Nutrition Sector NiESWG Borno Nutrition in Emergency Sector Working Group 3rd OCT 2017

1. Overview of needs: Nutrition sector key issues and needs? Serious nutrition situation with GAM between 10-14 % rates in northern Borno and parts of central Borno among other aggravating factors. Possible outbreak of water borne and diarrhoea diseases with negative impact on nutrition situation. Inadequate facilities for addressing malnutrition cases with medical complications. MUAC Screening of every child 6-59 months. Low coverage of MAM cases Slow achievement of set targets in Biu, Damboa, Gwoza, Kalabarge, Kukawa,Mobbar, Ngala and Nganzai

Changes in context 3: CH analysis (II) Food Security and Nutrition situation In the projected period (June – August 2017), a total of about 8.9 million people may fall into the three combined critical food insecurity situations (crisis, emergency and famine) in the 16 states; including 5.2 million people in Adamawa, Borno and Yobe states with about 50,000 people in famine situation, if no adequate remedial measures are provided on time. Table below shows projected situation in Borno

Changes in Context 4: Progress of nutrition interventions 2017 Fields in red have at least gap of 70%. Source of information is the NiESWG 5Ws (January-August, 2017)

3. People affected by Malnutrition The cohort of population during crises vulnerable to malnutrition in a community are children under 5 years and pregnant and breastfeeding women. They constitute the people in need of nutrition intervention. Children under 5 years of age whom are estimated to be 20% of a population as well as Pregnant and breastfeeding women between 15 and 49 years whom are estimated to be 8% of the population. The Sector specific people in need number is the sum of number of children (6-59m) and women (15-49years) to be reached with any one intervention respectively.

Populations in the six North east states   People in Need SAM without medical complication (6-59m) 20% * SAM (WHZ)% * 9 SAM with Medical complication (6-59m) Estimated at 10% of SAM MAM < 5 20% * MAM (WHZ)% * 2.6 MAM PLW ???? BSFP <5 ?????? BSFP PLW ????? VIT A <5 20% of the population Deworming (12-59m) 90% of the population eligible for Vit A Pregnant _ Iron 8% of the population*0.375 MNP (6-23m) 6% of total population*.3335 IYCF -PLW 8% of the population

Formula for estimating SAM/MAM Burden Burden = N x P x K Specific nutrition Activities estimation of Burden Formula for estimating SAM/MAM Burden Burden = N x P x K Estimated 2018 SAM and MAM caseload burden: For N estimation : proportion of 20% for children 6-59 months For P estimation : use of prevalence from the NFSS July 2017 (Borno & Yobe) NFSS Oct 2016 (Adamawa) For K estimation: 9 for SAM and 2.6 for MAM.   Indicators Adamawa Bauchi Borno Gombe Taraba Yobe Total PiN Target SAM without medical complication 34025 23818 154083 107858 217695 152386 61739 43217 42459 29722 199841 139888 709,842 496,889 SAM with Medical complication 3781 2646 17120 11984 24188 16932 6860 4802 4718 3302 22205 15543 78,871 55,210 MAM < 5 95018 66513 213278 149295 278511 194958 58351 40846 85643 59950 199465 139626 930,266 651,186 MAM PLW   - VIT A <5 717139 573712 1188645 950916 1199235 959388 423315 338652 748342 598673 819539 655631 5,096,215 4,076,972 Pregnant _ Iron 86057 142637 143908 50798 89801 98345 611,546 Deworming PiN MNP 6-23 months 167416 277489 279962 98823 174700 191321 1,189,711 IYCF 286856 475458 479694 169326 299337 327815 2,038,486 BSFP 6-23 months BSFP PLW To avoid double counting the PIN is calculated = Highest category of under five beneficiary (Vit A) + highest category of PLW beneficiary (IYCF)

7.1 million 6.7 million Nutrition Sector 6.1 million 0.0 million IN 2017 IN 2018 2018 NEEDS SEVERITY 7.1 million 6.7 million PEOPLE IN NEED PEOPLE IN NEED 6.1 million 0.0 million In Host Community In Host Community 0.49 million IDPs 0.0 million IDPs 0.35 million IDPs - Returnees 0.11 million 0.0 million Refugees - Returnees Returnees 0.06 million In inaccessible LGAs

2018 PEOPLE IN NEED PER CATEGORY PER STATE 2018 PEOPLE IN NEED PER SEX AND AGE PER STATE

5. Nutrition sector Severity MAP The nutrition Severity Map is based WHO crisis classification on Global acute malnutrition (GAM) six point scale from 1 (no nutrition problem) to 6 (catastrophic problem) with Weighting against other aggravating factors including Food security situation, presence of IDP in Host communities and access.   Severity Presence of GAM Indicator Score Weight 1 Normal 2 Acceptable 1-5% Minimal 3 Poor 5-9% Stressed 4 Serious 10-14% Crisis 5 Critical 15-30% 7 Emergency 6 catastrophic > 30% 11 Catastrophe

6. Discussions As the nutrition activities on supplementation are conducted as routine government intervention through the MCHW Camping bi-annually they don’t really qualify as humanitarian response. If this is agreeable then we should use the core interventions such as SAM, MAM treatment IYCF and BSFP to estimate the people in need for the emergency nutrition interventions. This will leave the PIN constituted of all U5 requiring BSFP (0-23 months) + PLW requiring IFE (IYCF-E)  and this will lower the no of PIN Options The states with minimal data (Gombe, Taraba, and Bauchi) use the 2015 NNHS survey prevalence to estimate the number of malnourished children and PLW and use this as PIN. The states with current humanitarian response (Yobe Adamawa and Borno) use the all children 0-23 m eligible for BSFP and PLW  eligible for IYCF-E