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Democratic Republic of Congo Final Report Cross-sectional anthropometric surveys of children aged 6-59 months living in Mapela, Tshimungu, Kimbanseke and Lobiko Aires de Sante in Masina and Kimbanseke communes, Eastern Kinshasa Democratic Republic of Congo. 16-18 April 2001 Save the Children (UK), Democratic Republic of Congo 1 EXECUTIVE SUMMARY Objectives · To estimate the nutritional status of children aged 6 to 59 months · To determine the demographic composition of households · To estimate morbidity of children under five years · To estimate retrospective mortality of children under five years · To evaluate the coverage of feeding programmes in the population surveyed Methodology On 16-18 April, Save the Children (SC) conducted a cross-sectional anthropometric surveys of children aged 6-59 months living in 4 Aires de Sante (Mapela,Tshimungu, Kimbanseke, Lobiko) in Masina and Kimbanseke communes in the East of Kinshasa. 938 children were selected for the measurement of height, weight and oedema using two stage 30 by 30 cluster sampling. Information was also collected on current morbidity and attendance of feeding centres. Additional information from the 817 households visited on household composition and under fives mortality was also collected. Data was cross-checked before analysis and 6 children’s records were subsequently disqualified, leaving a total of 931 children for analysis. Results The survey found an overall prevalence of 11.0% global acute malnutrition and 2.1 % severe malnutrition. In the absence of “aggrevating factors”, a prevalence above 10 % global malnutrition represents a “risky situation” for which targeted supplementary and therapeutic feeding appropriate responses (WHO, 2000)1. According to a recent ACF/CEPLANUT 2 nutrition survey, prevalence of global acute malnutrition in Kimbanseke commune (where 3 of the aires de sante in the SC survey were located) more than trebled in the period between September 1999 and February 2001 from 3.8% to 12.2%. It is apparent from these statistics that the nutritional status in Kimbanseke commune and most probably Masina and other vulnerable communes in Kinshasa has dramatically increased since the end of 1999 to unacceptably high levels and should be a cause for concern and appropriate action. Table 1: Summary of results of SC Nutrition Survey, Kinshasa, April 2001, by aires de sante Aires de Sante Global Global maln Chronic Chronic maln Feeding Morbidity U5s maln 95% CI Maln 95% CI Centre (last 24 mortality Coverage hrs) per/10,000/ day Tshimungu (n=435) 11.3 % (7.1% - 5.5%) 33.9 % 27.5% - 0.3% 8.2% 19.4 % 0.82 Mapela (n=224) 8.5 % (3.3% - 3.7%) 31.1 % 22.5% - 9.7% 15.8% 17.0 % 0.73 Kimbanseke (n=119) 5.0 % (-0.5% -0.5%) 33.3 % 20.9% - 5.7% 16.7% 12.6 % 1.1 Lobiko (n=153) 18.3% (9.7% - 26.9%) 41.7 % 30.6% - 2.8% 3.6% 17.7 % 0.32 Total (n=931) 11.0% (8.3% - 14.3%) 34.4% 30.0% - 38.8% 8.8% 17.6% 0.77 The table above shows considerable variation in prevalence of malnutrition and other health indicators between the four aires de sante surveyed. 1 The Management of Nutrition in Major Emergencies, WHO, 2000. 2 Kinshasa Enquetes Nutritionnelles Communes de Kimbanseke, Selembao, Bumbu et Kisenso. ACF/CEPLANUT. April 2001 2 Prevalence of global acute malnutrition varied considerably between the four aires de sante, from an acceptable 5.0% in Kimbanseke, to an alarmingly high level of 18.3 % in Lobiko. Overall chronic malnutrition affected approximately one third (34.4%) of the sample and was particularly high in Lobiko (41.7 %). All aires de sante had an under fives mortality rate below 2.0 (calculated as an average for the previous 12 months) which implies that the health situation is not “serious” and so is not a cause of undue concern3. Overall, 17.6 % of children were reported to have been ill in the 24 hours previous to the survey. In terms of symptoms of illness, fever was the most common (9.2%), followed by cough (2.6%) and diarrhoea (2.5%). The order and prominence of these three symptoms reflects the three major causes of morbidity and mortality in Kinshasa, namely malaria, respiratory diseases and diarrhoeal diseases. There was a positive statistical association between morbidity and malnutrition, with the proportion of malnourished who were also ill (30.7%) being almost double that of children who were not malnourished (16.0%). The feeding centre coverage was calculated as 8.8%, which means that only 8.8% of malnourished children in the survey were attending a feeding centre. The coverage varied considerably between aires de sante. Lobiko, which had the highest amount of malnutrition had an extremely and unacceptably low coverage of 3.6% whilst Kimbanseke which had the lowest prevalence of malnutrition had the highest coverage of 16.7 %. Lobiko The high prevalence of 18.3 % global acute malnutrition found in Lobiko is particularly worrying and represents a “serious” situation according to WHO guidelines. Approximately one fifth of households (17.8 %) and parcelles (20.2 %) in Lobiko were caring for at least one malnourished child, whilst 2.2 % of parcelles had two or three malnourished children. Lobiko also had the highest prevalence of chronic malnutrition (41.7%) suggesting a long term nutritional problem, as well as the lowest feeding centre coverage (3.6%). The latter means that only 3.6 % of malnourished children in Lobiko were attending a feeding centre for treatment. The under fives mortality rate of 0.32 was low and not critical. The particularly high level of malnutrition in Lobiko may be explained by its inaccessibility/limited road access, sandy soil (making it difficult to grow crops), and poor infra-structure including provision of potable water, latrines, health care and schools. Lobiko is essentially rural in nature with poor road access severely limiting the opportunity for engaging in trade with major markets. The absence of potable water is a huge constraint, with many households having to obtain water from the river. These problems appear particularly pronounced in the remote southern hilly areas furthest away from the road where there is no access to portable water and no latrines. Recommendations for SC health programme It is proposed that any nutrition input made by SC in Kinshasa should be targeted at Lobiko in order to tackle its alarmingly high rates of acute and chronic malnutrition and unacceptably low rates of feeding centre coverage. Recommended actions for SC health team 1. Ensure that the results of the recent SC nutrition survey are passed onto the relevant government/health authorities, feeding centres, religious groups and NGOs, and that the implications of this and other recent assessments are explained to them, highlighting the need for a co-ordinated and effective response in this and possibly other vulnerable areas of Kinshasa. 3 The management of Nutrition in Major Emergencies. WHO. 2000 3 2. Build good working relationships with appropriate authorities (particularly CEPLANUT), health/feeding centres, BDOM, ACF etc and initiate discussion with them to identify effective and sustainable strategies to reduce malnutrition/increase feeding centre coverage in Lobiko and other vulnerable areas of Kinshasa 3. Encourage the relevant authorities to initiate and support programmes that would help improve provision of water, sanitation, and health care in Lobiko. 4. Strengthen nutrition screening and referrals in Lobiko, both at the health centres and by Maman Bongisas. This should involve general training in the identification of malnutrition and should include the following: · Maman Bongisas – how to recognise oedema and how to use MUAC as a quick, cheap and relatively effective method for screening malnourished children for referral to health centres. · Health centre staff – how to identify oedema and how to use weight for height charts for identifying malnourished children for referral to feeding centres. 5. Identify realistic, effective and sustainable ways in which to improve the treatment provided at feeding centres (particularly Stage III-TFC), in partnership with those running the centres. This should involve training of feeding centre staff in how to treat malnutrition effectively. 6. Provide training for health & feeding centre staff, and Mamans Bongisas in the prevention of malnutrition, with an emphasis on the importance of breast feeding and good weaning practises. This should encourage improved screening, referrals and the counselling of mothers in good feeding practises. 7. Alert the general community to the problem of malnutrition, its causes, health implications and how to prevent it, e.g. input school curriculum, women’s groups, etc 8. Encourage the development of protocols for effective nutrition surveillance through the regular collection, analysis and interpretation of the data on malnutrition/health to allow the nutrition situation to be closely m onitored. 9. Strengthen first line treatment and preventative strategies for malaria, diarrhoea and respiratory infections. This would include the provision of free drugs to those attending feeding centres Mary Atkinson Nutrition Consultant MAY 2001 4 1.0 INTRODUCTION 1.1 Background Despite the signing of the Lusaka Peace Accord in 1999, the almost three year old multi-nation war in the Democratic Republic of Congo (DRC) continues. In addition to the large population displacement caused by the fighting, the economy is in crisis and is unable to sustain an ever -growing urban population. The health care system continues to deteriorate at an alarming rate. A sharp increase in epidemic diseases including cholera, measles, polio and meningitis reflects poor access to potable water (42%) and limited access to primary health care services (26%). It has been estimated that 2.2 million persons in the DRC suffer grave food insecurity, whilst 4 million reside in inaccessible areas vulnerable to food insec urity4. As with the rest of the country, the capital Kinshasa suffers from constant petrol shortages, with much of the transport infra-structure in a state of collapse.
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