Monthly Humanitarian Situation Report SENEGAL Date: October 2013 UNICEF WASH officer using the handwashing station at the entrance of a community nutrition site supported by World Vision under the national nutrition reinforcement program Highlights More than 15,000 children with SAM have been admitted from January to September 2013. 3,536 admissions took place in September (data from 44% of facilities). Based on the June 2013 nutritional survey results, UNICEF estimates that the SAM burden for 2014 will be 76,815 children under five and the proposed target considering conditions in the country is 47,270 children under five. According to this survey, 17 Departments out of 45 are in nutritional crisis by any or several of the following crisis thresholds: >15% GAM prevalence; >2% SAM prevalence; and >1% to <2%SAM prevalence considered critical due to high prevalence of aggravating factors (diarrhea and respiratory infections >50%). No additional emergency funding has been received this month. Thus UNICEF Senegal s requirements of US$ 3,305,266 in the HAC remain 75% funded. 1
Situation Overview & Humanitarian Needs The targets for the rehabilitation of children with Severe Acute Malnutrition (SAM) for 2013 in Senegal are based on the national 2012 nutrition survey using SMART methodology. According to this survey, the SAM burden for 2013 was estimated at 63,323 under-five children. In 2013, the sectoral group of partners agreed to an initial target of 38,968 SAM cases (62% 1 ) given funding trends and estimated geographical coverage of services, then revised to 42,843 at the mid-term review. Based on the same survey, the Moderate Acute Malnutrition (MAM) caseload is estimated at 255,675 cases for the year (Table 1). The 2012 survey further identified 16 out of 45 departments as critical. Based on this geographical breakdown, 11 out of 14 regions were identified as in need of emergency support based on prevalence of malnutrition and aggravating factors such as diarrhoea and ARIs: Diourbel, Fatick, Kaffrine, Kedougou, Kolda, Louga, Matam, Saint Louis, Sedhiou, Tambacounda and Thies. A Food Security and Nutrition survey took place in June 2013 (ENSAN 2013) with broad implication of concerned government ministries and partners. The nutritional situation in Senegal seems largely unchanged from 2012 when the emergency nutrition response was launched. This survey includes the following key findings (see page 3 and annex for details): Overall national Global Acute Malnutrition (GAM) average prevalence for under-five children has not reached the WHO 10% threshold but remains precarious at 9.1% 2 Four Departments have surpassed the 15% GAM crisis threshold of global acute malnutrition (Matam 20%, Kanel 18%, Podor 17% and Ranerou 16%) Twelve Departments have reached the GAM above 10% WHO warning threshold (GAM >10 % <15 %) Nine Departments are over the WHO SAM crisis threshold (>2%): Mbour 2,3%, Medina Yoro Fula 2,2%,Podor 3,9%, Ranérou 4%, Kanel 2,2%, Matam 4,5%, Goudiri 2%, Bounkiling 4,6%, Bakel 2,7% Only four Departments have the GAM below 5% (WHO acceptable threshold) National prevalence of chronic malnutrition is 16.5% 1 Taking into account SPHERE standard targets for treatment coverage which are 50% in rural areas and 70% in urban areas. 2 8,4-9,8 IC 2
ACCEPTABLE PRECARIOUS SERIOUS CRITICAL Global Acute Malnutrition <5% 5% to <10% 10% to <15% 15% Chronic Malnutrition <20% 20% to <30% 30% to <40% 40% Underweight <10% 10% to <20% 20% to <30% 30% SAM 2% Table 1: WHO Classification of Malnutrition Prevalence 2014 estimated SAM caseload 3 SAM burden in Senegal 76,815 SAM target caseload 47,270 Prevalence of Global Acute Malnutrition Global Acute Malnutrition Map of Senegal showing GAM by Department based on ENSAN 2013 survey The food security module of the ENSAN survey found a moderate level of food insecurity at 18.8%; that is 245,000 households or 2.2 million people. There is deterioration in rural food security however as compared to 2010. Rural households are more affected (25.1%) with the regions of Casamance showing very high levels (Ziguinchor 68%, Sédhiou 67% and Kolda 50%). The regions of Matam and Kedougou follow with high prevalence at 48% and 45.6% respectively. 3 Based on the June 2013 ENSAN survey (using SMART methods), the estimations for 2014 were made using the same methodology than for 2013 estimates (i.e. 1.5 incidence factor for MAM, 1.6 for SAM caseload and 2.6 for the burden). 3
Program response - SAHEL NUTRITION CRISIS Since the launch of the nutrition response in 2012, UNICEF provides training, anthropometric tools, Ready to Use Therapeutic Food (RUTF) and therapeutic milks, essential medicine (deworming, vitamin A, antibiotics, ORS/Zinc), as well as resources for coordination, supervision and monitoring of the response in all fourteen Health Regions in the country. Following a phased approach, from June 2012 Phase 1 covered Diourbel and Matam regions with 174 public health facilities to offer nutritional services strengthening capacity of district authorities and health providers, both directly and through INGO partners. Phase 2 effectively started in November 2012, covering Louga, Thies and St. Louis Regions, which count 367 health facilities. The final stage (or Phase 3) began in January 2013 in six additional regions, namely Fatick, Kaffrine, Kedougou, Kolda, Sedhiou and Tambacounda which count 400 additional health facilities making a total of 941 health facilities. In all these regions, UNICEF supports response plans that integrate Nutrition/Health, WASH and Communication for behavioural change. UNICEF s activities in response to the nutritional crisis in Senegal were officially launched in June 2012, and current targets shown in this report are set until the end of 2013. UNICEF and partners programing Coordination: The WASH sector group continues to meet once a month under UNICEF s leadership as cluster lead. The Health and Nutrition Sector group has decided to meet twice a month instead of monthly given the results of the latest nutritional survey and pressing needs in the sector. The group continues to be led by WHO and co-led by Action Contre la Faim (Action Against Hunger Spain) with support from UNICEF. The Refugees and the Food Security groups meet on an asneed basis. The humanitarian needs analysis exercise was launched by OCHA this month, with analysis currently taking place within the sector groups. An intersectoral meeting will take place on October 31 st to produce a first draft of Senegal s Humanitarian Needs Overview. A workshop with all actors, including government, is planned for the end of November to finalize the overview document before the planning exercise can be completed. Response: 3,536 children with severe acute malnutrition (SAM) were admitted in September, almost double the number reported in August. According to data shared by medical authorities, more than 15,000 SAM admissions have taken place between January and September 2013. This data represents on average 34% 4 of nutritional /health facilities expected to report on SAM treatment. 4 (minimum 22% in January and maximum 44% in September) 4
237 deaths of children with SAM have been reported so far in 2013, 72 of them in September. In addition, 145 children dropped out of the program in September and more than 1,400 were discharged recovered. Data on distribution of hygiene kits to mothers of children with SAM has also become available, showing that almost 6,000 families have benefitted from WASH in Nutrition so far this year. This intervention aims to reduce the exposure of young children to diarrhea which is among the underlying causes of malnutrition. The Cellule de Lutte Contre la Malnutrition (CLM), the government body in charge of prevention and community management of moderately acute and chronic malnutrition, officially released the results of the Food Security and Nutrition Survey (ENSAN) conducted in June 2013 with partner support. (See above for nutrition and food security findings) The latest nutritional survey of June 2013 confirms a nutritional crisis situation in the three Departments of Matam Region (Kanel, Ranerou and Matam departments), and in the Department of Podor (Saint Louis Region). Two UNICEF missions to these areas have taken place this month to help the local authorities develop emergency response plans to accelerate interventions until the end of the year. The new C4D specialist will also assist these areas in producing a better targeted communications strategy to bring about behavioral change. The response plans are based on a determinant analysis carried out with local actors during the visit. For Matam key determinants identified included: Prevalence of morbid factors Spacing of pregnancies (limited family planning) Limited access to water and sanitation and poor hygiene practices Barriers to access to basic services (barriers such as cost and distance) 5
Poor nutrition practices for infants and young children: limited exclusive breastfeeding, drastic interruption of breastfeeding, and absence of food diversification for young children Performance of the malnutrition management system (frequency and coverage of screening, coverage and effectiveness of outreach, involvement of health personnel, etc) Diarrhea Respiratory Infection Prevalence of morbid factors by region The new Nutrition Technical Assistants deployed in the medical Regions to support the management of SAM were officially confirmed in their functions at the beginning of October. Completeness of reporting of SAM admissions jumped by more 10 percentage points with the support of these additional human resources to the regional teams, which also enabled retroactive data sharing. 6
SAHEL NUTRITION CRISIS SENEGAL PERFORMANCE INDICATORS Sector Estimated # / % coverage Nutrition Children 0-59 months with Severe Acute Malnutrition admitted for therapeutic care Children 0-59 months in therapeutic care discharged recovered from SAM Number of Health Centers/Posts with SAM treatment Children <5 with Severe Acute Malnutrition with complications admitted to therapeutic care UNICEF & operational partners UNICEF 2013 Target Cumulative results 2013 % of Target Achieved Cluster 2013 Target 1 Sector / Cluster Cumulative results 2013 % of Target Achieved 42,843 2 15,165 3 35% 42,843 2 15,165 3 35% 11,032 7,298 4 66% 11,032 7,298 4 66% 941 841 90% 941 841 90% 1,517 5 1,646 109% 1,517 5 1,646 109% List of UNICEF Operational Partners: Action Against Hunger Spain, French Red Cross, Ministry of Health, Childfund (CRS, Plan, Africare, World Vision), Cellule de Lutte Contre la Malnutrition (CLM) WASH 1. UNICEF and Cluster Target for SAM related activities are the same; UNICEF is the supplier of RUTF to all public health facilities in Senegal 2. Revised target at Senegal Humanitarian Strategy mid-year review after updated context data. 3. Based on available data from government and NGOs covering approximately 34% of nutritional facilities on average and 44% for the month of August. 4. Recovery data for August admissions is collected in September and is therefore now available in the October SitRep. 5. WHO in Senegal defines this target as 10% of SAM admissions. This is a rolling target. Number of nutrition centers/posts with the WASH minimum package 2 Number of children with SAM benefiting from hygiene kits and counselling on key hygiene messages 841 420 50% 841 420 50% 15,165 5,918 3 39% 15,165 5,918 3 39% List of UNICEF Operational Partners: Ministry of Health, Ministry of Water and Sanitation, Local authorities (Mayor s office, etc.), CBOs, Senegalese Red Cross 1 This is primarily a UNICEF activity. There is currently no WASH sector-wide reporting on this indicator. Only UNICEF data is currently provided. 2 Minimum package is defined as: availability of drinking water, no open defecation and hygiene promotion. 3 Based on data reported by hygiene brigades Summary of Sahel Performance Indicators 7
Seasonal Floods and Water Shortage Update According to data collected by hygiene brigades (Ministry of Health) approximately 25,000 families were affected by flooding during this year s rainy season. Over 16,000 hygiene kits provided by UNICEF have been distributed to affected households, with other needs being met by sector group partners such as the Senegalese Red Cross and World Vision. More than 75 radio spots, 250 outreach talks and 32,000 home visits were carried out with UNICEF support in order to improve hygiene practices and water treatment. On October 18 th the UNICEF Representative officially handed over the school kits and disinfection products to the Ministry of Education in a symbolic ceremony. In September UNICEF distributed cleaning products to disinfect 150 schools affected by floods, as well as school supplies for affected children in these schools. At the end of September and beginning of October the city of Dakar suffered from an important water shortage. An estimated third of the population of the capital had no access to water for as long as three weeks. The risk of illness was aggravated by the recent flood season which had led to the contamination of many water sources being used by the population as a last resort. UNICEF worked with the Ministry of Health to reduce the risk of epidemics and improve preparedness for potential epidemic outbreaks, notably cholera. UNICEF supported the hygiene brigades with additional supplies for water treatment and water quality control. In addition, UNICEF called for the Direction of Prevention at the Ministry of Health to update its contingency plan and stock for the eventuality of an epidemic breakout. However, the surveillance system has so far shown no reason for concern. A new water cut is taking place this week while the pipes are being repaired. Nutritional Crisis Funding Update No additional emergency funding has been received this month. Thus UNICEF Senegal s requirements of US$ 3,305,266 in the HAC remain 75% funded. Revised HAC Requirement USD (as of June 2013) Funded USD (August 2013) Unfunded USD Gap % 3,305,266 2,469,490 835,776 25 Date of next SitRep: 30 November 2013 Giovanna Barberis Representative Tel: +221 33 889 03 00 E-mail: gbarberis@unicef.org For further information, please contact: Edele Thebaud Deputy Representative Tel: +221 33 889 03 00 E-mail: ethebaud@unicef.org 8
Annex: Prevalence of Acute Malnutrition by Department Departments Prevalence of Wasting (6-59 months old) Number (n) Global Moderate Severe Matam 337 20.5% 16.0% 4.5% Kanel 598 17.90% 15.70% 2.20% Podor 305 16.7% 12.8% 3.9% Ranérou 400 16.3% 12.3% 4.0% Bakel 446 14.3% 11.7% 2.7% Linguère 317 12.3% 11.7% 0.6% Tambacounda 353 11.6% 11.3% 0.3% Médina Yoro Foulah 633 11.5% 9.3% 2.2% Bounkiling 303 11.4% 9.2% 4.6% Dagana 253 11.1% 10.7% 0.4% Goudiry 394 10.9% 8.9% 2.0% Kaffrine 312 10.6% 9.9% 0.6% Koungheul 376 10.4% 9.6% 0.8% Gossas 232 10.3% 9.5% 0.9% Bambey 412 10.2% 9.7% 0.5% Saraya 283 10.2% 8.8% 1.4% Malem-Hodar 392 9.9% 8.2% 1.8% Diourbel 259 9.7% 9.3% 0.4% Louga 287 9.60% 8.20% 1.40% Goudomp 233 9.4% 9.0% 0.4% Birkelane 328 9.1% 8.5% 0.6% Salémata 188 8.5% 6.9% 1.6% Kolda 271 8.5% 7.7% 0.7% Foundiougne 239 8.40% 7.90% 0.40% M'bour 216 8.3% 6.0% 2.3% NioroduRip 392 8.2% 6.6% 1.5% Sedhiou 354 8.2% 8.2% 0.0% Vélingara 270 8.1% 6.7% 1.5% Saint-Louis 161 8.1% 8.1% 0.0% Mbacké 369 7.9% 7.6% 0.3% Tivaouane 239 7.90% 7.50% 0.40% Fatick 230 7.80% 7.40% 0.40% Thiès 213 7.5% 6.6% 0.9% Koumpentoum 321 7.5% 7.2% 0.3% Guinguinéo 348 7.2% 7.2% 0.0% Pikine 149 7.1% 6.7% 0.7% Kébémer 210 7.1% 6.2% 1.0% Bignona 265 6.8% 6.8% 0.0% Kédougou 305 6.2% 6.2% 0.0% Guediéwaye 116 6.0% 5.2% 0.9% Ziguinchor 251 5.2% 3.6% 1.6% Kaolack 302 4.6% 4.3% 0.3% Oussouye 228 4.4% 4.4% 0.0% Dakar 78 3.8% 2.6% 1.3% Rufisque 134 3.0% 3.0% 0.0% 9