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Growth and Malnutrition Among Preschool Children in Democratic Yemen G

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Growth and Malnutrition Among Preschool Children in Democratic Yemen G Bulletin of the World Health Organization, 66 (4): 491-498 (1988) © World Health Organization 1988 Growth and malnutrition among preschool children in Democratic Yemen G. BAGENHOLM,1 B. KRISTIANSSON,1 & A. A. A. NASHER2 A cross-sectional anthropometric study ofchildren aged 0-84 months was performed in 1982-83 in Democratic Yemen. The total sample included 3407 children, representing populations from urban, rural, and slum areas ofthe country. NCHS/WHO growth data were usedfor reference purposes. A high overall prevalence ofwasting (8. 7%) and stunting (35.2%) was found among the children. However, rural children exhibited a satisfactory weight-for-height during the first 6 months of life compared with both the reference and the urban and slum children. Slum children had a high prevalence of wasting during the first 18 months of life. For the younger age groups, rural children were shorter than urban children, but at 7years ofage all the children were similar, with a mean height-for-age corresponding to -1. 7 standard deviations ofthatfor the reference population. Mothers in the urban area weighed significantly more than those from the slum or rural areas (P <0.001), but all mothers had similar heights. Only a few studies have assessed growth and mal- years were eligible for inclusion in the study, and nutrition among children in Democratic Yemen. Table 1 contains demographic data on those sampled. Among these, a hospital-based study performed in Urban, rural, and slum populations were studied and 1976 showed an incidence of severe malnutrition the selection procedures outlined below were used. (cut-off level not defined) corresponding to 7 % of all children admitted (1). Also, in 1976 and 1978, 37% of children attending maternal and child health Urban population (MCH) centres in Aden were underweight, defined as Aden was chosen to represent the urban sample. a weight-for-age < 80% of that of the median of the Aden Governorate consists of four directorates, three reference population.a Two rural villages were of them in the city of Aden itself, while the fourth studied in 1978, and 44% of the children below 3 comprises the islands of Socotra and Perim. These years ofage were underweight (defined as 60-80% of two islands were excluded from the study, but the the Harvard standard for weight-for-age), while 12% three urban directorates were included. Each direc- had severe forms of malnutrition (<60% of the torate is made up of two or three districts, and where Harvard standard for weight-for-age). b districts in the same directorate were separated by These indications of an alarming nutritional situ- a non-residential area or road, all were included in ation prompted the present study, whose aim was the study (Seera directorate). In Meena and Asha'b to assess the growth of young children and mothers directorates, where two adjoining districts share and to measure the magnitude and prevalence of buildings and each district had its own maternal and malnutrition among children in different areas of the child health/family planning (MCH/FP) centre, a country. The study was carried out in 1982-83. coin was tossed to select one of the centres to repre- sent the districts. Data on the population as well as MATERIALS AND METHODS street maps for each directorate and district were All children in Democratic Yemen aged below 7 obtained. The size of the sample for each district/ directorate was proportional to its population relative 1 Department of Paediatrics I, Gothenburg University, East Hospital, S-416 85 Gothenburg, Sweden. Requests for reprints to the total urban population. should be sent to Dr Bagenholm at this address. In order to standardize the sample selection pro- 2 Friendship General Teaching Hospital, Aden, Democratic cedure in all the urban areas and minimize any bias, Yemen. since a mixture of socioeconomic levels was repre- a BAGENHOLM, G. Surveys of growth in children attending sented, the MCH/FP centre was used as the starting MCH centres in Aden city in 1976 and 1978. Stockholm, Radda point. A coin was first tossed to decide the direction Barnen, 1978. the street to proceed in order to select the first b KRISTIANSSON, B. ET AL. A pilot study ofnutrition and growth along of South Yemeni children. Results. Stockholm, Sweden, Radda household. Every house along the chosen direction Barnen, 1979. was then visited and all families with children below 4907 491- 492 G. BAGENHOLM ET AL. Table 1. Number of children investigated in the survey, by age group and area, Democratic Yemen Age group Months Years 0- 3- 6- 9- 12- 15- 18- 21- 2- 2.5- 3.5- 4.5- 5.5- 6.5- Area 2.9 5.9 8.9 11.9 14.9 17.9 20.9 23.9 2.49 3.49 4.49 5.49 6.49 7.00 Total Urban 22 23 34 53 29 41 27 29 66 117 125 119 122 53 860 Slum 19 17 18 20 16 11 14 14 43 45 55 53 53 21 399 Rural 85 88 104 126 92 50 99 87 165 298 299 280 267 108 2148 7 years of age were included in the study. If a cross- were selected that were typical of their respective road, junction, or end of a road was encountered, a areas with regard to social life, traditions, income- coin was tossed to define the next direction (right or generating activities, and degree of self-subsistency. left, etc.). The route to be followed in each area by the Villages whose total number of inhabitants ranged interview team, determined as described above, was from 1200 to 3500 were chosen, yielding 250-800 marked on the street map. The households that had preschool children per village. been selected for the survey were visited by the inter- The study in all the locations was performed by a viewers, who took all details, registered the eligible team of 17 individuals, 11 ofwhom participated in the children, and gave each child a serially numbered whole survey. Each house in the study areas was card. The family was instructed to bring their child or visited. In the rural villages, a census was also taken, children with the card(s) to the MCH/FP centre, whereas in the urban and slum areas only families where they were identified, examined, measured, and with children aged under 7 years were registered on weighed. the basis of house-to-house visits. Of 3607 eligible Mothers from only one directorate were measured children, 3499 (96%) participated in the study; how- and weighed. ever, 42 (1 %) were excluded because their question- naire forms were incomplete. The slum population The slum population studied consisted of all chil- Age assessment dren below 7 years of age who lived in the shanty In the urban area, 89% of the children had birth town of Dar Sa'ad in the northern outskirts of Aden certificates, while in the slum area the proportion was city. Although Dar Sa'ad was temporary in character, 83% and in the rural areas only 22.5%. The age of the population living there were often long-term resi- children without a birth certificate was assessed dents. The study area was one half of a well-defined with the aid of a local events calendar and a clinical entity, managed by the People's Defence Committee, examination. the local political administrative unit. Anthropometry The rural populations The weight and height of all children and mothers The rural populations were studied in seven differ- surveyed were determined. The weights of infants ent villages selected at random from four topographic and young children were measured to the nearest and five regional zones. The topographic zones com- 10 g on CMS portable-type field survey scales (model prised the coastal zone and plain, inland areas (300- 4125), while that of mothers was measured to the 1750 m above sea level), the highlands ( > 1750 m nearest 100 g on CMS model 4310 scales. Scales above sea level), and the Wadi Hadramaut (a valley were calibrated twice daily and checked against running approximately east-west in the inland areas). standard weights of 1 kg and 100 g. Double checks The regional zones consisted of the governorates were made periodically to ensure accurate pro- except Aden, which was already represented in the cedures. The heights of children aged > 2 years were urban sample. measured to the nearest millimetre with a Harpenden At least one village was selected from each topo- and Holtain portable stadiometer. Finally, the lengths graphic zone in a governorate. Because of the larger of children aged less than 2 years were measured to rural population in the inland areas, these were, the nearest millimetre with a Harpenden and Holtain however, represented by two governorates. Villages infant measuring table. ANTHROPOMETRIC STUDY OF PRESCHOOL CHILDREN IN DEMOCRATIC YEMEN 493 Growth reference data of the median of the reference population. From the values of weight and height obtained, the -Kwashiorkor: weight-for-age between -2 SD height-for-age, weight-for-height, and weight-for- and -3 SD of that of the median of the reference age were calculated for each individual child. The population and with oedema. results were categorized into age groups following previously recommended procedures (2). For refer- Statistics ence purposes, data from the National Centre for Data were compared using the x2 test and Student's Health Statistics (NCHS) were used (3) with the t-test. P-values less than 0.05 (5%) were considered modification suggested and elaborated by WHO (4), statistically significant. referred to hereafter as NCHS/WHO. All information was recorded on precoded forms and the subsequent calculations were performed RESULTS using a computer.
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