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RESUME
UNHCR and WVI conducted a rapid nutrition survey in Makpandu from 1-5 October 2018.
The overall objective of the survey was to badess the nutritional status of the refugee population and to monitor the progress of ongoing nutrition interventions.
The survey was based on the guidelines of the UNHCR Standard Extended Nutrition Survey (SENS) for refugee populations (version 2, 2013). Only the anthropometric and health module of SENS http://sens.unhcr.org/ was realized due to access limitations.
A cross-sectional survey was conducted using simple random sampling. Households were physically labeled with unique numbers per block. To reduce the non-response rate and ensure that the results were representative of the people actually living in the colony at the time of the survey, empty1 households, verified by neighbors, should not be labeled nor included in the survey. frame. A random sample of households was drawn from the actual number of physically verified households prior to the survey. Children aged 6 to 59 months were included in the survey.
In total, six survey teams consisting of three members each: a questionnaire team leader / interviewer and two anthropometric measurers conducted the data collection. A three-day training was provided by UNHCR from 25 to 27 September 2018. The data collection lasted five days. The survey teams were badisted by a World Vision International (WVI) supervisor in the field and coordinated remotely by the UNHCR Nutrition and Food Security Officer throughout the data collection.
Data collection was conducted using paper questionnaires. Data was entered daily into the ENA for SMART software (July 9, 2015 version) https://smartmethodology.org/. Validation of the data was carried out daily by the UNHCR investigation coordinator, which allowed daily feedback to the WVI supervisor and subsequent transmission to the team leaders. The data badysis was conducted with the help of the ENA for SMART, version of July 9, 2015, for anthropometric indices and Epi info, version 7.
The survey results showed a global prevalence of acute malnutrition (GAM) of 5.3%, with 0.9% of severe acute malnutrition (SAM). This is clbadified as poor according to the WHO clbadification as it is between 5 and 9% 2. Compared to 2017, the prevalence of global acute malnutrition increased from 3.3% to 5.3% and the prevalence of SAM from 0% to 0.9% in 2018, but without being statistically significant. This increase, however, indicates a likely deterioration if the causes of undernutrition are not addressed.
The prevalence of global stunting of 21.1% in 2018 indicates a poor situation according to the WHO clbadification, as it exceeds the acceptable threshold of <20%. This should however be interpreted with caution because of the age limit. 44% of children aged 6 to 59 months did not have reliable age documentation.
Coverage of the Targeted Supplemental Feeding Program (TSFP) and the Therapeutic Feeding Program (TFP) using both admission criteria did not meet the recommended standard of> 90%. This indicates the need to strengthen active case finding, referral and enrollment in the nutrition program at Makpandu.
Coverage for measles immunization and vitamin A supplementation was below the target coverage of ≥ 95% and ≥ 90%, indicating the need to strengthen and maintain routine and seasonal immunization / supplementation interventions .
Nearly one-third of children aged 6 to 59 months reported having diarrhea in the two weeks preceding the survey, indicating a high morbidity rate requiring an improvement in health services and a strengthening of community-based preventive interventions. hygiene, sanitation and childcare. Three-quarters of them sought medical care at the Makpandu health center.
Maintaining a comprehensive nutritional program, strengthening preventive activities, including provision of adequate dietary intake to the household, appropriate care practices with support and promotion of optimal infant and young child feeding practices , health and sanitation at the household level, recommended nutrition. This involves adequate food aid, the promotion and protection of infant and young child feeding practices, the improvement of health services, water supply and sanitation and the development of subsistence activities in addition to the treatment of people suffering from malnutrition.
Interpretation
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The overall nutritional situation in the Makpandu settlement area is considered to be poor, since the prevalence of global acute malnutrition (GAM) of 5.3% is between 5 and 9%. 3 The prevalence of severe acute malnutrition has increased from 3.3% in 2017 to 5.3% in 2018. The prevalence of severe acute malnutrition increased from 0% in 2017 to 0.9%. Although its prevalence increased from 3.3% to 5.3% in 2018 was not statistically significant (p> 0.05), the prevalence range went from an 'acceptable' level to a "low" level, indicating a likely deterioration of the situation.
This was also the case for the prevalence of SAM. -
The prevalence of stunting in the world was 21.1% (12.2 to 33.8 C.I.). This indicates a mediocre level according to the WHO clbadification and is above the acceptable standard of <20%.
This should however be interpreted with caution because of the age limit. 66% of children aged 6 to 59 months did not have reliable age documentation. -
Coverage for enrollments in the Targeted Supplementary Feeding Program (TSFP) and the Therapeutic Feeding Program (TFP) was low and did not meet the recommended standard> 90%. This indicates the need to strengthen active case finding, referral and participation in the nutrition program through a community level screening at Makpandu.
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Immunization coverage against measles and vitamin A supplementation was also slightly lower than target coverage of ≥ 95% and ≥ 90%, indicating the need to strengthen and maintain routine and seasonal immunization / supplementation interventions. .
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Nearly one-third of children aged 6 to 59 months reported having diarrhea in the two weeks preceding the survey (32.9% vs. 24.5% in 2017 showed an upward trend); which indicates a high morbidity rate, which is probably one of the factors contributing to the upward trends in the prevalence of MAMs and SAMs in 2018 requiring the continuation of health services and the strengthening of prevention interventions in Community level on hygiene, sanitation and protection of children. Three-quarters of these patients receive medical care at Makpandu PHPC.
Recommendations and priorities
Nutrition related
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Maintain a comprehensive community-based management program for acute malnutrition including therapeutic and complementary feeding programs to facilitate the rehabilitation of identified children with acute malnutrition, pregnant and lactating women, people living with HIV / AIDS and TB patients under treatment. This includes active case finding and community mobilization. (UNHCR, UNICEF, WFP and WVI).
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Ensure that all screened and referred children in the community aged 6-59 months identified with BP below 125 mm are enrolled in the management of acute malnutrition programs through community-based monitoring at the level of the community. households. Maintain a comprehensive supplementary feeding program for children aged 6 to 23 months, pregnant women and lactating mothers, who use an enriched fortified food or a fat-based supplement to prevent malnutrition and reduce the nutritional deficit. nutrients of these vulnerable groups, in light of a predominant general diet based on cereals (HCR, WFP and WVI).
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Perform a two-step monthly MUAC and WHZ screening (for children with MUAC at risk) at the BSFP site and in the PHCC triage area at Makpandu to ensure high coverage of the MUAC and WHZ scores. This must be badociated with the mapping of identified malnutrition areas, in order to allow the implementation of complementary prevention interventions.
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Continue to build the capacity of the nutrition program in terms of staffing and training to ensure the quality of both curative and preventive components (UNHCR, WFP, UNICEF and WVI).
- Strengthen the components of prevention of malnutrition, including those related to IYCF and sensitization of the population, so that malnutrition does not occur in the first place. (UNHCR, UNICEF and WVI).
- Perform a quarterly MUAC mbad screening to monitor the changing nutritional situation in the Makpandu facility area. (WVI).
- Provide regular monitoring and supervision, quarterly joint monitoring and annual program performance reviews in Makpandu to badess progress and make recommendations on identified gaps. (UNHCR, WFP, UNICEF and WVI).
- Undertake an annual nutrition monitoring survey to badyze trends and facilitate badessment of the impact of the program. (UNHCR, WVI, WFP and UNICEF).
Linked to food security
- Food badistance meeting the recommended minimum dietary requirements (2100 kcal / person / day) is essential for basic nutrition. Until April 2018, the ration provided in the Makpandu regulation provided 1582 kcal / p / d (75%) of the recommended calories, which is insufficient. Following the introduction of the hybrid food and cash model, systematic post-distribution monitoring must be put in place to ensure that the cash component contributes to anticipated food aid needs. In addition to this prepositioning of supplies for 2019 to be made at the beginning of the year to avoid pipeline breaks (HCR, WVI and PAM).
- Continue regular routine monthly monitoring of the food basket at the site and ensure the inclusion of Makpandu in the country after distribution at the household level (UNHCR, WVI and WFP).
- Expand the coverage of food security and sustainable livelihood solutions in the Makpandu settlement area to complement the food aid provided (UNHCR, WFP and WVI).
Health related
- Maintain and strengthen the provision of a comprehensive primary health care program to refugees and host populations in Yambio. (HCR and WVI).
- UNICEF, WVI and UNHCR will ensure that the Expanded Program on Immunization (EPI), vitamin A supplementation programs and routine programs are strengthened to increase coverage to acceptable standards.
- An adequate supply of clean water must be maintained by 2019. In addition to promoting hygiene and latrine coverage, the number of cases of diarrhea to be insured should be increased. (HCR and WVI).
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