Page 1 of 36

Flood Affected Nutrition survey of

Khyber Pakhtunkhwa (KP) Province

Pakistan

Implemented by:

Implemented by Department of Health of Khyber Pakhtunkhwa (KP) Province

Technical support from:

ACF-Canada, CDC and UNICEF

Financial support from:

UNICEF

December 2010

Page 2 of 36

ACKNOWLEDGEMENT

This report results from a great deal of planning, data collection, compilation and analysis by many

individuals and agencies who collaborated in and supported with valuable information, notably, The

Department of Health in KP, UNICEF, ACF-CA, CDC WFP and WHO.

The efforts of the survey teams are highly appreciated; all team members were from Merlin, Relief

Pakistan, RAHBAR, Salik Foundation, CDO, FPHC and SAHARA.

Special appreciation goes to: Dr. Sajid Shahin, Directorate General Health Services KP and his

team including DR. Qaiser Ali and Dr. Adnan Khattak for their support and supervision of the

survey, Erin Boyd, Aurore Virayie, Dr Sarita Neupane, Dr. Muhamad Rafiq, Aien Khan Afridi,

Dr. Mohammad Najeeb, Sumreen Gul, Dr. Fakhre Alam for their contribution in training and

supervision, Oleg Bilukha from CDC for his support on sampling, Shafat Sharif and Salman

Javaid from EYCON for their support in data entry and cleaning, and Teshome Feleke for his

input in preparing the draft report.

Page 3 of 36

Table of Contents

EXCUTIVE SUMMARY ............................................................................................................ 6

1. INTRODUCTION ................................................................................................................... 7

1.1. Background ........................................................................................................................ 7

1.2. Objectives ........................................................................................................................... 7

2. METHODOLOGY .................................................................................................................. 8

2.1. Sampling and variables measured ....................................................................................... 8

2.2. Implementation of the survey .............................................................................................. 9

2.3. Data entry and Analysis .................................................................................................... 10

3. RESULT AND DISCUSION ................................................................................................. 10

3.1. Sample coverage and Anthropometric data quality ........................................................... 10

3.2. Acute malnutrition rate ..................................................................................................... 11

3.3. Feeding program coverage and beneficiary load .............................................................. 12

3.4 Trend of acute malnutrition................................................................................................ 12

3.5. Acute malnutrition rate by sex and age group .................................................................. 13

3.6. Chronic malnutrition ........................................................................................................ 14

3.7 Maternal malnutrition ........................................................................................................ 15

3.8. Breast feeding practice ..................................................................................................... 15

3.9. Childhood morbidity and access to health ......................................................................... 15

3.10. Immunization, and Vitamin A interventions coverage ...................................................... 16

3.11. Water and sanitation ....................................................................................................... 17

3.12 Food consumption and sources of food ............................................................................ 18

4. CONCLUSION AND RECOMMENDATION .................................................................... 20

Page 4 of 36

List of Tables

Table 1. Number of villages and households used to derive the sample frame of flood affected areas .......... 8

Table 2 Assumptions used to calculate sample sizes ....................................................................................... 9

Table 3 Age distribution of 6-59 months old children by sex ....................................................................... 10

Table 4 Data quality check ............................................................................................................................ 10

Table 5 Prevalence of acute malnutrition ( < -2 whz or oedema) among children 6-59 months ................... 11

Table 6 Casdeload of underfive children by district ...................................................................................... 12

Table 7 wasting rate by sex ............................................................................................................................ 13

Table 8 child Illness reported in the last 2 weeks .......................................................................................... 16

List of Figures

Figure 1 Acute malnutrition rate of children 6-59 months old using MUAC cut-off points ......................... 11

Figure 2 acute malnutrition among emergency affected population of KP in 2009/10 ................................. 13

Figure 3 Wasting rate by age group ............................................................................................................... 14

Figure 4 Stunting and underweight rate ......................................................................................................... 14

Figure 5 Breast feeding initiation response by mothers of 6-59 months old children ................................... 15

Figure 6 Medical assistance sought by caretakers of under five children ...................................................... 16

Figure 7 Vitamin A supplementation and measles vaccination coverage ...................................................... 16

Figure 8 Sources of drinking water ................................................................................................................ 17

Figure 9 Household’s response on toilet facility ........................................................................................... 18

Figure 10 household’s response on the status of food consumption frequency ............................................. 18

Figure 11 Households with food consumption score ..................................................................................... 19

Figure 12 Sources of food .............................................................................................................................. 19

List of Appendix

Appendix 1 SUMMARY TABLE OF KEY FINDINGS .............................................................................. 21

Appendix 2 Anthropometric Plausibility check ............................................................................................. 23

Appendix 3 Questionnaire ............................................................................................................................ 27

Page 5 of 36

List of Acronyms

ACF-CA Action Contre la Faim Canada

ARI Acute Respiratory Infection

BHU Basic Health Unit

CDC Center of Disease Control

CI Confidence Interval

CMAM Community-based Management of acute malnutrition

DoH Department of Health

ENA Emergency Nutrition Assessment

FANS Flood-affected Areas Nutrition Surveys

FATA Federally Administered Tribal Areas

GAM Global Acute Malnutrition

HAZ Height for Age Z-score

HH Household

IDP Internally Displaced Person

KG Kilogram

KP Khyber Pakhtunkhwa

LHW Lady Health Worker

MAM Moderate Acute Malnutrition

MoH Ministry of Health

MUAC Mid Upper Arm Circumference

NGO Non-Governmental Organization

OPV Oral Polio Vaccination

OTP Out-Patient Therapeutic Program

PPS Probability Proportional to Size

SAM Severe Acute Malnutrition

SC stabilization centre

SFP Supplementary Feeding Program

SMART Standardized Monitoring and Assessment of Relief and Transitions

UC Union Council

UNICEF United Nations Children Emergency Fund

WFH Weight for Height

WFP World Food Program

WHO World Health Organization

WHZ Weight for Height Z-score

Page 6 of 36

EXCUTIVE SUMMARY

Introduction

Department of Health (DOH) of Khyber Pakhtunkhwa (KP) in collaboration with United Nations Children’s

Fund (UNICEF) conducted two nutritional surveys in flood affected areas of KP from 29th November to 12th

December 2010. The objective was to provide updated information on the nutritional situation of children 6-59

months in flood affected areas, and to recommend interventions to save lives and support livelihoods.

Methods

Two survey areas were purposively selected to match areas affected by the 2010 flood. Sampling size

calculation and sampling strategy was done using the Standardized Monitoring & Assessment of Relief and

Transition (SMART) methodology. The World Health Organization (WHO) growth standard was used as a

reference for classifying nutritional status of children. The number of children aged 6-59 months assessed was

1,138. The main indicators collected in the survey were nutritional status of children (weight, height, age), along

with infant feeding practices, childhood morbidity, program coverage on immunization and vitamin A

supplementation, food consumption, and sources of water and food.

Results and Conclusion

Prevalence of global acute malnutrition (GAM) in flood affected areas of Khyber Pakhtunkhwa province was

found to be 7.3% (with 95% CI 5.6%-9.5%) and severe acute malnutrition of 1.0% (with 95% CI

0.5%–1.7%). According to international standards, it was below the serious cut-off point of 10% and

termed as poor1. The emergency nutritional surveys conducted in the last two years (2009/10) in the

province consistently showed below serious levels of acute malnutrition prevalence. These results indicate

more to the impacts of relief activities than the effect of displacement or flood as they were conducted 3-4

months after emergency situation and after many of the relief activities are implemented. Chronic

malnutrition level was a matter of concern, specially in severely food insecure districts of Dir Lower, Dir

Upper, Kohistan, Malakand, Buner, D.I.Khan and Tank districts, as the survey documented a very high

levels of chronic malnutrition rate ( 47.8%). In addition, childhood illness (URI, fever and diarrhoea) were

reported to be high, immunization and vitamin A coverage were short of the targets and many households

in northern area did not have access to safe drinking water.

Recommendations

1. Continue implementing Community-based Management of Acute Malnutrition (CMAM) in flood

affected and food insecure districts as the case-load is high.

2. Continue provision of General Food, especially among population stranded in camps, and whose

livelihood was destroyed as a result of flood

3. Set-up nutrition surveillance system (such as sentinel surveillance) in areas frequently affected by

flood and in some of the most food insecure areas. Nutrition survey information should be used to

confirm the severity of a crisis immediately aftermath of emergency.

4. Implement intensive community and household behaviour change programming that includes infant and

young child feeding counselling and education targeted to mothers, caregivers, family members and

decision-makers to improve the nutrition of infants and young children to reduce the impact of stunting.

5. Implement nutritional programmes that target pre-pregnant and pregnant, and lactating women to

prevent under-nutrition.

6. Put more effort to raise the coverage of vital health programmes like immunization, vitamin A

distribution to the targeted 90% and above coverage.

7. Continue improving access to clean water and sanitation. Special consideration should be given to

northern districts in water development to improve safe water access.

1 World Health Organization (2000) The management of nutrition in major emergencies

Page 7 of 36

1. INTRODUCTION

1.1. Background

Following unprecedented heavy monsoon rains, floods affected Indus River basin dwellers of Pakistan in

July/August of 2010, Khyber Pakhtunkhwa (KP) province was among the first and most affected provinces

with 3.8 million people directly affected, mostly by destruction of property, livelihood and infrastructure,

with a death toll of 1,156 persons2. The flood severely affected, Dir Lower, Dir Upper, Kohistan, Swat,

Malakand, Shangla, Charsadda and Nowshera districts, and moderately affected Peshawar, Mardan and

Tank districts. Even before the floods, Dir Lower, Dir Upper, Kohistan, Malakand, Buner, D.I.Khan, Tank

and Swat districts were among the extremely food insecure districts and affected by conflict in KP3. As a

result of the flood, emergency interventions are on-going in these flood affected population since

September 2010. Immediate humanitarian response followed the incident of flood damage, and early

recovery activities continued during this survey. The relief and early recovery activities include; food aid,

nutrition, health, Water and Sanitation, non-food item distribution, shelter assistance, agriculture

interventions (seed and tools distribution) and establishment of temporary learning centres for the

displaced population.

In KP, NGO partners have established 211 Out-patient Therapeutic Programme (OTP) and 211

Supplementary Feeding Programme (SFP) site. In these sites about 297,000 children were screened for

malnutrition, 3,700 severely malnourished and 15,000 moderately malnourished children, and 5,700

malnourished pregnant and lactating mothers were treated through nutrition intervention from September

to December 2010.

Provincial Ministry of Health (MOH) in collaboration with UNICEF, conducted two nutritional

surveys in flood affected population of Khyber Pakhtunkhwa. The first survey included Dir Lower, Dir

Upper, Kohistan, Malakand, Shangla and Swat districts, and the second survey included Charsadda,

D.I.Khan, Mardan, Nowshera, Peshawar and Tank districts. Data collection took place from 29th

November to 12th December 2010.

1.2. Objectives

The main objective was to provide updated information on the nutritional situation of children aged 6-59

months in flood affected villages, coverage of Vitamin A supplementation and measles and polio

vaccination and recommendations for interventions to save lives and support livelihoods.

Specific objectives included the following:

• To estimate the prevalence of acute and chronic malnutrition among children 6-59 months of age;

• To estimate the coverage of vitamin A supplementation among children 6-59 months of age;

• To examine the progress of establishment of selective feeding programs for treatment of

malnourished children in communities;

• To estimate the prevalence of maternal malnutrition using the mid-upper arm circumference

(MUAC) among pregnant and lactating women;

• To examine food consumption;

• To recommend interventions to improve the nutritional situation;

• To estimate the prevalence of child illness (acute respiratory infection, diarrhoea) among children

6 to 59 months of age;

• To estimate the coverage of measles immunization among children 6 to 59 months of age;

• To estimate the coverage of Vitamin A supplementation among children

• To estimate the proportion of households with access to improved water sources and sanitation;

2 http://www.pakresponse.info/Default.aspx?tabid=64 3 WFP (2009) Food insecurity in Pakistan

Page 8 of 36

2. METHODOLOGY

2.1. Sampling and variables measured

Two survey areas were selected that correspond to districts that were affected by the 2010 flood as

indicated in Table 1 below. The sample frame (the list of villages and number of households affected) was

obtained from World Food Programme (WFP) that was generated from Pakistan Initial Vulnerability

Assessment (IVA) conducted from 29th July to 3

rd September 2010

4. Within the framework of SMART

(Standardized Monitoring and Assessment of Relief and Transition) methodology, the surveys were

undertaken using two stage cluster sampling procedure (34 clusters per one survey area). The first stage

sampling was done using proportion to population size (PPS). Nearly 570 children between 6 months and

59 months of age in each survey area were measured, 400 households in each survey areas were

interviewed. The sample size required was drawn using the ENA_SMART calculator5. Summary sample

frame and sample size calculation assumptions are indicated in Table 1 and 2.

Table 1: Number of villages and households used to derive the sample frame of flood affected areas

Survey 1. KP North Survey 2. KP South

District No. villages No. households District No. villages No. households

Dir Lower 389 64,429 Charsadda 80 44,550

Dir Upper 943 157,699 D.I.Khan 381 135,143

Kohistan 37 64,941 Mardan 179 36,145

Malakand 19 7,395 Nowshera 105 96,465

Shangla 125 38,821 Peshawar 85 50,067

Swat 463 103,347 Tank 59 20,189

Total 1,976 436,632 Total 889 382,559

Households within each cluster were selected using simple random sampling using a list developed during

the survey. In large villages, teams used segmentation method to select the sub-village to be sampled from

the list of sub villages in the village.

A household was considered absent when its members slept there last night and were out for the day of the

survey.

4 Please refer WFP report on Pakistan Floods Impact Assessment (September 2010) for details.

5 SMART METHODOLOGY ( 2010). Measuring Mortality, Nutritional Status, and Food Security in Crisis Situations.

Page 9 of 36

Table 2 Assumptions used to calculate sample sizes

In each cluster, data from 12 households were collected. A structured questionnaire was used to collect

data of children under-five and respondents of the household. Children’s data collected included: age, sex,

weight, height presence of oedema, MUAC (mid upper arm circumference), measles and polio vaccination,

vitamin A supplementation, and child morbidity information. To assess the caregiver nutritional status,

mothers had the MUAC measurement taken. In addition, information collected on status of the household,

type of shelter, household water source and consumption, sanitation facilities and practice, food

consumption of adults and children, and sources of food (please refer appendix 3 for the questionnaire).

UNICEF scales (Uniscale, SECA) were used to measure weight, standard height boards were used to

measure the length/height of children, MUAC tapes were used to measure mid-upper arm circumference

(MUAC) of children and mothers. Bilateral pitting oedema was diagnosed by placing the thumb on the

upper side of the foot and applying medium pressure for three seconds. Oedema was considered to be

present if a skin depression remained after the pressure was released. Age determination of the study

children was obtained using health cards or directly from mother’s recall. Malnourished children were

referred to feeding programs where available.

2.2. Implementation of the survey

Six teams in each survey area, 12 teams in total, were involved in the study. Each team was composed of

three people: two enumerators/measurers, and one team leader. All the team leaders and enumerators were

selected from NGOs implementing nutrition intervention in the survey areas. The staffs of NGOs

participated in the survey were from Merlin, Relief Pakistan, RAHBAR, Salik Foundation, Merlin, CDO,

FPHC, and SAHARA. The team leaders had minimum of degree qualification, and all enumerators were

women (lady health workers and lady health visitors). In addition, 12 supervisors, one supervisor/team

were appointed from each district by the DoH to supervise the fieldwork. Training on the survey

methodology and anthropometric measurements was conducted in a five-day session prior to beginning the

survey. Measurement standardization test and pre-testing exercise was conducted on the fourth and fifth

day of the training.

Parameters Value Justification

Estimated Prevalence of GAM (%) 20 The estimated GAM prevalence was determined according to the

preliminary estimates found in Sindh and Punjab.

± Desired precision (5) 5 The survey main objective is programmatic and GAM prevalence is

high enough to allow this level of precision.

Design Effect 1.6 Although the design effect found in Southern Sindh was 1.00, the

one in Punjab approximates 1.9.

Average HH Size 7 Average household (HH) size (7) used was taken from WFP-

Pakistan EMOPs plan.

% Children under-5 17% According to a survey from Save the children in NWFP 2009, the 6-

59 months represented 16 % of the population. Then, based on the

assumption that the 6-59 months comprise 90% of the children

under 5, a simple calculation was done to find the 17.7 % for the

proportion of under-5. This figure has been rounded down to 17%.

Expected Non-response Rate 10% The percentage of non-response chosen was relatively high because

IDP camps are included within the sampling frame, and there is still

a lot of movement of people who are returning back to their homes.

Children to be included 393 per one survey or 786 per two surveys

Households to be included 408 per one survey or 816 per two surveys

Page 10 of 36

2.3. Data entry and Analysis

Double data entry was done by EYCON consultancy firm. Anthropometric data was entered processed and

analyzed using ENA for SMART software. Household data was entered and cleaned using SPSS 13

package. The data has been cleaned through double-data-entry system followed by logical checks. The

2006 WHO growth standard was used as a reference to classify malnourished children.

3. RESULT AND DISCUSION

The data of the two surveys were pooled together to present results of flood affected areas in KP and

presented below. A summary statistics of the surveys are presented Appendix 1.

3.1. Sample coverage and Anthropometric data quality

Data was collected over 14 days from 29th November to 12th December 2010. The data collection took

place on consecutive days from Monday to Sunday with some travel days in between. Total sample

included in the survey was 800 households (404 in north and 396 in south) and 1,177 (647 in north and 530

in south) children 6-59 months of age. The sample coverage is above 100% given the planned sample size

of 816 children between 6-59 months of age for anthropometric measurement.

Nearly, 3.2% (38) children between 6-59 months old were removed from the weight for height analysis

because they were missing important data on sex, weight, height or age, and they were flagged from the

analysis based on extreme weight-for-height z-scores values ( excluded values less than -3 and greater than

3 z score from the observed mean). Among 1,177 children, 49.2% was boys and 50.8% was girls. The boy

to girl sex ratio was 1.0 and within the recommended range of 0.8-1.2 showing unbiased selection of the

study children (See Table 3).

Table 3 Age distribution of 6-59 months old children by sex

Boys Girls Total Ratio

no. % no. % no. % Boy: Girl

6-11 months 55 44.0 70 56.0 125 10.6 0.8

12-23 months 129 49.2 133 50.8 262 22.3 1.0

24-35 months 150 50.0 150 50.0 300 25.5 1.0

36-47 months 142 52.2 130 47.8 272 23.1 1.1

48-59 months 103 47.2 115 52.8 218 18.5 0.9

Total 579 49.2 598 50.8 1177 100.0 1.0

As Shown in Table 4 below, the anthropometric data quality is generally acceptable. However, it was

noted that there was some heaping of age at 12, 24, 36 and 48 and height digital preference at height of

0.0+, therefore weight for age and height for age index may not be accurate. Detail anthropometric data

plausibility check is presented in Appendix 2.

Table 4 Data quality check

Criteria Score/Value/Percent Data quality

Missing/flagged data 1.8% Good

Overall sex ratio ( sig. Chi square) P=0.58 Good

Overall age distribution ( sig. Chi square) P=0.01 Poor

Digital preference score- weight 4 Good

Digital preference score- height 16 Poor

Standard deviation-whz 1.15 Good

Skewness -whz -0.03 Good

Kurtosis-whz 0.06 Good

Overall score-whz 8% Acceptable

Page 11 of 36

3.2. Acute malnutrition rate

The overall prevalence of acute malnutrition in Khyber Pakhtunkhwa flood affected areas was found to be

7.3% (with 95% CI 5.6%-9.5%) and severe acute malnutrition of 1.0% (with 95% CI 0.5% – 1.7%).

According to international standards, it was below the serious cut-off point of 10% and termed as poor6.

There was no significant difference in rates of malnutrition between the north and south survey areas as the

confidence intervals overlap as shown in Table 5. Although there is no international reference, severe acute

malnutrition figures for all survey areas were also below the usual critical threshold of 4%, and no

significant difference was observed between the two surveys.

Table 5 Prevalence of acute malnutrition (< -2 whz or oedema) among children 6-59 months

Acute Malnutrition n GAM with CI SAM with CI

Northern survey 621 6.3 ( 4.3-9.1) 1.3 (0.7-2.5)

Southern survey 517 8.6 (5.8-12.5) 0.6 (0.2-1.8)

All 1138 7.3 (5.6-9.5) 1.0 ( 0.5-1.7)

Acute Malnutrition Expressed by MUAC

In some cases, MUAC is an alternative index of nutritional status where measurement of weight and height

are difficult. So it is a secondary indicator here as the survey was able to assess weight and height. MUAC

is also used as a vital screening tool in an emergency situation. Due to the fact that MUAC is also used for

admission and discharge criteria within community-based management of acute malnutrition in Pakistan7,

it will be useful in calculating the case load for therapeutic and supplementary feeding programmes.

Figure 1 Acute malnutrition rate of children 6-59 months old using MUAC cut-off points

6 World Health Organization (2000). The management of nutrition in major emergencies

7 Please refer Pakistan national guidelines of Community Management of acute malnutrition for details.

3.0 2.8 3.4

7.7 7.18.4

24.928.9

20.0

Provincial total North KPK South KPK

12.5-13.4 cm (At risk)

11.5-12.4 cm

(Moderate)

< 11.5 cm (Severe)

Page 12 of 36

3.3. Feeding program coverage and beneficiary load

The number of malnourished children is estimated in the assessed flood affected districts to provide

planning figures of caseload based on MUAC

prevalence of acute malnutrition (7.7% moderate

and 3.0% severe) as shown in Figure-1, and

estimated 17% of under-fives of the total flood

affected population. The point caseload for

therapeutic feeding program (both in-patient and

out-patient programmes) will be about 29,300

under five children and supplementary feeding

programme about 75,190 children across the

flood affected areas of the province. It is usual to

estimate period case load using an incidence rate

of 1.5 to 2 times of the point case-load per year.

Taking incidence rate of 1.5 (i.e. 50%) per year,

beneficiary load for 6 months will be about

36,620 under five children for therapeutic

feeding programme and 93,990 moderately

malnourished across the assessed districts. This is a huge number and the current nutrition programme

need to continue to reach these children. As shown in table 6 above, about 19% of the caseload resides in

Upper Dir followed by 17% in DI Khan, 13% in Swat, and 12% in Nowshera districts. Due to the

population density, the absolute numbers of both severely and moderately malnourished children are very

significant in these districts, which require attention in program implementation and expansion.

Community-based Management of Acute Malnutrition (CMAM) programs were established in many flood

and conflict affected districts of KP since 2009 to reduce mortality among moderately and severely

malnourished children, as well as to prevent vulnerable populations from becoming malnourished.

Currently, there are 211 Community Management of Acute Malnutrition sites in the flood affected districts

of the province. This programme is implemented by Merlin, Relief Pakistan, Abaseeen Foundation, NRSP,

RAHBAR, PEACE, Salik Foundation, Merlin, CDO, FPHC, and SAHARA.

Coverage is an important indicator for evaluating the feeding programmes. Unless high levels of coverage

can be achieved, selective nutrition programmes will not have a significant impact on the population.

However, to estimate coverage with reasonable precision, special coverage surveys need to be

implemented8. From the surveyed children, only about 4 children found admitted in OTP and 60 in SFP.

Given the programmatic figure, 297,000 children screened for malnutrition, 3,700 severely malnourished

and 15,000 moderately malnourished children and 5,700 malnourished pregnant and lactating mothers

admitted to nutrition intervention from September till December 2010, however, Community Management

of Acute Malnutrition must have a contribution in keeping malnutrition rate checked and providing a

safety net for the food deficient flood affected households.

3.4. Trend of acute malnutrition

A number of nutrition surveys in 2009-2010 were conducted after the emergency situation (either after flood,

displacement or returns to home), and in two different seasons (mid-year or end-year). There was no significant

increase in malnutrition rate in this latest flood emergency compared the previous year displacement as

indicated in the Figure 2 below. Malnutrition rates were contained below serious levels because of the following

range of factors; the integrated effort taken to reach IDP households in 2009 and flood affected in 2010

8 The appropriate methodology used to estimate feeding programme coverage is Centric Systematic Area Sampling

methodology. Please refer “Myatt. M, T. Feleke, S. Collins, K. Sadler (2003) A field trial of a survey method for

estimating the coverage of selective feeding programme. WHO bulletin No BLT/2003/007096”

Table 6 Caseload of under-five children by district

District Severe caseload Moderate caseload

Peshawar 2,234 5,735

Mardan 1,613 4,140

Nowshera 4,305 11,049

Charsadda 1,988 5,103

Tank 901 2,312

DI Khan 6,031 15,479

Malakand 330 847

Dir Lower 2,875 7,380

Dir Upper 7,037 18,062

Shangla 1,732 4,446

Swat 4,612 11,837

Kohistan 2,962 7,603

Total 36,620 93,992

Page 13 of 36

through general food distribution (GFD), therapeutic and supplementary nutrition interventions and

improved health services, and good water and sanitation coverage9. In fact, all the surveys were conducted

3-4 months after food aid and nutritional interventions were implemented, therefore, the global acute

malnutrition rate remained much below the emergency threshold. In addition, Khyber Pakhtunkhwa province

had inbuilt capacity of managing disaster than the other flood affected provinces like Punjab and Sindh in

2010 which helped to mitigate the impact of flood and keep malnutrition under control.

Figure 2: acute malnutrition among emergency affected population of KP in 2009/10

3.5. Acute malnutrition rate by sex and age group

It is interesting to note that the overall prevalence of acute malnutrition was higher among girls than boys

(9.3% vs. 5.2% respectively) but statistically insignificant. Wasting rate was higher in the younger age

group than the other age groups (Table 7 and Figure 3).

Table 7 wasting rate by sex

Boys

n = 554

Girls

n = 583

Prevalence of global malnutrition

(<-2 z-score and/or oedema)

5.2 %

(3.7 - 7.4)

9.3 %

(6.9 - 12.4)

Prevalence of moderate malnutrition

(<-2 z-score and >=-3 z-score)

4.5 %

(3.0 - 6.7)

(47) 8.1 %

(6.0 - 10.9)

Prevalence of severe malnutrition

(<-3 z-score and/or oedema)

0.7 %

(0.3 - 1.8)

(7) 1.2 %

(0.6 - 2.4)

9 Please refer UN-OCHA situation reports No 1-19 for the above services in the IDP camps.

7.8

6.25.2 5.5

6.3

8.6

2.31.7

1.1 1.1 1.30.6

IDP

s-M

ay

20

09

Re

sid

en

ts-M

ay

20

09

Re

turn

ee

-Sw

at-

Ma

y 2

01

0

Re

turn

ee

-Bu

nn

er-

Ma

y 2

01

0

Flo

od

aff

ect

ed

-

No

rth

-De

c 2

01

0

Flo

od

aff

ect

ed

-

So

uth

-De

c 2

01

0

GAM

SAM

Page 14 of 36

Figure 3 Wasting rate by age group

Normally, the prevalence of malnutrition tends to be higher in the younger age groups than in the older age

groups, because the younger groups are beginning to eat solid food and are also more exposed to disease.

This data therefore, demonstrates that younger aged children were more affected by acute malnutrition

than the older groups.

3.6. Chronic malnutrition

Figure 4 shows the prevalence of child stunting (haz) and underweight (waz). Stunting rate measures

chronic malnutrition while underweight rate measures both chronic and acute malnutrition. Both

underweight and stunting rate rely on accurate age record. In this survey, age verification was not

recorded. In addition, as indicated in section 3.1, there was a tendency of heaping of certain ages. So, we

need to be careful when interpreting the results. The overall stunting rate was 47.8% and underweight rate

was 28.1%.

Figure 4 Stunting and underweight rate

1.70.4 1.1 0.8 0.9

9.3

8.3

4.63.4

8.4

0

2

4

6

8

10

12

6_11 12_23 24-35 36-47 48-59

Pe

rce

nta

ge

Age group

Moderate wasting

Severe wasting

47.8

28.5

48.4

28.8

47.4

28.1

0

10

20

30

40

50

60

Stunting rate Underweight rate

Pe

rce

nta

ge

All KPK

North KPK

South KPK

Page 15 of 36

3.7. Maternal malnutrition

Maternal nutrition is a risk factor of public health importance that can be integrated into efforts to prevent

adverse nutritional outcomes of young children. Maternal malnutrition in this survey assessed for pregnant

and lactating women of children upto 24 months old only. Out of 469 pregnant and lactating mothers of 6-

24 months of children assessed in the study provinces, about 9 % were both pregnant and lactating, 36%

were pregnant and 55% breastfeeding.

Pregnant mothers with MUAC < 20.7cm (severe risk) and < 23.0cm (moderate risk) carry a risk of growth

retardation of the foetus. Nearly 5% of the 204 pregnant women assessed for MUAC had severe risk and

20% had moderate risk of malnutrition. Although there is no agreed international reference, it has been a

usual practice of admitting pregnant and lactating mothers with infants (children < 6 months) of MUAC of

21.0 cm into supplementary feeding programmes. Based on this criterion, 6% of the mothers were

considered malnourished.

3.8. Breast feeding practice

Only two variables were included in this survey to assess the breastfeeding practices. Whether the child (6-

24 months old child) was currently being breastfed and when the child started breastfeeding. The

questions could give information on initiation of breastfeeding and continued breastfeeding practices after

the child’s age of 6 months.

As shown in Figure 5, the proportion of children born between the last 6-24 months who were put to the

breast within one hour of birth was 36% among 343 children, therefore, initiation of breastfeeding within

the first hour of birth is not adequately practiced.

Continued breastfeeding up to the age of 2 years is recommended for continued optimal growth and

development of young children. Nearly 86% of the children between 6-24 months old reported to

continued breastfeeding.

Figure 5: Breastfeeding initiation response by mothers of 6-24 months old children

3.9. Childhood morbidity and access to health

Illness in the form of acute infections and re-infections (e.g. diarrhoea, respiratory tract infection, malaria,

worms) or chronic disease (e.g. TB, HIV/AIDS), puts demands on a body’s physical stores and hampers its

utilisation of nutrients which lead to malnutrition and/or death. Caretakers reported that 46% of 1,105

children 6-59 months of age had been sick in the previous 2 weeks. Acute Respiratory Infection (ARI) was

the most frequently reported illness (48%), followed by fever (46%), and diarrhoeal disease (34%). From

the sick 702 children, 68% had one sickness (either of the three), 26% had two sickness (two of the three),

and 8% had three sickness.

36

46

18

0

10

20

30

40

50

Less than an hour 1-24 hours After 1 day

Pe

rce

nta

ge

re

spo

nse

Page 16 of 36

Table 8 child Illness reported in the last 2 weeks

The child ill during the past two weeks Total

Yes No

Survey

Northern KP Count 486 164 650

% within Survey 74.8% 25.2% 100.0%

Southern KP Count 216 239 455

% within Survey 47.5% 52.5% 100.0%

Total Count 702 403 1105

% within Survey 63.5% 36.5% 100.0%

Figure 6 shows the health seeking behaviour when the child was ill. About 92% said that they sought for

some form of assistance. Majority (54%) sought for assistance from the general practitioners, and 33%

from government facilities. Only few caretakers sought assistance from traditional healers (1%). Nearly

8% of the respondent did not seek any assistance.

Figure 6: Medical assistance sought by caretakers of under five children

3.10. Immunization, and Vitamin A interventions coverage

Essential key nutrition and health intervention such as micronutrient supplementation, immunization and

the use of insecticide-treated bed nets can help reduce stunting, micronutrient deficiencies and child deaths

if implemented at sufficient scale10.

Figure 7 Vitamin A supplementation and measles vaccination coverage

10 Lancet Series; Maternal and Child Under nutrition – “What works? Interventions for maternal and child under nutrition and survival”, Jan 2008

0 10 20 30 40 50 60

Others

Tradditional healers

Government facilities

General practitioner

percentage

7367

78

6672

54

0

20

40

60

80

100

All KPK North KPK South KPK

Pe

rce

nta

ge

of

Ch

ild

ren

Vitamin A

supplementation

Measles Vaccination

Page 17 of 36

Nearly, 66% of 1,102 children aged 6 to 59 months reported to have received measles vaccination in the

previous six months. This figure includes 22% children with cards and 44% with verbal history. About 73% of

the under five years received vitamin A supplementation in the last 6 months, this figure is below target of

85%, better coverage would increase the children’s chances of survival as they face a risk of mortality

from diarrhoea and other infections (please see Figure 7 above for detail).

3.11. Water and sanitation

Drinking water from river, stream, dam, lake, pond, canal, and irrigation channel, unprotected well and

unprotected spring were considered unsafe water sources in this assessment. From the two survey response

of 800 households, about 70% were using drinking water from safe sources. Majority (19%) of the

surveyed households reported to collect drinking water from hand pump followed by unprotected spring

(14%), piped water to dwellings (12%), Protected well (10%), protected spring (9%) and supplied by

NGO/Government (9%). Nearly 30% reported to fetch from unsafe (unprotected) water source.

Significantly higher household (42%) from northern survey area reported to use unsafe source than the

households (19%) from southern survey districts as shown in the figure 8.

Figure 8 Sources of drinking water

Out of the total 794 households, 80% said that they had access to a toilet facility and 20% said they use

field/bush and others (sewage, shade, behind dwellings). Those who had access to toilet, majority (67%)

used flush/pour flush toilet and 33% pit latrine. In addition, about 68% the interviewed households did not

dispose child excreta properly. It has been observed in the field that drops of children and livestock

dispersed everywhere around the houses and villages hence contaminating the environment with human

and animal waste and possibly the water sources.

69.5

58.4

80.8

30.5

41.6

19.2

0

10

20

30

40

50

60

70

80

90

All KPK North KPK South KPK

Pe

rce

nta

ge

of

HH

wit

h w

ate

r so

urc

es

Safe water source

Unsafe water

source

Page 18 of 36

Figure 9 Household’s response on toilet facility

3.12. Food consumption and sources of food

Nearly 76% of the interviewed 796 households reported to have had 3 and above meals the day preceding

the survey date and 24% had less than 2 meals. In addition, about 30 % of under five children living in 719

households consumed two and less meals, and 70% consumed three and above meals the day preceding the

survey date. About 89% of the households reported that the frequency of meals in the previous day was the

same as their usual feeding habit as shown in Figure 10.

Figure 10 household’s response on the status of food consumption frequency

The 792 households who reported their food consumption frequency reported to had consumed on average

5 types of food (mean 4.9 with SD 1.0) per day from a total of 8 food groups. The food groups were

cereals (Wheat, rice and corn), pulses (dhal, beans, lentils, pea and nuts), poultry/meat/eggs, oil and fat,

milk and milk products, vegetables, fruit, and sugar/sweets. Households reported to had consumed mainly

(100%) cereal based food (primarily wheat followed by rice based diet), with 99% oil/fat, followed by 93%

sugar/honey, 91% vegetables, 84% pulses, 66% milk and milk products, and 46% fruits.

Food consumption score (FCS) was calculated based on the number of day’s particular food groups were

consumed as per WFP definition11

as follows: FCS = (cereal) + 3(pulses) + 4(poultry/meat/eggs) + 0.5(oil)

+ 4(milk products) + 1(vegetables) + 1(fruit) + 0.5(sugar/sweets). The cut‐offs applied were; 1) Poor food

11 WFP (September 2010) Pakistan Flood impact assessment

flush toilet

54%Pit Latrine

26%

No facility

20%

7 2 5 92 6

8792 89

78

9184

6 6 613

7 10

0

20

40

60

80

100

Northern

KPK

Southern

KPK

All KPK Northern

KPK

Southern

KPK

All KPK

Adult Children 6-59 months

Pe

rce

nta

ge

re

spo

nse

Less

Same

More

Page 19 of 36

consumption is score between 0.5 – 21, 2) Moderately food consumption is score between 21.5–34.5, and

Adequate food consumption is score of more than 35+. Generally, more than 90% of households had

adequate food consumption score and 10% had moderate to poor food consumption score as shown in

Figure 11.

Figure 11 Households with food consumption score

The households’ responses regarding the main sources of food in their last week day’s meals are indicated

in Figure 12. The evidence shows that the major source of food was purchase (68%) with considerable

contribution from own production (12%) and food aid (8%).

Figure 12 Sources of food

1 0 110

4 7

8996 92

0

20

40

60

80

100

120

North KPK South KPK All KPK

Pe

rce

nta

ge

of

ho

use

ho

lds

Poor

Moderate

Adequate

12%

68%

1%

3%

5%

8%

3%Own production

Market

Work for food

Borrowed

Gift

Food aid

Page 20 of 36

3.13. Household and housing status

The majority of the interviewed households were resident (75%) followed by or returnee (30%) with a

small proportion of IDPs (5%).

The majority of households were mud or mud brick (48%), followed by stone/concrete/brick (42%), and

10% others (thatch, plastic sheet and under shade).

4. CONCLUSION AND RECOMMENDATION

The global acute malnutrition rate in the study areas is generally termed as poor and there was no

significant difference in the malnutrition rates between survey one and survey two. The emergency

nutritional surveys conducted in the last two years (2009/10) in the province consistently showed below

serious levels of acute malnutrition. It should be noted that the surveys results indicate more to the impacts

of relief activities than the effect of displacement or flood as they were conducted 3-4 months after

emergency situation and after many of the relief activities are implemented. Chronic malnutrition level was

however a matter of concern, specially in severely food insecure districts of Dir Lower, Dir Upper,

Kohistan, Malakand, Buner, D.I. Khan, Tank districts, as the survey documented a very high levels of

chronic malnutrition rate (47.8%).

Childhood illness (ARI, fever and diarrhoea) were reported to be high in the study. Immunization and

vitamin A distribution coverage were short of the target 85%. Many households (42%) in northern survey

area do not have access to safe drinking water.

In view of the findings of this study, the following recommendations are derived at:

1) Continue implementing CMAM in flood affected and food insecure districts of Kyber

Pakhtunkhwa as the case-load is high.

2) Those households who are not able to produce enough food to sustain themselves after the flood

still need support in the form of immediate food aid and livelihood development for some time. In

addition to the loss encountered by the flood, highly food insecure districts necessitate the

implementation of food aid (GFD). Therefore, continue provision of GFD, especially among

population stranded in the camps, and whose livelihood was destroyed.

3) It is useful to set-up nutrition surveillance system (such as sentinel surveillance) in areas frequently

affected by flood and in some of the most food insecure areas. In addition to nutrition surveillance

information, composite indicators like IYCF indicators, health-care services, food insecurity, agro-

economic situation, disaster coping strategies should be used to plan for intervention. Nutrition

survey information should be used to confirm the severity of a crisis immediately aftermath of

emergency.

4) Significant work related to behaviour change is needed to improve knowledge and practices of the

community related to nutrition and infant and young child feeding in order to reduce the impact of

high stunting. Nutrition partners should implement intensive community and household behavior

change programming that includes counseling and education targeted to mothers, caregivers,

family members and decision-makers to improve the nutrition of infants and young children.

5) The long term problem of undernutrition in children cannot be solved without addressing the

nutrition of women throughout the nine months of pregnancy, and reaching them in adolescence

and young adulthood with adequate nutrition. Therefore, implement nutritional programmes that

target pre-pregnant and pregnant, and lactating women.

6) Still more effort is required to raise the coverage of vital health programmes like immunization,

vitamin A distribution to the targetted 90% and above coverage.

7) Continue improving access to to clean water and sanitation. Special consideration should be given

to northern districts in water development as they lag behind the southern areas.

Page 21 of 36

Appendix 1 SUMMARY TABLE OF KEY FINDINGS

Indicator North KP South KP All KP

Total number of study household 404 396 800

Number of 6-59 month old children included in weight for

height anthropometric analysis

621 517 1138

Global acute malnutrition rate– Weight for height <-2 Z

score or presence of oedema with 95% CI

6.3

(4.3-9.1)

8.6

(5.8-12.5)

7.3

(5.6-9.5)

Severe acute malnutrition rate – Weight for height <-3 Z

score or presence of oedema with 95% CI

1.3

(0.7-2.5)

0.6

(0.2-1.8)

1.0

(0.5-1.7)

Moderate acute malnutrition rate – MUAC between 11.5-

12.4 cm

7.1 8.4 7.7

Severe acute malnutrition rate – MUAC between < 11.5

cm

2.8 3.4 3.0

Oedema cases 1 0 1

Global underweight rate– Weight for Age <-2 Z score

with 95% CI

28.8

(24.8-32.2)

28.1

(22.7-34.3)

28.5

(25.0-32.3)

Global stunting rate– Height for Age <-2 Z score with 95%

CI

48.4

(43.3-53.4)

47.4

(41.3-53.6)

47.8

(43.4-52.3)

% children ill two weeks prior to survey 74.8 47.5 63.5

% of children having diarrhoea two weeks prior to survey 34.3 32.6 33.8

% of children having fever two weeks prior to survey 50.0 38.6 46.4

% of children having fever and cough two weeks prior to

survey

55.6 29.8 47.6

% of children received vitamin A supplementation in the

past 6 months

68.8 78.4 72.9

% Children ( 9-59 months) immunized against measles

since flood ( by card & recall)

71.4 50.4 61.9

% Initiated for breastfeeding ( within less than 1 hour) 52.2 18.9 36.4

% continued breastfeeding at 6-24 months age 83.5 87.8 85.5

Indicator ( continued from the previous page) North KP South KP Total

% of adults had 3 and above meals per day 82.3 69.3 76.4

Food Consumption Score

-Poor

-Moderate

-Adequate

1.0

10.2

88.8

0.0

3.8

96.2

0.5

7.1

92.4

Main Sources of food

-Market

-Own production

-Food Aid

15

63

5

7

73

11

12

68

8

Page 22 of 36

-Borrow

- Gift

-Work for food

-Others

5

5

2

5

2

5

1

1

3

5

1

3

Main Source of drinking water

-Piped into dwelling

-Public stand

- Hand Pump

-Tube well/Turbine

-Protected well

-Protected spring

-Supplied by NGO/Govt

-Unprotected well

-Unprotected spring

-Surface water/others

12

8

8

1

10

14

11

5

25

6

13

3

35

10

10

3

8

8

1

9

12

6

20

6

10

9

10

6

13

8

Kind of toilet facility

-Flush toilet

-Pit Latrine

-No facility

56

27

17

54

26

20

54

26

20

Household status

-Resident

-IDP

-Returnees

83.4

1.2

15.3

66.4

2.8

30.6

75.0

2.0

22.9

Types of housing they live in

-Concrete/stone

-Mud/mudbrick

41.3

47.0

43.4

48.7

42.4

47.9

Page 23 of 36

Appendix 2 Anthropometric Plausibility check

for Age distribution:

Month 6 : ##############

Month 7 : #################################

Month 8 : ######################

Month 9 : ###################

Month 10 : #####################

Month 11 : #################

Month 12 : #############################################

Month 13 : ##################

Month 14 : ####################

Month 15 : #########################

Month 16 : ##################

Month 17 : #####################

Month 18 : ########################

Month 19 : ##################

Month 20 : ############

Month 21 : ##############

Month 22 : ####################

Month 23 : ###########################

Month 24 : ##########################################

Month 25 : ###############################

Month 26 : #############################

Month 27 : ###############################

Month 28 : ##################

Month 29 : ######################

Month 30 : ###########################

Month 31 : ##################

Month 32 : ###################

Month 33 : #####################

Month 34 : #####################

Month 35 : ######################

Month 36 : ##############################################################

Month 37 : #########################

Month 38 : #############################

Month 39 : ######################

Month 40 : #######################

Month 41 : ############

Month 42 : ##############

Month 43 : ################

Month 44 : ##################

Month 45 : ###################

Month 46 : ############

Month 47 : #####################

Month 48 : ########################################

Month 49 : ##############################

Month 50 : ############

Month 51 : #################

Month 52 : #########################

Month 53 : ############

Month 54 : ###################

Page 24 of 36

Month 55 : ############

Month 56 : ###############

Month 57 : ################

Month 58 : ################

Month 59 : #######

Digit preference Weight:

Digit .0 : ##############################################

Digit .1 : ###########################################

Digit .2 : #############################################

Digit .3 : ##########################################

Digit .4 : ###################################

Digit .5 : ############################################

Digit .6 : #################################

Digit .7 : ##################################

Digit .8 : ####################################

Digit .9 : #################################

Digit Preference Score: 4 (0-5 good, 5-10 acceptable, 10-20 poor and > 20 unacceptable)

Digit preference Height:

Digit .0 : ############################################################

Digit .1 : ####################################

Digit .2 : ########################################

Digit .3 : ##########################

Digit .4 : #######################

Digit .5 : ##########################################

Digit .6 : ####################

Digit .7 : ####################

Digit .8 : ################

Digit .9 : ##########

Digit Preference Score: 16 (0-5 good, 5-10 acceptable, 10-20 poor and > 20 unacceptable)

Evaluation of Standard deviation, Normal distribution, Skewness and Kurtosis using the 3 exclusion

(Flag) procedures

WHZ Standard Deviation SD: 1.21 1.13 1.05

(The SD should be between 0.8 and 1.2)

Results for Shapiro-Wilk test for normally (Gaussian) distributed data: WHZ p= 0.000 p= 0.000 p= 0.020

HAZ p= 0.000 p= 0.000 p= 0.000

WAZ p= 0.000 p= 0.001 p= 0.000

(If p < 0.05 then the data are not normally distributed. If p > 0.05 you can consider the data normally

distributed)

Skewness

Page 25 of 36

WHZ 0.81 0.06 -0.03

HAZ -0.65 0.51 -0.05

WAZ -0.34 -0.11 -0.14

Kurtosis WHZ 4.95 0.99 0.06

HAZ 5.58 1.41 -0.56

WAZ 1.33 0.48 -0.29

Mean z-scores, Design Effects and excluded subjects

Indicator n Mean z-scores

± SD

Design

Effect

(z-score

< -2)

z-scores not

available*

z-scores out

of range

Weight-for-Height 1145 -0.61±0.92 1.65 24 14

Weight-for-Age 1136 -1.58±1.11 1.47 22 25

Height-for-Age 1045 -1.72±1.27 1.70 19 119

* contains for WHZ and WAZ the children with edema.

Page 26 of 36

Page 27 of 36

Appendix 3 Questionnaire

SECTION 1: Household Circumstances (Only for the Household)

1.1 What is the status of the household?

1 Resident

2 IDP

3 Returnee

1.2 Since how long have you been displaced?

Since how long have you returned?

___ Day ________ Week

___ Day ________ Week

1.3 What type of housing are they living in? (Major portion)

1 Mud/mud brick

2 Stone/concrete/brick

3 Thatch

4 Plastic shelter

5 Other (specify)

رہائشی/مقیم

متاثر

واپس آئے ہوئے

ہفتہ دن

ہفتہ دن

آپ کتنے عرصے سے بے گھر ہیں؟

کب واپس ہوئے؟ آپ

کس قسم کے گھر میں رہائش پذیر ہیں؟

کچی اینٹوں/مٹی سے بنا ہوا

پکی اینٹوں/سیمنٹ سے بنا ہوا

چھاجہ/جھوپڑی

پالسٹک وغیره کا عارضی شیلٹر

کوئی اور؟ (وضاحت)

Page 28 of 36

Section 2: Food Consumption

Adults

Children below 5 years

If no children below 5, write N/A

Yesterday, how many meals were eaten by:

2.1 │___│ 2.2 │___│

Is this number different from usual?

1= Less,

2= Same,

3= More

2.3 │___│ 2.4 │___│

Focus on food eaten

INSIDE the house

During how many days was the food item eaten in previous 7 days?

(Choose one Option)

What was the main source of the food in the past 7 days? (Choose one Option)

0 = Not eaten 1= 1 day

ہیں کھایان

2= 2 days 3= 3 day

4= 4 days 5= 5 days

6= 6 days 7= 7 days

1= Own crop/garden, production,

2= Market/shop purchase,

3= Work for food,

4= Borrowing/debts,

5= Gifts from neighbors/relatives,

6 = Food aid,

7 = Other

0 = Non applicable

Wheat, bread

2.5 │____│ 2.6 │____│

Rice, other cereals

2.7 │____│ 2.8 │____│

Maize یمکئ 2.9 │____│ 2.10 │___ │

خوراک کا اصراف :2حصہ

چ سال سے کم عمر والے بچےپان

کل کتنا کھانا کھایا؟

کیا وه مقدار معمول سے ہٹ کر

ہے؟

کم

معمول

زیاده جتنا

کیے گئے گھر میں استعمال

کھانے

پر توجہ

گذشتہ سات دنوں کے دوران

کتنے دن کھانا کھایا؟

کوئی ایک نمبر منتخب کریں

عہ کیا تھا؟گذشتہ سات دنوں کے دوران کھانے کا اہم ذری

(کوئی ایک منتخب کریں)

اپنی فصل/باغ مارکیٹ دوکان سے خریدا گیا

کھانے کے لیے کوئی کام کیا

ادھار

پڑوسیوں/عزیزوں کی طرف

سے مال

کھانا امداد میں مال

اور کچھ

چار دن

ھ دنچ

گندم کی

ل/کوئی اور اناجاوچ

بالغ

ایک دن

تین دن

پانچ دن

سات دن

دن دو

Page 29 of 36

Dhal, دال

beans, مونگ/ماش

Lentils, دال مسور کی

peas, مٹر

nuts, مونگ پھلی

2.11 │____│ 2.12 │____│

Vegetables یاںسبز 2.13 │____│ 2.14 │____│

Fruits یواجات/فروٹم 2.15 │____│ 2.16 │____│

Meat, poultry, fish

ی/مچھلیوشت/مرغگ

2.17 │____│ 2.18 │____│

Eggs ڈےان

2.19 │____│ 2.20 │____│

Milk, cheese, yogurt

ہ/ پنیر/دہیدودھ 2.21 │____│ 2.22 │____│

Sugar, honey

ہد/شینیچ 2.23 │____│ 2.24 │____│

Oil, ghee, butter

ھانے کا تیل، گھی، مکھنک 2.25 │____│ 2.26 │____│

Page 30 of 36

SECTION 3 : Water and Sanitation Facilities سہولت کی صفائی اور پانی :3 ہحص

3.1 What is the main source of drinking water

for their household

پانی کا اہم ذریعہ ں کے لیے پینے کےان خاندانو

کون سا ہے؟

01

Piped water – piped into dwelling

ھروں میں جڑی ہوئی پائیپ الئینگ

02 Piped water – public tap stand

ٹونٹی/ٹنکی وغیرهنل/

03 Hand pump

ہینڈ پمپنل/

04 Tube well / turbine

ٹیوب، ویل وغیره

05 Covered (protected) well

ڈھکے ہوئے محفوظ کونئے سے

06 Uncovered (unprotected) well

ھلے ہوئے غیرمحفوظ کونئے سےک

07 Protected spring

ین سے نکال محفوظ پانیزم

08 Unprotected spring

ین سے نکال غیر محفوظ پانیزم

09

Surface water (river, canal, stream, pond, irrigation channel)

یا، نہر وغیره کا پانیدر

10

Buy water from vendor:

truck/tanker/cart

یسوں سے خریدا ہوا ٹنکر کا پانیپ

11

Supplied by NGO / Govt.

کی سرڪاري يا غير سرڪاري تنظيم کسی طرف سے مہیا کیا گیا

12 Other (specify)

ی اورکوئ

88 Don’t know

ی علم نہیںکوئ

Page 31 of 36

3.2 What kind of toilet facility does your HH use?

آپ کا خاندان کس قسم کا بیت الخال استعمال کرتا ہے؟

1 Flush / Pour flush toilet

ہاؤ سے صاف ہونے واال پانیفلش/ب

2 Pit Latrine

ڑھا کھود کے بنایا گیا بیت الخالءگ

3 No facilities, bush or field

یںی سہولت نہکوئ

4 Other (specify)

ی اورکوئ

3.3 How are child excreta disposed?

ں کا پائخانہ کیسے ضایع کیا جاتا ہے؟بچو1

Left open

ھال ہوا؟ک

2 Buried ٹی ڈالنے سےم

3

Sewer connected

ڑھا کھود کے بنایا گیاگ

گڑھا کھود کے بنایا ہوا بیت الخالء 4

5 Other (specify) ی اورکوئ

0 Non applicable

3.4 Soap available at household for hand washing

ہاتھہ دھونے کے لیے صابن دستیاب ہے؟یا ک

a Yes ہاں

b No ہیںن

Page 32 of 36

Section 4: Anthropometric and Health Data for Children 6-59 months

Please, use code 88 if the respondent does not know the answer.

.استعمال کریں 88اگر جواب دہنده کچھہ بھی نہ جانتا ہو تو برائے مہربانی کوڈ

Variable

Comments Child 1

1ہبچ

Child 2

2ہبچ

Child 3

3ہ بچ

Child 4

4ہبچ

4.1 Sex جنس M = male مرد

F= female عورت

4.2 Birth Date یدائش کی تاریخپ

(only if official birth document)

(DD/MM/YY)

دن، مہینہ، سال

4.3 Age عمر (Months) مہینے

4.4 Weight وزن (Kg) _ _ . _ _ _ . _ _ _ . _ _ _ . _

4.5 Height قد (cm) _ _ _ . _ _ _ _ . _ _ _ _ . _ _ _ _ . _

4.6 W/H z-score 2-< =1 وزن/قد

2= <-2 and ≥ -3

3= <-3

(Choose one option)

4.7 MUAC

ے اوپری حصے کے درمیان بازو ک

کی پیمائش

(cm) _ . _ _ _ . _ _ _ . _ _ _ . _ _ ینٹی میٹرس

4.8 Edema

(Bilateral edema)

ں پیروں میں سوجن؟دونو

N= No ہیںن

Y= Yes ہاں

(Choose one option)

4.9 Is the child currently registered in a feeding centre?

یا بچہ اس وقت کسی غذائی مرکز میں ک داخل کیا گیا ہے؟

1= No ہیںن

2= SFC ی غذائیت کااضاف مرکز

Page 33 of 36

(Show samples of therapeutic food)

ی خوراک کا نمونہ افشفا بخش/اض دکھائیں

3= OTP

غذائی قلت کے عالج ید شد کا مرکز

4= SC ی نگہداشت کا غذائ مرکز

(Choose one option)

4.10 Has the child had measles vaccination?

کیا بچے کو خسرے کا ٹیکہ لگا؟

(Vaccination on upper left arm)

یں بازو پہ ٹیکے کا نشان دیکھیںبائ

1= No vaccination

ی بھی ٹیکہ نہیں لگاکوئ

2= Vaccination with card

ٹیکہ لگا اور کارڈ مال

3= Vaccination according to caretaker

تی مرکز سے ٹیکہ لگاحفاظ

(Choose one option)

منتخب کریں ایکی کوئ

4.11 Has the child received a Vitamin A capsule in the last 6 months?

ماه میں بچے کو وٹامن 6یا گذشتہ ک اے کا کئپسول دیا گیا؟

(Show capsules for different doses) تلف خوراک کے کئپسول مخ دکھائیں

N= No ہیںن

Y= Yes ہاں

(Choose one option)

منتخب کریں ایکی کوئ

4.12 Was the child ill during the past two weeks?

یا بچہ گذشتہ دو ہفتوں سے بیمار ک ہے؟

N= No; go to question 4.15

ہیں تو سوال نمبراگر ن دیکھیں 4.15

Y= Yes ہاں

(Choose one option)

ی ایک منتخب کریںکوئ

4.13 If yes, what kind of illness?

ہاں تو کون سی بیماری ہوئی اگر تھی؟

1= Diarrhea ہالاس

2= ARI س کی بیماریسان

3= Fever بخار

4= Other (specify)

اور؟ یکوئ

Page 34 of 36

(You can choose more than one option)

منتخب آپشن زائد سے یکا کریں

4.14 Where was the child taken for treatment?

الج کے لیے بچے کو کہاں لے ع جایا گیا؟

1= No where

ہیں بھی نہیںک

2= General practitioner

ڈاکٹر کے پاسعام

3= Hospital ہسپتال

4= Traditional healer

ی طبیب/حکیم کے پاسمقام

5= Other (specify)

ہیں اور؟ک

(You can choose more than one option)

4.15 (For children 6 to 24 months)

Is the child currently breastfed?

یا کوئی شیر خوار بچہ موجود ہے؟ک

(If children > 24 months , go to section 5)

N= No ہاں

Y= Yes نہیں

N/A = Non applicable

(Choose one option)

منتخب کریںکوئی ایک

4.16 (For children 6 to 24 months)

If the child has been breastfed

in the past or is currently

breastfed, when has this

breastfeeding started?

ی بچہ شیر خوار ہے تو اس اگر کوئ

نے کب دودھ پینا شروع کیا تھا؟

(If children > 24 months, go to

section 5)

1= Less than one hour

یک گھنٹے سے کما

2= 1-24 hours

کھنٹوں کے 24سے 1

دوران

3= after one day

یک دن کے بعدا

4= never breastfed

ں کا دودھہ نہیں پیاما

Page 35 of 36

(Choose one option)

کوئی ایک منتخپ کریں

4.17 (For children 6 - 12 months)

بچوں کے ماه تک کے 12ے س 6(

لیے)

How many times had the

child received OPV drops in

the last 6 months?

شتہ ماه کے دوران یا بچے کو گذک

دی گئی؟ (OPV)پولیو ویکسین

(If children > 12 months, go to

section 5)

Write the number of

times

خوراک دی (OPV)کتنی بار

گئی؟

Page 36 of 36

ماه تک کا بچہ موجود ہو (اگر ماں کا دودھہ پیتا ہو) یا 24ہ حصہ ان ماؤں کے لیے، جن کے پاس ی(

)ماں عورت کے پیٹ میں بچہ ہو۔

This section is to be filled only for mothers having children 0 to 24 months of age (if

breastfeeding) OR Pregnant.

SECTION 5: Maternal Nutrition ماں کی غذائیت 5حصہ :

Mother 1: :Mother 2 )1( ںما )2ں (ما

5.1

Are you currently pregnant?

یا آپ اس وقت امید سے ہیں؟ک

1 Yes 1 ہاں Yes ہاں

2 No ہیںن 2 No ہیںن

3 Don’t know ہیںپتا ن 3 Don’t know ہیںپتا ن

5.2 Are you currently breastfeeding?

یا ان دنوں آپ بچے کو اپنا دودھہ پال رہی ہیں؟ک

1 Yes 1 ہاں Yes ہاں

2 No ہیںن 2 No ہیںن

5.3 MUAC (cm)

بازو کے اوپری حصے کے درمیان کی پئمائش

کریں

_________ _________