emergency nutrition and health assessment …...nutrition programming makeshift settlements nayapara...

EMERGENCY NUTRITION AND HEALTH ASSESSMENT ROUND 3

Makeshift and Spontaneous Settlements Oct 20th – 31st 2018

Nayapara Refugee Camp Nov 1st - 8th 2018

Nutrition Sector Dissemination Workshop

December 2nd, 2018

COX’S BAZAR, BANGLADESH

OUTLINE

1. Background, Justification, and Objectives

2. Methodology

3. Makeshift Settlements (1st Survey)

4. Nayapara Refugee Camp (2nd Survey)

5. Comparative Results

6. Summary of Preliminary Results

7. *Group Work drafting recommendations

▪Data Quality

▪Sample Description

▪Preliminary Results

BACKGROUNDViolence in the Rakhine State of Myanmar erupted on 25August 2017 driving more than 702,160 Rohingya men,women, and children across the border into neighboringCox’s Bazaar, Bangladesh. These families joined an estimated212,000 Rohingya who had previously sought refuge inBangladesh. In response:

Evolving humanitarian context since Emergency Nutrition Assessment Round 1 (Oct-Nov 2017) and Round 2 (April-May 2018)• Access to health services expanded • Improved quality and quantity of water available in camps • Additional services for pregnant and breastfeeding women• General food distributions transitioning from emergency

rations to food vouchers

Scale up of emergency nutrition services• SCs, OTPs, TSFPs, BSFPs, IYCF-E

Source: ISCG. Cox’s Bazar Refugee Population as 10, Oct 2018

JUSTIFICATIONEmergency Nutrition Assessment Round 2 among children 6-59 months reported:

• GAM (WHZ) in Makeshift camps was 12.0% (9.4-15) and 13.6% (10.1-18.1) in Nayapara RC. Bothconsidered ‘Serious’ as interpreted by WHO thresholds.

• Stunting (HAZ) was over the 40% WHO emergency threshold in Nayapara RC, 40.4% (34.7-46.3)and the Makeshift camps prevalence of stunting, 37.7% (33.0-42.5), is at the upper level of‘Serious’ threshold.

• Prevalence of Anaemia in Makeshift camps, 32.3% (27.8-37.1), and Nayapara RC, 29.4% (24.3-35),are both categorized as ‘Medium’ Public Health Significance based on WHO thresholds.

In addition:

Round 3 was launched to determine the current nutrition status of women and U5 children Rohingyarefugees living in camps and also for comparability between the previous 2 rounds of assessments.

Important Note: Although the Round 3 Assessment was originally planned to include a third survey inKutupalong RC, a high rate of household level refusals linked to fears around relocations from thecamp among other issues led to the cancellation of data collection. Kutupalong RC is therefore notincluded in this assessment.

NUTRITION PROGRAMMINGMakeshift Settlements Nayapara RC

Round 2

April-May 2018

Round 3

Oct-Nov 2018

Round 2

April-May 2018

Round 3

Oct-Nov 2018

Estimated number of children 6-59 months* 164,647 156 633 3,029 4908

Number of SCs 6 4 1 1

Number of SCs per child 6-59 months 1 / 27,411 1/39158 1 / 3,029 1/4908

Number of OTPs 52 58 1 1

Number of OTPs per child 6-59 months 1 / 3,166 1/2700 1 / 3,029 1/4908

Number of TSFPs 18 29 2 2

Number of TSFPs per child 6-59 months 1 / 9,147 1/5401 1 / 1,515 1/2454

Number of BSFPs 18 29 2 2

Number of BSFPs per child 6-59 months 1 / 9,147 1/5401 1 / 1,515 1/2454

*Round 2 derived from IOM Needs and Population Monitoring estimates and Round 3 from UNHCR Pop Data used for JRP (Oct 31, 2018)

PRIMARY OBJECTIVES•To estimate household demographic composition (age and sex distribution, proportion of pregnant and lactating women)

•To determine prevalence of acute malnutrition, stunting, and underweight in children 6-59 months

•To determine prevalence of anaemia in children 6-59 months and non PLW women 15-49 years

•Additional indicators• Mortality (crude and under 5)

• Women and infant MUAC

• Pregnant women access to ANC services

• Women 15-49 years consuming iron-folic acid supplementation tablets

• Child morbidity and vitamin A and MNP supplementation

• Receipt of Rations

METHODOLOGYMakeshift Settlements Nayapara Refugee Camp

Cross-sectional household survey conducted using SMART (Standardized Monitoring and Assessment in Relief and

Transitions) Survey design for anthropometric and mortality data

Multi-stage cluster sampling Simple random sampling

Households selected from all residents residing in the

makeshift and informal settlement areas outside of

Kutupalong RC, Nayapara RC, and host communities

Households selected from all residents of Nayapara

Refugee Camp (registered and unregistered)

Sub-block population estimates derived from IOM Needs

and Population Monitoring estimates. Estimates then

updated to capture population movement. Households in

selected clusters were enumerated during Oct 3-11, nine

days preceding data collection

Household lists from UNHCR PROGRESS database for

registered refugees and from lists created to capture

unregistered persons and new arrivals. Newly arrived

households were enumerated during Oct 19-20, ten days

preceding data collection.

No exclusions

Sample size calculated using ENA software (updated July 9th, 2015)

MAKESHIFT SETTLEMENTSSAMPLING FRAME

Sampling frame included all makeshift and informal sites

hosting Rohingya in Ukhia and Tekanf Upazilas (not including

host communities), including:

Camp 1E; Camp 1W; Camp 2E; Camp 2W; Camp 3; Camp 4;

Camp 4 extension; Camp 5; Camp 6; Camp 7; Camp 8E;

Camp 8W; Camp 9; Camp 10; Camp 11; Camp 12; Camp 13;

Camp 14; Camp 15; Camp 16; Camp 17; Camp 18; Camp

19; Camp 20; Camp 20 ext.; Camp 21; Camp 22; Camp 23;

Camp 24; Camp 25; Camp 26; Camp 27

Source: ISCG Cox’s Bazar refugee population (Ukhia) as of 10, Oct 2018

SAMPLE SIZE CALCULATIONS - ANTHROPOMETRY

Parameter Makeshift Settlements Nayapara Refugee Camp

Estimated Prevalence of GAM 12% 13.6%

Desired Precision 3.5% 4.0%

Design Effect 1.4 1.0

Children to be Included 505 282

Average Household size 4.3 4.7

% of Children Under Five 18.8% 12.6%

Non-Response Rate 6% 8%

Households to be Included 738 575

SAMPLE SIZE CALCULATIONS - MORTALITY

Parameter Makeshift Settlements Nayapara Refugee Camp

Estimated Death Rate per 10,000/day 0.4 0.5

Desired Precision 0.35 0.35

Design Effect 1.4 1.0

Recall period in days 132 141

Population to be Included 1448 1,112

Average Household size 4.3 4.7

Non-Response Rate 6% 8%

Households to be Included 358 257

Makeshift Settlements

Oct 20th - Oct 31st 2018

Preliminary Results

MAKESHIFT - SAMPLE DESCRIPTIONStatus Clusters Households

Children Measured

(6-59 months)

Planned 53 742* 505

Surveyed 53 (100.0%) 664 (90%) 641 (126.9%)

Required** 90.0% 80.0%

Registration/Arrival Status Households

Registered Refugees -

Unregistered Refugees (all) 664 (100.0%)

Arrival prior to October 2016 39 (5.9%)

Arrival October 2016 to August 24, 2017 23 (3.5%)

Arrival August 25, 2017 to December 31, 2017 601 (90.5%)

Arrival January 1, 2018 to date of survey 1 (0.2%)

*All 742 planned households were visited, 53 (7%) households were absent, 25 (3%) households refused

**Required % of achieved data before reserve clusters must be employed per the SMART Methodology

Population SubsetRound 2

April-May 2018

Round 3

Oct-Nov 2018

All Household Members 3,404 3573

Average HH Size, mean (SD) 5.0 (2.3) 5.4 (2.3)

Population Subset % [CI 95%] % [CI 95%]

Female 51.0% [49.4-52.7] 52.0% [50.5-53.5]

Women, 15-49 Years 23.9% [22.8-25.0] 23.2% [22.2-24-1]

Pregnant and lactating women 9.3% 9.0%

Pregnant women 3.0% 2.8%

Lactating women 6.4% 6.3%

w/infant < 6 months 1.7% 1.6%

w/infant ≥ 6 months 4.6% [4.1-5.2] 4.7%

Children 0-59 months 20.2% [18.9-21.5] 20.7% [19.2-22.2]

Children 5-10 years 19.5% [17.9-21.1] 20.3% [19.1-21.6]

Children 11-17 years 16.3% [14.9-17.8] 16.2% [14.7-17.6]

Adults 18-59 years 39.8% [38.5-41.2] 39.0% [37.6-40.5]

Adults 60+ years 4.2% [3.6-4.9] 3.7% [3.1-4.3]

MAKESHIFT RESULTS - DEMOGRAPHY

MAKESHIFT - DATA QUALITY

Criteria SD Flagged Sex-ratio Age-ratio Digit Pref Weight

Observed 0.86 0.2% p=0.693 p=0.040 3

Desired 0.8 - 1.2 < 5% (p>0.05) (p>0.05) < 13

Interpretation Good Excellent Excellent Acceptable Excellent

Overall GAM data quality for children 6-59 months is considered excellent

*Score per ENA for SMART methodology plausibility check

CriteriaDigit Pref

Height

Digit Pref

MUACSkewness Kurtosis Poisson

Overall

Score*

Observed 5 3 0.03 0.11 p=0.110 9%

Desired < 13 < 13 < ± 0.6 < ± 0.6 (p> 0.01) < 15%

Interpretation Excellent Excellent Excellent Excellent Excellent Excellent

MAKESHIFT RESULTS - WASTING & STUNTING

Indicator

Round 2

April-May 2018

Round 3

Oct-Nov 2018 P-value

Sample % [95% CI] Sample % [95% CI]

Global Acute MalnutritionWHZ < -2 z +/- oedema*

Children 6 - 59

months (n=594)

12.0%

[9.4-15.0] Children 6 - 59

months (n=637)

11.0%

[8.4-14.2]P=0.626

Severe Acute MalnutritionWHZ < -3 z +/- oedema

2.0%

[1.1-3.6]

1.1%

[0.4-2.8]P=0.269

Global Acute MalnutritionMUAC < 125 mm +/- oedema

Children 6 - 59

months (n=600)

4.3%

[3.2-5.9] Children 6 - 59

months (n=640)

3.1%

[1.9-5.0]P=0.224

Severe Acute MalnutritionMUAC < 115mm +/- oedema

0.5%

[0.2-1.6]

0.0%P=0.031

Global Chronic MalnutritionHAZ < -2 z

Children 6 - 59

months (n=592)

37.7%

[33.0-42.5] Children 6 - 59

months (n=632)

26.9%

[22.4-31.9]P=0.002

Severe Chronic MalnutritionHAZ < -3 z

7.9%

[5.8-10.8]

5.9%

[4.0-8.5]P=0.228

*No cases of oedema

EVOLUTION OF GAM PREVALENCE IN MAKESHIFT CAMPS

Evolution of

GAM rates

among

children 6 to

59 months for

Makeshift

using the

SMART

methodology

in relation to

the 15%

WHO

Emergency

Threshold.

19.3%

12.0%

11.0%

5.0%

7.0%

9.0%

11.0%

13.0%

15.0%

17.0%

19.0%

21.0%

23.0%

25.0%

SMART Oct-Nov2017 SMART April-May 2018 SMART Oct-Nov 2018

MAKESHIFT RESULTS - HAZ STUNTING BY AGE

Prevalence

of stunting

by HAZ has

reduced

most notably

among

children 30-

41months

and 54-59

months.

MAKESHIFT RESULTS – OTHER MUAC

Indicator

Round 2

April-May 2018

Round 3



Low Women’s MUACMUAC < 210 mm

Women

15 - 49 years

(n=734)

2.6%

[1.6-4.2]

Women

15 - 49 years

(n=725)

3.0% [2.0-4.6] P=0.646


PLW*

15 - 49 years

(n=147)

3.4%

[1.4-7.8]

PLW*

15 - 49 years

(n=144)

2.8% [1.0-7.3] P=771

Indicator Sample Mean (SD) Sample Mean (SD) P-value

Women’s MUAC

Women

15 - 49 years

(n=734)

254 mm (29.1)

Women

15 - 49 years

(n=725)

256.4mm [31.7] -

Infant MUAC

Infants

0 - 5 months

(n=53)

124 mm (15.4)

Infants

0 - 5 months

(n=56)118.4mm [17.3] -

*Exclusively women who are pregnant or lactating with an infant <6 months, as this subset is eligible for ongoing humanitarian programs.

MAKESHIFT RESULTS - ANAEMIA

Severity

Round 2

April-May 2018

Round 3



Any anaemia (Hb<11.0 g/dL)

Children

6-59 months

(n=598)

32.3% [27.8-37.1]

Children

6-59 months

(n=636)

39.8% [34.1-45.4} P=0.043

Mild (Hb 10 to <11.0 g/dl) 19.6% [16.7-22.8] 21.5% [18.4-24.7] P=0.389

Moderate (Hb 7 to <10.0 g/dl) 12.5% [9.8-15.9] 18.1% [13.5-22.6] P=0.042

Severe (Hb <7.0 g/dl) 0.2% [0.1-1.2] 0.2% [0-0.5] P=1.0


Children

6-23 months

(n=196)

52.0% [44.0-60.0]

Children

6-23 months

(n=216)

53.2% [44.7-61.7] P=0.837

Mild (Hb 10 to <11.0 g/dl) 30.1% [23.8-37.3] 26.4% [21.3-31.4] P=0.381

Moderate (Hb 7 to <10.0 g/dl) 21.4% [16.0-28.1] 26.4% [18.8-33.4 P=0.338

Severe (Hb <7.0 g/dl) 0.5% [0.1-3.6] 0.4% [0-1.4] P=0.905


Children

24-59 months

(n=402)

22.6% [17.9-28.2]Children

24-59 months

(n=420)

32.9% [26.6-39.1] P=0.012

Mild (Hb 10 to <11.0 g/dl) 14.4% [11.2-18.4] 19.1% [15.1-23.0] P=0.079


Severe (Hb <7.0 g/dl) 0 0 -


Data not collected during Round 2Women 15-49 (non

pregnant, non

lactating) (n=217)

22.6% [16.7-28.5]-

MAKESHIFT RESULTS - ANAEMIA BY AGE

Prevalence

of anaemia

(Hb <11.0

g/dL) has

increased

across all

except 12-

17 age

category.

MAKESHIFT RESULTS - MORBIDITYIndicator

Round 2

April-May 2018

Round 3



Prevalence of diarrhoea*

Children

6-59 months

(n=628)

20.9%

[17.4-24.8]

Children

6-59 months

(n=682)

28.4% [24.5-32.4] P=0.007

Prevalence of acute respiratory

illness with fever*

26.1%

[21.1-32.0]10.9% [7.1-14.6] P=0.000

Prevalence of fever without cough*40.0%

[34.6-46.0]38.0% [33.0-43.0] P=0.597

Prevalence of fever with rash

(suspected measles)**

13.9%

[10.7-17.7]12.8% [9.8-15.7] P=0.635

Confirmed by health document 2.1% [0.7-5.9] 0.5% [0-1.1] P=0.176

Confirmed by recall 11.8% [9.0-15.4] 12.3% [9.3-15.3] P=0.818

Prevalence of diphtheria**6.2%

[3.7-10.3]2.6% [1.1-4.1] p=0.041

Confirmed by health document 1.9% [0.5-7.2] 0.1% [0-0.4] P=0.155

Confirmed by recall 4.3% [2.7-6.9] 2.5% [0.7-4.0] P=0.334

*Two-week recall period

**Confirmed by health facility document or recall, recall period since arrival in camp or Aug 25, 2017

MAKESHIFT RESULTS - HEALTH SEEKING BEHAVIORS

MAKESHIFT RESULTS – OTHER INDICATORS

Indicator

Round 2

April-May 2018

Round 3

Oct-Nov 2018

P-value


Children 6-59

months

Proportion of children that

received at least 1 sachet of

MNP since June 16,2018*

Children 6-59

months

(n=628)

29.9%

[22.3-39.0]

Children 6-59

months (n=682)58.7%

[49.1-68.2]P=0.000


received Vitamin A in past 6

months

Data not collected in Round 2

Children 6-59

months (n=682)92.1%

[88.9-95.3]-

Women 15-49

yrs

Proportion of pregnant women

enrolled in ANC program

Pregnant

women (n=89)

53.9%

[42.2-65.6]-

*Recall period Round 2 between January 1st 2018 and data collection, Round 3 between June 16th and data collection

MAKESHIFT RESULTS - RECEIPT OF FOOD RATIONS

Indicator

Round 2

April-May 2018

Round 3

Oct-Nov 2018


Proportion of households with a general food distribution

(GFD) ration card and/or e-voucher (SCOPE) card

Households

662/675

98.1%

[96.0-99.1]

Households

630/664

94.9%

[89.8-100]

Proportion of households with a GFD ration cardHouseholds

552/675

81.8%

[71.1-89.1]

Households

507/664

76.4%

[65.7-87.1]

Proportion of households with a SCOPE card for food rationsHouseholds

120/675

17.8%

[10.3-29.0]

Households

117/664

17.6%

[7.8-27.4]

MAKESHIFT RESULTS - MORTALITYIndicator

Round 2

April-May 2018

Round 3

October-November 2018 P-value

Sample Rate [95% CI] Sample Rate [95% CI]

Crude death rate*

Deaths/10.000/day

Mid-interval

population**

(n=3,412.5)

0.38 [0.23-0.64]

Mid-interval

population**

(n=3,549.5)

0.13 (0.06-0.28) P=0.033

Under 5 death rate

Deaths/10.000/day

Mid-interval

under 5

population**

(n=664.5)

0.86 [0.37-1.94]

Mid-interval

under 5

population**

(n=717)

0.42 (0.16-1.10) P=0.290

Cause of Death Sample Rate Sample Rate P-value

Illness Household

member deaths

(n=16)

100% Household

member deaths

(n=6)

83.3% -

Don’t Know - 16.7% -

For Round 2 January 1st, 2018 was used as the beginning of the mortality recall period (123 days). For Round 3 June 16th, 2018 was used as the

beginning of the mortality recall period (132 days).

**All household members present during recall period adjusted for in and out migration

Crude Death Rate emergency threshold considered 1 death/10,000/day

Nayapara Registered Camp

Nov 1 – Nov 8 2018

Preliminary Results

NAYAPARA RC - SAMPLE DESCRIPTIONStatus Households

Children Measured

(6-59 months)

Planned 575* 282

Surveyed 554 (96%) 352 (128.8%)

Required** 80.0%

Registration/Arrival Status Households

Registered Refugees 510 (92.1%)

Unregistered Refugees (all) (%)

Arrival prior to October 2016 17 (3.1%)

Arrival October 2016 to August 24, 2017 6 (1.1%)

Arrival August 25, 2017 to December 31, 2017 3.8 (%)

*All 575 planned households were visited, 19 households were absent, 1 household refused survey. Actual planned sample was 575 but 1 HH merged with

another HH as per survey HH definition.

** Required % of achieved data per the SMART Methodology

Population SubsetRound 2

April-May 2018

Round 3

Oct-Nov 2018

All Household Members 2,562 3,093

Average HH Size, mean (SD) 5.3 (2.3) 5.6 (2.3)

Population Subset % [CI 95%] % [CI 95%]

Female 50.6% [48.7-52.6] 52.5% [50.7-54.3]

Women, 15-49 Years 25.1% [23.5-26.9] 26.5 [25.0-28.1]

Pregnant and lactating women 7.1% 6.7%

Pregnant women 2.3% 2.1%

Lactating women 4.8% 4.6%

w/infant < 6 months 1.3% 1.3%

w/infant ≥ 6 months 3.5% 3.3%

Children 0-59 months 12.4% [11.2-13.8] 12.8% [11.7-14.1]

Children 5-10 years 18.9% [17.5-20.5] 18.7% [17.4-20.1]

Children 11-17 years 22.3% [20.7-23.9] 21.3% [20.0-22.8]

Adults 18-59 years 42.9% [41.0-44.9] 43.8%[42.1-45.6]

Adults 60+ years 3.5% [2.8-4.3] 3.4%[2.8-4.1]

NAYAPARA RC RESULTS - DEMOGRAPHY

NAYAPARA RC - DATA QUALITY

Criteria SD Flagged Sex-ratio Age-ratio Digit Pref Weight

Observed 0.85 0.6% p=0.488 p=0.297 7

Desired 0.8 - 1.2 < 5% (p>0.05) (p>0.05) < 13

Interpretation Good Excellent Excellent Excellent Excellent

Overall GAM data quality for children 6-59 months is considered excellent

*Score per ENA for SMART methodology plausibility check

CriteriaDigit Pref

Height

Digit Pref

MUACSkewness Kurtosis

Overall

Score*

Observed 6 5 0.32 0.26 7%

Desired < 13 < 13 < ± 0.6 < ± 0.6 < 15%

Interpretation Excellent Excellent Good Good Excellent

NAYAPARA RC RESULTS - WASTING & STUNTING

Indicator

Round 2

April-May 2018

Round 3


Sample % [95% CI] Sample* % [95% CI]

Global Acute MalnutritionWHZ <-2 z +/- oedema* Children

6 - 59 months

(n=279)

13.6%

[10.1-18.1] Children

6 - 59 months

(n=348)

12.1%

[9.1-15.9]P=0.578

Severe Acute MalnutritionWHZ < -3 z +/- oedema

1.4%

[0.6-3.6]

0.9%

[0.3-2.5]P=0.564

Global Acute MalnutritionMUAC < 125 mm +/- oedema Children

6 - 59 months

(n=279)

3.6%

[2.0-6.5] Children

6 - 59 months

(n=351)

3.7%

[2.2-6.2]P=0.947

Severe Acute MalnutritionMUAC < 115mm +/- oedema

0.4%

[0.1-2.0]

0.3%

[0.1-1.6]P=0.834

Global Chronic MalnutritionHAZ <-2 z Children

6 - 59 months

(n=275)

40.4%

[34.7-46.3] Children

6 - 59 months

(n=347)

38.3%

[33.4-43.5]P=0.595

Severe Chronic MalnutritionHAZ < -3 z

7.6%

[5.0-11.4]

8.1%

[5.6-11.4]P=0.818

*No cases of oedema identified

EVOLUTION OF GAM PREVALENCE IN NAYAPARA RC

Evolution of

GAM rates

among

children 6 to

59 months for

Nayapara RC

using the

SMART

methodology

in relation to

the 15%

WHO

Emergency

Threshold.

13.1%

12.5%

14.3%13.6%

12.1%

5.0%

7.0%

9.0%

11.0%

13.0%

15.0%

17.0%

19.0%

SENS Dec 2015 SENS Dec 2016 SMART Oct-Nov2017

SMART April-May2018

SMART Oct-Nov2018

NAYAPARA RC RESULTS - HAZ STUNTING BY AGE

Prevalence

of stunting

by HAZ has

reduced

most notably

among

young age

categories.

NAYAPARA RC RESULTS – OTHER MUAC

Indicator

Round 2

April-May 2018

Round 3




Women

15 - 49 years

(n=625)

2.4%

[1.5-3.9]

Women

15 - 49 years

(n=777)

1.3%

[0.7-2.4]P=0.135


PLW*

15 - 49 years

(n=92)

6.5%

[2.9-13.9]

PLW*

15 - 49 years

(n=105)

1.9%

[0.5-6.7]P=0.114

Indicator Sample Mean (SD) Sample Mean (SD) P-value

Women’s MUAC

Women

15 - 49 years

(n=625)

271 mm (1.5)

Women

15 - 49 years

(n=777)

270.6 mm (35.3) -

Infant MUAC

Infants

0 - 5 months

(n=34)

124 mm (18.5)

Infants

0 - 5 months

(n=39)

126.5 mm (14.3) -

*Exclusively women who are pregnant or lactating with an infant <6 months. This subset is eligible for ongoing humanitarian programs.

NAYAPARA RC RESULTS - ANAEMIA

Severity

Round 2

April-May 2018

Round 3




Children

6-59 months

(n=279)

29.4% [24.3-35.0]

Children

6-59 months

(n=349)

38.1% [33.2-43.3] P=0.021

Mild (Hb 10 to <11.0 g/dl) 18.6% [14.5-23.7] 19.5% [15.7-24.0] P=0.775

Moderate (Hb 7 to <10.0 g/dl) 10.4% [7.3-14.6] 18.1%[14.4-22.4] P=0.005

Severe (Hb <7.0 g/dl) 0.4% [0.1-2.5] 0.5%[0.2-2.1] P=0.852


Children

6-23 months

(n=90)

54.4% [44.0-64.5]

Children

6-23 months

(n=128)

59.4% [50.3-68.0] P=0.464

Mild (Hb 10 to <11.0 g/dl) 33.3% [24.3-43.8] 28.1%[20.5-36.8] P=0.415

Moderate (Hb 7 to <10.0 g/dl) 21.1% [13.8-30.8] 30.5%[22.7-39.2] P=0.114

Severe (Hb <7.0 g/dl) 0.2% [0.1-1.0] 0.8%[0.02-4.3] P=0.514


Children

24-59 months

(n=189)

17.5% [12.7-23.6]

Children

24-59 months

(n=221)

25.8% [20.2-32.1] P=0.040

Mild (Hb 10 to <11.0 g/dl) 11.6% [7.8-17.1] 14.5 [10.1-19.8] P=0.383


Severe (Hb <7.0 g/dl) 0.2% [0.1-1.0] 0.4% [0.01-2.5] P=0.709

Any anaemia (Hb<12.0g/dL)

Data not collected round 2

Women 15-49

(non pregnant,

non lactating)

(n=276)

22.8%[18.0-28.2] -

NAYAPARA RC RESULTS - ANAEMIA BY AGE

Prevalence

of anaemia

(Hb <11.0

g/dL)

NAYAPARA RC RESULTS - MORBIDITY

Indicator

Round 2

April-May 2018

Round 3

Oct-Nov 2018P-value


Prevalence of diarrhoea*

Children

6 - 59 months

(n=284)

23.9%

[19.3-29.3]

Children

6 - 59 months

(n=357)

25.2% [20.0-30.0] P=0.70

Prevalence of acute

respiratory illness with fever*

21.5%

[17.1-26.7]9.5% [6.9-13.0] P=0.00

Prevalence of fever without

cough

40.5%

[34.9-46.3]33.6% [28.9-38.7] P=0.0727

Prevalence of fever with rash

(suspected measles)**

11.6%

[8.4-15.9]10.9% [8.1-14.6] P=0.781

Prevalence of diphtheria**0.4%

[0.1-2.5]0% P=0.286

*Two-week recall period

** Confirmed by health facility document or recall, recall period since arrival in camp or Aug 25, 2017

NAYAPARA RC RESULTS - HEALTH SEEKING BEHAVIORS

NYAPARA RC RESULTS – OTHER INDICATORS

Indicator

Round 2

April-May 2018

Round 3

Oct-Nov 2018P-value


Children 6-59

months


received at least 1 sachet of

MNP since June 16,2018*

Children 6-59

months

(n=284)

58.5%

[52.6-64.1]

Children 6-59

months (n=357)83.8%

[79.6-87.2]P=0.00


received Vitamin A in past 6

months

Data not collected in Round 2

Children 6-59

months

(n= 357)

93.6%

[90.5-95.7]-

Women 15-49

yrs

Proportion of pregnant women

enrolled in ANC program

Proportion of women 15-49

years who are currently taking

IFA tablets

Pregnant

women (n=65)

80% [68.2-

88.9]-

*Recall period Round 2 between January 1st 2018 and data collection, Round 3 between June 16th and data collection

NAYAPARA RC RESULTS - RECEIPT OF FOOD RATIONS

Indicator

Round 2

April-May 2018

Round 3

Oct-Nov 2018


Proportion of households with a general food distribution

(GFD) ration card and/or e-voucher (SCOPE) card

Households

479 / 483

99.2%

[97.8-99.7]

Households

544/554

98.2%

[96.7-99.0]

Proportion of households with a GFD ration cardHouseholds

17/ 483

3.5%

[2.2-5.6]

Households

8/554

1.4%

[0.7-2.8]

Proportion of households with a SCOPE card for food rationsHouseholds

463 / 483

95.9%

[93.7-97.3]

Households

536/554

96.8%

[94.9-97.9]

NAYAPARA RC RESULTS - MORTALITYIndicator

Round 2

April-May 2018

Round 3

October-November 2018 P-value

Sample Rate [95% CI] Sample Rate [95% CI]

Crude death rate*

Deaths/10.000/day

Mid-interval

population**

(n=2,624)

0.21 [0.11-0.42]

Mid-interval

population**

(n=3,090)

0.21 (0.11-0.39) P=1.00

Under 5 death rate

Deaths/10.000/day

Mid-interval

under 5

population**

(n=309.5)

0.22 [0.04-1.26]

Mid-interval

under 5

population**

(n=378)

0.56 (0.19-1.64) P=0.47

Cause of Death Sample Rate Sample Rate P-value

Illness

Household

member deaths

(n=8)

62.5%

Household

member deaths

(n=9)

77.8%

Injury/Trauma 12.5%

Unknown 25.0% 22.2%

For Round 2 January 1st, 2018 was used as the beginning of the mortality recall period (123 days). For Round 3 June 16th, 2018 was used as the

beginning of the mortality recall period (141 days).

**All household members present during recall period adjusted for in and out migration

Crude Death Rate emergency threshold considered 1 death/10,000/day

COMPARATIVE PRELIMINARY RESULTS - MAKESHIFT SETTLEMENTSSurvey

IndicatorMakeshift Round 2

May 17th – 28th 2018

Makeshift Round 3

Oct 20th – 31st 2018

Statistical

Significance

GAM/SAM (WHZ)children 6-59 months

12.0% [9.4-15.0]

2.0% [1.1-3.6]

11.0% [8.4-14.2]

1.1% [0.4-2.8]

P=0.626

P=0.269

GAM/SAM (MUAC)children 6-59 months

4.3% [3.2-5.9]

0.5% [0.2-1.6]

3.1% [1.9-5.0]

0.0%

P=0.224

P=0.031

Stunting Global/Severechildren 6-59 months

37.7% [33.0-42.5]

7.9% [5.8-10.8]

26.9% [22.4-31.9]

5.9% [4.0-8.5]P=0.002

P=0.228

Low Women’s MUAC/ PLW MUAC

MUAC <210 mm

2.6% [1.6-4.2

3.4% [1.4-7.8]

3.0% [2.0-4.6]

2.8% [1.0-7.3]

P=0.646

P=0.771

Anaemia (Hb<11.0g/dL)children 6-59 months

32.3% [27.8-37.1] 39.8% [34.1-45.4] P=0.043

Any anaemia (Hb<12.0 g/dl)

Women 15-49 (non PLW)Data not collected in Round 2

22.6% [16.7-28.5] -

Children 6-59 months received Vitamin A in

past 6 months92.1% [88.9-95.3] -

Diarrhoea

children 6-59 months20.9% [17.4-24.8] 28.4% [24.5-32.4] P=0.007

Mortality (CDR & U5DR)0.38 [0.23-0.64]

0.86 [0.37-1.94]

0.13% [0.06-0.28]

0.42% [0.16-1.10]

P=0.033

P=0.290

COMPARATIVE PRELIMINARY RESULTS - NAYAPARA RCSurvey

IndicatorNayapara RC Round 2

May 17th – 28th

Nayapara RC Round 3

Nov 1st – Nov 8th

Statistical

Significance

GAM/SAM (WHZ)children 6-59 months

13.6% [10.1-18.1]

1.4% [0.6-3.6]

12.1% [9.1-15.9]

0.9% [0.3-2.5]

P=0.578

P=0.564

GAM/SAM (MUAC)children 6-59 months

3.6% [2.0-6.5]

0.4% [0.1-2.0]

3.7% [2.2-6.2]

0.3% [0.1-1.6]

P=0.947

P=0.834

Stunting Global/Severechildren 6-59 months

40.4% [34.7-46.3]

7.6% [5.0-11.4]

38.3% [33.4-43.5]

8.1% [5.6-11.4]

P=0.595

P=0.818

Low Women’s MUAC/ PLW MUAC

MUAC <210 mm

2.4% [1.5-3.9]

6.5% [2.9-13.9]

1.3% [0.7-2.4]

1.9% [0.5-6.7]

P=0.135

P=0.114

Anaemia (Hb<11.0g/dL)children 6-59 months

29.4% [24.3-35.0] 38.1% [33.2-43.3] P=0.021

Any anaemia (Hb<12.0 g/dl)

Women 15-49 (non PLW)Data not collected in Round 2

22.8% [18.0-28.2]-

Children 6-59 months received Vitamin A in

past 6 months93.6% [90.5-95.7] -

Diarrhoeachildren 6-59 months

23.9% [19.3-29.3] 25.2% [21-30] P=0.70

Mortality (CDR & U5DR)0.21 [0.11-0.42]

0.22 [0.04-1.26]

0.21[0.11-0.39]

0.56 [0.19-1.64]

P=1.00

P=0.47

SUMMARY OF PRELIMINARY RESULTS▪The Prevalence of acute malnutrition using weight-for-height (WHZ) has decreased slightly in both the Makeshift camps and

Nayapara RC surveys but is not statistically significant. Both survey populations are considered Serious based on WHO

Classifications of WHZ (≥ 10% - <15%). The prevalence of low MUAC (<210mm) in women 15-49 years in the Makeshift

camps was 3.0% and 1.3%. Low MUAC for PLW’s was under 3% in both surveys as well.

▪Stunting using height-for-age (HAZ) has declined significantly in the Makeshift camps from (38%) in Round 2 to (27%) in

Round 3 but this may be partially explained due to the round 3 survey including more 6-29 month children compared to 30-

59 month children than expected. Stunting in Nayapara RC (38%) remain near the WHO critical threshold (40%).

▪The prevalence of 6-59 month Anaemia increased significantly to (39.8%) in the Makeshift Camps and (38.1%) in Nayapara

RC which is approaching the ‘High’ WHO Category of Public Health Significance (Anaemia ≥ 40%). Anemia prevalence for15-49 women (non-PLW) in the Makeshift camps (22.6%) and Nayapara RC (22.6%) is classified as ‘Medium’ based on WHOCategory of Public Health Significance.

▪Two-week prevalence of Diarrhoea increased in both surveys, Makeshift Camps (28%) and Nayapara RC (25%), with the

increasing being significant in the Makeshift camps whereas Acute Respiratory Infection significantly decreased in both

surveys (Makeshift Camps 10.9%, Nayapara 9.5%.

▪Household level support with food assistance by Ration Card or E-Voucher (Scope card) was found to be nearly universal in

both sites.

▪Crude mortality rates are significantly below the emergency threshold of 1/10,000/persons/day in both survey sites.

The Survey Teams

The Government of Bangladesh

The Institute of Public Health & Nutrition

Refugee Relief & Repatriation Commissioner, Cox’s Bazar

Civil Surgeon, Cox’s Bazar

Action Against Hunger

Nutrition Sector

Assessment Technical Working Group

United Nations High Commissioner for Refugees

World Food Programme

United Nations Children's Fund

Terre des hommes (TDH)

The Bangladesh Rural Advancement Committee (BRAC)

The Donor Agencies : UNHCR, WFP, SiDA, ECHO, SDC & DFiD

Technical Rapid Response Team (Tech RRT)

ACKNOWLEDGEMENTS

emergency nutrition and health assessment …...nutrition programming makeshift settlements nayapara...

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