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
CDC. A manual for the basic assessment of nutrition status in
potential crisis situations. Atlanta, Georgia: Department of
Health and Human Services, 1981.
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).
Kloth TI, Burr WA, Davis JP, et al. Sahel nutrition survey,
1974.
Am J Epidemiol 1976;3:383-90.
de Ville de Goyet C, Seaman J, Geijer U. The management of
nutritional emergencies in large populations. Geneva: World
Health Organization, 1978.
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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