South Sudan

Standardised Expanded Nutrition Survey (SENS) Final report - Pamir & Ajoung Thok refugee camps, Ruweng State South Sudan (Survey conducted: 3-10 November 2018)



UNHCR, AHA and IRC carried out the nutrition survey in Pamir and Ajoung Thok refugee camps from 3 to 10 November 2018. Pamir and Ajoung Thok are the official refugee camps in Pariang County, Ruweng State. No nutrition survey was carried out in Yida as comprehensive services were not provided in 2018 in light of its exit strategy.
Refugees from Yida continue to be relocated to Pamir and Ajoung Thok refugee camps.
The overall aim of the survey was to assess the nutrition situation among the refugee population and to monitor ongoing programme interventions. In each of the camps a cross- sectional survey was conducted using the UNHCR Standardised Expanded Nutrition Survey (SENS) version 2, 2013 guidelines ( and the Standardised Monitoring and Assessments of Relief and Transitions (SMART) guidelines ( Systematic random sampling was used to identify the survey respondents.
The surveys had a total of 4 modules consisting of 3 individual level and 1 household level questionnaires following UNHCR SENS guidelines version 2, 2013. The modules included: 1. Anthropometry and health targeting all children aged 6 to 59 months in all the sampled households; 2. Anaemia targeting all children aged 6 to 59 months in all the sampled households and all non-pregnant women aged 15 to 49 years in every other sampled household, 3. Infant and Young Child Feeding (IYCF) targeting all children aged 0 to 23 months in all the sampled households; 4. Food security targeting every other sampled household. The Water, Sanitation, and Hygiene (WASH) and mosquito net coverage modules were not carried out. This is because there is a WASH monitoring system in place and WASH Knowledge Attitude and Practices (KAP) assessment was conducted within the same month as the nutrition survey. There was no blanket mosquito net distribution carried out within the year in Pamir and Ajoung Thok. The Emergency Nutrition Assessment (ENA) software version July 9th, 2015 was used to calculate the sample sizes of children and households for participating in the survey. The parameters used to calculate the sample sizes can be found under table 3 page 24.
A total of six survey teams composed of four members each (one team leader, one hemoglobin measurer, one anthropometric measurer/translator and one hemoglobin/anthropometric measurement assistant) were included in each survey. A standardized training lasting five days, which included a standardization test was provided. Data collection lasted eight days from 3 to 10 November with a one day break on the 7 November 2018. The survey teams were supported by a team of 3 supervisors and 2 coordinators who roved between the teams during the data collection.
Mobile phone questionnaires using Open Data Kit (ODK) android software was used for data collection for the four modules of SENS. Data validation was carried out on a daily basis by the survey coordinator and supervisors. This facilitated daily feedback to the survey teams. Data analysis used ENA for SMART July 9th , 2015 version for anthropometric indices and Epi info version 7 for the rest of the indicators.
The overall nutrition situation in both Pamir and Ajoung Thok is classified as poor nutrition situation as indicated by the Global Acute Malnutrition (GAM) prevalence of 5.5% (3.6-8.3 95% C.I) and 6.3% (3.9-10.1 95% C.I) respectively based on weight for height z scores. It is, however, below the critical WHO emergency threshold of 15%.
Compared to the situation in 2017 the nutrition situation is improving in Pamir though the status remained the same1 . In Ajoung Thok the GAM prevalence increased indicating a deteriorating situation. Addressing acute malnutrition (wasting) is of critical importance because of the heightened risk of disease and death for children who lose too much of their body weight. Severe acute malnourished children have a nine times elevated risk of death compared with normal children.2 The 2018 global stunting prevalence in Pamir was 28.3% (23.9-33.1 95% C.I) while in Ajoung Thok was 28.8% (23.6-34.6 95% C.I). This is categorized as poor according to WHO standards3 . Stunting prevalence reduced in Pamir in 2018 compared to that in 2017. This remained the same as in 2017 in Ajoung Thok as the reduction in the stunting prevalence was not statistically significant. The prevalence in Ajoung Thok however improved compared to 2015 and 2016. Stunting is an outcome of inadequate nutrition and repeated bouts of infection during the first 1000 days of a child’s life.
Stunting before the age of 2 years predicts poorer cognitive and educational outcomes in later childhood.4 Total anaemia prevalence among children aged 6 to 59 months in Pamir and Ajoung Thok was 46.8% (41.8-51.9 95% C.I) and 45.9% (39.7-52.2 95% C.I) which indicates a critical situation as it is above the 40% level of public health significance (WHO classification)5 . Compared to 2017 the prevalence of anaemia remained the same in Pamir and deteriorated in Ajoung Thok. Anaemia is recognised to adversely affect the cognitive performance, behaviour and physical growth of infants, preschool and schoolaged children, and increase the likelihood of associated morbidities. Anaemia is not only an indicator of potential iron deficiency in populations, but can also be taken as a proxy indicator for other micronutrient deficiencies.
The TFP and TSFP coverage based on all admission criterion in both Pamir and Ajoung Thok did not meet the recommended standard of >90%. This indicates the need to strengthen case finding both at the community level and the screening at the facility level.
The coverage of measles vaccination in Pamir was 90.5% which does not meet the recommended ≥95%. In Ajoung Thok the coverage (94.7%) was slightly below the standard. In regard to vitamin A supplementation the target coverage of ≥90% was not met in both camps. Ante natal coverage among pregnant women in Pamir was 88.8% and 90.9% in Ajoung Thok camp. Of these83.3% in Pamir and 90.9% in Ajoung Thok camp reported receiving Iron-folic acid pills. Efforts to strengthen this to be ensured.

21.2% of children aged 6-59 months in Pamir and 10.4% in Ajoung Thok reported to have had diarrhoea in the last two weeks prior to the survey indicating a morbidity caseload requiring continued health services provision.
The rate of timely initiation of breastfeeding was 84.1% and 93.0% while exclusive breastfeeding was 88.1% in Pamir and 94.4% in Ajoung Thok indicating a positive uptake of the breastfeeding messages. Timely introduction of complementary feeding was 66.6% and 75% in Pamir and Ajoung Thok respectively. This improved compared to the proportion in 2017. Consumption of iron rich foods was low. The proportion of children aged 6 -23 months that had consumed iron-rich or iron-fortified foods in Pamir was 28.4% and 35.4% in Ajoung Thok. Continued strengthening of the Infant and Young Child Feeding (IYCF) promotion program in regard to appropriate complementary feeding remains key including finding options to diversify the diet to include a better micronutrient profile.
Only a small proportion of the refugees in Ajoung Thok and Pamir refugee camps reported not using any of the negative coping strategies to fill the food assistance gap.
This was 19.8% in Pamir and 28.8% Ajoung Thok. This group is likely to be benefiting from the complementary livelihood interventions in place. This, however, needs to be scaled up to increase the proportion to cover majority of the population. The proportion that reported not using any of the negative coping strategies to fill the food assistance gap in Pamir decreased in 2018 compared to 2017 and remained the same in Ajoung Thok.