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EXECUTIVE SUMMARY
In March 2014, UNICEF and Ministry of Public Health and Population (MOHP) initiated a SMART nutrition survey in the Hodeida Governorate. The nutrition survey was conducted from March 25 to April 3, 2014, in Hodeida governorates stratified as highland and lowland regions. The samples used were 81 clusters for Hodeida governorate among this 41 were for lowland and 40 for highland.
Households in each cluster were selected resulting in a total of 1348 households for both the highland (618 HH) and the lowland (730 HH). All children under 5 years of age were measured in the 1348 households where children were available. One thousand six hundred and eighteen children of ages 0 to 5 years were available for the survey. Of the 1618 targeted children, 1452 (the highland-652 the lowland-800) children were available for anthropometric measurements. All 1452 children were analyzed for wasting, stunting and underweight using the ENA SMART methodology. All children under five years of age were included from each household. Data entry and analysis of anthropometric measurements were done using the Emergency Nutritional Analysis, Standardized Monitoring and Assessment of Relief and Transitions (ENA SMART). Some household information was analyzed using the software package for statistical analysis (SPSS) version 12. Children 6 to 59 months of age were measured. Weight, height, Mid Upper Arm Circumference (MUAC), and age were recorded. In addition, through interviews with mothers and other caretakers of children aged 0 to 59 months, detailed household, food consumption, child health and nutrition information was collected.
Most infants and children who die in developing countries do so because of infection and diseases associated with malnutrition. Malnutrition, especially stunting, has many functional consequences such as poor immune status. Infants born with Low Birth Weight (LBW - less than 2500 g.) suffer from high rates of morbidity and mortality from infectious diseases, and are underweight and stunted or wasted throughout their childhoods. The SMART nutrition survey results from the Hodeida Governorate shows that out of ten children, two children were wasted (low weight-for-height), and six children out of 10 children were stunted (low height-for-age). Moreover, strong epidemiological evidence suggests that there is a link between maternal and early childhood under nutrition and increased adult risk of various chronic diseases (Allen L, 2001).
The 2011 December Nutrition baseline survey (UNICEF/MOPHP) shows a 31.7% prevalence rate of wasting (low weight-for-height) in Hodeida Governorate while March 2014 Smart Nutrition survey (UNICEF/MOPHP) Hodeida shows 18.3%, which is low in comparison. Sharp decreased, the prevalence rate of wasting is noticed with the significant level P< 0.05. Even the survey time, sample size and month differ in these two studies. The prevalence of severe acute malnutrition (<- 3 Z-score and/or oedema) is 3.4% in the 2014 survey, while in the 2011 survey it is 9.9%. The prevalence of chronic malnutrition (stunting for children less than 5 years of age) is 66.3% in the highland and 54.6 % in lowland in both sexes. Boys are slightly (56.1.2%) more stunted than girls (52.7%) in lowland.
Among all household mothers, 14% in the highland and 17.4% in the lowland are less than 21.5 cm. MUAC and therefore classified as malnourished mothers .It should be noted that according to WHO, a prevalence rate of underweight individuals (i.e., with a BMI < 18.5 kg/m2) within a population is between 5-9% and should be considered a warning sign, requiring monitoring. However, this survey shows nutritional status based on Mid Upper arm circumference (MUAC) not on BMI (body mass Index). Mothers who were married in the age groups 10-15 years and 16-20 years in the both highland and lowland are more malnourished (highland-103 and Lowland-141 malnourished mothers) than the age groups 21-25 years and 26-30 years (Highland-11 and Lowland-17). Variations in underweight and overweight among mothers and children in different development regions of Yemen are observed. This could be associated with differences in populations’ food intakes, energy expenditures, and lifestyles in these governorates. Moreover, seasonal variation (mountainous and flat regions) and food availabilities could also be strong determinants. Particularly, a seasonal variation on nutritional status and food availability and its effect has been widely studied (Ferro-Luzzi, 1994). None of mothers are found smoking cigarettes in the highland and the lowland of Hodeida governorates. Report shows mothers who chew QAT every day (7 days a week) is 35.7% in the highland and 19.3% in the lowland.
Vitamin A supplementation reduces the risk of under-five mortality by about one-fourth among the millions of children deficient in this micronutrient. The children who received the third dose of polio and pentavalent vaccines are 52 % in the highland and 51% in the lowland while 26.3 % in the highland and 34.3% in the lowland received vitamin A supplementations within the last 6 months. Nine percent children in the highland and 16.3 % in the lowland take solid, semi-solids or liquids at least 4 times a day. Sixty five percent of children in the highland and 54 % in the lowland are introduced solid, semisolid and/or other liquids at the age of 6-8 months. Over the past 30 days, 16.4% children in the highland and 20.5% children in the lowland are went to the bed without food (Sleep hungry, because of not enough food) at the household level.
The Minimum Acceptable Diet (MAD) indicator measures the proportion of children 6-23 months of age who receive a minimally acceptable diet apart from breast milk. This study shows that 41% of children in the highland and 53% in the lowland have received at least >= 4 types of food during the previous day; 28% of 6-11 months children in the highland and 29% in the lowland have consumed >=4 food groups; and of those 18-23 months of age, 53% in the highland and 66% in the lowland have received 4 or more groups or types. The women’s dietary diversity measures the micronutrient adequacy of the diet and reports the mean number of food groups consumed in the previous day by women of reproductive age (15-49 years). However, food consume by women of reproductive age were not collected.
The major sources of income are temporary work, monthly salary and remittance in this study. This study shows 14 % in the both regions of lowland and highland depend up on remittance. Higher percentages of the households survive with temporary work (casual work); the highland 27.8% and 37.1% in the lowland. The main sources of drinking water are found in Hodeida governorate are open protected and unprotected well, piped water connected to home and unprotected surface water. Open protected well, around 23 % of both households of the lowland and the highland use water to drink. Forty two point five percent of households in the highland and 26.1% in the lowland are found defecating in the open field. Only 35.2% households in the highland and 31.7% in the lowland are used to defecate in the toilet which was equipped with flush mechanism to wash water down.
Over the past 30 days, 48.7% household’s member in the highland and 39.6% in the lowland reduced the size of meals because of the scarcity of food resources at the household level. Similarly, over the past 30 days, 23.9% household’s members in the highland and 22.6% in the lowland went to the bed without eating (Sleep-hunger) because of not enough food in the house. Over the past 30 days, 30.9% households in the highland and 22.3% in the lowland have reduced the expenditure on education and health to save money to purchase food.