Yemen

Nutrition and Mortality Survey Report - Ibb Governorate, Yemen - 25 March to 6 April 2017

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Introduction

Ibb Governorate is a central one located 193 kilometres south to Sana’a City and 214 kilometres north to Aden City. The Governorate in the map is taking a rhombus shape located in the middle of five governorates. Dhamar in the west, north and east, Al Baidha in the east, Ad Dhale’ in the east and south, Taiz in the south and west, and in the west. The Governorate area is 5.868 square kilometres (1.8% of the country area) in where a population size of 2,892,000 are living as the per 2017 projection (10.8% of the country population) with a sex ratio of 0.93 male: 1 female.
Administratively, the Governorate consists of 20 districts, namely Ad Dhihar, Al Makhadir, Al Mashannah, Al Qafr, Al Udayn, An Nadirah, Ar Radmah, As Sabrah, As Saddah, As Sayyani, Ash Sha'ir,
Ba'dan, Dhi As Sufal, Far Al Udayn, Hazm Al Udayn, Hubaysh, Ibb (the capital of the Governorate),
Jiblah, Mudhaykhirah, and Yarim. Ecologically, Ibb is a mountainous governorate in where 11 districts are classified as temperate highlands and 9 districts dry highlands based on CSO Yemen ecological division. On these highlands, man built the terraces for cultivation of crops. Fertile valleys of the western part of Ibb flow into the Tihama Plain, while valleys lie east of the Governorate flow into the south and then into the Gulf of Aden.
The Governorate has a mild climate throughout the year with heavy rains especially in the summer.
The annual rainfall rate exceeds 1,000 mm in the western and southern mountains. Abundance of water encouraged farmers to cultivate all the land despite the difficult mountains and steep terrains.
The Governorate earned the nickname of “green province” for its green terraces. Agriculture is the main economic activity that includes crops cultivation of grains (wheat, barley, and millet), fruits and vegetables, coffee, and Qat, while livestock breeding on the other hand is widely grazed. Health services are provided by 321 health facilitiesin the whole Governorate (16 hospitals, 118 health centres and 187 health units). Among these facilities, 305 deliver EPI services, 283 deliver IMCI services, 220 deliver CMAM services (25 of them provides SAM treatment services only), and 223 deliver reproductive health services. The national nutrition information system has shown that number of SAM admitted children increased from 11,930 cases (reported by 120 sites) in 2014 to 12,092 cases (reported by 140 sites) in 2015 that in 2016 increased to 18,508 cases (reported by 220 sites). This indicates that average admitted cases per reporting sites decreased from 99.4 in 2014 to 86.4 in 2015 then slightly decrease to 84.1 in 2016. The first SMART survey conducted in Ibb was in November/ December 2012 in two zones. Global acute malnutrition (GAM) was found as 7.6% (with 1.2% SAM) in Eastern Highlands and 8.6% (with 0.9% SAM) in Western Highlands (the weighted average was 8.0% GAM and 1.1% SAM). The DHS 2013 survey indicated a prevalence of wasting as 10.9% (with 2.7% SAM) while the CFSS 2014 indicated higher GAM levels (14.7%) but with almost same levels (2.6%). The most recent EFSNA that was conducted in November 2016 indicated GAM levels similar to that of SMART 2012 (8.0%) but with SAM levels of 1.7%. Almost 68% of Ibb households are food insecure as revealed by the EFSNA November 2016. This level is significantly higher that the pre-crises one (43%) as shown by CFSS 2014. However the IPC classification of Ibb since 2012 is IPC 3 (Crisis). Ibb is one of governorates which had heavily participated in the Peaceful Youth Revaluation of 2011 establishing one of largest sit-in squares in the country called “Gulf of Freedom”. That crisis ended by signing the GCC Initiative by different political parties. Ibb after that participated in the National Dialogue Conference in 2013. After Houthi forces have controlled the Capital Sana’a in September 2014 and allied with forces loyal of the former president, a severe political/military crises raised that ended as an internal war by March 2015. Ibb has not witnessed large-scale military operations such as those in governorates of Taiz, Aden, Lahj, Abyan and Marib, but on the other hand, it was the governorate to which large numbers of families from Taiz and southern governorates displaced to. In August 2015, limited military operations have taken place in the governorate during which antiHouthis could controlled 8 districts of Ibb, However, those operations were quickly foiled and the situation returned back to the rest. Although war operations is not heavily taking place in Ibb, the Governorate is indirectly affected by the crisis. The deterioration of national economy, losing of income sources and livelihood, the inflation due to continuous deterioration of the value of the local currency and the increase of prices of food of fuel are all driven to poor affordability and accessibility to accepted quantity and quality food. Accessing essential service such as health and education is also challenging. Assessment objectives The overall objective of the survey was to assess the current nutrition situation in Ibb Governorate and key determinants. Specific objectives are: 1. To assess the level of acute malnutrition (wasting), stunting and underweight among children aged 6-59 months in Western Highlands and Eastern Highlands of Ibb Governorate. 2. To assess the prevalence of exclusive breastfeeding among under six months, breastfeeding continuation at 1 and 2 years, children aged 6 to 23 months with proper complementary feeding practices in Western Highlands and Eastern Highlands of Ibb Governorate. 3. To assess the child morbidity through determining the prevalence of diarrhoea, ARI and fever in Western Highlands and Eastern Highlands of Ibb Governorate. 4. To assess the routine polio vaccination coverage among children aged 3 to 59 months, measles vaccination coverage among children aged 9 to 59 months and vitamin A supplementation coverage within the last 6 months prior to survey among children aged 6 to 59 months in Western Highlands and Eastern Highlands of Ibb Governorate. 5. To assess the level of acute malnutrition among women at child bearing age (15 to 49 years) in Western Highlands and Eastern Highlands of Ibb Governorate. 6. To assess the food consumption scoring (FCS) in past 7 days in Western Highlands and Eastern Highlands of Ibb Governorate. 7. To assess the mean coping strategy index (CSI) of households in Western Highlands and Eastern Highlands of Ibb Governorate. 8. To assess the household practice of a set of stress, crisis and emergency coping strategies in Western Highlands and Eastern Highlands of Ibb Governorate. 9. To assess the household head losing of income sources in Western Highlands and Eastern Highlands of Ibb Governorate due to the current conflict crisis. 10. To assess the monthly household expenditure of households in Western Highlands and Eastern Highlands of Ibb Governorate. 11. To assess the education level of household caregivers in Western Highlands and Eastern Highlands of Ibb Governorate. 12. To assess the main household drinking water source, the quality classification of the water sources and the cleanness of drinking water storage in Western Highlands and Eastern Highlands of Ibb Governorate. 13. To assess the household latrine type and the quality classification of sanitation facilities in Western Highlands and Eastern Highlands of Ibb Governorate. 14. To assess the practice of handwashing with water and soap (or soap alternatives) by household care giver after toilet and before the meal in Western Highlands and Eastern Highlands of Ibb Governorate. 15. To assess the crude and under-five mortality rates in Western Highlands and Eastern Highlands of Ibb Governorate during the past three and a half months.*

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