NUTRITION SURVEY IN AFDER AND LIBEN ZONES (SOMALI REGION) AND BORENA ZONE (OROMIYA REGION)

Part I: Borena Zone

1. Background

Borena zone constitutes 12 administrative weredas, 6 of them (Liben, Arero, Moyale, Teltele, Yabello and Dire) are lowland areas characterized by semi-arid and arid weather; while the other 6 (Bore, Uraga, G/Abaya, O/Shakiso, H/Mariam and A/Wadera) are situated in mid/highland altitudes although there are about 69 low lying peripheral PAs in these.

The pastoral weredas widely known as the Borena rangeland accounts for 80% share of the total zonal physical area while it inhabits only 23% of the total zonal rural population.

The physiographic differences in the weredas belonging to the two-altitudinal categories have different agro-ecological conditions and therefore socioeconomic and livelihood systems.

The rainfall in both altitudinal categories is biomodal, with the main rains (belg/ganna) that contributes for 65% of annual precipitation occur in Mid March to May and the small rains (Meher/hagaya) that contributes 35% occurs around September to end of November.

Since the zone can't make available food from its own sources in a sufficient amount, it has been continually under relief food support over the years. Ten out of the total Twelve weredas of the zone were under food stress during the whole 1999 and the situation continued in the year 2000 at an increased magnitude.

The weredas worst affected are Yabello, Dire, Teltele, Arero, Liben and Moyale. The team conducted nutrition surveys in Yabello, Dire and Teltele Woredas which are the worst affected among the six pastoral PAs.

2. Findings

2.1 Nutritional Status

Nutritional status at wereda level is given in (Table 1). A more detailed breakdown of nutritional status by surveyed PAs is given in Appendix A.

Nutritional status has fallen below the 90% WFL cut-off point for emergencies in all the three weredas, namely Dire, Teltele and Yabello. In Yabello, the mean WFL (86.1%) and the percent less than 80% (19.4) are dangerously close to the serious level cut-off points (85% and 20% respectively).

In Dire, the mean WFL is 77%, the percent less than 80% WFL is 61.8 and the percent less than 70% WFL is 20.2. The level of malnutrition observed in this area is probably the most severe ever recorded from similar surveys in the country.

Food assistance including supplementary foods for children is urgently required in all the three weredas inorder to prevent further declines in nutritional status. A delay in food assistance will increase the risk of mass death, especially among the vulnerable groups.

Table 2. Nutritional status by woreda

2.2 Family profile

2.2.1 Household size and head of household

The mean household size in the three weredas is 6.6 (n=307) and the proportion of children under five years is 42.5%. The frequency of household size by wereda is given in (Table B1). Of the 307 households interviewed in the three weredas, 15% were female headed and 85% male headed (Table B2).

2.2.2 Birth rate

Among the 307 interviewed households from the three weredas, 47.6% reported that they had a new child in that household during the last 12 months. Among the three weredas the highest number of births (57.3%) was reported from Dire wereda which has also the highest level of malnutrition (Table B3).

A rough estimate of the crude birth rate among the sample population (n=2028) in the three weredas is 72 per 1000 population (94 for Dire, 64 for Teltele and 58 for Yabello) much higher than the national average.

2.2.3 Death rate

In the sample population of the three weredas (n=2028), it was reported that 57 persons died during the previous one year prior to the survey. Of the 57 deaths 37 (64.9%) were males and 20 (35.1%) were females (Table B4).

The highest number of deaths (59.7%) occurred in Dire Wereda reflecting the depressing nutritional status in the area. The proportion of under five deaths was also highest in Dire (67.7%) followed by Yabello (46.2%) and Teltele (10%). In Dire, the proportion of all under five deaths to all deaths is therefore higher than the level commonly observed in developing countries (Table B5).

A rough estimate of crude death rate among the sample population in the three weredas (n=2028) is 28 per 1000 population, significantly higher than the national average. Relatively high crude death rate was observed in Dire (51/1000 population) and low rates in Yabello (17/1000 population) and Teltele (20/1000 population).

Most of the deaths in Dire (70.6%) were attributed to starvation while in Yabello and Teltele the cause for most deaths were various diseases.

2.3 Dietary pattern

2.3.1 Current child feeding and food source

Among 196 children under two years of age in the three weredas, 93.4% were on breast milk during the time of the survey. Of those who had already stopped breast feeding (n=112) only 14.3% fed for less than one year, 42% between one and two years and 43.8% over two years (Table B6). In general, duration of breast feeding is good among mothers in the study areas.

Regarding frequency of feeding during the previous 24 hours, a total of 742 meals (n=307) were reported from the three weredas (189 meals in Dire, 268 in Teltele and 285 in Yabello). The average number of meals per household was 3.2 in Teltele, 2.5 in Yabello and 1.7 in Dire weredas. This has a correlation with the nutritional status at wereda level (Table B7).

The proportion of meals at which cereals were recorded in Dire, Teltele and Yabello were 28.6%, 56.3% and 62.1%, respectively. Similarly, the proportion of meals at which milk was recorded in Dire, Teltele and Yabello were 7.9%, 19.8% and 4.2%, respectively (Table B8). Because of poor livestock productivity, most households drastically reduced frequency and quantity of milk intake and they rather have shifted their usual dietary consumption from milk to grain.

Among 307 interviewed households in the three weredas, only 1.3% of the households (all from Teltele) responded that they are still consuming maize from their own produce while 4.9% reported depending on home produced milk. The remaining households are relying on purchased or aid food. Driven by recurrently occurring drought, those who normally consume their own grains and milk at this time of the year are now dependent on purchased and/or aid food.

2.3.2 Child feeding in normal times and food source

More than 83% of households in the three weredas (n=307) reported milk as their main food in normal times. Some of the households also consume maize (35.2%) and other combinations as shown in table B9. Out of 256 households who normally give milk to their children, only 4.6% reported that they buy milk under normal conditions. Similarly, only 1.3% of the households (n=108) used to buy maize during normal times.

2.4 Health

Type and number of health institutions by wereda is given in table C1.

In all the three weredas, immunization services (EPI) are provided in health centers and all clinics except the Mekane Yesus Clinic in Yabello town. However, the coverage of EPI in the three weredas is low (Table C2). For example, in Teltele wereda, EPI coverage is very low with 54 children fully vaccinated during the last six months. The reasons given for low coverage were lack of transportation, lack of spare parts for cold chain equipment and shortage of fund for perdiem and other expenses. Cold chain equipments at Yabello and Teltele health centers are very old and require replacement. The EPI services in all weredas will hence require further strengthening with basic equipment, spare parts, motorcycles, vaccines and funds for perdiem.

Vitamin A capsule distributions were conducted in all the three weredas during two polio vaccination campaigns. Number of children and lactating mothers who received vitamin A capsules during the latest Polio vaccination campaign is given in table C3.

Common infections, such as diarrhea and acute respiratory infections were common among the study child population. A two weeks recall was used for ascertaining the incidence of these infections. Diarrhea was reported in 36.8% of the children (n=307), cough in 39.1% and fever in 31.6% (Table C4).

2.5 Condition of water and pasture

In normal times, the majority of the study households (73.0%) in the three weredas use pond as a source of water. Another 15% of the households depend on traditional and machine dug wells while more than 12% get their water supply from unprotected spring. More than 92% of the households get their water from unprotected sources (Table D1). The proportion of households who currently changed their normal water source in the three weredas is 86% (n=307).

Normally at this time of the year, ponds were used both for livestock and human consumption. There are 79 ponds in the three weredas out of which 34 are non-functional and need maintenance (Table D3). The current situation of the ponds is very different from the normal. Due to the failure of the rains for the last four seasons, the functional ponds have already dried up. Due to this many households are forced to depend on either water rationing or have to walk for many hours to fetch water. There are 20 motorized and 32 hand pumps in Dire, Teltele and Yabello weredas (Table D4). However, three of the motorized and seven of the hand pumps are not functional.

Pasture availability in the three weredas can be generalized as extremely poor.

2.6 Livestock condition

The current livestock condition in the study weredas is very depressing in that nearly all the cattle herd has extremely poor physical condition. The most affected are cattle, especially milking cows due to their higher physiological requirement for better quality feed sources.

Among the 307 interviewed households in the three weredas, 2026 cattle and 64 shoats died during the last six months (Table E1). The average death per household is 6.8 cattle. Among the dead, calves and productive cows constitute the greater part. The team has also witnessed many carcasses of dead cattle.

On the other hand, 1457 cattle and 266 shoats were sold by the 307 households during the last six months (Table E2). The average sale per household was 6.2 for cattle and 0.87 for shoats. In normal years, the total number of cattle and shoats reportedly sold per year by the sample households was 521 and 36 respectively.

2.7 Market condition

Livestock prices in markets in the three weredas have shown a remarkable decrease compared to that of the same period in the previous year. The only exception is a significant rise in goat price observed in Yabello wereda (Table F1, F2 and F3).

Market prices of the major grains in the survey weredas displayed marked increases in February 2000 over the levels during the same period in 1999 (Table F1, F2 and F3). The prices in Teltele are relatively higher than the other two weredas because of its distance from the sources. In general, the current market condition is signaling further deterioration in the food situation of the surveyed weredas.

Part II. Liben and Afeder Zones (Somali region)

3. Liben Zone

3.1 General

Liben zone is one of the nine zones of Somali regional state located in the south east of the country about 720 km from the capital Addis Ababa.

The zone has three weredas (Liben, Dollo-Odo and Moyale). Most of the areas are arid with a temperature ranging between 30 and 40⁰c and below 1500m below sea level. The communities are mainly pastorals depending on livestock and livestock products.

Most of the time these pastoral communities are subjected to food shortage due to inadequacy of pasture and water (drought), absence of livestock market, prevalence of human and livestock diseases, and poor infrastructure and public services.

For the last two years the zone was suffering from absence of rain fall resulting considerable human suffering with insufficient means of coping the risk with their own capacity, especially during the dry season.

Out of the three weredas in the zone, Dolo-Odo is reported to be the worst affected. The nutrition survey was therefore conducted in this wereda.

3.2 Findings

3.2.1 Nutritional status

Table 3. Nutritional status at the wereda level

In all the surveyed PAs in the wereda the mean WFL is below the 90% WFL cut-off point for emergencies. In one of the PAs (Suftu) the nutritional status of children was serious (83.8%). The nutritional status of children in Kolle and Kurawa PAs was also very close to the 85% cut-off point for serious level of malnutrition (85.7 and 85.2 respectively). A more detailed breakdown of nutritional status is presented in Appendix G.

3.2.2 Family profile

3.2.2.1 Family size and head of household

The mean household size in the study population (n=844) is 7.6. The distribution by household size catagories is given in table H1. No significant association was found between household size and malnutrition.

Among the interviewed households in the woreda 17.1% are headed by female (n=111) while the remaining 82.9% are male headed.

3.2.2.2 Birth rate

Among the 111 interviewed households 18.9% had reported that a child was born into that household within the last twelve months. A rough estimate of the crude birth rate among the sample population (n=844) is 25 per 1000 population which is much lower than the national average (Table H3).

3.2.2.3 Death rate

In the sample population (n=844) there were 31 deaths during the last twelve months. Out of these 71% were males while the remaining 29% were females (Table H4).

Among the 31 deaths, 64.5% were under five children. The ratio of all under five deaths to all deaths was higher than the level (50%) common in most developing countries (Table H5).

A rough estimate of the crude death rate in the study population (n=844) is 37 per 1000 population which is much higher than the national average.

3.2.3 Dietary pattern

3.2.3.1 Current child feeding and food source

Of those who had already stopped breast feeding (n=84) 38.1% fed between 6 and 12 months, 48.8% between 12 and 24 months and 13.1% over 24 months (Table H6). The main reasons for early cessation of breast feeding are sickness of mother or child and pregnancy.

The majority of the 111 interviewed households (83.6%) reported that the index child ate 2-3 times during the previous 24 hours (Table H7). The average frequency of meals in the sample children at the date of the survey was 2.5 per day. The current frequency of meal intake was reported as "low" by 82% of the sample households compared to normal times.

Dietary pattern among the study children based on 282 reported meals during 24 hours prior to the survey is given in table H8. The proportion of meals at which tea was recorded was the highest (60.6%) followed by maize (53.2%) and milk (34.0%).

Among the 111 respondants, only 9% reported to have their own maize stock and 11.7% have also reported relying on own produce milk. The remaining households are solely dependent on purchased food and aid. Many respondents said that they rely on incomes derived from sale of cattle, sale of wood, sale of palm leaves and petty commodity production.

3.2.4 Health

The distribution of health institutions and staff in the woreda is given in table I1.

Surprisingly, immunization services (EPI) are not provided in all health institutions in the wereda during the last one year. This was reported to be due to shortage of logistics and man-power. Cold chain equipment is however available at the health center in Dolo town.

Measles epidemic have been reported in Dolo-odo town during the time of the survey. Ten cases have already been identified.

Three rounds of polio vaccination campaigns were undertaken in the wereda. However, Vitamin A capsule distribution was carried out only in Dolo and Suftu towns. EPI and Vitamin A distribution services in the wereda will hence require urgent support with logistics, vaccines and capsules.

Diarrhea, cough, fever and other infections were extremely common among the study children (n=111) in the wereda. Diarrhea was reported in 65.8% of the children in the previous two week prior to the survey. Cough was reported in 80.2% of them and fever in 80.2% (Table I2). Four measles cased were also reported among the study children.

This very high morbidity rate reported by the study mothers is apparently caused by the absence of EPI and other basic primary health services in the wereda. Any future intervention aimed at improving the nutritional status of children and mothers and consequently reducing child and maternal mortality should give priority to initiating EPI and primary health care services in the wereda.

3.2.5 Water condition

Almost all the survey population in the wereda get their water from the two perennial rivers, namely, Genale and Dawa (Table J1). All households reported that they get adequate water year round in normal times and they are still using the same water sources (Table J2)

However, 58.5% of the households (n=111) complained that the water from the river makes the family ill and 34.2% stated contamination due to sharing with animals.

3.2.6 Agropastoral crop production

Although the wereda is catagorized as a pastoral society, maize and sorghum are cultivated along the perennial Genale and Dawa rivers. This is done mainly in the form of flood retreat farming from residual moisture of the river overflow and through the use of motorized water pumps.

There are 241 motorized pumps along the two rivers (172 along Dawa and 69 along Genale river). Out of these, 90 are non-functional and need maintenance (Table J3). It was reported that NCA provided seven water pumps to the community.

There are also seasonal rain fed agricultural practices on pocket crop fields. Due to the absence of rains during the last four seasons the rain fed farms are not planted.

3.2.7 Livestock condition

The physical condition of livestock is bad especially for cattle. Camels and goats are better off, since the browse is better than pasture. Local officials and the community have reported that endemic diseases such as FMD, trypanosomiasis and tick born are pervasive. Lack of drugs and health facilities has contributed to the wide spread of these diseases.

According to the responses of the interviewed households, 281 cattle and 1442 shoats died during the last six months (Table K1). The reasons they stated are; drought 75.7% and diseases 11.7%. As goats are more resistant to drought than cattle, it is not clear why such a high number of deaths was reported for goats. It is doubtful if the question was always answered correctly.

The average sale of cattle and shoats per household (n=111) per year during normal times is 0.47 and 4.7 respectively. The current average sale per household during the last six months was 1.1 for cattle and 9.2 for shoats (Table K2).

3.2.8 Market condition

Table L1 gives detailed grain and livestock prices at Dolo town market. Cereal prices have currently shown a sharp decrease compared to last year's of this time. The main reason for this is the on-going distribution of relief grain in the wereda. Livestock prices have shown marked increases over the levels during the same period in 1999. Hence, favourable price conditions were observed in the woreda.

In light of the prevailing other influencing factors, however, this is not a good indicator of the food situation in the coming months.

4. Afder Zone (Bare and Dolobye Weredas)

4.1 General

The overall weather and rainfall condition in the zone is reported to be the worst in the past three years. The past rainy season (Deyr) was even more worst than the past three years in all aspects.

Afder zone constitutes nine administrative weredas, out of which Dolobye, Bare, Hargele and Imi weredas are hardest hit by drought compared to the rest. The team conducted its survey in bare and Dolobye out of the four severely affected weredas.

4.2 Findings

4.2.1 Nutritional status

Table 4. Nutritional status by Wereda

In both weredas nutritional status has fallen below the 90% WFL cut-off point for emergencies. The results show that five PAs of the total twelve surveyed in Bare wereda exhibit below 85% WFL which is the cut-off for serious malnutrition. The mean WFL% for one of these five PAs, namely Wed-Kal is 79.1 alarmingly lower than the cut-off point for serious malnutrition. Detailed information by PA is given in Appendix G.

4.2.2 Family profile

4.2.2.1 Frequency of household size and head of household

The average family size for Bare and Dolobye weredas (n=240) is 7.3. Frequency of household size in the study households is given in table H1. Out of the 240 interviewed households in both weredas 16.3% are headed by women (Table H2).

4.2.2.2 Birth rate

There are 90 reported births in the sample households in both weredas during the last twelve months (Table H3). A rough estimate of the crude birth rate in the sample population in both weredas (n=1752) is 51 per 1000 population. This is more or less close to the national average.

4.2.2.3 Death rate

Among the interviewed households in both weredas (n=240) 95 deaths were reported during the last one year. Among the deaths 58% were males while 42% were females (Table H4). The proportion of under five deaths of the total deaths is 75.2% (Table H5). A rough estimate of the crude death rate in the sample population is 54 per 1000 population which is much higher than the national average. Most of the deaths were caused by disease (66%) while the remaining 34% were reportedly associated with starvation. Presumably, the extremely high death rate in the, area is seemingly associated with an occurrence of an epidemic among the study child population.

4.2.3 Dietary pattern

4.2.3.1 Current Child feeding and food source

Among the children who were not on breast milk at the time of the assessment (n=173) 24.9% stopped breast feeding when then they were less than one year old. The majority of mothers 65.3% stopped breast feeding while their children were between one and two years. Only 8.1% of the mothers breast fed beyond two years (Table H6).

Regarding frequency of feeding, 40% of the mothers (n=120) in Bare wereda reported feeding their children only once during the previous 24hrs. In Dolobye (n=120) only 4.2% fed their children once a day based on a 24 hours recall. This is in agreement with the observed level of malnutrition in the two weredas. Detailed information on the frequency of feeding is given in table H7.

In Dolobye wereda, based on 292 meals in a 24hrs dietary recall (n=120) the proportion of meals at which cereals were recorded was 65.4%. Milk and tea appeared in 23.6% and 25.7% of the meals, respectively. Wild fruit was reported in 2.4% of the meals (Table H8).

In Bare wereda, the total number of meals reported in a 24hrs. recall were 203. Out of these, the proportion of meals at which cereals were recorded was 84.7%. Milk occurred only in 6.4% of the meals (Table H8). This dietary information indicates that the food shortage problem is more pronounced in Bare than Dolobye wereda.

Among the interviewed mothers in Dolobye (n=120) only 6.7% reported that they are still getting maize from their own stock and 17.5% were consuming milk from their own produce. The remaining households get food either from the market or through food aid. Those who buy food get the money from sale of livestock, sale of vegetables, petty commodity production and sale of firewood.

In Bare, almost all households (n=120) reported that they have no food stock from their own produce. More than 93% of the households are currently depending on food aid. A considerable number of households, however, get some income from sale of incense.

4.2.3.2 Child feeding in normal times and food source

The majority of households in both weredas (n=240) reported that maize and sorghum are the main foods they give to their children normally (Table H9). Almost all households stated that they normally give milk to their children every day. At present, nearly all who used to give milk to their children have turned into other low quality foods. More than 32% of the mothers (n=240) also stated that they frequently give meat to their children in normal times. Egg was not, however, mentioned by any household as part of child diet in normal times. These findings revealed that there is a remarkable shift from nutritionally rich animal source foods to cereals.

4.2.4 Health condition

Bare and Dolobye weredas are served by one clinic each and a total of three health personnel (Table I1).

In both weredas, immunization (EPI) and other primary health services are not currently provided. Vitamin A capsule distribution has not also been conducted in both weredas. In general, the current status of health services in the area is very depressing and needs the immediate attention of all concerned bodies. Initiating other interventions in the absence of basic health services will have minimal impact on the well being of the communities in the area.

In Dolobye wereda, based on a two weeks recall, Diarrhoea, cough and fever were reported in 68.3%, 74.2% and 80% of the study children (n=120), respectively. Similarly, incidence of diarrhoea above 57%, cough 85% and fever above 80% were reported among the sample children (n=120) in Bare wereda (Table I2).

4.2.5 Water condition

In Dolobye wereda all the sample households (n=120) normally get their water supply from Genale and Web rivers (Table J1). As web river has already dried up 22.5% households have changed their water source (Table J2).

In Bare wereda (n=120) 91.6% of the households normally get their water supply from unprotected well while 8.3% use pond as their water source (Table J1). More than 83% reported that they get enough water throughout the year during normal times. More than 91% of the households still use the same water sources (Table J2). However, most households complained that they are forced to share the same water source with animals and the water has bad smell. Inaddition, 58% of the households stated that they walk long distances to obtain their household daily water supply.

4.2.6 Agropastoral crop production

Maize and sorghum are cultivated along the perennial rivers, Web and Genale. This is carried out using residual moisture of the river overflow and through the use of motorized pumps. There are also pocket crop fields that totally depend on rains.

There are 66 water pumps at 14 PAs in Dolobye wereda. At the moment, 16 of them are not functional (Table J3). NCA has provided two water pumps to communities living along the Genale river.

Many community members and local leaders raised a strong desire for initiating crop cultivation if pumps are provided either freely or at low cost. The team was able to observe pump irrigated maize and vegetable fields in Dolobye wereda.

4.2.7 Livestock condition

The physical condition of livestock is poor in both weredas. Camel and goat are relatively better compared to cattle.

Anthrax, FMD and pasteurellosis are the major livestock diseases frequently reported in the two weredas. The poor veterinary service in the area has partly contributed to cattle mortality and sickness.

The total number of reported animal deaths during the last six months among study households (n=240) in Dolobye and bare weredas was 1016 cattle and 2450 shoats (Table K1). Most of the deaths were attributed to the prevailing drought. Diseases have also been blamed as important causes of livestock deaths in the area.

The drought condition over the last three seasons had caused disposal of a large number of cattle and shoats that led to a significant reduction in hard size of the pastoralists. The average sale of livestock (both cattle and shoats) per household in a normal year was reported to be 3.2 (n=120) in Dolobye and 5.3 in Bare. The average sale per household during the last six months increased to 3.7 for Dolobye and 7.7 for Bare (Table K2).

4.2.8 Market condition

As both communities in Dolo-odo and Dolobye weredas use the same market in Dollo town, market price data for the two weredas are similar.

In Bare wereda, livestock prices have either shown a significant improvement or remained stable. The exceptions are cow and female sheep (Table L2).

As regards cereal prices, maize and wheat exhibited a significant decline compared to last year's price in February. This is probably due to the relief food distribution undergoing in the area.