EMERGENCY NUTRITION QUARTERLY BULLETIN (Second Quarter 2007) Emergency Nutrition Coordination Unit Early Warning Department (Disaster Prevention and Preparedness Agency) Figure 1

INSIDE SNNP REGION SILTI WOREDA, Page 2 BONA WOREDA, Page 2 DALE & ALETA WONDO WOREDAS, Page 3 OROMIA REGION META ROBI/ADA BERGA & ABUNA GINDBERET WOREDAS, Page 5 MELKA BELLO WOREDA, Page 6 AFAR REGION CHIFRA WOREDA, Page 8 SOMALI REGION ELKARE & HARGELE WOREDAS, Page 9 TIGRAY REGION A total of 16 nutrition surveys were conducted by SCUK, GOAL, ACF, WV-Ethiopia, Page 11 SCUSA, RENCU/DPPB in SNNPR, Afar, Somali and Tigray regions between late March and early June 2007. Twelve nutrition surveys were carried out in the predom- QUALITY CHECK OF ANTHROPOMETRY DATA FROM NUTRITION SURVEYS inantly cropping areas of Oromia, SNNPR and Tigray regions during the late post-har- Page 13 vest meher season while the remaining four were conducted in the pastoral areas of Somali and Afar regions. The prevalence of global acute malnutrition was below 10 DATA QUALITY CHECK OF EOS MUAC SCREENING percent in all surveyed woredas of Tigray, Oromia and SNNPR except in Bona in Page 15 SNNPR where Global Acute Malnutrition (GAM) was 16.4 percent. GAM was also slightly above 10 percent in Chifra and in the surveyed pastoral areas as shown in fig- NUTRITION SURVEY DATABASE Page 15 ure 2. The summary findings of the surveys conducted are presented and discussed in subsequent sections. Figure 1 presents nutrition intervention programmes, nutrition PERFORMANCE OF EMERGENCY NUTRI- survey coverage and EOS at woreda level. TION INTERVENTION PROGRAMMES Page 15 Figure 2

UPDATE ON THE PROGRESS OF NUTRI- Nutrition Survey Results - Ethiopia TION CLUSTER ROLL OUT IN ETHIOPIA April - June 2007 Page 17 18

SUMMARY FINDINGS OF MUAC, WFH AND 16 BODY-SHAPE RESEARCH STUDY 14

Page 17 12

10

8

6

4

2 Prevalence ofPrevalence acute malnutrition (%) 0

Silti Bona Chifra ENCU/DPPA Melka Bello Elkare/Hargele Raya Valley LZ Addis Ababa Eastern Platu LZ Abuna Gindberet Dale/AW Cofee LZ Middle Tekeze LZ Werie Catchment LZ West Central Teff LZ Atsbi W. Highland LZ Tel. (011) 5 523556 Central Mixed Crop LZ Meta Robi/Ada Berga Enderta Dry Midland LZ e-mail: [email protected] http://www.dppc.gov.et Severe Acute Malnutrition Moderate Acute Malnutrition

ENCU June 30, 2007 Page 1 SNNP REGION

SILTE ZONE meher & the current belg seasons. The communities interviewed rated the live- Silti Woreda stock and pasture conditions as average A 23 by 33 cluster nutrition survey using (42.4 percent) and good (63.6 percent) the SMART methodology was conduct- respectively. ed by GOAL in Silti woreda in March 2007 to serve as an end line evaluation Conclusion & Recommendations: of its CTC programme that had been The prevalence of global acute malnutri- implemented for eight months and hand- tion (8.9 percent) was relatively lower ed over to the woreda health sector in than in 2006 at the same season indicat- January 2007. A total of 763 children ing an improvement. Mortality was with- aged 6-59 months were surveyed. in acceptable limits. This was an indica- Retrospective mortality information was tion of the normal food security situation collected from 2690 individuals using 90 in the woreda at the time of the survey. days recall period. The Data were However, there was no improvement in analysed using Nutrisurvey SMART soft- vaccination coverage. Access to clean ware. water remained a concern to be addressed in the woreda. It was recom- Nutrition: The prevalence of GAM was mended to improve vaccination cover- estimated at 8.9 percent with 0.7 per- age and assure proper close monitoring cent Severe Acute Malnutrition (SAM) during the upcoming hunger season. while bilateral oedema was 0.1 percent. GAM was relatively higher among young SIDAMA ZONE (6-29 months) than among older chil-

dren (30-59 months). Compared with Bona Woreda May 2006 survey results with GAM of A mult-agency standard nutrition 20 x36 12.2 percent, the level of malnutrition in cluster survey using the SMART 2007 had decreased though not statisti- methodology was conducted in Bona cally significant. The prevalence of mal- Woreda in May 2007 after rapid assess- nutrition was classified as poor based on ment results indicated a deteriorating the national assessment guideline and nutritional status in April. A sample size typical in Ethiopian context. of 720 children aged 6-59 months partic- ipated in the survey. Health: Mortality rates with CMR at 0.11/10,000/day and under five mortality Silti Woreda Nutrition: The prevalence of global and rate at 0.16/10,000/day fell below the severe acute malnutrition was as 16.4 average levels for developing countries. and 3.2 percent respectively. No a single Compared with May 2006 sur- Both crude and under five death rates oedema case was reported. MUAC vey results with GAM of 12.2 had decreased compared to the May results mirrored that estimates by WHZ. percent, the level of malnutri- 2006 levels of 0.46 and 0.94/10,000/day No significant different between boys tion in 2007 had decreased respectively. Morbidity in children was and girls. The levels of malnutrition were though not statistically signifi- estimated at 23.9 percent with acute classified as critical according to the cant. watery diarrhea being top on the list of national guideline. Based on the SAM morbidities. Immunization coverage for prevalence of 3.2 percent as defined by BCG was 57.3 percent and measles WHZ-score it was estimated that a total Bona Woreda 75.1 percent. Vitamin A coverage was of 714 under five children needed thera- generally higher at 95.0 percent. About peutic and while 2943 were to be The levels of malnutrition 10 percent of the population has access enrolled in supplementary feeding inter- were classified as critical. to safe drinking water. Based on the SAM prevalence ventions. However, the admission crite- ria are based on weight for height per- of 3.2 percent as defined by Z- Livelihood/Food Security: According centage median bringing down the num- score it was estimated that a to the SNNPR Livelihood Profiles by ber of children that would be enrolled in total of 714 under-five children FewsNet in January 2006, large portion TFP and SFP to 434 and 2639 respec- needed therapeutic and while of the woreda lies within Alaba-Mareko tively. Bona is a newly established wore- 2943 were to be enrolled in Lowland Pepper LZ. It was reported that da, thus, no baseline data were avail- supplementary feeding inter- at the time of the survey the food securi- able for comparison. ventions. ty situation was satisfactory. The woreda received adequate rain during previous ENCU June 30, 2007 Page 2 cent inJune2007. in December2006to9.1per- malnutrition from16.4percent decrease inthelevelofacute was astatistically significant in thehungerseason,there vey wasconductedrelatively Despite thatthecurrentsur- Dale & Aleta Wondo Woredas ENCU AWD wasalsorecommended. eral healtheducation toaddressthe Improvement inwaterservicesandgen- of thechildren'snutritional status. gramme andpreventfurther worsening captured bytheEOSscreening pro- to take care ofchildrenthatwerenot basis ratherthanoncein three months foodonmonthly ing distributing TSFP interventioninBonainclud- EOS/ TSFP also recommendedtostrengthenthe in EthiopiafundedbyUNOCHA.Itwas diately initiatedbySavetheChildrenUS gramme wasrecommendedandimme- pro- the woredawascritical.SC/OTP Conclusion: 2. surveyed woredaarepresentedin Table Food andnutritioninterventionsinthe riorating foodsituationintheworeda. two mealsperdaytocopewiththedete- the interviewedhouseholdswereeating purchasing food. About 63percentof cent oftheinterviewedhouseholdswere However, atthetimeofsurvey, 23per- complemented bycasuallabour. nities inBonaissubsistenceagriculture (94.4 percent)livelihoodofthecommu- Livelihood/Food Security: ably acrosstheworedasinregion. and reportedindicatorsvariedconsider- ed inSNNPR.Generallytheassessed summarises thesurveyresults conduct- somewhat lowerat58.9percent. Table 1 tion coverageinthelast6monthswas national average.Vitamin supplementa- scar trailedat46.1percentfarbelowthe the nationalaverage.BCGconfirmedby cent, 11 percentage points higherthan Strategy (EOS)campaign was77per- routine andduringEnhancedOutreach Measles immunizationcoverageboth est at21.1percent. overall morbidityprevalencewasmod- ranked secondwith19.1percent. The the total reportedmorbidity. Scabies prevalent accountingfor36.8percentof Waterly Diarrhoea(AWD) wasmost ceding thesurveyindicatedthat Acute Retrospective morbiditytwoweekspre- ing tothenationalguidelines. emergency thatwasnotcriticalaccord- under fivemortality ratesindicatedan was availableintheworeda;however, data onpreviouslevelsofdeathrate ity ratewas1.1/10,000/day. Nobaseline 0.43/10,000/day whileunderfivemortal- Health: The CMRwasfoundtobe The nutritionalstatus in The main veys. mortality ratesbetwewnthetwosur- decrease inbothcrudeandunderfive malnutrition, therewasnosignificant the emergencylevels.Contrarytoacute 0.23/10,000/day respectively, farbelow were estimatedat0.05and The crudeandunderfivemortality rates 11.6 percent)inJune2007. December 2006to9.1percent(CI6.6- GAM (CI:13.7-19.2percent)in acute malnutritionfrom16.4percent tically significantdecreaseinthelevelof in thehungerseason,therewasastatis- current surveywasconductedrelatively SAM at0.9percent.Despitethatthe tion wasestimatedat9.1percentand The prevalenceofglobalacutemalnutri- and mortality results. tation islimitedtotheanthropometry mitted toENCUandhencethepresen- lettin surveyreportwasstillnotyetsub- survey. At thetimeofpreparing thisbul- as afollowupoftheDecember2006 Zone ofDaleand Aleta Wondo woredas tion surveyintheCoffee Livelihood ACF conducteda16x43standard nutri- Dale and Aleta Wondo woredas ENCU June30,2007 Page3 ENCU

FoodAid Jan Table 2:FoodandNutritionInterventionsinSurveyedWoredas ofSNNPR * NotReported Productive Safety Net Productive Safety Table 1:SurveyResults forSNNPR % Vitamin A in past 6 months (95% CI) 6months(95%% A Vitamin inpast % coverage(scar)(95%BCG CI) CI) bycard+recall(95%% Measles coverage bycard(95%%CI) Measles coverage Major illnessesorsymptoms % Morbidity Major causesofU5MR CI) U5MR Death//10,000/day(95% CI) CMR Death/10,000/day(95% % Kwashiorkor %SAMCI) Z-scores(95% % inGAM Z-scores(95% CI) No of children acutely malnourished* No ofchildrenacutelymalnourished* * MUACbelow12.0cmand/oroedema Outreach TherapeuticProgramme Estimated UnderFivepopulation EOS As %As ofscreenedchildren Estimated population size size Estimated population Therapeutic FeedingUnit %of ruralpopulation %of ruralpopulation - - June 07 6thround Key indicators

– – No of beneficiaries Noofbeneficiaries No of beneficiaries Noofbeneficiaries screening screening

Diariahoea & scabies Diariahoea & scabies 16.4 (12.3-20.6) 58.9 (53.0-63.4) 73.0 (67.9-77.5) 1.12 (0.38-1.85) 0.43 (0.18-0.67) 46.1(40.9-51.4) Dec. 2006 Malnutrition & Bona HC 3.2 (1.3-5.1) 4.0 (2.3-6.7) 111,495 SC 22,299 May 20-27 2,517 Bona unknown 13.0 Yes NO NO 0.0 0.0 Bona - 21.1 1.1 US

Sidama zone Yirgalem Hospital Mesenkela HC Sidama Zone Bokaso HC Bokaso HC 406,354 23,550 81,271 Dale & Aleta Wondo Dale ACF Yes NO 0.0 0.0 6.0 No No ENCU June30,2007 Page4 0.23 (0.0-1.06) 0.05 (0.0-0.15) 9.1 (6.6-11.6) 0.9 (0.1-1.8)

CLZ June

NR* NR NR NR NR NR NR 0.2

Aleta Wondo Aleta Wendo Dec. 2006 Chiko HC 368038 23,490 73,608 ACF Yes 568 NO HC 8.6 0.0 6.4

0.11(0.0-0.23)

0.16 (0.0-0.44) 95.0 (CI:NR) 57.3 (CI:NR) 75.1 (CI:NR) 8.9 (6.1-11.8) 23-28 March

5.1(CI: NR)

0.7(0.1-1.2) Silti zone Unknown

AWD 23.9 Silti 0.1

Dec. 2006 Silti Zone 162,807 19,841 3 GOAL 3,105 10.4 12.2 2,561 Silti Yes NO 0.0 No

nourished communities. typical forchronicallymal- were classifiedaspoor and Meta Robi and Ada Berga The levelsofmalnutrition in and Abuna Gindberet and Abuna Meta Robi/Ada Berga Woredas ENCU ETSEAZONE WEST SHEWA ly. Access tohealthservices wasgener- Berga and Abuna Gindberetrespective- and 81.6percentinMeta Robi/Ada supplementation washigherat76.6 A Abuna Gindberet(69.5percent). Vitamin Meta Robi/Ada Berga(64.2percent)and recall) coveragewasalso lowbothin woreda. Measlesvaccination(card+ and 20.6percentin Abuna Gindberet of 38.0percentinMeta Robi/AdaBerga age asindicatedbylowBCGcoverage Immunization coveragewasbelowaver- ty amongchildren. cough werethemaincausesofmorbidi- Gindberet respectively. Diarrhea& in Meta Robi/Ada Berga and Abuna children waslowat15.2and7.6percent Gindberet woreda.Overallmorbidityin and U5MRof0.89/10,000/dayin Abuna Meta Robi/AdaBergaandCMRof0.13 with CMRof0.08andU5MR0.24for and withinthenon-emergencylevels, Health: communities. typical forchronicallymalnourished Gindberet wereclassifiedaspoorand tion inMeta Robi/AdaBergaand Abuna national guidelinethelevelsofmalnutri- of thecurrentfindings. According tothe the surveyworedastoallowcomparison ous surveyshadbeenconductedinall Abuna Gindberetrespectively. Noprevi- cent in(Meta Robi/AdaBerga)and acute malnutritionwas0.5and0.3per- percent in Abuna Gindberet.Severe percent inMeta Robi/AdaBergaand5.1 acute malnutritionwasestimatedat6.8 Nutrition: subsequent topicsbelow. summarized in Table 3anddiscussedin methodology. The findingsare SMART taken from24to28May2007usingthe Abuna Gindberetworeda,wereunder- Meta Robi/AdaBergaandthesecondin zone. Two separate surveys,onein most affected woredasofWest Shewa SCUK toconductnutritionsurveysin requested Monitoring Team,DPPA food securitybytheMulti Agency Based onthereports ofdeteriorating RMAREGION OROMIA Gindberet Woredas Meta Robi/AdaBergaand Abuna Both CMRandU5MRwerelow The prevalenceofglobal relief foodassistance throughoutthe tion ofthesituation: were madetopreventfurther deteriora- areas thefollowingrecommendations food securitysituationinthelowland Recommendations: lowland areas. would helptoreflectthesituationin survey byagroecologicalbasisasthis have beenmoreappropriatetodothe geneous andhighlylocalized,itwould distribution ofmalnutritionwashetero- cal zones.Insuchasituationwherethe the effects oflessaffected agroecologi- the lowlandmighthavebeenmaskedby malnutrition asthenutritionalstatus of explained thelowprevalenceofacute poor. Geographicbiasmightpartly uation inthelowlandareasremained of thesurveywhilefoodsecuritysit- woredas wasfoundtobelowatthetime acute malnutritioninthethreesurveyed Conclusion: Oromia region. interventions inthesurveyedworedas tance. Table 4showsfoodandnutrition were receivingemergencyfoodassis- Berga and Abuna Gindberetworedas of 50,995beneficiariesinMeta Robi/Ada total tion, pooranduntimelyrainfalls. A growth, declininglandholding,degrada- in therecentyearsduetopopulation These woredasbecamefoodinsecure parts of Abuna Gindeberetworeda. disease wasreportedinthelowland Shortage ofgrazinglandandlivestock many households. lands weremoreaffected anddisplaced previous effect offloodandlandslideduringthe was reportedbelownormalduetothe on and agriculture andbenefitfromboth and Abuna Gindberetworedasrelieson the populationinMeta Robi/AdaBerga Livelihood/Food Security: parts. ally describedaspoorinthelowland Continue withtheongoing emergency meher belg ENCU June30,2007 Page5 seasons withhighdependence keremt rains. The previousharvest The prevalenceofglobal season wherethelow- Given thepoor Majority of meher normal levels. mortality rates werewithinthe .The crudeandunder five Bello wasreportedas"typical" The nutritionalstatus inMelka Melka BelloWoreda ENCU EAST HARARGEZONE all thesurveyedworedas. woredas. lowland populationinallthethree upcoming hungerseasontargeting the population. tion withparticular attentiontolowland keremt due topoorperformance ofboththe crop failureintheprevious fiveyears reported thattheworeda experienced crops include highly rain fedagricultureanddescribedas the populationisagrarianandrelieson Livelihood/Food Security: was estimatedat68.6percent. supplementation respectively. Vitamin A coverage ratesof55.8and41.0percent measles (cardandrecall)vaccination coverage asindicatedbylowBCGand EPI coveragewasbelowthenational reported thatthehealthcareserviceand most commoncauseofmorbidity. Itwas 18.0 percent.Diarrhealdiseasewasthe in childrenwasmodestestimatedat falling withinthenormallevels.Morbidity 0.14/10,000/day respectively, both tality rateswereestimatedat0.07and Health: for comparison. line data intheworedawereavailable were estimatedat0.6percent.Nobase- tion. Severeacutemalnutritionlevels with 6.2percentglobalacutemalnutri- Melka Bellowasreportedas"typical" Nutrition: ming. to provideinformationforIMCprogram- vey wasconductedamongotherthings crude deathraterespectively. The sur- estimate thelevelsofmalnutritionand 2895 individualswereinterviewedto ple sizeof720underfivechildrenand sam- methodology. A sampling SMART UK usinga24by30twostage cluster ed inMelkaBellobySavetheChildren standard nutritionsurvey wasconduct- A area wasbeneficiary offoodaidinthe Close monitoringoftheoverallsitua- Strengthening theEPIprogrammein Melka BelloWoreda meher and The crudeandunderfivemor- The nutritionalstatus in belg dependent. The main cash chat rains andhencethe and coffee. Itwas Majority of communities. close monitoringofthe strengthen theroutineEPIprogramwith and continue theexistingPSNP In themeantimeitwasrecommendedto deteriorate ornotinthecomingmonths. the mine whetherthenutritionsituationin ance ofthe security wassatisfactory. The perform- and underfivemortality rates.Food as wellacceptable levelsofcrude prevalence ofglobalacutemalnutrition Bello wasnormalasexplainedbylow The overallnutritionalstatus inMelka Conclusion &Recommendations: gramme. through anemergencyreliefpro- (PSNP) whilefourotherswereassisted Productive SafetyNetProgramme total of18 assumed toaffect the than its usualtimeofonset,hence current households interviewedstated thatthe time ofthesurvey80percent formance of the timeofsurveyduetobetterper- food securitysituationwasreportedat past years.However, arelativelybetter belg belg -dependent areaswaslikelyto ENCU June30,2007 Page6 kebeles rain started onemonthlater meher belg harvest woulddeter- rain in2006. At the were beneficiaryof belg belg -dependent harvest. A Table 3: Survey Results for Oromia East Hararge zone West Shewa zone Key indicators Melka Bello Meta Robi & Ada Abuna gindberet March 22- 4 April Berga 24-28 May 24-28 May % GAM in Z-scores (95% CI) 6.2 (4.3-8.0) 6.8 (5.0 - 8.7) 5.1(CI: 3.7 - 6.5) % SAM n Z-scores (95% CI) 0.6 (0.0-1.1) 0.5 (0.0 - 1.1) 0.3 (0.0 - 0.6) % Kwashiorkor 0.0 0.0 0.0 CMR Death/10,000/day (95% CI) 0.07(0.00- 0.16) 0.08 (0.0-0.18) 0.13 (0.0-0.28) U5MR Death/10,000/day (95% CI) 0.14 (0.0- 0.38) 0.24 (0.0-0.71) 0.89 (0.0-2.50) % Major causes of U5MR NR * NR Diarrhoea % Morbidity 18.0 15.2 7.6 Major illnesses or symptoms Diarrhea & Cough Diarrhea & Cough Diarrhoea & Cough %Measles coverage by card (95% CI) 12.0 (4.3-19.7) 5.6 (1.0-10.1) 1.2 (0.0-2.4) %Measles coverage by card + recall (95% CI) 55.8 (48.0-63.6) 64.2 (54.4-73.9) 69.5 (60.7-78.2) % BCG coverage (scar) (95% CI) 41.0 (31.8-50.2) 38.0 (30.7-45.2) 20.6 (14.5-26.7) % Vitamin A in past 6 months (95% CI) 68.6 (60.2-77.0) 76.6 (69.7-83.5) 81.6 (76.2-87.0) * Not Reported

Table 4: Food and Nutrition Interventions in Surveyed Woredas of Oromia East West Shewa Hararge Zone Region Zone Abuna Melka Bello Meta Robi Ada Berga Gindberet Estimated population size 146,051 144,252 117,922 200,522 Estimated Under Five population 29,210 28,850 23,584 40,104

Productive Safety Net – No of beneficiaries 24,626 No No No % of rural population 16.9% 0.0 0.0 0.0

Food Aid April-June 07 – No of beneficiaries No 36,537 4,906 9,510 % of rural population 0.0 25.0 4.2 4.7

EOS Screening May 2006 May 2007 May 2007 No No of children acutely malnourished* 1,849 1,245 851 No As a % of screened children 6.3 5.7 4.1 0.0

ENCU Therapeutic Feeding Unit No No No No

Outreach Therapeutic Programme No No No No

* MUAC below 12.0 cm and/or oedema

ENCU June 30, 2007 Page 7 in Chifraworeda. programme ommended OTP was underestimatedand rec- the SAMbasedonWHZ score, ENCUsuspected that population wasabout-1WHZ mean Z-scoreofthestudy Considering thattheoverall Chifra Woreda ENCU AFAR andSOMALIREGION tively lowat13.6 percent.Ofthereport- weeks precedingthesurvey wasrela- The overallreportedmorbidity withintwo national guidelines. within thenormalaccording tothe countries whilethatofunderfivewas pared tolevelsfoundindeveloping the CMRwassomehowhighercom- pare withthecurrentsurvey, however, respectively. No baselinedata tocom- rates were0.41and0.93/10,000/day Health: ous category. the levelofmalnutritionfellintoseri- trition aggravatingfactorsintheworeda, Taking intoaccountpresenceofmalnu- survey wasconductedinChifraworeda. compare asthiswasthefirsttime and girlswasnoted.Nobaselinedata to No significantdifference amongboys programmeinChifraworeda. OTP was underestimatedandrecommended pected thattheSAMbasedonWHZ was about-1WHZscore,ENCUsus- mean Z-scoreofthestudypopulation gramme. Consideringthattheoverall pro- eligible foradmissionintheOTP WHZ SAMresults noasinglechildwas weight forheightZ-score.Basedonthe 1.6 percent)thanthatwasestimatedby MUAC <11cm wasfivetimeshigher(at severe acutemalnutritionestimatedby case wasreported.Ontheotherhand cent, respectively. Noasingleoedema SAM wasestimatedat11.1 and0.3per- Nutrition: Afar DPPB. Children UKincollaborationwiththe vey wasconductedbySavethe within a90daysrecallperiod. The sur- was gatheredfrom2622individuals sampled andinformationonmortality dren agedbetween6-59monthswas total of639chil- methodology. A SMART conducted inChifraworedausingthe 21x30clusternutritionsurveywas A AFAR REGION ZONE ONE Chifra Woreda The crudeandunderfivedeath The prevalenceofGAMand vey intheworeda andthusitwasnot was ofconcern. This wasthefirstsur- in SAMestimatedbyWHZ andMUAC and Sphere Standard. The bigdifference based onthenationalcategorization the woredawasclassified asserious Conclusion: conflict around Awash River. livestock migrationwascausingsome da informedthesurveyteamthat, woreda. The administrationinthewore- the worstinlastfiveyears good pasture. 2007wasdescribed as Hebru, Mille, Aura and Teru insearchfor Warebabo (southWollo zone)and the woredatootherareaslike Herds oflivestockweremigratingfrom wheat reported tobestable withexceptionof poor animalconditions.Foodpriceswas same periodin2006becauseofthe decreased by50percentcompared to stock experts. Livestockpriceshad were describedasaveragebythelive- great problemandanimalconditions At thetimeofsurveypasture wasa Samsum primaryschool. drop outof95percentwasreportedin affected schoolattendanceandunusual drought wasalsoreportedtohave riorate forthreetofourweeksmore. The ed tobepoorandwasexpecteddete- Generally thefoodsecuritywasreport- complete failureof from poorperformanceof effect ofrecurrentdroughts resulting livestock werethreatenedbycumulative livestock andits products. Unfortunately woreda livelihooddependsmainlyon Livelihood/Food Security: compared withthenationalaverage. was 54.1percentstillconsideredlow coverage cent (8.9percent).Vitamin A extremely lowtrailingatbelow10per- coverage confirmedbyscarwas measles wasabout47percent.BCG Immunization coverageasestimatedby respectively. responsible forabout24and23percent 40 percentwhile AWD andcoughwere ed illnesses,feveraccountedforabove ENCU June30,2007 Page8 The nutritionalstatus in Sugum Karma Chifra rains. and results of August 2006. pared totheprevioussurvey been onthehighersidecom- critical andfoundtohave 15.7 percentwasclassified as The levelsofmalnutrition of Elkere andHargele Woredas ENCU SOMALI REGION crude mortality rate was Health: Somali regionsispresented in Table 5. and foodsecuritysituations in Afar and summaryof nutrition,health as critical. A The levelsofmalnutritionwere classified interpretation andnatureoftheincrease. ferent seasonstherebyconfoundingthe two surveyswereconductedindif- that wasreportedin August 2006. The compared levelsofGAM10.5percent April 2007hadincreasedsignificantly The levelsofmalnutritionreportedin 3123. wasestimatedtobe ding figureforSFP nutrition serviceswhilethecorrespon- under fivechildrenneededSC/OTP Based onsurveyresults atotal of190 girls. NoOedemacaseswerereported. els ofmalnutritionbetweenboysand percent. Nosignificantdifference inlev- 15.7 percentwhileSAMwaslowat0.9 Nutrition: death rates. to estimatethecrudeandunderfive collected from2085individualsinorder on mortality within90daysofrecallwas aged 6-59monthswas459.Information methodology. Samplesizeforchildren and April 2007usingtheSMART woredas bytheSCUKbetweenMarch conducted inErkaleandHargele 15x30clusternutritionsurveywas A AFDER AND LIBENZONE Sugum Normalization dependedmuchonthe security hadstarted beenstretched. was anindicationthathouseholdfood meals perdayasacoppingstrategy to bemade.Reductionofnumber worsen furtherifnointerventionswere Food securityprospectwasexpectedto intervention. SC/OTP cussing with Afar authoritiestostart the recommended aswell.IMCwasdis- programmewas individuals. SC/OTP for1555 food assistance fromDPPA strengthened. The region alsoasked ventions wererecommendedtobe andEOSinter- and deathrate.PSNP possible tocompare bothmalnutrition Elkare andHargeleWoredas (rains inJune) Based onthe surveyresults The prevalenceofGAMwas woredas in Afar andSomaliregions. tions undertaken inthesurveyed below showsfoodandnutrition interven- in theworedawereexpected. Table 6 2006 andimprovedpasture andharvest reported tobebettercompared with ban andotherreasons. Valley Feveranimal andmeatexport reliable marketforlivestockduetoRift to havebeendecreased. There wereno However, milkforchildren wasreported areas withrelativelygoodpasture. conditions wereexplainedasaveragein Gu described aspoorresultingfrom security inthetwoworedaswas Livelihood/Food Security: veys. woreda waslowinbothroundsofsur- Generally immunizationcoverageinthe supplementation. EOS vitamin A months hadpassed sincetheprevious the timeofsurveymorethansix programme atsixmonthsinterval.By plementation isprovidedthroughEOS sup- explained bythefactthatvitamin A April 2007. The difference couldbe cent in August 2006to19percentin decreased significantlyfrom42.5per- supplementation five percent.Vitamin A 38.3 percentwhileBCGwasjustabove averages. Measlescoveragestoodat woredas werefarbelowthenational programme forimmunizationinthetwo lowed bycoughandfever. Expanded continued tobetoponmorbiditylistfol- 30.5 percentin August 2006.Diarrhoea with aslightincreasecompared tothe ing thesurveywasabout40percent The overallmorbiditytwoweekspreced- between twosurveys. objective comparison oftheresults in explained earlierseasonalitylimits especially inElkareworeda. As reported tohaveledseveraldeaths was likelytobedue AWD thatwas increased. The increaseddeathrate that ofunderfivehadconsiderably the CMRhadslightlydecreasedwhile Compared tothe August 2006findings, tries andSubSaharan Africa. gency thresholdfordevelopingcoun- fied asseriousandpassed theemer- death rateamongunderfivewasclassi- the nationalguideline,levelsof ty ratewas2.2/10,000/day. According to 0.57/10,000/day. The underfivemortali- rains ornoharvestin2006. Animal ENCU June30,2007 Page9 Deyr rains were The food However, before the nutrition survey was conducted Islamic Relief implemented SFP in 10 sites (5 in Elkare and 5 in Hargele) in the two woredas. It was suspected that the coverage of the SFP was inadequate.

Conclusion: The levels of malnutrition of 15.7 percent was classified as critical and found to have been on the higher side compared to the previous survey. Mortality among under five children had also passed the emergency threshold level whose large part was likely explained by AWD. It was recommended to closely monitor the situation following relatively high levels of morbidity especially AWD coupled with deteriorating trend of food security.

Table 5: Survey Results for Afar and Somali Region Afar Somali Zone one Afder zone Key indicators Chefera Elkare and Hargele May 29-7 June March 26-7 April % GAM in Z-scores (95% CI) 11.1 (8.2-14.0) 15.7(11.6-19.8) % SAM n Z-scores (95% CI) 0.3 (0.0-0.7) 0.9 (0.0-1.9) % Kwashiorkor 0.0 0.0 CMR Death/10,000/day (95% CI) 0.41(0.12-0.69) 0.57 (0.24-0.91) U5MR Death/10,000/day (95% CI) 0.93(0.14-1.72) 2.23 (0.0-4.5) Major causes of U5MR NR * AWD % Morbidity 13.6 (CI: NR) 40.1(29.9-50.3) Major illnesses or symptoms Diarrhoea, ARI, Fever Diarrhea, ARI & Fever % Measles coverage by card (95% CI) 0.0 0.2(0.0-0.7) % Measles coverage by card + recall (95% CI) 47.1(36.2-58.1 38.3 (26.5-50.1) % BCG coverage (scar) (95% CI) 8.9 (4.5-13.3) 5.2(1.3-9.1) % Vitamin A in past 6 months (95% CI) 54.1(43.3-65.1) 19.0 (8.2-29.7)

* Not Reported

Table 6: Food and Nutrition Interventions in Surveyed Woredas of Afar and Somali Afar Somali Zone One Afder zone Chefera Elkare Hargele Estimated population size 89,505 40,192 74,182 Estimated Under Five population 17,901 8,038 14836

Productive Safety Net – No of beneficiaries 30,000 No No % of rural population 33.5 0.0 0.0

Food Aid Jan-June 07 – No of beneficiaries No No No % of rural population 0.0 0.0 0.0

EOS- Screening April 2007 NO NO No of children acutely malnourished* 2,517 NO NO As a % of screened children 21.0 0.0 0.0

Therapeutic Feeding Unit No No No

Outreach Therapeutic Programme No No No * MUAC below 12.0 cm and/or oedema

ENCU June 30, 2007 Page 10 lence ofacute malnutrition. icant difference in thepreva- livelihood zoneswithnosignif- considered normalinall the The nutritionsituationwas IRYREGION TIGRAY ENCU reported. mation onwater andsanitation was ing from62.9to79.7percent. Noinfor- age forBCGwasaboveaverage rang- est (88.2to94.6percent)and thecover- + recall)coveragewasone ofthehigh- respectively. Measlesvaccination(card and 0.14to0.86deaths/10,000/day were normalrangingfrom0.04to0.33 reported. BoththeCMRandU5MR and coughingwerethemajorillnesses least oneormoreillnesses.Diarrhea one outofthreechildrensuffered fromat from 27.7to45.5percent.Onaverage Health: not available. hood basis,data for comparison were previous surveysconductedonliveli- underestimated. Sincetherewereno tion inthesezonesmighthavebeen then theprevalenceofacutemalnutri- will benochangesinthefinalanalysis, slightly belowthecutoff points. Ifthere results ofsixlivelihoodzoneswere tion ofweight-for-heightinthesurvey however, surprisingthatstandard devia- prevalence ofacutemalnutrition.Itwas with nosignificantdifference inthe ered normalinallthelivelihoodzones line thenutritionsituationwasconsid- tively. According tothenationalguide- 5.1 to9.9and0.11.1percentrespec- Malnutrition inthe8zonesrangedfrom Acute MalnutritionandSevere Acute Nutrition: ried outintheeightlivelihoodzones. the summaryfindingsofsurveyscar- the preliminaryreports. Table 6presents and hencethefindingsbelowarefrom eight surveyswerestillbeingprepared piling thisbulletinthefinalreports forall Werei CatchmentLZ. At thetimeofcom- Central TeffMiddle TekezeLZ, and LZ LZ, CentralMixedCropWest Enderta DrymidlandLZ,RayaValley Highland LZ,Easternplateau zones coveredincluded Atsbi Wenberta done around2006/2007. The livelihood lished livelihoodzones,whichwere information followingthenewlyestab- tive wastogatherbaselinenutrition regional ENCU/DPPB. The mainobjec- were conductedin Tigray regionby eight standardized nutritionsurveys In thesecondquarterof2007,atotal of REGION TIGRAY Morbidity inchildrenranged The prevalenceofGlobal hunger season. around August toSeptember duringthe tional status wasexpectedtodeteriorate toring wasrecommendedasthenutri- withclosemoni- andEOS/TSFP PSNP insecure. Continuationoftheexisting zones aredescribedaschronicallyfood an areawheremostofthelivelihood typical inthepostharvestperiodand 5.1 to9.9percentGAMwasfoundbe Conclusion: in Table8. the surveyedlivelihoodsassummarized ventions respectively, implementedin units werethefoodandnutritioninter- andtherapeuticfeeding chase. PSNP holds getmostoftheirfoodthroughpur- is depletedandduringwhichhouse- hunger seasonwhenthe June toSeptembermarksthepeak ment fromPSNP. The periodbetween 30 percentoftheirannualfoodrequire- the poor. The poorhouseholdsearn10- rated asthemainsourcesofincomefor andwagelabourwere holds whilePSNP sources ofincomeforbetteroff house- The livestocksalesareimportant grammes. andEOSpro- the beneficiariesofPSNP erratic rainfall. All livelihoodzoneswere good foodsecurityifnotaffected by LZs weregenerallyconsideredtohave However, RayaVally andWest Central poor soilfertilityanderraticrailfall. insecurity duetoextensivedegradation, eight werereportedtohavechronicfood production. Sixlivelihoodzonesoutof mixed farmingwithcropandlivestock els vary, alllivelihoodzonespractice ends upinSeptember. Though thelev- keremt zones arepredominantlydependingon agricultural activitiesinmostofthese Integration Unit/DPPA, 2006/2007. The Profiles developedbyLivelihood extracted fromthe Tigray Livelihood incorporated inthisbulletinhasbeen mation onlivelihoodandfoodsecurity Livelihood/Food Security: ENCU June30,2007 Page11 rain whichstarts inJuneand The nutritionsituationwith meher The infor- harvest Table 7: Survey Results for Tigray Central & North Western, Eastern & Central and North Western Eastern zone Southern Southern zone Central & Central zone Southern Zone & Central zones zones Southern zone

Key indicators Atsbi wenberta Enderta Central mixed West central Werie Catchment Middle Tekeze Highland LZ Eastern plateau LZ drymidland LZ Raya valley LZ crop LZ Teff LZ LZ LZ 26 March - 04-18 April 26 March - 11-19 April 26 March - 23 April - 05-15 May 19-26 May 04 April 03 April 05 April 01 May

% GAM in Z-scores (95% CI) 6.8 (5.0-8.6) 6.3 (4.6-8.0) 6.8 (5.0-8.5) 5.1 (3.5-6.8) 9.9 (7.5-12.2) 9.1 (6.5-11.6) 8.0 (6.1-9.9) 8.2 (6.3-10.0)

% SAM n Z-scores (95% CI) 1.1 (0.4-1.8) 0.1 (0.0-0.4) o.2 (0.0-0.4) 0.2 (0.0-0.4) 0.1 (0.0-0.4) 0.4 (0.0-0.9) 0.5 (0.0-1.1) 0.5 (0.0-1.0)

% Kwashiorkor 0.2 0.1 0.2 0.2 0.0 0.0 0.3

CMR Death/10,000/day (95% CI) 0.29 (0.02-0.56) 0.33 (0.13-0.53) 0.07 (0.0-0.14) 0.25 (0.05-0.46) 0.08 (0.02-0.14) 0.04 (0.0-0.14) 0.16 (0.03-0.28) 0.17 (0.0-0.49)

U5MR Death//10,000/day (95% CI) 0.86 (-0.94-2.66) 0.26 (0.0-0.98) 0.14 (0.0-0.3) 0.32 (0.03-0.62) 0.19 (0.0-0.4) 0.20 (0.0-0.77) 0.33 (0.0-0.83) 0.21 (0.0-0.74)

Diarrhoea & Diarrhoea & Major causes of U5MR NR * NR NR NR NR NR Cough Cough

% Morbidity 45.5 30.2 41.5 27.7 30 27.3 29.5 31.1

Diarrhoea & Diarrhoea & Cough & Diarrhoea & Diarrhoea & Diarrhoea & Diarrhoea & Major illnesses or symptoms Fever Cough Cough Fever Cough Cough Cough Cough

% Measles coverage by card (95% CI) 60.3 (55.3-65.3) 69.67 (67.0-73.5) 39.2 (CI: NR) 18.7 (CI: NR) 43.6 (CI: NR) 56.4 (52.8-60.10 54.6 (49.5-59.6) 61.5 (58.0-65.0)

% Measles coverage by card+ recall (95% CI) 92.9 (89.3-95.4) 93.4% (78.0- 83.0) 88.2 (86 - 91) 91.0 (72.0 - 79.0) 94.5 (93.0 - 96.0) 94.6 (92.9-96.2) 94.6 (91.7-96.5) 92.1 (88.8-94.5)

% BCG coverage (scar) (95% CI) 77.8 (72.8-82.8) 79.65 (75.2-83.4) 64.5 (CI: NR) 62.85 (CI: NR) 68.6 (CI: NR) 66.1% (62.5-69.60 68.8 (63.9-73.3 73.3 (68.7-77.7) * Not Reported Table 8: Food and Nutrition Interventions in Surveyed Woredas of Tigray North Central & Western, Central and Southern Eastern & North Western & Eastern zone Southern Central & Southern zone Central zone Central zones zones Southern Zone zone Atsbi Central Werie Eastern Enderta Raya valley Middle wenberta mixed crop West central Teff LZ Catchment plateau LZ drymidland LZ LZ Tekeze LZ Highland LZ LZ LZ Estimated population size 104,747 422,556 400,297 204,547 342,291 403,291 384,561 199,673 Estimated Under Five population 20,949 84,511 80,059 40,909 68,458 80,658 76,912 39,935

Productive Safety Net – No of beneficiaries 61,818 222,764 194,913 99,496 149,007 63,250 119,059 82,925 % of rural population 59.0 53.0 49.0 48.6 44.0 16.0 31.0 41.5

-June 07 – No of beneficiaries No No No No No No No No % of rural population 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

EOS Screening June 2007 June 2007 June 2007 June 2007 June 2007 June 2007 June 2007 June 2007 No of children acutely malnourished* 2,467 7,818 5,855 3,502 3,608 4,744 6,294 3,288 As a % of screened children 15.0 15.0 10.0 10.0 8.0 7.4 10.1 10.8

Yes Yes Yes Axum HC Yes Yes Yes Yes Yes Adigrat HS Therapeutic Feeding Unit Adigrat HS Tahtay Maychew HC Samre HC Abi Adi HS Freweni HC Samare HC Alamata HS Adwa HS Freweni HC Shire MCH Abi Adi HS Axum HS Axum HS Shire HS

Yes Outreach Therapeutic Programme No No No No No No No Gov * MUAC below 12.0 cm and/or oedema

ENCU June 30, 2007 Page 12 ENCU FROM NUTRITIONSURVEYS DATA CHECKOF ANTHROPOMETRY QUALITY of the16surveys. percent. There wasnosexbiasinany to 62percentclosetheexpected51 group, (30-59months)liedbetween52 the likely49percentwhileolderage lied between38to48percentclose the youngeragegroup(6-29months) surveys presentedinthisbulletinwhere was nosignificantagebiasinthe16 months) inthedevelopingworld. There 2000) forthetarget children(6-59 ical demographicdistribution(WHO age andsexascompared withthetyp- samples werenotbiasedintermsof were checkedtoverifywhetherthe graphic profilesofthesurveysamples peaked WHZdistribution. kurtosis indicativeof a relatively Aleta Wondo CLZexhibitedapositive veys, i.e.Hargele&Elkere andDale& show kurtosisproblemwhile twosur- tion. Fourteenofthesurveys didnot metrical astobeinthenormaldistribu- tion ofWHZforeachsurveywassym- minus oneindicatingthatthedistribu- within theacceptable rangeofplusor surveys hadamomentofskewness raw data. ment errorandorovercleaningofthe of WHZ,whichmightbeduetomeasur- from Tigray regiondisplayedalowSD Surprisingly sixoutofeightsurveys within theplausiblerangeof0.8-1.2. z-scores of10surveysout16fell standard deviationofweight-for-height the data qualityinclude: table 9.Theindicatorsusedtocheck checked. The results arepresentedin ric data ofthenutritionsurveyswas thequalityofanthropomet- SMART Using theNutrisurveysoftware for this bulletin. erence forall16surveyspresentedin that therewasnosignificantdigitpref- and heightmeasurements indicated bution ofthefinaldecimalforweight ments: Bias inchildrenselection: Moment ofSkewness&Kurtosis: Bias inweight&heightmeasure- Standard DeviationofWHZ: The qualitycheckonthedistri- The demo- The All tion surveys. gation andperhaps conductingvalida- is anareathatrequiresfurtherinvesti- than theotherindicatorsandhencethis exhibition oflowSDismorecommon lence ofglobalacutemalnutrition. The were likelytounderestimatethepreva- that showedalowSDofWHZwhich except sixsurveysconductedin Tigray with thequalitycheckstandard criteria Conclusion: ENCU June30,2007 Page13 All surveyswereinline Table 9: Results of Survey Quality Check for the Second Quarter Digit preference Representative ness of the sample Skewness of Kurtosis of No. 0f WHZ Agency Woreda SD of WHZ Age group Distribution Sex Weight Height WHZ WHZ flags (%) (in months) (%) Ratio

6-29 46.8 Islamic Relief/SCUK Hargele & Elkere No No 0.91 0.61 1.81* 0.65 1.1 30-59 53.2

6-29 42.4 SCUK Chifera No No 0.87 0.38 0.53 0 1.1 30-59 57.6

6-29 44.1 SC-UK Melka Bello No No 0.81 0.04 0.45 0.28 0.9 30-59 55.9

6-29 45.4 SC-UK Meta Robi/Adea Berga No No 0.85 0.11 -0.16 0 1.0 30-59 54.6

6-29 46.7 SC-UK Abuna Gendeberet No No 0.84 0.18 -0.15 0 0.9 30-59 53.3

6-29 46.0 GOAL Silti No No 0.80 0.06 0.000 0 1.0 30-59 54.0

6-29 38.0 SNNPRENCU/Muti-agency Bona No No 0.91 -0.11 0.02 0 0.9 30-59 62.0

6-29 43.7 Tigray ENCU/DPPB Estern Plateau LZ No No 0.72** 0.09 0.09 0% 1.1 30-59 56.3

6-29 42.7 Tigray ENCU/DPPB Western Centeral LZ No No 0.76** 0.27 0.24 0% 1.0 30-59 57.3

6-29 48.3 Tigray ENCU/DPPB Raya vally LZ No No 0.76** -0.00 -0.23 0% 1.0 30-59 51.7

6-29 42.2 Tigray ENCU/DPPB Central mixed crop LZ No No 0.75** 0.21 0.18 0 1.0 30-59 57.8

6-29 46.0 Tigray ENCU/DPPB Enderta Dry Midland LZ No No 0.79** 0.16 0.27 0.15 1.1 30-59 54.0 6-29 42.3 Tigray ENCU/DPPB Astebi Womberta Highland LZ No No 0.83 0.23 0.59 0.16 1.1 30-59 57.7 6-29 44.3 Tigray ENCU/DPPB Middle Tekeze LZ No No 0.78** 0.15 0.03 0 1.0 30-59 55.7 6-29 44.5 Tigray ENCU/DPPB Werei Cathment LZ No No 0.80 0.08 -0.15 0 1.1 30-59 55.5 6-29 40.6 ACF Dale & Aleta Wondo CLZ No No 0.98 0.51 1.29 * 0.45 0.9 30-59 59.4 * Kurtosis Problem ** Low SD of WHZ

ENCU June 30, 2007 Page 14 ENCU URTO UVYDATABASE NUTRITION SURVEY

June 2007arekeptatENCUdata base. conducted. Rawdata andfinalreports ofthesesurveysexceptfewconducted April- refugee camps. Since2000toJune2007atotal of443standard nutritionsurveyswere and since 2000.Itdoesnotincludesurveysconductedinresettlementareas,IDP Table 10presents thenumberofstandardized nutritionsurveysconductedinEthiopia PROGRAMMES NUTRITION INTERVENTION PERFORMANCE OFEMERGENCY Standards. recommended bythenationalEmergency NutritionGuidelines andtheSphere results. The table belowsummarizes TFPs performance basedonselectedindicators nutrition interventionsinvarious woredainEthiopiabasedon2006and2007 survey Between JanuaryandJune 2007severalpartners wereimplementing emergency and implementeddepending onthelevelsofmalnutritionandaggravatingfactors. Following nutritionassessments, emergencynutritioninterventions arerecommended AAQAIYCHECKOFEOSMUACSCREENING QUALITY DATA were madeandre-submitted. revisited andeventuallycorrections process anddata compilationwere result, followuponthescreening authorities andotherstakeholders. As a positively receivedbytheregional regional level.Sofarthefeedbackwas ENCU totheDPPBandRHBat and vided jointlybyUNICEF, WFP Feedback onthedata qualitywaspro- ing womenthanchildren. malnutrition amongpregnantandlactat- severe and,highprevalenceofacute ished childrenbothmoderateand summation, unusuallevelsofmalnour- lems identifiedincluded:compilation, woredas implementingEOS.Mainprob- EOS MUACscreeningdata fromallthe conducting data qualitychecksforthe Beginning ofMay2007,ENCUhasbeen Table10: Numberofsurveysperregionandyear

Benshangul

Gambella Gambella

Region

Amhara Amhara Gumez

Oromia SNNPR Somali Somali Harare Tigray

Total Afar Afar

2000 25 0 0 0 0 0 8 5 3 9

2001 21 0 0 0 0 0 5 9 2 5

2002 94 24 20 35 0 0 0 4 6 5

2003 91 17 27 30 0 0 0 5 7 5

Year tions. tive decisionmakingontheinterven- ty oftheEOSdata forfasterandeffec- reduce weaknessandincreasereliabili- agreed criteriawilltoagreatextent holders. Itishopedthatthecommonly agreed andcommunicatedtoallstake- ing data. The criteriawillbediscussed, quality checkoftheEOSMUACscreen- developing a"standard criteria"forthe Currently ENCUisintheprocessof due poordata quality. delays ininterventionsthatmayresult and accountable fortheresults, and reminds themthattheyareresponsible data arebeingcheckedandsecond, als conductingthescreeningthat the regional,zone,woredaandindividu- back hadtwoadvantages. Firstalerts that qualitycheckandprovisionoffeed- UNICEF, WFP, MOHandENCUfound 2004 57 22 14

0 0 0 1 3 8 9

ENCU June30,2007 Page15 2005 72 11 20 25 0 0 0 6 3 7

2006 56 12 14 20 0 0 0 4 0 6

2007 27 1 0 0 1 8 2 2 4 9

Total 443 112 147 21 27 56 79 1 0 0

Table11: Performances of TFPs implemented by humanitarian agencies in Ethiopia (January - June 2007)

Type of Total Total Coverage Death Defaulter Agency Woreda Time Frame Recovery (%) Programme Admission Exits (%) Rate (%) Rate (%)

CONCERN Kalu Jan-May TFP 435 267 NA* 230 (86.1) 4.1 5.2

Dessie CONCERN Jan-May TFP 390 234 NA 190 (81.2) 2.6 7 Zuria MSF-Holland Humera Jan- Apr TFP 25 21 NA 16 (76.2) 9.5 14.3 MSF Holland Abdurafi Jan-Apr TFP 20 20 NA 18 (90) 5.0 0 Aleta ACF Jan-May TFP 492 458 NA 345 (75.3) 0.0 6 Wondo ACF Dale Jan.-March TFP 177 401 NA 293 (73.1) 0.0 6.9 MSF-Greece Addisamen Jan.-May TFP 231 251 NA 196 (78.1) 11.2 8.4 GOAL Derashe Apr-May TFP 111 30 98 28(93.3) 6.1 0 ADRA Kerafo Jan-Jun TFP 956 644 77.7 587(91.1) 1.7 6.1 Kedida WVE Jan-June TFP 212 117 NA 111(94.9) 2.5 4.3 Gamela WVE Damboya Jan-June TFP 421 229 NA 221(96.5) 1.3 2.2 WVE Durame Jan-June TFP 21 12 NA 11 (91.7) 0.0 8.3 SC US** Bona June-July TFP 319 79 75.2 41 (51.9) 0.0 0 Gondar Jan.-May TFP 115 115 NA 95 (82.6) 3.5 11.3 Hiwot Fana Jan.-May TFP 163 160 NA 98 (61.2) 3.1 16.2 Hospital Total 4028 3038 NA 2480 (81.6) 2.6 6.5

* Not available ** 29.1% of the total discharge were transfer out, while non-response was 1.3% up to 1st week of July. The information presented in Table 11 were submited by partners and from UNICEF data base. tions feeding programmes in Ethiopia is From Table 11 above it is clear that the calculating the coverage of the feeding performance of most of TFP implement- programmes. As it can be seen from the ed in the various woredas in terms of Table 11 above, only three (ADRA, recovery, death and defaulter rates were GOAL and SC US) out of seven agen- all impressive. All the indicators were cies were able to provide information on above the recommended Sphere coverage. Standard cut off points except in Bona woreda where the low cure rate was The other challenge is submission of mainly due to high transfer rate of 29.1 monthly TFP performance reports. percent. According to UNICEF data base dating back from 2003 to 2006 only 52% of the As a result of high recovery rate, out of reports were completed. 3038 children that were discharged from TFPs in the mentioned woredas, 2480 of ENCU calls upon all partners first, to them equivalent to 81.6 percent were consider and estimate the coverage of cured. In other words, these children the feeding programmes before inter- were saved from further nutritional sta- ventions commences as recommended tus deterioration and possibly death. in Sphere Standards and national guide- Overall death and defaulter rates in the lines. Second, partners should submit TFPs was generally low summarized at monthly feeding performance reports 2.6 and 6.5 percent respectively, both based on the national format throughout falling within the national and Sphere the feeding programme life. Standards recommended levels.

ENCU One major challenge in the implementa- tion of the emergency nutrition interven- ENCU June 30, 2007 Page 16 UPDATE ON THE PROGRESS OF NUTRITION CLUSTER ROLL OUT IN ETHIOPIA

After the Inter-Agency Standing formed. The core group has 29 mem- Committee (IASC) generic Terms of bers from nine NGOs (ACF, CONCERN, Reference (TOR) on the cluster CARE, GOAL, IMC, SC-UK, SC-US, approach was distributed globally, the WVE and VALID); three government Ethiopian government in collaboration institutions (DPPA, EHNRI, FMoH) and with humanitarian agencies reviewed four UN agencies (UNICEF, UNHCR, and approved the cluster approach roll WFP and WHO). The main tasks of the out in March 2007. UN level cluster core group include: preparing the nutri- leads in collaboration with government tion cluster TOR, action and contingency sector lead were required by the UN plans, identify gaps and recommend OCHA to coordinate the roll out of each ways for filling the gaps. The group respective cluster. On part of the UN agreed to meet weekly until its tasks are system, UNICEF is the cluster lead for completed. nutrition, water and sanitation. By the end of June 2007 the nutrition Coordination is critical for the successful cluster TOR were being finalized and and effective cluster roll out. UNICEF would be circulated to all MANTF mem- the nutrition cluster lead through ENCU bers for information and final comments had an advantage of having an already before send to the government for existing Mult-Agency Nutrition Task endorsement and UN OCHA for refer- Force (MANTF). This forum brings ence. together all stakeholders working in emergency nutrition in Ethiopia. The nutrition cluster approach provides a unique opportunity for streamlining An Adhoc MANTF meeting was held and decision making with respect to emer- members briefed about the need of the gency nutrition assessments and cluster approach and how it would work. responses. Let all stakeholders use the Since MANTF members are more than opportunity optimally. 100 participants, a small group called "nutrition cluster core group" was

SUMMARY FINDINGS OF THE MUAC, WFH AND BODY-SHAPE RESEARCH STUDY ENCU with funds from UNICEF con- were collected by SC-UK from Amhara tracted a consultant to conduct a and Somali regions. Data from Afar research in May 2006, looking at the region were provided by courtesy of relationship between MUAC, WHZ and CONCERN. A comparative analysis body shape (sitting to standing height between agrarian and pastoralist was ration) in agrarian and pastoralist popu- then undertaken using data from 1481 lations of Ethiopia. The principal reason and 2741 children respectively. to undertake the study was the discor- dance observed between the preva- The study findings confirmed the lence estimates returned by WHZ and hypothesis and showed that: MUAC case-definitions during nutrition surveys undertaken in Somali region. SSR (Sitting height to Standing height Ratio) differed between the populations The study investigated the hypothesis surveyed with pastoralists tending to that a portion of this observed discrep- have significantly lower SSR values ancy between the prevalence estimates (longer legs/shorter trunks) than agrari- returned by WHZ and MUAC case-defi- ans. nitions was due to differences in body- WHZ and WHZ case-status were sig- shape in older or taller children (i.e. age nificantly associated with body-shape 24 months or height 85 cm) between (SSR) in both pastoralist and agrarians agrarian and pastoralist populations. regardless of which reference popula- Data on sitting height along with stan- tion (NCHS or WHO) was used to calcu- dard anthropometric measurements late WHZ.

ENCU June 30, 2007 Page 17 ENCU members, Nutrition Technical Working The reportwassharedwithMANTF and analyzesuchsurveys. that willenablepartners toundertake of developingamethodandguidelines vey methodsusingMUACwiththeaim ing anoperationalresearchintothesur- The studyalsorecommendedconduct- lence ofacuteundernutritioninsurveys. preference ofWHZforestimatingpreva- The studyrecommendedusingMUACin in theagrariangroup. shape, butnosignificantbiaswasnoted toralist group,unlesscorrectedbybody- lence estimateswhenusedinthepas- introduced anupwardsbiasinpreva- It wasconcludedthattheuseofWHZ standard case-definitionwasdetected. shape inbothgroups. definition wasnotassociatedwithbody- shape inbothgroups whileMUACcase- SSR values. pastoralist groupbecauseofthesmaller groups, theeffect beinglargerinthe mate prevalenceofmalnutritioninboth WHZ case-definitionwastooveresti- MUAC wasalsoassociatedwithbody- No effect ofthebody-shapeonMUAC The effect ofbody-shapeforstandard request fromENCU. research reportisavailableupon agree onthewayforward. The full ings shouldbefurtherdiscussedand Members recommendedthatthefind- June 2007monthlyMANTFmeeting. Group (NTWG)andpresentedinthe ENCU June30,2007 Page18