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March-April 2011Food Security and Nutrition

Analysis Unit - Somalia

FSNAU

The FSNAU is managed by FAO and funded by the EC, SIDA, UKAID, DFID, ITALIAN COOPERATION, SDC, UNICEF, UNHCR, CHF and HRF

Current Nutrition Situation• Ananalysisofhistoricaldatafromsimilarseasons,200-2010wasconductedtoforecastthelikelysituationforApril2011,as illustrated in Map 1. This shows Sool Plateau of BariRegionintheAlertphase,withtherestofSomaliainSerioustoVery Criticalphases.

• FindingsfromanutritionsurveyconductedinMogadishuinApril 2011, and rapid nutrition assessments inShabelle,Juba regions in February-May 2011 reflect a sustainedCritical nutrition situation in thesepopulationgroups sincetheDeyr2010/11.ThenutritionsituationinShabelleriverine,Juba Pastoral, and parts of Sool Plateau (Bari region),appearslikelyCritical-Very Critical.

Food Security Situation:ThefoodsecuritysituationremainsasprojectedduringthepostDeyr 2010/11 analysiswith an estimated 2.4million people incrisis.However,theeffectsoftheongoingdrought,deterioratingpurchasing power, rampant conflict and limited humanitarianspacecontinue toaggravate thesituation inmostpartsof thecountry.TheJilaal (January-March)2011seasonwasparticularlyharsh,witha longspellofdryconditions foralmost9months,followingfailureofthe2010shortrains,duetotheLa-Ninaeffect.Theoutcomehasbeenseverewatercrisiswithextremelyhighpricesofwater, lowcereal availability andanupward trendoffoodprices, depletedpasture, deteriorated livestock condition,increased cases of livestock deaths, displacements andincreaseddestitutionincentralregions.Nevertheless,accordingto the April 2011 FSNAU/FEWSNET Climate Data Update,commencementofGu 2011 rains isobserved inmostpartsofthecountry,especiallyinBay,JubaandShabelleregions,andislikelytoleadtoimprovedwateravailability,pastureandbrowseconditions,andeventuallyproviderecoverytoanimalsafterthedryspell.AccordingtotheApril2011FSNAU/FEWSNET MarketDataUpdate,thepricesoflocallyproducedcerealsincreasedby23-33percentacrossthemainmarketsofallregionsapartfromLowerJuba(9%increaseforthewhitemaizeprice).Thepriceincrementsinthecurrenthungerperiodaresubstantiallyhigherthanthesametimelastyearduetodwindlinggrainstocksheldbyproducersandtraders,highdemand,risingtransportcosts,aswellasstockhoardingbyretailersandfarmersduetouncertaintyinthe Gu2011harvest.SinceAprillastyear,theredsorghumpriceshavemorethandoubled(137-183%)inallregionsoftheSorghum Belt. The white maize prices are also considerablyhigherthanayearagoinproducingregionsofShabelle(73%)and Juba (92%).).These circumstances have exacerbated theprecarious household food access in Somalia. Details of thefoodsecurity,marketandclimateupdate,areaccessibleathttp://www.fsnau.org/downloads.

OVERVIEW

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BELET WEYNE

Somalia - Gu (April-July) Median Estimates of Nutrition Situation (2008-2010)

P.O. Box 1230 Village Market, Nairobi, Kenya Email: [email protected] tel: 254-20-4000000 fax:254-20-4000555 FSNAU is managed by FAOThe boundaries and names on these maps do not imply official endorsement or acceptance by the United Nations. The regional & District boundaries reflect those endorsed by the Government of the Republic of Somalia in 1986.

Food Security and Nutrition Analysis Unit - Somalia http://www.fsnau.org

Swiss Agency for Development and Cooperation SDC

Technical Partner Funding Agencies

Median Estimates

Alert (5 - 9.9%)

Serious (10.0 - 14.9%)

Critical (15.0 - 19.9%)

Very Critical (>= 20%)

Acceptable (<5%)

Map 1: Estimated April 2011 Nutrition Situation

•Mogadishu: Findings from a nutrition survey conductedin Mogadishu in April 2011, in which 902 children aged6-59 months were assessed, indicate a Critical nutritionsituation, with a global acute malnutrition (GAM), (WHZscores<-2oroedema)of15.2% (10.9-20.7)andasevereacutemalnutrition(SAM)(WHZscore<-3oroedema)rateof 1.7% (0.9-3.1). The 90 days retrospective crude andunderfivedeathratesreportedare1.81(1.38-2.37),and2.2(1.41-3.48),indicatingaSerioussituationaccordingtoWHOclassification.Themain causes of death reported throughrespondent’srecallwerethroughaccidents/physicalinjuries,diarrhoeaandotherillnesses.Thenutritioninformationfromhealthfacilityreportsshowsahighandincreasingproportionofmalnourishedchildren(>20%).(Figure1).

According to theApril 2011 FSNAUMarket Data Update,local cereal prices increased significantly (26-35%) whencompared to the previous month. However, importedfood commodity prices remained stable in April. As poorhouseholds are mainly dependent on locally producedfoods,thehighpriceincreasestheirlimitedaccess,andisariskfactortotheCriticalnutritionsituation.

Ongoingresponseactivitieswhichalsomitigatedthenutritionsituationinclude4stabilizationcentersrunbyACF(2),SOS(1),BPHCC(1),33siteswithtargetedsupplementaryfeedingprograms(TSFP),51siteswithoutpatienttherapeuticcare(OTP), and one blanket supplementary feeding programsite. These are undertaken by UNICEF, WFP, OxfamNovib/Saccid, ACF, Concern Worldwide, with local non-governmentalorganizationsnamely,Sorrdo,Jumbo,MuslimAid,Hacda,SEA,Zamzam,SRCS,SOS,Dawa,andWardi. (Source: IASC – Nutrition Cluster 3W Matrix, Feb’11).

Overview 1MogadishuNutritionSurvey 4ShabelleRapidNutritionAssessment 6JubaRapidNutritionAssessment 7NutritionSurveyGuidelines 8BariRapidNutritionAssessment 8ChildDietaryDiversityAndMilkFeedingFrequencies 9EffectsOfDroughtInM&LShabelleRegions 10

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FSNAU Monthly Nutrition Update March - April 2011

•Lower and Middle Shabelle Regions: Results from tworapidmid upper arm circumference (MUAC) assessmentsconducted inApril 2011 in which 2,200 children from 20accessible villages in Lower Shabelle agro-pastoral andriverinepopulations,indicate21.7%(16.7-27.8),and19.1%(13.8-25.7)respectively,oftheassessedchildrenasacutelymalnourished(MUAC<12.5cmoroedema).IntheMiddleShabelle region, rapid MUAC assessment findings in theagro-pastoral, and riverine livelihood zones inwhich 2200children were assessed indicates 25.3% (23.1-27.6) and21.6%(20.4-23.0)respectivelyoftheassessedchildrenasacutelymalnourishedchildren.ThenutritioninformationfromhealthfacilitiesinShabelleagro-pastoralareasshowsahighproportionofacutelymalnourishedchildren(>20%),withadecreasingtrendsinceJanuary2011(Figure2).ThenumberofadmissionsofacutelymalnourishedchildrenintoselectivefeedingprogramsshowsanincreasingtrendsinceFebruary2011(866-1090).

IntegratedanalysisofthesefindingsindicatesalikelyVery Critical nutrition situation in the assessed villages, andreflectsadeteriorationfromtheDeyr2010/11nutritionphase.AdetailednutritionsurveyisscheduledforJune2011.

According to the FSNAU/FEWSNETMarket Update,April2011, whilemaize prices are 73% higher tha a year ago.However, cattle prices declined in most markets whereasmilk, cereal and diesel prices escalated at varying levels.Stability in wage rates and rising cereal prices over themonthofApril2011reducedthetermsoftradebyabouthalfof its levels a year ago.This negatively impactedon foodaccessduringthisperiod,therebyaggravatingthenutritionsituation.Gu rainshavebeenreported inShabelleregionsandarelikelytomitigatewaterandpasturestress.(Source, FSNAU/FEWSNET Climate Data Update April 2011).Ongoing response activities that mitigated the nutritionsituationinLowerShabelleinclude:onestabilizationcenter(SC)managedbyMSF-CH,andthreemanagedbyCOSV,withsupport fromUNICEF. Additionally, thereare51OTPsites, 10TSFPand1BSNP, runbyUNICEFandWFP incollaboration with Sorrdo, Jumbo, Concern Worldwide,MslimAid,SRCSandSWISSO-Kalmo.InMiddleShabelle,therearetwostabilizationcentersrunbySaccid(Adale)andIntersos (Jowhar),36OTPsmanagedby Intersos,Saccid,MercyUSAandMuslimAid,andeightTFSPsites. (Source: IASC – Nutrition Cluster 3W Matrix – Who does What Where, Feb’11).

•Middle and Lower Juba Regions: ArapidMUACassessmentconductedinFebruary2011among3,432childrenfrom31villages, indicated a likely sustainedVery Critical nutritionsituation in the assessed Pastoral and Agro-pastoralpopulations. The proportions of the acutely malnourishedchildren,withMUAC<12.5 cmor oedema, is 15.0%and15.6% respectively and 3.1% and 3.6% being severelymalnourished (MUAC <11.5 or Oedema) respectively.HowevertheriverinelivelihoodpopulationsindicatesalikelyCritical nutrition situation, with the proportion of childrenacutely malnourished (MUAC <12.5 cm or Oedema) as14.6% and severely malnourished as 3.2% (MUAC <11.5cmoroedema).Thisshowsaslightimprovement1fromtheVery Critical nutrition situation reported in the Deyr’10/11season, mostly attributable to off-season crop productionandmilk availability due to in-migration of livestock health

1A tally sheet was used during data collection. Hence the confidence intervals are unavailable

interventions.Healthfacilityreportsshowahigh(>20%)butdecreasing trendofacutelymalnourishedpastoralchildrensince January 2011. In the agro-pastoral livelihood zone,the trend ishigh (>20%)butstable,while in the riverine, itishigh(>20%)andincreasing.Datafromselectivefeedingprogramsindicateahigh(104inFebruary,156inMarchand182 inApril)and increasing trendofadmissionsofacutelymalnourishedchildren.Anintegratedanalysisofthisfindingsindicates a likely Very Critical situation across the threelivelihoods,sustainedsincetheDeyr’10/11.Pricesofmostmonitoredcommoditiesremainedgenerallystableinthepastonemonthexcept formaize,charcoalandfirewood,whichaccelerated from their March 2011 levels. The marginaldeclineincasuallaborwagerateandincreasedmaizepricehavedropped termsof tradebetween labor andmaize by15and68percentfromMarch’11andApril’10respectively,limitingfoodaccess.

Ongoing responseactivitieswhichhavealsomitigated thenutrition situation in Lower Juba, include 2 stabilizationcenters in Kismayo by MuslimAid, 6 OTP sites, 81 sitesproviding targeted supplementary feeding implemented byUNICEF in collaboration with SAF, AFREC APD, SRCS,DIAL,MuslimAid,WRRSandSordes.InMiddleJuba,thereisonestabilizationcenter,inMarere,runbyMSF-H,4OTPsitesand8sitesfortargetedsupplementaryfeedingprogramsites managed by APD, Zam zam, and SRCS. (Source: IASC – Nutrition Cluster 3W Matrix – Who does What Where, Feb’11).

Forcomments related to responseactivities,[email protected]@un.org.

•Bari Region – Sool Plateau Livelihood Zone: Fieldreportsbya localagency, followedbyarapidMUACassessmentof133childrenaged6-59months from threevillagesofBariregionindicateaworryingnutritionsituationwith 19.5%, with a MUAC <12.5cm or oedema and 5.3%severelymalnourished (MUAC<11.5 or oedema). Detailsareprovidedinthisupdate,andasurveyscheduledforJune2011.Healthfacilitydatafromtheassessedareashowshigh(>15%) and stable trend of acutely malnourished childrenbeing screened. Preliminary integrated analysis of thesituationinSoolisthereforelikelyVery Critical.

Pitting of bilateral oedema - Juba riverine, FSNAU, Feb 2011

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FSNAU Nutrition Survey Plans for the Gu 2011 SeasonFSNAU, in collaboration with partners is scheduled toconduct 34 nutrition surveys, based on the standard twostageclustersamplingmethodology,duringApriland July2011.Thetargetpopulationsareeight internallydisplacedpersons’ settlements, and 26 rural livelihoods both in thenorthandsouthcentralSomalia. Currently,sevensurveysareongoinginSomaliland(Hargeisa,Burao,BerberaIDPs),and Puntland (Bossaso, Qardho, Garowe and GalkayoIDPs),inpartnershipwiththeMinistriesofHealth.

In addition FSNAU, is scheduled to conduct nutritionand household food security surveys in at least sevenurban centers.Mogadishu survey was undertaken inApril2011, while studies are scheduled in Hargeisa, Boroma,Berbera, Bossaso,Garowe andGalkayo, to estimate boththenutritionandhousehold foodsecuritysituation in theseurbanpopulationgroups.TheremainderofthesurveysarescheduledaspertheplaninTable1.

National Immunization Days (NIDs)Somaliamarked the 4th anniversary of being polio-free on25th March2011,after jointpolio immunizationcampaignsspearheadedbyhealthauthoritiesatnationalandlocallevels,incollaborationwithWHO,UNICEF,otherpolioeradicationpartners and the Somali communities. To maintain highimmunity of children under the age of five, two rounds ofNational Immunization Days (NIDs) were planned for thisyear,thefirstroundintheweekof20-26thMarch2011.Formoreinformation,visittheSomaliaHealthClusteronhttp://www.emro.who.int/somalia/.

SPECIAL STUDIES

Knowledge, Attitudes and Practices (KAP) study on Fish Consumption

FSNAU is currently undertaking a KAP study on fishconsumptioninSomalia.

Themainpurposeofthestudyistogainafullunderstandingon the common practices, attitudes and beliefs on fishconsumption in Somalia, and the level of knowledge thecommunity has on the health and nutritive benefits of fishconsumption.This informationwill thenbeusedasabasisfordevelopingrelevantcommunicationstrategiespromotingthe consumptionof fish. Inaddition the informationwill beusedtosupplementbaselinefisherieslivelihoodinformationthatiscurrentlybeingcollectedinSomalia,inordertodesignappropriateinterventionsinthefisheriessector.Thespecificstudyobjectivesare:

1.TodeterminethemaintypesandformsoffishconsumedbycommunitiesinSomalia.

2.Todeterminethemaintypesandformsoffishconsumedby various groups (e.g. gender, age-groups, socio-economicgroups)inSomalia.

3.To identify the main factors affecting or influencing fishconsumptionamongthecommunities.

4.To gain understanding on the cultural beliefs, practicesandattitudesregardingfishconsumptioninSomalia.

5.To determine the preferred/popular storage, preparationandcookingmethodsusedinpreparingfish.

Studyfindingswillbesharedoncompletionofthestudy.

Multiple Indicator Cluster Survey (MICS) - UNICEF

The UNICEF led multiple indicator cluster survey (MICS) iscurrently ongoing in Somalia. InApril-May 2011, the studywas undertaken in Puntland, while plans are underway forSomalilandfromJune-July2011.Theobjectivesare:

1.Toprovideuptodate informationonthesituationofwomenandchildreninSomalia

2. To furnish data needed for progress towards MDGs andotherinternationallyagreedgoals.

3. To contribute to improvements of data and monitoringsystemsinSomalia.

Infant and Young Child Feeding (IYCF)

A meta-analysis of data from 22 nutrition assessmentsconducted in 2010 by FSNAU, on two indicatorsmeasuringinfant and young child feeding: child dietary diversity andnumber of milk feeds, among children aged 6-24months inSomalia,showsthatchilddietarydiversityandthelevelofmilkconsumptionarekeydeterminantsofbothwastingandstuntingindices. This highlights the necessity to continue collectionandanalysis of thedataasproxy indicators of thenutritionsituation.Adetailedreportispresentedwithinthispublication.

Nutrition Survey Planned Period Status

1 TogdheerPastoral June-July Planned2 WestGolis/GubanPastoral June-July Planned3 Agro-pastoralists-NW&Togdheer June-July Planned4 SoolPlateau June-July Planned5 HawdofSool/Togd/Galbeed June-July Planned6 EastGolis/Gebbi/KakarPastoral June-July Planned7 NugalValleyPastoral June-July Planned8 CoastalDeeh-NE July2011 Planned9 CoastalDeeh-Central July2011 Planned10 HawdLivelihood July2011 Planned11 AddunLivelihood July2011 Planned12 Cowpea-Central July2011 Planned13 NWUrban(Hargeisa,Berbera,Boroma) June-July Planned14-16 NEurban(Bossaso,Garowe,Galkayo) June-July Planned17-19 NWIDPs(Hargeisa,Burao,Berbera) May2011 On-going22 NEIDPs(Garowe,Galkayo,Bossaso) May2011 On-going25 HiranPastoral June-July Planned26 HiranRiverine June-July Planned27 HiranAgropastoral June-July Planned28 Shabelleriverine May-June Planned29 ShabelleAgropastoral May-June Planned30 ShabeleIDP May-June Planned31 MogadishuCity April Completed32 BakoolPastoral June-July Planned33 BakoolAgropastoral June-July Planned34 BayAgropastoral June-July Planned35 GedoRiverine June-July Planned36 GedoAgropastoral June-July Planned37 GedoPastoral June-July Planned38 JubaRiverine June-July Planned39 JubaAgropastoral June-July Planned40 JubaPastoral June-July Planned

Table 1: Summary of Nutrition Surveys

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Mogadishu,thecapitalcityofSomalia,hasremainedinastateofcivilunrestandtheepicentreofconflict,sinceJanuary1991.Thisconflicthashadanimpactonthegeneralhealthandwellbeingofthepopulationinthetown.Thelastnutritionsurveyinthetownwasconductedin2004andreportedaGAMandSAMrate of 13.8% (12.8- 19.6) and 3.2% (2.2- 4.7) respectively,while the under five and crudemortality rates reportedwere0.7per 10,000/day, and0.5per 10,000/day.Due to thehighlevel of insecurity experienced in the town, it has been verydifficult for FSNAU and partners to conduct regular surveysandin-depthnutritionsurveillanceactivities.Consequentlythenutrition informationcollected from theareahasbeenmainlythrough rapid MUAC nutrition assessments. Between 18th– 26th April 2011, FSNAU,ACF with partners namely, WFP,SAACID,SORDO,MURDO,TRG,SRCS,CBO(Hamarweyne,Hamarjabjab andWaaberi) andZAMZAMwith support fromlocal authorities, conducted a SMART nutrition assessmentin six districts1 in Mogadishu. Using a two-stage probabilityproportionate to size (PPS) sampling methodology, a totalof 902 children aged 6-59 months were assessed from 502households,while737householdswereassessedformortalityfrom a total of 35 clusters in the six districts. The surveycollectedanthropometric,morbidityandmortalitydata.

Results from the nutrition survey indicate aCritical nutritionsituation inMogadishu town,with a global acutemalnutrition(WHZ scores <-2 or oedema) of 15.2% (10.9-20.7) and asevereacutemalnutritionrateof1.7% (0.9-3.1).The90daysretrospective crude and under five death rates reported are1.81 (1.38-2.37),and2.2 (1.41-3.48),bothratesbeingabovetheemergencythresholdaccordingtoWHOclassificationandindicatingaSerioussituation.Themaincausesofdeathreportedthroughrespondent’srecallwereaccidents/physicalinjuries,diarrhoeaandotherillnesses2.TheFSNAUPostDeyr‘10/11integratednutritionanalysis,generallyclassifiedthenutritionsituationofthepopulationsinMogadishutownaslikelyVery Critical.DatafromrapidMUACassessmentsconductedinDecemberreportedaglobalacutemalnutrition(MUAC<12.5oroedema)rateof>15%;inadditiondatafromthehealthfacilities3intheareareportedahighandstabletrendinthenumberofacutelymalnourishedchildren.ThecurrentdatafromthehealthfacilitiesintheareafromthemonthofJanuarytoApril2011indicatesthesametrend,ofaveryhighandincreasingnumbersofacutelymalnourishedchildren(Figure1).

Highmorbidityratesinapopulationpredisposethepopulationtomalnutrition;inMogadishu,ahighproportionofthechildrenassessedinthesurveyhadreportedlyfallenilltwoweekspriortothesurvey,thetotalwithreportedrateofmorbidityreportedis37.7%.Theproportionofchildrenreportedtohavesufferedfromdiarrhoeainthe2weekspriortotheassessmentof11.8%,whilethosereportedlysufferingfrompneumoniaandmeasleswas12.6%and1.9%respectively.ThemeaslesimmunizationandvitaminAsupplementationstatusfortheassessedchildreninthe6monthspriortotheassessmentiswellbelowtherecommendedSpherestandards(24.5%and70.5%respectively),increasingthechildren’ssusceptibilitytodisease(Table2).

Qualitativedatacollectedduringthesurveyindicatessomeofthemainfactorsaffectingthenutritionalstatusofthepopulationincludingincreasedincidencesofdiarrhoeaandmeasles,reducedpurchasingpowerofhouseholds,lessincomeopportunityduetotheclosureoftheBakaramarket,householdsfromthedrought-affectedsurroundingruralareashavecometoMogadishulooking foropportunities,populationdisplacementsdue toconflict inpartsof the town,very limitedhumanitarian interventionspace,highcerealpricesforbothlocalandimportedcommodities,inadditiontothedisruptionofregionalmarketsduetohightaxationfromthelocalauthorities.Currentlythereareselectivefeedingprogrammesbeingundertakenbyseveralpartnersinthetown.ACFisconductingfeedingprogrammesin3districts,datafromtheirprogrammesindicateanincreasingnumberofacutelymalnourishedchildrenbeingadmittedtotheprogrammes.

1Wadajir,Dharkenley,Hamarweyne,Hamarjabjab,WaaberiandHodan2Diabetes,heartfailure,TB,whoopingcough,hypertension,etc3Medina,Waberi,HamarweyneandHamarjabjab

MOgADIShU NUTRITION SURVEY: Findings show Critical Nutrition Situation in the conflict-stricken Somalia Capital

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Figure 1: hIS Acute Malnutrition Trends in Mogadishu MChs 2010-11

Mother with child during the Mogadishu nutrition survey, FSNAU April 2011

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Indicator N % (CI)Total number of Clusters assessed 35Total number of Households assessed for children 502Total number of Households assessed for mortality 737Total number of Children assessedMaleFemale

902451451

100.050.050.0

47.0-53.047.0-53.0

Child MalnutritionGlobal Acute Malnutrition (WHO 2006)MaleFemale

137 15.2 10.9-20.771 15.7 11.5-21.266 14.6 9.6-21.6

Severe Acute Malnutrition (WHO 2006)Male Female

15 1.7 0.9-3.16 1.3 0.6-3.29 2.0 0.9-4.4

Oedema 1 0.1 0.0-0.3

Global Acute Malnutrition (NCHS)MaleFemale

118 13.1 9.3-18.259 13.1 9.3-18.159 13.1 8.8-19.2

Severe Acute Malnutrition (NCHS)MaleFemale

7 0.8 0.3-2.03 0.7 0.2-2.04 0.9 0.3-2.8

Global Acute Malnutrition (WHM<80% or oedema - NCHS) 63 7.0 4.2-9.8Severe Acute Malnutrition (WHM<70% or oedema - NCHS) 0 0.0 -

Severe to Moderate Acute Malnutrition by MUAC (<12.5 cm or oedema) Male Female

110 12.2 8.3-16.146 10.2 6.4-14.064 14.2 8.8-19.6

Severe Acute Malnutrition by MUAC (<11.5 cm or oedema) Male Female

21 2.3 1.1-3.67 1.6 0.3-2.814 3.1 1.6-4.6

Proportion of children Stunted (HAZ<-2)Male Female

147 16.3 12.2-21.580 17.7 13.0-23.767 14.9 10.2-21.1

Proportion of children Underweight (WAZ<-2)MaleFemale

131 14.5 10.8-19.271 15.7 11.6-21.060 13.3 9.1-19.1

Child MorbidityChildren reported ill in the previous 2 weeks 340 37.7 30.6-44.7Children reported with diarrhoea in 2 weeks prior to assessment 107 11.8 8.5-15.2Children reported with ARI within two weeks prior to assessment 114 12.6 8.2-17.0Children reported with febrile illness in 2 weeks prior to assessment 25 2.8 1.6-4.0Children reported with suspected measles within one month prior to assessment 17 1.9 0.15-3.6Child Immunization statusChildren immunized against measles 637 70.5 64.6-76.5By Recall 235 36.9 25.8-48.0By Card 402 63.1 52.0-74.2Children reported to have received vitamin A supplementation in last 6 months 221 24.5 18.3-30.7MortalityUnder 5 Death Rate (U5DR) as deaths/10,000/ day* 2.2 1.41-3.48Crude Death Rate (CDR) as deaths/10,000/ day 1.81 1.38-2.37

Table 2: Summary of Results for Mogadishu Nutrition Survey (N= 902)

Location Criteria Missing/ Flagged data

Overall sex ratio

Overall age distribution

Dig Preference score-weight

Dig Preference score-height SD WhZ Skewness

WhZKurtosis WhZ

Poisson Distribution

MogadishuNutritionSurvey

Category Good Acceptable Poor Good Acceptable Acceptable Good Good Unacceptable

Score 0 2 4 0 2 2 0 0 5

Table 3: Quality checks for survey data

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Inaddition,WFPare conductingwet feeding,whileOXFAM isproviding feedingandhealthprogrammes to thepopulation.Althoughtheseeffortsareassistinginmitigatingthesituation,itisnotsufficient,urgentscalingupofhealthandnutritionrelatedprogrammesareessentialgiventheeffectsofthepersistentconflictinthetownanditsresultantnegativeimpactonthefoodsecurity,healthandnutritionalwellbeingofthepopulation.Therearealsoalargenumberofinternallydisplacedpopulationslivinginthearea,thesepopulationshaveintegratedwiththelocalresidentsandfacethesamechallengesoftheurbanpoor.

Overall,thenutritionsituationinMogadishuisCritical,andthepopulationremainshighlyvulnerableduetothepersistentconflictinthetownwhichhasadirectimpactonhouseholdincome,foodsecurity,healthandnutritionalwellbeingofthepopulation.Pooraccesstohealthfacilitiesinthetownisalsoaninstigatingfactor.Diseaseoutbreakssuchasmeaslesandacutewaterydiarrhoeahaveadirectimpactonthehealthandnutritionalstatusofthechildren.Chronicunderlyingfactorssuchaspoorchildcareandfeedingpractices,inadequatesanitationfacilitiesandlackofaccesstosafedrinkingwaterwillremainaslongtermchallengestothehealthandnutritionwell-beingofthepopulation.Itisthereforeimperativetocloselymonitorthewellbeingofthepopulation,andtocontinueinterventionstargetingtheunderlyingcausesoffoodinsecurityanddiseaseintheregion.

ShABELLE RAPID NUTRITION ASSESSMENT

Between31stMarch and7thApril 2011,FSNAUconducted a rapid nutrition assessment in 40 purposively selected villages(basedonaccess)inMiddleandLowerShabelleregions.Thiswasafollowupassessmenttodeterminethenutritionsituationinthearea,followingtheDeyr ‘10/11integratednutritionassessmentandanalysiswhichwasnotconclusiveduetodataqualityconcerns.UsingMidupperArmCircumference(MUAC)measurements,atotalof4,395children,fromtheentireShabelleregionwereassessed.FromeachlivelihoodzoneinMiddleandLowerShabelle,10villageswereselectedand110children(aged6-59months)assessedpersite.

Findingsindicatethattheproportionofchildrenatriskofacutemalnutrition,withMUAC<12.5cmoroedema,as21.7%(16.7-27.8)and19.1%(13.8-25.7)intheLowerShabelleagro-pastoraland riverine populations respectively. In the Middle Shabelleregion,theproportionis25.3%(23.1-27.6)and21.6%(20.4-23.0)among theagro-pastoraland riverinepopulations respectively.Nocasesofoedemawerereportedamongtheassessedagro-pastoralpopulations,however,10cases (0.9%)were reportedamong the assessed Lower Shabelle riverine population andone(0.1%)intheMiddleShabelleriverinepopulation(See table 4 for a summary of the results).Thenutritioninformationfromhealth facility reports showsahighanddecreasingproportionof malnourished children (>20%). (Figure 2). These resultsindicatealikelyVery Criticalnutritionsituationintheassessedpopulationgroups,alikelydeteriorationfromthepreviousnutritionsituationofDeyr‘10/11.

ThelikelyVery Criticalnutritionsituationismainlyattributedtotheimpactoflimitedfoodaccessincludingreducedmilkconsumptionandpoordietarydiversity.Inaddition,informationfromhealthfacilitydataindicateshighcasesofmorbiditywithmeasles,acutewaterydiarrhea(AWD)andwhoopingcough.Thesefactorscombinedwiththechronic issuesaffectingmalnutritionsuchaspoorchildcareandfeedingpracticesandlackofadequateandappropriateaccesstosafewater,healthandsanitationfacilitiesfurtheraggravatesthepoornutritionsituation. AccordingtotheApril2011FSNAUFoodSecurityandNutritionBulletin,thewatersituationintheareaiscritical,withseveralboreholesandshallowwellsdryingup,andextremeovercrowdingatthewaterpoints.Theagro-pastorallivelihoodsarethemostaffectedbythedroughtintheregion,theyarelosinglivestockeitherthroughmortalityorsalesatlowerpricestopurchasefood.

LowerShabelle MiddleShabelleAgro-pastoral

N=109910sites

RiverineN=110010sites

Agro-pastoralN=110010sites

RiverineN=109510sites

ProportionofassessedchildrenwithMUAC<12.5cmoroedema

238(21.7%)CI:16.7-27.8

210(19.1%)CI:13.8-25.7

278(25.3%)CI:23.1-27.6

237(21.6%)CI:20.4-23.0

ProportionofassessedchildrenwithMUAC<11.5cmoroedema

36(3.3%)CI:1.7-6.1

61(5.5%)CI:3.2-9.5

106(9.6%)CI:8.4-11.0

125(11.4%)CI:10.1-12.9

Oedema 0(0.0%) 10(0.9%) 0(0.0%) 1(0.1%)

InadditiontoMUAC,ahighproportionoftheassessedchildren(about25-30%)inMiddleShabelleriverineandagro-pastoral,and40-47%inLowerShabellewerereportedtohavesufferedfromaninfectionintheprecedingtwoweekstotheassessment.The reported causesofmorbidity inMiddleShabelle livelihoodswere fever (about 10-12% ), anddiarrhoea (9-12%) in the

Table 4: Summary of Rapid Assessment Findings in Lower and Middle Shabelle regions

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Figure 2: hIS Acute Malnutrition Trends in Shabelle Agropastoral MChs 2010-11 (Source: COSV/MSF-S)

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riverineandagro-pastorallivelihoodzones.IntheLowerShabelleregions,morbiditywasmainlyattributedtodiarrhoea(24-31%),fever(10-11%andsuspectedmeasles,(10-9%)intheagro-pastoralandriverinelivelihoodsrespectively.

Interventionsgearedtowardsimprovedaccesstofood,healthcareservices,safedrinkingwaterandsanitationservicesremainaprioritytopreventfurtherdeteriorationofthenutritionsituationinShabelleregion.Thisneedstobecombinedwithrehabilitationofacutelymalnourishedchildrenintheregion.FSNAUwillcontinuetomonitorthesituationintheregion.

JUBA RAPID NUTRITION ASSESSMENT

Between21stto28thofFebruary2011FSNAUconductedrapidMUACassessmentsinthethreelivelihoodsofMiddleandLowerJubaregions,namelypastoral,agro-pastoralandriverine.Thiswasafollowupassessmenttomonitorthenutritionsituationinthearea,fromtheDeyr ‘10/11integratednutritionanalysis,whichindicatedaVery Criticalnutritionsituationamongthepopulationsgroups.Atotalof3,432children,(1,214fromtheriverine,1,102fromtheagro-pastoraland1,116frompastorallivelihood)aged6to59wereassessedusingMidupperArmCircumference(MUAC)measurement.Tallysheetswereusedinrecordingofdata(ratherthanrecordingofactualmeasurements)therebylimitingcalculationofconfidenceintervals.

Resultsof the rapidMUACassessmentspoints toVery Critical situation in thepopulationsof thepastoralandagro-pastorallivelihoodsofJubaregions.TheproportionofacutelymalnourishedchildrenwithMUAC<12.5cmoroedemaamongthepastoralandagro-pastoralpopulationwas15.0%and15.6%respectively,with3.1%and3.6%respectivelybeingseverelymalnourished(MUAC<11.5oroedema).TheseresultsindicatealikelysustainedVery Criticalnutritionsituation.Amongtheriverinepopulation,theproportionofacutelymalnourished(MUAC<12.5cmoroedema)childrenwas14.6%,including3.2%severelymalnourishedchildren(MUAC<11.5cmoroedema)(Table5).Thenutrition informationfromhealthfacilityreportsshowsahighandstableproportionofacuteleymalnourishedchildren(>20%).(Figure3and4).IntegratedanalysisoffindingsindicatesaVery Criticalnutritionsituation,thoughwithslightimprovementsintheriverinesincetheDeyr ’10/11assessment.(see table 5 for a summary of the results).

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Figure 3: hIS Acute Malnutrition trends in Juba Agropastoral MChs 2010-11

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Figure: 4 hIS Acute Malnutrition trends in Juba Pastoral MChs 2010-11

OveralltheresultsshowalikelysustainedVeryCriticalnutritionsituationamongthepopulationsinthethreelivelihoodsduetotheimpactofDeyr’10/11rainfallfailureandfollowedbytheabnormallyextendeddry Jilaal(January-March)season.Thesustainednutritionsituationisalsoattributedtothereducedaccesstocattleandcamelmilkduetopoorlivestockbodycondition,attributedtotheimpactofdrought.Inaddition,limitedfoodaccessandreducedincomeamongthepastoralandagro-pastoralpopulationremainsachallenge.Furthermore,thechronicunderlyingcausesofmalnutritionwhichincludeinadequatehealthservices,highmorbidity,poorinfantandyoungchildfeedingpractices,lackofaccesstosafedrinkingwaterandpoordietarypersistintheareaaggravated thepoornutritionsituation.Theslight improvementnotedamong the riverinepopulation is likelyattributed to theavailabilityoftheoff-seasoncrop,fruitsandvegetablefromtheriverinecommunitiesandthemutualbenefitfrommilkaccessfromcattlethathavein-migratedtotheriverbanksforfodderandwater.AccordingtotheFSNAUquarterlybriefApril,2011,theoff-seasonharvest,mainlymaize,sesameandcowpea,washarvestedintheriverinelivelihoodofJubaregions,fromthedesheks (depressionareas)andpumpirrigatedfarmsinJammame,Jilib,BualeandSakowdistricts.Thecurrentoff-seasonharvestindesheks isaresultofnaturalfloodsinMay2010,whichrechargedmostofthedesheks therebybringingopportunitiesfortworoundsofoff-seasoncropproduction(Sep‘10andMar’11).InadditiontothatthereisanincomefromthesaleoffodderandTFCandOTPinterventionprogramstargetingtheseverelymalnourishedchildrenattheriverineareas.

Riverine(N=1214;11sites)

Agro-pastoral(N=1102;10sites)

Pastoral(N=1116;10sites)

ProportionofassessedchildrenwithMUAC<12.5cmoroedema 178(14.6%) 173(15.6%) 168(15.0%)

ProportionofassessedchildrenwithMUAC<11.5cmoroedema 3.2% 35(3.1%) 40(3.6%)Oedema 9(0.7%) 5(0.4%) 2(0.2%)

Table 5: Summary of Rapid Assessment Findings in Juba regions

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NUTRITION SURVEY gUIDELINES AND DATA MANAgEMENT WORKShOP BASED ON EPI-INFO-ENA

InlinewiththeFSNAUobjectivetoenhancecapacityinearlywarningofgovernmentinstitutionsandpartners,FSNAUconducteda3daytrainingworkshopforthekeypartnermembersoftheSomaliaNutritionClusterinNairobifrom16thto18thMarch2011.Atotalof17participants,consistingof7internationalNGOsand8localNGOstookpartinthetraining.Theoverallaimoftheworkshopwastoempowerthepartnerstoconductnutritionsurveillanceactivitiesusingthestandardizedguidelinesendorsedbyclustermembers.

Thetrainingcovereddifferentpartsofthenutritionsurveyprocessincludingsurveyplanning,datacollection,entry,processingandanalysis.Otheraspectsemphasizedintheworkshopincludedsamplingtechniques,qualitycontrolofdata,anthropometricmeasurementsandagedetermination.Theparticipantswerealsoprovidedwithpractical sessionsondatamanagementandanalysisusingtheEPIInfoandENAsoftware,includinghowtocreatedataentrytemplates,datacleaningandprocessing,andcomputingindices.Differentmethodologieswereusedduringthetrainingcomprisingof:powerpointpresentations,demonstrations,groupdiscussionsandquestionsandanswerssessions.

Participants self evaluation pre and post training indicated significant improvement in their understanding of the key areascovered.Priortothetrainingmostparticipantsindicatedhavingalimitedunderstandingofcertainsurveymethodologiesanddatamanagement,howevertheyhadfairknowledgeinareasofsurveyplanning,datainterpretationandpresentation.Theposttrainingevaluationindicatedthattheparticipantsimprovedtheirknowledgeonalltheareascovered.

RAPID ASSESSMENT IN AFFECTED AREAS IN SOOL PLATEAU, BARI REgION

On26thApril2011,FSNAUreceivedaworrying report froma localNGO inPuntland,claiming increasedhumanandanimalmortalityarisingfromfoodinsecurityanddiseaseinBaqbaqandsurroundingvillages.Inanefforttoascertainthesituation,FSNAUcollectedanexhaustiverapidMidUpperArmCircumference(MUAC)assessmentandconductedfocusgroupdiscussionsintheaffectedvillageson3rdand4thMay2011.Atotalof133children(aged6-59months),fromthethreeaffectedvillagesofBaqbaq,Usuguse,andElmadobeinSoolPlateauofBariRegionwereassessed.

FindingsindicatethattheproportionofacutelymalnourishedchildrenwithMUAC<12.5cmoroedemais19.5%,with5.3%severelymalnourished(MUAC<11.5oroedema),and3(2.3%)casesofoedemawerereported.Thenutritioninformationfromhealthfacilityreportsshowsahighandstableproportionofacutelymalnourishedchildren(>15%).(Figure5).Thoughnot representativeof the livelihood, these results indicatealikelyVery Criticalnutritionsituationintheassessedaffectedpopulation, a likely deterioration from the previous nutritionsituation.

ThelikelyVery Criticalnutritionsituationismainlyattributedtothenegativeeffectsofthedroughtfrompreviouspoorrains,thereasonwhichhasresultedinlimitedaccesstofood,poordietarydiversityandreducedmilkconsumption.Inaddition,qualitative information from the area indicates livestockdeaths,increaseddestitution,andreducednumberofmealsconsumed.Thesefactorscombinedwiththechronicissuesaffectingmalnutritionsuchaslackofadequateandappropriateaccesstosafewater.Atpresent,wateraccessisaffectedbyhighpriceswiththecostofonedrumofwaterrangingfromSoSh. 170.000-200.000 (US$ 5.3-6.3) compared to SoSh20,000-30,000atthesameperiodlastyear;andconstrainedaccesstobasicservicesinthearea-onlyUsgurevillagehasarecentlyopenedhealthpost.Theothervillagershavetogothroughadifficult terrain to reachAllula/KandalaorQardhofurtheraggravatesthepoornutritionsituation

Interventionsgearedtowardsimprovedaccesstofood,healthcare services, safe drinking water and sanitation servicesremainaprioritytopreventfurtherdeteriorationofthenutritionsituation inBaqbaq,UsuguseandElmadobe inBari region.This needs to be combined with rehabilitation of acutelymalnourishedchildren in thearea. FSNAUwill continue tomonitorthesituationintheentirelivelihood.

Increased livestock mortality in Sool plateau, Bari Region, FSNAU April 2011

Figure 5: hIS Acute Malnutrition Trends in Sool Plateau of Bari Region

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The Association between Child Dietary Diversity and Milk Feeding Frequencies with Acute Malnutrition in Somalia

IntroductionThe impactof infantandyoungchild feeding (IYCF)practiceson thenutritionandhealthstatusand theextent towhichanindividualorpopulationismeetingtherecommendedfeedingstandardscanbeclearlydemonstratediftheappropriateIYCFindicatorsareusedinassessments.Inviewofthis,FSNAUhas,overtheyears,beenrefiningthemethodsofdatacollectionandanalysisofIYCFdata.In2010,FSNAUmodifiedthenutritionassessmentquestionnaireforcomprehensivenutritionsurveystoincludechilddietarydiversityandmilkfeedingfrequenciesindicators.Thisarticlepresentsthefindingsofametadataanalysisof the twonew IYCF indicators froma totalof twenty twoassessmentsusing thePopulationProportionate tosizesamplingmethodologyconductedduringtheGu(April-June)andDeyr(October-December)seasonsof2010byFSNAUandpartners.

Data analysisAtotalof3,883childrenaged6-24monthswereidentifiedfromthedatabase,ofwhom15.2% wereacutelymalnourished(WHZ4<-2oroedema)while23.4%werestunted(HAZ5<-2).Amedianof2.5foodgroupsoutofalistofeight6foodgroupsandamedianmilkfeedingfrequenciesof3.0(arangeof0-5times)wasconsumedbytheassessedchildren.

When analyzed against the recommended minimum feedingthresholdoffourfoodgroupsandtwomilkfeedingfrequencies,majority (81.7%), of the children consumedmilk at least twotimes in a day as recommended. On the other hand, only15.9%ofthechildrenwerefedonadietthatcomprisedoftherecommendedfourormorefoodgroups.Thisshowsahighmilkconsumptionbutpoordietarydiversity,Table6givesasummaryofthefindings.

Further statistical analysis show that child dietary diversity(numberof foodgroupsconsumed) is significantlyassociatedwith both WHZ-scores and HAZ-scores, where consumptionofahighernumberoffoodgroupsisassociatedwithimprovedWHZandHAZscores(p<0.01).Evenaftercontrollingforbreastfeedingstatus,theassociationremainedsignificant,implyingthatbesidesbreastmilk,childreninthisagegroupneedtoconsumemanyfoodgroupstopreventbothwastingandstunting.

Similarly,increasedfrequencyofmilkconsumptionisassociatedwithacorrespondingincreaseinWHZscore(p<0.01),(Table6).Thestrengthoftheassociation(τ)increaseswhenbreastfeedingstatusiscontrolledforshowingtheimportanceofbreastfeedingonthenutritionstatusofthechildren.Further,theresultsshowtheimportantnutritionalroleplayedbymilkamongchildrenintheSomalipopulation.However,milkfeedingfrequencyisnotsignificantlyassociatedwithHAZ(p=0.06),butwhenthebreastfeedingstatusiscontrolled,asignificantbutnegativeassociationisobserved(p=0.025).Thisrelationshiprequiresfurtherinvestigationbutmaysuggestthepresenceofotherconfoundingfactorsnotaccountedforintheanalysis,suchasqualityofthemilkfeeds,illness,orfrequencyofbreastfeeding.4WeightforHeightZscores5HeightforAgeZscores6Cereals,Milk,Meat/fish,Legumes,Whiteroots/tubers,Yelloworangefleshedtubers/VitaminArichvegetables,VitaminArichfruits,othervegetablesandfruits

Variable N %Totalchildrenassessed 3883 100ProportionAcutelyMalnourished(WHZ<-2oroedema) 591 15.2Meanweight-for-heightz-score -0.790±1.32Proportionstunted 911 23.4Meanweight-for-heightz-score 1.038±1.26Proportionconsuming≥ four foodgroups inaday 617 15.9Medianfoodgroupsconsumed 2.5Proportionconsumingmilkfor≥twotimesinaday 3175 81.7Medianfoodgroupsconsumed 3.0

Table 6.Summary of Findings of IYCF Data Analysis (2010)

Variables Nutrition Indicators Correlation(Kendall’s tau_b) p Value

Foodgroups WHZ-scores 0.080 0.000*HAZ-scores -0.039 0.001*

Milkfeedingfrequency WHZ-scores 0.041 0.000*HAZ-scores -0.022 0.060

Proportion malnourished RR (95% CI) p ValueDietaryDiversity

≥Fourfoodgroups<Fourfoodgroups

Proportion Wasted (WHZ<-2) 108(17.5%)483(14.8%) 1.18(0.98-1.43 0.085

DietaryDiversity≥Fourfoodgroups<Fourfoodgroups

Proportion Stunted (HAZ<-2)155(25.1%)756(23.1%) 1.09(0.93-1.216) 0.289

Milkfrequencyfornonbreastfedchildren≥Twotimes<Twotimes

Proportion Wasted (WHZ<-2) 225(14.5%)125(17.7%) 0.85(0.66-1.15) 0.326

Milkfrequencyfornonbreastfedchildren≥Twotimes<Twotimes

Proportion Stunted (HAZ<-2)310(20%)42(13.2%) 1.5(1.12-2.04) 0.004*

Table 7: Associations between Child dietary diversity and Milk feeding frequency with malnutrition

*Indicatessignificantassociation

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On thecontrary,analysisof theassociationbetween theproportionofwasted (WHZ<-2scoresoroedema)andstunted (HAZ<-2scores)children,withtheproportionofthosemeetingtherecommendedthresholdsofatleasttwomilkfeedingsandaminimumoffourfoodgroupsinaday,showsmixedresults(Table7).Thereisnostatisticallysignificantassociationbetweentheproportionmeetingthedietarydiversitythresholdbothwithglobalacutemalnutrition(GAM)rate,andglobalstunted(p>0.05).However,thereissignificantassociationbetweenthemilkfeedingfrequencythresholdwithstunting(p<0.01),butnotwithwasting(p>0.05).ThelackofassociationbetweentheseindicatorswhenusingcategoricalthresholdsandtheproportionsofthewastedandstuntedchildrenmayimplythatthesethresholdsarenotsensitivemeasuresfortheminimumrequiredmilkfeedingfrequenciesandnumberoffoodgroupsforSomalipopulation.

Inconclusion,themetadataanalysisshowsthatthenumberoffoodgroups,andfrequencyofmilkconsumptionarekeydeterminantsofbothWHZandHAZscores.Italsojustifiestheneedforcontinuedcollectionandanalysisoftheseimportant indicatorsofIYCFpractices.ThecategoricalthresholdsfortherequiredminimumnumberoffoodgroupsandmilkfeedingfrequenciesarenotsensitiveandmayneedtobereviewedtolevelsthatarespecificandsensitivetotheSomalicontext.

FSNAU Technical Series Report, Nutrition Situation Post Deyr 2010/11 , February 2011 FSNAU Technical Series Report, Post Deyr 2010/11, March 2011FSNAU/FEWSNET Market Data Update, April 2011FSNAU/FEWSNET Climate Data Update, April 2011FSNAU Food Security and Nutrition Brief, April 2011NOTE: The above publications and releases are available on the FSNAU website: www.fsnau.org

CAPACITY BUILDINg Aspartof thecapacitydevelopmentstrategy,FSNAUconducted four trainings in themonthsofMarch,AprilandMay2011 targetingdifferentgroupsofnutritionprofessionalsandpartners.Theaimoftheseworkshopswastoempowertheparticipantstoconductnutritionassessmentsusingthestandardinternationalnutritionguidelines(SMART),andtoequipthemwithskillstoconductbasicdataanalysisandinterpretation.

•FSNAU Nutrition Cluster Partners:Athreedaypartners’trainingonnutritionassessmentsanddatamanagementbasedonSMARTmethodologywasconductedinNairobi,with17participantsfromagenciesworkinginSomaliainMarch2011.

•Academic Institutions:o University of Hargeisa: AtwodaydatamanagementtrainingwasprovidedtomedicalstudentsattheUniversityofHargeisainApril

2011.o University of Nairobi:Msc.NutritionStudentsinApril2011onNutritionSurveillanceandInformationSystemso Kenyatta University:Msc.NutritionStudentsinMay2011NutritionSurveillanceandInformationSystems

Effects of the Drought on households in Middle & Lower Shabelle regions

Thepopulationoftheagro-pastoraldistrictsnamelyWalanweyneandQoryoleyareamongthoseseverelyaffectedbythedroughtintheregion.Thelackofadequaterainfallinthearearesultedinbelownormalcropproductionlastseasonandtheabnormaloutmigrationoflivestocktotheriverineareasinsearchofwaterandpasture;thisincreasedthepressureforresourcesinthearea.Householdsintheagro-pastoralareaarereportingreducedlivestockherdsizes,asaresultofthedrought,asisthecasewithFilayAdan.AdanAli,Filay’sfatherownedalargeherdofover100cows,butthat’snomore.‘We are only left with two cows now’,saysFilay.Filayiscurrentlylivingalonewithheracutelymalnourishedson,hersistersandbrothershaveleftthevillagetoseekcasuallabouropportunitiesinthetown.‘We have lost many animals and due to this we are not able to purchase food and get milk like we used to,water is also a big problem in the area’,shesays.Eventheremainingtwocowsarejusthand-fedandworse,thereisagreatfearofwideoutbreakofdiseasesifitrainsduetothehighrateoflivestockdeatheventhoughtherainsarestillsporadic.TherearemanyfamiliesinthesamesituationasAdan’sfamily,experiencingthenegativeimpactthedroughthashadonthelivelihoodsofpopulationsinthearea.Thelackofsafecleanwater,reducedhouseholdincomeandconsumption ofmilk are some themain factors affecting poor food access and poornutritionsituation in thearea.Malnutritionrates indicatea likelyVery Criticalnutritionsituationintheregion.Thesituationisworsenedbydiminishedaccesstohumanitarianhealthandnutritionservicesprovidedby internationalorganization this lead to limitedaccesstobasichealthservicesandlackofmedicalsuppliestothefewexistingMCHintheregion.ImmediateinterventionsthataimatrehabilitatingmalnourishedchildrensuchasFilay’ssoninadditiontointerventionstomitigatethenegativeimpactofthedroughtonthepopulation’slivelihoodisimperative.MURDOalocalNGOintheregionhascarriedoutsomewatertruckinginthearea,andhasalsosetupafeedingprogrammeforacutelymalnourishedchildreninQoryoleyhospital.

Acutely malnourished mother and child in Shabelle, FSNAU April 2011

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