ANTHROPOMETRIC NUTRITIONAL SURVEY

Transcription

1 ANTHROPOMETRIC NUTRITIONAL SURVEY Area of Coverage: Maikona Division Marsabit District (Kenya) 31 st Oct 7 th Nov 2000 Compiled by: Roselyn Owuor (Tearfund Nutritionist Maikona) I

2 Acknowledgement The nutritional survey would not have been a success without the support of the following: Food for the Hungry International, Marsabit, Christian Children Fund (CCF), Marsabit and Maikona, GTZ, Medical officer of health (MOH) Marsabit, MDM Nairobi, MSF-B Nairobi, Tearfund Maikona, Lokochokio and Nairobi. Sincere gratitude to the Public Health Technician and Community nurse in Maikona who assisted by providing us with the Community Health Workers to support us in the exercise. Lastly the relief committees in different locations played a major role in helping the team find its way within the villages. Thank you again SUMMARY OF THE FINDINGS 1.1 BACKGROUND Tearfund conducted a baseline nutritional and health survey in Maikona division, Marsabit district to assess the prevalence of malnutrition within the division. This was with the view of determining the effect of the ongoing drought on the nutritional status of population in Maikona division. 1.2 Objective - To conduct a baseline nutritional survey in Maikona division. - To determine the impact of the drought on the nutritional status of the population especially children below the age of 5years. Specific objectives To assess the nutritional and health status of children below the age of five years To assess the coverage of immunization in the division To find out losses of livestock brought about by the drought since To assess the time taken to reach the nearest water points in different communities and its impact on general livelihood. To find out the coverage the supplementary programme within the division. To assess the quantity of the general ration distributed in different centres in the month of September. To find out the average length of time (months) in which children are exclusively are exclusively breastfed. 1.3 Methodology Two way cluster sampling method was used. 30 clusters consisting of 30 children 65 to 110cm height were sampled within the division. A total of 900 children were assessed. 893 children were analyzed for their nutritional status. The remaining seven did not meet the selection criteria for analysis i.e. 65cm to 110cm in height. Semi-structured interviews were conducted with the parents of the children to get the information required. A one-day training was given to the enumerators. The survey lasted for a period of 9 days. II

3 1.4 Result Indicator Result Population represented Population assessed 900 Population included for analysis 893 Nutritional status (6-59 months) Global Acute malnutrition rate (<-2 z-scores) 25.1% (CI 20.1% %) Severe acute malnutrition rate (<-3 z-scores) 3.9% (CI 2.5% - 5.3%) Global acute malnutrition rate (<80% median) 17.4% (CI 13.5% %) Severe acute malnutrition rate (<70% median) 1.4% (CI 0.36% - 2.4%) Oedema 0.0% MUAC (Mid Upper Arm Circumference) <12.5cm (moderate malnutrition) 15.3% <11.0cm (severe malnutrition) 0.7% Nutritional status (6-24months) Global acute malnutrition rate (<-2 z-scores) 26.6% Severe acute malnutrition rate (<-3 z-scores) 5.3% Global acute malnutrition rate (<80% WFH) 18.1% Severe acute malnutrition rate (<70% WFH) 2.2% MALNUTRITION RATE ACCORDING TO LOCATION Centre Number of children Proportion malnourished (z-scores) Maikona % Kalacha % Huri hills % Elgade % Forolle % Turbi % Burgabo % Bubisa % Suspected vitamin C deficiency Swollen bleeding gums 0.8% Swollen paining joints 2.5% Both 0.2% Total 3.5% III

4 Immunisation coverage BCG 76.8% MEASLES 82.3% POLIO 93.5% VITAMIN A 51.1% Morbidity Diarrhoea 22.2% Respiratory Tract infections 35.5% Fever 16.3% Measles 0.0% UNIMIX in the month of September 85.7% RECOMMENDATION Nutrition - A targeted supplementary feeding programme should be established in Kalacha and Bubisa to curb the high malnutrition levels. - Mothers need to be sensitized on the importance of the appropriate period of complementary feeding. - Feeding practices of the community should be studied at a lower scale to aid in education. - Blanket supplementary feeding programme should continue until sufficient milk is available in the children s diet. - A follow-up nutritional survey should be conducted in 3months period to assess the impact of the current intervention. Immunization - The ministry of health needs to target the far villages in order to have a vast outreach. - These outskirt communities need to be sensitized on the importance of timely immunization. Morbidity - Education on proper hygiene needs to be emphasized. - Education on the cause, treatment and management on the common diseases within the area should be emphasized. Water supply - Areas on the out skirts of Kalacha, Turbi, Forolle and Bubisa will require provision of close water supply. - A more technical assessment needs to be conducted to validate these findings. General ration - The community and the relief committee need to be trained on the importance proper targeting to ensure adequate ration portion per beneficiary. IV

5 - A vulnerability study should be carried out by the experts concerned to find out if there is any change in the level of vulnerability with the continued drought. Livestock situation - An assessment needs to be to ascertain the extent at which the drought has affected the animals. - Mechanisms to curb the existing situation in the health and drought vulnerability of the livestock should be investigated in liaison with livestock expertise. 2.0 Introduction Marsabit district has been adversely affected by the drought that has lasted for the past four seasons. This phenomenon had in the recent past left many people destitute and in need of emergency food. Ongoing relief food activities by WFP and the GOK since September 1999 have greatly helped to relieve the hunger situation in the district. In relation to these activities Tearfund deployed to Maikona division in August 2000 to assist in providing a supplementary ration to the children under the age of five years. Her main operations within the division are community health education and monitoring of the Blanket Supplementary food to children below the age of 5years and pregnant and lactating mothers. To date 4106 beneficiaries are registered in the programme of which 3842 are children below the age of 5years and some vulnerable children above the age of five. The remaining 264 beneficiaries are pregnant and lactating mothers. According to 1999 national census a total of 4202 beneficiaries of the supplementary ration have been targeted by WFP in the current EMOP (phase 2) for Maikona division. Tearfund conducted a baseline nutritional survey in the division to assess the nutritional status of the population. It is important to note that the survey was conducted after 8 months of relief food intervention and 3 months of supplementary food intervention. There are no records of past nutritional status of the population before/during the intervention. 2.1 Objective To conduct a baseline nutritional survey in Maikona division, in order to determine the impact of the drought on the nutritional status of the population. Specific objectives To assess the nutritional and health status of children below the age of five years To assess the coverage of immunization in the division To find out losses of livestock brought about by the drought since To assess the time taken to reach the nearest water points in different communities and its impact on general livelihood. To find out the coverage the supplementary programme within the division. To assess the quantity of the general ration distributed in different centres in the month of September. To find out the average length of time (months) in which children are exclusively are exclusively breastfed. V

6 3.0 Methodology Two way cluster sampling was used. 30 clusters consisting of 30 children 65 to110cm height were sampled. The teams were composed of 4 supervisors and 3 enumerators respectively. A total of 900 children were assessed for their nutritional status. Of these 893 children qualified for analysis. The remaining seven did not meet the selection criteria for analysis i.e. 65cm to 110cm in height. 3.1 Training A one-day training on data collection was given to the enumerators. This included taking of anthropometric measurements, checking for oedema, conducting semi structured interviews. Semistructured interviews were conducted with the parents of the children to get the information required. The survey lasted for a period of 9 days. 3.2 Sampling Maikona division consists of persons. A total of persons were represented in this survey, this was due to inaccessibility to Shura sub-location. A total of 30 clusters of 30 children each were randomly selected in the locations within the division. A total of 900 children were assessed for their nutritional status. After cluster identification the survey team moved towards a chosen random direction by spinning a pencil. The teams moved within a radius of 45 until the total number of children were reached. 3.3 Study sample Children aged 6-59 months and who measured 110cm were eligible for the study. 3.4 Data collected - Age (cultural calendar was partially used ) - Weight (salter scale 25kg: precision 100g) - Height (precision 0.1cm) - Presence of bilateral oedema. - MUAC (precision 0.1cm) - Gender - Whether the child was receiving the supplementary ration or not - Distance from nearest water point - Period of exclusive breast feeding - Number of animals (shoats, camels, cows) lost to the drought - Diseases suffered in the past two weeks - Whether child has been immunized or not - Whether the child has recently suffered symptoms of vitamin C deficiency - Quantity of the general ration received per person for the month of September The questionnaire for survey is on appendix I attached. The data collected was analyzed manually using calculators, NCHS weight for height reference charts. VI

7 4.0 Results 4.1 Indicators and guidelines used The following WHO and MSF cut-off points were used to classify the nutritional status. 1. In Z-score Above sd normal to 1.00sd mild malnutrition <-2.00sd global acute malnutrition <-3.00sd severe acute malnutrition 2. Weight for height percent of median Above 85% normal 80% - 85% mild malnutrition <80% WFH global acute malnutrition <70% WFH severe acute malnutrition 3. MUAC (MSF nutritional guidelines) >12.5 cm mild malnutrition <12.5 cm moderate acute malnutrition <11.0 cm severe acute malnutrition 4. WHO cut-off of wasting prevalence using z-scores in populations <5% acceptable 5-9% poor 10-14% serious >15% critical 4.2 Distribution of malnutrition - Using MUAC (n = 893) Global acute malnutrition (<12.5 cm) 15.3% Severe acute malnutrition (<11.0 cm) 0.7% Table 1.1 Number > 12.5 cm < 12.5 cm <11.0 cm Oedema assessed No % No % No % No % In z-scores (n = 893) Global acute malnutrition rate 25.1% (CI 20.1% %) Severe acute malnutrition rate 4.0%% (CI 2.5% - 5.3%) VII

8 4.3 Malnutrition classification Table: 1.2 Oedema Yes No Weight for height analysis Vs oedema <-2sd >=-2sd Marasmus/kwashiorkor No % No % Marasmus Normal In WFH percent of median (n= 893) Global acute malnutrition rate 17.4% (CI 13.5% %) Severe acute malnutrition rate 1.4% (CI 0.36% -2.4%) Table 1.3 Oedema Yes No <80% >=80% Marasmus/kwashiorkor Kwashiorkor No % No % Marasmus Normal % % Table 1.4 Prevalence of acute malnutrition: z-scores by sex (6-59 months) Z- scores Males n=463 Females n=430 Total n=893 Proportion of global malnutrition (<-2.00) Proportion of severe malnutrition (<-3.00) % % % % % Table 1.5 Prevalence of acute malnutrition: WFH percent of median (6-59months) Percent of median Males n=463 Females n=430 Total n=893 Proportion of global 74 16% % % malnutrition (<80%) Proportion of severe malnutrition (<70%) % 2 0.5% % There was no significant difference in the malnutrition level of the boys and girls assessed. 4.4 Prevalence of malnutrition among 6 months to 24 months (6-24): z-scores (n=319) Global acute malnutrition rate <- 2 z - scores 26.6% Severe acute malnutrition rate <- 3 z-scores 5.3% VIII

9 Table1.6 z-scores Males n = 185 Females n = 134 Total n = 319 Proportion of global malnutrition (<-2.00) Proportion of severe malnutrition (<-3.00) % % % % % 4.4a Prevalence of malnutrition among 6 months to 24 months (6-24): percent of median Global acute malnutrition rate <80% WFH 18.1% Severe acute malnutrition rate <70%WFH 2.2% Table1.7 Percent of median Males n= 185 Females n= 134 Total n= 319 Proportion of global % % % malnutrition (80%) Proportion of severe malnutrition (70%) 5 2.7% 2 1.5% 7 2.2% There was no significant difference in the malnutrition levels of children below 24 months compared to other children. The malnutrition levels were equally high. Table 1.8 Prevalence of malnutrition per sub-location: z-scores Location Population Proportion< Proportion <-3.00 sampled No % No % Maikona centre Kalacha Huri hills Elgade Forolle Turbi Burgabo Bubisa Total As shown high malnutrition levels were indicated in Kalacha (38.1%) and Bubisa (37.3%). Huri hills registered very low (3.4%) malnutrition levels, which lie within the acceptable nutritional status in populations. 4.5 Immunization coverage Health cards and BCG scar were used to obtain the following information. IX

10 Table 1.9 Vaccination type Coverage (%) BCG 76.8 Measles 82.3 Polio 93.5 VITAMIN A 51.I As shown polio vaccination registered the highest (93.5%) coverage among the children assessed. This was followed closely by measles (82.5%) and BCG (76.8%). Vitamin A vaccination was the lowest (51.1%). Most of the children assessed had received their last vitamin A vaccination in However, this vaccine will be included in the second round of NIDS (national immunization day) towards the end of November. 4.6 Morbidity It was important to find out the commonly suffered diseases among the children. The data collected indicates the diseases suffered within a two weeks period before and during the survey period. Table 1.10 Morbidity No and % who responded YES No. and % who responded NO Diarrhea % % Respiratory tract % % infection Fever like illness % % measles 0 0.0% % Total % As indicated above 18.5% of the respondents said that their children had suffered the mentioned diseases. It was found that 22.2% of the children had suffered form diarrhea, 35.5% respiratory infections and 16.3% had fever like illness. There were no measles cases reported. 4.7 Suspected scurvy Table 1.11 Symptom Percentage Swollen bleeding gums 0.8 Swollen paining joints 2.5 Both 0.2 Total 3.5 As shown 3.5% of the children were reported to be suffering from symptoms of scurvy deficiency. Thus, the level of scurvy among children is evidently low in the division. 4.8 Period of exclusive breast feeding The data indicated below was elicited from 881 children. It was not possible to get information from the remaining children as their mothers had either passed away or were not present at the time of the survey. X

11 Table 1.12 Month No. of children Percentage (%) Up to 1 month moths months months Over 9 months Total It was found that most (51.5%) of the children in the community were introduced to complementary food between the ages of 4-6 months or when the child is learning how to sit or teeth. Very few (2.8%) children were exclusively breastfed for 2-3months. The remaining children were breast fed for 7-9 months (25.9%) or more (19.7%). This was either due to lack of sufficient complimentary food in the child s diet or mother s lack of awareness on the right timing of the initiation of the weaning period. 4.9 Quantity of the general ration received per centre for the month of September. The community has been receiving general relief food since March 2000 from WFP/GOK. This ration comprises of cereals, pulses and oil at theoretical quantities, which are supposed to provide 2100kcal/p/d at 100% of the ration. A full ration size (100%) comprises of 13.8kg of cereals, 2.4kg pulses and 0.75kg oil. In the month of September, the ration portion per person allocated by WFP/GOK was at the rate of 70%. That is, 9.6kg/person/month of cereals, 1.7kg/person/month of beans and 0.5kg/person/month of oil. This provides a calorific value of 1470kcal/p/d. The following table shows the quantity distributed in the feeding centres within Maikona division in the month of September. Table 1.13 Centre Quantity received/person or household Cereal (kg) Pulses (kg) Oil (kg) Maikona Bubisa Kalacha Forolle* 7 24/HH 1 4/HH /HH Huri hills 9 2 2/HH Turbi Elgade Burgabo * As shown there were two ration portions in Forolle. It was difficult to validate why there was this difference. However, the relief committee in the centre is currently under training on right food allocation. Half of the community in Burgabo receives s food from Turbi and part from Bubisa, hence the difference in portion sizes. XI

12 The table shows varied ration portions distributed by the relief committees in different feeding centres. The beneficiaries in Turbi received above the monthly requirement (11kg/p/m) of cereals allocated per beneficiary. Beneficiaries in Huri hills received almost the allocated monthly ration portion. In the other centres the beneficiaries received between 6 8 kg/p/m. in these centres the community is seemingly more than the food allocated to them. This is partly brought about by movement of people into these centre or lack of understanding by the community on the meaning of beneficiary targeting. Thus the allocated ration size for the vulnerable individuals is reduced to meet the needs of the entire population in the centres. It is also important note that the vulnerability of the community might have increased with prolonged drought Average time taken to reach the nearest water point The table below shows the average time to reach the nearest water point in different locations. The range of time used by the community is also indicated. Table 1.14 Location Average time taken (hrs) Range o f time taken (hrs) Maikona 30.3 minutes 5mins -1and 1/2hours Bubisa 1.8hrs 5mins to 6hrs Kalacha 1.7hrs 5mins to 12hrs Forolle 10 mins 10mins 48hrs Huri hills 4hrs 1hr- 7hrs Turbi 5hrs 1-9hrs Burgabo 8.5hrs 8-9hrs Elgade 25mins 10-40mins The data collected above indicates the time taken by the community to walk to the nearest point during the dry season. Water supply has been limited by the ongoing drought and as shown some of the community members walk as long as 12hrs to reach the nearest water point. The communities in Maikona and Elgade had sufficient water supply in spite due to availability of safe water wells in the location. These were dug by various NGO in the division. The community in Burgabo (Saba Sawal Jillo- area between Turbi and Bubisa), Turbi and the distant villages in Kalacha take the longest time to reach the nearest water point. Further, it was note that some members of the community in Forolle go to Ethiopia in search for water and this takes them about 48hrs Impact of the drought on the animals This information was elicited from 604 households. A household in this survey meant every mother whose child was assessed for nutritional status. This excludes the seven children who were flagged off from analysis. Following are the results obtained from the households surveyed. XII

13 Table 1.15 Animal Did not Sold or Lost Lost < Lost Lost Lost all have eaten none 1/2 1/2 3/4 No % No % No % No % No % No % No % Camels Cows Sheep Goats As shown the population has lost a large quantity of their livestock to the drought and the remaining stock are weak. If rains fail this season deterioration in the stocks might be the outcome. High losses were observed in sheep (452 households) and goats (429 households). Minimal losses were observed in cows (222) as almost half (301 households) of the households surveyed did not have any cows. Most of the people have their animals in Isiolo, Moyale and other pasture areas. 5.0 Discussions The results show a global malnutrition rate of 25.1% (z-scores WFH) and a lower prevalence of 17.4% using median. There were no oedema cases observed thus, wasting malnutrition was observed. The malnutrition levels are classified as critical according to WHO classification for wasting in populations. Worse levels were observed in Kalacha (38.1) and Bubisa (37.3%). This calls for more intervention in the mentioned areas to supplement for the ongoing general food distribution and supplementary blanket-feeding programme. No significant difference was observed in the malnutrition levels by age or sex. However, it was generally observed that women looked relatively weak. Low levels of vitamin C deficiency (3.5%) was observed indicating nutritional adequacy of the micronutrient in the children s diet. Immunization coverage in the division was excellent apart from vitamin A coverage. Children residing in the accessible areas were easily reached by the ministry of health staff. It was important to assess the relationship between common childhood diseases and nutritional status. Respiratory tract infection were found to be common (35.5%) among the assessed children, diarrhoel diseases (22.2%) and complaints of fever (16.3%) followed this. No measles cases were observed. The average period for exclusive breast-feeding was found to be 4-6months. Culturally weaning is initiated at this age and children are breast feed up to the age of 2-4 years. Hence, this could partly be the reason why mothers looked more malnourished than the children has the child depends so much on the limited stores of the mother for a long period. XIII

14 Varied ration sizes were also observed ranging from 9-11kg/p/m on the higher side and 6-8kg/p/m on the lower side. This indicates the community s difficulty in practicing targeting as they are used to sharing whatever quantity of food available amongst themselves. There has also been an influx of people especially in Bubisa from outside and within the division thus reducing the ration portion per person. Further, there could be a possibility that the level of vulnerability is increasing thus an increase in beneficiary numbers. A vulnerability assessment should thus be conducted to validate this assumption. The distant traveled to the nearest water supply also varied in the locations the longest time observed was 9-12hrs. These were mainly the pure pastoralists who had no other occupation. It was also observed that the drought had caused great losses animals. A greater impact of the drought was observed more on sheep and goats. As seen earlier 54.3% and 48.5% of the households surveyed had lost more than half of their sheep and goats respectively. The resistant of the sheep to the drought is thus relatively lower than the other animals mentioned. It is worth mentioning that the condition of the surviving animals is very poor especially in Maikona, Kalacha and Elgade. The community s coping mechanism was to either take the animals to pasture lands away from the villages or sell/eat the animals before they become weak. There is an ongoing project in Elgade by the AIM to support the community by buying animals from community members in exchange for cash or animal feed. The animals are then slaughtered and distributed to the vulnerable members of the community at the rate of 350g/p/d. This has played a great role in improving the nutritional status of the community in Elgade. Recommendation Nutrition - A targeted supplementary feeding programme should be established in Kalacha and Bubisa to curb the high malnutrition levels. - Mothers need to be sensitized on the importance of the appropriate period of complementary feeding. - Feeding practices of the community should be studied at a lower scale to aid in education. - Blanket supplementary feeding programme should continue until sufficient milk is available in the children s diet. - A follow-up nutritional survey should be conducted in 3months period to assess the impact of the current intervention. Immunization - The ministry of health needs to target the far villages in order to have a vast outreach. - These outskirt communities need to be sensitized on the importance of timely immunization. Morbidity - Education on proper hygiene needs to be emphasized. XIV

15 - Education on the cause, treatment and management on the common diseases within the area should be emphasized. Water supply - Areas on the out skirts of Kalacha, Turbi, Forolle and Bubisa will require provision of close water supply. - A more technical assessment needs to be conducted to validate these findings. General ration - The community and the relief committee need to be trained on the importance proper targeting to ensure adequate ration portion per beneficiary. - A vulnerability study should be carried out by the experts concerned to find out if there is any change in the level of vulnerability with the continued drought. Livestock situation - An assessment needs to be to ascertain the extent at which the drought has affected the animals. - Mechanisms to curb the existing situation in the health and drought vulnerability of the livestock should be investigated in liaison with livestock expertise. XV