South Sudan: RMF UNICEF Malnutrition Treatment and Prevention Program Jonglei State

11,448 Children Under 5 Screened for Signs of Malnutrition: Q2 2016

September 07, 2016
Dr. Taban Martin Vitale


Summary of Activities


PROJECT GOALS

The overall goal of this project is to reduce the GAM (General Acute Malnutrition) rate to an acceptable level of less than 15% in each of the Payams assigned to RMF. This will be in line with standards set by South Sudan National Nutrition Program.

PROJECT OBJECTIVES
  • To provide lifesaving nutrition services for acutely malnourished children (boys and girls) less than 5 years of age and Pregnant and Lactating Women (PLW).
  • To prevent malnutrition in early childhood through promotion of improved infant and young child feeding, as well as caregiving and care seeking practices at the facility, community, and family levels.
  • To prevent and treat micronutrient deficiency disorders in children through provision of multiple micronutrient supplementation, Vitamin A, and deworming campaigns in the assigned areas.
  • To strengthen the capacity of the County Health Department and provide appropriate resources for the initiation and integration of nutrition services into existing primary health care, as well as linking nutrition interventions in the health system in the targeted counties.
PEOPLE SERVED
  • 2 new Outpatient Therapeutic Programs (OTPs) were established, while the 7 existing OTPs continued to provide quality CMAM and IYCF services.
  • 8 TSFP centers were established (5 in Ayod and 3 in Boma) and are all providing quality nutrition services for Moderate Acute Malnourished (MAM) children and PLW.
  • The 2 Stabilization Centers in Ayod continued to provide inpatient services for Severe Acute Malnourished (SAM) children with complications.
  • 11,448 children under 5 were screened for signs of malnutrition during this quarter.
  • 731 SAM children were identified and referred to OTPs for management during this reporting period.
  • 27 SAM children with medical complications were identified and referred for management at the two Stabilization Centers in Ayod.
  • 627 MAM children were enrolled in a supplementary feeding program.
  • 3,710 children received deworming tablets during the reporting period.
  • 3,609 children received vitamin A supplementation according to South Sudan guideline during the reporting quarter.
  • 88% of the admitted SAM cases fully recovered, which is a good indicator as the proportion of recovered children was above the 75% recommended by South Sudan MOH and international protocols.
  • 1,974 Pregnant and Lactating Women (PLW) were screened for signs of acute malnutrition.
  • 603 PLW were enrolled in supplementary a feeding program during the reporting quarter.
  • 137 community mobilization sessions were conducted during the reporting quarter.
  • 21 mass screening sessions were conducted during the reporting quarter.
  • 4,982 mothers and caretakers received appropriate messages on IYCF, strengthening malnutrition prevention measures.
  • 8 mother-to-mother support groups were formed and all 16 groups were supported and continued to deliver services.
Challenges
  • All our areas of operation in Ayod are controlled by the opposition forces, and the security situation remains volatile, despite the signing of the peace agreement in August 2015. The population continues to be fluid, as people keep moving from one location to another in search of safety.
  • Irregular UNHAS flights to our areas.
  • In June, UNHAS stopped operation to Katdalok, an airstrip serving two of our OTPs in the area. This makes sustainability of the program in the area very difficult.
  • Provision of nutrition and other essential supplies to the newly opened OTPs in Pagil and Jiech was challenging during the rainy season. Fixed wing aircrafts were not able to land in the area, forcing us to depend solely on the helicopters operated by UNHAS, which is very expensive.
  • There is basically no infrastructure in these areas; previously existing infrastructure was destroyed during the fighting.
  • South Sudanese Pounds (SSPs) depreciation: Prices for basic commodities have increased more than tenfold.
  • Deteriorating economic crisis in the country: Commercial banks are not able to provide adequate amounts of USD to their clients, making it difficult for RMF staff to get their salaries and also affecting the procurement of basic commodities.
  • Lack of healthcare services in our areas of operation make it very difficult to help patients of all age groups who come to our clinics with medical conditions. It is unethical that health partners that have resources from donors are only providing services in the big centers and neglecting the communities at village level.
  • Irregular delivery of TSFP supplies by WFP to the TSFP centers led to a stock-out and poor treatment outcomes, as MAM and PLW cases had to default while waiting for nutrition supplies.
  • The slow, bureaucratic financial management system of WFP delayed the disbursement of funds, making continuity of services very challenging.


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Results &

Accomplishments

  • CMAM child malnutrition

    CMAM Services

    Community-based Management of Acute Malnutrition Model
    • 2 new Outpatient Therapeutic Programs (OTPs) were established, while the 7 existing OTPs continued to provide quality CMAM and IYCF services. RMF now has 9 fixed OTPs (3 in Boma and 6 in Ayod).
    • 8 TSFP centers were established (5 in Ayod and 3 in Boma) and are all providing quality nutrition services for Moderate Acute Malnourished (MAM) children and Pregnant and Lactating Women.
    • The 2 Stabilization Centers (SCs) in Ayod continued to provide inpatient services for SAM children with complications.
    • * 11,448 children under 5 were screened for signs of malnutrition.
    • 731 SAM children were identified and referred to OTPs.
    • 27 SAM children with medical complications were identified and referred for management at the two Stabilization Centers (SCs) in Ayod.
    • 627 MAM children were enrolled in a supplementary feeding program.
    • 3,609 children received vitamin A.
    • 88% of the admitted SAM cases fully recovered.
  • Mothers encouraging breastfeeding

    Support Groups

    Mother to Mother
    • Pictured above: Members of mother-to-mother support groups demonstrating to the group the importance of breastfeeding.
    • 8 mother-to-mother support groups were formed and all 16 groups were supported and continued to deliver services.
    • 4,982 mothers and caretakers received appropriate messages on IYCF, strengthening malnutrition prevention measures.
  • RMF nutrition nurses (in T-shirt) demonstrating to a new recruited CNV how to accurately measure MUAC

    New Staff

    Training and Support
    • Pictured above: RMF nutrition nurses (in T-shirt) demonstrating to a new recruited CNV how to accurately measure MUAC
    • RMF previously interviewed and recruited new nutrition officers/nurses from Juba and local staff from our areas of operation to support the trained CMAM nurses taken from Juba.
    • The newly recruited nutrition staff members were trained on CMAM/IYCF and existing nutrition staff members were supported, mentored, and refreshed on CMAM/IYCF through continued on-site supervision conducted by the nutrition program managers.
  • Nutrition education

    Meeting Needs Despite Challenges

    Administration and Supplies
    • High-speed WIFI internet service continues to benefit staff.
    • Monthly payment of the Thuraya (satellite phone) subscription fares enabled effective communication and coordination without interruptions.
    • Continued replenishment of nutrition supplies in all of our OTP and SC sites through chartered commercial and UNHAS operated aircrafts.
    • Our nutrition field based teams continued to have clean, safe drinking water through usage of the provided water purifying equipment.
    • Coordinated and signed a partnership agreement (Field Level Agreement) with WFP for implementation of TSFP activities in Ayod and Boma.
    • Coordinated and renewed our PCA with UNICEF for the OTP/SC program in Ayod and Boma.
    • Prepared and submitted a proposal to UNICEF for supporting the healthcare system in Ayod and Pibor.
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Numbers

Served

Direct Beneficiaries

Approximately 140,517 people living in the payams assigned to RMF projected from the 2008 South Sudan Population and Housing Census.
The project aims to provide treatment and multi-micronutrients to about 4,548 SAM children, 16,267 MAM children, and 7,569 PLW in 2016.

Indirect Beneficiaries

The whole population of the two counties, estimated to be 340,661 projected from the 2008 South Sudan Population and Housing Census.
The 1,721,036 people living in Jonglei State and Greater Pibor also benefit from the project indirectly, as there is frequent movement of people across counties.
The nutrition service centers also receive beneficiaries from the neighboring counties and Internal Displaced Persons from various areas of Jonglei State and other states in South Sudan.

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