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 ZIMBABWE NATIONAL NUTRITION SURVEY – 2010 .

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 .

1% (N = 35. 1995: WHO Global Database on Child Growth and Malnutrition .285) 14.5% (N = 35.8% (N = 35.1% (N = 35. 854. Geneva.266) months < .295) 4Children 5WHO 1.323) NCHS Reference (%) 27.9% (N = 35.695) 3.1% (N = 35.2 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.812) 2.1% (N = 35.069) 2.3% (N = 35.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 (%) 33.914) Rating Per Global Thresholds5 High Medium Low Medium 9.

5 Wasting Underweight Mean Z-Score 0 -0.5 -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 -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 .Under nutrition (Z-Scores) By Age Figure 12: Mean z-score by age and nutrition index Stunting 0.5 -1 -1.5 Mean Z-Score Wasting Underweight 0 -0.

9 % 20.9% 30.3 4.0% .0% . 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% .29 .19.0 .4 7.9% 35.8% 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 33.1a Prevalence of stunting in children 6-59 months of age.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 N 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.

by province 12.00%     5.00% 2.00% 6.Exclusive Breastfeeding By Province Percent children under 6 months of age exclusively breastfed.00% 0.8 % 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 .00% 4.00% 10.00% 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 .0% .4. + 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.Minimum Acceptable Diet By District Figure 17: Percent children 6-23 months of age who received a minimum acceptable diet Figure 2.9% 5.0% .8% 10.9.9% 0.9% 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 N Minimum acceptable diet is a composite of meal frequency and dietary diversity and considers breastfeeding  8.5% .2 0.1 4.in 14 districts less than 5% of children received an acceptable diet  ZIMBABWE NATIONAL NUTRITION SURVEY – 2010 .9 Percentage children between 6-23 months of age receiving a minimum acceptable diet.0% .

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 .

6% . Fever and Coughs By District Figure 4.4% 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. 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 4.4% .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 2.2% .7% .Prevalence of Diarrhea.3% . 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 2.2 3. 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 4.5% .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 N ZIMBABWE NATIONAL NUTRITION SURVEY – 2010 .6% .2 % 13.9% .9.16 .3b Prevalence of fever in children between 0-59 months of age.8% 18.9% 8.4% .1 8.2 0. by district Figure 18: Percent children 0-59 months of age who had diarrhea .3 % 16.4% .2 8.5% 9.3a Prevalence of cough in children between 0-59 months of age.9% .7.0% .7.12 .5% 7.8 % 12.1 7.1% 17.2 Prevalence of diarrhoea in children between 0-59 months of age.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 N B ei tb ri d g e U r b an N 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 2.13 .3 4.

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 27.4% 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 .8 % of women received iron/folate supplements during their pregnancies 86.

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 is not on target for achieving both MDG 1 (underweight) and Target 4 (<5 mortality). This means that 1 in every 3 children who are chronically malnourished. ZIMBABWE NATIONAL NUTRITION SURVEY – 2010 .8% chronic malnutrition remains unacceptably high in Zimbabwe. have poorer educational outcomes and are likely to experience reduced productivity. It is estimated that 12. are more susceptible to disease.Conclusion At 33. may suffer cognitive impairment.

All rates ruse the NCHS reference population 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. 2008. Government of Zimbabwe.

Government of Zimbabwe.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. 2008 ZIMBABWE NATIONAL NUTRITION SURVEY – 2010 .

ZIMBABWE NATIONAL NUTRITION SURVEY – 2010 . in terms of frequency and quality. Young children are not generally being provided with adequate complementary foods. 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.Conclusion contd. Infants under 6 months of age are not being exclusively breastfed.

Recommendations Chronic malnutrition should be considered a development priority for Zimbabwe. 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 child’s health and sanitary environment Treatment of acute malnutrition ZIMBABWE NATIONAL NUTRITION SURVEY – 2010 . evidence based policies and strategies of an intersectoral nature. Interventions to prevent chronic malnutrition should be guided by sound.

Thank you Tatenda Siyabonga .

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