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Integrated Community-based Management of Severe Acute Malnutrition in

children under five years in Magwi County Eastern Equatoria state

Quarterly report October-December 2019

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CONTENTS

CONTENTS ........................................................................................................................................ 2

ACRONYMS ...................................................................................................................................... 3

PROJECT SUMMARY .................................................................................................................... 4

1. INTRODUCTION ...................................................................................................................... 5

1.3 PROJECT APPROACH ............................................................................................................ 6

2. PROJECT IMPLEMENTATION ........................................................................................... 6

3. COMPLETED ACTIVITIES .................................................................................................. 6

5. WAY FORWARD .................................................................................................................... 15

6. LESSONS LEARNT ................................................................................................................ 15

7. CONCLUSION ......................................................................................................................... 15

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ACRONYMS

CHD County Health Department

CHW Community Health Worker

CMAM Community Management of Acute Malnutrition

CNV Community Nutrition Volunteers

GAM Global Acute Malnutrition

IHO Impact Health Organization

IYCF Infant Young Child Feeding

MOH Ministry of Health

OTP Out Patient Therapeutic Programme

PHCC Primary Health Care Centre

RUTF Ready to Use Therapeutic Foods

UNICEF United Nation Child Education Fund

WASH Water Sanitation and Hygiene

SC Stabilization Centre

MIYCN Maternal infant young child nutrition

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PROJECT SUMMARY.

Impact Health Organization (IHO) implements the Integrated Community-based Management

of Severe Acute Malnutrition in children under five years in Magwi County Eastern

Equatoria state with support from UNICEF South Sudan. The overall objective of the project is

to increase access to equitable and better-quality nutrition services to girls and boys under age

five, young girls and women and build resilience to shocks and emergencies in Magwi County,

South Sudan by the year 2021.

This quarterly report covers activities performed between October 1st 2019 and December 31st

2019. The implementation process involved both health facility and community-based activities.

Among these included screening, treatment, referral, awareness, Child friendly spaces and

Psychosocial support to the parents/caretakers. Among the activities conducted within this

reporting period included: screening of children 6-59 months for acute malnutrition (health

facility and community based screening), where 25470 (12,043 males, 13427 females) were

screened, of which 354 (178 males, 176 females) children (6-59) months were SAM, 3264

children (6-59) months attended child friendly spaces, 17 SAM children with medical

complications were admitted and 13 discharged cured in the SC, 285 Parents and Caregivers of

children under five years with SAM were provided with psychosocial support, 358 (91%)

children (6-59) months were discharged cured, 12 (3%) children defaulted from the programme

in this quarter, 22 (5.6%) children were discharged as non-recovered and there was only 1 deaths

registered both in OTP and SC during the quarter.

during implementing the project, IHO has learnt that; involving the key community influencers

through community meeting has greatly lead to positive nutrition behavior change, Motivation of

health workers is key to improve service delivery, community screening is very important, case

monitoring, on job mentorship for the nutrition workers, follow-up and community participation

plays a big role and improves access and quality of services.

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1. INTRODUCTION

Republic of South Sudan faces considerable humanitarian problems, which have increased

substantially since the outbreak of violence across the country in December 2013. The fighting in

Eastern Equatorial state have further aggravated the humanitarian situation, producing secondary

or third displacement. Among the most affected Counties in Eastern Equatoria is Magwi County

having figures way off thresholds in the thematic areas of WASH, nutrition, health and food

security. According to the South Sudan Humanitarian Needs Overview (HNO) 2018 reported

that Magwi County had a GAM rate of 15.2%, slightly above WHO emergency threshold of 15%

a serious indication that malnutrition will increase in the near future, SAM was reported at 2.8%

and MAM at 12.4%. According to the integrated food security phase classification report (IPC

Findings September 2018-March 2019), Magwi County is classified as Phase 3 (Crisis stage).

The FSNMS March 2018 report that FAW (Spodopterafrugiperda) attached most of the Maize

plantations in Magwi County. In addition, the County was faced with highest food deficits and

with highest levels of food insecurity due to high cereal deficit, hyper-inflation and the

prevailing insecurity. The level of households’ food insecurity is likely to be higher than the

previous year. Thus, scaled up efforts are required to support the populations most in need of

assistance.

The IHO July 2018 assessment reported that 52% health facilities had no nutrition services, 40%had no staff trained in nutrition,76% needed new latrines. Only 30% of the schools treated helminth infections among children. Only 2 schools screened children for malnutrition. One school reported visit from nearby health facilities to provide nutrition and health services like deworming. Only 3 schools had a kitchen garden and 3 schools provided meals to students. Only one school had least one teacher trained to implement school/nutrition programs, 60% of school had no latrine. Only 3 out of 5 functional clubs had its members trained on health, WASH and Nutrition issues. Therefore, this partnership greatly meets gaps in programme and geographical coverage with nutrition interventions in 12 OTP sites (10 Old and 2New) and 1 SC.

1.1 BACKGROUND OF IMPACT OF HEALTH ORGANIZATION (IHO)

Impact health organization (IHO) is a Development and Emergency not for profit organization

operating in South Sudan since 2015. IHO is registered with Relief and Rehabilitation

Commission under the New NGO bill and as well as a member with the South Sudan NGO

forum. The Mission of IHO is stated as “A world where people are healthy and treated with

dignity and respect” and IHO vision is “Help vulnerable communities achieve immediate and

lasting change in order to manage and maintain their own health and well-being”. IHO

Programs focus on Health, Nutrition and Water Sanitation and Hygiene (WASH).

1.2 PROJECT GOALS AND OBJECTIVES

The project Long term goal is to provide preventive and curative nutrition interventions to

Children 6-59 months through nutrition treatment for children 6-59 months in OTP centres and

IYCF counselling to PLW and caregivers of children below 24 months through health facilities

and community-based approach. This aimed at ensuring access to quality nutritional services,

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reduce mortality and severe acute malnutrition among children under five in Magwi County

targeted locations.

1.3 PROJECT APPROACH

The project uses different strategies which include on job trainings, supervision, and service

provision, follow up, mentorship and awareness. Community members both men, women, girls

and boys are on the front of the project. They worked as volunteers and were empowered to

promote referral of Malnutrition cases and follow up through home visits.

2. PROJECT IMPLEMENTATION

This particular quarter (October 2019 to December 2019) is the fourth quarter since the project

started in January 2019 in Magwi County. The project team includes Project coordinator,

nutrition officer, Assistant Nutrition Officers, Nutrition Assistants, Community Health Workers,

Community Nutrition Volunteers supported by Finance Officer and Logistic Officer. IHO

prepares weekly activity, movement, budget plan to ensure proper project management. At

inception IHO had a meeting with the County Administration, RRC, Payam Health Supervisors

and health facilities in charges/ Boma health committees.

3. COMPLETED ACTIVITIES

a) Screening of Children for Malnutrition.

Following CMAM guideline, in ensuring malnourished children (6-59 months) receive nutrition

treatment and support, IHO undertook active screening both at the community by CNVs and at

the OTP site by Nutrition Assistant and CHWs. At the end of this quarter, a total of 25470

children (6-59 months) have been screened. At the community level, the CNVs moved house to

house conducting screening of children for acute malnutrition and those found malnourished

according to the criteria were referred to OTP sites for re-screening and assessment by the

Nutrition Assistant for admission. The CNVs follows those community referrals who would not

turn up for rescreening at the OTP sites. This active case finding has greatly created a lot of

awareness and increase demand for nutrition services.

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Photo 1, shows a CNV taking MUAC of a child at Magwi PHCC during OTP day

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2000

4000

6000

8000

10000

12000

October November December

3-D Column 1

Graph 1: shows the number of children screened for SAM/MAM in the fourth quarter of

2019

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b) Treatment of children with SAM at OTP.

Following the screening both at the health facility and the community, 354 (178males, 176

females) children (6-59 months) were admitted for SAM nutrition treatment and 358 (91%)

children were discharged cured in this quarter. This was a good achievement following the

SPHERE standards cure rate of >75%. Only 12(3%) children defaulted, that shows great

improvement on defaulter compared to last quarter 47(14%) due to more awareness and

sensitization on danger of defaulting given to the caretakers by our nutrition teams at the sites. 22

(14 male, 8 female) (5.6%) children were discharged as non-respondent, home visits have been

carried out to identify the problem and some being referred for medical investigation and only 1

deaths due to anaemia occurred during this quarter.

0

20

40

60

80

100

120

140

October November December

No. of Admission

Cured

Defauter

Bar graph showing OTP performance indicator and number of admissions, discharged cured

and defaulters per quarter

c) Provided facility-based IYCF counseling

This fourth quarter, facility based IYCF education was undertaken at each OTP site supported by

IHO. Mothers including pregnant and lactating mothers and caregivers (Male and Female) were

educated on proper infant and young child feeding. The topics often covered range from

sanitation and hygiene, exclusive breastfeeding, weaning diet, balanced diet and identification of

danger signs. The children admitted in the program are always followed up by the CNVs to

continue promoting proper IYCF practices. A total of 712 men and 3928 women were reached

with facility based IYCF counselling.

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Photos3, shows a CNV conducting nutrition group counselling about adequate

complementary feeding at Magwi PHCC/ OTP site and photo 4, show nutrition assistant

conducting IYCF counselling session to mothers/caretakers at Obbo PHCC site.

d) Treatment of SAM children with complications

Following the strong coordination between staffs at the OTP sites, CNVs in the community and

the SC staff. The SAM children who are found with medical complications at the OTP sites are

referred to the SC for in patient management and referred back to the OTP sites after discharge

for OTP services and follow up. In this fourth quarter 17(9 males, 8 females) children have been

admitted in the SC and 13 discharged cured. The defaulter has been prevented due to possible

support from WFP, where, caretakers of admitted children are provided with daily food ratio

during their stay and this has significantly reduced the rate at which mothers of admitted children

escape from the SC.

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0

1

2

3

4

5

6

7

8

October November December

SC Admissions

Line graph showing the monthly SC admissions for the whole 4th quarter period.

e) Outreach activities.

In this quarter, Outreaches has greatly play a vital role in improving the access to nutrition

services by the community and prevent death of children due to malnutrition where health and

nutrition education on MIYCN, optimal WASH practices, screening for acute malnutrition and

monitoring of the community activities for CNVs and lead mothers in areas that are far (10KM)

from the facility. These are done weekly by the Nutrition Assistant and CHW. In this quarter a

total of 48 outreaches have been conducted by all the facilities including outreaches in schools. A

total 1342 children under five both male and female have been screened and 78 admitted into the

programme.

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Photo 5&6 shows outreaches conducted in Ayii village and Igili vil;lage of Magwi county by

IHO nutrition team.

f) Mother to mother support group meetings

Mother to mother support group are moving door to door in passing MIYCN key messages to the

community for the improvement of nutrition and local belief about foods. In this quarter IHO

conducted 26 mother to mother support group meetings with the aiming at increasing MIYCN

key message delivery in the communities, follow up with the progress of kitchen demonstration

gardens which can increase their household food security and also empowering them with good

saving cultures making some mother to mother support groups who have been able to buy

income generating livestock like Goats, pigs from their savings.

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Photo 7&8: shows a mother to mother support group meetings at Owinykibul PHCC and in

Amika village attended by the IHO staffs

e) Radio talk shows

In increasing and creation awareness on service delivery, empowering the community

on the cause of malnutrition, MIYCN key message, optimal WASH practices, IHO

conducted 3 radio talk shows at voice of freedom FM in Magwi involving school nutrition

club pupil from covenant primary school. The topics covered balanced diet using local

available foods, exclusive breastfeeding, danger of sharing, selling of RUTF. The talk

show covers greater population of greater Magwi County which greatly created a

awareness about nutrition services, exclusive breastfeeding and danger of sharing and

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selling of RUTF as evidenced by community interactions through phone calling in the

studio.

Photos showing two representative of school nutrition club pupil form covenant primary during the

radio talk shows about balanced diet.

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g) Meetings with community leaders.

IHO with the aims of increasing nutrition service deliveries, community acceptance of the

services and ownership we had conducted 3 key community stake holders’ meetings in 3 villages

of Palwar, Agoro and Igili. However, the two villages of Palwar and Agoro were not under IHO

catchment areas but with the support from UNICEF and WFP, IHO will start to operate in those

two villages as our 2 new added sites from the start of the new financial year 2020. A total of 84

community members participated in these meetings. These meetings have created a sense of

ownership of the project among the communities evidenced by community active participation in

nutrition activities. The meetings have also acted as plat form to receive key recommendations

from the community members concerning the project and how the nutrition status of the

community can be more improved.

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Photo 11&12 shows key community members attending the community meeting in Palwar and

Agoro village respectively

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h) Child friendly spaces and psychosocial support sessions.

In this fourth quarter, 40 psychosocial support sessions have been conducted with parents and

care givers at the OTP sites reaching 285 parents and care givers and in addition the OTP

sites were able to stimulate and give care to malnourished children with child friendly space

to help them open their mind despite of the health problems they are under going. In this

quarter 2879 children under five years have been reached with child friendly services.

Photos 13 Shows child in child friendly space in Magwi PHCC site

4. CHALLANGES

Lack of enough bed capacity for the stabilization center.

Lack of stores at the OTP sites making storage of supplies challenging.

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Poor road network that makes support supervision and transport of supplies challenging.

Lack of mobile network that makes coordination of activities difficult.

Some facilities lack OTP shelters.

5. WAY FORWARD

Impact Health Organization with support from UNICEF shall continue promoting Nutrition

services in Magwi County to achieve the set goals and objectives irrespective of the few

challenges in need of long term solutions.

6. LESSONS LEARNT

During the implementation of this project IHO has learnt the following:

Community meeting with key influencers improves the community participation and leads

to ownership of the programme.

Case monitoring and follow-up is an important strategy to achieve maximum recovery

Community participation improves access to services and leads to sustainability of the

project.

7. CONCLUSION

The Nutrition needs of the community in Magwi County require continues support. There IHO

with support from UNICEF will continue supporting the communities in order to reduce

Malnutrition.