Nutrition in Crisis Situations
Vol 14, September 2007
Highlights
Greater Horn of Africa
West Africa
Central Africa
Abbreviations and Acronyms
References
Summary of the nutrition survey results
Notes on the survey methodologies
Indicators and risk categories
Ethiopia—Worsening situation in Somali region— The situation has been
causing concern in part of Somali region since the intensification in
counter-insurgency operations in April 2007. Since June, a strict control on
border crossing with Somalia has also been established. These have resulted in a
decrease in livestock and livestock products sales, on which people from the
Somali region rely heavily to procure cereals and other imported items. Prices
of these products have also increased dramatically because of the reduced flow.
A UN mission conducted at the end of August 2007 reported that coping strategies
seem to get exhausted rapidly, access to remittance was more difficult, there
were problems with food distributions and feeding patterns were disrupted. There
is a fear that the situation is deteriorating rapidly. Among the recommendations
of the UN mission is the need for urgent food aid to 600,000 people, relaxation
of trade and commercial restrictions, and an independent investigation into the
allegations of human rights abuses.
Somalia—Increased number of people requiring humanitarian aid— Post-Gu
assessment has found that 1.5 M people are in need of humanitarian assistance,
an increase from the estimated 1 M after post-Deyr assessment. They represent
400,000 people displaced before April 2007, 325,000 people displaced from April
2007, and 785,000 of the rural population facing a humanitarian emergency or an
acute food and livelihood crisis. Lower and Middle Shabelle regions are the most
affected and represent 85% of those identified in a humanitarian emergency and
31% of those identified in acute food and livelihood crisis. Although this area
is the "bread-basket" of Somalia and generally the most resilient, it has
experienced its lowest cereal production in a decade (44% post-war average),
sharp rates of inflation in food and non-food items in the last months,
continued civil insecurity, and a high concentration of displaced people. FSAU
recommends an integrated and focused response in the Shabelle regions, including
assistance focused on immediate needs, but also activities to support
livelihoods and protect livelihood assets.
Sudan—Deteriorating humanitarian situation in Darfur— The humanitarian
situation has deteriorated, especially because of renewed displacement. It is
estimated that about 240,000 people have been newly-displaced or re-displaced
during 2007. In addition 30,000 Chadians are estimated to have sought refuge in
Darfur this year. They are mainly scattered along the border with only
approximately 6,000 registered in refugee camps. Moreover, heavy rains have
further worsened the situation. Insecurity is also still raging with an increase
in attacks against relief workers in 2007.
Chad—Grim situation in displaced camps— There has been a relative
decrease in violence over the past months in Eastern Chad. Assistance has been
provided to the estimated 230,000 refugees from Sudan and around 150,000
displaced people. The situation was critical among the displaced populations
according to a survey conducted in Gourougoun, Koubigou, Gassire and Koloma
camps in May 2007. Both the prevalence of acute malnutrition, and mortality
rates were high.
Uganda—Returns in the north—Following an improved security situation
and on-going peace talks between the Ugandan government and the Lord's
Resistance Army, displaced people in Northern Uganda have begun to return to
their homes. Out of the estimated 1,842,000 IDPs scattered in 242 camps in 2005,
539,550 have returned to their homes and 381,000 have moved to new sites closer
to their homes. About 916,000 have remained in camps. However, the proportion of
returnees varies depending on the location. While an estimated 92% of the people
displaced in 2005 have returned to Lango region, only 37% have returned to
Acholi. Nutrition surveys conducted in the IDP camps and in the areas of returns
showed nutrition situations under control or average, but mortality rates in
Pader and Northern Lira districts were of concern.
Risk Factors affecting Nutrition in Selected Situations
Situations in the table below are classed into five categories relating to prevalence
and or risk of malnutrition (I—very high risk/prevalence, II—high
risk/prevalence, III—moderate risk/prevalence, IV—not at elevated
risk/prevalence, V-unknown risk/prevalence; for further explanation see section
"Indicators and classification" at the end of the report).
The prevalence/risk is indirectly affected by both the underlying causes of
malnutrition, relating to food security, public health environment and social
environment, and the constraints limiting humanitarian response.
These categories are summations of the causes of malnutrition and the
humanitarian response, but should not be used in isolation to prescribe the
necessary response.
 J Adequate
K Mixed
L Inadequate
Food security has improved overall following a very good Meher (June to
September) rainy season (Fews, 09/07). However, the low lands of Oromiya did not
benefit from this generally good rain and the provision of food aid will be
needed until the end of 2007.
The number of people requiring assistance in Ethiopia towards the end of 2007
was revised in August and is estimated to be 263,700 in districts not included
in the Productive Safety Net Programme. As the amount of emergency food required
can be covered through existing DPPA stock, no appeal has been issued this year.
Floods have been reported throughout Somalia, and Acute Watery Diarrhoea has
continued to be reported in Amhara, SNNPP, Oromiya, Tigray, Afar and Somali (OCHA,
24/09/07).
The situation has been causing concern in part of Somali region since the
intensification in counter-insurgency operations by the Ethiopian National
Defence Force, following the attack on Chinese and Ethiopian oil workers and
security personnel, in April 2007 (UN, 09/07). Since June, a strict control on
border crossing with Somalia has also been established. These have resulted in a
decrease in livestock and livestock products sales, on which people from the
Somali region rely heavily to procure cereals and other imported items. Prices
of these products have also increased dramatically because of the reduced flow.
A UN mission conducted at the end of August 2007 reported that coping strategies
seem to get exhausted rapidly, access to remittance was more difficult, there
were problems with food distributions and feeding patterns were disrupted. There
is a fear that the situation is deteriorating rapidly. Among the recommendations
of the UN mission is the need for urgent food aid to 600,000 people, relaxation
of trade and commercial restrictions, and an independent investigation into the
allegations of human rights abuses. In response, the government of Ethiopia made
commitments to ensure the improvement of the humanitarian situation in
collaboration with UN and humanitarian partners (GoE, 19/09/07). MSF has claimed
that they had been denied access to Somali region (MSF, 04/09/07), but this was
refuted by the government of Ethiopia (IRIN, 04/09/07).
The nutrition situation was average in the predominantly cropping areas of
Oromiya, SNNPR and Tigray regions, according to the surveys conducted between
April and June 2007 (table 1), except in Bona district, Sidama zone (ENCU,
30/06/07). The food security situation was reported to have deteriorated and
this district had not benefited from the Productive Safety Net or from food
distributions in 2007. As a result of the survey, community-based management of
severe acute malnutrition was implemented and it was recommended that
supplementary feeding programmes be strengthened. Two surveys conducted in Afar
and Somali regions also showed worrying situations (figure 1).
Table 1 Prevalence of acute malnutrition, Ethiopia, 2007 (ENCU, 30/06/07)
Figure 1 Results of nutrition surveys, Afar and Somali regions, 2007 (ENCU,
30/06/07)
Overall, national cereal availability has been favourable (Fews, 08/07).
However, some of the districts previously affected by drought, i.e. Isiolo,
Wajir, Garissa and Tana river, have remained highly food-insecure. Evolution of
the food security situation will be determined by the forthcoming short rains
between October and December.
According to nutrition data, the nutrition situation seems to have improved
in Mandera, Marsabit, Wajir and Turkana districts in 2007 compared to 2006,
although the prevalence of acute malnutrition has remained high (Fews, 08/07).
Three random-sampled nutrition surveys conducted in April-May 2007 in Wajir
and Turkana districts showed critical nutrition situations in Wajir district and
central and south-east parts of Turkana district (figure 2) (Merlin, 04/07; WV,
05/07). The situation was better, although still of concern in south-west of
Turkana district. In both districts, food distribution and selective feeding
centres were implemented. Both surveys recommended that current programmes be
continued and strengthened when necessary and that long-term strategies to
address food insecurity be implemented.
Figure 2 Results of nutrition surveys, Kenya, April-May 2007 (MERLIN, 04/07;
WV, 05/07)
The security situation has remained volatile in Somalia (OCHA, 31/08/07). A
new wave of 63,000 people were displaced from Mogadishu to other areas in
Mogadishu, Lower and Middle Shabelle, Galgadud and Mudug regions, between June
and August 2007. This is in addition to the estimated 400,000 who moved between
February and May 2007, of whom 125,000 have been reported to have moved back to
Mogadishu, following a lull in the fighting between April and June 2007.
Post-Gu assessment has found that 1.5 M people are in need of humanitarian
assistance, an increase from the estimated 1 M after post-Deyr assessment (FSAU,
21/09/07) (see map). They represent 400,000 people displaced before April 2007,
325,000 people displaced from April 2007, and 785,000 of the rural population
facing a humanitarian emergency or an acute food and livelihood crisis (table
2).
Table 2 Estimated rural resident population by region in acute food and
livelihood crisis and humanitarian emergency (FSAU, 21/09/07)
Somalia integrated food security and humanitarian phase classification: Post
Gu 07 Projection, July through December 2007 (FSAU, 21/09/07)
Lower and Middle Shabelle regions are the most affected and represent 85% of
those identified in a humanitarian emergency and 31% of those identified in
acute food and livelihood crisis. Although this area is the "bread-basket" of
Somalia and generally the most resilient, it has experienced its lowest cereal
production in a decade (44% post-war average), sharp rates of inflation in food
and non-food items in the last months, continued civil insecurity, and a high
concentration of displaced people. FSAU recommends an integrated and focused
response in the Shabelle regions, including assistance focused on immediate
needs, but also activities to support livelihoods and protect livelihood assets.
Nutrition surveys conducted in May in the two regions showed a critical
situation, with a high prevalence of severe acute malnutrition and mortality
rates above alert thresholds (table 3) (FSAU, 05/07). No comparison with
previous assessments was possible. A MUAC assessment conducted among recently
displaced populations in Afgoye town in July 2007 showed that 21.5% of the
children had a MUAC below 12.5% (FSAU, 07/07).
On the other hand, Lower and Middle Juba have seen improvement in food
security (table 2) as well as in nutrition (FSAU, 06/07). However, nutrition
surveys conducted in June 2007 revealed a situation that was still precarious
(figure 3), especially among the riverine livelihood households, where both the
prevalence of acute malnutrition and mortality rates were of concern.
In Burhakaba district, Bay region, the nutrition situation was also of
concern as well as the mortality rates as of May 2007 (figure 3). According to
the post-Gu assessment, the livestock sector has improved and the exceptional
sorghum harvest of the last Deyr ensures adequate access to food and income for
most households, despite a very poor Gu season, which primarily affected crop
production.
Figure 3 Results of nutrition surveys, Somalia, 2007 (FSAU, 05/07; FSAU,
06/07)
In Gedo, despite some improvement, the situation has remained precarious
(table 2). In Hiran, the food and livelihood situation has continued to
deteriorate in the riverine and agro-pastoral populations.
In Central and North Somalia, there are no residents facing acute livelihood
crisis or a humanitarian emergency. However, Central Somalia and especially
Galgadud and Mudug regions have a high concentration of IDPs, 110,000 and
40,000, respectively, who are in need of humanitarian assistance. A nutrition
survey conducted in the IDP camp of Galkaio town, Mudug region, showed a dire
situation with a high prevalence of acute malnutrition, and mortality rates
above alert threshold (table 3). The camp lacked adequate sanitation facilities
and provision of safe drinking water. IDPs do not have good access to health
facilities. Furthermore, income opportunities seem very limited.
In the North, the nutrition situation of the Coastal-Deeh livelihood zone was
precarious in May 2007 (table 3).
Table 3 Results of nutrition and mortality surveys, Somalia, May 2007 (FSAU,
05/07)
Following the release of the post-Gu assessment, WFP increased the number of
beneficiaries of food aid from 1 M to 1.2 M and food was distributed in the
Shabelle regions (OCHA, 31/08/07). In Mogadishu, WFP had to halt its food
distribution because of insecurity at distribution sites. They will try to
establish a "wet feeding" programme where cooked food will be distributed
through national NGOs. Admissions to therapeutic feeding centres are reported to
have increased in Mogadishu (FSAU, 07/07).
Overall
Despite an improvement in the food security situation in most of the drought
and flood affected regions, the overall number of people in need of assistance
has increased due to the significant deterioration in the humanitarian situation
in the Shabelle regions caused by poor Gu season and renewed conflict.
Small-scale fighting over livestock and land has continued to cause localised
displacement in rural areas (OCHA, 31/08/07). Severe floods have especially
affected Unity and Upper Nile State but also Western Bahr el Ghazal, Lakes,
Central and Western Equatoria and more recently Southern Kordofan (OCHA,
31/08/07; UNNews, 24/09/07). Around 500,000 people have been affected. Food and
non-food assistance has been established. It is expected that the hunger-gap
period might be extended in the flood-affected areas. However, when floods
recede in December-February, food security should improve due to increase
availability of fish, water plants and good pasture.
A nutrition survey conducted in Kurmuk county, Blue Nile state, showed an
average nutrition situation: 9.4% (5.9-12.9) of the children surveyed were
acutely malnourished, which was comparable to that in early 2005 (GOAL, 04/07).
Child- feeding practices were poor with only 4.9% of the children exclusively
breastfed and 15.7% being introduced to complementary food between 6-9 months.
Less than 50% of the households had access to potable drinking water.
Nutrition surveys conducted in South Sudan showed critical situations (table
4). In Sobat corridor, Upper Nile state and Twic county, Warap state,
information on child-feeding practices revealed low proportions of exclusive
breast feeding and timely introduction of complementary feeding (GOAL, 03/07;
GOAL, 07/07). In Sobat corridor, almost none of the households had access to a
protected source of water, while 58.4% of the households in Twic county used
potable water. Diet diversity was poor in both survey areas with less than 10%
of the households having consumed food from three different food groups the day
prior to the survey.
In Athooc districts, although still critical, the situation had improved
compared to the same season in 2005. The area has experienced food insecurity
due to different factors such as floods in 2006, livestock diseases, persistent
cattle raids and inadequate fishing and farming equipment (AAH-US, 06/07).
Public health was also poor. None of the households surveyed had received food
assistance in the three months prior to the survey. However, food distributions
were being implemented for returnees at the time of the survey. There was no
selective feeding programme in the area.
In Khorfulus and Atar areas, the nutrition situation was appalling during the
hunger-gap season (table 4). The last harvest had been poor due to insecurity
and pests (AAH-US, 06/07). The population also had poor access to health
services, and water and sanitation were reported to be largely inadequate. There
had been a large number of returnees in the area.
Table 4 Results of nutrition surveys, South Sudan (GOAL, 04/07-08/07; AAH-US,
06/07)
Darfur
The humanitarian situation has deteriorated, especially because of renewed
displacement (OCHA, 31/08/07). It is estimated that about 240,000 people have
been newly-displaced or re-displaced during 2007 (see map).
Major displacements, January-September 2007 (OCHA, 09/07)
In addition 30,000 Chadians are estimated to have sought refuge in Darfur
this year. They are mainly scattered along the border with only approximately
6,000 registered in refugee camps (UNHCR, 09/07). Moreover, heavy rains have
further worsened the situation. Insecurity is also still raging with an increase
in attacks against relief workers in 2007 (UNNews, 27/09/07). In July, food was
delivered to approximately 3.1 M beneficiaries, an increase from previous months
explained by the inclusion of vulnerable rural residents during the hunger-gap
season in the beneficiaries of food distribution.
The UN Security Council has authorised the deployment of an hybrid United
Nations-African Union peace keeping force of 26,000 troops, which was accepted
by the government of Sudan (UNNews, 31/07/07; UNHCR, 09/07).
Nutrition surveys continue to show precarious to critical nutrition
situations (figure 4), which have remained stable compared to last year where
data are available. In Kebkabiya town, the situation has even deteriorated
compared to the same season in 2005 and 2006 (figure 5).
Figure 4 results of nutrition surveys, Darfur, 2007 (ACF-F, 05/07-08/07;
UNICEF, 05/07-07/07)
Figure 5 Trends in prevalence of acute malnutrition and mortality rates,
Kebkabiya town, North Darfur
A food security assessment conducted in Otash camp revealed that the main
sources of food for the displaced people were the general food distribution and
purchasing from markets (ACF-F, 02/07). People were entitled to a 75% food
ration. Most of the food ration was consumed (90%), while the rest was sold to
buy vegetables or to cover non-food needs. Most of the IDPs did not have a
regular source of income. The most common sources of income were urban casual
labour, selling of firewood, trading and NGO assistance. Access to potable water
and sanitation was reported to be below international standards.
Overall
The situation in Darfur and South Sudan was still precarious due to several
factors including insecurity, movement of people such as displacement in Darfur
and returns in South Sudan and floods.
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.
There has been a relative decrease in violence over the past months in
Eastern Chad (ICRC, 26/09/07). Assistance has been provided to the estimated
230,000 refugees from Sudan and around 150,000 displaced people. Regular food
distributions have been conducted for the refugees and IDPs (Fews, 07/07; Fews,
09/07). Access to potable drinking water and adequate sanitation seems a major
constraint in the camps. Moreover, floods in some of the camps have worsened the
situation (IRIN, 04/09/07). An outbreak of hepatitis E has spread in Eastern
Chad (WHO, 06/07).
The Security Council has authorised the establishment of a "multidimensional
presence" in Chad and Central African Republic. That presence would consist of
300 police and 50 military liaison officers of the new United Nations Mission,
and troops deployed by the European Union to protect and support it (UNSC,
25/09/07).
The situation was critical among the displaced populations according to a
survey conducted in Gourougoun, Koubigou, Gassire and Koloma camps in May 2007 (MSF-F/Epicentre,
05/07). Most of the families (76.5%) had arrived in the camps between 1 month
and 1 year before the survey took place and 21.3% arrived more than one year
before the survey. Both the prevalence of acute malnutrition, and mortality
rates were high (table 5). An assessment conducted among displaced camps in
May/June also showed a critical situation with a prevalence of acute
malnutrition above 20% (MSP/joint, 09/07). Nutrition interventions have been
implemented in most of the camps (see map).
Table 5 Prevalence of acute malnutrition and mortality rates, Gouroukoun,
Koubigou, Gassire & Koloma IDP camps, Chad, May 2007 (Epicentre/MSF-F, 05/07)
Nutrition Cluster, Who does What Where, IDP sites in Eastern Chad as of
August 2007 (OCHA, 09/07)
An upsurge in violence in North Kivu in September 2007 has displaced
thousands of new people (UNHCR, 29/09/07). Although some humanitarian assistance
has been organised, it seems that acute malnutrition is highly prevalent (OCHA,
28/09/07; WFP, 13/09/07).
An outbreak of Ebola haemorrhagic fever has been reported in the Province of
Kasai Occidental (WHO, 27/09/07).
Nutrition surveys conducted in Orientale, Katanga and Bandudu provinces
showed under control to average nutrition situations, except in Gungu health
zone where 2.3% of the children surveyed had oedema (figure 6). On the other
hand, a nutrition survey conducted in Rwanguba health zone in North Kivu showed
a very high prevalence of kwashiorkor, with 4.9% of oedematous children
(WV/Joint, 03/07). The overall prevalence of acute malnutrition was 12.5%.
Figure 6 Results of nutrition surveys, DRC, 2007 (AAH-US, 05/07-07/07;
WV/Joint, 03/07)
Karamoja region has three livelihood groups but pastoralists are predominant.
The region has experienced cyclic drought, the last one being in 2006, and has
also been prone to civil unrest. A nutrition survey conducted in three districts
of the region: Abim, Kaabong and Kotido during the dry season, showed a critical
nutrition situation (figure 7) (WFP/DHO, 03/07). The prevalence of acute
malnutrition had increased compared to that in November 2006, after the harvest
season.
Food security has recently improved following early minor harvests (Fews,
09/07). However, it was anticipated that, because of the below average rains
experienced this year (despite being better than last year), a resumption of
food assistance would be needed by the end of 2007 or beginning of 2008.
Following an improved security situation and on-going peace talks between the
Ugandan government and the Lord's Resistance Army, displaced people in Northern
Uganda have begun to return to their homes (UNHCR, 11/09/07). Out of the
estimated 1,842,000 IDPs scattered in 242 camps in 2005, 539,550 have returned
to their homes and 381,000 have moved to new sites closer to their homes. About
916,000 have remained in camps. However, the proportion of returnees varies
depending on the location. While an estimated 92% of the people displaced in
2005 have returned to Lango region, only 37% have returned to Acholi region.
Nutrition surveys conducted in the IDP camps and in the areas of returns
showed nutrition situations under control or average, but mortality rates in
Pader and Northern Lira districts are of concern (table 5).
Heavy rains since July this year have caused flooding in Teso, Karamoja,
Elgon, Lango and Acholi sub-regions, affecting an estimated 300,000 people
(UNICEF, 28/09/07). Although assistance has been organised, more funds are
needed to continue providing food and non-food aid to the affected population.
Table 5 Results of nutrition surveys, Northern Uganda (MoH/Joint, 08/07; AAH-US,
04/07)
Figure 7 Result of a nutrition survey, Karamoja region, March 2007 (WFP/DhO,
03/07)
| AAH-US |
Action Against Hunger USA |
| ACF-F |
Action Contre la Faim France |
| ACH-S |
Action Contra El Hambre Spain |
| BMI |
Body Mass Index |
| CMR |
Crude Mortality Rate |
| < 5 MR |
Under-five Mortality Rate |
| ENCU |
Emergency Nutrition Coordination Unit |
| FEWS |
Famine Early Warning System |
| FSAU |
Food Security Analysis Unit for Somalia |
| GoE |
Government of Ethiopia |
| ICRC |
International Committee of the Red Cross |
| IDP |
Internally Displaced Person |
| IRIN |
International Regional Information Network |
| MOH |
Ministry of Health |
| MSF |
Médecins Sans Frontières |
| OCHA |
Office for the Co-ordination of Humanitarian Assistance |
| PRONANUT |
Programme National de Nutrition- DRC |
| UNHCR |
United Nations High Commission on Refugees |
| UNICEF |
United Nations International Children’s Emergency Fund |
| UNSC |
United Nations Security Council |
| WFP |
World Food Programme |
| WHO |
World Health Organization |
| WV |
World Vision |
Greater Horn of Africa
Ethiopia
ENCU 30/06/07 Emergency Nutrition Quarterly Bulletin (Second quarter 2007)
FEWS 09/07 Ethiopia food security update– September 2007
GoE 19/09/07 Press statement on the humanitarian assessment mission
IRIN 04/09/07 Ethiopia: Government denies “blocking” NGO
MSF 04/09/07 MSF denied access to Somali region of Ethiopia
OCHA 24/09/07 Relief bulletin: Weekly humanitarian highlights in Ethiopia
UN 09/07 Report on the findings from the humanitarian assessment mission to the
Somali region
Kenya
FEWS 08/07 Kenya food security update
MERLIN 04/07 Integrated nutritional survey report, Wajir district
WV 05/07 Health & nutrition survey, Turkana district
Somalia
FSAU/N 05/07 Nutrition Update
FSAU/N 06/07 Nutrition Update
FSAU/N 07/07 Nutrition Update
FSAU 21/09/07 2007 Post-Gu Analysis, technical series, report No V.13
OCHA 31/08/07 Humanitarian situation in Somalia: Monthly analysis, August 2007
Sudan
AAH-US 06/07 Nutritional anthropometric survey, children under five years
old, Khorfulus & Atar areas, Jonglei state, Central Upper Nile final report,
Wudier district, Longuchok county, Upper Nile state
AAH-US 06/07 Nutritional anthropometric survey, children under five years old,
Athooc (Baidit and Jalle) payams, South Bor County, Jongley state Gogrial West
County, Warrap state
ACF-F 02/07 Otash: Findings of the rapid FS assessment
ACF-F 05/07 Nutritional anthropometric and retrospective mortality survey,
children 6 to 59 months, Al Salam IDP camp, South Darfur, Sudan
ACF-F 06/07 Nutritional anthropometric and retrospective mortality survey,
children 6 to 59 months, Kass town, South Darfur, Sudan
ACF-F 06/07 Nutritional anthropometric and retrospective mortality survey,
children 6 to 59 months, Abu Shok and As Salam IDP camps, North Darfur, Sudan
ACF-F 06/07 Nutritional anthropometric and retrospective mortality survey,
children 6 to 59 months, Kebkabiya town, North Darfur, Sudan
ACF-F 08/07 Nutritional anthropometric and retrospective mortality survey,
children 6 to 59 months, Seleah, South Darfur, Sudan
FEWS 27/08/07 Southern Sudan: Food security watch
GOAL 03/07 Findings of a multi-indicator nutrition, health, water and sanitation
and mortality survey, Twic county, Warap state, Southern Sudan
GOAL 04/07 Findings of a multi-indicator nutrition, health, water and sanitation
and mortality survey, Kurmuk county, Blue Nile state, Sudan
GOAL 07/07 Findings of a multi-indicator nutrition, health, water and sanitation
and mortality survey, Sobat corridor, Upper Nile state, South Sudan
OCHA 31/08/07 Sudan humanitarian overview, August 2007
OCHA 09/07 Darfur: Humanitarian profile
UNHCR 09/07 West Darfur Protection Review
UNICEF 05/07 Darfur Nutrition Update
UNICEF 07/07 Darfur Nutrition Update
UNNews 31/07/07 Security Council autheorises hybrid UN-African Union operation
in Darfur
UNNews 24/09/07 Flood victims in Sudan mount by 100,000 to well over half
million, UN reports
UNNews 27/09/07 UN mission reports more attacks on aid workers in South Darfur
West Africa
Niger
ACH 04/07 Enquête nutritionelle et de mortalité rétrospective
Fews 07/07 Perspectives sur la sécurité alimentaire
Central Africa
Chad
Epicentre/ 05/07 Enquête nutritionelle et de mortalité retrospective dans les
camps de déplacés MSF autour de Goz Beida, Dar es Sila, Tchad
Fews 07/07 Tchad: Rapport bimestriel sur la Sécurité Alimentaire et la Nutrition
Fews 09/07 Tchad: Rapport bimestriel sur la Sécurité Alimentaire et la Nutrition
ICRC 26/09/07 Chad: ICRC activities May to September 2007
IRIN 04/09/07 Chad: Floods hit refugees and displaced in east
MSP/Joint 09/07 Résultat d’analyse de l’enquête conjointe MSP/INSED-MP/OMS/PAM/UNICEF
du 26 Mai au 26 Juin, draft 1
UNSC 25/09/07 Security council authorise establishment of “multidimentional
presence” in Chad, Central African Republic, unanimously adopting resolution
1778 (2007)
WHO 06/07 La situation de l’hépatite E à l’Est du Tchad
DRC
AAH-US/ 05/07 Enquête nutritionnelle anthropométrique zone de santé d’Idiofa,
UNICEF province de Bandudu, Republique Democratique du Congo
AAH-US/ 05/07 Enquête nutritionnelle anthropométrique ,zone de santé de Gungu,
UNICEF province de Bandudu, Republique Democratique du Congo
AAH-US/ 06/07 Enquête nutritionnelle anthropométrique ,zone de santé de Bukana,
UNICEF province de Katanga, Republique Democratique du Congo
AAH-US/ 07/07 Enquête nutritionnelle anthropométrique ,zone de santé de Buta,
UNICEF province Orientale, Republique Democratique du Congo
AAH-US/ 07/07 Enquête nutritionnelle anthropométrique ,zone de santé de Mangobo,
UNICEF province Orientale, Republique Democratique du Congo
OCHA 28/09/07 DR Congo: OCHA North Kivu humanitarian situation report
UNHCR 29/09/07 DRC:Many thousands still fleeing fighting in North Kivu province
WFP 13/09/07 Renewed violence means tough life for DRC’s displaced
WHO 27/09/07 Ebola haemorrhagic fever in the DRC-update 3
WV/PRONANUT 03/07 Enquête nutritionnelle: Anthropométrie et mortalité
Uganda
AAH-US/ 05/07 Nutritional anthropometric survey, final report, IDP camps and
resettlement areas UNICEF of Lira district, Northern Uganda
AAH-US/ 05/07 Nutritional anthropometric survey, final report, IDP camps and
resettlement areas UNICEF of Gulu and Amuru districts, Northern Uganda
AAH-US/ 05/07 Nutritional anthropometric survey, final report, IDP camps and
resettlement areas UNICEF of Apac and Oyam districts, Northern Uganda
Fews 09/07 Uganda food security update
MoH/Joint 03/07 Rapid Nutrition Assessment in Greater Kotido, Final report
UNHCR 11/09/07 Uganda’s IDP camps start to close as peace takes hold
UNICEF 28/09/07 Uganda: UNICEF flood response
WFP/DHO 08/07 The health and nutrition assessment in internally displaced
people’s camps of Pader district, preliminary report
 Table Continued...
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The Greater Horn region
Kenya
Wajir district - The survey was conducted by MERLIN in April 2007. A
two-stage cluster sampling survey of 30 clusters was conducted to measure 884
children. The survey also estimated measles vaccination and vitamin A
distribution coverage, crude and under-five mortality rates and various food
security and public health indicators.
Turkana district - Two surveys were conducted by WV in May 2007.
Two-stage cluster sampling surveys of 30 clusters of 30 households in Central,
Kolokol, Kerio, Lokichar, Lokori & Lomelo divisions on one hand and in Kainuk,
Katilu, Loima and Turkwell divisions on the other hand, were conducted. The
survey also estimated measles vaccination and vitamin A distribution coverage,
crude and under-five mortality rates and various food security and public health
indicators.
Somalia
Lower & Middle Shabelle regions - Two two-stage 30-by-30
cluster-sampled nutrition surveys were conducted by FSAU/joint in riverine
areas, agro-pastoral areas in May 2007. The surveys also estimated measles
vaccination and vitamin A distribution coverage, crude and under-five mortality
rates and various food security and public health indicators.
Burhakaba district, Bay region - Two two-stage 30-by-30
cluster-sampled nutrition surveys were conducted by FSAU/joint in pastoral and
agro-pastoral areas in May 2007. The surveys also estimated measles vaccination
and vitamin A distribution coverage, crude and under-five mortality rates and
various food security and public health indicators.
IDPs, Galcayo town, Mudug region - An exhaustive assessment was
conducted by FSAU/joint in May 2007. 762 children were measured. The survey also
estimated measles vaccination and vitamin A distribution coverage, crude and
under-five mortality rates and various food security and public health
indicators.
Coastal Deeh, Bari, Nugal & Mudug regions - A two-stage 30-by-30
cluster-sampled nutrition surveys was conducted by FSAU/joint in May 2007. The
survey also estimated measles vaccination and vitamin A distribution coverage,
crude and under-five mortality rates and various food security and public health
indicators.
Lower & Middle Juba regions - Three two-stage 30-by-30 cluster-sampled
nutrition surveys were conducted by FSAU/joint in riverine areas, agro-pastoral
and pastoral areas in June 2007. The surveys also estimated measles vaccination
and vitamin A distribution coverage, crude and under-five mortality rates and
various food security and public health indicators.
Sudan
Al Salam IDP camp, South Darfur - A random-sampled nutrition survey
was conducted by ACF-F in May 2007. A two-stage 30-by-26 cluster sampling
methodology was used to measure 808 children. The survey also estimated measles
vaccination coverage and crude and under-five mortality rates.
Kass town, South Darfur - A random-sampled nutrition survey was
conducted by ACF-F in June 2007. A two-stage 30-by-30 cluster sampling
methodology was used to measure 957 children. The survey also estimated measles
vaccination coverage and crude and under-five mortality rates.
Seleah, South Darfur - A random-sampled nutrition survey was conducted
by ACF-F in August 2007. A two-stage 30-by-26 cluster sampling methodology was
used to measure 809 children. The survey also estimated measles vaccination
coverage and crude and under-five mortality rates.
Kebkabiya town, North Darfur - A random-sampled nutrition survey was
conducted by ACF-F in June 2007. A two-stage 30-by-30 cluster sampling
methodology was used to measure 960 children. The survey also estimated measles
vaccination coverage and crude and under-five mortality rates.
Abu Shok and As Salaam IDP camps, North Darfur - A random-sampled
nutrition survey was conducted by ACF-F in June 2007. A two-stage 30-by-30
cluster sampling methodology was used to measure 960 children. The survey also
estimated measles vaccination coverage and crude and under-five mortality rates.
Central, Northern and Southern Payams, Malakal county, Upper Nile -
The survey was conducted by AAH-US in March-April 2007. A two-stage cluster
sampling methodology of 34 clusters was used to measure 759 children between
6-59 months. The survey also estimated measles vaccination coverage and
retrospective mortality rates over three months prior to the survey.
Sobta corridor, Upper Nile state - A random-sampled nutrition survey
was conducted by GOAL in July 2007. A two-stage 30-by-23 cluster sampling
methodology was used to measure 707 children. The survey also estimated measles
vaccination and vitamin A distribution coverage, crude and under-five mortality
rates and various food security and public health indicators.
Twic county, Warap state - A random-sampled nutrition survey was
conducted by GOAL in March 2007. A two-stage 30-by-24 cluster sampling
methodology was used to measure 727 children. The survey also estimated measles
vaccination and vitamin A distribution coverage, crude and under-five mortality
rates and various food security and public health indicators.
Kurmuk county, Blue Nile state - A random-sampled nutrition survey was
conducted by GOAL in April 2007. A two-stage 30-by-18 cluster sampling
methodology was used to measure 555 children. The survey also estimated measles
vaccination and vitamin A distribution coverage, crude and under-five mortality
rates and various food security and public health indicators.
Athooc (Baidit and Jalle) districts, South Bor county, Jonglei state -
The survey was conducted by AAH-US in June 2007. A two-stage cluster sampling
methodology of 38 clusters was used to measure 829 children between 6-59 months.
The survey also estimated measles vaccination coverage and retrospective
mortality rate over three months prior to the survey.
Khorfulus and Atar areas, Jongley state - The survey was conducted by
AAH-US in June 2007. A two-stage cluster sampling methodology of 34 clusters was
used to measure 741 children between 6-59 months. The survey also estimated
measles vaccination coverage and retrospective mortality rate over three months
prior to the survey.
West Africa
Niger
Mayahi department, Maradi region - The survey was conducted by ACH-S
in April 2007. A two-stage cluster sampling methodology of 30 clusters of 18
households was used to measure 927 children between 6-59 months. The survey also
estimated measles vaccination and vitamin A distribution coverage, crude and
under-five mortality rates and various food security and public health
indicators.
Central Africa
Chad
Gourounkoun, Koubigou, Gassire & Koloma IDP camps - The survey was
conducted by Epicentre/MSF-F in May 2007. A two-stage cluster sampling
methodology of 30 clusters was used to measure 911 children between 6-59 months.
The survey also estimated measles vaccination coverage and retrospective
mortality rates over 2 months prior to the survey.
Democratic Republic of Congo
Rwanguba health zone, North Kivu - The survey was conducted by WV and
PRONANUT in March 2007. A two-stage 30 cluster sampling methodology was used to
measure 957 children between 6-59 months. The survey also estimated measles
vaccination coverage and retrospective mortality rate.
Mangobo health zone, Orientale - The survey was conducted by AAH-US in
July 2007. A two-stage 30 cluster sampling methodology was used to measure 962
children between 6-59 months. The survey also estimated measles vaccination
coverage and retrospective mortality rate.
Buta health zone, Orientale - The survey was conducted by AAH-US in
July 2007. A two-stage 30 cluster sampling methodology was used to measure 896
children between 6-59 months. The survey also estimated measles vaccination
coverage and retrospective mortality rate.
Bukama health zone, Katanga - The survey was conducted by AAH-US in
June 2007. A two-stage 30 cluster sampling methodology was used to measure 949
children between 6-59 months. The survey also estimated measles vaccination
coverage and retrospective mortality rate.
Idiofa health zone, Bandudu - The survey was conducted by AAH-US in
May 2007. A two-stage 30 cluster sampling methodology was used to measure 938
children between 6-59 months. The survey also estimated measles vaccination
coverage and retrospective mortality rate.
Gungu health zone, Bandudu province - The survey was conducted by AAH-US
in May 2007. A two-stage 30 cluster sampling methodology was used to measure 966
children between 6-59 months. The survey also estimated measles vaccination
coverage and retrospective mortality rate.
Uganda
IDP camps, Pader district, Northern Uganda - The survey was conducted
by WFP/DHO in August 2007. A random sampling methodology was used to measure
2474 children between 6-59 months. The survey also estimated measles vaccination
and vitamin A distribution coverage, crude and under-five mortality rates and
various food security and public health indicators.
IDP camps and Resettlement areas, Apac & Oyam districts, Northern Uganda -
The survey was conducted by AAH-US in May 2007. A two-stage cluster sampling
methodology of 32 clusters was used to measure 669 children between 6-59 months.
The survey also estimated measles vaccination coverage and retrospective
mortality rate.
IDP camps and Resettlement areas, Gulu & Amuru districts, Northern Uganda
- The survey was conducted by AAH-US in May 2007. A two-stage cluster
sampling methodology of 32 clusters was used to measure 763 children between
6-59 months. The survey also estimated measles vaccination coverage and
retrospective mortality rate.
IDP camps and Resettlement areas, Lira district, Northern Uganda - The
survey was conducted by AAH-US in May 2007. A two-stage cluster sampling
methodology of 32 clusters was used to measure 651 children between 6-59 months.
The survey also estimated measles vaccination coverage and retrospective
mortality rate.
Indicators, interpretation and classification
The methodology and analysis of nutrition and mortality surveys are checked
for compliance with internationally agreed standards (SMART, 2002; MSF, 2002;
ACF, 2002).
Most of the surveys included in the Reports on Nutrition Information in Crisis
Situations are random sampled surveys, which are representative of the
population of the targeted area. The Reports may also include results of rapid
nutrition assessments, which are not representative of the target population but
rather give a rough idea of the nutrition situation. In that case, the
limitations of this type of assessments are mentioned.
Most of the nutrition survey results included in the Reports target children
between 6-59 months but may also include information on other age groups, if
available.
Detailed information on the methodology of the surveys which have been reported
on in each issue, is to be found at the end of the publication.
Nutrition indicators
in 6-59 month olds
Unless specified, the Reports on Nutrition Information in Crisis Situations use
the following internationally agreed criteria:
- Wasting, defined as weigh-for-height index (w-h) < -2 Z-scores.
- Severe wasting, defined as weigh-for-height index < -3 Z-scores.
- Oedematous malnutrition or kwashiorkor, diagnosed as bilateral pitting oedema,
usually on the upper surface of the feet. Oedematous malnutrition is always
considered as severe malnutrition.
- Acute malnutrition, defined as the prevalence of wasting (w-h < -2 Z-scores)
and/or oedema
- Severe acute malnutrition, defined as the prevalence of severe wasting (w-h <
-3 Z-scores) and/or oedema.
- Stunting is usually not reported, but when it is, these definitions are used:
stunting is defined as < - 2 Zscores height-for-age, severe stunting is defined
< - 3 Zscores height-for-age.
- Mid-Upper-Arm Circumference (MUAC) is sometimes used to quickly assess
nutrition situations. As there is no international agreement on MUAC cut-offs,
the results are reported according to the cut-offs used in the survey.
- Micro-nutrient deficiencies are reported when data are available.
Nutrition indicators in adults
No international consensus on a definitive method or cut-off to assess adult
under-nutrition has been reached (SCN, 2000). Different indicators, such as Body
Mass Index (BMI, weight/height2), MUAC and oedema, as well as different cut-offs
are used. When reporting on adult malnutrition, the Reports always mention
indicators and cut-offs used by the agency providing the survey.
Mortality rates
In emergency situations, crude mortality rates and under-five mortality rates
are usually expressed as number of deaths/10,000 people/day.
Interpretation of indicators
Prevalence of malnutrition and mortality rates are late indicators of a crisis.
Low levels of malnutrition or mortality will not indicate if there is an
impending crisis. Contextual analysis of health, hygiene, water availability,
food security, and access to the populations, is key to interpret prevalence of
malnutrition and mortality rates.
Thresholds have been proposed to guide interpretation of anthropometric and
mortality results.
A prevalence of acute malnutrition between 5-8% indicates a worrying nutritional
situation, and a prevalence greater than 10% corresponds to a serious nutrition
situation (SCN, 1995). The Crude Mortality Rate and under-five mortality rate
trigger levels for alert are set at 1/10,000/day and 2/10,000/day respectively.
CMR and under-five mortality levels of 2/10,000/day and 4/10,000/day
respectively indicate a severe situation (SCN, 1995).
Those thresholds have to be used with caution and in relation to contextual
analysis. Trend analysis is also recommended to follow a situation: if nutrition
and/or mortality indicators are deteriorating over time, even if not above
threshold, this indicates a worsening situation.
Classification of situations
In the Reports, situations are classed into five categories relating to risk
and/or prevalence of malnutrition.
The prevalence/risk is indirectly affected by both the underlying causes of
malnutrition, relating to food, health and care, and the constraints limiting
humanitarian response. These categories are summations of the causes of
malnutrition and the humanitarian response:
- Populations in category I – the population is currently in a critical
situation; they either have a very high risk of malnutrition or surveys have
reported a very high prevalence of malnutrition and/or elevated mortality rates.
- Populations in category II are currently at high risk of becoming malnourished
or have a high prevalence of malnutrition.
- Populations in category III are at moderate risk of malnutrition or have a
moderately high prevalence of malnutrition; there maybe pockets of high
malnutrition in a given area.
- Populations in category IV are not at an elevated nutritional risk.
- The risk of malnutrition among populations in category V is not known.
Nutrition Causal Analysis
The Reports on Nutrition Information in Crisis Situations have a strong public
nutrition focus, which assumes that nutritional status is a result of a variety
of inter-related physiological, socio-economic and public health factors (see
figure). As far as possible, nutrition situations are interpreted in line with
potential underlying determinants of malnutrition.
References
Action contre la Faim (2002) Assessment and treatment of malnutrition in
emergency situation. Paris : Action contre la Faim.
Médecins sans Frontières (2002) Nutritional guidelines.
SCN (2000) Adults, assessment of nutritional status in emergency affected
population.
Geneva: SCN.
University of Nairobi (1995) Report of a workshop on the improvement of the
nutrition of refugees and displaced people in Africa. Geneva : SCN.
SMART (2002) www.smartindicators.org
Young (1998) Food security assessment in emergencies, theory and practice of a
livelihoods approach.
NICS Quarterly Reports
The UN Standing Committee on Nutrition, which is the focal point for
harmonizing nutrition policies in the UN system, issues these Reports on
Nutrition Information in Crisis Situations with the intention of raising
awareness and facilitating action. The Reports are designed to provide
information over time on key outcome indicators from emergency- affected
populations, play an advocacy role in bringing the plight of emergency affected
populations to the attention of donors and humanitarian agencies, and to
identify recurrent problems in international response capacity.
The Reports on Nutrition Information in Crisis Situations are aimed to cover
populations affected by a crisis, such as refugees, internally displaced
populations and resident populations.
This system was started on the recommendation of the SCN's working group on
Nutrition of Refugees and Displaced People, by the SCN in February 1993. Based
on suggestions made by the working group and the results of a survey of the
readers, the Reports on Nutrition Information in Crisis Situations are published
every three months.
Information is obtained from a wide range of collaborating agencies, both UN
and NGOs. The Reports on Nutrition Information in Crisis Situations are put
together primarily from agency technical reports on nutrition, mortality rates,
health and food security.
The Reports provide a brief summary on the background of a given situation,
including who is involved, and what the general situation is. This is followed
by details of the humanitarian situation, with a focus on public nutrition and
mortality rates. The key point of the Reports is to interpret anthropometric
data and to judge the various risks and threats to nutrition in both the long
and short term.
This report is issued on the general responsibility of the Secretariat of the
UN System/Standing Committee on Nutrition; the material it contains should not
be regarded as necessarily endorsed by, or reflecting the official positions of
the UNS/SCN and its UN member agencies. The designations employed and the
presentation of material in this publication do not imply the expression of any
opinion whatsoever on the part of the UNS/SCN or its UN member agencies,
concerning the legal status of any country, territory, city or area or of its
authorities, or concerning the delimitation of its frontiers or boundaries.
___________________________________________
This report was compiled by Dr Claudine Prudhon of the UNS/SCN Secretariat
Sarah Philpot assisted in the editing.
Design concept: Marie Arnaud Snakkers
The chairman of the UNS/SCN is Catherine Bertini
___________________________________________
The SCN Secretariat and the NICS Coordinator extend most sincere thanks to
all those individuals and agencies who have provided information and time for
this issue, and hope to continue to develop the excellent collaboration which
has been forged over the years.
___________________________________________
If you have information to contribute to forthcoming reports, or would like
to request back issues of the report, please contact:
Claudine Prudhon, NICS Coordinator,
UNS/Standing Committee on Nutrition
20, avenue Appia, 1211 Geneva 27, SWITZERLAND
Tel: +(41-22) 791.04.56, Fax: +(41-22) 798.88.91,
Email: scn@who.int
Web: http://www.unsystem.org/scn
___________________________________________
Funding support is gratefully acknowledged from the Canadian International
Development Agency, the Department of Foreign Affairs, Ireland, the Royal
Ministry of Foreign Affairs, Norway and UNHCR..
This report was made possible through the support provided to the Food and
Nutrition Assistance (FANTA) Project by the Office of Program, Policy and
Management at the Bureau for Democracy, Conflict and Humanitarian Assistance and
the Office of Health, Infectious Diseases and Nutrition at the Bureau for Global
Health at the U.S. Agency for International Development, under the terms of
Cooperative Agreement No. HRN-A-00-98-00046-00 awarded to the Academy for
Educational Development (AED). The opinions expressed herein are those of the
authors and do not necessarily reflect the views of the US Agency for
International Development.
ISSN 1564-376X
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