International Notes Rapid Nutritional Status Evaluation During Drought Conditions -- Republic of Niger

During the 1984 summer growing season, Niger experienced a severe drought. National food production was estimated to be 44% of that in 1983 (1). In response to the drought, the Government of Niger (GON) and the U.S. Agency for International Development (USAID) invited CDC to participate in a nutritional status assessment. Using previously developed CDC nutrition survey methodology, survey sites were chosen randomly in each of the seven departments of Niger. Between December 1984 and February 1985, 3,264 children between 65 and 110 cm tall (approximately 6-59 months of age) were surveyed. A standardized questionnaire was used to record height, weight, arm circumference, measles vaccination status, recent illness, clinical evidence of vitamin A and C deficiencies, and food aid status for each child.

Few children in any of the departments were less than 70% of median weight-for-height (2) (Table 2). The overall prevalence of children less than 80% of median weight-for-height ranged from 9.8% in Diffa to 13.7% in Maradi. Rates of children with possible borderline nutritional status (80%-85% of median weight-for-height) were higher (12.9% in Zinder to 19.0% in Agadez) than expected rates in the United States (3%-7%), depending on age. Measles vaccination levels ranged from 32.8% in Tahoua to 56.2% in Maradi. Reported diarrhea rates in the 2 weeks before the survey ranged from 16.4% in Niamey to 40.3% in Agadez. Eye signs suggestive of vitamin A deficiency were found in 2.1% of the children in one department and in smaller numbers in three other departments. Widely varying percentages of families reported receiving food aid in the past year.

While the small sample size limits the conclusions that can be drawn from disaggregated data, nutritional status appeared to vary by type of settlement. Groups of displaced women and children who had spontaneously gathered in urban centers and who were not receiving organized nutritional support were more severely affected than families who remained in their rural villages and families who had been relocated to off-season garden sites* where food aid was being distributed.

Recommendations to the GON emphasized identification and emergency support of displaced women and children, as well as implementation of basic nutrition and health activities at the off-season garden sites and in the rural villages. Because of the logistic difficulties with continuing weight-for-height measurements on a population basis, nutritional status surveillance by arm circumference measurement was recommended. Reported by the Government of the Republic of Niger; US Agency for International Development, Niger, Office of Foreign Disaster Assistance, US Agency for International Development, Washington DC; Div of Nutrition, Center for Health Promotion and Education, International Health Program Office, CDC.

Editorial Note

Editorial Note: During the past decade, CDC epidemiologists have participated in a number of rapid nutrition evaluations in sub-Saharan Africa. These surveys provide population-based data that can be used in decision-making during emergent situations.

Because of the long lead time necessary to arrange effective international food aid, it is particularly important for national governments and relief agencies to be able to estimate the population at risk before food supplies are exhausted. Such data collection is thus most useful for planning purposes if done shortly after poor harvests. The data collected in these and similar surveys can be used to estimate both the number of currently undernourished children and the number of those children whose weight-for-height status (i.e., 80%-85% of median) suggests that they are at greatest risk of becoming acutely undernourished as the local food supplies are exhausted before the next harvest. These latter children, although not yet acutely undernourished, are also logical candidates for inclusion in supplementary feeding programs.

The widely varying rates of recent diarrhea (range 16.4%-40.3%) may in part be explained by the survey design; such characteristics tend to cluster by geographic area. However, prolonged or recurrent diarrhea may be responsible for precipitating severe undernutrition among children already in marginal nutritional status (3).

Rates of clinical signs of vitamin A deficiency in one province exceeded the criteria suggested by the World Health Organization as indicating the need for large-scale distribution of vitamin A capsules (4). Lower rates in other departments may indicate that vitamin A deficiency is a less severe problem in these areas or may simply reflect sampling variability due to the unavoidably limited sample sizes, which are not specifically calculated to detect conditions as infrequent as clinical vitamin A deficiency. Thus, these lower rates must be interpreted with some caution. Because rapid nutritional status evaluations cannot be expected to provide reliable estimates of vitamin A, large-scale prophylaxis with 200,000 I.U. capsules (3) is probably warranted if relief foods are not known to contain sufficient quantities of vitamin A.

The proportion of families receiving food aid also varied considerably by cluster. Most food aid was received by families in off-season garden sites, while few families who lived in sedentary villages or who camped around urban areas had yet received aid. Plans were made to establish mechanisms for delivery of food aid to families not already settled in off-season garden sites, with highest priority to be given to families already displaced by famine.

References

1. CDC. Unpublished data.

2. National Center for Health Statistics. NCHS growth curves for children, birth-18 years, United States. Rockville, Maryland: National Center for Health Statistics, 1977; DHEW publication no. (PHS) 78-1650. (Vital and health statistics; series 11, no. 165).

3. Black RE, Merson MH, Eusof A, Huq I, Pollard R. Nutritional status, body size and severity of diarrhoea associated with rotavirus or enterotoxigenic Escherichia coli. J Trop Med Hyg 1984;87:83-9.

4. de Ville de Goyet C, Seaman J, Geijer U. The management of nutritional emergencies in large populations. Geneva: World Health Organization, 1978:18. *Sites where families are relocated during the dry season to cultivate small vegetable gardens.

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