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UNICEF SOUTH SUDAN COUNTRY OFFICE Rapid Response Team

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UNICEF SOUTH SUDAN COUNTRY OFFICE Rapid Response Team UNICEF SOUTH SUDAN COUNTRY OFFICE Rapid Response Team Report Location (State/County/Payam/etc): Unity/Rubkona/Nhialdiu Date of the Mission: 16-25 October 2014 1 Name & Title of Kibrom Tesfaselassie - Nutrition Specialist UNICEF Team Leader 2 Names & Titles (with 1. Elizabeth Mukheb, Child protection UNIDO – Tel No. 0927328405; [email protected] org/depart/section) 2. Hari Vinathan, Nutrition Consultant, UNICEF - Tel no. 0955492068; [email protected] of other members of 3. Luel Deng, Education officer, UNICEF - Tel no. 0955158685; [email protected] 4. Okwera Joseph Okot, Health consultant - Tel no. 0959001482; [email protected] the team 5. Paul Okullu, WASH officer, International Aids Services (IAS), Tel no. 0955963274 3 Sites visited Nhialdiu HQ, Nhialdiu payam, Rubkona County, Unity State GPS; virtually centre of Nhial-Diu:- Latitude : N 09001’19.91’’ Longitude : E 029040’45.44’’ Altitude : 428.4m Information and Data collected 4 General General information about the mission site Information Number of registered people: 40,000 based on WFP verification process for previously given registration card last July. Number of households: over 14,000 including IDPs Total number of children under five (if available): Not Applicable as there was no new registration. Total number of children under 18 years (if available): NA Humanitarian situation and needs (IDPs, last time they received support, who is in control of the area etc.): Nhialdiu is a Payam of Rubkona County consisting of 16 Bomas southwest of Bentiu town approximately 40 km away. As per WFP, this mission covers four/five Payams including IDPs, with a total of population above 40,000. Although the current security situation is relatively calm and the population seems relaxed, they are always taking precautions. Basic social services such as health, education and others have not been operational since the crisis broke out in Nhialdiu town which is highly populated by the IDPs from Mayom, Pariang and Bentiu. Since the start of the crisis the PHCC and schools have been closed and there has been a lack of essential drugs/medical equipment and learning/teaching materials. The community is fully dependant on livestock and traditional fishing to support their families. Generally, there are no service providers or any humanitarian interventions; that is why WFP/UNICEF organized a second mission to the same location and beneficiaries. The first RRM mission was conducted in July 2014 and over 37,000 beneficiaries were registered. However, the WFP mission was disrupted during Page 1 of 13 UNICEF SOUTH SUDAN COUNTRY OFFICE Rapid Response Team Report distribution. Currently, the area is flooded and movement is greatly hampered by water especially for children who could not cross deep water to reach the verification site. Because of this, only 2,275 (out of above 7,000 target children 6-59 months) were able to come and benefit from UNICEF interventions. Immediate Response Provided and Follow up Actions 5 Nutrition Provide a brief situation analysis and list down the critical humanitarian needs related to Nutrition Situation Overview Nutrition services such as outpatient therapeutic programmes (OTPs), targeted supplementary feeding and Humanitarian programmes (TSFPs) and infant and young child feeding (IYCF) counselling have not been operating in needs: Nhialdiu. In the PHCC, there is a lack of nutrition supplies, anthropometric equipment, office furniture and stationery. However, the PHCC infrastructure and human capacity of local nutrition workers are in place. Non-appearance of nutrition partners in the ground has also negative impact to nutrition situation in the area. Nhialdiu and other Payams’ community depend mainly on livestock and the nutrition situation is currently serious as per WHO classification thresholds for rates of global acute malnutrition (GAM). According to proxy indicator of MUAC measurement 78 (3.4 per cent) and 188 (8.3 per cent) severely and moderately children were identified respectively from a total of 2,275 children screened. See the table below. Moreover, the nutrition situation of pregnant and lactating mothers is critical with 20.8 per cent GAM which 5.7 per cent is severe based on the assessment conducted using MUAC measurement. This high level of under-nutrition can be justified that the inadequate household food resources are being prioritized to husband and elder children, while mothers eat less and young children are also being fed with breast milk for longer period without complementary foods. Immediate Summary of key interventions and results including challenges and how they were overcome Response/Results: Response/Results during RRM: 1. MUAC screening for malnourished children and PLW 1.1 A total of 2,275 children 6 – 59 months were screened for malnutrition using MUAC tape; among these 78 children (3.4%) and 188 children (8.3%) were found with SAM and MAM respectively. All SAM children newly identified are admitted in OTP site revitalized within Nhialdiu PHCC. See table below for details of screening result: Rate using MUAC M F Total MUAC only (%) Oedema (SAM) 0 0 0 <11.5cm (SAM) 45 33 78 SAM 3.4% >11.5 - <12.5cm (MAM) 95 93 188 MAM 8.3% >12.5 (Normal) 1038 971 2009 Total 1178 1097 2275 1.2 Total of 1,149 pregnant and breastfeeding mothers were screened using MUAC. See table below. Page 2 of 13 UNICEF SOUTH SUDAN COUNTRY OFFICE Rapid Response Team Report Pregnant breastfeeding Rate by MUAC MUAC Mothers mothers Total (%) <21.0cm (SAM) 22 44 66 5.7% (SAM) >18.0 - <21.0cm (MAM) 84 90 174 15.1% (MAM) >21.0 (Normal) 251 658 909 Total 357 792 1,149 2. 2,188 children 6-59 months (1,131 male and 1057 female) were supplemented with Vitamin A. 3. 1,765 children 12-59 months (917 male and 848 female) received deworming tablets. 4. IYCF key messages were conveyed in the local language to the whole population focusing for above 2,188 pregnant, breastfeeding mothers and mothers with children under 5. Data against the following indicators and mention the source of information in the end 2,275 # of children 6-59 months screened for acute malnutrition via the RRM 78 # of SAM cases detected 188 # of MAM cases detected 78 # of children 6-59 months admitted to a SAM management programme 0 # of MAM cases 6-59 months referred for treatment 1,458 # of PLW access IYCF messaging 2,188 # of children reached 6-59 months reached with Vitamin A 1,765 # of children 12-59 months reached with deworming medication Source of information: Tally Sheets Follow up Actions What key actions are required and by whom? required: Provide necessary support to sustain the OTP, TSFP and IYCF projects in Nhialdiu PHCC run by Local Health Workers who are working volunteers. Periodic monitoring/supervising and supplying nutrition items (therapeutic food and equipment) when needed from UNICEF. Recommended follow up visit is three months later – Mid January 2015. 6 Health Provide a brief situation analysis and list down the critical humanitarian needs related to Health Situation Overview Since the first RRM mission in July 2014, access and provision of health care services remained and Humanitarian hindered and the population in Nhialdiu have not been accessing health care services. Below are health needs: related needing to be addressed :- . Though masles vaccination was done during the July 2014 RRM mission, cases of measles are still been reported. There were high numbers of cases of Malaria in the OPD attendance during the RRM OPD consultations. Inadequate drugs and medical supplies in Nhialdiu health centre. Medical equipment and furniture in Nhialdiu health centre were all looted in July. Reproductive health and emergency obstetric cases remains challenging and need to be addressed. There were also no ANC services provided in Nhialdiu health centre. Limit numbers of skilled and trained middle cadre health personnel in Nhialdiu Health centre to provide health care services. Page 3 of 13 UNICEF SOUTH SUDAN COUNTRY OFFICE Rapid Response Team Report Immediate Summary of key interventions and results including challenges and how they were overcome Response/Results: CARE international in remote management has sent drugs supplies to Nhialdiu health centre, this made it possible to allow the Nhiladiu health centre to re-open since it closure in July. The County Health Department were supportive to mobilize the Nhalidiu facility health workers to resume work. UNICEF supplied the Nhalidiu health centre with PHCU kit. OPD consultations made during RRM mission between 20 and 25 October 2014. Under 5 year Consultations Male 119 Under 5 year Consultations Female 137 Over 5 year consultations Male 204 Over 5 year consultations Female 373 Total 833 The top three leading morbidity cases includes: Malaria, Pneumonia and Acute Watery Diarrhoea. However, Malaria remains the top leading morbidity. It was observed that Nhialdiu area is flooded, providing space for mosquitoes to bread. Some families are not consistently using/sleeping mosquito nets and this could be the possible reason making Malaria the leading cause of morbidity. Vaccination was conducted during the July 2014 RRM mission but still cases of Measles have been reported. The county surveillance focal person continues to collect data though the data remains confined in the Nhalidiu health centre. Despite the above achievements made, the fighting in July greatly affected the Nhiladiu PHCC. Drugs, medical equipment and supplies were completely looted. This has led to closure of the facility from July to September 2014, though CARE and UNICEF have provided drugs to the Nhialdiu health centre. However, EPI and reproductive health services remain major concerns to be addressed as CARE International is in Rubkona there is need for CARE to scale up and extend its full operation in Nhialdiu. The patient referral system is another concern to be addressed as there is no referral in place, therefore, due to poor linkage and distance between Koch and Leer county – the health facilities where most of the severe cases could be referred – are too far as Koch is two days walk and Leer about four to five days.
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