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Emergency Nutrition Assessment Round-2 (Final Report)

Subject/Objective: 
The principal objective was the evaluation of the nutritional status among Rohingya children 6-59 months within the survey areas, as well as to provide salient nutrition and nutrition-sensitive data to inform an effective humanitarian response to the Rohingya Crisis in Cox’s Bazar. Additionally, the assessment aimed to: • Estimate demographic characteristics of the households • Estimate crude death rate and under five death rate • Estimate MUAC among women 15-49 years and children 0-59 months • Determine the prevalence of malnutrition among children 6-59 months • Determine the prevalence of anaemia per haemoglobin among children 6-59 months • Determine the prevalence of morbidity among children 6-59 months • Estimate infant and young child feeding indicators • Assess food assistance and nutrition programming
Methodology: 
The survey of the Makeshift Settlements (28 April to 9 May) selected households using multi-stage cluster sampling among refugees residing outside of Kutupalong Refugee Camp and Nayapara Refugee Camp. Sub-block population estimates derived from The International Organization for Migration (IOM) Needs and Population Monitoring estimates. 55 clusters were drawn with a planned 13 households per cluster. The total estimated population of the Makeshift Settlements was 904,657. The survey of Nayapara Refugee Camp (17 May to 28 May) selected households using simple random sampling among those residing within the camp. Household lists were created from the UNHCR PROGRESS database for registered refugees (n=3,705) as well as household enumerations lists (n=1,015) created the week prior to data collection. The total estimated population of Nayapara Refugee Camp was 24,430. Data collection was planned for but ultimately canceled in Kutupalong Refugee Camp due to high numbers of systematic refusals linked to fears around relocations. Analysis of the data was conducted using ENA for SMART software (version 9th July 2015) and Stata Version 15. The anthropometric data was cleaned following SMART flag recommendations (+/- 3 of the survey’s observed median).
Key findings: 
The Emergency Nutrition Assessment Round 2 was conducted in Cox’s Bazar, Bangladesh from 28 April to 28 May 2018 with the aim of determining the nutrition status of all Rohingya living in the Makeshift Settlements and Nayapara Refugee Camp. The findings indicate that the prevalence of GAM among children 6-59 months using WHZ decreased significantly in the Makeshift Settleements from 19.3% during Round 1 to 12.0% during Round 2, falling below the 15% WHO emergency threshold, while Nayapara Refugee Camp remained under the same threshold from 14.3% during Round 1 to 13.6% during Round 2. Further, the mortality rates fell significantly below the WHO emergency threshold of 1/10,000 persons/day in both sites as well as below the SPHERE 0.40 threshold for South Asia. Chronic malnutrition among children 6-59 months has declined but remains at or near the 40% WHO critical threshold in both sites. The overall prevalence of anaemia among children 6-59 months decreased significantly in both sites. However, the largest gains in anaemia reduction were among older chidlren, while over half of all children 6-23 months remain aneamic. Data from the two-week recall among chidlren 6-59 months indicated a significant decrease of diarrhoeal disease and acute respiratory infection symptoms, and a sigificant increase in fever. However, given the crowded camp conditions, the disease burden remains a concern. Household level support with food assistance by ration card or e-voucher was found to be near universal in both sites. The proportion of children 6-59 months receiving fortified foods has increased to more than 80% in Nayapara Refugee Camp but remains below 50% in the Makeshift settlements. IYCF practices remain concerning with poor minimum acceptable diets for children 6-23 months and less than half of infants under 6 months are receiving the protective benefits of exclusive breastfeeding in the Makehsift Settlements. Compared to established WHO malnutrition cut-offs, the malnutrition status of the Rohingya during Round 2 of this assessment constitute serious levels of malnutrition in need of ongoing nutritional support. Although the results indicate significant improvement, particularly in the Makeshift Settlements, the prevalence of acute malnutrition remains high despite considerable scale up of nutrition treatment centres, food distributions, WASH facilities, and health services. In addition, the high prevalence of anaemia, concerning disease burden, and poor dietary indicators suggest an ongoing need to strengthen nutrition treatment and preventation programmes as supported by health and nutrition servcies, IYCF support, access to safe and adequate water and sanitation, appropriate shelter and education, and the provision of psychosocial support in order to better sreve the Rohingya refugee population of Cox’s Bazar.
Assessment Report: 
Publicly Available
Assessment Questionnaire: 
Assessment Data: 
Publicly Available
Contact(s): 
Ingo Neu
ineu@hotmail.com
Webspace(s): 
Assessment Date(s): 
28 Apr 2018 to 28 May 2018
Frequency: 
Other
Status: 
Report completed
Unit(s) of Measurement: 
Households
Individuals
Collection Method(s): 
Mixed
Population Type(s): 
Children under 5
Refugees
Lactating women
Pregnant women
Cluster(s)/Sector(s): 
Leading/Coordinating Organization(s): 
United Nations Children's Fund
United Nations High Commissioner for Refugees
World Food Programme
Action against Hunger
Centers for Disease Control and Prevention
Swedish International Development Agency
Location(s): 
Cox'S Bazar
Theme(s): 
Community Management of Acute Malnutrition
Food/Nutrition Crisis
Infant and Young Child Feeding
Disaster(s)/Emergency: 
Bangladesh: Rohingya Refugee Crisis 2017-2019