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Nutrition Information in Crisis Situations - AlgeriaNICS 7, August 2005About 160,000 people from Western Sahara are still refugees in camps in the area of Tindouf in Algeria (see RNIS 40) (WFP/UNHCR, 01/04). Isolation and the hostile environment of the area make humanitarian aid difficult to deliver and impede refugee self-sufficiency. A random-sampled nutrition survey was conducted in the camps in February 2005 (UNHCR/WFP/INRAN, 07/05). The prevalence of acute malnutrition was average and has remained stable when compared to 2002 (figure 12). Stunting has also remained stable (figure 13). Figure 12 Prevalence of acute malnutrition, Saharawi refugee camps, Algeria
Figure 13 Prevalence of stunting, Saharawi refugee camps, Algeria
High level of micronutrient deficienciesOn the other hand, anaemia has risen compared to 2001 and 2002 and especially among children (figure 14). This might be explained by the interruption of nutrition interventions, which were aimed at improving micronutrient deficiencies. Figure 14 Prevalence of anaemia, Saharawi refugee camps, Algeria
Clinical signs of micronutrients disorders were also looked at. Bleeding gums, a sign of scurvy was present in 27.4% (18/.4-36.5) of the 15-49 year old non-pregnant women examined; night blindness, a sign of vitamin A deficiency, was reported by 20.6% of the women and goitres were detected in 6.4% of them. Goitres were more likely to be due to an excess of iodine than to iodine deficiency. In fact, the survey conducted in 2002 reported extremely high urinary iodine excretion in adolescents. Iodine content of water was analysed during the present survey and was found to be high to extremely high, depending on the source of water. The highest concentration of iodine can even cause toxicity problems. The study team found it difficult to track records of food distributions. According to the WFP/UNHCR Joint Assessment Mission, conducted in January 2004, the food basket was composed of 450 g of cereals, 60 g of pulses, 25 g of oil, 30 g of sugar and 5 g of salt/pers/day (WFP/UNHCR, 01/04). No blended food was meant to be distributed. This was confirmed by the present survey, although some food is distributed by other partners on top of the general food distribution. It seems that no list of beneficiaries for food distribution was available. According to the information which could be found during the survey, it seems that the minimum energy requirements were met but that very low amounts of riboflavin, vitamin C, calcium, iron and vitamin A were available. Only a few families had sources of income, some were receiving remittances. Although vegetables were present in the market, families mostly bought cereals, pulses, oil and sugar because the food distribution was not, according to them, sufficient. Poor child feeding practicesChild feeding practices were not optimal, especially worrying was the exclusive breastfeeding rate (26.6%), which, however, seemed higher than in 2002 when it was only about 2%. Infant formula was given to about half of the infants who were not exclusively breast-fed. Moreover, 19.5% of the 0-23 month olds were at least partly bottle-fed, which is known to carry a high risk of contamination resulting in intestinal infection. RNIS 41, April 2003The last RNIS issue reported on the nutrition status of the Sahrawi refugee children in Algeria, based on a survey undertaken by UNHCR/WFP/ CIH in September 2002. Some 155,000 to 165,000 people, according to different estimates, are settled in four camps in an isolated desert area near Tindouf, since 1975. The prevalence of acute malnutrition was average: 10.6 % of the children were acutely malnourished, including 2.2% severe acute malnutrition. The prevalence of acute malnutrition has remained stable since 1997, whilst the prevalence of stunting has decreased from 49% in 1997 to 33% in 2002 (see RNIS 40). The latest results of the survey gave additional indications about the nutritional status and feeding patterns of this population (UNHCR/WFP/ CIH, 09/02). The nutrition status of 91 0-6 month olds was investigated. The results showed a good nutritional status: 1.1% of the infants were acutely malnourished (W-H < -2 Z-scores), none of the infants was severely malnourished (W-H< - 3 Z-scores). Breast-feeding was widespread: 97% of the 0-24 months had been breast-fed at some time of their lives and 84.1% were still breast- fed at one year. However, at the time of the survey, only 2.3% of the 0-6 month olds were exclusively breast-fed; in addition to breast-milk, they mainly received water, sweetened water, and different types of (non-breast) milk: infant formula, goats/camel milk and powdered milk. The consumption of infant formula and powdered milk was particularly of concern, as it is known to carry a high risk of contamination resulting in intestinal infection. About 30% of the 0-12 months were receiving infant formula, the proportion was lower for the 12-24 montholds; on the contrary, the use of powdered milk increased with age: about 10% of the 0-6 month olds were receiving powdered milk, whilst the proportion increased to 40% for the 6-12 month olds and 60% for the 12-24 month olds. The use of bottlefeeding was not investigated. Anaemia in children 6-59 months has decreased over the past years, but whilst it decreased in women of reproductive age between 1997 and 2001, it has remained stable since 2001 (see graph). Anaemia, Western Sahrawi refugees in Algeria
Clinical signs of scurvy or rickets were found only in two children. An analysis of the food distributed to the families from March to July 2002, based on the distribution records supplied by the Algerian Red Crescent, which included food from WFP but also from different other organisations, was also carried out. Calculation has been made taking into account a population number of 155,430, which has not been up-dated recently. Based on a minimum energy requirement of 2100 Kcal/pers/day and minimum macro-nutrient and micro-nutrient requirements taken from the "Management of Nutrition in Major Emergencies, WHO, 2000", the analysis showed that energy requirement was met, that fat requirement was also met and that protein content of the ration was 150% of the requirement. The content of the ration in calcium, iron, vitamin A, thiamine, riboflavin, niacin and vitamin C was also assessed. The ration contained low levels of calcium, vitamin C and riboflavin, whilst the level of the other micronutrients was adequate. Overall The nutrition situation of the Sahrawi refugee children is average (category III). It seems that the food distribution has been adequate in quantity, if not in quality, other the past months. In addition, the high prevalence of obesity in women observed in the 2001 survey does not suggest deficits in the quantity of food available. There is however a probable deficit in some micronutrients. The widespread use of infant formula and powdered milk also needs to be urgently investigated further as the public health consequences of the use of these products are well-known. To better understand the nutrition situation of the Sahrawi population, analyses of food security and underlying causes of malnutrition need to be undertaken. Recommendations and priorities From the UNHCR/WFP/ICH survey
RNIS 40, Dec 2002Western Sahara is a former Spanish colony which was subsequently annexed by Morocco and Mauritania in 1975-1976. The Sahrawi Polisario Liberation Front declared the Sahrawi Arab Democratic Republic (SADR) and formed a government in exile. In 1979, Mauritania abandoned its territorial claim but fighting between Morocco and the Polisario Front continued until 1991, when a UN sponsored peace plan was adopted. The peace process included a referendum in which the country's in- habitants must choose whether Western Sahara would integrate with Morocco or be independent. However, the referendum has not yet been implemented, because of a deadlock over who is eligible to vote (Oneworld, 12/02). By late 1975, thousands of people had fled annexed territories to camps in the east of the region. After the camps had been bombarded with napalm, people moved further to south-west Algeria, near the oasis town of Tindouf. Some 155,000 to 165,000 people, according to different estimates, mainly women, children and the elderly, are settled in four camps in this isolated desert area. The camps are administered by SADR ministries. Isolation and the environmental hostility of the area makes humanitarian aid difficult to deliver and impedes refugee self- sufficiency. Major food providers are WFP and ECHO. WFP often experiences lapses of contributions; in June 2002 refugees only received cereals as oil and pulses were not available (AFROL, 08/06/02). WFP also fears severe food shortfall from September 2002 (WFP, 08/02). Despite diet diversification activities (poultry, livestock and horticultural projects) and income- generating activities having been put in place, it is thought that the refugees are highly dependent on food aid. However, no food security assessment has been undertaken. Inadequate water supply and poor water quality appear to be two of the main problems in the camps (USCR, 2002). UNHCR had to postpone improvement in water delivery because of a funding short- fall (AFROL, 24/10/02). A survey was undertaken in September 2002 in the refugee camps, with the aim of assessing under- five anthropometric status and micronutrient defi- ciencies (ICH/UNHCR/WFP/MOH, 09/02). Prelimi- nary results indicate an average nutrition situa- tion: 10.6 % of the children were acutely mal- nourished, including 2.2 % severely malnourished. The prevalence of malnutrition has remained stable since 1997 (see graph). Acute malnutrition, Sarahwi refugees in Algeria
Stunting was present in 32.8% of the children (95% CI: 29.7-36.1), including 11.2% (95% CI: 9.2-13.5) severe stunting. After a significant improvement between 1997 and 2001, probably partly due to distribution of micronutrient enriched food, stunting has remained stable (see graph). Stunting, Sarahwi refugees in Algeria
According to vaccination cards, measles vaccination coverage of 12-23 month-old children was 66.7%, but was higher for BCG (78.6%) and DPT (77.0%). Adult anthropometry was not assessed in this survey, but the 2001 survey reported that about 60% of the women of reproductive age were overweight (BMI > 25) (CISP/UNHCR/INRAN, 12/01). Final results of the 2002 survey will be reported in the next RNIS issue, including micronutrient status and diet pattern. Overall The nutrition situation of Sahrawi refugee children seems average (category III) but could deteriorate if refugees were highly dependent on food aid and that food aid were to be disrupted by pipeline breaks. Analyses of food security and underlying causes of malnutrition need to be undertaken to better understand the overall nutrition situation of the refugees.
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