1. 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

2. Map: SE Livelihood Zones

3. 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( )
>6.2% (Pr=0.9) but Adale 16.8%
SAM (WHZ<-3 or oedema)
3.5 ( )
> 1.7% (Pr=0.9); but Adale 2.4%
Oedema
0.5 ( )
0.5%
0.2
MUAC (<12.5 cm or oedema)
8.5 ( )
7.1 ( )
> 15% but poor quality data - R3)
MUAC (<11.5 cm or oedema)
> 3% but poor quality data - R3
Stunting (HAZ<-2)
19.9( )
18.9 ( )
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 ( )
Under 5 death Rate/10,000/day (90days)
1.05 ( )
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

5. 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 ( )
>8.2% (Pr=0.9)
SAM (WHZ<-3 or oedema)
4.2 ( )
> 0.6% (Pr=0.9)
Oedema
0.9 ( )
0.5%
MUAC (<12.5 cm or oedema)
11.7 ( )
8.6 ( )
> 15% (but poor quality data - R3
MUAC (<11.5 cm or oedema
> 3% (but poor quality data - R3
Stunting (HAZ<-2)
19.9( )
17.6 ( )
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 ( )
Under 5 death Rate/10,000/day (90days)
0.79 ( )
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

7. 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 ( )
15.1 (11.4 – 19.8)
21.6 ( )
Mean WHZ
-0.37
(±1.12)
SAM (WHZ<-3 or oedema)
5.5 ( )
1.7 (1.0 – 3.0)
3.2 ( )
Oedema
0.1 ( )
0.0%
0.1
MUAC (<12.5 cm or oedema)
11.2 ( )
7.2 ( )
16.9 (12.4 _22.5)
Stunting (HAZ<-2)
27.5( )
14.8 ( )
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 ( )
0.99 (0.71 – 1.37)
0.62 ( )
Under 5 death Rate/10,000/day (90days)
2.32 ( )
1.40 (0.78 – 2.51)
1.44 ( )
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

8. 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 ( )
0.2
MUAC (<12.5 cm or oedema)
8.7 ( )
> 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

9. 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 ( )
0.3
MUAC (<12.5 cm or oedema)
9.4 ( )
> 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

10. 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 ( ) -
SAM (WHZ<-3 or oedema)
5.3 ( )
Oedema
0.1 ( )
0.0
MUAC (<12.5 cm or oedema)
5.1 ( )
15.4 ( )
14.7
MUAC (<11.5 cm or Oedema)
3.7 ( )
2.5
Stunting (HAZ<-2)
22.0( )
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 ( )
N/A
Under 5 death Rate/10,000/day (90days)
0.82 ( )
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

12. 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 ( ) -
SAM (WHZ<-3 or oedema)
7.4 ( )
Oedema
0.0
0.1
MUAC (<12.5 cm or oedema)
5.4 ( )
16.7 ( )
17.1
MUAC (<11.5 cm or Oedema)
3.2 ( )
2.9
Stunting (HAZ<-2)
21.7( )
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 ( )
N/A
Under 5 death Rate/10,000/day (90days)
0.84 ( )
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

14. 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 (
18.5 ( )
17.7
MUAC (<11.5 cm or Oedema)
4.6 ( )
3.5
Stunting (HAZ<-2)
21.7( )
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

16. 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 ( )
> 15% (29.2%; R3)
MUAC (<11.5 cm or Oedema)
0.3 ( )
> 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% ( )
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

21. 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

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