The five main sectors

nutrition

WASH

water, sanitation, & hygiene

child protection

education

health

(nutrition)

SUDAN

sector profiles (nutrition)

For a child, good nutrition begins at conception. This

is the start of the critical first 1,000

days, spanning from pregnancy to the child’s second birthday. Proper nutrition of the mother during pregnancy is essential. Then for the first six months a baby should have only breastmilk, followed by the timely introduction of nutritious complementary foods while continuting to breastfeed to the age of two. These practices lay the foundation for a healthy childhood. Without them, a child may not grow properly and can become malnourished.

In measuring malnutrition across countries, Sudan ranks as one of the worst in the world. Beyond the immediate danger, the lingering physical and developmental effects of malnourishment can doom a child to a lifetime of complications. The effects are irreversible.

Over 2 million children under the age of five here suffer from inadequate growth. These children are termed ‘stunted’. A stunted child in Sudan is more likely to die from disease, and more likely to perform poorly in school.

The result is lower learning and eventually lower income potential, and a tightening of the grip of poverty on the child and his family.

Beyond stunting, over half a million children here have severe acute malnutrition; they are at risk of death.

Behind the malnutrition figuresThe factors behind Sudan’s malnutrition are many: giving only breastmilk during a baby’s first six months is not common; children are more likely to use the outdoors for a toilet—open defecation—than a proper toilet; access to water and handwashing with soap is limited, resulting in deadly diseases such as diarrhea; and very young mothers are more likely to deliver low weight babies.

One-third of children in Sudan are stunted—low height for age—and 1 in 10 mothers here are malnourished. Why?

There are many contributors, the expected and the complex, to chronic under-nutrition in Sudan. It’s difficult to plant crops in the midst of conflict, and idle fields don’t put food on the table. The annual ‘hunger gap’—the four months or so from May to September—occurs when weather and food levels are particularly tough on families. Bumper harvests help to bridge this gap, but conflict and increasingly unpredictable rain patterns can make this time of year dangerous. Food prices are also relatively high so regular meals are out of reach for many poor families.

The health of a child begins with the health of the mother. In Sudan a baby’s health can be at risk because of early marriage. If the mother is still a girl her body requires nutrients to finish growing. A growing fetus also has nutritional needs. This means the pregnant girl and her unborn baby

In measuring malnutrition across countries, Sudan ranks as one of

the worst in the world.

Nutrition in Sudan

are competing for nutrients. This competition for limited nutrients is one of the reasons why nearly 1/3 of babies in Sudan are born underweight and undernourished, and why 1 in 10 mothers are malnourished.

Misinformation can also contribute to malnutrition here. Exclusive breastfeeding for the first six months is critically important to a child surviving and thriving. But there is a belief amongst mothers in Sudan that breastmilk turns bad once women become pregnant, so it should no longer be used to feed young children.

Each year UNICEF treats more than 130,000 children, aged 6 months to five years, for severe acute

malnutrition.

Nearly 1/3 of babies in Sudan are born underweight and undernourished

In Sudan more than two million

children under the age of five are malnourished

A stunted child in Sudan is more likely to die from disease, and more likely to perform poorly in school. The result is

lower learning and eventually lower income potential, and a tightening of the grip of

poverty on the child and his family.

What UNICEFSudan is doing UNICEF is the sector lead for Nutrition in Sudan’s humanitarian community. In that position we are able to influence both Government and partners and make a serious difference on the ground.

This can be seen in our work with CMAM, or Community Management of Acute Malnutrition. This approach is the international gold standard for assessing and treating severe malnutrition at community level—importantly to enable a community to manage this work on its own. UNICEF introduced CMAM into Darfur and based on its success there the Government of Sudan adopted it as the model for the country.

UNICEF supports 881 feeding centers in 15 of Sudan’s 18 states. At these centers we treat more than 130,000

UNICEF supports a total of 893 feeding centers in 15 of the country’s

18 states.

children, aged six months to five years, for severe acute malnutrition. For pregnant and lactating mothers we do micro-nutrient supplmentation, and breastfeeding support to prevent under-lnutrition.

While Community Management of Acute Malnutrition continues to be an essential lifesaving approach in many areas of Sudan, we also acknowledge that it’s about treatment. For the long-term, for the development of Sudan’s children, the focus must be on preventing malnutrition and pushing best practices and behaviors in food and health. We are working with the Government

that 130 of the total 184 localities have a stunting rate classified as high: above 30 percent. And 54 localities have a severe acute malnutrition rate—determined by measuring the circumference of a child’s upper arm—classified as very critical: above three percent.

By going below the state level in UNICEF’s push for local data we can see the stark differences between Sudan’s states and be more cost-effective and lifesaving in our work.From better information we also learned that malnutrition is a serious problem in Sudan’s non-conflict states. Even in the capital Khartoum under-nutrition is a major threat to

Armed now with better information, we are using our unmatched influence to push for improved coordination and

integrated service delivery.

on these issues and, thanks to UNICEF efforts, Sudan endorsed national Infant and Youth Child Feeding guidelines.

In addition to advocating for child-friendly policies, we are leveraging our leadership and expertise to better understand the nutrition situation at the local level. State level survey information can be helpful in painting the national picture, but in Sudan state level estimates mask huge disparities. A closer view is required to really learn what is going on.

Nutrition data for decision-makingFor more precise data we supported a survey that provides evidence of the local situation on nutrition, health, water and sanitation, and a family’s ability to access enough healthy food. We knew that more than two million children in Sudan are stunted, unlikely to fully grow and develop; with this survey we know where they live. We can now be smarter with where and how we focus resources to fight malnutrition.

Sudan is made up of 18 states and 184 localities (sub-state administrative divisions). Survey results revealed

families (population density, limited access to safe water, high food prices—amongst other things). The Government of Sudan has stepped up its acknowledgment of the crisis and commitment to manlutrition as a national priority. UNICEF and the Government convened the first-ever donor meeting on Nutrition to formally share the results.

Survey data were presented at locality level, and at central level it continues to shape planning and policies: for re-targeting the national Maternal and Child Health Acceleration Plan, to review the Humanitarian Needs Overview, and as a basis for scaling up the national CMAM strategy.

UNICEF Sudan, in partnership with the Federal Ministry of Health, also helped to develop and strengthen a Nutrition Surveillance System. This system includes a national database for all surveys and feeding center data, routine bi-monthly surveys, and the annual Sudan Health Bulletin. Because of UNICEF’s relationship with Government we serve as a knowledge broker on children’s issues. Armed now with better information, we are using our unmatched influence to push for improved coordination and integrated service delivery.

Plumpy’NutPlumpy’Nut is a peanut-based paste designed for emergency malnutrition cases, a convenient source of fats, fiber and essential vitamins and minerals. It has a two-year shelf life and makes sense in place like Sudan because it requires no water or refrigeration. Because of UNICEF’s lobbying efforts local production of Plumpy’Nut began in 2011 and the Government of Sudan recently invested USD eight (8) million for the procurement of Plumpy’Nut.

In addition to advocacy with the Government, UNICEF is collaborating with the local manufacturer to strengthen and lengthen the supply chain with warehouses in three Darfur states and the states of South Kordofan and Khartoum.

Current local Plumpy’Nut production capacity is 25,000 cartons per month—3.75 million individual servings.

Current local Plumpy’Nut production capacity is 25,000 cartons per month, 3.75 million individual servings.

(nutrition success story)

Abu Shouk, North Darfur. Beneath the shade of a large canvas tent in a North Darfur refugee camp, several mothers lie on hospital beds with their poorly, unsmiling children. Some sleep with their toddlers under half-draped mosquito nets; others are awake and keeping vigil, waiting for their boys or girls to find strength.

On one of the ward’s steel beds, Kaltouma Mohamed Adam is sat with her 18-month-old son Rami—a tiny child with wide, staring eyes and a glum expression.Kaltouma arrived in the refugee camp about one month ago. She doesn’t know her age, but looks about 16 years old. As she talks, Rami sits cross-legged on the bed next to her, clinging on to her left thigh as though he is worried he will fall off.

“I came to the clinic 14 days ago,” she said. “Rami had a cough and a runny nose, and this is why I decided to bring him.”

She and Rami are at the UNICEF-supported nutritional programme in Abu Shouk, a refugee camp that is home to more than 100,000 internally displaced people in North Darfur.

“Rami wasn’t able to eat,” said Kaltouma. “So he was taken to a medical assistant. She examined him with a stethoscope, and then said that he was such a bad case that he needed to be admitted to the ward.”

The programme is an example of the ‘integrated approach’ to service provision that UNICEF believes can maximise results when it comes to child health and nutrition.

Integrating service deliveryThe centre at Abu Shouk offers a programme that mirrors the long-established approach of CMAM—Community Management of Acute Malnutrition.

A Package of Child Health and Nutrition in North Darfur

This multi-pronged initiative tackles child malnutrition through volunteer-led mobilisation and supplementary feeding programmes.

In addition, health and WASH (water, sanitation and hygiene) services are also provided, such as vaccinations and handwashing instruction. So when malnourished boys and girls are brought in for treatment, immunizers also check whether they are up to date with their polio jabs.

Or if they are queuing to have their weight monitored, mothers can at the same time receive lessons on the importance of children using proper latrines. It means that UNICEF-supported staff is able to maximise the chances of improving the welfare of children in the camp.

“If you don’t have integration there will be more complications for the children,” said Ahmed Mohamed Abdel-Hamid, a medical coordinator. When mothers are with their children in the ward, said Mr. Abdel-Hamid, then the nurses will also take time to show them how to wash or give them breast-feeding advice.

“In addition,” he said, “if a child has a bed sore then the nurses will be able to treat it with a dressing. Or if they have an unexplained fever, then we can send them to the laboratory here and see if we can diagnose it.”

Vaccinators are also on hand to check whether children are up to date with their immunizations, a particularly important service for malnourished children who are at greater risk of complications if they contract dangerous diseases such as measles or polio.

The perils of traditionIn the case of young Rami, he became malnourished partly as a result of his mother

falling prey to one of the biggest bugbears of nutritional workers in Sudan—the influence of ‘traditional’ medicine.

Kaltouma recently became pregnant for the second time, and consequently she stopped breast-feeding. She believed, like many mothers in Sudan, that breastmilk becomes bad once women become pregnant, and should not be used to feed young children. Rami soon fell ill, and later entered the programme at Abu Shouk.

A community approachLike all initiatives for the Community Management of Acute Malnutrition, the Abu Shouk programme uses three key components, all designed to enable the community to help tackle child malnutrition for themselves.

Firstly, there is community mobilisation, where volunteers are encouraged to reach out to families in the camp and try to identify boys and girls who might benefit from the service.

Second, there are the two nutritional programmes: Supplementary and Outpatient Therapeutic. The Supplementary provides food rations for children who are only moderately malnourished. For more severe cases, Outpatient Therapeutic offers home-based treatment for boys and girls—though only if they are suffering no additional maladies as a result of their malnutrition.

Lastly, for the minority of cases who need it, there is Inpatient Care for the most severely malnourished children who have also developed medical complications.

Rami fell into this final category and was admitted to the stabilisation centre ward. Initially he was fed on formula milk. Like other children on the ward, he was also weighed every day and assessed by the medical assistant.

After a successful ‘appetite test’—where health workers see whether new children want to eat food—he began eating Plumpy’Nut, a supplementary paste given to malnourished children. Rami gained weight and his prospects are looking much better.

“It was the first time he ever got sick,” said his mother, Kaltouma. “But I’m very happy now that his health is improving.”

Health and WASH services are also provided, such

as vaccinations and handwashing instruction. So when a malnourished girl

is brought in for treatment, immunizers also check whether she is up to date with her polio

jabs. Or when queuing for weight monitoring, her mother learns about using proper latrines. An integrated approach means that UNICEF-

supported staff at feeding centers maximise the chances of improving

her overall wellness.

Sudan by the numbers: under-nutrition

SUDAN