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Meyu Muluke Woreda, ETHIOPIA July 19Th to 29Th 2013 Inés ZUZA

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Meyu Muluke Woreda, ETHIOPIA July 19Th to 29Th 2013 Inés ZUZA Meyu Muluke woreda, ETHIOPIA th th July 19 to 29 2013 Inés ZUZA SANTACILIA ACKNOWLEDGEMENTS International Medical Corps (IMC) and Coverage Monitoring Network extend its deep gratitude to all those who have contributed to this study including: the authorities in Meyu Muluke woreda (district) and East Hararghe province (Oromia Region), Ethiopia and to all the health personnel and village residents for their hospitality and cooperation. Avery special thanks to the mothers and caregivers of severely acute malnourished children. A very special thanks to the IMC team in Harar, to the Nutrition Officer (ALMAZ TASISA) for his support coordinating the SQUEAC at field level and for his contribution on the improvement of this report. Thanks you to the IMC team in Addis Ababa; the National Nutrition Manager-IMC (Beka TESHOME) for his collaboration. Thank you to the Federal Ministry of Health (MoH) for their zeal, support and motivation. The East Hararghe Nutrition Focal Person (Mesfin WORKU) for his support during the Harar training. To the Nutrition Focal Person (Daniel SISAY), the Extended Program of Immunization Focal Person (Iskender Mohamed), the Nutritional Survey Field Worker (Abdulahi AHMED) and the TB/HIV Focal Person (Ashenafi DOLEBO) in Meyu Muluke woreda. Thank you also to Ezana TESFAYE ZEMO from the Autralian MoH for all his support and commitment with the SQUEAC. This study would not have been possible without the hard work and commitment of everyone involved. Lastly, thank you to the Office of Foreign Disaster Assistance (OFDA) through GOAL for financing this project. 2 EXECUTIVE SUMMARY Meyu Muluke woreda (district) is one of the 19 woredas in East Hararghe province in the Oromia Zone of Ethiopia. It is composed of approximately 124 villages (divided into 19 kebeles) and an estimated population of 54,496 inhabitants (14.8 % of children between 6 and 59 months). The Dinkas and Luo tribes are the predominant ethnic group inhabiting Meyu Muluke woreda. Communities are pastoralist and agro pastoralist who continue to face food insecurity from re-occurring drought and subsequent livestock losses. International Medical Corps (IMC) was running a program to contribute to the reduction of morbidity and mortality related to acute malnutrition and improves nutrition practices in three woredas (Meyu Muluke, Kumbi, and Fedis) in East Hararghe Zone from January to July 2013. IMC has been working in food-insecure woredas of East Haraghe Zone since 2005, responding to the emergency nutrition needs. In Ethiopia, the nutrition services are delivered by the MoH. In July 2013 there were 13 OTP sites functioning in the Meyu Muluke woreda. The other six OTPs were having security problems. There are also three stabilization centres. Since the beginning of 2012 the MoH has created the Health Development Army (HDA). It is a team of community-level volunteers engaged in screening and mobilizing children under 5 and pregnant and lactating women. They can detect cases of a defined number of diseases (including malnutrition) and refer them to the health facilities. There is one HDA per 4 households. The Health Extensions Workers are formal salaried workers within the health system. They provide treatment for Severe Acute Malnutrition (SAM) as part of a Health Extension Program. Regarding the nutritional situation, no data of Meyu Muluke woreda is was available for the previous years. But data from Midega Tolla woreda, the nearest woreda available data (East Hararge Zone) in November 2012 was available the Global Acute Malnutrition and SAM rates which were respectively 10.0 % (7.4 -13.3 95% C.I.) and 0.2 % (0.0 -1.3 95% C.I.). Resume of coverage assessment The coverage assessment was conducted to evaluate access and coverage of the Community based Management of Acute Malnutrition programme for children aged 6 to 59 months with SAM. It was conducted between July 19th and 29th 2013 and it was the first of its kind for the area. It was conducted at the beginning of the rainy season and the Ramadan. 3 The SQUEAC methodology used consisted of 3 stages, applying the principles of triangulation (by source and method) and sampling to redundancy. The coverage investigation conducted in Meyu Muluke woreda showed a period coverage of 90.5% (95% IC: 81.6% - 99.4%) The table below presents the main barriers on which the program must act to improve coverage as well as specific recommendations how to do so: Barriers Recommendations - Long distances 1. Advocacy on including the WHO standards in - Previous Rejection the national guidelines - Stigma (mother ashamed) 2. Implement mechanism to reduce impact of the - Wrong Admission and Discharge distance and inaccessibility Criteria (MUAC at discharge < 110) 3. Strengthen community sensitization - Insecurity 4. Reinforce supervision and improve data quality and follow up 5. Think over IMC strategy during the periods of no programme implementation / sustainability 6. Repeat the SQUEAC in six months or one year // before IMC support 4 CONTENTS 1. INTRODUCTION ......................................................................................................................... 7 1.1 CONTEXT ......................................................................................................................... 7 1.2 International Medical Corps in Meyu Muluke woreda ............................................ 11 2. OBJECTIVES.............................................................................................................................. 13 3. METHODOLOGY ..................................................................................................................... 14 3.1. GENERAL OVERVIEW ................................................................................................... 14 3.2. STAGES ........................................................................................................................... 15 3.3. ORGANIZATION OF THE EVALUATION....................................................................... 20 3.4. LIMITATIONS ................................................................................................................ 21 4. RESULTS ................................................................................................................................. 22 4.1. STAGE 1 .......................................................................................................................... 22 4.1.1. Quantitative data analysis ........................................................................................ 22 4.1.2. Qualitative data analysis ........................................................................................... 30 4.2. STAGE 2 .......................................................................................................................... 31 4.3. STAGE 3 .......................................................................................................................... 33 A. The prior .................................................................................................................... 33 B. The likelihood ........................................................................................................... 34 C. The posterior ............................................................................................................ 35 5. DISCUSION ............................................................................................................................. 38 6. RECOMMENDATIONS .............................................................................................................. 41 Annex 1 : Survey questionnaire for current SAM children NOT in the program ......................... 44 Annex 2: Meyu Muluke wereda SQUEAC plan, July 2013 ............................................................. 45 Annex 3 : SQUEAC Survey team .................................................................................................... 46 Annex 4 : Terminology in Oromifa used to describe malnutrition and RUTF. Meyu Muluke woreda. Ethiopia. SQUEAC July 2013. ........................................................................................... 47 Annex 5: Weighted BBQ, Meyu Muluke woreda SQUEAC, Ethiopia. July 2013 ............................ 48 5 ABBREVIATIONS BBQ Barriers, Boosters and Questions CI Credible Interval CHD County Health Department CMAM Community based Management of Acute Malnutrition CMN Coverage Monitoring Network CSAS Centric Systematic Area Sampling EPI Expanded Program on Immunization FDA Food Distribution Agents GAM Global Acute Malnutrition HC Health Centers HDA Health Development Army HF Health Facility HP Health Post IMC International Medical Corps INGO International Non-Governmental Organisation LoS Length of Stay LP Land Preparation MAM Moderate Acute Malnutrition MoH Ministry of Health MUAC Mid-Upper Arm Circumference ODPPC Oromia Disaster Prevention and Preparedness Commission OFDA Office of Foreign Disaster Assistance OTP Outpatient Therapeutic Programme RHB Regional Health Bureau RUTF Ready to Use Therapeutic Food SAM Severe Acute Malnutrition SC Stabilization Centre SFP Supplementary Feeding Program SSI Semi Structure Interview SQUEAC Semi Quantitative Evaluation of Access and Coverage TSFP Targeted Supplementary Feeding Programmes UNICEF United Nations Children’s Fund WHO World Health Organisation 6 1. INTRODUCTION 1.1 CONTEXT 4.1.1. Overview of the area Meyu Muluke woreda (district) is one of the 19 woredas in East Hararghe province
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