Nutrition Survey Saharawi Refugee Camps, Tindouf, Algeria Synopsis: Report on Nutrition Survey and Anaemia Intervention Impact Analysis Survey Conducted: November 2012 Report Finalised: May 2013
P r e v a le n c e o f G lo b a l A c u te M a ln u tr itio n % 2012 Nutrition Survey Synopsis The 2012 Nutrition Survey main results and highlights are summarized below along with the interpretations of the main indicators collected (acute malnutrition, stunting, and anaemia prevalence in children and women). Also included in this synopsis are the key recommendations for improving the nutrition and health situation of the refugees from Western Sahara stemming from the report. 1,2 Acute malnutrition (wasting) in children 6-59 months Global acute malnutrition (GAM) often referred to as wasting is an indicator that reflects a rapid and recent worsening of the nutritional status (weight loss). GAM is a crucial indicator as children suffering from acute malnutrition have a high risk of death. Acute malnutrition is calculated by assessing the weight in relation to height or length (being too thin for his or her height) and it is normally disaggregated between moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The graph below (Figure 1) shows the figures, by camp (Wilaya), of the prevalence of GAM in children 6-59 months. 1 5 1 0 5 0 Aw serd D akhla Laayoune S m ara Aggregated W ila y a Figure 1 Global acute malnutrition prevalence in 6-59 months 1 Survey management and report preparation: Carlos Grijalva-Eternod (UCL), Chafik Meziani (UNHCR) 2 2012 Nutrition Survey: https://www.dropbox.com/s/wniph3ugngybw3q/2012%20nutrition%20survey%20reports.zip
P r e v a le n c e o f S tu n tin g % The overall prevalence of GAM is at 7.6%, ranging from 6% in Awserd to a significantly higher value of almost 11% in Laayoune. Overall, the prevalence of GAM remains similar to that observed in the 2010 Nutrition Survey (7.9%). MAM prevalence stands at 6.8% and accounts for 89% of the total GAM prevalence, ranging from 86% in Laayoune to 97% in Dakhla, while SAM is at 0.8%. Stunting (chronic malnutrition) in children 6-59 months Stunting often referred to as chronic malnutrition is the failure to grow adequately in length or height in relation to age (being too short for his or her age), ultimately resulting in a significantly reduced adult physical and cognitive capacity. As seen in the graph below (Figure 2), stunting prevalence stands at 25%, ranging from 23% in Laayoune to 29% in Smara. The small differences in stunting prevalence observed between camps were deemed to be of small significance. 4 0 3 5 3 0 2 5 1 5 1 0 5 0 Aw serd D akhla Laayoune S m ara Aggregated W ila y a Figure 2 Stunting prevalence in children 6-59 months Overall, there was a small but significant reduction in stunting prevalence between 2010 and 2012, from 30% to 25%, which amounts to a relative reduction of 16%. Interestingly, this reduction of stunting prevalence did not occur in all camps, as it was only observed in Dakhla and Laayoune, with a difference of 9 and 11 percentage points, respectively.
A n a e m ia p r e v a le n c e % Anaemia in children 6-59 months Anaemia, a disease commonly associated with insufficient nutrition leading in turn to an increased risk of morbidity and mortality, is a widespread public health problem in the camps. Notwithstanding, it was the prevalence of anaemia in children 6-59 months that showed the most encouraging results, when compared to the results of the 2010 survey, as illustrated below in the graph (Figure 3). Since 2010, there was a high and significant reduction in the overall anaemia prevalence, from 53% to 28% in 2012, a reduction observed also within each camp. The overall relative reduction of anaemia between 2010 and 2012 was 46%, ranging from the greatest relative reduction of 51%, observed in Laayoune, to the lowest of 40%, observed in Awserd. This significant reduction shifted the public health significance of anaemia prevalence in children from a high to a medium level. Furthermore, this significant reduction demonstrates the positive impact of ongoing anaemia prevention activities implemented in the camps, whilst highlighting in turn, the need to be further strengthened to improve the coverage of the activity. Despite this significant improvement, about one in four (28%) children aged 6-59 months still suffer from some form of anaemia, the most common type of anaemia being mild (16%). 8 0 M ild 6 0 4 0 3 9.6 % 4 2.3 % 5 1.0 % 4 7.7 % 4 6.0 % 0 A w s e rd D akhla Laayoune Sm ara A ggregated W ila y a Figure 3 Two-year anaemia prevalence change in children 6-59 months The arrows indicate relative change between 2010 and 2012
A n a e m ia p r e v a le n c e % Anaemia in women of reproductive age (15-49 years) Overall the prevalence of anaemia in non-pregnant women of reproductive age is 36%. Pregnant and lactating women presented greater values of anaemia prevalence, each at 55% (see Figure 4 above). The prevalence of anaemia in women of reproductive age was different between camps with Dakhla and Laayoune having the higher prevalence and Smara the lower. Comparing anaemia prevalence between 2010 and 2012 shows a relative reduction but significant reduction of 26% in non-pregnant women. Likewise, for lactating women there was a significant difference equivalent to a relative reduction of 18% in anaemia prevalence. Conversely, anaemia prevalence among pregnant women shows similar levels between the two surveys. 1 0 0 M ild 8 0 N o n -p r e g n a n t w o m e n (in c lu d in g la c ta tin g ) 1 8.6 % 6 0 3 2.7 % 2 6.7 % 2 5.8 % 2 9.5 % 4 0 A w s e rd D akhla Laayoune S m ara+27 A ggregated P re g n a n t Figure 4 Two-year anaemia prevalence change in women of childbearing age The arrows indicate relative change between 2010 and 2012 L a c ta tin g In addition to the nutrition indicators presented above, other indicators were collected in order to get a thorough overview of the underlying and direct causes of undernutrition. These indicators include infant and young child feeding indicators (exclusive breastfeeding and continued breastfeeding, minimum dietary diversity, minimum acceptable diet, minimum meal frequency, and consumption of iron-rich foods) and household food consumption score. The complete set of indicators is presented in the following table (Table 1).
Table 1: Summary of key indicators, 2012 Nutrition Survey in Western Sahara refugee camps Children aged 6-59 months Key indicators (%) Awserd Dakhla Laayoune Smara Aggregated 3 Global Acute Malnutrition 5.9 6.8 10.5 6.5 7.6 (6.4 8.8) Severe Acute Malnutrition 0.4 0.2 1.5 0.8 0.8 (0.3 1.3) Stunting 24.4 22.5 23.8 28.3 25.2 (22.8 27.6) Total Anaemia 28.7 26.6 30.2 27.3 28.4 (25.7 31.0) Moderate Anaemia 12.5 9.5 12.0 11.8 11.7 (9.9 13.4) Severe Anaemia 0...8 0.4 0.5 (0.1 0.8) Exclusive breastfeeding N/A N/A N/A N/A 18.4 (11.4 25.4) Continued breastfeeding at 1 year N/A N/A N/A N/A 78.9 (71.4 86.4) Continued breastfeeding at 2 years N/A N/A N/A N/A 28.7 (21.5 35.7) Minimum dietary diversity 20.1 52.3 34.7 28.6 32.1 (26.5 37.6) Minimum meal frequency 20.3 16.4 21.2 20.1 19.9 (15.4 24.4) Minimum acceptable diet 3.3 11.2 9.1 4.0 6.4 (3.9 8.8) Consumption of iron-rich/fortified foods 35.2 50.3 47.0 38.2 41.9 (36.5 47.4) Women of reproductive age (15 49 years) Key indicators (%) Awserd Dakhla Laayoune Smara Aggregated Total Anaemia 35.1 44.0 41.9 28.6 36.4 ( 33.2 39.6) Moderate Anaemia 18.3 22.3 23.1 12.0 18.2 (15.7 20.8) Severe Anaemia 2.5 6.6 3.9 2.6 3.6 (2.5 4.8) Households food security indicators Key indicators (%) Awserd Dakhla Laayoune Smara Aggregated FCS acceptable 4 63.7 58.2 59.2 57.3 59.5 (53.2 65.7) FCS borderline 5 25.7 38.2 36.0 35.0 33.7 (28.7 38.7) FCS poor 6 10.6 3.6 4.8 7.6 6.8 (4.5 9.1) N/A: Non-available data. Values were not calculated as there was not enough sample size. FCS: Food Consumption Score. Based on the survey s findings, and following discussions during the Inter-Agency Nutrition Expert Meeting that took place in March 2013, presented below are a summary of key recommendations to improve the nutrition and health situation of the Western Sahara refugees, taken into account the complete layers of factors than can influence nutrition outcomes. 3 Aggregated: All data from each camp was aggregated and weighted according to camp size 4 FCS > 42 5 FCS 28.5-42 6 FCS 0-28
Summary of key recommendations Strategies to improve coordination of actors working on nutrition-related activities: technically assess the effectiveness of the current coordination mechanisms (i.e. Nutrition, WASH, Health and Food) to expand capacities (e.g. partnerships, information sharing, guidelines development, etc.). Strategies to assess and improve the monitoring of the nutrition-related issues: technically review the current monitoring systems; implement nutrition surveys every two years and implement a survey to establish the nutrition status of special needs groups (school age children, elderly, etc.). Strategies to improve the Health Information System (HIS): collect and report basic standard UNHCR health indicators (e.g. low birth weight prevalence, infectious diseases), at the Wilaya level; strengthen the capacity with regards to reporting and monitoring of the HIS. Strategies to improve infant and child feeding (IYCF) practices: develop an integrated component for improving IYCF practices within the nutrition strategy; revise the current IYCF promotion and support protocols of the PISIS programme; revise and/or develop activities that emphasize peer- and community participation in supporting exclusive breastfeeding; develop a minimum package for mothers and caretakers to enhance their caring capacity; study the cultural and local factors affecting IYCF. Strategies to improve food security and nutrition sufficiency to vulnerable refugees: further improve the stability of the GFD and complementary foods; continue the provision of micronutrient-rich foods within the general food ration; continue to provide diverse commodities; continue the monitoring and evaluation of the food distribution system; improve the correct utilisation of the GFD; raising nutrition awareness (e.g. culinary contest, TV cuisine programme, women s groups). Strategies to combat acute malnutrition in children: through prevention, treatment, improved screening at the community level, strengthening of the current programmes, monitoring and evaluation. Strategies to continue to reduce anaemia and to combat stunting in women of childbearing age and children: improve the implementation of the anaemia and stunting reduction programme while strengthening BCC activities targeting PLW, mothers and caretakers, deworming programme; M&E, integrate programmes targeting pregnant and lactating women and explore delivering a minimum package for women of childbearing age addressing optimal wellbeing including maternal care, psychosocial support, and additional nutrient needs, among others. Strategies to address the emerging threat of the double burden of obesity and undernutrition: assess the prevalence of non-communicable diseases; implement operational research to better understand the cultural, social and biological aspects regarding overweight and non-communicable diseases; expand the current BCC activities to increase awareness about obesity and associated risks.