INTERAGENCY NUTRITION SURVEY

ON SYRIAN REFUGEES IN

JORDANPRELIMINARY RESULTS OF SOME KEY INDICATORS

4 MAY 2014

AMMAN, JORDAN

ACKNOWLEDGEMENTS

• Medair• CDC• UNFPA, UNHCR, UNICEF, WFP, and WHO

BACKGROUND

• Two independent surveys• 1 survey on the Syrian refugees in Zaatari camp• 1 survey on all Syrian refugees outside the camp

• Data collection ended on 1 May 2014• Results of some key indicators are presented here

SURVEY OBJECTIVES

• To estimate the prevalence of acute malnutrition among children 6-59 months

• To estimate the prevalence of acute malnutrition among women of reproductive age

• To measure the prevalence of anaemia in children aged 6-59 months and in women of reproductive age between 15-49 years (non-pregnant)

• To investigate IYCF practices among children 0-23 months

• To define the current state of food security among the refugee population

• To determine the population's access to, and use of, improved water and sanitation and hygiene facilities

SAMPLE SIZEParameter Used values - camp Used values – outside camp

Estimated prevalence (%) 5.8 5.1Desired Precision (%) 3 3Design Effect 1.1 1.9Average HH size 5 5% of children <5 years 19 19% of non-response Household 3 3Sample size: # of children 279 427Sample size: # of households 337 515

METHODOLOGY: ZAATARY CAMP SURVEY• Two stage cluster survey design (11x31)• Blocks were selected at the first stage sampling using PPS

technique• Block level population estimates obtained from IRD was used for

the PPS• Households within the selected blocks were then selected using

the systematic random sampling method

METHODOLOGY: OUTSIDE CAMP SURVEY• Two stage cluster survey design (10X52)• Sub-districts were selected at the first stage sampling using PPS based on

population estimates obtained from UNHCR• Households within the selected sub-districts registered with UNHCR

were then randomly selected for the survey• Selected households were contacted using the telephone numbers in the

UNHCR registration database; information on availability and willingness to participate in the survey was obtained prior to visiting the households

SURVEY TEAMS, DATA COLLECTION, AND SUPERVISION• A team of 6 (each consisting of 4-5 members) were used to collect the

data for both surveys• Each member of the survey team underwent a 3-day training and a

standardisation test and pilot test.• The two surveys were carried out sequentially – all six teams did the data

collection in Zaatri camp first followed by the outside survey.• The data collection in Zaatari camp lasted for 6 days and the data

collection for the out-of-camp survey was completed in 10 days

DATA COLLECTION AND QUALITY ASSURANCE• Each team was supervised by one supervisor• Mobile phones (Android OS) were used to collect data• Data was analysed on a daily basis and feedback were provided to

teams, as necessary• The ENA for SMART software determined the quality of the data as

excellent

RESULTS: ZAATARI CAMP SURVEY – GAM BY WHZ

 Category All (n=325)

Prevalence of global malnutrition (<-2 z-score and/or oedema)

(4) 1.2 %

(0.5 - 3.3 95% C.I.)Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema)

(3) 0.9 %

(0.3 - 2.9 95% C.I.)Prevalence of severe malnutrition (<-3 z-score and/or oedema)

(1) 0.3 %

(0.0 - 2.4 95% C.I.)

RESULTS: ZAATARI CAMP SURVEY – GAM BY MUAC

 Category All (n=326)

Prevalence of global malnutrition (< 125 mm and/or oedema)

(5) 1.5 %

(0.7 - 3.4 95% C.I.)Prevalence of moderate malnutrition (< 125 mm and >= 115 mm, no oedema)

(2) 0.6 %

(0.2 - 2.4 95% C.I.)Prevalence of severe malnutrition (< 115 mm and/or oedema)

(3) 0.9 %

(0.3 - 2.9 95% C.I.)

RESULTS: ZAATARI CAMP SURVEY - STUNTING

 Category All (n=312)

Prevalence of stunting(<-2 z-score)

(53) 17.0 %

(11.6 - 24.1 95% C.I.)Prevalence of moderate stunting(<-2 z-score and >=-3 z-score)

(44) 14.1 %

(9.6 - 20.3 95% C.I.)Prevalence of severe stunting(<-3 z-score)

(9) 2.9 %

(1.4 - 5.8 95% C.I.)

RESULTS: ZAATARI CAMP SURVEY – SUMMARY STATISTICS

Indicator n Mean z-scores ± SD

Design Effect (z-score < -2)

z-scores not available*

z-scores out of range

Weight-for-Height 324 0.26±0.90 1.00 3 0

Weight-for-Age 323 -0.25±1.02 1.00 2 2

Height-for-Age 312 -0.86±1.20 2.04 2 13

RESULTS: ZAATARI CAMP SURVEY – ANAEMIA

 Category n % (95% CI)Children 6-59 months(Hb<11g/dl)

320 48.7 (42.4-55.0)

Women 15-49 years(Hb<12g/dl)

306 44.7 (38.3-51.2)

RESULTS: ZAATARI CAMP SURVEY – MALNUTRITION AMONG WOMEN 15-49 YEARSCategory n % (95% CI)

women 15-59 years (MUAC <230 mm)

354 5.1 (3.4-7.6)

RESULTS: ZAATARI CAMP SURVEY – MEASLES AND VITAMIN A

Details n Yes, card % (95% CI)

Yes, recall % (95% CI)

No or unknown % (95% CI)

Measles 328 10.9 (4.9-16.9) 76.8 (68.9-84.7) 12.1 (7.7-16.6)

Vitamin A 328 8.8 (2.7-14.8) 69.8 (60.8-78.7) 21.3 (14.0-28.5)

RESULTS: ZAATARI CAMP SURVEY – POLIO COVERAGE

Category n None % (95% CI)

1 dose % (95% CI)

2 dose % (95% CI)

3 dose % (95% CI)

4 dose % (95% CI)

Children 0-59 months

356 6.4 (2.3-10.5)

17.1 (9.7-24.5)

37.3 (25.5-49.1)

21.0 (14.2-27.9)

17.9 (6.9-28.9)

RESULTS: OUTSIDE CAMP SURVEY – GAM BY WHZ

 Category Alln = 479

Prevalence of global malnutrition (<-2 z-score and/or oedema)

(4) 0.8 %(0.3 - 2.2 95% C.I.)

Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema)

(4) 0.8 %(0.3 - 2.2 95% C.I.)

Prevalence of severe malnutrition (<-3 z-score and/or oedema)

(0) 0.0 %(0.0 - 0.0 95% C.I.)

RESULTS: OUTSIDE CAMP SURVEY – GAM BY WHZ

 Category Alln = 483

Prevalence of global malnutrition (< 125 mm and/or oedema)

(2) 0.4 %(0.1 - 1.7 95% C.I.)

Prevalence of moderate malnutrition (< 125 mm and >= 115 mm, no oedema)

(1) 0.2 %(0.0 - 1.5 95% C.I.)

Prevalence of severe malnutrition (< 115 mm and/or oedema)

(1) 0.2 %(0.0 - 1.5 95% C.I.)

RESULTS: OUTSIDE CAMP SURVEY – STUNTING

 Category Alln = 467

Prevalence of stunting(<-2 z-score)

(42) 9.0 %(6.5 - 12.3 95% C.I.)

Prevalence of moderate stunting(<-2 z-score and >=-3 z-score)

(38) 8.1 %(5.9 - 11.2 95% C.I.)

Prevalence of severe stunting(<-3 z-score)

(4) 0.9 %(0.3 - 2.2 95% C.I.)

RESULTS: OUTSIDE CAMP SURVEY – SUMMARY STATISTICS

Indicator n Mean z-scores ± SD

Design Effect (z-score < -2)

z-scores not available*

z-scores out of range

Weight-for-Height

479 0.23±0.94 1.00 1 3

Weight-for-Age

478 -0.14±0.98 1.03 0 5

Height-for-Age

467 -0.55±1.06 1.16 1 15

RESULTS: OUTSIDE CAMP SURVEY – MALNUTRITION AMONG WOMEN 15-49 YEARS

Category n % (95% CI)

women 15-49 years (MUAC<230 mm)

693 3.4 (2.3-4.5)

RESULTS: OUTSIDE CAMP SURVEY – ANAEMIAGroup n Percentage (95% CI)

Children 6-59 months 477 25.9% (21.3 – 30.6)

Women 15-49 years 618 31.0 % (27.1-34.9)

RESULTS: OUTSIDE CAMP SURVEY – MEASLES AND VITAMIN A

Details Details n Yes, card % (95% CI)

Yes, recall % (95% CI)

No or unknown % (95% CI)

Measles Measles 484 10.5 (5.9-15.1) 73.1 (66.8-79.4) 16.3 (10.9-21.7)

Vitamin A Vitamin A 484 5.7 (1.6-9.9) 66.7 (58.1-75.3) 27.4 (19.5-35.4)

RESULTS: OUTSIDE CAMP SURVEY – MORBIDITY, DIARRHOEA

Category n Yes % (95% CI) No % (95% CI) Don’t know

Children 6-59 months

484 14.5 (10.5-18.3) 84.9 (80.9-88.8) 0.3 (0.08-1.3)

RESULTS: OUTSIDE CAMP SURVEY – POLIO COVERAGE

Category n None % (95% CI)

1 dose % (95% CI)

2 dose % (95% CI)

3 dose % (95% CI)

4 dose % (95% CI)

5 dose % (95% CI)

Children 0-59 months

539 11.6 (7.5-15.8)

22.8 (16.9-28.6)

45.4 (39.1-51.7)

17.4 (13.2-21.6)

2.0 (0.1-2.9)

0.5 (0.07-1.1)

CONCLUSIONS• Malnutrition levels are low in both camp and outside the camp

• The levels of anaemia is high in the camp and exceeds the global cut off for public health significance and needs immediate attention

• The prevalence of anemia outside the camp is medium in terms of public health significance

• The high level of anaemia may also indicate a poor micronutrient status in general

• Malnutrition among women of reproductive age is higher than children

• The vaccination coverage is higher in the camp compared to outside

• The survey methodology worked well in general despite difficulties of finding the households in some areas