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PubMedDate not supplied

["Silence, people are dying..." The Damergou famine, an examination of the facts].

This study illustrates the importance of rapid and rigorous nutritional surveys to evaluate precarious nutritional situations in the context of media uproar. It was performed in July 1993 in the Damergou district of Tanout in the Zinder department of Niger. In October 1992, the early warning system (SAP for Service d'alerte précoce) in the department reported and evaluated the food production deficit in the district. A food aid strategy was implemented according to these findings, and food was distributed from May. During June, 1993, a non-governmental organisation (NGO) used a tabloid press report to dramatise the situation, and declare that 75% of the children were malnourished, and that there were 56,000 people starving and unable to move to look for food. An international aid spiral of bidding and outbidding followed, based on simple presumption, probably justified, but not verified. The first surveys sent from the headquarters were unable to make any reliable evaluations or pertinent recommendations. The departmental health office then performed a rapid anthropometric nutritional survey (RANS) using a representative sample of the population. The survey was a cluster survey involving 29 villages and including 1,088 children between the ages of 6 months and 6 years old and their mothers. The 29 villages account for 10% of the population of the district. The findings were as follows: 2.8% of the families had emigrated since the harvest. The average price of a tiya (approximately 2.5 kg) of millet was 183 FCFA (French African Francs), the normal price at this time of year. The reserve of animal stock was 8.6 heads per family, inconsistent with massive destocking.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1994

Assessments of mortality, morbidity, and nutritional status in Somalia during the 1991-1992 famine. Recommendations for standardization of methods.

OBJECTIVES: To evaluate the various survey methods used in Somalia between 1991 and early 1993 while assessing documentation of mortality and malnutrition rates and common causes of morbidity and mortality. DATA SOURCES: Twenty-three population surveys were identified from the Center for Public Health Surveillance for Somalia, the United Nations Children's Fund, and other humanitarian organizations. STUDY SELECTION: Only surveys with defined populations and apparently systematic methodology that focused on mortality, morbidity, and/or nutritional status were included. RESULTS: Extensive methodological differences were found among the 23 surveys. Target populations and sampling strategies varied widely. Twelve studies were considered not reproducible. Of the 16 studies assessing mortality, only eight assessed cause of death. Use of units of measurement and inclusion of denominators in rate calculations were inconsistent. None of the studies provided confidence intervals around the point estimates of the rates. Of the 11 studies providing information on morbidity, none provided case definitions. And in the 16 studies reporting nutritional status, a variety of measurement methods and definitions of malnutrition were used. Three studies presented information based on mid-upper-arm circumference measurements, and 10 presented weight-for-height data below 70% and 80% of the reference median; only four studies presented z scores. CONCLUSIONS: While the results of some studies may have influenced policy and program management decisions, their effects may have been limited by failure to adequately document results and by differences among studies in objectives, design, parameters measured, methods of measurement, definitions, and analysis methods. We recommend that agencies conducting population studies in emergency situations define clear study objectives, use standard sampling and data collection methods, and ensure precise written documentation of study objectives, methods, and results.

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PubMed1993

Famine in Somalia.

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PubMed1975

Famine oedema.

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Adult↗
PubMed2006

Thrifty genes for obesity and the metabolic syndrome--time to call off the search?

Over the last 50 years there has been a major epidemic of obesity and associated co-morbidities, the so-called 'metabolic syndrome', mostly in the western world but with an increasingly global dimension. The development of such chronic diseases has a strong genetic component, yet the timescale of their increase cannot reflect a population genetic change. Consequently, the most accepted model is that obesity and its sequelae are a result of a gene-environment interaction, an ancient genetic selection to deposit fat efficiently that is maladaptive in modern society. Why we have this genetic predisposition has been a matter of much speculation. Following the seminal contribution of Neel, there has been a broad consensus that over evolutionary time we have been exposed to regular periods of famine, during which fatter individuals would have enjoyed a selective advantage by their greater survival. Consequently, individuals with genes promoting the efficient deposition of fat during periods between famines ('thrifty genes') would be favoured. In the modern environment this genetic predisposition prepares us for a famine that never comes, and an epidemic of obesity with all the attendant chronic illnesses follows. In this review I present details of the evidence supporting the famine hypothesis and then show that this idea has five fundamental flaws. In essence, famines are a relatively modern phenomenon and occur only about once every 100-150 years. Consequently, most human populations have only experienced at most 100 famine events in their evolutionary history. Famines involve increases in total mortality that only rarely exceed 10% of the population. Moreover, most people in famines die of disease rather than starvation and the age distribution of mortality during famine would not result in differential mortality between lean and obese individuals. A simple genetic model shows that famines provide insufficient selective advantage over an insufficient time period for a thrifty gene to have any penetration in the modern human population. Over the 40 or so years since Neel proposed the thrifty gene hypothesis, no convincing candidates for these genes have been discovered. My analysis suggests that perhaps it is time to call off the search.

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