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Food insecurity, malnutrition and mortality in Maewo and Ambae islands, Vanuatu

Published online by Cambridge University Press:  02 January 2007

Andre MN Renzaho*
Affiliation:
Program Quality Advisor, Program Effectiveness, World Vision Australia and Honorary Fellow, School of Health and Social Development, Deakin University, Australia
*
*Corresponding author: Email andre.renzaho@worldvision.com.au
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Abstract

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Context

This paper reports on findings from the ex-post evaluation of the Maewo Capacity Building project in Maewo Island, Vanuatu, which was funded by World Vision Australia.

Objectives

To examine the extent to which the infrastructure and systems left behind by the project contributed to the improvement of household food security and health and nutritional outcomes in Maewo Island, using Ambae Island as a comparator.

Setting

Two-stage cluster survey conducted from 6 to 20 July 2004, which included anthropometric measures and 4.5-year retrospective mortality data collection.

Participants

A total of 406 households in Maewo comprising 1623 people and 411 households in Ambae comprising 1799 people.

Main outcome measures

Household food insecurity, crude mortality rate (CMR), under-five mortality rate (U5MR) and malnutrition prevalence among children.

Results

The prevalence of food insecurity without hunger was estimated at 15.3% (95% confidence interval (CI): 12.1, 19.2%) in Maewo versus 38.2% (95% CI: 33.6, 43.0%) in Ambae, while food insecurity with hunger in children did not vary by location. After controlling for the child's age and gender, children in Maewo had higher weight-for-age and height-for-age Z-scores than children of the same age in Ambae. The CMR was lower in Maewo (CMR=0.47/10 000 per day, 95% CI: 0.39, 0.55) than in Ambae (CMR=0.59/10 000 per day, 95% CI: 0.51, 0.67) but no difference existed in U5MR. The major causes of death were similar in both locations, with frequently reported causes being malaria, acute respiratory infection and diarrhoeal disease.

Conclusions

Project initiatives in Maewo Island have reduced the risks of mortality and malnutrition. Using a cross-sectional 'external control group' design, this paper demonstrates that it is possible to draw conclusions about project effectiveness where baseline data are incomplete or absent. Shifting from donor-driven evaluations to impact evaluations has greater learning value for the organisation, and greater value when reporting back to the beneficiaries about project impact and transformational development in their community. Public health nutritionists working in the field are well versed in the collection and interpretation of anthropometric data for evaluation of nutritional interventions such as emergency feeding programmes. These same skills can be used to conduct impact evaluations, even some time after project completion, and elucidate lessons to be learned and shared. These skills can also be applied more widely to projects which impact on the longer-term nutritional status of communities and their food security.

Type
Research Article
Copyright
Copyright © The Authors 2006

References

1Centre for Public Health Nutrition (CPHN). Food Security Options Paper: A Planning Framework and Menu of Options for Policy and Practice Interventions. Improving Nutrition in NSW Series. New South Wales, Australia: CPHN, 2003.Google Scholar
2Pelletier, DL, Frongillo, EA, Schroeder, DG, Habicht, JP. The effect of malnutrition on child mortality in developing countries. Bulletin of the World Health Organization 1995; 73: 443–8.Google ScholarPubMed
3Food and Agriculture Organization of the United Nations (FAO). The State of Food Insecurity in the World: Monitoring Progress Towards the World Food Summit and Millennium Development Goals. Rome: FAO, 2003.Google Scholar
4Burgermeister, J. Number of chronically hungry people is rising by 5m a year. British Medical Journal 2005; 327: 1303.CrossRefGoogle Scholar
5Welegtabit, SR. Food Security Strategies for Vanuatu. Working Paper Series No. 58. Bogor, Indonesia: Coarse Grains, Pulses, Roots and Tuber Crops Centre, 2001.Google Scholar
6United Nations Programme on HIV/AIDS (UNAIDS). 2004 Report on the Global HIV/AIDS Epidemic: 4th Global Report. Geneva: UNAIDS, 2004.Google Scholar
7Southern Africa Development Community. Regional Emergency Food Security Assessment Report. Harare: Food, Agriculture and Natural Resources Vulnerability Assessment Committee, 2002.Google Scholar
8Food and Agriculture Organization of the United Nations (FAO). FAO and SIDS: Challenges and Emerging Issues in Agriculture, Forestry and Fisheries. Rome: FAO, 2004.Google Scholar
9Levine, S, Chastre, C. Missing the Point: An Analysis of Food Security Interventions in the Great Lakes. London: Overseas Development Institute, 2004.Google Scholar
10Renzaho, AMN, Renzaho, CC. In the shadow of the volcanoes: the impact of intervention on the nutrition and health status of Rwandan refugee children in Zaire two years on from exodus. Nutrition and Dietetics 2003; 60: 8591.Google Scholar
11Renzaho, AMN, Mahony, G, David, J, Campbell, D. World Vision Food Aid Program in Tete Province – Mozambique: Impact Evaluation and Documentation of Lessons Learned. Melbourne: World Vision Australia, 2004.Google Scholar
12Hofmann, C. Measuring the Impact of Humanitarian Aid. Humanitarian Policy Group Research Paper No. 15. London: Overseas Development Institute, 2004.Google Scholar
13Hansch, S. Measuring program impact: lessons in evaluation from humanitarian aid. Democracy at Large 2005; 1(3). Also available at http://www.democracyatlarge.org/vol1_no3/vol1_no3_ITT_Measuring_Impact_print.htm. Accessed 10 October 2005.Google Scholar
14Adelski, E, Hill, R, Mason, J, MeClelland, D, Muscat, R. Complex Humanitarian Emergencies and USAID's Humanitarian Response. Washington, DC: Centre for Development Information and Evaluation, US Agency for International Development, 2000.Google Scholar
15Petticrew, M, Roberts, H. Evidence, hierarchies and typologies: horses for courses. Journal of Epidemiology and Community Health 2003; 57: 527–9.CrossRefGoogle ScholarPubMed
16Habicht, JP, Victora, CG, Vaughan, JP. Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. International Journal of Epidemiology 1998; 28: 10–8.CrossRefGoogle Scholar
17Boe, S. Maewo Island Capacity Building Project: End of Project Report. Port Vila: World Vision Vanuatu, 1999.Google Scholar
18Penama Provincial Council. Penama Five-year Social Development Plan: 2003–2007. Saratamata: Penama Province, Ministry of Home Affairs, Republic of Vanuatu, 2002.Google Scholar
19Wassertheil-Smoller, S. Biostatistics and Epidemiology: A Primer for Health Professionals. New York: Springer-Verlag, 1995.CrossRefGoogle Scholar
20Food and Agriculture Organization of the United Nations (FAO). Conducting Small-scale Nutrition Surveys: A Field Manual. Rome: FAO, 1990.Google Scholar
21Campbell, MJ, Julious, SA, Altman, DG. Sample sizes for binary, ordered categorical, and continuous outcomes in two group comparisons. British Medical Journal 1995; 311: 1145–8.CrossRefGoogle ScholarPubMed
22Henderson, RH, Sundaresan, T. Cluster sampling to assess immunisation coverage: a review of experiences with a simplified sampling method. Bulletin of the World Health Organization 1982; 60: 253–60.Google ScholarPubMed
23Salama, P, Assefa, F, Talley L van der Veen, A, Gotway, C. Malnutrition, measles, mortality and the humanitarian response during a famine in Ethiopia. Journal of the American Medical Association 2001; 286: 563–71.CrossRefGoogle Scholar
24Médecins Sans Frontières. Nutrition Guidelines to Facilitate the Application of Fundamental Concepts and Principles Necessary for the Assessment of Nutritional Problems and The Implementation of Nutritional Programmes in Emergency Situations, 1st ed. Paris: Médecins Sans Frontières, 1995.Google Scholar
25Radimer, KL, Olson, CM, Campbell, CC. Development of indicators to assess hunger. Journal of Nutrition 1990; 120: 1544–8.CrossRefGoogle ScholarPubMed
26Hamilton, WL, Cook, JT, Thompson, W, Buron, L, Frongillo, JE, Olson, CM, et al. Household Food Security in the United States in 1995. Washington, DC: US Department of Agriculture Food and Consumer Service, Office of Analysis and Evaluation and Abt Associates, 1997.Google Scholar
27Kendall, A, Olson, CM, Frongillo, E Jr. Validation of the Radimer/Cornell measures of hunger and food insecurity. Journal of Nutrition 1995; 125: 2793–801.Google ScholarPubMed
28Welch, K, Mock, N, Netrebenko, O. Measuring hunger in the Russian Federation using the Radimer–Cornell hunger scale. Bulletin of the World Health Organization 1998; 76: 143–6.Google ScholarPubMed
29Studdert, L, Frongillo, E, Valois, P. Household food insecurity was prevalent in Java during Indonesia's economic crisis. Journal of Nutrition 2001; 131: 2685–91.CrossRefGoogle ScholarPubMed
30Frongillo, EA Jr, Rauschenbach, BS, Olson, CM, Kendall, A, Colmenares, AG. Questionnaire-based measures are valid for the identification of households with hunger and food insecurity. Journal of Nutrition 1997; 127(Suppl.) 699S705S.CrossRefGoogle ScholarPubMed
31Hatloy, A, Torheim, LE, Oshaug, A. Food variety–a good indicator of nutritional adequacy of the diet? A case study from an urban area in Mali, West Africa. European Journal of Clinical Nutrition 1998; 52: 891–8.CrossRefGoogle Scholar
32Hoddinott, J. Choosing Outcome Indicators of Household Food Security. Washington, DC: International Food Policy Research Institute, 1999.Google Scholar
33National Center for Health Statistics. A Growth chart for International use in Maternal and Child Health Care. Guidelines for Primary Health Care Personnel. Geneva: World Health Organization, 1978.Google Scholar
34Renzaho, A, Burns, C, Reidpath, D. Measuring refugee Malnutrition in the under-fives: pit falls in practice. Mots Pluriels 2002; 21: 110http://www.arts.uwa.edu.au/MotsPluriels/MP2102rbr.html/.Google Scholar
35Grein, T, Checchi, F, Escriba, JM, Tamrat, A, Karunakara, U, Stokes, C, et al. Mortality among displaced former UNITA members and their families in Angola: a retrospective cluster survey. British Medical Journal 2003; 327: 650.CrossRefGoogle Scholar
36de Onis, M, Monteiro, C, Akre, J, Clugston, G. The worldwide magnitude of protein–energy malnutrition: an overview from the WHO global database on child growth. Bulletin of the World Health Organization 2003; 71: 703–12.Google Scholar
37United Nations Children's Fund. At a glance: Vanuatu [online], 2003. Available at http://www.unicef.org/infobycountry/vanuatu_statistics.html. Accessed 10 Marth 2003.Google Scholar
38Renzaho, AMN. Evaluation of the Nthabiseng and Nazareth ADP Food Security Project in Lesotho: Summary of Key Achievements and Suggested Way Forward. Melbourne: World Vision Australia, 2005.Google Scholar
39Hoddinott, J. Examining the Incentive Effects of Food Aid on Household Behaviour in Rural Ethiopia. Washington, DC: International Food Policy Research Institute, 2003.Google Scholar
40Schmalbruch, G. Linking relief and development starts with addressing food insecurity. The ACP-EU Courier 2003; 197: 48–9.Google Scholar
41World Bank. World Bank Aid and Reform in Africa: Lessons from Ten Case Studies. Washington, DC: World Bank, 2001.Google Scholar
42Renzaho, AMN. Human right to food security in refugee settings: rhetoric versus reality. Australian Journal of Human Rights 2002; 8: 4356.CrossRefGoogle Scholar
43European Centre on Pacific Issues. Climate change: cyclones batter Pacific region. Europe Pacific Solidarity Bulletin 2004; 12: 10.Google Scholar