Coverage assessment of CMAM programmes in Ukhiya and Teknaf upzilas, Cox’s Bazar district, Bangladesh.

A coverage assessment using the SQUEAC methodology was completed in the CMAM programme of Ukhiya and Teknaf in March 2019. The assessment was the third SQUEAC assessment to be completed in the upazilas. The previous two assessments were completed in 2015 and 2017.
The 2019 assessment followed the three stages of the SQUEAC methodology. Stage 1 included a context review of the CMAM programme in 2017 and 2018 and a detailed analysis of key quantitative data over time and by nutrition facility. This was complemented by a qualitative investigation to gather data from community members, nutrition facility staff and nutrition programme partners to identify negative and positive factors affecting the uptake of CMAM services. During Stage 2, hypotheses about coverage were formulated and tested in selected villages followed by a process of “prior” building by the assessment team to estimate the coverage estimates of the OTP and TSFP. Finally a wide area survey was completed and to enable the team to estimate coverage for the OTP and for TSFP (combined for Ukhiya and Teknaf).
The coverage of the OTP was estimated to be 60.9% (95% CI: 48-72.2%). The precision of this estimate was 12% which is relatively wide (inaccurate) as it was difficult to find the necessary sample size of SAM cases using MUAC and presence of oedema to identify cases. The 2017 OTP coverage estimate in Ukhiya and Teknaf was 72.5% (95% CI: 61.2-81.3%).
The coverage of the TSFP was estimated to be 49.7% (95% CI: 43.7-55.9%). The precision of the final estimate was 5% which, for a coverage estimate, is narrow (accurate). This is because the team was able to find a large sample of MAM cases during the wide area survey. The 2017 TSFP coverage estimate in Ukhiya and Teknaf was 73.1% (95% CI: 65.1-75.15%).
The reduction in the coverage of both programmes was strongly linked to the impact of the massive Rohingya influx in the upazilas in the 18 months preceding the investigation. The arrival of around 800,000 refugees and the set up and expansion of camps in Ukhiya and Teknaf affected the operation of the CMAM programme in the host communities in a number of ways.