Presentation by Claudia Hudspeth, UNICEF Nutrition and Health Advisor, RIACSO
(This information can be found in the power-point presentation on the accompanying CD-ROM or on
www.sahims.net)
In April 2003, UNICEF, in collaboration with partners and Governments in the six crisis affected countries in the region, undertook a regional assessment of nutrition trends utilizing information from Demographic and Health Surveys and nutrition surveys undertaken during the crisis period. The presentation gave an overview of the findings as well as updates for countries with new nutritional information including Mozambique, Malawi and Zimbabwe.
The main conclusions from the regional review are as follows:
- Zambia, Malawi and Mozambique continue to have unacceptably high rates of malnutrition.
- The slow national trend of improvement in the 1990s ceased, except in Lesotho; Zimbabwe and Zambia showed a deterioration in 2001-2003.
- National averages hide large sub-national differences, with some districts showing significant improvements, while others have deteriorated.
- The nutritional status has deteriorated in the areas with originally better nutrition and improved in areas with originally worse nutrition.
- Younger children show deterioration, while older children show apparent improvement
- HIV/AIDS correlates negatively with nutritional status, but positively with the deterioration of nutritional status. The rate of deterioration is higher in urban areas than rural areas.
- Nutritional status is worse among children who are orphaned.
- The current HIV/AIDS pandemic will directly and indirectly increase young child malnutrition.
Indicative information from Mozambique suggests the nutritional status of children under five may have deteriorated further since the multi-sectoral assessment undertaken in December 2002. Areas showing deterioration are those with a concerning food security situation, high HIV/ AIDS prevalence, high proportions of child headed households and high levels of diarrhea and other illness. This requires close follow-up and monitoring.
Nutrition assessments were undertaken in 17 of Malawi's 24 districts in April and May 2003. Preliminary data from nine of ten districts, with data available, suggests an improvement in the levels of acute malnutrition. In one central district there has been an increase in the prevalence of acute malnutrition.
New, preliminary data from the national nutrition survey undertaken in Zimbabwe in February 2003 shows that while the national levels of malnutrition are not alarming (underweight at 17.2% and wasting at 4.4%), there are large differences in prevalence of malnutrition between districts. Particularly concerning is the high levels of severe malnutrition, with 25% of districts in Zimbabwe having alarming levels of severe malnutrition in children under the age of five. This finding while similar to other countries in the region presents a large divergence from what used to be a relatively good nutritional situation in Zimbabwe. In addition, areas in Zimbabwe exhibiting greater deterioration in nutritional status include both major urban centers and the provinces with high prevalence of HIV/ AIDS. This finding is similar to other countries in the region. Furthermore, the Zimbabwe data reflected the changing patterns of mortality in countries with high levels of HIV/AIDS prevalence. In Zimbabwe, the 20 - 45 age group, who are the most productive segment of society, accounted for 49% of the deaths, followed by the 1-5 years of age (17%) and the 5-19 years age group (10%). Lastly, the Zimbabwe survey showed a greater prevalence of malnutrition in orphans, indicating the need for enhanced programming and targeting of orphans and vulnerable children.
The regional presentation highlighted the importance of tackling the determinants of malnutrition that include not only food but access to adequate health care and proper caring practices.
Recommendations for actions are:
- To strengthen nutrition surveillance systems in all SADC countries
- To study the efficiency and effectiveness of the humanitarian response in 2001-2003
- To scale up programming around nutrition and HIV/ AIDS in the context of an integrated framework
- To scale up feeding programmes, especially therapeutic feeding programmes in countries with high levels of severe malnutrition
- To further refine programme targeting
- To study the relative importance of food, health and care in contributing to young child malnutrition
- To study the relationship between young child malnutrition and HIV/ AIDS
Issues raised in the discussion following the presentation included:
- The need to have data disaggregated by gender so as to help understand causality.
- The importance of tuberculosis and burden of disease in these studies, even though it usually only affects adults.
- The need to develop a different gauge to measure adult malnutrition.
- The need for the information gathered on nutritional status to be more efficient and more targeted to the "hotspots."
- The need to look into causality behind malnutrition especially in the context of HIV/ AIDS
- The importance of ensuring that aggressive work is done to determine food needs/basket as a component of an appropriate approach to dealing with HIV/AIDS. The SADC secretariat has begun working on this issue and health ministers in the region have recognized the importance of working with the food security group to secure a cross sectoral approach. Community level responses are key to successful interventions.
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