Attachments
•The drought in the Greater Horn of Africa (GHoA) is predicted to continue into the late annual rainy season (Figure 1). For the first time in 40 years, four consecutive seasons of below-normal rains have been recorded in the GHoA countries.
•The continued deterioration of the nutrition situation in the GHoA is driving an increase of Severe Acute Malnutrition admissions.
•Food insecurity compounded by rising food prices continues to negatively impact the quality of diets and the rate of malnutrition relapse in the GHoA countries •Trends in new admissions of acute malnourished cases among U5 children in nutrition programs in refugee sites and nutrition screening among new arrivals indicate critical levels of global acute malnutrition (above 15% of emergency) and acute food insecurity with further deterioration likely in 2023.
•Famine (IPC Phase 5) is projected among agropastoral populations in Baidoa and Burhakaba districts and displaced people in Baidoa town of Bay region in southern Somalia, where malnutrition and mortality levels are already very high.
• Emerging threats include Ebola disease caused by the Sudan virus –currently reported in Uganda, and other epidemic-prone diseases including measles, monkeypox, and cholera.
• WHO continues to provide support through coordinating the work of health sector partners, scaling up its support to countries to detect, prepare for and respond to disease outbreaks, to strengthen the provision of emergency health and nutrition services for those most affected. WHO is deploying funds, personnel, technical expertise and supplies.
• Donors continue to provide financial support. However, as of 10 October, only 28% of the 123.8M WHO appeal for 2022 has been funded, with additional 5% pledged. Continued humanitarian assistance will be required to address the high needs beyond December 2022 - and a rapid identification of additional funding and resources is now needed to mitigate morbidity and mortality.
1 Thematic Focus: Nutrition in the Greater Horn of Africa Countries
The seven countries in the greater Horn of Africa (GHoA) are facing one of the worst episodes of food insecurity seen in decades. A major driver for the current situation is drought, with this year’s early rainy season preluding one of the most severe droughts in the last 70 years. Moreover, more than 80% of the eastern Horn of Africa received below average precipitation which is recorded to be worse than the signature drought years 1984 and 2011. Rainfall forecast simulations from multiple forecast agencies consistently predict reduced rainfall during the late annual rainy season (October-December). In other areas there is flooding going on, for multiple years in a row. These unprecedented drought, flooding and other drivers translate in current and predicted high levels of food insecurity. Food insecurity is both a driver of forced displacement and an outcome of displacement in general. However, in the current situation both the displaced as well as the host populations are facing high levels of food insecurity. Following the Integrated Food Security Phase Classification (IPC), level 3 and level 4 food insecurity are no exception anymore - and with the late-year rainy season predicted to fail - preparing for and preventing the highest level of food insecurity (5, famine) is paramount for WHO and other actors. The food insecurity, compounded by rising food prices continues to impact negatively on the quality of diets and the rate of malnutrition relapse. The IPC acute malnutrition levels typically follow the trend of food insecurity in a lagged fashion, usually measured as Global, Moderate and Severe malnutrition (GAM, MAM, SAM) in children between 6 months and 5 years old (Figure 2). Consequently, continued deterioration of the nutrition situation in the GHoA has already led to a significant increase in SAM rates recently. A combination of reduced access to potable water, access to food and the subsequent displacement results in increased vulnerability to communicable disease, such as measles and cholera.
The consequences of the relationship between increasing levels of malnutrition and health risks and needs are evident - especially for pregnant and lactating mothers, neonates, children, the elderly, and people living with chronic diseases and disabilities. Increased numbers of outbreaks of various infectious diseases due to the acute malnutrition situation are evident throughout the GHoA region.
In Somalia, acute malnutrition case admissions among children under age five have continued to rise. Based on various assessments (IPC, FSNAU1 ), the total estimated acute malnutrition burden for Somalia from August 2022 to July 2023 is approximately 1.8 million children2 . This figure represents 54.5% of the total population of children in Somalia. Half a million children are likely to be severely malnourished. UNICEF is improving the access to nutrition, by stocking warehouses and by improving access to difficult to access areas. WHO assists with nutritional screening and malnutrition-related medical support at various locations in order to further assess the scale of the needs and provide the necessary support.
In the northern areas of Kenya, the nutrition situation has significantly deteriorated and is projected to exacerbate due to worsening food security situation resulting from four consecutive failed rainy seasons.
Up to August, northern states experienced a rapid deterioration in indicators with malnutrition rising in many of the hardest-hit counties. Some areas have a GAM of above 30%, and even 40% (Figure 3)3 . This is in most cases nearly an increase of 50% compared to last year’s dry season. Sector partners support integrated outreach services ongoing in 9 arid counties in hard-to-reach areas. The second round of mass screening in northern Kenya has been done and will inform further targeting. WHO works on strengthening nutrition surveillance, oedema screening and referral of children in health facilities. Additionally, WHO supports by providing capacity building in the management of severe acute malnutrition and outbreak investigation and confirmation.
In recent months, a range of emergencies including extensive flooding, conflicts, and rising food prices, have pushed South Sudan into an unmatched food insecurity and nutrition crisis, with rising numbers of children at risk daily from malnutrition and an array of diseases. Over 1.3 million children below the age of five are currently acutely malnourished with SAM rising in multiple areas. From January – August 2022, a total of 189,580 children suffering from SAM were treated in inpatient and outpatient therapeutic programs3 .
The attained treatment was 78.4% of the annual target and 62.7% of people in need. From WHO there are support projects in Fangak, Leer, Mayendit, and Pibor (June-November 2022) supporting 11 health facilities through sub-grantees. WHO is also involved in conducting mobile outreaches in three counties affected by food insecurity and malnutrition.
In Sudan, recent SAM rates of 2.76 are reported in the worst hit counties. Already high prevalence rates of chronic malnutrition (36.4% stunting) and acute malnutrition (13.6% wasting) are projected to worsen3 . Over 3 million children below age of 5 years are suffering from acute malnutrition in Sudan4 .
Food and nutrition insecurity are significant public health concerns in Djibouti. For July to December 2022, the IPC estimates that nearly 192,000 people will be acutely food insecure in IPC Phases 3 and 4, representing 16% of the analysed population (of almost 1.2 million people)5 . 54% of the rural households faced inadequate food consumption, with the highest levels in rural areas of Arta, Ali Sabieh and Obock. As a consequence of the situation MAM and GAM are recently increasing by up to 30%. UNICEF and WFP are taking the lead in the food insecurity response whereas WHO supports preparedness and response activities to prevent related disease and morbidity including efforts to decrease the prevalence of anaemia among pregnant women, capacity building on SAM and immunization campaigns.
In Karamoja district in Uganda a trend of worsening malnutrition is observed. SAM rates in several areas are nearing 5% with MAM rates between 10-20% also recorded (Figure 3)6 . The Inpatient Therapeutic Care program (ITC) performance has remained within the SPHERE standards from January-August 20227.
However, the Outpatient Therapeutic Care (OTC) program cure rates have been mainly below 75% due to high defaulter and non-response rates. To address the challenge, defaulter tracing has been intensified, and efforts to advocate for linkage with other nutrition-sensitive programs are made. WHO field teams at the regional hubs of Moroto, Gulu, and Soroti have identified the areas for support during monitoring visits to health facilities. These include nutrition screening at all health facilities and capacity building of health workers on management of nutrition data.
Sustained high levels of acute malnutrition in Ethiopia are reported, with SAM rates of above 2% (Figure 3) with a projection deterioration. The situation is affected by conflict in the northern Ethiopia and Somali region and cholera outbreaks in Oromia. UNICEF continues to strengthen emergency nutrition coordination at the national and the regional level. In 2022, 386,973 children admitted for SAM treatment representing 40% of the target. The number of children under the age of five years assisted with MAM for the same period is 1,045,459 and the pregnant and lactating women with acute malnutrition assisted is 615,985.