Nutrition Analysis Post Gu ‘12
Technical Series Report No VI. 47 September 26, 2012
Food Security and Nutrition Analysis Unit - Somalia Information for Better Livelihood
Technical Partners Funding Agencies
FSNAU Technical Series Report No. VI 47 Swiss Agency for Development and Cooperation SDC Issued September 26, 2012 Post Deyr 2011/12 Nutrition Analysis ii
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Acknowledgements FSNAU would like to thank all our 24 partner agencies for their participation and support in the Deyr 2011 seasonal nutrition assessments and analysis. Post Deyr 2011/12 Acknowledgement Nutrition Analysis From April through July 2012, a total of 46 nutrition surveys were conducted based on standard SMART methodology. Seventeen of the nutrition surveys were conducted in the south. Additionally, nutrition iii data from about 130 health and nutrition facilities was reviewed. Without the support and expertise of the 8 local NGOs, 3 International NGOs, 3 Local Authorities, 8 line Ministries and 2 UN agencies, this would not have been possible. Special thanks to UNICEF, for financial and/or technical support. A sincere note of appreciation also goes to the FSNAU nutrition team based in Somalia who work under such difficult conditions yet continue to produce such high quality professional work.
Participating Partners - north central regions only United Nations Children’s Fund (UNICEF), World Food Programme (WFP), Ministry of Health (MOH Somaliland), Ministry of Agriculture (Somaliland), Ministry of environment and rural development, and NERAD (Somaliland); Ministry of Health (Puntland), Ministry of Women Development and Family Affairs (MoWDFA), Ministry of Wildlife, Tourism and Environment (Puntland), Puntland State of Water and Energy (PSWEN), Medair, Somalia Red Crescent Society (SRCS), CAFDARO and Elberde primary health care organization (EPHCO). Mahad Sanid
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 TABLE OF CONTENTS 1 Executive Summary 1
2 cASES of Acutely Malnourished Children in somalia 10 3 nutrition Analysis in Somalia 13 4. rEGIONAL NUTRITION ANALYSIS 16
Post Deyr 2011/12 of Contents Table Nutrition Analysis 4.1 Gedo Region 16 4.2 MIDDLE and LOWER Juba Regions 20 4.3 bAy and Bakool Regions 27 iv 4.4 Middle and Lower Shabelle Regions 34 4.5 HIRAN region 39 4.6 Central Somalia: Galgadud and Mudug regions 42 4.7 Northeast Regions 48 4.8 Northwest Regions 58 5 urban Summary Findings 67 6 Plausibility checks 69 7 APPENDICES 73 7.1 Progression Of Estimated Nutrition Situation Gu ‘12 75 7.2 Nutrition Assessment Tools Post Gu ‘12 77 7.3 Nutrition Assessment Household Questionnaire, May 2012 Idp 81 7.4 Urban Rapid Assessment Record Form - Gu 2012 85 7.5 Mortality Questionnaire, June 2012 86 7.6 Field Supervisor– Verbal Autopsy 87 7.7 Southern Idps And Urban Questionnaire - July 2012 90 7.8 Somalia Livelihood Zones 91 8. Glossary of terms 92 List of Figures
Figure 1: Global Acute and Severe Acute Malnutrition, (WHZ < 2 and 3 z Scoresor Oedema) April- July 2012 – Somalia 1 Figure 2: Retrospective crude and under 5 death rates per 10,000 per day 2 Figure 3: Median wasting rates, WHOGS (WAZ<-2 and WAZ <-3) April- July 2012 3 Figure 4: Median Stunting rates, WHO GS (HAZ<-2 and HAZ <-3) April- July 2012 3 Figure 5: Propotion of Total Cases of Acutely Malnourished Children (WHZ<-Z or Oedema) by Region, September 2012 10 Figure 6: Trend in Level of Acute Malnutrition (WHZ<-2 or oedema, WHO 2006) in Gedo Region, 2006-2012 16 Figure 7: HIS Malnutrition Trends in Gedo Agropastoral MCHs - 2011-12 17 Figure 8: Trend in levels of Acute Malnutrition (WHZ <-2Z scores or oedema, WHO 2006), Juba Regions 2007 - 2012 20 Figure 9: HIS Malnutrition trends in Juba agro-pastoral MCHs 2010-2011 21 Figure 10: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) Bakool region, 2002- 2012 27 Figure 11: Admissions trends into OTP programmes Bakool 2012 28 Figure 12: Trend in levels of Acute malnutrition (WHZ< -2 or oedema , WHO 2006) Bay Agropastoral, 2002- 2012 28 Figure 13: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) Bay region, 2002- 2012 30 Figure 14: HIS Malnutrition trends in Bay Agro-pastoral MCHs,2010-2011 31 Figure 15: Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Middle and Lower Shabelle Regions (2007- 2012) 34 Figure 16: HIS Malnutrition Trends in Shabelle Reverine MCHs 2010-2011 35 Figure 17: HIS Malnutrition Trends in Shabelle Agropastoral MCHs 2010-2011 35 Figure 18: Trend in Levels of acute Malnutrition (WHZ<-2 or oedema, WHO 2006) in Hiran Region, 2007-2012 39 Figure 19: HIS Malnutrition trends in Hiran Riverine MCHs 2011-2012 40 Figure 20: Trends in Levels of acute malnutrition (WHZ<-2 or oedema, WHO 2006) Central Regions, 2007-2012 42 Figure 21: HIS Malnutrition Trends in Hawd LZ of Central areas(2010-2012) Source: MoH; SRCS 42 Figure 22: HIS Malnutrition Trends in Addun L/Z of Central areas (2011-2012) 42 Figure 23: HIS Malnutrition Trends in Cowpebelt L/Z (2011-2012) 43 Figure 24: HIS Malnutrition Trends in Central Coastal Deeh L/Z (2011-2012) 43 Figure 25: Trends in levels of acute malnutrition (WHZ<-2 or oedema, WHO 2006) Northeast regions (2007-2011) 49 Figure 26: HIS Malnutrition Trends in Golis/ Karkaar LZ (2010-2012) 49 Figure 27: HIS Malnutrition Trends in Sool Plateau LZ (2011-2012) 50 Figure 28: HIS Malnutrition Trends in Nugal Valley LZ (2011-2012) 50 Figure 29: Trend in Levels of Acute Malnutrition (WHZ<-2 or oedema, WHO 2006) in Northeast IDPs (2006-2012) 52 Figure 30 : Trends in levels of Acute Malnutrition (WHZ <-2Z scores or oedema, WHO 2006 in North West regions 2006-2011 59 Figure 31: HIS Malnutrition Trends in Health Facilities in NW West Golis MCHs - January 2011-June 2012 60 Figure 32: HIS Malnutrition Trends in Health Facilities in NW Hawd MCHs - January 2010-June ’12 62 Figure 33: Trend in Levels of acute Malnutrition (WHZ<-2 or oedema, WHO 2007)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 in Northwest Regions Region, 2007-2012 65
List Of Tables
Table 1: Nutrition Surveys Schedule April-July 2012 3 Table 2: Somalia Integrated Food Security Phase Classification, Population Numbers,Aug - Dec 2012 9 Table 3: Estimated Cases of Acute Malnutrition in Somalia, by Region, September 2012 10 Post Deyr 2011/12 of Contents Table Nutrition Analysis Table 4. The Nutrition Situation Classification Framework, Draft 8, January 2012 14 Table 5: Summary of Key Nutrition Findings in Gedo Livelihood Zones, May 2012 18 Table 6: Summary of Key Nutrition Findings in Dowlo IDPs May 2012 19 v Table 7: Summary of Key Nutrition Findings in Juba Livelihood Zones, July 2012 22 Table 8: Summary of Key Nutrition Findings in Kismayo IDPs July 2012 23 Table 9: Summary of Key Nutrition Findings in Bakool Pastoral livelihood zone - July 2012 28 Table 10: Summary of Key Nutrition Findings in Bay Regions-July 2012 32 Table 11: Summary of Key Nutrition Findings in Mogadishu Town - April- July 2012 35 Table 12: Summary of Key Nutrition Findings in Mogadishu IDPs - April- July 2012 36 Table 13: Proportion of the malnourished women in Banadir and Hiran Regions 40 Table 14: Summary of Key Nutrition Findings in Hiran region - July 2012 41 Table 15: Summary of Key Nutrition Findings in Hawd, Addun and Dhusamareb IDPs Central regions 44 Table 16: Summary of Key Nutrition Findings in Cowpea Belt Agro-pastoral and Coastal Deeh Pastoral of Central regions - July 2012 46 Table 17: Summary of Key Nutrition Findings in Northeast Regions - July 2012 51 Table 18: Summary of Key Nutrition Findings in Hawd, Addun and Coastal Deeh Northeast Regions 53 Table 19: Summary of Key Nutrition Findings among Northeast IDPs (Bossaso, Qardho, Garowe and Galkayo) May 2012 55 Table 20: Summary of Key Nutrition Findings in West Golis/Guban, Nugal Valley and Sool Plateau Livelihood Zones, December 2011 61 Table 21: Summary of Key Nutrition Findings in Hawd, East Golis and Agro-pastoral Livelihood Zones, July 2012 64 Table 22: Summary of Key Nutrition Findings for Hargeisa, Burao and Berbera IDPs, June 2012 66 Table 23: Summary of Urban Assessment Findings: Northwest and Northeast Regions – Post Gu ‘12 Table 24: Plausibility checks 72 Table 25: Summary of Nutrition Assessments (April - July 2012) 73
List Of Maps
Map 1: Somalia Nutrition Situation, January 2012 5 Map 2 Somalia Nutrition Situation, August 2012 5 Map 3: Estimated Nutrition Situation (September-November) 2012 6 Map 4: Somalia Acute Food Insecurity Overview, Rural, Urban and IDP Populations, July 2012 8 Map 5: Distribution of estimated Cases (%) of Acutely Malnourished Children in Somalia by Region, based on Prevalence, August 2012 11 Map 6: Gedo Region Livelihood Zones 16 Map 7: Juba Regions Livelihood Zones 20 Map 8: bay and Bakool Regions Livelihood Zones 27 Map 9: Shabelle Livelihood Zones 34 Map 10: Hiran Livelihood Zones 39 Map 11: Northeast Livelihood Zones 48 Map 12: Northwest Livelihood Zones 58
Special Articles
Sustained high levels of acute malnutrition across Somalia and Kenya border 24
Case study 1: A family’s experience during a hunger period, in Huddur district 29 Case study 2: Increased nutritional vulnerability among the families in the besieged Huddur town, Bakool region 33
Nutrition Survey Results in Mataban and Beletweyne, Hiran Region Indicate an Extremely Worrying Health Situation 38
Food safety and malnutrition in Somalia 47
Strengthening of Infant and Young Child Feeding Programming and Planning for Emergency; The Infant and Young Child Feeding (IYCF) London Workshop (25-29 June 2012) Preparedness and Response. 69
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 LIST OF ACRONYMS USED Post Deyr 2011/12 Acronyms Nutrition Analysis AWD Acute Watery Diarrhoea ARI Acute Respiratory Tract Infections vi CDC Center for Disease Control and Prevention, Atlanta CDR Crude Death Rate CHD Child Health Days CI Confidence Interval COSV Co-operatione Di Svillupo International 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 HAZ Height for Age Z Scores HIS Health Information System IDP Internally Displaced persons INGO International Nongovernmental Organization LZ Livelihood Zone MCH Maternal and Child Health Center MOH Ministry of Health MT Metric Ton MUAC Mid Upper Arm Circumference NCHS National Center for Health Statistics NGO Non Governmental Organization OTP Out Patient Therapeutic Programme OPD Out Patient Department PWA Post War Average R Reliability Score RR Relative Risk/Risk Ratio SAM Severe Acute Malnutrition SC Stabilization Center SC-Uk Save the Children - UK SRCS Somalia Red Crescent Societies SD Standard Deviation SFP Selective/Supplementary Feeding Program TFC Therapeutic Feeding Center TOT Terms of Trade U5DR Under Five Death Rate UNHCR United Nations High Commission for Refugees UNICEF United Nations Children’s Fund WAZ Weight-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 WVI World Vision International
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Post Deyr 2011/12 Forward Nutrition Analysis
vii
Forward
The FSNAU Post Gu 2012 Technical Series report (September 2012) is the seventh 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 bi-annual seasonal technical series reports and provides specific focus on nutrition information for the last 6 months.
The FSNAU Post Gu 2012 Technical Series report was released on September xx, 2012, and is accessible at http://www.fsnau.org/downloads/FSNAU-Post-Deyr-2011- 12-Technical-Report.pdf. It provides a detailed analysis of the integrated food security situation, by region and by sector.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012
1. Executive Summary
Nutrition Situation Overview
With the exception of the coastal strip of West Golis/Guban, the Coastal Deeh of North and Central, Cowpea Belt livelihood Post Deyr 2011/12 Executive Summary Nutrition Analysis zones, Bay and parts of Juba regions where the food security situation is of concern, increased purchasing power and 1 improved livestock productivity, and sustained humanitarian support enhanced household access to food and nutrition through the Gu (April-July) 2012 season, and mitigated the nutrition situation across the country. Humanitarian support in terms of cash, food and non-food items strengthened the communities’ purchasing power; while health care and nutrition support enabled control and management of A calm looking Somali child FSNAU 2011 endemic diseases, seasonal outbreaks, and malnutrition, Based on the Gu 2012 analysis, at national level, an thereby saving lives in these areas. Consequently across the estimated 236,000 (16% of the 1.5 million) Somali country, levels of acute malnutrition have declined to below children are currently acutely malnourished and in the Integrated Phase Classification (IPC) famine threshold of need of specialized nutrition treatment services. Of 30%, while crude death rates (CDR) are below the UNICEF the 236,000 children, 54,000 (3.5% of the 1.5 million emergency threshold of 2/10,000/day. Somali children) are severely malnourished requiring immediate lifesaving interventions. Seventy percent of From April-July 2012, FSNAU in collaboration with partner the malnourished are from the southern regions, where agencies conducted 46 representative nutrition surveys in there are concerns about their ability to access vital basic Somalia, assessing rural, urban and internally displaced services needed for survival. Nevertheless the figures populations (Table 1). Of these, 16 were done in the south; 4 reflect a reducing trend since August 2011, the peak of in central rural livelihood zones; 10 in northwest and northeast famine when an estimated 450,000 (30% of the 1.5 million rural pastoral and agro-pastoral livelihood zones; 8 in IDPs Somali children) of the children were acutely malnourished in the north and central regions; and 8 in the urban livelihood with 190,000 (13%) in severe state, and January 2012, when zones in the north. Due to security restrictions, updated 323,000 (or 22%) were acutely malnourished, with 93,000 nutrition and mortality data was not collected in Shabelle (6%) in severe state. Despite the improvements therefore, regions and the southern parts of Gedo, Bakool and Hiran lifesaving humanitarian assistance remains crucial between regions. However, indirect information on nutrition trends now and December 2012 to meet immediate nutrition, health from health centers and feeding programmes was analysed. and food needs, protect livelihoods and build resilience. Survey findings (Figures 1 and 2) show significant improvements Southern regions in the nutrition situation in parts of the southern and northeast • In Bay region and Juba riverine communities, the regions, and deteriorations in parts of the northwest regions situation has improved from Extremely Critical phase (Maps 1 & 2), since January 2012. Nevertheless, across the with GAM rates in excess of 30% in January 2012, to South, the situation remains Very Critical except for parts Very Critical with GAM rates of 20.4% (16.7 – 24.5) in of Juba and Hiran regions in Critical phase. In Central and Bay, and 21.5% (18.8-24.5) in Juba riverine. Northeast regions, the situation is Serious except for the • Juba pastoralists have improved from a Very Critical Coastal Deeh and Cowpea Belt in Central regions in Critical phase in January 2012 to Critical with the Global Acute phase. In the northwest regions, the situation is Serious in Malnutrition (GAM) rate currently at 15.8% (11.8-20.7). all livelihoods apart from the Hawd in Critical, Nugal Valley CDR is 0.44/10,000/day and within acceptable range. in Very Critical phases due to high morbidity and disease • For Mogadishu IDPs and urban, the situation has outbreaks, and West Golis/Guban in Very Critical phase due to deteriorated food security conditions. Figure 1: Global Acute and Severe Acute Malnutrition, (WHZ < 2 and 3 z Scoresor Oedema) April- July 2012 - Somalia 30
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Proportion (%) of acute malnutrition 0
P Hawd E. Golis Dolo IDPs E. Golis lz Burao ID P Bari urban Sool urban wdal urban Berbera ID P A Dobley IDPs Sanag urban Qardho IDPs Baidoa IDPs Mudug urban Hargeisa ID Garowe IDPs ogdher urban Galkayo IDPs . Golis/Guban Kismayo IDPs Bossaso IDPs T Agropastoral lz Juba riverine lz W Juba Pastoral lz . Galbeed urban Galgadud urban Agro pastoral Lz Mataban District Hawd pastoral lz alley lz (NW/NE) Dusamareb IDPs Addun pastoral lz CowPea (Central) W V Nugal region urban Beletweyne District Bakool pastoral Lz N. Gedo riverine lz N. Gedo pastoral lz Agro-pastoralists lz Juba Bay Coastal Deeh lz (NE) Mogadishu IDPs-Jul12 Mogadishu IDPs-Apr12 NW Mogadishu urban -Jul12 Mogadishu Urban-Apr12 Sool Plateau lz (NW/NE) Nugal Coastal Deeh lz (Central)
Northwest Regions Northeast/Central Regions Southern Regions
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 improved from Very Critical phase (with GAM of 20-22%) Urban livelihoods in January 2012 to Serious phase. In July 2012, FSNAU and partners undertook 10 nutrition o Mogadishu IDPs: GAM reate is currently 9.6% (7.1- surveys in the urban population of Somalia. Five regional 13.0) surveys were conducted in northwest regions, two in northeast, o Mogadishu urban: GAM rate is 10.8% (8.3-13.9) two in central regions and one in Mogadishu town. Post Deyr 2011/12 Executive Summary Nutrition Analysis • Findings from other parts of the south assessed during • Northwest regions: Gu 2012 survey findings depictAlert the Gu 2012 indicate a sustained Very Critical phase or Serious nutrition situation in urban populations and 2 with GAM rates between 20-29.9%. varied trend since January 2012. o Woq. Galbeed and Sanaag regions: The nutrition situation The 90 days retrospective crude death rate (CDR) in Bay remains Alert, with a GAM rates in the 5-9.9% range. region, Mogadishu IDPs and urban is in the range of 1- 1.49 o Awdal and Sool regions: The nutrition situation is in /10,000/day indicating a Critical situation, and highest in sustained Serious phase with GAM rate of 10-14.9%. the country, but nevertheless below UNICEF’s emergency o Togdher region: The nutrition situation has deteriorated threshold of 2/10,000/day. Across most of the other assessed from Alert in January 2012 to Serious with a GAM rate areas of Southern Somalia, crude death rates are below of 14.7% (10.5-20.3). 0.5/10,000/day and therefore within acceptable levels. For additional findings, refer to Figures 1 & 2, regional information, • Northeast regions: The nutrition situation among the and the summary table of findings. urban populations in the northeast regions is either sustained or has deteriorated since January 2012. Northern and Central regions o Bari region: The situation has deteriorated to a Critical There are improvements to a Serious nutrition situation from phase from Serious. Critical in East Golis of northeast along the Red sea, and in o Nugal region: The situation is in a sustained Serious the Hawd of central regions. However, in West Golis/Guban, phase the Hawd in the northwest, and Nugal Valley livelihood zones, the situation has deteriorated to Critical-Very Critical phases, • Central regions: The nutrition situation is Critical both while global acute malnutrition levels are elevated above in Galgadud and Mudug regions with GAM rate of 15- seasonal norms of 10-14.9%. 19.9%. In Mudug, the findings indicate deterioration from • West Golis/Guban: The deterioration is attributed to Serious phase in December 2011 when GAM and SAM declined milk and food access by women and children rates of 14.9% (11.7-18.7) and 4.15 (2.4-6.9) respectively left behind following rain failure and the out-migration of were recorded. A survey was not conducted in Galgadud livestock with men and boys. GAM rate is 21.7% (19.9- in December 2011. 26.1). • The Hawd livelihood zone at the Ethiopian border has • Mogadishu urban: The nutrition situation is in Serious deteriorated to Critical from Serious phase mainly due phase with GAM rate of 10.8% (8.3-13.9) sustained since to high morbidity, mainly acute watery diarrhea and April 2012 and an improvement from Very Critical in measles, in April-July. The GAM rate is 16.7% (11.5-23.5) January 2012, • Nugal Valley livelihood zone has deteriorated to Very Due to security reasons, it was not possible to undertake Critical from Critical phase due to high morbidity and nutrition surveys in the other urban livelihoods zones of the measles outbreaks in the Burao and Ainabo districts. southern regions. Nevertheless the nutrition situation in The GAM rate is 20.1% (16.5-24.3). these regions is likely Very Critical, and consistent with the Crude death rates are nevertheless within acceptable levels rural livelihoods and IDP populations with whom there is co- of <0.5/10,000/day based on UNICEF’s classification. For dependence. additional findings, refer to Figures 1 & 2, regional information, and the summary table of findings.
Figure 2: Retrospective crude and under 5 death rates per 10,000 per day 5 4.5 Crude death rate Under 5 death rate 4 3.5 3 2.5 2 1.5 1 0.5
Death rate/10,000/day 0
P Hawd E. Golis Dolo IDPs Burao ID P Berbera ID P Baidoa IDPs Hargeisa ID Garowe IDPs Galkayo IDPs . Golis/Guban Kismayo IDPs Bossaso IDPs Agropastoral lz Juba riverine lz E. Golis lz (NE) W Juba Pastoral lz Mataban District Agro pastoral Lz Hawd pastoral lz alley lz (NW/NE) Addun pastoral lz V Beletweyne District Bakool pastoral Lz N. Gedo riverine lz N. Gedo pastoral lz Agro-pastoralists lz Juba Bay Mogadishu IDPs-Jul12 Mogadishu IDPs-Apr12 NW Mogadishu urban -Jul12 Mogadishu Urban-Apr12 Sool Plateau lz (NW/NE) Nugal
Northwest Regions Northeast/Central Regions Southern Regions
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 1: Nutrition Surveys Schedule April-July 2012 • Southern regions: o The nutrition situation in Mogadishu IDPs has No. Livelihood Zone (LZ)/Population Group PERIOD improved to Serious with GAM rate of 9.6% (7.1- 1 Agropastoral LZ (Togdheer & Northwest) July 2012 13.0) from Very Critical phase in January 2012. 2 West Golis /GubanPastoral LZ July 2012 o Baidoa IDPs face a Critical nutrition situation with Sool Plateau LZ (Northwest and Post Deyr 2011/12 Executive Summary Nutrition Analysis 3 July 2012 Northeast) GAM rate of 15.8%. 4 Hawd Pastoral LZ (Northwest) July 2012 o Dolow, Kismayo, Dobley IDPs are faced with a Very East Golis/Gebbi Pastoral LZ 5 July 2012 Critical with GAM rates in the range of 20-29.9%. 3 (Northwest) East Golis/Kakaar Pastoral LZ 6 July 2012 (Northeast) Median levels of malnutrition Nugal Valley Pastoral LZ (Northwest and 7 July 2012 Median levels of acute malnutrition have been calculated Northeast) based on findings from the 46 nutrition surveys conducted 8 Coastal Deeh LZ (Northeast) July 2012 9 Coastal Deeh LZ (Central) July 2012 across Somalia in Gu 2012. They therefore exclude Shabelle Hawd Pastoral LZ (Central and 10 July 2012 and the southern parts of Gedo, Bakool and Hiran regions Northeast) which could not be accessed due to insecurity. Based on Addun Pastoral LZ (Central and 11 July 2012 Northeast the Gu 2012 survey findings, the median GAM rate for the 12 Sool Region Urban LZ July 2012 country is 17.2% which is consistent with 16.2%, the median 13 Sanaag Region Urban LZ July 2012 rate for the country based on 220 surveys conducted in 14 Bari Region Urban LZ July 2012 15 Nugal Region Urban LZ July 2012 Somalia from 2001-2011. The Gu 2012 median rate is 24.3% 16 Mudug Region Urban LZ July 2012 for IDPs only, and 16.1% for all excluding IDPs, and 21.6% 17 Awdal Region Uban LZ July 2012 for the south. (Source: FSNAU1 2012). 18 Woq Galbeed Region Urban LZ July 2012 19 Togdheer Region Urban LZ July 2012 20 Cowpea Belt (Central) July 2012 With regard to stunting, the Gu 2012 median rate for 21 Galgadud Region Urban LZ Somalia is 15.6%. This is lower than 23% which is the 22 Dusamareb IDPs May 2012 median rate for the country based on 220 nutrition surveys 23 Hargeisa IDPs May 2012 24 Burao IDPs May 2012 undertaken in 2001-2011. The difference is of statistical 25 Berbera IDPs May 2012 significance. The median stunting rate for IDPs, 22.0% and 26 Bossaso IDPs May 2012 southern regions, 19.2% are nevertheless consistent with 27 Qardho IDPs May 2012 the 10 year median rate. Additional details are provided in 28 Garowe IDPs May 2012 29 Galkayo/Margaga IDPs May 2012 the Figures 3 & 4 below. 30 Kismayo IDPs July 2012 31 Dobley IDPs July 2012 Figure 3: Median wasting rates, WHOGS (WAZ<-2 32 Dolo IDPs June 2012 and WAZ <-3) April- July 2012
33 Mogadishu IDPS April 2012 30.0 34 Mogadishu IDPs July 2012
35 Mogadishu Urban April 2012 25.0 24.3 Total wasting Severe wasting 36 Mogadishu Urban July 2012 21.6
37 Juba Pastoral LZ July 2012 20.0 17.2 38 Juba Agropastoral LZ July 2012 16.1 14.5 39 Juba Riverine LZ July 2012 15.0 40 North Gedo Pastoral LZ June 2012 Percent 11.8 11.8 41 North Gedo Riverine LZ June 2012 10.0 6.7 42 Bakool Pastoralists June 2012 6.1 43 Hiran Region – Beletweyne District July 2012 5.0 3.6 2.3 2.2 2 44 Hiran Region – Mataban District July 2012 1.4 0.0 45 Bay Region July 2012 All Incld IDPs All Exld IDPs IDPs only Northwest Northeast Central regions Southern regions 46 Baidoa IDPs July 2012 regions regions
Figure 4: Median Stunting rates, WHO GS (HAZ<-2 Internally displaced persons (IDPs) and HAZ <-3) April- July 2012 Except for Hargeisa and Mogadishu IDPs in Serious phase, 30.0 findings from nutrition surveys conducted in IDP settlements Total stunting Severe stunting 25.0 across Somalia depict a Critical - Very Critical situation with 22.0 GAM rates above the WHO emergency threshold of 15%. 20.0 19.2 15.6 14.7 • Northwest regions: The nutrition situation is sustained 15.0
Percent 12.6 in Serious phase in Hargeisa IDPs and Critical phase 12.0 10.0 in Berbera IDPs, but has improved to Critical from Very 7.8 5.9 4.3 Critical phase in Burao IDPs, since January 2012. 5.0 3.5 3.1 2.8 2.2 • Northeast and Central regions: The nutrition phase 0.6 0.0 has improved to Critical from Very Critical phase All Incld IDPs All Exld IDPs IDPs only Northwest regions Northeast regions Central regions Southern regions in Bossaso and Galkayo IDPs; deteriorated to Very Critical from Critical phase in Garowe and Qardho 1 FSNAU 2012: A Meta-analysis report on nutrition surveys undertaken in IDPs; and remains Very Critical in Dusamareb since Somalia in 2001-2011. January 2012.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Gender Statistical analyses for Gu 2012 survey findings show no WHZ<-2 threshold for acute malnutrition. A review of data significant differences between acute malnutrition and from therapeutic feeding centers (TFC) from 13 African • sex of the child, or with countries found that when children 6-59 months were • sex of the household head. admitted using UNISEX tables, there was no significant Post Deyr 2011/12 Executive Summary Nutrition Analysis difference in the number of boys and girls admitted and Likewise, there are no statistically significant differences there was no significant difference in the mortality rate2. 4 between sex of the child with The review meeting recommended the use of unisex (boys • morbidity status (based on recall) nor with only) reference tables based on the WHO growth standards • child feeding practices. for children aged 6-59 months in admissions to selective However in Sool plateau, there are statistical differences feeding programs. between stunting rate and sex of the child. Discussions are underway to establish the most appropriate Nevertheless, across all the surveyed population groups, way forward with regard to nutrition surveillance and a higher proportion of boys than girls tended to be acutely analysis. malnourished. This disparity is likely, given the use of the new WHO 2006 sex-differentiated reference standards, 2 Golden, M., Grellety, Y., Schwartz, H., & Tchibindat, F. (2010). Report which has been observed to discriminatively identify of a Meeting to harmonize the criteria for monitoring and evaluation of the more boys as acutely malnourished. With the new WHO treatment of acute malnutrition in West and Central Africa. 30th November – 1st December 2010; Dakar, Senegal. Retrieved February 27, 2012 http:// reference standards, a girl of a certain height has to be www.ennonline.net/pool/files/ife/consensus-meeting-on-m&e-imam-dakar- much lighter than a boy of the same height to meet the 2010-eng.pdf
Considerations for the Nutrition Outlook for September-November 2012
The projected nutrition outlook for September-November The carryover food stocks and incme access from the Deyr 2012 has been derived from the analysis of current situation 2011/12 and the below average Gu 2012 harvests are likely to vis-à-vis historical seasonal trends of nutrition, disease deplete by October. This is likely to contribute to increased outbreak patterns and its impacts on nutrition, anticipated cereal prices and further limit household access. Planned agricultural production, livestock and milk access, civil reduction of humanitarian assistance with the end of the insecurity which limits access to imports, and humanitarian 2011 famine, and some moderate flooding anticipated in assistance. Juba regions are likely to aggravate the nutrition situation.
• Pastoralists and northwest agro-pastoralists: Although In addition, based on historical trends uncontrolled outbreaks the current nutrition situation is Serious-Very Critical, of cholera, malaria or measles are expected in October- improvements are observed across all pastoral livelihood November 2012. This will further hinder any nutritional gains. zones associated with increased household food access. This is with the exception for West Golis/Guban livelihood The nutrition situation in the southern/central agro- zone. pastoralists is therefore likely to remain in Critical – Very Critical phases. (Map 3). The forecasted moderate El-Nino will bring above-average rains in October to December 2012. This will lead to • Riverine: The forecasted moderate El-Nino will bring continued improvements for pastoralists across the country, above-average rains in October to December 2012. This including West Golis/Guban, in terms of good pasture/water is likely to lead to river overflow into the underground availability; increased livestock holdings; improved milk storage facilities, contamination of water sources and availability; increased income following livestock demand displacements. Considering that seasonal outbreaks at the time of the Hajj festivity. of acute watery diarrhea/suspected cholera are also anticipated in October-November, the more likely scenario The nutrition situation in pastoral communities, and the is sustained Very Critical phase. (Map 3) northwest agro-pastoralists who are more inclined to pastoralism than farming are therefore likely to improve • IDPs: These remain vulnerable due to their dependence across the country (Map 3) but unlikely to improve beyond on humanitarian assistance, income from petty trade and seasonal levels of Serious in the north and central regions, casual labor opportunities that are closely linked with rural and Critical in the south. and urban livelihoods. The outlook of their nutrition situation therefore remains of concern, as in the Gu 2012. (Map 3). • Agro-pastoralists in south and central regions: The forecasted moderate El-Nino will bring above-average rains The current projection assumption will be reviewed in October in October to December 2012. This is likely to increase 2012 based on updated information on climate performance; cultivation, and with it labor opportunities for the poor. cereal price dynamics; humanitarian interventions; insecurity.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Post Deyr 2011/12 Executive Summary Nutrition Analysis
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FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Map 3: Estimated Nutrition Situation (September-November) 2012 Executive Summary
6
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Food Security Situation Overview
The food security and nutrition data indicate continued Outlook improvements in food security in Somalia. During 2011, a famine affected over 4 million people, or more than half A predicted moderate El Niño between now and Executive Summary of the population of Somalia, leading to tens of thousands December 2012, is expected to have positive impacts on of deaths. An estimated 2.12 million people are in crisis Somalia as this phenomenon is associated with average 7 for the August to December 2012 period, a 16 percent to above average October to December Deyr rains. reduction from the beginning of the year. Therefore However, these rains are not always well distributed and humanitarian assistance remains necessary between therefore, cropping conditions could vary greatly over the now and December to help food insecure populations rainfed, agro-pastoral areas. In addition, riverine areas are meet immediate food needs, protect livelihoods and likely to experience flooding as a result of heavy rainfall build resilience. and increased river levels. During the moderate 2006- 07 El Niño, Deyr rains caused flooding, which disrupted Poor rains and below average harvest production and markets, especially in the Juba Valley.
According to recent assessment findings, the August/ International food prices have risen and will likely have September Gu harvest is significantly below average an impact on prices in Somalia between now and due to a late start of rains, poor rainfall totals, and pest December, especially for wheat and sugar. Over the outbreaks, among other factors. However, food stocks past three years, wheat and wheat product imports have from last season’s exceptional Deyr harvest will help to averaged 73 percent of Somalia’s food imports in grain mitigate this shortfall and overall production for the 2012 equivalent terms. Prices for local maize and sorghum, calendar year will be average. Low cereal prices, high the staple foods consumed by the poor, are likely to rise casual labor wage rates, and high livestock prices over seasonably over the coming six months, but substantially the past six months have also contributed to reduced food lower than 2011. insecurity by significantly strengthening the purchasing power of poor agropastoral households. In pastoral areas, The epicentre of Somalia’s humanitarian crisis remains in households have also benefited from record livestock the South, largely due to the long-term effects of drought sales prices, robust livestock exports, and increasing and famine, and the short-term effects of this year’s poor livestock holdings, which have resulted in improved milk Gu rainy season. Efforts to meet immediate needs are availability. This improved access to milk, among a variety essential to prevent further deterioration of food security. of other factors, has driven a 27 percent reduction since Assistance to help food insecure populations meet January in the number of children requiring nutrition immediate food needs, protect their livelihoods, build their treatment. Currently 236,000 children are severely resilience, and improve food access remain necessary in malnourished, of which 70 percent are in the South. Somalia between now and the Deyr harvest in January.
While conditions have improved considerably since last year, the food security crisis has not ended. In the southern and central agro-pastoral areas, the below average Gu harvest, the continued need for cash to pay down debts, and low livestock holdings are keeping most southern and central agropastoral areas in IPC Phase 3 (Crisis). Other areas of concern include coastal areas and the coastal plains along the Gulf of Aden and the Indian Ocean in the northern and central regions.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Somalia Acute Food Insecurity Situation Overview Rural, Urban & IDP Populations: July, 2012
Map 4: Somalia Acute Food Insecurity Overview, Rural, Urban and IDP Populations, July 2012
75,000 (15%) Total (Bari & Nugal) Total Total (Bari & Nugal) Tot Urban Total (NW) Rural Total (Bari & Nugal) al… Total (NW) Tot Total (Bari & Nugal) 130,000 (7%) al… Tot Total (Shabelle+Banadir) Total (NW) Total (Shabelle+Banadir)
Executive Summary Total al… Tot Calula Total (NW) Urban al… Tot Rural TotalTotal (Juba) (Juba) Total (Shabelle+Banadir)al… Tot Total (Shabelle+Banadir) Tot al… BOSSASO HirHiraan .! al… Hiraan #! TotalTotal (Juba) (Juba) ! aan Qandala Tot ¹ al… GeGedo Hiraan Las Qoray/ 8 Zeylac HiraanHir doGedo Bossaaso aan Tot Badhan Gedo Total (Bay/Bakol) LughaGeye al… ERIGABO Gedo Total (Bay/Bakol) do Tot.! Total (Bay/Bakol) # AWDAL Total (Central) Tot ¹al… ! Total (Central) Iskushuban Total (Bay/Bakol)al… ! Mu BTotal (Central)aki Mudug Borama Tot Berbera d… SANAG al… 0 20 40 60 80 100 120 Mudug W. GALBEED Gal BFI Crisis Emergency Total (Central) BORAMAMu Ceel Afweyne Galgaduudg… Ceerigaabo BARI .! d… Sheikh Galgaduud 0 20 40 60 80 100 120 0 20 40 60 80 100 120 Gal BFI Crisis Emergency 0 20 40 60 80 100 Gebiley g… Aggregate Numbers 0 HAR20 GEY40SA 60 80 100 BURAO Stressed Stressed CrisisCrisis EmergencyEmergency !! .!0 !20 40 60 .! 80 100 120 ! Stressed Crisis Emergency Rural and Urban Populations !! Qardho in Phases 3, 4 & 5 Hargeysa OwdStressedweCrisisynEmergencye Xudun Bandar Beyla Caynabo Talex Phase % of (000’s) TOGDHEER Total Pop Burco SOOL Garowe #L.!aas Caanood 3 15% 1,120 Buuhoodle ¹LAS AN¹O#D !!.GAROWE Tot Eyl 4 2% 165 Total (Bari & Nugal)al… NUGTotal (BariA & Nugal)L Tot Total (Bari & Nugal) Burtinle Total al(NW)… Total (NW) Total (Bari & Nugal) Tot Total (NW) Total (Shabelle+Banadir) 5 0% 0 Tot al… Total (Shabelle+Banadir) Total (Bari & Nugal) al… Total (NW) Tot Total (Shabelle+Banadir) Total (Juba) Tot Jariialb… an Total (Juba) Total (NW) al… Galkacyo Tot Total (Bari & Nugal) Total (Shabelle+Banadir) Goldogob Total (Bari & Nugal)al… Hir Tot Total (Juba)Tot Hiraan Total (Bari & Nugal) aan al… al… GALKAYO Tot Hiraan Total (Shabelle+Banadir)Total=10% (NW) of the population Total (Juba) 70,000 (21%) !.! ! Total al(NW)… Tot GedoGe HiraanTot # Total (NW) Total al… al… Tot do Total (Shabelle+Banadir) Hiraan ¹ Gedo Total (Bari & Nugal) Total (Juba) Urban Total (Shabelle+Banadir)al… Tot Hir Total (Shabelle+Banadir)Total (Bay/Bakol)Tot al… aanGedo Rural Tot al… Total (Juba) Gedo Total (Bay/Bakol) Total (NW) Hiraan al… 85,000 (24%) Tot Ge TotalTotal (Juba) (Juba) Total (Bari & Nugal) Total (Central)Tot al… Total (Bay/Bakol)do Hir Total Hiraan Cadaado MUDUG al… Total (Bay/Bakol) Total (Central) GedoHir Tot aan Urban Total (Shabelle+Banadir) HiraanHiraan 0 20 40 60 80 100 120 Mu BFI Crisis Emergency Total (NW) aan Total (Central)al… Hobyo Ge Rural Gedo 370,000 (40%) Total (Central) Cabudwaaq d… Ge Tot do Mudug Tot Total (Bay/Bakol) Total Gedo Total (Juba) Gedo Gal al… do al… 0 20 40 60 80 100 120 DUSAMAREB Tot Total (Shabelle+Banadir) Total (Bay/Bakol) BFI Crisis Emergency ! Mudug Urban ! .! al… g… Tot Mu Total (Bay/Bakol) Galgaduud Tot Total (Central) Rural Hiraan al… d… Total (Bay/Bakol)Tot al… Total (Central) Dhusa Mareeb Galgaduud 0 20 40 60 80 100 120 Total (Juba) Tot Gal al… Tot 0 20 40 60 80 100 120 Total (Central) 0 20 80,00040 (24%)60 80 100 BFI Crisis Emergency al… g… Total (Central)Mu alGedo… Mudug Total 0 20 40 60 80 100 d… Stressed Crisis Emergency Hiraan Mu GALGADUD Stressed Crisis Emergency Tot 0 20 40 60 80 100 120 Mudug Urban d… Gal 0 20 40 60 80 100 120 Total (Bay/Bakol)al… Galgaduud Stressed Crisis Emergency BELET WEYNE Harardheere BFI Crisis Emergency Rural 50,000Gal (15%) g… Hir Ceel Barde .! Galgaduud Gedo g… Stressed Crisis Emergency # Total aan 0 20 40 60 80 100 Beled Weyne Total (Central) ¹ 0 20 40 60 80 100 120 Urban BAKOOL Ge 0 20 40 60 80 100 120 Ceel Bur 0 20 40 60 80 100 Total (Bay/Bakol)do Stressed RuralCrisis Emergency Stressed Crisis Emergency Mudug Rab- Stressed Crisis Emergency Tot Stressed Crisis Emergency Xudur al… Dhuure Total (Central) #.!HUDUR Ceel Dheere GalgaduudTot ! !Dolo ¹ w al… HIIRAN
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Mu g a Wajid Bulo Barde d… w e y Stressed Crisis Emergency a Aden Yabal
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N M. JUBA !BU'AALESablale #. L. SHATotalB (Bari & ENugal) LLE E ¹Bu'aale Brava ! Total (Bari & Nugal) ! Total (NW) Tot K al… Total (NW) 260,000 (17%) L. JUBA Total (Shabelle+Banadir)Tot Total al… Afmadow Jilib Total (Shabelle+Banadir) Urban Tot Total (Juba) Rural al… Total (Juba) Tot Hiraanal… Hiraan Jamaame Hir aanGedo Gedo Ge
# Total (Bay/Bakol)do KISMAAYO Total (Bay/Bakol) ¹!!.! Tot Kismayo al… Total (Bari & Nugal) TotalTotal (Central)(Central) Tot Total (Bari & Nugal) al… Mudug 0 20 40 60 80 100 120 Total Tot(NW) Mu BFI Crisis Emergency al… d… Badhadhe Total (NW) Galgaduud
Total (Shabelle+Banadir)Tot Gal al… g… 0 20 40 60 80 100 Total (Shabelle+Banadir) 165,000 (26%) Tot Total (Juba) 0 20 40 60 80 100 120 al… TotalStressed Crisis Emergency Total (Juba) Urban Tot Stressed Crisis Emergency Hiraanal… Rural Hiraan Hir aanGedo Gedo Ge ± Total (Bay/Bakol)do Total (Bay/Bakol) 0 40 80 160 240 320 400 Tot Total (Central)al… Total (Central) Kilometers Tot 0 20 40 60 80 100 120 al… BFI Crisis Emergency MuMudug d… GalgaduudGal g… Technical Partners 0 20 40 60 Fun80 ding A100gencies 0 20 40 60 80 100 120 Swiss Agency for Stressed Crisis Emergency Development and Stressed Crisis Emergency Cooperation SDC 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 47 Issued September 26, 2012 Table 2: Somalia Integrated Food Security Phase Classification, Population Numbers, Aug - Dec 2012
Total in UNDP UNDP UNDP Crisis and 2005 Urban in Rural in Urban in Rural in Urban in Rural in Region 2005 Total 2005 Rural Emergency Urban Stressed Stressed Crisis Crisis Emergency Emergency Population Population as % of Total
Population Executive Summary population North Awdal 305,455 110,942 194,513 35,000 35,000 0 20,000 0 5,000 8 9 Woqooyi Galbeed 700,345 490,432 209,913 220,000 40,000 0 10,000 0 0 1 Togdheer 402,295 123,402 278,893 40,000 65,000 15,000 10,000 0 0 6 Sanaag 270,367 56,079 214,288 10,000 25,000 25,000 35,000 5,000 5,000 26 Sool 150,277 39,134 111,143 0 20,000 15,000 10,000 5,000 0 20 Bari 367,638 179,633 188,005 20,000 40,000 60,000 15,000 20,000 0 26 Nugaal 145,341 54,749 90,592 0 20,000 20,000 5,000 5,000 0 21 Sub-total 2,341,718 1,054,371 1,287,347 325,000 245,000 135,000 105,000 35,000 10,000 12 Central Mudug 350,099 94,405 255,694 0 60,000 25,000 20,000 5,000 35,000 24 Galgaduud 330,057 58,977 271,080 10,000 60,000 15,000 35,000 0 35,000 26 Sub-total 680,156 153,382 526,774 10,000 120,000 40,000 55,000 5,000 70,000 25 South 0 Hiraan 329,811 69,113 260,698 15,000 20,000 15,000 50,000 0 15,000 24
Shabelle Dhexe (Middle) 514,901 95,831 419,070 0 115,000 30,000 25,000 0 45,000 19
Shabelle Hoose (Lower) 850,651 172,714 677,937 0 185,000 70,000 0 0 0 8 Bakool 310,627 61,438 249,189 20,000 110,000 20,000 55,000 5,000 0 26 Bay 620,562 126,813 493,749 25,000 145,000 35,000 230,000 0 0 43 Gedo 328,378 81,302 247,076 30,000 70,000 15,000 35,000 0 0 15 Juba Dhexe (Middle) 238,877 54,739 184,138 0 5,000 25,000 45,000 0 0 29
Juba Hoose (Lower) 385,790 124,682 261,108 0 10,000 20,000 45,000 20,000 5,000 23
Sub-total 3,579,597 786,632 2,792,965 90,000 660,000 230,000 485,000 25,000 65,000 22 Banadir 901,183 901,183 - 245,000 - 60,000 - 0 - 7 Grand Total 7,502,654 2,895,568 4,607,086 670,000 1,025,000 465,000 645,000 65,000 145,000 18
Distribution of Number % of Total Assessed and Contingency Population in Crisis and Emergency populations in affected population crisis Assessed Urban population in Crisis and Emergency 530,000 7 25%
Assessed Rural population in Crisis and Emergency 790,000 11 37%
IDP in settlements* (out of UNHCR 1.3million) to avoid double counting 800,000 11 38%
Estimated Rural, Urban and IDP population in crisis 2,120,000 28 100% Notes: 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 Stressed, Crisis and Emergency
3 Source UN-OCHA/UNHCR: New IDP updated January 18 2012 rounded to the nearest 5,000. Total IDP estimates are based on Population Movement Tracking data which is not designed to collect long-term cumulative IDP data
4 To avoid double counting, only IDPs in Settlements (Bossasso, Berbera, Galkayo, Hargeisa, Garowe, Kismayo, Afgoye, Burao and Mogadishu are considered in the overall population in Crisis. FSNAU does not conduct IDP specific assessments to classify them either in Crisis or Emergency
5. Percent of total population of Somalia estimated at 7,502,654 (UNDP/WHO 2005)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 2. Cases of Acutely Malnourished Children in somalia
FSNAU in collaboration with partners conducted a total of 46 Table 3: Estimated Cases of Acute Malnutrition in representative nutrition surveys throughout Somalia, between Somalia, by Region, September 2012 April – July 2012. Seventeen of the surveys were done in the Total acutely Total severely South, and the rest in the northern and central regions. With the malnourished malnourished Caseloads % of total % of total exception of Shabelle regions and the southern parts of Gedo, Cases Cases Bakool and Hiran which were inaccessible for security reasons, cases cases Bay 25,400 11 8,550 16 all population groups were assessed during this period. Table 10 Lower Shabelle 23,750 10 4,650 9 3 provides the summary of key findings from these surveys. Banadir (Mogadishu Town) 22,150 9 3,100 6 Woq Galbeed 18,800 8 3,700 7 Since 2008, FSNAU in collaboration with nutrition cluster Gedo 17,350 7 4,050 7 partners have illustrated the distribution of cases of the acutely Lower Juba 16,000 7 3,950 7 malnourished children in Somalia rather than just presenting Bakool 13,000 6 4,200 8 the prevailing nutrition situation. The purpose is to draw the Middle Shabelle 12,275 5 3,200 6 attention of response agencies and donors to the needs in Hiran 11,000 5 2,550 5 different parts of the countries, rather than just focusing on the Togdheer 10,850 5 2,150 4 prevailing situation. In this way, the impact of the population Middle Juba 9,900 4 2,450 5 density in determining response needs is manifested. Bari 9,000 4 2,600 5 Mudug 8,700 4 1,500 3 By extrapolating the prevalence rates of acute malnutrition Awdal 8,200 3 1,600 3 in each assessed population group to the total under five Galgadud 7,900 3 1,300 2 population during the Gu 2012, cases of acutely malnourished Mogadishu IDP 7,850 3 1,450 3 children, based on Weight-for-height Z scores (WHZ) findings, Sanag 7,250 3 1,450 3 have been estimated. The cumulative total cases at regional Sool 4,100 2 800 1 level has been obtained by adding the cases from the assessed Nugal 2,900 1 850 2 livelihood and IDP groups. For population groups where 236,400 100 54,100 100 representative nutrition survey data for the whole population forms the main reference, reliability of data is high and is acutely malnourished children in Somalia. Bay hosts 11%, ranked as 1 (R=1). For the Shabelle regions and southern Lower and Middle Juba region, 11%, Gedo 7% and Bakool parts of Gedo, Bakool and Hiran regions where it was not 6%. (Map 5 and Figure 5). possible to collect nutrition survey data, the median rates for surveys conducted in the Gu season during the period hence, Banadir, Middle and Lower Shabelle, Bay, Juba, 2001-2010 has been applied. This implies that FSNAU has Gedo and Bakool regions are host to 60% of all acutely estimated the current cases of malnourished children on the malnourished children in Somalia. basis of 100% of the population children aged below 5 years in Somalia. Population figures from the UNDP 2005 settlement • For cases of severe acute malnutrition, Shabelle regions, Bay survey are used as the standard reference for Somalia. (Table and Lower Juba, Gedo and Bakool regions are host to 63% 3). The integrated analysis and overall phase classification of the 54,000 children in the country, with Shabelle/Banadir of the assessed population is based on the Nutrition Situation hosting 20%, Bay 16%, and Juba regions 12%. Classification Framework. (Table 2). • Likewise, the northwest regions are host to 21% the total acutely malnourished and 18% of the severely malnourished. Analysis of the Post Gu 2012 findings indicatesan estimated total of 236,000 children as acutely malnourished. This This illustrates the implication of population density on translates to 16% of the 1.5 million under five population, caseloads, as Shabelle/Afgoye/Banadir, together with Woqoyi and implies 1 in 7 Somali children acutely malnourished. Galbeed are most densely populated areas of Somalia. This reflects a 27% decrease in numbers at the national In Figure 5, the proportion of cases of acutely malnourished level, compared to the Deyr 2011/12 when 323,000 children children by region is provided in descending order. were estimated to be acutely malnourished. Of these, 168,000, or 71% are located in the southern regions. In Map 6, illustrations for (i) the Gu 2012 nutrition situation and (ii) the cases for both total and severe acute malnutrition based Of the 236,000 children, a total of 54,000 children are on the May-July 2012 nutrition surveys data are provided. For severely malnourished. At national level, this translates more information please contact [email protected]. to 3.5% of all Somali children estimated to be severely malnourished. This reflects a significant decrease at the Figure 5: Propotion of Total Cases of Acutely national level, compared to the Deyr 2011/12 when 93,000 Malnourished Children (WHZ<-Z or Oedema) by Region, September 2012 children were estimated to be severely malnourished, and 30
160,000 in August 2011 at the peak of the famine. Of the Acutely malnourished Severely malnourished 25 54,000 severely malnourished children, 39, 500 (or 72%) 25
21
are located in the southern regions. 20
At regional level, these figures are derived by extrapolating 15
% of total caseload 11 11 the prevalence rate of acute malnutrition to the total under five 10
7 7 population. (Table 3). Hence, with regard to cases of acute 6 5 5 5 malnutrition: 3 • Shabelle regions (including Mogadishu IDPs and Banadir) 0 Shabelle & Northwest Bay L & M. Juba Gedo Central Bakool Northeast Hiran North IDPs Banadir rural & urban regions rural and are host to 25% while northwest regions host 21% of all the LZ urban LZ
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Map 5: Distribution of estimated Cases (%) of Acutely Malnourished Children in Somalia by Region, based on Prevalence, August 2012 Caseloads
11
Pregnant and lactating women The cumulative total estimate for acutely malnourished In the Gu 2011, the peak of the famine, the cases of acutely pregnant and lactating women based on MUAC malnourished pregnant and lactating women was estimated measurements < 23cm is 81,000. The severe at risk based at 101,000, based on MUAC measurements < 23cm, hence on MUAC<21cm is 19, 000. In the Deyr 2011, the cases of there is significant progress since then. acutely malnourished pregnant and lactating women was estimated at 85,000 based on MUAC measurements < 23cm. This indicates a 5% reduction in the cases.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 LINKING NUTRITION SITUATION TO RESPONSE
Nutrition Cluster response in 2012
Nutrition treatment services Special Article In eight months of service provision, the nutrition cluster response agencies reached 532,615 acutely malnourished children with treatment services (165,129 in stabilization centre/out-patient therapeutic care programme (SC/OTP) and 367,486 in targeted 12 supplementary feeding programme )TSFP). The number reached is above the post dyer caseload of 323,000 acutely malnourished children. The reason for surpassing the estimated caseload maybe due to population figures as well as the incidence rate of 2 which we use. The figure i below shows admission trends for January to August 2012. The low admissions figures for July and August are due to low reporting rate and not necessarily a drastic improvement in the nutrition situation..
Figure ii shows admission trends by zone. The Southern zone of Figure i: SC/OTP and TSFP admissions by month Somalia contributes most of the children reached consistent with the caseloads identified through nutrition surveys.
The table iii shows the prevalence and the cluster targets for July to December 2012. The Cluster aims to reach 142,000 (60%) acute malnourished children ( 109,000 moderate, 33,000 severely malnourished children) from the caseload of 236,000.
Maternal Child Health and Nutrition Prgrammes The cluster’s response agencies have also reached 1,100,618 targeted beneficiaries of which children 6- 23 months (907,071), pregnant and lactating women (193,547) with a preventive food ratio. From these a total of 983,321 are in the south central Somalia. Figure ii: Admissions trends by Zone
Transit IDPs WFP and partners reached 87,849 households with a 5 days High energy Biscuits supplementary ration and 19,605 children 6-59months with a supplementary ration of supplementary plumpy in the transit areas of Gedo and Lower Juba. This project will continue to offer relief to populations in transit in the border areas.
Basic Nutrition Service Package The cluster partners have embraced the basic nutrition services package (BSNP-) in programming in an effort to address underlying causes of malnutrition. In this regard, the cluster is sensitizing partners on the incorporation into programming of an innovative approach (home fortification), to deliver micronutrients to young children (6-23 months) so as to improve their micronutrient status and decrease morbidity.
Coordination mechanisms The cluster membership now stands at 142 partners, an increase by 31 members from last year’s 111 members. This resulted to an increase also of service delivery points from 1650 by the end of 2011 to 2454 currently. Regional coordination has greatly improved in the last quarter of the year in the areas where it had been weak due to poor access such as the Shabelles, Bay and Bakool. It is hoped that there will be a continued improvement in the coordination of services in these and other areas for effective response.
Table iii: Nutrition cluster target figures July to December 2012 Zone Prevalence Data GAM (60% target) Prevalence Data MAM (60% target) Prevalence Data SAM (60% target) South Somalia 150,850 90,510 113,700 68,220 37,150 22,290 Central Somalia 18,102 10,861 15,106 9,064 2,996 1,798 Northern Somalia 66,988 40,193 52,499 31,499 14,489 8,693 All Somalia 235,940 141,564 181,305 108,783 54,635 32,781 Rounded off to 236,000 142,000 181,000 109,000 55,000 33,000
For details, contact Nutrition cluster coordinator: Leo Matunga Email Address: [email protected] Nutrition cluster Lead: UNICEF
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 3. Nutrition Analysis in Somalia
The April-July 2012 (Gu) Nutrition Situation Analysis The Nutrition Situation Analytical Framework
Twice per year, in line with the seasonal assessments,
The Nutrition Situation Analytical Framework provides Nutrition Analysis post Gu (April – July) and post Deyr (October-December), a summary of international thresholds (WHO, UNICEF, FSNAU in collaboration with partners undertake a nutrition Fanta, Unicef) used to interpret findings from the various situation analysis by livelihood, region and IDP settlement. indicators. Where these are not available, contextually 13 During the April-July 2012 (Gu 2012) season, FSNAU in relevant analysis forms the basis. Considering the diversity collaboration with partners undertook 46 representative of indicators collected by FSNAU and partners in Somalia, nutrition surveys aimed at estimating the nutrition situation in (acute malnutrition, death rates, proportions at risk based on the various population groups in Somalia. The survey tools the mid upper arm circumference, nutrition trends from health used are provided in the appendices. Data management of facilities and selective feeding programs), the framework the nutrition surveys involved the use of the standard two forms the basis for integrated analysis of the situation. stage cluster sampling based on SMART recommendations, quality assurance during data collection and entry, and The January 2012 version of the analysis framework, used validation of data quality by running frequencies and in the Gu 2012 analysis, has three sections: plausibility checks of core statistical inferences. (Table 24). A. Core Outcome Indicators (mainly anthropometry related ENA software was used in the analysis of anthropometric information, and mortality. Those from surveys have and mortality data, and EpiInfo in the cross tabulations and more weight) analysis of non-anthropometric data. B. Immediate Causes C. Driving/Underlying Factors Analysis has been conducted using EpiInfo ENA, and interpretation of findings on specific indicators are based on Where representative nutrition surveys have been internationally recognized thresholds, mainly the UN-WHO, conducted, the global acute malnutrition (GAM), is the core UNICEF, Sphere, and FANTA/UNFAO. outcome reference indicator, denoting the prevalence of acute malnutrition. The outcome of the integrated nutrition • UN-WHO thresholds have been used to determine situation analysis process, the estimated nutrition situation, is the cut-offs for anthropometry where available, and to based on convergence of the evidence of the findings from interpret findings on acute malnutrition. the indicators. A minimum of 2 anthropometric indicators (global and severe acute malnutrition rates, for example • SPHERE 2011 has been referenced on cut-offs for have been used to make an analysis and classification of the the mid upper arm circumference for pregnant and situation into either of the six different phases. Information lactating women and aided in estimating prevalence from the season in progress only is used. However historical and cut off for child imunization status. Nevertheless data has been used for overall contextual and seasonal they are limited in providing thresholds for interpreting trends analysis. the situation. The overall analysis is consolidated into the Estimated • FANTA/UNFAO protocols have been referenced on Nutrition Situation Map. In the cartographical presentation, thresholds for dietary intake, however they are limited reliability of data source is illustrated through solid color (for in guiding on interpretation of the situation. survey data which is quite reliable, R=1), or through slash marks (when statistically representative data is not available, • The mean WHZ, are based on a “Review of in which case data reliability is lower and, R=2). Nutrition and Mortality Indicators for the Integrated Food Security Phase Classification Although FSNAU-led, the framework has been developed (IPC) by Young and Jaspars, 2009. over the years through a consultation process involving the WHO, UNICEF, WFP, ACF, CONCERN, SCUK, IMC, WV • The UNICEF 2005 classification has been used to and more recently, Medair, DIAL and the Nutrition Cluster interpret death rates. Support team as well as many nutrition partners in the region. The purpose is to have a tool that helps describe The findings for each of analyzed variables are categorized the nutrition situation with contextual analysis, rather than into six different phases based on the recognized thresholds: focus on prevalence estimates and thresholds which is Acceptable, Alert, Serious, Critical, Very Critical or traditionally the case in nutrition analysis. The January 2012 Extremely Critical. Where internationally recognized version accommodates current research developments, the interpretation frameworks are not available, for example, switch from NCHS 1997 to WHO 2006 growth standards and MUAC thresholds for the adult non-pregnant women, and a category for ‘extremely critical’ or ‘famine’ level nutrition the health information system trends, quartile distributions situation where for example global acute malnutrition rate of the meta-data at the FSNAU from 250 nutrition surveys is 30% and above. The analytical framework remains a conducted in 2007-2011 has been used. working document, updated and refined as new information and guidance becomes available.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 4. The Nutrition Situation Classification Framework, Draft 8, January 2012
A. CORE OUTCOME INDICATORS (Anthropometry & Death Rates) Reference Indicators Acceptable Alert Serious Critical Very Critical Extreme 15 to<20% or 3 to <10%; 10 to<15% or
Nutrition Analysis <3% where there is Usual range and where there is Global Acute Malnutrition1 significant increase >30% stable significant increase 20 to <30% (IPC Reference) Reliability (R) =1 from baseline/ from usual/ seasonal seasonal trends in trends in last >3 yrs 14 last >2 yrs Mean Weight-for-Height Z (WHZ) -0.40 to -0.69; -0.70 to -0.99; <-1.00; >-0.40 <-1.5 TBC scores (R=1) Stable/Usual >usual/increasing >usual/increasing SAM2 (WHZ and oedema3) <2.5% 2.5 – 3.4% 3.5 – 4.4% 4.5 – 5.9 6.0-9.9% ≥10% (WHO to advice on thresholds) R=1) 0.5 to <1 or doubling Crude death rate4/ 10,000/day (R=1) <0.5 <0.5 of rate in preceding 1 to <2 >2 >2 phase. Under five death rates5/10,000/day <1 1 to 1.9 2 to 3.9 <1 >4 >4 (R=1) ≥20.0%, Or 8.1-11.0 %, or 11.1-19. 9%, Or where there 2.0-5.5% with 5.6-8.0% where there is where there is significant MUAC6 Children: (% <12.5cm): Ref: increase from significant increase is significant increase from FSNAU Estimates 7 (R=2) <2.0% seasonal trends from seasonal increase from seasonal trends seasonal trends trends
MUAC<11.5cm8 (R=2) <1.0 <1.0 1.0-2.0 2.1-3.0 3.1-5.5 ≥5.5 Adult MUAC9 - Pregnant and Lactating(%<23.0cm,Meta Data- <13.5 13.6-21.5 21.6-27.0 27.1-35.0 35.0-49.9 ≥50.0 FSNAU Adult MUAC - Non-pregnant & non- <0.2 0.2-0.5 0.6-0.8 0.8-1.7 1.8-4.9 ≥5.0 lactating <18.5cm, Meta data FSNAU) Non Pregnant Maternal10 <10% 10.0 to 19.9% 20.0 to 39.9% >40% Undernutrition BMI<18.5 Non Pregnant Maternal11 TBC TBC TBC TBC Overnutrition BMI>24.9 Moderate (10 to Low proportion <15%) and stable High (> 15%) and V. low (<5%) (5 to <10%) and or low (5 to <10%) stable proportion High (> 15%) and increasing HIS12 Trends of Acutely Malnourished proportion in the stable trend in but increasing in the preceding proportion in the preceding Children preceding 3mths the preceding proportion in the 3mths relative 3mths relative to >2yr seasonal (Ref: HIS), (R=3) relative to >2yr 3mths relative preceding 3mths to >2yr seasonal trends seasonal trends to >2yr seasonal relative to >2yr trends trends seasonal trends Low levels (5 to Low (5 to < 10%) High levels (> 15%) <10%)and one & increasing or Sentinel13 Site Trends: levels of of malnourished High levels (> 15%) and Very low (<5%) round indicating moderate (10 to children identified as acutely children and increasing with increasing and stable levels increase, <15%) levels based malnourished(WHZ), FSNAU’06 SSS stable (seasonally trend (seasonally adjusted) seasonally on two rounds adjusted) adjusted (seasonally adjusted) OVERAL NUTRITION SITUATION Acceptable Alert Serious Critical Very Critical Extreme
B. IMMEDIATE CAUSES Reference Indicators Acceptable Alert Serious Critical Very Critical Poor HH Dietary Diversity <5% 5 – 9.9% 10-24.9% 25 – 49.9% >50% (% consuming<4fdgps) TBC TBC TBC TBC TBC Mean HH dietary diversity Score 13 • Normal levels, & -AWD 1 case Outbreak not contained and/or in non endemic area – limited Disease Outbreaks14: (seasonally seasonal -Measles 1 case access to treatment: adjusted). Frequency of reported trends, -Malaria–doubling of CFR for AWD >2% rural outbreaks of AWD &, malaria & Review cases in 2 weeks in • CFR for AWD >1% urban measles data in hyper endemic areas– AWD – duration exceed >6 wks relevant using RDT context Morbidity Patterns: Proportion of TBC TBC TBC TBC TBC children reported ill in 2wks prior Low proportion to survey (R=2) Low & stable reportedly sick, High levels and High with significant Health facility morbidity trends Very low proportion of from previous stable numbers in Increase in numbers of (R=3) /WHO surveillance (R=1) proportion reportedly sick based months but >2 months based on sick children, based on reportedly sick on seasonal trends increasing in >2 seasonal trends seasonal trends mnths based on seasonal trends
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 C. DRIVING FACTORS Reference Indicators Acceptable Alert Serious Critical Very Critical Complementary feeding15 in addition to breastfeeding i. Introduction of complementary
food at 6 mths of age: Nutrition Analysis ≥95% 80-94% 60-79% 0-59% 0-59% %introduced ≥95% 80-94% 80-94% 0-59% 0-59% ii. Meeting minimum recommended ≥95% 80-94% 80-94% 0-59% 0-59% feeding frequency16 15 iii. Dietary diversity17 score Breastfeeding (BF) Practices18 I. Exclusive BF for 6mths >90% 50-89% 12-49% 0-11% ii).Continued BF at 1 yr >90% 50-89% 12-49% 0-11% iii)Continued BF at 2yr reference >90% 50-89% 12-49% 0-11% Measles immunization/Status >95% 80-94.9% <80% Vitamin A Supplementation Coverage19:1 >95% 80-94.9% <80% dose in last 6 mths Population have access i). to a sufficient quantity of water for drinking, cooking, 100% TBC TBC TBC TBC personal & domestic hygiene–min 15lts pp/ day 100% TBC TBC TBC TBC ii).Sanitation facilities Access to Reduced access Limited access humanitarian Affected pop with access to formal/informal Should not be to humanitarian to humanitarian interventions Negligible or no access services: health services necessary support for most support for for most vulnerable majority vulnerable Selective Feeding20 Programs Available: Access Coverage of TFP /SFP & referral Should not be for most None available systems(Sphere04); necessary vulnerable -Admissions trends (R=3) Generally Food Borderline Acute Food and Humanitarian Famine/Humanitarian Food Security Situation- current IPC status Secure Food Secure Livelihood Crisis Emergency Catastrophe Unstable Prevailing Limited spread, low Widespread, high Civil Insecurity disrupted Widespread, high intensity structural peace intensity intensity tension Convergence of evidence on immediate Causes/Driving factors vis-à-vis Projected trend in 3 months 3 MONTH NUTRITION SITUATION time OUTLOOK No change: Stable; Uncertain: Potential to deteriorate Potential to improve:
Analytical Process: Key Points
1 Global Acute Malnutrition (weight for height <-2 Z score/oedema), IPC Vs 2, Nov 2011. 2 Severe Acute Malnutrition (weight for height <-3 Z score/oedema): Thresholds derived from quintile distribution of SAM from 250 SMART survey datasets at FSNAU, January 2012 3 Bilateral oedema is riverine livelihood specific indicator rather than for the whole country 4 Refs: i). Sphere 2004; ii). Emergency Field Handbook (A guide for UNICEF staff, pg 139) July 2005 5 WHO and Integrated Food Security Phase Classification Technical Manual Version 2.0, Final Draft, November 2011. Technical consultations 6 Mid Upper Arm Circumference, data source – rapid assessments, based on children 6-59 months: Thresholds derived from quintile distribution of SAM from 200 SMART survey datasets at FSNAU, January 2012 7 Follow up with S. Collins study/ Mike Golden/ Mark Myatt and on-going studies 8 Review of Nutrition and Mortality Indicators for the Integrated Food Security Phase Classification, Helen Young and Susanne Jaspars, Sept 2009 9 Thresholds for adult MUAC (pregnant/lactating and non-pregnant women) derived from quintile distribution of MUAC data from 99 SMART survey datasets at FSNAU 10 WHO Expert Committee, 1995 11 WHO Expert Committee, 1995 12 Health Information System, data source – health facilities 13 Data source, over 120 sentinel sites in different livelihoods in South Central Somalia 14 Data source, nutrition surveys, dietary studies and sentinel sites 15 Data source, nutrition surveys, Health Information System, Sentinel sites, feeding centers, rapid assessments 16 Data source, nutrition surveys and dietary studies 17 WHO 2008. Indicators for assessing infant and young child feeding practices. 2-3 feeds recommended for 6-8 months old, & 3-4 feeds for 9months old and above 18 WHO 2008. Indicators for assessing infant and young child feeding practices 19 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 20 WHO references 21 Data source, 12 Therapeutic Feeding Centers (TFC) and 14 Supplementary Feeding Centers (SFC)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 4. REGIONAL NUTRITION ANALYSIS
Map 6: Gedo Region Livelihood Systems
Regional Analysis 4.1 Gedo Region
16 Gedo region in southwest Somalia administratively comprises of six districts: Luuq, Dolo, Belet Hawa, Garbaharey, El Wak, and Bardera, see Map 6. Gedo region has three main rural livelihood zones namely: pastoral, agro- pastoral and riverine (Juba riverine pump irrigation). The pastoral livelihood, is further sub-divided into the Southern Inland and Dawa pastoralists. The Dawa pastoral livelihood zone located in northern Gedo is the largest pastoral group in the region rearing mainly cattle, a few sheep, goats and camel. The Southern Inland pastoral population is located in southern Gedo and mainly keep camel besides a few sheep and goats. The agro-pastoral population is divided into Southern agro-pastoral and Bay, Bakool and Gedo agro- pastoral - the sorghum high potential. Figure 6 indicates the historical trends of acute malnutrition in Gedo since 2006. of acute malnutrition compared to the Gu ’11 season. These improvements were mainly linked to the enhanced Historical Overview - Post Deyr ‘11/12 food security situation and humanitarian response in the region. Nevertheless, the nutrition situation remained of Food Security concern and was generally linked to seasonal outbreaks The FSNAU Post Deyr ‘11/12 integrated food security of acute watery diarrhea AWD, cholera, malaria, measles analysis classified both rural and urban livelihoods of Gedo and whooping cough. region to be either in Crisis or Emergency. In the rural livelihoods, the Crisis phase was identified mainly among Current Situation-Post Gu‘12 the southern agro-pastoral, southern inland pastoral, Juba Pump Irrigated and Dawa pastoralists. An estimated 32,000 Food Security
people in the urban livelihoods were identified in Crisis, Regional Analysis The FSNAU Post Gu ‘12 integrated food security analysis while an estimated 11,000 people of the riverine livelihood classifies both rural and urban livelihoods of Gedo region (Juba riverine pump irrigation) were identified to be in as either Stressed or in Crisis. In the rural livelihoods, the Emergency. However, the overall food security situation in Crisis phase is mainly identified among the Gedo agro- Gedo region showed an improvement, with the exception pastoral high potential,and Juba Pump Irrigated livelihood of the riverine livelihood which was affected by flash floods zones. However, the overall food security situation in Gedo and remained in Emergency. The general improvement of region shows an improvement from the respective Crisis the food security situation was due to a number of factors: and Emegency in Deyr ‘11/12 due to a number of factors: good cereal and cash crop harvest, in addition to improved good cereal and cash crop harvest, in addition to improved terms of trade (ToT) for local goat to cereal, increased terms of trade (ToT) for cereal to local goat, increased access to humanitarian interventions and improved livestock body conditions. Good off-season maize harvests from the Figure 6: Trend in Level of Acute Malnutrition (WHZ<- riverine areas, together with average camel milk production, 2 or oedema, WHO 2006) in Gedo Region, increased livestock prices and household income also 2006-2012 contributed to the improved food security situation in the 55.0 region. 50.0 45.0
40.0
35.0
Nutrition 30.0 The Post Deyr ’11/12 integrated nutrition situation analysis 25.0 20.0 % Malnourished
of Gedo region using data from health and feeding (SFP/ 15.0 OTP) facilities, indicated a sustained likely Very Critical 10.0 5.0
nutrition situation across all the three (agro-pastoral, 0.0 1 1 1 1 .06 .07 .08 .07 .08 .07 .08 .12 . 1 . 1 . 1 Jul.09 De.09 Jul.09 Jul.09 Ap r Ap r Ap r Jun.10 Jun.10 Jun.10 Ma r Dec.08 Dec.10 Dec.08 Dec.09 Dec.10 Dec.08 Dec.09 Dec.10 Ma y Ma y Ma y Ma y Jul y Jul y Jul y Aug. 1
pastoral and riverine) livelihood populations of Gedo region. Past .12 Dawo However, triangulation of data from health and feeding Ma y facilities in Gedo region indicated an improvement in levels
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 access to humanitarian interventions, improved livestock Figure 7: HIS Malnutrition Trends in Gedo body conditions and the anticipated good off-season maize Agropastoral MCHs - 2011-12
harvests from riverine areas. Average camel milk production, 60.0 increased in livestock prices and household income has also 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) 50.0
contributed to the improved food security situation. Regional Analysis
40.0 Nutrition 30.0 No surveys were conducted in Southern Gedo region due 17 to inaccessibility as a result of civil insecurity, therefore 20.0 Proportion of Children malnourished the available data (from health and feeding facilities) is 10.0 insufficient to make an overall nutrition situation estimation. 0.0 The current Gu’12 integrated nutrition situation analysis Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec of Northern Gedo region depicts a sustained Very Critical nutrition situation among the pastoral and riverine provided in Table 5. populations. Dolow IDPs An exhaustive nutrition survey conducted among the Dolow Nutrition assessments conducted in May ’12 in Northern IDPs in July 2012 reports a GAM rate of 25.9% and a Gedo region indicate elevated levels of acute malnutrition SAM rate of 7.5%,which indicates a Very Critical nutrition with GAM and SAM rates of 28.4% (23.0-34.5) and 6.2% (4.4- situation. The 90 days retrospective crude and under five 8.7) respectively in the Dawa pastoral, and GAM and SAM death rates reported are 0.60 and 0.81 per 10,000/day rates of 22.5% (19.2-26.1) and 6.1% (4.3-8.9) respectively, indicating an Alert situation according to UNICEF 2005 reported in the riverine livelihood zone. Data from health classification. Overall, the nutrition situation among the facilities from January to July 2012 in the pastoral, agro- Dolow IDPs is Very Critical, and the population remains pastoral (Figure 7) and riverine livelihood zones of Northern highly vulnerable due to the direct impact of household food Gedo region, indicate a high (>20%) and decreasing trend insecurity and the high disease burden in the town, further of acutely malnourished children. Analysis of data from aggravated by limited access to health services. Results feeding facilities in Northern Gedo region indicates a decline further indicated that a high proportion of the children in levels of acute malnutrition compared to the Deyr’11/12 assessed in the survey had fallen ill two weeks prior to the season. The analysis indicates a sustained Very Critical survey. nutrition situation in the two livelihoods in Nothern Gedo region. There was no statistically significant difference in the The overall rate of morbidity reported is 36.7%. The proportion of boys and girls acutely malnourished in both Regional Analysis proportion of children reported to have suffered from surveys (p> 0.05). The 90 days retrospective crude death diarrhoea in the 2 weeks prior to the assessment is rates is Serious among both the pastoral (0.59/10,000/day) 18.4%, while those suffering from suspected pneumonia and riverine (0.20/10,000/day) populations according to and measles is lower at 7.8% and 0.5% respectively. The UNICEF classification. The respective U5 death rates 1.36 measles immunization and vitamin A supplementation (0.77-2.36) and 1.60 (0.57-2.32) in pastoral and riverine status for the assessed children in the 6 months prior to livelihoods are also in Serious phase (Table 5). the assessment is high (89.4% and 90.9% respectively), however still below the recommended Sphere standards The nutrition situation remains concerning, given the area of 95%. is generally prone to seasonal outbreaks of AWD, cholera, malaria, measles and whooping cough. The situation is In addition chronic underlying factors that affect the further aggravated by chronic underlying factors such as: nutritional status of the population persist such as; poor household food insecurity, poor dietary quality, inadequate child care and feeding practices, inadequate sanitation social and care environment (sub-optimal child care and facilities and lack of access to safe drinking water remain feeding practices), and poor public health (limited access as long term challenges to the health and nutrition well- to basic human services such as safe water, health and being of the population. It is therefore crucial to initiate or sanitation facilities), which predispose the communities continue interventions targeting the health and nutrition of to high morbidity and subsequently high levels of acute the population and also address the underlying causes of malnutrition. food insecurity and disease.
It is therefore crucial to initiate or continue interventions targeting the health and nutrition of the population and also address the underlying causes of food insecurity and disease, therefore close monitoring of the situation is crucial. The key reference nutrition indicators used for analysis are
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 5: Summary of Key Nutrition Findings in Gedo Livelihood Zones, May 2012 Dolow IDPs Gedo Pastoral Gedo Riverine (N= 974 Boys=470, (N=694, Boys=339 ,Girls=335) (N=757, Boys=397, Girls=360) Girls=504) Indicator Results Outcome Results Outcome Results Outcome Child Nutrition Status Global Acute Malnutrition 28.4 (23.0-34.5) 22.5 (19.2-26.1) 25.9 (WHZ<-2 or oedema) Regional Analysis 31.0 (23.2-40.0) Very Critical 26.7 (22.6-31.3) Very Critical 31.1 Very Critical Boys 25.9 (21.0-31.5) 17.8 (14.1-22.1) 21.0 Girls Severe Acute Malnutrition 6.2 (4.4-8.7) 6.1 (1.3-8.9) 7.5 (WHZ<-3 or oedema) 18 6.2 (3.6-10.4) Very Critical 7.8 (5.6 -10.9) Very Critical 9.6 Very Critical Boys 6.2 (3.6-10.3) 4.2 (2.1-8.0) 5.6 Girls Mean of Weight for Height Z -1.30±1.11 Very Critical -1.16±1.11 Very Critical -1.26±1.12 Very Critical Scores Oedema 0.7 Very Critical 0 0.8 Very Critical Global Acute Malnutrition 26.3 (20.5-33.1) Very Critical 22.9 (19.1-27.3) Very Critical 23.9 Very Critical (NCHS) Severe Acute Malnutrition 2.1 (1.1- 4.0) Acceptable 3.9 (2.5-6.2) Serious 5.1 Critical (NCHS) Proportion with MUAC (<12.5 7.0 (5.1-9.4) 9.2 (6.4-12.9) 13.8 cm or oedema) 5.8 (3.9-8.6) Serious 7.0 (4.8 -10.2) Critical 14.0 Very Critical Boys 8.1 (5.4-11.9) 11.5 (7.0-18.2) 13.5 Girls Proportion with MUAC (<11.5 2.1 (1.3-3.5) 0.9 (0.4-2.3) 3.0 cm or oedema) 2.3 (1.1-5.0) Critical 0.5 (0.1-2.1) Acceptable 3.3 Critical Boys 1.9 (1.0-3.9) 1.4 (0.5-3.9) 2.7 Girls Stunting (HAZ<-2) 17.6 (13.9 -22.0) 19.0 (14.8-24.0) 29.8 Boys 15.4 (11.5-20.5) Critical 20.6 (15.3 -27.2) Critical 29.3 Critical Girls 19.6 (14.1-26.6) 17.1 (12.8-22.6) 30.4
Underweight (WAZ<-2) 23.1 (17.4-30.1) 21.0 (17.2-25.5) 31.6 Boys 24.4 (17.0 -33.8) Serious 23.6 (18.7-29.3) Serious 34.6 Critical Girls 21.9 (16.5-28.5) 18.2 (13.7-23.7) 28.7 High (>30%) HIS Nutrition Trends ( High (>30%) levels and High (>30%) levels and levels and Very Critical Very Critical Very Critical January –July 2012) increasing trends increasing trends increasing trends Child Morbidity & Immunization
Morbidity-36.7 Boys- Morbidity-29.2 (19.9-38.6) Morbidity-25.9 (18.2-33.5) 35.5;Girls-37.8 Boys 27.6 ;Girls-30.7 Boys-25.0;Girls-26.8 Disease trends (seasonally Diarroh-18.4 adjusted) Diarrohea-10.2 Diarrohea-10.3;Boys 9.2 Boys 18.7;Girls Morbidity refers to the Boys-9.9; Girls -10.5 Girls 11.5 Very Very Critical Very Critical 18.1 proportion of children Pneumonia- 10.5 Pneumonia-8.7 Critical Pneumonia -7.8 reported to be ill in the 2 Boys 9.0 ;Girls 11.9 Boys-9.2 ;Girls 8.2 Boys 7.6;Girls 8.0 weeks prior to the survey Measles-0.4 Measles0.3 Measles-0.5 Boys- 0.5; Girls 0.2 Boys-0;Girls-0.8 Boys-0.2;Girls -0.7
Vitamin A-90.8 Vitamin A-93.8 Vitamin A-93.1 Boys- Boys-95 :Girls-92.7 Boys-93.2 :Girls-93.1 91.9;Girls-90.6 Immunization Alert Alert Alert Measl-93.1 Measles-88.4: Measles-89.5 Boys-95 .0;Girls-91.4 ) Boys-89.4; Girls-89.5 Boys- 89.9;Girls-89.2 Death Rates Crude deaths, per 10,000 per day (retrospective for 90 0.59 (0.35-1.01) Serious 0.2 (0.11-2.32) Acceptable 0.60 Serious days) Under five deaths, per 10,000 per day (retrospective for 90 1.36 (0.77-2.36) Serious 1.6 (0.57-2.32) Serious 0.80 Alert days) Pregnant and lactating 30(24.0-37.7) Critical 24.9(19.4-30.4) Critical 24.1(18.030.2) Critical women (MUAC <23.0 cm) Pregnant and lactating 24.1(18.030.2) 4.3(2.6- 6.1) 4.8(3.5-6.1) women (MUAC <21.0 cm) Non pregnant and lactating 0 Acceptable 0.6(0.0-16) Acceptable 4.8(3.5-6.1) Serious women (MUAC <18.5 cm) Food security phase Stressed Serious Stressed/Crisis Serious Stressed/Crisis Serious
Overall Risk to Deterioration Stable Stable Stable
Overall Situation Analysis Very Critical Very Critical Very Critical
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 6: Summary of Key Nutrition Findings in Dowlo IDPs May 2012 Dowlo IDPs (N=974, Boys=470, Girls=504) Indicator Results Outcome Child Nutrition Status Global Acute Malnutrition (WHZ<-2 or oedema) 153 25.9 Very Critical Boys : 31.1 Girls 21.0
Severe Acute Malnutrition (WHZ<-3 or oedema) 7.5 Regional Analysis Very Critical Boys 9.6 Girls 0.8 Mean of Weight for Height Z Scores -1.26 ±1.12 Very Critical Oedema 0.80 Very Critical 19 Global Acute Malnutrition (NCHS) 23.9 Very Critical Severe Acute Malnutrition (NCHS) 5.1 Critical Global Acute malnutrition by MUAC (<12.5 cm or oedema) 13.8 Boys 14 Serious Girls 13.5 Severe Acute malnutrition by MUAC (<11.5 cm or oedema) 3 Boys 3.3 Critical Girls 2.7 Stunting (HAZ<-2) 29.8 Boys 29.3 Critical Girls 30.4 Underweight (WAZ<-2) 31.6 Boys 34.6 Critical Girls 28.7 HIS Nutrition Trends (July- December 2011) Child Morbidity & Immunization Morb-36.7 Boys- 35.5 Girls-37.8
Diarrohea-18.4 Boys-18.7 Girls-18.1 Disease trends (seasonally adjusted) Very Critical Pneum-7.8 Boys 7.6 Girls 8.0
Measle-0.5 Boys-0.2 Girls- 8.0 Death Rates Crude deaths, per 10,000 per day (retrospective for 90 days) 0.60 Serious Under five deaths, per 10,000 per day (retrospective for 90 days) 0.80 Alert Food security phase Crisis Very Critical Overall Risk to Deterioration Unstable Overall Situation Analysis Very Critical
Gender and nutrition analysis in Gedo Region
Nutrition assessments conducted in two livelihoods zones of Northern Gedo region recorded a higher proportion of acutely malnourished boys than girls in the pastoral (31% vs 25.9%) and riverine (26.7% vs 17.8%) livelihoods. Similarly, a higher proportion of acutely malnourished boys than girls are observed in the Dolow IDPs (31.1% vs 21 %). However, these differences are not statistically significant (Pr<75%). Similar patterns are more or less observed in the other forms of malnutrition where in the pastoral livelihood, 15.4% of boys compared to 19.6% of girls were stunted; and 24.4% of boys as compared to 21.9% of girls were underweight. In the riverine livelihood 20.6% of boys compared to 17.1% of girls were stunted; and 23.6% of boys as compared to 18.2% of girls were underweight. In the Dolow IDPs, 29.3% of boys compared to 30.4% of girls were stunted; and 34.6% of boys as opposed to 28.7% of girls were underweight. A higher proportion of girls than boys were reportedly ill two weeks prior to the assessment in the pastoral, agro-pastoral and riverine populations. However, there is no statistically significant difference between the sexes showing that they were both equally affected (Pr<75%). The gender disaggregated results of the assessed children is summarized on Tables 6 and 7.
Maternal nutrition status in Gedo region Non-pregnant and Pregnant and Lactating Women In the pastoral and riverine livelihoods of Northern Gedo and Lactating women among the Dolow IDPs, a significantly higher proportion of Gedo Proportion Proportion Proportion region No. No. pregnant and/or lactating women were acutely malnourished with with with Assessed Assessed (MUAC< 23.0 cm, and 21.0 cm, and/or bilateral oedema) MUAC<23cm(%) MUAC<21cm(%) MUAC<18.5cm(%) than non-pregnant and non-lactating women (MUAC<18.5). North 389 24.9(19.4-30.4) 4.3(2.6- 6.1) 162 0.6 (0.0-16) The proportion of acutely malnourished pregnant and/or Riverine Dawo 396 30 (24.0 -37.7) 2.3(0.6-3.8) 189 0 lactating women ranged between 24.1% (Serious) among the Pastoral Dolow IDPs population to 30% (Critical) in the Dawo pastoral Dollow 373 24.1(18.030.2) 4.8(3.5-6.1) 373 4.8(3.5-6.1) livelihood. The maternal malnutrition in Dolow IDPs is Critical IDPs among the pregnant and lactating women, with 24% of the assessed women recording MUAC measurements of <23cm. The high levels of acute malnutrition among the pregnant and/or lactating women is linked to increased nutrient needs during these periods which may not be met.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 4.2 MIDDLE and LOWER Juba Regions Map 7: Juba Regions Livelihood Zones
Middle and Lower Juba regions have three main rural livelihood zones namely: the pastoral (the Southern Inland
Regional Analysis and Southeast Pastoralists), agro-pastoral (Lower Juba and Southern Agro-pastoral) and the Riverine communities who 20 are purely agriculturalists. The Juba regions in southern Somalia have a total of seven districts namely: Sakow, Buale and Jilib in Middle Juba, and Jamame, Afmadow, Kismayo and Badhadhe in Lower Juba see Map 7.
The food security and nutrition situation in the Juba regions has varied over time and has largely been linked to rainfall performance and its resultant impacts on the different livelihood systems. Heavy rainfall in the Juba regions or in the Ethiopian highlands often results in floods that devastate crop cultivation and sanitation facilities in the Nutrition riverine areas, however, the riverine communities’ later The nutrition situation of the Middle and Lower Juba pastoral, benefit from recessional cropping from the Desheks and agro-pastoral, and riverine livelihood populations has been in fishing opportunities from the flood waters. The agro- a sustained Very Critical phase since Deyr ‘10/11. However, a pastoral communities, who rely on rain-fed agriculture, are significant reduction in the GAM and SAM rates of the three totally dependent on rainfall and so are the pastoralists, livelihoods was recorded compared to the Gu ’11. The poor whose livelihood is greatly influenced by water and pasture nutrition situation in Juba regions was mainly linked to food conditions. insecurity exacerbated by high morbidity. The consecutive seasons of poor rainfall performance experienced in the Historical Overview - Post Deyr ‘11/12 regions led to poor crop and livestock production as well as high livestock deaths, especially cattle, sheep and goats, Food Security resulting in limited access to milk and diversified foods at household level. The reduced humanitarian interventions The FSNAU Post Deyr ’11/12 analysis classified the food (health and nutrition services) and recurrent civil insecurity security situation of rural livelihoods of Juba regions in three in the area was a major concern, especially since high phases: Crisis, Emergency and Stressed and the urban morbidity remains a major risk factor to acute malnutrition. populations in either Emergency or Stressed. A total of Figure 8 indicates the historical trends of acute malnutrition 169,000 people were in crisis and in need of humanitarian in Middle and Juba Regions since 2007. assistance and livelihood support. Out of these, 74,000 people in the two regions were in a state of Crisis (35,000 Figure 8: Trend in levels of Acute Malnutrition (WHZ in M/Juba and 39,000 in L/Juba). While another 95,000 were <-2Z scores or oedema, WHO 2006), Juba Regions 2007 - 2012 identified to be inEmergency (50,000 in M/Juba and 45,000 50.0 in L/Juba). The population facing food insecurity declined 45.0
by 43% in the Deyr ‘11/12 (169,000) when compared with 40.0 295,000 in Gu ‘11. In addition, 20,000 people in both regions 35.0 were identified to beStressed (7,000 in M/Juba and 13,000 30.0 25.0 in L/Juba). In the urban livelihood in both regions, 69,000
% Malnourished 20.0
people were identified to be in crisis with 26,000 in M/Juba 15.0 and 43,000 in L/Juba in either Emergency or Crisis. The 10.0 5.0 situation of the riverine population in Middle and Lower 0.0 1 1 1 1 1 1 1 1 1 1 1 1 .12 .12 .12 . 1 . 1 Juba regions was critical due to the combined impacts of . 1 Jul.09 Jul.09 Jul.09 Jun.07 Jun.08 Jun.07 Jun.08 Jun.07 Jun.08 Oct. Oct. Oct. Dec.07 Dec.08 Dec.09 Dec.10 Dec.07 Dec.08 Dec.09 Dec.10 Dec.07 Dec.08 Dec.09 Dec.10 Ma y Ma y Ma y Jul y Jul y Jul y Aug. 1 Aug. 1 the previous droughts and severe flooding in Deyr ‘11/12 Aug. 1 Juba Pastoral Livelihood Zone Juba Agro-pastoral Livelihood Zone Juba Riverine Livelihood Zone season, which resulted in total maize crop failure.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Current Situation - Post Gu ‘12
Food Security Figure 9: HIS Malnutrition trends in Juba The food security situation in Juba regions shows some agro-pastoral MCHs 2010-2011 improvements since Deyr ‘11/12. Currently, a portion of 60 Regional Analysis 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) the Lower Juba agro-pastoral population (25% of Poor) is 50 identified in Emergency, while the South-East Pastoral, 21 Southern Agro-pastoral and Juba riverine livelihoods in both 40
Lower and Middle Juba regions are identified to be inC risis. 30
Significant improvements are visible in the Southern Inland Proportion of malnourished children 20 Pastoral (camel herders) population, which are classified as
Stressed. The positive changes discerned in the food security 10 situations are largely attributable to the effects of previous Deyr 0 ‘11/12 season which improved overall rangeland conditions, Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec resulting in improved livestock body conditions and market Data Source: Muslim AID UK, MSF and SCRCS value. Despite the above improvements in parts of Juba region, substantial food and income gaps still exist in most of The agro-pastoral population reported a GAM rate of 25.1% the major livelihoods. Civil insecurity and closure of Kismayo (22.2-28.3) and SAM rate of 5.8% (4.4-7.7), indicating a port activities have resulted in low trade activities and loss of sustained Very Critical nutrition situation since Deyr ‘11/12. employments from charcoal exports. A comparison with the previous GAM rate of 26.1% (22.4- 30.1) and SAM rate of 9.1% (7.1-11.5) reported in October Nutrition Situation ‘11 indicates no significant change (p>0.05). The 90 day retrospective crude and under five death rates reported Three comprehensive nutrition surveys conducted in July 2012 in July 2012 are 0.25 (0.07-0.88 ) and 0.85 (0.41- 1.78) among the pastoral, agro-pastoral and riverine livelihoods respectively, indicating acceptable and alert situations of Juba region indicate a sustained Very Critical nutrition (UNICEF 2005)1. Nutrition data from health facilities in the situation in the agro-pastoral and riverine populations but an Juba riverine, pastoral and agro-pastoral livelihoods all improvement to a Critical phase among the pastoral. Survey indicate high numbers (>30%) and an increasing trend of findings recorded a GAM rate of 15.8% (11.8-20.7), 25.1% acutely malnourished children Figure 9 show the malnutrition (22.2-28.3) and 21.1% (17.7-24.8) among the pastoral, agro- trend in health facilities in agro-pastoral areas. pastoral and riverine populations respectively. The SAM rates reported in the three livelihood zones were 2.1% (1.0-4.4), Close monitoring of the food security and nutrition situation 5.8% (4.4-7.7) and 6.6% (5.0-8.7) in the pastoral, agro-pastoral will be crucial in the Juba population. The population still and riverine livelihoods respectively. remain highly vulnerable to shocks and the current risk factors Among the riverine population of Juba, these findings indicate are: reduced access to humanitarian services, high morbidity a Very Critical nutrition situation, an improvement from burden- reported AWD and measles outbreaks , poor access the Extreme nutrition situation reported in the Deyr ‘11/12 to health care services and sanitation, sub-optimal child season. This is a significant improvement (p<0.05) in the feeding and care practices which all have a direct impact on GAM and SAM rates observed in the October ’11 survey that the health and nutritional status of children, therefore close reported GAM and SAM rates of 34.5% (29.9-39.5) and 11.8% monitoring of the situation is crucial. The key reference (9.4-14.8) respectively. The 90 day retrospective crude and nutrition indicators used for analysis are provided in Table 7. under five death rates are 0.20 (0.11-0.42 ) and 1.16 (0.57- 2.32) respectively, indicating Acceptable and Alert situations (UNICEF 2005). 1 UNICEF, 2005: The Emergency Field Handbook. A guide for UNICEF staff. (pg 139), July 2005. Retrieved March 5, 2012 at Among the pastoral population, a GAM rate of 15.8% (11.8- http://www.unicef.org/lac/emergency_handbook.pdf. 20.7) and a SAM rate of 2.1% (1.0- 4.4) is Critical, and when compared to the October ‘11 GAM and SAM rates of 27.3% (23.0-32.0) and 9.5% (7.1-12.8) respectively, illustrates an improvement from a Very Critical nutrition situation, with a significant decline in acute malnutrition rates (p<0.05). The crude and under five death rates are 0.44 (0.20-0.99) and 0.81 (0.29-2.27) respectively, indicating acceptable and alert situations. (UNICEF 2005).
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 7: Summary of Key Nutrition Findings in Juba Livelihood Zones, July 2012
Juba Pastoral Juba Agro-pastoral Juba Riverine (N=520, Boys=261 ,Girls=259) (N=773, Boys=369, Girls=404) (N= 817 Boys=381, Girls=436) Indicator Results Outcome Results Outcome Results Outcome
Regional Analysis Child Nutrition Status Global Acute Malnutrition (WHZ<-2 15.8 (11.8-20.7) 25.1 (22.2-28.3) 21.1 (17.7-24.8) or oedema) 17.6 (13.0-23.4) Critical 30.9 (26.4-35.8) Very Critical 27.8 (22.6-33.7) Very Critical Boys 13.9 (8.9-21.0) 19.8 (16.2-24.0) 15.1 (12.1-18.8) 22 Girls Severe Acute Malnutrition (WHZ<-3 2.1 (1.0-4.4) 5.8 (4.4-7.7) 6.6 (5.0-8.7) or oedema) 2.7 (1.2-5.9) Acceptable 6.8 (4.6-9.8) Critical 8.9 (6.2-12.7) Very Critical Boys 1.5 (0.6-3.8) 5.0 (3.2-7.5) 4.6 (2.8-7.4) Girls Mean of Weight for Height Z Scores -0.78±1.09 Serious -1.22±1.11 Very Critical -1.20±1.06 Very Critical Oedema 1.5 Very Critical 0.8 Very Critical 0.7 Very Critical Global Acute Malnutrition (NCHS) 14 (10.6-18.1) Serious 19.6 (17.0-22.6) Critical 18.8 (15.6-22.4) Critical Severe Acute Malnutrition (NCHS) 2.1 (1.0-4.3) Acceptable 2.8 (1.9-4.3) Alert 2.4 (1.5-3.9) Acceptable Proportion with MUAC (<12.5 cm or 18.1 (12.2-26.1) 16.1 (13.7-18.8) 14.6 (6.6-29.5) oedema) 17 (11.1-25.1) Very Critical 15.3 (12.0-19.3) Very Critical 15.9 (6.8-32.8) Very Critical Boys 19.2 (12.1-29.1) 16.9 (13.6-20.8) 13.5 (5.9-28.0) Girls Proportion with MUAC (<11.5 cm or 4 (2.4-6.5) 2 (1.3-3.3) 3.2 (0.8-12.1) oedema 4.5 (2.4-8.5) Very Critical 11.1 (0.4-2.7) Very Critical 3.3 (0.8-13.0) Very Critical Boys 3.5 (1.7-6.8) 2.9 (1.7-5.0) 3.2 (0.8-11.5) Girls
Stunting (HAZ<-2) 24 (19.1-29.6) 28.0 (24.9-31.3) 27.8 (24.3-31.5) Boys 29.1 (21.6-38.0) Critical 33.1 (28.4-38.1) Critical 34.2 (30.2-38.4) Critical Girls 18.9 (14.3-24.5) 23.4 (19.5-27.8) 22.2 (17.5 -27.8)
Underweight (WAZ<-2) 19.9 (15.3-25.4) 33.4 (30.2-36.8) 34.5 (30.3-38.9) Boys 23.8 (17.3-31.9) Alert 44.4 (39.4-49.5) Critical 44.1 (38.8-49.6) Critical Girls 16 (11.3-22.1) 23.4 (19.5-27.8) 26 (21.6-31.0)
High (>30%) levels High (>30%) levels HIS Nutrition Trends ( January- July High (>30%) levels and and increasing Very Critical Very Critical and increasing Very Critical 2012) increasing trends trends trends Child Morbidity & Immunization
Morb-31.1 (24.3-37.9) Morb-16.7 (13.1-20.3) Morb-42.4 (6.8-28.6) Boys 32.6 ;Girl- 30.1 Boys 17.5;Girls-16 Boys 42.4; Girls 42.4 Disease trends (seasonally adjusted) Morbidity refers to the proportion of Diarr-11.9 Diarr-9.6 Diarr-8.7 children reported to be ill in the 2 Boys-14.3;Girls10.3 Boys 7.9;Girls11.1 Boys 8.4;Girls 9.0 weeks prior to the survey Very Critical Very Critical Very Critical Pneumonia-7.6 Pneumonia -0.3 Pneumonia-8.0 Boys 5.4 ;Girls 9.0 Boys 0.2;Girls 0.4 Boys 7.4 ;Girls 8.5
Measles 2.1 Measles-0.7 Measles 0.8 Boys 1.9 ;Girls 2.2 Boys 0.2 ;Girls 1.2 Boys 0.9 ;Girls 0.6
Death Rates Crude deaths, per 10,000 per day 0.44 (0.20-0.99) Acceptable 0.25 (0.07-0.88) Acceptable 0.20 (0.11-0.42) Acceptable (retrospective for 90 days) Under five deaths, per 10,000 per 0.81 (0.29-2.27) Alert 0.85 (0.41-1.78) Alert 1.16 (0.57-2.32) Critical day (retrospective for 90 days) Pregnant and lactating women 43.0(32-54) Very Critical 26.3(18.8 -34.2) Very Critical 26.3(18.8 -34.2) Very Critical MUAC <23.0 cm Pregnant and lactating women 23.3(15.7-31.0) 3.0(0.7-5.2) 3.0(0.7-5.2) MUAC <21.0 cm Non pregnant and lactating 16.3(13.0-19.7) Alert 4.7(2.2-7.2) Serious 0.7(0.0-2.2) Serious women MUAC <18.5 cm Food security phase Stressed Serious Crisis Serious Crisis Serious Overall Risk to Deterioration Unstable Unstable Unstable Overall Situation Analysis Critical Very Critical Very Critical
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Kismayo and Dhobley IDPs
The nutrition situation of the internally displaced population in (p>0.05) in the nutrition situation. The 90 day retrospective Kismayo Town is classified asVery Critical. A comprehensive crude and under five death rates are 0.27 (0.13-0.55) and
nutrition survey conducted among the Kismayo IDPs in July 1.71 (1.08-2.71) respectively, both indicating Acceptable and Regional Analysis ‘12 reports a GAM rate of 28.0% (24.6-31.6) and a SAM rate Alert situations according to UNICEF (2005) classification. of 8.2% (5.7-11.7) which indicates a sustained Very Critical The worrying nutrition situation is mainly related to chronically 23 nutrition situation. A survey conducted in October ‘11 survey poor food access, and high morbidity due to inadequate reported a GAM rate of 26.7% (22.9-30.8) and a SAM rate sanitation facilities and safe water and lack of health services. of 9.5% (7.5-12.1), and thus there is no significant change
Table 8: Summary of Key Nutrition Findings in Kismayo IDPs July 2012 Kismayo IDPs Dobley IDPs (N=547, Boys=277, Girls=270) N=781, Boys=392, Girls=389 Indicator Results Outcome Results Outcome Child Nutrition Status 28(24.6-31.4) Global Acute Malnutrition (WHZ<-2 or oedema) 153 Very Critical 22 32 (26.7-38.0) Boys : 25 Very Critical 23.7(18.6-29.7) Girls 19 Severe Acute Malnutrition (WHZ<-3 or oedema) 8.2 (5.7-11.7 7.6 Boys 8.7(5.7-12.9) Very Critical 9.2 Very Critical Girls 7.8(4.6 -12.9) 5.9 Mean of Weight for Height Z Scores Oedema -1.45 ±0.92 -0.95±1.19 Global Acute Malnutrition (NCHS) 23.8 (20.6-27.3) Very Critical 20.6 Very Critical Severe Acute Malnutrition (NCHS) 4.2 (2.3-7.3) Serious 4.1 Serious Global Acute malnutrition by MUAC (<12.5 cm or oedema) 11.3 (8.5-14.9) 19.9 Boys 11.7 (8.2-16.4) Very Critical 19.4 Very Critical Girls 10.9( 7.3-16) 20.3 Severe Acute malnutrition by MUAC (<11.5 cm or oedema 4.5 ( 2.6-7.6) 7.1 Boys 3.9 (1.8-8.1) Very Critical 7.1 Very Critical Girls 5.1 ( 2.9-8.9) 7.1 Stunting (HAZ<-2) 35.1 (31.8-38.5) 15.4 Boys 38.5 (33.3-44.1) Very Critical 17.1 Critical Girls 31.4(27.1-36.2) 13.7 Underweight (WAZ<-2) 40.4 (36.2-44.8) 16.4 Boys 45.6 (39.5-51.8) Very Critical 18.9 Critical Girls 35.1 (30.3-40.2) 14.0 HIS Nutrition Trends (January - July 2012) Child Morbidity & Immunization Morbidity 18.6 (13.7-24.4) Morbidity 49.6 Boys 19.3 (13.9-24.7) Boys 49.7 Girls 17.8 (11.2-24.4) Girls 49.5
Diarrohea 12 ( 9.1-15.0) Diarrohea- 27 Disease trends (seasonally adjusted) Boys 11.9 (7.3-16.2) Boys 27 Girls 12.1 8-16.2) Girls 26.9
Pneum-2.6 ( 0-6.2) Critical Pneum- 23.4 Very Critical Boys 2.8 ( 0-6.5) Boys 22.7 Girls 2.5 (0-6.2) Girls 24.1
Meas-1.4 ( 0.3-2.4) Measle- 2.3 Boys1 ( 0-2.2) Boys 1.8 Girls 1.7 ( 0-3.5) Girls 2.8 Vita A- N/A Vita A-43.0 Boys Boys 44.4 Girls Girls 41.6 Immunization Status N/A Very Critical Measles – N/A Measles-40.1 Boys Boys 41.2 Girls Girls 39.1 Death Rates Crude deaths, per 10,000 per day (retrospective for 90 days) 0.27 (0.13-0.55) Acceptable 0.32 Acceptable Under five deaths, per 10,000 per day (retrospective for 90 1.71 (1.08-2.71) Serious 0.96 Alert days) Food security phase Crisis Serious Crisis Serious Overall Risk to Deterioration Unstable Unstable Overall Situation Analysis Very Critical Very Critical
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 An exhaustive nutrition survey conducted among the Dhobley IDPs in July, 2012 reports a GAM rate of 22% and a SAM rate of 7.6% which indicates a Very Critical nutrition situation. The 90 days retrospective crude and under five death rates reported are 0.32 and 0.96 per 10,000/day Regional Analysis indicating an Alert situation according to UNICEF (2005) 24 classification. Overall, the nutrition situation among the Dhobley IDPs is Very Critical, and the population remains highly vulnerable due to the direct impact of household food insecurity and the high disease burden in the town, further aggravated by the limited access to health services. There is need for continued support to the displaced population in terms of targeted food supplementation, income-generating activities, health education, shelter improvement and continued immunization programmes and other development interventions to improve the health and nutrition situation of the vulnerable IDPs in Dobley town.
Gender and nutrition analysis in Juba Region
The nutrition assessments conducted in the livelihood populations of Juba recorded a higher proportion of acutely malnourished boys than girls in the pastoral (17.6% vs 13.9%) and agro-pastoral (30.9% vs 19.8%) livelihoods. Similarly, a higher proportion of acutely malnourished boys than girls are observed in the riverine livelihoods (27.8% vs 15.1 %). These differences are statistically significant (p<0.05) among the boys and girls in the agro-pastoral and riverine livelihoods. In the pastoral livelihood, 29.1% of boys compared to 18.9% of girls were stunted; and 23.9 of boys as compared to 16% of girls were underweight. In the agro-pastoral livelihood ,33.1% of boys compared to 23.4% of girls were stunted; and 33.4% of boys as compared to 44.4% of girls were underweight, these differences are statistically significant (p<0,05). In the riverine livelihood, 34.2% of boys compared to 22.2% of girls were stunted; and 34.5% of boys as opposed to 44.1% of girls were underweight, therefore, these differences are statistically significant (p<0,05%). A higher proportion of boys than girls were reportedly ill two weeks prior to the assessment in the pastoral livelihoods while the proportions of girls and boys were similarly affected in the agro-pastoral and riverine populations. The gender disaggregated results of the assessed children is summarized on Tables 7 and 8.
Maternal nutrition status in Juba livelihood In the Juba livelihood, a significantly higher proportion of pregnant and/or lactating women were acutely malnourished (MUAC< 23.0 cm, and 21.0 cm, and/or bilateral oedema) than non-pregnant and non-lactating women (MUAC<18.5) across all the pastoral, agro-pastoral and riverine livelihoods in Juba region. The proportion of acutely malnourished pregnant and/ or lactating women ranged between 9.8% (Acceptable) among the Dhobley IDPs to 46.7% (Very Critical) in agro-pastoral livelihood. The high levels of acute malnutrition among the pregnant and/or lactating women is linked to increased nutrients needs during these periods which may not be met.
Pregnant and Lactating Women Non-pregnant and Lactating women Juba region Proportion with Proportion with Proportion with No. Assessed No. Assessed MUAC<23cm(%) MUAC<21cm(%) MUAC<18.5cm(%) Pastoral 135 43.0(32-54) 14.0(6.6-21.5) 526 16.3(13.0-19.7) Agro-pastoral 304 46.7(38.8-54.6) 23.3(15.7-31.0) 148 4.7(2.2-7.2) Riverine 369 26.3(18.8 -34.2) 3.0(0.7-5.2) 131 0.7(0.0-2.2) Dobley IDP 337 9.8(7.3-13.0) 8.3(5.7-11.9) 0 0 Kiusmayo IDP 265 29.4(24-35.5) 9.1(5.9 -13.2) 207 9.7(6.0-14.5)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Sustained high levels of acute malnutrition across Somalia and Kenya border
Seasonal rain failure is not unusual in the Horn of Nutrition Survey Map Africa negatively affecting the population’s livelihood Special Article systems in the region. Though all countries in the Horn of Africa are affected, the degree of severity varies 25 depending on the governing structures and response mechanism in each country. Communities at the Somalia-Kenya-Ethiopia borders have experienced recurrent rainfall failure in the past ten years, which has hindered rain fed crop production among agro- pastoralists, and resulted in massive death of livestock among both agro-pastoralists and pastoralists. This has impacted negatively on the communities’ resilience over the years. The result includes food crises, alarming levels of acute malnutrition and mortality.
Nutrition and mortality assessments conducted between January and July 2012 along the Kenya- Somalia border show high levels of acute malnutrition and at the same time reveal a severe humanitarian crisis in Somalia1.
Nutrition situation in Wajir and Mandera - Kenya Between January to July 2012, five representative nutrition surveys were conducted by UNICEF Kenya and other partners in North East Kenya, in the two districts of Wajir and Mandera. The results of a nutrition assessment conducted are as follows: • Wajir South: GAM rate of 23.1% (19,5-27.3), and SAM rates of 4.6% (3.5%-6.3%). The retrospective crude and the under five death rates are 0.30 (0.13-0.68) and 0.54 (0.19-1.52). • Wajir West and North: GAM rates of 14.6% (11.9-17.8) and SAM rates of 2.2% (1.4%-3.5%). The retrospective crude and the under five death rates are 1.0(0.51-2.03) and 0.49(0.27-0.89). These findings on acute malnutrition depict a Very Critical situation in Wajir South, and Serious nutrition situation in Wajir West and North. Death rates are within acceptable levels in Wajir South, but slightly elevated to Alert levels in Wajir West and North based on UNICEF 2005 classification. • Mandera West: GAM rate of 16.2% (13-19.9), and SAM rates of 3.5% (1.9% - 6.4%). The crude and under five death rates are 0.41 (0.22-0.77), 0.67 (0.29-1.53) respectively. • Mandera Central: GAM rate of 17.9% (14.9-21.4) and the SAM rates of 3.4% (2.1%-5.3%). The crude and under five death rates are 0.18 (0.07-0.43) 0.22 (0.05-0.87) respectively. • Mandera North and East: GAM rate of 15.9% (13.2-19.1) and the SAM rates of 2.2% (1.4%-3.5%). The crude and under five death rates are 0.23 (0.12-0.44) and 0.8 (0.34-1.84) respectively. These results depict indicate a Critical nutrition situation across Mandera. The crude and under five death rates are nevertheless within the Acceptable - Alert phases respectively, based on UNICEF 2005 classification.
Nutrition situation in Gedo and Juba regions - Somalia In July 2012, representative nutrition surveys conducted in Gedo and Juba regions in Somalia by FSNAU and partners are indicate a Critical and Very Critical nutrition situation among the populations in the two regions. No surveys were conducted in Southern Gedo region due to inaccessibility as a result of civil insecurity, therefore the available data (from health and feeding facilities) is insufficient to make an overall nutrition situation estimation. Nutrition assessments conducted in May ’12 in Northern Gedo region indicate elevated levels of acute malnutrition with GAM and SAM rates of 28.4% (23.0-34.5) and 6.2% (4.4-8.7) respectively in the Dawa pastoral, and GAM and SAM rates of 22.5% (19.2-26.1) and 6.1% (4.3-8.9) respectively, reported in the riverine livelihood zone. The analysis indicates a sustained Very Critical nutrition situation in the two livelihoods in Nothern Gedo region.
1 FSNAU Nutrition Update, May-June 2012
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Map showing nutrition situation in Somalia-Kenya border regions Three other comprehensive nutrition surveys conducted in July 2012 among the pastoral, agro-pastoral and riverine livelihoods of Juba region indicate a sustained Very Critical nutrition situation in the agro-pastoral and
Regional Analysis riverine populations but an improvement to a Critical situation among the pastoral. Survey findings recorded a GAM rate of 15.8% (11.8-20.7), 25.1% (22.2-28.3) and 21.1% (17.7-24.8) among the pastoral, agro-pastoral and 26 riverine populations respectively. The SAM rates reported in the three livelihood zones were 2.1% (1.0-4.4), 5.8% (4.4-7.7) and 6.6% (5.0-8.7) in the pastoral, agro-pastoral and riverine livelihoods respectively.
Conclusion: These results in the Somalia side as well as the neighboring country in Kenya indicate Serious, Critical and Very Critical nutrition situation. These findings clearly reflect the severity of nutrition situation in the cross- border communities largely due to poor food availability and household access which is as a result of the consecutive seasons of rain failure that adversely affected the livestock dependent population and insecurity. Lack of pasture and water has led to massive deaths of livestock, the main source of food and income for food and non-food items while the remaining livestock have out-migrated. Access to health, safe water and sanitation facilities in these areas are very limited leaving the population highly vulnerable to diseases, thereby aggravating the nutrition situation.
In the two border countries, it would be crucial to increase interventions on health and nutrition as well as food security. Rehabilitation of severely and malnourished children remains a priority in the short term to prevent any further deterioration. For a lasting solutions to the persistent problems of food and nutrition insecurity, longer term interventions in health, food and livelihoods are required.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 4 .3 Bakool AND Bay Regions Map 8: Bay and Bakool Regions Livelihood Zones
Bakool and Bay regions are located in southwest Somalia. Both regions have two predominant livelihood systems: the agro-pastoral, found in Bay region and in the southern parts Regional Analysis of Bakool, and the pastoral found mainly in Elberde district of Bakool region (referred herein as Bakool pastoralists). Bakool region comprises of five districts namely Huddur 27 (Huddur town is the regional capital), Wajid, Tieglow, Rabdure and Elberde. Bay region comprises of four districts, namely Baidoa, (Baidoa town is the regional capital), Qansahdere, Dinsor and Burhakaba (Map 8). The two regions have a high agricultural potential, with Bay region serving as the sorghum basket for Somalia.
Bakool Region
Historical Overview Post Deyr ‘11/12
Food Security The Post Deyr ‘11/12 analysis classified the food security of the population in Bakool region as Crisis. The total population in crisis was 140,000 which indicated a significant Current Situation, Post Gu ‘12 decrease by 30% from the Gu ‘11 season. Overall, the food security situation in the rural areas had indicated a significant Food security improvement following above normal rains that had led The current FSNAU Post Gu ’12 integrated food security to an improvement of both livestock and crop production. analysis identifies the Bakool Southern Inland Pastoral Cereal production in Bakool region significantly improved in Stressed phase, an improvement from Crisis in Deyr compared to previous seasons due to the above normal ‘11/12. The improvement in the food security situation in the Deyr ’11/12 rainfall performance. Humanitarian assistance Southern Inland Pastoral livelihood zone is mainly attributed and remittances from relatives within Somalia and in the to the positive impact of the Deyr ‘11/12 rainfall performance Diaspora also contributed to the significant increase in food which improved access to income and food from livestock access across all livelihoods. and related products, and to the increased access to humanitarian interventions in the region. The agro-pastoral Nutrition livelihoods however remains in Crisis due to the effect of The Post Deyr ‘11/12 integrated nutrition analysis based on below normal rain performance affecting crop production; health and nutrition facilities data classified the nutrition low terms of trade (labor to sorghum), low agricultural labor situation in both agro-pastoral and pastoral livelihood zones opportunities; reduced supply of cereal from neighbouring of Bakool region as likely Very Critical. Nutrition surveys regions and limited humanitarian interventions due to conducted in both livelihood zones in October 2011 did not the high civil insecurity in the region. These factors have meet the required quality standards for publication. The trend affected both availability and access to food. of acute malnutrition from 2002-2012 is shown on Figure 10. Nutrition Situation Figure 10: Trend in levels of acute malnutrition (WHZ< The Post Gu‘12 integrated nutrition situation analysis -2 or oedema, WHO 2006) Bakool region, using data from nutrition assessments, health and feeding 2002- 2012 facilities classifies the nutrition situation of the Bakool 60.0 pastoral population as Very Critical. A nutrition assessment 55.0 50.0 conducted in June 2012 in the Bakool pastoral livelihood 45.0 zone reported a GAM rate of 26.2% (20.6-32.8) and a SAM 40.0 rate of 5.7% (3.6- 9.1) including four (0.5%) oedema cases. A 35.0 30.0 significantly higher (p<0.05) proportion of boys (31.4%) than 25.0 girls (21.7%) are acutely malnourished. The results show a % malnourished 20.0 15.0 Very Critical nutrition situation but an improvement compared 10.0 to the July ‘11 findings when GAM and SAM rates of 55.9% 5.0 (50.6-61.2) and 20.4 (15.2-26.7) with three (7.4 %) oedema 0.0 1 1 1 cases were reported. OTP admission in Bakool region is and Jul'08 July' 1 Aug' 1 July' 1 Nov'07 Apr '08 Dec' 09 Dec' 09 June'09 June'09 June'12 increasing since April 2012 (See figure 11) The mortality rates
Bakool Agropastoral Bakool Pastoral are within the acceptable UNICEF levels with crude death rates (CDR) of 0.31 (0.15-0.61), and under five death rate of 0.86 (0.43-1.73), a significant improvement from the mortality rates reported in July 2011 (CDR - 1.89 and U5DR - 5.06).
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 The main causes of death reported through respondent’s Figure 12: Trend in levels of Acute malnutrition recall are measles and malaria for the under fives and TB (WHZ< -2 or oedema , WHO 2006) Bay Agropastoral , 2002- 2012 and malaria for adults. 80.0 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012)
70.0 Pockets of high malnutrition rates are noted in the 60.0
Regional Analysis following clusters/villages: Maroodicade, Buur Caliyow, 50.0 Habaasha Inashurbad, Elbaid, Morabus , Nuhley, Hiirey and Wargarweyne all in Elberde district. The concerned 40.0 28 villages are hosting an influx of IDPs from areas with high 30.0 Proportion of malnourished children civil insecurity particularly Huddur and Rabdhure. 20.0
10.0
No assessment was conducted in the agro-pastoral livelihood 0.0 of Bakool region, therefore there is insufficient data to Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec estimate the overall nutrition situation. However, data from Table 9: Summary of Key Nutrition Findings in Bakool health facilities indicates a high (>45%), and a stable trend of Pastoral livelihood zone - July 2012 acutely malnourished children. The information from partners Bakool Pastoral June‘2012 (N=732;Boys=341;Girls= 391) conducting feeding programmes in the area indicates high Indicator Results Outcome and fluctuating admission trends in the area. (Figure 12. ) Child Nutrition Status Global Acute Malnutrition 26.2 (20.6-32.8) (WHZ<-2 or oedema) 31.4 (24.6-39.0) Very Critical Figure 11: Admissions trends into OTP Boys 21.7 (15.7-29.3) programmes Bakool 2012 Girls Severe Acute Malnutrition 5.7 (3.6- 9.1) (WHZ<-3 or oedema) 8.8 (5.0-14.9) Critical Boys 3.1 (1.4- 6.6) Girls Mean of Weight for Height -1.35±1.03 Very Critical Z Scores Global Acute Malnutrition 24.8 (20.1-30.2) Very Critical (NCHS) Severe Acute Malnutrition 3.1 ( 1.8- 5.4) Alert (NCHS) Proportion with MUAC<12.5 cm or 15.1 (11.7-19.3) oedema 17.3 (13.3-22.1) Very Critical Boys 13.3 ( 9.2-18.7) Girls Proportion with 1.9 ( 1.1- 3.3) MUAC<11.5 cm or oedema 2.3 ( 1.2- 4.4) Serious Boys 1.5 ( 0.5- 4.7) Disease outbreaks continue with measles incidences being Girls reported in Elberde, Huddur and Tieglow (WHO Bulletin, Stunting (HAZ<-2) 23.9 (19.4-29.1) Boys 30.1 (24.6-36.2) Serious June 2012). Though limited, humanitarian interventions in Girls 18.6 (13.1-25.7) Underweight (WAZ<-2) 28.1 (22.2-34.9) the form of blanket, targeted and outreach supplementary Boys 34.8 (28.0-42.3) Critical feeding programs by organizations such as WFP, UNICEF, Girls 22.3 (15.8-30.5) 1 Child Morbidity & Immunization EPHCO and DADO , in parts of the agro-pastoral and pastoral Disease trends (seasonally Morbidity- 46.9 Boys-49.7; livelihood zone may have assisted to mitigate the poor nutrition adjusted) Girls-44.4 Morbidity refers to the Diarrhoea – 18.8 Boys- 19.0 Very Critical situation in Bakool region. The support needs to be continued proportion of children :Girls-18.6 and expanded to cover more rural villages in both livelihoods. reported to be ill in the 2 Pneumonia- 18.7 weeks prior to the survey Boys-19.0;Girls- 18.4 Vitamin A – 47.4 Very Critical Boys-45.6; Girls- 48.9 Immunization Status Measles Vacc –34.6 Boys- 32.7;Girls-36.2 Death Rates Crude deaths, per 10,000 per day (retrospective for 0.31 Acceptable 90 days) Under five deaths, per 10,000 per day 0.86 Acceptable (retrospective for 90 days) Women Nutrition Status N= 595 Proportion of acutely malnourished non 0.6 (0.01-1.7) Critical pregnant/lactating women (MUAC <18.5 cm) Proportion of acutely malnourished pregnant 2.4 (0.7-4.0) and lactating women (MUAC<21.0) Proportion of acutely malnourished pregnant 22.0 (17.5-26.5) Serious and lactating women Blanket supplementary feeding program(BSFP) in (MUAC<23.0) Stressed Serious Bakool,July 2012 Food security phase Overall Risk to Stable Deterioration Overall Situation Very Critical Analysis 1 Dareeyl Awareness and Development organization
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Bakool Region: Pastoral Livelihood
The food security situation of the Bakool pastoral population Gender and nutrition analysis in Bakool Regions has improved, however, the milk availability remains low Although nutrition surveys conducted in the Bakool pastoral currently, but is however projected to improve in the coming livelihood appeared to indicate a higher proportion of boys months. Although the food security outlook in the region is than girls as acutely malnourished, this difference is not of Regional Analysis positive, the nutrition situation in Bakool region is projected statistical significance (p>0.05). Other child data such as to be Very Critical in the coming months due to the persistent illness, and immunization status, also do not show any clear 29 disease outbreaks, high morbidity and poor child care differential proportions by gender. Analysis of the distribution of and feeding practices. In addition, the population remains malnutrition cases assessed by MUAC measurements reflects vulnerable to the chronic aggravating factors affecting a slightly higher proportion of girls (17.3%) than boys (13.3% malnutrition such as food insecurity, limited access to safe ) as acutely malnourished with MUAC<12.5 cm or oedema. water and sanitation facilities as well as limited humanitarian The gender disaggregated data of the assessed children is services (health, nutrition, wash and food). The population will summarized on Table 9. require appropriate humanitarian interventions to improve and prevent further deterioration. Table 9 highlights the key findings of the nutrition situation analysis.
Case study 1: A family’s experience during a hunger period, in Huddur district
Huddur town is the headquarter for Bakool region in southern Somalia and is located 180 km northwest of Baidoa and 90 km from the Ethiopian border. It has two main livelihood zones: the pastoral rearing mainly camel, sheep/goat and cattle and the agro-pastoralist who practice cropping farming alongside keeping different types of livestock. Bakool agro-pastoral livelihood was among areas where famine was declared on July 2011. The famine resulted from prolonged drought following very poor Deyr ’10/11 and Gu ’11 rainfall performances, which led to crop failure, loss of livestock. This situation contributed to poor household access to food, milk and income through sales, amidst very limited humanitarian activity to mitigate the situation. The results were a humanitarian catastrophe with malnutrition levels in excess of 30%, crude death rates above 2 per 10,000 per day, and at the least, 20% of households unable to access food needs. The case study below exemplifies how some households coped with the famine situation. Afifa, 34, is a mother of three children- two boys and one daughter and stays with her husband Adam in Dudmaale village, east of Huddur town.
The family has a small farm from which in normal circumstances, they produce enough food for their own consumption and for income. However, the last two seasons of the drought have been very harsh and the family farm did not produce anything from their farm. Prior to the drought, the family had seven goats and one pack camel. During the drought period, cereal prices escalated and so many families employed asset stripping distress coping strategies including sales of livestock at throw away prices, to meet the basic food needs. Afifa’s family sold their last goat with her kid in January 2012. For several times, the husband had to borrow cereals and cash from a nearby Abak beday village . As the drought intensified, the pack camel became weak and fell sick and could not stand on its own (see photo). For this reason, they were also forced to cheaply dispose off the camel at the local butchery. Unlike other families tha are relatively better off, Afifa’s family lacks has no means to fetch water, firewood, and lacked transport to move the family to a new place.
The health status of the family members worsened. About seven months prior to the interview, the youngest child was reportedly suffering from an unknown disease, with symptoms of high fever, cough, pallor, and swelling in the abdomen.. Afifa sought medical assistance for her son from a local drug vendor, in Huddur town, and ended up with wrong subscriptions. After several visits, spending borrowed cash buying medicine that did not help her son, she sought help from a new clinic supported by Muslim Aid. The child was diagnosed with Leishmaniasis, also known as kala-azar. He was treated and followed up for three weeks.
Travelling from Dudumaale to Huddur everyday was very expensive, and family was forced to split. Adam and Afifa agreed that Adam stays with their son in Huddur and Afifa takes care of the other children in the village. This was at a time, the many roadblocks erected by armed groups restricted trade movements limiting businesses in Huddur town. The lorries, cars, and even donkey carts were not allowed to deliver food to Huddur town. Due to this, many women smuggle in food from the villages in order to make a living. Circumstances forced Afifa to join this group. It’s a risky business but the little money she earns is what the family survives on. The case study explains how the population in this district is coping with the drought situation, highlighting resilience from the famine and the extent to which they have exhausted their coping strategies and are in dire need of assistance.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Bay Region to crickets, in addition to low cereal stock availability for the poor and deterioration of wage rates due to the low agricultural Historical Overview - FSNAU Post Deyr ‘11/12 labour. Cereal production in this Gu’12 season is well below average. It’s the second lowest Gu‘ cereal production in the Food security region since 2005. However, terms of trade between livestock/ Regional Analysis cereals has mitigated the situation. The FSNAU Post Deyr ‘11/12 integrated food security 30 analysis classified the agro-pastoral (low and high potential) Nutrition livelihood zones of Bay region in Crisis phase, indicating an improvement from the respective Famine phase in Gu ‘11. The improvement in Bay region was mainly attributed to good crop production, improved income from livestock and improved purchasing power resulting from the good Deyr ‘11 rainfall performance. Additionally, humanitarian assistance (cash and food distribution) and social support mitigated the situation. Cereal production from Deyr‘11/12 season was estimated at 6,1390 MT which was 195% of post war average (PWA) compared to 8% in Deyr ‘10/11. It was the third highest Deyr cereal production in the region since 1995. The purchasing power of households had improved as a result of better terms of trade (ToT) of daily labour wage and red sorghum. In addition, ToT between local goats and red Baneedi village hosting IDPs from Bakool sorghum had shown an increase due to the reduced cereal prices and improved livestock prices. The Post Gu‘12 integrated nutrition situation analysis, Figure 13: Trend in levels of acute malnutrition (WHZ< using data from nutrition assessments, health and feeding -2 or oedema, WHO 2006) Bay region, facilities classifies the nutrition situation of the Bay agro- 60.0 2002- 2012 pastoral livelihood population as Very Critical, indicating an 55.0 50.0 improvement from the Extreme levels in the Deyr ‘11/12. The 45.0 nutrition situation of the IDPs from Baidoa town, assessed for 40.0 35.0 the first time, indicates a Critical nutrition situation. 30.0 25.0 A nutrition survey conducted in July ‘12 in the agro-pastoral
% malnourished 20.0 15.0 livelihood zone of Bay region reported a GAM rate of 20.4% 10.0 5.0 (16.7-24.5) and a SAM rate of 6.9% (5.0-9.4) with nine (1.0 %) 0.0 oedema cases. These rates show a Very Critical nutrition 1 1 1 .'07
Oct' 1 situation, although an improvement from the Extreme nutrition July' 1 Aug' 1 July'12 May'07 Dec-09 No v June 09 situation reported in the October ‘11, when GAM and SAM Burhakaba Bay Agro-pastoral Agropastoral rates reported were ~30.0% and ~7.0%. A higher proportion Nutrition of assessed boys (22.2%) are acutely malnourished compared to girls (18.7%), although the difference is not statistically The Post Deyr ‘11/12 integrated analysis of data from nutrition significant. The 90 days retrospective crude (CDR) and assessments2 conducted in Bay region in October ‘11, in under five death rates (U5DR) of 1.40 (0.93-2.10) and 2.70 addition to data collected from health and feeding facilities (1.86-3.89) indicate a Serious situation according to UNICEF indicated a sustained Extremely Critical nutrition situation. classification, an improvement from Critical levels reported However, although the GAM rates remained above 30%, a in October ’11 when CDR of <2 was recorded. The health significant reduction in GAM rates was recorded (Figure 13) facilities also indicate a high number (>50 %) and stable trend compared to July ‘11 (GAM>50%). of acutely malnourished children and a stable trend (Figure 14). Morbidity levels reported in the two weeks prior to the Current situation, Post Gu‘12 assessment were high at 32.8% and immunization status for measles and vitamin A supplementation is extremely low Food security (<20%) compared with the Sphere recommended coverage of 95%. The FSNAU Post Gu’12 integrated food security analysis classifies the agro-pastoral (low and high potential) livelihood The sustained poor nutrition situation of the Bay agro- zones of Bay region in sustained Crisis, though with pastoral populations is attributed to chronic food insecurity increased numbers in crisis. This worsening trend in the Gu linked to overall poor crop production, high debt levels from ‘12 season is mainly attributed to poor crop production as a the previous season, reduced wage rates, low agricultural result of below normal rainfall and long dry spell, crop loss labour coupled with high morbidity and limited humanitarian assistance. Further aggravating factors include chronic 2 The surveys were conducted jointly by FSNAU/UNICEF, Somalia Red Crescent Society (SCRS)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 problems of poor child feeding and health care practices, and Baidoa Town is host to internally displaced persons (IDPs) low access to safe water, health and nutrition services, which fleeing from Banadir, Bay and Bakool regions mainly because predispose populations to high morbidity and consequently of insecurity and prolonged drought. Often, IDPs are faced high levels of acute malnutrition. with numerous problems including lack of food, malnutrition, poor sanitation and shelter due to loss of assets and a disruption of livelihood system. Regional Analysis Figure 14: HIS Malnutrition trends in Bay Agro-pastoral MCHs,2010-2011 60.0 In July 2012, FSNAU conducted a comprehensive nutrition 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) 31 survey among the Baidoa IDPs. The GAM and SAM rates
50.0 of 15.5% (11.6-20.4 ) and 5.1% (3.1-8.5) indicate a Critical nutrition situation (Table 10). More boys (17.1%) than girls 40.0 (14.1%) are acutely malnourished but the difference is not statistically significant. The 90 days retrospective CDR 30.0 and U5DR of 0.42 (0.27-0.66) and 1.52 (0.91-2.53) indicate Acceptable and Alert levels respectively, according to UNICEF 20.0 levels. Morbidity, a key nutrition aggravating factor remains Proportion of malnourished children high (28.3%) in the IDPs. Malnutrition rates for pregnant and 10.0 lactating women (MUAC <23.0 cm) is 24.1% (18.2-30.1). This rate is high and slightly above the baseline median rate of 0.0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 22.0% recorded from nutrition surveys in Somalia conducted between 2007-2010. Lack of stable livelihood systems among Nevertheless, recently improved income and food access the IDPs coupled with lack access to basic services continue resulting from increased ToT (labour to sorghum), social to expose this population group to risks of malnutrition, ill support mainly from the diaspora, control of disease health and food insecurity. Interventions to improve and outbreaks as well as some limited humanitarian assistance stabilize food access and provision of health services are may have mitigated further deterioration and contributed to crucial in addressing food insecurity and in tackling the high the reduction of the GAM and SAM rates. Immediate and morbidity levels, thereby mitigating the high levels of acute routine health, food and livelihood interventions are required malnutrition. to mitigate further deterioration and to address the extreme rates of acute malnutrition. In the medium term, interventions Gender and nutrition analysis in Bay Regions to support and rebuild livelihoods is critical. The key nutrition The analysis of the nutrition data in the assessed rural reference indicators of the analysis on the nutrition phase livelihoods as well as the Baidoa IDP populations shows classification are provided in Table 10. no statistically significant difference in distribution of the malnutrition cases between boys and girls. A high proportion of boys than girls are acutely malnourished, stunted and underweight across Bay agro-pastoral livelihood and Baidoa IDP populations. For example, in Bay agro-pastoral 22.2% (17.6-27.5 ) of boys compared to 18.7% (14.1-24.4) girls are acutely malnourished 39.9% (33.1-47.0 ) boys compared to 35.5% (27.4-44.5) of girls are stunted and 38.2% (31.8-45.4) of boys as opposed to 31.3% (24.5-39.1) of girls are underweight. Nevertheless, the distribution of malnutrition cases assessed by MUAC measurements in Bay agro-pastoral shows slightly more girls (20.3%) than boys (15.7%) identified as acutely malnourished with MUAC<12.5 cm or oedema (see nutrition summary Tables).
Maternal Nutrition Status in Bay and Bakool
Water source at Eldhere village in Bakool
Baidoa IDPs
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 10: Summary of Key Nutrition Findings in Bay Regions-July 2012
Bay Agro-Pastoral July 2012 (N=889;Boys=419 Baidoa IDP (July 2012) (N= 858 ;Boys= Girls= 470) 391 Girls= 467) Indicator Results Outcome Results Outcome Child Nutrition Status 20.4 (16.7-24.5) Global Acute Malnutrition (WHZ<-2 or oedema) 15.5 (11.6-20.4) 17.1 17.1 Regional Analysis 22.2 (17.6 -27.5) Boys Very Critical (12.8-22.6) Critical 18.7 (14.1-24.4) Girls 14.1 ( 9.6-20.3) 32 Severe Acute Malnutrition (WHZ<-3 or oedema) 6.9 ( 5.0- 9.4 ) 5.1 ( 3.1- 8.5) Boys 6.7 ( 4.2-10.5) Critical 6.1 ( 3.7- 9.9) Critical Girls 7.0 ( 4.6-10.6) 4.3 ( 2.1- 8.4) Mean of Weight for Height Z Scores -1.08±1.09 Critical - 0.76±1.16 Serious Global Acute Malnutrition (NCHS) 21.0 (17.0-25.7) Very Critical 15.1 (11.0-20.4) Very Critical Severe Acute Malnutrition (NCHS) 3.8 ( 2.5- 5.7) Alert 4.6 (2.6- 8.1) Critical Proportion with MUAC<12.5 cm or oedema 18.1 (14.7-22.1) 12.7 (8.8 -17.9) Boys 15.7 (12.4-19.8) Very Critical 14.4 (9.0-22.3) Very Critical Girls 20.3 (15.6-25.8) 11.2 (7.8 -15.7) Proportion with MUAC<11.5 cm or oedema 4.0 (2.6- 6.0) 2.6 (1.6- 4.4) Boys 2.8 (1.6- 4.9) Very Critical 3.5 ( 1.7- 7.0) Critical Girls 5.0 (3.1- 7.9) 1.9 ( 0.9- 4.1) Stunting (HAZ<-2) 37.6 (31.5 - 44.0) 36.0 (30.6-41.7) Boys 39.9 (33.1-47.0) Critical 36.3 (29.7-43.6) Critical Girls 35.5 (27.4-44.5) 35.6 (29.1- 42.8) Underweight (WAZ<-2) 34.6 (28.9-40.8) 25.7 (20.5-31.7) Boys 38.2 (31.6-45.4) Very Critical 25.6 (20.9-30.9) Critical Girls 31.3 (24.5-39.1) 25.8 (19.6-33.2) High (>50% and a stable HIS Nutrition Trends(Jan – July 2012) Very Critical N/A - trend Admission trends at TFPs/SFPs Bay Region – Low and fluctuating number Critical N/A (Jan-July 2012) of admissions Child Morbidity & Immunization Morbidity- 32.8 Morbidity- 28.3 Boys-31.9; Girls-33.6 Boys-27.4;Girls-29.1 Disease trends (seasonally adjusted) Diarrhoea – 16.4 Diarrhoea – 16.4 Morbidity refers to the proportion of children reported to Very Critical Very Critical Boys- 13.4:Girls-19.2 Boys- 13.4:Girls-12.0 be ill in the 2 weeks prior to the survey Pneumonia- 8.4 Pneumonia- 8.4 Boys-8.8;Girls- 8.1 Boys-7.2;Girls-7.5 Vitamin A – 17.5 Critical Vitamin A –28.7 Critical Boys- 16.8;Girls- 18.2 Boys-30.5;Girls-27.2 Immunization Status Measles Vacc –19.4 Measles Vacc – 30.8 Boys-18.1;Girls-20.7 Critical Boys-32.6;Girls-29.3 Critical Death Rates Crude deaths, per 10,000 per day (retrospective for 1.40 (0.93-2.10) 0.42 (0.27-0.66) Serious Acceptable 90 days) Under five deaths, per 10,000 per day (retrospective 1.52 (0.91-2.53) 2.70 (1.896-3.89) Serious Alert for 90 days) N=541 N=579 Women Nutrition Status Proportion of acutely malnourished non pregnant/ N=434 N=177 Critical Serious lactating women (MUAC <18.5 cm) 0.0 0.6 (0.0-1.6) Proportion of acutely malnourished pregnant and N=434 N=402 lactating women (MUAC<21.0) 2.3 (0.2-4.3) 6.5 (3.4-9.5 ) Proportion of acutely malnourished pregnant and N=149 N=402 Serious Serious lactating women (MUAC<23.0) 34.3(25.3-43.4) 24.1 (18.2-30.1) Crisis Serious Food security phase Crisis Critical Overall Risk to Deterioration Stable Unstable Overall Situation Analysis Very Critical Critical
In Bay Region, a significantly higher proportion of pregnant and/or lactating women are acutely malnourished (MUAC< 23.0 cm) than non-pregnant and non-lactating women (MUAC<18.5 cm) across all livelihoods and among the Baidoa IDPs settlements. Information on maternal nutrition indicates a worrying nutrition situation among women. Acute malnutrition (MUAC <23.0 cm) rates for pregnant and lactating women among the Bay agro-pastoral, Baidoa IDPs and Bakool pastoral livelihoods are 34.3% (25.3-43.4), 24.1% (18.2-30.1) and 22.0% respectively. These rates are extremely high and are either similar to or significantly above the baseline median rate of 22.0% recorded from the FSNAU surveys conducted between 2007-2010 (see Table 10). The high level of acute malnutrition among the pregnant and/or lactating women is linked to increased nutrient demands during pregnancy needs which are not being met.
Bay /Bakool Pregnant and/or Lactating women Non-pregnant/lactating women Surveyed population Proportion with Proportion with Proportion with MUAC<18.5 No. Assessed No. Assessed MUAC<23cm MUAC <21cm cm Bay 34.3 2.3 434 107 0 agro-pastoral (25.3-43.4) (0.2-4.3 ) 24.1 6.5 Baidoa IDP 402 177 0.6 (0.0-1.6 ) (18.2-30.1 ) (3.4-9.5 ) 22.0 2.4 Bakool pastoral 595 173 0.6 (0.01-1.7) (17.5-26.5) (0.7-4.0 )
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Case study 2: Increased nutritional vulnerability among the families in the besieged Huddur town, Bakool region.
Background Huddur is the urban center for Bakool region in southern Somalia and is located 180 km north west of Regional Analysis Baidoa and 90 km from the Ethiopian border. It has two livelihood zones: the pastoral and agro-pastoral low potential. Huddur district and Bakool region which has recently come under the administrative 33 control of the transitional federal government (TFG) had been run by a militia group since February 2012, that restricted and controlled entry of people not only goods and services. This has affected the supply of both locally produced and imported food items in the town as well as delivery of the essential health and nutrition services. The case study below exemplifies how the households are coping with the situation and the impact of the siege on nutrition and health of the population.
Case study Khazida, a 34 years old lactating mother and stays with her husband and their four children together with the paternal grandmother. The household of this family is located in Huddur town.
Hassan, Khazida’s husband was injured in a mortar shell bomb explosion in Mogadishu Bakara market two years ago, the mortar shell particles damaged the spinal code causing paralysis in his lower limps. Previously, Hassan was an unskilled labourer accessing income through construction work, unfortunately from the impact of his injury he is no longer physically fit to work in the same field. With the incapacitation of the household bread winner, Khazida had no alternative but to become the bread winner of her family which she does through sale of vegetables in Huddur market. A severely malnourished child with MUAC<11.5 cm Unfortunately, the siege of the town has affected her business as she is unable to get vegetable supplies from other areas. This has led to the closure of the business, and also compelled her to switch to severe coping mechanism to meet the basic food needs. Some of the coping strategies she employs include reduction of the meals consumed from three to two and more lately, to only one meal in a day. When the situation persisted she was again forced to send two of her children aged 6 and 7 years to her relative in a pastoral village called Hogir. “This is one of the worst decisions I have ever made but the circumstances forced me as I had no alternative and I could not wait to see my children die.” she said, in tears.
Khazida lives in Huddur where, unfortunately there has not been a functional health facility for over a year, hence, most of her children are not immunized. As fate would have it, in August 2012, prior to this case study, she lost one of her sons to suspected measles.
As may be expected for such a poor family with reduced food and income; high morbidity and poor nutrition situation is prevalent. MUAC assessment of the family members indicates that the youngest child in the family has severe acute malnutrition with a MUAC<11.5 cm. Khazida who is lactating has a MUAC of 21cm indicating high risk of malnutrition. In addition, five weeks prior to the interview, the youngest child was reportedly suffering from suspected respiratory infection but with no health services available, no medical assistance was sought for Abdullahi, other than administering concoction made from traditional herbs.
Conclusion The case study demonstrates how the population in this town is suffering from lack of supply of basic goods and services including food and health services and the extent to which they have exhausted their coping strategies and are in dire need of assistance. This piece therefore, calls for the immediate interventions to ease the human suffering in Huddur town, provision of essential nutrition and health services to rehabilitate the sick and malnourished children and adults as well as continued monitoring of the situation.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 4.4 Middle and Lower Shabelle Regions
Middle and Lower Shabelle Regions Map 9: Shabelle Livelihood Zones
Regional Analysis Middle and Lower Shabelle rural livelihoods comprise of riverine (pure farmers) and agro-pastoralists (Map 9). The 34 riverine population, located within 10 km of the Shabelle river cultivates maize, sesame and a variety of vegetables and fruits, and keep limited livestock holdings as a result of tsetse fly infestation. The agro-pastoral zone extends 20-40 km from the Shabelle River and incorporates both cultivation of crop (maize, cowpeas, sesame and fruit), and livestock rearing. The agricultural potential, as well as the labour and income opportunities in the area makes it a haven for seasonal casual work, and also for vulnerable populations in the event of shocks. The Shabelle regions continue to Nutrition struggle with the negative impacts of civil insecurity. This has affected the population’s well being, through disruption In Lower Shabelle region, the Post Deyr‘11/12 integrated of livelihoods, continued lack of access to humanitarian nutrition analysis indicated a likely Very Critical nutrition interventions, and a high number of IDPs in the region. situation among the riverine and agro-pastoral population. Due to the lack of access in the region for security Historical Overview - Post Deyr ‘11/12 reasons, no surveys were conducted. However, data from health facilities in the areas and information from feeding Food Security programmes indicated a declining number of admissions The food security situation in Shabelle regions (Middle and and numbers of acutely malnourished children reported Lower) showed improvement in the Deyr ‘11/12 season. The in health facilities and feeding centres. Among the agro- total population facing food insecurity in Middle Shabelle pastoral population, the data from health facilities indicated a region significantly decreased by 55% from the Gu’11 high (>30%) and increasing trend, while in the riverine, data season. Lower Shabelle region also showed significant indicated a high (>10%), and a declining trend of the number improvement with only 2% of the population in Crisis. The of acutely malnourished children. Although the nutrition main factor contributing to the significant improvement in the situation remained classified the same Very( Critical) as in food security situation in the two regions was related to the the Gu 2011 season, it was probable the nutrition situation good rainfall performance in the Deyr ‘11/12 season across had improved with the positive food security outcome most livelihoods in the regions, in addition to the off season indicators reported in the region. Figure 15 show the trends harvest in October 2011, this resulted in good cereal and of acute malnutrition 2007-2011 cash crop production and a decrease in local cereal prices. The increased humanitarian assistance during the October Current Situation, Post Gu ‘12 to December 2011 period also mitigated the situation. In addition, the availability and access to pasture and water Food Security resources improved livestock production and sales, milk availability from goats also considerably improved. The The food security and livelihood situations in Middle and urban population in Crisis remained the same, estimated Lower Shabelle regions continued to improve through the at 8,000 people. last Deyr 2011’/12 and Gu 2012 seasons. Figure 15: Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Middle and Lower A significant number of people in Adale and Aden Yabaal Shabelle Regions (2007- 2012) districts of Middle Shabelle remain in Crisis, however the 50.0 number affected has reduced since the Deyr 2011/12. This 40.0 is attributed to the positive impacts of good rainfall that has 30.0 led to above average crop production, improved livestock
20.0 condition and purchasing power. This has resulted in % Malnourished
10.0 improved availability of milk and milk products in Middle Shabelle region. The rest of the population is in Stressed 0.0
1 1 1 1 .07 .07 .08 .08 .09 .09 .07 .07 .08 .08 .09 .09 .07 .08 .08 .09 .09 Phase.
Jul.1 Jul.1
Jul.10 Jul.10 Jul.10
Jul. 1
Nov Nov Nov Nov Nov Nov Nov Nov Nov
May May May May May May May May
Aug. 1
Shabelle Riverine Shabelle Agropastoral Shabelle IDP
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Nutrition Table 11: Summary of Key Nutrition Findings in In the Shabelle regions, there were no nutrition surveys Mogadishu Town - April- July 2012 conducted in the Gu 2012 due to lack of access. The last Mogadishu Town Mogadishu Town surveys to be conducted in the region were done in July 2011. April 2012 July 2012 (N=959 Boys=497 (N=676; Boys=304 Due to the lack of sufficient data, there is no overall nutrition Girls=462) Girls=372) Regional Analysis Indicator Results Outcome Results Outcome situation estimate for the Shabelle regions. However data Child Nutrition from health facilities in the region shows high (>30%) and Status 10.3 Global Acute 10.8 35 stable trends of malnutrition among the Lower Shabelle (7.9-13.4) Malnutrition (8.3-13.9) 12.5 (WHO 2006) Serious 13.5 Serious agro-pastoral population and a high (>10%) and declining (9.3-16.6) Boys (9.9-18.2) 8.0 trend amongst the riverine population (Figure 16). Girls 8.6 (5.1-14.1) (5.6-11.3) Severe Acute Malnutrition 1.7 (0.9-3.1) 1.5 ( 0.7-3.0) The nutrition situation in the coming months is expected Acceptable Acceptable (WHO 2006) 1.8 (0.9-3.6) 3.0 (1.4-6.2) to improve given the positive food security indicators in Boys 1.5 (0.7-3.4) 0.3 (0.0-2.0) Girls Shabelle. However the degree of gains will depend on the Mean WHZ - 0.57±1.13 Alert - 0.44±1.16 Alert population’s exposure to risk factors which include seasonal (WHO, 2006) Oedema 0 Acceptable 0.4 Very Critical Global Acute 14.7 9.3 outbreaks of acute watery diarrhoea (AWD) in October- Serious Alert Malnutrition (NCHS) (11.8-18.0) (6.6-12.8) November, reduced access to humanitarian interventions Severe Acute 2.3 Acceptable 1.2 (0.4-3.1) Acceptable with the recent suspension of key actors and the increasing Malnutrition (NCHS) (1.4-3.6) Global Acute civil insecurity in the region. Persistent chronic factors - Malnutrition by MUAC 6.6 (5.1-8.6) 5.4 (3.8-7.6) (<12.5 cm or oedema) 6.9 (4.7-9.9) Serious 5.8 (3.5-9.4) Alert such as very limited access to specifically feeding and health Boys 6.4 (4.4-9.2) 5.0 (3.2-7.9) programmes, inappropriate child feeding and care practices, Girls poor access to safe water and sanitation facilities and civil Severe Acute 1.2 (0.7-2.3) malnutrition by MUAC insecurity are additional factors likely to negatively affect 1.2 1.2 (0.5-2.6) (<11.5 cm or oedema) (0.4-3.2) Serious 1.3 (0.4-4.2) Serious Boys the nutrition situation. 1.3 1.1 (0.3-3.5)
(0.6-2.8) Girls 25.2 Very 29.1 Figure 16: HIS Malnutrition Trends in Shabelle Morbidity Very Critical (19.7-30.7) Critical (22.6-35.6) Reverine MCHs 2010-2011 Immunization Status: 55.5 56.3 50.0 Measles vaccination (47.4 - 63.5) Very (46.9-65.7) Vitamin A Very Critical 45.0 60.5 Critical 56.9 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) Supplementation 40.0 (53.0-68.0) (48.0-65.8) Low 35.0 Low (>10%) HIS Nutrition Trends (>10%) and Serious and stable Serious 30.0 (January – July 2012) decreasing trend trend 25.0 Reduced Reduced 20.0 Admission trends at numbers of numbers of
Proportion of malnourished children 15.0 TFPs/SFPs admissions Serious admissions Serious (January – July 2012) to feeding to feeding 10.0 programmes programmes 5.0 Death Rates Crude deaths, per 0.0 10,000 per day 1.22 (0.56- 1.23 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Critical Critical (retrospective for 90 2.00) (0.81-1.83) days) Under five deaths, Figure 17: HIS Malnutrition Trends in Shabelle per 10,000 per day 1.06 (0.88- 1.54 Serious Serious Agropastoral MCHs 2010-2011 (retrospective for 90 1.69) (0.82-2.85) days) 50.0 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) Women Nutrition N=570 N= 398 45.0 Proportion of acutely malnourished non 40.0 pregnant/lactating 0.6 (0.0-1.7 Serious 0 Acceptable women (MUAC <18.5 35.0 cm) 30.0 Proportion of acutely malnourished 1.4 25.0 pregnant and 6.4 (3.0-9.8) - - (0.02-2.84) lactating women 20.0 (MUAC<21.0)
Proportion of malnourished children 15.0 Proportion of acutely malnourished 17.3 (12.0 - 7.5 10.0 pregnant and Alert Acceptable 22.7) (4.2-10.9) 5.0 lactating women (MUAC<23.0) 0.0 Food Security - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Food security phase Overall Situation Serious Serious Analysis
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 The nutrition situation of the Middle Shabelle agro-pastoral Banadir Region (Mogadishu) and riverine population is not classified due to lack of sufficient data. Data from the health facilities in the agro- In April 2012, FSNAU and partners conducted nutrition pastoral livelihood areas indicates a high (>20%) and surveys in Banadir region among the IDP and urban decreasing trend of acutely malnourished children (Figure population of Mogadishu town1. The nutrition survey results Regional Analysis 17), while among the riverine population, data indicates indicated a Serious and Critical nutrition situation among low proportions (<10%) and a declining trend of acutely the urban and IDP populations respectively, with a GAM 36 malnourished children. The positive food security indicators rate of 10.3% (7.9-13.4) among the urban population and noted in Lower Shabelle agro-pastoral and riverine areas 16.1% (13.3-19.5) among the IDP population. The 90 days are similar to the those of the riverine population of Middle retrospective crude and under five deaths reported were Shabelle region. The population still remains highly 1.22 (0.56-2.00) and 1.06 (0.88-1.69) while among the IDPs vulnerable to shocks and risk factors namely: reduced was 1.42 (1.05-1.92) and 2.80 (1.87-4.17). access to humanitarian services, reduced rainfall, high morbidity burden- reported AWD and measles outbreaks, In July 2012, FSNAU and partners conducted a repeat poor access to health care services and sanitation, sub- nutrition and food security assessments in Mogadishu optimal child feeding and care practices. Therefore close Town among the urban and the IDP population, as a way of monitoring of the situation is crucial. closely monitoring the nutrition and food security situation in the town.
1 All districts excluding Deynile and Huriwa
Table 12: Summary of Key Nutrition Findings in Mogadishu IDPs - April- July 2012
Mogadishu IDP Mogadishu IDP April 2012 July 2012 (N=929; Boys=456 Girls=473) (N=675; Boys=313 Girls=362) Indicator Results % Outcome Results % Outcome Child Nutrition Status Global Acute Malnutrition 16.1 (13.3-19.5) 9.6 (7.1-13.0) (WHO 2006) 19.1 (15.4-23.4) Critical 11.8 (8.5-16.3) Alert Boys 13.3 (9.7-18.0) 7.7 (4.7-12.4) Girls Severe Acute Malnutrition (WHO 2006) 3.7 (2.3-5.7) 1.8 (1.0-3.2) Boys 5.0 (3.1-8.2) Serious 2.2 (1.0-5.1) Acceptable Girls 2.3 (1.0-5.2) 1.4 (0.6-3.3) Mean WHZ (WHO, 2006) -0.85±1.09 Serious -0.57±1.08 Alert Oedema 0 Acceptable 0.1 Very Critical Global Acute Malnutrition (NCHS) 15.1 (12.2-18.7) Critical 8.8 (6.5-11.9) Alert Severe Acute Malnutrition (NCHS) 2.8 (1.8-4.3) Alert 0.9 (0.4-2.2) Acceptable Global Acute Malnutrition by MUAC (<12.5 cm or 10.6 (7.9-14.0) 8.4 (6.5-10.9) oedema) Boys 8.4 (5.3-12.9) Critical 6.9 (4.4-10.7) Critical Girls 12.7 (9.1-17.5) 9.7 (7.0-13.3) Severe Acute malnutrition by MUAC (<11.5 cm or 1.9 (1.0-3.4) 2.6 (1.5-4.5) oedema) Boys 1.5 (0.7-3.3) Serious 1.6 (0.7-3.6) Critical Girls 2.3 (1.1- 4.4) 3.5 (1.9-6.3) Morbidity 26.3 (18.2-34.5) Very Critical 45.9 (38.2-53.5) Very Critical Immunization Status Measles vaccination 61.3 (53.0-69.5) 67.2 (58.1-76.1) Very Critical Very Critical Vitamin A Supplementation 59.9 (50.4-69.4) 67.9 (58.9-76.8) Low (>10%) and Low (>10%) and stable HIS Nutrition Trends Serious Serious decreasing trend trend Reduced numbers of Reduced numbers of Admission trends at TFPs/SFPs (July- December admissions to feeding Serious admissions to feeding Serious 2011) programmes programmes Death Rates Crude deaths, per 10,000 per day (retrospective for 1.42 (1.05- 1.92) Critical 1.41 (0.99-2.02) Critical 90 days) Under five deaths, per 10,000 per day (retrospective 2.80 (1.87-4.17) Critical 2.81 (1.82-4.33) Critical for 90 days) Women Nutrition N= 523 Proportion of acutely malnourished non pregnant/ 0.6 (0.0-1.9) Serious 0 Acceptable lactating women (MUAC <18.5 cm) Proportion of acutely malnourished pregnant and 3.9 (1.8-6.0) - 5.2 (2.8 -7.7) - lactating women (MUAC<21.0) Proportion of acutely malnourished pregnant and 14.1 (9.4-18.7) Alert 19.1 (12.5 -25.7) Alert lactating women (MUAC<23.0) Food Security Food security phase
Overall Situation Analysis Critical Serious
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 The survey results of the urban population reported GAM respectively. The current integrated analysis indicates a and SAM rates of 10.8% (8.3-13.9) and 1.5% (0.7-3.0) Serious situation among the Mogadishu IDPs, although respectively. The 90 days retrospective crude and under there has been a significant improvement (p=0.002) in acute five death rates remain elevated at 1.23 (0.81-1.85) and malnutrition rates, the mortality rates still remain elevated. 1.54 (0.82-2.85) respectively, indicating a Critical situation Regional Analysis according to UNICEF classification, although a slight The improvement is mainly attributed to the large scale improvement was noted from results in April 2012 (Table multi-sectoral humanitarian interventions such as feeding, 11). HIS data from health facilities in Medina, Waaberi, health, water sanitation and hygiene (WASH) and shelter 37 Hamarweyne and Hamarjajab indicated a low number programmes in the town. The reduced frequency of (>10%) and stable trend of acutely malnourished children disease outbreaks and morbidity also helped to reduce for the previous six months period. The results depict a acute malnutrition rates. The population still remains highly sustained Serious nutrition situation among the Mogadishu vulnerable and heavily reliant on the interventions currently urban population. in place. A disruption in the provision of humanitarian interventions may lead to a sudden deterioration in the A survey conducted among Mogadishu IDPs in December ‘11 nutrition situation of the population. reported GAM rates of 20.5% (16.6-25.2) and SAM rates of 5.6% (3.8-8.1). In April 2012, the nutrition survey conducted Gender: Analysis of findings from the nutrition assessments among the IDP population showed improvements, with GAM conducted in Mogadishu Town generally indicate a higher and SAM rates of 16.1 (13.3-19.5) and 3.7 (2.3-5.7). The 90 proportion of boys than girls as acutely malnourished days retrospective crude and under five deaths reported (WHZ<-2 or oedema). However, these differences were remain unchanged from the April 2012 reported rates of generally not statistically significant (p>0.05). Other child 1.42 (1.05-1.92) and 2.80 (1.87-4.17). A nutrition survey data such as dietary diversity, illness, feeding practices, conducted among the IDP population in July 2012 reported and immunization status, do not show any clear differences a GAM and SAM rate of 9.6% (7.1-13.0) and 1.8% (1.0-3.2) by gender (Table 11 and 12). See tables X-, indicating the respectively. The mortality rates remain elevated, with the 90 gender disaggregated of the assessed children data by sex. days retrospective crude and under five death rates of1.41 (0.99-2.02) and 2.81 (1.82-4.33), indicating a Critical situation Information on maternal nutrition indicates a worrying according to UNICEF classification (Table 12). nutrition situation among women. Acute malnutrition rates for pregnant and lactating women (MUAC <23.0 cm) is The nutrition situation of the Mogadishu IDPs is classified 19.1% (12.5-25.7). Although this rate is high it is still below Serious, although the GAM and SAM rates are Alert, mainly the FSNAU median rate of 22.0% recorded from surveys because of the mortality and MUAC rates that remain between 2007-2010. Continued efforts in humanitarian elevated. However the results indicate an improvement assistance in activities like wet-feeding, supplementary and from survey results of December 2011 and April 2012 therapeutic programmes remain essential. that recorded Very Critical and Critical nutrition phases
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Nutrition Survey Results in Mataban and Beletweyne, Hiran Region Indicate an Extremely Worrying Health Situation
The civil conflict in Hiran region has had a negative impact on the population’s means of livelihood and access to basic services, Special Article thus affecting their overall food security and nutrition well being. Lack of adequate health facilities and limited access to the few operational facilities is a major problem in the region. Humanitarian agencies face a great challenge in establishing and running 38 health facilities in this highly insecure and volatile environment, where aid workers have in the past been directly targeted. From late 2011, many agencies closed their health programmes in the region as instructed by local authorities, leaving a major gap in the provision of health services to the population. As a result, the infrastructure, supplies and staff required for health facilities to function adequately is limited to only a few locations in Hiran region.
In July 2011 at the peak of famine in south Somalia, Trends in reported cholera cases, WHO, April – June 2012 the nutrition situation of Hiran region was classified as Very Critical based on nutrition surveys conducted in all three livelihoods. In the Deyr ‘11/12 season, no nutrition surveys were conducted due to lack of access. The nutrition situation was classified as likely Very Critical based on contextual information and data from health and feeding facilities. The Gu ’12 nutrition surveys conducted in the accessible districts of Mataban and Beletweyne, indicate improvements in GAM rates from >20% in July 2011(Very Critical) ( GAM) to 16% (Critical) (GAM -). The 90 days retrospective crude death rates reported in July 2011 were 1.53, 1.37 and 1.50/ 10,000 per day among the pastoral, riverine and agro- pastoral population respectively. The July 2012 survey findings indicate improvements in crude death rates to 0.80 (0.53-1.22) and 0.99 (0.70-1.41) in Beletweyne and Mataban districts respectively.
Although the overall global acute malnutrition and crude mortality rates and food security indicators show an improving trend, the recent Beletweyne and Mataban survey results indicate no significant change in the under five death mortality rates, elevated morbidity levels and extremely low immunization coverage. In July 2011, the 90 days retrospective under five deaths reported were 3.67, 4.13 and 4.24 among the pastoral, riverine and agro-pastoral population respectively. The July 2012 survey results report a U5DR of 2.23 (1.30-4.11) and 4.50 (3.02-6.64) among the Beletweyne and Mataban district populations respectively. These results are currently the highest in the country. The main reported causes of death were diarrhoea and acute respiratory infections.
Also of concern are the elevated morbidity rates reported in the districts. The proportion of children reported to have fallen ill in the two weeks prior to the survey was 63.8% (55.2-72.5) and 28.2% (20.5-35.9) in Beletweyne and Mataban districts respectively.
Qualitative information collected indicated that not only were operational health facilities limited, but also access to them was extremely difficult especially in Mataban district. According to the figure, a high number of cholera cases have been reported in the region since April 2012 (WHO June 2012), further compromising the health and nutritional well being of the population.
Proportion of Children that have received Measles Vaccination and Vitamin A supplementation District Measles Vaccination Vitamin A Supplementation Recommened Sphere Standards 12.7% 20.4 Beletweyn Above 95% (19.4-31.3) (7.6 -33.1) 11.0% 5.9% Mataban Above 95% (5.2-16.8) (1.2-10.5)
Another indicator supporting evidence of poor health services in the area is the extremely low immunization coverage. In Mataban district the proportion of children immunized against measles and having received vitamin A supplementation is a only 11.0% (5.2-16.8) and 5.9% (1.2-10.5). In Beletweyne district, the proportion of children that have received vitamin A supplementation is slightly higher (20.4%), compared to Mataban district although this rate is still far below the Sphere recommended standards. The measles vaccination status in Beletweyne district was also extremely low 12.7% (19.4-31.3). High morbidity rates and low immunization coverage, combined with limited access to health facilities increases the children’s vulnerability to malnutrition and death, therefore the situation needs to be urgently addressed.
Even though the nutrition situation is likely to improve due to increased milk availability and better food access (production, cereal prices etc), unless appropriate health interventions are made accessible to reduce the high disease burden, the situation may not improve, as these high morbidity levels predispose the children to disease and death.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 4.5 Hiran Region
Pastoral, Agro-pastoral & Riverine Livelihoods Map 10: Hiran Livelihood Zones
Hiran region comprises of three main livelihood groups: Regional Analysis the Pastoral (Southern Inland and Hawd pastoral) covering Mataban and Mahas districts; and the Agro-pastoral and 39 Riverine livelihood systems, both of which cut across Beletweyne, Buloburti and Jalalaqsi districts. (Map 10). Like many other regions in South Central Somalia, Hiran has not escaped the effects of high intensity civil conflict, which has affected people’s means of livelihood. Intermittent localised civil conflict, as well as the targeting of aid workers in the region, has continued to hinder humanitarian access.
Historical Overview - Post Deyr ‘11/12
Food Security
The overall food security situation in Hiran region showed an improvement following an average to good Deyr ‘11/12 Nutrition rainfall performance in most of the livelihood zones. This No surveys were conducted in the region during the Deyr resulted in increased own production (crop and milk), with ‘11/12 season due to inaccessibility as a result of insecurity. the exception of the agro-pastoral livelihood zone where the Therefore to estimate the Post Deyr ‘11/12 nutrition situation ‘below normal’ rainfall led to poor crop production. The total for the region, data from health facilities from July to number of people facing food insecurity was estimated at October was used. Information from health facilities in the 71,000 people in both the rural and urban areas, of which agro-pastoral livelihood zone of Hiran region, indicated a 40,000 were in Emergency and 31,000 were in Crisis. high (>20%) and increasing trend of acutely malnourished The agro-pastoral livelihood was the worst affected with children. Although there was a marked improvement in the 36,000 people in Crisis. The situation also deteriorated in food security situation and control of disease outbreaks, in urban areas, where 28,000 people were identified inC risis. the Deyr season, the nutrition situation remained The food security situation was projected to deteriorate • likely Very Critical among both the agro-pastoralists and within 4-5 months if humanitarian assistance in the region pastoralists due to a high proportion (>20%) of acutely remained limited. The good Deyr ’11/12 season also resulted malnourished children reported in health facilities in in improved water availability and pasture, resulting in an each of these zones. increased number of saleable animals. Cereal availability in • likely Very Critical in the riverine livelihood zone with a high the market increased, consequently the price of staple foods (>15%) number and stable trend of acutely malnourished continued to decline and was expected to drop further as children reporting at health facilities. more cereals arrive from other neighbouring regions. The Figure 18 shows trend of acute malnutrition in Hiran for ToT of labour and goat to cereal also increased, in addition, 2007-2012. the levels of social support (zakat) also improved. Civil insecurity remained a major risk factor likely to affect the Current Situation – Post Gu 2012 food security situation in the region.
Figure 18: Trend in Levels of acute Malnutrition Food Security (WHZ<-2 or oedema, WHO 2006) in Hiran Region, The food security situation of Hiran region has shown a 2007-2012 mixed trend in the Gu ’12 season. Hawd and Southern Inland 50.0 Pastoral livelihood zones of the region were, previously 40.0
30.0 classified in Crisis and Stressed phases respectively.
20.0 Hawd remains in Stressed, and Southern Inland Pastoral
% Malnourished 10.0 improved to Stressed phase. The agro-pastoral livelihood
0.0 1 1 1 is the worst affected and is classified in Crisis phase. In . 1 . 1 .09 .07 .09 .09 .07 .09 .09 .09 .07 .07 Jul. 1 Jun.08 Jun.08 Jul y Jul y Ma r Ma r No v No v No v No v No v Ma y Ma y Ma y addition, the riverine livelihood population, in rural areas are in Stressed phase. The improvement in the pastoral Mataban D July 2012 Beletweyne D July 2012
Hiran Pastoral Hiran Agropastoral Hiran Riverine livelihoods of the region is primarily attributable to average Gu’ 2012 seasonal rainfall performances that resulted in
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 improved water availability pasture and browse conditions. 12.7% (19.4-31.3) and vitamin A supplementation of 20.4(7.6- Subsequently, livestock body condition continued to improve, 33.1) increase the children’s vulnerability to malnutrition and resulting in increased number of saleable animals at high should be addressed urgently. prices. In riverine livelihood zones where rainfall performance was similar to agropastoral zones, the poor wealth group was The Mataban district nutrition survey also conducted in Regional Analysis July 2012 reported similar GAM and SAM rates of 16.7% not able to cover high irrigation costs due to poor economical (13.2-20.8) and 4.2% (2.3-7.3) respectively. The 90 days position and are thus faced with poor crop production. retrospective crude and under five deaths reported are 40 However, they have cereal stocks to last for a few months 0.99 (0.70-1.41) and 4.50 (3.02-6.64) respectively. Of great and they benefit from cash crop production employment. concern are the under five death rates in the district which Levels of social support such as zakat continued to improve are the highest reported rate in the country. The main in pastoral zones due to average seasonal performances causes of death reported were diarrhoea and fever. The while it indicated declined trend in agro-pastoral and riverine area has extremely limited health facilities and services, zones of the region as a result of poor rainfall performances. with the proportion of children immunized against measles and having received vitamin A supplementation a dismal Nutrition 11.0% (5.2-16.8) and 5.9 (1.2-10.5) respectively. The overall morbidity is high with 28.2% of the assessed children falling In the Gu ’12 season, lack of access to conduct livelihood ill in the two weeks prior to the survey. The proportion based nutrition surveys in the region persisted, however of children reported to have suffered from diarrhoea, in July 2012, FSNAU and partners were able to conduct pneumonia and fever is 9.1% (5.3-13.0), 8.8 (4.3-13.2) administrative based nutrition surveys in Beletweyne and and 13.4 (8.2-18.5) respectively. The integrated nutrition Mataban districts of Hiran region which were accessible. situation analysis indicates a Critical nutrition situation, Majority of the sampled clusters in Beletweyne district an improvement from the likely Very Critical, situation were riverine, while in Mataban district the clusters were reported among the pastoral population in the preceding predominantly pastoral. No surveys were undertaken in season, however the elevated under five mortality rates and Buloburti and Jalaqsi districts, therefore no overall nutrition extremely low immunization rates are alarming and should situation is reported for these two districts because of lack be immediately addressed. of adequate sufficient data. The poor nutrition situation in Hiran region is mainly The nutrition survey conducted in Beletweyne district, in attributed to the lack of access to health facilities (high July 2012 reported GAM and SAM rates of 16.6% (11.7-22.9) morbidity rates, low immunization coverage and high under and 3.3% (1.7-6.3) respectively. Data from health facilities in five mortality rates), in addition to the impacts of persistent Riverine show high (>20%) and increasing trend of acutely food insecurity (especially among the agro-pastoral malnourished children (Figure 22). The 90 days retrospective population) and civil insecurity in the region. Although the crude and under five deaths reported are 0.80 (0.53-1.22) projected outlook of the nutrition situation is likely to improve and 2.32 (1.30-4.11), with the under five death rate remaining due to the anticipated increase in milk availability/production elevated. The current integrated nutrition situation analysis and the current positive food security indicators in the region, indicates a Critical nutrition situation, an improvement from unless appropriate health interventions are accessible in likely Very Critical in the deyr ‘11/12 with the under five the region to control the high morbidity levels reported, the mortality rates remaining of concern. The overall morbidity situation may not improve (Table 13). was very high with 63.8% of the assessed children falling ill in the two weeks prior to the survey, with 40% (27.9-52.1) The information on maternal nutrition indicates a suffering from diarrhoea. High morbidity levels predisposes worrying nutrition situation among the pregnant and the children to acute malnutrition. The high morbidity rates lactating women in Beletweyne and Mataban districts. coupled with the extremely low immunization status - Measles Acute malnutrition rates for pregnant and lactating women in Beletweyne and Mataban district (MUAC Figure 19: HIS Malnutrition trends in Hiran Riverine <23.0 cm) is 22.7 (15.4-43.29) and 37.8 (28.7-46.9)
50.0 MCHs 2011-2012 respectively. The rate is high in Mataban district and
45.0 above the FSNAU median rate of 22.0% recorded from 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) 40.0 surveys between 2007-2010.
35.0 Table 13: Proportion of the malnourished women in Banadir and
30.0 Hiran Regions Surveyed Non-pregnant/ 25.0 Pregnant and/or Lactating women population lactating women 20.0 Proportion Proportion Proportion 15.0 No. with No. with with MUAC Proportion of malnourished children Assessed MUAC Assessed MUAC 10.0 <23cm <21cm <18.5 cm 5.0 Mogadishu 7.5 (4.2- 1.4 398 123 0 0.0 Urban 10.9) (0.02-2.84) Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Mogadishu 19.1 423 5.2 (2.8 -7.7) 135 0 IDPs (12.5-25.7) Beletweyne 22.7 0.63 475 5.1 (1.6-8.5) 219 District (15.4-29.9) (0.0-2.2) Mataban 37.8 16.5 0.7 426 196 District (28.7-46.9) (8.5-24.5) (0.0-2.4)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 14:Summary of Key Nutrition Findings in Hiran region - July 2012
Beletweyne District Mataban District July 2012 July 2012 (N=628; Boys=305 Girls=323) (N=480; Boys=247 Girls=233)
Indicator Results % Outcome Results % Outcome Regional Analysis
Child Nutrition Status
Global Acute Malnutrition (WHO 2006) 16.6 (11.7-22.9) 16.7 (13.2-20.8) 41 Boys 15.4 (10.7-21.7) Critical 21.1 (15.7-27.7) Critical Girls 17.6 (11.8-25.5) 12.0 (8.7-16.4)
Severe Acute Malnutrition (WHO 2006) 3.3 (1.7-6.3) 4.2 (2.3-7.3) Boys 3.0 (1.3-6.6) Serious 5.7 (3.2-9.8) Acceptable Girls 3.7 (1.9-7.0) 2.6 (1.0-6.3)
Mean WHZ (WHO, 2006) -0.86 ± 1.14 Serious -0.91 ± 1.12 Serious
Oedema 0 Acceptable 0.4 Very Critical
Global Acute Malnutrition (NCHS) 16.5 (11.9-22.5) Critical 15.7 (12.3-19.7) Critical
Severe Acute Malnutrition (NCHS) 1.7 (0.8-3.6) Acceptable 2.2 (1.2-4.1) Acceptable
Global Acute Malnutrition by MUAC 20.1 (12.4-30.9) 19.3 (14.7-24.9) (<12.5 cm or oedema) Boys 18.4 (10.9-29.4) Very Critical 18.6 (14.3-23.9) Very Critical Girls 21.7 (13.0-34.0) 20.1 (14.1-27.8)
Severe Acute malnutrition by MUAC 6.4 (3.4-11.5) 2.6 (1.6-4.2) (<11.5 cm or oedema) Boys 5.5 (3.1-9.5) Extreme 1.9 (0.7-5.0) Critical Girls 7.2 (3.6-13.8) 1.3 (1.8-6.1)
Morbidity 63.8 (55.2-72.5) Very Critical 28.2 (20.5-35.9) Very Critical
Diarrhoea 40.0 (27.9-52.1) Very Critical 9.1 (5.3-13.0) Serious
Pneumonia 9.0 (4.6-13.5) Serious 8.8 (4.3-13.2) Serious
Fever 26.6 (21.9-31.3) Very Critical 13.4 (8.2-18.5) Serious
Immunization Status Measles vaccination 19.4 (7.6 -31.3) 11.0 (5.2-16.8) Very Critical Very Critical Vitamin A Supplementation 20.4 (7.6-33.1) 5.9 (1.2-10.5)
Infant and Young Child Feeding N = N = 89
Proportion Still Breastfeeding 66.2 (55.5-77.0) 57.5 (39.8-75.2) Boys 65.8 (51.8-79.6) Critical 64.1 (42.7-85.2) Critical Girls 50.0 (54.1-79.3) 57.7 (29.7-85.7)
Proportion meeting recommended feeding 79.2 (71.0 - 87.5) 61.6 (45.3-78.0) Critical Critical Boys 79.7 (69.5-89.9) 76.9 (60.9-92.9) Girls 78.7 (66.9-90.4) 50.0 (29.1-70.9)
Death Rates (retrospective for 90 days)
Crude deaths, per 10,000 per day 0.80 (0.53-1.22) Serious 0.99 (0.70-1.41) Serious
Under five deaths, per 10,000 per day 2.32 (1.30-4.11) Critical 4.50 (3.02-6.64) Very Critical
Women Nutrition N= 475 N = 426
Proportion of acutely malnourished non pregnant/lactating women (MUAC <18.5 0.63 (0.0-2.2) Serious 0.7 (0.0-2.4) Serious cm)
Proportion of acutely malnourished pregnant and lactating women 5.1 (1.6 -8.5) - 16.5 (8.5-24.5) - (MUAC<21.0)
Proportion of acutely malnourished pregnant and lactating women 22.7 (15.43-29.9) Serious 37.8 (28.7- 46.9) Very Critical (MUAC<23.0)
Food security phase Stressed Serious Stressed Serious
Overall Situation Analysis Critical Critical
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 4.6 Central Somalia: Galgadud and Mudug in the Hawd was however, projected to improve to Serious regions based on the favourable food security outlook. An AWD/ cholera outbreak which was the main aggravating factor in the nutrition situation was under control by WHO and Central Somalia comprises of two regions, Galgadud partners. The populations of the Addun pastoral livelihood
Regional Analysis and South Mudug. There are four main livelihood zones, showed improvement from Critical in Gu ‘11 to Serious namely the purely pastoral Addun and Hawd; the fishing in Deyr ‘11/12. The improvement in Addun was linked and pastoral Coastal Deeh and the agro-pastoral Cowpea to improved access to milk, and dietary diversity, social 42 Belt. The Hawd and Addun pastoral livelihoods extend support, and humanitarian programmes (health services, across Galgadud, Mudug and southern Nugal regions, supplementary feeding, and WASH) in the region. From while the Coastal Deeh extends from the coast of Shabelle the outlook, Addun livelihood was projected to remain in through Galgadud up to Allula district in Bari region, cutting a Serious phase based on seasonal trends (Fig. 19). No across the South, Central and Northeast zones (Map 13). assessment was conducted in the cowpea agro-pastoral This section will discuss the nutrition situation of the Hawd and Coastal Deeh pastoral livelihoods of Central Somalia. and Addun pastoral livelihood zones together with the other Therefore there was no data to indicate that the nutrition livelihood zones in the Central zone. situation changed from the respective Critical and Very Critical levels reported among the cowpea agro-pastoral Historical Overview - Post Deyr ‘11/12 and Coastal Deeh pastoral livelihoods in Gu ‘11. The Dhusamareb IDPs were in a sustained Very Critical nutrition Food Security: phase since post Gu ‘11. The FSNAU Post Deyr ’11/12 analysis classified the Addun pastoral population of Central regions of Somalia in Crisis, Figure 21: HIS Malnutrition Trends in Hawd LHz of indicating a sustained situation since Gu ’11. The Hawd Central areas(2010-2012) Source: MoH; SRCS pastoral livelihood had however showed improvement 70.0 from the Crisis in Gu ’11 to Stressed phase. The situation 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) also improved in the Cowpea agro-pastoral livelihood from 60.0 an Emergency in Gu ’11 to Crisis phase due to the good 50.0
Deyr’ 11/12 rainfall performance that led to improved local 40.0 cowpea and sorghum production. The Coastal Deeh of central regions however, remained in persistent Emergency 30.0 due to the significant loss of livestock in the past, caused 20.0
CProportion (%) acutely malnourished urrent Situation- Post Gu ’11/12 by successive poor rainfall in previous seasons, in addition Food10.0 Security to widespread civil insecurity, limited humanitarian access The0.0 FSNAU Post Gu ’11/12 analysis classifies the Addun and trade disruptions. The regions in Central and South Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec pastoral population of Central regions of Somalia as Somalia continued to experience continuous civil unrest Stressed, indicating an improvement from the previous and the effects of droughts that led to internally displaced Crisis phase in the Post Deyr ‘11/12 analysis. The Hawd persons and pastoral destitution. Humanitarian access pastoral livelihood has sustained in Stressed phase since remained limited, aggravating the fragile food security and Deyr ’11/12. The situation has been sustained at the Crisis nutrition situation in the region further in Haradhere, Eldhere, phase in the Cowpea agro-pastoral livelihood. The Gu and Elbur districts. ’12 rains though below normal, has contributed to some Figure 20: Trends in Levels of acute malnutrition (WHZ<- improvements in livestock performance, reduced cereal 2 or oedema, WHO 2006) Central Regions, 2007-2012 Data Source: COSV/MSF-S prices and positive goat/cereal ToT, since the Deyr ‘11/12 was good in the cowpea belt. The Coastal Deeh of central 35 regions however, remains in persistent Emergency due to 30
25 the significant loss of livestock in the past, caused by the
20 previous successive poor rainfall seasons, in addition to
15 wide spread civil insecurity, limited humanitarian access
Acutely Malnourished 10 % Figure 22: HIS Malnutrition Trends in Addun L/Z of 5 Central areas (2011-2012)
0 No v Ma y No v Ma y No v Ma y No v Jul. 1 Dec. 1 Jun.12 No v Ma y No v Ma y No v Ma y No v Jul. 1 Dec. 1 Jun.12 Ma y Ma y Dec.09 Dec.10 Jun.12 Ma y Jun.12 Jul. 1 Dec. 1 Jun.12 Jul.10 70.0 .07 .08 .09 .10 .07 .08 .09 .10 .08 .09 .10 .08 .09 .10 .07 .09 .09 1 1 1 1 1 1 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) 60.0 Hawd Pastoral Addun Pastoral Coastal Deeh Cowpea Dusamareb
50.0
40.0
Nutrition: 30.0
The Post Deyr ‘11/12 integrated nutrition analysis depicted 20.0
a mixed picture of worsening, sustained or improved Proportion (%) acutely malnourished 10.0 nutrition situation in the livelihood zones of Central Somalia 0.0 compared to the Gu’11 season. The nutrition situation Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec deteriorated from Serious to Critical among the Hawd pastoral livelihood population. The Critical nutrition situation Data Source: COSV/MSF-S
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 and trade disruptions. Humanitarian access remains limited, Figure 23: HIS Malnutrition Trends in Cowpebelt L/Z aggravating the fragile food security and nutrition situation in (2011-2012) the region further in Haradhere, Eldhere, and Elbur districts. 50.0 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) 45.0 Nutrition 40.0 Regional Analysis The current Post Gu ‘12 integrated nutrition analysis depicts 35.0 30.0 a mixed picture of either sustained or improved nutrition 25.0 situation in the Central livelihood zones compared to the 20.0 43 Post Deyr ’11/12. The nutrition situation improved from 15.0 Proportion (%) acutely malnourished 10.0
Critical to Serious among the Hawd pastoral livelihood 5.0 population. The improvement in nutrition situation in the 0.0 Jan Feb Mar Apr May Jun Jul Hawd is attributed to favourable food security indicators including increased access to milk and improved dietary the Addun and an improvement from Critical to Serious diversity. Besides, there was no disease outbreak in the situation in Hawd pastoral livelihood. The Hawd pastoral area unlike in Deyr ‘11/12 when AWD/cholera outbreak was livelihood assessment reported a GAM rate of 11.2% (8.9- the main aggravating factor in the nutrition situation. The 14.0) and a SAM rate of 1.8% (0.9 – 3.4). No oedema was populations of the Addun pastoral livelihood have shown reported in the assessment. Boys (11.4%) and (10.9%) a sustained Serious nutrition situation since Deyr ’11/12. girls were equally affected (Pr<0.75). The results show an The stable nutrition situation in Addun is linked to improved improvement compared to the December ‘11 findings where access to milk, and dietary diversity, social support, and GAM and SAM rates of 18.6% (14.5-23.4) and 5.5% (4.0 -7.4) humanitarian programmes (health services, supplementary were reported respectively, including five (0.9%) oedema feeding, and WASH) in the region. Assessments conducted cases. The retrospective crude (CDR) and under-five in the cowpea agro-pastoral and Coastal Deeh pastoral death (U5DR) rates of 0.38 (0.19-0.76) and 0.50 (0.18-1.36) livelihoods of Central Somalia show a likely Critical nutrition respectively indicate Acceptable levels according to UNICEF situation from the respective Critical and Very Critical classification and indicates no change from the respective situation reported in the Gu ‘11. No assessment were rates (CDR and U5DR) of 0.49 (0.28-0.84) and 0.86 (0.30- carried out in the Deyr ’11/12 nutrition analysis in these two 2.41) in Deyr ‘11/12. There were no outbreaks of any disease livelihoods. The Dhusamareb IDPs are in a sustained Very reported. The screening data from health facilities in the Critical nutrition phase since post Gu ’11. Hawd pastoral livelihood zone (Figure 21) show high (>30%) and stable trend of acutely malnourished children . Gender: In the Hawd and Addun nutrition assessments conducted in the Galgadud and Mudug regions of Somalia, In the June ‘12 Addun assessment, the GAM rate was a higher proportion of boys than girls were acutely 14.5% (11.1-18.9) and the SAM rate was 2.4% (1.3 – 4.3) malnourished, however, there was no statistically significant with two (0.3%) oedema cases reported, indicating a difference (Pr<0.75). Other forms of malnutrition followed sustained Serious nutrition situation and no change from the the same pattern, except Dusamareb IDPs where boys respective GAM and SAM rates of 12.1% (9.0-16.0) and 2.8% (26.5%) were significantly (p<0.05) more stunted than (1.6-5.0) recorded in December ‘11. There are no significant girls (8.7%) among the Dusamaerb IDPs. Other child data differences in the level of acute malnutrition by gender, such as dietary diversity, illness, feeding practices, and even though a higher proportion of assessed boys (16.2%) immunization status, did not show any clear differences by compared to girls (12.7%) are acutely malnourished (WHZ<- gender. Analysis of household data by gender of household 2/oedema). The retrospective CDR and U5DR rates are 0.48 head did not find any significant difference nor clear trend (0.25-0.92) and 0.58 (0.19–1.76) both indicating Acceptable in the proportion with access to sanitation facilities, access levels according to UNICEF classification, and similar to the to safe drinking water nor consumption of a diversified diet. retrospective CDR and U5DR rates of 0.32 (0.16-0.66) and The gender disaggregated data by sex of the assessed 0.87 (0.31-2.42) reported in the December ’11 assessment. children and sex of the household head per livelihood is summarized in Table 14. Figure 24: HIS Malnutrition Trends in Central Coastal Hawd and Addun pastoral livelihoods of Central and Deeh L/Z (2011-2012) Northeast regions 50.0 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) 45.0
The detailed results of assessments in all the livelihoods 40.0 transcending the Central and NE regions including the Hawd 35.0 and Addun are discussed in the sections that follow. The 30.0 25.0 results of the key findings are summarized in Table 12 below. 20.0
The integrated analysis of data from nutrition assessments 15.0 conducted in June 2012 among the populations of Hawd Proportion (%) acutely malnourished 10.0 and Addun Livelihood zones of Northeast (Nugal) and 5.0 0.0 Central (Mudug and Galgadud), and the health and feeding Jan Feb Mar Apr May Jun Jul facilities’ information shows a sustained Serious phase in
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 15: Summary of Key Nutrition Findings in Hawd, Addun and Dhusamareb IDPs Central regions Hawd Addun Dusamareb IDPs (N=816: 432 boys; 384 girls) (N=701: (374 boys; 327 girls) (N=202: 109 boys; 93 girls) Indicator Results (%) Outcome Results (%) Outcome Results (%) Outcome Child Nutrition Status Global Acute Malnutrition (WHO 2006) 11.2 (8.9-14.0) 14.5 (11.1-18.9) 22.0 (16.1-29.3) Boys 11.4 (8.7-14.9) Serious 16.2 (11.7-22.0) Serious 24.8 (17.1-34.4) Very Critical Regional Analysis Girls 10.9 (7.9-14.9) 12.7 (9.1-17.5) 18.7 (11.2-29.6) Severe Acute Malnutrition (WHO 2006) 1.8 (0.9 – 3.4) 2.4 (1.3 – 4.3) 5.0 (2.5-9.8) Boys 1.9 (0.8-4.3) Acceptable 2.6 (1.1- 6.0) Acceptable 6.4 (3.2-12.5) Critical 44 Girls 1.6 (0.7-3.5) 2.2 (1.0-4.7) 3.3 (1.1-9.8) Mean WHZ (WHO, 2006) -0.71±1.06 Serious - 0.79±1.13 Serious -1.04±1.18 Critical
Global Acute Malnutrition (NCHS) 12.0 (9.6-15.1) Serious 14.8 (11.1-19.4) Serious 22.3 (16.2-29.8) Very Critical
Severe Acute Malnutrition (NCHS) 1.5 (0.8 – 2.8) Acceptable 1.7 (0.7 -4.4) Acceptable 3.0 (1.4-6.4) Alert Proportion with MUAC (<12.5 cm or oedema) 5.4 (3.3-8.6) 8.4 (5.8 – 12.1) 8.9 (5.1 – 15.1) Boys 5.3 (3.2-8.8) Alert 7.8 (5.1-11.5) Critical 8.3 (4.1-15.9) Critical Girls 5.5 (2.9-10.0) 9.2 (6.0-13.9) 9.7 (5.0-18.0) Proportion with MUAC (<11.5 cm or oedema) 0.4 (0.1– 1.1) Alert 1.7 (0.9-3.4) Serious 2.0 (0.6-6.5) Serious Stunting (HAZ<-2) 11.1 (7.5-16.3) 14.1 (10.1–19.4) 18.0 (12.5-25.2) Boys 12.6 (8.5-18.3) Serious 17.9 (13.0 -24.3) Serious 26.5 (17.2-38.4) Critical Girls 9.5 (5.9-14.9) 9.7 (6.1-15.0) 8.7 (4.7-15.5) Underweight (WAZ<-2) 10.7 (7.8–14.5) 12.9 (9.7-17.1) 23.1 (16.2-31.9) Boys 12.9 (9.2-17.9) Alert 14.7 (9.9-21.3) Alert 29.0 (21.0-38.5) Serious Girls 8.2 (5.3-12.5) 10.9 (7.6 -15.2) 16.3 (8.9-27.9) High (>30%) High (>30%) HIS Nutrition Trends(Jan – Jun 2012) proportion and Very Critical proportion and Very Critical N/A N/A stable trends stable trends Proportion of acutely malnourished registered in SFs 6.1 3.7 0.0 Boys 7.0 Very Critical 3.0 Very Critical 0.0 Very Critical Girls 4.8 4.8 0.0 Child Morbidity & Immunization Outbreak–None Outbreak–None Outbreak -None Morbidity– 30.6 Morbidity–36.8 Morbidity– 34.2 Boys– 30.1 Boys – 37.2 Boys – 29.4 Disease trends (seasonally adjusted) Girls -31.3 Girls -36.4 Girls -39.8 Morbidity refers to the proportion of children reported to be Critical Critical Serious ill in the 2 weeks prior to the survey Diarrhea :10.2 Diarrhoea - 11.7 Diarrhoea - 16.8 Pneumonia: 8.1 Pneumonia - 7.3 Pneumonia – 16.8 Fever: 21.0 Fever - 27.5 Fever - 17.8 Vitamin A–70.2 Vitamin A –64.9 Vitamin A–72.8 Boys – 69.2 Boys – 63.1 Boys – 77.1 Girls – 71.4 Girls - 67.0 Girls – 67.7 Immunization Status Serious Critical Serious Measles – 71.4 Measles – 60.8 Measles – 88.1 Boys – 70.1 Boys – 60.2 Boys – 92.7 Girls – 72.9 Girls -61.5 Girls – 82.8 Infant and Young child feeding N= 297 N=229 N=62 Proportion still breastfeeding 34.7 36.7 40.3 Boys - 35.0 Critical 37.3 Critical 44.8 Serious Girls - 34.3 36.1 36.4 Proportion meeting recommended feeding frequencies 41.4 17.5 27.4 Boys - 45.0 Serious 17.3 Very Critical 31.0 Very Critical Girls - 37.2 17.6 24.2 Proportion who reported to have consumed <4 food groups 97.6 96.1 95.2 Boys 97.5 Very Critical 96.4 Very Critical 100.0 Very Critical Girls 97.8 95.8 9.1 Death Rates Crude deaths per 10,000 per day (retrospective for 90 days) 0.38 (0.19-0.76) Acceptable 0.48 (0.25-0.92) Acceptable N/A N/A Under five deaths per 10,000 per day (retrospective for 90 0.50 (0.18-1.36) Acceptable 0.58 (0.19–1.76) Acceptable N/A N/A days) Women Nutrition & Immunization Status N=416 N=375 N=99 Proportion of acutely malnourished non pregnant/lactating 0.8 (0.0-2.0) Serious 0.0 Acceptable 0.0 Acceptable women (MUAC≤18.5 cm) Proportion of acutely malnourished non pregnant/lactating 5.8 (2.5-9.1) 5.6 (0.0-6.2) 3.5 (0.7-6.3) Acceptable Alert Alert women (MUAC≤21.0cm)
Proportion of acutely malnourished pregnant/lactating 33.3 (19.1- 47.6) 13.5 (9.6-17.3) Acceptable 18.6 (10.5-26.7) Alert Critical women (MUAC<23.0). Proportion of Women who received Tetanus Immunization No dose 24.2 31.7 19.2 One dose 13.7 Alert 32.0 Serious 23.2 Alert Two doses 21.3 16.8 35.4 Three doses 40.8 19.5 22.2 Public Health Indicators N=477 N=449 N=118 Household with access to sanitation facilities 76.5 39.4 61.9 Male headed 77.9 Alert 39.3 Very Critical 59.0 Serious Female headed 70.2 40.4 68.6 Household with access to safe water 44.4 16.9 78.0 Male headed 43.8 Serious 17.3 Very Critical 73.5 Alert Female headed 47.6 14.0 88.6 Food Security N=477 N=449 N=118 Proportion who reported to have consumed <4 food groups 1.9 9.6 11.9 Male headed 1.5 Acceptable 8.9 Alert 12.0 Serious Female headed 3.6 14.0 11.4 Household’s Main Food Source Own production 0.6 6.5 5.1 Purchase: 94.1 Very Critical 63.0 Very Critical 33.3 Very Critical Food aid 4.4 25.6 48.7 Borrowing 0.6 - - Food security phase Stressed Serious Stressed Serious Emergency Critical
Overall Situation Analysis Serious Serious Very Critical
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Data from health facilities in the Addun pastoral livelihood Central Agro-pastoral (Cow pea belt) and Coastal Deeh zone reported a high proportion (>30%) and stable trend of pastoral livelihoods of Central Somalia acutely malnourished children (Figure 24). The integrated analysis of data from nutrition assessments conducted in June 2012 among the populations of Cow Limited humanitarian interventions in the form of targeted pea belt and Coastal Deeh of Central (South Mudug and interventions are ongoing in parts of the Hawd and Addun Galgadud) regions, and the health facilities’ information Regional Analysis livelihood areas and may have assisted to mitigate the poor shows a Critical phase in both livelihoods. These nutrition situation in Central regions. The support needs to assessments did not meet certain data quality criteria 45 be continued and expanded to cover more rural villages of (recording high standard deviations and plausibility scores) Hawd, Addun and Coastal Deeh livelihood. for SMART surveys and therefore only point estimates calculated from standard deviation of 1 are provided. Dhusamareb IDPs The Cow pea (central agro-pastoral) livelihood assessment In May ‘12, FSNAU conducted a small sample cluster reported a GAM rate of 16% and a mean weight-for-height survey among IDPs in Dhusamareb, including those in Z score of -1.01 (±1.60). The HIS data from health facilities Guriel area who have been displaced from South Somalia in the cowpea belt livelihood zone remains high (>20%) or are pastoral destitute from the Central pastoral livelihood and show a stable trend (Figure 23). There was no survey zones. The GAM and SAM rates of 22.0% (16.1-29.3) and conducted on these populations in Deyr ‘11/12 and thus 5.0% (2.5-9.8) were reported respectively, indicating a Very no data to compare seasonal change. Integrated nutrition Critical nutrition situation. Although the overall nutrition analysis from health facility data and rapid assessment situation remains in the same phase (Very Critical), these conducted a year earlier in July 2011, had reported acute findings are indicating an improvement from the Post Deyr malnutrition (MUAC<12.5/oedema) and severe acute ’11/12 results when the GAM and SAM rates were 32.3% malnutrition (MUAC<11.5/oedema) rates of 12.5% and 4.9% (23.5-42.4) and 3.2% (1.0-6.2) respectively, likely due to respectively, classified the nutrition situation as likelyCritical . limited humanitarian interventions and social support, and improving food security situation in the host and surrounding The Coastal Deeh pastoral livelihood assessment reported communities. This population group and many others a GAM rate of 16.2% and a mean weight-for-height Z score cropping up in many other towns in the Central regions, of -1.04 (±1.49). The HIS data from health facilities in the however remain vulnerable to malnutrition, food insecurity Coastal Deeh of central areas remains high (>20%) and and other health challenges, and require continued show a stable trend (Figure 24). interventions. There were no outbreaks of any disease reported. Even The key nutrition evidence indicators of the analysis on the though not directly comparable, rapid assessment nutrition phase classification are provided in Table15. conducted a year earlier in July 2011, had reported acute malnutrition (MUAC<12.5/oedema) and severe acute malnutrition (MUAC<11.5/oedema) rates of 16.9% and 5.4% respectively, and Post Gu ’11 integrated analysis classified the nutrition situation as likely Very Critical. The key nutrition evidence indicators of the analysis on the nutrition phase classification for cow pea belt and CoastalDeeh are provided in Table16.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 16: Summary of Key Nutrition Findings in Cowpea Belt Agro-pastoral and Coastal Deeh Pastoral of Central regions - July 2012 Cowpea Belt Coastal Deeh (N=1174: 592 boys; 582 girls) (N=491: (244 boys; 247 girls)
Indicator Results (%) Outcome Results (%) Outcome Regional Analysis Child Nutrition Status
Global Acute Malnutrition (WHO 2006) 16.9 16.0 Critical Critical 46 [Calculated from SD of 1]
Severe Acute Malnutrition (WHO 2006) - - - -
Mean WHZ (WHO, 2006) -1.01 ±1.60 Critical -1.04 ±1.49 Critical
Stunting (HAZ<-2) 17.3 Critical 19.5 Critical [Calculated from SD of 1]
Underweight (WAZ<-2) 18.2 Alert 23.2 Serious [Calculated from SD of 1]
High (>20%) High (>20%) proportion HIS Nutrition Trends(Jan – Jun 2012) Very Critical proportion and stable Very Critical and stable trends trends
Child Morbidity & Immunization
Outbreak–None Outbreak–None Morbidity– 37.1 Morbidity–49.7 Disease trends (seasonally adjusted) Morbidity refers to the proportion of children reported to be ill in Critical Critical Diarrhoea :21.5 Diarrhoea - 31.2 the 2 weeks prior to the survey Pneumonia: 14.6 Pneumonia - 17.7 Fever: 17.2 Fever - 22.8
Vitamin A–2.3 Vitamin A –0.4 Immunization Status Very Critical Very Critical Measles – 3.3 Measles – 0.2
Death Rates
Crude deaths per 10,000 per day (retrospective for 90 days) 0.76 (0.48-1.22) Alert 0.56 (0.27-1.14) Alert
Under five deaths per 10,000 per day (retrospective for 90 days) 1.46 (0.86-2.48) Alert 1.34 (0.73–2.44) Alert
Food Security N=702 N=297
Food security phase Crisis Serious Emergency Critical
Overall Situation Analysis Likely Critical Likely Critical
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Food safety and malnutrition in Somalia
Food safety is not only an aspect of food security (access to sufficient amounts of safe and nutritious food), but also affects nutrition status by impacting on consumption and utilization of food in the body. Tens of thousands of people fall ill every year Regional Analysis and many die due to consumption of unsafe food including water and basic drinks1. Given the absence of a stable government, that can legislate and reinforce food safety standards and regulations, food safety is one of the major public health problems in Somalia. According to WHO’s Somalia Emergency Health Update bulletins, serious food born diseases, mainly acute watery 47 diarrhea (AWD), Salmonellosis, Hepatitis A and recurrent cholera epidemics are often observed in all regions of Somalia on a monthly, or seasonal basis.
According to the Meta analysis draft report (FSNAU, 2009)2, Somalia bears a heavy burden of reported child illness with 44.8% of the 105,314 children assessed between 2001-2008 having been reported ill in the two weeks prior to the (one month for suspected measles) individual surveys. A regression model (from the meta- analysis report) for the causes of malnutrition in Somalia reported a basal GAM prevalence of 9.6% and identified morbidity and dietary diversity as significant predictive factors, explaining 25.2% of the GAM prevalence, the remaining three quarters of the wasting prevalence thus explained by other causal factors including child feeding, food safety & hygiene, sanitation and food security factors as well as other diseases not covered in the surveys.
Food borne diseases, due to consumption of unsafe foods and drinks, whether infectious or toxic, are possibly major contributors to high malnutrition levels and related adverse effects including disability3 and organ dysfunctions in Somalia. While all population groups are susceptible to food-borne disease, there are groups more susceptible due to their low-levels of immunity, early stages of development or greater exposure, the most vulnerable groups being pregnant women and infants, developing foetus as well as young children4.
Due to poor storage and food handling practices, lack of a food safety policy and strategy, and monitoring system to evaluate the food safety and Contaminated odka (Fried meat) hygiene, there is unreliable data to measure the magnitude and severity of the problem. There is no active inspection for both imported and exported foods, nor a drug safety system. There is therefore some doubt whether all imported foods consumed in Somalia meet the internationally required standards and food safety criteria5. However, it is generally expected that most food storage systems at the household and commercial level are inappropriate and may contribute to both communicable and non communicable diseases country wide. For instance, there is great concern in sorghum and maize producing regions, because if this cereal is stored before it is fully dried it may facilitate aflatoxin contamination which leads to serious liver damage. Bay region is especially known for persistent elevated malnutrition levels even during bumper harvests, usually a time of sufficient food access6. The high malnutrition rates are attributed to a poor quality staple sorghum-based diet, and consumption of possibly contaminated sorghum stored underground. Further investigations are needed to determine the state of health of the population in regards to liver disease and oedematized wasting (very common in Juba regions) and the relationship with consumption of aflatoxin-contaminated cereals.
In Somalia it is also very common for food, diesel, kerosene, insect killers, fatal poisons, human or vet drugs to be all poorly stored together in one small living room, exposing people to mycotoxin, heavy metal and bacterial contamination. In addition, consumption of under-cooked meat and un-boiled milk contributes to the major zoonotic diseases such as brucellosis and bovine. Food spoilage is not restricted to cereal foods and affects animal source foods as well. The photo above illustrates a delicious Somali high-energy, high-protein ready-to-eat meat product that is common among Somali pastoralists called Muqmad or odkc that has been contaminated due to poor handling. The meat is preserved with ghee and sometimes, especially in urban areas, dates and sugar. The meat can be stored for a long time, but when it is not handled properly, and contaminated by dirty hands or spoons, the meat is easily spoiled.
To address this problem, the community (women, commercial groups, youth groups, and local governments) need to be educated on proper food storage and handling practices. Awareness on food safety standards in the community can be done through the local media and periodic workshops. In areas with more stable authorities, there is need to develop, implement, monitor and evaluate policies, strategies and programs that meet high levels of food safety for optimal nutrition.
1 Leon, W., & DeWaal, C.S. (2002). Is our food safe?: a consumer’s guide to protecting your health and the environment. Three Rivers Pr 2 FSANU (October 2009). Malnutrition Trends (2001-2008) in Somalia – A meta analysis study report. 3 WHO global strategy for food safety: safer food for better health 4 WHO/FAO, International Food safety Authority Network,2008. 5 FAO/WHO-The Codex Alimentarius. 6 FSNAU (August 2009). Nutrition Analysis Post Gu 2009. Technical Series Report .
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 4.7 Northeast Regions Map 11: Northeast Livelihood Zones
The Northeast regions are predominately pastoral with seven livelihood zones namely: the Hawd, Addun, Coastal Deeh, East Golis, Karkaar/Dharoor Valley, Nugal Valley Regional Analysis and Sool Plateau. The Hawd and Addun cut across the Northeast and Central regions and the East Golis, Sool 48 and Nugal Valley livelihoods cut across the NE and NW regions. (Map 11).
Historical Overview – Post Deyr ‘11/12
Food Security The FSNAU Post Deyr ‘11/12 integrated food security analysis classified the East Golis/ Karkaar/Dharoor valley in Stressed phase, indicating an improvement from Crisis in the previous Gu ’11 season, and the Sool plateau and Current Situation Nugal Valley livelihood zones of Bari and Nugal regions remained in Crisis. The Coastal Deeh livelihood zone was Food Security classified in a sustainedEmergency since Deyr ‘10/11. The The current FSNAU Post Gu ‘12 integrated food security Hawd and Addun pastoral livelihoods in Nugal and northern analysis has classified the East Golis/ Karkaar/Dharoor Mudug regions that were classified inA FLC (or Crisis) in Gu valley, the Hawd and Addun livelihood zones of Nugal and ‘11 were classified asStressed , indicating an improvement. northern Mudug regions in sustained Stressed phase. Food security improvements in the Golis, Hawd and Addun The Sool plateau and Nugal Valley livelihood zones of livelihood zones were attributed to a combination of factors Bari and Nugal regions are also classified in Stressed such as improved income from frankincense sales/export in phase, indicating an improvement from the Crisis phase the East Golis and a boom in livestock trade in the regions in Deyr ‘11/12. The upper partd (Alluula and Iskushuban) during Hajj, strengthened purchasing power resulting from Coastal Deeh livelihood zone of Bari region is classified in increased goat to rice ToT, and less restricted humanitarian a sustained Emergency since Deyr ‘10/11. However, the access in the northeast regions. Declined fishing activities lower part of Coastal Deeh (Bandar beyla, Eyl and Jarriban) (in the coastal areas) due to hot weather and insecurity in has improved to Crisis from Emergency in Deyr ‘ 1 1 / 1 2 . main export market (Yemen), limited access to milk and Food security improvements in the Sool plateau and Nugal number of saleable animals amongst the poor, high water Valley livelihood zones are attributed to a combination of prices, and high debt levels contributed to the sustained factors such as improved access to milk and strengthened livelihood crisis, especially in the Coastal Deeh and parts of purchasing power resulting from increased goat to rice ToT, Nugal Valley of Iskushuban and Qandala districts that had and less restricted humanitarian access in the northeast received below normal Deyr ‘11 rains. regions. The lower part of Coastal Deeh (Bandar beyla, Eyl and Jarriban) has also shown improvement in goat/rice Nutrition ToT, and increased milk production. However, limited (below The Post Deyr ‘11/12 integrated nutrition situation analysis baseline) livestock holding, low fishing activities, poor milk indicated a general improvement in the nutrition situation production in most parts of the Coastal Deeh livelihood in most of the livelihood zones compared to the Gu ‘11 and presence of pastoral destitutes aggravate the food season. The nutrition situation improved in the populations security situation. The situation is projected to improve in of Sool plateau, Addun, and Coastal Deeh livelihood zones the upper part of the livelihood in the next six months due from Critical in Gu ‘11 to Serious. The nutrition situation was to anticipated improvements in livestock body condition and classified as Critical in the Nugal Valley livelihood zone, sales, following the good rainfall prospects for the area and an improvement from Very Critical in the Gu ‘11 season. a reduction in the international antipiracy activities opening However, the nutrition situation slightly deteriorated in the up fishing opportunities. However, low kidding/calving and East Golis/Karkaar and Hawd pastoral livelihoods from associated milk production is expected for all species due Serious to Critical. These deteriorations were due to the to low conception rates in the current season. limited access to milk and poor dietary diversity following the effects of previous consecutive poor seasonal performance Nutrition and disease in these livelihood zones. The WHO/MOH The Post Gu ‘12 nutrition situation depicts a mixed picture reported AWD and cholera outbreaks in the Hawd areas of in the nutrition situation in the livelihood zones compared to Galkayo and Adaado districts that aggravated the situation. the Deyr ‘11/12 season (Figure 25). The nutrition situation However, considering the positive food security indicators, has improved in the populations of East Golis and Hawd the situation in Hawd was projected to improve. The nutrition livelihoods, from Critical in Deyr ‘11/12 to Serious. The situation also improved Garowe IDPs from the Very Critical nutrition situation in Sool, Addun and Coastal Deeh is phase in Gu ’11 to Critical, however a sustained Very Critical classified in a sustained Serious phase. However, the situation was observed among the Bossaso, Qardho and nutrition situation deteriorated among the populations of Galkayo IDPs. The results were consistent with historical Nugal Valley to Very Critical from Critical in Deyr ‘11/12. data on nutrition surveys conducted among the IDPs in the The situation in Nugal valley follows a seasonal pattern northeast region, which highlights the chronic nutritional of improvements in Deyr and deteriorations in Gu, having vulnerabilities. improved from Critical in Deyr ‘11/12 and deteriorated back to the Very Critical phase reported in Gu ’11. A measles outbreak reported in parts of the western districts of Nugal Valley largely contributed to the worsened situation, despite
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 the positive food security indicators. The improvements in (U5DR) of 0.11 (0.03-0.34) and 0.15 (0.02-1.18) indicate an East Golis and Hawd are linked to improved milk access, Acceptable situation according to UNICEF classification, dietary diversity and humanitarian intervention. The WHO/ similar to the respective CDR and U5DR of 0.26 (0.10-0.65) MoH had reported AWD and cholera outbreaks in the Hawd and 0.36 (0.04-2.82) reported in December ‘12. areas of Galkayo and Adaado districts that aggravated the
situation in Deyr ‘11/12, however, this was controlled and Besides the chronic poor infrastructure, the area received a Regional Analysis there was no disease outbreak reported in the livelihood second season of near normal rains , though with exception zone this season. Among the IDPs, the nutrition situation of pocket areas after a long period of four consecutive has improved in Bossaso and Galkayo from Very Critical below normal rainfall in the previous seasons, and so 49 to Critical level, and sustained Critical and Very Critical is yet to recover fully from livestock losses and debts. levels in Garowe and Qardho respectively. The results Improved sheep/goat calving has increased access to are consistent with historical data on nutrition surveys milk, but is limited due to the previous herd size reduction/ conducted among the IDPs in the northeast region, which losses. Access to camel milk is poor to average due to low highlights the chronic nutritional vulnerabilities. conception and calving in the previous season. Figure 25: Trends in levels of acute malnutrition Figure 26: HIS Malnutrition Trends in Golis/ Karkaar (WHZ<-2 or oedema, WHO 2006) Northeast LZ (2010-2012) regions (2007-2011) 40.0
30.0 2011 2012 35.0
25.0 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) 30.0
20.0 25.0
15.0 20.0 Acutely Malnoursihed
% 10.0 15.0
5.0
Proportion of malnourished (%) 10.0
0.0 1 1 1 1 1 1 1 1 1 1 1 1 . 1 .08 .09 .10 .08 .09 .10 .08 .09 .10 .08 .09 .10 .12 .09 .10 .07 5.0 Jul. 1 Jul. 1 Jul. 1 Jul. 1 Jul. 1 Jul.10 Jul.12 Jul.10 Jul.12 Jul.10 De.10 Jul.12 Oct.07 Oct.07 Jun.12 Jun.09 Jun.12 Jul y No v Jul y Jul y Dec. 1 No v No v Dec. 1 No v No v No v Dec. 1 Dec. 1 Dec. 1 Dec. 1 Dec.09 Dec.09 Dec.10 Dec.09 Dec.10 Dec.09 Dec.10 Ma y Ma y Ma y Ma y Ma y Ma y Ma y Ma y
East Golis Sool Plateau Nugal Valley Hawd Addun Coastal Deeh 0.0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Gender: Analysis of findings from the nutrition assessments Data Source: MoH; SRCS conducted in the northeast regions of Somalia generally indicates a higher proportion of boys than girls as acutely Data from the health facilities namely Ufeyn, Waaciye and malnourished (WHZ<-2 or oedema). Conversely, a higher Iskushuban indicate high proportions (>10%) of acutely proportion of girls than boy were acutely malnourished based malnourished children, with an increasing trend in three on MUAC (< 125 mm or oedema). However, these differences (Apr-Jun ’12) months (Figure 26). Considering these HIS were generally not statistically significant (Pr<0.75). Other trends, low mortality rates, and the continued gradual child data such as dietary diversity, illness, feeding practices, recovery of food security indicators, it is projected that the and immunization status, do not show any clear differences by nutrition situation among the East Golis livelihood population gender. Analysis of household data by gender of household is likely to remain Serious in the coming six months with head did not find any significant difference nor a clear trend expected above normal rainfall forecasts. The population in the proportion with access to sanitation facilities, access to remains vulnerable to natural shocks and requires close safe drinking water nor consumption of diversified diet. The monitoring, in addition, there is need to address the chronic gender disaggregated data by sex of the assessed children issues affecting the nutrition status of the population such and sex of the household head per livelihood is summarized as inadequate health and sanitation facilities, poor child on Tables 17 and 18. feeding and care practices and lack of adequate safe drinking water. In the short term, the rehabilitation of the The detailed results of the assessments in the Hawd and acutely malnourished children, is required. Addun, cutting across both NE and Central regions are discussed in the section for Central zone. Sool Plateau Livelihood Zone of Northeast The nutrition situation of the Sool plateau of Bari and Nugal East Golis/ Karkaar/Dharoor Livelihood Zones regions has sustained the Serious phase since Deyr The current Post Gu ’12 integrated nutrition situation analysis ‘11/12. Results from the nutrition survey conducted in July classifies the nutrition situation of the population in East Golis/ ‘12 covering four regions of Bari, Nugal, Sool and Sanaag Karkaar/Dharoor livelihood zone of Bari region as Serious. report a GAM rate of 11.3% (9.3-13.8) and a SAM rate of In July‘12, FSNAU and partners conducted a comprehensive 1.7% (0.9-3.0). No oedema was reported. The rates indicate nutrition survey in the East Golis/Karkaar/Dharoor livelihood no significant change from the December ‘12 GAM and zone of Bari region. The results indicated a GAM rate of SAM rates of 11.6% (8.7-15.3) and 3.4% (2.0-5.7). A higher 13.9% (10.8-17.6) and SAM rate of 4.1% (2.6-6.5) including percentage of boys (13.7%) than girls (9.0%) were acutely two (0.3%) oedema cases. These rates show an improvement malnourished, though not statistically significant. The 90 from the Critical situation reported in the December ‘12 days retrospective CDR and U5DR of 0.12 (0.05-0.31) and assessment conducted in the same livelihood and region, 0.40 (0.13-1.24) were reported respectively, both indicating when the GAM rate was 15.2% (12.1-18.8) and SAM rate was Acceptable levels according to UNICEF classification. HIS 3.8% (2.3-6.4). Higher proportions of assessed boys (14.1%) data in the area recorded low (<10%) and stable proportions were acutely malnourished as compared to girls (13.6%), of acutely malnourished children screened at health facilities although the difference was not statistically significant. The (Figure 27). 90 days retrospective crude (CDR) and under five death rates
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 The nutrition situation in the livelihood is mitigated by Figure 27: HIS Malnutrition Trends in Sool Plateau LZ increased milk access in the area, following successive (2011-2012) good Deyr ‘11/12 and Gu ’12 rains and localized humanitarian interventions such as cash relief, food aid, health and 18.0 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) nutrition. Although a sustained improvement is projected 16.0 with a good Deyr ‘12/13 forecast, the vulnerability of the 14.0 Regional Analysis region to natural shocks, e.g. drought, rise in prices, and 12.0 disease outbreaks necessitates continued close monitoring 10.0 50 of the situation. 8.0 6.0
Nugal Valley Livelihood Zone Proportion of malnourished children (%) 4.0 The current Post Gu ‘12 integrated nutrition analysis 2.0 classifies the nutrition situation of the Nugal Valley asVery 0.0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Critical, a deterioration from the Critical levels in the Deyr ‘11/12 (Table 14). The nutrition survey conducted in July ‘12 by FSNAU and partners covering the Nugal Valley livelihood Data Source: MoH; SRCS zone that cuts across NW and NE regions, reported a GAM % (8.9-16.3) and SAM rate of 3.1% (1.9-5.0) were recorded. rate of 20.1% (16.5-24.3) and a SAM rate of 5.4% (3.9 -7.5). A higher proportion of assessed boys (15.0%) were acutely No oedema was reported in the assessment. These results malnourished (WHZ<-2 or oedema) compared to girls show a deterioration (Pr>75%) from the GAM rate of 16.3% (10.0%) but this difference was not statistically significant. (13.5-19.6) and a SAM rate of 5.2% (3.9-6.8) reported in the The 90-days retrospective crude (CDR) and under five December ‘11 assessment. The 90 days retrospective crude death rates (U5DR) of 0.56 (0.27-1.14) and 1.34 (0.73-2.44) (CDR) and under five death rates (U5DR) of0.04 (0.01-0.32) respectively were recorded, both indicating Alert levels and 0.19 (0.02-1.46) respectively, are Acceptable and did and a slight deterioration from the Acceptable levels with not show any significant change from the respective CDR respective CDR and U5DR of 0.19 (0.08-0.43) and 0.77 and U5DR of 0.19 (0.09-0.40) and 0.48 (0.15-1.45) recorded (0.28-2.08) recorded in December ‘11. The reported deaths in December ‘11. were suspected to have mainly been caused by diarrhoea. Data from health facilities in the NE coastal areas also Though not statistically significant, a higher proportion of indicated a high (>15%) but decreasing proportion of acutely assessed boys (22.2%) than girls (17.9%) were acutely malnourished children. malnourished. Data from the health facilities namely Sinujiif, Gambool and Waaberi, indicates low numbers (<10%) but Morbidity, poor access to sanitation and drinking water in an increasing trend of acutely malnourished children (Figure the area remain critical, with 20.3% of the assessed children 28). The deterioration in the nutrition situation is likely linked reported to have fallen ill in the two weeks preceding the to disease outbreaks. A measles outbreak was reported assessment and only 63.1% and 55.2% of the households in the western parts of the livelihood. However, improved having access to sanitation facilities and safe drinking water dietary diversity and increased intake of milk and meat respectively. Previous consecutive rain failures in the Deyr products following the good Gu rainy season, and access to ‘10/11 and Gu ‘11 led to a significant deterioration of livestock humanitarian support given the relative stability in the area body conditions and deaths resulting in reduced household are mitigating factors and the situation is likely to improve in income, and meat and milk consumption. Therefore a the next season if disease outbreak is controlled. second successful season with pockets of poor rains is not sufficient for the households to fully recover their assets High morbidity rates (23.9%) reported from the survey and and livestock heads. The situation needs close monitoring from the local health facilities, low vitamin A supplementation amidst seasonal changes in labour opportunities from status (74.8%) and measles vaccination status (77.2%), fishing activities due to the presence of sea pirates, strong poor water and sanitation and limited health facilities in the sea tides, and chronically poor infrastructure and frequent community are some of the aggravating factors for the Very disease outbreaks. The findings for Coastal Deeh pastoral Critical nutrition situation. More than 40% of the households livelihoods are summarized in Table 17. do not have sanitation facilities and a large majority (>80%) of the assessed population do not have safe drinking water. Figure 28: HIS Malnutrition Trends in Nugal Valley LZ Therefore, the population groups in this livelihood zone need (2011-2012) continued nutrition and livelihood interventions with close monitoring especially in light of the chronic vulnerability in 30.0 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) the area. The key findings for East Golis, Sool and Nugal 25.0 livelihood zones are summarized in Table 17. 20.0 Coastal Deeh Livelihood Zone of Northeast The nutrition situation of the Coastal Deeh population 15.0
of Nugal, Bari and North Mudug regions has sustained 10.0 Serious levels since Deyr ‘11/12. Except for a few spots that received below normal Deyr rains, the area has experienced Proportion of malnoursihed children (%) 5.0 improved access to milk and income associated with 0.0 favorable terms of trade (local goat to rice). Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
A nutrition survey conducted in July ‘12, reported a GAM rate of 12.8 % (8.7-18.4) and SAM rate of 3.5% (1.7-6.8), Data Source: MoH; SRCS indicating a Serious nutrition situation and no change from the situation in Deyr ‘11/12 when a GAM rate of 12.2
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 17: Summary of Key Nutrition Findings in Northeast Regions - July 2012 East Golis Sool Plateau Nugal Valley (N= 695: Boys= 360; (N=748: Boys= 365; (N=619: Boys=311; Girls=308) Girls=335) Girls=383) Indicator Results Outcome Results Outcome Results Outcome Child Nutrition Status Global Acute Malnutrition (WHO
13.9 (10.8 – 17.6) 20.1 (16.5-24.3) 11.3 (9.3-13.8) Regional Analysis 2006) 14.1 (10.5 – 18.7) Serious 22.2 (17.2-28.5) Very Critical 13.7 (9.9-18.6) Serious Boys 13.6 (9.8 – 18.6) 17.9 (14.4-22.0) 9.0 (6.8-11.9) Girls Severe Acute Malnutrition (WHO 4.1 (2.6 – 6.5) 5.4 (3.9-7.5) 1.7 (0.9-3.0) 51 2006) 4.2 (2.5 – 7.2) Serious 6.2 (4.1-9.5) Critical 1.4 (0.6-3.4) Acceptable Boys 4.0 (2.2 – 7.3) 4.6(2.9-7.4) 1.9 (1.0-3.7) Girls Mean WHZ (WHO, 2006) -0.89 ±1.08 Serious -0.96 ±1.19 Critical -0.67 ±1.08 Alert Very Oedema 0.3 0.6 Very Critical 0.0 Acceptable Critical Global Acute Malnutrition (NCHS) 13.0 (10.4 – 16.1) Serious 20.0 (16.4-24.2) Very Critical 11.9 (9.4-15.1) Serious Severe Acute Malnutrition (NCHS) 1.9 (1.2 – 3.1) Acceptable 2.4 (1.5-3.9) Acceptable 2.0 (1.2-3.5) Acceptable Proportion with MUAC <12.5 cm or 5.2 (3.7 – 7.1) 2.8 (1.5-4.9) 2.7 (1.7-4.1) edema 4.7 (2.8 – 7.9) Alert 3.2 (1.5-4.9) Alert 1.9 (1.0-3.6) Alert Boys 5.7 (4.0 – 8.0) 2.3 (1.0-5.0) 3.4 (2.0-1.3) Girls 1.0 (0.5 – 2.0) 1.5 (0.9-2.7) 0.5 (0.2-1.3) Proportion with MUAC <11.5 cm or 1.4 (0.6 – 3.2) Serious 1.5 (0.7-3.4) Serious 0.5 (0.1-2.2) Acceptable edema 0.6 (0.1 – 2.5) 1.6 (0.7-3.5) 0.5 (0.1-2.1) Stunting (HAZ<-2) 11.2 (8.5 – 14.7) 5.2 (3.5-7.7) 12.0 (9.0-15.9) Boys 11.5 (7.4 – 17.5) Alert 6.1(3.8-9.7) Acceptable 16.2 (11.5-22.5) Acceptable Girls 10.8 (8.1 – 14.4) 4.2 (1.9 -9.3) 8.0 (5.3-11.7) 14.5 (11.4 – Underweight (WAZ<-2) 18.3) 14.6 (12.2-17.4) 11.6 (8.5-15.6) Boys 15.0 (11.1 – 20.0) Alert 16.5 (12.1-22.0) Alert 12.6 (8.5-18.2) Alert Girls 13.9 (10.3 – 12.7 (9.2-17.4) 10.7 (7.4-15.2) 18.6) High (>10%) and Low (<10% but Low (<10) and HIS Nutrition Trends(Jan-Jun 2012) Serious Serious Alert increasing increasing stable Proportion of acutely malnourished 3.0 19.8 15.8 registered in SFs Very 3.9 22.9 Very Critical 12.7 Very Critical Boys Critical 2.0 16.1 20.0 Girls Child Morbidity & Immunization Outbreak –None Measles outbreak Morbidity- 27.9 Outbreak – in the western Boys- 27.5 None parts Girls-28.4 Morbidity-22.3 Morbidity- 23.9 Diarrhoea – 9.1 Boys-21.7 Disease trends (seasonally adjusted) Boys-24.8 Boys -9.2 Girls-23.0 Morbidity refers to the proportion Girls-23.1 Girls- 9.0 Serious Very Critical Diarrhoea – 7.8 Very Critical of children reported to be ill in the 2 Diarrhoea – 8.1 Pneumonia- 9.5 Boys-6.8 weeks prior to the survey Boys-9.6 Boys- 8.9 Girls-8.7 Girls-6.5 Girls- 10.1 Pneumonia- 6.4 Pneumonia- 8.1 Fever= 21.3 Boys-5.7 Boys-8.7 Boys- 20.6 Girls-7.1 Girls-7.5 Girls- 22.1 Vitamin A – 71.7 Vitamin A –74.8 Vitamin A- 78.3 Boys- 73.9 Boys-76.5 Serious Boys-79.4 Serious Immunization Status Girls- 69.3 Girls-73.1 Girls-77.3 Serious Measles –69.8 Measles – 77.2 Measles – 74.5 Boys-71.1 Boys-77.8 Serious Boys- 75.1 Serious Girls-68.4 Girls-76.6 Girls-73.9 Infant and Young child feeding N= 221 N=217 N=249 Proportion still breastfeeding (6-24 46.6 43.3 42.5 months) 46.4 Serious 39.5 Serious 39.2 Serious Boys 46.8 47.2 45.8 Girls Proportion meeting recommended 60.6 45.6 29.1 feeding frequencies 56.3 Serious 50.1 Critical 31.5 Very Critical Boys 65.1 40.1 26.7 Girls Proportion who reported to have 76.5 96.3 95.6 consumed <4 food groups 75.0 Critical 95.4 Very Critical 94.4 Very Critical Boys 78.0 97.2 96.8 Girls Death Rates Crude death per 10,000 per day 0.11 (0.03 – Acceptable 0.04 (0.01-0.32) Acceptable 0.12 (0.05-0.31) Acceptable (retrospective for 90 days) 0.34) Under five deaths/10,000 /day 0.15 (0.02-1.18) Acceptable 0.19 (0.02-1.46) Acceptable 0.40 (0.13-1.24) Acceptable (retrospective for 90 days) Women Nutrition & Immunization N=410 N=435 N=496 Status Proportion of acutely malnourished N=278 N=299 N=268 non pregnant/lactating women Acceptable Acceptable Alert 0.0 0.0 0.0 (MUAC≤18.5 cm) Proportion of acutely malnourished N=132 N=136 N=228 non pregnant/lactating women Alert Acceptable Acceptable 8.3 (3.4-13.3) 2.9 (0.0-7.2) 0.0 (MUAC≤21.0cm)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Summary of Key Nutrition Findings in Northeast Regions - July 2012-Continued Proportion of acutely malnourished N=132 N=136 N=228 pregnant/lactating women Critical Acceptable Critical 28.8 (18.6-39.0) 10.6 (1.7-19.4) 0.0 (MUAC<23.0). Proportion of Women who received Tetanus Immunization 36.1 24.7 16.8 No dose 8.8 23.8 17.8 Regional Analysis One dose Alert 21.7 16.2 Serious 34.0 Serious Two doses 33.4 35.4 31.3 Three doses Public Health Indicators N= 442 N= 351 N=425 52 Household with access to sanitation 60.2 57.6 67.5 facilities 57.3 Critical 56.7 Critical 66.0 Critical Male headed 65.0 60.2 81.4 Female headed Household with access to safe water 31.0 12.3 10.2 Male headed 31.9 Critical 7.1 Very Critical 10.3 Very Critical Female headed 29.4 28.9 9.3 Food Security Proportion who reported to have 1.6 11.7 1.6 consumed <4 food groups 0.7 Acceptable 12.3 1.8 Acceptable Male headed- Alert 3.1 9.6 0 Female headed- Household’s Main Food Source Own production - 97.2 93.7 Purchase: 97.5 Acceptable 96.6 Acceptable 94.2 Acceptable Borrowing 2.5 98.8 90.7 Food security phase Stressed Serious Stressed Serious Stressed Serious
Overall Risk to Deterioration Likely to sustain Uncertain Likely to sustain Overall Situation Analysis Serious Very Critical Serious
IDPs of the Northeast: Bossaso, Qardho, Garowe and improvement from the Alert levels with respective rates Galkayo of 0.68 (0.44-1.07) and 1.51 (0.84-2.72) reported in the The nutrition situation of IDPs in the northeast regions November 2011 assessment. The results also show an has either improved or remains at sustained Critical-Very improvement from seasonal levels of GAM rates >20% Critical phases as classified in the PostDeyr ’11/12. Based usually observed in the Gu since 2009. Data from health on surveys conducted in May ‘12, the nutrition situation is facilities in Bossaso indicated a high (>15%) but decreasing currently classified as Critical among Bossaso, Garowe trend of acutely malnourished children. The improvement and Galkayo IDPs, and Very Critical among Qardho IDPs, is attributed to interventions by humanitarian organizations as the population remains vulnerable to effects of pastoral and the Puntland authorities in the form of targeted food destitution conflict and unfavourable market forces. distributions for the acutely malnourished and other nutrition and health services. Other factors such as unstable access Findings from the Bossaso IDPs assessment recorded a to casual labour at the Bossaso port, out-migration of the GAM rate of 18.7% (15.7-22.1) and SAM rate of 3.9% (2.8 better off escaping the high temperatures, and reduced - 5.4), with two (0.2%) oedema cases. Significantly more fishing activities because of the high tides and winds at sea, boys (22.4%) than girls (15.4%) were acutely malnourished still contribute to the persistent poor nutrition situation. The (Pr>87.5%), a disparity possibly explained by the use of findings of IDPs assessments among Bossaso, Garowe and the new WHO 2006 sex-differentiated reference standards, Galkayo IDPs are presented in Table 17. which has been observed to discriminatively identify Among the Qardho IDPs, a small sample cluster survey more boys as acutely malnourished. The results indicate conducted in May 2012, reported a GAM rate of 21.7% a Critical nutrition situation, a significant improvement (16.8-27.6) and SAM rate of 5.6% (3.3-9.2), indicating a Very (Pr>87.5%) from the Very Critical situation reported in Critical nutrition situation. These findings are consistent the November 2011 assessment when a GAM rate of with the November 2011 assessment that reported a GAM 24.1% (21.3-27.2) and SAM rate of 7.2% (6.0 - 8.7) were rate of 20.4% (14.8-27.4) and SAM of 6.1% (3.6-10.2), recorded. The retrospective crude and under five death indicating a sustained Very Critical nutrition levels. Similar rates of 0.33 (0.15-0.73) and 0.61 (0.28-1.32), both indicate proportions of boys (20.2%) and girls (23.2%) were acutely Acceptable levels among the Bossaso IDPs according to malnourished based on weight-for-height Z scores (<-2) UNICEF classification. The CDR and U5DR show a slight and/or oedema. The displaced populations in Qardho have Figure 29: Trend in Levels of Acute Malnutrition (WHZ<-2 or oedema, WHO 2006) in Northeast IDPs (2006-2012)
30.0
25.0
20.0
15.0 Acutely Malnourished 10.0 %
5.0
0.0 1 1 1 1 1 1 1 1 . 1 . 1 . 1 . 1 .12 .12 .07 .08 .12 .12 .08 Jul.09 Jul.09 Jul.09 Jun. 1 Jun. 1 Jun. 1 Jun. 1 Oct.06 Oct.08 Jun.10 Jun.10 No v No v No v No v Dec.10 Dec.09 Dec.10 Dec.10 Dec.09 Dec.10 Ma y Ma y Ma y Ma y Ma y Ma y Ma y June.10
Bossaso Galkayo Garowe Qardho
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 also benefitted from the supplementary and therapeutic children and Diaspora support, have contributed to the nutrition interventions by Puntland authorities, together with stability, and in mitigating possible deterioration in this local and international organizations, which have mitigated vulnerable population. However, continued conflict-related the situation from further deterioration. displacements from the south-central regions have exerted pressure on the host communities, coupled with limited The results of the Garowe nutrition assessment conducted
labour opportunities and high food prices have constrained Regional Analysis in May 2012 show a GAM rate of 19.2% (15.9- 23.1) and a access to food and economic resources among the IDPs. SAM rate of 4.7% (0.9- 3.7), including two (0.2%) oedema cases, indicating a sustained Critical nutrition situation. Results for the Galkayo IDP assessment conducted in 53 Similar levels were reported in the November 2011 survey May 2012 recorded a GAM rate of 19.2% (16.1-22.8) and with GAM and SAM rates of 17.8 % (14.7-21.2) and 4.5 % SAM rate of 4.1% (3.0-5.6) including two (0.5%) cases (3.2-6.3) respectively. Boys (19.3%) and girls (19.2%) were of oedema, indicating a Critical nutrition situation. The equally acutely malnourished (WHZ<-3/oedema). The proportion of boys (21.3%) who were acutely malnourished CDR and U5DR of 0.43 (0.25-0.75) and 0.59 (0.25-1.39), was higher than that of girls (17.3%), but the difference was both indicate Acceptable levels among the Garowe IDPs not statistically significant. Although these findings show according to UNICEF 2005 classification. The CDR and improvement from Very Critical levels of 21.8% (18.6-25.4) and 5.9% (4.2-8.2) for GAM and SAM rates respectively U5DR show similar levels to the retrospective rates of 0.30 reported in November 2011, the change is not statistically (0.15-0.59) and 0.77 (0.31-1.88) reported in the November significant (Pr<75%). The retrospective crude and under 2011 survey. The internally displaced populations in five death rates of 0.22 (0.11-0.43) and 0.62 (0. 27-1.44) Garowe have historically reported stable Serious-Critical among Galkayo IDPs are both within the Acceptable levels levels since June 2010 (Fig. 31). Continued government, according to WHO classification and an improvement from non-governmental organization interventions including the respective Alert rates of 0.80 (0.45-1.42) and 1.39 (0.62- active case finding and referral of acutely malnourished 2.08 reported in the November 2011 survey.
Table 18: Summary of Key Nutrition Findings in Hawd, Addun and Coastal Deeh Northeast Regions Hawd Addun Coastal Deeh (N=816: 432 boys; 384 girls) (N=701: (374 boys; 327 girls) (N=385: 209 boys; 176 girls) Indicator Results (%) Outcome Results (%) Outcome Results Outcome Child Nutrition Status Global Acute Malnutrition (WHO 2006) 11.2 (8.9-14.0) 14.5 (11.1-18.9) 12.8 (8.7–18.4) Boys 11.4 (8.7-14.9) Serious 16.2 (11.7-22.0) Serious 15.0 (9.4–23.3) Serious Girls 10.9 (7.9-14.9) 12.7 (9.1-17.5) 10.0 (6.1–15.9) Severe Acute Malnutrition (WHO 2006) 1.8 (0.9 – 3.4) 2.4 (1.3 – 4.3) 3.5 (1.7–6.8) Boys 1.9 (0.8-4.3) Acceptable 2.6 (1.1- 6.0) Acceptable 3.9 (1.9–7.1) Serious Girls 1.6 (0.7-3.5) 2.2 (1.0-4.7) 2.9 (1.0–8.0) Mean WHZ (WHO, 2006) -0.71±1.06 Serious -0.79±1.13 Serious -0.77 ±1.09 Serious Global Acute Malnutrition (NCHS) 12.0 (9.6-15.1) Serious 14.8 (11.1-19.4) Serious 13.5 (9.3–19.2) Serious
Severe Acute Malnutrition (NCHS) 1.5 (0.8 – 2.8) Acceptable 1.7 (0.7 -4.4) Acceptable 1.3 (0.5 – 3.5) Acceptable Proportion with MUAC (<12.5 cm or 5.4 (3.3-8.6) 8.4 (5.8 – 12.1) 2.6 (1.2 – 5.6) oedema) 5.3 (3.2-8.8) Alert 7.8 (5.1-11.5) Critical 1.9 (0.7 – 4.9) Alert Boys 5.5 (2.9-10.0) 9.2 (6.0-13.9) 3.4 (1.1 – 10.3) Girls Proportion with MUAC (<11.5 cm or 0.4 (0.1– 1.1) Alert 1.7 (0.9-3.4) Serious 0.8 (0.2 –2.5) Alert oedema) Stunting (HAZ<-2) 11.1 (7.5-16.3) 14.1 (10.1–19.4) 12.0 (8.8–16.2) Boys 12.6 (8.5-18.3) Alert 17.9 (13.0 -24.3) Alert 12.9 (8.5 –19.1) Alert Girls 9.5 (5.9-14.9) 9.7 (6.1-15.0) 11.0 (6.4– 18.4) Underweight (WAZ<-2) 10.7 (7.8–14.5) 12.9 (9.7-17.1) 14.2(10.4–19.3) Boys 12.9 (9.2-17.9) Alert 14.7 (9.9-21.3) Alert 16.5(11.4–23.3) Alert Girls 8.2 (5.3-12.5) 10.9 (7.6 -15.2) 11.6 (6.7–19.3) High proportion High (>15%) but High (>15%) but HIS Nutrition Trends(Jan – June 2011) Serious Critical Critical (>10%) and stable decreasing decreasing Proportion of acutely malnourished 6.1 3.7 8.2 registered in SFs 7.0 Very Critical 3.0 Very Critical 9.7 Critical Boys 4.8 4.8 5.6 Girls Child Morbidity & Immunization Outbreak–None Outbreak–None Outbreak–None Morbidity– 30.6 Morbidity–36.8 Morbidity–20.3 Disease trends (seasonally adjusted) Boys– 30.1 Boys – 37.2 Boys – 20.1 Morbidity refers to the proportion of Girls -31.3 Girls -36.4 Girls -20.5 Critical Critical Serious children reported to be ill in the 2 weeks prior to the survey Diarrhea :10.2 Diarrhoea - 11.7 Diarrhoea - 5.2 Pneumonia: 8.1 Pneumonia - 7.3 Pneumonia - 4.9 Fever: 21.0 Fever - 27.5 Fever - 15.8 Vitamin A–70.2 Vitamin A –64.9 Vit A –76.1 Boys – 69.2 Boys – 63.1 Boys – 78.5 Girls – 71.4 Girls -67.0 Girls -73.3 Immunization Status Serious Critical Serious Measles – 71.4 Measles – 60.8 Measles – 68.3 Boys – 70.1 Boys – 60.2 Boys – 70.3 Girls – 72.9 Girls -61.5 Girls - 65.9 Infant and Young child feeding N= 297 N=229 N=129 Proportion still breastfeeding (6-24 34.7 36.7 42.6 months) 35.0 Critical 37.3 Critical 37.7 Critical Boys - 34.3 36.1 48.3 Girls -
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Summary of Key Nutrition Findings in Hawd, Addun and Coastal Deeh Northeast Regions-Continued Proportion meeting recommended feeding 41.4 17.5 35.7 frequencies 45.0 Serious 17.3 Very Critical 33.3 Serious Boys - 37.2 17.6 38.3 Girls - Proportion who reported to have 97.6 96.1 97.7 consumed <4 food groups Regional Analysis 97.5 Very Critical 96.4 Very Critical 98.6 Very Critical Boys - 97.8 95.8 96.7 Girls - Death Rates Crude deaths/ 10,000/ day (retrospective 54 0.38 (0.19-0.76) Acceptable 0.48 (0.25-0.92) Acceptable 0.56 (0.27-1.14) Alert for 90 days) Under five deaths/ 10,000 /day 0.50 (0.18-1.36) Acceptable 0.58 (0.19–1.76) Acceptable 1.34 (0.73–2.44) Alert (retrospective for 90 days) Women Nutrition & Immunization N=416 N=375 N=238 Status Proportion of acutely malnourished non pregnant/lactating women (MUAC≤18.5 0.8 (0.0-2.0) Serious 0.0 Acceptable 0.0 Acceptable cm) Proportion of acutely malnourished 5.8 (2.5 -9.1) non pregnant/lactating women 3.5 (0.7-6.3) Acceptable Alert 1.0 (0.0-3.2) Acceptable (MUAC≤21.0cm) Proportion of acutely malnourished 13.5 (9.6-17.3) Acceptable 18.6 (10.5-26.7) Alert 14.4 (7.5-21.4) Alert pregnant/lactating women (MUAC<23.0). Proportion of Women who received Tetanus Immunization 24.2 31.7 20.2 No dose 13.7 Alert 32.0 Serious 8.8 Alert One dose 21.3 16.8 30.3 Two doses 40.8 19.5 40.8 Three doses Public Health Indicators N=477 N=449 N=252 Household with access to sanitation 76.5 39.4 63.1 facilities 77.9 Alert 39.3 Very Critical 62.7 Serious Male headed 70.2 40.4 63.9 Female headed Household with access to safe water 44.4 16.9 55.2 Male headed 43.8 Serious 17.3 Very Critical 47.9 Serious Female headed 47.6 14.0 69.9 Food Security N=477 N=449 N=252 Proportion who reported to have 1.9 9.6 2.4 consumed <4 food groups 1.5 Acceptable 8.9 Alert 1.2 Acceptable Male headed 3.6 14.0 4.8 Female headed Household’s Main Food Source Own production 0.6 6.5 0.0 Purchase: 94.1 Very Critical 63.0 Very Critical 75.8 Very Critical Food aid 4.4 25.6 23.4 Borrowing 0.6 0.0 0.0 Food security phase Stressed Serious Stressed Serious Crisis Serious Overall Situation Analysis Serious Serious Serious
These findings indicate considerably high morbidity rates Overall, the nutrition situation is Critical to Very Critical (>37%) which have a direct effect on the nutrition status of the among IDPs of Northeast. Bossaso, Garowe and Galkayo children. Suspected measles outbreak reported in Galkayo IDPs are in Critical levels while Qardho IDPs is in Very district during the Gu season was controlled. For all the four Critical nutrition. The reasons for the persistent situation IDP populations, vaccination status by recall and Vitamin A and for the improvements are multiple and are associated supplementation are still sub-optimal (60-80%) and far below with climate, food security, level of social support, the Sphere (2004) threshold (Table 19). population and conflict dynamics in the south as well as health related factors. The reliance of IDPs on insufficient Although the IDPs population in the urban settlements often humanitarian assistance and on irregular casual labour have better dietary diversity and access to safe water and for income to buy food and other none food items makes sanitation facilities compared to the rural households, the them susceptible to food insecurity and malnutrition. The household’s access to food, water and other basic services situation is exacerbated by the high food prices and poor among this group is dependent on the level of income or food access resulting from the effects of conflict and past purchasing power and social support, which remain a major drought in the region and inability of the host communities challenge for most displaced populations when food prices to provide social support. Interventions to improve and rise. Among the assessed IDP populations, only 5% or fewer stabilize food access and provision of health services are households in Bossaso, Qardho, Garowe and Galkayo IDP crucial in addressing limited food and in tackling the high settlements consumed poorly diversified diets, comprising of morbidity levels, thereby mitigating the high levels of acute three or fewer food groups, mainly obtained through purchase malnutrition. Where substantial support was reported (87-99.6%). Furthermore, a high proportion of the assessed and the food security indicators of the surrounding host households among the IDP settlements have access to communities improved, the nutrition situation also showed sanitation facilities, with the proportion of the assessed some improvement. Continued and concerted efforts are households reporting access to some type of sanitation thus needed to rehabilitate acutely malnourished children facility ranging from 84% in Bossaso, to 100% in Qardho and prevent further deterioration. IDP settlements. Similarly, the proportion of the assessed households reporting access to safe drinking water ranged from 71.1% in Garowe to 99% in Qardho.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 19: Summary of Key Nutrition Findings among Northeast IDPs (Bossaso, Qardho, Garowe and Galkayo) – May 2012
Bossaso Qardho IDPs Garowe Galkayo (N=1009; 481boys, 528 girls) (N=202; 101 boys, 101 girls) (N=821; 422 boys, 399 girls) (N= 997; 473 boys, 524 girls)
Indicator Results Outcome Results Outcome Results Outcome Results Outcome Regional Analysis Child Nutrition Status 19.2 (16.1 – Global Acute Malnutrition 22.8) 18.7 (15.7 – 22.1) 21.7 (16.8 -27.6) 19.2 (15.9 – 23.1) 55 (WHO 2006) 21.3 (17.2 – 22.4 (17.5 – 28.1) Critical 20.2 (14.0-28.3) Very Critical 19.3 (15.4 – 23.9) Critical Critical Boys 26.1) 15.4 (12.6 – 18.7) 23.2 (17.2-30.6) 19.2 (14.8 – 24.5) Girls 17.3 (13.2 – 22.4) Severe Acute Malnutrition 3.9 (2.8 – 5.4) 5.6 (3.3-9.2) 4.7 (3.2 – 6.8) 4.1 (3.0 – 5.6) (WHO 2006) 4.9 (2.9 – 8.0) Serious 6.1 (2.7-13.0) Critical 4.6 (2.6 – 8.0) Critical 5.2 (3.6 – 7.5) Serious Boys 3.1 (1.9 – 4.9) 5.1 (2.2-11.4) 4.9 (3.2 – 7.3) 3.1 (1.9 – 4.9) Girls Mean WHZ (WHO, 2006) -1.06 ±1.05 Critical -0.83 ±1.37 Serious - 0.97 ±1.15 Serious -1.04 ±1.11 Critical Global Acute Malnutrition 19.3 (16.4 – 16.6 (14.1 – 19.5) Critical 22.5 (17.2-28.9) Very Critical 17.8 (14.5 – 21.7) Critical Critical (NCHS) 22.6) Severe Acute Malnutrition 1.3 ( 0.6 – 2.8) Acceptable 2.5 (1.0-5.9) Alert 2.3 (1.5 – 3.7) Acceptable 2.1 (1.4 – 3.3) Acceptable (NCHS) Proportion with MUAC <12.5 11.5 (9.0 – 14.4) 12.4 (8.7-17.3) 9.9 (7.7 – 12.6) 6.6 (4.8 – 8.8) cm or oedema 9.4 (6.8 – 12.7) Critical 16.0 (10.0-24.2) Very Critical 7.1 (4.7 – 10.7) Critical 4.5 (2.8 – 7.0) Serious Boys 13.4 (9.9 – 17.5) 8.9 (4.7-16.4) 12.8 (9.5 – 17.0) 8.4 (5.8 – 11.9) Girls Proportion with MUAC <11.5 3.8 (2.6 – 5.5) Very Critical 3.0 (1.4-6.4) Critical 2.1 (1.3 – 3.3) Critical 1.3 (0.7 – 2.6) Serious cm or oedema 17.3 (13.1 – 22.5) Stunting (HAZ<-2) 34.9 (31.1 – 39.0) 33.3 (25.9-41.7) 25.9 (22.0 – 30.3) 19.0 (14.7 – Boys 40.2 (35.6 – 44.9) Serious 36.8 (25.4-49.9) Serious 25.3 (20.4 – 30.9) Serious Alert 24.1) Girls 30.2 (25.3 – 35.6) 29.8 (20.3-41.5) 26.6 (21.9 – 31.9) 15.8 (11.1 – 22.0) 22.6 (18.6 – 27.1) Underweight (WAZ<-2) 32.0 (27.6 – 36.8) 25.4 (18.8-32.4) 36.2 (32.4 – 40.2) 26.1 (20.9 – Boys 37.0 (31.5 – 42.8) Serious 27.6 (19.7-37.1) Serious 37.2 (32.2 – 42.5) Serious Serious 32.1) Girls 27.5 (22.2 – 33.4) 22.4(15.6-31.1) 35.1 (28.9 – 41.9) 19.4 (15.1 – 24.5) HIS Nutrition Trends(Jan- High (>15%) but Critical N/A - N/A - N/A - Jun’12) decreasing High but steadily Admission trends at TFPs/ Low and stable decreasing in SFPs Critical N/A - number of SC Critical N/A - number of OTP (Jan-July’12) admissions admissions Proportion of acutely 12.4 22.7 15.4 5.0 malnourished registered in SFs 10.9 Very Critical 25.0 Critical 15.5 Very Critical 5.6 Very Critical Boys 10.1 20.8 15.4 4.3 Girls
Child Morbidity & Immunization Suspected measles Outbreak – Outbreak – None Outbreak -None outbreak- Disease trends (seasonally None Morbidity-44.0 Morbidity–41.0 controlled. adjusted) Morbidity-42.6 Boys- 43.0 Boys-40.8 Morbidity–37.5 Morbidity refers to the Boys- 42.6.9 Girls- 44.9 Critical Critical Girls-41.4 Critical Boys-38.1 Very Critical proportion of children reported Girls- 42.6 Diarrhoea -19.0 Diarrhoea- 21.4 Girls-37.0 to be ill in the 2 weeks prior to Diarrhoea -20.3 Pneumonia- 22.1 Pneumonia-6.6 Diarrhoea the survey Pneumonia- 7.4 Fever-23.6 Fever-29.0 -15.7 Fever-36.6 Pneumonia-9.9 Fever-29.6 Vitamin A– Vitamin A–80.2 Vitamin A–66.3 Vitamin A– 73.6 85.9 Boys-81.5 Boys-63.4 Boys-75.6 Boys- 87.3 Girls- 79.0 Girls- 69.3 Girls-71.4 Immunization Status Alert Serious Serious Girls-84.5 Alert Measles – 82.8 Measles – 62.9 Measles- 73.0 Measles- 82.9 Boys-84.4 Boys-60.4 Boys-76.3 Boys-83.7 Girls-81.3 Girls-65.3 Girls-69.4 Girls-82.3 Infant and Young child N=407 N=76 N=313 N=413 feeding Proportion still breastfeeding 54.1 46.1 52.1 37.3 (6-24 months) 56.1 Alert 45.2 Serious 50.9 Alert 38.5 Critical Boys 52.3 47.1 53.2 36.3 Girls
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Summary of Key Nutrition Findings among Northeast IDPs (Bossaso, Qardho, Garowe and Galkayo) – May 2012-Continued Proportion meeting recommended feeding 56.6 28.9 44.7 32.4 frequencies 57.1 Alert 31.0 Very Critical 44.0 Serious 34.2 Critical Boys 56.0 26.5 45.5 31.0 Girls Regional Analysis Proportion who reported to 80.1 84.2 92.3 91.2 have consumed <4 food groups 75.7 Critical 88.1 Critical 89.9 Very Critical 92.1 Very Critical Boys 83.9 79.4 94.8 90.4 56 Girls Death Rates Crude deaths, per 10,000 per 0.22 (0.11 – 0.33 (0.15 – 0.73) Acceptable N/A - 0.43 (0.25-0.75) Acceptable Acceptable day (retrospective for 90 days) 0.43) Under five deaths, per 10,000 0.62 (0.27 – per day (retrospective for 90 0.61 (0.28 – 1.32) Acceptable N/A - 0.59 (0.25-1.39) Acceptable Acceptable 1.44) days) Women Nutrition & N=597 N=52 N=326 N=544 Immunization Status Proportion of acutely malnourished non pregnant/ N=354 N=19 N=217 N=314 Serious - Alert Alert lactating women (MUAC≤18.5 0.6 (0.0-1.4) 5.3 0.5 (0.0-1.4) 0.3 (0.0-0.9) cm) Proportion of acutely malnourished non N=225 N=33 N=109 N=230 Alert Very Critical Serious Alert pregnant/lactating women 3.1 (0.2-6.0) 10.3 6.4 (2.1-10.7) 1.7 (0.0-3.9) (MUAC≤21.0cm) Proportion of acutely N=230 N=225 N=33 N=109 malnourished pregnant/ Acceptable Very Critical Alert 33.9 (27.9- Very Critical 13.3 (7.8-18.9) 46.7 24.8 (15.9-33.7) lactating women (MUAC<23.0). 39.8) Proportion of Women who received Tetanus Immunization 17.1 15.4 15.0 19.3 No dose 9.5 3.8 5.2 11.2 One dose Alert Alert Alert Serious 18.3 23.1 22.4 28.9 Two doses 55.1 57.7 57.4 40.6 Three doses Public Health Indicators N=611 N=100 N=498 N=597 Household with access to 84.0 100.0 95.8 97.5 sanitation facilities 83.7 Serious 100.0 96.1 97.0 Male headed Acceptable Acceptable Acceptable 85.4 100.0 94.4 98.7 Female headed Household with access to safe 93.3 99.0 71.1 95.1 water 93.5 98.7 71.3 Serious 96.8 Male headed Alert Acceptable Acceptable 92.1 100.0 70.0 90.5 Female headed Food Security N=611 N=100 N=498 N=597 Proportion who reported to 2.1 5.0 0.6 2.8 have consumed <4 food groups 1.7 6.4 0.7 3.2 Male headed Acceptable Acceptable Acceptable Acceptable 4.5 0.0 0.0 1.9 Female headed Household’s Main Food Source Purchase: 99.3 87.0 99.6 94.1 Borrowing 0.0 Alert 1.0 Serious 0.0 Alert 1.8 Alert Food Aid 0.0 0.0 0.0 0.0 Food security phase Emergency Very Critical Emergency Very Critical Emergency Very Critical Emergency Very Critical Overall Situation Analysis Critical Very Critical Critical Critical
Gender and nutrition analysis in Northeast Regions conducted during Gu ’12, more boys than girls were acutely malnourished in Galkayo IDPs (21.3% vs. 17.3%), but the In most of the nutrition assessments conducted in the NE differences was not statistically significant. Similar trends regions of Somalia, a higher proportion of boys than girls are reported in the livelihood based assessments where were acutely malnourished, even though this was generally higher percentage of the boys tend to be more malnourished not statistically significant (Pr<0.75), except for Bossaso than the girls including Nugal Valley (22.2% vs. 17.9%) and IDPs (22.4% vs. 15.4%) where there was a statistical Sool plateau (13.7% vs. 9.0%) livelihoods of Bari and Nugal significance (Pr>75%). However, other child data such as regions, as well as in Addun (16.2% vs. 12.7%) and Coastal dietary diversity, illness, care and feeding practices, and Deeh (15.0% vs. 10.0%) pastoral livelihoods of NE regions. immunization status, do not show any clear differences by gender and so the disparity is likely due to the use of the Analysis of household data by gender of household head new WHO 2006 sex-differentiated reference standards, did not find any significant difference nor clear trend in which has been observed to discriminatively identify more the proportion with access to sanitation facilities, access boys as acutely malnourished. With the new WHO reference to safe drinking water nor consumption of diversified diet. standards, a girl of a certain height has to be much lighter The gender disaggregated data by sex of the assessed than a boy of the same height to meet the WHZ<-2 threshold children and sex of the household head per livelihood is for acute malnutrition. In the other IDP assessments summarized on Tables 18-19.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 MATERNAL NUTRITION STATUS IN NORTHEAST AND CENTRAL SOMALIA
The proportion of the global and severely malnourished pregnant and/ or lactating women based on the Sphere MUAC cut-offs of 23.0, and 21.0cm, and/or bilateral oedema in the Northeast and Central regions, vary widely from Acceptable-Alert in most rural livelihood population groups to Very Critical situation in some IDP population groups. For the non-pregnant or non-lactating, the situation is within acceptable levels in most surveys based on MUAC cut Regional Analysis -off of 18.5cm or presence of bilateral oedema. 57 Pregnant and/or Lactating Women Non Pregnant/Lactating Women Proportion with MUAC Proportion with MUAC Proportion with MUAC No Assessed No Assessed <23cm(%) <21cm(%) <18.5cm(%) Bossaso IDPs 225 13.3 (7.8-18.9) 3.1 (0.2-6.0) 354 0.6 (0.0-1.4) Qardho IDPs 33 46.7 10.3 19 5.3 Garowe IDPs 109 24.8 (15.9-33.7) 6.4 (2.1-10.7) 217 0.5 (0.0-1.4) Galkayo IDPs 230 33.9 (27.9-39.8) 1.7 (0.0-3.9) 314 0.3 (0.0-0.9) Hawd 171 13.5 (9.6 -17.3) 3.5 (0.7-6.3) 245 0.8 (0.0-2.0) Addun 172 18.6 (10.5-26.7) 5.8 (2.5 –9.1) 203 0.0 Coastal Deeh 97 14.4 (7.5-21.4) 1.0 (0.0-3.2) 141 0.0 Nugal Valley 152 9.8 (4.5-15.3) 1.3 (0.0-3.2) 207 0.5 (0.0-1.5 Sool Plateau 133 21.1(13.2-28.9) 5.3 (0.1-11.5) 236 0.4 (0.1-1.3) East Golis 132 28.8 (18.6-39.0) 8.3 (3.4-13.3) 278 0.0
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 4.8 Northwest Regions
The Northwest regions comprise mainly of pastoral Map 12: Northwest Livelihood Zones livelihood zones namely: West Golis, Guban, East Golis/
Regional Analysis Gebbi Valley of Sanaag region, the Hawd of Hargeisa and Togdheer, Sool Plateau and the Nugal Valley. In addition, 58 there is an agro-pastoral livelihood zone that is sub-divided into two, namely, the Agro-pastoral of Awdal and Woqooyi Galbeed regions and Agro-pastoral of Togdheer region. The livelihood zones cut across the five administrative regions of Awdal, Woqooyi Galbeed, Togdheer, Sool and Sanaag. (Map 12). The East Golis, Nugal Valley and Sool plateau also extend to the Northeast regions of Bari and Nugal respectively. However, the nutrition situation among the population in the Historical Overview Post Deyr ‘11/12 Hawd livelihood significantly deteriorated from Alert levels in Gu ‘11 to Serious. This was mainly attributed to reduced Food Security milk access following opportunistic livestock out-migration to Ethiopia where water and pasture condition was better The FSNAU Post Deyr ‘11/12 integrated food security compared to the situation in Hawd of Togdheer and Sool analysis classified the food security situation of the agro- regions. The nutrition situation of the IDPs in Hargeisa town pastoral, West Golis/Guban, East Golis and Hawd pastoral was sustained at Serious level since Deyr ‘10/11, while the livelihoods in the Northwest as Stressed indicating a nutrition situation among the Burao IDPs deteriorated from stable food security situation since the Gu ‘10 season, but Critical in Gu ’11 to Very Critical in Deyr ‘11/12. The nutrition an improvement for East Golis and Hawd of Togdheer situation among the Berbera IDPs also deteriorated to livelihoods which were in Crisis in the Gu ‘11. The population Critical levels from Serious in Gu ‘11. The lack of stable in Nugal Valley and Sool plateau were in Crisis, a sustained livelihood systems among the IDP populations, coupled phase for Nugal Valley livelihood but an improvement with irregular access to basic services continue to expose from Emergecy for Sool Plateau since the Deyr ‘09/10. this population group to risks of malnutrition, morbidity and The general improvement in the food security situation in food insecurity. The chronic risk factors for malnutrition these livelihoods was mainly attributed to the improved among the populations in the Northwest region include high milk availability owing to improved pasture condition and morbidity rates, a precarious food security situation, poor water availability. Other factors that contributed to the dietary diversity, poor child feeding and care practices, in improvement included kidding among the small rumminats, addition to inadequate safe drinking water, limited access increased income from sale of livestock and related to health and sanitation facilities, remain a challenge to the products, better purchasing power due to improved livestock population especially among the displaced persons and the prices and reduced household expenses and unrestricted rural populations. The historical trend of malnutrition in the humanitarian access due to relative civil tranquility. respective livelihoods since 2003 is shown in (Figure 30).
Nutrition Current Situation Post Gu ‘12 The Post Deyr ‘11/12 integrated nutrition situation analysis showed a general improving trend in the nutrition situation in Food Security Northwest livelihoods with most livelihoods showing either a significant improvement or stable situation compared to the The FSNAU Post Gu ‘12 integrated food security analysis in Gu ‘11 situation. The nutrition situation for the West Golis the most of Northwest indicates a Stress phase of acute and Nugal Valley livelihoods significantly improved from food insecurity situation in the agro-pastoral, , Hawd, Sool Very Critical in Gu ‘11 to Serious and Critical respectively. Plateau and Nugal Valley pastoral livelihoods which is an The situation among the population in the Sool Plateau improvement from Crisis for Nugal Valley and Sool plateau improved from Critical in Gu ’11 to Serious while that of in Deyr ‘11/12 but a stable situation for the other livelihoods. the agro-pastoral and East Golis/Gebbi Valley livelihood The general improvement in the food security situation in zones remained stable at Serious level. The improvement these livelihoods is mainly attributed to the positive impact recorded in the respective livelihoods was mainly attributed normal of Gu ’12 rainfall in most parts of these livelihoods to improved milk access at the household level and declined which improved livestock body conditions and production morbidity levels. and thus increased milk availability and access owing to
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Figure 30 : Trends in levels of Acute Malnutrition (WHZ <-2Z scores or oedema), WHO 2006 in North West regions 2006- 2011
30% Regional Analysis
15%
% Malnourished 59
0% 1 1 1 1 1 1 1 1 1 1 1 1 June 12 Oct 2008 Oct 2009 Jun 2009 July 20 1 July 20 1 July 20 1 Dec 2009 Dec 2009 Dec 2009 Dec 2010 Dec 2010 Jun 2012 July 20 1 Dec 20 1 July 20 1 Dec 20 1 Dec 20 1 Dec 20 1 Dec 20 1 July 20 1 Dec 20 1 Dec 2010 July 2012 Dec 2009 Dec 2010 Dec 2010 Dec 2010 Dec 2009 June 2010 June 2010 June 2012 June 2008 June 2010 Dec 2009 June 2009 June 2010 June 2010 June 2012 June 2012 June 2010 August 2006 March 2010
W Golis East Golis Sool Plateau Nugal Valley Hawd Agro-pastoral
improved pasture and water availability and kidding among deterioration. On the other hand, the nutrition situation the small rumminats, increased income from sale of livestock among the populations in the Sool Plateau, East Golis/Gebbi and livestock products (milk and ghee). The food security Valley and Agro-pastoral livelihoods has remained stable at situation among the population in Golis Guban and East Serious levels since Deyr ‘11/12. Golis livelihood has deteriorated from Stressed in Deyr ‘11/12 to Crisis. The deterioration in these livelihoods is The nutrition situation of the displaced people in Hargeisa linked to the effect of failure of the hays rains over last two and Berbera towns is sustained at Serious and Critical seasons in most of Golis Guban affecting water availability levels respectively since Deyr ‘11/12, while the situation and rangeland condition thereby resulting in poor livestock among the Burao IDPs has improved from Very Critical to body condition, low milk production and limited saleable Critical. Household access to food, health and other basic livestock. These together with the increased level of services among the IDP is highly dependent on humanitarian indebtness has affected food availability and access in services and availability of casual labour and petty trades these livelihoods. in the host urban areas. This irregular access to basic services continue to expose this population group to risks Nutrition of malnutrition, morbidity and food insecurity. The Post Gu ‘12 integrated nutrition situation analysis shows either stable or deteriorating trend in the nutrition Gender: The analysis of nutrition data among the assessed situation in Northwest livelihoods compared to the Deyr rural livelihood population as well as the IDPs populations of ‘11/12. The nutrition situation for the West Golis and Nugal the northwest regions, shows no statistical differences in the Valley livelihoods has deteriorated from Serious and Critical distribution of acute malnutrition, morbidity levels, access respectively in Deyr ‘11/12 to Very Critical. The nutrition to vitamin A supplementation and immunization services situation among the population in the Hawd livelihood has between boys and girls. However, across all livelihoods and significantly deteriorated from the Serious levels in Deyr IDPs, slightly higher proportion of boys than girls are acutely ‘11/12 to the current Critical. This deterioration is mainly malnourished, stunted and underweight. Additionally, there attributed to reduced food access especially household milk is no statistically significant difference between the female access in Guban1 where following below normal Gu rainfall and male headed households in terms of distribution of acute performance, livestock have been forced to out-migrate in malnutrition, consumption of diversified diets, and access search of water and pasture while those remaining in the to safe water and sanitation facilities. area are weak with low milk production. Out-migration of Pastoral Livelihood Zones livestock often leads to family splitting where women and young children are left behind with inadequate or no milk West Golis, Nugal Valley and Sool Plateau Livelihood access and without saleable animals to cater for food and Zones non-food items and services. In Nugal Valley and Hawd livelihoods where food security is either stable or improved, The current nutrition situation of the populations in both high morbidity and especially measles outbreak in Burao West Golis/Guban and Nugal Valley livelihoods is Very and Ainabo districts has significantly contributed to the Critical, indicating a deterioration from the Serious and
1 For nutrition assessment, West Golis and Guban livelihoods are sampled Critical levels respectively in the Deyr ‘11/12. The results of together as one population and therefore there is one GAM rate, however the nutrition surveys conducted in July 2012 among West food security assessment and classification treat the two livelihoods separately Golis population indicate a GAM rate of 21.7% (17.9-26.1)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 levels, according to UNICEF classification which is similar to levels recored in Deyr ‘11/12 assessments. In Deyr ‘11/12 assessment, the respective crude death rate and under five death rate were 0.54 (0.33-0.89) and 0.27 (0.06-1.13)
Regional Analysis among West Golis; 0.19 (0.09-0.40) and 0.48 (0.15-1.45) among Nugal Valley, and 0.48 (0.22-1.06) and 1.22 (0.19- 60 7.31) in Sool Plateau livelihood. The key nutrition findings in these livelihoods which form the basis of the analysis and classification outcome are provided in table 20.
The deterioration recorded in the two pastoral livelihoods is linked to multiple causes. Severe reduction in household milk access has played a key role in West Golis/Gubban where livestock out migration has left some family member An enumerator conducting an interview in a Hargeisa IDP camp especially women and young children with reduced milk access and without saleable livestock or livestock’s products and a SAM rate of 5.5% (3.7-7.9) indicating a significant to generate income to buy food and other essential goods deterioration (p<0.05) when compared with a GAM rate of and services. In Nugal Valley, outbreak of measles in Burao 13.8% (11.4-16.6) and a SAM rate of 2.2% (1.4-3.5) recorded and Ainabo districs has aggrevated the nutrition situation in the December ‘11 assessment. Similarly, results from with almost half of all acute malnutrition cases identified in an assessment done among the Nugal Valley livelihood the livelihood concentrated in the two districts. It is important population reported a GAM rate of 20.1% (16.5-24.3) and to point out that for the second successive Gu season, Nugal a SAM rate of 5.4% (3.9-7.5), showing a deterioration Valley and West Golis/Guban livelihoods have recorded compared with a GAM rate of 16.3% (13.5-19.6) and a SAM a Very Critical nutrition situation indicating seasonal rate of 5.2% (3.9-6.8), reported in the December 2011. The vulnerability that need targeted response to address change was however not statistically significant (p>0.05). In underlying causes. Appropriate interventions to address Sool plateau, results indicate a sustained Serious nutrition both the short term acute needs such as rehabilitation of situation since Deyr ‘11/12 with a GAM rate of 11.3% (9.3- acutely malnourished children and long term programmes 13.8) and a SAM rate of 1.7% (0.9-3.0) reported in July that address chronic food insecurity, nutrition and health 2012 assessments. This is similar to the GAM rate of 11.6% are vital to address a conspicuous seasonal hunger gaps in (8.7-15.3) and a SAM rate of 3.4% (2.0-5.7) recorded in Gu season especially in West Golis/Guban and underlying December 2011 assessment. The nutrition data from health factors that influencing the health and nutrition situations in facilities in the West Golis and Nugal Valley livelihood zone the area. Concerted efforts to manage and control recurrent indicate a high (>10%) and stable proportion of acutely outbreaks of measles in Togdheer region and Sool regions malnourished children (Figure 31), while in Sool plateau, a need to be imple bmented as a matter of priority. low (<10%) and fluctuating trend is recorded. Morbidity, a key nutrition aggravating factor remain high (>22%) in the Figure 31: HIS Malnutrition Trends in Health Facilities three livelihoods while child feeding practices in terms of in NW West Golis MCHs - January 2011-June 2012 continued breastfeeding, feeding frequency and dietary 35.0 diversity is persistently below the recommended standards. 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) 30.0 The measles immunization and vitamin A supplementation 25.0 status was relatively high but below the recommended Sphere standard of 95%. The CDR and U5DR is 0.24 20.0
(0.11-0.53) and 0.45 (0.10-1.89) respectively among West 15.0
Golis; 0.04 (0.02-0.32) and 0.19 (0.02-1.46) among Nugal 10.0 Valley, and 0.12 (0.05-0.31) and 1.22 (0.13-1.24) in Sool Proportion of Children malnourished 5.0 plateau. These death rates are all within the Acceptable 0.0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 20: Summary of Key Nutrition Findings in West Golis/Guban, Nugal Valley and Sool Plateau Livelihood Zones, July 2012 West Golis/Guban Nugal Valley Sool plateau (N=588: Boys=312; Girls=276) (N=619: Boys=311; Girls=308) (N=748: Boys= 365; Girls=383) Indicator Results Outcome Results Outcome Results Outcome Child Nutrition Status Global Acute Malnutrition (WHZ<-2 20.1 (16.5-24.3)
21.7 (17.9 -26.1) 11.3 (9.3-13.8) Regional Analysis or oedema) 22.2 (17.2-28.5) 27.0 (23.4-31.0) Very Critical Very Critical 13.7 (9.9-18.6) Serious Boys 17.9 (14.4-22.0) 15.8 (9.8-24.4) 9.0 (6.8-11.9) Girls Severe Acute Malnutrition (WHZ<- 5.5 (3.7-7.9) 5.4 (3.9-7.5) 1.7 (0.9-3.0) 61 3 or oedema) 8.4 (6.0-11.5) Critical 6.2 (4.1-9.5) Critical 1.4 (0.6-3.4) Acceptable Boys 2.2(1.1- 4.5) 4.6 (2.9-7.4) 1.9 (1.0-3.7) Girls Mean of Weight for Height Z -1.06±1.15 Critical - 0.96±1.19 Serious -0.67±1.08 Alert Scores Oedema 0 Very Critical 0.6 Very Critical 0 Acceptable Global Acute Malnutrition (NCHS) 22.1 (18.1-26.0) Very Critical 20.0 (16.4-24.2) Very Critical 11.9 (9.4-15.1) Serious Severe Acute Malnutrition (NCHS) 2.6(1.5-4.5) Alert 2.4 (1.5-3.9) Acceptable 2.0 (1.2-3.5) Acceptable Proportion with MUAC<12.5 cm or oedema) 6.5 (4.5-9.2) 2.8 (1.5-4.9) 2.7 (1.7-4.1) Serious Alert Alert Boys 5.4 (3.5-8.5) 3.2 (1.5-4.9) 1.9 (1.0-3.6) Girls 7.6 (4.6-12.3) 2.3 (1.0-5.0) 3.4 (2.0-1.3) Proportion with MUAC<11.5 cm or 1.2 (0.5-2.7) 1.5 (0.9-2.7) 0.5 (0.2-1.3) oedema 1.6 (0.7-3.8) Serious 1.5 (0.7-3.4) Serious 0.5 (0.1-2.2) Acceptable Boys 0.7 (0.2-3.0) 1.6 (0.7-3.5) 0.5 (0.1-2.1) Girls Stunting (HAZ<-2) 9.0 (6.7-12.1) 5.2 (3.5-7.7) 12.0 (9.0-15.9) Boys 12.9 (9.0-18.0) Alert 6.1 (3.8-9.7) Alert 16.2 (11.5-22.5) Serious Girls 4.7 (2.9-7.7) 4.2 (1.9 -9.3) 8.0 (5.3-11.7) Underweight (WAZ<-2) 16.8 (13.1-21.2) 14.6 (12.2-17.4) 11.6 (8.5-15.6) Boys 23.2(18.4-28.6) Alert 16.5 (12.1-22.0) Alert 12.6 (8.5-18.2) Alert Girls 9.5 (5.9-14.9) 12.7 (9.2-17.4) 10.7 (7.4-15.2) High (>20% High (>10%) and stable and stable Malnutrition Trends at Health Low (<10% and trend of acutely Very Critical trend of acutely Serious Alert facilities (January – July 2012) trend malnourished malnourished children in MCHs children in MCHs Proportion of acutely malnourished 9.4 19.8 15.8 children in SFs 9.5 Very Critical 22.9 Very Critical 12.7 Very Critical Boys 9.3 16.1 20.0 Girls Child Morbidity & Immunization Measles outbreak in Burao and Ainabo Morbidity- 29.3 Morbidity-22.3 distritcs Boys- 31.1 Boys-21.7 Morbidity- 23.9 Girls-27.2 Girls-23.0 Disease trends (seasonally adjusted) Boys-24.8 Diarrhoea– 12.9 Diarrhoea – 7.8 Morbidity refers to the proportion Girls-23.1 Boys- 13.8 Very Critical Very Critical Boys-6.8 Very Critical of children reported to be ill in the 2 Diarrhoea – 8.1 Girls- 12.0 Girls-8.7 weeks prior to the survey Boys-9.6 Pneumonia- 3.9 Pneumonia- 6.4 Girls-6.5 Boys-4.5 Boys-5.7 Pneumonia- 8.1 Girls- 3.3 Girls-7.1 Boys-8.7 Girls-7.5 Vitamin A –72.8 Vitamin A –74.8 Vitamin A- 78.3 Boys- 74.0 Serious Boys-76.5 Serious Boys-79.4 Serious Girls- 71.4 Girls-73.1 Girls-77.3 Immunization Status Measles –75.3 Measles – 77.2 Measles – 74.5 Boys-75.3 Serious Boys-77.8 Serious Boys- 75.1 Serious Girls-75.4 Girls-76.6 Girls-73.9 Infant and Young Child Feeding N=183 N=217 N=249 (6-24 Months) Proportion still breastfeeding 52.0 43.3 42.5 Boys 47.2 Alert 39.5 Serious 39.2 Serious Girls 57.1 47.2 45.8 Proportion meeting recommended 38.8 45.6 29.1 feeding frequencies 37.5 Critical 50.1 Critical 31.5 Very Critical Boys 40.0 40.1 26.7 Girls Proportion who reported to have 100 96.3 95.6 consumed <4 food groups 100 Very Critical 95.4 Very Critical 94.4 Very Critical Boys 100 97.2 96.8 Girls Death Rates Crude deaths, per 10,000 per day 0.24 (0.11-0.53) Acceptable 0.04 (0.01-0.32) Acceptable 0.12 (0.05-0.31) Acceptable (retrospective for 90 days) Under five deaths, per 10,000 per 0.45 (0.10-1.89) Acceptable 0.19 (0.02-1.46) Acceptable 0.40 (0.13-1.24) Acceptable day (retrospective for 90 days) Women Nutrition and Immunization Status Proportion of acutely malnourished N=318 N=299 N=268 non pregnant/lactating women Serious Acceptable Acceptable 0.5 (0.0-1.6) 0 0 (MUAC <18.5 cm) Proportion of acutely malnourished N=260 N=136 N=228 Acceptable pregnant and lactating women 4.6(0.0-13.9) 2.9 (0.0 -7.2) 0 (MUAC<21.0)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Summary of Key Nutrition Findings in West Golis/Guban, Nugal Valley and Sool Plateau Livelihood Zones, July 2012-Continued Proportion of acutely malnourished N=260 N=136 N=228 pregnant and lactating women Critical Acceptable Acceptable 28.1(8.6-47.6) 10.6 (1.7-19.4) 0 (MUAC<23.0) Proportion of Women who received Tetanus immunization Regional Analysis No dose 29.7 24.7 16.8 One dose 19.5 23.8 17.8 Serious Serious Serious Two doses 18.1 16.2 34.0 62 Three doses 32.7 35.4 31.3 Public Health Indicators N= 349 N= 425 N=351 Household with access to 40.4 57.6 67.5 sanitation facilities 40.5 Very Critical 56.7 Critical 66.0 Critical Male Headed 39.4 60.2 81.4 Female Headed Household with access to safe 39.8 12.3 10.2 water 37.7 Very Critical 7.1 Very Critical 10.3 Very Critical Male Headed 60.6 28.9 9.3 Female Headed Food Security Proportion who reported to have 12.9 11.7 1.6 consumed <4 food groups 11.4 Acceptable 12.3 Acceptable 1.8 Acceptable Male Headed 27.3 9.6 0 Female Headed Household’s Main Food Source- 68.5 97.2 93.7 Purchase 67.1 Acceptable 96.6 Acceptable 94.2 Acceptable Male Headed 81.8 98.8 90.7 Female Headed Serious Serious Food security phase Crisis Stressed Stressed Serious Overall Risk to Deterioration Unstable Unstable Stable Serious Overall Situation Analysis Very Critical Very Critical
East Golis/Gebbi Valley and Hawd Livelihood Zones children recorded in these facilities (Figure 32). In East Golis of NW livelihoods, data from health facilities shows a high (>10%) The integrated nutrition analysis of East Golis/Gebbi Valley and fluctuating trend of acutely malnourished children which is livelihood indicates a sustained Serious nutrition situation similar to trends observed in 2011 indicating a stable nutrition since the Post Deyr ‘10/11. A nutrition survey among the situation. Good access to milk at household level in East population in this livelihood in July 2012 reported a GAM Golis/Gebbi Valley livelihoods, better access to humanitarian rate of 13.6% (10.5-17.5) and a SAM rate of 2.6% (1.5- support and income from the sale of frankincense are key 4.5), showing similar results with those of December ‘11 mitigating factors to acute malnutrition. The retrospective assessment when a GAM rate of 10.5% (7.4-14.7) and a crude and under five death rates of0.26 (0.09-0.75) and 0.47 SAM rate of 0.8% (0.3-2.8), were reported. On the other (0.11- 1.95) respectively in Hawd and of 0.18 (0.06-0.49) and hand, integrated nutrition analysis among the Hawd 0.36 (0.09-1.52) in East Golis/Gebbi Valley livelihood, are all pastoral population indicates a Critical nutrition situation, within the Acceptable level according to UNICEF classification. a significant deterioration from theSerious level recorded in These show similar levels as the retrospective crude and under Deyr ’11/12 season. A nutrition survey conducted in July ‘12 five death rates of 0.78 (0.50-1.21) and 0.19 (0.02- 1.50) in among the Hawd pastoral population reported a GAM rate Hawd and 0.59 (0.27-1.27) and 0.75 (0.28-2.00) in East Golis/ of 16.7% (11.5-23.5) and a SAM rate of 4.2% (2.3-7.6) which Bebbi Valley livelihood respectively reported in Deyr ‘11/12 indicates a significant deterioration from rates recorded in a assessments. The key nutrition findings in these areas which similar assessment in December 2011, when a GAM rate form the basis of the analysis in the classification outcome, of 10.7% (8.4-13.6) and a SAM rate of 1.8% (0.9-3.6) (Pr= are provided in Table 21. 93.4%) was recorded. The deterioration among the Hawd livelihood group is largely linked to high (>20%) morbidity, Figure 32: HIS Malnutrition Trends in Health Facilities in NW Hawd MCHs - January 2010-June ’12 especially the outbreak of measles in Burao district reported 30.0 since March 2012. Morbidity in Hawd livelihood showed a 2011 2012 2 per. Mov. Avg.(2011) 2 per. Mov. Avg.(2012) statistically significant association with acute malnutrition 25.0
where children who were reportedly sick in two weeks prior 20.0 to the assessment were almost two times more likely to be 15.0 malnourished as compared to those who were not sick. (RR=1.62: 1.03-2.54) 10.0 Proportion of Children malnourished 5.0 The analysis of nutrition data from health facilities in Hawd 0.0 areas of Northwest indicates Critical levels of malnutrition with Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec high (>15%) and stable proportions of acutely malnourished
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Agro-pastoral Livelihood Zones: Awdal/Galbeed and The death rates from the current assessments indicate Togdheer Agropastoral sustained Acceptable mortality levels with CDR of 0.21 The Northwest agro-pastoral zone comprises the agro- (0.05-0.75) and U5DR of 0.36 (0.09-1.52). These rates are pastoralists of Togdheer who are more pastoral than agro- similar to those reported in Deyr ‘11/12 assessment when pastoralist and mainly grow grass/hay for livestock and the
CDR of 0.05 (0.0-0.10) and U5DR of 0.28 (0.15-0.53) was Regional Analysis agro-pastoralist of Awdal and Galbeed Regions who mainly recorded. practice crop farming alongside keeping different types of 63 livestock. The integrated nutrition situation analysis of the Across all livelihoods in Northwest region, both pastoral and Northwest agro-pastoral population indicates a sustained agro-pastoral population in the rural areas are characterized Serious nutrition situation since Post Deyr ‘10/11.The with persistent sub-optinmal child feeding practices where nutrition assessment conducted among these agro-pastoral children are breastfed for short period, are fed infrequently population in July 2012 reported a GAM rate of 13.5% (10.3- and on poorly diversified diets. In addition, limited access 17.3) and a SAM rate of 1.1% (0.5-2.6) indicating a sustained to safe water, sanitation and health facilities is evidenced Serious nutrition situation, similar to levels recorded in across rural livelihoods, predisposing children to diarrhoeal the December ‘11 assessment when a GAM rate of 10.1% disease. Morbidity trends are persistently high in these (7.1-14.1) and a SAM rate of 2.6% (1.4-4.9) were reported. livelihoods. Provision of safe drinking water, adequate Morbidity is relatively low (12.2%) as compared to the health and sanitation facilities and improvement of child other livelihoods in Northwest and is within the seasonal care and feeding practices remain crucial issues that trend for the area. The nutrition data from health facilities require immediate interventions and sustained efforts. The indicates a high (>10%) and fluctuating proportion of acutely key nutrition findings in these areas which form the basis malnourished children reflecting aSerious nutrition situation. of the analysis in the classification outcome are provided in Table 21.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 21: Summary of Key Nutrition Findings in Hawd, East Golis and Agro-pastoral Livelihood Zones, July 2012 The Hawd Livelihood Zone East Golis/Gebbi Valley Agro-pastoral Zone (N=410: Boys=215; Girls=195) (N=504: Boys=232; Girls=272) (N=451:Boys=233; Girls=218) Indicator Results Outcome Results Outcome Results Outcome Child Nutrition Status
Regional Analysis Global Acute Malnutrition 16.7 (11.5-23.5) 13.6 (10.5-17.5) 13.5 (10.3-17.3) (WHZ<-2 or oedema) 18.8 (12.0-28.1) Critical 18.0 (13.9-23.0) Serious 17.0 (12.3-32.9) Serious Boys 14.4 (9.7-20.9) 9.8 (5.9-15.8) 9.7 (6.8-13.6) 64 Girls Severe Acute Malnutrition 4.2 (2.3 -7.6) 2.6 (1.5-4.5) 1.1 (0.5-2.6) (WHZ<-3 or oedema) 5.8 (3.2-10.2) Serious 2.2 (0.9-5.0) Alert 0.9 (0.2-3.6) Acceptable Boys 2.6 (0.9-6.9) 3.0(1.4-6.2) 1.4 (0.5-4.2) Girls Mean of Weight for Height Z Scores - 0.90±1.14 Serious -0.69±1.14 Alert - 0.68±1.16 Alert Oedema 0 Acceptable 0.2 Very Critical 0 Acceptable Global Acute Malnutrition (NCHS) 17.6 (12.7-24.0) Critical 14.2 (10.7-18.6) Serious 12.4 (8.9-17.0) Serious Severe Acute Malnutrition (NCHS) 2.7 (1.6-4.5) Alert 2.0 (1.0-3.9) Acceptable 0.4 (0.1-1.8) Acceptable Proportion with MUAC <12.5 cm or 5.6 (3.6-8.7) 4.8 (3.2-7.1) 2.2(1.2-4.2) oedema 5.1 (2.8-9.2) Serious 5.6 (3.5-8.9) Alert 2.6 (1.2-5.3) Alert Boys 6.2 (3.1-12.0) 4.0 (2.3-7.0) 1.8 (0.7-4.7) Girls Proportion with MUAC <11.5 cm or 1.2 (0.4-3.3) 0.8 (0.3-2.0) 0.2 (0.0-1.7) oedema 1.4 (0.3-5.9) Serious 0.9 (0.2-3.6) Acceptable 0 Acceptable Boys 1.0 (0.2-4.2) 0.7 (0.2-3.0) 0.5 (0.1-3.5) Girls Stunting (HAZ<-2) 1.5 (0.5-4.4) 3.4 (1.9-6.1) 5.1 (3.2-8.1) Boys 0.9 (0.2-3.7) Acceptable 4.4 (2.1-8.8) Acceptable 7.3 (4.5-11.7) Alert Girls 2.1 (0.6-6.5) 2.6 (1.6-6.4) 2.8 (1.2-6.3)
Underweight (WAZ<-2) 15.4 (11.1-20.8) 7.4 (5.0 -10.8) 8.2 (5.4-12.3) Boys 17.2 (11.7-24.6) Alert 11.7 (7.6 -17.6) Acceptable 11.6 (6.9-18.7) Acceptable Girls 13.3 (8.9-19.5) 3.7 (1.4-9.4) 4.6 (2.8 -7.4)
Malnutrition Trends at the health facilities High (>15%) and Low (<10%) and High (>10%) and Critical Alert Serious (Janauray- July 2012) stable trends increasing trend fluctuating trend.
17.1 12.3 1.8 Proportion of acutely malnourished 14.6 Very Critical 17.1 Very Critical 2.6 Very Critical children in SFs 20.7 6.3 0 Child Morbidity & Immunization Measles outbreak in Burao district Morbidity- 12.3 Morbidity- 12.2 Morbidity-22.8 Boys-12.5 Boys-11.6 Boys-21.6 Girls-12.1 Girls-12.8 Disease trends (seasonally adjusted) Girls-24.1 Diarrhoea – 5.8 Diarrhoea– 5.6 Morbidity refers to the proportion of children Diarrhoea– 8.5 Very Critical Boys-6.5 Critical Boys-6.3 Critical reported to be ill in the 2 weeks prior to Boys- 7.9 Girls-5.1 Girls-4.8 the survey Girls-9.2 Pneumonia-3.4 Pneumonia-1.6 Pneumonia- 4.4 Boys-3.4 Boys-1.7 Boys-5.1 Girls-3.3 Girls-1.4 Girls-3.6 Vitamin A– 75.4 Vitamin A– 66.4 Vitamin A-64.5 Critical Critical Boys- 75.3 Serious Boys-65.9 Boys-70.0 Girls-75.4 Girls-66.9 Girls-58.7 Immunization Status Measles – 67.6 Measles – 64.1 Measles –66.7 Critical Critical Boys-69.3 Critical Boys- 65.1 Boys-72.1 Girls-65.6 Girls-63.2 Girls-61.0 Infant and Young Child Feeding (6-24 N=177 N=183 N=155 Months) Proportion still breastfeeding 30.8 54.8 43.1 Boys 29.9 Serious 46.4 Alert 47.9 Serious Girls 31.9 60.0 39.0 Proportion meeting recommended 45.8 feeding frequencies 30.8 Critical 51.4 Critical Critical 51.4 Boys 32.2 45.3 41.5 Girls 29.2 56.7 Proportion who reported to have 36.2 100 95.4 consumed <4 food groups 31.2 Critical 100 Very Critical 94.4 Very Critical Boys 41.7 100 96.3 Girls Death Rates Crude deaths, per 10,000 per day 0.26 (0.09-0.75) Acceptable 0.18 (0.06-0.49) Acceptable 0.21 (0.05-0.79) Acceptable retrospective for 90 days) Under five deaths, per 10,000 per day 0.47 (0.11-1.95) Acceptable 0.36 (0.09-1.52) Acceptable 0.36 (0.09-1.52) Acceptable retrospective for 90 days)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Summary of Key Nutrition Findings in Hawd, East Golis and Agro-pastoral Livelihood Zones, July 2012-Continued
Women Nutrition and Immunization Status
Proportion of acutely malnourished non Regional Analysis N=239 N=334 N=231 pregnant/lactating women (MUAC <18.5 Acceptable Serious Acceptable 0 0 0 cm) Proportion of acutely malnourished pregnant and lactating women 4.7 (0.2-9.1) 2.4 (0.0-7.5) 0.8 (0.0-2.5) 65 (MUAC<21.0 cm) Proportion of acutely malnourished N=127 N=172 N=208 pregnant and lactating women Alert Alert Acceptable 16.3 (5.4 -27.2) 14.6 (0.0-35.1) 6.5 (0.9-12.0) (MUAC<23.0 cm) Proportion of Women who received Tetanus immunization No dose 31.2 22.4 19.0 One dose 27.9 13.4 14.8 Serious Serious Alert Two doses 23.3 33.8 40.0 Three doses 17.6 30.6 26.3 Public Health Indicators N= 237 N= 271 N=269 Household with access to sanitation 38 28.4 15.2 facilities 40.1 Very Critical 29.1 Very Critical 16.0 Very Critical Male Headed 30.9 24.3 7.7 Female Headed Household with access to safe water 11.0 20.9 8.6 Male Headed 10.4 Very Critical 16.0 Very Critical 8.6 Very Critical Female Headed 12.7 39.7 7.7 Food Security Proportion who reported to have 28.7 10.4 consumed <4 food groups 2.2 29.4 9.9 Male Headed 2.6 27.9 Critical Acceptable 15.4 Alert Female Headed 0 Household’s Main Food Source-Purchase 96.2 98.5 90.7 Male Headed 96.7 Acceptable 98.3 Acceptable 90.5 Acceptable Female Headed 94.5 100 92.3 Food security phase Stressed Serious Stressed Serious Stressed Serious
Overall Risk to Deterioration Stable Stable Stable Overall Situation Analysis Critical Serious Serious
IDPs of the North West: Hargeisa, Burao and Berbera
The integrated nutrition situation analysis of the Northwest However, it is important to note that although the current GAM IDPs populations indicates a sustained Serious and Critical rate indicates a change in the nutrition situation classfication nutrition sitaution among the Hargeisa and Berbera IDPs as it is below 20%, the change is not statistically significant respectively, and an improvement in Burao IDPs from Very (Pr<75%). It is anticipated that the nutrition situation among Critical to Critical. The results of a nutrition assessment these IDPs will continue improving as has been seasonally conducted among the IDPs in Hargeisa town in June 2012 observed in Deyr seasons when livestock-related export reported a GAM rate of 12.0% (9.2-15.5) and a SAM rate of casual labour opportunities increases in Burao town during 2.9% (1.7-4.8), rates which are similar to the a GAM rate of Haji festivities. Availability of casual labour provide income 12.0% (8.9-16.1) and a SAM rate of 1.3% (0.7-2.3) reported which is key among the IDPs who rely on food purchase as in November ’11 assessment. Among the Berbera IDPs, a major source of food. Figure 33 shows historical trend of a GAM rate of 16.3% (13.6-19.3) and a SAM rate of 3.5% acute malnutrition 2007-2012. (2.1-5.6) was recorded in June 2012 assessments indicating Figure 33: Trend in Levels of acute Malnutrition (WHZ<-2 a stable Critical nutrition situation. These results are within or oedema, WHO 2007) in Northwest Regions Region, 2007-2012 similar nutrition levels as the findings of an exhaustive nutrition survey in November ‘11 when a GAM rate of 18% 30% and SAM rate of 3.1% were recorded.
In Burao IDPs assessment, a GAM rate of 18.4% (14.7-22.7) 15%
and a SAM rate of 4.3% (2.6-6.9) are reported indicating a % Malnourished
Critical nutrition situation and a slight improvement from the 0% 1 1 1 1 1 1 Very Critical situation reported in November ’11 assessment Apr 09 Apr 09 Apr 09 Jun-12
Jun 10 Jun 10 Dec 09 July 08 Sep 07 Jun 10 Dec 09 Dec 08 Dec 08 Dec 09 Sep 07 Sep 07 Jun 2012 Dec 20 1 Dec 20 1 Dec 20 1 May 20 1 May 20 1 May 20 1 Dec 2010 Dec 2010 Dec 2010 when a GAM rate of 20.3% (15.3-26.3) and a SAM rate of June 2012 Hargeisa IDPs Burao IDPs Berbera IDPs 4.5% (2.6-7.9) was recorded.
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 22: Summary of Key Nutrition Findings for Hargeisa, Burao and Berbera IDPs, June 2012
Hargeisa IDPs Burao IDPs Returnees Berbera IDPs Returnees (N=497 Boys=238; Girls=259) (N=517: Boys=257; Girls=260) (N=555 Boys=257; Girls=260) Indicator Results Outcome Results Outcome Results Outcome Child Nutrition Status Global Acute Malnutrition (WHZ<-2 or 12.0 (9.2-15.5) 18.4 (14.7-22.7) 16.3 (13.6-19.3)
Regional Analysis oedema) Critical Critical 14.9 (10.9-20.0) Serious 23.36 (18.2-29.4) 19.0 (14.8-24.0) Boys 9.2 (6.2-13.6)) 13.5 (9.8-18.2) 13.6 (10.0-18.1) Girls Severe Acute Malnutrition (WHZ<-3 or 2.9 (1.7-4.8) 4.3 (2.6-6.9) 3.5 (2.1-5.6) oedema) 66 3.8 (2.2-6.7) Alert 5.4 (3.1-9.5) Serious 4.4 (2.3-8.2) Serious Boys 2.0 (0.9-4.6) 3.1 (1.5 - 6.4) 2.61 (1.2-5.5) Girls - 0.93 ±1.13 Mean of Weight for Height Z Scores -0.61 ±1.17 Alert Serious -0.94 ±1.06 Serious
Oedema 0.4 Very Critical 0.6 Very critical 0 Acceptable Global Acute Malnutrition (NCHS) Critical Critical 12.3 (8.8-17.0) Serious 19.1 (15.3-23.6) 15.1 (12.9 -17.6) Severe Acute Malnutrition (NCHS) 1.2 (0.5-3.0) Acceptable 3.8 (2.3-6.1) Serious 0.7 (0.3-1.9) Acceptable Proportion with MUAC <12.5 cm or 4.1 (2.4-6.9) 10.3 (7.2-14.5) 4.4 (2.9-6.8) oedema Critical 3.8 (1.7-8.3) Alert 8.3 (4.6-14.5) 2.8 (1.3-5.9) Alert Boys 4.4 (2.5-7.5) 12.2 (8.8-16.8) 6.1 (3.5-10.3) Girls Proportion with MUAC <11.5 cm or oedema 1.4 (0.6-3.5) 3.0 (1.7-5.4) 1.4 (0.6-3.5) Critical Boys 1.3 (0.4-3.9) Serious 2.7 (1.0-6.5) 1.3 (0.4-3.9) Serious Girls 1.6 (0.5-5.3) 3.3 (1.7-6.3) 1.6 (0.5-5.3) 1.4 (0.6-3.3) Stunting (HAZ<-2) 10.7 (7.0-15.9) 8.4 (5.9-11.9) 1.8 (0.7-4.2) Boys 15.7 (10.3-23.1) Serious 12.1 (8.5 -16.8) Alert Acceptable 1.1 (0.3-3.4) Girls 6.0 (3.3-10.8) 4.9 (2.7-8.7) Underweight (WAZ<-2) 13.3 (9.7-18.1) 16.8 (13.2-21.1) 9.6 (7.3-12.6) Boys 16.1 (11.5 -22.0) Alert 22.0 (16.7-28.5) Alert 12.3 (8.9-16.8) Acceptable Girls 10.8 (6.8-16.6) 11.7 (8.3-16.2) 6.8 (4.2-11.0) Low (<10%) but Low (<5%) and High (>10%) and HIS Nutrition Trends(January – July 2012) Alert Alert Serious increasing stable trend fluctuating Proportion of acutely malnourished children - - in SFs Child Morbidity & Immunization
Morbidity-31.8 Morbidity-40.3 Morbidity-20.7 Boys-31.5 Boys-42.0 Boys-21.5 Girls-32.0 Girls-38.5 Girls-20.0 Disease trends (seasonally adjusted) Diarrhoea– 20.3 Diarrhoea– 27.0 Diarrhoea– 8.0 Morbidity refers to the proportion of children Boys- 21.4 Very Critical Boys- 29.5 Very Critical Boys- 8.8 Very Critical reported to be ill in the 2 weeks prior to the Girls-19.3 Girls-24.4 Girls-7.1 survey Measles- 4.2 Measles- 6.6 Measles- 3.4 Boys-2.5 Boys-8.3 Boys-3.9 Girls-5.8 Girls-4.8 Girls-2.9
Vitamin A– 84.5 Vitamin A– 75.4 Vitamin A– 82.0 Boys- 83.6 Alert Boys- 75.3 Serious Boys- 83.0 Serious Girls-85.3 Girls-75.4 Girls-81.1 Immunization Status Measles – 83.7 Measles – 67.6 Measles – 77.5 Boys- 82.8 Alert Boys-69.3 Serious Boys-77.5 Serious Girls- 84.6 Girls-65.6 Girls-76.4 Infant and Young Child Feeding (6-24 Months) Proportion still breastfeeding 47.1 38.3 54.9 Boys 45.9 Serious 41.0 Serious 54.0 Alert Girls 48.1 36.0 55.8 Proportion meeting recommended feeding frequencies 41.0 Critical 21.8 Critical 45.1 Critical Boys 38.8 20.5 46.0 Girls 43.0 22.8 44.2 Proportion who reported to have consumed <4 food groups 95.6 100 96.7 Boys 96.5 Very Critical 100 Very Critical 100 Very Critical Girls 95.0 100 93.2 Death Rates Crude deaths, per 10,000 per day 0.14 (0.03-0.61) Acceptable 0.50 ( 0.28-0.88) Serious 0.49 (0.39-0.79) Acceptable retrospective for 90 days) Under five deaths, per 10,000 per day 0.21 (0.03-0.61) Acceptable 1.01 (0.36-2.80) Serious 0.74 (0.28-19.7) Acceptable retrospective for 90 days) Women Nutrition and Immunization Status Proportion of acutely malnourished non N=140 N=165 N=229 pregnant/lactating women (MUAC <18.5 Acceptable Very Critical Acceptable 0 2.2 (0-4.6) 0 cm) Proportion of acutely malnourished pregnant and lactating women 0 0 1.5 (0.0- 4.4) (MUAC<21.0) Proportion of acutely malnourished N=127 N=100 N=138 pregnant and lactating women Acceptable Acceptable Acceptable 2.3 (0.0-4.9) 12.4 (4.9-19.8) 5.1 (1.4-8.7) (MUAC<23.0)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Summary of Key Nutrition Findings for Hargeisa, Burao and Berbera IDPs, June 2012-Continued Proportion of Women who received Tetanus immunization 12.1 (7.8 -16.4) 5.3 (2.6-8.08) 22.1 (16.8-27.5) No dose 20.7 (14.8-26.6) Critical 5.6 (2.5-8.8) 14.5 (9.4-19.6) One dose 29.3 (23.4-35.2) 33.5 (24.1- 42.9) 30.2 (23.5-37.0) Critical Very Critical Two doses 37.9 (31.0-44.7) 55.5 (45.4-65.6) 33.2 (26.8-39.6) Three doses Regional Analysis Public Health Indicators Household with access to sanitation 87.8 82.8 96.1 facilities 89.1 Alert 82.5 Alert 96.1 Acceptable Male Headed 67 83.8 83.1 95.9 Female Headed Household with access to safe water 100 95.4 97.9 Male Headed 100 95.5 Acceptable 98.2 Acceptable Acceptable Female Headed 100 95.2 95.9 Food Security Proportion who reported to have consumed <4 food groups 4.5 43.7 13.0 Critical Male Headed 4.6 Acceptable 40.4 13.0 Serious Female Headed 4.1 50.6 12.2 88.0 Household’s Main Food Source-Purchase 100 73.6 97.4 Male Headed 100 70.2 Acceptable Acceptable 97.5 Acceptable Female Headed 100 84.2
Food security phase Stressed Stressed Stressed
Overall Risk to Deterioration Stable Stable Stable Overall Situation Analysis Serious Critical Critical
The mortality rates are within acceptable UNICEF levels in and health facilities. High morbidity rates that persist among Hargeisa with crude death rates (CDR) of 0.14 (0.03-0.61) the assessed IDPs also need to be addressed through both and under five death rate of 0.21 (0.03-0.61) and among curative and preventive measures. In the absence of a stable the Berbera IDPs with recorded CDR of 0.49 (0.39-0.79) livelihood system among the displaced populations, they and U5DR of 0.74 (0.28-19.7). In Burao IDPs assessment are constantly faced with chronic food insecurity and poor an Alert CDR of 0.50 (0.28-0.88) and a Serious U5DR of nutrition situation. Access to basic services such as safe 1.01 (0.36-2.80) was reported. These rates are similar to the water, good shelter and sanitation facilities remain limited respective crude and under five death rates of 0.31 (0.18- and whatever is available is dependent on humanitarian 0.54) and 0.14 (0.02-1.11) recorded among Burao IDP, 0.38 assistance. Continued monitoring to assess the constantly (0.20-0.71) and 0.44 (0.14-1.40) among Hargeisa IDPs, and changing food security and nutrition situation among the 0.37 (0.18-0.76) and 1.27 (0.55-2.95) reported among the IDPs should be maintained, so as to provide up-to-date Berbera IDPs in November 2011 assessments. information that will guide on appropriate interventions to meet the needs of this vulnerable group. A long term Morbidity levels remain high among IDP populations in solution such permanent settlement of the protracted IDPs the three host towns, with the reported morbidity in the will be required in the long run for the people to have stable two weeks prior to the assessment of 31.8% in Hargeisa , livelihood and bring to an end the humanitarian dependence 40.3% in Burao and 20.7% in Berbera. Household dietary status of the displaced people in Somaliland. diversity remains a concern among the displaced population and especially among the Burao IDPs where nearly a half Gender and nutrition analysis in North West Regions (43.7%) of the households were consuming poorly diversified Analysis of the nutrition data in the assessed rural diets comprised of three or fewer food groups. Access to livelihoods as well as among the internally displaced basic human services such as access to safe water and populations shows no statistically significant differences sanitation facilities among the IDPs is relatively better than in the distribution of the acute malnutrition cases between among the rural populations but it is highly dependent on boys and girls. In addition, there was no statistically humanitarian support. The key nutrition findings in these significant difference in the distribution of stunting and areas which form the basis of the analysis are provided in underweight between boys and girls in the assessed Table 22. rural and IDPs populations. This is with exception of the population in Sool plateau, Hargeisa and Burao IDPs Immediate interventions to rehabilitate acutely malnourished where a significantly higher proportion of boys than children and address food and health needs are required. girls was stunted and in West Golis where significantly Income generation activities to boost the economic status higher boys (12.9% (9.0-18.0) than girls 4.7% (2.9-7.7) of the displaced population are needed, these interventions was underweight (P<0.05). In all other rural livelihoods should also be backed by long term interventions such as and IDPs populations, more boys than girls are acutely improved child care and feeding practices, improved dietary malnourished, stunted and underweight with exception of diversity and enhanced access to safe water and sanitation Hawd livelihoods where slightly more girls than boys are
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 stunted but the differences were statistically insignificant than girls was ill, better fed or had higher access to health (p>0.05). For example, in Nugal valley, 22.2% (17.2-28.5) and nutrition services while the opposite was true in other of boys compared with 17.9% (14.4-22.0) of girls were surveys. The differences were however not statistically acutely malnourished; 6.1% (3.8-9.7) of boys as opposed significant (p>0.05).
Regional Analysis to 4.2% (1.9-9.3) of girls were stunted; and 16.5% (12.1- 22.0) of boys compared to 12.7% (9.2-17.4) of girls were At the household level, results showed a large majority 68 underweight. This disparity is likely given the use of the (~80%) of the households assessed were male headed. new WHO 2006 sex-differentiated reference standards, Analysis of the differences of household characteristics such which has been observed to discriminatively identify as consumption of diversified diets, access to basic services more boys as malnourished than girls. With the new WHO such as safe water and sanitation facilities did not show a reference standards, a girl of a certain height has to be clear pattern, whereby in some livelihoods slightly more male much lighter than a boy of the same height to meet the headed households had better access to these services and WHZ<-2 threshold for acute malnutrition. A review of TFC the opposite was true for other livelihoods. These differences data from 13 African countries found that when children were however not statistically significant (p>0.05). It is 6-59 months were admitted using UNISEX tables; there important to point out that due to the small proportion of was no significant difference in the number of boys and the female headed households and unclear definition of a girls admitted and there was no significant difference in the household head in Somalia context, existence/or lack of any 2[1] mortality rate . difference in access to public health services between male The distribution by sex of morbidity cases, childfeeding and female headed households may have been obscured. practices and access to health services such as measles A meta-analysis of a large set of similar studies or a study vaccination and vitamin A supplements showed a mixed designed to capture such households characteristics would pattern where in some surveys a higher proportion of boys address this limitation. The gender disaggregated data by
2 [1] Golden, M., Grellety, Y., Schwartz, H., & Tchibindat, F. (2010). Report sex of the assessed children and sex of the household head of a Meeting to harmonize the criteria for monitoring and evaluation of the per livelihood is summarized on Tables 20,21&22. treatment of acute malnutrition in West and Central Africa. 30th November – 1st December 2010; Dakar, Senegal. Retrieved February 27, 2012 http:// www.ennonline.net/pool/files/ife/consensus-meeting-on-m&e-imam-dakar- 2010-eng.pdf
MATERNAL NUTRITION STATUS IN NORTHWEST In the northwest, a significantly higher proportion of pregnant and/or lactating women were acutely malnourished (MUAC< 23.0 cm) than non-pregnant and non-lactating women (MUAC<18.5 cm) across all livelihoods and among the three IDPs settlements. The proportion of malnourished pregnant and/or lactating women ranged between 2.3% (Acceptable) among the Hargeisa IDPs to 28.1% (Critical) among women in West Golis livelihood while most of the assessed non-pregnant and non-lactating women were not identfied as malnourished with exception of 2.2% in Burao IDPs and 0.5% of the West Golis. The high level of malnutrition among the pregnant and/or lactating women is linked to increased nutrients needs which are not being met.
Proportion of the malnourished women in Northwest Regions
NW/IDPs Pregnant and/or Lactating women Non-pregnant/lactating women Surveyed population Proportion with Proportion with No. Proportion with No. Assessed MUAC<23cm MUAC <21cm Assessed MUAC<18.5 cm Hargeisa IDP 127 2.3 (0.0-4.9) 0 140 0 Berbera IDP 138 5.1 (1.4-8.7) 1.5 (1.4-8.7) 229 0 Burao IDP 100 12.4(4.9-19.8) 0 165 2.2(0.0-4.6) West Golis 260 28.1 (8.6-47.6) 4.6 (0.0-13.9) 318 0.5 (0.0-1.6) NW Hawd 127 16.3 (5.4 -27.2) 4.7 (0.2-9.1) 239 0 NW Agro-pastoral 208 6.5 (0.9-12.0) 0.8 (0.0-2.5) 231 0 Nugal Valley 136 10.6 (1.7-19.4) 2.9 (0.0 -7.2) 299 0 Sool Plateau 228 0 0 268 0 East Golis 172 14.6 (0.0-35.1) 2.4 (0.0-7.5) 334 0
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Strengthening of Infant and Young Child Feeding Programming and Planning for Emergency Preparedness and Response. Regional Analysis The Infant and Young Child Feeding (IYCF) London Workshop (25-29 June 2012)
Infant and young child feeding (IYCF) is core to child health, growth, development and survival. Unfortunately, 69 poor IYCF practices persist in many countries including Somalia where nutrition assessments across the country continue to report sub-optimal child feeding practices. Improved non-emergency IYCF programming is therefore one of the best ways of ensuring good infant and child feeding in emergency (IYCF-E). In light of this, a workshop on Strengthening of Infant and Young Child Feeding Programming and Planning for Emergency Preparedness and Response was jointly organized and funded by the Inter Agency Standing Committee (IASC), Global Nutrition Cluster, IYCN Unit in UNICEF and Save the Children UK and held in London, UK from 25th to 29th June 2012. A total of 68 nutritionist/IYCF experts, representing 22 countries, participated, including the UNFAO-FSNAU Somalia IYCF focal point (See Photo of the participants below).
The main goal of the workshop was to determine how to improve non-emergency infant and young child feeding in (IYCF) programming and learn how to streamline appropriate infant and young child feeding in emergency (IYCF-E) in programming. The specific objectives of the workshop were to ; i. Increase awareness of the importance of IYCF and IYCF-E; ii. Share experiences, challenges, and lessons-learned in IYCF and IYCF-E programming in different contexts; iii. Orient and disseminate IYCF and IYCF-E policies and capacity development tools; Workshop participants iv. Assist in the development of agency/wider consortium action plans.
The workshop used various methods of training including power point presentations, lesson sharing on best practices, discussions, questions and answers session and group work. Among the topics covered included: the current global situation of IYCF and IYCF-E; policies and programming of IYCF and IYCF-E; monitoring and evaluation of IYCF and IYCF-E; IYCF and IYCF-E survey and assessments; funding for IYCF and linking of IYCF and IYCF-E programming.
Major highlights and way forward There is evidence1 showing that optimal IYCF reduces risk of mortality and malnutrition, prevents illness, growth faltering and poor child development and death. However when this is not or is imperfectly achieved in non-emergencies it becomes extra hard in emergencies.
It was further observed that globally, there has been very little improvement in rate of exclusive breastfeeding (EBF) since 1990 and it remains below 40%; Quality of complementary feeding (minimum acceptable diet) remains generally very poor and frequently correlates with high stunting rates. Most countries lack national monitoring systems for IYCF interventions23.
In addition, IYCF-E is often missing or is implemented ad hoc in an emergency response: Often, IYCF programme staff do not have the required skills to tackle the specific IYCF-E needs and the response approaches tend not to focus on additional or special needs of infant and child caregivers in emergencies. IYCF and IYCF-E are strongly linked and inter-related whereby the success of the IYCF-E will depend on the status of IYCF in non-emergency situation. The workshop concluded that protecting and promoting appropriate infant and young child feeding is critical to saving lives, and that strengthening IYCF outside of emergencies is essential to reducing the loss of life when disasters strike. For Somalia, there is a need to improve non-emergency and emergency IYCF programming; build capacity for IYCF and IYCF-E staff, document and disseminate results/impact of IYCF intervention through various channels including publication in peer reviewed journals and impact research; and learn from successful programmes such as CMAM on how to accelerate IYCF initiatives; Advocacy on IYCF at various levels including among donors is required. On donor advocacy, the participants drafted a letter to be sent to various donors calling for donors’ support to ensure that IYCF becomes an essential component of humanitarian action as well as development investments.
1 Lancet Child Survival series 2003 & UNICEF database 2012, from DHS, MICS and national surveys 2 A composite indicator representing the proportion of children who meet the minimum recommended dietary and diversity and feeding frequency 3 UNICEF. IYCF Programming status: Results of 2010-2011 assessment of key action for comprehensive IYCF programmes in 65 contries
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 5. Urban NUTRITION SITUATION
Northwest Urban conducted in July 2012 recorded Results of the nutrition assessments conducted in July 2012 • GAM rate of 15.2% (8.4-25.8) and SAM rate of 2.0% Urban Analysis in the urban centers in Northwest region indicate a sustained (0.8-5.0) in Galgadud and a Serious nutrition situation among the urban population in • GAM rate of 17.4% (13.7-21.8) and SAM rate of 3.7% Awdal region with a GAM rate of 14.9% (11.8-18.7) and 70 (2.5-5.6) in Mudug region. among the Sool region urban with GAM rate of 13.6% In December 2011, MUAC assessments conducted in (8.7-20.7) since Deyr ‘11/12. Nutrition situation among the the urban centres had classified Galgadud and Mudug urban population in Togdheer region has deteriorated from regions as likely Very Critical with 19.2% acute malnutrition Alert in Deyr ‘ 11/12 to Serious with a GAM rate of 14.7% (MUAC<12.5/oedema) rate, thus indicating a likely (10.5-20.3). Among the urban populations in W. Galbeed improvement in the current situation. In Mudug, the findings and Sanaag regions, a sustained Alert nutrition situation indicate a deterioration from Serious phase in December with a GAM rates of 5.2% (3.7-7.3) and 8.1% (5.7-11.3) 2011 when GAM and SAM rates of 14.9% (11.7-18.7) and respectively is recorded. 4.15 (2.4-6.9) were recorded respectively.
Northeast Urban Mogadishu Urban The nutrition situation among the urban populations in the In July 2012, FSNAU and partners conducted a repeat northeast regions is either sustained or has deteriorated nutrition and food security assessments in Mogadishu from the situation in the Deyr ‘11/12. Nutrition assessments Town among the urban and the IDP population, as a way of conducted in July 2012 in the urban areas of Bari region closely monitoring the nutrition and food security situation recorded a GAM rate of 16.5% (13.4-20.2) and a SAM rate of in the town. 3.4% (2.4-5.0), indicating a Critical nutrition situation and a The survey results of the urban population reported GAM deterioration from the Serious situation with GAM and SAM and SAM rates of 10.8% (8.3-13.9) and 1.5% (0.7-3.0) rates of 11.8% (9.1-15.1) and 2.1% (1.3-3.4) respectively, in respectively, the results indicate a sustained Serious December 2011. In Nugal region, a GAM and a SAM rate nutrition situation among the Mogadishu urban population. of 12.6% (10.1-15.7) and 1.8% (0.9-3.4) were recorded The 90 days retrospective crude and under five death rates respectively, indicating a sustained Serious nutrition remain elevated at 1.23 (0.81-1.85) and 1.54 (0.82-2.85) situation to the Deyr ‘11/12 GAM and SAM rates of 11.3% respectively, indicating a Critical situation according to (9.1-13.9) and 3.8% (2.5-5.9). UNICEF classification, although a slight improvement was noted from results in April 2012. For details refer to Banadir Central urban regional surveys. In Central Somalia urban, the nutrition situation is Critical both in Galgadud and Mudug regions. Nutrition assessments
Table 23: Summary of Urban Assessment Findings: Northwest and Northeast Regions – Post Gu ‘12
Population MUAC<11.5 Overall Estimated Nutrition GAM WHO SAM WHO MUAC<12.5 cm Assessed cm Morbidity Situation NORTH WEST REGIONS Awdal 14.9 (11.8-18.7) 1.9 (1.0-3.5) 3.5 (2.0-6.0) 0.9 (0.3-3.1) 7.9 (1.3-14.4) Serious Sustained W. Galbeed 5.2 (3.7-7.3) 0.5 (0.1-1.9) 0.9 (0.3-3.0) 0 8.6 (5.8-11.5) Alert-Sustained Serious-Deteriorated Togdheer 14.7 (10.5-20.3) 3.0 (1.4-6.5) 6.4 (3.9-10.4) 1.8 (0.9-3.7) 25.4 (20.2-30.6) from Alert Sool 13.6 (8.7-20.7) 2.0 (0.9-4.4) 12.4 (8.7-17.3) 4.0 (2.1-7.4) 21.0 (16.0-26.0) Serious-Sustained Sanaag 8.1 (5.7-11.3) 0.7 (0.2-2.1) 5.2 (2.8-9.6) 0.9 (0.3-2.3) 24.1 (19.2-29.1) Alert -Sustained NORTH EAST REGIONS Critical-deterioration Bari (N=656) 16.5 (13.4-20.2) 3.4 (2.4- 5.0) 7.3 (4.5-10.1) 2.1 (0.7-3.6) 28.8 (24.2-33.5) from serious Nugal (N=676) 12.6 (10.1-15.7) 1.8 (0.9- 3.4) 4.7 (2.7-6.8) 1.0 (0.1-2.0) 19.1 (11.4-26.8) Serious -Sustained Critical-- improvement Galgadud (N=457) 15.2 (8.4-25.8) 2.0 (0.8- 5.0) 7.7 (1.8-13.5) 2.2 (0.0-4.8) - from likely Very Critical. Critical- deterioration Mudug (N=620) 17.4 (13.7-21.8) 3.7 (2.5-5.6) 9.0 (5.0-13.1) 2.4 (1.0-3.9) - from Serious
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 6. Plausibility checks
Guidance for use of the Plausibility checks Percent of flag: Flags are measurement that are highly Digit preference DP for weight and height: Indicates how unlikely to occur in nature and are therefore highlighted by Post Deyr 2011/12 Plausibility Checks Nutrition Analysis accurately children were weighed and when done correctly the software. These incoherent measurements should be there shouldn’t be any digit preference. This normally occurs corrected or discarded prior to analysis, 0% flags is ideal but when enumerators round to the nearest cm/kg or half cm/ should be less that 2-3% of children measured. 71 kg. The signs; +, ++, +++ indicate if there was any DP for a number and if it was, mild, moderate or severe, respectively. Age distribution: This allows for a view of the Digit Preference scores for weight and hight are graded representativeness of the sample, and should be similar to as; (0-5 Excellent,> 5-10 Good, >10-20 Accept and > 20 the distribution within the population. Age bias is of particular Problematic) concern for anthropometry. As younger aged (6-29) children are more likely to be malnourished than the older age group Standard Deviation (SD) of WHZ: Indicates whether there (30-59), this means under representation of the younger age was a substantial random error in measurements. In a normal group may give a lower prevalence than the actual one and distribution the SD is equal to +1, but should lie between 0.8 vice versa. The age ratio allows a view of this relationship and 1.2 Z score. SD increases as the proportion of erroneous and should fall between 0.78 and 1.18 with an ideal falling results in the data set increases. around 1.0.
Skewness of WHZ: This is a measure of degree of Sex ratio: Allows a view of the representativeness of the asymmetry of the data around the mean. A normal sample and should be similar to the distribution within the distribution is symmetrical and has zero skewness and population. This should not vary too much from the expected should lie between +1 or -1. Positive skewness indicates a sex ratio and should fall between 0.8 and 1.2. long right tail and negative skewness indicates a long left tail. Poisson Distribution: Tests if cases are randomly Kurtosis of WHZ: This demonstrates the relative distributed or aggregated over the clusters by calculation peakedeness or flatness compared to a normal distribution. of the Index of Dispersion (ID) and comparison with the The normal distribution has zero kurtosis and surveys should Poisson distribution. lie between +1 and -1. Positive kurtosis indicates a peaked distribution while negative indicates a flat one. Table 23 provides a summary of findings on plausibility checks for nutrition assessments conducted in the Gu ’12. Plausibility Checks
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 24: Plausibility checks
Digit Digit Missing/ Overall sex Overall age Preference Preference Skewness Poisson Location Criteria Flagged data ratio distribution score-weight score-Height SD WHZ WHZ Kurtosis WHZ Distribution
Northeast
May-12 Category Excellent Excellent Problematic Excellent Good Excellent Excellent Excellent Acceptable Plausibility Checks
Bossaso IDPs Score 0 0 10 0 2 0 0 0 3 May-12 Category Excellent Excellent Acceptable Excellent Good Good Excellent Excellent Good Garowe IDPs Score 0 0 4 0 2 2 0 0 1 72 May-12 Category Excellent Excellent Problematic Excellent Excellent Good Excellent Excellent Excellent Galkayo IDPs Score 0 0 10 0 0 2 0 0 0
May-12 Category Excellent Excellent Excellent Acceptable Good Problematic Excellent Excellent Excellent
QardhoIDPs Score 0 0 0 4 2 20 0 0 0
May-12 Category Excellent Excellent Good Good Acceptable Acceptable Excellent Excellent Excellent
Dhusamareb IDPs Score 0 0 2 2 4 6 0 0 0
Category Excellent Excellent Excellent Excellent Good Excellent Excellent Excellent Good
East Golis Jul-12 Score 0 0 0 0 2 0 0 0 1
Northwest
Category Excellent Excellent Excellent Good Acceptable Acceptable Excellent Excellent Excellent
Hargeisa IDPs Jul-12 Score 0 0 0 2 4 6 0 0 0
Category Good Excellent Excellent Excellent Problematic Good Excellent Excellent Excellent
Burao IDPs Jul-12 Score 5 0 0 0 10 2 0 0 0
Category Excellent Excellent Acceptable Good Good Excellent Excellent Excellent Excellent
Berbera IDPs Jul-12 0 0 4 2 2 0 0 0
Category Excellent Excellent Acceptable Excellent Acceptable Good Excellent Excellent Good 0 0 4 0 4 2 0 0 1 West Golis Jul-12 Score Category Excellent Excellent Acceptable Excellent Acceptable Acceptable Excellent Excellent Excellent 0 0 4 0 4 6 0 0 0 NW Agropastoral Jul-12 Score Category Excellent Good Excellent Acceptable Good Excellent Excellent Excellent Excellent 0 2 0 4 2 0 0 0 0 East Golis Jul-12 Score Category Excellent Excellent Acceptable Good Good Good Excellent Excellent Problematic 0 0 4 2 2 2 0 0 5 Hawd-NW Jul-12 Score Category Good Excellent Excellent Excellent Good Excellent Excellent Excellent Excellent 5 0 0 0 2 0 0 0 0 Sool plateau Jul-12 Score Category Excellent Excellent Excellent Acceptable Excellent Excellent Excellent Excellent Excellent 0 0 0 6 0 0 0 0 0 Nugal valley Jul-12 Score CENTRAL Category Good Good Acceptable Excellent Excellent Good Excellent Excellent Acceptable Addun Jun-12 Score 5 2 4 0 0 2 0 0 3 Category Excellent Good Excellent Excellent Good Excellent Excellent Excellent Excellent Hawd Jun-12 Score 0 2 0 0 2 0 0 0 0 Coastal Deeh Category Excellent Good Excellent Excellent Good Excellent Excellent Excellent Acceptable Jun-12 Score 0 2 0 0 2 0 0 0 3 Category Problematic Excellent Acceptable Excellent Problematic Problematic Excellent Excellent Problematic
Cowpea Belt Jun-12 Score 20 0 4 0 10 20 0 0 5
Souther regions Category Excellent Acceptable Problematic Excellent Good Excellent Excellent Excellent Good
Mogadishu IDPs Jul-12 Score 0 4 10 0 2 0 0 0 1 Category Good Excellent Acceptable Good Acceptable Good Excellent Excellent Good
Mataban Jul-12 Score 5 0 4 2 4 2 0 0 1 Category Excellent Excellent Excellent Excellent Good Good Excellent Excellent Problematic
Beletweyne Jul-12 Score 0 0 0 0 2 2 0 0 5 Category Excellent Acceptable Problematic Excellent Excellent Acceptable Excellent Excellent Excellent
Mogadishu Urban Jul-12 Score 0 4 10 0 0 6 0 0 0 Category Excellent Good Problematic Good Acceptable Excellent Excellent Excellent Problematic
Bakool Pastoral Jul-12 Score 0 2 10 2 4 0 0 0 5 Category Excellent Excellent Problematic Good Acceptable Excellent Excellent Excellent Good
Bay Pastoral Jul-12 Score 0 0 10 2 4 0 0 0 1 Category Excellent Acceptable Problematic Good Problematic Acceptable Excellent Excellent Problematic
Baidoa IDPS Jul-12 Score 0 4 10 2 10 6 0 0 5 Category Excellent Excellent Good Excellent Problematic Good Excellent Excellent Excellent
North Gedo Riverine Jun-12 Score 0 0 2 0 10 2 0 0 0 Category Excellent Excellent Excellent Excellent Acceptable Good Excellent Excellent Problematic
North Gedo Pastoral Jun-12 Score 0 0 0 0 4 2 0 0 5 Category Excellent Excellent Acceptable Excellent Acceptable Good Excellent Excellent Excellent
Dolow IDPs Jun-12 Score 0 0 4 0 4 2 0 0 0 Category Excellent Excellent Problematic Good Acceptable Good Excellent Excellent Excellent
Juba Agropastoral Jul-12 Score 0 0 10 2 4 2 0 0 0 Category Excellent Good Problematic Excellent Acceptable Excellent Excellent Excellent Excellent
Juba Riverine Jul-12 Score 0 2 10 0 4 0 0 0 0 Category Excellent Excellent Acceptable Good Acceptable Excellent Excellent Excellent Problematic
Juba Pastoral Jul-12 Score 0 0 4 2 4 0 0 0 5 Category Excellent Excellent Problematic Excellent Acceptable Excellent Excellent Excellent Excellent
Kismayu IDP Jul-12 Score 0 0 10 0 4 0 0 0 0 Category Excellent Excellent Acceptable Excellent Acceptable Acceptable Excellent Excellent Excellent
Dobley IDP Jul-12 Score 0 0 4 0 4 6 0 0 0
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Table 26: Summary of Nutrition Assessments (April - July 2012)
GAM based SAM based on WHO on Date of CDR/ U5DR / Affected Region/ 2006 WHO Participating Nutrition Sample 10,000/ 10,000/ Livelihood <-2 Z scores 2006 <-3 Z Oedema Agencies Survey Size Mean WHZ day day or oedema scores/ Post Deyr 2011/12 Survey Findings Nutrition Analysis Summary (%) Oedema (%) 73 Northern regions
1. Guban/West 21.7 5.6 0.24 0.45 Golis 0 588 (17.9-26.1) (3.7-7.9) -1.06±1.15 (0.11-0.53) (0.10-1.89) (Large sample cluster July,2012 survey) 2.East Golis/Gebi 2.6 0.18 0.36 13.6 Karkar (Large sample 504 (1.5-4.5) -0.69±1.14 0.2 (0.06-0.49) (0.09-1.52) July,2012 (10.5-17.5) cluster survey) 1.7 3. Sool Plateau 11.3 0.12 0.40 (0.9-3.0) 0 (Large sample cluster 748 (9.3-13.8) -0.67±1.08 (0.05-0.31) (0.13-1.24) July,2012 survey) 4.Hawd Livelihood 16.7 4.2 0.26 0.47 0 zone (Large sample 410 (11.5-23.5) (2.3-76) -0.90±1.14 (0.09-0.75) (0.11-1.95) July,2012 cluster survey) 5.North West Agro 1.1 0.21 pastoral (Large 13.5 0.36 July ,2012 451 (0.5-2.6) 0.0 (0.05-79) sample cluster (10.3-17.3) -0.68±1.60 (0.09-1.52) survey) 6.Nugal Valley 20.1 5.4 0.04 0.19 0.2 (Large sample cluster July ,2012 (16.5-5.24.3) (3.9 -7.5) -0.96±1.19 (0.01-0.32) (0.02-1.46) 619 survey) 7. East Golis/Karkar 13.9 4.1 0.11 0.15 Gaagab Dharror July ‘12 575 (10.8-17.6) (2.6-6.5) -0.89 ±1.08 0.0 (0.03-0.34) (0.02-1.18) (Large sample cluster FSNAU , survey) UNICEF, MOHL. 8.Coastal Deeh SRCS, (Large sample cluster SDRA AID 12.8 3.5 0.56 1.34 June 2012 385 -0.77 ±1.09 0.3 survey) ORGANIZATION (8.7-18.4) (1.7-6.8) (0.27-1.14) (0.73-2.44)
Northern IDPs 9. Garowe IDPs 19.2 4.7 0.43 0.59 (Large sample cluster 821 (15.9–23.1) (3.2 –6.8) 0.2 (0.25-0.75) (0.25-0.75) May,2012 -0.97 ±1.15 survey) 0.61 10. Bossaso IDPs 18.7 3.9 0.33 May,2012 0.2 (0.28-1.32) (Large sample cluster 899 (15.7-22.1) (2.8-5.4) -1.06 ±1.05 (0.15-0.73) survey) 11. Galkayo IDPs 19.2 4.1 0.22 0.62 0.2 (Large sample cluster 997 (16.1-22.8) (3.0-5.6) -1.04 ±1.11 (0.11-0.43) (0.27-1.44) May,2012 survey) 12.Burao IDPs 18.4 4.3 0.5 1.01 0.6 (Large sample cluster July 2012 517 (14.7-22.7) (2.6-6.9) -0.93±1.13 (0.28-0.88) (0.36-2.80) survey)
13.Hargeisa IDPs 2.9 0.14 0.21 12.0 0.4 (Large Sample July 2012 497 (1.7-4.8) -0.61±1.17 (0.03-0.61) (0.03-1.65) (9.2-15.0) cluster survey)
14. Berbera IDPs 3.5 0.74 16.3 0.49 (Large sample cluster July 2012 517 (2.1-5.6) -0.94±1.06 0 (0.28-1.97) (13.6-19.3) (1.4-8.7) survey)
21.7 5.6 15. Qardho IDPs May,2012 198 (16.8-27.6) (3.3-9.2) -0.83 ±1.37 0.5 (Small sample IDPs)
Central Regions
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Summary of Nutrition Assessments (April - July 2012) continued 22.0 5.0 16.Dhusamareb IDPs May 2012 200 (16.1-29.3) (2.5-9.8) 0.5 - - (Small sample IDPs)
17. Hawd Pastoral 11.2 1.8 0.38 0.50
Post Deyr 2011/12 Survey Findings Nutrition Analysis Summary June 2012 (Large sample cluster FSNAU, UNICEF, 816 (8.9-14.0) (0.9-3.4) -0.71 ±1.06 0.0 (0.19-0.76) (0.18-1.36) survey) SRCS MOH
18. Addun Pastoral 2.4 0.48 0.58 74 14.5 (Large sample cluster June 2012 701 (1.3-4.3) -0.79 ±1.13 0.3 (0.25-0.92) (0.19-1.76) (11.1 –18.9) survey)
19. Cowpea belt 0.76 1.46 June 2012 (Large sample cluster 1174 16.0 -1.01 ±1.60 (0.48 –1.22) (0.86 -2.48) survey) Shabelle Regions 20.Mogadishu Town 10.8 1.5 1.23 1.54 0.4 (Large sample cluster July 2012 676 (8.3-13.9) (0.7-3.0) -0.44 ± 1.16 (0.81-1.85) (0.82-2.85) survey)
21..Mogadishu IDP 9.6 1.41 2.81 1.8 0.1 (Large sample cluster July 2012 670 (7.1-13.0) -0.57 ±1.08 (0.99-2.02) (1.82-4.33) (1.0-3.2) survey) FSNAU, UNICEF, COSV, 22. Beletweyne MERCY USA, 16.6 0.8 2.32 district 3.3 IINTERSOS, July 2012 628 (11.7-22.9) 0 (0.53-1.22) (1.30-4.11) (Large sample cluster SRCS, (1.7-6.3) -0.86 ±1.14 survey) ZAMZAM, 23. Mataban district MUSLIM AID 16.7 4.2 0.99 4.50 (Large sample cluster July 2012 480 (13.2-20.8) (2.3-7.3) -0.91± 1.12 0.4 (0.70-1.41) (3.02-6.64) survey) Juba Regions 24. Juba Pastoral 2.1 0.44 0.81 (Large sample cluster 15.8 1.5 FSNAU , July,2012 525 (1.0-4.4) -0.78±1.09 (0.20-0.99) (0.29-2.27) survey) UNICEF (11.8-20.7) AFREC, WVI, 25.Juba Agropastoral MERCY USA, 5.8 0.25 0.85 (Large sample cluster 25.1 0.8 SRCS, MERCY July,2012 773 (4.4-7.7) -1.16±1.2 (0.07-0.88) (0.41-1.78) survey) USA,SAF, (22.2-28.3) EIRG,APD, 26.Juba Riverine JUBA 6.6 0.20 1.16 21.1 0.7 (Large sample cluster FOUNDATION, July,2012 817 (5.0-8.7) -1.19±1.06 (0.11-0.42) (0.57-2.32) (17.7-24.8) survey) WRRS, JCC, 27.Kismayu IDP MVDO, PCDDO, 0.27 1.71 28.0 8.2 (Large sample cluster ICDA, AMA-UK July,2012 711 -1.45±0.92 2.7 (0.13-0.55) (1.08-2.71) (24.6-31.6) (5.7-11.7) survey) 28.Dhobley 0.32 0.96 July,2012 781 22 7.6 0.95 ±1.19 2.0 (Exhaustive) Gedo Region 29. North Gedo Dawo 28.4 0.59 1.36 Pastoral 6.2 -1.30 ± 0.7 June’12 694 (23.0-34.5) (0.35-1.01) (0.77-2.36) (Large sample cluster (4.4-8.7) 1.11 survey) 30. North Gedo 22.5 6.1 0.2 1.6 Riverine -1.16 ±1.11 June’12 757 (19.2-26.1) (4.3-8.5) 0 (0.11-42.0) (0.57-2.32) (Large sample cluster survey) 31.Dolo IDPs 25.9 7.5 -1.26 ±1.2 0.8 0.60 0.80 (Large sample cluster June’12 974 survey) Bay Bakool Region
32.Bay Agro pastoral 20.4 6.9 1.0 1.40 2.70 (Large sample cluster July, 2012 889 -1.08 ±1.09 (16.7-24.5) (5.0-9.4) ( 0.3-1.7) (0.93-2.10) (1.86-3.89) survey) 33.Bakool Pastoral 26.2 5.7 0.5 0.31 0.86 (Large sample cluster July, 2012 727 (20.6-32.8 (3.6- 9.1) -1.35±1.03 (0.01-1.1) (0.15-0.61) (0.43-1.73) survey) 34.Baidoa IDPs 15.5 0.42 1.52 5.1 -0.76±1.16 1.7 (Large sample cluster July, 2012 858 (11.6-20.4) (0.27-0.66) (0.91-2.53) ( 3.1-8.5) survey)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 7. APPENDICES
7.1 Progression of Estimated Nutrition Situation Deyr ‘08 /’09 - Gu ‘12 SOMALIA - ESTIMATEDDeyr NUTR IT‘08/09ION SITUATION JANUARY 2009 SOMALIA - ESTIMATEDGu NUT ‘09RITION SITUATION JULY 2009 N N " "
0 0 CALUULA
' ' " CALUULA " 0 0
43°0'0"E 46°0'0"E 49°0'0"E Appendices ° ° 2 2
1 1 Alula Alula QANDALA " QA NDALA " ZEYLAC " ZEY LAC " (! LAASQORAY !( Gulf of Aden " LAASQORAY " Kandala Kandala Gulf of Aden Zeylac Bosaso Zeylac Bosaso DJIBOUTI LUGHAYE " DJIBOUTI LUGHAYE " Lughaye Lughaye BERBERA Badhan Awdal " BERB ERA Badhan Awdal " Erigavo (! !( Iskushuban Baki Berbera ISKUSHUBAN BAKI " Baki Berbera ISK USHUBA N " BAKI " 75 Borama " Sanag Iskushuban Borama Sanag El Afwein Bari El Afwein Bari Erigavo SHEIKH CEEL AFWEYN " " SHEIKH CEEL AFWE YN Sheikh " Sheikh " Woq. Galbeed Woq. Galbeed GEBILEY " GE BILEY Gabiley "Gabiley (! Bender Beila QARDHO BANDARBEYLA Hargeisa " " Harge!isa QA RDHO BANDARBEYLA OWDWEYNE (! Gardo ! " " " OWDWEYNE !( Bender Beila " Odweine Odweine Gardo Burco Caynaba Burco Taleh XUDUN TALEEX " " XUDUN TALEEX N Caynaba " " N Xudun " " Taleh Togdheer CAYNABO " 0 CAYNABO Xudun 0 ' Togdheer ' " 0 0
° ° Sool 9 Sool 9 ^ Buhodle Garowe Buhodle Garowe Lasanod (! !( BUUHOODLE " BUUHOODLE Lasanod "
EYL Nugal " EYL Nugal " " Eyl Eyl District Capital Burtinle BURTINLE Burtinle " BURTINLE " " Major Road District Capital Coastline Coastline JARIIBAN " JARIIBAN " International Boundary GALDOGOB Jariban International Boundary " GA LDOGOB Jariban " ETHIOPIA Goldogob ETHIOPIA Goldogob Regional Boundary Galkayo Regional Boundary Galkayo District Boundary (! District Boundary !( River River
CABUDWAAQ " CABUDWAA Q CADAADO " "
N CADAADO N " Adado " Adado " Mudug
0 0 Abudwaq
' Mudug ' Hobyo Abudwaq Hobyo 0 0 ° ° 6 6
Dusa Mareb HOBYO " Dusa Mareb HOBYO " Indian Ocean Indian Ocean Galgadud Galgadud CEEL BARDE " CEEL BARDE El Bur " Haradhere CEEL BUUR El Bur Haradhere El Barde " XARARDHEERE CEEL BUUR Belet Weyne " " XARA RDHEERE El Barde Belet Weyne "
Rab Dhuure Bakol " Rab Dhuure Bakol " DOOLOW Rab-Dhuure Hiran " DOOLOW Rab-Dhuure Hiran Hudur " Hudur TAYEEGLOW " TAY EEGLOW El Der " Dolo BULO BURTO CEEL DHEER El Der LUUQ WAAJID " " Dolo BULO BURTO CEEL DHEER LEGEND BELET XAAWO " " ADAN YABAAL LUUQ WA AJID " " " Tieglo " BELET XAA WO " " ADAN YABAAL Bulo Burti " Tieglo " Luuq Wajid Luuq Wajid Bulo Burti Nutrition Situation Aden Yabal JALALAQSI Aden Yabal Belet Hawa " JALALAQSI Belet Hawa " Jalalaqsi Jalalaqsi Acceptable Garbahare Baidoa Adale Garbahare Baidoa Adale N N (! " !( " 0 0 QANSAX DHEERE ' Alert ' Gedo " M. Shabelle QA NSAX DHEE RE CEEL WAQ BUUR HAKABA 0 M. Shabelle 0 " Gedo CADALE " " BUUR HA KABA Qansah Dere Jowhar " CEEL WA Q ° ° " " CADALE Wanle Weyne LEGEND Qansah Dere Jowhar "
3 3 WANLA WEYN Wanle Weyne El Waq " El Waq WA NLA WEY N " Insufficient data but likely Bay Balad Bay DIINSOOR Balad " BALCAD DIINSOOR BAARDHEERE Bur Hakaba " " " Nutrition Situation BAARDHEERE Bur Hakaba BALCAD to be Alert " " Afgoye AFGOOYE Afgoye " AFGOOYE Bardera !" Serious Dinsor (! Acceptable Bardera Dinsor !Ba!(nadir L. ShabelleBanadir QORYOOLEY L. Shabelle Insufficient data but likely " QORYOOLEY Qoryoley " Sakow Kurtun Warrey Qoryoley SAAKOW KURTUNWAAREY Sakow Kurtun Warrey " " Marka Alert SAAKOW " KURTUNWA AREY ! to be Serious " Marka M. Juba SABLAALE M. Juba Critical Sablale " SABLA ALE Sablale " Serious BARAAWE Buale " BARA AWE Insufficient data but likely Buale " Brava Brava to be Critical Critical Very Critical Jilib Jilib Afmadow AFMADOW JILIB Afmadow " " Very Critical AFM ADOW JILIB Projected Trend (July - December'09) " " Projected Trend (January - July '09) Insufficient data but likely Potential to Improve to be Very Critical JAMAAME " Potential to Improve " J" amame JAMAAM E 0 "Jamame 0 Hot Spot for Very Critical ' ' L. Juba Uncertain ^ 0 L. Juba Uncertain IDP Phase 0 ° °
0 0 Potential to Deteriorate IDP Phase Potential to Deteriorate Serious Kismayo (! Kismayo !( Serious Critical Badhadhe Critical Badhadhe Very Critical BADHAADHE " BADHAADHE " The Nutrition Situation is analysed using a range of nutrition Very Critical ± indicators from direct and indirect sources from July to Dec '08: The Nutrition Situation is analysed using a range of nutrition nutritional surveys (Oct-Dec '08), health facility data, rapid ± indicators from direct and indirect sources from Jan to July '09: MUAC assesments, selective feeding centre data, health reports 40 20 0 40 80 120 160 nutritional surveys (Apr-July'09), health facility data, rapid 43°0'0"E 46°0'0"E and others 49°0'0"E 40 20 0 40 80 120 160 MUAC assesments, selective feeding centre data, health reports Kilometers Datum: WGS84, Data Source: FSAU, 2006 Kilometers and others Admin. layers: UNDP, 1998
Food Security and Nutrition Analysis Unit - Somalia http://www.fsnau.org Food Security Analysis Unit - Somalia http://www.fsausomali.org P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] tel: 254-20-4000000 fax:254-20-5000555 tel: 254-20-3745734 fax:254-20-3740598 FSNAU is managed by FAO. FSAU is managed by FAO. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. SOMALIA - TEhe reSgionaTl & DiIstrMict bounAdarieTs refleEct thoDse en doNrsed bUy the GToverRnmentI ofT the RIeOpublic Nof Som alSia in 1I98T6. UATION JULY 2010 The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986. SOMALIA - ESTIMATED NUDeyrTRITIO ‘09/10N SITUATION JANUARY 2010 Gu ‘10
CALUULA Calula Gulf of Aden " BOSSASO Alula (!. QANDALA " Qandala ZEYLAC DJIBOUTI " Las Qoray/ LAASQORAY (! Zeylac Bossaaso " Badhan Lughaye ERIGABO Kandala !. Zeylac Bosaso AWDAL ! Iskushuban LUGHAYE ( " Badhan Baki AwdalLughaye Borama Berbera SANAG BERBERA Erigavo Baki (!" Iskushuban BORAMA Ceel Afweyne BAKI Berbera ISKUSHUBAN BARI " " !. Sheikh Ceerigaabo Borama W. GALBEED El Afwein Sanag Gebiley SHEIKH CEEL AFWEYN Bari HARGEYSA BURAO Woq. Galbeed " Sheikh " !. ! !.(! GEBILEY Qardho G" abiley Hargeysa Xudun Bandar Beyla ! QARDHO BANDARBEYLA Owdweyne Caynabo Harge!isa " Gardo " Talex OWDWEYNE ! " TOGDHEER Burco Caynaba Taleh Odweine XUDUN TALEEX " " Bender Beila Burco SOOL CAYNABO Xudun Togdheer " Laas Caanood Garowe !. Sool Buuhoodle LAS ANOD !!.GAROWE Buhodle Lasanod !Garowe " BUUHOODLE Eyl District Capital " NUGAL Major Road EYL Nugal Eyl " Burtinle Coastline Burtinle BURTINLE " International Boundary Regional Boundary ETHIOPIA Galkacyo Jariiban JARIIBAN " Goldogob GALDOGOB Jariban District Boundary " !.GALKAYO Goldogob ! River (! Galkayo
Cadaado CABUDWAAQ MUDUG " CADAADO " Adado Mudug Cabudwaaq Hobyo Hobyo DUSAMAREB Abudwaq !. Dhusa Mareeb
HOBYO Dusa Mareb " Indian Ocean GALGADUD BELET WEYNE Harardheere Galgadud Ceel Barde !. CEEL BARDE Beled Weyne " Haradhere CEEL BUUR XARARDHEERE Ceel Bur El Barde Belet Weyne " " BAKOOL El Bur Rab- Xudur Rab Dhuure Bakol Dhuure " !.HUDUR HIIRAN Ceel Dheere DOOLOW
Rab-Dhuure w " Hudur Hiran Dolo o
TAYEEGLOW Luuq l " El Der Bulo Barde Dolo a Wajid g BULO BURTO CEEL DHEER e BELET XAAWO LUUQ WAAJID " ADAN YABAAL " w
" y " " Tieglo Bulo Burti " a Aden Yabal Luuq Wajid H a GARBAHAREY Baydhaba T Nutrition Situation d !. Jalalaqsi Aden Yabal le JALALAQSI BAIDOA Cadale Belet Hawa " e Garbaharey Jalalaqsi B !. Garbahare Baidoa Adale ^ Acceptable LEGEND JowhaMr . SHABELLE Qansax !. Gedo QANSAX DHEERE M. Shabelle Dheere Wanle Weyne JOWHAR Alert " BUUR HAKABA CEEL WAQ " CADALE Nutrition Situation " Qansah Dere Wanle WeyneJowhar " GEDO BAY El Waq WANLA WEYN " Ceel Waq Bay Balad Bur Hakaba Balcad DIINSOOR Acceptable Serious " BALCAD BAARDHEERE Bur Hakaba " Dinsor " Afg(!oye BANADIR AFGOOYE Baardheere /" (!" MOGADISHU Bardera Dinsor AfgBoyeanadir Alert Qoryoley Critical L. Shabelle Mogadishu !. QORYOOLEY Sakow Marka Q" oryoley Kurtun Warrey SAAKOW
KURTUNWAAREY A Very Critical Sakow " " Marka Serious Kurtun Warrey M. JUBA BU'AALE Y !. Sablale SABLAALE L. SHABELLE M. Juba Sablale " Critical N Bu'aale Brava Likely Serious BARAAWE Buale "
Brava E Very Critical L. JUBA K Afmadow Jilib Likely Critical Jilib Afmadow AFMADOW JILIB " " Insufficient data but likely Projected Trend (January - July 2010) Likely Very Critical to be Serious Jamaame JAMAAME L. Juba J" amame Potential to Improve Insufficient data but likely KISMAAYO ^ Hot Spot for Critical Uncertain to be Very Critical Kismayo (!. Kismayo Potential to Deteriorate IDP Phase IDP Phase Serious Serious Badhadhe Badhadhe BADHAADHE " Critical Critical
Very Critical Projected Trend (July - December 2010) Very Critical The Nutrition Situation is analysed using a range of nutrition Potential to Improve The Nutrition Situation is analysed using a range of nutrition ± indicators from direct and indirect sources from July to indicators from direct and indirect sources from April to December '09: nutritional surveys, health facility data, rapid Uncertain July '10: nutritional surveys, health facility data, rapid 40 20 0 40 80 120 160 MUAC assesments, selective feeding centre data, health reports MUAC assesments, selective feeding centre data, health reports Potential to Deteriorate Kilometers and others 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 Swiss Agency for Development The boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. and Cooperation SDC The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986. 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 47 Issued September 26, 2012 SOMALIA - ESTIMATED NUTRITION SITUATION Deyr ‘10/11 August 16th , 2011 (GBaseud o n‘ 11June/July surveys) SOMALIA - ESTIMATED NUTRITION SITUATION JANUARY 2011
Calula (.!BOSSASO Calula Qandala Las Qoray/ Zeylac BOSSASO Badhan Bossaaso (!. Lughaye ERIGABO Qandala .! AWDAL Las Qoray/ Iskushuban Appendices Zeylac ! Badhan Bossaaso Baki ! Lughaye ERIGABO Berbera !. Borama SANAG AWDAL BORAMA Ceel Afweyne BARI Baki ! Iskushuban .! Sheikh Ceerigaabo Berbera W. GALBEED Borama SANAG Gebiley BORAMA Ceel Afweyne BARI HARGEYSA BURAO !( !. Sheikh .! ! .! W. GALBEED Ceerigaabo !( Qardho Gebiley HARGEYSA Hargeysa Owdweyne Xudun Bandar Beyla !. ! !.BURAO Caynabo Talex ! Qardho TOGDHEER Hargeysa Bandar Beyla Owdweyne Caynabo Xudun SOOL 76 Talex Burco TOGDHEER Laas Caanood Garowe Burco SOOL .! Buuhoodle LAS ANOD !(.GAROWE Laas Caanood Garowe !. Buuhoodle LAS ANOD !!.GAROWE Eyl NUGAL Eyl NUGAL Burtinle Burtinle
Galkacyo Jariiban Jariiban Goldogob !( Goldogob Galkacyo !(.! GALKAYO !(!. GALKAYO
Cadaado MUDUG Cadaado MUDUG Hobyo Cabudwaaq Cabudwaaq Hobyo !. (.! DUSAMAREB DUSAMAREB Dhusa Mareeb Dhusa Mareeb GALGADUD GALGADUD Harardheere Harardheere BELET WEYNE!. BELET WEYNE! Ceel Barde Beled Weyne Ceel Barde Bel.ed Weyne BAKOOL Ceel Bur BAKOOL Ceel Bur Rab- Xudur Rab- Xudur Dhuure !.HUDUR Dhuure HIIRAN Ceel Dheere .!HUDUR Ceel Dheere Dolo w HIIRAN w o Dolo Luuq l Bulo Barde o g a Wajid Luuq l Bulo Barde e w a Wajid g y Nutrition Situation a Aden Yabal e
a w
H y Nutrition Situation GARBAHAREY Baydhaba T a Aden Yabal d Jalalaqsi H a
!. T e GARBAHAREY Baydhaba l Acceptable d e BAIDOA Cadale Jalalaqsi Acceptable Garbaharey e .! B !. l BAIDOA Cadale e Garbaharey Jowhar Alert B .! Alert Qansax !. Dheere Wanle Weyne Qansax Jowhar GEDO BAY ^ Wanle Weyne .! M. SHABELLE Serious Dheere Serious Ceel Waq Bur Hakaba Balcad GEDO BAY M. SHABELLE Critical Dinsor Afg!(oye Ceel Waq Bur Hakaba Balcad Baardheere "/!(BANADIR Critical MOGADISHU Dinsor Afg!(oye Very Critical Qoryoley Baardheere /"!(BANADIR Sakow Ma!.rka Very Critical MOGADISHU Kurtun Warrey Qoryoley Likely Critical A .! M. JUBA BU'AALE Sakow Marka Y !. Sablale L. SHABELLE Likely Critical Kurtun Warrey Likely Very Critical
N Bu'aale ^Brava M. JUBA BU'AALE Likely Very Critical .! Sablale L. SHABELLE
E Data analysis ongoing L. JUBA Bu'aale Brava K Afmadow Jilib Not classified due to IDP Phase insufficient data L. JUBA Serious Afmadow Jilib Jamaame ^ Hotspot for Concern/ Likely Critical KISMAAYO Deterioration Very Critical !. Jamaame Kismayo !( The Nutrition Situation is analysed using a range of nutrition IDP Phase indicators from direct and indirect sources from October to Serious KISMAAYO December '10: nutritional surveys, health facility data, rapid (.! MUAC assesments, selective feeding centre data, health reports Badhadhe Kismayo and others Critical
Very Critical Badhadhe Projected Trend (January - June 2011) Potential to Improve The Nutrition Situation is analysed using a range of nutrition indicators from direct and indirect sources from October to Uncertain December '10: nutritional surveys, health facility data, rapid Projected Trend (January - June 2011) MUAC assesments, selective feeding centre data, health reports Potential to Improve Potential to Deteriorate and others Uncertain Technical Partner Funding Agencies ± Potential to Deteriorate Swiss Agency for 0 37.5 75 150 225 300 375 Development and Cooperation SDC Kilometers 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 noSt imOply oMfficialA endLorsIemAen t o-r acEcepStanTce IbyM the UAniteTd NEatiDons. ThNe reUgionaTl & RDistIricTt boIuOndariNes re fleSct IthoTse UendoArsedT byI thOe GoNvernment of the Republic of Somalia in 1986. Technical Partner Funding Agencies January , 2012 (Based on November/December, 2011 surveys) Swiss Agency for Development and Gu ‘12 Cooperation SDC Deyr ‘11/12 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.
Calula
.!BOSSASO !( Qandala Las Qoray/ Zeylac Badhan Bossaaso Lughaye ERIGABO .! AWDAL Iskushuban Baki !( Borama Berbera SANAG BORAMA Ceel Afweyne BARI .! W. GALBEED Sheikh Ceerigaabo Gebiley HARGEYSA BURAO !( .! ! .! !( Qardho Hargeysa Owdweyne Xudun Bandar Beyla Caynabo Talex TOGDHEER Burco SOOL Laas Caanood Garowe .! Buuhoodle LAS ANOD !(.GAROWE
Eyl NUGAL Burtinle
Galkacyo Jariiban Goldogob !(.! GALKAYO
Cadaado MUDUG Hobyo Cabudwaaq .! DUSAMAREB!( Dhusa Mareeb GALGADUD Harardheere BELET WEYNE! Ceel Barde Bel.ed Weyne BAKOOL Ceel Bur Rab- Xudur Dhuure ! .HUDUR HIIRAN Ceel Dheere
Dolo w o
Luuq l Bulo Barde
a Wajid g w e Nutrition Situation a y Aden Yabal H a GARBAHAREY Baydhaba T d Jalalaqsi Acceptable e .! l BAIDOA Cadale e Garbaharey B .! Alert Jowhar Qansax ! Dheere Wanle Weyne . Serious GEDO BAY M. SHABELLE Critical Ceel Waq Bur Hakaba Balcad Dinsor Afg!(oye Very Critical Baardheere /"!(BANADIR MOGADISHU Qoryoley Likely Critical Sakow .! Kurtun Warrey Marka Likely Very Critical M. JUBA BU'AALE .! Sablale L. SHABELLE Data analysis ongoing Bu'aale Brava IDP Phase L. JUBA Serious Afmadow Jilib Critical Very Critical Jamaame Note The Nutrition Situation is analysed using a range of nutrition Even though the nutrition situation in the South is Very Critical, indicators from direct and indirect sources from October to KISMAAYO there are significant improvements from the famine thresholds December '11: nutritional surveys, health facility data, rapid .! observed in the July-October 2011 period when GAM rates MUAC assesments, selective feeding centre data, health reports Kismayo and others were in excess of 30%
Badhadhe Projected Trend (January - June 2011) Potential to Improve
Uncertain ± Potential to Deteriorate 0 37.5 75 150 225 300 375
Kilometers
Technical Partner Funding Agencies Swiss Agency for Development and Cooperation SDC 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 47 Issued September 26, 2012 7.2 Nutrition Assessment Tools Post Gu ‘12
NUTRITION ASSESSMENT HOUSEHOLD QUESTIONNAIRE, Gu 2012 Pastoral Appendices
NUTRITION ASSESSMENT HOUSEHOLD QUESTIONNAIRE, Gu 2012- PASTORAL
Household Number ______date______team Number ______cluster Number ______Cluster 77 Name ______District: ______Q1-7 Characteristics of Household Q1. Household size1 : (i) Today______(ii) In the last 30 days______Q2. Number of children less than 5 years (0-59 months) Today: ______Q3a. Household head: 1=Male 2=Female Q3b. Marital status of caregiver: 1=Married & staying with spouse 2=Married but not stayed with spouse for 6 months or more 3=Widow/ widower 4=Divorced 5=Never married Q3c. Highest level of mother’s/caregiver’s education: 0=None 1= Primary/Intermediary 2= Secondary 3= Tertiary (college/university) 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. Are you hosting any recently (in the last 6 months) internally displaced persons? 0= No 1= Yes
c. 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 Q7. 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 7=Self-Employment (Bush products/handicraft) 8=gifts/ zakat 9= Others, specify ______Q8-15 feeding and immunization status of children aged 6 – 59 months in the household.
Q11 Q10 Q14 How many times How many times Q 12 Q13 Q8 Q9 did you feed the did you feed the Has child been No of doses of Q15 child in the last child with milk in Has child been immunized polio vaccine Does child have Child Age Are you breast- 24 hours (besides the last 24 hours provided with against measles2 given to the child First Date of immunization (months) feeding1 the child? breast milk)? (besides breast Vitamin A in the in the last 6 orally? Name Birth card? (mention by name) 0=Zero times milk)? last 6 months? months? 0= No (if child is more 1= 1 time 0=None (show sample) 0= No 0=none -- /-- /-- 1=Yes than 24 months 0= No 2=2 times 1= 1 time 0= No 1=Yes 1=one old, skip to Q12) 1=Yes 3 = 3 times 2=2 times 1=Yes 9=Don’t know 2=two 4=-4 times 3=-3 times 9=Don’t know 3=three or more 5= 5 or more times 4= 4 times 9=Don’t know 5= 5 times or more 1 2 3
4
Q16-28 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
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Q27
Where did you Q25 seek healthcare Q28 Suspected Q20 assistance when Q23 Measles6 Q26 child was sick? (If Is the child Q17 Q18 Q21a Q22 in last one Q19 MUAC Q21b yes in Q21 – 25) currently Q16a Diarrhea3 Pneumonia Fever5 month Did the child If yes in registered Appendices (cm) Q16b Weight Height in last two (oof wareen/ in the sleep under a Oedema Q21a, for 0=No assistance in any Sex (kg) (cm) weeks wareento)4 last two mosquito net To the how many sought feeding First Age in the last weeks last night? nearest days did 1=Own centres? Name To the To the two weeks 0= No tenth of the child medication 1=Male (month) nearest nearest 0= No 0= No 0= No 78 1=yes a cm have 2=Traditional 0= None 2=Female tenth of tenth of 1=yes 0= No 1=yes 0= No 1=yes 1=yes diarrhea? healer 1= SFP a kg a cm 1=yes 9=Don’t 3=Sheikh/ 2= TFC/SC know (≥6 mo) Prayers 3= OTP 4=Private Clinic/ 4= Other Pharmacy 5= Public health facility 1
2
3
4
29a. Anthropometry (MUAC) for adult women of childbearing age (15-49 years) present at the household
No of doses Physiological Is women currently Illness in last 14 of Tetanus status Did the woman sleep registered in Codes for adult illnesses days? vaccine under the mosquito received 1= Pregnant net last night 0=None 0= None Age MUAC If yes, what illness? Sno Name 1=SFP (food) (years) (cm) 2= Lactating (infant (use codes on the 0= None 0= No 2=MCHN (Food and 1= ARI <6months) right) 1= One 1=yes Vitamins) 2=Diarrheal 2= Two 3= None of the 3=MCH - vitamins 3=Fever/Febrile If no, skip to 29b 3=Three above 4=Other, (specify) 4=Joint
1 Mother: 5=Urinary tract infection (UTI) 6=Pain in the chest 7= Pain in lower abdomen/pelvis
8=Anemia 9= Reproductive
10=Other, specify
29b. Where do you usually 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
29c. If ‘No assistance’ in 28b, why? 1 = Too expensive 2 = Too far 3 = Not enough time 4 = Security concerns 5= Other, specify ……
30a. Child dietary Diversity
Please describe the foods (all meals and snacks) that the children (6-24 months) ate yesterday during the day and night, whether at home or outside the home. Start with the first food you ate yesterday morning. Record the respective codes to the foods mentioned. When a mixed dish is reported, ask about and tick all of the ingredients in their respective columns.
Write down all foods and drink mentioned. When composite dishes are mentioned, ask for the list of ingredients. 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.
First Name Breakfast Snack Lunch Snack Dinner Snack
1.
If 6-24 months
Did the child (Name) consume food 7 When the respondent recall is complete, fill in the food groups based on the information recorded above. For any food groups not from any these food groups in the last mentioned, ask the respondent if a food item from this group was consumed by the children. 24 hours?8 0=No 1= Yes Child 1 Child 2 Child 3 1. Cereals, roots and tubers (maize, ground maize, wheat, millet, rice, sorghum, spaghetti, bread, chapatti , macaroni, canjera; white potatoes, cassava, arrowroot, white sweet potatoes, or foods made from these)
2. Legumes, nuts and seeds (cowpeas, beans, lentils , peanut, pumpkin seed, lentil seed, sunflower seed, wild nuts)
3. Milk and milk products (Fresh/fermented/powdered sheep, goat, cow or camel milk, Cheese (sour milk), condensed milk, yoghurt) 4. Flesh (meat, fish and poultry) products (fish, beef, lamb, goat, camel, wild game, such as Dik Dik, chicken, other birds such as guinea fowl and francolin)
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 5. Eggs (eggs of chicken, or eggs of fowl)
6. Vitamin A rich fruits and vegetables (ripe mangoes, pawpaw, wild fruits such as gob, hobob, berde, isbandlays, kabla, coasta, red cactus fruit; yellow fleshed pumpkins, carrots, orange sweet potatoes, yellow cassava) 7. Other fruits and vegetables (banana, orange, apple, coconut, custard apple, dates, unripe mangoes, grapes, guava, wild fruits and 100% fruit juices; tomato, onion, squash, bell pepper, cabbage ,light green lettuce, white radish ) Appendices Q 30b. Total number of food groups consumed by each child
Q31a Household Food Consumption & Dietary Diversity2: Please describe the foods (meals and snacks) that members of your 79 household ate or drank yesterday during the day and night at home3. Start with the first food or drink of the morning. Include wild foods e.g. game meat, honey, fruits, vegetables, leaves.
Write down all foods and drink mentioned. When composite dishes are mentioned, ask for the list of ingredients. 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.
Breakfast Snack Lunch Snack Dinner Snack
Any household When the respondent9 recall is complete, fill in the food groups based on the information recorded above. For any food groups not member10 mentioned, ask the respondent if a food item from this group was consumed 0=No 1= Yes 1. Cereals and cereal products (maize, ground maize, wheat, white wheat, wholemeal wheat, millet, rice, white grain sorghum, red sorghum , spaghetti, bread, chapatti , macaroni, canjera) 2. Milk and milk products (Fresh/fermented/powdered sheep, goat, cow or camel milk, Cheese (sour milk), condensed milk, yoghurt) 3. Vitamin A rich vegetables and tubers (yellow fleshed pumpkins, carrots, orange sweet potatoes, yellow cassava) 4. Dark green leafy vegetables (amaranth, kale, spinach, , onion leaf, pumpkin leaves, cassava leaves, dark green lettuce) 5. Other vegetables (tomato, onion, squash, bell pepper, cabbage ,light green lettuce, white radish ) 6. Vitamin A rich fruits (ripe mangoes, pawpaw, wild fruits such as gob, hobob, berde, isbandlays, kabla, coasta, red cactus frui,) 7. Other fruit (banana, orange, apple, coconut, custard apple, dates, unripe mangoes, grapes, guava, wild fruits and 100% fruit juices) 8. Organ meat (liver, kidney, heart or other organ meat) 9. Meat and Poultry (beef, lamb, goat, camel, wild game, such as Dik Dik, chicken, other birds such as guinea fowl and francolin) 10. Eggs (eggs of chicken, or eggs of fowl) 11. Fish (fresh or dried) and other seafood (shellfish) 12. Legumes, nuts and seeds (cowpeas, beans, lentils , peanut, pumpkin seed, lentil seed, sunflower seed, wild nuts) 13. White roots and tubers (white potatoes, cassava, arrowroot, white sweet potatoes, or foods made from roots) 14. Oils and Fats (cooking fat or oil, ghee, butter, sesame oil, margarine) 15. Sweets (sugar, honey, sweetened soda and fruit drinks, chocolate biscuit, cakes,, candies, cookies, Sugar cane and sweet sorghum) 16. Coffee, tea and Spices (coffee, tea, spices such as black pepper, cardamoms, cinnamon, ginger, nutmeg, cloves, salt. Condiments such as ketchup, soy sauce, chilli sauce) Q 31b. Total number of food groups consumed? Q 31c. Did you or anyone in your household eat anything (meal or snack) OUTSIDE of the home yesterday
Q32 a. In the last three months, what is the main source in the household of these foods: i) Staple cereal? ______ii) Milk? ______(Use codes below)
1= Own production 2= Purchasing 3=Community Gifts/Donations 4= Food aid 5= Bartering 6= Borrowing 7= Gathering
Q32b. 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
Q33 How many meals4 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 + Coping Strategies
Q 34. 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: Indicate type of Pastoralism practiced : 1= Nomadic/mobile 2= Sedentary/ settled
0=Never (zero times/week) 1=Hardly at all (<1 times/ week) In the past 30 days, if there have been times when you did not have enough food or 2=Once in a while (1-2 times/ week) money to buy food, how often has your household had to: 3= Pretty often? (3-6 times/week) 4=All the time (Every day) 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)? 2 FAO Household Dietary Diversity Tool 3 Include foods prepared inside the home but consumed outside the home 4 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 47 Issued September 26, 2012 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)? Appendices
Agro-pastoralists Livelihood: 0=Never (zero times/week) 1=Hardly at all (<1 times/ week) 80 In the past 30 days, if there have been times when you did not have enough food or money to buy food, how often has 2=Once in a while (1-2 times/ week) your household had to: 3= Pretty often? (3-6 times/week) 4=All the time (Every 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 (go an) 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)?
WATER & SANITATION
Q35-36 Access to drinking water and sanitation facilities
Q35 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) …
Q36 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
Checked by Supervisor (Sign) ______
(Footnotes) 1 Child having received breast milk either directly from the mothers or surrogate mother breast within the last 12 hours 2 Measles immunization is a shot in the upper arm given to children after 6 months of age at health clinics or by mobile health teams 3 Diarrhea is defined for a child having three or more loose or watery stools per day 4 ARI asked as oof wareen or wareento. The three signs asked for are chest in-drawing, cough, rapid breathing/nasal flaring and fever 5 Fever – The three signs to be looked for are periodic chills/shivering, fever, sweating and convulsions 6 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 7 Respondent refers to the person responsible for food preparation on the recall day. For the child, refer to the mother or caregiver 8 WHO, 2008. Indicators for assessing infant and young child feeding practices: Conclusion of a consensus meeting held 6-8 November 2007 in Washington D.C., USA ;FANTA 2002 Summary Indicators for Infant and Child Feeding Practices; 9 Respondent refers to the person responsible for food preparation on the recall day. For the child, refer to the mother or caregiver 10
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 7.3 NUTRITION ASSESSMENT HOUSEHOLD QUESTIONNAIRE, May 2012 IDP
Household Number ______date______team Number ______cluster Number ______Cluster Name ______District: ______Appendices Q1-7 Characteristics of Household Q1. Household size1 : (i) Today______(ii) In the last 30 days______Q2. Number of children less than 5 years (0-59 months) Today: ______81 Q3a. Household head: 1=Male 2=Female Q3b. Marital status of caregiver: 1=Married & staying with spouse 2=Married but not stayed with spouse for 6 months or more 3=Widow/ widower 4=Divorced 5=Never married Q3c. Highest level of mother’s/caregiver’s education: 0=None 1= Primary/Intermediary 2= Secondary 3= Tertiary (college/university) 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. Are you hosting any recently (in the last 6 months) internally displaced persons? 0= No 1= Yes
c. 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 Q7. 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 7=Self-Employment (Bush products/handicraft) 8=gifts/ zakat 9= Others, specify ______Q8-15 feeding and immunization status of children aged 6 – 59 months in the household.
Q11 Q14 Q10 How many times Q 12 Q13 How many times did No of doses of Q8 Q9 did you feed the Has child been Q15 you feed the child polio vaccine child with milk in Has child been immunized Does in the last 24 hours given to the Child Age Are you breast- the last 24 hours provided with against measles2 child have First Date of (besides breast milk)? child orally? (months) feeding1 the child? (besides breast Vitamin A in the in the last 6 immunization Name Birth 0=Zero times (mention by name) milk)? last 6 months? months? card? 1= 1 time 0=none (if child is more 0=None (show sample) 0= No 0= No -- /-- /-- 2=2 times 1=one than 24 months 0= No 1= 1 time 0= No 1=Yes 1=Yes 3 = 3 times 2=two old, skip to Q12) 1=Yes 2=2 times 1=Yes 9=Don’t know 4=-4 times 3=three or 3=-3 times 9=Don’t know 5= 5 or more times more 4= 4 times 9=Don’t know 5= 5 times or more 1 2 3 4 Q16-27 Anthropometry and morbidity for children aged 6 – 59 months in the household
Q26
Where did you seek healthcare Q24 assistance Q27 Suspected Q25 when child Q20 Measles6 was sick? (If Is the child Q23 Q22 in last one D i d t h e yes in Q21 currently Q19 MUAC Q21 Q16a Q17 Pneumonia month child sleep – 24) registered Q18 (cm) Diarrhea3 Fever5 in Q16b (oof wareen/ under a in any Oedema in last two the last Sex Weight (kg) wareento)4 in mosquito 0=No feeding Height (cm) To the weeks two weeks First Age the last two n e t l a s t assistance centres? nearest Name To the weeks night? sought To the nearest 0= No tenth of 1=Male (month) nearest 0= No 1=Own 0= None tenth of a cm 1=yes a cm 0= No 1=yes 0= No 2=Female tenth of a kg 0= No 1=yes 1=yes 0= No medication 1= SFP 1=yes 9=Don’t 1=yes 2=Traditional 2= TFC/ know healer SC (≥6 mo) 3=Sheikh/ 3= OTP Prayers 4= Other 4=Private Clinic/ Pharmacy 5= Public health facility 1 2
1 Number of persons who live together and eat from the same pot
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 28a. Anthropometry (MUAC) for adult women of childbearing age (15-49 years) present at the household
Is women currently No of doses of Physiological status Did the woman sleep registered in Illness in last 14 Codes for adult Tetanus vaccine under the mosquito days? illnesses received 1= Pregnant net last night 0=None Age MUAC Sno Name 1=SFP (food) If yes, what 0= None
Appendices (years) 0= None (cm) 2= Lactating (infant 0= No 2=MCHN (Food and illness? 1= One <6months) 1=yes Vitamins) 1= ARI 2= Two 3= None of the above 3=MCH - vitamins If no, skip to 28c 2=Diarrheal 3=Three 4=Other, (specify) 3=Fever/Febrile 82 4=Joint 1 Mother: 5=Urinary tract infection (UTI) 6=Pain in the chest 7= Pain in lower abdomen/pelvis
8=Anemia 9= Reproductive
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 ……
29a. Child dietary Diversity
Please describe the foods (all meals and snacks) that the children (6-24 months) ate yesterday during the day and night, whether at home or outside the home. Start with the first food you ate yesterday morning. Record the respective codes to the foods mentioned. When a mixed dish is reported, ask about and tick all of the ingredients in their respective columns.
Write down all foods and drink mentioned. When composite dishes are mentioned, ask for the list of ingredients. 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.
First Name Breakfast Snack Lunch Snack Dinner Snack
1.
If 6-24 months
Did the child (Name) consume food from When the respondent7 recall is complete, fill in the food groups based on the information recorded above. For any food groups not any these food groups in the last 24 mentioned, ask the respondent if a food item from this group was consumed by the children. hours?8 0=No 1= Yes Child 1 Child 2 Child 3 1. Cereals, roots and tubers (maize, ground maize, wheat, millet, rice, sorghum, spaghetti, bread, chapatti , macaroni, canjera; white potatoes, cassava, arrowroot, white sweet potatoes, or foods made from these)
2. Legumes, nuts and seeds (cowpeas, beans, lentils , peanut, pumpkin seed, lentil seed, sunflower seed, wild nuts)
3. Milk and milk products (Fresh/fermented/powdered sheep, goat, cow or camel milk, Cheese (sour milk), condensed milk, yoghurt) 4. Flesh (meat, fish and poultry) products (fish, beef, lamb, goat, camel, wild game, such as Dik Dik, chicken, other birds such as guinea fowl and francolin) 5. Eggs (eggs of chicken, or eggs of fowl)
6. Vitamin A rich fruits and vegetables (ripe mangoes, pawpaw, wild fruits such as gob, hobob, berde, isbandlays, kabla, coasta, red cactus fruit; yellow fleshed pumpkins, carrots, orange sweet potatoes, yellow cassava) 7. Other fruits and vegetables (banana, orange, apple, coconut, custard apple, dates, unripe mangoes, grapes, guava, wild fruits and 100% fruit juices; tomato, onion, squash, bell pepper, cabbage ,light green lettuce, white radish )
Q 29b. Total number of food groups consumed by each child
Q30a Household Food Consumption & Dietary Diversity2: Please describe the foods (meals and snacks) that members of your household ate or drank yesterday during the day and night at home3. Start with the first food or drink of the morning. Include wild foods e.g. game meat, honey, fruits, vegetables, leaves.
Write down all foods and drink mentioned. When composite dishes are mentioned, ask for the list of ingredients. 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.
2 FAO Household Dietary Diversity Tool 3 Include foods prepared inside the home but consumed outside the home
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 Breakfast Snack Lunch Snack Dinner Snack
Any household When the respondent9 recall is complete, fill in the food groups based on the information recorded above. For any food member10 groups not mentioned, ask the respondent if a food item from this group was consumed 0=No 1= Yes Appendices Appendices 1. Cereals and cereal products (maize, ground maize, wheat, white wheat, wholemeal wheat, millet, rice, white grain sorghum, red sorghum , spaghetti, bread, chapatti , macaroni, canjera) 2. Milk and milk products (Fresh/fermented/powdered sheep, goat, cow or camel milk, Cheese (sour milk), condensed milk, yoghurt) 83 3. Vitamin A rich vegetables and tubers (yellow fleshed pumpkins, carrots, orange sweet potatoes, yellow cassava) 4. Dark green leafy vegetables (amaranth, kale, spinach, , onion leaf, pumpkin leaves, cassava leaves, dark green lettuce)
5. Other vegetables (tomato, onion, squash, bell pepper, cabbage ,light green lettuce, white radish ) 6. Vitamin A rich fruits (ripe mangoes, pawpaw, wild fruits such as gob, hobob, berde, isbandlays, kabla, coasta, red cactus frui,) 7. Other fruit (banana, orange, apple, coconut, custard apple, dates, unripe mangoes, grapes, guava, wild fruits and 100% fruit juices) 8. Organ meat (liver, kidney, heart or other organ meat) 9. Meat and Poultry (beef, lamb, goat, camel, wild game, such as Dik Dik, chicken, other birds such as guinea fowl and francolin) 10. Eggs (eggs of chicken, or eggs of fowl) 11. Fish (fresh or dried) and other seafood (shellfish) 12. Legumes, nuts and seeds (cowpeas, beans, lentils , peanut, pumpkin seed, lentil seed, sunflower seed, wild nuts)
13. White roots and tubers (white potatoes, cassava, arrowroot, white sweet potatoes, or foods made from roots)
14. Oils and Fats (cooking fat or oil, ghee, butter, sesame oil, margarine) 15. Sweets (sugar, honey, sweetened soda and fruit drinks, chocolate biscuit, cakes,, candies, cookies, Sugar cane and sweet sorghum) 16. Coffee, tea and Spices (coffee, tea, spices such as black pepper, cardamoms, cinnamon, ginger, nutmeg, cloves, salt. Condiments such as ketchup, soy sauce, chilli sauce) Q 30b. Total number of food groups consumed? Q 30c. Did you or anyone in your household eat anything (meal or snack) OUTSIDE of the home yesterday
Q31 a. In the last three months, what is the main source in the household of: i) Staple cereal? ______ii) Milk? ______(Use codes below)
1= Own production 2= Purchasing 3=Community Gifts/Donations 4= Food aid 5= Bartering 6= Borrowing 7= Gathering
Q31b. 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
Coping Strategies
Q 32. 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)
Urban/IDPs Livelihood Group
0=Never (zero times/week) In the past 30 days, if there have been times when you did not have 1=Hardly at all (<1 times/ week) enough food or money to buy food, how often has your household had 2=Once in a while (1-2 times/ week) to: 3= Pretty often? (3-6 times/week) 4=All the time (Every 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
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 WATER, SANITATION AND HYGIENE
Q33-38 Access to water (quality and quantity)
Q33 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) Appendices 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 84 well 12 = other (specify) … Q34a If the household has no access to protected water sources (if the answer to Q33 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)
Q34b If you get your water from a protected water source (if the answer to Q33 is 1, 2, 3, 4, 5, 6 or 7), How many days in the last year month were you NOT able to get water from the protected source 1= None 2 = 1-5 days 3 = >5 days
Q34c What was reason for not getting water? 1 = couldn’t afford 2 = source dried up 3 = machine broke down 4 = other, specify ______
Q35a 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
Q35b Most days (on average) how much water do you collect for the household
Jerican (20 Jerican (5 Drum (200liters) Haan (local container with O t h e r Total No. of Liters liter) liter) capacity of about 12.5 container liters) (specify) No. of containers
Q36 Is the water for drinking treated and/or chlorinated4 at the Household level? 0 = No 1 = Yes
Q37 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)
Q38 Does the family pay for drinking water? 0 = No 1 = Yes
Q39-40 Sanitation and Hygiene (access and quality)
Q39a 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
Q39b If the answer to Q39a 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
Q39c If the answer to Q39a 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
Q40 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= Plant extracts
Q41 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
Checked by Supervisor (Sign) ______
(Footnotes) 1 Child having received breast milk either directly from the mothers or surrogate mother breast within the last 12 hours 2 Measles immunization is a shot in the upper arm given to children after 6 months of age at health clinics or by mobile health teams 3 Diarrhea is defined for a child having three or more loose or watery stools per day 4 ARI asked as oof wareen or wareento. The three signs asked for are chest in-drawing, cough, rapid breathing/nasal flaring and fever 5 Fever – The three signs to be looked for are periodic chills/shivering, fever, sweating and convulsions 6 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 7 Respondent refers to the person responsible for food preparation on the recall day. For the child, refer to the mother or caregiver 8 WHO, 2008. Indicators for assessing infant and young child feeding practices: Conclusion of a consensus meeting held 6-8 November 2007 in Washington D.C., USA ;FANTA 2002 Summary Indicators for Infant and Child Feeding Practices; 9 Respondent refers to the person responsible for food preparation on the recall day. For the child, refer to the mother or caregiver
4 Chlorinated water should have a characteristic taste and smell
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 7.4 Urban Rapid Assessment Record Form - Gu 2012
Date______Team No:___ Cluster No. ___ Cluster Name______
Appendices Town______Region ______85
Illness in past 14 days? Sex: 0 =No Age Oedema If Yes specify Household Weight Height MUAC SNo Child No. 1=Male (Months) 1= Yes 1= Diarrhoea Number (kg) (cm) (cm) 2=Female 2=No 2=Pneumonia 3=Malaria 4=Measles
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 7.5 Mortality Questionnaire, June 2012
Household No ___ Date______team No ___ cluster No ______Cluster Name ______Enumerator ______Appendices 5: Arrived 2: Sex 3: Age 4: Born since 6: Reason for 7: Cause of No. 1: First Name (1=M; since __ / 3/ 86 (yrs) __ / 3/ 2012 leaving death 2=F) 2012 a) How many members are present in this household now? List them.
b) How many members have left this household (out migrants) since Mar __, 2012? List them
c) Do you have any member of the household who has died since Mar __, 2012? List them
Codes Reason for migration Cause of death
1= Civil Insecurity 6= Hospitalised 1= Diarrhoea 6= Violence/Physical injuries 2= Food Insecurity 7= In boarding school 2= Fever 7= Pregnancy/Birth complications 3= Employment 8= Grazing/herding 3= Measles 8= Other, specify (e.g. still birth) 4=Divorce/ Married away 9= Other, specify 4= Breathing Difficulty 5=Visiting 5= Malnutrition/Hunger
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 47 Issued September 26, 2012 7.6 FIELD SUPERVISOR– VERBAL AUTOPSY
Supervisor’s Name: ______Village: ______Date of interview: ____/_____ / 20___
Post Deyr 2011/12 Nutrition Analysis Household No: _____ Team No: ______Cluster No: ____
FIELD SUPERVISOR – VERBAL AUTOPSY 87
Instructions to interviewer: 1) Introduce yourself and explain the purpose of your visit. 2) Ask to speak to the mother or to another esent adult caretaker who was pr during illnesses the that lead to death. a. If this is not possible, arrange a time to revisit the household when the mother or caretaker will be home.
I. Information on the deceased If IDP, Date of arrival to the camp: Date of death: Name: ______/_____/______/_____/_____ Age :______Date of birth: ____/_____/_____ Settlement: ______Place of death: Sex: ! 1=Male ! 2=Female Section: ______1=Home !2= Hospital
3=Other, specify: ______II. Information about the respondent
Name: ______Age: ______Relationship with deceased: ______
III. Respondents accounting of illness Could you tell me about the events that led to his/her death?
1-‐2 days before death:
1 week before death:
1=Seen at health ! post 2=Discharged from the hospital ! 3=Inpatient/outpatient diagnosis 4 = Stayed at home
IV. Symptoms during illness Tell me if the patient had any of the following symptoms during the illness that led to death (answer all questions)
1. Did s/he cough/difficulty have If YES: in breathing? a. For how long did s/he have cough? ______days b. Was the cough severe? 0=No 1= Yes 9=Don’t Know 0= No 1= Yes c. Was there any blood in the sputum? ……….. 0=No 1= Yes 9=Don’t Know If NO, go to question 2 d. Did s/he have fast breathing OR chest indrawing? 0=No 1= Yes 9=Don’t Know e. Did s/he have difficulty in breathing? 0=No 1= Yes 9=Don’t Know 2. Did s/he fever have ? If YES: 0= No 1= Yes a. For how long did s/he have fever? ______ days If NO, go to question 3 b. Did s/he have chills/rigors?? 0=No 1= Yes 9=Don’t Know 3. Did s/he have diarrhoea? If YES: a. For how ong l did have s/he diarrhoea? ______days 0= No 1= Yes b. When the diarrhoea was most severe, how many times did s/he pass watery stool If NO, go to question 4 in a day? ______times c. Was there mucous with blood in the stools? 0=No 1= Yes 9=Don’t Know d. What was the color of stool? …………………………………………………..
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 4. Did s/he vomit ? If YES: a. For how long did vomit? s/he ______days 0= No 1= Yes b. When the vomiting was most severe, how many times did s/he vomit in a day? If NO, go to question 5 ______times Post Deyr 2011/12 Nutrition Analysis c. What was the colour of the vomit? ……………………………………………… d. Did s/he have abdominal pain? 0=No 1= Yes 9=Don’t Know 88 5. Did s/he headache ? If YES : a. For how long did s/he headache? ______days 0= No 1= Yes b. Did s/he stiff have neck OR bulging fontanelle? 0=No 1= Yes 9=Don’t Know c. if YES For how long did she have stiff neck? ______days If NO, go to 6 question 6. Did s/he convulsions have ? If YES: a. For how long did have s/he convulsions? ______days 0= No 1= Yes If NO, go to question 7 7. Did s/he skin have rash? If YES: a. For how long did s/he skin rash? ______days 0= No 1= Yes b. Where was the rash located? 1= Face 2= Trunk 3=All over the body If NO, go question to 8 c. What did the rash look like?? 1= Measles rash 2= Rash with clear fluid 3= Rash with pus 9= Don’t Know d. Did s/he have red eyes/ running nose? 0=No 1= Yes 9=Don’t Know 8. Did s/he become very thin or If YES: did s/he have leg or foot a. Did s/he receive nutrition support? 0=No 1= Yes 9=Don’t Know swelling ? 0= No 1= Yes if YES: Please specify which programme ……1= SFP/OTP 2= Discharged from SC/ITFC If NO, go to question 9 9. Did s/he yellow have discoloration of the 0=No 1= Yes 9=Don’t Know eyes/palms? 10. Did s/he have any animal If YES: bite? What type of bite?...... 1=snake bite 2=dog bite 3= Insect bite 4= Water 0= No 1= Yes animals (shark, crocodile, hippos, etc) 5= Other, specify ………………………….. 11. Did s/he suffer any physical If YES: injuries? What type injury of ?...... 1=gunshot 2=stabbed 3= explosion 4= burns 0= No 1= Yes 5= severe falls 6=car accidents 7= Other, specify ……………………………… 12. Any other fatal events If YES: 0= No 1= Yes What type?...... 1=suicide 2=drowning 3= Other, specify ……………………….. ONLY for mothers who died while pregnant after or up to 6 weeks delivery 1. Where did she give birth? 1= Home 2=Hospital 3=Other, specify …………………………….. 2. Was there excessive bleeding before/during/after delivery? 0=No 1= Yes 9=Don’t Know 3. Convulsions before or after delivery? 0=No 1= Yes 9=Don’t Know ONLY for INFANTS who died in the first 28 days after birth. 1. Where was the baby 1= born? Home 2=Hospital 3=Other, specify …………………………….. 2. Was s/he able to breathe after birth? 0=No 1= Yes 9=Don’t Know 3. Was s/he able to suckle in a normal way after birth? 0=No 1= Yes 9=Don’t Know V. Any previously known medical conditions? 0=No 1= Yes 9=Don’t Know List: ______
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 FOR SUPERVISOR’S USE ONLY
Ia. Suspected Primary (immediate) cause of death*: ______
Post Deyr 2011/12 Nutrition Analysis Ib. Due to (underlying cause of death)**:______
Ic. Significant conditions not related to the primary cause of death: ______89
Supervisor’s Signature: ______
* Use the code below *Immediate causes **Underlying Causes 1. Diarrhea 1. Cholera 2. Fever 2. Measles 3. Coughs 3. Malaria 4. Hemorrhage 4. Meningitis 5. Crush 5. Anemia 6. Suffocation/chocking (Asphyxia) 6. Hepatitis 7. Acute malnutrition (marasmus, kwashiorkor) 7. Whooping cough 8. Physical injuries Gunshot ( wounds, stabs, deep cuts) 8. Tuberculosis (TB) 9. Road accident 9. Pneumonia 10. Killed (fighting/revenge execution) 10. Pregnancy/birth complications 11. Drowning 11. Hunger/Starvation 12. Hypertension 12. Accidents 13. Animal bites (snake, dog, insect, or water animals) 13. Poison 14. Burn 14. Food Poisoning 15. Falls 15. Asthma 16. Cancer, 17. Diabetes 18. Coronary heart disease 19. Suicide 20. STD/HIV/AIDS
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 7.7 SOUTHERN IDPs and urban questionnaire - July 2012
Rapid Nutrition Assessment Form Date: ______District: ______Livelihood: ______cluster Name: ______
Post Deyr 2011/12 Nutrition Analysis Cluster No. __ Team No. ___
90 Women aged 15-49 yrs Children aged 6-59 months Illness in past 14 days? Vaccination in the Physiological last 6 months Registered in Status: No = 0 feeding centre? Household Edema 1=Pregnant MUAC Sex: Age If Yes, specify No = 0 Number Child Weight Height MUAC 2=Lactating (cm) [for 1=Male (Months) (indicate ALL that If Yes, specify (indicate 0=None No. (kg) (cm) 1= Yes (cm) 3=Not Woman] 2=Female apply) 1 ALL that apply) 1=SFP 2=No pregnant/ 1=Diarrhoea 1=Polio 2=TFC/SC lactating 2=Pneumonia 2=Vitamin A supp 3=OTP 3=Fever 3=Measles2 4= Measles
(Footnotes)
1 Diarrhea is defined for a child having three or more loose or watery stools per day; Pneumonia asked as oof wareen or wareento. The three signs asked for are chest in-drawing, cough, rapid breathing/nasal flaring and fever; Fever – The three signs to be looked for are periodic chills/ shivering, fever, sweating and convulsions; 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 Measles immunization is a shot in the upper arm given to children after 6 months of age at health clinics or by mobile health teams
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 SOMALIA: LIVELIHOOD ZONES 7.8 Somalia Livelihood Zones
Calula Appendices Appendices DJIBOUTI Gulf of Aden Qandala Zeylac Bossaaso 91 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
Eyl NUGAL Burtinle
Jariiban ETHIOPIA Goldogob Galkacyo n a e c O n a Cadaado MUDUG i d Hobyo n Cabudwaaq I
Dhusa Mareeb
GALGADUD Harardheere Ceel Barde Beled Weyne Ceel Bur BAKOOL Livelihood zones Rab-Dhuure HIIRAN Addun Pastoral: Mixed sheep & goats, camel Xudur Awdal border & coastal towns: Petty trading, fishing, salt mining Dolo Ceel Dheere Bulo Barde Central regions Agro-Pastoral: Cowpea, sheep & goats, camel, cattle 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 Bur Hakaba Balcad Hiran riverine: Sorghum, maize, cattle & shoats Afgoye Baardheere Dinsor /" BANADIR Juba pump irrigation: Tobacco, onions, maize MOGADISHU Kakaar-Dharor Pastoral: Sheep, goats, camel
A Qoryoley Sakow L. & M. Shabelle Agro-Pastoral Irrigated: Maize/Sorghum & cattle 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 Afmadow Potato zone & vegetables 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 47 Issued September 26, 2012 8. Glossary of Terms
Anthropometry The technique that deals with the for simple random sampling must be multiplied measurements of the size, height, weight, and by a factor called “design effect”; A measure of
Glossary proportions of the human body. how evenly or unevenly the outcome (for example Baseline data Baseline data represent the situation before wasting, stunting, or mortality) is distributed in the 92 or at the beginning of a program or intervention. population being sampled. Survey data may be compared to baseline data if Global Acute Malnutrition (GAM) GAM includes all defined criteria for comparison are met (e.g., similar children suffering from moderate and severe acute methods and coverage) malnutrition; percent of children under 5 who have Bias Anything other than sampling error which causes low weight-for-height measured by -2 z-scores and the survey result to differ from the actual population with or without oedema. prevalence or rate. Growth Monitoring Observation of a child growth Chronic Malnutrition Chronic malnutrition is an indicator of over time by periodic assessment of his/her weight- nutritional status over time. Chronically malnourished for-height or weight-for-age. children are shorter (stunted) than their comparable Household A group of persons who live together and eat age group. from the same pot (i.e. the HEA definition) Cluster Sampling Cluster sampling requires the division of Kwashiorkor Sign of severe malnutrition characterized by the population into smaller geographical units, e.g. bilateral oedema. villages or neighbourhoods. In a first step, survey organizers select a defined number of units among Malnutrition State in which the physical function of an all geographical units. In a second and sometimes individual is impaired to the point where he or she third step, households are selected within the units can no longer maintain adequate bodily performance using simple random sampling, systematic random process such as growth, pregnancy, lactation, sampling, or the modified EPI method. physical work, and resisting and recovering from disease. Confidence interval When sampling is used, any figure derived from the data is an estimate of the actual Morbidity A condition related to a disease or illness. value and is subject to sampling errors, i.e., there is a Oedema An accumulation of excessive extra cellular risk that the result obtained is not exactly equal to the fluid in the body; a distinguishing characteristic actual value. The estimated prevalence coming out of of kwashiorkor when bilateral. All children with a sample is therefore accompanied by a confidence nutritional oedema are classified as severely interval, a range of values within which the actual malnourished. value of the entire population is likely to be included. This value is generally 95% in nutrition and mortality Outcome Wasting and mortality are examples of outcomes surveys. This means that we can be 95% confident measured in surveys. that the true prevalence lies within the given range. Prevalence Proportion of a population with a disease or Crude mortality rate (CMR) Mortality rate from all causes condition of interest at a designated time. of death for a population (Number of deaths during a P-value If you want to know whether there is a significant specified period /number of persons at risk of dying difference between two survey estimates, frequently during that period) X time period. a statistical test is applied and a P value calculated. Cut-off points The point on a nutritional index used to The P value is the probability that the two estimates classify or screen individuals’ anthropometric status. differ by chance or sampling error.
Design Effect (DE) Cluster sampling results in greater Recall period A defined period in the past used to statistical variance (see definition below) than simple calculate estimated mortality and/or morbidity rates. random sampling because health outcomes tend to Reference Population The NCHS (1977) and WHO (2006) be more similar within than between geographical reference values are based on two large surveys of units (see cluster sampling). To compensate for the healthy children, whose measurements represent resulting loss in precision, the sample size calculated an international reference for deriving an individual’s
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 anthropometric status. to reverse stunting; measured by the height-for-age index. Sample A subset of the total population that should be selected at random to guarantee a representation of Systematic Random Sampling (SRS) A methodology the total population. which selects a sampling unit at random, then selects th every n household thereafter, where ‘n’ equals the Glossary Sample size The size of the sample calculated based on sampling interval. objectives of the survey and statistical considerations. Underweight Percentage of children under the age of 93 Sampling error Sampling error is the degree to which a five with weight-for-age below -2SD from median sample might differ from the whole target population, weight-for-age of reference population. e.g., how well it represents a target population or total population. Sampling error can be quantified (e.g., in Urban town/center (based on UNDP definition/Pre-War a confidence interval). definition): The regional capital and all the district capitals. These urban areas had most of the social amenities Sampling frame The list of all the ultimate sampling units such as schools, mosques, district hospitals, markets, from which the sample is selected. etc. Moreover, there was a greater prospect of the visible Sampling interval The sampling interval is the total number presence of some sort of local government or administrative of sampling units in the population divided by the structures in the regional and district capitals. desired sample size.
Sampling unit The unit that is selected during the process Wasting (1) Growth failure as a result of recent rapid weight of sampling; depending on the sampling process the loss or failure to gain weight; wasted children are sampling unit can be a person, household, cluster, extremely thin; readily reversible once condition district, etc. improve; wasting is measured by the weight-for- Severe Acute Malnutrition (SAM) SAM includes height index. all children suffering from severe malnutrition; percent Wasting (2) Percentage of children under the age of five of children under 5 who have low weight-for-height suffering from moderate or severe wasting (below measured by -3 z-scores and with or without oedema. minus two standard deviations from median weight- Simple Random Sampling The process in which each for-height of reference population). Wasting differs sampling unit is selected at random one at a time from acute malnutrition because it does not take into from a list of all the sampling units in the population. consideration the presence/absence of oedema.
Stunting (chronic malnutrition) Growth failure in a child Z-score Score expressed as a deviation from the mean value that occurs over a slow cumulative process as a result in terms of standard deviation units; the term is used of inadequate nutrition and/or repeated infections; in analyzing continuous variables such as heights stunted children are short for their age and may and weights of a sample. look younger than their actual age; it is not possible
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012 The Information Management Process
Gathering & processing • FSNAU has a unique network of 32 specialists all over Somalia, who assess the nutrition and food security situation regularly and 120 enumerators throughout the country, who provide a rich source of information to ensure a good coverage of data. • Nutrition data is processed and analyzed using the Statistical Package for Social Sciences (SPSS), EPInfo/ENA and STATA software for meta-analysis. • FSNAU developed the Integrated Phase Classification (IPC), a set of protocols for consolidating and summarizing situational analysis. The mapping tool provides a common classification system for food security that draws from the strengths of existing classification systems and integrates them with supporting tools for analysis and communication of food insecurity. • Food security information is gathered through rapid assessments as well as monthly monitoring of market prices, climate, crop and livestock situations. • Baseline livelihood analysis is conducted using an expanded Household Economy Approach (HEA). • The Integrated Database System (IDS), an online repository on FSNAU’s official website www.fsnau.org, provides a web-based user interface for data query, data import and export facilities from and into MS Excel, graphing, spreadsheet management and edit functions.
Validation of Analysis • Quality control of nutrition data is done using the automated plausibility checks function in ENA software. The parameters tested include; missing/flagged data, age distribution, kurtosis, digit preference, skewness and overall sex ratio. • Quality control of food security data is done through exploratory and trend analysis of the different variables including checks for completeness/missing data, market price consistency, seasonal and pattern trends, ground truthing and triangulation of data with staff and other partner agencies, and secondary data such as satelitte imagery, international market prices, FSNAU baseline data, etc. • Before the launch of the biannual seasonal assessment results (Gu and Deyr), two separate day-long vetting meetings are held comprising of major technical organizations and agencies in Somalia’s Food Security and Nutrition clusters. The team critically reviews the analysis presented by FSNAU and challenges the overall analysis where necessary. This is an opportunity to share the detailed analysis, which is often not possible during shorter presentations or in the briefs.
Products and Dissemination • A broad range of FSNAU information products include, monthly, quarterly and biannual reports on food and livelihood insecurity, markets, climate and nutrition, which are distributed both in print and digital formats including PowerPoint presentations and downloadable file available on the FSNAU site. • Feedback meetings with key audiences enable us to evaluate the effectiveness of our information products. We constantly refine our information to make sure it is easily understandable to our different audiences. • FSNAU has also developed a three year integrated communication strategy to ensure that its information products are made available in ways appropriate to different audiences including, donors, aid and development agencies, the media, Somalia authorities and the general public.
United Nations Somalia, Ngecha Road Campus Box 1230, Village Market, Nairobi, Kenya Tel: +254-(0)20-4000000/500, Cell: +254-(0)722202146 / (0)733-616881 Fax: +254-20-4000555 Email: [email protected] Website: www.fsnau.org
FSNAU Technical Series Report No. VI 47 Issued September 26, 2012