Nutritional surveys in Iraq: a call for improved quality

Summary of published paper¹

Nutrition surveys can provide useful information if implemented using standardised methods

Many reports on Iraq have claimed to demonstrate a rise in death and disease rates since the Gulf War of January/February 1991 and the economic sanctions that followed. There has however been a great deal of disagreement regarding the magnitude of morbidity and mortality increases and their cause. A recent study reviewed twenty-seven surveys on the nutritional status of Iraqi children in the 1990s.

The study found that many once-off small scale nutrition surveys have been of little value. These studies, although limited in resources and population access in a tense political environment, could have contributed far more if they had used standardised and comparable measurements methods, had specified the method of sample selection used and had assured data accuracy by providing appropriate training and field supervision for data collectors. Even more useful would have been some coordination among researchers to assure that the onetime studies built on, and were comparable to, previous studies.

Far more valuable were five large-scale studies. These contributed, not only to identification of levels of malnutrition, but also permitted characterisation of health education and promotion needs, and helped prioritise spending in the oil for food programme. In addition, they showed the limited impact of goods provided by the 'oil for food programme' in the first fifteen months of implementation.

Future surveys need not suffer from many of these limitations. If implemented using standardised methods and well-defined populations, small studies can provide useful information on nutrition trends. With even a small amount of co-ordination, such studies can be used to assess previously surveyed populations to provide a time series or un-surveyed groups, so as to acquire supplementary information for better characterisation of the overall population. The large, reliable studies can be stored in public access data banks. This would provide baseline information for those interested in providing followup studies in a local area.

The study concluded that 'given the depth of the humanitarian crisis in Iraq, the large population exposed to malnutrition, and the long duration of sanctions, we now have an opportunity to learn from past shortcomings to improve humanitarian assessment and action'.

¹Studies of young child malnutrition in Iraq: Problems and insights, 1990-1999: Garfield. R. Nutrition Reviews, Vol 58, no 9, pp 269-277