A Nutrition and Food Security Assessment of the Dry Zone of Myanmar, - PowerPoint PPT Presentation

A Nutrition and Food Security Assessment of the Dry Zone of Myanmar, June 24 th - July 18 th 2013 January 16th 2014

O BJECTIVES 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

Agroeco logical Agroecological Characteristics zone zone name number 1. Low land, not flood prone, no irrigation 1 Dry land farming 2. Suitable soil for cultivation 3. Only single or double cropping possibilities 1. High land (greater than 300 meters) High land with 2. Soil suitable for orchards, 2 sloping plantations, forest agriculture 3. Sloping/ shifting cultivation agriculture practiced 1. Flood plain with good soil fertility Flood plains and 3 2. Irrigated land irrigated areas 3. Multi-cropping possibilities year round

M ETHODS (1/5): D ESIGN 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 A household: “ a person or group of households per village (12 households with people eating and sleeping in the same children under 5 for nutrition/IYCF data and compound four nights weekly and 13 (minimum 10) households with/without sharing resources, not including those children under 5 for food security/HH data) who may have migrated”

M ETHODS (2/5) S AMPLE 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

M ETHODS (3/5): Q UESTIONNAIRES • 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

M ETHODS (4/5): M EASUREMENTS • 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

M ETHODS (5/5): F IELD LOGISTICS • 64 staff (10 from DRD), 9 teams, 8 supervisors • 2 weeks training, including practice anthropometry & village pilot • 3.5 weeks field work

N UTRITION R ESULTS

S AMPLE SIZE ACHIEVED : Maximum achieved Dry land Highland Dry Zone sample sizes Flood plains/ farming zone farming zone Planned total irrigated zone (1) (2) sample size (3) Villages 152 51 50 51 150 Households with children 1808 601 607 600 ND U5 Households with OR without children U5 1803 617 574 612 1500 Children U5 2037 687 689 600 1800 Children U2 822 290 289 243 522 Mothers (children U5) 1789 591 598 599 ND

% Wasted / acutely malnourished (0-59 month olds) 20 2 5 Z one 1 S evere Z one 2 P ublic H ealth S ignificance P r e v a le n c e o f G lo b a l A c u te M a ln u tr itio n % P r e v a le n c e o f G lo b a l A c u te M a ln u tr itio n % M oderate Z one 3 2 0 C ritical 15 1 5 H igh 10 1 0 P o o r 5 5 A cce p ta b le 0 0 0 -5 6 -1 7 1 8 -2 9 3 0 -4 1 4 2 -5 3 5 4 -5 9 0 -5 6 -1 7 1 8 -2 9 3 0 -4 1 4 2 -5 3 5 4 -5 9 0 -5 6 -1 7 1 8 -2 9 3 0 -4 1 4 2 -5 3 5 4 -5 9 Zo n e 1 Zo n e 2 Zo n e 3 Ag g re g ate d A g e (m o n th s) A g roecolog ical Z ones

% Stunted/chronically malnourished (0-59 month olds) 50 S evere 5 0 P ublic H ealth S ignificance Z one 1 M oderate Z one 2 V ery high 40 Z one 3 4 0 P r e v a le n c e o f S tu n tin g % P r e v a le n c e o f S tu n tin g % H igh 30 3 0 M edium 20 2 0 10 1 0 Low 0 0 Zo n e 1 Zo n e 2 Zo n e 3 Ag g re g ate d 1 8 -2 9 3 0 -4 1 4 2 -5 3 5 4 -5 9 1 8 -2 9 3 0 -4 1 4 2 -5 3 5 4 -5 9 1 8 -2 9 3 0 -4 1 4 2 -5 3 5 4 -5 9 0 -5 6 -1 7 0 -5 6 -1 7 0 -5 6 -1 7 A groecological Zones A g e (m o n th s)

Weight for Height Z-score (WHZ) and Height for Age Z-score (HAZ) distributions <-2 = wasted <-2 = stunted .5 .4 .4 .3 .3 .2 .2 .1 .1 0 0 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6 Weight-for-length z-score Height-for-age z-score

% Babies born Low Birth Weight (<2500g) 4 0 P re v a le n c e o f L o w B irth w e ig h t % 3 0 2 0 1 0 0 Zo n e 1 Zo n e 2 Zo n e 3 Ag g r e g a te d A g ro e c o lo g ic a l Z o n e s

% Undernutrition in mothers 2 5 Z o n e 1 P re v a le n c e o f m o th e rs ' u n d e rn u tritio n % Z o n e 2 Z o n e 3 A g g re g a te d 2 0 • Mean MUAC pregnant/lactating mothers : 1 5 26.0cm • Mean MUAC non- 1 0 pregnant/lactating mothers: 26.8cm 5 M U A C < 2 1 0 c m B M I < 1 8 .5 k g /m 2 In d ic a to r

DISEASE AND PUBLIC HEALTH

% Child sickness (previous two weeks) 2 0 Z o n e 1 Dry Zone sickness prevalence: 28.0% Z o n e 2 Z o n e 3 1 5 P re v a le n c e o f M o rb id ity % 1 0 5 0 r h a s r r h a s r r h a s r e e e e e e g e e g e e g e e h h h v o l v o l v o l u u u s t s t s t e e e o h o h o h O O O a a a F F F r r r C C C e e e r r r a M a M a M i i i D D D

Health caring practices: Care of children with diarrhoea 8 0 6 0 P ro p o rtio n % 4 0 2 0 0 m o r e flu 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 Zin c s yr u p D ia rrh o e a c a r e

Health caring practices: Hygiene practices 1 0 0 Z o n e 1 Z o n e 2 Z o n e 3 P ro p o rtio n % 5 0 0 H a n d w a s h in g H a n d w a s h in g H a n d w a s h in g H a n d w a s h in g D is p o s a l a fte r c h ild a fte r c h ild p r io r to p r io r to o f fa e c e s d e fa e c a te d d e fa e c a te d fo o d p r e p a r a tio n fo o d p r e p a r a tio n in to ile t (w ith s o a p ) fo r c h ild r e n fo r c h ild r e n (w ith s o a p ) H y g ie n e p ra c tic e s

Household latrine access 6 0 Z o n e 1 Z o n e 2 Z o n e 3 A g g re g a te d 4 0 P ro p o rtio n (% ) 2 0 F lu s h la tr in e P it la tr in e P it la tr in e P it la tr in e N o la tr in e V e n tila te d w ith s la b w ith o u t s la b o p e n d e fe c a tio n im p r o v e d

Village main water source 1 0 0 Z o n e 1 Z o n e 2 Z o n e 3 Households with access to protected water year round: 64.5% % o f v illa g e s 5 0 0 l d l d l d e l e l e l e n e n e n l l l o w o o w o o w o h h h P P P e g e g e g r u r u r u o o o d d d b b b / d / d / d l l l l n l n l n e e e a a a w w w H H H e e e b b b u u u T T T W a te r s o u rc e s

DIET

Infant and Young Child Feeding practices C o n s u m p tio n o f M N P C o n s u m p tio n o f fo r tifie d fo o d s C o n s u m p tio n o f ir o n -r ic h o r ir o n -fo r tifie d fo o d s M in im u m a c c e p ta b le d ie t (b r e a s tfe d c h ild r e n ) C o m p le m e n ta ry M in im u m m e a l fr e q u e n c y (b r e a s tfe d c h ild r e n ) fe e d in g M in im u m d ie ta r y d iv e r s ity T im e ly in tr o d u c tio n o f s o lid , s e m is o lid , o r s o ft fo o d s T im e ly c o m p le m e n ta r y fe e d in g B o ttle fe e d in g E v e r b r e a s tfe d C o n tin u e d b r e a s tfe e d in g a t 2 ye a r s B re a s tfe e d in g C o n tin u e d b r e a s tfe e d in g a t 1 ye a r T im le y in itia tio n o f b r e a s tfe e d in g E x c lu s iv e b r e a s tfe e d in g 0 5 0 1 0 0 P ro p o rtio n (% )

Mean dietary diversity scores (child, mother, household) 12 1 2 Z one 1 D ie ta ry d iv e rs ity s c o re (ID D S & H D D S ) Z one 2 Z one 3 A g greg ated 9 7 7 • Individual Dietary * M others Diversity Score non-pregnant/ 4 4 * lactating mothers: 4.4 • Individual Dietary 2 Diversity Score pregnant/ lactating mothers: C h ild re n A ll No -p re g n a n t P re g n a n t Ho u s e h o ld s 4.2 6 - 2 3 m o n th s n o -la c ta tin g o r la c ta tin g

Q UESTIONS / COMMENTS ?

HOUSEHOLD FOOD SECURITY , WEALTH AND POVERTY

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…