EMERGENCY NUTRITION QUARTERLY BULLETIN (First Quarter 2007) Emergency Nutrition Coordination Unit Early Warning Department (Disaster Prevention and Preparedness Agency)

INSIDE AMHARA REGION

KALU & DESSIE ZURIA WOREDAS Page 2 HARARE REGION

SOFI & ERER WOREDAS Page 3 SOMALI REGION

DOLO BAY & DOLO ADO WOREDAS Page 4 A total of 12 nutrition surveys conducted between late December 2006 and early March 2007 are presented in this bulletin. Eleven surveys were carried OROMIA REGION out in cropping areas of Amhara, Harare, Oromia and SNNPR during the FEDIS WOREDA meher post-harvest season while the remaining one was conducted in the Page 5 pastoral area of Somali region. The prevalence of global acute malnutrition SNNP REGION was found to be below 10 % in all cropping woredas but one, i.e. Dessie Zuria with 16% GAM, and above 20% in the surveyed pastoral area. The overall HULLA & BORICHA WOREDAS good nutrition status in the cropping areas confirmed the food security findings Page 6 whereby the 2006 meher harvest was reported to be generally good. In con- DUNA WOREDA trast, the nutrition status in the pastoral population seemed to be little influ- Page 7 enced by the food security situation and remained very poor (when defined by the weight-for-height indicator) in spite of the good performance of the 2006 HUMBO & SODO ZURIA WOREDAS Page 8 deyr rains.

MIRAB ABAYA & BOREDA ABAYA WOREDAS Nutrition Survey Results - Ethiopia Page 9 January - March 2007 SURVEY DATA QUALITY CONTROL Page 11 25

NUTRITION SURVEY DATABASE 20 Page 13 15

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0 Prevalence of acute malnutrition (%)

ENCU/DPPA Duna Fedis Kalu Hulla Boreda Humbo Boricha Addis Ababa Sodo Zuria Sofi & Erer Mirab Abaya Dessie Zuria Tel. (011) 5 523556 Dolo Ado/Bay e-mail:[email protected] http://www.dppc.gov.et Severe Acute Malnutrition Moderate Acute Malnutrition

ENCU March 31, 2007 Page 1 AMHARA REGION SOUTH WOLLO ZONE from 6% to 17% in Kalu, and from 10% to 18% in Dessie Zuria, with 2002/03

Kalu and Dessie Zuria Woredas being the worst year in terms of nutrition status in both woredas. Over the past 6 Two nutrition surveys were conducted in years the level of malnutrition in Dessie Kalu and Dessie Zuria in January as part Zuria was above the NSP baseline of the regular monitoring of Concern ranges in all seasons surveyed and project areas. The SMART method was remained above 10% in spite of a sub- used for the planning phase, resulting in stantial percentage of the population sampling 38 clusters of 23 children in receiving food aid and/or PSNP. In Kalu Kalu and 31 clusters of 23 children in malnutrition levels were also higher than Dessie Zuria. the NSP range over the past 6 years, except for the post harvest season 04- Nutrition: The prevalence of global 05, again in spite of ongoing food aid acute malnutrition was estimated at and PSNP. The prevalence of GAM for 7.7% with 0.1% SAM in Kalu and at January 2007 was above the NSP base- 16.2% with 1.4% SAM in Dessie Zuria. A line of 5.8-7.8% for post-harvest (Dec- total of 16 surveys have been conducted Feb) in DZ while it was comparable to over the past 6 years in each woreda. the NSP baseline in Kalu. The prevalence of global acute malnutri- tion ranged over seasons and years

Comparison of malnutrition levels between Dessie Zuria /Kalu and NSP baseline

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% Acute Malnutrition Acute % 6

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0 LB 00 K 00 EB 01 LB 01 PH 01/02 LB 02 PH 02/03 EB 03 LB 03 K 03 EB 04 LB 04 PH 04/05 LB 05 PH 05/06 LB 06 PH 07 ENCU Kalu and Dessie Zuria Upper NSP Dessie Zuria Kalu Lower NSP Woredas Health: The crude mortality rate was coverage was at 73% in Kalu and 61% The nutrition situation was 0.06 and 0.36 deaths/10,000/day in Kalu in DZ falling under similar ranges as in typical in Kalu with 7.7% GAM and Dessie Zuria respectively while the the previous surveys with 73% in Kalu while it was rated as serious in under-five mortality rate was estimated and 58% in DZ. Dessie Zuria with 16.2% at 0.34 deaths/10,000/day in each wore- GAM. The poor nutrition and da. Retrospective morbidity was low with Food Security: Kalu woreda, because food security in Dessie Zuria 10% in Kalu and 14% in DZ. Measles of its high proportion of lowlands and was a matter of concern, as (by card and recall) and vitamin A cover- low-midlands, is predominantly depen- the next significant harvest age was estimated at 93% and 97% in dant on kremt rains (Aug.-Sept.) to sup- was not due before June/July Kalu, and at 90% and 94% in DZ. These port meher crops harvested from in the areas benefiting from results were very similar to those of the November to December. In higher areas belg and not before previous survey conducted in July/Aug of the woreda belg crops (oat, barley November/December in the 2006 where measles and vitamin A cov- and wheat) are also cultivated and har- predominantly meher-depen- erage was estimated at 92% and 97% in vested in June/July. In contrast, Dessie dant area. Kalu, and at 85% and 91% in DZ. BCG

ENCU March 31, 2007 Page 2 traditional hunger period. to fillthefoodgapduring the and usualcopingmechanisms was expectedtobenormal security inthecomingmonths period. Prospectforfood typical forthepostharvest 4.9% GAMwasfoundtobe The nutritionsituationwith Sofi andErer Woreda ENCU HARARE REGION lowed by stretch frommid-marchto mid-June fol- absence ofdisease. water andpasture availabilityand reported asgoodduetoadequate rains whilelivestockconditionwas untimely andunevenlydistributed vest wasratedaspoor, mostlydueto nuts inthelowlandareas. The hunger chat inthemidland areasandground- sorghum whilethemain cash cropis September. The mainfoodcropis ly ing. The woredasaredescribedassole- plemented bysubsidiarylivestockrear- Sofi andErerisrain-fedagriculturecom- Food Security: tively withaBCGcoverageof74%. were estimatedat92%and76%respec- supplementation recall) andvitamin A 9%. Measlesvaccination(bycardand while retrospectivemorbiditywaslowat 0.10 deaths/10,000/dayrespectively tality rateswereestimatedat0.05and Health: woredas. baseline data wereavailableforthese cases ofoedemawereobserved.No 4.9% with0.3%severemalnutrition.No acute malnutritionwasestimatedat Nutrition: February. conducted byDPPA/B inSofiandErer standard 30xclustersurveywas A In DessieZuria,the2006 reported asgoodinthewholeworeda. and livestockconditionwerealso control. Water andpasture availability improved cropmanagementandpest evenly distributed vest wasreportedtobegooddue population whoissolely is alsoasignificantproportionofthe November/January respectively. There crops harvestedinJune/Julyand kremt dependant on portion ofhigh-andmid-lands,isboth Zuria woreda,becauseofits highpro- insecurity. InKalu,the2006 dant andhenceatgreatriskoffood meher Sofi andErerWoredas rains tosupport The crudeandunderfivemor- harvest dependant. The prevalenceofglobal kremt belg The mainlivelihoodof rains untilmid- (Jan.-Feb.) and belg kremt belg meher meher and Belg depen- meher rains, kremt rains har- har- tion status. ther deteriorationofthechildrennutri- every 3monthsinordertopreventfur- consider monthlydistributioninsteadof guideline,andto ing aspar the TSFP maximum of3weeksafter thescreen- distributionwastimely, i.e.a EOS/TSFP was recommendedtoensurethatthe dominantly before November/Decemberinthepre- the areasbenefitingfrom harvest wasnotduebeforeJune/Julyin ter ofconcern,asthenextsignificant food securityinDessieZuriawasamat- access tofood. The poornutritionand be atthelowestduetoimproved the malnutritionratesareexpectedto after themainharvestingseasonwhen GAM. The surveyshadbeenconducted serious inDessieZuriawith16.2% with 7.7%GAMwhileitwasratedas typical forthistimeoftheyearinKalu Conclusion: hunger period. the foodgapduringtraditional mal andusualcopingmechanismstofill coming monthswasexpectedtobenor- est. Prospectforfoodsecurityinthe malnutrition isexpectedtobeatits low- the postharvestperiod,whenacute 4.9% GAMwasfoundtobetypicalfor Conclusion: pasture andabsenceofmajordiseases. as goodduetoavailabilityofwaterand The livestockconditionwasalsorated distribution andcessationoftherains. tion withregardtotheonset,amount, good duetofavorablewheathercondi- meher wood, charcoalandlabor. The 2006 this timeoftheyearincludessalefire- September andcopyingstrategiesat gap lasts about4monthsfromJuneto ENCU March31,2007 Page3 production wasreportedtobe meher The nutritionsituationwas The nutritionsituationwith -dependant area.It belg and not Dolo Bayand Ado failure ofthe conducted after thecomplete while thepreviousonewas ducted after good The presentsurveywascon- as compared toJanuary2006. tically significantimprovement GAM anddidnotshowstatis- remained seriouswith22.5% The nutritionsituation Woredas dyer rains. dyer rains ENCU the 2006 pasture availability. The performanceof rains arecriticalinimproving waterand October andceasesinDecember. Both April toJunewhilethelatterstarts from sons: theformerusuallyoccursfrom dyer rainsarethetwomainrainysea- Dawa andGenalerivers. The guand subsistence farmingisfoundalongthe livestock andproducts while dominantly pastoral andhighlyreliant on Food Security: 35% respectively. tion coveragewerealsolowat45%and supplementa- and recall)vitamin A measles coverage(confirmedbycard under fivehavingaBCGscarwhile coverage waslowwith24%ofchildren causes ofmorbidity. BCGvaccination malaria beingcitedasthemostcommon bidity wasaround21%withcoughand deaths/10,000/day. Retrospectivemor- below theemergencythresholdof2 the underfivemortality ratewasat0.29 threshold of1death/10,000/daywhile estimated at0.03belowtheemergency Health: results with4.9%. found tobesimilartheJanuary06 far belowtheGAMestimateandwas tional oedemawasestimatedat6.5% by MUACbelow12.5cmand/ornutri- The levelofacutemalnutritiondefined with 18.8%GAM(CI:15.9%-21.6%). Dolo Ado, DoloBayandBareworedas, ed inJanuary06thepastoral areasof tion ascompared tothesurveyconduct- icant difference inthelevelofmalnutri- severe malnutrition. There wasnosignif- 22.5% (CI:19.1%-25.8%)with2.7% acute malnutritionwasestimatedat Nutrition: their nutritionprogramtotheMoH. an endlinesurveybeforehandingover and DoloBayattheendofFebruaryas by SavetheChildren-USinDolo Ado 25x40clustersurveywasconducted A livestock was generallyinagoodcondi- places, ascompared tolastyear's. The very good,andevenexcessive insome SOMALI REGION AFDER AND LIBENZONE Dolo Bayand Ado Woredas The crudemortality ratewas deyr The prevalenceofglobal rains wasdescribedas The 2woredasarepre- due in April. the performanceofcominggurains security prospectwillnowdependon improved nutritionalstatus. Futurefood rity situationdidnottranslateinto rains. However, theimprovedfoodsecu- the completefailureof2005 ducted duringthesameseasonbutafter rains whilethepreviousonewascon- dry season,jilaal,after good2006 survey wasconductedduringthelong compared toJanuary2006. The present tistically significantimprovementas with 22.5%GAManddidnotshowsta- Ado andDoloBayremainedserious the agro-pastoral communitiesofDolo Conclusion: areas andresultedinreducedyields. the alreadyripenharvestinriverine ed thattheexcessiverainhadaffected able termsoftrade.Itwasfurtherreport- prices haddecreasedresultinginfavor- livestock hadincreasedandthecereal cantly decreasedwhereasthepriceof year thedeathsofanimalshadsignifi- that compared tothesameseasonlast amongst goats andcamels.Itwasnoted tion, thoughdiseaseswerereported ENCU March31,2007 Page4 The nutritionsituationin deyr deyr Fedis Woreda OROMIA REGION The prevalence of global acute malnutrition was esti- EAST HARARGHE ZONE mated at 6.8%. There was no statistically significant differ- Fedis Woreda ence in the level of malnutri- A 26 x 30-cluster survey was conducted previous survey conducted during the tion as compared to the previ- by GOAL in February as an end line sur- same post-harvest season last year with ous survey conducted during vey while handing over its nutrition pro- 6.9% GAM (CI: 5.3-9.0%). The crude the same season last year gram to the MoH. At the time of the writ- and under five mortality rates were esti- with 6.9% GAM. ing up of this bulletin the survey report mated at 0.21 and 0.87 respectively, was not available and hence the presen- below the emergency thresholds of 1.0 tation is limited to the summary findings. and 2.0 deaths/10,000/day. Measles The prevalence of global acute malnutri- vaccination coverage (by card and tion was estimated at 6.8% (CI: 4.9- recall) was estimated at 49% while vita- 8.6%) with 0.5% SAM. There was no min A supplementation coverage was at statistically significant difference in the 89%. level of malnutrition as compared to the

Table 1: Survey Results for Amhara, Harare, Somali and Oromia Amhara Harare Somali Oromia South Wollo Zone - Afder/Liben Zones East Hararghe Key indicators Dessie Zuria Kalu Sofi & Erer Dolo Bay & Dolo Ado Fedis January 10-18 January 22-29 Feb 18-March 4 Feb 25- March 1 February 19-24 GAM in Z-scores 16.2% 7.7% 4.9% 22.5% 6.8% (95% CI) (13.5%-18.9%) (5.4%-10.1%) (2.8%-6.9%) (19.1%-25.8%) (4.9%-8.6%) SAM in Z-scores 1.4% 0.1% 0.3% 2.7% 0.5% (95% CI) (0.6%-2.2%) (0.1%-0.3%) (0%-0.7%) (1.4%-4.1%) (0%-1.0%) Kwashiorkor 0.1% 0% 0% 0% 0% CMR Death/10,000/day 0.36 0.06 0.05 0.03 0.21 (95% CI) (0.06-0.65) (0-0.17) (0-0.11) (0.01-0.15) (0.02-0.45) U5MR Death/10,000/day 0.34 0.34 0.10 0.29 0.87 (95% CI) (0.40-1.08) (0-0.77) (0-0.31) (0.01-0.58) (0.03-1.77) Major causes of U5MR ARI Urinary tract obstruction Not reported Not reported Not reported Morbidity 14.2% 10.1% 9.2% 20.9% 15.6% Major illnesses or symptoms Diarrhea & ARI Diarrhea & Malaria Diarrhea & Cough Cough & Malaria Diarrhea Measles coverage by card 30.2% 47.7% 14.0% 6.4% 5.7% (95% CI) (23.8%-36.5%) (42.2%-53.2%) (not reported) (1.1%-11.8%) (not reported) Measles coverage by card + recall 90.2% 92.7% 92.2% 44.6% 48.6% (95% CI) (86.2%-94.2%) (90.4%-94.9%) (not reported) (34.4%-54.9%) (not reported) BCG coverage (scar) 61.0% 72.7% 73.9% 23.7% 36.0% (95% CI) (55.9%-66.1%) (67.7%-77.7%) (not reported) (15.7%-31.7%) (not reported) Vitamin A in past 6 months 93.6% 96.9% 76.3% 35.0% 89.1% (95% CI) (88.7%-98.5%) (94.8%-99.1%) (not reported) (27.9%-42.6%) (not reported)

Table 2: Food and Nutrition Interventions in Surveyed Woredas of Amhara, Harare, Somali and Oromia Amhara Somali Oromia Harare South Wollo Zone Afder Zone Liben Zone East Haraghe Dessie Zuria Kalu Sofi & Erer Dolo Bay Dolo Ado Fedis Estimated population size 274,878 221,639 47,804 82,908 124,443 206,947 Estimated Under Five population 54,976 44,328 9,561 16,582 24,889 41,389 Productive Safety Net – No of beneficiaries 73,275 51,993 Data not available 69,524 No No % of rural population 26.7% 23.5% at woreda level 33.6% Food Aid Jan-June 07 No No No No No No EOS Screening December 2006 December 2006 October 2006 October 2006 October 2006 No of children acutely malnourished* 1,317 474 565 No 5,225 2,649 As a percentage of screened children 5.0% 1.6% 6.3% 27% 9.9% Therapeutic Feeding Unit Dessie HS No No No Dolo Ado HC Fedis HC Outreach Therapeutic Programme Concern Concern No SC-US SC-US GOAL * MUAC below 12.0 cm and/or oedema ENCU March 31, 2007 Page 5 wider geographic area. main harvestingseasonon a was conductedduring the kebele whilethecurrent one and inthemostfoodinsecure ducted duringthehunger gap The previoussurveywascon- les ofHullawith18.1%GAM. April 2006in12midlandkebe- previous surveyconductedin icantly lowerascompared toa mated at9.2%andwassignif- acute malnutritionwasesti- The prevalenceofglobal Hulla Woreda ENCU stock condition werereportedtobe and pasture availability as welllive- December andpestinfestation. Water continuous rainsfromSeptember to decrease inyieldbyone third,dueto to bebelowaveragewith an estimated the 2006 According toworedaagricultureofficials livestock holdingandreliablerains. of its perennialstockofenset,significant are describedasfoodsecurebecause Enset andBarleyLivelihoodZone Hulla arepart oftheSidama-Gedeo even in"good"years. The Highlandsof duce enoughfoodforthewholeyear However, mosthouseholds donotpro- with tworainyseasons, reported asarelativelyproductivearea Sidama Coffee LivelihoodZoneandare The MidlandsofHullaarepart ofthe lands (64%)andthemidlands(36%). into 2agro-ecologicalzones:thehigh- Food Security: and 84%respectively. tion coveragewasrelativelyhighat88% supplementa- and recall)vitamin A the survey. Measlesvaccination(bycard a diseaseepisodeinthe2weekspriorto 13% ofthechildrenhavingexperienced Retrospective morbiditywaslowwith tries of0.27and1.0deaths/10,000/day. below theaveragefordevelopingcoun- deaths/10,000/days respectivelywere tality ratesof0.21and0.45 Health: Hulla with18.1%GAM. April 2006in12midlandkebelesof pared toaprevioussurveyconductedin found tobesignificantlylowerascom- comparison purposes.Itwas,however, baseline nutritiondata wereavailablefor 9.2% with0.6%severemalnutrition.No acute malnutritionwasestimatedat Nutrition: ly handedovertotheMoH. US nutritionprogramwasbeinggradual- 2006, asanendlinesurveywhileSC- of HullatowardstheendDecember by SavetheChildren-USin32kebeles 26x30clustersurveywasconducted A NPREGION SNNP IAAZONE SIDAMA Hulla Woreda The crudeandunderfivemor- meher The prevalenceofglobal Hulla woredaisdivided harvest wasexpected belg and kremt . son. rate around April duringthehungersea- nutrition status wasexpectedtodeterio- monitor thesituationclosely, asthe continuation oftheCTCprogramandto the Woreda HealthBureauforsmooth SC-US tomaintain adequatesupportto vesting season.Itwasrecommendedfor one wasconductedduringthemainhar- during thehungergapwhilecurrent The previoussurveywasconducted April 2006to9.2%inDecember2006. malnutrition decreasedfrom18.1%in situation: theprevalenceofglobalacute a significantdifference inthenutrition with theprevioussurveyresults showed wider inthecurrentsurvey, comparison Though thegeographiccoveragewas Conclusion &Recommendations: sale ofpersonalassets. migration, consumptionofwildfoodor vey. There wasnoreportofunusual good toaverageatthetimeofsur- respectively. were estimatedat50%,84% and80% supplementation coveragerates min A BCG, measles (cardandrecall)vita- cited asthemaincausesofmorbidity. 11.2% withmalaria anddiarrheabeing Morbidity inchildrenwasestimatedat tries of0.27and1.0deaths/10,000/day. below theaveragefordevelopingcoun- 0.16 deaths/10,000/dayrespectively, tality rateswereestimatedat0.10and Health: the prevalenceofacutemalnutrition. not statistically significantdifferences in GAM (95%CI:9.6%-15.7%)therewas 8.8%) andinMarch2005with12.3% 2006 with6.8%GAM(95%CI:5.2%- previous surveysconductedinMay severe malnutrition.Whencompared to 8.2% (95%CI:6.2%-10.2%)with0.2% acute malnutritionwasestimatedat Nutrition: February. by WVEinBorichaattheendof 22x30clustersurveywasconducted A Boricha Woreda ENCU March31,2007 Page6 The CrudeandUnderFivemor- The prevalenceofglobal time oftheyear. uation wasnormalforthis and thatthefoodsecuritysit- tion (8.2%)wasrelativelylow prevalence ofacutemalnutri- son andshowedthatthe during thepost-harvestsea- The surveywasconducted year. typical forthis timeofthe 6.6% GAMwasconsidered as The nutritionsituationwith results of19.2%. December EOSscreening much lowerthan the mated at2.8%andwasfar cm and/oroedemawasesti- defined byMUACbelow12.0 The levelofacutemalnutrition Boricha Woreda Duna Woreda ENCU seasons, zone isalowrainfallareawithtworainy rely highlyonmarkets. The Bilate Basin year evenina"good"andhence not produceenoughfoodforthewhole rearing. However, mosthouseholdsdo cash crop,andthesearebylivestock main foodcropwhilecoffee isthemain seasons, relatively productiveareawithtworainy income. The Coffee livelihoodzoneisa while livestockisanimportant sourceof include coffee, chatandchillipeppers each rainyseason. The maincashcrops and teff areplantedtwiceayearduring crops suchasbeans,sweetpotatoes the productionofmaize;shorter-cycle as foodinsecureand (11%). The MaizeBeltzoneisdescribed Zone Livelihood Basin Agro-Pastoral Livelihood Zone(25%)andtheBilate rest belongstotheSidamaCoffee Maize BeltLivelihoodZonewhilethe in Boricha(64%)livestheSidama Food Security: normal forthistimeoftheyear. and thatthefoodsecuritysituationwas malnutrition (8.2%)wasrelativelylow showed thattheprevalenceofacute during thepost-harvestseasonand Conclusion: and pasture availability. condition wasalsogoodaswellwater adequate rainperformance.Livestock and betterthanthepreviousyeardueto reported thatthe2006 tion ofgreenmaizeinJuly. Itwas season, whichendswiththeconsump- of April toJunerepresents thehunger livelihood zonesofBorichathemonths stock holdingperhousehold.Inthe3 ly foodsecureduetosubstantial live- tional oedema. ing aMUACbelow 12.0cmand/ornutri- the childrenscreenedidentified ashav- fied asacutelymalnourished, i.e.19%of where highlevelofchildren wereidenti- screening conductedin December, situation followingthe6th round ofEOS vey objectivewastoverifythenutrition SNNPR RENCUinFebruary. The sur- in Dunabyamulti-agencyteamled 25x31clustersurveywasconducted A AIAZONE HADIYA Duna Woreda belg belg The surveywasconducted and and Most ofthepopulation kremt kremt. belg meher and isrelative- -dependent for Enset isthe was good woreda ismostly beans andpeasasthemajorcrops. The ing withenset,wheat,potatoes, barley, The mainlivelihoodissubsistencefarm- highlands (59%)andmidlands(30%). over 2mainagro-ecologicalzones,the Food Security: and 105.4%forvitamin A. reporting acoverageof96%formeasles statistics oftheWoreda Health Bureau and foundtobemuchlowerthanthe estimated at64%and60%respectively supplementation were and vitamin A Measles vaccination(bycardandrecall) with 17.6%retrospectivemorbidity. 1.00 deaths/10,000/dayrespectively tality rateswereestimatedat0.44and Health: to 4.7cm. cm, thedifferences rangedbetween0.1 dren actuallyhadaMUACbelow12.0 was foundthatonly44%ofthesechil- re-measured in2kebelesofDuna.It were dren registeredintheEOS/TSFP total of103chil- similar discrepancies. A showed by SNNPRRENCUandGOAL tion assessmentconductedinJanuary post-EOSscreeningverifica- 19.2%. A than theEOSscreeningresults of mated at2.8%andwasfarmuchlower below 12.0cmand/oroedemawasesti- of acutemalnutritiondefinedbyMUAC with 0.6%severemalnutrition. The level and/or oedemawasestimatedat6.6% acute malnutritiondefinedbyWHZ Nutrition: food security indicators showedthatthe areas suchas Duna.Inaddition,allthe as typicalforchronically food insecure uation with6.6%GAMwas considered EOS screeningresults. The nutritionsit- ous nutritionsituationasdepicted bythe The surveyresults didnotconfirmaseri- Conclusion andRecommendations: tile parts ofDawrozone. households hadbeentransferredtofer- program wasimplementedinDunaand noted thatthegovernmentresettlement the termsoftradewerefavorable.Itwas tion werealsoreportedtobegoodwhile pasture availability, andlivestockcondi- reported inwethighlands.Water and rains thoughlocalizedcropfailurewas tory duetogoodperformanceofthe production for2006wasratedsatisfac- November-December. The overallcrop hence themainharvestingperiodis ENCU March31,2007 Page7 The crudeandunderfivemor- The prevalenceofglobal Duna woredastretches meher dependant and food security situation was satisfactory occurs from February, when the main Humbo Woreda at the time of the survey. It was recom- season crops run out, to June, when the The prevalence of acute mal- mended to strengthen the screening first green crop is harvested. The food nutrition (2.4%) was low and component of the EOS by providing security at the time of the survey was typical for this time of the year, adequate training prior to the campaign rated as satisfactory as a result of the i.e. post-harvest season, and supervision during its implementa- 2006 meher harvest due to adequate when household food security tion, thereby improving the data quality kremt rains distribution. Around 94% of is improved. and minimizing inclusion errors. the households interviewed reported own production as the main source of WOLAYITA ZONE food with maize and sweet potatoes being the main food consumed in the past month while 76% of the households Humbo Woreda reported livestock condition to be good A 22 x 30 cluster survey was conducted to average. by WVE in Humbo at the end of February as part of the monitoring of its Conclusion: The prevalence of acute operational area. malnutrition (2.4%) was low and typical for this time of the year, i.e. post-harvest Nutrition: The prevalence of global season, when household food security acute malnutrition was estimated at is improved. Future food security will 2.4% (CI: 1.1%-3.7%) with 0.3% severe depend on the harvest of sweet pota- malnutrition. There is no baseline for this toes and of enset to a lesser extent, to particular woreda, as previous surveys fill the hunger gap of February to May. conducted over the past 6 years were rather patchy and covering different sea- Sodo Zuria Woreda sons. The level of acute malnutrition A 22 x 32 cluster survey was conducted since 2000 ranged from 2.1% to 12.5%. by WVE in Sodo Zuria at the end of When compared to the NSP (Nutrition February as part of the monitoring of its Surveillance Program) baseline range of operational area. 4.2-6.8% wasting, the observed level of malnutrition was typical for the post har- Nutrition: The prevalence of global vest season in Wolayita. acute malnutrition was estimated at 3.9% with 0.4% severe malnutrition. A Health: The mortality rates for the popu- number of surveys were conducted in lation and for the under-five children this woreda over the past 6 years, how- were estimated at 0.24 and 0.71 ever not on a regular basis and at differ- deaths/10,000/day respectively, below ence seasons. The level of acute malnu- the average for developing countries of trition recorded since 2000 ranged from 0.27 and 1.0 deaths/10,000/day. 2.7% to 20.0%. When compared to the Retrospective morbidity was high at NSP (Nutrition Surveillance Program) 39% with malaria/fever and ARI/cough baseline range of 4.2-6.8% wasting, the

ENCU being cited as the 2 top main causes of observed level of malnutrition was typi- morbidity in the 2 weeks prior to the sur- cal for the post harvest season in vey. BCG, measles vaccination (by card Wolayita. and recall) and vitamin A supplementa- tion coverage were estimated at 57%, Health: The mortality rates for the popu- 85% and 92% respectively. lation and for the under-five children were estimated at 0.09 and 0.28 Food Security: Most of the population deaths/10,000/day respectively while of Humbo (90%) lives in the Wolayita retrospective morbidity was around Maize and Root Crop LZ while the 20%. BCG vaccination, measles vacci- remaining 10% belongs to the Chamo- nation (by card and recall) and vitamin A Abaya Irrigated Banana LZ. The former supplementation coverage were rela- Sodo Zuria Woreda is described as an area with the most tively high at 85%, 82% and 89% varied cropping of all Ethiopia with two The prevalence of acute mal- respectively. growing cycles per year while the latter nutrition was low at 3.9% and is described as the most prosperous typical for this time of the year, Food Security: About two thirds of the zone of the Region with irrigated banana i.e. post-harvest season with population of Sodo Zuria lives in the production, cotton production and abun- a normal meher harvest. Wolayita Maize and Root Crop LZ while dant pasture. Seasonal food shortage

ENCU March 31, 2007 Page 8 meher been replenished bythe household foodstocks had post harvestseasonwhile the vey wasconductedduring the aggravating factors. The sur- was lowat2.5%inabsence of The levelofacutemalnutrition crop production. Mirab Abaya Woreda ENCU stretches over twolivelihoodzones,the Food Security: 93% and97%respectively. coverage werefoundtobe highat82%, supplementation recall) andvitamin A BCG, measlesvaccination(bycardand tries of0.27and1.0deaths/10,000/day. below theaveragefordevelopingcoun- deaths/10,000/day respectivelylying were estimatedat0.12and0.19 lation andfortheunder-fivechildren Health: 2003 withGAMof8.8%(CI:6.4-11.9%). this woredadatedbacktoFebruary recorded. The lastsurveyconductedin malnutrition. Nocasesofoedemawere 2.5% (CI:1.2-3.8%)with0.4%severe acute malnutritionwasestimatedat Nutrition: ing ofits operationalarea. February aspart oftheregularmonitor- by WVEinMirab Abaya attheendof 17x30clustersurveywasconducted A hunger gaps. harvest oftherootcrops, tofillthe performance ofthe Future foodsecuritywilldependonthe season withanormal for thistimeoftheyear, i.e.post-harvest malnutrition (3.9%)waslowandtypical Conclusion: seeds. of agriculturalinputs andimproved performance, andincreasedutilization normal yearasaresultofadequaterain meher vey wasratedasgoodduetherecent The foodsecurityatthetimeofsur- and thesecondin August-September. hunger seasons:thefirstinMarch-April whilst intheBarley/WheatLZthereare2 shortage occursfromFebruarytoJune Maize/Root CropLZseasonalfood food insecuremostyears.Inthe latter thepoorerhalfofpopulationis two growingcyclesperyearwhileinthe most variedcroppingofallEthiopiawith mer isdescribedasanareawiththe Wolyata BarleyandWheatLZ. The for- the remainingthirdbelongsto AOGF ZONE GAMO GOFA Mirab Abaya Woreda Mirab Abaya harvest, whichwassimilartoa The mortality ratesforthepopu- The prevalenceofglobal The prevalenceofacute Mirab Abaya woreda Mirab Abaya belg meher rains andthe harvest. Gamo Gofa Maize andRootCropLZ stretches over2livelihood zones,the Food Security: high at87%each. plementation coveragewasrelatively sup- (by cardandrecall)vitamin A the top2diseases.Measlesvaccination at 20%withdiarrheaandmalariabeing Retrospective morbiditywasestimated tries of0.27and1.0deaths/10,000/day. below theaveragefordevelopingcoun- deaths/10,000/days respectivelywere tality ratesof 0.16 and0.17 Health: comparison purposes. baseline nutritiondata wereavailablefor 1.2% with0.2%severemalnutrition.No acute malnutritionwasestimatedat Nutrition: end ofFebruary. by WVEinBoreda Abaya towardsthe 17x30clustersurveywasconducted A occurs around April toMay. ing thehungergap,whichnormally address anticipated foodshortage dur- wasexpectedto gram andEOS/TSFP production. The ongoingsafetynetpro- been replenishedbythe son whilethehouseholdfoodstockshad conducted duringthepostharvestsea- coverage. The surveywas vitamin A and morbidityrates,highmeasles household foodsecurity, lowmortality aggravating factorswithadequate trition waslowat2.5%inabsenceof Conclusion: a "normal"year. food securitysituationwasequivalentto the surveyindicatedthatworeda and copingstrategiesusedatthetimeof pasture. The foodsecurityindicators duction, cottonproductionandabundant of theRegionwithirrigatedbananapro- described asthemostprosperouszone while thelatterconsistingoflowlandsis trypanosomias andrelativeisolation erratic weather, highpopulationdensity, described ashighlyfoodinsecuredueto of upperlowlandsandmidlandsis Banana LZ(30%). The formerconsisting (60%) andtheChamo-AbayaIrrigated Gamo GofaMaizeandRootCropLZ Boreda Abaya Woreda Boreda Abaya ENCU March31,2007 Page9 The crudeandunderfivemor- The prevalenceofglobal The levelofacutemalnu- Boreda Abaya woreda Boreda Abaya meher crop Boreda Abaya (70%) and the Gamo Gofa Enset and woreda food security situation was Barley LZ (30%). The former consists of equivalent to a "normal" year. Woreda upper lowlands and midlands and is The level of acute malnutrition described as highly food insecure due to Conclusion: The level of acute malnu- was low with 1.2% GAM and erratic weather, high population density, trition was very low with 1.2% GAM and indicative of a satisfactory trypanosomias and relative isolation. indicative of a satisfactory food security food security situation at the The latter consists of wet midlands and situation at the household level. The sur- household level. highlands and most of the population is vey was conducted after the main har- food secure except the poorer house- vesting season, which was rated as holds due to insufficient land holding. good. It was anticipated that the ongo- Belg and kremt rains are two important ing Safety Net Program and EOS/TSFP rainy seasons for growing crops and would cover the existing needs during pasture regeneration. The food security the coming hungry season due in April. indicators and coping strategies used at the time of the survey indicated that the

Table 3: Survey Results for SNNPR Sidama Zone Hadiya Zone Gamo Gofa Zone Wolayita Zone Key indicators Hulla Boricha Duna Boreda Abaya Mirab Abaya Humbo Sodo Zuria December 25–29 Feb. 26- March 2 February 18-23 Feb 27-March 3 Feb. 26-March 2 Feb. 16-March 2 Feb 22-March 3 GAM in Z-scores 9.1% 8.2% 6.6% 1.2% 2.5% 2.4% 3.9% (95% CI) (7.0%-11.2%) (6.2%-10.2%) (4.4%-8.8%) (0.1%-2.2%) (1.2%-3.8%) (1.1%-3.7%) (2.2%-5.6%) SAM in Z-scores 0.5% 0.2% 0.6% 0.2% 0.4% 0.3% 0.4% (95% CI) (0%-1.0%) (0%-0.4%) (0%-1.3%) (0%-0.6%) (0%-0.9%) (0%-0.7%) (0%-1.0%) Kwashiorkor 0.1% 0% 0.6% 0% 0% 0.1% 0.4% CMR Death/10,000/day 0.21 0.10 0.44 0.16 0.12 0.24 0.09 (95% CI) (0.07-0.36) (0-0.20) (0.22-0.67) (0-0.32) (0-0.26) (0.09-0.40) (0-0.17) U5MR Death//10,000/day 0.45 0.16 1.00 0.17 0.19 0.71 0.28 (95% CI) (0.01-0.89) (0-0.44) (0.26-1.74) (0-0.53) (0-0.61) (0.03-1.39) (0-0.68) Major causes of U5MR Not reported Not reported Diarrhea/ARI Diarrhea Diarrhea Fever Not reported Morbidity 13.0% 11.2% 17.6% 19.7% 15.6% 39.3% 20.6% Major illnesses or symptoms Diarrhea & Cough Malari & Diarrhea Diarrhea & Scabies Diarrhea & Malaria Fever & Diarrhea Fever & ARI Cough & Diarrhea Measles coverage by card 3.7% 11.7% 3.2% 15.4% 32.6% 16.2% 45.3% (95% CI) (1.8%-5.5%) (8.5%-14.9%) (1.7%-5.6%) (11.3%-20.7%) (26.9%-38.8%) (12.4%-20.8%) (40.1%-50.5%) Measles coverage by card + recall 87.7% 83.6% 64.0% 87.2% 93.2% 84.5% 82.2% (95% CI) (80.9%-94.6%) (78.1%-89.1%) not reported (82.2%-91.0%) (89.1%-95.9%) (80.2%-88.5%) (77.8%-85.9%) BCG coverage (scar) 55.3% 49.5% 41.6% 72.7% 81.5% 57.0% 85.3% (95% CI) (47.1%-63.4%) (41.0%-58.9%) (36.6%-46.7%) (66.8%-78.0%) (76.1%-85.9%) (51.5%-62.4%) (81.1%-88.7%) Vitamin A in past 6 months 83.8% 79.6% 59.7% 86.8% 97.3% 92.1% 89.2% (95% CI) (CI: NR) (70.5%-88.6%) (54.6%-64.6%) (82.0%-90.6%) (94.3%-98.8%) (88.5%-94.6%) (85.5%-92.1%)

Table 4: Food and Nutrition Interventions in Surveyed Woredas of SNNPR Sidama Zone Hadiya Zone Gamo Gofa Zone Wolayita Zone Hulla Boricha Duna Boreda Abaya Mirab Abaya Humbo Sodo Zuria Estimated population size 123,375 248,553 117,045 73,138 70,972 135,205 237,031 Estimated Under Five population 24,675 49,711 23,409 14,628 14,194 27,041 47,406 Productive Safety Net – No of beneficiaries 9,133 39,760 10,913 16,569 26,769 41,729 29,536 % of rural population 7.0% 16.0% 9.3% 23.0% 37.7% 30.9% 12.5% Food Aid Jan-June 07 No No No No No No No EOS Screening Nov/Dec 2006 Nov/Dec 2006 Nov/Dec 2006 Nov/Dec 2006 Nov/Dec 2006 Nov/Dec 2006 Nov/Dec 2006 No of children acutely malnourished* 2,517 1,134 4,218 1,308 279 1,527 2,639 As a percentage of screened children 13.0% 3.0% 18.4% 12.0% 2.7% 6.0% 8.8% Yirba HC Therapeutic Feeding Unit Hagerselam HC No No No No No Darara HC Outreach Therapeutic Programme MoH MoH No No No IMC IMC * MUAC below 12.0 cm and/or oedema

ENCU March 31, 2007 Page 10 ENCU piled intable 6. Findings ofthequalitycheckarecom- results wererepresentative andreliable. ments and(2)whetherthesurvey the samplingproceduresandmeasure- nificant biashadbeenintroducedduring checked inordertodetermine(1)ifsig- The qualityofthesurveyresults was should liebetween0.9and1.1. much fromtheexpectedsexratioand ratio ofboystogirlsshouldnotvarytoo shown inthetable 5.Likewisethesex developing world(WHO,2000),as tion forchildren6-59monthsinthe vary toomuchfromthetypicaldistribu- tribution oftheseagegroups shouldnot bias duetomisreportingofage. The dis- around wholeyearsinordertominimize months and54-months,arecentered 29 months,30-4142-53 proposed agegroups, 6-17months,18- by thesurveys.Innutritionsurveys population group(6-59months)targeted and sex,arerepresentative ofthe samples arenotbiasedintermsofage vey samplesallowverifyingwhetherthe The demographicbreakdownofthesur- within theselectedkebeles. allocated randomlytothevillagelevel at kebelelevelusingPPSandwerethen stages, i.e.clusterswerefirstlyselected veys clusterselectionwasdonein2 veys outof12.Fortheremaining6sur- at villagelevelusingPPSinonly6sur- ter selectionwasdoneinasinglestage included inthesample.Inpractice,clus- ulation hasanequalchanceofbeing ensuring thateachindividualofthepop- to size)samplingtechnique,thereby using thePPS(probabilityproportional done onthesmallestgeographicalunits In theory, clustersselectionshouldbe UVYDT ULT CONTROL QUALITY DATA SURVEY 6-59 months(WHO,2000) Table 5:Typical demographicdistribution Bias inchildrenselection Bias inclusterselection 45 ots9.00% 19.20% 22.40% months 54-59 25.50% months 42-53 months 30-41 months 18-29 61 ots23.90% Total months 6-17 Age groups sex ratioof1.2. surveys, i.e.HullaandDolo Ado, witha was aslightsexbiastowardsboysin2 61% closetotheexpected51%. There (30-59 months)liedbetween52%to expected 49%whiletheolderagegroup between 39%to48%closethe younger agegroup(6-29months)lied 12 surveysconductedinthisquarter:the There wasnosignificantagebiasinthe usually moreaffected bymalnutrition. evidence thateitherboysorgirlsare affect malnutritionratesunlessthereis the actualone.Sexbiasislesslikelyto a higherprevalenceofmalnutritionthan tation oftheolderagegroups) maygive younger agegroups (orunder-represen- al onewhileover-representation ofthe prevalence ofmalnutritionthantheactu- older agegroups) maygivealower groups (orover-representation ofthe under-representation oftheyoungerage (30-59 months). This meansthatan be malnourishedthanolderagegroups (6-29 months)areusuallymorelikelyto anthropometry, asyoungeragegroups Age biasesareofparticular concernfor ware. soft- done byNutrisurvey, theSMART tion. These checks areautomatically ness andkurtosisoftheWHZ distribu- includes thestandard deviation,skew- those ofanormaldistribution. This characteristics oftheWHZcurveto can thenbeassessedbycomparing key distributed. The overallqualityofsurvey WHZ ofthesampleshouldbenormally In agoodsurveythedistributionof in allsurveyspresentedthisbulletin. erence neitherforweightnorheight digit preference. There wasnodigitpref- determining whetherthereissignificant final decimalforweightandheight biases arecheckedbyassessingthe tion ineitherdirection.Measurements changes intheprevalenceofmalnutri- nutritional status andcanresultinmajor significant errorsinclassifyingchildren precision inmeasurements cancause the nearest1mmforlength/height.Poor to thenearest100gforweightand Children shouldbemeasuredprecisely

Overall qualityofthesurvey Bias inmeasurements ENCU March31,2007 Page11 - The standard deviation of weight-for- bution. A normal distribution has zero height: In a normal distribution the SD of kurtosis. The moment of kurtosis should WHZ is equal to + 1. The SD of WHZ lie between plus or minus one. Positive should lie between 0.8 and 1.2 z-score kurtosis indicates a relatively peaked units for weight-for-height. High SD indi- distribution while negative kurtosis indi- cates that there are substantial random cates a relatively flat distribution. Four errors in the measurements. In 3 sur- surveys, i.e. Hulla, Boricha, Fedis and veys out of 12 the SD of WHZ was just Dolo Ado out of 12 exhibited a positive below the lower limit of 0.8. kurtosis and hence a peaked WHZ dis- tribution. - The skewness of weight-for-height: this

is a measure of the degree of asymme- Conclusion try of the data around the mean. A nor- None of the surveys presented in this mal distribution is symmetrical and has bulletin showed significant bias in sam- zero skewness. The moment of skew- pling and/or measurements. However, 3 ness should lie between plus or minus surveys showed a low SD and hence one. Positive skewness indicates a long were likely to underestimate the preva- right tail while negative skewness indi- lence of wasting. Until there is further cates a long left tail. None of the surveys guidance from the SMART group it exhibited skewness problem. remained difficult to explain such a find- ing whereas all the other indicators were - The kurtosis of weight-for-height: this is in line with the quality standards. a measure of the relative peakedness or flatness compared with a normal distri-

Table 6: Results of Survey Quality Check Area Sampling Digit preference SD Skewness Kurtosis % of WHZ Representativeness of the sample Agency Surveyed frame Weight Heightof WHZ of WHZ of WHZ flags Age Group Distribution Sex Ratio 6-29 months: 45.3% Concern Kalu Kebele No No 0.785 0.236 0.028 0.1% 1.0 30-59 months: 54.7% 6-29 months: 43.0% Concern Dessie Zuria Kebele No No 0.797 0.005 0.240 0% 1.1 30-59 months: 57.0% 6-29 months: 43.7% DPPA/B Sofi & Erer Village No No 0.935 0.304 1.905 0.2% 1.1 30-59 months: 56.3% 3.262 6-29 months: 47.7% GOAL Fedis Village No No 0.923 0.781 0.3% 1.1 positive kurtosis 30-59 months: 52.3% Dolo Bay & 2.358 6-29 months: 44.8% 1.2 SC-US Kebele No No 0.940 0.616 1.0% Dolo Ado positive kurtosis 30-59 months: 55.2% bias towards boys 1.911 6-29 months: 39.1% 1.2 SC-US Hulla Kebele No No 0.886 0.415 0.1% positive kurtosis 30-59 months: 60.9% bias towards boys SNNPR 6-29 months: 46.9% Duna Village No No 0.764 0.143 0.268 0% 1.0 RENCU 30-59 months: 53.1% 6-29 months: 44.0% WVE Mirab Abaya Village No No 0.852 -0.097 0.415 0% 1.0 30-59 months: 56.0% 2.865 6-29 months: 40.3% WVE Boricha Kebele No No 0.964 0.766 0.3% 1.0 positive kurtosis 30-59 months: 56.3% 6-29 months: 43.5% WVE Boreda Abaya Kebele No No 0.805 0.190 0.349 0% 0.9 30-59 months: 56.5% 6-29 months: 44.7% WVE Sodo Zuria Village No No 0.861 0.125 0.225 0% 1.1 30-59 months: 55.3% 6-29 months: 41.8% WVE Humbo Village No No 0.875 0.115 0.108 0% 0.9 30-59 months: 58.2%

ENCU March 31, 2007 Page 12 NUTRITION SURVEY DATABASE

Table 7 presents the number of standardized nutrition surveys conducted in Ethiopia since 2000. It does not include sur- veys conducted in resettlement areas, IDP and refugee camps.

Table 7: Number of surveys per region and year Year Region Total 2000 2001 2002 2003 2004 2005 2006 2007 SNNPR 9 5 35 30 14 25 20 6 144 Oromia 3 2 20 27 22 20 14 1 109 Amhara 5 9 24 17 9 7 6 2 79 Somali 855581112155 Tigray 006733 0 019 Afar 004516 4 020 Gambella 000000 0 0 0 Benshangul Gumez 000000 0 0 0 Harare 000000 0 1 1 Total2521949157725611427

ENCU March 31, 2007 Page 13