Standardized Expanded Nutrition Survey 2017 - Kenya

Abstract
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The UNHCR Standardized Expanded Nutrition Surveys (SENS) provide regular nutrition data that plays a key role in delivering effective and timely interventions to ensure good nutritional outcomes among populations affected by forced displacement.

The refugee complex of Dadaab is home to an estimate of 208,000 registered refugees of which the vast majority are Somalis who fled conflict and drought in their home country several decades ago. The Dadaab refugee complex is situated in northeastern Kenya, near the border with Somalia. Dadaab was established in the year 1991 following the beginning of the civil war in Somalia. Somalis were forced to flee as the war worsened, leaving to neighbouring countries including Kenya, Ethiopia and Sudan. Today, Dadaab is home to refugees from many countries in eastern and central Africa, including South Sudan, Burundi, Congo, Ethiopia, Eritrea and Somalia. Somali refugees make up more than 90% of the population. Until early 2017, it consisted of five refugee camps. However, one of the camps, Kambioos, which was also the newest, was closed in March 2017 as refugees began returning to Somalia and the few remaining moved into the other camps. Ifo 2 camp was closed in May 2018 in line with the cam consolidation approach, with refugees either moving to the other camps or being repatriated voluntarily. Refugees live in mud-walled houses with iron sheeting roofs, while some, especially new arrivals, live in tents.

The Standardised Expanded Nutrition Survey (SENS) was conducted in the 4 Dadaab refugee camps (Dagahaley, Ifo, Ifo 2 and Hagadera) between 28 August and 23 September 2017 by nutrition partners (MSF-Switzerland, Islamic Relief Kenya, International Rescue Committee and Kenya Red Cross) with overall coordination by UNHCR supported by WFP.

After the increase in the prevalence of GAM observed in 2016 (10.2% weighted prevalence of GAM in all camps from 8.1% in 2015), the 2017 SENS indicated weigthed prevalence of GAM 9.7% which is close to what it was in 2016. The difference between the weighted prevalence of GAM in all the camps in 2016 and 2017 is not statistically significant. However, its to be mentioned that the prevalence of GAM in Dagahaley, Hagdera, and Ifo 2 camp is 8.3%, 8.6%, and 9.4% which is classified as POOR nutrition sitation, while in Ifo camp its 12.7% classified as SERIOUS nutrition sitaition as per the WHO classiciation of the public health significance. Overall, weighted anaemia prevalence showed a sharp increase among children aged 6-59 months to 60.7%, up from 49.7% in 2016. This is well above the 40% of public health significance (critical threshold) and requires attention. In all camps, anaemia was well above the 40% of public health significance (critical threshold). The children 6-23 age group had the highest prevalence of anaemia; however, the prevalence in the children 24-35 age group was also very concerning as it was above the critical threshold in all camps.

Geographic coverage
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Dadaab Refugee Camps (Ifo,Ifo2, Dagahaley and Hagadera), in Northern Kenya

Analysis unit
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Children 0-23 months
Children 6-59 months
Women 15-49 years
Households

Universe
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Children 0-59 months Women 15-49 years Refugee households

Kind of data
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Sample survey data [ssd]

Sampling procedure
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A two-stage cluster survey with probability proportion to size sampling was employed in this survey.
Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology to collect and analyse data on child anthropometry and UNHCR's Standardised Expanded Nutrition Survey (SENS) Guidelines for Refugee Populations was used to guide data collection for other indicators.

The same households sampled by SMART were used in all indicators. Anaemia sample was drawn from the SMART sample size, as recommended by the UNHCR Standardised Expanded Nutrition Survey (SENS) Guidelines.
For each of the indicators used, households and individuals were sampled as follows:

Household-level indicators:
- WASH: every household
- Food Security: every other household
- Mosquito net: every other household

Individual-level indicators:
- Children 0-59 months: all eligible children in all households were assessed (based on the above calculations)
- Women 15-49: all eligible women in every other household were assessed.

The 2-stage cluster sampling method was used to select 30 clusters from each of the 3 camps. At the first stage, a list of blocks was made before the required number were selected using sampling with probability proportional to size (PPS) using ENA softwareIn nearly all cases, a cluster was the equivalent of a block. However, there were exceptions where, for some larger blocks, more than 1 cluster was selected. In this case, the blocks were split further to cater for more than one cluster. In the event that a selected block had more than 250 households, according to SMART guidance, segmentation was done, after which one of the segments was randomly selected to be the cluster.

All households in the selected clusters were labelled before data collection. At the second stage, the required number of households were selected using systematic random sampling from a list of households. A random number was selected between 1 and the sampling interval, which was calculated by dividing the total number of households in the cluster with the required number of households. The selected number became the first household to be surveyed. Subsequent households were selected by adding the sampling interval until the required number of households were completed. All eligible children below 5 years of age from all selected households were surveyed for the Child Anthropometry and Health, and Infant and Young Child Feeding (IYCF), and WASH. Half of the selected households were selected for the Food Security and Women questionnaire. The survey respondents were the primary caretakers of children below 5 years. Abandoned households were not included in the sampling frame. Absent households or households where children were absent were re-visited before the end of the day. If they were found to be empty, they were recorded as missing and were not replaced. Children who were in health centres at the time of the survey were recorded as absent.

Mode of data collection
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Face-to-face [f2f]

Research instrument
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1) Children 6-59 months (SENS Modules 1-2): Anthropometric status, oedema, enrolment in selective feeding programmes and blanket feeding programmes (CSB++), immunisation (measles), vitamin A supplementation in last six months, de-worming, morbidity from diarrhoea in past two weeks, haemoglobin assessment.
2) Children 0-23 months (SENS Module 3): Questions on infant and young children feeding practices.
3) Women 15-49 years (SENS Module 2): Pregnancy status, coverage of iron-folic acid pills and post-natal vitamin A supplementation, MUAC measurements for pregnant and lactating women (PLW), and haemoglobin assessment for non-pregnant women.
4) Food Security (SENS Module 4): Access and use of the general food ration (GFR), coping mechanisms when the GFR ran out ahead of time and household food dietary diversity using the food consumption score.
5) WASH (SENS Module 5): Water, sanitation and hygiene- Questions on quality and quantity of drinking water, satisfaction with the drinking water supply, and sanitation facilities

摘要
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联合国难民署标准化扩展营养调查（SENS）定期提供营养数据，这些数据在确保因被迫流离失所而受到影响的人群中取得良好的营养结果方面发挥着关键作用。
达达布难民复杂地区是约208,000名登记在册的难民的家，其中绝大多数是索马里人，他们几十年前因国内冲突和干旱而逃离家园。达达布难民复杂地区位于肯尼亚东北部，靠近与索马里的边界。达达布是在1991年，也就是索马里内战开始的那一年建立的。随着战争的加剧，索马里人被迫逃离，流亡到包括肯尼亚、埃塞俄比亚和苏丹在内的邻近国家。如今，达达布是来自东非和中非许多国家的难民的家园，包括南苏丹、布隆迪、刚果、埃塞俄比亚、厄立特里亚和索马里。索马里难民占人口的90%以上。直到2017年初，它由五个难民营组成。然而，其中一个营地，即卡米波斯营地，也是最新的营地，于2017年3月关闭，因为难民开始返回索马里，而少数剩余的难民搬进了其他营地。伊佛2营地于2018年5月关闭，这是根据营地整合方法进行的，难民要么搬进其他营地，要么自愿遣返。难民们住在用泥土墙和铁皮屋顶建造的房屋中，而一些难民，尤其是新来的难民，则住在帐篷里。
标准化扩展营养调查（SENS）于2017年8月28日至9月23日在达达布的四个难民营（达加哈利、伊佛、伊佛2和哈杰达拉）进行，由营养合作伙伴（瑞士医疗队、肯尼亚伊斯兰救援组织、国际救援委员会和肯尼亚红十字会）执行，由联合国难民署协调，并由世界粮食计划署支持。
在2016年观察到严重急性营养不良（GAM）的患病率增加（所有营地的加权患病率为10.2%，而2015年为8.1%）之后，2017年SENS显示加权患病率为9.7%，与2016年相近。2016年和2017年所有营地GAM加权患病率之间的差异不具有统计学意义。然而，值得注意的是，达加哈利、哈杰达拉和伊佛2营地的GAM患病率分别为8.3%、8.6%和9.4%，被归类为营养状况不佳，而伊佛营地的患病率为12.7%，根据世界卫生组织对公共卫生重要性的分类，被归类为严重营养不良。总体而言，6至59个月儿童加权贫血患病率急剧上升至60.7%，高于2016年的49.7%。这一比例远高于公共卫生重要性的40%（临界阈值），需要引起关注。在所有营地，贫血患病率都远高于40%的公共卫生重要性（临界阈值）。6至23岁年龄组的儿童贫血患病率最高；然而，24至35岁年龄组的儿童贫血患病率也非常令人担忧，因为在所有营地中都超过了临界阈值。
地理覆盖范围
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肯尼亚北部达达布难民营（伊佛、伊佛2、达加哈利和哈杰达拉）
分析单位
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0-23个月儿童
6-59个月儿童
15-49岁妇女
家庭

总体
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0-59个月儿童
15-49岁妇女
难民家庭

数据类型
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样本调查数据 [ssd]
抽样程序
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本调查采用了两阶段集群调查，采用按规模成比例抽样。
标准监测和评估援助及过渡（SMART）方法用于收集和分析儿童体格测量数据，以及联合国难民署标准化扩展营养调查（SENS）指南用于指导其他指标的收集。
在所有指标中，都使用了SMART抽样调查的相同家庭。贫血样本是从SMART样本量中抽取的，如联合国难民署标准化扩展营养调查（SENS）指南所建议的。
对于每个使用的指标，家庭和个人按以下方式进行抽样：
家庭层面指标：
- 水卫生：每个家庭
- 食品安全：每隔一个家庭
- 蚊帐：每隔一个家庭
个人层面指标：
- 0-59个月儿童：评估所有家庭的合格儿童（根据上述计算结果）
- 15-49岁妇女：评估每隔一个家庭的合格妇女。
使用了两阶段集群抽样方法，从每个营地中选择30个集群。在第一阶段，制作了区块清单，然后使用ENA软件按照规模成比例（PPS）抽样，选出所需数量的区块。在几乎所有情况下，集群相当于区块。然而，对于一些较大的区块，可能会选择超过一个集群。在这种情况下，区块会被进一步分割，以适应超过一个集群。如果选定的区块有超过250个家庭，根据SMART指导，会进行分割，然后随机选择一个分割段作为集群。
在数据收集之前，对所有选定的集群中的家庭进行了标记。在第二阶段，使用从家庭清单中进行的系统随机抽样选择所需数量的家庭。随机选择一个介于1和抽样间隔之间的数字，抽样间隔是通过将集群中家庭的总数除以所需家庭数量计算得出的。所选数字成为第一个被调查的家庭。随后，通过添加抽样间隔，直到完成所需数量的家庭。对所有选定的家庭中5岁以下的所有合格儿童进行了儿童体格测量和健康、婴儿和幼儿喂养（IYCF）、水卫生的调查。所选家庭中的一半被选用来进行食品安全和妇女问卷。调查受访者是5岁以下儿童的初级照顾者。弃置的家庭不包括在抽样框架中。在当天结束时之前，会重新访问缺席的家庭或儿童缺席的家庭。如果发现它们是空的，它们将被记录为缺失，并且不会被替换。在调查时在卫生中心的孩子被记录为缺席。
数据收集方式
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面对面 [f2f]
研究工具
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1) 6-59个月儿童（SENS模块1-2）：体格状况、水肿、选择性喂养计划（CSB++）和毛毯喂养计划（ blanket feeding programmes）的登记，免疫接种（麻疹）、过去六个月内维生素A补充剂、驱虫、过去两周内腹泻发病率，血红蛋白评估。
2) 0-23个月儿童（SENS模块3）：关于婴儿和幼儿喂养实践的提问。
3) 15-49岁妇女（SENS模块2）：怀孕状况、铁剂和叶酸片覆盖范围和产后维生素A补充剂，孕妇和哺乳期妇女的MUAC测量（PLW），以及非孕妇妇女的血红蛋白评估。
4) 食品安全（SENS模块4）：一般食品配给（GFR）的获取和使用，当GFR提前用尽时的应对机制，以及家庭食品饮食多样性使用食品消费评分。
5) 水卫生（SENS模块5）：水、卫生和卫生设施-关于饮用水质量与数量的提问，以及饮用水供应的满意度，以及卫生设施。