FSNAU Nutrition Update, December 2016

Issued: January 3, 2017

Results of Deyr 2016 IDP assessment conducted in November 2016 across Somalia show rapid deterioration in the nutrition situation among IDPs in Mogadishu (Banadir), Dhusamareb (Galgadud) and Qardho (Bari) while prevalence of Critical levels of acute malnutrition

OVERVIEW
FSNAU assessed the nutritional status of 7 234 children (6-59 months) from 4 639 households in 12 main displaced populations settlements across Somalia in November 2016  using SMART Methodology. Galkacyo IDPs were not surveyed due to Insecurity. The objective of the 12 integrated nutrition and food security surveys was to assess the nutrition and food security situation of these vulnerable IDP population groups as part of FSNAU’s biannual surveillance activities Mortality and nutritional status information as well as household food security data was gathered at the same time, from the same households. Weight-for-height, height-for-age and weight-for-age were calculated for children using the ENA for SMART and epinfo software.

Prevalence of Global Acute Malnutrition (GAM) was estimated using World Health Organization growth standards while Crude Death Rates (CDRs) and Under - Five Death Rates (U5DR) were calculated using the most recent population estimates available (UNDP PESS, 2014). Sampling was based on two stage probability proportionate to size (PPS) cluster sampling procedure for all assessments except Qardho and Dhusamareeb exhaustive sampling was employed.

Mortality survey was collected at all household level retrospectively (90 day recall period) and anthropometry were collected among all households with children aged 6-59 months. While the other contextual factors on food security, water and sanitation, household food consumption and coping strategy and hunger scale questionnaires were collected at every second household (odd numbered household). Variables such as anthropometric and all other contextual indicators and mortality were entered using EPI info soft 3.5.4 and ENA SMART software (July 9th, 2015 version). For quality assurance, supervisors would export EPI info file having anthropometric dataset to ENA software and were able to gauge  quality of data and survey team performance on a daily basis using ENA SMART software plausibility parameters. The summary results from Deyr 2016 nutrition assessment among 12 IDP settlements across Somalia.

Acute malnutrition in children 6-59 months is a direct outcome indicator of recent changes in nutritional status and sickness. (Map 1 and Table 1) show coverage of IDP nutrition situation in Deyr 2016 among 12 IDP settlements across Somalia (location of IDP’s, sample size and response rate). Map 1 also displays GAM results (color code).

POST Deyr 2016 ASESSMENT RESULTS

Post Deyr 2016  assessment results, indicate an improvement in nutrition situation among IDPs in Dolow,Dhobley,Baidoa, Kismayo and Berbera while rapid deterioration was noted since July 2016 among Mogadishu IDPs (14.7% to 16.6 %) Dhusamreb IDPs (10.1 % to 26.4 %) in South central Central) region and  Qardho IDPs (12.6 % to 15.2 %) in northeast region. Critical levels of Global Acute Malnutrition (GAM rate ≥15 %) were observed in five out of 12 IDP populations surveyed during Deyr 2016 assessment. These are Mogadishu and Dhusamareb IDPs in south-central region and  Bossaso ,Garowe and Qardho in northeast region. It is also of a concern to note that nutrition situation among IDPs in Garowe & Bossaso is sustained as Critical over the last two years or more. Serious GAM levels (≥10 and < 15 %) were recorded among  IDPs in Dolow,Dhobley, Kismayo, Baidoa and in south-central region, and Hargeisa and Burao IDPs in northwest. Alert levels of GAM (≥5 % and <10 %) were seen only in northwest among Berbera IDPs.

Deyr 2016 assessment recorded Critical levels of GAM (≥15 %) and SAM (≥4-5.6 %) prevalence among IDPs in Mogadishu and Dhusamareb. Significant increase in SAM prevalence was recorded among Hargeisa IDPs (from 1.9% in Gu 2016 to 3.5% in Deyr 2015). Serious levels of SAM prevalence were recorded among four IDPs surveyed (Bossaso,Hargeisa, Baidoa and Garowe). Among Garowe IDPs Serious SAM prevalence is sustained since Deyr 2015. Alert SAM levels were noted among  Burao, Berbera in northwest, Qardho in northeast, and Dhobley and Dolow in south-central while Kismayo IDP showed Acceptable SAM prevalence.

Alert CDR was observed among Dhobley, Mogadishu and Hargeisa IDPs. U5DR was acceptable in all12 IDP settlements of Mogadishu  IDPs showed doubling of CDR since Gu 2016 (July). Improvement in both CDR and U5DR was seen in Dolow and Kismayo IDPs along with improvement in morbidity as well as in nutrition situation, which is primarily attributed to scaling up of assistance.

There was no major outbreak of communicable disease reported. However, morbidity prevalence in two weeks prior to the assessments were high (>25%) in all IDPs, Qardho and Garowe  consistently reported  morbidity greater than 30 percent, while low morbidity (<10%) were seen in nortwest and Dolow IDPs.

The current IDP assessment also looked into other public health indicators such as immunization coverage for measles and supplementation of Vitamin A within a six month recall period. Measles coverage and vitamin A supplementation was the lowest (<40%) for IDPs residing in Dhusmareeb,Mogadishu and Dhobley However, coverage estimate was only calculated by asking mothers (recall) and hence interpretation should be used with caution.

cross the 12 IDPs surveyed in Somalia the Deyr 2016 assessments identified a total of 18 450 acutely malnourished children which include 4 200 children that were severely malnourished.  

Conclusion:

The results of the Deyr 2016 assessment show that acute malnutrition among protracted IDPs in south-central region of Somalia showed some improvement, with the exception of Mogadishu and Dhusamareb which showed rapid deterioration to Critical GAM. Northeast IDPs showed sustained Critical  GAM (≥15%) .

It’s also worth to note that IDP access to and coverage of vital public health programs such as routine immunization and Vitamin A supplementation were the lowest for IDP residing in Dhusmareeb, Mogadishu and Dhobley in south central Somalia. Measles coverage in Dhusamareb and Mogadishu was 30.1 percent and 20.4 percent respectively. Consequently, any measles outbreak where these IDP reside will further escalate the morbidity and mortality rate found from the current assessment. Mop-up campaigns should be conducted to raise the coverage to reach the SPHERE standards (≥90%).

The worsening  nutrition  situation among Mogadishu , Dhusamareeb  and Qardho  is partly linked  to limited access to humanitarian interventions, unstable casual labour for income to purchase food, high  morbidity, low immunization  coverage, continuous arrival of new IDPs and on-going evictions particularly among Mogadishu IDPs. Nutrition interventions should be prioritised to displaced population and accompanied by efforts to reduce high morbidity and improving health services.

Results highlight the necessity to rapidly detect the acute worsening of a protracted crisis, and need to scale up of existing Community Management of Acute Malnutrition (CMAM) programs to contain and arrest critical levels of acute malnutrition (where wasting prevalence is the highest or sustained as critical for many seasons) for those IDP’s located in Bossaso, Qardho,Garowe, Dhusmareeb, and Mogadishu

NUTRITION SITUATION AMONG IDPs IN SOUTHERN AND CENTRAL SOMALIA

Mogadishu IDP settlement shows an evolving humanitarian situation with Critical levels of acute malnutrition and high mortality rates. Deyr 2016 assessment has recorded a GAM prevalence of 16.6 percent and SAM prevalence of 4.0 percent indicating a Critical nutrition situation which reflect deterioration when compared with GAM rate of 14.7 percent recorded in Gu 2016 and GAM rate of 11.4 percent recorded in Deyr 2015. The severe acute malnutrition rates are also nearly double from the levels observed in Deyr 2015 and increase from Gu 2016 (3.5%).

The crude and under five death rates reported are 0.61/10,000/day  (Alert) and 0.74/10,000/day (Acceptable) for Mogadishu IDPs according to WHO classification, and a deterioration from the post Gu 2016 reported crude and under five mortality rates of 0.33 /10,000/day,and 0.40 /10,000/day, respectively. Main causes of under-five death reported were fever, diarrhoea and acute respiratory infection (ARI).

No major outbreaks of communicable disease were reported during this period but increased seasonal trends in communicable disease like Acute Water Diarrhoea (AWD), and ARI were observed. Morbidity levels decreased as compared to levels reported in Gu 2016 from 44.6 to 29.6 percent. Information from implementing partners in Mogadishu indicate increasing trend in OTP and TSP admissions from October to November 2016.

Ongoing eviction of IDPs in Mogadishu, high morbidity, low immunization coverage (< 40 %), arrival of new IDPs from drought affected areas and IDP returnees from Kenya, decreased labour opportunities coupled with shrinking interventions are likely to aggravate in the nutrition situation.

Dolow IDPs

 Settlement recorded a GAM rate of 14.9 percent and SAM rate of 2.3 percent indicating an Serious nutrition situation which is significant improvement when compared with GAM prevalence of 25 percent recorded in Deyr 2015 and GAM prevalence of 21.8 percent recorded in Gu 2016.

The improvement is linked to the scaling up of humanitarian support in these settlements. The on-going targeted assistance by WFP, UNICEF, COOPI and DRC include: cash vouchers for households and families of malnourished children, food for asset as well as routine TSF/OTP programs in the area.

Decrease in both Crude Death Rates (0.24) and Under Five Death Rates (0.47) suggesting Acceptable situation and an improvement from Gu 2015 when Serious CDR and U5DR of 0.90/10,000/day and 1.20/10,000/day were recorded respectively (Figure 6).

Morbidity rate 8.6 percent among Dolow IDPs in Deyr’2016 is lower when compared to 24.3 percent observed during Deyr 2015 or 13.4 percent noted in Gu 2016.

Low morbidity, improved referrals and case finding and scaling up of humanitarian intervention can be attributed to significant improvement of malnutrition observed among IDPs of Dolow.

Dhobley IDPs

The nutrition situation among Dhobley IDPs settlement is showing some improvement representing Serious nutrition situation with a GAM prevalence of 13.5 percent and SAM prevalence of 2.1 percent. This indicates that there is a significant improvement (p < 0.05) in nutrition situation in Deyr 2016 (13.5 %) when compared to Gu 2016 (17.7% GAM) which was Critical nutrition situation. However significant differences (p < 0.05) when comparing GAM and SAM in Deyr 2016 to GAM and SAM in Deyr 2015.

Alert levels of CDR (0.40/10000/day) and U5DR (0.17/10000/day) were recorded during the 90 days recall retrospective study in Deyr 2016.  The overall morbidity reported two weeks prior to the assessment shows decreased levels (26.2%) in Deyr 2016 when compared to Gu 2015 (42.9%).

Baidoa IDP  

The nutrition result indicates Serious nutrition situation (GAM of 13.4 percent and SAM of 3 percent).

This improvement nutrition situation from Critical to Serious was recorded in Deyr 2016 (13.4%) when compared to Gu 2016 (18%) and sustained Serious when compared to Deyr 2015 (14.5%). This is mainly linked to improved water and sanitation facilities and access to health services.

The overall morbidity reported two weeks prior to the assessment shows sustained high levels of  (28.2%) in Deyr’ 2016 when compared to Deyr 2015 (24.2%) and Gu’ 2016 (37.4%)

Kismayo IDPs 

The nutrition assessment conducted in Kismayo IDPs in November 2016 recorded a Sustained Serious level of GAM rate of 13 percent and Acceptable SAM rate of 0.7 percent. This is a sustained nutrition situation when compared with GAM rate of 14.5 in Gu 2016 and 12.9 percent GAM in Deyr 2015. The difference in GAM prevalence across the three seasons were not statistically significant.

Acceptable levels of both CDR (0.19/10000/day) and U5DR (0.27/10000/day) were recorded in Kismayo IDPs in Deyr 2016. This is a sustained levels of Acceptable in Gu 2016 CDR (0.49/10000/day) and in Deyr 2015 (0.47/10000/day) and improvement to Alert level in U5DR from Serious levels recorded in Gu 2016 (1.2/10000/day).

The overall morbidity reported two weeks prior to the assessment is low levels (16.8%) in Deyr 2016 when compared to Deyr 2015 (27.6%) and Gu 2016 (28.1%). This is mainly attributed to improved water and sanitation facilities and  access to health services.

Low vitamin A supplementation was recorded among Kismayo IDPs of 45.3 percent and measles vaccination coverage 41.2 percent

Click this link to access the full Update in pdf format: FSNAU-Nutrition-Update-December-2016