GOAL ETHIOPIA. FINDINGS OF NUTRITION SURVEY BORANA ZONE-OROMIA REGION JUNE 12th 26th, 2000

Transcription

1 GOAL ETHIOPIA FINDINGS OF NUTRITION SURVEY BORANA ZONE-OROMIA REGION JUNE 12th 26th, 2000 JANE BLACKHURST GOAL NUTRITIONIST ADDIS ABABA JULY 2000

2 2 ACKNOWLEDGEMENTS I would like to thank to the following people for their help support and advice in the preparation and implementation of this survey. All GOAL staff in Yabello, Addis Ababa and Dublin The Oromia DPPB Borana Zonal Health Department The Yabello and Teltele Emergency Task Force Committees Yabello and Teltele Health Authorities Extra Special thanks to Kerren Hedland WFP for all her help with EPI info among other things and to Colette Kirwin GOAL, my survey partner.

3 3 LIST OF ABBREVIATIONS CBR CDC CMR DPPC GAM MoH MSF MUAC NCHS PA SAM UNHCR WFP W/H/L WHO Crude Birth Rate Centre for Disease Control Crude Mortality Rate Disaster Prevention and Preparedness Commission Global acute malnutrition (<-2 Z-scores W/H +/- oedema) Ministry of Health Médecins Sans Frontières Mid-upper arm circumference National Centre for Health Statistics Peasant Association Severe acute malnutrition (<-3 Z-scores W/H +/- oedema) United Nations High Commission for Refugees World Food Programme Weight for height or length as a percentage of the median World Health Organisation

4 4 TABLE OF CONTENTS 1.0 EXECUTIVE SUMMARY OBJECTIVES METHODOLOGY RESULTS Nutritional indices of children 6-59 months (65-110cm W/L/H) Nutritional indices of a convenience sample of elderly people Food security CONCLUSIONS RECOMMENDATIONS INTRODUCTION AND BACKGROUND INFORMATION OBJECTIVES METHODOLOGY Sampling Method Sample size Sample Population Data collected Team Composition Implementation RESULTS Demographic Distribution Nutritional status by z-scores and percentage of the median Levels of Malnutrition in the Elderly Food security LIMITATIONS CONCLUSIONS RECOMMENDATIONS REFERENCES... 18

5 5 LIST OF TABLES TABLE 1 HOUSEHOLD DEMOGRAPHY...8 TABLE 2 TABLE 3 DISTRIBUTION OF SAMPLE BY AGE AND SEX...8 NUTRITIONAL STATUS - CHILDREN 6-59 MONTHS OR CM W/L/H...8 TABLE 4 PREVALENCE OF MALNUTRITION BY AGE CATEGORY...9 TABLE 5 PREVALENCE OF MALNUTRITION BY WOREDA...9 TABLE 6 TABLE 7 TABLE 8 MEAN WEIGHT/LENGTH/HEIGHT BY WOREDA...9 PREVALENCE OF GLOBAL MALNUTRITION BASED ON MAIN PRE- DROUGHT LIVELIHOOD STATUS...10 PREVALENCE OF SEVERE ACUTE MALNUTRITION BASED ON MAIN PRE-DROUGHT LIVELIHOOD STATUS...10 TABLE 9 NUTRITIONAL STATUS OF THE ELDERLY BY MUAC MEASUREMENTS...10 TABLE 10 FOOD AID RECEIVED BY TYPE AND POPULATION COVERAGE...11 TABLE 11 CEREAL SOURCES PRE-DROUGHT AND CURRENTLY...11 TABLE 12 MILK SOURCES PRE-DROUGHT AND CURRENTLY...11 TABLE 13 LIVELIHOODS PURSUED IN PRE-DROUGHT YEARS...12 TABLE 14 CURRENT SOURCES OF INCOME OR FOOD BY HOUSEHOLD...12 TABLE 15 LANDHOLDINGS PER HOUSEHOLD...14 TABLE 16 MORTALITY RATES...14 TABLE 17 PERCENTAGE AND FREQUENCY OF REPORTED CHILD ILLNESSES...14 LIST OF APPENDICES APPENDIX 1 APPENDIX 2 APPENDIX 3 MAP OF SURVEY AREA SURVEY QUESTIONNAIRES ANALYSIS OF MALNUTRITION BY CLUSTER

6 1 1.0 Executive Summary GOAL in collaboration with the Disaster Prevention and Preparedness Commission (DPPC) and Ministry of Health (MoH) conducted a baseline nutrition survey of the pastoral and agro-pastoral areas of Yabello and Teltele Woredas of Borana Administrative Zone, Oromia Regional State from June th Objectives To quantify the nutritional status of children aged 6-59 months or between cm in length in GOAL Ethiopia s relief project areas of Borana Administrative Zone To assess the nutrition status of people above 55 years old living in the project area using MUAC measurements of a convenience sample in the survey area To examine the current situation with regard to food security with particular focus on the following: Aid coverage Food sources Effects of the drought on livelihood strategies Effects on health 1.2 Methodology A two stage 30 cluster survey was conducted, based on a population sampling frame of 18 peasant associations (PAs) (60 villages), 9 in Yabello woreda and 9 in Teltele woreda. Standard UNHCR/WFP/MSF methodology was followed. The sample size was calculated using the expected prevalence of malnutrition for Teltele woreda of 35% (CARE, April 2000). Precision was calculated at 3%, error risk at 5% and a design effect of 2. Weight, height, age, and presence or absence of oedema were recorded for 1,950 children aged between 6-59 months or with a length between cm. Anthropometric measurements were made by fully trained medical personnel. Results for weight and height index values are based on the Reference Population Table of the NCHS/CDC/WHO Mid-upper arm circumference measurements (MUAC) were taken on a convenience sample of people aged above 55 years, who lived in the household and were present at the time of interview. A questionnaire was completed for each child and data were collected on vaccination and health history and child feeding. Household surveys were conducted in 1,103 households and community interviews were carried out in 49 villages. Data collected included: household size and composition; births and deaths in the previous 12 months; pre-drought and current livelihood strategies, food types and sources, livestock status and land resources. 1

7 2 1.3 Results Nutritional indices of children 6-59 months (65-110cm W/L/H) Sample by age and sex SEX No. % of sample Male Female Ratio M:F 1.06:1 Nutritional status of children between children months or between cm length/height Anthropometric Indices No. % 95% CI* Z-Scores (Weight for height/length) > 2 Z-scores (obese) to 2.0 Z-scores (normal) to <-2.0 z-scores (moderate malnutrition) <-3 z-scores or oedema (SAM) Total <-2 Z-scores or oedema (GAM) % of the median (Weight for height/length) <80% or oedema =GAM <70% or oedema = SAM Mean weight for length 94.5 SD 37.4 *95% confidence intervals with calculated cluster effect GAM = Global acute malnutrition SAM =Severe acute malnutrition Nutritional indices of a convenience sample of elderly people Classification of Muac Nutritional Status No. % Measures Above 24cm Normal weight cm Mild malnutrition cm Moderate malnutrition Below 22cm Severe malnutrition TOTAL Total Malnourished Food security Food security is poor with the majority of the population dependent on aid for their main source of food. Although crops and livestock benefited temporarily from scattered rainfall, crops are wilting and livestock are again threatened by lack of pasture, water and disease. Income diversification has taken place due to the lack of rain and poor harvest and many households have resorted to selling household assets or migration as coping strategies. At the community 2

8 3 level, 77.5% of the communities reported a high level of illnesses in the previous six months. 1.4 Conclusions Overall nutritional status in the under five population has improved in the Yabello and Teltele woredas in comparison with surveys conducted in March (Norwegian Church Aid et al, 2000) and April (CARE, 2000). In spite of this improvement, a very high percentage of the population is dependent on food Aid for their main food source. Nutritional status varied with location, with some villages showing high levels of malnutrition and others showing a very low prevalence. The prevalence of moderate and severe malnutrition observed in the elderly is extremely high as was found by Help Age International (April,2000) 3. Livelihood strategies have changed and the more extreme coping strategies such as selling essential household assets have already started to be adopted. Market conditions are improving with the re-appearance of some products, such as milk, that were not available six months ago. However, only people with enough purchasing power can access them. Harvest predictions are poor and the condition of livestock will likely deteriorate again due to pressure on pasture, water sources and disease. The combination of the above factors would indicate that although the prevalence of malnutrition has significantly decreased over the past two months, the current situation is very unstable and could deteriorate rapidly. 1.5 Recommendations As the majority of the population are currently reliant on free food aid, it is imperative that the general ration and supplementary distribution are continued for a minimum of six months until the crops planted during the September rains are harvested. NGOs should co-ordinate their activities along with the Government Emergency Task Force Committees to ensure that an adequate level of protein and energy is being distributed between the general and supplementary rations. An ongoing system of food distribution surveillance and monitoring should be established in the area in order to ensure that the correct rations are reaching the target population. 1 Norwegian Church aid found a mean WFL of 86.1% in Yabello and 89.3% in Teltele compared to the current findings of 94.1% and 95.0% respectively. 2 CARE found a global malnutrition rate of 21.8% in Yabello and 34.8% in Teltele compared to the current findings of 11.2% and 12.3% respectively 3 HelpAge found a total of 86.7% below the 24cm MUAC cut-off point for malnutrition for three woredas including Yabello and Teltele compared to a total of 77.3% in the current survey. 3

9 4 The location of distribution sites should be reviewed and research into the feasibility of introducing additional sites, which would reduce travel distance for a large number of beneficiaries, should be carried out. Differing levels of malnutrition were found in the various PAs with no apparent relationship. It is recommended that a complete re-registration and screening is carried out in the worst affected areas to target the malnourished. Research into the viability of establishing mobile outreach teams to conduct weight for height screening to locate and register malnourished children for supplementary feeding in EPI outreach sites, in tandem with the EPI programme, should be carried out. Given the high levels of malnutrition in the elderly, supplementary food should be made available specifically targeted to this population. In Boran culture, children under five receive preferential feeding. It is recommended that in order to target children above the age of five who appeared to be malnourished, school feeding programmes, starting in September, should be established in a number of areas to target these children, with the dual benefit of increasing nutritional status and encouraging education. It is recommended that a repeat survey be carried out in early September prior to the next rains to assess the impact of the drought. The survey should include some assessment of children aged over five years, adults and elderly to deliver a more complete picture of nutritional status. As seed has been distributed but no crop harvested due to lack of sufficient rainfall, it is recommended that seed and tool distribution be provided prior to the onset of the September rains. The loss of oxen for ploughing has meant that many agriculturists or agropastoralists are using their hands to plant crops. The viability of providing oxen for the use of communities who have none remaining should be investigated. 4

10 5 2.0 Introduction and background information Borana Administrative Zone in Southern Oromiya Regional State has 12 administrative woredas, two of which - Yabello and Teltele - are included in the survey. Both woredas are lowland areas characterised by arid and semiarid weather conditions. Rainfall is bimodal with the main rains, the ganna, accounting for 65% of the annual precipitation which falls between mid-march to May and the small rains, hagaya which provide the remaining 35% of rainfall and occur from September until the end of November. These woredas have not received any sizeable rains since October/November 1998 when the hagaya failed. Data indicates that the current climatic drought cycle may have shrunk from five to three years in the zone (UNDP June 2000). The zone is drought prone and has continually received food aid for a number of years. Both Yabello and Teltele woredas are pastoral and agro-pastoral areas which have been under food stress for the whole of 1999, a situation which has continued. UNDP (June 2000) estimated that if the mid March to May rains did not arrive there would be a need for a major relief operation. 3.0 Objectives To quantify the nutritional status of children aged 6-59 months or between cm in length in GOAL Ethiopia s relief project areas of Borana Administrative Zone. To assess the nutrition status of people above 55 years old living in the project area using MUAC measurements of a convenience sample in the survey area. To examine the current situation with regard to food security with particular focus on the following: Aid coverage Food sources Effects of the drought on livelihood strategies Effects on health 4.0 Methodology 4.1 Sampling Method As recommended by the UNHCR/MSF/WFP, the two stage random cluster sampling method was used. Thirty clusters were selected from a population sampling frame of 18 Peasant Associations (60 villages) using population proportion to size techniques, based on the DPPB Yabello and Teltele Woreda Task Force population figures (April and May 2000 respectively) 4. Fifteen clusters were taken from Teltele woreda and 15 from Yabello woreda, all of which were receiving supplementary distribution from GOAL at the time 4 CSA (1994) projected the population to be 53,671 by 2000, whereas the woreda task force figures which were used estimated the population to be at 75,211 for the area, thus increasing the %of population covered by the sampling frame 5

11 6 of the survey (see Appendix 1:Map). A total of 65 children per cluster were randomly selected. 4.2 Sample size The sample size was calculated using the expected prevalence of malnutrition of 35% for Teltele Woreda (CARE, April 2000). Precision was calculated at 3%, error risk at 5% and a design effect of 2. A total of 1,950 children were assessed with 65 children in each cluster from a total estimated under-five population of 12,589, (15.5%). The percentage of under-fives was calculated using the average number (18%) for Oromiya region (Yabello Health Centre, April 2000/CSA,1994). 4.3 Sample Population Children aged from 6-59 months or between cm were included. Of the 1,950 children assessed, 52 were excluded as they were outside the selected length/height cut-offs. In addition a convenience sample of elderly persons, (aged over 55 years) who were resident in the chosen households and present at the time of the assessment were selected for MUAC measurements. 4.4 Data collected Information was collected through anthropometric measurements and three questionnaires:- child, household and community, conducted through interviews (see Appendix 2:Questionnaires). All questionnaires were piloted prior to the survey. Information per child: Sex Age (in months) Weight (kg) with a precision of 100g using hanging Salter Weigh Tronix scales (maximum 25kg) for children below three years and metric bathroom type mechanical International Dispensary Association scales with a precision of 500g (maximum 120kg) for children above three years. Height (cms) to the nearest 0.1cm using the Oxfam nutritional survey kit length/height boards. Children between 65 and 85cm were measured horizontally. The boards were marked with red lines between these lengths to facilitate this. Presence or absence of bilateral oedema on both feet after 3 seconds of pressure. Other information per child was collected using a child questionnaire Vaccination status Current and recent health history Breastfeeding practices A record of the types, frequency and sources of meals consumed over the previous 24 hours. 6

12 7 Household surveys were conducted in 1,103 households and information on the following areas was collected: Demographic breakdown of the household Births and deaths over the previous 12 months Pre-drought and current livelihood strategies Livestock and land holdings Access to school feeding programme MUAC measurements and frequency of meals consumed by people aged over 55 years in the household. Help Age colour-coded MUAC tapes for older people in sub-saharan Africa were used. Community questionnaires were conducted in 49 out of the 60 villages and information was collected about the following areas: Number of households and population Pre-drought and current livelihood and coping strategies Livestock holdings and crop planting Water sources (previous and current) Food consumption, security and priority of food distribution Community health and mortality 4.5 Team Composition Two teams conducted the survey and each was composed of the following An expatriate nutritionist or nurse as team leader and interviewer An interpreter who worked alongside the expatriate A fully trained Ministry of Health nurse/health assistant, responsible for anthropometric measurements A recorder, also trained in anthropometric assessment, who doublechecked and recorded the measurements A facilitator who assisted in the random selection of the households, communicated with and organised the villagers All members of the team received a full day training course by a qualified nutritionist to ensure that the techniques and methodology to be followed were understood. 4.6 Implementation The survey was conducted from th June 2000 in 18 PAs, nine in Yabello woreda and nine in Teltele woreda, Borana Administrative zone, Oromia Regional State. Both Yabello and Teltele Emergency Task Force Committees were informed about the purpose and scheduling of the survey and were asked to disseminate information to the relevant PA Chairmen and Development Agents in advance of the survey. The population were requested to remain in their houses until completion of the assessment. 7

13 8 5.0 Results Analysis was done using EPIINFO 6, EPINUT 2.0 and EXCEL. Weight for height index values are based on the Reference Population Tables of the NCHS/CDC/WHO Demographic Distribution Household Level Table 1 Household demography No of Households Total population % Under-fives % Aged 5-55 years % Elderly (55+ years) No % No % No % 1,103 7,173 2, , The average household size is 6.5 persons which is higher than the national average of 4.8 for Oromia region (Ministry of Health, 1998) Under-five years of age Level Table 2 Distribution of sample by age and sex Age class Sex Total Male Female No % total No % total No Total % 6-29 months months TOTAL Nutritional status by z-scores and percentage of the median Table 3 Nutritional status - children 6-59 months or cm W/L/H Anthropometric Indices No. % 95% CI* Z-Scores (Weight for height/length) > 2 Z-scores (obese) to 2.0 Z-scores (normal) to <-2.0 z-scores (moderate malnutrition) <-3 z-scores or oedema (*SAM) Total <-2 Z-scores or oedema (*GAM) % of the median (Weight for height/length) <80% or oedema =GAM <70% or oedema = SAM Mean weight for length 94.5 SD % confidence intervals with calculated cluster effect *GAM = Global acute malnutrition *SAM =Severe acute malnutrition 8

14 9 The prevalence of global malnutrition is 11.8% which is classified as a level of malnutrition requiring targeted supplementary feeding (>10% GAM), (MSF, 1995) Malnutrition by age Table 4 Prevalence of malnutrition by age category Anthropometric Indices % CI* % CI* months months Z-Scores (W/H/L) -3.0 to <-2.0 z-scores <-3 z-scores or oedema (*SAM) Total <-2 Z-scores or oedema (*GAM) % of the median (W/H/L) <90% W/H <80% or oedema =GAM <70 or oedema = SAM All the severely malnourished children >-3SD were aged between months. Of these, 66.7% were in the 6-29 month category Malnutrition by sex There was no significant difference between nutritional status and sex in either age category Malnutrition by location Table 5 Prevalence of malnutrition by woreda Woreda Global acute malnutrition Severe acute malnutrition No % 95% CI No. % 95% CI Yabello Teltele % confidence intervals with calculated cluster effect There was no statistical difference between prevalence of malnutrition and woreda. Table 6 Mean weight/length/height by Woreda Woreda Mean W./L % Standard Deviation Yabello Teltele

15 10 Although clusters are not traditionally analysed separately, due to the wide geographical spread of the clusters, analysis revealed that levels of global malnutrition ranged from 1.3% to 26.2%, with nine of the clusters having a prevalence of over 15% (see Appendix 3). However no obvious relationship was detected. Overcrowding in some areas or remote location may explain higher levels in these areas Malnutrition and livelihood Tables 7 and 8 show the number of children with global malnutrition in each of the three largest livelihood categories. For example 45 malnourished children came from agriculturist households, constituting 20% of all children from purely agriculturist households. Table 7 Prevalence of global malnutrition based on main predrought livelihood status Livelihood No. Globally malnourished % Globally malnourished Agriculturist Agro-pastoralist Pastoralist 11 5 Table 8 Prevalence of severe acute malnutrition based on main predrought livelihood status Livelihood No. Globally malnourished % Globally malnourished Agriculturist Agro-pastoralist Pastoralist 0 0 As is shown in both Table 7 and 8, the pre-drought agro-pastoralist population in this area appears to be most affected. 5.3 Levels of Malnutrition in the Elderly Table 9 Nutritional Status of the elderly by MUAC measurements Classification of Muac Nutritional Status No. % Measures Above 24cm Normal weight cm Mild malnutrition cm Moderate malnutrition Below 22cm Severe malnutrition TOTAL Total Malnourished A high percentage of the elderly measured were malnourished (77.3%), and 46.8% of this malnutrition was severe. 10

16 Food security Aid The majority of the households interviewed (89.5%) received some food aid. Of the children who were not exclusively breastfeeding (n=1670), 18.8% (n=314) were reported to be totally reliant on aid food and 12.2% (n=204) were reported to have no access to food other than wild foods. Breastfeeding data was deemed unreliable as many of the mothers reported breastfeeding for 2-3 years, but had children under that age and were not feeding more than one child simultaneously. Table 10 Food Aid received by type and population coverage AID No of % Households Receiving Aid (total) Of the 89.5% receiving aid: Receiving General Ration Receiving supplementary food Receiving General & supplementary Food Sources Table 11 Cereal sources pre-drought and currently Source Pre-drought Current Pre-drought % of communities Aid only Aid & Market Market only % Home-grown Combination grown & purchased Total A total of 91.8% of the cereals consumed in communities comes from free Aid or Aid supplemented by foods purchased. Table 12 Milk sources pre-drought and currently Source Pre-drought Current Pre-drought % of communities None Own animals Purchased Own & purchased Own animals There has been a 54% reduction in the consumption of milk from pre-drought to current times and 19.6% of those communities have changed from producing their own milk to solely purchasing it. Milk is one of the main traditional sources of nutrition for the Borana people and was not available on the market six months earlier. 11

17 12 At the community interview level, 63% reported that wild foods were being consumed. In addition, the variety of food in the diet has reduced on average by 50.%, (ranging from 0-100%) excluding aid and wild foods which leads to questions about the nutritional value of the foods left Livelihood Changes In pre-drought years the households interviewed pursued the following livelihoods: Table 13 Livelihoods pursued in pre-drought years Livelihood No. % Agro-pastoralist % Agriculturist Pastoralist Petty trader/merchant Other Total Households Current sources of income or food The households interviewed commonly adopted several of the income/food sources. Table 14 shows the number and percentage of households using each strategy. Table 14 Current sources of income or food by household Income/food source No % Aid sell firewood/charcoal Sell animals (mainly goats) Sell water Daily labour Petty trader Sell milk Merchant Sell grass Gold mining Migrate send money Nothing - no aid Sell agricultural produce Migrate no money Sell soil/building materials Other A variety of other strategies had been adopted such as selling stones, clay or trees for building and dried flowers for stuffing mattresses. People also reported selling the only assets they had remaining such as the roof of their huts or household pottery. Migration was another strategy adopted; however 12

18 13 in many cases the male members of the household has simply migrated and does not send money to the family. Not only are people diversifying their incomes, but the undertaking of dangerous jobs such as gold mining was seen (an increase of 6.3%) from pre-drought years. There have been many reports of high malarial risk in the gold-mining areas, in addition to the lack of adequate safety precautions. The price of firewood, which is already low (2-3 Birr for a large bundle of firewood), is likely to decrease further due to increased competition, as increasing numbers turn to wood harvesting for income. Opportunities for daily labour are fast diminishing as traditional daily work such as weeding in the larger farms are not available due to the lack of rain Livestock Holdings Figures for cattle loss vary. According to the households interviewed, there was a 77.8% (n=10,389) reduction in the cattle herd over the previous six months. However it is not clear whether the cattle died or were sold on. From the community level questionnaires it is estimated that 42.5% of the cattle died. Statistics from the Borana Zone Belg Assessment Report (DPPC multi-agency June 2000) report a 50.2% cattle loss attributable to drought in Yabello and a 24.2% loss in Teltele. In any case, cattle loss varied by household which means that all households were not affected equally. At the community level (n=49), lack of water (77.6%), lack of pasture (89.95%) and disease (77.6%) were all reported as major problems for the livestock. Although there has been a visible improvement in the physical condition of the livestock, which is reflected in market prices, people reported widespread cattle migration from Kenya. This will put additional pressure on grazing areas and water sources and may introduce further diseases Crop Performance At the community level 98% of those interviewed said that they had planted crops. However it was clear that although the low rainfall between March and May had allowed crop planting in many areas, the absence of any further rain has meant that the crops are wilting in the fields. Crop yield, given the lack of further rainfall, is expected to be maximum of about 20% (Teffaro, personal communication, Ministry of Agriculture, Teltele, June 2000). Beans and chick peas, which are shallow crops, appear to be the only crops doing well. 13

19 Land holdings Table 15 Landholdings per household Land (hectares) No % < < > None The average amount of land per household is quite small and those who do not own land rent small areas from the Government Effects on Health Crude Birth Rate Crude Birth Rate: 287 out of a total population of 7,173 people which gives a CBR of 40/1000. This is similar to the National level (40.5/1000) but higher than the average for Oromia (30.8) (Ministry of Health, 1998) Mortality From the 1,103 households visited, a total of 101 deaths were reported over the previous 12 months. From the total household population of 7,173 people, 44.5% (n=45) were under five years of age, 21.8% (n=22) were over 55 years of age and the remaining 33.7% (n=34) were between these ages. Table 16 Mortality Rates Population CMR* <5 year mortality rate Total 0.4/10,000/day 0.6/10,000/day *Crude mortality rate In sub-saharan Africa the CMR is 0.4/10,000/day and the under-five mortality rate is 1.0/10,000/day (MSF,1995) Morbidity From the child questionnaires, it was reported that 16.7% (n=317) of the children were currently ill, or had been in the previous two weeks. Table 17 Percentage and frequency of reported child illnesses Illness* Frequency reported % Diarrhoeal diseases Common Cold Fever Skin infection Eye infection Malaria Other TOTAL *The occurrence of these illnesses was not medically diagnosed. 14

20 15 At the community level, 77.5% reported high levels of disease, the most prevalent of which were malaria (26%), diarrhoeal diseases (20.6%), common cold (11%), skin diseases and gastric complaints ( both 8.6%). 6.0 Limitations The MUAC measurements on the elderly were made only on the elderly who were present at the time of the assessment. It is possible that these people may have been less healthy than the elderly not assessed who had gone to the farms or elsewhere at the time of the survey. Interviews were carried out by expatriate staff using a local interpreter. There may be errors due to the language barrier. The target group were extremely vulnerable and despite being informed that the survey was not related to food distributions, they may have given distorted information in the belief that the outcome of the survey would affect their next distribution. The timing of food distributions may have affected the availability of food at the household level at the time of the survey. Had the survey been conducted a week or more later in some areas, recently distributed food may have finished at the household level. The sampling methodology was limited by road access, weather conditions and the degree of co-operation by the PA Chairmen and personnel. It was logistically impossible to access large areas of the PAs which may have affected the results. Children under five receive priority feeding in the survey populations. Hence the results may not represent the conditions of the population as a whole. The survey was conducted after the region had received a little rain. The rain did not continue so the picture presented may be more optimistic than the current survey results indicate. 7.0 Conclusions Overall nutritional status in the under five population has improved in the Yabello and Teltele woredas in comparison with surveys conducted in March (Norwegian Church Aid et al, 2000) and April (CARE, 2000). In spite of this improvement, a very high percentage of the population is dependent on food aid for their main food source. Nutritional status varied with location, with some villages showing high levels of malnutrition and others showing a very low prevalence. 5 Norwegian Church aid found a mean WFL of 86.1% in Yabello and 89.3% in Teltele compared to the current findings of 94.1% and 95.0% respectively. 6 CARE found a global malnutrition rate of 21.8% in Yabello and 34.8% in Teltele compared to the current findings of 11.2% and 12.3% respectively 15

21 16 The prevalence of moderate and severe malnutrition observed in the elderly is extremely high, as was found by Help Age International (April,2000) 7. Livelihood strategies have changed and the more extreme coping strategies such as selling essential household assets have already started to be adopted. Market conditions are improving with the re-appearance of some products, such as milk, that were not available six months ago. However, only people with enough purchasing power can access them. Harvest predictions are poor and the condition of livestock will likely deteriorate again due to pressure on pasture, water sources and disease. The combination of the above factors would indicate that although the prevalence of malnutrition has significantly decreased over the past two months, the current situation is very unstable and could deteriorate rapidly. 8.0 Recommendations As the majority of the population are currently reliant on free food aid, it is imperative that the general ration and supplementary distribution are continued for a minimum of six months until the crops planted during the September rains are harvested. NGOs should co-ordinate their activities along with the Government Emergency Task Force Committees to ensure that an adequate level of protein and energy is being distributed between the general and supplementary rations. An ongoing system of food distribution surveillance and monitoring should be established in the area in order to ensure that the correct rations are reaching the target population. The location of distribution sites should be reviewed and research into the feasibility of introducing additional sites, which would reduce travel distance for a large number of beneficiaries, should be carried out. Differing levels of malnutrition were found in the various PAs with no apparent relationship. It is recommended that a complete re-registration and screening is carried out in the worst affected areas to target the malnourished. Research into the viability of establishing mobile outreach teams to conduct weight for height screening to locate and register malnourished children for supplementary feeding in EPI outreach sites, in tandem with the EPI programme, should be carried out. Given the high levels of malnutrition in the elderly, supplementary food should be made available specifically targeted to this population. 7 HelpAge found a total of 86.7% below the 24cm MUAC cut-off point for malnutrition for three woredas including Yabello and Teltele compared to a total of 77.3% in the current survey. 16

22 17 In Boran culture, children under five receive preferential feeding. It is recommended that in order to target children above the age of five who appeared to be malnourished, school feeding programmes, starting in September, should be established in a number of areas to target these children, with the dual benefit of increasing nutritional status and encouraging education. It is recommended that a repeat survey be carried out in early September prior to the next rains to assess the impact of the drought. The survey should include some assessment of children aged over five years, adults and elderly to deliver a more complete picture of nutritional status. As seed has been distributed but no crop harvested due to lack of sufficient rainfall, it is recommended that seed and tool distribution be provided prior to the onset of the September rains. The loss of oxen for ploughing has meant that many agriculturists or agropastoralists are using their hands to plant crops. The viability of providing oxen for the use of communities who have none remaining should be investigated. 17

23 18 References Care Ethiopia (April 2000) A short summary nutrition survey report Addis Ababa DPPC Multi-agency Report (June 2000) Borena Zone Belg Assessment Report Federal Democratic Republic of Ethiopia, Ministry of Health (January 1998) Health and Health Related Indicators HelpAge International (April 2000) Nutritional Assessment of Older People, Borena Zone, Ethiopia Medecins Sans Frontieres (1995) Nutrition Guidelines MSF Paris Ministry of Health, January 1998 Health and Health related Indicators Federal Democratic Republic of Ethiopia Norwegian Church Aid, Dutch Interchurch Aid, EECMY/SES (March 2000) Report on Nutrition Survey in Borena Zone (Oromiya region) and Afder and Liben Zones (Somali Region) UNDP Emergencies Unit for Ethiopia (March 2000) Borena Zone of Oromiya: Relief Assistance Alleviates Crisis but more help needed A field Mission Report United Nations Emergency Unit for Ethiopia (July 2000) Update on the Current Humanitarian Situation in Ethiopia 18

24 APPENDIX 1 MAP OF SURVEY AREA (not available)

25 APPENDIX 2

26 CHILD INFORMATION QUESTIONNAIRE IDENTIFICATION Survey date: Cluster No: Woreda: PA Ketena Ola Name of interviewer: Name of respondent: Child Name Child No: Child age HEALTH INFORMATION 1. Is the child fully vaccinated? Yes No Polio & vitamin A mass campaign Yes No 2. Did the child have the following illnesses in the last two weeks? (circle yes or no) Diarrhoea no blood Yes No Bloody Diarrhoea Yes No Cough Yes No Fever Yes No Measles Yes No CHILD FEEDING INFORMATION 3. Is the child on breast-milk Yes No 4. If not on breast-milk how old was he/she when completely weaned (tick the relevant box) 1 Never-breast-fed 2 6 months 1 year 3 1-1½ years years 5 Not own child/don t know 5. Why was breast-feeding stopped? (tick the relevant box) 1 Usual time to stop 2 Mother was sick 3 Low milk production 4 Other (specify) 6. How many times did the child eat yesterday? (*do not include breast feeds) (circle the answer) What kinds of foods did the child eat yesterday excluding breast? (tick all foods eaten) KEY Source Own produce Purchased Aid (specify Other (specify) donor) Type of food Eat en Usual food Y/N Sour ce (1-4) Type of food Maize Dairy products (milk,butter) Wheat Vegetables Barley Fruit Teff Wild foods (roots, berries) Sorghum Other (specify) Beans/pulses Eggs Meat Eat en Usual food Y/N Sour ce (1-4)

27 HOUSEHOLD SURVEY IDENTIFICATION Survey date: Cluster No: Woreda: PA Ketena Ola Name of interviewer: Name of respondent: Information on children under 5 years of age: Number of under 5 s Child 1 name: Child No: Sex: (M/F) Age Child 2 name: Child No: Sex: (M/F) Age Child 3 name: Child No: Sex: (M/F) Age Child 4 name: Child No: Sex: (M/F) Age Child 5 name: Child No: Sex: (M/F) Age DEMOGRAPHY 1. Head of household 1. Male 2. Female If female why? (tick relevant box) 1 Husband died/divorced 2 Husband migrated 3 Second/third wife 4 Other (specify) 2. Number of people living in the household 0-5 years 6-54 years 55+ years 3. Have any children been born to this household in the past 12 months (Gana)? Yes No 4. Has anyone died in this household in the past 12 months (Gana)? Yes No 5. Details of deceased CATEGORY AGE 0-12 months months 5-54 years 55+ years months CAUSE OF DEATH Disease Accident Malnutrition Other (specify) Sex (M/F) Age at death (1-5) Cause of death (if known) (1-4) 6. ELDERLY INFORMATION NO NAME AGE MUAC Number of meals/day NUTRITIONAL STATUS

28 7. In good years, what activities provide households with the most food or cash on average? (tick) 1. Sell cattle/other animals 4 Sell grass 2. Sell agricultural produce 5 Sell water 3. Sell milk/other dairy products 6 Migrate and send money 4. Sell firewood Other (specify) Pastoralist Agro-pastoralist Agriculturist 8. What activities provide the households with food or cash now? (tick) 1. Sell cattle/other animals 4 Sell grass 2. Sell agricultural produce 5 Sell water 3. Sell milk/other dairy products 6 Migrate and send money 4. Sell firewood Other (specify) LIVESTOCK & CROPS 9. How many cattle have died over the past six months? 10. How many cattle do you have left? (write the number of each) Cattle Goats Shoats Camels Donkeys/asses/horses 11. How much land do you own? None 0-< 5 ha 5-10 ha >10 ha 12. Do you have children who participate in a school feeding programme? Yes No

29 Survey date: PA No of households: COMMUNITY INTERVIEW QUESTIONNAIRE IDENTIFICATION Cluster No: Woreda: Ketena Ola Ola population Name of interviewer: Interviewees Present LIVELIHOOD INFORMATION 1. In good years, what activities provide households with the most food or cash on average? (tick) 1. Sell/consume own cattle/other animals 4 Other (specify) 2. Sell/consume agricultural produce 5 3. Sell/consume milk/other dairy products 6 Pastoralist Agro-pastoralist Agriculturist 2. What activities provide the households with food or cash now? (tick) 1. Sell/ consume cattle/other animals 4 Sell grass 2. Sell/ consume agricultural produce 5 Sell water 3. Sell/ consume milk/other dairy products 6 Migrate and send money 4. Sell firewood Other (specify) LIVESTOCK & CROPS 3. How many cattle have died over the past six months? 4. How many cattle does the community have left? (write the number of each) Cattle Goats Shoats Camels Donkeys/asses/horses 5. What are the main problems affecting the livestock of the moment? (tick) Shortage of grass Shortage of water Disease: (specify) Other (specify) 6. Has the community planted any crops in the past 3 months? (circle) YES NO WATER 7. Where do people get drinking water from in normal times? Tick & write return walking time (hrs) Protected well Unprotected well Protected spring Unprotected spring Pond 8. Where do you people get drinking water from now? Tick box and return walking time (hrs) Protected well Unprotected well Protected spring Unprotected spring Pond

30 FOOD CONSUMPTION & SECURITY 9. What are the main foods consumed in this area in good times? KEY Source Own produce Purchased Aid (specify donor) Other (specify) Type of food Eaten Source (1-4) Type of food Eaten Source (1-4) Maize Dairy products (milk,butter) Wheat Vegetables Barley Fruit Teff Wild foods (roots, berries) Sorghum Other (specify) Beans/pulses Eggs Meat 10. What are the main foods consumed now in this area? KEY Source Own produce Purchased Aid (specify donor) Other (specify) Type of food Eate n Source (1-4) Maize Dairy products (milk,butter) Wheat Vegetables Barley Fruit Teff Wild foods (roots, berries) Sorghum Other (specify) Beans/pulses Eggs Meat Type of food Eaten Source (1-4) 11. What coping mechanisms or unusual behaviours have occurred in the area in recent months? Migration Higher death rate Sale of assets (personal) Sale of assets (productive) Consumption of wild foods Closure of schools School feeding programme YES NO Other: COMMUNITY HEALTH 12. Is there evidence of unusual outbreaks of human diseases in the area? YES NO If yes, what type of diseases: Approximately how many people have died in the ola in the previous 6 months? 14. Number of under 5 s Number of elderly Other 15. In order of priority, who is given food first: 16. under 5yrs school age children adults elderly 17. Is priority given to male female

31 APPENDIX 3

32 Analysis by cluster Number and percentage of children with global malnutrition per cluster Woreda PA Name Cluster No of Cluster % of No malnourished size cluster Teltele Gendile Teltele Jerarsa Teltele Bullo Danbi Teltele Billa Teltele Kulcha Teltele Kulcha Teltele Kulcha Teltele Folatelle Teltele Folatelle Teltele Folatelle Teltele Ibsa Teltele Ibsa Teltele Watwonto Teltele Millemii Teltele Millemii Yabello Gegna Yabello Gegna Yabello Gegna Yabello Surupa Yabello Surupa Yabello Bildim Rasso Yabello Towayo Yabello El Wayo Yabello Derito Yabello Derito Yabello Yubda Yabello Obda Yabello Didyabello Yabello Didyabello Yabello Didyabello TOTAL 1898