D. Nutrition

 

Coordinating agency: UNICEF, WHO

Government counterparts: Ministry of Health and Social Welfare; Ministry of Agriculture and Industry

Implementing Partners: National Nutrition Research Center.

Aimag level: Office of the Governor/Public Health Center. Soum level: Office of the Governor, Soum hospitals, IFCR, MRC, SCF (UK), WV1 and others to be specified.

Location of Initiative: All affected soums

 

D.1. Background and Context

 

According to the UNICEF supported national nutrition survey conducted in November 1999 by the Nutrition Research Center, it is estimated that 12.5%, 24.6%, and 3.7% of children under five were underweight, stunted, and suffering from wasting, respectively (less than 2 S.D.(standard deviations), according to NCHS-CDC-WHO standards). 8.44 percent of children under five exhibited severe stunting (Z-score < - 3 S.D.). It should also be noted that overall children in rural areas were 57% more likely to be stunted than those in cities.

 

The survey also revealed that 56.5% of children under-five and 71.1% of mothers in rural areas are suffering from anemia. 32% of all children under five suffer from rickets. Among children aged 8 – 11 years 21.3% suffer from iodine defficiency disorders.

 

Thus, the nutrition situation in Mongolia in November 1999 sets a stage for a significant escalation of malnutrition in affected areas. The situation was already fragile during the period the survey was conducted, because of the changes occurring in the social and economic environment of the country. A steady level of poverty, around 36% in 1995 and 1998, and an increase in extreme poverty, reported by the 1995 and 1998 Living Standard Measurement Survey (LSMS), raise serious concerns. Unless basic social services are protected and employment opportunities created, the deterioration in access and quality of those services will continue.

 

The recent dzud disaster, due to its magnitude and devastating effects on the life of the population in several aimags, its disruption of the food security mechanism, and its projected indirect effects on the overall economy of the country, may become the catalyst for a progressive sharp deterioration in the food security situation, and subsequently in the population’s nutritional status. Moreover, according to the November 1999 national survey, conducted just before the dzud, 26.4% and 9.4% of children under 5 were already stunted and severely stunted ( - 3 S.D.), respectively, in 3 of the affected aimags which were included in the survey sample.

 

Since 1992, the FAO has classified Mongolia as a Low Income Food Deficit country due to low net income per person, net importation of basic foodstuffs for three years or more, and lack of sufficient foreign exchange to purchase needed food on the international market. In Mongolia, food security is also contingent upon weather conditions and the difficulties of long distance transport, a major hindrance in domestic food distribution. Although the national average iodized salt consumption was 46.8% of households, in many remote regions, including significant areas affected by the disaster, less than 25% of households are consuming iodized salt. Coverage of women and children with other micronutrient supplement (Vit. A,D, and iron) remain low.

 

The 70% decline in domestic food production from 1991 to the present has created a dependency on imported food. The lack of cash in Mongolia’s rural areas raises serious questions about how the rural population procure food and other items even in normal times, let alone during the current emergency situation. The Mongolian diet is dominated by meat, dairy, and flour products. The return to livestock herding as a survival strategy since the transition began has increased the dependence on meat and milk. Although in 1979-1981 estimated dietary caloric intake was 2400 kcl/day/person and 82 grams of protein, by 1992-1994 the estimate had fallen to 1920 kcal/day/person and 66 grams of protein.

 

During the coming spring, the situation amongst the affected population is likely to become desperate, because of the depletion of winter food reserves of dry meat and dairy products, which are presently being consumed. Even if they overcome a difficult summer, herders and non-herders will not be able to prepare sufficient food reserves for next winter, because there will not be enough livestock to slaughter and because food prices will increase. A sharp decline in caloric and protein intake is foreseen unless remedial actions are taken. Malnutrition, especially among the poor (whose children are already 64% more likely to be underweight compared to those in the better-off households, according to the 1999 survey [RR=1.64, 95% C.L. 1.27-2.10]), will certainly rise. This situation will also increase the susceptability of children to infectious diseases due to the general undernourishment.

 

Food aid is foreseen for the most vulnerable segments of the population and is addressed in the food aid appeal once the WFP mission provides its assessment. Supplementary feeding, mostly through a protein enriched soybean mixture, high energy biscuits, and micronutritiont supplementation for infants, children under 5, and pregnant women in the most affected areas.

 

Severe scarcity of fluids, and therefore dehydration, is foreseen in the Gobi area, where the traditional sources of liquids in summer are milk and airag, the traditional drink of fermented mare’s milk. The issue of improving water supply is attended to elsewhere in the appeal.

 

D. 2 Objectives

 

To contribute to restoring adequate nutrition in affected areas occupied by 350,000 people. To prevent a sharp increase in malnutrition resulting from a sharp fall in protein intake, dietary imbalances, and inadequate intake of micronutrients, especially among children and women in affected areas. To provide immediate supplementary feeding to infants, children under 5, and pregant women based on identified needs. To improve monitoring of nutrition status among the affected population.

 

D.3 Strategy for Implementation

 

A general food aid component for the disaster-affected people will be forthcoming as soon as the WFP mission, who arrived in Mongolia in late March, has completed their assessment of food requirements.

A combination of growth monitoring and promotion activities including supplementary feeding, micronutrient supplementation and information-education –communication (IEC) will be implemented. The final design of the intervention will depend on a more detailed assessment now pending.

 

The program will achieve its objectives through the following strategies:

 

  1. Building on local, community and family capacity to restore food security.
  2. Building on already existing systems/networks (PHC and schools) to, for example, distribute supplementary food and essential micronutrients.
  3. Procuring items through already well-established cost-effective supplies (UNICEF warehouse in Copenhagen, regional networks, et al).
  4. Strenghtening outreach (feldshers) and establishing add-on services (for example, supplementary feeding in PHC) when needed.
  5. Promoting education on proper nutrition and care practices in households and facilities.
  6. Reinforcing growth monitoring and nutrition surveillance.
  7. Coordinating interventions among partners and with the government.
  8. Strenghtening collaboration with NGOs (IFCR – SCF UK, others).

 

Activities

 

1. Acute Emergency phase: April 00-September 00

  1. Conduct an immediate assessment of the vulnerabililty level of populations in affected aimags.
  2. Introduce supplementary feeding (soy bean mixture, high energy biscuits, etc.) for children under 5 and pregnant women during the near term.
  3. Strengthen micronutrient supplementation with emphasis on vitamin A (to prevent ARI and other diseases), vitamin D, iron folate and multivitamin (for pregnant women) and pediatric iron for infants and young children.
  4. Provide generically-labelled breastmilk substitutes for infants who cannot be breastfed due to failed lactation among malnourished mothers. (carefully controlled administration and education efforts will be undertaken in order not to affect current high breastfeeding rates in the country).
  5. Strengthen growth monitoring at the soum hospital level with involvement of communities and families.
  6. Utilize growth monitoring charts extensively for screening under-nutrition in children under 5.
  7. Strengthen community and family care capacity according to the UNICEF nutrition strategy.

 

2. Rehabilitation phase: May 00 to April 01

In addition to the above-mentioned activites:

  1. Establish routine mechanisms and make periodic re-assessements to monitor the effectiveness of inputs, complementary and unmet needs, household food security, and access to potable water supply.
  2. Encourage local authorities to utilise the information obtained immediately and introduce a systematic compiling and response system.
  3. Support local feeding programs for small children in hospitalas and kindergartens.

 

Target groups

 

Families with children under 5 and pregnant women. Disaster-affected people, including children under five, pregnant and lactating women, and boarding school children.

 

 

D.4. Budget for Implementation

 

Item

Unit Cost

US$

Total Cost

US$

High energy biscuits

0.80 x 25,000 packs

20,000

Soybean Protein Mixture

1.50 x 25,000 packs

37,500

Generically labelled breastmilk substitute

2.00 x 3,840 kg

7,680

Vit A supplements

8.90 x 500 bottles

4,450

Vit D supplements

2.87 x 800 bottles

2,296

Pediatric iron folate in liquid form

0.47 x 4,470 bottles

2,100

Multivitamin tabl. N1000

5.00 x 900 boxes

4,500

Iodized salt

0.30 x 8,900 kg

2,670

Basic kitchen equipment – hospitals/kindergarten

300.00 x 152 hospitals

45,600

Height measurement instrument

22.05 x 152 hospitals

3,352

Uniscale

82.80 x 3 x 152 hospitals

37,754

Supply subtotal

 

167,902

Freight (30%) express delivery

 

50,372

Growth monitoring/nutrition surveillance

200.00 x 152 hospitals

30,400

Workshop – rapid nutrition assessment

1,200.00 x 13 aimags

15,600

WHO manual on Nutritional assessment

25.00 x 149 hospitals

3,725

IEC activities through mass media

5,000.00

5,000

Distribution and monitoring costs

200.00

29,800

Total

 

303,000

 



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