| Measuring drought and drought impacts in Red Sea Province |
|5. Nutritional status of children in Red Sea Province, November 1985 to November 1987. Mary Cole and Roy Cole|
The nutritional surveillance teams at Oxfam Port Sudan undertook six province wide tours of Red Sea Province between November 1985 and November 1987. Weight for height measurements were taken on approximately 2000 children less than or equal to 115 cm in height during each tour (cycle). The present study is a reanalysis and a synthesis of the data collected during this time.
In Red Sea Province as a whole, the nutritional status of children <=115 cm in height improved significantly between cycles 1-3 inclusive and 4-6 inclusive (approximating 1986 and 1987). Female children had a marginally better mean percent weight for height than male children in 1987, but equal proportions of males and females were malnourished (less than 80% reference median weight for height) in both cycles 1-3 and 4-6. Significantly more females than males were severely malnourished in cycles 13 (less than 70% reference median weight for height). There was a significantly higher proportion of males than females in the sample in cycles 13 and 4-6. Unfortunately we lack mortality data and details of refusal rates by sex which would be required to interpret these results. The percentage of the sample less than 75 cm in height increased significantly between cycles 1-3 and 4-6.
At the district level, Rural Port Sudan and North Tokar Districts had a percentage of malnourished children which was lower than the province wide average in 1986. Halaib District had a percentage of malnourished children that was equal to the province wide average in 1986, and Derudeb, Haya, Sinkat and South Tokar Districts had a percentage of malnourished children that was above the province wide average in 1986. Between cycles 1-3 and 4-6, the nutritional status of children in Rural Port Sudan and North Tokar did not change. The nutritional status of children in the remaining districts improved significantly between cycles 1-3 and 4-6, with the important exception of Haya District. The poor nutritional status of children in Haya District remained unchanged between cycles 1-3 and 4-6. This was particularly alarming because it has been estimated that up to 28% of the total population of the province live in Haya District for all or part of the year.
The highest rates of malnutrition were found in children less than 75 cm in height. This approximates to children less than one year of age. These results should be interpreted with caution, however, because the majority of these children were measured upright rather than supine, a technique which has not been validated. In children over 75 em in height, highest rates of malnutrition were found in the height category 75.1-85 cm. This corresponds to weaning age. The poor nutritional status of breast fed babies raises concerns about maternal health and nutrition during pregnancy and lactation. Children of weaning age are at high risk of malnutrition also. More information is needed about infant feeding practices and weaning in Red Sea Province.
Seasonal changes in nutritional status were apparent in both cycles 1-3 and 4-6. Children had the worst nutritional status in August and September, at the end of the dry summer season with the associated lack of cereals, grazing and milk. Children had the best nutritional status in January, after the harvest and when grazing and milk production had improved. By district, Halaib and Rural Port Sudan Districts did not show such seasonal trends in nutritional status. These districts are in the north of the province and have low rainfall with little seasonal variation. Seasonal variations in nutritional status should be considered when comparing the results of surveys undertaken at different times of the year.
Children who were living in settlements described as camps had a significantly worse nutritional status than children living in railway towns, towns or rural areas in 1986. By 1987, however, there was no significant difference in the nutritional status of children in any of the settlement types.
There was no correlation between the mean relief grain ration per family per day by settlement and the mean percent weight for height of children by settlement. This may be a reflection of the limitations of the analysis, which were imposed by the methods of data collection by both the Relief Section and the nutritional surveillance teams. Improved coordination between the Relief section and nutritional surveillance teams must be a priority in the future if nutritional surveillance data are to contribute to relief allocations in a meaningful way.
The smallest unit of analysis (the settlement) explained 12.9% of the variation in percentage weight for height found in cycles 1-6. It is likely that of those variables measured the individual settlement is the single most important factor in determining the nutritional status of children. The practical implications of this finding are that as many settlements as is practical should be sampled during nutritional surveillance in order to obtain an accurate picture of the nutritional status of children, and research into the causes of malnutrition in Red Sea Province should focus on the settlement.
The Ministry of Health of the Sudan government, together with USAID, undertook a survey of the nutritional status of children under five years of age in Northern Sudan during 1986 and 1987. These surveys found that children in Red Sea Province had a consistently higher nutritional status than had been found in the Oxfam surveys. This was probably because the government surveys included urban areas, which were excluded from Oxfam surveys. The results of the government surveys confirmed Oxfam findings with respect to the high risk of malnutrition in weaning age children, and the importance of the settlement in explaining variation in nutritional status.
After an initial phase of famine relief, the emphasis of relief efforts in Red Sea Province has been on a general concept of recovery rather than on nutritional interventions per se. Because of the alarming rates of malnutrition in babies and children of weaning age, pregnant and lactating women and children of weaning age should be targeted with specific interventions aimed at improving their health and welfare. This will involve examining the nutritional value of the relief ration, and developing new methods of targeting and monitoring. This should become primarily a gender issue. Oxfam should encourage innovative approaches to nutritional surveillance in the field in order to develop methods of assessment which are acceptable to the Beja, and locally appropriate standards for nutritional status which could be used in conjunction with internationally accepted standards. Methodological issues which have been raised as a result of practical experience should be addressed promptly and incorporated into guidelines which could be used in the event of future relief efforts in Red Sea Province.