ENVIRONMENTAL AND NUTRITION OUTCOMES - Food Security, Food Prices and Climate Variability - page 165

organization may acquire the data. Most indicators are based on changes in government-
collected statistics such as admissions to feeding programs or iodized salt consumption, which
may have only a tenuous connection with actual malnutrition rates which require examina-
tion of individual children. Nearly all food crises involve direct food assistance in the form of
free food, or in monetary support so that households can purchase their own. If nutrition
problems are not linked to either availability (supply) or access (cost), then food security pro-
grams that only provide extra food are extremely unlikely to be effective in reducing malnu-
trition and stunting, and will fail in their goal to break the cycle of poverty and poor
nutrition.
Causes of malnutrition and stunting
A case study from South Sudan, published in 2011, provides some insight into the causes of
malnutrition. A nutrition causal analysis was commissioned to understand the causes of the
poor nutrition situation in South Sudan during the 2008-2011 period. A nutrition causal
analysis provides a multi-sectoral overview of the contributing factors affecting the nutritional
status within a given community. The analysis had several objectives (Woldetsadik, 2011):
• toassessthemagnitudeofacutemalnutritioninchildrenaged6-59months;
• establishanassociationbetweenmalnutritionandcontextualvariables;
• todeterminetherelativeimportanceofdifferentfactorsthatinluencenutritionalstatus;
and
• conductalogisticregressionanalysisandestablishcausalitypathwaysbasedonthestatisti-
cal association between the nutritional status of children and the set of associated under-
lying causes (socio-economic, consumption related, hygiene related, environmental and
health related).
The study used a randomized sampling of households in 2008 and 2011. The sample was
taken using a proportion formula for follow-up surveys considering the higher confidence
interval of the acute global acute malnutrition prevalence in 2008 and 2011. Household selec-
tion was based on two-stage cluster sampling with probability proportional to size. Both
anthropometric and contextualized data were collected simultaneously from 48 clusters during
the study. In total, the data of 572 children from the same number of households were col-
lected. Univariate, bivariate and multivariate analysis were performed using the frequency
tabulation, chi-square factor analysis, cluster analysis and logistic regression (Woldetsadik,
2011). Further details of the methods and sampling can be found in the report, which can be
downloaded from the Global Food Security Cluster website, and other sites online.
The average annual acute malnutrition found in the analysis was at 19 percent, which is
above the emergency threshold set by the United Nations World Health Organization of 15
percent.
The study found that the following parameters were significantly associated with acute
malnutrition in South Sudan:
• educationalstatusofthecaretaker;
• mother'soccupation;
• householdwatertreatmentpractice;