GARBATULLA DISTRICT February 2012 Integrated … the current survey as well as trend analysis based...

Small Scale Survey; February 2012

GARBATULLA DISTRICT

February 2012 Integrated Small Scale Survey Report

SUMMARY OF KEY FINDINGS

Global Acute Malnutrition (GAM) was 19.5% (14.9- 24.9); this is above WHO emergency threshold.

A general reduction in trend of severe acute malnutrition from 4.3% (2.1- 8.6) in May 2011 to approximately 1.8 %( 0.7- 4.5) in February 2012 has been noticed.

Flooding was experienced in the region due to heavy rains experienced in November – December 2011; as well as flooding of Ewaso Nyiro River. This led to absolute and partial destruction of community livelihood strategies and social support structures like homes transport and for a while relief food supplies could not reach the intended beneficiaries. The community received support from the government and various partners/stakeholders in the area.

The fifth and final round of blanket supplementary feeding targeting children below five years of age, pregnant and lactating mothers was successfully completed.

Livestock had moved back into Garbatulla district with increased milk availability in most parts of the district.

Purchase (38.0%) and food assistance (26.0%) continue to be the main sources of food of most households in Garbatulla district

High food prices were the main stressors experienced by households three months prior to the survey. This has increased from 45.1% in September 2011 to 53.8% in February 2012. High food prices accounted for 34.2% in February 2011.

1. INTRODUCTION

The fifth round of the Small Scale survey was undertaken in Garbatulla district in the month of February 2012; implemented by ACF USA in partnership with the Ministry of Health and Arid lands Resource Management Project (ALRMP) at the district level. As indicated in the seasonal calendar below, this was during the “bon agaya” season. This report therefore presents results of the current survey as well as trend analysis based on past survey and surveillance data Table 1: Seasonal calendar and critical events (Adopted from ALRMP: Drought Monitoring Bulletin for Isiolo, Garbatulla and Merti Districts. April 2011.)


2. METHODOLOGY

The small scale survey involved collecting data from a randomly selected small sample size of (cases) children/households in the sentinel site (Garbatulla District). Point estimates and confidence intervals provide results with a 50.0% and 95.0% precision respectively. The aforementioned provide either very low or high precision than necessary for the purpose of an early warning system. As such, through the calculator, an 85% probability was considered as precise enough for decision making. Based on this, a survey design of 30 clusters of 10 units each was used thereby providing a sample size of 300 elementary sampling units (households). A two-stage cluster sampling using probability proportional to size (PPS) was employed. In the first stage, the primary sampling units of 30 clusters were randomly selected from the sampling frame (list of villages based on available population estimates) using ENA for SMART software (November 2011 version). The second stage entailed the random selection of ten households from each cluster. An updated list of households in the sampled villages was obtained from the village elders and local authority. Simple random sampling was then used in household selection. In the absence of the list; the revised EPI method was used in household selection all in all ensuring that the principle of representativeness was adhered to in sample selection. Children aged 6-59 months were targeted for the anthropometric survey. The CDC calculator was used for analyzing the probability (at 85%) of the true prevalence to exceed a determined threshold as well as level of significant difference in survey results. Other data sets focusing on nutrition, FSL1 and WASH2 components were gathered through a structured questionnaire, observation and informal interviews. The questionnaire was administered in each of the ten sampled households per cluster irrespective of whether it had a child aged 6-59 months or not. Data entry and analysis was thereafter undertaken in Microsoft Excel.

1 Food Security and Livelihood 2 Water Sanitation and Hygiene

• Short dry period

“Bon agaya” • Short rains

• Long rains start • Milk increases • Kidding/lambing

• A long dry spell (Atholes)

• Start of short rains (Agaya)

• Milk increases

Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec


3. RESULTS OF NUTRITION, HEALTH AND CARE PRACTICES

3.1. ACUTE MALNUTRITION PREVALENCE

Using the CDC (Centre for Disease Control) probability calculator, the surveyed population has 85% probability to reach 17.1% for GAM3, and 1.1% of SAM4 in February 2012. The GAM level lies above the WHO emergency threshold of 15.0% indicating the need for continued appropriate interventions in the area.

Table 2: Trends of GAM and SAM rates with 85% probability threshold

FEB 2010 SSS

MAY 2010 SSS*

SEPT 2010 SMART

FEB 2011 SSS

MAY 2011 SSS

SEPT 2011 SMART

FEB 2012 SSS

N=Sample size 367 356 857 333 332 542 329 Global Acute Malnutrition (<-2 z-score and/or Oedema)

14.6% 12.8% 13.2% 13.6% 19.1 % 16.6% 17.1%

Severe Acute Malnutrition (<-3 z-score and/or Oedema)

2.6% 0.1% 1.1% 0.7% 3.2 % 2.2% 1.1%

*SSS= Small Scale Survey Malnutrition rates in Garbatulla district (WHO 2006 Growth Standards) are illustrated below. There seems to be a general increase in malnutrition rates. Only surveillance results are presented here.

3 Global Acute Malnutrition 4 Severe Acute Malnutrition


T rends of GAM and SAM rates in Garbatulla District Surveillance Site; Feb 2010 - Feb 2012

17.2%

3.8%

14.0%

1.4%

15.6%

0.9%

21.6%

4.3%

19.5%

1.8%

0%

5%

10%

15%

20%

25%

GAM SAM

WHO STANDARDS 2006Feb-10 May-10 Feb-11 May-11 Feb-12

Figure 1: Trends of GAM and SAM in Garbatulla District Surveillance site

3.2. HEALTH AND NUTRITION

This section highlights key aspects pertaining to high impact nutrition indicators such as micro-nutrient supplementation, de-worming as well as other health related indicators such as measles immunization, morbidity and bed net coverage. A two week recall period was used to determine common causes of morbidity amongst the children. 70.5% of households reported to have children who had suffered from one form of illness or the other two weeks prior to the survey. These as well as morbidity trends since February 2011 are illustrated in the figure below. The figure shows a decline in diarrheal incidences with a marked increase in cases of fever, cough and difficulty in breathing. Malaria incidences seem to be static


Morbidity trends of three common illnesses amongst children aged 6-59 months in Garbatulla District; February 2012

0

20

40

60

80

Diarrhoea Malaria Fever/Cough

%

Feb-10 May-10 Feb-11 May-11 Feb-12

Figure 2: Morbidity trends amongst children 6-59 months Diarrheal incidences accounted for 12.4% of morbidity cases. This is a decline compared to the past four rounds of surveillance data as illustrated above. Appropriate management of these cases through replacement of lost fluids and salts is necessary to curb negative effects that may occur due to dehydration. Trends in this management are shown below. Table 3: Trends in the management of diarrheal incidences

Even though there is a slight improvement in zinc supplementation during diarrheal incidences, the levels indicated fall short of the national target of 50.0%. The main concern reported in this case being lack of zinc supplements in the KEMSA kit. Most caretakers (84.1%) sought medical assistance when the children were sick. The public clinics (93.7%) were the main points for medical assistance. Table 4: Trends of mosquito bed net usage and ownership

FEB 2011 MAY 2011 SEPT 2011 FEB 2012

Mosquito bed net ownership 77.9% 76.0% 79.2% 82.0%

May 2011 %

Sept 2011 %

Feb 2012 %

Oral Rehydration salts 86.5 78.1 90.0 Home made fluids 13.5 5.5 30.0 Zinc supplementation 5.4 4.1 10.0 Sugar salt solution 8.1 32.9 40.0


Mosquito bed net usage by all household member 76.5% 68.7% 56.3% 65.8% Mosquito bed net usage by children <5yrs of age 77.7% 69.3% 85.0% 84.1% The national target for vitamin A supplementation is 80.0%. The table below indicates vitamin A supplementation trends since February 2010 with the current findings showing a marked improvement. This could be attributed to Malezi bora campaigns, full scale outreach programme and the BSFP5 activities.

Table 5: Vitamin A supplementation trends

FEB 2010 %

MAY 2010 %

FEB 2011 %

MAY 2011 %

SEPT 2011 %

FEB 2012 %

Vitamin Supplements received at least once

67.0 86.8 71.8 77.6 81.9 94.6

Never received 33.0 13.2 28.2 22.4 18.1 5.4 Total number of Children

367 326 333 332 542 332

Analysis of these supplementation rates by the various age groups indicate a decline in supplementation as the children grow older necessitating a need for advocacy in this area. Table 6: Trends in Vitamin A Supplementation by Age Group

Age Group Number Of Times SEPT 2011 FEB 2012 6-11 months Once 55.6% 67.6% 12-59 months

Once 50.7% 53.0% Twice 34.2% 39.9% Thrice 3.1% 1.3%

It is recommended that infants be immunized against measles at 9 months of age or earlier in the case of HIV infection. The trends of measles immunization coverage presented below are therefore based on this age group. The trends below indicate positive trends as there is a gradual increase in the proportion of children immunized and have cards to attest to it.

5 Blanket supplementary feeding Programme


Trends of measles immunization coverage; Feb 2010- Feb 2012

0

25

50

75

100

Feb '2010 Sept '2010 Feb '2011 May '2011 Sept '2011 Feb '2012

Time frame

%Not Immunized Card Recall

Figure 3: Measles immunization trends in Garbatulla district

Appropriate and timely supplementation of iron folic acid during pregnancy contributes to reduction in maternal mortality. The trends of this in Garbatulla district have so far unveiled rates of 64.8%, 73.3% and 86.8% in May 2011, September 2011 and February 2012 respectively. These are commendable as they lie above the national target of 50.0%. It is important to note that only households with children less than two years were targeted for this variable so as to minimize recall bias

4. RESULTS OF WATER AND HYGIENE PRACTICES DATA

4.1. General context

Heavy down pour was experienced in Garbatulla district in November/ December 2011. During this period, most roads were rendered impassable with some households in certain areas such as Garfasa region being displaced. The rains were reported to be so heavy that in some areas such as Malkadaka the main water sources was destroyed, forcing households to walk for longer distances to access water. Reports from hospital personnel and statistics also indicated an increase in diarrheal incidences during this time more so in Sericho division.

4.2. Access to water

Boreholes have been the main water source for majority of the households in Garbatulla District since May 2011(67.3%, 60.7%, 69.3% in May, September 2011 and February 2012 respectively). Table 7: Trends in sources of water for drinking in Garbatulla district


Survey results indicate an overall improvement in use of safe water sources. Nonetheless, the proportion of households accessing water from unsafe sources such as unprotected shallow wells and earth pans seems to have slightly increased. Majority (93.0 %) of the households walked for less than 30 minutes to the main water source. The queue times at water sources were however of concern as long queues were observed in areas like Kulamawe, Sericho, Iresaboru, Gafarsa and Korupu. Current findings indicate that approximately 82.2% of households queued at the water sources for more than 15 minutes as tabulated below. Table 8: Queuing time at water source

Excessive queuing time at water points is an indicator of insufficient water availability due to either an inadequate number of water points or inadequate yield at water sources. (SPHERE 2011). 32.7% of the sampled households had indeed reported to have changed their water source three months to the survey. Safe7 and unsafe8 water sources accounted for 24.5% and 75.5% respectively. The change in water source was due to water drying up (18.4%) and breakdown (69.4%) at the water source in areas such as Malkadaka location.

6 Classified as unsafe as the original source could not established. 7 Piped water system from borehole/spring 8 Unprotected shallow well, earth pan, water seller, river

SOURCE Feb 2010

May 2010

FEB 2011

May 2011

Sept 2011

Feb 2012

SAFE Piped water system from borehole 38.7 31.7 44.6 67.3 60.7 69.3 UNSAFE Water trucking6 N/A N/A N/A 3.3 11.1 0 Unprotected shallow well 33.0 36.7 26.8 9.6 15.5 17.7 Earth pan/Dam N/A N/A N/A 0.3 2.4 6.7 Water seller/ donkey cart 0.3 10.0 5.4 6.3 0.8 0 Others water sources 3.3 7.0 9.7 13.0 9.5 6.3

Duration of queuing May 2011 Sept 2011 Feb 2012

Less than 15 minutes 34.1 % 20.2 % 17.8 %

15 – 30 minutes 30.8 % 55.2 % 41.7 %

More than 30 minutes 35.1% 24.6 % 40.5 %


Trends in Per Capita Water consumption in Garbatulla District

0

25

50

75

100

Feb '10 May '10 Feb '11 May '11 Sept '11 Feb '12TIME FRAME

%<15 L/P/D <20 L/P/D

Figure 4: Trends in per capita Water consumption It is evident that water shortage in Garbatulla District has been a major issue whereby majority (95.7% and 100%) of the households did not meet the minimum SPHERE and National standards of 15 and 20 L/P/D respectively. 69.7% of households reported to pay for water in Garbatulla District during the month of February 2012. This indicates an increase when compared to September 2011. The increase could be attributed to the population in Sericho area who had to pay more for pumping of water from the source. The cost and mode of payment varied from one area to another whereby majority (69.4) pay 2 KSH for a twenty liter Jerri can. It was also noted that other households paid Kshs 10 - 400 per month irrespective of the amount of water consumed especially in areas such as Kinna, Garbatulla and Modogashe. Water related conflicts were experienced by 40.3% of the households. Causes of these conflicts were little water availability / rationing at the source (61.1%), payment requirements (1.7%), restricted users (1.7%) amongst others (35.5%) such as long queuing times.

4.3. Hygiene practices Table 9: Water storage facilities

Majority of households stored water in closed containers. However, it is noted that the trends of those using open storage containers is on the rise. Correct hand washing at critical times is very important in the elimination of transmission of infections. Notable critical times are before eating, after visiting the latrine, when handling food as well as when feeding children. Indeed, all sampled households in Garbatulla district reported to wash hands at one point or the other thus

Feb 2011 May 2011 Sept 2011 Feb 2012

Open Container 4.7 11.3 3.6 18.0

Closed Container 94.7 88.3 95.8 80.3

Any Container 0.7 0.3 0.6 1.7


the reduction of diarrhea incidences. Trends of hand washing times in the area since February 2011 are indicated below. Table 10: Hand washing times

However, use of soap or ashes during hand washing was minimal as shown below. Although it indicates a gap in the effectiveness of the hand washing process; the slight improvement on use of soap could be attributed to bar soap distribution and hygiene promotion demonstrations to the community members by ACF. Table 11: Hand washing practice

5. RESULTS OF FOOD SECURITY & LIVELIHOODS DATA

Most (84.6%) household head’s were male with their main occupation being daily wage labour (34%). This has shifted from livestock herding (32.9%) that was reported to be the main occupation of household heads in September 2011. Other household head occupations in February 2012 were livestock herding (26.3%), petty trade (16.7%), employment (16.3%), and farming (5.7%).

5.1. Livestock ownership and milk production

The majority of the households reported to own livestock (70%, 72.3%, 70%, and 67.3% in February, May, September 2011, and February 2012 respectively). The mean number of livestock per household by type is tabulated below in Table 12.

Table 12: Mean number of livestock owned per household since February 2011 - February 2012

CATTLE CAMEL GOAT SHEEP

Month FEB-11

MAY-11

SEPT-11

FEB-12

FEB-11

MAY-11

SEPT-11

FEB-12

FEB-11

MAY-11

SEPT-11

FEB-12

FEB-11

MAY-11

SEPT-11

FEB-12

Mean No. per 12 11 5 8 14 7 1 11 21 15 12 17 20 14 9 16

FEB 2011 %

MAY 2011 %

SEPT 2011 %

FEB 2012 %

Does not wash 3.8 0.0 1.4 0.0 Does not wash at any special time; washes when dirty

65.0 13.3 5.5 0.0

After toilet 54.5 84.0 91.8 99.7 Before cooking 91.2 55.3 67.1 39.3

Before eating 52.7 95.3 89.0 96.0 Before breastfeeding 21.9 25.3 17.8 27.3 After taking children to the toilet 72.0 48.7 21.9 48.7 After handling animals 25.3 16.3 2.7 13.3

FEB 2011 %

MAY 2011 %

SEPT 2011 %

FEB 2012 %

Only water 66.6 52.7 39.7 45.3 Water and soap 29.8 7.7 21.9 35.7 Soap when I can afford it 3.3 39.7 38.4 18.0 Water and ashes 0.3 0.0 0.0 1.0


HH

The current mean numbers of animals by type has shown an increase compared to September 2011. This could be attributed to livestock births as well as the observed availability of water, pasture and browse since the rains in November 2011. These mean numbers of livestock is however a decrease compared to February 2011 The table below illustrates the trends in changes in livestock ownership. Other than camels where slightly more than half (53.4%) reported to have the same proportion, all other animals reported some changes. Households generally acquired more livestock with sheep accounting for the largest increase (35.3 %).

Table 13: Changes in Household Livestock Ownership since February 2011 – February 2012

Note: Number of households is not expressed as a percentage

A number of factors were cited as the causes of increase or decrease. Figure 5 below illustrates the trends in the main causes of livestock changes over the past three months (Nov 2011 – February 2012). The trends clearly indicate that livestock increase is mainly contributed to births while the decrease is due to deaths related to drought. Even though rains in the district begun in mid October 2011, the area still felt the impact of the drought as the findings below indicate. This is because the possible time for pasture to regenerate after the rainfall would be at least one month flowing into November. Secondly, the movement of livestock back into the district was reported to reach its peak in December, which would also imply that some of the livestock had died enroute to the district due to drought.

Cattle Camel Goat Sheep

Month FEB -11

MAY -11

SEPT-11

FEB -12

FEB -11

MAY -11

SEPT -11

FEB -12

FEB-11

MAY -11

SEPT -11

FEB-12

FEB-11

MAY -11

SEPT -11

FEB-12

Same (%) 29.4 28.6 5.1 26.5 29.4 64.5 11.1 53.4 9.3 12.8 3.7 18.0 15.1 9.3 1.7 18.7

Increase (%) 27.1 9.2 1.1 32.4 50.0 3.2 11.1 14.3 42.9 12.2 6.6 28.6 40.8 12.4 2.9 35.3 Decrease (%) 43.5 62.2 93.8 41.2 20.6 32.3 77.8 33.3 47.8 75.0 89.7 53.4 44.1 78.3 95.5 46

No. of HH 85 119 176 102 34 62 36 21 161 172 271 161 179 161 242 150


Causes of changes in livestock ownership

0

20

40

60

80

100

Newly born Bought Sold Animals Died -Disease

Animals Died -Drought Related

MORE LESSCause of changes

Perc

enta

geFeb-11 May-11 Sep-11 Feb-12

Figure 5: Changes in household livestock ownership

5.2. Milk production and consumption

Movement of livestock into Garbatulla district was evident during the survey period especially in areas of Sericho division. This could probably be attributed to availability of water and pasture in the area following heavy down pour in the region in November/December 2011. The presence of this could therefore indicate the increase in the proportion of households that milked animal the day before the survey. In February 2012, 51.2% of households had milked their animals the day preceding the survey as compared to 48.0%, February 2011. Proportion of household’s consuming milk had also increased to 98.7% in February 2012 with the trends indicated in table below. Table 14: Trends in proportion of households consuming milk

The above factors have in turn led to increased consumption of milk at household level in February 2012; with the average amount of milk consumed per household being 1.37 litres up from 0.6 litres in September 2011. An average of 1.6 litres was consumed per household per day in February 2011. The main source of this milk was purchase (72.2%), followed by own production (33.4%) and gifts (1.3%). The figure below shows the trends in since February 2011.

Time Proportion of households consuming milk a day before the survey

Feb 2011 93.0% Feb 2012 98.7%


Sources of Household Milk Consumption

0%

20%

40%

60%

80%

Own Production Purchase

Perc

enta

ge

Feb-11 May-11 Sep-11 Feb-12

Figure 6: Trends in source of household milk consumption (Feb 2011- Feb 2012)

5.3. Household Dietary Diversity

A 24 hour recall period was used to determine household dietary diversity using 12 food groups. As illustrated in the table below; the situation in February 2012 seems to have improved as compared to September 2011. This is because the proportion of households consuming the various food groups seems to be on the rise, despite for fish, legumes and pulses. Table 8: Trend of household dietary diversity by food group; Feb 2010 – Feb 2012

The above information was further analyzed into three main categories as illustrated below.

FEB 2010

%

MAY 2010

%

SEPT 2010

%

FEB 2011

%

MAY 2011

%

SEPT 2011

%

FEB 2012

% Cereals 97 100 99 99 99 96 100 Roots & Tubers 25 55 65 50 39 59 63 Vegetables 12 38 33 41 40 32 48 Fruits 6 19 12 14 10 7 10 Eggs 2 7 19 12 9 6 7 Meat 18 28 37 32 23 20 33 Fish 5 6 22 9 4 16 5 Legumes/Pulses 33 51 73 70 66 75 68 Dairy 42 77 85 81 77 91 96 Fats 68 86 90 77 91 97 99 Sugars 82 92 93 95 97 98 99 Condiments 69 95 40 77 88 80 99


Table 15: Household Dietary Diversity score classification

5.4. Sources of food

Purchase (37.5%) and food assistance (28.3%) were the predominant sources of food for households during this period. The figure below indicates the trends in household food sources since February 2011.

TRENDS IN HOUSEHOLD FOOD SOURCES IN GARBATULLA DISTRICT

0%

25%

50%

75%

100%


Food

from

Sou

rce

Own production: CROPS Own production: MILK Own production: MEATPurchase Credit Food assistance

Figure 7: Trends in Household food sources; February 2011- February 2012

5.5. Stress factors and coping strategies

In the last three months, 96.6% of households reported to have been negatively affected by various stressors in one way or the other. These were then ranked in order of importance as illustrated in the figure below.

FEB 2010

%

MAY 2010

%

SEPT 2010

%

FEB 2011

%

MAY 2011

%

SEPT 2011

%

FEB 2012

% Low dietary diversity: (<= 3 food groups)

32.7 7.7 7.7 12.0 4.3 1.6 1.0

Medium dietary diversity: (4-5 food groups)

32.3 16.3 13.1 17.0 22.0 14.1 8.3

High dietary diversity: (>= 6 food groups)

35.0 76.0 79.2 71.0 73.7 84.3 90.7


Trends in stress factors ranked as highest in Garbatulla district

0

20

40

60

80

100

Reduced WaterAvailable

Reduced ForageAvailable

High LevelLivestock Death

High FoodPrices

ReducedIncome

Reduced CreditAccess

%Feb-11 May-11 Sep-11 Feb-12

Figure 8: Trends in stress factors ranked as Highest in Garbatulla District; Feb 2011 – February 2012 The figure above and below indicate general decline in most of the trends that were ranked as highest or second highest apart from food prices above that seems to be steadily increasing .

Trends in stress factors ranked as second highest in Garbatulla district

0

20

40

60

80

Reduced WaterAvailable

Reduced ForageAvailable

High LevelLivestock Death

High Food Prices Reduced Income Reduced CreditAccess

%


Figure 9: Trends in stress factors ranked as Second Highest in Garbatulla District; Feb 2011 – February 2012 The table below indicates trends of the various coping strategies employed by households in times of stress since February 2011. During the data collection exercise, a three month recall period is used to establish the coping strategies. Indeed, a critical look at the table below indicates a general increase in the proportion of households employing most of the listed coping strategies. This could be attributed to the negative effects of the previous drought and recent floods.


Table 16: Coping strategies in response to shocks experienced in the past 3 months

FEB 2011 %

MAY 2011 %

SEPT 2011 %

FEB 2012 %

Ate less 5 11.1 6.4 10.9 Sold small animals 4.5 3.8 1.2 6.6 Spent less on food 3.5 5.7 3.7 2.2

Skipped days without eating 3 1.2 2.3 3.8 Borrowing 2 1.7 2.5 3.4 Sold large animals 4 0.9 1.9 1.7

Moved location 13 21 5.6 11.9

Spent less on NFI 1.5 4.3 5.0 4.0 Purchased on credit 8 8.2 11.9 11.0

Alternative income 3.5 3.6 5.6 5.3 Spent more on water 3 2.1 1.7 3.6

Spent savings 5 3 3.7 7.4

Relied on food assistance 15.5 15.1 20.4 22.1

6. CONCLUSION AND RECOMMENDATIONS

Garbatulla district had experienced severe drought since May 2011 through to October 2011 driving it into an emergency phase that saw the inception of blanket supplementary feeding programs. This situation was there after worsened by floods experienced in the area between November and December 2011. The floods affected household livelihood strategies and social support structures like homes, transport and for a while relief food supplies could not reach the intended beneficiaries. During this period (Nov- Dec 2011), an increase in diarhoea incidences were reported in Sericho division and its surroundings. Active and prompt emergency response measures were put in place by the various stakeholders on the ground to curb the effects of the floods. These included distribution of water treatment products such as pur, other non food items and canvass tents. Diarrhea Diseases are an immediate cause of malnutrition. As such, an overall decline in diarrheal incidences in February 2012 may have contributed to the general decline in point estimates of severe malnutrition cases reported. Other probable factors for improvement of the situation could be the blanket supplementary feeding program that acted as a protection ration to this community. Nevertheless, cases of moderate malnutrition still seem to be on the rise. Exit indicators in the targeted feeding programs showed a marked increase in defaulter rates in the months of November and December 2011. This was due to two factors. First, the impact of floods on access and secondly the aflatoxin scare reported in the region. During this period, Corn Soy Blend supplied was reported to be potentially contaminated by aflatoxin. There was therefore a need to halt normal operations and sensitize the community on aflatoxins while at the same time assessing the commodity. The situation was eventually contained and normal


program operations resumed. The water and hygiene situation in the region is poor. Increased distance and long queuing times at water points generally hinders adequate water consumption. Current findings indicated that over 80.0% of households in Garbatulla district did not meet the sphere9 or the national10 per capita water consumption. Even though majority (93.0 %) of households in the district walked for less than 30 minutes to the main water source; queuing times at water points was quite prolonged as 82.2% of households lined up for more than 15 minutes; more so at boreholes. Long queues were indeed seen in areas like Kulamawe, Sericho, Iresaboru, Gafarsa and Korupu. Breakdown of some boreholes was also reported in areas such as Malkadaka. Water related conflicts were experienced in the region by about 40.3% of the households. These conflicts were related to little water availability / rationing at the source (61.1%), long queuing times (35.5%), and payment requirements (1.7%) amongst others such as restricted users (1.7%). Hand washing at critical points such as after visiting the latrine was reportedly high (99.0%); a lot of effort still needs to be done in terms of hygiene promotion. This is because hand washing at other critical times such as after taking children to the toilet (48.7%), before cooking (39.3%) and breastfeeding (27.3%) was poor. This situation is further affected by in- effective hand washing practices as only 35.7% used soap. The food security and livelihood situation seemed to have improved from past months. During this month, the proportion of households consuming various food groups had increased as those falling in the high dietary diversity group moving from 80.4% in September 2011 to 90.7% in February 2012. There is general improvement on dietary diversity; however, the trends indicate that proteins (meat, fish, and eggs) and vitamin rich foods (fruits, vegetables) are rarely consumed. Livestock had moved back into the district with milk being available as observed. Main sources of food were purchase and food assistance. However, high food prices were reported to be the main stressors with the majority of households relying either on food assistance, credit purchase or moving to another location to cope with these stressors. The general nutrition situation of Garbatulla district seems to be above emergency thresholds at this point in time. One third (35.3%) of the sampled children are at risk of malnutrition which underscores the severity of the above stress factors; therefore strong measures should be put in place in order to avoid alarming malnutrition rates in the near future. A decline was also reported in the severe malnutrition cases. Close monitoring of the situation is very important through programmatic mechanisms to ensure that the increase in moderately malnourished children do not slip into severe state. In view of the above situation and prevailing conditions, the following recommendations are thus presented: Nutrition

Active case finding screening makes use of MUAC measurements which is quick and convenient. However, detailed analyses of malnourished children during this round of data collection indicate that only 9.2% meet the MUAC admission criteria used in active case finding with all the rest being malnourished by WHZ. There is therefore a need for review of active case finding methodology specific to the region

9 15 litres per person per day 10

20 litres per person per day


Most of the population in Garbatulla district is nomadic. This has impacted on provision of health services in some of the areas. There is therefore a need to foster pastor friendly program such as having outreach program in areas that lack a health facility during the migratory seasons so as to meet the “mobile” population health needs

Undertake a nutrition programme coverage assessment to determine actual coverage of nutrition programme activities.

Water and Sanitation

Proper and timely maintenance and repair of broken water points so as to reduce queuing time and per capita water consumption.

Establishment and strengthening of existing water user committees to be able to handle conflicts arising at various water points.

Although community has put effort towards better hygienic practices, there is concern about the minimal use of effective materials such as soap during hand washing. Promotion of an appropriate alternative yet effective such as ash is therefore recommended.

Health and hygiene promotion program focusing on key issues in response to the poor hand washing and water storage practices unveiled. This will aide in maximizing the impact of health and nutritional outcomes.

Food security and livelihoods

Recovery interventions need to be implemented to strengthen livelihoods after last year’s crisis impact focusing on reestablishing productive assets and productivity of households.

Recovery activities need to go hand in hand with DRM activities, to work on household and community capacity and resilience to withstand new shocks, e.g. droughts and flooding.

Seasonal hunger safety nets should be established in most vulnerable areas, to prevent communities and households from seasonal fluctuations of food availability and access, and hence prevent seasonal malnutrition.

Improved natural resource management to increase rangeland, water productivity and contribute to positive impact on livelihoods, especially livestock and irrigation.

More holistic and integrated education sessions on health, hygiene and nutrition need to be transmitted to communities and households, to disease prevalence and impact on malnutrition.

GARBATULLA DISTRICT February 2012 Integrated … the current survey as well as trend analysis based...

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