a1 Department of International Health and Development, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70118, USA
a2 School of Public Health, Louisiana State University, New Orleans, LA, USA
a3 United Nations Children's Fund (UNICEF), Eastern and Southern Africa Regional Office (ESARO), Nairobi, Kenya
a4 UNICEF, Regional Inter-Agency Coordination Support Office (RIACSO), Johannesburg, South Africa
a5 UNICEF, Malawi
a6 UNICEF, Johannesburg, South Africa
a7 UNICEF, Zambia
a8 UNICEF, Mozambique and Lesotho
Objective To investigate trends in child malnutrition in six countries in southern Africa, in relation to the HIV epidemic and drought in crop years 2001/2 and 2002/3.
Design Epidemiological analysis of sub-national and national surveys with related data.
Setting Data from Lesotho, Malawi, Mozambique, Swaziland, Zambia and Zimbabwe, compiled and analysed under UNICEF auspices.
Subjects Secondary data: children 0–5 years for weight-for-age; HIV prevalence data from various sources especially antenatal clinic surveillance.
Results Child nutritional status as measured by prevalence of underweight deteriorated from 2001 onwards in all countries except Lesotho, with very substantial increases in some provinces/districts (e.g. from 5 to 20% in Maputo (Mozambique, 1997–2002), 17 to 32% in Copperbelt (Zambia, 1999–2001/2) and 11 to 26% in Midlands province (Zimbabwe, 1999–2002)). Greater deterioration in underweight occurred in better-off areas. Areas with higher HIV/AIDS prevalences had (so far) lower malnutrition rates (and infant mortality rates), presumably because more modern areas – with greater reliance on trade and wage employment – have more HIV/AIDS. Areas with higher HIV/AIDS showed more deterioration in child nutrition. A significant area-level interaction was found of HIV/AIDS with the drought period, associated with particularly rapid deterioration in nutritional status.
Conclusions First, the most vulnerable may be households in more modern areas, nearer towns, to whom resources need to be directed. Second, the causes of this vulnerability need to be investigated. Third, HIV/AIDS amplifies the effect of drought on nutrition, so rapid and effective response will be crucial if drought strikes again. Fourth, expanded nutritional surveillance is now needed to monitor and respond to deteriorating trends. Finally, with or without drought, new means are needed of bringing help, comfort and assistance to the child population.
(Received June 08 2004)
(Accepted February 17 2005)
p1 Presently Consultant to UNICEF, RIACSO, Johannesburg, South Africa.
p2 Presently UNICEF Representative, Laos.
p3 Presently Special Advisor on Human Rights to the Executive Director, UNICEF.