Post Gu 2013 Nutrition Analysis Technical Report

Issued: October 31, 2013

A large proportion of Somali population remains poor and vulnerable. Disruptions, lack of essential health services and support structures increase the malnutrition risk to the population, in particular children, pregnant and nursing women. Nutrition assessment is a critical first step in efforts aimed at improving the nutritional status of the Somali population.

Between May – July 2013, FSNAU conducted 50 nutrition surveys across Somalia covering all regions & livelihood zones. Forty two of these surveys were based on SMART methodology and eight were surveys that used Mid Upper Arm Circumference (MUAC) as an indicator of wasting. Results show that acute malnutrition continues to be a serious public health problem in Somalia. A National median Global Acute Malnutrition (GAM) rate of 14.4 percent suggests that one out of every seven children (6-59 months) suffers from acute malnutrition and requires nutritional support. Significant association between prevalence of GAM and Severe Acute Malnutrition (SAM) was noted (r=0.83, p<0.05). The 2013 Gu survey results also show that despite high levels of GAM and frequent illness, mortality rates were not elevated. Under five death rate (U5DR) < 1.0/10,000/day was seen in most of the populations surveyed.

Gu 2013 estimates suggest that a total of 206,100 children 6-59 months are estimated to suffer from acute malnutrition including 40,950 children with severe acute malnutrition. This is a slight reduction in the number from December 2012 when 215,000 acute malnourished children were estimated. It was observed that 68 percent of these children (2 out of every 3 acute malnourished Children) were from South –Central Somalia even though the region accounts for only 56 percent share of the total population. The median GAM rate of 16.1 percent in South-Central Somalia was significantly higher than 11.4 percent median GAM in Northwest Somalia. Highest GAM levels was seen in Bakool pastoral livelihood region (27.4 %) of South Somalia.

Acute malnutrition (GAM) among IDPs was significantly higher (17.3 %) than among the urban populations (10.1 %) or rural livelihoods (14.4 %). Similar trends were noted for SAM as 3.1 percent of 6-59 month children suffered from SAM in IDPs compared to 1.2 percent in urban areas or 2.0 percent in rural areas. Critical levels of SAM were seen in Dobley IDPs (6.4 %) and Garowe IDPs (5.8 %) besides Bay Agro pastorals (6.0 %). Serious levels of SAM were observed in Bakool pastoral (5.4 %), North Gedo pastoral and North Gedo Agro pastorals (5.0 %). The results of Gu survey suggest that under five death rate tended to be higher in population groups with higher SAM prevalence though the association is statistically not significant.

Higher morbidity rate was seen in children with greater prevalence of acute malnutrition, though no significant association was observed. The morbidity rate in Northeast Somalia was higher than other regions and it is attributed to high concentration of IDPs in this region. This was also reflected by the higher morbidity rate in IDPs, (39.3 %) which was higher than morbidity rates seen in Urban (21.8 %) or rural livelihoods (23.9 %).

Results of Gu 2013 assessment suggest that Stunting is not a serious public health issue in Somalia. Stunting was seen in only 10.8 percent of 6-59 month old children surveyed. Exceptions were seen in some population groups: critical level of stunting in Bay Agro pastorals (46.9 %) of which 23.1 percent had severe levels of stunting. In Mogadishu IDPs alert levels of stunting (22.1%) were observed of which 46.7 percent had severe form of stunting. No significant association between acute malnutrition and stunting was observed. However prevalence of stunting in children (6-59 months ) showed a significant correlation with prevalence of underweight (r = 0.93, p < 0.01) in different regions.

Prevalence of malnutrition: (wasting, stunting and underweight) tended to be higher in boys compared to girls but differences were not statistically significant.

Vitamin A supplementation coverage is of serious public health concern as only in two of the surveyed populations, ≥ 90 percent of the 6-59 month children were reported to have received Vitamin A supplementation (Burao IDPs and Sool plateau). If children have insufficient vitamin A, their ability to resist diseases such as diarrhoea, measles and acute respiratory infections is greatly hampered. High acute and chronic malnutrition were observed in the areas (Kismayo IDPs, Bay Agro pastorals, Kismayo town) where < 10 percent of children were reported to have received Vitamin A supplementation. This suggests that improving coverage of Vit A supplementation will help improve immunity of young children and promote healthy growth and development and potentially help combat malnutrition.

Critical levels of Maternal malnutrition were seen in Bari region (28.8 %), Mataban district (32.5 %), Kismayo IDPs (44.4 %) and Galkayo IDPs (28.8 %). The significant correlation of maternal malnutrition with underweight and stunting in children suggest that unless it is addressed immediately the intergenerational cycle of growth failure will continue in Somalia.

Infant Young Child Feeding (IYCF) practices directly affect the nutritional status of children under two years of age and, ultimately, impact child survival. In Somalia, poor infant and young child feeding practices were observed as only 67 percent of the children in North West and South compared to 51 percent in North East and Central received breast milk in addition to complementary food at one year of age. And the proportion of children who were breastfed till 2 years (20–23 months) declined to 12.1 percent in South Somalia, 16.7 percent in North East and Central regions and 14.9 percent in North west region.

Poor Infant and Young Child Feeding (IYCF) practices were also reflected by the minimum meal frequency given to infants and children (6-24 months). Median of 25.6 Infant and young child feeding minimum meal frequency observed suggests that only 1 in 4 children received complementary foods as often as recommended by WHO. Regional differences were noted in the minimum meal frequency in South Somalia (34 %), compared to 22 percent in Northeast and Central region and 26 percent in Northwest region. A very large variation in the dietary diversity for child feeding was noted – Only 1 percent of 6-23 month old children in North West Agro pastorals received complementary feeing from 4 or more food groups compared to 97 percent of the children from Addun livelihood.

The reasons for persistently high rates of GAM and morbidity suggest that the interventions must be multi-sectoral and integrate food, health, hygiene, sanitation and care. Supporting and protecting optimal infant and young child feeding in Somalia is an essential intervention to save children’s lives. Treatment is urgently needed for those who are acutely malnourished (206,100 children). However additional support interventions are needed in order to prevent malnutrition.

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