Food Security and Nutrition Analysis Unit Somalia Post Deyr ’10/11 Food Security and Nutrition Analysis Unit Somalia Information for Better Livelihoods January 24th 2011 Integrated Nutrition Situation Analysis Hiran Lower Shabelle Middle Shabelle Banadir EUROPEAN COMMISSION Swiss Agency for Development and Cooperation SDC

Map: SE Livelihood Zones

Middle Shabelle Agropastoral Livelihood Zone, Summary of Findings Outcome indicators Middle Shabelle Agropastoral Livelihood Zone, Summary of Findings Deyr’09/10 (N=649) Gu’10 (N=212) Deyr ’10/11 (N=1650) Child Nutrition status GAM (WHZ<-2 or oedema) 12.5(9.8-15.2) >6.2% (Pr=0.9) but Adale 16.8% SAM (WHZ<-3 or oedema) 3.5 (2.2-4.9) > 1.7% (Pr=0.9); but Adale 2.4% Oedema 0.5 (0.0-1.0) 0.5% 0.2 MUAC (<12.5 cm or oedema) 8.5 (6.5-10.5) 7.1 (3.0 -11.2) > 15% but poor quality data - R3) MUAC (<11.5 cm or oedema) > 3% but poor quality data - R3 Stunting (HAZ<-2) 19.9(16.3-23.5) 18.9 (12.1-25.6) HIS Nutrition Trends Low (<10) & stable trend (Jul-Dec’09) Low (<10) & stable trend (Jan-Jun’10); lower than 09 trends High (>20%) & increasing trend (July-Dec10); higher than 09 trends TFPs/SFPs Admission trends N/A Crude death Rate/10,000/day (90days) 0.93 (0.62-1.38) Under 5 death Rate/10,000/day (90days) 1.05 (0.47-2.33) OVERALL NUTRITION SITUATION Serious Alert but Critical for Adale ** deterioration Child Morbidity, Immunization, IYCF Disease Oubreaks: Morbidity based on 2wk recall No outbreak Morbidity – 43.3% Morbidity – 33.7% Outbreak –AWD, measles and whooping cough in all the livelihood Immunization status/Vit. A Measles: 38.2; Vit. A: 40.7 Measles: 44.3; Vit. A: 40.7 Children eating from <4 fdgps Children meeting min. feeding freq. Public Health Indicators; Gender N=478 N=116 Households (HH) accessing safe water 34.2 32.8 HH accessing sanitation facilities 26.0 30.0 HH accessing health facilities 47.7 - Relation between GAM & child sex Relation between GAM & sex of hh head Insignificant Food Security Phase Proportion of hh consuming <4 fd gps HE/AFLC AFLC/BFI Overall Risk to Deterioration POTENTIAL TO IMPROVE STABLE POTENTIAL TO DETERIORATE

Middle Shabelle Riverine Livelihood Zone, Summary of Findings Outcome indicators Middle Shabelle Riverine Livelihood Zone, Summary of Findings Deyr’09/10 (N=640) Gu’10 (N=222) Deyr ’10/11 (N=1650) Child Nutrition status GAM (WHZ<-2 or oedema) 11.6 (7.7-15.4) >8.2% (Pr=0.9) SAM (WHZ<-3 or oedema) 4.2 (2.7-5.8) > 0.6% (Pr=0.9) Oedema 0.9 (0.0-1.9) 0.5% 0.55.50.5 MUAC (<12.5 cm or oedema) 11.7 (8.3-15.1) 8.6 (4.5 -12.6) > 15% (but poor quality data - R3 MUAC (<11.5 cm or oedema > 3% (but poor quality data - R3 Stunting (HAZ<-2) 19.9(16.3-23.5) 17.6 (11.7-25.5) HIS Nutrition Trends High (>15) but stable trend (Jul-Dec’09) High (>20%) & stable trend (Jan-Jun’10); higher than 09 trends High (>15%) & stable trend July-Dec’10); consistent with 09 trends TFPs/SFPs Admission trends N/A Crude death Rate/10,000/day (90days) 0.61 (0.36-1.05) Under 5 death Rate/10,000/day (90days) 0.79 (0.38-1.67) OVERALL NUTRITION SITUATION Serious Alert ** deterioration Child Morbidity, Immunization, IYCF Disease Oubreaks: Morbidity based on 2wk recall No outbreak Morbidity – 42.3% Outbreak- AWD Morbidity – 43.7% Outbreak –AWD, measles and whooping cough in all the livelihoods Immunization status/Vit. A Measles: 54.7; Vit. A: 49.2 Measles: 57.2; Vit. A: 51.8 Children eating from <4 fdgps 29.3 Children meeting min. feeding freq. 32.9 Public Health Indicators; Gender N=434 N=120 Households (HH) accessing safe water 51.6 25.0 HH accessing sanitation facilities 31.7 70.0 HH accessing health facilities 56.9 - Relation between GAM & child sex Relation between GAM & sex of hh head Insignificant Food Security Phase Proportion of hh consuming <4 fd gps AFLC CFI HE/AFLC Overall Risk to Deterioration POTENTIAL TO IMPROVE STABLE POTENTIAL TO DETERIORATE

Deyr’09/10 (N=734) Gu’10 (N=639) Deyr’10/11 (N=682) Outcome indicators Afgoye IDPs, Summary of Findings Deyr’09/10 (N=734) Gu’10 (N=639) Deyr’10/11 (N=682) Child Nutrition status GAM (WHZ<-2 or oedema) 15.9 (11.7-20.2) 15.1 (11.4 – 19.8) 21.6 (18.2 -25.3) Mean WHZ -0.37 -1.08 (±1.12) SAM (WHZ<-3 or oedema) 5.5 (2.7-8.2) 1.7 (1.0 – 3.0) 3.2 (2.2 -4.6) Oedema 0.1 (0.0-0.4) 0.0% 0.1 MUAC (<12.5 cm or oedema) 11.2 (8.0-14.3) 7.2 (5.0 -9.4) 16.9 (12.4 _22.5) Stunting (HAZ<-2) 27.5(21.6-33.4) 14.8 (104-20.7) 11.4 (8.7 – 14.9) HIS Nutrition Trends High (>10) & stable(Jul-Dec’09) N/A TFPs/SFPs Admission trends Crude death Rate/10,000/day (90days) 1.27 (0.79-2.04) 0.99 (0.71 – 1.37) 0.62 (0.26 -1.46) Under 5 death Rate/10,000/day (90days) 2.32 (1.32-4.06) 1.40 (0.78 – 2.51) 1.44 (1.03 -2.0) OVERALL NUTRITION SITUATION Critical Very Critical Child Morbidity, Immunization, IYCF Disease Oubreaks: Morbidity based on 2wk recall No outbreak Morbidity – 47.4% No Outbreak- Morbidity – 34.6% Outbreak of AWD and malaria Morbidity – 43.8% Immunization status/Vit. A Measles: 69.8; Vit. A: 70.8 Measles: 61.7; Vit A: 59.2 Measles: 75.5 Vit A: 73.3 Children eating from <4 fdgps 15.5 86.2 Children meeting min. feeding freq. 36.6 32.8 Public Health Indicators; Gender N=403 N=383 N=397 Households (HH) accessing safe water 98.3 83.2 96.0 HH accessing sanitation facilities 99.0 99.7 98.7 HH accessing health facilities 48.8 - Women Nutrition Status Proportion with MUAC<18.5 cm (non pregnant and non lactating) 0.7 (N=135) Proportion with MUAC<23.0 cm (pregnant + lactating) 5.1 (N=253) Gender: Relation between GAM & child sex Relation between GAM & sex of hh head Insignificant Food Security Phase Proportion of hh consuming <4 fd gps HE AFLC 10.1 OVERALL RISK TO DETERIORATION STABLE UNCERTAIN

Deyr ‘09/10 (N=???) Gu ’10 (N=2200) Deyr ‘10/11 (N=2200) Outcome indicators Lower Shabelle Agropastoral Livelihood Zone, Summary of Findings Deyr ‘09/10 (N=???) Gu ’10 (N=2200) Deyr ‘10/11 (N=2200) Child Nutrition status - GAM (WHZ<-2 or oedema) Mean WHZ SAM (WHZ<-3 or oedema) Oedema 0.1 (0.08 -1.02) 0.2 MUAC (<12.5 cm or oedema) 8.7 (8.3-9.1) > 15% but poor quality data - R3 MUAC (<11.5 cm or oedema > 3% but poor quality data - R3 Stunting (HAZ<-2) HIS Nutrition Trends Low (<10) & declining trend (Jul-Dec’09) High (>20%) & increasing trend (July-Dec10); higher than 09 trends TFPs/SFPs Admission trends N/A Crude death Rate/10,000/day (90days) Under 5 death Rate/10,000/day (90days) OVERALL NUTRITION SITUATION Serious ** deterioration Child Morbidity, Immunization, IYCF Disease Oubreaks: Morbidity based on 2wk recall Outbreak – localized AWD Morbidity – Outbreak –AWD, measles and whooping cough in all the livelihood Immunization status/Vit. A Measles: Children eating from <4 fdgps Children meeting min. feeding freq. Public Health Indicators; Gender N= Households (HH) accessing safe water HH accessing sanitation facilities HH accessing health facilities Relation between GAM & child sex Relation between GAM & sex of hh head Insignificant Food Security Phase Proportion of hh consuming <4 fd gps BFI Overall Risk to Deterioration STABLE POTENTIAL TO DETERIORATE

Lower Shabelle Riverine Livelihood Zone, Summary of Findings Outcome indicators Lower Shabelle Riverine Livelihood Zone, Summary of Findings Gu ‘10 (N=2200) Deyr ‘10/11 (N=2200) Child Nutrition status - GAM (WHZ<-2 or oedema) Mean WHZ SAM (WHZ<-3 or oedema) Oedema 0.05 (0.04 -0.06) 0.3 MUAC (<12.5 cm or oedema) 9.4 (9.2-9.6) > 15% but poor quality data - R3 MUAC (<11.5 cm or oedema > 3% but poor quality data - R3 Stunting (HAZ<-2) HIS Nutrition Trends High (>20%) & stable trend (Jan-Jun’10); higher than 09 trends High (>15%) & stable trend July-Dec’10); consistent with 09 trends TFPs/SFPs Admission trends N/A Crude death Rate/10,000/day (90days) Under 5 death Rate/10,000/day (90days) OVERALL NUTRITION SITUATION Serious ** deterioration Child Morbidity, Immunization, IYCF Disease Oubreaks: Morbidity based on 2wk recall Outbreak –AWD, measles and whooping cough Morbidity – Immunization status/Vit. A Measles: Food Security Phase Proportion of hh consuming <4 fd gps BFI Overall Risk to Deterioration POTENTIAL TO IMPROVE POTENTIAL TO DETERIORATE

Deyr’09/10 (N=695) Gu’10 (N=1100) Deyr ’10/11 (N=1100) Outcome indicators Hiran Pastoral Livelihood Zone, Summary of Findings Deyr’09/10 (N=695) Gu’10 (N=1100) Deyr ’10/11 (N=1100) Child Nutrition status GAM (WHZ<-2 or oedema) 21.2 (16.5-25.8) - SAM (WHZ<-3 or oedema) 5.3 (3.1-7.6) Oedema 0.1 (0.0-0.4) 0.0 MUAC (<12.5 cm or oedema) 5.1 (3.1-7.6) 15.4 (15.1-15.8) 14.7 MUAC (<11.5 cm or Oedema) 3.7 (3.5 -3.9) 2.5 Stunting (HAZ<-2) 22.0(16.9-27.0) HIS Nutrition Trends High (>15) & stable trend (Jul-Dec’09) High (>10%) & stable trend (Jan-Jun’10); lower than 09 trends Low(<10%) and stable due to closure of HF’s in June’10 – therefore reduced numbers of children TFPs/SFPs Admission trends High and increasing numbers High and increasing numbers in Mahas (upto 400) in Apr-Jun’10 Crude death Rate/10,000/day (90days) 0.50 (0.27-0.95) N/A Under 5 death Rate/10,000/day (90days) 0.82 (0.40-0.67) OVERALL NUTRITION SITUATION Very Critical Likely Very Critical Likely Critical Child Morbidity, Immunization, IYCF Disease Oubreaks: Morbidity based on 2wk recall No outbreak Morbidity – 51.4% RDT – 4.9% Outbreak –whooping cough in Mahas (30 cases with 4 deaths) and Mataban (40 cases) in Apr-Jun’10 Morbidity – Out breaks –whooping cough in B/burti (Nov – Dec) Immunization status/Vit. A Measles: 32.7; Vit. A: 31.7 Measles: ------- VitA: --------- Children eating from <4 fdgps Children meeting min. feeding freq. Public Health Indicators; Gender N=403 N= Households (HH) accessing safe water 20.0 HH accessing sanitation facilities 18.1 HH accessing health facilities 47.7 Relation between GAM & child sex Relation between GAM & sex of hh head Insignificant Food Security Phase Proportion of hh consuming <4 fd gps HE/AFLC 47.5 Overall Risk to Deterioration STABLE POTENTIAL TO DETERIORATE

Deyr’09/10 (N=795) Gu’10 (N=1100) Deyr ’10/11 (N=1100) Outcome indicators Hiran Agropastoral Livelihood Zone, Summary of Findings Deyr’09/10 (N=795) Gu’10 (N=1100) Deyr ’10/11 (N=1100) Child Nutrition status GAM (WHZ<-2 or oedema) 23.4 (19.0-27.8) - SAM (WHZ<-3 or oedema) 7.4 (3.9-10.9) Oedema 0.0 0.1 MUAC (<12.5 cm or oedema) 5.4 (2.5-8.3) 16.7 (16.4-17.0) 17.1 MUAC (<11.5 cm or Oedema) 3.2 (3.0 -3.4) 2.9 Stunting (HAZ<-2) 21.7(17.1-26.4) HIS Nutrition Trends High (>15) & increasing trend (Jul-Dec’09) High (>10%) & stable trend (Jan-Jun’10) High (>10%) & stable trend (July -Dece’10) TFPs/SFPs Admission trends High and increasing numbers of admissions High and increasing numbers in the 3 districts (upto 1800) in Apr-Jun’10 Crude death Rate/10,000/day (90days) 0.54 (0.36-0.82) N/A Under 5 death Rate/10,000/day (90days) 0.84 (0.32-2.17) OVERALL NUTRITION SITUATION Very Critical Likely Very Critical Child Morbidity, Immunization, IYCF Disease Outbreaks: Morbidity based on 2wk recall No outbreak Morbidity – 51.4% RDT – 4.9% Outbreak –whooping cough in the three districts (604 cases) in Apr-Jun’10 Morbidity – Outbreak –whooping cough in the three districts in Nov Dec ‘10 Immunization status/Vit. A Measles: 32.7; Vit. A: 31.7 Measles: ------- VitA: --------- Children eating from <4 fdgps Children meeting min. feeding freq. Public Health Indicators; Gender N=478 N= Households (HH) accessing safe water 18.3 HH accessing sanitation facilities 30.9 HH accessing health facilities Relation between GAM & child sex Relation between GAM & sex of hh head Insignificant Food Security Phase Proportion of hh consuming <4 fd gps HE/AFLC 52.6 Overall Risk to Deterioration STABLE POTENTIAL TO DETERIORATE

Deyr’09/10 (N=197) Gu’10 (N=1760) Deyr ’10/11 (N=1100) Outcome indicators Hiran Riverine Livelihood Zone, Summary of Findings Deyr’09/10 (N=197) Gu’10 (N=1760) Deyr ’10/11 (N=1100) Child Nutrition status GAM (WHZ<-2 or oedema) >18.8 (pr =0.90) - SAM (WHZ<-3 or oedema) >2.6 (pr =0.09) Oedema 0.5 0.4 MUAC (<12.5 cm or oedema) 10.1 (4.8-15.4 18.5 (18.2-18.8) 17.7 MUAC (<11.5 cm or Oedema) 4.6 (4.4-4.8) 3.5 Stunting (HAZ<-2) 21.7(17.1-26.4) HIS Nutrition Trends High & stable trend (Jul-Dec’09) High (>10%) but declining trends in the last 3-4months trend (Jan-Jun’10) High (>10%) but declining trends in the last 3-4months trend (July - Dece’10 TFPs/SFPs Admission trends High and increasing numbers of admissions High and increasing numbers in the 3 districts (upto 1800) in Jan-Jun’10 Crude death Rate/10,000/day (90days) N/A Under 5 death Rate/10,000/day (90days) OVERALL NUTRITION SITUATION Critical Likely Very Critical Child Morbidity, Immunization, IYCF Disease Oubreaks: Morbidity based on 2wk recall No outbreak Morbidity 60.9% RDT – Outbreak –whooping cough in the three districts (604 cases) in Apr-Jun’10 Morbidity – Outbreak –whooping cough in the B/Burti districts in Nov –Dec ‘10 Immunization status/Vit. A Measles: 63.5; Vit. A: 63.4 Measles: ------- VitA: --------- Children eating from <4 fdgps Children meeting min. feeding freq. Public Health Indicators; Gender N=434 N= Households (HH) accessing safe water 31.6 HH accessing sanitation facilities 43.5 HH accessing health facilities Relation between GAM & child sex Relation between GAM & sex of hh head Insignificant Food Security Phase Proportion of hh consuming <4 fd gps HE/ AFLC 43.0 HE Overall Risk to Deterioration STABLE Potential to deteriorate

Deyr’09/10 (N=) Gu’10 (N=660) Deyr ’10/11 (N=1320) Outcome indicators Mogadishu/ Banadir Region, Summary of Findings Deyr’09/10 (N=) Gu’10 (N=660) Deyr ’10/11 (N=1320) Child Nutrition status GAM (WHZ<-2 or oedema) - SAM (WHZ<-3 or oedema) Oedema 0.0 MUAC (<12.5 cm or oedema) 11.7 (6.7-16.6) > 15% (29.2%; R3) MUAC (<11.5 cm or Oedema) 0.3 (0.0-0.7) > 3% (12.0%; R3) Stunting (HAZ<-2) HIS Nutrition Trends Very high numbers (>20%) and stable in at least 6 months period in three MCHs – Medina, Harmar Janjab and Hamar weyne (Source: HIS data, Jul –Dec’09). Very high (>20%) and fluctuating trends in the last 6 months in Medina, Waberi, Hamar weyne and hamar Jabjab. Low levels (<5%) and stable trends in Zam zam (Jan-Jul’10). Very high (>20%) and fluctuating trends in the last 6 months in Medina, Waberi, Hamar weyne and hamar Jabjab. Low levels (<5%) and stable trends in Zam zam (July-Dec’10). TFPs/SFPs Admission trends High and increasing numbers of admissions (in charge) in ACF managed centers (Hodan and Forlanini). Source: ACF, Mogadishu – Nov’ 2009) 1,200 new admissions reported in Mogadishu; high SAM (34%) and MAM (19.5%) among the screened children; increased death rates among U5s High and increasing numbers of admissions (in charge) in ACF managed centers (Hodan and Forlanini). Source: Jul’ 2010) High and increasing numbers of admissions (in charge) in ACF managed centers (Hodan and Forlanini). Source: Jul – Dec ’ 2010) Crude death Rate/10,000/day (90days) N/A Under 5 death Rate/10,000/day (90days) OVERALL NUTRITION SITUATION Likely Very Critical Likely Critical Child Morbidity, Immunization, IYCF Disease Oubreaks: Morbidity based on 2wk recall No outbreak Morbidity: 17.9% (12.9-22.9) Out break AWD, cholera Immunization status/Vit. A Measles: ------- Vit A: --------- Measles: 80.2%; VitA: 88.0% Children eating from <4 fdgps Children meeting min. feeding freq. Food Security Phase Proportion of hh consuming <4 fd gps HE/ AFLC 43.0 HE Overall Risk to Deterioration UNCERTAIN

Key Driving Factors Aggravating factors Mitigating Factors Civil Insecurity – Shabelle and Hiran are the most affected; Mogadishu remains the epicentre. Limited humanitarian space - displacement associated with civil insecurity Disease Outbreaks – AWD, cholera, malaria Taxation Limited access to health centres Limited medical supply in the area New IDPs Outbreak of AWD, Measles and malaria in M. & L. Shabelle; and Whooping cough /AWD in Hiran Mitigating Factors Limited access to SF programs Income from sale of fodder and some labour opportunities among the riverine Social support

Nutrition Situation Estimates Nutrition Situation Estimates, July 2010 Nutrition Situation Estimates, January 2011