Sudan

Sudan: Nutrition and food security survey among IDPs and affected residents in El Fasher town & its attachments area

Attachments

Inter-agency assessment: UNICEF, ACF France, WFP, State Ministry of Agriculture, CHF International, WHO

Field work: 26 to 31 March, 2005

Funded by: UNICEF Sudan

1. BACKGROUND

According to UN Humanitarian Profile 10, the greater Darfur region that comprises the three Darfur states had about two million IDPs, of which about 410,000 live in North Darfur State -- both in camps and host communities across the State. Due to sudden and massive incursions by the militia, most of the IDPs had to run for their lives and consequently were not able carry with them any of their belongings -- food stores, basic kitchen sets and mattresses -- to places where they currently live. While there is a direct impact of the conflict on the lives and livelihoods of IDPs, undisplaced communities are also suffering indirectly as in several instances they are hosting their displaced relatives and friends. Kinship assistance has been very strong in these Muslim communities.

El Fasher is one such place where host communities and IDPs are living together. The population projections reveal the town currently has about 221,500 people, of whom about 15% are displaced people. These IDPs originally, before the displacement, were either pastoralists or agriculturists or agro-pastoralists, thereby producing foods for themselves and also for the market-dependent urban population close to their villages. Following displacement and subsequently compounded by 2004 droughts they were neither able to access and till their lands nor to produce any foods. Consequently, the prices of basic food items in the local markets have been showing sharp increases which currently lie well beyond the economic reach of both the host communities living in town as well as the IDPs themselves. In addition, North Darfur state as a whole has generally failed to present its people sustainable alternative livelihood strategies since time immemorial.

El Fasher town has been poorly serviced by aid agencies, especially in relation to food assistance, as Aid agencies are committing all of their efforts and resources to places outside the town. The State Ministry of Health has been managing therapeutic and supplementary feeding programs to benefit malnourished children, while WFP is still considering re-establishing their General Food Distributions, after they suspended their assistance in July 2004.

2. PURPOSE

Current partners of State Ministry of Health and UNICEF, operating outside El Fasher town, normally assess, assist and monitor food, nutrition and, health interventions programs for the affected people in their operational areas on a SIX monthly intervals in order to understand and address the changing needs of the affected population. In El Fasher town, the State Ministry of Health has been managing UNICEF and WFP assisted therapeutic and supplementary feeding programs to contain severe and moderate acute malnutrition among vulnerable children, under-five years old. In addition, as sources reveal, some people from the town also access free food (targeted and general), medical and non-food services meant for IDPs in the adjacent Abu Shouk camp.

Although the two projects -- TFC and SFC - became operational in October 2004, no assessment/survey has taken place to understand either improvements or deteriorations in the health and nutrition situation of these children. Hence this survey was essential to understand the prevailing situation among both affected residents and the IDPs living in town. It was carried out as an inter-agency exercise coordinated jointly by SMOH and UNICEF. The survey was fully funded by UNICEF.

3. OBJECTIVES

- To determine malnutrition prevalence among 6 to 59 month old children in El Fasher AU and understand risks to their normal living

- To estimate CRUDE and UNDER-FIVE mortality over a certain time-period in the past

- To identify underlying causes of malnutrition and mortality -- food, health and care -- for response

- To estimate coverage of population under feeding interventions (both targeted and general)

- To estimate measles immunization coverage among 9 to 59 months children.

- To make timely and appropriate recommendations for response

- To provide a platform from which to evaluate future responses to the concerns of affected people

4. SURVEY METHODOLOGY AND ORGANIZATION

A technical 'task force' was formed to finalize and guide the survey. This included SMOH, UNICEF, ACF France, WFP, WHO, and CHF International. The 'task force' met twice to finalize the methodology -- survey design and data collection tools. The sampling methodology and data collection instruments were translated into Arabic, pre-tested and were customized before use.

Two stage cluster sampling technique

A standard two-stage 30 x 30 random cluster sampling technique was used to choose clusters and households with in each cluster1. An official list of all locations in El Fasher AU, with their respective population figures, was obtained from reliable sources, which provided a basis for drawing a representative sample into the study. IDP details were hard to come by, despite considerable efforts by the coordinators.

In stage one, the list of villages/sections/residential units in the town was re-organized in the ascending order of their population and 6-59 month child population was computed for each village/section. Then cumulative total of 6-59 month was established with attribution of numbers to each village/section to determine the size of children.

Then, as we needed a minimum of 30 clusters into the sample, the total 6-59 month population in the sampling universe was divided by 30 to get a sampling interval. A random number was drawn between zero and the sampling interval to mark the first cluster. The remaining 29 clusters were selected by successively adding the sampling interval to the random number. By interpretation, a large section/village may have sent more than one cluster into the sample and a small section/village may /may not have sent any cluster at all.

In stage two, survey teams went to each of the chosen 30 clusters and, with local support, located their centers. They then spun their pens to choose a random direction and counted houses on both sides from center to the periphery and allotted numbers to each of the houses counted. Using raffle, they selected the first house from this pool of houses and chose subsequent houses that were to the right of the first.

Sample size and data collection

Anthropometric survey (questionnaire in annex 1): There was an understanding with all survey teams that they measured at least 32 6-59 month old (or 65 to 110 cm high) children in each cluster/village into the Anthropometric Survey, to get a total of 960 children into the study. An additional two children were measured to cover for any errors in data or measurements. Anthropometric survey skipped those households that had no 6-59 month children, but measured all of them in the selected households until the teams got 32 in each cluster/village.

Survey teams strictly applied both age and height criteria to carefully choose only those children that either aged 6-59 month or measured 65 to 110cm high. When age was unknown or difficult to determine, the teams depended on height. When children were either not available or houses closed during their visit time, the teams returned to them later and took measurements. Likewise, if chosen children were at TFC/SFC, they were measured there.

Mortality survey (questionnaire in annex 2) was carried out in the first 30 households, with or without 6-59 month children, in each of the 30 clusters (total of 900 households). A 90-day recall method was used to collect mortality data retroactively for previous 90 days preceding visit date.

Household food security survey (questionnaire in annex 3) was conducted in all selected households, with or without children. By the end of field work, the teams had administered household questionnaires to 687 households.

Training

One round of THREE-Day training was held to train and familiarize survey teams to the methodology and data collection instruments. SMOH, UNICEF, WHO and ACF France facilitated training sessions. First day was dedicated to in-house discussion, second day for pre-testing and standardizing the tools, and third day for feedback and finalize the methodology and instruments. ACF France took the responsibility to train teams on anthropometric and morbidity survey as well as standardize data collection and recording.

Samples covered for this survey

- 30 villages/clusters, which is 35% of total villages in the sampling universe

- 687 households, which is roughly 2.40% of total households in the sampling universe

- 5,444 people, which is 2.46% of total population in the sampling universe

- 1067 6-59 month old children, which is 2.41% of total 6-59 month children in the sampling universe

Survey teams

This was an inter-agency assessment coordinated jointly by SMOH and UNICEF. Human resource was drawn from different agencies to ensure accuracy and accountability as well as build capacity of staff for use in future surveys. The following agencies committed human and material resources for the survey:

- SMOH: 15 staff for anthropometric, morbidity, mortality and household survey

- ACF France: 11 staff for anthropometric, morbidity and, mortality survey

- WFP: One staff for supervising the survey

- SMOA: Three staff -- two for household survey and one for supervision

- CHF Int'l: Four staff for household survey

- UNICEF: One staff for overall supervision along with Team Leader from SMOH

Technical supervision

SMOH was the overall coordinator of the survey. Their Nutrition Director and UNICEF's national Nutritionist worked together to coordinate the whole survey. In addition, WFP and SMOH provided two nutrition specialists who assisted the teams and controlled quality. All four of them visited the teams daily during field work and acted as troubleshooters to ensure high quality data collection.

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