Nutrition Update: November-December 2010

Issued: December 23, 2010

In November 2010, FSNAU with financial support from UNICEF and  SCUK and in collaboration with the Ministry of Health and Labour (MOHL) in Somaliland, the Ministry of Health (MoH)  in Puntland, and many partners in South Central regions conducted 10 representative nutrition surveys using the standard methodology. Six of these surveys focused on IDPs in Hargeisa, Burao and Berbera in Somaliland, and Garowe, Galkayo and Bossaso in Puntland; three were rural livelihood based surveys conducted in Nugal valley, Hawd and Addun pastoral livelihoods with one administrative assessment covering Galgadud region. The assessed areas are highlighted  in Map 1.
Results generally indicate an improving trend or Sustained Nutritional Crisis among the IDP populations and in the regional and livelihood assessments, except for the Galkayo

IDPs and Nugal Valley livelihood populations that showed some deterioration. Seventeen additional livelihood based nutrition surveys are currently on-going in the North, South and Central regions. Additional small sample surveys are planned in, Juba, Bay, Bakool, Hiran and Shabelle regions during December 2010 due to access restrictions. The findings will be shared in the Post Deyr’10/11 analysis due for release on January 28th with the details presented in the Nutrition Technical Series Report due mid February 2011.

IDPs Findings

In the northwest IDP settlements of Hargeisa, Burao and Berbera, the GAM (WHZ Z scores <-2 or oedema)  rates reported are 10.8 (8.9-13.0), 12.1 (8.8-15.4) and 14.2 (10.9-18.3) respectively, all indicating a Serious situation, and an improvement from Critical in Burao and Berbera but a sustained Serious situation in Hargeisa from the Gu 2010 analysis. The crude death rates were 0.36 (0.21 – 1.62), 0.47 (0.29-0.75) and 0.12 (0.05-0.33) in Hargeisa, Burao and Berbera respectively, indicating an Alert situation in Hargeisa and Acceptable levels in Burao and Berbera settlements according to WHO references. The improvements are likely attributable due to the positive impacts of the Gu which reduced cereal and milk prices as well as increased casual labour opportunities in the port towns with the livestock trade boom during the peak export Haj season. Further, humanitarian interventions in the form of targeted feeding programmes by Medair and WFP and outreach feeding programmes by the MoHL are likely to have prevented a further deterioration. However, continued support for the displaced population’s livelihoods and public health environment is required to mitigate the expected impact of high food prices and disease in the upcoming season where the food security outlook is less optimistic.

In the northeast IDP camps of Garowe, Galkayo and Bossaso, the GAM rates reported were 13.3% (11.0-15.9), 16.3% (13.2-20.0) and 15.6% (12.7-19.1) indicating a sustained Serious situation in Garowe and Critical situations in Galkayo and Bossaso. The situation in Galkayo has deteriorated from Serious levels (GAM rate >11.3, Pr=0.90) referring to the probability calculator, while in Bossaso there is an the improvement from the Very Critical (GAM rate > 26.0, Pr=0.90) situation reported in Gu 10. 

The crude death rates were reported as 0.31 (0.16-0.62); 1.00 (0.52-1.93) and 0.15 (0.05-0.42) in Garowe, Galkayo and Bossaso respectively, indicating an Acceptable activation in Bossaso and Garowe and situation and serious levels in Galkayo settlements according to WHO reference standards. The improvement of the nutrition situation among the Bossaso IDPs could be attributed to improved food access as a result of increased income earning opportunities port activities and resumption of fishing activities not available during the Gu season due to the closure of the port and the seasonal out-migration of the better off (who normally offer casual work). The provision of food and other nutrition and health services by the humanitarian organizations has also likely played a mitigation role for these populations. Although there is a significant improvement among the Bossaso IDPs, the levels of acute malnutrition among the three IDP populations remains above or near the emergency threshold of 15% and sustained livelihood support and public health interventions are required due to their nutritional vulnerability.

Central/North East and Northwest Findings

•    The results of the nutrition assessment in the Hawd livelihood zone report a GAM (WHZ Z scores <-2 or oedema) rate of 13.0% (10.4-16.2) and a SAM (WHZ Z scores <-3 or oedema) rate of 2.9 % (1.8- 4.7) indicating a Serious nutrition situation and though not statistically significant, an improvement from the Critical nutrition situation reported in the previous season. The retrospective crude (CDR) and under-five death (U5DR) rates of 0.30 (0.14 – 0.62) and 0.63 (0.21-1.92) were reported in the Hawd pastoral livelihood zone, both indicating Acceptable levels according to the WHO threshold levels of 1/10,000/day and 2/10,000/day respectively, with the reported deaths mainly attributed to diarrhoea and suspected measles. The improving trend in the nutrition situation is likely attributed to increased access to milk and milk products at the household, following improved pasture and water availability associated with the favourable Gu ’10 rains; in addition to the ongoing humanitarian interventions in the area.

•    In the Addun livelihood zone, GAM and SAM rates of 11% (7.7- 15.5) and 2.5% (1.3- 5.1) were reported respectively, indicating a Serious nutrition situation and a significant improvement (p<0.01) from the Very Critical nutrition situation reported in the June 2010 nutrition assessments. The retrospective CDR and U5DR rates of 0.71 (0.41- 1.20) and 1.91 (0.93-3.87) indicate some concern as they are approaching the Alert thresholds. with the reported the deaths mainly attributed to diarrhea and measles. The improvement in the nutrition situation however, is  mainly attributed to the improving livestock body conditions, which increased milk and household income from animal sales, in addition to humanitarian interventions. A higher proportion of boys (14.9%) than girls (6.8%) were acutely malnourished (p<0.05).

•    The results of the nutrition survey in Nugal Valley livelihood zone reported a GAM rate of 10.3% (7.0-14.8)  and a severe acute malnutrition (SAM <- 3 or oedema) rate of 1.0% (0.4-2.3), indicating a Serious nutrition situation.  The 90 days retrospective crude and under five mortality rates were estimated at 0.53 (0.32-0.90) and 0.61 (0.20-1.87) deaths/10,000/day; indicating Alert and acceptable levels respectively according to the WHO classification. Although according to the GAM rate reported, the nutrition situation has been classified as Serious and thus a deterioration from Alert levels in Gu ’10, there is no statistical difference (Pr=59.4%) between the two surveys.

•    Results of the Galgadud regional assessment covering four districts of Adaado, Dhusamreeb, Balanbal and Abudwaq districts recorded GAM and SAM rates of 12.6% (10.0-15.9) and 1.5% (0.8-2.9) respectively indicating a Serious nutrition situation.  This indicates a significant improvement (p<0.01) from a previous assessment conducted in November 2009 that covered all districts in the region and reported a Critical nutrition situation, with GAM and SAM rates of 19.4% (14.5-24.3) and 5.5% (3.0-7.9) reported. The crude and under-five mortality rates of 0.47 (0.24-0.89) and 1.95(1.04-3.64) respectively, were below the respective emergency thresholds though the under 5 rate was of concern . The improving trend in the nutrition situation is also attributed to increased access to milk and milk products following pasture and water availability associated with the favourable Gu ‘10 rains, in addition to the  increased humanitarian interventions in the area.