Sudan: Nutritional anthropometric survey, children under five years old - results summary central, northern and southern Payams of Malakal County, Upper Nile State



Upper Nile state borders White and Blue Nile states to the North; Ethiopia to the East; South Kordofan and Unity states to the West and Jonglei state to the South. The state comprises of 12 counties namely: Renk, Melut, Manyou, Fashoda, Malakal, Panyikang, Maban, Maiwut, Baliet, Nasir and Longuchok. Malakal has five administrative payams namely Northern, Central, Southern, Lelo and Ogod. Malakal town hosts the state headquarters. It lies on the Eastern bank of White Nile River and is the second largest city in South Sudan.

The community in Malakal County has experienced of lot of movements, due to previous insecurity situation, seasonal food insecurity and other pull factors associated with urban settings. Since the county is located on Shilluk land, the predominant residents belong to the Shilluk ethnicity with increasing numbers from other ethnic groups particularly the Nuer and Dinka clans(1). The population of Malakal town (Central, Southern and Northern Zones) within which the assessment focused was estimated at 129,626(2).
Owing to the proximity of the county to the White Nile River and road access to Khartoum, fishing and commercial trade are important sources of livelihood to the community.

Persistent civil insecurity and population movement are threats to food security in Malakal County. The latest insecurity incident occurred towards the end of November 2006 when skirmishes erupted in Malakal town. An unknown number of deaths, and some households fled from the town to neighbouring counties. Thee events also led to destabilization of humanitarian service provision, through evacuation of technical staff.
The impact of the fighting on various activities (such as labour migration, trade and access to markets) and the community's livelihoods have not yet been fully established.

Population increase directly affects demand, prices of various commodities and services. In January to December 2006 ADRA tracked and recorded a total of 19,336 returnees belonging to 4,324 households who expressed their intentions to settle down in Malakal town(3). Moreover since January to February 2007 ADRA's monthly summary updates show that there were 5,652 IDP returnees who have been registered.
The significant increase in the population size, due to high influx of returnees may have had an important effect on the community's food security, and demand on health and education, among other important services.

In June and December 2005, GOAL undertook two nutritional surveys in the region. GAM rates of 22.8% (20.0%-25.9%) and 21.6% (19.1%-24.4%) (Z-scores, reference NCHS, at 95% confidence interval) respectively. Both surveys showed acute malnutrition prevalence above the emergency thresholds of 15%.
No survey was carried out in the year 2006.
In line with the above context and need for programming data, ACF-USA decided to implement a nutritional survey in Malakal County.
The present survey was conducted between 6th March and 2nd April 2007 with the following objectives.

To evaluate the nutritional status of children aged 6 to 59 months.

To estimate the measles immunization coverage of children aged 9 to 59 months.

To estimate the crude mortality rate through a retrospective survey.

To capacity build Ministry of Health and one National NGO


SMART methodology was applied in the training, planning, collection and analysis of both anthropometric and mortality data.
All the accessible villages in three of the five payams (Southern, Central and Northern) were assessed during the nutritional survey. Population figures obtained from the SRRC were cross-checked alongside other sources such as GOAL survey report 2005, WHO (NIDS) 2006, RRR/UNMIS report 2007 as well as MOH Public Health Survey 2005. Thereafter, the population figures were extrapolated considering the population movements in the area.
Using malnutrition prevalence of 25.0% based on previous surveys, precision of 4.2% and design effect of 2, a sample size of 804 children was obtained. The sample would then be composed of 34 clusters of 23 children each.

Retrospective mortality data with a recall period of 90 days was collected alongside the anthropometric data and in every household selected by the methodology.
Qualitative information on food security, water, sanitation and hygiene (WASH), Maternal and Child Health (MCH), awareness, accessibility and utilization of health care services was collected through household interviews, using structured questionnaires, and observation.

During the data collection exercise households were randomly selected by first going to the centre of the clustered sub village and spinning a pen to determine the starting direction in order to eliminate bias towards the centre. The team then moved along the pointed direction to the periphery of the village where the pen was re-spinned and thereafter a starting point established using simple balloting. In the selected household mortality and anthropometric questionnaires were administered where applicable. Owing to the adjacent nature of the residential areas, the subsequent households were chosen by moving to the right till the cluster was completed.


(1) Return and its impact on Malakal town by RRR/UNMIS, Malakal; March 2007.
(2) Source: Extrapolated figures used by GOAL 2005 survey, SRRC, NIDs 2006 and MOH public Health survey of October 2005.
(3) Return and its impact on Malakal town by RRR/UNMIS, Malakal; March 2007.