DPPC WFP SC_UK

Summary Report of the West Hararghe Nutrition Survey,

October 8, 2002

The food and nutritional situation in parts of in Oromiya Region is critical. In the dry midlands and lowlands the survey result indicates that the global acute malnutrition is 15.1% (with severe malnutrition 3.6%).

The failure of the short Belg rains coupled with the late onset of the long Meher rains has led to a period of prolonged drought in , leaving millions of people unable to meet their food needs in the end of 2002 and very likely throughout 2003.

In response to the emerging food crisis in West Hararghe Zone, a nutrition survey team composed of the Federal and Regional Disaster Prevention and Preparedness Commissions, the Zonal DPP and Health Departments, CARE Ethiopia, World Food Programme and Save the Children-UK conducted a nutrition survey from September 20 – 30, 2002 to quantitatively assess the health and nutritional status of the affected population.

The Belg multi-agency assessment in late June warned that the failure of the Belg rains would cause an increase in food insecurity in several areas of the country, including West Hararghe. Food distribution has already underway in the zone, but by early September high levels of malnourished children in several villages were reported. Emergency assessment teams in August/September initially reported large numbers of visually identifiable cases of acute malnutrition, increased numbers of child deaths and increased numbers of children admitted to local hospitals with symptoms of severe malnutrition. The objective of this survey was therefore, to determine nutritional status of the affected population in West Hararghe in order to confirm the emergency situation and advocate for appropriate intervention.

Since the effect of the drought varies in different agro-ecological zones and thus affects the nutritional status of the population differently, the zone was divided into two survey areas: highland/wet midland zones (survey area one) and lowland/dry midland zones (survey area two). A 30 by 30 cluster sample survey consistent with international standards was undertaken in the two survey areas. Anthropometric, health and food security data were collected. The number of children (between the ages of 6 and 59 months) included in the survey was 938 and 933 in survey one and two respectively. Height was used as a proxy indicator for age, therefore all children between 65 cm and 110 cm were included in the survey.

Major Findings:

The following table indicates the results of nutritional and health status of the two survey areas:

Table 1: Anthropometric Survey Results in 30-by-30 clusters

Survey area Sample GAM* SAM ** Oedema size

Survey 1: highland and wet midland 938 7.9 % 1.6 % 11 (1.2%) areas of , , Kunni, , Ciro, Daro Lebu, and Bokie CI: 6.4 –10.0%) CI: (0.9 – 2.7%) CI: (0.6% - 2.2%) woredas

Survey 2: , dry midland and lowland 933 15.1 % 3.6% 26 (2.8%) areas of Anchar, Guba Koricha, Habro, Daro Lebu, and Bokie woreda , and all CI***: (12.9% - 17.6%) CI: (2.6% - CI: (1.9 –4.1%) areas of Miesso, 5.1%)

Table 2: Relevant Morbidity Data

Survey area Illness in the last two weeks (% of occurrence) Measles Diarrhea Cough Measles Malaria/ Fever Immunization Survey 1: 12.6 5.8 0.2 6.6 21.5% Survey 2: 23.4 12.1 0.3 12.6 25.7%

The Global Acute Malnutrition rate (GAM) in survey one (highland/ wet midland) is 7.9%. According to the Emergency Nutrition Guideline1[1] a GAM of 5 to 9%, in the

* GAM (Global Acute Malnutrition) is the percentage of children with moderate and severe malnutrition i.e. their weight for height ratio more than 2 standard deviatesions below the average of the reference population.

** SAM (Severe Acute Malnutrition) is the percentage of children whose weight for height is more than 3 standard deviations below the average of the reference population and children with Oedema.

*** CI- Confidence Interval is that the true prevalence falls within the range specified.

1[1] The Emergency Nutritional Guidelines were adopted specifically for the Ethiopian context and the classification is attached with the report. presence of aggravating factors is classified as “poor”. In some parts of the highlands and wet midlands, aggravating factors include low access to food (below the mean energy requirement) due to below average crop production and cash crop performance and low vaccination coverage.

The Global Acute Malnutrition rate in survey two (lowland/dry midland) is 15.1%. According to the Emergency Nutrition Guideline a GAM between 15 and 19 % in the presence of aggravating factors is classified as “critical”. The aggravating factors in survey 2 include poor access to food (failure in long cycle crops, failure of the transitory food harvest such as sweet potato, poor access to livestock products and low livestock market value), low vaccination coverage, high incidence of diarrheal diseases and several reported cases of malaria/ fever. High prevalence of Vitamin A deficiency disease was also detected in the surveyed areas.

It should be noted that the reported GAM represents an estimate of prevalence of malnutrition of all children sampled in the respective survey areas. However, pocket areas with significantly higher prevalence of malnutrition have also been observed.

The results of the survey indicate that the situation is in line with other severely affected areas of the country. Thus; immediate food and health assistance is required in West Hararghe. The survey does not and cannot adequately capture the extent of the large- scale deterioration of the situation as it only evaluates the current situation. It is clear that there has already been a deterioration of the humanitarian condition, particularly in the lowlands, due to the damage on major food and cash crops (estimated failure70 - 80%), and one should expect that there would be further critical deterioration on the livelihoods of the people in the zone.

Communities, many of whom have not fully recovered from the drought of 2000, are already living a very precarious existence and are unable to cope with further shocks. Many people have already sold most of their productive assets and have little or no cash to purchase increasingly expensive food from the market. To date, interventions have included the distribution of grains and fortified blended.

Recommendation:

Given the nutrition survey result and other qualitative indicators, the assessment team recommends the following for immediate action in West Hararghe:

General relief food distribution (blended food, grain and oil) should continue in all the lowland and dry midland and pocket areas of the highland and wet midlands for the next 9 - 12 months, Targeted distribution of supplementary food such as Famix/CSB (take home dry rations) should be undertaken for lowland/dry midland areas for the next 6 months Specialized agencies and NGOs should provide support to strengthen the health institutions in the most affected areas of the zone to run therapeutic feeding programs for severely malnourished children. Training should include appropriate management of therapeutic foods (such as F100 and F75), ongoing monitoring of nutritional status, and proper screening and targeting of children for supplementary food distribution. In the worst affected areas where there is no health facilities near by the beneficiaries establishment of feeding centers may be considered. Therefore, close follow up of the situation is further recommended, Continued close monitoring of the water supply situation to prevent and respond to shortages Capacity building of local health institutions in providing vaccines and essential drugs to rural communities. Furthermore, the survey team strongly recommends that vitamin A and measles immunization campaign be undertaken in all drought -affected areas in the zone, Provision of maize and sorghum seeds by March/April 2003 for the lowland/dry midland areas, Training on appropriate food aid targeting and monitoring as per the DPPC guidelines for community leaders at grass root level and woreda officials, Follow up nutrition survey every quarter to monitor the trend and Continued monitoring of the food security situation and coordinated activities are necessary to ensure effective intervention.

Classification of Severity of Malnutrition in a Community, Based on the Prevalence of Wasting for Children Under 5 Years of Age.

(Emergency Nutrition Guideline, June 2002)

Indicators Stage of Alert Global acute malnutrition prevalence >20%and /or SAM>=5% Global acute malnutrition prevalence 15-19% and Critical aggravating factors Global acute malnutrition prevalence 15-19% Global acute malnutrition prevalence 10-14% and aggravating factors Serious Global acute malnutrition prevalence 10-14% Global acute malnutrition prevalence 5-9 % and aggravating factors Poor Global acute malnutrition prevalence 2-9% Normal for a chronically malnourished population

Potential aggravating factors include:

¾ Poor household food availability (due to a poor harvest, high market prices or insecurity)

¾ Where the population is entirely dependent on food aid (for example in a refuge camp) a general food ration providing less than 1900 kcal/person/day.

¾ Epidemics of measles, cholera, shigella and other important communicable diseases.

¾ Inadequate shelter and severe cold.

¾ Low levels of measles vaccination and vitamin A supplementation. ¾ Inadequate water supplies

Consideration of aggravating factors is an absolutely essential part of a good interpretation of anthropometric data. The situation may be worse if there is more than one aggravating factor.