1. WEST POKOT COUNTY SMART SURVEY PRELIMINARY FINDINGS MAY,2012

2. OBJECTIVES OF WEST POKOT SMART SURVEY OVERAL OBJECTIVE: To determine the rates of acute malnutrition amongst children aged 6- 59 months in West Pokot County. Specific survey objectives  Determine the prevalence of acute malnutrition in the children aged 6-59months.  Determine the Crude and under five mortality rates of the entire population  Determine the morbidity rates in children aged 0-59 months.  Estimate the coverage of immunization (measles, OPV1&3), and micronutrient supplementation amongst children aged 0-59 months.  Estimate the coverage of women supplemented with iron folate for 90 days in their last pregnancy  Assess household food security, Maternal Child Health care and WASH practices.  To develop capacity amongst focal government ministries and community members on how to undertake SMART surveys

3. SURVEY AREA COVERED The survey was conducted in 3 districts and 14 divisions across the county: DISTRICTS: West Pokot, Central Pokot, and Pokot North DIVISIONS: Kapenguria, Kongelai, Sook, Chepararia, Lelan, Sigor, Tapach, Chesegon, Alale, Kacheliba, Kasei, Konyao, Kiwawa, & Batei The identified areas had slight difference in their livelihood zones as follows; West Pokot- Mixed Farming Central Pokot- Agro-Pastoral Pokot North- Pastoral SURVEY FINDINGS: 39 villages were randomly sampled based on PPS. However, 10.0% of these were inaccessible prompting the team to move into the RC’s (4) as per SMART methodology guidelines. Design effect of 1.21 unveiled

4. SAMPLING DESIGN TWO STAGE CLUSTER SAMPLING (PPS) FIRST STAGE: Clusters selected using PPS sampling methodology  Obtain population of the survey sites was obtained to the smallest geographical unit, being a village.  Enter data into the ENA software alongside the planning information. Based on the desired precision, prevalence and design effect  Cluster assignment proportion to population size. SECOND STAGE-households/children: (12HH/cluster)through simple random sampling  Obtain a list of HH from village elder  Randomly select 12 households through simple random sampling

5. PLAUSIBILITY CHECK INDICATORSURVEY VALUEACCEPTABLE VALUE/RANGECOMMENT Digit preference - WEIGHT 2(0-5 good, 5-10 acceptable, 10-20 poor and > 20 unacceptable) Good Digit preference - HEIGHT 7Acceptable Design Effect W/H 1.21 Design effect Mortality 1.0 WHZ ( Standard Deviation) 0.990.8 – 1.2Good WHZ (SKEWNESS) 0.09If between minus 1 and plus 1, the distribution can be considered symmetrical. Symmetrical WHZ (KURTOSIS) - 0.20If less than an absolute value of 1 the distribution can be considered as normal. Normal distribution PERCENTAGE OF FLAGS WHZ: 0.2%, HAZ: 3.0 %, WAZ: 0.7 % Less than 3% - 5% of the entire sampleAcceptable range AGE DISTRIBUTION (%) Group 1: 06-17 months 24.8%20% - 25%Within acceptable ranges. Recall (calendar of event) was used in 32.4% of the cases to estimate ages of children Group 2: 18-29 months 23.8%20% - 25% Group 3: 30-41 months 22.3%20% - 25% Group 4: 42-53 months 20.3%20% - 25% Group 5: 54-59 months 8.8%10.0%

6. Plausibility check continued…. INDICATOR SURVEY VALUE ACCEPTABLE VALUE/RANGE INTERPRETATION/ COMMENT Age ratio: (6-29): (30-59) MONTHS 0.95The value should be around 1.0Acceptable SEX RATIO 1.170.8 – 1.2ACCEPTABLE SEX RATIO p VALUE p-value = 0.077BOYS and GIRLS are equally represented OVERAL SURVEY QUALITY 5.0 %0-5 = Excellent; 5-10= GoodEXCELLENT POISSON DISTRIBUTION GAM: ID=1.43 (p=0.041) SAM: ID=1.43 (p=0.042 If the p value is between 0.05 and 0.95 the cases appear to be randomly distributed among the clusters, if ID is higher than 1 and p is less than 0.05 the cases are aggregated into certain cluster (there appear to be pockets of cases). If this is the case for Oedema but not for WHZ then aggregation of GAM and SAM cases is likely due to inclusion of oedematous cases in GAM and SAM estimates. Aggregation of GAM and SAM cases is likely due to inclusion of oedematous cases in GAM and SAM estimates. One confirmed oedema case reported in Naruoro, Alale. Case referred.

7. DEMOGRAPHIC CHARACTERISTICS Demographic characteristicsn Total number of HH 459 Total household sample 2884 Total under five sample 616 Males 1461 Females 1443 Sex Ratio 1:1 PLW 276

8. MALNUTRITION RATE TRENDS INDEX INDICATOR20112012Statistical significance WHO 2006 GAM: W/H < -2 z and/or Oedema 14.9% (13.5 – 18.8) 12.3 % (9.3- 16.0) p =0.144 SAM: W/H < -3 z and/or Oedema 2.3% (1.3 – 4.2) 1.5 % (0.7 – 3.2) p =0.325 Prevalence of stunting: H/A <-2 37.5% (33.0 – 42.3) 43.2 % (38.5 - 48.0) p =0.086 Prevalence of underweight: W/A <-2 30.4% (26.3- 34.9) 36.1% (31.6 – 40.9) p =0.071 No statistical significance in malnutrition rates above when compared to 2011

9. NUTRITION STATUS BY MUAC NUTRITIONAL STATUS BY MUAC 2011 % 2012 % Prevalence Severe Acute Malnutrition (SAM): MUAC < 11.5 CM and/or Oedema 0.6 (0.1 - 2.5) Prevalence Moderate Acute Malnutrition (MAM): MUAC ≥11.5 CM and <12.5CM 3.4 (1.8 - 6.2) Prevalence of Global Acute Malnutrition (GAM): MUAC < 12.5 cm or edema 3.9 (2.2 - 6.8) At risk MUAC ≥12.5 and <13.5 cm n=88 14.316.40

10. Nutrition Status of caregivers of <5 year old children

11. MORTALITY RESULTS MORTALITY RATES WEST POKOT COUNTY 201020112012 Total CRUDE MORTALITY RATE (Number/10,000/day) 1.17 ( 0.5 – 1.79) 1.66 (0.9 – 3.04) 0.23% (0.11-0.49) UNDER FIVE MORTALITY RATE (Number/10,000/day) 0.99 (0.7 – 1.28) 1.30 (0.84 – 1.98) 0.58% (0.19-1.78) CAUSES OF DEATH IN 2012: Main causes of death amongst adults: poisoning, mental problems, fever, cough, ARI Main causes of death amongst children under five: fever, ARI, death at birth GENERAL FINDINGS: Only 3 facilities (Kacheliba, Kapenguria and Sigor facilities have documented deaths) Deaths outside facility are rarely reported Main cause of deaths in 2011 as per Nutrition survey were malaria, diarrhea and vomiting

12. MORBIDITY RATES AMONGST 0-59MONTHS; 2011-2012  72.1% of HH had children who had been sick two weeks to the survey Short Rain Assessment 2012: West Pokot reported an increase in diarrhea and dysentery cases among children under five attributable to poor hygienic practices

13. Management of Diarrhea Disease (%) Shortage in supplies KEMSA kit

14. 2011 % 2012 % OPV 1: CARD61.8 71.5 OPV 1: RECAL31.1 24.9 OPV 3: CARD57.4 64.4 OPV 3: RECAL29.7 23.6 Immunization and Vitamin A supplementation coverage AGE GROUP NO.OF TIMESRESULT 2012 (%) 6-11 (n=63)ONCE41.2 12-59 (n=474) ONCE39.2 TWICE27.0 THRICE5.1 Defaulter rates seem to increase as the children grow older. Vitamin A supplementation below target with most cases being reported in places like Naruoro, Narochichi, Chesikiro, Kamayech and Katuda villages Issues reported during Malezi bora:  Planting season; Mothers have competing activities hindering attendance to medical services  Had to reach areas because of terrain and heavy rains  Poor documentation at facility level reported during brainstorming sessions Attributed to supplementation during illness

15. MEASLES IMMUNIZATION COVERAGE No statistical difference

16. High Impact Nutrition Intervention INDICATORS HINI INDICATORS 2011 % 2012 % % 2-5 years old children de-wormed twice a year 40.310.3 %<5s supplemented with zinc last time they had diarrhea 0.01.5 %of women supplemented with iron for 90 days in their last pregnancy 84.247.8  Iron out of stock for quite sometime, only folic available  Combined iron folate brought in February 2012  DHIS record indicate a 1.0% coverage in iron supplementation in MAY 2012, documentation???? Not comparable as indicator for last year was based on 1 year old

17. INFANT AND YOUNG CHILD FEEDING PRACTICES INFANT AND YOUNG CHILD NUTRITIONn 2012 BREASTFEEDING PRACTICES Early initiation of breastfeeding (within an hour)215 84.0% Exclusive breastfeeding rates (0-5 months)21 36.2% MINIMUM DIETARY DIVERSITY Proportion of infants aged 12-15 months fed on breast milk43 91.5% Proportion of infants aged 6-8 months receiving solid, semi solid or soft foods28 87.5% Proportion of breastfed children 6-23 months consuming ≥3 food groups54 36.5% Proportion of non breastfed children 6-23 months consuming ≥4 food groups4 10.5% Proportion of both breastfed and non breastfed children 6-23 months consuming ≥ 3 or ≥ 4 food groups respectively56 23.9% EBF & Dietary diversity score below target

18. IYCN Continued............ MINIMUM MEAL FREQUENCY Proportion of breastfed children 6-8months and 6- 23 months having at least 2 meals and ≥ 3 meals a day respectively 13 7.2% Proportion of non breastfed children 6-23 months having ≥4 meals a day 9 24.3% Proportion of breastfed children 6-8 months, 6-23 months and non breastfed 6-23 months having ≥2, ≥3 and≥4 meals a day respectively 161 73.9%

19. SOURCES OF DRINKING WATER (%) WASH

20. WATER TREATMENT 31.5% Safe sources; 68.5% Unsafe sources

21. ACCESS TO LATRINE 42 ODF Villages CLTS trainings

22. HAND WASHING AT CRITICAL TIMES

23. GENERAL HAND WASHING PRACTICES (%)

24. Households Mosquito bed net ownership and utilization High ownership attributed to mass distribution in Sep-Oct 2011 High bed net ownership but low utilization. Observations during survey indicate that bed nets Used in grain store Used to cage chicken from eating flowering beans/legumes Making children’s undergarments

25. FSL: MAIN SOURCES OF LIVELIHOOD 83.3% of households own Livestock

26. HOUSEHOLD FOOD SOURCES

27. HOUSEHOLD DIETARY DIVERSITY SCORE (HDDS)

28. Household Dietary Diversity by Food Groups

29. SUMMARY OF GENERAL FINDINGS  There is no significant difference in GAM 12.3 % (9.3-16.0) and SAM 1.5% (0.1-3.2) rates  There is no significant difference in the stunting 43.2% (38.5-48.0) and wasting levels 36.1% (31.6-40.9) amongst children aged 6-59 months.  There is a significant drop in mortality levels i.e. both crude rates 0.23 %(0.11-0.49) and amongst under-fives 0.58% (0.19-1.78)  There is a significant increase in diarrhoeal incidences (51.3%)  Exclusive breast- feeding rates (36.2%) are below national target of 50 %.  There is a slight increase in Zinc supplementation (1.5%) but below national target of 50%. (KDHS Report 2008-9-0.0%)  Iron supplementation amongst pregnant women (47.8%) noted a significant decrease below national targets of 50%.  Low Household Dietary Diversity (45.2%)

30. RECOMMENDATIONS FOR DISCUSSION FindingPossible CausesPossible Solutions NUTRITION Stunting (43.2%)Low IYCN Practices (Low EBF rates & DDS) Further investigations on IYCN practices, Strengthen the Community units, Support and strengthen MTMSGs Low Vitamin A coverage (32.1%)Numerous hard to reach areas Enhance social mobilization, support outreach services Strengthen the PULL system and facility systems Zinc supplementation (1.5%)Erratic supplies, Iron-Folate supplementation (47.8%) Erratic supplies, numerous hard to reach areas Low Deworming (10.3%)Numerous hard to reach areas Enhance social mobilization, support outreach services Low Immunization Coverage (OPV 3 64.4%, Measles 54%) Few refrigerators, Hard to reach areas Enhance mass social mobilization, support outreach services provide storage equipment(Cool boxes and refrigerators ) for facilities Increase in Malaria incidences (31.5%) Inappropriate use of mosquito nets, inadequate knowledge among community members Increase awareness in order to change attitudes and practices

31. WASH Open defecation still predominant (59.9%) Inadequate knowledge Low latrine coverage Strengthen CLTS Utilization of the community strategy to increase community awareness on hygiene practices Increase in Diarrhoea Disease (51.3%) Unsafe water sources, no treatment of water before use, open defecation, Inadequate knowledge on hygiene practices FSL Low HDDS (45.2%) Poor quality seeds-poor harvest, fertilizer, Lack of appropriate storage practices Provide agricultural extension services (appropriate farming techniques) RECOMMENDATIONS Cont.........

32. LETS DISCUSS………….