EMERGENCY NUTRITION AND HEALTH ASSESSMENT … · Multi-stage cluster sampling Simple random sampling ... Sampling frame included all makeshift and informal sites ... • Nayapara

EMERGENCY NUTRITION AND HEALTH ASSESSMENT ROUND 2

Makeshift and Spontaneous Settlements April 28th - May 9th 2018

Nayapara Refugee Camp May 17th - 28th 2018

Preliminary Results

COX’S BAZAR, BANGLADESH

OUTLINE

1. Background, Justification, and Objectives

2. Methodology

3. Makeshift Settlements (1st Survey)

4. Nayapara Refugee Camp (2nd Survey)

5. Comparative Results

6. Key Messages

Data Quality

Sample Description

Preliminary Results

BACKGROUNDViolence in the Rakhine State of Myanmar erupted on 25August 2017 driving more than 702,160 Rohingya men,women, and children across the border into neighboringCox’s Bazaar, Bangladesh. These families joined an estimated212,000 Rohingya who had previously sought refuge inBangladesh. In response:

Evolving humanitarian context since Emergency Nutrition Assessment Round 1 (Oct-Nov 2017)• Access to health services expanded

• Improved quality and quantity of water available in camps

• Additional services for pregnant and breastfeeding women

• General food distributions transitioning from emergency rations to food vouchers

Scale up of emergency nutrition services• SCs, OTPs, TSFPs, BSFPs, IYCF-E

Source: ISCG Situation Update: Rohingya Refugee Crisis as of 7 June 2018

JUSTIFICATION

Round 2 was launched to determine the nutrition status of women and children under fiveamong Rohingya refugees living in the camps.

Also for comparability between Emergency Nutrition Assessment Round 1 and Round 2, todocument the evolving malnutrition landscape.

Emergency Nutrition Assessment Round 1 among children 6-59 months reported:

• GAM per WHZ above 15% WHO emergency threshold in Kutupalong Refugee Camp andMakeshift Settlements

• Nayapara Refugee Camp falling just below same cut-off

• Stunting above 40% critical threshold in all sites

• Anaemia above 40% threshold for high public health significance in all sites

Important Note: Although the Round 2 Assessment was originally planned to include a thirdsurvey in Kutupalong RC, a high rate of household level refusals linked to fears aroundrelocations from the camp lead to the cancellation of data collection. Kutupalong RC istherefore not included in this assessment.

NUTRITION PROGRAMMINGMakeshift Settlements Nayapara RC

Round 1

Oct-Nov 2017

Round 2

April-May 2018

Round 1

Oct-Nov 2017

Round 2

April-May 2018

Estimated number of children 6-59 months* 131,925 164,647 5,265 3,029

Number of SCs 4 6 0** 1

Number of SCs per child 6-59 months 1 / 32,981 1 / 27,411 0 1 / 3,029

Number of OTPs 31 52 1 1

Number of OTPs per child 6-59 months 1 / 4,256 1 / 3,166 1 / 5,265 1 / 3,029

Number of TSFPs 11 18 1 2

Number of TSFPs per child 6-59 months 1 / 11,933 1 / 9,147 1 / 5,265 1 / 1,515

Number of BSFPs 13 18 1 2

Number of BSFPs per child 6-59 months 1 / 10,148 1 / 9,147 1 / 5265 1 / 1,515

*Derived from ISCG Population Estimates Round 1 and IOM Needs and Population Monitoring estimates Round 2

**Cases in need of SC treatment were referred to the SC in the Ukhia Health Complex outside of the camp (host community)

Source: Nutrition Sector, Cox’s Bazar

PRIMARY OBJECTIVES•To estimate household demographic composition (age and sex distribution, proportion of pregnant and lactating women)

•To determine prevalence of acute malnutrition, stunting, and underweight in children 6-59 months

•To determine prevalence of anaemia in children 6-59 months

•Additional indicators• Women and infant MUAC

• Child morbidity

• Mortality (crude and under 5)

• Infant and Young Child Feeding

• Receipt of Rations

• Nutrition Programming

•Joint assessment of immunization coverage and sero-prevalence conducted amongselected households with results released separately

METHODOLOGYMakeshift Settlements Nayapara Refugee Camp

Cross-sectional household survey conducted using SMART (Standardized Monitoring and Assessment in Relief and

Transitions) Survey design for anthropometric and mortality data

Multi-stage cluster sampling Simple random sampling

Households selected from all residents residing in the

makeshift and informal settlement areas outside of

Kutupalong RC, Nayapara RC, and host communities

Households selected from all residents of Nayapara

Refugee Camp (registered and unregistered)

Sub-block population estimates derived from IOM Needs

and Population Monitoring estimates. Estimates then

updated to capture population movement. Households in

selected clusters were enumerated during April 14th - 19th,

nine days preceding data collection

Household lists from UNHCR PROGRESS database for

registered refugees and from lists created to capture

unregistered persons and new arrivals. Newly arrived

households were enumerated during May 9th - 12th, five

days preceding data collection.

No exclusions

Sample size calculated using ENA software (updated July 9th, 2015)

MAKESHIFT SETTLEMENTSSAMPLING FRAME

Sampling frame included all makeshift and informal sites

hosting Rohingya in Ukhia and Tekanf Upazilas (not including

host communities), including:

• Kutupalong - Balukhali Expansion Site

(Camps 1W - 13 & 17 - 20*)

• Hakimpara (Camp 14)

• Jamtoli (Camp 15)

• Bagghona/Potibonia (Camp 16)

• Chakmarkul (Camp 21)

• Unchiprang (Camp 22)

• Shamlapur (Camp 23)

• Leda Makeshift & Expansion (Camp 24)

• Nayapara Expansion & Shal Bagan (Camp 26)

• Jadimura (Camp 27)

*Ongoing relocations to Camp 20 during data collection likely increased original

population estimates used for the sampling frame. *Makeshift settlements in Teknaf not pictured

Source: ISCG Cox’s Bazar refugee population (Ukhia) as of 25 March 2018

SAMPLE SIZE CALCULATIONS - ANTHROPOMETRY

Parameter Makeshift Settlements Nayapara Refugee Camp

Estimated Prevalence of GAM 20% 12%

Desired Precision 4.5% 4.0%

Design Effect 1.4 1.0

Children to be Included 463 254

Average Household size 4.3 4.7

% of Children Under Five 18.8% 13.0%

Non-Response Rate 10% 12%

Households to be Included 706 524

SAMPLE SIZE CALCULATIONS - MORTALITY

Parameter Makeshift Settlements Nayapara Refugee Camp

Estimated Death Rate per 10,000/day 1.3 0.8

Desired Precision 0.5 0.35

Design Effect 1.4 1.0

Recall period in days 123 144

Population to be Included 2,475 1,742

Average Household size 4.3 4.7

Non-Response Rate 10% 12%

Households to be Included 640 421

Makeshift Settlements

April 28th - May 9th 2017

Preliminary Results

MAKESHIFT - DATA QUALITY

Criteria SD Flagged Sex-ratio Age-ratio Digit Pref Weight

Observed 0.88 0.3% p=0.079 p=0.278 4

Desired 0.8 - 1.2 < 5% (p>0.05) (p>0.05) < 13

Interpretation Good Excellent Good Excellent Excellent

Overall GAM data quality for children 6-59 months is considered excellent

Somewhat narrow standard deviation believed to be observed homogeneity within the population

*Score per ENA for SMART methodology plausibility check

CriteriaDigit Pref

Height

Digit Pref

MUACSkewness Kurtosis Poisson

Overall

Score*

Observed 6 4 0.00 0.37 p=0.773 8%

Desired < 13 < 13 < ± 0.6 < ± 0.6 (p> 0.01) < 15%

Interpretation Excellent Excellent Excellent Good Excellent Excellent

MAKESHIFT - SAMPLE DESCRIPTIONStatus Clusters Households

Children Measured

(6-59 months)

Planned 55 715* 463

Surveyed 55 (100.0%) 675 (94.4%) 596 (128.7%)

Required** 90.0% 80.0%

Registration/Arrival Status HouseholdsChildren Measured

(6-59 months)

Registered Refugees - -

Unregistered Refugees (all) 675 (100.0%) 596 (100.0%)

Arrival prior to October 2016 21 (3.1%) 14 (2.4%)

Arrival October 2016 to August 24, 2017 23 (3.4%) 19 (3.2%)

Arrival August 25, 2017 to December 31, 2017 630 (93.3%) 562 (94.3%)

Arrival January 1, 2018 to date of survey 1 (<1%) 1 (<1%)

*All 715 planned households were visited, 39 households were absent, 1 household level refusal

**Required % of achieved data before reserve clusters must be employed per the SMART Methodology

Population SubsetRound 1

Oct-Nov 2017

Round 2

April-May 2018

All Household Members 6,146 3,404

Average HH Size, mean (SD) 4.7 (2.1) 5.0 (2.3)

Population Subset % [CI 95%] % [CI 95%]

Female 51.4% [50.2-52.5] 51.0% [49.4-52.7]

Women, 15-49 Years 23.7% [23.0-24.5] 23.9% [22.8-25.0]

Pregnant and lactating women 9.8% [9.1-10.6] 9.3% [8.5-10.2]

Pregnant women 3.1% [2.7-3.6] 3.0% [2.4-3.6]

Lactating women 6.7% [6.2-7.2] 6.4% [5.6-7.1]

w/infant < 6 months 2.2% [1.8-2.6] 1.7% [1.4-2.2]

w/infant ≥ 6 months 4.5% [4.0-5.0] 4.6% [4.1-5.2]

Children 0-59 months 20.3% [19.3-21.4] 20.2% [18.9-21.5]

Children 5-10 years 18.7% [17.8-19.6] 19.5% [17.9-21.1]

Children 11-17 years 15.9% [14.9-16.9] 16.3% [14.9-17.8]

Adults 18-59 years 40.8% [40.0-41.8] 39.8% [38.5-41.2]

Adults 60+ years 4.3% [3.8-4.9] 4.2% [3.6-4.9]

MAKESHIFT RESULTS - DEMOGRAPHY

MAKESHIFT RESULTS - WASTING & STUNTING

Indicator

Round 1

Oct-Nov 2017

Round 2

April-May 2018 P-value

Sample % [95% CI] Sample % [95% CI]

Global Acute MalnutritionWHZ < -2 z +/- oedema*

Children 6 - 59

months (n=1,086)

19.3%

[16.7-22.2] Children 6 - 59

months (n=594)**

12.0%

[9.4-15.0]<0.001

Severe Acute MalnutritionWHZ < -3 z +/- oedema

3.0%

[2.2-4.2]

2.0%

[1.1-3.6]0.238

Global Acute MalnutritionMUAC < 125 mm +/- oedema

Children 6 - 59

months (n=1,087)

8.6%

[6.8-10.7] Children 6 - 59

months (n=600)

4.3%

[3.2-5.9]0.001

Severe Acute MalnutritionMUAC < 115mm +/- oedema

1.3%

[0.8-2.1]

0.5%

[0.2-1.6]0.108

Global Chronic MalnutritionHAZ < -2 z

Children 6 - 59

months (n=1,071)

44.1%

[40.7-47.5] Children 6 - 59

months (n=592)

37.7%

[33.0-42.5]0.031

Severe Chronic MalnutritionHAZ < -3 z

12.0%

[10.1-14.3]7.9%

[5.8-10.8]0.019

*No cases of oedema identified **Four children were not measured due to disability

MAKESHIFT RESULTS - HAZ STUNTING BY AGE

Prevalence

of stunting

by HAZ has

reduced

most notably

among

young age

categories.

MAKESHIFT RESULTS - MUAC

Indicator

Round 1

Oct-Nov 2017

Round 2



Low Women’s MUACMUAC < 210 mm

Women

15 - 49 years

(n= 1,385)

8.6%

[6.7-11.1]

Women

15 - 49 years

(n=734)

2.6%

[1.6-4.2]<0.001


PLW*

15 - 49 years

(n=311)

12.2%

[8.6-17.2]

PLW*

15 - 49 years

(n=147)

3.4%

[1.4-7.8]0.003

Indicator Sample Mean (SD) Sample Mean (SD) P-value

Women’s MUAC

Women

15 - 49 years

(n= 1,385)

247 mm (31.8)

Women

15 - 49 years

(n=734)

254 mm (29.1) <0.001

Infant MUAC

Infants

0 - 5 months

(n=128)

119 mm (17.4)

Infants

0 - 5 months

(n=53)

124 mm (15.4) 0.057

*Exclusively women who are pregnant or lactating with an infant <6 months, as this subset is eligible for ongoing humanitarian programs.

MAKESHIFT RESULTS - ANAEMIA

Severity

Round 1

Oct-Nov 2017

Round 2



Any anaemia (Hb<11.0 g/dL)

Children

6-59 months

(n=1,082)

47.9% [44.1-51.7]

Children

6-59 months

(n=598)

32.3% [27.8-37.1] <0.001

Mild (Hb 10 to <11.0 g/dl) 30.8% [27.7-34.0] 19.6% [16.7-22.8] <0.001

Moderate (Hb 7 to <10.0 g/dl) 16.9% [14.5-19.7] 12.5% [9.8-15.9] 0.037

Severe (Hb <7.0 g/dl) 0.2% [0.1-0.7] 0.2% [0.1-1.2] 0.935

Any anaemia (Hb<11.0 g/dL)Children

6-23 months

(n=349)

61.6% [55.8-67.1]

Children

6-23 months

(n=196)

52.0% [44.0-60.0] 0.055

Mild (Hb 10 to <11.0 g/dl) 32.1% [27.5-37.1] 30.1% [23.8-37.3] 0.638


Severe (Hb <7.0 g/dl) 0.3% [0.1-2.0] 0.5% [0.1-3.6] 0.677


24-59 months

(n=733)

41.3% [37.5-45.3]Children

24-59 months

(n=402)

22.6% [17.9-28.2] <0.001

Mild (Hb 10 to <11.0 g/dl) 30.2% [26.5-34.1] 14.4% [11.2-18.4] <0.001


Severe (Hb <7.0 g/dl) 0.1% [0.1-0.9] 0 -

MAKESHIFT RESULTS - ANAEMIA BY AGE

Prevalence

of anaemia

(Hb <11.0

g/dL) has

reduced

across all

except the

youngest age

category.

MAKESHIFT RESULTS - MORBIDITY

Indicator

Round 1

Oct-Nov 2017

Round 2



Prevalence of diarrhoea*

Children

6-59 months

(n=1,110)

41.3%

[36.5-46.2]

Children

6-59 months

(n=628)

20.9%

[17.4-24.8]<0.001

Prevalence of acute respiratory

illness with fever*

57.7%

[52.7-62.4]

26.1%

[21.1-32.0]<0.001

Prevalence of fever without

cough*†

25.2%

[20.5-30.6]

40.0%

[34.6-46.0]<0.001

Prevalence of fever with rash

(suspected measles)**

Data not collected during Round 1

13.9%

[10.7-17.7]-

Confirmed by health document 2.1% [0.7-5.9]

Confirmed by recall 11.8% [9.0-15.4]

Prevalence of diphtheria**6.2%

[3.7-10.3]-

Confirmed by health document 1.9% [0.5-7.2]

Confirmed by recall 4.3% [2.7-6.9]

*Two-week recall period † Round 2 stipulated without cough and without rash given the need for higher sensitivity during malaria season

**Confirmed by health facility document or recall, recall period since August 25th, 2017

MAKESHIFT RESULTS - HEALTH SEEKING BEHAVIORS

MAKESHIFT RESULTS - IYCF

Indicator

Round 1

Oct-Nov 2017

Round 2

April-May 2018P-value


Ever BreastfedChildren 0 - 23

months (n=497)

98.6%

[97.1-99.3]

Children 0 - 23

months (n=265)

96.6%

[93.4-98.3]0.070

Timely Initiation of

Breastfeeding

Children 0 - 23

months (n=490)

43.9%

[35.6-50.4]

Children 0 - 23

months (n=256)

55.5%

[48.3-62.4]0.017

Exclusive

Breastfeeding*

Children 0 - 5

months (n=132)

56.1%

[45.1-66.4]

Children 0 - 5

months (n=58)

50.0%

[34.4-66.0]0.535

Continued

Breastfeeding at

One Year*

Children 12 - 15

months (n=73)

97.3%

[89.2-99.2]

Children 12 - 15

months (n=37)

97.3%

[83.8-99.6]0.991

Continued

Breastfeeding at

Two Years*

Children 20 - 23

months (n=45)

71.1%

[54.3-83.6]

Children 20 - 23

months (n=40)

62.5%

[44.7-77.5]0.443

*Survey sample size was not calculated for IYCF indicators, and therefore the precision of some indicators is insufficient to draw firm conclusions


Indicator

Round 1

Oct-Nov 2017

Round 2



Introduction of

Complementary

Foods*†

Children 6 - 8

months (n=66)

71.2%

[56.5-82.5]

Children 6 - 8

months (n=34)

85.3%

[67.8-94.1]0.163

Minimum Dietary

Diversity 4 of 7 food groups

Children 6 - 23

months (n=361)

8.3%

[5.2-13.0]

Children 6 - 23

months (n=207)

12.6%

[8.4-18.3]0.174

Minimum Meal

Frequency3 meals per day

61.2%

[54.6-67.5]

57.5%

[48.5-66.0]0.500

Minimum

Acceptable DietMDD + MMF

6.4%

[3.8-10.4]

7.3%

[4.1-12.4]0.732

*Survey sample size was not calculated for IYCF indicators, and therefore the precision of some indicators is insufficient to draw firm conclusions.†Proportion of infants 6-8 months of age who receive solid, semi-solid, or soft foods (WHO)


*Examples include carrot, pumpkin, sweet potato, mango, papaya, dark green leafy vegetables, long beans

Consumption

of grains,

legumes, dairy,

and other

fruits and

vegetables

among

children 6-23

months has

increased since

Round 1

(<0.05)

MAKESHIFT RESULTS - RECEIPT OF FOOD RATIONS

Indicator

Round 1**

Oct-Nov 2017

Round 2**

April-May 2018


Proportion of households receiving food distributions*Households

1,066/1,297

82.2%

[75.1-87.6]Data not collected during Round 2

Proportion of households with a general food distribution

(GFD) ration card and/or e-voucher (SCOPE) card†§


Households

662/675

98.1%

[96.0-99.1]

Proportion of households with a GFD ration card†Households

552/675

81.8%

[71.1-89.1]

Proportion with documented receipt in April 2018Households

542/552

98.2%

[95.4-99.3]

Proportion of households with a SCOPE card for food rations§Households

120/675

17.8%

[10.3-29.0]


119/120

99.2%

[93.3-99.9]

*Defined as one person in the household receiving at least one bag of rice in a distribution between August 25th 2017 and Round 1 data collection†Presence of a ration card was visually confirmed. Ration card from ICRC in Chakmarkul and Unchiprang, or a ration card from Tika in Baghona, or from

WFP in all other camps were considered. WFP was not providing GFD in-kind in Chakmarkul, Unchiprang, and Baghona at the time of the assessment. 6

of 13 households without ration cards at the time of the visit reported they had ration cards (but it could not be visually confirmed).§Presence of a e-voucher or SCOPE card was visually confirmed.

**Round 1 recall period: between August 25th 2017 and data collection. Round 2 recall period: between January 1st 2018 and data collection

MAKESHIFT RESULTS - NUTRITION PROGRAMMING

Indicator

Round 1

Oct-Nov 2017

Round 2



Proportion of children

identified as SAM (WHZ)

enrolled in an Outpatient

Therapeutic Feeding Program

Children 6-59

months with SAM

(WHZ) (n=33)*

12.1%

[4.5-28.8]

Children 6-59

months with SAM

(WHZ) (n=12)*

16.7%

[3.9-50.0]0.702

Proportion of children that

received fortified blended

foods in the past two weeks**

Children 6-59

months (n=1,110)

12.8%

[8.7-18.4]

Children 6-59

months (n=628)

49.8%

[40.1-59.6]<0.001


received micronutrient

powder***

Children 6-59

months (n=1,110)

10.3%

[7.1-14.6]

Children 6-59

months (n=628)

29.9%

[22.3-39.0]<0.001

*Small sample size greatly reduces precision and produces wide confidence intervals. Interpret with caution.

**Corn or wheat soy blend (CSB++/WSB++)

***Recall period Round 1 between August 25th 2017 and data collection, Round 2 between January 1st 2018 and data collection

MAKESHIFT RESULTS - WHZ VS. MUACGlobal Acute Malnutrition by WHZ vs. MUAC among Children 6-59 months (n=594)*

Children with

GAM by WHZ

who are not GAM

by MUAC

(55/71) = 77.5% *Only children with

both WHZ and

MUAC values

included in analysis

MAKESHIFT RESULTS - MORTALITYIndicator

Round 1

Oct-Nov 2017

Round 2


Sample Rate [95% CI] Sample Rate [95% CI]

Crude death rate*

Deaths/10.000/day

Mid-interval

population**

(n=5,373.5)

1.36 [1.07-1.73]

Mid-interval

population**

(n=3,412.5)

0.38 [0.23-0.64] <0.001

Under 5 death rate

Deaths/10.000/day

Mid-interval under

5 population**

(n=1,007.5)

1.22 [0.70-2.13]

Mid-interval under

5 population**

(n=664.5)

0.86 [0.37-1.94] 0.550

Cause of Death Sample Rate Sample Rate P-value

Illness

Not reported

Household

member deaths

(n=16)

100% -

Injury/Trauma 0.0% -

*For Round 1 the end of Ramadan (June 25, 2017) was used as the beginning of the mortality recall period (138 days). For Round 2 January 1st, 2018

was used as the beginning of the mortality recall period (123 days).

**All household members present during recall period adjusted for in and out migration

Crude Death Rate emergency threshold considered 1 death/10,000/day

Nayapara Refugee Camp

May 17th - May 28th 2017

Preliminary Results

NAYAPARA - DATA QUALITY

Criteria SD Flagged Sex-ratio Age-ratio Digit Pref Weight

Observed 0.80 0.0% p=0.906 p=0.108 6

Desired 0.8 - 1.2 < 5% (p>0.05) (p>0.05) < 13

Interpretation Good Excellent Excellent Excellent Excellent

Overall GAM data quality for children 6-59 months is considered good

Narrow standard deviation believed to be observed homogeneity within the population

*Score per ENA for SMART methodology plausibility check

CriteriaDigit Pref

Height

Digit Pref

MUACSkewness Kurtosis

Overall

Score*

Observed 7 7 -0.03 0.19 10%

Desired < 13 < 13 < ± 0.6 < ± 0.6 < 15%

Interpretation Excellent Excellent Excellent Excellent Good

NAYAPARA - SAMPLE DESCRIPTIONStatus Households

Children Measured

(6-59 months)

Planned 524 254

Surveyed 483 (92.2%) 279 (110.0%)

Required** 80.0%

Registration/Arrival Status HouseholdsChildren Measured

(6-59 months)

Registered Refugees 411 (85.1%) 245 (87.8%)

Unregistered Refugees (all) 72 (14.9%) 34 (12.2%)

Arrival prior to October 2016 2 (0.4%) -

Arrival October 2016 to August 24, 2017 8 (1.7%) 4 (1.4%)

Arrival August 25, 2017 to December 31, 2017 59 (12.2%) 27 (9.7%)

Arrival January 1, 2018 to date of survey 3 (<1%) 3 (1.1%)

*All 524 planned households were visited, 41 households were absent, no household level refusals

** Required % of achieved data per the SMART Methodology

Population SubsetRound 1

Oct-Nov 2017

Round 2

April-May 2018

All Household Members 3,093 2,562

Average HH Size, mean (SD) 5.3 (2.5) 5.3 (2.3)

Population Subset % [CI 95%] % [CI 95%]

Female 51.1% [49.3-52.8] 50.6% [48.7-52.6]

Women, 15-49 Years 24.4% [22.9-25.9] 25.1% [23.5-26.9]

Pregnant and lactating women 7.0% [6.2-8.0] 7.1% [6.1-8.1]

Pregnant women 2.2% [1.7-2.7] 2.3% [1.8-3.0]

Lactating women 4.9% [4.2-5.7] 4.8% [4.0-5.7]

w/infant < 6 months 1.6% [1.3-2.2] 1.3% [0.9-1.8]

w/infant ≥ 6 months 3.2% [2.6-3.9] 3.5% [2.8-4.3]

Children 0-59 months 15.0% [13.8-16.3] 12.4% [11.2-13.8]

Children 5-10 years 19.8% [18.5-21.3] 18.9% [17.5-20.5]

Children 11-17 years 21.2% [19.8-22.7] 22.3% [20.7-23.9]

Adults 18-59 years 40.9% [39.2-42.6] 42.9% [41.0-44.9]

Adults 60+ years 3.1% [2.6-3.8] 3.5% [2.8-4.3]

NAYAPARA RESULTS - DEMOGRAPHY

NAYAPARA RESULTS - WASTING & STUNTING

Indicator

Round 1

Oct-Nov 2017

Round 2


Sample % [95% CI] Sample** % [95% CI]

Global Acute MalnutritionWHZ <-2 z +/- oedema* Children

6 - 59 months

(n=398)

14.3%

[11.2-18.1] Children

6 - 59 months

(n=279)

13.6%

[10.1-18.1]0.796

Severe Acute MalnutritionWHZ < -3 z +/- oedema

1.3%

[0.5-2.9]1.4%

[0.6-3.6]0.912

Global Acute MalnutritionMUAC < 125 mm +/- oedema Children

6 - 59 months

(n=400)

7.0%

[4.9-9.9] Children

6 - 59 months

(n=279)

3.6%

[2.0-6.5]0.047

Severe Acute MalnutritionMUAC < 115mm +/- oedema

1.8%

[0.9-3.6]

0.4%

[0.1-2.0]0.068

Global Chronic MalnutritionHAZ <-2 z Children

6 - 59 months

(n=392)

44.4%

[39.5-49.3] Children

6 - 59 months

(n=275)

40.4%

[34.7-46.3]0.303

Severe Chronic MalnutritionHAZ < -3 z

12.5%

[9.6-16.1]7.6%

[5.0-11.4]0.034

*No cases of oedema identified

NAYAPARA RESULTS - MUAC

Indicator

Round 1

Oct-Nov 2017

Round 2




Women

15 - 49 years

(n=693)

3.5%

[2.3-5.1]

Women

15 - 49 years

(n=625)

2.4%

[1.5-3.9]0.256


PLW*

15 - 49 years

(n=116)

3.5%

[1.3-8.9]

PLW*

15 - 49 years

(n=92)

6.5%

[2.9-13.9]0.306

Indicator Sample Mean (SD) Sample Mean (SD) P-value

Women’s MUAC

Women

15 - 49 years

(n=693)

257 mm (1.3)

Women

15 - 49 years

(n=625)

271 mm (1.5) <0.001

Infant MUAC

Infants

0 - 5 months

(n=52)

118 mm (13.2)

Infants

0 - 5 months

(n=34)

124 mm (18.5) 0.111

*Exclusively women who are pregnant or lactating with an infant <6 months. This subset is eligible for ongoing humanitarian programs.

NAYAPARA RESULTS - ANAEMIA

Severity

Round 1

Oct-Nov 2017

Round 2




6-59 months

(n=399)

46.6% [41.8-51.5]

Children

6-59 months

(n=279)

29.4% [24.3-35.0] <0.001

Mild (Hb 10 to <11.0 g/dl) 31.1% [26.7-35.8] 18.6% [14.5-23.7] <0.001


Severe (Hb <7.0 g/dl) 0 0.4% [0.1-2.5] -


6-23 months

(n=117)

65.0% [55.8-73.1]

Children

6-23 months

(n=90)

54.4% [44.0-64.5] 0.128

Mild (Hb 10 to <11.0 g/dl) 40.2% [31.6-49.4] 33.3% [24.3-43.8] 0.315


Severe (Hb <7.0 g/dl) 0 0.2% [0.1-1.0] -


24-59 months

(n=282)

39.0% [33.5-44.9]

Children

24-59 months

(n=189)

17.5% [12.7-23.6] <0.001

Mild (Hb 10 to <11.0 g/dl) 27.3% [22.4-32.8] 11.6% [7.8-17.1] <0.001


Severe (Hb <7.0 g/dl) 0 0.2% [0.1-1.0] -

NAYAPARA RESULTS - ANAEMIA BY AGE

Prevalence

of anaemia

(Hb <11.0

g/dL) has

reduced in

all but the

youngest age

categories.

NAYAPARA RESULTS - MORBIDITY

Indicator

Round 1

Oct-Nov 2017

Round 2



Prevalence of diarrhoea*

Children

6 - 59 months

(n=408)

34.3%

[30.0-39.1]

Children

6 - 59 months

(n=284)

23.9%

[19.3-29.3]0.004

Prevalence of acute

respiratory illness with fever*

50.3%

[45.4-55.1]

21.5%

[17.1-26.7]<0.001

Prevalence of fever without

cough*†

16.9%

[13.6-20.9]

40.5%

[34.9-46.3]<0.001

Prevalence of fever with rash

(suspected measles)**


11.6%

[8.4-15.9]-

Prevalence of diphtheria**0.4%

[0.1-2.5]-

*Two-week recall period † Round 2 stipulated without cough and without rash given the need for higher sensitivity during malaria season

**All cases by self report (not health facility documents). Cases include children reportedly diagnosed by hospital or clinic but confirmed by caregiver

recall. Recall period since August 25th, 2017

NAYAPARA RESULTS - HEALTH SEEKING BEHAVIORS

NAYAPARA RESULTS - IYCF

Indicator

Round 1

Oct-Nov 2017

Round 2



Ever BreastfedChildren 0 - 23 months

(n=175)

97.7%

[94.0-99.1]Children 0 - 23

months (n=125)

100.0% 0.088

Timely Initiation

of Breastfeeding

Children 0 - 23 months

(n=171)

48.5%

[41.1-56.1]

76.0%

[67.7-82.7]<0.001

Exclusive

Breastfeeding*


(n=54)

72.2%

[58.6-82.7]

Children 0 - 5

months (n=34)

73.5%

[56.1-85.8]0.894

Continued

Breastfeeding at

One Year*


(n=28)

96.4%

[76.3-99.5]

Children 12 - 15

months (n=20)100.0% 0.398

Continued

Breastfeeding at

Two Years*


(n=21)

66.7%

[43.8-83.7]

Children 20 - 23

months (n=25)

64.0%

[43.2-80.6]0.852

*Survey sample size was not calculated for IYCF indicators, and therefore the precision of some indicators is insufficient to draw firm conclusions


Indicator

Round 1

Oct-Nov 2017

Round 2



Introduction of

Complementary

Foods*†

Children 6 - 8

months (n=19)

94.7%

[68.4-99.3]

Children 6 - 8

months (n=16)

81.3%

[53.6-94.2]0.227

Minimum Dietary

Diversity 4 of 7 food groups

Children 6 - 23

months (n=121)

15.7%

[10.2-23.4]

Children 6 - 23

months (n=91)

37.4%

[28.0-47.8]<0.001

Minimum Meal

Frequency3 meals per day

65.3%

[56.3-73.3]

61.5%

[51.1-71.0]0.576

Minimum

Acceptable DietMDD + MMF

15.7%

[10.2-23.4]

29.7%

[21.1-39.9]0.016

*Survey sample size was not calculated for IYCF indicators, and therefore the precision of some indicators is insufficient to draw firm conclusions.†Proportion of infants 6-8 months of age who receive solid, semi-solid, or soft foods (WHO)


*Examples include carrot, pumpkin, sweet potato, mango, papaya, dark green leafy vegetables, long beans

Consumption

of legumes,

dairy, and

other fruits

and

vegetables

among

children 6-23

months has

increased since

Round 1

(<0.05)

NAYAPARA RESULTS - RECEIPT OF FOOD RATIONS

Indicator

Round 1**

Oct-Nov 2017

Round 2**

April-May 2018


Proportion of households receiving food distributions*Households

223 / 258

86.4%

[81.7-90.1]Data not collected during Round 2

Proportion of households with a general food distribution

(GFD) ration card and/or e-voucher (SCOPE) card†§


Households

479 / 483

99.2%

[97.8-99.7]

Proportion of households with a GFD ration card†Households

17/ 483

3.5%

[2.2-5.6]


16 / 17

94.1%

[62.7-99.4]

Proportion of households with a SCOPE card for food rations§Households

463 / 483

95.9%

[93.7-97.3]


462 / 463

99.8%

[98.5-99.9]

*Defined as one person in the household receiving at least one bag of rice in a distribution between August 25th 2017 and Round 1 data collection, only

unregistered households eligible for GFD during round 1. †Presence of a ration card was confirmed by household recall or visual confirmation.§Presence of a e-voucher or SCOPE card was confirmed by household recall or visual confirmation.

**Round 2 recall period: between January 1st 2018 and data collection

NAYAPARA RESULTS - NUTRITION PROGRAMMING

Indicator

Round 1

Oct-Nov 2017

Round 2



Proportion of children

identified as SAM (WHZ)

enrolled in an Outpatient

Therapeutic Feeding Program

Children 6-59

months with SAM

(WHZ) (n=5)*

40.0%

[10.0-80.0]

Children 6-59

months with SAM

(WHZ) (n=4)*

25.0%

[3.3-76.5]0.786


received fortified blended

foods in the past two weeks**Children 6-59

months (n=408)

23.3%

[19.4-27.6]

Children 6-59

months (n=284)

82.8%

[77.9-86.7]<0.001


received micronutrient

powder***

10.5%

[7.9-13.9]

58.5%

[52.6-64.1]<0.001

*Small sample size greatly reduces precision and produces wide confidence intervals. Interpret with caution

*Corn or wheat soy blend (CSB++/WSB++)

**Round 1 between August 25th 2017 and data collection, Round 2 between January 1st 2018 and data collection

NAYAPARA RESULTS - WHZ VS. MUACGlobal Acute Malnutrition by WHZ vs. MUAC among Children 6-59 months (n=279)*

Children with

GAM by WHZ

who are not GAM

by MUAC

(32/38) = 84.2% *Only children with

both WHZ and

MUAC values

included in analysis

NAYAPARA RESULTS - MORTALITY

Indicator

Round 1

Oct-Nov 2017

Round 2


Sample Rate [95% CI] Sample Rate [95% CI]

Crude death rate*

Deaths/10.000/day

Mid-interval

population**

(n=3,647.5)

0.75 [0.56-1.01]

Mid-interval

population**

(n=2,624)

0.21 [0.11-0.42] <0.001

Under 5 death rate

Deaths/10.000/day

Mid-interval under

5 population**

(n=490)

0.80 [0.37-1.73]

Mid-interval under

5 population**

(n=309.5)

0.22 [0.04-1.26] 0.248

Cause of Death Sample Rate Sample Rate P-value

Illness

Not reported

Household

member deaths

(n=8)

62.5% -

Injury/Trauma 12.5% -

Unknown 25.0% -

*For Round 1 the end of Ramadan (June 25, 2017) was used as the beginning of the mortality recall period (153 days). For Round 2 January 1st, 2018

was used as the beginning of the mortality recall period (144 days).

**All household members present during recall period adjusted for in and out migration

Crude Death Rate emergency threshold considered 1 death/10,000/day

EVOLUTION OF GAM PREVALENCE IN NAYAPARA RC

Evolution of

GAM rates

among

children 6 to

59 months for

Nayapara RC

using the

SMART

methodology

in relation to

the 15%

WHO

Emergency

Threshold.

COMPARATIVE PRELIMINARY RESULTS - MAKESHIFT SETTLEMENTSSurvey

Indicator

Makeshift Round 1

Total Population 720,902

Oct 29th - Nov 20th 2017

Makeshift Round 2

Total Population 904,657

May 17th – 28th 2018

Statistical

Significance

GAM/SAM (WHZ)children 6-59 months

19.3% [16.7-22.2]

3.0% [2.2-4.2]

12.0% [9.4-15.0]

2.0% [1.1-3.6]

<0.001

0.238

GAM/SAM (MUAC)children 6-59 months

8.6% [6.8-10.7]

1.3% [0.8-2.1]

4.3% [3.2-5.9]

0.5% [0.2-1.6]

0.001

0.108

Stunting Global/Severechildren 6-59 months

44.1% [40.7-47.5]

12.0% [10.1-14.3]

37.7% [33.0-42.5]

7.9% [5.8-10.8]

0.031

0.019

Anaemia (Hb<11.0g/dL)children 6-59 months

47.9% [44.1-51.7] 32.3% [27.8-37.1] <0.001

Diarrhoeachildren 6-59 months

41.3% [36.5-46.2] 20.9% [17.4-24.8] <0.001

Exclusive Breastfeeding infants 0-5 months

56.1% [45.1-66.4] 50.0% [34.4-66.0] 0.535

Continued BF, 1 Year children 12-15 months

97.3% [89.2-99.2] 97.3% [83.8-99.6] 0.991

Min. Acceptable Dietchildren 6-23 months

6.4% [3.8-10.4] 7.3% [4.1-12.4] 0.732

Mortality (CDR & U5DR)1.36 [1.07-1.73]

1.22 [0.70-2.13]

0.38 [0.23-0.64]

0.86 [0.37-1.94]

<0.001

0.550

COMPARATIVE PRELIMINARY RESULTS - NAYAPARA RCSurvey

Indicator

Nayapara RC Round 1Total Population 38,997

Nov 20th - Nov 27th

Nayapara RC Round 2Total Population 24,430

May 17th – 28th

Statistical

Significance

GAM/SAM (WHZ)children 6-59 months

14.3% [11.2-18.1]

1.3% [0.5-2.9]

13.6% [10.1-18.1]

1.4% [0.6-3.6]

0.796

0.912

GAM/SAM (MUAC)children 6-59 months

7.0% [4.9-9.9]

1.8% [0.9-3.6]

3.6% [2.0-6.5]

0.4% [0.1-2.0]

0.047

0.068

Stunting Global/Severechildren 6-59 months

44.4% [39.5-49.3]

12.5% [9.6-16.1]

40.4% [34.7-46.3]

7.6% [5.0-11.4]

0.303

0.034

Anaemia (Hb<11.0g/dL)children 6-59 months

46.6% [41.8-51.5] 29.4% [24.3-35.0] <0.001

Diarrhoeachildren 6-59 months

34.3% [30.0-39.1] 23.9% [19.3-29.3] 0.004

Exclusive Breastfeeding infants 0-5 months

72.2% [58.6-82.7] 73.5% [56.1-85.8] 0.894

Continued BF, 1 Year children 12-15 months

96.4% [76.3 - 99.5] 100.0% 0.398

Min. Acceptable Dietchildren 6-23 months

15.7% [10.2-23.4] 29.7% [21.1-39.9] 0.016

Mortality (CDR & U5DR)0.75 [0.56-1.01]

0.80 [0.37-1.73]

0.21 [0.11-0.42]

0.22 [0.04-1.26]

<0.001

0.248

SUMMARY OF PRELIMINARY RESULTSThe Prevalence of acute malnutrition using weight-for-height (WHZ) has decreased significantly in the Makeshift Settlements

to below the WHO Emergency Threshold (15%)

Acute malnutrition prevalence remains below emergency levels in Nayapara RC (14%)

More than 75% of acutely malnourished children in both surveys were identified by WHZ only (missing by MUAC)

Stunting using height-for-age (HAZ) has declined but remains at or near the WHO critical threshold (40%) in both Makeshift

Settlements (38%) and Nayapara RC (40%). Decline most pronounced in younger children. Still a public health concern.

The prevalence of Anaemia has decreased significantly, to below the severe health problem threshold (40%) in both sites;

from nearly 1-in-2 children anemic in Oct-Nov to 1-in-3 anemic in April-May. Still a public health concern in younger children.

Two-week prevalence of Diarrhoea and Acute Respiratory Infection have decreased in both sites, but the rate of Fever has

more than doubled in Nayapara RC (40% vs. 17%). Seeking treatment in formal health centers for child morbidities has

increased in the Makeshift Settlements but decreased in Nayapara RC.

Household level support with food assistance by Ration Card or E-Voucher was found to be nearly universal in both sites.

The proportion of children 6-59 months receiving fortified foods has increased by 4-fold in the Makeshift Settlements and 3-

fold in Nayapara RC, but remains below 50% in the Makeshift Settlements. The proportion of children receiving micronutrient

powders has increased significantly in both sites. Meanwhile, the proportion of children 6-23 months reportedly achieving

minimum acceptable diet remains low.

Crude mortality rates are significantly below the emergency threshold of 1/10,000/persons/day in both sites.

The Survey Teams

Action Against Hunger

Nutrition Sector

Assessment Technical Working Group

The Government of Bangladesh

The Camp in Charge of Nayapara RC

The Institute of Public Health & Nutrition

United Nations High Commissioner for Refugees

United Nations Children's Fund

The Centers for Disease Control and Prevention

World Food Programme

Save the Children

ACKNOWLEDGEMENTS

Documents

EMERGENCY NUTRITION AND HEALTH ASSESSMENT … · Multi-stage cluster sampling Simple random sampling ... Sampling frame included all makeshift and informal sites ... • Nayapara