The One Health Concept; Applied in nutrition sensitive
interventions
VÉTÉRINAIRESSANS FRONTIÈRESSUISSE
Nutrition-sensitive livestock-based emergency interventions in
Ethiopia
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Lensse Gobu (BSc, MPH)Tropentag , September 19, 2018
Outline of the Presentation
� Background- Context� Nutrition sensitive interventions- experience
of VSF-Suisse in Ethiopia� EVSP as a showcase� Lessons learnt
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Background- Ethiopia (2017)
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Population• 94.3 million (100+
according to UN)• Annual growth rate of 2.3%
- 12% are pastoralists
Geography• It is the 27th largest country in the world• 11 administrative regions• Pastoralists live in parts of 4 of the regions
Service • 2.6 health service provider (all level)
for 1000 population
The current challenge in pastoral areas of Ethiopia
• Inadequate access to services• Inadequate institutional capacity• Vulnerability due to recurrent droughts• Inadequate infrastructure• Increased competition for resource and associated
conflicts
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Somali Region of Ethiopia• One of the 11 Regions of Ethiopia- 5 m population• Stunting (chronic malnutrition) prevalence is 27.4%
(National- 38.4%)• Wasting (acute malnutrition)- 22.7% (the highest from all
regions) National- 10%• The highest prevalence of anaemia in children -82.6%
(national prevalence- 56%).• The highest prevalence of severe anaemia in children-
12.8% (national prevalence- 2.9%)• The highest prevalence of anaemia in women - 59%
(national prevalence- 23%)
Source: EDHS 2016
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VSF-Suisse and Its Nutrition Sensitive interventions in Ethiopia
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Trajectory of one-health implementation-in VSF-CH in Ethiopia
Nutrition-based livestock offtake project; 2012
EVSP-Emergency veterinary support programme; 2013
NEVSP- Nutrition based emergency Veterinary support program in Siti Zone; 2015/16
BCIN- Behavioral Change for improved Nutrition; 2015-16
Different one health initiatives integrated to RESET project; 2017-2019
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Nutrition based livestock off-take
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� 5 kgs of camel meat per household per week for 12 consecutive weeks.
� Households severely affected by drought-induced emergency nutrition situation-with malnourished children < five were targeted.
� These interventions improved the availability of animal derived protein in the targeted households
� Implemented in severe drought scenario
Implemented in three projects in Somali Region
1. UN/OCHA financed project in Gode and Hargele Districts-2012
2. SDC financed and UN/OCHA co-financed project in Siti Zone-2015- 2016
3. SDC financed project in Warder Zone- 2017/2018
Milking goats distribution
• Implemented in 2 rounds:– Kebriderhar and Shilabo
Districts– Nogob and Jarar Zones
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� Fresh goat milk � Households with malnourished children < five� Recently been discharged from therapeutic
feeding centers
The intervention
• 9 goats/HH with a package ofvoucher-based veterinaryservices
• Locally available and culturallyappropriate nutrient densefood.
• Implemented in scenarioswhere there is some pasture
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Effects….
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Improvement of the family food basket
Cash injection to the local economy through the sale of meat and milking goats
EVSP as a showcase
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Project details of the EVSP Name of the project Emergency Community Veterinary Support Program
to Mitigate Drought in Korahe Zone Through Improved Food and Nutritional Security (EVSP)
Duration October 2012- April 2013
Core activities • Community-based livestock service interventions,
• Emergency animal health treatment based on vouchers
• Milking goats distribution
Donor UN/OCHA- HRF
Targets of the project • 760,000 livestock of poor households (6,000HHs)
• 50 households hosting children in emergency nutrition services specifically targeted for milking goats distribution.
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Why milk?• Animal milk -an important component ofpastoralist diets across the world (Sadler, Kervenet al. 2010).
• A nutrient-dense food known to contribute ahigh proportion of the nutrients, such as highquality protein and micronutrients.
• A need to improve availability of milk for youngchildren of drought affected vulnerablecommunity members in program targetedareas.
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Why milking goats?
• Contributes to asset building• More sustainable source of food• Safer than collecting the milk from market(avoids spoilage during handling, storage andtransportation of the milk)
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Why 9 goats per HH? 1. Milking Performance of Ethiopian Goats (in Somali)
– Daily milk yield:- 0.5-2.0 Liters/Day (assumed an average of 1.25 Lt/Day
– Lactation length:- 80-200 Days (assumed an average of 160 days in milk)
2. How much milk is needed to supplement a child?– Daily milk-based diet recommended for children under 5 years of age is 360-
480ml/Day (an average of 420) for healthy and nutritious life.
3. How much milk is needed for one household?Assumptions:
– 4 children per household
– 4 children X 0.42 Lt/day = 1.68 Lts;
4. How many goats can provide this volume of milk daily?– A best goat can give 1.25 Lts/ day, two milking goats can give 2.5 Lts/ Day which is
sufficient for about 5 children.
– The least producing goat yielding only 0.5 Liters of milk per day- we need 4milking goats per household to feed 4 children.
– 4 milking goats with their kids- 9 m17
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MUAC for ageAssessed using WHO Anthro for PC software
MUAC for age before intervention MUAC for age after the intervention
Age
groups
N MUAC-for-age (%)
% < -3SD % <-2SD Mean SD
(6-11) 5 80 80 -3.33 0.86
(12-23) 15 46.7 73.3 -2.55 1.26
(24-35) 28 75 96.4 -3.43 0.82
(36-47) 15 66.7 93.3 -3.42 0.93
(48-60) 24 33.3 66.7 -2.74 1.18
Total: 88 56.8 81.8 -3.06 1.1
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Age
groups
N Mid-upper arm circumference-for-age
(%)% < -3SD % < -2SD Mean SD
(6-11) 0
(12-23) 13 7.7 38.5 -1.42 1.29
(24-35) 17 5.9 47.1 -1.9 0.72
(36-47) 19 10.5 52.6 -2.08 0.87
(48-60) 16 25 50 -2.29 0.82
Total: 65 12.3 47.7 -1.95 0.95
Number of food groups consumed in a day
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3 4 5 6 7% at Baseline 2.2 61.5 28.6 5.5 2.2% at intervention 1.5 21.5 53.9 21.5 1.5
0
10
20
30
40
50
60Pe
rcen
tage
of
Hou
seho
lds
Household Dietary Diversity Score
Other outcomes of the project
• Feeding practices– % of HHs giving pure goat milk to their childrenincreased from 17.3% at baseline to 50% atintervention.
– A two-fold increase (from 20% at baseline to41%) in the % of HHs giving milk with tea for theiraffected children as ‘special’.
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Other outcomes, …..cont’d
• Livelihoods– The mean monthly income has increased from880 birr to 1,380 birr indicating an increasingtrend in income among the beneficiaries in theintervention period.
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Other outcomes….
• KII with the father of one of thebeneficiaries
“I was ‘Faramaal’ (flexing muscles) before I got the milkinggoat. Men from poor households like me water more than100 camels of the better-off families from 10-15 m depthwells by lifting 20 liter of water per minute for 8 consecutivehours per day in exchange of 3 liters milk for free or for lowerprice. We then used this milk to feed our needy children.”
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• Another beneficiary mentioned theunintended effect of this intervention onthe families as:
“After you have given us the milking goats wegot trust from others. People started givingus credit from shops, which means that webecame part of the community.”
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• However, None of the mothers werebreastfeeding at the end of the intervention
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• Nutrition sensitive interventions needed tobe coupled with tailored BCC interventions toimprove the nutritional status.
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The BCIN study
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The learning continued……
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One health for integrated service delivery for pastoral areas?
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The challenge-access to services
• Inadequate healthservices– Only 62% of women
access ANC (51 % inSomali Region)
– 26% of deliveries arein health institutions(18% in SomaliRegion)
– Immunizationcoverage for under 1is 39% (22% inSomali Region)
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Inadequate vet services• Less than 10% of
households report accessto vet services
• In Ethiopian SomaliRegional State as of 2015:– Only 1 regional lab in
Jijiga– 622 AH facilities (70%
are functional)– 5% reporting rate– 23% vaccine
distribution– 81,660 livestock per
clinic
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People
Livestock
Their environment
WHAT WE DO
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to promoteEnvironmental
Health
Our goal: Ensuring healthy people derive their livelihoods from healthy livestock in a sustainably managed environment.to support
AnimalHealth
to ensureHuman Health
Thank you!
Lensse Gobu: [email protected]