Volume 3 May, 2013

Impact of the Current Socio-Economic Situation on Children and Women in Malawi January-February 2013 Introduction Despite the Government’s effort to cushion the population from the impact of the current economic hardship through the scaling up of social protection measures as described in the Economic Recovery Plan, there are some signs of continued deterioration of the wellbeing of the population, especially the most vulnerable such as women and children living in poverty. This statement is based on the findings highlighted in the present sentinel monitoring report conducted in 12 districts covering the months of January and February 2013: - Maternal case fatality increased from 13 in November-December 2012 to 17 in January- February 2013. - The total number of children with severe acute malnutrition who are receiving Ready to Use Therapeutic Food (RUTF) increased in the Southern Region in January and February 2013 to 362 children from 292 children during the same period in 2012. - The total number of children with moderate acute malnutrition and who are under the supplementary food programme (SFP) has declined to 691

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in January and February 2013 from 727 children during the same period in 2012. This could be associated with some increased shortages of SFP supplies. Generally school attendance of children has decreased in January and February 2013 compared to the same period in 2012. Teachers attributed this to farming activities and/or food insecurity. Generally the number of crimes committed by children increased in January and February 2013 compared to last year. The total number of child victims of crimes is also on the rise.

The sentinel monitoring survey collects proxy indicators from administrative data in selected sites in different parts of the country in the fields of health, education, child protection and the economic environment. In addition, qualitative interviews are conducted with community key informants to investigate contextual reasons for changes. A total of 12 districts are monitored, namely Mzimba, Nkhata Bay and Karonga from the North, Dowa, Lilongwe and Salima from the Central and Machinga, Chiradzulu, Nsanje, Balaka, Phalombe and Neno from the South. Sentinel surveillance is conducted in 37 sites, selected based on differentiation of health facility by

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their remoteness in relation to the district centre. This brief report covers data for January and February in 2012 and 2013 and also reviews trends since June 2012.

Health and Nutrition Indicators monitored in the area of health and nutrition included the number of qualified health workers, reported births and deaths, drug availability and trends in child uptake of under nutrition programmes. Data is collected from 12 District Hospitals (DHOs) and 25 health centres.

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Key Findings: 1. Among the 33 health facilities with valid data, there is an increase in number of deliveries at health centres by 9% in January-February 2013 compared to same period in 2012 while the total number of skilled midwives declined by 9% from 575 in February 2012 to 524 in February 2013. Increased number of deliveries with smaller number of skilled staff may have posed a risk of deterioration of attention. 2. Maternal case fatality increased from 13 in November-December 2012 to 17 in January-February 2013, reported in a total of 36 health facilities. The total number of maternal deaths registered from June 2012 to February 2013 reached 18 cases at Lilongwe DHO, 12 at Machinga DHO and 10 at Mzimba DHO. 3. There is a declining trend in the total number of child deaths1 from 106 (from 12 health facilities) in January 2013 to 84 cases (from 11 1

Child death in this study referred to deaths of children under 5 years and excluding infant death of age below 12 months.

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health facilities) in February 2013. However, Balaka DHO had the highest increase in child deaths between January 2012 and January 2013 (from 14 to 20). Health workers interviewed attributed this situation to malaria and malnutrition. Infant deaths totaled 162 in JanuaryFebruary 2013. Salima DHO reported the highest increase in infant death, increasing from 43 deaths between November and February in 2011/12 to 55 deaths during the same period in 2012/13. The number of health facilities with malaria drug stock outs increased in past months (from 3 in November to 6 in February), with the average number of days of stock outs also on the rise (1.7 in November to 16.5 in February). Shortages of ARVs were reported at Lilongwe DHO and Makioni Health Centre in Salima. Lilongwe DHO had a complete stock out of ARV (Efavirenz) from November 2012 up to February 2013. Overall, the number of children receiving Ready to Use Therapeutic Foods (RUTF) to treat severe acute malnutrition has declined during January-February 2013 compared to the same period 2012 (580 and 540, respectively.) However, in the Southern region, the trend is the opposite. Among 14 facilities in the South with valid data, the number of children with severe acute malnutrition and receiving RUTF increased from 292 to 362. Among 21 health facilities with valid data, the number of children with moderate acute malnutrition receiving the Supplementary Food Programme (SFP) declined in January–February 2013 (691) compared to the same period in 2012 (727). This could be associated with the increase in stock outs of SFP supplies. Among the 15 health facilities with valid data ,the total number of stock out days of SFP supplies increased from

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77 days in January-February 2012 to 138 days in same months in 2013. Eight health facilities reported a complete stock out of SFP supplies in Jan 2013 (including all 3 health facilities in Nsanje.) 9. There was a general decline in the number of children admitted to Nutrition Rehabilitation Unit (NRU) for severe acute malnutrition. Among 13 health facilities with valid data, the total number declined from 539 in January-February 2012 to 357 in same period in 2013. Mzuzu HC and Salima DHO reported a complete stock out of therapeutic milks F75 and F100 in January and February 2013. 10. The major problems reported by health workers remains the shortage of drugs, lack of equipment and materials, and shortage of permanent staff. 11. The functionality of the referral system was also a problem. Figure 1: Functionality of Referral System (% of 36 facilities) 50 45 40 35 30 25 20 15 10 5 0

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average, 28% had also indicated that an ambulance to facilitate referrals was not available. Education Indicators monitored: The study focuses on school attendance for standards 2, 4 and 7 and teacher attendance on the 10th day of school each month. Key findings : 1. There is a general decline in student attendance in January-February in 2013 compared to the same period in 2012. 2. At Tchesamu Primary School in Nkhata Bay; observed attendance rate is only around 30% in all classes monitored for the 3 years. 3. For schools with low attendance rates, teachers attributed the problem to farming activities and/or food insecurity. 4. High teacher attendance rates were observed between January and February 2013 with the lowest rate of 64% at Mwanga School in Phalombe. 5. The main problems identified by various stakeholders (students teachers and parents) are lack of learning materials (from head teachers), inadequate salaries (from teachers) and parents complained about lack of learning materials and student absenteeism.

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Child Protection Indicators monitored: The study monitors the recorded number of cases of crimes by children, number of cases of child victims and number of abandoned children as recorded by 13 Victim Support Units (VSUs) in 12 districts.

About 23% of the health facilities described their referral system as not functional in January 2013 but this increased to 47% in February. On

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Key Findings: 1. Except Lilongwe, generally cases of crimes committed by children increased in January-February 2013 compared to the same period in 2012, from 119 to 167, respectively. 2. The total number of child victims increased from 148 in JanuaryFebruary 2012 to 172 in the same months in 2013. No clear trend is observed, however, 5 districts reported an increase (Karonga, Nkhata Bay, Mzimba, Phalombe and Balaka) while other 6 reported a decline (Dowa, Salima, Machinga, Chiradzulu, Nsanje and Neno). 3. There is a general increase in the number of abandoned children. The total number increased from 42 in January-February 2012 to 75 during the same period in 2013 in 12 districts monitored. Mzimba Police recorded the largest increase; from 3 cases in 2012 to 32 cases in 2013. 4. Police officers attributed increased crimes of children and abandoned children to economic hardship and food insecurity. Water in Rural Communities Indicators monitored: Access to water in the communities over time is monitored through the number of functional boreholes in 24 communities. Key Findings: 1. 11 villages recorded an increase in functional boreholes with the highest number of boreholes reported by villages surrounding Kalembo Health Facility in Balaka from 14 in November-December 2012 to 16 functional boreholes in JanuaryFebruary 2013. 2. Two villages lost their only functional borehole in February

2013 compared to December 2012 (Nkhulambe and Mleremba in TA Nazombe in catchment area of Nkhulambe Health Facility in Phalombe). 3. Two villages continue to live without a functional borehole since June 2012 (Mbangala and Chatanga in TA Kayembe in the catchment area of Chisepo Health Facility in Dowa). Commodity Prices in Rural Communities Indicators monitored: The prices of basic commodities including sugar, salt, cooking oil, bath soap and maize are monitored in 24 communities in 12 districts. Key Findings: 1. A general increase in prices of all commodities monitored continues. The data for January-February 2013 compared to the same months in 2012 shows an average increase in prices of sugar (11%), salt (55%), cooking oil (35%), bath soap (41%) and maize (111%). Living Standards in Rural Communities Indicators monitored: Community leaders are asked to provide information relating to the number of deaths and their perception about living standards in their communities. Key Findings: 1. There was an increase in the reported number of deaths in the communities from 28 in January and February 2012 to 64 in the same months 2013. 2. Perception on the living standards of people in the communities as reported by village heads continues to deteriorate. According to the village heads interviewed in 12 districts, every month since October 2012 living conditions are worse off compared to the

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previous month. 3. Ganyu(casual labour) has been the most important coping strategy for communities over time with about 60% of the Village Heads indicating this as the main strategy between September 2012 and February 2013. Conclusion The sentinel monitoring study highlights the potential impacts of the current economic situation on vulnerable children and women. Evidence points to an increase of maternal fatalities and some facilities continue to have drug stockouts. Perception on functionality of health referral systems has deteriorated in past months. An increase of the number of children with severe acute malnutrition receiving RUTF in the southern region may indicate overall deterioration of food and nutritional security. Although improvements in student and teacher attendance rates have been reported, school attendance remains low. There is a general increase in the number of cases of crimes by children and abandoned children. Prices of basic commodities are on the rise and 60% of communities reported using ganyu as a coping mechanism.

About Malawi Child Watch Malawi Child Watch is electronically published quarterly by UNICEF to share information amongst key stakeholders on pressing issues affecting children, especially those living in poor and marginalized families.

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