 months by domain, Borno State Domain Northern Borno Southern Borno Central Borno MCC & Jere % [95% CI] % [95% CI] % [95% CI] % [95% CI] Zero Doses 5.1 [2.5,10.0] 2.9 [1.8,4.6] 6.5 [3.1,13.1] 5.6 [2.9,10.3] One Dose 3.0 [1.5,6.0] 1.1 [0.5,2.5] 2.5 [1.2,5.3] 2.4 [1.3,4.5] Two Doses 9.3 [4.8,17.1] 6.9 [4.4,10.6] 4.4 [2.7,7.2] 10.4 [7.3,14.5] Three or More Doses 79.1 [67.7,87.3] 87.2 [81.0,91.6] 86.2 [80.0,90.7] 80.8 [73.0,86.7] Unknown Number of Doses 3.6 [0.9,12.8] 1.9 [0.6,5.8] 0.4 [0.1,2.8] 0.9 [0.3,2.7] Number of Children 0-59 months Among children reporting receipt of zero doses, 29.4 [8.0,66.6] 11.1 [2.4,38.4] 44.1 [14.2,79.0] 18.9 [10.2,32.4] percent reporting displacement in the past year Number of children with zero doses

76 Number of doses of polio vaccination received among children 0-59 months by domain, Yobe State Domain Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) % [95% CI] % [95% CI] % [95% CI] % [95% CI] Zero Doses 6.9 [4.0,11.8] 17.3 [10.9,26.5] 11.4 [5.6,22.1] 19.6 [12.2,29.9] One Dose 5.8 [3.2,10.3] 6.0 [3.6,9.9] 8.9 [5.9,13.4] 5.5 [3.3,9.1] Two Doses 10.5 [6.9,15.8] 12.9 [9.5,17.1] 12.1 [7.6,18.6] 16.1 [12.0,21.2] Three or More Doses 74.6 [64.7,82.5] 62.4 [53.1,70.8] 66.5 [54.9,76.3] 57.8 [46.5,68.3] Unknown Number of Doses 2.2 [0.8,5.5] 1.4 [0.5,3.6] 1.1 [0.3,3.6] 1.0 [0.3,3.8] Number of Children 0-59 months Among children reporting receipt of zero doses, percent reporting displacement in the past year [0.2,11.4] 2.7 [0.9,8.0] 21.4 [8.9,43.1] Number of children with zero doses

77 Results FOOD DISTRIBUTIONS

78 Percentage of children aged 0-59 months in households enrolled in a food distribution program, by age Age in months % [CI] N [4.1,10.6] [7.3,17.6] [5.4,12.5] [7.1,14.5] [6.5,13.7] [6.0,13.9] 862

79 Percentage of children aged 0-59 months in households enrolled in a food distribution program, by sex and state Sex Male Female State Borno Yobe % [CI] N 8.9 [6.3,12.3] 9.7 [6.6,14.0] 13.3 [8.7,20.0] 5.8 [3.1,10.7]

80 Percentage of children aged 0-59 months in households enrolled in a food distribution program, by domain Northern Borno Southern Borno Central Borno MCC & Jere Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) % [CI] N 27.5 [12.5,50.0] [1.1,5.3] [18.8,51.0] [4.1,22.8] [3.6,25.3] [0.5,2.7] [1.3,21.0] [6.0,25.1] 597

81 Percentage of Households who Received CSB by State Households who received CSB Borno State Yobe % [CI] % [CI] 2.3 [1.1,4.6] 1.2 [0.5,3.2] Number of Households

82 Percentage of Households who Received CSB by Domain - Borno Domain Northern Borno Southern Borno Central Borno MMC/Jere % [CI] % [CI] % [CI] % [CI] Households who received CSB 10.3 [3.3,27.4] 0.5 [0.2,1.5] 1.7 [0.7,3.8] 3.5 [1.2,10.0] Number of Households

83 Percentage of Households who Received CSB by Domain - Yobe Domain Central Yobe Southern Yobe (9a) Southern Yobe (9b) Northern Yobe % [CI] % [CI] % [CI] % [CI] Households who received CSB 0.6 [0.3,1.6] 1.9 [0.4,8.3] 1 [0.3,3.1] 0.7 [0.3,1.7] Number of Households

84 Results VITAMIN A, ANTHELMINTHIC DRUGS, AND MICRONUTRIENT POWDERS

85 Percentage of Households Receiving MNCHW Services in an Area by State State Borno Yobe % [95% CI] % [95% CI] Percentage of HHs who lived in an area where there was a MNCHW campaign 45.1 [37.3,53.2] 35.6 [28.2,43.8] Percentage of HHs who received some services during a MNCHW campaign 31.8 [25.8,38.5] 26.0 [20.5,32.5] Number of HHs At a health facility [4.7,20.8] [16.5,39.9] Households who received some services during a MNCHW campaign, At another site [68.8,91.3] [41.6,68.1] location: At their own house [1.8,23.7] [9.9,31.2] Number of households receiving some services during a MNCHW campaign

86 Percentage of Households Receiving MNCHW Services in an Area by Domain - Borno Domain Northern Borno Southern Borno Central Borno MMC/Jere % [95% CI] % [95% CI] % [95% CI] % [95% CI] Percentage of HHs who lived in an area where there was a MNCHW campaign 50.0 [31.6,68.4] 49.7 [36.7,62.7] 38.5 [24.4,55.0] 45.3 [32.3,58.9] Percentage of HHs who received some services during a MNCHW campaign 30.5 [19.3,44.7] 38.5 [28.2,49.9] 27.4 [17.2,40.7] 29.5 [19.8,41.5] Number of HHs Households who At a health facility [7.3,55.3] [1.9,22.0] [0.5,26.7] [4.9,41.4] received some services during a MNCHW campaign, location: At another site 73.8 [43.6,91.1] 85.7 [64.4,95.2] 95.9 [73.3,99.5] 73.1 [44.5,90.3] At their own house Number of households receiving some services during a MNCHW campaign 2.5 [0.6,10.0] 7.4 [1.2,33.8] [1.5,50.1]

87 Percentage of Households Receiving MNCHW Services in an Area by Domain - Yobe Domain Central Yobe Southern Yobe (9a) Southern Yobe (9b) Northern Yobe % [95% CI] % [95% CI] % [95% CI] % [95% CI] Percentage of HHs who lived in an area where there was a MNCHW campaign 41.4 [27.0,57.5] 29.5 [18.4,43.8] 23.3 [12.7,38.9] 44.2 [28.9,60.7] Percentage of HHs who received some services during a MNCHW campaign 30.9 [20.1,44.2] 22.4 [14.0,33.9] 16.2 [9.0,27.5] 30.4 [19.6,43.9] Number of HHs Households who received At a health facility [10.5,53.0] [26.2,72.7] [0.8,37.6] [0.5,9.0] some services during a MNCHW campaign, location: At another site 53.4 [30.0,75.4] 40.6 [19.7,65.6] 87.2 [58.8,97.0] 68.7 [42.4,86.8] At their own house Number of households receiving some services during a MNCHW campaign 19.9 [6.4,47.6] 10.1 [2.3,35.0] 6.4 [0.8,35.9] 29.0 [11.4,56.3]

88 Percentage of children receiving Vitamin A, anthelminthic drug, and micronutrient powders (MNP) in the past 6 months, by sex & age Sex Male Female Age in months Children age 6-59 months given Vitamin A Children age months given an anthelminthic drug Children age 6-23 months given micronutrient powders (MNP) % [CI] N % [CI] N % [CI] N 56.0 [50.2,61.8] 57.3 [51.4,63.0] 47.6 [41.3,54.0] 55.8 [49.2,62.1] 58.5 [52.4,64.3] 59.1 [52.6,65.3] 58.5 [51.7,65.0] [14.9,22.9] 20.2 [16.1,25.1] [12.5,21.1] 20.1 [16.0,25.0] 19.7 [15.5,24.8] 21.7 [17.3,27.0] [0.6,2.5] 1.5 [0.6,3.9] 1.0 [0.3,3.3] 1.6 [0.8,3.1]

89 Percentage of children receiving Vitamin A, anthelminthic drug, and micronutrient powders (MNP) in the past 6 months, by domain Domain Northern Borno Southern Borno Central Borno MCC & Jere Central Yobe Southern Yobe (A) Northern Yobe Southern Yobe (B) Children age 6-59 months given Vitamin A Children age months given an anthelminthic drug Children age 6-23 months given micronutrient powders (MNP) % [CI] N % [CI] N % [CI] N [32.5,71.5] [13.5,42.9] [0.1,7.0] [59.7,83.6] [11.9,29.8] [46.7,77.1] [7.9,27.1] [0.3,4.8] [44.6,73.7] [10.5,26.9] [0.3,3.5] [42.9,71.4] [14.3,39.4] [0.8,8.9] [26.5,49.8] [9.8,28.8] [0.4,10.6] [46.2,77.0] [16.4,41.8] [0.1,3.7] [27.4,58.2] [3.7,10.8] [0.1,7.2] 189

90 Percent of children with acute malnutrition enrolled into a treatment or cash transfer program, by sex, age and state a Number of children age 0-59 months diagnosed with severe acute malnutrition b : Enrolled in a Enrolled in a cash treatment program transfer program Number of children age 6-59 months diagnosed with moderate acute malnutrition c : Enrolled in a treatment Enrolled in a cash Number program transfer program % [CI] % [CI] % [CI] % [CI] Sex Male 8.4 [3.6,18.3] 1.7 [0.2,11.4] [8.6,27.7] 2.3 [0.4,10.9] 87 Female 5.4 [1.6,16.7] 4.4 [1.4,13.0] [2.2,15.9] 9.4 [3.9,21.2] 87 Age in months [3.2,16.9] 2.8 [0.8,9.4] [6.5,20.7] 6.1 [2.3,15.0] [2.1,30.4] 4.9 [0.7,28.6] [2.5,22.4] 5.3 [1.3,18.9] 42 State Borno 6.4 [2.4,16.0] 2.1 [0.3,12.7] [5.1,24.1] 5.2 [1.6,15.5] 67 Number Yobe 7.5 [2.8,18.7] 3.6 [1.0,11.9] [5.2,20.1] 6.4 [2.2,17.3] 107 a Domain level estimates not presented given small sample of children eligible for the question b Severe Acute Malnutrition includes children with Mid-upper arm circumference < 115mm, weight-for-height z-scores <-3, and/or bilateral oedema c Moderate Acute Malnutrition includes children with Mid-upper arm circumference >=115 and < 125mm

91 Results HEALTH DIARRHEA AND ARI

92 Percent of children aged 0-59 months with diarrhea in the previous two weeks who received ORS or Zinc, by sex and state Had diarrhea in the last two weeks Sex State Male Female Borno Yobe % [CI] % [CI] % [CI] % [CI] [26.4,32.1] [24.2,29.6] [26.5,32.8] [23.3,30.4] Number of children age 0-59 months Number of children age 0-59 months with diarrhea in the last two weeks: Oral rehydration salts (ORS) Zinc Both Number of children age 0-59 months with diarrhea in the last two weeks 14.8 [11.6,18.7] 4.2 [2.6,6.7] 2.8 [1.6,5.1] 20.5 [16.5,25.3] 5.8 [3.7,8.9] 3.4 [1.9,6.0] 21.8 [16.7,28.0] 6.5 [4.1,10.1] 4.6 [2.7,7.5] 13.5 [10.1,17.8] 3.5 [2.2,5.5] 1.7 [0.9,3.3]

93 Percent of children aged 0-59 months with diarrhea in the previous two weeks who received ORS or Zinc, by age group Had diarrhea in the last two weeks Age in months % [CI] % [CI] % [CI] % [CI] % [CI] % [CI] 14.8 [11.5,19.0] 36.3 [31.4,41.5] 38.2 [33.9,42.6] 28.4 [25.0,32.0] 25.6 [22.1,29.5] 21 [17.9,24.4] Number of children age 0-59 months Number of children age 0-59 months with diarrhea in the last two weeks: Oral rehydration salts (ORS) Zinc Both Number of children age 0-59 months with diarrhea in the last two weeks 7.0 [2.1,21.2] 2.3 [0.5,10.6] 0.2 [0.0,1.5] 18.2 [13.0,24.9] 4.9 [2.1,10.8] 2.9 [0.9,9.2] [13.2,23.4] [12.9,23.7] [3.1,8.0] [2.4,8.8] [1.5,5.4] [1.7,6.9] 20.7 [15.2,27.5] 6.4 [3.7,11.0] 5.2 [2.8,9.5] 16.6 [11.4,23.4] 4.5 [2.0,9.4] 1.8 [0.6,5.1]

94 Percent of children aged 0-59 months with diarrhea in the previous two weeks who received ORS or Zinc, by domain, Borno State Had diarrhea in the last two weeks Domain Northern Borno Southern Borno Central Borno MCC & Jere % [CI] % [CI] % [CI] % [CI] 31.6 [23.1,41.6] 26.1 [21.4,31.5] 30 [23.9,37.0] 31.7 [26.8,37.0] Number of children age 0-59 months Number of children age 0-59 months with diarrhea in the last two weeks: Oral rehydration salts (ORS) Zinc Both Number of children age 0-59 months with diarrhea in the last two weeks 13.2 [7.1,23.3] 8.5 [3.0,21.9] 6.6 [1.9,20.2] 16.6 [9.2,28.0] 4.3 [1.9,9.4] 1.8 [0.6,5.5] 15.9 [9.5,25.5] 3.8 [1.4,10.0] 2.5 [0.6,10.4] 28.4 [19.3,39.8] 9.0 [4.7,16.5] 7.1 [3.8,13.0]