Zimbabwe National Nutrition Survey - 2010

Background

In 2008, the FNC hosted a meeting to review the nutrition surveillance system National Nutrition Surveillance and Assessment (NaNSA) Task Force recommended a large scale nutrition survey To disaggregated at the district level. Designed to serve as a baseline for future surveillance efforts.

ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Survey Objectives

Determine the nutritional status of children 6-59 months of age in each District Explore the prevalence and distribution of underlying determinants of malnutrition among children 0-59 months of age in each district Provide platform for recommendations for action at district and national level

ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Survey Design Conceptual Framework

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Findings: Explain various indices

Height for Age Weight for Age Weight for Height or Mid-Upper Arm Circumference

Stunting or Chronic Malnutrition

ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Underweight

Wasting or Acute Malnutrition

Results: National Prevalence Malnutrition (1)

Figure 5: Prevalence of malnutrition at national level with global threshold rank Indicator Stunting (Chronic Malnutrition)1 Underweight 2 Wasting (Acute Malnutrition)3 Overweight4
1Children 6-59

WHO Standard (%) 33.8%

(N = 35,323)

NCHS Reference (%) 27.1%

(N = 35,914)

Rating Per Global Thresholds5 High Medium Low Medium

9.9%
(N = 35,285)

14.5%
(N = 35,812)

2.1%
(N = 35,069)

2.1%
(N = 35,695)

3.1%
(N = 35,295)
4Children 5WHO

1.3% (N = 35,266)

months < - 2 SD Height for Age 2Children 6-59 months <-2 SD Weight for Age 3Children 6-59 months <-2 SD Weight for Height
ZIMBABWE NATIONAL NUTRITION SURVEY 2010

6-59 months >+2 SD Weight for Height TRS No. 854, Geneva, 1995: WHO Global Database on Child Growth and Malnutrition

Under nutrition (Z-Scores) By Age

Figure 12: Mean z-score by age and nutrition index Stunting 0.5 Wasting Underweight

Mean Z-Score

-0.5
-1 -1.5 -2 6-11 12-17 18-23 24-35 36-47 48-59 Age in Months

Stunting and underweight begin prior to the age of six months Stunting and underweight peak at 24 months and there is little recovery thereafter Wasting appears better than the standard population we need further work to understand why

ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Under nutrition (Z-Scores) By Age

Figure 12: Mean z-score by age and nutrition index Stunting 0.5 Mean Z-Score Wasting Underweight

0
-0.5 -1 -1.5 -2 6-11 12-17 18-23 24-35 36-47 48-59 Age in Months

Pregnancy to 24 months is often referred to as the window of opportunity Interventions targeted at these age groups will have the greatest impact at population level

ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Prevalence of Stunting By District

Figure 9: Percent children 6-59 months of age below -2 SD Height for Age (WHO)
Figure 1.1a Prevalence of stunting in children 6-59 months of age, by district (W HO)
Hu r u ng w e K ar ib a U r ba n K ar o i U r b an UM P K ar ib a Ma zo w e B in d u ra G o kw e No r th B in g a V icto r ia F a lls G o kw e S ou th Hw a n ge U r ba n K ad o m a Ma k on d e Zvi m b a G o ro m o n zi Ha r a re U rb a n Mu r e h wa Ch e g u tu S ek e Ma r o n de r a Ma k on i Hw e d za Mu ta sa Hw a n ge Lu p a n e Nk ay i K we kw e Ch ik o m b a Mu ta r e Ur b a n Nya n g a S ha m v a Mu d zi Mb i re Ce n te n a ry G u ru v e Mt D a rw in Ru sh i n g a

Mu to ko

Ch ir u m h a nz u B ub i Tsh o l ots h o Um g u za S hu r u g wi B ul il im a B ul a wa yo U r ba n Zvi sh a va n e Um zi n gw a n e Ins iza P lu m tre e Ma n g we Ma to b o Mb e r e ng w a Ch iv i Ma s vin g o Za ka G we r u G u tu

B uh e r a

Mu ta r e

Ch im a n i ma n i B iki ta Ch ip i n g e

Ch ir e d zi

Legend
0% - 19.9 % 20.0 - 29 .9% 30.0% - 3 4.9% 35.0% - 4 7.8% Districts w ith lo we r than e xp ected samp le size

G wa n d a Mw e n ez i

B ei tb ri d g e

33.8% of children between 6-59 months of age are stunted National figures obscure wide variation between districts Rates of stunting in 24 districts are above 35% high according to global thresholds

B ei tb ri d g e U r b an

ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Exclusive Breastfeeding By Province

Percent children under 6 months of age exclusively breastfed, by province
12.00% 10.00% 8.00% 6.00% 4.00% 2.00% 0.00%

5.8 % of children are exclusively breastfed through 6 months of age Rates are lower than those previously reported possibly due to different indicator definitions Rates of EBF are extremely low and highly concerning EBF is the foundation of child survival programming

ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Minimum Acceptable Diet By District

Figure 17: Percent children 6-23 months of age who received a minimum acceptable diet Figure 2.9 Percentage children between 6-23 months of age receiving a minimum acceptable diet, + byminimum district according to of age and breastfeeding status( meal frequency dietary diversity)
Hu r u ng w e K ar ib a U r ba n K ar o i U r b an UM P K ar ib a Ma zo w e B in d u ra G o kw e No r th B in g a V icto r ia F a lls G o kw e S ou th Hw a n ge U r ba n K ad o m a Ma k on d e Zvi m b a G o ro m o n zi Ha r a re U rb a n Mu r e h wa Ch e g u tu S ek e Ma r o n de r a Ma k on i Hw e d za Mu ta sa Hw a n ge Lu p a n e Nk ay i K we kw e Ch ik o m b a Mu ta r e Ur b a n Nya n g a S ha m v a Mu d zi Mb i re Ce n te n a ry G u ru v e Mt D a rw in Ru sh i n g a

Mu to ko

Ch ir u m h a nz u B ub i Tsh o l ots h o Um g u za S hu r u g wi B ul il im a B ul a wa yo U r ba n Zvi sh a va n e Um zi n gw a n e Ins iza P lu m tre e Ma n g we Ma to b o Mb e r e ng w a Ch iv i Ma s vin g o Za ka G we r u G u tu

B uh e r a

Mu ta r e

Ch im a n i ma n i B iki ta Ch ip i n g e

Ch ir e d zi

Legend
15.0% - 2 0.8% 10.0% - 1 4.9% 5.0% - 9.9% 0.5% - 4.9% Districts w ith lo we r than e xp ected samp le size

G wa n d a Mw e n ez i

B ei tb ri d g e

B ei tb ri d g e U r b an

Minimum acceptable diet is a composite of meal frequency and dietary diversity and considers breastfeeding 8.4% of children between 6-23 months of age received a minimum acceptable diet (just 1 in 10 children) National figures obscure wide variation between districts - in 14 districts less than 5% of children received an acceptable diet

ZIMBABWE NATIONAL NUTRITION SURVEY 2010

HH Food Consumption National

Low 12%

12% of children between 0-59 months resided in households with a low food consumption score

Moderate 21% High 67%

ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Prevalence of Diarrhea, Fever and Coughs By District

Figure 4.2 Prevalence of diarrhoea in children between 0-59 months of age, by district

Figure 18: Percent children 0-59 months of age who had diarrhea , fever and cough in the two weeks preceding the survey
Hu r u ng w e Mb i re Ce n te n a ry

Figure 4.3a Prevalence of cough in children between 0-59 months of age, by distr

Diarrhea
B in g a V icto r ia F a lls

Hu r u ng w e K ar ib a U r ba n K ar o i U r b an

Mb i re Ce n te n a ry G u ru v e Mt D a rw in Ru sh i n g a UM P
K ar ib a U r ba n

cough
B in g a V icto r ia F a lls Hw a n ge U r ba n

G u ru v e Mt D a rw in K ar o i U r b an

Ru sh i n g a UM P

K ar ib a Ma zo w e B in d u ra G o kw e No r th Ma k on d e Zvi m b a Ha r a re U rb a n Ch e g u tu G o kw e S ou th K ad o m a S ek e

S ha m v a

Mu d zi

K ar ib a Ma zo w e B in d u ra G o kw e No r th Ma k on d e Zvi m b a Ha r a re U rb a n Ch e g u tu G o kw e S ou th Hw a n ge U r ba n K ad o m a S ek e

S ha m v a

Mu d zi

Mu to ko

Mu to ko

G o ro m o n zi Mu r e h wa

G o ro m o n zi Mu r e h wa

Nya n g a Ma r o n de r a Ma k on i Hw e d za Mu ta sa

Nya n g a Ma r o n de r a Ma k on i Hw e d za Mu ta sa

Hw a n ge

Lu p a n e

Nk ay i

K we kw e

Ch ik o m b a Mu ta r e Ur b a n

Figure 4.3b Prevalence of fever in children between 0-59 months of age, by district
B ub i Tsh o l ots h o Um g u za G we r u B ul il im a

fever
Hu r u ng w e

Hw a n ge

Lu p a n e

Nk ay i

K we kw e

Ch ik o m b a Mu ta r e Ur b a n

Ch ir u m h a nz u G u tu S hu r u g wi B ul a wa yo U r ba n Zvi sh a va n e Um zi n gw a n e Ins iza Ma s vin g o Ch iv i Za ka

B uh e r a

Mu ta r e

Ch ir u m h a nz u B ub i Tsh o l ots h o Um g u za S hu r u g wi B ul il im a B ul a wa yo U r ba n Zvi sh a va n e Um zi n gw a n e Ins iza P lu m tre e Ma n g we Ma to b o Mb e r e ng w a Ch iv i Ma s vin g o Za ka G we r u G u tu

B uh e r a

Mu ta r e

Ch im a n i ma n i B iki ta Ch ip i n g e

Ch im a n i ma n i B iki ta
K ar ib a U r ba n

Mb i re Ce n te n a ry

Ch ip i n g e
K ar o i U r b an

G u ru v e Mt D a rw in

Ru sh i n g a UM P

P lu m tre e Ma n g we Ma to b o Mb e r e ng w a Ch ir e d zi

K ar ib a

S ha m v a Ma zo w e B in d u ra

Mu d zi

Ch ir e d zi

Legend
Mu to ko

G wa n d a Mw e n ez i

Legend
2.7% - 7.9% 8.0% - 12 .8 % 12.9% - 1 7.1% 17.2% - 2 3.3% Districts w ith lo we r than e xp ected samp le size

G wa n d a Mw e n ez i
B in g a V icto r ia F a lls

G o kw e No r th

Ma k on d e

2.4% - 9.5% 9.6% - 16 .3 % 16.4% - 2 0.4%

B ei tb ri d g e

Zvi m b a Ha r a re U rb a n Ch e g u tu G o ro m o n zi Mu r e h wa

B ei tb ri d g e
Hw a n ge U r ba n

G o kw e S ou th

K ad o m a

S ek e Ma r o n de r a Ma k on i Hw e d za

Nya n g a

20.5% - 3 4.5% Districts w ith lo we r than e xp ected samp le size

B ei tb ri d g e U r b an

B ei tb ri d g e U r b an

Mu ta sa Hw a n ge Lu p a n e Nk ay i K we kw e Ch ik o m b a Mu ta r e Ur b a n

Ch ir u m h a nz u B ub i Tsh o l ots h o Um g u za S hu r u g wi B ul il im a B ul a wa yo U r ba n Zvi sh a va n e Um zi n gw a n e Ins iza P lu m tre e Ma n g we Ma to b o Mb e r e ng w a Ch iv i Ma s vin g o Za ka G we r u G u tu

B uh e r a

Mu ta r e

Ch im a n i ma n i B iki ta Ch ip i n g e

Ch ir e d zi

Legend
2.4% - 7.5% 7.6% - 13 .2 % 13.3% - 1 8.8% 18.9% - 2 8.0% Districts w ith lo we r than e xp ected samp le size

G wa n d a Mw e n ez i

B ei tb ri d g e

B ei tb ri d g e U r b an

ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Results: Access to nutrition services, water and Sanitation

Only 25.2% of new mothers received a Vitamin A supplement within 8 weeks of their last delivery Only 27.8 % of women received iron/folate supplements during their pregnancies 86.4% children 6 59 months received vitamin A in children About a third of the children live in households with un safe water resources and/or in households that practice unsafe disposal of children's stools
ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Conclusion
At 33.8% chronic malnutrition remains unacceptably high in Zimbabwe. This means that 1 in every 3 children who are chronically malnourished, are more susceptible to disease, may suffer cognitive impairment, have poorer educational outcomes and are likely to experience reduced productivity. Zimbabwe is not on target for achieving both MDG 1 (underweight) and Target 4 (<5 mortality). It is estimated that 12, 000 (preventable) child deaths per year are attributable to under nutrition in Zimbabwe Scaling up nutrition in Zimbabwe will be critical towards reversing these trends.
ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Implication of Malnutrition on Progress Towards MDG 1

Figure 7: Percent underweight children by year of survey including MDG 1 Target 18

16
Percent Children 14 12 10 8 6 4 1988

17

17 15

13

13
MDG 1 Significantly off target 7

1994

1999 2006 Year of Survey

2010

2015

Source: MDG Mid-term Review, Government of Zimbabwe, 2008. All rates ruse the NCHS reference population
ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Implication of Malnutrition on Progress Towards MDG 4

Figure 8: Under-five mortality rate by year of survey including MDG 4 Target 120
Deaths per 1000 Live Births

100 80 60 40 20 0

102
82 86 35% attributable to malnutrition 34

MDG 4 Significantly off target

1999

2006

2009

2015

Year of Survey
Source: MDG Mid-term Review, Government of Zimbabwe, 2008
ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Conclusion contd.
Infants under 6 months of age are not being exclusively breastfed. Young children are not generally being provided with adequate complementary foods, in terms of frequency and quality. There are major gaps in key interventions such as post-partum Vitamin A and iron/folate Malnutrition levels appear to be exacerbated by underlying causes such as lack of access to improved water and sanitation and episodes of illness.
ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Recommendations
Chronic malnutrition should be considered a development priority for Zimbabwe. Interventions to prevent chronic malnutrition should be guided by sound, evidence based policies and strategies of an intersectoral nature. Resources should be made available to scale-up high impact interventions such as (behavior change): Exclusive breastfeeding from birth to 6months Appropriate complementary feeding from 6-23months Maternal nutrition (supplementation and BCC) Improving the childs health and sanitary environment Treatment of acute malnutrition
ZIMBABWE NATIONAL NUTRITION SURVEY 2010

Thank you Tatenda Siyabonga