CAMBODIA ANTHROPOMETRICS SURVEY 2008Initial Findings of National Survey

Survey Description Cluster sample survey designed to detect a two

percentage point change in acute malnutrition and to provide provincial estimates of key nutrition indicators; separate domain of informal urban settlements also surveyed, but not analyzed yet

Field work carried out in November, with mop-up activities completed in December

7,600 households selected; interviews completed in 7,495 households (response rate >98%)

Primary objective of the survey is to determine the affect of increased food prices on nutrition

90.0

95.0

100.0

105.0

110.0

115.0

120.0

125.0

130.0

1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12

2005 2006 2007 2008

Relative price of food (food price index/consumer price index) by month in Cambodia from January 2005 to December 2008

Child anthropometry

Section I

05

101520253035404550

JAN FEB MAR APR MAY JUN SEP OCT NOV DEC

Wasting prevalence of children 0-4 years of age by month, CDHS 2000 & 2005

2000

2005

05

101520253035404550

JAN FEB MAR APR MAY JUN SEP OCT NOV DEC

Underweight prevalence of children 0-4 years of age by month, CDHS 2000 & 2005

2000

2005

Standard Deviation of Child Anthropometry

Indicators from CAS 2008HAZ WAZ WHZ

1.8 1.26 1.13

From Mei et al, 2007

16.8

8.4 8.9

Y2000 Y2005 Y2008

Percentage of children under five years classified as acutely malnourished according to Weight for Height, CDHS 2000/5 & CAS 2008

38.4

28.2 28.8

Y2000 Y2005 Y2008

Percentage of children under five years classified as malnourished according to Weight for age, CDHS 2000/5 & CAS 2008

9.4

29.1

6.4

24.2

8.9

28.8

W/H W/A

Expected levels are calculated using the percent decrease from DHS 2000 & 2005 and applying this to November 2005 levels

Comparison of similar months and expected levels of selected child anthropometry indicators

DHS Nov 2005 Expected Nov 2008 CAS 2008

49.7

43.239.5

Y2000 Y2005 Y2008

Percentage of children under five years classified as chronically malnourished according to Height for Age, CDHS

2000/5 & CAS 2008

39.3

32.8

16.9 16.3

28.4 27.2

8.3 8.7

30.4

21.1

9.0 8.5

RURAL URBAN RURAL URBAN

Sum of W/A Sum of W/H

Percentage of underweight and wasted children by place of residence, DHS 2000/5 & CAS 2008

2000 2005 2008

Child disease

Section II

1015202530354045505560

JAN FEB MAR APR MAY JUN JUL SEP OCT NOV DEC

Fever prevalence among children 0-4 years of age, CDHS 2000 & 2005

2000

2005

05

101520253035404550

JAN FEB MAR APR MAY JUN JUL SEP OCT NOV DEC

Diarrhea prevalence among children 0-4 years of age by month, CDHS 2000 & 2005

2000

2005

05

101520253035404550

JAN FEB MAR APR MAY JUN JUL SEP OCT NOV DEC

Prevalence of acute respiratory infection symptoms among children 0-4 years of age by month, CDHS 2000 & 2005

2000

2005

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

ARI Diarrhea Fever

Percent decrease of infectious disease prevalence from 2000 to 2005, CDHS month of February

URBAN

RURAL

21.6 22.1

29.7

2005 NOV 2005 2008

Period prevalence of diarrhea among youngest child 0-4 years of age, CDHS 2005 & CAS 2008

37.1 39.6

58.9

2005 NOV 2005 2008

Period prevalence of fever among youngest child 0-4 years of age, CDHS 2005 & CAS 2008

21.415.8

28.9

2000 2005 2008

Prevalence is calculated using methodology from the DHS 2000. Symptoms include cough and diffi culty breathing

Period prevalence of symptoms of acute respiratory infection among the youngest child 0-4 years of age, DHS 2000/5 & CAS

2008

8.9

15.6

2005 2008

Prevalence calculated using DHS 2005 methodology. Symptoms include cough, diffi culty breathing, and that these are chest related

Period prevalence of symptoms of acute respiratory infection among the youngest child 0-4 years of age, DHS 2005 & CAS

2008

15.88.9

15.48.3

28.9

15.6

ARI 2000 Method. ARI 2005 Method.

The methodology for calculating prevalence differed from 2000 to 2005. 2 symptoms were included in 2000 (cough & difficulty breathing) and a third symptom (chest-related) was

added in 2005

Period prevalence of symptoms of acute respiratory infection among youngest child 0-4 years of age, DHS 2005 & CAS 2008

2005 NOV 2005 2008

37.634.1

22.516.8

9.55.5

61.5

45.6

31.6

20.116.7

9.1

RURAL URBAN RURAL URBAN RURAL URBAN

Fever Diarrhea ARI

Percentage of children under 5 with disease in the two weeks preceding the survey by place of residence, DHS 2005 & CAS 2008

2005 2008

Woman anthropometry and micronutrient deficiency

Section III

7.2%

19.1%

5.2%

0.9%

6.3%

16.1%

3.7%1.5%

< 145 cm Total (<18.5) Moderate + Severe (<17.0) ≥ 30.0

Height Thin Obese

Among Women 15-49 Years of Age with a Child Under-5, Height and Levels of Body Mass Index, CDHS 2005 & CAS 2008

CDHS '05 CAS '08

8

2.2

5.1

1.6

unadjusted adjusted

Adjusted levels of night blindness consider women who also have vision problems during the day to not be suffering from night blindness

Percentage of women who suffered night blindness during last pregnancy, DHS 2005 & CAS 2008

2005 2008

Section IVFood consumption and coping strategies

4.7 4.6 5.4

4.6 4.5 5.2

4.7 4.7 4.8 4.6 4.5 5.2

national rural urban national rural urban

child mother

Mean number of food groups consumed by children and mothers in the day or night preceding the interview, CAS 2008

2005 2008

Question: How many times did [name] eat solid, semi-solid, or soft foods other than liquids yesterday during the day or at night?

71

59

52

43

41

43

7

71

70

60

56

44

52

13

Rely on less preferred and less expensive food

Purchase food on credit, incur debts

Reduce food eaten

Restrict consumption by adults for small children to eat

Mothers and elder sisters eat less than others

Borrow food, or rely on help from friends or relatives

Consume seed stocks

CAS 2008 field work was carried out primarily in November, while the CDRI survey took place during the month of May

Percentage of households using coping strategy related to food at least one time in the previous month, CAS 2008 & CDRI 2008 Survey

CAS CDRI

21

27

20

34

15

10

8

7

8

3

2

2

33

30

25

41

16

17

17

10

9

4

3

4

Increase exploitation of common property resources

Seek alternative or additional jobs

Plant more or new crops

Decrease expenditures for health care

Decrease expenditures for fertiliser, pesticide, etc

Increase migration for work or food

Sell more animals than usual

Sell jewellery

Take children out of school

Sell domestic assets

Sell productive assets

Sell land

CAS 2008 field work was carried out primarily in November, while the CDRI survey took place during the month of May

Percentage of households using coping stategy not related to food at least one time in the previous month, CAS 2008 & CDRI 2008 Survey

CAS CDRI

Section VConclusions

Conclusions 1 Improvements in maternal nutrition are

giving kids a better start, but this improvement is not carrying on through the first 5 years. The malnutrition-infection cycle for children under 5 is worsening and this is likely to have been caused by the increases in food prices

18.6

25.3

35.9

42.7

46.6 45.4

12

18.6

27.9 28.2

35.2 34.4

7.5

15.6

25.4

33.536.2

40.5

0 - 5 6 - 11 12 - 23 24 - 35 36 - 47 48 - 59

Percentage of children underweight by age group, DHS 2000/5 & CAS 2008

2000 2005 2008

0%

10%

20%

30%

40%

50%

60%

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 53 55 57

Data smoothed with a three month rolling average

Percentage of children underweight by age in months, DHS 2000/5 & CAS 2008

DHS 2000 DHS 2005 CAS 2008

20.9

17.719

17.7

15.3

12.813.8 13.1

8.26.9 7.6

5.3

9.8

11.8

9.8 10.1

7.15.5

0 - 5 6 - 11 12 - 23 24 - 35 36 - 47 48 - 59

Percentage of children wasted by age group, DHS 2000/5 & CAS 2008

2000 2005 2008

Conclusions 2 Infection has increased in both urban and

rural areas, but levels are much higher in rural areas. Consumption of quality food is decreasing in both urban and rural areas, but the decrease is larger in urban areas. Poor urban areas have been affected the most by increased food prices and it can be considered an emergency situation in those areas. Many rural areas and entire provinces are facing crisis levels of acute malnutrition.

9.97.7 9.6 9.69.8 8.9

15.9

7.6

Poor Rich Poor Rich

Rural Urban

Wealth quintiles constructed using a simplified version of DHS methodology. Poor consists of the two lowest quintiles, while rich includes the two highest quintiles

Percentage of wasted children under-5 by place of residence and wealth, DHS 2005 & CAS 2008

2005 2008

Program Implications 1 The malnutrition-infection cycle is not going to

be broken with short-term staple food interventions. Breaking this cycle needs to be the focus.

Community screening for severe malnutrition with supported referral is needed; the immediate need is greatest in poor, urban areas.

The situation should be closely monitored with incidence data that can be disaggregated to the local level.

Program Implications 2 It does not make sense to focus only on

maternal nutrition and nutrition of children under 2. The improvements for both of these groups are keeping national levels of U-5 malnutrition below emergency levels, but these improvements will be erased if we do not react to the worsening nutrition status of older children.

Planned Further Analysis Child anthropometry by additional

background characteristics such as profession

Infant and young child feeding indicators Child and maternal supplementation Informal urban settlements

Future considerations There is not yet evidence that food prices

are going to drop to pre-crisis levels. If prices stay high, the nutrition situation will likely worsen.

The global recession is likely to make it more difficult for many families in Cambodia. As the recession deepens the impact on nutrition will be felt more and more, especially in combination with high food prices.