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.

Rehabilitation of Borehole Saves Thousands of Lives and Livestock during Drought

By Ayuko Matsuhashi

A signboard on the sight of rehabilitated borehole
A signboard on the sight of the rehabilitated borehole ©UNICEF/2017/Tsegaye

HARSHIM, SOMALI, 19 January 2017 – “For three months, the borehole was not functional and people suffered a lot. There was little rain, so most of the birkas[1] became empty. Additionally, water from birkas is usually contaminated so we suffered from diarrhoea,” Muse Hassan Ali, 45-years-old recalls the time that he and his neighbours did not have access to safe and sustainable water in his town. Birkas are underground water storage systems intended to collect rain water during the rainy season and store for use during the dry season. Birkas can also be used to store water transported by trucks during emergencies.

According to the Harshim woreda (district) administrator, Sied Abraham, this borehole in Harshim town is the only sustainable water source that survived the 2015 El-Niño drought. It was drilled by the Somali Regional Water Bureau (RWB) following a UNICEF groundwater mapping in 2009 to identify potential drilling sites. The depth of the borehole is 535 meters, one of the deepest in the Somali region. After this borehole became non-functional due to electromechanical failure last year, UNICEF, with generous financial contribution from European Commission’s humanitarian aid department (ECHO), supported the RWB to rehabilitate the borehole by replacing a submersible pump, generator and an electric cable.

An immediate rehabilitation of the only sustainable water source in the woreda was crucial not only for Harshim town, but a large part of the region. It typically benefits over 9,000 people in Harshim and neighbouring woredas as well as people who cross the border from Somalia. At the end of 2016, it also served people in far-reaching woredas when drought conditions worsened once again due to the negative Indian Ocean Dipole (IOD). The RWB and partners began providing emergency water trucking, using this borehole as their source. Thus, its well-functioning affects a high number of direct and indirect beneficiaries across the region.

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Roda Ahmed, 35 years old and Rahma Ahmed, 30 years old collecting clean water from the on-site water point ©UNICEF/2017/Tsegaye

Roda Ahmed, 35 years old, is with her five children collecting water. “This is a source of life. Now I can cook and feed my children,” she says. Another woman from Harshim town also with five children, Rahma Ahmed, explains, “Since this borehole has been working, we stopped drinking water from birkas.

In addition to people collecting water near the borehole, the on-site trough draws in many pastoralists and their livestock. It takes more than a day for Farah Aden, 60 years old, to walk to the Harshim borehole with his 10 camels. “We are grateful for this borehole. Water is always a great cost for livestock. The functionality of this borehole has impacted our life a lot.” Indeed, during drought periods such as this one, entire herds may be wiped out, as evidenced by dozens of dead carcasses along the roads across the region.

Pastoralists come to Harshim town from neighbouring woredas and Somalia looking for water
Hundreds of livestock come from all over the Harshim woreda and drink water at the on-site trough ©UNICEF/2017/Tsegaye

As he contemplates this grave issue in his region, Muse pauses before emphasizing, “Still, this is not enough. There is a great pressure on this borehole. The generator is working 22 hours every day.”

UNICEF and partners will continue efforts to support the Government of Ethiopia to increase water coverage and functional water schemes in the Somali region to save the lives of children, their families and their livestock and contribute to a better future for all.

[1] traditional water harvesting pond

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.”

IMGL0189-2

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.

IMGL0200-2
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.

UNICEF’s largest global purchase of Therapeutic Food for children in drought-stricken Ethiopia through donor support

Drought in Ethiopia
A mother feeds a her malnourished child a Ready-to-Use Therapeutic Food (RUTF), a high protein and high energy peanut-based paste, in Arsi zone, Oromia, Ethiopia. In Ethiopia, after two years of erratic rainfall and drought, one of the most powerful El Niño weather events for 50 years is wreaking havoc on lives and livelihoods. ©UNICEF Ethiopia/2016/Ayene

ADDIS ABABA, 22 April 2016 – Today, UNICEF thanked donors for their generous contributions and the Government for its strong leadership, which together have enabled a concerted response to the current El Niño driven drought in Ethiopia, particularly in treating children with severe malnutrition.

With support from donors, UNICEF has procured 543,631 cartons of Ready-to-Use Therapeutic Food (RUTF), which represents 22 per cent of the global order for 2015 and is one of the largest single purchases in UNICEF’s history. The donors include the Governments of Canada, Germany, Japan, Sweden, United Kingdom and United States and partners including ECHO and the Bill & Melinda Gates Foundation.

To date in 2016, UNICEF procured in 2015 a further 73,344 cartons of RUTF out of a global procurement estimated at 565,623 cartons, which corresponds to 13 per cent of the global supply. In addition to RUTF, other supplies including therapeutic milk, routine drugs and hygiene and sanitation commodities have been procured as part of the drought response. To accommodate this large volume of supplies and enhance preparedness for the drought response, UNICEF rented a new warehouse in the Gerji area of Addis Ababa, earlier this year.

“On behalf of the Government of Ethiopia and UNICEF, I would like to express my sincere appreciation to the humanitarian donors for their timely and generous financial contributions to purchase Ready-to-Use Therapeutic Food that will save the lives of millions of children diagnosed with severe malnutrition,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia. “I would also like to especially thank the Ethiopian Customs Authority, the Ethiopian Food Medicine and Health Care Administration and Akakas Logistics, this enormous supply chain operation would not have been possible without their active support. By accelerating our joint nutrition interventions, we can transform the lives of millions of children to become healthy citizens and reach their full potential.”

Ethiopia is experiencing one of the worst droughts in decades due to El Niño weather condition which continues to wreak havoc on the lives of children and their families’ livelihoods. According to the latest Humanitarian Requirement Document issued this year, 6 million children are at risk from hunger, disease and lack of water. Malnutrition rates have greatly increased – 450,000 children are expected to be treated for severe acute malnutrition (SAM) this year.

Inauguration of new UNICEF warehouse
Inauguration of new UNICEF warehouse (L-R) Ms Gillian Mellsop, UNICEF Representative to Ethiopia, Dr Kebede Worku, State Minister of the Federal Ministry of Health, and Ms. Emma William, Deputy Head, DFID Ethiopia ©UNICEf Ethiopia/2016/Tsegaye

As part of the joint drought response coordinated by the Government, UNICEF is leading the Nutrition, Water Sanitation Hygiene, Education (together with Save the Children) clusters and the Child Protection sub-cluster. Together with other partners, UNICEF implements life-saving humanitarian responses including procurement and supply of therapeutic food and milk, drugs, other medical supplies, plus water/sanitation and education and child protection supplies.

UNICEF also supports the treatment of severely malnourished children through the community-based management of acute malnutrition, with training, quality assurance and coordination with other partners. Regular nutrition screening helps ensure that malnutrition in children is diagnosed and treated early, thereby reducing cases of severe acute malnutrition and life-threatening complications.

The supply of RUTF procured by UNICEF to date to respond to the current emergency is worth US$28 million including freight and in-country distribution. With the continued effort of the Government and support from humanitarian actors, 350,451 children were treated for severe acute malnutrition in 2015.

EU gives €3 million to improve the nutritional status of children in Ethiopia

Funds to reach over one million beneficiaries in Ethiopia 

Asmera Bere feeds her son, Amanuel Shibabaw, feeds to her child a nutritious porridge made from locally available products, at the health post as a demonstration to cook at home
Asmera Bere feeds her son, Amanuel Shibabaw, a nutritious porridge made from locally available products, at the health post as a demonstration to cook at home ©UNICEF Ethiopia/2014/Sewunet

ADDIS ABABA, 21 March 2016 – The European Commission today announced a €3 million grant to UNICEF to improve the nutrition for severely malnourished children in the drought affected areas in Ethiopia. 

The EU funding aims to strengthen the current emergency response and reach an estimated 40,000 Severe Acute Malnutrition (SAM) children. It will help provide supplies (40,000 boxes of Ready-to-use Therapeutic Food (RUTF) and 19,700 packs of amoxicillin). The funds will also support one round of Extended Outreach Strategy (EOS) screening which provides biannual vitamin A supplementation and de-worming to children under 5 years of age. Screening for acute malnutrition for children and pregnant and lactating women will also be covered.

“The El Niño phenomenon is impacting entire regions in Africa, notably Ethiopia. The EU support will help UNICEF provide life-saving assistance to the most vulnerable. It will help more than a million children suffering from malnutrition get treatment,” said Jean-Louis De Brouwer, Director of Operations in the European Commission’s Humanitarian and Civil Protection department (ECHO).

“We are grateful to the EU for its continued support for life saving interventions addressing malnutrition in Ethiopia,” said UNICEF Representative to Ethiopia, Ms Gillian Mellsop. “Children are always the most vulnerable group in emergencies but when support is made available, we can change their lives for the better.”

The EU funding targets close to half a million children under the age of five along with nearly 140 000 pregnant and lactating women in the Somali region. UNICEF, at the request of the Government, is responsible for the procurement of supplies for Severe Acute Malnutrition (SAM) management as a key input to the emergency nutrition responses throughout the country. It also provides technical and financial support to ensure programme quality and coverage. 

UNICEF is supporting the Government in responding to the emergency by scaling up and strengthening the treatment of children with severe acute malnutrition, increasing the intensity and frequency of screening of children and pregnant and lactating women, and ensuring key preventative nutrition services are provided to prevent excess morbidity and mortality.

According to the revised Humanitarian Requirement Document (HRD), over 10.2 million people in need of food aid and estimated 435,000 in need of treatment for severe acute malnutrition by the end of 2016. This has significantly devastated livelihoods and greatly compromised the health and wellbeing of children and women, through malnutrition and hygiene-related diseases across Ethiopia with six regions hit particularly hard.