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.

New HIV infections among adolescents projected to rise by nearly 60 per cent by 2030 if progress stalls – UNICEF

Urgent action needed to improve HIV prevention and treatment for young people 

NEW YORK/JOHANNESBURG/ADDIS ABABA 1 December 2016 – New HIV infections among adolescents are projected to rise from 250,000 in 2015 to nearly 400,000 annually by 2030 if progress in reaching adolescents stalls, according to a new report released by UNICEF today. 

“The world has made tremendous progress in the global effort to end AIDS, but the fight is far from over – especially for children and adolescents,” said UNICEF Executive Director Anthony Lake.  “Every two minutes, another adolescent – most likely a girl – will be infected with HIV. If we want to end AIDS, we need to recapture the urgency this issue deserves — and redouble our efforts to reach every child and every adolescent.” 

AIDS remains a leading cause of death among adolescents, claiming the lives of 41,000 adolescents aged 10-19 in 2015, according to the 7th Stocktaking Report on Children and AIDS: For Every Child: End AIDS.

The report proposes strategies for accelerating progress in preventing HIV among adolescents and treating those who are already infected. These include:

·         Investing in innovation including in locally grown solutions.

·         Strengthening data collection.

·         Ending gender discrimination including gender-based violence and countering stigma.

·         Prioritising efforts to address adolescents’ vulnerabilities by providing combination prevention efforts including pre-exposure prophylaxis, cash transfers and comprehensive sexuality education.

Globally there were nearly 2 million adolescents aged 10 -19 living with HIV in 2015. In sub-Saharan Africa, the region most impacted by HIV, girls accounted for three out of every four new infections among adolescents aged 15-19.

Other findings in the report include:

·         Remarkable progress has been made in preventing mother-to-child transmission of HIV. Globally, 1.6 million new infections among children were averted between 2000 and 2015.

·         1.1 million children, adolescents and women were newly infected in 2015.

·         Children aged 0–4 living with HIV face the highest risk of AIDS-related deaths, compared with all other age groups, and they are often diagnosed and treated too late. Only half of the babies born to HIV-positive mothers receive an HIV test in their first two months, and the average age that treatment begins among children with vertically acquired HIV in sub-Saharan Africa is nearly 4 years old.

Despite progress in averting new infections and reducing deaths, funding for the AIDS response has declined since 2014, UNICEF said. 

Haregua Askale stands in her traditional bar waiting for customers

In Ethiopia, the prevalence of HIV is low compared to other African countries. In 2011, 1.5 per cent of the population between the ages of 15 and 49 was HIV positive. However, taking into account the country’s large and growing population, the absolute number of people infected with HIV is high. By the end of 2015, the estimated number of people living with HIV was 740,000 including 84,000 children under the age of 15 years.

The 2011 Ethiopian Demographic Health Survey (EDHS) has provided evidence that the epidemic continues to be highly heterogeneous by region, ranging from the lowest (0.9 per cent) in SNNPR to the highest (6.5 per cent) in Gambella. The survey also indicates disparity by gender (1.9 per cent) for adult women whereas (1.0 per cent) for adult men. HIV prevalence is also increasingly concentrated in large urban areas and along major transport corridors. According to the 2015 Ethiopia Public Health Institute (EPHI) study, 67 per cent of people living with HIV reside in urban areas. 

Young people are often at a greater risk of infection. They may have shorter relationships and more partners, or engage in risky sexual practices. Also, girls are at a high risk of HIV infection due to gender-based inequality and partner violence.

Over the last ten years, Ethiopia has dramatically reduced new infections and AIDS related deaths by more than 50 per cent (UNAIDS 2015). As part of the global target to end AIDS by 2030, UNAIDS sets new targets for 2020 referred to as 90:90:90 – which implies reaching- 90 per cent of HIV testing, 90 per cent of Antiretroviral Treatment and 90 per cent of reducing viral load. By the end of 2015, Ethiopia had already enabled more than 60 per cent of the people living with HIV to know their status and 52 per cent, or more than 386,000 of people living with HIV to receive Antiretroviral Treatment (Global AIDS Response Progress Reporting ETHIOPIA: 2015 REPORT).

The effort to eliminate mother-to-child transmission is also on track, whereby, 67 per cent of HIV-positive pregnant women access and receive Antiretroviral Treatment to reduce the risk of mother-to-child transmission during pregnancy and delivery (EPHI-2015).

Ensuring every child is accounted for and no one is left behind in Ethiopia

By Hannah Godefa

On August 6th, I was fortunate to be a part of a campaign in Ethiopia when the establishment of the Vital Events Registration Agency (VERA) kicked off throughout the country.

VERA is an incredibly important institution for individuals, societies and government. For individuals, registration can be used as legal documents and proof for identification purposes. Information complied from these areas are then needed for admin applications like public health programmes and the electoral roll.

On the first day of the campaign, I visited the Gulele Sub City, Woreda 9 VERA team. UNICEF supports the campaign to ensure all resources needed for registration like registry, certificates, awareness creation, materials and logistics make it to all regions, all the way to the lowest levels of administration.

Vital events registration kicks off in Ethiopia

This process is incredibly important because it will ensure that every child will be accounted from the earliest days of life. This means big advancements for accountability when it comes to harmful traditional practices including child marriage, as every individual will have a marriage certificate with the new system from VERA. It will also make it easier for government, non-profit and civil society partners to identify when these practices are occurring.

Birth registration is the first recognition of a child’s existence by the state. Where births remain unregistered, there is an implication that these children are not recognized as persons before the law. The absence of the system of birth registration results in the violation of children’s rights to name and nationality; to protection from abuse, neglect, and exploitation, including early marriage, child labour  and trafficking; to basic social services, including education and health; and the personal rights of orphans and other vulnerable children.

Currently, birth, death, marriage and divorce will be kept recorded from the kebele civil status office to the federal level, so that there is less room for discrepancies and human rights crime.

Participating in the registration process was an incredibly humbling and powerful experience for me, and I am very excited to see how UNICEF will work with VERA and local partners to ensure that every child is accounted for, and no one is left behind.

Early Childhood Development- Investing in the seeds of tomorrow’s fruits

Gillian Mellsop, UNICEF Representative to Ethiopia

‘Children are today’s flowers and tomorrow’s fruit’ is a saying in Ethiopia and there is no better investment that cultivates the fruit and speaks to the ‘right in principle and right in practice’ mantra more than early childhood development.

Parents and communities want the best for their children and understand that the early years of a child’s life are crucial. However, they may not have the means or the knowledge on how to ensure their next generation best thrives.

Last week, the latest offering from the world-renowned Lancet, Advancing Early Childhood Development: from Science to Scale, showed that almost one in two – 43 per cent – of children under five in low-and middle-income countries are at risk of not achieving their cognitive potential. No country can risk losing nearly half of the brain potential of its youngest citizens – low- and middle-income countries least of all.

Advances in neuroscience show that experiences in early childhood have a profound impact on brain development and on subsequent learning and health. Children who are poorly nourished and nurtured, or those who do not receive early stimulation, are likely to learn less in school and go on to earn less as adults.

In Ethiopia, over 5 million children are stunted which has a serious impact on human development and economic growth. And currently, the most disadvantaged children in rural and hard to reach communities are either coming to grade 1 without having the necessary preparation or are enrolling late – under 40 per cent of children in Ethiopia have access to pre-school provision. Once in primary education, many are at risk of dropping out of school too early.

The good news is that early childhood development interventions, including parenting and care programmes, cost as little as 50 cents (US$) per child per year, when combined with existing services such as health – according to the Lancet Series. And much of what needs to be done at the community level can be achieved by mothers and fathers, grandparents, siblings and caregivers.

The findings in the Series underscore the importance of increased global dedication to early childhood development. Earlier this year, World Bank Group President Jim Yong Kim and UNICEF Executive Director Anthony Lake signalled a renewed commitment to prioritizing investments in the youngest children when they announced a new alliance urging global and national leaders to step up and accelerate action and funding for nutrition and early childhood development (ECD) programmes. The Lancet estimates that individuals who suffer a loss of about a quarter of average adult income per year, while countries may forfeit up to as much as two times their current GDP expenditures on health or education. Consequences of inaction impact not only present but future generations.

Drought response in Afar - UK AID
Zebiba Meher feeds her son Ready to Use Therapeutic Food (RUTF) for the past four months. Now the nutritional status of eleven-month-old Bedru has improved from severe to moderate acute malnutrition. He is a much healthier and happier child now. Dubti health center, Afar region, Ethiopia. 25-August-2016 ©UNICEF Ethiopia/2016/Ayene

When children have the opportunity to develop their cognitive capacity, they will pass similar or even better opportunities to their children when they grow up.  Increasing investment in Ethiopia’s young children can break the vicious cycle of intergenerational poverty.

Therefore, prioritizing ECD at the national level is a way for governments to stimulate economic growth. Evidence suggests that every dollar invested in quality ECD programmes brings a return of between US$6 and US$17. Moreover, research by

Nobel Laureate James Heckman found that the rate of return for investments in quality early childhood development for disadvantaged children is 7-10 per cent per annum through better outcomes in education, health, sociability, economic productivity and reduced crime.

This year, the importance of interventions in early childhood was also recognized by the inclusion of an ECD target in the Sustainable Development Goals – indeed, this is the first time ECD has been explicitly included in global development goals. SDG Target 4.2 aims to increase the percentage of children under 5 years of age who are developmentally on track in health, learning and psychosocial well-being.

For many children, lack of educational support at home is one of the biggest obstacles to reaching their full potential. In light of differing needs of families, a range of early childhood education services are offered in Ethiopia, including kindergarten, pre-primary class (‘O-class’) and several school readiness programmes. Parenting education programmes are also provided so families can learn about the importance of early nutrition, hygiene, care and stimulation.

The evidence presented this past week, combined with the current momentum globally, speaks for itself. We are well versed in the elements that affect the development of children’s brains – good nourishment, stimulated minds, and protection from violence. It is now vital that we use this growing body of evidence to effect real changes for children, at both the community and policy levels.

Early child development has to be put on the agenda for children’s rights. In Ethiopia, UNICEF, with the support from partners, takes an integrated approach to addressing early childhood development within Ethiopia’s Early Childhood Care Education Policy.

We owe it to our future generations to prioritize and invest in young children. It is our moral, economic, and social imperative to enable all children to reach their full potential.

Girls spend 160 million more hours than boys doing household chores everyday – UNICEF 

 NEW YORK/ ADDIS ABABA, 7 October, 2016 – Girls between 5 and 14 years old spend 40 per cent more time, or 160 million more hours a day, on unpaid household chores and collecting water and firewood compared to boys their age, according to a report released by UNICEF ahead of International Day of the Girl on 11 October.

Harnessing the Power of Data for Girls: Taking stock and looking ahead to 2030 includes the first global estimates on the time girls spend doing household chores such as cooking, cleaning, caring for family members and collecting water and firewood.

The data show that the disproportionate burden of domestic work begins early, with girls between 5 and 9 years old spending 30 per cent more time, or 40 million more hours a day, on household chores than boys their age. The numbers rise as girls get older, with 10 to 14 year olds spending 50 per cent more time, or 120 million more hours each day.   

“The overburden of unpaid household work begins in early childhood and intensifies as girls reach adolescence,” said UNICEF’s Principal Gender Advisor Anju Malhotra.  “As a result, girls sacrifice important opportunities to learn, grow, and just enjoy their childhood. This unequal distribution of labour among children also perpetuates gender stereotypes and the double-burden on women and girls across generations.”

The report notes that girls’ work is less visible and often undervalued. Too often adult responsibilities such as caring for family members, including other children, are imposed on girls. Time spent on chores limits a girl’s time to play, socialize with friends, study and be a child. In some countries, collecting firewood and water puts girls at risk of sexual violence.

The report also found that:

  • Girls between 10 and 14 years old in South Asia and the Middle East and North Africa spend nearly double the amount of time on household chores compared to boys.
  • The countries where girls between 10 and 14 years old bear the most disproportionate burden of household chores compared to boys are; Burkina Faso, Yemen and Somalia.
  • 10 to 14 year-old girls in Somalia spend the most amount of time on household chores in total: 26 hours every week. 

“Quantifying the challenges girls face is the first critical step towards meeting the Sustainable Development Goal on gender equality and breaking-down barriers that confront the world’s 1.1 billion girls,” said UNICEF Chief of Data and Analytics Attila Hancioglu.

Harnessing the Power of Data for Girls: Taking stock and looking ahead to 2030 notes that data for two thirds of the 44 girl-related indicators in the Sustainable Development Goals (SDGs) – the global roadmap to end poverty, protect the planet and ensure prosperity for all – are either limited or poor. In addition to household chores, the report presents data on girl-related issues addressed by the SDGs including violence, child marriage, female genital mutilation and education. Achieving the SDGs that address these issues and empowering girls with the knowledge, skills and resources they need to reach their full potential, is not only good for girls, but can drive economic growth, promote peace and reduce poverty

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In Ethiopia, girls face a multiplicity of social and structural barriers in all the developmental domains hindering their capacity to seize opportunities and make strategic life choices that will enable them realize their full potential.  The limited age and gender disaggregated data and evidence available in the country shades light to some of these challenges. For example, girls carry a heavy burden of household chores and fall behind their class and unable to follow their education.

Female children under age 15 are about three times more likely than male children to fetch drinking water (EDHS: 2011) http://www.unicef.org/ethiopia/ET_2011_EDHS.pdf

In addition, forty one percent of women aged 20-24 were married by the age of 18 (EDHS: 2011). Girls age 0-14 are exposed to FGM/C with prevalence as high as 60 per cent in the Afar region (Welfare Monitoring Survey: 2011).

In its recently adopted country programme strategy (2016-2020), UNICEF has incorporated an outcome on adolescent girls’ and has developed a girls’ strategy to strengthen the efforts of the Government of Ethiopia to empower girls and free them from child marriage and FGM/C by 2025.   

El Niño is over but its impact on children is set to worsen as disease, malnutrition continue to spread

In Eastern and Southern Africa alone, 26.5 million children are in need of aid

NAIROBI/NEW YORK, July 8, 2016 – The 2015-2016 El Niño has ended but its devastating impact on children is worsening, as hunger, malnutrition and disease continue to increase following the severe droughts and floods spawned by the event, one of the strongest on record, UNICEF said today.

And there is a strong chance La Niña – El Niño’s flip side – could strike at some stage this year, further exacerbating a severe humanitarian crisis that is affecting millions of children in some of the most vulnerable communities, UNICEF said in a report called It’s not over – El Niño’s impact on children.

Children in the worst affected areas are going hungry. In Eastern and Southern Africa – the worst hit regions – some 26.5 million children need support, including more than one million who need treatment for severe acute malnutrition.

In many countries, already strained resources, have reached their limits, and affected families have exhausted their coping mechanisms – such as selling off assets and skipping meals. Unless more aid is forthcoming, including urgent nutritional support for young children, decades of development progress could be eroded.

HALABA WOREDA, SNNPR – 24 JANUARY 2016In many countries, El Niño affected access to safe water, and has been linked to increases in diseases such as dengue fever, diarrhoea and cholera, which are major killers of children. In South America, and particularly Brazil, El Niño has created favourable breeding conditions for the mosquito that can transmit Zika, dengue, yellow fever and chikungunya.  If La Niña does develop, it could contribute to the spread of the Zika virus to areas that have not been affected to date.

UNICEF also said there are serious concerns that Southern Africa, the global epicentre of the AIDS pandemic, could see an increased transmission of HIV as a result of El Niño’s impact. Lack of food affects access to anti-retroviral therapy (ART), as patients tend not to take treatment on an empty stomach, and many people will use their limited resources for food rather than transport to a health facility. Drought can also force adolescent girls and women to engage in transactional sex to survive. And, mortality for children living with HIV is two to six times higher for those who are severely malnourished than for those who are not.

“Millions of children and their communities need support in order to survive. They need help to prepare for the eventuality La Niña will exacerbate the humanitarian crisis. And they need help to step up disaster risk reduction and adaptation to climate change, which is causing more intense and more frequent extreme weather events,” said UNICEF’s Director of Emergency Programs, Afshan Khan. “The same children who are affected by El Niño and threatened by La Niña, find themselves on the frontlines of climate change.”

Ministers of Water, Sanitation and Hygiene to meet in Ethiopia

SWA Meeting of Ministers Announcement
Minister of Water, Irrigation and Electricity, H. E Motuma Mukassa, announces that Ethiopia is hosting the meeting of Ministers of Water, Sanitation and Hygiene which is organized by the Sanitation and Hygiene for All (SWA) and convened by UNICEF. ©UNICEF Ethiopia/2016/Bizuwerk

Ministers of Water, Sanitation and Hygiene from around the world will meet in Ethiopia from 15-16 March 2016 to plan and prepare for the implementation of the Sustainable Development Goals (SDGs) related to sanitation, water and hygiene.

The meeting is organized by the Sanitation and Water for All partnership (SWA), and convened by UNICEF. SWA has over 100 partners, mostly governments, and works as a platform for encouraging and coordinating political dialogue and action around water, sanitation and hygiene issues.

“This meeting will be different from all other high level meetings organized by SWA previously, mostly because of the timing: it will be the first global meeting on these topics after the UN Member States agreed on the Sustainable Development Goals last September, “says Motuma Mukassa, Minister of Water, Irrigation and Electricity of Ethiopia. Mr Motuma also underscores that the SDG targets on water and sanitation requires a higher level of coordination, alignment and communication both at global and national levels.

Ethiopia is selected to host this meeting for its commitment to implementing innovative ways towards achieving universal access to sanitation, water and hygiene by coordinating different ministries, increasing sector funding and investing in the training of health workers. The country’s One WASH National Progrmame (OWNP), launched in September 2013, is one of the most ambitious in the sector. It is based on a sector-wide approach and involves the ministries of water, health, education and finance and the government’s main development partners. Ethiopia devises this programme to modernize the way water and sanitation services are delivered to its people.  Recently, with UNICEF’s support, Ethiopia also started a South-South collaboration with Brazil in the area of urban sanitation and regulatory framework for WASH service delivery.

The Ministerial Meeting is a unique opportunity for countries to identify the major bottlenecks to achieving the SDG water, sanitation, and hygiene targets and lay groundwork for clear action plans, strategies and milestones.

High-level delegates, including the Prime Minister of Ethiopia, Hailemariam Desalegn, Kevin Rudd, Chair of SWA and the 26th Prime Minister of Australia and Anthony Lake, Executive Director of UNICEF will attend the meeting.