Nutritional status and early warning of mortality in southern Ethiopia, 1988-1991
1994
Lawrence, M. | Yimer, T. | O'Dea, J.K.
Objective: Ethiopian Government guidelines on nutritional survey data and relief provision call for intervention once mean weight-for-length (W/L) in an area falls below 90% of reference, on the basis that mortality is unlikely to rise until this level is reached. In this paper the appropriateness of the 90% cut-off is examined using data from Wolayita, southern Ethiopia. Survey design and subjects: Fifteen to 25 villages are selected at random for survey each year, with all children 70-110 cm in length being followed up every 2 months. During the 3 years covered by these analyses 21 701 W/L measurements were made on 5455 children from 65 villages. 126 of the children died. Results: In the first and third survey years, rapid declines in mean W/L were recorded, with mortality increasing very roughly three-fold (compared to year 2, P < 0.01), even though mean W/L remained at or above 90% of reference at all times. A logistic regression analysis relating mortality to W/L indicates that between 20% and 35% of the greater mortality in years 1 and 3 can be explained by the observed changes in W/L. The remainder occurred because of an increase in underlying or background risk (which might perhaps be expected in the circumstances of generally deteriorating nutritional status). Conclusions: The results suggest that child mortality is likely to increase before area mean W/L falls to 90% of reference, indicating that emergency interventions should be triggered earlier than at present.
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