FSNAU Nutrition Analysis Technical Series Report Post Gu 2015
Issued: October 16, 2015
Between May through July 2015, FSNAU conducted 39 seasonal nutrition surveys across most regions and livelihood zones of Somalia, covering displaced (13), urban (6) and rural populations (20). The overall goal of this seasonal assessment was to establish the extent and the severity of acute malnutrition and determine the contributing factors of malnutrition among different livelihoods in Somalia in. The assesments were conducted in collaboration with Government institution (Ministry of Health) and partners.
METHODOLOGY
The surveys were cross sectional based on two-stage cluster sampling using Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology. The first stage of sampling was selection of clusters with Probability Proportional to Size (PPS) and the second stage was the selection of households within the clusters using simple random sampling approach. The assesments covered 26 845 Children (6-59 months) from 16 919 households. Weight-for-Height Z-Score was measured for 33 surveys while Mid Upper Arm Circumference (MUAC) was used as an indicator of wasting in the remaining six.
KEY FINDINGS
Acute Malnutrition (GAM)
The 2015 Gu nutrition survey results indicate a median GAM rate of 13.6 percent (Serious) and a median SAM rate of 2.3 percent (Alert) for children under the age of five in Somalia. No change in GAM prevalence phase was noted for 22 out of 39 livelihoods surveyed while 18 out of 39 livelihoods showed no change in SAM since Deyr 2014/15. Improvement in nutrition situation was noted in five livelihoods:-Bay Agro pastorals, Hawd (Northeast & Central), Bakool Pastoral, Sool Urban and Bossasso IDPs.
The prevalence of acute malnutrition) which exceeds the UN trigger for emergency nutrition action (i.e. GAM ≥ 15 %) was seen only in South Central region in 9 livelihoods:- North Gedo (Pastoral & Riverine), South Gedo (Pastoral, Agro pastoral and Riverine), Mataban District and Beletweyne district as well as in Central Coastal Deeh and Cowpea livelihood zones.
Out of 13 IDP settlements surveyed during 2015 Gu, five showed Critical levels of GAM (≥15 %): Dhobley IDPS (Lower Juba), Baidoa IDPs (Bay), Dolow IDPs (Gedo), Garowe (Nugaal) and Galkayo (Mudug). It is of concern that acute malnutrition levels in three of these IDP settlements (Dolow, Garowe and Galkayo) are sustained at Critical levels over the past two years. Internally Displaced Persons (IDPs) in Dhobley currently face a nutrition emergency as reflected in Critical levels of GAM and SAM which are accompanied by Critical levels of Crude Death Rate (CDR). The nutrition situation among Dollow IDPs has also deteriorated since December 2014 with an increase in Critical levels of GAM, a near doubling of CDR as well as increases in Under-Five Death Rate (U5DR) and morbidity levels.
Critical levels of GAM prevalence (≥15%) were recorded in two out of six urban areas surveyed during 2015 Gu (18.4% in Bari and 15.7% in Nugal) while Serious GAM prevalence (10-14.9%) was noted among Mogadishu urban (10.5%) and Alert (5-9.9) in Sool urban and Kismayo urban.
Out of 15 livelihoods with Critical GAM/MUAC, 12 showed sustained Critical levels of acute malnutrition.
Mid Upper Arm Circumference (MUAC)
FSNAU conducted nutrition survey using Mid-Upper Arm Circumference (MUAC) for measuring acute malnutrition in six difficult to access areas. The results for five livelihoods out of six indicate prevalence of Critical[1] levels of acute malnutrition (≥10.7 % children with MUAC <12.5 cms) was observed among all livelihoods: Pastoral, Agro pastoral and Riverine in South Gedo, Coastal Deeh and Cowpea Belt. Critical levels of severe acute malnutrition (≥2.5% of children with MUAC<11.5 cms) was observed South Gedo Pastoral and Cowpea Belt Agro pastoral while Very Critical levels of severe acute malnutrition (>4% of children with MUAC<11.5 cms) were recorded in Coastal Deeh of Central region.
Critical levels (10.7-16.7%) of MUAC <12.5 cms or MUAC <11.5 cms in 2.5-4% of children < 5 yrs. were observed only in the South Central region.
Gender Differences in prevalence of Acute Malnutrition
Higher prevalence of GAM and SAM was observed among boys (6-23 months and 24-59 months) compared to girls in all livelihoods (pastoral, agro pastoral, riverine, IDPs) with the exception of urban where girls 6-23 months of age have a higher rate of GAM and a similar rate of SAM compared to boys of the same age cohort.
Mortality
Gu results of a 90-day recall mortality survey show Acceptable CDR and U5DR in all the livelihoods surveyed in North West and Northeast region. Serious levels of CDR were recorded only in South Central region among livelihoods of Shebelle Agro pastoral (0.56), Mogadishu urban (0.54) and IDP (0.63), Dolow IDP (0.9) and Dhusamareb IDP (0.64). Dhobley IDP was the only exception with Critical CDR of 1.18/10 000/day with Serious U5DR of 1.15/10 000/day.
Critical levels of U5DR (2.5-3.9) were not seen in any of the livelihoods surveyed. Alert (≤1/10 000/day to Serious levels of U5DR (1-1.9)/10,000/day) were recorded only in the South Central region. It was noted that U5DR is higher (Serious) in areas with high prevalence of Maternal malnutrition: Shabelle Agro pastoral and Beletweyne District or in livelihoods where high prevalence of Morbidity is recorded (Dhobley IDP, Mogadishu IDP and Baidoa IDP).
Morbidity
It is estimated that acute malnutrition contributes to increased morbidity and Gu 2015 results reflect this through a significant positive association between prevalence of GAM and prevalence of morbidity (r = 0.4, p<0.02). This suggests that sustained high levels of acute malnutrition seen in Somalia despite relative improvement in the overall food security situation are because the health and care environments are compromised. Median Morbidity rates during Gu 2015 assessment varied from a low of 12.8 percent in North West region to high of 33.4 percent in North East and 29 percent in South Central region
Stunting
The overall Stunting rate in Somalia is 12 percent and is considered Low (<20%). However, there are major differences between zones: 15 percent in South and Central; 10.8 percent in Northeast; 4.1 percent in Northwest; and 15.8 percent among IDPs.
Underweight
The overall Underweight rate in Somalia is 13.4 percent and is considered Medium (10-19.9%), with substantial variation across the country at sub national level: 16.7 percent in South & Central; 15.1 percent in Northeast; 2.6 percent in Northwest; and 18.8 percent among IDPs.
Coverage with Vitamin A Supplementation
Coverage for children aged 6-59 months who receive vitamin A (based solely on recall in the last 6 months) should be > 95 percent as per Sphere standards[2] . Gu 2015 results show the median coverage for Somalia as 66.5 percent. Regional differences were noted in the proportion of children aged 6-59 months who received vitamin A: 48.4 percent in South Central, 74.5 percent in Northeast and 60 percent in Northwest.
Maternal Malnutrition
Gu 2015 data indicate prevalence of Very Critical levels (≥31.5 %) of maternal malnutrition among Dhusamareb IDPs and Critical levels (23.4 -31.4%) among Dhobley IDP, Qardho IDP and Hawd central. It is of concern that Very Critical levels of maternal malnutrition among Dhusamareb IDPs and Critical levels among Dhobley IDPs and Hawd Central are sustained since Deyr 2013/14.
Current case load:
2015 Gu assessment results indicate that currently 214 650 children under the age of five in Somalia are suffering from acute malnutrition and of these, 39 650 (18.5%) are severely malnourished (based or prevalence). As more children become malnourished through the end of the year, the number of acutely and severely malnourished children are expected to increase, respectively, to 343 440 and 63 440 (based on incidence).
Current Hot spots
With Critical rates of acute malnutrition (GAM >15% or >10.7% of children have Mid-Upper Arm Circumference (MUAC) below the 12.5 centimeter threshold), the following livelihood zones and population groups are considered priorities (hotspots) for nutrition programming:
• Gedo Region: Pastoral, Agro pastoral and Riverine populations and Dollow IDPs
• Hiran Region: Beletweyne and Mataban Districts
• Bay Region: Baidoa IDPs
• Lower Juba Region: Dhobley IDPs
• Nugaal Region: Garowe IDPs, Nugal Urban
• Mudug Region: Galkayo IDPs
• Galmudug State: Coastal Deeh Pastoral and Cowpea Belt Agro pastoral livelihood zones
• Bari region: Urban Bari
• Awdal and Woqoi Galbeed: Guban Pastoral Livelihood Zone
Projected Nutrition Situation
The nutrition situation in the drought affected areas of Northwest agro pastoral and Gubal Pastoral livelihoods is expected to deteriorate to Serious and Critical levels of acute malnutrition respectively as the drought condition is expected to worsen until Deyr rains are fully established in October. Deterioration of the current nutrition situation is also expected among Bossaso IDPs in the Northeast and in Bay Agro pastoral and in Middle and Lower Shebelle livelihoods in the South.
CONCLUSION
An estimated 214 700 children under the age of five are acutely malnourished (39 700 of them severely malnourished) based on prevalence results from 39 nutrition surveys conducted from May to July 2015 by the FSNAU and partners. The number of acutely and severely malnourished children is likely to increase to 343 400 and 63 400, respectively, through the end of the year (incidence). The severely malnourished face a high risk of morbidity and death. Internally Displaced Persons (IDPs) in Dhobley currently face a nutrition emergency as the prevalence of Global Acute Malnutrition (GAM) has nearly doubled (from 11 percent in Deyr 2014/15 to 20.7 percent in Gu 2015) and is accompanied by Critical levels of Crude Death Rate-CDR (>1/10 000/day). IDPs in Dollow have had further deterioration in their nutrition situation since December 2014 with an increase in Critical levels of GAM (from 21.6 percent to 26.4 percent) along with an increase in both Crude Death Rates and Under-five Death Rates.
Current Serious rate of GAM prevalence (13.6%) in Somalia clearly highlight the need to treat acutely children by supporting and scaling up the nutrition programs. Persistently high rates of GAM and morbidity among certain livelihoods in South Central region (Gedo, Hiran, Lower Juba, Nugal and Mudug region) suggest efforts to address the underlying causes of malnutrition must be supported through multi-sectoral and integrated interventions in different sectors: food, health, and hygiene, safe access to water and sanitation and care. Supporting and protecting optimal infant and young child nutrition in Somalia is an essential intervention to protect and save children’s lives.
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