GOAL ETHIOPIA by shs19146

VIEWS: 85 PAGES: 32

									       GOAL ETHIOPIA




FINDINGS OF NUTRITION SURVEY
BORANA ZONE-OROMIA REGION
     JUNE 12th – 26th, 2000




                JANE BLACKHURST
                GOAL NUTRITIONIST
                     ADDIS ABABA
                        JULY 2000
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




                  LIST OF ABBREVIATIONS


    CBR     Crude Birth Rate

    CDC     Centre for Disease Control

    CMR     Crude Mortality Rate

    DPPC    Disaster Prevention and Preparedness Commission

    GAM     Global acute malnutrition (<-2 Z-scores W/H +/- oedema)

    MoH     Ministry of Health

     MSF    Médecins Sans Frontières

    MUAC    Mid-upper arm circumference

    NCHS    National Centre for Health Statistics

     PA     Peasant Association

    SAM     Severe acute malnutrition (<-3 Z-scores W/H +/- oedema)

    UNHCR   United Nations High Commission for Refugees

    WFP     World Food Programme

    W/H/L   Weight for height or length as a percentage of the median

    WHO     World Health Organisation
4




                                       TABLE OF CONTENTS


1.0       EXECUTIVE SUMMARY ...................................................................... 1
    1.1 OBJECTIVES ........................................................................................... 1
    1.2 METHODOLOGY ...................................................................................... 1
    1.3 RESULTS ................................................................................................ 2
      1.3.1 Nutritional indices of children 6-59 months (65-110cm W/L/H)...... 2
      1.3.2 Nutritional indices of a convenience sample of elderly people ...... 2
      1.3.3 Food security................................................................................. 2
    1.4 CONCLUSIONS ........................................................................................ 3
    1.5 RECOMMENDATIONS ............................................................................... 3

    2.0 INTRODUCTION AND BACKGROUND INFORMATION ....................................... 5

    3.0 OBJECTIVES ........................................................................................... 5

    4.0 METHODOLOGY ...................................................................................... 5
      4.1 Sampling Method .............................................................................. 5
      4.2 Sample size....................................................................................... 6
      4.3 Sample Population ............................................................................ 6
      4.4 Data collected ................................................................................... 6
      4.5 Team Composition ............................................................................ 7
      4.6 Implementation ................................................................................. 7

    5.0 RESULTS ................................................................................................ 8
      5.1 Demographic Distribution.................................................................. 8
      5.2 Nutritional status by z-scores and percentage of the median............ 8
      5.3 Levels of Malnutrition in the Elderly................................................. 10
      5.4 Food security .................................................................................. 11

    6.0 LIMITATIONS ......................................................................................... 15

    7.0 CONCLUSIONS ...................................................................................... 15

    8.0 RECOMMENDATIONS ............................................................................. 15

    REFERENCES ............................................................................................... 18
5




                                          LIST OF TABLES

TABLE 1 HOUSEHOLD DEMOGRAPHY ..........................................................................8

TABLE 2 DISTRIBUTION OF SAMPLE BY AGE AND SEX....................................................8

TABLE 3 NUTRITIONAL STATUS - CHILDREN 6-59 MONTHS OR 65-110CM W/L/H............8

TABLE 4 PREVALENCE OF MALNUTRITION BY AGE CATEGORY .......................................9

TABLE 5 PREVALENCE OF MALNUTRITION BY WOREDA ................................................9

TABLE 6 MEAN WEIGHT/LENGTH/HEIGHT BY W OREDA ..................................................9

TABLE 7 PREVALENCE OF GLOBAL MALNUTRITION BASED ON MAIN PRE- DROUGHT
        LIVELIHOOD STATUS ...................................................................................10

TABLE 8 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                   MAP OF SURVEY AREA

APPENDIX 2                   SURVEY QUESTIONNAIRES

APPENDIX 3                   ANALYSIS OF MALNUTRITION BY CLUSTER
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
12-26th 2000.


1.1      Objectives

§     To quantify the nutritional status of children aged 6-59 months or between
      65-110cm 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 65-110cm.
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 1982.

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
 2




 1.3    Results

 1.3.1 Nutritional indices of children 6-59 months (65-110cm W/L/H)

                            Sample by age and sex
 SEX                        No.                   % of sample
 Male                       976                   51.4
 Female                     922                   48.6
                                Ratio M:F 1.06:1

 Nutritional status of children between children 56-59 months or between
                           65-110cm length/height
Anthropometric Indices                        No.      %    95% CI*
Z-Scores (Weight for height/length)
> 2 Z-scores (obese)                              20        1.0    0.9996-1.004
-2.0 to 2.0 Z-scores (normal)                     1655      87.2   86.185-88.215
-3.0 to <-2.0 z-scores (moderate malnutrition)    199       10.5   10.486-10.514
<-3 z-scores or oedema (SAM)                      24        1.3    1.295-1.305
Total <-2 Z-scores or oedema (GAM)                223       11.8   11.785-11.815
% of the median (Weight for height/length)
<80% or oedema =GAM                               141       7.4    7.388-7.412
<70% or oedema = SAM                              6         0.3    0.298-0.302
Mean weight for length                                      94.5   SD 37.4
            *95% confidence intervals with calculated cluster effect
     GAM = Global acute malnutrition       SAM =Severe acute malnutrition

 1.3.2 Nutritional indices of a convenience sample of elderly people

 Classification of Muac         Nutritional Status           No.        %
 Measures
 Above 24cm                     Normal weight                50         22.7
 23.1-24cm                      Mild malnutrition            29         13.2
 22.1-23 cm                     Moderate malnutrition        38         17.3
 Below 22cm                     Severe malnutrition          103        46.8
 TOTAL                                                       220        100
 Total Malnourished                                          170        77.3

 1.3.3 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
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 20001 (Norwegian Church Aid et al, 2000) and April 20002 (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
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 agro-
    pastoralists 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
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 semi-
arid 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
      65-110cm 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
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 65-110 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
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 double-
      checked 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 12-26th 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
  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 1982.

  5.1     Demographic Distribution

  5.1.1 Household Level
  Table 1       Household demography
  No of            Total          %                       % Aged 5-55    % Elderly
  Households       population     Under-fives             years          (55+ years)
                                  No     %                No    %        No     %
  1,103            7,173          2,088 29.1              4,713 65.7     372    5.2

  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)

  5.1.2 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          394      20.8           378      19.9          772      40.7
  30-59 months         582      30.7           544      28.7          1126     59.3
  TOTAL                976      51.4           922      48.6          1898     100.0


  5.2     Nutritional status by z-scores and percentage of the median
  Table 3       Nutritional status - children 6-59 months or 65-110cm W/L/H
Anthropometric Indices                                No.      %        95% CI*
Z-Scores (Weight for height/length)
> 2 Z-scores (obese)                                  20       1.0      0.9996-1.004
-2.0 to 2.0 Z-scores (normal)                         1655     87.2     86.185-88.215
-3.0 to <-2.0 z-scores (moderate malnutrition)        199      10.5     10.486-10.514
<-3 z-scores or oedema (*SAM)                         24       1.3      1.295-1.305
Total <-2 Z-scores or oedema (*GAM)                   223      11.8     11.785-11.815
% of the median (Weight for height/length)
<80% or oedema =GAM                                   141      7.4      7.388-7.412
<70% or oedema = SAM                                  6        0.3      0.298-0.302
Mean weight for length                                         94.5     SD 37.4
              95% confidence intervals with calculated cluster effect
      *GAM = Global acute malnutrition      *SAM =Severe acute malnutrition

                                           8
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).

5.2.1 Malnutrition by age

Table 4      Prevalence of malnutrition by age category

Anthropometric Indices     6-29            95% CI*       30-59      95% CI*
                           months                        months
Z-Scores (W/H/L)
-3.0 to <-2.0 z-scores     5.11            5.1-5.12      5.37       5.360-4.380
<-3 z-scores or oedema
(*SAM)                     0.84            0.836-0.840   0.42       0.417-0.423
Total <-2 Z-scores or
oedema (*GAM)              5.95            5.939-5.961   5.80       5.788-5.812
% of the median (W/H/L)
<90% W/H                   17.4            17.383-       21.5       21.482-21.518
<80% or oedema =GAM        4.8             17.417        2.6        2.593-2.607
<70 or oedema = SAM        0.3             0.298-0.302   0.1        0.99-0.11

All the severely malnourished children >-3SD were aged between 12-48
months. Of these, 66.7% were in the 6-29 month category.


5.2.2 Malnutrition by sex
There was no significant difference between nutritional status and sex in
either age category.

5.2.3 Malnutrition by location
Table 5      Prevalence of malnutrition by woreda
Woreda     Global acute malnutrition        Severe acute malnutrition
           No      %      95% CI            No.      %         95% CI
Yabello    107     11.2   11.18-11.22       10       1.0       0.996-1.004
Teltele    116     12.3   12.28-12.32       14       1.5       1.495-1.505
           95% 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                    94.1                          30.9
Teltele                    95.0                          43.1




                                       9
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.

5.2.4. 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 pre-
             drought livelihood status
Livelihood         No. Globally malnourished      % Globally malnourished
Agriculturist                  45                            20
Agro-pastoralist              158                            71
Pastoralist                    11                             5
Table 8      Prevalence of severe acute malnutrition based on main pre-
             drought livelihood status
Livelihood         No. Globally malnourished      % Globally malnourished
Agriculturist                   5                           20.8
Agro-pastoralist               18                            75
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                    50       22.7
23.1-24cm                    Mild malnutrition                29       13.2
22.1-23 cm                   Moderate malnutrition            38       17.3
Below 22cm                   Severe malnutrition             103       46.8
TOTAL                                                        220       100
Total Malnourished                                           170       77.3

A high percentage of the elderly measured were malnourished (77.3%), and
46.8% of this malnutrition was severe.




                                      10
11




5.4       Food security

5.4.1 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)                                    934                 84.7
Of the 89.5% receiving aid:
Receiving General Ration                                    670              60.7
Receiving supplementary food                                770              69.8
Receiving General & supplementary                           578              52.4

5.4.2 Food Sources
Table 11           Cereal sources pre-drought and currently
        Source          Pre-drought                        Current
      Pre-drought           % of        Aid only       Aid & Market       Market only
                        communities                                           %
     Home-grown             67.3             36.7            28.6             2
     Combination            32.7             14.3            12.2            6.1
       grown &
      purchased
        Total               100              51              40.8             8.1

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        None         Own        Purchased      Own &
                      communities                 animals                  purchased
     Own animals          95.9        54.3         23.9           19.6        2.2

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
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.

5.4.3 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                    820                 75.1%
Agriculturist                       161                 14.7
Pastoralist                         65                  6.0
Petty trader/merchant               33                  3.1
Other                               13                  1.2
Total Households                    1092                100

5.4.4. 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                                        916       83.0
sell firewood/charcoal                     352       31.9
Sell animals (mainly goats)                182       16.5
Sell water                                 166       15.0
Daily labour                               156       14.1
Petty trader                               54        4.9
Sell milk                                  54        4.9
Merchant                                   53        4.8
Sell grass                                 40        3.6
Gold mining                                16        1.5
Migrate – send money                       34        3.1
Nothing - no aid                           24        2.2
Sell agricultural produce                  14        1.3
Migrate – no money                         12        1.1
Sell soil/building materials               7         0.6
Other                                      77        7.0

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
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.

5.4.5 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.

5.4.6 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
14




5.4.7 Land holdings
Table 15     Landholdings per household
Land (hectares)            No                      %
<1                         365                     33.6
1-<5                       545                     50.2
5-10                       29                      2.7
> 10                       9                       0.8
None                       138                     12.7
 The average amount of land per household is quite small and those who do
not own land rent small areas from the Government.

5.4.8 Effects on Health

5.4.8.1      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).

5.4.8.2      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).

5.4.8.3      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        160                       45.5
Common Cold                65                        18.5
Fever                      42                        11.9
Skin infection             20                        5.7
Eye infection              19                        5.4
Malaria                    6                         1.7
Other                      40                        5.6
TOTAL                      352                       100
*The occurrence of these illnesses was not medically diagnosed.

                                     14
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 20005 (Norwegian Church Aid et al , 2000) and April 20006 (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
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
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 agro-
     pastoralists 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
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
 APPENDIX 1

MAP OF SURVEY AREA

   (not available)
APPENDIX 2
                                 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
4    2-3 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)
         1           2               3              4              5              6

7.       What kinds of foods did the child eat yesterday excluding breast? (tick all foods eaten)

         KEY                   1                     2                       3                     4
     Source               Own produce            Purchased             Aid (specify         Other (specify)
                                                                         donor)

     Type of food          Eat         Usual   Sour         Type of food             Eat    Usual     Sour
                            en         food     ce                                    en    food       ce
                                        Y/N    (1-4)                                         Y/N      (1-4)
Maize                                                   Dairy          products
                                                        (milk,butter)
Wheat                                                   Vegetables
Barley                                                  Fruit
Teff                                                    Wild     foods   (roots,
                                                        berries)
Sorghum                                                 Other (specify)
Beans/pulses
Eggs
Meat
                                   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           1               2               3                 4               5
       AGE         0-12 months        13-36       37-59 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     NUTRITIONAL
                                                                     meals/day       STATUS
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
                              COMMUNITY INTERVIEW QUESTIONNAIRE

                                             IDENTIFICATION

Survey date: ____________              Cluster No: ______ Woreda: ___________
PA ____________________                Ketena __________ Ola _______________
No of households: ________                   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                                        Other (specify)
Shortage of water
Disease: (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
FOOD CONSUMPTION & SECURITY

9.      What are the main foods consumed in this area in good times?
        KEY                  1                    2                   3                               4
       Source          Own produce           Purchased        Aid (specify donor)              Other (specify)

      Type of food        Eaten        Source                 Type of food             Eaten          Source
                                        (1-4)                                                          (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                  1                   2                   3                     4
       Source           Own produce         Purchased         Aid (specify donor)    Other (specify)
      Type of food      Eate        Source            Type of food             Eaten        Source
                           n         (1-4)                                                    (1-4)

Maize                                                 Dairy             products
                                                      (milk,butter)
Wheat                                                 Vegetables
Barley                                                Fruit
Teff                                                  Wild foods (roots, berries)
Sorghum                                               Other (specify)
Beans/pulses
Eggs
Meat


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:
         1.      ________________________            ________________________
         2.      ________________________            ________________________

13.      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
APPENDIX 3
                           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            1           4            63         6.3


Teltele     Jerarsa           2           10            65         15.4

Teltele     Bullo Danbi       3            5            63         7.9

Teltele     Billa             4           10            63         15.9

Teltele     Kulcha            5            8            61         13.1
Teltele     Kulcha            6            7            65         10.8
Teltele     Kulcha            7            7            63         11.1
Teltele     Folatelle         8           12            60         20.0
Teltele     Folatelle         9            5            65          7.7

Teltele     Folatelle         10           8            63         12.7

Teltele     Ibsa              11           8            61         13.1
Teltele     Ibsa              12          10            65         15.4
Teltele     Watwonto          13           6            65          9.2
Teltele     Millemii          14           9            55         16.4
Teltele     Millemii          15           7            65         10.8
Yabello     Gegna             16           3            60          5.0
Yabello     Gegna             17           2            65          3.1
Yabello     Gegna             18           2            62          3.2
Yabello     Surupa            19           1            57          1.8
Yabello     Surupa            20           2            65          3.1
Yabello     Bildim Rasso      21          11            65         16.9
Yabello     Towayo            22           4            65          6.2

Yabello     El Wayo           23           9            64         14.1
Yabello     Derito            24           7            64         10.9
Yabello     Derito            25           8            64         12.5
Yabello     Yubda             26           6            65          9.2
Yabello     Obda              27           6            65          9.2
Yabello     Didyabello        28          17            65         26.2

Yabello     Didyabello        29          13            65         20.0
Yabello     Didyabello        30          16            65         24.6
            TOTAL                                      1898

								
To top