Trends in malnutrition prevalence and mortality

The May 2010 issue of the Centre for Research on the Epidemiology of Disasters (CE-DAT) publication, CE-DAT Scene¹ includes a summary of the 2009 trends in malnutrition and mortality. These make interesting reading.

Prevalence of global acute malnutrition

Out of 99 settings in Africa and Asia for which data from both 2008 and 2009 were available, 48% showed an increase in the prevalence of global acute malnutrition (GAM) and 42% show a decrease. Kenya and Sudan, in particular, were countries where the nutritional situation worsened considerably. The Mandera district in Kenya's North Eastern province had the highest reported prevalence's of GAM (31.9% and 31.3%). Compared to 2008 figures, this represented an increase in of the order of 5 to 10%. In the east of the district, at the border with Ethiopia and Somalia, the situation improved with GAM levels decreasing from between 26 and 27%, to 20%.

In Sudan, the nutritional deterioration was less substantial than in Kenya. Here, the increase in GAM prevalence was generally less than 5%. An exception was Aweil East county in North Bahr-El-Ghazal, where GAM prevalence almost doubled compared to 2007, going from 16% to 29.5%. Balliet county in Upper Nile, on the other hand, experienced a considerable decrease in prevalence from 28.8% in 2008 to 22% in 2009.

In 2009, the GAM prevalence in two refugee camps in Bangladesh were at their highest levels since 2005 and the second highest since 1998. Compared to 2008, the prevalence doubled from 8.5% and 9.2% for Kutupalong and Nayapara, respectively, to 17.9% in both camps in 2009.

More positive developments were seen in Somalia. The Somaliland regions of Awdal, Togdheer and Woqooyi Galbeed halved the prevalence of GAM from around 20% to about 10%. In general, the situation in Puntland also improved, with the exception of its capital city Garowe. Here, GAM prevalence among the internally displaced population (IDPs) increased from 21.2% in 2008 to 24% in 2009. Regions south of Mogadishu reported a slight increase in malnutrition prevalence.

Surveys conducted in the north of Cote d'Ivoire showed a decrease in GAM prevalence from around 17% to values between 6.8% and 8.5%.

Crude mortality rate

Of the 48 locations for which crude mortality rates (CMR) from both 2008 and 2009 were available, 44% had higher rates in 2009 than in 2008 while 40% had lower rates. Seventeen percent remained unchanged.

Similarly to malnutrition prevalence patterns, the North Eastern province of Kenya had the greatest deterioration in CMR.

Overall, rates in 2009 were about twice as high as the rates of 2008. Although all rates were below the emergency threshold of 1 death/10,000/year, the trend is alarming.

Sudan also showed some alarming CMR patterns, especially in the Kurmuk area, Blue Nile State. The CMR in 2009 was 1.3/10,000/day, compared to 0.9/10,000/day in 2008. The situation has been alarming for several years and is mainly due to the high number of diarrhoea-related deaths, indicating a need for more water, sanitation and hygiene assistance projects.

Surveys from North Bahr-El-Ghazal also reported increasing CMRs from 0.2/10,000/day in 2008 to 0.7/10,000/day in 2009, the highest rates since 2003. Finally, Twic area in Warab state had a 2009 CMR of 0.9/10,000/day, 0.3 higher than in 2008 and just below the emergency threshold.

Positive trends were reported in Somalia. Most of the locations had lower CMRs in 2009 compared to 2008. Noteworthy are the improvements in the Awdal region (0.5 v 1.1), Bossaso city (0.4 v 1) and Togdheer (0.6 v 1.1). The Shabelle and Juba regions around Mogadishu, however, remain of concern with mortality rates often increasing and almost all above the emergency threshold.

Under five mortality rate

Fifty one percent of the locations (25/55) reporting under five mortality rates (U5MR) in 2008 and 2009 had lower U5MRs in 2009 compared to 2008. For three locations, 2009 rates were equal to those of 2008, and the remaining locations had higher figures in 2009.

Unlike CMR, Kenya did not show a particularly alarming trend. Areas where U5MR was elevated in 2008 had lower rates in 2009 and those areas where U5MR increased in 2009 remained within an acceptable range. The highest reported value was 1.5/10,000/day in the northern part of Mandera district, North Eastern province.

In Sudan, U5MR patterns followed the CMR trends. Main areas of concern are Kurmuk area, Blue Nile state (2.8) and Twick area, Warab state (2.3), as well as Aweil north and Aweil West in North Bahr-El-Ghazal, where U5MR increased from 0.3/10,000/day in 2008 to 1.2/10,000/day in 2009.

The biggest improvement is again in Somalia where, except for Gedo, Jubaland and Lower Shabelle, all locations had U5MRs below the emergency threshold. Gedo had the highest U5MR with 2.7/10,000/day, a doubling compared to 2008. Finally, a survey conducted among displaced people in Garowe city in Nugaal region reported an important increase from 0.3 in 2008 to 1.3/10,000/day in 2009.

¹CE DAT SCENE (2010). Newsletter 13 - May 2010