What do the health indicators tell us about humanitarian crises in 2008?

Published by oliviadaoust| Filed under Newsletter

January is typically the month of statistical overviews. Analysts rush through their databases to come up with summary tables and analyses showing clear improvements, deteriorations or no change at all. So did we.
Although there is often a considerable lag between field work and the publication of the survey report, CE-DAT has already collected information from 99 nutrition and mortality surveys for 2008. Several of them were conducted in locations that had already been surveyed in 2006 or 2007. We present here some preliminary findings for some places in Sudan, Ethiopia, Kenya and Uganda based on the comparison of 2006/2007 health data with the 2008 data . Note: the tables below should be interpreted with some caution. Mortality and nutrition indicators are known to vary depending on the season. Therefore, the comparison of surveys from different years and different seasons could be biased by a seasonality effect.
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Regions:

Sudan - Darfur region Sudan - southern region Ethiopia Kenya Uganda
Sudan - Darfur region The mortality rates for the Darfur region show a positive evolution. All surveys conducted in 2008 had CMRs that were below the emergency threshold of 1 death per 10,000 people per day. In addition, improvement was reported for almost all places. Noteworthy is the considerable CMR reduction in Kass and Otash camp. Child mortality showed a similar improving trend. Not one location reported an increase in U5MR and only 1 (Kass) had a rate that was still above the emergency threshold of 2 deaths per 10,000 children per day. As far as this later is concerned, we note however that U5MR has decreased by 50%. There is less reason to be optimistic about the nutritional situation. Although in general malnutrition has decreased, the percentage of undernourished children is still above the threshold of 10%.

Table 1: Average Crude Mortality Rates (in deaths per 10,000 people per day)

Location		2008 Value	Reference Value
Sudan, North Darfur Camp:Abu Shok Sudan, North Darfur Camp:As Salam	=	0.3	0.5 (2007)
Sudan, North Darfur City:Kabkabiya	=	0.6	0.5 (2007)
Sudan, South Darfur Camp:Kalma	↓	0.6	1.0 (2006)
Sudan, South Darfur Camp:Al Salam	=	0.8	0.9 (2007)
Sudan, South Darfur Camp:Otash	↓	0.7	2.0 (2006)
Sudan, South Darfur City:Kass	↓	0.8	2.1 (2007)

Table 2: Average Under 5 Mortality Rates (in deaths per 10,000 children under 5 per day)

Location		2008 Value	Reference Value
Sudan, North Darfur Camp:Abu Shok Sudan, North Darfur Camp:As Salam	=	0.8	0.9 (2007)
Sudan, North Darfur City:Kabkabiya	↓	0.9	1.3 (2007)
Sudan, South Darfur Camp:Kalma	↓	1.2	1.8 (2006)
Sudan, South Darfur Camp:Al Salam	=	1.3	1.6 (2007)
Sudan, South Darfur Camp:Otash	↓	1.3	2.6 (2006)
Sudan, South Darfur City:Kass	↓	2.2	4.4 (2007)
Sudan, South Darfur Camp:Gereida	↓	1.3	3.0 (2006)

Table 3: Average Global Acute Malnutrition (% of 6-59 months old, Z-scores)

Location		2008 Value	Reference Value
Sudan, North Darfur Camp:Abu Shok Sudan, North Darfur Camp:As Salam	↓	17.9	22.3 (2007)
Sudan, North Darfur City:Kabkabiya	↓	24.2	27.0 (2007)
Sudan, South Darfur Camp:Kalma	↓	10.7	14.6 (2006)
Sudan, South Darfur Camp:Otash	↑	19.5	15.6 (2006)
Sudan, South Darfur City:Kass	↓	18.5	27.7 (2007)
Sudan, South Darfur Camp:Gereida	=	14.0	15.5 (2006)

Sudan - southern region The crude mortality rates in southern Sudan were below the threshold of 1/10,000/day and around the expected values for Sudan. Overall, they have remained stable when compared to the previous years. However, a survey conducted in Bentiu and Rubkoana (Unity State) showed a considerable increase in child mortality, reaching the U5MR threshold. As far as malnutrition is concerned, levels were above emergency thresholds, but have remained stable over the last years or even improved (Unity State).

Table 1: Average Crude Mortality Rates (in deaths per 10,000 people per day)

Location		2008 Value	Reference Value
Sudan, Jonglei Ad3:Atar Sudan, Jonglei Ad3:Khorfulus	↓	0.4	0.7 (2007)
Sudan, Unity City:Bentiu Sudan, Unity City:Rubkoana	↑	0.7	0.5 (2007)
Sudan, North Bahr-El-Ghazal Ad2:Aweil West Sudan, North Bahr-El-Ghazal Ad2:Aweil North	=	0.2	0.2 (2006)

Table 2: Average Under 5 Mortality Rates (in deaths per 10,000 children under 5 per day)

Location		2008 Value	Reference Value
Sudan, Jonglei Ad3:Atar Sudan, Jonglei Ad3:Khorfulus	↓	0.5	1.7 (2007)
Sudan, Unity City:Bentiu Sudan, Unity City:Rubkoana	↑	2.0	1.0 (2007)
Sudan, North Bahr-El-Ghazal Ad2:Aweil West Sudan, North Bahr-El-Ghazal Ad2:Aweil North	↓	0.3	0.8 (2006)

Table 3: Average Global Acute Malnutrition (% of 6-59 months old, Z-scores)

Location		2008 Value	Reference Value
Sudan, Jonglei Ad3:Atar Sudan, Jonglei Ad3:Khorfulus	↓	23.9	31.6 (2007)
Sudan, Unity City:Bentiu	=	18.8	19.4 (2007)
Sudan, Unity City:Rubkoana	=	18.8	20.5 (2007)
Sudan, North Bahr-El-Ghazal Ad2:Aweil West Sudan, North Bahr-El-Ghazal Ad2:Aweil North	=	18.8	17.4 (2006)

Ethiopia The surveys included in CE-DAT, so far, suggest a deterioration of the health situation in some areas in Ethiopia. Both mortality and malnutrition indicators show higher figures for 2008 compared to 2007 or 2006. Even though no mortality rate exceeds the emergency threshold, in Damot Woyde and Dugna Fango, the U5MR has almost reached the 2/10,000/day. As for malnutrition, the surveys from SNNP region show significantly higher values than in previous years.

Table 1: Average Crude Mortality Rates (in deaths per 10,000 people per day)

Location		2008 Value	Reference Value
Ethiopia, Oromia Ad3:Darolebu	↑	0.3	0.1 (2007)
Ethiopia, SNNP Ad3:Boricha	↑	0.3	0.1 (2007)
Ethiopia, SNNP Ad3:Damot Woyde	↑	0.5	0.1 (2007)
Ethiopia, SNNP Ad3:Dugna Fango	=	0.5	0.3 (2007)
Ethiopia, SNNP Ad3:Offa	↑	0.4	0.1 (2007)

Table 2: Average Under 5 Mortality Rates (in deaths per 10,000 children under 5 per day)

Location		2008 Value	Reference Value
Ethiopia, Oromia Ad3:Darolebu	↑	0.9	0.2 (2007)
Ethiopia, SNNP Ad3:Boricha	↑	0.9	0.2 (2007)
Ethiopia, SNNP Ad3:Damot Woyde	↑	1.9	0.2 (2007)
Ethiopia, SNNP Ad3:Dugna Fango	↑	1.9	0.6 (2007)
Ethiopia, SNNP Ad3:Offa	↑	0.9	0.2 (2007)

Table 3: Average Global Acute Malnutrition (% of 6-59 months old, Z-scores)

Location		2008 Value	Reference Value
Ethiopia, Oromia Ad3:Darolebu	=	7.4	8.6 (2007)
Ethiopia, SNNP Ad3:Boricha	↑	19.5	8.2 (2007)
Ethiopia, SNNP Ad3:Damot Woyde	↑	12.5	2.2 (2007)
Ethiopia, SNNP Ad3:Dugna Fango	↑	12.5	2.2 (2007)
Ethiopia, SNNP Ad3:Offa	↑	8.4	1.1 (2007)

Kenya Surveys were conducted along the border with Ethiopia in the North Eastern Province and presented a mixed picture. Crude mortality rates in 2008 were around the expected level for the country and well below the emergency threshold. The U5MR however showed discrepant patterns. In the northwestern area of the province rates in 2008 were higher than 2007 whereas in the northeastern region, the opposite was true and the situation had improved. Malnutrition was well exceeding the emergency thresholds in all surveyed places, with 2008 data worse than that of 2007.

Table 1: Average Crude Mortality Rates (in deaths per 10,000 people per day)

Location		2008 Value	Reference Value
Kenya, North Eastern Ad3:Tabaka Kenya, North Eastern Ad3:Dandu	↑	0.4	0.2 (2007)
Kenya, North Eastern Ad3:Banisa Kenya, North Eastern Ad3:Malkamari Kenya, North Eastern Ad3:Rhamu Dimtu	=	0.4	0.3 (2007)
Kenya, North Eastern Ad3:Khalalio Kenya, North Eastern Ad3:Central Mandera	=	0.3	0.2 (2007)

Table 2: Average Under 5 Mortality Rates (in deaths per 10,000 children under 5 per day)

Location		2008 Value	Reference Value
Kenya, North Eastern Ad3:Tabaka Kenya, North Eastern Ad3:Dandu	↑	1.0	0.3 (2007)
Kenya, North Eastern Ad3:Banisa Kenya, North Eastern Ad3:Malkamari Kenya, North Eastern Ad3:Rhamu Dimtu	=	1.6	1.4 (2007)
Kenya, North Eastern Ad3:Khalalio Kenya, North Eastern Ad3:Central Mandera	↓	0.4	0.8 (2007)

Table 3: Average Global Acute Malnutrition (% of 6-59 months old, Z-scores)

Location		2008 Value	Reference Value
Kenya, North Eastern Ad3:Tabaka Kenya, North Eastern Ad3:Dandu	↑	20.3	17.5 (2007)
Kenya, North Eastern Ad3:Banisa Kenya, North Eastern Ad3:Malkamari Kenya, North Eastern Ad3:Rhamu Dimtu	↑	21.6	18.7 (2007)
Kenya, North Eastern Ad3:Khalalio Kenya, North Eastern Ad3:Central Mandera	↑	27.9	20.9 (2007)

Uganda Compared to 2007, mortality had increased in the locations that were surveyed in 2008. CMRs were equal to or above the emergency threshold and U5MRs were considerably elevated. Malnutrition levels, on the other hand, were still below the emergency threshold.

Table 1: Average Crude Mortality Rates (in deaths per 10,000 people per day)

Location		2008 Value	Reference Value
Uganda, Pader Ad3:Parabongo Uganda, Pader Ad3:Lapono Uganda, Pader Ad3:Paimol Uganda, Pader Ad3:Wol	=	1.0	0.9 (2007)
Uganda, Amuru Uganda, Gulu	↑	1.3	0.3 (2007)

Table 2: Average Under 5 Mortality Rates (in deaths per 10,000 children under 5 per day)

Location		2008 Value	Reference Value
Uganda, Pader Ad3:Parabongo Uganda, Pader Ad3:Lapono Uganda, Pader Ad3:Paimol Uganda, Pader Ad3:Wol	↑	1.7	0.8 (2007)
Uganda, Amuru Uganda, Gulu	↑	1.9	0.2 (2007)

Table 3: Average Global Acute Malnutrition (% of 6-59 months old, Z-scores)

Location		2008 Value	Reference Value
Uganda, Pader Ad3:Parabongo Uganda, Pader Ad3:Lapono Uganda, Pader Ad3:Paimol Uganda, Pader Ad3:Wol	=	5.0	6.2 (2007) 4.7 (2007) 4.0 (2007) 6.7 (2007)
Uganda, Amuru Uganda, Gulu	↑	8.7	3.1 (2007)

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What do the health indicators tell us about humanitarian crises in 2008?