Attachments
Introduction
Malnutrition is a major public health problem of the world. It dramatically increases the risk of early death, is responsible either directly or indirectly for more than one third of all childhood deaths, and deprives children of the opportunity to develop to their potential. It is both a cause and a result of poverty and underdevelopment.
The nutrition situation in Somalia is deteriorating with a national median global acute malnutrition level of 17.4 % (emergency level is 15%) with 1.2 million children under the age of five with acute malnutrition., including over 231,829 who have, or will suffer, life-threatening severe acute malnutrition (SAM). Without appropriate treatment, acute malnutrition may result in the death of the child. Even children who survive may remain vulnerable to other episodes of malnutrition and disease and present lower intellectual and psycho-motor abilities, which will in turn reduce their chances later in life.
Since 2008, there has been a progressive introduction and scaling up of nutrition interventions to manage severe and moderate acute malnutrition in Somalia. These programs have been organized and managed by several implementers with the assistance of many different international and local agencies and non-governmental organizations in collaboration with Ministry of Health authorities.
The nutrition and overall health sector context in Somalia has evolved, thus these guidelines have been updated according to the current nutrition situation and Somalia context, and in line with the revised WHO (2013) recommendations and relevant health sector policies and guidelines in Somalia. To this effect, UNICEF, in coordination with the Nutrition cluster, is supporting the Ministry of Health authorities in the revision and updating of the current IMAM guidance, training package, and reporting tools that would enable partners to respond effectively and efficiently to manage acute malnutrition in Somalia.
The IMAM programme in Somalia is marred by several challenges covering infrastructure, capacity, and community engagement. Capacity of health systems to take on treatment of SAM in terms of staffing, logistics, monitoring, and supervision requires a more holistic systems approach. Staff capacity gaps root from a lack of integration of IMAM in the national training curriculum for health workers. A high staff attrition/turn over has resulted in a shortage of trained staff in facilities. Furthermore, the IMAM programme implementation quality is still non- optimal due to the difficulty in integrating service delivery and the inadequate linkage and reinforcement with wider preventative interventions. Issues around coverage of services including monitoring of progress on reaching children with SAM (numbers admitted, effectiveness of treatment and coverage) also prevail. Difficulties in estimating incidence complicates the estimation of the burden and coverage of nutrition services in Somalia. The community component has often been neglected, and there is extensive evidence showing that IMAM without a strong community component results in limited coverage and therefore limited impact. Overall, conflict, insecurity, difficult social environment related to complex clan structure, population displacement and the inability for IDPs to access services in some host areas, and the transhumance nature of pastoralist populations further exacerbates the already fragile nutrition service delivery environment in Somalia. Lack of health infrastructure and discontinuity of programmes in some areas, with regular closure and re-opening of programmes often results in overall fragmentation of interventions to prevent malnutrition.
These guidelines take into consideration these specific challenges of implementing the management of acute malnutrition in Somalia and the adaptations that programmes have made as a consequence. In order to increase coverage, promote early diagnosis and reduce the need for transfers, these guidelines promote the use of intense community mobilisation as the first priority in all programmes. When possible, protocols are adapted for the eventuality of a complicated cases that cannot be transferred to a Stabilization centre (SC).