Malnutrition among Children under Five Years, Cameroon

166 Pages·2006·1.4 MB·English

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AFRICA NUTRITION CHARTBOOKS
NUTRITION OF YOUNG CHILDREN AND MOTHERS
IN CAMEROON
Findingsfromthe2004 CameroonDemographic andHealth Survey
ORCMacro
11785BeltsvilleDrive
Calverton,Maryland,USA
May2006
Thischartbookwasproducedby theMEASUREDHSprogram,whichisfundedbytheU.S.AgencyforInternationalDevelopment(USAID)throughtheBureau
forGlobalHealth,OfficeofHealth,InfectiousDiseasesandNutrition(GH/HIDN).ThechartbookbenefitedfromfundsprovidedbytheUSAID Bureaufor
AfricathroughitsOfficeofSustainableDevelopment.CopiesofthischartbookmaybeobtainedbycontactingtheMEASUREDHSprogram,ORCMacro,at
theaboveaddress,bytelephoneat(301)572-0200,byfaxat(301)572-0999,oronthewebatwww.measuredhs.com
N
I S
InstitutNationaldelaStatistique
Contents
INTRODUCTION...............................................................................................................................................................................................1
FIGURE1: INFANTANDCHILDMORTALITY,CAMEROONCOMPAREDWITHOTHERSUB-SAHARANCOUNTRIES................................................2
FIGURE2: CONTRIBUTIONOFUNDERNUTRITIONTOUNDER-FIVEMORTALITY,CAMEROON.............................................................................4
FIGURE3: SURVIVALANDNUTRITIONALSTATUSOFCHILDREN,CAMEROON...................................................................................................6
MALNUTRITIONINCAMEROON.......................................................................................................................................................9
FIGURE4: MALNUTRITIONAMONGCHILDRENUNDERFIVEYEARS,CAMEROON............................................................................................10
FIGURE5: CHANGESINUNDERNUTRITIONRATESAMONGCHILDRENUNDERTHREEYEARS,CAMEROON1991,1998AND 2004, ...................12
FIGURE6: STUNTING,WASTING,ANDUNDERWEIGHTBYAGE,CAMEROON...................................................................................................14
FIGURE7: UNDERNUTRITIONAMONGCHILDRENUNDERFIVEYEARSWHODONOTRESIDEWITHTHEIRMOTHERS,CAMEROON..................16
FIGURE8: UNDERWEIGHTAMONGCHILDRENUNDERFIVEYEARS,CAMEROONCOMPAREDWITHOTHERSUB-SAHARANCOUNTRIES...........18
FIGURE9: STUNTINGAMONGCHILDRENUNDERFIVEYEARS,CAMEROONCOMPAREDWITHOTHERSUB-SAHARANCOUNTRIES...................20
CONCEPTUALFRAMEWORK FORNUTRITIONALSTATUS.........................................................................................................22
IMMEDIATE INFLUENCESOFMALNUTRITION.............................................................................................................................25
FIGURE10: CHILDRENUNDERFIVEYEARSLIVINGINHOUSEHOLDSWITHADEQUATELYIODIZEDSALTBYREGION,CAMEROON....................26
FIGURE11: NIGHTBLINDNESSAMONGMOTHERSOFCHILDRENUNDERFIVEYEARS,CAMEROON...................................................................28
FIGURE12: VITAMINASUPPLEMENTATIONAMONGMOTHERSOFCHILDRENUNDERFIVEYEARSBYREGION,CAMEROON.............................30
FIGURE13: VITAMINASUPPLEMENTATIONAMONGCHILDREN6-59MONTHSINTHEPASTSIXMONTHSBYREGION,CAMEROON..................32
FIGURE14: ANEMIAAMONGCHILDREN6-59MONTHSANDMOTHERSBYREGION,CAMEROON.......................................................................34
FIGURE15: IRONSUPPLEMENTATIONAMONGMOTHERSOFCHILDRENUNDERFIVEYEARS,CAMEROON.........................................................36
FIGURE16: DIARRHEAANDCOUGHWITHRAPIDBREATHINGAMONGCHILDRENUNDERFIVEYEARSCOMPAREDWITH
MALNUTRITIONRATES,CAMEROON..............................................................................................................................................38
UNDERLYING BIOLOGICALANDBEHAVIORALINFLUENCESOFMALNUTRITION..................................................................41
FIGURE17: FERTILITYANDBIRTHINTERVALS,CAMEROONCOMPAREDWITHOTHERSUB-SAHARANCOUNTRIES...........................................42
FIGURE18: UNDERNUTRITIONAMONGCHILDRENAGE12-23MONTHSBYMEASLESVACCINATIONSTATUS,CAMEROON...............................44
FIGURE19: MEASLESVACCINATIONCOVERAGEAMONGCHILDRENAGE12-23MONTHS,CAMEROONCOMPAREDWITHOTHER
SUB-SAHARANCOUNTRIES............................................................................................................................................................46
FIGURE20: FEEDINGPRACTICESFORINFANTSUNDERSIXMONTHS,CAMEROON.............................................................................................48
iii
FIGURE21: INFANTSUNDERFOURMONTHSWHOAREEXCLUSIVELYBREASTFEDANDTHOSEWHORECEIVEABOTTLE,
CAMEROONCOMPAREDWITHOTHERSUB-SAHARANCOUNTRIES.................................................................................................50
FIGURE22: FEEDINGPRACTICESFORINFANTSAGE6-9MONTHS,CAMEROON.................................................................................................52
FIGURE23: INFANTSAGE6-9MONTHSRECEIVINGSOLIDFOODSINADDITIONTOBREASTMILK,CAMEROONCOMPAREDWITH
OTHERSUB-SAHARANCOUNTRIES................................................................................................................................................54
FIGURE24: CHILDRENAGE10-23MONTHSWHOCONTINUETOBEBREASTFED,CAMEROONCOMPAREDWITHOTHERSUB-SAHARAN
COUNTRIES....................................................................................................................................................................................56
UNDERLYING SOCIALANDECONOMIC INFLUENCESOF MALNUTRITION...............................................................................59
FIGURE25: STUNTINGANDWASTINGAMONGCHILDRENUNDERFIVEYEARSBYMOTHER’SEDUCATION,CAMEROON...................................60
FIGURE26: STUNTINGANDWASTINGAMONGCHILDRENUNDERFIVEYEARSBYSOURCEOFDRINKINGWATER,CAMEROON.........................62
FIGURE27: STUNTINGANDWASTINGAMONGCHILDRENUNDERFIVEYEARSBYTYPEOFTOILET,CAMEROON...............................................64
BASICINFLUENCES.......................................................................................................................................................................67
FIGURE28: STUNTINGANDWASTINGAMONGCHILDRENUNDERFIVEYEARSBYREGION,CAMEROON...........................................................68
FIGURE29: STUNTINGANDWASTINGAMONGCHILDRENUNDERFIVEYEARSBYURBAN-RURALRESIDENCE,CAMEROON.............................70
MATERNALNUTRITIONALSTATUS..............................................................................................................................................73
FIGURE30: MALNUTRITIONAMONGMOTHERSOFCHILDRENUNDERFIVEYEARSBYREGION,CAMEROON.....................................................74
FIGURE31: MALNUTRITIONAMONGMOTHERSOFCHILDRENUNDERFIVEYEARSBYRESIDENCE,CAMEROON................................................76
FIGURE32: MALNUTRITIONAMONGMOTHERSOFCHILDRENUNDERFIVEYEARSBYEDUCATION,CAMEROON...............................................78
FIGURE33: MALNUTRITIONAMONGMOTHERSOFCHILDRENUNDERFIVEYEARS,CAMEROONCOMPAREDWITHOTHER
SUB-SAHARANCOUNTRIES............................................................................................................................................................80
APPENDICES...................................................................................................................................................................................83
APPENDIX1 STUNTING,WASTING,UNDERWEIGHT,ANDOVERWEIGHTRATESBYBACKGROUNDCHARACTERISTICSCAMEROON2004............85
APPENDIX2 NCHS/CDC/WHOINTERNATIONALREFERENCEPOPULATIONCOMPAREDWITHTHEDISTRIBUTIONOF
MALNUTRITIONINCAMEROON.....................................................................................................................................................86
iv
Introduction
1
Malnutrition is one of the most important health and welfare problems among infants and young children in Cameroon. It
is a result of both inadequate food intake and illness. Inadequate food intake is a consequence of insufficient food available
at the household level, improper feeding practices, or both. Improper feeding practices include both the quality and quantity
of foods offered to young children as well as the timing of their introduction. Poor sanitation puts young children at
increased risk of illness, in particular diarrheal disease, which adversely affects their nutritional status. Both inadequate food
intake and poor environmental sanitation reflect underlying social and economic conditions.
Malnutrition has significant health and economic consequences, the most serious of which is an increased risk of death.
Other outcomes include an increased risk of illness and a lower level of cognitive development, which results in lower
educational attainment. In adulthood, the accumulated effects of long-term malnutrition can be a reduction in workers’
productivity and increased absenteeism in the workplace; these may reduce a person’s lifetime earning potential and ability
to contribute to the national economy. Furthermore, malnutrition can result in adverse pregnancy outcomes.
The data presented here are from the 2004 Cameroon Demographic and Health Survey (Enquête Démographique et de
Santé - EDSC III) a nationally representative survey of 10,462 households, conducted by National Institute of Statistics
(NIS), in collaboration with Ministry of Planning, Development Programming and Regional Development
(MINPLAPDAT), Yaoundé, Cameroon. ORC Macro furnished the technical assistance to the survey as part of the
MEASURE DHS+ program, while funding was provided by the U.S. Agency for International Development (USAID) the
World bank, United Nations Children’s Fund (UNICEF) ,and United NationsPopulation Fund (UNFPA).
Of the 8,097 children age 0-59 months that were part of the study, a subsample (50 percent) of children was measured to
provide anthropometric data. Of the 3,705 children who were measured, there were 3,156 children whose mothers were
interviewed. All nutritional analyses in this chartbook includes these 3,156 children unless otherwise noted. Therefore,
results may differ from the Cameroon EDSC III 2004 report due to these differences in sub-sample selection. Nutritional
data collected on these children include height, weight, age, breastfeeding history, and feeding patterns. Information was
also collected on the prevalence of diarrhea and acute respiratory infection (ARI) in the two weeks prior to the survey and
on relevant sociodemographic characteristics. For comparison, data are presented from Demographic and Health Surveys
conducted in other sub-Saharan countries.
1ThetechnicalmethodofidentifyingamalnourishedpopulationasdefinedbytheU.S.NationalCenterforHealthStatistics(NCHS),theCentersforDiseaseControl
andPrevention(CDC),andtheWorldHealthOrganization(WHO)ispresentedinAppendix2.
1
Figure 1: Infant and Child Mortality, Cameroon Compared with Other
Sub-Saharan Countries
Malnutrition compromises child health, making children susceptible to illness and death. Infectious diseases such as
acute respiratory infections, diarrhea, and malaria account for the greatest proportion of infant and under-five mortality.
The infant mortality rate (under-one rate) is a commonly used measure of infant health and is a sensitive indicator of the
socioeconomic conditions of a country. The under-five mortality rate is another informative indicator of infant and child
survival.
 Cameroon’s under-one mortality rate (74 deaths per 1,000 births) indicates that 7 percent of children
born in Cameroon will die before their first birthday.This rate is in the lower range of allthe sub-Saharan
countries surveyed.
 Cameroon’s under-five mortality rate (144 deaths per 1,000 births) indicates that 14 percent of children
born in Cameroon will die before their fifth birthday. This rate is near the lower end of the range of sub-
Saharan countries surveyed.
2
Figure 1
Infant and Child Mortality, Cameroon Compared with
Other Sub-Saharan Countries
Deaths per 1,000 Births
250
Under-One Mortality Rate Under-Five Mortality Rate 229
201
200 196
189
184
181
177
166168
160
152153
147
150 144
112113 111115
100 95 97 98 99 100101104107 93 94 102
88 89 89
81
74 77
64 65
57 58
48
50
0
EritreaGM2aa0bd0oa2nga2s0c0ar0G2hZ0ai0nm3ab2aC0b0aw3eme1r9o9o9nBKu2re0kni0yn4aaU2F0ga0as3nod2a002300B0Ze-a0nim1nbi2a002E1t00hi1o-0pi2aGu2i0nT0ea0anz19a9ni9aNiM1go9zer9ai9amb2i0q0u3eM2al0a0ôwRt3iew2ad'0nI0dv0aoir2e0010998-M9al9i2001 GabonEMr2ita0rd0ea0aga2sZ0ic0am2rb2a0b0w3eG1h9a9n9aK2eC0n0ay3ame2r0oT0oa3nnzU2a0g0nai4nadM1ao9z9a290m0bi0-q0u1eB2e00niE3tnhi2Zo0ap0i1mabi2a002ôt00Ge0ui1d-'nI0ev2aBoiur1rek9i91n99a9F8-a9s9oM2al0a0Rw3iw2a0n0d0aNi2g0er0i0a20M0a3li2001
C C
3 Source: DHS Surveys 1999-2004
Figure 2: Contribution of Undernutrition to Under-Five Mortality,
Cameroon
Undernutrition is an important factor in the death of many young children. Even if a child is only mildly malnourished,
the mortality risk is increased. Under-five mortality is largely a result of infectious diseases and neonatal deaths in
developing countries. Respiratory infections, diarrhea, malaria, measles, and other infectious diseases take their toll on
children.
Formulas developed by Pelletier et al.1 are used to quantify the contributions of moderate and severe malnutrition to
under-five mortality.
In Cameroon,
 Twenty-nine percent of all deaths that occur before age five are related to malnutrition (severe and
moderate malnutrition).
 Because of its extensive prevalence, moderate malnutrition (26 percent) contributes to more deaths than
severe malnutrition (3 percent).
 Moderate malnutrition is implicated in 89 percent of deaths associated with malnutrition.
1Pelletier,D.L.,E.A. Frongillo,Jr.,D.G. Schroeder,andJ.P.Habicht.1994. Amethodologyforestimatingthecontributionofmalnutrition
tochildmortalityindevelopingcountries. JournalofNutrition124(10Suppl.):2106S-2122S.
4
Figure 2
Contribution of Undernutrition to Under-Five Mortality,
Cameroon
Causes of Under-5
Mortality
Other
Malaria
causes
Contribution to
Under-5 Mortality
Moderate Malnutrition - 26%
AIDS ARI
Severe Malnutrition - 3%
Measles Diarrhea
Neonatal
deaths
Note: Calculation based
on Pelletier et al., 1994. Source: EDSC-III 2004
5
Figure 3: Survival and Nutritional Status of Children, Cameroon
Malnutrition and mortality both take a tremendous toll on young children. This figure illustrates the proportion of
children who have died or are undernourished at each month of age.
In Cameroon,
 Between birth and 21 months of age, the percentage of living children who are not malnourished drops
rapidly from about 90 percent to 32 percent. Thereafter, the rate remains between 40 and 50 percent through
59 months.
 Between birth and 21 months of age, the percentage of children who are moderately or severely
malnourished1 increases dramatically from 4 percent to 51 percent. This percentage then declines to 24
percentat 32 months and remains the same through 59 months.
 From birth until 21 months, the percentage of children who have died increases gradually, from 9 percent
to 17 percent. The rate increases up to 29 percent at 32 months and then remains between 20to 30 percent
through 59 months.
1Achildwith aZ-scorebelowminus threestandarddeviations(-3SD)onthereferencestandardis consideredseverelymalnourished,
whileonewithaZ-scorebetween-2 SDand -3 SDisconsidered moderatelymalnourished.
6