MARCH BULLETIN 2017 Nutrition Situation and Response in Former Unity State In this issue: 1. Situation Overview 1. Situation Overview 2. Response The February 2017 IPC estimated that 4.9 million (41.7 a) Gap analysis and increasing geographical %) of the total population were estimated to be food in- coverage of responses secure (IPC 3, 4 and 5) between February and April with b) Types of nutrition being implemented and 100,000 people facing famine (IPC 5) in two counties of scaled up Leer and Mayandit. Two other counties-Kouch and Panyi- c) Emergency Nutrition response mecha- jar were classified as IPC 4 implying that were at the tip- nisms being implemented ping point to IPC 5 if responses won't be scaled up. The d) Emergency Nutrition response mecha- food insecurity situation was expected to worsen be- nisms being implemented tween May and July during which the food insecure pop- e) Funding status for implementation of re- ulation was estimated to increase to 5.5 million (46.7%) sponse in the four counties of the population. 3. Capacity building 4. Coordination Following the release of the IPC in February 2017 that 5. Challenges declared famine-IPC 5 in two counties, the nutrition clus- 6. Key Messages ter has been closely monitoring the evolving nutrition situation in those counties. The monitoring involved i) conducting SMART surveys in three counties (Panyijar, lected sites below. The decreasing admissions trend was Leer and Kouch) to provide benchmark information for associated with the combination of the on-going GFD, monitoring of the planned and on-going nutrition re- OTP and TSFP interventions implemented by partners. sponses and ii) Weekly reports of new SAM and MAM Despite the decrease in weekly admission in Panyijiar admissions were also initiated in the beginning of March during March, the overall number of admissions in 2017. March was higher than those reported in February; part- ly due to an increased number of operational sites. The graph below depicts an increasing trend in MAM admission in an average of nine TSFP sites in three months. A SMART survey conducted (2 weeks after famine decla- ration) in Panyijar reported critical nutrition situation with GAM and SAM of 16.0 and 3.5 percent respectively. Crude and under-five mortality rates were normal com- pared to Sphere and international emergency thresh- olds. When compared with SMART survey results con- ducted during same period in April 2016, there was no significant difference in MUAC, GAM and SAM preva- lence, crude and under-five mortality levels. SMART survey in Kouch was being conducted by end of March whose results will be reported in the April bulletin. Leer survey was delayed due to access and security con- During the month of March, over all 2,926 SAM and 5460 cerns, however, it is expected to be conducted in the MAM children and were newly admitted in Unity state. 3rd week of April. Weekly new SAM and MAM admissions in the four coun- ties during the month of March indicated a decreasing trend towards the end of the month. See graphs in se- Program Updates Response overview In Leer county, SAM and MAM new admissions dropped b) Types of nutrition services being imple- during the 5th week of March. mented and scaled up: The nutrition cluster dis- cussed and agreed with partners to implement and strengthen the existing curative (SAM and MAM) and pre- ventive interventions. The preventive nutrition interven- tions included IYCF in mother to mother support groups, micronutrient supplementation, deworming and Blanket Supplementary feeding programme (BSFP). Following the famine declaration, WFP scaled up BSFP response to be implemented in the TSFP sites. The aim was to increase BSFP coverage and ensure continuity of BSFP responses in- between general food distributions (GFD) rounds in three counties of Leer, Mayandit and Panyijar. By the end of SAM and MAM caseload and targets revisions: March, Medair had started implementing BSFP in 6 of the 13 sites planned in Leer. This measure complements BSFP Following the release of the February IPC, SAM and MAM responses implemented along with GFD covering all the caseload and targets were revised. SAM and MAM targets counties in former Unity State. increased two to four folds in Leer and Panyijar counties. Apart from the deterioration of food security and nutrition Moreover, partners expressed commitment to implement situation, the increase was partly associated with use of integrated Community Case Management (iCCM) in their MUAC screening data in projecting revised caseload in- operational sites. Where it was not possible to implement stead of WHZ-score; since there was no such information the entire iCCM package, a minimum of screening and during the IPC process. Mayandit nutrition survey data was treatment of malaria among under-five children presenting recent (January 2017) and therefore there were no changes with SAM will be done. By the end of March, two partners in caseload and targets for both SAM and MAM. (Medair and IRC) were implementing iCCM in their opera- tional areas in Leer and Panyijar counties respectively. 2. Response In order to increase coverage and ensure that all SAM and a) Gap analysis and increasing geographical MAM children are immediately enrolled in the selective coverage of responses: Before the nutrition respons- feeding programme, mass screening was agreed on as es were scaled up, a coverage gap analysis was conduct- initial response strategy. In view of this, house to house ed. The gap analysis focused i) on the number of sites that mass screening was planned to be conducted once per were operational before the famine was declared ii) sites month involving all under-five children in each partner’s that would open as part of scale up and iii) timeline for respective areas. By the end of March partners reported to opening of sites. As of 22-25th February when the gap have conducted mass screening in their respective sites. analysis was conducted for the first time, 37 OTP, one Sta- bilization Centre SC) and 41 TSFP sites were operational in Project monitoring frequency increased by partners from the four counties. More than half of those sites were in Pa- monthly during pre-famine period to weekly basis in order nyijar County. As a result of scale up in the four counties, to improve quality of nutrition services. This will be as- by the end of March, the number of operational OTP sites sessed in April as to what extent has it been implemented. increased from 37 to 52 sites; SC increased from 1 to 3 and TSFP sites increased from 41 to 46. In terms of capacity, partners scaled up their respective human resources capacities in the four counties in different However, a considerable gap of 23, 24 and 5 OTP, TSFP ways. These included: relocating staff to Unity from other and SC sites respectively still existed partly due to insecu- locations, surge capacity, seconding technical and recruit- rity and access particularly in Leer, Mayandit and Kouch. ment of additional staff. These measures were taken to Important to note is that there was still no SC services in cope with the increased number of operational sites to be Leer and Mayandit counties due the reasons explained opened and high demand for quality improvement in all above. SCI had agreed to support Nile Hope in establish- nutrition sites. ing at least one SC in Leer County. A mission involving Concern, Nile Hope and SCI was conducted in Leer to esti- mate the SAM beneficiaries that would be enrolled in the c) Supplies: By end the of March there was no report- SC and identify locations. A decision was expected to be ed supply shortage for SAM and MAM management in for- made mid-April. Population movement and opening of new mer unity state particularly in the most affected four coun- sites while maintaining the vacated sites also explain the ties. Sporadic site level shortage were reported in Panyijar reasons why the gap still exists despite the increase in County for RUTF and RUSF due to delayed submission of number of new sites that have resumed nutrition services supply replenishment requests. In order to prevent or opened up. Program Updates Response overview interruption of nutrition services associated with late deliv- 17,501 pregnant and lactating women received key IYCF ery of nutrition supplies, the ICWG and logistic cluster pri- messages. All pregnant and lactating mothers and vulnera- oritized delivery of nutrition, health, WASH and FSL sup- ble households, i.e. households containing children and/or plies. women with low nutritional status, benefitted from distribu- tion of NFI kits. However, the stock status of supplies at nutrition site level was not easy to establish. In view of this, the nutrition clus- With respect to the routine program the total of 2926 SAM ter in consultation with WFP and UNICEF and all partners and 5460 MAM children were newly admitted in selective introduced a monthly site level stock status tracking tool. feeding programs(OTP,TSFP). Due to the significant differ- The RUTF and RUSF supplies tracking tool will be complet- ence in numbers of OTP and TSFP sites reporting, compari- ed by partners and submitted to the cluster latest on 15th son of total admissions can only be made between Febru- of subsequent months. The report will be summarized and ary and March that had relatively similar numbers of re- reported to all partners once per month. porting sites. Based on this we can conclude that OTP and TSFP admissions in Unity increased by 14.3% and 25% re- Due to the increased SAM and MAM caseload and targets spectively. mentioned earlier, supply requirements for Unity in par- ticular in two of the four counties increased two to four times between January and February 2017.