The nutrition status of children under the age of five is generally accepted as one of the best indicators of prevailing poverty and food insecurity in the region/country. The Food Security and Nutrition Analysis Unit (FSNAU) provides a snapshot of current nutrition situation in Somalia through biannual assessment of nutrition status. Between November 2013 and January 2014 (Post Deyr), FSNAU conducted 40 nutrition surveys across Somalia covering all regions & livelihood zones and assesses nutrition status of 27, 581 children (6-59 months).
Twenty seven of these surveys were based on SMART methodology and 13 were surveys that used Mid Upper Arm Circumference (MUAC) as an indicator of wasting. Deyr 2013/14 results indicate that high levels of acute malnutrition persists across Somalia with one out of every seven children (< 5 yrs.) suffering from acute malnutrition. Median Global Acute Malnutrition (GAM) rate of 14.2 percent in the Deyr 2013/14 assessment suggests that nutrition situation in most livelihoods is either sustained or improved since Gu 2013 when Median GAM of 14.4 percent was recorded. However Qardho IDPs and Berbera IDPs were an exception as prevalence of acute malnutrition has increased from serious (10-14.9%) to critical levels (>15%). When current nutrition situation is compared to the situation 12 months back (Deyr 2012/13), there is no change in prevalence of acute malnutrition in most livelihoods, except amongst Garowe IDPs where GAM prevalence deteriorated from serious to critical levels. It was observed that critical levels of GAM were more prevalent among IDP children (15.8%) and in South Somalia (15.1%) compared to North East and North West regions of Somalia.
Deyr 2013/14 results show an increase in Severe Acute Malnutrition (SAM) prevalence. Critical SAM levels (> 4.5 %) were observed in Dolow IDPs, Qardho IDPs and among Bay agro pastorals during Deyr 2013/14 assessment while serious levels (3.5-4.4%) were seen in Dobley IDPs, Berbera IDPs, Garowe IDPs and in Beletweyne district. Compared to levels in July 2013 ( Gu 2013), increase in prevalence of SAM was noted in Dolow IDPs in South and Qardho IDPs in North East. High SAM prevalence in areas with high GAM prevalence was noted and is reflected by their positive correlation (0.73).
Malnutrition is associated with increased illness and death. Under five Death rate (U5DR) was acceptable or serious in most regions exception Beletweyne where critical levels are seen (>2%).Higher morbidity rate was seen in children with greater prevalence of acute malnutrition. However no significant association was observed between prevalence of GAM and SAM with U5DR and prevalence of morbidity. Morbidity exceeding 50 percent was recorded in some populations: Beletweyne, Mataban and Dolow IDPs.
Similar levels of acute malnutrition can reflect different contributing factors . Understanding the underlying causes is important for the interpretation of the situation. The deterioration in Qardho IDPs is attributed to increase in morbidity (is it 46% now compared to 21.8 % in Gu 2013 or 25 % in Deyr /Dec2012). Even stunting and underweight levels in Qardho are higher in Deyr 2013 compared to Gu 2013 suggesting deterioration in nutrition. For Berbera IDPs, the high GAM prevalence seen in Deyr 2013/14 is a reflection of seasonal trend as well as poor IYCF practices suggested by low dietary diversity. Only 0.4 percent of children aged 6-23 months were reported to have consumed diversified diets comprised of four or more food groups.
Deyr 2013/14 estimates indicate that a total of 202726 children 6-59 months suffer from GAM including 51227 SAM children. The current GAM estimate is slightly lower than the number recorded in Gu 2013 (206100) or Deyr 2012/13 (215050). However the current number of SAM children) is 25 percent higher than 40950 seen in in Gu 2013 or 12.5 percent higher than the SAM (44600) children recorded in in Deyr 2012/13. This suggests an increasing trend of SAM in Somalia. It was also noted that 68 percent of the GAM children (2 out of every 3 acute malnourished Children) are from South Somalia while 6 percent were among IDPs.
Median Stunting rate of 14 percent suggests that it is not a public health problem in Somalia. However pockets of high stunting (≥ 30 %) were seen in Bay Agro pastorals and in Beletweyne in South Somalia and among IDPs: Baidaoa and Kismayo in South and Qardho IDPS in North East. Positive association between prevalence of GAM and stunting (0.33) and SAM and stunting (0.45) suggest that acute malnutrition is often superimposed on chronic malnutrition and this further aggravates malnutrition levels in the community.
Very high levels of underweight (>30%) were seen in South Somalia (Bay Agro pastoral, Beletweyne and Kismayo IDPs) and high levels ( 20-29.9 %) were prevalent among children in IDPs: Baidaoa, Dolow, Bossaso, Qardho, Garowe and Galkayo. FSNAU assessments show a strong (0.89) between prevalence of Stunting and underweight in the children surveyed.
Prevalence of malnutrition in Somalia: wasting(GAM), stunting and underweight tended to be significantly higher in boys compared to girls. Age disaggregated data did not show any significant differences in prevalence of acute malnutrition between 6-23 months and 24-59 months. However prevalence of stunting and underweight (indicators of food insecurity, poor IYCF and poverty) was significantly higher in younger children (6-23 months) compared to older children (24-59 months). This suggests that malnutrition efforts should prioritize targeting the younger age group of 6-23 months in both IDP camps and in host communities with special focus on timely introduction of complementary feeding.
Very critical levels of maternal malnutrition (MUAC < 23 cms) were recorded for Dhusamareb IDPS (38.2%) and critical levels in E Golis (31.5%). Marked reductions in child undernutrition can be achieved through improvements in nutritional status of mothers.
Access to safe water did not show any significant association with prevalence of acute malnutrition GAM/SAM.
The projected outlook of nutrition situation for February to April 2014 is deterioration in Northwest Agro-pastoral and Sool plateau from current Alert phase to Serious and likely improvement among Berbera IDPs. In North East current nutrition situation is expected to be sustained except deterioration is expected in Sool plateau which cuts across NW and NE regions and Bossaso IDPs consistent with seasonal trends. In South Somalia current Serious toCritical situation seen in Deyr 2013/14 in the IDPs/ livelihoods is expected to be sustained from Feb –April 2014 including the improvements seen in Bay, Bakool, North Gedo, Juba Pastoral in Deyr 2013.
The persistently high rates of acute malnutrition and increasing trends of SAM suggest that Somalia should take acute malnutrition in children seriously. There is a strong link between acute and chronic malnutrition, as a single or repeated bouts of acute malnutrition will contribute to growth failure. More efforts must be exerted in order to reduce the current level of acute malnutrition through strengthening the current curative and preventive nutrition programmes. Lack of attention to child nutrition today will result in considerably higher costs tomorrow.