In early January 2011, the protests started off peacefully in Syria, but they later erupted into an uprising by mid-March 2011. Intense fighting has been taking place since then resulting to thousands of Syrians being displaced in neighbouring countries of Lebanon, Turkey, Iraq and Jordan.
UNICEF and WFP initiated a joint nutrition assessment for Syrian children aged 6 to 59 months and pregnant and lactating women in Lebanon to establish the nutrition wellbeing of vulnerable displaced Syrian for potential nutrition and health related interventions taking into consideration existing public health programmes and strategies.
According to UNICEF's State of the World’s Children (2012) and FHS (2009), the nutrition situation in Syria was worse than in Lebanon before the onset of the crisis in Syria, based on wasting (12%), stunting (28%) or underweight (10%) data available. There was insufficient information to determine whether those leaving the country are nutritionally worse or better than those remaining in the country. Furthermore, there was no nutrition assessment/ screening established at the point(s) of entry to provide information on the nutrition wellbeing of those arriving in Lebanon The proposed nutrition assessment established the nutrition situation for the Syrian women and children in Lebanon and provides guidance on likely response to these individuals. The information provided baselines for monitoring for future nutrition programmes, if response is necessary.
The nutrition assessment aimed at filling the information gap on the nutritional status of vulnerable Syrian women and children and to propose interventions if there was any urgent need for response to mitigate deterioration. Specific objectives of the assessment in Lebanon were:
- To estimate wasting (acute malnutrition), stunting (chronic malnutrition) and underweight of Syrian children aged 6-59 months.
- To estimate the acute malnutrition levels for Syrian women of child bearing age based on MUAC measurement.
- To identify/document the underlying factors likely to influence the nutrition well-being of the Syrian population.
- To identify interventions and ensure that interventions are aligned with existing strategies and integrated.
- To establish household food consumption baseline.
The SMART (Standardized Monitoring and Assessment of Relief and Transition) methodology was used to collect and analyze data on child anthropometry. Additional questionnaires were designed for to collect quantitative data on infant and child feeding, health (disease and immunization), water and sanitation services and food security. A total of 42 clusters were randomly selected for all registered refugees in Lebanon, using probability proportional to size (PPS). UNHCR population figures from ProGres1 were used for cluster allocation.
Two-stage cluster sampling design was used. SMART software – Emergency Nutrition Assessment (ENA) was used to calculate the sample size, to select different clusters (localities) and households. The sample size was 500 households (42 clusters of 12 families2) and UNHCR registered families lists were used as the data reference for the household/ family selection.
A total of four (4) assessment teams composed of three members (who speak Arabic) each were formed for the assessments. A training lasting four days was provided, using standard training package, followed by a one-day pre-test exercise, to assess the training quality and the teams’ readiness for data collection. The assessment teams were supported by supervisors and coordinators throughout the duration of data collection.
Anthropometric data for children aged 6-59 months were entered using ENA for SMART software (Delta version, November 8th 2011) by the coordination team. All other data were doubled entered by a team of clerksusing an Excel template. A data cleaning process was conducted whereby data capture and errors were eliminated. Data analysis was done using ENA for SMART, Food Consumption Scores (FCS), Coping Strategy Indices (CSI) and SPSS software.