POVERTY: GUINEA: Evading the cholera epidemic*

CONAKRY, 12 December 2011 (IRIN)
 Photo: Anna Jefferys/IRIN
An actor, personifying cholera, tries to creep up on his victims

With just two cholera cases reported in 2011, Guinea escaped an epidemic in West and Central Africa that infected 85,000 people and killed 2,500 in the first 10 months of 2011. Luck, as well as targeted prevention efforts on the part of aid agencies and the government brought this about, specialists told IRIN, but a far deeper countrywide overhaul of the water and sanitation system is needed to diminish the likelihood of future outbreaks.
After widespread cholera infection in 2009, the government and aid agencies boosted prevention efforts in Guinea, making chlorine to sterilize water more readily available, spreading hand washing and clean water storage messages, and improving access to drinking water in schools and villages. These efforts have paid off: the absence of “cholera is one of the few highlights” this year, said Julien Harneis, head of the UN Children’s Fund (UNICEF) in Guinea.

Fish faeces and hand washing
Prevention is working better than in the past partly because aid agencies have developed a more sophisticated understanding of what drives the disease. In coastal areas of Guinea, including the capital, Conakry, fish proved to be an effective cholera host, passing it on through their faeces at markets across the city.
Cases dropped significantly once fish storage and transportation were cleaned up. “Approaches to cholera treatment and prevention are more sophisticated now, and are based on a more in-depth scientific understanding,” said Harneis, who recently returned from a regional workshop in the Senegalese capital, Dakar, on how the disease is spread in the region.
A cholera emergency contingency team - made up of representatives from the Ministry of Health, the International Committee of the Red Cross, administrators from the principal hospital, Donka, NGOs such as Action Contre la Faim (ACF) and UN agencies, including UNICEF - now meets regularly to discuss early warning and response.
Hygiene practices and access to clean water are the main problems in Guinea. One marker of poor hygiene practices is that diarrhoea prevalence is similar in areas with high or low access to clean water, and in Conakry it is double that in rural regions. “The vast majority of people use unsanitary shared latrines… and the seaside is used for defecation in large parts of the city,” said Lalit Patra, head of water, sanitation and hygiene (WASH) at UNICEF in Guinea.

 Photo: Anna Jefferys/IRIN
ACF pays Conakry residents to clear up rubbish to create a more sanitary environment

ACF tackles cholera by using street theatre to educate residents in at-risk neighbourhoods in cholera prevention, backed up by house-to-house visits where they distribute hygiene kits and give further advice.
In Matoto, northeast Conakry, an actor representing cholera infects all who approach him. In the question and answer session after the show, another actor asks the audience of mainly women and children, “How can someone be infected by cholera?” A woman grabs the microphone to answer: “With dirty hands, and when you don’t store your water well.”
Hand washing and other hygiene practices have improved. “People are doing better - they wash their hands, there are more toilets in schools, but there remains too much to do,” Hawa Touré, Joint Director of Community Health at the Ministry of Health, told IRIN.

No water surveillance
Emergency prevention and response in Guinea are working well, but a more holistic water and sanitation strategy is needed to prevent future outbreaks, Patra told IRIN.
Cholera is unlikely to disappear anytime soon - the nature of the disease in the region has changed to become “hyper-endemic”, meaning it is ever-present, with regular peaks, say aid agencies.
There has been no systematic water quality surveillance in Guinea to date, but it is highly likely to be polluted, as sources are not protected and sewage can enter pipes.
The work of aid agencies such as ACF and UNICEF has had an impact. UNICEF has helped build water points and latrines in schools, and has worked with communities in 120 villages to discourage open defecation but Patra said more resources are needed to scale up such work throughout the country, and access to clean water should be made cheaper.
The government, private sector and large agencies have traditionally turned to drilling boreholes as the answer to a lack of water, but at $10,000-$12,000 per borehole this approach is very expensive. Cheaper solutions include using local equipment to manual drilling - successfully tried in Chad and Democratic Republic of Congo - installing hand-pumps, or building water pipe systems in mountainous regions. “I was shocked that nothing else had yet been tried here,” Patra told IRIN.
Trying alternatives will not be easy. Trainers will have to be imported from abroad and a monopoly of French and Germany manufacturers will need to be dismantled, said Patra, who suggests India as a cheaper alternative, based on his experience in promoting governance and community management of locally appropriate WASH technologies in Bangladesh, Indonesia and India.
Bold steps are needed to keep Guinea cholera-free in the long term. As Harneis put it: “We have been lucky… but whether or not we get cholera next year - that will be the real lesson.”
http://www.irinnews.org/report.aspx?reportID=94449

MALNUTRITION: The vital statistics of hunger

4 July 2011 (IRIN)

 Photo: Action contre la Faim
Aid workers and health officials measure a child's height and weight in western Chad

 Louise Masese-Mwirigi, an analyst recording nutrition data in southern Somalia with her team, have on occasion had to turn away from a village because the local authority that consented to the survey a week ago is no longer in charge or may have changed their minds when they arrive. Fighting between the government, its allies and various armed groups in parts of Somalia has severely restricted humanitarian space.
“The situation is uncertain in Somalia and access is a problem - especially in the last two years in central and southern Somalia,” said Masese-Mwirigi, who works for the UN Food and Agriculture Organization’s Food Security and Nutritional Analysis Unit (FSNAU) for Somalia.
Armed with an electronic weighing scale and a metre-long board to measure the height of children, Masese-Mwirigi and her team, led by Mohamed Moalim, along with Action Contre la Faim (ACF), a food relief NGO, have carried out a survey in the Mogadishu region, where the capital is located.
The survey is the first in seven years. “It took a month of planning… we could access six districts but had to let go of the remaining three because of security concerns.”
A rapid assessment by FSNAU in Mogadishu in December 2010 picked up high levels of malnutrition based on the measurement of the middle upper arm circumference (MUAC) - a quick, easy and cheap approximate measure of malnutrition in children younger than five years. "We felt we needed more information through a comprehensive nutrition survey, given the rains had performed poorly and the MUAC results were indicating high levels of malnutrition in the town."
The MUAC measurement uses a long strip of plastic with a series of colour-bands that is put around a child’s bare upper arm. The colours show the level of malnutrition: green indicates a 135mm circumference, which is normal; yellow - 125mm to 134mm - shows a risk of malnutrition; orange - 110mm-124mm means moderate malnutrition; red, for measurements less than 110mm, is an indication of severe malnutrition and risk of death.
In the past two years FSNAU have had to depend entirely on MUAC in parts of the conflict-hit areas. “It is less resource-intensive, and quick and ideal for emergency situations, but ideally we would like a more thorough survey,” Masese-Mwirigi said.

Detailed data
A thorough survey would take into account four variables - age, weight, height and gender - as well as the MUAC. Crude mortality rate (usually measured in deaths per 10,000 people per day in emergency situations), rate of disease prevalence, child care and feeding practices, household food security, and water and sanitation indicators, are also taken into account to understand the overall nutrition situation.
When two of the anthropometric variables are used together they are called an index. Three indices are commonly used to assess the nutritional status of children: weight for age (WFA), height for age (HFA) and weight for height (WFH).
These indices are then compared to a reference standard to get a sense of the severity and distribution of the nutritional problem in a country.
The survey is the first in seven years. It took a month of planning… we could access six districts but had to let go of the remaining three because of security concerns
The WFA of a child compared to a reference population will tell if the child is normal, overweight or underweight. HFA indicates whether the child’s height is normal for his or her age. If the child is not as tall as expected then he or she is stunted, reflecting a long-term, chronic problem - stunting is a good indicator of chronic malnutrition.
WFH is commonly used in acute emergencies to determine the scale of the crisis. It is often used when the child’s age is not known, and in countries like Somalia, where hardly any public records of births and deaths exist. WFH is regarded as a good indicator of acute or short-term exposure to a negative environment, such as a drought, as it reflects recent weight loss or gain. WFH is a measure of acute malnutrition.

Room for error
With so many measurements involved there is always a lot of room for error.
For instance a baby can often be not held properly to measure its length, or perhaps the child is not standing straight. Aid organisations are constantly trying to improve the skills of surveyors involved in taking measurements by organising training workshops periodically.
Determining the correct age can also be problematic. “We use the calendar of events to accurately determine a child’s age,” explained Masese-Mwirigi. Events like major natural disasters or elections can indicate when a child was born.
The other contentious issue in measuring malnutrition is what is considered average. The World Health Organization (WHO) provides a reference of growth standards, against which surveys calculate their deviations from the norm.
Yet the WHO growth standards might not be the norm for a particular ethnic population that is naturally long-limbed, like Kenya’s Maasai, or short-limbed, like the Gurkhas of Nepal. Even though the WHO standards were recently updated to better reflect human genetic diversity some experts feel country- or region-specific growth standards should be developed.
Prominent experts like Mark Myatt, Senior Research Fellow at the Division of Epidemiology, of the Institute of Ophthalmology, University College, London, feel MUAC is a much more accurate measure.
But that is not all. There are different scales of malnutrition. For individuals malnutrition can be moderate acute or severe acute.
To work out levels of malnutrition, WFA, HFA and WFH measurements are used to calculate and classify using what is known as the “percentage of the median” and “Z-scores”.
For instance, in expressing the WFH as a “percentage of the median”, a child’s weight is divided by the average weight for a child of that height, as provided in the WHO growth standards, and then multiplied by 100 percent. Fortunately, there is computer software that does the calculation.
The “Z-score” represents the difference between the observed weight and the median weight of the reference population, expressed in standard deviation units. When the percentage of the median is less than 70 percent, and the Z-score is less than -3, or oedema is present, the child is said to be suffering from severe acute malnutrition.

GAM or SAM?
Populations are described as severe acute or global acute. “Global acute malnutrition (GAM) refers to the total cases of moderate acute and severe acute malnutrition (SAM) in a population,” Médecins Sans Frontières (MSF), the medical NGO, notes in their useful manual, A Beginner’s Guide to Malnutrition.
GAM is calculated with the Z-score defined as a weight-for-height index less than -2 standard deviations from the mean weight of a reference population of children of the same height.
A GAM value of more than 10 percent generally identifies an emergency. Commonly used thresholds for GAM are less than five percent (acceptable), between five and just under 10 percent (poor), between 10 percent and under 15 percent (serious), while anything more is critical.
Clinical signs such as bilateral oedema - swelling in the feet, legs or face caused by an extreme shortage of protein - are a separate indicator of severe malnutrition in children.
“We recorded a GAM rate of 15.2 percent for Mogadishu in our survey,” said Masese-Mwirigi. In Somalia the FSNAU has been recording GAM rates of 15 percent and above for a long time, GAM rates of over 15- 20 percent indicate a critical nutrition situation, while rates over 20 percent are seen as very critical. The GAM rates reported in Mogadishu town are high, also given that there are a large number of feeding interventions in the town.
Prices of the staple grains - maize and sorghum - have gone up by between 52 and 95 percent in most markets. FSNAU reports that in some areas prices have doubled and even tripled since 2010.
In 2011 the major rainy season began late and was poorly distributed across time and place in southern Somalia - the second bad season consecutively, as the first harvests in January failed.
A smaller cereals harvest, low stocks and poor access because of continued conflict to Bakara, the main market in Mogadishu, have made basic foodstuffs harder to get and more expensive.

http://www.irinnews.org/report.aspx?reportid=93128

POVERTY: CHAD: The Libya fallout

DAKAR, 29 June 2011 (IRIN)

 Photo: Craig Murphy/IOM : Migrants arriving in Chad (file photo)

 Chadian families are facing worsening food insecurity, becoming more indebted, and selling off personal possessions as they try to cope with the loss of remittances from relatives who have returned home from Libya.
Remittances, which half of the households in Chad's western and southwestern regions of Kanem and Bahr el Ghazal used to receive, are down by 57 percent, according to a survey by NGOs Oxfam and Action Against Hunger (ACF). Households on average were sent US$220 per month.
Most families in the two regions have reduced the number of meals they eat; 70 percent are eating less nutritious foods, while just under a third are resorting to wild foods such as leaves and berries.
One in five households interviewed had sold possessions to raise money; while most said they had taken out loans to get by.
At the same time, families are struggling to feed returning members: Some 43,000 migrants have returned in trucks from Libya to Chad over the past three months, according to Craig Murphy, operations officer at the International Organization for Migration (IOM). In Bahr el Ghazal family size has increased by as many as 13 people, according to the Oxfam/ACF survey.
"These people are going home to zones which already experience food insecurity even when there is no `crisis', said Philippe Conraud, head of humanitarian operations at Oxfam in West Africa. "They need food, water - the basics, to get by."

Chronic hunger
People in the Sahel are chronically food insecure: In 2010 some 10 million people were at risk of hunger due to prolonged drought and poor harvests; almost one in five children were chronically malnourished, and 5 percent severely, according to the UN Children's Fund (UNICEF) and the World Food Programme (WFP).
A minority of families are looking to new income sources: begging, sending children out to work, travelling to other towns and cities in search of work, or harvesting their crops early, according to ACF and Oxfam.
Many returnees are determined to find any work they can. Seventeen-year-old Moussa, who just returned home to Faya, the largest city in northern Chad, after working on a farm in Libya, told IOM he would try to find work in a salt mine now that he is home.
Agencies - including IOM, the World Health Organization (WHO), WFP, UNICEF, and NGOs including Oxfam and the International Rescue Committee (IRC) - have been helping provide returnees with food, medicine and water at transit centres and in major destination towns such as Faya. Nutritional support, which is urgently needed, will soon be put in place, said WHO programme coordinator Thomas Karengera.

Measles
Many migrants arrived with measles, leading IRC, WHO and UNICEF to launch vaccination campaigns for children aged six months to 15 years. A national measles vaccination campaign will soon be launched to contain the spread of the disease. As of 19 June some 5,311 people had contracted the disease across 20 of Chad's 22 regions since the beginning of the year, with 63 deaths thus far, according to Chad's Health Ministry.
"We are vaccinating children as soon as they arrive at transit centres, so the disease should not spread further," Felix Léger, IRC Chad country director, told IRIN. Many migrants are arriving run-down, malnourished and dehydrated, he said, increasing their receptiveness to the disease.

Cash
Oxfam is considering cash distributions to vulnerable families but first needs to ascertain if traders have enough capacity to supply the markets.
Cash in fragile markets will not work. "We don't want to be in a situation where cash distributions cause prices to rise, so those without cash cannot afford the high prices. That could have a harmful impact," Conraud told IRIN. Only 46 percent of traders in Kanem and Bahr el Ghazal had over two months of stocks, according to their research.
Prices of some basic foods have risen: In Kanem's capital, Mao, imported wheat was 43 percent higher in April 2011 compared to April 2010; peanut oil was up by 44 percent, and rice 6 percent; millet prices had dropped.
It is still unclear how many Chadians are likely to return from Libya said IOM's Murphy, who estimates tens of thousands remain. The number of arrivals has declined in recent weeks, "but this could just be a lull," he said.

Persecution
Migrants who had recently arrived told IOM they are being driven out not only by ongoing fighting and instability but also the loss of employment and fear of being persecuted. Fighters from the Sahel were reportedly hired early on to support Col Gaddafi, leading to fears among migrants that they will be targeted.
Some migrants may plan to return to Libya as soon as fighting stops, said Murphy. This may be the reason why migrants were left stranded on the road by trucks in Zourake near the Niger border, he said.
Donors and aid agencies need to step up, warned Conraud. "If more migrants need to leave Libya, and arrive in the vulnerable Sahelian zone, then households' ability to get by will be seriously compromised. Very few actors from the international community are aware of this situation; everyone is looking at the Libyan side of the border, but more need to look at the Mali, Niger and Chad sides," he said.
http://www.irinnews.org/report.aspx?reportID=93098

MALNUTRITION: Guatemala: Extreme Weather Triggers Hunger Alert

April 20, 2011
The Guatemalan government on Tuesday declared a nationwide "nutritional risk alert" to avoid a food crisis in the country's poorest areas where thousands of people don't have enough food to survive.
Press secretary Ronaldo Robles told reporters that the measure was taken by President Alvaro Colom and his Cabinet to facilitate the implementation of a contingency plan designed by the National Council for Food and Nutritional Security, or Conasan.

"This is a nutritional risk alert, not an emergency. What is being sought with this measure is, precisely, to prevent the emergency," Robles said.
To implement the plan, which includes the distribution of food to at-risk families, the government needs 324 million quetzales ($40.5 million), of which it only has 46 million quetzales ($5.8 million).
"Financial resources will have to be sought from different sources, but the important thing is obtaining them by means of a tax reform," Robles said.
In addition to the distribution of food, the plan sets forth mechanisms to monitor the results obtained in its initial phases, as well as the stockpiling of reserves to prevent the development of a full-blown food emergency.
Extreme effects caused by climate change ranging from prolonged droughts to heavy rains have damaged the harvests of millions of poor farmers in the country's interior.
The so-called "dry corridor," which spans nine provinces, along with the southern coastal communities affected by the rains, are the areas that have been most affected.
Conasan says that some 5,000 children suffer from acute malnutrition nationwide and another 10,000 are "at risk" due to their lack of minimum nutrients.
A study by the national ombud's office released last week said that up until March at least 808,137 cases of chronic malnutrition had been tallied on the national level.
Action Against Hunger, an international NGO, said that in the dry-corridor provinces of Jalapa and Chiquimula the lack of food forced poor families to reduce the average amount of food a person consumes each day by 40 percent from 1.23 pounds to 0.75 pounds.
http://latino.foxnews.com/latino/news/2011/04/20/extreme-weather-triggers-hunger-alert-guatemala/

MALNUTRITION: Action Against Hunger (ACF) Releases Annual Report

 16. Mar, 2011
Action Against Hunger has recently released its annual report, sharing informative information on child and women nutrition across the globe. The report, entitle “Malnutrition – Just Stop It” looks at who is most affected by malnutrition in the world and what is being done to combat this ongoing epidemic.
We know that this is a complex problem and this report looks at the policies and issues that are in place and if they are working and progressing by eliminating the problem. The report also shares stories of those living with malnutrition and fighting this health disease and serves as a great informative piece as well as an eye opening read.
http://www.thejustcause.org/action-against-hunger/

MALNUTRITION: Bangladesh improves

Feb 28, 2011

IRIN highlights a recent report from Action Against Hunger (ACF International) which looks at the progress made towards reducing malnutrition in Bangladesh.
ACF, a non-governmental organisation which works to end world hunger, hails Bangladesh as one of the global “success stories” when it comes to reducing its rates of child malnutrition over the past 15 years. Government data has shown that the level of underweight children has dropped in Bangladesh from 56 per cent in 1996 to 43 per cent in 2009 and from 18 per cent to 13 per cent for those whose growth is stunted.
Bangladesh has also been praised by the United Nations as one of 16 countries which are on course to achieve their Millennium Development Goal (MDG) for reducing child mortality rates. In its latest MDG Country report, Bangladesh gained recognition for making “significant strides” in child health. For example, its under-five mortality rate was 54 deaths for every 1,000 live births in 2008, a stark decrease from a rate of 146 deaths in 1991. Child mortality is expected to drop still further by 2015, to around 48 deaths per 1,000 live births.
But while the UN notes Bangladesh has “recorded impressive feats in pulling people out of poverty” and reducing malnutrition, the country is not expected to meet its MDG target for lowering the number of underweight children. According to data in the Country report, the prevalence of underweight under-fives stood at 45 per cent in 2009, too high for the country to meet its target of 33 per cent by 2015.
ACF acknowledges that despite reductions in malnutrition rates, there are still over 2 million acutely malnourished children in Bangladesh. However, the organisation is optimistic that progress continues to be made. A national poverty reduction strategy is beginning to tie together the actions and objectives of various ministries. And the government has introduced poverty measures, such as food and cash transfers, for families who have been affected by food price hikes or natural disasters. Various climate adaptation programmes are also being tested to help families cope with regular flooding and a new agricultural policy has boosted food production by providing credit for small farmers and encouraging private sector involvement in farming.
Certain aid organisations in Bangladesh, such as Médecins Sans Frontières (MSF), are also trialling schemes which focus on education. Rural mothers in particular lack knowledge about nutrition, in a country where over 80 per cent of people’s diet consists of rice. According to MSF, although education cannot solve all the problems, such as in cases where families lack money to buy food, a great deal can be achieved by changing the poor food habits of families. The organisation therefore hopes that education is one key way to further reduce rates of malnourishment in the children of Bangladesh.
http://www.soschildrensvillages.org.uk/charity-news/progress-in-bangladesh-towards-health-and-nutrition-of-children

MALNUTRITION: BANGLADESH: Under-nutrition progress “success story”

28 February 2011 (IRIN)


In Bangladesh, just getting to school can sometimes be an ordeal




 Photo: Peter Murimi/IRIN : Sailing to his floating garden -- one of the initiatives cited for Bangladesh's success in fighting under-nutrition

NGO Action Against Hunger (ACF) in a recent report singled out Bangladesh - along with Peru, Brazil, Malawi and Mozambique - as a “success story” in its bid to reduce child under-nutrition in the past 15 years.
Government surveys showed a reduction from 1996 to 2009 in the percentage of children underweight for their age (56 to 43 percent); stunting, or short for age, (55 to 41 percent); and wasting, or underweight for height, (18 to 13 percent) - though this translated into a still high 2.1 million acutely malnourished children. Nevertheless, some notable programmes and policies are in place, according to ACF:
• The national poverty reduction strategy sets as a goal nutrition security, while a 2008-2015 food policy action plan attempts to boost food security for all by bringing together the objectives of various ministries, donors and NGOs.
• Safety nets for the poor, including food or cash transfers accounted for almost 13 percent of the 2009-2010 budget and helped families weather both perennial natural disasters and food price increases.
• Bangladesh has suffered from some of the world’s most extreme weather during the past two decades, according to NGO Germanwatch’s Global Climate Risk Index 2011, but the government’s national adaptation programme includes such things as floating gardens that do not require soil.
• A new agricultural extension policy (1995-2010) has helped boost food production - with credit for small farmers, national agricultural extension services and private sector collaborations to improve seed access; and has helped bring down poverty rates more steeply in rural than in urban areas.

Challenges
But sound policies have not always translated into even progress, said Flavio Salio, head of Médecins Sans Frontières (MSF) in Bangladesh.
MSF is currently piloting community treatments for severe wasting, or acute malnutrition.
"A big obstacle is… the lack of coordination [among] government ministries, NGOs and other stakeholders. There is also a lack of clear nutritional guidelines, and a lack of human resources and health facilities, especially in rural areas,” said Salio.
There is no national authority coordinating nutrition activities and government support and the monitoring of NGO nutrition work is “largely non-existent”, said ACF.
Salio added: “There is a lack of understanding among the general Bangladeshi population about the problem malnutrition constitutes.”
More awareness-raising is needed until people recognize malnutrition as a serious health problem that can lead to complications with infectious diseases like malaria and pneumonia, he said.
Almost one-third of the beneficiaries of one programme targeting vulnerable families; half of primary education stipend recipients; and 40 percent of workers hired on a 100-day employment programme were not actually poor, according to World Bank, the multi-donor National Food Policy Capacity Strengthening Programme and local NGO Bangladesh Rural Advancement Committee (BRAC).
http://www.irinnews.org/report.aspx?ReportID=91975

Malnutrition: Survey reveals acute malnutrition in Punjab’s flood-hit areas

 February 04, 2011
LAHORE: The global malnutrition rate among children under five in the flood-affected areas of Punjab is 13.9 percent while the rate of severe acute malnutrition associated with a morbidity rate of 3.5 percent, reveals a nutrition survey report issued by the Punjab government’s Planning and Development Department on Thursday. The survey was conducted by the Bureau of Statistics, and Planning and Development Department in collaboration with UNICEF and ACF, and its report was revealed at a seminar held at the Royal Palm Country Club. In his welcome address, Planning and Development Board chief economist, Dr Rizwan Taqi, quoting the report, said that more than 60 percent households were living in ‘kacha’ (houses with mud or thatched wall) while the rest were in ‘paka’ (houses made of concrete and cement walls). He said that majority of the people were taking cereals, wheat, oil and sugar for more than 5-6 days a week but the consumption of meat, fruits and vegetables was extremely low. P&D Secretary, Ali Tahir, said that the aim of survey was to assess the nutritional status of children between 6 months to six years, pregnant and lactating women. He said the report revealed that there was a dire need for reinforcing and integrating community based programmes to address child and maternal malnutrition in the flood-affected areas. Punjab Bureau of Statistics Director General, Shamim Rafiq, said that flooded areas in the province were divided into two categories, moderately affected areas and severely affected areas. The severely affected districts are DG Khan, Layyah, Muzaffargarh and Rajanpur. He said that 1,200 households were surveyed in these districts. UNICEF representative from Sri Lanka, Dr SM Moazzam, said that the survey recommended that an integrated and targeted plan should be executed to improve the knowledge about infant and child feeding practices, and improve access to and knowledge of basic hygiene, sanitation and health services for affected communities. staff report
http://www.dailytimes.com.pk/default.asp?page=2011%5C02%5C04%5Cstory_4-2-2011_pg13_8

MALNUTRITION: 54,000 Nigerian children to benefit from 3m Euro emergency aid

Jan 17, 2011 BYCHIOMAOBINNA
AT least 54,000 children suffering from acute malnutrition in seven drought-affected, states of northern Nigeria are to benefit from emergency aid funded by a 3-million Euro grant from the European Commission for Humanitarian Aid (ECHO) to UNICEF Nigeria.
The funding will support the governments to treat malnourished children in the seven affected states. They are Kebbi, Sokoto, Katsina, Zamfara, Jigawa, Yobe and Borno states. These states border Niger Republic and the Republic of Chad – both of which appealed last year for humanitarian food aid following severe food shortages caused by the ongoing Sahel drought and climate change.
A press statement from the United Nations Children Fund (UNICEF) states that the money purchased 53,730 cartons of Ready to Use Therapeutic Foods (RUTF) used to treat children with severe malnutrition. One course of treatment consumes about one cartoon of RUTF over eight weeks.
According to the statement, “To date about 40,000 children have benefitted from the project – also known as Community Management of Acute Malnutrition (CMAM). It is a joint initiative of the Federal and State governments in collaboration with UNICEF; initially for 15 communities in Gombe, Kebbi and Sokoto, it has now been expanded to 145 communities in seven states”.
This expansion has been possible through the support of ECHO, the humanitarian aid agency of the European Union.
CMAM field work is implemented directly by respective state governments in partnership with Médecins Sans Frontières (MSF)-France, Save the Children UK, and Action Against Hunger (ACF)-US. Part of the ECHO funds also supported the second round of Rapid Nutrition Assessment surveys in December 2010 in eight Sahel States.
UNICEF recognises food insecurity, poor child care practices, and poor health care services as the three main causes of malnutrition. Apart from the effects of Sahel drought in Northern Nigeria, other major challenges in the region include poor child care practices – particularly low exclusive breastfeeding rates – as well as inadequate quality and quantity of complementary foods.
http://www.vanguardngr.com/2011/01/54000-nigerian-children-to-benefit-from-3m-euro-emergency-aid/

MALNUTRITION: UNICEF Receives 3 Million Euros From ECHO to Fight Child Malnutrition in Northern Nigeria

ABUJA, 14 January 2011:
About 54,000 severely malnourished children in seven drought-affected, northern Nigerian states will benefit from emergency aid funded by a 3-million Euro grant from the European Commission for Humanitarian Aid (ECHO) to UNICEF Nigeria.
The funding will support governments to treat malnourished children in Kebbi, Sokoto, Katsina, Zamfara, Jigawa, Yobe and Borno. These states border Niger Republic and the Republic of Chad – both of which appealed last year for humanitarian food aid following severe food shortages caused by the ongoing Sahel drought and climate change.
The money purchased 53,730 cartons of Ready to Use Therapeutic Foods (RUTF) used to treat children with severe malnutrition. One course of treatment consumes about one cartoon of RUTF over eight weeks.
To date about 40,000 children have benefitted from the project – also known as Community Management of Acute Malnutrition (CMAM). It is a joint initiative of the Federal and State governments in collaboration with UNICEF; initially for 15 communities in Gombe, Kebbi and Sokoto, it has now been expanded to 145 communities in seven states.
This expansion has been possible through the support of ECHO, the humanitarian aid agency of the European Union. CMAM field work is implemented directly by respective state governments in partnership with Médecins Sans Frontières (MSF)-France, Save the Children UK, and Action Against Hunger (ACF)-US. Part of the ECHO funds also supported the second round of Rapid Nutrition Assessment surveys in December 2010 in eight Sahel States.
UNICEF recognises food insecurity, poor child care practices, and poor health care services as the three main causes of malnutrition. Apart from the effects of Sahel drought in Northern Nigeria, other major challenges in the region include poor child care practices - particularly low exclusive breastfeeding rates - as well as inadequate quality and quantity of complementary foods.

About UNICEF
UNICEF is on the ground in over 150 countries and territories, including Nigeria, to help children survive and thrive, from early childhood through adolescence. UNICEF supports child health and nutrition, good water and sanitation, quality basic education for all boys and girls, and the protection of children from violence, exploitation, and AIDS. UNICEF has been on the ground in Nigeria since 1953 to support the Government of Nigeria implement programmes and policies for the realization of children's rights.

http://www.reliefweb.int/rw/rwb.nsf/db900sid/JALR-8D4CG4?OpenDocument

MALNUTRITION: D.R. Congo: ACF Fighting deadly malnutrition

Jan 4th, 2011 By ONE Partners
Putting an end to world hunger can seem like an impossible task, but Susannah Masur from Action Against Hunger has the numbers to prove that we’re making progress.
Last month I traveled to Kisangani, a mid-sized city that hugs the banks of the famed Congo River, to document Action Against Hunger’s partnership with the Congolese Ministry of Health to combat deadly malnutrition in the three rural health zones around the city.
Severe malnutrition is a leading killer of children worldwide. In fact, at least 3.5 million of them die every year from the condition. Yet, this public health catastrophe gets very little public attention. I think part of the reason is that hunger, especially in Africa, is often seen as an inevitable result of poverty. In other words, it’s just something that happens.
But while the causes of hunger are many, one thing is for certain: Childhood deaths from hunger are entirely preventable.
For the first time, caregivers can bring malnourished children to their local health clinics once a week to be weighed and measured and get a supply of Plumpy’nut — a specially-formulated Ready-to-Use Therapeutic Food that has revolutionized care for severe malnutrition — to eat at home. Before, all treatment for severe malnutrition required prolonged hospitalization, presenting a major challenge in many underserved areas.

  Photo courtesy of ACF-DR Congo, S. Vidyarthi.

This year, in collaboration with local health authorities, we treated 35,000 cases of severe malnutrition across the Democratic Republic of Congo by employing a community-based model that is bringing life-saving care close to home. I wanted to see the model at work in the areas around Kisangani, where child malnutrition is rife and the effects of the second Congolese civil war can still be seen in the bombed out buildings and crumbling infrastructure. [video shows the programs in action]
In outpatient centers managed by the Congolese Ministry of Health and integrated into the local health system, nurses trained and equipped by Action Against Hunger are treating and monitoring acutely malnourished children during their weekly visits. This year 3,200 doctors and nurses received comprehensive training on care for severely malnourished children through the partnership. And, the beauty of the system is that it can continue long after we leave.
On my first day in the village of Wanie Rukula I met Nico, a young boy who just a few months ago was so severely malnourished he was on the brink of death and could barely move. But last month I watched him kick around a handmade soccer ball with his friends while his beaming parents looked on. What better proof do we need that deaths from malnutrition can become a relic of the past. All we need is the will to do it.

Susannah Masur is the communications officer at Action Against Hunger. To learn more about ACF, visit http://www.actionagainsthunger.org
http://www.one.org/blog/2011/01/04/fighting-deadly-malnutrition-in-d-r-congo/

Action Against Hunger's (Action Contre La Faim ACF) Impact in 2010

This year an earthquake and cholera devastated Haiti, floods destroyed Pakistan, deadly hunger ravaged D.R. Congo, and severe drought hit Niger.
Action Against Hunger was there, and in more than 40 other countries, providing life-saving assistance and helping restore self-sufficiency to millions.
Here’s just a glimpse of our impact in 2010.


35,000 children treated for severe malnutrition in D.R Congo
Since 2003, Action Against Hunger has been building the capacity of local health systems in D.R. Congo to combat acute malnutrition, a potentially deadly condition. This year alone, we trained 3,200 health workers and equipped 450 health centers so life-saving care can continue for the long term.


290,000 Pakistanis benefited from emergency water & sanitation programs
After floods swept over Pakistan, destroying vital infrastructure and leaving millions at risk of water-borne illnesses like cholera and diarrhea, Action Against Hunger rushed to provide hundreds of thousands of displaced Pakistanis with access to clean water and emergency sanitation.



50,000 Guatemalans assisted by ACF when floods displaced thousands
In the aftermath of tropical storm Agatha, Action Against Hunger provided emergency relief in the hard-hit region of Escuintla, distributing emergency food provisions, providing tools to assist the local population with clean-up efforts, and restoring access to safe water.


300,000 Haitians benefited from daily access to clean water
After the devastating earthquake struck Haiti, Action Against Hunger was one of the first organizations to provide immediate access to clean drinking water for survivors in Port-au-Prince, and we have scaled up our emergency water and sanitation programs in response to the recent cholera outbreak. These programs reached more than 300,000 beneficiaries in 2010.



5,600 families helped when a food crisis hit Niger
In response to massive food shortages and staggering acute malnutrition rates in Niger, Action Against Hunger provided families hit hard by the crisis with access to seeds, livestock, and cash-for-work programs to increase their income.

http://www.actioncontrelafaim.ca/index.php?option=com_content&view=article&id=1203&Itemid=492&lang=en

MALNUTRITION: MALI-NIGER: Good early warning, slow response

Photo: Catherine-Lune Grayson/IRIN
Political will led the government to declare a crisis in Niger, but a few kilometres away, the Malian authorities played down the situation, say some NGOs (file photo) BAMAKO, 22 October 2010 (IRIN) - Mali’s crisis early warning system is lauded in the sub-region for its accuracy and efficiency but some say good, timely information warning of the impact of poor rains on grazing land and water availability this year, did not necessarily translate into a swift response by the government or international community.
In neighbouring Niger, President Mahamadou Danda appealed to the international community for emergency aid to stem the food insecurity crisis in March 2010, but the government of Mali did not.
An NGO representative who preferred anonymity told IRIN: “The government of Mali was reluctant to recognize the crisis... On one side of the border the government declared a crisis, while on the other - just a few kilometres away - the government said nothing, despite there being the same vulnerable populations facing the same livelihood problems and suffering from the same lack of rainfall.”
The government's decision on how to handle the situation was based as much on politics as on information, the head of a different NGO told IRIN.
Mali's early warning system - Système d’Alerte Précoce, or SAP - was created in 1986 and involves setting up teams made up of experts from the livestock, water and forests, and agriculture ministries, elected officials and political party representatives in each county of Mali. These teams discuss rainfall levels, animal health, and water availability, writing up a report which they send to the regional authorities and national government, said SAP coordinator in the capital, Bamako, Mary Diallo.
SAP has also teamed up with NGO Action Against Hunger (ACF) to set up software to take satellite photographs that identify different types of biomass, enabling people to see how much vegetation is growing in specific areas. “These pictures mean we can confirm or deny the information that we received from these technical teams,” Diallo told IRIN. Soon the pictures will also look at the presence of water to better enable agencies to predict pastoralist grazing routes.
ACF head in Mali David Kerespars told IRIN: “The early warning system has undeniably helped provide relevant information which has given us an idea of the vulnerabilities in Mali this year. This information has been used by the Food Security Commission to target and calibrate its response. “
Politics versus information
The SAP works because it is “technical, not political”, said Diallo. “We tell the government the truth and suggest what it needs to do to avoid famine. We don’t try to please the authorities, or our partners.”
Despite this, the government was slow to pick up on the information, and decided not to declare an emergency, said the aid representative. While the government launched a response to help populations in the north, “there was a lack of alarm about the message that was passed on to agencies and the international media, so donors, in turn, did not respond on a big scale.”
Because of this missing sense of urgency, UN agencies were also far more concerned with responding in Niger, than in Mali, said the aid worker. “They followed the government line.”
In Niger, after the coup d’état in February 2010, “everything dramatically changed,” in regard to the government’s openness about the extent of the crisis, an aid worker told IRIN. The previous administration had been reticent in publicizing the extent of the disaster - estimated to be over seven million facing food shortages - as had also been the case in 2005.
While early warning systems exist in Niger, they are not as advanced as those in Mali, said ACF. The organization is considering extending its satellite system to Niger.
The scale of the needs was - and is - far greater in Niger than in Mali where only 258,000 were estimated to be affected by food insecurity. But aid groups, including the International Committee of the Red Cross, have told IRIN they would have liked to scale up aid projects in northern Mali, given the resources.
UN agencies did not comment. But at the height of the crisis, World Food Programme head Alice Martin-Dahirou told IRIN they had actively supported the government’s efforts, and had been proactive in bringing together all the relevant actors to discuss a plan of action.
Diallo said the government's response was based on the SAP findings. The government and donors distributed cereals, animal feed, and helped destock sick animals who were suffering because of the 2009 drought.
The 2010 harvest is expected to be good in most of the affected regions, following decent rains. A CILSS (inter-state committee to fight drought in the Sahel) annual crop assessment mission is currently assessing the prospects, and will soon publish its results.
http://www.irinnews.org/report.aspx?ReportID=90845

MALNUTRITION: MALI: Pockets of extreme vulnerability persist

20 September 2010 (IRIN) - Good rains in much of northern Mali over recent months have caused pasture to regenerate and animals to begin to recover in parts of Gao, Timbuktu and Kidal regions, but extreme vulnerability persists for Gao-based farming communities, who have exhausted all their coping mechanisms and are unable to recover their livelihoods, say aid agencies. "The pastoralist crisis is on the point of ending... and the price of animals is rising again, but for non-pastoral communities who depend on a good harvest, we have not yet seen the end. We are still in the peak of crisis, and emergency activities need to continue," said Philippe Conraud, Oxfam's West Africa emergency coordinator. Rains started slowly in June but became more intense in mid-July and August in much of the north, according to Action Against Hunger (ACF), and have continued into September. The practice of seasonal livestock movements has again picked up in much of the north, and the latest US Agency for International Development FEWS NET report [ http://www.fews.net ] predicted the 258,000 food-insecure would start to meet more of their food needs in coming months, though they may continue to face moderate food insecurity until the end of the year. Grain prices have risen to the five-year average, and the price of goats and sheep is rising to pre-crisis levels - up to US$50 from just $10 per animal in the peak of the pastoralist crisis, estimates head of NGO Agronomes et Vétérinaires sans Frontières (AVSF) Marc Chapon. But sedentary, farming communities in Gao continue to live in a situation of extreme stress as the pre-harvest lean season continues. They lack the option to up and leave to greener pastures, and must wait until harvest to repay debts. Repeat shocks, including the 2008 food price crisis and repeat drought have led households to go into extreme debt, said ACF head in Mali David Kerespars, and Oxfam's Conraud. ACF estimates 40 percent of households in Ansongo, on the Niger river in Gao are in debt and have no means to pay back creditors. Without help, Conraud predicts, "in the middle and long-term it could get even worse." Global acute malnutrition rates among under-fives in Ansongo are 18.5 percent, according to ACF's latest June nutrition assessment, up from 15.9 percent at the same time in 2009. With UK backing, ACF runs therapeutic feeding clinics through 17 regional health centres, and is providing wider food security interventions to all under fives to prevent them from becoming malnourished. Cases of acute malnutrition with complications are referred to regional health centres. Meanwhile, across the north, the government is subsidizing grain prices, and aid agencies, including the World Food Programme (WFP), the UN Children's Fund (UNICEF), the International Committee of the Red Cross, ACF, Oxfam, Save the Children and CARE, continue to support the government's response efforts to treat malnourished children, provide supplementary food, food and healthcare for animals, and help improve stock management. Variegated vulnerability Vulnerability is highly variegated among different livelihood groups in the north, say aid agencies. In areas surveyed in the Kidal and Timbuktu regions, global acute malnutrition is no higher than 10 percent, estimates UNICEF's nutrition manager Katrien Ghoos, though UNICEF's recent malnutrition assessment results are yet to be verified or published. While pastoralists are also highly vulnerable to shock, given "they have milk and animals, but no alternatives," and their acute malnutrition tends to rise sharply in a crisis, their prospects can shift dramatically when grazing land improves as animals are quick to recover milk production. Semi-sedentary agro-pastoralist populations who settle for months at a time along the River Niger, are slightly more protected from shock, says ACF's Kerespars. "They have more ability to cope with shocks such as droughts as they can migrate, find odd jobs, do artisanal work, or borrow money," he said. But the poorest of these communities in Gao have also exhausted their coping mechanisms, and are finding it hard to turn to short-term construction or labour in the fields, which can supplement over half of their income, given such work opportunities are down by a third this year, according to FEWS NET. Early recovery Early recovery efforts must start as soon as possible to help people bring their livelihoods back to pre-crisis levels, says Conraud. Oxfam hopes to start a cash transfer programme to help households pay off their debts and avoid having to sell grain at rock-bottom prices. The NGO and other aid agencies are meeting donors to try to encourage them to support such middle-term recovery efforts. The need to get communities back on their feet is all the more important, given the likelihood of northern communities facing more problems in the future, say aid agency representatives. The problems facing northern Mali - including drought, ongoing tension over pastoralist routes, continually growing populations, and ongoing insecurity - are not going to go away, warned WFP head Alice Martin-Dahirou.
Http://www.irinnews.org/report.aspx?ReportID=90522

MALNUTRITION: CHAD: Malnutrition outstrips response

DAKAR, 24 August 2010 (IRIN) - In parts of Chad acute malnutrition levels far exceed the international emergency threshold, according to a new study - fallout, partly, from crop failure hitting already fragile communities where access to basic health services is low and aid agencies are scarce. The study, by Action contre la Faim (ACF) along with the government, donors and UN agencies, showed that in Nokou and Mao in the western Kanem region, acute malnutrition strikes 27.2 percent and 21 percent of under-five children, respectively. The figures for severe acute malnutrition - which commonly results in death if untreated - are 6.4 and 4.7 percent. The highest numbers are in the central-west Barh El Gazel region, where 28.1 percent of children are acutely malnourished - 10.4 percent severe. Even in a part of the world where periods of grave hunger are common, the recent survey numbers shock, Cyprien Fabre, head of the West Africa office of the European Commission's humanitarian aid department (ECHO), told IRIN. "In the Sahel [region of Africa] we always have high malnutrition rates during the lean season, above the World Health Organization emergency threshold of 15 percent," he told IRIN. "But when we see numbers like 27 and 28 percent, it's appalling." Of the roughly 102,000 children nationwide classified as having severe acute malnutrition, about half are in Chad's Sahel band - a semi-arid zone some 500km wide stretching from near the capital N'djamena to the border with Sudan, according to UN Children's Fund (UNICEF). Malnutrition rates are higher than in neighbouring Niger, another West African country where poor food and fodder production from 2009 has destabilized agro-pastoralist communities who already live on next to nothing during lean seasons. In Chad, UNICEF says, under-nutrition is also due to poor access to health services and safe drinking water, inappropriate infant feeding practices and a lack of trained staff in hard-hit areas. Malnutrition has been above the 15 percent threshold in Chad for a decade, according to UNICEF. Kalzeubé Payimi Deubet, governor of Barh El Gazel, lives about 100m from the main regional hospital. He says he sees malnourished children daily. "It is difficult just being in that atmosphere," he told IRIN. "You have little children, their skin just sagging over bones - nothing but skin and bones."Response, but not enough While aid groups have been operating for years in eastern Chad, where over 400,000 Darfur refugees and displaced Chadians live, humanitarian agencies are scarce in the rest of the country. UNICEF has long pointed to the lack of aid partners as a barrier to tackling acute malnutrition in Chad. From January to May 6,508 children were treated at UNICEF-supported therapeutic feeding centres in the Barh El Gazel and Kanem regions, according to UNICEF. The recovery rate at outpatient therapeutic feeding centres was 88 percent; in inpatient feeding centres the rate was lower and varied widely - from 16 percent to 75 percent. UNICEF says this is due in part to the lack of centres for severe cases (Barh El Gazel, population 260,865, has just one); in many cases children are simply arriving too late. Malnourished children with other health complications receive medical treatment in addition to therapeutic feeding. For severe acute malnutrition children receive foods like special fortified milk several times a day and are closely monitored by health staff. Some children can be treated at home with nutrient-dense, ready-to-eat Plumpy'nut, with regular checks. Barh El Gazel governor Kalzeubé told IRIN children in many of the region's villages are simply not being reached, even for detecting under-nutrition. "We do not have the means to diagnose and treat all children." ACF operates 33 nutritional centres in Kanem and Barh El Gazel - expected to reach 43 in the coming months, with one mobile clinic - according to ACF head in Chad Jean-François Carémel. Some areas with high malnutrition are supported by Médecins Sans Frontières and other NGOs, but "the system is not covering all the needs," Carémel told IRIN. He said government health structures are "weak" with a lack of skilled staff and quality care. Under a just-revised national protocol for treating malnutrition - to reflect changed World Health Organization standards - more children would be classified as needing treatment, which will only underscore the deficiencies of the health system, ACF says. Funding shortfall The UN Office for the Coordination of Humanitarian Affairs in Chad said the nutrition response needed more aid workers and more dollars. "We received US$3.8 million from the UN Central Emergency Response Fund (CERF) early in the year for this crisis but much remains to be done," said OCHA humanitarian affairs officer David Cibonga. "We need more aid groups to fill coverage gaps. At the same time we need more funds; the UN consolidated appeal for Chad is funded at only 50 percent." OCHA is seeking another $8 million from CERF. Parallels with Niger 2005 Patricia Hoorelbeke, ACF West Africa representative, said Chad's nutritional situation today is similar to Niger's in 2005, when few humanitarian agencies were in place when a hunger crisis hit. "There is a lack of implementing partners in Chad as was the case in Niger at that time; that's still a major problem." ECHO's Fabre said the comparison is apt. "There is not enough attention [by aid agencies and donors] to the nutritional situation in much of Chad. The problem is overshadowed by the refugee situation in eastern Chad and by Niger." For Nicolas Louis, ECHO's representative in Chad, the "weak humanitarian response" to date has dire consequences: "Quite high morbidity and mortality, as well as potential long-term effects on psychomotor development." He added: "Irregular migration [driven by the crisis] and household debt burden could block some families from restoring their lives and livelihoods, thereby making them more vulnerable to future shocks."

MALNUTRITION: NIGER: Mixed blessing of first rain

DAKAR, 29 June 2010 (IRIN) - The beginning of the rainy season in the arid Sahel region of West Africa is bringing hopes of renewed grazing land and harvests, but also apprehension in Niger as weakened animals are succumbing to the first rains, according to the government, aid workers and herders. The head of the Niger Association for the Revival of Breeding (AREN), Dodo Boureima, told IRIN the circumstances are "absolutely dramatic". "Our generation has never experienced such a situation and it is well beyond anything we anticipated. Thousands of animals [in Dakoro, southern Niger] have already died because of the first rains and we are expecting more losses," said Boureima. The first heavy rains fell in the southern region on 16 June. Sudden temperature change, the physiological demands on the digestive system of changing from a fodder to a grass diet, and water-borne diseases are always taxing for the cattle. "Since the animals are already extremely weak, many are expected to die with the first rains," said NGO Action Against Hunger's (ACF) West Africa regional representative Patricia Hoorelbeke. Cattle were hit by last year's drought, which left the country with limited grazing land and caused the price of animal feed to soar, making it unaffordable for subsistence farmers. [http://www.irinnews.org/report.aspx?ReportId=89575] Hoorelbeke said the most at-risk animals - cows and sheep - were also the Sahel's most common. Camels and goats are generally more resilient and more likely to survive the first rains. The Ministry of Livestock and Animal Husbandry is currently assessing post-rain fatalities to identify suitable responses. "The current response is inadequate," said ACF's Hoorelbeke. "In the next month of so, there will be grazing land again. It is time to identify those [animals that] have lost too much [weight] to recover and to focus on the future." Hoorelbeke noted that recovery can be a lengthy process. During livestock surveys in 2000, she met breeders who said they had still not mananged to build their herds back to the size they were before the 1984 drought.

Niger malnitrition: ACF activity

In response to massive food shortages and staggering acute malnutrition rates in Niger, global humanitarian organization Action Against Hunger ACF International launched an emergency response to provide nutritional support to children, increase the income of vulnerable families, and bolster a national initiative to dampen the impact of the crisis. These interventions come on the heel of an announcement by the government of Niger that the rate of severe food insecurity in the country has tripled since last year.Government authorities estimate that nearly a million children in Niger are moderately malnourished and another 200,000 have severe acute malnutrition, a life-threatening condition. Over 58% of Niger’s population is deemed food insecure, according to recent surveys. Assessments conducted in December by the Nigerien government showed that some 7.8 million people will be forced to cope without food reserves for at least six months before the October harvest; food stocks for severely insecure households—approximately 20% of the population—have already been depleted. These severe food shortages result from a number of factors, including drought-like conditions, high staple food prices, and a sharp drop in the market price of cattle.“The food situation in Niger has reached a critical stage,” says Lauren Taylor, Niger Desk Officer for Action Against Hunger, which has delivered humanitarian programs in Niger since 1997. “Families with no other options are going days without eating or are resorting to begging and borrowing to cope with massive shortfalls.”Action Against Hunger is providing logistical and technical support for the Nigerien government’s response, which includes cash-for-work programs to create 800 new village grain banks and reinforce another 1,000 existing banks, food and seed distributions to vulnerable households during the planting season, and bolstering national grain reserves. The national plan covers approximately 30% of the food insecure population for three months.In addition, a program to provide nutritional care for children under five is intended to reach 378,000 children with severe acute malnutrition and more than 1.2 million children with a moderate form of the condition. The government will also provide a blanket distribution of supplementary nutrition products to 500,000 children between six and 23 months of age as a preventative measure against malnutrition
http://allhumanitytv.blogspot.com/2010/04/hunger-and-malnutrition-crisis.html