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ENCU June 30, 2006 1

QUARTERLY BULLETIN (April - June 2006)

Emergency Nutrition Coordination UnitDisaster Prevention and Preparedness Agency

This bulletin presents the summary findings of standard nutrition surveys carriedout by GOAL, Action Contre La Faim, World Vision-Ethiopia, Save the Children-USA and DPPA/B during the second quarter of 2006.

As a result of early warning reports ofdeteriorating food security in March06 confirmed by rapid assessmentsin April 06 the Regional FoodSecurity, Disaster Prevention andPreparedness Bureau and theRegional Health Bureau of SNNPRrequested partners to conduct nutri-tion surveys in the most affectedareas of the region. This included Siltiand Sankura woredas of Silti zone,Hulla (Midlands), Boricha andShebedino woredas of Sidama zone,Mareko and Meskan (Lowlands)woredas of Gurage zone, and KedidaGamela of KT zone.

The survey findings from SNNPR arepresented below, summarized intable 1 and displayed on map 1 (inannex) with the existing food/nutritioninterventions.

Most of the baseline information onlivelihood and food security incorpo-rated in this bulletin has been extract-ed from the SNNPR LivelihoodProfiles, FewsNet/USAID, January06. The profiles describe the majorcharacteristics of each livelihoodzone and how households from differ-ent wealth groups make ends meetfor a reference or baseline year. Thehousehold economy baseline canthen be used to understand theimpact of a hazard on food security.Such analysis remained limited in the

SNNP REGION

ENCU/DPPAAddis AbabaTel. (011) 5 523556e-mail:dominiqueb@dppc.gov.ethttp://www.dppc.gov.et

SNNP REGION

SILTI ZONE (SILTI AND SANKURA WOREDAS) Page 2

SIDAMA ZONE (HULLA, BORICHA AND SHEBEDINOWOREDAS) Page 3

GURAGE ZONE (MAREKO AND MESKAN WOREDAS)Page 5

KT ZONE (KEDIDA GAMELA WOREDA)Page 5

HADIYA ZONES (ANGACHA AND SHASHEGOWOREDAS)Page 6

OROMIA REGION

EAST HARARGHE ZONE (KOMBOLCHA WOREDA)Page 8

EAST SHEWA ZONE (BOSSET WOREDA)Page 9

SURVEY DATA QUALITYPage 11

NUTRITION SURVEY DATABASE Page 12

INSIDE

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EMERGENCY NUTRITION

present bulletin, as relevant foodsecurity indicators to allow compari-son with the baseline year were notsystematically collected in the nutri-tion surveys.

A survey was also conducted in thelowlands of Tocha and Marekaworedas of Dawro zone during thesecond quarter of 2006. However, abias was introduced in the selectionof the children, which affected therepresentativeness of the sample.Thus the results were not consid-ered to be reliable and were reject-ed.

Finally a nutrition assessment usingMUAC was undertaken in Angachaand Shashego woredas of KT andHadiya zones; results are presentedseparately.

Nutrition: The prevalence of global acutemalnutrition was estimated at 12% in bothworedas with severe acute malnutrition of2% and 2.4% in Silti and Sankura respec-tively. Baseline for comparison of the cur-rent findings to a "normal" year was notavailable neither for Silti nor for Sankura.

Health: Crude and Under Five mortalityrates were below the emergency thresh-olds of 1 and 2 deaths/10,000/day, withCMR of 0.46 and U5MR of 0.94 for Siltiand CMR of 0.45 and U5MR of 1.41 forSankura. Morbidity in children in the 2weeks prior to surveys was high, 34% inSilti and 44% in Sankura with diarrhea,fever and malaria being reported as themain causes of morbidity. Health care uti-lization was average, as indicated by BCGcoverage of 59% in Silti and 47% inSankura. Measles vaccination coverage(by card and recall) remained below therecommended 90% coverage level both inSilti (65%) and Sankura (66%) while vita-min A supplementation was around 83%in both woredas. The availability of healthfacilities was reported to be low in bothworedas, not meeting the governmentpolicies on service provision requiring 1health post per 5,000 people and 1 healthcentre per 10,000 people. This was com-pounded by a lack of basic equipment,shortage of drugs, lack of trained healthstaff, and lack of transport and of bednets.

Water and Sanitation: Water access isproblematic in both woredas, with criticalshortages during the dry season both forhuman and animal consumption. The safewater coverage is estimated at 15% and25% in Sankura and Silti respectively.

Livelihood/Food Security: Sankuraworeda and most of Silti woreda belong tothe Alaba-Mareko Lowland PepperLivelihood Zone while a small proportionof Silti covers another 2 zones, Gurage-Silti Midland Enset and Chat LivelihoodZone and Gurage-Silti Highland Ensetand Barley Livelihood Zone (FewsNet,SNNPR Livelihood Profiles, Jan. 06). Inthe Lowlands Pepper LZ households relymostly on long cycle crops harvested inNovember and consequently any fluctua-tion in rainfalls during the meher season

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reduces food and cash incomes. Maize isthe main staple and the consumption ofgreen maize in August/September miti-gates the hungry season, which typicallyoccurs from May to July. Pepper is themain cash crop and income generatingactivity, which is complemented by smalllivestock holding. The Midland Enset andChat LZ is a relatively food secure areathat has rarely experienced drought andhas no history of food aid while theHighland Enset and Barley LZ has beenhistorically self-sufficient in crop produc-tion and households remain generallyfood secure. At the time of the survey77% and 50% of the households inter-viewed in Silti and Sankura respectivelystated relying on their own production asa main source of food. Livestock condi-tion was generally rated as good thoughin some areas it was reported to be pooras a result of insufficient water and pas-ture, and diseases. No unusual copingstrategies were recorded during the sur-veys. It was mentioned that some parts ofSilti and Sankura had experienced floodearlier in 2006 with 15 affected kebeles inSankura. Flooding is a recurrent hazardoccurring each year caused by rains inneighboring highlands. Land preparationwas going on while in some areas maizewas already in its early stage of develop-ment. Both woredas benefits from theEOS and Safety Net Programme in formof Cash-For-Work, targeted at 15 out of30 kebeles in Sankura and at 25 out of 43kebeles in Silti.

Conclusion & Recommendations: Thenutrition situation was ranked as "serious"both in Silti and Sankura woredas withGAM of 12% and presence of aggravat-ing factors such as high morbidity, inade-quate safe water supplies and sanitation,and declining food security in areasaffected by the recent floods. There wasalso a threat of malaria epidemic in theflooded areas. The short-term recommen-dations included immediate provision oftreatment of severe malnutrition (in SiltiGOAL started OTP just after the survey),revision of the EOS/TSFP beneficiarieslist by repeating a screening to cater fornew cases not included in the Jan. 06 list,and improved delivery of the PSPN withtimely payment of the beneficiaries, asdelays were reported in both woredas.

Silti and Sankura Woredas

SILTI ZONE

The nutrition situation wasranked as "serious" both inSilti and Sankura woredaswith GAM of 12% and pres-ence of aggravating factorssuch as high morbidity, inade-quate safe water supplies andsanitation, and declining foodsecurity in areas affected bythe recent floods.

Silti & Sankura Woreda

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SIDAMA ZONE

Nutrition: The situation in the midlandsof Hulla was rated as "serious" with18.1% global acute malnutrition, 2.1%severe acute malnutrition and 1.1% kwa-shiorkor. No baseline data were availablefor comparison.

Health: The crude and Under Five mor-tality rates of 0.09 and 0.12deaths/10,000/days respectively werelow and lied within the non-emergencyranges. Measles (card and recall) andBCG vaccination coverage was relativelyhigh at 77.3% and 69.4% respectivelywhile vitamin A supplementation washigher at 94.5% due to the recent EOScampaign.

Livelihood/Food Security: Hulla woredais divided into 2 agro-ecological zones:the highlands (64%) and the midlands(36%). The Midlands of Hulla are part ofthe Sidama Coffee Livelihood Zone(FewsNet, SNNPR Livelihood Profiles,Jan. 06) and is reported as a relativelyproductive area with two rainy seasons,belg and kremt. Enset is the main foodcrop while coffee is the main cash crop,and these are supplemented by smallquantities of maize, sorghum, beans,yams, taro and sweet potatoes. Howeverdue to high population density and smalllandholding sizes most households donot produce enough food for the wholeyear even in a "good" year and hence relyhighly on markets. Livestock, mainly cat-tle, is also a source of income but grazingland is scarce. The hunger season, staplefood prices and livestock sales peak inApril-June and run up to July-August atthe start of the green maize harvest.

Conclusion: Although the survey wasconducted during the hunger season theprevalence of acute malnutrition wasunexpectedly high in the midlands ofHulla. When compared to surveys under-taken during the same period of time inother woredas of SNNPR the prevalenceof acute malnutrition was significantlyhigher. The survey report did not includerelevant information on the prevailingfood security situation at the time of thesurvey and the performance of the 06belg rains, thus it remained unclear whythe nutrition situation was so bad, andwhat would be the prospect for the com-

Hulla Woreda (Midlands)ing months. It is hoped that this gap willbe filled by the upcoming belg assess-ment. Meanwhile it is strongly recom-mended to consider the implementationof food aid targeted at the midlands ofHulla, or alternatively to increase thenumber of PSNP beneficiaries in thispart of Hulla in order to prevent furtherdeterioration of the nutrition situation. Boricha Woreda

Nutrition: The nutrition situation inBoricha was reported as "typical" with6.8% global acute malnutrition. Whencompared to last year around the sameseason (March 27-31, 05) where GAMwas of 12.3% (95% CI: 9.6%-15.7%) thenutrition situation was similar with nostatistically significant difference.

Health: The Crude and Under Five mor-tality rates were estimated at 0.04 and0.1 deaths/10,000/day respectively,below the emergency thresholds.Morbidity in children was estimated at20%. In Boricha malaria occurs through-out the year with a peak from May toNovember while due to widespread dryseason water shortages diarrhoeal dis-eases are most common fromDecember to March. BCG, measles(card and recall) and vitamin A supple-mentation coverage rates were estimat-ed at 70%, 66.2% and 82.5% respective-ly.

Livelihood/Food Security: Most of thepopulation of Boricha (64%) lives in theSidama Maize Belt Livelihood Zonewhile the rest lives in the Sidama CoffeeLivelihood Zone (25%) and the BilateBasin Agro-Pastoral Livelihood Zone(11%) (FewsNet, SNNPR LivelihoodProfile, Jan. 06). The Maize Belt LZ isdescribed as belg-dependent as the pro-duction of maize planted once a year ishighly dependant on the belg rains. Themain cash crops include coffee, chat andchilli peppers while livestock is an impor-tant source of income. This zone hasbecome food insecure in the recentyears due to population growth, declin-ing landholding, deforestation, landdegradation, declining soil fertility andpoor rainfalls. The Coffee LZ is a rela-tively productive area; however due tohigh population density and small land-

Boricha WoredaThe prevalence of acute mal-nutrition (6.8%) remained rel-atively low although in themidst of the hungry season.This was a reflection of thenormal food security situationprevailing in the woreda at thetime of the survey.

The situation in the midlandsof Hulla was rated as "seri-ous" with 18.1% global acutemalnutrition. When comparedto surveys undertaken at thesame time in other parts ofSNNPR the prevalence ofacute malnutrition was signifi-cantly higher.

Hulla Woreda

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holding sizes most households do not pro-duce enough food for the whole year evenin a "good" year and hence rely highly onmarkets. Enset is the main food crop whilecoffee is the main cash crop. The BilateBasin LZ represents agro-pastoral low-lands and is relatively food secure due tosubstantial livestock holding per house-hold. The hungry season occurs from Aprilto June across the 3 livelihood zones ofBoricha and ends in July with the con-sumption of green maize. It was reportedthat at the time of the survey the foodsecurity situation was satisfactory. Theprevious meher harvest had been relative-ly good and above average for 63% of thecommunities interviewed. FurthermoreBoricha had received so far adequate belgrains and planting of the major food cropswas timely. The livestock and pasture con-dition was described as medium (30%) togood (67%) by the communities inter-viewed.

Conclusion & Recommendations: Theprevalence of acute malnutrition (6.8%)remained relatively low although in themidst of the hungry season. This was areflection of the normal food security situ-ation prevailing in the woreda at the timeof the survey. It was recommended to con-tinue the existing CTC program until thenext harvest and design an exit strategy inthe meantime.

Vitamin A coverage was estimated at72.5%.

Livelihood/Food Security: Shebedinoworeda comprises 2 agro-ecologicalzones, the midlands (68%) and high-lands (32%) which correspond to 2 liveli-hood zones: the Sidama CoffeeLivelihood Zone accommodating 76% ofthe population and the Sidama-GedeoHighland Enset and Barley LivelihoodZone with 24% of the population(FewsNet, SNNPR Livelihood Profiles,Jan. 06). The Coffee livelihood zone is arelatively productive area with two rainyseasons, belg and kremt. Enset is themain food crop while coffee is the maincash crop, and these are supplementedby small quantities of maize, sorghum,beans, yams, taro and sweet potatoes.Due to high population density and smalllandholding sizes most households donot produce enough food for the wholeyear even in a "good" year and hencerely highly on markets. Livestock mainlycattle is a source of income but grazingland remains scarce. The HighlandEnset and Barley livelihood zone is foodsecure with no history of food aid; rainsare reliable, the area exports high quali-ty enset, households have largereserves of mature enset (Enset takes 4-6 years to mature), and livestock espe-cially cattle contribute to 40-50% of theannual household cash income. Thehunger season, staple food prices andlivestock sales peak in April-June in theCoffee LZ and July-September in theEnset and Barley LZ, and ends in Julyand October respectively with the greenmaize harvest.

Conclusion & Recommendations: Thenutrition situation was considered as"typical" for this time of the year, wherethree quarters of the woreda populationwere in the midst of the hungry season.The performance of the belg rains willdetermine the crop and livestock produc-tion in the coming months particularly inthe low parts of the woreda and whetherthe nutrition situation will be likely todeteriorate or not. In the meantime it wasrecommended to continue the existingfood and nutrition interventions (PSPN,food aid, CTC) at least until the end ofthe hungry season, and to review theneeds based on the performance of thenext cropping season.

Shebedino Woreda

Nutrition: The prevalence of global acutemalnutrition was estimated at 7.4% with0.5% severe malnutrition. Comparisonwith a survey conducted in May 05 withGAM of 16% (95% CI: 12.8%-19.1%)showed that the level of malnutrition wassignificantly lower this year than last yearat the same season.

Health: The mortality rates for the gener-al population and for the Under Five with0.13 and 0.23 deaths/10,000/day respec-tively fell under normal ranges for devel-oping countries. Morbidity in children wasestimated at 19% with diarrhea, ARI andmalaria being reported as the main dis-eases. In the midlands of Shebedinomalaria occurs throughout the year with apeak from April to October. The BCG cov-erage was low at 42.6% and did not showany increase since last year with 43.3%coverage in May 05. Likewise measlescoverage (card and recall) of 71.8% wassimilar to the May 05 coverage of 71.5%.

Shebedino WoredaThe nutrition situation withglobal acute malnutration of7.4% was considered as "typ-ical" for this time of the year,where three quarters of theworeda population were in themidst of the hungry season.

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GURAGE ZONE

Nutrition: The nutrition situation inMareko and the lowlands of Meskan wasconsidered as "serious" with prevalenceof global acute malnutrition of 13.6% and9.9% respectively, and with the presenceof aggravating factors, i.e. poor house-hold food availability. The level of severeacute malnutrition was particularly high inMareko with 2.7% and 1.3% kwashiorkorwhile in the lowlands of Meskan SAM wasof 1.6% with 1% kwashiorkor.

Health: In both woredas the mortalityrates for the general population and forthe Under Five children were below theemergency thresholds of 1 and 2deaths/10,000/day respectively. The sus-pected causes of mortality in childrenwere ARI, malaria and diarrhea. Malariain these areas was not considered as aseasonal phenomenon and occurredthroughout the year. Morbidity was high inMareko with more than one third of thechildren having suffered from a disease inthe 2 weeks prior to the survey. In the low-lands of Meskan morbidity was lower andestimated at 21%. In Mareko and the low-lands of Meskan respectively BCG cover-age was average with 55% and 60%while estimated measles coverage with95% and 84% (card and recall) and vita-min A supplementation with 87% and 84%were relatively high.

Water and Sanitation: Access to potablewater was reported to be low (20% cover-age in Mareko) while sanitation was poorwith insufficient number of latrines and ifpresent with low utilization.

Livelihood/Food Security: Marekoexclusively belongs to the lowlands and isdescribed as the Alaba-Mareko LowlandPepper Livelihood Zone while the low-lands of Meskan belong to the same liveli-hood zone (FewNet, SNNPR LivelihoodProfiles, Jan. 06). Households rely mostlyon long cycle crops harvested inNovember and consequently any fluctua-tion in rainfalls during the meher seasonreduces food and cash incomes. Maize isthe main staple and the consumption ofgreen maize in August/September miti-gates the hungry season, which typicallyoccurs from May to June. Pepper is themain cash crop and income generating

Mareko Woreda & Meskan (Lowlands)

activity complemented by livestock sale.Survey findings indicated that the previ-ous meher harvest in Mareko and thelowlands of Meskan was below averagedue to either rain shortage or rainexcess, resulting in early depletion ofhousehold food stock. At the time of thesurvey 62% of the households inter-viewed in Mareko still relied on their ownproduction as a main source of foodwhile in the lowlands of Meskan 80%already relied on food purchase. Themajor staple crops (maize and sorghum)were already planted and were in goodcondition in most areas except in partsrecently flooded.

Conclusion & Recommendations:The surveys were conducted at the timeof the hunger season when a seasonalpeak of malnutrition was expected.Baseline nutrition data, referring to a"typical" year, were not available forcomparison of the same season.However, the food security analysis indi-cated that the hunger gap started earlierthis year as a result of a poor 05 meherharvest. Recommendations included theestablishment of therapeutic feeding forimmediate treatment of the severelymalnourished children (OTP was startedboth in Mareko and Meskan in April/Mayby ACF and Valid International) andclose monitoring of the situation in thecoming months, as the performance ofthe belg rains would determine whetherthe hungry season would be prolongedor not.

KT ZONEKedida Gamela Woreda

Nutrition: The prevalence of globalacute malnutrition was estimated at8.5% with 1.3% severe malnutrition.There was no significant difference inacute malnutrition rates between thepresent survey and the last one conduct-ed in November 05 with 4.7% GAM (95%CI: 6.7%-10.4%).

Health: The utilization of health serviceswas good, as indicated by the BCG vac-cination coverage of 91%. The coverageof measles vaccination by card and

Mareko Woreda & Meskan (Lowlands)

The nutrition situation inMareko and the lowlands ofMeskan was considered as"serious" with a prevalence ofglobal acute malnutrition of13.6% and 9.9% respectively.The previous meher harvestwas below average due toeither rain shortage or rainexcess, resulting in earlydepletion of food stocks andearly start of the hungry sea-son.

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recall (90%) and vitamin A supplementa-tion (95%) were equally high. Morbidityin children was of 19% while CMR andU5MR were under normal ranges with0.31 and 0.89 deaths/10,000/dayrespectively.

Livelihood/Food Security: The woredacomprises two agro-ecological zones:the mid-highlands (93%) and the high-lands (7%). The majority of the popula-tion relies on agriculture with some live-stock rearing and benefits from bothmeher and belg cropping seasons. Theworeda is made of 3 livelihood zones:Badewacho-Alaba Maize midlands(27% of the population), Kedida-Badewacho Coffee midlands (35% ofthe population) and Hadiya-KembataCereal and Enset upper midlands andhighlands (38% of the population). TheMaize LZ is reported to be the most vul-nerable zone due to recurrent droughtwith high dependency on food aid whilethe 2 other livelihood zones are relative-ly food secure (FewsNet SNNPR liveli-hood Profiles, Jan 06). The surveyreport indicated that due to delayed 06belg rains short maturing belg crops andlong cycle meher crops were not timelyplanted. In addition heavy rains in thesecond decade of March partially orcompletely destroyed both food andcash crops in eight PAs affecting 1357households. At the time of the surveygrain availability on the markets wasfound to be low while grain prices wereconsiderably increased. Most house-holds reported consuming Amicho(immature Enset) as the main staplefood while in normal years its consump-tion was reported to be unusual.Availability of pasture and drinking waterfor livestock was adequate and livestockcondition was good. All PAs of the wore-da benefit from the Productive SafetyNet in form of cash and the number ofbeneficiaries was increased by 44% thisyear as compared to 2005. Howevercash transfers only started 2 monthsafter the completion of the public worksand only to a small proportion of thebeneficiaries. On the other hand EOSfood (25 kg CSB and 3 liters oil per per-son) had already been distributed to the2600 children and mothers identifiedduring the last screening of December05. In the meantime WVE and the

KT and HADIYA ZONES

A 30 cluster survey was conducted byMSF-CH in these 2 woredas. Though theindicator used was MUAC instead ofweight for height, the sampling for clustersand children followed the recommendedrandom procedures thus the results wereconsidered to be representative of thepopulation surveyed. A total of 846 chil-dren aged 12-59 months were measuredand checked for bilateral oedema.Wasting (125 mm < MUAC) was estimat-ed at 8.6% with 0.5% of severe wasting(MUAC < 110 mm) and 1% kwashiorkor.

Angacha & Shashego Woredas

Woreda health Office had undertaken asimilar screening and identified an addi-tional 4000 beneficiaries, who received 18kg of supplementary food per person. TenPAs of the woreda also benefit from theWorld Bank supported Food SecurityProgram, which comprises communitygrant and capacity building.

Conclusion & Recommendations: Thenutrition situation was rated as "poor" with8.5% GAM and presence of aggravatingfactors such as poor grain availability andaccessibility. Due to weather hazards (lateonset of the belg rains and floods) it wasanticipated that the overall crop perform-ance and productivity would be belowaverage, and that the food security woulddeteriorate in the coming months andimpact negatively on the nutritional status.Therefore, it was recommended tostrengthen the existing interventionsnamely ensuring timely payment of PSNPbeneficiaries, and to consider emergencyfood aid for the second half of 2006depending on the findings of the upcomingbelg assessment.

The nutrition situation wasrated as "poor" with 8.5% GAMand presence of aggravatingfactors such as poor grainavailability and accessibility.Due to the weather hazards(late onset of belg and floods)it was anticipated that the foodsecurity would deteriorate inthe coming months and impactnegatively on the nutritionalstatus.

Kedida Gamela Woreda

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Table 1: Survey results in SNNPR

Table 2: Absolute needs for SFP and TFP, and existing food/nutrition interventionsKAT zone

Silti Sankura Midlands of Hulla

Boricha Shebedino Mareko Low lands of Meskan

Kedida Gamela

Total Population Under Five Population

186,919 37,384

91,787 18,357

53,747 10,750

272,832 54,566

223,350 44,670

66,335 13,277

62,506 12,501

173,357 34,671

No. of moderate and severe cases at survey time (WH%M)

MAM: 2,280 SAM: 485

MAM: 1,175 SAM: 312

MAM: 1,130 SAM: 150

MAM: 1,091 SAM: 273

MAM: 1,965 SAM: 446

MAM: 863 SAM: 265

MAM: 500 SAM: 162

MAM: 1,421 SAM: 346

EOS - January 06 Moderate & Severe caseloads

(based on WH%M)MAM: 904 SAM: 172

MAM:299 SAM: 206

(w oreda) MAM: 1,569 SAM: 308

MAM: 823 SAM: 24

MAM: 1089 SAM: 109

MAM: 573 SAM: 106

(w oreda) MAM: 620 SAM: 145

MAM: 1,404 SAM: 182

Therapeutic Feeding Units No NoHargeselam

HC since July 05

Yirba & Darara HC

since Mar 05

Leku HC since July 05

Koshe HC since Dec 05

Butajira hospital

Taza HC since June 05

Outreach Therapeutic Programme

GOAL since May 06 No OTP

SC-US since Aug. 05

SC-US since Mar. 05

SC-US since July 05

ACF since April 06

ACF/Valid since May 06

Catholic HC since June 05

Food Aid – Jan-June 06 No. of Beneficiaries % of rural population

No No No 5,780 2.1%

6,940 3.1%

2,070 3.1%

No No

Safety Net No. of Beneficiaries % of rural population

19,841 11%

14,098 15%

(w oreda) 9,133 17%

39,760 15%

12,340 6%

21,256 32%

(w oreda) 23,605 10%

23,486 13%

Sidama Zone Gurage ZoneSilti Zone

KT Zone

Silti May 8-12

Sankura May 15-19

Midlands of Hulla

April 14-16Boricha

May 11-15Shebedino May 23-28

Mareko April 13-17

Lowlands of Meskan May 22-26

Kedida Gamela

May22-June 2GAM in Z-scores

(95% CI)12.2%

(10.3-14.5%)11.9%

(9.9-14.1%)18.1%

(15.2-21.1%)6.8%

(5.2-8.8%)7.4%

(5.7-9.6%)13.6%

(11.0-16.2%)9.9%

(6.7-13.0%)8.5%

(6.7-10.4%)SAM in Z-scores

(95% CI)2.0%

(1.2-3.1%)2.4%

(1.5-3.6%)2.1%

(0.2-3.9%)0.5%

(0.2-1.3%)0.5%

(0.2-1.2%)2.7%

(1.8-3.6%)1.6%

(0.9-2.3%)1.3%

(0.6-2.1%)Kw ashiorkor 0.8% 1.0% 1.1% 0% 0% 1.3% 1.0% 0.8%

CMR Death/10,000/day (95% CI)

0.46 (0.2-0.8)

0.45 (0.2-0.8)

0.09 (NR)

0.04 (NR)

0.13 (NR)

0.21 (0.03-0.38)

0.16 (0.05-0.27)

0.31 (NR)

U5MR Death/10,000/day (95% CI)

0.94 (0.2-2.0)

1.41 (0.6-2.7)

0.12 (NR)

0.1 (NR)

0.23 (NR)

0.77 (0.11-1.43)

0.73 (0.27-1.18)

0.89 (NR)

Major causes of U5MR Malaria, diarrhea

Malaria Unknow n NR NR ARI, malaria NR NR

Morbidity (past 2 w eeks) 33.8% 43.6% 23.2% 19.2% 19.3% 36% 21.1% 18.8%Major illnesses or symptoms

Diarrhea, fever, malaria

Diarrhea, fever, malaria

Diarrhea, cough

Cough, fever, diarrhea

Diarrhea, fever, malaria

Diarrhea, fever

Diarrhea, fever, cough

Fever, diarrhea

Measles coverage by card (95% CI)

4.5% (2.9-6.9%)

2.7% (1.5-4.7%)

17% (NR)

25.7% (NR)

NR 11.8% (9.7-13.9%)

9.8% (7.8-11.8%)

52.1% (47.3-56.9%)

Measles coverage by card + recall (95% CI)

65% (60.5-69.3%)

66.2% (61.7-70.4%)

77.3% (NR)

66.2% (NR)

71.8% (NR)

94.6% (93.1-96.1%)

83.9% (81.5-86.3%)

89.7% (86.4-92.4%)

BCG coverage (scar) (95% CI)

59% (54.4-63.0%)

47% (42.6-51.6%)

69.4% (NR)

70% (NR)

42.6% (NR)

55.1% (52.1-58.1)

59.8% (56.6-63.0%)

90.7% (87.4-93.0%)

Vitamin A in past 6 months (95% CI)

81.9% (78.0-85.0%)

84.3% (80.6-87.3%)

94.5% (NR)

82.5% (NR)

72.5% (NR)

86.5% (84.3-88.7%)

83.5% (NR)

95% (92.5-96.8%)

Gurage ZoneSilti Zone Sidama Zone

Key indicators

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OROMIA REGION

In the second quarter of 2006 two nutrition surveys were undertaken in 2 woredas ofOromia region, Kombolcha in East Hararghe and Bosset in East Shewa. Theseworedas were flagged as of concern by the Oromia Regional Food Security, DisasterPrevention and Preparedness Bureau. The survey findings are presented below, sum-marized in table 2 and displayed on map 2 (in annex) with the existing food/nutritioninterventions.

EAST HARARGHE ZONEKombolcha Woreda

Nutrition: The prevalence of global andsevere acute malnutrition was estimatedat 6.3% and 0.4% respectively and con-sidered as "typical" with few aggravatingfactors (high morbidity, inadequateaccess to safe water, low measles andvitamin A coverage). No previous anthro-pometric data were available for compar-ison.

Health: It was reported that the woredahad only 1 health centre, 3 clinics and 3health posts with an estimated 68% cov-erage. The utilization of health servicesremained poor as shown by the low BCGvaccination coverage (33%). The cover-age of measles vaccination by card andrecall (33.5%) and vitamin A supplemen-tation (21.4%) was equally low in spite ofEOS interventions. Morbidity was high,with 1 out 4 children suffering from a dis-ease in the past 2 weeks prior to the sur-vey while mortality rates, CMR of 0.22deaths/10,000/day and U5MR of 0.49deaths/ 10,000/day remained underacceptable ranges.

Water and Sanitation: Access to ade-quate water for both human and livestockwas reported to be problematic particular-ly during the dry seasons. The woreda'saccess to safe water supply was as lowas 20%. The majority of the householdsurveyed (60%) reported sourcing theirwater from unprotected springs or ponds.Poor access to safe water and lack ofsanitation was reflected by the highprevalence of diarrheaol diseases, whichaccounted for more than half (54%) of themorbidity in children.

Livelihood/Food Security: The woredacomprises 2 agro-ecological zones, 26%lowlands and 74% midlands, and 2 rainyseasons, belg and meher. Livelihood in

the lowlands is mostly based on live-stock while in higher altitudes crop culti-vation prevails. It was reported that theprevious 05 meher harvest partly faileddue to shortage of rains and that the 06belg rains were below normal and hencea low prospect for the belg harvest. Atthe time of the survey, the most commonsources of food were own production(65%) and purchase (34%); only 1% ofthe households reported relying on foodaid while the Productive Safety NetProgramme had not started. The live-stock condition was reported to be ingood (64%) to poor (33%) condition withbelow average water availability andpasture, and high prevalence of dis-eases such as abasenga, assenga,haria, and mefira.

Conclusion & Recommendations:Overall, the food security and nutritionsituation in the area was considered tobe "typical" in a food insecure area suchas Kombolcha. Recommendationsincluded close monitoring of the foodsecurity situation in view of anticipatedpoor performance of the 06 belg rains,strengthening of health services espe-cially preventative care e.g. EPI, andimproving availability and quality ofdrinking water.

Kombolcha WoredaThe nutrition situation wasconsidered to be "typical" with6.3% global acute malnutritionin spite of the partly failed 05meher harvest. It was report-ed that the 06 belg rains werebelow normal and hence a lowprospect for the coming belgharvest.

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EAST SHEWA ZONE

Bosset Woreda

Nutrition: The prevalence of globaland severe acute malnutrition was esti-mated at 4.8% and 1.2% respectively.The third round of EOS screening con-ducted around the same time showedsimilar low levels of malnutrition with3% of the children screened sufferingfrom acute malnutrition (MUAC<120mm and/or oedema).

Health: Morbidity in the 2 weeks priorto the survey was low at 12%. TheCMR and U5MR of 0.17 and 0.45deaths/10,000/days respectively liedwithin the non-emergency ranges.Measles (card and recall) and BCGvaccination coverage remained low at39.1% and 41.4% respectively whilevitamin A supplementation (87.3%)was higher due to the recent EOS cam-paign.

Water and Sanitation: The main iden-tified community water sources includ-ed piped water (59%), river (31%) andpond (10%). Water availability forhuman consumption varied being goodfor 37.3%, average for 22.3%, andbelow average for 40% of the respon-dents.

Livelihood/Food Security: Bossetworeda is mainly relying on agricultureand is meher dependent. The belg pro-duction contributes little to the overallannual production. However, belg rainsare important for the regeneration ofpasture and replenishment of waterpoints. The woreda is classified as achronically food insecure woreda andbenefits from the Safety NetProgramme and EOS. In addition 10lowland kebeles receive emergencyfood aid for the period of Jan-June 06and 40% of the woreda population aretargeted by the World Bank supportedFood Security Program. WVE alsooperates a Food Security Program. Atthe time of the survey three rounds offood aid distribution were completedwhile the PSNP beneficiaries had notbeen paid and the EOS/TSFP rationhad not been distributed 6 months afterthe last screening conducted in

November 05. Cash disbursement fromthe World Bank project was going on.The main food source was reported tobe from own production (66%) and pur-chase (30%). Migration was very low(5%) and described as part of the usualmigration pattern in search of employ-ment. Sale of personal asset and live-stock for grain purchase was rarelyreported. Like elsewhere gradual grainprice increment was observed over thepast six months.

Conclusion & Recommendations: Thenutrition and food security situation inBosset was found to be normal. It wasrecommended to strengthen the ongoingprograms especially the PSNP andEOS, and continue monitoring of the sit-uation over the coming months.

Bosset WoredaThe nutrition and food securitysituation in Bosset was foundto be normal with global andsevere acute malnutrition at4.8% and 1.2% respectively.

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Table 3: Survey results in Oromia regionEast Hararghe

ZoneEast Shewa

ZoneKombolcha

April 2-6Bosset

May 15-23GAM in Z-scores

(95% CI)6.3%

(4.4-9.0%)4.8%

(3.4-6.2%)SAM in Z-scores

(95% CI)0.4%

(0.2-1.6%)1.2%

(0.5-1.9%)Kwashiorkor 0.1% 0.2%

CMR Death/10,000/day (95% CI)

0.22 (0.1-0.5)

0.17 (NR)

U5MR Death/10,000/day (95% CI)

0.49 (0.1-1.6)

0.45 (NR)

Major causes of U5MR Diarrhea, malaria, malnutrition

NR

Morbidity (past 2 weeks) 25.8% 11.6%Major illnesses or symptoms

Diarrhea, cough and vomiting

Diarrhea

Measles coverage by card (95% CI)

6.4% (NR)

18.4% (14.2-23.5%)

Measles coverage by card + recall (95% CI)

33.5% (29.3-38%)

39.1% (33.5-45.1%)

BCG coverage (scar) (95% CI)

33% (28.9-37.3)

41.4% (36.9-46.1%)

Vitamin A in past 6 months (95% CI)

21.4% (17.9-25.4%)

87.3% (NR)

Key indicators

East Hararghe Zone

East Shewa Zone

Kombolcha BossetTotal Population

Under Five Population115,786 23,157

122,662 24,532

No. of moderate and severe cases at survey time (WH%M)

MAM: 718 SAM: 46

MAM: 735 SAM: 98

EOS - May 06 Moderate & Severe caseloads

(based on MUAC)*MAM: 1,096 SAM: 448

Data not available

Therapeutic Feeding Units Kombolcha HC since Oct 05

No

Outreach Therapeutic Programme No NoFood Aid – Jan-June 06

No. of Beneficiaries % of rural population

1,140 1%

7,770 6%

Safety Net No. of Beneficiaries % of rural population

15,164 13%

16,372 13%

Table 4: Absolute needs for TFP and SFP and existing food/nutrition interventions

* In March 06 a new method was adopted by the EOS using MUAC as a single criteria for screen-ing with MUAC < 110 for severe malnutrition and 110 mm =< MUAC < 120 mm for moderate mal-nutrition.

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SURVEY DATA QUALITY

The quality of the anthropometric data ofthe nutrition surveys reported in this bul-letin was checked by using the SMARTsoftware, Nutrisurvey. The plausibilitycheck includes several indicators:

The distribution of the final decimal forweight and height measurements: Thisis called the digit preference and indi-cates whether measurers are roundingweight and height to the nearest kilo-gram or centimeter respectively. The standard deviation of weight-for-

height: this indicates whether there aresubstantial random errors in the meas-urements. In a normal distribution theSD of WHZ is equal to + 1. The SD ofWHZ should be between 0.8 and 1.2 z-score units for weight-for-height. The SDincreases as the proportion of erroneousresults in the dataset increases. If theSD is high (over 1.2) then it is likely thatthere are lots of extreme WHZ valuesand values more than plus or minus 3 z-scores of the mean. This is the mostimportant plausibility check. Wide SDcan increase prevalence of wasting dra-matically while narrow SD can reducethe prevalence of wasting. The changein prevalence due to errors is muchmore dramatic for severe than for globalwasting. The skewness of weight-for-height:

this is a measure of the degree of asym-

metry of the data around the mean com-pared to a normal distribution, which issymmetrical and has zero skewness.The moment of skewness should liebetween plus or minus one. Positiveskewness indicates a long right tail whilenegative skewness indicates a long lefttail. The kurtosis of weight-for-height: this

is a measure of the relative peakednessor flatness compared to a normal distri-bution, i.e. whether the tails of the WHZdistribution is very long (Mexican hat) orvery short (pudding shape) with toomany values in the shoulders of the dis-tribution. A normal distribution has zerokurtosis. The moment of kurtosis shouldlie between plus or minus one. Positivekurtosis indicates a relatively peakeddistribution while negative kurtosis indi-cates a relatively flat distribution.

Nutrisurvey software reports the stan-dard deviation, moment of skewnessand moment of kurtosis of the WHZ ofthe sample and compares them to a nor-mal distribution to determine whether thedata are plausible. With a good survey,i.e. no sampling bias and few measure-ments errors the distribution of the WHZis expected to follow the characteristicsof a normal distribution.

Agency WoredaDigit

Preference Weight

Digit Preference

Height

SD of WHZ

Skewness of WHZ

Kurtosis of WHZ

GOAL Kombolcha No No 0.912 0.259 0.770

GOAL Silti No Digit .5 + 0.859 -0.062 0.180

GOAL Sankuro No No 0.968 -0.027 0.343

GOAL Shebedino No Digit .0 + 0.879 0.327 1.052

ACF Mareko No Digit .0 + Digit .5 +

0.876 0.112 1.058

ACF Low lands of Meskan

No No 0.915 0.347 1.726 kurtosis problem

SC-US Midlands of Hulla

No Digit .0 +++ Digit .5 ++

0.969 0.979 5.352 kurtosis problem

SC-US Boricha No Digit .0 +++ Digit .5 ++

0.985 0.925 6.37 kurtosis problem

WVE - DPPA/B Bosset No No 0.910 0.127 0.889

WVE Kadida Gamela

Digit .0 ++ Digit .5 +

No 1.029 -0.041 1.532 kurtosis problem

Table 5: Results of the plausibility check

Digit preference: + small, ++ medium, +++ large

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The Standard Deviation (SD) of WHZfor all surveys fell under the acceptablerange of 0.8-1.2, with 7 out of 11 sur-veys falling under the narrower range of0.9-1.1, i.e. closer to 1.0 the expectedSD for a normal distribution.

None of the survey showed a skewedWHZ distribution, the moment of skew-ness for all surveys lying betweenminus and plus one. In other words thedistribution of WHZ for each survey wassymmetrical as expected in a normaldistribution.

Four surveys out of 11 showed a kurto-sis problem with a positive moment ofkurtosis indicative of a peaked distribu-

tion as compared to a normal distribu-tion.

There was still a significant digit prefer-ence in height measurements- especial-ly with SC-US survey teams, though thiswas not systematic as compared to thesurveys conducted in the first quarter of2006. This is the area which still requiresimprovement in future surveys, with abetter precision in measurements to thenearest 100 g for weight and to the near-est 1mm in height.

NUTRITION SURVEY DATABASE

The table below presents the number of standardized nutrition surveys undertak-en in the rural woredas of Ethiopia since 2000. It does not include surveys under-taken in resettlement, IDP or refugee camps.

2000 2001 2002 2003 2004 2005 2006SNNPR 9 5 35 30 14 25 9 127Oromia 3 2 20 27 22 20 8 102Amhara 5 9 24 17 9 7 2 73Somali 8 5 5 5 8 11 7 49Tigray 0 0 6 7 3 3 0 19Afar 0 0 4 5 1 6 2 18

Gambella 0 0 0 0 0 0 0 0Benshangul Gumez 0 0 0 0 0 0 0 0

Total 25 21 94 91 57 72 28 388

Year TotalRegion

Table 6: Number of surveys in rural woredas by region and year

Map 1: Prevalence of global acute malnutrition and food/nutrition interventions - SNNPR

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Map 2: Prevalence of global acute malnutrition and food/nutrition interventions - Oromia