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close this book Measuring drought and drought impacts in Red Sea Province
close this folder 5. Nutritional status of children in Red Sea Province, November 1985 to November 1987. Mary Cole and Roy Cole
View the document Summary
View the document Introduction
View the document Methods
View the document Results
View the document Conclusions
View the document Discussion
View the document Future directions.
View the document Appendix 5.1. Data collection form, nutritional surveillance teams, Oxfam
View the document Appendix 5.2. Claasifications of coded variables.
View the document Appendix 5.3. Ecozones in Red Sea Province (from Watson, 1976).
View the document Appendix 5.4. Seasons by month and ecozone, Red Sea Province.
View the document Appendix 5.5. Classification of fled Sea Province into food security zones, 1987.
View the document Appendix 5.6. Locations of sampled sites, nutritional surveillance cycle 1.
View the document Appendix 5.7. Names of sampled sites, nutritional surveillance cycle 1.
View the document Appendix 5.8. Locations of sampled sites, nutritional surveillance cycle 2.
View the document Appendix 5.9. Names of sampled sites, nutritional surveillance cycle 2.
View the document Appendix 5.10. Locations of sampled sites. nutritional surveillance cycle 3.
View the document Appendix 5.11. Names of sampled sites, nutritional surveillance cycle 3.
View the document Appendix 5.12 Locations of sampled sites, nutritional surveillance cycle 4.
View the document Appendix 5.13. Names of sampled sites, nutritional surveillance cycle 4.
View the document Appendix 5.14 Locations of sampled sites, nutritional surveillance cycle 5.
View the document Appendix 5.15. Names of sampled sites, nutritional surveillance cycle 5.
View the document Appendix 5.16. Locations of sampled sites, nutritional surveillance cycle 6.
View the document Appendix 5.17. Names of sampled sites, nutritional surveillance cycle 6.

Results

1. Timing and location of Oxfam Port Sudan Nutritional Surveillance.

Table 5.2. Timing of Oxfam Nutritional Surveillance Cycles 1-6.

         

CYCLE BY MONTH

YEAR

J

F

M

A

M

J

J

A

S

O

N

D

1985

                   

1

1

1986

1

1&2

2

2

2

2

3

3

3

3

3

4

1987

4

4

4&5

5

5

5

5

6

6

6

6

 

The average time taken to survey the whole province was four months. Three surveys were completed in 12 months. Cycles 1 and 4, 2 and 5, and 4 and 6 were carried out at comparable times of year (Table 5.2). Within each cycle, the order in which the districts were visited varied (Table 5.3). The locations of the sites sampled in cycles 1-6 are shown in Appendix 5.6.

Table 5.3. Districts visited by monfh, NST cycles 1-6.

     

MONTH BY CYCLE

DISTRICT

1

2

3

4

5

6

DERUDEB

NOV

MAR

SEP

JAN

MAY

SEP

HALAIB

JAN

JUN

OCT

JAN

JUN

OCT

HAYA

DEC

APR

AUG

DEC

MAR

SEP

N.TOKAR

JAN

MAY

OCT

DEC

MAY

OCT

R.P.S.

JAN

JUN

NOV

MAR

JUL

DEC

SINKAT

DEC

APR

SEP

DEC

APR

OCT

S.TOKAR

JAN

MAR

SEP

JAN

MAR

OCT

Table 5.4. Total number of visits and number of places visited by district, cycles 1-6.

DISTRICT

NUMBER OF

NUMBER OF

% VISITED

% VISITED

 

VISITS

PLACES

> ONCE

3 TIMES

DERUDEB

57

37

35

13.5

HALAIB

75

47

45

13

HAYA

77

53

38

7.5

N.TOKAR

72

37

62

19

R.P.S.

67

49

29

8

SINKAT

79

55

35

9

S.TOKAR

77

47

43

17

TOTAL

504

325

40

12

Oxfam received many complaints from community leaders of repeat sampling and excessive visits by nutritional surveillance teams. Table 5.4 shows the total number of visits made to each district over cycles 1-6, together with the total number of different places visited. Over all cycles (two years), 40% of places visited were visited more than once, and 12% of places visited were visited three or more times. The maximum number of times any place was visited was four times.

2. Description of the sample.

a. Sample size

Sample sizes by district and cycle for children 75.1-115 cm and <75 cm are shown in Tables 5.5 and 5.6 respectively.

Table 5.5. Sample sizes (children >75 cm) by cycle and district.

 

CYCLE

DISTRICT

1

2

3

9

5

6

1-3

4-6

DERUDEB

169

322

258

211

195

189

749

595

HALAIB

264

324

231

203

190

190

819

583

HAYA

150

337

252

277

258

248

739

783

N.TOKAR

330

324

257

255

224

232

911

711

R.P.S.

214

327

266

252

264

254

807

770

SINKAT

227

338

257

293

267

262

822

822

S.TOKAR

301

323

241

291

292

279

865

862

TOTAL

1665

2295

1762

1782

1690

1654

5712

5124

Table 5.6. Sample sizes (children <75 cm) by cycle and district.

 

CYCLE

DISTRICT

1

2

3

4

5

6

1-3

4-6

DERUDEB

22

34

42

35

46

51

98

132

HALAIB

66

44

56

41

53

57

166

151

HAYA

30

33

49

53

75

86

112

2;4

N.TOKAR

89

41

44

53

77

70

174

200

R.P.S.

26

41

35

52

96

76

102

224

SINKAT

40

40

44

65

66

68

124

199

S.TOKAR

88

46

59

70

70

81

193

221

TOTAL

361

279

328

369

481

489

968

1339

The percent of the total sample which comprised children less than or equal to 75 cm by district and cycle is shown in Table 5.7. For Red Sea Province as a whole there was a significantly higher percentage of children less than 75 cm tall in cycles 46 than in cycles 1-3. At the district level there was a significantly higher percentage of children less than 75 cm tall in cycles 4-6 than in cycles 1-3 for all districts except Halaib and South Tokar.

Table 5.7. Percent of sample <75 cm by cycle and district.

 

CYCLE

DISTRICT

1

2

3

4

5

6

1-3

4-6

DERUDEB

11.5

9.6

14.0

14.2

19.1

21.3

11.6

18.2**

HALAIB

16.7

8.7

15.6

15.3

23.5

23.5

16.9

20.6

HAYA

16.7

8.9

11.2

16.1

22.5

25.7

13.2

21.2**

N.TOKAR

21.2

11.2

14.6

17.2

25.6

23.2

16.0

22.0**

R.P.S.

10.8

11.1

11.6

17.1

26.7

23.0

11.2

22.5**

SINKAT

15.0

10.6

14.6

18.2

19.8

20.6

13.1

19.5**

S.TOKAR

22.6

12.5

19.7

19.4

19.3

22.5

18.2

19.5

TOTAL

17.9

10.8

15.7

17.2

22.2

22.8

14.5

20.7**

** Significant difference between cycles 1-3 and 4-6 (p<.05)

b. Proportions of males and females in the sample.

The ratios of males to females by district and cycle for children greater than 75 cm and less than or equal to 75 cm are shown in Tables 5.8 and 5.9 respectively.

Table 5.8. Ratios of males:females (children >75 cm) by cycle and district.

 

CYCLE

DISTRICT

1

2

3

4

5

6

1-3

4-6

DERUDEB

1.06

1.37*

1.10

1.22

1.44*

1.33

1.20*

1.32*

HALAIB

0.89

0.98

0.94

0.88

1.18

0.96

0.94

1.00

HAYA

1.14

1.13

0.97

1.16

0.97

1.25

1.08

1.12

N.TOKAR

1.17*

1.13

1.14

0.92

1.20

1.17

1.15*

1.08

R.P.S.

1.55*

1.14

1.53*

1.17

1.28*

1.17

1.36*

1.21*

SINKAT

1.39*

1.28*

0.85*

1.02

1.09

1.02

1.15*

1.04

S.TOKAR

1.01

1.07

0.94

1.12

1.20

1.05

1.01

1.12

TOTAL

1.14*

1.15*

1.05

1.07

1.18*

1.13*

1.12*

1.12*

* Significantly different from 1.00 at p=.05

In the sample 75.1-115 cm, there was a significantly higher proportion of males than females for the whole province in both cycles 1-3 and 4-6. By district, Derudeb and Rural Port Sudan had significantly higher proportions of males than females in both cycles 1-3 and 4-6, while North Tokar and Sinkat districts had significantly higher proportions of males than females in cycles 1-3 only.

Table 5.9. Ratios of males:females (children <75 cm) by cycle and district

 

CYCLE

DISTRICT

1

2

3

4

5

6

1-3

4-6

DERUDEB

0.83

0.62

0.68

0.75

0.92

1.09

0.69

0.91

HALAIB

0.89

0.63

0.60

1.73

1.04

0.68

1.71

1.01

HAYA

1.50

1.06

0.88

1.04

1.08

0.95

1.07

1.02

N.TOKAR

0.98

1.28

1.00

1.41

0.97

1.19

1.04

1.15

R.P.S.

1.36

0.78

1.19

1.36

1.13

1.24

1.04

1.22

SINKAT

1.00

1.35

1.39

0.81

0.83

0.74

1.24

0.79

S.TOKAR

1.26

0.92

0.97

0.89

1.50

1.08

1.08

1.13

TOTAL

1.07

0.91

0.91

1.07

1.06

0.98

0.97

1.03

Despite some apparently large differences between the proportions of males and females less than 75 cm, none were significantly different from a ratio of 1.00 (50% males, 50% females). This is because statistical significance depends not only on the proportions found, but on the size of the sample. The sample sizes for children less than 75 cm were very small. c. Distribution of heights in the sample.

Height distributions for the total sample for cycles 1-3 and 4-6 are shown in Figure 5.1. There was a significantly higher percentage of children in the height category 55.1-65.0 cm in cycles 4-6 than in cycles 1-3. There was a significantly lower percentage of children in the height category 95.1-105.0 cm in cycles 4-6 than in cycles 1-3. No significant differences were found between the percentage of males and females in each height category in either cycles 1-3 or 4-6.


Figure 5.1. Height distributions m the total sample, cycles 1-3 and cycles 4

3. The nutritional status of children, total province.

Unless otherwise specified, results refer to children 75.1-115 cm in height. a. Means and distribution of percent weight for height, total province.

The percentage of children in each percent weight for height class for cycles 1-3 and 4-6 are shown in Figure 5.2. For both cycles 1-3 and 4-6 the largest percent of the sample fell between 80 and 89.9% weight for height. Males and females are aggregated because no significant differences were found between the percentage of males and females in each percent weight for height class in either cycles 1-3 or 4-6. In cycles 46, however, females had a higher mean percent weight for height than males (see Table 5.10).

Table 5.10 Mean percent weight for height and standard deviation by sex, Red Sea Province, cycles 1-3 and 46.

CYCLE

 

MALE

FEMALE

TOTAL

1-3

MEAN

86.68

87.04

87.26

 

SD

7.99

8.12

8.05

4-6

MEAN

88.08*

88.58*

88.34**

 

SD

7.76

8.05

7.90

* Significant difference between males and females (p<0.05).

** Significant difference between cycles 1-3 and 4-6 (p<.051.

For both cycles 1-3 and 4-6 the mean percent weight for height for the total sample was above 85% weight for height. The centre of the distribution therefore fell towards the upper limits of the 80-89.9% class.


Figure 5.2 Distribution of percent weight for height children 75.1-115 cm, Red Sea Province.

There was an upward shift in the distribution of percent weight for height between cycles 1-3 and 4-6. This is reflected in the mean percent weight for height which was significantly higher in cycles 4-6 than 1-3 (p<.05). There was a significant decrease in the percentage of the sample in the 80-89.9% weight for height class between cycles 1-3 and 4-6, and a corresponding increase in the 90-99.9% weight for height class over the same periods. Although there was a decrease in the percentage of the sample in the 70-79.9% weight for height class between cycles 1-3 and 4-6, this was not statistically significant. When all weight for height classes less than 80% weight for height were aggregated, however, the changes between cycles 1-3 and 4-6 became significant (see the Results section).

b. Rates of malnutrition, total province.

Children between 70% and 79.9% of their reference median weight for height are classified as "moderately malnourished". Children less than 70% of their reference median weight for height are classified as "severely malnourished". For the purpose of this report the following definitions have been used:

Malnourished - those children less than 80% of their reference median weight for height. This includes both moderately and severely malnourished children.

Severely malnourished - those children less than 70% of their reference median weight for height.

i. Percentage of malnourished children, total province.

The percentage of the total sample who were malnourished together with the 95% confidence interval for the population estimate, is shown in Table 5.11. Province-wide, there was no significant difference between the percentage of males and females who were malnourished. A significantly lower percentage of children were malnourished in cycles 4-6 than in cycles 1-3.

Table 5.11. Percent less than 80% reference median weight for height (malaourished) by sex, with 95% confidence intervals, Red Sea Province.

CYCLE

MALES

 

FEMALES

 

TOTAL

 
 

%

95% CI

%

95% CI

%

95% CI

1-3

16.68

1.36

16.65

1.43

16.63

0.49*

4-6

13.72

1.32*

12.64

1.35*

13.19

0.47*

* Significant difference in cycles 1-3 and 4-6.

ii. Percentage of severely malnourished children, total province.

The percentage of the total sample who were severely malnourished, together with the 95% confidence interval for the population estimate, is shown in Table 5.12.

Table 5.12 Percent less than 70% reference median weight for height (severely malnourished) by sex, with 95% confidence Intervals, Red Sea Province.

   

SEX

       

CYCLE

MALES

 

FEMALES

 

TOTAL

 
 

%

95% CI

%

95% CI

%

95% CI

1-3

1.89

0.43*

2.74

0.63*

2.27

0.43

4-6

1.36

0.44

1.34

0.47

1.35

0.32**

* Significant difference between males and females (p<.05).

** Significant difference between cycles 1-3 and 4-6 (p<.05).

In cycles 1-3 there was a significantly higher percentage of severely malnourished females than males. There was no significant difference in the percentage of severely malnourished males and females in cycles 4-6. The percentage of severely malnourished females decreased significantly between cycles 1-3 and 4-6, whereas the percentage of severely malnourished males stayed the same.

c. Malnutrition rates by district.

i. Percentage of malnourished children by district.

The percentage of the sample who were malnourished by district and sex, together with the 95% confidence interval for the population estimate, is shown in Table 5.13. There was a significant difference between the percentage of malnourished males and females in South Tokar District in cycles 1-3. A significantly higher percentage of males than females were malnourished. There were no other significant differences between the percentages of malnourished males and females by district, either in cycles 1-3 or 4-6.

Table 5.13. Percent less than 80% reference median weight for height (malnourished) by district and sex, with 95% confidence Intervals for the estimate.

   

CYCLES 1-3

CYCLES 4-6

DISTRICT

 

MALES

FEMALES

TOTAL

MALES

FEMALES

TOTAL

DERUDEB

MEAN

21.57

21.11

21.36

15.04

18.75

16.64**

 

CI

4.07

4.42

3.00

3.88

4.89

3.05

HALAIB

MEAN

14.90

15.13

15.02

8.25

6.51

7.38**

 

CI

3.58

3.49

2.50

3.23

2.89

2.19

HAYA

MEAN

20.30

19.10

19.76

18.12

15.99

17.11

 

CI

4.12

4.17

2.93

3.79

3.79

2.69

N.TOKAR

MEAN

11.50

14.15

12.73

11.65

11.40

11.53

 

CI

2.89

3.39

2.21

3.33

3.44

2.40

R.P.S

MEAN

10.75

11.70

11.15

10.45

9.46

10.00

 

CI

2.87

3.48

2.22

2.98

3.13

2.16

SINKAT

MEAN

18.18

20.94

19.46

14.35

10.45

12.41**

 

CI

3.86

4.16

2.76

3.43

3.05

2.30

S.TOKAR

MEAN

28.28*

20.00*

24.16

14.25

12.56

13.46**

 

CI

4.32

3.86

2.91

3.27

3.29

2.33

PROVINCE MEAN

16.68

16.65

16.63

13.72

12.64

13.19**

 
 

CI

1.36

1.43

0.49

1.32

1.35

0.47

* Significant difference between males and females.

** Significant difference between cycles 1-3 and 4-6.

From Table 5.13 the districts in Red Sea Province can be divided into two groups: those that showed a significant decrease in the percentage of malnourished children between cycles 1-3 and cycles 4-6, and those that showed no significant difference in percentage of malnourished children between cycles 1-3 and 4-6. Derudeb, Halaib, Sinkat and South Tokar Districts all had a significant decrease in the percentage of malnourished children between cycles 1-3 and 4-6. Haya, North Tokar and Rural Port Sudan Districts showed no change in the percentage of malnourished children between cycles 1-3 and 4-6. This is summarized in Map 5.1.

Map 5.2 shows a comparison of the percentage of the sample who were malnourished in each district for cycles 1-3 in relation to the province-wide mean percentage of malnourished children for cycles 1-3. Districts are ranked as above the province-wide mean, equal to the province wide mean, or below the province-wide mean with respect to the percentage of malnourished children. Map 5.3 shows the same information for cycles 4-6.


Map 5.1. Changes in malnutrition rates by district. cycles 1-3 to 46.


Map 5.2. Percentage of malnourished children, district means compared to province-wide mean. cycles 1-3.


Map 5.3. Percentage of malnourished children, district means compared to provincewide mean. cycles 46.

It should be remembered that the province-wide percentage of malnourished children was lower in cycles 4-6 than in cycles 1-3, and that the relation of each district to the province-wide mean should be interpreted in conjunction with the absolute district figures shown in Table 5.13. A district by district summary combining these data is given below.

DERUDEB: The percentage of malnourished children was higher than the provincewide average in cycles 1-3, and although it decreased significantly, still remained worse than average in cycles 4-6.

HALAIB: The percentage of malnourished children was equal to the province-wide average in cycles 1-3 and decreased significantly, resulting in a lower than average percentage of malnourished children in cycles 4-6. Halaib District was the only district with average or higher than average percentage of malnourished children to improve significantly between cycles 1-3 and 4-6.

MAYA: The percentage of malnourished children was higher than the province-wide average in cycles 1-3 and did not change significantly in cycles 4-6. Because the province-wide average percentage of malnourished children decreased between cycles 1-3 and 4-6 while the district average for Haya remained the same, the percentage of malnourished children in Haya was worse in relation to the rest of Red Sea Province in cycles 4-6 than in cycles 1-3. Haya district was the only district with a higher than average percentage of malnourished children that failed to improve between cycles 1-3 and 4-6.

NORTH TOKAR: The percentage of malnourished children was better than average in cycles 1-3 and did not change significantly in cycles 4-6. However because the provincewide average percentage of malnourished children decreased in cycles 4-6, North Tokar moved from being better than the province-wide mean in cycles 1-3 to being equal to the province-wide mean in cycles 4-6.

RURAL PORT SUDAN: The percentage of malnourished children was lower than average in cycles 1-3. The percentage of malnourished children did not change significantly between cycles 1-3 and 4-6, but despite the fact the province-wide mean improved, Rural Port Sudan still had a lower than average percentage of malnourished children in cycles 4-6.

SINKAT: The percentage of malnourished children was higher than average in cycles 1-3 but decreased significantly and were equal to the average in cycles 4-6.

SOUTH TOKAR: The percentage of malnourished children was higher than average in cycles 1-3 but decreased significantly and were equal to the average in cycles 46. The percentage of malnourished males decreased more than the percentage of malnourished females, so the significantly higher percentage of malnourished males than malnourished females found in cycles 1-3 was not found in cycles 4-6.

ii. Percentage of severely malnourished children by district.

The percentage of the sample who were severely malnourished broken down by district and sex, together with the 95% confidence interval for the estimate, is shown in Table 5.14.

Table 5.14. Percent less than 70% weight for height by district and sex, with 95% confidence Intervals for the estimate.

CYCLES 1-3 CYCLES 4-6

DISTRICT

 

MALES

FEMALES

TOTAL

MALES

FEMALES

TOTALS

DERUDEB

MEAN

2.21

4.40

3.20

0.88

2.34

1.51**

 

CI

1.46

2.20

1.29

1.01

1.89

1.00

HALAIB

MEAN

1.77

2.13

1.95

1.03

0.34

0.69**

 

CI

1.36

1.40

0.97

1.18

0.67

0.69

HAYA

MEAN

2.87

3.09

2.98

1.93

1.63

1.79

 

CI

1.71

1.83

1.25

1.35

1.32

0.95

N.TOKAR

MEAN

1.44

1.65

1.54

0.54

0.88

0.70

 

CI

1.08

1.24

0.82

0.76

1.01

0.63

R.P.S

MEAN

0.65

1.75

1.12

1.43

1.43

1.43

 

CI

0.75

1.42

0.74

1.16

1.27

0.86

SINKAT

MEAN

1.18*

3.93*

2.43

1.44*

0.50*

0.97**

 

CI

1.03

1.99

1.07

1.17

0.70

0.68

S.TOKAR

MEAN

4.37

3.95

4.16

1.32

1.23

1.28**

 

CI

1.96

1.88

1.36

1.07

1.09

0.77

PROVINCE MEAN

1.89*

2.74*

2.27

1.36

1.34

1.35**

 
 

CI

0.43

0.63

0.43

0.44

0.47

0.32

* Significant difference between males and females.

** Significant difference between cycles 1-3 and 4-6.

As noted previously, there was a significantly higher percentage of severely malnourished females than severely malnourished males in cycles 1-3. At the district level the significantly higher percentage of severely malnourished females than severely malnourished males was found only in Sinkat district, although many other districts showed a similar pattern but did not reach statistical significance, possibly because of small sample size.

No district had a percentage of severely malnourished children which was significantly different from the province-wide mean. Small sample size may have influenced the lack of statistical significance. The tendency was, however, for those districts with the highest rates of moderate malnutrition to have the highest rates of severe malnutrition.

4. Further characterisation of malnutrition in Red Sea Province.

a. Percentage of malnourished children by height category.

The total sample of children of all heights was broken down into height categories. The percent of children in each height category who were malnourished is shown in Figure 5.3. Children less than 55 cm were excluded because of extremely small numbers. No significant differences were found between the percentage of malnourished males or the percentage of malnourished females in any height category in either cycles 1-3 or 4-6.


Figure 5.3. Percent less than 80% reference median weight for height by height category, cycles 1-3 and 46.

In both cycles 1-3 and 4-6 the highest rates of malnutrition were seen in the height category 65.1-75 cm. High rates of malnutrition were also seen in children 55.165 cm. These results must be interpreted with extreme caution, however, because of the measurement technique used for the majority of children in these height categories. In children aver 75 cm tall highest rates of malnutrition were seen in the category 75.185 cm. Malnutrition rates then declined with height, and the lowest rates were seen in the tallest height category. There was a significant in the percentage of malnourished children in all height categories between cycles 1-3 and 4-6. The largest decreases were seen in the height categories 55.1 to 65 cm and 65.1 to 75 cm.

b. Percentage of malnourished children by season.

The results presented above are annual averages. It is important to understand the seasonal variations in malnutrition rates, for example to identify times of high risk, and to construct a framework with which to interpret the results of future surveys carried out at specific times of the year.

As described in the methods section, a season (major wet, minor wet, dry and harvest) was assigned to each case based on ecozone and time of year. Results from this analysis failed to detect seasonal differences; there were no significant differences between the mean percent reference median weight for height or the percentage of malnourished children between any of the seasons. This did not reflect the experience in the field, where May and June were described as the worst months for children's health, and January the best month, irrespective of ecozone. A further analysis was carried out by cycle, which corresponded to months of the year (see Table 5.3).


Figure 5.4. Percent less than 80% reference median weight for height by cycle. children 75.1-115 cm. Red Sea Province.

For the total province, the percentage of malnourished children peaked in September, then decreased in January and remained at this level until peaking again in September (Figure 6.4). Malnutrition rates were therefore worst in September, but improved by January to a level which is sustained for the rest of the year.

When broken down by district and cycle, two patterns emerge: Figure 5.5 shows the percentage of malnourished children by cycle for Halaib and Rural Port Sudan districts, and Figure 5.6 shows the percentage of malnourished children by cycle for the remaining districts of Derudeb, Haya, North Tokar, Sinkat and South Tokar. The latter group of districts followed the pattern described for the province as a whole. In Halaib district there was a steady decrease in the percentage of malnourished children with no seasonal variation apparent. In Rural Port Sudan there was some variation in the percentage of malnourished children, but it was small and not consistent with seasonality.


Figure 5.5. Percent less than 80% reference median weight for height (malnourished) by cycle, Halaib and Rural Port Sudan districts.


Figure 5.6. Percent less than 80% reference median weight for height (malnourished) by cycle, Derudeb, Haya, North Tokar, Sinkat and South Tokar Districts.

c. Percentage of malnourished children by settlement type.

The settlements visited by the Oxfam Port Sudan nutrition surveillance teams in cycles 16 were classified as being railway towns, towns, rural settlements or camps (settlements of displaced people that grew up during the drought). Table 5.15 gives the percentage of malnourished children by settlement type for cycles 1-3 and 4-6.

Table 5.15. Percentage of children less than 80% reference median weight for height (malnourished) by settlement type, cycles 1-3 and 4-6, with 95% confidence Intervals for the population estimate.

CYCLE

SETTLEMENT

CYCLES 1-3

CYCLES 4-6

 

MEAN

95% CI

MEAN

95% CI

RAILWAY

17.1

4.24

14.0

3.32

TOWN

19.5

2.66

10.6

2.17

RURAL

16.2

1.16

13.0

1.13

CAMP

24.5

4.14*

13.8

3.86

* Significantly different from other settlement types (p<.05).

There was a significantly higher percentage of malnourished children in the camps in cycles 1-3 than in all other types of settlements in cycles 1-3. There was no significant difference in the percentage of malnourished children in railway towns, towns and rural areas in cycles 1-3. There was no difference between the percentage of malnourished children in any of the settlement types in cycles 4-6.

d. Percentage of malnourished children by food security zone.

Red Sea Province was classified into three zones of drought impacts and food security for the years 1987 and 1988. Nutritional surveillance data for 1987 (cycles 4-6) were analyzed by "food security zone" for the same year. The percentage of malnourished children by food insecurity zone in cycles 4-6 are shown in Table 5.16.

Table 5.16. Percentage of children less then 80% reference rnedian weight for height by food security zone, cycles 4-6, with 95% confidence intervals for the population estimate.

FOOD SECURITY ZONE

N

MEAN

95% CI

HIGH SECURITY

1891

11.37

1.46

MEDIUM SECURITY

1535

12.77

1.70

LOW SECURITY

1029

15.74

2.27*

* Significantly different from other food security zones (p<.05).

There was no significant difference between the percentage of malnourished children in the high and medium food security zones. The percentage of malnourished children in the low food security zone was significantly higher than the percentage of malnourished children in the high and medium food security zones.

e. Percentage of malnourished children and the World Food Programme relief grain ration.

Mean percent reference median weight for height of children 75.1-115 cm for each settlement was correlated with the settlement average World Food Programme grain ration per family per day at the time of the nutritional surveillance. Spearman's rank correlation of mean percent weight for height with mean grain relief grain ration gave a correlation coefficient of -0.157 for cycles 1-3 and 0.008 for cycles 4-6. These correlation coefficients were not significantly different from zero. There was no correlation between mean percent weight for height and relief grain ration; the ration neither increased or decreased in a consistent pattern as malnutrition rates increased.

f. Variation In percentage of malnourished children within and between settlements.

One-way analysis of variance (ANOVA) of percent weight for height and settlement for cycles 1-6 showed that 12.9% of the total variation in percent weight for height could be explained by the relationship of percent weight for height to settlement. Unfortunately, Oxfam Port Sudan did not have the facilities to be able to carry out multiple regression on the nutritional surveillance data, so it was not possible to determine the amount of variance in percent weight for height explained by all the variables examined or their inter-relationships.

g. Comparison of Oxfam nutritional surveillance results with Sudan Emergency and Recovery Surveillance System (SERISS) results.

The Republic of Sudan Ministry of Health and USAID conducted four rounds of nutritional surveillance of children under five years old in the six northern regions of Sudan between May 1986 and July 1987. Red Sea Province was included in the surveys. Figure 5.7 shows the comparison of weight for height z-scores for children under five years old collected by SERISS, and weight for height z-scores for children less than or equal to 115 cm in height collected by Oxfam Port Sudan.

SERISS found consistently higher weight for height z-scores than Oxfam Port Sudan; children surveyed by SERISS had a better nutritional status than children surveyed by Oxfam Port Sudan. In the SERISS surveys, however, standard deviations of weight for height z-scores were as high as 2.73, whereas standard deviations for weight for height z-scores in the Oxfam surveys were close to 1.0. A similar seasonal pattern of changes in weight for height z-scores was seen in both surveys. Other SERISS findings which were similar to those of Oxfam Port Sudan included:

1. Nutritional status improved from 1986 to 1987.

2. High malnutrition rates were seen in the 12-21 month age group.

3. The smallest unit of analysis (the village council) was the single most important variable determining nutritional status.


Figure 5.7. Mean weight for height z-scores from SERISS and Oxfam nutritional surveillance, Red Sea Province