NNUTRITION UUPDATE Food and Agriculture Food Security Organization of the Assessment Unit United Nations December 2001 OVERVIEW The Nutrition Survey results from Belet Hawa have confirmed our worst fears. Malnutrition rates in the district are appalling high with a total of 37%1 of children less than five years malnourished, including 8% severely malnourished (W/H using Z-score). Unfortunately, no-one who has followed the situation will find the results ‘shocking’ in a population already known to have the poorest health services, the most fragile water and food security ‘systems’ and an ever volatile civil insecurity. This, as a starting point, with the added burden of a prolonged drought and an interruption in the pipeline of the main food-aid organisation spelled disaster in recent months. The extent of human suffering is now evident. This month we have also seen reports and preliminary results from a number of nutrition surveys in various parts of Somalia. All the surveys have shown malnutrition rates among children under the age of five years of between 14% and 19% using W/H less than -2 Z scores. According to international guidelines, unless a dramatic improvement in food security is imminent, these results demand an emergency type intervention in order to prevent further mortality and morbidity. So, do the In this issue of ‘Nutrition Update’ ……. situations in Hargeisa, Burao, Rabdure and Qansaxdheere constitute emergencies? Certainly for the malnourished children in § Nutrition survey in Belet Hawa – each place they do. But this does not mean that we should preliminary results, respond with solutions that merely aim to make the picture look § Nutrition survey in Rabdure – summary better by concentrating on food aid interventions in isolation. and analysis, § Nutrition survey Burao – preliminary Each year, we wait until the human suffering indicator – results, malnutrition, confirms food insecurity information. When we are convinced that a problem exists, we reluctantly recommend food- § Anaemia prevalence survey in aid along with the wise words, ‘food-aid is not the answer’. But Somaliland where are the interventions that aim at reducing the ever-increasing vulnerability of the people of Somalia? Unfortunately there are very few. NUTRITION ASSESSMENTS AND SURVEYS Area Organisations Status Somaliland Toghdheer- Burao UNICEF, MOHL, SRCS Preliminary results now available. Somaliland Awdal UNICEF, MOHL, SRCS Undergoing analysis Somaliland Sool - Haud NPA & FSAU Repeat assessment undertaken. Somaliland All regions UNICEF, MOHL Preliminary results of anaemia survey available. Puntland Mudug - Galgodob UNICEF Undergoing analysis. Puntland Mudug - Galcayo UNICEF, MSF-H, FSAU. Postponed. Puntland/Central Mudug - Haradheere CISP Early 2002 South Bakool - Rabdure UNICEF Report now available. Summary in this issue. South Bay - UNICEF Preliminary results available. Qansaxdheere Awaiting report. South Gedo - Luuq ACF Postponed South Gedo – Bulla Hawa FSAU, UNICEF, Gedo Preliminary results in this issue. Health Consortium, CARE GEDO REGION – UPDATE ON INTERVENTIONS § WFP and NCA have committed to supporting a two-month food aid intervention in Garbaharey and Burdhubo and the first food-aid distribution has been undertaken successfully in both locations. § Gedo Health Consortium2 has received funding from the Dutch Government to implement supplementary feeding in Belet Hawa and Garbaharey with the possibility of extending ‘satellite’ services to Burdhubo and Dolo. Initial screening in Belet Hawa town has shown that out of 650 screened (at the health facility), 30% were malnourished (W/H less than 1 Unless otherwise stated, all malnutrition rates in this document refer to Z-scores. Global malnutrition: - W/H < -2 Z-scores; incl. oedema. Severe malnutrition: W/H <-3 Z-scores; incl. oedema. 2 Trocaire, AMREF and CORDAID. The FSAU Nutrition Surveillance Project is funded by USAID/OFDA Monthly Update of Information on Nutrition - November 2001 –2 Z scores). In Garbaharey, 70% were malnourished out of the 270 screened at the health facility. The supplementary feeding programme will involve the distribution of ‘pre-mix’ ration (blended food mixed with oil), which is expected to contribute to increased weight gain, and decreased marketability of the food. § GHC will also examine the possibility of supporting health services in the El Bon area. § UNICEF has committed to supporting Tear Fund with the provision of blended food for their proposed supplementary feeding programme in Luuq District. § The planned nutrition survey in Luuq District has been postponed again due to insecurity. § ACF continue to report increases in numbers of ‘new admissions’ and ‘total attending’ both therapeutic and supplementary feeding programmes in Luuq and El Bon. The admission of children from surrounding districts has also been reported. It is hoped that movement of people to benefit from aid projects will now decrease with the strengthening of both food-aid distribution and supplementary feeding interventions in other districts in Gedo. ACF will monitor this issue to ensure that organisations operating in other areas can monitor food-aid related displacement and support interventions in the locations of origin. NUTRITION SURVEY IN BELET HAWA, GEDO REGION Preliminary results B. Owadi & J. King’ori, FSAU Situated in the north west of Gedo Region, Belet Hawa District is one of the most populated in the region with an estimated population size of 60,000. It is located along the border of Kenya to the West, Ethiopia to the North-west, Dolow to the North East, Elwak to the South-West, Luuq to the East and Garbaharey to the South-East. About 70% of the population depends on livestock for their livelihood and around 15% are agro-pastoralists. The district has faced recurrent droughts for the past three years leading to a steady depletion of assets and an ever-increasing vulnerability. Along with four other districts in northern Gedo, Belet Hawa is now considered the most critically affected area in Somalia. The recent rainfall performance has been completely hopeless and at the time of the survey, most animals had either left the district or had died. The death of donkeys, which are used as pack animals, has caused further distress to households attempting to relocate or to those who use the animals for firewood collection as a source of income. Animals who have left the district for better pastures have also experienced diseases (this report confirmed in Bay and Lower Juba) and so the expected income from these animals has not materialised. Persistently high malnutrition and high attendance levels at the district MCH have been recorded particularly in the period between July 2000 and February 2001. Over that period a supplementary feeding programme was implemented through the MCH. This activity ceased in April 2001. The district has experienced repeated incidences of insecurity and these along with the presence of land mines in the district have severely hindered humanitarian operations. With the failure of Gu rains, livestock moved out of Gedo Region, and Belet Hawa District in particular, and this further worsened food insecurity. In view of the threatened population livelihood, water shortage and limited alternatives for survival, a better understanding of the situation was sought. A district nutrition survey was Nutrition status Proportion th th conducted between 11 and 15 Global Acute Malnutrition 37.2%3 95% C.I. 34.1-40.5 December 2001 aimed at Weight for height <2 z-score or oedema determining the nutritional status of Severe Acute Malnutrition 7.9% 95% C.I. 6.2- 9.8 children aged 6-59 months and the Weight for height <3 z-score and/or oedema factors influencing the same. The Oedema 2% survey was led by FSAU and the team included UNICEF, CARE and Gedo Health Consortium. A total of 948 children were surveyed using a 30 by 30 two- stage cluster sampling methodology. Preliminary results are presented here. The team saw emaciated children in most villages and many children who were unable to stand and had difficulty in breathing. The condition of the population in Belet Hawa town appeared much better than that of people in the villages. Animal carcasses were observed by the team and one village, Lanameer, had physically moved to create a distance between the people and the stench of rotting animals. Many households were observed to have few or no remaining possessions. Most households have no access to clean water. Morbidity, health care and feeding in children Proportion As indicated in the table, incidence of respiratory Acute respiratory infection in past two weeks 67% infection and diarrhoea in young children is Children with diarrhoea in past two weeks 62% extremely high indicating both a cause of further Malaria in the past two weeks 46% malnutrition, a deterioration in children already Vitamin A supplementation in past 6 months 81% malnourished and an increased vulnerability to disease in an already compromised population. Measles immunization in past 6 months 43% The high proportion of vitamin A coverage is Frequency of feeding in a day most likely linked to the recent Polio Ø Once 9% 4 immunisation campaign in the district. Ø Twice 59% Ø 3-4 times 26% Ø Five and above 5% 3 Global malnutrition rate is the total rate, so the proportions shown for severe malnutrition and oedema are included in this number. 4 To be confirmed 2 Monthly Update of Information on Nutrition - November 2001 Interventions q Sorghum was distributed by CARE in Belet Hawa district each month up to July 2001 and again in Belet Hawa.Pop-60,700 October 2001 (720 MT). Families with ICRC malnourished children or with members who are 900 UNICEF 800 CARE elderly or disabled were targeted along with WFP 5 700 displaced households. FOOD GAP 600 q In December, 720 MT were distributed to an 500 estimated 14,000 beneficiaries with each receiving MT 400 50 kg of sorghum and 2 kg of oil. (See chart). 300 q No protein foods have been distributed but lentils 200 will be distributed in late December.