Limits...
Child acute malnutrition and mortality in populations affected by displacement in the Horn of Africa, 1997-2009.

Mason JB, White JM, Heron L, Carter J, Wilkinson C, Spiegel P - Int J Environ Res Public Health (2012)

Bottom Line: GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations.The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention.This could help to prioritize limited resources in the current situation of food insecurity and save lives.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70118, USA. masonj@tulane.edu

ABSTRACT
Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997-2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, < -2SDs of references plus edema: GAM) were extracted from reports of 1,175 surveys carried out between 1997-2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20-25% GAM in pastoral populations and 10-15% GAM in agriculturalists are suggested. The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention. This could help to prioritize limited resources in the current situation of food insecurity and save lives.

Show MeSH

Related in: MedlinePlus

Percentage of surveys with U5MR > 1/10,000/day by range of GAM %, by livelihood group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3367278&req=5

ijerph-09-00791-f003: Percentage of surveys with U5MR > 1/10,000/day by range of GAM %, by livelihood group.

Mentions: A question relevant to decision-making on needs for emergency intervention concerns when the U5MR is expected to be elevated; GAM is relevant when U5MR is not assessed (as in one third of the data here), and to add to the interpretation of new survey results when it is. The percentage of surveys with U5MR > 1/10,000/day by range of GAM (equivalent to the positive predictive value) is shown in Figure 3, separately for livelihood groups, and by time period cut at 2005, since the relation between GAM and U5MR was shown to change through time (see Figure 2). We can thus estimate the GAM at which the U5MR starts to rise. In the agricultural population, this is at 15% GAM or higher, more pronounced before 2005: thus for example over the whole time period, below 15% GAM 33% of surveys gave U5MR > 1/10,000/day, this rose to 55% after GAM of 15%. In the pastoral population over the whole period 50–60% of surveys with GAM less than 25% had elevated U5MR, and this rose sharply to over 80% above 25% GAM. In line with the observed decrease in U5MR (but not GAM) since 2005, the percentage of surveys with elevated U5MR is less in the more recent time period, for both livelihood groups, and the cut points less clear. In the earlier period there was less assistance (which is likely to account for at least part of the differences between periods), thus in a new situation before assistance is launched the earlier U5MR-GAM relation may be the more appropriate. Together with the results in Table 5, this suggests GAM cut-points of 10–15% for agricultural populations and 20–25% for pastoralists, for indicating likely sharp increases in U5MR, particularly when there is minimal assistance in place. The dotted horizontal lines in Figure 1A–C represents the higher levels of these suggested cut-points for GAM.


Child acute malnutrition and mortality in populations affected by displacement in the Horn of Africa, 1997-2009.

Mason JB, White JM, Heron L, Carter J, Wilkinson C, Spiegel P - Int J Environ Res Public Health (2012)

Percentage of surveys with U5MR > 1/10,000/day by range of GAM %, by livelihood group.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3367278&req=5

ijerph-09-00791-f003: Percentage of surveys with U5MR > 1/10,000/day by range of GAM %, by livelihood group.
Mentions: A question relevant to decision-making on needs for emergency intervention concerns when the U5MR is expected to be elevated; GAM is relevant when U5MR is not assessed (as in one third of the data here), and to add to the interpretation of new survey results when it is. The percentage of surveys with U5MR > 1/10,000/day by range of GAM (equivalent to the positive predictive value) is shown in Figure 3, separately for livelihood groups, and by time period cut at 2005, since the relation between GAM and U5MR was shown to change through time (see Figure 2). We can thus estimate the GAM at which the U5MR starts to rise. In the agricultural population, this is at 15% GAM or higher, more pronounced before 2005: thus for example over the whole time period, below 15% GAM 33% of surveys gave U5MR > 1/10,000/day, this rose to 55% after GAM of 15%. In the pastoral population over the whole period 50–60% of surveys with GAM less than 25% had elevated U5MR, and this rose sharply to over 80% above 25% GAM. In line with the observed decrease in U5MR (but not GAM) since 2005, the percentage of surveys with elevated U5MR is less in the more recent time period, for both livelihood groups, and the cut points less clear. In the earlier period there was less assistance (which is likely to account for at least part of the differences between periods), thus in a new situation before assistance is launched the earlier U5MR-GAM relation may be the more appropriate. Together with the results in Table 5, this suggests GAM cut-points of 10–15% for agricultural populations and 20–25% for pastoralists, for indicating likely sharp increases in U5MR, particularly when there is minimal assistance in place. The dotted horizontal lines in Figure 1A–C represents the higher levels of these suggested cut-points for GAM.

Bottom Line: GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations.The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention.This could help to prioritize limited resources in the current situation of food insecurity and save lives.

View Article: PubMed Central - PubMed

Affiliation: School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70118, USA. masonj@tulane.edu

ABSTRACT
Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997-2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, < -2SDs of references plus edema: GAM) were extracted from reports of 1,175 surveys carried out between 1997-2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20-25% GAM in pastoral populations and 10-15% GAM in agriculturalists are suggested. The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention. This could help to prioritize limited resources in the current situation of food insecurity and save lives.

Show MeSH
Related in: MedlinePlus