Type of the survey: SMART 18 th to 24 th February, 2012

1. Tana River County SMART SurveyConducted by:International Medical Corps and Ministry of Public Health and Sanitation Services With support from UNICEF KCO Type of the survey: SMART 18th to 24th February, 2012 Martin Meme – Consultant Nutritionist

2. Survey Implementation Dates • Survey Team Training: 5 days (13th - 17th February 2012) including anthropometric survey standardization, piloting, adjustment of survey tools and logistics • Data Collection: 7 days (18th-24th February 2012)

4. Survey Background • Tana River County comprises of 3 districts (Tana North, Tana River and Tana Delta) covering an area of 180,385 km². • County comprises of 3 livelihood zones (Marginal mixed farming, Mixed farming and Pastoral). • Food security situation in the county was at ‘Stressed Phase’ with the status rated at ‘Alert and Deteriorating’ (ALRMP Drought Early Warning Bulletin - January 2012). • This survey therefore served to assess the nutritional situation in the county to gauge the performance of HINI and inform future programming

5. Objectives of the survey • To evaluate the nutritional status of children aged 6 to 59 months • To assess the nutritional status of pregnant and lactating mothers aged 15-49 years • To estimate the measles and polio immunization coverage for children aged 9 to 59 months • To estimate the crude and under-five mortality rates • To estimate the systematic treatment (vitamin A supplementation and de-worming coverage) • To identify factors likely to have influenced the nutritional status of young children • To estimate the prevalence of some common illnesses (e.g. measles, diarrhea, malaria, and ARI)

6. Objectives of the survey cont.. 8. To estimate the impact and coverage of general food distribution and feeding programs 9. To establish the current household food security situation 10. To establish the situation of water and sanitation 11. To assess the percentage of mothers accessing MCH facilities and the level of exclusive breastfeeding of children under six months 12. To estimate the iron /folate coverage among mothers

7. Sampling Methodology

8. Plausibility check

9. Nutrition status- Wasting (WHZ)by Sex (WHO 2006)

10. Prevalence of Wasting (WHZ) by Age

11. Prevalence of Underweight (WAZ) by Sex

12. Prevalence of Stunting (HAZ) by Sex

13. Prevalence of Wasting by MUAC

14. Child Morbidity N=579 (67.4%)

15. Zinc Supplementation during Last DD Episode

16. Immunization, Vitamin A Coverage and Deworming

17. Water and Environmental Sanitation

18. Washing of hands

19. Estimated feeding programs point coverage

20. Nutritional status of Women by MUAC

21. Maternal Health-Care

22. Household Food Consumption

23. Household Food Consumption cont..

24. Breastfeeding practices

25. Complementary Feeding Practices – Frequency of Meals

26. Complementary Feeding Practices – Dietary Diversity 6-23 months old

27. Mortality • Crude mortality rates (CMR): 0.75/10,000/day [0.53-1.06 95% CI]* • Under 5 mortality rates (U5MR): 1.23/10,000/day [0.62-2.20 95% CI]* • Mortality rates below ‘alert’ threshold

28. Conclusions • This survey was conducted during the hunger-gap period that precedes the onset of long rains in TRD. • Though both UFMR and CMR are low, the prevalence of GAM 13.5 is beyond acceptable level according to WHO benchmarks and rated ‘Risky’. • The prevalence of underweight in the County (27.2%) is above the average for Coast province (23.5%) but below the national average (16.1%) while that of stunting (33.4%) was below both that of Coast province (39.0%) and national average of 35.3% (KDHS 2008-2009). • Underfive children in TRD county were faced with a high burden of morbidity (> 2/3rds sick) mainly due to ARI and malaria. • Zinc supplementation dismally covering only 10% children during diarrhoea and attributed to erratic availability in medical facilities.

29. Conclusions cont... • Vitamin A supplementation and deworming coverage were below WHO recommendation of 80% • WASH practices still poor in the county: • Less than 1/3rd households have access to toilets • Less than 1/5th HHDs treat unsafe drinking water • Appropriate hand washing practised by only about 1/10th of the childcare givers • Coverage of selective feeding practices (particularly OTP) commendably high – but many factors militating potential gains • Attendance to ANC high (more than 4/5th but more than ¾ of the mothers give birth without supervised medical care.

30. Conclusions cont... • IYCF Practices: • Breastfeeding practices (timely initiation, EBF and maintenance of b/feeding at 1 yr) good but low at 2 years (FGDs indicate socio-cultural and ignorance factors mainly responsible for non-compliance). • Although complementary feeding practices (frequency of meals) optimal for approximately 1/3rd of the children, qualitative analysis of the diet indicates poor dietary profiles for eligible children with more than half subsisting on poorly diversified diets. • Food security status: • Household food consumption during the survey’s conduct indicates significant reduction in daily meal frequency • Only about half households took highly diversified diets

31. Conclusions cont... • 60% HHDs relying of food purchase as their major food source (a number of main food stress coping strategies practised apply to serious food deficit periods). FGDs discussants complained of high food prices in the market. • FGDs and observations revealed a community readily embracing farming activities in the on-going irrigation scheme rehabilitation.

32. Recommendations

33. Recommendations cont..