Seasonality, sex, and acute malnutrition in Chad’s Sila Province

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The Sustainable Development Goals (SDGs) set to eliminate all forms of malnutrition by 2030. However, since the adoption of the SDGs, progress on child wasting has been slow. Recently, there have been renewed efforts towards a greater understanding of the seasonality, or within year changes, of wasting, or low weight for height, with seasonality identified as the "missing link" or major gap in wasting prevention. Importantly, a recent paper that adapts UNICEF's (1990) conceptual framework on the causes of malnutrition to the context of Africa's drylands reemphasizes the critical role of seasonality and environment as a critical trigger of the underlying and immediate drivers of acute malnutrition, mediated through livelihoods and institutions.

There is a wealth of recent research that shows that wasting and stunting affects boys more than girls. Even if the reasons for the disparity remain unknown, the available evidence and expert advice points to a need to revise the common perception that it is girls, rather than boys, who are more vulnerable to malnutrition.

In this briefing paper we discuss four key findings from research conducted in the Sila Province in eastern Chad that underscore a need for the design and evaluation of programs aimed at preventing wasting to account for seasonality and sex.

  1. There is much more to the concept of seasonality than the existence of wet and dry seasons. A full understanding of its complexities requires a variety of approaches, including drawing on local perspectives and data gathered systematically over an extended period (longitudinal data).

  2. Data on wasting prevalence indicates there are two peaks every year: a primary and larger peak during the start of the rains, and a secondary and smaller peak prior to the harvest period. Each peak likely has a different set of contributing factors, or drivers.

  3. Boys are more susceptible to this seasonal variability in wasting than girls, who fare better. These seasonal gender disparities are likely linked to social norms and values and are reversed with increasing age.

  4. Different care practices for boys and girls could be driving seasonal differences in wasting, not least because of the potential role of water contamination.

This research was undertaken in collaboration between Tufts University and Concern Worldwide. The data described in this brief comes from a mixed methods study, using both qualitative interviews and quantitative longitudinal data collection. Concern collected data on children aged 6-59 months across 89 households for 23 months (May 2018 -- March 2020) in the Sila Province of Chad with in-depth qualitative work carried out in August 2018 and May/June 2019. For the full report, detailed methodology, and instrument please see https://fic.