Food hand-outs not enough to prevent malnutrition, says study

//NOTE TO SUBSCRIBERS: This story replaces one issued under the same title on 15 March, which has been withdrawn// Disease is a major factor leading to malnutrition in southern Sudan, resulting from a hostile and underdeveloped environment where health services are poor and access to safe drinking water and hygiene is limited, according to a new study. Compounding this are inappropriate practices related to feeding, hygiene and health care. A study conducted by Action Contre la Faim-USA (ACF-USA) among children under five in the Nuer community of Old Fangak, central Upper Nile, found that most of the malnourished children had been sick over an extended period, suffering from diarrhoea, respiratory infections and fever, or a combination of several illnesses. Disease and inadequate food intake seemed to have particularly affected children under five years old, the report stated. There were no safe water points in the area, which had only one borehole, the study found. In addition people tended to use water sources - rivers, swamps, stagnant pools and hand-dug wells - that were close by, irrespective of the water's quality, the report stated. While guinea worm filter cloths were used by over 70 percent of the population, only 2 percent of people were boiling their drinking water. Levels of hygiene were also poor, with defecation in the open, little washing of hands, dirty clothes, little access to soap and mothers not washing breasts before breastfeeding. Despite a number of interventions in the region - including feeding programmes - the incidence of global acute malnutrition rose steadily between April 2001 and March 2003. Mothers were found to be so busy with household chores that childcare was affected, the study noted. Women were occupied with cleaning, grinding, cooking and fetching water, as well as farm work, constructing tukuls (huts) and brewing beer, to such an extent that they did not have enough time to tend to their children's needs, including feeding and detecting sickness. To a lesser extent, it is assumed that their heavy workload also affected pregnancy and children's birth weight, the study noted. Weaning practices were also found to be inappropriate, with mothers introducing cow's milk (unboiled) too early and solids too late (at 12 months). Solid food in the form of thick porridges were often introduced too late, in a diet that often lacks fruit and vegetables. In addition, families generally ate only twice a day - to save any extra food and because grinding is manual and therefore time consuming - which was insufficient, the report said. Once children reached two years, they were generally considered able to eat unaided from a common bowl, leading to weaker or smaller children losing out. "From the age of two to three years, children are considered as small adults, and mothers focus their attention on the younger children," the study noted. When children reached six to eight years old, they became involved in herding cattle, fetching water and grinding, activities which were particularly energy consuming. ACF-USA made a number of recommendations, including the promotion of adequate breastfeeding; a balanced diet; school feeding; health education; hygiene awareness; and a collective mill for women. The response to malnutrition in Old Fangak - and by extension any Sudanese community - had to be multi-sectoral, with the complementary intervention of agencies specialised in different fields, said the report.