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Drought, conflict and undernutrition in Ethiopia

Summary of research1

Location: Ethiopia

What we know: Conflict and drought can have negative impacts on child undernutrition.

What this article adds: A recent pooled analysis of 231 surveys conducted between 2000 and 2013 (175,607 children age 6 to 59 months) estimated the prevalence of childhood wasting and investigated the effects of drought and conflict on wasting in crisis-affected areas in Ethiopia. Pooled prevalence of wasting was high (11%) with regional variation (21.5% in Somali region), but decreased over the study period from 19.1% in 2000 to 8.5% in 2013. More than half the surveys (61.9%) exceeded the 10% wasting emergency threshold. Compared with areas unaffected by drought, the estimated prevalence of wasting was 34% higher in areas affected by moderate levels of drought, but similar in severely drought-affected areas. This may be explained by early warning systems and the Productive Safety Net Programme that target severe drought areas. No difference in wasting was found between conflict-affected compared to unaffected areas; conflict was short-lived and of low magnitude. Despite progress, a wasting problem persists among children in Ethiopia. Nutrition interventions should include moderate drought areas.

An estimated 50 million children under five years old worldwide had acute malnutrition in 2014 (UNICEF, WHO and World Bank Group, 2015). The burden is particularly heavy in Africa, where conflict, political fragility and drought are prevalent. While the prevalence of child undernutrition has declined in Ethiopia since 2000, stunting and wasting remain a major concern. In 2014, five million children (40% of the child population) were stunted and around one million (9%) were wasted (CSAE, 2014). It is estimated that undernutrition in Ethiopia was responsible for 378,000 child deaths from 2005 to 2009 and cost around 16.5% of the country’s gross domestic product (GDP), an estimated US$4.7 billion in 2009 alone (NEPAD, ECA, and WFP, 2014). The problem of undernutrition is worse in crisis-affected areas in the country, where food insecurity is heightened due to climate shocks and conflicts. Few studies have been done on the associations between child undernutrition, conflict and drought in East Africa, including Ethiopia. This study estimated the prevalence of childhood wasting and investigated the effects of drought and conflict on wasting in crisis-affected areas in Ethiopia.

A search of the Complex Emergency Database was conducted for nutrition surveys carried out in Ethiopia from 2000 to 2013. Data were extracted on the prevalence of wasting (weight-for-height z-scores below –2) among children aged 6 to 59 months in areas of Ethiopia that had sufficient data available. Data on any conflict events and episodes of seasonal drought affecting survey areas were extracted from publicly available data sources. Random-effects Bayesian meta-analysis was used to synthesise the evidence. Data were gathered from 231 small-scale surveys with sample sizes ranging from 300 to 1,227 children (total pooled sample 175,607 children). It was found that 26 (11.3%) of the surveys (20,259 children) were conducted in areas affected by conflict in the six months before the surveys, while 155,348 children lived in areas where no conflicts were recorded. Overall, 132 (57.1%) of the surveys were from areas affected by mild to extreme drought three months before the survey implementation month. The pooled numbers of children affected by mild drought were 79,389, moderate drought 13,323 and severe drought 6,583. A total of 76,312 children were living in areas where no episodes of drought were recorded.

Overall, 21,709 children were wasted; estimated pooled prevalence of wasting over the 14-year period was 11.0% (95%, credible interval (CrI): 10.3–11.7). A total of 143 of the surveys (61.9%) reported a wasting prevalence of over 10%, exceeding the World Health Organisation (WHO) emergency threshold. The highest regional prevalence was observed in Somali region (21.5%, 2891 children affected). The estimated prevalence of wasting decreased steadily over the study period from 19.1% (2,233 children) in 2000 to 8.5% (817 children) in 2013. Compared with areas unaffected by drought, the estimated prevalence of wasting was 34% higher in areas affected by moderate levels of drought (posterior odds ratio, OR: 1.34; 95% CrI: 1.05–1.72) but similar in severe drought-affected areas (OR: 0.96; 95% CrI: 0.68–1.35). Although the pooled prevalence of wasting was higher in conflict-affected than unaffected areas, the difference was not plausible (OR: 1.02; 95% CrI: 0.82–1.26).

The authors identify factors influencing the decline in the prevalence of wasting in Ethiopia over the study period. From 2000 to 2011, Ethiopia’s average GDP grew by over 10% annually and the population living below the national poverty line declined from 44% in 2000 to 30% in 2011. The population consuming less than the minimum dietary energy requirement dropped from 41.9% in 2000 to 33.6% in 2011 and the country achieved the Millennium Development Goal (MDG) target of reducing extreme hunger by half. In addition, Ethiopia launched a national nutrition strategy in 2008 with the aim of improving food and nutrition security.

In 2005, the Ethiopian Government, in collaboration with partner organisations, launched the Productive Safety Net Programme (PSNP) to ensure food supplies to chronically food-insecure areas that are highly vulnerable to climate shocks. Hence, areas affected by severe drought are more likely to benefit from the programme. Furthermore, the country’s early warning system, which targets the areas affected by severe drought, may also help mitigate the impact of severe droughts. This may explain the results and underscore the need for interventions to go beyond predefined, severe drought-prone areas, with strengthened early warning systems and interventions that also benefit moderately drought-prone areas.

The study found no evidence of a difference between the prevalence of wasting in areas affected and unaffected by conflict; most of the conflict events which occurred were short-lived (mostly one day) and of low magnitude (mainly no fatalities). They may therefore not have had a major impact on the nutrition situation.

In conclusion, pooled prevalence indicates a persistent childhood wasting problem in Ethiopia. National nutrition strategies should target areas of persistent undernutrition. Although areas affected by severe drought must remain a national priority for specific targeted actions, nutrition policy should consider interventions that go beyond the predefined, severe drought-prone areas and incorporate areas where moderate droughts occur.


Footnotes

1Delbiso TD, Rodriguez-Llanes JM, Donneau AF, Speybroeckc N and Guha-Sapira D. (2017). Drought, conflict and children’s undernutrition in Ethiopia 2000–2013: A meta-analysis. Bull World Health Organ 2017;95:94–102. doi: 10.2471/BLT.16.172700


References

CSAE 2014. Ethiopia mini demographic and health survey 2014. Addis Ababa: Central Statistical Agency Ethiopia; 2014.

UNICEF, WHO and World Bank Group 2015. Levels and trends in child malnutrition, joint child malnutrition estimates: Key findings of the 2015 edition. Washington: United Nations Children’s Fund, the World Health Organization and World Bank Group; 2015. Available from: http://www.who.int/ nutgrowthdb/jme_brochure2015.pdf?ua=1 [cited 2015 Dec 8].

NEPAD Planning and Coordinating Agency, UN ECA and UN WFP. The cost of hunger in Africa: social and economic impact of child undernutrition in Egypt, Ethiopia, Swaziland and Uganda. Addis Ababa: African Union Commission: 2014. Available from: www.uneca.org/sites/default/files/PublicationFiles/COHA Abridged English_web.pdf [cited 2016 Jan 20].

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Drought, conflict and undernutrition in Ethiopia. Field Exchange 55, July 2017. p35. www.ennonline.net/fex/55/droughtconflict