Standardized Expanded Nutrition Survey 2018 - Kenya

Abstract
---------------------------

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 between 20 August and 8 September 2018 in the 3 Dadaab refugee camps (Dagahaley, Ifo and Hagadera) to assess the magnitude and severity of malnutrition, assess trends by comparison with previous years and support programmatic decisions.

The weighted prevalence of global acutemalnutrition, the most important indicator, was 8.0% overall, falling within the POOR category (5-9%). However, there was a marked improvement from 9.7% in 2017. Only Ifo camp was within the SERIOUS category (10-14%). The high prevalence of anaemia remains a major concern, as shown by the anaemia prevalence among children which remained above the 40% critical threshold, despite having decreased. Anaemia prevalence among non-pregnant women jumped to 48.9% overall, from 43.6% in 2017 and was above the 40% threshold for all camps. Some improvement was recorded in terms of infant and young chid feeding indicators, although there is still room for improvement. The access to safe drinking water also continued to be satisfactory, while gaps were still observed in terms of sanitation. The duration of the food ration and dietary diversity basically reflect what has been observed in recent surveys.

Geographic coverage
---------------------------

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

Analysis unit
---------------------------

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

Universe
---------------------------

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

Kind of data
---------------------------

Sample survey data [ssd]

Sampling procedure
---------------------------

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
---------------------------

Face-to-face [f2f]

Research instrument
---------------------------

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
---------------------------
联合国难民署标准化扩展营养调查（SENS）定期提供营养数据，这些数据在确保受强迫位移影响的人群获得良好营养结果方面发挥着关键作用，并为实施有效和及时干预措施提供支持。

达达布难民综合体是约208,000名登记难民的家园，其中绝大多数是索马里人，他们几十年前逃离了国内的冲突和干旱。达达布难民综合体位于肯尼亚东北部，靠近索马里边界。1991年，在索马里内战爆发后，达达布得以建立。随着战争的加剧，索马里人被迫逃离，前往包括肯尼亚、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，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。截至2017年初，它由五个难民营组成。然而，其中一个营地，卡米博斯，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，而少数剩余的人搬进了其他营地。2018年5月，根据营地整合方法，伊福2营地关闭，难民要么搬进其他营地，要么自愿遣返。难民居住在泥墙房屋中，屋顶用铁皮覆盖，而一些人，尤其是新到的人，住在帐篷里。

标准化扩展营养调查（SENS）于2018年8月20日至9月8日在达达布的3个难民营（达加海莱、伊福和哈格达雷）进行，以评估营养不良的严重程度和严重性，通过与往年进行比较来评估趋势，并支持项目决策。

全球急性营养不良的加权患病率，最重要的指标，总体为8.0%，处于较差类别（5-9%）。然而，与2017年的9.7%相比，情况有了明显改善。只有伊福营地处于严重类别（10-14%）。贫血的患病率仍然是一个重大关注点，如儿童贫血患病率所示，尽管有所下降，但仍然高于40%的临界阈值。非孕妇妇女的贫血患病率总体上升到48.9%，从2017年的43.6%上升，并且所有营地均超过40%的阈值。在婴儿和幼儿喂养指标方面，虽然有所改善，但仍有许多改进的空间。安全饮用水的获取也一直令人满意，但在卫生方面仍存在差距。食物配给量和饮食多样性基本上反映了最近调查中观察到的结果。

地理覆盖范围
---------------------------
肯尼亚北部达达布难民营（伊福、达加海莱和哈格达雷）

分析单元
---------------------------
0-23个月大的儿童
6-59个月大的儿童
15-49岁的妇女 家庭

总体
---------------------------
0-59个月大的儿童 妇女15-49岁 难民家庭

数据类型
---------------------------
样本调查数据 [ssd]

抽样程序
---------------------------
本调查采用两阶段集群调查，并使用按规模成比例抽样。
采用了标准化援助和过渡监测与评估（SMART）方法以及联合国难民署标准化扩展营养调查（SENS）指南来收集和分析儿童体格测量数据，并指导其他指标的数据收集。

在所有指标中，均使用SMART抽取的相同家庭样本。根据联合国难民署标准化扩展营养调查（SENS）指南，贫血样本从SMART样本量中抽取。
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：
- WASH：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个月大的儿童：评估所有家庭中所有符合条件的儿童（根据上述计算）
- 15-49岁的妇女：评估每个家庭中每隔一个符合条件的妇女。

使用了两阶段集群抽样方法，从每个3个营地中各选择30个集群。在第一阶段，制作了一份街区清单，然后使用ENA软件按照规模成比例（PPS）抽样选择所需数量的街区。在几乎所有情况下，集群等同于街区。然而，对于一些较大的街区，选择了多个集群。在这种情况下，街区被进一步分割，以容纳多个集群。如果选定的街区有超过250个家庭，根据SMART指南，进行分割，然后随机选择一个分割部分作为集群。

在数据收集之前，对选定集群中的所有家庭进行了标记。在第二阶段，使用从家庭清单中进行系统随机抽样所需数量的家庭。从1到抽样间隔之间选择一个随机数，抽样间隔是集群中家庭总数除以所需家庭数量。所选的数字成为第一个被调查的家庭。通过添加抽样间隔，直到完成所需数量的家庭。对所有选定家庭中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）以及WASH的调查。一半的选定家庭被选为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。弃户未包括在抽样框架中。在当天结束之前，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，则记录为缺失，并且不进行替换。在调查时在医疗中心的孩子记录为缺席。

数据收集方式
---------------------------
面对面 [f2f]

研究工具
---------------------------
1) 6-59个月大的儿童（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（CSB++）的登记、免疫接种（麻疹）、过去六个月内的维生素A补充剂、驱虫、过去两周内腹泻的发病率、血红蛋白评估。
2) 0-23个月大的儿童（SENS模块3）：关于婴儿和幼儿喂养实践的提问。
3) 15-49岁的妇女（SENS模块2）：怀孕状况、铁剂叶酸片和产后维生素A补充剂的覆盖率、孕妇和哺乳期妇女（PLW）的MUAC测量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、在GFR提前用完时的应对机制以及家庭食品饮食多样性（使用食品消费分数）。
5) WASH（SENS模块5）：水、卫生和健康-关于饮用水质量和大小的提问，以及对饮用水供应的满意度，以及卫生设施。