5. DISCUSSION
- Nutritional status
Global acute malnutrition was observed to be within the range 3.1% to 7.1% (5.1%), exhibiting a slight decrease from the February 2002 range of 3.7% to 8.0 (5.8%), indicating a slight improvement of the nutrition situation.
The study identified marked age and gender difference in acute malnutrition. Whilst more females are acutely malnourished than boys at the age of 6 to 29 months, the opposite is true as they grow older (30-59 months). Acute malnutrition also was found to be more prevalent in children between the ages of 6 and 29 months due to their higher susceptibility to changes in household food security. The gender differences however require further investigations as to the childcare and feeding practices (intra-household food distribution).
Relative to neighbouring Binga district, which has similar agro-ecological conditions and household economy, the rate of acute malnutrition remains higher. This may be due to the continued presence and complementarity of SC (UK) and Catholic Commission for Justice and Peace (CCJP)/ Catholic Development Commission (CADEC) projects - general rations and supplementary feeding respectively.
Table 12: Comparison of Malnutrition Rates
| Area and Date of Survey |
|
|
|
|
|
| Nyaminyami (July 2002) |
|
|
| Nyaminyami (Feb 2002) |
|
|
| Binga (May 2002) |
|
|
| National (2002)13 |
|
|
Little statistical correlation with water and sanitation was found and disease played a less significant role than in February 2002 (RR = 1.8). Consequently, changes in acute malnutrition may be attributed to either care related or food security constraints. Two possible ways in which food security may have changed since February are in relation to seasonal factors and the provision of food aid. The current assessment was carried out 3 months after the harvest period, and even though harvests were small in Nyaminyami, the food availability situation was better than in February. In relation to food aid, after the first survey Christian Care began implementing general food distributions under the World Food Programme, an exercise that may also have contributed to the decrease.
That said, we might have expected to have seen a greater decrease in malnutrition rates as a result of these factors. The lack of significant improvement in nutritional status may be due to the poor harvest, the fact that Christian Care rations were fixed at a maximum level of 5 people per household, and that beans were not always available for distribution. The latter factor meant that beneficiaries only received maize grain and sometimes cooking oil. Due to communities' reliance on food aid, this left them with no source of dietary protein hence the increase in oedematous malnutrition. According to the HEA, a large portion of expenditure on food was restricted to staple food purchases, for the poor and middle, maize was very dominant, whereas the better off bought a more varied food basket
Despite the low rate, aggravating factors in malnutrition, namely high respiratory and diarrhoeal disease prevalence, still exist, thus classifying the situation as a risky situation - one that requires development agencies to be "alert" in as far as the livelihood security situation is concerned14;15 . The lack of significant improvement in spite of the interventions currently underway further further emphasises this.
The finding that the rate of acute malnutrition in children from households that can be defined as "poor" in relative terms in the district is more than twice the rate for the "better off" provides a strong indication that acute malnutrition is linked to overall poverty levels within the district.
The chronic malnutrition rate was found to be 38.8%, a level which indicates a compromise in children's physical and cognitive development which will compromise future productivity. This is a result of chronic calorific deficit (or poor health conditions) resulting in stunted growth. The result shows that 38.8% of the children in Nyaminyami are likely not to achieve their genetic potential in terms of both physical and intellectual potential. The high rate reflects the chronic livelihood constraints prevalent in the district.
- Coping Strategies
Observations during the survey period and the May HEA revealed existence of the following indications of nutritional risk:
- Drought and subsequently decreased production
- Major pests (tsetse) affecting crops or livestock
- Declining food stocks at household, district and national level
- Rising market prices
- Evidence of excessive sale of household assets.
- Shift to eating crisis ("famine") foods
These shocks and stresses directly affect coping (- the first four), and demonstrate an end to coping (- the latter two), rendering communities vulnerable to the prevalent nutritional shocks and stresses. As such, it is imperative that agencies continue to avert disaster through provision of food aid until such a time when communities can be assisted to get back on their feet.
Acute malnutrition, or wasting, is not yet a problem of public health significance, but indicators suggest coping mechanisms have been exhausted. The rate has dropped by only 0.7% in spite of the harvest and food aid provided in the district.
- Measles vaccination coverage
Measles vaccination coverage was found to be low in Nyaminyami district. However, in a bid to eliminate measles, the Ministry of Health in collaboration with UNICEF embarked on a national immunisation and Vitamin A supplementation campaign in July 2002 where all children between 9 and 59 months were targeted to be given an extra measles dose regardless of their immunisation status. Vitamin A was also administered to all children between 6 and 71 months. This presumably increased the coverage of measles vaccination significantly.
Footnote:
- Ministry of Health and Child Welfare\UNICEF; National Nutrition Assessment - Preliminary results
- WHO - Rapid Health Assessment, 1999
- UNHCR/WFP: Guidelines for Selective Feeding Programmes in Emergency Situations. 1999
|
