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Rapid SMART Assessment Report
Herat IDPs Camps, Herat province
Date: 6-11 April 2019
Lead by: Dr. Baidar Bakht Habib
Author: Dr. Ahmad Abib Habibi, Dr. Sayed Rahim RASTKAR and Beka Teshome
Funded by: AHF-OCHA
Action Contre la Faim
AAH is a non-governmental, non-political and non-religious organization
AFG
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Contents Acknowledgment ......................................................................................................... 6
ABBREVIATIONS ........................................................................................................... 7
Executive summary ......................................................................................................................................... 8
1. background ........................................................................................................... 10
2. Objectives ............................................................................................................ 11
2.1 Specific objective ..................................................................................................................................... 11
3. METHODOLOGY ...................................................................................................... 11
3.1. Geographic target area and population group .................................................................................. 11
3.2. Survey period .......................................................................................................................................... 11
3.2. Survey design ..................................................................................................................................... 12
3.3. Sample size ........................................................................................................................................ 12
3.4. Sampling procedures ......................................................................................................................... 12
3.4.1. First stage sampling: selection of clusters ................................................................................. 12
3.4.2. Second stage sampling: selection of households ....................................................................... 13
3.5. Organization of the Survey ................................................................................................................ 14
3.5.1. Survey Coordination................................................................................................................... 14
3.5.2. Survey Teams ............................................................................................................................. 14
3.5.3. Training of the Survey Teams .................................................................................................... 14
3.6. Data collection and field work ........................................................................................................... 14
3.6.1. Anthropometric survey ............................................................................................................ 14
3.6.2. Mid-upper arm circumference of women 15 – 49 years........................................................ 15
3.6.3. Child Morbidity ......................................................................................................................... 15
3.7. Data quality assurance ...................................................................................................................... 15
4. Data management and Analysis ............................................................................... 16
5. Results ................................................................................................................. 16
5.1. General characteristics of study population and households ................................................................ 16
5.1.1. Households and children 6-59 months ............................................................................................ 16
4.1.1. Pregnant and Lactating Women................................................................................................ 17
4.2. Anthropometric results ..................................................................................................................... 17
4.2.1. Distribution by sex and age ....................................................................................................... 17
4.2.2. Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex 18
4.2.3. Prevalence of acute malnutrition by age, based on weight-for-height z-scores and/or oedema 19
4.2.4. Prevalence of acute malnutrition based on MUAC cut off's (and/or oedema) ..................... 20
4.3. Prevalence of Combined Acute Malnutrtion based on WHZ and/or MUAC ..................................... 22
4.3.1. Prevalence of underweight based on weight-for-age z-scores .............................................. 23
4.3.2. Prevalence of stunting based on height-for-age z-scores and by sex ................................... 24
4.3.3. Mean z-scores, Design Effects and excluded subjects ........................................................... 24
4.4. Child morbidity .................................................................................................................................. 25
4.5. Maternal nutritional status ............................................................................................................... 26
4.6. Proportion of acutely malnourished children enrolled in & referred to a nutrition program .......... 26
5. discusion .............................................................................................................. 27
6. Recommendations .................................................................................................. 29
7. Annexes ............................................................................................................... 30
Annex 1: Plausibility check for: Herat_IDP camps ( Shaidayee) _April_2019_Afghanistan.as ..................... 30
Annex 3: Selected clusters Herat IDPs Shaidayee camp ............................................................................... 33
Annex 4: Selected clusters Herat IDPs Shahrak Sabz & Shahrak Satar Pahlawan ......................................... 33
Annex 5. Herat IDPs camps field Map. ........................................................................................................... 1
Annex 6: Rapid SMART Assessment questionnaires for children and pregnant and lactating women .......... 1
Annex 7: Event calendar .................................................................................................................................. 1
Tables of Contents Table 5- 1: Summary of households and children 6-59 months planned and those surveyed ............. 16 Table 5-2: Distribution of age & sex of children 6-59 months, Herat city IDPs camp (Shaidayee) .............. 17 Table 5-3: Distribution of age & sex of children 6-59 months, Herat city IDPs camp (Shahrak Setar Pahlawan) .......................................................................................................................................................... 17 Table 5 4: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex ........................................................................................................................................................ 18 Table 5 5: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex ........................................................................................................................................................ 18 Table 5 6: Prevalence of acute malnutrition by age, based on weight-for-height z-scores and/or oedema, Shaidayee camp ............................................................................................................................... 19 Table 5 7: Prevalence of acute malnutrition by age, based on weight-for-height z-scores and/or oedema, Shahrak Sabz & Shahrak Satar Pahlawan camps ............................................................................................ 19 Table 5 8: Distribution of acute malnutrition and oedema based on weight-for-height z-scores. ............... 20
Table 5 9: Distribution of acute malnutrition and oedema based on weight-for-height z-scores. ...... 20 Table 5 10: Prevalence of acute malnutrition based on MUAC cut offs (and/or oedema) and by sex. ........ 20 Table 5 11: Prevalence of acute malnutrition based on MUAC cut offs (and/or oedema) and by sex.21 Table 5 12: Prevalence of acute malnutrition by age, based on MUAC cut off's and/or oedema, Shaidayee camp .................................................................................................................................................................. 21 Table 5 13: Prevalence of acute malnutrition by age, based on MUAC cut off's and/or oedema, Shahrak Sabz & Shahrak Satar Pahlawan camp ............................................................................................................ 22 Table 5 14: Prevalence of malnutrition based on both criteria (WHZ+MUAC) and by sex........................... 22 Table 5 15: Prevalence of malnutrition based on both criteria (WHZ+MUAC) and by sex........................... 22
Table 5 16: Prevalence of underweight based on weight-for-age z-scores by sex., Herat IDP camps ......... 23
Table 5 17: Prevalence of underweight based on weight-for-age z-scores by sex, Herat IDP camps .......... 23
Table 5 18: Prevalence of stunting based on height-for-age z-scores and by sex., Herat IDP camps .......... 24 Table 5 19: Prevalence of stunting based on height-for-age z-scores and by sex., Herat IDP camps .......... 24 Table 5 20: Mean z-scores, design effect and excluded subjects, Shaidayee camp ...................................... 25 Table 5 21: Mean z-scores, design effect and excluded subjects, Shahrak Sabz & Shahrak Satar Pahlawan camp .................................................................................................................................................................. 25 Table 5 22: Morbidity among children 6-59 months, Herat IDP camps ........................................................ 25 Table 5 23: Morbidity among children 6-59 months, Herat IDP camps ........................................................ 25
Table 5 24: Maternal nutritional status based on MUAC cut-off points for PLW, Herat IDP camps. .......... 26 Table 5 25: Maternal nutritional status based on MUAC cut-off points for PLW, Herat IDP camps. .......... 26 Table 5 26: Proportion of Acutely Malnourished Children 6-59 Months Enrolled in a Treatment Programme ........................................................................................................................................................................... 27
ACKNOWLEDGMENT
This survey would not have been possible without the financial support provided by Afghanistan
Humanitarian Fund (AHF). Action Against Hunger (AAH) would also like to thank all stakeholders and
partners who provided support to the Rapid SMART Assessments team in Herat city IDPs Camps,
Herat province:
Herat Provincial Public Health Directorate (PPHD) and Herat Provincial Nutrition officer (PNO)
for the support provided in the authorization of the survey.
Public Nutrition Department (PND), Nutrition cluster and Afghanistan Information
Management Working Group (AIM-WG) for their support in methodological review and
guidance.
Afghanistan Humanitarian Fund (AHF) for their financial support in the survey.
All the community members for welcoming and supporting the survey teams during the data
collection process.
All health and nutrition sector stakeholders who are currently providing health and nutrition
services in the IDP’s camps of Herat province.
Agencies for Assistance and Development of Afghanistan (AADA) especially Dr. Abdul Qadir
Baqakhil, Dr. Qudratullah Barak and Dr. Fazal Karim Noori for smoothly implementation of the
assessment in the IDP camps in Herat province.
The survey teams are highly appreciated for doing their very best during the training and
implementation of the assessments.
AAH colleagues at Kabul and Paris for technical, logistics and administrative support.
Statement on Copyright
© Action Against Hunger
Action Against Hunger is a non-governmental, non-political and non-religious organization.
Unless otherwise indicated, reproduction is authorized on condition that the source is credited. If
reproduction or use of texts and visual materials (sound, images, software, etc.) is subject to prior
authorization, such authorization was render null and void the above-mentioned general authorization
and was clearly indicate any restrictions on use.
The content of this document is the responsibility of the authors and does not necessarily reflect the
views of AAH and AHF.
ABBREVIATIONS
AAH Action Against Hunger
AIM-WG Afghanistan Information Management Working Group
CDC Communicable Disease Control
CSO Central Statistics Organization
DoPH Directorate of Public Health
ENA Emergency Nutrition Assessment
GAM Global Acute Malnutrition
HH Household
IDPs Internal Displaced Peoples
IOM International Organization for Migrant
KM Kilo Meter
MAM Moderate Acute Malnutrition
MoPH Ministry of Public Health
MUAC Mid Upper Arm Circumference
NRC Norwegian Refuges council
OPD Outpatient Department
OCHA Office for coordination and humanitarian affairs Common Humanitarian fund
PPS Probability Proportional to Size
PLW Pregnant and lactating Women
PPHD Provincial Public Health Directorate
PND Public Nutrition Department
PNO Provincial Nutrition Officer
RC Reserve Cluster
SAM Severe Acute Malnutrition
SD Standard Deviation
SMART Standardized Monitoring and Assessment of Relief and Transition
TAPI Tajikistan Afghanistan Pakistan India
UNHCR United Nation High Commission for Refuges
UNIECF united Nation International Children’s Emergency Fund
W/H Weight for Height
WFP World Food Program
WHO World Health Organization
WHZ Weight for Height Z score
Executive summary
In April 2019, Action Against Hunger (AAH) in collaborations with the Ministry of Public Health
(MoPH) and Directorate of Public (DoPH) Health of Herat province, conducted two nutrition
assessments in Herat IDPs Camps. This was done in response to the need to determine the
malnutrition levels and to inform the intervention response for the camps.
The main objective of the surveys was to assess the current nutrition situation among children 6-59
months of age, Pregnant, and Lactating Women (PLW) in Herat IDPs Camps of Herat province and
provide key recommendations.
The surveys applied a two-stage cluster sampling using the Rapid SMART methodology based on
probability proportional to population size (PPS). Stage one sampling involved the sampling of the
clusters included in the survey while the second stage sampling involved the selection of the
households from the sampled clusters. The smallest geographical unit in Herat IDPs Camps i.e. a
Chief/Malik defined a cluster. A total of 1,130 children aged 6-59 months (615 from Shaidayee camp
and 515 children from Shahrak Sabz and Shaharak SatarPahlawan) were assessed.
Data collection took place from 6th to 11th of April 2019, in two phases. The first phase rapid nutrition
assessment conducted in (Shaidayee camp of Herat IDPs Camps between 6-8 Aprils) while the second
phase of the rapid nutrition assessment was conducted in Shahrak Sabz and Shaharak Satar Pahlawan
between 8-11 April 2019). Summary of key findings are presented in tables below.
The survey results indicated a Global Acute Malnutrition (GAM) rate for children 6-59 months old
based on WHZ and oedema of 8.7 % (6.5 – 11.6 95% C.I.) and 7.1% (4.9-10.3 95% CI) in Shaidayee
and Shahrak Sabz & Shahrak Satar Pahlawan of Herat IDP camp, respectively. The results also
indicated very high rates of chronic malnutrition of 35.9 % (28.1-44.5 95% C.I.) and 40.5 % (30.5-51.5
95% C.I.) in both camps respectively.
It is notable that surveys results shown 25.1% of pregnant and lactating women suffering from
malnutrition in Shaidayee camp and 24.2% of pregnant & lactating women suffering from malnutrition
in Shahraks Sabz & Shharak Satar Pahlawan based on MUAC (<230 mm).
Summary of Key Survey Findings:
Child Health and Nutrition Status
Indicators
Shaidayee Camp
Result
Shahrak Sabz and
Satar Pahlawan
camp Result
GAM rate among children aged 6-59 months
based on Weight for Height- Z- Score <-2 SD
and/or Oedema
8.7 %
(6.5-11.6 95% C.I.)
7.1 %
(4.9-10.3 95% C.I.)
SAM rate among children aged 6-59 months based
on Weight for Height Z-Score <-3 SD and/or
Oedema
1.6 %
(0.9-3.1 95% C.I.)
1.0 %
(0.4-2.2 95% C.I.)
GAM rate among children aged 6-59 months
based on MUAC <125 mm and/or Oedema
5.2 %
(3.3-8.1 95% C.I.)
5.6 %
(3.2-9.8 95% C.I.)
SAM rate among children aged 6-59 months based
on MUAC <115 mm and/or Oedema
1.0 %
(0.5-2.0 95% C.I.)
0.8 %
(0.3-2.0 95% C.I.)
GAM rate among children aged 6-59 months
based on combined criteria (WHZ <-2 SD and/or
MUAC <125 mm and/or Oedema)*
10.9%
(8.2-14.2 95% C.I.)
10.5%
(7.5-14.6 95% CI)
SAM rate among children aged 6-59 months based
on combined criteria (WHZ <-3 SD and/or MUAC
<115 mm and/or Oedema)*
2.1%
(1.3-3.4 95% C.I.)
1.2%
(0.6-2.4 95% CI)
Stunting or chronic malnutrition among children
aged 6-59 months based on Height for Age Z-
Score <-2 SD
35.9 %
(28.1-44.5 95% C.I.)
40.5 %
(30.5-51.5 95% C.I.)
Underweight among children aged 6-59 months
based on Weight for Age Z-Score <-2SD
20.4 %
(15.9-25.8 95% C.I.)
20.0 %
(13.9-28.0 95% C.I.)
Children aged 6-59 months that reported of
having Diarrhea during the past 14 days of the
survey (based on two weeks recall method)
44.9% 48.3%
Nutrition status of Pregnant and lactating
Indicators Shaidayee Camp
Result
Shahrak Sabz and
Satar Pahlawan
camp Result
Undernutrition among Pregnant Women based on
MUAC <230 mm 25.0% 26.7%
Undernutrition among only Lactating Women
based on MUAC < 230 mm 23.3% 24.5%
Undernutrition among Pregnant and Lactating
Women (PLWs) based on MUAC <230mm 25.1% 24.2%
1. BACKGROUND
Herat is one of the thirty-four provinces of Afghanistan, located in the western part of the country.
Together with Badghis, Farah, and Ghor provinces, it makes up the northwestern region of
Afghanistan. It’s primary city and administrative capital is Herat City. The province of Herat is divided
into 20 districts; Enjil, Guzara, Karrukh, Zenda Jan, Pashtoon Zarghoon, Kushk E Rubat Sangi, Gulran,
Adraskan, Kushk e kohna, Ghoryan, Obe, Kohsan, Shindand, Farsi, Chesht e Sahrif, Zerko, Poshko,
Kozeor and Zawol and the Center of Herat. The total population of the province is 205,5141. It is the
second most populated province in Afghanistan behind Kabul Province. The population is multi-ethnic
but largely Persian speaking.
Herat province shares a border with Iran in the West and Turkmenistan in the North, making it an
important trading province. The Trans-Afghanistan Pipeline (TAPI) is expected to pass through Herat
from Turkmenistan to Pakistan and India in the South. The Salma Dam, which is feeding by the Hari
River, is also located in this province.
According to OCHA assessment reports from Dec 2018, recently 16,000 families (around 80,000)
people arrived in Herat province since the last 4 months from Badghis, Ghor, Daikundi, Faryab and 3
districts (Gulran, ZerKoh and Koshk konha) of Herat province. Currently, based on Herat province CDC
database around 30,000 families are living in IDP’s camps near to the Herat city. They are settled in
Central and East part of the province (10-20 KM far from the city) under the tents (some tents are
distributed by IOM and UNHCR) but most of them are using unusable fabrics as tents and living in
warm and sandy deserts of Herat.. Most of the vulnerable population are women and children, they
are suffering from different diseases and at the same time, they have nothing to eat2 By the month of
April 2019, the IDPs who are using unusable fabrics as tent were also affected by heavy raining in
camps area
According to joint Winterization Response Strategy Report September 2018 to February 2019, cluster
partners have noted a decrease in child health conditions associated with poor shelter condition and
lack of adequate health care. For instance, in Herat IDPs camps, 48.6% of households had experienced
frequent cases of acute watery diarrhea and 20 % experience respiratory tract, chest and skin
infections. The situation is deteriorating and multi-faceted, exacerbated by negative coping
mechanisms such as child marriage and labor. A policy brief published by Norwegian Refugee Council
(NRC) 27 Nov 2018 indicates that inability of IDPs to access adequate housing and land, or to find
employment matching their skill set generates a cycle of other needs and negative coping strategy. In
Afghanistan, today 63 % of respondents to the NRC survey rated their housing condition as either
poor or very poor.
Instead of full SMART due to short time, low funded and clear geographical delimited small
administrative units, the two Rapid SMART assessments were conducted in both camps. List of
Chief/Malik with their respective population was obtained from the community leaders. Chief/Malik
in the IPD camps were considered as clusters and the sampled clusters were selected with probability
proportional to population size (PPS
1 Afghanistan CSO Report 2018-19. 2 Herat Assessment Compiled Report-OCHA Dec 2018.
There was no recent data for the nutrition situation in Herat IDPs camps . The need to get a better
understanding and assess the severity of the current nutrition status of the community in the IPD
camps was raised by the Nutrition Cluster along with Assessment and Information Management
Working Group/PND/MoPH, which recommended two assessments using Rapid SMART
methodology in Herat IDPs Camps. It was also an opportunity to build capacity of the AYSO staffs.
2. OBJECTIVES
2.1 Broad objective
The overall objective of the rapid SMART assessments was to estimate the current prevalence of acute
malnutrition among children 6-59 months of age, and Pregnant, and Lactating Women (PLW) in Herat
IDPs camps, Herat province, Afghanistan.
2.1 Specific objective
The specific objectives included the following:
To estimate the prevalence of global and severe acute malnutrition in children aged 6-59
months.
To estimate prevalence of chronic malnutrition and underweight among children aged 6-59
months.
To estimate the prevalence of acute malnutrition among the pregnant and lactating women
(PLWs) using Mid-Upper Arm Circumference (MUAC).
To estimate the prevalence of diarrhea among children 6-59 months in the last two weeks prior
to the survey dates.
3. METHODOLOGY
3.1. Geographic target area and population group
The two rapid SMART assessments were carried out in Shaidayee camp and Shahrak sabz and
Shaharak Setar pahlawan camp of Herat IDPs Camps. All the 53 Chief/Malik3 (32 in Shaidayee & 21 in
Shahrak Sabz and Shahrak Pahlawan) were included in the sampling frame. The study population was
children from the age of 6 to 59 months and Pregnant and Lactating Women (PLW).
3.2. Survey period
Four-days training was organized from 31st March to 3rd April 2019 and six days data collection took
place from 6th to 11th of April, 2019, in two phases. The first phase data collection was conducted in
3 Chief/Malik is the community leader, which is leading a group of families or households.
Shaidayee between 6-8 April while the second phase data collection was conducted in Shahrak Sabz
and Shahrak Setar Pahlawan between 8-11 April 2019.
3.2. Survey design
The two rapid nutrition assessments (Shahrak Shaidayee camp & Shhahrak Sabz and Shahrak Setar
Pahlawan Camp) in Herat IDPs Camps were cross-sectional with two-stage cluster samplings based
on the SMART methodology.
3.3. Sample size
A pre-determined sample size of 25 clusters with 10 households (250 households) was chosen for the
each rapid assessment and was expected to be enough to ensure representativeness with acceptable
precision4. To reach required sample, the Rapid SMART methodology proposes to use a simplified rule
to convert children into households:
A. When the percentage of children under age of 5 is below 15%, 25 clusters of 12 households
would be enough to estimate GAM prevalence.
B. When the percentage of children under age of 5 is above 15%, 25 clusters of 10 households
would be enough to estimate GAM prevalence.
As the reference percentage of under-5 population for Afghanistan, is 17.3% (Afghanistan Updated
Population CSO 2018-19), the option B was applied. 25 Cluster of 10 households were selected
randomly using PPS by ENA software (2015 updated version) out of the total list of population living
in the IDPs camps near to Herat city in the different camps.
3.4. Sampling procedures
The surveys applied a two-stage cluster sampling method referring to the SMART methodology based
on probability proportional to population size (PPS). Stage one sampling involved the sampling of the
clusters included in the survey while the second stage sampling involved the selection of the
households from the sampled clusters. The smallest geographical unit in IDPs Camps i.e. a Chief/Malik
defined a cluster.
3.4.1. First stage sampling: selection of clusters
List of Chief/Malik with their respective population was obtained from World Vision International
Mobile health teams and community leaders. Chief/Malik in the IPD camps were considered as clusters
and the sampled clusters were selected with probability proportional to population size (PPS). All the
4As per the rapid SMART guideline, a sample size of minimum 200 children would be enough to estimate GAM prevalence for cluster random sampling.
53 enumeration areas of the IDPs Camps (32 in first & 21 in the second) along with their respective
populations were entered into ENA software and clusters were selected automatically to be included
in the survey ( Annexes 3 & 4) . There was no inaccessible clusters for both rapid assessments.
All the clusters (from the updated sampling frame) with their respective population sizes were entered
into ENA for SMART and 25 clusters were selected. In Chief/Malik where more than one cluster was
assigned, segmentation was done one segment was selected as cluster . The segmentation of clusters
was done based on water tankers, shops and roads.
3.4.2. Second stage sampling: selection of households
Household definition: Group of people living under same roof and sharing food from the same pot5.
In households with multiple wives, those living and eating in different houses were considered as
separate HHs. Wives living in different houses and eating from same pot were considered as one HH.
The second stage of sampling was the selection of households within the selected clusters
(Chief/Malik) using a systematic random method as described below.
On arrival at the Chief/Malik:
The survey team members introduced themselves and explained the objective of the survey to
the Chief/Malik leader.
In collaboration with the Chief/Malik leader, the team prepared a list of all households in the
Chief/Malik.
The required number of households was selected using systematic random sampling.
The sampling interval was determined by:
Sampling interval = Total number of sampling units in the population
Number of sampling units in the sample (10)
Selection of the first sampling unit: A number between 1 and the sampling interval was
randomly chosen.
Selection of the following sampling units: Number of the 1st sampling unit + sampling interval;
etc.
In cases where there was no eligible children and having PLWs, a household was still considered part
of the sample, where only anthropometric data of PLW was collected. If a respondent was absent
during the time of household visit, the teams left a message and re-visited later the house to collect
data, with no substitution of households.
Each team was assisted by a Chief/Malik guide (Chief/Malik leader) to lead and guide the survey team
within the Chief/Malik and locating the selected households.
5 WFP Household definition
3.5. Organization of the Survey
3.5.1. Survey Coordination
With the lead of Action Against Hunger Afghanistan, communication was done of survey objectives
to AADA and all the relevant administrative authorities as well as stakeholders such as MoPH, PND,
PPHD, Community leaders and other stakeholders. It was also an opportunity to build capacity of the
AADA staffs.
3.5.2. Survey Teams
Eight teams each comprising two enumerators (1 male & 1 female) were deployed to collect data in all
the selected clusters from 6th to 11th April 2019. Four supervisors were assigned to supervise the
survey teams (1 supervisor per 2 survey teams).
3.5.3. Training of the Survey Teams
Training was carried out by AAH’s survey manager and was conducted in the local language6. Four
supervisor (1 supervisor per 2 teams), were responsible for ensuring the recording of all data collected
as well as ensuring accuracy of measurements taken, methodology and any other technical issues
raised while in the field. Candidates with prior experience in nutrition survey were given preference.
Training was conducted for four days from 31st March to 3rd April 2019, and training covered survey
objectives, basic malnutrition, concept of sampling and Rapid SMART survey methodology followed
by anthropometric measurements, recognition of the signs and symptoms of malnutrition including
nutritional bi-lateral oedema and interview techniques.
As a means to verify anthropometric skills of enumerators and to detect differences among measurers
a standardization test was conducted during the fourth day of the training. Ten children were
measured once by the survey supervisor and then each of the 16 enumerators were allowed to
measure the children’s weight, height and MUAC twice with a time interval between individual
measures. Observations of errors in the performance of each team about undertaking measurements
and completing the questionnaires were identified, discussed and corrected with all team members by
the team supervisors and the Survey Manager.
3.6. Data collection and field work
3.6.1. Anthropometric survey
6ACF surveillance team members had been trained on anthropometric measurement, survey methodology, interview skill and other practical aspects in addition to their extensive experience in carrying out surveys in Afghanistan.
Structured questionnaires (Annex 6) were used to collect anthropometric and morbidity data from all
children within the eligible age range (6-59 months) using anthropometric questionnaire. Once
measured, visible small mark on the left upper arm or on the fingernails of the child was made in order
to avoid measuring the same child several times. The collected data were:
Age: The age of children was estimated based on using birth certificate record, vaccination card or
parent records of exact birth dates or ages in completed months. In case the above-mentioned
documents were not available, local event calendar was used (Annex 7). The calendar of local events
was jointly developed with the survey assistants and camp leaders. All the birth dates were collected
in accordance with Hijri Calendar – Afghanistan Official Calendar and were converted to Georgian
format using date converter.
Sex: Male or female
Weight: Children’s weights were taken without clothes using SECA scales (100g precision).
Height/length: Children were measured using wooden UNICEF measuring boards (precision of 0.1cm).
Children less than 2 years were measured lying down, while those greater than or equal to 2 years
were measured standing up.
Mid-upper arm circumference: MUAC measurements were taken at the mid-point of the left upper
arm used WFP child tapes (precision of 0.1cm).
Bilateral pitting oedema: Assessed by the application of normal thumb pressure on both feet for 3
seconds. Occurrence of pitting oedema on both feet upon release of the fingers indicated nutritional
oedema classified as severely malnourished.
3.6.2. Mid-upper arm circumference of women 15 – 49 years
All women aged (15-49) were assessed for their nutritional status based on MUAC measurements. The
nutritional status of pregnant and lactating women was derived using the MUAC cut-off of 230 mm.
3.6.3. Child Morbidity
Two-weeks retrospective morbidity data was collected from mothers/caregivers of all children (6-59
months) included in the anthropometric measurement. The mother/caregiver was asked whether the
child had diarrhea in the past two weeks preceding the survey.
3.7. Data quality assurance
Assurance of data quality was insured through conducting high quality training for survey teams
coupled with standardization test, practical field exercise and close supervision of survey teams during
data collection. The survey supervisors were in charge of the data quality control as they ensured that
HH selection was done correctly, interviews were done correctly and consistently from one household
to the other and anthropometric measurements correctly taken. All the filled questionnaires were
reviewed in the field by the survey supervisors for accuracy and completeness before the teams left
the given clusters. The survey supervisors reported daily and submitted all the verified completed
forms to the survey manager for review and feedback given every evening. The survey manager also
did Field visits during the survey period to ensure quality during data collection. Daily data entry and
regular plausibility checks were done and feedback given to survey team.
4. DATA MANAGEMENT AND ANALYSIS
The anthropometric data were analyzed using ENA software 2011 version (updated 9 July 2015). The
indices were compared to the World health Organization Standards 2006 to determine the levels of
wasting, underweight and stunting. SMART flags: WHZ -3 to 3; HAZ -3 to 3; WAZ -3 to 3 were used
in final analysis to exclude z-scores with extreme values from observed mean. Morbidity and PLW data
were analyzed on excel 2010.
5. RESULTS
5.1. General characteristics of study population and households
5.1.1. Households and children 6-59 months
In Shaidayee camp, out of 250 households planned, data was collected from a total of 241 households
(96.4%) and in Shahrak Sabz and Shahrak Setar Pahlawan, out of 250 planned data was collected from
a total 249 households were surveyed (99.6%) and none response rate was 0.4% (10 households were
refused ). Further, the camp population was recorded based on families and the actually survey was
done based on WFP Household definition7 and the surveyed children were higher than expected,
about 282.5% of the sample size of children 6-59 months of age was met without resulting to visit the
six planned reserve clusters (RCs). A total of 866 children aged 6-59 months (615 children from
Shaidayee camp and 504 children from Shahrak Sabz & Shaharak Satar Pahlawan camp) were assessed
for their nutritional status using anthropometric measurement.
Table 5- 1: Summary of households and children 6-59 months planned and those surveyed
7 Group of people living under same roof and sharing food from the same pot
Number of HH planned
Shaidayee camp 250
Shahrak Sabz & Shaharak Satar
Pahlawan camp 250
Number of HH surveyed Shaidayee camp 241
4.1.1. Pregnant and Lactating Women
In these assessments, 450 pregnant & lactating women (223 in Shaidayee camp, 227 in Shahrak Sabz
& Shaharak Satar Pahlawan camp) were screened for malnutrition by MUAC.
4.2. Anthropometric results
4.2.1. Distribution by sex and age
The age and sex distribution of the sample population in the two surveys are illustrated in Table 5-2
and Table 5-3. Among the surveyed children, 583 (51.6%) were boys while 547 (48.4%) were girls. The
overall sex ratio of the surveyed children in Shaidayee was 1.1 and for the Shahrak Sabz and Shahrak
Setar Pahlawan was 1.0 indicating that both sexes were equally represented within the sample. The
overall data quality was scored as Good (score of 12% for Shaidayee, score of 13% for Shahrak sabz and
Shahrak Setar Pahlawan).
Table 5-2: Distribution of age & sex of children 6-59 months, Herat city IDPs camp (Shaidayee)
Table 5-3: Distribution of age & sex of children 6-59 months, Herat city IDPs camp (Shahrak Setar Pahlawan)
Shahrak Sabz & Shaharak Satar
Pahlawan camp 249
Number of children 6-59 months
planned
Shaidayee camp 200
Shahrak Sabz & Shaharak Satar
Pahlawan camp 200
Number of children 6-59 months
surveyed
Shaidayee camp 615
Shahrak Sabz & Shaharak Satar
Pahlawan camp 515
Boys Girls Total Ratio
AGE (mo) no. % no. % no. % Boy: girl
6-17 55 53.9 47 46.1 102 16.6 1.2
18-29 92 50.5 90 49.5 182 29.6 1.0
30-41 77 53.8 66 46.2 143 23.3 1.2
42-53 55 48.2 59 51.8 114 18.5 0.9
54-59 48 64.9 26 35.1 74 12.0 1.8
Total 327 53.2 288 46.8 615 100.0 1.1
Boys Girls Total Ratio
AGE (mo) no. % no. % no. % Boy: girl
6-17 72 52.9 64 47.1 136 26.4 1.1
4.2.2. Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex
Global acute malnutrition (GAM) WHZ is defined as <-2 z scores weight-for-height and/or oedema
while severe acute malnutrition is defined as <-3z scores weight-for height and/or oedema.
The prevalence of GAM and SAM in the IDP camps are presented in Tables 5-4 and 5-5. Prevalence
of GAM in Shaidayee was 8.7% (6.5–11.6 95% C.I.), whereas SAM was 1.6% (0.9-3.1 95% C.I.). GAM
prevalence in Shahrak sabz & Shahrak Setar Pahlawan) was 7.1% (4.9-10.3 95% C.I.), and SAM was
found to be 1.0% (0.4-2.2 95% C.I.). No oedema case was observed during the assessment in both
camps.
In the final analysis, 18 children (7 in Shaidayee & 11 in Shahrak sabz & Shahrak Setar Pahlawan) were
excluded due to out of range values using observed means SMART flags (-3 to 3 Z-score).
Table 5 4: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema)
and by sex
Status
Shaidayee camp
All n = 608
Boys n = 323
Girls n = 285
Prevalence of global malnutrition (<-2 z-score and/or oedema)
(53) 8.7 % (6.5 - 11.6 95% C.I.)
(33) 10.2 % (7.1 - 14.4 95% C.I.)
(20) 7.0 % (4.2 - 11.6 95% C.I.)
Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema)
(43) 7.1 % (5.0 - 10.0 95% C.I.)
(24) 7.4 % (4.7 - 11.6 95% C.I.)
(19) 6.7 % (3.9 - 11.1 95% C.I.)
Prevalence of severe malnutrition (<-3 z-score and/or oedema)
(10) 1.6 % (0.9 - 3.1 95% C.I.)
(9) 2.8 % (1.4 - 5.4 95% C.I.)
(1) 0.4 % (0.0 - 2.8 95% C.I.)
The survey did not find any cases of Oedema in both Camps. Table 5 5: Prevalence of acute malnutrition based on weight-for-height z-scores (and/or oedema) and by sex
Status
Shahrak Sabz & Shahra kSatar Pawlawan camp
All n = 504
Boys n = 250
Girls n = 254
18-29 62 44.3 78 55.7 140 27.2 0.8
30-41 51 45.5 61 54.5 112 21.7 0.8
42-53 45 54.2 38 45.8 83 16.1 1.2
54-59 26 59.1 18 40.9 44 8.5 1.4
Total 256 49.7 259 50.3 515 100.0 1.0
Prevalence of global malnutrition (<-2 z-score and/or oedema)
(36) 7.1 % (4.9 - 10.3 95% C.I.)
(22) 8.8 % (5.5 - 13.8 95% C.I.)
(14) 5.5 % (3.1 - 9.7 95% C.I.)
Prevalence of moderate malnutrition (<-2 z-score and >=-3 z-score, no oedema)
(31) 6.2 % (4.1 - 9.1 95% C.I.)
(18) 7.2 % (4.3 - 11.9 95% C.I.)
(13) 5.1 % (2.7 - 9.4 95% C.I.)
Prevalence of severe malnutrition (<-3 z-score and/or oedema)
(5) 1.0 % (0.4 - 2.2 95% C.I.)
(4) 1.6 % (0.6 - 3.9 95% C.I.)
(1) 0.4 % (0.0 - 3.1 95% C.I.)
4.2.3. Prevalence of acute malnutrition by age, based on weight-for-height z-scores and/or oedema
Age disaggregated results are shown the younger children ( 6-29 months) were more affected than
older children, for more details refer to table 5-6 & 5-7.
Table 5 6: Prevalence of acute malnutrition by age, based on weight-for-height z-scores and/or oedema, Shaidayee camp
Severe wasting
(<-3 z-score)
Moderate wasting (>= -3 and <-2 z-
score )
Normal (> = -2 z score)
Oedema
Age (mo) Total no. No. % No. % No. % No. %
6-17 99 6 6.1 20 20.2 73 73.7 0 0.0 18-29 181 2 1.1 11 6.1 168 92.8 0 0.0 30-41 140 2 1.4 6 4.3 132 94.3 0 0.0
42-53 114 0 0.0 3 2.6 111 97.4 0 0.0 54-59 74 0 0.0 3 4.1 71 95.9 0 0.0
Total 608 10 1.6 43 7.1 555 91.3 0 0.0 Table 5 7: Prevalence of acute malnutrition by age, based on weight-for-height z-scores and/or oedema, Shahrak Sabz & Shahrak Satar Pahlawan camps
Severe wasting
(<-3 z-score)
Moderate wasting
(>= -3 and <-2 z-score )
Normal (> = -2 z score)
Oedema
Age (mo) Total no. No. % No. % No. % No. % 6-17 130 4 3.1 14 10.8 112 86.2 0 0.0
18-29 137 0 0.0 5 3.6 132 96.4 0 0.0 30-41 111 1 0.9 6 5.4 104 93.7 0 0.0 42-53 82 0 0.0 6 7.3 76 92.7 0 0.0 54-59 44 0 0.0 0 0.0 44 100.0 0 0.0 Total 504 5 1.0 31 6.2 468 92.9 0 0.0
Table 5 8: Distribution of acute malnutrition and oedema based on weight-for-height z-scores.
Shaidayee camp
<-3 z-score >=-3 z-score
Oedema present Marasmic kwashiorkor
No. 0 (0.0 %)
Kwashiorkor No. 0
(0.0 %)
Oedema absent Marasmic
No. 15 (2.4 %)
Not severely malnourished No. 600 (97.6 %)
Table 5 9: Distribution of acute malnutrition and oedema based on weight-for-height z-scores. Shahrak Sabz & Shahra kSatar Pawlawan camp
<-3 z-score >=-3 z-score
Oedema present Marasmic kwashiorkor
No. 0 (0.0 %)
Kwashiorkor No. 0
(0.0 %)
Oedema absent Marasmic
No. 13 (2.5 %)
Not severely malnourished No. 502 (97.5 %)
4.2.4. Prevalence of acute malnutrition based on MUAC cut off's (and/or oedema)
The prevalence of global acute malnutrition based on MUAC (<125mm) and/or oedema in Shaidayee
camp was 5.2% (3.3-8.1 95% C.I.) and of severe acute malnutrition (MUAC <115mm and/or oedema)
was 1.0% (0.5-2.0 95% C.I.). In Shahrak sabz & Shahrak Satar Pahlawan camp the GAM prevalence
based on MUAC was 5.6% (3.2-9.8 95% C.I.), and the SAM prevalence was found to be 0.8% (0.3-2.0
95% C.I.). Detailed results are presented in tables 5-10 and 5-11.
Table 5 10: Prevalence of acute malnutrition based on MUAC cut offs (and/or oedema) and by sex. Shaidayee camp
All n = 615
Boys n = 327
Girls n = 288
Prevalence of global malnutrition (< 125 mm and/or oedema)
(32) 5.2 % (3.3 - 8.1 95%
C.I.)
(16) 4.9 % (2.7 - 8.7 95% C.I.)
(16) 5.6 % (2.7 - 11.0 95% C.I.)
Prevalence of moderate malnutrition (< 125 mm and >= 115 mm, no oedema)
(26) 4.2 % (2.6 - 6.9 95%
C.I.)
(14) 4.3 % (2.2 - 8.2 95% C.I.)
(12) 4.2 % (1.9 - 9.0 95% C.I.)
Prevalence of severe malnutrition (< 115 mm and/or oedema)
(6) 1.0 % (0.5 - 2.0 95%
C.I.)
(2) 0.6 % (0.1 - 2.6 95% C.I.)
(4) 1.4 % (0.6 - 3.4 95% C.I.)
Table 5 11: Prevalence of acute malnutrition based on MUAC cut offs (and/or oedema) and by sex. Shahrak Sabz & Shahra kSatar Pawlawan camp
All n = 515
Boys n = 256
Girls n = 259
Prevalence of global malnutrition (< 125 mm and/or oedema)
(29) 5.6 % (3.2 - 9.8 95% C.I.)
(11) 4.3 % (2.3 - 7.9 95% C.I.)
(18) 6.9 % (3.8 - 12.4 95% C.I.)
Prevalence of moderate malnutrition (< 125 mm and >= 115 mm, no oedema)
(25) 4.9 % (2.7 - 8.5 95% C.I.)
(10) 3.9 % (2.2 - 6.7 95% C.I.)
(15) 5.8 % (2.9 - 11.2 95% C.I.)
Prevalence of severe malnutrition (< 115 mm and/or oedema)
(4) 0.8 % (0.3 - 2.0 95% C.I.)
(1) 0.4 % (0.1 - 2.9 95% C.I.)
(3) 1.2 % (0.4 - 3.7 95% C.I.)
According to table, 5-12 & 5-13, younger children 6-29 months were more malnourished by MUAC
than older children above 2 years of age. This is perhaps indicative of suboptimal feeding practices of
children below 2 years.
Table 5 12: Prevalence of acute malnutrition by age, based on MUAC cut off's and/or oedema, Shaidayee camp
Severe wasting
(< 115 mm)
Moderate wasting
(>= 115 mm and < 125 mm)
Normal (> = 125 mm )
Oedema
Age (mo) Total no. No. % No. % No. % No. %
6-17 102 5 4.9 19 18.6 78 76.5 0 0.0 18-29 182 1 0.5 5 2.7 176 96.7 0 0.0 30-41 143 0 0.0 2 1.4 141 98.6 0 0.0 42-53 114 0 0.0 0 0.0 114 100.0 0 0.0 54-59 74 0 0.0 0 0.0 74 100.0 0 0.0 Total 615 6 1.0 26 4.2 583 94.8 0 0.0
Table 5 13: Prevalence of acute malnutrition by age, based on MUAC cut off's and/or oedema, Shahrak Sabz & Shahrak Satar Pahlawan camp
Severe wasting
(< 115 mm)
Moderate wasting
(>= 115 mm and < 125 mm)
Normal (> = 125 mm )
Oedema
Age (mo) Total no. No. % No. % No. % No. %
6-17 136 4 2.9 14 10.3 118 86.8 0 0.0 18-29 140 0 0.0 7 5.0 133 95.0 0 0.0 30-41 112 0 0.0 2 1.8 110 98.2 0 0.0 42-53 83 0 0.0 2 2.4 81 97.6 0 0.0 54-59 44 0 0.0 0 0.0 44 100.0 0 0.0 Total 515 4 0.8 25 4.9 486 94.4 0 0.0
4.3. Prevalence of Combined Acute Malnutrtion based on WHZ and/or MUAC
The prevalence of combined GAM among children 6-59 months in Herat IPDs (Shaidayee camp was
10.9% (8.2-14.2 95% CI), Shahrak Sabz & Shahrak Satar Pahlawan camp was 10.5% (7.5-14.6 95% CI)
as presented in table 7 below. The prevalence of combined SAM among children 6-59 months were
in Shaidayee camp : 2.1% (1.3- 3.4 95% CI) ; in Shahrak Sabz & Shahrak Satar Pahlawan camp : 1.2%
(0.6- 2.4 95% CI). Although there is not globally established threshold for combined GAM and SAM,
further analysis done for the caseload calculation suggesting that combined GAM indicator captured
more acutely malnourished children.
Table 5 14: Prevalence of malnutrition based on both criteria (WHZ+MUAC) and by sex.
Shaidayee camp
All n = 608
Boys n = 323
Girls n = 285
Prevalence of global acute malnutrition ( MUAC<125mm+ WHZ<-2 SD)
(66) 10.9% (8.2-14.2 95% CI)
(38) 11.8% (8.4-16.2 95% CI)
(28) 9.8% (6.1-15.5 95% CI)
Prevalence of severe acute malnutrition ( MUAC<115mm+ WHZ<-3 SD)
(13) 2.1% (1.3- 3.4 95% CI)
( 9) 2.8% (1.4- 5.4 95% CI)
(4) 1.4% (0.6- 3.5 95% CI)
Table 5 15: Prevalence of malnutrition based on both criteria (WHZ+MUAC) and by sex.
Shahrk Sabz & Shaharak Satar pahlawan
All n = 504
Boys n = 250
Girls n = 254
Prevalence of global acute malnutrition ( MUAC<125mm+ WHZ<-2 SD)
(53) 10.5% (7.5-14.6 95% CI)
(27) 10.8% (7.6-15.2 95% CI)
(26) 10.2% ( 6.5-15.7 95% CI)
Prevalence of severe acute malnutrition ( MUAC<115mm+ WHZ<-3 SD)
(6) 1.2% (0.6- 2.4 95% CI)
(4) 1.6% (0.6- 3.9 95% CI)
(2) 0.8% (0.2- 3.2 95% CI)
4.3.1. Prevalence of underweight based on weight-for-age z-scores
Weight for Age is a composite index that measures both stunting and wasting.
The prevalence of underweight in Shaidayee camp and Shahrak Sabz & Shahrak Satar Pahlawan camp
of Herat IDP camp were 20.4% (15.9-25.8 95% C.I) and 20.0% (13.9-28.0 95% C.I.), respectively as
indicated in table 5-16 and 5-17.
Table 5 16: Prevalence of underweight based on weight-for-age z-scores by sex., Herat IDP camps
Table 5 17: Prevalence of underweight based on weight-for-age z-scores by sex, Herat IDP camps
Shaidayee camp
All
n = 602 Boys
n = 318 Girls
n = 284
Prevalence of underweight (<-2 z-score) (123) 20.4 %
(15.9 - 25.8 95% C.I.)
(68) 21.4 % (15.8 - 28.3 95%
C.I.)
(55) 19.4 % (14.4 - 25.5 95%
C.I.)
Prevalence of moderate underweight (<-2 z-score and >=-3 z-score)
(97) 16.1 % (12.5 - 20.5 95% C.I.)
(52) 16.4 % (11.8 - 22.2 95%
C.I.)
(45) 15.8 % (11.7 - 21.0 95%
C.I.)
Prevalence of severe underweight (<-3 z-score)
(26) 4.3 % (2.9 - 6.4 95% C.I.)
(16) 5.0 % (3.4 - 7.5 95% C.I.)
(10) 3.5 % (1.7 - 7.1 95% C.I.)
Shahrk Sabz & Shaharak Satar pahlawan camp
All
n = 505 Boys
n = 251 Girls
n = 254
Prevalence of underweight (<-2 z-score) (101) 20.0 %
(13.9 - 28.0 95% C.I.)
(55) 21.9 % (15.5 - 30.0 95%
C.I.)
(46) 18.1 % (11.3 - 27.8 95%
C.I.)
Prevalence of moderate underweight (<-2 z-score and >=-3 z-score)
(81) 16.0 % (11.4 - 22.2 95% C.I.)
(44) 17.5 % (12.4 - 24.2 95%
C.I.)
(37) 14.6 % (9.4 - 21.9 95%
C.I.)
Prevalence of severe underweight (<-3 z-score)
(20) 4.0 % (2.0 - 7.8 95% C.I.)
(11) 4.4 % (2.1 - 8.8 95% C.I.)
(9) 3.5 % (1.3 - 9.0 95% C.I.)
4.3.2. Prevalence of stunting based on height-for-age z-scores and by sex
Stunting is indicated by low height/length for age compared to WHO standard 2006.
From the survey findings, the stunting rate for children aged 6-59 months in Herat IDPs camps were
35.9% (28.1-44.5 95% C.I.) in Shaidayee camp and 40.5% (29.3-51.5 95% C.I.) in Shahrak Sabz &
Shahrak Satar Pahlawan camp as indicated in tables 5-18 and 5-19.
Table 5 18: Prevalence of stunting based on height-for-age z-scores and by sex., Herat IDP camps
Table 5 19: Prevalence of stunting based on height-for-age z-scores and by sex., Herat IDP camps
4.3.3. Mean z-scores, Design Effects and excluded subjects
The overall score for the current Rapid SMART surveys was categorized as a good (12% for Shaidayee and 13% for Sharhak Sabz. Meanwhile the SD was in limited range (0.8-1.20) for more plausibility check see Annex 1 & 2)
Shaidayee Camp
All
n = 582 Boys
n = 307 Girls
n = 275
Prevalence of stunting (<-2 z-score)
(209) 35.9 % (28.1 - 44.5 95%
C.I.)
(114) 37.1 % (28.1 - 47.2 95%
C.I.)
(95) 34.5 % (27.1 - 42.9 95%
C.I.)
Prevalence of moderate stunting (<-2 z-score and >=-3 z-score)
(124) 21.3 % (16.7 - 26.8 95%
C.I.)
(75) 24.4 % (18.2 - 32.0 95%
C.I.)
(49) 17.8 % (13.6 - 22.9 95%
C.I.)
Prevalence of severe stunting (<-3 z-score)
(85) 14.6 % (10.4 - 20.2 95%
C.I.)
(39) 12.7 % (8.1 - 19.3 95% C.I.)
(46) 16.7 % (12.5 - 22.0 95%
C.I.)
Shahrk Sabz & Shaharak Satar pahlawan
All
n = 459 Boys
n = 229 Girls
n = 230
Prevalence of stunting (<-2 z-score)
(186) 40.5 % (30.5 - 51.5 95% C.I.)
(93) 40.6 % (29.3 - 53.1 95% C.I.)
(93) 40.4 % (29.9 - 51.9
95% C.I.)
Prevalence of moderate stunting (<-2 z-score and >=-3 z-score)
(92) 20.0 % (14.8 - 26.6 95% C.I.)
(48) 21.0 % (13.5 - 31.1 95% C.I.)
(44) 19.1 % (14.2 - 25.3
95% C.I.)
Prevalence of severe stunting (<-3 z-score)
(94) 20.5 % (14.4 - 28.3 95% C.I.)
(45) 19.7 % (12.9 - 28.7 95% C.I.)
(49) 21.3 % (14.6 - 30.0
95% C.I.)
Table 5-20 and 5-21 shows the distribution of the sample statistics for the surveys. The standard
deviations (SD) for WHZ, WAZ & HAZ were within the acceptable range of 0.8-1.2. However, with
design effect of 4.03 and 5.08 respectively, for HAZ for both IDPs, the sample population showed
some degree of heterogeneity for chronic malnutrition for more information refer to Annex 1 and 2
plausibility check.
Table 5 20: Mean z-scores, design effect and excluded subjects, Shaidayee camp Indicator N Mean z-
scores ± SD Design Effect (z-score < -2)
z-scores not available*
z-scores out of range
Weight-for-Height 608 -0.39±1.11 1.14 0 7
Weight-for-Age 602 -1.04±1.10 2.12 0 13
Height-for-Age 582 -1.49±1.35 4.03 0 33 * contains for WHZ and WAZ the children with edema.
Table 5 21: Mean z-scores, design effect and excluded subjects, Shahrak Sabz & Shahrak Satar Pahlawan camp Indicator N Mean z-scores ±
SD Design Effect (z-
score < -2) z-scores not
available* z-scores out of
range
Weight-for-Height 504 -0.31±1.14 1.23 0 11
Weight-for-Age 505 -1.04±1.13 3.68 0 10
Height-for-Age 459 -1.64±1.43 5.08 0 56
* contains for WHZ and WAZ the children with oedema
4.4. Child morbidity
High prevalence of diarrhea was recorded in both Shaidayee and Shahrak Sabz & Shahrak Satar
Pahlawan camps of Herat (Table 5-22 and 5-23). Nearly one out of two surveyed children were
reported as suffering from diarrhea in the past two weeks prior to the assessment.
Table 5 22: Morbidity among children 6-59 months, Herat IDP camps
Table 5 23: Morbidity among children 6-59 months, Herat IDP camps
Shaidayee camp
(N=615)
n %
Diarrhea 6-59 months, two weeks recall 276 44.9%
Shahrak Sabz & Shahrak Satar Pahlawan camp
(N=515)
N %
4.5. Maternal nutritional status
The nutritional status of pregnant and lactating women was analyzed by MUAC. From the survey
findings, 25.1% and 24.2% of women were found to be acutely malnourished in Shaidayee and in
Shahrak Sabz & Satar Pahlawan camps, respectively as indicated in table 5-24 and 5-25.
Table 5 24: Maternal nutritional status based on MUAC cut-off points for PLW, Herat IDP camps.
Table 5 25: Maternal nutritional status based on MUAC cut-off points for PLW, Herat IDP camps.
4.6. Proportion of acutely malnourished children enrolled in & referred to a nutrition program
The number of children enrolled in the nearby OPD-SAM program was only 8.8 % and 9.1% in
Shaidayee and Shahrak Sabz & Shahrak Satar Pahlawan camps, respectively. Overall, of children
identified as acutely malnourished by the survey teams only 32.4% in Shaidayee and 42.4% in Shahrak
Sabz & Shahrak Satar Pahlawan camp were enrolled in a program at the time of survey (Table 5-26).
The low coverage of nutrition services is seen as a gap in response needs in the camps. All acutely
malnourished children found during assessment were referred using referral forms to the nearby
health center with OPD-SAM and OPD-MAM program. Some of the teams could not use the WHZ -
score chart properly in the field and missed passive screening.
Diarrhea 6-59 months, two weeks recall
249 48.3%
Shaidayee IDPs camp (N=223)
n %
Global Acute Malnutrition (GAM) MUAC < 230 mm
56 25.1%
Moderate Acute Malnutrition (MAM) MUAC < 230 -≥185 mm
53 23.8 %
Severe Acute Malnutrition (SAM) MUAC < 185 mm
3 1.3%
Shahrak Sabz & Satar Pahlawan IDPs camp
(N=227)
N %
Global Acute Malnutrition (GAM) MUAC < 230 mm
55 24.2%
Moderate Acute Malnutrition (MAM) MUAC < 230 -≥185 mm
53 23.3%
Severe Acute Malnutrition (SAM) MUAC < 185 mm
2 0.9%
Table 5 26: Proportion of Acutely Malnourished Children 6-59 Months Enrolled in a Treatment Programme
Sample Enrolled in an
OPD-SAM Enrolled in an OPD-MAM
Enrolled in an IPD-SAM Not Enrolled
Acutely malnourished children 6-59 months by WHZ, MUAC, or oedema (N=34) in Shaidayee camp
(3) 8.8% (8) 23.5% (0) 0.0% (23) 67.6%
Acutely malnourished children 6-59 months by WHZ, MUAC, or oedema (N=33) in Shahrak Sabz & Shahrak Satar Pahlawan
camp
(3) 9.1% (11) 33.3% (0) 0.0% (19)57.6%
5. DISCUSION
The GAM prevalence based on weight-for-height <-2 z-scores was classified as medium level of
severity for both IDPS, {Shaidayee camp was at 8.7% (6.5-11.6 95% CI), Shaharak Sabz & Shahrak
Satar Pahlawan was at 7.1% (4.9-10.3 95% CI)}, according to UNICEF-WHO severity classification.
If MUAC and WHZ criteria are combined, the overall prevalence of children likely to be eligible for
SAM and MAM management in the camps were Shaidayee 10.9% (8.2-14.2 95% CI), Shahrak Sabz &
Shahrak Satar Pahlawan 10.5% (7.5-14.6 95% CI. Combined WHZ (<-3 z-score) and MUAC (<115 mm)
illustrates that SAM prevalence was at (Shaidayee 2.1% (1.3- 3.4 95% CI), Shahrak Sabz & Shahrak
Satar Pahlawan 1.2% (0.6- 2.4 95% CI). This suggests a high proportion of children under-five affected
by acute malnutrition in the camps when considering both WHZ and MUAC criteria instead of
considering separately those 2 indicators. Combined prevalence captures a greater proportion of
acutely malnourished children 6-59 months, and may inform better the estimation of SAM and MAM
caseloads in the camp, ultimately, strengthening planning and programming.
Figure 1: GAM children captured by WHZ, MUAC and combined
By considering the combined GAM rate, it is estimated that 3,308 children are acutely malnourished
in the Shaidayee camp as today (out of 175,440 population with combined GAM rate 10.9%), and
1,876 children acutely malnourished in the Shahrak Sabz & Shahrak Satar Pahlawan camp as today (
out of 103,292 population, with combined GAM 10.5%), with 17.3% under-five population estimation.
Stunting prevalence was at (35.9% (28.1-44.5 95% CI) in Shaidayee camp and 40.5% (30.5-51.5 95%
CI) in Shahrak Sabz & Shahrak Satar Pahlawan camp. High stunting levels are usually seen in contexts
with very low access to health services, low sanitation levels and low maternal nutritional status,
High stunting rates are in line with the compromised nutritional status of women in childbearing age
(15-49 years). From the survey findings it shows pregnant and lactating women (PLWs) malnutrition
status was at 25.1% in Shaidayee % and was at 24.2% in Shahrak Sabz & Shahrak Satar Pahlawan
based on MUAC < 230 mm.
From the direct observation of the Rapid SMART survey teams shows that the poor awareness about
the available health and nutrition services, weak Health Education and weak awareness of use of safe
drinking water soureces were the biggest limitations during the survey period. The proportion of
children (6-59 months) reported having diarrhea based on two-week recall period was very high for
both camps : Shaidayee 44.9 %, Shahrak Sabz & Shahrak Satar Pahlawan 48.3%/ It means that 1 in 2
children are reported to be suffering from diarrhea. The burden of diseases among under-five increases
the SAM and MAM caseloads, as disease is an immediate cause to under-nutrition.
10.9%
8.7%
5.2%
11%
7.1%
5.6%
GAM COMBINED
GAM ONLY WHZ
GAM ONLY MUAC
GAM COMBINED
GAM ONLY WHZ
GAM ONLY MUAC
Shahrak Sabz & Shahrak Satar Palwan camp
Shaidayee camp
21
6. RECOMMENDATIONS
Increasing IHNMT numbers in the camps; as per the SMART technical team observations
from the IDP camps, it is recommended to keep the number of existing integrated health
and nutrition mobile “IHNMT teams in the area.
Expending active case finding in the camps; during the assessments in Shaidayee, Shahrak
Sabz and Satar Pahlawan Camps, 67 active SAM cases were recorded, out of them 32 cases
were not admitted in the program, which shows low nutrition program coverage in the
camps. So, it is highly recommended to conduct an exhaustive Active-Adaptive case finding
in the targeted area to have most of the malnourished children in the program.
Expanding TSFP Program, PLW malnutrition in both Rapid SMART assessments was 24.5
%, which indicate an inadequate nutrition status of current pregnant and lactating women
To improve the situation and to get rid of the PLW malnutrition, it is needed to expand the
existing TSFP program in the camps and to make the services available for all malnourished
children and PLWs.
Launching food demonstration program in the IDPs community to increase knowledge of
women on proper using of nutritious locally available foods to prevent the maternal
nutrition .
Advocacy for health program and enhancing Health Education; Poor awareness about the
available health and nutrition services and weak Health Education were the biggest
limitations during the assessment, to make the program implementation smooth and to
make the existing services accessible for all people conducting public awareness, personal
& environmental hygiene and health education sessions are needed and highly
recommended.
Provide WASH community mobilization to increase access to safe drinking water and
hygiene to decrease the high burden of diarrhea.
21
7. ANNEXES
Annex 1: Plausibility check for: Herat_IDP camps ( Shaidayee) _April_2019_Afghanistan.as Standard/Reference used for z-score calculation: WHO standards 2006 (If it is not mentioned, flagged data is included in the evaluation. Some parts of this plausibility report are more for advanced users and can be skipped for a standard evaluation) Overall data quality Criteria Flags* Unit Excel. Good Accept Problematic Score Flagged data Incl % 0-2.5 >2.5-5.0 >5.0-7.5 >7.5 (% of out of range subjects) 0 5 10 20 0 (1.1 %) Overall Sex ratio Incl p >0.1 >0.05 >0.001 <=0.001 (Significant chi square) 0 2 4 10 0 (p=0.116) Age ratio(6-29 vs 30-59) Incl p >0.1 >0.05 >0.001 <=0.001 (Significant chi square) 0 2 4 10 0 (p=0.908) Dig pref score - weight Incl # 0-7 8-12 13-20 > 20 0 2 4 10 0 (5) Dig pref score - height Incl # 0-7 8-12 13-20 > 20 0 2 4 10 4 (17) Dig pref score - MUAC Incl # 0-7 8-12 13-20 > 20 0 2 4 10 2 (11) Standard Dev WHZ Excl SD <1.1 <1.15 <1.20 >=1.20 . and and and or . Excl SD >0.9 >0.85 >0.80 <=0.80 0 5 10 20 5 (1.11) Skewness WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6
0 1 3 5 1 (-0.28) Kurtosis WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6 0 1 3 5 0 (-0.11) Poisson dist WHZ-2 Excl p >0.05 >0.01 >0.001 <=0.001 0 1 3 5 0 (p=0.214) OVERALL SCORE WHZ = 0-9 10-14 15-24 >25 12 % The overall score of this survey is 12 %, this is good. Annex 2: Plausibility check for: Herat_IDP_camps ( HSharak Sabz) _April_2019_Afghanistan.as Overall data quality Criteria Flags* Unit Excel. Good Accept Problematic Score Flagged data Incl % 0-2.5 >2.5-5.0 >5.0-7.5 >7.5 (% of out of range subjects) 0 5 10 20 0 (2.4 %) Overall Sex ratio Incl p >0.1 >0.05 >0.001 <=0.001 (Significant chi square) 0 2 4 10 0 (p=0.895) Age ratio(6-29 vs 30-59) Incl p >0.1 >0.05 >0.001 <=0.001 (Significant chi square) 0 2 4 10 4 (p=0.001) Dig pref score - weight Incl # 0-7 8-12 13-20 > 20 0 2 4 10 0 (5) Dig pref score - height Incl # 0-7 8-12 13-20 > 20 0 2 4 10 2 (11) Dig pref score - MUAC Incl # 0-7 8-12 13-20 > 20 0 2 4 10 2 (10)
Standard Dev WHZ Excl SD <1.1 <1.15 <1.20 >=1.20 . and and and or . Excl SD >0.9 >0.85 >0.80 <=0.80 0 5 10 20 5 (1.13) Skewness WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6 0 1 3 5 0 (-0.05) Kurtosis WHZ Excl # <±0.2 <±0.4 <±0.6 >=±0.6 0 1 3 5 0 (-0.04) Poisson dist WHZ-2 Excl p >0.05 >0.01 >0.001 <=0.001 0 1 3 5 0 (p=0.185) OVERALL SCORE WHZ = 0-9 10-14 15-24 >25 13 % The overall score of this survey is 13 %, this is good
Annex 3: Selected clusters Herat IDPs Shaidayee camp
Enumerations area Total Population Cluster Number
Street 1: Chief /Malik 01 8000 1,2
Street 1: Chief /Malik 02 6300 3
Street 2: Chief /Malik 03 9100 4
Street 3:Chief /Malik 01 8400 5
Street 3:Chief /Malik 02 9800 6,7
Street 4: Chief /Malik 01 3500 8
Street 4:Chief /Malik 02 4200
Street 4:Chief /Malik 03 4200 9
Street 4: Chief /Malik 04 4130 10
Street 4:Chief /Malik 05 3850
Street 5:Chief /Malik 01 5600 11
Street 5:Chief /Malik 02 5460 12
Street 5:Chief /Malik 03 4690 13
Street 5:Chief /Malik 04 5600 14
Street 5:Chief /Malik 05 4200
Street 6:Chief /Malik 01 4550 15
Street 6:Chief /Malik 02 3920 RC
Street 6:Chief /Malik 03 3780
Street 6:Chief /Malik 04 4550 16
Street 6:Chief /Malik 05 3150
Street 6:Chief /Malik 06 3850 17
Street 6:Chief /Malik 07 4200 18
Street 7:Chief /Malik 01 4690
Street 7:Chief /Malik 02 4900 19
Street 7:Chief /Malik 03 5600 RC
Street 7:Chief /Malik 04 5600 20
Street 7:Chief /Malik 05 6160 21
Street 7:Chief /Malik 06 9100 22
Street 7:Chief /Malik 07 6090 23
Street 8:Chief /Malik 01 4550 24
Street 8:Chief /Malik 02 5320 RC
Street 8:Chief /Malik 03 3850 25
Street 8:Chief /Malik 04 4550
Annex 4: Selected clusters Herat IDPs Shahrak Sabz & Shahrak Satar Pahlawan
Shaharak Sabz 1:Chief /Malik 01 18011 1,2,RC,3,4
Shaharak Sabz 2:Chief /Malik 01 3388
Regristion :Chief /Malik 01 5173 5,6
Shaharak Satar Palawan :Chief /Malik 03 3500 7
Shaharak Satar Palawan:Chief /Malik 04 5600 8
Shaharak Satar Palawan :Chief /Malik 05 6300 9,10
Shaharak Satar Palawan :Chief /Malik 06 2800 RC
Shaharak Satar Palawan: Chief /Malik 07 3500 11
Shaharak Satar Palawan :Chief /Malik 08 4900 12
Shaharak Satar Palawan :Chief /Malik 09 4200 13
Shaharak Satar Palawan :Chief /Malik 10 3500 14
Shaharak Satar Palawan :Chief /Malik 11 2800 RC
Shaharak Satar Palawan :Chief /Malik 12 4200 15
Shaharak Satar Palawan :Chief /Malik 13 4900 16
Sofi Qudos :Chief /Malik 01 5600 17,18
Sofi Qudos :Chief /Malik 02 4900 19
Sofi Qudos :Chief /Malik 03 3920 20
Sofi Qudos :Chief /Malik 04 4550 21,22
Sofi Qudos :Chief /Malik 05 3850 23
Sofi Qudos :Chief /Malik 06 4550 24
Sofi Qudos :Chief /Malik 07 3150 25
Annex 5. Herat IDPs camps field Map.
25
3
161,140
Street 1
باغ وحش
End of IDPs
Street 2
Resurved Clusters
Total IDPs Households
Stre
et 6
Stre
et 7
Stre
et 8
Herat Rapid SMARTs Field Plan
ShahrakSabz 1 Shahrkasabz2 Regration
This area will be covered by first Rapid SMART
This area will be covered by Second Rapid SMART
Health and Nutrition Team
Total Clusters
Stre
et 1
Stre
et 2
Pediatric Hopstial
Prot
ecte
d ID
PS
Stre
et 5
Stre
eet 3
Stre
et 4
Shah
rak
Sabz
Str
eet
Shai
daye
Gar
den
Police Check
Point
Canal West
North
East
South Sofi Qodus Garden
Herat Karokh Highway
Sata
r Pah
law
an S
hahr
ak
Behind of Sofi Qodus Garden
RNA2
Total Clusters 25
Reserve Clusters 3Total IDPs Population 103,292
RNA1
Annex 6: Rapid SMART Assessment questionnaires for children and pregnant and lactating women
Date
(dd/mm/year) Cluster Name
Cluster Number Team Number HH Number
Child Questionnaire 6-59 months
Note only if length is measured for a child who is older than 2 years or height is measured for a child who is younger than 2 years, due to unavoidable circumstances in the field. Child Questionnaire
Child (6-59 months) ID Number
For any child that is identified as acutely malnourished (WHZ, MUAC, or edema)
Q1. Is the child currently receiving any malnutrition treatment services?
Probe, ask for enrollment card, and observe the treatment food (RUTF / RUSF) to
identify the type of treatment service
1=OPD SAM
2=OPD MAM
3=IPD SAM
4=No treatment
98=Don’t know
If the child is not enrolled in a treatment program, refer to nearest appropriate
treatment center
Q2. Did you refer the child?
1 2 3 4 5 6 7 8 9 10
Child ID
Sex (f/m)
Birthday (dd/mm/yyyy)
Age (months)
Weight (00.0 kg)
Height or length
(00.0 cm)
Measure (l/h)*
Bilateral
edema Y/N
MUAC (000 mm)
Left arm
With clothes
(y/n)
1
2
3
4
5
6
7
8
1=yes
0=no
Woman (15-49 years) age in years
Physiologic Status of woman
1=Pregnant
2=Lactating
3=Pregnant and lactating
4=None
MUAC measurement (mm)
Child (6-59 months) ID Number
Q3. In the past two weeks, has the child had diarrhea?
Diarrhea defined as the passage of three or more loose or liquid
stools in a day
1=yes
0=no
98=don’t know
General comments (optional)
Annex 7: Event calendar
اسم ماه ماه 1393 ماه 1394 ماه 1395 ماه 1396 ماه 1397 ماه 1398
حمل
شروع مکاتب. چهار شنبه اول
سال . 13 بدر. گل های الله . وقت
کاهوها . زاده ولد گسفندها .
سماروق . روز نوروز وقت
سیالبها . گل دختر
49
شروع مکاتب. چهار شنبه اول
سال . 13 بدر. گل های الله .
وقت کاهوها . زاده ولد گسفندها
. سماروق . روز نوروز وقت
سیالبها . گل دختر
37
شروع مکاتب. چهار شنبه اول
سال . 13 بدر. گل های الله .
وقت کاهوها . زاده ولد گسفندها
. سماروق . روز نوروز وقت
سیالبها . گل دختر
25
شروع مکاتب. چهار شنبه اول
سال . 13 بدر. گل های الله .
وقت کاهوها . زاده ولد گسفندها
. سماروق . روز نوروز وقت
سیالبها . گل دختر
13
شروع مکاتب. چهار شنبه اول
سال . 13 بدر. گل های الله .
وقت کاهوها . زاده ولد گسفندها
. سماروق . روز نوروز وقت
سیالبها . گل دختر
1
شروع مکاتب. چهار شنبه اول
سال . 13 بدر. گل های الله .
وقت کاهوها . زاده ولد گسفندها
. سماروق . روز نوروز وقت
سیالبها . گل دختر
فصل کاهو. 8 ثور. پیروزی
مجاهدین. فصل میوه هایی
نارسیده . وقت غوره
اخکوک.رواشک و نیش زدن
تاریاک
فصل کاهو. 8 ثور. پیروزی
مجاهدین. فصل میوه هایی
نارسیده . وقت غوره
اخکوک.رواشک و نیش زدن
تاریاک
فصل کاهو. 8 ثور. پیروزی
مجاهدین. فصل میوه هایی
نارسیده . وقت غوره
اخکوک.رواشک و نیش زدن
تاریاک
فصل کاهو. 8 ثور. پیروزی
مجاهدین. فصل میوه هایی
نارسیده . وقت غوره
اخکوک.رواشک و نیش زدن
تاریاک
فصل کاهو. 8 ثور. پیروزی
مجاهدین. فصل میوه هایی
نارسیده . وقت غوره
اخکوک.رواشک و نیش زدن
تاریاک
شروع درو گندم ابی . کندن کرابیه
. پیله ابریشم . پخته شدن زردالو .
14 جوزا روز مادر . وقت پشها .
وقت جوجها . پخته شدن زردالو.
کشت زعفران. سیب شکره . وقت
خوشه زدن. رمضان
شروع درو گندم ابی . کندن
کرابیه . پیله ابریشم . پخته شدن
زردالو . 14 جوزا روز مادر .
وقت پشها . وقت جوجها . پخته
شدن زردالو. کشت زعفران.
سیب شکره . وقت خوشه زدن.
رمضان
شروع درو گندم ابی . کندن
کرابیه . پیله ابریشم . پخته شدن
زردالو . 14 جوزا روز مادر .
وقت پشها . وقت جوجها . پخته
شدن زردالو. کشت زعفران.
سیب شکره . وقت خوشه زدن.
رمضان
شروع درو گندم ابی . کندن
کرابیه . پیله ابریشم . پخته شدن
زردالو . 14 جوزا روز مادر .
وقت پشها . وقت جوجها . پخته
شدن زردالو. کشت زعفران.
سیب شکره . وقت خوشه زدن.
رمضان
شروع درو گندم ابی . کندن
کرابیه . پیله ابریشم . پخته شدن
زردالو . 14 جوزا روز مادر .
وقت پشها . وقت جوجها . پخته
شدن زردالو. کشت زعفران.
سیب شکره . وقت خوشه زدن.
رمضان
سرطان 58
باد 120 روزه. کندم درو. وقت
میوه های تابستانی ) انگور و
شفتالو( رخضتی چهار نیم ماه .
کشت شالی.
46
باد 120 روزه. کندم درو. وقت
میوه های تابستانی ) انگور و
شفتالو( رخضتی چهار نیم ماه .
کشت شالی.
34
باد 120 روزه. کندم درو. وقت
میوه های تابستانی ) انگور و
شفتالو( رخضتی چهار نیم ماه .
کشت شالی.
22
باد 120 روزه. کندم درو. وقت
میوه های تابستانی ) انگور و
شفتالو( رخضتی چهار نیم ماه .
کشت شالی.
10
باد 120 روزه. کندم درو. وقت
میوه های تابستانی ) انگور و
شفتالو( رخضتی چهار نیم ماه .
کشت شالی.
اسد 57
وسط بادها 120 روزه . 28 اسد )
ازادی اقغانستان ( امدن مالدارها
به قریه . وقت جمعه واری ماش
مشنگ کنجت
45
وسط بادها 120 روزه . 28 اسد
) ازادی اقغانستان ( امدن
مالدارها به قریه . وقت جمعه
واری ماش مشنگ کنجت
33
وسط بادها 120 روزه . 28 اسد
) ازادی اقغانستان ( امدن
مالدارها به قریه . وقت جمعه
واری ماش مشنگ کنجت
21
وسط بادها 120 روزه . 28 اسد
) ازادی اقغانستان ( امدن
مالدارها به قریه . وقت جمعه
واری ماش مشنگ کنجت
9
وسط بادها 120 روزه . 28 اسد
) ازادی اقغانستان ( امدن
مالدارها به قریه . وقت جمعه
واری ماش مشنگ کنجت
سنبله 56
وقت جمع واری پسته . جمع
واری تخم زاعفران . شروع فراه
باد . وقت زخیره ایزوم
44
وقت جمع واری پسته . جمع
واری تخم زاعفران . شروع فراه
باد . وقت زخیره ایزوم
32
وقت جمع واری پسته . جمع
واری تخم زاعفران . شروع فراه
باد . وقت زخیره ایزوم
20
وقت جمع واری پسته . جمع
واری تخم زاعفران . شروع فراه
باد . وقت زخیره ایزوم
8
وقت جمع واری پسته . جمع
واری تخم زاعفران . شروع فراه
باد . وقت زخیره ایزوم
میزان 55برگ ریزی یا خزان . کشت تیرماه
. جمعه واری علوفه . وفت انار .43
برگ ریزی یا خزان . کشت
تیرماه . جمعه واری علوفه .
وفت انار .
31
برگ ریزی یا خزان . کشت
تیرماه . جمعه واری علوفه .
وفت انار .
19
برگ ریزی یا خزان . کشت
تیرماه . جمعه واری علوفه .
وفت انار .
7
برگ ریزی یا خزان . کشت
تیرماه . جمعه واری علوفه .
وفت انار .
بعقر 54
جشن گل زعفران . اماده نمودن
الندی . وقت چهار مغز42
جشن گل زعفران . اماده نمودن
الندی . وقت چهار مغز30
جشن گل زعفران . اماده نمودن
الندی . وقت چهار مغز18
جشن گل زعفران . اماده نمودن
الندی . وقت چهار مغز6
جشن گل زعفران . اماده نمودن
الندی . وقت چهار مغز
شروع بادخزانی. گذاشتن بهاری و
کرسی . شروع امتحان هایی
مکاتب .
شروع بادخزانی. گذاشتن بهاری
و کرسی . شروع امتحان هایی
مکاتب .
شروع بادخزانی. گذاشتن بهاری
و کرسی . شروع امتحان هایی
مکاتب .
شروع بادخزانی. گذاشتن بهاری
و کرسی . شروع امتحان هایی
مکاتب .
شروع بادخزانی. گذاشتن بهاری
و کرسی . شروع امتحان هایی
مکاتب .
یجد 52
6 جدی . چله کالن . سر زمستان .
شب یالدا . وقت الندی ها وقت
اماد کردن غذاهایی محلی . ساه
باد .
40
6 جدی . چله کالن . سر زمستان
. شب یالدا . وقت الندی ها وقت
اماد کردن غذاهایی محلی . ساه
باد .
28
6 جدی . چله کالن . سر زمستان
. شب یالدا . وقت الندی ها وقت
اماد کردن غذاهایی محلی . ساه
باد .
16
6 جدی . چله کالن . سر زمستان
. شب یالدا . وقت الندی ها وقت
اماد کردن غذاهایی محلی . ساه
باد .
4
6 جدی . چله کالن . سر زمستان
. شب یالدا . وقت الندی ها وقت
اماد کردن غذاهایی محلی . ساه
باد .
دلوه 51برف باری . چله خورد. جنگ چله
ها.39
برف باری . چله خورد. جنگ
چله ها.27
برف باری . چله خورد. جنگ
چله ها.15
برف باری . چله خورد. جنگ
چله ها.3
برف باری . چله خورد. جنگ
چله ها.
تحو 50
امادگی نوروز. 24) قیام مردم
هرات ( کشت پالیزها . کشت گندم .
کوچ کردن کوچیها. پتک .
مندوالق. مخ و فت . امن بمن
38
امادگی نوروز. 24) قیام مردم
هرات ( کشت پالیزها . کشت گندم
. کوچ کردن کوچیها. پتک .
مندوالق. مخ و فت . امن بمن
26
امادگی نوروز. 24) قیام مردم
هرات ( کشت پالیزها . کشت گندم
. کوچ کردن کوچیها. پتک .
مندوالق. مخ و فت . امن بمن
14
امادگی نوروز. 24) قیام مردم
هرات ( کشت پالیزها . کشت گندم
. کوچ کردن کوچیها. پتک .
مندوالق. مخ و فت . امن بمن
2
امادگی نوروز. 24) قیام مردم
هرات ( کشت پالیزها . کشت گندم
. کوچ کردن کوچیها. پتک .
مندوالق. مخ و فت . امن بمن
ثورجوزا 3559
سقو 529 1754
122436
41
48
47 1123