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What happened, where and when?
The BAY (Borno, Adamawa, and Yobe) states in Nigeria are facing a severe nutrition crisis characterized by high levels of severe acute malnutrition (SAM) and moderate acute malnutrition (MAM). This crisis is driven by a combination of socio-economic factors, including food insecurity, displacement, poor healthcare infrastructure, and inadequate nutrition services. In June 2024, the Nutrition Sector launched an Emergency alert triggered by the recent results of the Sentinel Surveillance (community and facility sentinel), SMART survey, and SAM admissions which all indicate that the nutrition situation has significantly deteriorated in the 3 BAY states. Recent data released by the NE Nutrition Sector show that the overall prevalence of global acute malnutrition (GAM) and severe acute malnutrition (SAM) in the inaccessible areas across BAY states were 19.9 percent and 9.2 percent respectively. This indicates an increase of 1.1 % point for GAM and 0.7%-point for SAM compared to the May 2024 prevalence, in which prevalence was GAM (18.8%) and SAM (8.5%) respectively. Most cases are coming from inaccessible locations that are not covered by nutrition partners and the Nutrition Sector has called on implementing partners to support especially in these locations. Also, to note, these locations are not covered by the reserve allocation. In Borno, 12 out of the 22 Local Government Areas (LGAs) assessed triggered deterioration alerts. These alerts include Diarrhea Negative Alerts in Jere, Kaga, Mafa, Mobbar, Monguno, and Nganzai; Malnutrition Negative Alerts in Bayo and Chibok; Combined Diarrhea and Malnutrition Negative Alerts in Bama, Damboa, Gwoza, and Konduga. Notably, no LGA showed positive alerts for malnutrition, diarrhea, or both (i.e., a reduction in GAM by 5%, SAM by 1%, and diarrhea by 5%) compared to the previous cycle. These areas are among the top LGAs with the highest incidence of SAM admissions complicated by acute watery diarrhea (AWD), acute respiratory infections (ARI), and suspected measles. The high prevalence of SAM is compounded by a large number of internally displaced persons (IDPs) and returnees. The coverage of Integrated Management of Acute Malnutrition (IMAM) programs is very low due to access constraints, leading to inadequate treatment and follow-up of malnutrition cases. Although the July Sitrep is yet to be released, however, in June 2024, Adamawa state recorded its highest SAM admissions of the year, with a 24% increase from the previous month. A total of 4515 children with SAM, both with and without medical complications, were admitted to various Outpatient Therapeutic Programs (OTPs) and stabilization centers (SCs). According to the June Sitrep from the Nutrition cluster, Adamawa state has a substantial number of children with MAM, exacerbating the SAM burden due to the lack of MAM treatment services. In a recent active case finding, 3,580 children were identified as moderately malnourished, while 1,200 were severely malnourished. The state is working hard to promote appropriate Maternal Infant and Young Child Nutrition (MIYCN) practices, however, the lack of resources and supply chain issues remain significant challenges. Meanwhile, the Surveillance Report for Yobe State in June 2024 reveals a severe nutritional crisis, with alarming rates of acute malnutrition among children under five years of age. The overall Global Acute Malnutrition (GAM) rate stands at 32.9%, well above the emergency threshold of 15%, and the Severe Acute Malnutrition (SAM) rate is 10.2%. This crisis is particularly acute for children aged 6-23 months, with a GAM rate of 56.2% and a SAM rate of 27.3%. The same report documents that Yobe State treated 13,010 children under five for SAM in June 2024, with 10,970 of these children discharged as recovered. Despite these efforts, the state faces ongoing challenges in maintaining adequate supplies and ensuring compliance with IMAM guidelines. The state struggles with issues such as child swapping to receive multiple rations of Ready-to-Use Therapeutic Food (RUTF), misuse of RUTF, particularly in border LGAs, and a break in the supply pipeline for Ready-to-Use Supplementary Food (RUSF). The nutrition sector has reported that the RUTF and RUSF pipelines may break in July due to an increase in acute malnutrition admissions during the first quarter of 2024. If admissions remain at the same level, the utilization of RUTF and RUSF stocks will be much higher than the estimated target for the second quarter of 2024 and the two pipelines for the rest of the year. There is a need to procure commodities immediately to avert a stockout and secure RUTF and RUSF to treat some 390,000 acutely malnourished children during the lean season. Additionally, high diarrhea prevalence, reaching up to 23.3% among the 6-23 months age group, exacerbates the issue and contributes to the deteriorating nutritional status of children in the state. The widespread nature of the malnutrition crisis, with 16 out of 17 LGAs having GAM rates above 15%, requires a coordinated, state-wide response to address the issue effectively. Continued strengthening and expansion of these systems will be crucial for informed decision-making and effective program implementation. As a result, the Yobe and Adamawa State Governments in a letter dated 8 and 9 July respectively, requested the support of the NRCS in addressing critical preventive and therapeutic needs of the malnourished population in the state, with emphasis on capacity building of health care workers, and supplementary feeding program.