FSAU/MOHL/UNICEF/SRCS

Abbreviations and acronyms

ARI: Acute Respiratory Infections
FAO: Food and Agriculture Organisation
FEG: Food Economy Group
FSAU: Food Security Assessment Unit
GAM: Global Acute Malnutrition
Ha:  Hectares
H/A: Height for Age
IDP: Internally Displaced People
KM:  Kilo Metres
MCH: Maternal and Child Health
MT:  Metric Tonnes
NCHS: National Centre for Health Statistics
NGOs: Non-Governmental Organisations
NIDs: National Immunisation Days
OR:  Odds Ratio
SACB: Somalia Aid Coordination Body
UN: United Nations
UNICEF: United Nations Children's Fund
WFP: World Food Programme
W/H: Weight for Height
WHO: World Health Organisation

Deyr Season

Short rains normally expected from October to December in southern Somalia. Deyr rains are less widespread and less reliable than the Gu rains. They are usually patchy and localised. Its harvest is normally expected between December and January and provides key food requirement to take households through the Jilaal season. The harvest is normally not significant when compared to the primary/main harvest of the year.

Gu Season

The main rainy season in Somalia normally expected between April and June. About 70% of the annual crop and livestock production depend on the Gu rains. This is the heaviest and most reliable rainfall in Somalia. Its harvest is normally expected between July and August.

Jilaal Season

This is the dry season of the year in Somalia normally between January and March. There is normally no crop production during this season and the river levels normally drop. Consequently, most livestock migrate in search of water and pasture during this period.

ACKNOWLEDGEMENTS

Food Security Analysis Unit (FSAU) and UNICEF acknowledge the participation of Ministry of Health and Labour (MOHL) Somaliland and Somali Red Crescent Society (SRCS) in the Sool plateau of Sanaag and Sool regions nutrition survey.

UNICEF funded survey vehicles, provided survey equipment, photocopied survey questionnaires, participated in training of survey teams and survey coordination, supervised data collection and reviewed the draft survey report. FSAU funded personnel related expenses, led the training of survey teams, supervised data collection, undertook data entry and analysis, produced survey report and led the overall coordination of the survey. The contribution of MOHL in coordination, community mobilisation, provision of a training venue, supervisors and enumerators is highly appreciated. The provision of enumerators, supervisor and a debriefing venue following data collection by SRCS is gratefully acknowledged.

Thanks too to the local authorities, parents/care takers, community guides and the community as a whole in the plateau for their cooperation, time and provision of information individually and in focus group discussions that helped the survey team get a better understanding of the nutrition situation in the area. The contribution of WFP, COOPI, CINS, CARE, CEFA and HOVYOKO (a local NGO) by providing background information on the area is also greatly appreciated. FSAU and UNICEF also express their sincere appreciation to the entire survey team for the high level of commitment, sincerity and initiatives demonstrated during all stages of the survey.

EXECUTIVE SUMMARY

The Sool Plateau food economy zone (FEZ) stretches across Sool, Sanaag and Bari regions of Northern Somalia. The Sool Plateau of Sool and Sanaag regions host a population estimate of 69,550 (WHO population estimates, revised in June 2004 by survey team). Pastoralism is the main means of livelihood with shoats and camels being the dominant animal species. The plateau has experienced more than four years of drought that led to severe pasture depletion, cumulative degradation of rangeland with little potential for recovery and regeneration and water scarcity. All these culminated in significant livestock deaths including pack camels towards the end of the year 2003.

A nutrition survey and an inter-agency assessment were conducted in May/June 2003 and in October 2003 respectively. This led to commencement of various interventions in December 2003, during which nutritional screening of children was undertaken using weight for height, revealing high levels of malnutrition. Since December 2003 FSAU has undertaken three rounds of sentinel sites data collection in the Sool Plateau of Sool and Sanaag regions which has revealed a gradual improvement in the under fives nutritional status from around 19% to 15% of those screened. In contrast, the nutrition status for mothers was seen to deteriorate from 17% to 33%.

Between 29th May and 8th June 2004 a nutrition survey was conducted by FSAU, UNICEF, MOHL and SRCS to determine changes in nutritional status and establish the influencing factors since the last survey in May 2003. Using a two-stage (30x30) cluster sampling methodology, a total of 901 children aged 6-59 months and measuring 65-110 cm in height/ length were surveyed. The children came from 457 randomly selected households. A high proportion (about 32%) of the households was female headed while the rest were male headed. A total of 901 households were surveyed for mortality. Adults nutritional status, vitamin A deficiency and dietary diversity were also assessed. Qualitative data on care and feeding practices, food security and health related issues were collected through focus group discussions, key informant interviews or direct observations.

A high proportion (93.1%) of the children aged between 6 and 24 months were introduced to foods other than breast milk very early in life between 0-3 months. The results further indicate reduction on frequency of feeding of children. The proportion of children feeding few times per day between 1-2 times increased by more than half from about 17% in 2003 to 42%. At the same time the proportion of children feeding more than 4 times reduced, only about 7% of the children were feeding more than 4 times per day compared to 27% in 2003.

Child feeding practices were found to be sub-optimal among children aged 6-24 months. Among children of breast feeding age, the proportion still breastfeeding reduced from 61% in the previous survey to 31%. This can be attributed to the high demand of women's time, leaving children for long hours as they engage in casual employment and search for loans to buy food. Additionally, mothers were opting not to breastfeed their children due to lack of enough foods to feed themselves too as was noted in the focus group discussions.

The incidence of ARI, diarrhoea, malaria and measles in two weeks prior to the survey was 22.9%, 17.8%, 8% and 8% respectively. A high (70%) proportion of the children had received polio vaccine doses at least once or more times, 73% were immunised against measles while 57.8% had received vitamin A supplementation in the past six months prior to the survey.

Of the households that owned livestock three years prior to the survey, majority had lost significant proportions of livestock at the time of survey. About 19% had lost all their shoats while 68.1% had lost between 50% and 99% of their shoats. About 40% had lost all their camels while a half had lost between 50 and 99% of their camels. Both the survey and FSAU food security information indicate a shift in people's livelihood patterns recently. About a half of the surveyed households relied on self employment or petty trade as the main means of livelihood, about 37% on pastoral while the rest depended on casual labour, relatives or external assistance. Qualitative information from focus group discussions, key informant interviews and food security information indicate that the household level coping mechanisms have been overstretched and people are resulting in extreme coping strategies for example significantly reducing the amount of food consumed and frequency of meals.

Unprotected wells and rain water from catchments or ponds were the main water sources for both drinking and cooking/personal hygiene. At the time of survey, 56.5% of the households had to cover more than five kilometres to access the nearest water point. Majority (75.3%) of the households used more than 15 litres of water in their households on a daily basis.

Survey results indicate a global acute malnutrition rate of 13.7 % (weight for height <-2 Z score or oedema) compared to 12.5 % recorded in May 2003 survey. Severe acute malnutrition (weight for height <-2 Z score or oedema) was 3.1% compared to 1.8 % in 2003 with oedema cases having increased from 5 to 12 cases. The malnutrition rates by sex were statistically significant with more girls (18.1%) being malnourished than boys (p<0.05); a factor that will require further investigation. Malaria and dietary diversity had a statistically significant association (p<0.05) with malnutrition.

The underfive mortality rate increased from 1.9 deaths/10000/day in 2003 to 2.89 deaths/10000/day. Crude mortality rate was 0.86 deaths/10000/day compared to 0.88 deaths/10000/day in 2003. A total of 11.2% of the mothers were malnourished (MUAC<21 cm).

The difference in the levels of global acute malnutrition in both surveys is not statistically significant although the rates remain higher than those seen in similar communities in the country. The increase in under five mortality rate to the alert level reveals a poor situation in the plateau. Malaria, dietary diversity, child sex, care practices and food insecurity contribute to the levels of malnutrition in the plateau. Overall, food insecurity had far reaching effects on the livelihood means of the dominantly pastoral population. Access to food in sufficient quantities or good quality was greatly compromised following significant losses of livestock or animals moving to distant locations. Care aspects have also been negatively affected as women have to spend long hours in search of casual employment or credit facilities.

The ongoing interventions from local communities, local and international NGOs have played a key role in preventing deterioration in the nutrition situation in the plateau. As was noted in the survey, following the interventions measles immunisation and vitamin A supplementation coverage had slightly improved. Inadequate Gu 2004 rains were received in the plateau while the next rains (Deyr 2004 rains) are expected in the next two to three months. However, even if good Deyr rains are received, it will take time for the population to recover. Following consultations with partners and sharing of the preliminary survey findings the enlisted recommendations were made:

a. Continuation of targeted food distribution in the highly vulnerable areas of the plateau for next 2-3 months assuming proper 2004 Deyr rains.

b. Continuation of supplementary feeding programme for pregnant/lactating mothers and children under five years in the plateau also in the next 2-3 months and treatment of the severely malnourished children assuming proper Deyr rains.

c. Continued close monitoring the food security and nutrition situation in the area/intensification of surveillance activities.

d. Intensify promotive and preventive health care interventions focusing on immunisation, hygiene, and control of water related diseases. Additionally, improve access to public health facilities.

e. Promote nutrition education through the MCH/outposts focusing on breastfeeding, complementary feeding and frequency of feeding of infants and young children as well as feeding of sick children.

f. Rehabilitate run-down boreholes, berkads and dams with an aim of ensuring water availability for both human and livestock in the long run.

g. Promote alternative income generating activities through a credit programme to reduce over-reliance on livestock sources of livelihood.

SUMMARY OF FINDINGS

Table 1: Summary of survey findings

                              2003 2004 Indicator     No % No %
Children under five years screened during the survey                  895  99.4               901  100
Global acute malnutrition - W/H<-2 Z score or presence of oedema      112  12.5(CI 10.5-14.9) 123  13.7(CI 11.5-16.1)
Severe acute malnutrition - W/H<-3 Z score or presence of oedema      16   1.8(CI 1.1-3.0)    28   3.1(CI2.1-4.5.)
Global acute malnutrition - W/H<- 80% of median or presence of oedema 58   6.5                78   8.7
Severe acute malnutrition - W/H<- 70% of median or presence of oedema 3    0.2                23   2.6
Oedema                                                                5    0.5( CI 0-0.9)     12   1.3( 0.7-2.3)
Proportion of children with diarrhoea in two weeks prior to survey    219  24.5               160  17.8
Proportion of children with ARI in two weeks prior to survey          206  22.9
Proportion of children with malaria in two weeks prior to survey      110  12.3               72   8.0
Proportion of children with measles in one month prior to survey      33   3.7                72   8.0
Proportion of children supplemented with Vitamin A in the last 
six months prior to the survey                                        427  26.0               521  57.8
Proportion of children immunised against measles (9-59 months)        217  26                 857  73
Proportion of malnourished women (MUAC<21 cm)                         48   11.2

Under five mortality rate                                               
1.9 deaths/10,000/day
2.89 deaths/10,000/day
Crude mortality rate
0.88 deaths/10,000/day
0.86 deaths/10,000/day

1 INTRODUCTION

Sool plateau of Sool & Sanag regions (surveyed)Sool plateau

Food Economy Zones

Coastal Deeh: Sheep
East Golis Pastoral: Frankinncense
Gebi Valley Pastoral: Frankinsence, sheep and goats
Kakaar-Dharor Pastoral: Sheep, goats, camel
Nugal Valley Pastoral: Sheep & camel
Sool plateau
BARI REGION

The plateau has experienced more than four years of a chronic drought situation that led to severe pasture depletion, water scarcity, cumulative degradation of rangeland with little potential for recovery and regeneration. All these culminated in massive livestock deaths including pack camels towards the end of the year 2003. This negatively affected the migration options for poor and middle pastoral groups. Overall, the pastoralists have lost large herds of livestock including pack camels. Nutrition and food security data from the area have persistently shown a poor situation in wellbeing of the population.

1.1 Survey Justification

A nutrition survey and an inter-agency assessment were conducted in May/June 20031 and in October 2003 respectively. This led to commencement of various interventions2 in December 2003 within the Plateau. During these interventions, nutritional screening of children has been undertaken using weight for height, revealing high levels of malnutrition. Since December 2003 FSAU has undertaken three rounds of sentinel sites data collection in the Sool Plateau of Sool and Sanaag regions which has revealed a gradual improvement in the under fives nutritional status from around 19% to 15% of those screened. In contrast, the nutrition status for mothers was seen to deteriorate from 17% in December 2003 to 33% in April 2004. However, in view that these data (screening and sentinel sites data) are collected using different methodologies and in different locations, it is difficult to directly compare the various results. A clear understanding on the changes in nutritional status in Sool Plateau of Sanaag and Sool regions since the last nutrition survey lacks, hence the need for the current nutrition survey.

1.2 Survey Objectives

1. To determine the levels of malnutrition in Sool Plateau of Sanaag and Sool regions through anthropometric measurements using weight for weight of children aged 6 - 59 months or 65 - 110 cm tall.
2. To describe factors influencing the nutrition status of children in Sool Plateau of Sanaag and Sool regions in relation to care practices, food security, health, water and sanitation situation.
3. To determine the coverage of measles vaccination and Vitamin A supplementation in Sool Plateau of Sanaag and Sool regions.
4. To determine the incidence of diarrhoea, measles and ARI two weeks prior to the survey.
5. To determine the extent of vitamin A deficiency in the survey area
6. To determine the levels of malnutrition among adult women using Mid Upper Arm Circumference.
7. To determine any changes in the nutritional status in Sool Plateau of Sanaag and Sool regions since the previous nutrition survey in May/June 2003.

2 BACKGROUND INFORMATION

2.1 General background

Sool plateau in an ecosystem mainly inhabited by pastoralists. The plateau covers three regions in northern Somalia: Sanaag, Sool and Bari Regions. The current nutrition survey was conducted in the same areas covered during the May/June 2003 nutrition survey i.e. in the part of Sool plateau covering Sanaag and Sool Regions. This is also the largest part of the plateau. The estimated population size of the survey area was about 69,550 (WHO population estimates, revised in June 2004 by survey team). The population of the plateau are mainly pastoralists most whom live the nomadic lifestyle and keeping camels, goats, sheep and cattle with insignificant agro-pastoral inhabitants. The surveyed part of the plateau has had recurrent political tensions being claimed by both the Somaliland and Puntland governments.

2.2 Food security overview

The Sool plateau is predominantly a pastoral community (accounting for 85-90% of the population) who keep camel, cattle, sheep and goats. The remaining 10-15% live in urban areas. The area used to be good grazing area and could sustain a high livestock population. Traditionally, the area was used only as a wet season grazing area, though with increased numbers of livestock over the last two decades, the area has been converted into an all year grazing area. This and the prevailing drought situation has resulted to severe degradation of rangeland.

Pastoralism is the main source of livelihood for the population of Sool plateau. The sales of livestock and livestock products (milk, ghee and skins) provide the main income sources, out of which households purchase food and non- food items. In a normal year, the sales of livestock and livestock products contribute 60-70% of the poor household's income in a year. The rest of the income comes from self employment activities such as collection and sale of bush products, employment and gifts. The plateau has had four successive years of poor rains since 2000 resulting in severe pasture depletion and water scarcity, high livestock deaths that has seriously affected people's livelihood. Consequently, people have resorted to distress means of living. Over the years, the economic situation of the plateau has exacerbated by huge expenditure burden incurred by costly water trucking schemes for both human and livestock consumption. The cumulative impact of all these negative indicators caused the pastoral livelihood to collapse. Destitution is on the rise within the plateau. The community is now highly dependant on both formal and informal support for survival. This includes clan or kin based donations in kind or cash, food distribution by religious groups and interventions from the humanitarian community.

The main water sources within the plateau include berkads, water catchments (balleys, open wells and ponds) mainly following a wet season and boreholes. Most of the boreholes yield hard water limiting its use especially for domestic purposes. Berkads are highly prone to microbial contamination owing to the mode of water harvesting as well as handling of the same during collection for consumption purposes. The table below summarises key events that have affected food security in the plateau.

Table 2:.Chronology of events affecting food security in the Sool plateau of Sool and Sanaag 2001 - 2004
Period
Event

Dec,2001: Below normal Deyr rains. Large number of livestock migrated to Nugal valley, difficult to sell livestock due to poor body condition, poor prices in local and export markets. Jan - March 2002:
Worsening situation. Berkads and Balleys dry and water prices go up. Camels migrate to the Hawd area south of Sool region some of the family members remain with the small livestock. Terms of trade for pastoral households worsen. 20-30% mortality rate of shoats. Poor households.
April - June 2002
Poor Gu rains sporadic and poor distribution with strong Hagay winds causing early drying up of pasture and water sources. High mortality and abortions. Jul- Aug 2002
Majority of poor households becoming increasingly vulnerable to the high costs of commodities. Changes in consumption patterns, By August water prices go up putting more strain on the already weakened purchasing power. Milk production has fallen to 50% of the baseline. By august 25,000 people estimated to food insecure. Sept- Dec 2002
Sool plateau of eastern Sanaag received significant Deyr rains in the first week improving water and pasture availability, though livestock production is far below normal. Pasture improvement though parts of the plateau that cover Huddun and Taleh Districts continue to be of concern. By November Berkads replenished but pasture regeneration not adequate. Extensive out migration of camel herds and 20-30 % from the rain deficit areas to upper Nugal valley and the Hawd where the rains were good. By December the pastoralists were still experiencing the cumulative effects of several consecutive poor rainy seasons. Jan- March 2003
Reduced camel calving rate due to the effect of drought. Milk prices higher than normal by 30% due to low milk production. Terms of trade favourable due to increased demand at both local and export market but livestock still in poor body condition. Widespread depletion of natural resources. Water points pressured by the high concentration of livestock. Abnormal migration of livestock mainly in Eastern Sanaag. A drum of water costing $2 compared to $1.50 during the same period in 2002. Main expenditure for families water and food. The poor pastoralists and the lower strata of the middle wealth group have limited access to daily food intakes. Cash and assets drawn down on the cost of the high water prices. Persistent drought of three years has decreased the number of animals in their herds and lessened the ability to cope with the long dry spell.

Meanwhile the middle and the better off wealth groups were able to transport their livestock and households to where they could find water.

April - June 2003: Parts of Sool plateau received heavy rains in April. Some rains received in May but the cumulative number of rainy days was below normal. Poor and middle pastoralists who did not move out of the plateau were finding it increasingly difficult to obtain sufficient cash to buy food having lost up to 60% of their income. With virtually no income from milk sales which used to provide approximately 40% of household's income and the rest coming from livestock sales and now has reduced by 50%. By June 3,500 households facing 25-35 % of their energy requirements.

July- Sept 2003: Food security situation reached an alarming stage. The pastoralist lost their assets and many in the middle wealth group slipping to the poor or very poor wealth groups and a danger of others becoming destitute. High water prices continue, sale of breeding animals, normal coping strategies almost being exhausted. Reduction of number of meals from three to one per day. Poor and middle wealth groups sold their breeding and pack animals. Drastic cut in asset holdings among all wealth groups, 80 % of the camels and more than 50% of the shoats on the plateau have been sold, moved out or died. As a result of complete failure of Gu rains water trucking continued. Terms of Trade were still favourable but the number of animals in good marketable condition was minimal. Animals that had moved out of the plateau were in good body condition and those that remained behind were of below normal body condition.

Oct-2003: Multi-agency assessment revealed that cumulative losses (mortalities and distress sales) over the past years greatly reduced herds and altered herd composition. Camel losses were 60-70 % with even higher losses of pack animals of over 80% and shoats 40-50%. Drop in reproduction rates thus 60-70 % drop in income from livestock sales thus drastically reducing the purchasing power. Terms of trade poor, in a normal year one shoat is exchanged for a 50kg bag of rice but had now changed to 2 - 3 shoats per 50kg bag of rice.

Dec 2003: Some showers of rain received in the western border of Sool plateau towards the upper Nugal valley. Prior to these rains the pastoralists of Sool plateau of Sanaag had made the longest ever out migration to Sool plateau of Bari and coastal grazing area, while the others moved towards the Sool plateau of Sool region. The huge migration exceeded the rangeland carrying capacity and limited the possibility of pasture regeneration. Emergency interventions by the humanitarian community commenced in the plateau.

Jan -March 2004: The area still remains under emergency situation.

April - 2004: Some rains in Taleh and Sarmanyo villages from third week of march. These attracted livestock from the Sool of Sanaag. Sool plateau remain in a state of humanitarian emergency.

2.3 Humanitarian operations in Sool plateau

2.3.1 Development Activities

International agencies operating in the region include CEFA and CINS that are involved in agriculture, fisheries, rehabilitation of social services etc. CARE international and COOPI are also based in Erigavo and are involved in emergency humanitarian interventions. Horn relief is involved in pastoral issues, ILO in rehabilitation of basic infrastructure and NPA in both water sources rehabilitation and health issues. SRCS is also providing health services. Local NGOs like Havoyoco undertake water point's rehabilitation. UNICEF, MOHL, WHO and WFP are also involved in humanitarian interventions in the plateau.

Following the May/June 2003 nutrition survey and Interagency assessment in October 2003, several humanitarian interventions have been implemented in the Sool Plateau since November 2003. Table 3 below provides a summary of these humanitarian responses and agencies involved.

Table 3: Summary of humanitarian interventions in the Sool Plateau of Sool and Sanaag Regions including other parts of the regions.

Intervention..............Agency

- Free food distribution: WFP, PENHA, Islamic religious groups, Diaspora community and Business communities in Hargeisa and Burao
- Health related interventions: UNICEF, MOHL, WHO
- Water and sanitation related interventions: NPA, UNICEF, COOPI and Horn Relief
- Livestock interventions: COOPI, Candlelight
- Cash related interventions: UN-OCHA, Horn Relief, NPA and CARE

Free Food distribution

WFP has undertaken three rounds of free food distribution in Sool and Sanaag Regions targeting families of malnourished children identified through the screening process, as well as destitute families in settled communities in Eastern Sanaag. Each targeted family receives 50kg of maize,

5kg pulses and 2.3kg of oil during each round of distribution. About 1496 MT of food have been distributed with much of it going to locations within the plateau. In the first round undertaken in December 2003, 388 MT of food benefited 6846 households. In the second (February 2004) and third (April 2004) rounds, 475 MT and 632 MT were distributed respectively.

In April, 2004 PENHA, a local NGO undertook free food distribution in 29 locations in Sanaag region hence covering parts of the plateau. A total of 107.1 MT of food consisting of rice, sugar and vegetable oil were distributed. Islamic religious groups, Somalis in Diaspora Hargeisa and Burao business communities had also contributed foods for the population in the plateau. Between December 2003 and January 2004, Candlelight (a local NGO relocated about 180 families in Sool Plateau and Lower Nugal plus their livestock, to areas that had received some rains in addition to providing each of these families with some food consisting of rice, wheat flour, sugar and vegetable oil.

Health related interventions

UNICEF in collaboration with MOHL and WHO have undertaken three rounds of health related interventions in the plateau which included provision of vitamin A and iron/folic acid supplementation to children and pregnant women respectively, provision of antenatal care services, provision of supplementary food to all malnourished children identified during the screening process, immunisation of under five children against the immunisable childhood diseases, treatment of common illnesses on an out patient basis and provision of health and nutrition education on child feeding and environmental hygiene.

During the first round, 62 villages in the Plateau were covered. A total of 6,890 under-five year old children were screened, 18.9% based on <80% median or oedema were malnourished. In the second round, 7035 were screened with 16.3% being malnourished while in the third round 7144 under fives were screened and 21% were malnourished. All malnourished children received supplementary food in addition to their households receiving food from WFP. At the time of survey, the fourth round of interventions was underway.

Water and sanitation related interventions

Through its pastoralist livelihood emergency programme, COOPI is rehabilitating wells mainly in the western side of the plateau. The majority of the water facilities have been either non-functional or functioning at low capacity. An assessment carried out by COOPI showed that availability of water was the basis for establishment of the various settlements. Key problems related to water and sanitation identified were user practices that lead to water contamination and lack of infrastructure for watering the livestock. Within the plateau COOPI has plans to access water to about 5000 households by rehabilitating existing water sources. The project is also creating awareness on the link between water contamination and water related diseases.

Between November 2003 and March 2004, Horn Relief in partnership with UNICEF rehabilitated thirty three wells in Eastern Sanaag targeting 15,000 direct beneficiaries. In January 2004 both agencies also distributed 600 jerry cans and 7 bladder tanks to 600 highly vulnerable pastoralists in Xingalool; Baragaha Qol; Shimbiralle and Ballibusle in Sanaag Region. Additionally, for 13 days in November 2003, Horn Relief with funding from CARE implemented the 'Subsidizing of Fuel for Water Trucking in Eastern Sanaag' project through which 14 litres of water per day was distributed to several vulnerable pastoral households and their livestock. Subsequently, from March to May 2004, Horn Relief in partnership with VSF Suisse subsidized fuel for water truckers in 10 water collection points in villages in Eastern Sanaag Region. NPA was also involved in rehabilitation of water facilities (shallow wells and boreholes) and water trucking. PENHA contributed to water provision through water trucking in Habarshiro and Balibusle.

Livestock related interventions

Since March 2004, COOPI has been implementing a Pastoralists Livelihood Emergency Assistance programme that aims at reducing diseases or parasites among the livestock that have survived the drought. The interventions include deworming, tick control and mass treatment of livestock. The interventions are implemented in areas with high concentration of livestock. At the time of the survey these activities had been implemented in Awbogays and Garadag in Sanaag and similar work had just started in Lasanood (Kalabadh, Yagoori and Sukiria). The programme targets to treat 350,000 livestock and at the time of the survey a total of 80,000 had been treated for 2,000 families. Notable though, is that of the locations covered at the time of survey, only Awbogays is within the Sool Plateau of Sool and Sanaag Regions.

Cash related interventions

Between December 2003 and February 2004, Horn Relief with funding from NOVIB and in partnership with NPA and UN-OCHA, carried out the free cash distribution. A total of US $50 cash grants were distributed to 13,830 vulnerable households in the Gebi Valley and Sool Plateau of Sool and Sanaag regions covering Badhan, Dhahar, Erigavo, Taleex and Hudun Districts. CARE has also undertaken cash for work activities.

2.3.2 Health

The Ministry of Health and Labour, Somaliland with support from UNICEF has continued to support healthcare provision in the area. Currently there are two operational MCHs (Ceel Afwein and Dhahar) and 11 health posts. There are however plans by ministry of health and labour and UNICEF to upgrade Xingalool health post to an MCH. Awrbogeys and Daraweyne have also been recommended to be upgraded. The MCHs are managed by auxiliary nurses who have been trained on the job while the health posts are managed by community health workers who operate a basic kit for treatment of minor ailments. Traditional birth attendants provide antenatal and post natal care. Although not located within the plateau, Erigavo MCH supported by SRCS also benefits populations from the plateau.

The Minimum Essential health Service Package offered in MCH/OPDs includes antenatal care and postnatal services, under five clinics, OPD clinics, immunization services and preventive and promotive services. The health posts offer treatment of small ailments.

2.3.3 Morbidity

Malaria, diarrhoea, respiratory tract infections and anaemia are among the common diseases reported in the livelihood zone.

2.4 Water and environmental sanitation

There is extensive contamination of surface supplies and dug wells. Most have no proper fencing and covers hence are liable to extensive contamination. This is due to unhygienic drawing of water, lack of treatment processes for drinking water and poor understanding of the health risks associated with contaminated water. Additionally, most households have no latrines with open defecation being the only means of disposal for human waste. 15

2.5 Previous nutrition information in Sool Plateau - 2002 to date Nutrition data in the Sool Plateau indicates a poor nutritional status. With reference to sentinel sites surveillance data, the nutritional status of children has improved while that of mothers seems to have deteriorated from 17% malnourished in November/December 2003 to 33% in April 2004. Table 4 presents a summary of the nutrition information among underfives. For more details on the areas covered by each of the presented data, see appendix 6.

Table 4: Summary of the nutrition information among underfives in the Sool plateau of Sool and Sanaag Regions

Date Data type Agency

< -2z-score or oedema
<-3z-score or oedema
<80% ofmedian or oedema
<70% of median or oedema
MUAC <12 .5 cm or oedema.
<11cm or oedema.
- July 2002 - Rapid assessment, FSAU, 6.3, 0.4
- May/June 2003: Nutrition survey, FSAU/UNICEF/MOHL/SRCS - 12.5%, 1.8%
- July 2003: Health facilities - MOHL, 15%
- October 2003: Interagency assessment - UNICEF/FSAU/WFP/OCHA/Horn Relief/NPA, 6%
- November 2003 - Rapid assessment - FSAU/MOHL/Horn Relief - 13.7% 3.5%
- November/December 2003 - 1st round of sentinel sites surveillance - FSAU - 18.9% 3.8%
- December 2003 - 1st Round ofinterventions screening - UNICEF/WHO/MOHL - 18.9%
- December 2003 - Rapid assessment - UNICEF/FSAU/WHO - 27% 5.8%
- January 2004 - 2nd round of sentinel sites surveillance - FSAU - 21% 5.7%
- February 2004 - 2nd round interventions screening - UNICEF/WHO/MOHL - 23.8%, 2.1%
- March 2004 - 3rd round interventions screening UNICEF/WHO/MOHL 21% 1.1%,
- April 2004- 3rd round of sentinel sites surveillance FSAU 15% 1.9%

3 METHODOLOGY

3.1 Survey Design

The study was both descriptive and analytical in nature. Cross -sectional data was collected through a standard household questionnaire for nutrition (see appendix 2) Retrospective mortality data for the past 90 days prior to the survey was also collected among the study households (see appendix 4). Qualitative data was collected by survey supervisors and coordinators through focus group discussions and key informant interviews to provide further understanding of the underlying causes of malnutrition.

3.2 The sampling procedure

Using a two-stage cluster sampling methodology, 30 clusters were randomly selected based on population proportional basis from Sool plateau of Sool and Sanaag Regions. Initially a sampling frame was constructed from which a representative sample could be drawn. A list of all villages within the Plateau, with their respective populations was used to construct cumulative population figures for the plateau. At the time of the survey, pastoralists were in the process of migrating into areas where rains had been received within the plateau or outskirts of the Plateau. With help of the survey team who comprised people from within the plateau or had recently travelled in the area, all these locations were included in the sampling frame hence giving these pastoralists an equal chance of being sampled for the survey. The population estimate figures were initially received from WHO and further verified for authenticity by the survey team. An estimated population of 69,550 was used from which a cluster interval of 2,318 was calculated. Using currency numbers on a bunch of Somali notes a random number, 2308 was chosen within the cluster interval to determine the first cluster. The subsequent clusters were determined systematically by adding the cluster interval (2,318) to the first randomly selected number (see appendix 1). Due to insecurity in one of the randomly selected cluster/village, replacement was done with the nearest accessible village inhabited by population with similar basic characteristics with the selected village. From the 30 randomly selected clusters, a total of 913 children between the heights/length of 65 and 110cm and 6-59 months old were randomly surveyed. However, insufficient information on some children and extreme measurements led to the dropping off of 12 children at analysis. Thus only 901 were included in the analysis of child data.

In each of the clusters, mortality questionnaires were exercised to 30 households. Same sampling frame was used in cluster selection hence the same clusters selected for the nutrition data were also used for the mortality data. In total, mortality data was collected from 905 households irrespective of whether with an under-five or not (see section 3.2.1 for details of household selection).

3.2.1 Study population and sampling criteria

The study population consisted of people living in the Sool Plateau and comprised all the children aged 6-59 months or measuring 65-110 cm for height/length. On the visit to each cluster, the centre was identified and a pen was spun to determine the direction to follow in the selection of the households with children aged 6 to 59 months. The total number of the households from the centre to the end was established and given numbers to enable random selection of the first household with a child of the required age or height. From the first household with a child aged 6-59 months, the same direction was followed to get the next household. On reaching the edge of the cluster the right-hand direction (clockwise direction) was followed until details of 30 children were collected from that cluster. If a cluster was exhausted of children before the required 30 children had been reached, a neighbouring area was randomly selected. All eligible children in the household were measured and if a child or primary caregiver was absent, an appointment was booked for a later visit in the course of survey. If a child was in a relative or neighbour's house, the child could be called and assessed.

With reference to mortality, the data was collected retrospectively with the first questionnaire being exercised on the first randomly selected household irrespective of presence of an under-five child or not. Same direction (which has been randomly picked by spinning a pen) as indicated above was followed but unlike the survey for children where only households with children were visited for interview, the mortality questionnaire was exercised in every household in the identified direction. The survey team turned to the right side on reaching the cluster edge, until 30 households were surveyed from the cluster.

3.3 Data collection

3.3.1 Anthropometric measurements

The anthropometric data were collected using the procedure stipulated by the WHO (1995) for taking anthropometric measurements. Adherence to this procedure was ensured. The protocol used was as follows: Weight. Salter Scale with calibrations of 100g-unit was used. This was adjusted before weighing every child by setting it to zero. The female children would be lightly dressed before having the weight taken while clothes for the male children were removed. Two readings were taken for each child and the average recorded on the questionnaire.

Height. For height, a vertical or horizontal measuring board reading a maximum of 175cm and capable of measuring to 0.1cm was used to take the height or length of a child. The child would stand on the measuring board barefooted; have hands hanging loosely with feet parallel to the body, and heels, buttocks, shoulders and back of the head touching the board. The head would be held comfortably erect with the lower border of the orbit of the eye being in the same horizontal plane as the external canal of the ear. The headpiece of the measuring board was then pushed gently, crushing the hair and making contact with the top of the head. Height/length was then read to the nearest 0.1cm. Two readings were recorded and the computed average used in the analysis.

Length. For children aged 6 to 24 months or between 65cm to 84.5cm length instead of height was taken. The child was made to lie flat on the length board. The sliding piece was placed at the edge of the bare feet as the head (with crushing of the hair) touched the other end of the measuring device. Then two readings were taken and the average computed.

3.3.2 Child age determination

Difficulties were encountered in determining the exact ages of children. Useful documents like growth monitoring/clinic attendance cards, or any other viable formal card were used when available. Calendars of events (see in the appendix) were also used as proxies to accurate age determination. Though not entirely accurate, ages were still regarded as important indicators though not used for anthropometric analysis and were approximate/average pointers. The nutrition indicator employed was weight for height as interest was in the wasting status (acute malnutrition).

3.3.3 Oedema

Defined as bilateral oedema on the lower limbs detected by gently pressing the feet to check if a depression is left after at least three seconds of pressing.

3.3.4 Morbidity

Diarrhoea: Diarrhoea was defined for a child having three or more loose or watery stools per day.

Measles: A child with more than three signs of the following was considered having measles: fever, and skin rash, runny nose or red eyes, and/or mouth infection, or chest infection Acute Respiratory Infection (ARI): Asked as oof wareen or wareento. The signs asked included cough, rapid breathing and fever. Suspected malaria/acute febrile illness: The signs to be looked for are periodic chills, fever, sweating and sometimes a coma.

3.3.5 Mortality

A proxy indication of mortality was taken retrospectively to provide some idea on the health situation of the population. The mortality assessment was done concurrently with nutrition survey in which a 30 by 30 cluster sampling methodology was used. The survey methodology used for the nutrition survey was adopted with the exception that households were selected as the second sampling unit. The selection of clusters and households were the same as for nutrition survey. At least 30 households were randomly selected in each cluster and the mortality questionnaire administered to a responsible member of that household. All households within the selected cluster were eligible for inclusion in the mortality survey, whether there was under-five or not.

Households were systematically surveyed until the 30th household. Each household surveyed was asked the composition of their members in two parts; - those members less than 5 years and the total number of household members. The household was then asked how many if any of the household members had died in the last three months. The mortality questionnaire is appended in the report. A total of 905 households with and with no under-five child at the time of the survey were included in the survey.

The overall mortality was calculated by taking the total number of deaths multiplied by a factor (10,000). This was divided by the population of the surveyed households using the formulae below: MR=n/{[(n+N)+N]/2}. Where n=total number of persons reported dead in the households surveyed. N=total number of people living in those households at the time of survey.The mortality was calculated retrospectively for the past 3 months, the recall period. Mortality rates per 10,000 persons per day were obtained by dividing the figure above by 93 days that was used as the recall period. Calculation of under-five mortality rates was done using the same formulae but with a denominator of under-five children in the surveyed households.

In case a member had died, the household was asked to explain the signs and symptoms of the person before he/she died.

Mortality rates can be interpreted according to the following reference
For under-five years old children
-Under-five mortality rates >= 2 deaths/10,000/day indicate a situation of alert
-Under five mortality rate >=4 deaths/10,000 children/day indicate an emergency
For the total population -Mortality rates >=1 deaths/10,000 persons/day indicate an alert situation
-Mortality rates >=2 deaths/10,000 persons/day indicate an emergency.

3.3.6 Dietary Diversity

Dietary diversity was determined by taking a simple count of various food groups consumed in a given household over the past twenty four hours. Additionally, the frequency that given members of the household (less than five or over five year olds) consumed certain food groups was also determined. The food groups considered were Cereals/staples; Beans and other pulses; Dairy and dairy products (milk); Fats/oil/Ghee; Sugars in tea and others; Meat and meat products; Eggs; Fish and sea food; Roots and tubers; Fruits; Vegetables and Beverages, spices & other products.

3.3.7 Adult Nutritional Status

Adult nutritional status was determined among mothers in households surveyed by use Mid Upper Arm Circumference (MUAC). The overall nutritional status was defined as: mothers with MUAC less than 21 cm as being malnourished while those with a MUAC equal or greater that 21 cm were of normal nutritional status

3.3.8 Vitamin A Deficiency

Vitamin A deficiency (VAD) can be assessed via clinical assessments namely night blindness, bitots spots, corneal xerosis and corneal ulceration; biochemical or dietary assessments. During the survey, VAD was assessed if any members of a household suffered from night blindness.

3.3.9 Consumption Coping Strategies

Consumption coping strategy was determined and calculated as per The Coping Strategies Index Field methods manual by CARE and WFP. Respondents were asked to identify how many times a given coping strategy had been in the past 30 days prior to survey.

3.4 Description of survey activities

Table 5: Chronology of activities for the Sool plateau nutrition survey

Major Activity

Dates. 2004: Preparation of tools, methodology & review of secondary data (Nairobi)
17th - 25th May: Training of enumerators and pre-testing (Erigavo, Sanaag)
29th - 31st May: Cluster Identification
2nd June: Collection of data
3rd - 8th June: Entry of data
9th - 11th June: Preliminary analysis
7th - 9th July: Presentation of preliminary results
21st July: Report writing
12th - 31st July: Circulation of report
31st July

Six teams consisting of two enumerators and one supervisor conducted the survey with each team handling one cluster in a day. An elder from a particular village/cluster assisted the teams in identification of the cluster and its centre. Supervisors were seconded from the participating partners namely; MOHL, SRCS, and FSAU. Overall support, supervision and co-ordination was done by two FSAU nutritionists, one UNICEF nutrition officer and 1 MOHL national PHC coordinator. MOHL staff and FSAU nutrition monitor in the region assisted in the identification of the qualified enumerators who were selected on the basis of their experience with previous nutrition surveys and UNICEF multi-indicator cluster surveys.

3.5 Quality control procedures

A comprehensive training of enumerators and supervisors was conducted covering interview techniques, sampling procedure, inclusion and exclusion criteria, sources of errors taking of measurements, standardising the questions in the questionnaire, levels of precision required in measurements, diagnosis of oedema, verification of deaths within households, handling of equipment, interview techniques and the general courtesy during the survey.

Rigorous standardisation of measurement and pre-testing of the questionnaire and equipment was carried out in a village in the outskirts of Hargeisa town (training of survey team was undertaken in Hargeisa). Standardisation involved taking repeated measurement of 10 children from an MCH by all the teams and comparing with some reference. Pre-testing also involved familiarising survey teams with village/cluster entry; administering the questionnaire, sampling procedure, correct taking of measurements and documentation. After the field exercise, views were exchanged to address the difficulties identified, appropriateness of the questions reviewed and necessary changes were made.

Quality of data was also ensured through (i) close monitoring of fieldwork by FSAU team led by two nutritionists, UNICEF nutrition officer and national MOHL PHC coordinator, (ii) crosschecking of filled questionnaires on daily basis and (iii) daily review undertaken with the enumerators to address any difficulties encountered, (iv) progress evaluation was carried out according to the time schedule and progress reports shared with partners on regular basis, (v) continuous data cleaning after entry in the field that made it easy to detect any outliers/ mistakes and to replace or repeat households depending on magnitude of error and (vi) monitoring accuracy of equipment (weighing scales) by regularly measuring objects of known weights.

3.6 Data analysis

3.6.1 Entry, cleaning, processing and analysis

Data was entered and analysed using EPIINFO computer based package. Running and tabulating all variable frequencies was carried out as part of data cleaning. The EPINUT programme was used to convert the measurements (weight and height) into nutritional indicators and comparison made with the National Centre for Health Statistics (NCHS) references as designed by WHO (1983). Analysis of certain variables e.g. total food groups consumed and the total losses in livestock ownership was undertaken in Microsoft Excel.

3.6.2 General characteristics of study population

Frequencies and cross-tabulations were used to give percentages, means and standard deviations in the descriptive analysis and presentation of general household and child characteristics.

3.6.3 Creation of nutritional status indices

The anthropometric measurement of weight and weight were used to compute the W/H nutritional status indicators of the studied children. Weight For Height (W/H) expressed the weight of the child as a percentage of the expected weight for the standard child of that height as given by NCHS. WFH measures acute malnutrition or wasting. Using EPINUT Z-scores were generated and the anthropometric indicator, WFH, was used to classify children into categories of nutritional status as follows:

< -3 Z-Scores or oedema = Severe acute malnutrition
-3 Z-Scores =WFH< -2 Z-Scores = Moderate acute malnutrition
<-2 Z-score or oedema = Global/total acute malnutrition
= -2Z-Scores = Normal

4 SURVEY RESULTS

4.1 Household characteristics of study population The nutrition survey covered a total of 457 households with a mean household size of 7.38 SD= 2.88 persons. Male headed households comprised 67.6% while the rest are female-headed households (32.4%). The mean number of the under fives per household was 1.9 per household.

Table 6: Household characteristics. Omitted.

4.2 Livelihood, Assets Ownership and Coping Strategies

Most of the households relied on self employment or petty trade as a means of livelihood (50%), 36.7% pastoral, 8.7% casual labour, 3.9% depend on relatives for assistance while the rest lacked a definite means of livelihood or relied on external assistance for example food aid. Within the Sool Plateau livelihood zone pastoralism would normally be the main means of livelihood but with the chronic drought situation, the pastoralists have lost most of their livestock while the remaining livestock have poor body condition hence fetching poor market prices.

Table 7: Distribution of households by means of livelihood, Assets Ownership and consumption coping strategies

Of the 276 households that owned shoats in the past three years to the survey, about 68% had lost between 50% and 99% of the shoats while about 19% had lost all the shoats. Only 3.2% had their shoats increase over the same period. Similarly, of the 206 households that owned camels three months prior to the survey, about a half had lost between 50% and 99% of the camels while about 40% had lost all their camels at the time of survey. Only 2.4% of the households had their camels increase over the same period.

All surveyed households reported to have employed at least one or more of the consumption coping strategies. Borrowing of food from relatives, reliance on credit and switching from high quality to low quality foods are some of the coping strategies employed by more than half the households in Sool plateau of Sool and Sanaag Regions.

Livelihood means (N=457) 
                                                   N      %
Self employment/Petty trade                        229    50.1
Pastoral                                           168     36.7
Casual labour                                      40      8.7
Depend on relatives                                14     3.9
No specific livelihood or rely on                  7      1.5
external assistance .e.g. Food aid

Assets Ownership
Change in shoats owned in past 3 years (N = 276)  
Gained shoats                                       9   3.2
Lost <50%                                           27  9.8
Lost between 50% to 99%                             188 68.1
Lost all shoats (100%)                              52  18.8


Change in camels owned in past 3 years (N = 206)
Gained camels                                       5    2.4
Lost <50%                                           15   7.3                                      
Lost between 50% to 99%                             104  50.5 
Lost all camels (100%)                              82   39.8

Consumption coping strategies (N=457)

- Switch from high quality to low quality less      231   50.5
  expensive foods
- Borrow food or rely on help from relatives        274  60
- Purchase food on credit                           264   57.8
- Gather wild food or hunt                          54   11.8
- Sell livestock at give-away price to buy staples? 194  42.5
- Send household members to eat elsewhere?          146  32
- Limit portion size at mealtimes                   293  64.1
- Restrict consumption of adults in order for small 267  58.4
  children to eat
- Ration the money you had and buy prepared food    180  39.4
- Reduce number of meals eaten in a day             293  64.1
- Skip entire days without eating                   194  42.5
- Deplete assets to get food, i.e. sell livestock,  69   15.1
  land, jewellery, etc)

As shown on table 8 below, at the time of survey, majority of the households were relying on water from unprotected well/spring (about 59%), while about 32% were depending on rain water from catchments for their drinking or cooking and personal hygiene. Collectively, about 8% and 9% were obtaining water from boreholes, berkads, and public taps for drinking and cooking /personal hygiene respectively.

Table 8: Water access, sanitation and health seeking behaviour About 57% of the households were travelling over five kilometres in search of water. Most of the households in the survey area use more than 15 litres of water daily.

Latrine use in the survey area is quite low. Collectively about 12.9% of the population reported using improved pit latrines or traditional pit latrines. Majority (87%) disposed faecal waste on the open ground/ in the bush. Personal and food hygiene was also low, almost half 48.7% were not always washing their hands before eating or during food preparation.

Water access                             N    (%)
Main source of drinking water (n=457):
Boreholes                               29    6.3
Berkads                                 6     1.3
Rain water from catchments or ponds     148   32.4
Unprotected well/spring                 272   59.5
Public tap                              2     0.4

Main source of cooking water and 
personal  hygiene (n=457):

Boreholes                              30    6.6
Berkads                                10    2.2
Rain water from catchments or ponds    147   32.2
Unprotected well/spring                268   58.6
Public tap                             2     0.4

Distance to the nearest water point: 
(n=457)
0 - 500 metres                         49    10.7
501 - 1000 metres                      73    16
1001 - 5000 metres                     77    16.8
>5000 metres                           258   56.5

Amount of water used in the household 
per day
More than 15 litres                    344   75.3
11-15 litres                           58    12.7
6-10 litres                            36    7.9
less than 6 litres                     19    4.2

Sanitation and hygiene
Sanitation facility (n=457):
Improved/ventilated pit latrine        15    3.3
Traditional pit latrine                44    9.6
Bush/open grounds                      398  87.1

Wash hands after defecation (n=457)
Always                                 234   51.2
Often                                  113   24.7
Sometimes                              45    9.8
Hardly rarely                          65   14.3

Wash hands before eating or food 
preparation: (n=457)
Always                                 234   51.2
Often                                  113   24.7
Sometimes                              45    9.8
Hardly rarely                          65    14.3

Table 9: Health seeking behaviour

Majority (77%) of the households were seeking healthcare assistance when sick. They were consulting mainly private/pharmacy with almost a third consulting traditional healer and a very low proportion (5.7%) consulting public health facility. Of those not seeking health care when member of household was sick, about 66% and 34% reported that it was due to lack of health facility and money respectively.

Seek healthcare assistance when a member
 is sick (n=457):
                                       N      %
Yes                                   352    77
No                                    105    23

Reason (n=105)
No health facility in near distance   69     65.7
No money                              36     34.3

Where (n=352):
Traditional healer                    105    29.8
Private clinic/pharmacy               227    64.5
Public health facility                20     5.7

Table 10: Formal and informal support

Social support networks within Somalia are a major source of support in Somalia. At the time of survey about a quarter (24.1%) of the households had received some form of social support, three months prior to the survey. Loans were the main form of informal support received. Overall, a half (50.5%) of the households had received some form of formal support with free food distribution being the main support, reported by 37.6% of the households.

Informal support (N = 457)           N        %

Loans                                68      14.9
Gifts                                21      4.6
Remittances from abroad              19      4.2
Zakat from better off households     11      2.4
Remittances from within Somali       2       0.4

Formal support (N = 457)
Free food                            172     37.6
Free cash                            62      13.6
Supplementary food                   47      10.3
Water subsidy                        40      8.8
Cash for work                        18      3.9
Food for work                        14      3.1
Transportation of animals subsidy    3       0.7
Veterinary care                      2       0.4

Table 11: Distribution of children according to age and sex

A total of 901 children were surveyed of whom 48.6% were boys and 51.4 % were girls. The ratio of boys to girls was 0.94:1. The 901 children came from the 457 households surveyed in the Sool plateau of Sool and Sanaag Regions.

                 Boys          Girls        Total
                 N    %       n   %       N    %

6-11 months      41   47.7    45   52.3   86   9.5
12-23 months     77   47.8    84   52.2   161  17.9
24-35 months     99   50.5    97   49.5   196  21.8
36-47 months     109  49.1    113   50.9  222  24.6
48-59 months     112  47.5    124  52.5   236  26.2
Total            438  48.6    463   51.4  901  100 26

Table 12: Summary of Global Acute malnutrition and Severe Acute Malnutrition

As shown on Table 7 the global acute malnutrition using W/H Z score (<-2 z-scores or oedema) was 13.7% while severe acute malnutrition (<-3 z-score or oedema) was 3.1%. Oedema cases alone accounted for 1.3%.

Malnutrition Rates
                             Proportion   No.
Global Acute Malnutrition(<-2 Z score or oedema)      13.7% (CI 11.5 - 16.1)  123
Severe Acute Malnutrition (<-3 Z score or oedema)  3.1% (CI 2.1 - 4.5)

Nutrition status categories 

                             Males   Females   Total  Proportion No.  Proportion  No.  Proportion  No.
Global acute malnutrition
(W/H<-2 z score/oedema)      8.9% (CI 6.4 - 11.9)  3918.1% (CI 14.7 - 22) 84  13.7% (CI 11.5 - 16.1)  123
Severe acute malnutrition    2.7% (CI 1.4 - 4.7) 12  3.5% (CI 2.0 - 5.6) 16 3.1% (CI 2.1 - 4.5) 28
(W/H <-3 z score/oedema) 
Oedema                       1.6(CI: 0.6-3.3) 7 1.1CI: 0.3-2.5) 5  1.3CI: 0.7- 2.3) 12

Table 14: Nutrition status using W/H z-scores or oedema according to age groups

Age groups    Severe (<-3z or oedema)   Moderate (>=-3z/<-2z)  Total malnourished (<-2z or oedema)   Normal (>-2 z and no oedema)
6-11 months   3 (10.7%)                 8 (8.4%)               11(8.9%)                               75 (9.6%)
12-23 months  10 (35.7%)                20 (21.1%)             30 (24.4%)                             131 (16.8%)
24-35 months  5 (17.9%)                 17(17.9%)              22(17.9%)                              174(22.4%)
36-47 months  4 (14.3%)                 25 (26.3%)             29 (23.6%)                             193 (24.8%)
48-59 months  6 (21.4%)                 25 (26.3%)             31(25.2%)                              205( 26.3)
Total         28 (3.1%)                 95(10.5%)              123 (13.7%)                            778(86.3%)

Table 15: Malnutrition prevalence using W/H percentage of median categories

Nutrition status categories - Males  Females  Total  Proportion  No.  Proportion No.         Proportion No.

Global acute malnutrition (W/H<80% or oedema) 5.02 (CI:3.2-7.5) 22  12.1 (CI: 9.3- 15.4) 56 8.6 (CI: 6.9- 10.7) 78

Severe acute malnutrition (W/H<70% or oedema) 2.5 (CI: 1.3-4.4) 11  2.5  (CI: 1.3- 4.5)  12  2.5 (CI: 1.6-3.8)  23

Oedema                                        1.6 (CI: 0.6-3.3)  7  1.1CI: 0.3-2.5)  5   1.3CI: 0.7- 2.3) 12

4.8 Morbidity, measles immunisation, polio vaccination and vitamin A supplementation

Table 16: Morbidity, measles immunisation, polio vaccination and vitamin A supplementation

As indicated in table 16, the incidences of ARI (23%) and diarrhoea (18%) within two weeks prior to the survey were high while malaria was relatively low (8%) within the same period. The incidence of measles among the under-five population one month prior to the survey was about 8%. Measles vaccination coverage for eligible children was fairly good (73%) based on mothers recall and 46% by card verification. This is in view of the few health facilities existing. About 70% of the children had received between 1 - 2 doses of polio while 30% had received three doses. More than half (57.8%) of the surveyed children had received Vitamin A supplementation in the last six months. About 6% the households reported problem of night blindness. Of those who had night blindness about a quarter (26%) of them were children under five while 74% were people over five years.

                                                    Number  %
Incidence of major child illnesses (n=901)
ARI                                                 206     22.9
Diarrhoea within two weeks prior to survey          160     17.8
Malaria within two weeks prior to survey            72      8.0
Measles within one month prior to the survey        72      8.0

Measles immunisation
Children receiving measles vaccination (9 - 11 months) (N=42)   25   60
Children receiving measles vaccination (12- 23 months) (N=161)  116  72
Children receiving measles vaccination (9 - 59 months) (N=857)  627  73
Verification for those vaccinated by card                       287  46

Children who have ever received Polio dose (N= 901)
One to two times                                        267     29.6
Three times                                             364     40.4
None                                                    270     30     

Vitamin A supplementation (n= 901) 
Children receiving Vitamin A supplementation in past 6 months  521   57.8 
  

Table 17: Children feeding practices

At the time of the survey, more than about a third 31.2% of the children aged between 6-24 months were breastfeeding. Of those who had been stopped from breastfeeding, about 27% had stopped breastfeeding before six months, 31% before the first year and 42% after the first year. A high proportion (93%) of the children aged 6-24 were introduced to foods other than breast milk early in life between the time of birth and the third month of life, 5% between 4 and 6 months, while only about 2% were introduced to complementary feeding at seven months and above. Collectively a high proportion (42%) of the children were fed between 1-2 times per day, about 52% three times and only about 7% were fed more than four times a day.

                                                         N     (%)
Are you breastfeeding child (age 6-24 months) (n=321):
Yes                                                      100   31.2
No                                                       221   68.8

Age when child stopped breastfeeding (n=221):
0 - 5 months                                             59    27
6 - 11 months                                            69    31
12 months or more                                        93    42

Weaning age (age 6-24 months) (n=321):
0 - 3 months                                             299   93.1
4 - 6 months                                             16    5.0
7 months or more                                         6     1.9

Feeding frequency (n=901):
Once                                                     98    10.9
2 times                                                  278   30.9
3 times                                                  465   51.6
4 or mores times                                         60    6.7

Table 18: Distribution of dietary diversity among children

As shown on the table, most (59.9%) of the children had consumed three or less food groups3 within 24 hours prior to the survey. About 40% had consumed 4 or more food groups within the same period. The range of food groups consumed was 1 - 8. Foods rich in micro-nutrients and proteins were rarely consumed. Cereals, sugars and fats were the commonly consumed food groups and were all eaten by above 73% of the children. All other food groups were eaten by less than 5% of the children with the exception of meats, pulses and dairy eaten by about 17% to 22% of the children.

No of food groups (n=901)    N      %
<= 2 food groups            179     19.9
3 food groups               361     40.1
> 4 food groups             361     40.1

Normal Nutrition Status

<= 2 food groups 10( 5.6)  22( 12.3)  147( 82.1)
3 food groups    14(3.9)   41(11.4)   306(84.8)
>=4 food groups  4(1.1)    32( 8.9)   325(90.0)
Total            28( 3.1)  95(10.5)   778(86.3)

4.11 Adult Women Malnutrition

Malnutrition rates among adults were investigated using mid upper arm circumference (MUAC) measurements of women of child bearing age (15 - 49 years). Of the 429 women assessed, 11.2% (MUAC <21 cm) malnourished.

4.12 Vitamin A deficiency

Table 20: Vitamin A deficiency

Vitamin A deficiency (VAD) as assessed by way of night blindness was prevalent in 5.9% of the population. Of the vitamin A deficient cases, about 30% were underfives while the rest were above five years of age. Consumption of vitamin A rich foods (milk, fish, vegetables, meats) was minimal as observed in dietary diversity assessment, predisposing children to vitamin A deficiency.

                                 N         %
Night blindness n= (457)  
Yes                              27       5.9
No                               430      94.1

Persons vitamin A deficient
Below 5yrs                       7       25.9
Above 5 yrs                      20      74.1


4.13 Mortality rates

A total of 901 households were surveyed for mortality indicator with a recall period of 90 days prior to the survey being used. The results were as presented below:

Mortality rates;

 For children aged 0-59 months (under-five mortality rate)

Under five population in surveyed households =1,458

Number of under five deaths =38

Under five mortality rate =2.89 deaths per 10,000 children per day

For the total population (Crude mortality rate)

Total population in surveyed households =5950

Total number of deaths in the households = 46

CMR =0.86 deaths per 10,000 persons per day


Figure 3: Causes of underfive mortality

As shown on the graph diarrhoeal diseases was the main cause of under-five mortality. Other causes of child death included pneumonia, ARI, malaria deaths at birth. causes of deaths among <5 childrenin the last 3 months0246810121416Diarrohea PneumoniaMalariaARIAneamiaMeaslesOthers Number of deaths
Injuries from gunshots, car accidents, ARI, diarrhoea and drowning were among the causes of death among persons above five years of age.


Table 21: Comparison of survey results
2003 Survey.... 2004 Survey......No %.......N %

Total children surveyed                          895  100                   901  100
Global Acute Malnutrition (<-2 Z scores/oedema)  112  12.5(CI: 10.5 - 14.9) 123  13.7(CI: 11.5 - 16.1)
Severe Acute Malnutrition (<-3 Z scores/oedema)  16   1.8CI: 1.1 - 3.0)     28   3.1(CI: 2.1 - 4.5)
Oedema                                           5    0.55(CI: 0.2 - 1.4)   12   1.3%(CI 0.7 - 2.3)
Underfive mortality rate

1.9 deaths/10000/day
2.89 deaths/10000/day
Crude mortality rate
0.88 deaths/10000/day
0.85 deaths/10000/day

ARI within two weeks prior to survey        206  22.9
Diarrhoea within two weeks prior to survey  219  24.5   160   17.8
Malaria within two weeks prior to survey    110  12.3   72    8.0
Measles one month prior to survey           33   3.7    72    8.0
Measles immunisation coverage (9-59 months) 217  26     627   73

Children receiving vitamin A supplementation six months prior to survey  427   47.7   521   57.8
Feeding Frequency of children excluding breastfeeding    
Once                                                    12    1.3    98     10.9 
2 times                                                 138   55.7   278    30.9                     
3 times                                                 495   60     565    51.6
4 or more times                                         244   27.4   60     6.7      




The difference in the levels of global acute malnutrition in both surveys is not statistically significant although the rates remain higher than those seen in similar communities in the country. With the exception of measles, overall morbidity had decreased while vitamin A supplementation had increased. Under five mortality rate had increased to the alert level.


4.14 Relationship between malnutrition and other factors

The risk factors that had a significant association with malnutrition was child sex, malaria and dietary diversity.

Table 22: Risk factors and relation to total malnutrition

Children with malaria were more likely to be malnourished compared to those not suffering from malaria in the last two weeks prior to the survey. Girls were two times more likely to be malnourished than boys. Additionally, children who ate three or less food groups were 1.6 times more likely to be malnourished than their counterparts who ate four or more food groups.

Further analysis revealed no statistical significant association between malnutrition and household head sex, sanitary facility, child's age group, diarrhoea, measles, vitamin A supplementation, ARI and breastfeeding.

Exposure variable
                           N    (%)   Crude RR    95% CI  p-value   
                 
Household head sex                                       
Male                      86      13.4    0.95    0.66    0.85
Female                    37      14.2     -      1.36     -                        
                          
Sanitary facility: 
Pit latrine/flush toilet   12     10     0.7      0.4     0.26
Bush/open ground           111    14.2    -       1.24     -                            

Child sex:                 
Male                       39     8.9     2.04    1.43    0.000
Female                     84     18.1     -      2.91

Age group: 
6-23                       41     16.6    1.32    0.94    0.14
24-59                      82     12.5    -       1.87     - 

Diarrhoea:
Yes                        30     18.8    1.49    1.03     - 
No                         93     12.6    -       2.17    0.05

Malaria:
Yes                        16     22.2     -      1.08      - 
No                         107    12.9    1.72    2.75    0. 04

Measles:
Yes                        14     19.4    1.48    0.9      - 
No                         109    13.1    -       2.44    0.18

Vitamin A:
Yes                         69    13.2     -      0.67     - 
No                          54    14.2    0.93    1.30    0.74

ARI
Yes                         34    16.5    1.29    0.9      - 
No                          89    12.8    -       1.85    0.21

Breastfeeding
Yes                         17    17      1.21    0.7
No                          106   14      -       2.08    0.6 

Dietary diversity
< = 3 food groups           87    16.1    1.62    2.33    -
>= 4 food groups            36    10.0    1.12    32      0.011 


4.15 Qualitative information

Qualitative information was collected from focus group discussions and key informants. A total of six focus group discussions were held, four with mothers and two with men The discussions were centred around feeding and care practices, health care, food security, water and sanitation issues.

Care and feeding practices

Like most other parts of Somalia, breast feeding and complementary feeding was found to be sub-optimal. Majority of the mothers give water and sugar (Fax) within a few hours after delivery and start breastfeeding within 24 - 48 hours. Reasons given for not starting breastfeeding immediately was that the mother has no milk, that the baby lacks strength to suckle, the mother has abdominal pains and breastfeeding increases bleeding. In addition to the Fax and breast feeding, the infants are introduced to goats or cows milk within the first month while other semi solid foods such as porridge are introduced between 2 and 3 months.

The most common food fed to young children is light porridge made from sorghum or maize flour with sugar and milk added. Rice with milk, sugar and ghee, oil, sphaghetti and Anjera (Somali pancake) are among other foods fed to the children. Usually children are fed four or more times a day in normal times but this had changed recently. At the time of the survey, it was revealed that there was further reduction in the number of meals among the children from the usual 3-4 to 1-2 per day in several households, while the adults were mainly having one meal per day. It was noted that children were always given priority in feeding during normal and crisis times. It was also noted that due to the reduced numbers of livestock majority had no access to milk, which usually is a key food for children. Hence children from poor families were being fed mainly on sorghum or maize porridge and occasionally rice or Anjera.

Qualitative data further revealed that when children were sick certain foods are withheld, for example if a child has diarrhoea, milk is withheld. The drought had also affected the care aspects of children in the sense that mothers spent a lot of time outside the home looking for loan, casual work or even borrowing food. Women also reported to have reduced breastfeeding their children since they also lacked enough food to feed themselves.

Food security

The Gu rains set in late were inadequate and unevenly distributed, only localised in some areas e.g. Balibusle, Baraagtaq, Elbur, Fadhigaab, Awarbogays, Gowsowyne and Sinaaro. Much more promising although still scattered rains were received during the month of May 2004 in most parts of the plateau, resulting in accumulation of water in the various water sources. Consequently, this attracted the return of most livestock from the Nugal Valley among other areas. It was observed that the impact of the drought, migration, and deteriorating purchasing power was more on poor pastoralists than on the middle and the wealthy groups since the latter can afford to migrate or truck their animals to other locations.

It was further indicated that the household level coping mechanisms have been overstretched. Some poor households have resulted to extreme coping mechanisms for example, skipping entire days without a meal. Wide-spread animal deaths or even loss of family's entire livestock were common. Remittances and social support, both from abroad and locally, are important sources of relief for pastoral families. However, loss of assets due to the prolonged drought has made it increasingly difficult for the normal social institutions to cope with the magnitude of problems being experienced in the area


Health related issues

The most common diseases among children reported at the time of the survey were ARI, diarrhoea and malaria. There were also reports of some cases of measles. Although health posts are available the community felt that the Community Health Workers did not have adequate skills to provide quality health care. .Additionally the focus group discussions revealed that residents of some of the villages have to walk approximately 20-30kms to reach the nearest health facility. The heath facilities are unevenly distributed hence limiting their use.


5 DISCUSSION

5.1 Food security situation: Livelihood means, Assets ownership and Coping mechanisms

In Sool plateau the sale of livestock and livestock products (milk, ghee and skins) provide the main income sources, out of which households purchase food and non- food items. In view that there have been significant losses of livestock (about 90% of the pastoralists have lost 50% or more if not all their camels and about 87% have lost 50% or more if not all of their shoats over a three years period) pastoralists have continued to experience difficulties in accessing food since the last survey in May 2003. Livestock production (milk) is negligible. Furthermore, minimal milk is available for household consumption which is particularly important for children. According to the interagency assessment in October 2003, camels failed to conceive during the last Gu 2003 season (the breeding male didn't rut and females were weak). The next conception opportunity was expected in Gu 2004 which means the first offspring (if conception is successful) will be born in Gu 2005, and there will be limited camel milk available for sale or consumption until then. Recovery from the livestock losses to a normal situation will take time as the majority particularly the poor and middle level wealth group have depleted their assets. Similarly the livestock production will take time before going back to normal as currently the body condition of all species is still very poor. Although food is available in the market the majority reported that it was not readily accessible due to reduced purchasing power.

Pastoralism is usually the main means of livelihood for majority of the population in the plateau. The survey findings shown that self employment or petty trade was the main means of livelihood for about 50% while pastoralism was reported by about 37%. This indicates a shift in the peoples way of life and can be attributed to the significant livestock losses. The forms of petty trade that the population engaged in include charcoal trade, tea shops and sale of firewood. Qualitative data reported that the plateau population are currently surviving. All the surveyed households were employing at least one or more of known coping mechanisms with at least 55% or more resorting to purchasing food on credit, borrowing or relying on relatives or reducing the number of meals eaten in a day. The fact that a high proportion was purchasing food on credit or borrowing has increased the debt burden of the people and repayment may be difficult since they have already lost virtually all their assets. Even with a normal Deyr season it still remains difficult for the population to recover.

5.2 Interventions

Substantial interventions both informal and formal have been implemented in Sool and Sanaag regions since December 2003. The coverage of these interventions not only includes the plateau but also other parts like Nugal valley and Gebi valley livelihood zones as described in section 2.3. However, the nutrition survey only covered the Sool plateau livelihood zone. About half of the surveyed population had benefited from one or more of the formal interventions while about 24% had received some form of informal support three months prior to the survey. Social support networks have played a key role in maintaining the Sool plateau population but as more people continue losing assets, it is becoming increasingly difficult for keens to adequately support each other. Overall, the ongoing interventions have gone a long way in preventing deterioration of the situation in the Plateau, maintaining the malnutrition levels at similar levels.


5.3 Health issues influencing nutritional status

The relationship between diseases and nutrition is well documented. Repeated attacks of diarrhoea for example are associated with poor nutrient absorption and considerable nutrient losses. The resulting nutritional deficiency causes impaired immunity and increased vulnerability to more infection resulting in a vicious cycle of infection and malnutrition.

At the time of the survey incidences of common infections among children within two weeks prior to the survey were high with diarrhoea at 18%, ARI 24%, measles 8% and malaria 8%. However the rates are lower than those observed in 2003 with the exception of measles. Malaria showed a significant relationship with malnutrition. Children with malaria were 1.72 times more likely to be malnourished than those without malaria. Diarrhoea was the leading cause of mortality among underfives. Although the majority of households sought health care when a member was sick, mainly from private clinics/pharmacies, it becomes extremely difficulty to establish the efficacy of these health provision systems. Only a minority (5.7%) sought healthcare from public health facilities. Availability of functional public health facilities is limited to two MCHs namely Dhahar and Ceel Afweyn further limiting regular access to health care services especially for the poor who may not afford the same from private facilities. The focus group discussions further revealed that the residents sought medical care for children only when the child got worse and home remedies had failed. Late treatment of diseases prolongs the diseases paves way for malnutrition.

An increase in vitamin A supplementation and measles immunisation coverage was noted which has an overall effect of enhancing the population immunity. This was attributed to the improved access to health services through the ongoing interventions during which child immunisation, treatment of diseases and vitamin A supplementation are undertaken.

5.4 Water and Sanitation

At the time of the survey only a small proportion (8%) of the population were relying on protected sources of water for drinking, the remaining majority about (92%) were obtaining drinking water from unprotected sources (rain water from catchments/ponds or unprotected well or spring). In the previous survey a higher proportion (68%) was obtaining water from protected sources either berkads or boreholes. Access to safe water has slightly decreased compared to May 2003. The high incidences of diarrhoeal diseases among children revealed in the survey are strongly attributed with the reduced availability and consumption of safe water as well as poor personal and food hygiene with a high proportion of the households not washing hands regularly before eating. Human waste disposal practices are suboptimal, about 87% use open ground or bush for a sanitation facility increasing the risks of contaminating water in unprotected sources.

5.5 Childcare care practices

WHO and UNICEF recommend that infants be exclusively breastfed at least for the first six months of life. Feeding children with foods and fluids other than breast milk during this period significantly reduces breast milk supply, and increases the risks of deaths from diseases like diarrhoea.

Overall, child feeding practices were found to be sub-optimal among children aged 6-24 months. Among children of breast feeding age, the proportion still breastfeeding reduced from 61% in the previous survey to 31%. Likewise the .proportion of those who had stopped breastfeeding was higher about 68% compared to 39 % in 2003. This can be attributed to the high demand of women's time, leaving children for long hours as they engage in casual employment and search for loans to buy food. Additionally, mothers were opting not to breastfeed their children due to lack of enough foods to feed themselves too as was noted in the focus group discussions. In addition to inadequate food the stress being experienced by mothers as they look for food may have also affected their milk production.

A high proportion (93.1%) of the children aged between 6 and 24 months were introduced to foods other than breast milk very early in life between 0-3 months. The results further indicate reduction on frequency of feeding of children. The proportion of children feeding few times per day between 1-2 times increased by more than half from about 17% in 2003 to 42%. At the same time the proportion of children feeding more than 4 times reduced, only about 7% of the children were feeding more than 4 times per day compared to 27% in 2003. Inadequate care for both mothers and children remains an underlying cause of malnutrition in the plateau.

5.6 Nutritional status

The survey results indicate persistently high malnutrition with no difference in the nutritional status of the population since the previous survey in May 2003. The global acute malnutrition rate (weight for height <-2 Z score or oedema) was 13.7 % compared to 12.5 % recorded in May 2003 survey. Severe acute malnutrition was 3.1% compared to 1.8 % in 2003 with oedema cases having increased from 5 to 12 cases. The malnutrition levels indicate a serious situation according to WHO classification of malnutrition levels of public health significance. Additionally, the rates remain higher than those seen in similar communities in the country. The level of adults malnutrition is high though since the status was not assessed in 2003, it is difficult to make comparisions. The underfive mortality rate increased to an alert level of 2.89 deaths/10000/day from 1.9 deaths/10000/day in May 2003 suggesting that the overall well being of the population is worse than it was in 2003.

The malnutrition rates by sex were statistically significant with more girls (18.1%) being malnourished than boys (p<0.05); a factor that will require further investigation. Malaria and dietary diversity both showed a statistically significant association with malnutrition. About 80% of the children were consuming three or more food groups over the past twenty four hours to survey. In order of importance, cereals, sugar and fats/oil were the main food groups consumed. The main foods given during the ongoing free food distribution in the plateau are cereals, sugar, fats/oil and pulses which are only distributed by WFP. It appears that the food distribution contributed to the dietary diversity, ultimately preventing a deterioration of the nutritional status. Limited consumption of other food groups like vegetables and fruits, which are good sources of essential micronutrients also limits accessing essential nutrients for growth. The survey indicates that vitamin A deficiency is prevalent in the area among both adults and children.


6 CONCLUSIONS AND RECOMMENDATIONS.

The nutrition situation in the plateau still remains poor. Food insecurity, poor care practices and disease tend to counter the effects of humanitarian efforts. Therefore concerted humanitarian efforts are still essential in the plateau. This will prevent a deterioration of the nutrition situation. Even with a normal Deyr 2004 season, recovery at the plateau will take time and strategies of helping the community regain their assets are essential.

Following the presentation of preliminary survey results and discussions of the same with partner agencies the following recommendations have been made.

a. Continuation of targeted food distribution in the highly vulnerable areas of the plateau for next 2-3 months assuming proper 2004 Deyr rains.

 b. Continuation of supplementary feeding programme for pregnant/lactating mothers and children under five years in the plateau also in the next 2-3 months and treatment of the severely malnourished children assuming proper 2004 Deyr rains.

c. Continued close monitoring the food security and nutrition situation in the area/intensification of surveillance activities.

d. Intensify promotive and preventive health care interventions focusing on immunisation, hygiene, and control of water related diseases. Additionally, improve access to public health facilities.

e. Promote nutrition education through the MCH/outposts focusing on breastfeeding, complementary feeding and frequency of feeding of infants and young children as well as feeding of sick children.

f. Rehabilitate run-down boreholes, berkads and dams with an aim of ensuring water availability for both human and livestock in the long run.

g. Promote alternative income generating activities through a credit programme to reduce over-reliance on livestock sources of livelihood.



Appendix 1: Sampling Frame for the Sool & Sanaag Sool Plateau Survey, June 2004
S/NO VILLAGE .... FOOD ECONOMY ZONE....ESTIMATED POPULATION ....
CUMULATIVE POPULATION.....CLUSTER NUMBER

Awr-Bogays Pastoral         5000  1,2    2
Kulaal Pastoral             1500  6500   3
Sarmaanyo Pastoral          4000  10500  3,4   4
Laso-Curdan Pastoral        1000  11500  5   
Qandhilecile Pastoral       1000  12500  5  6
Habaaloamre Pastoral        500   13000  7
Xadhan Pastoral             800   13800  8
Sufur Wayne  Pastoral       500   14300  6  9
Dhaban Pastoral             750   15050  10
Daraymadoobe Pastoral       400   15450  11
SamirGood Pastoral          700   16150  12
Xaabo Deri Pastoral         200   16350  7  13
Goof Pastoral               500   16850  14
GodCanod   Pastoral         1000  17850  15
Ceeryaan Pastoral           1000  18850  8  16
Sugbo pastoral              500   19350  17
GarabCade Pastoral          150   19500  18
Xamlika Pastoral            800   20300  19
Midhacaanyo Pastoral        500   20800  20
Fiqiga  Pastoral            1500  22300  9   21
Booda Cade Pastoral         800   23100  22
Gelisle  Pastoral           700   23800  10  23
Beer Wayso Pastoral         600   24400  24
DararWayne Pastoral         2000  26400  11 25
Dalya Pastoral              500   26900  26
Dogoble Pastoral            800   27700  27
Bohol Pastoral              1200  28500  12  28
Shoodhe Pastoral            200   28700  29
Karin Biyood Pastoral       400   29100  30
Kalshiikkh Pastoral         700   29800  31
Kurxero Pastoral            500   30300  13 32
Caadayo Pastoral            400   30700  33
Mooda Pastoral              400   31100  34
Dhanbacal Pastoral          700   31800  35
Dibqarax Pastoral           100   31900  36
BiyoGuudud Pastoral         200   32100  37
DuudCas Pastoral            300   32400  38
Ardaa Pastoral              800   33200  14 39
Arden labi Pastoral         300   33500  39 40 40
Dhabaro Pastoral            800   34300  41
LayMadh Pastoral            500   34800  15 42
Guryo San Pastoral          500   35300  43
Dhadhin Yaxy Pastoral       600   35900  44
Jed Xilood Pastoral         400   36300  45
Kulaal( Jeexa) Pastoral     700   3700   46 Cama
yulug Pastoral              500   37500  16  47
Siiga Dheer Pastoral        800   38700  48
Far Dhidar Pastoral         400   38700  49
Ceel Nimcoon Pastoral       600   39300  50
Ceel Afwayn Pastoral        5800  45100  17,18,19 51
Suuf Dheere Pastoral        800   45900  52
DanWayn/Eil Ofwayn Pastoral 900   46800  20 53
Carmale Pastoral            600   47400  54
Dhanaan Pastoral            500   47900  55
Shimbiraale Pastoral        800   48700  21  56
Dawaco Pastoral             300   49000  57
Damalehagare Pastoral       1000  50,000 58
Sibaayo Pastoral            50    50050  59
Qoyan Pastoral              500   50550  60 X
ingalool Pastoral           3000  53550  22, 23 61
Wardheer Pastoral           1000  54550  62
Baraagtagol Pastoral        1500  56050  24  63
QolofWayne Pastoral         400   56450  64
Dhahar Pastoral             6000  62450  25,26 65
Balli Basle Pastoral        1000  63450  27  66 X
aaris Pastoral              400   63850  67
Habarshile Pastoral         700   64550  68
Gooran Pastoral             200   64750  69
Maygaag Pastoral            400   65150  28  69
Kala dhac Pastoral          700   65850  70
Ceel Buh Pastoral           1800  67650  29  71
Danabbilis Pastoral         200   67850  72
Dikhsule Pastoral           500   68350  73
Durdur Pastoral             600   68350  74
Shidaleh Pastoral           600   69550  30



Cluster sampling interval 2318 and the first random number 2308
Appendix 2: Sool Plateau of Sool & Sanaag Nutrition Survey Questionnaire
Date_________________ Team Number __________ Cluster Number _________ Name of Supervisor___________
 Name of District ______________
Name of Village/Town _______________ Name of section____________ Household Number ____________ 
Name of the household head ____________________
Q1-14 Characteristics of Household
Q1 What is the sex of the household head? 1=M, 2=F
Q2 How many people live in this household (Household size)? _____________
Q3 How many children are below five years in this household (Number of < 5 years)? ____________
Q4 What is your place of permanent settlement (district and village) District: ______________ Village: ________
Q4a. What is your present household residence status? 1= residents 2=Internally displaced 3= 
Returnees 4= internal migration 5=0thers specify_________________
Q5 Where did you come from before settling in this current location? (Place of origin) __________________
Q6 How long have you lived in this current location?__________________
Q7 What was your reason for coming to this current location? (Can select more than one option if appropriate): 
1= Insecurity 2=Lack of jobs 3= 
Food shortage 4=Water shortage 5=Pasture Shortage 6=Others; specify _________________________
Q8 Does any member of the household regularly migrate with livestock? 1=Yes 2=No
Q8a If answer to Q8 is Yes, proceed to question 9
Q8b If ans to Q8 is No, when did this household stop migrating with livestock (month and year) _____________
Q8c If ans to Q8 is No, Why did this household stop migrating with livestock _______________________________
Q9 When did member(s) of this household migrate with livestock last? Month ______________ Year ____________
Q10 Where did member/members of this household migrate to? ________________
Q11 Were there any members of the household left behind? 1=Yes 2= No
Q11a If yes who? 1= Women 2= Children 3= Old people
Q12 Have those who migrated returned with livestock? 1=Yes 2=No
Q13 How did they move their livestock? 1= Truck 2=Hoof
Q14 What is the main livelihood system used by this household? 1= Pastoral 2=Settlement 
self-employment 3=Petty trade or business 4=Other (specify) ___________________
Q15-16 Livestock & Berkad Ownership:

Household Ownership

Q15: Present Number
Q16: ThreeYears Ago Number 1. Shoats, 2. Camels, 3. Berkads
Q17-27 Morbidity, feeding & immunization status of children aged 6 - 59 months (or 65 - 110cm) in the household. 
Sno, Name
Q17: Diarrhoea in last two weeks. 1= Yes - 2= No
Q18: ARI in the last two weeks. 1=Yes . 2=No
Q19: Malaria in the last two weeks. 1=Yes - 2=No
Q20: Measles in last one month. 1=Yes - 2=No
Q21: Vaccinated against measles
1=In past six months (by card)
2=In past six months (Recall)
3=Before six months (by card)
4=Before six months (Recall)
5= None
Q22: Vit. A provided in the last 6 months (Show Vit. A capsule) 1=Yes - 2=No
Q23: Are you breast feeding the child? 1=Yes 2=No
Q24: If not breast feeding, how old was the child when you stopped breast-feeding?, 1= Less than
6 months - 2= 6 - 11 months - 3=12 - 18 months - 4=18 months or more -5= Never breastfed
Q25: At what age was child given water/ foods other than breast milk
1=0-3 months
2=4-6 months
3=7 months or more.
Q26: How many times do you feed the child in a day?
1=  Once
2=  Twice
3=  3-4 times
4=  5 or more times
Q27: How many times has the child ever been given polio vaccine orally
1=1-2 times 2=3 and above 3=Never
Q28  When your child is sick, do you seek assistance? 1= Yes 2=No
Q28a If yes where do you seek assistance? 1= Traditional healer 2= Private clinic/Pharmacy 3= Public health facility 4= Other specify _________________
Q28b If No, why? __________________________________________________
Q29  Does any member of this household have difficult seeing at night or in the evening when other people do not? 1= Yes 2= No
Q29a If yes specify member 1= < 5 years 2 = > 5 years
Q30 - 36 Anthropometry for children aged 6 - 59 months (or 65 - 110cm) in the household
SNo
Name
Q30: Sex (F/M)
Q31: Age in months
Q32: Oedema (Yes/No)
Q33: Height (cm)
Q34: Weight (kg)
Q35: MUAC(cm)
Q36: Received UNIMIX in past 6 months (Yes/No)
Q37 What is the MUAC measurement of the childs mother? 
Q 39: Dietary Diversity
Twenty four-hour recall for food consumption in the households: The interviewers should establish whether the previous day was usual or normal for the households. If unusual- feasts, funerals or most members absent, then another day should be selected or alternatively choose on another household.

Food consumption and source of food, source of income for food purchases
What members of this household consumed these foods in the last 24 hours?
Beginning yesterday when people woke up, did any of these members in your household consume these foods.
1=Yes 0=No
Codes:
0=none 1= once 2= twice
3=3 times 4=4 times
5=5 or more times
Type of food
Freq. (<5yrs)
Freq->5yrs
a) Cereals/staples (rice, wheat, pasta, sorghum, maize)
b) Beans and other pulses/legumes
c) Dairy and dairy products (milk)
d) Fish/ sea foods
e) Eggs
f) Meat/offal
g) Sugar in tea and others
h) Fats/oils/ghee
i) Roots and tubers
j) Fruits
k) Vegetables
i) Beverages, spices & other products
Q38:  Consumption Coping Strategies
Relative Frequency
In the past 30 days, if there have been times when you did not have enough food or money to buy food, how often has your household had to:
All the time? Every day
Pretty often? 3-6 */week
Once in a while? 1-2 */week
Hardly at all? <1 */ week
Never
0*/week
a. Switch from high quality to low quality less expensive foods?
b. Borrow food, or rely on help from a friend or relative?
c. Purchase food on credit?
d. Gather wild food or hunt?
e. Sell livestock at give-away price to buy staples?
f. Send household members to eat elsewhere?
g. Send household members to beg?
h. Limit portion size at mealtimes?
i. Restrict consumption of adults in order for small children to eat?
j. Feed working members of HH at the expense of non-working members
k. Ration the money you had and buy prepared food?
l. Reduce number of meals eaten in a day?
m. Skip entire days without eating?
n. Deplete assets to get food, i.e. sell livestock, land, jewelry, etc)?
Q40-45 Access to water for Human Consumption (quality and quantity)
Q40 Main source of drinking water 1 = piped 2 = public tap 3 = Tube well/borehole 4= protected well or spring 5 = Rain water 6= unprotect spring and well 7= river 8= other
Q41 Main source of water for cooking and personal hygiene 1 = piped 2 = public tap 3 = Tube well/borehole 4= protected well or spring 5 = Rain water 6= unprotect spring and well 7= other
Q42 Average household water use per day per household for drinking, cooking and personal hygiene is 1= 0-2 litres 2 = 3 - 5 litres 3 = 6-10 litres 4= 11-15 litres 5= more than 15 litres
Q43 Distance to the nearest water point 1= 0-500 metres 2 = 501 - 1000 metres 3= 1001 - 5000 metres 4 = more than 5000 metres
Q44 Water and systems are maintained such that quantities of water are available 1 = never 2 = sometimes 3 = almost always 4= always
Q45 Number of clean water storage containers of 20 litres 1= 1-2 containers 2 = 3-4 containers 3 = 4-5 containers 4= more than 5 containers
Q46-50 Sanitation and Hygiene (access and quality)
Q46 Type of toilet used by most members of the household 1= Improved pit latrine 2=Traditional pit latrine 3=Open pit 4= Bucket 5=Bush 6= Other
Q47 Number of people who use the same toilet 1= 1-5 people 2= 6-10 people 3 = 11-15 4= 16 - 20 people 5= more than 20 people 6= Not applicable
Q48 Household members wash their hands after defecation 1= always 2= often 3=sometimes 4= hardly rarely
Q49 Household members wash their hands before eating or food preparation 1= always 2= often 3=sometimes 4= hardly rarely
Q50 Distance between toilet and water source 1 = 0 - 5 metres 2= 6 - 10 metres 3= 11- 20 metres 5= 21 - 29 metres 5= 30 metres or more
Q51 - 52 Formal and Informal Support or Assistance in last three months (circle all options that apply)
Q51 Informal support received in last three months 1= Yes 2=No
Q51a Amount and Frequency of each
Type of support
Frequency
Amount (Where applicable)
1=Zakat from better-off households
2=Remittances from Abroad
3=Remittances from within Somalia
4=Gifts
5=loans
9=Other (Specify) _________________________
Q52 Formal international or national aid support received in last three months 1= Yes 2=No
Q52a Amount and Frequency of each
Type of support
Frequency
Amount (Where applicable)
1= Free cash
2=free food
3=cash for work
4=food for work
5=supplementary food
6=water subsidy
7 transportation of animals subsidy
8=veterinary care
9=Other (Specify) _______________

Appendix 3: Sool Plateau of Sool & Sanag Nutrition Survey Questionnaire - Somali Version
Foomka Sahanka Nafaqada-Sool Plateau (Sool and Sanaag)
Taariikh_________ Numberka Kooxda __________ Numberka goobta _________ Magaca kormeeraha_______ Magaca degmada _____
Magaca xaafadda/Magaalada ______ Magaca waaxda_______ Numberka qoyska _______Magaca madaxa qoyska _________
S1-14 Astaamaha qoyska
S1 Waa maxay jinsiga madaxa qoyska? 1=Lab, 2=Dhedig
S2 Immisa ruux baa ku nool qoyska (Tirada)? _____________
S3 Immisa ruux baa ka yar shan sano qoyskan (Tirada < 5 Sano)? ____________
S4 Waa xagee degaanka aad rasmi ahaan u deggan tahay (degmo iyo xaafad) Degmo: ________ Xaafad: _________
Q4a Hadda. waa maxay xaaladda deegaan ee qoyska? 
(Haddii jawaabtu tahay 1, u gudub su'asha 8aad) 1= Degaan 2=Soo barakacay 3= Soo noqday (qaxootinimo)
4= gudaha degaankiisa ku barakacay 5=Waxyaabo kale Caddee_________________
S5 Xaggee ka timid inta aadan halkan soo degin? (Meesha asal ahaan aad ka timid) ___________
S6 Muddo intee la'eg ayaad halkan ku nooleyd?__________________
S7 Waa maxay sababta aad halkan u timid? (waad xulan kartaa wax hal doorasho ka badan hadday haboonaato): 
1= nabadgelyo xumo 2=Shaqo laaan 3= Cunto yaraan 4=Biyo yaraan 5=Daaq yaraan 6=Waxyaabo kale caddee____________
S8 Ma jiraa xubin (xubno) qoyska ah oo si joogto ah xoolaha ula hayaama? 1=Haa 2= Maya
Q8a Haddii S8aad haa tahay, u gudub su'aasha 9aad
Q8b haddii S8aad maya tahay, goorma ayuu qoyska joojiyey hayaaminta xoolaha (Bisha iyo Sanadka) ________
Q8c If S8aad maya tahay, Muxuu qoysku u joojiyey hayaamintii xoolaha ________________
S9 Goormaa ugu dambeysay in xubnaha qoysku hayaamiyaan xoolo? Bisha______________ Sanadka ____________
S10 Xaggee xubnaha qoyskani u hayaameen waqtigaas? ________________
S11 Ma jiraan xubno qoyska ah oo looga tegay degaanka xilligii hayaanka? 1=Haa 2= Maya
S11a Hadday haa tahay kumuu ahaa ruuxa laga tegay? 1= Haween 2= Carruur 3= Waayeel
S12 Ma soo laabteen dadkii la hayaamay xoolah? 1=Haa 2=Maya
S13 Sidee bay xoolaha u kaxeeyeen? 1= Ayagoo adeegsanaya gawaari waa weyn 2=Lugeysiin
S14 Waa maxay hab nololeedka ugu badan ee qoyskani isticmaalo? 1= Xoolo dhaqasho 2=Iskii uga shaqeysta
 degaankiisa 3=Ganacsi yar yar 4=Waxyaabo kale caddee ___________________
S15-16 Lahaansho xoolo iyo berkad:
Hantida
Qoyska
Q15
Hadda
Tirada
Q16
Ka hor 3 sano
Tirada
1. Ari (riyo iyo ido)
2. Geel
3. Berkado
Q17-27 Cudurada, quudinta iyo Tallaalka ee caruurta 6 - 59 bilood (ama 65 - 110cm).
Taxa
Magac
Q17 Shuban labadii 7aad ee la soo dhaafay
1= Haa
2= Maya
S18 Oofwareen (burukiito) labadii7aad ee la soo dhaafay
1= Haa
2= Maya
S19 Duumo labadii 7aad ee la soo dhaafay
1=Haa
2=Maya
S20
S22 Jadeeco Bishii la soo dhaafay
1= Haa
2= Maya
S21 Laga talaaley jadeeco
1=lixdii bilood la soo dhaafey (kaar)
2=Lixdii bilood la soo dhaafey (xusuus)
3=Lix bilood ka hor (kaar)
4=Lix bilood ka hor (xusuus)
5=weligii lagama talaalin
S22 La siiyey VItaminA lixdii bilood ee la soo dhaafey
S23 Hadda ma nuujisaa ilmaha
1=Haa
2=Maya
S24 Haddaadan nuujin immisa jir buu ahaa markii laga guriyey?
1= Ka yar 6 bilood
2= 6 - 11 bilood
3=12 - 18 bilood
4=18 bilood ama ka badan
5= Weligii lama nuujin
S25 Imisa jir buu ahaacunuga markii la siiyaybiyo/cuntadii ugu horeysay ee aan aheyn caanaha naaska
Imisa jeer baad quudisaa cunuga maalintii
1= 0-3 bil
2= 4-6 bil
3= 7 bil ama ka badan
S26 1= hal jeer
2 = laba jeer
3 = 3 - 4 jeer
4 = 5 jeer ama in ka badan
S27 Imisa jeer ayaa afka laga siyey Talalka dabeysha weligiis.
1= 1-2 jer
2 = 3& ka badan
3 = Lama siin weligiis
1, 2, 3
S28 Kaalmo ma raadsataa markuu ilmuhu kaa xanuunsado? 1= Haa 2=Maya
S28a Hadday haa tahay xaggee ka raadsataa? 1= dhaqtar dhaqameedr 2= Xarun caafimaad gaarah/farmashiye 3= xarun caafimad oo dadka u dhexaysa
4= wax kale, caddee ______________
S28b Hadday maya tahay waa maxay sababtu? ______________________________
S29 Ma jiraa xubin (xubno) qoyska ah dhibaato xagga aragtida ah qaba habeenkii ama fiidkii, taas oo xubnaha kale aysan la wadaagin ? 1= Haa 2= Maya
S29a Hadday S29 haa tahay, Caddee 1= < 5 Sano 2 = > 5 ano
S30 - 36 18 Miisaamidda iyo dhererinta ilmaha da'dooda u dhexeyso 6 - 59 bilood (ama 65 - 110cm) ee qoyska
S37 waa maxay cabbirka cududa hooyada dhashay ilmahan (MUAC)? _________ Tirada Taxan Magac
S30 Jinsi(F/M)
S31 Da'da oo bilo ah
S32 Barar (Haa/Maya)
S33 Dherer (cm)
S34 Culeys (kg)
S35 Cudud cabir (cm) (MUAC)
S36 Ma la siiyey UNIMIX lixdii bilood ee tegtay
1=Haa 2=Maya, 1, 2, 3
Q38 La Tacaalidda Duruufaha
Inta jeer
30kii maalmood ee tegey, haddii aadan haysan cunto kugu filan ama lacag aad ku iibsato raashin sidee buu qoysku badanaaba ka yeeli jirey?
Waqtigoo idil? Maalin kasta
In badan? 3-6 */week
Marmar 1-2 */week
Dhif iyo naadir <1 */ week
Marnaba
0*/week
a) Ka wareegid cuntada tayada sare leh, u leexasho mid leh tayo hoose oo ka jaban?
b) Deynsasho cunto ama ku tiirsanaan caawinaad ka timaada saaxiib ama qaraabo?
c) Ku soo iibsataa cuntada deyn?
d) Soo gurasho cuntada duurka laga helo iyo ugaarsi
e) Ku gadid xoolahaaga qiimo aan u qalmin si aad ugu so iibsato cuntada lama huraanka ah.
f) u dirid xubin qoyska ah si uu uga soo cunteeyo meel kale
g) Yareyn xaddiga cuntada ee la cuno wakhtigiiba (3da wakhtiba)?
h) Yareyn cuntada la siiyo dadka waaweyn si carruurta yar yar u helaan waxay cunaan?
i) Beekhaami lacagtaada oo soo iibso cunto diyaarsan (Karsan)
jl) Yaree inta goor ee maalinkii wax la cuno
k) Maalmo dhan oo aan wax la cunin
l) Dabar goyn hantidaadii ma guurtada ahayd, si aad cunto u hesho (Gadasho dhulkaaga, xoolahaaga iwm) IWM)
Q 39 Kala Duwanaanshaha Cuntada
Xasuusasho waxa qoyskani cunay 24kii saaz ee tegay: Wareystahu ha hubsado in shalay ay u ahayd maalin caadi ah qoyskan. Haddiii ay jiree feestooyin aan caadi ahayn, Tacsi IWM ama xubnaha qoysku intooda badan maqan yihiin u soo noqono maalin kale ama ku baddalo qoyskan mid kale'.
Cuntada la cunay iyo isha ay ka soo jeeddo, isha dakhliga cuntada lagu soo gatay ay ka timid?
Waa maxay waxa xubnaha qoyskani cuneen 24 kii saac ee la soo dhaafay
laga soo bilaabo shalay markii la soo toosay maxay xubnaha qoyskani ka cuneen cuntooyinkan.
1=Haa 2=maya
0=Waxba 1= Hal mar 2= Laba goor
3=Saddex goor 4=4 Goor
5=5 goor iyo ka badan
Nooca cuntada
Inta jeer (<5yrs)
Inta jeer >5yrs
a) Firiley/Cuntada rigliga ah (Bariis, Qamadi, Baasto, Mesago, Galley)
B) Noocyada digiraha
c) caanaha iyo wax laga soo saaro
d) kalluunka iyo cuntada badda
e) ukun
f) Hilib/uurku jirta
g) Shaah sonkor leh ama cunto kale oo sonkor leh
h) Dufan/saliid/subag
i) xidida dhirta iyo buruqda laga cuno
j) Fruits (cambe, liin, bombelmo IWM)
k) Khudaarta cagaaran
i) Cabitaan,xawaash
Regions Nutrition Survey. June 2004. FSAU, UNICEF and Partners.
Q40-45 Helitaanka biyaha Aadamigu Cabb0 (Tiro iyo Tayo)
S40 Isha ugu badan ee laga helo Biyaha la cabo 1) pipe lagu keenay 2) Tubo 3) Ceel riig ah (matoor leh) 4) Ceel daboolan 5) Biyo xareed ah 6) war iyo ceel aan daboolayn
S41 halka ugu badan ay ka yimaadaan biyaha wax lagu karsado ama la isku nadifiyo 1)pipe lagu keenay 2) Tubo 3) Ceel riig ah 4) Ceel daboolan 5) Biyaha roobka 6) war iyo ceel aan daboolnayn
7) Webi 8) meelo kale ,Caddee, _________________
S42 Celceliska biyaha qoysku uu u isticmaalo Karin iyo nadaafadda jirka waa 1= 0-2 litir 2 = 3 - 5 litir 3 = 6-10 litir 4= 11-15 litir 5= Ka badan 15 litir
S43 Fogaanta goobta biyaha ee ugu dhaw 1= 0-250 mitir 2= 251-500 mitir 3= 501-750 mitir 4= 751-1000 mitir 5= ka badan 1000 mitir
S44 Biyaha iyo habka lagu helaba waa la ilaaliyey (La xafidey) sidaa darteedna cadadkii loo baahnaa waa diyaar 1= Marnaba 2= Marmar 3= ugu dhawaan had iyo goor 4= Had iyo goor
S45 Tirada Caagaga biyaha lagu soo dhaansho (10-20 litres) ee qoyskan waa 1=1-2 2= 3-4 3= 4-5 5= ka badan 5 caag
Q46-50 Fayadhawrka iyo Nadaafadda (Helitaan iyo Tayaba)
Q46 Nooca musqusha inta badan xubnaha qoysku isticmaalaan waa: 1= Musqul god la sii hagaajiyey 2=Musqul god caadi ah 3=Musqul god dusha ka furan 4= Duurka 5= Kuwa kale___
Q47 Tirada dadka hal musqul wada isticmaala waa: 1= 1-5 qof 2= 6-10 qof 3 = 11-15 qof 4= 16 - 20 qof 5= ka badan 20 qof 6= aan waafaqsaneyn midna
Q48 Xubnaha qoysku ma dhaqdaan gacmaha musqusha ka dib 1= Had iyo goor 2= Badanaa 3=Marmar 4= Dhif iyo naadir
Q49 Xubnaha qoysku ma dhaqdaan gacmaha diyaarinta iyo cunitaanka ka hor 1= Had iyo goor 2= Badanaa 3=Marmar 4= Dhif iyo naadir
Q50 Fogaanta u dhaxeysa musqusha iyo isha biyaha 1 = 0 - 5 mitir 2= 6 - 10 mitir 3= 11- 20 mitir 5= 21 - 29 mitir 5= 30 mitir ama ka badan
Q51 - 52 Taageerada toosan iyo midda dadban ee qoysku helay 3dii bilood ee la soo dhaafey (goobo geli dhamaan doorashooyinka ku habboon)
Q51 Kaalmo dadban (aan rasmi ahayn) ma helay qoyskan 3dii bilood ee la soo dhaafey? 1= Haa 2=Maya
Q51a Cadadka iyo Inta jeer
Nooca kaalmada
Inta goor
Cadadka (xaddiga) (Markey ku haboon tahay )
1=Zako ka timaado qoysaska ladan
2=Xawaalad dibadda ka timaadda
3=Xawaalad ka timaadda wadanka gudihiisa
4=Deeq
5=Amaah
9=Wax kale, _________________________
Q52 Kaalmo rasmi ah oo caalami ah ama waddaniyadeed 3dii bilood ee u dambeeyey 1= Haa 2=Maya
Q52a Caddadka iyi inta goor mid walba.
Nooca Kaalmada
Inta goor
Cadadka (Xaddiga)
1= Lacag bilaash aad ku heshay
2=Cunto bilaash lagugu siiyey
3=Lacag aad shaqo ku badalatey (Cash for work)
4=Cunto aad shaqo ku badalatey (food for work)
5=Cunto kabid ahaan laguu siiyey (suppl.Food)
6=Biyo laguu siiyey kabid ahaan (subsidy water)
7= xoolo laguu siiyey gaadiid ceshi
8=Kaalmo xanaanada xoolaha (veterinaty) aad heshay
9=Kale, caddee _________________________
Sool Plateau of Sanaag and Sool
Appendix 4: Sool Plateau Mortality Questionnaire Set
Qaabka Su'aalaha Qoyska ee Foomka dhimashada.
Date________ Team Number ________ Cluster Number ________Tariikh_______ Numbarka koxda______Kalaster Numbar___________
Name of Interviewer __________________Name of Village/Town ____________________
Magaca waydiiyaha___________________ Magaca Tuulada/magallo_________________
Name of section _______________ Household Number _____________________
Magaca Qaybta__________________ Nambarka Gurga_____________________.
Name of the household head ___________________ Mgaca madaxa Qoyska _____________________
MORTALITY MODULE (SU'ALLAHA DHIMASHADA.
CHILD: (This questionnaire should be preferably administered to all women in the household)
1. Have you ever given birth?
Weligaa Ilma ma dhashay.
(Birth- a child who ever breathed or cried or showed signs of live even if he/she lived only a few minutes or hours)
Ilma nool oo neefsanaya markuu dhasho oo leh callmadihii nololed.
Yes.........................
Haa
No...........................
Maya
2. Have you any live birth between the 2nd March 04 and now?
Miyaad dhashay ilma nool intii u dhaxaysay 2nd Bishii March 04 iyo hadeertada aynu joogno.
Yes...... No...........
Haa......Maya
If yes, how many?...
Haddii ay haa tahay waa imisa?.........
3. Have you any under five child other than your own in your household coming in since the. 2ND March 04
Miyey jiraan wax carruur ah shan sano ka yar oo aadan dhalin oo idiin yimi ilaa. 2ND March 04
Yes....... No........
Haa.......Maya
If yes, how many?..........
Haddii ay haa tahatay waa imisa.........
4. How many under 5yrs children were living in this household as on the 2ND March 04
5. Imisa carruura oo shan sano ka yar ayaa gurigan ku nool illaa 2ND March 04
Number.......................
Tirada.....................
6. How many Under 5yrs children live with you now?
Imisa carruur shan sano ka yar ayaa hadda ku nool guriga.
Sons at home.............
Imasa wiilaal ah
Daughters at home ......
Imisaa gabdh ah
7. Do you have any Under 5yrs child who has died since the 2nd March 04?
8. Imisa wax carruur shan sano ka yar ayaa kaa dhintay ilaa 2nd March 04?
Yes.......No......If yes, then Sons dead ............
Haa.......Maya......haday jirti imisa wiil.. ama gabdhood baa dhintay.......
Daughters dead..............
9. If there has been death of an Under 5yrs child in this household, then what were the signs and symptoms
 of death?/suspected cause of death?
Miyuu jiraa ilmo shan sano kar oo ka dhintay gurigan, muxuuse ahaa calamadaha ama waxa aad umalaynaysid inuu u dhintay.
Child1..........................
Ilmaha kowaad...........
Child2..........................
Ilmaha Labaad..............
Child3........................
Ilmahasadexaad.............
Child4 ........................
ABOVE FIVE YEARS OLD IN THE HOUSEHOLD( Inta ka weyn shan sanadood ee Gurigaan)
10. How many above five years old were living in this household as on the 2nd March 04?
11. Imisa qof oo shan sano ka weyn ayaa gurigan ku noolaa ilaa 2nd March 04?
(List the names somewhere separate and account for everybody as per the questions below) 
Ku qor magacyada meel gaara ee dadkan
Number >5yrs....................
Tirada shan sano ka yar...................
12. How many above 5 yrs live in this household now?
Imisa qof oo shan sano ka weyn ayaa ku nool gurigiina imika?
Number..............
Tirada.................
13. Do you have any over 5 years old person in this household who has died since the 2nd March 04?
14. 14 Miyuu jiraa qof shan sano ka weyn oo gurigan ah oo dhintay ilaa 2nd March 04?
Yes.... No...........
Haa.........Maya...........haday jirti imisaa ka yar shansano.............
If yes, no. >5yrs..................
15. If there has been death of >5yrs person in this household, then what were the signs and symptoms of death?
Haddii uu jiro qof ka weyn shan sano oo dhintay, maxay ahaayeen calamadihii iyo sababtii uu u dhintay, imisa qofbaa se dhintay?
Peron1..........................
Ilmaha 1aad...................
Person2........................
ILmaha 2aad...................
Person3........................
Ilmaha 3aad......................
Person4 ........................
Ilmaha 4aad..................




NOTES

1 Survey was undertaken by FSAU, UNICEF, SRCS and MOHL.

2 Interventions consist of targeted food distribution, supplementary feeding of malnourished children, water trucking, mass treatment of livestock, free cash distribution, cash for work, treatment of common illnesses and immunization of children.

 3 The food groups categorisation is based on the FAO categorisation referred on pg 20.

 REFERENCES

CARE and WFP: Field Methods Manual. The Coping Strategies Index - A tool for rapid measurement of household food security and the impact of food aid programs in humanitarian emergencies.

 FSAU, September 2002: Food Utilisation in Somalia

FSAU and partners, May 2003: Sool Plateau of Sool and Sanaag Regions Nutrition Survey Report.

FSAU, November 2003: Nutrition Training Manual: A guide to data collection, analysis, interpretation and use.

FSAU, April 2004: Dietary Diversity in Somalia

Naomi Saville, Progressive Interventions April 2004. The Contribution of Honey and other Natural Resource Products to Food Security in Somaliland.

SACB: Nutrition survey guidelines for Somalia.

Standardized Monitoring and Assessment of Relief and Transition (SMART). Standardizing Survey methodology. Technical Series. July 23 - 26, 2002. Washington, DC.

WHO, 1995: Guide on rapid nutritional assessment in emergencies