Assessment of 24 years infant growth monitoring in a rural area of Senegal (1969-1992)

Bilan de 24 années de suivi pondéral de nourrissons d’une zone rurale au Sénégal (1969-1992)

Catherine Enel (1) , Sybil Pinchinat (2) , Gilles Pison (1, 3) , Kirsten B. Simondon (2)

1 INED - Institut national d'études démographiques
2 IRD - Institut de Recherche pour le Développement
3 EAE - Eco-Anthropologie et Ethnobiologie

Undernutrition in young children in developing countries is associated with an increased risk of death. But in several studies, a decrease in mortality was not associated with any decrease in the prevalence of undernutrition. Study area: A rural population of Casamance, Senegal, has been under yearly demographic surveillance by The French National Institute of Demographic Studies (INED) since 1985. Between 1960-1964 and 1990-1994, under-5 and child (1-4 years) mortality rates dropped from 312 to 127 and from 201 to 68 per 1000, respectively. Since 1961, French Catholic nuns who are also professional nurses have been in charge of a private village dispensary located in a rural area of Casamance, Senegal. This dispensary delivers permanent, high quality service and is widely attended. Growth monitoring programme: A growth-monitoring programme, supported by Cathwell, was initiated in 1969 for 0-5 year old children (0-3 from 1985). Children were weighed wearing light clothes to the nearest 10g. Weights were recorded in a register that also contained information concerning identity (name, sex, date of birth) and address. All weights were plotted on growth charts kept by the mothers. During the sessions, the nurses provided nutrition education messages (i.e. preparation of high-energy and nutrient-dense infant gruels using local foods), advice on illness management (oral rehydration during diarrhoea) and hygiene (well and water-jar disinfection, construction of pit-latrines), importance of vaccination. From 1975, they also distributed free chloroquine during the malaria transmission season (May-November) for prevention and early presumptive treatment. Most likely thanks to this programme, infant and child mortality reached a low level at the end of the 1980’s. In 1990, plasmodium resistance to chloroquine appeared, increasing malaria mortality. Methods: All weight measurements taken at 3-23 months of age between 1969-1992 in a private dispensary of a rural area in Casamance, Senegal, have been analysed. This area has been under demographic surveillance by The French National Institute of Demographic Studies (INED) since 1985. Monitoring has shown a dramatic decrease in child mortality over the period 1960-1990. Results: The average coverage of the programme during the month of February was 88% for infants aged 3-23 months. The evolution of mean weight was examined at 5, 11 and 15 months of age (1969–1992). It confirms stagnation, even deterioration in some years, for all three age-cohorts (Figure 1). An unexpected finding is that in for 15-month-old infants underweight during the rainy season increases over time since 1975 (Figure 2). Conclusion: The nutritional status has not improved over time, despite intense growth monitoring in a highly accessible, smoothly functioning health system, and an impressive decrease in 0-5 year mortality.

La malnutrition, chez les jeunes enfants des pays en développement, est souvent associée à un risque accru de décès. Mais certaines études ont montré que la baisse de la mortalité n’est pas toujours associée à une diminution de la malnutrition. Les mesures pondérales mensuelles d’enfants de 3 à 23 mois révolus, enregistrées dans un dispensaire privé d’une zone rurale du Sénégal, ont été analysées pour la période 1969-1992. Cette zone fait l’objet d’un suivi démographique longitudinal depuis 1985 qui montre une forte baisse de la mortalité infantile pour la période 1960-1990. L’étude montre que 88 % des enfants résidant dans la zone d’étude participent au suivi pondéral et que, entre 1969 et 1992, le poids moyen des 3-23 mois à 5, 11 et 15 mois d’âge stagne, malgré un système de santé efficace. Les poids moyens des nourrissons de 15 mois sont plus faibles en saison humide, avec une aggravation depuis 1975. L’étude conclut qu’une intervention ciblée sur la santé, avec des programmes de vaccinations et de prévention du paludisme, améliore la survie des enfants sans améliorer leur statut nutritionnel.

Mots clés: Sénégal; Malnutrition; Milieu rural; Insuffisance pondérale; Nutrition; Nourrisson; Mortalité

Domaines: Sciences de l'Homme et Société; Santé; Démographie

Catherine Enel, Sybil Pinchinat, Gilles Pison, Kirsten B. Simondon. Bilan de 24 années de suivi pondéral de nourrissons d’une zone rurale au Sénégal (1969-1992). Cahiers d'études et de recherches francophones. Santé, 2006, 16 (2), pp.97-101. ⟨10.1684/san.2006.0021⟩. ⟨hal-04006356⟩