EMERGENCY NUTRITION

ENCU/EWD/DPPA QUARTERLY BULLETIN Tel. (011) 5 523556 e-mail:[email protected] (Third Quarter 2006) http://www.dppc.gov.et Emergency Nutrition Coordination Unit Early Warning Department (Disaster Prevention and Preparedness Agency)

INSIDE

SNNP REGION

WOLAYITA ZONE ( AND WOREDAS) Page 2

SIDAMA ZONE (DALE AND ALETA WONDO WOREDAS) Page 4

SILTI ZONE (DALOCHA WOREDA) Page 5

HADIYA ZONE (SHASHEGO WOREDA) Page 6 OROMIA REGION

EAST HARARGHE ZONE (DEDER AND META WOREDAS) Page 7 This bulletin compiles the results from 14 surveys carried out in rural woredas WEST HARARGHE ZONE (DARO LEBU WOREDA) of between June and September 06. An additional 8 surveys were Page 8 conducted in the refugee camps of Ethiopia. Summary results for rural Ethiopia are presented in the graph below.

SOUTH WOLLO ZONE (KALU AND ZURIA WOREDAS) Nutrition Survey Results - June/September 2006 Page 9 Rural Ethiopia

SOMALI REGION 18 . 0

16 . 0 AFDER ZONE (ELKERE AND HARGELLE WOREDAS) Page 12 14 . 0

12 . 0 AFDER AND LIBEN ZONES (DOLO ADO, DOLO BAY AND BARE WOREDAS - PASTORAL) 10 . 0

Page 13 8.0

LIBEN ZONE (MOYALE AND HUDET WOREDAS) 6.0

Page 14 4.0 REFUGEE CAMPS 2.0

Page 16 Prevalence of global acute malnutrition (%) 0.0 Offa Damot WeydeDalocha Daro Lebu D/AW MaizeShashego LZ Meta Deder Kalu Elkere & HargeleDessie ZuriaDO/DB/ Ba re Pas toralD/AW Coffee LZ SURVEY QUALITY CONTROL Page 18

Severe Malnutrition Moderate Malnutrition NUTRITION SURVEY DATABASE Page 20

ENCU September 30, 2006 Page 1 SNNP REGION

WOLAYITA ZONE

Offa and Damot Weyde Woredas

Two surveys were conducted in flash floods in March or lack of rains. Wolayita zone, one in Offa and one in The livestock was reported to be in a Damot Weyde, as part of the regular good condition due to adequate pasture monitoring of Concern project areas. and water availability. The SMART method was used for the planning phase, resulting in sampling Conclusion: The prevalence of malnu- 40 clusters of 20 children for anthro- trition was low in both woredas, reflect- pometry and 40 clusters of 12 house- ing a satisfactory nutrition and food holds for mortality. security situation, and was typical for this time of the year. Historical data from Nutrition: The prevalence of global SC-UK NSP indicated a baseline preva- acute malnutrition was estimated at lence of malnutrition of 4.5-6.5% for the 3.6% and 3.8% with 0.2% and 0.1% late Belg (June-August) in Wolayita. severe malnutrition in Offa and Damot When compared to the last surveys con- Weyde respectively. Severe malnutri- ducted in December 05, the post-har- tion consisted solely of kwashiorkor, no vest season, with 4.7% GAM (CI: 7.3- marasmus were recorded. 13.1%) in Offa and 4.0% GAM (CI: 2.5- 6.4%) in Damot Weyde, there was no Health: The crude mortality rate was significant difference in the malnutrition 0.14 and 0.39 deaths/10,000/day in rates. Offa and Damot Weyde respectively. The under-five mortality rate was 0.47 Trend analysis: A total of 16 surveys and 0.69 deaths/10,000/day in Offa and had been conducted over the past 6 Damot Weyde respectively, below the years in Damot Weyde woreda with average for developing countries of 1 GAM ranging from 3 to 10%. The NSP deaths/10,000/day. Causes of death in baseline ranges for East Wolayita by both adults and children were related to season (reference year 1996) are 4.9- malaria. In these 2 woredas malaria 6.8% for post-harvest (PH=Dec.-Feb.), occurs throughout the year with 2 sea- 4.8-6.7% for early belg (EB=March- sonal peaks (Feb.-April and Oct.-Nov.). May), 4.7-6.5% for late belg (LB=June- Aug.) and 4.4-6.3% for kremt (K=Sept.- Food Security: Most of the population Nov.), and were plotted on graph 1 to of Offa and Damot Weyde lives in the allow comparison. The nutrition situation Wolayita Maize and Root Crop in Damot Weyde since 2000 was overall Livelihood Zone, which is described as similar to the NSP baseline, except for chronically food insecure, the severity the early belg season for 2003 and 2005 of which varies from year to year. Food where it was above the NSP reference access is highly seasonal depending values. Damot Weyde benefited from

ENCU on rainfall patterns and crop produc- food aid and Productive Safety Net tion. Even in a year with relatively good Programme over the years under study, crop production the area receives food as shown in graph 2. aid. The hunger gap usually occurs Offa and Damot Weyde from February, when the main harvest Woredas from October-November is exhausted, until June, when the first green crop is The prevalence of malnutri- harvested. It was reported that the 05 tion was low with 3.6% in meher harvest was good while harvest- Offa and 3.8% in Damot ing of belg crops (green maize, beans, Weyde, and was typical for sweet potatoes, teff and sorghum) had this time of the year com- started in early June. The belg harvest pared to the NSP baseline was also expected to be good due to range of 4.5-6.5% for late adequate belg rains- except in some belg. lowlands kebeles affected either by

ENCU September 30, 2006 Page 2 ENCU (PH=Dec.-Feb.), 5.4-7.4%forearly 1996) are4.2-6.0%forpost-harvest Wolayita byseason(reference year baselinerangesforWest NSP with GAMrangingfrom4to19%. The been conductedoverthepast 4years, In Offa woredaatotal of9surveyshad

GAM % 10 12 0 2 4 6 8 GAM % Rural Population (%) 10 15 20 25

10 15 20 25 30 35 40 0 5

LB 00 LB

0 5 K 00 K

0020 0220 0420 2006 2005 2004 2003 2002 2001 2000 EB 03 EB EB 01 EB Comparison of malnutrition levels and NSP baseline and NSP levels malnutrition of Comparison Food Aid and Productive Safety Net Programme Programme Net Safety Food and Aid Productive

Comparison of malnutrition levels and NSP baseline and NSP levels malnutrition of Comparison

K 03 K K 01 K

Upper NSP

Upper NSP 02 EB

Graph 2: Damot Woyde Woreda Damot Woyde Graph 2:

PH 03/04 PH

Graph 1: Damot Woyde Woreda Woreda Damot Woyde Graph 1: LB 02 LB

Graph 3: Offa Woreda Woreda Offa Graph 3:

K 02 K EB 04 EB

FA

Damot Woyde Damot EB 03 EB

on graph4. Programme data byyeararepresented aid andProductiveSafetyNet on graph3toallowcomparison. Food kremt belg belg Offa 04 LB

PSNP LB 03 LB ENCU September 30, 2006 Page3 (EB=March-May), 4.5-6.4%forlate (LB=June-Aug.) and6.6-8.7%for

(K=Sept.-Nov.), andwereplotted

PH 03/04 PH

PH 04/05 PH EB 04 EB

Lower NSP

Lower NSP

EB 05 EB

LB 04 LB

PH 04/05 PH

PH 05/06 PH

EB 05 EB

PH 05/06 PH

LB 06 LB LB 06 LB Graph 4: Offa Woreda Food Aid and Productive Safety Net Programme

25

20

15

10

5

Rural Population (%) Population Rural 0 2000 2001 2002 2003 2004 2005 2006

FA PSNP

Note: the NSF reference year refers that NSP baseline indicate the preva- to the year with the lowest prevalence lence of malnutrition in a population of malnutrition amongst the years which has received some food assis- where the population received below tance. average amounts of relief. This means SIDAMA ZONE

Dale and Aleta Wondo Woredas

Two surveys were conducted by ACF in 2 Maize LZ. CMR and U5MR were different livelihood zones across these below the alert thresholds of 1 and 2 woredas, one in the Coffee Livelihood deaths/10,000/day respectively. Zone and one in the Maize Livelihood Retrospective morbidity in children Zone. The SMART methodology was used over the past 2 weeks was estimated for the planning phase, resulting in sam- at 20% in both zones with diarrhea pling 30 clusters of 17 children for anthro- and fever being cited as the main pometry and 30 clusters of 17 households causes of morbidity. BCG coverage

ENCU for mortality. was estimated at 56% in the Coffee LZ and 61% in the Maize LZ. Nutrition: The prevalence of global acute Estimated measles vaccination cov- malnutrition in the Coffee LZ was estimat- erage (by card and recall) was 94% ed at 16.5% with 3.1% severe malnutrition in the Coffee LZ and 98% in the and 1% kwashiorkor while it was estimat- Maize LZ while vitamin A supplemen- ed at 7.6% in the Maize LZ with 0.2% of tation was 89% and 91% respective- severe malnutrition and no cases of kwa- ly. shiorkor. There was a statistically signifi- cant difference in the malnutrition rates Food Security: Around 43% and between the 2 livelihood zones, with a sig- 60% of the population of Dale and nificantly higher prevalence of malnutrition Aleta Wondo respectively live in the in the Coffee LZ. No baseline data were Sidama Coffee Livelihood Zone while 27% of the populations of Dale and of Dale and Aleta Wondo available for these 2 livelihood zones. However, previous surveys were conduct- Aleta Wondo live in the Sidama Woredas ed in Dale woreda in December 05 and Maize Belt Livelihood Zone. The The nutrition situation in the April 05 with global acute malnutrition of Coffee LZ covers the midland areas Coffee LZ was critical with 5.3% (CI: 3.5-7.9%) and 16.0% (CI: 12.8- and is described as relatively food 16.5% GAM while in the 19.6%) respectively. secure despite huge disparities Maize LZ it was typical with between wealth groups, especially in 7.6% GAM. The timing of the Health: The crude and under-five mortali- terms of land holding. There was little 2 surveys was different, i.e. ty rates were 0.20 and 0.19 food aid even in a year such as 2003- Coffee LZ during the hungry deaths/10,000/day in the Coffee LZ and 4, when coffee production and prices season and Maize LZ after 0.16 and 0.57 deaths/10,000/day in the were low and maize prices were high the start of the green maize harvest.

ENCU September 30, 2006 Page 4 05, whereGAM was6.7% vey conductedinSeptember found withtheprevioussur- No significantdifference was year. as typicalforthistimeofthe 5.7% GAMwasconsidered The nutritionsituationwith Dalocha Woreda ENCU coverage. supplementation mated 95%vitamin A recall wasestimatedat88% withanesti- morbidity. Measlescoveragebycardand measles accountingfora quarterofthe the 2weekspriortosurveywas22%,with dren underfive.Morbidityinchildren and 0.02deaths/10,000/dayforthechil- deaths/10,000/day forthetotal population Health: (CI: 5.2-8.5%). September 05,whereGAMwas6.7% with theprevioussurveyconductedin able. Nosignificantdifference wasfound a typicaloraverageyearwasnotavail- malnutrition ratesatdifferent seasonsfor 0.3% severemalnutrition.Baseline,i.e. malnutrition wasestimatedat5.7%with Nutrition: regular monitoringofSC-USprojectarea. ducted inDalochaworedaaspart asthe standard 30x30clustersurveywascon- A nutrition situationintheCoffee LZwas Conclusion &Recommendations: an endwiththestart ofthegreenharvest. hunger gapintheMaizeLZhadcometo the midstofhungergapwhereas LZ wasdifferent; theCoffee LZwasstillin However, thetimingofsurveysineach and earlierstart ofthehungergap. resulting inearlierdepletionoffoodstock average bymostsurveyedcommunities, meher inputs. Inbothlivelihoodzoneslastyear veyed communities,mostlyduetolackof in badconditionstwothirdsofthesur- crops intheMaizeLZwerereportedtobe by hailorinadequaterains.Incontrast, remaining 25%hadbeenaffected either of thesurveyedcommunitieswhile Coffee LZwereingoodcondition75% Survey findingsindicatedthatcrops inthe when thegreenharvestofmaizestarts. food pricespeakfrom April untilJuly, hood zonesthehungergapandstaple degradation andpoorrains.Inbothliveli- tion growth,declininglandholding,land described asfoodinsecureduetopopula- Maize LZcoversthelowlandareasandis due todroughtinneighboringareas. The SILTI ZONE Dalocha Woreda harvest wasdescribedasbelow Mortality rateswerelowwith0.05 The prevalenceofglobalacute The Aleta Wondo woredas. Health Offices torunOTPsinDaleand ACF resumedits supporttotheWoreda ished cases.Followingthesurveys ral andtreatmentofseverelymalnour- woreda capacity forthedetection,refer- was recommendedtostrengthenthe good hunger gapinJulyandtherelatively in theCoffee LZwiththeendof tion situationwouldgraduallyimprove pated thatthefoodsecurityandnutri- maize harvest.Itwas,however, antici- conducted after thestart ofthegreen while thesurveyinMaizeLZwas by abelowaverage05 the endofhungerseason-preceded the Coffee LZwasconductedtowards explained bythefactthatsurveyin malnutrition ratescouldbepartly than intheCoffee LZ. The difference in with GAMandSAMsignificantlylower a chronicallymalnourishedpopulation the MaizeLZwasconsideredtypicalfor the otherhandnutritionsituationin al andsevereacutemalnutrition.On rated ascriticalwithhighlevelsofglob- 65% oftheannualfoodrequirements. meher woreda wasaconcernfor thecoming but excessraininsome parts ofthe opment ofthecrops wasratedasgood very goodcondition(88%). The devel- and thatthelivestockwasinagoodto above normal(60%)to(17%), viewed reportedthattherainfallwas the majorityofcommunitiesinter- maize harvest. At thetime ofthesurvey to July/August,thestart ofthegreen hunger seasonrunsfromMay/Juneup with noexperienceofdrought. The described ashistoricallyfoodsecure i.e. droughtandflooding. The latteris affected byrecurrentclimatichazards, with avaluablecashcropindustrybut LZ. The formerisrelativelyfoodsecure Gurage-Silti MidlandEnsetandChat Alaba-Mareko LowlandPepperLZand belongs to2livelihoodzones:the Food Security: ENCU September 30, 2006 Page5 belg harvest, accountingforabout performance. Meanwhileit Dalocha woreda meher harvest, Conclusion: The nutrition situation was recommended emergency food aid for considered as satisfactory given that the the second half of this year for 6% of the survey was conducted towards the end of population. This was expected to stabi- the hunger gap, when a seasonal peak of lize the food security and nutrition situa- malnutrition is expected. The belg tion until the main harvest due around assessment report indicated that the belg November. harvest was inadequate in Dalocha and

HADIYA ZONE

Shashego Woreda

A standard 30x30 cluster survey was con- It was reported, though, that the crop ducted by MSF-CH in Shashego woreda condition and harvest outlook was rated in order to verify reports of deteriorating as average to good by 57% of the food security. respondents and that the green harvest was expected to start 2-3 weeks after Nutrition: The prevalence of global acute the survey. malnutrition was estimated at 7.7% with 1.7% severe malnutrition and 1.3% kwa- Conclusion & Recommendations: shiorkor. No previous surveys had been Though the prevalence of global acute conducted in Shashego to allow compar- malnutrition was below 10% and con- ison. sidered as typical for a chronically mal- nourished population, the prevalence of Shashego Woreda Health: The mortality rates were below severe acute malnutrition in form of Though the prevalence of the alert thresholds with CMR of 0.45 and kwashiorkor was high. It was recom- global acute malnutrition at U5MR of 0.97 deaths/10,000/day. BCG, mended to build the capacity of the 7.7% was considered as typi- measles (by card and recall) and vitamin woreda health services to treat severe cal for a chronically malnour- A coverage was estimated at 69%, 71% malnutrition. However, to date no sup- ished population, the preva- and 63% respectively. port for implementation of therapeutic lence of severe malnutrition in feeding has been provided to form of kwashiorkor was high Food Security: Relevant information on Shashego woreda. with 1.3% the food security situation at the time of the survey was not included in the report.

Table 1: Survey Results in SNNPR Wolayita Zone Sidama Zone Hadiya Zone Silti Zone Dale & Aleta Wondo Dale & Aleta Wondo Key indicators Offa Damot Woyde Shashego Dalocha (Coffee Livelihood Zone) (Maize Livelihood Zone) June 9-15 June 17-24 June 27-July 3 July 21-25 June 13-17 Aug 3-7 GAM in Z-scores 3.6% 3.8% 16.5% 7.6% 7.7% 5.7% (95% CI) (2.3-4.8%) (2.5-5.2%) (12.5-20.5%) (4.9-10.3%) (5.5-10.0%) (4.2-7.2%) SAM in Z-scores 0.2% 0.1% 3.1% 0.2% 1.7% 0.3% (95% CI) (0-0.6%) (0-0.4%) (1.4-4.8%) (0-0.6%) (0.9-2.6%) (0-0.7%) Kwashiorkor 0.2% 0.1% 1.0% 0 1.3% 0.1% CMR Death/10,000/day 0.14 0.39 0.20 0.16 0.45 0.05 (95% CI) (0.03-0.31) (0.11 - 0.68) (0-0.43) (0-0.48) (0.25 - 0.64) (0.03-0.09) U5MR Death/10,000/day 0.47 0.69 0.19 0.57 0.97 0.02 (95% CI) (0.35-1.28) (0.24 -1.62) (0-0.55) (0-1.69) (0.29 – 1.65) (0.01-0.06) Fever & Major causes of U5MR Malaria Malaria ARI NR NR malnutrition Morbidity NR NR 23.1% 20.3% 28% 22.3% Fever & Measles & Major illnesses or symptoms NR NR Diarrhea & fever Fever & diarrhea diarrhea fever Measles coverage 18.6% 15.2% 11.5% 12.2% 8.5% 9.3% by card (95% CI) (14.7-22.4%) (11.0-19.4%) (8.7-14.3%) (9.6-15.0%) (6.9-10.0%) (8.8-9.8%) Measles coverage 94.3% 98.2% 71.2% 87.8% NR NR by card + recall (95% CI) (92.3-96.3%) (97.0-99.4%) NR (83.8-91.9%) BCG coverage (scar) 58.6% 57% 56% 60.8% 69% 70% (95% CI) (52.7-64.5%) (51.5-62.5%) (51.7-60.3%) (56.6-65.0%) (67.0-73.0%) (66.9-73.3%) Vitamin A in past 6 months 79.8% 69.6% 89% 91.4% (62.7%) 94.7% (95% CI) (73.3-86.2%) (61.2-78.1%) (86.0 - 92.0%) (NR) (59.0-65.0%) (90.4-99.1%)

ENCU September 30, 2006 Page 6 Table 2: Food and Nutrition Interventions in Surveyed Woredas of SNNPR Wolayita Zone Sidama Zone Hadiya Zone Silti Zone Offa Damot Dale Aleta Wondo Shashego Dalocha Woy de Estimated population size 160,507 217,083 386,289 349,865 118,382 148,110 Estimated Under Five population 32,317 43,417 77,258 69,973 23,687 29,622 Productive Safety Net – No of beneficiaries 27,301 32,572 23,550 23,490 19,487 26,444 % of rural population 18.4% 16.3% 6.1% 6.7% 17.3% 16.4% Food Aid Aug-Dec. 06 – No of beneficiaries 9,000 No No No No No % of rural population 5.6% EOS – 5th round May/June 06 No of children acutely malnourished * 857 1,364 5,329 8,834 Results 1,577 As a percentage of screened children 3.6% 3.8% 12.2% 20.2% unreliable 5.9% Bokaso HC Therapeutic Feeding Unit Gesuba HC HC Mesenkela HC No No No Yirgalem Hospital

Outreach Therapeutic Programme Concern Concern ACF ACF No SC-US * MUAC < 120 mm and/or oedema OROMIA REGION EAST HARARGHE ZONE meher, occurs from mid-June to mid- September and the secondary season, Deder and Meta Woredas belg, occurs from February to mid-April. Two standard 30x30 cluster surveys were It was reported that there was not indi- conducted by GOAL in East Hararghe, cation of a major shock to food insecu- one in Deder and one in Meta, in order to rity at the time of the survey, which coin- validate the EOS screening results of the cided to the midst of the hunger gap, round of May 06, where levels of severe typically occurring from May to August. malnutrition were found to be high. Information on the belg performance and next harvest outlook were not Nutrition: The prevalence of global incorporated in the survey reports. acute malnutrition was estimated at 9.5% However, the report from the DPPA-led and 9.3% with 2.2% and 2.0% SAM in belg assessment indicated that the belg Deder and Meta respectively. crop production prospect in lowlands of Kwashiorkor accounted for 1.2% in East Hararghe was poor due to inade- Deder and 1% in Meta. When using the quate belg rains and recommended EOS case-definition for malnutrition, emergency food aid for 19% and 16.6% GAM (MUAC<120 cm and/or oedema) of the population in Deder and Meta and SAM (MUAC<110 mm and/or oede- respectively. ma) were estimated at 5.5% and 2.3% respectively in both woredas. Conclusion & Recommendations: The survey results by MUAC did not show any significant difference from the Health: The estimated CMR and U5MR EOS screening results undertaken in were respectively 0.36 and 0.58 late May, where the percentage of deaths/10,000/day in Deder and 0.2 and screened children with acute malnutri- ENCU 0.38 deaths/10,000/day in Meta. tion was 4.9-5.2% with 1.7-2.0% severe Presumed causes of death in children malnutrition. The prevalence of acute included malnutrition and diarrhea. malnutrition by WHZ was below 10% in Retrospective morbidity in children both woredas and considered as typical under-five was found to be 33% and 25% for a chronically food insecure popula- Deder and Meta in Deder and Meta respectively. Measles tion. However, level of severe malnutri- Woredas (by card and recall) and vitamin A supple- tion, specifically of kwashiorkor, remained of concern. It was, therefore, The prevalence of global mentation coverage was estimated at recommended that the woreda capacity acute malnutrition was 75% and 84% respectively in Deder, and for the management of severe malnutri- below 10% in both woredas at 78% and 91% in Meta. tion should be built and adequate tech- and survey results by MUAC nical and logistical support should be were similar to the EOS Food Security: Deder and Meta mainly given to the health facilities. screening results. rely on rain-fed agriculture and benefit from 2 rainy seasons: the main season,

ENCU September 30, 2006 Page 7 in November. prior tothe the endofhungergap and vey wasconductedjust after insecure population. The sur- typical forachronically food 6.5% GAMwasconsidered as The nutritionsituationwith Daro LebuWoreda meher harvest due ENCU ly. BCGcoverage(verifiedbyscar)was were lowwith51%and60%respective- coverage supplementation vitamin A tion coverage(bycardandrecall) a protectedsource.Measlesvaccina- the respondents gettingtheirwaterfrom potable waterwaspoorwithonly22%of a quarterofthemorbidity. Access to ed at27%,withdiarrheaaccountingfor the 2weekspriortosurveywasestimat- Retrospective morbidityinchildren for thechildrenunderfive. population and0.46deaths/10,000/day 0.16 deaths/10,000/dayforthetotal average fordevelopingcountrieswith Health: 6.5% (CI:4.8-8.7%). at thesameseason,whereGAMwas pared tothesurveyconductedlastyear the prevalenceofmalnutritionascom- There wasnosignificantdifference in 6.5% with0.6%severemalnutrition. acute malnutritionwasestimatedat Nutrition: ect area. proj- as theregularmonitoringofGOAL conducted inDaroLebuworedaaspart standard 30x30clustersurveywas A WEST HARARGHEZONE Table 3:SurveyResults inOromiaRegion Daro LebuWoreda Major illnesses or symptoms or illnesses Major Vitamin A in past 6months U5MR Death/10,000/day U5MR by card + recall CI) (95% CMR Death/10,000/day CMR BCG coverage (scar) (scar) BCG coverage Mortality rateswerebelowthe Measles coverage Measles coverage by card (95% CI) (95% card by GAM in Z-scores SAM in Z-scores Key indicatorsKey Major causesMajor (95% CI) (95% (95% CI) (95% (95% CI) (95% wsiro .%10 0.4% 1.0% 1.2% Kwashiorkor (95% CI) (95% The prevalenceofglobal (95% CI) (95% (95% CI) (95% of U5MR obdt 32.2.% 27.2%. 24.5%. 33.2%. Morbidity Diarrhea & Diarrhea scabies Malnutrition & June 4 29-July (80.3-87.0%) (48.4-57.4%) (70.8-78.5%) (7.1 -12.5%) (7.1 (0.14–1.67) (0.17–0.66) (3.6-7.9%) (1.1-4.0%) diarrhea 83.9% 83.9% 52.9% 75.1% Deder Deder 5.4% 5.4% 2.2% 9.5% 0.58 0.36 East Zone Hararghe Diarrhea & Diarrhea scabies health, waterandsanitation activities. existing plies, andtostrengthenGOAL transfer oftechnicalskillandfoodsup- ment ofseveremalnutritioninterms strengthen theworedacapacity fortreat- food distributionuntilthenextharvest,to was recommendedtocontinuegeneral to the after theendofhungergapandprior lation. The surveywasconductedjust ical forachronicallyfoodinsecurepopu- nutrition situationwasconsideredastyp- Conclusion &Recommendations: good livestockcondition. average togoodresultinginvery nities ratedthepasture conditionas munities. Inaddition90%ofthecommu- mal toabovenormalby77%ofthecom- vious the surveyedcommunitieswhilepre- reported tobebelownormalby93%of regeneration. The both forcropproductionandpasture September) are2important seasons and end April) and agro-pastoralism. its populationreliesmostlyonagriculture sists oflowlandandmidlandareas Food Security: access toprimaryhealthcare. also lowat44%indicativeofapoor ENCU September 30, 2006 Page8 meher meher (88.3-93.5%) (61.9-70.5%) (75.5-82.9%) (16.1-23.4%) ( 0.09–1.48) ( malnutrition & Diarrhea (7.0-12.4%) (0.06–0.47) (1.0-3.7%) July 6- 11 July 6- 91.3% 91.3% 66.4% 78.4% 19.5% 2.0% 2.0% 9.3% Meta 0.38 0.20 harvest dueinNovember. It harvest wasratedasnor- Daro Lebuworedacon- kremt belg Belg (end June-end West Hararghe (55.6-64.5%) (39.6-48.6%) (46.6-55.8%) Diarrhea & Diarrhea & Diarrhea Aug. 21-27 (7.1-12.6%) Daro Lobu Daro (0.3-1.3%) (5.1-8.2%) rains were Zone cough fever 60.1% 60.1% 44.1% 51.2% 9.5% 9.5% 0.6% 6.5% 0.46 0.16 (mid Feb- NR NR The Table 4: Food and Nutrition Interventions in Surveyed Woredas of Oromia East Hararghe West Hararghe Zone Zone Deder Meta Daro Lobu Estimated population size 243,516 238,983 166,187 Estimated Under Five population 40,180 47,797 32,374 Productive Safety Net – No of beneficiaries 25,000 33,975 37,722 % of rural population 10.2% 14.4% 27.0% Food Aid Aug-Dec. 06 – No of beneficiaries 46,700 39,230 10,280 % of rural population 19.0% 16.6% 7.4% EOS – 3rd round May 06 No of children acutely malnourished * 2,405 2,221 445 As a percentage of screened children 5.2% 4.9% 1.8% Therapeutic Feeding Unit Deder Hospital No No Outreach Therapeutic Programme No IMC IMC * MUAC < 120 mm and/or oedema

AMHARA REGION

SOUTH WOLLO ZONE Food Security: Kalu woreda, because

Kalu and Woredas of its high proportion of lowlands and low-midlands, is predominantly depen- Two surveys were conducted in South dant on kremt rains (Aug.-Sept.) to sup- Wollo zone, one in Kalu and one in port meher crops harvested from Dessie Zuria, as part as the regular November to December. In higher areas monitoring of Concern project areas. of the woreda belg crops (oat, barley and The SMART method was used for the wheat) are also cultivated and harvested planning phase, resulting in sampling in June/July. In contrast, Dessie Zuria 37 clusters of 22 children for anthro- woreda, because of its high proportion of pometry and 37 clusters of 14 house- high- and mid-lands, is both dependant holds for mortality. Due to abnormal SD on belg (Jan.-Feb.) and kremt rains to of the WHZ for one team, only 31 clus- support belg and meher crops harvested ters out of the initial 37 were included in in June/July and November/January the analysis for Dessie Zuria. respectively. There is also a significant proportion of the population who is sole- Nutrition: The prevalence of global ly belg dependant and hence at great acute malnutrition was estimated at risk of food insecurity. In Kalu, the 05 10.2% and 12.4%, with 0.4% and 1.2% meher was reported to be poor due to severe malnutrition in Kalu and Dessie erratic rains and pest infestation. The 06 Zuria respectively. Prevalence of kwa- belg harvest, started in early June, was shiorkor was 0.3% in Dessie Zuria rated as good due to good belg rain per- while no kwashiorkor was recorded in formance. It was estimated that belg har- ENCU Kalu. vest yield was 30% greater than the pre- vious year's yield. Availability of water Health: The crude mortality rate was was good in all areas of Kalu while live- 0.49 and 0.31 deaths/10,000/day in stock condition was good in highlands Kalu and Dessie Zuria respectively, and average in low- and mid-lands due above the average for developing to pasture shortage and diseases. In countries of 0.27 deaths/10,000/day. Dessie Zuria, the 05 meher harvest was The under-five mortality rate was 0 and reported as better than the previous Kalu & Dessie Zuria 0.27 deaths/10,000/day in Kalu and meher harvest. The belg rains were, Woredas Dessie Zuria respectively, below the however, delayed and erratic and this average for developing countries of 1 year's belg harvest, started mid-June, The nutrition situation in Kalu deaths/10,000/day. Measles (by card was 20% less than in the previous year. (10% GAM) and Dessie and recall) and vitamin A supplementa- The water availability was good in all Zuria (12% GAM) was not tion coverage was estimated at 92% parts of the woreda but the quality of the typical for this time of the and 97% respectively in Kalu, and at pasture was not satisfactory and hence year compared to NSP base- 85% and 91% in Dessie Zuria. BCG livestock condition was reported to be line range of 5.0-6.9% for vaccination coverage (confirmed by a average. In both woreda it was too early late belg. scar) was 73% in Kalu and 58% in Dessie Zuria. ENCU September 30, 2006 Page 9 ENCU in Kalu,andfrom10to18%Dessie over seasonsandyearsfrom6to17% of globalacutemalnutritionranged years inbothworedas. The prevalence had beenconductedoverthepast 6 Trend analysis: cant difference inthemalnutritionrates. in DessieZuria,therewasnosignifi- Kalu and12.4%GAM(CI:9.5-15.1%) with 8.2%GAM(CI:5.9-11.3%) in January 06,thepostharvestseason, pared tothelastsurveyconductedin the yearinbothworedas.Whencom- situation wasnottypicalforthistimeof Wollo. This indicatedthatthenutrition for thelate prevalence ofmalnutrition5.0-6.9% gaveabaseline data fromSC-UKNSP rated aspoorinmostareas.Historical Zuria thefoodsecuritysituationwas already harvested highland areaswerebetteroff having were exhaustedwhilemidlandand ket, ashousehold land areaswereheavilyreliantonmar- Zuria wasratedaspoor. InKalu,low- security situationinKaluandDessie Conclusion: to predictthenext

GAM % 10 12 14 16 18 20 0 2 4 6 8 Belg

The nutritionandfood LB 00 LB

Rural Population (%) baseline and NSP /Kalu Zuria Dessie between levels malnutrition of Comparison Graph 5: (June-August) inSouth total of15surveys A 10 20 30 40 50

belg

meher 0 00 K meher

0020 0220 0420 2006 2005 2004 2003 2002 2001 2000 EB 01 EB crops. InDessie

harvest. LB 01 LB food stocks Food Aid and Productive Safety Net Programme Programme Net Safety Food and Aid Productive

Upper NSP PH 01/02 PH

Graph Zuria 6: Dessie Woreda

LB 02 LB PH 02/03 PH Dessie Zuria Dessie

FA EB 03 EB graph 7. ongoing foodaidandPSNP, asshownin vest season04-05,againinspiteof rangesexceptfortheposthar- the NSP malnutrition levelswerealsohigherthan PSNP, asillustratedingraph6.InKalu population receivingfoodaidand/or spite ofasubstantial percentage ofthe surveyed andremainedabove10%in baselinerangesinallseasons the NSP malnutrition inDessieZuriawasabove tance. Overthepast 6yearsthelevelof which hasreceivedsomefoodassis- lence ofmalnutritioninapopulation baselineindicatethepreva- that NSP average amounts ofrelief. This means where thepopulationreceivedbelow lence ofmalnutritionamongsttheyears refers totheyearwithlowestpreva- noting thattheNSFreferenceyear graph 5toallowcomparison. Itisworth (K=Sept.-Nov.), andwereplottedon (LB=June-Aug.) and6.6-8.6%for (EB=March-May), 5.0-6.9%forlate (PH=Dec.-Feb.), 5.9-7.9%forearly 1997) are5.8-7.8%forpost-harvest South Wollo byseason(referenceyear baselinerangesfor woredas. The NSP in termsofnutritionstatus inboth Zuria, with2002/03beingtheworstyear

PSNP

LB 03 LB

ENCU September 30, 2006 Page10 K 03 K

Kalu

EB 04 EB LB 04 LB

Lower NSP

PH 04/05 PH

LB 05 LB

PH 05/06 PH LB 06 LB kremt belg belg Graph 7: Kalu Woreda Food Aid and Productive Safety Net Programme

60

50

40

30 20

10 Rural Population (%) 0 2000 2001 2002 2003 2004 2005 2006

FA PSNP

Table 5: Survey Results in Amhara Region

South Wollo Key indicators Dessie Zuria Kalu Aug. 9-18 July 25-Aug. 6 GAM in Z-scores 12.4% 10.2% (95% CI) (9.6-15.1%) (7.9-12.5%) SAM in Z-scores 1.2% 0.4% (95% CI) (0.4-2.0%) (0-0.8%) Kwashiorkor 0.3% 0% CMR Death/10,000/day 0.31 0.49 (95% CI) (0.11-0.52) (0.17-0.81) U5MR Death/10,000/day 0.27 0 (95% CI) (0-0.89) Major causes Diarrhea, ARI - of U5MR Morbidity NR NR Major illnesses or -- symptoms Measles coverage by card 24.7% 50.1% (95% CI) (19.2-30.2) (44.1-56.0%) Measles coverage 84.7% 92.1% by card + recall (95% CI) (79.6-89.8%) (89.7-94.4%) BCG coverage (scar) 57.9% 73.4% (95% CI) (52.1-63.6%) (69.1-77.8%) Vitamin A in past 6 months 90.6% 96.6% (95% CI) (85.1-96.1%) (94.2-99.0%)

Table 6: Food and Nutrition Interventions in Surveyed Woredas of Amhara South Wollo Dessie Zuria Kalu Estimated population size 249,779 196,506 Estimated Under Five population 44,960 32,816

ENCU Productive Safety Net – No of beneficiaries 73,275 63,903 % of rural population 29.4% 32.5% Food Aid Aug-Dec. 06 – No of beneficiaries 2,000 4,000 % of rural population 0.8% 2.0% EOS – 4th round May 06 No of children acutely malnourished * 925 483 As a percentage of screened children 3.7% 1.5% Therapeutic Feeding Unit Dessie Hospital No Outreach Therapeutic Programme Concern Concern * MUAC < 120 mm and/or oedema

ENCU September 30, 2006 Page 11 SOMALI REGION

AFDER ZONE

Elkere and Hargelle Woredas

As a result of the 2005 deyr rain failure to the Afder pastoral FEZ (Household in Afder zone, Islamic Relief Ethiopia Economy Analysis Baseline Study, SC- started to implement a feeding pro- UK/DPPB, Oct. 01). Pastoralism is pre- gramme in these 2 woredas with provi- dominant in the semi-arid lowlands sion of supplementary food. Before areas of Elkere and Hargelle while agro- implementing a full CTC package, IRE pastoralism is found near the banks of hired SC-UK to conduct a survey cov- the rivers and in higher areas in Elkere. ering both woredas in order to get Pastoralists highly rely on camel and baseline. The survey included 45 clus- shoats whilst agro-pastoralists rely more ters of 20 children. on cattle and less on camels and culti- vate sorghum and maize. The woredas Nutrition: The prevalence of acute benefit from 2 rainy seasons, the gu malnutrition was estimated at 10.5% rains (April-June), and the deyr rains with 0.5% severe malnutrition. No (Oct.-Dec.), and experienced 2 dry sea- cases of kwashiorkor were recorded. sons jilaal (Jan.-March) and hagaai No previous surveys were conducted in (July-Sept.). The 2006 gu rains were these woredas to allow comparison. reported below normal to very poor in most parts of Elkere and in the Eastern Health: The crude mortality and under and Northern parts of Hargelle. five mortality rates were estimated at Livestock condition was good but live- 0.62 and 1.79 deaths/10,000/day stock production and reproduction levels respectively. These rates were below were below normal, with reduced herd the emergency threshold of 1 sizes and decreased milk production. death/10,000/day for CMR and 2 Seasonal livestock migration was under- deaths/10,000/day for U5MR but above going to the west and South of Hargelle the average for developing countries of and to neighboring woredas in search of 0.27 and 1 death/10,000/day for CMR water and pasture. The crop production and U5MR respectively. The main pre- from agro-pastoral and riverine areas- sumed causes of death in children typically occurring once a year in were diarrhea and fever. Retrospective July/August, was rated as very poor due morbidity was high, with 30% of the to early cessation of the gu rains in May children under five having experienced and long dry spells within the season. a disease episode in the 2 weeks prior Cereal prices were already high at the to the survey. BCG vaccination cover- time of the survey and expected to age was extremely low with only 1.3% increase further, as the dry hagaai sea- of children under five having a BCG son progresses. This resulted in unfa- scar. Measles vaccination verified by vorable terms of trade (cereal vs. live- ENCU card was also extremely low with 1.3% stock) and the need for the households Elkere & Hargelle and still below the recommended cov- to sell more livestock heads to meet Woredas erage of 95%, when confirmed by card their food requirements. The households and recall, with an estimated coverage who lost their livestock during the last The nutrition situation in of 51%. Vitamin A supplementation drought were described at high risk of Elkere and Hargelle was coverage by recall was equally low with food insecurity. It was also reported that considered as poor with 43% of the children having received the overflow of Web River had caused 10.5% GAM. The survey was vitamin A in the past 6 months. It was displacement in some kebeles of conducted during the hagaai reported that most of the health facili- Hargelle with about 2500 displaced peo- dry season, when water, pas- ties were not fully functional due to lack ple. ture availability and milk pro- of skilled staff and inadequate drug and duction were low. The per- medical supplies. formance of the next deyr rains due in early October Food Security: Elkere comprises two will determine the food secu- Food Economy Zones, the Afder pas- rity and nutrition situation in toral FEZ and the Afder agro-pastoral the coming months. FEZ while Hargelle exclusively belongs

ENCU September 30, 2006 Page 12 Conclusion & Recommendations: ty and nutrition situation in the coming The nutrition situation in Elkere and months, especially for the pastoral com- Hargelle was considered as poor in munities. It was recommended to contin- presence of aggravating factors: poor ue complete and timely general food dis- access to food, high morbidity, and low tribution as per the recent DPPA led measles coverage with confirmed Pastoral Area Assessment and allocate cases of measles. The survey was con- additional relief food to flood displaced ducted in the midst of the hagaai dry people; to implement a measles vacci- season, when water, pasture availabili- nation campaign with vitamin A supple- ty and milk production were low. This mentation; and to equip the health facili- was compounded by a poor harvest ties with adequate man power and sup- and high cereal prices. The perform- plies. ance of the next deyr rains due in early October will determine the food securi-

AFDER and LIBEN ZONES

Dolo Ado, Dolo Bay and Bare Woredas - Pastoral

A 45 x 20 cluster survey was conduct- than in January, when the coverage was ed in the pastoral kebeles of Dolo Ado, nil. Poor access to health care was still Dolo Bay and Bare as a follow up of the prevailing in the 3 woredas with inade- January 06 survey. quate number of structures and profes- sionals as well as lack of drugs and med- Nutrition: The prevalence of global ical supplies. acute malnutrition was estimated at 14.5% (CI: 11.8-17.2%) with 0.7% Food Security: The livelihood of the severe malnutrition. There was no sig- pastoralist communities is mainly nificant difference in the prevalence of dependent on livestock, which in turns malnutrition as compared to the survey depends on the availability of water and conducted in January 06, where GAM pasture. This year's gu rains (April-June) was 18.8% (CI: 15.9-21.6%). was reported to be below normal to poor in most parts of Dolo Ado, Dolo Bay and Health: The crude mortality rate was Bare while these woredas were also estimated at 0.62 below the emergency amongst the worst affected by the previ- threshold of 1 death/10,000/day while ous failure of the deyr rains in 2005. the under five mortality rate was at 2.50 Livestock was reported to be in a better above the emergency threshold of 2 condition than in January but milk pro- deaths/10,000/day. The main cause of duction was below normal due to earlier death in children was diarrhea. depletion of water and pasture than Retrospective morbidity was high, with usual. As the dry season progresses fur-

ENCU 39% of the children under five having ther deterioration in terms of water and experienced a disease episode in the 2 pasture availability was expected, at Dolo Ado, Dolo Bay & weeks prior to the survey. BCG vacci- least until early October when the next Bare Woredas - nation coverage was low, with 11% of rains were due. At the time of the survey children under five having a BCG scar, the majority of the pastoral population Pastoral and similar to the coverage found in relied on purchases and relief as the The nutrition situation in the January 06, i.e. 9.6%. Measles vacci- main sources of food. The survey teams pastoral communities of Dolo nation verified by card was extremely reported that about 1250 households Ado, Dolo Bay and Bare was low with 1.3% and again comparable had been displaced from neighboring rated as serious with 14.5% with the Jan. 06 results of 1.5%. Somalia to Bare due to clan conflict and GAM and did not show sig- However, measles coverage confirmed were in great needs of basic necessities nificant improvement as by card and recall with 57.8% was sig- such as food, shelter and clothes. compared to January 2006 nificantly higher as compared to with 18.8% GAM. January with 17.2%, but still below the Conclusion & Recommendations: The Future food security recommended 95% coverage in spite nutrition situation in the pastoral commu- prospect will now depend on of a vaccination campaign conducted in nities of Dolo Ado, Dolo Bay and Bare the performance of the com- the first half of 2006. Likewise vitamin A was rated as serious and did not show ing deyr rains. supplementation with 49% was higher significant improvement as compared to

ENCU September 30, 2006 Page 13 January 2006. The ongoing relief food below the recommended 95% coverage distribution and EOS TSFP did not in spite of a vaccination campaign con- translate into improved nutritional sta- ducted in the first half of 2006. Likewise tus. This might be due to several rea- vitamin A supplementation with 41.9% sons such as insufficient allocation, was higher than in February (0%), as a poor targeting, or inadequate quantity result of the supplementation campaign. and quality of the food basket. The Poor access to health care was still pre- present survey was conducted during vailing in the 3 woredas with inadequate the short dry season, hagaa, while the number of structures and professionals previous one was conducted at the as well as lack of drugs and medical beginning of the long dry season, jilaal, supplies. after the complete failure of the 2005 deyr rains. Future food security Food Security: The majority of the pop- prospect will now depend on the per- ulation in Hudet and Moyale is pastoral- formance of the coming deyr rains. It ist and relies on livestock rearing. This was recommended to continue (1) the year's gu rain performance was reported general food distribution as per the to be medium and accompanied by an recent DPPA led Pastoral Area improvement in water and pasture avail- Assessment and allocate food and ability, livestock condition and produc- non-food items to the Somalian tion. The food security situation was refugees, (2) running the Unicef-sup- described as improved compared with ported mobile clinics and (3) close that of last year. However, population monitoring of the situation. remained highly vulnerable to future shock due to decreased livestock hold- LIBEN ZONE ing as a result of recurrent droughts.

Moyale and Hudet Woredas Conclusion & Recommendations: A 45 x 20 cluster survey was conduct- The survey was inconclusive as to the ed in Moyale and Hudet as a follow up nutrition situation. Like in other pastoral of the February 06 survey. areas of the Somali region food security prospect will be determined by the com- Nutrition: Due to a major age bias in ing deyr rains. It was recommended to the sample and a low SD of the WHZ, continue provision of relief food, support

ENCU the anthropometric results were not to mobile health clinics and close moni- deemed to be reliable and the preva- toring of the situation. lence of malnutrition found at 7.6% was likely to be underestimated. Therefore, it was not possible to draw conclusions on the nutrition situation and to com- pare it with the previous survey.

Health: The crude and under five mor- tality rates were estimated at 0.25 and 0.88 below the emergency threshold of 1 and 2 death/10,000/day respectively. Retrospective morbidity was at 20% Moyale and Hudet with diarrhea and fever being cited as Woredas the main causes of morbidity. BCG vac- Due to a major age bias in cination coverage was low with 21% of the sample and a low SD of children under five having a BCG scar the WHZ the prevalence of and not significantly different to the malnutrition found at 7.6% Feb. 06 coverage of 15%. Measles was likely to be underesti- vaccination verified by card was mated. extremely low with 1% and again com- Like in other pastoral areas parable with the Feb. 06 results of of the Somali region food 2.7%. However, measles coverage security prospect will be confirmed by card and recall with determined by the coming 41.8% was significantly higher as com- deyr rains. pared to February with 22.9% but still

ENCU September 30, 2006 Page 14 Table 7: Survey Results in Somali Region Afder Zone Afder & Liben Zone Liben Zone Dolo Ado, Dolo Bay & Key indicators Elkere & Hargelle Moyale & Hudet Bare (Pastoral) Aug. 12-23 Aug. 25-Sept. 5 Aug. 26 – Sept. 8 Unreliable GAM in Z-scores 10.5% 14.5% results due to (95% CI) (8.1 -12.8%) (11.8-17.2%) bias SAM in Z-scores 0.5% 0.7% - (95% CI) (0.1-1.0%) (0.1-1.3%) Kwashiorkor 0% 0% 0% CMR Death/10,000/day 0.62 0.62 0.25 (95% CI) (0.37–0.87) (0.40-0.90) (0.10-0.50) U5MR Death/10,000/day 1.79 2.50 0.88 (95% CI) (0.82–2.75) (1.60-3.40) Major causes Diarrhea Diarrhea & Diarrhea of U5MR & fever fever Morbidity 30.5%. 39.4%. 19.7%. Major illnesses or Diarrhea Diarrhea Diarrhea & symptoms & fever & cough cough Measles coverage by card 1.3% 1.3% 1.0% (95% CI) (0-3.0%) (0-3.1%) (0-2.3%) Measles coverage by card 75.1% 57.8% 41.8% + recall (95% CI) (70.8-78.5%) (47.9-67.7%) (31.4-52.2%) BCG coverage (scar) 51.0 11.0% 21.5% (95% CI) (40.1-62.0%) (5.5-16.4%) (12.8-30.3%) Vitamin A in past 6 months 42.5% 49.0% 41.4% (95% CI) (31.2-53.9%) (38.8-59.1%) (30.6-52.3%)

Table 8: Food and Nutrition Interventions in Surveyed Woredas of Somali Afder Zone Liben Zone Elkere Hargelle Dolo Bay Bare Hudet Moyale Dolo Ado Estimated population size 37,000 75,000 87,200 97,480 86,549 286,000 157,495 Estimated Under Five population 7,400 15,000 17,440 19,496 17,310 57,200 31,499 Productive Safety Net – No of beneficiaries 9,667 No 22,574 20,590 No 25,645 37,809 % of rural population 26.1% 25.9% 21.1% 10.0% 24.0% Food Aid Aug-Dec. 06 – No of beneficiaries 26,200 28,800 28,700 42,200 7,000 85,400 57,500 % of rural population 70.8% 38.4% 32.9% 43.3% 8.2% 31.7% 36.5% EOS No No No No No No No Hargelle Bare District Therapeutic Feeding Unit No No No No No Hospital Center Outreach therapeutic Feeding - - SC-US - No No SC-US ENCU

ENCU September 30, 2006 Page 15 of aggravating factors. tion below14%inabsence with globalacutemalnutri- Ethiopia wasratedaspoor refugee populationliving in The nutritionsituationofthe REFUGEE CAMPS ENCU 16.4%, andKebribeya with2006GAM 2006 GAMof14.3%and2005 GAMof 19.3% (CI:16.8-22.1%),Shimelba with (CI: 7.0-10.2%)and2005 GAMof site, Bongawith2006GAM of8.6% 20.7% (CI:18.1-23.5%)at Nuer/Dinka 9.3% (CI:6.2-12.5%)and2005 GAMof Anyuak site,andwith2006GAMof 8.7% and2005GAMof21.9%at Pugnido camps with 2006GAMof compared tolast year. This inluded uation hadsignificantlyimprovedas the 5remainingcamps thenutritionsit- 2005 GAMof9.8%(CI:8.0-12.0%).In GAM of13.9%(CI:10.1-17.6%)and GAM of12%,andDimmawith2006 with 2006GAMof11.5% and2005 GAM of9.5%(CI:7.7-11.7%), Yarenga of 10.2%(CI:8.8-11.5%) and2005 This includedSherkolewith2006GAM trition betweenthisyearandlastyear. ence intheprevalenceofacutemalnu- camps therewasnosignificantdiffer- variable trendsinmalnutrition.In3 year results tolastyearresults showed one recordedcase.Comparison ofthis was onlypresentinSherkolecampwith between 0.5%to1.6%.Kwashiorkor 14.3% withseveremalnutritionlying malnutrition rangedfrom8.6%to Nutrition: ple sizes. methodforcalculationofsam- SMART Sherkole, andKebribeya,usingthe (Nuer/Dinka site),Bonga,Dimma, surveys wereconductedinPugnido Shimelba and Yarenga whilecluster ducted inPugnido(Anyuaksite), Tigray. Exhaustivesurveyswerecon- Eritrean refugeesinShimelbacamp refugees inKebribeyaSomaliregion; Beneshangul Gumuzregion;Somalian in Yarenja andSherkolecamps in Dimma camps inGambellaregionand refugees inPugnido,Bongaand Ethiopia, asfollows:Sudanese 7 camps locatedin4regionsof population. The refugeesarehostedin and nutritionsituationoftherefugee regular yearlymonitoringofthehealth August 4. This exercisewaspart ofthe camps ofEthiopiabetweenMay27and 8 nutritionsurveysintherefugee conducted Returnees Affairs) andWFP (Administration ofRefugeesand UNHCR jointlywith ARRA REFUGEE CAMPS The prevalenceofacute women while therapeuticfeedingwas ished children,pregnant and lactating was targeted atmoderatelymalnour- general ration,supplementary feeding per personday. Inadditiontothe food basketprovidedaround 2100kcal grain insteadof500g. The standard per day, exceptin Yarenka with330gof oil, 50gpulsesand5saltperperson prised 500gcerealgrain,30vegetable uted by ARRA. The foodbasketcom- anddistrib- relief foodprovidedbyWFP Food Security: quate duringthedryseason. water supplywasreportedtobeinade- per dayrespectivelywhileinSherkole with 6and10litersofwaterperperson lower thantherecommendedstandards Kebribeya camps accesstowaterwas reta disposal.However, inBongaand ply, andof1pitper20personsforexc- liters perpersondayforwatersup- the Sphere minimumstandards of15 satisfactory inmostcamps andmeeting sanitation situationwasdescribedas Water andSanitation: ative healthcare. which providedbothpreventiveandcur- benefited fromaprimaryhealthservice, 99%). Itwasreportedthatallcamps recorded intheremaining6camps (94- as compared tothehighcoverage was lowerinPugnidocamps (73-78%) supplementation (byrecall) Vitamin A explained lowvaccinationcoverage. between camps, whichmightpartly Vaccination cardretentionwasvariable Dimma, Bongaand Yarenja respectively. in Shemilba,Pugnido(Nuer/Dinka), other camps at58,67,86,88and94% Kebribeya respectively, andhigherin 36% inSherkole,Pugnido(Anyuak)and was lowinsomecamps at19,21and vaccination coverage(verifiedbycard) high, rangingfrom79%to98%.Measles cination coverage(verifiedbyscar)was the alertU5MRthresholdof2.BCGvac- 0.26 and1.90deaths/10,000/daybelow Under Fivemortality ratesrangedfrom below thealertCMRthresholdof1while from 0.07to0.54deaths/10,000/day Health: of 16.2%(CI:12.8-19.6%). of 10.5%(CI:6.6-14.4%)and2005GAM ENCU September 30, 2006 Page16 Crude mortality ratesranged All camps received The waterand targeted to severely malnourished chil- decreased malnutrition rates down to 9- dren. Some camps also benefited from 14%. In the remaining 3 camps the nutri- blanket supplementary feeding target- tion situation had remained stable since ed at all children under five and preg- last year. Overall, it was recommended nant/lactating women. School feeding to improve feeding programme coverage was also run for primary schools in all by conducting regular mass screening, camps but Kebribeya. In most camps to initiate community-based treatment of refugees had access to a small plot of severe malnutrition, to enhance imple- land, where they cultivated mainly mentation of IMCI (Integrated maize to be consumed in its green Management of Childhood Illness) at form. Targeted supplementary feeding institutional and community level, and to coverage was estimated between 23 to mainstream sanitation, health and nutri- 90% while therapeutic feeding cover- tion education. Where the prevalence of age ranged from 39 to 100%. malnutrition was below 10% it was also recommended to discontinue blanket Conclusion & Recommendations: supplementary feeding. The nutrition situation of the refugee population living in Ethiopia was rated as poor with global acute malnutrition below 14% in absence of aggravating factors. In 5 camps, where the last year nutrition situation was rated as serious with GAM ranging from 16 to 22%, the situation had markedly improved with

Table 9: Survey results in refugee camps Pugnido * Pugnido Sherkole Dimma Shemlba * Yarenja * Bonga Key indicators (Anyuak) (Nuer/Dinka) K/Beyah June 5-9 May 24-27 May 23-26 June 19-25 July 4-7 July 30-Aug 4 July 30-Aug 4 GAM in Z-scores 10.2% 9.3% 10.5 % 13.9 % 8.6 % 8.7% 14.3% 11.5% (95% CI) (8.8-11.5%) (6.2-12.5%) (6.6–14.4%) (10.1-17.6%) (7.0-10.2%) SAM in Z-scores 0.6% 1.1% 0.5 % 1.3 % 0.6 % 0.6% 1.6% 1.2% (95% CI) (0-1.2%) (0.6-1.7%) (0-1.1%) (0- 2.7%) (0-1.3 %) Kwashiorkor 0.1% 0% 0% 0% 0% 0% 0% 0% CMR Death/10,000/day 0.27 0.31 0.07 0.20 0.44 0.8% 0.07 0.54 (95% CI) (0.05-0.49) (0.14-0.47) (0-0.16) (0-0.41) ( 0.17– 0.72) U5MR Death/10,000/day 0.9 0.43 0.26 0.67 0.93 1.9% 0.42 1.2 (95% CI) (0.20-1.60) (0.18-0.67) (0.18-0.70) (0-2.02) (0.18–1.68) Major causes of U5MR NR NR NR NR NR NR NR NR Morbidity NR NR NR NR NR NR NR NR Major illnesses or symptoms NR NR NR NR NR NR NR NR Measles coverage by card 19.1% 66.9% 36.6% 85.6% 87.5% 21.0% 57.2% 93.9% (95% CI) (NR) (NR) (31.2– 42.0%) (NR) (84.0– 91.0%) Measles coverage by card + recall 88.7% 89.7% 91.2% 91.8% 94.8% 76.2% 97.5% 98.4% (95% CI) (NR) (NR) (88.0– 94.4%) (NR) (92.5 -97.1% ) BCG coverage (scar) 86.7% 89.8% 81.2% 92.4% 97.0% 78.6% 91.0% 98.0% (95% CI) (NR) (NR) (76.8– 85.6%) (NR) (95.2 – 98.8%) Vitamin A in past 6 months 96.4% 72.5% 95.8 94.3% 94.7% 77.7% 90.0% 98.5% (95% CI) (NR) (NR) (93.6– 98.0%) (NR) (92.4 -97.0% ) * Exhaustive surveys - No CI

ENCU September 30, 2006 Page 17 SURVEY QUALITY CONTROL

The quality of the survey results pre- sented in this bulletin was checked in Bias in children selection order to determine (1) if significant bias Another rule for representativeness is had been introduced during the sam- that the characteristics of the sample pling procedures and measurements should be similar to those of the popula- and (2) whether the survey results were tion. The age and sex breakdown of the representative and reliable. Quality survey samples allow verifying whether control results are compiled in table 11. the samples are not biased in terms of age and sex, and are representative of Bias in cluster selection the age group (6-59 months) targeted by One of the basic rules for a sample to the surveys. In nutrition surveys the pro- be representative is that each individual posed age groups, 6-17 months, 18-29 in the population has an equal chance months, 30-41 months, 42-53 months of being included in the sample. In clus- and 54-months, are centred around ter surveys this is achieved by applying whole years in order to minimize bias the PPS (probability proportional to due to misreporting of age. The distribu- size) sampling technique, whereby tion of these age groups should not vary clusters are selected according to the too much from the typical distribution for relative size of the geographical units. children 6-59 months in the developing Though most surveys conducted in world, as shown in table 10. Likewise the rural Ethiopia are usually described as sex ratio of boys to girls should not vary "2-stage cluster surveys", there are in too much from the expected sex ratio reality "3-stage cluster surveys". and should lie between 0.9 and 1.1. Generally, the selection of clusters is done in two stages instead of one: clus- Age biases are of particular concern for ters are firstly selected from a list of anthropometry, as younger age groups kebeles using PPS and are then allo- (6-29 months) are usually more likely to cated randomly to the village level with- be malnourished than older age groups in the selected kebeles. The extra stage (30-59 months). This means that an based on random selection introduces under-representation of the younger age a bias, as the relative sizes of the vil- groups (or over-representation of the lages are not taking into account for the older age groups) may give a lower selection. This observation remained prevalence of malnutrition than the actu- valid for all the 14 cluster surveys con- al one while over-representation of the ducted in rural woredas and presented younger age groups (or under-represen- in this bulletin. This was clearly a devi- tation of the older age groups) may give ation from the recommended PPS pro- a higher prevalence of malnutrition than cedure though it was not known by how the actual one. There was no age bias in much this practice affected the repre- 11 out of 22 surveys. In 8 surveys there sentativeness of the sample. In the was some degree of age misrepresenta- future clusters should be selected in a tion while in the remaining 3 surveys

ENCU single stage from the list of the smallest there was a major age bias and gross geographical units, i.e. villages, and under-representation of the younger age time should be invested in collecting groups. The latter included Dale/Aleta population sizes or household numbers Wondo Maize LZ with 33% of children 6- prior to any survey implementation. 29 months, Dale/Aleta Wondo Coffee LZ Table 10: Typical demographic distribution 6-59 months (WHO, 2000) Age groups Boys Girls Total Group 1: 6-17 months 12.5% 11.4% 23.9% Group 2: 18-29 months 13.1% 12.4% 25.5% Group 3: 30-41 months 11.4% 11.0% 22.4% Group 4: 42-53 months 10.2% 9.0% 19.2% Group 5: 54-59 months 5.0% 4.0% 9.0%

ENCU September 30, 2006 Page 18 ENCU under-represented. ed andinanother5surveysgirlswere 2 surveysboyswereunder-represent- surveys therewasnosexbiaswhilein affected bymalnutrition.In15outof22 either boysorgirlsareusuallymore tion ratesunlessthereisevidencethat Sex biasislesslikelytoaffect malnutri- ed. surveys waslikelytobeunderestimat- prevalence ofmalnutritioninthese3 for thisagegroup. Therefore, the 29 monthsinsteadoftheexpected49% Moyale/Hudet with30%ofchildren6- with 30%ofchildren6-29monthsand neous results inthedataset increases. SD increasesastheproportion oferro- score units forweight-for-height. The WHZ shouldliebetween0.8 and1.2z- SD ofWHZisequalto+1. The SDof urements. In anormaldistributionthe substantial randomerrorsinthemeas- height: thisindicateswhetherthereare - ware. soft- done byNutrisurvey, theSMART tion. These checksareautomatically ness andkurtosisoftheWHZdistribu- includes thestandard deviation,skew- those ofanormaldistribution. This key characteristicsoftheWHZcurveto can thenbeassessedbycomparing distributed. The overallqualityofsurvey WHZ ofthesampleshouldbenormally In agoodsurveythedistributionof ing with0.0and0.5. an over-representation ofvaluesend- conducted intherefugeecamps with for heightwaspresentinallsurveys ence forweightwhiledigitpreference all surveystherewasnotdigitprefer- there isasignificantdigitpreference.In and heightdeterminingwhether assessing thefinaldecimalforweight Measurements biasesarecheckedby malnutrition ineitherdirection. in majorchangestheprevalenceof children nutritionalstatus andcanresult cause significanterrorsinclassifying Poor accuracyinmeasurements can the nearest1mmforlength/height. ly tothenearest100gforweightand Children shouldbemeasuredaccurate- The standard deviationofweight-for-

Overall qualityofthesurvey Bias inmeasurements WHZ distribution. a positivekurtosisandhencepeaked out of22exhibitedkurtosisproblemwith a relativelyflatdistribution.Fivesurveys tribution whilenegativekurtosisindicates kurtosis indicatesarelativelypeakeddis- lie betweenplusorminusone.Positive kurtosis. The momentofkurtosisshould normaldistributionhaszero tribution. A many valuesintheshouldersofdis- very short(puddingshape)withtoo distribution isverylong(Mexicanhat)or bution, i.e.whetherthetails oftheWHZ flatness compared withanormaldistri- a measureoftherelativepeakednessor - exhibited skewnessproblem. cates alongleft tail. Noneofthesurveys right tail whilenegativeskewnessindi- one. Positiveskewnessindicatesalong ness shouldliebetweenplusorminus zero skewness. The momentofskew- mal distributionissymmetricalandhas nor- try ofthedata aroundthemean. A is ameasureofthedegreeasymme- - underestimated. rate forMoyale/Hudetwaslikelytobe This meantthatthereportedmalnutrition i.e. Moyale/HudetwithaSDbelow0.8. acceptable rangeforallsurveysbutone, nutrition. The SDofWHZwaswithinthe bias canreducetheprevalenceofmal- from data "overcleaning"orselection increase prevalencewhilenarrowSD Wide SDfrommeasurementerrorscan whether forclustersorchildren. directed tominimizeselectionbias ning of2006.Efforts shouldnowbe dramatically improvedsincethebegin- rejected. Accuracy ofmeasurements had hence anthropometricresults were was identifiedassignificantlybiasedand good: onlyonesurvey(Moyale/Hudet) The qualityofthesurveyswasoverall The skewnessofweight-for-height:this The kurtosisofweight-for-height:thisis

ENCU September 30, 2006 Page19 Conclusion Table11: Results of Survey Quality Check

Implementing Digit preference Skewness of Kurtosis of No of WHZ Representativeness of the sample Area surveyed SD of WHZ Agency WHZ WHZ flags* (%) Weight Height Age groups Sex ratio (boys/girls) Dale/Aleta Wondo Groups 1 & 2 under-represented ACF No No 0.930 0.082 1.096 0 1.1 Coffee LZ Groups 4 & 5 over-represented Dale/Aleta Wondo Groups 1 & 2 under-represented 1.2 ACF No No 0.809 -0.058 -0.019 0 Maize LZ Groups 4 & 5 over-represented girls under-represented Concern Offa No No 0.819 0.105 0.005 0 No bias 1.0 1.2 Concern Damot Weyde No No 0.814 0.081 0.219 0 No bias girls under-represented Digit .0 + Concern Kalu No 0.814 0.245 0.245 0 No bias 1.1 Digit .5 + 0.7 Concern Dessie Zuria No No 0.795 -0.079 0.058 0 Group 1 under-represented boys underrepresented GOAL Deder No No 0.924 0.045 0.37 0 Group 1 under-represented 1.0 GOAL Meta No No 0.893 0.270 0.697 0 Group 1 under-represented 1.1 GOAL Daro Lebu No No 0.807 0.356 0.441 0 No bias 1.0 2 1.2 MSF-CH Shashego No No 0.950 -0.386 1.009 No bias (0.2%) girls under-represented 37.157 4 SC-US Dalocha No No 1.033 0.228 kurtosis No bias 1.1 (0.4%) problem Groups 1 & 2 under-represented SC-UK Moyale & Hudet No No 0.751 0.134 0.451 1 (0.1%) 0.9 Groups 4 & 5 over-represented 2.395 Dolo Ado, Dolo Bay & 2 Groups 1 & 2 under-represented SC-UK No No 0.859 0.574 kurtosis 1.0 Bare (0.2%) Groups 5 over-represented problem 2 SC-UK Elkere & Hargelle No No 0.842 0.162 0.539 Group 1 under-represented 1.1 (0.2%) UNHCR/ Sherkole camp No Digit .0 ++ 0.897 0.253 0.281 0 No bias 1.1 WFP/ARRA 1.529 UNHCR/ Pugnido (Anyuak) Digit .0 +++ 1.3 No 0.923 0.661 kurtosis 0 Groups 4 & 5 under-represented WFP/ARRA camp Digit .5 + girls under-represented problem 2.859 UNHCR/ Pugnido (Nuer/Dinka) Digit .0 +++ 1 1.2 No 0.924 0.561 kurtosis No bias WFP/ARRA camp Digit .5 + (0.1%) girls under-represented problem UNHCR/ 0.8 K/Beyah camp No Digit .0 + 0.836 0.031 -0.171 0 Group 1 under-represented WFP/ARRA boys under-represented UNHCR/ Dimma camp No Digit .0 ++ 0.864 0.219 0.030 0 Group 4 under-represented 1.0 WFP/ARRA 4.369 UNHCR/ 1 Shemlba camp No Digit .0 + 0.939 0.831 kurtosis No bias 1.0 WFP/ARRA (0.1%) problem UNHCR/ Digit .0 +++ Yarenja camp No 0.835 0.039 0.012 0 No bias 1.0 WFP/ARRA Digit .5 + 2.060 UNHCR/ Digit .0 +++ Bonga camp No 0.894 0.359 kurtosis 0 No bias 1.0 WFP/ARRA Digit .5 + problem * Based on Epi-Info criteria: WHZ outside of -4 and +5 SD

NUTRITION SURVEY DATABASE

Table 12 presents the number of standardized nutrition surveys conducted in rural Ethiopia since 2000. It does not include surveys conducted in resettlement areas, IDP and refugee camps.

Table12: Number of Surveys by year and region Years Region 2000 2001 2002 2003 2004 2005 2006 Total SNNPR 9 5 35 30 14 25 15 133 Oromia 3 2 20 27 22 20 11 105 Amhara 59241797475 Somali 85558111052 Tigray 006733019 Afar 004516218 Gambella 00000000 Benshangul Gumez 00000000 Total 25 21 94 91 57 72 42 402 ENCU

ENCU September 30, 2006 Page 20