1. INTERAGENCY NUTRITION SURVEY ON SYRIAN REFUGEES IN JORDAN PRELIMINARY RESULTS OF SOME KEY INDICATORS 4 MAY 2014 AMMAN, JORDAN

2. ACKNOWLEDGEMENTS Medair CDC UNFPA, UNHCR, UNICEF, WFP, and WHO

3. BACKGROUND Two independent surveys 1 survey on the Syrian refugees in Zaatari camp 1 survey on all Syrian refugees outside the camp Data collection ended on 1 May 2014 Results of some key indicators are presented here

4. SURVEY OBJECTIVES To estimate the prevalence of acute malnutrition among children 6-59 months To estimate the prevalence of acute malnutrition among women of reproductive age To measure the prevalence of anaemia in children aged 6-59 months and in women of reproductive age between 15-49 years (non-pregnant) To investigate IYCF practices among children 0-23 months To define the current state of food security among the refugee population To determine the population's access to, and use of, improved water and sanitation and hygiene facilities

5. SAMPLE SIZE ParameterUsed values - campUsed values – outside camp Estimated prevalence (%)5.85.1 Desired Precision (%)33 Design Effect1.11.9 Average HH size55 % of children <5 years19 % of non-response Household33 Sample size: # of children 279427 Sample size: # of households337515

6. METHODOLOGY: ZAATARY CAMP SURVEY Two stage cluster survey design (11x31) Blocks were selected at the first stage sampling using PPS technique Block level population estimates obtained from IRD was used for the PPS Households within the selected blocks were then selected using the systematic random sampling method

7. METHODOLOGY: OUTSIDE CAMP SURVEY Two stage cluster survey design (10X52) Sub-districts were selected at the first stage sampling using PPS based on population estimates obtained from UNHCR Households within the selected sub-districts registered with UNHCR were then randomly selected for the survey Selected households were contacted using the telephone numbers in the UNHCR registration database; information on availability and willingness to participate in the survey was obtained prior to visiting the households

8. SURVEY TEAMS, DATA COLLECTION, AND SUPERVISION A team of 6 (each consisting of 4-5 members) were used to collect the data for both surveys Each member of the survey team underwent a 3-day training and a standardisation test and pilot test. The two surveys were carried out sequentially – all six teams did the data collection in Zaatri camp first followed by the outside survey. The data collection in Zaatari camp lasted for 6 days and the data collection for the out-of-camp survey was completed in 10 days

9. DATA COLLECTION AND QUALITY ASSURANCE Each team was supervised by one supervisor Mobile phones (Android OS) were used to collect data Data was analysed on a daily basis and feedback were provided to teams, as necessary The ENA for SMART software determined the quality of the data as excellent

10. RESULTS: ZAATARI CAMP SURVEY – GAM BY WHZ CategoryAll (n=325) Prevalence of global malnutrition (<-2 z-score and/or oedema) (4) 1.2 % (0.5 - 3.3 95% C.I.) Prevalence of moderate malnutrition ( =-3 z-score, no oedema) (3) 0.9 % (0.3 - 2.9 95% C.I.) Prevalence of severe malnutrition (<-3 z-score and/or oedema) (1) 0.3 % (0.0 - 2.4 95% C.I.)

11. RESULTS: ZAATARI CAMP SURVEY – GAM BY MUAC CategoryAll (n=326) Prevalence of global malnutrition (< 125 mm and/or oedema) (5) 1.5 % (0.7 - 3.4 95% C.I.) Prevalence of moderate malnutrition ( = 115 mm, no oedema) (2) 0.6 % (0.2 - 2.4 95% C.I.) Prevalence of severe malnutrition (< 115 mm and/or oedema) (3) 0.9 % (0.3 - 2.9 95% C.I.)

12. RESULTS: ZAATARI CAMP SURVEY - STUNTING CategoryAll (n=312) Prevalence of stunting (<-2 z-score) (53) 17.0 % (11.6 - 24.1 95% C.I.) Prevalence of moderate stunting ( =-3 z-score) (44) 14.1 % (9.6 - 20.3 95% C.I.) Prevalence of severe stunting (<-3 z-score) (9) 2.9 % (1.4 - 5.8 95% C.I.)

13. RESULTS: ZAATARI CAMP SURVEY – SUMMARY STATISTICS Indicatorn Mean z- scores ± SD Design Effect (z-score < -2) z-scores not available* z-scores out of range Weight-for-Height3240.26±0.901.0030 Weight-for-Age323-0.25±1.021.0022 Height-for-Age312-0.86±1.202.04213

14. RESULTS: ZAATARI CAMP SURVEY – ANAEMIA Categoryn% (95% CI) Children 6-59 months (Hb<11g/dl) 32048.7 (42.4-55.0) Women 15-49 years (Hb<12g/dl) 30644.7 (38.3-51.2)

15. RESULTS: ZAATARI CAMP SURVEY – MALNUTRITION AMONG WOMEN 15-49 YEARS Categoryn% (95% CI) women 15-59 years (MUAC <230 mm) 354 5.1 (3.4-7.6)

16. RESULTS: ZAATARI CAMP SURVEY – MEASLES AND VITAMIN A Detailsn Yes, card % (95% CI) Yes, recall % (95% CI) No or unknown % (95% CI) Measles32810.9 (4.9-16.9)76.8 (68.9-84.7)12.1 (7.7-16.6) Vitamin A3288.8 (2.7-14.8)69.8 (60.8-78.7)21.3 (14.0-28.5)

17. RESULTS: ZAATARI CAMP SURVEY – POLIO COVERAGE Categoryn None % (95% CI) 1 dose % (95% CI) 2 dose % (95% CI) 3 dose % (95% CI) 4 dose % (95% CI) Children 0-59 months 3566.4 (2.3- 10.5) 17.1 (9.7- 24.5) 37.3 (25.5- 49.1) 21.0 (14.2- 27.9) 17.9 (6.9- 28.9)

18. RESULTS: OUTSIDE CAMP SURVEY – GAM BY WHZ Category All n = 479 Prevalence of global malnutrition (<-2 z-score and/or oedema) (4) 0.8 % (0.3 - 2.2 95% C.I.) Prevalence of moderate malnutrition ( =-3 z-score, no oedema) (4) 0.8 % (0.3 - 2.2 95% C.I.) Prevalence of severe malnutrition (<-3 z-score and/or oedema) (0) 0.0 % (0.0 - 0.0 95% C.I.)

19. RESULTS: OUTSIDE CAMP SURVEY – GAM BY WHZ Category All n = 483 Prevalence of global malnutrition (< 125 mm and/or oedema) (2) 0.4 % (0.1 - 1.7 95% C.I.) Prevalence of moderate malnutrition ( = 115 mm, no oedema) (1) 0.2 % (0.0 - 1.5 95% C.I.) Prevalence of severe malnutrition (< 115 mm and/or oedema) (1) 0.2 % (0.0 - 1.5 95% C.I.)

20. RESULTS: OUTSIDE CAMP SURVEY – STUNTING Category All n = 467 Prevalence of stunting (<-2 z-score) (42) 9.0 % (6.5 - 12.3 95% C.I.) Prevalence of moderate stunting ( =-3 z-score) (38) 8.1 % (5.9 - 11.2 95% C.I.) Prevalence of severe stunting (<-3 z-score) (4) 0.9 % (0.3 - 2.2 95% C.I.)

21. RESULTS: OUTSIDE CAMP SURVEY – SUMMARY STATISTICS Indicatorn Mean z- scores ± SD Design Effect (z-score < -2) z-scores not available* z-scores out of range Weight-for- Height 479 0.23±0.94 1.0013 Weight-for- Age 478 -0.14±0.98 1.0305 Height-for- Age 467-0.55±1.061.16115

22. RESULTS: OUTSIDE CAMP SURVEY – MALNUTRITION AMONG WOMEN 15-49 YEARS Categoryn % (95% CI) women 15-49 years (MUAC<230 mm) 6933.4 (2.3-4.5)

23. RESULTS: OUTSIDE CAMP SURVEY – ANAEMIA GroupnPercentage (95% CI) Children 6-59 months47725.9% (21.3 – 30.6) Women 15-49 years61831.0 % (27.1-34.9)

24. RESULTS: OUTSIDE CAMP SURVEY – MEASLES AND VITAMIN A Details n Yes, card % (95% CI) Yes, recall % (95% CI) No or unknown % (95% CI) Measles 48410.5 (5.9-15.1)73.1 (66.8-79.4)16.3 (10.9-21.7) Vitamin A 4845.7 (1.6-9.9)66.7 (58.1-75.3)27.4 (19.5-35.4)

25. RESULTS: OUTSIDE CAMP SURVEY – MORBIDITY, DIARRHOEA CategorynYes % (95% CI)No % (95% CI)Don’t know Children 6-59 months 48414.5 (10.5-18.3)84.9 (80.9-88.8)0.3 (0.08-1.3)

26. RESULTS: OUTSIDE CAMP SURVEY – POLIO COVERAGE Categoryn None % (95% CI) 1 dose % (95% CI) 2 dose % (95% CI) 3 dose % (95% CI) 4 dose % (95% CI) 5 dose % (95% CI) Children 0-59 months 53911.6 (7.5- 15.8) 22.8 (16.9- 28.6) 45.4 (39.1- 51.7) 17.4 (13.2- 21.6) 2.0 (0.1- 2.9) 0.5 (0.07- 1.1)

27. CONCLUSIONS Malnutrition levels are low in both camp and outside the camp The levels of anaemia is high in the camp and exceeds the global cut off for public health significance and needs immediate attention The prevalence of anemia outside the camp is medium in terms of public health significance The high level of anaemia may also indicate a poor micronutrient status in general Malnutrition among women of reproductive age is higher than children The vaccination coverage is higher in the camp compared to outside The survey methodology worked well in general despite difficulties of finding the households in some areas