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International Notes Evaluation of Drought-Related Acute Undernutrition -- Mauritania, 1983

In August 1983, the government of the Islamic Republic of Mauritania requested emergency food assistance from several international agencies to relieve major food shortages resulting from the worst drought since the early 1970s. The various donors were asked to accept responsibility for providing food and emergency health services in different segments of the country's 12 regions, which have a combined population of 1.6 million persons. The U.S. Agency for International Development (USAID) accepted responsibility for three of the most severely affected regions: Adrar (population 55,000), Tagant (population 70,000), and Trarza (population 235,000). Using CDC methodology for nutritional assessment in emergency situations (1), surveys were performed in these three regions between September 1983 and November 1983.

A total of 300 children in Adrar, 360 in Tagant, and 870 in Trarza who were between the ages of 6 months and 5 years were included in the survey. Levels of acute undernutrition, defined as greater than two standard deviations below median weight-for-height using National Center for Health Statistics/Centers for Disease Control/World Health Organization standards (2), exceeded 10% in all three regions (Table 1); normally, 3% or less of children fall below this weight-for-height level, due to reasons other than food deprivation. These levels of undernutrition were equal to or higher than those reported for Mauritania in surveys done during the 1969-1974 Sahelian drought (3). However, little overt marasmus and no kwashiorkor were seen. Scurvy was observed in two of the regions, and xerophthalmia was observed in two of the regions at levels high enough to warrant widespread vitamin A prophylaxis. History of recent diarrhea was common. In the two regions where immunization status was assessed, only one-third of eligible children had been immunized against measles. Food aid had been received by a majority of families, but often the rations were incomplete or were not delivered frequently enough to ensure minimum recommended daily caloric intake (4). Furthermore, although protein intake exceeded daily requirements, the diet contained negligible amounts of both vitamins A and C. Reported by the Government of the Islamic Republic of Mauritania; U.S. Agency for International Development, Nouakchott, Mauritania; Office of Foreign Disaster Assistance, US Agency for International Development, Washington, DC; International Health Program Office, Div of Reproductive Health, Div of Nutrition, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: The goals of the nutrition surveys performed in Mauritania were: (1) to determine the magnitude of nutrition-related health problems; (2) to determine which groups in the population were at greatest risk; (3) to determine the prevalence of other health conditions that could exacerbate the health status of an already malnourished population; and (4) to provide a baseline for intervention programs. In part, because of the survey findings, USAID has worked with the government of Mauritania to encourage more adequate and timely distribution of wheat, vitamin-fortified milk powder, and oil rations. Temporary supplementary feeding centers have been set up in main population centers, and USAID has distributed large quantities of oral rehydration salts and vitamin C tablets in the three regions for which it has accepted responsibility. A national plan for xerophthalmia prophylaxis and treatment is being developed, and efforts are under way to intensify the current mobile and fixed center immunization programs. Finally, a mortality and nutrition surveillance system designed to provide information useful in targeting relief efforts is being field-tested in the Adrar region. This system uses village leaders to collect simple census and demographic data, periodic age- and sex-specific mortality data, and arm circumference measurements of children.

CDC also participated recently in a health and nutrition assessment in Mozambique (5). Such population-based studies have been useful in planning and monitoring emergency food assistance programs. AID* has notified its missions in other drought-affected countries in Africa about the availability of this type of technical assistance.

References

  1. CDC. A manual for the basic assessment of nutrition status in potential crisis situations. Atlanta, Georgia: Department of Health and Human Services, 1981.

  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: Data from the National Health Survey, no. 165).

  3. Kloth TI, Burr WA, Davis JP, et al. Sahel nutrition survey, 1974. Am J Epidemiol 1976;3:383-90.

  4. de Ville de Goyet C, Seaman J, Geijer U. The management of nutritional emergencies in large populations. Geneva: World Health Organization, 1978.

  5. Rutherford GW. Use of nutritional morbidity and mortality surveys in planning a disaster relief program, Mozambique. Presented at the 33rd Annual Conference of the Epidemic Intelligence Service, Atlanta, Georgia, April 1984. *AID refers to the parent agency in Washington, D.C.; USAID refers herein to the AID mission in Mauritania.



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