team 2 case study

Biyyoolessaii Ija Biyyoolessaii Ija MukaaMukaa

“Fruit of the “Fruit of the Land”Land”

Team 2Team 2Devin Broadwater, Karen Hamby, Devin Broadwater, Karen Hamby, Naomi Chen, Amanda Hasseltine, Naomi Chen, Amanda Hasseltine,

Bernice BoursiquotBernice BoursiquotOnline Image. 07 November 2009. EthioGardian.com

Presentation OutlinePresentation Outline

Demographics on OromiyaDemographics on Oromiya

Meet the Adabbos, an Average Oromo familyMeet the Adabbos, an Average Oromo family

Child Malnutrition and Its FactorsChild Malnutrition and Its Factors

Strategy to Combat Child Malnutrition Strategy to Combat Child Malnutrition Emergency Food AidEmergency Food Aid Comprehensive ApproachComprehensive Approach Allocation of FundsAllocation of Funds

SummarySummary

Oromiya Region Oromiya Region BackgroundBackground

DemographicsDemographics 27 Million People27 Million People 4.8 People Per Household4.8 People Per Household Ethnic GroupsEthnic Groups

87.8% Oromo87.8% Oromo 7.22% Amhara7.22% Amhara

ReligionReligion 48.2% Christian48.2% Christian

Orthodox and Orthodox and ProtestantProtestant

47.5% Muslim47.5% Muslim 88.7% Rural Inhabitants88.7% Rural Inhabitants

Current Health CrisisCurrent Health Crisis

34.4% of Children under 34.4% of Children under the age of five are the age of five are underweightunderweight

Estimated 126,000 Estimated 126,000 children are in need of children are in need of urgent therapeutic care urgent therapeutic care for severe malnutrition in for severe malnutrition in EthiopiaEthiopia This number is expected This number is expected

to climbto climb Ethiopia is rated the sixth Ethiopia is rated the sixth

worst country in terms of worst country in terms of nutritional outcomes nutritional outcomes worldwide.worldwide.

Central Statistical Agency (CSA) of Ethiopia, 2007

Meet the AdabbosMeet the Adabbos

The World Factbook 2009. Washington, DC: Central Intelligence Agency, 2009. https://www.cia.gov/library/publications/the-world-factbook/index.htmlOnline image. PBS.org

Online image. Current food shortages in Ethiopia. (2009) http://news.bbc.co.uk/2/hi/8319741.stm

Identifying Cases of Identifying Cases of Severe Acute Severe Acute MalnutritionMalnutrition

Children with mid-upper arm circumference (MUAC) <11cm or Children with mid-upper arm circumference (MUAC) <11cm or bilateral leg pitting edema referred to regional health centers bilateral leg pitting edema referred to regional health centers weight for height. Children with weight for height less than weight for height. Children with weight for height less than 85% of median national center for health statistics (NCHS) 85% of median national center for health statistics (NCHS) classified as having Severe Acute Malnutritionclassified as having Severe Acute Malnutrition Advantages:Advantages:

Practice currently in usePractice currently in use Independent of ageIndependent of age Simple, low cost technologySimple, low cost technology Low stress on children and caregiversLow stress on children and caregivers Accurate Accurate Highly sensitive and specific Highly sensitive and specific

Recommendation: increase usage of MUAC measurementsRecommendation: increase usage of MUAC measurements

Belachew, T, & Nekatibeb, H. (2007). Assessment of outpatient therapeutic programme for severe acute malnutrition in three regions of Ethiopia. East African Medical Journal. Amsalu, S & Tigabu, Z. (2008). Risk factors for severe acute malnutrition in children under the age of five: A case-control study. Ethiop.J.Health Dev.

Black. “Framework of the relations of poverty, food insecurities, and other underlying and immediate causes to maternal and child malnutrition and its short-term and long-term consequences” Maternal and Child Undernutrition.

Cholera Cholera OutbreakOutbreakAugust 8August 8thth 2009 2009

The shaded region The shaded region indicates the area of indicates the area of outbreak.outbreak.

Online image. Zones affected with the cholera are highlighted in red (the current map of Oromia). Ethiopia: Cholera and Severe Acute Malnutrition Ravage Oromia

The Three SectionsThe Three Sections

WestWest•Generally Food Stable Generally Food Stable •Without CholeraWithout Cholera

SouthSouth•Highly Food InsecureHighly Food Insecure•Without CholeraWithout Cholera

NorthNorth•Highly Food InsecureHighly Food Insecure•With CholeraWith Cholera

Current TrendCurrent Trend

The 1 million dollar The 1 million dollar question (USD)?question (USD)?

How can severe acute malnutrition be How can severe acute malnutrition be sustainably reduced in the Oromiya region of sustainably reduced in the Oromiya region of

Ethiopia with 1 USD million?Ethiopia with 1 USD million?

The Two-Pronged The Two-Pronged StrategyStrategy

Emergency Food AidEmergency Food Aid Comprehensive Comprehensive ApproachApproach

Emergency Food AidEmergency Food Aid

Ready to use therapeutic foods (RUTFs) are currently distributed in Ethiopia

•High rate of acceptance•Distributed by government, Doctors Without Borders, and other non-governmental organizations (NGOs)

Immediate response to current Ethiopia conditions•Results:

•Point of entry•Local acceptance

•Requirement:•Using available infrastructure to deliver RUTFs•Coordinate with work of NGO’s within the region

Belachew, T, & Nekatibeb, H. (2007). Assessment of outpatient therapeutic programme for severe acute malnutrition in three regions of Ethiopia. East African Medical Journal.

Comprehensive Targeted Comprehensive Targeted ApproachApproach

Develop local RUTF’s—”Fruit of the land”Develop local RUTF’s—”Fruit of the land” Local farmersLocal farmers

Training of CHA’sTraining of CHA’s Community membersCommunity members

Radio Soap OperaRadio Soap Opera Mass communication, disseminationMass communication, dissemination

Time Emergency /Imported

RUTFs

Local RUTFs Community Health

Advisors

Soap Opera Accountability and Evaluation

1-3 months Evaluate current

partner NGO efforts

Focus groups

Identify farmers, formulas

Stockpile food-secure area crops

Recruit CHA’s

-- Ethics clearance

Assess distrib.

Adapt local RUTF “chain”

3-6 months Start efficacy trial

Start efficacy trial with several

formulas

Create curriculum

-- Baseline statistics

Local distribution

feasibility

6-9 months Analyze results

Discontinue

Analyze results

Plant for next season

Training -- Intervention impact

AssessmentAssessment

Time Emergency /Imported

RUTFs

Local RUTFs Community Health

Advisors

Soap Opera Accountability and Evaluation

9-12 months -- Local crop farming,

production

Educating community

Local economic initiatives

Identify radio

stations, recruit talent

Harvest trends

Economic stability

indicators

12-18 months -- Same as above

Same as above

Quality assurance

Training new CHA’s

Preliminary scripts

Same as above

Fidelity of CHA training

Concept testing

18-24 months -- Same as above

Same as above

Recording Same as above

ImplementationImplementation

ReplicationReplicationTime Emergency /

Imported RUTFs

Local RUTFs Community Health

Advisors

Soap Opera Accountability and Evaluation

3 years -- Local crop farming,

production

Educating community

Local economic initiatives

Training new CHA’s

Broadcast Evaluate media reach,

impact

Crop sustainability

Child nutrition indicators

5 years -- Same as above

Same as above Fundraising to record

new episodes

Same as above

10 years -- Same as above

Same as above Syndication Same as above

Expected InterventionExpected Intervention

Allocation Of FundsAllocation Of FundsShort Term – 15%Short Term – 15%

Import Tax 20-50% of cost

Short Term

$150,000

RUFTs $77,700

Cost of RUTFs $77,700

Internal Shipment $22,300

Internal travel & distribution $20,000

Efficacy evaluation/ research $30,000

Allocation Of Funds Allocation Of Funds Long Term – 85%Long Term – 85%

Long Term

$850,000

Education/ CHAs $340,000

Acceptance of paying for supplements

Sanitation

Breastfeeding/ Child feeding practices

Family Planning

Female Empowerment

Malnutrition screening (bangle)

Soap Opera

$85,000

Accountability & Evaluation

$85,000

Local RUTFs

$340,000

SummarySummary

Child malnutrition is a multi-faceted issueChild malnutrition is a multi-faceted issue Requires:Requires:

Comprehensive, long-term approachComprehensive, long-term approach Community involvement Community involvement

Four components :Four components : Initial importation of RUTF’sInitial importation of RUTF’s Training Oromiyan farmers to produce local Training Oromiyan farmers to produce local

RUTFsRUTFs Training CHA’s to educate mothers on proper Training CHA’s to educate mothers on proper

feeding practicesfeeding practices Health soap opera broadcastingHealth soap opera broadcasting