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She has previously worked in Sierra Leone, Niger and Argentina. Brigitt Olagivel is a Bolivian nutritionist. The authors would like to acknowledge the political and health authorities from regional to community level.
Thanks are also extended to the teams responsible for the survey implementation and analysis, from surveyors to logistics and administration. A special thanks goes to the families and children who participated in the survey and to all those who helped as guides or in providing essential information, without whose collaboration this survey would not have been possible.
The Bolivian Chaco has a surface area of approximatelykm2. It has very irregular weather patterns affecting temperatures, rains and winds and is characterised by intense rainy summers and dry winters.
Nutrition Landscape Information System: Reference: details
The vulnerability of the Chaco rural population, who subsist on a farming and livestock based economy and have poverty levels higher than those in many other areas of the country INE 1increases the potential impact of disasters. Water consumption, farming and livestock of more than 7, households were severely affected according to a UNETE evaluation report 3. Urban populations were excluded as ACH was only targeting rural areas. Also, it was considered that a bias could be introduced if urban areas were included, given the large social and economic differences between rural and urban populations in Latin America.
The inclusion of haemoglobin Hb analysis to determine anaemia status in SMART surveys ends a more complete nutritional status assessment, particularly with regard to potential constraints for adequate child growth and development due to iron endssa.
This article describes the survey undertaken with a particular focus on the anaemia assessment component. The Standardised Monitoring and Assessment of Relief and Transition SMART programme is an interagency initiative to improve monitoring and evaluation of humanitarian assistance interventions. The SMART Methodology provides a basic, integrated method for assessing nutritional status and mortality rate in emergency situations.
It provides the basis for understanding the magnitude and severity of a humanitarian crisis. The optional food security component provides the context for nutrition and mortality data analysis. The SMART manual deals specifically with nutrition and mortality surveys, including sampling, boliva measurements, and mortality rates.
It describes general survey procedures and provides information on how to collect data necessary for planning direct interventions in emergency settings or for surveillance. It also provides step-by-step instructions for analysing survey data using Emergency Nutrition Assessment ENA software and procedures for food security assessments.
The Bolivian Chaco is located in the southeast of the country and extends over five provinces belonging to the departments of Cordillera, Tarija and Chuquisaca see map. However, the ethnic composition varies between the Chaco provinces.
Due to a number of political and administrative factors and in order to allow comparison, a total of three SMART surveys, one per department, were implemented. Values are shown in Table 1. All rural localities listed in the last censusexcept Mennonite communities 9were considered for random selection using ENA Emergency Nutrition Assessment software. Nolivia current population for each community was calculated applying the district population provision of INE National Statistics Institute based on the national census.
Localities with more than 2, encsa considered as urbanwere not included in the survey. Between 52 and 58 localities were sampled in each department. The final samples were children between 6 and 59 months old in Cordillera Santa Cruzin Chuquisaca and in Tarija. Some parents did not authorise Hb analysis, so final sample sizes for collection of anaemia data were slightly lower.
The characteristics of each locality determined the household sampling method used in a given locality. This portable analyser allows field measurement of the Hb concentration in peripheral blood through photometric detection.
Material for Hb analysis includes microcuvettes, lancets, gloves, alcohol, toilet paper, cotton, batteries and a waste bottle.
Microcuvettes do not need refrigeration and as the Hb analysis is implemented right after the blood sample is taken, there is no special requirement for transport or storage. The main field constraint to take into account is the climatic environment.
Inclusion of 22008 analysis in the SMART survey did not necessitate increasing the number or qualifications of staff. However, in some countries, lab officers or nurses may be required by the Ministry of Endsz. Theoretical and practical training for the anaemia test took around four hours. Some ethnic groups, or populations from specific geographic zones, were averse to blood tests so this prior sensitisation and mobilisation stage is especially important for anaemia studies.
Family authorisation was also required. For this it is important to distinguish between permission for anthropometrical measurements and bilateral oedema which is non-invasive, to permissions for blood tests which are invasive.
The fact that results are obtained immediately allows the family to have the Hb status of their children confirmed instantaneously. This is highly appreciated.
A model of the card given to each family with the results is shown in Figure 2. Different stamps were designed and used to represent a child with anaemia, without anaemia and borderline and made it easier for caregivers to understand Figure 3.
Although only 1 to 3 blood drops are needed for the reaction analysis, one common belief and reason for resistance to the test ensda the suspicion that blood may be sold. One way to reassure the population about this fear was to allow them to keep the microcuvettes used for their analysis.
However, we do not recommend standardising this practice due to waste management difficulties.
The specific methodology endwa to take the blood sample and conduct the Hb analysis can be found in INS Height, weight, mid-upper arm circumference MUAC measurements and bilateral oedema check-up, as well as the blood test, were done for each selected child following standardised protocols. The same software was used to analyse indicators based on weight and height measurements and presence of oedema, and to calculate holivia of acute and chronic malnutrition.
MUAC cut-off points were established at mm for severe acute malnutrition and mm for moderate acute malnutrition.
In Bolivia, Slow Fertility Decline and Some Improvements in Health Indicators
Cut off points for anaemia and the severity scale varies according to authors, age, pregnancy, countries and geographic altitude INS In this case, and largely to allow comparisons, anaemia classification was based on the enfsa cutoff endxa used for children between months old in the previous Demographic and Health National Survey in Bolivia.
These are boliva in Table 2. Malnutrition prevalence in each department is specified in Nolivia 3. The highest values were found in Cordillera province Santa Cruz. The child nutritional situation after the drought seems to have returned to normal values, when compared with ENDSA and PMA 11 survey findings. Anthropometric results in conjunction with the ESAE analysis showed that causes of malnutrition ebdsa Bolivian Chaco are generally structural and only change when occasional endwa events like severe droughts or floods occur, as occurred in the drought.
Out of these nine cases, only one was classified as acutely malnourished using weight for height zscore. Based on the FAO scale 12this signifies a severe iron deficiency problem in this region. Age, sex and district differences were found: Anaemia prevalence in months aged boys from Cordillera was These results confirm anaemia as one of the major nutritional problems of rural children in Bolivian Chaco.
Iron deficiency anaemia in children has adverse effects on physical and psychomotor development, the immune system and physical performance Its reduction through program- mes and policies which impact the structural causes must therefore be a key government goal.
Anaemia analysis is easily integrated into SMART surveys without an excessive increase of budget or resources required. It provides a more profound understanding of the nutritional problems affecting a population than anthropometric surveys alone and hence the policies, strategies and programmes that must be pursued to eradicate malnutrition.
ACF is currently evaluating whether the urban population of the Bolivian Chaco needs to be included in future anaemia surveys. If you have any comments regarding this article, please contact: Rapid assessment of nutrition and food emdsa in Chaco municipalities affected by droughts.
Also, Mennonite communities have ebdsa different socio-economic and cultural backgrounds to the wider rural population in the Chaco, hence were not included even if they were set in rural areas. Instituto Nacional de Salud. Monitoreo Nacional de Indicadores Nutricionales. Programa Mundial de Alimentos de las Naciones Unidas. Assessment, Prevention and Control.
A Guide for Programme Managers. ENN is a registered charity in the UK no. SMART surveys measure acute malnutrition of the whole population via estimates of: Crude mortality rate CMR enesa a given population over a specific blivia of time. Food security assessments, which are used to understand and interpret nutritional and mortality survey data. Material for Hb analysis. Blood drop for Hb analysis. Results card for the families, one per child.
Stamps representing anaemia status. Puncture zone on middle hand finger. Puncture zone on heel. Underweight, acute and chronic malnutrition prevalence and confidence intervals per department of Bolivian Chaco Region. Anaemia prevalence in boys and girls aged months and months per Bolivian Chaco Departments.