CHARITY JOBS IN AFRICA

Organization: Save the Children
Country: South Sudan (Republic of)
Closing date: 13 Sep 2013

Background and Context****Through its years of operations in South Sudan, SCI’s nutrition programmes have significantly improved the nutrition status of women, children and their families and have recorded significant gains in expanding nutrition programme coverage and responsiveness. Currently, through multiple funding sources, SCI supports 23 sites providing community-based management of acute malnutrition (CMAM) and plans to extend CMAM throughout the SCI-support network of primary health care facilities. Save the Children implement multi-sectoral intervention including health, nutrition, food security, education, child protection and emergency program in the target communities.

Targets Counties

a) Akobo County

The GAM rate of 25.7% (95%CI: 21.8-30.0) and SAM rate of 4.8% (95%CI: 3.1-7.5) for the county indicate a critical nutrition situation. These findings indicate a sustained nutrition situation from the March 2012 and Dec 2012 assessments. However, the respective Crude and under five death rates of 0.36 (95% CI: 0.18-0.73) and 0.60 (95%CI; 0.17-2.06) reported rates within acceptable range according to WHO thresholds. Compared to the mortality situation reported in the same period last year, there has been a significant improvement from the CMR of 4.22 and U5MR of 3.02 reported in the SMART survey conducted in Akobo county same season last year.

Child nutrition status as per the result indicate that the prevalence of malnutrition vary significantly by age. GAM reduces by nearly 20 percentage points between the 6-17 (37.0%) and the 30-41 (17.0%) and the 54-59 (17.0%) age groups. Sevee acute malnutrition is also higher among the younger age group, double the rates reported among the older age groups. This information is crucial because it provides vital data on which age group is most affected and to be targeted with food security, nutrition and health interventions. Specifically, this information suggest that the greatest window of opportunity to correct malnutrition and enhance child health and survival could be obtained by targeting the children below 30 months of age and also the care giver practices for children in this age group.

Analysis indicate that child morbidity was high in this population with 2 in every 3 children (71.7%) having reported some sort of illness 2 weeks prior to the assessment. In order to establish likely link between the nutrition outcome and the morbidity rates, association analysis was conducted which revealed that child illness is a significant contributing factor to acute malnutrition in this population {OR=1.8 (1.15-3.06)}. The odds ratio indicate that those who were reportedly ill two weeks prior to the assessment, were nearly two times likely to be malnourished than those who were not ill during the same period. Nearly a third of the children reported diarrhea and this could be associated with poor hygiene and suboptimal environmental factors that predispose children to increased disease incidence. Poor waste disposal(80% using bush) and lack of treatment of drinking water (88.8% not applying any treatment method) are likely causes of diarrhea related cases reported in the study. Although infant and young children feeding were sub-optimal, analysis did not reveal any significant relationship between nutrition outcome and the IYCF indicators.

Underweight (24.1%) and stunting (13.1%) malnutrition reported serious and alert levels respectively among the child population in Akobo county. These levels are consistent with the trends seen in many parts of South Sudan where acute malnutrition has consistently been showing critical levels hence is more of a public health concern among the young children than the other anthropometric indicators.

Also of concern is that majority of households in Akobo County spend over 50% of their income on food coupled with the fact that a good percentage of them rely on food purchases. Household food security is therefore a likely concern in this population. Additionally, displacements caused by frequent conflicts between the Nuers and Murles have also had a bearing on food security due to disruption of farming activities as well market activities. This is estimated to have undermined a section of the population’s ability to embark on their farming activities hence affecting their household food security situation. As recent as February 2013, an attack around Pibor led to displacement of population from Nyandit payam which led to IDP situation around Akobo town increasing the population’s vulnerability.

In conclusion the nutrition situation in Akobo County is critical (>15% according to WHO thresholds) and a major public health concern, with very concerning rates of severe acute malnutrition, more particular in the younger age group, hence should be targeted with key interventions to correct and possibly reverse the undesirable effects of malnutrition on children. Morbidity is a major driving factor of malnutrition in this population and therefore more need to be done to contain the rampant health problems through improved health services. Additionally, of immediate concern would be to identify and treat the malnourished cases in the community by strengthening the existing feeding programme.

b) Nyirol County

In 2013 April the prevalence of Global Acute Malnutrition (GAM) for Nyirol County was 26.9% (95%CI: 22.9-31.4), and the severe acute malnutrition (SAM) rate (WHZ<-3 or oedema) was 7.1% (95%CI: 5.2-9.5), including one (0.2%) oedema case. The index of dispersion for WHZ<-3 was higher than 1 indicating possible clustering of SAM cases with 40% of the cases reported in 5 clusters that also reported high morbidity rates. Boys and girls were equally malnourished. The results of the nutrition assessment in Nyirol County indicated GAM and SAM rates that are critically above the emergency levels of 15% and 1% respectively according to WHO classification, and a sustained nutrition situation from the March 2012 situation when GAM and SAM rates of 23.9% (95%CI: 19.1-29.5) and 4.7% (95%CI: 2.6-8.1) were reported respectively. The Crude mortality rate (CMR) and under five mortality rate (U5MR) of 1.25 (95% CI: 0.83-1.87) and 2.29 (95%CI; 1.38-3.77) were recorded respectively. Both CMR and U5MR rates were also above the WHO’s alert thresholds of 1/10,000/day and 2/10,000/day respectively and a sustained situation from the CMR of 1.65 (95%CI: 1.12-2.43) and U5MR of 2.74 (95%CI: 1.51-4.95) reported in the SMART survey in the same population the previous year. Most deaths among adults and children over 5 years were due to violence/physical injuries (21.2%) reflecting the outcome of cattle rustling and tribal clashes that affected some of the villages assessed. Diarrhea also contributes to most of the deaths both among children below five years (35.7%) and among the older children and adults. Morbidity also contributed to acute malnutrition and is associated with poor drinking water quality, poor sanitation and hygienic practices reported in the assessment.

High prevalence of morbidity was reported in the assessment. The percentage of children who had reportedly suffered from one or more communicable childhood diseases in the two weeks prior to the assessment was 44.6%. About 46% of the reported illness was diarrhea; 27.5% of the children who fell ill had fever while 13.9% had cough. Low immunization and vitamin A status was reported with only 11.4% having received vitamin A supplementation, and 26.3% of the children (9-59 months) having received measles vaccine in the previous 6 months. Although a high proportion (84.1%) of children continued breastfeeding at 12-15 months, only 11.3% were exclusively breastfed.

In conclusion the nutrition situation in Nyirol County is critically above the emergency threshold, with very concerning rates of severe acute malnutrition, crude and under five mortality rates. Even though the key underlying factors affecting the nutritional status of the children i.e. morbidity, poor child care, lack of safe drinking water and limited sanitation and hygiene facilities remain key risk factors, it is important to note that food insecurity is also currently a critical factor affecting the nutrition status of the population. Increased food prices (with majority of the households currently relying on purchase of food as their main source), leading to reduced quantity and diversity of foods consumed are contributing factors to the current poor nutrition status among the assessed Nyirol population.

c) Kapoeta North

A SMART Nutrition survey conducted in March 2013 revealed the prevalence of GAM and SAM among children6-59 months of age based on WHO 2006 standards were 16.6% (95% C.I: 13.3 – 20.5) and 3.8% (95% C.I: 2.4 – 5.8) respectively. Both GAM and SAM were higher than the emergency thresholds.

The observed CMR and U5MR (0.27 and 0.90 deaths per 10000 people per day) were much lower than previously reported. This may be explained partly by increased vitamin A and measles vaccination and reduced morbidity in the period of the survey. The intense health and nutrition intervention project currently undertaken by SCI may have in part contributed to reduced mortality and increased coverage of vitamin A and measles vaccination. However, it is noteworthy that vitamin A and measles coverage are both below the recommended threshold (80%). It is likely that the figures for mortality observed here would be much higher during the rainy season as observed in the previous surveys. Poor hygiene, sanitation and poor health seeking behavior all lead to increased morbidity, hence higher death rates. One key cause of error in estimating death rate is the tendency for interviewers to forget to specify the recall period (ie 90 days). In the current survey, specifying the recall period was heavily emphasized to avoid capturing of general deaths that might have occurred in the history of the HH.

While the rate of breastfeeding was high (99%), only 49.5% of infants were exclusively breastfed for the first 6 months of life. This is below the standard threshold of 80% for exclusive breastfeeding. This is likely to lead high morbidity as observed due to unhygienic conditions during food preparation. Prevalence of timely initiation of breastfeeding with 1 hour of birth was sub-optimal (34%). The high rate of introduction of liquids within the first three days of life (27.7%) is not in tandem with recommendations for exclusive breastfeeding for the first 6 months of life. Cow’s milk, plain water and water with salt were the frequently provided fluids. Focus group discussion (FGD) with mothers revealed that lack of breast milk, early subsequent pregnancy, breast disease and heavy workload for women were potential key hindrances to optimal breastfeeding.

The timing of the introduction and quality of complementary foods are key determinants of infant growth and health. It is recommended that complementary foods are introduced at six months of age, when breast milk alone is no longer adequate for the child’s growth. Young children need at least four meals per day, as they are not able to absorb larger quantities of nutrients in fewer meals. Additionally, children need to be fed on complementary foods made from diverse foodstuffs that provide a variety of nutrients.

About 80% of infants and young children 6-23.9 months of age [n= 400, 81%] were fed on complementary foods before attaining 6 months of age. Only half of the children [n=120, 51.1%] start complementary food at 6 months of their age. In 1.4% of the cases, complementary foods were introduced later than 7 months of age. According to focus group discussion results, mothers exclusively breastfeed beyond six months due to lack alternative food to give to the child. The use of Oral Rehydration Solution (ORS) was negligible as only 1.2% of the mothers reported using this life saving intervention.

Dietary diversity is considered adequate when a child consumes food from four or more food groups. Only 9% (n=44) of the children 6-23.9 months consumed a minimum diversified diet. Cereals were the predominant food group at 23.1% (n=114). Consumption of legumes, fish and meat were negligible. Surprisingly, only 2% of all the infants were reported to have consumed milk the previous day despite the presence of livestock. This may be explained by the fact that cattle were still away in cattle camps at the time of the survey. FGD results showed that porridge from sorghum or cereal flour from relief agencies is the most common food for infants. Only 6.9% of infants were reported to have eaten at least 3 times the day prior to the survey. This means the minimum meal frequency of at least 3 is not met in this population. This result agrees with the finding that 95% of the HH reported to have gone without food in the last month preceding the survey.

About 50% of mothers reduced fluid consumption when their child fell sick. Similarly, almost 56% of mothers reduced amount of food when the child was sick. It is recommended that mothers practice responsive feeding especially when their children become ill and to increase fluid intake and increase feeding frequency.

Why the survey:

Following the above survey results for 2013 pre harvest, there is need to monitor the Post and Pre harvest community Nutrition Status. This will indicate progress and impact of the Current interventions in the three counties. This survey TOR will be reviewed in September.

Objectives of the Nutrition Survey:

The proposed nutrition survey has the following objectives:

1. To assess the prevalence of malnutrition in children aged 6-59 months as a proxy for the wider population.
2. To estimate the mortality rates through a retrospective survey in the County.
3. To determine the morbidity and health seeking behaviors’ in the County.
4. Estimate measles vaccination and Vitamin A supplementation rates
5. To determine infant and young child feeding practices amongst the community in relation to malnutrition and morbidity.
6. Analyze and identify some of other potential factors contributing to malnutrition such as water and sanitation and the broader food security and livelihoods situation.

Duration: 21 Days Per County

Key responsibilities:

The consultant will, in coordination with the Save the children team undertakes the following activities:

1. Develop the Survey Methodology and present to the Nutrition Cluster.
2. Update, review and share the MOH/Nutrition Cluster already developed survey five modules tools for use in the SMART methodology Nutrition assessment survey.
3. Be responsible for preparation for the surveys, including review of population statistics, calculating the sample size, selecting, clusters, developing an efficient survey schedule
4. Share the Survey full Plan with the Nutrition Advisor and M&E advisor, DDPI, FM and ICCM officer in the specific County.
5. Brief the SMOH on the survey Methodology, Survey objective and plan and result sharing plan.
6. Share the training plan, conduct Train of 24 enumerator and data entry clerk from SC, (including pre-testing questionnaire).
7. Assume overall responsibility for implementation of the exercise including daily supervision of survey teams, daily data quality assurance
8. Supervise data entry and assure data entry quality. Ensure anthropometric data is entered each night and analyzed for errors. Feedback given to team on daily basis in order to ensure validity and reliability of results.
9. In Support with Save the Children Data entry clerks, be responsible for overseeing data cleaning and analysis using anthropometric software (ENA) for the core anthropometric and Mortality and others e.g EPINFO, SPSS on the other indicators.
10. Demonstrate presentation of the results in 2006 WHO growth standard and annex analysis with NCHS Growth Standards.
11. Conduct a one day Preliminary result sharing with the SMOH and SCI teams.
12. Prepare and submit a data set and preliminary results in 10 days on completion of the survey field work.
13. Write and submit full report within one week on returning from the field, the report should be as guided by the cluster guidance.

Expected Output:

• Comprehensive survey report with practical recommendations in addressing the situation, to SCI Nutrition Advisor and M&E Advisor
• The cleaned version of the raw data used to calculate the survey results to be sent to the SCI Nutrition Advisor and M&E Advisor

Time Frame and Accountability:

The consultancy period will last approximately 30 days, starting early October 2013 (this includes desk review, enumerators training, data collection, support to data entry / analysis and reporting.
The consultant shall report directly to SCI Nutrition Advisor. S/he will also liaise closely with DDPI, Field Manager and Nutrition Programme Manager

Save the Children will provide:

• Guidance throughout the evaluation period.
• Data entry/analysis shall be joint venture between consultant and save nutrition staff
• Feedback the Nutrition survey findings to
  0 The partners at the field level (Nutrition and Health stakeholders)
  0 SCI Director of Programme Advocacy and Development Nutrition,
  0 M&E and Nutrition Advisor in Juba and Health and Nutrition Managers,
  0 Field Managers in the County
  0 Nutrition cluster – Survey technical working group
• Logistic arrangements for all field travel
• Approval of all deliverables including final sign offs for the purpose of making payments.
• Accommodation will be provided by save the children in the program sites.
• The consultant will be covered for transport, food and Accommodation.

Qualifications and Experience Required

The successful candidate shall:

• Have a university degree or the equivalent, with advanced education in nutrition, with a specific competency in therapeutic and supplementary feeding in humanitarian emergencies.
• Have significant experience in undertaking nutrition surveys (design and methodologies, SMART training, field supervision and data analysis/write up) and particular experience of using the SMART methodology and associated software.
• Have experience on SMART Survey in South Sudan.
• Have experience training and working with non-English speakers and people of low education levels
• Have patience and experience training through practical examples and practical (over theory)
• Be fluent in English with excellent writing and presentation skills.
• Having worked in South Sudan is an added advantage

Terms of payment

The consultants will receive remuneration under the following terms of payment, which will be based on the output of the work and not on the duration that it might take.

1. 50 % of the total shall be paid upon completion of training, data collection from the field and sharing of preliminary results.
2. 50% of remaining balance shall be paid upon submission of first final report and other outputs to Save the Children.

How to apply:

Please apply with a covering letter and up-to-date CV to jobs.southsudan@savethechildren.org

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