Coordination mechanism: Sector
Year of activation: 2008
NCC: UNICEF P4,FT
IMO:UNICEF NoB TA
UNICEF lead, FMOH co-lead 8 sub-national coordination hubs
January to December 2022
Despite humanitarian interventions, malnutrition in Sudan remains the number of Acute malnutrition children and PLW that need humanitarian assistance increased by 8.8% from 3.6 million in 2021 to 3.9 million in 2022. Out of the 3.9 million, over three million children are estimated to be suffering from acute malnutrition of which 618,950 and 2451,406 are diagnosed with severe acute Malnutrition (SAM) and moderate acute malnutrition respectively . Moreover, approximately 905 000 pregnant and lactating women (PLW) estimate be suffering acute malnutrition in 2022. 15 out of the 18 states reported extremely high global acute malnutrition (GAM) rates in 2020 including high to very levels of malnutrition in 125 localities representing over 63% of the entire country.
Drivers of malnutrition can be characterized as; (i) economical, such as income poverty and high food prices which contribute to inadequate food intake and dietary diversity at household level; (ii) displacement due to conflict or flood contributing to destruction of food commodities and disease outbreaks; (iii) COVID-19 pandemic leading to disruption in health and nutrition services; and (iv) prevailing inappropriate feeding practices due to cultural norms and illiteracy and (v) political instability. These have contributed to affect essential early childhood development and growth among vulnerable children.
Most vulnerable communities live in areas ranked as severity four and five in terms of malnutrition – sensitive indicators for food security, clean drinking water and low social protection coverage. According to the latest IPC report, the number of food insecure increased by about 34 percent from 7.1 million people in 2021 to 9.8 million in 2022. Furthermore, micronutrient deficiencies are prevalent with only 7.6 percent of households use iodized salt (S3M II Survey). Scaling up maternal nutrition services remains a concern with approximately 905,00 PLW needed moderate acute malnutrition (MAM) management services to attain adequate diet. About 1.9 under-five care takes including PLWs need appropriate infant and young child nutrition (IYCF) counselling services
Standard Expanded Nutrition Survey (SENS) conducted among refugees in White Nile, East Darfur, South and West Kordofan indicate ‘critical’ rates of GAM (>15 percent) and SAM (>3 percent) among children between six to 59 months of age. Based on this assessments, it was estimated that 137,191 of under-fives and PLWs across Sudan needed humanitarian nutrition assistance of which 92% of were under-five children. The survey also indicates high rates of anemia (>40 percent) among children and women (aged 15-49 years), as well as low Vitamin A supplementation coverage for refugees in all above mentioned refugee-hosting states.
;To mitigate and prevent morbidity and mortality associated with malnutrition, the sector will focus on the immediate life-saving nutrition needs that include: Out-patient treatment and in-patient treatment of severe acute malnutrition, treatment of moderate acute malnourished under-fives and global acute malnutrition among PLWs) in prioritized localities. Preventive nutrition needs are Infant and Young Child Feeding practices, emergency supplementary feeding programme (e-BSFP) for under-fives and PLWs, within the crisis hit populations, Food based prevention of malnutrition (FBPM) for under 2 children and PLWs at the risk of developing acute malnutrition, provision of micronutrient powders to children under 5 years (Home Fortification) and salt iodization (USI; treatment and prevention of anaemia, Vitamin A supplementation, capacity building of partners and system strengthening. Implementing multi-sectoral nutrition sensitive interventions (WASH, Health, Food Security, social protection education) ,. Strengthening evidence generation and analysis through implementing SMART surveys in prioritized localities, improved analysis of nutrition information and operational studies to guide informed decision making and planning are critical. These needs have significant impact on physical, mental and wellbeing of children, pregnant and lactating women, and the community in general.
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.
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.
|Country Advocacy Strategy developed||No|
|Link to document|
|Advocacy activities included in annual work plan||Yes|
|Specific WG leading advocacy work established||Yes|
|Contingency plan or ERP plan developed/updated||Yes|
|Link to document|
|Intersectoral Collaboration (ISC)|
|Intersectoral projects currently under implementation||No|
The sector coordinated preparation of a minimum intervention package involving WASH, Health, Food Security and Livelihood and Child protection AoR. The minimum package with activities and indicators has been included into the different sectors HRP and bilateral partner's projects.
In addition to the Nutrition Sector in collaboration with WASH, Health and Food Security conducted a intersectoral vulnerability analysis based on the severity scale.53 localities were identified as a priority for intersectoral Intergration.