Mason John B, White Jessica M, Heron Linda, Carter Jennifer, Wilkinson Caroline, Spiegel Paul
School of Public Health and Tropical Medicine, Tulane University, 1440 Canal Street, New Orleans, LA 70118, USA.
Int J Environ Res Public Health. 2012 Mar;9(3):791-806. doi: 10.3390/ijerph9030791. Epub 2012 Mar 6.
Drought and conflict in the Horn of Africa are causing population displacement, increasing risks of child mortality and malnutrition. Humanitarian agencies are trying to mitigate the impact, with limited resources. Data from previous years may help guide decisions. Trends in different populations affected by displacement (1997-2009) were analyzed to investigate: (1) how elevated malnutrition and mortality were among displaced compared to host populations; (2) whether the mortality/malnutrition relation changed through time; and (3) how useful is malnutrition in identifying high mortality situations. Under-five mortality rates (usually from 90-day recall, as deaths/10,000/day: U5MR) and global acute malnutrition (wasting prevalences, < -2SDs of references plus edema: GAM) were extracted from reports of 1,175 surveys carried out between 1997-2009 in the Horn of Africa; these outcome indicators were analyzed by livelihood (pastoral, agricultural) and by displacement status (refugee/internally displaced, local resident/host population, mixed); associations between these indicators were examined, stratifying by status. Patterns of GAM and U5MR plotted over time by country and livelihood clarified trends and showed substantial correspondence. Over the period GAM was steady but U5MR generally fell by nearly half. Average U5MR was similar overall between displaced and local residents. GAM was double on average for pastoralists compared with agriculturalists (17% vs. 8%), but was not different between displaced and local populations. Agricultural populations showed increased U5MR when displaced, in contrast to pastoralist. U5MR rose sharply with increasing GAM, at different GAM thresholds depending on livelihood. Higher GAM cut-points for pastoralists than agriculturalists would better predict elevated U5MR (1/10,000/day) or emergency levels (2/10,000/day) in the Horn of Africa; cut-points of 20-25% GAM in pastoral populations and 10-15% GAM in agriculturalists are suggested. The GAM cut-points in current use do not vary by livelihood, and this needs to be changed, tailoring cut points to livelihood groups, to better identify priorities for intervention. This could help to prioritize limited resources in the current situation of food insecurity and save lives.
非洲之角的干旱和冲突导致人口流离失所，增加了儿童死亡和营养不良的风险。人道主义机构正试图利用有限的资源减轻影响。以往年份的数据可能有助于指导决策。分析了不同受流离失所影响人群（1997 - 2009年）的趋势，以调查：（1）与东道国人口相比，流离失所者中营养不良和死亡率升高的情况；（2）死亡率/营养不良关系是否随时间变化；（3）营养不良在识别高死亡率情况方面的有用程度。从1997 - 2009年在非洲之角进行的1175次调查的报告中提取了五岁以下儿童死亡率（通常来自90天回忆，以死亡数/10000/天计：U5MR）和全球急性营养不良（消瘦患病率，<参考值的 - 2标准差加水肿：GAM）；这些结果指标按生计（牧民、农业）和流离失所状况（难民/境内流离失所者、当地居民/东道国人口、混合）进行分析；检查这些指标之间的关联，并按状况分层。按国家和生计绘制的GAM和U5MR随时间变化的模式阐明了趋势并显示出显著的对应关系。在此期间，GAM稳定，但U5MR总体上下降了近一半。流离失所者和当地居民的平均U5MR总体相似。牧民的GAM平均是农业人口的两倍（17%对8%），但流离失所者和当地人口之间没有差异。与牧民不同，农业人口流离失所时U5MR上升。U5MR随着GAM的增加而急剧上升，根据生计不同，在不同的GAM阈值时情况不同。牧民的GAM切点高于农业人口，这能更好地预测非洲之角的U5MR升高（1/10000/天）或紧急水平（2/10000/天）；建议牧民群体的GAM切点为20 - 25%，农业人口为10 - 15%。目前使用的GAM切点没有按生计区分，这需要改变，根据生计群体调整切点，以更好地确定干预重点。这有助于在当前粮食不安全的情况下优先分配有限资源并拯救生命。
