WASH IN NUTRITION Session number 3 Caroline Abla

WASH IN NUTRITION Session number 3 Caroline Abla International Medical Corps 9 th October 2014

Background Armed groups occupied the regions of Timbuktu, Kidal and Gao in Mali between March 2012 through January 2013. Control was regained in January 2013

Background contd • Health system severely disrupted; displacement of health staff, looting of health facilities and high insecurity on the roads hindering both access to health facilities and quality of care • During conflict health and nutrition indicators were poor (DHS 2013); – Infant mortality 56/1000 – Under five mortality: 96/1000 • Rural areas: 113/1000 – National GAM prevalence 12. 7%, SAM prevalence 5. 1% – GAM prevalence in Timbuktu estimated at 16% (SMART 2011)

Programme details: IMC Mali • Programme activities started in Timbuktu and Gourma Rharous in April 2013 as emergency response • The objective was to reduce the prevalence of acute malnutrition via multi-sectoral interventions addressing the underlying causes of malnutrition Nutrition activities: CMAM and IYCF • 14 health facilities; – 2 Referral health centres – 12 health clinics • Direct beneficiaries: 15, 281 children under 5 and 3, 898 PLW Nutrition activities integrated with primary/secondary health care, reproductive health, WASH and GBV

Programme details contd • IMC integrated WASH activities within its CMAM program as follows: – distribution of WASH kits to caretaker of OTP beneficiaries (2 collapsible jerricans of 10 litres each, 1 bucket of 14 litres each, 7 soaps and 9 pads of 10 Aquatab tablets each. Soaps and Aquatab tablets was renewed every 4 weeks and at discharge, each child received supplies for 1 month) – hand washing and water purification demonstrations – ensuring availability of potable water at supported health facilities – Nutrition and WASH education

Key findings/experiences • GAM prevalence in Timbuktu decreased to 13. 3% (SMART August 2014) – A decrease of 2. 7% compared to GAM of 16% in 2011 • At national level an increase of 0. 6% from 12. 7% to 13. 3% (2013 – 2014)GAM prevalence 18 16 16 14. 8 GAM prevalence (%) 14 13. 3 12. 7 12 10 8 6 4 2 0 2011 2013 National Timbuktu 2014

Key findings/experiences contd • OTP defaulter rate 10. 4% from April till July • OTP defaulter rate 0. 0% from July till December • Coincides with the peak distribution of WASH kits

Conclusions & recommendations • Integrated WASH activities in CMAM contributes to prevent acute malnutrition and improves defaulter rate • Integrated implementation was not a major challenge despite emergency context • WASH is thus a key area which could maximize nutritional impact.

Discussion points • Morbidity data was not included in latest SMART survey but from observations number of diarrhoea cases has decreased – Prior to intervention incidence of diarrhoea was 5% in Timbuktu (SMART 2011) • Long term impact of integrated nutrition and WASH on stunting could not yet be determined