Battling malnutrition in the south

Since June, Girara health centre in southern Ethiopia has been a hive of activity each Monday when health staff run the outpatient therapeutic clinic.

"When we started, it was so crowded," Meherey Gedebo, the nursing officer, said. "There were a lot of people coming for treatment. Now, new admissions are minimal - today we had only 78 cases."

Among them was three-year-old Misera Yohannes, who had been brought to the clinic by his father, Yohannes Bate, 40. The mother was at home nursing a 15-day-old baby.

"I have a cow which refused to give milk after losing a calf," Yohannes told IRIN at the centre. "During that time, I could not give this child any milk; that is why it got to this. But even now, we are only buying milk for the mother so she can feed the new baby."

Miserach will receive Plumpy’nut treatment, then supplementary foods for another few weeks. Thereafter, the parents would normally be expected to take over the proper feeding of the child.

Yohannes said he would try to sell firewood and grass to feed the child. He would also use the 80 birr (US$8) the family earned each month from the government safety nets programme.

"Most of these people are very poor," Meherey said. "The hope is, if the rains continue, this may be over in two to three months’ time. The numbers are decreasing and the health condition of the children is getting much better."

Adenech Mekannen, a 27-year-old mother of four, brought her three-year-old daughter to the centre after failing to harvest enough last year to feed the children from her half-hectare of land.

"This year was the worst," she told IRIN. "Because of the drought, it was difficult for us to feed the children. Even the five-year-old got Plumpy’nut and has recovered."

Plumpy’nut, a ready-to-eat peanut paste with skimmed milk, icing sugar and vitamins, enables children to recover in six to eight weeks. The treatment is administered at home, thereby avoiding the need for hospitalisation.

Staff at Girara and Badessa supplementary feeding centres complained that households sometimes shared the Plumpy’nut among several children – and even adults – thereby reducing the amount available for those in need.

Some of the supplementary food had also found its way to the local markets. "We now teach the others why it is not right [to share the product]," said a feeding centre official.

Widespread malnutrition

Last year’s drought, followed by erratic rains and a sharp rise in global food prices, made it difficult for many Ethiopian households to eat properly, according to aid workers. As a result, malnutrition has become rampant.

Photo: Erich Ogoso/IRIN
A family at Galicha Sake, Wolayita Distric,t where malnutrition is rampant

"The current nutritional crisis is caused by multiple factors – one of which is drought," Sally Stevenson of MSF-Greece said. "It also depends on localised conditions, including how long it rains, delivery of food and existence of safety nets."

In a 25 August report, the UN Office for the Coordination of Humanitarian Affairs (OCHA) in Ethiopia noted that overall admissions of children to therapeutic centres remained high.

An additional 34 vulnerable woredas had been identified by the UN World Food Programme (WFP) in Afar, Amhara, Oromiya and the Southern Regions. The agency was, however, facing a shortfall of 170,000 tonnes of food valued at US$138.8 million and had cut rations in July.

The number of feeding centres, on the other hand, increased over the past three months in the most affected areas from 200 to 600, with more than 26,500 admissions, according to the UN World Health Organization.

"There is no longer enough land to support the many people in Ethiopia, so micro-nutrient deficiency is common," Aaron White of the NGO Samaritan’s Purse, told IRIN in Addis Ababa. "Part of the problem is that people do not have the right foods to eat."

An assessment by Samaritan’s Purse in Kedida Gamella district of Kembata Timbaro zone, Southern Region, found 10.7 percent of sampled children with global acute malnutrition (GAM). Of the district’s 111,150 people, 22,236 are children under five.

It found severe acute malnutrition (SAM) rates of 2.3 percent – which was higher than the rates in May and June 2006. Overall child morbidity was also high.

The situation differs in various parts of Ethiopia, according to NGOs. “In Siraro [Oromiya Region] the situation is stabilising – our impression, based on the findings from our medical programmes - is that the situation is improving,” Stevenson said.

"The rains are good, crops are coming on well and general distribution has had an impact," she added. "The situation in Afar is different. We have found SAM rates of 9 percent - against a threshold of 3 percent."

There are a limited number of humanitarian actors in Afar and capacity to assess and respond to the needs of the affected communities is restricted without a rapid influx of NGOs into the region, according to OCHA. Yet some 16 woredas face a critical situation and require close monitoring.

Community-based approach

Faced with the cyclical pattern of hunger and malnutrition in Ethiopia, aid workers are concentrating on community-based therapeutic care (CTC).

"It is a no-patient system where the children stay at home and the mothers take care of them," said John Rynne, country director of GOAL. "Managing malnutrition was always the job of NGOs. Medical staff were not trained to handle it. That was the traditional model, now we work with staff – train them to treat the kids."

CTC integrates supplementary and therapeutic feeding, hygiene and health promotion and food security activities.

For severe malnutrition, ready-to-use therapeutic foods are combined with outpatient drug treatment. It may involve small referral inpatient units for those with complications, alongside supplementary feeding programmes.

"Each village now has volunteers trained in nutrition education," said Mulugeti Beshada, manager for Concern Worldwide’s livelihood programme in Damot Woyde, Wolayita district. The NGO supports 10,000 children in supplementary feeding centres and 500 in therapeutic care.

Mestewat Giridan, CTC manager, said community volunteers had played a key role. "We used to go from home to home screening children," she told IRIN in Badessa. "Now the volunteers report cases and friends tell friends. Self-referral is happening."