Menu
Menu
Menu
Menu
Background: Malnutrition places a heavy burden on the health, well-being, and sustainable development of populations in Sudan, especially a country affected by conflict, which continues to experience high levels of food insecurity, undernutrition, and micronutrient deficiencies; 3.3 million are acutely malnourished, with 522,000 children suffering from severe acute malnutrition and approximately 2.2 million children requiring treatment for moderate acute malnutrition. This study aims to describe the nutritional status of children under five years old and identify the progress toward the achievement of the Global Nutrition Targets. Methods: This is a secondary data analysis of a quantitative survey, using the second-round of the Simple Spatial Survey Method (S3M II) in Sudan in the period 2018–2019. The analysis used an area-based sampling methodology in all 18 Sudanese states. Data from the WHO Tracking Tools of the Global Nutrition Targets was used to reflect the progress in achieving the targets in Sudan. Results: Global stunting prevalence was at 36.35 percent including moderate stunting prevalence and severe stunting prevalence (21.25 percent and 15.06 percent respectively). Global wasting prevalence was 13.6 percent including moderate wasting prevalence and severe wasting prevalence (10.8 percent and 2.7 percent respectively). Sudan has made great progress in achieving the target of increasing exclusive breastfeeding. However, despite the welcome commitments by the Government and all stakeholders, Sudan is still struggling to implement strategies, policies, and regulatory measures to address malnutrition and achieve the Global Nutrition Targets in 2025 and the Sustainable Developmental Goals in 2030. Therefore, more than ever, there is a need for comprehensive, multi-sectoral action to address malnutrition in all its forms.
This manuscript is a secondary data analysis of a quantitative descriptive study, based on the data from the second-round of the Simple Spatial Survey Method (S3M II) in Sudan in the period 2018–2019. In this manuscript, we used two types of data resources. First, the data from the S3M II report to describe the nutrition indicators in children under five years-old [14]. Second, the data from the Tracking Tools of the Global Nutrition Targets was used (stunting, wasting, overweight, and exclusive breastfeeding) to reflect the progress of achieving the targets in Sudan [15]. We compared the findings of the S3M II survey with the baseline data of 2010 in the dashboard of the Tracking Tools. We compared the findings of S3M II with the findings of S3M I in the discussion to have an overview on the changes occurring on the nutritional status of children in the period between 2013 and 2018. Both surveys adapted the same methodology. However, the overall sample size increased in S3M II compared to S3M I, which was mainly due to improved access to the villages. The survey S3M II used an area-based sampling methodology in all 18 Sudanese states. It gathered data on 230 critical indicators regarding the following broad topics: health; nutrition; water, sanitation, and hygiene (WASH) as well as child and social protection. The nutritional status of children aged 6–59 months in S3M II was assessed via anthropometric measurements of weight, height, and mid-upper-arm circumference (MUAC) using standard measurement tools; Seca electronic scale bat.mains.solar for weighing, portable L-hgt mea.syst/SET-2 for height, and Children’s Mid Upper Arm Circumference measuring tape with cut-off point at 11.5 cmt. Using weight and height measurements, the corresponding nutritional indices of weight-for-age Z-score (WAZ), height-for-age Z-score (HAZ), and weight-for-height Z-score (WHZ) were calculated using the WHO Child Growth Standards (WGS) as reference standard [16], to determine the child’s underweight status, stunting status, and wasting status, respectively. Table 1 shows the standard thresholds for wasting, stunting, and overweight. The Z-scores were calculated using the Z-scorer package in R software. MUAC, on the other hand, was used as-is without standardization and assessed based on accepted cut-offs for wasting status [17]. Finally, nutritional oedema was assessed clinically using the bilateral pitting oedema test. Following this the prevalence of various forms of undernutrition in children 6–59 months are given. Prevalence thresholds for public health significance for wasting, stunting, and overweight in children. Source 1: New prevalence thresholds for stunting, wasting, and overweight in children’ [19]. Source 2: Prevalence thresholds for wasting, overweight, and stunting in children under 5 years [20]. The survey S3M I was carried out in all 18 states of Sudan using the same methodology of area-based sampling. A total of 45,094 households and 71,625 children below 5 years of age were surveyed. Data collection took place during June/July 2013 for 14 states and in November 2013 for the remaining 4 states (Khartoum, Red Sea, South and West Kordofan) in Sudan. A total of 59 indicators was measured covering child and maternal health and nutrition as well as WASH services [18]. The WHO, in collaboration with United Nations Children’s Fund (UNICEF) and the European Commission (EC), developed the Tracking Tool to help countries set their national targets and monitor progress. This tool allows users to explore scenarios taking into account different rates of progress for the six global targets and the time remaining until 2025. The baseline data for Sudan was taken from the household health survey, second round 2010 [15]. The S3M survey was designed to be spatially representative of the whole country, including its smaller administrative units up to the locality level, except for a few inaccessible areas. The selection of sample units was performed based on random sample selection using sampling software designed to undertake S3M variable density sampling. An even distribution of primary sampling units (PSUs) (i.e., villages/city blocks) was selected from across the country. About 31, 32, 33 PSUs (i.e., villages/city blocks) were selected based on their proximity to centroids of a hexagonal grid laid over the entire country. Across Sudan, a total of 93,882 households and 145,002 children below 5 years of age were surveyed. To select PSUs, the map-segment-sample approach was used for within-community sampling of PSUs. In this approach, PSUs organized as ribbons of dwellings were sampled systematically, while those organized as clusters of dwellings were sampled using a random walk strategy [21,22]. The S3M II survey collected data in two phases. Data from phase one states (North Darfur, East Darfur, West Kordofan, River Nile, Sennar, South Darfur, North Kordofan, Khartoum and Northern states) in Sudan was collected in October 2018. Data from phase two states (White Nile, Kassala, Blue Nile, Central Darfur and West Darfur, Red Sea, South Kordofan and Gedaref states) in Sudan was collected from November 2018 to January 2019.
N/A
