Sudan

Despite the ongoing scale up of treatment and preventive nutrition responses (in-patient, outpatient and targeted supplementary feeding programmes) the prevalence of risk factors (health, WASH, food security, and feeding practices) show no signs of significant improvements. For example, over one-third of acutely malnourished children live in extreme and catastrophic severity scale for WASH and health clusters exposing them to heightened morbidity and mortality risks. These needs have significant impact on physical, mental and well-being of children, pregnant and lactating women, and the community in general. The immediate life-saving nutrition needs include preventive and social protection nutrition services for children under-two, treatment of malnutrition for children under-five and PLWs and emergency supplementary feeding programme (e-BSFP) for underfives and PLWs. Affected people The Nutrition Cluster’s 2023 PiN is 4 million. It remains at the same elevated levels as in 2022. Children underfive years account for over 76 per cent and 23 per cent pregnant and lactating women (PLWs) need life-saving treatment and preventive nutrition responses. With respect to refugees, over 67,000 (of whom 66 per cent are under-five and 34 per cent are PLW) are in urgent need of life-saving nutrition support. Children under-five especially children under the age of two and PLWs are the most vulnerable groups due to their increased physiological and biological needs. Moreover, women, young girls and boys suffer disproportionately. The risk of acute malnutrition increases among children in distressed conditions (IDPs, returnees, refugees etc). Based on the 2022 MSNA results, displaced households reported more severe and moderate malnourished cases than those who were not displaced. Children in such circumstances are likely to miss lifesaving nutrition services exposing them to increased malnutrition, morbidity, and mortality risks. The 2018 S3M II revised results and recent SMART surveys indicate that 64 localities have very high (15 per cent and above) prevalence of GAM, of which five localities have catastrophic levels (GAM 30 per cent and above). 39 per cent of all children under-five years in need of nutrition treatment live in 66 localities (in 16 States) are classified as extreme as per OCHA/Global Nutrition Cluster (GNC) classification. Malnourished children face heightened mortality risk. In countries with relatively similar nutrition situations like Sudan, children under-five years with SAM and stunted are estimated to be 11 times more likely to die than their well-nourished peers, while for those with MAM the rate is four times higher. Among those severely malnourished, one in five children will die if not treated, and the risk increases to 9 out of 10 for SAM cases with complications. Sub-optimal IYCF practices continue to remain low. While exclusive breast-feeding prevalence among children under-six months in Sudan is over 62 per cent age-appropriate dietary diversity is very low at 25.4 per cent. Anemia prevalence in children aged 6-59 months estimated at 48 per cent is among the highest falling into severe levels as per WHO classification.   Children living in refugee camps, IDPs in and outside hosting sites, orphans, abandoned children, single parents mostly below the age of 18 years, patients with chronic and neglected diseases and people with disabilities are likely to have limited access to nutrition services in some locations.

About 6.3 million children under-five were screened for malnutrition.

A total of 321,613 cases of under-five with SAM were admitted and treated for acute malnutrition in over 1838 operational sites representing over 100% of the sector annual target of 320,864 with over 90% reporting rate. Of the SAM cases above 36,651 representing 74.8 % of the annual target of 49,021 where SAM with medical complications were admitted in 148 SCs and provided with specialist care in Stabilization centres with 92% reporting rate as of December 2022.  

Meanwhile, total of 785,000 moderately malnourished under-five children representing about 77.1% of the 1,017,624 annual targets were admitted and treated in 1362 Targeted supplementary feeding programme (TSFP) sites. The number of TSFP decreased to 1,189 in December. The correspond admission of PLW in TSFP was 163,256 representing over 40% of the annual target 405,600).

With respect to prevention, a total of 389,927 under-two children representing over 93% of the target (417,852) and 131,078 PLW were enrolled in FBPM. During the same period, a total of 726,760 care takers were counselled on IYCF representing over 73% of the target (990,000); while 596,011 under-five children representing over 123% of the annual target (483,284) were supplemented with micronutrient powders (MNPs). During the same period a total of 6,341,056 (202%) of the target) under-five children were screened for acute malnutrition and referrals made accordingly.

In addition, 600,496 children 6-59 months were reached with vitamin A supplementation, mostly through measles outbreak response campaigns. Ministry of health- supported by UNICEF- piloted routine vitamin A supplementation in Khartoum state, reaching 47,763 children in two localities. This piloting was achieved with support from UNICEF and in collaboration with WFP, which contributed to supporting distribution of MNPs in vitamin A targeted localities.

As result of the declaration of the dry spell in Feb 2022, the sector revised its PIN for acute malnutrition in those localities where additional 31,000 and 122,000 SAM and MAM cases (153,000 in total) were estimated representing 10% increase on the initial caseload.  In view of this, the sector mobilized partners to scale up nutrition responses in dry spell localities where partners expressed commitment to open 303 OTPs, 257 TSFP sites, 21 SCs and 1586 Mother to Mother support groups. By the end of the dry spell in September, a total of 79 (26%); 59 (23%) and 4 (19%) of the partners commitment to open OTP, TSFP and SCs sites above were opened respectively.  In additional, initial analysis of the prioritization of OTP response based on funding availability was prepared in collaboration with UNICEF for 2023 was done. Similar analysis will be done for TSFP and SC in first quarter of 2023.

In terms of capacity building, a total of 5,704 community volunteers and 1,090 frontline nutrition staff were trained on the CMAM package. Meanwhile 3,620 frontline staff were trained on facility-based Infant and Young Child Feeding (IYCF)  and 17,829 volunteers  on community-based IYCF counselling. A total of 52,076 mothers of acutely malnourished children were trained on MUAC screening, bringing the total number of mothers trained on the family MUAC approach to 210,602 from 13 states. Moreover, a total of 87 staff from State MOH and partners were  trained on  nutrition supply chain management. 

 50 SMART survey managers from UN, NGOs and FMOH were trained. As a result, SMART survey resumed to be implemented in Sudan. A total of 10 SMART surveys were conducted of which 9 have been validated by the sector NISTWG. Four of the seven surveys had very high GAM prevalence ranging from 17.2% in Gadeer to 27% in Aroma locality well above WHO 15% emergency threshold.  Two surveys results were classified as high-GAM of 11.5 and 12% and one survey results (Jebel Mara) medium levels- GAM of 6.4%.

The NISTWG of the sector also reviewed and approved 9 SMART survey protocols SMART surveys to be implemented first quarter of 2023 in South, North and Central Darfur States, South Kordofan, Khartoum, Blue and White Nile by various nutrition sector partners.

Sector developed the minimum intervention package with a nutrition lens across WASH, FSL, Health, Education, and protection sectors to be implemented by partners in respective sectors

Improved timeliness of reporting of admissions from quarterly to monthly as well initiated monthly tracking of selected indicators for early warning and early action and supply availability at facility level tracking at site level.  Monthly availability of supplies at national level was tracked and update provided to all nutrition sector partners.

Sudan: Humanitarian Response Plan 2022 (January 2022) [EN/AR] - Sudan 

The broader challenges include: Deteriorating macroeconomic situation has affected the operations of humanitarian interventions corresponding to a sizeable increase of project costs attributed to hyperinfl­ation and extreme devaluation of local currency. Increasing food prices, disruption of markets and livelihood activities negatively impact household purchasing capacity and eventually adversely impacting nutrition especially among the vulnerable groups.

Some of main sector challenges included: access and insecurity in some of the localities, Late reporting, and no real time of nutrition information to guide understanding of the evolving situation; Limited technical capacity among some of partners; Gaps in treatment and geographical coverage of nutrition services of SC/OTP/TSFP; Poor nutrition infrastructure in some of facilities-need rehabilitation; lack of incentives for staff/CHVs

Moreover, interrupted supplies availability in some of the localities and limited funding for the sector responses with only 11% of the requirement funded. A significant number of children and PLWs in need of life-saving nutrition interventions up to 42 % and 54% with respect to SAM and MAM were not targeted. Other main  challenges that the sector encountered in 2022 include the following: Limited funding to cope with increased needs associated with deteriorating nutrition situation associated with dry spell, increased inflation, collapse of the economy, worsening of social services etc;  Late funding for humanitarian activities;  Political instability and tribal conflict at some areas and states affecting continuity of nutrition services and for children enrolled in programme (some children and PLWs cannot finish treatment regimen for acute malnutrition); Inaccessibility due to geographical and insecurity and therefore preventing implementation of life-saving and preventive nutrition responses ;  Lead time of nutrition supplies imported from outside the country and limit capacity of local suppliers to deliver on time;  Customs and testing procedures related to nutrition clearance (lengthy; unclear in sometimes); . Late referrals of SAM with medical complications contributing to preventable loss of children’s lives; Health and nutrition workers strike affecting provision of nutrition services; Staff turnover in some of the nutrition sites e.g in some sites is high as 50% ;  Restriction funding transfer to the SMOH- affecting FMOH/SMOH to fulfill its roles.