International Notes Rapid Nutrition Evaluation During Drought Conditions -- Burkina Faso, 1985

Burkina Faso, a landlocked Sahelian country with a population of 7.2 million, experienced a severe drought in late 1984 and early 1985. At the request of the U.S. Agency for International Development and the Government of Burkina Faso, a rapid evaluation of the nutrition status of children 65-110 cm tall (approximately 6-59 months of age) was undertaken. The survey was conducted in Soum and GnaGna, two of the eight drought-affected provinces in northern Burkina Faso. Ten villages in each province were randomly selected for data collection (1).

A random sample of 339 children in Soum and 366 children in GnaGna were included in the survey. Height, weight, and arm circumference of the children in each village were measured, and clinical examinations for edema and avitaminosis A and C were done on 30-40 children. A standardized questionnaire to evaluate the children's measles vaccination status, recent illnesses, and food consumption was administered to the mothers of children in the sample.

Acute undernutrition (less than 80% of the median weight-for-height (2,3)) was found in 10.6% of children in Soum and 5.7% of children in GnaGna (Table 5). Severe acute undernutrition (less than 70% of the median weight-for-height) was found in 1.8% of children in Soum and in 1.1% of children in GnaGna. However, an additional 14.2% of children in Soum and 11.2% of those in GnaGna were between 80% and 84% of median weight-for-height. Similar rates of undernutrition were detected by arm circumference less than 12.5 cm and weight-for-height less than 80% of the median; 7.7% of children in Soum and 4.9% of children in GnaGna had arm circumferences below this level. No kwashiorkor, as evidenced by pedal edema, was seen. Clinical signs of vitamin A and vitamin C deficiencies were found infrequently in both provinces. An episode of diarrhea within the past 2 weeks was reported among 21% of children in Soum and 11% of children in GnaGna. Sixty-five percent of the children in Soum and 59% in GnaGna had been immunized against measles. Among families surveyed in Soum, 88% were currently receiving food aid; none of the families surveyed in GnaGna were receiving aid.

Recommendations emphasized: (1) increased distribution of basic rations in the most severely affected provinces and of supplemental feeding for vulnerable groups in all the drought-affected provinces; (2) ongoing surveillance at the village level, as well as follow-up nutrition surveys in the drought-affected provinces, to monitor changes in nutrition status and to target populations at highest risk; (3) further identification and assessment of displaced families for targeting food aid, particularly for children and pregnant and lactating women; (4) increased distribution of measles vaccine and oral rehydration solutions to help prevent measles infection and diarrhea, diseases that are important causes of morbidity and mortality in undernourished populations. Reported by the Government of Burkina Faso; U.S. Agency for International Development, Ouagadougou, Burkina Faso; Office of Foreign Disaster Assistance, U.S. Agency for International Development, Washington, D.C.; International Health Program Office, Div of Nutrition, Div of Health Education, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: The rates of acute undernutrition found in these two provinces of Burkina Faso were not as high as those of other countries affected by the 1984-1985 drought, such as Chad and Sudan (4,5). However, 11%-14% of children surveyed were between 80% and 84% of median weight-for-height, a level indicating borderline undernutrition. In contrast, only 3%-7% (depending on height) of the U.S. reference population fall between 80% and 84% of median weight-for-height. These children in this range were probably at high risk of developing acute undernutrition, particularly since the survey was conducted 7-8 months before the expected harvest season, and food resources were rapidly being exhausted.

The investigators were able to sample only the stable populations in the provinces and were not able to measure the nutrition status of children whose families had migrated because of food shortages. Because those latter children would be expected to have a poorer nutritional status than those whose families remained in their villages, the results of this survey are minimal estimates of the severity of undernutrition among all children in the drought-affected areas.

Recommendations resulting from the surveys stressed early provision of food to prevent further undernutrition. However, attention was also given to other causes of morbidity and mortality in drought situations. These included: vitamin A deficiency, measles, diarrhea, and scurvy. Although the prevalence of clinically evident vitamin deficiency was low, the risk of deficiencies will increase if local food resources dwindle and the population becomes increasingly dependent on food aid, which consists primarily of grains low in vitamins A and C. Vitamin A deficiency is of particular concern, because it is the major cause of permanent blindness in preschool-aged children in the developing world and is easily prevented by vitamin A supplementation (6).

The prevalence of diarrhea was lower than that reported in the other surveys of drought-affected countries. However, diarrhea still represents an important potential source of morbidity and mortality in an undernourished population (7). Measles is a major cause of mortality in undernourished populations (5). Measles immunization levels were relatively high as a result of a recent nationwide immunization campaign; however, ongoing effort is needed to immunize those not reached by the campaign and those too young for immunization during the campaign.

Continued nutrition surveillance is necessary to help monitor changes in nutrition status and to target those at highest risk. In addition, attention should be given to assessing the nutrition status of children of displaced families and nomads who are at high risk of developing undernutrition during periods of food shortage.

References

1. CDC. Evaluation of drought-related acute undernutrition--Mauritania, 1983. MMWR 1984;33:565-7.

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. World Health Organization. A growth chart for international use in maternal and child health care. Geneva: World Health Organization, 1978.

4. CDC. Rapid nutritional and health assessment of the population affected by drought-associated famine--Chad. MMWR 1985;34:665-7.

5. CDC. Unpublished data.

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

7. Koster FT, Curlin GC, Aziz KM, Haque A. Synergistic impact of measles and diarrhoea on nutrition and mortality in Bangladesh. Bull WHO 1981;59:901-8.

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