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.

 

Mobile Health and Nutrition Teams Save Lives in Remote Drought-affected Areas

By Rebecca Beauregard

GASHAMO, SOMALI, 15 February 2017 – Under the shade of a tree and settled on plastic mats, the mobile health and nutrition team (MHNT) is in full operation. An array of bright coloured fabric represents the crowd of mothers and children gathered around them, all in varying stages of screening, vaccinations, treatment or referral. In the rural Somali region, Gashamo woreda (district), 63 km off the paved road, the MHNT has been operating as a static clinic for the past two months as part of the response to the Horn of Africa drought caused by the negative Indian Ocean Dipole (IOD).

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The MHNT in full operation with MHNT team leader Mohammed Miyir at its centre in white. ©UNICEF/2017/Tesfaye

Facing food and grazing shortages and in need of water, drought-affected pastoralist families and their livestock began traveling long distances in search of water. As one of the most vulnerable communities across the country, unique interventions are required to provide them a safety net in times of emergency.

The Government of Ethiopia (GoE) has provided a swift response by setting up five temporary sites in Gashamo woreda, which offer health and nutrition services as well as food and water. This arrangement is crucial and specific to pastoralist communities, where families are scattered across hundreds of kilometres of harsh semi-arid desert.

28-year-old Mohammed, a senior clinical nurse by training, works alongside two nurses who treat and manage cases, in addition to two health extension workers (HEWs) who screen patients and conduct community health education. Mohammed and his team were assigned to this hotspot priority one site by the Somali Regional Health Bureau (RHB), following a recent updating of hotspot woredas, which are most affected by malnutrition according to the latest meher seasonal assessment.

“My family is 200 km away and I am not sure when I will visit them. Probably when the drought is over,” says Mohammed. “But our work here is very important, there are thousands of people who otherwise would not have access to any health services. Especially during a severe drought, our services save lives.” He explains further that while the Ethiopian health system is highly developed, utilizing catchment areas for a tiered health facility structure is not feasible in pastoralist communities.

“Pastoralists are always on the move in order to provide grazing and water for their livestock, so expanding health facilities in these remote areas does not add value. Right now, there are over two thousand families in this location, so why not set up a permanent health post to serve them? Because perhaps in one or three months, there will be 20 families here, or none. Across the region, there are remote areas where people come and go, so the normal health system does not serve its purpose [in this context].”

MHNT in Somali drought 2017
Mohammed, 28-years-old, explains the unique pastoralist context at Al Bahi temporary site where over 2,000 households have gathered. ©UNICEF/2017/Tesfaye

This is the reason MHNTs were created and why they have helped improve the health and nutrition situation of pastoralist families for the past decade. From regular risk assessments and categorization of vulnerable woredas by the Ministry of Health and partners, including UNICEF, MHNTs are deployed for a minimum of three months, depending on the emergency situation and needs. With the onset of a sudden disease outbreaks or other emergencies, the MHNT will temporary relocate to the affected area to provide initial rapid response and then return to their assigned woreda.

The MHNTs work six days per week, traveling from location to location and setting up mobile clinics along the way. They make contacts with social mobilisers, volunteers from the community, to ensure everyone knows the day and place where the MHNT will be. The social mobilisers know their community well, even those families that are spread out across a vast terrain, and they guarantee everyone receives the information. Every time, a crowd of mostly women and children are gathered, anticipating the needed treatment and care.

The MHNTs conduct screening for malnutrition, provide routine immunizations and basic healthcare treatment, ante-natal care and emergency delivery services, common illness management, health education and promotion, as well as refer patients to higher levels of care as and distributing household water purification supplies as necessary. When the latter happens, they often utilize their vehicles to bring patients to the nearest health facility, as it would be near impossible for timely care otherwise.

UNICEF supports the GoE’s MHNT programme with the generous effort from donors, through vehicle provision, transportation allowances, emergency supplies and technical guidance. There are 49 MHNTs currently operating in Somali and Afar regions, moving around their respective regions according to the identified need.

Our visit is cut short as the team has just identified two children who are not responding to malnutrition treatment – as per the protocol, severe acute malnutrition (SAM) cases should return to the MHNT on a weekly basis to record progress or be referred to higher levels of care. These cases have been escalated to SAM with medical complications and the mothers are encouraged to gather their belongings and take the MHNT car to the nearest stabilisation centre about 30 km away. “Working in a static clinic may be nice,” says Mohammed, who has been working on the MHNT for nearly seven years, “and over time, as Somali region becomes more developed, the health system may be able to cover all areas. But until then, I know there is a great need and I am proud to be working on this team.”

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.

KfW provides vehicles to support Mobile Health and Nutrition Teams in Somali region

By Somali Region Mass Media Agency

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Mr. Hassan Ismail, Head of Ethiopian Somali Regional Health Bureau ©2016/Mukhtar Mohamed

JIGJIGA, SOMALI REGION, 13 December 2016– In partnership with UNICEF, the KfW Development Bank, which administers Germany’s financial cooperation in developing countries, provided 15 vehicles to support the Mobile Health and Nutrition Teams (MHNT) across the Somali region.

Regional officials and UNICEF staff attended the handover ceremony in Jigjiga, the capital town of the Somali region. Hassan Ismail, Head of the Ethiopian Somali Regional Health Bureau, emphasizing the benefits of the15 vehicles for MHNT services, said, “The vehicles will contribute for the success of MHNTs to reach vulnerable women and children with basic health and nutrition services in drought-affected pastoralist areas.”

The mobile teams conduct outreach services and targeted campaigns, such as the Enhanced Outreach Strategy (EOS) that provides children vitamin A supplementation, treatment for intestinal worms, and screening for acute malnutrition in far-reaching pastoralist areas.

Fartun Mahdi Abdi, Head of the Water Bureau and representing the Vice President of the Somali region at the ceremony, also reiterated the contribution these vehicles will have to reducing maternal and child mortality as well as strengthening the quality of health services.

 Fartun Mahdi Abdi, left, Head of the Water Bureau, receives keys to the 15 vehicles from Dr. Marisa Ricardo of UNICEF Ethiopia.  ©2016/Mukhtar Mohamed
Fartun Mahdi Abdi, left, Head of the Water Bureau, receives keys to the 15 vehicles from Dr. Marisa Ricardo of UNICEF Ethiopia. ©2016/Mohamed

With the support of donors such as KfW, UNICEF Ethiopia provides the Government of Ethiopia with medicine and other supplies for MHNT operations. As a result, 362,815 medical consultations took place between January and October 2016 across Somali and Afar regions. Forty seven per cent of these are children.

UNICEF Ethiopia, through the generous support of KfW, provided an additional five vehicles to MHNTs in Afar for the same purpose.

Prolonged drought and intermittent flooding has gravely affected these areas in recent years, first caused by the effects of El Niño weather in 2015, and currently from effects of the Indian Ocean Dipole, another climatic phenomena.

New National Nutrition Programme II envisions an Ethiopia free of malnutrition

By Fanna Minwuyelet and Eric-Alain Ategbo

Last week, Ethiopia launched the second National Nutrition Programme (NNP) II focusing on the first 1,000 days of life to eradicate chronic malnutrition by 2030.  State Minister of Health and Chairperson of the National Nutrition Coordination Body (NNCB), Dr Kebede Worku, recognized 13 ministries[1] that represent the Federal Democratic Republic of Ethiopia to support the achievement of the targets laid out in the National Nutrition Programme II.

The ministries have recognised that high malnutrition rate in Ethiopia is unacceptable and have stressed the need for strengthened collaboration to reduce the impact of malnutrition in the country. The findings of ‘The Cost of Hunger in Africa,’ study revealed that Ethiopia loses 55.5 billion birr annually due malnutrition.

Ethiopia launched the second National Nutrition Programme
As malnutrition remains to be the underlying cause of more than one in five child deaths in Ethiopia, the goal of the NNP II is to provide a framework for coordinated and integrated implementation of multisector nutrition interventions.

The NNP II is developed taking into account past experiences and lessons learned from the implementation of the NNP I and integrating new initiatives from the second Growth and Transformation Plan (GTP II).

The updated aims of the NNP II include reducing the prevalence of three crucial indicators for children under five: stunting from 40 per cent to 26 per cent; underweight from 25 per cent to 13 per cent and wasting from 9 per cent to 4.9 per cent.

With the following five strategic objectives, the NNP II envisions Ethiopia free of malnutrition and diet-related non-communicable diseases by 2050.

  1. Improve the nutritional status of women (15 -49 years) and adolescent girls (10 – 19 years)
  2. Improve the nutritional status of children from birth up to 10 years
  3. Improve the delivery of nutrition services for communicable and non-communicable/lifestyle related diseases
  4. Strengthen the implementation of nutrition-sensitive interventions across sectors
  5. Improve multisector coordination and capacity to implement the national nutrition programme

The Government of Ethiopia has demonstrated policy commitment to streamline nutrition efforts by incorporating indicators into the Government’s five-year Growth and Transformation Plan II (GTP II; 2016-20).

UNICEF contributed to this important signing through technical support as a National Nutrition Technical Committee (NNTC) member and played a leading role in supporting the Government of Ethiopia to establish and nurture multisectoral coordination bodies at both federal and regional levels.

The event was attended by representatives from civil society organizations, academia, the Addis Ababa Chamber of Commerce, donors and UN agencies.


[1] Ministry of Health,  Ministry of Education, Ministry of Agriculture and Natural Resources,  Ministry of Livestock and Fisheries,  Ministry of Industry,  Ministry of Water Irrigation and Electricity,  Ministry of Trade,  Ministry of Finance and Economic Cooperation,  Ministry of Labour and Social Affairs,  Ministry of Women and Children Affairs,  Ministry of Youth and Sports, Government Communication Affairs Office as well as National Disaster Risk Management Coordination Commission