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Nutrition surveillance for sudan

  1. Nutrition Information System for Sudan Dr. Kazuko Yoshizawa Nutrition Advisor for S/FMOH, WHO Sudan Ms. Durria Mohamed Osman Information, Documentation and Research PHC, FMOH Jan. 17, 2006 WHO Khartoum
  2. Objective • To give situation analysis • To explore possible networking with different sections of WHO, MOH and other UN agencies for revitalization and strengthening of the government nutrition and food security and the response mechanism.
  3. Background • Nutrition and food security information system (surveys and surveillance) and the response mechanism used to exist, which were lead by the government but not functioning now. • UNICEF, WFP, FAO and NGOs are conducting surveys and surveillance covering different regions of the country and collecting information for the programme, mostly for acute malnutrition.
  4. Contd. • Prevalence of chronic malnutrition in children under 5 is 43% and acute malnutrition is16% for North Sudan while they were 45% and 21% respectively among the same age group for Southern Sudan (MICS 2000, personal contact with FMOH). • Prevalence of micronutrient deficiency diseases are high (iodine, VA, iron/folic acid)
  5. Child Survival, Growth and development Adequate dietary intake Health Outcome Immediate determinants Health services and healthy environment Care for women Breastfeeding/feeding Psychosocial care Food processing Hygiene practices Home health practices Household food security Underlying determinants Family and community resources and control …. Human, Economic Organisational Potential resources: Basic determinants Supportive political, cultural, religious, economic and social systems and women’s status enhanced. adequate and/or appropriate knowledge and non-discriminatory attitudes and practices at household and community levels in access to available resources UNICEF 2003:secondary source
  6. Malnutrition is multi-factorial. • Malnutrition is recognized as an underlying cause to explain almost 60% of death in <5. • The three major causes of death in <5: pneumonia, diarrhoea and malaria. • Malnutrition is an outcome of socio-economic development
  7. HNP-related MDG indicators, Sudan (Sudan Health Report, 2003, World Bank)
  8. Malnutrition Indicators • Global Malnutrition: < 80% WFH • Moderate Malnutrition: 70 – 79.9% WFH • Severe Malnutrition : < 70% WFH and/or with edema
  9. The 4th MDG is to reduce <5 mortality by two-thirds between 1990 and 2015 (Sudan Health Status 2003)
  10. Measuring Socio-Economic Disparities in Health (Sudan Health Status 2003)
  11. Early Warning System for Darfur by WHO/FMOH • Weekly • Communicable diseases • Cases of malnutrition • Weight for Height <70% of the median NCHS/WHO/CDC • Information is disseminated to the partners in and out of Sudan. • Response mechanism
  12. Contd. Most of SM cases reported from several camps: South Darfur: Kalma (14.1%), Ottash (3.9%), Geredha (5.4%), Mersheng (4.7%) and Wehida (6.5%) North Darfur: Abu Shoak (10.9%) and Zamzam (2.5%) West Darfur: Morni: (3.2%) and Zalling (2.2%)
  13. Malnutrition under 5
  14. Malnutrition over 5
  15. Five Year Trend World Vision: presented in WDC 2002
  16. Surveys in Sudan 1986-87 Sudan Emergency, Recovery Information & Surveillance System (SERISS): A national survey by NND and Health Statistics Department, MOF. Pop. <5 yrs, 80,000 in all the 6 northern regions, funded by USAID Data collection: over a period of a whole year Has served as the baseline data for future surveys to be compared with. 1990 -Quarterly nutrition monitoring survey at the national level in order to bridge the food gap which was then going on in Kordofan, Darfur, Eastern and parts of Central zones.
  17. Contd. 1992 A community based nut surveillance for early earning purpose was introduced. Objective: the timely and appropriate intervention: To meet this objective, data analysis at the provincial level. Monitoring of nutritional status of children and mothers. The programme was expanding is expanded at the health area. Functioning in Kassala, Sennar and N. Kordofan Micronutrient prevalence survey (IDD, VAD, IDA) are conducted in some parts of the country. Questions were added to the quarterly monitoring surveys to cover micronutrient deficiencies as well.
  18. Contd. • 1989-90 Demographic Survey • 1999 Safety Motherhood Survey • 2000 Multiple Indicator Cluster Survey
  19. Response • In response to the drought of 1983, 1984 and 1985, the government established a Relief and Rehabilitation Commission (RRC) for policies, plans and programme to rehabilitate the affected areas by coordinating national and international efforts.
  20. Cont. • EWU was set up within the RRC. • Food Security Unit was set up in MOAP. • Khartoum MOH set up an emergency preparedness unit for natural and man-made disasters to info collection and to response within the health sector. Experiences 2005 in WHO/MOH: night blindness in WN, goiter for treatment in SD, no buffer stock of supplement of lipidol
  21. Health/nutrition indicators to facilitate coordination • The status of the population and the effectiveness of relief (e.g. death rates x 10,000, trends) • Reasons for alert (e.g. signs of epidemics) • Difference between crisis and normal seasonal variations ( e.g. epidemiological curve) • Security (e.g. No. of intentional injuries) • Quality of water • Water, sanitation, availability of soap and buckets (e.g. No. of cases of diarrhea) • Food security (e.g. No. of cases of acute malnutrition) • Nutritional value of food aid • Health care (e.g. closest functioning health facility, availability of drugs) • Logistic and communications (e.g. state of cold chain)
  22. Cont. You must monitor support activities, too: • How is the health information system working ? • How often are coordination meetings held ? • Is training being organized ? Is it attended ? • Are new projects being prepared ? Funded ? • You need denominators: get figures or estimates on the No. of population and breakdown • Review the Case Definitions with the partners, not only for diseases: e.g. who is the affected population ?
  23. Chronic/Noncommunicable Disease (CD) • The rapid rise of chronic, noncommunicable diseases represents one of the major health challenges to global development. • Chronic diseases currently account for some 60% of global deaths and almost one third of the global burden of disease. • The principle CD: stroke, cancer, diabetes and chronic respiratory diseases.
  24. WHO: "Stop the global epidemic of chronic disease" A new report forecasts that deaths from chronic diseases in the Western Pacific Region will increase by 20% over the next 10 years Manila –Determined global action to prevent chronic disease could save the lives of 36 million people who would otherwise die by 2015. Chronic diseases are by far the leading cause of death in the world and their impact is steadily growing.
  25. No DESCRIPTION COUNTRIES MAJOR RISK FACTORS & UNDERLYING CAUSES I Advanced nutritional transitional stage: ▪high levels of overnutrition / obesity; ▪dietary risk factors for chronic diseases; ▪moderate under-nutrition and micronutrient deficiencies in certain population sub-groups. All Gulf Cooperation Council countries – Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates. ▪Very high intake of energy dense foods (fats, sugar, refined carbohydrates); ▪Low fruits & vegetables consumption; ▪Aggressive commercial marketing of processed foods (fast foods, breast- milk substitutes, carbonated drinks); ▪Insufficient / ineffective nutrition education; ▪Lack of clear nutrition policy, goals and targets. II Early Nutrition Transitional stage: ▪ Moderate levels of overweight / obesity; ▪ Dietary risk factors for chronic diseases; ▪ Moderate levels of undernutrition in limited areas and population groups; ▪Widespread micronutrient deficiencies. Egypt, Iran, Jordan, Libya, Lebanon, Morocco, Palestine, Syria, Tunisia. ▪Co-existence of increased dietary energy (fats, sugars and refined carbohydrates); ▪Low consumption of fruits & vegetables; ▪Poverty pockets - particularly urban and peri-urban poor and remote rural; ▪Lack of clear nutrition policy, goals and targets; ▪Uncoordinated nutrition programmes. Bagchi 2005 in Cairo
  26. No DESCRIPTION COUNTRIES MAJOR RISK FACTORS & UNDERLYING CAUSES III Mixed scenarios: •Significant under- nutrition : both acute and chronic child and maternal malnutrition; •Emerging over- nutrition in specific population groups (affluent urban) Pakistan •Wide-spread low-grade poverty and insufficient income; •Inadequate dietary intakes in large segments of the population; •Lack of clear nutrition policy, goals and targets; •‘Ad hocism’ in nutrition programmes; •Inadequate institutional capacity and trained manpower. IV Countries with complex emergencies / humanitarian crises: •Severe child and maternal under- nutrition; •Widespread micronutrient deficiencies. Afghanistan, Djibouti, Somalia, Sudan, Yemen. •Disruption of national developmental programmes due to continuing civil conflicts and insecurity; •Insufficient and inadequate food supply and consumption; •Overall poor level of health and environmental conditions; •Inadequate institutional capacity and trained manpower. Bagchi 2005 in Cairo
  27. Summary • PEM and micronutrient deficiency disorders are significant public health problems: acute and chronic • Some of the diet related non-communicable diseases might be emerging soon among some population (urban). • There was no nutrition information system and the response mechanism lead by the government.
  28. Recommendation • Revitalization and strengthening of the currently and previously existing system by the government.
  29. Areas to cover for nutrition information system in Sudan • Malnutrition and food security • Communicable disease • Non-communicable disease • Food safety and environment • Socio-economic factors
  30. Potential Opportunities For Nutrition Information • Liaise with Sections of Epidemiology, EWRS, Statistics, Planning, GIS, IEC of WHO/MOH • Liaise with/set up HIS • Scaling up of the currently existing system in other states • Liaise with UN agencies and NGOs (Nut Coordination Meeting; Darfur and non-Darfur)
  31. Contd. For Response mechanism • Revitalization of previously existed a Relief and Rehabilitation Commission Rationale: resources, know-how and baseline database are available Needs: vision, appropriate technology and capacity building