Emergency Nutrition and Mortality Survey in Northeastern Chad

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Emergency Nutrition and Mortality Survey in
Northeastern Chad
May- June 2004
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Background

• Nutritional status, morbidity and retrospective
  mortality was assessed among three populations
  
• Sudanese refugees in spontaneous border
  settlements
  
• Registered refugees in camps
• Indigenous populations in the proximity of camps

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Bahai and Cariari spontaneous settlements

• Methodology
• Systematic random sampling
• Households sampled n263
• Children 6-59 months n422

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Results Bahai and Cariari spontaneous settlements

• Among children aged 6-59 months
• Global Acute Malnutrition 39.2
• Severe Acute Malnutrition 6.4
• Measles vaccination 23.9
• Reported diarrhea 35.1
• Reported ARI symptoms 50.6

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Results Bahai and Cariari spontaneous settlements

• Among households
• Received food in June distribution 90
• Shared June food distribution with other
  families 28
  
• Median hours to nearest available water 4
• Living without shelter 98

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Figure 1 Distribution of weight-for-height
z-scores, Bahai and Cariari settlements,
Northern Chad, May-June 2004 survey
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Refugee camps of Iridimi, Touloum and Kounoungo

• Methodology
• Cluster sampling in Iridimi and Toulom and
  systematic random sampling in Kounoungo
  
• Households sampled n293
• Children 6-59 months n430

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Results in Refugee camps of Iridimi, Touloum and
Kounoungo

• Among children aged 6-59 months
• Global Acute Malnutrition 35.6
• Severe Acute Malnutrition 5.5
• Measles vaccination 83.1
• Reported diarrhea 58.2
• Reported ARI symptoms 72.5

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Results in Refugee camps of Iridimi, Touloum and
Kounoungo

• Among households
• Received food in June distribution 99
• Shared June food distribution with other
  families 24
  
• Median hours to nearest available water 3

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Figure 2 Distribution of weight-for-height
z-scores, Iridimi, Konongo and Touloum camps,
North-eastern Chad, May-June 2004 survey
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Indigenous population in the areas ofIridimi,
Touloum and Bahai

• Methodology
• Convenience sample
• Households sampled n115
• Children 6-59 months n175

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Results Indigenous population in the areas
ofIridimi, Touloum and Bahai

• Among children aged 6-59 months
• Global Acute Malnutrition 35.0
• Severe Acute Malnutrition 3.7
• Measles vaccination 31.6
• Reported diarrhea 45.8
• Reported ARI symptoms 58.3

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Results Indigenous population in the areas
ofIridimi, Touloum and Bahai

• Among households
• Shared June food distribution with other
  families 87
  
• Median hours to nearest available water 3

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Figure 3 Distribution of weight-for-height
z-scores, Chadian villages, North-eastern Chad,
May-June 2004 survey
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Aggravating Factors

• Onset of rainy season
• Access to population on border limited
• Continued threat of violence

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Conclusions

• Levels of Global Acute Malnutrition (GAM)
  indicate a serious crisis
  
• Compared to GAM, crude mortality rates are still
  relatively low but may increase rapidly
  
• Measles immunization coverage is dangerously low
  in the frontier settlements
  
• Rates of diarrheal disease are very high
• If immediate action is not taken the combination
  of these factors may lead to increases in serious
  illness and death
  

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Comparison of Global Acute Malnutrition and Crude
Mortality Rates Refugees in Goma (1994), Gode,
Ethiopia (1999-2000) and Chad (2004

Comparison of Global Acute Malnutrition and Crude
Mortality Rates Refugees in Goma (1994), Gode,
Ethiopia (1999-2000) and Chad (2004)

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MSF Guidelines define 40-50 GAM as a famine
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35.6 ?
35
29.1
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Children with Global Acute Malnutrition (GAM)
(weight for height
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Adult Crude Mortality Rate (/10,000 persons/day)
MSF Guidelines define 20 GAM as a serious
crisis
20.5
20
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13.0
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3.2
5
2.6
Emergency Threshold is 1 / 10,000 persons / day
0
(1994)
(June, 2004)
(1999-2000)
Varying Crude Mortality Rates are possible
given different population estimates. A CMR of
13.0 is lower than other calculations that range
up to a CMR of 31.2/10,000 per day.
? Refugee camps Global Acute Malnutrition (GAM)
of 35.6 Frontier settlements GAM of 39.2.
Emergency threshold for crude mortality is 1
/ 10,000 persons / day Refugee camps Crude Mo
rtality Rate of 2.6 assumes that any missing
persons are dead. CMR without inclusion of
missing persons is 1.6. Frontier settlements
Crude Mortality Rate of 1.1 including missing
persons and .6 without inclusion of missing
persons.
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Food Recommendations

• Blanket supplementary feeding program for all
  children less than 5 years of age and pregnant
  and lactating women and the vulnerable
  
• Expand selective feeding programs for severely
  and moderately malnourished children
  
• Increase the level and coverage of the general
  food ration
  

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Health Recommendations

• Increase measles vaccination and Vitamin A
  coverage immediately
  
• Implement water and sanitation programs to
  prevent diarrheal diseases
  
• Provide shelter

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Other Recommendations

• Increase in number of staff and improve living
  conditions for their work
  

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Acknowledgements

• UNHCR, Geneva
• UNHCR, Abeche, Guerida, Iriba and Ndjamena
• UNICEF Chad
• WFP Chad
• MOH Chad- Chadian Centre for Nutrition and
  Technology
  
• WHO Chad
• IRC
• MSF Belgique
• IMC
• CARE
• CDC- International Emergency and Refugee Health
  Branch, Division of STD Prevention and the
  Special Pathogens Branch
  

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