FSNAU OVERVIEW FSNAU. December Food Security and Nutrition Analysis Unit - Somalia

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1 Bi-Monthly Nutrition Update, December Food Security and Nutrition Analysis Unit - Somalia December OVERVIEW NUTRITION ASSESSMENT SHOWS SUSTAINED PREVALENCE OF SERIOUS TO CRITICAL LEVELS OF ACUTE MALNUTRITION(GAM >10%) IN 10 OUT OF 13 MAIN SETTLEMENTS OF INTERNALLY DISPLACED PERSONS (IDPS) AND INCREASE IN MALNUTRITION AMONG DOLOW, BAIDOA, BOSSASO AND HARGEISA IDPS assessed the nutritional status of children 6-59 months old from households among the 13 main settlements of displaced populations across Somalia in November using SMART Methodology 1 (Table 3). The mortality and nutritional information as well as household food security data was collected at the same time, from the same households by a survey team consisting of four people. The weight-for-height, height-for-age and weight-for-age were calculated for children using the ENA for SMART and Epinfo software. Prevalence of global acute malnutrition (GAM) was estimated using World Health Organization growth standards while Crude death rates (CDRs) and death rates for children aged <5 years were calculated using the most recent population estimates available. ASESSMENT RESULTS Key Highlights High U5DR among Kismayo IDPs persist because of increase in morbidity (by 21%) Increase in prevalence of acute malnutrition (GAM & SAM) among Dolow IDPs Critical levels of SAM are sustained among Dolow and Dusamareb IDPs Diarrohea and Measles outbreak increase CDR (Critical) and U5DR (alert) among Dhobley IDPs though nutrition situation shows improvement Improvement in nutrition situation among Mogadishu and Kismayo IDPs (GAM, SAM) Decrease in caseload for acute malnutrition since : 18 percent decrease in GAM cases and 43 percent decrease in SAM cases though the number are still higher than Post assessment results (Figure 1) show high prevalence of acute malnutrition (GAM >10%) in 10/13 IDPs assessed compared to 12/13 IDPs in. Critical levels of acute malnutrition (GAM >15%) were recorded in five IDPs - Baidoa, Dollow in South and Bossaso Garowe and Galkayo in Northeast region. Serious levels of acute malnutrition (GAM %) were recorded among IDPs in Mogadishu, Dhobley and Dhusamareb in South central region, Qardho in Northeast and Hargeisa in Northwest. Deterioration in nutrition situation was noted among Baidoa IDPs in South, Bossaso in Northeast and Hargeisa in Northwest while nutrition situation improved among IDPs in Mogadishu, Kismayo, Dhobley and Dhusamareb IDP in South Central region and Burao and Berbera IDPs in Northwest. Figure 1: Prevalence of Global Acute Malnutrition (GAM) in the main IDP settlements across Somalia (November ) Very CriAcal (>30%) 30 CriAcal (15-30%) Serious (10- <14.9%) Alert (5- <9.9%) Acceptable (0- <5%) 0 1 Standardized Monitoring and Assessment of Relief and Transitions ( Technical Partners Funding Agencies

2 Bi-Monthly Nutrition Update, December Critical levels of severe acute malnutrition (SAM) were recorded among Dolow (4.3%) and Dhusamareb (4.2%) IDPs in South central region (Table 1). Sustained prevalence of critical SAM levels in these IDPs suggests that nutrition support services to treat these children need to be scaled up. As security and access has not been an issue for Dolow IDPs, increase in the GAM rate in Dolow by 2.8 percent in last 6 months (from 18.8% in to 21.6 % in ) suggests that adequate humanitarian assistance may not be reaching the children most in need. Increase in Crude Death Rates (CDR) and Under-Five Death Rates (U5DR) was observed among Dhobley IDPs even though nutrition situation (both GAM & SAM) shows improvement. As there has been no significant change in prevalence of morbidity in children in the last 6 months, underlying cause for changes in mortality is unclear. Improvement in both CDR and U5DR was seen in Mogadishu IDP along with improvement in nutrition situation, which is attributed to scaling up of humanitarian intervention. Kismayo IDPs also showed improvement in nutrition situation and CDR but serious levels of U5DR still persist. This is not surprising as a 21 percent increase in morbidity since the last 6 months has been recorded among Kismayo IDP because of measles outbreak and lack of a functional immunization system. Table 1: Nutrition situation in the main IDP settlements across Somalia (November ) IDP assessed GAM -WHO/ UNICEF SAM - CDR Sphere U5DR Sphere Stunted-WHO/ UNICEF Underweight WHO/UNICEF Morbidity Plausibility Score SOUTH CENTRAL Mogadishu Dolow Dobley Baidoa Kismayo Dhusamreeb NORTH EAST Bossaso Qardho Garowe Galkayo NORTH WEST Hargeisa Burao Berbera NUTRITION SITUATION AMONG IDPs IN DIFFERENT REGIONS OF SOMALIA Results of assessment are summarized in Table 1 and 2 along with trends for the past two seasons which are essential to ensuring appropriate assessment of changes over time NUTRITION SITUATION AMONG IDPs IN SOUTH CENTRAL REGION Mogadishu IDPs Existence of humanitarian emergency situation was reported in Mogadishu IDP during assessment with Critical levels of GAM (18.9%) and SAM (5.5%) accompanied by CDR >1. Results of Dyer assessment show a marked improvement in nutrition situation in these IDPs from Critical to Serious (Figure 2). Improvement in both GAM (13.4%) and SAM (2.5%) as well as CDR (0.58) was observed. The improvement can be attributed to increase in humanitarian support following Post results. Nutrition interventions were scaled up in Mogadishu IDPs: increase in OTP from 19 to 21, 14 more TFSP sites and increase in support from WFP to beneficiaries from earlier. Additionally, there was no major outbreak in communicable diseases during this period compared to post assesment when AWD and measles outbreaks were reported. 2

3 Bi-Monthly Nutrition Update, December The crude and under five death rates reported are 0.58/10 000/day and 0.84/10 000/day respectively in the Mogadishu IDPs, indicating Serious and Alert situation according to WHO classification, an improvement from the previously reported crude and under five mortality rates of 1.35/10 000/day, and 3.35/10 000/day respectively. High morbidity rates of 39.2 percent in Mogadishu IDPs are attributed to outbreaks of Acute Watery Diarhea (AWD) and other seasonal infections that have been reported in the last couple of months. Dolow IDP settlement recorded Critical GAM (21.6 %) and SAM (4.3%) levels during assessment, indicating sustained Critical nutrition situation since. However both GAM and SAM levels are higher during Post compared to (Figure 3). The Crude and under five death rates in the assessed Dolow IDP groups in Gedo region are within the Acceptable WHO/UNICEF levels of <0.5 and <1/10,000/day. This reflects an improvement in mortality levels since. Morbidity rate in Dollow IDPs is still high (36.9 %), although it is a reduction compared to 43.3 percent reported in and 55.2 percent in. Baidoa IDP settlement recorded a Critical levels of GAM (15.3%) which suggest a deterioration in nutrition situation since last (12.9%) and /14 (14.3%) [Figure 4]. Similar deterioration in prevalence of SAM to serious levels (3.3%) from alert levels recorded in (2.4%) was observed. This is accompanied by increase in U5DR (1.21) to serious levels from acceptable levels (0.76) recorded during assessments. Increased morbidity (45.2% during compared to 32.3% in ) can be attributed to the deterioration of malnutrition situation seen among the Baidoa IDPs. Figure 2: GAM trends among Mogadishu IDPs Figure 3: GAM trends among Dollow IDPs Figure 4: GAM trends among Baidoa IDPs Dhobley IDPs showed an improvement in nutrition situation with Serious levels of GAM (11% ) during Post compared to Critical GAM (16.5%) recorded during. Significant improvement in SAM (1.4% during ) was noted compared to Serious levels of SAM (4%) recorded during assessment. Improvement in nutrition is not reflected in increased levels of CDR (Critical -1.25) recorded during accompanied by increase in U5DR (1.55-Serious). Improvement in the nutrition situation is a result of humanitarian interventions: cash vouchers/cash for work/rehabilitation of SAM, but the outbreak of a measles epidemic and low coverage with vaccination/ Vitamin A supplementation appears to be responsible for the increase in U5DR. Dhusamareb IDPs showed an improvement in nutrition situation to Serious GAM levels (14.4%) in /15 compared to Critical levels recorded in (18.2%) or Dyer /14 (16%). However this is not accompanied by improvement in SAM; Critical levels of SAM ( 4 %) continue to persist among these IDPs. Both CDR and U5DR levels are in the acceptable range and continued improvement in prevalence of morbidity is observed. Figure 5: GAM trends among Kismayo IDPs Kismayo IDPs settlement show a marked improvement in nutrition situation. Alert levels of GAM (8.5%) and SAM (1.6%) were recorded during assessment compared to Critical GAM (16.6%) and Serious SAM 3

4 Bi-Monthly Nutrition Update, December (3.6%) recorded during (Figure 5). This improvement in nutrition situation improvements can be attributed to ongoing humanitarian interventions: cash for work and cash for voucher. CDR also showeed improvement but Serious levels of U5DR were sustained because of increase in morbidity to 62.3 percent recorded during assessment compared to 41.2 percent morbidity noted during assessment. Increase in diarrhea, and febrile illness (pneumonia) was reported during this period accompanied by low immunization coverage, which has a protective effect. Table 2: Recent Trends in Nutrition Situation of IDPs in Somalia IDPs GAM % SAM % CDR U5DR MORBIDITY % SOUTH CENTRAL Mogadishu Kismayo Dhobley Baidoa Dhusamareb Dolow Median for South NORTH EAST Bossaso Qardho Garowe Galkayo Median for Northeast NORTH WEST Hargeisa Burao Berbera Median for Northwest NUTRITION SITUATION AMONG IDPs IN NORTHEAST REGION Bossaso IDPs show a deterioration in nutrition. Critical levels of GAM (17.2 %) have been observed in the assessment period compared to Serious levels (13.2%) recoded in (Figure 6). Serious levels of SAM prevalence however have been sustained. Figure 6: GAM trends among Bossaso IDPs Qardho IDPs show stable nutrition since. Serious levels of GAM (11.1%) and Alert levels of SAM (1.8%) were recorded during assessment. Although CDR levels are in the acceptable range, increase in the U5DR from acceptable (0.69) in to serious (1.09) is of concern as decline in morbidity has been recorded. Garowe IDPs show sustained Critical levels of acute malnutrition (GAM>15%) though some improvement in prevalence of SAM has been recorded (3.9% in compared to 4.4% in ). Increase in morbidity and poor vaccination coverage could be the underlying cause for this. Both CDR and U5DR are in the acceptable range. Galkayo IDPs show sustained nutrition situation even though GAM prevalence is still Critical (15.1%). Serious levels of SAM persist since while both CDR and U5DR are in the acceptable range. 4

5 Bi-Monthly Nutrition Update, December NUTRITION SITUATION AMONG IDPs IN NORTHWEST REGION Results of assessment among three IDP settlements in Northwest Region are summarized in Table 2. Deterioration in the nutrition situation in last 6 months (since ) has been observed among Hargeisa IDPs during assessment while Berbera and Burao IDPs show improvement. Hargeisa IDP settlement recorded a GAM rate of 11.1 percent indicating a Serious nutrition situation which is a deterioration from a previous Alert phase- GAM rate of 8.1 percent recorded in - but stable and following seasonal trends when compared to GAM rate of 10.6 percent recorded in (Figure 7). Figure 7: GAM trends among Hargeysa IDPs Although the severe acute malnutrition rates (1.6 %) are nearly 5 times the levels observed 6 months ago (0.3 %) depicting deterioration, the prevalence is within Alert levels, and the nutrition situation is stable when compared to same time last year. Berbera IDP settlement recorded a GAM rate of 9.9 percent indicating an Alert nutrition situation which is an improvement when compared to Serious levels (GAM rate of 10 percent) recorded in and Critical with GAM rate of 16.1 percent recorded in. The improvement is linked to the continued improvement in the humanitarian support in these settlements. SAM prevalence (1.9%) in this settlement has not shown any change in phase since last but prevalence has reduced by half and is showing change in phase compared to last year (3.8%). Burao IDP settlement recorded a GAM rate of 9.7 percent indicating an Alert nutrition situation, an improvement when compared to GAM rate of 12.4 percent recorded in and a GAM rate of 10.0 percent recorded in. SAM prevalence (0.6) has improved over the past 12 months. CASELOAD OF ACUTE MALNUTRITION AMONG IDPs The total number of children with acute malnutrition among the displaced population at the time of the assessment is which include SAM children. This represents a seasonal decrease of over 18 percent compared to but it is still 31 percent higher compared to (Figure 8). SAM caseloads show a drastic decrease (43%) in number of severely malnourished children since but it is 18 percent higher compared to. The number of malnourished (GAM and SAM) children is projected to rise to and 4 680, respectively, in the next six months to come (incidence). Figure 8: Caseload trends for Acute Malnutrition among IDPs in Somalia GAM SAM 5

6 Table 3: Details of Nutrition assessment among IDPs (November ) Bi-Monthly Nutrition Update, December Map1: Somalia Food Security Access Map and Field Monitoring Location Data POST Post /15 Nutrition Assessment Nutrition coverage Assessment in Somalia Coverage Plan Region/IDP # Households # Children 6-59 Surveyed months surveyed SOUTH Mogadishu Kismayo Dhobley Baidoa Dollow CENTRAL Dhusamareb NORTH EAST Bossaso Qardho Garowe Galkayo NORTH WEST Hargeisa Burao Berbera TOTAL lf of Aden DJIBOUTI Awdal Sanag Woq. Galbeed Togdheer Sool Nugal ETHIOPIA Mudug Galgadud Bari CONCLUSION Bakol Hiran Although mortality remains low, Serious to Critical levels acute malnutrition persist among IDPs across Somalia. The current nutrition services need to be expanded to reach more children with special emphasis on the community component (MUAC screening and referral). There is an urgent need to undertake wide coverage community campaigns in all IDP settlements to deliver a minimum package of routine vaccinations, vitamin A and micronutrient supplementation, and deworming to reduce morbidity. KENYA Gedo M. Juba L. Juba Bay M. Shabelle Banadir L. Shabelle ± Kilometers Post /15 coverage No coverage due to insecurity FAO- INTERSOS SWISS-KALMO Recent and forthcoming publications and releases Post Food Security and Nutrition Technical Report, October Post Nutrition Technical Report, October Food Security and Nutrition Quarterly Brief, October Climate Update, October Market Data Update, October Nutrition Update November NOTE: The above publications and releases are available on the website: Physical Address: United Nations Somalia, Ngecha Road Campus. Postal address: PO Box 1230, Village Market, Nairobi, Kenya Telephone: Fax: , Comments and information related to nutrition: info@fsnau.org, Website: 6