Famine in the horn of africa over the last decade
Download
1 / 25

Famine in the Horn of Africa Over the Last Decade - PowerPoint PPT Presentation


  • 99 Views
  • Uploaded on

Famine in the Horn of Africa Over the Last Decade. Paul B Spiegel MD, MPH 1 Peter Salama MBBS, MPH 2 Susan Maloney MD, MPH 1 Albertien van der Veen, MSc 3 1 CDC , 2 UNICEF, 3 WHO. Somalia 1991-92: Background.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Famine in the Horn of Africa Over the Last Decade' - leena


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Famine in the horn of africa over the last decade l.jpg

Famine in the Horn of AfricaOver the Last Decade

Paul B Spiegel MD, MPH1

Peter Salama MBBS, MPH2

Susan Maloney MD, MPH1

Albertien van der Veen, MSc3

1 CDC, 2 UNICEF, 3 WHO


Somalia 1991 92 background l.jpg
Somalia 1991-92: Background

  • Drought, civil unrest, collapse of government, destroyed infrastructure led to many deaths among Somalis during 1992

  • Difficult to provide aid due to insecurity

  • In absence of health care infrastructure, health status of population described through epidemiological studies which influenced how aid was provided


Somalia 1991 92 results l.jpg
Somalia 1991-92 : Results

  • 23 surveys evaluated which had defined pop. and apparent systematic methodology*

    • Extensive methodological differences

    • 12 (52%) not reproducible

    • Units of measurement and denominator estimates inconsistent

    • 8 of 16 (50%) surveys examining mortality assessed cause of death

* Boss, L. P., Toole, M. J., and Yip, R. Assessments of mortality, morbidity, and nutritional status in Somalia during the 1991-1992 famine. Recommendations for standardization of methods. JAMA. 1994: 272(5); 371-6.


Somalia 1991 92 results cont l.jpg
Somalia 1991-92: Results cont

  • 0 of 11 surveys examining morbidity provided case-definitions

  • Of 16 surveys examining nutritional status, variety of definitions of malnutr. and measurement methods used

    • 3 (19%) - MUAC only

    • 10 (63%) - Referenced wt/ht data using % of reference of median

    • 4 (25%) - Presented data using z-scores


Somalia 1991 92 recommendations l.jpg
Somalia 1991-92: Recommendations

  • Define clear study objectives

  • Use standard sampling and data collection methods

  • Ensure precise written documentation of objectives, methods, and results


Ethiopia 1999 2000 background l.jpg
Ethiopia 1999-2000: Background

  • Ethiopia subject to recurrent drought and food insecurity exacerbated by civil strife

    • Crises generally involve massive excess mortality and population displacement without formation of discrete camps

  • Prior to crisis of 1999-2000, eastern and southern regions of Ethiopia subject to 3 successive years of drought


Ethiopia 1999 2000 background cont l.jpg
Ethiopia 1999-2000: Background cont

  • Beginning in 1999, data from early warning systems in many regions of Ethiopia indicated rapidly deteriorating food security and nutrition situation

  • More than 10 million people estimated to need food assistance during peak of crisis in early 2000


Ethiopia 1999 2000 mission l.jpg
Ethiopia 1999-2000: Mission

  • Members of IERHB/CDC seconded to UNICEF as Nutrition Technical Advisors June-Sept. 2000 at request of OFDA

  • Terms of Reference:

    • Co-ordinate and identify gaps

    • Provide technical assistance

  • WHO sent Nutritionist with whom we collaborated closely



Slide11 l.jpg

Zone

UNDP



Slide13 l.jpg

<5 Nutrition Surveys in Ethiopia, Jan.-Jun. 2000 Woreda

Global Acute Malnutrition (GAM)

0-9%

10-19%

20-29%

30-39%

40+%

N=38


Ethiopia 1999 2000 evaluation l.jpg
Ethiopia 1999-2000: Evaluation Woreda

  • Evaluated 125 nutrition surveys from Nov. 1998-Jun. 2000 by 14 different NGOs

    • RHA*: 16 (13%)

    • Cluster: 109 (87%)

      • 42 surveys part of early warning system with different aim and cluster methodology

      • 67 surveys were “intended” to provide useful data to direct programs

    • Only 5 surveys (4%) recorded measles vaccination coverage

* RHA= rapid health assessments using convenience samples


Evaluation of intentional surveys l.jpg
Evaluation of “Intentional” Surveys Woreda

  • Valid (i.e. representative):

    • >30 clusters

    • PPS

      and

  • Precise:

    • >10 children per cluster

1. Binkin N, Sullivan K, Staehling N, Nieburg P. Rapid Nutrition Surveys: How many clusters are enough? Disasters 1995; 16:97-103.

2. Sullivan KM. The effect of sample size on validity and precision in probability proportionate to size cluster surveys, Society of Epidemiologic Research, Utah, 1995


Categorization of cluster surveys n 25 l.jpg
Categorization of Cluster Surveys Woreda(N=25)

No. of Clusters

No. of Children /Cluster


Valid and precise cluster surveys 7 of 67 10 5 l.jpg
Valid and Precise Cluster Surveys Woreda7 of 67 (10.5%)

No. of Clusters

No. of Children /Cluster


Slide18 l.jpg

<5 Nutrition Surveys in Ethiopia, Jan.-Jun. 2000 Woreda

Global Acute Malnutrition (GAM)

0-9%

10-19%

20-29%

30-39%

40+%

N=38


Slide19 l.jpg

<5 Nutrition Surveys in Ethiopia: Jan-Jun 2000 Woreda

Global Acute Malnutrition (GAM)

0-9%

10-19%

20-29%

30-39%

40+%

Valid and Precise: N=2 (5.3%)


Usaid funding for ethiopia 1999 2000 l.jpg
USAID Funding for Ethiopia 1999/2000 Woreda

1999 2000

Development Assistance

Food $ 32,264,600 $ 36,200,741

Non-food $ 38,214,000 $ 42,677,000

Total $ 70,478,600 $ 78,877,741

Humanitarian Assistance

Food $288,968,022 $ 82,956,723

Non-food $ 11,740,022 $ 1,350,700

Total $300,708,022 $163,185,164

Grand Total $371,186,622 $163,185,164

Source: USAID Ethiopia office 9-01


Problems with surveys l.jpg
Problems with Surveys Woreda

  • Methodology

    • Sample size inadequate (clusters and/or children)

    • Non-probabilistic sampling

      • Not proportional to population size

      • Targeting of drought-affected areas within woreda

      • Choosing children most malnourished

    • Always include measles vaccination coverage


Problems with surveys cont l.jpg
Problems with Surveys cont Woreda

B. Survey Analysis:

  • Nutrition indicators (ER setting)

    • Wt/Ht z-scores for children <5yrs

    • 95% CIs using C-sample in EpiInfo

    • Ensure include edema as cases of severe malnutr.

  • Measles Immunization coverage

    • Report % recorded on imm. card vs. verbal+card


Problems with surveys cont23 l.jpg
Problems with Surveys cont Woreda

C. Survey Reporting:

  • State objectives and detailed methodology

  • State results clearly with units, including:

    • Sample size and number of clusters

    • Number of household refusals or absences

    • 95% confidence intervals (+/- DEFF)

  • Interpret results and compare to baseline data or data from previous surveys if available

  • Make recommendations (underlying causes)


Recommendations l.jpg
Recommendations Woreda

Options for NGOs:

  • ?Make sampling methodology simpler

  • Improve training manuals

  • Ensure field staff appropriately trained

  • Send “HQ staff” to do surveys

  • Co-ordinate with 1-2 “survey NGOs” in field

  • Provide survey form templates with programs for data analysis


Recommendations cont l.jpg
Recommendations cont Woreda

Options for policymakers/donors:

  • Be wary of data/reports provided by NGOs

  • Have technical persons available (in country vs. contactable elsewhere) to interpret surveys

  • Field personnel appropriately trained who make decisions based on survey results


ad