Somalia

Monthly Nutrition Update for Somalia Sep 2001


OVERVIEW
Over the past one month, the situation for many people in some parts of Southern Somalia has worsened considerably. As both food and water access is reduced, poorer agro-pastoral families and individuals have moved towards urban centres or travel regularly to areas where relief assistance is being provided. In northern Gedo, camels, sheep and cattle have moved from the region in search of pasture and water, leaving behind the goats with the younger and weaker family members and their carers. With deterioration in the condition of these remaining animals, many poorer households are consequently experiencing a significant reduction in their access to basic foodstuffs. In Gedo, relief efforts have been hampered by insecurity in some districts e.g. Bulla Hawa and Dolo, placing additional stress on districts where interventions are ongoing e.g. Luuq.

Throughout 2001, few nutrition surveys have been undertaken in Somalia. On numerous occasions, plans were set in place only to be cancelled due to lack of access usually related to insecurity. In September, nutrition surveys were planned in Rabdure and Qansadheere in Bakol and Bay respectively and a nutrition assessment in the Haud area of Somaliland. These exercises have now been ‘postponed’.

In the next ‘Nutrition Update’, which is currently being prepared, a summary of nutrition data from reporting health facilities will be presented enabling readers to observe trends in attendance and malnutrition as well as the wide range of factors that influence both of these numbers. The next issue will be released in early October.

SOUTHERN SOMALIA J King’ori, FSAU

GEDO REGION UPDATE

FSAU has estimated that this region will experience a food deficit of about 5,800 MT in the period between Gu 2001 and Gu 2002. The affected population is mainly the agro-pastoral group, who are the majority, with the north being affected than the south. CARE continues to distribute approximately 700 MT of sorghum per month to an estimated population of 14,000 people in the districts of Luuq, Bulla Hawa, Dolow and El Wak in northern Gedo. Total crop failure has been reported in the rain fed areas. Camels and cattle have already moved away from many areas towards Lower/Middle Juba and to Takaba Division in Kenya. The condition of the remaining animals is poor and their milk yields have greatly reduced. The closure of Somalia-Kenya border has negatively affected income to households in Bulla Hawa, Dolow and El Wak. With relative improvement in security in Bulla Hawa, an estimated 10,000 IDPs moved back from Mandera in June 2001, many having lost their belongings in the process. Insecurity throughout the region continues to hamper relief operations and assessments. The region is also experiencing serious water shortage thus forcing people to travel for long distances and share the scarce water with animals. Some households have moved closer to Daua (at the Ethiopia-Somalia border) and Juba Rivers for easier access to water.

Because of the interruptions in services and the cessation of supplementary feeding, attendance for screening at health facilities has declined significantly in recent months to as little as 20% of the previous levels. Attendance is now more likely to be related to illness and exacerbated by food insecurity, with fewer healthy children attending. It is not surprising therefore to find the actual proportion of malnourished children increasing e.g. out of 141 children screened in Garbaharey in July, 50% were malnourished. Levels of severely malnourished children have also increased both in number and percentage for all reporting facilities, a possible indication that coping strategies are failing for many households. A case in point is Bulla Hawa MCH, where despite a relatively stable high level of moderate malnutrition, the rate of severe malnutrition has risen from 4% in April to around 8% in August. Of the 507 children screened during August in the newly opened health facility in El Wak, 22% were malnourished. Malaria, diarrhoea and pneumonia are currently among the most commonly treated conditions in the MCH centres. Bardera in south Gedo remains one of the districts least affected by the current crisis. The newly opened MCH has recorded 4% malnutrition out of 145 children screened in August 2001.

In Gedo, supplementary feeding has ceased at all health facilities in all districts with the exception of Luuq, where ACF has intensified efforts in both supplementary and therapeutic feeding programmes. The numbers of beneficiaries in the newly established supplementary feeding programme in ElBon (agro-pastoral area) is also high. In the absence of other comprehensive health, food and nutrition projects in neighbouring districts, a number of people have migrated to Luuq in search of assistance. It is hoped that the establishment of the ‘expanded and extended supplementary feeding programme’ in other districts and regions by other organisations will curb this tendency.

CARE Somalia continues with its monthly food distribution targeting households with malnourished children under five years, as well as those hosting dependant elderly or disabled persons in the four districts highlighted above. Fresh registration, by CARE, of new beneficiaries for emergency food distribution commenced in September in North Gedo. Screening of children during this exercise suggested high proportions of both moderately and severely malnourished children. CARE has expanded coverage through inclusion of new villages for food distribution.

There is little doubt that the health and overall welfare of the population of Gedo Region is already the worst in Somalia. Surveys during 2001 in neighbouring areas of Kenya showed global malnutrition rates of 20% and over. Sheer numbers of malnourished children presenting at health facilities and observations during screenings for general rations act to reinforce this suggestion. The lack of nutrition surveys in Gedo over the past one year is extremely unfortunate and in general attributable to insecurity. It is hoped that before the end of 2001 two surveys will be undertaken and the possibilities of putting alternative monitoring systems in place are being considered.

BAY REGION

Bay region, which is highly populated and was considered as the main sorghum producer in Somalia, is considered to be the second most severely affected region in Southern Somalia. After the very good Gu 2000 production, this year’s crop production was a massive failure. In addition, the chronic water problems are now causing serious constraints in access. Some pockets are already facing food shortage.

According to July and August nutrition reports from MCH facilities of Baidoa (DMO), Berdaale, Qansax Dheere, and Dinsor, proportion of children considered malnourished appears high at over 40% of the above 400 children screened in each of the month in each facility. The attendance in Dinsor MCH decreased considerably between June and July, due to conflicts that afflicted the area.

Supplementary feeding programmes supported by UNICEF operate at Baidoa (DMO), Dinsor, Qansaxdheere, and Berdaale MCH and the facilities have continuously recorded high attendance of over 400 children per month. The addition of family ration (to families with malnourished children) to the supplementary feeding programme has been ongoing in Baidoa (DMO) since late 2000. As mentioned previously, UNICEF and WFP are considering expanding family ration distribution to other districts in Bay Region.

BAKOOL REGION

The agro-pastoral community in the region continue to face imminent food shortage following poor crop performance. The water points also continue to be overcrowded by livestock from the region, creating an increased pressure on the limited water supply.

The supplementary feeding programmes (SFP) in the region continue to record high number of beneficiaries but with a rising trend. In Rabdure, the number has increased from 412 in May to 495 in July. In Huddur, the numbers rose from 196 to 581 in the same period. These SFP figures include the malnourished cases recorded in the month and the SFP beneficiaries discharged in months under consideration.

Decentralisation of SFP and health services from the MCH is one of the strategies to be employed in Huddur and Rabdure Districts through UNICEF/WFP/IMC intervention package. One static clinic will be maintained as two additional outreach clinics are established in other two villages within each district. In each clinic, synchronized activities of screening for malnutrition, blended food distribution, systematic treatment, family ration distribution, EPI and health education will be carried out. In addition to the above strategy, the World Food Programme has responded to the problem of newly established settlements around Rabdure (IDPs in the area) by undertaking a detailed assessment of the origins of the people. An initial distribution will be undertaken at the camps followed by a second round of distribution in the villages from where they people have come.

MIDDLE AND LOWER JUBA

The regions generally had a good crop harvest (except Hagar and Afmadow Districts) and the livestock are in good condition. The area is hosting livestock from Gedo, some parts of Bay Region and parts of Kenya. This is due to the relatively good pastures as result of good rains received in the Gu season. Despite that, the area has had incidences of insecurity, which have culminated in fighting along the riverine areas and disruption of trade links with major trading towns like Mogadishu. The closure of Somalia-Kenya border has also had some negative influences.

Insecurity has resulted in some population movement towards middle Juba. Livestock prices are currently low due to low seasonal demand in Kenya as well as due to the closing of the border. Currently Hagar District is experiencing water shortage and some households have started moving towards the Juba River.

Data from most MCH centers in Lower and Middle Juba (Jilib, Bulo-Haji, Kudha, Muslim Aid Kismayo, Muganbo, SRCS-Kismayo and Badhadhe) indicated relatively low levels of malnutrition of about or less than 8% of the screened children in July 2001. The food security situation in the area is relatively stable when compared to other parts of Somalia and so far the population appears to be coping with the negative effects of increased food prices, low seasonal demands for livestock and low cross border business activities.

NUTRITION SURVEY IN EL DER, GALGADUD REGION - preliminary results S. Matu, FSAU

Elder is a coastal district in Galgadud region with an estimated area of approximately 10,000 square kilometres. The district falls within the pastoral food economy group with limited fishing activities. Since 1993, CISP has been supporting health care services in the district with the monitoring of the nutritional status of children in the district as one of the main activities. Nutrition data generated from screening of under five children in the two MCH’s in the district has consistently indicated low proportions of malnourished children ranging from 0% to 10% compared to other facilities in the South and Central zone that have reported as high as 30%. However, there was need to clearly understand the nutritional status of the district to facilitate accurate monitoring and to support CISP in evaluating its health programme.

In August 2001 CISP, UNICEF and FSAU carried out a nutrition survey in Elder District aimed at determining the nutritional status of children aged 6 - 59 months. A total of 907 children were surveyed using a 30 by 30 two-stage cluster sampling methodology. Preliminary survey results indicate a global acute malnutrition rate (weight for height Z-score <-2 or oedema) of 9%, 95% C.I. 7.1% - 10.9%. Severe acute malnutrition (weight for height <-3 Z-score or oedema) was 1%, 95% C.I. 0.8% - 2.5%. The observed malnutrition prevalence from the survey results confirms the levels generated from the health facilities.

The incidences of diarrhoea and acute respiratory tract infections two weeks prior to the study were reported at 19% and 38% respectively. Vitamin A supplementation within six months prior to the study was 84% while the measles coverage in the study area was 73% according to mothers’ recall.

Majority (59%) of the households obtained drinking water from open wells, 31% from the only borehole in the district and 10% from berkads. Water accessibility for villages far from Elder town is quite limiting with some families having to travel for 10 - 60 kilometres to access water. About two-thirds of the studied households reported purchases as the main food source, while about 20% reported animal products from own production. Sale of animals or their products was reported to be the main source of income by 42% of the population, followed by small business (19.6%) and casual labour (13.6%). Other sources of income include salaried employment, sale of crops and remittances. Normally households will sell their livestock to supplement their food needs in addition to meeting other needs.

The malnutrition prevalence rates in Elder are lower than nutrition survey results in other parts of South and Central Somalia which have generally over the past two years reported global acute malnutrition rates greater than 12%, with the exception of Bualle District Survey (January 2001,Total malnutrition 8.4%). A detailed examination of factors influencing nutrition in this population will therefore be undertaken to understand both the positive influences that enable the rates to be lower and the negative influences that lead to a total malnutrition rate of 9% in a relatively food secure population.

Information on livelihoods in this area point to the possibility that most families have access to animal source foods, which may in part account for the relatively low malnutrition rates reported. Additionally, information gathered from focus group discussions indicated that milk; cowpeas and beans formed a major component of most families’ diets, providing good sources of proteins and contributing significantly towards better nutritional status. The high measles vaccination and vitamin A supplementation provided as part of CISP health activities in the district are also likely to have a positive impact on the nutritional status of the children in the area.

One of the continuing and significant negative influences on nutrition is likely to be the distance from many of the villages to a water source. This not only influences the quality and quantity of water available at household level but negatively impacts the amount of time and energy available for childcare. A detailed survey report will be released soon.

SURVEILLANCE IN SOMALILAND S. Matu, FSAU

Nutrition data from SRCS-supported health facilities in Somaliland indicate relatively low proportions of malnourished children screened in the current year compared to previous years. Despite the relatively low malnutrition rates observed in these facilities, certain pockets within Somaliland show increased vulnerability. The Haud area is a case in point and has been consistently highlighted as vulnerable in past FSAU food security reports. Poor gu rains were received in this area, which places this predominantly pastoralist population in a vulnerable state.

With reference to health facility data, Burao Kenya MCH in Togdheer region has consistently reported higher proportions of malnourished children compared to the other SRCS-supported health facilities. Yagoori MCH in Sool region has also reported a sharp increase in the proportions of malnourished children screened in the months of April to June, partly explained by the fact that these MCH’s receive patients and malnourished children from the Haud area. The attendance ranged between 600 and 300 in Yagoori and between 500 and 250 in Burao Kenya in the January through July period.

ASSESSMENT PLANNED FOR THE HAUD IN SOMALILAND

The assessment, which was to be undertaken jointly by Norwegian People’s Aid and FSAU during August, was postponed due to issues related to security. The assessment was rescheduled for September and has now been postponed again.

SURVEILLANCE IN PUNTLAND B. Owadi, FSAU

From the ongoing nutrition surveillance activities in the North East Somalia, there is an indication of declining nutrition situation in the towns and poor pastoral villages in southern Mudug and North Nugal. The health facilities that have been previously recording low malnutrition levels as well as low children attendance figures are already noting a rising trend. The urban centres of Galcayo and Bossasso continue to receive increased pressure from emigrant labourers who are unable to get jobs or alternatively surviving on remunerations whose values have been substantially reduced. Commodity prices have also increased significantly when compared to the previous season’s commodity prices partly due to inflation as well as the economic downturn in Puntland occasioned by the ‘livestock ban’ and lately, the mounting political tension.

In Jeriban MCH an attendance of less than 50 in the previous months has now increased to over 100. This increase was explained by the relatively good pasture and water in the Addun areas as compared to other areas in the region with a resultant concentration of pastoralists in this area. The same observation was noted for the Balibusle MCH in the neighbouring Balibusle district whose attendance had been less than 100 children in the previous months but has doubled since July. This increase in attendance is associated with pressure on available resources in the areas mentioned.

The condition for majority of the villages in Bari, south Nugal and north Mudug remain relatively stable with malnutrition rates in most facilities still lower than the previous seasons’ levels.

MALNUTRITION PERSISTS IN GALCAYO B. Owadi, FSAU

In the August Nutrition Update, Galcayo was noted as recording increased malnutrition cases, an increase that was attributed to influx of emigrants from nearby drought affected districts especially Golgodob with supportive information coming from Galcayo MOSA-supported MCH. Accordingly, nutrition surveillance activities were intensified in the area.

The situation in Golgodob still remains precarious although some interventions have been initiated in the area. For example, MSF-Holland has opened an MCH while UNICEF has started water projects in the area. Although Golgodob was highlighted as one of the areas from where malnourished children in Galcayo originate, it is noticeable that the town receives many ‘distress emigrants’ from almost all nearby villages.

Reports from both the MOSA and SRCS managed MCHs in Galcayo so far indicate a worsening nutrition status in the town. This month’s update analyses the information from the Galcayo-SRCS supported MCH. This is a facility, which has previously been recording low malnutrition. From a malnutrition rate of less than 3% in the last four months, the rate had risen to 5% by end of July. Although still low, this is an indication that the malnutrition situation may be deteriorating. Correspondingly, attendance levels at the facility have also risen steadily from 100 children in January to over 160 by the end July.

The general downturn in nutritional status in the area may imply that the affected groups are already experiencing compromised coping mechanisms which may exacerbate the levels of destitution in town. This is consistent with food security highlights that have noted pockets of the very poor to be seriously affected in the area. Galcayo town is noted as in a precarious state mainly because of the negative effects of livestock ban that limited the people’s prospects for local and migratory labour opportunities. The effects of the recent Gu crop failure have also compromised many people’s food supply with a result ‘distress’ migration to urban centres thereby increasing pressure on the already scarce resources. The prevailing spate of inflationary tendencies in the region has also eroded the scarce but relatively constant wage rates offered in the region.

DANGORAYO-NUGAL REGION B. Owadi, FSAU

In the July update, Dangorayo was noted as quite vulnerable to food and nutrition insecurity. The food security assessment conducted by FSAU in July had indicated water shortage as the main problem affecting the population in the District with corresponding consequences of heightening the already compromised welfare of the population owing to inflation and the continued effects of livestock ban. UNICEF has initiated projects aimed at improving the water situation in the district.

Reports from the Dangorayo MCH indicate deterioration in the nutrition status, with the levels of malnourished children rising further to 32% from the previous months level of 23% (of children screened at the clinic). The attendance levels have also risen sharply from a low of 230 children in June to over 400 children in July, a situation that can possibly be explained by pastoralist who had moved to nearby villages coming back to benefit from nearby water. The pasture condition has also been relatively good hence attracting livestock, though with accompanied population pressure on the resource base of the community. On the other hand, malnutrition rates have been increasing not only due to downturn in the economy but also due to overcrowding of pastoralists in the area putting additional pressure on the limited water thereby compromising the quality. Disease prevalence especially ARI has also increased at the facility.

It is also notable that though malnutrition rates are increasing, proportions of severely malnourished is low at less than 1%, a scenario that could imply that the deterioration in people’s welfare has not reached its critical low levels when the cases of destitutes and severely malnourished may be expected to increase significantly. However, the rising malnutrition rates signals a gloomy picture should factors exacerbating the precarious food insecurity continue.

NUTRITION SURVEYS AND ASSESSMENTS

Location
Organisations
Dates
Status
Haud area, SOOL NPA, FSAU Sept. 24 - Sept. 27 CANCELLED
Qansahdheere, BAY UNICEF, FSAU Sept. 22 - Oct. 18 CANCELLED
Rabdure, BAKOOL UNICEF, FSAU Sept. 22 - Oct. 18 CANCELLED
Luuq, GEDO ACF September. / October Pending confirmation
Bulla Hawa / Dolo, Gedo CARE, Gedo Health Consortium, FSAU November Planning stage

DADAAB REFUGEE CAMP, KENYA/SOMALIA BORDER

NGOs operating in the refugee camps in Dadaab (Ifo, Dagahaley and Hagadera) have expressed much concern about the welfare and nutritional status of the refugees in recent months. The reduction in general rations and the absence of essential items such as oil and pulses has contributed to a rise in the number of malnourished children attending supplementary and therapeutic feeding programmes. Recent intensification of the supplementary feeding programme, including an increase of supplementary rations has alleviated the situation somewhat. Nevertheless, the reestablishment of a general ration of adequate quality and quantity will be vital in order to prevent deterioration of the situation.

SACB NUTRITION WORKING GROUP

Sixteen people representing fourteen organisations attended the working group meeting that was held on 3rd September. Among the issues discussed were the following.

  • The current issues related to levels of food insecurity experienced and expected for some groups, especially in Bay, Bakool, Gedo and the Haud in Somaliland.
  • Reported outbreaks of measles and high number of deaths from suspected malaria reported by IMC.
  • Increase in population movement in their areas of operation reported by IMC. Some tables distributed.
  • Food supply to the refugees in Dadaab refugee camp (Kenya/Somalia border) reported to be poor. Repatriation programmes from such locations will be of interest to this group.
  • MSF remains willing and able to provide support for the follow-up of kala’azar cases.
  • Guidelines for supplementation of pregnant and lactating women as well as general guidelines for supplementary feeding need to be consolidated and finalised.
  • Group will consider a set of recommendations for management of severely malnourished children when therapeutic feeding centres are not available. A smaller group will attempt to work on this during September.
  • Anaemia was again acknowledged to be a very serious problem throughout Somalia.

Prevalence study by UNICEF in Somalia is expected to be completed in the near future and will provide the group with a starting point for the development of a realistic and ideally inter-sectoral strategy to deal with the issue. Significant interventions will include, but will not be limited to, iron supplementation.

Recommended strategy for dealing with current food insecurity experienced by vulnerable groups

As some members of the group have already commenced discussions on the expansion and extension of supplementary feeding programmes, the group supported the idea of recommending to all partners that the following strategy should be supported where indicated and feasible.

In areas where food security has been threatened, supplementary feeding programmes should be accompanied by distribution of family ration.

Where possible such interventions should be extended to rural areas and not concentrated in urban areas only.

These interventions should be accompanied where possible by immunisation and other health promotion activities.

HEALTH ISSUES UPDATE

According to information provided by SACB partners, during August 2001 no major specific health problems have been reported .

  • Cholera: the outbreak reported in Luuq district at the end of June (24th June) has subsided with all cases of diarrhoea reported in the last 3 weeks of August having tested negative.
  • Kala Azar: the number of cases testing positive to DAT during July and August remain stable (36 and 28 respectively). No cases reported from other areas during this month.
  • Dysentery: according to WHO outbreak surveillance during August, 54 cases of Bloody Diarrhoea have been reported in Somalia scattered in various locations.
  • Rabies: no data has been received from WHO office in Mogadishu for the month of August. No reports have been received from suspected cases form any other area in Somalia.
  • No reports suggesting outbreaks of meningitis or Haemorrhagic fever.
  • Measles: 50 cases have been reported from Burdubo (Gedo region) in the last week of August, most of them <5y , according to the Gedo Consortium the initial cases were coming from Mogadishu. Additional information is not available yet. Some cases have been reported from Qansadere district but mainly affecting adults.

WEBSITES

This ‘Nutrition Update’, along with other relevant materials, is available on the following websites:


WORKSHOPS, MEETINGS AND TRAINING COURSES

As part of its Short Course Series, the Regional Centre for Quality of Health Care (RCQHC) Institute of Public Health, Makerere University, Kampala, Uganda is offering the following course: ‘Performance Improvement for Reproductive and Child Health Care’, September 17-21, 2001. For details contact Sheila Magero (Course Administrator). Email: mail@rcqhc.org

RELEVANT PUBLICATIONS

  • ‘Nutrition Manual for Field Workers in Somalia’, Somali and English language versions. Produced by and available from FAO Somalia. FAO Somalia 2000
  • ‘The Household Economy Approach’, SCF.
  • ‘The Management of Nutrition in Major Emergencies’. Produced by WHO with contributions from UNHCR, IFRC and WFP and published in late 2000. Available from WHO.2000
  • ‘Maternal Health Services’. Guidelines for qualified Health Personnel. UNICEF Somalia 1999.
  • ‘Somalia Standard Treatment Guidelines and Rational Use of Drugs at the PHC level’. Volume I and II. WHO. 1998
  • ‘Field Exchange’, a quarterly publication produced by The Emergency Nutrition Network. Aims to improve emergency food and nutrition programme effectiveness by providing a forum for exchange of ideas and keeping field staff up to date with current research and evaluation findings. For further details contact foreilly@tcd.ie or visit the website at www.tcd.ie/enn.

RECENT REPORTS
  • Monthly Food Security Report for Somalia for August, FSAU. Issued September 2001.
  • Brief Summary of the Humanitarian Situation in Somalia. FEWS NET. August 2001.
  • Food Security Update in Somalia: September 12, 2001. FEWS NET.

For current and past reports on food security, nutrition and health, visit the UN Somalia website at: www.unsomalia.org

FSAU
Physical address: Peponi Plaza, (Block C), Peponi Road, Westlands, Nairobi.
Postal address: PO Box 1230, Village Market, Nairobi
Telephone: +254-2-741299, 745734, 748297. Fax: 740598
General email: fsauinfo@fsau.or.ke
Comments and information related to nutrition: Noreen.Prendiville@fsau.or.ke

The FSAU Nutrition Surveillance Project is funded by USAID/OFDA