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1
Monthly Humanitarian Situation Report SENEGAL
Date: September 2013
Mothers receiving advice on nutrition good practices
from outreach workers in a community nutritional site in Fatick region
Highlights
Based on available data more than 11,000 SAM admissions have been reported in Senegal
between January and August 2013. August reports (available for 32% of facilities) show 1,617 new
SAM admissions.
The region of Diourbel has already reached 141% of its annual SAM target. The region admits
more than double the monthly SAM cases than any other region.
The June 2013 nutritional survey shows that overall national Global Acute Malnutrition (GAM)
average prevalence for under-five children has not reached the 10% threshold but remains
precarious at 9.1%. However, four Departments have surpassed the 15% crisis threshold of
global acute malnutrition (Matam 20%, Kanel 18%, Podor 17% and Ranerou 16%). Sixteen
Departments are areas of concern, with ten Regions concerned. Nine Departments have
surpassed the 2% SAM threshold.
UNICEF Senegal’s requirements of US$3,305,266 in the HAC for 2013 are 60% funded.
2
Situation Overview & Humanitarian Needs
The targets for the rehabilitation of children with Severe Acute Malnutrition (SAM) for 2013 in Senegal
are based on the national 2012 nutrition survey using SMART methodology. According to this survey, the
SAM burden for 2013 was estimated at 63,323 under-five children. In 2013, the sectoral group of
partners agreed to an initial target of 38,968 SAM cases (62%1) given funding trends and estimated
geographical coverage of services, then revised to 42,843 at the mid-term review. Based on the same
survey, the Moderate Acute Malnutrition (MAM) caseload is estimated at 255,675 cases for the year
(Table 1). The 2012 survey further identified 16 out of 45 departments as critical. Based on this
geographical breakdown, 11 out of 14 regions were identified as in need of emergency support based on
prevalence of malnutrition and aggravating factors such as diarrhoea and ARIs: Diourbel, Fatick, Kaffrine,
Kedougou, Kolda, Louga, Matam, Saint Louis, Sedhiou, Tambacounda and Thies.
A Food Security and Nutrition survey took place in June 2013 (ENSAN 2013) with broad implication of
concerned government ministries and partners. The nutritional situation in Senegal seems largely
unchanged from 2012 when the emergency nutrition response was launched. This survey includes the
following key findings (see page 3 and annex for details):
Overall national Global Acute Malnutrition (GAM) average prevalence for under-five
children has not reached the 10% threshold but remains precarious at 9.1%2.
Four Departments have surpassed the 15% crisis threshold of global acute malnutrition
(Matam 20%, Kanel 18%, Podor 17% and Ranerou 16%)
Twelve additional Departments have reached the 10% GAM warning threshold
Nine Departments are over the 2% Severe Acute Malnutrition crisis threshold: Mbour
2,3%, Medina Yoro Fula 2,2%,Podor 3,9%, Ranérou 4%, Kanel 2,2%, Matam 4,5%, Goudiri
2%, Bounkiling 4,6%, Bakel 2,7%
National prevalence of chronic malnutrition is 16.5%
Based on the June 2013 ENSAN survey (using SMART methods), the estimations for 2014 were made
using the same methodology than for 2013 estimates (i.e. 1.5 incidence factor for MAM, 1.6 for SAM
caseload and 2.6 for the burden). Thus the estimated under-five SAM caseload for 2014 is of 47,271 cases
and the overall SAM burden is 76,817 cases. MAM caseload is estimated as just over 250,000 under-five
children.
1 Taking into account SPHERE standard targets for treatment coverage which are 50% in rural areas and 70% in urban areas.
2 8,4- 9,8 IC
3
Global acute malnutrition in Senegal 2011-2013
Regions
Global Acute
Malnutrition
(SMART 2011)
Global Acute
Malnutrition
(SMART 2012)
Global Acute
Malnutrition
(ENSAN 2013)
Dakar
6.1 5.3
Diourbel 10.3 7.9 9.4
Fatick
6.8 8.2
Kaffrine
11 10.5
Kaolack
9.3 7.1
Kédougou 6.7 8.6 9.2
Kolda 7.9 10.3 10.1
Louga 8.2 9.7 8.9
Matam 14.1 15.4 18.8
Saint-Louis 8 11.8 12.5
Sedhiou
8.9 10.2
Tambacounda 6.1 14 11.8
Thiès 7.9 7.2 8.2
Ziguinchor
6 6.4
National
8,8 9.1
Table 1: Comparative GAM 2011, 2012, 2013 by Region
Figure 2: Map of Senegal showing GAM by Department based on ENSAN 2013 survey
Global Acute
Malnutrition 2013
Prevalence of Global Acute Malnutrition
4
The food security module of the ENSAN survey found a moderate level of food insecurity at 18.8%; that is
245,000 households or 2.2 million people. There is deterioration in rural food security however as
compared to 2010. Rural households are more affected (25.1%) with the regions of Casamance showing
very high levels (Ziguinchor 68%, Sédhiou 67% and Kolda 50%). The regions of Matam and Kedougou
follow high prevalence at 48% and 45.6% respectively.
Program response - SAHEL NUTRITION CRISIS
Since the launch of the nutrition response in 2012, UNICEF provides training, anthropometric tools,
Ready to Use Therapeutic Food (RUTF) and therapeutic milks, essential medicine (deworming, vitamin A,
antibiotics, ORS/Zinc), as well as resources for coordination, supervision and monitoring of the response
in all fourteen Health Regions in the country. Following a phased approach, from June 2012 Phase 1
covered Diourbel and Matam regions – with 174 public health facilities to offer nutritional services –
strengthening capacity of district authorities and health providers, both directly and through INGO
partners. Phase 2 effectively started in November 2012, covering Louga, Thies and St. Louis Regions,
which count 367 health facilities. The final stage (or Phase 3) began in January 2013 in six additional
regions, namely Fatick, Kaffrine, Kedougou, Kolda, Sedhiou and Tambacounda. In all these regions,
UNICEF supports response plans that integrate Nutrition/Health, WASH and Communication for
behavioural change. UNICEF’s activities in response to the nutritional crisis in Senegal were officially
launched in June 2012, and current targets are set until the end of 2013.
UNICEF and partners’ programing
Based on available data more than 11,000 SAM admissions have been reported in Senegal between
January and August 2013. The five regions for which August data is available have reported 1,617
new SAM admissions. This number represents 306 nutritional facilities which have reported in August
(32% of total facilities). Reports are still awaited from five additional Regions.
The region of Diourbel has already reached 141% of its annual SAM target. The region admits more
than double the monthly SAM cases than any other region.
The CLM has provided community level nutrition surveillance to 1,399,776 children under five in its
screening of the second quarter. UNICEF and its partners contributed to setting up the mechanism
that allows for this kind of community surveillance for malnutrition.
UNICEF delivered 1,500 cartons of Plumpynut to health facilities in the month of August and an
additional 1,000 in September.
5
UNICEF has supported the Ministry of Health to recruit and train five additional local Nutrition
Technical Assistants to be placed within Health Regions nutrition teams in Louga, Thies, Saint Louis,
Podor, Sedhiou. This approach is already successfully used in the Health Regions for which UNICEF
received CERF funding3 to accelerate the emergency response and provide nutrition management
support to capacity of Regions. Two more technical assistants will be recruited for Tambacounda and
Matam. In all, UNICEF is providing 13 nutrition technical assistants to the government of Senegal
countrywide as an approach favored by the Ministry of Health.
In light of persistent Severe Acute Malnutrition in the country as evidenced by the latest nutrition
data, UNICEF believes there is need to strengthen the community level work conducted by the CLM
and its partners. Additional resources are needed to support outreach for good practices as well as to
increase the coverage and frequency of active screening so that children are identified and treated
early on.
11.2% of SAM cases reported suffer of complications such as diarrhea, acute respiratory infections or
oedema. 26 deaths occurred in August, more than half of which in the Region of Diourbel. A joint
supervision mission by UNICEF, French Red Cross and the Ministry of Health to Diourbel is awaiting
confirmation by the Ministry and is expected to help shed light on the reasons for this.
Figure 3: Deafaulters by month.
The number of defaulters4 has increased with the agricultural season linked to the August rains. Thus
236 defaulters have been reported in August, totalling 631 this year. Mothers are less likely to take
the time to bring children to nutrition facilities while having to spend time in the fields.
3 Fatick, Kaffrine, Kedougou (shared with Tambacounda), Kolda, Sedhiou (shared with Kolda), Tambacounda
4 Defaulter is defined as missing two consecutive doctor’s appointments
6
SAH
EL N
UTR
ITIO
N C
RIS
IS –
SEN
EGA
L P
ERFO
RM
AN
CE
IND
ICA
TOR
S
Sector Estimated # / % coverage
UNICEF & operational partners Sector / Cluster
UNICEF 2013
Target
Cumulative results 2013
% of Target
Achieved
Cluster 2013
Target1
Cumulative results 2013
% of Target
Achieved
Nutrition Children 0-59 months
with Severe Acute
Malnutrition admitted
for therapeutic care
42,8432
11,0323
26% 42,8432
11,0323
26%
Children 0-59 months
in therapeutic care
discharged recovered
from SAM
9,341 5,6064
60% 9,341 5,6064
60%
Number of Health
Centers/Posts with
SAM treatment
941
841 90% 941
841 90%
Children <5 with
Severe Acute
Malnutrition with
complications
admitted to
therapeutic care
1,1035
1,236 112% 1,1035 1,236 112%
List of UNICEF Operational Partners: Action Against Hunger – Spain, French Red Cross, Ministry of Health,
Childfund (CRS, Plan, Africare, World Vision), Cellule de Lutte Contre la Malnutrition (CLM)
1. UNICEF and Cluster Target for SAM related activities are the same; UNICEF is the supplier of RUTF to all public
health facilities in Senegal
2. Revised target at Senegal Humanitarian Strategy mid-year review after updated context data.
3. Based on available data from government and NGOs covering approximately 36% of nutritional facilities in the
month of August.
4. Recovery data for July admissions is collected in August and is therefore now available in the September SitRep.
5. WHO in Senegal defines this target as 10% of SAM admissions. This is a fluctuating target.
WASH Number of nutrition
centers/posts with the
WASH minimum
package2
841
420 50% 841
420 50%
Number of children
with SAM benefiting
from hygiene kits and
counselling on key
hygiene messages
11.,032 1,5333
14% 11,032 1,5333
14%
List of UNICEF Operational Partners: Ministry of Health, Ministry of Water and Sanitation, Local authorities
(Mayor’s office, etc.), CBOs, Senegalese Red Cross 1 This is primarily a UNICEF activity. There is currently no WASH sector-wide reporting on this indicator. Only
UNICEF data is currently provided. 2 “Minimum package” is defined as: availability of drinking water, no open defecation and hygiene promotion. 3Based on partial data
Table 4: Summary of Sahel Performance Indicators
7
Seasonal Floods Update
Part of a road washed away by flood waters Child in flooded house along an inlet in Joal, Thies region
The Ministry of Education has identified 107 flooded schools, 4 occupied by families displaced from
their homes and 11 otherwise damaged by the rains in Dakar, Saint Louis, Fatick, Kaffrine. Kaolack
and Ziguinchor. UNICEF is supporting these schools with supplies to disinfect the facilities before the
beginning of the school year in October and with school supplies. In a recent WASH rapid assessment,
an additional 23 schools were found to be occupied by displaced families and will be disinfected by
the WASH sector when the facilities are vacated.
The Department of Mbour (Thies Region) declared an emergency after a road was washed away by
flood waters and several neighborhoods were affected by flooding. Two joint mission of UNICEF and
the National Hygiene Service (MoH) to visit the floods affecting the regions of Dakar, Fatick, Kaffrine,
Kaolack and Thies have found a situation under control by authorities. More than 5,000 flood-
affected families have received hygiene kits provided by UNICEF to hygiene brigades, with a
reinforcement of 5,500 kits to the most affected areas to be delivered by the end of the month.
UNICEF has also provided the funding needed for sensitization of the population on good hygiene
practices and the treatment of water for drinking.
According to WHO and the Ministry of Health, epidemiological surveillance shows that despite the
floods the situation remains normal for the season in terms of suspected cases of malaria and
diarrhea stating “no reason for concern at this time”.
8
Figure 5: Suspected cases of bloody diarrhea by week, comparative 2012-2013. Source: WHO Senegal
Funding Update
UNICEF Senegal has received an additional $500,000 from the ECHO regional pool. With this new
funding UNICEF Senegal’s requirements of US$ 3,305,266 in the HAC are currently 60% funded.
Date of next SitRep: 30 October 2013 For further information, please contact:
Giovanna Barberis
Representative
Tel: +221 33 889 03 00
E-mail: [email protected]
Edele Thebaud
Deputy Representative
Tel: +221 33 889 03 00
E-mail: [email protected]
Revised HAC Requirement USD (as of June 2013) Funded USD
(August 2013)
Unfunded USD Gap %
3,305,266 2,469,490 835,776 25
Su
sp
ect
Cases
Weeks
9
Annex: Prevalence of Acute Malnutrition by Department
Departments Prevalence of Wasting (6-59 months old)
Number (n) Global Moderate Severe
Matam 337 20.5% 16.0% 4.5%
Kanel 598 17.90% 15.70% 2.20%
Podor 305 16.7% 12.8% 3.9%
Ranérou 400 16.3% 12.3% 4.0%
Bakel 446 14.3% 11.7% 2.7%
Linguère 317 12.3% 11.7% 0.6%
Tambacounda 353 11.6% 11.3% 0.3%
Médina Yoro Foulah 633 11.5% 9.3% 2.2%
Bounkiling 303 11.4% 9.2% 4.6%
Dagana 253 11.1% 10.7% 0.4%
Goudiry 394 10.9% 8.9% 2.0%
Kaffrine 312 10.6% 9.9% 0.6%
Koungheul 376 10.4% 9.6% 0.8%
Gossas 232 10.3% 9.5% 0.9%
Bambey 412 10.2% 9.7% 0.5%
Saraya 283 10.2% 8.8% 1.4%
Malem-Hodar 392 9.9% 8.2% 1.8%
Diourbel 259 9.7% 9.3% 0.4%
Louga 287 9.60% 8.20% 1.40%
Goudomp 233 9.4% 9.0% 0.4%
Birkelane 328 9.1% 8.5% 0.6%
Salémata 188 8.5% 6.9% 1.6%
Kolda 271 8.5% 7.7% 0.7%
Foundiougne 239 8.40% 7.90% 0.40%
M'bour 216 8.3% 6.0% 2.3%
NioroduRip 392 8.2% 6.6% 1.5%
Sedhiou 354 8.2% 8.2% 0.0%
Vélingara 270 8.1% 6.7% 1.5%
Saint-Louis 161 8.1% 8.1% 0.0%
Mbacké 369 7.9% 7.6% 0.3%
Tivaouane 239 7.90% 7.50% 0.40%
Fatick 230 7.80% 7.40% 0.40%
Thiès 213 7.5% 6.6% 0.9%
Koumpentoum 321 7.5% 7.2% 0.3%
Guinguinéo 348 7.2% 7.2% 0.0%
Pikine 149 7.1% 6.7% 0.7%
Kébémer 210 7.1% 6.2% 1.0%
Bignona 265 6.8% 6.8% 0.0%
Kédougou 305 6.2% 6.2% 0.0%
Guediéwaye 116 6.0% 5.2% 0.9%
Ziguinchor 251 5.2% 3.6% 1.6%
Kaolack 302 4.6% 4.3% 0.3%
Oussouye 228 4.4% 4.4% 0.0%
Dakar 78 3.8% 2.6% 1.3%
Rufisque 134 3.0% 3.0% 0.0%