Seasonal Trends in Pastoral Malnutrition in Somalia

By Louise Masese Mwirigi and Joseph Waweru

Ms Lousie Masese-Mwirigi works as a Nutrition Analyst for the Food and Agriculture Organization of the United Nations (UNFAO) - Food Security and Nutrition Analysis Unit (FSNAU), Somalia. A post-graduate of nutrition, she has over eight years of experience in conducting food security and nutrition assessments in addition to monitoring and evaluation activities, especially in Somalia, Kenya and in the East Africa region. She has worked previously with WFP, Kimetrica International, UNICEF and Feed the Children.

Joseph Waweru is a Nutrition Analyst in FSNAU Unit of the UNFAO in Somalia, where he has worked for the last six years. A post-graduate of nutrition, he has over five years of experience in conducting multi-sectoral assessments, surveillance and analysis mainly in nutrition, food security and livelihoods. He is also the technical focal point on infant and young child feeding.

The co-authors would like to express sincere thanks to Grainne Moloney, Chief Technical Advisor for her technical input and guidance and the Nairobi nutrition team, Tom Oguta, Mohamed Borle, Abukar Yusuf and Ahono Busili for review of the article, Matilda Kosgey for assisting with analysis and Nura Gureh, Fuad Hassan, Osman Warsame, and Abdullahi Warsame for data collection in the field. We also thank the local authorities of Somaliland for all the logistical support in sanctioning these studies.

The Food Security and Nutrition Analysis Unit (FSNAU) is a project managed by the Food and Agriculture Organization of the United Nations (UN-FAO). The overall purpose of the project is to ensure a broad range of stakeholders have access to timely and accurate food security, nutrition and livelihood information for improved emergency response and development planning. This empowers communities, agencies and authorities in Somalia, as well as the international aid community, to respond appropriately in a country that has suffered nearly two decades of political instability. FSNAU activities.

FSNAU's activities primarily revolve around continuous monitoring through data collection and analysis of relevant food security, nutrition and livelihood information, in addition to applied research on underlying causes of chronic food and nutrition insecurity. Information is collected by a team of FSNAU professionals, strategically located all over Somalia, who process it through an integrated database and information management system. In addition to food security assessments, FSNAU conducts continuous nutrition surveillance at livelihood level through the collection and analysis of data from nutrition assessments, health information systems (105 mother and child healthcare centres are monitored throughout the country) and targeted feeding centre statistics. Furthermore, reliable and relevant population information such as disease outbreaks, child care and feeding practices (dietary diversity, meal frequency, breastfeeding, etc), vaccination status, public health indicators and civil insecurity data are also collected and analysed for a clear understanding of causal factors affecting the nutrition situation of the population.

Nutrition assessments and analysis are conducted biannually succeeding the two main rainfall seasons - namely the Gu (long rains, April to June) and Deyr (short rains, October to December) seasons. This results in an integrated analysis of the situation communicated cartographically (in map form). Information on the latest food security and nutrition situation is shared with stakeholders via the FSNAU website (www.fsnau.org), meetings and presentations and through technical publications such as the Food Security and Nutrition Briefs, Nutrition Updates and Technical reports. Analysis from routine nutrition surveillance activities guides FSNAU in identifying potential areas for further research to better understand the main underlying causes of malnutrition, in order to advocate for appropriate response in Somalia.

Milk, migration and malnutrition

A woman in search of water

The main livelihood systems in Somalia are pastoral, agro-pastoral and riverine, which rely on adequate rainfall. Given 20 years of conflict, these systems are highly vulnerable to shocks, such as consecutive seasons of rain failure, drought, floods and inflation. These have a direct impact on the food security and nutrition situation of the population. The population in Somalia is faced with a chronic nutrition crisis, with global acute malnutrition rates (GAM) in most parts exceeding the emergency threshold of 15%.

One of the main contributing causes of malnutrition in Somalia is co-morbidity. However, it has been observed among the pastoral population especially, that when access to milk is reduced, acute malnutrition rates in that population tend to increase. Rates recover when milk access is increased. This is attributed to the fact that pastoral populations mainly rely on the consumption and sale of animals and animal products such as milk for subsistence and commercial purposes. Milk, the predominant food among the pastoral population, is a good source of high quality protein and micronutrients and an important contributor to the total energy intake of individuals. Consequently, increasing the intake of milk is protective against acute malnutrition as well as stunting in young children¹. Studies conducted amongst other pastoral populations in Eastern Africa have noted the important contribution that livestock milk makes to the energy and nutrient requirements of pastoral populations, especially children. This observed relationship between seasonality and acute malnutrition rates among the pastoral population prompted FSNAU to conduct detailed analysis to understand the main influencing factors affecting malnutrition in different seasons.

In a normal dry season, pastoralists migrate within their region in search of pasture and water as they await the seasonal rains. During this normal migration, the entire household will migrate together. Hence all the household members will continue to benefit directly from livestock products. In situations where the area has experienced consecutive seasons of rainfall failure resulting in scarcity of water and inadequate pasture, pastoral populations cope through abnormal migration out of their region. Abnormal migration is an extreme coping strategy and often results in families splitting up so that the women and young children are left behind with a few lactating or weak animals. Meanwhile, the adult men and adolescent boys move great distances to areas outside their region in search of water and pasture for their livestock. This splitting up of families negatively impacts the food security and nutrition situation of the household. The vulnerable groups left behind consequently experience reduced access to food, milk and animal products and the income associated with livestock migration. Household food consumption decreases with reduced income from the sales of milk and animal products that are normally used to supplement food and buy non-food items. Furthermore, with the limited milk available, market prices for milk rise.

This reduced consumption of milk and household income directly impacts on the nutritional status of the children, as has been observed in the presented case of the West Golis/Guban pastoralists.

The case of West Golis/Guban pastoralist population

A woman milking a goat

The pastoral livelihood zone of West Golis/Guban (goat, camel and sheep rearing) encompass the coastal plains and highlands of north-west Somalia. FSNAU conducted two repeat nutrition assessments among the West Golis/Guban pastoral population. The first took place during the drought in the Deyr '08/09 season (October 2008), and the second during a rainy season Gu '09 (June 2009).

Both assessments used probability proportionate to size sampling methodologies. The results were compared to observe the main factors affecting acute malnutrition during both seasons. Specifically, GAM and SAM rates, dietary diversity, morbidity pattern, meal consumption, milk consumption and milk prices recorded in two seasons were compared (see Table 1 for summary of main findings).

Devr 2008

Prior to the Deyr 2008/09, animals from the West Golis/Guban livelihood zone had abnorDevr 2008 Prior to the Deyr 2008/09, animals from the West Golis/Guban livelihood zone had abnormally out migrated southwards to Awdal and Galbeed regions, due to four consecutive seasons of poor rainfall. In addition, an outbreak of livestock disease resulted in high deaths of sheep and goat, reducing livestock holdings. The overall impact was a reduction in household food access to, and consumption of, milk. The nutrition survey conducted in October 2008 indicated a global acute malnutrition rate of 22.3% and a severe acute malnutrition rate of 6.6 %, indicating a Very Critical² nutrition situation. The proportion of households that reported consuming milk everyday was only 33%, moreover the cost of milk was high, with 1 litre of milk costing 3,500 Somaliland shillings ($0.6) at the local markets. The overall household dietary diversity was Critical³, with 23.6% of the households assessed consuming less than 4 food groups in a day, whilst the proportion of households consuming at least three meals a day was less than half of the population (47.7%). In addition to the precarious food security situation negatively impacting on the nutritional status of the vulnerable pastoral population, the proportion of children assessed who had suffered from diarrhoea in October 2008 was high at 28.6%. During periods of water scarcity, the population consume unsafe water predisposing them to diarrhoea and further risk of acute malnutrition.

Gu 2009

Fortunately, the Gu 2009 rainy season was normal. The area received adequate rainfall that increased water and pasture availability, and prompted the migration of livestock back to the area. Additionally, livestock from other areas, namely Shiniile bordering zone five of Ethiopia and Djibouti, also migrated to the West Golis/Guban livelihood zones. This resulted in improved household availability and consumption of milk and animal products. The nutrition survey conducted during this rainy season in June 2009 indicated a marked improvement in the nutritional status of the population, with a global acute malnutrition rate of 13.3%, and a severe acute malnutrition rate of 2.5 %, indicating a serious nutrition situation. Household milk consumption had significantly increased, with 60.4% of the households reported to be consuming milk. The price of milk in the local markets had also decreased with a litre of milk being sold at 1,500 SL shillings. The overall dietary diversity also improved in the wet season with only 13.5% of the households reportedly consuming less than 4 food groups a day. The proportion of households consuming at least three meals a day also increased to 67.7%. Furthermore, water availability and access improved in the area, with resultant decline in the incidence of reported diarrhoea, compared to the Deyr '08/09.

Milk consumption and acute malnutrition prevalence

During the drought period, analysis shows that children from households where milk was not consumed were about one and half times (RR= 1.36, CI:1.14-1.64) more likely to be acutely malnourished. Results also indicate that a significantly higher proportion (p= ?0.000) of households consumed milk during the wet season compared to the drought period. Milk prices were also significantly higher during the drought compared to the wet season when milk is available on the market, the prices are lower and more households are able to access milk. This situation is reversed during the drought when lack of income and reduced food supply increases prices in the market, leading to a less diversified diet. When livestock migrate in the normal manner, milk is available more readily, at household level and at the market. Milk prices were lower during the wet season. Furthermore, households were able to sell animals and animal products (such as milk) at a good price because their body condition was good. Therefore they were able to access income to purchase food. During the drought, food prices were generally higher, coupled with lowered income from the reduced livestock and milk sales. Furthermore, there was an increased proportion of households adopting coping strategies, e.g. reliance on social support from relatives and borrowing of food. The data demonstrates clearly that the increased consumption and availability of milk to the household during the dry season does affect the nutritional well being of household members.

Morbidity

Analysis also revealed that the morbidity rates reported during the drought were higher than those reported in the wet season. Diarrhoea was the most reported disease and a major factor aggravating high acute malnutrition rates among the children assessed. The total morbidity reported in the drought season was 37.4% compared to 16.2% reported during the wet season. Diarrhoea remained the main illness in both periods, although a significantly lower proportion of children suffered from diarrhoea during the wet season (10.8%) compared to the dry season (28.6%). This could be attributed to the fact that during the wet season, there is water available in the usual water catchments, reducing the risk of children consuming contaminated water. Furthermore, during droughts, women have to travel long distances in search of water for domestic uses, reducing the standard of childcare and feeding practices, as young children are often left in the care of their slightly older siblings or very elderly relatives. The improvement in the morbidity rate in the wet season was therefore due to availability of water, improved nutrition status and its impact on immunity against diseases. In addition, when the Very Critical nutrition situation was reported in the Deyr '08/09, it prompted humanitarian interventions in the area. UNICEF, Ministry of Health, World Vision and SRCS implemented selective feeding and health programmes which mitigated the poor nutrition situation in the livelihood Zone. Child Health Days were also conducted in the region. This included activities such as immunisation, vitamin A supplementation, deworming and screening of children.

Conclusions

The case of West Golis/Guban is a clear illustration that milk availability and consumption has a very significant influence on the nutritional status and well being of the pastoralist population. It also demonstrates the natural ability of a pastoral population to recover from non cumulative shocks if appropriate responses are made in a timely manner. In addition to the more immediate nutrition and health interventions conducted, it is important to incorporate programmes that decrease the population's vulnerability to natural shocks. Programmes that highlight and address the issues related to the welfare of women, especially in situations where families have been split up during periods of abnormal migration, are crucial. Livestock and water intervention activities are also key, e.g. vaccination of livestock, destocking during the drought periods and restocking after drought, provision of livestock feeds and water through water trucking, rehabilitation of boreholes, shallow wells and seasonal water catchments, and provision of water storage containers for storing water safely. There is also a need to promote food processing and preservation techniques. Households can be taught how to prepare cheese and ghee and how to preserve meat, with high nutritional value, which can be consumed during lean times. The promotion of consumption of other foods such as fish is also important, for example in the case of West Golis, which is on the coast. Fish are high in nutritive value and are rarely consumed by the population because of cultural beliefs and attitudes. Rangeland and herd management programmes are also beneficial to households to ensure sufficient pasture during drought periods and enable optimisation of animal productivity.

For more information, contact: Louise Masese Mwirigi, P.O. Box 1230- 00621, Nairobi, Kenya. Tel: 254-20-4000000/4000527 or +(254) 733 442929 Fax: 254-20-4000555
e-mail: Louise.masese@fao.org or joseph.waweru@fao.org

¹Milk Matters. A Literature review for the Pastoralist Health and Nutrition Initiative. Mark Myatt et al, November 2008

²FSNAU Framework for Estimating the Nutrition Situation, Draft 7 August 2010

³If proportion of households consuming <4 food groups is 25-40% - FSNAU Framework for Estimating the Nutrition Situation,