Box 7

PROBLEMS WITH THE INTERPRETATION OF THE RESULTS OF NUTRITION SURVEYS

Many Governments and donor organizations attach considerable importance to nutritional status information as an indicator of the extent to which famine conditions are present in a population and thus of the need for the provision of food relief. This attitude can be largely attributed to the following factors:

i) nutrition surveys focus on children aged 1-5 who are the most physiologically vulnerable. Furthermore, malnutrition among this group proves more compelling than among others in the community;

ii) the surveys provide hard, "scientific" data;

iii) high rates of malnutrition are taken as "proof" of inadequate food intake.

While there is undoubtedly a role for nutritional surveillance as a food security monitoring tool, its usefulness is probably more limited than is commonly recognized by most relief agencies and donor organizations. While in richer countries nutritional status often involves continuous clinic-based monitoring which may be conducted in a reliable manner, in much of Sub-Saharan Africa it involves the anthropometric measurement (weight and height) of children in periodic surveys, the results of which are often unclear.

Confounding variables such as disease may significantly affect the rates of malnutrition. Thus, a survey in a village where poor water quality has led to a high incidence of diarrhoeal diseases may result in very high weight-for-height estimates. The most appropriate response in such a situation would be to provide oral-rehydration therapy and measures to improve water quality in addition to food relief. In some instances food relief may not be required at all. Thus, as a guide for the need for food relief interventions, nutritional status can be misleading.

The out-migration from the affected area and increased mortality frequently associated with periods of severe transitory food insecurity and famine introduces bias into nutritional surveys.

Unexpectedly low rates of malnutrition may, rightly or wrongly, be interpreted as being affected by the death or out-migration of the most severely malnourished and their non-inclusion in the sample.

In order that nutrition surveys yield statistically valid results it is necessary to have large sample sizes and follow strict research protocols. In areas of poor infrastructure such surveys are costly in terms of the logistical support and the time of skilled staff. During relief programmes when skilled staff are often in short supply and face many other demands on their time, the opportunity costs of carrying out large surveys are high. As a result of the pressures and logistical difficulties the strict protocols are not always followed and the results may not be meaningful.

Observer error (i.e. measurement errors by the assessment team) can become significant unless the assessment teams are subject to regular observer evaluations and retraining. An experiment by two NGO nutritional assessment teams in Sudan in 1985 which involved the measurement of the same 131 children resulted in one NGO estimating that 24% of the sample were less than 80% of the weight for height standard while the other NGO estimated that 48% were less than 80% of the weight for height standard (Soeters 1988).

As a result of the above factors, a gradually emerging consensus among experienced relief agencies is that while periodic anthropometric surveys do provide useful information for food needs assessments and the design of appropriate interventions. Other data gathering techniques should be used to complement anthropometric surveys. A growing trend among such agencies is, therefore, to reduce the resources devoted to anthropometric surveys to a minimum and to increase the resources devoted to the collection of "socio-economic" information such as alternative income sources, coping mechanisms and access to "famine foods", which are able to provide a fuller picture of food needs and help inform decisions regarding appropriate interventions.

Box 8

CASE STUDY: EARLY WARNING IS NOT ENOUGH

The Ethiopian Famine of 1984-85 resulted in total excess mortality of 0.4-0.5 million. It was caused by the complex interplay of a number of factors including drought, civil war, the poor performance of the Ethiopian Government and its unpopularity with western donors. The nature of the interplay and the relative contribution of each factor is still a matter of dispute, but the fact is that it occurred in a country which, following the famine of 1973-5, had set up an early warning system which was considerably more sophisticated than then existed in most other countries in Africa.

Northern areas of the country experienced poor rains in 1983 and 1984. Significant parts of the northern provinces of Eritrea and Tigray were under the effective control of rebel movements. Up to half the GNP was being expended on the civil war. Using the reports produced by the early warning system, the government appealed to the international community for assistance on several occasions throughout 1983 and 1984. Some donors responded in 1983 but the response to the crucial March 1984 appeal, which had requested a total of 450,000 tons of grain, was very poor. Among the reasons contributing to the poor response to the March Appeal were:

· the donors felt the earlier appeals had been exaggerated;

· reports originating in the rebel-held areas that western food aid was being used by the Ethiopian Army and being re-exported to the USSR made donors extremely cautious about approving new assistance;

· keys donors had closed their development programmes in the country for policy (foreign and economic) reasons which limited their ability to corroborate the government's assessments and made them unusually dependent on assessments by the UN for this purpose;

· the government was perceived not to be giving sufficient priority to the relief efforts, for instance the main port had been closed to food aid shipments between December 1983 to April 1984 and travel in the area where the famine was developing by donors and foreign media was severely restricted.

In March 1984 a crucial FAO/WFP food aid assessment mission visited the country. While recognizing that the gravity of the situation warranted the provision of 685,000 tons of emergency food aid, the mission concluded that unless the handling capacity of the ports was improved, only 125,000 tons could be managed. Discussions with the government on the mission were prolonged, and by the time the report was issued in June, the crisis had worsened due to the failure of the "Beig" crop. The NGOs in the country increased their pressure on donors and their own relief efforts. In August the government issued another appeal but this was at a time when the government was preparing for the 10th Anniversary celebrations of the 1974 Revolution and downplayed the existence of the famine. At the beginning of Oct., following the celebrations, travel restrictions to the affected area were eased and donors began the process of mobilizing assistance, but even at this late stage there was a failure to appreciate the unprecedented scale of assistance that would be required. On October 21st, the BBC broadcasted a news report from one of the feeding camps which was quickly transmitted around the world and evoked an immediate and unprecedented international response.

Q. What data are useful in designing "early warning systems"?

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ANSWER

Early warning systems often rely on data such as rainfall, food production, crop marketing, and nutritional surveys.