EXECUTIVE SUMMARY
1. Introduction
Nyaminyami (or Kariba Rural) district is ranked as the least developed district in all of Zimbabwe¹ . The communal lands are mainly classified as natural regions IV and V, and agriculture also suffers from destruction of produce by wildlife from Matusadona Game Park within the district. As of February 2002, 5.8% of children were acutely malnourished, while 34.1% were chronically malnourished.
In line with Save the Children (UK)'s ongoing situation assessment and reports by the District Food and Nutrition Management Team of imminent food insecurity, this assessment was commissioned.
2. Objectives
The objective of the current survey was to estimate the prevalence of acute malnutrition in children 6-59 months of age in Binga district. A similar survey was carried out in Nyaminyami in February 2002, thus secondary objectives were therefore to assess changes in acute malnutrition over the 4-month period, and to assist with understanding the impact of food aid programmes being implemented in the district. The survey was carried out soon after a household economy assessment, and so also served as a situation assessment.
3. Methodology
The nutrition survey was conducted from the 16th to the 21st of July 2002. 30 communities were selected from the area of interest, 30 children randomly selected from each selected community using standard household selection techniques. A total of 924 children were thus sampled, from whom measurements of physical growth (anthropometric measurements e.g. weight and height) were taken and analysed to compute indicators of nutritional status.
Acute or current malnutrition comprises wasting (marasmus) and kwashiorkor. Wasting (or "thinness") was assessed using the weight for height index, which expresses the weight of a child in comparison to his height. The index is based on comparison of weight and height measurements to reference values. The assessment of kwashiorkor or oedematous malnutrition was based on the presence of bilateral (symmetrical) oedema, which is the main clinical sign of kwashiorkor.
The two main signs of acute malnutrition are a decrease in the value of the weight for height index and the presence of oedema. The combination of these two signs and a cut off value for the index are used to define 2 classes of acute malnutrition - "moderate" and "severe", which are referred to as "global" acute malnutrition when combined.
4. Main results
The survey design requires that the true levels of malnutrition be presented within a range of values defined by what is called the confidence interval (C.I.). (This is the estimated prevalence plus or minus the precision achieved.) The 95% confidence interval implies that the probability of the true value lying within the range is 95%. In other words, we are 95% certain that the level of malnutrition is within the range presented
Global acute malnutrition defined by an index weight-for-height < - 2 Z-scores or presence of oedema: 5.1%
95% confidence interval: 3.1% to 7.1%
Severe acute malnutrition defined by an index weight-for-height < - 3 Z-scores or presence of oedema: 2.1%
95% confidence interval: 0.8% to 3.4%
Acute malnutrition was found to be relatively low 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. Acute malnutrition also was found to be more prevalent in children 6 -29 months due to their higher susceptibility to changes in household food security.
5. Conclusions
Acute malnutrition was found to be not yet a problem of public health significance, but indicators suggest coping mechanisms have been exhausted.
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 concerned.²³; The lack of significant improvement in spite of the interventions currently underway further emphasises this.
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 physical and intellectual potential. The high rate reflects the chronic livelihood constraints prevalent in the district.
As such, it is imperative that agencies continue to avert disaster through co-ordinated provision of food aid until such a time when communities can be assisted to get back on their feet.
6. Recommendations
From the survey findings, and considering findings from the HEA, it is recommended:
- To continue co-ordinated blanket food aid in the district in order to restore people's ability to obtain and produce food and provide an income transfer with which people can recover their health, welfare, education and a reasonable existence.
- To complement food aid by implementing supplementary feeding of malnourished children. Recommendation of both interventions is based on experiences drawn from the collective impact of the two in Binga district. While food aid serves as a livelihood support mechanism, supplementary feeding directly improves child nutritional status, hence the synergism.
- To consider increasing Christian Care - World Food Programme ration per household to ensure mean per-capita calorific returns from the programme that are close to average dietary requirements.
- To embark on agri-input support mechanisms, coupled with training in the appropriate crops and inputs for the agro-ecological conditions of the district. Due to the poor agricultural production and costs of coping so far experienced, it will be necessary to start rebuilding lives and livelihoods by supporting communities to get back on their feet in the coming season.
- To facilitate improvement of sanitation coverage coupled with health and hygiene education. Lack of toilets predisposes communities to unsanitary practices and concomitantly sanitation related communicable diseases.
- To improve, through action or advocacy, therapeutic feeding in the District Hospital to meet conditions stipulated in the WHO recommendations in Management of Severe Malnutrition in Children.
Footnotes:
- UNDP Zimbabwe Human Development Report, 2000
- WHO - Rapid Health Assessment, 1999
- UNHCR/WFP: Guidelines for Selective Feeding Programmes in Emergency Situations. 1999
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