INTEGRATED MANAGEMENT OF ACUTE MALNUTRITION PROGRAMME AND STOCKS REPORT UNICEF WCARO

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1 United Nations Children s Fund Telephone West and Central Africa Facsimile Regional Office P.O. Box DakarYoff Dakar, Senegal INTEGRATED MANAGEMENT OF ACUTE MALNUTRITION PROGRAMME AND STOCKS REPORT YEAR INTEGRATED MANAGEMENT OF ACUTE MALNUTRITION PROGRAMME AND STOCKS REPORT UNICEF WCARO Any information that may be of use for the report or enquiries concerning its contents should be addressed to Sara Gari (sgarisanchis@unicef.org) or AnneCeline Delinger (adelinger@unicef.org) or Patricia Hoorelbeke (phoorelbeke@unicef.org) at the UNICEF West and Central Regional Office, Dakar Senegal.

2 Introduction This report summarizes IMAM program activities and the supply chain of ready to use therapeutic food (RUTF), therapeutic milks and biscuits, in West and Central African countries. Data reported in this report reflects the conditions until the end of reported month. The objective of the report is to ensure good information to nutrition partners, donors and stakeholders in the region about IMAM program and supplies status. The information is sourced from national government, UNICEF Country Offices and where possible from collaborating partner organisations. Sphere Guidelines The Sphere Handbook based on the Humanitarian Charter and Minimum Standards in Humanitarian Response contributes to an operational framework for accountability in humanitarian work and disaster assistance efforts. According to these minimum standards, all programs delivering the management of severe acute malnutrition services are obligated to maintain and report on the following elements: Coverage is >50% in rural areas, >70% in urban areas and >90% in camp situations, The proportion of exits from therapeutic care who have died is <10%, recovered is >75% and defaulted is <15%. Harmonization of IMAM reporting A major evaluation of the IMAM programs in 9 countries of West and Central Africa was completed in 2010 and found that different actors and implementers within the region using different criteria for admission and discharge, different terms and definitions, and a variety of reporting formats which did not allow data to be meaningfully collated to present accurate overall results. A regional followup meeting in December 2010 was convened to address the differences identified in the evaluation and come to agreement on a harmonized approach for the region for implementation of management of acute malnutrition. The meeting included 56 senior participants from National Governments, agencies of the United Nations within the region and from their respective Headquarters, the major donors, the nongovernmental humanitarian organizations and international experts on malnutrition. Countries implementing IMAM programs are in the process of adopting the harmonized protocols and reporting standards to facilitate quality implementation of these lifesaving interventions. Supply Hubs In order to provide nutritional products to country programs in a timely and effective manner, UNICEF West and Central Africa Regional Office (WCARO) is managing 2 regional buffer stocks of RUTF. These revolving stocks serve to greatly reduce the time between orders and delivery and also as a prepositioned stock of RUTF in case of emergency. Where needed, the supply hubs advance stocks to Country Offices and get replenished with the new supply orders made to Copenhagen by the Countries served. This system eliminates the need for expensive air freight and has expanded to include other essential and complementary items for Health and WASH. The two hubs are in Accra, Ghana (based in the United Nations Humanitarian Response Depot) and in Douala, Cameroon where UNICEF maintains a warehouse with support from a dedicated Supply Officer who ensures rapid clearing and transit of materials to Chad, Cameroon and Central African Republic. The two supply hubs allow transport of RUTF in less than 10 days to the majority of Sahel and Coastal countries in the region. Recommended amounts of RUTF and RUSF for treatment or prevention Please note for planning purposes, it is estimated that one successful case of SAM treated uses one carton of RUTF (150 sachets). In implementation, the average amount of RUTF per cure is often less (between 100 to 130 sachets). All other lipid based spreads are referred to as Ready to Use Supplementary Foods (RUSF). For treatment of moderate acute malnutrition in children 6 months and older with a supplementary spread (such as Plumpy Sup), it is recommended one sachet per day (92 g 500 kcal) with normal diet (one carton contains 150 sachets, the quantity needed to treat 5 children for one month). For prevention of acute malnutrition with fortified spreads, the recommended amounts for children 6 months and older are as follows. With PlumpyDoz, one tablespoon per day (46g) along with normal diet is recommended (one carton contains 36 pots of 325g each, so one carton allows to supplement 8 children for one month). With Nutributter, one sachet per day (20g) is given along with normal diet (one carton contains 78 strips of 7 sachets, so one can estimate one carton for 19.5 children for one full month).

3 Anthropometric references used for admission and discharge in IMAM programs and IMAM national protocol in use WHZ < 3 Z score (2005 WHO growth standards Unisex) MUAC < 115mm IMAM National Protocol RUTF part of the Essential Drugs List Yes No Yes No First Current Next version version review Yes No Benin X X 2009 X Burkina Faso X X 2007 X Cameroon X X 2007 X CAR X X 2010 X Chad X X 2007 X Congo X X Ongoing X Côte d Ivoire X X Ongoing X DRC X X 2008 Ongoing X Gambia X X 2009 X Ghana X On going X Guinea X X 2008 X Guinea Bissau X X 2007 X Liberia X X 2009 X Mali X X 2007 X Mauritania X X 2007 X Niger X X 2005 Ongoing X Nigeria Admission on MUAC & Discharge after 2 months of treatment X IPF guidelines on going Senegal X X 2010 X Sierra Leone X X 2009 X Togo X X 2008 X X

4 Regional Summary SAM Estimated Burden and Targeted Caseload for Note: These data reflect the estimated number of children under 5 years old at risk of severe acute malnutrition (SAM) in (3,631,688) and the number of children under 5 who will be targeted for therapeutic treatment (1,621,753) depending of several factors especially IMAM coverage, Technical and financial capacities, Presence of operational partners, Humanitarian access, etc.. COUNTRIES Estimated Burden of GAM in 2016 (children 659m) Estimated Burden of SAM in 2016 (children 659m) Clusters reported SAM annual target (new admissions 2016) TOTAL SAM ADMISSIONS to date BURKINA FASO 499, , , ,979 CAMEROON 228,178 77,627 67,380 66,231 CHAD 402, , , ,100 GAMBIA 84,124 10,217 5,620 6,671 MALI 715, , , ,961 MAURITANIA 129,761 33,757 28,694 18,446 NIGER 1,248, , , ,341 NIGERIA 2,135, , , ,221 SENEGAL 327,868 68,647 54,918 39,147 TOTAL SAHEL 5,770,033 1,503,998 1,280,053 1,295,097 Benin na na na 5,567 CAR na 28,000 16,800 26,156 Congo na na na 239 Cote d'ivoire na na DRC na 2,047, , ,232 Ghana na na na 10,515 Guinea na na na 37,233 Guinea Bissau na na 1,000 1,335 Liberia na 31,976 16,000 12,464 Sierra Leone na na na 29,643 Togo na 19,750 7,900 7,667 TOTAL NON SAHEL 2,127, , ,051 GRAND TOTAL 5,770,033 3,631,688 1,621,753 1,751,148

5 Regional Summary SAM Estimated Burden and Targeted Caseload for 2016 Note: These data reflect the estimated number of children under 5 years old at risk of severe acute malnutrition (SAM) in 2016 (4,750,707) and the number of children under 5 who will be targeted for therapeutic treatment (1,964,532) depending of several factors especially IMAM coverage, Technical and financial capacities, Presence of operational partners, Humanitarian access, etc.. COUNTRIES Estimated Burden of GAM in 2016 (children 659m) Estimated Burden of SAM in 2016 (children 659m) Nutrition Cluster Targeted Caseload (children 659m) BURKINA FASO 509, , ,702 CAMEROON 264,228 71,433 64,255 CHAD 727, , ,889 GAMBIA 69,110 10,437 6,251 MALI 708, , ,947 MAURITANIA 153,767 27,123 21,376 NIGER 1,479, , ,794 NIGERIA 1,571, , ,377 SENEGAL 407,586 86,026 68,821 TOTAL SAHEL 5,891,198 1,906,156 1,475,411 Benin na 44,300 6,645 CAR na 38,999 29,249 Congo 69,340 21,777 6,533 Cote d'ivoire na na na DRC na 2,469, ,000 Ghana na 89,619 44,809 Guinea na 81,296 44,624 Guinea Bissau na na na Liberia na 39,884 21,274 Sierra Leone na 30,529 24,424 Togo na 28,904 11,562 TOTAL NON SAHEL 69,340 2,844, ,121 GRAND TOTAL 5,960,538 4,750,707 1,964,532

6 Regional Summary National Stocks of RUTF/RUSF These data reflect the current stock (5 th February 2016) as mentioned in VISION (management software). It could therefore not reflect the real stock, depending on the update status of each country. COUNTRIES F100 Sachet 114g/CAR90 F75 Sachet 114g/CAR90 RUTF Sachet 92g/CAR150 Biscuit Pack 510g/CAR24 IN STOCK IN THE PIPELINE IN STOCK IN THE PIPELINE IN STOCK IN THE PIPELINE IN STOCK IN THE PIPELINE Benin Burkina Faso ,705 Cameroon ,528 11,998 Central Afr.Rep , Chad 46 34,100 45,075 Congo Congo, Dem. Rep ,701 38,145 Cote D'Ivoire ,290 6,000 Gambia 500 2,200 Ghana ,000 9,746 1,000 Guinea ,601 GuineaBissau Liberia ,989 2,821 Mali ,891 25,905 Mauritania ,010 Niger ,056 20,155 Nigeria , ,863 Senegal ,285 2,000 Sierra Leone 2, ,836 4,288 9,778 Togo ,667 Regional HUB (Accra& Douala) 18,125 7, Grand Total 5, , , ,583 17,800

7 Summary Total of new SAM Admissions per year 2010 Table 1 Total admissions per year in West and Central Africa Region NEW SAM ADMISSIONS WEST AND CENTRAL AFRICA REGION Sahel NonSahel , ,083 25, , , ,297 1,195, , ,949 1,396,335 1,112, ,466 1,530,047 1,187, ,745 1,740,263 1,283, ,474 2,000,000 1,800,000 1,600,000 1,400,000 1,200,000 WEST and CENTRAL AFRICA REGION Number of New SAM Admissions per year 1,195,082 1,396,335 1,530,047 1,740,263 In five years (2010), the total number of New SAM Admissions in the West and Central Africa Region has more than triple, from 504,265 new admissions recorded in 2010 to 1,740,263 in. This increase in new admissions is mainly due the scaling up of IMAM programs (with almost 11,000 health centres offering IMAM services in to 14,000 in ), and deterioration in contexts with increasing vulnerability and increase of conflict affected between 2010 and. 1,000, , , , , , ,

8 Table 2 Total admissions per year in NONSAHEL COUNTRIES (Benin, CAR, Congo, Cote d Ivoire, DRC, Ghana, Guinea, Guinea Bissau, Liberia, Sierra Leone, Togo) NONSAHEL JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC TOTAL ,030 2,055 2,303 1,986 1,499 1,760 2,357 2,849 2,477 2,437 1,969 1,460 25,182 18,159 18,083 15,639 13,259 13,216 12,428 14,953 14,198 20,344 22,409 17,812 17, ,352 26,406 27,491 26,011 23,780 23,825 23,720 22,947 21,032 19,591 22,366 20,685 18, ,962 24,047 24,714 25,641 27,035 25,711 22,501 21,270 21,534 23,392 22,973 22,837 15, ,793 38,227 33,721 30,943 26,928 25,942 26,281 27,910 27,260 28,151 28,409 26,918 22, ,745 39,637 39,360 39,645 37,747 34,382 34,416 42,562 40,521 39,622 43,160 36,089 29, ,474 Figure 1 Total admissions per year in NonSahel countries 50,000 45,000 NonSahel Number of new SAM admissions In the 11 Non Sahelian Countries in the West and Central Africa Region, the total number of new SAM admissions recorded has reached 456,474 in it s 6 times more than in 2010 thanks to scaling up of IMAM programs. 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5, However, it should be noted that 71% of these cases were admitted in DRC 0 Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec

9 Table 3 Total admissions per year IN SAHEL COUNTRIES (Burkina Faso, Cameroon, Chad, Gambia, Mali, Mauritania, Niger, Nigeria, and Senegal) SAHEL Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec Total SAM Targeted Caseload ,224 28,394 34,989 29,555 42,695 39,239 40,095 41,905 40,770 43,903 44,461 30, ,652 Na Na 33,852 32,604 47,764 47,769 60,694 61,345 58,228 72,505 68,278 69,238 65,474 52, ,287 Na Na 54,616 55,327 61,490 66,563 89,501 86,094 87,968 90, ,664 99,691 83,282 67, ,424 1,027, % 71,508 68,002 77,102 84, , , ,065 92, , ,393 94,112 73,504 1,112,869 1,171,455 95,0% 88,463 77,060 78,929 93, , , , , , ,751 96,891 74,443 1,187,302 1,191, % 68,545 80,094 89, , , , , , , , ,608 84,984 1,283,789 1,280, % Program Coverage of targeted Caseload In, a total of 1,283,789 children underfive with SAM were admitted in IMAM programs across the nine Sahelian Countries. Estimated SAM burden TOTAL SAM ADMISSIONS % Coverage of annual Burden Burkina Faso 149, , % Cameroon 77,627 66, % Chad 154, , % Gambia 10,217 6, % Mauritania 33,757 18, % Mali 181, , % Nigeria (11 states) 461, , % Niger 368, , % Senegal 68,647 39, % TOTAL 1,503,998 1,295, % The significant scaleup of SAM programming over the past five years ensured the SAM treatment services in a majority of health centers across the Sahel region more than 8,000 in versus 6,735 in. All nine countries showed an increase in SAM admissions, but three in particular the Gambia (3,164 new admissions in versus 6,674 in ), Mali (52,156 in versus 137,965) and Senegal (13,628 in versus 39,147 in ) have more than doubled the number of admissions since. 180, , , , ,000 80,000 60,000 40,000 20,000 0 Sahel Number of new SAM admissions Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec 2010 Figure 2 Total admissions per year in Sahel countries

10 BENIN At the beginning of 2016, 17 out of 34 health districts provide IMAM services in Benin In, UNICEF relaunched its support to the nutrition department of the Ministry of Health for IMAM reporting. A database (monthly compilation report) for health areas and the central level was developed and a volunteer was recruited by UNICEF for six months to support the MoH in data collection and reporting. A nutrition survey using SMART Methodology was conducted in April/May in the 9 communes of the Atacora department. The prevalence of global acute malnutrition (GAM) was 7.5% ( % confidence intervals) at the department level and ranged between 3.7% and 13.5% in the communes. Severe acute malnutrition (SAM) rate is 1.2% ( % confidence intervals) at the department level and ranged between 0.2%2.8% at the commune level. The prevalence were over the emergency threshold in the municipality of Materi and in alert for the municipalities of Cobly, Tanguiéta, Boukoumbé and Kérou. The distribution of acute malnutrition by age showed highest prevalence among younger children (12.5% GAM children 6 to 11 months and 11.3% GAM among children 12 to 23 months). Number of functional OTP: 463 Number of functional IPF: 23 Year/Month JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC TOTAL , , ,307 BeninNumber of new SAM admissions 1,400 Total new admissions for : 3,945 Total new admissions for : 4,279 1,200 1, JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC

11 BURKINA FASO The estimated SAM burden for was estimated at 149,000 while the Targeted Caseload was about 119,000 SAM Children. At the end of, a total number of 119,979 SAM children have been treated (100.8% of the Targeted CSL). Integrated Management of Acute Malnutrition is effective at country level as expected in the IMAM Scaleup plan developed. The scale up plan has effectively ended in and a review of the implementation is expected in An intern of Montpellier II University will work between March and August 2016 on the bottlenecks analysis regarding the program management and therefore will also try to explain the recurrent decline of new SAM admissions between July and August. Number of functional OTP: 1,658 Number of functional IPF: 66 Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC Total ,592 3,502 3,726 3,480 3,778 4,670 3,734 3,147 3,309 4,281 4,738 4,699 47,656 3,832 3,583 3,676 3,030 3,359 3,251 3,251 3,168 3,376 3,001 3,134 2,833 39,494 3,787 3,787 3,787 6,755 6,755 6,755 5,715 4,928 7,872 9,778 8,920 8,267 77,106 7,338 7,303 6,077 6,922 8,569 8,648 6,781 5,416 6,392 14,083 10,810 9,674 98,013 6,881 6,719 8,294 8,931 9,599 9,634 6,764 6,801 9,265 11,899 11,572 11, ,892 7,726 9,377 8,472 10,280 11,178 9,914 8,100 6,946 8,407 15,318 14,611 9,650 91,843 18,000 Burkina FasoNumber of new SAM admissions 16,000 14,000 12,000 10,000 8,000 6,000 4, ,000 JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC Table 2: Number of Health Centers with IMAM activities (OTP and IPF) Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,696 1,696 1,696 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658 1,658

12 CAMEROON The estimated SAM burden for was estimated at 77,627 while the Targeted Caseload was about 67,380 SAM Children. At the end of, a total number of 66,231 SAM children have been treated (98.3% of the Targeted CSL). Integrated Management of Acute Malnutrition is effective in 4 regions: North, ExtremeNorth, and Adamaoua and East regions. Since the Central Africa Republic crisis, response has been intensified in the East and Adamaoua regions following the large influx of refugees. In the Extreme Nord with the influx of refugees from Nigeria, a specific nutrition response is in place in Minawao refugee s camp. A nutrition survey using SMART Methodology has been held during September/October in the same four regions (Adamaoua, East, FarNorth and North). Estimates of global acute malnutrition (GAM) in the Far North and Adamaoua regions have drastically increased in the past year. In the Far North region, GAM approaches the emergency threshold (15%), with 2.2% SAM children reach emergency threshold (>2%), the same situation as in and. Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL 1,639 1,432 2,390 2,942 2,380 3,331 1,989 2,521 3,162 4,610 2,363 2,362 31,121 4,231 4,005 3,370 2,924 2,491 3,392 3,617 2,756 3,479 3,753 2,995 3,287 40,300 5,023 3,580 4,492 5,196 7,068 6,014 6,653 7,141 6,302 6,116 5,629 1,099 64,313 5,931 5,949 4,414 5,540 6,724 7,511 7,624 8,322 6,902 5,409 5,371 3, ,962 4,754 6,188 5,820 4,048 5,060 7,916 6,661 7,458 6,515 4,070 3,779 66,231 North 747 1,731 2,023 1, ,028 2,339 1,625 1,016 2,058 1,092 1,107 17,171 Extreme North 1,934 2,084 3,255 3,290 1,985 2,596 3,930 3,748 5,276 3,315 2,125 1,980 35,518 Est ,747 Adamawa ,904 CAR Refugees ,114 Nigerians Refugees ,777 : Data are still not complete 10,000 8,000 6,000 4,000 2,000 Cameroon Number of new SAM admissions in 4 Regions JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC Table 2: Number of Health Centers with IMAM activities (OTP and IPF) Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC Nord/Extreme Nord East/Adamawa Nord Extreme Nord East/Adamawa

13 CENTRAL AFRICAN REPUBLIC As of December, a total of 26,156 children underfive have been newly admitted for Severe Acute Malnutrition (SAM) treatment, including children from IDP sites. The SAM cases with complications represent a proportion of 16% (4,153) in IPF. In July a Nutrition survey using SMART Methodology was conducted in different IDPs sites, including a retrospective mortality survey. The results presented a stable situation except for in Boda enclave where both global acute malnutrition (9.2%) and severe acute malnutrition (2.2%) where over emergency thresholds. Number of functioning IPF: 40 Number of functioning OPT: 310 Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL ,132 1,279 1,506 1,378 1, ,022 1, ,018 1,222 1,464 1,631 1, NA NA NA 10, ,007 2,757 2,034 1,959 1,919 1,636 1,035 1,208 16,294 2,723 2,873 1,786 2,053 2,651 2,811 2,654 2,983 1,722 1,635 1,375 1,451 26,717 2,550 1,963 1,687 2,158 2,097 2,890 2,776 1,874 2,268 1,594 1,964 2,335 26,156 3,500 Central African RepublicNumber of new SAM admissions 3,000 2,500 2,000 1,500 1, JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

14 CHAD Taking into account new SAM admission trends during first semester of, a revision of the SAM target Caseload was done in July in collaboration with the Government, the number of SAM children 659 month expected to receive treatment is 154,400. At the end of, a total number of 155,100 SAM children have been treated (100.5% of the Targeted CSL). The first National Nutrition Survey using SMART Methodology was conducted in October/November. Final results show a GAM prevalence at 11.7% ( % Confidence Intervals) and a SAM prevalence at 2.9% ( % Confidence Intervals) above the emergency threshold. Year/ JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC TOTAL Month ,430 2,494 2,453 2,651 4,555 5,988 6,133 6,522 6,819 6,838 5,640 3,913 56,436 3,474 3,833 5,205 4,834 6,866 9,244 7,839 5,207 5,939 5,515 5,521 6,459 69,936 7,348 10,376 13,006 13,123 13,889 15,888 12,305 14,661 14,242 12,179 11,687 7, ,685 8,403 8,787 11,360 12,731 12,197 16,581 14,031 11,902 14,208 13,559 12,229 9, ,423 9,068 11,985 12,201 15,124 14,930 17,009 13,695 11,484 13,419 11,314 8,739 9, ,369 9,400 12,287 13,047 12,341 14,879 14,755 13,475 14,740 12,672 14,663 12,533 10, ,100 SAHEL 9,030 12,030 12,763 12,043 14,408 14,333 13,111 14,481 12,358 14,464 12,533 10, ,967 SUD ,238 Et IDPs 18,000 16,000 Chad Number of new SAM admissions in the Sahel Band 14,000 12,000 10,000 8,000 6,000 4, ,000 JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC Table 2: Number of Health Centers with IMAM activities (OTP and IPF) Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC

15 CONGO (Brazzaville) To date, the IMAM program is only functional in Likouala region for the refugees from the Central African Republic. In the rest of the country, no IMAM services are available Congo revised its IYCF strategy, and the IMAM national protocol has been updated in Number of functional OTP: 5 Number of functional IPF: 10 Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC TOTAL , ,506 1, CongoNumber of new SAM admissions Total new admissions for : 1,174 Total new admissions for : 1,506 Total new admissions for : 1, JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC

16 COTE D IVOIRE In, UNICEF has reiterated its support the Nutrition department of the Ministry of Health to strengthen the IMAM program. The national protocol for the management of acute malnutrition was updated and data collection tools developed. Key priorities for 2016 are i) Implement the program in priority areas (5 out of 82 health districts); ii) Strengthen the reporting system for health districts and the central level and ensure an adequate supply chain management at all levels. A SMART survey was conducted in August in collaboration with ACF and the Ministry of Health in periurban areas of Abidjan. The prevalence of global acute malnutrition and severe acute malnutrition in children underfive were estimated at 4.3% ( % Confidence Intervals) and 0.1% ( % Confidence Intervals), respectively. The survey also found that 5% ( % Confidence Intervals) of women of reproductive age were underweight (BMI < 18.5) and 13.6% ( % Confidence Intervals) were obese (BMI > 30). In, 5,242 new SAM admissions were reported at national level. Details of monthly admissions are not available for and a new data reporting system is being established to improve the monitoring of the program at national level. Year/Month JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC TOTAL ,753 1,753 1, ,196 1,196 1, ,170 6,450 Graph 1: New SAM admissions Cote d'ivoirenumber of new SAM admissions New admissions : 12,170 New admissions : 6,450 New admissions : 5,242 JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC

17 DEMOCRATIC REPUBLIC OF CONGO The estimated SAM burden for was estimated at 2,047,964, while the Targeted Caseload was about 300,000 SAM Children. At the end of, a total number of 325,000 SAM children have been treated (108.41% of the Targeted CSL). The National Nutrition Programme (PRONANUT) and health zones are supported by 38 implementation partners (27 international NGO and 11 national NGOs). In addition to implementing NGO partners, UNICEF, WFP and UNHCR provide financial and technical support for IMAM in DRC through the National Nutrition programme. Availability of data remain a great challenge. Significant efforts are being made to improve evidence generation and management as far as IMAM is concerned. However timely and complete reporting need serious improvement. Use of new technology, SMS or internet based is being considered IMAM performance indicators have been included in the revision of the National Health Monitoring Information System Due to lack of infrastructure, in country distribution of ready to use therapeutic food (RUTF) is challenging and result sometimes in pipeline breakdown mainly at the enduser point. In DRC a total of 3,656 health centres and hospital offer IMAM services (3,243 Outpatient treatment facilities and 413 Inpatient facilities) resulting in a geographic coverage estimated at 38.2 % Year/ Month JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC TOTAL 14,548 14,548 11,705 10,846 11,063 9,969 12,305 10,268 15,355 18,144 13,442 14, ,025 19,570 21,164 18,398 17,799 17,491 16,069 14,257 13,821 13,787 17,064 16,373 15, ,321 19,054 20,208 21,741 21,205 19,111 14,760 15,126 15,932 17,026 17,839 17,425 10, ,787 25,747 22,776 19,927 19,256 18,436 18,553 19,216 19,783 22,243 22,688 21,438 17, ,442 28,668 28,945 28,725 26,237 23,765 22,593 29,693 28,767 29,810 32,601 25,805 19, ,232 35,000 DRCNumber of new SAM admissions 30,000 25,000 20,000 15,000 10,000 5,000 JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC Table 2: Geographical Coverage over the last 4 years IPF OTP 2,059 2,912 3,243 Total 1,350 2,30 2,422 3,25 3,656 Coverage (geographic) 16% 25% 28% 37% 40%

18 GAMBIA The estimated SAM burden for was estimated at 10,217, while the Targeted Caseload was about 5,620 SAM Children. At the end of, a total number of 6,671 SAM children have been treated (118.5% of the Targeted CSL). 153 health workers (doctors, nurses and community health nurses) and 240 community members are trained on IMAM A national nutrition survey using the SMART Methodology was conducted in September October. The results of the survey showed no improvement/worsening of the situation with a prevalence of GAM of 10.3% ( % Confidence Intervals) and SAM of 2.2% ( % Confidence Intervals) The program focus is on providing lifesaving treatment to children with severe acute malnutrition and scaling up interventions to prevent malnutrition through promotion of optimum maternal, infant and young child feeding and integration with services to increase access to improved Wash services. Number of functional IPF: 19 Number of functional OTP: 72 Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL , , , , GambiaNumber of new SAM admissions JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC NOTE: Mass active screening activities have been organized in March Table 2: Number of Health Centers with IMAM activities (IPF only) Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC

19 GHANA IMAM is implemented in all regions of Ghana, covering 110 out of 216 districts (51%) UNICEF supports the national IMAM program in 96 districts in five focus regions: Northern, Upper East, Upper West, Central and Eastern Regions, (44% of all districts) In the UNICEF supported regions, there was an increase in the total number of cases admitted on a monthly basis in in comparison with. The graph below further illustrates admissions trends and performance since 2010 to date only in the five UNICEF supported regions The prevalence of wasting in children 059 months of age was 4.7% and severe wasting 0.7% from the Ghana DHS. Number of functional OTP: 1,101 Number of functional IPF: 55 Year/ Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL , , , , , ,025 1,020 1,103 1, ,515 1,200 GhanaNumber of new SAM admissions in 5 focus regions 1, JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

20 GUINEA The IMAM program in Guinea has national geographic coverage. All 410 health centers and 38 hospitals spread within the 8 administrative regions of the country have functional IMAM programs. A total of 104 trainers and 642 care givers and focal points have been trained on IMAM standards (admission/ discharge criteria) and program monitoring focusing on performance indicators data quality and information flow. An intensification of active screening and growth monitoring activities through home visits reached more than 800,000 children under five years of age in. Four UNV staffs were recruited to strengthen supervision and improve the quality of care, the timeliness and quality of reporting. A revision of IMAM monitoring tools was completed to improve the quality of data. 121 PMTCT/Antenatal care providers were trained in nutritional care (including IYCF component) of children exposed to HIV. Nutrition and food security technical committees were established in 4 out of 8 regions trained to use/monitor data in order to identify gaps and bottlenecks. Nutrition and food security indicators are regularly analyzed with the aim of strengthening specific and sensitive interventions. The national nutrition survey (SMART Methodology) conducted in July reported a national prevalence of Global Acute Malnutrition of 8.1% ( % Confidence Intervals) and Severe Acute Malnutrition of 2.0% ( % Confidence Intervals) Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL 3,991 3,991 3,991 11,973 3,457 3,511 3,239 2,682 1,893 2,591 4,698 3,780 3,032 3,119 2,984 2,247 37,233 5,000 4,500 4,000 Guinea ConakryNumber of new SAM admissions New admissions : 33,083 New admissions : 11, 973 3,500 3,000 2,500 2,000 1,500 1, JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Note: Quarterly data (Q1=11,973) have been divided by three to get monthly data

21 GUINEA BISSAU IMAM program is implemented in 5 health regions with 10 IPF and 14 OTP functional to date. IMAM performance indicators are integrated in the National Health Monitoring Information System. A center of excellence is currently running in Cumura hospital allowing students and new health staff to learn and practice management of acute malnutrition Number of functional OTP: 14 Number of functional IPF: 10 Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL ,162 Na , ,335 Note: In GB was in process of elaboration of an updated version of the IMAM protocol and the national database system was not functioning at the time. 160 Guinea BissauNumber of new SAM admissions JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

22 LIBERIA The IMAM programme in Liberia is implemented in 15 counties. IMAM services are offered in 87 of the 88 health districts (99%) nationwide. Outpatient services are offered in 15 communitybased temporary sites, and 121 fixed sites (74 health clinics, 30 health centers, and 17 county hospitals) while inpatient services are offered in 16 public hospitals and 1 health center with 24hour treatment facility. In, the programme focused on expanding outpatient services to cover all health districts in six counties. 320 health providers (2 doctors, 94 nurses, and 224 other health workers) were trained on the national protocol and had started to provide treatment services in their respective health facilities immediately after the training. A reported 36% of the estimated SAM burden were admitted in, marking a 9 percentage point increase in admission compared to the 27% coverage of. These improvements are due to the increased number of treatment sites and countywide nutrition screenings in three out of the six counties highly affected by the Ebola outbreak. The overall quality of nutrition services in has improved compared to with: 96% cured rate, 2% defaulter rate, 1% death rate, and 1% nonresponder rate. Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL * ,271 * ,757 ** ,919 1, ,112 1,172 1,137 1, , , ,074 1,201 1,258 1,298 1,264 1,013 1,146 12,464 * 4 Counries for and 0 ** 8counties in 1,400 LiberiaNumber of New SAM Admissions (15 counties in ) 1,200 1, JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Note: Data from the last quarter of are not complete. Table 2: Number of Health Centers with IMAM activities (OTP and IPF) JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC OTP ,051 1,106 1,145 1, IPF

23 MALI The estimated SAM burden for was estimated at 181,000, while the Targeted Caseload was about 136,000 SAM Children. At the end of, a total number of 137,961 SAM children have been treated (101.4% of the Targeted CSL), out of which 85.6% were in the Southern regions of the country. The results from the nutrition survey based on the SMART Methodology show a national prevalence of 12,4% ( % Confidence Intervals) GAM and 2,8% ( % Confidence Intervals) SAM. Mass screening campaigns were technically and financially supported by UNICEF in 22 health districts not supported by NGOs in the period SepNov. A qualitative research was carried out to gather further information on the barriers preventing access to treatment in 5 health districts with low coverage according to the national SLEAC survey. The research highlighted the need to elaborate a national community mobilization strategy and community action plans in the health districts surveyed. An IPF center of excellence was set up in the health Centre of Dioila (with the support of ALIMA) to allow MoH health staff to improve their practical skills in the management of severe acute malnutrition with complications during a 3week practical internship. Timely and reliable transmission of nutritional data remains a challenge. A pilot project for the transmission of nutritional data through Rapid SMS is being carried out in Mopti region to improve data transmission. Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL 1,747 1,747 1,747 2,079 2,079 2,079 2,027 2,027 2,027 2,997 2,997 2,997 26,550 3,549 2,081 1,847 2,029 3,633 4,841 4,820 7,243 5,771 5,408 6,384 4,550 52,156 6,672 5,908 7,778 9,855 11,292 11,859 11,899 10,917 13,320 12,792 9,368 8, ,993 8,296 7,771 6,939 9,109 9,112 10,530 14,844 9,813 10,266 12,211 10,324 8, ,995 6,984 7,470 6,941 9,344 9,314 11,209 13,496 13,858 17,505 17,930 13,553 10, ,961 20,000 Mali Number of new admissions 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Note: For each quarter of data have been divided by three to get monthly data Table 2: Number of Health Centers with IMAM activities (OTP and IPF) Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC 1,237 1,264 1,282 1,282 1,282 1,289 1,289 1,299 1,302 1,302 1,309 1,311 1,311 1,311 1,311 1,311 1,311 1,311 1,311 1,311 1,311 1,307 1,307 1,307 1,307 1,307 1,307 1,307 1,307 1,307 1,307 1,307 1,307 1,307 1,307 1,307

24 MAURITANIA The estimated SAM burden for was estimated at 33,757, while the Targeted Caseload was about 28,694 SAM Children. At the end of, a total number of 18,446 SAM children have been treated (64.3% of the Targeted CSL). The national nutrition survey was conducted in June reporting a GAM prevalence of 14.0% ( % Confidence Intervals) and a SAM prevalence of 1.9% ( % Confidence Intervals). An IMAM program review was organized in May. Active screening was organized by NGOs in the 7 more affected regions (GAM prevalence over 15% or SAM prevalence over 2%) with UNICEF support. As a result, 623,400 children 659 months of age were screened and 1.4% (8,898) were diagnosed with SAM and referred to Health Facilities. Number of functional OTP : 551 Number of functional IPF: 26 Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL , ,406 1,352 1,655 1, , ,243 1,401 1,488 1,798 2,173 1,192 1,823 1,277 1,068 1,083 16,286 1,248 1,360 1,566 1,767 1,823 2,481 1,416 1,446 1,733 1,549 1,577 1,144 19,110 1,208 1,567 2,024 1,914 2,324 2,132 1,353 1,851 1,713 1, ,446 3,000 MauritaniaNumber of new SAM admissions 2,500 2,000 1,500 1, JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC Table 2: Number of Health Centers with IMAM activities (OTP and IPF) Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

25 NIGER The estimated SAM burden and Targeted Caseload for were estimated at 368,114. At the end of the year, a total number of 354,341 SAM children have been treated (96.3%). Revision of the IMAM national protocol is ongoing. Number of functional OTP: 878 Number of functional IPF: 44 Year/ JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC TOTAL Month ,553 12,477 15,058 26,729 32,429 29,725 37,894 39,632 41,363 34,038 25,957 22, ,893 16,930 21,100 26,827 21,434 32,364 25,628 25,140 28,467 25,959 25,289 26,430 17, ,462 17,528 16,680 27,226 27,158 35,976 30,883 31,037 45,349 38,224 35,152 38,838 24, ,036 25,723 23,532 26,272 25,304 42,291 35,167 37,375 34,430 50,912 47,219 31,960 26, ,327 35,914 23,986 22,723 25,259 37,760 35,197 27,025 32,848 37,378 34,699 29,091 22, ,837 24,977 22,029 26,207 31,210 29,382 25,548 30,824 33,703 34,956 41,977 30,330 23, ,187 60,000 Niger Number of new SAM admissions 50,000 40,000 30,000 20,000 10, Table 2: Number of Health Centers with IMAM activities Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC

26 NIGERIA In, in the 11 Northern states of the country, the estimated SAM burden was estimated at 461,236, while the Targeted Caseload was established at 345,927. At the end of the year, a total number of 397,221 SAM children have been treated (114.8%). A national health and nutrition survey covering 36 states and the Federal Capital Territory (FCT) was carried out in JulySeptember. The survey found elevated prevalence of SAM of 2.6% in Borno state ( % Confidence Intervals) and 2.0% in Yobe state ( % Confidence Intervals) The scaling up of IMAM continues with 106 new IMAM functional sites in. The total number of sites providing IMAM services is 746 across 11 states of northern states (Katsina, Jigawa, Kebbi, Sokoto, Gombe, Zamfara, Yobe, Borno, Kano, Bauchi and Adamawa). IMAM services are operational in 20 IDP camps in the 3 emergency states; Adamawa, Borno and Yobe. The program in the IDP camps is additional to the existing routine IMAM program. A recent assessment in the 3 emergency states showed that about 70 percent of IDPs have returned to their home. There are 278 CMAM sites established across the 3 states, including the sites in IDP camps. From January to December, 381,146 children were screened with MUAC in IDP camps and host communities. Systematic screening is conducted in IDP camps once every week. The proportion of children found with severe acute malnutrition among screened children in IDP camps is 3.2 %, which is similar to the overall estimates in the host community, showing a very worrying nutritional situation among this population. Table 1: New SAM admissions in the Northern States (by month) Year/Month JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC TOTAL ,330 2,116 1,411 2,044 6, ,272 1,298 1,983 1,990 1,998 2,953 5,088 3,769 4,683 7,495 7,653 3,916 44,098 5,314 5,103 7,264 7,527 9,706 12,292 11,852 14,008 15,139 17,697 12,410 12, ,030 9,809 11,636 13,218 15,944 20,560 20,201 23,196 25,524 22,660 19,328 18,842 16, ,506 16,500 16,901 18,761 21,713 24,749 22,711 19,834 19,213 18,835 21,232 19,744 15, ,100 16,826 16,716 19,958 25,325 28,558 34,726 29,042 36,634 39,191 30,565 26,946 15, ,247 13,661 20,202 24,402 28,956 35,334 39,076 36,127 47,437 45,928 46,564 34,299 25, ,221 Adamawa ,068 1,288 2,216 1,662 1,547 1,389 1,055 12,687 Borno 1, ,043 1,672 1,478 1,827 2,428 3,062 3,025 3,384 2,551 2,246 24,510 Yobe 2,032 2,778 2,869 3,301 3,780 4,328 3,920 3,875 5,260 7,005 4,235 3,432 46,815 Graph 1: New SAM admissions in the Northern States (by month) 50,000 45,000 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 Nigeria Number of New SAMAdmissions in the 11 Northern States JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC Table 2: Number of Health Centers with IMAM activities (OTP and IPF) Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC

27 SENEGAL In, the estimated SAM burden was estimated at 68,647, while the Targeted Caseload was established at 54,918. At the end of the year, a total number of 39,147 SAM children have been treated (71.3%) A national nutrition survey using SMART Methodology initially planned in JulyAugust has been carried out in OctNov. The results found a GAM Prevalence of 9.0% ( % Confidence Intervals) and 1.3% ( % Confidence Intervals) for SAM prevalence. Three survey strata (the Department of Podor and the regions of Louga and Matam) had a GAM prevalence above 15%. Number of functional OTP/IPF: 1,379 Year/Month JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC TOTAL ,163 3,532 2,452 3,265 1,643 13, ,072 1,494 1,744 1,768 1,795 1,929 3,554 2,485 2,962 1,433 22,152 4,001 2,406 2,062 2,086 2,330 3,653 2,594 2,491 2,922 2,652 2,851 1,455 31,503 1,790 2,702 2,666 2,548 2,360 3,644 3,465 5,345 4,507 4,660 3,812 1,648 39,147 6,000 Senegal Number of new SAM admissions 5,000 4,000 3,000 2,000 1,000 JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC Table 2: Number of Health Centers with IMAM activities (OTP and IPF) Year/Month JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC ,167 1,276 1,276 1,276 1,276 1,379 1,379 1,379 1,379 1,379 1,379 1,379 1,379 1,379

28 SIERRA LEONE The Government of Sierra Leone has made nutrition a priority in its current fiveyear Poverty Reduction Strategic Plan for the period UNICEF in collaboration with donors and implementing partners continued to support the Ministry of Health and Sanitation (MoHS) in the provision of treatment to SAM children (with and without complications) using ReadytoUseTherapeutic Food (RUTF) countrywide. Currently, the Integrated Management of Acute Malnutrition (IMAM) programme is providing treatment to children under 5 suffering from Severe Acute Malnutrition (SAM) in 596 MoHS Peripheral Health Units ((PHUs), out of 1,185 PHUs). The MoHS and its partners continue to train and provide support to 596 Outpatient Treatment Program (OTP) facilities (representing 50.3% PHUs coverage) Number of functional OTP: 603 (source: MoHS DFN Jan 2016) Number of functional IPF: 20 (source: MoHS DFN Jan 2016) Admission data is complete for OctoberNovember and partially for December Year/Month JAN FEB MAR APR MAY JUN JUL AUG SEPT OCT NOV DEC TOTAL ,030 2,055 2,303 1,986 1,499 1,588 1,852 2,474 2,219 2,255 1,758 1,257 23,276 2,089 2,011 2, ,392 1,875 2,211 1,314 15,537 2,446 2,146 3,301 3,004 3,247 4,245 4,311 3,570 2,174 3,233 2,272 1,786 35,735 2,910 2,138 1,800 3,362 3,620 3,124 2,666 2,073 3,260 2,178 2,827 2,559 32,517 2,887 1,749 2,395 2,966 2,292 2,100 3,259 2,211 1,941 2,565 2,420 1,796 28,581 2,520 1,932 2,632 3,338 2,777 3,083 2,315 2,067 1,266 2,544 2,556 2,613* 29,643 *This is not a final data for Dec. It is expecting to have a final data by the end of February ,000 Sierra LeoneNumber of new SAM admissions 4,500 4,000 3,500 3,000 2,500 2,000 1,500 1, JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC Note: RUTF distribution stopped from March to August ;

29 TOGO In January 2016, all the regions of the country are covered by IMAM program with the strongest emphasis in the northern regions (the most vulnerable regions are Kara & Savanes). In, under five malnourished children were admitted to health facilities and to community programs by community health workers. The program is implemented at both community and health facility levels in Kara and Savanes but only at health facility level in Lomé, Maritime, Plateaux and Central regions. 481 health workers were trained on the management of SAM (301 in and 180 in ), and 646 community health workers were trained on the management of SAM in two regions (Savanes and Kara) The main activities of IMAM implemented during are: (i) Training of 180 health workers on the prevention and management of severe acute malnutrition (revised protocol in ), (ii) monitoring and evaluation at regional level, (iii) revision of data entry mask and management tools in line with the revised protocol, (iv) Technical to strengthen the supervision and improve the timeliness and quality of reporting. Number of functional OTP: 304 Number of functional IPF: 45 Number of CTC 1 villages: 541 Year/Month JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC TOTAL , , , , , TogoNumber of new SAM admissions JAN FEB MAR APRIL MAY JUNE JULY AUG SEPT OCT NOV DEC Note: Admission data for excludes data on CTC Villages and IPF and OTP reports are highly incomplete. 1 Community Therapeutic Care

30 Contacts in WCARO Nutrition Section Regional Nutrition Advisor o Noel Marie Zagre, nzagre@unicef.org, Direct / Mobile Nutrition Specialist Emergency and Resilience o Patricia Hoorelbeke, phoorelbeke@unicef.org, Direct / Mobile Nutrition Specialist Micronutrients and Knowledge Management o Nita Dalmiya, ndalmiya@unicef.org, Direct / Mobile Nutrition Specialist IYCF and IMAM o Hélène Schwartz, hschwartz@unicef.org, Direct / Mobile Nutrition Specialist Nutrition Information System o Sara GariSanchis, sgarisanchis@unicef.org, Direct / Mobile