The 2nd group was
composed of 151 children that were admitted in the Bele rehabilitation
centre, owing to their critical nutritional status.
In
reference to the proposed quantitative objectives, the project reached
165% of the target for the outreach component (set at 2 000 children),
and 100% as regards rehabilitation of severely malnourished cases.
1.3. Supplementary food distribution outputs
> The initial and final distribution per range of nutritional status
show the following break down:
| Range |
<70% |
70 75% |
75
— 80% |
> 80% |
Oedema |
| Initial Rate |
14% |
23% |
49% |
2% |
12% |
| Final Rate |
2.5% |
2.5% |
7% |
88% * |
- |
(*
91% among the children above 80% of W/H, were actually measured at
above 85%.)
>
In terms of global malnutrition rate, the terminal value, as
observed at the end of the intervention, can be estimated at 12% of
the initial target group, or 2% of the general population of the under
5 in the area.
>
The average weight gain during the operational phase was 1727
g per child (observed range: 1120 — 2 269), for an individual amount
of distributed food estimated at 38500 g on average.
> The total cost, including all project
related expenditure, and notably the nominal cost of food, drugs, transport,
labour and supervision, may be evaluated at around 7.3 EB
per kilo. As the cost of the product itself (farmix) is of 4
EB/Kg, the cost of the distribution represents 3.3 EB per kilo.
>
Based on the studied sample, only 5.5 % (Confidence interval:
2% — 9% with p<0.05) of the children have not gained weight
during the intervention.
> Among the total target group of 3 319 children, 68 have died
after the selection process and during the supplementary food support
phase, which indicates a death rate of 2%.
>
Out of the 151 children admitted in the Bele rehabilitation centre,
142 left the nutrition unit when cured, after an average duration of
stay of approximately 1 month. 9 deaths have been reported, which represents
a death rate of 6%, 3 times higher than what was observed in the population
of children monitored through the project outreach activities.
Il.
Development of MOH capacities and preparedness to cope with
food crisis
11.1. Purpose
To
entrust the MOH with the responsibility of implementing the project
in 7 kebeles
and to build up its human and material resources to improve their operational
skills and capacities.
11.2. Outputs
The
operational role played by the MOH in the implementation of the project
was more important than expected, as they covered 11 kebeles
instead of the 7 planned in the proposal, on the own request of the
Health Office. They were thus in charge of 34% of the cumulated population,
calculated on the number of households.
The
constant interactions with the project team have created the conditions
of a skill transferring mechanism, which can be seen in the results
observed in the areas under the MOH responsibility. A comparative analysis
of the data collected during the initial survey shows a strong congruence
between the two operators, in terms of both demographical and nutritional
information. Notably the efficacy of the referral system (94.5%) is
exactly similar in the 2 areas.
Concerning
the outputs, the comparison of the 2 percentages of rehabilitated children
at the end of the project period observed in a sample of the 2 areas
of intervention does net reveal any significant difference (p>0.30).
3
major fields can be identified where the MOH capacities have been actually
strengthened:
>
in the perception of the importance of monitoring: at the supervision
level, the managerial staff is convinced about the necessity of a close
monitoring system to ensure, in the long run, a field implementation
in compliance with the pursued objectives. The satisfying reliability
of the MOH reporting system during the unfolding of the project is a
sign of this perception.
> In
the staff technical and practical skills, which have been reinforced
through the collaboration established with the project team. The organisation
of a planned training session in November 2000, centred around nutritional
and programme operational issues in the context of food crisis has contributed
to materialise this process.
> In
the logistical capacities at the disposal of MOH, with the purchase
of 2 new motorbikes, that facilitate the transport of the field teams
and increase the MOH range of intervention, this aspect being even more
relevant with the opening of new access roads through the intervention
of the French NGO “SOS Sahel”.
III.
Impact assessment 
111.1.
Purpose
To
design appropriate instruments to conduct an impact assessment study.
111.2.
Outputs
A
questionnaire has been addressed to a randomly selected sample of 228
families in the covered areas (114 families identified as the “target
group”, having at least one child directly concerned with the scheme
and the remaining 114 families identified as the “control group”, having
no child concerned by the program).
This
study was designed to answer the following questions:
was
the recent episode of child malnutrition avoidable, this is to say linked
with other factors than food scarcity? What are the main determinants
leading to a specific vulnerability to food crisis? What would have
been the situation in the absence of the intervention? What is the impact
of the project upon the attitude and practices of the targeted families?
SITUATION RE ASSESSMENT AND LESSONS
LEARNT
1.
Benefits and achievements
The
infant reported mortality rate in the year prior the survey was calculated
at 85‰ (20 deaths) for the target group
and 89‰ (19) for the control group. It is clear that without
the intervention, this rate would have been much higher in the target
group. 129 children belong to the target group (15 families of the target
group having two children concerned by the scheme) out of a total of
236. Applying the death rate of 2% observed in the project global population,
2 children would have died during that period out of the targeted 129.
18 children deaths may thus be considered as pertaining to the group
of children not included in the project, but living in the same families,
or 107 (236-129), leading to an estimated death rate of 168‰ for
this specific group which is almost twice as high than the 89‰ observed
in the control group
It seems
relevant to suggest that in the absence of the project intervention,
the infant death rate observed in the targeted children group would
have been at least equal to the 168‰ calculated in the group of children
not included in the scheme, leading to a theoretical number of
avoided deaths of: (168 - 20) x 3.319 = 490.
2.
Significant changes
According
to the survey, as far as the family structure is concerned, there is
no significant difference between the 2 groups, notably regarding the
size of the family (6.46 and 6.82), the number of under 5 in the house
(2,07 and 1.88), the age of the youngest child.
But,
the ratio number of U5/family size (0.28 and 0.32) shows a very significant
difference (p< 0.01). In other words,
under 5 children living in families with higher ratio infant/adult are
more likely to develop a form of acute malnutrition in a situation of
food crisis. This show that the importance of the number
of productive persons in a family is only relative.
Concerning
social and economical factors (and using
comparison of means on paired ranges method), the only variables
that differ from one group to another are the amount of food reserves
reported at the time of the survey (p<0.01) and the number of living
animals (p<0.02). The control group owned a little more reserves
and animals that the target group, although the difference is limited
(1.6 month as apposed to 1.8,1.8 animal as opposed to 2.3).
In
terms of long term coping strategies, which are mainly polygamy and
migration, there is no significant difference between the groups.
The
2 strategies seem chronologically successive: the second weddings took
place much earlier (in the 80s for a large majority) than the migrations
(mostly found in the last 3 years).
There
was a precedent crisis for 91 % of the target group, as opposed to 77%
(p<0.01) of the control group. 3 periods are dominant in the answers:
85/89 (20 and 30%), 94/95 (10 and 20%) and 97/98/99 (70 and 50%). The
control group being less affected by the last crisis, is likely not
to have exhausted its capacities to cope.
The
2 groups have a similar access to Income Generating Schemes. Although
80% of the target group report some work in the last year as apposed
to 87% in the control group, the cumulated amount of labour days is
identical: 169 days against 170 (a labour period given in days was counted
as the next unit in terms of month).
Coming
to the impact assessment, it is not surprising to note that only 26%
of the targeted families report having some food during the crisis,
as opposed to 55% of the control group. In most of the cases observed
in the target group, this food was given to and eaten by the child,
but the intake was clearly insufficient (quantitatively and qualitatively).
The
acquisition of knowledge about nutrition has been rated according to
the number of symptoms that the respondents could spontaneously quote.
On average, the target group gave 1.4 symptoms, as against 1.1 for the
other group (p<0.02). 54% of the target group report to have learnt
from the project, as well as 9% of the control group.
Concerning
the future, respectively 95 and 91 % of the respondents expect a similar
crisis to come. Their projected attitude to cope do net show any difference,
taking into account the nature of the given strategies: no response
at all (17 and 14%), counting on relief (10 and 7%), relying
on God (8 and 11%), or on own efforts (58 and 63%).
3. Lessons
Learnt
The
intervention has proved to avoid a quite high number of under 5 deaths,
that might not have been avoided by IGS alone. It allowed to define
a predictive instrument to evaluate the death rate among a population
of affected children, which appears, in cumulative figures, to be similar
to the malnutrition rate. A rough estimation of the cost per avoided
death gives a total of 1500 EB.
This
type of outreach selective strategy has been well accepted and understood
by the population, as shown by the fact that 88% of the malnourished
children were considered as back to a normal or sub normal nutritional
status at the end of the intervention, which tends (among other signs)
to turn down the fear of a grossly diverted use of the food.
The
implementation itself was logistically much heavier than expected, due
to the necessity of reaching more than 3000 children in 24 kebeles,
over a period of 6 months. This strategy was actually very demanding
in terms of human and transport resources, and this was done to the
detriment of the Information Education Communication aspect, that was
not given the expected emphasis. The distribution mechanism can be evaluated
as very effective in limiting the death rate, but rather poor on bringing
behavioural changes.
The
main conclusion that could be drawn is that there is little room to
support the hypothesis of an important role played by inadequate feeding
practices in the history of child malnutrition in Kindo Koysha. This
might concern up to 10 to 20% of the target population only. As far
as short-terms strategies are concerned, there is probably a valuable
effort to make in the field of food and cash management and saving centred
around the most vulnerable families.
Concerning
long-term strategies, the population seems to be progressively moving
towards a new set of collective references: a process of change is slowly
operating within the population of Kindo Koysha as a whole. The fact
that above 90% of all respondents anticipate a future crisis show that
there is a very realistic perception of the real situation, and this
has an influence, on the long term strategies evolved by the families
— if not on the short term ones, (see “Cash for work and food insecurity
in Kindo Koysha”, SOS Sahel 1994 report): polygamy seems to be receding,
and the use of contraceptive
methods appears to be much more consistent than a few years ago. In
the meantime, migration is clearly emerging as a valuable option in
the last few years.
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