FSNAU. Overview. May - June Food Security and Nutrition Analysis Unit - Somalia

Transcription

1 Bi Monthly Nutrition Update May - June, 2010 Food Security and Nutrition Analysis Unit - Somalia May - June 2010 Overview Nutrition Situation In May and June 2010, /UNICEF in collaboration with MOHL in Somaliland, MOH in Puntland, and Muslim Aid, Somalia Red Crescent Society (SRCS), Zam Zam, INTERSOS, COSV, ASAL, TRG, SACOD, Hawa Abdi Hospital, New Ways, Mercy USA, AMA, and Hirda in South Central regions conducted 12 representative nutrition surveys, which assessed internally displaced populations (IDPs) and rural livelihood zones 1. Seven IDP assessments were conducted in the Afgoye corridor in Lower Shabelle; Hargeisa, Burao and Berbera Towns in the Northwest, and Galcayo, Bossaso and Garowe Towns in the Northeast regions. The rural livelihood based surveys were conducted in Central/Northeast and Gedo regions. Results indicate a Sustained Nutritional Crisis both in the IDP settlements and the rural livelihoods. 1 additional livelihood based small sample nutrition cluster surveys are on-going in the north and a further 12 scheduled in Juba, Bay, Bakool and Hiran regions in the south. The findings will be shared in the Post Gu 10 Nutrition Technical Series Report due mid September Overview 1 Afgoye IDP Assessment Findings 3 Garowe, Bossaso and Galcayo IDPs Hargeisa, Burao and Berbera IDPs 8 KAP Study Boroma, Burao and Bossaso 10 Gedo Nutrition Assessment Findings 11 Hawd & Addun Livelihood Assessment Findings 13 Plausibility Checks 16 IDP Nutritional Status The nutrition situation of the Afgoye IDP population remains Critical as reported in the Deyr 09/10. The preliminary results of the Afgoye nutrition assessment conducted in June 2010 provides prevalence rates of.1% ( ) and 1.% ( ) for GAM (WHZ <-2 or oedema) and SAM (WHZ <-3 or oedema) with no oedema case. A two survey probability calculator did not show any significant change from the GAM and SAM rates of.9% ( ) and.% (2.-8.2) reported in the December 2009 assessment. The situation therefore remains Critical. and girls were acutely malnourished in equal proportions (p>0.0). The 90 days retrospective crude (CDR) and under-five year death rates were 0.99 ( ) and 1.40 ( ) deaths/10,000/day respectively, both being classified as alert according to WHO classification. This is an improvement from CDR and UDR rates of 1.2 ( ) and 2.32 ( ) deaths/10,000/ day reported in the Deyr 09/10. The morbidity rate was high, with 34.6% of the assessed children reportedly ill in the 2 weeks prior to the assessment. The prevalence of reported diarrhoea, acute respiratory tract infections, ARI and fever was 11.3%, 3.3% and 2.1%. The high levels of febrile illness reported are consistent with the peak of the Gu rainy season. A malaria assessment conducted simultaneously using rapid diagnostic tests nevertheless confirmed only 1.8% of the assessed population as positive for Plasmodium falciparum. The IDP population remains extremely vulnerable due to lack of adequate health and sanitation facilities, limited access to clean water and to humanitarian interventions, coupled with poor shelter conditions. In the Northeast IDPs, results analyzed using the CDC probability calculator at 90% probability estimate GAM and SAM rates as >26% and SAM rate >3.3% in Bossaso IDPs. This indicates a Very Critical nutrition situation, and a significant deterioration (p=0.026) from the Critical phase in December These results are in line with the historical data collected annually from 2000, with the exception of 2009, 1 Probability proportionate to size sampling methodology was used in the Afgoye IDP and Central/Northeast surveys, while the 33x6 small sample cluster surveys conducted in Gedo, Northwest and Northeast IDP population groups. A Mother and her children, Burao IDP camp, Togdheer region,, Dec 09 when results fell below 20%. The deterioration in Bossaso IDPs could be attributed to the reduced humanitarian assistance provided in recent months, in addition to reduced income access. The latter is associated with low labour opportunities following reduced activities at the Bossaso port as a result of high sea tide in June September; and the seasonal out-migration of the better off (who normally offer casual work) due to high temperatures. High morbidity of 2.2% assessed by recall among the assessed population, (mainly from diarrhea, 46.4%) in the preceding two weeks also aggravated the situation. The on-going outpatient therapeutic and supplementary feeding programs managed by UNICEF, WFP and partners however are responding to the situation. Results for the Garowe IDP nutrition assessment, show a GAM rate of > 11.%, and a SAM rate > 3% indicating a Serious nutrition situation. This is an improvement from July 2009 nutrition assessment findings which indicated a Very Critical level. In Galcayo IDPs, the GAM and SAM rates are estimated at > 11.3% and >1.2% respectively, indicating a Serious nutrition situation and a significant improvement from the Very Critical situation in December 2009, (p>0.0). The improvements in the Galcayo and Garowe IDPs are likely attributed to the positive impact of the Gu 10 rainfall that has increased milk and meat access, and the declining food prices noted in the towns. Ongoing interventions including active case finding and referral of acutely malnourished children have also assisted in abating the situation. In all the three IDP surveys, boys and girls were equally affected by acute malnutrition (p>0.0). In the Northwest IDPs, results analyzed using the CDC The is managed by FAO and funded by USAID/OFDA, the EC, SIDA and UNICEF and UNHCR

2 Bi Monthly Nutrition Update May - June, 2010 probability calculator at 90% probability estimate GAM and SAM rates as >13.0% and >0.9% in the Hargeisa IDPs, >1.3% and >3.4% in Burao IDPs and >.% and.4% in Berbera IDPS. and girls were acutely malnourished in equal proportions (p>0.0) in all the surveys. The findings indicate a deterioration of the nutrition situation for Burao IDPs, though not of statistical significance (Pr=0.), from Serious in the Deyr 09/10, to Critical, mainly attributed to an increased influx of vulnerable and asset stricken IDPs from South Central Somalia, who are dependent on the protracted IDPs for food and basic requirements. The findings however indicate sustained Serious and Critical nutrition situations among the Hargeisa and Berbera IDPs. South Central Nutritional Status In Gedo Region, three nutrition surveys were conducted in the pastoral, agropastoral and riverine livelihood zones. Results based on the CDC probability calculator at 90% probability indicate that the GAM and SAM rates are > 16.3% and > 3.% respectively in the pastoralist population. The results reflect a Critical nutrition situation and an improvement from Very Critical levels in December 2009 when a GAM >20% was recorded. The improvement in the GAM, though not statistically significant (p=0.48), is largely attributed to increased access to milk and milk products following improved water availability and rangeland conditions that favored livestock production in the Gu 10. In the agropastoral assessment, a GAM rate of >21.%, and a SAM rate of >.6% were reported, while a GAM rate of >.9%, and a SAM rate of 2.4% was reported in the riverine population. The results indicate a sustained Critical nutrition situation in the riverine livelihood and slight deterioration from Critical to Very Critical in the agro-pastoral livelihood, which is not statistically significant (p>0.0) when compared to the situation 2 in December The slight deterioration in the agropastoral could be as result of the impact of past crop failures, including Deyr 09/10 and damage of crop by pest/ grasshoppers. Nevertheless the trend is likely to be reversed with anticipated good cereal production across the region and improved milk access following the good Gu 10 rains. and girls were acutely malnourished in equal proportions in the three livelihoods (p>0.0). In Central/Northeast regions, two nutrition surveys were conducted in the Hawd and Addun livelihood zones. Results indicate a GAM rate of.3% ( ) and a SAM rate of 3.9% ( ) in the Hawd reflecting a sustained Critical nutrition situation. Nevertheless, statistical analysis of the findings based on the CDC probability calculator indicate a significant improvement 3 in the global acute malnutrition rate (Pr=93.6%) from the November 2009 findings 4. The general improvement is associated with increased access to milk and milk products following pasture and water availability with the favorable Gu 2010 rains and the impact of humanitarian interventions. The crude death rate (CDR) is 1.0 ( ), above the alert threshold indicating deterioration since November The 33 reported deaths were reportedly attributed to diarrhea (9 cases mainly from Abudwaq) and acute respiratory infections (6). For the Addun livelihood zone, findings indicate a GAM rate of 22.8% ( ) and SAM rate of.1% (4. 10.), reflecting a Very Critical nutrition situation. Statistical analysis based on the CDC 2 In December 2009 assessments, the GAM and SAM rates of >18.2% and 2.6% (pr=0.90) were recorded in the agropastoralists 3 Using the CDC Calculator, a two-tailed % and one-tailed 8.% probabilities are considered operationally different between two surveys 4 In Nov 09, the GAM and SAM rates were 19.1% ( ), in the Hawd, and 20.2% (.6 24.) and 4.6% ( ) in Addun, respectively probability calculator indicates insignificant deterioration in the GAM, but significant deterioration in the SAM (Pr=93.2%). Whereas the Gu 2010 rains have also been favourable in the Addun livelihood zone, the area is faced with conflict and hosts large numbers of internally displaced persons from South Central. Limited road transport hinders access to food and non-food items from Bossaso sea port. The CDR is 0.2 ( ) and within alert levels. The 18 reported deaths were mainly attributed to birth related complications (6) and accidents/conflict related killings. Statistical analysis using the CDC probability calculator also shows a more concerning nutrition situation in the Addun compared to the Hawd, both for the GAM (Pr=99.8%), and SAM (Pr=92.6%). Acute Watery Diarrhea, AWD, (Excerpt from the May 2010 Somalia Health Cluster Bulletin #3) The number of cholera cases reported from Banadir Hospital in Mogadishu is relatively high. In May 2010, the hospital registered 46 cases of whom 89% were children under years. At the cholera treatment centre of Merka Hospital in Lower Shabelle region, four of the samples collected, tested positive for positive for Vibrio cholera serotype inaba Between 3 rd and 30th May, 109 sentinel sites of the Communicable Disease Surveillance (CDS) in South Central Somalia reported a total of 6,292 consultations for five health events. AWD cases accounted for 3,664 (of these.% children); malaria for 6 cases (of these 0% children); bloody diarrhoea for 924 (of these 9% children); measles 3 cases (of these 91% children), and meningitis 20 cases (3% of these children). The integrated disease surveillance and response system (IDSR) in districts of Lower and Middle Juba reported 422 consultations from 14 health facilities. AWD cases accounted for 833 consultations (6% of them children 4) of all the consultations. The IDSR also reported a total of consultations and 20 deaths (90% over years) from 36 health facilities in Lower Shabelle. Of all consultations, Acute respiratory infections (ARI) accounted for 21% (464) of all consultations, while AWD for 1% (221 cases of which 166 children). About 11% of all AWD cases were reported from Afgoye district. For details, refer to the Somalia Health Cluster Bulletin # 3, May 2010 accessible at int/somalia/healthcluster.htm Knowledge, Attitudes and Practices (KAP) Study also conducted a KAP study in the Boroma, Burao and Bossaso Towns and selected villages in these districts. This is an activity under UNFAO s Rapid Response Rehabilitation of Rural Livelihoods Project. The overall aim of the project is to mitigate the chronic food crisis in the country by increasing domestic food production, and reducing livestock losses for the poor rural households. Support to strategies using livestock resources to address the food crisis (mainly improving of slaughter houses with value added services such as promotion of use of by-products such as offal for improved nutrition and increased incomes) is one of the expected project outcomes. The main objective of the KAP study was to gain an understanding of the communities knowledge, attitudes and common practices regarding offal consumption, in order to design an appropriate nutrition education package for the targeted communities. The findings will serve as baseline information upon which to monitor progress of this intervention. The overall results indicate that offal consumption is generally culturally acceptable; however preference, availability, common beliefs and socio economic status are key determinants of the extent to which it is consumed. 2

3 Bi Monthly Nutrition Update May - June, 2010 LOWER SHABELLE REGION Afgoye IDP Assessment Findings The nutrition situation of the Afgoye IDP population remains Critical as reported in the Deyr 09/10 according to the WHO classification. In June 2010, /UNICEF in collaboration with Muslim Aid, Somalia Red Crescent Society (SRCS), Zam Zam, INTERSOS, COSV, ASAL, TRG, SACOD, Hawa Abdi Hospital, New Ways and Mercy USA conducted a nutrition survey in Afgoye IDPs using a 2 stage probability proportional to size cluster sampling methodology among 639 children, from 2 clusters. Preliminary findings indicate point prevalence rates of.1% ( ) and 1.% ( ) for GAM (WHZ <-2 or oedema) and SAM (WHZ <-3 or oedema) with no oedema case. A two survey probability calculator did not show any significant change from the GAM rates of.9% ( ) but SAM rates were significant different (p=0.01; Pr=0.99) dropping from.% (2.-8.2) reported in the December 2009 assessment. The situation therefore remains Critical 1 (Figure 1). The 90 days retrospective crude and under-five year death rates were 0.99 ( ) and 1.40 ( ) deaths/10,000/day respectively, both being classified as alert according to WHO classification, this is an improvement from the previous CDR and UDR rates of 1.2 ( ) and 2.32 ( ) deaths/10,000/day respectively that were above the emergency thresholds in the previous assessment. The proportion of children who had reportedly suffered from one or more communicable childhood diseases during the two weeks prior to the assessment was 34.%. The prevalence of diarrhoea, ARI and fever was 11.3%,.3% and 2.1% 1 There were significant variations in acute malnutrition recorded in certain sections of the population, who were receiving social support in cash and food assistance. Figure 1. Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Shabelle Regions ( ) % respectively. The high levels of febrile illness reported are consistent with the peak of the Gu rainy season. Nevertheless, a rapid diagnostic test for malaria conducted concurrently with nutrition assessment, confirmed a low prevalence of 1.8% of the assessed population as positive to Plasmodium falciparum. There was no outbreak of Acute Watery Diarrhoea (AWD) reported among the Afgoye IDP s. The proportion of children who reportedly received immunization against measles and polio and those who received vitamin A supplementation were 61.%, 82.0% and 9.2% respectively, all falling short of the recommended 9% Sphere (2004) levels and a drop from the rates of 69.8%,.8% and 0.8% reported in the previous assessment conducted in December Coverage for the full tetanus immunization among women of reproductive age was also fairly low. Only 66% of women had ever received any dose of tetanus vaccination with few proportions of 32.2 % and 18.3 % among the assessed mothers having received the 2 nd doses and 3 rd doses. Of the pregnant and lactating women assessed,.6% were acutely malnourished (MUAC<23.0 cm) while some 3.3% were acutely malnourished (MUAC 18. cm) among the non pregnant and non lactating women. Overall, 6.3% of all the assessed women had low MUAC measurement for their physiological status (See Table 1). The improved access to sanitation facilities (99.%) and to protected drinking water sources (83.2%) are mitigating factors in preventing disease outbreaks and further deterioration of the nutrition situation. However, the IDP population still remains vulnerable to inadequate dietary diversity, with 10.1% of the households reportedly consuming a poorly diversified diet, in addition to reported inappropriate child feeding practices. Only.% of the children aged 6-24 months reportedly consumed at least four out of eight food groups 2 and only 36.6% met the recommended feeding frequency for the ages, despite a high proportion of the children still breastfeeding. Recent conflict and insecurity has had a significant impact on the availability of humanitarian assistance to the Afgoye IDPs, notably the suspension of the general food distributions for the last 6 months. However mitigating factors likely to have prevented deterioration in the nutrition situation have been early onset and above average Gu rains, which has led to agricultural labour opportunities and increased purchasing power for poorer households. Despite this, the Afgoye IDP s food security situation remains precarious, and they are remain vulnerable to future shocks 0.0 May.0 Nov.0 May.08 Nov.08 May.09 Nov.09 May.0 Nov.0 May.08 Nov.08 May.09 Nov.09 Nov.0 May.08 Nov.08 May.09 Nov.09 Jun Cereals, milk, oils, pulses, meats, roots & tubers, vitamin A -rich fruits & vegetables, other fruits & vegetables (FANTA, 2002) Shabelle Riverine Shabelle Agropastoral Shabelle IDP 3

4 Bi Monthly Nutrition Update May - June, 2010 Table 1: Summary of Key Findings for Afgoye IDPs Assessments Afgoye IDPs (2 Clusters) Indicator n % 9% CI Total number of households assessed for children Household Head Male Headed Female Headed Total number of children assessed: Child malnutrition Global Acute Malnutrition (WHO 2006) Mean WHZ (WHO, 2006) -0.3 ± 1.31 Severe Acute Malnutrition (WHO 2006) Oedema Global Acute Malnutrition (NCHS) Severe Acute Malnutrition (NCHS) Global Acute Malnutrition (WHM<80% or oedema - NCHS) Severe Acute Malnutrition (WHM<0% or oedema - NCHS) Global Acute Malnutrition by MUAC (<12. cm or oedema) Severe Acute Malnutrition by MUAC (<11. cm or oedema) Number of children Stunted (HAZ<-2) Number of children Underweight (WAZ<-2) Child Morbidity Children reported ill in the previous 2 weeks Children reported with diarrhoea in 2 weeks prior to assessment Children reported with ARI in 2 weeks prior to assessment Children reported with febrile illness in 2 weeks prior to assessment Proportion who tested RDT positive for malaria (N=126) Children reported with suspected measles within one month prior to assessment Child Immunization status Children (6-9 months) immunised against measles (recall) Children who received vitamin A suppl in last 6 months (recall) Children who have ever received polio vaccine (recall) No doses Three or more Infant and young child feeding (N=232) Proportion still breastfeeding <24months Proportion meeting recommended feeding frequencies Proportion who reported to have consumed 4 food groups Maternal Health and Nutrition (N=396) Total women who are acutely malnourished Pregnant & lactating women acutely malnourished (MUAC<23.0 cm) (N=26) Non pregnant women acutely malnourished (MUAC 18. cm) (N=120) Women who received tetanus immunization (recall) No dose Three doses Household Access to Essential Indicators Reported Households consumed 3 food groups Access to mosquito Net Access to safe/protected drinking water Access to latrine Crude Death Rate (deaths/10,000/day) Under five Death Rate (deaths/10,000/day)

5 Bi Monthly Nutrition Update May - June, 2010 Northeast ZONE Galcayo, Bossaso and Garowe IDPs The relative peace and economic activities in Garowe, Bossaso and Galcayo Towns in the Northeast regions have made them host to a large population of internally displaced persons (IDP) fleeing from conflict, economic and food insecurity in the central and southern parts of Somalia and Ethiopia 1. Unfortunately, the lack of an established livelihood support system for IDPs coupled with their limited access to basic needs and services including food, clothing, shelter, water, sanitation, health and housing, predispose them consistently to acute malnutrition, ill health and food insecurity (Figure 2). The integrated analysis of the Post Deyr 09/10 indicates a Very Critical, Critical and Serious nutrition situation among the Galcayo, Bossaso and Garowe IDPs respectively. Figure 2: Trends in Levels of Acute Malnutrition (WHZ<-2 or oedema) in Northeast IDPs ( ) 30 % 0 Jul.02 Jul.03 Jul.04 Oct.04 Oct.06 Oct.08 Jul.09 Dec. Jun.10 May Between the 8 th and th of June 2010, in collaboration with UNICEF and the Ministry of Health conducted three interagency IDP nutrition assessments in Galcayo, Bossaso and Garowe IDP settlements. These assessments were conducted to monitor the levels of acute malnutrition among the IDPs in the Northeast zone in order to inform on the appropriate interventions for these vulnerable populations. A 33x6 cluster sampling methodology was used in each of the three IDPs populations. A total of 198, 209, and 198 children aged 6-9 months from 9, 10 and 88 households were assessed from the Galcayo, Bossaso and Garowe IDP settlements respectively. Using the CDC probability calculator, the results show a GAM rate of >26% (Pr. =90%) and SAM rate of >3.3% among the Bossaso IDPs. This indicates a Very Critical nutrition situation, and a significant deterioration (p=0.026) from the December 2009 assessment with a GAM rate of >1.%. Nevertheless, there is a decline in the proportion of severely acutely malnourished (WHZ <-3 or oedema) children from the prevalence rate of >. % (p=0.38). (31.3%) and (31%) were equally affected with acute malnutrition. The deterioration in Bosasso IDPs could be attributed to limited 1 FEWS NET (2009), Bossaso Urban Household Economy Study, A Special Report by the Famine Early Warning Systems Network, Somalia May. 08 Jul.09 Dec. Jun.10 May Jul.09 Jun.10 Bossaso Galkayo Garowe access to the general humanitarian assistance in addition to reduced income access. The latter is associated with low labour opportunities following both the closure of the port activities as a result of high sea tide; and the seasonal out-migration of the better off (who normally offer casual work) due to high temperatures and strong tidal waves. High morbidity by recall, among the assessed population, with 2.2% reported to have been ill (mainly from diarrhoea, 46.4%) in the two weeks prior to the assessment, is also an aggravating factor. Mitigating factors however include the outpatient therapeutic and supplementary feeding programs managed by UNICEF, WFP and partners. The results for the Garowe nutrition assessment, (33x6) based on the CDC probability calculator, indicate a GAM (WHZ<- 2 or oedema) rate of > 11.% (Pr. =90%), while the SAM (WHZ <-3 or oedema) rate is > 3% (Pr. =90%). This indicates a Serious nutrition situation, but an improvement from results of an exhaustive nutrition assessment conducted in July 2009, when the GAM rate was 24.% and SAM rate 6.%. The improvement in both Galcayo and Garowe is attributed to the positive impact of the Gu 10 rainfall, that has increased milk and meat access for the population, and the declining food prices noted in the towns. Ongoing interventions including active case finding and referral of acutely malnourished children have also assisted in abating the situation. The results for the Galcayo IDP assessment (33x6) based on the CDC probability calculator, indicates a high probability (Pr. =90%) that the global acute malnutrition (GAM) rate (WHZ<- 2 or oedema) is > 11.3% while the severe acute malnutrition (SAM) (WHZ <-3 or oedema) rate is >1.2%. This indicates a Serious nutrition situation and a significant improvement from the GAM rate of >23.% (Pr=90%) and SAM rate of >6.3% (Pr=90%) recorded in December 2009, (p>0.0). (14.3%) and (.1%) were equally affected with acute malnutrition (p>0.0). The proportion of children (aged 6-9 months) who had suffered from one or more communicable diseases during the two weeks prior to the assessment was very high: 46.9%; 2.2%; and 3.4% among the assessed Galcayo, Bossaso and Garowe IDP populations respectively. As shown in Table 2, the incidences of reported diarrhoea in the two weeks prior to the assessment are high among the Galcayo, Bossaso and Garowe IDP populations (20.2%; 46.4% and.1% respectively). High incidences of ARI (21.%; 3.9%; and.%) and febrile illness 36.4%; 4.8%; and 29.3% were also reported among the Galcayo, Bossaso and Garowe IDP populations respectively. Morbidity is normally closely correlated with acute malnutrition, for example, the Bossaso IDP children reported to have suffered from ARI within the two week prior to the assessment were nearly twice as likely to be acutely malnourished than those who were well (RR=1.33; ). Although the cases of suspected measles were low, it continues to be a risk factor in undernourished populations. According to the Sphere (2004) minimum operating standards, vaccination coverage for measles, as well as polio and vitamin

6 Bi Monthly Nutrition Update May - June, 2010 groups, mainly obtained through purchase. A relatively high proportion of the assessed households among the IDP settlements had access to sanitation facilities, with 1.3%, 86% and 88.6% of the assessed households in the Galcayo, Bossaso and Garowe IDP settlements respectively, reporting access to appropriate sanitation facilities. This pattern is emulated with other indicators, such as access to clean water (94.%; 62.6% and 46.% respectively). Access to mosquito nets, was low at (41.%; 6.% and 44.9%), in Galcayo, Bossaso and Garowe IDP populations. (See Table 2). Overall, the nutrition situation among the assessed IDP populations is precarious, with a Very Critical nutrition situation among the Bossaso IDP population and Serious nutrition situations among the populations of both the Galcayo and Garowe IDP populations. The worrying nutrition situation in Bossaso is mainly attributed to the high morbidity levels and poor access to food arising from low labour/income opportunities associated with the seasonal out-migration of the well off households, in addition to the sea closure. Food prices in Bossaso remain high, thus limiting access among the poor IDP population. There is a need to intensify humanitarian assistance to rehabilitate acutely malnourished children and prevent further deterioration. The positive performance of the Gu 10 rainfall and the resultant increased milk availability and access, coupled with the declining food prices has contributed to the improvement in the nutrition situation recorded among the Garowe and Galcayo IDP populations. Whilst the IDPs show relatively good indicators of access to basic services, they remain in a vulnerable situation and are in need of continued support, especially in view of the continuing insecurity in southern Somalia. Child feeding practices remain poor among the three IDP populations and concerted efforts to improve the situation are imperative. Rapid Diagnostic Test for Malaria- May 2010 A supplementation, should be above 9%. However, for the three IDP populations, vaccination status by recall is relatively high but slightly below this threshold, with the exception of polio immunization in Bossaso and Galcayo IDP populations and Vitamin A supplementation in Galcayo and Garowe IDP populations which was above 9%. The high coverage of these health programmes is mainly due to the impact of the child health days (CHDs) carried out by UNICEF and partners in the beginning of June Tetanus vaccination among the women of reproductive age was 41.%, 90.% and 92.0% among the Galcayo, Bossaso and Garowe IDP populations respectively. Infant and young child feeding practices remain suboptimal among the three IDP populations of Galcayo, Bossaso and Garowe, with the proportion of children 6-24 months still breastfeeding being 0.9%, 46% and 38.3% respectively. While only 26%,.% and 29.8% respectively) were meeting the minimum recommended complementary feeding frequencies. In addition, 2.1%, 41.% and 12.9% of the assessed children in Galcayo, Bossaso and Garowe respectively, were feeding on poorly diversified diet comprised of three or fewer food groups. Poor child feeding deprives these children of the essential quality and quantity nutrients required for growth and development hence exposing them to malnutrition and increased risks to morbidity. Household food insecurity and access to basic services remains a challenge for most displaced populations. Among the three assessed IDP populations, 1.1%, 1.8% and 2.1% in Galcayo, Bossaso and Garowe IDP populations respectively, consumed a poorly diversified diets comprising of three or fewer food Northeast team taking interview-garowe, May

7 Bi Monthly Nutrition Update May - June, 2010 Table 2: Summary of Key Findings of Galkayo, Bossaso and Garowe IDP Settlements Galcayo (33 Clusters) Bossaso (33 Clusters) Garowe (33 Clusters) Indicator N 9 % (CI) N 9 % (CI) N 9 % (CI) Total number of households assessed for children Household Head Male Headed Female Headed Total number of children assessed: Child malnutrition Global Acute Malnutrition (WHO 2006) Mean WHZ (WHO, 2006) Severe Acute Malnutrition (WHO 2006) (WHO, 2006) (WHO,2006) >11.3% (Pr=0.90) ±1.41 >1.2 (Pr=0.90) >26% (Pr=0.90) ±1.09 >3.3% (Pr=0.90) >11.% ( Pr=0.90) ±1.0 >3.0(Pr=0.90) Oedema Global Acute Malnutrition (NCHS) ( ) 6 >22% (Pr=0.90) 26 >13.0(Pr=0.90) Severe Acute Malnutrition (NCHS) 3 1.( ) 3 >0.6 (Pr=0.90) >1.4(Pr=0.90) Global Acute Malnutrition (WHM<80% or oedema - NCHS) ( ) (12.-2.). ( ) Severe Acute Malnutrition (WHM<0% or oedema - NCHS) 1 0.(0.0-1.) (0.0-1.) Global Acute Malnutrition by MUAC (<12. cm or oedema) 14.1 ( ) ( ) (.-16.) Severe Acute Malnutrition by MUAC (<11. cm or oedema) ( ) 4 2.0(0.1-4.) Number of children Stunted (HAZ<-2) Number of children Underweight (WAZ<-2) Child Morbidity ( ) ( ) ( ) ( ) ( ) ( ) Children reported ill in the previous 2 weeks ( ) 1 2.2( ) 0 3.4( ) Children reported with diarrhoea in 2 weeks prior to assessment ( ) ( ) 10.1( ) Children reported with ARI within two weeks prior to assessment ( ) 3.9 ( ) 31.( ) Children reported with febrile illness in 2 weeks prior to assessment ( ) (38.-.0) ( ) Children reported with suspected measles within one month prior to assessment 6 3.0( ) ( ) 0 0 ( ) Child Immunization status Children (9-9 months) immunised against measles ( ) ( ) ( ) Children reported to have received vitamin A supplementation in last 6 months ( ) ( ) ( ) Children who have ever received polio vaccine No doses Three or more (0.1-8.) 1.2( ) 26.3( ) 2.( ) ( ) 24.4( ) 12.4( ) 8.4( ) (0.-6.4) 9.6(4.-14.) 32.8 ( ) 4.0( ) Infant and young child feeding Proportion still breastfeeding < 24 months ( ) ( ) ( ) Proportion meeting recommended feeding frequencies ( ) 0.( ) ( ) Proportion who reported to have consumed <4 food groups ( ) ( ) ( ) Maternal Health and Nutrition Total women who are acutely malnourished.4 ( ) 8.( ) 8.0 ( ) Pregnant women who are acutely malnourished MUAC<23.0 cm) 16.1(1.-30.) 21.2( ) 22.4 ( ) Non pregnant women acutely malnourished (MUAC 18. cm) Women who received tetanus immunization No dose Three doses Household Access to Essential Indicators Proportion of households who reported to have consumed < 4 food groups ( ) 22.3( ) 14.8(.3-22.) 3.2(0.-6.9) (3.2-.).( ) 31.8( ) 1.4( ) ( ) 10.3( ) 3.9(2.-0.2) 43.( ) ( ) ( ) 2 2.1( ) Access to mosquito Net ( ) 6.( ) (3-8.3) Access to safe/protected drinking water ( ) ( ) ( ) Access to latrine (.-84.8) 92 86(.-96.4) ( )

8 Bi Monthly Nutrition Update May - June, 2010 NorthWest ZONE Hargeisa, Burao and Berbera IDPs: Assessment Findings The nutrition situations of the IDPs/returnees of Hargeisa, Burao and Berbera in the Northwest have remained of concern, with global acute malnutrition rates oscillating between Serious and Very Critical levels over the last two seasons. According to post Deyr 09/10 integrated analysis, a sustained Serious and Critical nutrition situation was observed among the Hargeisa and Berbera protracted IDPs respectively, while the nutrition situation of Burao IDPs reported an improvement from Critical to Serious compared to the situation in the previous Gu 09. The poor nutrition situation among the internally displaced population was attributable to high morbidity rates, poor child feeding and care practices, and reduced access to nutritious foods due to high costs. Between 9 th and 16 th, June 2010, and MoHL conducted small sample (33X6) cluster surveys among 228, 209, and 212 children aged 6-9 months in Hargeisa, Burao and Berbera IDP settlements respectively, to monitor the nutrition situation. Results analyzed using the CDC probability calculator, estimate a global acute malnutrition (GAM) rate (WHZ <-2 Z score or oedema) and a severe acute malnutrition (SAM) rate (WHZ <-3 or oedema) of >13.0% and >0.9% respectively at 90% probability among the Hargeisa IDPs. In Burao IDPs, a GAM (WHZ<-2 Z score or oedema) rate of >1.3% (Pr=0.90), and a SAM (WHZ<-3 or oedema) rate of >3.4% (Pr=0.90) were reported, while a GAM (<-2 Z score or oedema) level of >.% (Pr=0.90), and a SAM (<-3 or oedema) level of.4% (Pr=0.90) was reported among the Berbera IDPs. and girls were acutely malnourished in equal proportions (p>0.0). The findings indicate a deterioration of the nutrition situation of the Burao IDPs though not statistically significant (Pr=0.) from Serious (GAM of >13.9% and SAM >4.4% in December 2009) to Critical levels relative to the situation reported in the Deyr 09/10. The deterioration is mainly attributed to an increased influx of IDPs from South and Central Somalia; Figure 3: Trends in levels of Acute Malnutrition (WHZ <-2Z scores or oedema, WHO 2006 Hargeisa, Burao and Berbera IDPs Percentage 30% % 0% Harg IDP Sep 0 Harg IDP Dec 08 Harg IDP Apr 09 Harg IDP Dec 09 Harg IDP Jun 2010 Burao IDPs Sep 0 Burao IDPs July 08 Burao IDPs Dec 08 Burao IDPs Apr 09 Burao IDPs Dec 09 Burao IDPs Jun 2010 Berb Sep 0 Berb Apr 09 Berb Dec 09 these new IDP arrivals are extremely vulnerable and not able to access food and other basic requirements easily. The findings however indicate sustained Serious and Critical nutrition situations among the Hargeisa and Berbera IDPs respectively. The proportions of children who had suffered from one or more communicable childhood diseases during the two weeks prior to the assessment were 32.9%, 3.4% and 28.8% among the assessed IDP populations of Hargeisa, Burao and Berbera IDPs respectively (Table 3). In Hargeisa, the prevalence of reported diarrhoea, ARI and febrile illness by recall was 13.2%, 1.1% and 20.6% respectively. In Burao, 16.2%, 12.9% and 20.0% of the assessed children were reported to have diarrhoea, ARI and fever respectively. A further 13.2%, 11.3% and 18.9% reportedly suffered from diarrhoea, ARI and fever respectively within two weeks prior to the assessment among the assessed children in Berbera IDPs. A few cases of suspected measles were also reported in Hargeisa (0.4%), Burao (2.3%) and Berbera (0.9%). These levels were consistent with the seasonal morbidity patterns recorded from the health facilities. The proportion of children who reportedly received immunization against measles and polio and those who received vitamin A supplementation ranged from % to 94% indicating a high and stable (relative to findings from previous assessments) coverage for the health programs associated with Child Health Days (CHD) activities, but still falling short of the recommended 9% SPHERE (2004) levels. About %, 93.4% and 80.% of the assessed children had received measles vaccination, at least one dose of polio immunization and vitamin A supplements among Hargeisa IDPs. Similar rates were reported in Burao (83.%, 94.3% and 89.4%) and Berbera (80.2%, 89.2% and 82.%) respectively. Access to sanitation facilities and protected drinking water is high among the assessed IDPs, (Table 3) although issues of cost and sharing are common concerns. Besides, high morbidity rates and poor dietary quality, suboptimal feeding practices remain a key risk factor to poor nutrition situation among the IDP populations of NW. Of the assessed children aged 6-24 months, as low as 49% are still breastfeeding and the proportions meeting the recommended complementary feeding frequency as well as diversified diet, ranges from 26% to 61%. The IDP populations in the three urban centres depend on petty trade and casual labour opportunities for their food purchases; however such opportunities are not readily available to the majority and many households depend on borrowing or relief assistance to get food. There is need for support to improve the population wellbeing among the IDP settlements. Targeted food supplementation, income-generating activities, health education and continued immunization programmes and other development interventions are needed to improve the health and nutrition situation of the vulnerable returnee/idp population in Somaliland. Hargeisa IDPs Burao IDPs Berbera IDPs 8

9 Bi Monthly Nutrition Update May - June, 2010 Table 3: Summary of Key Findings for Hargeisa, Burao and Berbera IDPs Assessments Hargeisa IDPs 33 Clusters Burao IDPs 33 Clusters Berbera IDPs 33 Clusters Indicator n % (9% CI) n % (9% CI) n % (9% CI) Total number of households assessed for children Household Head Male Headed Female Headed Total number of children assessed: Child malnutrition Global Acute Malnutrition (WHO 2006) >13.0 (Pr=90%) >1.3 (Pr=90%) >. (Pr=90%) Mean WHZ (WHO, 2006) ± ± ±1.14 Severe Acute Malnutrition (WHO 2006) >0.9(Pr=90%) >3.4(Pr=90%) >.4(Pr=90%) Oedema (0.0 2.) 1 0. (0.0 1.) 1 0. ( ) Global Acute Malnutrition (NCHS) ( ) ( ) ( ) Severe Acute Malnutrition (NCHS) ( ) ( ) 11.2 (1.-8.) Global Acute Malnutrition (WHM<80% or oedema - NCHS) ( ) ( ) ( ) Severe Acute Malnutrition (WHM<0% or oedema - NCHS) ( ) (0.2.4) 1 0. ( ) Global Acute Malnutrition by MUAC (<12. cm or oedema) (2.-9.6) ( ) ( ) Severe Acute Malnutrition by MUAC (<11. cm or oedema) ( ) 2.3 ( ) (1.0-6.) Number of children Stunted (HAZ<-2) Number of children Underweight (WAZ<-2) Child Morbidity ( ) ( ) ( ) ( ) ( ) ( ) Children reported ill in the previous 2 weeks 32.9 ( ) ( ) ( ) Children reported with diarrhoea in 2 weeks prior to assessment ( ) ( ) ( ) Children reported with ARI in 2 weeks prior to assessment ( ) ( ) (.-1.1) Children reported with febrile illness in 2 weeks prior to assessment ( ) ( ) ( ) Children reported with suspected measles within one month prior to assessment ( ) 2.3 (0.0.2) ( ) Child Immunization status Children (6-9 months) immunised against measles 11.0 (6.-82.) ( ) ( ) Children who received vitamin A suppl in last 6 months (3.-8.9) ( ) 82. ( ) Children who have ever received polio vaccine No doses Three or more Infant and young child feeding ( ) 1.1 ( ) 18.0 ( ) 8.3 ( ) ( ).3 ( ).3 ( ) 63.6 ( ) (4.2-1.) 6.1 ( ) 9.9 (.-14.3) 3.1 ( ) Proportion still breastfeeding < 24 months ( ) ( ) (1.8-2.) Proportion meeting recommended feeding frequencies ( ) ( ) ( ) Proportion who reported to have consumed 4 food groups ( ) ( ) 4.3 ( ) Maternal Health and Nutrition N=121 N= 1 N=118 Total women acutely malnourished Pregnant & lactating women acutely malnourished (MUAC<23.0 cm) Non pregnant women acutely malnourished (MUAC 18. cm) Women who received tetanus immunization No dose Three doses Household Access to Essential Indicators ( ) 1.4 ( ) 2.6 ( ) 33.9 ( ) ( ) 16. ( ) 33.9 ( ) 26.0 ( ) ( ) 18.6 ( ) 16.9 ( ) 43.2 ( ) Reported Households consumed 3 food groups ( ) ( ) ( ) Access to mosquito Net ( ) ( ) ( ) Access to safe/protected drinking water (.6-9.1) Access to latrine ( ) ( ) ( ) 9

10 Bi Monthly Nutrition Update May - June, 2010 Knowledge, Attitudes and Practices of Offal Consumption among the Somali Population in Boroma, Burao and Bossaso The UNFAO in partnership with relevant line ministries and several international and national NGOs 1, is currently implementing a Rapid Response Rehabilitation of Rural Livelihoods Project in Somaliland, Puntland, and South Central Somalia through World Bank funding. The overall aim of the project is to mitigate the chronic food crisis in the country by increasing domestic food production and reducing livestock losses for the poor rural households. Support to strategies using livestock resources to address the food crisis (mainly improving of slaughter houses with value added services) is one of the expected outcomes; while promotion of use of by-products, such as offal for improved nutrition and increased incomes, is a major activity under this project. Offal refers to those parts of livestock carcass which are not skeletal muscle; and covers internal organs including the heart, liver, kidney and lungs, the abdomen, intestines and extremities. Between 28 th May and 6 th June 2010, UNFAO/ conducted a knowledge, attitudes and practices (KAP) study in Boroma, Burao and Bossaso towns and selected villages in these districts. The main purpose was to gain an understanding of the communities knowledge, attitudes and common practices regarding offal consumption, in order to design an appropriate nutrition education package for the targeted communities. Additionally, the findings from the KAP study will serve as baseline information upon which to monitor progress of the intervention. Qualitative data collection techniques comprising of focus group discussions, key informant interviews, field observations and proportion piling were used. The overall results indicate that offal consumption is generally culturally acceptable, considered palatable, associated with known benefits to the body and consumed by people of all ages. The main type of offal consumed are liver, kidney, stomach/intestines, head, heart and bones (bone marrow). The main factors influencing the type of offal consumed by individuals are: preference, socio economic status, availability and access, local beliefs, age, gender, the known benefits and the socio-economic perceptions surrounding its consumption. Preference: Offal from sheep or goat is most preferred, followed by camel and lastly cattle. Poorer households prefer offal to skeletal muscle (with the exception of liver and kidney) because they are cheaper in price. Liver and kidney are considered expensive, and mainly constitute breakfast foods for the better off households. The brain, spleen, lungs, trachea and oesophagus are rarely consumed as they are considered tasteless, difficult to prepare and of no benefit to the body. Availability: Offal are mostly available in the towns where slaughtering is done often. Lack of cold storage facilities however limit the time of their availability to the mornings. Age: Liver is not commonly served to children under the age of two years as it is believed to negatively impact on their ability to speak properly. The heart also is not served to young boys as it is believed to make them cowardly. Elderly people rarely consume the tongue as it is considered tasteless. Gender: Liver and kidney are mainly consumed by men, (and by those of higher socio-economic status due to the high costs), with the other types of offal believed to be women s food. Nevertheless, women consume liver, kidney and heart especially after giving birth or when either diagnosed or believed to be suffering from anaemia as these are believed to give more blood, are important in treating and preventing anaemia and healing of physical injuries. This highlights that women usually consume liver and/or kidneys for curative purpose rather than for prevention of anaemia. Beliefs: Consumption of stomach and intestines is believed to ease stomach problems, constipation and promotes good health. The head is consumed to relieve headaches, help cure eyesight problems and promote recovery after eye or head surgery. The tongue helps relieve throat pains and is given to women just after delivery to boost the amount of blood. Bones are used to prepare soup, and the marrow extracted and consumed in the form of fat or ghee. Bones are believed to help in bone fracture injuries, while the marrow promotes health and is used as a laxative. During preparation, offal, especially stomach and intestines, is first cleaned and washed thoroughly, and then either boiled or fried. It can be served with various accompaniments such as bread, rice, canjera, or pasta. Offal is mainly served at breakfast time or as a snack, but can also constitute main meals. The cultural acceptability of offal consumption across all the socio economic groups provides a great starting point for nutrition education and promotion. Nevertheless, the diverse cultural beliefs associated with consumption of the different types of offal (e.g. liver by women and children, and the heart by young boys) can hinder some of the vulnerable groups, mainly women and children, from fully benefiting, and should, therefore, be addressed. It is therefore important to train change agents, mainly health workers and school teachers as part of the advocacy strategy through campaigns, health clinics and schools respectively. This is especially important in light of the recently concluded Somali National Micronutrients and Anthropometric Study ( 2009) that reveals high levels of iron deficiency and anaemia in women and children 2. Women and children, with the support of men and other community members should be encouraged to consume liver and kidneys along with other offal meat to promote their health. Availability of cold storage facilities in the slaughter houses could also help preserve and thereby increase access to offal. For additional information, please refer to the KAP Study report scheduled for release on July 16 th, MoA, MoL, MoAL, MoPDE, ASAL, OXFAM GB, Terre Solidali in Somaliland and/or Puntland, and CEFA, WFL, SATG, HARDO, SOADO, COOPI, GEELO, ASEP, SADO, GTZ, GVV, SARD, SAREDO, ICDA, APDN, SOWELPA, MoFRI-TFG in South Central zone 2 The overall anaemia prevalence among children aged 6-9 months was 4.2% ( ), while the prevalence of vitamin A deficiency was 2.6% ( )- see MDD Report for further details. 10 Key Informant interview- Hargeisa, June 2010

11 Bi Monthly Nutrition Update May - June, 2010 GEDO REGION Gedo Nutrition Pastoral, Agropastoral and Riverine Assessment Findings The nutrition situation in Gedo region has remained precarious, with all assessments conducted in the region since 199 recording Global Acute Malnutrition (GAM) rates above the emergency threshold of %. The post Deyr 09/10 integrated analysis showed a sustained Very Critical nutrition situation among the pastoral and agro-pastoral populations and Critical situation among the riverine populations. The persistent poor nutrition situation in Gedo region was attributable to food insecurity, high morbidity rates, poor child feeding and care practices, and reduced access to nutritious foods due to high costs. Figure 4 indicates the trends of acute malnutrition (using WHO reference growth standards) in Gedo since Figure 4: Trend in Levels of acute Malnutrition (WHZ<-2 or oedema, WHO 2006) Gedo Region, % % 0% Oct.02 Oct.04 Mar.06 Apri.06 Apr.0 May.08 Dec.08 Jul.09 De.09 Jun.10 Apr.0 May.08 Dec.08 Jul.09 Dec.09 Jun.10 Apr.0 May.08 Dec.08 Jul.09 Dec.09 Jun.10 B/Hawa Luuq Gedo R Bardera Town Gedo Pastoral Gedo Agropastoral Gedo Riverine Between th and 2 th, June 2010, in collaboration UNICEF, Trocaire, SRCS, AMA and HIRDA conducted small sample (33X6) cluster surveys among 196, 198, and 186 children aged 6-9 months in pastoral, agro-pastoral and riverine livelihood populations respectively, to monitor the nutrition situation. Results analyzed using the CDC probability calculator, estimate a global acute malnutrition (GAM) rate (WHZ <-2 Z score or oedema) and a severe acute malnutrition (SAM) rate (WHZ <-3 or oedema) of >16.3% and >3.% respectively at 90% probability among the pastorals. These results indicate a Critical nutrition situation, an improvement from a Very Critical levels recorded in December 2009 when a GAM>20% was reported. The improvement in the pastoral livelihood is largely attributable to the improved water availability and rangeland conditions and the resultant improvement of livestock production and access to milk due to the good Gu 10 rainfall. However, a comparison between the current and December 2009 GAM rates using the CDC calculator show that the change is not statistically significant (P=0.48). In the agro-pastoral livelihood assessment, a GAM (WHZ<- 2 Z score or oedema) rate of >21.% (Pr=0.90), and a SAM (WHZ<-3 or oedema) rate of >.6% (Pr=0.90) were reported, while a GAM (<-2 Z score or oedema) level of >.9% (Pr=0.90), and a SAM (<-3 or oedema) level of 2.4% (Pr=0.90) was reported among the Riverine population. The results indicate a sustained Critical nutrition situation in the Riverine livelihood and slight deterioration from Critical to Very Critical in the agro-pastoral livelihood. However, when the current GAM and SAM rates from the agropastoral assessment are compared with the respective GAM and SAM rates of >18.2% and 2.6% (pr=0.90) recorded in December 2009 assessment, the deterioration is not statistically significant (p>0.0). The slight deterioration in the agropastoral population could be as result of the impact of the past crop failures including Deyr 09/10 and damage of crop by pest/grasshoppers in the current season, however, it is anticipated trend is highly likely to be reversed with prospects of good cereal production across the region and improved milk access following the good Gu 10 rains. and girls were acutely malnourished in equal proportions in the three livelihoods (p>0.0), however stunting was significantly higher among boys than girls (p<0.0). The proportions of children who had suffered from one or more communicable childhood diseases during the two weeks prior to the assessment were 1.%, 2.3% and 32.8% among the assessed Pastoral, Agro-pastoral and Riverine populations respectively. In Pastoral, the prevalence of reported diarrhoea, ARI and febrile illness by recall was 19%, 32.2% and 34.3% respectively. In agro-pastoral, 9%, 11.1% and 18.% of the assessed children were reported to have diarrhoea, ARI and fever respectively, while 14%, 6.% and 22% reportedly suffered from diarrhoea, ARI and fever respectively within two weeks prior to the assessment in the Riverine livelihood zone. Rapid diagnostic test for malaria (plasmodium falciparum) conducted concurrently with the nutrition assessment confirmed a low prevalence (1.4%) of malaria in the entire region. A few cases of suspected measles were also reported in pastoral (0.%) and agro-pastoral (1.%) populations and no case was reported among the Riverine livelihood population. These levels indicate sustained high morbidity patterns in the region. The proportion of children who reportedly received immunization against measles and polio and those who received vitamin A supplementation still fell short of the recommended 9% SPHERE (2004) levels. The proportion of the children who had received at least one dose of polio immunization was highest at 8.3%, 8.4% and 94.1% among the assessed children from the pastoral, agro-pastoral and riverine livelihood respectively. The respective Vitamin A supplementation and measles vaccination coverage rates reported were.9% and % in pastoral; 6.3% and 4.2% in agropastoral and 8.1% and 86% in the Riverine livelihoods. Infant and child feeding practices remain suboptimal in the region, with the proportion of children aged 6-24 months still breastfeeding at the time of the assessment ranging from 38% to 6%. Complementary feeding was equally poor with as many as 2.1% of the assessed children aged 6-24 months in pastoral livelihood not meeting the minimum recommended complementary feeding frequency while more than 0% consumed poorly diversified diet comprised of three or fewer food groups (Table 4). 11

12 Bi Monthly Nutrition Update May - June, 2010 Table 4: Summary of Key Findings for Gedo Pastoral, Agropastoral and Riverine Assessments Pastoral 33 Clusters Agropastoral 33 Clusters Riverine 33 Clusters Indicator n % (9% CI) n % (9% CI) n % (9% CI) Total number of households assessed for children Household Head Male Headed Female Headed Total number of children assessed: Child malnutrition Global Acute Malnutrition (WHO 2006) >16.3 (Pr=90%) >21. (Pr=0.90) >.9 (Pr=90%) Mean WHZ (WHO, 2006) -1.0 ± ± ±1.0 Severe Acute Malnutrition (WHO 2006) 11 6 >3.(Pr=90%) >.6 (Pr=0.90) >2.4 (Pr=90%) Oedema 1 0. (0.0 1.) Global Acute Malnutrition (NCHS) 41 >1(pr=0.90) 49 >19.9 (Pr=0.90) 39 >16.4 (Pr=0.90) Severe Acute Malnutrition (NCHS) 8 >2.(pr=0.90) 8 >2.(Pr=0.90) 11 >0.4 (Pr=0.90) Global Acute Malnutrition (WHM<80% or oedema - NCHS) ( ) ( ) ( ) Severe Acute Malnutrition (WHM<0% or oedema - NCHS) 2 1.0( ) 1 0.(0.0-1.) 0 0 Global Acute Malnutrition by MUAC (<12. cm or oedema) ( ) ( ) ( ) Severe Acute Malnutrition by MUAC (<11. cm or oedema) ( ) (0.6-.) ( ) Number of children Stunted (HAZ<-2) Number of children Underweight (WAZ<-2) Child Morbidity ( ) ( ) Children reported ill in the previous 2 weeks ( ) ( ) ( ) ( ) ( ) ( ) ( ) Children reported with diarrhoea in 2 weeks prior to assessment ( ) (.-12.6) ( ) Children reported with ARI in 2 weeks prior to assessment ( ) ( ) ( ) Children reported with febrile illness in 2 weeks prior to assessment ( ) 3 18.( ) ( ) Children reported with suspected measles within one month prior to assessment 1 0. (0.0-1.) 3 1.( ) 0 0 Child Immunization status Children (6-9 months) immunised against measles 14.0 ( ) ( ) ( ) Children who received vitamin A suppl in last 6 months 2.9 ( ) 1 6.3( ) ( ) Children who have ever received polio vaccine No doses Three or more Infant and young child feeding ( ) 13.2 ( ) 16.3 ( ).6 (4.4-6.) (.-23.6) 24.2( ) 23.2(.9-30.) 3.9( ) ( ) 41.4 (2.1-.).6 ( ) 3.1 ( ) Proportion still breastfeeding <24months ( ) (2.-48.) ( ) Proportion meeting recommended feeding frequencies ) ( ) (36.8-.) Proportion who reported to have consumed <4 food groups ( ) ( ) ( ) Maternal Health and Nutrition N=99 N=89 Total women who are acutely malnourished Pregnant women acutely malnourished (MUAC<23.0 cm) ( ) ( ) Non pregnant women acutely malnourished (MUAC 18. cm) Women who received tetanus immunization No dose Three doses Household Access to Essential Indicators (.2-31.) 19.3 ( ) 23.4 ( ) 33.6 ( ) ( ) 21.9( ) 26.( ) 19.( ) ( ) 11.2 ( ) 36.0 ( ) 4.2 (36.9-.) Reported Households consumed 3 food groups ( ) ( ) 60 6 ( ) Access to mosquito Net ( ) ( ) ( ) Access to latrine (6.-1.6) 6 8.3( ) ( ) 12

13 Bi Monthly Nutrition Update May - June, 2010 The food security situation in Gedo region is improving following early onset of good Gu 10 rainfall, which resulted in improved livestock and crop production and increased water availability. The majority of the assessed households are reportedly accessing staple food through own production. However, dietary diversity remain poor with 49.4% of the pastoral, 4.1% of the agro-pastoral and 6% of the riverine households consuming poorly diversified diets comprised of three or fewer in the previous 24 hours to the assessment. Access to sanitation facilities in the three livelihoods ranged from 12% to 8.3%, while all the assessed households in three livelihoods reportedly accessed water from unprotected sources, indicating that the Gu rains have only increased the availability but not quality of water. Overall, the nutrition situation in Gedo region although ranging between Critical and Very Critical shows signs of improvement, mainly attributed to the mitigating impact of normal Deyr 09/10 and Gu 10. The good Gu 10 rainfall performance in the region has, amongest others increased availability and access of milk and water and an anticipated average to above average cereal harvest. However, morbidity remains unabated and is associated with high acute malnutrition rates in the region. Other potential issues influencing the nutrition situation include chronic factors such as poor child care and feeding practices, and limited access to basic services such as sanitation facilities and safe water, which predispose populations to high morbidity and subsequent high levels of acute malnutrition. In view of Gedo region being situated at the border with Kenya and Ethiopia and the tendency of the people from the three countries crossing over in search of assistance, multi-sectoral and coordinated cross boarder responses that address these underlying causes are required in the region Central/Northeast Regions Map 1: Assessed Livelihood zones and Regions Hawd and Addun Pastoral Livelihood Assessment Findings The pastoral livelihoods of Hawd and Addun in Central/ Northeast regions (Map 1) have displayed a persistent Critical to Very Critical nutrition situation over the last three years. The Post Deyr 09/10 integrated nutrition analysis indicated a sustained Critical phase in both the Hawd and Addun livelihoods since Deyr 0/08. The concerning nutrition situation has largely been attributed to acute food insecurity as a result of successive seasons of rain failure and the ensuing poor rangeland conditions resulting in livestock out-migration, high livestock off-take and declined herd sizes. Other factors further exacerbating the situation were high food prices, displacement due to conflict, a high morbidity burden and limited access to humanitarian assistance. Figure illustrates the trends in acute malnutrition in these livelihoods from 2004 to date, which highlights the sustained emergency. Figure : Trends in Levels of Acute Malnutrition (WHZ<-2 oroedema, WHOGS) Hawd & Addun Livelihoods, Nov0 Jun08 Nov08 Jun08 May09 Nov09 May10 Nov0 Jun08 Nov08 Jun09 Nov09 May10 Hawd Pastoral Addun Pastoral Between 9 th to th May 2010, in collaboration with WFP, UNICEF, MOH, SRCS conducted two nutrition assessments in the Hawd and Addun livelihood zones of central and northeast Somalia. The main objectives of the assessments were to determine the nutritional status of children aged 6-9 months and to monitor the trends of acute malnutrition in the two livelihoods. Using the standard two stage cluster sampling (PPS), 28 and 30 clusters were randomly sampled and a total of 64 and 66 children aged 6-9 months assessed from 38 and 396 households in the Hawd and Addun livelihoods respectively. The results of the livelihood assessments are presented in Table. Findings from the Hawd pastoral livelihood zone indicate a sustained Critical nutrition situation with a global acute malnutrition rate (GAM <-2 or oedema) rate of.3% ( ) and a severe acute malnutrition (SAM <-3 or oedema) rate of 3.9 % ( ), including two (0.3%) oedema cases. (.1%) and girls (.%) were affected equally (p>0.0). Statistical analysis of the findings using the CDC probability calculator indicate a significant improvement in the GAM rate (Pr=93.6%) compared to the November 2009 assessments when the GAM rate was 19.1% ( ); however, the change is insignificant (Pr=61.6%) for the SAM rate compared to the rate of 4.3% (2..9) six months earlier. The improving trend in the nutrition situation is attributed to increased access to milk and milk products following pasture and water availability associated with the favorable Gu 2010 rains; in addition to the humanitarian interventions, conducted in the area. The retrospective crude (CDR) and under-five death (UDR) rates of 1.0 ( ) and 1.8 ( ) were reported in the Hawd pastoral livelihood zone, and mainly attributed to diarrhea, accident or due to unknown 13