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The One Health Concept; Applied in nutrition sensitive

interventions

VÉTÉRINAIRESSANS FRONTIÈRESSUISSE

Nutrition-sensitive livestock-based emergency interventions in

Ethiopia

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Lensse Gobu (BSc, MPH)Tropentag , September 19, 2018

Outline of the Presentation

� Background- Context� Nutrition sensitive interventions- experience

of VSF-Suisse in Ethiopia� EVSP as a showcase� Lessons learnt

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Background- Ethiopia (2017)

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Population• 94.3 million (100+

according to UN)• Annual growth rate of 2.3%

- 12% are pastoralists

Geography• It is the 27th largest country in the world• 11 administrative regions• Pastoralists live in parts of 4 of the regions

Service • 2.6 health service provider (all level)

for 1000 population

The current challenge in pastoral areas of Ethiopia

• Inadequate access to services• Inadequate institutional capacity• Vulnerability due to recurrent droughts• Inadequate infrastructure• Increased competition for resource and associated

conflicts

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Somali Region of Ethiopia• One of the 11 Regions of Ethiopia- 5 m population• Stunting (chronic malnutrition) prevalence is 27.4%

(National- 38.4%)• Wasting (acute malnutrition)- 22.7% (the highest from all

regions) National- 10%• The highest prevalence of anaemia in children -82.6%

(national prevalence- 56%).• The highest prevalence of severe anaemia in children-

12.8% (national prevalence- 2.9%)• The highest prevalence of anaemia in women - 59%

(national prevalence- 23%)

Source: EDHS 2016

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VSF-Suisse and Its Nutrition Sensitive interventions in Ethiopia

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Trajectory of one-health implementation-in VSF-CH in Ethiopia

Nutrition-based livestock offtake project; 2012

EVSP-Emergency veterinary support programme; 2013

NEVSP- Nutrition based emergency Veterinary support program in Siti Zone; 2015/16

BCIN- Behavioral Change for improved Nutrition; 2015-16

Different one health initiatives integrated to RESET project; 2017-2019

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Nutrition based livestock off-take

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� 5 kgs of camel meat per household per week for 12 consecutive weeks.

� Households severely affected by drought-induced emergency nutrition situation-with malnourished children < five were targeted.

� These interventions improved the availability of animal derived protein in the targeted households

� Implemented in severe drought scenario

Implemented in three projects in Somali Region

1. UN/OCHA financed project in Gode and Hargele Districts-2012

2. SDC financed and UN/OCHA co-financed project in Siti Zone-2015- 2016

3. SDC financed project in Warder Zone- 2017/2018

Milking goats distribution

• Implemented in 2 rounds:– Kebriderhar and Shilabo

Districts– Nogob and Jarar Zones

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� Fresh goat milk � Households with malnourished children < five� Recently been discharged from therapeutic

feeding centers

The intervention

• 9 goats/HH with a package ofvoucher-based veterinaryservices

• Locally available and culturallyappropriate nutrient densefood.

• Implemented in scenarioswhere there is some pasture

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Effects….

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Improvement of the family food basket

Cash injection to the local economy through the sale of meat and milking goats

EVSP as a showcase

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Project details of the EVSP Name of the project Emergency Community Veterinary Support Program

to Mitigate Drought in Korahe Zone Through Improved Food and Nutritional Security (EVSP)

Duration October 2012- April 2013

Core activities • Community-based livestock service interventions,

• Emergency animal health treatment based on vouchers

• Milking goats distribution

Donor UN/OCHA- HRF

Targets of the project • 760,000 livestock of poor households (6,000HHs)

• 50 households hosting children in emergency nutrition services specifically targeted for milking goats distribution.

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Why milk?• Animal milk -an important component ofpastoralist diets across the world (Sadler, Kervenet al. 2010).

• A nutrient-dense food known to contribute ahigh proportion of the nutrients, such as highquality protein and micronutrients.

• A need to improve availability of milk for youngchildren of drought affected vulnerablecommunity members in program targetedareas.

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Why milking goats?

• Contributes to asset building• More sustainable source of food• Safer than collecting the milk from market(avoids spoilage during handling, storage andtransportation of the milk)

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Why 9 goats per HH? 1. Milking Performance of Ethiopian Goats (in Somali)

– Daily milk yield:- 0.5-2.0 Liters/Day (assumed an average of 1.25 Lt/Day

– Lactation length:- 80-200 Days (assumed an average of 160 days in milk)

2. How much milk is needed to supplement a child?– Daily milk-based diet recommended for children under 5 years of age is 360-

480ml/Day (an average of 420) for healthy and nutritious life.

3. How much milk is needed for one household?Assumptions:

– 4 children per household

– 4 children X 0.42 Lt/day = 1.68 Lts;

4. How many goats can provide this volume of milk daily?– A best goat can give 1.25 Lts/ day, two milking goats can give 2.5 Lts/ Day which is

sufficient for about 5 children.

– The least producing goat yielding only 0.5 Liters of milk per day- we need 4milking goats per household to feed 4 children.

– 4 milking goats with their kids- 9 m17

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MUAC for ageAssessed using WHO Anthro for PC software

MUAC for age before intervention MUAC for age after the intervention

Age

groups

N MUAC-for-age (%)

% < -3SD % <-2SD Mean SD

(6-11) 5 80 80 -3.33 0.86

(12-23) 15 46.7 73.3 -2.55 1.26

(24-35) 28 75 96.4 -3.43 0.82

(36-47) 15 66.7 93.3 -3.42 0.93

(48-60) 24 33.3 66.7 -2.74 1.18

Total: 88 56.8 81.8 -3.06 1.1

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Age

groups

N Mid-upper arm circumference-for-age

(%)% < -3SD % < -2SD Mean SD

(6-11) 0

(12-23) 13 7.7 38.5 -1.42 1.29

(24-35) 17 5.9 47.1 -1.9 0.72

(36-47) 19 10.5 52.6 -2.08 0.87

(48-60) 16 25 50 -2.29 0.82

Total: 65 12.3 47.7 -1.95 0.95

Number of food groups consumed in a day

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3 4 5 6 7% at Baseline 2.2 61.5 28.6 5.5 2.2% at intervention 1.5 21.5 53.9 21.5 1.5

0

10

20

30

40

50

60Pe

rcen

tage

of

Hou

seho

lds

Household Dietary Diversity Score

Other outcomes of the project

• Feeding practices– % of HHs giving pure goat milk to their childrenincreased from 17.3% at baseline to 50% atintervention.

– A two-fold increase (from 20% at baseline to41%) in the % of HHs giving milk with tea for theiraffected children as ‘special’.

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Other outcomes, …..cont’d

• Livelihoods– The mean monthly income has increased from880 birr to 1,380 birr indicating an increasingtrend in income among the beneficiaries in theintervention period.

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Other outcomes….

• KII with the father of one of thebeneficiaries

“I was ‘Faramaal’ (flexing muscles) before I got the milkinggoat. Men from poor households like me water more than100 camels of the better-off families from 10-15 m depthwells by lifting 20 liter of water per minute for 8 consecutivehours per day in exchange of 3 liters milk for free or for lowerprice. We then used this milk to feed our needy children.”

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• Another beneficiary mentioned theunintended effect of this intervention onthe families as:

“After you have given us the milking goats wegot trust from others. People started givingus credit from shops, which means that webecame part of the community.”

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• However, None of the mothers werebreastfeeding at the end of the intervention

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• Nutrition sensitive interventions needed tobe coupled with tailored BCC interventions toimprove the nutritional status.

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The BCIN study

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The learning continued……

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One health for integrated service delivery for pastoral areas?

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The challenge-access to services

• Inadequate healthservices– Only 62% of women

access ANC (51 % inSomali Region)

– 26% of deliveries arein health institutions(18% in SomaliRegion)

– Immunizationcoverage for under 1is 39% (22% inSomali Region)

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Inadequate vet services• Less than 10% of

households report accessto vet services

• In Ethiopian SomaliRegional State as of 2015:– Only 1 regional lab in

Jijiga– 622 AH facilities (70%

are functional)– 5% reporting rate– 23% vaccine

distribution– 81,660 livestock per

clinic

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People

Livestock

Their environment

WHAT WE DO

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to promoteEnvironmental

Health

Our goal: Ensuring healthy people derive their livelihoods from healthy livestock in a sustainably managed environment.to support

AnimalHealth

to ensureHuman Health

Thank you!

Lensse Gobu: lensse.gobu@vsf-suisse.org