Technical Series Report No VI. 30 February 22, 2010

Nutrition Situation Post Deyr ‘09 /10

Food Security and Nutrition Analysis Unit - Somalia Box 1230, Village Market Nairobi, Kenya Tel: 254-20-4000000 Fax: 254-20-4000555 Website: www.fsnau.org Email: [email protected]

Technical and Funding Agencies Managerial Support

European Commission FSNAU Technical Series Report No VI. 30 ii Issued February 22 2010 Acknowledgement

FSNAU would like to thank all partner agencies for their participation and support in the Deyr ’09/10 seasonal nutrition assessments and analysis. From October until December 2009, a total of 36 nutrition surveys were conducted, 80 health centres visited and nearly 5,300 children measured in rapid urban assessments. Without the support and expertise of 18 local NGOs, 10 International NGOs, 2 Local Authorities and 3 UN agencies, this would not have been possible. A sincere note of appreciation also goes to the FSNAU nutrition team based in Somalia and Nairobi who work under such difficult conditions yet continue to produce such high quality professional work.

Participating Partners United Nations Children’s Fund (Unicef), World Food Programme (WFP), World Health Orga- nization (WHO), Ministry of Health (MOH), Ministry of Health and Labour (MOHL), World Vision, International Medical Corps (IMC), Merlin, Gedo Health Consortium (GHC), Muslim Aid – UK, Co-operative Di Svillupo International (COSV), Save the Children UK, Mercy USA, Intersos, Medair, Somalia Red Crescent Society (SRCS), Degares, Green Hope, African Muslim Aid (AMA), African Rescue Committee (AFREC), Himilo Relief and Development Association (HIRDA), Zam Zam Foundation, Community Organization, SACOD, Somali Aid Foundation (SAF), Economic Independent Research Group (EIRG), Juba Foundation, WRRS, RAHO, JCC, MVDO, PCDDO, Inter-care development Association (ICDA).

Mahad Sanid

FSNAU Technical Series Report No VI. 25 iii Issued February 22 2010 TABLE OF CONTENTS 1. EXECUTIVE SUMMARY 1

2. DEVELOPMENT OF CASELOADS OF ACUTELY MALNOURISHED CHILDREN IN SOMAILA 6

3. NUTRITION ANALYSIS IN SOMALIA 8

4. REGIONAL NUTRITION ANALYSIS 10 4.1 Gedo Region 10 4.2 Lower and Middle Juba Regions 14 4.3 Bay and Bakool Regions 17 4.4 Lower and Middle Shabelle Regions 21 4.6 Hiran Region 25 4.5 Central Regions 28 4.7 Northeast Regions 32 4.8 Northwest Regions 38 4.9 Urban Nutrition analysis 47

5. GUIDELINES ON THE USE OF PLAUSIBILITY CHECKS 49

6. Summary of Nutrition Survey Findings, Oct. - Dec. ‘09 51

7. APPENDICES 54 7.1 Progression of Estimated Nutrition Situation Deyr 06/07 - Deyr ’09 54 7.2 Nutrition Assessment Tools Post Deyr ‘09 56 73: Somalia Livelihood Zones 69

LIST OF TABLES

Table 1: Timeline of activities for Deyr 2009 Nutrition Situation Analysis 2 Table 2: Somalia Integrated Food Security Phase Classification, Population Numbers, January - June 2010 5 Table 3: Nutrition Situation Categorisation Framework 8 Table 4: Summary of Key Nutrition Findings in Gedo Region 12 Table 5: Summary of Key Nutrition Findings in Middle and Lower Juba Regions 16 Table 6: Summary of Key Nutrition Findings in Bay and Bakool Regions 20 Table 7: Summary of Key Nutrition Findings in Middle and Lower Shabelle Region 23 Table 8: Summary of Key Nutrition Findings in Hiran Region 27 Table 9: Summary of Key Nutrition Findings in Central Regions 31 Table 10: Summary of Key Nutrition Findings in Golis, Nugal valley and Coastal Deeh 34 Table 11: Summary of Key Nutrition Findings in Sool Plateau in Northeast 35 Table 12: Summary of Key Nutrition Findings in IDPs-Northeast Regions 36 Table 13: Summary of Results Sool plateau and Golis Livelihood Zones 40 Table 14: Summary of Key Nutrition Findings in Hawd of Sool Hargeisa and Livelihood Zones 42 Table 15: Summary of Key Nutrition Findings in Togdheer Region Livelihood Zones 44 Table 16: Summary of Key Nutrition Findings Agropastoral of Adwal and Galbeed 45 Table 17: Summary of Key Nutrition Findings of the North West IDPs Hargeisa, Burao and Berbera 46 Table 18: Summary of Key Findings, Rapid Urban Nutrition Assessments, Nov. - Dec. ‘09 48 Table 19: Plausibility Checks 50 Table 20: Summary of Nutrition Survey Findings, Oct. - Decc. ‘09 51

FSNAU Technical Series Report No VI. 30 iv Issued February 22 2010 LIST OF MAPS

Map 1: Estimated Nutrition Situation, Jan. - Jun. 2010 3 Map 2: Somalia Integrated Food Security Phase Classification, Rural Populations, Jan. - Jun. 2010 5 Map 3: Estimated Caseloads of Acute Malnutrition, Jan. - June 2010 7 Map 4: Gedo Region Livelihood Zones 10 Map 5: Juba Regions Livelihood Zones 14 Map 6: Bay and Bakool Regions Livelihood Zones 17 Map 7: Shabelle Livelihood Zones 21 Map 8: HiranRegion Livelihood Zones 25 Map 9: Central: Livelihood Zones 28 Map 10: Northeast Livelihood Zones 32 Map 11: Northwest Livelihood Zones 38

LIST OF FIGURES

Figure 1: Global Acute and Severe Acute Malnutrition Deyr ’09 (Oct. - Dec.) WHOGS <-2WHZ & <-3WHZ and /or oedema 1 Figure 2: Median Rates of Global Acute Malnutrition, Deyr ’09 3 Figure 3: Median Rates of Stunting & Underweight, Deyr ’09 3 Figure 4: Trends in levels of Acute Malnutrition (WHZ<-2 or oedema, WHO 2006) in Gedo Region , 2002-2009 10 Figure 5: Trends in levels of Acute Malnutrition (WHZ <-2Z scores or oedema,WHO 2006) in Juba Regions 2003 – 2009 14 Figure 6: Acute Watery Diarrhea cases in Juba Regions as reported in Somalia Health Cluster Bulletin Dec.‘09 15 Figure 7: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Bakool region 2002- 2009 17 Figure 8: Trend in levels of acute malnutrition (WHZ< -2 or oedema , WHO 2006) in Bay region 2002- 2009 18 Figure 9: Bay agro-pastoral SFP admission, 2008 - 2009 19 Figure 10: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Shabelle region 2002- 2009 22 Figure 11: HIS Trends in % of Malnutrition children repoting, Mogadishu MCHs, 2008 - 2009 24 Figure 12: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Hiran region 2002- 2009 ) 26 Figure 13: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Central region 2002- 2009 30 Figure 14: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Northeast region 2002- 2009 33 Figure 15: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Northeast IDPs 2002 - 2009 35 Figure 16: Admissions rates to Bossaso Stabilization centre Jan. - Dec. 2009 36 Figure 17: Trend in levels of acute malnutrition (WHZ< -2 or oedema, (WHO 2006) in Northwest region 2002- 2009 38 Figure 18: Trends in proportion of acutely Malnutrition Children attending MCH in Sool Plateau , Jan-Dec. 2009 39 Figure 19: HIS Malnutrition Trends in East Golis/ Gebbi Valley Pastoral MCHs - Jan 2008- Dec 2009 41 Figure 20: HIS Malnutrition trends in Nugal Valley Pastoral MCHs, Jan 2008- Dec 2009 42

SPECIAL ARTICLES

CDC Probability Calculator – FSNAU Experience 13 The Relationship between Gender Roles and the Nutritional Status of a Population 37 Coping Strategies Index (CSI) 53

FSNAU Technical Series Report No VI. 25 v Issued February 22 2010 LIST OF ACRONYMS

AWD Acute Watery Diarrhea ARI Acute Respiratory Tract Infections ACF Action Contre La Faim AFLC Acute Food and Livelihood Crisis BFI Borderline Food Insecure CDC Center for disease control CMAM Community Management of Acute Malnutrition CMR Crude Mortality Rate (Retrospective) COSV Co-operatione Di Svillupo International CTC Community Therapeutic Care Deyr Short Rainy Season (October - December). FAO Food and Agricultural Organization of the United Nations FSNAU Food Security and Nutrition Analysis Unit FEWSNET Famine Early Warning System Network GAM Global Acute Malnutrition GHC Gedo Health Consortium Gu Long Rainy Season (April - June) HAZ Height for Age Z Scores HE Humanitarian Emergency HIS Health Information System IDP Internally Displaced persons LZ Livelihood Zone MCH Maternal and Child Health Center MOH Ministry of Health MOHL Ministry of Health and Labour MT Metric Tonne MUAC Mid Upper Arm Circumference NCHS National Center for Health Statistics NGO Non Governmental Organization OTP Out patient Therapeutic Programme Pr Probability PWA Post War Average SAM Severe Acute Malnutrition SRCS Somalia Red Crescent Societies SD Standard Deviation SFP Selective/Supplementary Feeding Program U5MR Under Five Mortality Rate (Retrospective) WAZ Weght for Age Z Scores WHO World Health Organization of the United Nations WFP World Food Program of the United Nations WHZ Weight for Height Z Scores

FSNAU Technical Series Report No VI. 30 vi Issued February 22 2010 Forward

The FSNAU Post Deyr ‘09/10 Technical Series report (February 2010) is the third edition of the bi-annual nutrition situation technical series launched by the Food Security and Nutrition Analysis Unit (FSNAU) in February 2009. The publication complements the FSNAU biannual seasonal technical series reports and provides specific focus on nutrition information for the last 6 months.

The FSNAU Post Deyr ’09/10 Technical Series report will be released in the coming weeks and provides a detailed analysis by region and by sector, of the integrated food security situation.

FSNAU Technical Series Report No VI. 25 vii Issued February 22 2010 FSNAU Technical Series Report No VI. 30 viii Issued February 22 2010 1. Executive Summary

An integrated analysis of the nutrition information from July to December 2009 indicates a varied yet alarming situation throughout the country (Map 1). Civil insecurity in Mogadishu, Juba, Hiran and Central regions of Somalia leading to on-going population displacement, the persistent and severe drought conditions in Central and Hiran regions1, and parts of the northwest region and the continuing elevated commodity prices, remain the key driving factors in the current analysis. Major contributing factors to the chronic nutrition crisis are the high disease burden, exacerbated by limited access to health services, safe water and sanitation facilities, and sub optimal infant and young child feeding practices. Access to safe water and sanitation facilities in rural areas of Somalia remains unacceptably low at 19.1% and 35% respectively, although this does vary by region, mainly due to reliance of households on safer trucked water in the drought affected regions. Access to health services is also of great concern with many carers, choosing instead, damaging and sometimes dangerous alternatives to conventional health care through traditional means. Further, increasing availability of breast milk substitutes and feeding bottles are creating a hazard on children’s lives, resulting in very low exclusive breastfeeding rates and increased exposure to pathogens. Therefore, unless a concerted effort is made to address all these factors, in addition to enhancing house food security and livelihoods, sustained improvements in the nutrition situation will not be realised.

FSNAU and partners conducted a total of 36 representative nutrition surveys in October to December 2009 (Table 1 for Timeline). Of these, and referring to the WHO Growth Standards, 16 reported rates of global acute malnutrition (GAM) <15%, 12 reported rates in the 15-20% range, with the remaining 8 reporting rates >20%. The median rate of global acute malnutrition (GAM) for all the 36 surveys was 16%, a decrease from 19% from the last round of comparable surveys. Rates of severe acute malnutrition remain high in executive summary many parts, with a median rate of 4.2% for all 36 surveys. When applying the national median rate of 16% for GAM and 4.2% for SAM (WHO Growth Standards), this translates into an estimated 240,000 acutely malnourished children, of whom 63,000 are severely malnourished, representing 1 in 6 and 1 in 22, of all children under 5 Poor infant and young child feeding practices, including years in Somalia. This national rate has indicated a slight bottle-feeding in deplorable conditions is a predisposing reduction from the Gu six month ago, where 19% GAM factor to diarrhea and malnutrition, FSNAU, Dec. 2009 and 4.5% SAM were reported predominantly due to some improvement in northern regions. For South and Central Somalia, however, median rates remain unchanged in 6 months at 19% GAM and 4.5% SAM with 81% of the Somali caseload of acutely malnourished children in South and Central regions, the area’s most affected by insecurity and limited humanitarian space (see Figures 1,2 and 3).

In general, crude and under five years mortality rates, Figure 1: Global Acute and Severe Acute Malnutrition remained below the respective emergency thresholds of Deyr ’09/10 (Oct - Dec) WHOGS <-2WHZ & 2 and 4 deaths per 10,000 population per day, with the <-3WHZ and /or oedema exception of Alert levels (CMR of 1-2/10,000day and U5MR of 2-4/10,000/day) reported in 3 surveys (Afgoye IDPs, Juba pastoral and the Hawd pastoral of Central regions). A summary of the key findings are presented below, with detailed analysis by region and livelihood within the upcoming Post Deyr Nutrition Technical Series, due mid February 2010 presented later in this publication.

South & Central regions: The sustained Critical and Very Critical nutrition situation in most parts of South and Central Somalia continues to highlight the impact of years of civil war on the population’s ability to deal with shocks1. The widespread lack of access to appropriate health service, safe water and improved sanitation further increase the risk of disease, and many common childhood illnesses can be fatal.

Acute Watery Diarrhoea (AWD) was again reported this season in several regions and is likely a major contributor to the high levels of acute malnutrition reported, particular in Juba regions. In spite of this year being a bumper harvest in parts, it has yet to translate into improved nutritional status as children are fed a predominantly cereal and oil based diet, missing the essential micronutrients and proteins essential for health, growth and development.

1 There is slight improvement in the Cowpea belt, the agricultural area in Central regions.

FSNAU Technical Series Report No VI. 25 1 Issued February 22 2010 As mentioned earlier the highest levels Table 1. Timeline of activities for Deyr 2009 Nutrition Situation Analysis of acute malnutrition are reported NUTRITION SURVEYS DEYR 2009/2010 PERIOD I. in South Central at 19% GAM and Livelihood Zone/Population Assessed 1 Togdheer Agro-pastoral Oct-Nov’09 4.5% SAM compared to the national 2 Togdheer Pastoral Oct-Nov’09 rate of 16% GAM and 4.2% SAM. 3 West Golis Pastoral Dec’09 4 Northwest Agro-pastoral Dec’09 Further, the very high stunting of 5 Sool Plateau (Northwest) Dec’09 22% in the South and Central 6 Hawd of Sool/Galbeed Pastoral (Northwest) Dec’09 7 East Golis Pastoral (Northwest) Dec’09 regions, unchanged from 6 months, 8 Nugal Valley Pastoral (Northwest) Dec’09 yet compared to the 14% and 9 Sool Plateau (Northeast) Dec’09 10 Coastal Deeh (Northeast) Dec’09 11% reported in the northwest and 11 Golis/Kakaar Pastoral (Northeast) Dec’09 northeast respectively, continues to 12 Nugal Valley Pastoral (Northeast) Dec’09 13 Hawd Pastoral (Central) Oct-Nov’09 illustrate the chronic nature of this 14 Addun Pastoral (Central) Oct-Nov’09 crisis. Currently with the reducing 15 Mudug Region Oct-Nov’09 16 Galgadud Region Oct-Nov’09 humanitarian space, access to 17 Hiran Pastoral Oct-Nov’09 nutritional rehabilitation services is 18 Hiran Agro-pastoral Oct-Nov’09 19 Hiran Riverine Oct-Nov’09 also a limiting factor to recovery and 20 Shabelle Pastoral Dec’09 the nutrition situation here remains 21 Shabelle Riverine Dec’09 22 Bay Agro-pastoral Dec’09 in crisis, with a poor outlook for the 23 Bakool Pastoral Dec’09 coming months. (Figure 1). 24 Bakool Agro-pastoral Dec’09 25 Gedo Pastoral Dec’09 26 Gedo Agro-pastoral Dec’09 Northern regions 27 Gedo Riverine Dec’09 28 Juba Pastoral Dec’09 In the northwest regions, there is a 29 Juba Agro-pastoral Dec’09 mixed picture in the nutrition situation 30 Juba Riverine Dec’09 31 Hargeisa IDP Dec’09 with notable recovery to Alert from 32 Burao IDP Dec’09 the previous Serious situation in the 33 Berbera IDP Dec’09 34 Bossaso IDP Dec’09 western Golis Guban, Northwest 35 Galcayo IDP Dec’09 Agropastoralists and Sool Plateau of 36 Afgoi IDP Dec’09 Sanag as a result of in migration of II. HEALTH FACILITY REVISITS/HIS DATA Jan-Dec’09 III. RAPID URBAN NUTRITION ASSESSMENTS Dec’09 livestock and the subsequent increased IV. FSNAU & PARTNERS NUTRITION ANALYSIS Jan 11th-20th, 2010 access to milk. Humanitarian support V. FSNAU INTERNAL NUTRITION SITUATION REVIEW Jan 19th, 2010 has also improved since July 2009. VI. NUTRITION SITUATION VETTING MEETING WITH PARTNERS Jan 25th, 2010 st Similar conditions are experienced VII. FSNAU PRESS RELEASE Feb 1 , 2010 VIII. FSNAU FOOD SECURITY AND NUTRITION BRIEF RELEASE Feb 12th, 2010 in the Hawd of Togdheer pastoralists, FSNAU POST DEYR 09/10 NUTRITION TECHNICAL IX. Feb 22th 2010 with the nutrition situation having SERIES REPORT RELEASE improved to Serious from Critical. The Toghdeer agropastoralists remain in a Critical nutrition phase mainly due to persistent poor access to water and food insecurity as a result of four season of crop failure. Given the population density, even without Very Critical rates of acute malnutrition, 13% of all acutely malnourished Somali children reside in the executive summary northwest, therefore integrated efforts to meet their needs are key. In the northeast regions, analysis of the nutrition situation is also providing a mixed picture, though with general improvement from 6 months ago. Serious rates of acute malnutrition are now being reported in East Golis, Guban & Karkaar and Nugal Valley, from Critical in July 2009; while Alert rates are reported in Sool Plateau, from Serious in July 2009. The sustained Critical rates in the Hawd and Addun highlight the concerning nutrition situation and the elevated needs in the northeast. It is estimated that 3% (excluding the IDPs in the region, also at 3%) of all acutely malnourished children in Somalia reside in the northeast regions.

IDPS The IDPs continue to be a nutritionally vulnerable group, even in areas of relative peace and improved access in the northern regions. The median GAM rate at 16.7% and SAM rate of 5.0% are slightly higher than the national rates of 16.0% and SAM rate of 4.2%. However the median rates of global acute malnutrition in the IDPs have shown some improvement from the 20% GAM reported during the Gu ’09. This is mostly due to improvement in the situation in Bossaso, where, although rates are still unacceptably high at 17.4%, this is the first year in the last 6 years, that levels below 20% are reported. Stunting, however, is continuing to be a specific concern, where, compared to the national rate of 20%, in the IDPS the rate is 25%, meaning 1 in 4 children not being able to reach their full developmental potential. The window of opportunity for reversal of stunting is up to 2 years, so efforts focused on integrated health and nutrition programmes are key for these children. Of note also is the situation in the Afgoye IDPs where a slight deterioration has been reported with recent surveys reporting a GAM rate of 15.9% and SAM rate of 5.5%, up from 11.7% and 3.5% reported in the Gu. Galkayo also is of great concern with Very Critical rates of GAM of 23.7% and SAM of 6.3% reported in December. Response agencies in the area also currently report very high numbers of severely malnourished children being admitted into the selective feeding programmes. Based on the above highlighted aggravating factors, coupled with the prevailing insecurity which limits humanitarian access, the nutrition vulnerability is likely to persist and potentially deteriorate unless a combination of emergency nutrition interventions, adequate integrated humanitarian response and capacity strengthening of current and new nutrition stakeholders is undertaken alongside improved humanitarian access.

FSNAU Technical Series Report No VI. 30 2 Issued February 22 2010 Map 1: Nutrition Situation Estimates, January 2010 executive summary

Figure 2: Median Rates of Global and Severe Acute Figure 3: Median Rates of Stunting & Underweight Malnutrition (WHO GS) - Deyr 2009/2010 (WHO GS) - Deyr 2009/2010

30 Total Stunting Total Underweight 25

20

% 15

10

5

0 Total (Inc IDP) Total (Excl IDP) IDP NW NE South Central (Excl IDP)

FSNAU Technical Series Report No VI. 25 3 Issued February 22 2010 Food Security Overview

The findings of the FSNAU, FEWSNET and partners post Deyr ‘09/10 seasonal assessment confirms that a wide- spread Humanitarian Crisis still persists in Somalia, with 42% of the population or estimated 3.2 million people in need of emergency humanitarian assistance and/or livelihood support until June 2010. The results indicate that, although there are some positive indicators in terms of the lifting of the livestock export ban and improved crop and livestock production in southern parts of the country, the food security and nutrition situation in central regions remains in crisis, where 70% of the population require assistance. The situation is exacerbated by escalating conflict and displacements, creating a double burden for drought affected populations in central regions, having to support those recently displaced yet with reduced access to assistance from aid agencies due to the insecurity.

The people currently in crisis include 1.25 million rural people affected by drought, 580,000 urban people who struggle with very high food and non-food prices, and 1.39 million internally displaced people (IDPs) who are flee- ing from the conflict (Maps 2 and Table 2).

Sustained Humanitarian Emergency in Central and Hiran The epicentre of the humanitarian crisis continues to be in Mudug, Galgadud and Hiran regions of south and central Somalia due to the ongoing drought and civil unrest, which has left 70% of the populations in those regions in Crisis. In these regions, livestock herds have been decimated due to 6 consecutive seasons of below average rainfall and destitute pastoralists are gathering in main villages and towns in search of assistance. In order for these populations to recover, a combination of expanded lifesaving and livelihood support is required urgently at scale.

Internally Displaced People - the Largest Population Group in Crisis Internally Displaced Populations (IDPs) continue to be the largest single population group in crisis, representing 43% of the total 3.2 million, and with the ongoing conflict in the country this number is likely to continue to remain high and even increase further. Most of the IDPs, are concentrated in south and central Somalia.

Deepening Drought and Humanitarian Emergency in Parts of the North Of particular concern are the populations in crisis in the north, the result of a drought following 4 seasons of below average rainfall. This has left 290,000 pastoral and agropastoral populations in crisis and in need of both life saving and livelihood support to recover. Sool Plateau of Sanaag region and Togdheer Agropastoral livelihood zones that were identified inAcute Food and Livelihood Crisis (AFLC) with High Risk to Humanitarian Emergency (HE) during Gu ’09 have deteriorated to Humanitarian Emergency. Fortunately, humanitarian access to these regions is good, therefore it is essential for agencies to extend the much needed life saving and/or livelihood support interventions to the population in these areas to prevent further deterioration.

executive summary Indications of Improvement in Food Security for the Urban Poor The overall food security situation in urban areas has shown some improvement, with a significant proportion of poor households continuing to struggle to meet their basic food needs. Humanitarian crisis for the urban poor persists in central regions as well as in parts of the North, while there are some indications of improvement in the Northwest and parts of the South. Currently 580,000 urban populations are in crisis. This is a slight decline from the figure of 655,000 in the Post Gu ’09. Out of the total population in crisis, about 465,000 people are in AFLC and about 115,000 are in HE. Food access for these people is constrained by persisting, high food prices, low income opportunities, the presence of large number of IDPs and shrinking humanitarian support in parts.

Good Crop Production and Improving Food Security in the South There are good indications for agricultural areas in the South, where a positive harvest was received in this Deyr, which is 121% of the Deyr Post-War Average (1999 – 2008). The overall cereal production in southern Somalia is estimated to be the highest Deyr cereal harvest in the last seven Deyr seasons. Cash crop production is also significant and off-season cereal production is expected in March in Juba regions. Food access improved for most farmers in Bay, who received a bumper sorghum harvest this year, as well as for the farmers in Juba regions, Bakool Agropastoral and others. This has resulted in a reduction of the rural population in crisis by 15% from 6 months ago.

Integrated Food Security Phase Classification Maps Table 2 provides the estimated number and proportion of the population (UNDP 2005 figures) categorized to be in Acute Food and Livelihood Crisis or Humanitarian Emergency by region. For more information, refer to the Food Security and Nutrition Brief, February 12, 2010 available at http://www.fsnau.org/fileadmin/uploads/1648.pdf ; and the upcoming Technical Series Report Post Deyr ‘09/10 Analysis at http://www.fsnau.org or contact FSNAU: info@ fsnau.org.

FSNAU Technical Series Report No VI. 30 4 Issued February 22 2010 Map 2: Somalia Integrated Food Security Phase Classification, Rural Populations, July - Dec. ‘09 executive summary

Table 2: Somalia Integrated Food Security Phase Classification,Population Numbers, January - June, 2010 Urban in Rural in Acute UNDP 2005 UNDP 2005 UNDP 2005 Total in AFLC and Acute Food and Food and Urban in Humanitarian Rural Humanitarian Region Total Urban Rural HE as % of Total Livelihood Crisis Livelihood Crisis Emergency (HE)2 Emergency (HE)2 Population1 Population1 Population1 population (AFLC)2 (AFLC)2 North Awdal 305,455 110,942 194,513 5,000 20,000 0 0 8 Woqooyi Galbeed 700,345 490,432 209,913 0 30,000 0 0 4 Togdheer 402,295 123,402 278,893 50,000 75,000 0 5,000 32 Sanaag 270,367 56,079 214,288 25,000 60,000 5,000 20,000 41 Sool 150,277 39,134 111,143 15,000 35,000 5,000 5,000 40 Bari3 367,638 179,633 202,737 80,000 0 25,000 0 29 Nugaal 145,341 54,749 75,860 25,000 25,000 0 15,000 45 Sub-total 2,341,718 1,054,371 1,287,347 200,000 245,000 35,000 45,000 22 Central Mudug 350,099 94,405 255,694 35,000 90,000 0 100,000 64 Galgaduud 330,057 58,977 271,080 20,000 65,000 10,000 155,000 76 Sub-total 680,156 153,382 526,774 55,000 155,000 10,000 255,000 70 South Hiraan 329,811 69,113 260,698 25,000 50,000 5,000 160,000 73 Shabelle Dhexe (Middle) 514,901 95,831 419,070 25,000 135,000 0 35,000 38 Shabelle Hoose (Lower) 850,651 172,714 677,937 35,000 15,000 10,000 0 7 Bakool 310,627 61,438 249,189 25,000 70,000 0 25,000 39 Bay 620,562 126,813 493,749 25,000 5,000 0 0 5 Gedo 328,378 81,302 247,076 30,000 40,000 0 20,000 27 Juba Dhexe (Middle) 238,877 54,739 184,138 5,000 0 0 0 2 Juba Hoose (Lower) 385,790 124,682 261,108 10,000 0 0 0 3 Sub-total 3,579,597 786,632 2,792,965 180,000 315,000 15,000 240,000 21 Banadir 901,183 901,183 - 30,000 - 55,000 9 Grand Total 7,502,654 2,895,568 4,607,086 465,000 715,000 115,000 540,000 24

Assessed and Contingency Population in AFLC and HE Number affected % of Total population Distribution of populations in crisis Assessed Urban population in AFLC and HE 580,000 85 18% Assessed Rural population in AFLC and HE 1,255,000 175 39% Estimated number of new IDPs-updated January 29, 2010 (UNHCR) 1,115,0004 155 35% Estimated number of protracted IDPs 275,0004 45 8% Estimated Rural, Urban and IDP population in crisis 3,225,000 435 100.0%

(Endnotes) 1 Source: Population Estimates by Region/District, UNDP Somalia, August 1, 2005. FSNAU does not round these population estimates as they are the official estimates provided by UNDP 2 Estimated numbers are rounded to the nearest five thousand, based on resident population not considering current or anticipated migration, and are inclusive of population in High Risk ofAFLC or HE for purposes of planning 3 Dan Gorayo is included within Bari Region following precedent set in population data prior to UNDP/WHO 2005 4 Source UN-OCHA/UNHCR: New IDP updated January 29, 2010 rounded to the nearest 5,000. Protracted IDP revised from UN-OCHA/UNHCR estimate (previously 400,000) following the new IDP movement which included protracted IDP (February 2008). Total IDP estimates are based on Population Movement Tracking data which is not designed to collect long-term cummulative IDP data 5 Percent of total population of Somalia estimated at 7,502,654 (UNDP/WHO 2005)

FSNAU Technical Series Report No VI. 25 5 Issued February 22 2010 2. Development of Caseloads of Acutely Malnourished Children in Somaila

FSNAU, in collaboration with nutrition cluster partners, in 2008 began to illustrate, cartographically, the distribution of estimates of acutely malnourished children in Somalia. The objective being to highlight to response agencies and donors the needs in different parts of the countries, and move away just from the situation analysis, to also consider the impact of population density in determining response needs.

Map 3 illustrates the total caseload based on the most recent nutrition assessments in a given area, and where recent survey data are not available; extrapolations are made using median rates specific to the region as appropriate. This has meant that the current map developed by FSNAU has estimated the caseload of malnourished children of 100% of the population from 6 months to 5 years in Somalia. Population figures from the UNDP 2005 settlement survey are used, as the standard reference for Somalia.

Map 3, therefore, illustrates the distribution of the total estimated caseload of acutely malnourished children and the regional importance, which relates to population density. To explain, the Deyr’09 nutrition cycles estimated approximately 240,000 children 6-59months as acutely malnourished of which 63,000 are severely malnourished in the total population. These figures are derived using the national median rate of 16% for global acute malnutrition and 4.2% as the median severe acute malnutrition rate, from the thirty six representative surveys conducted in October-December 2009.

The distributions of the 240,000 (100%) acutely malnourished children are illustrated in blue, and the distributions of the 63,000 (100%) severely acutely malnourished children are illustrated in red. For example 27% of the 240,000 acutely malnourished children reside in the Shabelle regions, followed by Central, Bay and the Northwest, each region with 13%. Apart from Bay, neither of these areas report a Very Critical nutrition situation (>20% GAM) yet due to the population density, the absolute numbers of acutely malnourished children are very significant. For the severely malnourished children, the regions hosting the majority are again the Shabelle at 35%, followed by Bay at 15% and Central regions at 11%. This, therefore, highlights that the focus should not just be on areas of Critical and Very Critical nutrition situation but also on the distribution of these cases.

The indicators used are based on the WHO Growth Standards 2006, <-2 WHZ and/or oedema for GAM and <-3 and/or oedema for SAM. FSNAU also computes the caseload by region and district using the WHO GS WHZ, and MUAC (<12.5cm, <11.5cm and <11cm). For more information please contact [email protected]. caseloads of acute malnutrition

A Rapid Diagnostic Test for Malaria, FSNAU, Elberde Dec. 09 Malaria is one of he contributing factors to acute malnutrition in south central regions of Somalia.

FSNAU Technical Series Report No VI. 30 6 Issued February 22 2010 Map 3: Estimated Caseloads of Acute Malnutrition July - December 2009 caseloads of acute malnutrition

FSNAU Technical Series Report No VI. 25 7 Issued February 22 2010 3. Nutrition Analysis in Somalia

The nutrition information component of the Food Security and Nutrition Analysis Unit has been operational in Somalia since 2000. From that time the nutrition project has been the main source of nutrition information in Somaila for response actors. In an effort to illustrate the nutrition situation in a manner helpful for response agencies and donors, the project has developed over the years, a format for analyzing the nutrition situation which results in a cartographical output. The development of this analysis framework, below, although led by the FSNAU Nutrition team, has also involved a consultative process with many nutrition partners in the region including, WHO, UNICEF, WFP, ACF, CONCERN, SCUK, IMC and WV. This came out of an identified need for a type of tool to describe the nutrition situation creating a contextual analysis, rather than focus on prevalence estimates and thresholds which is traditionally the case in nutrition analysis.

This framework forms the basis for the nutrition situation classification and theEstimated Nutrition Situation map and is based on international thresholds, where available, and contextually relevant analysis where not available. There are three sections to the analysis framework, A. Core/ Anthropometry Related Information, Biochemical indicators Biological and C. Risk/Underlying Factors. A minimum of 2 anthropometric indicators are required to make an analysis with the supporting non anthropometric indicators (Table 3). Information only from the current season is used and when sufficient data is not available, this is illustrated though slash marks on the map. However historical data is used for overall contextual and trends analysis.

Twice per year, in line with the seasonal assessments post Gu (April – June) and post Deyr (October-December), the nutrition team develops an updated nutrition situation analysis at livelihood level by region and by IDP settlement. The overall analysis is consolidated into the Estimated Nutrition Situation Map. The analysis framework, below, is considered a working document, and will be updated and refined as new information and guidance becomes available. The nutrition situation, presented by region over the coming pages has been developed using this framework.

Table 3: Nutrition Situation Categorisation Framework A. Core/Anthropometry Related Information Reference Indicators Acceptable Alert Serious Critical Very Critical 10 to<15% 15 to<20% >/=20% or Global Acute Malnutrition1 or where there has been (or where there has been (Or where there has 5 to <10% usual (WHO Reference) <5% a significant increase a significant increase from a significant increase range and stable from seasonally adjusted seasonally adjusted previous from seasonally adjusted previous surveys) surveys) previous surveys) 3 to <4% SAM2 (WHZ using NCHS – not 4 to <5% >/=5% applicable to WHOGS SAM) (or where there has been (Or where there has a (to be updated when global consensus <0.5% 0.5 to <3% a significant increase from larger significant increase nutrition analysis for new WHO Growth standards) seasonally adjusted previous from seasonally adjusted Oedema – proportion of cases, trends surveys) previous surveys) in numbers 1 to <2 /10,000/day 2 – 5/10,000/day CMR3/10,000/day Include information as to Include information as to Include information as to <0.5/10,000/day 0.5 to <1/10,000/day the main causes and likely the main causes and likely the main causes and likely progression progression progression Under five years mortality rates <1/10,000/day 1-1.99/10,000/day 2-3.9/10,000/day 4 to <10/10,000/day >/=10/10,000/day 10-14.9% >15% MUAC4 Assessment <5% with increase or where there has been a Or where there has a (% <12.5cm) from seasonally <5% 5-9.9% significant increase from significant increase from Ref: FSNAU Estimates 5To be adjusted previous seasonally adjusted rapid seasonally adjusted rapid confirmed rapid assessments assessments assessments Adult MUAC - Pregnant and Lactating women TBC – based on historical analysis from nutrition surveys conducted in Somalia – ongoing in FSNAU (% <23.0cm, Sphere 2004) Chronic malnutrition/ stunting6 <10% 10 to <20% 20 to <40% >40% (HAZ) Very low Low numbers of acutely High with significant Low numbers of numbers malnourished children High levels and stable numbers increasing numbers HIS7 Nutrition Trends acutely malnourished of acutely from previous months but of acutely malnourished in >2 rounds of acutely (Ref: HIS) for area and stable malnourished increasing in >2 rounds children’s (seasonally adjusted) malnourished children from (seasonally adjusted) children (seasonally adjusted) screening Sentinel8 Site Trends Low levels and one Increasing levels based on High levels of malnourished levels of children identified as acutely Very low and round indicating Increasing levels with two rounds (seasonally children and stable (seasonally malnourished (WHZ), Ref: FSNAU stable levels increase (seasonally increasing trend adjusted) adjusted) SSS adjusted)

B. Biochemical Indicators

Reference Indicators Acceptable Alert Serious Critical Very Critical

Vitamin A9 <2% >/=2 to 10 to <20% >/=20% Iron Deficiency Anaemia10 40%

Iodine11 (Median urinary iodine concentration in 100-199 50-99 20-49 <20 school age children mm/lt)

FSNAU Technical Series Report No VI. 30 8 Issued February 22 2010 C. Risk / Underlying Factors Reference Indicators Acceptable Alert Serious Critical Very Critical Poor dietary diversity12 for population <5% 5 to<10% 10 to <25% 25 to <50% >50% (<4 food groups) AWD 1 case Outbreak not contained and/or in non endemic area – limited Normal levels, access to treatment: Disease Outbreaks13: seasonally adjusted, Measles 1 case (seasonally adjusted) Review data in CFR for AWD >2% rural Frequency of reported outbreaks of AWD &, malaria relevant context Malaria – doubling of cases in a CFR for AWD >1% urban and measles, 2 week period in hyper endemic areas in the South – using AWD – duration exceed >6 wks RDT’s Generally Food Acute Food and Humanitarian Famine/ Humanitarian Food Security14 Situation - current IPC status Generally Food Insecure Secure Livelihoods Crisis Emergency Catastrophe <5% Meal Frequency15 in addition to breastfeeding >25% 20-25% 5-19.9% <20% i). 6-8 months old16 2-3 <2 ii). 9 months old & above 3-4 <3 Breastfeeding Practices17 90% and above 50-89% 12-49% 0-11% i). Exclusive BF for 6 mths ii). Complementary Feeding introduced at 6 months 95% and above 80-94% 60-79% 0-59% reference

Immunization & Vitamin A Supplementation >95% 80-94.9% Coverage18: <80% Measles– Campaigns <80% Vitamin A – one dose in last 6 months) Campaigns >95% 80-94.9% Population have access to a sufficient quantity of water for drinking, cooking and personal and 100% TBC TBC TBC TBC domestic hygiene – min 15lts/person/day Reduced access Limited access Affected pop with access to formal/informal Should not be Access to humanitarian to humanitarian to humanitarian Negligible or no access services: health services, etc Is this useful? necessary interventions for most vulnerable support for most support for majority vulnerable Selective Feeding 19 / Programmes Available Availability of therapeutic/ supplementary feeding Should not be

programmes/ services and referral systems. Access for most vulnerable None available nutrition analysis necessary Coverage – access to available services, coverage of availability of services – Is this useful? Prevailing structural Limited spread, Widespread, high Widespread, high Civil Insecurity Unstable disrupted tension peace low intensity intensity intensity Key Points: i) To make a statement on the nutrition situation, a minimum of two core indicators and two risk / underlying factors are recommend ensuring a reliable analysis. ii) The overall classification of the nutrition situation for a given area is done taking into account historical nutrition and contextual data. Triangulation of all indicators is also undertaken. iii) It is not necessary for all the indicators to fall into one category in fact this will rarely happen, the idea is to look at the bigger picture in terms of where the indicators are currently, where they have come from and where they are likely to go to make the overall statement of the situation. iv) Where possible nutrition information should be analysed at livelihood level and not at administrative level, this is the case in Somalia. v) The references or cut offs used for GAM, SAM, CMR and Immunization coverage are consistent with the international ranges. However, for many of the other indicators, agreed international ranges/ thresholds for each categorisation are lacking. As such, the various ranges have been developed following analysis of available nutrition data from Somalia. vi) Other contexts may need to refine certain indicators such as dietary diversity and MUAC, currently they are based on the meta analysis of historical data from FSNAU vii) Further inclusion of indicators relating to, displacement and population concentration for displacement are required. viii) The age of the data needs to be considered and ideally should be from the current season. If the data is from an earlier season this needs to be considered in the overall analysis, the reliability must be considered as it may affect the results. ix) This tool should only be used by nutrition experts who have the ability to critically evaluate and contextualize nutrition information (Footnotes) 1 Global Acute Malnutrition (weight for height <-2 Z score/oedema), WHO, 1995 2 Severe Acute Malnutrition (weight for height <-3 Z score/oedema), WHO, 1995, ENCE guidelines 3 Crude Mortality Rate, Refs: i). Sphere 2004; ii). Emergency Field Handbook (A guide for UNICEF staff, pg 139) July 2005 4 Mid Upper Arm Circumference, data source – rapid assessments, based on children 6-59 months 5 Follow up with S. Collins study/ Mike Golden/ Mark Myatt and on-going studies 6 WHO, 1995 7 Health Information System, data source – health facilities 8 Data source, over 120 sentinel sites in different livelihoods in South Central Somalia 9 WHO, 1996, Indicators for assessing Vitamin A deficiency and their application in monitoring and evaluating intervention programmes 10 WHO, 2001 11 WHO, 2001 12 Data source, nutrition surveys, dietary studies and sentinel sites 13 Data source, nutrition surveys, Health Information System, Sentinel sites, feeding centres, rapid assessments 14 Data source, FSNAU food security analysis 15 Data source, nutrition surveys and dietary studies 16 FANTA, 2003. Generating indicators of appropriate feeding of children 6 through 23 months from the KPC 2000+ WHO, 2003. Infant and Young child feeding. A tool for assessing national practices, policies and programmes 17 FANTA, 2003. Generating indicators of appropriate feeding of children 6 through 23 months from the KPC 2000+ WHO, 2003. Infant and Young child feeding. A tool for assessing national practices, policies and programmes 18 WHO references 19 Data source, 12 Therapeutic Feeding Centers and 14 Supplementary Feeding Centers

FSNAU Technical Series Report No VI. 25 9 Issued February 22 2010 SOMALIA: LIVELIHOOD ZONES

Calula

DJIBOUTI Gulf of Aden Qandala

Zeylac Bossaaso Lughaye AWDAL Ceerigaabo Las Qoray/Badhan Baki Berbera SANAG Iskushuban Borama Ceel Afweyne BARI Sheikh Gebiley W. GALBEED

Hargeysa Qardho Burco Owdweyne Xudun Caynabo Talex Bandar Beyla TOGDHEER SOOL

Laas Caanood Buuhoodle Garowe

Legend Eyl "/ NUGAL Country capital Burtinle International boundary

Regional boundary Jariiban ETHIOPIA Goldogob District boundary Galkacyo n a e River c O

Coastline n a Cadaado MUDUG i d Hobyo n Cabudwaaq I

4. REGIONAL NUTRITION ANALYSIS Dhusa Mareeb

4.1 Gedo Region GALGADUD Harardheere Gedo Region in south west Somalia comprises of six Map 4: Gedo Region Livelihood Zones Ceel Barde Beled Weyne districts; Luuq, Dolo, Belet Hawa, Garbaharey, El Wak, Ceel Bur and Bardera. The region has three main rural livelihood BAKOOL Livelihood zones Addun Pastoral: Mixed sheep & goats, camel zones namely; pastoral, agropastoral and riverine (Juba Rab-Dhuure HIIRAN Xudur Awdal border & coastal towns: Petty trading, fishing, salt mining riverine pump irrigation). The pastoral livelihood, Ceel Dheere further sub-divided into the Southern Inland and Dawa Dolo Central regions Agro-Pastoral: Cowpea, sheep & goats, camel, cattle Bulo Barde pastoralists, is the most predominant group accounting Luuq Wajid Tayeglow Coastal Deeh: Sheep for about 64% of the rural population in the region. The Dawo Pastoral: Shoats, cattle, camel Dawa Pastoral livelihood located in northern Gedo is the Aden Yabal Beled Hawa East Golis Pastoral: Frankinncense largest pastoral group in the region with mainly cattle, Jalalaqsi Baydhaba Cadale Fishing sheep and goats rearing. The Southern Inland Pastoral Garbaharey population is located in southern Gedo and mainly keep Jowhar M. SHABELLE Gagaab Pastoral: Frankincense camel alongside sheep. The agropastoral population is Guban Pastoral: Sheep, goats & camel Qansax Dheere Wanle Weyne divided into Southern agro-pastoral and Bay-Bakool high GEDO BAY Hawd Pastoral: Camel, sheep & goats potential agropastoralists. (Map 4) Hiran Agro-Pastoral Ceel Waq Balcad Bur Hakaba Hiran riverine: Sorghum, maize, cattle & shoats Gedo is one of the regions adversely affected by the Afgoye Juba pump irrigation: Tobacco, onions, maize cumulative effects of extended conflict and recurrent Baardheere Dinsor "/ BANADIR natural disasters. These have resulted in the disruption MOGADISHU Kakaar-Dharor Pastoral: Sheep, goats, camel

A Qoryoley L. & M. Shabelle Agro-Pastoral Irrigated: Maize/Sorghum & cattle of livelihood systems, including loss of livestock and Sakow Y Marka crop failure and culminated in a persistent emergency Kurtun Warrey L. & M. Shabelle Agro-Pastoral rain-fed: Maize,cowpeas, sesame & cattle

situation for large parts of the population. According to N M. JUBA Lower Juba Agro-Pastoral: Maize & cattle Sablale

the bi-annual FSNAU seasonal analysis, northern Gedo E L. SHABELLE North-West Agro-Pastoral: Sorghum, cattle Bu'aale has persistently faced a Humanitarian Emergency (HE) North-West Valley Agro-Pastoral: Irrigated vegetables, shoats

K Brava crisis since 2004. The situation in Northern Gedo Hagar Figure 4. Trends in levels of Acute Malnutrition (WHZ<-2 or Nugal Valley Pastoral: Sheep & camel has been attributed to climatic factors on one hand, oedema, WHO 2006) in Gedo Region , 2002-2009 Potato zone & vegetables where rain failure/drought has contributed to crop 30% Afmadow Jilib Shabelle riverine: Maize, fruits & vegetables failures and death of livestock, especially cattle 25% which are less drought resistant in nature; and on Sool-Sanag Plateau Pastoral: Camel, sheep & goats 20% the other hand, to humanitarian interventions in South-East Pastoral: Cattle, sheep & goats Jamaame the area which may have contributed to disruption 15% L. JUBA Southern Agro-Pastoral: Camel, cattle, sorghum

of livelihood systems. This may have contributed 10% Southern Juba riverine: Maize, sesame, fruits & vegetables to abandoning of key livelihood activities, such Southern coastal pastoral: Goats, cattle as crop farming, even in seasons with favourable 5% Kismayo

regional nutrition analysis regional Togdheer Agro-Pastoral: Sheep, goats & vegetables 0% weather conditions. The nutrition situation like Oct-02 Oct-04 Mar-06 Apr-06 Apr-07 May-08 Dec-08 Jul-09 Dec-09 Apr-07 May-08 Dec-08 Jul-09 Dec-09 Apr-07 May-08 Dec-08 Jul-09 Dec-09 Urban food security in the region, has remained unstable, B/Hawa Luuq D Gedo R Bardera Gedo Pastoral Gedo Agro-pastoral Gedo Riverine ± Town with all assessments conducted in the region since Badhadhe 0 20 40 80 120 160 200 West Golis Pastoral: Goats, camel, sheep 1995 recording Global Acute Malnutrition (GAM) rates above the emergency threshold of 15%. Figure 4 indicates Bay-Bakool Agro-pastoral Low Potential Kilometers the trends of acute malnutrition (using WHO reference growth standards) in Gedo since 2002. Bakool Agro-pastoral Low Potential Bay Agro-pastoral High Potential Historical Overview - Post Gu’09 Southern Inland Pastoral: Camel, Sheep & Goats The FSNAU Post Gu ’09 integrated food security phase classification indicated that the rural population in Northern Datum: WGS84, Data Source: FSAU, 2009, Gedo was persistently faced with a Humanitarian Emergency (HE) while southern Gedo was classified in anAcute Admin. layers: UNDP, 1998 Food and Livelihood Crisis (AFLC) phase. Approximately, 39,000 people were faced with HE, and 110,000 people were in AFLC phase in the entire region. These phase classifications were linked to the cumulative effect of the poor rainfall performances and the resulting negative impact on the different livelihoods, including diminished cereal Food Security Analysis Unit - Somalia http://www.fsausomali.org and livestock production as well as the impact of market forces and civil insecurity. According to the FSNAU Post P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] Gu’09 analysis, most parts of Gedo region had received below average Gu ’09 rainfall resulting in average water tel: 254-20-3745734 fax:254-20-3740598 availability and pasture conditions and poor cereal production estimated at 26% of post-war average (PWA). The FSAU is managed by FAO. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. in-migration of livestock at the time, across Elwak on the Kenyan border exerted further pressure onT hthee re galreadyional & D istrict boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986. reduced water and pasture availability in the region. The overall livestock body condition in the region was therefore average, and milk production low. Coupled with low cereal production, access to a diverse diet constituting of these foods was poor, thus influencing the nutrition situation of the population.

FSNAU Technical Series Report No VI. 30 10 Issued February 22 2010 The integrated analysis of data from nutrition assessments conducted in Gedo region in July 2009, health informa tion and selective feeding facilities indicated a Very Critical nutrition situation in the pastoral and riverine livelihoods, and Critical in the agropastoral livelihood. The high vulnerability to acute malnutrition in the region is largely attributed to chronically high morbidity, poor access to diversified diets and basic services and sub optimal infant and young child feeding practices.

Current Situation Food Security The Post Deyr’09/10 analysis shows normal rainfall performance in most parts of Gedo region, with the exception of localized areas of Southern inland Pastoral and Riverine livelihood zones of Garbaharey district. As a result, crop production has significantly improved from 26% of PWA in Gu’09 to 54% in the current season, while cereal prices are on the decline. However, crop production is still far below the PWA and five years averages for the region. The normal rainfall has likewise improved water availability and pasture conditions in the region and this has not only enhanced livestock body condition and production, but also minimised out-migration of livestock to other regions. Livestock out-migration and the resultant family splitting deprive family members who are left behind of milk access. Milk availability and access mostly from camel has increased as the income from sale of livestock and other livestock related products. The FSNAU Post Deyr’09/10 analysis indicates that northern Gedo remain in HE while southern Gedo is either in BFI or AFLC with about 70,000 and 20,000 people currently faced with Acute Food and Livelihood Crisis and Humanitarian Emergency respectively in the region.

Nutrition

The integrated analysis of information from nutrition regional nutrition analysis assessments1 conducted in Gedo in December 2009, health information and selective feeding facilities’ data show a Very Critical nutrition situation among the pastoral and a Critical situation among the riverine and agropastoral populations. The nutrition assessment in the pastoral population recorded a GAM rate of >20% but displayed a high standard deviation on weight-for-height that did not pass EPI-ENA software plausibility check, and for that reason the actual point prevalence is not reported. Nevertheless, the data indicates the likelihood of a sustained Very Critical nutrition situation as reported in Gu’09 when an assessment conducted in July’09 recorded a GAM rate of 22.6% (18.3 – 27.5) and a SAM rate of 5.4% A child with bilateral oedema in bullowein village, (3.9 – 7.5). However, with the improved food security Gedo region, Dec’ 2009 indicators including increased camel milk production and access coupled with low cereal prices in the region particularly among the Southern Inland pastoral population in southern Gedo, the nutrition situation of this population group is likely to improve in the coming months. In the riverine and agropastoral livelihoods, a small sample cluster assessment (33x6) was conducted in each livelihood and the likely threshold of the acute malnutrition estimated using the CDC calculator at 90% probability level. The riverine assessment estimated GAM rate as >16.5 % (Pr.=0.9), and a SAM rate as >4.2% (Pr.=0.9) indicating a Critical nutritional phase and an improvement from Gu’09 assessment in July’09 when a GAM rate of 22.9% (18.7 – 27.7) and a SAM rate of 5.6% (3.9 – 8.1) were reported. However, when the two GAM rates for July and December 2009 assessments are compared using CDC calculator, there is no statistical difference indicating that the improvement is not significant and the population is still affected by the high rates of acute malnutrition (p=0.65). The assessment conducted among the agropastoral population estimated a GAM rate of >18.2% (Pr.=0.9) and SAM rate of >2.6% (Pr.=0.9 indicating a Critical nutrition situation similar to the levels reported in July’09 assessment in the same population when a GAM rate of 19.9% (17.3 – 22.8) and SAM rate of 4.4% (2.9 – 6.6) were recorded. The surveys were conducted jointly by FSNAU/UNICEF, Trocaire/GHC, African Muslim Aid (AMA), Himilo Relief and Development Association (HIRDA) and Somalia Red Crescent Society (SCRS)

The sustained poor nutrition situation in the region is linked to poor diet quality due to the cumulative effects of seasons of reduced food availability and access. However, the normal Deyr’09/10 rainfall in the region is expected to bring some relief and act as a mitigating factor to acute malnutrition. Morbidity remains high and is associated with high acute malnutrition rates in the region. Other potential issues influencing the nutrition situation such as poor child care and feeding practices, and limited access to basic human services such as sanitation facilities and safe water, predispose populations to high morbidity and subsequent high levels of acute malnutrition. Multi-sectoral and coordinated cross boarder responses that address these underlying causes are required in the region. The key nutrition evidence indicators of the analysis on the nutrition phase classification are provided inTable 4.

FSNAU Technical Series Report No VI. 25 11 Issued February 22 2010 Table 4: Summary of Key Nutrition Findings in Gedo Region

Pastoral (N=754) Agropastoral (=753) Riverine (N=676) Indicator Results % Outcome Results % Outcome Results % Outcome Child Nutrition Status 22.6 19.9 22.9 Global Acute Malnutrition (WHZ<-2 or oedema) Very Critical Critical Very Critical (18.3 – 27.5) (17.3 – 22.8) (18.7 – 27.7) 5.4 4.4 5.6 Severe Acute Malnutrition (WHZ<-3 or oedema) Very Critical Critical Very Critical (3.9– 7.5) (2.9 – 6.6) (3.9 – 8.1) Oedema 0.1 0.4 0.1 Acceptable Acceptable Acceptable (0.1 – 1.3) Global Acute Malnutrition (WHZ<-2 or oedema; 23.0 19.3 23.4 Very Critical Critical Very Critical NCHS) (18.6 – 28.1) (16.5 – 22.3) (19.0 – 28.4) Severe Acute Malnutrition (WHZ<-3 or oedema; 2.7 2.0 2.7 Serious Alert Alert NCHS) (1.8– 3.9) (1.2 – 3.3) (1.6 – 4.5) Acute malnutrition by MUAC (<12.5 cm or 6.6 13.4 13.8 Serious Critical Critical oedema in nutrition surveys) (3.4 – 9.8) (11.1 – 16.1) 9.7 – 17.8) 22.9 34.3 31.2 Stunting (HAZ<-2) Serious Serious Critical (19.0 – 27.4) (30.9 – 37.8) (26.2 – 36.7) 28.6 31.6 31.9 Underweight (WAZ<-2) Serious Serious Critical (23.7 – 33.9) (28.4 – 35.1) (27.3 – 36.8) High levels and High levels and High levels and HIS Nutrition Trends(Aug-Nov’08) Critical Critical Critical stable increasing increasing Admission trends at TFPs/SFPs (Gedo – Jan- High levels and High and Critical Critical High and stable Critical Jun’09) stable increasing Proportion of malnourished registered in SFs 3.5 Very Critical 6.1 Very Critical 2.5 Very Critical Child Morbidity & Immunization Disease trends (seasonally adjusted) Outbreak – None Outbreak -None Outbreak -None Morbidity refers to the proportion of children Morbidity – 28.4 Critical Morbidity– 45 Critical Illness – 41.4 Critical reported to be ill in the 2 weeks prior to the survey RDT – 0.5 RDT – 0.2 RDT- 1.1 Vitamin A – 88.2 Alert Vitamin A – 69.6 Vitamin A – 82.7 Immunization Status Serious Alert Measles – 91.1 Measles- 66 Measles- 84.2 Mortality N=782 N=790 N=784 Crude Mortality Rate per 10,000 per day 0.77 1.17 0.81 Alert Serious Alert (retrospective for 90 days) (0.45 – 1.30) (0.75 – 1.81) (0.44 – 1.51) Under five mortality rate per 10,000 per day 1.34 3.82 2.90 Alert Serious Serious (retrospective for 90 days) (0.68 – 2.64) (2.20–6.58) (1.67 – 5.0) Women Nutrition & Immunization Status Proportion of malnourished non pregnant women 1.6 0.7 2.4 Acceptable Acceptable Acceptable (MUAC≤18.5 cm) (N=322) (N=439) N=267 Proportion of malnourished pregnant women 26.2 36.2 26.1 Very Critical Very Critical Very Critical (MUAC<23.0). (N=130) (N=130) N=119 Proportion of Women who received Tetanus

regional nutrition analysis regional Immunization One dose 15.0 Alert 30.3 Critical 18.8 Alert Two doses 42.5 26.3 21.8 Three doses 30.3 6.1 44.6 Public Health Indicators N=453 N=473 N=374 Households with access to safe water 13 Very Critical 1.9 Very Critical 32.9 Very Critical Household with access to sanitation facilities 19.2 Very Critical 11.6 Very Critical 46.3 Very Critical Households with access to health facility 64.7 Serious 12.9 Very Critical 55.3 Serious 18.3 16.5 24.4 Proportion who own mosquito nets Very Critical Very Critical Very Critical N=1550 N=1603 N=1349 14.8 13.8 17.6 Proportion who use mosquito nets Very Critical Very Critical N=1550 N=1603 N=1349 Food Security N=453 N=473 N=374 Households with poor dietary diversity (< 4 food 36.9 33.6 36.1 Critical Critical Critical groups) (24.2 – 49.5) (29.4 – 38.1) (23.6 – 48.5) Household’s Main Food Source Purchase: 94.7 62.8 4.5 Serious Own Production 0 Acceptable 34.9 87.2 Acceptable Food aid 1.3 0.2 0 Food security phase AFLC/HE Very Critical AFLC/HE Very Critical AFLC/HE Very Critical Overall Situation Analysis Very Critical Critical Very Critical

FSNAU Technical Series Report No VI. 30 12 Issued February 22 2010 Probability Calculator – FSNAU Experience

FSNAU has used the two-stage cluster sampling techniques preferred in emergency situations for their practicability in as- sessing a combination of anthropometric, micronutrient, morbidity, food security, health programmes and household indica- tors. For a long period, it used the 30X30 cluster surveys with sample size of 900 or more. In 2005, FSNAU fully adopted the ENA/SMART (2005) Guidelines, calculating the sample size required in each assessment using the Probability Proportionate to size (PPS) sampling methodology. In emergency situations like Somalia, when rapid and appropriate humanitarian response is essential for effective targeting of scarce resources to communities most in need, FSNAU piloted and used the Lot Quality Assurance Sampling (LQAS) methodology1 with 33 clusters of 6 children in 2007-2008 using a decision rule to classify the prevalence of Global Acute Malnutrition (GAM) rates as exceeding or not exceeding pre-established thresholds.2 These small sample surveys came in with new challenges – wider confidence levels (thus lesser precision) that often cut across different phases of emergency classification; elimination of extra children to apply the LQAS decision rule (the sample has to be 198 children); and risk to overestimate GAM rates.3

CDC has proposed the use of two calculators – the first for estimating prevalence and the other for determining significant changes between two surveys (Bilukha & Blanton, 2008). Consequently, in 2009 FSNAU used the CDC Probability Calculator to estimate GAM levels for small sample cluster surveys.

Probability Calculator Two Surveys Calculator Total Estimated 95% Confidence Number of Confidence Interval Known, but Design Effect Unknown Sample Prevalence Design Interval Clusters Enter the sample size, the prevalence, lower confidence, upper Size Effect confidence limit and the number of clusters Survey 1 n prevalence lower upper C Deff Total Number Estimated 95% Confidence Sample Prevalence of Design 199 18.60% 12.70% 24.40% 33 1.08 Interval Size Clusters Effect Threshold t-value Probability of exceeding the theshold n p lower upper C Deff std err 2.5% 13.97 1.00 734 15.90% 11.70% 20.20% 25 2.33 2.06% 5.0% 8.45 1.00 7.5% 5.71 1.00 Survey 2 10.0% 3.88 1.00 Total Number Estimated

95% Confidence special article Sample Prevalence of Design 12.5% 2.50 0.99 Interval 15.2% 1.28 0.90 Size Clusters Effect 17.5% 0.39 0.65 n p lower upper C Deff std err 20.0% 0.47 0.32 597 11.70% 8.80% 14.70% 25 1.18 1.43% 22.5% 1.27 0.11 Pooled Std p1-p2 t p DF 2 sided 1 sided 25.0% 2.00 0.03 Error 27.5% 2.70 0.01 4.20% 2.51% 1.68 0.100 48 90.0% 95.0%

The simple spreadsheet calculator provides the exact probability that the prevalence of an indicator exceeds a certain threshold. FSNAU and partners jointly agreed to determine level of GAM and SAM rates for small sample surveys at a 90% probability. This is more precise than the PPS point estimates and LQAS decision rule, which make programmatic decisions at 50% and 10% probability levels respectively.4 In the example provided, with a sample of 199 children from 33 clusters, the point esti- mate is 18.6% (12.7-24.4) and the calculator estimates GAM>15.2% (Pr=0.90). The second calculator is used to determine differences between two surveys, in order to test deterioration or improvement in malnutrition rates. A two-tailed 75% and one-tailed 87.5% probabilities are considered operationally different between two survey results, even if the p value is not less than the conventional statistical significance level of 0.05. In the example provided, a significant difference is reported in the GAM rate of 15.9% (11.7-20.2) in Survey 1 and GAM rate of 11.7% (8.8-14.7) in Survey 2 at a 2-tailed 90% probability. Not that p>0.05, but the difference noted being >=75% probability is still considered operationally significant. The following lessons outline the experience with use of the CDC calculator over the last one year:

• The calculator is easy to use and allows classification into nutrition phases required for the IPC. The calculator has increased confidence in the use of small sample surveys

• The second calculator has enabled comparison of results from surveys in the same livelihood in different times to measure changes and trends and between different livelihoods conducted at the same time.

• However, • Being a new concept, some partners confuse the value presented for example as GAM>18.3% (Pr=.90) for a point prevalence of 18.3%. • The two survey calculator does not allow comparison between a cluster survey and an exhaustive or random sample survey. • Questions arise on whether the calculator can be used for other child and HH indicators other than GAM and SAM rates.

1 Deitchler, M., Valdez, J.J., Egge, K., Fernandez, S., Hennigan ,M. (2007). A field test of three LQAS designs to assess the prevalence of acute malnutrition. Int J Epidemiol; 36:858–864 2 Oguta, T., Moloney, G. & Masese, L. (2008). Piloting LQAS in Somaliland. Field exchange. Emergency Nutrition Network. 33: 26-28. 3 Bilukha, O.O. (2008). Old and new cluster designs in emergency field surveys: in search of a one-fits-all solution.Emerging Themes in Epidemiology, 5:7 4 Bilukha, O. O. & Blanton C. (2008). Interpreting results of cluster surveys in emergency settings: Is the LQAS test the best option? Emerging Themes in Epidemiology; 5:25.

FSNAU Technical Series Report No VI. 25 13 Issued February 22 2010 SOMALIA: LIVELIHOOD ZONES

Calula

DJIBOUTI Gulf of Aden Qandala

Zeylac Bossaaso Lughaye AWDAL Ceerigaabo Las Qoray/Badhan Baki Berbera SANAG Iskushuban Borama Ceel Afweyne BARI Sheikh Gebiley W. GALBEED

Hargeysa Qardho Burco Owdweyne Xudun Caynabo Talex Bandar Beyla TOGDHEER SOOL

Laas Caanood Buuhoodle Garowe

Legend Eyl "/ NUGAL Country capital Burtinle International boundary

Regional boundary Jariiban ETHIOPIA Goldogob District boundary Galkacyo n a e River c O

Coastline n a Cadaado MUDUG i d Hobyo n Cabudwaaq I

Dhusa Mareeb

GALGADUD Harardheere Ceel Barde Beled Weyne Ceel Bur BAKOOL Livelihood zones Addun Pastoral: Mixed sheep & goats, camel Rab-Dhuure HIIRAN Xudur Awdal border & coastal towns: Petty trading, fishing, salt mining Ceel Dheere Dolo Central regions Agro-Pastoral: Cowpea, sheep & goats, camel, cattle Wajid Tayeglow Bulo Barde 4.2 Lower and Middle Juba Regions Luuq Coastal Deeh: Sheep Aden Yabal Dawo Pastoral: Shoats, cattle, camel Beled Hawa Jalalaqsi East Golis Pastoral: Frankinncense Middle and Lower Juba in south Somalia have a total of seven districts namely Sakow, Buale and Jilib in Middle Juba, Garbaharey Baydhaba Cadale Fishing and Jamame, Afmadow, Kismayo and Badhadhe in Lower Juba. The two regions have three main rural livelihood Jowhar M. SHABELLE Gagaab Pastoral: Frankincense zones namely, the pastoral (the Southern Inland and Southeast Pastoralists), agropastoral (Lower Juba and Southern Guban Pastoral: Sheep, goats & camel Qansax Dheere Wanle Weyne Agropastoralists) and the riverine communities who are purely farmers. G(MapED 5).O BAY Hawd Pastoral: Camel, sheep & goats Hiran Agro-Pastoral Ceel Waq Bur Hakaba Balcad The food security and nutrition situation in the Juba Hiran riverine: Sorghum, maize, cattle & shoats Map 5: Juba Regions Livelihood Zones Afgoye Juba pump irrigation: Tobacco, onions, maize regions have varied over time and been linked to rainfall Baardheere Dinsor "/ BANADIR MOGADISHU Kakaar-Dharor Pastoral: Sheep, goats, camel

A Qoryoley performance and the resultant impacts on the different L. & M. Shabelle Agro-Pastoral Irrigated: Maize/Sorghum & cattle Sakow Y Marka livelihood systems. Heavy rainfall in the Juba regions Kurtun Warrey L. & M. Shabelle Agro-Pastoral rain-fed: Maize,cowpeas, sesame & cattle

N M. JUBA Lower Juba Agro-Pastoral: Maize & cattle or in the Ethiopian highlands often results in floods that Sablale

E L. SHABELLE North-West Agro-Pastoral: Sorghum, cattle devastate crop cultivation, in the riverine areas, however, Bu'aale North-West Valley Agro-Pastoral: Irrigated vegetables, shoats the riverine communities’ later benefit from recession K Hagar Brava Nugal Valley Pastoral: Sheep & camel crops from the Desheks and fishing opportunities from Potato zone & vegetables Afmadow the flood waters. The agropastoral communities, who rely Jilib Shabelle riverine: Maize, fruits & vegetables on rain-fed agriculture, are totally dependent on rainfall Sool-Sanag Plateau Pastoral: Camel, sheep & goats performance as are the pastoralists, whose livelihood South-East Pastoral: Cattle, sheep & goats Jamaame is greatly influenced by pasture conditions and water L. JUBA Southern Agro-Pastoral: Camel, cattle, sorghum availability. The nutrition situation in Juba regions Southern Juba riverine: Maize, sesame, fruits & vegetables equally, varies across livelihoods with the pastoral Kismayo Southern coastal pastoral: Goats, cattle Togdheer Agro-Pastoral: Sheep, goats & vegetables population remaining mostly in the Serious levels since ± Urban Gu’07 while in the riverine and agropastoral livelihoods, Badhadhe 0 20 40 80 120 160 200 West Golis Pastoral: Goats, camel, sheep the situation has fluctuated betweenSerious and Critical Bay-Bakool Agro-pastoral Low Potential Kilometers phases. The only exception was Gu ’09 when a Very Bakool Agro-pastoral Low Potential Critical nutrition situation was recorded in the pastoral Bay Agro-pastoral High Potential and agropastoral livelihoods and was largely attributed to Southern Inland Pastoral: Camel, Sheep & Goats an outbreak of acute watery diarrhoea. Figure 5 shows Datum: WGS84, Data Source: FSAU, 2009, Admin. layers: UNDP, 1998 the trends of acute malnutrition in Juba regions Figure 5: Trend in levels of Acute Malnutrition (WHZ <-2Z scores since 2003. or oedema, WHO 2006) in Juba Regions 2003 - 2009 Food Security Analysis Unit - Somalia http://www.fsausomali.org Historical Overview - Post Gu ’09 P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] tel: 254-20-3745734 fax:254-20-3740598 FSAU is managed by FAO. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The FSNAU Post Gu ’09 integrated food security The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986. analysis reported mixed rainfall outcomes in Juba regions, with near normal and poor Gu rainfall performance in Middle Juba and parts of Lower Juba regions respectively. In addition, a good Hagaa rainfall was reported in the two regions,

regional nutrition analysis resulting to good off-season crop production. Poor Gu ’09 rainfall particularly in parts of Lower Juba, contributed to poor rangeland conditions and low water availability in pastoral and agropastoral areas. This prompted early out-migration of livestock to the riverine areas, reducing milk availability and access in the affected areas. The impact of the Gu ’09 rains was also evidenced in the cereal production, with Middle Juba recording bumper maize harvest estimated at 210% of PWA, while Lower Juba region had crop failure. During the Post Gu ‘09 season, no one was faced with a Humanitarian Emergency; however, about 45,000 people in both regions were faced with Acute Food and Livelihood Crisis (AFLC).

The integrated Post Gu ’09 nutrition situation analysis indicated a significant deterioration of the nutrition situation of the agropastoral and pastoral population from Serious levels recorded in Post Deyr ’08/09 to a Very Critical phase, while the riverine livelihood was in a sustained Serious phase. The deterioration of the nutrition situation in the pastoral and agropastoral livelihoods, was largely attributed to morbidity related factors, especially the outbreak of acute watery diarrhoea cases from March 2009 across all livelihoods. According to the Somali Health Cluster Bulletin, AWD cases were still prevalent at the time of the assessment with a total of 736 cases, 82% of whom were children under the age of five years, recorded in the two regions between 27th June and 31st July 2009. The situation was worsened by the limited access to the health services for the majority of the rural pastoral and agropastoral communities.

The relatively stable, though Serious, nutrition situation, among the riverine communities in Juba regions at that time was attributed to good milk availability and access from the livestock in-migrating from drought affected pastoral and agropastoral areas and regions outside Juba regions. The riverine community also have comparatively better access

FSNAU Technical Series Report No VI. 30 14 Issued February 22 2010 to health services from humanitarian organizations than their counterparts in the pastoral and agropastoral livelihood areas. The nutrition situation of Kismayo IDPs was in a sustained Critical phase since the Deyr’07/08 with 14% of the, 1530 children assessed in July 2009 being identified as acutely malnourished (MUAC<12.5 cm or oedema).

Current Situation

Food Security The FSNAU Post Deyr ’09/10 analysis shows a normal rainfall performance in Middle Juba and Lower Juba regions with the exception of coastal areas of Jamame and Kismayo, which received poor rainfall. The good rainfall performance resulted in good crop production in both regions, estimated at 219% and 104% of PWA in Middle and Lower Juba regions respectively. The normal rainfall received in the regions has also contributed to good water availability and pasture condition, thereby improving livestock body condition and milk production. Milk production is above average for the Southern Inland Pastoral population, who mainly keep camel besides sheep and goat, but poor among the South Mothers feeding children, Buale WV TFC, Juba region, East Pastoral who keep cattle, sheep and goat. The current FSNAU, September, 2009 Post Deyr ’09/10 analysis indicates that about 15,000 people in both regions are faced with Acute Food and Livelihood

Crisis (AFLC), a decrease from, 45,000 people in Post Gu’09. regional nutrition analysis

Nutrition Situation

The current Post Deyr ’09/10 integrated analysis of the nutrition assessments, health information and targeted feeding facilities data, indicates a sustained Very Critical nutrition situation among the pastoral and Serious among the riverine populations. The agropastoral population show an improvement of nutrition situation from Very Critical in Gu ’09 to the current Critical levels. The nutrition assessments conducted in December 2009 recorded respective GAM and SAM rates of 23.5% (17.9 – 30.2) and 7.5% (5.3 – 10.7) in the pastoral livelihood indicating a sustained Very Critical nutrition situation from July’09 assessment when a GAM rate of 20.6%(16.1-26.1) and SAM rate of 6.8% (4.2-10.8) were recorded. Small sample assessments (33x6) conducted in December 2009 and using the CDC calculator to estimate acute malnutrition at 90% probability level, indicated the respective GAM and SAM levels to be >16% and >2.5% in the agropastoral livelihood while in the riverine population, the GAM level was assessed as >12.2% and the SAM rate at >4.6% (Pr.=0.90). The results of the agropastoral livelihood shows a Critical nutrition situation and an improvement from the Very Critical levels in July 2009 assessment, when a GAM rate of 21.7% (19.0-24.7) and SAM rates of 7.4 % (4.8-11.2) were recorded. However using the CDC calculator, there is no significant difference between the GAM rate recorded in July 2009 and the current GAM level reported in December 2009 assessments in the agropastoral population indicating that the improvement was not statistically significant (p=0.638) . The riverine results indicate a sustained

Serious nutrition situation with similar results as those of July 2009 assessment, when a GAM rate of 12.5% (10.1-15.4) and SAM rate of 3.6% (2.2-5.9) were reported.The Nutrition surveys were co-funded jointly by FSNAU/UNICEF and World Vision, and implemented jointly with African Muslim Aid (AMA), African Rescue Committee (AFREC), Himilo Relief and Development Association (HIRDA) and Somalia Red Crescent Society (SCRS), Somali Aid Foundation (SAF), Economic Independent Research Group (EIRG), Juba Foundation WRRS, RAHO, JCC, MVDO, PCDDO, Inter-care development Association (ICDA).

The high acute malnutrition level, particularly in the pastoral Figure 6: Acute Watery Diarrhoea Cases in Juba Regions livelihood, is largely attributed to morbidity related factors, as reported in the Somalia Health Cluster Bulletin especially the outbreak of acute watery diarrhoea across 2008-2009 all livelihoods in the two regions. A review of the Somali Health Cluster Bulletins shows that AWD cases are regularly reported in the two Juba regions with AWD outbreak starting in the dry Jilal season (January to March) and reaching the peak in April with the onset of Gu rains, and in the Deyr starting September and peaking in October, after which the trend of AWD cases start declining with December recording the lowest number of cases. However, a comparison of the AWD cases reported in years 2008 and 2009 indicates that year 2009 did not only report a higher AWD burden but the reported AWD cases between May to December 2009 remained significantly higher than hoset reported in the same period in 2008 with the last four months recording more than

FSNAU Technical Series Report No VI. 25 15 Issued February 22 2010 four hundred cases of AWD (Figure.6). The sustained high AWD cases and the generally elevated disease burden in an environment of limited access to health services for the majority of the population has in no doubt contributed to a Very Critical and Critical nutrition situation in the pastoral and agropastoral livelihoods respectively, which is higher than the Serious levels normally reported in these livelihoods. The on-going health responses by WHO and other local NGOs in the regions, should not only be sustained but also expanded to cover the affected people. The positive food security indicators in the two regions, including good crop production, improved milk production and increased income from the sale of crop and livestock and livestock products are important mitigating factors. Based on current improvements in food security and the on-going AWD management, the nutrition situation in the pastoral livelihood is projected as likely to improve in the coming months. Nevertheless, chronic poor child care and feeding practices, limited access to safe water and sanitation facilities as well as health services remain key aggravating factors to the acute malnutrition in Juba regions. Measures to improve and sustain health service delivery, access to safe water and sanitation facilities as well as addressing poor child care practices are recommended in the two regions. Table highlights the key findings of the nutrition situation analysis. Table 5. Summary of Key Nutrition Findings in Middle and Lower Juba Regions

Pastoral (N=689) Agropastoral (=203) Riverine (N=203) Indicator Results % Outcome Results % Outcome Results % Outcome Child Nutrition Status Global Acute Malnutrition (WHZ<-2 or oedema) 23.5 (17.9 – 30.2) Very Critical >16.0 (Pr.= 0.90) Critical >12.2 (Pro. 90%) Serious

Severe Acute Malnutrition (WHZ<-3 or oedema) 7.5 5.3 – 10.7) Very Critical >2.5 (Pr.= 0.90) Alert >4.6 (Pro. 90%) Critical Oedema 0.4 Acceptable 0 Acceptable 1.0 Alert

Global Acute Malnutrition (WHZ<-2 or oedema; NCHS) 22.4 (16.8 – 29.1) Very Critical >15.4(Pr.=0.90) Critical >8.5 (Pr.=0.90) Serious

Severe Acute Malnutrition (WHZ<-3 or oedema; NCHS) 3.6 (2.0– 6.4) Serious >1.2(Pr.=0.91) Alert >2.9(Pr.0.90) Alert Acute malnutrition by MUAC (<12.5 cm or oedema in 17.3 12.6 (6.6 – 18.7) Critical Very Critical 21.7 (15.1 – 28.2) Very Critical nutrition surveys) (11.4 – 23.3) 39.4 Stunting (HAZ<-2) 23.2 (16.7 – 31.3) Serious 29.6 (23.3 – 36.8) Serious Critical (31.7 – 47.7) 30.5 Underweight (WAZ<-2) 24.3 (19.7 – 29.7) Serious Serious 29.6 (23.2– 36.9) Critical (21.8 – 41.0) High levels and High levels and High and stable HIS Nutrition Trends(Aug-Dec’09) Critical Critical Critical stable stable trends High numbers High and stable High and stable with increasing Admission trends at TFPs/SFPs (Aug-Dec’09) number of Critical number of Critical Critical trends of admissions admissions admission Proportion of acutely malnourished registered in SFs 23.6 (9.9-37.3) Very Critical 27.5 Very Critical 42.6 Critical Child Morbidity & Immunization Outbreak – 425 Outbreak – 425 AWD Outbreak – 425 AWD cases Disease trends (seasonally adjusted) cases reported in AWD cases reported in Morbidity refers to the proportion of children reported to Dec’09 Very Critical reported in Dec’09 Very Critical Very Critical Dec’09 be ill in the 2 weeks prior to the survey Morbidity– 57.7 Morbidity – 56.7 Morbidity – 57.1 RDT positive – 3.2 Vitamin A -46.9 Vitamin A-69.4 Vitamin A-70.4 Immunization Status Serious Serious Serious Measles – 61.7 Measles -78.1 Measles -80.3 Infant and Young Child feeding (6-24 months) N=267 N=79 N=96 Proportion still breastfeeding 62.2 Critical 80 Alert 69.7 Serious Proportion introduced to complementary food at age of regional nutrition analysis 10.5 Very Critical 24.4 Very Critical 2.7 Very Critical six months Proportion meeting recommended minimum feeding 55.9 Critical 68.9 Serious 67.1 Serious frequency Mortality N=700 NA NA Crude Mortality Rate per 10,000 per day (retrospective 2.20 (1.71 – 2.81) Critical for 90 days) Under five mortality rate per 10,000 per day 3.01 (2.19 – 4.14) Serious (retrospective for 90 days) Women Nutrition & Immunization Status Proportion of acutely malnourished non pregnant women 0.7 (N=293) Acceptable 0 (N=56) Acceptable 0 (N=58) Acceptable (MUAC≤18.5 cm) Proportion of acutely malnourished pregnant women 32.7 (N=107) Very Critical 53.8 (N=26) Very Critical 30.8 (N=26) Very Critical (MUAC<23.0). Women who received Tetanus Immunization One dose 26.4 31.1 18.4 Two doses 34.7 32.1 36.7 Critical Alert Alert Three doses 7.8 22.6 29.5 Public Health Indicators N=395 N=101 N=97 Households with access to safe water 5.1 Very Critical 16.2 Very Critical 29.9 Very Critical Household with access to sanitation facilities 2.8 Very Critical 40.0 Critical 36.1 Very Critical Proportion who own mosquito nets 78.2 N=1246 NA NA Proportion using mosquito nets 75.4 N=1246 NA NA Food Security N=395 N=101 N=97 Household’s Main Food Source Purchase: 83.4 9.1 30.7 Own Production 14.0 91.0 69.3 Food aid 0.8 - - Borrowing 0.5 0.9 - Gathering 1.3 - Food security phase BFI/AFLC Critical BFI/AFLC Critical BFI Serious Overall Situation Analysis Very Critical Critical Serious

FSNAU Technical Series Report No VI. 30 16 Issued February 22 2010 4.3 Bay and Bakool Regions

Map 6: Bay and Bakool Regions Livelihood Zones Bay and Bakool regions are located in the southwest of Somalia. Bakool Region comprises of five districts namely Huddur (the regional capital), Wajid, Tieglow, Rabdure and Elberde. Bay region comprises of four districts, namely Baidoa, (the regional capital), Qansahdhere, Dinsor and Burhakaba. Both regions have two predominant livelihoods systems; the agrpastoral, located both in Bay and the southern parts of Bakool, and the pastoral located in Elberde district (Map 6).

Bakool Region

Historical Overview - Post Gu ’09 According to the Post Gu’ 09 integrated food security phase classification, the food security situation in Bakool region deteriorated for all rural livelihoods, as well as the Urban areas, in the preceding six months following four consecutive seasons of crop failure. Over half of the population or 160,000 agropastoralists, pastoralists and urban population were either in Acute Food and Livelihood Crisis (56% in AFLC) or in regional nutrition analysis Humanitarian Emergency (44% in HE). The Gu ‘09 production was only 23% of the Post War Average (PWA) due to severe moisture stress at the crop development stage and short, erratic and poorly distributed rains that ended early. Both pastoral and agropastoral livelihoods suffered from pasture and water shortages, poor livestock body conditions, low milk production and family splitting, due to livestock out-migration to Bay, Juba and Lower Shabelle regions. Livestock herds significantly reduced from baseline level for all species: camel 31%, cattle 56%, and sheep/goats 19% for pastoral as well as Bakool agropastoral areas, 31% for camel, 60% for cattle and 24% for sheep and goats. Income reduced as a result of limited agricultural activities, low investments and reduction in wage labour availability.

In the Gu ‘09 a probability proportionate to size (PPS) Figure 7: Trend in levels of acute malnutrition (WHZ< -2 or nutrition assessment was conducted in both the Bakool oedema, WHO 2006 ) in Bakool region 2002- 2009 ) agropastoral and pastoral livelihood zones. The integrated nutrition situation analysis using data from the assessment, 30 together with information from health and selective feeding facilities indicated Serious and Very Critical nutrition

situation phases respectively. The June 2009 Bakool 15

agro-pastoral nutrition assessment reported a global acute Percentage malnutrition rate (WHZ <-2 or oedema) rate of 14.9% (12.1- 18.3) and a severe acute malnutrition (WHZ <-2 or oedema) 0

rate of 3.4% (2.1-5.4) including one case of oedema, based on Jul 08 Oct'03 Jan'06 Apr 08 Dec 06 Dec 09 Dec 09 Apr 04 Jan.06 Nov.'07 Nov.'07 Nov.'07 Sept'03 Sept'02 WHO 2006 growth standards. The mitigating factors mainly June 09 June 09 Wajid Huddur Dist Elberde Rabdure Dist Tieglo Bakool Agrop Bakool Past constituted the positive impact of humanitarian services IDP Dist that included targeted supplementary feeding programs, general food distribution and relatively better access to health services. In the Bakool pastoralists, analysis of data from nutrition assessments, health facilities and feeding centre information, indicated a sustained Very Critical nutrition phase. The Bakool pastoral nutrition assessment, conducted in June 2009, reported a high GAM rate of 25.1% (18.6 – 32.8) and a SAM rate of 1.2% (0.5 – 2.6). The underlying causes of acute malnutrition in the pastoral areas included high morbidity coupled with limited access to health services, safe water and sanitation, and poor child care and feeding practices. The negative impact of these factors were exacerbated by the frequent seasons of poor rainfall experienced, that affected the livestock body conditions and production, and also led to out-migration of livestock therefore reducing milk access for household members left behind. See Figure 7 for an illustration of the trends in levels of acute malnutrition in Bakool region from 2002 to current.

Current situation Food security The Post Deyr ‘09/10 integrated food security phase classification indicates that 40% of the population in Bakool region is in crisis with 122,727 people in Humanitarian Emergency (HE) (25,890 people) or in Acute Food and Livelihood Crises (AFLC) (96,837), with a projected early warning level of Watch up to June ’10. However the agropastoralists have improved and the overall numbers in AFLC and HE reduced slightly since Gu ‘09 (AFLC was 91,000 people and HE was

FSNAU Technical Series Report No VI. 25 17 Issued February 22 2010 70,000 people). The urban poor in AFLC has remained the same from the previous Gu ’09 (AFLC was 25,000 people). The current food security situation in Bakool region is average in terms of production due to normal rainfall in agropastoral, but below normal in pastoral areas. Below average rangeland conditions causing abnormal livestock out-migration; poor livestock body conditions, especially of cattle; low milk production; and high livestock off-take are the risk factors in the pastoral areas. The situation is exacerbated by a highly volatile political conflict between opposing groups struggling for power. The Deyr ’09/10 regional cereal production is 123% of PWA and 82% of the 5-year average, which is the 3rd lowest in over a decade. Labour opportunities are limited to agricultural activities in agropastoral areas, while there is significant reduction in livestock herd sizes attributed to recurrent droughts. Poor households are resorting to distress strategies, such as increased charcoal production, collection of firewood/building materials, labour migration to main towns and seeking social support (in-kind food or cash) in the neighbouring region of Bay, which experienced a bumper harvest.

Nutrition

Bakool Agropastoral Livelihood Zone The Post Deyr ‘09/10 integrated nutrition situation analysis based on the December 2009 nutrition survey data together with information from health and selective feeding facilities, indicates a sustained Serious nutrition situation. The December 2009 Bakool agropastoral small sample cluster survey reported GAM and SAM levels of >13.5% and >4.0% respectively using the probability calculator. Similar findings were obtained in the July 2009 assessment when a GAM and SAM rate of 14.9% (12.1 – 18.3) and 3.4% (2.1 – 5.4) were recorded respectively. The mitigating factor is likelythe positive impact of humanitarian services that include relatively better access to health care services and targeted supplementary feeding programs. In November 2009 for example, GTZ opened an MCH with support from UNICEF in Huddur Town and established five health posts. (WHO, Health Cluster Bulletin, Dec ‘09) Nevertheless, admissions of acutely malnourished children into targeted supplementary and therapeutic feeding centers indicate an increasing trend which is worrying. Table 6 provides a summary of the key findings from the assessment.

Bakool Pastoral Livelihood Zone The Post Deyr ‘09/10 integrated nutrition situation analysis using data from nutrition assessments, jointly by FSNAU/ UNICEF, World Vision, International Medical Corps, Somalia Red Crescent Society, Degares and Green Hope, together with information from health and selective feeding facilities data, indicates a sustained Very Critical nutrition situation. The December 2009 Bakool pastoral small sample cluster nutrition survey1 reported GAM and SAM levels of >29.2% and >4.7% respectively, using the CDC calculator at 90% probability level. These results are similar to the June 2009, which reported a GAM rate of 25.1% (18.6 – 32.8) and a SAM rate of 1.2% (0.5 – 2.6) in the same livelihood zone. When the GAM rates for June and December ‘09 assessments are compared using CDC calculator, there is no statistical significant difference (p=0.18) in the assessments in the pastoral population of Bakool. The underlying causes of acute malnutrition in the pastoral areas include food insecurity due to the ongoing drought conditions, high morbidity coupled with limited access to health care, safe water and sanitation services, and poor child care and feeding practices. The negative impact of these factors are often exacerbated by the frequent seasons of poor rainfall as currently experienced in the area, that not only affect the livestock body conditions and production, but also lead to out-migration of livestock reducing milk access. regional nutrition analysis Table 6 provides a summary of the key findings from the assessment.

Bay Region

Historical Overview - Post Gu ’09 The analysis from the Post Gu ‘09 of the food security situation in Bay region remained unchanged since Deyr ‘08/09. Most of the rural agropastoral communities were identified as Borderline Food Insecure (BFI), with the exception of Bardaale (part of Baidoa District), agropastoral livelihood bordering Bakool region, where 5,000 people were in AFLC and 5,000 people in HE. An estimated 20,000 urban poor in Bay region were in AFLC.

The integrated analysis of information from nutrition Figure 8: Trend in levels of acute malnutrition (WHZ< -2 or assessments conducted in June ’09, together with health oedema , WHO 2006) in Bay region 2002- 2009 information and selective feeding programs data indicated

a Very Critical nutrition situation in Bay agropastoral 30 livelihood with a GAM and a SAM rate of 23.9% (19.2 – 29.4) and 5.2 (3.9 – 6.9) respectively, including one 15

(0.1%) oedema case. Health information systems (HIS) Percentage data showed high and decreasing proportions of acutely malnourished children with SFP admission numbers with 0 Mar'07 Mar'07 Sep'06 Sep'03 May'02 May'07 May'07 Dec-09 Nov.'07 Nov.'07 high and decreasing numbers recorded in Bay agropastoral June 09 Qansahdere Berdalle Dist Dinsor Dist Burhakaba Burhakaba Bay Agro-past livelihood (Figure 9). Dist Past Agrop

FSNAU Technical Series Report No VI. 30 18 Issued February 22 2010 Overall, poor dietary quality (cereal and oil based diets) Figure 9: Trends in SFP Admission into Bay Agropastoral MCHs - Deyr ‘09/10 chronic poor child care and feeding practices, limited 350

access to safe water and sanitation facilities as well as 300

health services were the key aggravating factors to the acute 250

malnutrition in Bay regions. See Figure 8 for an illustration 200 of the trends in levels of acute malnutrition in Bay region 150 from 2002 to current. 100 50 Current situation 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Food security 2008 2009 2 per. Mov. Avg.(2008) 2 per. Mov. Avg.(2009)

The food security situation in Bay region has shown a significant improvement for the agropastoral livelihood. All those classified in Humanitarian Emergency (HE) in the Gu ’09 have improved to Acute Food and Livelihood Crisis (AFLC), while a proportion of those in AFLC have improved to Borderline Food Insecure (BFI). The number of the urban poor in AFLC, 20,000 people, remains the same as labour opportunities (constructions and portage activities) have reduced since July 2009.

The food security situation significantly improved in Bay region, primarily due to an exceptionally goodDeyr cereal and cash crop production. This has not only improved food access through increased own production, but is also generating increased opportunities for income from livestock product sales, wage labour and marketing activities. The Deyr ’09 cereal production is 212% PWA and 207 % five-year average, which is the th6 highest production in over a decade. regional nutrition analysis This good production is due to good rainfall received at the crop development stage, increased cultivated area and an enhanced security situation. There is also normal grazing and browsing conditions and good livestock body conditions for all species leading to normal calving and kidding rates. Milk production is normal and herd sizes are increasing for all species. Labour opportunities and daily wage rates have also improved due to high labour demand for Deyr ‘09 agricultural activities.

Nutrition

Bay Agropastoral Livelihood Zone The recent integrated analysis of information from probability proportionate to size (PPS) nutrition assessments conducted in Bay region in Dec 2009, jointly by FSNAU/UNICEF, World Vision, International Medical Corps, Somalia Red Crescent Society, Degares and Green Hope, together with health information and feeding facilities’ data, indicates a sustained Very Critical nutrition situation among the agropastoral population in Bay region ( Figure 9) illustrates the trends of acute malnutrition in Bay region from 2002-2009). The results indicate a GAM level of 21.7% (15.6 – 27.9) and a SAM rate 6.9% (3.4 - 10.4), including one (0.5%) oedema case. This indicates a sustained nutrition phase from the Post Gu’ 09, when the situation was classified asVery Critical. The previous nutrition assessment was conducted in July 2009 and GAM and SAM rates of 23.9% (19.2 – 29.4) and 5.2% (3.9 – 6.9) were reported respectively indicating a Very Critical nutrition situation.

The sustained nutrition situation is mainly attributed to chronically high morbidity rates, aggravated by the reduced access to health and nutrition services provided by local and international agencies. The inadequate access to safe water and sanitation services and the persistently poor child care and feeding practices, have also continued to impact negatively on the nutrition situation of the population. Although the Bay region food security situation is positive in terms of increased food availability and food access, with relatively good cereal availability, poor dietary quality is a major concern and children cannot meet their nutritional requirement for healthy growth and development on a diet of oil and cereals. This is further exacerbated by very poor access to basic health care services and the high disease burden are the major underlying factors to the nutrition crisis. It is notable that one of the highest rates of stunting (38%) is reported in Bay region, again reflecting the burden of micronutrient deficiencies and frequent illness on child nutrition. Integrated interventions to address these underlying factors at scale are the only solution for this chronic crisis. Table 6 provides a summary of the key findings from the assessment.

FSNAU Technical Series Report No VI. 25 19 Issued February 22 2010 Table 6: Summary of Key Nutrition Findings in Bay and Bakool Regions

Bakool agropastoral Bay agropastoral (N=592) Bakool pastoral (N=247) (N=251) Indicator Results % Outcome Results % Outcome Results % Outcome Child Nutrition Status 21.7 13.5 29.2 Global Acute Malnutrition (WHZ<-2 or oedema) Very Critical Serious Very Critical (15.6 – 27.9) (pr=0.90) (pr=0.90) 6.9 4.0 4.7 Severe Acute Malnutrition (WHZ<-3 or oedema) Very Critical Critical Very Critical (3.4– 10.4) (pr=0.90) (pr=0.90) Oedema 0.5 0.0 0.0 Acceptable Acceptable Acceptable (0.0 – 1.0) Global Acute Malnutrition (WHZ<-2 or oedema; 17.0 >11.6 >23.6 Critical Critical Very Critical NCHS) (11.6 – 22.4) (pr=0.90) (pr=0.90) Severe Acute Malnutrition (WHZ<-3 or oedema; 1.6 >2.1 >0.4 Alert Serious Alert NCHS) (0.4– 2.7) (pr=0.90) (pr=0.90) Acute malnutrition by MUAC (<12.5 cm or oedema 4.8 9.5 15.7 Alert Serious Very Critical in nutrition surveys) (2.5 –7.1) (5.8 – 13.2) (8.9 – 22.6) 36.8 26.2 19.4 Stunting (HAZ<-2) Serious Serious Serious (31.7 – 41.8) (19.7 – 32.7) (35.6 – 46.5) 40.7 24.6 31.9 Underweight (WAZ<-2) Very Critical Serious Serious (35.0 – 46.6) (18.0– 31.3) (23.3 – 40.5) High levels High levels with High levels HIS Nutrition Trends(Aug-Nov’08) and increasing Critical decreasing Critical and fluctuating Critical trends trends trends High number High numbers High numbers Admission trends at TFPs/SFPs (Gedo – Jan- with increasing with increasing with increasing Critical Critical Critical Jun’09) trend of trend of trends of admission admission admission Proportion of acutely malnourished registered in 3.8 Very Critical 5.1 Very Critical 18.2 Critical SFs Child Morbidity & Immunization No outbreak No outbreak No outbreak Disease trends (seasonally adjusted) Morbidity refers to the proportion of children Morbidity– 28.2 Acceptable Morbidity – 26.9 Acceptable Morbidity – 35.6 Acceptable reported to be ill in the 2 weeks prior to the survey RDT positive Not conducted Not conducted – 2.1 Vitamin A -37.7 Vitamin A 38.1 Vitamin A 77.3 Immunization Status Serious Serious Serious Measles – 35.3 Measles -65.8 Measles -68.8 Infant and Young Child feeding (6-24 months) N N N Proportion still breastfeeding 14.2 Serious 12.8 Serious 27.5 Serious Proportion introduced to complementary food at 16.1 Critical 31.2 Critical 10.4 Critical age of six months Proportion meeting recommended minimum 9.3 Critical 27.9 Critical 64.8 Serious feeding frequency Mortality N=750 Not conducted Not conducted Crude Mortality Rate per 10,000 per day 0.57 Alert - - - - (retrospective for 90 days) (0.33 – 0.99) Under five mortality rate per 10,000 per day 0.68 Acceptable - - - - (retrospective for 90 days) (0.17 – 2.60) Women Nutrition & Immunization Status Proportion of acutely malnourished non pregnant 1.2 2.8 3 Acceptable Acceptable Acceptable regional nutrition analysis women (MUAC≤18.5 cm) (N=403) (N=71) (N=92) Proportion of acutely malnourished pregnant women 1.3 13.5 12.5 Alert Serious Serious (MUAC<23.0). (N=233) (N=40) (N=33) Proportion of Women who received Tetanus Immunization No dose 56.9 24.3 3.2 One dose 22.1 Critical 28.6 Critical 13.8 Critical Two doses 13.6 30.4 21.9 Three or more 7.2 16.5 31.7 Public Health Indicators N=370 N=112 N=121 Households with access to safe water 10.2 Very Critical 9.8 Very Critical 1.0 Very Critical Household with access to sanitation facilities 15.0 Very Critical 33.9 Critical 13.5 Very Critical 19.3 Proportion who own mosquito nets - - - - N=1150 15.3 Proportion using mosquito nets - - - - N=1150 Food Security N=372 N=112 N=121 Household’s Main Food Source Purchase: 21.3 70.6 65.5 Own Production 73.8 29.3 34.4 S Food aid 0 0 0 Food security phase BFI/AFLC Serious AFLC/HE Critical AFLC/HE Critical

Overall Situation Analysis Very Critical Serious Very Critical

FSNAU Technical Series Report No VI. 30 20 Issued February 22 2010 SOMALIA: LIVELIHOOD ZONES

Calula

DJIBOUTI Gulf of Aden Qandala

Zeylac Bossaaso Lughaye AWDAL Ceerigaabo Las Qoray/Badhan Baki Berbera SANAG Iskushuban Borama Ceel Afweyne BARI Sheikh Gebiley W. GALBEED

Hargeysa Qardho Burco Owdweyne Xudun Caynabo Talex Bandar Beyla TOGDHEER SOOL

Laas Caanood Buuhoodle Garowe

Legend Eyl "/ NUGAL Country capital Burtinle International boundary

Regional boundary Jariiban ETHIOPIA Goldogob District boundary Galkacyo n a e River c O

Coastline n a Cadaado MUDUG i d Hobyo n Cabudwaaq I

Dhusa Mareeb 4.4 Lower and Middle Shabelle Regions GALGADUD Harardheere Ceel Barde Beled Weyne Ceel Bur Middle and Lower Shabelle Regions comprise mainly Map 7: ShabelleBAK LivelihoodOOL Zones Livelihood zones Addun Pastoral: Mixed sheep & goats, camel of riverine, agropastoral and urban livelihoods (Map 7), Rab-Dhuure HIIRAN Xudur Awdal border & coastal towns: Petty trading, fishing, salt mining Ceel Dheere Dolo Central regions Agro-Pastoral: Cowpea, sheep & goats, camel, cattle with a large number of IDPs settling in the Afgoye cor- Bulo Barde Luuq Wajid Tayeglow Coastal Deeh: Sheep ridor as a result of continued insecurity in Mogadishu. Dawo Pastoral: Shoats, cattle, camel Aden Yabal The riverine zone is located within 10 km of the ShabelleBeled Haw a Jalalaqsi East Golis Pastoral: Frankinncense Garbaharey Baydhaba Cadale Fishing River where maize, sesame and a variety of vegetables Jowhar M. SHABELLE Gagaab Pastoral: Frankincense Guban Pastoral: Sheep, goats & camel Qansax Dheere Wanle Weyne and fruits are cultivated, with limited livestock GholdEDO- BAY Hawd Pastoral: Camel, sheep & goats Hiran Agro-Pastoral ings as a result of tsetse fly infestation. FurtherCeel W aonq is Balcad Bur Hakaba Hiran riverine: Sorghum, maize, cattle & shoats Afgoye Juba pump irrigation: Tobacco, onions, maize the agropastoral zone, which extends 20-40 kmB afromardheer e Dinsor "/ BANADIR MOGADISHU Kakaar-Dharor Pastoral: Sheep, goats, camel

A Qoryoley the Shabelle River with maize, cowpeas, sesame and L. & M. Shabelle Agro-Pastoral Irrigated: Maize/Sorghum & cattle Sakow Y Marka fruit cultivation and some livestock holdings as their Kurtun Warrey L. & M. Shabelle Agro-Pastoral rain-fed: Maize,cowpeas, sesame & cattle N M. JUBA Lower Juba Agro-Pastoral: Maize & cattle Sablale

E L. SHABELLE North-West Agro-Pastoral: Sorghum, cattle main means of livelihood. The agricultural potential, as Bu'aale North-West Valley Agro-Pastoral: Irrigated vegetables, shoats K Hagar Brava well as the labour and income opportunities in the area, Nugal Valley Pastoral: Sheep & camel Potato zone & vegetables make it a haven for seasonal and vulnerable populationsAfmadow Jilib Shabelle riverine: Maize, fruits & vegetables in normal and shock years. This has resulted in a high Sool-Sanag Plateau Pastoral: Camel, sheep & goats South-East Pastoral: Cattle, sheep & goats Jamaame density population living in this area, aggravated byL. J highUBA Southern Agro-Pastoral: Camel, cattle, sorghum in-flow of IDPs from Mogadishu. UNHCR estimates that 366,000 IDPs are living along the Afgoye corridor as a Southern Juba riverine: Maize, sesame, fruits & vegetables Kismayo Southern coastal pastoral: Goats, cattle result of the continuing violence and clashes in Mogadishu. Togdheer Agro-Pastoral: Sheep, goats & vegetables ± Urban Badhadhe 0 20 40 80 120 160 200 West Golis Pastoral: Goats, camel, sheep

Bay-Bakregional nutrition analysis ool Agro-pastoral Low Potential Historical Overview - Post Gu’ 09 Kilometers Bakool Agro-pastoral Low Potential Bay Agro-pastoral High Potential Southern Inland Pastoral: Camel, Sheep & Goats According to the FSNAU Post Gu ‘09 analysis, the food security situation showed a mixed picture indicating de- Datum: WGS84, Data Source: FSAU, 2009, terioration in agropastoral areas of Middle Shabelle and improvement in agropastoral and riverine livelihoods of Admin. layers: UNDP, 1998 Lower Shabelle. Almost half of the population or 48% in Middle Shabelle were in crisis with 158,000 people in Food Security Analysis Unit - Somalia http://www.fsausomali.org Humanitarian Emergency (HE) and 59,000 in Acute Food and LivelihoodP.O. Box 1230 CrisesVillage Market, N(AFLC)airobi, Kenya Em awithil: fsauinfo @afs aprojectedu.or.ke early tel: 254-20-3745734 fax:254-20-3740598 FSAU is managed by FAO. warning level of Watch up to December ’09. Agropastoral livelihoodsThe boundaries and ncontinuedames on these maps d oto not i mdeteriorateply official endorsement osincer acceptanc e Deyrby the Unite d‘08/09, Nations. however, the overall numbers in AFLC and HE slightly reducedThe regio nsinceal & District bDeyroundaries r ef‘08/09lect those endo r(AFLCsed by the Gove rnwasment of t he164,000 Republic of Som alandia in 198 6HE. was 65,000) due to a small improvement in the riverine areas. The urban poor in AFLC slightly reduced from Deyr ‘08/09 (AFLC was 30,000) to 25,000. Lower Shabelle, in contrast, had a significant improvement in the food security situation for riverine and agropastoral livelihoods, such that the there were only 5,000 people in HE (53,000 in Deyr ‘08/09) and 50,000 people in AFLC (71,000 in Deyr ‘08/09). Similarly, there was a significant improvement in the food security situation for the urban poor with 35,000 in AFLC, a reduction from 65,000 estimated in the Deyr ‘08/09.

The Post Gu ‘09 integrated nutrition analysis indicated that the nutrition situation had deteriorated in the agropas- toral population from the previous Serious situation reported in the Deyr ‘08/09 to Critical in the Gu ’09 returning to previous levels where the GAM rates reported were above the emergency threshold of 15% (Fig 10). The IDPs (Merka-Afgoye corridor) and riverine populations remained in a sustained Serious nutrition phase. Historically these areas have witnessed an improving trend in nutrition situation, likely attributed to the improving food security indicators and interventions, especially among the IDP groups. Outbreaks of disease, such as acute watery diarrhoea, especially in Wanlaweyne and Merka, alongside outbreaks of measles and cholera in Afgoye and Merka were likely attributing factors to the deteriorating nutrition situation in the agropastoral populations.

Current Situation

Food Security In Middle Shabelle, the total population in crisis has reduced to 168,000 from 217,000 in Gu ‘09, with a majority of those who were in HE moving to AFLC. Only 35,000 remain in HE while 133,000 persons are in AFLC. In the agropastoral livelihood, 50-75% of the poor remain in HE while 25-50% of the poor and 75% of the middle class wealth group are in AFLC. A further 50% of the poor in riverine are also in AFLC. In Lower Shabelle, there are no populations in HE and the total population in crisis are 15,000 persons in the poor wealth group in AFLC (com- pared to 48,000 in Gu ‘09). This population includes 25% of the poor agropastoral in Walanweyne, 25% of the poor riverine in Sablale and 25% of the poor riverine in Merka, Qoryoley and Kurtnunwarey.

The food security situation has shown improvement in the Shabelle regions, but the recovery has been slow. The gradual recovery in the current food security situation in Middle and Lower Shabelle is a result of the regions recov- ering from long-term impacts of five, and now the sixth in parts of Middle Shabelle, consecutive seasons of below average crop production due to poor rainfall; limited irrigation facilities and lack of inputs; deteriorated rangeland conditions causing abnormal livestock out-migration; poor livestock body conditions; low milk production; and high

FSNAU Technical Series Report No VI. 25 21 Issued February 22 2010 livestock off-take. The situation is exacerbated by highly volatile civil insecurity with clan conflict over limited resources, as well as political conflict between opposing groups struggling for power. The Deyr ‘09/10 rains were normal in Lower Shabelle and below normal in Middle Shabelle, except in Adale district (the cowpea belt). Lower and Middle Shabelle regions produced 22,550 MT and 10,330 MT of cereals, accounting for the second (18%) and third (8%) of the national production respectively after Bay region. The Deyr ’09/10 regional cereal production is 144% and 99% of the 5-year average in Middle and Lower Shabelle regions respectively but only 80% and 62% of PWA in the respective regions. Labour opportunities are limited to agricultural activities in riverine areas, but there is a significant improvement in livestock assets.

Nutrition The nutrition situation has significantly improved in the agro-pastoral population from the previousCritical situation reported in the Gu ’09, where the GAM rate was above the emergency threshold of 15% (Figure 10 ) to Serious. The improvement is attributed to improved food security following increased access to and consumption of milk and crops (maize rice, sesame and cow peas) following normal rainfall in the cowpea-belt agro-pastoral areas. The riverine population remained in a sustained Serious nutrition phase for the fourth consecutive season. The riverine population has had better dietary diversity and access to fish, fruits and vegetables than their agro-pastoral counterparts. The IDPs (Afgoye corridor), however showed a deterioration in their nutrition situation from the previously sustained Serious situation to a Critical phase. Furthermore, except for Merka town, no disease outbreaks were reported in Middle and Lower Shabelle, unlike the previous season when AWD, especially in Wanlaweyne and Merka, alongside outbreaks of measles and cholera in Afgoye Figure 10. Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Shabelle Regions and Merka had aggravated the (2000-2009) nutrition situation. The IDPs previously witnessed a stable 30.0 or improving trend in nutrition situation, likely attributed to the interventions at scale in the areas, but reductions in the scale

15.0 and quality of interventions, % interruptions to humanitarian access, continued influx of new IDPs in the last six months with Percentage poor shelter and limited access

to food and non food items have 0.0

likely led to this deterioration. Nov.07 Nov.08 Nov.09 Nov.07 Nov.08 Nov.09 Nov.07 Nov.08 Nov.09 May.07 May.08 May.09 May.07 May.08 May.09 May.08 May.09

Shabelle Riverine Shabelle Agropastoral Shabelle IDP The results of nutrition assess- ments conducted in December 2009 reported a GAM rate of 15.9% (11.7-20.2) among the Afgoye IDPs with a SAM rate of 5.5% (2.7-8.2) including one oedema case (0.1%) which indicates a deterioration to a Critical phase from the regional nutrition analysis Serious nutrition situation in the previous assessments in May 2009, when GAM and SAM rates of 11.7% (8.8-14.7) and 3.5% (2.0-5.1) were recorded respectively. The increase in GAM rate was significant at 90% probability using the CDC calculator. The 90 days retrospective crude and under-five year mortality rates were 1.27 (0.79-2.04) and 2.32 (1.32-4.06) deaths/10,000/day respectively, both being above the emergency thresholds and indicating a dete- rioration from the respective rates of 0.50 (0.28-0.88) and 1.00 (0.46-2.19) in the previous assessment. The actual causes of these elevated death rates are not known, but high morbidity incidences (47.4%), high numbers of severely malnourished children and poor shelter conditions following continued movements of IDPs back and forth from Mogadishu are aggravating factors for poor health outcomes (Table 7). The December 2009 Nutrition surveys in Shabelle regions were conducted jointly by FSNAU/UNICEF, Muslim Aid, Somalia Red Crescent Society (SRCS), Green Hope, Zam Zam, COSV, INTERSOS, SACOD and Community Organization.

The result for the riverine livelihood survey in Middle Shabelle reported a GAM rate of 11.6% (7.7-15.4) and a SAM rate of 4.2% (2.7-5.8) including six (0.9%) oedema cases, which indicates a sustained Serious nutrition situation with no change from the results of the previous assessment conducted in May 2009 reporting a GAM rate of 10.3% (5.4-15.3) and a SAM rate of 2.0% (0.1-3.9) with two (1.0%) oedema cases. The 90 days retrospective crude and under-five year mortality rates were0.61 (0.36-1.05) and 0.79 (0.38-1.67) deaths/10,000/day respectively both below the alert levels. Although the food security indicators remain positive, especially in Lower Shabelle, outbreaks of AWD in Merka should be monitored in the event that it spreads to the neighbouring riverine region, compromising the nutritional situation of the vulnerable population.

FSNAU Technical Series Report No VI. 30 22 Issued February 22 2010 Table 7. Summary of Key Nutrition Findings in Middle Shabelle Region

IDPs (N=734) Agro-pastoral (=649) Riverine (N=640) Indicator Results % Outcome Results % Outcome Results % Outcome Child Nutrition Status Global Acute Malnutrition (WHZ<-2 or oedema) 15.9 (11.7 – 20.2) Critical 12.5 (9.8-15.2) Serious 11.6 (7.7-15.4) Serious Severe Acute Malnutrition (WHZ<-3 or oedema) 5.5 (2.7 – 8.2) Very Critical 3.5 (2.2 - 4.9) Serious 4.2 (2.7-5.8). Critical Oedema 0.1 (0.0 – 0.4) Alert 0.5 (0.0 – 1.0) Serious 0.9 (0.0 – 1.9) Serious Global Acute Malnutrition (WHZ<-2 or oedema; 12.2 10.2 (7.0 – 15.8 (12.0 – 19.6) Critical Serious Serious NCHS) (9.7 – 14.6) 13.3) Severe Acute Malnutrition (WHZ<-3 or oedema; 2.5 (1.1– 3.8) Alert 2.3 (1.2 – 3.4) Alert 2.3 (1.2 – 3.5) Alert NCHS) Acute malnutrition by MUAC (<12.5 cm or 11.7 (8.3 – 11.2 (8.0 – 14.3) Critical 8.5 (6.5 – 10.5) Serious Critical oedema in nutrition surveys) 15.1) 19.9 (16.3 – 37.0 Stunting (HAZ<-2) 27.5 (21.6 – 33.4) Serious Alert Serious 23.5) (29.7 – 44.3) 16.6 (12.6 – 24.2 Underweight (WAZ<-2) 23.6 (18.5 – 28.7) Serious Alert Serious 20.7) (18.2 – 30.2) Low levels High levels HIS Nutrition Trends(Aug-Dec’08) - - (<10%) and Serious (>15%) but Critical declining stable Proportion of acutely malnourished regis- 4.1 5.1 (0.0-12.5) - 8.6 (0.3-17.0) - - tered in SFs (0.0-8.9) Child Morbidity & Immunization No Outbreak No Outbreak regional nutrition analysis Disease trends (seasonally adjusted) No Outbreak Morbidity– Morbidity– 43.3 Morbidity refers to the proportion of children re- Morbidity– 47.4 Serious Serious 42.3 Serious RDT positive ported to be ill in the 2 weeks prior to the survey RDT positive – N/A RDT positive – N/A – N/A Vitamin A - Vitamin A -70.8 Vitamin A -40.7 49.2 Immunization Status Serious Critical Critical Measles – 69.8 Measles – 38.2 Measles – 54.7 Infant and Young Child feeding (6-24 N=284 N=245 N=241 months) Proportion still breastfeeding 50.0 41.6 49.4 Proportion introduced to complementary food 12.0 6.9 7.5 at age of six months Proportion meeting recommended minimum 44.0 - 47.3 54.4 feeding frequency Mortality N=549 N=692 N=577 Crude Mortality Rate per 10,000 per day 0.93 0.61 1.27 (0.79 – 2.04) Serious Alert Alert (retrospective for 90 days) (0.62 – 1.38) (0.36-1.05) Under five mortality rate per 10,000 per day 1.05 0.79 2.32 (1.32 – 4.06) Serious Alert Acceptable (retrospective for 90 days) (0.47-2.33) (0.38-1.67) Women Nutrition & Immunization Status Proportion of acutely malnourished non preg- 0.7 0.4 0.3 (N=298) Acceptable Acceptable Acceptable nant women (MUAC≤18.5 cm) (N=289) (N=278) Proportion of acutely malnourished pregnant 9.4 8.7 17.3 (N=104) Critical Alert Alert women (MUAC<23.0). (N=96) (N=104) Proportion of Women who received Tetanus N=402 N=385 N=381 Vaccine 1 doze 16.9 14.3 14.4 - - - 2 dozes 15.2 15.1 22.0 3 dozes 31.8 13.8 36.7 Public Health Indicators N=403 N=478 N=434 Households reported with access to safe 34.2 Very Criti- 51.6 98.3 (97.1 – 99.4) Alert Critical water (16.0 – 52.4) cal (31.2 – 71.9) Household reported with access to sanitation 26.0 Very Criti- 31.7 Very Criti- 99.0 (97.8 – 100.0) Alert facilities (14.9 – 37.0) cal (15.1 – 48.4) cal Households with access to health facility 48.8 Critical 47.7 Critical 56.9 Serious 64.5 62.4 Proportion who own mosquito nets 4.7 (N=400) (N=389) (N=378) Proportion using mosquito nets ------Food Security N=404 N=389 N=378 Household’s Main Food Source Purchase: 24.5 55.0 43.4 Own Production 0.0 41.9 53.7 Food aid 74.3 0.5 1.6 Critical/ Food security phase HE Very Critical HE/AFLC Very Criti- AFLC Critical cal Overall Situation Analysis Critical Serious Serious

FSNAU Technical Series Report No VI. 25 23 Issued February 22 2010 In the Middle1 Shabelle the agropastoral assessment reported a GAM rate of 12.5% (9.8-15.2) and SAM rate of 3.5% (2.2-4.9) with three (0.5%) oedema cases. The results of the previous assessment in May 2009 displayed a high standard deviation on the weight-for-height z-scores (WHZ) that did not pass the EPI-ENA quality/plausibility check, nonetheless it reported a point prevalence GAM rate of 19.6% (14.6-28.8) and a SAM rate of 8.2% (5.7-11.6) with a 90% probability that the GAM rate >15.5% and SAM rate > 6.5% indicating a Critical nutrition situation. The current Serious nutrition situation therefore indicates a significant improvement (p=0.023; Pr=97.7%) from the Criti- cal phase reported the previous six months. The 90 days retrospective crude and under-five year mortality rates were 0.93 (0.62-1.38) and 1.05 An assessment team in a previous survey, Shabelle (0.47-2.33) deaths/10,000/day respectively, both classified in the borderingalert phase. Given the AWD, cholera and measles outbreak and the elevated mortality rates (CMR and U5MR mortality rates of 1.02 and 2.43 respectively) reported that time 6 months ago, the deterioration was linked to disease rather than food insecurity. There was no disease outbreak reported in the agropastoral population this time round and food security indicators showed substantial improvement including increased milk access and consumption, which could explain the situation reverting to Serious nutrition situation reported the previous year in Deyr ‘08/09 (Table 7).

There were no comprehensive nutrition assessments conducted in Lower Shabelle regions, for lack of access to these areas. However, given that food security indicators have improved in Lower Shabelle more than in Middle Shabelle and similar trends are observed in HIS data, the nutrition situation in agropastoral and riverine are both likely to be Serious in Lower Shabelle as well. The key nutrition findings in these areas which form the basis of the analysis on the classification outcome are provided in the Table 7.

Mogadishu is also likely to be Very Critical show- Figure 11: HIS Trends in % of Malnourished children ing no change from previous assessments. Although reporting, Mogadishu MCHs 2008-2009 no assessment was conducted in Mogadishu, HIS data from three of the four reviewed health facili- ties are indicating very high numbers (>20%) of acutely malnourished children but stable for the previous six months period under review (Source:

regional nutrition analysis HIS data July-December ’09, Figure 11). Further, response agencies implementing selective feeding programmes report high and constant levels of ad- missions of severely malnourished children. Due to the poor civil security situation, there continues to be displacement within and out of Mogadishu town with poor access to safe water, sanitation facilities and health services into the surrounding regions or IDP camps, causing concern of deterioration in their nutrition situation.

FSNAU Technical Series Report No VI. 30 24 Issued February 22 2010 SOMALIA: LIVELIHOOD ZONES

Calula

DJIBOUTI Gulf of Aden Qandala

Zeylac Bossaaso Lughaye AWDAL Ceerigaabo Las Qoray/Badhan Baki Berbera SANAG Iskushuban Borama Ceel Afweyne BARI Sheikh Gebiley W. GALBEED

Hargeysa Qardho Burco Owdweyne Xudun Caynabo Talex Bandar Beyla TOGDHEER SOOL

Laas Caanood Buuhoodle Garowe

Legend Eyl "/ NUGAL Country capital Burtinle International boundary

Regional boundary Jariiban ETHIOPIA Goldogob District boundary Galkacyo n a e River c O

Coastline n a Cadaado MUDUG i d 4.5 Hiran region Hobyo n Cabudwaaq I Hiran region comprises of three main livelihood groups: Map 8: Hiran Region Livelihood Zones the Southern Inland Pastoral covering Mataban and Mahas districts; and the agropastoral and riverine, both Dhusa Mareeb of which cut across Beletweyne, Buloburti and Jalalaqsi districts. Like many other regions in Somalia, Hiran region has not escaped the effects of high intensity civil conflict, which has affected people’s means of livelihood. GALGADUD Harardheere Intermittent localised civil conflict, as well asC theee targetl B-arde Beled Weyne ing of aid workers in the region, has continued to hinder Ceel Bur humanitarian access. As a gateway connectingBA theK NorthOO L Livelihood zones with South Somalia, Hiran continues to experience vola- HIIRAN Addun Pastoral: Mixed sheep & goats, camel tile civil insecurity andR beingab -aD regionhuu borderingre Ethiopia, Xudur Awdal border & coastal towns: Petty trading, fishing, salt mining the effects of cross-border tensions still abound (Map 8). Ceel Dheere Dolo Central regions Agro-Pastoral: Cowpea, sheep & goats, camel, cattle Historical Overview - Post Gu ’09 Bulo Barde Luuq Wajid Tayeglow Coastal Deeh: Sheep According to the FSNAU Post Gu ’09 analysis, the food Aden Yabal Dawo Pastoral: Shoats, cattle, camel Beled Hasecuritywa situation had deteriorated since Deyr ‘08/09 due Jalalaqsi East Golis Pastoral: Frankinncense to a combination of factors including cumulative impacts Baydhaba Cadale Fishing of fiveGa consecutiverbahar eseasonsy of below normal crop produc- regional nutrition analysis tion, recurrent conflict, and fluctuating and low economic activity. Consequently,J o245,000wha r(74%)M of. theS totalHA regionalBE LLE Gagaab Pastoral: Frankincense population Qwerean classifiedsax Dh ine ehumanitarianre crisis, of which 165,000 were inHE , while 80,000 were in AFLC. This Guban Pastoral: Sheep, goats & camel was an increase in the total number of people in crisis from 200,000Wan inle Deyr We ‘08/09yne of which 135,000 were in HE Hawd Pastoral: Camel, sheep & goats GEDOand 65,000 were in AFLC. The agropastoralBAY livelihood zone was the worst affected with 94,000 people in HE and 29,000 in AFLC. The pastoral livelihood had 35,000 people in HE and 27,000 in AFLC, while an estimated 29,000 Hiran Agro-Pastoral Ceel Waq Balcad of riverine livelihood population were in HE.Bu r Hakaba Hiran riverine: Sorghum, maize, cattle & shoats Afgoye Juba pump irrigation: Tobacco, onions, maize BaardheTheere Post Gu ‘09 integratedDinsor nutrition analysis of the data from nutrition assessments,"/ trendsB of AadmissionsNAD fromIR the health facilities and selective feeding program data indicated a Very Critical nutrition MsituationOGADISH inU the agropastoral Kakaar-Dharor Pastoral: Sheep, goats, camel

A livelihood, a deterioration from the Critical situation inQ Deyror y‘08/09ole yphase and a sustained Critical nutrition situation L. & M. Shabelle Agro-Pastoral Irrigated: Maize/Sorghum & cattle Sina theko riverinew and pastoral livelihoods in Hiran region, attributed to the unstable food security and high morbidity Y Marka rates, which continue to be experiencedKu inr ttheun region. Wa rrey L. & M. Shabelle Agro-Pastoral rain-fed: Maize,cowpeas, sesame & cattle

N M. JUBA Lower Juba Agro-Pastoral: Maize & cattle Current Situation – Post Deyr ’09/10Sablale

E L. SHABELLE North-West Agro-Pastoral: Sorghum, cattle Bu'aale Food Security North-West Valley Agro-Pastoral: Irrigated vegetables, shoats

K Brava HagarThe overall food security situation in Hiran region has remained at crisis levels since Gu ’09. Although population numbers reduced slightly from 165,000 in the Gu ‘09 to 164,000 in the Deyr ’09/10 in HE and from 80,000 to 73,000 Nugal Valley Pastoral: Sheep & camel in AFLC, the total population in crisis have remained more or less stable with 237,000 people (about 73% of the Potato zone & vegetables Afmadow region’s rural and urban population)Jilib still in crisis. Currently 100% of the poor, 50-75% of the middle-income group’s Shabelle riverine: Maize, fruits & vegetables agropastoral population remains in HE and 25-50% of the middle income are in AFLC. The riverine also has 100% of both the poor and middle-income groups in HE. Among the pastoral, 100% of poor and middle income group Sool-Sanag Plateau Pastoral: Camel, sheep & goats and 50% of the better off in Hawd as well as 75% of the poor in Southern Inland Pastoral are in HE. The continued South-East Pastoral: Cattle, sheep & goats Jamaame L. JUBAhumanitarian crisis is the result of continued seasons of poor rainfall, the seventh in succession in Deyr ‘09/10, Southern Agro-Pastoral: Camel, cattle, sorghum which has led to another season of crop failure (crop production is at 31% of 1999-2008 PWA) and limited livestock production and saleable animals, alongside high livestock off-take. Furthermore, poor pasture has resulted in delay Southern Juba riverine: Maize, sesame, fruits & vegetables in return of the livestock that migrated to Lower Shabelle region, resulting in poor access to milk in Hiran region, Southern coastal pastoral: Goats, cattle Kisfurthermay compromisingo the nutrition situation especially of women and children. Decreased income and limited labour Togdheer Agro-Pastoral: Sheep, goats & vegetables opportunities are also having an impact on household income and resulting in further food access stress. This has resulted in some distress coping strategies, such as an increase in charcoal production± and migration to main towns. Urban Badhadhe 0 20 40 80 120 160 200 West Golis Pastoral: Goats, camel, sheep Nutrition Bay-Bakool Agro-pastoral Low Potential The nutrition situation of the agropastoral population in Hiran indicates a sustainedKilome Veryters Critical situation since Gu ‘09 while the pastoral populations show a deterioration from the Critical phase in Gu ’09 to current Very Critical. Bakool Agro-pastoral Low Potential The riverine population remains in a sustained Critical phase since the Gu ‘07. Historically, the agropastoral and Bay Agro-pastoral High Potential riverine populations of Hiran region have usually been about or above the emergency thresholds of 15% (Figure 12). Southern Inland Pastoral: Camel, Sheep & Goats Datum: WGS84, Data Source: FSAU, 2009, Admin. layers: UNDP, 1998

FSNAU Technical Series Report No VI. 25 25 Issued February 22 2010 Food Security Analysis Unit - Somalia http://www.fsausomali.org P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] tel: 254-20-3745734 fax:254-20-3740598 FSAU is managed by FAO. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986. The results of three nutrition assessments conducted jointly by FSNAU/UNICEF, WFP, International Medical Corps, Save the Children - UK, Mercy USA and Somalia Red Crescent Society between the 26th October and the 5th of November 2009, reported a GAM rate of 21.2% (16.5-25.8) and a SAM rate of 5.3% (3.1-7.6) with 1 (0.1 %) oedema case in Hiran pastoral livelihood; which indicates deterioration from the previous Critical phase in the Gu ’09 to a Very Critical current nutrition situation. This was the second nutrition assessment that focused on Hiran pastoralists. The assessment conducted in April 2009 had reported a GAM rate of >15.0% (Pr=0.95) using the CDC calculator, falling in the Critical levels of 15.0-19.9%. However, analysis using the two survey CDC calcula- tor did not show any significant change between the surveys. The respective Crude and Under Five Death Rates of 0.50 (0.27 – 0.95) and 0.82 (0.40 – 1.67) deaths/10,000 persons/day among the pastoralists are both below the alert threshold. The high morbidity rates experienced in the area, with more than half (51.1%) of the assessed children reportedly having fallen ill in the two weeks prior to the assessment, however, are still of concern. Although there has been no reported outbreak of disease, the area needs to be monitored closely due to the hindrance of humanitar- ian interventions in the area. Figure 12. Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Hiran region (2000-2009) Percentage

In the Hiran agropastoralist assessment, findings recorded a GAM rate of 23.4 % (19.0-27.8) and a SAM rate of 7.4% (3.9-10.9) with no oedema case. These results indicate a Sustained Very Critical nutrition situation in the agropastoralists. The respective crude and under five year mortality rates of 0.54 (0.36-0.82) and 0.84 (0.32-2.17) are below the WHO alert levels of 1/10,000/day and 2/10,000/day, although morbidity rates are high and remain of major concern, with nearly half (41.6%) of the assessed children reported to have fallen ill in the two weeks prior to the assessment in the agropastoral households. In the Hiran riverine livelihood zone, using the CDC Probability

regional nutrition analysis Calculator, results show a high probability of the GAM level falling above 18.8% (Pr=0.90) and SAM rate falling above 2.6 % (P=0.90), indicating a Critical nutrition situation. This situation indicates a sustained situation from findings of the assessments conducted in April 2009, which reported a GAM rate of 16.9% (11.5-22.2) and a SAM rate of 4.6% (2.7-6.5) including four (0.7%: 0.0-1.4) oedema cases. Statistical analysis between the November ‘09 and the April 2009 surveys did not indicate any significant difference in the three assessments results.

The key nutrition findings in these areas which form the basis of the analysis on the classification outcome are provided in Table 8.

FSNAU Technical Series Report No VI. 30 26 Issued February 22 2010 Table 8. Summary of Key Nutrition Findings in Hiran Region

Pastoral (N=695) Agropastoral (=795) Riverine (N=197) Indicator Results % Outcome Results % Outcome Results % Outcome Child Nutrition Status 21.2 Very 23.4 Very >18.8 Global Acute Malnutrition (WHZ<-2 or oedema) Critical (16.5 – 25.8) Critical (19.0-27.8) Critical (pr=0.90) 5.3 Very 7.4 Very >2.6 Severe Acute Malnutrition (WHZ<-3 or oedema) Alert (3.1– 7.6) Critical (3.9-10.9) Critical (pr=0.90). Oedema 0.1 (0.0 – 0.4) 0 0.5 Acceptable Acceptable Alert (0.0 – 0.0) (pr=0.90) Global Acute Malnutrition (WHZ<-2 or oedema; 20.1 Very 23.0 Very >19 (pr=0.90) Critical NCHS) (15.0 – 25.2) Critical (18.8 – 27.3) Critical Severe Acute Malnutrition (WHZ<-3 or oedema; 3.3 3.9 Serious Serious >1.1 (pr=0.90) Alert NCHS) (1.5 – 5.1) (1.7 – 6.1) Acute malnutrition by MUAC (<12.5 cm or 5.1 5.4 10.1 Serious Serious Critical oedema in nutrition surveys) (3.1-7.6) (2.5-8.3) (4.8-15.4) 22.0 21.7 20.8 Stunting (HAZ<-2) Serious Serious Serious (16.9 – 27.0) (17.1 – 26.4) (13.9 – 27.7) 23.5 26 24.8 Underweight (WAZ<-2) Serious Serious Serious (18.4 – 28.7) (20.9 – 31.9) (17.9 – 31.8) High levels High and stable HIS Nutrition Trends (July-Dec. ‘09) High levels and stable Critical with increasing Critical Critical trends trends High numbers High number with High numbers with with increasing Admission trends at TFPs/SFPs (July-Dec. ‘09) increasing trend of Critical Critical increasing trends Critical trend of

admission of admission regional nutrition analysis admission Proportion of acutely malnourished 12.9 9.2 Critical Critical 0 Critical registered in SFs (3.5-22.3) (3.0-15.3) Child Morbidity & Immunization Disease trends (seasonally adjusted) No Outbreak No Outbreak No Outbreak Morbidity refers to the proportion of children Morbidity – 41.6 Very Morbidity– 51.4 Critical Serious Morbidity – 60.9 reported to be ill in the 2 weeks prior to the RDT positive Critical RDT positive – 4.9 RDT positive – N/A survey – 4.5 Vitamin A -31.7 Vitamin A 35.5 Vitamin A 63.4 Immunization Status Serious Serious Serious Measles – 32.7 Measles - 40 Measles -63.5 Infant and Young Child feeding (6-24 N=203 N=279 N=65 months) Proportion still breastfeeding 37.6 - 44.7 - 57.4 - Proportion introduced to complementary 8.7 - 13.9 - 12.1 - food at age of six months Proportion meeting recommended minimum 53.5 - 60.7 - 62.1 - feeding frequency Mortality N=672 N=692 Crude Mortality Rate per 10,000 per day 0.50 0.54 Alert Alert N/A (retrospective for 90 days) (0.27 – 0.95) (0.36 – 0.82) Under five mortality rate per 10,000 per day 0.82 0.84 Serious Alert N/A (retrospective for 90 days) (0.40 – 1.67) (0.32-2.17) Women Nutrition & Immunization Status Proportion of acutely malnourished non 1.5 2.1 3.2 Alert Acceptable Acceptable pregnant women (MUAC≤18.5 cm) (N=1) (N=315) (0.0 – 7.9) Proportion of acutely malnourished pregnant 21.2 Very 23.3 Very 10.5 Serious women (MUAC<23.0). (N=14) Critical (N=168) Critical (0.0 – 27.2) Proportion of Women who received Tetanus Immunization No Dose 22.6 12.3 9.5 Critical Critical Critical One Dose 14.7 11.6 39.6 Two Doses 10.2 10.7 30.1 Three or More 52.3 33.5 20.6 Public Health Indicators N=403 N=478 N=434 Households with access to safe water 20 (4.3 – 35.6) Critical 18.3 (3.0 – 33.6) Critical 31.6 Serious 30.9 (16.5 – Household with access to sanitation facilities 18.1 (5.3 – 30.8) Critical Serious 43.5 Serious 45.3) 22.3 22.1 Proportion who own mosquito nets N/A N=274 N=241 15.6 16.0 Proportion using mosquito nets N/A N=1226 N=1090 Food Security N=403 N=478 N=434 Households with poor dietary diversity (< 4 47.5 52.6 Very 43.0 Very Critical food groups) (39.3-55.7) (43.4-61.7) Critical (28.6-57.4) Critical Household’s Main Food Source Purchase: 82.2 62.7 Own Production 12.9 32.1 Food aid 0.5 3.7 Food security phase HE Critical HE Critical HE Serious Overall Situation Analysis Very Critical Very Critical Critical

FSNAU Technical Series Report No VI. 25 27 Issued February 22 2010 SOMALIA: LIVELIHOOD ZONES

Calula

DJIBOUTI Gulf of Aden Qandala

Zeylac Bossaaso Lughaye AWDAL Ceerigaabo Las Qoray/Badhan Baki Berbera SANAG Iskushuban Borama 4.6 Central Somalia: Galgadud and Mudug regionsCeel Afwey ne BARI Sheikh Gebiley W. GALBEED Central Somalia comprises of the two regions of Galgadud and South Mudug. There are four main livelihood zones: two of which are pastoral (Addun, Hawd);Ha ronegey swhicha is pastoral as well as fishing (Coastal Deeh) and one agropastoralQardh o Burco Owdweyne Xudun livelihood (Cowpea Belt). The Hawd and Addun pastoral livelihoods spanCa yacrossnabo the regions of Galgadud,Talex Mudug and Bandar Beyla TOGDHEER Southern Nugal, while the Coastal Deeh spans from the coast of Galgadud up to Allula,SO cuttingOL across the Central and Northeast regions, (Map 9). This section will cover the nutrition situation in the Hawd and Addun Pastoral as well as the agropastoral Cowpea belt. The Coastal Deeh Pastoralists is discussed in the sectionLaas covering Caanood the Northeast zone. Buuhoodle Garowe Historical Overview - Post Gu ’09 Legend According to the FSNAU post Gu ’09 integrated food se- Map 9: Central regions Livelihood Zones Eyl "/ NUGAL curity phase Cclassificationountry ca panalysis,ital the situation in Central Burtinle regions had significantlyInternation adeterioratedl bounda inry severity since the Deyr ‘08/09, with the number of people in Humanitarian Emergency R(HE)egi oincreasingnal bou bynd 20%ary in all livelihoods. An Jariiban ETHIOPIA Goldogob estimated 79%Dis oftr ithect bpopulationoundary of Galgadud and 51% of Galkacyo n a e the populationRi vofe Mudugr were either in Acute Food and c O Livelihood Crisis (AFLC) or Humanitarian Emergency Coastline n (HE), with 75% of the 440,000 people in crisis falling in a Cadaado MUDUG i HE. An estimated 385,000 of those in crisis were rural d Hobyo n pastoralists and 55,000 were urban poor. Cabudwaaq I

The Post Gu ’09 integrated analysis of the nutrition infor- Dhusa Mareeb mation in Central regions indicated an alarming nutrition situation in the two main pastoral livelihoods. Both the GALGADUD Harardheere Hawd and Addun pastoral livelihoodsCe indicatedel Barde no sigBel-ed Weyne Ceel Bur nificant change from the post DeyrB ‘08/09,AKOO remainingL in Livelihood zones Addun Pastoral: Mixed sheep & goats, camel a Critical nutrition phase.Ra Theb-Dh uCriticalure situation in bothH IIRAN Xudur Awdal border & coastal towns: Petty trading, fishing, salt mining livelihoods was attributed to a combination of factors Ceel Dheere Dolo Central regions Agro-Pastoral: Cowpea, sheep & goats, camel, cattle including the chronic food insecurity, ongoing displace-Bulo Barde Luuq Wajid Tayeglow Coastal Deeh: Sheep ment and high morbidity burden coupled with a severe Aden Yabal Dawo Pastoral: Shoats, cattle, camel lack ofBe accessled Haw toa basic services and limited humanitarian Jalalaqsi East Golis Pastoral: Frankinncense assistance for theGar affectedbaharey population.Baydhab Thea Coastal Deeh Cadale Fishing pastoral livelihood zone and the Cowpea Belt agropastoralJow livelihoodhar M. SH zoneABE reportedLLE a sustained SeriousGagaab Pa snutrition,toral: Frankincen se Guban Pastoral: Sheep, goats & camel with a risk to furtherQa ndeteriorationsax Dheere in the CowpeaWa Beltnle W asey nae result of the below normal Gu ’09 rains. GEDO BAY Hawd Pastoral: Camel, sheep & goats Hiran Agro-Pastoral Ceel Waq Bur Hakaba Balcad Current Situation Hiran riverine: Sorghum, maize, cattle & shoats Afgoye Juba pump irrigation: Tobacco, onions, maize Baardheere Dinsor "/ BANADIR MOGADISHU Kakaar-Dharor Pastoral: Sheep, goats, camel regional nutrition analysis

A Food Security Qoryoley L. & M. Shabelle Agro-Pastoral Irrigated: Maize/Sorghum & cattle Sakow Y Marka The food security situation in theKu drought-affectedrtun Warrey central regions remains in crisis. In the rural L.population, & M. Shabelle Agro- Ptheastora l rain-fed: Maize,cowpeas, sesame & cattle

N number of peopleM. JU inB AHumanitarian Emergency (HE) has decreased from 308,000 in the Gu’09 toLo w254,000er Juba Agro- Pinasto rtheal: Ma ize & cattle Sablale E Deyr ‘09/10 while the total number of peopleL. S HinA AcuteBELL FoodE and Livelihood Crisis (AFLC) hasN increasedorth-West Agro-Pa sfromtoral: So rghum, cattle Bu'aale North-West Valley Agro-Pastoral: Irrigated vegetables, shoats K 76,000 inHa gthear Gu’09 to 154,000 in theB rDeyrava ’09/10. This increases the total rural population in crisis to 408,000 in the Deyr’09/10. Furthermore there is an early warning of ‘watch1’ for further deterioration. The reductionNug aofl Va llpopulationey Pastoral: Sheep & camel Potato zone & vegetables Afmadow in HE was due to some positiveJilib food security indicators from the Cow Pea Belt, which received normalShabelle riv erainsrine: Mai zande, fruits & vegetables produced a good harvest of cash crops – cow peas. Sool-Sanag Plateau Pastoral: Camel, sheep & goats South-East Pastoral: Cattle, sheep & goats L. JUBA Jamaame The food security situation continued to remain in crisis however in the pastoral areas, due to the 6 consecutiveSouthern Agro- Pseasonsastoral: Cam el, cattle, sorghum of rain failure leading to limited livestock production and reproduction as well as high livestock off-take,South compoundedern Juba riverine: Maize , sesame, fruits & vegetables Kismayo Southern coastal pastoral: Goats, cattle by the effects of high food and non-food prices, high water prices alongside depletion of pasture andTo gthedheer Asignificantgro-Pastoral: Sheep , goats & vegetables decline of household income. Food access significantly ±deteriorated in the Hawd and Addun livelihoodUrban zones as a resultBad hofad thehe deteriorating rangeland conditions0 (water20 40 and80 pasture)120 160 resulting200 in poor livestock body conditions;West Golis Pastor alowl: Goa ttos, c amel, sheep Bay-Bakool Agro-pastoral Low Potential none calving/kidding rates for all livestock species; overstressedKilometers and forced abnormal migration within the regions; Bakool Agro-pastoral Low Potential high livestock off-take and declines in livestock herds significantly below the baseline; and veryB afewy Agro -pasmarketabletoral High Potenti al livestock for selling resulting in a decline in prices. However, the Cowpea Belt and Coastal Deeh livelihoodSouthern Inland P azonesstoral: Cam el, Sheep & Goats continued to receive normal rains throughout the season, leading to the normal production of cowpeaDatum: andWGS sorghum84, Data So urce: FSAU, 2009, in these regions. This has resulted in an improvement in rangeland conditions (water and pasture) resultingAdm inin. ala yhighers: U NDP, 1998 conception rate for both camel and shoats, and medium for the cattle in the Coastal Deeh.

Food Security Analysis Unit - Somalia http://www.fsausomali.org 1 A “watch” status indicates an occurrenceP.O of,. Bo xor 12 predicted30 Village M aHazardrket, Nairo beventi, Keny astressing Email: fsa livelihoods;[email protected] ewith low or uncertain Vulnerability. Close moni- toring and analysis is required. tel: 254-20-3745734 fax:254-20-3740598 FSAU is managed by FAO. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986.

FSNAU Technical Series Report No VI. 30 28 Issued February 22 2010 The calving/kidding rate this season remains poor as a result of low conception rate in the previous season, yet this is projected to change due to the high conception rate this season. The situation is further exacerbated by resource based conflicts around the rural settlements, including Hobyo, and the current clashes between various armed groups in the region. Distress coping strategies have increased in the Hawd and Addun with drop out pastoralist settlements established in the Hawd livelihood, resulting from the near complete and irreversible depletion or loss of assets.

Nutrition The Post Deyr ‘09/10 integrated nutrition analysis conducted by FSNAU and partners has indicated a sustained Critical nutrition situation in the Hawd and Addun pastoralists, a Serious nutrition situation in the Cowpea agropastoralists and an Alert nutrition phase in the Coastal Deeh pastoralists. Furthermore, the Hawd and Addun livelihood zones indicate a further risk to deterioration if the underlying factors are not addressed.

Hawd and Addun Pastoralists In November 2009, FSNAU conducted two livelihood based nutrition assessments alongside two regional as- sessments in Galgadud and Mudug, jointly by UNICEF, WFP, MOH, SRCS and Merlin, with preliminary results reported in the FSNAU Nutrition Update in December 2009. The integrated analysis was conducted in Decem- ber 2009-January 2010 with the results shown in Table 8.

The Hawd pastoral reported a sustained Critical nutri- regional nutrition analysis tion situation, with a risk of deterioration, indicating no significant change from theGu ’09. The assessment reported a GAM rate of 19.1% (15.3-23.0) and a SAM rate of 4.3% (2.7-5.9) with 1 (0.2%) oedema cases, Poor water and sanitation practices, with an elevated under-five mortality threshold of 2.0 Addun Livelihood Zone, FSNAU Nov. ‘09 (0.94-4.24). The survey conducted in the Gu ’09, which reported a GAM rate of 18.0% (13.8-23.1) and a SAM rate of 5.5% (3.7-7.9) reported no significant difference. Mor- bidity remains high, with half of the assessed children reportedly ill in the two weeks prior to the assessment and immunisation remains below the accepted levels of 80%. Although a large number of assessed households reported having access to safe water (50.5%), the main source of this water remains water trucking. Furthermore, poor infant and young child feeding practices continue to predispose young children to illnesses and malnutrition. The poor food security indicators and increased insecurity in the livelihood indicates that the nutrition situation is likely to continue to deteriorate further in the coming months. This is exacerbated with the hampered response from agencies work- ing in the regions due to threats and instability and the lack of access to basic services for the affected population .

The Addun pastoral assessment reported a sustained Critical nutrition situation, with risk of deterioration, indicating no significant change from the PostGu ’09. The findings reported a GAM rate of20.2 % (15.6-24.7) and a SAM rate of 4.6% (2.8-6.3) with 3 (0.5%) oedema cases, and mortality levels below the alert threshold. Although the GAM rate falls just within the Very Critical nutrition situation phase according to the classification table, other indicators suggested that it falls in the Critical phase. Furthermore, using the CDC calculator, there is no significant difference between the respective GAM rates recoded in the recent survey and those reported in the Gu ’09, which reported a GAM rate of 17.3% (13.8-21.5) and a SAM rate of 2.6% (1.6-4.4). However, a significant difference was noted between the SAM rates recorded in the two assessments, at a probability of 93.9%. Almost half of the population assessed were reported to have access to sanitation facilities (48.4%) while 20.7% had access to safe water. The numbers with access to sanitation facilities was higher than usually expected of a pastoralist population, but further analysis indi- cated that the majority (69%) of those with access share a latrine with more than two households. This corresponds to the living situation of the Addun pastoralists, who live in communities rather than dispersed like other pastoral populations in Somalia. The poor food security indicators, poor infant and young child feeding practices (Table 8) and the high disease burden indicate that the nutrition situation is at risk to deteriorate in the coming months. No significant difference was noted between the Hawd and Addun assessments from the nutrition assessments, de- spite the Addun noting an elevated GAM rate falling within the Very Critical nutrition phase classification. Similar food security indicators, similar security threats and the hampered humanitarian response, indicate that the nutri- tion situation is similar across both livelihoods, with both experiencing a likelihood to deteriorate. Furthermore, the underlying causes of malnutrition, such as infant and young child feeding practices and morbidity, remain in a similar worrying nutrition situation across both livelihoods.

Two regional based nutrition assessments in Mudug and Galgadud region were conducted alongside the livelihood- based assessments in the Hawd and Addun at the request of WFP for response analysis and monitoring. In Galgadud, a GAM rate of 19.4% (14.5-24.3) and a SAM rate of 5.5% (3.0-7.9) were reported, which indicate a Critical nutrition

FSNAU Technical Series Report No VI. 25 29 Issued February 22 2010 situation and a deterioration from the Serious levels reported in the May 2009 assessment, when a GAM rate of 14.3% (10.3-19.3) and a SAM rate of 3.3% (1.9-5.3) were recorded (Table 8). Further analysis with the CDC calcula- tor indicated a significant difference between the two surveys at a probability of 85.1%. The crude and under-five mortality levels were both below the alert levels, although above the sub-Sahara Africa references. As in the liveli- hood surveys, morbidity remains a high burden with more than half (54.9%) of the assessed children reported to have suffered from one or more communicable childhood diseases during the two weeks prior to the assessments. Furthermore, it was associated with the increased risk of acute malnutrition, with children who were reportedly ill almost twice as likely to be acutely malnourished than their counterparts who were not ill (RR =1.76; 1.25-2.49).

Mudug region reported Very Critical levels of acute malnutrition in the Deyr ’09/10 analysis, and a deterioration from the Critical levels reported in May ’09. A GAM rate of 22.3% (17.6-27.0) and a SAM rate of 6.1% (4.1-8.1) was reported in the November ’09 assessment as compared to the Gu ’09, where a GAM rate of 18.3% (15.4-21.6) and a SAM rate of 4.9% (3.7-6.6). A significant deterioration was reported using the CDC calculator (pr=85.1%). However, no significant difference was reported between the two regions, indicating that both regions are equally vulnerable. Furthermore, there was no significant difference between the livelihood-based assessments and the regional assessment, indicating that the area is in a Critical nutrition situation. The four surveys were conducted jointly by FSNAU/UNICEF, WFP, MOH, SCRS and Merlin

Cowpea Belt Agropastoralists The agropastoral Cowpea belt, covering parts of Mudug, Galgadud and Middle Shabelle, received good Deyr rains in the current season, rejuvenating pasture and enabling normal crop production of cowpea and sorghum, with stocks available in the coming 3-4 months. Although no assessment was currently conducted in the livelihood, triangula- tion from various sources of data indicates a sustained Serious nutrition situation. Increased milk consumption and the positive food indicators, combined with the HIS trends indicating high but declining levels of acute malnutrition in the last few months. A MUAC rapid assessment conducted in 3 sites in the livelihood zone and measuring 296 children ,reported 4.7% with a MUAC less than 12.5cm, and none less than 11.5cm. Furthermore, as the livelihood cuts across to Middle Shabelle agropastoral and has a similar livelihood, food security indicators and recovery mechanisms, the results from the area could be extrapolated to give an indication on the nutrition situation in the Cowpea Belt. The Shabelle agropastoral assessment reported a GAM rate of 12.5% (9.8-15.2) and a SAM rate of 3.5% (2.2-4.9), indicating a Serious nutrition situation.

Overall, the trend analysis as shown in Figure 13 indicates that the Central regions have a history of chronic nutri- tional vulnerability, with median wasting estimated at 18.9% in the Hawd and Addun (2001-2009). This is attributed to a number of factors, including persistent drought in the previous seasons which has devastated the population’s livelihood assets. However there have been positive food security indicators in the Cowpea Belt agropastoral and Coastal Deeh Pastoral which has seen a corresponding Figure 13: Trends in levels of Acute Malnutrition (WHZ<-2 or improvement in the nutrition situation. Nevertheless, oedema, WHO 2006) in Central Regions 2001-2009 continued interventions need to be sustained to prevent

regional nutrition analysis any further deterioration, especially in service provision. As in all the other regions, there is a high disease burden and access to safe water and sanitation facilities remain poor. Limited access to basic services, poor infant and young child feeding and care practices and widespread civil insecurity that has led to population displacement and also limited humanitarian support services, continue to contribute the chronic nutritional vulnerability in the Hawd and Addun, where the situation needs to be closely monitored.

FSNAU Technical Series Report No VI. 30 30 Issued February 22 2010 Table 9: Summary of Key Nutrition Findings in Central Regions

Hawd (N=580) Addun (N=615) Galgadud(N=567) Mudug(N=567) Indicator Results % Outcome Results % Outcome Results % Outcome Results % Outcome Child Nutrition Status

Global Acute Malnutrition (WHZ<-2 or 19.1 (15.3 - 23.0) Critical 20.2 (15.6 -24.7) Very Critical 19.4 (14.5-24.3) Critical 22.3 (17.6-27.0) Very Critical oedema)

Severe Acute Malnutrition (WHZ<-3 or 4.3 (2.7 - 5.9) Critical 4.6 (2.8 - 6.3) Critical 5.5 (3.0-7.9) Very Critical 6.1 (4.1-8.1) Very Critical oedema) Oedema 0.2 (0.0-0.5) Acceptable 0.5 (0.0 – 1.0) Alert 0.5 (0.0-1.1) Alert 0.5 (0.0-1.1) Alert

Global Acute Malnutrition (WHZ<-2 or 17.9 (13.9-22.8) Critical 19.4 (14.6-24.1) Critical 19.8 (14.3-25.2) Critical 21.3 (16.4-26.1) Very Critical oedema; NCHS) Severe Acute Malnutrition (WHZ<-3 or 1.9 (0.8 - 3.0) Alert 2.4 (1.3 - 3.6) Alert 2.3 (0.6-4.0) Alert 2.9 (1.2-4.5) Alert oedema; NCHS) Acute malnutrition by MUAC (<12.5 cm or 6.7 (4.1 - 9.3) Serious 5.7 (3.1 - 8.2) Serious 7.6 (4.9-10.3) Serious 5.8 (3.4-8.2) Serious oedema in nutrition surveys) Stunting (HAZ<-2) 19.3 (13.7-24.9) Alert 19.7 (14.6 - 24.7) Alert 21.7 (15.9-27.5) Serious 15.0 (11.6-18.4) Alert Underweight (WAZ<-2) 22.4 (16.4 - 28.4) Serious 22.8 (17.4 - 28.2) Serious 25.0 (19.3-30.8) Serious 19.2 (15.0-23.4) Alert High levels with High levels with High levels with High levels with HIS Nutrition Trends(July-Dec. ‘09) Critical Critical Critical Critical increasing trends increasing trends increasing trends increasing trends High number with High numbers with High number with High numbers with Admission trends at TFPs/SFPs (Galkayo increasing trend of Critical increasing trend of Critical increasing trend of Critical increasing trend of Critical July-Dec. ‘09) admission admission admission admission Proportion of acutely malnourished registered 5.4 0.8 2.7 2.3 Very Critical Very Critical Very Critical Very Critical in SFs (0-9.7) (0-2.5) (0.0-6.3) (0.0-5.7) regional nutrition analysis Child Morbidity & Immunization

Outbreak – 182 AWD Outbreak – No Outbreak – No Outbreak – No Disease trends (seasonally adjusted) cases reported in Nov.09 Outbreak Outbreak Outbreak Morbidity refers to the proportion of children in Nugal region (NEZ) Very Critical Serious Serious Serious reported to be ill in the 2 weeks prior to the Morbidity– 50.5 Morbidity – 46.3 Morbidity -54.9 Morbidity – 51.4 survey RDT positive – 0.3 RDT positive – 1.0 RDT positive- 0.9 RDT positive – 0.2

Vitamin A -61.7 Vitamin A -40.4 Vitamin A -50.6 Vitamin A -55.2 Immunization Status Serious Serious Serious Serious Measles – 55.0 Measles -44.5 Measles -43.2 Measles -55.8 Infant and Young Child feeding (6-24 N=184 N=202 N=193 N=201 months) Proportion still breastfeeding 30.9 Critical 31.0 Critical 36.4 Critical 32.8 Critical Proportion introduced to complementary food 3.2 Critical 26.6 Critical 1.7 Critical 16.9 Critical at age of six months Proportion meeting recommended minimum 27.7 Serious 24.7 Serious 20.7 Serious 20.9 Serious feeding frequency Mortality N=755 N=801 N=791 N=655 Crude Mortality Rate per 10,000 per day 0.90 (0.60 – 1.36) Alert 0.93 (0.38 – 2.28) Alert 0.78 (0.50-1.22) Alert 0.85 (0.38-1.90) Alert (retrospective for 90 days) Under five mortality rate per 10,000 per day 2.00 (0.94 – 4.24) Serious 0.61 (0.38 – 0.97) Acceptable 1.61 (0.72-3.54) Alert 0.35 (0.16-0.76) Acceptable (retrospective for 90 days) Women Nutrition & Immunization Status Proportion of acutely malnourished non 0.4 0.6 0.9 0.4 Acceptable Acceptable Acceptable Acceptable pregnant women (MUAC≤18.5 cm) (N=249) (N=312) (N=149) (N=186) Proportion of acutely malnourished pregnant 14.8 (N=81) Serious 25.4 (N=71) Very Critical 12.1 (N=91) Serious 18.3 (N=93) Critical women (MUAC<23.0).

Proportion of Women who received Tetanus Immunization None 41.5 43.9 28.2 33.1 Critical Critical Critical Critical One 25.5 29.0 15.7 30.5 Two 20.3 18.5 30.5 24.2 Three or more 12.7 8.6 25.6 12.1

Public Health Indicators N=333 N=382 N=298 N=365 Households with access to safe water 50.5 Serious 20.7 Very Critical 39.3 Critical 38.9 Critical Household with access to sanitation facilities 52.9 Serious 48.4 Critical 28.9 Very Critical 62.2 Serious Proportion who own mosquito nets 46.5 24.6 22.8 60.0 Proportion using mosquito nets Food Security N=333 N=382 N=298 N=365 Households with poor dietary diversity (< 4 10.7 4.5 Acceptable Serious 6.4 Alert 1.4 Acceptable food groups)

Household’s Main Food Source Purchase: 88.6 61.2 54.3 82.7 Own Production 0.3 8.6 9.3 1.1 Food aid 1.5 9.4 14.3 1.6

Food security phase AFLC/HE Critical AFLC/HE Critical AFLC/HE Critical AFLC/HE Critical Critical with risk to Overall Situation Analysis Critical with risk to deterioration Critical with risk to deterioration Critical with risk to deterioration deterioration

FSNAU Technical Series Report No VI. 25 31 Issued February 22 2010 4.7 Northeast Regions

The Northeast regions are predominately pastoral with eight livelihood zones namely; the Hawd, Addun, Coastal Deeh, East Golis, Gagaab, Kakaar, Nugal Valley and Sool-Saanag Plateau. The Hawd and Addun, cutting across the Northeast and Central regions, are discussed in the Central section, with the remaining livelihoods discussed below (Map 10).

Historical Overview - Post Gu ‘09 The food security situation of the Hawd and Addun Pastoral livelihoods in southern Nugal and north Mudug regions deteriorated from Acute Food and Livelihood Crisis (AFLC) to Humanitarian Emergency in Gu ’09 following four successive seasons of rain failure that also affected parts of the Coastal Deeh Pastoralists in north Mudug and Nugal regions. Poor rangeland conditions, combined with limited options for out-migration, led to weak and emaci- ated livestock, low calving rates for camels, low milk production and high livestock off-take with herd size, of all livestock species well below the baseline levels. The total population in crisis in Bari, Nugal and northern Mudug regions was estimated at 210,000, of which 145,000 were urban poor. Of the total population in crisis, 169,900, or 79%, were inS AFLCOM AandL 44,100,IA: LorI 21%,VE inL IHEH.O ThereOD were ZO 66,000NE SIDPs in the region who were in need of hu- manitarian assistance.

The FSNAU Post Gu’09 integrated nutrition situation Map 10: Northeast Livelihood Zones analysis indicated a deterioration in the Golis/Gagaab and Karkaar Pastoral livelihoods to Critical, from Alert and likely to be Alert phases in the Post Deyr’08/09. The Calula Nugal Valley livelihood zone had also deteriorated to DJIBOUTI Qandala a Critical nutrition situation,G whileulf o thef ASoolde Plateaun of Bari regionZeylac had deteriorated to Serious. The deterioration Bossaaso in the nutritionLug hsituationaye in these livelihood zones was AWDAL Ceerigaabo Las Qoray/Badhan mainly attributedBa ktoi a combination of factors, including Berbera SANAG Iskushuban unfavourableBorama food security indicators, particularly low Ceel Afweyne BARI milk production, a persistent water Scrisisheikh in the region and Gebiley W. GALBEED limited access to health, safe water and sanitation facili- ties. The CoastalH Deehargey slivelihooda zone of Nugal, Mudug Qardho Burco Owdweyne Xudun and Bari regions reported a persistent Serious nutritionCaynabo Talex Bandar Beyla TOGDHEER situation with potential to deteriorate, mainly owing to SOOL the worsening food security indicators identified in the Gu’09. The Addun pastoral livelihood zone of Mudug Laas Caanood Buuhoodle and Nugal regions were classified in a sustainedCritical Garowe Legend nutrition phase, however, the Hawd livelihood zone of Eyl "/ Mudug and Nugal regions showed slight improvement NUGAL Country capital Burtinle Inregional nutrition analysis ternatiofromnal bVeryou nCriticaldary in the Deyr’ 08/09 to Critical in the Post Gu’09. Protracted IDPs and the urban poor popula- Regionaltion bo uofn Bossasodary Town were classified as Very Critical and Critical respectively. Jariiban ETHIOPIA Goldogob District boundary Galkacyo n a Current Situation e River c O

Coastline n Food Security a Cadaado MUDUG i The overall food security situation of the Hawd and Addun Pastoral livelihoods in southern Nugal and dnorth Mudug Hobyo n regions has remained at Humanitarian EmergencyCabudwaaq (HE) since Gu ‘09. However, there is significantI improvement in Hawd of Eyl and Garowe districts with 25% of the poor and 25% of the middle wealth group who were in HE Dhusa Mareeb during Gu ‘09 shifting to Acute Food and Livelihood Crisis (AFLC), and 50% of the middle in AFLC shifting to Borderline Food Insecure (BFI) in Deyr ‘09/10. The total population in crisis in Bari, Nugal and northern Mudug GALGADUD Harardheere regions is estimated at 286,000, of which 155,000 are urban poor. Of the total population in crisis, 176,000 or 62% Ceel Barde Beled Weyne are in AFLC and 110,000 or 38% are in HE. IDP populationsCeel Bur in the region that are in need of humanitarian assist- BAKOOL Livelihood zones ance remain the same as in the Gu ‘09, however recent clashes in Galkayo causedAddun P asignificantstoral: Mixed sheep & displacementgoats, camel so these Rab-Dhuure HIIRAN Xudur Awdal border & coastal towns: Petty trading, fishing, salt mining numbers may rise further. Ceel Dheere Dolo Central regions Agro-Pastoral: Cowpea, sheep & goats, camel, cattle Wajid Tayeglow Bulo Barde LuTheuq food security situation remains unchanged for the Hawd and Addun pastoralCoasta l livelihoodDeeh: Sheep zones due to decreased Aden Yabal Dawo Pastoral: Shoats, cattle, camel Beled Hawa cereal prices, increased livestock pricesJalala qbutsi limited marketable animals, lowEa scalving/kiddingt Golis Pastoral: Frankinnce nandse very poor milk Garbahareproductiony Bay dThishaba was the fifth successive seasonCad aofle poor rainfall (Deyr ‘07/08, FGuishin g’08, Deyr ‘08/09, Gu ‘09 and Deyr ‘09/10), which has affected pastureJo wandha rwaterM. S conditionsHABELL inE the Hawd and Addun,Gagaab P aasstor awelll: Frank inascen spartse of Coastal Deeh Guban Pastoral: Sheep, goats & camel Qansax Dheere Wanle Weyne Pastoral in north Mudug and Nugal regions. Nugal valley and Sool Plateau livelihoodHawd Pasto rzonesal: Camel , ofshe eNugalp & goats and Bari regions GEDO BAY have received near normal to normal rainfall; however, huge livestock in migrationHiran A gisro -Plikelyastoral to cause early pasture and Ceel Waq Bur Hakaba Balcad water depletion. Poor rangeland and water conditions in north Bari, north MudugHiran riv eandrine: S osouthrghum, m aNugalize, cattle & forced shoats livestock Afgoye Juba pump irrigation: Tobacco, onions, maize Baardheere Dinsor "/ BANADIR MOGADISHU Kakaar-Dharor Pastoral: Sheep, goats, camel

A Qoryoley L. & M. Shabelle Agro-Pastoral Irrigated: Maize/Sorghum & cattle Sakow Y Marka FSNAU Technical SeriesK uReportrtun W Noarre yVI. 30 32 L. & M. Shabelle Agro-Pastoral raiIssuedn-fed: Maiz eFebruary,cowpeas, sesa m22e & 2010 cattle

N M. JUBA Lower Juba Agro-Pastoral: Maize & cattle Sablale

E L. SHABELLE North-West Agro-Pastoral: Sorghum, cattle Bu'aale North-West Valley Agro-Pastoral: Irrigated vegetables, shoats K Hagar Brava Nugal Valley Pastoral: Sheep & camel Potato zone & vegetables Afmadow Jilib Shabelle riverine: Maize, fruits & vegetables Sool-Sanag Plateau Pastoral: Camel, sheep & goats South-East Pastoral: Cattle, sheep & goats Jamaame L. JUBA Southern Agro-Pastoral: Camel, cattle, sorghum Southern Juba riverine: Maize, sesame, fruits & vegetables Kismayo Southern coastal pastoral: Goats, cattle Togdheer Agro-Pastoral: Sheep, goats & vegetables ± Urban Badhadhe 0 20 40 80 120 160 200 West Golis Pastoral: Goats, camel, sheep Bay-Bakool Agro-pastoral Low Potential Kilometers Bakool Agro-pastoral Low Potential Bay Agro-pastoral High Potential Southern Inland Pastoral: Camel, Sheep & Goats Datum: WGS84, Data Source: FSAU, 2009, Admin. layers: UNDP, 1998

Food Security Analysis Unit - Somalia http://www.fsausomali.org P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] tel: 254-20-3745734 fax:254-20-3740598 FSAU is managed by FAO. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986. to out-migrate to over-populated areas of Sool plateau of Bari, Nugal valley and Hawd of Sool and Nugal regions, and has led to weak and emaciated livestock, low calving rates for camels, low milk production and high livestock off-take with herd size of all livestock species well below the baseline levels.

Based on findings from 24 nutrition assessments conducted by FSNAU & partners from 2002 -2009 (Figure 14), the nutrition situation of both the rural & urban population in the northeast has been consistently below the emergency threshold of 15 % until 2006. Following deterioration of the food security situation in the Hawd, Addun and the Coastal Deeh livelihood zones in 2007, the nutrition situation deteriorated and the levels of acute malnutrition have exceeded the emergency threshold. The situation of IDPs in Bossaso and Galkayo has been different from that of the host communities, with rates of acute malnutrition consistently exceeding the emergency threshold, due to their higher nutritional vulnerability.

Nutrition The FSNAU Post Deyr ’09/10 integrated nutrition situation analysis indicates that the Hawd and Addun pastoral livelihood zones of Mudug and Nugal regions reported a persistent Critical nutrition situation, which is likely to deteriorate due to worsening food security indicators (see Central). Golis/Gagaab pastoral livelihoods have shown an improvement from Critical in the Gu ’09 to Serious in the Post Deyr’09/’10 while the Sool Plateau of Bari region and Nugal Valley livelihood zones have shown an improvement from the Critical classification phase in the Post Gu’09 to Alert and Serious phases in the Post Deyr ’09/10. The nutrition situation in the Coastal Deeh livelihood zone of Nugal, Bari and Mudug regions has also shown improvement from Serious in the Gu’ 09 to Alert in the Post Deyr ’09/10. The improvement in the nutrition situation in these livelihood zones is mainly attributed to favourable

food security indicators, particularly increased milk production. Of great concern however, are the protracted IDPs: regional nutrition analysis Galkayo IDPs reported a persistent Very Critical nutrition situation with no change from Gu’ 09. The nutrition situa- tion in the Bossaso IDPs, while still above emergency threshold, has shown improvement from Very Critical in the Gu’09 to Critical in the Post Deyr ’09/10, likely linked to increased access to integrated humanitarian interventions at scale, such as child health days, OTP/SFP services and improved access to safe water and sanitation facilities. The sub-optimal nutrition situation amongst the IDP population is associated with a combination of factors namely high morbidity burden, reduced access to a diversified diet due to the high and increasing food prices and poor child care and feeding practices. The results are consistent with historical data on nutrition surveys conducted among the IDP population in the northwest region, which highlight the chronic nutritional vulnerabilities (Figure 15).

Golis/Gagaab/ Livelihood Zones According to the Post Deyr ’09/10 integrated nutrition situation analysis, there is an improvement in the Golis /Gagaab livelihood zone of the northeast region from Critical Figure 14: Trends in levels of acute malnutrition (WHZ< -2 or in the Gu’ 09 to Serious in the Post Deyr’09/10, yet oedema, WHO 2006 ) in Northeast region 2002- 2009 with risk to deteriorate. The results of the rapid as- sessments conducted in Dec’09 based on the CDC calculator indicate a high probability that a GAM level >8.1% (Pr.=0.90) and a SAM level >0.3% (Pr.=0.90). Similarly, the results of the MUAC assessment indi- cates a low proportion (5.2%) of children with MUAC

<12.5 cm or oedema. When compared to the June percentage 2009 nutrition assessment findings, which reported a GAM rate of 17.9% (14.4-22.0) with a SAM rate of 3.3% (1.9-5.8), there is significant improvement in the both GAM and SAM rates (p=0.005) mainly attributed to improved coverage of health programmes (measles, polio vaccination, vitamin A supplementation) and reduced morbidity, coupled with a strong social support system.

The livelihood zone has received below normal rainfall for two consecutive seasons, including Deyr ’09/10, which has led to a poor livestock production, resulting in reduced household access to income and milk. The morbidity rates reported in the area are still high (19.8 %), further exacerbating the poor nutrition situation in the area. Poor sanitation facilities, lack of adequate clean water with 9 months of water trucking, and limited health facilities are the chronic underlying factors also affecting the nutritional status of the population. Close monitoring of the nutri- tion situation of this population group remains crucial, in addition to initializing interventions aimed at rehabilitating acutely malnourished children and improving access to health facilities.

Nugal Valley Livelihood Zone The nutrition situation of the population in the Nugal valley livelihood zone of Nugal region is classified as Seri- ous, indicating an improvement from the Post Gu ’09. This is attributed to high livestock in-migration as a result of good rains received in the area which has contributed to water and pasture availability, improved livestock body conditions, resulting in increased meat and milk consumption and household income. Results of the rapid weight

FSNAU Technical Series Report No VI. 25 33 Issued February 22 2010 for height assessment conducted in Dec’ 2009 show a GAM level of >8.4 % ( Pr=0.90) and a SAM level of >2.0 %( Pr=0.90) based on the CDC calculator at 90% probability level, with no case of oedema. This indicates an Alert nutrition situation. Although there is a lack of nutrition assessments from previous seasons to directly compare the results with, the situation indicates an im- provement from the Critical nutrition situation in the Gu ’09. Nevertheless, the nutrition situation is at risk to deteriorate due to increasing morbidity, low immunization status of children and worsening food security following early depletion of pasture and water as a result of huge livestock in-migration. Data from health facilities in the area reported low numbers and stable trend of acutely malnourished children. In addition to the food security Enumerator prepares to measuring a child, Hawd and morbidity risk factors, the population remains vulner- Livelihood zone, FSNAU, Dec. ‘09 able to the persistent hazards associated with poor child care and feeding practices, low immunization status, poor sanitation and limited health facilities in the area. The livelihood zone will need close monitoring of both the food security and nutrition situation. Livelihood support, health care together with selective feeding programmes targeting acutely malnourished children, in addition, remains crucial in mitigating the current nutrition situation.

Coastal Deeh Livelihood Zone

The Coastal Deeh livelihood zone of Nugal, Bari and Mudug regions has reported an Alert nutrition situation, with an indication of a likelihood to improve due to positive food security indicators in the Deyr ’09/10 season. The results of the rapid weight for height assessment conducted in Dec. 2009 using CDC calculator at 90% probability level, show a high probability that the GAM level is >6.9%(Pr.=0.90) and the SAM level above 2.0% (Pr.=0.90).These results indicate an Alert nutrition situation, an improvement from the Gu’09 integrated analysis and the May 2009 nutrition assessment, which reported GAM and SAM rates of >12.6% (Pr=0.90) and >2.0%(Pr=0.90) respectively, indicating significant improvement in the both GAM and SAM rates. Most of the coastal areas experienced normal rainfall, which has led to improved water and pasture availability, increasing the access to milk. Furthermore, access to fishing and reduced morbidity, particularly diarrhoea, remains key factors in the improved the nutrition situation in the area (Table 11). Table 10: Summary of Key Nutrition Findings in Golis, Nugal Valley and Coastal Deeh Golis/Gagaab (N=213) Nugal Valley (N=200) Costal Deeh(N= 198) Indicator Results % Outcome Results % Outcome Results % Outcome

regional nutrition analysis Child Nutrition Status >8.1 >6.9 Global Acute Malnutrition (WHZ<-2 or oedema) Alert >8.4 (Pr=0.90) Alert Alert (Pr=0.90) (Pr=0.90) >0.3 >2.0 Severe Acute Malnutrition (WHZ<-3 or oedema) Alert >2.0 (Pr=0.90) Alert Alert (Pr=0.90) (Pr=0.90) Accept- Oedema 0 0 Acceptable 0 Acceptable able Global Acute Malnutrition (WHZ<-2 or oedema; >5.9 >6.7 >5.1 Alert Alert Alert NCHS) (Pr=0.90) ( Pr=0.90) (Pr=0.90) Severe Acute Malnutrition (WHZ<-3 or oedema; Accept- >0.1 >0.1 0 Alert Alert NCHS) able (Pr=0.90) (Pr=0.90) Acute malnutrition by MUAC (<12.5 cm or oedema in 5.2 Serious 3.0 Alert 4.5 Alert nutrition surveys) 1.8.3) 16.4 9.5 6.1 Stunting (HAZ<-2) Alert Acceptable Acceptable (12.7-21.0 ( 6.2-14.2 ) (3.5-10.4) 12.2 2.0 7.7 Underweight (WAZ<-2) Alert Acceptable Acceptable ( 8.0-18.2) (0.8- 5.2) (4.7-12.2 ) Low levels HIS Nutrition Trends(Aug-Nov’08) and increas- Serious <10% and Stable Alert <10% and Stable Alert ing Selective feeding Programmes None Critical None Critical None Critical Child Morbidity & Immunization Disease trends (seasonally adjusted) Morbidity– Morbidity – 25.5 Morbidity 10.7 Morbidity refers to the proportion of children reported 19.8 Serious Critical Serious to be ill in the 2 weeks prior to the survey (14.2-5.5) Vit A -83.1 Vit A 31.0 Vit A 69.6 Immunization Status Alert Critical Serious Measles – 82 Measles -30.6 Measles -66 BFI/moder- Food security phase Critical AFLC Serious BFI Alert ate to AFLC Overall Situation Analysis Serious Serious Alert

FSNAU Technical Series Report No VI. 30 34 Issued February 22 2010 Sool Plateau Livelihood Zone Table 11. Summary of Key Nutrition Findings in Sool The Post Deyr ’09 integrated nutrition situation analysis Plateau in Northeast regions indicates an obvious improvement in Sool Plateau of Bari Sool Plateau (N=213) and Nugal regions from Serious in the Gu ‘09 to Alert in Indicator Results % Outcome Deyr’09/10 (Table 11), attributed to the normal rain per- Child Nutrition Status Global Acute Malnutrition (WHZ<-2 or >7.1 Alert formance, livestock in-migration and increased access to oedema) (Pr= 0.90) Severe Acute Malnutrition (WHZ<-3 or >2.0 milk, water and income. Findings from a small scale cluster Alert survey conducted in Dec’ 2009 show a GAM level of >7.1% oedema) (Pr= 0.90) Oedema 0 Acceptable (Pr=0.90) and a SAM level of > 2.0 %(Pr=0.90) based on Global Acute Malnutrition (WHZ<-2 or >7.0 Serious the CDC calculator; and indicate an Alert nutrition situation, oedema; NCHS) Pr= 0.90) Severe Acute Malnutrition (WHZ<-3 or >0.1 Alert an improvement from the Serious phase following the Gu oedema; NCHS) (Pr= 0.91) ’09 integrated analysis. Acute malnutrition by MUAC (<12.5 cm 4.6 Alert or oedema in nutrition surveys) Stunting (HAZ<-2) 13.1( 8.8-18.9) Alert Analysis of MUAC measurements from 198 children Underweight (WAZ<-2) 10.6( 5.5-19) Alert (conducted in Dec’09) from this livelihood zone indicates Low levels and HIS Nutrition Trends(Aug-Nov’08) Alert 4.6% of the children with MUAC<12.5cm and/or oedema stable Selective feeding Programmes None Critical (Table 11). Data from health information systems (HIS) in Child Morbidity & Immunization the area indicates low numbers and stable trends of acutely Disease trends (seasonally adjusted) Morbidity refers to the proportion of Morbidity– 22.6 Serious malnourished children screened at health facilities. The children reported to be ill in the 2 weeks improvement of the nutrition situation in the livelihood prior to the survey Vit A -84.1 is mainly attributed to improved household food security Immunization Status Alert Measles– 78.5

situation following normal to good rains received in the Food security phase BFI/moderate risk Serious regional nutrition analysis area, compared to the Post Gu ‘09 season. Consequently, Overall Situation Analysis Alert water availability, pasture and livestock body conditions Figure 15: Trends in Levels of Acute Malnutrition (WHZ<-2 were favourable, with more livestock in-migration result- or oedema) in Northeast IDPs (2002-2009) ing in increased meat and milk consumption and access to income. Child Health Days conducted in the region have also improved the vitamin A supplementation and measles vaccination status of children. Although improvements in

the nutritional situation in the area have been observed, the Pecentage vulnerability of the region, to natural shocks, e.g. drought, necessitates continued close monitoring of the situation.

IDPs of the Northeast: Galkayo and Bossaso The integrated analysis of the Post Deyr ’09/10 nutrition information indicates a Very Critical situation in Galkayo IDPs with no change from the Post Gu ’09; and slight improvement in the Bossaso IDPs from Very Critical in post Gu’ 09 to Critical in the Deyr ’09.

Findings from the Dec. 2009 nutrition assessments conducted jointly by FSNAU/UNICEF, Somalia Red Crescent Society (SRCS), MOH and Merlin show a GAM level of >23.7% (Pr=0.9) and SAM level of >6.3 % (Pr=0.90) in Galkayo IDPs based on the CDC probability calculator. These indicate a sustained Very Critical nutrition situation with no change from the Very Critical levels recorded in the July 2009 exhaustive assessment, which reported a GAM rate of 20.0% and a SAM rate of 7.4 %. (Figure 15).

The Bossaso IDP assessment estimated a GAM level of >17.5% (Pr=0.09) and a SAM level of > 5.5 % (Pr=0.90) based on the CDC probability calculator, indicating a Critical nutritional phase and an improvement from Gu’09 assessment in July’09 when a GAM rate of of 21.4% (18.8-24.1) and a SAM rate of 4.8 % (3.0-6.0). However, when the two GAM and SAM rates from July and December 2009 assessments are compared using CDC calculator, there is no significant change in GAM rates, though this is the first time in 6 years GAM rates <20% have been reported. The slight improve- ment among Bossaso IDPs is attributed to integrated interventions including vaccinations through child health days and the rehabilitation of severely malnourished children through the stabilization centres. Furthermore, there have been no recently reported cholera outbreaks, which had a significant effect on the poor nutrition situation in Gu ’09. However, the current HIS data from the health facilities in Bossaso IDP settlements show persistent high numbers of acutely mal- nourished children screened in the last six months. Both IDPs report a very high proportion of stunting (20 to <40%) which provides evidence of the sustained poor nutrition among this population.

Findings indicate considerably high morbidity rates, which have a direct effect on the nutrition situation of the children. However, the immunization status of the assessed children, in Galkayo and Bossaso IDP population shows improvement. Child Health Days conducted by UNICEF, WHO and MOH in the IDP population groups have improved the overall immunization status of the children with vitamin A supplementation and measles vaccination status at 89.2% and 94.7%, in Galkayo, and 85.6% and 92.8% in the Bossaso IDPs respectively.

FSNAU Technical Series Report No VI. 25 35 Issued February 22 2010 The proportion of IDP households with access to safe water Figure 16: Admission numbers to Bossaso Stabilization and sanitation facilities in is low in Bossaso (19% and 44.8% Centre per month Jan. - Dec. 2009 respectively), but higher in Galkayo (94.8% and 81.0% respec- 60

tively), indicating that a large proportion of the Bossaso IDP 50 51 households are predisposed to disease, especially diarrhoea. 42 The worrying IDP nutrition situation is generally due to a com- 40 39 40 bination of factors, including a high disease burden, reduced 34 34 30 30 31 27 access to a diversified diet due to the increasing food prices and 24 22 sub-optimal child care and feeding practices. The results are 20 consistent with historical data on nutrition surveys conducted 16 10 amongst the IDP population in the northeast region, which

highlights their chronic nutritional vulnerabilities (Figure 15). 0

The key nutrition indicators of these IDP populations that form the basis of the analysis are provided in Table 12.

Table 12. Summary of Key Nutrition Findings in Northeast IDPs

Galkayo (N=209) Bossaso (=210) Indicator Results % Outcome Results % Outcome Child Nutrition Status Global Acute Malnutrition (WHZ<-2 or oedema) >23.7 (Pr=0.90) Very Critical >17.5 (Pr=0.90) Critical Severe Acute Malnutrition (WHZ<-3 or oedema) >6.3(Pr=0.90) Very Critical >5.5 (Pr=0.90) Very Critical Oedema 0 - >1.3(Pr=0.90) Alert Global Acute Malnutrition (WHZ<-2or oedema; >22.5 (Pr=0.90) Very Critical >12.6 (Pr=0.90) Critical NCHS) Severe Acute Malnutrition (WHZ<-3 or oedema; >5.1 (Pr=0.91) Alert >1.6(Pr=0.90) Serious NCHS) Acute malnutrition by MUAC (<12.5 cm or oedema in 25.4(17.2-33.7) Very Critical 14.8­(­9.20.3) Very Critical Rapid assessments) Stunting (HAZ<-2) 45.2(36.2-54.5) Critical 41.4(33.5-49.9) Critical Underweight (WAZ<-2) 45.5(35.8-55.5) Critical 39.0 (32.46.1) Serious High levels and HIS Nutrition Trends(July’09) Critical High/fluctuating trends Critical stable High number with Admission trends at TFPs/SFPs(Galkayo//Boss-N– High and fluctuating increasing trend of Critical Critical Jan-Dec’09) numbers of admission admission Proportion of acutely malnourished registered in SFs 50.8 Serious 6.9 Very Critical Child Morbidity & Immunization Morbidity refers to the proportion of children Morbidity– 47.1 Morbidity –53.8 (CI: Very Critical Very Critical reported to be ill in the 2 weeks prior to the survey (39.1- 55.1) 42.5- 65.2) Vit A : 89.2 Vit A 94.7 Immunization Status Serious Serious Measles –: 85.6 Measles - 92.8 Infant and Young Child feeding (6-24 months) N=72 N=92 regional nutrition analysis Proportion still breastfeeding 40.2 (16.6-53.9 Serious 53.9 (41.9-65.5) Serious Proportion introduced to complementary food at age 10.3 (2.4-18.1) Critical 3.7 (1.3-8.9) Critical of six months Proportion meeting recommended minimum feeding 17.5 (2.4-18.1 ) Critical 36.7( 24.7 -48.7) Critical frequency Women Nutrition & Immunization Status Proportion of acutely malnourished non pregnant 0 0 Acceptable Acceptable women (MUAC≤18.5 cm) (N=39) (N=5 Proportion of malnourished pregnant women 21.7 17.4 Very Critical Very Critical (MUAC<23.0). (N=23) (N=23 Proportion of Women who received Tetanus N=109 N=105 Immunization 16.5 3.8 No dose 30.3 Very Critical 4.8 Alert One dose 27.5 19.0 Two doses 25.7 72.4 Three or more doses Public Health Indicators N=478 Households with access to safe water 94.8 Serious 19.0 Very Critical Household with access to sanitation facilities 81.0 Serious 44.8 Critical Proportion who own mosquito nets 57.5(40.6-74.4) Critical 0.0 Critical Household’s Main Food Source Purchase: 81.9(72.2-9.1.5) 96.3 (91.7-100.8) Food aid 6.8 (1.2-12.5) 2.9 Gifs 6.0(1.9-10.1) --- Food security phase HE Very Critical HE Critical Overall Situation Analysis Very Critical Critical

FSNAU Technical Series Report No VI. 30 36 Issued February 22 2010 The Relationship between Gender Roles and the Nutritional Status of a Population

The term “gender” refers to the socially constructed roles of men and women as well as to the interactions between them. In this sense, it differs from the term “sex”, which refers to the biological differences between men and women. Gender behaviors and relations play key roles in the food security and nutrition situation of a household. In Somalia, women are primarily the household care givers and are solely responsible for ensuring that appropriate and adequate meals are made available for all their family members. It is customarily the role of women is to process, store, prepare and distribute food, they are also responsible for collecting firewood and fetching water. In addition, women are in charge of safeguarding the health of family members, especially the vulnerable ones: infants and children, the sick, handicapped and elderly. They are responsible for ensuring general hygiene in the household. During normal seasons, women participate in the productive activities; such as farming and assisting in herding animals together with older children, thus contributing Processing of cowpea, FSNAU, Middle Shabelle. Dec. ‘09 to the household’s income, giving them the ability to participate in decision-making on food security and nutrition issues in the household. However during abnormal seasons of stress, some of the coping strategies the households are forced to adapt impact negatively on women, for example, they have reduced access to crop and livestock production, they also spend more time on typical roles, such as walking longer distances in search of water compromising on appropriate child care and feeding practices. Drought affecting both livestock and crop productivity result in increased work burden for all household members, but more for women and children in many situations.

During the Deyr ‘09/10, rainfall performance was below average in most parts of central, and pockets in the northern areas. Pastoralists from the central and Bakool regions, and agropastoralists from Togdheer region experienced abnormal out migration after many consecutive seasons of poor rainfall. This led to family splitting, with the older male migrating with the

livestock in search of pasture and water, leaving the women and special article children behind with one or two lactating animals. The relationship between abnormal livestock migration and consequently, the reduction in milk consumption leading to malnutrition has been clearly documented in Somalia (Ref. FSNAU Nutrition Technical Series Report, September 11 2009). The women left behind when families split, struggle with limited resources, to provide for the family; the livestock produce insufficient milk due to their limited access to water and pasture, and the households are unable to meet their nutritional requirements adequately. Women take on Members of a split family, FSNAU, East Golis, the additional role of heads of households during such periods of Sanaag, Dec. ‘09 stress and the overwhelming workload amidst dwindled income and food access, negatively impacts on the quality of care they are able to give to children. During times of stress, men also take up additional household tasks. In normal times, men are in charge of general herd management and selling of livestock. In the Deyr ‘09/10, shifts in roles between and women were observed. Men joined with women to carry out livestock product-related activities and manage vulnerable animals (calves and small ruminants), they also assisted in farming activities such as harvesting and planting, feeding of animals, cleaning of sheds and sale of milk. The extent of sharing of responsibilities and tasks however, varied across regions.

FSNAU nutrition assessments conducted during the current Deyr ’09/10 season indicated no improvement in the Critical nutrition situation in Central and Togdheer agro-pastoralists, and the Very Critical situation in Bakool pastoralists. Improvements were however noted in the northern coastal livelihoods of Golis and Guban, associated among other factors, with increased access to milk and livestock products since the Gu ’09. This further demonstrates that milk availability and consumption has a very significant influence on the nutritional status of the pastoral women and children. In crisis situations where food is in short supply, women and girls are more likely to reduce their food intake as a coping strategy in favour of other household members, contributing to under-nutrition in these groups. Pregnant or lactating women may be disproportionately affected by under-nutrition due to their increased physiological requirements. Infant and young child care is also compromised as caregivers (the women) spend more hours Men and women planting cowpea, FSNAU, away from the household in search of water and alternate sources Middle Shabelle, Dec. ‘09 of income, with the small children left in the care of siblings.

Sustainable household access to water, food and health care services remain basic human rights that will need to be embedded in humanitarian programming in Somalia, in the medium term. It is, therefore, crucial to further incorporate the role of gender during the integrated analysis of food security and nutrition, so as to fully understand the linkages between gender roles and the underlying causes of malnutrition. In this regard, two key aspects might be considered: 1) gender equity in access to and control of natural and productive resources; and 2) the participation of rural women in household decision-making, both in normal times, and during crises. This information would highlight the different options of safety nets accessible to women as key caregivers, especially during both normal and stressful times; and guide humanitarian agencies on equitable targeting of available resources.

FSNAU Technical Series Report No VI. 25 37 Issued February 22 2010 4.8 Northwest Regions

The Northwest regions comprise mainly of pastoral livelihood zones namely; West Golis, Guban, East Golis of Sanaag region, the Hawd, Sool Plateau and the Nugal Valley. In addition, there are two agropastoral livelihood zones consisting of the Northwest Agropastoral of Awdal and Galbeed region and Togdheer Agropastoral of Togdheer and Sahil region. The livelihood zones cut across the administrative regions of Awdal, Galbeed, Togdheer, Sool and Sanaag (Map 11). SOMALIA: LIVELIHOOD ZONES Historical Overview Post Gu ‘09 Map 11: Northwest Livelihood Zones The FSNAU Post Gu ’09 integrated food security analysis classified the West Golis/Guban in Acute Food and Liveli- hood Crisis (AFLC), similar to the Post Deyr ‘08/09 phase, Calula nevertheless the food security indicators showed a generalD JIBOUTI Gulf of Aden Qandala improvement. The Northwest agropastoral and the East Golis Zeylac Bossaaso Lughaye (of Sanaag region) livelihood zones were also classified to be AWDAL Ceerigaabo Las Qoray/Badhan Baki Berbera SANAG Iskushuban in AFLC, with an indication of a worsening situation. The Borama Ceel Afweyne BARI Sheikh Togdheer agro-pastoral and the Sool Plateau pastoral liveli- Gebiley W. GALBEED hood zones were classified in AFLC, with 75% of the poor Hargeysa Qardho Burco Owdweyne Xudun identified in Humanitarian Emergency (HE). The popula- Caynabo Talex Bandar Beyla TOGDHEER tions of the Hawd and the Nugal Valley livelihood zones were SOOL also classified inAFLC, with a moderate risk of deterioration. Laas Caanood Buuhoodle Garowe The estimated rural population in AFLC was 240,000 people, Legend Eyl which was an increase from the 45,000 people in Deyr ‘08/09,"/ NUGAL Country capital Burtinle in addition to the 20,000 people identified inHE . The popuI-nternational boundary

lation of the urban poor in AFLC also increased by 36% toR egional boundary Jariiban ETHIOPIA Goldogob District boundary Galkacyo n 150,000; however the number in HE remained the same at 30,000 similar to the Post Deyr ‘08/09. a e River c O

Coastline n The Post Gu ‘09 integrated nutrition analysis clas- Figure 17: Trends in levels of Acute Malnutrition (WHZ <-2Z scores or a Cadaado MUDUG i d oedema, WHO 2006 in Northwest Regions 2002-2009Hobyo n sified the West Golis/Guban, East Golis and Gebbi Cabudwaaq I Valley of Sanaag region, Nugal Valley, Sool Plateau Dhusa Mareeb and Hawd of Hargeisa to be in a Serious nutrition 30% situation, while both the agropastoral livelihood GALGADUD Harardheere Ceel Barde Beled Weyne Ceel Bur zones and the Hawd of Togdheer were classified as 15% BAKOOL Livelihood zones Addun Pastoral: Mixed sheep & goats, camel Rab-Dhuure HIIRAN Critical. The nutrition situation among the Hargeisa, Percentage Xudur Awdal border & coastal towns: Petty trading, fishing, salt mining Ceel Dheere Dolo Central regions Agro-Pastoral: Cowpea, sheep & goats, camel, cattle Bulo Barde Berbera, and Burao IDPs was classified as Serious, Luuq Wajid Tayeglow Coastal Deeh: Sheep 0% Critical and Very Critical respectively. Historically Aden Yabal Dawo Pastoral: Shoats, cattle, camel Beled Hawa Jalalaqsi East Golis Pastoral: Frankinncense Baydhaba Cadale Fishing

Garbaharey Jun 06 Tog

the nutrition situation in the North West region has Apr 09 Berb Berb Dec 09 Berb Sep 07 Gebbi Valley Gebbi Valley Jowhar Gagaab Pastoral: Frankincense W Golis Oct 08 W Golis Jun 09

W Golis Dec 09 M. SHABELLE Tog Past Oct 09 Tog Tog Agro Oct 09 Tog Harg IDP Apr 09 Harg IDP Harg IDP Dec 08 Harg IDP Dec 09 Harg IDP Harg IDP Sep 07 Harg IDP East Golis Jun 09 Guban Pastoral: Sheep, goats & camel Burao IDPs Apr 09 Burao IDPs Tog Region Aug 03 Region Tog Burao IDPs July 08 Burao IDPs Dec 08 Burao IDPs Dec 09 Burao IDPs Sep 07 Qansax Dheere Sool Plateau jun 03 Sool Plateau Jun 08 Nugal Valley Dec09 Nugal Valley

been below emergency thresholds (GAM <15%) apart Aug 06 Sool Plateau Sool Plateau Dec 09 Sahil Region May 02 Sool Plateau May 03 E Golis/gebbi Dec 09 Awdal Region Jan 02 Awdal Wanle Weyne GEDO BAY Dec 09 Agro- Gal/Awl Hawd Pastoral: Camel, sheep & goats Hawd of Hargeisa Dec 09 Hiran Agro-Pastoral from the IDP populations, that have been reporting Ceel Waq Balcad W Golis East Golis Bur HSoolaka Plateauba Nugal Togdheer region Galbeed Hargeisa IDPs Burao IDPs Hiran riveBerberarine: Sor gIDPshum, maize, cattle & shoats regional nutrition analysis Afgoye Juba pump irrigation: Tobacco, onions, maize high rates of acute malnutrition (Figure 17). Baardheere Dinsor "/ BANADIR MOGADISHU Kakaar-Dharor Pastoral: Sheep, goats, camel

A Qoryoley L. & M. Shabelle Agro-Pastoral Irrigated: Maize/Sorghum & cattle Sakow 35.00% Y Marka 30.00% Kurtun Warrey L. & M. Shabelle Agro-Pastoral rain-fed: Maize,cowpeas, sesame & cattle

Current Situation N M. JUBA Lower Juba Agro-Pastoral: Maize & cattle Sablale

E L. SHABELLE North-West Agro-Pastoral: Sorghum, cattle Bu'aale North-West Valley Agro-Pastoral: Irrigated vegetables, shoats K Hagar Brava Food Security Nugal Valley Pastoral: Sheep & camel Potato zone & vegetables Afmadow Jilib The FSNAU Post Deyr ’09/10 integrated food security analysis has classified the West Golis/Guban in Acute FoodShabelle river ineand: Maize, frui ts & vegetables Sool-Sanag Plateau Pastoral: Camel, sheep & goats South-East Pastoral: Cattle, sheep & goats Livelihood Crisis (AFLC), indicating no change in the phase classification,Jamaame however, the food security indicators show L. JUBA Southern Agro-Pastoral: Camel, cattle, sorghum further improvement from the Gu ‘09. The Northwest agro-pastoral and the East Golis (of Sanaag region), Hawd andSouther n NugalJuba riverine: Maiz e, sesame, fruits & vegetables Kismayo Southern coastal pastoral: Goats, cattle valley livelihood zones have also been classified in AFLC. However, the populations of Nugal Valley livelihoodTogdhee r Azonesgro-Pastoral: She ep, goats & vegetables ± Urban indicate a moderate risk of deterioration. The TogdheerBad hagropastoraladhe and the Sool0 20 4Plateau0 80 120 pastoral160 200 livelihood zonesWest Golis P ahavestoral: Goats, camel, sheep Bay-Bakool Agro-pastoral Low Potential Kilometers also deteriorated and are now currently identified as being in a Humanitarian Emergency (HE). The estimatedBakool Agr o-ruralpastoral Low Po tential Bay Agro-pastoral High Potential population in AFLC is now 245,000 people, an increase from 240,000 people in Gu ‘09. The total population Sinouther n HEInland Past orisal: Ca mel, Sheep & Goats Datum: WGS84, Data Source: FSAU, 2009, 45,000. The population of the urban poor in AFLC has also increased to 200,000 from 150,000, while the numberA indmin .HE layers: UNDP, 1998 also increased to 35,000 from 30,000 in Gu ‘09.

Food Security Analysis Unit - Somalia http://www.fsausomali.org P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] tel: 254-20-3745734 fax:254-20-3740598 Nutrition FSAU is managed by FAO. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The current Post Deyr ‘09/10 nutrition situation indicates improvementThe regional & D isintrict b oumostndaries reflect thofose e ndtheorsed by tlivelihoodhe Government of the Republi c zonesof Somalia in 198 6compared. to the Post Gu ‘09. The West Golis and Guban livelihood zones indicate an improvement from Serious to Alert, while the East Golis of Sanaag/Gebbi valley livelihood zones show slight improvement from Critical to Serious. The nutrition situation for the Sool Plateau livelihood zone compared to the Post Gu ‘09, has also improved from Serious to Alert. Also illustrat- ing an improvement are the populations of the Hawd of Sool livelihood zone, from Serious to Alert, and the agropastoral populations of Awdal and Galbeed from a Critical nutrition situation to Alert. The Hawd of Hargeisa remain in a sustained Serious nutrition situation, while the nutrition situation of the agropastoral population of Togdheer remains Critical.

FSNAU Technical Series Report No VI. 30 38 Issued February 22 2010 However the following livelihood zones: - Hawd of Har- Figure 18: Trends in proportion of acutely malnutrition attending the MCH in Sool Plateau Jan. 08 - Dec. ‘09 geisa, Sool Plateau, East Golis and upper Nugal Valley pose 30.0 2008 2009 a risk to deteriorate if the food security indicators in these 2 per. Mov. Avg.(2008) 2 per. Mov. Avg.(2009) areas do not improve in the coming season. The nutrition situation of the IDPs from Burao is classified as Serious, 20.0 which illustrates an improvement from Very Critical in the Post Gu ‘09, while the nutrition situation of the Berbera IDP 10.0 population still remains as Critical. The nutrition situation of the Hargeisa IDPs remains stable at Serious. 0.0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Sool Plateau Livelihood Zone of NW The Post Gu ‘09 integrated nutrition analysis classified the nutrition situation of the Sool Plateau of Sool and Sanaag region as Serious. The Serious nutrition situation was attributed to reduced intake of milk and meat products following the Gu ’09 rain failure and out migration of livestock. The Post Deyr ‘09/10 integrated nutrition analysis has classi- fied the livelihood zone as Alert with a risk of deterioration. The slight improvement in the nutrition situation of the populations of Sool Plateau LZ is likely attributed to increased access to humanitarian support in the region, due to increased efforts by response agencies.

A small sample cluster survey conducted in the livelihood zone assessed a total of 362 children from 60 clusters in the livelihood. The results were analyzed using the CDC probability calculator, which indicated a global acute malnutrition level (GAM <-2 Z score or oedema) of >9.1% (Pr=0.90), and a severe acute malnutrition level (SAM <-3 or oedema)

of >0.4% (Pr=0.90). Analysis of MUAC measurements indicates the proportion of children with MUAC of <12.5cm regional nutrition analysis or oedema as 4.5% (1.6-6.7). Data from health information systems (HIS) in the area indicates high numbers and an increasing trend of acutely malnourished children screened at health facilities (Figure 18). An integrated analysis of nutrition, health and food security indicators (Table 13) indicate that the current nutrition situation in the Sool Plateau livelihood zone is Alert. Following the average performance of Deyr’09 rains in Sool Plateau, reports indicated that water catchments were replenished and pasture conditions improved, resulting in better access to livestock products and income for the households, and translating to an im- proved Alert nutrition situation in the livelihood. However, pasture and water conditions in western parts of Sool pla- teau (particularly Erigavo, Elafweyn and Taleh districts) as well as the neighbouring upper Nugal Valley and East Golis livelihood zones were poor, due to the below average rainfall reported in the area. Consequently it is crucial to monitor the food security indicators in the entire livelihood zone, because if they do not improve, there is a risk of de- terioration in the nutrition situation. FSNAU staff assessing for oedema in Elbuh village, Sool Areas affected by poor rainfall performance are experiencing Plateau Livelihood zone poor pasture and water conditions, leading to out-migration of livestock and families splitting. Men migrate with the livestock, leaving behind the women and children. The vul- nerability of the women and children left behind has increased due to their limited access to and control over livestock products, and income from sales. In addition, women are spending longer hours away from the home in search of water, compromising child care practices in the households, leaving children further susceptible to malnutrition. Further factors aggravating the vulnerable nutritional situation in the area include lack of adequate safe water, high morbidity rates and limited access to sanitation and health facilities. Although no disease outbreaks have been reported in Sool livelihood zone, an increased number of diarrhoea, ARI and conjunctivitis have been reported in local health centres. Humanitar- ian interventions currently on going in the area include water trucking by Horn Relief and general food distributions by World Food Programme (WFP). Close monitoring of the nutrition situation of this population group is vital due to the risk of deterioration, in areas affected by negative food security indicators. Furthermore, initializing interventions aimed at rehabilitating acutely malnourished children, improving access to health facilities and supporting livelihoods and protecting vulnerable groups are fundamental.

West Golis/Guban Livelihood Zone The nutrition situation of the West Golis/Guban livelihood zone continues to show an improvement, and has currently been classified as Alert, according to the Post Deyr ‘09/10 integrated nutrition situation analysis. The Post Gu ’09 integrated nutrition analysis indicated an obvious improvement in the nutrition situation of the population in the West Golis/Guban livelihood zone from Very Critical in the Post Deyr ‘08/09 to Serious. The livelihood has historically been classified as having an Alert nutrition situation apart from the Gu ’08 to Gu ’09 period, when the region experienced four seasons of consecutive rainfall failure.

FSNAU Technical Series Report No VI. 25 39 Issued February 22 2010 Table 13: Summary of key Nutrition Findings in Sool Plateau and Golis Livelihood Zones

West Golis/Guban East Golis/ Gebbi Valley Sool Plateau (N=362) (N=198) (N=213) Indicator Results Outcome Child Nutrition Status Global Acute Malnutrition (WHZ<-2 or oedema) >9.1 (Pr=0.90) Alert >6.8 (Pr=0.90) Alert >8.1 (Pr=0.90) Alert Severe Acute Malnutrition (WHZ<-3 or oedema) >0.4 (Pr=0.90) Alert >0.4 (Pr=0.90) Acceptable <0.3 (Pr=0.90) Acceptable Oedema 0.28 (1 case) Acceptable 0 Acceptable 0 Acceptable Global Acute Malnutrition (WHZ<-2 or oedema) NCHS >8.0 (Pr=0.90) Acceptable >6.8 (Pr=0.90) Serious >5.9 (Pr=0.90) Severe Acute Malnutrition (WHZ<-3 or oedema) >0.1 (Pr=0.90) Acceptable >0.4 (Pr=0.90) Acceptable 0 NCHS Acute malnutrition by MUAC (<12.5 cm ) 4.5 (1.6-6.7) Alert 5.6 (1.7-9.4) Alert 6.1 (3.0-9.2) Serious Stunting (HAZ<-2) 13.8 (10.1-17.5) Alert 11.6 (5.0-17.2) Alert 16.8 (13.0-20.8) Alert Underweight (WAZ<-2) 11.3 (6.9-15.7) Alert 7.6 (2.9-12.3) Alert 12.5 (7.5-17.5) Alert High numbers and High numbers and Low numbers increasing trend increasing trend of and stable trend HIS Nutrition Trends (Jun-Dec ‘09) Serious Serious Alert of malnourished malnourished children in of malnourished children in MCHs MCHs children in MCHs Child Morbidity & Immunization Disease trends (seasonally adjusted) Morbidity- 28.7 Morbidity- 26.4 Morbidity- No outbreaks Morbidity refers to the proportion of children reported Diarrhoea – 9.0 Critical Alert Diarrhoea – 9.6 Serious to be ill in the 2 weeks prior to the survey ARI- 15.5 ARI- 7.7 Vita A – 87.9 Vita A – 83.1 Immunization Status - - Alert Alert Measles- 50.0 Measles- 82 Food security phase HE Very Critical AFLC Critical AFLC Critical Overall Situation Analysis Alert Alert Serious

The December 2009 nutrition assessments in the northwest regions were conducted jointly by FSNAU/UNICEF, WFP, MOHL, Medair and Somalia Red Crescent Society (SRCS).

A small sample cluster survey (33x6) conducted in the livelihood zone assessed a total of 198 children from 33 clusters in the livelihood. Results analyzed using the CDC probability calculator, indicated a global acute malnutrition level (GAM <-2 Z score or oedema) of >6.8% (Pr=0.90), and a severe acute malnutrition level (SAM <-3 or oedema) of >0.4% (Pr=0.90). Similarly, the results of the MUAC measurements indicates a low proportion (5.6%) of children with MUAC measurements of <12.5cm or oedema (Table 13). Data from health information systems (HIS) in the area indicates a low number and stable trend of acutely malnourished children screened at health facilities. According to qualitative data collected during the Post Deyr ‘09/10 rapid nutrition assessments, animal products including milk, were available and consumption was satisfactory, due to the in migration of animals in to the region. The improvement was mainly attributed to the improved food security indicators, in addition to the sustained selective feeding and health interventions in the area. The progressive recovery of the west Golis/Guban livelihood zone nutrition situation is a clear illustration of the importance of milk and livestock products in the nutritional status of a pastoralist population, it further demonstrates the ability of pastoralist populations to recover from shocks, if appropriate interventions are well established and the relevant food security indicators improve. Feeding centres and mobile clinics in the region by UNICEF, MOHL, SRCS and World Vision have continued to facilitate the rehabilitation of acutely malnourished children and reduce morbidity. These interventions, in addition to the Child Health Days, have also supported improved

regional nutrition analysis immunization and vitamin A supplementation rates, reducing the population’s susceptibility to disease. Although a continued improvement in the nutritional situation in the area has been observed, the vulnerability of the region to natural shocks such as drought, necessitates continued close monitoring of the situation.

East Golis and Gebbi Valley Livelihood Zones of Sanaag Region The Post Gu ‘09 integrated nutrition analysis classified the nutrition situation in the East Golis of Sanaag region as Critical. Poor household access to milk and meat for consumption, to food and non-food commodities due to high prices, and to clean water and appropriate sanitation and health facilities1 were the main driving factors.

The current Post Deyr ’09/10 integrated nutrition analysis, classified the nutrition situation in the area as Serious indicating a slight improvement from Critical in the previous season (Table 13). The slight improvement is likely attributed to selective feeding and health interventions conducted mainly in and around Erigavo district by WFP, SRCS, UNICEF and Horn Relief (providing cash for work, mainly in Gebbi Valley). A small sample cluster survey conducted in the East Golis/Gebbi Valley livelihood zone assessed a total of 213 children from 33 clusters in the live- lihood. The results analyzed using the CDC probability calculator, indicated a GAM level (<-2 Z score or oedema) of >8.1% (Pr=0.90), and a SAM (<-3 or oedema) level of >0.3% (pr=0.90). Results of the MUAC measurements indicates 6.1% of assessed children with MUAC measurements of <12.5cm or oedema. Data from Erigavo, Kulmiye, Barwaqo and Elafweyn health facilities in the area reported high numbers and an increasing trend of acutely mal- nourished children (Figure 19). There were no disease outbreaks in the livelihood, however an increased number of diarrhoea cases have been noted in Hadftimo. The overall morbidity rate of children reported to be ill two weeks prior to the assessment was high at 26.4%. The immunization and vitamin A supplementation rates recorded during the

1 FSNAU Technical Series, Report No V.16, February 20, 2009, Nutrition Situation Post Deyr 2008/09

FSNAU Technical Series Report No VI. 30 40 Issued February 22 2010 assessment, indicate improved coverage of vaccination in Figure 19: HIS Malnutrition trends in East Golis/ Gebbi the livelihood zone again likely linked to the Child Health Valley Pastoral MCHs - Jan. ’08- Dec. ’09 Days. However, poor sanitation facilities, lack of adequate 50.0 safe water and limited health facilities still remain as the 2008 2009 2 per. Mov. Avg.(2008) 2 per. Mov. Avg.(2009) chronic underlying factors affecting the nutritional status 40.0 of the population. Limited physical access due to the mountainous terrain of this livelihood, continues to pose 30.0 a serious challenge to access formal services in the area.

percentage 20.0 The food security situation in the livelihood zone remains

precarious, and continues to contribute to the Serious nu- 10.0 trition situation. The livelihood zone has received below

normal rainfall for five consecutive seasons, including 0.0 Deyr ’09/10; this has led to abnormal out migration of Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec animals and poor animal body conditions, resulting in reduced household income and meat and milk consumption. The gum (frankincense) production remains poor, thus directly affecting the supplementary income from sales of gum, which has drastically reduced in the livelihood zone. Close monitoring of the nutrition situation of this population groups remains crucial, in addition to the expansion of interventions aimed at rehabilitating acutely malnourished children and improving access to health facilities, especially in the areas outside of Erigavo district, as there is a risk of the nutrition situation deteriorating if there is no improvement in the food security indicators in the coming season. regional nutrition analysis The Hawd Livelihood Zone – Hargeisa and Sool The Post Gu ’09 integrated nutrition situation analysis, clas- sified the Hawd of Hargeisa (Galbeed region) and of Sool Region as Serious, with a risk of deterioration in the Hawd of Hargeisa. The Hawd of Togdheer region was classified as Critical, with potential to deteriorate, whilst the southern part of the Hawd of Togdheer Region was classified asVery Criti- cal. According to the Post Deyr ‘09/10 integrated nutrition analysis, the nutrition situation has been classified asSerious in the Hawd of Hargeisa and Togdheer, while the nutrition situation in the Hawd of Sool region is Alert. This indicates an improvement in the Hawd of Togdheer and Sool regions, while the Hawd of Hargeisa remains in a sustained Serious nutrition situation. The improvement in the nutrition situa- Camel and calf left behind during a family split, tion of the Hawd of Sool and Togdheer livelihood zones is FSNAU, Hawd, Dec. ‘09 mainly attributed to the Deyr ‘09/10 rains in the area, which has contributed to water and pasture availability, improved livestock body conditions, and thereby, improved access to income through sales of animal products and milk consumption at the household level.

In the Hawd of Hargeisa, the Deyr ‘09/10 rain performance was below average and did not translate into improvements in access to livestock products and the nutrition situation as observed in the Hawd of Sool. A sustained Serious nutrition situation phase is therefore noted in the Hawd of Hargeisa, mainly attributed to the negative food security indicators observed in the livelihood. The lack of adequate water and pasture in the area has led to reduced animal production and sales in the area, directly affecting the pastoral population’s nutritional status (Table 14). Health facilities in the area indicate report high numbers and an increasing trend of acutely malnourished children. No disease outbreaks were reported in the area during the Deyr ’09 season. Immunization and vitamin A supplementation were below the recom- mended standards, and availability and accessibility of health services in the area remain a challenge. The area’s nutrition situation requires keen surveillance. Efforts to rehabilitate acutely malnourished children and expansion of health care services in the area are recommended.

The Hawd of Sool also illustrated an improvement in the nutrition situation of the population. The Post Gu ‘09 integrated nutrition situation analysis classified the area as Serious. The Post Deyr ‘09/10 integrated nutrition analysis has classi- fied the nutrition situation asAlert . The improvement was attributed to the good rainfall performance experienced in the Hawd of Sool region, the area has received a large influx of livestock from other areas that have in migrated because of the improved pasture and water availability in the region. As a result, the availability and consumption of animal prod- ucts, especially milk in the area, has increased. In addition to the low GAM levels (Table 14) reported in the area, data from health facilities in the area also reported a low number of acutely malnourished children. There were no disease outbreaks reported in the area, however increased cases of ARI were reported. Nevertheless, continued monitoring of the nutrition situation in the area still remains necessary.

FSNAU Technical Series Report No VI. 25 41 Issued February 22 2010 Table 14: Summary of Key Nutrition Findings Hawd of Sool/Hargeisa and Nugal Valley Hawd of Sool/ Hargeisa (N=198) Nugal Valley (N=373) Indicator Results Outcome Child Nutrition Status Global Acute Malnutrition (WHZ<-2 or oedema) >9.4 (Pr=0.90) Alert >9.2 (Pr=0.90) Alert Severe Acute Malnutrition (WHZ<-3 or oedema) 0 Acceptable >1.7 (Pr=0.90) Acceptable Oedema 0 Acceptable 0 Acceptable Global Acute Malnutrition (WHZ<-2 or oedema) NCHS >7.1 (Pr=0.90) Alert >7.1 (Pr=0.90) Alert Severe Acute Malnutrition (WHZ<-3 or oedema) NCHS 0 Acceptable >0.3 (Pr=0.90) Acceptable Acute malnutrition by MUAC (<12.5 cm ) 8.1 (4.4-11.7) Serious 5.0 (2.2-7.4) Serious Stunting (HAZ<-2) 12.1 (6.9-17.3) Alert 9.3 (6.5-12.1) Alert Underweight (WAZ<-2) 9.1 (4.6-13.5) Alert 10.1 (6.2-14.0) Alert HIS Nutrition Trends (Jun- Dec ‘09) High and increasing trend High no. and increasing Hawd of Hargeisa Serious of acutely malnourished Serious Low numbers and stable Hawd of Sool Alert children Child Morbidity & Immunization Disease trends (seasonally adjusted) No disease outbreaks Morbidity refers to the proportion of children reported to be No disease outbreaks Alert Alert ill in the 2 weeks prior to the survey Vita A – 27.3 Immunization Status Critical - - Measles- 64.6 Food security phase AFLC Critical AFLC Critical Overall Situation Analysis: Serious Hawd of Hargeisa Serious Upper Nugal Valley likely to deteriorate Hawd of Sool Alert

Nugal Valley Livelihood Zone The Post Deyr ‘09/10 integrated nutrition situation has classified the nutrition situation in the Nugal valley liveli- hood as Serious. The livelihood continues to experience poor rainfall performance, affecting the water and pasture availability and animal body conditions, consequently having a direct impact on milk production, consumption and income of households. A small sample cluster survey conducted in the livelihood zone assessed a total of 373 children from 62 clusters in the livelihood. The results analyzed Figure 20: HIS Malnutrition Tends in Nugal Valley using the CDC probability calculator, indicated a global Pastoral MCHs, Jan ‘08 - Dec. ‘09 acute malnutrition level (GAM <-2 Z score or oedema) 70.0 2008 2009 of >9.2% (Pr=0.90), and a severe acute malnutrition level 2 per. Mov. Avg.(2008) 2 per. Mov. Avg.(2009) (SAM <-3 or oedema) of >1.7% (Pr=0.90). Results of the 60.0 MUAC measurements indicates 5.0% of assessed children 50.0 with MUAC measurements of <12.5cm or oedema (Table 40.0

14). Data from the health facilities namely, Elafweyn, 30.0 Garadag and Huddun indicates high numbers and a stable trend of acutely malnourished children (Figure 20), no 20.0 disease outbreaks have been reported in the area. How- 10.0

regional nutrition analysis ever, the nutrition situation in the upper parts of Nugal 0.0 Valley livelihood zone appears worse than the rest of the Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec livelihood zone.

The lower parts of Nugal livelihood zone rainfall performance was better, therefore prompting in migration of live- stock into the other area, thus increasing the availability and consumption of animal products. On the contrary, the situation was less positive in the upper parts of Nugal valley, where rainfall performance has been poor in the area for five consecutive seasons now. There is a risk of deterioration in the upper Nugal nutrition situation due to the lack of water, poor pasture and consequently lack of adequate animal products for consumption and sale. Therefore the area needs to be closely monitored, with enhanced interventions to improving the nutritional status of acutely malnourished children.

The Hawd of Togdheer Livelihood Zone The worrying nutrition situation observed during the Post Gu ‘09 in the Hawd of Togdheer livelihood zone, prompted FSNAU and partners to conduct a comprehensive nutrition assessment to further understand the immediate and underly- ing causes of malnutrition in the area. The nutrition survey conducted in October 2009, reported a GAM (<-2 z scores or oedema) rate of 10.4% (7.8-13.7), and a SAM (<-3 z score) rate of 1.0% (0.4-2.4), indicating a Serious situation. The improvement of the nutrition situation from Critical in the Gu ’09, was mainly attributed to an improved food security situation as a result of the rains received in the area in October 2009. Although the overall rainfall performance of the Deyr ‘0/10 season in the area was below normal, the rains brought some relief, improving water availability and pasture in comparison to the previous seasons characterized by rain failure. These slight improvements resulted in availability and consumption of milk and animal products by households in the area. A total of 64.8% of the assessed households reported to have consumed milk in the 24 hours preceding the survey, with 24.1% of the households consuming at least

FSNAU Technical Series Report No VI. 30 42 Issued February 22 2010 <4 food groups a day. However breastfeeding and child feeding practices remained wanting. The proportion of children aged 6-24 months and breastfeeding was 40.3%, while the proportion of children with appropriate feeding practices was only 25.7%. Although there were no dis- ease outbreaks reported in the area, the overall morbidity was high, with 48.4% of the children assessed reported to have fallen ill two weeks prior to the nutrition survey. Diarrhoea (27.7%), suspected measles (21.5%) and ARI (13.5%) were the diseases reported, with diarrhoea being the highest form of illness reported among the assessed children. (Table 15). Wasted child with burn marks from traditional healing of diarrhoea, illustration of poor child care practices. The vaccination and vitamin A supplementation status of the children assessed for the last 6 months fell below the recommended standards, a decline from the previous season, where a higher number of children were reported to have been immunized and received vitamin A supplementation. Accessible selective feeding programmes targeting acutely malnourished children, and health programmes aimed at reducing morbidity are vital in the area, in addition close monitoring of the nutrition is required, as the population still remain vulnerable.

Agropastoral Livelihood Zones The nutrition situation of the agropastoral populations of the Togdheer region remains Critical, according to the Post regional nutrition analysis Deyr ‘09/10 integrated nutrition analysis. High morbidity rates (36.8%) and a precarious food security situation are the main factors attributed to the poor nutrition situation affecting the agropastoral livelihood in the area. The agropasto- ralists of Togdheer regions are more of livestock holders than crop cultivators in comparison to the agropastoralists of Awdal and Galbeed region, and therefore more vulnerable, to the drought in the region that has affected the pastoral populations in the area. Additionally, the low crop production noted in the area has increased their vulnerability, the agro-pastoralists of this region produced just 2% of the 11,000MT of total cereal production in the Northwest region2. The FSNAU food security analysis has classified the livelihood zone as inHumanitarian Emergency.

In October 2009, FSNAU and partners conducted a comprehensive nutrition survey in the livelihood zone. The results indicated a global acute malnutrition rate (GAM <-2 z scores or oedema) of 16.1% (13.1-19.1), and severe acute malnutrition rate of 2.9% (1.5-4.4). The proportion of children assessed that had fallen ill 2 weeks prior to the survey was high, at 36.8%. Feeding and care practices remained sup-optimal, with 14.7% of the population consuming <4 food groups a day3, only 46.4% of the children aged 6-24 months were still breastfeeding at the time of the survey and only 27.9% were meeting the recommended feeding frequency (Table 15).

The proportion of the households that had consumed milk in the 24 hours preceding the assessment was 66.4%; households attributed the reduction in milk consumption, to poor animal body conditions because of the lack of ad- equate water and pasture in the area, in addition to the low incomes from low crop production sales. Data from the health facilities in the area also recorded a high number and increasing trend of acutely malnourished children. In addition, data from feeding centres in Burao, also indicated increased admissions, with majority of reported to have come from the rural villages in Togdheer region. The measles immunization and vitamin A supplementation status was also below the recommended standards (66.4% and 68.0% respectively). Availability of water, sanitation and health facilities in the area are limited, with only 20.1% of the population having access to safe water and only 39.7% accessing sanitation facilities. In addition to the concerning food security indicators, these factors further exacerbate the poor nutrition situation in the area. The Togdheer agropastoral population are currently the rural livelihood zone with the most worrying nutrition situation in the Northwest region.

2 FSNAU Technical series Post Deyr ‘09/10 3 This indicates the dietary diversity of the population is Serious, according to the FSNAU Estimated Framework of estimating the Nutrition Situation

FSNAU Technical Series Report No VI. 25 43 Issued February 22 2010 Table 15: Summary of Key Nutrition Findings in Togdheer Pastoral and Agro-pastoral Livelihoods, October 2009

Togdheer Pastoral Togdheer Agropastoral Indicator Results Outcome Results Outcome Child Nutrition Status Global Acute Malnutrition (WHZ<-2 or oedema) 10.4 (7.8-13.7) Serious 16.1 (13.1-19.1) Critical Severe Acute Malnutrition (WHZ<-3 or oedema) 1.0 (0.4-2.4) Acceptable 2.9 (1.5-4.4) Alert Oedema 0 Acceptable 0.4 (0.0-1.8) Serious Global Acute Malnutrition (WHZ<-2 or oedema; NCHS) 10.1(7.8-13.0) Serious 15.8(12.7-18.9) Critical Severe Acute Malnutrition (WHZ<-3 or oedema; NCHS) 0.4 (0.0-1.8) Acceptable 0.4 (0.0-1.9) Acceptable Acute malnutrition by MUAC (<12.5 cm or oedema in nutrition 8.8 (4.2-13.5) Serious 8.7 (5.7-11.7) Serious surveys) Stunting (HAZ<-2) 8.3 (5.3-12.6) Alert 13.9 (10.7-17.3) Serious Underweight (WAZ<-2) 7.6 (4.2-11.1) Alert 11.5(8.5-14.4) Serious High levels and High levels and HIS Nutrition Trends(Jan-Jun ‘09) Critical Critical increasing increasing Child Morbidity & Immunization Outbreak – None Outbreak -None Disease trends (seasonally adjusted) Morbidity – 48.4 Morbidity– 36.8 Morbidity refers to the proportion of children reported to be ill in the 2 Critical Critical Diarrhoea- 27.7 Diarrhoea –21.0 weeks prior to the survey ARI-13.5 ARI -18.2 Vitamin A – 60.8 Vitamin A – 66.4 Immunization Status Critical Critical Measles – 57.3 Measles- 68.0 Infant and Young Child Feeding (6-24 months) Proportion still Breastfeeding 40.3 Critical 46.3 Critical Proportion of Children introduced to complimentary feeding at the age of 6 months Proportion of Children meeting required minimum feeding frequency 25.7 Critical 27.9 Critical Mortality Crude Mortality Rate per 10,000 per day (retrospective for 90 days) 0.71 (0.42-1.19) Alert 0.59 (0.36-0.97) Alert Under five mortality rate per 10,000 per day (retrospective for 90 0.98 (0.43-2.26) Alert 1.13 (0.51-2.48) Alert days) Women Nutrition & Immunization Status Proportion of acutely malnourished non pregnant women 0 Alert 1.6 (N=0-3.9) Alert (MUAC≤18.5 cm) Proportion of acutely malnourished pregnant women (MUAC<23.0). 14.4 (N=18) Alert 15.2(N=10) Alert Proportion of Women who received Tetanus Immunization None 14.3 (8.5-20.1) 12.6 (7.6-17.6) One dose 12.3 (7.9-16.6) Critical 10.9 (7.2-14.6) Critical Two dose 22.5 (16.5-28.6) 19.4 (15.2-23.7) Three dose 50.9 (39.9-61.9) 57.1 (50.1-64.1) Public Health Indicators Proportion of malnourished children registered in SFs regional nutrition analysis Very Very Households with access to safe water 0.9 20.1 Critical Critical Very Very Household with access to sanitation facilities 36.3 39.7 Critical Critical Food Security Households with poor dietary diversity (< 4 food groups) 24.9 Serious 14.7 Critical Household’s Main Food Source Purchase: 92.8 97.7 Own Production 0.7 1.2 Food aid 0 0 Humanitarian Very Food security phase AFLC Critical Emergency Critical Overall Situation Analysis Serious Critical

The agropastoral livelihood zones of Awdal and Galbeed recorded an improvement in the nutrition situation accord- ing to the Post Deyr ‘09/10 integrated nutrition situation analysis, from a Critical to Alert nutrition situation. The improvement is mainly attributed to the improved crop production experienced in the area, especially in Gebiley district, which produced 85% of the total cereal production of the agropastoralist production in the Northwest region. A small sample cluster survey conducted in the livelihood zone assessed a total of 198 children from 33 clusters in the livelihood. The results analyzed using the CDC probability calculator, indicated a global acute malnutrition level (GAM <-2 Z score or oedema) of >9.8% (Pr=0.90), and a severe acute malnutrition level (SAM <-3 or oedema) of >0.7% (Pr=0.90). Results of the MUAC measurements indicates 3.5% of assessed children with MUAC measure- ments of <12.5cm or oedema (Table 16).

FSNAU Technical Series Report No VI. 30 44 Issued February 22 2010 Table 16: Summary of Key Nutrition Findings Agropastoral of Awdal and Galbeed (N=198)

Indicator Results Outcome Child Nutrition Status Global Acute Malnutrition (WHZ<-2 or oedema) >9.8 (Pr=0.90) Alert Severe Acute Malnutrition (WHZ<-3 or oedema) >0.7 (Pr=0.90) Acceptable Oedema 0 Acceptable Global Acute Malnutrition (WHZ<-2 or oedema) NCHS >8.7 (Pr=0.90) Alert Severe Acute Malnutrition (WHZ<-3 or oedema) NCHS >0.1 (Pr=0.90) Acceptable Acute malnutrition by MUAC (<12.5 cm ) 3.5 (1.9-6.0) Alert Stunting (HAZ<-2) 20.7 (14.8-26.2) Serious Underweight (WAZ<-2) 13.1 (8.5-17.7) Alert Low no and stable trend of malnourished HIS Nutrition Trends(Jan-Jun ‘09) Alert children in MCHs Child Morbidity & Immunization Disease trends (seasonally adjusted) Morbidity- 29.8 Morbidity refers to the proportion of children reported to be ill in the 2 Critical weeks prior to the survey Immunization Status Vita A – 74.2 Measles- 61.1 Serious Food security phase AFLC Critical

Overall Situation Analysis Alert regional nutrition analysis Data from the health facilities namely, Gebiley, Dila, Togwajale and Baki indicates high numbers and a stable trend of acutely malnourished children, however the two health facilities bordering the Hawd of Hargeisa namely Adadley and Bali-Abamu reported a low number but increasing trend of acutely malnourished children, mainly attributed to the worrying nutrition situation in the Hawd of Hargeisa.

There was no disease outbreaks reported in the area, although the overall morbidity reported from the small cluster assessment was high at 29.8%. The immunization and vitamin A status for the last 6 months indicated that 74.2% and 61.1% of the children assessed had received vitamin A supplementation and measles vaccination.

The assessment also reported that there was adequate milk consumption in the livelihood, in addition to improved cereal consumption and income from crop production at the household level.

IDPs of the North West: Hargeisa, Burao and Berbera The nutrition situation of Burao IDPs has improved from, Critical to Serious, while a sustained nutrition situation was observed among the Hargeisa IDPs at Serious and the Berbera IDPs at Critical according to the Post Deyr ’09/10 integrated nutrition analysis.

Small sample cluster surveys conducted among the Hargeisa, Burao and Berbera IDPs assessed a total of 198 children from 33 clusters in the each of the settlements. Results analyzed using the CDC probability calculator, indicated a global acute malnutrition level (GAM <-2 Z score or oedema) of >11.4% (Pr=0.90), and a severe acute malnutrition level (SAM <-3 or oedema) of 1.5% (pr=0.90), among the Hargeisa Child with Oedema in Berbera IDP camp IDPs. While in Burao a GAM (<-2 Z score or oedema) level of >13.9% (Pr=0.90), and a SAM (<-3 or oedema) level of 4.4% (Pr=0.90) were reported. A GAM (<-2 Z score or oedema) level of >19.2% (Pr=0.90), and a SAM (<-3 or oedema) level of 2.9% (pr=0.90) was reported among the Berbera IDPs (see Table 17 for all survey results).

Data from the health facilities in Hargeisa, Burao and Berbera indicated a high and increasing trend of acutely mal- nourished children, morbidity data collected indicated that the proportion of children that had suffered from one or more illnesses in the two weeks prior to the assessment was high (Hargeisa- 39.0%, Burao- 33.8% and 29.9% in Berbera). The main factors contributing to the worrying nutrition situation among the IDP population include the high morbidity rates, poor child feeding and care practices and reduced access to nutritious foods due to high costs, coupled with chronic underlying risk factors such as poor access to safe water and sanitation facilities. It is therefore imperative to continue, expand and initiate (in affected areas that have not began) appropriate interventions to im- mediately rehabilitate acutely malnourished children, these interventions should also be backed by long term inter- ventions such as improved child care and feeding practices, improved dietary diversity and enhanced access to safe water and sanitation and health facilities.

FSNAU Technical Series Report No VI. 25 45 Issued February 22 2010 Table 17: Summary of Key Nutrition Findings in IDPs of Hargeisa Burao and Berbera, Dec. 2009

Hargeisa IDPs N=198 Burao IDPs N=198 Berbera IDPs N= 198 Indicator Results Outcome Results Outcome Results Outcome Child Nutrition Status >13.9 Global Acute Malnutrition (WHZ<-2 or oedema) >11.4 (Pr=0.90) Serious Serious >19.2 (Pr=0.90) Critical (Pr=0.90) Severe Acute Malnutrition (WHZ<-3 or oedema) >1.5 (Pr=0.90) Alert >4.4 (Pr=0.90) Critical >2.9 (Pr=0.90) Alert Oedema 0 Acceptable 1.0 ( 2 cases) Serious 0.5 ( 1 case) Serious Global Acute Malnutrition (WHZ<-2 or oedema) NCHS >12.2 (Pr=0.90) Serious >17.5 (Pr=0.90) Serious >19.6 (Pr=0.90) Critical Severe Acute Malnutrition (WHZ<-3 or oedema) NCHS >1.0 (Pr=0.90) Alert >0.9 (Pr=0.90) Critical >1.0 (Pr=0.90) Alert Very Acute malnutrition by MUAC (<12.5 cm or oedema) 6.7 (1.8-11.5) Serious 6.1(2.2-9.9) Serious 17.8 (11.6-24.0) Critical Stunting (HAZ<-2) 22 (14.4-29.7) Serious 10.1 (4.8-15.4) Alert 13.6 (7.7-19.4) Alert Underweight (WAZ<-2) 20.5 (12.8-28.3) Serious 15.2 (8.7-21.6) Serious 22.8 (14.3-13.4) Serious High levels and High levels and High levels and HIS Nutrition Trends(Jan-Jun ‘09) Critical Critical Critical increasing increasing increasing Child Morbidity & Immunization Outbreak Outbreak – None -None Outbreak -None Disease trends (seasonally adjusted) Morbidity – 39.0 Morbidity– 33.8 Morbidity– 29.9 Morbidity refers to the proportion of children reported to Diarrhoea- 17.9 Critical Diarrhoea Critical Diarrhoea –20.3 Critical be ill in the 2 weeks prior to the survey ARI-24.1 –19.2 ARI -5.6 Fever- 30.8 ARI -8.6 Fever – 13.3 Fever – 15.2 Vitamin A – Vitamin A – 78.5 Vitamin A – 93.0 Immunization Status Critical 89.9 Serious Serious Measles – 83.1 Measles- 89.7 Measles- 85.4 Infant and Young Child Feeding (6-24 months) Proportion still Breastfeeding 41.4 (30.0-50.0) Critical 35.8 (24.6-47.1) Critical 45.1 (33.3-56.8) Critical Proportion of Children introduced to complimentary Very Very Very 14.9 (4.3-25.5) 10.4 (3.5-17.4) 13.0 (0.9-25.0) feeding at the age of 6 months Critical Critical Critical Proportion of Children meeting required minimum feeding 86.6 (77.5- 42.9 (29.1-56.7) Critical Serious 52.1 (36.6-67.6) Critical frequency 95.6) Women Nutrition & Immunization Status Proportion of malnourished non pregnant women 0 Alert 0 Alert 0 Alert (MUAC≤18.5 cm) Proportion of malnourished pregnant women 9.5 (N=21) Alert 11.1(N=27) Alert 16.0(N=25) Serious (MUAC<23.0). Proportion of Women who received Tetanus Immunization None 18.6 (8.9-28.2) 17.5 (0-25.1) 15.4 (8.7-22.1) regional nutrition analysis One dose 19.6 (11.9-27.3) Critical 7.5 (2.6-12.4) Critical 0 Critical Two dose 18.6 (10.3-26.8) 20 (11.7-28.3) 37.7 (27.7-47.7) Three dose 43.3 (31.1-55.5) 55 (47.5-62.5) 31.5 (21.7-41.4) Public Health Indicators Very Very Very Proportion of malnourished children registered in SFs 3.6 (0-10.9) 9.1 (0-23.1) 15.6 (2.8-28.3) Critical Critical Critical Households with access to safe water 91.8 Serious 66.4 Critical 88.6 Serious Very Household with access to sanitation facilities 36.3 79.9 Critical 99.2 Alert Critical Food Security Household’s Main Food Source Purchase: 94.9 90.6 89.1 Own Production 1.0 - - Food aid 0 0 0 Humanitarian Very Food security phase AFLC Critical Emergency Critical

Overall Situation Analysis Serious Serious Critical

FSNAU Technical Series Report No VI. 30 46 Issued February 22 2010 4.9 URBAN NUTRITION ANALYSIS

In December 2009, a rapid urban nutrition assessment was conducted in 27 Somali urban centers, using Mid Upper Arm Circumference (MUAC) of children aged 6-59 months, household dietary diversity in the preceding 24 hrs to the study, and coping strategies undertaken at the time (December 2009) compared to December 2008, reviewed.

A total of 5,156 children from 530 poor households were assessed with varied findings, these findings however are not representative, therefore should be interpreted with caution, they are merely to highlight vulnerability. The urban centers indicating the highest proportion of acutely malnourished children (with MUAC <12.5cm or oedema) were as follows:

• Abudwaq, Dusamareb and Eldheer in Central regions,

• Dinsor and Elberde in Bay

• Afgoye in Shabelle region and Offloading Cargo at Berbera Sea Port. Port activities • Luuq, Bardera and Belet-Hawa in Gedo. contribute significantly to the local economy of Berbera, Kismayo and Bossaso Towns. In Central regions, this is mainly attributed to persistent poor household food security combined with insecurity and reduced access to services. In Bay and Gedo, both dis- ease and lack of dietary diversity are the main driving factors.

A concerning proportion of households in Lasanod (42.5%) and a significant proportion in Afgoye, Doble, Abudwaq, Beletweyne and Burao (10% each) reportedly, consumed a poorly diversified diet (<4 food groups). While purchase is the main means by which urban livelihoods access food and is reflected likewise in the assessed centers (Table 18), the situation in Dusamareb reflects the crisis with food aid reported as the main source for 55% of the assessed households. Borrowing of food is also a major food source in Eldheer (40%) and Haradhere (21.1%).

The change in proportion of households reportedly employing either of the following coping strategies: Skipping

entire days without a meal, OR restricting consumption by adults in order for small children to eat, OR borrowing urban analysis food or relying on help from friends or relative (considered in this analysis as severe) in December 2008 and 2009 were analyzed. Improvements are observed in Juba region, where the proportions have decreased from 35-40% in December 2008 to 5-30% In December 2009. Elbur in Galgadud (33% to 0%) has reported an improvement possibly linked to access to food aid. In other areas, findings indicate varied situations (see Table 18 for summary of the findings).

An integrated analysis of the findings based on the Nutrition Situation Framework (Feb’08 Draft) indicates a concerning nutrition situation for the urban poor households ranging from Serious to Very Critical, similar to the adjacent rural livelihoods across all regions. The high disease incidence in Juba unfortunately has negated the gains made through improved access to food, leading to an overall Critical situation in the urban centers therein; while the declining humanitarian space in Shabelle regions has reduced the access to basic services and may have contributed to the Very Critical situation. For details on the urban food security situation, refer to the Food Security and Nutrition Brief, February 12, 2010.

FSNAU Technical Series Report No VI. 25 47 Issued February 22 2010 Table 18: Summary of Key Findings, Rapid Urban Nutrition Assessments, Nov. - Dec. ’09

Coping Strategies: Proportion Of Households Either 1. Skipping Entire Days Without A Meal, Or Proportion 2. Restricting June 2009 Of Hh Nutrition Proportion Consumption Reportedly Overall Phase Of Children By Adults In Urban Consuming Main Source Of Nutrition (Ref:nutrition Region No. Assessed With Order For Small Center < 4 Food Food Situation Situation Muac<12.5 Children To Eat, Groups In Jan 2010 Post Gu’09 Cm Or Preceding 3. Borrowing Food Tec Series 24 Hours Or Relying On Help Report) From Friends Or Relatives June June Dec Dec 2009 2008 2008 2009

Purchase (45%) Luuq 110 Children, 14.5% Gedo 0% Own Production 25% 15% 25% 30% Critical Very Critical 20 Households (55%) 110 Children Bardera 15.5% 0% Purchase (50%) 40% 20% 40% 40% Critical Very Critical 20 Households 110 Children Purchase (65%) Belet-Hawa 17.2% 0% N/A N/A 30% 25% Critical N/A 10 Households Own Prod’n (35%) Critical Juba Jilib N/A N/A N/A N/A N/A N/A N/A N/A N/A

110 Children 100% Doble 14.5% 10% Purchase (195%) 57.1% 40% 30% Critical Critical 20 Households Afmadow 110 Children 12.7% 5% Purchase (85%) N/A N/A 35% 15% Critical N/A 20 Households Very Critical 220 Children Buale 13.6% 5% Purchase (100%) 100% 45.9% 65% 5% Critical -Cholera 20 Households Outbreak Likely 110 Children Bay Dinsor 23.5% N/A N/A N/A N/A N/A N/A Very Very Critical 20 Households Critical Likely 220 Children Bakool Elberde 19.1% N/A N/A N/A N/A N/A N/A Very Very Critical 20 Households Critical 110 Children Likely Huddur 8.1% N/A N/A N/A N/A N/A N/A Serious 20 Households Serious Own Production 220 Children Shabelle Jowhar 8.6% 0% (65%) 53% 23% 90% 60% Serious Serious 20 Households Purchase (35%) 220 Children Purchase (95%) Very Afgoye 21.8% 10% 78% 100% 100% 75% Very Critical 20 Households Critical 220 Children N. East1 Galcayo 13.2% 1 0% Purchase (95%) 91.2% 80% 90% 70% Serious Critical 20 Households

urban analysis 220 Children Garowe 10.9% 5% Purchase (100%) 70% 62.5% 85% 90% Serious Critical 20 Households Bossaso 221 Children 11.5% 0% Purchase (100%) N/A N/A 60% 85% Serious Critical 10 Households 436 Children N. West Burao 14.2% 10.3% Purchase (100%) 42.5% 70% 42.5% 90% Critical Very Critical 40 Households 440 Children Hargeisa 2.3% 8.8% Purchase (97.5%) 33% 48.8% 57.5% 72.5% Serious Critical 40 Households Serious 110 Children Togwajale 5.5% 0% Purchase (100%) 42.5% 85% 90% 80% Very Critical 20 Households

110 Children Erigavo 6.4% 5.3% Purchase (94.7%) 82.5% 82.5% 94.7% 89.5% Serious Critical 20 Households 220 Children Boroma 9.1% 0% Purchase (94.7%) 55% 62.5% 30% 35% Serious Critical 20 Households 220 Children Lasanod 14.5% 42.5% Purchase (75%) 72.5% 93.5% 22.5% 55% Serious Critical 20 Households Abudwaq 220 Children Very Central (Ubax & 39.1% 10% Purchase (70%) N/A N/A 95% 90% N/A 20 Households Critical October) 220 Children Purchase (55%) Very Eldheer 36.8% 5% N/A N/A 100% 95% N/A 20 Households Borrowing (40%) Critical 209 Children Elbur 14.4% 0% Purchase (100%) N/A N/A 33.3% 0% Serious N/A 10 Households 220 Children Food Aid (55%) Very Dusamareb 26.4% 0% N/A N/A 45.0% 85% N/A 20 Households Purchase (35%) Critical Purchase (78.9%) 220 Children Haradhere 7.7% 0% Borrowing N/A N/A 45% 50% Critical N/A 20 Households (21.1%) 220 Children Hiran Beletweyne 17.7% 10% Purchase (100%) N/A N/A 35% 0% Critical N/A 20 Households

1 For figures quoted for Galkayo, Garowe and Bossaso, the WHZ indicator (based on WHO GS) was used, not MUAC, based on three small sample surveys conducted.

FSNAU Technical Series Report No VI. 30 48 Issued February 22 2010 5. GuidELINES ON THE use of Plausibility checks

Digit preference DP for weight and height: Indicates how accurately children were weighed and when done correctly there shouldn’t be any digit preference. This normally occurs when enumerators round to the nearest cm/kg or half cm/kg. The signs; +, ++, +++ indicate if there was any DP for a number and if it was, mild, moderate or severe, respectively. Digit Preference scores for weight and hight are graded as; (0-5 good, 5-10 acceptable, 10-20 poor and > 20 unacceptable)

Standard Deviation (SD) of WHZ: Indicates whether there was a substantial random error in measurements. In a normal distribution the SD is equal to +1, but should lie between 0.8 and 1.2 Z score. SD increases as the proportion of erroneous results in the data set increases.

Skewness of WHZ: This is a measure of degree of asymmetry of the data around the mean. A normal distribution is symmetrical and has zero skewness and should lie between +1 or -1. Positive skewness indicates a long right tail and negative skewness indicates a long left tail.

Kurtosis of WHZ: This demonstrates the relative peakedeness or flatness compared to a normal distribution. The normal distribution has zero kurtosis and surveys should lie between +1 and -1. Positive kurtosis indicates a peaked distribution while negative indicates a flat one. plausibility checks

Percent of flag: Flags are measurement that are highly unlikely to occur in nature and are therefore highlighted by the software. These incoherent measurements should be corrected or discarded prior to analysis, 0% flags is ideal but should be less that 2-3% of children measured.

Age distribution: This allows for a view of the representativeness of the sample, and should be similar to the distribution within the population. Age bias is of particular concern for anthropome- try. As younger aged (6-29) children are more likely to be malnourished than the older age group (30-59), this means under representation of the younger age group may give a lower prevalence than the actual one and vice versa. The age ratio allows a view of this relationship and should fall between 0.78 and 1.18 with an ideal falling around 1.0.

Sex ratio: Allows a view of the representativeness of the sample and should be similar to the distribution within the population. This should not vary too much from the expected sex ratio and should fall between 0.8 and 1.2.

Table 19 provides a summary of findings on plausibility checks for nutrition assessments conducted in the Deyr ’09/10

FSNAU Technical Series Report No VI. 25 49 Issued February 22 2010 Table 19: Plausibility Checks plausibility checks

FSNAU Technical Series Report No VI. 30 50 Issued February 22 2010 6. Nutrition Survey Findings Summary, Oct. - Dec. ‘09 Summary of Nutrition Survey Findings, Oct. - Dec. ‘09 GAM based SAM based GAM SAM on WHO on based on based on Date of 2006 CMR/ U5MR / Affected Region/ WHO NCHS <-2 NCHS <-3 Participating Nutrition Sample <-2 Z 10,000/ 10,000/ Livelihood 2006 <-3 Z Z scores Z scores/ Agencies Survey Size scores or day day scores/ or oedema Oedema oedema Oedema (%) (%) (%) (%)

Northwest 1. Guban/West Golis >6.8 >0.4 >6.8 >0.4 (Small sample cluster Nov ’09 198 (Pr.=0.90) (Pr.=0.90) N/A N/A (Pr.=0.90) (Pr.=0.90) survey) 2.East Golis/Gebi >8.1 >0.3 >5.9 Karkar (Small sample Nov ’09 213 0 N/A N/A (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) cluster survey) 3.Burao IDP (Small >13.9 >4.4 >17.5 >0.9 sample cluster survey) Nov ’09 198 N/A N/A (Pr=0.90) (Pr=0.90) (Pr.=0.90) (Pr.=0.90) 4.Nugal Valley (Small >9.2 >1.7 >7.1 >0.3 Nov ’09 373 N/A N/A sample cluster survey) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90)

5.Hargeisa IDP(Small survey findings of summary >11.4 >1.5 >12.2 >1.0 Sample cluster Nov ’09 198 N/A N/A (Pr=0.90) (Pr=0.90) (Pr.=0.90) (Pr.=0.90) survey) 6. Sool Plateau (Small >9.1 >0.4 >8.0 >0.1 Nov ’09 362 N/A N/A sample cluster survey) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) 7. Berbera IDP (Small sample cluster survey) >19.2 >2.9 >19.6 >1.0 Nov ’09 198 N/A N/A (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90)

8.Togdheer Agro 16.1 2.9 15.8 0.4 0.59 1.13 Nov’09 716 Pastoral (13.1-19.1) (1.5-4.4) (12.7-18.9) (0.0-1.9) (0.36-0.97) (0.51-2.48) 10.4 1.0 10.1 0.4 0.71 0.98 9.Togdheer Pastoral Nov’09 702 (7.8-13.7) (0.4-2.4) (7.8-13.0) (0.0-1.8) (0.42-1.19) (0.43-2.26) 10.Hawd of Sool FSNAU , UNICEF, >9.4 >7.1 (Small sample cluster MOHL.SRCS, Nov’09 198 0 0 N/A N/A (Pr.=0.90) (Pr.=0.90) survey) SDRA AID ORGANIZATION 11.Agro Pastoral of Awdal and Galbeed >9.8 >0.7 >8.7 >0.1 Nov’09 198 N/A N/A (Small sample cluster (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) survey) Northeast

12.Nugal Valley (Small >8.4 >2.0 >6.7 >0.1 Nov ’09 200 N/A N/A sample cluster survey) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90)

13. Sool Plateau >7.1 >2.0 >7.0 >0.1 (Small sample cluster Nov ’09 213 N/A N/A (Pr.=0.90) (Pr.=0.90) Pr.= 0.90) (Pr.= 0.91) survey) 14.Coastal Deeh >6.9 >2.0 >5.1 >0.1 (Small sample cluster Nov ’09 198 N/A N/A (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) survey) 15. Golis/ >8.1 >0.3 >5.9 Dharoor(Small sample Nov ’09 213 0 N/A N/A (Pr=0.90) ( Pr.=0.90) (Pr.=0.90) cluster survey) 16. Bossaso >17.5 >5.5 >12.6 >1.6 IDPs(Small sample Nov ’09 210 N/A N/A (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90 cluster survey)

17. Galkayo IDP(Small >23.7 >6.3 >22.5 >5.1 Nov ’09 209 N/A N/A sample cluster survey) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90 (Pr.=0.91)

Central Regions 19.1 4.3 17.9 1.9 0.90 2.00 18. Hawd Pastoral FSNAU, UNICEF, Nov’09 580 (15.3-23.0) (2.7-7.9) (13.9-22.8) (0.8-3.0) (0.60-1.36) (0.94-4.24) SRCS MOH 20.2 4.6 19.4 2.4 0.93 0.61 19. Addun Pastoral Nov’09 615 (15.6-24.7) (2.8-6.3) (14.6-24.1) (1.3-3.6) (0.38-2.28) (0.38-0.97)

FSNAU Technical Series Report No VI. 25 51 Issued February 22 2010 Summary of Nutrition Survey Findings, Oct. - Dec. ‘09 continued

GAM based SAM based GAM SAM on WHO on based on based on Date of 2006 CMR/ U5MR / Affected Region/ WHO NCHS <-2 NCHS <-3 Participating Nutrition Sample <-2 Z 10,000/ 10,000/ Livelihood 2006 <-3 Z Z scores Z scores/ Agencies Survey Size scores or day day scores/ or oedema Oedema oedema Oedema (%) (%) (%) (%)

22.3 6.1 21.3 2.9 0.35 0.85 20. Mudug Nov’09 567 FSNAU UNICEF, (17.6-27.0) (4.1-8.1) (16.4-26.1) (1.2-4.5) (0.16-0.76) (0.38-1.90) SRCS MOH,WFP 19.4 5.5 19.8 2.3 1.61 0.78 21. Galgadud Nov’09 567 (14.5-24.3) (3.0-7.9) (14.3-25.2) (0.6-4.0) (0.72-3.54) (0.50-1.22)

Hiran Regions 21.2 5.3 20.1 3.3 0.50 0.82 22. Hiran Pastoral Nov ’ 09 695 FSNAU, UNICEF, (16.5-25.8) (3.1-7.6) (15.0-25.2) (1.5 – 5.1) (0.27-0.95) (0.40-1.67) 23. Hiran Agro- SRCS, IMC. 23.4 7.4 23.0 3.9 0.54 0.84 Nov ’ 09 795 pastoral SCUK. CONCERN (19.0-27.8) (3.9-10.9) (18.8-27.3) (1.7-6.1) (0.36-0.82) (0.32-2.17) 24. Hiran WORLWIDE >18.8 >2.6 >19 >1.1 Riverine(small sample Nov ’ 09 197 N/A N/A (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) cluster survey) Shabelle Regions 25. Shabelle 12.5 3.5 12.2 2.3 0.93 1.05 Nov ’ 09 649 Agropastoral FSNAU, UNICEF, (9.8-15.2) (2.2-4.9) (9.7-14.6) (1.2-3.4) (0.62-1.38) (0.47-2.33) COSV, MERCY 11.6 4.2 10.2 2.3 0.61 0.79 26. Shabelle Riverine Nov ’ 09 640 USA, IINTERSOS, (7.7-15.4) (2.7-5.8) (7.0-13.3) (1.2 – 3.5) (0.36-1.05) (0.38-1.67) SRCS, ZAMZAM, 27. Shabelle IDP 15.9 5.5 15.8 2.5 1.27 2.32 MUSLIM AID Nov ’ 09 734 (Merka/Afgoye) (11.7-20.2) (2.7- 8.2) (12.0-19.6) (1.1-3.8) (0.79-2.04) (1.32-4.06)

Gedo Region >20 3.5 23.4 2.7 0.54 1.34 28. Gedo Pastoral Dec’09 595 FSNAU GHC, (2.2-5.5) (18.2-29.5) (1.5-4.9) (0.29-1.01) (0.60-2.98) SRCS, WFP 29. Gedo Riverine >16.5 >4.2 AFRICA MUSLIM >17.8 >4.1 (Small sample cluster Dec ’09 196 (Pr.=0.90) (Pr.=0.90) N/A N/A AID, HIRDA,NCA, (Pr.=0.90) (Pr.=0.90) survey) COSV 30.Gedo Agro pastoral >18.2 >2.6 >15.9 >1.5 (Small sample cluster Dec ’09 198 (Pr.=0.90) (Pr.=0.90) N/A N/A (Pr.=0.90) (Pr.=0.91) survey) Juba Regions 31. Juba Riverine >12.2 >4.6 >8.5 >2.9 summary of findings survey (Small sample cluster FSNAU , UNICEF Dec ’09 203 N/A N/A (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.91) survey) AFREC, WVI, 32. Juba Agropastoral MERCY USA, >16.0 >2.5 >15.4 >1.2 (Small sample cluster SRCS, MERCY Dec ’09 203 N/A N/A (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.91) survey) USA,SAF, EIRG,APD, JUBA FOUNDATION, 23.5 7.5 22.4 3.6 2.20 3.01 33. Juba Pastoral WRRS, JCC, Dec ’09 689 (17.9-30.2) (5.3-10.7) (16.8-29.1) (2.0-6.4) (1.71) (2.19-4.14) MVDO, PCDDO, ICDA, AMA-UK Bay & Bakool Regions 21.7 6.9 17.0 1.6 0.57 0.68 34. Bay Agro-pastoral Dec ’09 592 (15.6-27.9) (3.4-10.4) (11.6-22.4) (0.4-2.7) (0.33-0.99) (0.17-2.60) FSNAU,UNICEF, 35.Bakool Agro- WFP,SRCS, >13.5 >4.0 >11.6 >2.1 Pastoral (Small Dec ’09 251 N/A N/A GREENHOPE, (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) sample cluster survey) DEGARES, 36.Bakool Pastoral GAREDO >29.2 >4.7 >23.6 0.4 (Small sample cluster Dec ’09 247 N/A N/A (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) (Pr.=0.90) survey)

FSNAU Technical Series Report No VI. 30 52 Issued February 22 2010 COPING STRATEGIES INDEX (CSI)

Background: FSNAU first introduced the use of CSI in Somalia in 2004 -2005 as a proxy measure of household food security. Data sets were developed using a generic CSI strategies list and weighting from work done in Kenya. Unfor- tunately, the lack of sensitivity of the generic CSI as a measure of food insecurity in Somalia, coupled with data quality concerns, limited the degree to which substantive findings could be generated from the existing data. Whereas the con- cept of CSI was endorsed at this stage as a proxy indicator for food security, FSNAU needed to enhance the sensitivity of the tool by tailoring a set of strategies with their severity weightings to each of the four main livelihood systems (Pastoral, Agropastoral, Riverine and Fishing). In 2005, then FSAU, with the support of an international consultant developed a Somalia Livelihoods Coping Strategies Index (SLCSI) to complement the existent data sources on food security and nutrition in Somalia. This was piloted in a nutrition survey covering the Hargeisa Protracted IDP population in September 2005; however many questions were raised on its applicability and analysis. Subsequently no further developments were made on integrating the livelihood specific CSI into FSNAU nutrition assessments.

In 2009, FSNAU engaged an outside professional (intern) who guided a validation process before the official rollout. The process involved refining the:

• List of strategies tailored to each livelihood groups

• Severity weighting of each strategy to reflect the perceived severity in each livelihood group. (See example of pastoral livelihood strategy list used in the recently concluded assessments).

1=Hardly 2=Once In the past 30 days, if there have been times when you 0=Never 3= Pretty at all (<1 in a while 4=All the time did not have enough food or money to buy food, how (zero times/ often? (3-6 times/ (1-2 times/ (Every day) often has your household had to: week) times/week) week) week) a. Reduce home milk consumption and sell more of milk produced?

b. Consume less preferred cereals special article

c. Borrow food on credit from another household (Aamah)? d. Reduce number of meals per day? e. Reduce the portion size/quantity consumed at meal times (Beekhaamis)?

f. Rely on food donations (gifts) from the clan/ community (Kaalmo)? g. Consume weak un-saleable animals (caateysi)? h. Send household members to eat (for food) elsewhere?

i. Skip (go an) entire days without eating (Qadoodi)? j. Beg for food (Tuugsi/dawarsi)? k. Rely on hunting for food (ugaarsi)?

FSNAU CSI Roll Out

During the Post Deyr 2009/10 assessments, CSI was embedded in 19 out of the 36 nutrition assessments conducted in Somalia; 3 in Riverine, 6 in the Agropastoral and 4 in Pastoral livelihoods zones. The other 6 were conducted among the IDP in which urban- tailored coping strategies were applied. However, given that the coping strategies in the latter are yet to be validated, the present analysis findings are exclusive and only based on 13 assessments conducted in the three main livelihood systems. The analysis of the CSI data has been informed by the need to establish the relative food security status of households with malnourished children as well as estimating the mean CSI of the respective livelihood zones.

According to literature reported in the CSI field manual, the CSI indicator has been shown to correlate well with other measures of food security (such as dietary diversity, caloric intake as well as nutritional outcomes). It is also reported that some studies have shown correlation with other determinants of food such as income, food budgets and asset data. The strength of the relationship between the CSI and such indicators has been tested in over 14 studies, with measures of dietary diversity, meal frequency and caloric intake showing negative correlations, meaning that as CSI increases the related variable decreases.

It is too early at this point to analyse the data, given the availability of only one data time period, however FSNAU will con- tinue to include this indicator in future surveys conducted biannually and establish its role as a monitoring tool. CSI trend analysis therefore, will be possible from now onwards once subsequent data generated from seasonal assessments are made available. This indicator shall provide invaluable findings permitting triangulation of information on household food security situation whether worsening, improving or unchanged in different livelihood zones in Somalia and enhance the understanding of the role of food insecurity in child nutritional status.

FSNAU Technical Series Report No VI. 25 53 Issued February 22 2010 Table 18: Summary of Nutrition Assessments (Aug-Dec 2009)

7. APPENDICES

7.1 Progression of Estimated Nutrition Situation Deyr ’06/07 - Deyr ’09/10

Deyr ‘06/07 Gu ‘07

Deyr ‘07/08 SOMALIA - ESTIMATED NUGuTR IT‘08ION SITUATION AUGUST 2008 N N " " 0 0 ' CALUULA ' " 0 43°0'0"E 46°0'0"E 49°0'0"E 0 ° ° 2 2 1 Alula 1 QA NDALA " ZEY LAC " LAASQORAY !( " Gulf of Aden Kandala Zeylac Bosaso DJIBOUTI LUGHAYE Lughaye" Awdal BERBE RA Erigavo Badhan " Iskushuban !( Berbera BAKI Baki ISK USHUBA N Borama " " El Afwein Sanag Bari SHEIKH CEEL AFWE YN Woq. Galbeed " Sheikh " GE BILEY "Gabiley Bender Beila Hargeisa QA RDHO BANDARB EYLA !( " " OWDWEYNE " !( Gardo Odweine Burco Taleh XUDUN TALEEX N N Caynaba " " " " 0 0 CAYNABO Xudun ' ' Togdheer " 0 0 ° ° 9 9 Sool

Buhodle Garowe Lasanod !( BUUHOODLE "

EYL Nugal " Eyl Burtinle BURTINLE "

JARIIBAN " GA LDOGOB Jariban Go"ldogob Galkayo ETHIOPIA !(

CABUDWAA Q " N N CADAADO " " " Adado 0 0 ' Mudug ' Abudwaq Hobyo 0 0 ° ° 6 6

Dusa Mareb HOBYO " Indian Ocean Galgadud CEEL BARDE " El Bur Haradhere CEEL BUUR El Barde XARARDHEERE Belet Weyne " "

Rab Dhuure Bakol " LEGEND DOOLOW Rab-Dhuure Hiran " Hudur TAY EEGLOW " El Der Nutrition Situation Dolo BULO BURTO CEEL DHEER LUUQ WA AJID " " BELET XAAWO " ADAN YABAAL " " Tieglo Luuq Wajid Bulo Burti " No data Aden Yabal JALALAQSI Insufficient data but likely Belet Hawa " Jalalaqsi Garbahare Baidoa Adale N N to be critical " " 0 0 !( ' ' QA NSAX DHEE RE 0 0 Gedo M. Shabelle Alert " BUUR HA KABA ° CEEL WA Q ° " CADALE " Qansah Dere Jowhar " 3 3 Wanle Weyne El Waq WA NLA WEY N " Serious Bay Balad DIINSOOR " Bur Hakaba BALCAD BAARDHE ERE " " Afgoye Critical AFGOOYE Bardera Dinsor !("Ba!(nadir L. Shabelle Very Critical QORYOOLEY Kurtun Warrey "Qoryoley Sakow SAAKOW KURTUNWA AREY " " Ma!(rka IDP Phase M. Juba Sablale SABLA ALE Serious "

Buale BARAA WE Brava " Critical Very Critical Jilib Afmadow AFM ADOW JILIB The Nutrition Situation is analysed using a range of " " Projected Trend (July - December '08) nutrition indicators from direct and indirect sources Potential to Improve from July to Dec '08: nutritional surveys, sentinel sites, " " JAMAAME 0 0 "Jamame ' health facility data, rapid MUAC assesments, select' ive 0 L. Juba Uncertain 0 ° feeding centre data, health reports and others ° 0 0

Potential to Deteriorate " Kismayo !( District Capital Coastline

Badhadhe International Boundary BADHAADHE " Regional Boundary ± District Boundary 40 20 0 40 80 120 160 River 43°0'0"E 46°0'0"E 49°0'0"E Kilometers Datum: WGS84, Data Source: FSAU, 2006 Admin. layers: UNDP, 1998

Food Security Analysis Unit - Somalia http://www.fsausomali.org P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] tel: 254-20-3745734 fax:254-20-3740598 FSAU is managed by FAO. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986.

FSNAU Technical Series Report No VI. 30 54 Issued February 22 2010 SOMALIA - ESTIMATED NUTRITION SITUATION JANUARY 2009 N N SOMALIA - ESTIMATED NUTRITION SITUATION JULY 2009 " " 0 0 ' ' CALUULA " 0 0 43°0'0"E 46°0'0"E 49°0'0"E ° ° Deyr ‘08/09 Gu ‘09 2 2 CALUULA 1 1 Alula " QA NDALA " ZEY LAC " Alula QANDALA LAASQORAY !( " " ZEYLAC Kandala " Gulf of Aden LAASQORAY Zeylac Bosaso Gulf of Aden " (! DJIBOUTI LUGHAYE Kandala " Lughaye Zeylac Bosaso Awdal BERB ERA Erigavo Badhan " Iskushuban DJIBOUTI LUGHAYE Baki !( Berbera " BAKI ISK USHUBA N Lughaye Borama " " Sanag Awdal BERBERA Badhan El Afwein Bari " (! Berbera ISKUSHUBAN BAKI Baki SHEIKH CEEL AFWE YN " " " Sheikh " Borama Sanag Iskushuban Woq. Galbeed El Afwein Bari GE BILEY " Erigavo Gabiley SHEIKH CEEL AFWEYN Bender Beila " Sheikh " Hargeisa QA RDHO BANDARBEYLA ! " " Woq. Galbeed ! OWDWEYNE GEBILEY " !( Gardo G" abiley Odweine Burco Taleh QARDHO (! BANDARBEYLA XUDUN TALEEX Hargeisa " N N " Caynaba " " OWDWEYNE Gardo " " " (! Bender Beila 0 0 CAYNABO Xudun ' Togdheer ' Odweine " Burco Caynaba 0 0 XUDUN TALEEX ° ° " " 9 Sool 9 Xudun Taleh Togdheer CAYNABO " Buhodle Garowe Sool Lasanod !( BUUHOODLE " Buhodle Lasanod Garowe EYL ^ Nugal " BUUHOODLE (! Eyl " Burtinle BURTINLE Nugal EYL " District Capital " " " Eyl District Capital Burtinle Coastline BURTINLE " JARIIBAN Major Road International Boundary " GA LDOGOB Jariban ETHIOPIA Go"ldogob Coastline Regional Boundary Galkayo JARIIBAN International Boundary " District Boundary GALDOGOB Jariban !( " Regional Boundary ETHIOPIA Goldogob River Galkayo District Boundary (! CABUDWAA Q " N N CADAADO " River " " Adado 0 0 ' ' Abudwaq Mudug Hobyo CABUDWAAQ 0 0 " ° ° CADAADO " 6 6 Adado Mudug Abudwaq Hobyo

Dusa Mareb HOBYO " Indian Ocean Dusa Mareb HOBYO Galgadud " CEEL BARDE " El Bur Haradhere Indian Ocean CEEL BUUR El Barde Belet Weyne " XARA RDHEERE " Galgadud CEEL BARDE " El Bur Rab Dhuure Bakol Haradhere " El Barde CEEL BUUR XARARDHEERE Belet Weyne " " DOOLOW Rab-Dhuure Hiran " Hudur TAY EEGLOW Rab Dhuure Bakol " El Der " Dolo BULO BURTO CEEL DHEER LEGEND LUUQ WA AJID " " DOOLOW BELET XAA WO " " Tieglo ADAN YABAAL Rab-Dhuure Hiran " Luuq Bulo Burti " " Hudur Wajid Nutrition Situation TAYEEGLOW Dolo " El Der BULO BURTO CEEL DHEER Aden Yabal LUUQ WAAJID " " JALALAQSI BELET XAAWO " " ADAN YABAAL Belet Hawa " " Tieglo Bulo Burti " Jalalaqsi Acceptable Luuq Wajid Garbahare Baidoa Adale N N " " Aden Yabal JALALAQSI 0 0 !( Belet Hawa ' Alert ' " QA NSAX DHEE RE 0 Gedo M. Shabelle 0 " BUUR HA KABA Jalalaqsi ° CEEL WA Q ° Garbahare Baidoa Adale " Qansah Dere " Jowhar CADALE 3 Wanle Weyne " 3 El Waq WA NLA WEY N " Insufficient data but likely (! Bay Balad Gedo QANSAX DHEERE M. Shabelle DIINSOOR " BUUR HAKABA " CEEL WAQ CADALE BAARDHEERE Bur Hakaba BALCAD to be Alert " Qansah Dere " Jowhar " " Wanle Weyne " LEGEND Afgoye El Waq WANLA WEYN " AFGOOYE Serious Bardera " Bay Balad Dinsor ! DIINSOOR ! !( " BALCAD Banadir BAARDHEERE Bur Hakaba Nutrition Situation L. Shabelle Insufficient data but likely " " QORYOOLEY Afgoye "Qoryoley AFGOOYE Kurtun Warrey " Sakow SAAKOW " KURTUNWA AREY to be Serious Bardera Dinsor " Ma!rka ! ! L. ShabelleBa(nadir Acceptable M. Juba Critical QORYOOLEY Sablale SABLA ALE Q" oryoley " Sakow Kurtun Warrey SAAKOW KURTUNWAAREY " " Marka Alert Buale BARA AWE Insufficient data but likely Brava " M. Juba to be Critical Sablale SABLAALE " Serious Buale BARAAWE Jilib Very Critical " Afmadow Brava AFM ADOW JILIB " " Projected Trend (January - July '09) Insufficient data but likely Critical to be Very Critical Jilib " " Potential to Improve JAMAAM E Afmadow AFMADOW JILIB 0 0 Very Critical "Jamame " " ' ' Projected Trend (July - December'09) 0 L. Juba Uncertain IDP Phase 0 ° ° 0 0 Potential to Improve Potential to Deteriorate Serious JAMAAMEJamame Kismayo !( L. Juba " Hot Spot for Very Critical Critical Uncertain ^ Potential to Deteriorate IDP Phase Badhadhe Very Critical Kismayo (! BADHAADHE Serious " The Nutrition Situation is analysed using a range of nutrition indicators from direct and indirect sources from July to Dec '08: nutritional surveys (Oct-Dec '08), health facility data, rapid Badhadhe Critical ± BADHAADHE MUAC assesments, selective feeding centre data, health reports " Very Critical 40 20 0 40 80 120 160 and others

43°0'0"E 46°0'0"E 49°0'0"E appendix Kilometers Datum: WGS84, Data Source: FSAU, 2006 The Nutrition Situation is analysed using a range of nutrition Admin. layers: UNDP, 1998 indicators from direct and indirect sources from Jan to July '09: ± nutritional surveys (Apr-July'09), health facility data, rapid Food Security Analysis Unit - Somalia http://www.fsausomali.org 40 20 0 40 80 120 160 MUAC assesments, selective feeding centre data, health reports P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] Kilometers and others tel: 254-20-3745734 fax:254-20-3740598 FSAU is managed by FAO. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. Food Security and Nutrition Analysis Unit - Somalia http://www.fsnau.org The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986. P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] tel: 254-20-4000000 fax:254-20-5000555 FSNAU is managed by FAO. Deyr ‘09/10 The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. SOMALIA - ESTIMATED NUTRITION SITUATION JThe rAegionaNl & DiUstrict bAoundaRries reYflect t ho2se en0dors1ed b0y the Government of the Republic of Somalia in 1986.

CALUULA Gulf of Aden " Alula QANDALA " ZEYLAC DJIBOUTI " LAASQORAY (! " Kandala Zeylac Bosaso LUGHAYE " AwdalLughaye Badhan BERBERA Erigavo Baki (!" Iskushuban BAKI Berbera ISKUSHUBAN " " Borama El Afwein Sanag SHEIKH CEEL AFWEYN Bari Woq. Galbeed " Sheikh " GEBILEY G" abiley ! QARDHO BANDARBEYLA Harge!isa " Gardo " OWDWEYNE ! " Burco Caynaba Taleh Odweine XUDUN TALEEX " " Bender Beila

CAYNABO Xudun Togdheer " Sool Buhodle Lasanod !Garowe " BUUHOODLE District Capital "

Major Road EYL Nugal Eyl " Coastline Burtinle BURTINLE " International Boundary Regional Boundary ETHIOPIA JARIIBAN " GALDOGOB Jariban District Boundary " Goldogob River (! Galkayo

CABUDWAAQ " CADAADO " Adado Mudug Hobyo Abudwaq

HOBYO Dusa Mareb " Indian Ocean Galgadud CEEL BARDE " Haradhere CEEL BUUR XARARDHEERE El Barde Belet Weyne " " El Bur

Rab Dhuure Bakol " DOOLOW Rab-Dhuure " Hudur Hiran TAYEEGLOW Dolo " El Der BULO BURTO CEEL DHEER BELET XAAWO LUUQ WAAJID " ADAN YABAAL " " " " Tieglo Bulo Burti " Luuq Wajid Aden Yabal JALALAQSI Belet Hawa " Jalalaqsi Garbahare Baidoa Adale LEGEND

Gedo QANSAX DHEERE M. Shabelle " BUUR HAKABA CEEL WAQ " CADALE Nutrition Situation " Qansah Dere Wanle WeyneJowhar " WANLA WEYN El Waq " Bay Balad DIINSOOR Acceptable BAARDHEERE " Bur Hakaba BALCAD " "

AFGOOYE (!" Bardera Dinsor AfgBoyeanadir Alert L. Shabelle Mogadishu QORYOOLEY Q" oryoley SAAKOW KURTUNWAAREY Sakow " " Marka Serious Kurtun Warrey Sablale SABLAALE M. Juba " Critical BARAAWE Buale " Brava Very Critical Jilib Afmadow AFMADOW JILIB " " Insufficient data but likely Projected Trend (January - July 2010) to be Serious

JAMAAME L. Juba J" amame Potential to Improve Insufficient data but likely Uncertain to be Very Critical Kismayo Potential to Deteriorate IDP Phase Serious Badhadhe BADHAADHE " Critical Very Critical The Nutrition Situation is analysed using a range of nutrition ± indicators from direct and indirect sources from July to December '09: nutritional surveys, health facility data, rapid 40 20 0 40 80 120 160 MUAC assesments, selective feeding centre data, health reports

Kilometers and others

Food Security and Nutrition Analysis Unit - Somalia http://www.fsnau.org P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] tel: 254-20-4000000 fax:254-20-4000555 FSNAU is managed by FAO The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986. FSNAU Technical Series Report No VI. 25 55 Issued February 22 2010 7.2 Nutrition Assessment Tools Post Deyr ‘09

FSNAU POST Deyr ASSESSMENT 2009/10 Rapid Nutrition Assessment Guidelines

INSTRUCTIONS FOR USE

Overview: Rapid assessment tools are essential in countries with high vulnerability to shocks where populations are at risk of malnutrition. This is particularly relevant in Somalia with recurrent shocks such as ongoing conflict and natural disaster (drought, flooding, etc). They provide a means of identifying in a very short space of time areas of risk of malnutrition, the need for a more detailed assessment such as a nutrition survey and the need for emergency interventions.

Criteria: This tool aims to be used in situations where concern has been raised over the nutritional situation, such as recent displacement, or previously inaccessible areas becoming accessible, or additional shocks such as floods, drought, or where there is insufficient time to conduct a more detailed assessment etc. In addition if an agency has phased out of an area and wants to monitor if there is a need to re establish programmes then this can be used. This tool can be used in an assessment lasting from a few hours to a few days depending on the size of the team and the level of information available. In addition it can be used for one or more villages/camps again depending on the time and size of team available.

Team: The tool should only be used by experienced and trained nutrition staff. At a minimum at least one experienced nutritionist should lead the assessment and where necessary can train community health workers on the ground on the day if the size of the assessment area and population warrants many staff members. However for the Post Deyr Assessment all Nutrition Field Analysts will the only one using this tool. Each of you in your location will then administer the tool fully by yourself in order to ensure consistency and high quality data. The tool is designed so that this it is feasible for one person to conduct this.

Methodology: -

1) ANTHROPOMETRIC DATA The most appropriate method for determining nutritional status in a rapid assessment is by using MUAC both for children from 6 months to 5 years, checking for oedema and if there is sufficient time and staff and a concern then also for pregnant and breast feeding mothers. In addition to nutrition, key informant interview and focus group discussions need to be held to gather additional information of health, food security, water and sanitation, child care practices and security where relevant.

Unlike nutrition surveys the sampling does not have to be done in a statistically significant way. However the following steps have been identified to give a rough estimate of the nutritional situation using MUAC: A tally sheet to record the results is attached

1 Children 6 – 59 months can also be roughly estimated to measure between 65-110cm. Therefore in order to reduce the time identifying the correct age, which is not always easy, a pole can be made marked with the 65 of both 65 and 110cm for ease of selection. These poles have been provided with the lower mark indicating 65cm and the upper 110cm. Only children measuring between the two marks should be included in this assessment.

2. On arrival in the location initially estimate the total number of the households in the village/ camp/ town through discussions with the sheikhs/ camp leaders: • If the total number of households is less than 110 - go to ALL households and measure the MUAC of the ALL children aged 6 months -5 years (65-110cm) • If the total number of households is >100 – randomly select 110 children 6 – 59 months – this can be done by going to the centre of the village, tossing a pen in the

FSNAU Technical Series Report No VI. 30 56 Issued February 22 2010 air and following the following the direction of the pen to the outside edge of the village. Then traveling from one edge of the village to the other opposite edge and measure ALL the children in the households to your right along that direction or line. • If 110 children are not reached when you get to the edge of town/village then change direction and follow a different line from the edge of town and repeat this until a total of 110 children are measured. This will ensure the new arrivals on the outskirts of towns are included as well as those in the centre – this is relevant with the recent displacement from the floods

1. MUAC must only be taken on the LEFT arm 2. All children should also be checked for oedema - if a case is suspected then this MUST be confirmed by the nutrition analyst. It is essential that all staff are well trained in checking for oedema. 3. To avoid repeating a measurement on the same child when there are more than one measurers - a marker pen can be used to leave a visible small mark on the child once measured such as on the top of the left hand. 4. During this walk, observations on the living conditions, food availability and preparation, asset ownership, water and sanitation facilities etc should be taken into consideration which can then be discussed when holding an informal FGD or KI interview

Reporting of Anthropometric Data: Reports should be short and should be released within a few days of the rapid assessments especially if the situation is of concern. A draft template has been attached in Annex 2 and outlines the key areas to be covered in the report. When reporting on the nutritional status, it is essential to report BOTH the absolute numbers and % of each cut off point in MUAC. However the numbers MUST NEVER BE REPORTED IN % GLOBAL ACUTE MALNUTRITION or % SEVERE ACUTE appendix MALNUTRITION. This classification can only be reserved for a statistically significant nutrition surveys otherwise the figures may be quoted out of context and therefore misinterpreted.Reports must always state the methodology, the tools used and that this is a rapid assessment therefore cannot be interpreted in a statistically significant manner. Where necessary if the rapid assessment is indicating an area of concern recommendations for a more detailed assessment such as a nutrition surveys should be made. A sample is in Annex 3.

2) Other Data on underlying causes

Information should also be included on other factors that can affect nutrition such as health, child care practices, water and sanitation. Our food security colleagues will already be collecting food security data through a focus group so we don’t need to. Ideally this other data should be collected through a focus group where women are present and IDP’s if there is displacement into that location. Therefore rather than establish a new focus group on arrival complete the anthropometric data collection then join the focus group and ask your questions at the end. In addition if you have any other points that are not included and that you feel will affect nutrition and are relevant please do add as they will contribute to the overall analysis

FSNAU Technical Series Report No VI. 25 57 Issued February 22 2010 Annex 1 - Tally Sheet for MUAC Screening Children 6 – 59 months. – Please just use one sheet per village and one tick per child. For ease of completion please group the children into ten so the first ten measured the results should be in the first box the second 10 in the second row etc see( Annex 3 for an sample)

Screening Data / Rapid Assessment Tool - Children under 5 years Name Village:______Date:______Name of Screener:______

Children under 5years ( MUAC only to be measured on children 6 months and above or 65-110cm lying (65-84.9cm or standing for the 85 cm in height and above) Clinical signs of Oedema malnutrition <65cm Child Group <11.5cm 11.5-12.4cm 12.5-13.4cm >/=13.5 (65-110) (oedema or maras- mus

Child 1 - 10

Child 11 – 20

Child 21 – 30

Child 31 – 40

Child 41 – 50

Child 51 – 60

Child 61 – 70 appendix Child 71 – 80

Child 81 – 90

Child 91 – 100

Child 100-110

TOTAL

FSNAU Technical Series Report No VI. 30 58 Issued February 22 2010 Annex 2 - Report Summary Table These questions should be asked in the focus groups discussion. Please join the food security team once you have completed the anthropometric component rather than setting up a separate group but make sure there are women present and actively contributing and displaced if appropriate

Interviewer Name

Date of Assessment Region District Village

Recent Displacement If Y what numbers and whether this is in or out displacement from Y / N this location What was the main cause for the displacement? When did the majority arrive?

Information available of the current nutritional status (previous surveys, feeding centre statistics, health cen- tre data etc)

SOCIAL CARE ENVIRONMENT

Shelter conditions for the ma- If displacement any immediate concerns on child care practices? Please below jority (please circle) 1) Good 2) Basic but reasonable 3) Very Poor appendix HEALTH SITUATION

Any recent incidence of Acute Watery Diarrhoea in Y / N this location?

If yes, Please describe how the incidence of Acute Minimum / Moderate / Severe Watery Diarrhoea has affected nutrition status of Comment children in the last month, circle minimum moder- ate or severe.

Recent Are the Health services Can communities Top 3 illnesses for Are there any Health Outbreaks? functioning (do they access the health <5yrs Services Available have staff drugs etc) services 1) Y / N Y / N Y / N 2) Y / N If N how close is near- If Y what? If N why not? 3) est (km) WATER Describe the quality of this D o f a m i l i e s h a v e What water storage L i s t t h e m a i n water (pls ask to see the water sufficient quantities for containers are being sources of drinking then circle then option most drinking during the day? used by the majority - water appropriate) (circle) please list 1) Reasonable Y / N 2) Unclean If N why not? Not sure 3)

SANITATION List the main sanitation facilities used now by List any concerns the community may have about the sanita- the community tion, such as the impact of the recent floods

FSNAU Technical Series Report No VI. 25 59 Issued February 22 2010 Nutrition Programmes SFC (Location, Agency, Nos of TFC / CTC (Location, Agency, Nos of List the closest nutrition admissions) admissions) programmes available for referral if malnourished cases are identified and the agency that operates and where possible recent trends in admissions if a nutrition worker from a feeding centre is available to speak with.

Summary of Nutrition Status: - Children 6 months to 5years MUAC (cm) Nutritional status N= ( % ) >13.4cm 12.5cm to 13.4cm At risk of Malnutrition 11.5cm to 12.4cm Moderate Malnutrition < 11.5 cm Severe Malnutrition Oedema Severe Malnutrition

CONCLUSIONS - To be completed by Nutrition Analyst once all the data has been collected from the village, add additional paper if necessary Main Problems Identified: (summarise the key findings)

Conclusion: Think about all the information collected and decide whether the nutrition situation is: i). very critical, ii). Critical, iii). Serious iv). Alert. how many people are affected, is the situation likely to deteriorate.

Sample - Screening Data / Rapid Assessment Tool - Children 6 months to 5 years Name Village: El Eak Date: 15th December 2006 Name of Screener: Mohamed Ibrahim

Children under 5years ( MUAC only to be measured on children 6 months and above or 65-110cm standing) Clinical signs of Child Group <11.5cm 11.5-12.4cm 12.5-13.4cm >/=13.5 Oedema appendix malnutrition <1yr Child 1 - 10 1 1 1 1 1 1 1 1 1 1 Child 11 – 20 1 1 1 1 1 1 1 1 1 1 Child 21 – 30 1 1 1 1 1 1 1 1 1 1 Child 31 – 40 1 1 1 1 1 1 1 1 1 1 Child 41 – 50 1 1 1 1 1 1 1 1 1 1 Child 51 – 60 1 1 1 1 1 1 1 1 1 1 Child 61 – 70 1 1 1 1 1 1 1 1 1 1

Child 71 – 80 1 1 1 1 1 1 1 1 1 1 Child 81 – 90 1 1 1 1 1 1 1 1 1 1 Child 91 – 100 1 1 1 1 1 1 1 1 1 1 Child 100-110 11 11 11 11 11 TOTAL 5 10 18 72 5 0

Summary of Nutrition Status: - Children 6-59 months MUAC (cm) Nutritional status N= 110 (100 % ) >13.5cm 72 (65.5%) 12.5cm to 13.4cm At risk of Malnutrition 18 (16.4%) 11.5cm to 12.4cm Moderate Malnutrition 10 ( 9%) < 11.5 cm Severe Malnutrition 5 ( 4.5%) Oedema Severe Malnutrition 5 (4.5%)

FSNAU Technical Series Report No VI. 30 60 Issued February 22 2010 Nutrition Assessment Household Questionnaire, Deyr 2009 HHNO:

NUTRITION ASSESSMENT HOUSEHOLD QUESTIONNAIRE, Deyr 2009

Livelihood ______Household Number ______Date______Team Number ______Cluster Number ______Cluster Name ______District: ______Region ______

Q1-8 Characteristics of Household Q1. Household size1 ?______Q2. Number of children less than 5 years (0-59 months)? ______Q3. Sex of household head2? 1=Male 2=Female Q4a .How long has this household lived in this locality? 1= Resident 2= IDP<6 Months 3=IDP >6 months 4= Returnee (within the last 6 months) 5 = Refugee 6=Migrant b. If IDP > 6months is it: 1= before 2007 2= during or after 2007 c. Are you hosting any recently (in the last 6 months) internally displaced persons? 0= No 1= Yes d. If yes, Number of persons ______Q5. How many mosquito nets does the household have? 0=none 1=one 2=two 3=three 4= 4 or more Q6. What was the source of the net? 1= NGO 2=Health Centre 3= Purchase 4=other, specify Q7a. What is the household’s main source of income? 1= Animal & animal product sales 2= Crop sales/farming 3 = Trade 4= Casual labor 5= Salaried/wage employment 6= Remittances/gifts/zakat 7=Self-Employment (Bush products/handicraft) 8= Others, specify ______Q7b. Total Livestock holding: No of camels: ______Number of cattle:______Number of sheep:______Number of goats ______

Q7c. Local unit for Land holding (circle the appropriate one): 1=Ta’ab 2=Darab 3= Jibaal 4= Qodi

Q7d. Total land holding based on local unit (indicate actual number): ______

Q8-15 Feeding and immunization status of children aged 6 – 59 months in the household. appendix

Q8 Q9 Q10 Q11 Q12 Q 13 Q14 Q15 First Age How long (If 6-24 How many times Has child Name (months) Are after birth months) (If 6-12 do you feed the Has child been No of dozes you did you put months child in a day been provided Vaccinated of polio (if child is breastfeeding1 the baby to If you stopped (besides breast with Vitamin against vaccine given more than the child? the breast breastfeeding At what age milk)? A in the last 6 measles? to the child 24 months TBC before the was child months? 0= No orally? old, skip (if no, skip to child was 12 given water/ 1= 1 time (show sample) 1=Yes 0=none to Q13) Q10) 0=Never months, why foods other 2=2 times 1=one 1=within 1 hr did you stop? than breast 3 = 3 times 0= No 2=two 0= No 2= within 24 0= Never milk? 4=-4 times 1=Yes 3=three or 1=Yes hrs breastfed 5= 5 or more more 3= after 1 1= Pregnancy 1= <1 weeks times day 2=Illness 2=1wk – 3 3=Child months refused 3=4-6 4= Other months 4=6 months or more. 1 2

3 4

Q16-27 Anthropometry and morbidity for children aged 6 – 59 months in the household

1 Number of persons who live together and eat from the same pot at the time of assessment 2 One who controls and makes key decisions on household resources (livestock, assets, income, and food), health and social matters for and on behalf of the household members.

FSNAU Technical Series Report No VI. 25 61 Issued February 22 2010 Q16a Q16b Q17 Q18 Q19 Q20 Q21 Q22 Q23 Q24 Q25 Q26 Q27 Diarrhea2 Serious Fever4 Suspected First Age Sex Oedema Height Weight MUAC in last ARI (oof in the Measles5 D i d t h e W h e r e d i d Is the child Name (cm) (kg) (cm) two wareen/ last two in last one child sleep y o u s e e k currently (month) 1=Male 0= No weeks wareento)3 weeks month u n d e r a h e a l t h c a r e registered 2=Female 1=Yes To the To the To the 0= No in the last 0= No 0= No mosquito a s s i s t a n c e in any nearest nearest nearest 1=Yes two weeks 1=Yes 1=Yes n e t l a s t w h e n c h i l d feeding tenth of tenth of tenth of 0= No night? was sick? (If centres? a cm a kg a cm 1=Yes 0= No yes in Q21 – 1=Yes 24) 0=None (>6 mo) 1= SFP 0 = N o 2= TFC/ a s s i s t a n c e SC sought 3= OTP 1 = O w n 4= Other medication 2=Traditional healer 3 = S h e i k h / Prayers 4 = P r i v a t e c l i n i c / Pharmacy 5 = P u b l i c health facility 1 2 3 4

28a. Anthropometry (MUAC) for adult women of childbearing age (15-49 years) present at the household

I s w o m e n No of dozes of P h y s i o l o g i c a l Did the woman c u r r e n t l y Codes for adult illnesses Tetanus vaccine status sleep under the registered in received 0= none of the mosquito net 0=none Illness in last 0= None Age 0=none MUAC above last night Sno Name 1=SFP 14 days? If yes, (years) 1= one (cm) 1=Pregnant 2=MCHN what illness? 1= ARI 2= Two 2 = L a c t a t i n g 0= No 3=MCH -vitamins 2=Diarrhea 3=three (infant <6months) 1=Yes 4=other 3=Fever 4=Joint 1 Mother: 5=Urinary tract infection 6=Pain in the chest 7= Pain in lower abdomen/pelvis 8=Anemia 9=Reproductive appendix 10=Other, specify 28b. Where do you seek health assistance when sick? 0=No assistance sought 1=Own medication 2=Traditional healer 3=Sheikh/Prayers 4=Private clinic/ Pharmacy 5= Public health facility 28c. If ‘No assistance’ in 28b, why? 1 = Too expensive 2 = Too far 3 = Not enough time 4 = Security concerns 5 = other, specify …… Q29 In the past 30 days, if there have been times when people did not have enough food or money to buy food, which of the following coping strategies did they use? (Select based on relevant livelihood system)

Pastoralist Livelihood: Please Tick where applicable In the past 30 days, if there have been times when you did 1=Hardly at 2=Once in a 3= Pretty 0=Never (zero 4=All the time not have enough food or money to buy food, how often has all (<1 times/ while (1-2 often? (3-6 times/week) (Every day) your household had to: week) times/ week) times/week) a. Reduce home milk consumption and sell more of milk produced? b. Consume less preferred cereals c. Borrow food on credit from another household (Aamah)? d. Reduce number of meals per day? e. Reduce the portion size/quantity consumed at meal times (Beekhaamis)? f. Rely on food donations (gifts) from the clan/community (Kaalmo)? g. Consume weak un-saleable animals (caateysi)? h. Send household members to eat (for food) elsewhere? i. Skip (go an) entire days without eating (Qadoodi)? j. Beg for food (Tuugsi/dawarsi)? k. Rely on hunting for food (ugaarsi)?

Agropastoralists Livelihood:

Please Tick where applicable

FSNAU Technical Series Report No VI. 30 62 Issued February 22 2010 2=Once 4=All In the past 30 days, if there have been times when you 0=Never 1=Hardly at 3= Pretty in a while the time did not have enough food or money to buy food, how (zero times/ all (<1 times/ often? (3-6 (1-2 times/ (Every often has your household had to: week) week) times/week) week) day) a. Shift from high priced cereal varieties to low price cereal varieties? b. Shift from high quality cereals to low quality cereals (from osolo to obo)?

c. Borrow food on credit from shop (Deyn)? d. Borrow food on credit from another household (Aamah)? e. Reduce home milk consumption and sell more of milk produced? f. Reduce the number of meals in a day by adults?

g. Stop all home milk consumption and sell all milk produced? h. Rely on food donations (gifts) from the close relatives (Qaraabo)? i. Rely on food donations (gifts) from the clan/ community (Kaalmo)? j. Skip (gone) entire days without eating (Qadoodi)?

k. Community identified your household as in need of food and fives support? (Qaraan) l. Send household children to live or eat with relatives (elsewhere)?

Riverine Livelihood Please Tick where applicable 4= Pretty In the past 30 days, if there have been times 1=Never 2=Hardly at 3=Once in 5=All the often? when you did not have enough food or money to buy food, (zero times/ all (<1 times/ a while (1-2 time (Every (3-6 times/

how often has your household had to: week) week) times/ week) day) appendix week) a. Shift to less preferred foods (e.g. white maize to yellow maize)? b. Reduce the portion size/quantity consumed at meal times (Beekhaamis)? c. Consume poor quality foods (unsafe or spoilt)? d. Reduce number of meals per day by one (e.g. from three to two)?

e. Consume wild foods and fish from the river? f. Consume immature crops (fruits or cereals)?

g. Reduce number of meals per day by two (e.g. from three to one)? h. Feed particular members (elderly, children) at the expense of other household members?

i. Consume seeds meant for future planting? j. Borrow food for consumption (to be repaid in future – in kind)? k. Eat prohibited/ unacceptable foods (animal skins, grass, roots, clotted blood, tree leaves, warthogs, etc)?

Fishing Livelihood Please Tick where applicable

4= Pretty In the past 30 days, if there have been times when you did 1=Never 2=Hardly 3=Once in 5=All the often? not have enough food or money to buy food, how often has (zero times/ at all (<1 a while (1-2 time (Every (3-6 times/ your household had to: week) times/ week) times/ week) day) week) a. Consume low quality fish and fish parts? b. Increase number of family members going fishing (to increase catch)? c. Reduce portion size of meals? d. Decrease fish consumption and increase consumption of non- fish items?

e. Reduce number of meals per day? f. Borrow or purchase food on credit? g. Rely on gifts (donations) of food? h. Consume only non- fish items (no fish consumption)?

i. Consume left-over or thrown away fish (left on beach, market, etc)? j. Beg for food (Tuugsi/dawarsi)?

FSNAU Technical Series Report No VI. 25 63 Issued February 22 2010 a. Reduce food intake of adults (relative to children)?

b. Skip (go an) entire days without eating (Qadoodi)? c. Consume recognised health hazard fish?

Urban Livelihood

Please Tick where applicable

2=Hardly 3=Once 4= Pretty 5=All In the past 30 days, if there have been times when you did not 1=Never at all (<1 in a while often? the time have enough food or money to buy food, how often has your (zero times/ times/ (1-2 times/ (3-6 times/ (Every household had to: week) week) week) week) day) a. Shift to less preferred (low quality, less expensive) foods (from osolo to obo)? b. Limit the portion/quantity consumed in a meal (Beekhaamis)? c. Take fewer numbers of meals in a day? d. Borrow food on credit from the shop/market (Deyn)? e. Borrow food on credit from another household (Aamah)? f. Restrict consumption of adults in order for small children to eat? g. Rely on food donations from relatives (Qaraabo)? h. Rely on food donations from the clan/community (Kaalmo)? i. Seek or rely on food aid from humanitarian agencies? j. Send household members to eat elsewhere? k. Beg for food (Tuugsi/dawarsi)? l. Skip entire days without eating (Qadoodi)? m. Consume spoilt or left-over foods

Q30 In the last three months, what is the main source of staple food in the household? 1= Own production 2= Purchas- ing 3=Gifts/Donations 4= Food aid 5= Bartering 6= Borrowing 7= Gathering

Q31 How many times did you receive cereal food aid in the last 6 months? 0=never 1= once 2= twice 3= three times 4= fourth 5= five times 6= six times or more

Q32 How many meals1 has the household had in the last 24 hours (from this time yesterday to now)? 0= none 1= One 2=Two 3= Three 4=Four +

Q33 – 35 Cereal Consumption:

appendix A standard unit of measurement, based on what is available at the local market, (and predetermined at the survey training stage), will be used to estimate the volume of cereal consumed; and the actual weight consumed calculated by multiplying the number of units consumed with the weight of cereal in the standard unit. Complete this section before conducting the survey at the cluster Wheat Cereal Type Sorghum Cereal blend Maize Rice (e.g amount of Bread Pasta Other (specify) (CSB/ Unimix) flour in a pancake) GRAIN (if applicable) N a m e o f Standard unit FLOUR (if applicable)

GRAIN (if applicable) Weight of cereal in the Standard FLOUR (if applicable) unit (kg)

Determine if yesterday represents a TYPICAL day (with no festivals etc) for this household. If yes, administer the questions below. If not, select the previous day and administer the questions below. Wheat (e.g Other (specify e.g. Sorghum Maize Rice flour in a bread, pasta, cereal TOTAL pancake) blend) Q33. What type of cereal did you consume in the household since this time yesterday? (Tick where appropriate – indicate if GRAIN or FLOUR if applicable) Q34. How much of these cereal did you consume in the household since this time yesterday? (no. of units based on local measure)

3. A meal refers to food served and eaten at one time (excluding snacks) and includes one of the three commonly known: - breakfast, lunch and supper/dinner

FSNAU Technical Series Report No VI. 30 64 Issued February 22 2010 Q35a For each cereal type, Is this amount usual for the household for this time of the year? (1=Yes; 0 – No) if yes, skip to Q36 Q35b If No, how does the amount change for each cereal type compared to usual? (1 = Increase; 2 = Decrease) Q35c What is usual quantity consumed? (No. of units) Q35d Overall Why is the amount different than usual for this time of the year? 1 =there is poor harvests, 2 = there is good harvest 3= there are reduced income 4= there are increase income 5- more people in the household 6 =less people in the household 7 = Other reason (mention))

WASH Questionnaire

Q36-41 Access to water (quality and quantity)

Q36a What is the household’s main source of drinking water? Protected sources: 1 = Household connection 2 = Standpipe (Kiosk/Public tap/Taps connected to a storage tank) 3 = Protected Shallow well (covered with hand pump/motorized pump) 4 = Tanker 5 = Spring 6 = Bottled water 7 = Rooftop rainwater Unprotected sources 8 = Berkads 9 = River/stream 10 = Dam/Pond (Balley) 11 = Open Shallow well 12 = Other (specify) …

Q37a If the household has no access to protected water sources (if the answer to Q35a is 8, 9, 10, 11 or 12), what is the main reason? 0= Not Available 1 = Distance too far 2 = Security Concerns 3= Cannot afford 4 = Queuing time is too long 5 = Other reasons (specify) Q37b If you get your water from a protected water source (if the answer to Q35a is 1, 2, 3, 4, 5, 6 or 7), is the water available?

1= Always/Mostly available 2=Seasonally available Q37c If the water system is mechanized (if the answer to Q35a is 1, 2, 3 or 4), how frequently did it breakdown last month? 0 = Did not breakdown 1 = Once 2 = 2 to 3 times 3 = More than 3 times

Q38a Is the water for drinking treated and/or chlorinated2 at the Household level? 0 = No 1 = Yes Q38b If Yes, what is the method of treatment (select more than 1 option if applicable)? 1 = Boiling 2 = Chlorination 3 = Straining/filtering 4 = Decanting/letting it stand and settle 5 = Leaving the water out in the sun 6 = Other (specify) Q38c If Aquatabs are used, are Aquatabs used for household treatment on a daily basis? 0= No 1 = Yes Q38d If Aquatabs are used, how much do they cost the family per month? …………. Currency (circle as appropriate): Somali Shillings Somaliland Shillings

Q39 What is the average time taken per TRIP to and from the main water source (including waiting and collecting time)? 1 = Less than 30 minutes 2 = 30 to 60 minutes 3 = More than 1 hour

Q40 How many water collecting and storage containers of 10 or 20 liters are there in the household? 1 = 1 to 2 containers 2 = 3 to 4 containers 3 = 5 to 6 containers 4 = more than 6 Q40a Does the family pay for drinking water? 0 = No 1 = Yes Q41-43 Sanitation and Hygiene (access and quality)

Q41a What type of toilet is used by most members of the household? 0 = No toilet is available (an open pit/open ground is used) 1 = Household latrine 2 = Communal/ Public latrine 3 = Flush toilet Q41b If the answer to Q41a is 0, what is the main reason? 1 = Pastoral/ frequent movements 2 = Lack resources to construct 3 = Lack of space to construct 4 = Don’t see the need 9= Don’t know Q41c If the answer to Q41a is 1, 2, or 3 , how many households share/use the same toilet? 1= One 2= 2 to 3 3= 4 to 9 4= 10 or more 9 = Don’t know

Q42 When you wash your hands, what substance do you use for hand washing? 0= None (only with water) 1= Soap/Shampoo 2= Sand 3= Ash 4 = P l a n t extracts Q43 Have you been exposed to information on correct personal hygiene and sanitation practices in the last 3 months? (select more than 1 option if applicable) 0= No 1= Yes via mass media 2= Yes via printed media 3= Yes via interpersonal communication 4= Yes via group meetings

(Footnotes) 1 Child having received breast milk either directly from the mothers or wet nurse breast within the last 12 hours 2 Diarrhoea is defined for a child having three or more loose or watery stools per day 3 ARI asked as oof wareen or wareento. The three signs asked for are chest in-drawing, cough, rapid breathing/nasal flaring and fever 4 Fever – The three signs to be looked for are periodic chills/shivering, fever, sweating and convulsions 5 Measles (Jadeeco): a child with more than three of these signs– fever and, skin rash, runny nose or red eyes, and/or mouth infection, or chest infection

2 Chlorinated water should have a characteristic taste and smell

FSNAU Technical Series Report No VI. 25 65 Issued February 22 2010 Urban Assessment Household Questionnaire, 2009

URBAN ASSESSMENT HOUSEHOLD QUESTIONNAIRE, 2009 HHNO: Household Size ______Date______Enumerator: ______Name of Town ______Section: ______

Q 1 Food Consumption & Dietary Diversity

Twenty four-hour recall for food consumption in the households: The interviewers should establish whether the previous day and night was usual or normal for the households. If unusual- feasts, funerals or most members absent, then another day should be selected.

Did a member of your *Codes: Food group consumed: What foods groups household consume food did members of the household consume from from any these food groups 1= Own production 5=Bartered yesterday morning and including the night)? from yesterday morning and 2=Purchases 6=Borrowed Include any snacks consumed. including the night? 7=Gathering/ 3=Gifts from friends/ relatives 1=Yes wild 2= No 4=Food aid 8= N/A What is the main source of the dominant food item Type of food consumed? (Use codes above)? A1. Cereals and cereal products (e.g. maize, spaghetti, rice, caanjera, bread)? A2. Milk and milk products (e.g. goat/camel/ fermented milk, milk powder)? A3. Sugar and honey? A4. Oils/fats (e.g. cooking fat or oil, butter, ghee, margarine)? A5. Meat, poultry, offal (e.g. goat/camel meat, beef; chicken or their products)? A6. Pulses/legumes, nuts (e.g. beans, lentils, green grams, cowpeas; peanut)? A7. Roots and tubers (e.g. potatoes, arrowroot)? A8. Vegetables (e.g. green or leafy vegetables, tomatoes, carrots, onions)? A9. Fruits (e.g. water melons, mangoes, grapes, bananas, lemon)? A10. Eggs? A11. Fish and sea foods (e.g. fried/boiled/ roasted fish, lobsters)? A12. Miscellaneous (e.g. spices, chocolates, sweets, beverages, etc)?

Q2. In general what is the main source of staple food in the household? (*Use codes in 29 above) ______Q3 Total number of food groups consumed in the household: ______

Q4 How many meals1 did the adults (18+ years) in this household eat from yesterday morning and including the night (in the last 24 hours)? 1= One 2=Two 3= Three Q5 How many meals did the children (<5 years) in this household eat from yesterday morning and including the night (24 hours)? 1= One 2=Two 3=Three 4=N/A

Q6. Coping and coping strategies During the PAST YEAR, have there been times when you did not have 2 = No enough money to buy food or cover other essential expenditures (health, 1 = Yes (skip) cooking fuel, school etc.)? During the PAST Year Now (In Dec. 2009) If yes, how did your household manage to put food on the table last (Dec. 2008) year? And how has your household managed to put food on the 2 = No table this year? 1 = Yes (skip to 1 = Yes 2 = No 2008) B1 Rely on less preferred and less expensive food 1 = Yes 2 = No 1 = Yes 2 = No B2 Borrow food, or rely on help from friends or relatives 1 = Yes 2 = No 1 = Yes 2 = No B3 Purchase food on credit, incur debts 1 = Yes 2 = No 1 = Yes 2 = No B4 Limit portion size at meals 1 = Yes 2 = No 1 = Yes 2 = No B5 Restrict consumption by adults in order for small children to eat 1 = Yes 2 = No 1 = Yes 2 = No B6 Reduce number of meals eaten in a day 1 = Yes 2 = No 1 = Yes 2 = No B7 Skip entire days without eating 1 = Yes 2 = No 1 = Yes 2 = No

1 A meal refers to food served and eaten at one time (excluding snacks) and includes one of the three commonly known: - breakfast, lunch and supper/dinner

FSNAU Technical Series Report No VI. 30 66 Issued February 22 2010 B8 Purchase food on credit 1 = Yes 2 = No 1 = Yes 2 = No B9 Consume seed stocks held for the next season 1 = Yes 2 = No 1 = Yes 2 = No Decrease expenditures for fertilizer, pesticide, B10 1 = Yes 2 = No 1 = Yes 2 = No fodder, animal feed, vet. Care…. B11 Sell domestic assets (radio, furniture, fridge, TV, carpet…) 1 = Yes 2 = No 1 = Yes 2 = No Sell productive assets (farm implements, sewing machine, B12 1 = Yes 2 = No 1 = Yes 2 = No motorbike, land…) B13 Sell more animals than usual 1 = Yes 2 = No 1 = Yes 2 = No B14 Decrease expenditures for health care 1 = Yes 2 = No 1 = Yes 2 = No B15 Take children out of school 1 = Yes 2 = No 1 = Yes 2 = No B16 Seek alternative or additional jobs 1 = Yes 2 = No 1 = Yes 2 = No Increase the number of members out-migrating for work and/or B17 1 = Yes 2 = No 1 = Yes 2 = No food B18 Increase in the amount of remittances received 1 = Yes 2 = No 1 = Yes 2 = No

6.6 Urban Assessment Household Questionnaire, 2009 Mortality Questionnaire, Deyr 2009

Household No: _____ Date: ______Team No: ____ Cluster No: ____ Enumerator’s Name: ______

2: Sex (1=M; 4: Born since 5: Arrived since __ 6: Reason for 7: Cause of No. 1: First Name 3: Age (yrs) 2=F) __ / 03/2009 / 03/ 2009 leaving death a) How many members are present in this household now? List them. appendix

b) How many members have left this household (out migrants) since March __, 2009? List them

c) Do you have any member of the household who has died since March __, 2009? List them

Codes Reason for migration Cause of death 1= Civil Insecurity 6= Hospitalised 1= Diarrhoeal diseases 6= Anaemia 2= Food Insecurity 7= In boarding school 2= ARI 7= Birth complications 3= Employment 8= Grazing/herding 3= Measles 8= Accident/ killed/ 4=Divorce/ Married away 9= Other, specify 4= Malaria physical injuries 5=Visiting 5= STD/ HIV/AIDS 9= Hunger/starvation 10= Other, specify

Summary*

Total U5

Current HH Members Arrivals during the Recall period Number who have left during Recall period Births during recall Deaths during recall period

* For Supervisor Only

FSNAU Technical Series Report No VI. 25 67 Issued February 22 2010 Data Collection Form for Malaria

Post Deyr ’09 Nutrition Rapid Nutrition Assessment Form Weight and Height Measurement Record Sheet for Children aged 6-59 months or Measuring 65-109.5cm

Illness in past 14 days? No = 0 Sex: 1=Male Age Oedema Yes specify appendix Sno 2=Female (Months) 1= Yes Weight Height MUAC Diarrhoea=1 2=No ARI =2 Malaria=3, Measles=4 1

2

3

4

5

6

7

8

9

10

11

12

13

14

FSNAU Technical Series Report No VI. 30 68 Issued February 22 2010 SOMALIA: LIVELIHOOD ZONES 7.3: Somalia Livelihood Zones

Calula

DJIBOUTI Gulf of Aden Qandala

Zeylac Bossaaso Lughaye AWDAL Ceerigaabo Las Qoray/Badhan Baki Berbera SANAG Iskushuban Borama Ceel Afweyne BARI Sheikh Gebiley W. GALBEED

Hargeysa Qardho Burco Owdweyne Xudun Caynabo Talex Bandar Beyla TOGDHEER SOOL

Laas Caanood Buuhoodle Garowe

Legend Eyl "/ NUGAL Country capital Burtinle International boundary

Regional boundary Jariiban ETHIOPIA Goldogob District boundary Galkacyo n a e River c O

Coastline n a Cadaado MUDUG i d Hobyo n Cabudwaaq I

Dhusa Mareeb appendix

GALGADUD Harardheere Ceel Barde Beled Weyne Ceel Bur BAKOOL Livelihood zones Addun Pastoral: Mixed sheep & goats, camel Rab-Dhuure HIIRAN Xudur Awdal border & coastal towns: Petty trading, fishing, salt mining Ceel Dheere Dolo Central regions Agro-Pastoral: Cowpea, sheep & goats, camel, cattle Bulo Barde Luuq Wajid Tayeglow Coastal Deeh: Sheep Aden Yabal Dawo Pastoral: Shoats, cattle, camel Beled Hawa Jalalaqsi East Golis Pastoral: Frankinncense Garbaharey Baydhaba Cadale Fishing Jowhar M. SHABELLE Gagaab Pastoral: Frankincense Guban Pastoral: Sheep, goats & camel Qansax Dheere Wanle Weyne GEDO BAY Hawd Pastoral: Camel, sheep & goats Hiran Agro-Pastoral Ceel Waq Balcad Bur Hakaba Hiran riverine: Sorghum, maize, cattle & shoats Afgoye Juba pump irrigation: Tobacco, onions, maize Baardheere Dinsor "/ BANADIR MOGADISHU Kakaar-Dharor Pastoral: Sheep, goats, camel

A Qoryoley L. & M. Shabelle Agro-Pastoral Irrigated: Maize/Sorghum & cattle Sakow Y Marka Kurtun Warrey L. & M. Shabelle Agro-Pastoral rain-fed: Maize,cowpeas, sesame & cattle

N M. JUBA Lower Juba Agro-Pastoral: Maize & cattle Sablale

E L. SHABELLE North-West Agro-Pastoral: Sorghum, cattle Bu'aale North-West Valley Agro-Pastoral: Irrigated vegetables, shoats K Hagar Brava Nugal Valley Pastoral: Sheep & camel Potato zone & vegetables Afmadow Jilib Shabelle riverine: Maize, fruits & vegetables Sool-Sanag Plateau Pastoral: Camel, sheep & goats South-East Pastoral: Cattle, sheep & goats Jamaame L. JUBA Southern Agro-Pastoral: Camel, cattle, sorghum Southern Juba riverine: Maize, sesame, fruits & vegetables Kismayo Southern coastal pastoral: Goats, cattle Togdheer Agro-Pastoral: Sheep, goats & vegetables ± Urban Badhadhe 0 20 40 80 120 160 200 West Golis Pastoral: Goats, camel, sheep Bay-Bakool Agro-pastoral Low Potential Kilometers Bakool Agro-pastoral Low Potential Bay Agro-pastoral High Potential Southern Inland Pastoral: Camel, Sheep & Goats Datum: WGS84, Data Source: FSAU, 2009, Admin. layers: UNDP, 1998

Food Security Analysis Unit - Somalia http://www.fsausomali.org P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] tel: 254-20-3745734 fax:254-20-3740598 FSAU is managed by FAO. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986.

FSNAU Technical Series Report No VI. 25 69 Issued February 22 2010