| Measuring drought and drought impacts in Red Sea Province |
|6. The nutritional status of children in Red Sea Province, July-October 1989: a supplement to the November 1985-November 1987 results. Mary L. Cole and Roy Cole|
It is encouraging that the province-wide rate of malnutrition has fallen significantly between 1987 and 1989. The province-wide percentage of malnourished children (13.69 ± 1.8) is below that at which Oxfam recommends general feeding (over 20% malnourished), but within the range of 10-20% malnourished children at which selective feeding programmes for vulnerable groups should be considered (Oxfam's Practical Guide to Selective Feeding Programmes, Oxfam Health Unit, 1984). Seasonality should be considered when interpreting these figures. They represent the percentage of malnourished children during the summer season, which has been shown to be the worst season with respect to malnutrition rates (see previous paper). It is likely that the percentage of malnourished children will decline further in the winter months.
For the first time since nutritional surveillance by Oxfam Port Sudan began, there was a significant difference in the percentage of malnourished children by sex at the province-wide level in 1989. The nutritional status of males was significantly worse than the nutritional status of females, both in terms of those less than 80% weight for height (malnourished) and those less than 70% weight for height (severely malnourished). This was due to a lack of improvement in the nutritional status of males between 1987 and 1989, whereas the nutritional status of females improved between 1987 and 1989. In those severely malnourished the situation of males and females has reversed since 1986. In 1989 significantly more males than females were severely malnourished, whereas in 1986 significantly more females than males were malnourished.
Interpreting the gender differences in nutritional status in Red Sea Province is difficult because of the absence of mortality data and reliable information on feeding practices and food intake. We could speculate that for whatever reason, given good rains and harvest, it is usual for the nutritional status of females to be better than that of males, and that the lack of difference in the nutritional status of males and females in 1986 and 1987 was because females bore the brunt of the food stress. The increase in the percentage of females in the sample to 50% in 1989 may indicate that female mortality in 1986 and 1987 was disproportionately high, an indicator of food stress. Alternatively, one or many factors may have prevented an improvement in the nutritional status of males, despite a general improvement in conditions. There may also have been an increase in male mortality, which would not be unexpected in view of the increased rates of severe malnutrition seen in males in 1989. Although we lack information to come to any sound conclusions for the causes of gender differences in nutritional status in Red Sea Province, it is obvious that gender is an important factor which must be considered in the future.
There was a smaller range in the percentage of malnourished children by district in 1989 than in 1986 or 1987. It appears that as conditions improve, variation in the nutritional status of children by district declines. Only Halaib district had a percentage of malnourished children which was significantly higher in 1989 than in 1987, although the figure was not significantly different from that in 1986. Two factors may have influenced the percentage of malnourished children in Halaib district in 1989:
1. The exceptional rains of 1988 did not extend into Halaib district.
2. Because of this, out migration from Halaib district to other areas may have been high in 1989, leaving a residual population of poorer families and/or the sick and elderly at the dumping points who then relied on food aid.
At the district level, three other results need to be highlighted as being of particular concern:
1. The continuing poor nutritional status of male children in Haya district.
2. The significant decline in the nutritional status of male children in Rural Port Sudan.
3. The continuing poor nutritional status of children in South Tokar.
The poor nutritional status of males in Haya and Rural Port Sudan districts is particularly important in view of the recent findings that over 50% of the population live in these two districts at some time of the year (ERGO Low Level Aerial Survey of Red Sea Province, 1989). The poor nutritional status of males in Haya represents a continuation of the situation found in 1986 and 1987. In Rural Port Sudan, however, the nutritional status of males has declined significantly between 1986 and 1987 despite the general province-wide improvement over the same time. There is no immediate explanation for the poor nutritional status of males in Haya and Rural Port Sudan. More information is needed to characterise malnourished males in these districts accurately. Haya and Rural Port Sudan districts would be good starting points for more detailed research on the causes of gender differences in nutritional status.
South Tokar district was the only district to have a percentage of malnourished children below the province-wide mean in 1989. Individual settlements in South Tokar had percentages of malnourished children as high as 53% (Garora town). This is a reflection of the continuing refugee problem in these areas, together with the lack of access of the Beni 'Amer to the grazing and agriculture which were rich after the rains of 1988.
There was no significant change in the percentage of severely malnourished children between 1987 and 1989, despite a decrease in the percentage of all malnourished children. This rate of severe malnutrition may be a "baseline level" caused as much by poor health conditions as by food stress. The high incidence of diarrhoea and vomiting in both malnourished and severely malnourished children highlights the need for co-ordinated preventive and promotive health care strategies to accompany attempts to reduce food stress. Forty percent of all malnourished children, however, had no identifiable concurrent illness at the time of the survey. As highlighted in the surveys of 1986 and 1987, more information is required about the functional significance of the 80% weight for height cut off in terms of health and development of children in Red Sea Province.
Despite the technical limitations associated with the measurement of children less than 75 cm in height, the continuing high rates of malnutrition seen in this height category should be a cause for concern and future investigation.
The Oxfam nutritional surveillance teams encountered continued strong resistance to the weighing and measuring of children. Ground teams for the aerial survey who were touring Red Sea Province at the same time reported seeing women and children running from settlements as their vehicle approached. On enquiring about this, they were told the women were hiding the children in case they had to be weighed. Apart from the bias that this introduces to the sample, it seems highly undesirable to enforce such obviously unpopular practices. This is not the type of relationship between the Beja and Oxfam which will enhance long term development efforts based on trust and open communication. The time has come to seriously investigate alternative forms of nutritional surveillance, or to abandon this line of research completely in favour of less invasive measures. There are no plans for further Oxfam nutritional surveillance in the immediate future.