Agriculture Reference
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• hand-washingbehavior;
• childillnesswithin15daysbeforethesurveyespeciallydiarrheaandmalariaincidences;
• assistanceduringdeliveryandplaceofdelivery;
• availabilityofprenatalcare;and
• excretalandhouseholdwastedisposal.
Although the model included information on household food insecurity, no food availability
data or environmental parameters such as production or weather data were included in the
regression. These variables were included in a measure of food insecurity, which was described
with the Household Food Consumption Score (Deitchler et al ., 2011). The consumption
score provides responses to questions recalling inadequate access to food, focused on captur-
physical consequences of this deficiency (Deitchler et al ., 2011).
Although the study found that the prevalence of acute malnutrition is higher among chil-
dren with low dietary diversity, the analysis found no significant relationship between malnu-
trition, household hunger scale and the food consumption score. This means that the rate of
acute malnutrition was the same in households with poor or extremely low food security and
those adequate or acceptable levels of food security. Access to food also did not affect acute
malnutrition rates, thus the entirely health-related, feeding practice and sanitary findings of
the study were the causes of malnutrition in the region.
Woldetsadik also reported on seasonal changes in malnutrition rates as well as changes
through time. He showed that the pre-rainy season and rainy season had much higher rates
of malnutrition than post-harvest. In the months preceding the rains both fish and milk, major
components of the local diet, are at an annual low. Cattle are grazing in the distant lowland
region and as the rivers and pools dry up, fish no longer supplements the diet. Therefore as
crop stocks continue to be eaten the population becomes increasingly vulnerable to food
shortages ( Figure 8.3 ). These seasonal increases reflect the seasonal price increases described
in Chapter 6 , and are likely due to a number of factors, not just the diversity and amount of
The conclusion that can be reached from this analysis is that providing more food or
income support for purchasing more food in the markets would not lead to lower malnutri-
tion rates for the households described in the study. In fact, little or no change in the acute
malnutrition rates has been seen in South Sudan over the past decade, despite huge increases
in the amount of assistance to Sudan from 2005 to 2008 (FAIS, 2012), and substantial amounts
going directly to South Sudan after the end of the conflict in 2011. Thus although more
information about market functioning and environmental dynamics would be useful, much
more will be needed than simply information to address the needs of the poorest and most
food insecure in regions like South Sudan.
Although the study found that the prevalence of acute malnutrition is higher among chil-
Evidence on environment and nutrition outcomes
In addition to the causes of malnutrition in a particular region, the links between environ-
mental change and nutrition outcomes over the longer term are poorly described in the liter-
ature. At a larger level, the survival and well-being of human populations remain fundamentally
dependent on ecosystem services - including clean water, plant and animal species for food
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