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  • Title: Nutritional status and early warning of mortality in southern Ethiopia, 1988-1991.
    Author: Lawrence M, Yimer T, O'Dea JK.
    Journal: Eur J Clin Nutr; 1994 Jan; 48(1):38-45. PubMed ID: 8200328.
    Abstract:
    OBJECTIVE: Ethiopian Government guidelines on nutritional survey data and relief provision call for intervention once mean weight-for-length (W/L) in an area falls below 90% of reference, on the basis that mortality is unlikely to rise until this level is reached. In this paper the appropriateness of the 90% cut-off is examined using data from Wolayita, southern Ethiopia. SURVEY DESIGN AND SUBJECTS: Fifteen to 25 villages are selected at random for survey each year, with all children 70-110 cm in length being followed up every 2 months. During the 3 years covered by these analyses 21,701 W/L measurements were made on 5455 children from 65 villages. 126 of the children died. RESULTS: In the first and third survey years, rapid declines in mean W/L were recorded, with mortality increasing very roughly three-fold (compared to year 2, P < 0.01), even though mean W/L remained at or above 90% of reference at all times. A logistic regression analysis relating mortality to W/L indicates that between 20% and 35% of the greater mortality in years 1 and 3 can be explained by the observed changes in W/L. The remainder occurred because of an increase in underlying or background risk (which might perhaps be expected in the circumstances of generally deteriorating nutritional status). CONCLUSIONS: The results suggest that child mortality is likely to increase before area mean W/L falls to 90% of reference, indicating that emergency interventions should be triggered earlier than at present. Ethiopia has adopted a weight/length (W/L) standard of 90% of the reference group as indicative of high child mortality risk. This study compares trends in levels of W/L and child mortality. The study area in Wolayita area, southwest of Addis Ababa, is known for periodic high food insecurity requiring emergency food aid relief. Data were collected between November 1988 and October 1991 in 2 month intervals between November and September and 1 month intervals until October. All children under 110 cm in length were measured and weighed. The sample included 15 villages in 1988-89 and a subsample of 40-50 children per village, and 25 villages and all children (90-100) per cluster in 1990-91. The total number of children surveyed is 5455, of which 126 died within 2 months of measurement and 24 died without a 2 month measurement. The mean number of measurements per year ranges from 4.2 to 3.4. Results of logistic regression reveal that W/L declined until 1990 and after. Declines are apparent in post harvest periods; improvements occurred in the second half of the year. Mortality is found to be 3 times greater in year 1 and year 3 than in year 2. The annual mortality rate is found to be higher than for all of Ethiopia in those years. However, the logistic regressions indicate that the relative mortality risk is quite similar for all three years; the mortality risk at 80% W/L as a ratio of mortality risk at 100% W/L is 4.9, 5.6, and 4.6, respectively, for years 1, 2, and 3. The differences in mortality are attributed to mortality risk rather than from changes in W/L. Logistic regressions of the difference between the current W/L and the W/L in the previous 2 months indicates that the mortality risk was greater in years 1 and 3 than year 2 by a factor of three times among those with a rapid decline in W/L of 10% over 2 months. If the risk remains the same as in year 2, mortality risk may have increased by 39% in year 1 and 93% in year 3, or actual increases of 20% and 35% due to changes in W/L. Policy should change to more immediate intervention before the mean W/L falls below 90% of the reference. Particular attention needs to be directed to those with rapid declines of over 2% over a period of four months. Nutritional status data serve to confirm a developing crisis, and change in W/L and level of W/L are important.
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