South Sudan: Humanitarian Response for Conflict-Affected Populations in Unity State: SMART Nutrition Survey Report December 2015



Mayendit County is one of the nine counties of Unity State; it borders Leer, Koch, Tonj North, Tonj East, Rumbek North, and Panyijar counties. Mayendit South where the survey was conducted has five payams namely; Madol 1, Madol 2, Bhor, Pabuong and Malkuer. Agriculture is the county’s primary economic activity. The people are nomadic agro – pastoralists who engage in both agriculture and rearing of livestock, especially cattle. Fishing is also prevalent in the area.

Samaritan’s Purse International Relief and UNIDO are implementing various interventions in the county namely food security, water, sanitation and hygiene (WASH) nutrition and health.

Back in April 2014, the World Food Programme (WFP) and UNICEF conducted a rapid assessment which identified a population of 20,500 in southern Mayendit with a proxy Global Acute Malnutrition (GAM) rate of 29.2% and Severe Acute Malnutrition (SAM) rate of 1.9%. In August 2014, Samaritans Purse (SP) conducted mass Mid Upper Arm Circumference (MUAC) screening which registered a children under five (U5) proxy GAM rate of 9.9% and a Pregnant and Lactating Women (PLW) under nutrition rate of 26.2%. While Mayendit saw an improvement in malnutrition prevalence in 2014, recent mass MUAC screening conducted by SP in March 2015 registered a proxy GAM of 20.24% in children U5. Due to its more secure location, it is likely that southern Mayendit will receive an influx of Internally Displaced Persons (IDPs) as fighting resumes during the dry season. This will put additional pressure on already limited food resources and increase the likelihood of a deterioration of U5 and PLW’s nutritional status. In addition, the recent Knowledge Attitude and Practices (KAP) survey that was conducted in November 2015 by SP showed that the nutrition situation was poor as the levels were above the emergency threshold of 15%.

To get a better understanding and assess the severity of the nutrition and mortality situation in Mayendit County, SP with OFDA funding conducted a Nutrition and Mortality SMART survey from the 10th to 23th December, 2015. Enumerator training was conducted from 11th to 14th December, 2015 with data collection conducted from the 15th to 23rd December, 2015.


The overall survey objective was to determine the nutrition status among children aged 6 -59 months and to estimate crude and under-five retrospective mortality rates in Mayendit County. This also included collecting morbidity data (2-week recall), immunization and supplementation coverage, and a qualitative component on Food Security and Livelihoods (FSL).


The survey was a cross sectional study with two-stage cluster sampling using SMART methodology. Anthropometric data, two-week retrospective morbidity, Measles and vitamin A coverage and retrospective mortality data was collected. The sampling frame was drawn from the population of five payams. The first stage involved random selection of 36 clusters based on probability to proportional to size using the ENA for SMART software Nov, 2013 version (9th July 2015 update).


Findings of the nutrition survey indicate poor nutrition situation among the surveyed population as per WHO standards. The prevalence of Global Acute Malnutrition (GAM) in Mayendit County based on weight for height z scores /and or oedema was 16.1% [(12.1 – 21.0 95% C.I.) and the prevalence of Severe Acute Malnutrition (SAM) was 2.4% [1.3 – 4.5, 95% C.I.]. The poor nutrition situation is attributed to poor food security due to the insecurity and high incidence of disease among children aged 6-59 months. Results for Anthropometry, Mortality, and Immunization and Morbidity indicators are summarized below.

Conclusion and recommendations

The findings of the assessment depict a poor nutrition situation, above the WHO emergency threshold in Mayendit South which is being caused by an interplay of factors ranging from household food insecurity, disease, poor maternal care practices and limited programme coverage. This calls for concerted efforts with an integrated approach on the interventions being implemented in the area with a special focus on the Supplementary Feeding Programme (SFP) due to the high cases of moderately malnourished children and Outpatient Therapeutic Programme (OTP) due to the high numbers of severely malnourished children. The IYCF programme currently being implemented requires to integrate a BCC and an IMCI component in order to improve the nutrition situation. In addition, the health programme implemented should be scaled up and increase its focus on integrated management of childhood illnesses (IMCI). In addition, the food security and livelihoods (FSL) programme implemented in the area require immediate scale-up as the population start the dry period and as drought makes most of the households vulnerable to food insecurity and eventually malnutrition. The FSL programme needs to focus on empowering the livelihoods of the population e.g. giving fishing nets, in order for them to be able to mitigate household food insecurity.

Lastly, there is an urgent need to increase the coverage and scale up of the programmes currently implemented in Mayendit South in order to have a wider reach of the vulnerable populations.

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