Nutrition Situation in the Arid and Semi-Arid Areas, February 2015

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Key Messages:-

Nutrition and food security situation has deteriorated to Crisis levels in parts of Wajir, Isiolo and northern Garissa

In Wajir West, an estimated 1 out of 14 children is severely malnourished Marsabit and Mandera counties remain vulnerable, yet stable

Nutrition situation is stable in Turkana, although high malnutrition rates still persist The nutrition situation in the rest of the county remains unchanged from previous season Nutrition interventions are ongoing in the affected counties

 

Nutrition Situation in the Arid and Semi-Arid Areas, February 2015

A comprehensive nutrition situation analysis was conducted across the most vulnerable arid and semi-arid counties to monitor the nutrition situation in February 2015, as part of the short rains seasonal performance assessments. Analysis indicates a concerning yet stable nutrition situation in in the Northwest Pastoral cluster (Turkana, Marsabit and Samburu), Agro-pastoral cluster (West Pokot, Baringo, Kajiado, Laikipia, Nyeri North, and Narok) and Coastal Marginal Agriculture cluster (Taita Taveta, Lamu Kilifi, Kwale), compared to July 2014. However a deterioration has been noted in the Northeast Pastoral cluster (Wajir, Garissa and Isiolo), Tana River county remains stable. Other areas of concern are parts of the South Eastern Marginal cluster (Meru North and Tharaka, however Kitui and Makueni counties remain stable.

Nutrition surveys were conducted in Tana River, Isiolo, Wajir1 and northern Garissa2 counties in Feb 2015.                                                                                                                                                                              

1 Wajir West, Wajir East and South 2 Balambala, Lagdera and Dadaab sub counties

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In Isiolo and Tana River counties, the surveys were conducted as part of the regular annual monitoring, however surveys conducted in Wajir and Garissa counties were prompted after surveillance data from the counties showed possible deterioration in the nutrition and food security situation in the counties. In the other ASAL areas where no nutrition surveys were conducted this season, the nutrition situation analysis was conducted using secondary information namely: - MUAC surveillance data (Source: NDMA), MUAC screening data, IMAM admission trends, routine health information and food security indicators as well as most recent nutrition survey results.

According to the recent nutrition survey results3, Wajir West has reported the highest GAM and SAM rates,

at 22.6% (17.7-28.3) and 7.1% (4.9-10.3), these results indicate a deterioration in the severe acute malnutrition rates reported from the previous survey conducted in the area in June 20144, indicating a Very Critical

nutrition situation. The results estimate that 1 out of 14 children is severely malnourished in Wajir West. The deterioration in the malnutrition situation here is mainly attributed to the negative effects of consecutive poor rainfall performance on food security in the area. This has resulted to reduced household food security and low household milk consumption and production. In Wajir East/South the nutrition situation remains Critical with GAM and SAM rates at 17.4% (14.2-21.0) and 3.4% (2.0-5.6) according to the recent survey. Survey results for northern Garissa indicate a Critical nutrition situation, with GAM of 15.2% (11.9-19.1) and SAM 2.7% (1.7-4.2). Isiolo county survey results indicate a GAM and SAM of 13.2 % (10.8-16.0) and 1.0% (1.0-3.0) respectively, indicating a Serious nutrition situation, further analysis shows that a high number of malnutrition cases were noted in Merti and Sericho bordering Wajir West and Northern Garissa county. The main factors aggravating acute malnutrition in these areas is the declining food security situation caused by the negative impact of the underperforming October to December 2014 short rains season coupled with chronic vulnerabilities such as poor infant and young child feeding and care practices, high morbidity and limited access to clean water and appropriate sanitation.. The food security situation in parts of Wajir, Isiolo and northern Garissa has deteriorated and been classified as Crisis (IPC Phase 35). In Tana River county, the

nutrition survey conducted in February 2015, recorded a GAM and SAM rate of 9.9% (6.8 - 14.2) and 1.0% (0.4- 2.5) respectively, indicating a Poor nutrition situation according to WHO classification, however the situation is stable compared to the same time last year. The food security situation in the county has been classified as Stressed (IPC Phase 2) in the northern parts of the county bordering Garissa, and Minimal (IPC Phase 1) in the southern part of the county.

The short rains 2014 seasonal assessment led by the KFFSG6, estimate the total population requiring

immediate humanitarian assistance at 1,600,000 million, a slight increase compared to the 1,500,000 reported after the long rains 2014 seasonal assessment. Based on current nutrition situation analysis, the current expected total caseloads of children requiring treatment in the ASAL and urban areas for acute malnutrition is 304, 083, a slight decline from 352,508 July 2014. The decline is because of the improvements noted in West Pokot, Baringo and Samburu, however, increases have been noted in Wajir, Isiolo and Garissa counties. Overall, the total number of children in the ASAL areas admitted to programmes managing severe acute malnutrition indicated a declining trend, from October to December 2014. The total number of children admitted to Outpatient Therapeutic Programme in December 2014 was 2,220, a slight decrease from November, 2,326 and October 2,418. A similar trend was observed for the Supplementary Feeding Programme with the total admissions at December 14 being 4,750, November 5,624 and October 6,887. The highest numbers of admissions was noted in Turkana, Mandera and Wajir counties. A detailed breakdown of admission by county between July and December 2014 is available in the annex.

Ongoing nutrition interventions in the county include:- activating of contingency plans in affected areas, delivery of high impact nutrition interventions (HINI), increased active case finding of children with acute

                                                                                                                                                                             

3  Nutrition Information Technical Working Group (NITWG), has validated all the mentioned surveys, all surveys published here have passed those quality checks   4 Comparison should be interpreted with caution as surveys are in different seasons

5 Integrated Phase Classification of Food Security- More information on the analysis process at www.ipc.org 6 Kenya Food Security Steering Group

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0 10 20 30 40

Turkana Marsabit Samburu

Pr op or tio n   of  C hil dr en  w it h   M U A C   <1 35 m m County

Proportion   of  Children   at  Risk  of  Malnutrition   (MUAC<135mm)  December  2014  vs  December    LTA

Dec-­‐14 Dec-­‐14  LTA

Figure 3: Trends of Children at Risk of Malnutrition (MUAC<135 mm) Northwest Pastoral Cluster

Figure 4: Trends in SAM Admissions – Pastoral N.W Cluster  

malnutrition for referral and treatment. Essential emergency nutrition supplies have been prepositioned and there are enough supplies available in the ASAL counties, with elevated monitoring/surveillance of the nutrition situation and program quality both at the county and national level. Children at risk of malnutrition (MUAC<135mm) should also have their weight for height measurements taken during screening to identify moderately malnourished children requiring treatment.

Nutrition Situation by Livelihood Zone Clusters Northwest Pastoral Cluster- Turkana, Marsabit and Samburu

Analysis of nutrition information7 in the northwest pastoral Livelihood zone (LHZ), indicates an improving trend in the nutrition situation compared to July 2014. In June 2014, comprehensive nutrition surveys conducted in Turkana, Marsabit and Samburu confirmed a declining nutrition situation due to the negative impacts of the poor performance of the long rains 2014 season, with Turkana North, East/South and Central, Marsabit (North Horr/Loyangalani) reporting GAM8 rates above emergency thresholds ranging

between 20.5-29.2%. Across the cluster MUAC data from NDMA sentinel sites between the months of August to December 2014 generally indicate a decreasing trend (Oct- Dec 2014) of the children at risk of malnutrition (MUAC <135mm, figure 3) compared to the previous season. Although there is an improvement, acute malnutrition still remains high and above emergency thresholds especially in Marsabit and Turkana.

IMAM9 data (OTP and SFP) from health facilities in

the three counties shows a stable trend (OTP) and a declining trend (MAM) for October to December 2014 in the number of new admissions10 (see figure 4).

The overall food security situation in the cluster is classified as Stressed (IPC Phase 2), an improvement from the previous season where pockets of Crisis (IPC Phase 3) were identified in parts of Turkana and Marsabit. The main factors affecting the food security situation include poor temporal and uneven distribution of the short rains season, human and livestock diseases, high food prices, human wildlife conflict, livestock migration and insecurity related to

                                                                                                                                                                             

7  NDMA Sentinel site MUAC data and food security indicators and Feeding programme admission trends (DHIS) 8 Global Acute Malnutrition

9 Integrated Management of Acute Malnutrition 10 Source DHIS

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resource based conflicts and cattle rustling. Morbidity incidences were on the increase across the cluster but within the seasonal ranges. In Turkana county, there were eight reported cases of measles, while dysentery cases doubled to 2,064 between July - December 2014 from 1,024 reported in the same period in 2013, mainly attributed to poor sanitation and hygiene. The food security situation and the morbidity levels have an effect on the nutritional status of the population, this is coupled with the chronic vulnerabilities in the cluster which include, poor access to health services and safe water and sanitation and inadequate child feeding and care practices. The total estimated caseloads for Turkana, Marsabit and Samburu are 59,038, 13,905 and 9,614 respectively, with no change compared to July 2014, see annex for detailed caseloads by county.

RESPONSE ACTIONS IN THE CLUSTER

Turkana: 111 facilities and 144 outreach offering high impact nutrition interventions with partners (this is coverage of 90.2%). Mass screening is planned for March 2015 having been last done in October 2014. Turkana County continues with active case finding through House to house screening in the existing community units. Kenya Red Cross (KRCS) and World Vision supporting the emergency response in Lomelo and Kainuk divisions in Turkana east and south respectively. The county government, NDMA, WFP and Kenya Red Cross and other partners are prepositioning general food ration and food for assets program. Other interventions include:

• The hunger safety net programme by Oxfam and Equity bank backed by the NDMA short message and call back system for quality control.

• The resilience programmes such as small scale farming along the Turkwel and Kerio rivers, bee keeping

and community savings and credit facilities spearheaded by livestock, agriculture and forestry/environment ministries as well as TALSP World Vision Kenya.

• Cross-border peace initiatives for mobile pastoralists on sharing of water and pasture resources.

Coordination efforts on going on a monthly basis. Sector team plans to update the response plan in March 2015.

Marsabit: From January 2015 7,600 children have been screened in all the hot spots( North Horr, Laisamis & Loyangalani) 1,874 children (25%) <5 yrs. were referred and enrolled in selective feeding programs and are accessing nutrition services across the county. Other identify areas of priority for screening in Chalbi, Saku are currently undertaking the same with Moyale scheduled to commence next week from 23rd Feb 2015. 66

outreaches site maintained with reviews ongoing based on mass screening reports and the caseloads and scale up/scale down/remapping will be ongoing on need basis. KRCS has provided additional HR for a short period to support Illeret, North Horr and Loyangalani areas as per the response gaps identified by the sub county teams. On job based Capacity building is ongoing especially for newly deployed staff to ensure there are able to provide quality nutrition services at the tier 1 & 2. This is supported by Feed the Hungry Kenya (FHK) and Concern Wide (CWW). Response gaps highlighted for refresher training, Laisamis mass screening and data quality assessments. The gap is costed at Kshs 3.5M. Partners currently reviewing support to address gap. Other related interventions: Cash transfer program supported by KRCs on going targeting 1,400 households with malnourished children in Laisamis and North Horr sub counties in collaboration with WFP, NDMA to ensure that no duplication in targeting. Each H/hold received their first distribution of Kshs 3000/month in Jan 2015. In addition the program also targets 94 ECD centers for support with Cereals (school meals) across all the sub counties. This support will be ongoing to March 2015. The Nutrition team is monitoring IMAM program performance in areas where these two protection programs are running to evaluate its effect on target outcomes for IMAM and also document any learning.

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Figure 5: Trends of Children at Risk of Malnutrition (MUAC<135 mm) Northwest Pastoral Cluster   0 100 200 300 400 500 600 700 SA M  a dm is sio ns Months-­‐2014

Trends  in  SAM  admission-­‐Pastoral   N.E   cluster

Tana  River Isiolo  County Mandera  County

Wajir  County Garissa  County

Northeast Pastoral Cluster - Mandera, Wajir, Garissa, Isiolo, Tana River

The NDMA drought early warning information bulletins (Oct-Dec 2014) indicated a declining food security and nutrition situation in Wajir, northern Garissa and Isiolo. These same areas were also highlighted as vulnerable due to the negative impacts of the poor performance of the long rains 2014. To closely monitor the nutrition situation, the NTIWG, with support from partners11 conducted nutrition surveys in Isiolo and

Tana River, Wajir (except Wajir North) and northern Garissa12.

Results of the Isiolo nutrition survey indicate a GAM rate of 13.2% (10.8-16.0) and a SAM rate of 1.0% (1.0-3.0), indicating a Serious nutrition situation and the rates are not significantly different compared to the previous survey conducted in February 2014 that indicated a GAM rate of 11.5% and SAM of 1.0%. Analysis indicates that there are pockets of high malnutrition in Merti and Sericho areas bordering Wajir and Garissa county. The main factors affecting the current nutrition situation are household food insecurity as a result of the negative impact of the short rains season in the area, coupled with high levels of chronic vulnerabilities in the population. In parts of Isiolo, (Merti and Sericho sub counties) the food security situation has been classified to be in Crisis (IPC Phase 3) according to the short rains 2014 seasonal assessments conducted by the KFSSG technical team, the rest of the county remains Stressed (IPC Phase2). NDMA sentinel site data (MUAC) and IMAM admission data especially in Merti and Sericho sub counties showed an increasing trend in the proportion of children at risk of malnutrition (MUAC<135mm) and increased admissions to IMAM programme. The total current estimated caseloads for children requiring treatment for acute malnutrition in the county is 3,133, a slight increase from July 2014.

In Garissa, results from a rapid SMART nutrition survey conducted in early February 2015 that covered Dadaab, Lagdera and Balambala sub counties indicate a GAM rate of 15.2% (11.9-19.1) and a SAM rate of 2.7% (1.7-4.2), indicating a Critical nutrition situation. In July 2014, the Garissa county estimate for acute malnutrition indicated a Serious nutrition situation across the county, with GAM and SAM rates of 14.6% (1.8-17.8) and 2.9 (1.0-4.2) respectively. Surveillance data had indicated a worsening food security and nutrition situation in the northern parts of Garissa, prompting the needs for a rapid nutrition

survey in the area, with survey results confirming a decline in the nutrition situation. The declining situation is mainly attributed to the negative impacts of consecutive seasons of poor rainfall performance in the area, which has impacted on food security in the area. Morbidity and chronic issues such as poor access to health services, safe water and proper sanitation in addition to poor infant and young child care and feeding practices further exacerbate the situation. According to the food security assessment, the area has been

                                                                                                                                                                              11  UNICEF,  Save  the  Children,  IRK,  Mercy  USA  and  ACF   12 Lagdera, Balambala and Dadaab sub counties

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identified to be in Crisis (IPC Phase 3), a deterioration from the previous food security classification. Lack of adequate pasture, browse and water due to the poor rainfall performance in this pastoralist area has led to poor livestock body conditions, resulting in abnormal out migration and low milk production. Coupled with high food prices, this has reduced the household food security in the area. IMAM trends in these counties shows an increasing trend of admissions (see figure 5).

Two rapid SMART nutrition surveys were conducted in early February in Wajir county - Wajir West and Wajir East/South, due to surveillance data that showed a declining nutrition situation in these areas. The results of the survey in Wajir West indicate a GAM rate of 22.6% (17.7-28.3) and a SAM rate of 7.1% (4.9-10.3), indicating a Very Critical nutrition situation. These results indicate a significant deterioration in the SAM rates reported in June 2014, whereby the rates of malnutrition were 3.2% (2.2-4.8), these results estimate that 1 in 10 children is severely malnourished. In Wajir East/South, the nutrition situation remained stable at Critical levels from the previous survey conducted in July 201413, with the current GAM and SAM rates of

17.4% (14.2-21.0) and 3.4% (2.0-5.6) compared to the previous GAM and SAM rates in July 2014 of 16.8% (13.9-20.2) and 3.1% (2.0-4.7) respectively. Analysis of surveillance data for Wajir North, indicated a stable nutrition situation, and a regular nutrition survey will be conducted in the area in June 2015. The food security situation analysis indicates the overall food security situation in Wajir West and parts of Wajir East/South to be in Crisis (IPC Phase3), as a result of the poor performance of the long and short rains season 2014. The poor performance has led to low milk production and consumption at household level, low livestock prices coupled with high food prices, reducing household food security. In addition to the precarious food security situation, chronic issues such as morbidity, inadequate access to health services, safe water and appropriate sanitation and poor Maternal Infant and Young Child Nutrition practices increase the vulnerability of the population to high malnutrition.

In Tana River the annual SMART nutrition survey conducted in early February indicated a GAM rate of 9.9% (5.8-16.3) and a SAM rate of 1.0% (0.2-4.3), indicating a Poor nutrition situation. These results indicate a stable nutrition situation compared to the previous survey results reported in the county in July 2014, which indicated a GAM and SAM of 7.5% (5.3-10.4) and 1.9% (0.2-4.3) respectively. The main factors affecting the nutrition situation in the county include poor feeding and care practices, inadequate access to health facilities, safe water and sanitation and high morbidity.

No survey conducted in Mandera county in February, however information from NDMA MUAC sentinel sites, indicates a declining trend in number of children at risk of malnutrition (MUAC<135mm). The data also shows lower proportion of children at risk of acute malnutrition (MUAC<135mm) in December 2014 compared to the Long Term Average (LTA) at the same time last year. In July 2014, results from surveys indicated a Very Critical nutrition situation with GAM rates in the county above 20%. Based on the surveillance data from NDMA, and also the IMAM admissions, the nutrition situation seems stable. The current food security situation in the county is Stressed (IPC Phase 2), this is an improvement compared to the previous long rains season which was classified as Stressed with pockets of Crisis (IPC Phase 3). The key factors affecting food security include insecurity (inter clan conflicts and terrorism) which have affected service delivery in the county and markets, and poor seasonal performance of the rains and its impacts on livestock production, coupled with high food prices. The nutrition rates remain high and service delivery in parts of the county remains a challenge, it is therefore imperative to closely monitor the situation in Mandera. Overall, the IMAM data from health facilities in the pastoral northeast cluster shows a fluctuating trend (Oct-Dec 2014) in the number of new admissions14 (see figure 5). The highest admission trends were noted in

Wajir county, this is in line with the declining nutrition situation reported in the county. IMAM trends are also high in Garissa and Mandera counties. Reporting has been interrupted in Mandera county in the months of November and December 2014 due to reduced health workers in the facilities. The total estimated caseloads for the northeast cluster have increased slightly and the details can be found in the annex 1.

                                                                                                                                                                              13 Survey not directly comparable because conducted in different seasons 14  Source  DHIS  

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0 5 10 15 20 25 30

Baringo Laikipia Kajiado Narok Nyeri West

Pokot %   o f   C h il d re n  w it h  M U A C  < 1 35 m m County

Proportion  of  Children  at  Risk  of  Malnutrition  (MUAC<135mm)   Dec  2014  vs  Dec  LTA

Dec-­‐14 Dec-­‐14  LTA

Figure 6: Trends of Children at Risk of Malnutrition (MUAC<135 mm) Agro Pastoral Cluster  

RESPONSE ACTIONS IN THE CLUSTER:

Mandera: contingency plan review under way. Response plan not activated. KRCS through UNICEF is supporting health facilities with personnel

Wajir: response plan finalized and costed. Mass screening, sensitization on Maternal infant and young child nutrition and emergency coordination forums to kick off from 23rd February 2015. Funding gap for response

actions is Kshs 7,645,852.00 with main areas that are not adequately funded being mass screening, recruitment and training of additional health staff for surge capacity

Isiolo: response plan finalized and costed. Mass screening for Isiolo and Garbatulla sub counties planned, after hot spot mapping in the sub counties is finalized. The plan prioritizes training of new staff and scaling up of existing outreaches to cover the hot spot areas to achieve 50% coverage. Gap is costed at Kshs 4.2 M Tana River: response plan to be discussed at county level

Agro-pastoral Cluster -Baringo, Laikipia, Kaijado, Narok, Nyeri (Kieni), West Pokot

Analysis of secondary data from the counties in the agro-pastoral cluster indicate a stable nutrition situation, apart from pockets in Baringo and West Pokot that showed some slightly elevated rates of malnutrition. The proportion of under-fives malnourished by MUAC at risk (<135mm) was at 17.1%, 10.1%, 9.5%, 7.5%, 2.7%, 1.2% and for Baringo, Narok, West Pokot, Kajiado, Laikipia and Kieni counties respectively. However, all the counties’ MUAC rates for December 2014 were below the long-term averages except for West Pokot County where the current rates were slightly above LTA, but showed a declining trend. The trends of the proportion of children at risk of malnutrition in the agro pastoral cluster remained stable in the rest of the counties (see figure 6).

IMAM trends for counties in the cluster showed a declining trend, the highest admissions were noted in Barinog and West Pokot. The areas that reported high number of SAM and MAM admissions in West Pokot county are Amakuriat, Alale, Nakwapuo, Ptira and Kasisit and in Baringo county Cheptunguny, Tamough, Kacheliba and Chesta. The total estimates for the number of children requiring treatment for acute malnutrition has reduced slightly and can be found in the annex.

South Eastern Marginal Agriculture Cluster (Meru North, Tharaka, Mbeere, Kitui, Makueni)

The nutrition situation in the south eastern marginal agriculture cluster is stable, according to analysis of surveillance data, except in Meru North and Tharaka counties, where increased malnutrition rates have been noted, with the MUAC rates for December 2014 above the long term average. The proportion of under-five children at risk of malnutrition (MUAC <135mm) was at 19%, 10%, 8%, 7.7% and 5.6%, for Meru North, Kitui, Makueni, Tharaka and Mbeere respectively. MUAC at risk was below LTA across the clusters except for Meru North and Tharaka counties where the MUAC at risk was above LTA (see figure 7).

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The rates of children at risk of malnutrition in Meru North, have remained persistently high, however a nutrition survey conducted in the area in 2013 indicated low rates of acute malnutrition, yet extremely high rates of chronic malnutrition (stunting). The main issues affecting malnutrition were poor feeding and care practices. Malnutrition rates are expected to worsen during the peak of lean season in February to March, 2015 especially in marginal mixed livelihood zones of Kitui, Meru North, Tharaka and Mbeere. In Kitui there was observed increase in cases of severe acute malnutrition (SAM) and Moderate acute malnutrition (MAM) in the month of December, 2014 at 77 cases and 492 cases respectively when compared to previous month of November 2014. The main factors affecting malnutrition include chronic factors such as poor child feeding and care practices, chronic food insecurity at household level and limited access to health services in some areas.

IMAM admission trends in Kitui have shown an increasing trend between October and December 2014, while in Makueni the trends are declining. The estimated caseloads of malnutrition remain the same (see annex).

RESPONSE ACTIONS IN CLUSTER

Baringo: KRCS is supporting 20 integrated outreach clinics in Baringo East, with World vision covering the rest of the county in partnership with MOH. Currently 85 out 184 health facilities are implementing IMAM. KRCS and the MOH are planning to carry out mass screening in the first week of March 2015 in the entire county but with priorities in four sub-counties which were ranked as most affected by the current dry spell in the just completed short rains assessment; namely East Pokot, Marigat, Mogotio and Baringo North. There are also two outreach clinics per sub-county each month supported by beyond zero campaign however some are not integrated. The emergency response plan is currently being reviewed and costed.

Laikipia: Response plan developed with target areas for response identified. Response initiation to be planned first week March 2015

Kajiado: Nutrition response plan is finalized but pending activation as other sector plans have not been finalized. Actions like Mass screening have been marked for urgent action. WFP is supporting visit to all health facilities for data monitoring and report review from March 2015. This will provide a better outlook for the county as DHIS data has been missing.

Narok: Review of response plan pending

Nyeri (kieni): Discussion on response pending. To be initiated first week March 2015

West pokot: Mass screening and active case finding conducted in December in 87 sites and 74 sites in January 2015. Active case finding on going. Currently, only 66 health facilities are offering IMAM out of 84. NDMA, MoH, ACF, KRCS jointly drafted an emergency response plan with clear action points on interventions to be undertaken. 19 7.7 5.55 10 8 0 5 10 15 20 25 30

Meru  North Tharaka Mbeere Kitui Makueni

%  o f   C h ild re n  w it h  M U A C   <135m m County

Proportion  of  Children  at  Risk  of  Malnutrition   (MUAC<135mm)              Dec-­‐14  vs  Dec-­‐14  LTA

Dec-­‐14 Dec-­‐14  LTA

0 5 10 15 20 25 30

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

%   of  C hi ld re n   w it h   M U A C   of   <1 35 m m Month

Trends  of  Proportion  of  Children  at  Risk  of  Malnutrition   (MUAC  <135mm)  2014

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Coastal Marginal Agriculture (Taita Taveta, Kwale, Kilifi and Lamu)

The nutrition status of the population in the Coast Marginal agricultural cluster is stable according to preliminary analysis of the secondary data from sentinel sites. The number of children at risk of malnutrition and those measured as underweight at the health facilities had remained generally low over the last six months, with the proportion of children at risk of malnutrition (MUAC <135mm) below 5%. However the nutrition data on food frequency and diversity collected at field level showed that the population were currently consuming one to two meals per day and the meals composed of two to three food groups which is not adequate for good nutrition.

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Annexes

Annex 1: Summary of Nutrition Survey Results- February 2015

                                                                                                                                                                              15  

Global  Acute  Malnutrition  <-­‐2  or  oedema   16  Severe  Acute  Malnutrition  <-­‐3  or  oedema   17  Mid  Upper  Arm  Circumference   18  

Isiolo  SMART  survey  was  done  in  February  2014  and  not  June  2014  

Location   GAM15   Change   SAM16   Change   MUAC17  <12.5  cm   Change  

June  2014   Feb  2015   June  

2014   Feb  2015   June   2014   Feb  2015   Isiolo   11.518   (8.7-­‐15.2)   13.2   (10.8-­‐16)   No   significant   change   1.0   (0.4-­‐2.3)   2.7   (1.7-­‐4.2)   No  significant   change   3.4   (1.9-­‐5.9)   3.5   (2.2-­‐5.4)    No   significant   change   Wajir  West     20.7   (17.6-­‐24.3)   22.6   (17.7-­‐28.3)   No   significant   change   3.2   (2.2-­‐4.8)   7.1   (4.9-­‐10.3)   Significant   Deterioration     5.8     Wajir   East   and  South   16.8   (13.9-­‐20.2)   17.4   (14.2-­‐21)   No   significant   change     3.1   (2.0-­‐4.7)   3.4     (2.0-­‐4.7)   No  significant   change     6.9   (5.0-­‐9.6)   5.0   (3.3-­‐7.6)   No   significant   change   Garissa   (Dadaab,   Balambala   and   Lagdera   sub  counties)   14.6   (11.8-­‐17.8)   15.2   (11.9-­‐19.1)   No   significant   change   2.9   (1.9-­‐4.2)   2.7   (1.7-­‐4.2)   No  significant   change   4.1   (2.5-­‐6.9)   Not   available     Tana  River   7.5   (5.3-­‐10.4)   9.9   (6.8-­‐14.2)   Not   significant   0.9   (0.4-­‐2.0)   1   (0.4-­‐2.5)   Not   significant   4.2   (2.7-­‐6.9)   3.4   No   significant   change  

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Annex 2: Summary of Nutrition Situation Results- July 2014

                                                                                                                                                                              19  

Global  Acute  Malnutrition  <-­‐2  or  oedema   20  Severe  Acute  Malnutrition  <-­‐3  or  oedema   21  Mid  Upper  Arm  Circumference   22  Survey  conducted  in  July  2012   23  Survey  conducted  in  November  2013  

 

Location   GAM19   Change   SAM20   Change   MUAC21  <12.5  cm   Change  

July  2014   July  2013   July  2014   July  2013   July  2014   July  2013  

Turkana   Central   28.7   (24.5-­‐33.2)   17.2   (13.2-­‐21.9)   Significant   Deterioration   6.8   (4.7-­‐9.7)   3.9   (2.5-­‐6.1)   Significant   Deterioration   9.6   (7.3-­‐12.5)   7.0   (4.9-­‐10.1)   No  Significant   Change   Turkana   South/East   24.5   (20.8-­‐28.6)   16.5   (13.6-­‐19.9)   Significant   Deterioration   4.8   (3.6-­‐6.5)   2.7   (1.8-­‐4.0)   Significant   Deterioration   5.1   (3.5-­‐7.4)   7.9   (5.9-­‐10.5)   No  Significant   Change   Turkana   North     27.2   (22.7-­‐32.1)   15.322   (11.7-­‐19.6)   Significant   Deterioration   5.2   (3.3-­‐8.1)   2.3   (1.3-­‐4.1)   Significant   Deterioration   4.6   (3.1-­‐6.6)   2.0   (1.1-­‐3.6)   Significant   Deterioration   Turkana   West     17.4   (14.3-­‐21.0)   9.7   (7.7-­‐12.1)   Significant   Deterioration   4.6   (3.1-­‐6.6)   2.0   (1.1-­‐3.6)   Significant   Deterioration   7.8   (6.0-­‐10.2)   4.2   (3.0-­‐6.0)   Significant   Deterioration   Baringo     (East  Pokot)   21.1   (17.2-­‐25.7)   13.423   (10.8-­‐16.5)   Significant   Deterioration   3.4   (2.3-­‐5.1)   3.0   (1.7-­‐5.3)   No  Significant   Change   9.1   (6.7-­‐12.1)   7.4   5.3-­‐10.1)   No  Significant   Change   Samburu     17.3   (14.2-­‐20.9)   12.4   (10.5-­‐14.5)   Significant   Deterioration   3.3   (1.9-­‐5.4)   1.7   (1.1-­‐2.5)   Significant   Deterioration   4.1   (2.5-­‐6.7)   4.4   (3.3-­‐5.8)   No  Significant   Change   Wajir  West     20.7   (17.6-­‐24.3)   11.5   (8.5-­‐15.1)   Significant   Deterioration   3.2   (2.2-­‐4.8)   3.1   (2.0-­‐4.8)   No  Significant   Change         Wajir   East   and  South   16.8   (13.9-­‐20.2)   10.5   (7.7-­‐15.5)   Significant   Deterioration   3.1   (2.0-­‐4.7)   2.0   (1.0-­‐4.0)   No  Significant   Change   6.9   (5.0-­‐9.6)   3.6   (2.1-­‐5.9)   Significant   Deterioration   Mandera   Central   22.3   (17.8-­‐27.6)   20.6   (16.2-­‐25.8)   No  Significant   Change   4.2   (2.7-­‐6.5)   3.9   (2.0-­‐7.6)   No  Significant   Change   5.8   (4.0-­‐8.2)   8.6   (6.0-­‐12.1)   No  Significant   Change   Mandera   East   23.6   (19.0-­‐29.0)   14.6   (11.8-­‐17.9)   Significant   Deterioration   5.6   (3.3-­‐9.3)   2.7   (1.6-­‐4.7)   Significant   Deterioration         Mandera   North   27.3   (23.1-­‐32.0)   16.8   (13.4-­‐20.8)   Significant   Deterioration   5.4   (3.6-­‐7.9)   2.2   (1.0-­‐4.7)   Significant   Deterioration         Garissa     14.6   (11.8-­‐17.8)   12.0   (9.3-­‐15.5)   No  Significant   Change   2.9   (1.9-­‐4.2)   1.3   (0.8-­‐2.3)   Significant   Deterioration   4.1   (2.5-­‐6.9)   4.4   (3.1-­‐6.3)   No  Significant   Change   Tana  River   7.5   (5.3-­‐10.4)   13.8   (10.4-­‐18.0)   Significant   Improvement   0.9   (0.4-­‐2.0)   2.2   (1.3-­‐3.7)   Significant   Improvement   4.2   (2.7-­‐6.9)   4.5   (2.9-­‐6.9)   No  Change   Nairobi   5.7   (4.2-­‐7.6)       1.9   (1.1-­‐3.2)       3.3   (2.3-­‐4.3)      

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Annex 3: Estimated Caseloads February 2015 Summary

County SAM Caseloads MAM Caseloads PLW Caseloads

Turkana 11644 41490 6666 Marsabit 2149 10365 2193 Samburu 1158 7495 981 Mandera 12532 41553 10415 Wajir 5555 18315 2995 Isiolo 363 2457 645 Garissa 1634 7566 3551 Tana River 694 6172 490 Baringo 1496 9269 837 West Pokot 425 9204 1354 Kajiado 957 6539 1278 Narok 6504 4878 1583 Laikipia 1939 8852 1868 Meru North 0 9504 348 Kitui 1252 -5644 608 Makueni 1180 7866 531 Mbeere 0 1777 132 Kwale (Kinango) 477 3161 314 Kilifi 1419 3370 405 Taita Taveta 435 1034 253 Machakos 342 2454 164 Total 52,155 208,965 37,611

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Annex 4: Total Admissions by County

County Total Admissions - July to December 2014

SAM MAM PLW Turkana 2,969 9212 5287 Marsabit 1362 4916 2048 Samburu 495 1620 1129 Mandera 2160 4094 2101 Wajir 2003 4912 3585 Isiolo 207 545 457 Garissa 1832 3951 2695 Tana River 197 629 467 Baringo 705 1794 1021 West Pokot 1642 3150 1466 Kajiado 294 302 129 Narok 132 38 1 Laikipia 191 207 40 Meru north - - - Kitui 558 2504 1108 Makueni 359 740 221 Mbeere - - - Kwale (Kinango) 185 715 97 Kilifi 324 548 143 Taita Taveta 8 70 28 Total 15625 39947 22023

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Annex 5: Food Security IPC Map Food Security IPC Map

Figure

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References