water resource assessment of the dry zone Component 2 Final_29Aug2013.pdf
A Nutrition and Food Security Assessment of the Dry Zone ... zone survey - Nutrition... · A...
Transcript of A Nutrition and Food Security Assessment of the Dry Zone ... zone survey - Nutrition... · A...
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A Nutrition and Food Security Assessment of the Dry Zone of Myanmar,
June 24th - July 18th 2013
January 16th 2014
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OBJECTIVES
1. Estimate the prevalence of indicators
of undernutrition in the Dry Zone, and
three different agroecological zones
within
2. Estimate infant and young child
feeding practice rates
3. Assess the differences in the nutrition
situation by agroecological zone and
the likely reasons, examining the
associations between nutrition and
other indicators
4. Make recommendations for
programming, policy and advocacy
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Agroecological zone
number
Agroecological zone name
Characteristics
1 Dry land farming
1. Low land, not flood prone, no
irrigation
2. Suitable soil for cultivation
3. Only single or double cropping possibilities
2
High land with sloping agriculture
1. High land (greater than 300
meters)
2. Soil suitable for orchards,
plantations, forest
3. Sloping/ shifting cultivation
agriculture practiced
3 Flood plains and irrigated areas
1. Flood plain with good soil fertility 2. Irrigated land 3. Multi-cropping possibilities year round
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METHODS (1/5): DESIGN
A cross sectional, two stage, random,
cluster survey of rural villages, with 3
strata (agroecological zones)
Stage 1: Random selection of 50 village
clusters per zone
Stage 2: Random selection of 40
households per village (12 households with
children under 5 for nutrition/IYCF data and
13 (minimum 10) households with/without
children under 5 for food security/HH data)
A household: “ a person or group of people eating and sleeping in the same compound four nights weekly and sharing resources, not including those who may have migrated”
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METHODS (2/5) SAMPLE SIZE
Nutrition: • 1,800 children 0-59 months Infant and Young Child Feeding: • 522 0-24 month olds Mothers: • All of the children 0-59 months Food security, wealth/poverty and Water Sanitation and Hygiene (WASH): • 1,500 households (with/without U5s) • Including 560 households with child
nutrition and household food security data
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METHODS (3/5): QUESTIONNAIRES
• Village profile: Population (for weighting);
crop production; market, clinic and water
source access and distance by season;
and common diseases affecting children
• Household: Written consent and
household demography
• Mother: Anthropometry; ANC/PNC; 24
hour diet recall
• Household Food Security,
wealth/poverty, WASH
• Child under 5: Anthropometry; recent
sickness; supplementation and
vaccination status and hygiene practices
• Child under 2: Infant and Young Child
Feeding practices
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METHODS (4/5): MEASUREMENTS
• Children: weight, height/length, Mid Upper Arm
Circumference (MUAC) and check for oedema.
Date of birth
• Mothers: weight, height and MUAC. Age
• Salt iodisation test at household level
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METHODS (5/5):
FIELD LOGISTICS
• 64 staff (10 from DRD), 9
teams, 8 supervisors
• 2 weeks training, including
practice anthropometry &
village pilot
• 3.5 weeks field work
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NUTRITION RESULTS
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Maximum achieved
sample sizes Dry land
farming zone (1)
Highland farming zone
(2)
Flood plains/
irrigated zone (3)
Dry Zone total
Planned sample size
Villages 51 50 51 152 150
Households with children U5 601 607 600 1808 ND
Households with OR without children U5 617 574 612 1803 1500
Children U5 687 689 600 2037 1800
Children U2 290 289 243 822 522
Mothers (children U5) 591 598 599 1789 ND
SAMPLE SIZE ACHIEVED:
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% Wasted / acutely malnourished (0-59 month olds)
0-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
90-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
90-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
9
0
5
1 0
1 5
2 0
2 5
A g e (m o n th s )
Pre
va
le
nc
e o
f G
lo
ba
l A
cu
te
M
aln
utritio
n %
Z o n e 1
Z o n e 2
Z o n e 3
Zo n e 1 Zo n e 2 Zo n e 3 Ag g r e g a te d
0
5
1 0
1 5
2 0
A g ro e c o lo g ic a l Z o n e s
Pre
va
le
nc
e o
f G
lo
ba
l A
cu
te
M
aln
utritio
n % M o d e ra te
S e v e re
A c c e p ta b le
P o o r
H ig h
C rit ic a l
P u b lic H e a lth S ig n ific a n c e
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% Stunted/chronically malnourished (0-59 month olds)
0-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
90-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
90-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
9
0
1 0
2 0
3 0
4 0
5 0
A g e (m o n th s )
Pre
va
le
nc
e o
f S
tu
ntin
g %
Z o n e 1
Z o n e 2
Z o n e 3
Zo n e 1 Zo n e 2 Zo n e 3 Ag g r e g a te d
0
1 0
2 0
3 0
4 0
5 0
A g ro e c o lo g ic a l Z o n e s
Pre
va
le
nc
e o
f S
tu
ntin
g %
M o d e ra te
S e v e re
L o w
M e d iu m
H ig h
V e ry h ig h
P u b lic H e a lth S ig n ific a n c e
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Weight for Height Z-score (WHZ) and Height for Age Z-score (HAZ) distributions
0.1
.2.3
.4.5
Pro
po
rtio
n
-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
Weight-for-length z-score
0.1
.2.3
.4
Pro
po
rtio
n
-6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
Height-for-age z-score
<-2 = wasted <-2 = stunted
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Zo n e 1 Zo n e 2 Zo n e 3 Ag g r e g a te d
0
1 0
2 0
3 0
4 0
A g ro e c o lo g ic a l Z o n e s
Pre
va
len
ce
of
Lo
w B
irth
we
igh
t %
% Babies born Low Birth Weight (<2500g)
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% Undernutrition in mothers
M U A C < 2 1 0 c m B M I < 1 8 .5 k g /m 2
5
1 0
1 5
2 0
2 5
In d ic a to r
Pre
va
len
ce
of
mo
the
rs
' u
nd
ern
utr
itio
n % Z o n e 2
Z o n e 3
Z o n e 1
A g g re g a te d
• Mean MUAC pregnant/lactating mothers: 26.0cm
• Mean MUAC non-pregnant/lactating mothers: 26.8cm
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DISEASE AND PUBLIC HEALTH
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% Child sickness (previous two weeks)
Fever
Co
ug
h
Dia
r rh
oea
Measle
s
Oth
er
Fever
Co
ug
h
Dia
r rh
oea
Measle
s
Oth
er
Fever
Co
ug
h
Dia
r rh
oea
Measle
s
Oth
er
0
5
1 0
1 5
2 0
Pre
va
len
ce
of
Mo
rb
idit
y %
Z o n e 1
Z o n e 2
Z o n e 3
Dry Zone sickness prevalence: 28.0%
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Health caring practices: Care of children with diarrhoea
m o r e f lu id s m o r e fo o d O R S H o m e O R S Zin c ta b le t Z in c s yr u p
0
2 0
4 0
6 0
8 0
D ia r r h o e a c a r e
Pro
po
rtio
n %
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Health caring practices: Hygiene practices
H a n d w a s h in g
a f te r c h ild
d e fa e c a te d
H a n d w a s h in g
a f te r c h ild
d e fa e c a te d
(w ith s o a p )
H a n d w a s h in g
p r io r to
fo o d p r e p a r a t io n
fo r c h ild r e n
H a n d w a s h in g
p r io r to
fo o d p r e p a r a t io n
fo r c h ild r e n
(w ith s o a p )
D is p o s a l
o f fa e c e s
in to ile t
0
5 0
1 0 0
H y g ie n e p ra c tic e s
Pro
po
rtio
n %
Z o n e 1
Z o n e 2
Z o n e 3
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Household latrine access
F lu s h la tr in e P it la tr in e
V e n tila te d
im p r o v e d
P it la tr in e
w ith s la b
P it la tr in e
w ith o u t s la b
N o la tr in e
o p e n d e fe c a tio n
2 0
4 0
6 0
Pro
po
rtio
n (
%)
Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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Tu
be
we
ll/b
ore
ho
le
Ha
nd
du
g w
ell
Po
nd
Tu
be
we
ll/b
ore
ho
le
Ha
nd
du
g w
ell
Po
nd
Tu
be
we
ll/b
ore
ho
le
Ha
nd
du
g w
ell
Po
nd
0
5 0
1 0 0
W a te r s o u rc e s
% o
f v
illa
ge
s
Z o n e 1 Z o n e 2 Z o n e 3
Village main water source
Households with access to protected water year round: 64.5%
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DIET
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0 5 0 1 0 0
E x c lu s iv e b r e a s t fe e d in g
T im le y in it ia t io n o f b r e a s t fe e d in g
C o n t in u e d b r e a s t fe e d in g a t 1 ye a r
C o n t in u e d b r e a s t fe e d in g a t 2 ye a r s
E v e r b r e a s t fe d
B o t t le fe e d in g
T im e ly c o m p le m e n ta r y fe e d in g
T im e ly in t r o d u c t io n o f s o lid , s e m is o lid , o r s o f t fo o d s
M in im u m d ie ta r y d iv e r s ity
M in im u m m e a l f r e q u e n c y (b r e a s t fe d c h ild r e n )
M in im u m a c c e p ta b le d ie t (b r e a s t fe d c h ild r e n )
C o n s u m p t io n o f ir o n - r ic h o r ir o n - fo r t if ie d fo o d s
C o n s u m p t io n o f fo r t if ie d fo o d s
C o n s u m p t io n o f M N P
P ro p o r t io n (% )
C o m p le m e n ta ry
fe e d in g
B re a s t fe e d in g
Infant and Young Child Feeding practices
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Mean dietary diversity scores (child, mother, household)
C h ild re n
6 - 2 3 m o n th s
A ll N o -p re g n a n t
n o -la c ta t in g
P re g n a n t
o r la c ta t in g
H o u s e h o ld s
2
7
1 2
Die
ta
ry
div
ers
ity
sc
ore
(ID
DS
& H
DD
S)
Z o n e 2
Z o n e 3
Z o n e 1
A g g re g a te d
M o th e rs
*
* • Individual Dietary Diversity Score non-pregnant/ lactating mothers: 4.4
• Individual Dietary Diversity Score pregnant/ lactating mothers: 4.2
4 4
7
9
12
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QUESTIONS / COMMENTS?
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HOUSEHOLD FOOD SECURITY, WEALTH AND POVERTY
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POTENTIAL CAUSES OF UNDERNUTRITION:
Using: Descriptive analysis • Q1: What indicators are
inadequate? • Q2: What patterns exist
between agroecological zones?
And Exploration of associations and risk factors NOTWITHSTANDING THE LIMITATIONS OF THE CROSS SECTIONAL DATA…
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Season
Months of food gap
J u n J u l A u g S e p O c t N o v D e c J a n F e b M a r A p r M a y
0
1 0
2 0
3 0
4 0
5 0
M o n th
Pro
po
rtio
n (
%)
Seasonal timing places the survey in the hunger gap, impacting on the ‘high’ rates of acute malnutrition, and other indicators (e.g. diet diversity, sickness) – worst case scenario (acute malnutrition)?
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Undernutrition in children and mothers
1. Wasting more likely in stunted children (a risk factor), and vice versa
2. Birth weight determines later nutrition status (and LBW is a risk factor for stunting)
3. Mother’s nutrition status (BMI) determines child’s nutrition status (WHZ) (and low BMI is a risk factor for wasting)
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Inadequate diets
1. Late and non-exclusive breastfeeding
2. Poor dietary diversity and meal frequency for children during the complementary feeding period
3. Low diet diversity diets for mothers, particularly pregnant/breastfeeding – affects their nutrition and the nutrition of their baby
4. Diet diversity of mother a determinant of child’s diet, regardless of HH economic status, suggesting need to tackle poverty and/or increase knowledge and change attitudes around IYCF/diets
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Recent sickness/age Wasting/age
0-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
90-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
90-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
9
0
2 0
4 0
6 0
A g e (m o n th s )
Pre
va
le
nc
e o
f M
orb
id
ity
%
Z o n e 1
Z o n e 2
Z o n e 3
0-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
90-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
90-5
6-1
7
18-2
9
30-4
1
42-5
3
54-5
9
0
5
1 0
1 5
2 0
2 5
A g e (m o n th s )
Pre
va
len
ce
of G
lo
ba
l A
cu
te
Ma
lnu
trit
ion
%
Z o n e 1
Z o n e 2
Z o n e 3
Disease and poor public health environment, including WASH
1. Sickness – similar trends as wasting and stunting
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Disease and poor public health environment, including WASH
2. Inappropriate care of sick children
3. Poor hygiene practices, particularly hand washing
4. Poor latrine access
5. Use of unprotected water sources
6. Poor drinking water treatment practices
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Household food insecurity
1. Low contribution of household subsistence production to household food needs (livestock ownership and land access determinants of mothers BMI)
2. Reliance on market purchase for food access
(due to small landholdings/high landlessness; limited irrigation/low yields; small stocks) (poor economic access to food)
3. Challenges in accessing market may impede food access
4. Potentially, poor intrahousehold food allocation
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Household incomes/expenditure
1. Low incomes from limited sources, agriculture-focused so vulnerable to climatic and economic shocks
2. Typicality of loan taking / credit purchase, for many, on unfavourable terms; i.e entrenched indebtedness
3. Poor economic access to food: high proportionate spends on food needs, much on rice (driving poor diversity of diets)
A ll fo o d R ic e P a d d y p u r c h a s e
o n c r e d it
2 0
4 0
6 0
8 0
Fo
od
ex
pe
nd
itu
re
(%
of
tota
l e
xp
en
dit
ure
) Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
*
*
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Challenges of physical access – affecting causes of undernutrition through different pathways?
• As the highest rates of sickness are in zone 2 it could be that factors associated with the zones could be ‘causing’ malnutrition, particularly poor infrastructure/ service access.
Ra in
y se a s o n
Su m
me r s
e a s o n
Win
ter s
e a s o n
Ra in
y se a s o n
Su m
me r s
e a s o n
Win
ter s
e a s o n
Ra in
y se a s o n
Su m
me r s
e a s o n
Win
ter s
e a s o n
0
1 0
2 0
3 0
4 0
S e a s o n
Tra
ve
l ti
me
fo
r a
ro
un
d t
rip
to
ma
rke
t (h
rs)
Z o n e 1 Z o n e 2 Z o n e 3
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CONCLUSIONS
1. The nutrition situation in the Dry Zone is more concerning than expected. Both acute and chronic malnutrition require attention, as well as the nutrition status of mothers, particularly pregnant and lactating mothers
2. Zone 3 (irrigated/flood plains) is generally better off, but the situation in the whole Dry Zone warrants attention. The population of Zone 2 (highland farming) may be particularly vulnerable due to access issues as well as poorer food security
3. Children’s nutrition status is associated with mother’s nutrition status and may be poor from birth, so a life cycle approach is vital
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4. Individual explanatory variables explain only a small proportion of variance of nutrition indicators. This highlights that a multisector approach is needed
5. Sickness is a key driver of undernutrition, particularly in older children and in zone 2
6. Deficiencies in the water, sanitation and hygiene environment are implicated
7. Poor diets are an important driver of undernutrition, in children and mothers
8. The relationship of nutrition with household economy / poverty is not clear, but widespread low incomes, high debts and insecure livelihood need to be tackled to improve diets and nutrition
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QUESTIONS / COMMENTS?
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Spare slides in case of questions about some specifics
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Key preventative health interventions (children)
B e d n e t u s e
(6 - 5 0 m o n th s )
M e a s le s
v a c c in a t io n
(1 2 - 2 3 m o n th s )
An t ih e lm in th
c o v e r a g e
(1 2 - 5 9 m o n th s )
V ita m in A
s u p p le m e n ta t io n
(6 - 5 9 m o n th s )
T B v a c c in a t io n
b y B C G s c a r
(0 - 5 9 m o n th s )
0
5 0
1 0 0
P r e v e n ta t iv e H e a lth C a r e
Pro
po
rti
on
%
Z o n e 1
Z o n e 2
Z o n e 3
*
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0 5 0 1 0 0
D o c to r
N u r s e
M id w ife
A u x ilia r y m id w ife
T r a d itio n a l b ir th a tte n d a n t
O th e r
P ro p o r t io n (% )
Z o n e 2
Z o n e 3
Z o n e 1
Ante-natal Care provision
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0 5 0 1 0 0
P o s tp a r tu m V it A
V ita m in B 1
Ir o n d u r in g p r e g n a n c y
P ro p o r t io n (% )
Z o n e 2
Z o n e 3
A g g re g a te d
Z o n e 1
Mother’s micronutrient supplementation
0 5 0 1 0 0
1 - 2 t im e s a m o n th
1 - 2 t im e s a w e e k
3 - 4 t im e s a w e e k
5 d a y s a w e e k
P ro p o r t io n (% )
Z o n e 2
Z o n e 3
A g g re g a te d
Z o n e 1
5 days a week
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Drinking water treatment
B o ilin g C lo th f iltr a tio n L e a v in g it
to s e ttle
N o filtr a tio n O th e r
2 0
4 0
6 0
8 0
1 0 0
Pro
po
rtio
n (
%)
Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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0 5 0 1 0 0
S ta r c h y s ta p le s
F a ts /o ils
L e g u m e s
O th e r V ita m in A r ic h fr u its a n d v e g s
O th e r fr u its a n d v e g e ta b le s
F is h a n d m e a t
D a r k g r e e n le a fy v e g e ta b le s
E g g s
M ilk a n d d a ir y p r o d u c ts
O r g a n m e a t
P ro p o r t io n (% )
Z o n e 2
Z o n e 3
Z o n e 1
Food group consumption (mothers, 24 hour recall)
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Zo n e 1 Zo n e 2 Z o n e 3 A g g re g a te d
0
5 0
1 0 0
A g ro e c o lo g ic a l Z o n e s
Pro
po
rtio
n %
A d e q u a te (H D D S > 4 )M o d e ra te (H D D S 3 -4 )S e v e re (H D D S < 3 )
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Zo n e 1 Zo n e 2 Zo n e 3 A g g re g a te d
2 0
4 0
6 0
8 0
1 0 0
A g ro e c o lo g ic a l Z o n e s
Pro
po
rti
on
%
A d e q u a te (F C S > 3 8 .5 )B o rd e rlin e (F C S 2 4 .6 -3 8 .5 )P o o r (F C S < 2 4 .6 )
*
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L a n d le s s < 2 2 - 4 5 - 1 0 > 1 0
0
1 0
2 0
3 0
4 0
5 0
A c re s o f la n d a c c e s s ib le to th e h o u s e h o ld
Pro
po
rti
on
of
ho
us
eh
old
s (
%)
Z o n e 2
Z o n e 3Z o n e 1
A g g re g a te d
H o u s e h o ld s e n g a g e d in a g r ic u ltu re0
2 0
4 0
6 0
8 0
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L a n d le s s < 2 2 - 4 5 - 1 0 > 1 0
0
1 0
2 0
3 0
4 0
5 0
A c re s o w n e d b y th e h o u s e h o ld
Pro
po
rtio
n o
f h
ou
se
ho
lds
(%
)
Z o n e 2
Z o n e 3Z o n e 1
A g g re g a te d
0
2 0
4 0
6 0
Pro
po
rtio
n o
f a
cc
es
se
d l
an
d
irri
ga
ted
(%
)
*
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2 0
4 0
6 0
8 0
1 0 0
% H
ou
se
ho
lds
wit
h s
tap
le s
toc
ks
Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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5
1 0
1 5
2 0
2 5
Me
dia
n d
ay
s o
f s
toc
k a
va
ila
ble
pe
r h
ou
se
ho
ld Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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< 1 1 - < 2 2 - < 3 3
0
2 0
4 0
6 0
8 0
M o n th s w o rth o f s to c k
Pro
po
rtio
n o
f h
ou
se
ho
lds
(%
)
Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
*
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2 0
4 0
6 0
8 0
1 0 0
% H
ou
se
ho
lds
wit
h i
od
ise
d s
alt
Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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R e p o rte d p ro b le m s
to m e e t fo o d n e e d s
in th e la s t 1 2 m o n th s
R e p o rte d p ro b le m s
to m e e t fo o d n e e d s
in th e la s t 7 d a ys
D a ily c o p in g
1 0
2 0
3 0
4 0
5 0
Pro
po
rti
on
(%
)
Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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N o h u n g e r
H H S < 1
M o d e ra te h u n g e r
H H S 2 -3
S e v e re h u n g e r
H H S 4 -6
5 0
1 0 0
Pro
po
rti
on
(%
)Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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A d e q u a te
C S I < 3
M o d e ra te
C S I 3 -3 .4
S e v e re
C S I > 3 .4
5 0
1 0 0P
ro
po
rti
on
(%
)Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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N o in c o m e 1 in c o m e 2 in c o m e s 3 + in c o m e s
1 0
2 0
3 0
4 0
5 0P
ro
po
rti
on
(%
)Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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N o in c o m e < 2 5 U S D 2 5 -5 9 U S D 5 0 -7 5 U S D 7 5 -9 9 U S D > 1 0 0 U S D
1 0
2 0
3 0
4 0P
ro
po
rti
on
(%
)Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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W a g e la b o u r
a g r ic u ltu r a l
W a g e la b o u r
n o n -a g r ic u ltu r a l
S e llin g
p a d d y
S e llin g
p u ls e s /b e a n s
5
1 0
1 5
2 0
2 5P
ro
po
rti
on
(%
)Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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A ll fo o d R ic e P a d d y p u r c h a s e
o n c r e d it
2 0
4 0
6 0
8 0F
oo
d e
xp
en
dit
ure
(%
of
tota
l e
xp
en
dit
ure
) Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
*
*
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T o ta l F o o d N o n -fo o d E d u c a tio n A d u lt
h e a lth
C h ild
h e a lth
T r a n s p o r t
5 0 ,0 0 0
1 0 0 ,0 0 0
1 5 0 ,0 0 0
2 0 0 ,0 0 0
2 5 0 ,0 0 0E
xp
en
dit
ure
(k
ya
t)Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
*
*
L a s t m o n th e x p e n d itu re L a s t 6 m o n th s e x p e n d itu re
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< 1 0 0
U S D
1 0 0 -2 0 0
U S D
2 0 0 -3 0 0
U S D
2 0
4 0
6 0P
ro
po
rti
on
(%
)Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
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B e lo w n a tio n a l
p o v e r ty lin e
B e lo w fo o d
p o v e r ty lin e
1 0
2 0
3 0
4 0P
ro
po
rti
on
(%
)Z o n e 2 Z o n e 3Z o n e 1 A g g re g a te d
*
*
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METHODS (2/5) MORE ON SAMPLE SIZE Nutrition and IYCF: 1,800 children 0-59 months, including 522 0-24 month olds: • For anthropometric indices: using stunting 39% in 0-59 month olds, precision 5%, power
90%, design effect 1.5, 10% refusal = 426 0-59 month olds per zone (9 per village cluster) • For IYCF: exclusive breastfeeding 8% in 0-5 month olds, precision 5%, power 90% = 80
infants per zone, * 4 and design effect of 1.5 = 480 0-24 month olds • Estimate 8.8% U5s (2.6% U2s) in Dry Zone, and 31% HH with a child U5 = 12 children U5
in 39 households, of which 3 U2 And their mothers Food security, wealth/poverty and WASH: 1,500 households (with/without U5s), including 560 HH with child nutrition and household food sec data • Prevalence 50%, precision 10%, power 90%, design effect 5 = 340 HH per zone (7 per
village cluster), BUT 7HH=2U5. Increase pragmatically to 13 (10 minimum) households
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METHODS: DATA MANAGEMENT AND PROCESSING
• Anthropometry data double entered & processed in ENA for SMART (2011)
• Other data entered in Excel / SPSS
• Data entry complete September
• Datasets merged & analysed in ‘svy’ in STATA (12.0)
• Data weighted at cluster & strata level for child/mother/household level estimates, & strata level for analysis of village data
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Undernutrition Child stunting (HAZ score / <-2 HAZ (y/n)), wasting (WHZ score / <-2
WHZ (y/n)) Maternal undernutrition (BMI score / < 18.5 (y/n))
Inadequate diet
IYCF practices: exclusively breastfed (y/n), meal frequency / min meal freq (y/n), dietary diversity score** / min diet
diversity (y/n), min adequate diet (y/n) Mother’s dietary diversity score**
Disease Recent morbidity (y/n)
Household food insecurity
Travel time to market Household Dietary Diversity Score**
Food Consumption Score, including adequacy (y/n)** Income amount
Food expenditure and food expenditure amounts HH subsistence production (y/n)**
Livestock ownership (y/n)**
Household poverty and demography Probability of falling below national poverty line
Sex of household head (m/f) Number of people in the household
Dependency ratio Labour migration (y/n)
Inadequate care environment
Poor public health environment Antihelminth (y/n);
Vitamin A supplementation (y/n) Hand washing wiih soap
Child’s faeces disposal in latrine (y/n) Drinking water on the premise (y/n)
Clinic in village (y/n) and time to travel to the clinic Latrine access (y/n)**
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Detecting significant associations
Requires variability in the population, as well as a sufficiently powered sample. No evidence of association or risk does not mean no association or risk exists….
e.g. poverty
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Significant associations
Nutrition indicators as explanatory variables
• Outcome HAZ, explanatory variable birthweight, R2 = 13.1% (0.1, 0.4)
• Outcome WHZ, explanatory variable birthweight, R2 = 7.8% (0.1, 0.3)
• Outcome WHZ, explanatory variable mother’s BMI, R2 = 1.4% (0.0, 0.1)
• Outcome stunting, explanatory variable wasting, OR 1.68 (1.16, 2.42)
• Outcome stunting, explanatory variable low birth weight, OR 10.66 (2.47, 45.98)
• Outcome wasting, explanatory variable mother’s BMI, OR 0.93 (0.87, 0.98)
Diet indicators as explanatory variables
• Outcome HAZ, explanatory variable adequate HDDS, R2 = 2.2 (0.1, 1.3)
• Outcome HAZ, explanatory variable adequate FCS, R2 = 1.8 (0.1, 0.7)
• Outcome BMI, explanatory variable mother’s IDDS, R2 = 1.3 (0.5, 0.0)
• Outcome stunting, explanatory variable Minimum Meal Frequency, OR 1.73 (1.07, 2.8)
• Outcome wasting, explanatory variable Minimum Adequate Diet, OR 3.24 (1.06, 9.9)
Public Health environment as explan
• Outcome BMI, explanatory variable latrine access, R2 = 3.4 (-0.7, 0.0)
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More regression results
Household food security indicators as explanatory variables • Outcome BMI, explanatory variable
HH livestock ownership, R2 = 2.3 (-0.0, 0.0)
• Outcome BMI, explanatory variable HH subsistence production, R2 = 1.9 (1.8, 0.0)
• Outcome stunting, explanatory variable adequate HDDS, OR 0.43 (0.18, 0.99)