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Comparison of estimates of malnutrition in children aged 0–5 years between clinic-based nutrition surveillance and national surveys

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Abstract

This study documents a marked discrepancy between the nutritional status of children aged 0–5 years in Botswana when measured by national surveys compared to clinic-based surveillance. We compared the average prevalence of underweight (weight-for-age z-scores below 2 standard deviations of the mean of the Center for Disease Control (CDC)/WHO reference standards) in children 0–5 years of age. According to clinic surveillance, prevalence of underweight has fallen from 14.6±0.03 to 3.5±0.04 per cent between 1993 and 2010. In national surveys, it had fallen from 14.6±0.01 to 11.5±0.01 per cent between 1993 and 2007. We explored several possibilities to explain this discrepancy, and conclude that it is because of sampling bias in the clinic surveillance. This finding underlines the need for properly conducted surveys to ensure accurate information about the nutritional status of children.

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References

  • Babu, S.C. and Quinn, V.J. (1994) Food security and nutrition monitoring in Africa: Introduction and historical background. Food Policy 19 (3): 211–217.

    Article  Google Scholar 

  • Quinn, V.J. and Kennedy, E. (1994) Food security and nutrition monitoring systems in Africa: A review of country experiences and lessons learned. Food Policy 19 (3): 234–254.

    Article  Google Scholar 

  • Morgan, R. (1985) The development and applications of a drought early warning system in Botswana. Disasters 9 (1): 44–50.

    Article  Google Scholar 

  • Ismail, S.J. (1991) Nutrition surveillance: Experience from developing countries. Proceedings of the Nutrition Society 50: 673–679.

    Article  Google Scholar 

  • Belbase, K. and Morgan, R. (1994) Food security and nutrition monitoring for drought relief management: The case for Botswana. Food Policy 19 (3): 285–300.

    Article  Google Scholar 

  • Kachale, M.P. (2009) Establishment of the Botswana Vulnerability Assessment and Analysis System for National Food Security. Report submitted to the Ministry of Finance and development planning and SADC RVAC-PMU., http://www.sadc.int/fanr/aims/rvaa/Documents/Botswana/2009%20Botswana%20VAA%20Synthesis%20Report.pdf, accessed 4 November 2010.

  • Mason, J.B. and Mitchel, J.T. (1983) Nutritional surveillance. Bulletin of the World Health Organization 61 (5): 745–755.

    Google Scholar 

  • Pelletier, D.L. and Johnson, U. (1994) The use of information in the Iringa Nutrition Program: Some global lessons for nutrition surveillance. Food Policy 19 (3): 211–217.

    Article  Google Scholar 

  • Bailes, A. (2006) National nutrition surveillance system: A review and recommendations report supported by UNICEF Botswana. Unpublished consultancy report.

  • Boonstra, E., Lindbaek, M., Fidzani, B. and Bruusgaard, D. (2001) Cattle eradication and malnutrition in under-fives: A natural experiment in Botswana. Public Health Nutrition 4 (4): 877–882.

    Article  Google Scholar 

  • Ministry of Finance and Development Planning. (1986) Report of the drought assessment tour by the Inter-Ministerial Drought Team, 25 January to 12 February 1986. Ministry of Finance and Development Planning, Gaborone, mimeo.

  • Buchanan-Smith, M. (1990) Report on the Evaluation of the Drought Relief and Recovery Program, 1982–1990: Drought, Income Transfers, and Rural Household Economy. Gaborone, Botswana: Government Printer.

    Google Scholar 

  • Cogill, B. (1990) Report on the Evaluation of the Drought Relief and Recovery Program, 1982–1990: Information System. Gaborone, Botswana: Government Printer.

    Google Scholar 

  • Chaudhuri, S. (1987) Growth Monitoring and Promotion in Botswana: Present Status and Future Prospects – Final Report/Consultant. Gaborone, Botswana: Ministry of Health/UNICEF.

    Google Scholar 

  • Yambi, O. (1988) Report on the Evaluation of the Botswana National Nutritional Surveillance System. Gaborone, Botswana: Government of Botswana. Report for the Ministry of Health and UNICEF Botswana.

  • Serdula, M.K. et al (1987) Validity of clinic-based nutritional surveillance for prevalence estimation of undernutrition. Bulletin of the World Health Organization 65 (4): 529–533.

    Google Scholar 

  • Mahgoub, S.E.O., Nnyepi, M., and Bandeke, T. (2006) Factors affecting prevalence of malnutrition among children under three years of age in Botswana. African Journal of Food, Agriculure, and Nutrition Development 6: 3–15.

    Google Scholar 

  • Nnyepi, M.S., Bond, J., Johnson, N. and Weatherspoon, L. (2004) Influence of complementary foods on the growth indicators of children in Gabane, Botswana. African Journal of Agriculture, Food, Nutrition and Development 4 (1), http://www.ajol.info/index.php/ajfand/article/view/19149.

  • Shapiro, R.L. et al (2010) Antiretroviral regimens in pregnancy and breast-feeding in Botswana. New England Journal of Medicine 362: 2282–2294.

    Article  Google Scholar 

  • Ministry of Finance and Development Planning (MFDP) and Food and Nutrition Unit. (1996) Determinants of child nutritional status in Botswana: A national study. Gaborone, Botswana. Unpublished report.

  • CSO. (1996) Botswana Demographic Health Survey III. Gaborone, Botswana: Government Printers.

  • CSO. (2001) Botswana Multiple Indicator Survey. Gaborone, Botswana: Government Printers.

  • CSO. (2009) Botswana Demographic Health Survey IV. Gaborone, Botswana: Government Printers.

  • Nnyepi, M.S. (2007) Household factors are strong indicators of children's nutritional status in children with access to primary health care in the greater Gaborone area. Scientific Research and Essays 2 (2): 055–061.

    Google Scholar 

  • UNICEF Botswana. (2010) Baseline nutrition economic study in the context of the rising food prices. Unpublished report.

  • NACA. (2003) Botswana 2003 Second-generation HIV/AIDS Surveillance: A Technical Report. Gaborone, Botswana: National Aids Coordinating Agency.

  • NACA. (2000) Botswana AIDS Impact Survey II: Popular Report. Gaborone, Botswana: National Aids Coordinating Agency.

  • CSO. (1984) Botswana Family Health Survey I. Gaborone, Botswana: Government Printers.

  • CSO. (1988) Botswana Family Health Survey II. Gaborone, Botswana: Government Printers.

  • Caufield, L.E., De Onis, M., Blossner, M. and Black, R. (2004) Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria and measles. American Journal of Clinical Nutrition 80 (1): 193–208.

    Google Scholar 

  • WHO Multicenter Growth Reference Study Group. (2006) WHO child growth standards based on length/height, weight and age. Acta Paediatrica 95 (supplement S450): 76–85.

  • De Onis, M., Garza, C., Onyango, A.W. and Borghi, E. (2007) Comparison of the WHO child growth standards and the CDC 2000 growth charts. Journal of Nutrition 137: 144–148.

    Google Scholar 

  • Jerome, N.W. and Ricci, J.A. (1997) Food and nutrition surveillance: An international overview. American Journal of Clinical Nutrition 65 (4): 1198s–1202s.

    Google Scholar 

  • Mock, N. and Mason, J. (1999) Nutrition information systems for implementing child nutrition programs. Asian Development Review 17 (1.2): 214–245.

    Google Scholar 

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The authors compare measures of nutritional status obtained by clinic-based surveillance and national surveys in Botswana. They find a simple sampling bias in the clinic-based surveillance.

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Nnyepi, M., Gobotswang, K. & Codjia, P. Comparison of estimates of malnutrition in children aged 0–5 years between clinic-based nutrition surveillance and national surveys. J Public Health Pol 32, 281–292 (2011). https://doi.org/10.1057/jphp.2011.32

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