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Nutrition Information in Crisis Situations -
Niger
NICS 16, March 2008
Despite good sorghum and millet harvests, maize has become both scarce and
more expensive (FEWS, 11/07). However, price increases seem to be more related
to trade speculation and are more or less limited to surplus areas.
Grazing conditions for livestock remained favorable, improving both their
physical status and monetary value.
Niger has also been affected by the meningitis outbreak that has struck what
is called the African meningitis belt. Although none of the country's
departments has reached epidemic levels, a total of 217 cases and 15 deaths
(Case fatality rate: 6.9%) have been reported since January 1, 2008 (WHO,
02/03/08).
The Government of Niger and partners conducted another national nutrition
survey in November 2007, at the time of the cereal harvest (INS/Joint, 11/07).
The overall prevalence of acute malnutrition remained unchanged in most of the
regions, since the last survey done in June 2007 (figure 6). The two regions
demonstrating a significant change were Tahoua, where acute malnutrition
increased from 7.5% (5.5-10.2) in June to 14.2% (11.9-17.0) in the current
survey, and Diffa where acute malnutrition decreased from 19.4% (16.0-23.4) to
11.4 (9.0-14.4).
Figure 6 Trends in prevalence of acute malnutrition, Niger
Compared to October 2005, the prevalence of acute malnutrition seemed lower
in most of the regions, although the difference seemed significant (confidence
intervals did not overlap) in Tillaberi only. On the other hand, U 5 mortality
rates were above alert threshold in Dosso, Tillaberi and Zinder and seemed to
have significantly increased compared to June 2007 and November 2005 (figure 7).
Figure 7 Trends in under-five mortality rates, Niger
Other surveys were conducted at department levels in Maradi and Tahoua
regions (ACH-S, 09/07-01/08; MSF-B, 11/07) (table 5). They revealed precarious
nutrition situations. In Dakoro, Maradi region, the prevalence of acute
malnutrition had significantly decreased in November 2007, which was the harvest
season, compared to April 2007, where the prevalence of acute malnutrition was
17.7% (14.5-20.9) (MSF-B, 11/07). The same pattern was observed in Mayahi
department where the prevalence of acute malnutrition significantly decreased in
January 2008, after the harvest, compared to September 2007 (ACH-S, 09/07; AAH-S,
01/08).
Table 5 Results of nutrition and mortality surveys, Maradi and Tahoua
regions, Niger (ACH-S, 09/07-01/08; MSF-B, 11/07)
NICS 15, December 2007
Plentiful rainfall in August partially offset the early and abrupt end to the
rainy season in September. It is still not entirely clear how the harvest will
be affected, but it is generally expected that some areas will be negatively
impacted with grain output predicted to be insufficient in nearly 1,500 villages
(FEWS, 09/07). While worrisome, this estimate is considerably lower than last
year, when almost 4,000 villages experienced grain shortfalls.
Market prices, which are lower than last year and the 5-year average for the
same time of year, reflect the adequacy of current grain stocks. The August
rains also replenished valuable watering holes in pastoralist zones, thus
providing better access for livestock. With good pasture, the condition of
animals has improved, increasing their resale value (FEWS, 09/07).
Nutrition situation still precarious is most parts of the country
A GoN/joint nutrition survey conducted in April 2007 found the country-wide
prevalence of acute malnutrition to be 11.2% (C.I. 10.1-12.4) among children
6-59 months (INS-N/joint, 09/07). However, wide regional disparities exist and
many areas are still facing serious to critical nutrition situations (figure 5).
Diffa and Agadez had the highest prevalence of acute malnutrition, with rates of
19.4% (C.I. 16.0-23.4) and 17.4% (C.I. 14.7-20.6) respectively, although the
results from Agadez are not fully representative as certain areas could not be
accessed during the survey due to insecurity. Severe malnutrition and mortality
rates appeared to be under control (figure 5).
Concern completed two nutrition surveys in the districts of Tahoua and Illela,
Tahoua region in June 2007 (Concern, 06/07). Acute malnutrition was 12.7% (C.I.
10.1-15.3) in Tahoua district and 8.6% (C.I. 6.7-10.8) in Illela, rates that
were both higher than that of 7.5% (C.I. 5.5-10.2) from the national survey done
in Tahoua region at roughly the same time (table 4). It should be noted,
however, that the confidence intervals of all three surveys overlapped.
Figure 5 Results of National Nutrition Survey, Niger (INS-N/JOINT 06/07)
Additional surveys in rural areas of Zinder and Magaria, Zinder region were
carried out by MSF-CH in July 2007. Results obtained were similar to those from
surveys done in August 2006 and show that the nutrition situation remains
worrisome (table 4).
A MSF-B survey in the Dakoro health district of Maradi showed a serious
nutrition situation, with a high prevalence of severe malnutrition (table 4).
Mortality rates, however, were with acceptable ranges.
Table 4 Result of Nutrition Surveys, Niger (CONCERN 06/07; MSF-CH, 07/07; MSF-B
04/07)
NICS 14, September 2007
As of mid-2007, the food security situation in Niger was considered average
and the nutrition situation still precarious (Fews, 07/07). About 400,000 people
were identified to be at high risk of food insecurity but it was considered that
no free food distribution was necessary. Cash for work and distribution of seeds
for production during off-cropping season were recommended.
A nutrition survey conducted in April 2007, before the hunger-gap, in Mayahi
department, Maradi region, showed a nutrition situation of concern, with a
prevalence of acute malnutrition of 13.6% (11.7-15.6), including 1.0% (0.1-1.9)
severe acute malnutrition (AAH, 04/07). Mortality rates seemed under control.
NICS 12, February 2007
The food security situation has remained stable for the beginning of the year
with good grain availability and access (FEWS, 15/03/07). Millet prices have
declined in major markets and stabilised in other markets. Water availability
was also good in most parts of the country. However, pastoralists in the north
of Tahoua, Zinder and Diffa regions were facing food insecurity, which is usual
for this time of the year, due to food stock depletion and decrease in water
availability.
Improved nutrition situation compared to 2005 but still poor
The preliminary results of a nationwide nutrition survey conducted in October
and November last year seemed to show an improvement in the nutrition situation
(FEWS, 15/03/07). Similarly, results of nutrition surveys conducted in three
districts of Tahoua region in November 2006 (MSF-S, 11/06) showed average
nutrition situations (table 4) that were similar to April 2006 and better than
in October 2005 in the entire Tahoua region. Mortality rates were also average
(table 4).
Table 4 Acute malnutrition and mortality, Tahoua district, Niger (MSF-S,
11/06)
NICS 11, November 2006
The food security and nutrition situation was not critical in Niger in
October 2006, with a less severe hungry period than last year (Fews, 31/10/06).
Availability of cereals was good, and subsidised and free food distributions
were continuing. Crop estimates suggest that this year’s harvest will be good
globally. However, pockets of food insecurity persist with some departments
having had food deficits for the last two years: Tillaberi, Tchintabaraden,
Maine Soroa, Arlit, Bilma and Tchirozerine (WFP, 30/11/06). Moreover, in Bilmat,
Tchirozerine, Main Soroa and Tillaberi, the deficits are 50% or more of needs.
A nutrition survey conducted in Aguie health district, Maradi region, in
September 2006 (end of the hunger-gap period) showed an average nutrition
situation with 8.2% (6.0-10.4) acute malnutrition, including 0.8% (0.2-1.3)
severe malnutrition (MSF-B, 09/06). Mortality rates were also average: CMR = 0.5
deaths/10,000/day (0.3-0.7) and U5MR = 1.3 deaths/10,000/day (0.6-2.1).
NICS 10, August 2006
About 3.8 m people have been estimated to be food insecure during this year’s
hunger-gap season, of whom 1.8 m face severe food insecurity (WFP, 14/08/06).
The areas the most affected are Keita, Illela, Tchintabaraden, Loga, Bouza,
Doutchi, Tera, Ouallam and Gaya in Dosso, Tahoua and Tillaberi regions. The plan
of action to address the needs of these 1.8 m people includes targeted free-food
distribution, discharge rations for families of children admitted to feeding
centres, and cereal banks. In addition blanket supplementary food distributions
are being implemented for children less than three years old in the most remote
areas of Taouha, Zinder and Maradi regions. The government of Niger has also
announced that access to health care will be free for children under five
(Liberation, 07/07/06). As usual at this time of year, admissions to the 850
feeding centres throughout the country are on the rise (FEWS, 17/08/06).
Floods at the end of August have displaced about 17,000 people, especially in
Agadez and the south of the country (IRIN, 30/08/06).
Nutrition surveys conducted in Maradi and Tahoua regions in March-April and
May (onset of the hunger-gap season) showed poor to serious nutrition situations
(figure 6) (ACH-S, 04/06; MSF-S, 05/06). The situation in pastoral areas of
Tahoua and Maradi was especially worrying. March-April represents the lean
season for pastorals, while the lean season has not yet begun for the
agricultural and agro-pastoral. This might explain the differences between the
groups. Compared to the surveys conducted among the same groups in October 2005,
the situation has improved significantly in agricultural and agro-pastoral zones
but has remained within the same range in pastoral areas (see NICS 8). It is
difficult to know if this improvement is due to a recovery in food security or
only reflects seasonal variations, as the October survey was done at the end of
the lean season for agricultural and agro-pastoral areas. Under-five mortality
rates were above alert thresholds in three of the four surveys (figure 6).
Figure 6 Prevalence of acute malnutrition and mortality rates, Maradi and
Tahoua regions, Niger (ACH-S, 04/06; MSF-S, 05/06)
NICS 9, May 2006
Despite a generally good 2005 harvest, some pockets of food insecurity have
been identified in pastoral and agro-pastoral areas at the onset of the
hunger-gap season (FEWS, 03/06). They result from insufficient food stocks,
reimbursement of debts contracted during last year's crisis, cereal and fodder
deficits and relatively high food prices. Two random-sampled nutrition surveys
conducted just after the harvest in the rural surroundings of Zinder town and in
Magaria department in Zinder region showed average to precarious nutrition
situations (table 4). On the other hand, mortality rates were extremely high,
probably due to the high number of malaria cases during this period (table 4).
When compared to August 2005, which was during the hunger gap, the nutrition
situation has significantly improved around Zinder town (see NICS 7).
Table 4 Results of nutrition and mortality surveys in Zinder region, Niger,
December 2005 (MSF-CH, 12/05)
NICS 8, January 2006
The situation in Niger is still precarious despite a good 2005 agricultural
season which has improved food availability and access (FEWS, 19/12/05). Millet
prices decreased by 50% in November 2005 compared to August the same year but
remained 9% higher than the average price for the same month over the last five
years. Food insecurity continues to prevail in some areas, partly due to the
consequences of the crisis, such as high levels of debt, loss of assets and
limited food stocks.
Concerted plans are being organised to answer the food insecurity in both the
short and long term, and the capacity to monitor and assess the food security
situation has been strengthened.
A random-sampled nutrition survey was conducted in Niger at national and
regional level between mid-September and mid-October 2005 by UNICEF/CDC (WHO,
19/12/05). Preliminary results showed high levels of acute malnutrition (figure
6). Crude mortality rates seemed under control, while under-five mortality rates
were above alert threshold in Zinder and Tahoua (figure 6). Other nutrition
surveys were conducted in agricultural, agro-pastoral and pastoral zones of
Maradi and Tahoua in the same period (ACH-S, 10/05) (table 6). They revealed a
prevalence of acute malnutrition within the same range as the UNICEF/CDC survey
and not different from surveys conducted in August 2005 (see NICS 7). The
nutritional status of children under five was significantly better (although
still serious) in the pastoral group than in the agro-pastoral group, which
showed the highest prevalence. MUAC was measured among mothers and showed only 2
women with a MUAC < 185 mm in the three zones together. 7.3%, 6.1% and 17.3% of
the women had a MUAC >= 185 and < 220 mm, showing an energy deficiency in the
agricultural, agro-pastoral and pastoral zone, respectively. The percentage of
families that had received food distributions varied from 44.8% in the
agro-pastoral area to 27.4% in the agricultural zone and 9.1% in the pastoral
zone.
Table 6 Results of nutrition surveys in Maradi and Tahoua regions, Niger
(ACH-S, 10/05)
Figure 6 Results of a nutrition survey, Niger (WHO, 12/05)
NICS 7, August 2005
Late and insufficient response to the crisis
The worsening of the crisis in Niger and the late response has raised
concerns. According to the Humanitarian Policy Group, the slowness of the
donors' engagement is not the only factor (HPG, 08/05). Alerts on the potential
gravity of the situation were late and the early response to the crisis, which
was the sale of subsidised cereals, was not sufficient to avoid a deterioration
in the situation. The amount of the subsidised cereals sold was not enough to
have a significant impact on the price of food, which remained at more than
twice the price of last year. Moreover, the most impoverished Nigerians could
not afford to buy this food. Part of the problem might be that, in the
assessment of the crisis, the food availability approach prevailed over the
"food access" approach: food was available during the crisis but was too costly
for impoverished people.
The government of Niger was afraid that emergency assistance such as free
food distributions would undermine the development process and market
mechanisms. It also seems that there was a lack of capacity to react to the
Niger crisis; humanitarian organisations being already involved in big crises
such as Darfur and the Tsunami.
Scaling-up of emergency programmes
The response to the crisis has intensified since July 2005 with several NGOs
implementing emergency programmes.
The UN organisations have recently increased their demand of funds to US$ 81
m, of which about half was pledged as of late August (IRIN, 25/08/05). WFP began
free food distribution for 1.85 m people at the beginning of August (WFP,
23/08/05). A total of 3 m people will receive free food aid from a number of
organisations. Some areas have been added to the distribution plan recently, to
take the current situation into account (WFP, 02/09/05).
However, MSF warns that the proportion of the families who get free food
distribution is insufficient to meet the needs of the population in some
locations, and that the ration distributed lacks fortified blended food; a food
more suitable for young children than whole grains (MSF, 22/08/05).
Nutrition surveys conducted in May 2005 in parts of Tahoua and Maradi showed
a critical prevalence of acute malnutrition, and under-five mortality rates
above alert threshold (table 5) (Epicentre/MSF, 05/05). The surveys showed a
worse situation than in Maradi and Zinder regions in January 2005 (HKI/WFP,
01/05). The situation has probably deteriorated further since May and as of
August 2005, admissions to therapeutic feeding centres were still on the rise (MSF,
22/08/05).
Table 5 Results of surveys in Niger, 2005 (Epicentre/MSF-F, 05/05; Epicentre/MSF-CH,
08/05)
A more recent survey conducted in the rural surroundings of Zinder town in
August 2005 also showed a critical situation (table 5) (Epicentre/MSF-CH,
08/05). Moreover, the prevalence of acute malnutrition among the 6-29 month old
children was appalling: 32.6% (27.0-38.2). The crude and under-five mortality
rates were above emergency threshold (table 5). Moreover, it seemed that the
mortality was higher in the recent months than at the beginning of 2005.
According to the families interviewed in the surveys in Maradi and Zinder,
access to subsidised cereals or free cereal distributions seemed low with only
about 10% of the families having access to them (Epicentre/MSF-F, 05/05;
Epicentre/MSF-CH, 08/05).
The onset of the rainy season, which is good so far, is raising hope for the
future with good harvests expected, as well as a replenishment of pasture (FEWS,
01/09/05). Humanitarian aid and support to livelihoods will, however, be needed
until the households recover from the crisis.
NICS 6, May 2005
A food crisis is looming in Niger. Last year’s weather conditions were bad
with drought and locust invasion (FAO/WFP, 21/12/04). Some political decisions
may also worsen the situation, such as the implementation of a 19% tax on all
goods, including food stuffs (CI, 31/03/05).
According to MSF, more than 3,000 children were admitted to their therapeutic
feeding centre in Maradi, southern Niger, in the first four months of 2005,
which is three times higher than for the same period in previous years (MSF,
26/04/05). Two new TFCs have been opened as well as 13 consultations sites for
home treatment of severe malnutrition. A nutrition survey conducted in January
2005 in the rural areas of Zinder and Maradi revealed 13.4% acute malnutrition,
including 2.7% severe acute malnutrition (WFP, 22/04/05). Two other surveys
conducted in April 2005 in the same area but not precisely the same populations
showed about 19% acute malnutrition (WFP, 20/05/05). According to MSF, last
year’s crops was poor with over 90% of the culture destroyed in the most
affected areas (MSF, 28/04/05). Livestock was also affected with only scant
pasture remaining and a lack of fodder. Poor households are especially affected
in pastoral, agro-pastoral and localised areas of agricultural zones (FEWS,
16/03/05) (see map). Cereal availability in market is low, which triggered
significant increases in cereal prices which were 46% higher in March 2005 than
at the same period in 2003. On the other hand, prices of livestock were low.
People are reported to increasingly moving to towns in search of food and
income. A UN appeal was launched on 19 May 2005, requesting US$ 16.2 million to,
amongst other things, provide food aid to 3.6 m people in 3,815 villages in the
areas of Tillaberi, Tahoua, Maradi, Diffa, Agadez and Zinder (OCHA, 19/05/05)
and cater for malnourished children.
Recommendations
Priority needs and humanitarian response plan from the CAP:
- Recuperate malnourished children under five, and pregnant and lactating
women through therapeutic and supplementary feeding.
- Increase food availability and accessibility at community-level, through
subsidised sales, food-for-work activities, cash-for-work, food-for-training,
and support to cereal banks.
- Support existing health services to prevent water-borne diseases in
affected areas.
- Ensure livestock survival through the distribution of fodder.
Food security indicators, Niger (Reliefweb, 10/05/05)
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