Cluster highlights SUDAN NUTRITION CLUSTER BULLETIN INSIDE THIS ISSUE KEY FACTS MAY 2014, ISSUE 1

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..........1 Nutrition in emergencies performance (Jan Mar 2014)............3 New displacements in Darfur.................4 Oscar winning nutrition project...................4 Success story from the field.

1 MAY 2014, ISSUE 1 SUDAN NUTRITION CLUSTER BULLETIN Cluster coordinator: Samson Desie sdesie@unicef.org Skype: sdesie Cluster highlights Government lead: Federal Ministry of Health (FMOH) Salwa Sorkti ssorkti@gmail.com INSIDE THIS ISSUE Cluster highlights Nutrition in emergencies performance (Jan Mar 2014) New displacements in Darfur Oscar winning nutrition project Success story from the field...5 Sudan simple spatial sampling (S3M) survey The ongoing conflict in South Sudan continued with an influx of Southern Sudanese arriving in some of the other Sudanese states. The nutrition situation of the new arrivals is extremely critical and the sector response is active at all sites. So far 7,201 children have received nutrition support. A new wave of displacement, severely affecting 62,611 children under 5 and 10,435 pregnant and lactating women, has resulted from the ongoing conflict across KEY FACTS Darfur. Of the 42,915 children under 5 who have been evaluated for their nutritional status, 12,835 were found to be acutely malnourished, giving a proxy Global Acute Malnutrition of 29.9 per cent. This is twice the internationally-recognized emergency threshold. These malnourished children have a 10- times greater risk of death than well-nourished ones. Lifesaving emergency nutrition services were provided to 40,131 children across Darfur. Upcoming events Key contacts About the Sudan Nutrition Cluster Bulletin Sudan has a huge burden of acute malnutrition and the latest simple spatial sampling (S3M) survey showed that around 2 million children will suffer from acute malnutrition in Currently less than 22% of these children have access to treatment. Only 27 per cent of the required funds have been received to date. The upcoming rainy season may hamper the ongoing response activities for the Southern Sudanese influx and new internally displace persons (IDPs) in Darfur. 1

2 The major constraints that humanitarian partners are currently facing in the ongoing emergency nutrition operation in some areas/localities are: (i) a lack of access because of security concerns; (ii) continuous population movements into localities already prone to high levels of insecurity, malnutrition, disease and food insecurity and (iii) inadequate resource mobilization. In the last half of 2013, Sudan conducted a national survey using the simple spatial sampling (S3M) methodology. The survey measured a range of indicators (health, water, sanitation and hygiene [WASH] and nutrition) over small geographical areas, giving results at locality level and lower. This 's CHF Oscar award was given to the project 'Extending integrated nutrition services to the conflict affected population in North Darfur', implemented by Relief International in Zam Zam camp, North Darfur. In competition with two other CHF projects one Figure 1: National admissions of new severe acute malnutrition cases from Myanmar and another from Colombia the project won an innovation award at the pooled funds workshop in Jordan at the Office for the Coordination of Humanitarian Affairs (OCHA) in May Table 1: Performance in the quarter (Jan-Mar 2014) compared with annual targets for nutrition in emergencies Number of currently open sites 98 SCs 516 OTPs 293 TSFPs 293 BSFPs 347 IYCF 251,441 Children screened this quarter (Q1-2014) 1,000,000 86,024/ 96,148 Children admitted to TSFP /BSFP this quarter 236,188/ 227,812 22,266 Children admitted to SC/OTP this quarter 200,000 60,028 Caretakers and PLW participated in IYCF sessions this quarter 300,000 5,921,817 Children received Vitamin A this quarter 6,561,074 BSFP Blanket Supplementary Feeding Programme; IYCF Infant and Young Child Feeding; OTP Outpatient Therapeutic Programme; PLW Pregnant and Lactating Women; SC Stabilization Centre; TSFP Targeted Supplementary Feeding Programme. 2

Nutrition in emergencies performance (Jan-Mar 2014) Figure 2: Targeted Supplementary Feeding Programme (TSFP) performance indicators (Jan Mar 2014) Community-based management of acute malnutrition

The number of children treated for severe acute malnutrition (SAM) has continued to rise as a result of new emergencies happening across Darfur and Kordofans.

This is over 1,000 more children admitted for SAM as compared to the same time in 2013. The total admission during this quarter is 11.1 per cent of the annual target.

3 Nutrition in emergencies performance (Jan-Mar 2014) Figure 2: Targeted Supplementary Feeding Programme (TSFP) performance indicators (Jan Mar 2014) Community-based management of acute malnutrition (CMAM) performance The nutrition cluster has continued to respond to emergencies in the first quarter of The number of children treated for severe acute malnutrition (SAM) has continued to rise as a result of new emergencies happening across Darfur and Kordofans. Admissions are 3 per cent higher this as compared to the same period last (Jan Mar). To the end of March 2014, 22,266 children have been admitted for SAM. This is over 1,000 more children admitted for SAM as compared to the same time in The total admission during this quarter is 11.1 per cent of the annual target. However more cases are expected during the third and fourth quarters of the. Performance indicators are also showing robust results in terms of treatment outcomes. The grey area (see pie chart) of the performance indicators shows the rate of default, which needs further follow-up and support. Accordingly, in a collective effort to address this high rate of default the cluster is working to strengthen and harmonize the engagement and approach of community volunteer nutrition workers (CVNWs). Capacity development During the quarter, 717 health professionals having various levels of skill were trained on CMAM. It is expected that this training will improve the coverage and quality of CMAM services. Similarly 1,327 CVNWs were also trained on community mobilization and infant and young child feeding (IYCF) activities. Infant and young child feeding (IYCF) activities By training the CVNWs, the unit was able to reach 60,028 mothers with one-to-one counselling in addition to the 4,645 group counselling sessions conducted during the quarter. Figure 3: Severe acute malnutrition (SAM) performance indicators (Jan Mar 2014) Humanitarian Response Sudan: 3

New displacements in Darfur, Sudan As a result of a recent wave of violence across Darfur almost 177,000 people have been newly displaced since late February 2014. (OCHA Sudan, 14 May 2014).

To date, 42,915 of the children under 5 have been evaluated for their nutritional status and 12,835 of them were found to be acutely malnourished.

4 New displacements in Darfur, Sudan As a result of a recent wave of violence across Darfur almost 177,000 people have been newly displaced since late February (OCHA Sudan, 14 May 2014). Among these people, who have been displaced or severely affected by the ongoing conflict in Darfur, are 62,611 children under 5 and 10,435 pregnant and lactating women. To date, 42,915 of the children under 5 have been evaluated for their nutritional status and 12,835 of them were found to be acutely malnourished. This represents a proxy Global Acute Malnutrition of 29.9 per cent twice the internationally-recognized emergency threshold. These malnourished children have a risk of death which is 10-times greater than that of well-nourished children. Across Darfur, 40,131 children received lifesaving emergency nutrition services. Based on the critical nutritional situation observed in the rapid assessments, an agreed set of emergency nutrition responses and an operating framework with activities has been developed and is in effect. Given the overwhelming crisis on the ground, partners have prioritized lifesaving emergency nutrition interventions. Accordingly emergency nutrition interventions, including nutritional assessments covering 68.5 per cent of affected children, have been undertaken. While conducting mass nutrition screenings, 40,131 children received 1,538 cartons of high energy nutritious supplement (BP-5 biscuits). The supplement was distributed as a two-week ration to cover the gap until all response programmes are set in place. Furthermore, 30,225 children (of those reached with BP-5 biscuits) received a one-month ration of integrated/ emergency blanket supplementary feeding to prevent further deterioration of their nutritional status. During this quarter, acute malnutrition management was scaled up to reach an additional 2,061 SAM cases and 8,748 moderate cases. CHF Oscar winning project successful implementation of an innovative approach This the CHF Oscar award was given to the project 'Extending integrated nutrition services to conflict affected population in North Darfur', implemented by Relief International (RI) in North Darfur. The project won an innovation award in competition with two other CHF projects one from Myanmar and another from Colombia at OCHA's pooled funds workshop held in Jordan, May The innovative approaches are known as 'Strategies for success: use of mother-to-mother peer educators/community outreach workers' and as 'Seeing beneficiaries as clients'. 4 Rasha Ahmed on admission: weight 4.7 kg; mid-upper arm circumferences (MUAC) 9.1 cm Rasha Ahmad on discharge/referral to a supplementary feeding programme: weight 6.8 kg; MUAC 11.6 cm

Success story from the field (accountability community participatory approach to improve coverage) Context: One of the major challenges for the CMAM programme in the eastern states, and particularly

5 Success story from the field (accountability community participatory approach to improve coverage) Context: One of the major challenges for the CMAM programme in the eastern states, and particularly in Red Sea state, is the poor community outreach component that results in low coverage; almost 12 per cent of the Outpatient Therapeutic Programmes (OTPs) in the state serve smaller numbers of children than they should. Action: During this quarter, has begun pilot programmes in the Red Sea states to train sheikhs (traditional healers) on MUAC screening. has adopted this strategy because many locals seek help from the sheikhs first before looking any further for health assistance. Accordingly two sheikhs have been trained on MUAC screening in the locations where they practice and have been supplied with MUAC tapes. A success story: Rasha was a baby girl, eight months old, living in Zam Zam camp about 20 km from El Fasher town. She was admitted to the RI-supported Outpatient Therapeutic Programme Centre diagnosed as suffering from SAM with some medical complications. After 58 days of medical and nutritional treatment she was successfully cured. Her mother Fatima had stopped breastfeeding when Rasha was three months old because of a superstitious belief linked to breastfeeding. Early cessation of breastfeeding, added to inadequate and poor weaning practices, placed Rasha at risk of being severely malnourished. Results: Five cases of malnutrition were referred by one sheikh to the nearest OTP during one 21 day period. Unfortunately, the other sheikh was not monitored. The MUAC measurement has become one of the sheikh's tools in Asotriba and the sheikh has become one of the referral points for the OTP there. This will ultimately lead to the early detection and referral of cases. "The MUAC is one of the tools that the sheikh/traditional healer is using in Asotriba" 5

6 Humanitarian Response Sudan: Sudan S3M During 2013 a multi-indicator health, WASH and nutrition survey was carried out in all 18 states of Sudan by the Federal Ministry of Health and, with technical support from Valid International and funding from the UK Department for International Development (DFID). Data collection took place during June/July 2013 for 14 states and in November 2013 for the remaining four states (Khartoum, Red Sea, South and West Kordofan). The survey used the Simple Spatial Survey Method (S3M), an area-based sampling methodology that uses maps for the selection of sample points. For this survey, the size of the area for which results are available is approximately 187 km². The results, available at the locality and sub-locality levels, are now being used to facilitate better targeting of existing interventions and to inform programme expansion. The maps of results for the national level are classified into three groups low, medium and high for every indicator. The cut-offs used for each indicator are based on international public targets. The green colour on the maps indicates a 'good' situation (as determined by the cut-offs used), yellow indicates 'acceptable' and red indicates a 'poor' situation. The key results of the S3M show that: More than 2 million children in Sudan are stunted and unlikely to ever reach their full growth and development potential. Sudan has a huge burden of acute malnutrition and the S3M showed that over half a million children will suffer from life-threatening SAM during of the 184 localities have a SAM rate (measured by MUAC) that is classified as very critical (above 3 per cent). The highest SAM measured was above 20 per cent in three localities in the South Darfur and Red Sea states. State-level estimates mask huge disparities in most indicators. 128 of the total 184 localities have a stunting rate classified as high (above 30 per cent). There are pockets of very high stunting rates, found mostly in the eastern states of Red Sea, Kassala and Gedaref. The highest rate of 73 per cent was found in Gedaref state. The household use of iodised salt has improved since the last national survey (Sudan Household Health Survey [SHHS] 2010, where the national average was 9.5 per cent). There are 42 localities where more than 50 per cent of households are using iodised salt. Maternal under-nutrition is very high in Sudan and for up to 62 per cent of mothers in some locations the degree of under-nourishment is classified as 'extreme' (highest in the Eastern state of Red Sea). 6

Figure 4: Wasting severe (MUAC) Upcoming events SUDAN No alert Watch Emergency Inaccessible areas Class boundaries are 1% and 3%.

May 2014, WFP meeting hall Khartoum open space assessments, 25-28 May 2014 CERF MS Mission familiarization workshop, 25-29 May 2014 National Nutrition Cluster

7 Figure 4: Wasting severe (MUAC) Upcoming events SUDAN No alert Watch Emergency Inaccessible areas Class boundaries are 1% and 3%. Unpopulated areas Figure 5: Proportion of households using adequately iodised salt ( >= 15 parts per million [ppm]) Nutrition Technical Working Group meeting, 19 May 2014, WFP meeting hall Khartoum open space assessments, May 2014 CERF MS Mission familiarization workshop, May 2014 National Nutrition Cluster coordination meeting, 19 June 2014, FMOH Conference Hall GLOBAL International Symposium on Understanding Moderate Malnutrition in Children for Effective Interventions. IAEA (27-29 May 2014, Vienna, Austria) Micronutrient Forum Global Conference (2-6 June 2014, Addis Ababa, Ethiopia) Technical Meeting on Nutrition ENN (7-9 Oct 2014, Oxford, UK). 3rd World Congress of Public Health Nutrition (7-12 Nov 2014, Las Palmas, Canary Islands, Spain) 2nd International Congress on Hidden Hunger (3-6 March 2015, Stuttgart, Germany) 7

8 Key contacts Title/Responsibilities Location Organization Focal Point Phone number Cluster Coordinator Office-Villa II Samson Desie Cluster cocoordinator/co-chair Kuweiti Building- Block IV, 8th Floor FMOH Dr. Somia Okoued Strategic Advisory Group chair Khartoum FMOH Dr. Talal Elfadil Technical working group chair Khartoum FMOH Dr. Ali Arabi National CMAM focal person-head of M & E Unit Khartoum FMOH Amira Mohd. Almunier amiraalmunier@gmail.com Sector Monitoring and Reporting Officer Khartoum Najlaa Osman Khidir nkhidir@unicef.org Sub-national cluster coordination- Darfur El Fasher Field Office Jasinta H.Achen jachen@unicef.org Sub-national cluster coordination Kordofans and and Abyei Adm. Area Kadugli El Sadig Adam Ahmed esaahmed@unicef.org Sub-national cluster coordination East Sudan Kassala Ibrahim Eltahir Ibrahim ieibrahim@unicef.org Sub-national cluster coordination Blue Nile El Damazin Gamar Musa Kodi gkodi@unicef.org About the Sudan Nutrition Cluster Quarterly Bulletin The Sudan Nutrition Cluster quarterly bulletin is produced by the Sudan Nutrition Cluster Coordination and National Nutrition Directorate of the Federal Ministry of Health with the collaboration of cluster partners including: Almanar, American Refugee Committee, CARE International Switzerland, Catholic Relief Services, Committee d'aide Medicale, Concern Worldwide, FAO, GOAL, Humanitarian Aid Commission, International Medical Corps, Ministry of Agriculture, MSF-E, Norwegian Church Aid, Relief International, Save the Children Switzerland, Save the Children Sweden, Tearfund,, WFP, WHO, World Relief, World Vision International. 8

Improving blanket supplementary feeding programme (BSFP) efficiency in Sudan

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