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PubMed1995

Nutritional assessments, food security and famine.

The widely held view that malnutrition is a late indicator of famine is challenged on the basis of evidence that people often deliberately reduce their food intake as an early response to inadequate food security. This broadens the possible interventions in response to high malnutrition rates to include measures to support livelihoods under threat of collapse. In the late stages of famine, social disruption and distress migration often result in a degraded health environment which may raise the threshold of nutritional status associated with an increased mortality risk. It is important to assess the underlying causes of malnutrition and the associated health risks. At present, the main objective of nutrition surveys is usually to obtain a reliable estimate of the prevalence of malnutrition among children under five years of age, with little analysis of the underlying causes of malnutrition. Experience from the 1984-85 famine in Darfur led to the development of an alternative approach to nutritional assessment which could be applicable elsewhere in Africa. The combination of quantitative and qualitative methods was particularly valuable as a means of gaining a wider and deeper understanding of the nature of the nutritional situation.

Cause of Death↗
PubMed1995

Nutrition, disease and death in times of famine.

In this article we review the relationship between malnutrition and mortality, and the interaction of morbidity, with the aim of clarifying the health risks of malnutrition in situations of famine and food insecurity. Apart from reviewing what is known about this relationship, we highlight areas where further research is needed. Among refugee and famine affected populations living in camps, there appears to be a close association between high rates of malnutrition and excess mortality. Results from community-based prospective studies of malnutrition and mortality among individuals conclude that as nutritional status declines the risk of death increases, although the discriminating power of different nutritional indices and the strength of the association varies considerably in different locations and at different times. These differences are attributed mainly to the different prevailing patterns of morbidity and growth failure, which are influenced by both environmental and social factors. In situations of famine and population displacement, the deterioration in the health environment increases exposure to infection and is likely to raise the threshold of nutritional status which corresponds to an increased risk of mortality. This has important implications for nutritional assessments and interventions.

Africa↗
PubMed1990

Famine in southern Ethiopia 1985-6: population structure, nutritional state, and incidence of death among children.

OBJECTIVE: To assess the effects of drought on mortality in children. DESIGN: Prospective epidemiological study forming part of nutritional monitoring during famine relief work. SETTING: 24 Food distribution sites in Arero and Borana provinces in southern Ethiopia. PATIENTS: A monthly average of 14,173 and 5,334 children under 5 were examined in 1985 and 1986, respectively. Altogether 148,966 child months (105,872 for 1985 and 43,094 for 1986) were available for analysis. INTERVENTION: The families of all children were supplied with food each month. Basic medical care was also provided. MAIN OUTCOME MEASURE: Mortality in children under 5. RESULTS: A 40% increase in crude mortality was observed among children living in traditional and stable societies. The severe consequences were observed mainly among children living in relief shelters, where a threefold to fourfold increase in crude mortality was recorded among children. Increased childhood mortality was also associated with high prevalence of malnutrition, living in the most arid areas, and the dry season. A long period of food aid was needed to normalise the nutritional state, especially for children living in relief shelters. CONCLUSIONS: The most severe consequences of the widespread famine that occurred in the Arero and Borana provinces of southern Ethiopia during 1985-6 were seen among children living in relief shelters. Early food intervention may decrease the scale of migration and thus also reduce the severe consequences of a famine.

Altitude↗
PubMed1995

Infant mortality and famine: a study in historical epidemiology in northern England.

OBJECTIVE: To examine whether periodic variations in annual infant mortality were associated with malnutrition and the poor quality of the food supply available to the community. DESIGN: Retrospective study of historical epidemiology of infant mortality by time series analysis and family reconstitution of parish registers of burials and baptisms. SETTING: Penrith, Cumbria, England, 1557-1812. SUBJECTS: A total of 17,500 births during 1557-1812. RESULTS: This community in the Eden Valley, Cumbria, close to the Scottish borders, was living under marginal conditions with high mortality and low fertility. Clear oscillations in infant mortality synchronise with the oscillations in the wheat price index which is regarded as a measure of the availability of food to the community, and to pregnant and nursing mothers in particular. Input-output analysis showed that the relationship between the wheat price index (input) and infant mortality (output) was highly significant (p < 0.001). Events during the famine of 1623 have been analysed in detail: high wheat prices during pregnancy caused subsequent severe infant mortality but did not have indirect effects on the subsequent mortality of the surviving children over the age of 1 year. Non-stationary oscillations in neonatal and post neonatal mortality were strongly coherent (p < 0.001) with the wheat price index throughout the period. CONCLUSIONS: Infant mortality is particularly sensitive to famine and also to the quality of the food supply available to pregnant and nursing mothers. The lags between neonatal and post-neonatal mortalities and wheat prices, together with the analysis of the famine of 1623, support the hypothesis that neonatal mortality was related to malnutrition in pregnancy whereas post-neonatal mortality was primarily directly dependent on exogenous causes in the first year of life.

England↗
PubMed1996

Schizoid personality disorder after prenatal exposure to famine.

OBJECTIVE: The authors tested whether early prenatal exposure to famine was associated with schizophrenia spectrum personality disorder in addition to being associated with schizophrenia per se as shown in a previous study. METHOD: The risk of schizoid personality disorder, as defined by ICD-6 to ICD-9, in men at age 18 years was compared in birth cohorts that were conceived at the height of the Dutch Hunger Winter famine and in unexposed birth cohorts of 1944-1946 in the famine region of Holland. RESULTS: The exposed cohort had a significantly greater risk (relative risk = 2.01) of schizoid personality disorder. CONCLUSIONS: Prenatal nutritional deficiency was associated with a greater risk of schizoid personality disorder in men at age 18 years.

Adolescent↗
PubMed2001

Effects of prenatal exposure to the Dutch famine on adult disease in later life: an overview.

People who were small at birth have been shown to have an increased risk of CHD and chronic bronchitis in later life. These findings have led to the fetal origins hypothesis that proposes that the fetus adapts to a limited supply of nutrients, and in doing so it permanently alters its physiology and metabolism, which could increase its risk of disease in later life. The Dutch famine--though a historical disaster--provides a unique opportunity to study effects of undernutrition during gestation in humans. People who had been exposed to famine in late or mid gestation had reduced glucose tolerance. Whereas people exposed to famine in early gestation had a more atherogenic lipid profile, somewhat higher fibrinogen concentrations and reduced plasma concentrations of factor VII, a higher BMI and they appeared to have a higher risk of CHD. Though the latter was based on small numbers, as could be expected from the relatively young age of the cohort. Nevertheless, this is the first evidence in humans that maternal undernutrition during gestation is linked with the risk of CHD in later life. Our findings broadly support the hypothesis that chronic diseases originate through adaptations made by the fetus in response to undernutrition. The long-term effects of intrauterine undernutrition, however, depend upon its timing during gestation and on the tissues and systems undergoing critical periods of development at that time. Furthermore, our findings suggest that maternal malnutrition during gestation may permanently affect adult health without affecting the size of the baby at birth. This gives the fetal origins hypothesis a new dimension. It may imply that adaptations that enable the fetus to continue to grow may nevertheless have adverse consequences for health in later life. CHD may be viewed as the price paid for successful adaptations to an adverse intra-uterine environment. It also implies that the long-term consequences of improved nutrition of pregnant women will be underestimated if these are solely based on the size of the baby at birth. We need to know more about what an adequate diet for pregnant women might be. In general, women are especially receptive to advice about diet and lifestyle before and during a pregnancy. This should be exploited to improve the health of future generations.

Adult↗
PubMed1993

Mortality rates in displaced and resident populations of central Somalia during 1992 famine.

Famine and civil war have resulted in high mortality rates and large population displacements in Somalia. To assess mortality rates and risk factors for mortality, we carried out surveys in the central Somali towns of Afgoi and Baidoa in November and December, 1992. In Baidoa we surveyed displaced persons living in camps; the average daily crude mortality rate was 16.8 (95% CI 14.6-19.1) per 10,000 population during the 232 days before the survey. An estimated 74% of children under 5 years living in displaced persons camps died during this period. In Afgoi, where both displaced and resident populations were surveyed, the crude mortality rate was 4.7 (3.9-5.5) deaths per 10,000 per day. Although mortality rates for all displaced persons were high, people living in temporary camps were at highest risk of death. As in other famine-related disasters, preventable infectious diseases such as measles and diarrhoea were the primary causes of death in both towns. These mortality rates are among the highest documented for a civilian population over a long period. Community-based public health interventions to prevent and control common infectious diseases are needed to reduce these exceptionally high mortality rates in Somalia.

Adolescent↗
PubMed1989

Demographic pressure and the Irish famine: Malthus after Mokyr.

"This paper presents a fresh analysis of demographic pressure in pre-Famine Ireland. The crucial issue is one of measurement. Population pressure is taken as the ratio of population to non-reproducible natural resources, that is, land." The author develops a measure of land quality that is used to test the Malthusian hypothesis. "The central finding of this paper may be stated quite simply: when proper account is given to the measurement of land quality and demographic pressure, then the Malthusian hypothesis that income per capita decreases with population pressure is not rejected by the evidence of pre-Famine Ireland."

Agriculture↗
PubMed1990

Effect on famine on child survival in Matlab, Bangladesh.

"This paper examines how the level of child mortality and rate of out-migration, and their covariates were affected during the 1974 famine and the periods immediately following the famine in Bangladesh." The authors examine several variables affecting mortality and out-migration, including socioeconomic status, sex factors, age factors, educational status, and religion. Data are from the Matlab Demographic Surveillance System.

Age Factors↗
PubMed1988

Famine and man: lessons from the Irish past, a guide to the future?

"The intention of the present study was to examine such information as is available on the Ethiopian famine of the 1980s, and to compare it with known sequelae of the Irish Famine [of the mid-nineteenth century]. From this comparison it may be possible to determine if features common to all disasters of this nature are identifiable, and ultimately, whether the information gained can be employed to prevent their recurrence and further large-scale loss of life."

Africa↗
PubMed2004

Quality of malnutrition assessment surveys conducted during famine in Ethiopia.

CONTEXT: During 1999 and 2000, approximately 10 million people were affected by famine in Ethiopia. Results of nutrition assessments and surveys conducted by humanitarian organizations were used by donors and government agencies to determine needs for food aid and to make other decisions on geographic allocation of limited resources; however, accurate results might have been hampered by methodological errors. OBJECTIVES: To identify common methodological errors in nutrition assessments and surveys and to provide practical recommendations for improvement. DESIGN AND SETTING: Nutrition assessments and surveys (n = 125) conducted by 14 nongovernmental organizations (NGOs) in 54 woredas (districts) in Ethiopia from May 1, 1999, through July 31, 2000. Surveys were ranked as valid and precise according to 5 criteria: use of population proportional to size sampling, sample size, number of clusters, number of children per cluster, and use of weight-for-height index. MAIN OUTCOME MEASURES: Number and proportion of surveys that used standard, internationally accepted methods and reported valid and precise results. RESULTS: Fifty-eight of the 125 surveys (46%) were not intended to be standard 30 x 30 cluster surveys. Of the remaining 67 surveys, 6 (9%) met predetermined criteria for validity and precision. All 67 used the anthropometric index of weight-for-height, with 58 (87%) reporting z scores. Fifty-four (81%) used nonrandom sampling without consideration of population size and 6 (9%) had sample sizes of fewer than 500 persons. CONCLUSIONS: Major methodological errors were identified among 30 x 30 cluster surveys designed to measure acute malnutrition prevalence in Ethiopia during the famine of 1999-2000. Donor agencies and NGOs should be educated about the need for improved quality of nutrition assessments and their essential role in directing allocation of scarce food resources.

Adult↗
PubMed2004

Long term consequences of the 1944-1945 Dutch famine on the insulin-like growth factor axis.

The insulin-like growth factor axis is highly responsive to nutritional status and may be involved as one of the underlying mechanisms through which caloric restriction could affect cancer risk. High levels of circulating insulin-like growth factor (IGF)-I, or IGF-I relative to IGF binding protein (IGFBP)-3 have been related to various human cancer types. In a group of 87 postmenopausal women, we found that childhood exposure to the 1944-1945 Dutch famine was associated with increased plasma levels of IGF-I and IGFBP-3, whereas IGFBP-1 and -2 levels were weakly decreased. These results are opposite to immediate responses seen under starvation and we hypothesize that this could indicate a permanent overshoot upon improvement of nutritional status after the famine.

Adolescent↗
PubMed1982

Gender and energy balance: sex differences in adaptations for feast and famine.

According to this theory/review, the cross-culturally common finding of more women than men among the obese is at least in part a consequence of sex differences in evolutionary selection pressure. James and Trayhurn claim that the propensity to obesity is linked to th ability to survive a fast and both may involve reduced heat production. The present theory extends this relationship to sex differences in energy balance. According to the theory proposed here, mammalian females were subjected to more severe selection pressures during times of short food supply than males were and hence females were under more pressure to evolve mechanisms to facilitate survival during famine, which led to sex differences in obesity. The data relevant to sex differences in starvation survival, obesity and heat production, and the possible evolutionary roles and implications of sex differences in chromosomes and in organizational and activational sex hormones are reviewed. The conclusion is that evolution has created a linkage between sex chromosomes, hormones and energy balance, and this linkage is at least in part responsible for the greater resistance of the female to famine and for her greater tendency to become obese in times of feast.

Adaptation, Physiological↗
PubMed1980

Molluscum contagiosum and herpes simplex in Maasai pastoralists; refeeding activation of virus infection following famine?

An epidemic of molluscum contagiosum and oro-genital herpes simplex was observed in Maasai pastoralists of the Rift Valley. It coincided with a period of refeeding following famine, when the relief diet was different from normal milk fare. We propose that refeeding may be an important mechanism for activation of certain viral infections previously suppressed by famine.

Adolescent↗
PubMed1989

Health needs of older adults displaced to Sudan by war and famine: questioning current targeting practices in health relief.

The high rates of death, disability and illness and the scarcity of resources associated with relief operations for victims of oppression, war and famine have led to some support systems of triage for health and nutritional care in relief. Two vulnerable groups have often been given priority for targeting in health relief--young children and their mothers. This paper reports the findings of a study of the health needs of another vulnerable group, older adults, among those who had been recently displaced to Sudan in 1984-1985 by the war and famine in Tigray region of Ethiopia. The study attempted to determine the extent to which morbidity events and migration affected the life-style of older adults and the socio-economic support mechanisms which were available to them. The findings indicate that older adults (those over 45 years of age) were a very small proportion of the population and that over half of those aged 60 years and over (defined as 'elderly' in this paper) had been left behind in Tigray. This may well indicate that disability, illness or both, forced many older adults, particularly those most in need, to remain in Tigray. Among older adults living in Sudan, high levels of minor disability, social isolation and total economic dependency indicated vulnerability, but older adults had not been specifically considered in health policies and plans. Their primary needs were basic--for cloth, food, shelter, transport, seeds, oxen and farming tools. We conclude that priority in relief should be to support individuals, families and entire communities by adequately providing for basic needs. Furthermore, international relief agencies should give equal consideration to those who remain in their homes and those who migrate for assistance. This approach would take into consideration quality of life, not just the number of lives saved among those who reach the camps and shelters, and would assume responsibility for 'Health for All', not just for selected 'vulnerable groups'.

Aged↗
PubMed2003

Food-aid cereals to reduce neurolathyrism related to grass-pea preparations during famine.

Neurolathyrism is a spastic paraparesis that can be caused by excessive consumption of the drought-resistant grass pea (Lathyrus sativus). Devastating neurolathyrism epidemics have occurred during major famine crises in various parts of the world. We investigated in a case-control study the effects of food aid on risk of paralysis. Risk increased with consumption of boiled grass pea (adjusted odds ratio 2.78, 95% CI 1.09-7.13 with cereals; 5.22, 2.01-13.55 without cereal) and raw unripe green grass pea (1.96, 1.16-3.31; p=0.011), but not with the fermented pancake, unleavened bread, and gravy preparations. In a correlational study there was an inverse relation between the number of new cases and the amount of food-aid cereals distributed per person. During famine, cereals and nutritional information should reach people before they have grass pea as the only food.

Case-Control Studies↗
PubMed1999

Adaptive responses of Ralstonia eutropha to feast and famine conditions analysed by flow cytometry.

Results obtained by flow cytometry allow conclusions to be drawn about how the physiological states of Ralstsonia eutropha JMP134 are connected with survival strategies under distinct growth conditions. During both feast and famine conditions the cells were found to proceed through sharply separated phases of life. Two sources of carbon and energy, one poor (0.02% phenol) and one rich (0.2% pyruvate and 0.1% yeast extract) were chosen to study the cellular responses. Despite the major differences in carbon source, when growth stages of the bacteria on the two substrates were characterised in batch growth, only minor differences were found in the time course of the membrane potential related fluorescence intensity (MPRFI). This also applied to the rRNA content and the size-correlated forward scatter (FSC) signal of the cells, both of which increased to high levels during the (early) exponential growth phase. On the rich medium, DNA synthesis initially occurred in an uncoupled manner, then a high rate of PHB formation followed when nutrients began to be limiting. Under famine conditions, the cellular responses were much more complex. PHB was synthesised, then DNA synthesis occurred in a 'eukaryotic' mode, to be succeeded by renewed PHB synthesis. To obtain defined cell physiological states, the chemostat technique was used in addition to batch experiments. The results obtained clearly indicated that key events in cell physiology, including initiation of DNA replication and overflow metabolism, occurred in a hierarchically ordered manner and were tightly correlated with changes in the environmental conditions of the bacterial cells.

Adaptation, Physiological↗
PubMed2001

Effects of prenatal exposure to the Dutch famine on adult disease in later life: an overview.

Chronic diseases are the main public health problem in Western countries. There are indications that these diseases originate in the womb. It is thought that undernutrition of the fetus during critical periods of development would lead to adaptations in the structure and physiology of the fetal body, and thereby increase the risk of diseases in later life. The Dutch famine--though a historical disaster--provides a unique opportunity to study effects of undernutrition during gestation in humans. This thesis describes the effects of prenatal exposure to the Dutch famine on health in later life. We found indications that undernutrition during gestation affects health in later life. The effects on undernutrition, however, depend upon its timing during gestation and the organs and systems developing during that critical time window. Furthermore, our findings suggest that maternal malnutrition during gestation may permanently affect adult health without affecting the size of the baby at birth. This may imply that adaptations that enable the fetus to continue to grow may nevertheless have adverse consequences of improved nutrition of pregnant women will be underestimated if these are solely based on the size of the baby at birth. Little is known about what an adequate diet for pregnant women might be. In general, women are especially receptive to advice about diet and lifestyle before and during a pregnancy. This should be exploited to improve the health of future generations.

Adaptation, Physiological↗