emergency nutrition quarterly bulletin · silti woreda compared with may 2006 sur-vey results with...

QUARTERLY BULLETIN (Second Quarter 2007)

EMERGENCY NUTRITION

ENCU June 30, 2007

INSIDE

ENCU/DPPAAddis AbabaTel. (011) 5 523556e-mail: [email protected]://www.dppc.gov.et

SNNP REGION SILTI WOREDA, Page 2 BONA WOREDA, Page 2DALE & ALETA WONDO WOREDAS, Page 3

OROMIA REGIONMETA ROBI/ADA BERGA & ABUNA GINDBERETWOREDAS, Page 5MELKA BELLO WOREDA, Page 6

AFAR REGIONCHIFRA WOREDA, Page 8

SOMALI REGIONELKARE & HARGELE WOREDAS, Page 9

TIGRAY REGIONPage 11

QUALITY CHECK OF ANTHROPOMETRYDATA FROM NUTRITION SURVEYS Page 13

DATA QUALITY CHECK OF EOS MUACSCREENINGPage 15

NUTRITION SURVEY DATABASE Page 15

PERFORMANCE OF EMERGENCY NUTRI-TION INTERVENTION PROGRAMMES Page 15

UPDATE ON THE PROGRESS OF NUTRI-TION CLUSTER ROLL OUT IN ETHIOPIAPage 17

SUMMARY FINDINGS OF MUAC, WFH ANDBODY-SHAPE RESEARCH STUDYPage 17

Emergency Nutrition Coordination UnitEarly Warning Department

(Disaster Prevention and Preparedness Agency)

Nutrition Survey Results - EthiopiaApril - June 2007

0

2

4

6

8

10

12

14

16

18

Bona

Elkare/Hargele

Chifra

Central M

ixed Crop LZ

Werie Catch

ment LZ

Dale/AW Cofee LZSilti

West Centra

l Teff L

Z

Middle Tekeze LZ

Enderta Dry M

idland LZ

Meta Robi/Ada Berga

Atsbi W. H

ighland LZ

Eastern Platu LZ

Melka Bello

Abuna Gindberet

Raya Valley LZ

Prev

alenc

e of a

cute

maln

utrit

ion (%

)

Severe Acute Malnutrition Moderate Acute Malnutrition

A total of 16 nutrition surveys were conducted by SCUK, GOAL, ACF, WV-Ethiopia,SCUSA, RENCU/DPPB in SNNPR, Afar, Somali and Tigray regions between lateMarch and early June 2007. Twelve nutrition surveys were carried out in the predom-inantly cropping areas of Oromia, SNNPR and Tigray regions during the late post-har-vest meher season while the remaining four were conducted in the pastoral areas ofSomali and Afar regions. The prevalence of global acute malnutrition was below 10percent in all surveyed woredas of Tigray, Oromia and SNNPR except in Bona inSNNPR where Global Acute Malnutrition (GAM) was 16.4 percent. GAM was alsoslightly above 10 percent in Chifra and in the surveyed pastoral areas as shown in fig-ure 2. The summary findings of the surveys conducted are presented and discussedin subsequent sections. Figure 1 presents nutrition intervention programmes, nutritionsurvey coverage and EOS at woreda level.

Figure 2

Figure 1

Silti Woreda

Compared with May 2006 sur-vey results with GAM of 12.2percent, the level of malnutri-tion in 2007 had decreasedthough not statistically signifi-cant.

ENCU June 30, 2007

A 23 by 33 cluster nutrition survey usingthe SMART methodology was conduct-ed by GOAL in Silti woreda in March2007 to serve as an end line evaluationof its CTC programme that had beenimplemented for eight months and hand-ed over to the woreda health sector inJanuary 2007. A total of 763 childrenaged 6-59 months were surveyed.Retrospective mortality information wascollected from 2690 individuals using 90days recall period. The Data wereanalysed using Nutrisurvey SMART soft-ware.

Nutrition: The prevalence of GAM wasestimated at 8.9 percent with 0.7 per-cent Severe Acute Malnutrition (SAM)while bilateral oedema was 0.1 percent.GAM was relatively higher among young(6-29 months) than among older chil-dren (30-59 months). Compared withMay 2006 survey results with GAM of12.2 percent, the level of malnutrition in2007 had decreased though not statisti-cally significant. The prevalence of mal-nutrition was classified as poor based onthe national assessment guideline andtypical in Ethiopian context.

Health: Mortality rates with CMR at0.11/10,000/day and under five mortalityrate at 0.16/10,000/day fell below theaverage levels for developing countries.Both crude and under five death rateshad decreased compared to the May2006 levels of 0.46 and 0.94/10,000/dayrespectively. Morbidity in children wasestimated at 23.9 percent with acutewatery diarrhea being top on the list ofmorbidities. Immunization coverage forBCG was 57.3 percent and measles75.1 percent. Vitamin A coverage wasgenerally higher at 95.0 percent. About10 percent of the population has accessto safe drinking water.

Livelihood/Food Security: Accordingto the SNNPR Livelihood Profiles byFewsNet in January 2006, large portionof the woreda lies within Alaba-MarekoLowland Pepper LZ. It was reported thatat the time of the survey the food securi-ty situation was satisfactory. The woredareceived adequate rain during previous

SILTE ZONE Silti Woreda

meher & the current belg seasons. Thecommunities interviewed rated the live-stock and pasture conditions as average(42.4 percent) and good (63.6 percent)respectively.

Conclusion & Recommendations: The prevalence of global acute malnutri-tion (8.9 percent) was relatively lowerthan in 2006 at the same season indicat-ing an improvement. Mortality was with-in acceptable limits. This was an indica-tion of the normal food security situationin the woreda at the time of the survey.However, there was no improvement invaccination coverage. Access to cleanwater remained a concern to beaddressed in the woreda. It was recom-mended to improve vaccination cover-age and assure proper close monitoringduring the upcoming hunger season.

Bona WoredaThe levels of malnutritionwere classified as critical.Based on the SAM prevalenceof 3.2 percent as defined by Z-score it was estimated that atotal of 714 under-five childrenneeded therapeutic and while2943 were to be enrolled insupplementary feeding inter-ventions.

SNNP REGION

SIDAMA ZONE

Bona Woreda

A mult-agency standard nutrition 20 x36cluster survey using the SMARTmethodology was conducted in BonaWoreda in May 2007 after rapid assess-ment results indicated a deterioratingnutritional status in April. A sample sizeof 720 children aged 6-59 months partic-ipated in the survey.

Nutrition: The prevalence of global andsevere acute malnutrition was as 16.4and 3.2 percent respectively. No a singleoedema case was reported. MUACresults mirrored that estimates by WHZ.No significant different between boysand girls. The levels of malnutrition wereclassified as critical according to thenational guideline. Based on the SAMprevalence of 3.2 percent as defined byWHZ-score it was estimated that a totalof 714 under five children needed thera-peutic and while 2943 were to beenrolled in supplementary feeding inter-ventions. However, the admission crite-ria are based on weight for height per-centage median bringing down the num-ber of children that would be enrolled inTFP and SFP to 434 and 2639 respec-tively. Bona is a newly established wore-da, thus, no baseline data were avail-able for comparison.

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Health: The CMR was found to be0.43/10,000/day while under five mortal-ity rate was 1.1/10,000/day. No baselinedata on previous levels of death ratewas available in the woreda; however,under five mortality rates indicated anemergency that was not critical accord-ing to the national guidelines.Retrospective morbidity two weeks pre-ceding the survey indicated that AcuteWaterly Diarrhoea (AWD) was mostprevalent accounting for 36.8 percent ofthe total reported morbidity. Scabiesranked second with 19.1 percent. Theoverall morbidity prevalence was mod-est at 21.1 percent.

Measles immunization coverage bothroutine and during Enhanced OutreachStrategy (EOS) campaign was 77 per-cent, 11 percentage points higher thanthe national average. BCG confirmed byscar trailed at 46.1 percent far below thenational average. Vitamin supplementa-tion coverage in the last 6 months wassomewhat lower at 58.9 percent. Table 1summarises the survey results conduct-ed in SNNPR. Generally the assessedand reported indicators varied consider-ably across the woredas in the region.

Livelihood/Food Security: The main(94.4 percent) livelihood of the commu-nities in Bona is subsistence agriculturecomplemented by casual labour.However, at the time of survey, 23 per-cent of the interviewed households werepurchasing food. About 63 percent ofthe interviewed households were eatingtwo meals per day to cope with the dete-riorating food situation in the woreda.Food and nutrition interventions in thesurveyed woreda are presented in Table2.

Conclusion: The nutritional status inthe woreda was critical. SC/OTP pro-gramme was recommended and imme-diately initiated by Save the Children USin Ethiopia funded by UN OCHA. It wasalso recommended to strengthen theEOS/ TSFP intervention in Bona includ-ing distributing TSFP food on monthlybasis rather than once in three monthsto take care of children that were notcaptured by the EOS screening pro-gramme and prevent further worseningof the children's nutritional status.Improvement in water services and gen-eral health education to address theAWD was also recommended.

Dale and Aleta Wondo woredas

ACF conducted a 16 x 43 standard nutri-tion survey in the Coffee LivelihoodZone of Dale and Aleta Wondo woredasas a follow up of the December 2006survey. At the time of preparing this bul-lettin survey report was still not yet sub-mitted to ENCU and hence the presen-tation is limited to the anthropometryand mortality results.

The prevalence of global acute malnutri-tion was estimated at 9.1 percent andSAM at 0.9 percent. Despite that thecurrent survey was conducted relativelyin the hunger season, there was a statis-tically significant decrease in the level ofacute malnutrition from 16.4 percentGAM (CI: 13.7-19.2 percent) inDecember 2006 to 9.1 percent (CI6.6-11.6 percent) in June 2007.

The crude and under five mortality rateswere estimated at 0.05 and0.23/10,000/day respectively, far belowthe emergency levels. Contrary to acutemalnutrition, there was no significantdecrease in both crude and underfivemortality rates betwewn the two sur-veys.

Dale & Aleta WondoWoredas

Despite that the current sur-vey was conducted relativelyin the hunger season, therewas a statistically significantdecrease in the level of acutemalnutrition from 16.4 percentin December 2006 to 9.1 per-cent in June 2007.

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Sidama Zone Silti Zone Bona Dale Aleta Wondo Silti

Estimated population size Estimated Under Five population

111,495 22,299

406,354 81,271

368038 73,608

162,807 32,561

Productive Safety Net – No of beneficiaries % of rural population

NO 0.0

23,550 6.0

23,490 6.4

19,841 12.2

Food Aid Jan-June 07 – No of beneficiaries % of rural population

NO 0.0

NO 0.0

NO 0.0

NO 0.0

EOS- 6th round screening No of children acutely malnourished*

As % of screened children

Dec. 2006 2,517 13.0

No No 0.0

Dec. 2006 568 8.6

Dec. 2006 3,105 10.4

Therapeutic Feeding Unit Bona HC Bokaso HC

Mesenkela HC Yirgalem Hospital

Aleta Wendo HC

Chiko HC No

Outreach Therapeutic Programme Yes SC-US

Yes ACF

Yes ACF

Yes GOAL

Table 2: Food and Nutrition Interventions in Surveyed Woredas of SNNPR

Table 1: Survey Results for SNNPR

* MUAC below 12.0 cm and/or oedema

Sidama zone Silti zone Key indicators Bona

May 20-27 Dale & Aleta Wondo

CLZ June Silti

23-28 March

% GAM in Z-scores (95% CI) 16.4 (12.3-20.6) 9.1 (6.6-11.6) 8.9 (6.1-11.8)

% SAM Z-scores (95% CI) 3.2 (1.3-5.1) 0.9 (0.1-1.8) 0.7(0.1-1.2)

% Kwashiorkor 1.1 0.2 0.1 CMR Death/10,000/day (95% CI) 0.43 (0.18-0.67) 0.05 (0.0-0.15) 0.11 (0.0-0.23) U5MR Death//10,000/day (95% CI) 1.12 (0.38-1.85) 0.23 (0.0-1.06) 0.16 (0.0-0.44)

Major causes of U5MR Malnutrition & unknown NR* Unknown

% Morbidity 21.1 NR 23.9 Major illnesses or symptoms Diariahoea & scabies NR AWD % Measles coverage by card (95% CI) 4.0 (2.3-6.7) NR 5.1(CI: NR) % Measles coverage by card + recall (95% CI) 73.0 (67.9-77.5) NR 75.1 (CI: NR)

% BCG coverage (scar) (95% CI) 46.1(40.9-51.4) NR 57.3 (CI: NR) % Vitamin A in past 6 months (95% CI) 58.9 (53.0-63.4) NR 95.0 (CI: NR)

* Not Reported

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Meta Robi/Ada Bergaand Abuna Gindberet

Woredas

The levels of malnutrition inMeta Robi and Ada Bergawere classified as poor andtypical for chronically mal-nourished communities.

Based on the reports of deterioratingfood security by the Multi AgencyMonitoring Team, DPPA requestedSCUK to conduct nutrition surveys inmost affected woredas of West Shewazone. Two separate surveys, one inMeta Robi/Ada Berga and the second inAbuna Gindberet woreda, were under-taken from 24 to 28 May 2007 using theSMART methodology. The findings aresummarized in Table 3 and discussed insubsequent topics below.

Nutrition: The prevalence of globalacute malnutrition was estimated at 6.8percent in Meta Robi/Ada Berga and 5.1percent in Abuna Gindberet. Severeacute malnutrition was 0.5 and 0.3 per-cent in (Meta Robi/Ada Berga) andAbuna Gindberet respectively. No previ-ous surveys had been conducted in allthe survey woredas to allow comparisonof the current findings. According to thenational guideline the levels of malnutri-tion in Meta Robi/Ada Berga and AbunaGindberet were classified as poor andtypical for chronically malnourishedcommunities.

Health: Both CMR and U5MR were lowand within the non-emergency levels,with CMR of 0.08 and U5MR of 0.24 forMeta Robi/Ada Berga and CMR of 0.13and U5MR of 0.89/10,000/day in AbunaGindberet woreda. Overall morbidity inchildren was low at 15.2 and 7.6 percentin Meta Robi/Ada Berga and AbunaGindberet respectively. Diarrhea &cough were the main causes of morbidi-ty among children.

Immunization coverage was below aver-age as indicated by low BCG coverageof 38.0 percent in Meta Robi/Ada Bergaand 20.6 percent in Abuna Gindberetworeda. Measles vaccination (card +recall) coverage was also low both inMeta Robi/Ada Berga (64.2 percent) andAbuna Gindberet (69.5 percent). VitaminA supplementation was higher at 76.6and 81.6 percent in Meta Robi/AdaBerga and Abuna Gindberet respective-ly. Access to health services was gener-

ally described as poor in the lowlandparts.

Livelihood/Food Security: Majority ofthe population in Meta Robi/Ada Bergaand Abuna Gindberet woredas relies onagriculture and benefit from both meherand belg seasons with high dependenceon meher rains. The previous harvestwas reported below normal due to theeffect of flood and landslide during theprevious keremt season where the low-lands were more affected and displacedmany households.

Shortage of grazing land and livestockdisease was reported in the lowlandparts of Abuna Gindeberet woreda.These woredas became food insecurein the recent years due to populationgrowth, declining landholding, degrada-tion, poor and untimely rain falls. A totalof 50,995 beneficiaries in Meta Robi/AdaBerga and Abuna Gindberet woredaswere receiving emergency food assis-tance. Table 4 shows food and nutritioninterventions in the surveyed woredas inOromia region.

Conclusion: The prevalence of globalacute malnutrition in the three surveyedworedas was found to be low at the timeof the survey while the food security sit-uation in the lowland areas remainedpoor. Geographic bias might partlyexplained the low prevalence of acutemalnutrition as the nutritional status ofthe lowland might have been masked bythe effects of less affected agro ecologi-cal zones. In such a situation where thedistribution of malnutrition was hetero-geneous and highly localized, it wouldhave been more appropriate to do thesurvey by agro ecological basis as thiswould help to reflect the situation in thelowland areas.

Recommendations: Given the poorfood security situation in the lowlandareas the following recommendationswere made to prevent further deteriora-tion of the situation:

Continue with the ongoing emergencyrelief food assistance throughout the

OROMIA REGION

WEST SHEWA ZONE

Meta Robi/Ada Berga and AbunaGindberet Woredas

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Melka Bello WoredaThe nutritional status in MelkaBello was reported as "typical".The crude and under fivemortality rates were within thenormal levels.

A standard nutrition survey was conduct-ed in Melka Bello by Save the ChildrenUK using a 24 by 30 two stage clustersampling SMART methodology. A sam-ple size of 720 under five children and2895 individuals were interviewed toestimate the levels of malnutrition andcrude death rate respectively. The sur-vey was conducted among other thingsto provide information for IMC program-ming.

Nutrition: The nutritional status inMelka Bello was reported as "typical"with 6.2 percent global acute malnutri-tion. Severe acute malnutrition levelswere estimated at 0.6 percent. No base-line data in the woreda were availablefor comparison.

Health: The crude and under five mor-tality rates were estimated at 0.07 and0.14/10,000/day respectively, bothfalling within the normal levels. Morbidityin children was modest estimated at18.0 percent. Diarrheal disease was themost common cause of morbidity. It wasreported that the health care service andEPI coverage was below the nationalcoverage as indicated by low BCG andmeasles (card and recall) vaccinationcoverage rates of 55.8 and 41.0 percentrespectively. Vitamin A supplementationwas estimated at 68.6 percent.

Livelihood/Food Security: Majority ofthe population is agrarian and relies onrain fed agriculture and described ashighly meher dependent. The main cashcrops include chat and coffee. It wasreported that the woreda experiencedcrop failure in the previous five yearsdue to poor performance of both thekeremt and belg rains and hence thearea was beneficiary of food aid in the

past years. However, a relatively betterfood security situation was reported atthe time of the survey due to better per-formance of meher rain in 2006. At thetime of the survey 80 percent of thehouseholds interviewed stated that thecurrent belg rain started one month laterthan its usual time of onset, henceassumed to affect the belg harvest. Atotal of 18 kebeles were beneficiary ofProductive Safety Net Programme(PSNP) while four others were assistedthrough an emergency relief pro-gramme.

Conclusion & Recommendations:The over all nutritional status in MelkaBello was normal as explained by lowprevalence of global acute malnutritionas well as acceptable levels of crudeand under five mortality rates. Foodsecurity was satisfactory. The perform-ance of the belg harvest would deter-mine whether the nutrition situation inthe belg-dependent areas was likely todeteriorate or not in the coming months.In the mean time it was recommended tocontinue the existing PSNP andstrengthen the routine EPI program withclose monitoring of the belg-dependentcommunities.

Melka Bello Woreda

EAST HARARGE ZONE

upcoming hunger season targeting thelowland population in all the threeworedas.

Strengthening the EPI programme inall the surveyed woredas.

Close monitoring of the overall situa-tion with particular attention to lowlandpopulation.

Table 3: Survey Results for Oromia

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Table 4: Food and Nutrition Interventions in Surveyed Woredas of OromiaEast

Hararge Zone

West Shewa Zone Region

Melka Bello Meta Robi Ada Berga Abuna Gindberet


146,051 29,210

144,252 28,850

117,922 23,584

200,522 40,104


24,626 16.9%

No 0.0

No 0.0

No 0.0

Food Aid April-June 07 – No of beneficiaries % of rural population

No 0.0

36,537 25.0

4,906 4.2

9,510 4.7

EOS Screening No of children acutely malnourished*

As a % of screened children

May 2006 1,849

6.3

May 2007 1,245

5.7

May 2007 851 4.1

No No 0.0

Therapeutic Feeding Unit No No No No

Outreach Therapeutic Programme No No No No


East Hararge zone West Shewa zone Key indicators Melka Bello

March 22- 4 April Meta Robi & Ada Berga 24-28 May

Abuna gindberet 24-28 May

% GAM in Z-scores (95% CI) 6.2 (4.3-8.0) 6.8 (5.0 - 8.7) 5.1(CI: 3.7 - 6.5) % SAM n Z-scores (95% CI) 0.6 (0.0-1.1) 0.5 (0.0 - 1.1) 0.3 (0.0 - 0.6) % Kwashiorkor 0.0 0.0 0.0 CMR Death/10,000/day (95% CI) 0.07(0.00- 0.16) 0.08 (0.0-0.18) 0.13 (0.0-0.28) U5MR Death/10,000/day (95% CI) 0.14 (0.0- 0.38) 0.24 (0.0-0.71) 0.89 (0.0-2.50) % Major causes of U5MR NR NR Diarrhoea % Morbidity 18.0 15.2 7.6 Major illnesses or symptoms Diarrhea & Cough Diarrhea & Cough Diarrhoea & Cough %Measles coverage by card (95% CI) 12.0 (4.3-19.7) 5.6 (1.0-10.1) 1.2 (0.0-2.4) %Measles coverage by card + recall (95% CI) 55.8 (48.0-63.6) 64.2 (54.4-73.9) 69.5 (60.7-78.2) % BCG coverage (scar) (95% CI) 41.0 (31.8-50.2) 38.0 (30.7-45.2) 20.6 (14.5-26.7) % Vitamin A in past 6 months (95% CI) 68.6 (60.2-77.0) 76.6 (69.7-83.5) 81.6 (76.2-87.0)

* Not Reported

*

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A 21x30 cluster nutrition survey wasconducted in Chifra woreda using theSMART methodology. A total of 639 chil-dren aged between 6-59 months wassampled and information on mortalitywas gathered from 2622 individualswithin a 90 days recall period. The sur-vey was conducted by Save theChildren UK in collaboration with theAfar DPPB.

Nutrition: The prevalence of GAM andSAM was estimated at 11.1 and 0.3 per-cent, respectively. No a single oedemacase was reported. On the other handsevere acute malnutrition estimated byMUAC <11cm was five times higher (at1.6 percent) than that was estimated byweight for height Z-score. Based on theWHZ SAM results no a single child waseligible for admission in the OTP pro-gramme. Considering that the overallmean Z-score of the study populationwas about -1 WHZ score, ENCU sus-pected that the SAM based on the WHZwas underestimated and recommendedOTP programme in Chifra woreda.

No significant difference among boysand girls was noted. No baseline data tocompare as this was the first time thesurvey was conducted in Chifra woreda.Taking into account presence of malnu-trition aggravating factors in the woreda,the level of malnutrition fell into the seri-ous category.

Health: The crude and under five deathrates were 0.41 and 0.93/10,000/dayrespectively. No baseline data to com-pare with the current survey, however,the CMR was somehow higher com-pared to levels found in developingcountries while that of under five waswithin the normal according to thenational guidelines.

The overall reported morbidity within twoweeks preceding the survey was rela-tively low at 13.6 percent. Of the report-

ed illnesses, fever accounted for above40 percent while AWD and cough wereresponsible for about 24 and 23 percentrespectively.

Immunization coverage as estimated bymeasles was about 47 percent. BCGcoverage confirmed by scar wasextremely low trailing at below 10 per-cent (8.9 percent). Vitamin A coveragewas 54.1 percent still considered lowcompared with the national average.

Livelihood/Food Security: Chifraworeda livelihood depends mainly onlivestock and its products. Unfortunatelylivestock were threatened by cumulativeeffect of recurrent droughts resultingfrom poor performance of Karma andcomplete failure of Sugum rains.Generally the food security was report-ed to be poor and was expected to dete-riorate for three to four weeks more. Thedrought was also reported to haveaffected school attendance and unusualdrop out of 95 percent was reported inSamsum primary school.

At the time of survey pasture was agreat problem and animal conditionswere described as average by the live-stock experts. Livestock prices haddecreased by 50 percent compared tosame period in 2006 because of thepoor animal conditions. Food prices wasreported to be stable with exception ofwheat

Herds of livestock were migrating fromthe woreda to other areas likeWarebabo (south Wollo zone) andHebru, Mille, Aura and Teru in search forgood pasture. 2007 was described asthe worst in the last five years in theworeda. The administration in the wore-da informed the survey team that, thelivestock migration was causing someconflict around Awash River.

Conclusion: The nutritional status inthe woreda was classified as seriousbased on the national categorizationand Sphere Standard. The big differencein SAM estimated by WHZ and MUACwas of concern. This was the first sur-vey in the woreda and thus it was not

Chifra Woreda

AFAR and SOMALI REGION

Chifra WoredaConsidering that the overallmean Z-score of the studypopulation was about -1 WHZscore, ENCU suspected thatthe SAM based on the WHZwas underestimated and rec-ommended OTP programmein Chifra woreda.

ZONE ONE

AFAR REGION

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A 15x 30 cluster nutrition survey wasconducted in Erkale and Hargeleworedas by the SC UK between Marchand April 2007 using the SMARTmethodology. Sample size for childrenaged 6-59 months was 459. Informationon mortality within 90 days of recall wascollected from 2085 individuals in orderto estimate the crude and under fivedeath rates.

Nutrition: The prevalence of GAM was15.7 percent while SAM was low at 0.9percent. No significant difference in lev-els of malnutrition between boys andgirls. No Oedema cases were reported.Based on survey results a total of 190under five children needed SC/OTPnutrition services while the correspon-ding figure for SFP was estimated to be3123.

The levels of malnutrition reported inApril 2007 had increased significantlycompared levels of GAM of 10.5 percentthat was reported in August 2006. Thetwo surveys were conducted in two dif-ferent seasons thereby confounding theinterpretation and nature of the increase.The levels of malnutrition were classifiedas critical. A summary of nutrition, healthand food security situations in Afar andSomali regions is presented in Table 5.

Health: Based on the survey resultscrude mortality rate was

0.57/10,000/day. The under five mortali-ty rate was 2.2/10,000/day. According tothe national guideline, the levels ofdeath rate among under five was classi-fied as serious and passed the emer-gency threshold for developing coun-tries and Sub Saharan Africa.Compared to the August 2006 findings,the CMR had slightly decreased whilethat of under five had considerablyincreased. The increased death ratewas likely to be due to AWD that wasreported to have led to several deathsespecially in Elkare woreda. Asexplained earlier seasonality limitsobjective comparison of the results inbetween two surveys.

The overall morbidity two weeks preced-ing the survey was about 40 percentwith a slight increase compared to the30.5 percent in August 2006. Diarrhoeacontinued to be top on morbidity list fol-lowed by cough and fever. Expandedprogramme for immunization in the twoworedas were far below the nationalaverages. Measles coverage stood at38.3 percent while BCG was just abovefive percent. Vitamin A supplementationdecreased significantly from 42.5 per-cent in August 2006 to 19 percent inApril 2007. The difference could beexplained by the fact that vitamin A sup-plementation is provided through EOSprogramme at six months interval. Bythe time of the survey more than sixmonths had passed since the previousEOS vitamin A supplementation.Generally immunization coverage in theworeda was low in both rounds of sur-veys.

Livelihood/Food Security: The foodsecurity in the two woredas wasdescribed as poor resulting from poorGu rains or no harvest in 2006. Animalconditions were explained as average inareas with relatively good pasture.However, milk for children was reportedto have been decreased. There were noreliable market for livestock due to RiftValley Fever animal and meat exportban and other reasons. Deyr rains werereported to be better compared with2006 and improved pasture and harvestin the woreda were expected. Table 6below shows food and nutrition interven-tions undertaken in the surveyedworedas in Afar and Somali regions.

SOMALI REGION

Elkare and Hargele Woredas

Elkere and HargeleWoredas

The levels of malnutrition of15.7 percent was classified ascritical and found to havebeen on the higher side com-pared to the previous surveyresults of August 2006.

possible to compare both malnutritionand death rate. PSNP and EOS inter-ventions were recommended to bestrengthened. The region also askedfood assistance from DPPA for 1555individuals. SC/OTP programme wasrecommended as well. IMC was dis-cussing with Afar authorities to start theSC/OTP intervention.

Food security prospect was expected toworsen further if no interventions wereto be made. Reduction of number ofmeals per day as a copping strategywas an indication that household foodsecurity had started been stretched.Normalization depended much on theSugum (rains in June)

AFDER AND LIBEN ZONE

Table 6: Food and Nutrition Interventions in Surveyed Woredas of Afar and Somali

ENCU June 30, 2007

However, before the nutrition survey was conducted Islamic Relief implemented SFP in10 sites (5 in Elkare and 5 in Hargele) in the two woredas. It was suspected that thecoverage of the SFP was inadequate.

Conclusion: The levels of malnutrition of 15.7 percent was classified as critical andfound to have been on the higher side compared to the previous survey. Mortalityamong under five children had also passed the emergency threshold level whose largepart was likely explained by AWD. It was recommended to closely monitor the situationfollowing relatively high levels of morbidity especially AWD coupled with deterioratingtrend of food security.

Afar Somali Zone One Afder zone

Chefera Elkare Hargele


89,505 17,901

40,192 8,038

74,182 14836


30,000 33.5

No 0.0

No 0.0

Food Aid Jan-June 07 – No of beneficiaries % of rural population

No 0.0

No 0.0

No 0.0

EOS- Screening No of children acutely malnourished*


April 2007 2,517 21.0

NO NO 0.0

NO NO 0.0

Therapeutic Feeding Unit No No No

Outreach Therapeutic Programme No No No

Table 5: Survey Results for Afar and Somali Region

Afar Somali Zone one Afder zone Key indicators Chefera

May 29-7 June Elkare and Hargele

March 26-7 April % GAM in Z-scores (95% CI) 11.1 (8.2-14.0) 15.7(11.6-19.8) % SAM n Z-scores (95% CI) 0.3 (0.0-0.7) 0.9 (0.0-1.9) % Kwashiorkor 0.0 0.0 CMR Death/10,000/day (95% CI) 0.41(0.12-0.69) 0.57 (0.24-0.91) U5MR Death/10,000/day (95% CI) 0.93(0.14-1.72) 2.23 (0.0-4.5) Major causes of U5MR NR AWD % Morbidity 13.6 (CI: NR) 40.1(29.9-50.3) Major illnesses or symptoms Diarrhoea, ARI, Fever Diarrhea, ARI & Fever % Measles coverage by card (95% CI) 0.0 0.2(0.0-0.7) % Measles coverage by card + recall (95% CI) 47.1(36.2-58.1 38.3 (26.5-50.1) % BCG coverage (scar) (95% CI) 8.9 (4.5-13.3) 5.2(1.3-9.1) % Vitamin A in past 6 months (95% CI) 54.1(43.3-65.1) 19.0 (8.2-29.7)

* Not Reported


*

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ENCU June 30, 2007

TIGRAY REGION

In the second quarter of 2007, a total ofeight standardized nutrition surveyswere conducted in Tigray region byregional ENCU/DPPB. The main objec-tive was to gather baseline nutritioninformation following the newly estab-lished livelihood zones, which weredone around 2006/2007. The livelihoodzones covered included Atsbi WenbertaHighland LZ, Eastern plateau LZ,Enderta Dry midland LZ, Raya ValleyLZ, Central Mixed Crop LZ, WestCentral Teff LZ, Middle Tekeze LZ andWerei Catchment LZ. At the time of com-piling this bulletin the final reports for alleight surveys were still being preparedand hence the findings below are fromthe preliminary reports. Table 6 presentsthe summary findings of the surveys car-ried out in the eight livelihood zones.

Nutrition: The prevalence of GlobalAcute Malnutrition and Severe AcuteMalnutrition in the 8 zones ranged from5.1 to 9.9 and 0.1 to 1.1 percent respec-tively. According to the national guide-line the nutrition situation was consid-ered normal in all the livelihood zoneswith no significant difference in theprevalence of acute malnutrition. It washowever, surprising that standard devia-tion of weight-for-height in the surveyresults of six livelihood zones wereslightly below the cut off points. If therewill be no changes in the final analysis,then the prevalence of acute malnutri-tion in these zones might have beenunderestimated. Since there were noprevious surveys conducted on liveli-hood basis, data for comparison werenot available.

Health: Morbidity in children rangedfrom 27.7 to 45.5 percent. On averageone out of three children suffered from atleast one or more illnesses. Diarrheaand coughing were the major illnessesreported. Both the CMR and U5MRwere normal ranging from 0.04 to 0.33and 0.14 to 0.86 deaths/10,000/dayrespectively. Measles vaccination (card+ recall) coverage was one of the high-est (88.2 to 94.6 percent) and the cover-age for BCG was above average rang-ing from 62.9 to 79.7 percent. No infor-mation on water and sanitation wasreported.

Livelihood/Food Security: The infor-mation on livelihood and food securityincorporated in this bulletin has beenextracted from the Tigray LivelihoodProfiles developed by LivelihoodIntegration Unit/DPPA, 2006/2007. Theagricultural activities in most of thesezones are predominantly depending onkeremt rain which starts in June andends up in September. Though the lev-els vary, all livelihood zones practicemixed farming with crop and livestockproduction. Six livelihood zones out ofeight were reported to have chronic foodinsecurity due to extensive degradation,poor soil fertility and erratic rail fall.However, Raya Vally and West CentralLZs were generally considered to havegood food security if not affected byerratic rainfall. All livelihood zones werethe beneficiaries of PSNP and EOS pro-grammes.

The livestock sales are importantsources of income for better off house-holds while PSNP and wage labour wererated as the main sources of income forthe poor. The poor households earn 10-30 percent of their annual food require-ment from PSNP. The period betweenJune to September marks the peakhunger season when the meher harvestis depleted and during which house-holds get most of their food through pur-chase. PSNP and therapeutic feedingunits were the food and nutrition inter-ventions respectively, implemented inthe surveyed livelihoods as summarizedin Table 8.

Conclusion: The nutrition situation with5.1 to 9.9 percent GAM was found to betypical in the post harvest period and inan area where most of the livelihoodzones are described as chronically foodinsecure. Continuation of the existingPSNP and EOS/TSFP with close moni-toring was recommended as the nutri-tional status was expected to deterioratearound August to September during thehunger season.TIGRAY REGION

The nutrition situation wasconsidered normal in all thelivelihood zones with no signif-icant difference in the preva-lence of acute malnutrition.

ENCU June 30, 2007

Eastern zone Central & Southern

zones Southern

zone Eastern &

Central zone North Western &

Central zones

North Western, Central & Southern

zone

Central and Southern

Zone

Atsbi wenberta

Highland LZ Eastern

plateau LZ Enderta

drymidland LZ Raya valley

LZ Central

mixed crop LZ

West central Teff LZ Middle Tekeze LZ

Werie Catchment

LZ


104,747 20,949

422,556 84,511

400,297 80,059

204,547 40,909

342,291 68,458

403,291 80,658

384,561 76,912

199,673 39,935


61,818 59.0

222,764 53.0

194,913 49.0

99,496 48.6

149,007 44.0

63,250 16.0

119,059 31.0

82,925 41.5

-June 07 – No of beneficiaries % of rural population

No 0.0

No 0.0

No 0.0

No 0.0

No 0.0

No 0.0

No 0.0

No 0.0

EOS Screening No of children acutely malnourished*


June 2007 2,467 15.0

June 2007 7,818 15.0

June 2007 5,855 10.0

June 2007 3,502 10.0

June 2007 3,608

8.0

June 2007 4,744

7.4

June 2007 6,294 10.1

June 2007 3,288 10.8

Therapeutic Feeding Unit Yes Freweni HC

Yes Adigrat HS Freweni HC

Yes Samare HC

Yes Alamata HS

Yes Adigrat HS Adwa HS Axum HS

Yes Axum HC

Tahtay Maychew HC Shire MCH Shire HS

Yes Samre HC Abi Adi HS

Yes Abi Adi HS Axum HS

Outreach Therapeutic Programme No No No No No Yes Gov No No

Table 7: Survey Results for Tigray

Table 8: Food and Nutrition Interventions in Surveyed Woredas of Tigray


Eastern zone Central & Southern

zones Southern zone Eastern &

Central zone Central and

Southern Zone North Western,

Central & Southern zone

North Western & Central zones

Key indicators Atsbi wenberta Highland LZ 26 March -

04 April

Eastern plateau LZ 04-18 April

Enderta drymidland LZ

26 March - 03 April

Raya valley LZ 11-19 April

Central mixed crop LZ

26 March - 05 April

Werie Catchment LZ

05-15 May

Middle Tekeze LZ

19-26 May

West central Teff LZ

23 April - 01 May

% GAM in Z-scores (95% CI) 6.8 (5.0-8.6) 6.3 (4.6-8.0) 6.8 (5.0-8.5) 5.1 (3.5-6.8) 9.9 (7.5-12.2) 9.1 (6.5-11.6) 8.0 (6.1-9.9) 8.2 (6.3-10.0)

% SAM n Z-scores (95% CI) 1.1 (0.4-1.8) 0.1 (0.0-0.4) o.2 (0.0-0.4) 0.2 (0.0-0.4) 0.1 (0.0-0.4) 0.4 (0.0-0.9) 0.5 (0.0-1.1) 0.5 (0.0-1.0)

% Kwashiorkor 0.2 0.1 0.2 0.2 0.0 0.0 0.3

CMR Death/10,000/day (95% CI) 0.29 (0.02-0.56) 0.33 (0.13-0.53) 0.07 (0.0-0.14) 0.25 (0.05-0.46) 0.08 (0.02-0.14) 0.04 (0.0-0.14) 0.16 (0.03-0.28) 0.17 (0.0-0.49)

U5MR Death//10,000/day (95% CI) 0.86 (-0.94-2.66) 0.26 (0.0-0.98) 0.14 (0.0-0.3) 0.32 (0.03-0.62) 0.19 (0.0-0.4) 0.20 (0.0-0.77) 0.33 (0.0-0.83) 0.21 (0.0-0.74)

Major causes of U5MR Diarrhoea & Cough NR NR NR NR NR NR Diarrhoea &

Cough

% Morbidity 45.5 30.2 41.5 27.7 30 27.3 29.5 31.1

Major illnesses or symptoms Diarrhoea & Cough

Diarrhoea & Cough

Cough & Fever

Diarrhoea & Cough Fever Diarrhoea &

Cough Diarrhoea &

Cough Diarrhoea &

Cough

% Measles coverage by card (95% CI) 60.3 (55.3-65.3) 69.67 (67.0-73.5) 39.2 (CI: NR) 18.7 (CI: NR) 43.6 (CI: NR) 56.4 (52.8-60.10 54.6 (49.5-59.6) 61.5 (58.0-65.0)

% Measles coverage by card+ recall (95% CI) 92.9 (89.3-95.4) 93.4% (78.0- 83.0) 88.2 (86 - 91) 91.0 (72.0 - 79.0) 94.5 (93.0 - 96.0) 94.6 (92.9-96.2) 94.6 (91.7-96.5) 92.1 (88.8-94.5)

% BCG coverage (scar) (95% CI) 77.8 (72.8-82.8) 79.65 (75.2-83.4) 64.5 (CI: NR) 62.85 (CI: NR) 68.6 (CI: NR) 66.1% (62.5-69.60 68.8 (63.9-73.3 73.3 (68.7-77.7)

* Not Reported

*

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ENCU June 30, 2007

QUALITY CHECK OF ANTHROPOMETRY DATAFROM NUTRITION SURVEYS

Using the Nutrisurvey software forSMART the quality of the anthropomet-ric data of the nutrition surveys waschecked. The results are presented intable 9.The indicators used to checkthe data quality include:

Bias in children selection: The demo-graphic profiles of the survey sampleswere checked to verify whether thesamples were not biased in terms ofage and sex as compared with the typ-ical demographic distribution (WHO2000) for the target children (6-59months) in the developing world. Therewas no significant age bias in the 16surveys presented in this bulletin wherethe younger age group (6-29 months)lied between 38 to 48 percent close tothe likely 49 percent while the older agegroup, (30-59 months) lied between 52to 62 percent close to the expected 51percent. There was no sex bias in anyof the 16 surveys.

Bias in weight & height measure-ments: The quality check on the distri-bution of the final decimal for weightand height measurements indicatedthat there was no significant digit pref-erence for all 16 surveys presented inthis bulletin.

Standard Deviation of WHZ: Thestandard deviation of weight-for-heightz-scores of 10 surveys out of 16 fellwithin the plausible range of 0.8-1.2.Surprisingly six out of eight surveysfrom Tigray region displayed a low SDof WHZ, which might be due to measur-ment error and or over cleaning of theraw data.

Moment of Skew ness & Kurtosis: Allsurveys had a moment of skew nesswithin the acceptable range of plus orminus one indicating that the distribu-tion of WHZ for each survey was sym-metrical as to be in the normal distribu-tion. Fourteen of the surveys did notshow kurtosis problem while two sur-veys, i.e. Hargele & Elkere and Dale &Aleta Wondo CLZ exhibited a positivekurtosis indicative of a relativelypeaked WHZ distribution.

Conclusion: All surveys were in linewith the quality check standard criteriaexcept six surveys conducted in Tigraythat showed a low SD of WHZ whichwere likely to underestimate the preva-lence of global acute malnutrition. Theexhibition of low SD is more commonthan the other indicators and hence thisis an area that requires further investi-gation and perhaps conducting valida-tion surveys.

ENCU June 30, 2007

Table 9: Results of Survey Quality Check for the Second QuarterDigit preference Representative ness of the sample

Agency Woreda Weight Height

SD of WHZ Skewness of WHZ

Kurtosis of WHZ

No. 0f WHZ flags (%) Age group

(in months) Distribution

(%) Sex

Ratio

Islamic Relief/SCUK Hargele & Elkere No No 0.91 0.61 1.81* 0.65 6-29 30-59

46.8 53.2 1.1

SCUK Chifera No No 0.87 0.38 0.53 0 6-29 30-59

42.4 57.6 1.1

SC-UK Melka Bello No No 0.81 0.04 0.45 0.28 6-29 30-59

44.1 55.9 0.9

SC-UK Meta Robi/Adea Berga No No 0.85 0.11 -0.16 0 6-29 30-59

45.4 54.6 1.0

SC-UK Abuna Gendeberet No No 0.84 0.18 -0.15 0 6-29 30-59

46.7 53.3 0.9

GOAL Silti No No 0.80 0.06 0.000 0 6-29 30-59

46.0 54.0 1.0

SNNPRENCU/Muti-agency Bona No No 0.91 -0.11 0.02 0 6-29 30-59

38.0 62.0 0.9

Tigray ENCU/DPPB Estern Plateau LZ No No 0.72** 0.09 0.09 0% 6-29 30-59

43.7 56.3 1.1

Tigray ENCU/DPPB Western Centeral LZ No No 0.76** 0.27 0.24 0% 6-29 30-59

42.7 57.3 1.0

Tigray ENCU/DPPB Raya vally LZ No No 0.76** -0.00 -0.23 0% 6-29 30-59

48.3 51.7 1.0

Tigray ENCU/DPPB Central mixed crop LZ No No 0.75** 0.21 0.18 0 6-29 30-59

42.2 57.8 1.0

Tigray ENCU/DPPB Enderta Dry Midland LZ No No 0.79** 0.16 0.27 0.15 6-29 30-59

46.0 54.0 1.1

Tigray ENCU/DPPB Astebi Womberta Highland LZ No No 0.83 0.23 0.59 0.16 6-29 30-59

42.3 57.7 1.1

Tigray ENCU/DPPB Middle Tekeze LZ No No 0.78** 0.15 0.03 0 6-29 30-59

44.3 55.7 1.0

Tigray ENCU/DPPB Werei Cathment LZ No No 0.80 0.08 -0.15 0 6-29 30-59

44.5 55.5 1.1

ACF Dale & Aleta Wondo CLZ No No 0.98 0.51 1.29 * 0.45 6-29 30-59

40.6 59.4 0.9

* Kurtosis Problem** Low SD of WHZ

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ENCU June 30, 2007

Beginning of May 2007, ENCU has beenconducting data quality checks for theEOS MUAC screening data from all theworedas implementing EOS. Main prob-lems identified included: compilation,summation, unusual levels of malnour-ished children both moderate andsevere and, high prevalence of acutemalnutrition among pregnant and lactat-ing women than children.

Feedback on the data quality was pro-vided jointly by UNICEF, WFP andENCU to the DPPB and RHB at theregional level. So far the feedback waspositively received by the regionalauthorities and other stakeholders. As aresult, follow up on the screeningprocess and data compilation wererevisited and eventually correctionswere made and re-submitted.

UNICEF, WFP, MOH and ENCU foundthat quality check and provision of feed-back had two advantages. First alertsthe regional, zone, woreda and individu-als conducting the screening that thedata are being checked and second,reminds them that they are responsibleand accountable for the results, anddelays in interventions that may resultdue poor data quality.

Currently ENCU is in the process ofdeveloping a "standard criteria" for thequality check of the EOS MUAC screen-ing data. The criteria will be discussed,agreed and communicated to all stake-holders. It is hoped that the commonlyagreed criteria will to a great extentreduce weakness and increase reliabili-ty of the EOS data for faster and effec-tive decision making on the interven-tions.

DATA QUALITY CHECK OF EOS MUAC SCREENING

NUTRITION SURVEY DATABASE

Table 10 presents the number of standardized nutrition surveys conducted in Ethiopiasince 2000. It does not include surveys conducted in resettlement areas, IDP andrefugee camps. Since 2000 to June 2007 a total of 443 standard nutrition surveys wereconducted. Raw data and final reports of these surveys except few conducted April-June 2007 are kept at ENCU data base.

Table10: Number of surveys per region and year Year Region

2000 2001 2002 2003 2004 2005 2006 2007 Total

SNNPR 9 5 35 30 14 25 20 9 147 Oromia 3 2 20 27 22 20 14 4 112 Amhara 5 9 24 17 9 7 6 2 79 Somali 8 5 5 5 8 11 12 2 56 Tigray 0 0 6 7 3 3 0 8 27 Afar 0 0 4 5 1 6 4 1 21

Gambella 0 0 0 0 0 0 0 0 0 Benshangul

Gumez 0 0 0 0 0 0 0 0 0 Harare 0 0 0 0 0 0 0 1 1 Total 25 21 94 91 57 72 56 27 443

Following nutrition assessments, emergency nutrition interventions are recommendedand implemented depending on the levels of malnutrition and aggravating factors.Between January and June 2007 several partners were implementing emergencynutrition interventions in various woreda in Ethiopia based on 2006 and 2007 surveyresults. The table below summarizes TFPs performance based on selected indicatorsrecommended by the national Emergency Nutrition Guidelines and the SphereStandards.

PERFORMANCE OF EMERGENCY NUTRITION INTERVENTION PROGRAMMES

Table11: Performances of TFPs implemented by humanitarian agencies in Ethiopia (January - June 2007)

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ENCU June 30, 2007

Agency Woreda Time Frame Type of Programme

Total Admission

Total Exits

Coverage (%) Recovery (%) Death

Rate (%) Defaulter Rate (%)

CONCERN Kalu Jan-May TFP 435 267 NA* 230 (86.1) 4.1 5.2

CONCERN Dessie Zuria Jan-May TFP 390 234 NA 190 (81.2) 2.6 7

MSF-Holland Humera Jan- Apr TFP 25 21 NA 16 (76.2) 9.5 14.3 MSF Holland Abdurafi Jan-Apr TFP 20 20 NA 18 (90) 5.0 0

ACF Aleta Wondo Jan-May TFP 492 458 NA 345 (75.3) 0.0 6

ACF Dale Jan.-March TFP 177 401 NA 293 (73.1) 0.0 6.9 MSF-Greece Addisamen Jan.-May TFP 231 251 NA 196 (78.1) 11.2 8.4

GOAL Derashe Apr-May TFP 111 30 98 28(93.3) 6.1 0 ADRA Kerafo Jan-Jun TFP 956 644 77.7 587(91.1) 1.7 6.1

WVE Kedida Gamela Jan-June TFP 212 117 NA 111(94.9) 2.5 4.3

WVE Damboya Jan-June TFP 421 229 NA 221(96.5) 1.3 2.2 WVE Durame Jan-June TFP 21 12 NA 11 (91.7) 0.0 8.3

SC US** Bona June-July TFP 319 79 75.2 41 (51.9) 0.0 0 Gondar Jan.-May TFP 115 115 NA 95 (82.6) 3.5 11.3

Hiwot Fana Hospital Jan.-May TFP 163 160 NA 98 (61.2) 3.1 16.2

Total 4028 3038 NA 2480 (81.6) 2.6 6.5

From Table 11 above it is clear that theperformance of most of TFP implement-ed in the various woredas in terms ofrecovery, death and defaulter rates wereall impressive. All the indicators wereabove the recommended SphereStandard cut off points except in Bonaworeda where the low cure rate wasmainly due to high transfer rate of 29.1percent.

As a result of high recovery rate, out of3038 children that were discharged fromTFPs in the mentioned woredas, 2480 ofthem equivalent to 81.6 percent werecured. In other words, these childrenwere saved from further nutritional sta-tus deterioration and possibly death.Overall death and defaulter rates in theTFPs was generally low summarized at2.6 and 6.5 percent respectively, bothfalling within the national and SphereStandards recommended levels.

One major challenge in the implementa-tion of the emergency nutrition interven-

tions feeding programmes in Ethiopia iscalculating the coverage of the feedingprogrammes. As it can be seen from theTable 11 above, only three (ADRA,GOAL and SC US) out of seven agen-cies were able to provide information oncoverage.

The other challenge is submission ofmonthly TFP performance reports.According to UNICEF data base datingback from 2003 to 2006 only 52% of thereports were completed.

ENCU calls upon all partners first, toconsider and estimate the coverage ofthe feeding programmes before inter-ventions commences as recommendedin Sphere Standards and national guide-lines. Second, partners should submitmonthly feeding performance reportsbased on the national format throughoutthe feeding programme life.

* Not available** 29.1% of the total discharge were transfer out, while non-response was 1.3% up to 1st week of July.The information presented in Table 11 were submited by partners and from UNICEF data base.

ENCU June 30, 2007

After the Inter-Agency StandingCommittee (IASC) generic Terms ofReference (TOR) on the clusterapproach was distributed globally, theEthiopian government in collaborationwith humanitarian agencies reviewedand approved the cluster approach rollout in March 2007. UN level clusterleads in collaboration with governmentsector lead were required by the UNOCHA to coordinate the roll out of eachrespective cluster. On part of the UNsystem, UNICEF is the cluster lead fornutrition, water and sanitation.

Coordination is critical for the successfuland effective cluster roll out. UNICEFthe nutrition cluster lead through ENCUhad an advantage of having an alreadyexisting Mult-Agency Nutrition TaskForce (MANTF). This forum bringstogether all stakeholders working inemergency nutrition in Ethiopia.

An Adhoc MANTF meeting was held andmembers briefed about the need of thecluster approach and how it would work.Since MANTF members are more than100 participants, a small group called"nutrition cluster core group" was

formed. The core group has 29 mem-bers from nine NGOs (ACF, CONCERN,CARE, GOAL, IMC, SC-UK, SC-US,WVE and VALID); three governmentinstitutions (DPPA, EHNRI, FMoH) andfour UN agencies (UNICEF, UNHCR,WFP and WHO). The main tasks of thecore group include: preparing the nutri-tion cluster TOR, action and contingencyplans, identify gaps and recommendways for filling the gaps. The groupagreed to meet weekly until its tasks arecompleted.

By the end of June 2007 the nutritioncluster TOR were being finalized andwould be circulated to all MANTF mem-bers for information and final commentsbefore send to the government forendorsement and UN OCHA for refer-ence.

The nutrition cluster approach providesa unique opportunity for streamliningdecision making with respect to emer-gency nutrition assessments andresponses. Let all stakeholders use theopportunity optimally.

UPDATE ON THE PROGRESS OF NUTRITION CLUSTER ROLL OUT IN ETHIOPIA

SUMMARY FINDINGS OF THE MUAC, WFH AND BODY-SHAPE RESEARCH STUDYENCU with funds from UNICEF con-tracted a consultant to conduct aresearch in May 2006, looking at therelationship between MUAC, WHZ andbody shape (sitting to standing heightration) in agrarian and pastoralist popu-lations of Ethiopia. The principal reasonto undertake the study was the discor-dance observed between the preva-lence estimates returned by WHZ andMUAC case-definitions during nutritionsurveys undertaken in Somali region.

The study investigated the hypothesisthat a portion of this observed discrep-ancy between the prevalence estimatesreturned by WHZ and MUAC case-defi-nitions was due to differences in body-shape in older or taller children (i.e. age24 months or height 85 cm) betweenagrarian and pastoralist populations.Data on sitting height along with stan-dard anthropometric measurements

were collected by SC-UK from Amharaand Somali regions. Data from Afarregion were provided by courtesy ofCONCERN. A comparative analysisbetween agrarian and pastoralist wasthen undertaken using data from 1481and 2741 children respectively.

The study findings confirmed thehypothesis and showed that:

SSR (Sitting height to Standing heightRatio) differed between the populationssurveyed with pastoralists tending tohave significantly lower SSR values(longer legs/shorter trunks) than agrari-ans.

WHZ and WHZ case-status were sig-nificantly associated with body-shape(SSR) in both pastoralist and agrariansregardless of which reference popula-tion (NCHS or WHO) was used to calcu-late WHZ.

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ENCU June 30, 2007

The effect of body-shape for standardWHZ case-definition was to overesti-mate prevalence of malnutrition in bothgroups, the effect being larger in thepastoralist group because of the smallerSSR values. MUAC was also associated with body-

shape in both groups while MUAC case-definition was not associated with body-shape in both groups. No effect of the body-shape on MUAC

standard case-definition was detected.

It was concluded that the use of WHZintroduced an upwards bias in preva-lence estimates when used in the pas-toralist group, unless corrected by body-shape, but no significant bias was notedin the agrarian group.

The study recommended using MUAC inpreference of WHZ for estimating preva-lence of acute undernutrition in surveys.The study also recommended conduct-ing an operational research into the sur-vey methods using MUAC with the aimof developing a method and guidelinesthat will enable partners to undertakeand analyze such surveys.

The report was shared with MANTFmembers, Nutrition Technical Working

Group (NTWG) and presented in theJune 2007 monthly MANTF meeting.Members recommended that the find-ings should be further discussed andagree on the way forward. The fullresearch report is available uponrequest from ENCU.

emergency nutrition quarterly bulletin · silti woreda compared with may 2006 sur-vey results with...

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