Menu ENN Search

Evaluation of SCUK Emergency Nutrition Intervention in Malawi During 2002-2003

Selling maize husks in Malawi

The 2001 harvest in Malawi was particularly poor and it was recognised by June/July that there would be a substantial maize deficit. Furthermore the grain reserve had been sold off, and the money from this reserve was 'missing'.

SCUK conducted a study using the household economy approach (HEA) in late October 2001 in Mchinji district, which suggested that the population were in serious stress. The assessment and verification revealed that 65% of households were suffering from a serious lack of food. Production was down by 40% and terms of trade indicated that between January and October 2001 the cost of a kilogram of maize had increased by 340%. Nutrition surveys were conducted in Mchinji and Salima districts in December 2001. These indicated a deteriorating nutritional status prior to the official hunger gap period with GAM 11.8% and 9.3% and SAM 3.8% and 4.8% in Mchinji and Salima respectively. The rates of severe acute malnutrition were particularly high.

SCUK General Food Distribution Response:

In November 2001 SCUK started advocating for emergency assistance for Malawi. A proposal was submitted to DFID for a two-month food distribution for Mchinji District and it was eventually funded in February 2002. The initial planned response was a two-month general ration distribution in Mchinji District, which was later changed to a one-month distribution. It was planned to distribute to 60% of the population targeting around 400 villages. On registration of villages and beneficiaries the population increased substantially therefore a decision was made to target 50% of the population instead. Distribution commenced in early March. A total of around 45,000 households received a 50kg bag of maize and around 41,000 children received a 10kg bag of Likuni Phala. Village relief committees were set up and community targeting completed.

Follow up nutritional surveys were conducted in March 2002, which indicated that the nutritional status of the under-five children had deteriorated substantially particularly in Salima: GAM increased from 9.3% to 19% (see table 1 below). Over a ten-week period the malnutrition rate had doubled.

This led to a further two-month food distribution funded by DFID planned for May/June targeting 45% of the population. A blanket supplementary food (Likuni Phala) was included as part of the general ration - increasing the ration size to 20kgs per household assuming that there were at least two individuals either under five or pregnant/lactating women.

Mothers and children awaiting assesment in Malawi

The second distribution was planned for May/June when the main staple had already been harvested. A no cost extension was agreed to this programme by DFID until end of December 2002 as by this time other players were also distributing some food. By June 2002 the JEFAP (Joint Emergency Food Aid Programme) had also kicked in with distributions. JEFAP consisted of a consortium of NGOs with Care International the lead agency, and the UN (mainly WFP) importing and distributing food countrywide.

The nutritional status was improving with GAM in Salima down from 19% in March 2002 to 8.1% in June 2002, and in Mchinji it had reduced from 12.5% in March to 5.6% in June. There was a further significant reduction in malnutrition rates in September 2002.

Results and conclusions of the General Ration Distribution:

Table 1: Results of Nutrition Surveys
  Salima Mchinji
  GAM SAM GAM SAM
December 2001 9.3 % 4.8 % 11.8 % 3.8 %
March 2002 19 % 6 % 12.5 % 3.6 %
June 2002 8.1 % 2.0 % 5.6 % 1.6 %
September 2002 3.8 % 0.7 % 3.0 % 2.4 %
December 2002 2.1 % 0.1 % 2.9 % 1 %

Selective Feeding Programmes:

The treatment of moderate and severe malnutrition with targeted feeding programmes was far less successful. Historically, Malawi treats malnutrition in Nutrition Rehabilitation Units (NRUs) attached to health centres and hospitals. The tool for measuring malnutrition in Malawi has historically been weight/age - a measure of chronic malnutrition which is best addressed through longer-term food security/community based interventions. Therefore success rate in these NRUs was pretty awful with high defaulter rates and no proper guidelines. The food pipeline was not always reliable. A similar situation prevailed for treatment of moderate malnutrition conducted at MCH clinic level.

There was little capacity within the NGO or UN communities to address these issues. In early 2002 nutrition task force meetings were instigated. It was recognised that guidelines were fundamental to improving the treatment of acute malnutrition. By August 2002 Malawi draft guidelines for the treatment of moderate and severe acute malnutrition were developed, with support from two external consultants, funded by Unicef. This was a major accomplishment.

SCUK feeding programmes

The records for the supplementary and therapeutic feeding programmes are extremely poor; therefore it was very difficult to analyse coverage of the programme and its impact on reducing malnutrition. It is also difficult to try to understand why the programme was so slow in starting up. From one report, (nutritionist hand-over notes August 2002) it appears that the SFP started in May-June 2002. This is after the hunger gap and not timely. By August SFPs were functioning in 9 centres in Salima and 4 in Mchinji. Data on admissions and discharges and numbers in the different centres in Salima from September 2002 to January 2003 were poor. The figures do not tally indicating poor data collection. The records were substantially better in Salima than in Mchinji.

There are some better statistics from May to August 2003 in both Salima and Mchinji. From the Co-Guard report it appeared that coverage in Salima district was 20-32%, cure rates less than 20% and default rates 70-80%. In Mchinji coverage was higher at around 60%, cure rates around 55% and default rates approximately 30%. These are well below Sphere minimum standards.

With the limited data it is not possible to know overall recovery, length of stay or what weight gains were achieved. It appears that SCUK stopped the SFP in Jan/Feb 2003, as records are only available again in May 2003, under Co- Guard. It is difficult to understand why the SFP was stopped or not functioning properly during this period as this was the 'hunger gap' and there appeared to be funding through the DEC.

Staffing levels was most likely the main constraint. Although there was an international nutritionist during most of the programme period, this person supported two districts and was also involved in national guidelines, technical meetings etc. National technical staff were not recruited until late 2002 up to May 2003. Once these staff were recruited record keeping and reporting certainly improved.

In August/September 2002 a consortium was established with 10 NGO's to co-ordinate and support supplementary feeding programmes. There was an extension to Co-Guard in the form of Co-Guard Two for a further period. However SCUK pulled out of the consortium on the main grounds that the SFP focus was changing to a community based approach, which would be quite different to what was being implemented under the Malawi Nutrition Guidelines. SCUK used some of its final funding from the DEC to support SFP during the hunger gap Jan-March 2004. This was done through the provision of food to the clinics and distributions.

Results and Conclusions of Supplementary Feeding Programme:

Therapeutic Feeding Programmes:

SCUK provided technical and resource support to the NRUs. Again there are little data on the therapeutic feeding programme apart from records of numbers of admissions and discharges over the period of 2002-2003 in a number of NRUs (Mchinji at Kapiri Hospital, Kochilia and Mchinji hospitals). These three hospitals were visited during this evaluation and staff involved in treatment of malnutrition interviewed. There was adherence to guidelines, drug protocols and feeding schedules. The Multi charts for documenting daily activities were also being used. Staff were very positive about the new guidelines. They felt that cure rates and recovery time had improved substantially. In general, children were in phase 1 for 3-4 days. In Kapiri it was felt that the burden of HIV/AIDs was affecting treatment. With increasing numbers of children HIV positive, more expensive antibiotics were required to treat infections. In all cases eight feeds of milk were given in phase 1, and there was general consensus that the F75 and F100 milks had made it much easier to treat malnutrition. It was much easier to make up feeds as there was no need to cook the milk. This was particularly useful overnight. The results were similar when Mua and Salima Hospitals were visited in Salima district.

Results and comments on Treatment of Severe Malnutrition:

Summary conclusions:

For further information contact; Frances Mason at; F.Mason@savethechildren.org.uk

More like this

FEX: Malawi food shortage: how did it happen and could it have been prevented?

By Sarah King Sarah King is currently working as an Emergency Capacity Building Officer with Christian Aid. Having completed a MSc in Public Health Nutrition at LSHTM, she...

FEX: Evolution of a Crisis: a Save the Children UK perspective

By Mark Wright Mark Wright was the Save the Children Programme Officer for Southern Africa from November 2000 to November 2002. This article details Save the Children UK's...

FEX: Integrating CTC in health care delivery systems in Malawi (Special Supplement 2)

By Kate Sadler & Tanya Khara (Valid International), Alem Abay (Concern Malawi) In February 2002, the Malawi government declared a national nutritional emergency and the UN...

FEX: Case Studies (Special Supplement 2)

3.1 CTC in Ethiopia- Working from CTC Principles Isolated village in the highlands of South Wollo, Ethiopia. By Kate Golden (Concern Ethiopia) and Tanya Khara (Valid...

FEX: Capacity Building in Times of Emergency: Experiences From Malawi

By Claire de Menezes Claire de Menezes is a paediatric nurse specialising in infectious disease. Having spent 16 months working in Sudan with Action Contre la Faim and one...

FEX: Comparative Experiences of Community Managed Targeting in Tanzania, Zimbabwe and Malawi

Monitoring food distribution in Zimbabwe Summary of an evaluation by Save the Children UK and Tulane University reviewing their experiences of utilising the Community Managed...

FEX: Impact of HIV/Aids on Acute Malnutrition in Malawi

By Susan Thurstans, AAH and Mary Corbett, ENN Susan Thurstans is HIV Adviser with Action Against Hunger, based in Malawi This article developed from an interview by Mary...

FEX: Evolution of GOAL Activities in Malawi

By Andy Nicholson Andy Nicholson is currently Country Director of GOAL in Malawi. He has been in Africa since 1990 working mainly in emergencies in Sierra Leone, Liberia,...

FEX: Introduction (Special Supplement 2)

Glossary ACF Action Contre la Faim CHA Community Health Assistant CHAM Christian Health Association of Malawi CNW Community Nutrition Worker CTC Community Therapeutic...

FEX: CTC Approach (Special Supplement 2)

by Steve Collins (Valid International) 2.1 Main principles of CTC Community Therapeutic Care (CTC) is a community-based model for delivering care to malnourished people. CTC...

FEX: References for Special Supplement 1

Women selling food in South Sudan AbuSaleh A, 1993. Cost effectiveness of feeding programs in Hartisheik A camp, for Somali refugees, Ethiopia 1988-1989. Unpublished report...

FEX: Home-Based Therapy With RUTF In Malawi

By Dr. Mark Manary and Heidi Sandige Dr. Mark Manary is an Associate Professor of Paediatrics at Washington University School of Medicine and Lecturer at Malawi School of...

FEX: Impact of local RUTF manufacture on farmers’ incomes in Malawi

By Marta Ortiz Nunez Marta Ortiz Nunez is a recent Masters graduate in International Development. In 2006 she co-founded a Spanish non-governmental organization focusing on...

FEX: Outpatient therapeutic programme (OTP): an evaluation of a new SC UK venture in North Darfur, Sudan (2001)

Summary of internal evaluation1 by Anna Taylor (headquarters nutrition advisor for SC UK) North Darfur experienced a severe drought in 1999 and 2000. This caused widespread...

FEX: Estimating the Target Under Five Population for Feeding Programmes in Emergencies

By Anna Taylor Anna Taylor has been the nutritional advisor for Save the Children UK for a number of years. She has recently taken up a new post of Head of Basic Services in...

FEX: CTC in North Darfur, North Sudan: challenges of implementation (Special Supplement 2)

By Kate Sadler (Valid International) and Anna Taylor (SC-UK) People waiting at a clinic in Darfur, North Sudan. Child eating plumpynut® in Darfur, North Sudan. North Darfur...

FEX: Creating an enabling policy environment for effective CMAM implementation in Malawi

By Mr Sylvester Kathumba Mr Sylvester Kathumba is Principal Nutritionist with the Ministry of Health, Malawi. This article was authored by Mr Sylvester Kathumba with policy...

FEX: Community-based Approaches to Managing Severe Malnutrition

One nutrition worker's solution to childcare at a busy feeding distribution! A three day meeting was held in Dublin hosted by Concern and Valid International between 8-10th of...

FEX: Distributing food (Special Supplement 1)

Food may be distributed in many different ways but the method of distribution will, to a large extent, depend on the eligible groups and the method for identifying them....

Review of the efficacy and impact of emergency programmes

Donor: CIDA Collaborators: SCUK and Westminster University ENN Project Lead: Jeremy Shoham Timeframe: Project completed in 2011 Background This project was undertaken in...

Close

Reference this page

Evaluation of SCUK Emergency Nutrition Intervention in Malawi During 2002-2003. Field Exchange 24, March 2005. p19. www.ennonline.net/fex/24/scuk

(ENN_2419)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.