Assessment of nutritional status of children of pastoralists in a humanitarian setting: A Cross-sectional Standardized Monitoring and Assessment of Relief and Transitions Survey

The AVSI Foundation in collaboration with the South Sudan Nutrition Cluster conducted a SMART nutrition and mortality survey covering all the eight Payams of the former Ikwoto County in the former Eastern Equitoria State. The main objective of the survey was to assess the current prevalence of acute malnutrition and retrospective mortality rates in the County. The Standardized Methodology for Assessment in Relief and Transitions (SMART) which applies a two-stage cluster sampling was used. A total of 623 children aged 6-59 months from 532 households in 36 clusters were sampled for anthropometric measurements. The mortality assessment was conducted concurrently in all 532 households. Additional information on Infant and Young Child Feeding practices (IYCF) was collected in the 532 households visited to provide more insight into possible risk factors associated with the high acute malnutrition prevalence. The prevalence of Global Acute Malnutrition (GAM) defined as Weight-for-Height <-2 Z scores and/or oedema for the County was 10.3% (7.9 - 13.3 95% C.I.) and the severe acute malnutrition (SAM) prevalence defined as Weight-for-Height <-3 Z scores and/or oedema was 1.6% (0.9 - 3.1 95% C.I.) The GAM and SAM prevalence indicated a serious nutrition situation according to WHO classification. Two edema cases were identified during the assessment. The crude mortality rate (CMR) and under five mortality rate (U5MR) were 1.79 (1.32 – 2.42 95% C.I). and 1.24 (0.47-3.21 95% C.I.) respectively. The CMR rate was above the WHO emergency thresholds of 1/10,000/day. The U5MR was below the WHO emergency threshold of 2/10,000/day and was therefore classified as ‘Alert’. Most deaths were due to illness (73.8%). Information on infant and young child feeding (IYCF) practices was collected. The proportion of children exclusively breast fed to the age of 6 months was (78%) which was lower than the WHO recommended standard of >80%. Another 76.2% of children (0-23.9 months) were initiated to breastfeeding within one hour after delivery. Introduction of solid, semi-solid or soft foods among children aged 6 to 8.9 months was low (51.5%). Findings indicated suboptimal IYCF practices.