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: gbarberis@unicef.org

Edele Thebaud

Deputy Representative

Tel: +221 33 889 03 00

E-mail: ethebaud@unicef.org

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%