Technical Series Report No VI. 25 September 11, 2009 Nutrition Situation Post Gu 2009 Food Security and Nutrition Analysis Unit - Somalia Box 1230, Village Market Nairobi, Kenya Tel: 254-20-4000000 Fax: 254-20-4000555 Website: www.fsnau.org Email: [email protected] Technical and Funding Agencies Managerial Support European Commission FSNAU Technical Series Report No VI. 25 ii Issued September 11, 2009 Acknowledgement FSNAU would like to thank all partner agencies for their participation and support in the Gu ’09 seasonal nutrition assessments and analysis. From April until July 2009 a total of 33 nutrition surveys were conducted, 80 health centres visited and nearly 12,000 children measured in rapid assessments. Without the support and expertise of 15 local NGO, 12 International NGO, 2 Local Authorities and 3 UN agencies, this would not have been possible. A sincere note of thanks and appreciation also goes to the FSNAU nutrition team based in Somalia and Nairobi who work under such difficult conditions yet continue to produce such high quality professional work. Participating partners United Nations Children’s Fund (UNICEF), Ministry of Health and Labor (MOHL), Ministry of Health (MOH), World Food Program (WFP), World Health Organization (WHO), Horn Relief, Somalia Red Crescent Society (SRCS), Muslim Aid-UK, Mercy USA, Co-operative Di Svillupo International (COSV), AFREC (African Rescue Committee), World Vision International (WVI), International Medical Corps (IMC), Gedo Health Consortium (GHC), CARE, Action Contre La Faim (ACF), Intersos, Merlin, Save the Children (UK), Concern Worldwide, MSFB, MSFH, MSF-CH, COOPI, AID organization, Social Development and Research Association (SDRA), Norwegian Church Aid (NCA), Africa Muslim Aid, HIRDA, Green Hope, Degares, Goolyome Relief And Development Organization (GREDO), Somalia Aid Foundation (SAF), Economic Independence Research Group (EIRG), APD, Juba Foundation, WRRS, JCC, VDO, PCDDO, Intercare Development Association (ICDA), Jubaland Charity Center (JCC). Mahad Sanid FSNAU Technical Series Report No VI. 25 iii Issued September 11, 2009 TABLE OF CONTENTS 1. EXECUTIVE SUMMARY 1 2. DEVELOPMENT OF CASELOADS OF ACUTELY MALNOURISHED CHILDREN IN SOMAILA 6 3. NUTRITION ANALYSIS IN SOMALIA 8 4. REGIONAL NUTRITION ANALYSIS 10 4.1 Gedo Region – Pastoral, Agro-Pastoral And Riverine Livelihood Zone 10 4.2 Lower and Middle Juba Regions – Pastoral, Agro-Pastoral and Riverine Livelihood Zone 14 4.3 Bay and Bakool Regions 16 4.4 Lower and Middle Shabelle Regions 20 4.5 Central Somalia: Galgadud and Mudug Regions (Addun, Hawd and Deeh Pastoral; and Cowpea Belt) 23 4.6 Hiran Region – Pastoral, Agro-Pastoral and Riverine Livelihood Zone 26 4.7 Northeast Regions 29 4.8 Northwest Regions 38 4.9 Urban Nutrition analysis 46 5. GUIDANCE FOR USE OF THE PLAUSIBILITY CHECKS 49 6. APPENDICES 52 6.1: Somalia Livelihood Zones 52 6.2 Progression of Estimated Nutrition Situation Deyr ’06/07 - Gu ’09 53 6.3 Nutrition Assessment Tools Post Gu ‘09 54 LIST OF TABLES Table 1: Timeline of activities for Gu 2009 Nutrition Situation Analysis 1 Table 2: Somalia Integrated Food Security Phase Classification, Population Numbers, July - December 2009 5 Table 3: Nutrition Situation Categorisation Framework 8 Table 4: Summary of Key Nutrition Findings in Gedo Region 12 Table 5: Summary of Key Nutrition Findings in Middle and Lower Juba Regions 16 Table 6: Summary of Key Nutrition Findings in Bay and Bakool Regions 19 Table 7: Summary of Key Nutrition Findings in M. and L. Shabelle Region 22 Table 8: Summary of Key Nutrition Findings in Central Regions 25 Table 9: Summary of Key Nutrition Findings in Hiran Region 28 Table 10: Summary of Key Nutrition Findings in Northeast Regions 31 Table 11: Summary of Key Nutrition Findings in Northeast Regions 32 Table 12: Summary of Key Nutrition Findings in IDPs-Northeast Regions 34 Table 13: Summary of Key Nutrition Findings in IDPs-Northeast Regions Qardho IDPs (Exhaustive) N=478 35 Table 14: Summary of Results Sool plateau and Lower Nugal Livelihood Zones 36 Table 15: Sool Plateau of Sool and Sanaag Region Livelihood Zone 39 Table 16. Summary of Key Nutrition Findings in West Golis/Guban, East Golis of Sanaag region and Gebbi Valley 41 Table 17: Key Reference Indicator 42 Table 18: Nugal Valley Livelihood Zone 43 Table 19: Summary of Results of Northwest Agro-pastoral LHZs 43 Table 20: Summary of Key Nutrition Findings of the North West IDPs Hargeisa, Burao and Berbera 45 Table 21: Summary of Key Findings, Rapid Urban Nutrition Assessments, June - July 2009 47 Table 22: Summary of Nutrition Assessments (April - July 2009) 48 Table 23: Plausibility Checks 50 FSNAU Technical Series Report No VI. 25 iv Issued September 11, 2009 LIST OF MAPS Map 1: Estimated Nutrition Situation, July 2009 2 Map 2: Somalia Integrated Food Security Phase Classification, Rural Populations, July - Dec. ‘09 5 Map 3: Somalia Integrated Food Security Phase Classification, Urban Populations, July - Dec. ‘09 5 Map 4: Estimated Nutrition Situation, July 2009 6 Map 5: Gedo Region Livelihood Zones 10 Map 6: Juba Regions Livelihood Zones 14 Map 7: Bay and Bakool Regions Livelihood Zones 17 Map 8: Shabelle Livelihood Zones 20 Map 9: Central: Livelihood Zones 23 Map 10: HiranRegion Livelihood Zones 26 Map 11: North West Livelihood Zones 38 LIST OF FIGURES Figure 1: Median Rates of Global Acute Malnutrition, Gu ’09 2 Figure 2: Median Rates of Stunting & Underweight, Gu ’09 2 Figure 3: Global Acute and Severe Acute Malnutrition Gu ’09 (April - July) WHOGS <-2WHZ & <-3WHZ and /or oedema 3 Figure 4: Comparing GAM rates, Household milk consumption and milk prices of the Deyr 08/09 and the Gu 09 7 Figure 5: Trends in levels of Acute Malnutrition (WHZ<-2 or oedema, WHO 2006) in Gedo Region , 2002-2009 10 Figure 6: Trends in levels of Acute Malnutrition (WHZ <-2Z scores or oedema,WHO 2006) in Juba Regions 2003 – 2009 14 Figure 7: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Bakool region 2002- 2009 17 Figure 8: Bakool agro-pastoral SFP admission 18 Figure 9: Trend in levels of acute malnutrition (WHZ< -2 or oedema , WHO 2006) in Bay region 2002- 2009 18 Figure 10: Cholera outbreak in Bur-hakaba WVI 19 Figure 11: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Shabelle region 2002- 2009 21 Figure 12: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Central region 2002- 2009 ) 24 Figure 13: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Hiran region 2002- 2009 26 Figure 14: Trend in levels of acute malnutrition (WHZ< -2 or oedema, WHO 2006) in Northeast region 2002- 2009 30 Figure 15: MCHs in Sool Plateau, January 2008 - July 2009 36 Figure 16: Stunting Prevalence by Regions in Somalia (2001 - 2008) 37 Figure 17: Trend in levels of acute malnutrition (WHZ< -2 or oedema, (WHO 2006) in Northwest region 2002- 2009 38 Figure 18: Dhahar and Hingalool MCH Nutrition Trends Jan-Jun 2009 39 Figure 19: Badhan and Hadaftimo MCH Nutrition Trends Jan-Jun 09 41 SPECIAL ARTICLES Trends in Pastoral Malnutrition - The Case of West Golis/Guban Livelihood Zones, Somaliland 7 Somalia National Micronutrient Malnutrition Study: Field Experiences 13 Piloting the Trials of Improved Practices (Tips) in Somalia 37 Stunting Trends in Somalia: The Case of Bay Region 37 Breast Feeding is the Best Feeding Method for Healthy Growth and Development (World Breastfeeding Week 2009) 51 FSNAU Technical Series Report No VI. 25 v Issued September 11, 2009 LIST OF ACRONYMS ARI Acute Respiratory Tract Infections ACF Action Contre La Faim AFLC Acute Food and Livelihood Crisis BFI Borederline Food Insecure CARE Canadian Relief Everywhere CMAM Community Management of Acute Malnutrition CMR Crude Mortality Rate (Retrospective) COSV Co-operatione Di Svillupo International CTC Community Therapeutic Care FAO Food and Agricultural Organixation of the United Nations FSNAU Food Security and Nutrition Analysis Unit FEWSNET Famine Early Warning System Network GAM Global Acute Malnutrition GHC Gedo Health Consortium HE Humanitarian Emergency HIS Health Information System IDP Internally Displaced persons LQAs Lot Quality Assurance Sampling LZ Livelihood Zone MCH Maternal and Child Health Center MOH Ministry of Health MOHL Ministry of Health and Labour MT Metric Tonne MUAC Mid Upper Arm Circumference NCHS National Center for Health Statistics OTP Out pateint Therapuetic Programme PWA Post War Average SAM Severe Acute Malnutrition SRCS Somalia Red Crescent Societies SD Standard Deviation SFP Selective/Supplementary Feeding Program TIPS Trials of Imporved Practice U5MR Under Five Mortality Rate (Retrospective) WHO World Health Organization of the United Nations WFP World Food Program of the United Nations WHZ Weight for Height Z Scores FSNAU Technical Series Report No VI. 25 vi Issued September 11, 2009 Forward This nutrition situation technical series report is a recent publication of the Food Security and Nutrition Analysis Unit (FSNAU). The FSNAU biannual seasonal technical series reports have always included an integrated analysis of all sectors including nutrition, however given the scale of nutrition information available, a separate publication was deemed appropriate. Therefore, this report does not replace the seasonal technical series report rather complements it, with a specific focus on nutrition information. The FSNAU Post Gu ’09 Technical Series report, will be released in the coming weeks and provides a detailed analysis by region and by sector of the integrated food security situation. FSNAU Technical Series Report No VI. 25 vii Issued September 11, 2009 FSNAU Technical Series Report No VI. 25 viii Issued September 11, 2009 1. Executive Summary An integrated analysis of the nutrition information from the Gu‘ 09 season indicates a varied yet alarming situation throughout the country (See Map 1). Civil insecurity in Mogadishu leading to on-going population displacement, the severe and deepening drought conditions in Central regions, parts of the South and in the northwest regions and the continuing elevated commodity prices, are the key driving factors in the current analysis.