Summary of a report on the Underlying Causes of Malnutrition in Twic County, Warap State, South Sudan. August 2007
Consecutive surveys in Twic County have shown constantly high levels of malnutrition despite the interventions currently being carried out. GOAL, together with other NGOs, has been carrying out feeding responses to alleviate malnutrition, and more recently food security awareness. Programme coverage and meeting international emergency feeding standards have been a challenge due to the low attendance in the various feeding sites.
To understand the underlying causes of malnutrition hence has become inevitable to identify appropriate interventions. Focus group discussions and key informant interviews were conducted in order to understand the community’s perspective on various issues. The discussions and interviews were based on UNICEF’s conceptual framework of causes leading to malnutrition, morbidity and mortality. This approach identifies three levels of factors leading to malnutrition: immediate causes, underlying causes and basic causes.
The general findings show that malnutrition is a multi-deficiency syndrome, linked with inappropriate care practices, substandard levels or access to health services, water supply, hygiene & sanitation, inadequate health education and a poor understanding of the importance of food quality, quantity and diversity. In addition women’s heavy workloads and cultural beliefs and traditions which probably originated from what could be coping strategies also play a big role in malnutrition.
A keynote to the approach towards alleviating malnutrition is to modify the strategy used in carrying out the interventions recommended. Impact on behaviour change at individual and household level is still wanting. This has always been a challenge because most interventions take a top down approach and disregard the cause of the underlying problems. Behaviour change campaigns have to consider cultural beliefs and traditions, social pressures, and community motivation towards the key positive messages they are passing on.
A focus group meeting (Terry Theuri)
While disseminating the messages, community prioritised, interactive, participatory methods should be used. To enable this means that capacity building of health promoters is necessary to ensure that they are at a level where they understand the above mix.
Chart 1 summarises the main underlying causes of malnutrition in Twic County and their basic contributors. Chart 2 shows the food availability, seasons and principal morbidities – see below.
majority of the underlying causes of malnutrition fall under the social and
care environment, showing that, to have an impact on malnutrition in Twic
County, this is where programmatic resources should be directed. Nutrition
interventions in Twic (based heavily on feeding programmes) do not address
these causes adequately at present. Feeding programmes should therefore be
discontinued unless there is an emergency, and resources re-allocated to
prevention of malnutrition orientated activities.
and strengthen the current CTC (Community Therapeutic Care) approach to
prevention and treatment of malnutrition in Twic County that GOAL is currently
implementing in partnership with Action Against Hunger-UK
other intervention strategies that tackle malnutrition in a sustainable way.
key messages need to be focussed to address key underlying problems found here.
need to be given in a culturally sensitive way, be participatory and content
needs to be correct. To achieve this, community health educators need to be
trained on methods for public health message dissemination and behaviour change
a culturally appropriate high-energy complementary recipe that uses low cost,
locally available foods, and teach it to mothers through cooking
and expansion of food diversification initiatives such as seed distributions
and introduction of fruit trees with the necessary training, support and follow-up.
of fishing equipment with seed distributions to improve household access to
to breastfeeding and complementary feeding through initiatives that enable
mothers to spend more time at home. For example, the introduction of energy
saving stoves made from locally available materials and water purification
initiatives (such as filtration and chlorination) that allow mothers to collect
water from a near-by source.
Vitamin A supplementation to post-partum women (to ensure sufficient Vitamin A
in breastmilk and to increase mothers’ levels ahead of the next pregnancy)
through encouraging up-take of postnatal care.
culturally acceptable ways for improved sanitation.
all GOAL programmes are run in a gender sensitive way, or with a gender bias
- Increase soap distributions from the clinics as a way to promote hygiene, and further investigate soap making for promotion within the community.
Chart 1 Causes of malnutrition in Twic County
Household food insecurity
Inadequate social and care environment
Poor public health
Chart 2 Twic County - Food availability, seasons and principal morbidities
For full report email Terry Theuri at nutco at goalsouthsudan.org