SELALE UNIVERSITY COLLEGE OF HEALTH SCIENCE

PUBLIC HEALTH DEPARTMENT

Nutritional Status Assessment Among Children Aged 0 To 5 Year Attending Out

Patient Under 15 Department At Salale University Comprehensive Specialized
Hospital North Showa Zone,Oromia,Ethiopia , June 2022

BY
Damessa Meassa Halake Dep’t: Nutrition ID:173/14

MINI STUDY TO BE SUBMITTED TO THE DEPARTMENT OF PUBLIC HEALTH,

COLLEGE OF HEALTH SCIENCES, SALALE UNIVERSITY.
ACKNOWLEDGMENT
First, I would like to express my deepest appreciation and thanks to Salale University,
Department of Public Health for giving me such a golden opportunity relevant asseignment.
Also, I would like to extend my heartfelt thanks to all of my instructors and Salale University
Hospital Staffs for supporting me in morale and providing necessary materials during the entire
process of this Mini Study.

i
Table of Contents
ACKNOWLEDGMENT....................................................................................................................................i
1. List of Tables.......................................................................................................................................iv
2. List of Figures.......................................................................................................................................v
3. Introduction.........................................................................................................................................1
4. SWOT Analysis.....................................................................................................................................2
4.1 Strengths.....................................................................................................................................2
4.2 Weakness.....................................................................................................................................3
4.3 Opportunities...............................................................................................................................4
4.4 Threats.........................................................................................................................................4
5. Objectives of the study........................................................................................................................5
5.1 General objective:........................................................................................................................5
5.2 Specific objectives........................................................................................................................5
6. Methods..............................................................................................................................................5
6.1 Study Area and Period.................................................................................................................5
6.2 Study Design................................................................................................................................6
7. Population...........................................................................................................................................6
7.1 Source population........................................................................................................................6
7.2 Study population.........................................................................................................................6
8. Inclusion and exclusion criteria...........................................................................................................6
8.1 Inclusion criteria..........................................................................................................................6
8.2 Exclusion criteria..........................................................................................................................6
9. Sample size determination..................................................................................................................6
10. Data collection procedure...............................................................................................................7

ii
 11. Data quality assurance.................................................................................................................7
12. Variables..........................................................................................................................................7
12.1 Dependent Variable.....................................................................................................................7
12.2 Independent Variables.................................................................................................................7
13. Standard and Operational Definitions.............................................................................................8
14. Data Analysis and result presentation.............................................................................................8
15. Ethical considerations......................................................................................................................9
16. Dissemination..................................................................................................................................9
18. Results.............................................................................................................................................9
18.1 Socio-Demographic Characteristics of the Mother and Father....................................................9
18.2 Water and Sanitation Service of the Household..........................................................................9
18.3 Maternal Health Conditions and Antenatal Follow-Up Behavior...............................................10
18.4 Child health Practice..................................................................................................................11
19. Conclusion and Recommendations................................................................................................16
20. Nutritional Management Monitoring and Evaluation checklist....................................................17
21. References.....................................................................................................................................20
22. Appendix........................................................................................................................................21
22.1 Questionnares...........................................................................................................................21

iii
 1. List of Tables

Table 1. 1 Frequency Distribution of Socio-Demographic Characteristics of the House holds.................10

Table 2. 1 Health conditions of mothers and children................................................................................12

Table 3. 1Children Malnutrition Status among Age 0 to 5Years...............................................................13

iv
 2. List of Figures
Figure 1. 1 Weight For Height of children as compared to the standard reference population...................14

Figure 2. 1 Height/Length For Age of children as compared to the standard reference population............15

Figure 3. 1 Weight For Age of children as compared to the standard reference population.......................16

Figure 4. 1 BMI For Age of children as compared to the standard reference population.........................17

v
 3. Introduction
Malnutrition is described as both a lack of nutrition and a surplus of nutrients. Diet and disease
are frequently linked to lifestyle, living conditions, access to basic requirements for existing
populations, and health care(1).

Early-life micronutrient deficit and nutrition disorders are not only life-threatening, but also
difficult to overcome. In Asia and Africa, annual economic losses due to low weight, poor
growth, and vitamin and mineral deficiencies amount for 11% of GDP. Because nutrition is both
fundamental and a driver of long-term development, combating malnutrition in all forms
necessitates collaboration with a wide range of stakeholders to create visible changes to current
issues(2).

Undernutrition is still a major problem, affecting child development and survival rates,
particularly in low- and middle-income countries(3,4). Around the world, 22.2 percent (150
million) of children are stunted, while 7.5 percent (50.5) are wasted(3). After more than two
decades of decline, global hunger is on the rise, with one of the worst-case situations
documented in South Sudan, where famine was declared in February 2017. War is largely to
blame for the rise in global hunger, which explains why conflict zones bear the burden of food
insecurity and malnutrition(5). Conflict-affected nations accounted for over 489 million of the
815 million hungry people in 2016, and they also accounted for 75 percent (122 million) of the
world's stunted children.

Recent assessments of progress toward the World Health Organization's (WHO) global nutrition
targets for 2025 suggest that current rates of improvement may not be enough to reach the
established goals, notwithstanding significant variation in progress between areas and toward
targets. By the year 2050, it is predicted that over 70% of the world's population would be living
in cities. At the same time, global nutritional issues continue to take a significant toll. In 2018,
about 200 million children under the age of five were malnourished, with at least 340 million
experiencing hidden hunger(6,7).

Many causes, such as population expansion, globalization, pandemics, droughts, weather

changes, political crises, and locust invasion, will impact food transportation, production, and
storage systems in the future. Several of these factors will be tested during the learning journey
on altering food systems, and one of the most important drivers of change, particularly in poor
countries, will be considered(8).

While some urban residents face food insecurity, other sub-populations are said to be suffering
from dietary excess and obesity as a result of more sedentary lifestyles and the shift to diets high
in sugar, fats, and refined foods but low in fiber. However, it is unclear whether and how these

1
tendencies are linked to urbanization. Varying regions and populations experience these changes
at different speeds, but the developing world has the most rapid changes.

The Sustainable Development Goal (SDG) calls for ending all kinds of malnutrition by 2030,
including meeting internationally agreed-upon targets for stunting and wasting in children under
the age of five. Acute malnutrition, both moderate and severe, has significant consequences,
including increased morbidity and mortality, poor intellectual development, sub-optimal adult
labor capacity, and an increased risk of disease in maturity. Indeed, Moderate Acute Malnutrition
(MAM) and Severe Acute Malnutrition (SAM) account for almost 11.5 percent of all fatalities in
children under the age of five who could have been saved each year(9).

The 2019 EMDHS statistics in Ethiopia show slow progress, with 37 percent of children under
the age of five stunted and 12 percent severely stunted. Overall, 7% of Ethiopian children are
wasted, and 21% of all children are underweight, with 6% being seriously underweight(10).

Child stunting was found to be prevalent in 45 percent of children, which is much higher than the
regional and national averages. 11.9 percent of stunted children were moderately stunted,
compared to 33.1 percent of severely stunted children In Fiche Town(11).
The attempts to improve diet data collecting and analysis must continue, and the startling gap in
micronutrient data must be addressed immediately. Data collection and analysis are not enough;
all stakeholders must be able to use the information to make evidence-based decisions(12).

Therefore, the findings showed that, the magnitude of the problem and the cause of the problem
were different for different areas and this study aimed to assess the magnitude of malnutrition
among 0-5 Years old age children Attending Salale University Hospital.

4. SWOT Analysis
4.1 Strengths
1. Customer perspective
 Good community participation because of good linkage system created by
the hospital.
 Good Social Participation on all aspects of the hospital which affects
catchment population.
2. Financial perspective
 Effectively implementing of outsourcing & Fee waiver service
 Effective utilization of allocated & internal revenue budget

2
  Efficiently using HCF and community Insurances
3. Internal process

Implementation of reforms like KPI,BSC,EHSTG

4.2 Weakness
Customer perspective

 Attitude of some part of the community towards the hospital

 Inability to know what is expected from the attendant & the Patient
and what to be served.
2.Financial perspective

 Defects in proceeding according to financial rules and regulations

 Lack of additional Financial income other than the regular one

3. Internal process

 Poor inventory system

 poor referral system
 lack of regular monitoring of service quality
 Irregular health education
4. Capacity building

 ,CRC, EBC, CASH, SaLTS, ,EHAQ,HMIS effectively

 Regular board meeting

 Strong private wing service

 Established and effectively running different committees ( DTC ,IP,

Discipline , GG&QI, clinical chart audit committee, PMT etc)
 Established internet service
 Motivated & committed staffs
 No training on some program in hospital reform for new staffs.
 Lack of experience sharing from others hospital which is role model for
others.
 Not Fully established civil servant army (1:5) in the hospital

3
Not organized PMT in the hospital
4.3 Opportunities
1. Costumer perspective

Potentially participatory community

2. Financial perspectives

Financial and Material support by different government ,community and

NGOs

3. Internal process

 Governing of the hospital by board

 Partner support in different service areas

4. Capacity building

 Training given by partners

4.4 Threats
1. Costumer perspective

 Inadequate supply of drugs

 High expectation of the community beyond the possible potential of the

hospital.eg Adult ICU service

 Scarcity of bioengineers for biomedical equipments maintenance.

2. Financial perspective

 Shortage of budget allocated

 Lack of manpower
 On job training given by the trained staff members or from outside like
NGO.
 Availability of d/t guide lines, internet service
 Morning session , consultation

4
 3. Internal process

 Shortage of some medical equipment’s and drugs :suction machines and

ER drugs leading to staff dissatisfactions

 Lack of specialists’ , radiologist, ,orthopedist, ,pathologist….

 Inadequacy of diagnostic modalities: FNAC,, thyroid function test, CT

scan..

 Inadequate rooms for different services

5. Objectives of the study

5.1 General objective:
To assess the nutritional status among Children Age 0 to 5Years attending pediatric OPD at Salale
University Comprehensive Specialized Hospital North Showa Zone,Oromia,Ethiopia from June
6 to 9, 2022.

5.2 Specific objectives

To Determine Stunting status among Children Age 0 to 5Years attending pediatric OPD at Salale
University Comprehensive Specialized Hospital North Showa Zone,Oromia,Ethiopia from June
6 to 9, 2022.

To Determine Under Weight status among Children Age 0 to 5Years attending pediatric OPD at
Salale University Comprehensive Specialized Hospital North Showa Zone,Oromia,Ethiopia from
June 6 to 9, 2022.

To Determine Wasting status among Children Age 0 to 5Years attending pediatric OPD at Salale
University Comprehensive Specialized Hospital North Showa Zone,Oromia,Ethiopia from June
6 to 9, 2022.

5
 6. Methods
6.1 Study Area and Period
Salale University Comprehensive Specialized Hospital Found in Fitche town which is located
in North Shewa zone of central Ethiopia 112 km away from Addis Ababa along the road to Bahir
Dar. The town covers a total land area of 3,325.1 hectares.
The town is divided into 4 kebele administrations. The altitude of the town ranges from 2510
meters to 2972 meters above sea level.
The catchment population of Hospital is Male 841600 Female 858400 Total 1.7 Million

54,570 are infants less than one year and ,279,327 are under 5 years.
Reproductive age (15-49years) of females are estimated to be around 376,210 of
which 13,054 are pregnant mothers.
The study was conducted In Salale University Comprehensive Specialized Hospital, Oromia
Regional State, Ethiopia, from June 6 to 9, 2022.

6.2 Study Design

The Pilot study was conducted To Assess the nutritional status among Children Age 0 to 5Years
attending pediatric OPD at Salale University Comprehensive Specialized Hospital North Showa
Zone,Oromia,Ethiopia

7. Population
7.1 Source population
Source populations Was all children aged 0 to 5 YearsWho Attending Salale University
Comprehensive Specialized Hospital.

7.2 Study population

all children aged 0 to 5 Years Who Attending Salale University Comprehensive Specialized
Hospital During Study Period

8. Inclusion and exclusion criteria

8.1 Inclusion criteria
All children who attend the hospital during data Collection was included

8.2 Exclusion criteria

Those chronically ill and difficult to measured by Anthropometry methods are excluded

6
 9. Sample size determination
Quota was used until data collector get 50 children by collecting data from all children who come to
Hospital

10. Data collection procedure

Data Was collected using interviews through structured questionnaire which was adapted from
different literature. Mothers /caregivers was interviewed. The questionnaire was prepared in
English and then translated into Mothers /caregivers language.

Anthropometric data was collected data collector using a measuring board with a headboard and
sliding foot piece and stadiometer to measure height/length and weight Salter scale using a basin
and standardized scales were used. It was collected using the procedure stipulated by the World
Health Organization/ United Nations Children’s Fund for taking anthropometric measurements.

The weight of the child was measured by an electronic digital weight scale with
minimum/lightly/clothing and no shoes. Calibration was done before weighing each child by
setting it to zero. The height of the child was measured by two workers. For those, less than
2years of age measurement was done without shoes and the height read to the nearest 0.1cm by
using a horizontal wooden length measuring board with the infant in a recumbent position on a
hard and flat surface.

However, the height of children 24 months and above was measured using a vertical wooden
height board by placing the child on the measuring board, and the child standing upright in the
middle of the board. The child’s head, shoulders, buttocks, and heels touch the board. The height
(length) of the child was recorded to the nearest 0.1cm.

Mid Upper Arm Circumference (MUAC) was measured using non-stretchable tape on the left
mid-upper arm to the nearest 1 mm. MUAC below 12.5 cm indicates acute undernutrition.

Edema was assessed by applying thumb pressure on the upper side of both feet for three
seconds. It was diagnosed if a bilateral depression (pitting) remained after the pressure is
released.

11. Data quality assurance

 All completed data sets was examined by the Data Collector for completeness during data
collection

7
 12. Variables
12.1 Dependent Variable
 The main outcome variable in this study was nutrition status measured as underweight, stunting, BMI, and
wasting.

12.2 Independent Variables

 Child age
 sex
 Immunization status
 Maternal educational status,
 ANC follow up
 Hand washing practices of moth
 family size,
 Complementary feeding initiation time
 Duration of breastfeeding
 Prelacteal feeding, colostrum feeding
 Number of children less than 5 years,
 Latrine availabile
 Water source

13. Standard and Operational Definitions

Wasting: the weight-for-height <-2 z score in relation to the reference population.

Stunting: height-for-age <-2z score

Under weight:Weigt-for-age <-2z score

Over Weight BMI >2z score

Handwashing frequently: Those who wash hands during all activities such as; after latrine,
before preparing food, before serving food, after cleaning child feces, etc.

Hand washing less frequently: Those who do not wash their hands during activities such as;
after latrine, before preparing food, before serving food, after cleaning child feces.

8
Complementary foods: Foods that are required by the child, at 6 months of age, in addition to
breastfeeding so long as breastfeeding is not sufficient.

14. Data Analysis and result presentation

Data entry and analysis was done using SPSS version 24.0. Anthropometric indices Was
calculated using WHO Anthro Version 3.2.2 Software. Descriptive analysis was used to describe
the percentages and frequency of socio-demographic characteristics and other relevant variables
in the study.

15. Ethical considerations

The study was conducted after obtaining an official letter from Salale University. Oral consent
was obtained from each parent/caregiver of the children before initiation of data collection. To
maintain the confidentiality of information collected from each study participant, names and
other identifiers was not used in the questionnaire. Information related to the analysis result of
the study population was identified using codes and analysis was done on data with codes.

16. Dissemination
Primarily, the result of this study was presented to Salale University, And also it was
communicated to the North Showa Zone Health department and Salale University Hospital and
other concerned bodies including the study community.

18. Results
18.1 Socio-Demographic Characteristics of the Mother and Father
Among mothers assessed from the current study, this study revealed that about 40 (80%) of
mothers could not read or write, 4 (8%) were informally educated, 3 (3%) had primary level, 3
(6%) had secondary level.Regarding occupational status of the father Farmer 36(72%),
Merchant 3(6%), Government employer3(6%), Private 4(8%) and Daily laborer 4(8%).This

9
 study also identify major sources of income which is Trade 6(12%), Farming 41(82%), and
Government paid 3(6%).

18.2 Water and Sanitation Service of the Household

Among 50 respondents who were asked what their main source of drinking water for the household, this study
revealed that about 8 (16%) of them used water piped to dwelling, 34(68%) used public tap/stand pap, 8 (16%) used
protected well. This study indicated that about 43 (86%) mothers or caretakers always washed their hands
frequently ,7(14%) not washed their hand frequently.

18.3 Maternal Health Conditions and Antenatal Follow-Up Behavior

This study indicated that 46 (92%) mothers had a complete antenatal follow up, 4 (8%) of them had incomplete
ANC follow up during pregnancy.

Table 1. 1 Frequency Distribution of Socio-Demographic Characteristics of the House

holds
among Children Age 0 to 5Years attending pediatric OPD at Salale University Comprehensive
Specialized Hospital North Showa Zone,Oromia,Ethiopia, June 2022

Variable Freuency Percent

current marital status marred
47 94.0
divorsed
3 6.0
Maternal Parity
1 12 24.0
2 12 24.0
3 10 20.0
4 13 26.0
5 3 6.0
highest level of Maternal No formal education 40 80.0
education can read and write 4 8.0
primary school 3 6.0
secondary school 3 6.0
occupational status of the
Farmer 36 72.0
father
Merchant 3 6.0
Government employer 3 6.0
Private 4 8.0
Daily laborer 4 8.0
occupational status of the
Housewife 35 70.0
mother /caregiver
Merchant 5 10.0

10
 Government employer 3 6.0
Private 4 8.0
Daily labor 3 6.0
major sources of income
Trade 6 12.0
Farming 41 82.0
Governmenpaid 3 6.0
Maternal hand washing
Washes frequently 43 86.0
practices
Not wash frequently 7 14.0
common source of drinking
Piped into dwelling 8 16.0
water
Public tap/ stand pipe 34 68.0
Protected well 8 16.0
toilet facility of household
Open field 4 8.0
Pit latrine without
37 74.0
slab/open pit
Pit latrine with slab 9 18.0

18.4 Child health Practice

Child Feeding Practice and Vaccination Status of Children
From 50 children, assessed, 20 (40%) were male and 30 (50.1%) were female Pertaining to vaccination, 41 (82%)
completed their vaccines, about 5 (10%) had not completed their vaccines, and the rest, 4 (8%), did not take the
vaccine at all

Regarding feed colostrum to child 46(92%) mothers feed for their new babies while 4(8%) do
not feed colostrums and frequency of breast feeding is <8 times 5(10%) mothers while >=8 times
45(90%) mothers feed breast for their children.

On other hand mothers who feed breast on their child demand are 43(86%) while 7(14%) mother
give their breast while they cry.

Complementary Feeding Starting Time

From 50 children, 7 (14%) of them started supplementary feeding before 6 months, 43(86%) of them started at 6
months.

Table 2. 1 Health conditions of mothers and children

among Age 0 to 5Years attending pediatric OPD at Salale University Comprehensive Specialized
Hospital North Showa Zone,Oromia,Ethiopia, June 2022

11
Variable Category Freuency Percent
ANC follow up
Yes 46 92.0
No 4 8.0
Sex of Child
Male 20 40.0
Female 30 60.0
immunization Status
Not vaccinated 4 8.0
Partially vaccinated for age 5 10.0
Fully vaccinated for age 41 82.0
feed colostrum to child
Yes 46 92.0
No 4 8.0
pre-lacteal feeding
Yes 1 2.0
No 49 98.0
frequency of breast feeding
<8 times 5 10.0
>=8 Times 45 90.0
When do you breast feed
When she/he cries 7 14.0
your child
On demand 43 86.0
start complementary
Before 6 month 7 14.0
feeding
At 6 Month 43 86.0

Child Nutrition Status

Prevalence of Malnutrition (Wasting, Stunting, and Underweight)
Of the overall sample of 50 children, 50 (100%) of them were included and measured for their height and weight to
ascertain the nutritional status based on the Four indicators of WFH, HFA, BMI, and WFA, the results showed that 3
(6%), 5 (10%), 2 (4%) ,1(2%) were underweight, stunted, wasted, and over Weight respectively.

Table 3. Children Malnutrition Status among Age 0 to 5Years

attending pediatric OPD at Salale University Comprehensive Specialized Hospital North Showa
Zone,Oromia,Ethiopia, June 2022

12
 Variable Category Freuency Percent
Wasting Staus
Wasted 2 4.0
Normal 48 96.0
Stunting Status
Stunting 5 10.0
Normal 45 90.0
Under Weight Status
Under Weight 3 6.0
Normal 47 94.0
BMI Status
Over Weight 1 2.0
Normal 49 98.0

Figure 1. 1 Weight For Height of children as compared to the standard reference population

13
Figure 2. 1 Height/Length For Age of children as compared to the standard reference population

14
Figure 3. 1 Weight For Age of children as compared to the standard reference population

15
Figure 4. 1 BMI For Age of children as compared to the standard reference population

Priority Problems
 Undernutrition is found in some children

 Some Mothers do not only breast feed their child up to 6 month

 Still there is mothers who do not feed their child colestrum

 Some mothers do not feed their child Until they cry

 Some mothers do not wash their hand frequently

 Incomplete Immunization problems

Intervention
 Health education on breast feeding, Complementary feeding
 Counseling on maternal ANC

16
  Campaign on Child Immunization
 Awareness on Sanitation and hand washing practice

19. Conclusion and Recommendations

There was stunting (10%), wasting (4%), and underweight (6%) in this Mini study and this may
be higher if probability study method is done and sample size is increased compared to the
national or regional malnutrition prevalence. Maternal illiteracy, the age of child, not
breastfeeding exclusively, absence of ANC, not being vaccinated, and poor caretaker hand
washing practice were identified risk factors of under-five malnutrition. Education and training
for mothers on exclusive breastfeeding practice, child care, and infection prevention protocol
should be given and further strengthened at community level. ANC program for all pregnant
women should be initiated and established at all levels of Health Facility. Policymakers should
pay special attention to policies targeted at reducing under-five malnutrition.

20. Nutritional Management Monitoring and Evaluation

checklist
S.N Questions Yes No Remark
(√) (×)
1 Policies and guidance
Are there national policies aligned with global guidance on management of malnutrition
including in health facilities and in the community? Note that policies are formal statements
issued by the state.
Are there clear national operational procedures or guidelines for management of malnutrition
including in health facilities and in the community? Note that procedures are step-by-step
instructions for implementation and guidelines are designed to advise on processes for
implementation.
Are there temporary and interim protocols in place to face with the constraints brought by the
COVID19 pandemic in Facility? Are interim protocols in place to face other infectious
disease outbreaks in Health Facilty?
2 Contingency plans
Is there an inter-Facility contingency plan that includes a comprehensive section on the
management of malnutrition?
3 Capacity building
Is there an in-Facility repository for malnutrition management operational guidance and tools
in national and/or local language(s)?
Are there training materials in malnutrition management ready in the national and/or local
language(s)?
Is there a pool of trained health and nutrition personnel in malnutrition management in

17
 Facility?
Are there pre-determined trainers on malnutrition management in The Facility?
4 Data
Do you have routine and recent data on key malnutrition indicators in country?
Is data from different Health Facility available?
Do you have up-to-date data on the coverage of the malnutrition management interventions in
Facility?
Are monitoring indicators and tools pre-agreed upon and harmonized?
In the event of an emergency, does the government and/or nutrition sector or cluster partners
have the capacity to undergo an initial rapid assessment? Do they have the capacity to
implement a SMART assessment 4 to 6 months after the emergency onset?
5 Supplies
Are pathways to purchase medical supplies needed for the management of malnutrition such
as Ready to Use Foods, antibiotics, and anti-helminths clear?
Are other supplies needed for setting up malnutrition management space available or
included in the interagency contingency plan?
Are the supplies amount and location known by main actors and accessible in case of an
emergency?
6 Capacity Mapping
Has there been a mapping of the capacity of local and international partners to respond to
malnutrition management needs during a crisis?
Is there a focal organization that partners can rely on or go to for expert malnutrition
management advice?
Technical Working Group (TWG)
Is there malnutrition TWG established prior to the emergency?
Does the malnutrition TWG have Terms of references?
Does the TWG have chairs in place?
Has an evaluation of the chair’s work been done once a year?
Does the TWG have a workplan?
Does the TWG monitor its progress against set targets once every 3 months
Do the TWG members meet every month?
7 Need assessment and analysis
Was a quick secondary data review done?
Have you gathered information on existing policies, guidance, training materials, trained
personnel, contingency plans, prepositioned supplies, malnutrition management TWG that
were present before the emergency?
Has an initial rapid assessment that includes malnutrition indicators taken place in the first
weeks and months following the crisis?

How is the access to data from the relevant sectors such as food security, health, WASH, and
protection to support analysis of malnutrition needs?
Are communities consulted and involved in the assessment of needs?
Does the Humanitarian Needs Overview (HNO) provide specific and to the point information
on the malnutrition situation before the emergency for rapid onset emergencies and how the
emergency affected nutrition status? For protracted emergencies, does the HNO discuss the
current nutrition status of the population?
8 Strategic Planning
Does the Humanitarian Response Plan (HRP) and the nutrition cluster strategic plan address
the malnutrition needs raised in the HNO, are the two documents aligned?

18
 Does the Humanitarian Response Plan (HRP) and the nutrition cluster strategic plan cover
aspects on malnutrition management planned interventions including considerations on
whether the population is static or on the move?
Does the HRP and the nutrition cluster strategic plan provide a clear strategy on how to
address the coverage gaps in malnutrition management services?
Does the HRP and the nutrition cluster strategic plan include a section on how the quality of
the malnutrition management interventions in Facility will be enhanced?
Are different community groups and members views taken into consideration as the plan is
put together?
Has the HRP and the nutrition cluster strategic plan been converted into an operational yearly
workplan?
9 Implementation and Monitoring
Policies and guidance
Are all partners adhering to the interim or the national malnutrition management protocol?
Capacity
Has there been any discussion on the minimum capacity required for nutrition activities and
capacity mapping? Is the capacity of partners to deliver malnutrition management program
been assessed?
Does the sector have a capacity building strategy for malnutrition management, and if yes, is
this being implemented?
Is a training schedule for malnutrition management training planned?
Service Delivery
In addition to the nutrition cluster strategy, is there malnutrition management strategy and
approach standardized across all partners?
Are training curricula and Information Education and Communication materials for
malnutrition in the national and/or local language standardized and distributed/used?
Is an acute malnutrition program taking place systematically at all levels of health and
nutrition service provision –community, outreach, health facility including at the hospital
and/or the stabilization center (SC)?
Is there a good linkage between health and nutrition program to promote continuum of care
and referral systems from the community to health facilities including stabilization centers?
Is the delivery and quality of malnutrition management activities the same for all partners?
Are the malnutrition management activities of community volunteers standardized across all
partners?
Are there systems for effectively avoiding duplication of services?
10 Supplies
Is there an effective supply needs and requirements monitoring in place?
Do partners face challenges in accessing supplies ( those include all supplies needed for SAM
and MAM treatment, for example RUTF)?
Are the partners implementing the complete agreed package of acute malnutrition
management interventions in a given area?
Is the coverage of the package of nutrition specific interventions adequate?
Interface with other sectors
Interface with the wash sector: have the different ways nutrition and WASH sectors can
support and collaborate been mapped out? For example, do outreach services/OTPs and SC
have separate latrines for men and women as well as clean water points? Outside the facilities,
are water points available in villages and latrines in communities with elevated percentages of
GAM?
Interface with the food security sector: have the different ways nutrition and FS sectors can
support and collaborate been mapped out? are there implementation plans jointly prepared

19
 with the Food Security sector? For example, is the FSC able to provide foods that are
appropriate to 6-23 months old?
Interface with the health sector: have the different ways nutrition and health sectors can
support and collaborate been mapped out? For example: are referrals to other health services
such as skilled attendant’s delivery services, pre- and post-natal care and immunization
mapped out and established?
Are linkages with protection and Mental Health and Psychosocial Support services mapped
out and established?
Monitoring
Are the indicators discussed and agreed upon by partners? Are reporting and data collection
tools harmonized and are all partner using the same reporting format?
Are qualitative indicators used to monitor the quality of malnutrition management
interventions or are only output indicators used?
Is reporting timely? How many centers are reporting? Is the humanitarian response website
updated regularly?
Are the performance indicators routinely analyzed and action is taken to address the
shortfalls?
Is there any cross learning between partners delivering nutrition specific services?
Is a bulletin issued frequently to inform progress and inform where the key documents are?
11 Operational Peer Review and Evaluation
Is there a plan to map capacities of partners, develop joint training plans develop joint
supervision tools and establish on-the-job coaching techniques?
Is there a plan to jointly monitor the quality of the response and address gaps that are flagged?
Is amalnutrition management integrated in routine health services in country?
Are the nutrition malnutrition management indicators integrated in the Health Monitoring
Information System (HMIS)?
Are the medical and therapeutic food supplies budgeted and purchased as part of the national
health system ongoing programs?

21. References
1. Blössner M, Onis M De, Prüss-üstün A, Campbell-lendrum D, Corvalán C, Woodward A.
Malnutrition Quantifying the health impact at national and local levels. 2005;(12).
2. UNICEF. Child Stunting , Hidden Hunger and Human Capital in South Asia. Unicef
[Internet]. 2018;21(22):7–12. Available from:

20
 https://www.unicef.org/rosa/media/1611/file
3. IEG. Global Nutrition Report- Shining a light to spur action on nutrition. Glob Nutr Rep
[Internet]. 2018;(June):118. Available from: http://www.segeplan.gob.gt/2.0/index.php?
option=com_content&view=article&id=472&Itemid=472
4. FAO, WFP. Monitoring food security in countries with conflict situations. A joint FAO /
WFP update for the members of the United Nations Security Council. 2020;(7):40.
Available from: Food and Agriculture Organization of the United Nations
5. Kiarie J, Karanja S, Busiri J, Mukami D, Kiilu C. The prevalence and associated factors of
undernutrition among under-five children in South Sudan using the standardized
monitoring and assessment of relief and transitions (SMART) methodology. BMC Nutr.
2021;7(1):1–11.
6. Budreviciute A, Damiati S, Sabir DK, Onder K, Schuller-Goetzburg P, Plakys G, et al.
Management and Prevention Strategies for Non-communicable Diseases (NCDs) and
Their Risk Factors. Vol. 8, Frontiers in Public Health. Frontiers Media S.A.; 2020.
7. UNICEF. State of the World’s Children 2019: Children, food and nutrition [Internet].
Unicef. 2019. 1–258 p. Available from: https://www.unicef.org/media/63016/file/SOWC-
2019.pdf
8. Kerina Tull. Learning Journey on Changing Food Systems: Urban Food Systems and
Nutrition. 2018;1–51. Available from:
https://assets.publishing.service.gov.uk/media/5bae42ffed915d259eaa7769/383_Urban_Fo
od_Systems_and_Nutrition.pdf
9. Grote U. IFPRI: Global Food Policy Report 2018. Food Secur. 2018;10(6).
10. Ethiopian Public Health Institute (EPHI), ICF. Ethiopia Mini Demographic and Health
Survey 2019: Final Report [Internet]. 2021. 1–207 p. Available from:
https://dhsprogram.com/pubs/pdf/FR363/FR363.pdf
11. Agric F. DOI: 10.18697/ajfand.91.17650. 2020;20(3):15992–6012.
12. Thurstans S, Opondo C, Seal A, Wells J, Khara T, Dolan C, et al. Boys are more likely to
be undernourished than girls: A systematic review and meta-analysis of sex differences in
undernutrition. BMJ Glob Heal. 2020;5(12):1–17.

21
 22. Appendix
22.1 Questionnares
S.N Part 1: Socio-Demographic information Response Skip
1. Age of the mother /caregiver ___________
2. What is the current marital status of the mother 1. Single
/caregiver
2. Married
3. Divorced
4. Widowed
3. Maternal Parity ______________________

4. Do you have ANC follow up during Yes/No

pregnancy( for this child)
5. What is the highest level of education you 1. No formal education
completed? For the mother or caregiver 2. can read and write
3. primary school
4. secondary school
5. College/ university
completed
6. What is the occupational status of the father 1. Farmer
2. Merchant
3. Government employer
4. Private
5. Daily laborer
7. What is the occupational status of the mother 1. Housewife
/caregiver 2. Merchant
3. Government employer
4. Private
5. Daily labor
8. What are your major sources of income 1.Trade 2.Farming
3.Governmenpaid
4. Animal breeding
9. How many family members live in this house? Less than five
Five
Greater than five
10.
How many wife\ wives do you have( for father)

11. How many under 5 children do you have _________

12. Maternal hand washing practices 1. Washes frequently

2. Not wash

22
 frequently
13. Part two: Child health

14. Name of Child and Father ______________________

15. What is the Sex of Child? 1. Male 2.female
16. What is the age of your child? ___________ Months
17. 1. Not vaccinated
What is the immunization level of
2.Partially vaccinated for age
your child?
3. Fully vaccinated for age
18. What is the birth order of the child? __________
19. What is birth interval from the
__________ Months
preceding child?
20. Did you feed colostrum to your
0. No 1. Yes
child?
21. In the first three days after delivery,
did you give 0. No 1. Yes
pre-lacteal feeding to your child?
22. 1. When she/he cries
When do you breast feed your child
2. On demand 3. On Schedule
23. Did the child start complementary
0. No 1. Yes
feeding?
24. If yes to Questio above, at what age
did your child starts ___________________
complementary feeding?
25. What is the daily frequency of
complementary
feeding?
26. What is the daily frequency of
complementary ___________
feeding?
27. Part 3 : Households Information
28. What is your common source of 1. Piped into dwelling
drinking water 2. Public tap/ stand pipe
3. Protected well
4. Rain water
5. Bottled water
6. Surface water (river/lake/pond/stream
dam)
29. What kind of toilet facility do you 1. Open field
use? 2. Pit latrine without slab/open pit

23
 3. Pit latrine with slab
4. Cemented latrine
5. Flush/ pour flush to septic tank
Part 4:Anthropometric Measurements

No Weight measurements(kg) Height measurements(cm)

30. 1st 2nd 3rd average 1st 2nd 3rd average

MUAC in cm______________ Bilateral Pitting Edema? 1.Yes 2.No

24