Baby WASH: increasing communities’ awareness through health extension workers

by Hiwot Ghiday, Selamawit Yetemegn, Anina Stauffacher

Sekota Woreda, Northern Amhara region, 5 October 2018– Nigist lives 20km north of Sekota town in the mountainous and remote northern part of Ethiopia. Together with her husband and two children she lives in a one-room rock-built house in the centre of the village. The village is surrounded by rocky crop fields, where the men plough with the help of two oxen.

In early August, during the rainy season, everything looks not lush but pleasantly green. As Nigist takes a seat on a dusty plastic chair, the neighboring children come closer sitting and standing on the gravely dirt curious to hear and see what she is about to tell.

With the youngest child safely on her back, Nigist starts talking about how she cares for him. She explains how she washes the baby’s hands and face three times per day often with soap. “I would always like to wash my baby with soap, but we sometimes find it difficult to afford soap, then I wash him with water only”, she says. “I also wash his body every other day, for my older child it is less frequent”. Nigist’s understanding of the consequences of not properly washing her children’s hands and face with soap seems limited and leads her not to prioritize buying soap rather than other items.

UNICEF in collaboration with the BBC Media Action is currently piloting an EU-funded Baby WASH project in Zequalla and Sekota Woredas, Wag Himra Zone, northern Ethiopia. The aim of the Baby WASH project is to reduce the microbial burden encountered by young children in their play and feeding environments. In addition, the project aims to reduce trachoma and other disease exposure of children and therefore help reducing child stunting [1].

In August 2018, health extension workers were trained to work with the communities to change hygiene practices improving early childhood development. The focus lies on safe disposal of child feces, handwashing with soap, face hygiene, shoe wearing, protective play areas and food hygiene.

During the training, health extension workers learnt about Baby WASH activities and how to work with the communities to effectively change behavior. Listening groups and group discussions at community level using radio recordings are part of the methods the health extension workers use to raise Baby WASH issues in their own community. Additionally, during public discussion led by the local health office, key expectations were raised and discussed.

Debessa, a health extension worker describing the training on Baby WASH activities and how she plans to work with mothers in her community ©UNICEF2018Stauffacher
Debessa, a health extension worker describing the training on Baby WASH activities and how she plans to work with mothers in her community ©UNICEF/2018/Stauffacher

Debessa is one of the two health extension workers in the kebele where Nigist lives. Debessa says: “I know about safe sanitation and hygiene practices, but these interventions focusing on babies and young children are new for me. It is very interesting and I am learning a lot during the training.” Debessa is happy about attending the training together with other colleagues from Sekota Woreda.

She and her colleague working in the same kebele agree: “we are very motivated to go back home and work with the mothers on the Baby WASH, it is exciting. For the handwashing practices specifically focusing on babies and young children, we will connect it to previous handwashing promotion activities. To encourage families to properly dispose child feces, we expect that it will need some time for the change to be effective because this is a new concept for many in the community. And potties are expensive, it isn’t a priority for the families to spend money on potties particularly at this time of the year where families invest most of their money in farming”.

The key actions promoted during the training are summarized in form of pictures with both Amharic and Hemtegna language so training material can be used at community level.

Piloting the EU-funded Baby WASH project in collaboration with the government is a promising way forward to start triggering behavioral change with a focus on pregnant women, babies and children under 3. Shifting from a “have to” approach to a stronger focus of “how to”, Baby WASH requires close integration with existing interventions on maternal, new born and child health, early childhood development and nutrition.

A paper published by UNICEF and John Hopkins University in the Journal of Tropical Medicine and International Health highlighted the need to target interventions to reduce unsafe practices of disposal of baby and child feces. UNICEF Ethiopia WASH has included Baby WASH into its strategy for the new country program to contribute to the improvement of early childhood development.

[1] Stunting is a sign of ‘shortness’ and develops over a long period of time. In children and adults, it is measured through the height-for-age nutritional index. In Ethiopia approximately 40 per cent of children are stunted.

EU and UNICEF launch a photo book on the success story of reducing malnutrition in Ethiopia

25 April 2018, HAWASSA – Today, the European Union (EU) and UNICEF launched a photo book entitled “Ending malnutrition in Ethiopia – A SUCCESS STORY” which illustrates Ethiopia’s success story in ending malnutrition, through the voices, stories and images of Ethiopians.

The nutrition photo book launch and photo exhibition held in the presence of Dr Abreham Alano, Head of the SNNP Regional Health Bureau, H.E Ambassador Johan Borgstam, Head of the European Union Delegation to Ethiopia, Ms Gillian Mellsop, UNICEF Representative to Ethiopia and other key stakeholders from the Government and other partners is a celebration of the success achieved so far in the reduction of malnutrition in Ethiopia while advocating for continued multi-sectoral efforts since malnutrition among children and women in Ethiopia remains a major concern.

It is also a celebration of how Ethiopia has managed to sustain improvements in nutrition, yet also a reminder of all the work that needs to be done to ensure everyone enjoys optimal nutrition.

On the occasion, Dr Abreham Alano, Head of the SNNP Regional Health Bureau thanked the EU and UNICEF for their support in results gained thus far in reducing stunting and  malnutrition, on the health care utilization as well as maternal and child mortality reduction and urged them to continue their support until the targeted results are achieved.

Ambassador Johan Borgstam, Head of EU delegation to Ethiopia on his part said, “It is an honour for me to open this photo book and exhibition launching event today on a topic of malnutrition which is a priority of both the Government of Ethiopia and of the EU’s development cooperation policy. Malnutrition is not only a major health problem affecting children and adults in partner countries, it also has important economic and social dimensions challenging their development by deteriorating the well-being of their entire population.”

Ethiopia has experienced rapid and sustained improvements in nutrition during the past 15 years. For instance, the country has seen a steady reduction in stunting – the fastest rate of improvement in Africa – as well as a significant decline in the percentage of underweight and wasted children. Yet, Ethiopia remains in a precarious situation, with large absolute numbers of affected children: 5 million children are stunted and 1.3 million children under five suffer wasting.

“I would like to highlight the importance of long-term investments to ensure that progress is sustained in ending malnutrition in Ethiopia. While the achievements we recognize today are indeed a success story, we cannot afford to rest on our laurels. Undernutrition still remains a challenge and it requires us all to redouble our efforts to ensure that every child enjoys better health and nutrition,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia. With the Government’s leadership and the strong commitment of partners, this goal is achievable. Let’s walk together with the same single-minded determination, zeal, and focus to end undernutrition in Ethiopia.”

To further reduce these numbers, the EU has provided €10,000,000 to support vulnerable populations in 17 woredas (districts) in Oromia, SNNP and Amhara regions of Ethiopia through a project entitled “Multi-sectoral interventions to improve nutrition security and strengthen resilience.” This joint action plan which is being implemented by UNICEF and FAO aims to contribute to the improvement of nutritional status of children, adolescents, pregnant and lactating women using the life cycle approach.

Promotion of Dietary Diversity for the Healthy Growth and Development of Children

By Esete Yeshitla

Sekota, AMHARA, 21 June 2017- Meet Netsanet, a strong and independent 25-year-old mother who is very self-assured; reminiscent of her name, which means ‘freedom’.

When we visit Netsanet in her house, it is a typical morning for her. First, she waters her home garden: cabbage, carrots, tomatoes and other vegetables. The seeds were provided by FAO with funding from the European Union through the woreda (district) agriculture office as a support for her family to have balanced meals. Her next task is feeding her chickens, from which she uses eggs for cooking and as a source of income. She sells eggs on Thursdays at the nearby Hamusit market. She then starts preparing breakfast. She takes fresh vegetables from her garden; a couple of eggs, milk, mixed grains and starts to cook the meal for her daughter.

Netsanet, preparing food as per lessons learned from health extension workers
Netsanet, preparing food as per lessons learned from health extension workers, at the woreda health post. Sekota woreda , Hamusit kebele ©UNICEF Ethiopia/2017/Nahom Tesfaye

Netsanet has two daughters, Mekdes age 5 and in kindergarten; and Tsige age 2. Netsanet explains the difference between her two pregnancies, birth and the girls’ first two years of life. “I had my first child at home, as we did not have awareness. I was lucky that I did not face any complications when I had her. If something bad had happened, I would have regretted it,” says Netsanet.

Back then, even when health extension workers insisted that women give birth at the health centre, it was embarrassing for most women. Netsanet explains, “Nowadays, even the wife of a priest gives birth at the health centre. We lost many of our sisters due to high blood loss during birth. I am grateful for the awareness we are getting now.”

Twice a month, they participate in awareness training at the health post, as part of a UNICEF-supported, European Union-funded programme called EU-SHARE. They also receive education on how to prepare balanced meals for young children under two years old, something Netsanet did not know how with her first child. She says, “I was younger, I only breastfed Mekdes when I had spare time as I was busy with house chores.” For her second daughter, she breastfeeds her 8-10 times per day. Netsanet says, “It makes my child strong and at the same time, it serves as protection against unwanted pregnancy.”

Netsanet has witnessed the results. “My first child was fragile and got sick regularly. I used to spend most of my time at the hospital or pharmacy. She was malnourished and at one point, I thought I would lose her. Thank God she was better after she started taking the [ready-to-use therapeutic foods] that was provided by the health post.”

Netsanet put into practice the education given to her about healthy nutrition with Tsige. She started to feed her food when she was six months old. She says, “We did not know that we can feed different vegetables to our babies.”

Netsanet and her husband have three plots of land allotted by the Government, which they use for harvesting crops. Netsanet says, “We do not sell what we produce. We use it for our consumption.”  In addition to selling eggs, Netsanet buys lambs, raises them and sells the sheep. She also buys grains from retailers and sells it for extra money. Netsanet adds, “So the money I get, I use it to buy other stuff.”

This is not the only work Netsanet has. She is also a member of the health development army (HDA), a strategic network the Government has galvanised to reach rural communities. As part of the Government’s intervention, health extension workers train women from the community to become HDA members and drive health-related behaviour change, including breastfeeding and child feeding practices, within their communities. Netsanet is a leader of five teams that each consist of five women- a ‘network’. Netsanet and five additional network leaders are supervised by a health extension worker.

Netsanet, feeding her tow year daughter porridge made of balance nutritional ingredients based on lessons from the wereda health post.
Netsanet, feeding her two-year-old daughter porridge made of balance nutritional ingredients based on lessons from the woreda health post; Sekota woreda, Hamusit kebele ©UNICEF Ethiopia/2017/Nahom Tesfaye

Mothers meet to discuss twice a month. They meet at the health post to demonstrate how to make food for children. They bring whatever food stuff they can find at home such as eggs, flour and milk, then they cook and feed their children.

The Government of Ethiopia has placed malnutrition high on both the political and the development agenda over the past decade. As a result, bold actions have been taken in health and other nutrition-related sectors, putting in place policies, programmes and large-scale interventions to significantly reduce malnutrition among the most vulnerable groups: young children and pregnant and lactating women.

The EU- SHARE project addresses gaps in implementation of the National Nutrition Programme while strengthening nutrition outcomes of major health, food security and livelihoods Government programmes. The primary focus is on the first 1, 000 days of a child’s life, in order to accelerate the decline in stunting.

Sekota is the woredas targeted by the project and has received support with an aim to enhance quality and uptake of nutrition services being delivered to the community. This is done through building the technical capacity of health workers, improving availability of nutrition supplies and sensitizing community members towards proper infant and young child feeding practices.

These interventions have a significant impact in the overall reduction of child malnutrition, especially through contributing to the improvement of nutrition and dietary diversification practices for adolescent girls, pregnant and lactating women, and children younger than five, just like Netsanet and her girls.

Integrated Nutrition Services for Better Nutrition Outcomes 

By Nardos Birru

BOLOSO SORE, SOUTHERN NATIONS, NATIONALITIES AND PEOPLE’S REGION, 26 January 2017 – It was a sunny afternoon at the Chamahinbecho health post and the trees planted by health extension workers 10 years ago provided much needed shade in the compound. A group of mothers were sitting under the trees discussing how to best feed their toddlers and among them was Beyenech.

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Beyenech (middle), waiting for the porridge to feed her baby at a cooking demonstration session at Chamahinbecho health post, Boloso Sore woreda, SNNPR ©UNICEF/2017/Pudlowski

The cheery Beyenech, a mother of three, came to the health post to get her 1-year-old son weighed as part of the growth monitoring and promotion session that they attend on a monthly basis.

“I bring my son here every month and the health extension worker measures his weight and gives me advice,” says Beyenech. “She teaches us how to prepare meals for our children using different foods. I can see that my child is growing healthy and am glad to hear that [confirmed by] the health extension worker.”

Beyenech is among the many mothers in Chamahinbecho kebele (sub-district) who are benefiting from a project supported by the European Union called EU-SHARE. The project aims to contribute to improved nutritional status of children under five, adolescent girls and pregnant and lactating women through strengthening nutrition outcomes of Government health, food security and livelihood programmes. The strategy involves integration of the multi-sector interventions at the household level to create synergetic effects that will maximize programme results.

Nutrition services for adolescents

UNICEF Ethiopia 2017 04-1056
Adolescent deworming service. Chamahinbecho health post, Boloso Sore woreda, SNNPR ©UNICEF/2017/Pudlowski

It is not only Beyenech’s son who is benefiting from the nutrition services at the health post; her 15-year-old daughter has participated in the deworming campaign organized for adolescent students in the kebele. Beyenech speaks of her daughter, “Wubalem received a deworming tablet from the adolescent deworming campaign at her school last year. She also told me about the nutrition and hygiene practices that she heard from group discussion sessions during the campaign.”

Deworming of intestinal worms and schistosomiasis is an important service for young students, as both ailments affect the health and education of children and adolescents. A student with worms will be too sick or tired to attend school or will have difficulty concentrating in school. If left untreated over time, they may face stunting or malnutrition due to anaemia, as well as impaired cognitive development.

The Government-led programme, which is supported by EU-SHARE, contributes to the health and nutrition status of adolescents while improving school attendance rates. EU-SHARE project supports the programme through procurement of deworming tablets, provision of information, education and communication as well as behavioural change communication materials that are helpful to create awareness and initiate discussion on nutritional requirements during adolescence. The programme also includes technical support to health workers who carry out the deworming campaigns. Students like Wubalem have a better chance to succeed with their education due to initiatives like these.

Improving dietary diversity through backyard gardening

EU-SHARE also includes nutrition-sensitive agriculture interventions which is implemented by FAO as part of the Government’s commitment to integrate nutrition into the agriculture sector. Promotion of backyard gardening is among the initiatives being implemented in the kebele.

After meeting the eligibility criteria targeting vulnerable families, Beyenech has been selected among the 1,960 beneficiaries targeted for seed supplementation led by the woreda agriculture office. She received vegetable seeds and began growing carrots, cabbage and tomato in her backyard garden. Beyenech explained, “I started preparing a porridge mixed with vegetables from my garden, using what I learned from the cooking demonstrations at the health post. I also prepare roasted vegetables along with shiro wot [chickpea stew] for the rest of my children.”

UNICEF Ethiopia 2017 03-1876 (2)
Beyenech, a mother of three, showing her backyard garden. Chamahinbecho kebele, Boloso Sore woreda, SNNPR. ©UNICEF/2017/Pudlowski

Beyenech aspires for her children to have a better future. She wants them to be top students and become teachers or doctors so they have the knowledge and skills to impact the next generation in the community.

“Such type of nutrition interventions that consider integration as a cornerstone by addressing the different aspects of nutrition are a key weapon to combat the problem of malnutrition in a sustainable manner,” said Israel Mulualem, the nutrition focal person in Boloso Sore woreda health office.

The four-year EU-Share programme has been operational since 2015 and continues to support children, mothers and their families in seventeen woredas located in SNNP, Oromia and Amhara regions. Together with the Government of Ethiopia and donors such as the European Union, UNICEF is able to support existing initiatives of Government programmes so that children such as Wubalem, Setot and Teketel may have a bright future.

New EU funding will provide essential nutrition treatment for 130,000 children under the age of five in Ethiopia

03 May 2017, ADDIS ABABA – The European Union (EU) has given €3 million in humanitarian funds to support UNICEF’s emergency interventions in Ethiopia. The new grant will provide life-saving nutrition treatment for severely malnourished children living in drought-affected areas of the country.

In Ethiopia, below-average rainfall has worsened the situation in Somali, Afar, and parts of Oromia and Southern Nations, Nationalities, and People’s (SNNP) regions, already severely affected by protracted drought. Access to water, sanitation and health services in these areas is critically low. In addition, livestock deaths have further reduced communities’ capacity to cope, resulting in food and nutrition insecurity. An estimated 303,000 children under the age of five are at risk of severe acute malnutrition (SAM) in 2017.

A boy is being treated for a severe malnutrition at a UNICEF supported stabilization centre“We are grateful for EU’s continuous and generous assistance for life-saving interventions addressing malnutrition at this critical time,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia. “We believe that the funding will significantly improve the health condition of children affected by the current drought and reduce the long term impact of malnutrition including life-long cognitive impairments.”

The EU humanitarian funding will support UNICEF to reduce child mortality and morbidity associated with SAM. In order to reach vulnerable children in remote areas, UNICEF will support the Government to expand existing healthcare services and provide treatment supplies – including ready-to-use-therapeutic food (RUTF), therapeutic milk, and medicines. The intervention will also aim at mobilizing communities’ awareness on preventing malnutrition.

“As devastating drought hits pastoral communities in the south and south-east of Ethiopia, bringing in its wake Acute Watery Diarrhoea (AWD) , food and water shortages, the EU is scaling up funding to provide children with vital nutrition care,” said Ségolène de Beco, Ethiopia Head of Office for EU Civil Protection and Humanitarian Aid (ECHO). “Infants and young children are extremely vulnerable to a combination of malnutrition and diseases. To avoid unnecessary deaths and suffering, we need to respond to the needs of these children in time with appropriate treatment and care.”

The concerted efforts of UNICEF with the EU, the Government of Ethiopia and other partners, will relieve the suffering of children while continuing to build long term resilience and strengthening the Government’s capacity to respond to future nutrition emergencies.

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.