NUTRITION SURVEILLANCE IN SOMALIA

1. NUTRITION SURVEILLANCE IN SOMALIA NIPHORN Meeting, Nairobi, 1st to 3rd February, 2007 Grainne Moloney, Nutrition Project Manager, FSAU

2. Nutrition Coordination in Somalia • Prior to the conflict in 1991, coordination was managed under the Ministry of Health both at national and regional level • Now all sector coordination is under one governing body – Somalia Support Secretariat (formerly SACB), supported by UNDP. • Nutrition Working Group/ Nutrition Cluster Coordination co chaired by UNICEF & FSAU with UNICEF chairing the Cluster Coordination • Monthly meetings with UN, NGO, CBO in Nairobi: Update on Nutrition Information, Emergency Response, Health , Food Security, Logistics, new developments, etc • Regional meetings in Somalia frequency varies depending on location, access and availability of partners • Challenges - lack of Gov, often lack of technical staff (in field), too much to cover in short period – lack of time to discuss more proactive issues such as guidelines etc

3. Nutrition Data Collection & Sources Nutrition Surveys • National Level MICS, UNICEF. 1999, Sept 2006 – useful for MDG monitoring 2) Localised: • National Nutrition Assessment Guidelines have been produced endorsed and updated on an annual basis by FSAU/ UNICEF in collaboration with the NWG members. • Nutrition Surveys are conduced by UN agencies, predominantly FSAU with support UNICEF/WFP and NGO (MSFB, MSFH, ACF, IMC, WVI). In many instances surveys are done on an interagency basis as recommended by the NWG • Nutrition Surveys are done in areas of operation (for NGO) and areas of concern or where there is no data (FSAU) , right now a database exist in FSAU. Ongoing analysis on seasonality to review the trends in malnutrition over the different seasons

4. Nutrition Data Collection & Sources Feeding Centre Statistics UNICEF consolidates the information from NGO statistics into a central excel database then shares with partners. Sentinel Sites FSAU collect bi monthly data from 102 sentinel sites (villages) in Sth and Central Somalia. 50 kids per sites, WHZ, MUAC, Oedema. Morbidity, dietary diversity – useful for trends - ? Mean WHZ Rapid Assessments Dec 06, developed a MUAC rapid assessment tool (adapted from Darfur) used in the Deyr 06 assessment measuring 100 children per site and classifying % <12.5cm. HIS Data 105 HC measure WHZ of all children 6-59months and collect additional info on morbidity, Epi, maternal health monthly, data submitted to key agencies (FSAU - nutrition, UNCIEF- Epi, WHO morbidity) Central database in Nairobi – useful for trends analysis

5. Nutrition Data Collection & Sources Dietary Diversity Information collected from sentinel sites and assessments – ongoing work on use of indicators (FAO) and recall period (WFP) Child care feeding practices Information collected predominantly from nutrition assessment – need for further investigation into obstacles - ? KAP survey OUTPUTS Monthly Nutrition Update – produced by FSAU – inputs from UNICEF Quarterly Food Security and Nutrition Brief Bi annual IPC - seasonal analysis – Nutrition Situation Map Nutrition assessment reports Training Materials – food preservation, hygiene promotion, micronutrients Website – www.fsausomali.com – (updates, assessment reports, training materials plan to continue expanding info available.)

6. Nutrition Key Indicators and Categorization – Version 1 Jan 07

7. Key Indicators and Categorization Contd. – Version 1 Jan 07

8. Nutrition Situation - Maps Nutrition Situation, July 06 Nutrition Situation, Jan 07

9. Link with Food Security Analysis • FSAU food security project collects information on markets prices livestock, agriculture, security climate (FEWSNET), though a range • Two main assessments linked to the rains are conducted annually, post Gu (June) post Deyr (December) leading to the production of the IPC – includes nutrition information – IPC is recognised as a valuable tool for linking information to action by partners and donors • In addition quarterly briefs on risk factors and early warning are produced incorporating nutrition and food security information • The IPC is now being rolled out in the Horn East and Central Africa Region as a tool for classifying severity across different contexts. – currently Somalia specific • There is a need to review the nutrition indicators due to the heavy reliance on WHZ and mortality data only available from localised assessments which may not be representative of larger areas and across season.

10. Integrated Food Security and Humanitarian Phase Classification Reference Table (FAO/FSAU June 2006)

11. Somalia Food Security Phase Classification – Post Deyr ’06/’07 Projection Jan - June ’07 Post Gu ’06 Projection Jul ‘06 - Dec ’06

12. Specific Issues for Nutrition Surveillance in Somalia • Challenge of access to conduct good quality large scale assessment • Lack of capacity of Somali based staff • Limited partners – concentrated in certain areas. • Lack of structures of long term integrations of monitoring systems – HIS exists but needs much support • Reliability of age data – stunting data??? • Different ethnic groups (Bantu – riverine, pastoral, agropastoral) • Interpretation of nutrition data only high rates of wasting trigger appropriate response • Need to further link nutrition assessments to seasonality and livelihood zones for better trends analysis & interpretation of results over time • Limited if no data on micronutrients available • Differing needs of IDP’s.

13. Way Forward • Recommend nutrition surveys for 2007 will be based on seasonality from previous analysis and will be conducted at livelihood level not administrative (except for IPD) to link with food security analysis • Use of mapping/ segmentation rather that EPI for 2nd level sampling • Use of uniscales to reduce measurement error • Review Sentinel site data, ? Mean whz, interpretation of results • Move away from estimates of malnutrition when recent surveys are not available to a statement reflecting a range of indicators • Establishment of Somalia regional based experts in conducting nutrition surveys (UNICEF/ FSAU) when access is an issue • Continue analysis in using non anthropometric indicators such as dietary diversity, meal frequency - easier to monitor also at community level. • Review use of MUAC in rapid assessments, • Discuss the possibility of conducting micronutrient deficiency prevalence assessment with FSAU/UNICEF/ WHO/MI, KAP. • ? Roll out of new WHO Growth Curves • ? Integration of Nutrition Information System into Gov/ … future??