Malnutrition in Emergencies: The Determinants and Policy Implications of Malnutrition in Darfur, Sudan.

摘要

This dissertation focuses on investigating the causes of malnutrition in the crisis-affected region of Darfur, Sudan, on exploring the relationship between household headship and food security and on examining the role of care in determining malnutrition in emergencies. For the first two papers it uses data from Sudan's joint WFP/UNICEF/CDC/Ministry of Health annual Emergency Food Security and Nutrition Assessments between 2005 and 2007, the third paper is a review of the literature.;Most previous analyses of the nutritional situation in Darfur have focused on the prevalence rates of wasting and paid limited attention to its causes. The first dissertation paper aims to provide a causal analysis of child wasting in Darfur. It identifies predictors of wasting and assesses how these differed between 2005 and 2007, and across different categories of crisis-affected populations (internally displaced people (IDPs) living in camps, IDPs living within the host community, and the resident population). Results show that wasting increased between 2005 and 2007 in all categories of displacement, despite improvements in access to clean water, sanitation and many health outcomes. The predictors of wasting were not universal however: they changed from year to year and varied from one vulnerable group to another.;The second dissertation paper analyzes the relation between household headship and food consumption in Darfur as it had been subject to demographic alterations due to the conflict. The results show that men-headed households (MHH) owned more assets than women-headed households (WHH), spent a lower share of their expenditures on food and had better dietary diversity scores. This relative poverty of WHH translated into poorer dietary diversity only in the displaced de jure WHH whether living in camps or with the community. Results also show that subtle differences in the determinants of consumption exist among the different categories of headship (MHH, de jure WHH and de facto WHH) and depending on their displacement status.;The third dissertation paper reviews the effect of displacement on maternal mental health (mothers being the primary responsible for child care provision), the relation between maternal mental health and child malnutrition, and in this light, the effect of complex emergencies on the care of children. Malnutrition is a complex consequence of inadequacies in food, health, and care and the concept of care remains the least studied of all three. It finds enough evidence that maternal mental health directly affects the care dimension and consequently the other related causes of malnutrition.;Needs assessment and relief programs should take into consideration subtle differences among groups usually labeled as vulnerable and be flexible enough to change with time. Analysis of malnutrition should also go beyond the usual analysis of food and health and give the care dimension the attention it deserves.