fsnau nutrition update may-june 2015

FSNAUFSNAU Quarterly Nutrition Update, April-June 2015

June 2015Food Security and Nutrition

Analysis Unit - Somalia

FSNAU

OVERVIEW

FSNAU and partners conducted joint Nutrition and Food security surveys among different Internally Displaced Persons (IDP) settlement across Somalia. The objective of the surveys was to assess the nutrition situation of the IDP population as part of FSNAU’s seasonal surveillance activities. The Standardized Monitoring and Assessment of Relief and Transitions (SMART) methodology was used for assessment. Sampling was based on two stage probability proportionate to size (PPS) cluster sampling protocol for all assessments except Dhobley which was an exhaustive survey. Retrospective mortality data for 90 days prior to the assessments was also collected among the study households using household questionnaires. A total of 8 824 children (6-59 months) from 5 697 households were covered Table 1). The mortality, food security and nutritional data was collected concurrently from the same households Data analysis was carried out using revised ENA and EPI info software.

Acute malnutrition in children 6-59 months is a direct outcome indicator of recent changes in nutritional status. The summary of Gu 2015 nutrition assessment among 13 IDP settlements across Somalia is shown in Table 2. Since Deyr 2014/15, deterioration in nutrition situation is noted among IDPs in Kismayo and Dhobley in South Central (SC) region while significant improvement was seen among Bossaso IDPs in North East (NE) region. Critical levels of Global Acute Malnutrition (GAM rate ≥15 %) were observed among 5 out of 13 IDP settlements surveyed during Gu 2015 assessment.

Figure 1: Global Acute Malnutrition (GAM) Prevalence among IDPs in Somalia (%) Gu 2015

These are Dhobley, Baidoa and Dolow IDPs in South Central region and Garowe and Galkayo in Northeast region (Figure 1). It is of concern that nutrition situation in three of these IDPs (Dolow, Garowe & Galkayo) is sustained as Critical over the past two years. Current nutrition situation among Dhobley IDPs suggest humanitarian crisis as GAM has nearly doubled from 11 percent in Deyr 2014/15 to 20.7percent in Gu 2015 and it is accompanied by Critical levels of Crude Death Rate (CDR) (>1/10000/day). Serious GAM levels (≥10 and < 15 %) were recorded among IDPs in Mogadishu, Kismayo and Dhusamareb in South Central region, Bossaso and Qardho in Northeast region and Hargeisa IDPs in Northwest. Alert levels of GAM (≥5 % and <10 %) were seen only in Northwest ( Burao and Berbera IDPs).

RESULTS OF GU 2015 ASSESSMENT SHOW SIGNIFICANT DETERIORATION IN NUTRITION SITUATION AMONG DHOBLEY IDPs WHILE PREVALENCE OF CRITICAL LEVELS OF ACUTE MALNUTRITION ARE SUSTAINED AMONG DOLOW IDPs IN SOUTH SOMALIA AND BOSSASO AND GALKAYO IDPs IN NORTH EAST REGION OF SOMALIA. RAPID NUTRITION ASSESSMENT IN URBAN AREAS OF BULO BURTE SHOW PREVALENCE OF VERY CRITICAL LEVELS OF ACUTE MALNUTRITION AND CRITICAL LEVELS IN XUDUR

Table 1: Sample Size for IDP Nutrition Surveys (Gu 2015)

26.4

20.7 20.2

15.7 15.3 14.9 14.0 12.5 12.5

10.5 10.5 7.3 7.1

0

10

20

30

Acceptable (0-‐<5%)

Alert (5-‐<9.9%)

Serious (10-‐<14.9%)

Cri@cal (15-‐30%)

Very Cri@cal (>30%)

IDP Settlement # Households # Children Mogadishu 535 847Kismayo 300 514Dhobley 454 682Baidoa 429 567Dollow 490 852Dhusamareb 143 414Bossaso 360 912Qardho 192 591Garowe 306 826Galkayo 526 1016Hargeisa 400 548Burao 327 585Berbera 348 470TOTAL 5697 8824

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FSNAU Quarterly Nutrition Update, April-June 2015

Gu 2015 assessment recorded Critical levels of SAM prevalence among three IDPs- Dolow and Baidoa in South Central and Galkayo in Northeast region (Figure 2). Sustained prevalence of Critical SAM among Dolow IDPs is of concern (4.3% in Deyr 2014/15 & 5% in Gu 2015). Significant increase in SAM prevalence was recorded among Dhobley IDPs (from 1.4% in Deyr 2014/15 to 3.8% in Gu 2015) and Galkayo IDPs (from 2.6% in Deyr 2014/15 to 4.7% in Gu 2015). Serious levels of SAM prevalence were recorded among 4 IDPs surveyed (Mogadishu, Kismayo, Dhobley and Dhusamareb) and among Mogadishu IDPs Serious SAM prevalence is sustained since Deyr 2014/15. In Northwest region, Alert SAM levels were noted among Hargeisa and Berbera IDPs while Burao IDP shows Acceptable SAM prevalence.

Gu 2015 assessment results show Acceptable levels (<0.5) of CDR (crude death rate) in Northeast and Northwest region as well as among Kismayo and Baidoa IDPs in SC region. Critical CDR (1.47/10,000/day) was recorded only among Dhobley IDPs and similar observation was also made in Deyr 2014/15. Acceptable Under 5 death rate (U5DR<=1) were recorded among all the IDPs surveyed in Northeast and Northwest region in Gu 2015, while Serious levels of U5DR (1-1.9) were recorded among all the IDPs in South Somalia. Compared to Deyr 2014/15, an increase in U5DR in Gu 2015 is seen in Mogadishu and Dolow IDPs which is associated with increase in SAM prevalence over last 6 months noted among these IDPs.

Critical CDR levels (1.47/10 000/day) seen among Dhobley IDPS are indicative of acute crisis situation. With critical levels of acute malnutrition prevailing in this IDP, immediate treatment of the identified children will help avert situation from getting worse.

Table 2: Nutrition Situation in different IDPs across Somalia (Post Gu 2014)

Conclusion

The results of the Gu 2015 assessment show that acute malnutrition among protracted refugee in both South Central and Northeast region of Somalia in 11 out of 13 IDP settlements exeeds the emergency threshold ( >10% GAM). Even though the current child mortality rates are within the Acceptable range, many of those already undernourished are more susceptible to disease and this is reflected in high prevalence of morbidity. Nutrition interventions should be prioritised to these areas and accompanied by efforts to reduce infections by educating households on proper care and hygiene practices and improving health seeking behavior for management of children’s infections.

GAM (%) SAM (%)Plausability Score

Settlements Gu 2015 Deyr 2014 Gu 2014 Deyr 2013 Gu 2015 Deyr 2014 Gu 2014 Deyr 2013Mogadishu 14.9 13.40 18.90 8.20 3.30 2.50 5.50 1.60 14Kismayo 12.5 8.50 16.60 16.20 2.80 1.60 3.60 3.40 19Dhobley 20.7 11.00 16.50 15.80 3.80 1.40 4.00 4.10 9Baidoa 15.3 15.30 12.90 14.30 3.30 3.30 2.40 2.50 3Dhusamareb 10.5 14.40 18.20 16.00 2.60 4.20 4.60 4.20 11Dolow 26.4 21.60 18.80 19.70 5.00 4.30 4.10 4.80 3Median for South 15.1 13.9 17.4 15.9 3.3 2.90 4.05 3.75Bossaso 12.5 17.20 13.20 13.50 1.50 3.10 2.90 2.80 8Qardho 14 11.10 12.20 18.50 2.20 1.80 1.70 4.90 9Garowe 15.7 19.60 21.00 15.80 1.90 3.90 4.40 4.10 7Galkayo 20.2 15.10 16.50 15.00 4.70 2.60 2.50 2.90 7Median for Northeast 14.9 16.2 14.9 15.4 2.05 2.85 2.70 3.50

Hargeisa 10.5 11.10 8.10 10.60 2.1 1.60 0.30 1.90 5Burao 7.1 9.70 12.40 10.00 0.5 0.60 1.80 1.00 0Berbera 7.3 9.90 10.00 16.10 1.1 1.90 1.70 3.60 0Median for Northwest 7.3 9.9 10.0 10.6 1.1 1.60 1.70 1.90

Figure 2: SAM Prevalence among IDPs in Somalia (Gu 2015)

5.0 4.7

4.1 3.8

3.3 2.8 2.6

2.2 2.1 1.9 1.5

1.1 0.5

0

1.5

3

4.5

6

Acceptable (0-‐<1%)

Alert (1.1-‐2.4%)

Serious (2.5-‐4%)

CriAcal (4-‐5.6%)

Very CriAcal (>5.6%)

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CASELOADSResults of Gu 2015 in five out of 13 IDP settlement assessment indicate that the total number of children with acute malnutrition (GAM and SAM) among the displaced population is 15 300 and 3 140 (prevalence) respectively (Table 3). This represents an increase of four percent in GAM cases in Gu 2015 compared to Deyr 2014/15 but a decrease of 15 percent when compared to Gu 2014/15. SAM caseloads show a drastic increase (by 20%) compared to Deyr 2014 though it is a 30 percent decrease when compared with Gu 2014. The number of malnourished) children is projected to rise to 27 550 (GAM) and 5,650 (SAM) during the next six months (incidence).

NUTRITION SITUATION AMONG IDPs IN NORTHWEST REGION

Results of Post Gu 2015 assessment among three IDPs in Northwest is stable and same phases have been sustained since Deyr 2014/15.

Burao IDP settlement recorded Alert levels of GAM (7.1%) and Acceptable levels of SAM prevalence (0.5%) which are sustained since Deyr 2014/15. Compared to GAM prevalence in Gu 2014 (Serious -12.4%) an improvement in nutrition situation is suggested by Alert GAM (7.1%) in Gu 2015 but this change is statistically not significant. Over the 12 months, a more than threefold improvement has been observed in SAM prevalence (1.8% in Gu 2014 to 0.5 % in Gu 2015). This may be attributed to sustained Mother and Child Health and Nutrition (MCHN) interventions targeting lactating mothers and children under-five years.

Hargeisa IDP settlement recorded Serious levels of GAM prevalence (10.5%) and Alert levels of SAM (2.1%) in Gu 2015 which indicate a sustained nutrition situation since Deyr 2014/15. Trends suggest deterioration since Gu 2014, particularly as the SAM prevalence has deteriorated nearly seven fold as illustrted in the figure below. Other than Gu 2013 the trend graph also illustrates stable nutrition situation among IDPs in Hargeisa over the past ten seasons

Berbera IDP settlement recorded Alert levels of both GAM (7.3 %) and SAM prevalence (1.1%) in Gu 2015. These findings indicate sustained Alert nutrition situation over the last 6 months. Season on season comparison indicate a deterioration from borderline Serious levels (10% GAM) recorded in Gu 2014 to Alert (7.3%) in Gu 2015. Although not statistically significant, this systematic improvement in the last 12 months is linked to the continued humanitarian support to population in this settlement, notably MCHN programmes. Over the same period SAM prevalence has also remained unchanged.

MortalityThe Crude and under five death rates in the three assessed IDP settlements in Northwest regions remain within the Acceptable WHO/UNICEF levels of <0.5 and <1/10 000/day. These reflect a stable mortality trends since Gu 2013.

MorbidityMorbidity rates (≤15%) are recorded among IDPs in Northwest region. Highest morbidity is seen among Burao IDP (15.0%) compared to Hargeisa (12.8%) and Berbera (6.4%) IDPs. However, on the flip side, the prevalence in Hargeisa and Berbera registered increased incidences than those reported six months ago, indicating increased vulnerability to drivers of malnutrition, whereas, Burao registered a drop in incidences, though not statistically significant. Morbidity remains to be a key driver of malnutrition in Somalia due to suboptimal provision of health services.

IDPs Settlements

GAM SAMGu 2015 Deyr 2014 Gu 2014 Gu 2015 Deyr 2014 Gu 2014

SOUTHMogadishu 10 043 9 032 12 750 2 224 1 685 3 700

NORTHEASTBossaso 1 225 1 686 1 300 147 304 250Qardho 67 53 50 11 9 50Garowe 298 372 400 36 74 100Galkayo 1 872 1 399 1 550 436 241 200

NORTHWESTHargeisa 924 977 700 185 141 50Burao 366 500 650 26 31 100Berbera 511 693 700 77 133 100Total Prevalence 15 300 14 700 18 100 3 141 2 600 4 550 Total Incidence 27 550 26 460 28 960 5 654 4 680 7 280

Table 3: Caseload of Acute Malnutrition among IDPs in Somalia

Figure 3: Trends in GAM and SAM prevalence among Hargeisa IDPs

13 10.8 10.9 12 12 10.9

18.2

10.6

8.1

11.1 10.5

0.9 1.5 2.2 1.3

2.9 2.3 2.5 1.9 0.3 1.6 2.1

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GAM SAM Linear(GAM) Linear(SAM)

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NUTRITION SITUATION AMONG IDPs IN NORTHEAST AND CENTRAL REGIONS

Bosaso IDPs: Gu 2015 nutrition assessment results show a significant improvement (p<0.05) in nutrition situation in Gu 2015 with Serious levels of GAM ( 12.5%) and Alert SAM (1.5%) compared to the Critical GAM level (17.2% ) and Serious SAM (3.1%) reported in Deyr 2014/15 assessment. The current nutrition situation is similar to the Serious GAM (13.2%) seen in Gu 2014 (Figure 4).

Qardho IDPs show stable nutrition situation since Deyr 2014. A total of 591 children were assessed during Gu 2015, and results show a Serious level of GAM (14.0%) and Alert level of SAM (2.2%). Similar nutrition situation (Serious) among Qardho IDPS was recorded in Deyr 2014/15 (11.1% GAM) and Gu 2014 (12.2% GAM).

Garowe IDPs: 826 children were surveyed in Garowe IDPs and Critical levels of acute malnutrition ( GAM 15.7%) is recorded in Gu 2015 which are sustained as Critical since previous seasons of Deyr 2014 (19.6% GAM) and Gu 2014 (21.0% GAM), but showing statistically significant (p<0.05)improvement for both GAM and SAM, compared to Gu 2014. High morbidity level (46.8%) has been recorded in Gu 2015 assessment, which is almost similar to the morbidity results seen in Deyr 2014 (45.2%), but higher than the result of Gu 2014 (32.8%) and this can be among the contributing factors of persisting Critical malnutrition level (Figure 5).

Galkayo IDPs: A total of 1016 children were surveyed, and results show sustained Critical nutrition situation (20.2% GAM) during Gu 2015. The current GAM and SAM however, are significantly higher (p<0.05) when compared to Deyr 2014/15 (15.1% GAM ) and Gu 2014 (16.5% GAM), as well as Deyr 2014/15 (2.6% SAM) and Gu’2014 (2.5% SAM) (Figure 6).

Figure 4: GAM and SAM trends among Bosaso IDPs

26

15.6

24.4 24.1

18.7 20.6

17.3

13.5 13.2

17.2

12.5

3.3 2.8 4.7

7.2

3.9 4.4 3.8 2.8 2.9 3.1

1.5

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2010 Gu 2010 Deyr 2011 Gu 2011 Deyr 2012 Gu 2012 Deyr 2013 Gu 2013 Deyr 2014 Gu 2014 Deyr 2015 Gu

Prevalen

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Figure 5: GAM and SAM trends among Garowe IDPs

11.5 13.3

20.5

17.8 19.2

14.3

19.2

15.8

21 19.6

15.7

3 2.5 4.4 4.5 4.7

3.7 5.5

3.9 4.4 4.1

1.9

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Figure 6: GAM and SAM trends among Galkayo IDPs

11.4

16.3

20.3 21.8

19.2

17

19.4

15

16.5

15.1

20.2

1.2 2.9 1.8

5.9 4.1 4.4

2.5 2.9 2.5 2.6

4.7

0

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15

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25

2010 GU 2010 Deyr 2011 Gu 2011 Deyr 2012 Gu 2012 Deyr 2013 Gu 2013 Deyr 2014 Gu 2014 Deyr 2015 Gu

Preval

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Since prevalence of Morbidity (35.9%) among children who reported sick prior two weeks of assessment was higher when compared with Deyr 2014 (23.2%) or Gu 2014 (29.8%) it can be an aggravating factors for persistence of Critical malnutrition levels seen among Galkayo IDPs. Dhusamareb IDPs show Serious nutrition situation (10.5% GAM) in Gu 2015 when 414 children were assessed. This is sustained as Serious since Deyr 2014/15 (14.4% GAM). However current GAM in Gu 2015 is a significant improvement (P<0.01) compared to the Critical level of GAM (18.2%) seen in Gu 2014 assessments (Figure 7).

NUTRITION SITUATION AMONG IDPs IN SOUTH REGION

Mogadishu IDPs Nutrition situation among Mogadishu IDPs is a good reflection of on-going humanitarian interventions. Critical GAM (18.9%) was observed during Post Gu 2014 which showed a significant improvement in Post Deyr 2014/15 (Serious levels of GAM-13.4%) when humanitarian interventions were scaled up. Results of Gu 2015 assessment (14.9% GAM and 3.3% SAM) show nutrition situation is sustained as Serious. It was noted that cases of acute malnutrition were concentrated in certain clusters : Madina ( J.Dauud – maslax, Dadban (Rangaabo), Dharkeynleey- Hanaano Bulsho, Badbaado, in Hawlwadaag (Maalin and Jugweyn IDPs), Shangani distirct: Jabuuti (Ex Ministry of treasury), Hodon- Naafada,and kulmiye IDPs and in Waberi districts–Maajo and

Hamarjabjab_Afisyoone (Figure 8).

The Crude death rate (0.76/10,000/day) observed during Gu 2015 assessment also indicate a Serious nutrition situation. However doubling of under- five death rate to Critical level (1.53/10,000/day) in Gu 2015 from Serious levels (0.87) seen in Deyr 2014/15 is of concern. No major outbreaks of communicable disease were reported during this period but high morbidity rate of 39.3 percent observed among Mogadishu IDPs can be attributed to outbreaks of AWD and other seasonal infections. Main causes of 13 under five death reported was fever (3), Diarrhea 3), respiratory infection (3) and Measles (1).

Information from implementing partners in Mogadishu partners (SOS, CPD/SCI, Mercy USA, ACF, AID vision and IRC) indicate increasing trend in OTP and TSP admissions from March-May 2015. There are also very high evictions of IDP settlements going on which has negative impact on their living condition in term of shelter, water, sanitation and interventions. Two TSP sites located in Sigale and Darwiishta were closed as result of this eviction.

Figure 8: Trends in GAM and SAM prevalence among Mogadishu IDPs

30

20.5

9.6

16

12.6

8.2

18.9

13.4 14.9

10

3.7 3.6 2.9 1.6 5.5

2.5 3.3

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Gu 2011 Deyr 2011 Gu 2012 Deyr 2012 Gu 2013 Deyr 2013 Gu 2014 Deyr 2014 Gu 2015

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Figure 7: GAM and SAM trends among Dhusamareb IDPs

34

27.3

22 22.6 21.4

16 18.2

14.4

10.5

6.2 2.9 5 5.8

3.1 4.6 4.6 4.2

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Gu 2011 Deyr 2011 Gu 2012 Deyr 2012 Gu 2013 Deyr 2013 Gu 2014 Deyr 2014 Gu 2015

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Deterioration in nutrition situation among Mogadishu urban is suggested by increase in GAM from Alert (9.7%) in Deyr 2014/15 to Serious (10.5 %) in Post Gu’ 2015 assessment. SAM rate also increased from Acceptable (0.9%) during Post Deyr 2014/15 to Alert (2.2%) during Post Gu 2015. The change is however statistically not significant. Post Gu 2015 assessments show Alert rate for both Crude (<0.54/10,000/day and under five death rates (0.64/10,000/day) among urban population.

Dolow IDPs

Critical nutrition situation among Dolow IDPs is sustained since Gu 2012. Post Gu 2015 assessment records Critical rates for both GAM (26.4 %) and SAM (5.0%). The GAM rate observed in Gu 2015 is 7.6 percent higher when compared to Gu 2014 and 5 percent higher when compared to Deyr 2014/15, suggesting an increasing trend in acute malnutrition Figure 10). This is accompanied by increase in both Crude death rates (0.90) and under five death rates (1.20 suggesting Serious situation and a deterioration) from Deyr 2014/15 when CDR of 0.46/10,000/day and U5DR of 0.89/10,000/day was recorded (Figure 11).

Morbidity rate (29%) among Dolow IDPs in Gu 2015 is lower when compared to 36.9 percent observed during Deyr 2014/15 or 43.3 percent noted in Gu 2014. High morbidity, low humanitarian support, poor child feeding practices can be attributed to the deterioration of malnutrition situation seen among the Dolow IDPs.

Figure 9: Mortality trends among Mogadishu IDPs

1.07 0.6

1.35

0.6 0.76

0.85

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0.87

1.53

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Gu 2013 Deyr 2013 Gu 2014 Deyr 2014 Gu 2015

Death R

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CDR U5DR Linear(U5DR) Linear(CDR)

Figure 10: Trends in GAM and SAM prevalence among Dolow IDPs

25.9 24.9

16.4

19.7 18.8

21.6

26.4

7.5 5.4

3.3 4.8 4.1 4.3 5

0

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Gu 2012 Deyr 2012 Gu 2013 Deyr 2013 Gu 2014 Deyr 2014 Gu 2015

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Figure 11: CDR and U5DR trends among Dolow IDPs

0.75

0.77 0.7

0.46

0.9 0.87

1.29 1.24

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Gu 2013 Deyr 2013 Gu 2014 Deyr 20145 Gu 2015

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Dhobley IDPs

Findings from a nutrition survey, in which 682 children aged 6-59 months were assessed, indicates a Critical nutrition situation (20.7% GAM) with SAM rate of 3.8 percent (Serious). This shows significant deterioration (p < 0.05) in nutrition situation in Gu 2015 compared to Deyr 2014/15 (11% GAM). But when GAM in current Gu 2015 was compared to GAM in Gu’ 2014, no significant difference (p >0.05) were noted.

Significant deterioration of SAM (3.8%) was noted in Gu 2015, compared to Serious levels of SAM (1.4%) recorded in Deyr 2014.

Critical CDR (1.18/10000/day) and Serious U5DR (1.15/10000/day) was recorded during the 90 days recall retrospective study in Gu 2015. The main causes of U5DR death reported among 9 children were diarrhea (5) followed by Malaria and Pneumonia (Table 4).

Baidoa IDP results show a Critical nutrition situation, with a GAM rate of 15.3 percent (12.6-18.5) and a SAM rate of 4.1 percent (2.7-6.0). This suggests persistence of Critical nutrition situation recorded in Deyr 2014/15 (15.3%) and a deterioration when compared to Serious GAM recoded in Gu’ 2014 (12.9%). However this deterioration in GAM is not statistically significant (P<0.25) and is only a phase change.

Critical levels of SAM (4.1%) were recorded in Gu 2015 compared to Serious levels observed in Deyr 2014/15 (3.3%), but this change is not significant.

The 90 days recall retrospective crude and under five death rates report Acceptable CDR ( 0.27/10000/day) and Serious U5DR (1.39/10000/day) during Gu 2015.

The overall morbidity reported two weeks prior to the assessment shows sustained high levels (46.8%) in Gu 2015 when compared to Deyr 2014 (45.2%).

Table 4: Cause of Crude Death Rate and Under Five Death RateUnderlying cause CDR (n=28) U5DR (n=9)Diarrhea 3 5Malaria 4 2pneumonia 4 2Violence 3Malnutrition 2Birth Complication 6others 6

Figure 12: GAM & SAM trends among Dhobley IDPs

22 20.8 20.3

15.8 16.6

11

20.7

7.6 5.1 6.4

4.1 4 1.4

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Figure 13: Trends in GAM and SAM prevalence among Baidoa IDPs

15.5

12.8

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REPORT ON NUTRITION SURVEILLANCE (MONTHLY MUAC) IN BULOBURTE URBAN, HIRAN REGION1

BACKGROUND:Buloburte town and its outskirts were severely affected by the siege and trade restrictions established by the insurgents for the last couple of years. The continuously worsening blockade forced thousands of residents to flee from the area, occasioned lack of job opportunities and unprecedented localized inflation resulting in household food insecurity which can adversely impacts nutrition status of young children . In the last 9 months the people were also prevented to flee from the area as a result of an announcement made by insurgents that those remaining in the town and nearby area will be targeted. This stopped the many people to move out who would otherwise scape the barricade.

FSNAU introduced a system of nutrition surveillance (based on monthly MUAC) with the objective of providing information on number of children falling below a MUAC threshold on a monthly basis and detect the potential problems which once detected will lead to further actions. MUAC3 was used as it is a good indicator of muscle mass and can be used as a proxy of wasting. It is also a very good predictor of the risk of death. It is therefore a very successful screening tool that rapidly identifies children likely to die unless provided with nutritional and medical treatment.

METHODOLOGYTen sub-villages were selected from the 28 sub-villages of the town using ENA cluster sampling table. Fixed sample size of 100 children (6-59 months) was used. Households were identified using simple random sampling and ten children were examined in each cluster and the morbidity data was collected by interviewing the heads of the identified households. The data was entered and analysed using ENA software and MS excel.

RESULTS AND DISCUSSIONThe results of rapid MUAC assessment conducted in April, May and June 2015 (prevalence of global and severe acute malnutrition and/or oedema at 95% confidence intervals) are presented in Table 5. The distribution of the sample by sex for children the sampled population revealed that the overall sex ratio was 1.0, which is expected for a normally distributed populations especially for <5 yrs.

Table 5: Summary of Monthly Rapid MUAC Assessment in Bulo BurteMonth April 2015 May 2015 June 2015Sample Clusters = 10, n = 100,

Boys = 53, Girls = 47Clusters = 10, n = 100, Boys = 52, Girls = 48

Clusters = 10, n = 100, Boys = 47, Girls = 53

Number Percent, Range Number Percent, Range Number Percent, RangeMUAC< 125mm (Global Acute Malnutrition)

Overall 33 33.0% (25.3-41.8) 35 35.0% (27.1-43.8) 25 25.0% (17.5-34.3)Boys 16 30.2% (20.2-42.4) 16 30.8% (23.1-39.7) 11 23.4% (13.6-37.2)Girls 17 36.2% (21.5-54.0) 19 39.6% (23.9-57.7) 14 26.4% (16.4-39.6)

MUAC<115 mm (Severe Acute Malnutrition)Overall 19 19.0% (8.4-22.4) 22 22.0% (12.6-35.6) 19 19.0% (12.5-27.8)Boys 8 15.1% (8.6-25.1) 10 19.2% (8.2-38.8) 8 17.0% (8.9-30.1 95% CI)Girls 11 23.4% (11.3-42.3) 12 25.0% (13.3-42.1) 11 20.8% (12.0-33.5)

Oedema4

Overall 6 6.0% 7 7.0% 7 7.0%Boys 3 5.7% 3 5.7% 3 6.4%Girls 3 6.4% 4 8.3% 4 7.5%

Morbidity Prevalence Diarrhoea 22 22% 30 30% 10 10%Pneumonia 3 3% 2 2% 3 3%Fever 5 5% 7 7% 1 1%Suspected Measles 4 4% 5 5% 1 1%Total 34 34% 44 44% 15 15%

Prevalence of acute Malnutrition based on MUACDuring May 2015 rapid assessment, the survey results found 33 percent prevalence of global malnutrition (MUAC < 125 mm and/or oedema) andwere severely malnourished (MUAC < 115 mm and/or oedema). Although there is no statistically significant change in malnutrition prevalence, the surveillance data show encouraging reduction by June compared to April and May assessments. The reduction in malnutrition figures can be attributed to the general food distribution, blanket distribution of plumpy-doz, SFP and OTP service that are/being implemented by Mercy USA in partnership with WFP2. However, we have to note that the high inflation of foodstuff, lack of job opportunities, inaccessibility to humanitarian assistance and depletion of the existing coping strategies will remain as long as the siege and movement restriction are not ended.

1 For details contact [email protected]/[email protected] Humanitarian response :Mercy USA distributed general food ratio to town nearby outskirt residents and started SFP and OTP programs in early May. 3 Mid‐upper arm circumference: MUAC was measured at the mid‐point of the left upper arm for measured children (precision of 0.1cm). 4 Bilateral oedema: Assessed by the application of normal thumb pressure for at least 3 seconds to both feet.

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Data from health facilities also confirms the observations made during MUAC assessment. The HIS trend (Figure 14) show significant decrease (14.8%) in May 2015 compared April 2015 (21.1%) and May 2014 (27.6%). This was attributed to distribution of food aid, nutrition therapeutic and supplementary programs and improved health services which started concurrently in the town.

Gender differences were noted in prevalence of acute malnutrition (Figure 15) . It was observed that prevalence of acute malnutrition/odema was higher among girls than boys, a pattern seen across all the three assessments.

The rapid assessment also enquired on child sickness in the last two weeks prior to the survey date. Acute malnutrition is associated with an increased risk of morbidity for affected individuals. Decrease in morbidity prevalence to 15 percent was noted in June 2015 from 44 percent seen during May 2015 when prevalence of acute malnutrition decreased to 25 percent in June 2015 from 35 percent seen during May 2015.

CONCLUSIONThe nutrition situation in Buloburte has started to decrease but the reduction is not yet significant. Population and trade movement continue to be harnesed and this in turn exacerbates the humanitarian crisis in the area. Therefore improving humanitarian access should be a priority for all.

RECOMMENDATIONS üHousehold food security in Bulo Burte can only improve with end of the siege in the affected area and resumption of trade

and population movement.ü There is need to maintain and expand the food aid distribution and targeted nutrition services in the affected area.ü Strengthening of the health service provision in the area and delivery of supplies and deployment of health professionals is

required.ü Integrated health and nutrition assessments will help to better understand the situation.

Figure 15: Gender difference in prevalence of MUAC<12.5cm)

0.0% 5.0% 10.0% 15.0% 20.0% 25.0% 30.0% 35.0% 40.0%

Apr-‐15 May-‐15 Jun-‐15

30.2% 30.8%

23.4%

36.2% 39.6%

26.4%

Boys Girls

Pre

vale

nce

%

Figure 14: SAM Buloburte urban HIS data 2014-2015

5

15

25

35

45

55

65

75

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Prop

ortion

of m

alnou

rishe

d chil

dren

2014 2015 2 per. Mov. Avg.(2014) 2 per. Mov. Avg.(2015)

Figure 16: Morbidity and Acute malnutrition prevalence during April-June 2015

33 35

25

19 22

19

34

44

15

0

5

10

15

20

25

30

35

40

45

50

Apr-‐15 May-‐15 Jun-‐15

GAM SAM Morbidity

Rat

e

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RAPID MUAC ASSESSMENT IN XUDUR URBAN, BAKOOL REGION, SOMALIA*

BACKGROUND

Xudur is a town in the southern Bakool region of Somalia. It serves as the province’s capital and is the center of the Hudur District. For the last three to four years Xudur town is experiencing blockades and trade control which has resulted in high food prices. Household food insecurity has become an issue because many families in the sieged town cannot afford to buy the food available. Due to insecurity, the chances for humanitarian aid to access the area is limited and this can in turn result in deterioration of the nutrition situation of the under five children in the town .

MUAC measurement is a good method for assessing nutrition in community based rapid assessments. Nutrition surveillance through monthly MUAC assessment is initiated in Xudur town by FSNAU in partnership with ACF Somalia from May 2015.The purpose of surveillance here is NOT to provide an accurate or reliable prevalence estimate but to detect a potential problem which once detected will lead to further actions which might include a cross-sectional survey with SMART methodology.

METHODOLOGYTen sub-villages were selected from the 28 sub-villages of the town using ENA cluster sampling table. Households were identified using simple random sampling and ten children were examined in each cluster and the morbidity data was collected by interviewing the heads of the identified households. The data was entered and analysed using ENA software and MS excel.

RESULTS AND DISCUSSION

A rapid assessment of malnutrition was conducted in Xudur town during May 2015 (12th -17th) using MUAC assessment and 106 children (6-59 months) were measured. MUAC is a criteria-referenced indicator and is one of the best predictors of mortality. This means that it identifies children with a high risk of an outcome such as near term death if left untreated (and a good chance of survival if treated). The cut-offs commonly used are <11.5cm for severe acute malnutrition, and 11.5–<12.5cm for moderate acute malnutrition. The results (Table 6) show that 26 children (24.5%) had MUAC <12.5 cm or were suffering from global acute malnutrition. Children with a threshold of MUAC<11.5 cm requires admission to SAM treatment and 6 children (5.6%) in Xudur had MUAC < 11.5 cms. Results show that boys are more at risk of malnutrition compared to girls.

MUAC assessment in June 2015 shows an improvement in nutrition situation. MUAC < 12.5 cms was recorded among 16.4 percent of under-five children in June 2015 compared to 26.4 percent in May 2015. It was observed that the prevalence of MUAC < 11.5 cms (severe acute malnutrition) was nearly thrice as high among boys in May 2015 (15.2 %) compared to girls (5.0%) but no severe malnutrition cases were recorded in June 2015 among boys while prevalence of MUAC < 11.5 cms increased in girls ( 9.8%) compared to May 2015 (5%)

Table 6: Summary of Monthly Rapid MUAC Assessment Results in Xudur town

Sample May 2015 June 2015

Number/Total assessed Percent of total/ Range Number/Total assessed Percent of total / RangeMUAC< 12.5cm

Overall 26/106 24.5% (19.0-35.5) 18/110 16.4% (10.6-24.4)Boys 13/46 28.2% (20.9-47.0) 7/49 14.3% (7.1-26.7)Girls 13/60 21.7% (13.1-33.6) 11/61 18.0% (10.4-29.5)

MUAC< 11.5cm

Overall 6/106 5.6% (5.2-16.5) 6/110 5.5% (2.5-11.4)

Boys 4/46 8.6 (7.6-28.2) 0/49 0.0% (0.0- 7.3)

Girls 2/60 3.3 (1.7-13.7) 6/61 9.8% (4.6-19.8)

Health facilities are limited in Xudur but existing health facilities data also show high prevalence of acute malnutrition prevalence among underfive children >25%, (Figure 17) .

Rapid MUAC Assesment

*This assesment is done in partnership with ACF. For details contact [email protected] or [email protected]

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Rapid assessment in Xudur shows that 6.6 percent of under-five children suffer from oedematous malnutrition/ Kwashiorkor (Table 7) at time of assessment. Oedema was recoded among 6.6 percent of under-five children in May 2015 and prevalence was higher in boys (10.8%) compared to girls (3.3%). However no cases of oedema were observed during June assessment.

Morbidity

High prevalence (39.6%) of diarrhoea and fever was recorded among under-five children in Xudur during May 2015 assessment (Table 8) compared to June 2015 (20.9% diarrhoea and 15.5% fever. Pneumonia was reported among 18.8 percent of the under five children in May 2015 compared to 5.5 percent reported during June 2015.No cases of Measles were reported.

CONCLUSION:Nutrition situation in Xudur town is improving but the current prevalence of MUAC<12.5 cms (16.4%) suggests situation is still Critical.

RECOMMENDATIONPrevalence of Critical levels of acute malnutrition in Xudur call for all government and non-governmental partners to scale up the implementation of the treatment of acute malnutrition, and increase access and coverage to health and nutrition services across the region to address morbidity and malnutrition. If crisis levels of wasting are not dealt with now, it can act as a springboard for a sudden leap in mortality when a disaster strikes.Implementation of a longer-term nutritional surveillance systems is needed to better identify trends and relationships in the factors underlying malnutrition in Xudur.

Disease( Number and % of total)

May 2015n=106

June 2015N=110

Diarrhoea 42 (39.6%) 23/110 (20.9%)

Pneumonia 20 (18.8%) 6/49 (5.5%)Fever 42 (39.6%) 17/61 (15.5%)

Suspected Measles 0 0

Table 8: Prevalence of Morbidity in 6-59 month children during 2 weeks preceding assessment

Children assessed

Prevalence of Oedema(Number and % of total)

May 2015 June 2015

Overall 5/106 (4.7%) 0/110

Boys 4/46 (8.7%) 0/49

Girls 1/60 (1.7%) 0/61

Table 7: Prevalence of Oedema (Kwashirokar) in 6-59 Month old children in Xudur

Figure 17: Health Facility Malnutrition Trends in Bakool Agro-pastoral MCHs,Bakool – 2014-2015

39.7 41.9 39.8 40.4 36.2 38.1 38.1

45.6

34.6 32.4 33.8 30.9 29.3

35.6 36.2 31.1 32.6

5

15

25

35

45

55

65

75

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

Prop

ortio

n of m

alnou

rishe

d chil

dren

2014 2015 2 per. Mov. Avg.(2014) 2 per. Mov. Avg.(2015)

Table 9: Colour Code Used for Interpretation of Acute Malnutrition

Outcome Indicator Phase 1-Minimal Phase 2: Stressed Phase 3-Crisis Phase 4 - Emergency Phase 5 -Famine

Acceptable Alert Serious Critical Very CriticalGlobal Acute Malnutrition (GAM) Weight

for Height-WHZ(R1) =3- WHO/UNICEF

<5% 5- <10 % 10 to<15% or>usual and increasing

15-30%Or >usual and

increasing>30%

Severe Acute Malnutrition (SAM) (WHZ and oedema) (R=3) -FSNAU <1 1.1-2.4 2.5-4 4-5.6 >5.6

Crude death rate (CDR)/ 10,000/day IPC <0.5 <0.5 0.5 to <1 1 to <2 >2Under five death rate (U5DR)/10,000/

day IPC ≤1 ≤1 1 to 1.9 2 to 3.9 >4

Mid Upper Arm Circumference (MUAC ≤12.5cm): (R=3)—FSNAU <5 %

5--7.4 %with increase from seasonal trends

7.5- 10.610.7-16.7 %

or significant increase from seasonal trends

>16.7%

MUAC≤11.5cm (R=3)-FSNAU < 1 % 1-1.6 % 1.7-2.4 % 2.5-4 % >4%

1 R –Reliability Score (3=high, 2=medium, 1=low)

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Physical Address: United Nations Somalia, Ngecha Road Campus. Postal address: PO Box 1230, Village Market, Nairobi, KenyaTelephone: +254-20-4000500. Fax: +254 20 4000555,

Comments and information related to nutrition: [email protected], Website: http://www.fsnau.org

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L. JUBA

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GALGADUD

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M. JUBA

W. GALBEED

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L. SHABELLE

M. SHABELLE

BANADIR

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BurcoQardho

Ceerigaabo

Talex

Galkacyo

Luuq

Iskushuban

Ceel Bur

Bur Hakaba

Hargeysa

Dinsor

Bulo Barde

Xudun

Jariiban

Baardheere

Berbera

Baydhaba

Jilib

Burtinle

Sakow

Ceel Afweyne

Beled Weyne

Garowe

Kismayo

Zeylac

Caynabo

Qandala

Xudur

Dhusa Mareeb

Ceel Dheere

Cadale

Ceel Waq

Sablale

Laas Caanood

Bossaaso

Baki

Bu'aale

Calula

Cadaado

Garbaharey

Ceel Barde

Jowhar

Balcad

Wajid

Jalalaqsi

Badhadhe

Bandar BeylaOwdweyne

Tayeglow

Las Qoray/Badhan

Buuhoodle

Gebiley

Brava

Afgoye

Cabudwaaq

Sheikh

Wanle Weyne

Harardheere

Borama

Lughaye

Aden Yabal

Qoryoley

Beled Hawa

DoloRab-Dhuure

Jamaame

Qansax Dheere

Goldogob

MarkaKurtun Warrey

±0 70 140 210 280 35035

Kilometers

1:2,300,000

Livelihood Zones01: Guban Pastoral

02: West Golis Pastoral

03: Northwest Agropastoral

04: Togdheer Agropastoral

05: Hawd Pastoral

06: Northern Inland Pastoral - Goat & Sheep

07: East Golis - Frankincense, Goats & Fishing

08: Coastal Deeh Pastoral & Fishing

09: Addun Pastoral

10: Cowpea Belt

11: Southern Inland Pastoral – Camels, Goat/Sheep, Cattle

12: Southern Agropastoral - Goat,Camel,Sorghum

13: Riverine Pump Irrigation

14: Riverine Gravity Irrigation

15: Sorghum High Potential Agropastoral

16: Bay Bakool Low Potential Agropastoral

17: Southern Rainfed - Maize, Cattle & Goats

18: Juba Pastoral - Cattle & Goats

19: Urban

01

02

03 04

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08

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1011

12

18

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1311

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14

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1411

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11 18

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16

05

Datum: WGS84, Data Source: FSNAU, 2014, Admin layers: FAO GAUL 2009

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06

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08

Map Revised and Updated: April, 2015

SOMALIA: LIVELIHOOD ZONES

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Recent publications and releases

• FSNAU Post-Deyr 2014 Food Security and Nutrition Outlook (February to June 2015), February 2015 • FSNAU Post Deyr 2014/15 Food Security and Nutrition Technical Report, March, 2015• FSNAU Post Deyr 2014 Nutrition Technical Report, March 2015• FSNAU Special Nutrition Update April 2015 • FSNAU Quarterly Brief April 2015 • FSNAU Climate Update, May 2015• FSNAU Market Data Update, May 2015 • Karkaar Dharor Pastoral Livelihood Zone Baseline Report May 2015

NOTE: The above publications and releases are available on the FSNAU website: www.fsnau.org

Somalia Livelihood Zones

fsnau nutrition update may-june 2015

Documents