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Role play as part of the programme in Mukaram P Acharya/WFP, Sudan Field Article Improving blanket supplementary feeding programme (BSFP) efficiency in Sudan By Pushpa Acharya and Eric Kenefick Pushpa Acharya is currently working as Head of Nutrition for the World Food Programme in Sudan. She has a PhD in Human Nutrition from the University of Massachusetts. She has over 21 years of professional experiences with national governments and UN agencies. Prevalence of acute malnutrition across Sudan is high and ranges from 11 to 29% 1 . Specific causes of acute malnutrition are largely unknown. High rates are observed during both nonlean and lean seasons. Major efforts are being exerted by the Ministry of Health and humanitarian aid agencies to treat malnourished children with therapeutic programmes implemented through approaches involving in particular community based management of acute malnutrition (CMAM), in-patient care, and targeted supplementary feeding programmes. Additionally, in areas with higher acute malnutrition rates, blanket supplementary feeding programmes (BSFP) are implemented during lean seasons as a preventive approach. In spite of all these programmes, repeated survey results show that acute malnutrition rates remain unabated (see map). Pilot to improve BSFP performance In 2010, WFP’s targeted supplementary feeding programme (SFP) aimed at treating moderately malnourished children reached over 200,000 children. In addition, 415,000 children aged 6-59 months were reached through a BSFP aimed at preventing the usual peak of acute malnutrition observed during lean seasons in Darfur. While the targeted SFP met the SPHERE standard for all performance indicators across Sudan, 2009 programme monitoring data of the BSFP led to questions about its efficiency in reducing rates of acute malnutrition usually observed during lean seasons. In order to improve efficiency of the BSFP in Sudan, means of improving performance of the programme were explored. A pilot was designed and implemented in one area in Kassala State. Kassala was selected because of WFP’s preexisting SFP programme, presence of a WFP nutritionist and the relative safety and accessibility of the area compared to Darfur and other areas of conflicts. The pilot programme began in March 2010 and is continuing until end of 2011. Nutritional and programming context Prior to the pilot, GAM prevalence rates in Kassala were usually high and similar to that seen in Darfur (19.2% SHHS 2006, 15% SMoH 2009, 16.7% SHHS 2010). Mukaram, one of the shanty towns on the outskirts of Kassala town, was selected for the pilot by the State Ministry of Health (SMoH). The area is one of the poor neighbourhoods of Kassala and is situated relatively near to the main town and hence easier for SMoH staff to monitor. Prior to the pilot study, mid upper arm circumference (MUAC) measurements of all children in the catch- 1 Sudan Household Health Survey 2010 Eric Kenefick is current Head of Programme for WFP in Sudan. He has spent the past 15 years working or WFP and UNICEF in vulnerability analysis and M&E. He is a graduate of Tulane University’s School of Public Health and Tropical Medicine. The project is implemented by the State Ministry of Health. The commitments of the Director of Nutrition Ms Sit Eldat Ahmed Al, and Ms Khalda Khalafalla – WFP Kassala, were critical in the smooth functioning and success of the programme. Dr Amal Abdalla – WFP Sudan – coordinated the project and provided the technical guidance without which the intended results would not have been achieved. Map 1: Prevalence of acute malnutrition in Sudan Boundaries shown on this map do not imply official endorsement or acceptance by the United Nations World Food Programme. This map is for planning purpose only. WFP can not guarantee that this map product is error free and therefore we accept no liability or consequential and indirect damages arising from use of this map product. Data Sources: VAM Unit: WFP Sudan Sudan Boundaries: Sudan Interagency Mapping (SIM) Table 1: Number of children under 5 years enrolled in SFP in two PHCs, Mukaram, Kassala, 2009 Month Number of children January 137 February 125 March 20 April 208 May 227 June 200 July 156 August 106 September 129 October 145 November 55 December 90 59
Field Article ment areas of these two Primary Heath Care Centres (PHC) confirmed a high prevalence of acute malnutrition where 15.5% of the children had MUAC below 125 mm 2 . There were and remain two Supplementary Feeding Programme (SFP) centres located in the area within the PHC. The catchment area of the two centres was estimated to have a population of 10,000 people with 1,500 children under five years of age. These centres usually saw high numbers of children with moderate acute malnutrition (MAM) enrolled in the SFP programme throughout the year. The admission numbers for MAM cases in 2009 for the two SFP centres in Mukuram can be seen in Table 1. Very high numbers of admission were seen at the SFP centres located in Mukaram in March 2010 at the start of the pilot. This may have been due to intensive communication with the community prior to the start of the pilot combined with the provision of a blanket food ration, thereby attracting greater numbers of MAM children into the Mukaram catchment area. Figure 1 shows the trend in admission of malnourished children from January 2009 to December 2010 in ten SFP centres in Kassala, including those in Mukaram. This is presented as a percentage of MAM cases enrolled in the SFP relative to the estimated number of children under five in the catchment area of each of the centres (15% of the catchment population). The the coverage of SFP in the catchment areas is unknown. Seasonal trends are observed with higher prevalence rates during the lean season (May – Sept) 3 and lower rates during the postharvest season (Oct-Dec). The coverage of the SFP in Kassala is unknown 4 . Pilot intervention design The design of the pilot study included intensive community engagement and sensitisation. A community club was established in each of the health centres. The clubs were equipped with cooking facilities for recipe development/trials, toys to entertain children while their mothers participated in discussions, and other essential resources. These facilitated participation of women in the discussion/awareness sessions held in the clubs twice a week. Prior to the establishment of the clubs, meetings were held with the community elders to sensitise them to the objective of the programme and also to identify and select community change agents. The tasks of the ‘community change agents’ (the frontline workers of the intervention) included support to the MoH staff in growth monitoring of the children enrolled in the BSFP, keeping children entertained during the club Table 2: Nutrition status of children enrolled in the BSFP pilot Month Total number of children
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