Tajikistan

Tajikistan national nutrition survey Oct/Nov 2001

Format
Assessment
Source
Posted
Originally published


SUMMARY REPORT
I. Introduction

The National Nutrition Survey 2001 is a collaborative work that complements 2 previous National Nutrition Surveys conducted in Sept/Oct 2000 and Sept/Oct 1999.

The survey combined an analysis of the nutritional situation of children aged 6-59 months and their care-givers in four regions of the country, with a causal analysis assessing the relative importance of factors known to cause acute malnutrition.

The survey was funded by USAID. It was instigated and designed by CARE International Tajikistan.

Training was conducted by CARE International Tajikistan and AAH-UK. AAH-UK acted as a coordinating agency to assist in oversee the implementation, analysis and interpretation of results and publicisedissemination of the conclusions and recommendations of the survey.

The data collection took place between 24th October and 16th November 2001, and was conducted by 10 collaborating agencies: the International Federation of the Red Cross and Red Crescent Societies (IFRC) in partnership with the Red Crescent Society of Tajikistan (RCST), Mission Ost, Medecins Sans Frontieres - Holland (MSF-H), Save the Children-USA (SC-USA), Children’s Aid Direct (CAD), Mercy Corps Tajikistan, Action Against Hunger (AAH-UK), CARE, the United Nations World Food Program (WFP) and the National Nutrition Institute of Tajikistan.

The four administrative regions of Tajikistan selected for the survey were: Kurgan Teppe Region (West Khatlon); Kouliab Region (East Khatlon); RRS Region; Sughd Region.

Results were analysed simultaneously by AAH-UK and by Tulane University, New Orleans.

This is a preliminary report intending to present a summary of the main findings and results of the National Nutrition Survey. A draft comprehensive report (in both English and Russian) has been presented to all implementing partners. The release of the final report will follow, subject to inter-agency endorsement.

II. Aims and objectives

Main Aim: To assess the nutritional status of children aged from 6 to 59 months old and their care-givers in 4 administrative regions of Tajikistan and to conduct a causal analysis of the current situation to provide insights into specific factors causing malnutrition in each of the 4 regions.

Specific Objectives

  • To evaluate the rates of malnutrition of children aged 6-59 months.
  • To evaluate the nutrition status of the primary caregivers of these same children.
  • To identify variations in malnutrition and influencing factors between the 4 administrative regions of Tajikistan.
  • To assess the relative importance of different factors which cause acute malnutrition of children and their caregivers.
  • To make relevant comparisons between the present survey and the National Nutrition Surveys of 2000 and 1999 where possible.

III. Methodology

The standard two-stage cluster sampling methodology was used to randomly select 30 children from 30 clusters in each survey region. Children from 6- 59 months of age were selected, to represent the age group most vulnerable to disease and malnutrition, and resulting morbidity and mortality.

Mothers or primary care givers of these selected children were also measured and interviewed, using a structured questionnaire to assess household food security issues, child feeding practices and morbidity information. A focus group was conducted in each cluster in which 7-10 people representing a cross-section of the community participated.

Anthropometric variables of height and weight were collected for children and MUAC (Middle Upper Arm Circumference) measurements for their caregivers.

Field Team Training

A total of 17 teams (four people in each team) were recruited by the Implementing Partners. One Survey Team Leader conducted one focus group discussion in each cluster and managed two anthropometric data collection field workers and one Interviewer who carried out household interviews. I can’t find anywhere in this introductory part an explanation of the questionnaires used.

Survey Team Leaders were trained for two days in Dushanbe on Methodology, anthropometric measurement demonstrations, interview and Focus Group discussions

Survey team Members were trained at four separate 2-day training sessions (based in each administrative area) containing 4 or 5 teams (16 to 20 people total). Anthropometric measuring, Interview and Focus Group discussions training was given in detail to all team members along with their team leaders

Constraints and Limitations

Due to the cold weather, there were some difficulties experienced by teams in removing children’s clothes to weigh the children. In such cases team leaders made an adjustment to child weights according to their estimation of the weight of a child’s clothes. These adjustments were unfortunately not accurately documented or uniformly executed. It appeared that the majority of these adjustments were overestimations of the weight of the children’s clothes and is likely to have resulted in a small reduction in the actual weight reported for many children. This may have caused an increase in the numbers of malnourished children and therefore caution is advised in interpretation of the figures. This issue was particularly prevalent in the Kurgan Teppe and Kouliab regions. The authors feel that this problem is associated with the limited time allocated to training survey teams, and non-uniformity of pre-survey training.

IV. Results of the anthropometric survey

The cut-off points for acute malnutrition used in this survey are <-3 z-scores reference weight-for-height = severe malnutrition and >=3 and <-2 z-scores reference weight-for-height = moderate malnutrition.


Table 1: Acute Malnutrition Oct/Nov 2001 (Z-score analysis)
Global Acute Malnutrition Severe Acute malnutrition
Region
No. Child
%
CI
%
CI
RRS
944
16.1
11.9-20.3
4.0
2.3-5.8
Sughd
908
15.4
11.8-19.0
3.4
2.1-4.8
Kurgan-Teppe
931
20.0
16.2-23.8
5.6
3.8-7.3
Kouliab
921
17.6
14.0-21.2
3.9
2.3-5.5
All Regions
3704
17.3
15.4-19.2
4.2
3.4-5.1

Rates in Kurgan Teppe region have increased the most since 1999 but this year all areas are seen to be suffering from high rates of child malnutrition. These results are alarming and represent a worsening situation over the past 2 years, with increasing levels of child malnutrition.

Table 2: Chronic Malnutrition Oct/Nov 2001 (Z-score analysis)

Global Chronic Malnutrition
Region
No. Child
%
CI
RRS
944
32.8
28.2-37.5
Leninabad
894
43.8
39.6-48.1
Kurgan-Teppe Khatlon
931
36.9
33.3-40.6
Kouliab Khatlon
921
34.9
30.7-39.0
All Regions
3664
37.3
35.1-39.5

The Sughd region shows the highest prevalence of stunted children and a statistically significant higher rate of stunting than both the RRS and Kouliab regions. The rates of stunting overall have changed little in the last 2 years: 35.9% was reported in 2000 and 35.3% in 1999.


Table 3: Acute malnutrition in primary care-givers Oct / Nov 2001

Region
No. Women
% MUAC<22.0
CI
RRS
943
11.2%
8.2-14.2
Sughd / Leninabad
905
10.2%
8.1-12.3
Kurgan-Teppe
928
10.4%
7.7-13.1
Kouliab
916
8.1%
5.7-10.6
All Regions
3692
10.0%
8.7-11.3
(The cut-off point used for acute malnutrition of care givers was MUAC = <22.0cm)

No significant differences in malnutrition rates are observed between regions.

V. Main observations and associations by region

Fever and coughwas the most common symptoms of illness reported by caregivers, concurring with that reported for their children. Malaria may be a cause of these reported fevers as it was a prevalent disease in the same month. . Cough was the second most prominent symptom. Illness was linked to caregivers’ malnutrition with those who had been ill having a 1.44 times greater chance of being malnourished. Once again the relationship between illness and malnutrition is complicated by the close inter-relationship.

Kurgan Teppe

Kurgan Teppe region had the highest rates of malnutrition, which had significantly increased since 1999. Despite this, access to kitchen gardens was high in KT region (85.8% of households had kitchen gardens), 91% of households had some land, household food production in KT was higher than in RRS and Sughd, the regular consumption of all groups of foods was the best in this area, as was the predominance of mothers breast-feeding for 6 months or more. However, the highest incidence of illness was observed in KT, as was the highest number of mothers introducing foods to their children at 9 months of age or later. It can therefore be concluded that disease and infant-feeding practices play a major part in the malnutrition observed in this region.

Kouliab

In Kouliab region the lowest rates of caregiver malnutrition are observed. The average area of land per household observed in Kouliab is the highest. Higher rates of child malnutrition are observed in peri-urban areas of Kouliab. Kouliab shows the highest average livestock holdings per household - no livestock ownership is associated with increased risk of malnutrition. Selling of assets as a coping mechanism is lowest in Kouliab, and the levels of migration of household members are also lowest here.

RRS

Although the RRS region did not see the lowest average wheat harvest, the access to land is the lowest in this region. The highest levels of cessation of breast-feeding before 6 months are observed in RRS, and the lowest predominance of breast-feeding for 6 months are also observed here. High consumption of dairy products is observed in RRS.

Sughd / Leninabad

In the Sughd region, the lowest global and severe rates of malnutrition are observed, although the highest levels of chronic malnutrition are observed. A major problem in Sughd is soil salinity, and the lowest wheat harvests per household are observed (although Sughd region has the lowest average household size). Remittances as a main source of income are highest in the Sughd region. Sale of assets as a coping mechanism is also high. Composition of family diet is found to be poor. Incidence of illness observed is lower here.

VI. Summary of conclusions

The rates of malnutrition in all regions, amongst both children 6-59 months and their caregivers (particularly pregnant and lactating women), show a worrying nutritional situation. In particular, the rates of severe malnutrition are alarming and represent a significant deterioration in acute nutritional status since previous surveys.

Breast-feeding practices, poor weaning and infant-feeding practices and diarrheoal disease associated with contaminated water sources continue to be major contributing factors to acute malnutrition in young children. Although the most at-risk group remains the 6-29 month age-group in each region, their risk to become malnourished compared with children in 30-59 month age-group is not as pronounced as in last year’s survey. The number of children in the 30-59 month age-group suffering from acute malnutrition has significantly increased since the last 2 National Surveys, which suggests that the contribution of food insecurity to malnutrition has become much more significant as an underlying cause.

Care-giver malnutrition is in evidence to a considerable degree in all regions, using a MUAC cut-off point of 22.0cm. This raises concern as to the general food security situation in the regions surveyed. The significantly higher rates of malnutrition noted for pregnant / lactating women over those not pregnant / lactating in the KT and RRS regions are of concern, in terms of the health and nutritional status of both mothers and children. Malnourished pregnant women are at a higher risk of complications during birth and of bearing low birth-weight babies.

The survey observed that the major factors affecting household food security include: diminishing agricultural yields as a result of recurrent drought, further break-down of irrigation structures or lack of repair to irrigation systems, deterioration in seed quality, increased migration of household members in search of work, increasing unemployment, exhaustion of coping mechanisms, collapse of family support networks, and depletion of productive and non-productive assets. Poor households are finding it increasingly difficult to bridge the gap when harvests are poor and sources of alternative cash income are not available.

Programmes of humanitarian assistance would appear not to be having a wide-reaching impact on all those at risk of malnutrition, or indeed those suffering from acute malnutrition. The remit of the survey did not include an assessment of the impact of the WFP / implementing partners food aid distribution. However, it would seem that although around a quarter of the surveyed population was in receipt of some quantity of food aid, the amounts of food that are received may be insufficient.

VII. Recommendations

A draft comprehensive report has been presented to all implementing partners in early January 2002. Based on this document and the experience gained during the implementation of the National Nutrition Survey, the implementing partners have been requested to input on recommendations backed up by the survey findings.

These recommendations will be presented in the final report that will follow.

Reporting:

Tamsin Walters
Nutritionist,
Action Against Hunger-UK
Tajikistan

Rebecca Brown
Nutrition and Food Security Adviser
Action Against Hunger (UK)
1 Catton Street
London, WC1R 4AB
United Kingdom

Press Contact:

Sophie Noonan/Cara Wilkins
Action Against Hunger - UK
1 Catton Street
London, WC1R 4AB
United Kingdom
Tel. 020 7831 5858
Email: aahuk@gn.apc.org
Website: www.aahuk.org