Saving Ethiopia’s adolescents from the scourge of parasites

By Fanna Minwuyelet


Southern Nations, Nationalities and People’s Region, Ethiopia, 23 February 2016 –Tesfatsion Alemayehu wants to be an engineer someday, but the 14-year-old girl has trouble concentrating in school. She is often dizzy and light headed and complains of a stomach ache.

Tesfatsion likely has worms.

Intestinal worms and bilharzia are rampant in Ethiopia and children suffering from these afflictions are often too sick or tired to go to school or concentrate. In the long term, the result is malnutrition, anaemia, stunting and even impaired cognitive development, all of which result in poor educational achievement.

So one day in February, Tesfatsion is standing in line at her Gurmu Koisha school where she will receive a de-worming tablet from the local health extension workers.

The tablet will take care of Tesfatsion’s worms which could be schistosomes that cause bilharzia and are carried by snails that live in fresh water. Once the worms are gone, she will be able to concentrate in school again.

Integrating Nutrition, Water and Sanitation Behaviour Change Interventions

The programme, which is funded by EU-SHARE and implemented by local authorities and UNICEF, is much more than just giving pills, however. In the shade next to where the students are lining up, trained nutrition club members are conducting games that impart key nutrition and hygiene lessons.

These activities, known as behaviour change interventions, help the students understand the benefits of the tablets and teaches helpful nutrition and hygiene practices that can minimize future parasitic infections.

For her part, Tesfatsion particularly likes the “Who am I?” game in which students learn about six common iron-rich food groups. Learning about which foods contain iron is especially valuable for young girls like Tesfatsion as they start menstruating.

Schools as gateways to behaviour change

14 years old Tesfa Tsion , 10th grade, takes medication for intestinal parasites. Gurumu Koysha primary and secondary school, Wolayta, Boloso Sore Woreda, SNNPR.
14 years old Tesfa Tsion , 10th grade, takes medication for intestinal parasites. Gurumu Koysha primary and secondary school, Wolayta, Boloso Sore Woreda, SNNPR. ©UNICEF ETHIOPIA/ 2016/ Meklit Mersha

Samson Alemayehu, the head of the health bureau at Boloso Woreda, where Tesfatsion lives, said his department is working with the schools to provide these services.

“We believe that Behaviour Change Communication interventions that take place in the schools by health and nutrition clubs play a big role in increasing awareness in the community, particularly on basic hygiene sanitation and optimal feeding,” he said.

The Health Bureau implements the program through the Health Development Army, which is present in every community and the 1-5 network, in which one person is responsible for five others.

The programme supports the integration of water and sanitation as well as nutrition education into the large scale de-worming campaign in 436 woredas across the country.

It also supports the de-worming specifically of adolescents in high schools in 86 woredas in Amhara, Oromia and SNNP regions free of charge.

“I need to attend all the classes and study hard to make my dream a reality,” said Tesfatsion.

 

Reclaiming Young Lives in the El-Nino Affected South

By Bethlehem Kiros

SHEBEDINO WOREDA, SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S REGION (SNNPR), November 2016 – Looking drowsy and barely active for a two-and-a-half –year-old, Maritu Sultan is sitting on a hospital bed next to her father, Sultan Lentata. Two days ago she was admitted to the Shebedino Hospital Stabilization Centre (SC) due to oedema caused by severe acute malnutrition (SAM). Sultan rushed his daughter to the health post in his kebele (sub-district) when her feet and facial swelling and vomiting became worse. The health extension workers (HEWs) at the health post referred his daughter to the hospital as she needed immediate attention. Maritu had received treatment for SAM in the Outpatient Therapeutic Feeding Programme (OTP) at the health post in the past and recovered well, however she relapsed after a few months. Sultan admits he knows the reason for it,

“The HEWs instructed us on how to feed her after she was discharged but we did not have the means to give her what she needed,” he says.  Referring to himself as a poor farmer, he says the recent drought brought calamity on his household. “To begin with, I do not have much land and the corn I planted was destroyed by the flood and hail that came after the drought. So there was not much to eat at home,” he elaborates.

Two and a half years old Maritu Sultan is admitted at the stabilization center in Shebedino hospital to receive treatment for sever acute malnutrition and Edema.
Maritu Sultan, two-and-a-half-years-old, and her father Sultan Lentata in Shebedino Hospital Stabilization Centre for severely malnourished children. Sultan says his daughter became ill due to shortage of food. “The drought decreased our yield and flood and hail destroyed what I planted so there wasn’t enough food for the children at home.” ©UNICEF Ethiopia/2016/Meklit Mersha

The SNNPR is among the six regions in Ethiopia that have been particularly affected by the recent El Niño-caused drought and flooding, with 71 out of 137 woredas (districts) in the region classified as priority one woredas, requiring urgent humanitarian response. Consequently, UNICEF Ethiopia has continued its support to the Government of Ethiopia for the strengthening of Community-Based Management of Acute Malnutrition (CMAM), a programme that offers a package of services to tackle malnutrition.

Through the provision of ready-to-use therapeutic food (RUTF) at health posts and therapeutic milks and essential drugs at the SCs, a high number of SAM cases are being treated in the region.

Shebedino hospital, where Maritu is being treated, is among the 286 health centres and hospitals that have SCs for in-patient care in the region. According to Zerihun Asres, a stabilization nurse in the hospital, the number of SAM cases referred to them is declining, as the majority of cases are treated as outpatient at health centres and health posts.

Though it has only been a couple of days, Sultan is pleased with the progress his daughter is showing. “She can now take the milk they give her without throwing up,” he says. “I do not want any of my children to go through this again. Once she is discharged from here, I have to do my best to provide for her so that she can grow healthy.”

Tigist Angata is another parent grateful for the SAM treatment her firstborn son, Wondimu Wotei received. “I had almost given up because he was very small and I did not have enough milk to nurse him,” she recounts.  At six months old, the HEWs in Telemo Kentise health post found in her kebele referred him to the SC in Shebedino hospital. He was only 3.5 kg at the time, approximately the size of a healthy newborn. Upon his return from the SC, he ate RUTF for a month and was discharged when he reached 4.4 kg. “He ate so well, which made me realize how much my son was deprived of food,” says Tigist. She adds that she is trying her best to prepare food for him at home, based on the lesson she received from the HEWs. However, eight-month-old Wondimu has not gained any weight since he was discharged from OTP. Her family’s livelihood is based on what her husband earns working on other farms. Due to the drought, he has not been able to work much since last year, which has caused a serious food shortage in their home.

Tigist Anagata with her first born, 7-months-old Wondimu Wotei.
Tigist Angata with her firstborn, eight-month-old Wondimu Wotei, who was treated for SAM at the Telemo health centre Stabilization Centre as an in-patient and later at the Telemo health post as an outpatient. He was discharged from treatment after he gained one kg. UNICEF Ethiopia/2016/Meklit

Though poverty seems to have a firm hold in her home, Tigist feels like the situation is better than what it used to be when her son was sick. “I was very distressed at the time because I was sick and he did not seem like he had much hope. But the therapeutic milk and food have brought him back to life and I am very happy and thankful for that,” she says. Her hope is for Wondimu to grow strong, become educated and find a better life than her and her husband’s.

Through the contribution of many donors, including the European Commission’s humanitarian aid department (ECHO), UNICEF supported the Government in treating 272,165 SAM cases across the country from January to October 2016. Of those treated, 21,671 children were admitted for treatment in SCs while 250,494 received SAM treatment in the OTP. In SNNPR alone, CMAM services are available in all 106 woredas.

EU Partnership Paves the Way for Better Nutrition for Children and Women in Ethiopia

By Nardos Birru

ADDIS ABABA, September 2016 – Ethiopia has experienced repeated droughts, particularly in the past few years, which have eroded rural livelihoods, causing increased food insecurity and malnutrition among vulnerable communities. The 2015/2016 El Niño-driven drought, for instance, left 9.7 million people in need of emergency food assistance.

In response to recurrent food insecurity, UNICEF has partnered with the European Union (EU) to contribute to building resilience of the most vulnerable groups, which includes children under five, as well as pregnant and lactating women. Resilience, or the ability of a community to withstand, adapt and quickly recover from shocks such as drought, is a cornerstone of the EU’s humanitarian and development assistance.

To this effect, the EU has provided €10 million to UNICEF-assisted programmes as part of its Supporting the Horn of Africa’s Resilience (SHARE) initiative through a project entitled Multi-Sectoral Interventions to Improve Nutrition Security & Resilience. The project is implemented in collaboration with the Food and Agriculture Organization of the United Nations (FAO) in the drought-affected woredas (districts) of Amhara, Oromia Southern Nations, Nationalities and People’s Region (SNNP) regions, benefiting 285,665 households.

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As part of the community-based nutrition programme, Binti, a Health Extension Worker counsels a mother on best nutrition practices. ©UNICEF/2014/Nesbitt

How does SHARE work?

The project aims for communities to have access to quality nutrition services in their vicinity and a better understanding of the importance of proper infant and young child feeding (IYCF) practices.

It covers a wide range of interventions including the promotion of exclusive breast feeding and adequate complementary feeding, vitamin A supplementation and deworming of children, as well as the promotion of hygiene and sanitation.

This is complemented by a series of nutrition-sensitive agriculture interventions led by FAO in partnership with the Ministry of Agriculture. This component helps build the capacity of women to improve the variation of their diet through livestock and poultry rearing, as well as backyard gardening. It also brings opportunities for women to collaborate as peer support groups to produce nutritionally valuable complementary foods such as cereal mixtures for sale. This stimulates the local economy by creating jobs and empowering women to ensure the healthy growth of their children.

An evidence-based approach

Launch of document entitled “Situation Analysis of the Nutrition Sector in Ethiopia” from 2000-2015
Left to right: H.E Chantal Hebberecht, Ambassador of the European Union; Birara Melese, National Nutrition Programme Team Coordinator; Gillian Mellsop, UNICEF Representative to Ethiopia; at the launch of the 2000-2015 “Situation Analysis of the Nutrition Sector in Ethiopia” in Addis Ababa, Ethiopia ©UNICEF/2016/Tesfaye

One achievement of the project was an initiative to analyze and document the nutrition situation in the country from 2000 to 2015.  The report was launched in March 2016 and highlights critical gaps in terms of existing policies and programmes which need to be addressed urgently to accelerate nutrition results for women and children. Key findings of the situation analysis report include poor water supply and sanitation as high risk factors for child stunting, educating mothers as a key factor for improving nutrition, as well as the need to improve production diversity, nutrition knowledge and women’s empowerment to ensure that diverse and nutritious foods are available and accessible at all times.

The SHARE project also serves as a platform for multiple non-governmental organizations where they can exchange expertise and best practices to improve implementation and follow a harmonized approach in their respective intervention sites. This way, efforts are combined and the impact on the nutrition status of children and women will be maximized.

UNICEF would like to express its gratitude to the EU for the generous financial contribution to UNICEF-assisted programmes and looks forward to strengthening successful collaboration for children and women in Ethiopia. Thanks to EU support, over 225,000 children under five and over 50,000 mothers will have better access to improved nutrition services. This is in line with the efforts of the Government of Ethiopia to realize the Seqota Declaration to make undernutrition, in particular child undernutrition, history in Ethiopia.

Surviving hard times through therapeutic foods

Story – Bethlehem Kiros

Photos – Meklit Mersha 

SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S REGION (SNNPR), November 2016- Poverty and drought have left people in many parts of Ethiopia to grapple with food shortage; SNNPR is no different. Children are most affected, as evidenced by a high number of severe acute malnutrition (SAM) cases. Fortunately, the Government of Ethiopia implements the Community-Based Management of Acute Malnutrition (CMAM) programme, supported by UNICEF with generous contribution from European Commission’s humanitarian aid department (ECHO). The programme enables children affected by malnutrition to receive life-saving services at stabilization centres (SC) and health posts, such as 32-year-old Bogalech Boreda’s twin infants.

Bogalech Boreda, 32, has 6 children. Her youngest 10-months-old twins Tegegn and Kibru Elias have both become severely malnourished because she could not nurse them sufficiently.
Bogalech’s 10-month-old twins Kibru and Tegegn have been in the Outpatient Therapeutic Feeding Programme (OTP) for SAM more than once. Since Bogalech has three more children at home, she says feeding the twins has not been easy.

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She gets help from her older children when they return from school, such as Caleb, 12, pictured here holding one of the twins.  Still, taking care of the infants occupies most of Bogalech’s day, making it impossible for her to work. Her husband is unemployed with an additional two children from another wife, his earnings from a small plot of farm land are not enough to provide for them.

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The health extension workers (HEWs) of Morancho Kutela health post have arranged for Bogalech to receive targeted supplementary food multiple times since the twins were born. “I normally had enough milk to nurse my children in the past,” explains Bogalech, “but now, there are two of them and I also do not eat enough at home, so they have been suffering since they were born.”

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Three weeks before the picture was taken, Tegegn suffered from diarrhoea and was referred to the Stabilization Centre (SC) at the kebele’s (sub-district) health centre. After a few days of antibiotics and therapeutic milk treatment, he was referred to the health post for OTP to continue his treatment as an outpatient. Since his brother’s situation was not much better, both were enrolled to receive the RUTF.

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In the two weeks since the boys’ treatment began, Bogalech says she has seen progress on her babies’ health and appearance. “They love the [RUTF], they just cannot get enough of it. And the thought of having something to give them when they are hungry gives me such relief,” she adds. Since she is nursing them and providing additional food in her home, she hopes they will grow strong and healthy.

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Their middle-upper arm circumference (MUAC) and weight is measured every week until they reach their target weight for discharge. Currently at 6.2 kg, Tegegn’s target weight for discharge is 6.9 kg, which is still about 2 kg underweight for an average 10-month-old boy according to World Health Organization guidelines. His MUAC was 10.9 cm when he was first enrolled for treatment and has now reached 11.25 cm.

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Bogalech dreams of starting an avocado and corn flour business in the market to support herself and her children.

Government of Ethiopia and Humanitarian Partners Release 2017 Humanitarian Response Planning Document

ADDIS ABABA, 11 January 2016 – The Government of Ethiopia has released the Joint Government and Partners’ Humanitarian Document, an initial humanitarian response planning document for 2017 while the comprehensive Humanitarian Requirements Document (HRD) is being finalized. Based on the early warning data and modelling undertaken by partners such as UNICEF, the document reflects the joint humanitarian response planning and provides a shared understanding of the crisis, including the most pressing humanitarian needs.

While Ethiopia battles residual needs from the El Niño-induced drought, below average rains in the southern and eastern parts of the country caused by the negative Indian Ocean Dipole, another climatic phenomena, have led to new symptoms of drought. It is anticipated that 5.6 million people will need emergency food assistance in 2017, in addition to those still suffering from effects of El Niño. Ongoing assessments for the HRD will provide total figures of those in need for 2017.

In 2016, international donors contributed US$894 million toward the humanitarian response efforts and from that figure, UNICEF raised US$108.7 million to support the Government of Ethiopia and partners to reach around seven million people with access to health and nutrition care, education, safe water, sanitation and hygiene services, and protection support. At least 73 per cent of those reached were children.

The total anticipated financial requirements for the 2017 HRD is US$1.1 billion, of which, the UNICEF Humanitarian Action for Children (HAC) appeal for Ethiopia is US$110.5 million. This includes US$13.6 million to respond to the new influx of South Sudanese refugees in the Gambella region. While the funding will be critical to UNICEF’s ability to respond to immediate needs, it will also be used to take appropriate actions to strengthen preparedness, improve early warning systems and reduce vulnerability, contributing to more resilient communities.

Immediate responses have already taken shape from regional governments allocating funds to water trucking and fodder provision in the south and south eastern regions, those most affected by the below average rainfall. In 2016 and years prior, UNICEF has supported such emergency interventions, in addition to child health and nutrition, sustainable water and sanitation, quality education for boys and girls, and the protection of children from violence and exploitation. UNICEF Ethiopia looks forward to continuing this support with the Government of Ethiopia and partners in 2017, for every child and their family.

Italy supports vital events registration in Ethiopia

The Italian Government funds UNICEF with Euro 500,000 to UNICEF to strengthen vital events registration system in Oromia and SNNP regions

ADDIS ABABA, 7 December 2016 – The Italian Agency for Development Cooperation funded UNICEF with a total contribution of €500,000 to strengthen the civil registration system for children’s rights to identify in two regions of Ethiopia: Oromia and SNNPR, in collaboration with the respective regional Vital Events Registration Agencies (VERAs). 

The support is crucial as it represents the preliminary condition towards the creation of a fully functional civil and vital registration system of birth, death, marriage and divorce. The funding aims to improve and standardize the Civil Registration and Vital Statistics (CRVS) system and contribute to children’s right to identity to protect them from abuse and exploitation, as well as ensure their access to basic services.

Financial contribution signing ceremony between Italy and UNICEF.

The support comes at a critical time in light of Ethiopia’s creation of a fully functional nationwide civil and vital registration system of birth, death, marriage and divorce in August.

The funding aims to improve and standardize the Civil Registration and Vital Statistics (CRVS) system and help protect children from abuse and exploitation, as well as ensure their access to basic services.

In addition, vital events registration is an important pre-requisite for measuring equity, monitoring trends, and evaluating the impact and outcomes of broader development programmes, such as the Sustainable Development Goals (SDGs).

At the signing ceremony, the Ambassador of Italy to Ethiopia, H.E. Giuseppe Mistretta stated that “the registration of birth represents the first step towards the recognition of an individual within a society, allowing him or her to access to basic services and protect him or her from abuses and violence. Avoiding anonymity and invisibility, birth registration sets the basis for an efficient planning of the governmental policies and strategies of good governance”.

“All our current and upcoming projects of the Italian Agency for Development Cooperation in Ethiopia are aligned with the priorities and strategies set by the Government of Ethiopia. This initiative’s  objectives are also expressed by the Proclamation on Vital Events Registration and National ID (Proclamation No. 760/2012), adopted in August 2012. Coherently with the government strategy, the initiative we are signing today aims at improving the institutional and technical capacity of Regional Vital Events Registration Agency (RVERA) in Oromia and SNNPR to effectively lead and coordinate the registration of vital events” said Ms. Ginevra Letizia, Head of the Addis Ababa Office of the Italian Agency for Development Cooperation.  

Ethiopia has one of lowest levels of birth registration in the world at just 7 per cent. With the new system, however, registration of vital events in Ethiopia has been modernized. From regional up to federal and city level administration, UNICEF is supporting standardisation of registration and certification services, which has been officially launched nationwide.

“UNICEF appreciates the timely contribution from the Italian Government to count every child, and in the process, to make every child count. With proof of age and identity, we can protect every child from diverse child protection concerns including abuse, neglect and exploitation, early marriage, child labour and trafficking, and help them to access basic social services, including education and health,” said Gillian Mellsop, UNICEF Representative to Ethiopia. 

After a harrowing journey, a bittersweet homecoming for Ethiopian migrant children

By Christine Yohannes

ADDIS ABABA, 29 June 2016–One year ago, 14-year-old Tesfaye* set off from his hometown of Hadiya in the Southern Nations, Nationalities, and Peoples’ Region of Ethiopia towards South Africa. Like many young people, Tesfaye sought what he thought would be a brighter future abroad.

Unfortunately for Tesfaye, his journey came to an abrupt halt after one month when he was arrested in Zambia. Along with 39 other Ethiopian children, he was charged under the Anti-Human Trafficking Act that prescribes a minimum mandatory sentence of 15 years for smuggling or consenting to be smuggled.

UNICEF- IOM partnership assisted voluntary returning children to Ethiopia
Tesfaye 15 and one of the youngest from the returnees is slowly readjusting to the possibility of reuniting with the family he had decided to leave behind. He is now finding relief in the piece of paper as he draws and writes his past struggles to be a living example to his peers who would consider a similar escape. UNICEF in collaboration with IOM returns children from third countries. Which is facilitated through a Cooperation Agreement signed between the two agencies since 2013 and renewed in 2016. This collaboration supports the Government of Ethiopia’s (GoE) Safe Return and Reunification Programme for Unaccompanied and Migrant Children. ©UNICEF Ethiopia/2016/Tsegaye

Although he was not yet 15 at the time, Tesfaye was tried as a 23-year-old because of the eight-year difference between Gregorian calendar used in most of the world, including Zambia, and the Julian calendar used in Ethiopia. Tesfaye was unable to explain the situation due to his limited English and was subsequently convicted and jailed in Mukobeko Maximum Security Prison in Kabwe, which houses adult criminal offenders,along with other children who had been detained.

A long  journey

In response to news of this detainment, UNICEF and the International Organization for Migration (IOM) worked together with the Zambian Human Rights Commission and Zambian officials to get the children released from prison and sent home. Following high level advocacy and personal commitment from IOM and UNICEF staff members, all 39 children were pardoned by the Zambian President.

IOM Zambia provided support to the Zambian authorities to ensure that protection assistance, including safe shelter and medical assistance was provided to all children once they were released from prison. Their first stop for these children once in Ethiopia is the IOM Assisted Voluntary Return and Reintegration (AVRR) Transit Centre, which is operated in close collaboration with UNICEF and the Government of Ethiopia, in Addis Ababa. The centre receives some 100 to 200 unaccompanied minors every month who have returned from other transit or destination countries.

UNICEF supports the Ethiopian Bureau of Women and Children Affairs with trained social workers to conduct documentation, family identification and reunification of the children. The social workers provide psychosocial support services at the transit center and accompany the children to their families, where they also provide a reunification grant to each child’s family.

Although Tesfaye is now safe in the IOM Transit Centre, he will not soon forget the ordeal he went through. He says, “I want to teach and raise awareness for others that might try to do this,” adding, “It should stop with me!”

Dreams cut short

Jacky* 17, also from Hadiya, was a straight-A student with big dreams for his future when he left home in search of better opportunities. “I do not blame my country for my decision to leave and for trying my luck in South Africa,” he says.

He recalls 25 days of travelling on foot, his subsequent arrest and confinement in a prison room shared with over 200 other detainees, going days without food and enduring brutality and theft.

“I sold my cow and my inherited share of my father’s land to pay for my trip, only to be arrested a 120km from my destination,” said Jacky. “I had high hopes for my future in South Africa but being exposed to deadly diseases in prison made me realize that it is worth striving for a better life in my own country.”

Home at last

UNICEF- IOM partnership assisted voluntary returning children to Ethiopia
UNICEF in collaboration with IOM returns children from third countries. Which is facilitated through a Cooperation Agreement signed between the two agencies since 2013 and renewed in 2016. This collaboration supports the Government of Ethiopia’s (GoE) Safe Return and Reunification Programme for Unaccompanied and Migrant Children. ©UNICEF Ethiopia/2016/Tsegaye

Harrowing as their stories are, at least Tesfaye and Jacky are home at last. Some children remain in Kabwe as they had come of age while in prison. The Zambian Human Rights Commission , with support from UNICEFand IOM, continues to work to enable the release of these children and their return to Ethiopia.

Going forward, UNICEF, in partnership with IOM, will support the Child Justice Forum and the Zambian Human Rights Commission to prevent this from happening to other children in the future. UNICEF will also extend its support by monitoring prisons and police cells to identify and help children in similar situations as there are reports of more smuggled and trafficked children; eight more children await trial on a similar accusation.

“I cannot say I have come [home] when half of me [more children] is still in prison” Jacky continued “ I have learned from my mistakes, so I would like to teach everyone about creating jobs in our lands.”

*Names of the children have been changed to protect their privacy