FSNAU Releases Post Deyr 2014/15 Nutrition Analysis Technical Series Report


The prevalence of acute malnutrition among children under five years is a sensitive and objective crisis indicator, reflecting the wider situation of emergency affected populations, including their food security, livelihoods, public health and social environment. The Food Security and Nutrition Analysis Unit (FSNAU) conducted 41 anthropometric and retrospective mortality surveys from October to December 2014 (post-Deyr 2014/15) covering 28 996 children (6-59 months) from 17 790 households across most regions and livelihood zones of Somalia. The main objectives of this survey were to assess the nutritional status of children (6-59 months of age) and women of reproductive age and to estimate both the crude and under-five mortality rates. The assessments were conducted in collaboration with government institutions (Ministries of Health) and partners. Surveys were conducted using standardized monitoring and assessment of relief and transitions (SMART) methodology. Weight for Height was measured for 36 surveys while Mid Upper Arm Circumference (MUAC) was used as an indicator of wasting in the remaining five.

 Results from these surveys indicate that 12 percent of all children under the age of five in Somalia are acutely malnourished, with 1.9 percent being severely malnourished.  It was observed that in 13 out of the 36 livelihoods assessed the prevalence of acute malnutrition exceeds the UN trigger for emergency action Global Acute Malnutrition (GAM) ≥ 15% or Critical prevalence). In five out of the 13 Internally Displaced Persons (IDP) settlements assessed, Critical prevalence of acute malnutrition (GAM) are  recorded.  Highest prevalence of acute malnutrition was recorded among livelihoods of North Gedo Pastoral (25.2%) and North Gedo Agro pastoral (24.7%). Critical levels of GAM-MUAC were  noted  among all livelihoods of South Gedo where access is an issue for humanitarian support (Pastoral, Agro pastoral and Riverine).

It was noted that Critical levels of GAM prevalence are prevalent only among rural livelihoods of South-Central region and among IDPs in South-Central and Northeast region. None of the livelihoods/ IDPs in Northwest region shows prevalence of Critical levels of GAM and Severe Acute Malnutrition (SAM).  The median GAM (15.3%) and median SAM (3.3%) rates in South Central region of Somalia are higher when compared to 12.9 percent median GAM and 2.2 percent median SAM in the Northeast region or 9.9 percent median GAM and 1.1 percent median SAM in the North West region though these differences are not statistically significant. Deyr 2014/15 assessment also shows 22 cases of bilateral oedema (Kwashiorkor) in nine of the 41 livelihoods surveyed.

 Since post-Gu  2014 (July 2014), deterioration in GAM is noted among Hargeisa IDPs and East Golis in Northwest, Bossaso IDPs and Nugal Valley in Northeast and among Baidoa IDPs and North Gedo Pastorals in South-Central region of Somalia. Sustained Critical situation was observed among livelihoods of Bay Agro pastorals, Beletweyne District, Mataban District and in all livelihoods of North and South Gedo region (Pastorals, Agro pastorals and Riverine). Significant improvement in nutrition situation in Deyr 2014 compared to Gu 2014 was noted among Bakool pastorals and in Mogadishu and Kismayo IDPs. Seasonal fluctuations may have some role in generating peaks of wasting prevalence  recoded among East Golis, Nugal Valley and Hargeisa IDPs. It was observed that the prevalence of GAM and SAM is higher in boys (6-23 months and 24-59 months) compared to girls in all livelihoods.  

Critical levels of SAM prevalence  (> 4%[1])  was  recorded  only among livelihoods  in South-Central Somalia namely: Bay Agropastorals, North Gedo Agro Pastorals Beletweyne district, and Dolow and Dhusamareb IDPs. Significant association between prevalence of GAM and SAM was noted (r=0.85; p<0.01).

GAM-MUAC (<12.5 cms) shows Critical levels of acute malnutrition in 8 out of 41 livelihoods (10.7-16.7 %) and Serious levels in another 9 livelihoods. Significant association between GAM (Weight for Height) and GAM-MUAC (r=0.38, p<0.05) was noted.

 Prevalence of SAM-MUAC (<11.5 cms) was Critical among 5 livelihoods (Shabelle Riverine and Agropastorals, Bay Agropastoral, Kismayo IDP and Mogadishu IDP ) while very Critical levels of severe acute malnutrition were noted among livelihood of Coastal Deeh. 

The overall prevalence of Stunting in Somalia is Low (10.8%) which suggests that it is not a problem of public health significance. However high prevalence of stunting (30-39%) was noted among IDPs in Baidoa, Kismayo, Dusamareb and Bossaso. These pockets of high stunting also exhibit high prevalence of GAM. This is also reflected in the significant association observed between GAM and Stunting (r=0.38; p<0.05) and SAM and Stunting (r-0.51; p<0.01).

Deyr 2014/15 results show Medium prevalence of Underweight across Somalia (11.6 %) ). However, there are several population groups with High (20-29%) Underweight prevalence (Bay Agropastoral, North Gedo Pastoral, North Gedo Riverine, Beletweyne District, Baidoa IDPs,  Kismayo IDPs,  Dhusamareb IDPs,  Bossaso IDPs and Garowe IDPs). Very High underweight prevalence (32.0%) was observed among Dolow IDPs. Significant association  between prevalence of underweight and GAM (r=0.75; p<0.01) and SAM (r=0.80, p<0.01) is noted among all livelihoods. Prevalence of Stunting and Underweight was more in boys compared to girls irrespective of age group (6-23 and 24-59 months).

Out of 41 population groups surveyed, 35 show Acceptable levels of Under-Five Death Rate (U5DR <1/10 000/day). In the remaining 6, Serious to Critical levels of U5DR (>1/10 000/day) are recorded  out of which 4 were IDPs settlements. The doubling of U5DR noted among Kismayo IDPs is of public health significance despite the significant improvement in GAM prevalence in this settlement. The increase in U5DR is closely associated with infection and illness as Kismayo IDPs recorded the highest prevalence of Morbidity (62.3%) which is significantly higher than levels reported in Gu 2014 (41.2%). Diarrhoea was reported as the main cause of death in 11 out of 13 children in this IDP settlement.

U5DR shows a significant association (P<0.01) with both GAM-MUAC (r=0.46) and SAM-MUAC (r=0.44) but not with Weight for Height which  suggests that MUAC is a better indicator of mortality risk associated with malnutrition and helps to identify and screen children most in need of treatment.

 Immunization is an important public health intervention which protects children from illness. According to the Deyr 2014/15 results, all regions in Somalia reported low measles vaccination (below the Sphere standards of >95%). Similarly, coverage for vitamin A supplementation was below the Sphere standards recommendation (> 95%), exception being  Burao IDPs where 96.6 percent coverage with vitamin A supplementation was reported. It is of concern that <10 percent of children in livelihoods of Bay Agro pastorals, Shabelle Agro pastorals and Shabelle Riverine received Vitamin A supplementation

It has been well documented that the nutrition status and well-being of a mother consequently has an impact on her own children’s nutrition well-being. Critical levels of Maternal malnutrition among Dobley IDPs (23.8%), North Gedo Agro pastoral (25.4%) and Addun Central (26.6%)  and Very Critical levels among livelihoods of Hawd central (34.4%), Dhusamareb IDPs  (35.8%), Coastal Deeh (36.3%) and Cowpea belt (37.2%) were observed.   This suggest that unless it is addressed immediately the Intergenerational cycle of poverty and growth failure will persist in Somalia.

Contrary to popular belief, acute malnutrition in Somalia does not occur only in food insecure populations, implying that it is not an issue of food access alone, but it is largely influenced by caring practices, access to safe water/sanitation and disease. This is highlighted by the paradox of Bay Agropastoral which is reportedly the food basket of Somalia but shows  sustained  Critical  GAM and Very Critical SAM prevalence.

 Improved Nutrition situation in Mogadishu and Kismayo IDPs where humanitarian emergency situation was observed during Gu 2014  demonstrate the impact of targeted nutrition interventions by UN/NGOs.

An estimated 202 600 children under the age of five are acutely malnourished, including 38 200 who are severely malnourished and face a high risk of morbidity and death.  The numbers of acutely and severely malnourished children have declined by 7 and 13 percent, respectively, since July 2014. Regional distribution of caseload shows that South and Central Somalia account for 74 percent of the GAM caseload (2 out of every 3) and 85 percent of the SAM caseload. Although mortality in these areas is still low, the persistent high GAM rates suggest the critical need for sustaining and scaling up of multi-sectoral efforts to address the underlying causes of malnutrition, supported by continued humanitarian action.

With Critical[2] rates of acute malnutrition, the following livelihood zones and population groups  are considered as priorities for nutrition programming: Pastoral, Agro pastoral and Riverine livelihoods in North and South Gedo Regions; Agropastoral livelihoods and Baidoa IDPs in Bay Region; Beletweyne and Mataban Districts in Hiran Region; Hawd in Central and North East, Bossaso IDPs in Bari Region; Garowe IDPs in Nugal Region; and Galkayo IDPs in Mudug region. Current efforts underway to treat malnutrition must be intensified,  but bringing sustainable reductions in child malnutrition requires an integrated package of measures that tackle both the causes and effects of malnutrition, backed up by strong political and institutional support. Longer term flexible humanitarian funding for Somalia will help  ensure continuity and linkage to early recovery and transition.

 Although current efforts underway to treat malnutrition must be intensified, bringing sustainable reductions in child malnutrition requires an integrated package of measures that tackle both the causes and effects of malnutrition, backed up by strong political and institutional support. Longer term flexible humanitarian funding for Somalia will help ensure continuity and linkage to early recovery and transition.

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