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

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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.”

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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.

The Government of Japan gives US$ 2 million to UNICEF for drought affected populations in Somali Region

06 April 2017, ADDIS ABABA – The Government of Japan announced a US$2 million grant to UNICEF to assist water supply, sanitation and hygiene (WASH), nutrition and prevention of acute watery diarrhoea in drought affected populations in the Somali region. The WASH sector will be taking the lion’s share with US$1,500,000 and the rest US$500,000 will be utilized by nutrition programme within an implementation period of six months. This assistance is provided as a swift response to the joint call for support by Deputy Prime Minister Mr Demeke Mekonnen and United Nations Secretary-General Mr Antonio Guterres at UNECA on 29 January 2017 on the occasion of the High Level Forum on the humanitarian situation in Ethiopia.

The funding from the Japan Government aims to improve access to safe and reliable water to 115,000 women, men, boys and girls through drilling of new boreholes, rehabilitating non-functional water points and providing non-food items for distribution. In addition, 9,000 children with severe acute malnutrition will receive adequate treatment and 31,488 mothers and caregivers will be trained on adequate infant and young child feeding practices during emergency. The funding will also help prevent and control water-borne diseases, particularly the transmission of acute watery diarrhoea among affected and at-risk populations by securing access to safe water.

Ambassador of Japan to Ethiopia, Mr Shinichi Saida said, “We sincerely hope that Japan’s urgent humanitarian assistance for the drought response will reach the most vulnerable people as swiftly as possible and have a quick impact on the affected communities. Japan appreciates the WASH sector emergency response and its delivery promoted by Ministry of Water, Irrigation and Electricity in Ethiopia and UNICEF Ethiopia.”

“Children are extremely vulnerable in emergencies, often living in unhealthy and unsafe conditions and at high risk of contracting diseases,” said Ms Gillian Mellsop, UNICEF Representative to Ethiopia. “This contribution is a tangible demonstration of Japan’s commitment to safeguard children’s future and enhance resilience building of communities affected by the recurrent drought.”

Bundesminister Dr. Gerd Müller visits Waaf Dhuug Temporary Settlement Site in Somali Region of Ethiopia
A child rests comfortably on his mother’s arms in Waaf Dhuug Temporary Resettlement Site ©UNICEF Ethiopia/2017/Sewunet

Adding to an already dire situation, during the second half of 2016, a strong negative impact of Indian Ocean Dipole (IOD) led to below-average rainfall in different parts of Ethiopia including the Somali region. As a result, the water level declined significantly with seasonal rivers, springs and ponds drying up earlier than normal and increasing frequency of non-functionality of water supply schemes due to over utilization.

UNICEF is currently involved in operations across all the drought affected regions and contributes to the ongoing drought response effort through water trucking, rehabilitation of non-functional water supply schemes, building water storage capacity at critical and good yielding boreholes, provision of therapeutic food supplies, screening of children and pregnant and lactating women for malnutrition and monitoring for the provision of quality nutrition services.

UNICEF’s drought response activities are guided by its Core Commitments for Children in Humanitarian Action, which prioritize timely response in key lifesaving sectors, namely nutrition, health, water, sanitation, and hygiene.

German funds for the Horn of Africa drought response to increase from 100 million Euro to 300 million Euro

On 03 April 2017, UNICEF, WFP, and UN-OCHA went on a joint one-day field visit with the German Minister for Development Cooperation (BMZ) to Kebri Dahar and Waaf Duug Temporary Resettlement Site in Doolo Zone, Somali Region, Ethiopia. The Minister was accompanied by 16 German journalists, BMZ officials, German Embassy partners, GiZ and KfW. The Somali Regional President and key regional government counterparts have also joined the field visit. The visit was part of the German Minister’s visit to Ethiopia to discuss the Marshall Plan for Africa with Ethiopian Government and AU Officials. 

The Minister and his delegation visited the Urban WASH programme (borehole and water trucking) in Kebri Dahar town, as well as UNICEF’s emergency Health, Nutrition and WASH programmes in the Waaf Dhuug Resettlement Site for drought displaced people. More specifically, the Minister was able to see a Mobile Health and Nutrition Team operating with the German funded vehicles, a stabilization centre for severely malnourished children that utilizes German funded Ready to Use Therapeutic Food (RUTF) and a water point. The Minister also visited WFP’s school feeding programme at the Waaf Dhuug primary school and a WFP food distribution.   

Bundesminister Dr. Gerd Müller visits Waaf Dhuug Temporary Settlement Site in Somali Region of Ethiopia
Bundesminister Dr. Gerd Müller visits a school for community and settlers at Waaf Dhuug Temporary Settlement Site in Somali Region of Ethiopia. ©UNICEF Ethiopia/2017/Zerihun Sewunet

Waaf Dhuug Temporary Resettlement Site (TRS) hosts 4,500 host community and 3,882 drought displaced people, of which more than 85 per cent are women and children from surrounding grassing areas. The site was established in January 2017 and is one of the 58 Temporary Resettlement Site established by the Somali Regional Government in response to the drought emergency. Majority of the pastoralist community have moved into the TRS due to extensive loss of livestock as a result of the drought. They have left their villages in search of water and health and nutrition services for themselves and their children. Discussing with the Minister, Kadar Kaydsane, 35 years old and a mother of 10  said, “We walked for five hours to get to Waaf Dhuug and we lost all our livestock on the way. We came here to find water and other services provided by the Government.” 

Bundesminister Dr. Gerd Müller visits Waaf Dhuug Temporary Settlement Site in Somali Region of Ethiopia
Bundesminister Dr. Gerd Müller discusses with the community at Waaf Dhuug Temporary Settlement Site in Somali Region of Ethiopia. ©UNICEF Ethiopia/2017/Zerihun Sewunet

The Minister and German development partners recognized the importance of investing in building resilience, for instance through funding water schemes and strengthening Government systems, such as the Health Extension Programme. The Minister further appreciated the German Government’s strong partnership with UNICEF and was impressed by the integrated drought emergency response at the resettlement site, but recognized that the challenges are very complex and the required funding remains significant. As a response to the dire need of the people affected by the drought, the Minister announced that German funds for the Horn of Africa drought response will be increased from 100 million Euro to 300 million Euro.

 

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).

MHNT in Somali drought 2017
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.