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
Oct-Nov 2018 P-value
Sample % [95% CI] Sample % [95% CI]
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
Low Women’s MUACMUAC < 210 mm
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
Oct-Nov 2018 P-value
Sample % [95% CI] Sample % [95% CI]
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
Any anaemia (Hb<11.0 g/dL)
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
Any anaemia (Hb<11.0 g/dL)
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
Moderate (Hb 7 to <10.0 g/dl) 8.2% [5.7-11.6] 13.8% [9.1-18.5] P=0.045
Severe (Hb <7.0 g/dl) 0 0 -
Any anaemia (Hb<12.0 g/dL)
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
Oct-Nov 2018 P-value
Sample % [95% CI] Sample % [95% CI]
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
Sample % [95% CI] Sample % [95% CI]
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
Proportion of children that
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
Sample % [95% CI] Sample % [95% CI]
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
Oct-Nov 2018 P-value
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
Oct-Nov 2018 P-value
Sample % [95% CI] Sample % [95% CI]
Low Women’s MUACMUAC < 210 mm
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
Low Women’s MUACMUAC < 210 mm
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
Oct-Nov 2018 P-value
Sample % [95% CI] Sample % [95% CI]
Any anaemia (Hb<11.0 g/dL)
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
Any anaemia (Hb<11.0 g/dL)
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
Any anaemia (Hb<11.0 g/dL)
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
Moderate (Hb 7 to <10.0 g/dl) 5.3% [2.9-9.6] 10.9% [7.1-15.7] P=0.035
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
Sample % [95% CI] Sample % [95% CI]
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
Sample % [95% CI] Sample % [95% CI]
Children 6-59
months
Proportion of children that
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
Proportion of children that
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
Sample % [95% CI] Sample % [95% CI]
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