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’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.
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.
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.”
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.
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.
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.
Bogalech dreams of starting an avocado and corn flour business in the market to support herself and her children.
Afar Region – Ethiopia Ms Leila Pakkala and Ms Valerie Guarnieri, UNICEF and WFP Regional Directors for Eastern and Central Africa, have visited the ongoing government-led drought response where UNICEF-WFP are closely collaborating. The drought is affecting six regions in Ethiopia, and 9.7 million people are in need of urgent food relief assistance including approximately 5.7 million children who are at risk from hunger, disease and lack of water as a result of the current El Niño driven drought.
In Afar Region, where an estimated 1.7 million people are affected by the drought, including 234,000 under-five children, the Regional Directors visited UNICEF/WFP/Government of Ethiopia supported programmes. These included the targeted supplementary feeding programme (TSFP) and an outreach site where one of Afar’s 20 Mobile Health and Nutrition Teams (MHNTs) provides preventive and curative health, nutrition and WASH services to a hard-to-reach community in Lubakda kebele.
The Mobile Health and Nutrition Team provides Outpatient Therapeutic Programme (OTP) and targeted supplementary feeding programme (TSFP) services to remote communities. The TSFP is integrated with MHNT services that address under five children and pregnant and lactating women with moderate acute malnutrition, and link them to TSFP when they are discharged from OTP. This solves the challenge in addressing the SAM–MAM continuum of care and preventing moderate acute malnourished children deteriorating into severe acute malnutrition.
The Directors also visited a multi-village water scheme for Afar pastoralist communities in Musle Kebele, Kore Woreda (district) which suffers from chronic water insecurity.
“Valerie and I are hugely impressed by the work of the WFP and UNICEF teams in Afar,” said UNICEF’s Pakkala. “The quality of the work being done in such difficult circumstances – from the mobile health and nutrition teams, to WASH, protection, education and advocacy – is remarkable. We were also immensely impressed with the national level partnership between UNICEF and WFP, and our credibility with government and donors. The relationship and collaboration is a model for other countries to learn from and emulate.”
“Ethiopia is showing us that drought does not have to equal disaster,” said Valerie Guarnieri of WFP. “We can clearly see the evidence here that a robust, government-led humanitarian response – supported by the international community – can and does save lives in a time of crisis.”
UNICEF and WFP continue to support the Government in responding to the current drought with a focus on the most vulnerable and hard to reach communities by using proven context specific solutions and approaches.
ADIGUDOM, Ethiopia, 27 April 2016 – For Kibrom Mekonnen, the itching was the worst at night, all over his hands and chest and keeping him awake.
“When I slept it just kept itching,” said the 14-year-old, sitting in the examination room at the Adigudom Primary Hospital in Hintalo Wejarat Woreda (district) in the Tigray Region. “But I was afraid if I started scratching, it would get worse.”
Kibrom’s instincts were right because he has scabies, a contagious skin infection caused by mites that burrow along the top layer of the skin, lay eggs, hatch and spread throughout causing terrible itching.
The real danger, however, can be in the scratching which opens up sores in the skin.
“By itself, it is irritating and itchy but it also exposes you to other infections,” explained UNICEF Heath Specialist Yayneshet Gebreyohannes. “It can result in systemic infections if left untreated.”
Drought brings scabies revival
Scabies has actually been fairly rare in Ethiopia for the past several years, but with the sharp drop in the availability of water due to the worst drought the country has faced in decades, it reappeared.
Casual contact, a handshake or even a hug, is not enough to transmit the mites. There has to be prolonged skin contact or sharing of clothes, which means that outbreaks often happen within the tight confines of homes and schools.
With less water available to wash and maintain personal hygiene, there have been outbreaks in the country.
In the Tigray Region for instance, there were 27,000 new cases reported between October last year to March this year, and nearly 10,000 of those were in Kibrom’s woreda.
Since then however, there has been a significant drop in the number of cases due to the Government leadership and solid response and also UNICEF support to prevent and treat the disease.
In addition to providing medicated soap and permethrin lotion to treat the disease, UNICEF has distributed brochures and teaching guides to educate people about how to combat it and most importantly, not to stigmatize the victims.
Stopping the itch
Kibrom thinks he was infected by a visiting relative, about his age, when the latter visited from a rural village and shared Kibrom’s bed about a week earlier.
The nurse examines his hands where telltale rashes have appeared in the folds of the skin at the joints.
She walks him through the three-day treatment of soap and medication and promises to visit his family home to advise them on precautions to be taken and provide medication for the rest of the family.
For instance his clothes will have to be treated with boiling water, as will his bed linens and many of the fabrics in the house.
Kibrom is lucky in that his home has piped water, but when water is unavailable, health workers advise people to tie clothes into plastic bags for three days – the lifespan of the mite.
Kibrom is also lucky because his area was targeted by the information campaign so that someone at school identified his condition and explained to him what the horrific itching was all about. Otherwise, he might have just tried to endure – and possibly infected others.
“I kept thinking it was going to go away on its own,” he recalled.
The scabies response is part of UNICEF’s health, communication, and water, hygiene and sanitation response for drought and flood-affected populations. UNICEF also provides financial support, supplies including medicines and vaccines, and technical assistance to the Government for the prevention and treatment of major causes of childhood illnesses and deaths such as acute watery diarrhoea and other diarrhoeal diseases, vaccine preventable diseases, as well as other diseases such as meningitis.
AMHARA REGION, Ethiopia, February 2016 – Moyanesh Almerew, a Health Extension Worker in Arara Kidanemeheret Kebele (sub-district) in Amhara Region can testify to how bad the current drought in Ethiopia is for children. She is one of thousands employed as part of the nationwide Health Extension Programme, a community-based programme bringing basic health services to the doorstep of Ethiopia’s large, rural population. According to Moyanesh, they have had seen many more cases of severe acute malnutrition among children this year as compared to previous years and the cases they are receiving are worse. Among them, six-month-old, Fikir, whom Moyanesh saw during a home visit, stands out.
“You would not believe how thin she was when we first found her,” recounts Moyanesh, “She had never been vaccinated so when we tried to give her the vaccines, it was not possible because she was only skin and bones,” explains Moyanesh. When she was first brought to the Arara Kidanemeheret Health Post, the child weighed just 4.5 kg and the measurement of her mid-upper arm circumference – the criteria for identifying severe malnutrition – was 10.5 cm. She was severely acutely malnourished.
Thankfully, after receiving treatment, Fikir has gained 2kg after treatment, which included medicine and therapeutic food for several weeks, and her mid-upper arm circumference grew to 11.8 cm, which puts her in the moderately acutely malnourished range. She continues to receive outpatient treatment at the health post.
Moderately acutely malnourished children are enrolled in the World Food Programme-supported Targeted Supplementary Feeding programme through which they receive fortified blended food and vegetable oil for six months to aid their nutritional recovery. Both this and the UNICEF-supported treatment for severe acute malnutrition are routine responses which are all the more critical in a crisis.
Seven-month-old Mastewal is another child who has been treated at the Arara Kidanemeheret Health Post. Her mother, Weynitu, says that the drought has taken quite a toll on her family, especially on Mastewal. The child was extremely emaciated before receiving treatment for severe acute malnutrition. Weynitu walks for more than two hours over steep hilly ground to get to the health post for Mastewal’s treatment but she says it is worth all the hardship since her daughter has shown a lot of progress in the last few of months.
To Moyanesh, it is a relief to see the wonders that therapeutic food treatment does for the children. “I doubt that some of these children would have survived if they didn’t receive this treatment,” she says.
Across the country, 458,000 children are expected to need treatment for severe acute malnutrition in 2016. More broadly, 10.2 million people, 6 million of them children, are in need of emergency food assistance due to the drought. UNICEF, the Nutrition sector lead agency, continues to coordinate the nutrition emergency response. With the support of donors, UNICEF provides supplies for the management of severe acute malnutrition and supports the treatment of malnourished children through the community-based management of acute malnutrition, along with training, quality assurance and monitoring of the nutrition emergency response. UNICEF is also supporting efforts to provide drought-affected communities with access to clean water and health services to address major causes of child illnesses and deaths that have been exacerbated by the drought.
To continue nutrition emergency response activities over the coming months, additional funds of US$5 million are needed, subject to needs-based revisions. A further US$ 42 million is needed over the next four years to strengthen nutrition services and build resilience to future shocks among communities that are worst-affected by the drought.
By Efa Workineh, CBNC Project Officer, Save the Children, Ethiopia; Tadesse Bekele, Regional Programme Manager, Save the Children, Ethiopia; Hailemariam Legesse, Health Specialist, UNICEF Ethiopia; Asheber Gaym, Health Specialist, UNICEF Ethiopia
Abuna Gindeberet Woreda is one of the eighteen woredas (districts) found in West Shoa Zone, Oromia Regional State, 182 km west of Addis Ababa, Ethiopia’s capital.
Baby Elias Suyum Belacho was born in Guro Furto health centre in Gartoke Kebele (sub district) of Abuna Gindeberet Woreda on September 20 2015. His mother, Shure Negasa and father, Suyum Belacho took good care of Elias, the fourth born in the family, even prior to his birth. During her pregnancy, Shure attended three Ante Natal Care (ANC) visits at the Guro Furto health centre. Unfortunately, she had not received the required post-natal visit schedule following her delivery.
When Elias was three weeks old, he attended the routine community based new-born care assessment provided as part of the community based new-born care programme of the national Health Extension Programme (HEP) package. (The HEP is a community health programme covering the whole of Ethiopia provided by two female community health workers (health extension workers) working at rural health posts, at present over 38,000 health extension workers are providing services in over 16,000 health posts across Ethiopia. The community based new-born care programme (CBNC) is one of the key public health interventions provided by HEP through extensive partner support. UNICEF is the major supporter of CBNC scale up in Ethiopia). Emushe Abebe, the health extension worker providing CBNC noted that Elias’ respiration rate was found to be 72 breaths per minutes in two counts; much higher than the upper limit of 60 expected at his age. During the assessment, Emushe asked Shure if she has noted any other symptoms that Elias has been showing recently. Shure explained that Elias had been coughing for the last two days. Thanks to her Community Based New-born Care (CBNC) training, the health extension worker correctly diagnosed Elias’ condition as new-born sepsis; a potentially lethal advanced infection in new-borns. In addition, she found out that Elias was underweight, which was caused by not enough breastfeeding. As per her CBNC training, she classified Elias’s condition to be very severe. Shure was not aware that she had to breastfeed at least eight times per day and because she did not realise that Elias was seriously sick, she never reached out for medical assistance.
After counselling by the health extension worker, Shure agreed to start the treatment at home immediately and to continue taking Elias to the health post. 48 hours after initiating the standardised (Chart Booklet) treatment with gentamicin and amoxicillin antibiotics, the HEW assessed the status of the child and found that he was rapidly improving. By now he was physically stable: he showed a lower breathing rate of 48/minute and he was breastfed more than 10 times a day. Following the seven days’ full course treatment, Elias completely recovered from his illness.
Elias’ mother Shure Negasa, who was not aware of her child being in life threatening condition, has promised to seriously take care for her new-born child and other children. From now onwards she will seek health care when ever needed and she will teach her neighbour’s what she experienced.
When Ethiopia along with 196 other countries signed the Millennium Declaration in New York in 2000, maternal and child health situation was bad for the majority of the population. Under five mortality rate – number of children dying before their fifth birthday from 1000 born alive- in 1990 (the beginning of measurements for the MDGs) was 222; one of the highest in the world. Many were sceptical that the country would achieve the targeted reduction of two thirds of the 1990 levels by 2015. Against all odds, the country has achieved child health target of the millennium development goals MDG 4 three years ahead of 2015 by reducing the 1990 child mortality rate to less than 68 child deaths per 1000 live births.
Clear health policy and strong implementation supported by coordinated international partnership; a large scale community health programme targeting rural villages through the health extension programme; sustained investments in health and sustained economic growth are among the reasons for this success story.
Highly appreciable as the improvements in child health are, an under five mortality rate of 68 translates to the unacceptable number of over 200,000 child deaths annually. More than 43 per cent of these child deaths occur during the first 28 days following child birth (the neonatal period) the majority occurring in the few days following birth. Breathing difficulties; premature birth and new-born infections/sepsis are responsible for the majority of neonatal deaths and most are preventable or easily treatable with currently available medical care. Access to health care is nevertheless essential to obtain the benefits of these lifesaving interventions. For the tens of thousands of new-borns born at home and far from health facilities, accessing these lifesaving interventions have been largely impossible.
To overcome this formidable challenge to access key new-born health interventions, Ethiopia in collaboration with its major child health partners including UNICEF has adopted novel public health interventions of ICCM/CBNC (Integrated community case management of childhood illnesses/ community based new-born care). ICCM/CBNC interventions rely on task shifting of key child health interventions responsible for majority of child deaths to community health workers who receive training on detection and treatment of key childhood illnesses at home or at village clinics (health posts). They also timely refer new-borns and older children with severe illnesses to higher level care.
The EU-ESDE (European Union- Enhancing Skilled Delivery in Ethiopia) project, allocated Euro 42 million for a three-year support to maternal and new-born health to Ethiopia from 2014-2016. The EU is one of the major partners for the national scale up of ICCM/CBNC programme in Ethiopia. Since its inception in 2013, the ICCM/CBNC programme has rapidly scaled up to increase availability of CBNC services in 75 per cent of the total health posts in the country. Key interventions of the programme include training and mentoring of health extension workers on key skills of detections of new-borns and infants with illness through clear symptoms and signs and provision of essential interventions including provision of antibiotics to sick new-borns.
Emushe Abebe, the HEW who provided the critical intervention that saved the life of Elias is one of the 2500 health extension workers who received training through EU-ESDE (European Union- Enhancing Skilled Delivery in Ethiopia) project support. She is saving lives of many children like Elias, and teaches mothers like Shure the importance of seeking health care.
Moges dashes across the grass with a herding whip in hand. At three years old he can’t make it crack like his father or the other men in Romey Kebele (sub-district), a pastoralist area a few hours outside Addis Ababa where his family lives. But he smiles proudly as he loops it in wide circles around his head.
Muluemebet Balcha, one of the Health Extension Workers (HEW) that helped save Moges’ life, remembers how distraught his mother was. Ms. Muluemebet had contacted her to offer postnatal care for Moges through the Ethiopian government’s Health Extension Programme (HEP). “She was desperate. She thought the child would have died,” she said.
“I gave him treatment and on the second day he got well. I was very happy to see him survive,” she remembers.
Prior to becoming this kebele’s first HEW, Ms. Muluemebet says not all new-borns in the area were as lucky as Moges. “Before that training was given so many children who encountered the same problem died,” she said. The HEP has done wonders for families in hard-to-reach rural areas like Moges’ ever since it was established in 2003.
With help from UN agencies like UNICEF, it continues to grow. As of 2015 there were more than 38,000 HEWs like Ms. Muluemebet working in over 16,000 health posts across the country. Each health post serves around 5,000 people, meaning the vast majority of Ethiopia’s population of 99 million are within reach of free, basic health care.
Teshome Alemu, Moges’ father, says he owes his child’s life to the HEWs. “To go to [the nearest hospital] you may not even afford the transportation cost,” he said. “If you don’t have money, you can suffer a lot. The children will also suffer.”
“The provision of this service in our Kebele is very beneficial,” he added.
In September 2013 Ethiopia turned heads around the world by announcing it had achieved Millennium Development Goal 4, which pushed for a reduction of child mortality rates by 67 percent, three years ahead of its 2015 deadline. What started as 205 deaths for every 1,000 children in 1990 tapered off to 59 deaths per 1,000 in 2015. While developments in technology and new levels of political support are partially responsible for this drop, the HEP was a key driver in making this improvement a reality.
Meeting MDG 4 was a milestone in the country’s history, but HEWs aren’t claiming “mission accomplished” quite yet.
“The size of kebeles and their population means they cannot be covered by one HEW. I am the only health worker serving this community so it is very tough to reach all the households,” says Ms. Muluemebet, outlining challenges she and the program at large still faces.
Because she balances so many patients, she’s not always able to put in the time to make sure health education sticks. “Given the awareness of the community, it takes a long time to implement some of the activities. Families are getting the education needed, but sometimes it takes them a while to put it into practice,” she says.
Moges’ mother, Kokeb Nigusse, admits that while the community is grateful for the free services they provide, not everyone follows their advice to the fullest.
“They give the children medicinal drops, injections and syrup when they are sick,” she said. “They check up on the children. They also follow up and give injections to pregnant women. More significantly they advise us to deliver in health institutions and not at home.” Despite this last suggestion, she says, house deliveries still occur.
With more support from Ethiopia and UNICEF, that is beginning to change. “Before I started work, most mothers delivered at home. But now, if you take this year’s data, out of 171 pregnant mothers only 20 delivered at home,” said Ms. Muluemebet. The rest delivered at the local HEP health centre.
There have also been gains in building confidence in mothers like Ms. Kokeb, who are reluctant to vaccinate their children. “Vaccination of children was very low previously but now almost all children get vaccinated,” says Ms. Muluemebet. “I informed her that if the child gets sick he should get treatment even before baptism, because the community believes they shouldn’t get anything before baptism.”
Pneumonia, diarrhoea and malaria are three of the five most common life-threatening conditions that new-borns face in Ethiopia. These threats have curtailed with the debut of the integrated community case-based management of common childhood illnesses (ICCM) regime. So far, more than 28,000 HEWs like have been trained in ICCM.
With help from the financial support of its donors, UNICEF has guided development of the ICCM and HEP programs, given technical assistance to Ethiopia’s Ministry of Health, and delivered 10,000 health kits to HEP health posts throughout the country. Ms. Muluemebet says the change from this support has been enormous.
“I am a witness to seeing mothers die while giving birth,” she says. “But with the HEP we can easily detect mothers who need help, or who need to get service at health centres, and if it is beyond their capacity they call the ambulance and they take the mother to health centre and they can be easily saved.”
Moges and Ms Kokeb were saved from having to travel great lengths to get basic care. Today they walk hand-in-hand across the bright green plains that surround their vast plot of land, happy, at ease and part of a complete family. As the HEP continues to grow, success stories like theirs will become a shared experience for millions more Ethiopians.
World Health Organization, UNICEF and Rotary International, on the occasion of World Polio Day 2015, renew their commitment to finish the race for polio eradication and secure a long-lasting legacy for a healthy Ethiopia
Addis Ababa, 23 October 2015 – Marking the occasion of World Polio Day 2015, the World Health Organization, UNICEF and Rotary International, jointly reaffirm their commitment to ensure Ethiopia joins all countries in a polio-free world by 2018 – the global target for polio eradication world-wide.
Ethiopia has been free of the wild-polio virus (WPV) for the last 21 months, since the last confirmed case in Ethiopia’s Somali Region. The 2013-2014 Horn of Africa (HOA) polio outbreak resulted in 223 WPV cases across Somalia, Kenya and Ethiopia combined. Out of this number, 10 WPV type-1 (WPV1) cases were reported in Ethiopia, all in the Somali Region. The HOA polio outbreak was a devastating setback for the region, Ethiopia as a country and its people.
Due to the aggressive and innovative response led by the Ethiopian Federal Ministry of Health (FMOH) and polio partners, the outbreak was declared successfully interrupted by national and international experts in June 2015. The last reported wild polio virus WPV on the entire continent of Africa was 14 months ago – with the last WPV1 case confirmed in neighboring Somalia in August 2014. While these successes are cause for celebration; we also underline the importance of sustained commitment at every level.
In an effort to maintain the momentum, we each play our part as polio partners and bring an important and unique contribution to the polio eradication efforts. “Thirty years ago, we told the world what Rotary believes: that we can achieve the eradication of only the second human disease in history. Our belief is close to becoming reality. For every child, let’s make sure that reality is a bright one. On 23 October, Rotary will host its third annual World Polio Day event,” states K.R. Ravindran Rotary International President in his friendly call to partners and allies to join World polio Day 2015.
WHO and UNICEF continue to prioritise quality polio supplementary immunisation activities (SIA); alongside sustained quality disease surveillance; coordination and technical assistance; social mobilisation; vaccine procurement; cold chain and logistic support. Routine immunisation, the backbone to polio prevention, is the flagship programme for FMOH, WHO, UNICEF and other partners.
The National Routine Immunization Improvement Plan 2014-2016, with the objective to achieve national Penta 3 coverage of 95 per cent by 2016, provides focused support to 51 zones, home to the vast majority of unimmunized children of the country.
“In the spirit of the polio legacy, we as UNICEF and as a global polio eradication partner, are working together towards a country with a strong routine immunization system, to protect all children, everywhere against polio and vaccine preventable diseases, paving the way for a better future for all,” states Patrizia DiGiovanni, Officer in Charge of UNICEF Ethiopia.
As we commemorate World Polio Day 2015 alongside the 70th anniversary of the United Nations, we reflect upon and celebrate the polio eradication initiative contribution to themes of development and human rights; and we envision further contributions to an even brighter future. Closing out 2015 we celebrate together in recognising Ethiopia’s achievements made towards the Millennium Development Goals particularly the reduction of under-five mortality; and we look towards a polio-free world by 2018.
WHO Representative, Dr Pierre M’pele Kilebou affirms, “WHO is proud of its contribution towards the success attained so far in achieving MDG 4, interruption of WPV transmission and routine immunization improvement; and our efforts would continue to sustain the gain that Ethiopia have realized.”
Even more ambitiously, we all envision the polio eradication legacy contribution to the 2030 Sustainable Development Goals for equitable health and development for all children and families. The possibilities are endless; the successes are at our fingertips. In partnership, we are almost there. We will continue to work together for a polio-free Ethiopia until the job is done. And then we will keep going.