|Refugee Nutrition Information System (RNIS), No. 27 - Report on the Nutrition Situation of Refugee and Displaced Populations (UNSSCN, 1999, 78 p.)|
|2. Great Lakes Region|
|Democratic Republic of Congo (DRC)|
|United Republic of Tanzania|
|6. Liberia/Sierra Leone Region|
|7. Guinea Bissau|
|12. Afghanistan Region|
|13. Bhutanese Refugees in Nepal|
|14. Refugees from Rakhine State, Myanmar in Bangladesh|
|15. Kosovo Crisis|
|Listing of Sources for June 1999 RNIS Report *27|
|Abbreviations used in the text|
|Tables and figures|
The initial optimism which greeted the suspension of the economic sanctions on Burundi earlier this year is beginning to fade. The price of an average family's food basket has fallen slightly since the lifting of the embargo but still remains nearly twice as high as it was before the sanctions were imposed. At the same time, the local currency has continued to devalue compared to both official and unofficial US dollar rates partially because of a severe shortage of foreign currency in the country (OCHA -05/05/99).
Security incidents and attacks on civilian populations continue particularly in Bubanza, Bujumbura, Bururi and Makamba provinces. Burundian Government sources claim that the attacks in the South have been launched from Tanzania by Interahamwe militia and rebels of the Force de Defense pour la Democratie (IRIN -06/04/99, 09/04/99, 28/05/99). Of particular concern was the attack in Ruyigi's Kinyinya commune where the destruction of some 600 households was confirmed. This area was previously considered relatively secure and had seen considerable progress in the reconciliation process (OCHA - 05/05/99).
Despite the fighting, further peace talks took place in Arusha in May (IRIN- 1/05/99, 27/05/99). The government has unveiled a "plan for society" which details its vision of a proposed ten-year transition period. The plan envisages a democracy based on "consensus" and an enlarged national assembly which will include groups taking part in the Arusha peace process which are not currently represented in parliament (IRIN -04/06/99). It remains to be seen how the government's opponents react to this proposal.
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There are currently estimated to be over half a million displaced people in Burundi. The situation remains fluid: new people are forced to flee even while others return. For example, violence in Makamba caused the displacement of 12,000 people in areas along the Tanzanian border and the local authorities have asked for WFP's assistance (WFP -21/05/99).
WFP provides food assistance to approximately 451,000 people per month, which includes the following categories, emergency distributions - 119,000; nutritional support - 47,500; vulnerable groups - 25,000; seeds protection rations - 126,000; returnee packages - 3,500; and food for work - 130,000. The original planning figure was 282,000, but this figure has been increased as a result of a large seeds protection ration distribution programme jointly implemented by WFP and FAO. Emergency distributions target not only IDPs but also resettled IDPs and residents who are considered food insecure (WFP - 24/06/99).
As reported in RNIS 26, the nutritional situation of many of the war-affected populations in Burundi does appear to be slowly improving. The surveys described below all show a decrease in the prevalence of malnutrition in these populations. Additional data from UNICEF covering the period from September 1998 to February 1999 indicates the prevalence of malnutrition in 10 Provinces ranged from 5.6% to 14.7%. This represents an improvement compared with data collected between January and August 1998 (which ranged between 10.0% to 23.8% in seven Provinces). Reports from these surveys are not currently available to the RNIS, and thus the representativeness of the sample is unknown (UNICEF - 21/06/99).
A survey undertaken by ACF in Kayanza Province in January recorded a decrease in the prevalence of wasting in children under five since the last survey in this area in 1997 (see Annex). Acute wasting and/or oedema had decreased from 14.0% to 9.8% and severe wasting and/or oedema was estimated at 1.7% compared to 2.3%. (Oedema was recorded in 0.9% of the children surveyed). However, the two survey populations were different: - the earlier survey was only in the camps and the second survey included residents, thus the decrease in the rates of wasting and/or oedema found might be expected even without an improvement in the nutritional status of IDP's.
Adult nutritional status was also measured as a large proportion of beneficiaries in the feeding centres in this area were adults. The table below shows the distribution of the population by Chronic Energy Deficiency (CED) level. It can be seen that only 52% of the adult (aged 15y+) population were categorised as "normally" nourished according to the classification employed; 8.4% of the total adult population were defined as severely malnourished.
* please note that the RNIS will soon be issuing a special report on the classification of adult nutritional status
One of the problems with this classification scheme is that it does not take into account physiological changes during ageing. The data obtained in this study (and many others) describe a decreasing BMI as age increases. If adults younger than 50 years are examined separately then only 4.0% of the population is classified as severely malnourished (<16 kg/m2 and/or oedema), 2.2% of women and 5.6% of men. In adults over 50 years, 6.8% of women and 7.7% of men were defined as severely malnourished (BMI<15.0 kg/m2). Oedema was reported in 0.2% of the under-50 age group and 3.4% of the over-50 age group. (The presence of oedema in the younger age group is used as an admission criterion to the TFC, but cannot be in the older group as oedema may be caused by various common pathological conditions as well as malnutrition in this group).
For less severe adult malnutrition, ACF uses a BMI of 16.0-16.9 kg/m2 and/or a MUAC<21 cm as adult admission criteria into their supplementary feeding programme in the study area. Using this definition, 18.6% of adult women and 12.9% of adult men were classified as malnourished.
In general, coverage of the nutritional programmes was low - only 12.3% of wasted children and 4.9% of malnourished adults were enrolled in a programme. Measles vaccination was confirmed by card for 66.4% of the children. The retrospective CMR for the study population showed an improvement compared to 1997 and was estimated to be 0.56/10,000/day. Under five mortality was 0.93/10,000/day compared to 4.5/10,000/day in August 1997.
By questioning respondents about their activities, sources of food and revenue, agricultural systems, household social structure (sex of head of household etc), origins and access to health care, the survey also examined possible indicators of vulnerability in this community. Although no causal relationships could be established, an association between head of household's gender and malnutrition in children was clearly seen - children in female-headed households were more likely to be wasted. In addition, a wasted child was less likely to live in a household possessing at least one animal. The elderly living alone were also vulnerable. The authors of the study were careful to stress that the study population is a relatively homogenous group in terms of activities and income and thus these indicators alone will not be sufficient to differentiate between vulnerable and non-vulnerable households.
Oxfam/SCF-UK/Solidarites/MOH conducted a follow-up survey in March in Gitega province where Oxfam has established a supplementary feeding programme (see Annex). The results of all three surveys are shown in graphs below. It can be seen that the level of wasting and/or oedema has decreased in both the north and southern areas of the province over the past fifteen months. CMR in the northern part of the province also decreased from 0.57/10,000/day in November to 0.25/10,000/day in March. In the South, CMR decreased from 0.79/10,000/day to 0.44/10,000/day. Mortality for children under five years also decreased during the period in both regions - from 0.67/10,000/day to 0.38/10,000/day in the North and from 1.23/10,000/day to 0.96/10,000/day in the South. According to vaccination cards carried by the mother, 53.5% of children were vaccinated in the north and 60.1% in the south. This can be compared to 63% and 64% respectively in November.
Other indicators of an improving nutritional situation included a drop in new admissions to the feeding programmes, and increased land cultivation by the population. Health services are now functioning in the province. Given these improvements Oxfam is now working towards a hand-over of the management and logistics of the feeding programme to the provincial Ministry of Health. It is envisaged that this will take six months. Oxfam will train health centre staff and mothers in best nutrition and hygiene practices (OCHA -05/05/99, Oxfam - 27/04/99, 19/05/99).
Muramvya and Mwaro provinces
Results from a nutritional survey undertaken by Solidarites in February in Muramvya and Mwaro provinces among children under five years old recorded 11% acute wasting with 1.5% severe wasting. CMR was reported to be 0.53/10,000/day (OCHA - 18/05/99).
Children's Aid Direct in collaboration with the DPAE (Department of Agriculture) conducted a food security survey in Bubanza Province in March as a complement to the anthropometric survey undertaken in February (which found a prevalence of 9.75% acute malnutrition, of which 2.7% was nutritional oedema). The population is estimated at 270,000 with almost 60% being internally displaced. The displaced have been moved from large camps to smaller sites with the aim of moving people closer to their origin and hence improve accessibility to land.
No significant difference was found between residents and the internally displaced in terms of their cultivation and food production. The IDPs may have smaller fields to cultivate, but the residents have insufficient seeds and other agricultural inputs to plant the whole area. Unlike the IDPs they do not benefit from seeds and tools distributions.
Insecurity has contributed to a 40% decrease in agricultural production, as a result of restricted access, and increased prices of fertilisers and pesticides. Small livestock have been affected particularly badly, and have decreased by 90%, while large livestock have decreased by 37%, as compared with the situation before the crisis. However in recent months, improved security has increased access to markets, health centres and fields, but despite this, instability in some parts of Bubanza prevents the population returning to their original collines. The on-going food insecurity is reflected in the many re-admissions reported by the supplementary and therapeutic feeding programmes, as discharged children become malnourished once again.
Army worm infestation
More generally, FAO has identified some 20,000 hectares of land which have been infested by army worm in the north-eastern areas of Burundi. The infestation threatens to reduce cereal crops including wheat, rice, maize, millet, sorghum and sugar cane crops. Pasture lands are also affected and cause a negative impact on livestock. WFP and government officials are reviewing the situation in order to discuss possible food aid requirements resulting from the infestation (WFP - 14/05/99).
Refugees in Burundi
A new UNHCR verification exercise carried out in Citiboke revealed that only 363 Congolese remained on site, approximately 100 less than during the last survey carried out in February (OCHA - 16/04/99). There are also some 2,000 urban Rwandan refugees in the country.
Overall, the improvements in the nutritional situation in Burundi reported in RNIS 26 have been sustained, and the IDPs are currently considered to be at moderate nutritional risk (category IIb).
Priorities and Recommendations:
· Although the nutrition surveys describe an improving situation the food security of the IDPs in Burundi is still fragile. Food assistance may still be required in some areas where previously it was not necessary and in other cases assistance may be slowly phased out. Ongoing food economy assessments carried out by WFP and others should establish which areas are most in need of assistance.
· Funds are urgently needed for the WFP operation to provide assistance for the refugees in the region generally, including those in Burundi. Breaks in the pipeline mean that rations will either be cut or distributions undertaken less frequently.
From the ACF survey:
· Given the fragile state of the population's nutritional status the supplementary and therapeutic feeding programmes should be continued.
· Ensure that the population is aware of these facilities, and hence that the coverage of the programmes will improve, this is particularly true for adult males.
· Undertake further studies on the nutritional situation of the population
From the CAD study in Bubanza:
· Include vulnerable residents in the collines in seed distribution programmes.
· Encourage breeding of small livestock where security allows through associations of credit schemes.