INTEGRATED MANAGEMENT OF ACUTE MALNUTRITION PROGRAMME AND STOCKS REPORT APRIL - JUNE 2014

Transcription

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 APRIL JUNE Representing conditions until end of June,

2 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 Hélène Schwartz and Patricia Hoorelbeke at the UNICEF West and Central Regional Office, Dakar Senegal. 1

3 Introduction This report summarizes IMAM program activities and the supply chain of ready to use therapeutic food () and ready to use supplementary foods (RUSF) and management of acute malnutrition programmes 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 the availability and rational use of stocks for the treatment and prevention of acute malnutrition. The information is sourced from government sources, UNICEF Country Offices and, where possible from collaborating partner organisations. Sphere Guidelines The Sphere Handwork based on the Humanitarian Charter and definition of the Minimum Standards 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. Country programs 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) with support from ECHO purchased about 27,000 cartons of (2010). These revolving stocks serve to greatly reduce the time between orders and delivery and also as a prepositioned stock of 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 2

4 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 in less than 10 days to the majority of Sahel and Coastal countries in the region. Recommended amounts of 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 (150 sachets). In implementation, the average amount of 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

5 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 Yes No Yes No First version IMAM National Protocol Current version Next review part of the Essential Drugs List Benin X X On going X Burkina Faso X X X X On going X Cameroon X X 2007 X CAR X X X On going X Chad X X 2007 X Congo X X X Côte d Ivoire X X On going X DRC X X 2008 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 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 Yes No X 4

6 Regional Summary National Stocks of /RUSF Note: These data reflect the current stock (19 th of August ) as mentioned in VISION (management software). It could therefore not reflect the real stock, depending on the update status of each country. In stock BENIN 5 In the pipeline TOTAL BURKINA FASO In stock 6, In the pipeline 104,507 0 TOTAL 110, CAMEROON In stock In the pipeline 2, TOTAL 2, CENTRAL AFRICAN REPUBLIC In stock 6, In the pipeline 12,528 TOTAL 18, CHAD In stock 1, In the pipeline 72, TOTAL 74, In stock CONGO In the pipeline 120 TOTAL COTE D IVOIRE In stock 2, In the pipeline TOTAL 2, DEMOCRATIC REPUBLIC OF CONGO In stock 43, ,180 In the pipeline 25, TOTAL 69, ,922

7 In stock GAMBIA In the pipeline 3,400 Include 1,700 cartons of BP100 TOTAL 3,400 GHANA In stock In the pipeline 269 TOTAL GUINEA In stock 2, Include 1,990 cartons of BP100 In the pipeline 1, TOTAL 3, GUINEA BISSAU In stock 1, In the pipeline TOTAL 1, LIBERIA In stock In the pipeline 2,947 TOTAL 3, MALI In stock 22, In the pipeline 32,594 1,828 TOTAL 55, ,379 MAURITANIA In stock 1, In the pipeline 6,088 TOTAL 7, NIGER In stock 35,816 1,278 2,179 In the pipeline 68, TOTAL 104,401 1,278 2,629 6

8 NIGERIA In stock 3, In the pipeline 101, TOTAL 105, SENEGAL In stock 2, In the pipeline 4,000 TOTAL 6, SIERRA LEONE In stock 10, In the pipeline 7,956 TOTAL 18, TOGO In stock 2,048 In the pipeline 85 TOTAL 2, In stock 13,000 In the pipeline ACCRA SUPPLY HUB TOTAL 13, DOUALA SUPPLY HUB In stock 31,731 In the pipeline 0 TOTAL 31,

9 Regional Summary Total of new SAM Admissions per year 2010 Benin 3,945 4,279 Burkina Faso 47,656 39,494 77,106 98,013 Cameroon (North & Ext North) 31,121 40,300 64,313 CAR 12,022 4,843 16,294 Chad 56,436 69, , ,423 Congo 1, Côte d Ivoire 12,170 6,450 DRC 157, , ,563 Gambia 3,164 4,261 Ghana 1,906 2,804 3,431 5,206 Guinea Guinea Bissau 1,162 Liberia 3,271 8,757 6,919 Mali 26,550 52, ,993 Mauritania 3,120 10,757 16,286 Niger 330, , , ,327 Nigeria (11 states) 44, , , ,100 Senegal 13,628 22,152 Sierra Leone 23,276 15,537 35,735 32,517 Togo 5,357 4,363 6,278 TOTAL 504, ,010 1,189,525 1,388,095 8

10 BENIN IMAM started to be implemented as part of the emergency response in northern Benin in 2006 It has been officially integrated in the minimum package of interventions to be scaled up nationwide by the MoH since It has been officially integrated in the National Food and Nutrition strategy and its costed plan since Screening of malnutrition and followup are officially part of CHW s activities since as stated in the national guidelines on community health promotion. 17 health districts out of 34 are covered by the IMAM program in Benin The revision of the national protocol started on the July Number of functional OTP: 346 Number of functional IPF: 16 Data not available BeninNumber of new SAM admissions Total new admissions for : 3,945 Total new admissions for : 4,

11 BURKINA FASO An IMAM Scaleup plan 2015 has been developed Revision of the IMAM national protocol on going Number of functional OTP: 1592 Number of functional IPF: ,592 3,502 3,726 3,480 3,778 4,670 3,734 3,147 3,309 4,281 4,738 4,699 3,832 3,583 3,676 3,030 3,359 3,251 3,251 3,168 3,376 3,001 3,134 2,833 3,787 3,787 3,787 6,755 6,755 6,755 5,715 4,928 7,872 9,778 8,920 8,267 7,338 7,303 6,077 6,922 8,569 8,648 6,781 5,416 6,392 14,083 10,810 9,674 6,892 6,709 8,289 8,927 9,594 9,256 3,743 16,000 Burkina FasoNumber of new SAM admissions 14,000 12,000 10,000 8,000 6,000 4, ,000 Table 1: Number of Health Centers with IMAM activities (OTP and IPF) 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 10

12 CAMEROON The only regions in Cameroon with management of acute malnutrition programs are: North, ExtremeNorth, Adamaoua and East region. Since the Republic of Central Africa crisis, response was intensified in the East and Adamaoua regions following large influx of refugees 1,639 1,432 2,390 2,942 2,380 3,331 1,989 2,521 3,162 4,610 2,363 2,362 4,231 4,005 3,370 2,924 2,491 3,392 3,617 2,756 3,479 3,753 2,995 3,287 5,023 3,580 4,492 5,196 7,068 6,014 6,653 7,141 6,302 6,116 5,629 1,099 5,588 5,471 3,759 4,508 4,709 3,401 8,000 Cameroon Number of new SAM admissions 7,000 6,000 5,000 4,000 3,000 2,000 1,000 Note: Data are representative of ExtremeNorth and North regions only from up to February. From March, data include admission from South and Adamaoua regions Table 1: Number of Health Centers with IMAM activities (OTP and IPF)

13 CENTRAL AFRICAN REPUBLIC Number of functional OTP: 107 Number of functional IPF: ,132 1,279 1,506 1,378 1, , ,018 1,222 1,464 1,631 1, ,007 2,757 2,034 1,959 1,919 1,636 1,035 1,208 2,723 2,873 1,786 2,053 2,386 2,286 3,500 Central African RepublicNumber of new SAM admissions 3,000 2,500 2,000 1,500 1,

14 CHAD ,430 2,494 2,453 2,651 4,555 5,988 6,133 6,522 6,819 6,838 5,640 3,913 3,474 3,833 5,205 4,834 6,866 9,244 7,839 5,207 5,939 5,515 5,521 6,459 7,348 10,376 13,006 13,123 13,889 15,888 12,305 14,661 14,242 12,179 11,687 7,981 8,403 8,787 11,360 12,731 12,197 16,581 14,031 11,902 14,208 13,559 12,229 9,435 8,994 11,735 11,945 14,893 14,556 15,017 18,000 16,000 14,000 Chad Number of new SAM admissions in the Sahel Band 12,000 10,000 8,000 6,000 4, ,000 Table 1: Number of Health Centers with IMAM activities (OTP and IPF) Note: The number of health centers decreased as of February due to the end of activities of 3 NGOs 13

15 CONGO (Brazzaville) Number of functional OTP: n/a Number of functional IPF: CongoNumber of new SAM admissions

16 COTE D IVOIRE Revision of the national protocol in July. Final version still to be validated Organization of a training of trainers facilitated by Pr Michael Golden and Dr Yvonne Grellety in July A nutrition survey based on the SMART methodology, representative of 10 sanitary regions (regions with a prevalence of chronic malnutrition > 30%) has started in August Cote d'ivoirenumber of new SAM admissions New admissions : 12,170 New admissions : 6, Note: Quarterly data (Q1=5260; Q2=1693; Q3=3588; Q4=1629) have been divided by three to get monthly data 15

17 DEMOCRATIC REPUBLIC OF CONGO Geographical coverage of management of acute malnutrition: 27% The PRONANUT is supported by 46 partners Number of functional OTP: 2059 Number of functional IPF: ,548 14,548 11,705 10,846 11,063 9,969 12,305 10,268 15,355 18,144 13,442 14,832 19,570 21,164 18,398 17,799 17,491 16,069 14,257 13,821 13,787 17,064 16,373 15,528 17,763 20,243 20,630 20,088 17,899 13,930 14,055 15,157 16,811 17,261 17,053 10,673 25,380 21,526 17,662 14,273 11,346 4,254 30,000 DRCNumber of new SAM admissions 25,000 20,000 15,000 10,000 5,000 Note: The completeness of the monthly reports for is under 100% 16

18 GAMBIA 153 health workers (Doctors, Nurses and community health nurses) and 240 community members are trained on IMAM In March, an exercise of mass active screening has been organized Number of functional OTP: 70 Number of functional IPF: GambiaNumber of new SAM admissions NOTE: Mass active screening activities have been organized in March, 17

19 GHANA IMAM is implemented in all regions of Ghana, covering 83 of the 216 districts. UNICEF supports IMAM in a total of 59 districts in five focus regions: Northern, Upper East, Upper West, Central and Eastern Regions, representing 71 percent of all districts implementing CMAM in Ghana. The remaining districts receive IMAM supplies and technical assistance from USAID. Following the results of the coverage surveys conducted in November in six districts in the three northern regions, active screening has been intensified hence the increased number of admissions in the 1st quarter of. Revision of the IMAM national protocol on going Number of functional OTP: 1,640 Number of functional IPF: GhanaNumber of new SAM admissions in 5 focus Regions Note: The and data include the Upper East, Upper West, Northern, Eastern and Central Regions (UNICEF focus regions). The previous years are representative of the three Northern regions only. 18

20 GUINEA 650 persons have been trained on IMAM (staff of health centers, nutrition focal points, doctors and pediatrician) 3,991 3,991 3,991 4,500 Guinea ConakryNumber of new SAM admissions 4,000 3,500 3,000 2,500 2,000 1, , Note: Quarterly data (Q1=11,973) have been divided by three to get monthly data 19

21 GUINEA BISSAU Key Program details IMAM performance indicators integrated in the National Health Monitoring Information System IMAM implementation in 6 IPF and 13 OTP in 5 health regions (Biombo, Bafata, Gabu, Oio and Farim) A center of excellence is currently running in Cumura hospital allowing students and new health staff to learn and practice management of acute malnutrition Guinea BissauNumber of new SAM admissions

22 LIBERIA Number of functional OTP nationwide: 93 Number of functional IPF nationwide: 17 Graph 1: New SAM admissions for the 4 refugee affected counties Grand Gedeh, Maryland, Nimba and River Gee ( & ) and for 15 counties (from November onwards) (by month) LiberiaNumber of new SAM admissions in 4 counties ( & ) and 8 counties () 1,200 1,

23 MALI Key Program details A national coverage survey based on the SLEAC methodology has been carried out in June July. Results are not yet available 1,747 1,747 1,747 2,079 2,079 2,079 2,027 2,027 2,027 2,997 2,997 2,997 3,549 2,081 1,847 2,029 3,633 4,841 4,820 7,243 5,771 5,408 6,384 4,550 6,672 5,908 7,778 9,855 11,292 11,859 11,899 10,917 13,320 12,792 9,368 8,333 8,296 7,771 6,939 9,109 9,098 10,517 9,662 14,000 MaliNumber of new SAM admissions 12,000 10,000 8,000 6,000 4,000 2,000 Note: For each quarter of data have been divided by three to get monthly data Table 1: Number of Health Centers with IMAM activities (OTP and IPF) 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 22

24 MAURITANIA ,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 1,057 1,190 1,317 1,460 1,444 2, MauritaniaNumber of new SAM admissions Table 1: Number of Health Centers with IMAM activities (OTP and IPF)

25 NIGER Number of functional OTP and IPF: 857 Number of functional IPF: ,553 12,477 15,058 26,729 32,429 29,725 37,894 39,632 41,363 34,038 25,957 22,038 16,930 21,100 26,827 21,434 32,364 25,628 25,140 28,467 25,959 25,289 26,430 17,894 17,528 16,680 27,226 27,158 35,976 30,883 31,037 45,349 38,224 35,152 38,838 24,985 25,723 23,532 26,272 25,304 42,291 35,167 37,375 34,430 50,912 47,219 31,960 26,142 25,839 16,928 20,158 23,312 25,708 24,999 60,000 Niger Number of new SAM admissions 50,000 40,000 30,000 20,000 10, Graph 2: New SAM admissions (by week) 16,000 14,000 12,000 NigerNumber of new SAM weekly admissions 10,000 8,000 6,000 4,000 2,

26 NIGERIA Scaling up of IMAM continued with the addition of 3 states to bring the total to 11 states; Katsina, Jigawa, Kebbi, Sokoto, Gombe, Zamfara, Yobe, Borno, Kano, Bauchi and Adamawa A national coverage survey has been carried out in AprilMay. Results are not yet available ,330 2,116 1,411 2, ,272 1,298 1,983 1,990 1,998 2,953 5,088 3,769 4,683 7,495 7,653 3,916 5,314 5,103 7,264 7,527 9,706 12,292 11,852 14,008 15,139 17,697 12,410 12,718 9,809 11,636 13,218 15,944 20,560 20,201 23,196 25,524 22,660 19,328 18,842 16,588 16,500 16,901 18,761 21,713 24,749 22,711 19,834 19,213 18,835 21,232 19,744 15,907 16,068 16,435 17,814 25,111 28,374 32,747 35,000 NigeriaNumber of new SAM admissions in the Northern States 30,000 25,000 20,000 15,000 10,000 5, Table 1: Number of Health Centers with IMAM activities (OTP and IPF)

27 SENEGAL An external evaluation of the IMAM programs is planned in October A national nutrition survey based on the SMART methodology was carried out in JuneJuly. Prevalence of Global Acute Malnutrition is critical (GAM>15%) in the region of Matam and the department of Podor (region of SaintLouis) and serious (GAM>10% and <15%) in the region of Tambacounda and in the department of Dagana (region of SaintLouis) ,163 3,532 2,452 3,265 1, ,072 1,494 1,744 1,768 1,795 1,929 3,554 2,485 2,962 1,433 2,383 1,632 1,676 1,767 2,874 1,609 4,000 Senegal Number of new SAM admissions 3,500 3,000 2,500 2,000 1,500 1, Note: Up to April, data are representative of 4 regions (Matam, Diourbel, Tamba and Kolda). 9 regions are included in May, while data are representative of Tambacounda, Matam, Kolda and Fatick for June. Table 1: Number of Health Centers with IMAM activities (OTP and IPF)

28 SIERRA LEONE IMAM national protocol reviewed in October. The revision will be finalized in. Number of functional OTP: 423 Number of functional IPF: 19 Number of functional SFP: ,030 2,055 2,303 1,986 1,499 1,588 1,852 2,474 2,219 2,255 1,758 1,257 2,089 2,011 2, ,392 1,875 2,211 1,314 2,446 2,146 3,301 3,004 3,247 4,245 4,311 3,570 2,174 3,233 2,272 1,786 2,910 2,138 1,800 3,362 3,620 3,124 2,666 2,073 3,260 2,178 2,827 2,559 2,887 1,749 2,366 2,962 2,285 1,178 5,000 Sierra LeoneNumber of new SAM admissions 4,500 4,000 3,500 3,000 2,500 2,000 1, , Note: distribution stopped from March to August 27

29 TOGO Currently, all the regions of the country are implementing IMAM program with management of SAM with a stronger focus in the northern regions (the most vulnerable: Kara & Savanes) Data come from IPF, OTP and Community management of SAM (treatment of SAM children without medical complications (IMCI reference) in the community by community health worker) Number of functional OTP: 304 Number of functional IPF: TogoNumber of new SAM admissions Note: From January, community data (management of severe acute malnutrition by Community Health Workers) are not included. 28