Save the Children UK

ANTHROPOMETRIC & FOOD SECURITY ASSESSMENT FIK, , & DEHUN WOREDAS OF FIK ZONE 14 – 17 JULY 2000

EXECUTIVE SUMMARY

An anthropometric and food security assessment was conducted in Fik, Hamero, Segeg and Dehun Woredas of Fik Zone. A formal 30 children x 30 cluster sample survey was not practical due to security constraints1 and the absence of the population because of out-migration.

However, the results deserves attention as the proportion of malnourished in all the four woredas are alarmingly high, well above the acceptable level of 10% global acute malnutrition.

The global acute malnutrition as indicated by weight-for –height Z-scores were: Fik: 24.1% (95% confidence interval: 20.5 – 28.10) Hamero: 32.2% (95% confidence interval: 27.4 – 37.7) Segeg: 34.3% (95% confidence interval: 29.0 – 40.0) Dehun: 40.2% (95% confidence interval: 35.1 – 45.5) The food security indicators are not promising as: Ø Gu harvest was poor. Ø Livestock prices are 50% less than normal times. Ø Relief distribution is irregular and is deficient in protein and micro-nutrients.

The population is dependent on general ration and complementary distributions of CSB and oil by ICRC and SC UK.

Recommendation ? The general ration should be distributed regularly and equitably amongst the affected population. ? A complete general ration with the inclusion of a protein and high energy source should be distributed. ? Adequate quantity of general relief distribution for at least two months should be pre-positioned in Fik zone in preparation of the dyer rains in October/November. ? A feasibility study should be conducted to investigate and prioritize the possibilities of safe water provision to the four Woredas. ? An intensive outreach program should be initiated immediately in Fik Woreda to refer all severely malnourished children to the therapeutic feeding center. ? An intensive wet feeding program should be considered for Hamero town and Gasangas in Hamero Woreda. ? An immediate distribution of blanket supplementary food should be provided to the vulnerable population in Segeg and Dehun for the first month followed by a targeted supplementary program.

1 ICRC has recently ceased operations in Fik zone due to security incident. ICRC was operational in Segeg, Dehun from May 2000, and Fik and Hamero from July 2000. 1 I. BACKGROUND

Somali National Regional State is one of the most marginalised and neglected regions of . The total population of the region estimated by CSA 1997 was 3,493,860. The region’s infrastructure is poorly developed and the population is ill served with the basic health and social infrastructure. The current drought in 1999/2000 has dramatically affected the population in particular the pastoral community.

Fik zone2 is one of the 9 administrative zones in with 7 Woredas, namely Fik, Hamero, Segeg, Dehun, , and Muluqamayo. The total population of the area was estimated in the 1997 census as 224,883.

Following the DPPC’s 2000 relief appeal, the Woredas of Fik, Hamero, Segeg and Dehun were identified as worst-affected by the drought3. In late April 2000 a rapid screening was conducted in Fik and Hamero Woredas. On recommendation from the screening an emergency nutrition intervention with a therapeutic feeding center in Fik town, and blanket supplementary distribution of CSB and oil to the vulnerable population in Fik and Hamero for 6 weeks was implemented. Following the completion of the blanket supplementary distribution a targeted supplementary program was planned.

In addition, SC UK managed the distribution of 7,729mt of DFID-funded grain in Gode, Degahabour and Fik zones for the month of May 2000.

Discussions with ICRC lead to an agreement that they would intervene in Segeg and Dehun and SC UK in Fik and Hamero until July 2000. And when the targeted supplementary program started in Fik and Hamero, ICRC would assist with blanket supplementary distribution in these two Woredas also until August 20004.

To monitor the current nutritional and livelihood indictors an assessment was conducted in Fik, Hamero, and on request from the communities for assistance Segeg and Dehun Woredas were included in this assessment.

II. Methodology

An anthropometric and food security assessment was conducted in Fik, Hamero, Segeg and Dehun Woredas of Fik Zone. A formal 30 children x 30 cluster sample survey was not practical due to security constraints5 and the absence of the population because of out-migration to Gode, Imi, Gudis etc.

The team chose general distribution points as their sites, with the assumption that the worst affected population will be found at these sites. The assessment did not coincide with a general distribution. It is accepted from the outset that the results will implicate the worst case scenario, but will assist SC UK to plan future interventions, with particular interest in Segeg and Dehun.

At each site the team held discussions with elders explaining the purpose of the assessment. The team chose the starting point of the cluster by going to the center of the site and spinning a pen. The direction to start the survey was determined by the direction pointed by tip of the pen. Starting with

2 Fik zone is an operational area for SC (UK). Since 1997 an integrated food security project involving re- stocking livestock and building of water-ponds (“birkas”) has been implemented in Fik and Hamero Woredas. 3 UNDP-Emergencies Unit for Ethiopia, January 2000 4 This general ration was distributed in the three zones in June, July and August 2000. 5 One relief agency has ceased operations in July in Fik zone due to security incident in Hamero Woreda. 2 the first house, consecutive houses were chosen systematically until the minimum number of 30 children per cluster was achieved. In each household all children between the ages of 6-59mths were surveyed. The survey was conducted very early in the morning (0600hrs) to minimize absenteeism.

Anthropometric data

Ø Weight was recorded with minimum clothing to nearest 0.1kg using Salter Scale. Ø Length was measured to the nearest 0.5cm. Ø Age was estimated by the mothers however, due to recall bias height restrictions between 65cm and 110cms were used. Ø Nutritional oedema was defined with the presence of bilateral oedema. This was detected by applying normal thumb pressure to the feet for three seconds. If the shallow pit remained when the thumb was lifted on both feet, nutritional oedema was confirmed.

Food security stress indicators

Stress indicators such as current food sources and agricultural and livestock condition, relief distribution and unusual migration were discussed with community members.

III. Results

i. Nutritional status

The number of clusters and children surveyed is depicted in Table 1.

Table 1: Number of clusters and children surveyed in the four woredas of Fik zone, July 2000 No. of clusters No. of children Sex ratio boy: girl Fik 17 514 0.86 Hamero 11 331 1.2 Segeg 10 300 0.97 Dehun 12 358 1.1

Severity of nutritional status in the four woredas assessed is shown in Table 2. The mean weight-for- length percentage median is serious in three of the four woredas according to DPPC guidelines6. Hamero and Segeg: 85%, and Dehun: 84% and Fik Woreda 87%.

6 Mean weight-for-length % median classification: >95% - good; 90-94% - satisfactory; 85-89 – poor; <85% - serious. 3 Table 2: Acute malnutrition as indicated by weight-for-height Z scores from July 2000 assessment in four woredas of Fik Zone Woreda Combined Boys Girls Fik Global acute < -2 Z scores + oedema 24.1 25.3 23.1 C.I.: 20.5 – 28.10 C.I.: 20.0 – 31.4 C.I.: 18.4 – 28.6 Severe < -3 Z scores + oedema 2.1 3.0 1.4 C.I.: 1.1 – 3.9 C.I.: 1.3 – 6.2 C.I.: 0.5 – 3.9 Hamero Global acute < -2 Z scores + oedema 32.3 29.3 36.0 C.I.: 27.4 – 37.7 C.I.: 22.9 – 36.6 C.I.: 28.4 – 44.3 Severe < -3 Z scores + oedema 6.6 5.5 8.0 C.I.: 4.3 – 10.0 C.I.: 2.8 – 10.2 C.I.: 4.4 – 13.9 Segeg Global acute < -2 Z scores + oedema 34.3 40.5 28.3 C.I.: 29.0 – 40.0 C.I.: 32.6 – 48.9 C.I.: 21.4 – 36.3 Severe < -3 Z scores + oedema 5.7 8.1 3.3 C.I.: 3.4 – 9.1 C.I.: 4.4 – 14.0 C.I.: 1.2 – 7.9 Dehun Global acute < -2 Z scores + oedema 40.2 37.6 43.0 C.I.: 35.1 – 45.5 C.I.: 30.7 – 45.1 35.6 – 50.8 Severe < -3 Z scores + oedema 8.1 5.9 10.5 C.I.: 5.6 – 11.6 C.I.: 3.1 – 10.6 C.I.: 6.5 – 16.3 Malnutrition rates greater than 20% are considered serious.

ii. Food security stress indicators a. Agricultural activities The Gu7. rains started late, in May and ended early. The rains regenerated pasture that has improved the physical condition of livestock, in particular shoats8 and encouraged the return of livestock to the area. However, the rains were insufficient to replenish the water table to normal year levels.

Although the population is predominantly classified as pastoralist, a majority of sites report that in “normal” years they cultivate maize and sorghum with the long rains (Gu) It was observed that some communities had planted maize and expected a harvest in August/September9. b. Livestock condition It was reported that the drought had severely affected shoats and cattle due to lack of pasture and water. However, with regeneration of pasture, the physical condition of shoats has improved and other livestock such as cattle and camel are returning from distant grazing and water holes. Therefore, the price of livestock has improved from March 2000 but it is still 50% below the price at normal times. Figure 1 presents the relative prices for shoats and cattle.

7 Gu rains: normally are from March/April to May/June. Dayr rains: are normally October to November. 8 Shoats – goats and sheep 9 Observation from the field in August report that the harvest was poor. 4 Figure 1: Reported prices of shoat and cattle from the four Woredas comparing March and July 2000 to a “normal year”

200 1000 800 150 600 100 400 50 200 Price in birr/cattle Price in Birr/shoat 0 0 March '00 July'00 Normal year March '00 July'00 Normal year Fik Hamero Segeg Dehun Fik Hamero Segeg Dehun

N.B. Though it is expected the reported prices were understated, the ratio between the different prices over time is expected to be closer to reality .

c. Price of grain The price of relief grain (wheat) reported in all sites is approximately 30 to 40% of last year’s price. Some sites in Fik Woreda reported 50 birr for 50kg, however the average price quoted was 100 birr. d. Current Consumption The normal staple diet reported in this area is sorghum, maize, milk and meat (latter consumed once a month). However, during this assessment all sites were reliant on relief wheat and supplementary food i.e. CSB10. Recent consumption of milk was reported at a few sites in Fik alone. No consumption of wild food was reported.

Two sites in Hamero (Hamero Town and Hardagha) and one in Fik town (Kebele 04) are consuming only CSB with oil. The absence of general ration is of concern. e. Water availability and accessibility As discussed above the Gu rains were inadequate and too short to replenish the water tablelands, hence access and availability of water was an issue particularly for the population in Bermyl and Garasley in Dehun. In Hamero, the quality of water is poor due to turbidity and salt. In Segeg the population has access to water from shallow wells. Fik is the only Woreda that does not report water as a problem. f. Relief Activities The majority of sites have received monthly relief rations 2 times over the last four months, although some had received three times. All the population was targeted regardless of need. However, the quantity of food received varied from as little as 3kg to 75kg per family, generally the furthest sites from the Zonal capital (Fik town) and respective Woreda capitals received less.

Supplementary food (CSB) and oil complementing11 the general distribution distributed by ICRC and SC UK in Segeg/Dehun and Fik/Hamero respectively, was reported at all sites for the months of June and July.

Other nutritional activities operational in the area were the SC UK therapeutic feeding center in Fik town12. At the time of this assessment the center had an admission of approximately 250 children.

10 CSB – Corn Soya Blend, a high energy high protein 11 ICRC distribution consists of 10kg CSB/person/month plus 2 l oil/person/month. SC UK distribution consists of 4kg CSB/mother or under 5 child/fortnight plus 1 l oil/mother or under 5 child/month. 12 Fik therapeutic feeding center opened on June 5th. 5 The blanket complementary CSB ration also conducted by SC UK was distributed to 16987 beneficiaries in Fik Woreda and 9377 in Hamero.

IV. DISCUSSION Although the survey methodology has its limitations, the results deserves attention as the proportion of malnourished in all the four woredas is alarmingly high, i.e. well above the acceptable level of 10% global acute malnutrition and the food security indicators are not promising.

The acute malnutrition rate in Fik Woreda is lower in comparison with the other three Woredas assessed. This can be attributed to a number of factors: - Gu rains were better distributed in Fik Woreda - Pasture regeneration and physical condition of livestock better in Fik Woreda - SC UK therapeutic and blanket supplementary feeding program

In instances where the global malnutrition rate is at such dramatically high levels intensive feeding programs on their own will not have the desired impact until an appropriate and adequate general ration is distributed equitably to the population regularly.

The population’s normal dietary components are not available, particularly their source of protein and micro-nutrients i.e. milk and meat. This absence is not compensated by intake of wild foods. The population is reliant on the general relief distribution for the major proportion of their daily dietary need. However, the general ration is deficient in micro-nutrients and insufficient in protein and energy in the absence of pulses and oil. Therefore, with such appalling high rates of malnutrition concerned authorities should firstly, give priority to this population for an adequate and complete general ration.

Secondly, in order to prevent a deterioration of the nutritional status it is imperative that this population is supported through the coming months (i.e. until the dyer rains13) with regular relief distribution. Considering the logistic complexities of transportation to Fik Zone particularly during the wet season, it is crucial that an adequate general ration is pre-positioned for at least 2 months prior to arrival of dyer rains (late September).

V. RECOMMENDATIONS ? The general ration should be distributed regularly and equitably amongst the affected population. ? A complete general ration with the inclusion of a protein and high energy source should be distributed. ? Adequate quantity of general relief distribution for at least two months should be pre-positioned in Fik zone in preparation of the dyer rains in October/November. ? A feasibility study should be conducted to investigate and prioritize the possibilities of safe water provision to the four Woredas. ? An intensive outreach program should be initiated immediately in Fik Woreda to refer all severely malnourished children to the therapeutic feeding center. ? An intensive wet feeding program should be considered for Hamero town and Gasangas in Hamero Woreda. ? An immediate distribution of blanket supplementary food should be provided to the vulnerable population in Segeg and Dehun for the first month followed by a targeted supplementary program.

13 The quality and quantity of the dyer rains will aid to prioritize and determine the extent of relief operations needed for the forthcoming 5 months. 6