Integrated SMART survey

Transcription

1 Integrated SMART survey Tando Muhammad Khan (TMK) and Badin districts, Sindh Province, Pakistan. November 2013 Title: SMART survey Executive Summary Place: TMK and Badin Districts of Sindh Province, Pakistan Funded By: ECHO By: Hailu Wondim, Action Against Hunger / ACF International

2 1. Introduction The broad situation of the nutritional status in Pakistan is well reported in the 2011 Pakistan National Nutrition Survey (NNS) which indicates that malnutrition rates are unacceptably high and reports around 57% of the 30,000 households surveyed nationally face food insecurity 1. Initial response in to improve the effects of the emergency in Sindh province, Pakistan Emergency Food security Alliance (PEFSA) was created and funded under European Commission Humanitarian Office (ECHO). Alliance members worked together on a set of objectives and ACF was designated as the lead agency to mainstream nutrition in the overall intervention strategy in Tando Muhammad Khan (TMK) and Badin districts, with a major aim of reaching acutely malnourished children under five years of age, as well as pregnant and lactating women. Currently, the nutrition mainstreaming component operates under PEFSA alliance, and is in its third phase of implementation. In order to continue monitoring the nutritional situation in the province in TMK and Badin districts, and to inform program actions in future interventions in the districts, ACF has conducted two SMART nutrition surveys in each of these districts. 2. Objectives The overall objective of the nutrition survey was to measure the extent and severity of acute malnutrition in children aged 6 to 59 months and their caregivers (pregnant and lactating women). The specific objectives for TMK and Badin Districts were: To estimate the prevalence of acute and chronic malnutrition among children 6-59 months of age; To estimate the prevalence of maternal malnutrition among pregnant and lactating women; To assess crude mortality rate and under five mortality rates; To assess morbidity and immunization coverage among 6-59 months children; To examine the population s access to, and use of, improved water, sanitation and hygiene; To examine the food security situation, copying mechanisms and household food availability for the next three months. 1 National Nutrition Survey of Pakistan. Department of pediatrics and child health, Aga Khan University, Pakistan, Pakistan Medical Research Council (PMRC), Nutrition Wing, Cabinet Division, Government of Pakistan. Supported by Unicef Pakistan. Nov Page 2 of 5

3 3. Methodology Study area: The survey was conducted in all UCs of TMK and Badin Districts of Sindh Province. Study period: The study was conducted from October 31th through 13th of November, Study design: The survey was a cross sectional study with two-stage cluster sampling using Standardized Monitoring of Relief and Transition (SMART) methodology. Villages are considered as the smallest geographical unit (clusters). Study population: Children 6 59 months old: Anthropometric measurements and oedema was measured from children 6-59 months old in the sampled household in all selected villages. Pregnant and Lactating Mothers: To estimate the prevalence of malnutrition among pregnant and lactating mothers in all selected villages. Household members: To assess the retrospective mortality rate Households: Household food security and WASH information was collected from subsamples of selected households in all selected villages. This was supplemented by village level focus group discussion with key informants. Sample size: Emergency Nutrition Assessment (ENA) for SMART software delta version (September 1, 2013 version) was used for sample size calculation (Parameters used for sample size calculation are in Annex 1). 4. Preliminary results For the sake of timely presentation of survey results, Table 1 summarizes preliminary findings with regards to nutrition and health indicators. A total of 690 children in TMK and 553 children in Badin were assessed for their nutritional status through anthropometric measurements from 525 sampled households in each district. The data quality analysis is presented in annex 2 (plausibility check on anthropometric results). Page 3 of 5

4 Table 1: Summary of Nutrition and Health indicator results, TMK and Badin District, November Results presented in brackets are expressed with 95.0% confidence interval (CI). Index Indicators TMK Result (%) Badin Result (%) WHO 2006 Mortality rate - s HAZ- s WAZ-s MUAC CMR U5MR Maternal Malnutrition Global Acute Malnutrition (GAM) Weight for height< -2 z and/or oedema Severe Acute Malnutrition (SAM) Weight for height < -3 z and/or oedema Stunting for age <-2 z- Underweight Weight for age <-2 z- Global Acute Malnutrition MUAC <125 mm or oedema Severe Acute Malnutrition MUAC <115 mm or oedema (<115mm) Crude Mortality Rate Number of death/10,000/day Under Five Mortality Rate Number of under five deaths/10,000/day Pregnant and lactating mothers (MUAC<210 mm) 19.4 ( ) 22.1 ( ) 5.1( ) 5.6 ( ) 54.9 ( ) 59.6 ( ) 47.6 ( ) 51.5 ( ) 20.0 ( ) 21.0 ( ) 6.3 ( ) 7.6 ( ) 0.37 ( ) 0.12 ( ) 0.85 ( ) 0.0( ) 22.4 ( ) 23.0( ) Measles vaccination 9-59 months; by card 34.1 ( ) 32.9 ( ) 9-59 months; by card and recall 79.7 ( ) 58.6 ( ) BCG vaccination 6-59 months; by scar 77.7 ( ) 63.4 ( ) Vitamin A supplementation 6-59 months; by recall 93.0 ( ) 70.2 ( ) The final report will be available in the coming weeks. Page 4 of 5

5 Annex 1: Sample size calculation for nutrition status using ENA for SMART software (September 1, 2013 version) District Estimated GAM Precision DEFF U5 Population Av. HH size Contingency Sample size Children Sample size HHs Clusters (15HHs/ cluster) TMK Badin Annex 2: Plausibility check summary, TMK District CRITERIA Missing/ flagged data sex ration age Weight Standard deviation Skewness Kurtosis Poisson Score Interpretation Excellent Excellent Excellent Excellent Excellent Excellent Excellent Excellent Excellent Excellent Excellent Annex 3: Plausibility check summary, Badin District CRITERIA Missing/ flagged data sex ration age Weight Standard deviation Skewness Kurtosis Poisson Score Interpretation Good Accept Excellent Excellent Good Excellent Excellent Good Excellent Excellent Good