Research proposal on the nutritional state of children under five years of age in Somalia

1. Research proposal on the nutritional state of children under five years of age in Somalia December, 2012.

2. The Somalia Background • Somalia, situated in the Horn of Africa, lies along the Gulf of Aden and the Indian Ocean. It is bounded by Djibouti in the northwest, Ethiopia in the west, and Kenya in the southwest • Surface area: 637,700 km², with water covering 10,320 km². Generally arid and barren, with two chief rivers, the Shebelle and the Juba • Population: 10 million inhabitants. About 85% of local residents are ethnic Somalis • Since 1991 Somalia has been engulfed in anarchy. Years of peace negotiations between the various factions were fruitless, and warlords and militias ruled over individual swaths of land • In 1991, a breakaway nation, the Somaliland Republic, proclaimed its independence. Since then several warlords have set up their own ministates in Puntland and Jubaland. Although internationally unrecognized, these states have been peaceful and stable

3. The Somalia Background……cont • 1992: Africa's worst drought of the century occurred, and, coupled with the devastation of civil war, Somalia was plunged into a severe famine that killed 300,000 • Dec 1992: U.S. troops were sent in to protect the delivery of food • May 1993: UN took control of the relief efforts from the U.S. • The warlord Mohamed Farah Aidid ambushed UN troops and dragged American bodies through the streets, causing an about-face in U.S. willingness to involve itself in the fate of this lawless country • Mar 1994: The last of the U.S. troops departed, leaving 19,000 UN troops behind • Aug 2000:a parliament convened in nearby Djibouti and elected Somalia's first government in nearly a decade. After its first year in office, the government still controlled only 10% of the country before its mandate expired in Aug 2003 • Oct 2002: new talks to establish a government began • Aug 2004:a 275-member transitional parliament was inaugurated for a five-year term. Parliament selected a national president in September, Abdullahi Yusuf Ahmed, the president of the breakaway region of Puntland. The new government, however, spent its first year operating in Kenya—Somalia remained too violent and unstable to enter—eventually settling in the provincial town of Baidoa.

4. The Somalia Background ……cont • May 2006: the country's worst outbreak of violence in 10 years began, with Islamist militias, called the Somali Islamic Courts Council (SICC), battling rival warlords • Jun 2006:the Islamist militia seized control of the capital, Mogadishu, and established control in much of the south. Somalia's transitional government, led by President Abdullahi Yusuf and situated in Baidoa, spent months engaged in unsuccessful peace negotiations with the Islamic Courts Council • In the meantime, neighboring Ethiopia, which has clashed in the past with Somalia's Islamists and considers them a threat to regional security, began amassing troops on the border • Dec 2006: Ethiopia launched air strikes against the Islamists, and in a matter of days Ethiopian ground troops and Somali soldiers loyal to the transitional government regained control of Mogadishu. A week later most of the Islamists had been forced to flee the country. Ethiopia announced that its troops would remain in the country until stability was assured and a functional central government had been established, ending Somalia's 15 years of anarchy • Oct 2011: Kenya government entered Somalia in an operation that eventually led to the capture of major cities including Afmadhow and the port city of Kismayu

5. Research Background • Levels of malnutrition have reached a new peak and are currently the highest in the world (International Committee of the Red Cross, ICRC – 2012). In some parts of Somalia, the number of children with severe acute malnutrition has almost doubled since March 2011 • "A dramatic increase in cases of malnutrition can be observed even in the Bay and Lower Shabelle regions, usually described as the country's breadbaskets, where nearly 11 per cent of children under five suffer from severe acute malnutrition," said Andrea Heath, the ICRC's economic-security coordinator for Somalia. • The ICRC assessment includes data from 39 clinics and 18 outpatient therapeutic feeding centres. The facilities are run by the Somali Red Crescent Society with support from the ICRC. • "These deeply disturbing findings show that the population is no longer able to cope with harsh climate conditions, such as the current drought, while at the same time struggling to survive armed conflict and other violence," said Ms Heath. "The groups hardest hit are rain-fed farmers and pastoralists who have not been able to gain access to alternative pastureland. Significant crop failures, very high livestock losses, increased food prices, recurrent fighting and the absence of humanitarian aid are the main reasons that an already desperate situation has become even worse in many parts of central and southern Somalia." • As a first step in responding to the crisis, the ICRC and the Somali Red Crescent will expand services in existing outpatient therapeutic feeding centres and health-care facilities. Ten new feeding centres will be opened in Bakool, Gedo and the Afgoye corridor. Additional mobile teams made up of nurses and nutritional specialists will visit people in the areas worst affected. In addition, a new feeding programme supplementing the regular therapeutic feeding will be launched for malnourished children under five and other vulnerable groups, such as pregnant and lactating women. • Since October 2010, the ICRC has distributed emergency supplies to half a million people throughout Somalia and has delivered water to almost a million.

6. The purpose of the study • The purpose of the study is to assess the nutritional state of children under five years of age in Somalia, determine the factors that are associated with it and come up with an effective solution to solving the nutritional problem

7. Research Hypothesis • The level of malnutrition among children under the age of 5 years of age is associated with the duration of breastfeeding and other factors which includes social economic status, age of the child, location (rural and urban) and level of education of the children’s parents or guardians

8. Research Objectives • The main objectives • To determine the proportion of malnutrition among children under the age of five years in Somalia • To determine the level of malnutrition among children under the age of five years in Somalia

9. Other Objectives • To capture the demographic information of children under the age of five years and of their parents and guardians • To assess the relationship between malnutrition and duration of breastfeeding among children under the age of five years in Somalia • To determine the relationship between malnutrition and other factors such as; • the level of education of the parent / guardian • Gender of the child • Age of the child • Socio-economic status • Partial breastfeeding and total breastfeeding • Weight of the child

10. Research Methodology • Data collection will take place for a period of 3 months in clinics and outpatient therapeutic feeding centers. Parents / guardians of the children will be interviewed and the Inclusion criteria is: • Children under the age of five years • A representative sample of male / female adult respondents • Quantitative Approach will be used in this study • Quantitative Approach has the following features; • employs face to face interviews • entails use of large samples which give a good representation of target populations • Uses structured questionnaires thus giving the respondents an easier time in identifying with the questions at hand • gives a clear validation of facts, estimates, relationships and predictions

11. The sample defined • A sample is an important feature in this research in which the goal is to make inferences about the population from a sample • Parents or guardians of all the children attending clinics or outpatient therapeutic feeding Center will be sampled using systematic random sampling approach and interview • A sample size of 200 children will be used

12. Statistical test to be used and it’s interpretation • Analysis will be done in SPSS 18.0 statistical software • All the continuous and interval data will be tested for normality to aid in identifying the statistical tool to be used • Chi-Square test will be used to test the association between malnutrition (dependent variable) and independent variables . This will be used for categorical data (for example gender, level of education of the parent / guardian) • Non parametric Mann Whiney U test and parametric test (T test) will be employed for skewed data and normal data respectively • P value • P <= 0.05 the results are statistically significant • P > 0.05 the results are not statistically significant

13. Presentation of research findings • Analysis will be done and results presented in tables and graphs

14. Expected results • The rate of malnourished children in Somalia is high as recorded by seven in ten of the surveyed children • Factors that are associated with malnutrition includes; • The level of education of the parent or guardian • The age of the child • The duration of breastfeeding • Nature of breastfeeding (partial or total) • The location; more rural dwellers seems to be malnourised

15. Time plan

16. Budget

17. Thank you