NUTRITION SURVEILLANCE IN SOMALIA

1
NUTRITION SURVEILLANCE IN SOMALIA
NIPHORN Meeting, Nairobi, 1st to 3rd February,
2007
Grainne Moloney, Nutrition Project Manager, FSAU
2
Nutrition Coordination in Somalia

• Prior to the conflict in 1991, coordination was
  managed under the Ministry of Health both at
  national and regional level
• Now all sector coordination is under one
  governing body Somalia Support Secretariat
  (formerly SACB), supported by UNDP.
• Nutrition Working Group/ Nutrition Cluster
  Coordination co chaired by UNICEF FSAU with
  UNICEF chairing the Cluster Coordination
• Monthly meetings with UN, NGO, CBO in Nairobi
  Update on Nutrition Information, Emergency
  Response, Health , Food Security, Logistics, new
  developments, etc
• Regional meetings in Somalia frequency varies
  depending on location, access and availability of
  partners
• Challenges - lack of Gov, often lack of
  technical staff (in field), too much to cover in
  short period lack of time to discuss more
  proactive issues such as guidelines etc

3
Nutrition Data Collection Sources

• Nutrition Surveys
• National Level
• MICS, UNICEF. 1999, Sept 2006 useful for MDG
  monitoring
• 2) Localised
• National Nutrition Assessment Guidelines have
  been produced endorsed and updated on an annual
  basis by FSAU/ UNICEF in collaboration with the
  NWG members.
• Nutrition Surveys are conduced by UN agencies,
  predominantly FSAU with support UNICEF/WFP and
  NGO (MSFB, MSFH, ACF, IMC, WVI). In many
  instances surveys are done on an interagency
  basis as recommended by the NWG
• Nutrition Surveys are done in areas of operation
  (for NGO) and areas of concern or where there is
  no data (FSAU) , right now a database exist in
  FSAU. Ongoing analysis on seasonality to review
  the trends in malnutrition over the different
  seasons

4
Nutrition Data Collection Sources

• Feeding Centre Statistics
• UNICEF consolidates the information from NGO
  statistics into a central excel database then
  shares with partners.
• Sentinel Sites
• FSAU collect bi monthly data from 102 sentinel
  sites (villages) in Sth and Central Somalia. 50
  kids per sites, WHZ, MUAC, Oedema. Morbidity,
  dietary diversity useful for trends - ? Mean
  WHZ
• Rapid Assessments
• Dec 06, developed a MUAC rapid assessment tool
  (adapted from Darfur) used in the Deyr 06
  assessment measuring 100 children per site and
  classifying lt12.5cm.
• HIS Data
• 105 HC measure WHZ of all children 6-59months
  and collect additional info on morbidity, Epi,
  maternal health monthly, data submitted to key
  agencies (FSAU - nutrition, UNCIEF- Epi, WHO
  morbidity) Central database in Nairobi useful
  for trends analysis

5
Nutrition Data Collection Sources

• Dietary Diversity
• Information collected from sentinel sites and
  assessments ongoing work on use of indicators
  (FAO) and recall period (WFP)
• Child care feeding practices
• Information collected predominantly from
  nutrition assessment need for further
  investigation into obstacles - ? KAP survey
• OUTPUTS
• Monthly Nutrition Update produced by FSAU
  inputs from UNICEF
• Quarterly Food Security and Nutrition Brief
• Bi annual IPC - seasonal analysis Nutrition
  Situation Map
• Nutrition assessment reports
• Training Materials food preservation, hygiene
  promotion, micronutrients
• Website www.fsausomali.com (updates,
  assessment reports, training materials plan to
  continue expanding info available.)

6
Nutrition Key Indicators and Categorization
Version 1 Jan 07
Nutrition key indicators Alert Serious Critical Very Critical
GAM (WHZ) from nutrition surveys 5-9.9 usual range and stable 10-14.9 15-19.9 (or 10-14.9 where there has been a significant increase from seasonally adjusted previous surveys) gt20 or (15-19.9 where there has been a significant increase from seasonally adjusted previous surveys)
SAM (WHZ) from nutrition surveys lt1.5 1.5-2 2-3 gt3
CMR/10,000/day from nutrition surveys 0.45-0.99 1-1.99/10,000/day gt2/10,000/day gt2/10,000/day
MUAC Screening TBC ( lt12.5cm) lt5 5-9.9 10-14.9 gt15
Feeding Centre Data adjusted on length of operation coverage Low admissions and stable Low admissions but increasing in last 2 months (seasonally coverage adjusted) Significant increasing admission - (seasonally coverage adjusted) Significant increasing admissions out of season
HIS Nutrition Trends Low numbers of acutely malnourished for area and stable (seasonally adjusted) Low numbers of acutely malnourished children from previous months but increasing in gt2 rounds (seasonally adjusted) High levels and stable numbers of acutely malnourished childrens (seasonally adjusted) High with significant increasing numbers in gt2 rounds of acutely malnourished children from screening
Poor dietary diversity for population (lt4 food groups) assessments SSS lt5 5-9.9 10-25 gt25
7
Key Indicators and Categorization Contd.
Version 1 Jan 07
Nutrition key indicators Alert Serious Critical Very Critical
Meal Frequency At least 5 x day (for lt5yrs) gt20 5-19.9 lt5 lt20
Sentinel Site Trend - levels of children identified as acutely malnourished from HC data low levels and one round indicating increase seasonally adjusted) Increasing levels to based on two rounds (seasonally adjusted) High levels of malnourished children and stable (seasonally adjusted) (15-19.9) Increasing levels to with increasing trend
Affected pop with access to formal/informal humanitarian assistance feeding centres health centres, clean water etc Access to humanitarian interventions for most vulnerable Reduced access to humanitarian support for most vulnerable Limited access to humanitarian support for majority Negligible or no access
Health (seasonally adjusted) Frequency of cases of ARI, Suspected malaria, and diarrhoea Measles Immunisation Coverage (Measles Vit A) Within expected seasonal norms 1 case lt95 Seasonal increase in Suspected Malaria, ARI and Diarrhoea- contained 1 case lt95 Seasonal increase not contained, Epidemic Epidemic lt95 Pandemic Pandemic lt95
Food Security Situation - current IPC status Chronically food secure Acute Food and Livelihoods Crisis HE Famine/ Humanitarian Catastrophe
8
Nutrition Situation - Maps
Nutrition Situation, Jan 07
Nutrition Situation, July 06
9
Link with Food Security Analysis

• FSAU food security project collects information
  on markets prices livestock, agriculture,
  security climate (FEWSNET), though a range
• Two main assessments linked to the rains are
  conducted annually, post Gu (June) post Deyr
  (December) leading to the production of the IPC
  includes nutrition information IPC is
  recognised as a valuable tool for linking
  information to action by partners and donors
• In addition quarterly briefs on risk factors and
  early warning are produced incorporating
  nutrition and food security information
• The IPC is now being rolled out in the Horn East
  and Central Africa Region as a tool for
  classifying severity across different contexts.
  currently Somalia specific
• There is a need to review the nutrition
  indicators due to the heavy reliance on WHZ and
  mortality data only available from localised
  assessments which may not be representative of
  larger areas and across season.

10
Integrated Food Security and Humanitarian Phase
Classification Reference Table (FAO/FSAU June
2006)
11
Somalia Food Security Phase Classification
Post Deyr 06/07 Projection Jan - June 07
Post Gu 06 Projection Jul 06 - Dec 06
12
Specific Issues for Nutrition Surveillance in
Somalia

• Challenge of access to conduct good quality large
  scale assessment
• Lack of capacity of Somali based staff
• Limited partners concentrated in certain areas.
  
• Lack of structures of long term integrations of
  monitoring systems HIS exists but needs much
  support
• Reliability of age data stunting data???
• Different ethnic groups (Bantu riverine,
  pastoral, agropastoral)
• Interpretation of nutrition data only high rates
  of wasting trigger appropriate response
• Need to further link nutrition assessments to
  seasonality and livelihood zones for better
  trends analysis interpretation of results over
  time
• Limited if no data on micronutrients available
• Differing needs of IDPs.

13
Way Forward

• Recommend nutrition surveys for 2007 will be
  based on seasonality from previous analysis and
  will be conducted at livelihood level not
  administrative (except for IPD) to link with food
  security analysis
• Use of mapping/ segmentation rather that EPI for
  2nd level sampling
• Use of uniscales to reduce measurement error
• Review Sentinel site data, ? Mean whz,
  interpretation of results
• Move away from estimates of malnutrition when
  recent surveys are not available to a statement
  reflecting a range of indicators
• Establishment of Somalia regional based experts
  in conducting nutrition surveys (UNICEF/ FSAU)
  when access is an issue
• Continue analysis in using non anthropometric
  indicators such as dietary diversity, meal
  frequency - easier to monitor also at community
  level.
• Review use of MUAC in rapid assessments,
• Discuss the possibility of conducting
  micronutrient deficiency prevalence assessment
  with FSAU/UNICEF/ WHO/MI, KAP.
• ? Roll out of new WHO Growth Curves
• ? Integration of Nutrition Information System
  into Gov/ future??

14
(No Transcript)