Notes from the Field: Malnutrition and Mortality --- Southern Somalia, July 2011

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In July 2011, the internationally supported Food Security and Nutrition Analysis Unit --- Somalia* conducted nutrition and mortality surveys across 17 livelihood zones† in southern Somalia to assess the impact of 18 months of insecurity and drought, which have resulted in crop failure, livestock mortality, increased cereal prices, and widespread malnutrition. On July 14, CDC was asked to assist with analyzing the survey data. This report describes the results of that analysis.

Fifteen of the 17 surveys were conducted using standardized monitoring and assessment of relief and transitions (SMART) methodology, which incorporates standard guidelines, questionnaires, and a software package to assess data quality (1). The remaining two surveys employed lot quality assurance sampling (LQAS), a method to assess whether a health condition in a given population exceeds a critical threshold. As of August 1, surveys in 15 livelihood zones (13 using SMART and two using LQAS) had been assessed for data quality using emergency nutrition assessment software (2). Prevalence of global acute malnutrition (GAM) was estimated using World Health Organization growth standards (3). Crude mortality rates (CMRs) and mortality rates for children aged <5 years were calculated using the most recent population estimates available (4).

Prevalence of GAM was >20% in all 15 livelihood zones analyzed (Figure). In 11 of the 15 zones, GAM exceeded the famine threshold of 30% (range: 39%--55%). In four zones, CMR exceeded the famine threshold of 2 deaths/10,000 population per day (range: 2.2--6.1); in all zones, the mortality rate among those aged <5 years ranged from 4.1 to 20.3 deaths/10,000/day. Survey results for three zones (Lower Shabelle Agropastoral, Afgooye [internally displaced persons], and Bakool Agropastoral) were beyond the famine thresholds for both GAM and CMR (Figure) and therefore were classified as Famine/Humanitarian Catastrophe on the integrated food security phase classification scale (5).

The current situation, with extremely high levels of acute malnutrition and mortality, represents the worst nutrition crisis in Africa since the 1991--1992 famine in Somalia. Because the harvest season is still months away, the severe nutrition crisis is likely to spread across southern Somalia in the coming months. An opportunity exists for the international community to improve nutrition and prevent additional deaths. Priority interventions must focus on ensuring improved access to food and nutrition and health-care services.

Reported by

Grainne M. Moloney, Elijah O. Odundo, Louise M. Masese, Ahono R. Busili, Tom J. Oguta, Joseph M. Waweru, Mohamed A. Borle, Abukar Y. Nur, Food Security and Nutrition Analysis Unit --- Somalia. Leisel E. Talley, MPH, Jeffrey D. Ratto, MPH, Curtis Blanton, MS, Michael L. Gerber, MPH, Mark A. Anderson, MD, Kashef Ijaz, MD, Scott F. Dowell MD, Div of Global Disease Detection and Emergency Response, Center for Global Health, CDC. Corresponding contributor: Mark A. Anderson, manderson@cdc.gov, 770-488-0689.

Acknowledgments

Mohamed Moalim, Bashir Osman, Mohammed Haji Nur, Ibrahim Mohamud Mohamed, Abdikarim Aden, Hussein Hirey and Mohammed Hussein Nur, Food Security and Nutrition Analysis Unit --- Somalia.

References

1. Standard Monitoring & Assessment of Relief & Transitions (SMART). Measuring mortality, nutritional status, and food security in crisis situations: SMART methodology version 1, April 2006. Available at http://smartmethodology.org/images/stories/SMART_Methodology_08-07-2006.pdf. Accessed August 1, 2011.
2. CDC. Emergency nutrition assessment software. Atlanta, GA: US Department of Health and Human Services, CDC; 2011. Available at http://www.cdc.gov/globalhealth/gdder/ierh/researchandsurvey/enasoftware.htm. Accessed August 1, 2011.
3. World Health Organization. The WHO child growth standards. Geneva, Switzerland: World Health Organization; 2011. Available at http://www.who.int/childgrowth/en/index.html. Accessed August 1, 2011.
4. Food Security and Nutrition Analysis Unit. Total population in acute food and livelihood crisis (AFLC), humanitarian emergency (HE) and famine in Somalia. Available at http://fsnau.org/downloads/Total%20Population%20in%20AFLC%2C%20HE%20and%20Famine%20in%20Somalia.pdf. Accessed August 1, 2011.
5. IPC Global Partners. Integrated food security phase classification technical manual. Version 1.1. Rome, Italy: Food and Agriculture Organization of the United Nations; 2008. Available at http://www.fao.org/docrep/010/i0275e/i0275e.pdf. Accessed August 1, 2011.