How we collect and harness data to find better ways to deal with malnutrition in South Sudan
By: Sarah King,
Regional Nutrition & Advocacy
Officer, Action Against Hunger
Two years ago this week, famine was declared in parts of South Sudan. Famine is a rare and specific technical classification of food insecurity, mortality, and malnutrition among populations. It is declared when the following criteria are met, among others:
1 in 5 households face an extreme food shortage
More than 30% of the population is malnourished
At least 2 in every 10,000 people die per day
4 in every 10,000 children under five die per day.
In this century, famine has been declared twice: in Somalia in July 2011, after an estimated 250,000 people died, and in Unity State, South Sudan, in February 2017.
After major humanitarian aid interventions, these areas of South Sudan are no longer experiencing famine, but immense challenges remain. More than seven million people in the world’s newest nation are in dire need of humanitarian assistance and protection. According to the latest analysis, released on February 22, hunger continues to rise: the number of people suffering from acute food insecurity has increased by 13 percent since January last year.
Action Against Hunger has worked in South Sudan since 1985 – long before the country gained independence in 2011 – helping vulnerable communities improve nutrition, food security, water, sanitation, and hygiene. Our expert teams also carry out nutrition assessments: we collect and analyze crucial community data to help organizations, governments, and world leaders understand the country’s food crisis and how best to tackle it.
Below, Sarah King, Action Against Hunger’s Regional Nutrition and Advocacy Officer for East Africa, shares the story behind one of these surveys.
When conflict broke out in South Sudan five years ago, a protracted humanitarian crisis began, resulting in an unstable economy, widespread political insecurity, destruction of infrastructure, severe food insecurity, and high rates of malnutrition. In situations where the need is acute, how does Action Against Hunger determine what kinds of interventions are needed, and whether nutrition is improving?
Our teams collaborate closely with communities, listening and learning from their perspectives. We are also fueled by data, which is why we work on public health surveillance and evaluation activities, assessing the impact and effectiveness of our programs and monitoring the nutrition situation on the ground closely. This process includes Standard Monitoring and Assessment of Relief and Transition surveys – SMART surveys – an assessment method designed specifically for measuring malnutrition in emergency situations.
The survey looks at two main indicators that can reliably signal how severe a food crisis is for an entire community: nutrition status of children under five years old and mortality rate of the general population.
Last year, I co-managed one of these SMART surveys in Aweil East, an area in Northern Bahr el Ghazal, South Sudan. With a team of 24 data collectors, we visited 450 households in 35 villages throughout Aweil East over a period of just seven days. In each household, we measured the height, weight, and mid-upper arm circumference of children between six months and five years old – these are the measurements used to determine nutrition status.
We also interviewed parents and other caregivers, asking questions about household mortality, illness, sanitation, and food security. At the end of the survey, we compiled and analyzed the data and submitted it to South Sudan’s Nutrition Information Working Group for validation.
The survey discovered an estimated global acute malnutrition (GAM) rate of 21% -- this is the combined rate of both moderate and severe forms of acute malnutrition. GAM rates over 15% are classified as “Critical” – the most urgent of the World Health Organization’s emergency standards. We also found high rates of food security and hunger, indicating that families in the region face significant challenges accessing food and are frequently unable to achieve nutrient adequate diets with the resources available.
Our survey’s most important finding is that, despite the health, nutrition, sanitation, and food security services provided by humanitarian organizations, two out of every ten children were experiencing acute malnutrition, also known as wasting – the deadliest form of malnutrition. These children either did not have enough food to eat, or they had an illness leading to sudden weight loss.
Humanitarian assistance has staved off the worst and has helped bring parts of the country back from famine, but the survey reveals more action is needed; too many children are still suffering from life-threatening malnutrition.
Public health surveillance plays an integral role in emergencies because the last thing we want to do is to make the situation worse. Nutrition assessments force the humanitarian community to take stock of our activities, to ask hard questions, and to push ourselves to improve – to find a better way to deal with hunger.
There are no easy answers to these questions, but it’s our priority every single day at Action Against Hunger. That’s why, in addition to our work in health centers diagnosing and treating malnourished children, we are constantly testing new approaches, collaborating with new partners to tackle malnutrition holistically, and using data to unflinchingly evaluate our work.
We innovate through our work with mothers, teaching them how to measure their children’s upper arms for malnutrition so they know when they’re sick. We teach parents how to prevent malnutrition through good sanitation and hygiene practices – some mothers are even building their own latrines. We aim to change norms that can have detrimental impacts on families, such as our trainings to reduce gender-based violence. And we grow gardens with communities, helping to foster nutritious diets and to provide opportunities for income. It is an immense responsibility and privilege to be part of this work each day.
This story was originally published as a blog post for the Congressional Hunger Center, where the author is a Mickey Leland International Hunger Fellow. It has been adapted for this website.