1. GREATER MWINGI (Mumoni, Kyuso, Migwani, Tseukuru, Mwingi East and Mwingi central districts) KITUI COUNTY

2. An anthropometric nutrition surveys was implemented in Greater Mwingi in March 2012. The geographical areas surveyed were:- -Mwingi Central district -Mwing East district -Tseukuru district -Migwani district -Kyuso district -Mumoni district

3. The objectives for the survey were To evaluate the nutritional status of children aged 6-59 months To estimate measles and immunization coverage of children aged 9-59 months. To estimate the coverage of Vitamin supplementation among the targeted children. To estimate the retrospective morbidity, crude and under five mortality rate. To assess infant and young child feeding practices To estimate the coverage of general food distribution and feeding programs To describe the current household food security situation To describe the current water and sanitation situation and hygiene practises. To recommend appropriate interventions based on survey findings.

4. METHODOLOGY Two-stage cluster sampling using SMART methodology was applied to randomly identify clusters with the probability of being selected proportional to the population size in each cluster. 40 clusters children between 6-59 were sampled. A total of 601 households were sampled for the survey and a total of 40 clusters were selected for the survey. 16 households per cluster were included in the survey

5. RESULTS Anthropometric and Mortality data results Child Nutrition Status W/H (WHO)- Z scores (534) Global Acute Malnutrition (GAM) (<-2 z-score and/or oedema) 2.8% [1.5- 5.0] Severe Acute Malnutrition (SAM) (<-3 z-score and/or oedema) 0.0% [0.0- 0.0] Child Nutrition status W/H (NCHS)- Z-scores(536) Global Acute Malnutrition (GAM) (<-2 z-score and/or oedema) 3.0% [1.8- 4.9] Severe Acute Malnutrition (SAM) (<-3 z-score and/or oedema) 0.2% [1.6- 4.7] Child Nutrition Status H/A (WHO)- Z scores (520) Prevalence of stunting (<-2 z-score) 46.2%[41.8-50.6%] Prevalence of severe stunting (<-3 z-score) 15.2%[12.4-18.5] Child Nutrition Status H/A (NCHS)- Z scores (520) Prevalence of stunting (<-2 z-score) 39.2% [35.3-43.4] Prevalence of severe stunting (<-3 z-score) 11.2% [8.4-14.7]

6. Child Nutrition Status W/A (WHO)- Z scores (536 Prevalence of underweight (<-2 z-score) 25.9&[21.9-30.5] Prevalence of severe underweight (<-3 z-score) 5.0% [3.3-7.6] Child Nutrition Status W/A (NCHS)- Z scores (536) Prevalence of underweight (<-2 z-score) 31.9%[27.3-36-9] Prevalence of severe underweight (<-3 z-score) 5.0[3.2-7.8] Mortality Crude Death rate/10,000/day0.67[0.35-1.30] 0-5 Death rate/10,000/day1.95[0.83-4.53] Child MUAC (567) SAM (<115 mm) GAM (<125mm) At risk ( >125-<134 mm) 0.5% 4.1% 11.8%

7. Maternal nutrition status (lactating and pregnant mothers) % Women with MUAC <21 cm % Women Pregnant and lactating Maternal nutrition status (lactating and pregnant mothers) <21.0 0.4% 55.0% 0.7%

8. Vaccination coverage, Vitamin A and Iron supplementation Measles coverage ≥ 9 months (509) Card According to mother Not Immunized 68.6% 22.6% 8.8% De-worming (471)>= 1 year Received once in last 6 months 23.4% DPT3 (n =543) Card According to mother Not immunized 71.1% 22.5% 6.4% Vitamin A coverage (last 6 months) (543) Received Not received 47.7% 52.3% Vitamin A coverage (6- 11) Last 6 months (71) Received Not received 39.4% 60.6% Vitamin A coverage (12- 59) Last 6 months (472) Received Not received 45.8% 54.2% Mother Iron supplementation (last pregnancy) Yes No Don ’ t Know 64.2% 33.2% 2.6%

9. Morbidity for the last 2 weeks Child Illness in the last 2 weeks Yes No 59.4% 40.6% Treatment Sought for diarrhoea ORS Homemade sugar salt solution Another homemade liquid Zinc Other drugs Nothing 27.6% 13.8% 6.9% 17.2% 20.7% 13.8% Child Slept under mosquito net last night Yes No 70.8% 29.2%

10. Disease patterns in the last two weeks before the survey

11. Infant and young child feeding practice Exclusive breastfeeding0-5 Months (n=43)23.3% Early Initiation of breast feeding0- 23 Months (n=205)85.4% Continued breastfeeding at 1year12-15 Months (n=33)97.0% Introduction of solid, semi-solid or soft foods 6-8 Months (n33)97% Minimum diet diversity (all)6-23 Months (n=162)16.1% Minimum diet diversity (breast fed)6-23 Months (n=151)15.9% Minimum diet diversity (non breast fed)6-23 Months (n=11)18.2% Minimum meal frequency6-23 Months (n=162)79.6% Minimum meal frequency (Breast fed)6-23 months (n-151)78.8% Minimum meal frequency (non breast fed) 6-23 Months (n= 11)90.9% Minimum Acceptable diet6-23 Months (n=162)15.4% Minimum Acceptable diet (Breast fed)6-23 months (n=151) 15.2% Minimum Acceptable diet (non Breast fed) 6-23 Months (n= 11)18.2% Child ever breastfed0-23 months (203)99.0% Continued breastfeeding at 2years20-23 months (n=30)83.3%

14. Latrine useN% latrine30467.7 Hole92 Designated open area102.2 Undesignated Open area12628.1 Total449100 Latrine ownership

15. SourceN% Own production34376.1 purchases10322.8 gifts from friends10.2 food aid40.9 Total451100 Main source of dominant food consumed in the household

16. Most of the respondents 70.7% kept goats, 36.6% Donkey, 37.2% Cattle while only 4.2% kept sheep. Majority of the household had 98.8% practiced crop farming; among the popular crops they plant included maize 83.7%, millet 52.6%, cow peas 61.2%, green grams 43.0%, and sorghum 37.4%, beans 27.5% 18.8% pigeon peas In the households most of them 69% said they consumed 3 meals and above normally while during the survey 70.1% of them consumed 3 or more times in a day showing no significant difference Among the respondents 40.8% had received food aid in the last three months, 17% were in food for work program while 12.4% were in cash grants program. Food security

17. Food diversity Food diversity was measured during the survey and the food diversity score was 5.54, meaning that most of the respondents ate less than half of the 12 food groups Majority of them 96.9% ate cereals, 75% legumes, sugar 82.5%, milk 68.8%, condiments 84.5% while the least consumed foods were fish, eggs tubers and meat.

19. Conclusion The surveys results 2.8% and 0.0% GAM and SAM respectively are lower below the emergency cut off of 15%. The survey covered the larger Mwingi districts that could be compared with a survey done in 2008, that had a GAM of 3.6% and was not significant different with the current survey. The KDHS 2008 had a GAM of 4.7% for eastern province. This shows that the survey was not significant different between the two assessments. Another nutrition survey done in the April 2011 had a GAM of 10.2% and SAM of 1.5% but was done only in two districts Tesukur u and Mwingi east, hence the results cannot be compared with the current survey. The underweight and stunting for both surveys was high as April 2011 had underweight prevalence of 37.3% and stunting of 35.1% while March 2011 had 25.9% and 46.2% underweight and stunting respectively –

20. The acute malnutrition shows good good nutrition state in the larger Mwingi districts this could be attributed to the fact that last seasons short rains were good and the community harvested enough food that there were consuming during the survey. The under five mortality was quite high though below emergency cut off this is attributed to the outbreak of measles in the community that’s was reported late last year and early 2012 that caused mortality to some children in the community.

21. The religious sect Kavonokya that cuts across many villages in the larger Mwingi district has also contributed to poor health seeking behaviour hence mortality and low immunization coverage as there sect members don’t accept medicine and any sort of modern treatment or prevention of disease. Infant and young child feeding (IYCF) practices were good especially, early initiation to breastfeeding, continued breast feeding and meal frequency, while exclusive breast feeding and food diversity was quite poor.

22. The water sources were not potable and majority of the households did not treat their water before drinking predisposing them to water borne diseases 25.1% did not wash their hands with soap The current food security in the area is average as most of the households their main source of food was from their farm There is also an uptake of growing of traditional crops which survive under minimal rain fall that is usually experienced in the region that has enhanced the food security of the populace.

23. The food diversity score was average and this could be attributed to lack of appropriate nutrition education on importance of these foods.

24. Short Term recommendations Continue treatment of the severely malnourished and moderate malnourished children and ensure smooth flow of nutrition supplies in the county. Community sensitization to the Kavonokya religious sect on health seeking practices. Improve on Vitamin A coverage through campaigns Promote improved access to safe water and WATSAN education to the communities. Initiate IYCF trainings to improve breastfeeding and Infant feeding especially exclusive breast feeding and food diversity Initiate nutrition education in the communities to improve diet diversity. Continue Advocacy for drought resistant crops for the communities

25. Long Term Recommendations Establish community units to cover the this will enhance –Quick and timely referrals for malnourished and sick children –Access to health services –Vaccination coverage and micro nutrient supplementation. –Positively towards hygiene and sanitation practices Provide long lasting solution for water problems in dry areas boreholes and Dams

26. Plausibity check Indicator Survey Comments Digit preference - weight 2 good Digit preference - height 0 good WHZ ( Standard Deviation) 0.93 good WHZ (Skewness) 0 good WHZ (Kurtosis) 0 good Percent of flags 0 good Age distribution (%) good Group1 6-11 mo 1.1 good Group 2 12-23 mo 0.8 good Group 3 24-35 mo 0.9 good Group 4 36-47 mo 1.1 good Group 5 48-59 mo 1.1 good Age Ratio : G1+G2/G3+G4+G5 good Sex Ratio 1.0 good General acceptability 6% good