SOMALI NUTRITION STRATEGY 2011 – 2013 - ReliefWeb

As highlighted in the situation analysis young child feeding practices in Somalia tend to be
inadequate, with only one in ten children being appropriately fed. Energy density of complementary
feeds is low and diet diversity poor. A recent review of 42 efficacy trials and effectiveness studies on
complementary feeding interventions concluded that carefully designed programmes that include
pre-tested educational messages provided through multiple channels had an effect in improving
complementary feeding. A greater impact was seen when animal-source foods were specifically
promoted in the messages or when food supplements were provided as well. Educational strategies
should focus on imparting the knowledge and develop skills to maximise use of locally-available,
high-quality foods, as well as food safety, cultural beliefs and intra-family food distribution. As
recommended in the review, this strategy aims to deliver nutrition counselling through multiple
channels, individual, community and mass media integrated into the programmes that reach mothers
and children ie nutrition programmes, schools, community based initiatives and MCH and outreach
services. The integration of support for IYCF into the CMAM approach, piloted in Sierra Leone and
Zimbabwe by UNICEF & Save the Children UK may be a useful model to adapt to Somalia.
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Outcome 4 Improved availability and coverage of micronutrients and de-worming
interventions to the population
Micronutrient malnutrition has wide-ranging effects on health, learning ability and productivity and
has high social and public costs leading to reduced work capacity due to high rates of illness
and disability. As highlighted in the situational analysis, prevalence of both nutritional anaemia and
vitamin A deficiency in women and children in all three zones of Somalia are above WHO thresholds
for the classification of a severe situation.
There are different approaches to preventing micronutrient malnutrition. The best way is to ensure the
consumption of a balanced diet but this requires universal access to adequate food and appropriate
dietary habits, neither of which reflect the current scenario in Somalia, and both of which are
complex and long term issues to address. In the shorter term, micronutrient supplementation and
food fortification and deworming have been proven both highly effective and low cost interventions.
With their high benefit to cost ratio, these interventions have been identified as among the top ten
cost-effective solutions to global challenges (Copenhagen Consensus 2008).
In Somalia, bi annual vitamin A supplementation and deworming are currently key components
of child health days, multiple micronutrient supplementation for pregnant and lactating women
is available through MCH. Activities identified in this strategy aim to strengthen these existing
interventions and to develop new approaches to increase coverage through novel population based
strategies eg through schools and nutrition programme beneficiaries.
Another novel approach identified in this strategy is the fortification of food, in particular cereal
flours. Food fortification is able to deliver nutrients to the population without requiring changes in
food consumption patterns. It is usually socially acceptable, requires no change in food habits, can
produce nutritional benefits for the target population quickly and is a safe, cost-effective way of
reaching large target populations (WHO FAO Guidelines on Food Fortification with Micronutrients
2006). Also food fortification can provide nutrients that are not obtainable in sufficient doses from
local foods, such as folic acid for the prevention of birth defects. This new area for Somalia will
require preliminary work before going to scale. With nearly half the population receiving humanitarian
food assistance, the fortification of grains distributed through the general food ration is a priority.
Furthermore as even in a good year, Somalia imports 60% of its cereal requirement, fortification
of imported cereal flours presents an important vehicle for improving the micronutrient intake of a
significant proportion of the population. Fortification of flour at the community level may be a useful
approach in low access areas.