The study was conducted within the pogramme area of the Lao-German Integrated Food Security Programme. The programme supported ethnic groups living in mountainous areas, the Austro-Asiatic groups in Nalae district and the Hmong-Mien in Sing district. Support comprised of activities in the fields of agriculture, food and cash crop production, curative and preventive health care, primary and non-formal education, as well as communal infrastructure.
The objective of the study was to analyse the nutrition situation within the programme area, to identify most important causes of malnutrition as well as effective interventions, and thus to contribute to better nutrition programming.
Two cross-sectional surveys were conducted, one before and the second one after the four years of community based intensive interventions. Standardised questionnaires were used for household interviews and anthropometric measurements taken from children and women to assess their nutritional status (1997: 497 households and women, 614 pre-school children; 2001: 652 households and women, 892 pre-school children).
Chronic malnutrition was extremely high at the start of the programme and exceeded the national average, but came down significantly particularly for the most seriously affected children (HAZ < -2: 69% to 58%; HAZ < -3: 40% to 29%). The annual rate of reduction exceeded national and global progress with regard to chronic malnutrition and underweight of children as well as chronic dietary energy deficiency of women. The child death rate was extremely high and came down to national averages in Nalae district.
The diet was sufficient in energy but low in fat and high quality protein, and sub-optimal to meet micronutrient requirements. Not the quantity of rice consumed, but the variety in side dishes and the consumption of snacks were associated with a child s nutritional status. Food diversity and nutritional status were not linked, but a higher number of food items derived from forest resources was associated with a lower nutritional status.
Culture and tradition determined infant and young child feeding practices. Pre-lacteal feeding, late initiation of breastfeeding and too early introduction of complementary food were the major problems among the Austro-Asiatic group, among the Hmong-Mien it was the late introduction. Low quality of complementary food was a problem in both groups. Morbidity was high but dropped significantly. A behavioural change towards more favourable early infant feeding and hygiene practices was noticeable, as was the improved access to and use of health services.
Women s social status and parents literacy status were the key determinants of child malnutrition. A better status of women, along with better education, mitigated the negative effects of other factors jeopardizing children s nutritional status, such as low income, the hard work entailed in slash-and-burn cultivation, or other difficulties associated with the location. Improving women s education could further enhance the positive impact of their status on child nutrition.
A household s income situation determined child malnutrition in both years. Income increased by 45% on average. Nutritional improvements achieved by the end of the programme were equally distributed over all income groups. The improved production system was associated with better nutrition, but the quantity of rice produced did not play a role. Increased income and better rice yields indicate achievements in poverty reduction and food security, but did not result in nutritional improvements.
Major determinants of the nutritional improvements measured over the years were the hygiene behaviour, improved water supply and the rice production system.
The improved agriculture production system as well as the water supply system resulted in a reduced daily workload particularly for women. Presumably both, the time gained as well as the increased availability of water, helped to improve matters related to nutrition.
At the end of the programme, the nutritional situation within the group of households applying the three improvements was comparable to the situation within an educated household where women s status was high. However, the interventions helped reduce chronic malnutrition in four years while social changes would require a longer period of time.
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