As the crisis in CAR wore on through a violent 2014, nutrition experts began to worry. They knew that the majority of families were unable to plant their crops or earn their living, and that the price of essential foods like rice had increased by as much as 25%. Displaced families had poor access to safe water and sanitation, and one-third of health centers had been destroyed.
Questions were quickly asked: How many children were severely malnourished and needed services? What remote areas were most affected by malnutrition? To answer these questions, we needed data (a big ask in a country where roads – where they exist – are blocked by armed barricades and cut off by fighting).
To get this data, we carried out a SMART survey – a simplified field survey designed to give a snapshot of the situation on the ground. From July to November last year, 120 data collectors went inside nearly 9,500 houses to weigh and measure children under five and talk to their families. They surveyors wanted to find out both the level of malnutrition in each of CAR’s 16 prefectures as well as the rate of deaths and coverage of measles vaccinations.
Here’s what they found:
- Stunting is beyond the emergency threshold of 40% in seven of the 16 prefectures and in the capital Bangui. This is a major problem because stunting is irreversible and can have a huge impact on the development of a nation. A stunted child is not only too short for his or her age, they can also suffer from stunted development of the brain and cognitive capacity – undermining their performance at school and future earning potential.
- Rates of severe malnutrition aren’t as bad as we feared. However, seven prefectures have more than 2 per cent of children who are severely malnourished compared to only two prefectures in 2012. These children need improved access to nutrition services to safeguard their lives and future health.
- The crisis has been a killer. Overall mortality is above emergency levels* in 11 out of the 16 prefectures as well as in Bangui – a significant increase since 2012. Armed conflict increased the death rate of adults in volatile areas. Meanwhile, for children under-5 the biggest killers were not bullets but instead malaria, respiratory infections, and diarrhoea. Little bodies weakened by malnutrition struggle to fight off diseases; and the combination of malnutrition and childhood illnesses is often deadly, especially in areas where clinics were shut down due to violence.
- We’re making progress in re-starting routine immunisation services, but children in the hardest-to-reach areas are missing out. While a child in the capital city Bangui has a more than 80% chance of getting vaccinations or vitamin supplements, a child in Vakaga in the far northern tip of the country, has only a 30% chance.
- We still need more information on the most vulnerable children. Surveyors couldn’t go to displacement sites, or to the bush where people have fled violence or into enclaves where minority populations are besieged by armed groups. A second SMART survey in March this year will produce data on the situation of children living in these precarious locations.
* Emergency levels are defined as two deaths per day for every 10,000 people
The SMART survey was carried out by UNICEF in partnership with the Ministry of Health, the Ministry of Planning and the Central African Institute of Statistics, Economic and Social Studies.