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Ikwoto county Nutrition and Mortality SMART survey

Subject/Objective: 

The overall goal of the SMART nutrition survey was to assess the nutritional conditions in former Ikwoto county at the peak of the harvesting season. The SPECIFIC OBJECTIVES of such study were: i) to estimate the prevalence of acute malnutrition (Global and Severe) among children aged 0-59 months; ii) to estimate the retrospective crude and under five mortality rates; iii) to assess Infant and Young Child Feeding (IYCF) practices among children aged 0-23 months and; iv) to analyze possible factors contributing to malnutrition. In agreement with the SMART protocol, such an assessment was VALIDATED by the UN-led Nutrition Information Working Group (NIWG). Additionally, given the high level of environmental and socioeconomic heterogeneity characterizing former Ikwoto county a geographical and gender analysis of nutrition data was performed.

Methodology: 

STUDY DESIGN: The nutrition survey adopted a cross sectional household survey design using the two-stage cluster sampling based on the SMART methodology. Clusters were selected using probability proportional to population size (PPS). STUDY POPULATION: The target population for the anthropometric survey was children aged 6-59 months while all households were targeted for retrospective mortality assessment. Children aged 0-23 months were targeted to obtain information on Infant and Young Child Feeding (IYCF) practices. SAMPLE SIZE DETERMINATION: Sample size for anthropometry and retrospective mortality was determined using Emergency Nutrition Assessment (ENA) for SMART software July 9th 2015 version.
For anthropometry, a total of 551 children in 528 households was calculated; for mortality, a total of 2222 persons and 433 households was calculated. Information on infant and young child feeding practices was collected in all the 528 households with children 0-23 months to provide a snapshot of IYCF practices in the area. 36 clusters were selected to be included in the survey, each one comprising 15HHs. LIMITATIONS: due to the small sample size the results of the IYCF survey should be interpreted and utilized cautiously. For the same reason, the same caution should be applied in reading the geographical sub-county analysis, which nevertheless provides an accuracy comparable, when not superior, to the flagship Food Security and Nutrition FSNMS survey conducted every six months in the country.

Key findings: 

MALNUTRITION: Based on weight-for-height measurements, the Global Acute Malnutrition (GAM) rate of 10.3% (7.9-13.3 95% C.I.) and a Severe Acute Malnutrition (SAM) rate of 1.6% (0.9-3.1 95% C.I.) indicate a serious nutrition situation as per the WHO malnutrition thresholds. Moreover, by analyzing separately the results by gender and for the three livelihood regions characterizing the county, it is evident that a significant section of the population faces much direr nutritional conditions. Indeed, GAM rate varies from 8,8% (5,9-13,2 95% C.I.) in Geria, to 13,8%(6,9-25,7 95%C.I.) in Behind the Mountain -- the dry area of Kidepo Valley comprising Chahari and Chorokol payam. Additionally, overall, the GAM rate varies from 7.8% (5.2-11.6 95% C.I.) for girls, to 13.0% (9.2 - 18.0 95% C.I.) for boys. The combination of the gender and regional segmentation analysis shows that for boys from Behind the Mountain the GAM rate stands at 19,0% (9,0-35,8 95% C.I.). As these boys represent 16.7% of the total population of children below five-year of the county, it follows that 16.7% of the households are in IPC “Emergency” conditions (Phase 4). This share of the population is very close to the 20% cutoff point which, based on nutritional data, would qualify the entire county of former Ikwoto as in Emergency (IPC Phase 4). Taking into consideration that such data were gathered at the peak of harvesting season, it can be concluded that former Ikwoto county is an area that flips between Crisis (IPC Phase 3) and Emergency (IPC Phase 4) conditions, depending on the agricultural season. This is indeed what the UN-led IPC analysis predicted for Ikwoto county for the period 2017. Based on the data gathered by AVSI, this dynamic is likely to continue throughout 2018. CONTRIBUTING FACTORS: This result is in direct relation to the presence of aggravating factors such as poor Infant and Young Child Feeding practices, high morbidity rate, low coverage of micronutrient supplementation and deworming, food insecurity, poor Water, Sanitation and Hygiene practices. Review of secondary data from AVSI Multi-Sector Survey conducted on May 2019 in the same area indicated the morbidity rate in the former Ikwoto was high at 43%; vaccination coverage was 81.5%, and 72.6% of children reportedly received Vitamin A supplementation; deworming in the past 6 months before the survey stood at 65.4%; the assessment also showed a significant number of households (2000) suffered severe hunger with majority of the population reporting that they experienced food shortages. IYCF PRACTICES: In particular, only 15.2% of children 6-23 months were consuming the minimum acceptable diet. Exclusive breastfeeding to the age of 6 months (78%) was below the World Health Organization recommended standard of >80%. The proportion of infants reportedly put to the breast within the first hour of birth was also low at 76.2%. Introduction of solid, semi-solid or soft foods at the age of 6 months was found to be low at 51.5%.

Sample size: 
623 children aged 6-59 months from 532 households
Assessment Report: 
Publicly Available
Assessment Questionnaire: 
Publicly Available
Assessment Data: 
Publicly Available
Operations(s)/Webspace(s): 
Assessment Date(s): 
24 Nov 2017 to 03 Dec 2017
Status: 
Report completed
Unit(s) of Measurement: 
Households
Individuals
Collection Method(s): 
Structured Interview
Population Type(s): 
Children under 5
Cluster(s)/Sector(s): 
Leading/Coordinating Organization(s): 
AVSI Foundation
Location(s): 
Ikotos
Theme(s): 
Food/Nutrition Crisis
Disaster(s)/Emergency: 
South Sudan: Food Insecurity - 2015-2020