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Distribution of Nutritional Indicators

The distribution of nutritional indicators at the start and end of the survey is given in table 7. As can be seen from the table, the proportion of the study children below median minus 2 SD to be high for both height-for-age and weight-for-age indicators and lowest for the weight-for-height indicator. A similar pattern is observed in the control group.

TABLE 7. Distribution of Nutrition Indicators at the Beginning and End of the Survey (Percentages)

 Weight/Age Height/Age Weight/Height Start End Start End Start End Below median - 1 SD Subjects 70.0 70.9 72.2 75.3 26.0 23.4 Control 66.5 66.2 67.7 66.9 28.5 29.1 Below median - 2 SD Subjects 33.2 29.4 45.7 46.1 3.5 3.6 Control 30.4 25.0 36.7 31.8 2.5 2.7

Number of children examined: at start of survey, subject N = 1,174, control-group N = 158; at end of survey, subject N = 1,171, control-group N = 148.

TABLE 8. Prevalence of Malnutrition at the Beginning and End of the Survey (Percentages)

 Weight/Age Height/Age Weight/Height Start End Start End Start End Excess below median - 1 SD Subjects 54.1 55 0 56.8 59 4 10.1 6.5 Control 50 6 50.3 51.8 51.1 12.6 13.2 Excess below median - 2 SD Subjects 30.9 27.1 43.4 43.8 1.2 1.3 Control 28.1 22.7 34.4 29.5 0.2 0.4

Prevalence is expressed as percentage in excess of the value in the reference population

Prevalence of Malnutrition

Data collected during the survey were compared with the distribution of the indicators in the reference population. The proportion of children in the reference population falling below the median minus 1 SD for each of the three indicators was 15.9 per cent, with 2.3 per cent falling below the median minus 2 SD. These two figures were subtracted from the values presented in table 7 to obtain those in table 8. The same approach was followed in calculating subsequent prevalence of malnutrition using the same three indicators. In general, the data indicate that the supplementary feeding programmes in Addis Ababa do not seem to have had a marked impact on the nutritional status of the beneficiaries. Statistically significant improvement in the prevalence of malnutrition was noted in the weight-for-age indicator, while the indicator of height-for-age and weight-for-height showed no reduction in the prevalence of malnutrition between the start and end of the survey. Comparable values were observed in the control group, thus supporting the observations in the study population.

Effectiveness of the Feeding Programmes

The effectiveness of the feeding programmes is expressed in terms of the percentage of reduction in the prevalence of malnutrition (median minus 2 SD) between the start and the end of the study. Table 9 shows a reduction of 12.3 per cent only for the weight-for-age indicator Negative signs for the other two indicators show an increase in prevalence during the course of the study.

TABLE 9. Reduction in Prevalence of Malnutrition (Effectiveness of Feeding Programmes)

 Weight/ Age Height/ Age Weight/ Height Below median - 1 SD Subjects -1.7 -4.6 34.7 Control 0.6 1.5 -4.8 Below median - 2 SD Subjects 12.3 -0.9 -8.3 Control 19.2 14.2 100.0

Reduction is expressed as the difference between final and initial prevalence values (table 8) as a percentage of the initial value (initial value minus final value, divided by initial value, times 100).

TABLE 10. Prevalence of Malnutrition, by Sex (Percentages)

 Girls Boys Weight/age Height/age Weight/height Weight/age Height/age Weight/height Start End Start End Start End Start End Start End Start End Excess below median- 1 SD Subjects 56.0 54.9 55.1 59.3 99.8 6.3 52.4 55.1 58.3 59.6 10.4 6.7 Control 44.1 52.0 47.9 45.4 9.1 6.5 57.1 52.6 55.9 56.7 17.4 19.7 Excess below median - 2 SD Subjects 32.7 29.0 43.9 45.6 0.3 1.6 29.3 25.2 42.9 42.1 2.0 1.2 Control 25.2 19.0 29.0 28.4 1.0 1.6 31.0 26.5 40.0 30.6 1.5 0.9

Number examined: Girls at start of survey, subject N = 569, control-group N = 80; at end of survey, subject N = 568, control-group N = 75. Boys at start of survey, subject N = 605, control-group N = 78; at end of survey, subject N = 603, control-group N = 73.

TABLE 11. Prevalence of Low Levels of Weight for Age, by Age Group (Percentages) Age Groups (in Months)

 Age Groups (in Months) 6- 11.9 12-23.9 24-47.9 48-71.9 Start End Start End Start End Start End Excess below median - 1 SD Subjects 48.4 - 58.9 56.5 51.1 56.0 58.7 53.2 Control 24.1 - 55.1 43.2 50.2 52.8 65.9 50.2 Excess below median - 2 SD Subjects 23.2 - 39.1 33.4 28.2 32.1 28.5 23.3 Control 9.7 - 37.2 15.9 28.3 25.6 31.0 21.4 Number examined Subjects 99 - 326 98 581 624 168 447 Control 25 - 38 22 62 67 33 59

Prevalence of Malnutrition by Sex

The data on the prevalence of malnutrition by sex (table 10) show that more girls than boys were malnourished at the start of the survey in terms of weight-for-age and height-for-age indicators, which were 32.7 vs. 29 3 per cent and 43.9 vs. 42.9 per cent respectively (differences not statistically significant). However, the relationship was reversed for the weight-for-height indicators, which were 0.3 vs. 2.0 per cent. At the end of the survey more girls seem to have been malnourished than boys for all the indicators. In the case of the control group, however, more boys were malnourished than girls at the start of the survey for all indicators, although these differences were statistically insignificant. Comparison of the prevalence of malnutrition between the start and end of the survey shows reduction only in the weight-for-age indicator among the girls. Improvement was seen in all indicators for boys, but without statistical significance In the control group, reduction in prevalence was noted among the girls in the weight-for-age and height-for-age indicators, but neither was statistically significant. Control-group boys showed reduction in all the indicators, but again without statistical significance.

TABLE 12. Prevalence of Low Levels of Height for Age, by Age Group (Percentages)

 Age Groups (in Months) 6-11.9 12-23.9 24-47.9 48-71.9 Start End Start End Start End Start End Excess below median - 1 SD Subjects 44.7 - 66.9 70.8 51.6 43.4 62.1 57.3 Control 20.1 - 63.0 38.6 51.8 55.7 62.9 50.2 Excess below median - 2 SD Subjects 260 - 67 3 54.8 38.5 42.6 54.2 43.3 Control 17.7 - 47.7 29.5 29.9 27.5 40.1 31.6

Number of children examined as in table 11.

TABLE 13. Prevalence of Low Levels of Weight for Height, by Age Group (Percentages)

 Age Groups (in Months) 6-11.9 12-23.9 24-47.9 48-71.9 Start End Start End Start End Start End Excess below median - 1 SD Subjects 8.3 - 13.5 10.4 6.3 6.2 4.3 6.0 Control 20.1 - 18.3 6.8 9.9 9.5 8.3 -10.8 Excess below median - 2 SD Subjects 3.8 - 1.9 1.8 1.1 2.2 -1.7 -0.1 Control 5.7 - 0.0 2.2 0.9 -0.8 0.0 1.1

Number of children examined as in table 11.

Prevalence of Ma/nutrition by Age Groups

Data on the relationship between age and prevalence of malnutrition as reflected by the three indicators are presented in tables 11-13. The prevalence of malnutrition at the start of the survey was the lowest among children 611.9 months old and highest in those 12-23.9 months old from the standpoint of weight-for-age and height-forage values. The weight-for-height indicator showed the highest prevalence in the youngest age group and the lowest in the oldest group, those 48-71.9 months old. The control group followed a similar pattern. As the feeding programmes do not include children under 6 months old, and the survey lasted for a year, none of the children examined were in the 6-11.9 month age group at the end of the survey. Nonetheless, among the rest of the subjects the prevalence of malnutrition was highest in the same age group using the same indicators at the end of the study as at the beginning.

In general, the prevalence of malnutrition was highest in the 12-23.9-month age group, which then tended to decrease as children grew older. However, all indicators showed some degree of improvement in the nutritional status of children 12-23.9 and 48-71.9 months old at the end of the survey. The change is statistically significant only for height for age in the older group. In the 24-47.9 month age group, however, no reduction in the prevalence of malnutrition was observed in any indicator. The prevalence of malnutrition both at the start and end of the survey and the reduction observed were less marked in weight for height in all age groups. Thinness was not associated with shortness in any age group at either end of the survey.

TABLE 14. Centile Distribution of Nutritional Indicators, for All Ages and Both Sexes (Percentages)

 Centile Distribution 0- 10- 20- 30- 40- 50- 60- 70- 80- 90- 9.9 19.9 29.9 39.9 49.9 59.9 69.9 79.9 89.9 100 Weight for age Subjects Start 54.9 13.7 9.9 6.3 4.6 3.4 2.8 2.0 1.0 1.3 End 52.9 15.7 10.9 7.0 5.0 3.1 2.5 1.5 0.8 0.6 Control Start 57.0 10.8 8.2 7.6 5.7 5.1 1.3 1.9 - 2.5 End 60.1 8.1 13.5 6.1 6.8 2.0 1.4 1.4 - - Height for age Subjects Start 62.4 10.8 8.6 3.9 3.1 2.4 2.0 2.1 1.5 3.2 End 63.0 11.0 7.0 6.3 3.0 3.2 1.5 1.4 0.9 2.6 Control Start 58.9 12.0 5.1 2.5 2.5 3.8 3.2 3.8 1.9 6.3 End 61.5 10.1 8.1 4.7 3.4 2.0 2.0 2.0 4.7 1.4 Weight for height Subjects Start 13.7 10.1 14.8 12.9 12.3 9.5 7.1 7.0 5.2 7.6 End 10.2 11.2 13.3 14.9 11.2 11.4 8.1 7.0 4.9 7.9 Control Start 13.3 22.2 16.5 10.1 13.3 6.3 7.6 5.1 1.9 3.8 End 18.2 23.6 12.2 12.2 7.4 4.7 6.1 8.8 2.7 4.1

Number of children examined: at start of survey, subject N=1,174, control-group N=158; at end of survey, subject N = 1,170, control-group N = 148.

Centile Distribution of Nutritional Indicators

The centile distribution presents a continuous distribution of the three nutritional indicators and provides an overall view of the nutritional condition of the population benefiting from the feeding programmes. As can be seen in table 14, a large proportion of malnourished children in both study and control groups are clustered in the first ten centiles except for the weight-for-height indicator, which appears to have a uniform distribution in the first fifty centile brackets.

Comparisons of the Effects of the Feeding Programmes on the Prevalence of Malnutrition

As mentioned earlier, the study was designed to compare the prevalence of malnutrition among the different feeding schemes to measure their effectiveness in reducing undernutrition. Data on comparisons of the prevalence of malnutrition and effectiveness of different feeding schemes reveal the following:

- The prevalence of malnutrition both at the start and end of the survey is the highest in scheme 2 for all indicators.

- Schemes 3 and 5 show the highest percentage of reduction of malnutrition (19.3 per cent each) in the weight-for-age indicator. However, as the same value is exhibited by the control group, the improvement can hardly be attributed to the intervention programme.

- No marked association of thinness with stunting (weight/height) is observed in children in any of the feeding programmes.

- Statistical tests on comparisons of the prevalence of malnutrition and the effectiveness of the intervention programme in reducing malnutrition among the different schemes show no significant values for any of the indicators.

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