UNITED REPUBLIC OF TANZANIA Tanzania National Nutrition Survey

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UNITED REPUBLIC OF TANZANIA Tanzania National Nutrition Survey 2014 DPG MEETING 24 TH OF

UNITED REPUBLIC OF TANZANIA Tanzania National Nutrition Survey 2014 DPG MEETING 24 TH OF MARCH 2015

Outline 1. Introduction & Rational for a National Nutrition Survey 2. Objectives 3. Methodology

Outline 1. Introduction & Rational for a National Nutrition Survey 2. Objectives 3. Methodology 4. Results 5. Summary and Conclusions

Introduction

Introduction

Why a Specific National Nutrition Survey in 2014? Last data TDHS 2010. Next TDHS

Why a Specific National Nutrition Survey in 2014? Last data TDHS 2010. Next TDHS 2015 results expected in 2016 Need to report on MDGs and MKUKUTA II progress in 2015 Need to have more frequent data between 2 TDHS Following the revision of National Food and Nutrition Policy, need to prepare a National Nutrition Program to reach 2025 WHA targets

Main Objective of the Survey To assess nutritional status of children aged 0 -59

Main Objective of the Survey To assess nutritional status of children aged 0 -59 months and of women aged 15 -49 years, coverage level of infant and young child feeding practices, micronutrients interventions and handwashing practices in Tanzania (Mainland Zanzibar) practices

Methodology

Methodology

DHS vs SMART - Same Methodology? TDHS 2010 Survey Design Sampling Design Sample Size

DHS vs SMART - Same Methodology? TDHS 2010 Survey Design Sampling Design Sample Size Tanzania NNS SMART 2014 ü Cross-sectional Household Survey ü Representativity: Zonal (8 zones) ü Two Stage Cluster Sampling ü Cluster Selection EA from census selected wiht PPS Method ü HH Selection Systematic Random Sampling ü Representativity: Regional (30 regions) ü Two Stage Cluster Sampling ü Cluster Selection EA from census selected wiht PPS Method ü HH Selection Systematic Random Sampling ü 475 Clusters ü 7491 Children 0 -59 months ü 991 Clusters ü 16 984 Children 0 -59 months

DHS vs SMART - Same Methodology? . . . TDHS 2010 Training Data Collection

DHS vs SMART - Same Methodology? . . . TDHS 2010 Training Data Collection Analysis and Reporting ü Survey Training ü Approximately 5 months Tanzania NNS SMART 2014 ü Survey Training ü Standardization Test ü Less than 2 months ü Data entry during fieldwork ü Intensive Supervision & Data Quality Review ü ü Standardized and ü comprehensive format ü ü Preliminary Results 2 ü months after data ü collection ü Standardized and comprehensive format Exclusion of SMART flags Double Data Entry Data Quality Review Plausibility Check Report Final Report completed in less than 2 months after data collection

Results

Results

12. 5 MDG 1 Prevalence of Underweight was reduced by 19% since 2010 and

12. 5 MDG 1 Prevalence of Underweight was reduced by 19% since 2010 and 46% since 1992. Tanzania is on track to reach the target indicator 1. 8 of MDG 1.

Stunting prevalence was reduced by 18% since 2010 and by 30% since 1992.

Stunting prevalence was reduced by 18% since 2010 and by 30% since 1992.

Status of Stunting in Tanzania according to SMART Survey 2014 Kagera Njombe Iringa Ruvuma

Status of Stunting in Tanzania according to SMART Survey 2014 Kagera Njombe Iringa Ruvuma Kigoma Rukwa Geita Dodoma Katavi Morogoro Lindi Mbeya Manyara Singida Mtwara Tabora Mwanza Mara Unguja North Pwani Shinyanga Pemba South Arusha Simiyu Unguja South Pemba North Tanga Town West Kilimanjaro Dar es Salaam 52 52 51 49 49 48 46 45 43 37 37 36 36 34 34 33 32 32 31 31 30 28 27 26 25 25 24 21 18 16

Prevalence of stunting vs Number of Stunted Children +2, 700, 000 stunted children 58%

Prevalence of stunting vs Number of Stunted Children +2, 700, 000 stunted children 58% of stunted children live in 10 regions 14

+105, 000 SAM children +340, 000 MAM children

+105, 000 SAM children +340, 000 MAM children

Trends in nutritional status of children under 5 Tanzania There are improvements of all

Trends in nutritional status of children under 5 Tanzania There are improvements of all forms of malnutrition among children under five years in Tanzania Sources: WHO Global database and TNNS survey 2014

Coverage of Vitamin A Supplementation increased in Mainland but not in Zanzibar

Coverage of Vitamin A Supplementation increased in Mainland but not in Zanzibar

Quality of Complementary Food for Children 6 -23 months has not improved in

Quality of Complementary Food for Children 6 -23 months has not improved in

Chronic Energy Deficiency among women (15 – 49 years) - Thinness Chronic Energy Deficency

Chronic Energy Deficiency among women (15 – 49 years) - Thinness Chronic Energy Deficency among women has improved in Mainland Zanzibar

Obesity among women (15 – 49 years) Obesity among women has increased in Mainland

Obesity among women (15 – 49 years) Obesity among women has increased in Mainland Zanzibar

Coverage of Iron and Folic Acid Supplementation during pregnancy has improved, but the level

Coverage of Iron and Folic Acid Supplementation during pregnancy has improved, but the level is still very low

Use of Iodized Salt at Household level has decreased in Mainland despite provision of

Use of Iodized Salt at Household level has decreased in Mainland despite provision of potassium iodate to TASPA

Summary & Conclusions

Summary & Conclusions

Summary and Conclusion • The National Nutrition Survey showed a marked improvement in the

Summary and Conclusion • The National Nutrition Survey showed a marked improvement in the prevalence of all forms of malnutrition among children under five years in prevalence Tanzania. Underweight The prevalence of underweight among children under five was reduced by 46 per cent between 1991 and 2014. Tanzania is on track to reach the 50% target by 2015 for indicator 1. 8 of MDG 1.

Summary and Conclusions • Stunting üStunting prevalence was reduced by 18% since 2010 üStunting

Summary and Conclusions • Stunting üStunting prevalence was reduced by 18% since 2010 üStunting prevalence was reduced from “very high” level to “high” level. üHowever, more than 2, 700, 000 children U 5 are stunted in Tanzania ü More than 58% of stunted children live in 10 regions: Kagera, Kigoma, Mbeya, Mwanza, Dodoma, Morogoro, Geita, Dar-Es-Salaam, Tabora and Ruvuma. Nutrition Interventions should be prioritized in the regions with the higher number of stunted children and the higher prevalence of chronic malnutrition.

Summary and Conclusions • Wasting ü Prevalence of acute malnutrition in Tanzania is very

Summary and Conclusions • Wasting ü Prevalence of acute malnutrition in Tanzania is very low (less than 5%), but the caseload of moderate and severe acute malnutrition is high ü Approximately 340, 000 children will suffer from Moderate acute malnutrition in Tanzania for 2015 ü More than 105, 000 children will suffer from Severe Acute Malnutrition in Tanzania for 2015. Severe acute malnutrition is associate with high risk of dying if not treated.

Summary and Conclusions • Infant and Young Child Feeding (IYCF) practices üIndicators of IYCF

Summary and Conclusions • Infant and Young Child Feeding (IYCF) practices üIndicators of IYCF Practices has not improved between 2010 and has not improved 2014 and this is relation with low coverage

What do we say about the results The increased Political commitment translated into increased

What do we say about the results The increased Political commitment translated into increased Political commitment increased allocation of human and financial resources and improved coordination mechanisms for nutrition since 2011 are among the reasons that contributed to this success.

Way Forward üDissemination of the results through Press, various forum and publications üUse the

Way Forward üDissemination of the results through Press, various forum and publications üUse the results in prioritizing planning and budgeting for 2015/16 eg Prioritize nutrition interventions in the regions with the higher number of stunted children and the higher prevalence of chronic malnutrition. ü Strengthen nutrition-sensitive interventions: policies and programming in agriculture and food security; social safety nets; early child development; women’s empowerment; child protection; WASH; health and family planning services. ü Scale-up treatment of severe acute malnutrition through health facilities and community management of acute malnutrition

Way Forward üScale-up promotion of infant and young child feeding practices using SBCC approach

Way Forward üScale-up promotion of infant and young child feeding practices using SBCC approach ü Integrate nutrition interventions and increase community involvement during Child Health Days ü Strengthen actions towards universal iodization of salt in all regions, especially in the low performing regions ü Develop a plan to fight anemia among women at reproductive age & children U 5 ü Develop a plan to fight against overweight and obesity

Acknowledgements • SMART Survey Consultant : Ms Fanny Cassard (Consultant, UNICEF) • SMART Survey

Acknowledgements • SMART Survey Consultant : Ms Fanny Cassard (Consultant, UNICEF) • SMART Survey Technical Committee üMs. Aneth Vedastus (TFNC), Ms Elizabeth Lyimo (TFNC), Mr Luitfrid Nnally (TFNC), Mr. Samson Ndimanga (TFNC), Ms. Tufingene Malambugi (Mo. HSW), Ms. Asha Hassan (Mo. H – Zanzibar), Ms Fahima Mohammed (OCGS), Mr. Deogratius Malamsha (NBS), Mr. Richard Mwanditani (UNICEF). • SMART Survey Steering Committee üMr. Obey Assery (Prime Minister’s Office), Dr. Joyceline Kaganda (TFNC), Dr. Sabas Kimboka (TFNC), Mr. Geoffrey Chiduo (TFNC), Dr. Biram Ndiaye (UNICEF), Dr. Sudha Sharma (UNICEF), Ms Martha Nyagaya (Irish Aid), Dr. Stevens Isiaka ALO (WHO), Mr. Mlemba Abassy Kamwe (NBS), Mr. Philip Mann (UN REACH), Mr. Rogers Wanyama (WFP), Ms. Lisha Lala (DIFD), Dr Mohammed J. U. Dahoma (Mo. H – Zanzibar), Dr. Vincent Assey (MOHSW) and Dr. Elifatio Towo (TFNC).

Acknowledgements • Financial Support ü Irish Aid ü DFID üUNICEF • Technical Support ü

Acknowledgements • Financial Support ü Irish Aid ü DFID üUNICEF • Technical Support ü UNICEF ü ACF-Canada

Asante Sana

Asante Sana