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Post Deyr '09/10 Technical Series 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.
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