EXECUTIVE SUMMARY
This SMART survey was conducted in Kutubdia Upazila, which is in the Southeastern part of Bangladesh. The Upazila is bounded by the Bay of Bengal on the North, South and West, Kutubdia channel, Banshkhali, Chakaria and Moheskhali on the East. Kutubdia Upazila is located at 21.8167° North 91.8583° East. Kutubdia Upazila is one of the most isolated islands of Cox’s Bazar District and is highly vulnerable to flooding and cyclones. As a result, there have been occasional displacement of the population and disruption of livelihoods, damaging their agricultural crops, fisheries, houses, and salt cultivation. Majority of the population in Kutubdia Upazila are underprivileged with poor living conditions and limited access to diversified food. In addition, lack of awareness about nutritional knowledge, care practices and health seeking behaviors among the community people as well as lack of essential health care services and slow functioning of community health system contribute to high rates of morbidity and poor health and nutrition status of children, pregnant and lactating women (PLWs) and adults in this area.
Since the severe cyclonic storm “Mora” in May 2017, AAH immediately responded and started CMAM community-based Outpatient Therapeutic (OTP) program and Stabilization Centre to address the high prevalence of acute malnutrition due to the extensive cyclonic damage in Kutubdia Upazila. These components were fully integrated with Government IMCI program where AAH provided technical support. AAH had to stop OTP program in March 2021 due to fund crisis because of the prioritization to other Upazillas with presence of refugees by the donor committee. . However, WFP recently started supplementary feeding program (SFP) in partnership with local NGO SHED for the prevention of moderately acute malnutrition among children and PLWs. Since then, integrated SMART nutrition assessments have been occasionally conducted in the Upazila to monitor the situation.
A SMART survey was conducted in Kutubdia Upazila between 7th and 19th June 2021. The survey applied a cross-sectional study design using a two-stage cluster sampling approach based on the probability proportional to population size. This survey was a follow up to a similar one conducted in March 2020 with the baseline survey conducted in December 2017 in the Upazila. The survey objective was to monitor the trends and changes in the indicators over the past one year with the main objective being to assess the nutrition status of children aged 6-59 months in the Upazila.
The survey also sought to determine the crude and under five mortality rates in the Upazila. To achieve this, the survey calculated a sample size of 401 children (6-59 months) and 661 households for the anthropometry survey and 3084 persons and 590 households for the mortality survey. A total of 48 clusters/villages were determined for representativeness. In stage 1 clusters/villages were selected randomly based on probability proportionate to population size (PPS principle) using Emergency Nutrition Assessment (ENA) software updated version 11th January 2020. In stage 2, simple random sampling was used to select 14 households in each selected cluster. The survey surpassed the minimum target of 90% for selected clusters and 80% for sampled children. Table 1 summarizes the survey findings.