Malnutrition, measles, mortality, and the humanitarian response during a famine in Ethiopia

Peter Salama, Fitsum Assefa, Leisel Talley, Paul Spiegel, Albertien Van Der Veen, Carol A. Gotway

Research output: Contribution to journalArticle

Abstract

Context: The World Food Programme estimated that 10 million people were at risk of starvation in Ethiopia in 2000 but later reported that a famine had been averted. However, no population-based data on mortality or nutrition existed for Gode district, at the epicenter of the famine in the Somali region of Ethiopia. Objectives: To estimate mortality rates, determine the major causes of death, and estimate the prevalence of malnutrition among children and adults for the population of Gode district. Design and Setting: Two-stage cluster survey conducted from July 27 through August 1, 2000, which included anthropometric measures and 8-month retrospective mortality data collection. Participants: A total of 595 households comprising 4032 people living in Gode district of Ethiopia. Main Outcome Measures: Crude mortality rates and mortality rates for children younger than 5 years, causes of death, weight for height of less than -2 z scores among children aged 6 months to 5 years, and body mass index of less than 18.5 kg/m2 among adults and older persons. Results: Of the 595 households, 346 (58.2%) were displaced from their usual places of residence. From December 1999 through July 2000, a total of 293 deaths occurred in the sample population; 159 (54.3%) deaths were among children younger than 5 years and 72 (24.6%) were among children aged 5 to 14 years. The crude mortality rate was 3.2/ 10000 per day (95% confidence interval [Cl], 2.4-3.8/10000 per day), which is 3 times the cutoff used to define an emergency. The mortality rate for children younger than 5 years was 6.8/10000 per day (95% Cl, 5.4-8.2/10000 per day). Approximately 77% of deaths occurred before major relief interventions began in April/May 2000. Wasting contributed to 72.3% of all deaths among children younger than 5 years. Measles alone or in combination with wasting accounted for 35 (22.0%) of 159 deaths among children younger than 5 years and for 12 (16.7%) of 72 deaths among children aged 5 to 14 years. The prevalence rate for wasting (weight for height of <-2 z score) among children aged 6 months to 5 years was 29.1% (95% Cl, 24.7%-33.4%). Using a method to adjust body mass index for body shape, the prevalence of undernutrition (body mass index <18.5 kg/m2) among adults aged 18 to 59 years was 22.7% (95% Cl, 17.9%-27.5%). Conclusions: To prevent unnecessary deaths, the humanitarian response to famine needs to be rapid, well coordinated, and based on sound epidemiological evidence. Public health interventions, such as mass measles vaccination campaigns with coverage extended to children aged 12 to 15 years should be implemented as the first priority. The prevalence of wasting and undernutrition among children and adults, respectively, should be assessed in all prolonged, severe famines.

Original languageEnglish (US)
Pages (from-to)563-571
Number of pages9
JournalJournal of the American Medical Association
Volume286
Issue number5
StatePublished - Aug 1 2001
Externally publishedYes

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Ethiopia
Measles
Starvation
Malnutrition
Mortality
Body Mass Index
Cause of Death
Child Nutrition Disorders
Population
Mass Vaccination
Weights and Measures
Immunization Programs
Emergencies
Public Health
Outcome Assessment (Health Care)
Confidence Intervals

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Salama, P., Assefa, F., Talley, L., Spiegel, P., Van Der Veen, A., & Gotway, C. A. (2001). Malnutrition, measles, mortality, and the humanitarian response during a famine in Ethiopia. Journal of the American Medical Association, 286(5), 563-571.

Malnutrition, measles, mortality, and the humanitarian response during a famine in Ethiopia. / Salama, Peter; Assefa, Fitsum; Talley, Leisel; Spiegel, Paul; Van Der Veen, Albertien; Gotway, Carol A.

In: Journal of the American Medical Association, Vol. 286, No. 5, 01.08.2001, p. 563-571.

Research output: Contribution to journalArticle

Salama, P, Assefa, F, Talley, L, Spiegel, P, Van Der Veen, A & Gotway, CA 2001, 'Malnutrition, measles, mortality, and the humanitarian response during a famine in Ethiopia', Journal of the American Medical Association, vol. 286, no. 5, pp. 563-571.
Salama, Peter ; Assefa, Fitsum ; Talley, Leisel ; Spiegel, Paul ; Van Der Veen, Albertien ; Gotway, Carol A. / Malnutrition, measles, mortality, and the humanitarian response during a famine in Ethiopia. In: Journal of the American Medical Association. 2001 ; Vol. 286, No. 5. pp. 563-571.
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abstract = "Context: The World Food Programme estimated that 10 million people were at risk of starvation in Ethiopia in 2000 but later reported that a famine had been averted. However, no population-based data on mortality or nutrition existed for Gode district, at the epicenter of the famine in the Somali region of Ethiopia. Objectives: To estimate mortality rates, determine the major causes of death, and estimate the prevalence of malnutrition among children and adults for the population of Gode district. Design and Setting: Two-stage cluster survey conducted from July 27 through August 1, 2000, which included anthropometric measures and 8-month retrospective mortality data collection. Participants: A total of 595 households comprising 4032 people living in Gode district of Ethiopia. Main Outcome Measures: Crude mortality rates and mortality rates for children younger than 5 years, causes of death, weight for height of less than -2 z scores among children aged 6 months to 5 years, and body mass index of less than 18.5 kg/m2 among adults and older persons. Results: Of the 595 households, 346 (58.2{\%}) were displaced from their usual places of residence. From December 1999 through July 2000, a total of 293 deaths occurred in the sample population; 159 (54.3{\%}) deaths were among children younger than 5 years and 72 (24.6{\%}) were among children aged 5 to 14 years. The crude mortality rate was 3.2/ 10000 per day (95{\%} confidence interval [Cl], 2.4-3.8/10000 per day), which is 3 times the cutoff used to define an emergency. The mortality rate for children younger than 5 years was 6.8/10000 per day (95{\%} Cl, 5.4-8.2/10000 per day). Approximately 77{\%} of deaths occurred before major relief interventions began in April/May 2000. Wasting contributed to 72.3{\%} of all deaths among children younger than 5 years. Measles alone or in combination with wasting accounted for 35 (22.0{\%}) of 159 deaths among children younger than 5 years and for 12 (16.7{\%}) of 72 deaths among children aged 5 to 14 years. The prevalence rate for wasting (weight for height of <-2 z score) among children aged 6 months to 5 years was 29.1{\%} (95{\%} Cl, 24.7{\%}-33.4{\%}). Using a method to adjust body mass index for body shape, the prevalence of undernutrition (body mass index <18.5 kg/m2) among adults aged 18 to 59 years was 22.7{\%} (95{\%} Cl, 17.9{\%}-27.5{\%}). Conclusions: To prevent unnecessary deaths, the humanitarian response to famine needs to be rapid, well coordinated, and based on sound epidemiological evidence. Public health interventions, such as mass measles vaccination campaigns with coverage extended to children aged 12 to 15 years should be implemented as the first priority. The prevalence of wasting and undernutrition among children and adults, respectively, should be assessed in all prolonged, severe famines.",
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N2 - Context: The World Food Programme estimated that 10 million people were at risk of starvation in Ethiopia in 2000 but later reported that a famine had been averted. However, no population-based data on mortality or nutrition existed for Gode district, at the epicenter of the famine in the Somali region of Ethiopia. Objectives: To estimate mortality rates, determine the major causes of death, and estimate the prevalence of malnutrition among children and adults for the population of Gode district. Design and Setting: Two-stage cluster survey conducted from July 27 through August 1, 2000, which included anthropometric measures and 8-month retrospective mortality data collection. Participants: A total of 595 households comprising 4032 people living in Gode district of Ethiopia. Main Outcome Measures: Crude mortality rates and mortality rates for children younger than 5 years, causes of death, weight for height of less than -2 z scores among children aged 6 months to 5 years, and body mass index of less than 18.5 kg/m2 among adults and older persons. Results: Of the 595 households, 346 (58.2%) were displaced from their usual places of residence. From December 1999 through July 2000, a total of 293 deaths occurred in the sample population; 159 (54.3%) deaths were among children younger than 5 years and 72 (24.6%) were among children aged 5 to 14 years. The crude mortality rate was 3.2/ 10000 per day (95% confidence interval [Cl], 2.4-3.8/10000 per day), which is 3 times the cutoff used to define an emergency. The mortality rate for children younger than 5 years was 6.8/10000 per day (95% Cl, 5.4-8.2/10000 per day). Approximately 77% of deaths occurred before major relief interventions began in April/May 2000. Wasting contributed to 72.3% of all deaths among children younger than 5 years. Measles alone or in combination with wasting accounted for 35 (22.0%) of 159 deaths among children younger than 5 years and for 12 (16.7%) of 72 deaths among children aged 5 to 14 years. The prevalence rate for wasting (weight for height of <-2 z score) among children aged 6 months to 5 years was 29.1% (95% Cl, 24.7%-33.4%). Using a method to adjust body mass index for body shape, the prevalence of undernutrition (body mass index <18.5 kg/m2) among adults aged 18 to 59 years was 22.7% (95% Cl, 17.9%-27.5%). Conclusions: To prevent unnecessary deaths, the humanitarian response to famine needs to be rapid, well coordinated, and based on sound epidemiological evidence. Public health interventions, such as mass measles vaccination campaigns with coverage extended to children aged 12 to 15 years should be implemented as the first priority. The prevalence of wasting and undernutrition among children and adults, respectively, should be assessed in all prolonged, severe famines.

AB - Context: The World Food Programme estimated that 10 million people were at risk of starvation in Ethiopia in 2000 but later reported that a famine had been averted. However, no population-based data on mortality or nutrition existed for Gode district, at the epicenter of the famine in the Somali region of Ethiopia. Objectives: To estimate mortality rates, determine the major causes of death, and estimate the prevalence of malnutrition among children and adults for the population of Gode district. Design and Setting: Two-stage cluster survey conducted from July 27 through August 1, 2000, which included anthropometric measures and 8-month retrospective mortality data collection. Participants: A total of 595 households comprising 4032 people living in Gode district of Ethiopia. Main Outcome Measures: Crude mortality rates and mortality rates for children younger than 5 years, causes of death, weight for height of less than -2 z scores among children aged 6 months to 5 years, and body mass index of less than 18.5 kg/m2 among adults and older persons. Results: Of the 595 households, 346 (58.2%) were displaced from their usual places of residence. From December 1999 through July 2000, a total of 293 deaths occurred in the sample population; 159 (54.3%) deaths were among children younger than 5 years and 72 (24.6%) were among children aged 5 to 14 years. The crude mortality rate was 3.2/ 10000 per day (95% confidence interval [Cl], 2.4-3.8/10000 per day), which is 3 times the cutoff used to define an emergency. The mortality rate for children younger than 5 years was 6.8/10000 per day (95% Cl, 5.4-8.2/10000 per day). Approximately 77% of deaths occurred before major relief interventions began in April/May 2000. Wasting contributed to 72.3% of all deaths among children younger than 5 years. Measles alone or in combination with wasting accounted for 35 (22.0%) of 159 deaths among children younger than 5 years and for 12 (16.7%) of 72 deaths among children aged 5 to 14 years. The prevalence rate for wasting (weight for height of <-2 z score) among children aged 6 months to 5 years was 29.1% (95% Cl, 24.7%-33.4%). Using a method to adjust body mass index for body shape, the prevalence of undernutrition (body mass index <18.5 kg/m2) among adults aged 18 to 59 years was 22.7% (95% Cl, 17.9%-27.5%). Conclusions: To prevent unnecessary deaths, the humanitarian response to famine needs to be rapid, well coordinated, and based on sound epidemiological evidence. Public health interventions, such as mass measles vaccination campaigns with coverage extended to children aged 12 to 15 years should be implemented as the first priority. The prevalence of wasting and undernutrition among children and adults, respectively, should be assessed in all prolonged, severe famines.

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