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EXECUTIVE SUMMARY
UNHCR in collaboration with AHA, IRC and WFP carried out the nutrition survey in Pamir and Ajoung Thok refugee camps from 21 to 31 October 2019. Pamir and Ajoung Thok are the official refugee camps in Pariang County, Unity State. No nutrition survey was carried out in Yida as comprehensive services were not provided in 2019 considering 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 (http://sens.unhcr.org/) and the Standardised Monitoring and Assessments of Relief and Transitions (SMART) guidelines (https://smartmethodology.org/). 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.
Information on mosquito net coverage was carried out within the year in Pamir and Ajoung Thok in a separate partner assessment. 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 6 on 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 21-31 October with a two days break on the 26 and 27 October 2019. The survey teams were supported by a team of 5 supervisors and 3 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 daily 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 poor1 as indicated by the Global Acute Malnutrition (GAM) prevalence of 7.8% (5.1-11.7 95% C.I) and 9.1% (8.3-9.9 95% C.I) respectively based on weight for height z scores.
Compared to the situation in 2018 the nutrition situation remained the same but the slight increase in the trends of GAM prevalence indicates a likely deteriorating situation2 . The prevalence of SAM increased to 2.1% in Ajoung Thok classified as Critical (UNHCR thresholds SAM >2% critical). 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.3 The 2019 global stunting prevalence in Pamir was 23.6% (18.9-29.2 95% C.I) while in Ajoung Thok was 22.7% (20.8-24.8 95% C.I). This is categorized as high according to WHO standards4 . Stunting prevalence remained the same as in 2018 in Pamir and decreased in Ajoung Thok. In 2018 stunting among children 6-59 months in Pamir and Ajoung Thok was 28.3% and 35.5%. 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.5 Total anaemia prevalence among children aged 6 to 59 months in Pamir and Ajoung Thok was 47.3% (41.1-53.6 95% C.I) and 44.1% (38.3-50.1 95% C.I) which indicates a critical situation as it is above the 40% level of public health significance (WHO classification)6 . Compared to 2018 the prevalence of anaemia remained the same in both Pamir and Ajoung Thok. Anaemia is recognised to adversely affect the cognitive performance, behaviour and physical growth of infants, preschool and school-aged children, and increase the likelihood of associated morbidities.7 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 OTP and TSFP enrolment based on all admission criterion in both Pamir and Ajoung Thok is far below the recommended standard of >90%. This indicates the strong 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 93.6% which is slightly below the recommended ≥95%. In Ajoung Thok the target was met. Vitamin A supplementation met the target coverage of ≥90% in both camps. Ante natal coverage in Pamir was 90.1% and 90.5% in Ajoung Thok camp. Efforts to maintain and strengthen this to be ensured.
24.8% of children aged 6-59 months in Pamir and 9.3% in Ajoung Thok reported to have had diarrhoea in the last two weeks prior to the survey indicating a morbidity caseload requiring continued health and hygiene services provision. 74% of children aged 6-59 months in Pamir and 70.6% in Ajoung Thok reported to have been dewormed in the last six months prior to the survey. This was slightly below the UNHCR target of ≥75% indicating the need to strengthen routine and campaign interventions in both camps.
The rate of timely initiation of breastfeeding was 89.8% and 92.8% while exclusive breastfeeding was 100% in Pamir and 93.9% in Ajoung Thok indicating positive uptake of the breastfeeding messages. Timely introduction of complementary feeding was 72.2% and 92.8% in Pamir and Ajoung Thok respectively. This improved compared to the proportion in 2018. Consumption of iron rich foods although improving remains inadequate. The proportion of children aged 6 -23 months that had consumed iron-rich or iron-fortified foods in Pamir was 49.5% and 59.4% 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.
Majority of the refugees in Pamir and Ajoung Thok refugee camps continued to use negative coping strategies to fill the food assistance gap. Only 34.9% in Pamir and 42.6% in Ajoung Thok reported not using negative coping strategies. 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 negative coping strategies to fill the food assistance gap in Pamir increased in 2019 compared to 2018 in both camps.