Progress of Regional Economic Integration in East Africa

East African countries are deeply committed to adopting and implementing regional integration initiatives, which are viewed as a common approach for the region's growth. At the regional level, the main goal is to create the Economic Community as the sixth and final stage of integration, which includes increasing inter-sectoral coordination and establishing regional free trade zones, common market, economic union, and monetary union spanning the entire continent. In this article, we will look at their priorities, major accomplishments, and problems, as well as the progress achieved in the integration process and the threats it faces. The theoretical section of this research was carried out in Africa, specifically East Africa. The research data came from articles and document analysis. There were also secondary sources used. The research is one of the first to evaluate integration areas in East Africa that could lead to faster integration. It assists organizations such as IGAD, COMESA, and EAC in revising or reassessing their strategies, as well as their institutional weaknesses and strengths, in order to achieve their integration objective successfully

Progress of Regional Economic Integration in East Africa

East African countries are deeply committed to adopting and implementing regional integration initiatives, which are viewed as a common approach for the region's growth. At the regional level, the main goal is to create the Economic Community as the sixth and final stage of integration, which includes increasing inter-sectoral coordination and establishing regional free trade zones, common market, economic union, and monetary union spanning the entire continent. In this article, we will look at their priorities, major accomplishments, and problems, as well as the progress achieved in the integration process and the threats it faces. The theoretical section of this research was carried out in Africa, specifically East Africa. The research data came from articles and document analysis. There were also secondary sources used. The research is one of the first to evaluate integration areas in East Africa that could lead to faster integration. It assists organizations such as IGAD, COMESA, and EAC in revising or reassessing their strategies, as well as their institutional weaknesses and strengths, in order to achieve their integration objective successfully

Factors influencing delay in seeking tuberculosis treatment in Belet-Weyne District, Somalia

Magister Public Health - MPHDelays in seeking effective treatment for tuberculosis increase the level of disease morbidity and mortality rate as well as the risk of its transmission in the community (WHO, 2006b). In Somalia, Tuberculosis (TB) remains one of the greatest health threats as it is the leading cause of death in the economically active age groups and in people living with HIV/AIDS (WHO, 2004). This study was carried out with the aim of determining factors influencing delays in seeking TB treatment in Belet-Weyne district.South Afric

Child dietary diversity and associated factors among children in Somalian IDP camps

Background: Malnutrition and food insecurity are major challenges in Somalia, particularly among small children living in internally displaced persons (IDP) camps. Poor diet has been identified as key driver of malnutrition in young children who depend for their diets on their household’s socio-economic standing and access to food, as well as on the family’s caring and feeding practices. Objective: To assess the dietary diversity and identify the factors associated with it among children (6-23 months) in Somalian IDPs Methods: We used a cross-sectional survey conducted in eleven IDPs camps in Somalia in June 2014 and in June 2015. A total of 3188 children aged 6 to 23 months were surveyed. Child diets were assessed using food frequency questionnaires, and dietary diversity was categorized using the minimum child dietary diversity (MDDC) indicator. Multivariable logistic regressions were used to identify the factors associated with the children's dietary diversity. We built and compared two models using alternatively the household dietary diversity score and (HDDS) the food consumption score (FCS) as food security proxies. Results: Around 15% of children among IDP camps reached the minimum dietary diversity. Overall our results confirm that not only food security proxies are the factor more associated with MDDC, but HDDS performs better than FCS. In addition, results identified that: women as key decision-maker in the household, duration of household permanence in the settlement, women’s physiological status, frequency of milk feeding to child, type of toilet and measles vaccination were positively associated with MDDC. Conclusions: To improve child dietary diversity in IDP camps, food security interventions should be broadened to include female empowerment and inclusive nutrition education (encouraging male participation) programmes, as well as initiatives for targeting children who do not live with pregnant or lactating women, and that can support families beyond the first months after their arrival.JRC.D.4-Economics of Agricultur

Malnutrition and morbidity trends in Somalia between 2007 and 2016: results from 291 cross-sectional surveys

Background More than two decades of conflict and natural disasters in Somalia have resulted in one of the longest running humanitarian crises in the world. Nutrition data have been collected over the years despite challenges to inform programmatic action. This paper explores malnutrition and morbidity trends in Somalia during the last decade, disaggregated by geographical zone and livelihood system. Methods We used data from 291 cross-sectional surveys conducted in children aged 6–59 months between 2007 and 2016 in Somalia. Wasting, morbidity and stunting prevalences over time were analysed by geographic area, livelihood system and season. Logistic regressions were used to test trends. Results The wasting trends show a striking peak in 2011, more marked in southern and central Somalia and coinciding with the famine declaration. The trend declines slightly thereafter although not consistently across all zones and livelihoods, and it raises again in 2016 especially among internally displaced persons (IDPs). Stunting declined for all groups and in all zones but with more consistent patterns in northern Somalia. Morbidity also showed a declining trend, although with multiple peaks depicting disease outbreaks. Pastoralist showed the lowest stunting estimates overall, while agrarian populations showed the lowest prevalence of wasting and morbidity. IDPs were the most affected by all outcomes. Seasonality affected the three outcomes differently by livelihood system. Stunting rates increased after the 2011 famine for all age groups within children under 5 years. Conclusions Despite the continuous complex situation in Somalia, there has been a sustained decline in stunting and morbidity in the last decade. Wasting trends have remained at very high levels especially in north-east and the south zones of Somalia. The findings support the importance of performing trend analyses disaggregated by zone and livelihood groups within countries to better identify priorities for programme intervention.JRC.D.4-Economics of Agricultur

MUAC-for-age more useful than absolute MUAC for nutritional surveillance in Somalia: results from nineteen cross-sectional surveys (2007–2016)

Abstract Background Somalia is affected by a civil war and a protracted humanitarian crisis for more than two decades. The international community has put in place nutrition surveillance systems to monitor the situation and inform decisions. However, the indicators commonly used to identify acute malnutrition, weight-for-height Z-score (WHZ) and mid upper arm circumference (MUAC), do not always converge in their estimations of acute malnutrition, creating challenges for decision making. Furthermore, the divergences are not consistent across livelihood populations within the country. We explored the MUAC-for-age Z-score (MUACAZ) as an alternative indicator in Somalia to minimize the discrepancy. Methods We analyzed data from nineteen cross-sectional surveys conducted in Somalia between 2007 and 2016. We compared the acute malnutrition prevalence estimates by each of the indicators and the degree of overlap in the individual diagnosis of acute malnutrition between the WHZ and the MUAC-based indicators. We performed multivariate regression analysis with sex, age and stunting as independent variables and acute malnutrition as the dependent outcome, defined by WHZ, MUAC or MUACAZ. We performed all the analysis in the population overall and in each of the livelihood populations separately. Results A total 255,623 measurements of children 6–59 months of age were analyzed. The overall prevalence of global acute malnutrition by MUACAZ (15.8%) was similar to the one obtained using WHZ (16%), whereas prevalence based on MUAC was much lower (7.8%). These patterns of divergence were sustained throughout the nineteen surveys and the livelihoods studied, with only few exceptions. However, the proportion of overlap in the individual diagnosis of children as acutely malnourished was low between WHZ and absolute MUAC diagnosis (18.1%) and also between WHZ and MUACAZ (28.3%). Results show that age, sex and stunting status of the child affected the likelihood of being diagnosed as acutely malnourished to varying degrees, depending on the indicator used. Conclusions The MUAC-for-age (MUACZ) indicator yielded acute malnutrition prevalence estimates convergent with those obtained by WHZ indicator. However, the degree of overlap between these two indicators for individual diagnosis of acute malnutrition is low. Further studies of MUACAZ as an alternative indicator for nutrition surveillance are needed

MUAC-for-age more useful than absolute MUAC for nutritional surveillance in Somalia: results from nineteen cross-sectional surveys (2007-2016)

Background: Somalia is affected by a civil war and a protracted humanitarian crisis for more than two decades. The international community has put in place nutrition surveillance systems to monitor the situation and inform decisions. However, the indicators commonly used to identify acute malnutrition, weight-for-height Z-score (WHZ) and mid upper arm circumference (MUAC), do not always converge in their estimations of acute malnutrition, creating challenges for decision making. Furthermore, the divergences are not consistent across livelihood populations within the country. We explored the MUAC-for-age Z-score (MUACAZ) as an alternative indicator in Somalia to minimize the discrepancy. Methods: We analyzed data from nineteen cross-sectional surveys conducted in Somalia between 2007 and 2016. We compared the acute malnutrition prevalence estimates by each of the indicators and the degree of overlap in the individual diagnosis of acute malnutrition between the WHZ and the MUAC-based indicators. We performed multivariate regression analysis with sex, age and stunting as independent variables and acute malnutrition as the dependent outcome, defined by WHZ, MUAC or MUACAZ. We performed all the analysis in the population overall and in each of the livelihood populations separately. Results: A total 255 623 measurements of children 6-59 months of age were analyzed. The overall prevalence of global acute malnutrition by MUACAZ (15.8%) was similar to the one obtained using WHZ (16%), whereas prevalence based on MUAC was much lower (7.8%). These patterns of divergence were sustained throughout the nineteen surveys and the livelihoods studied, with only few exceptions. However, the proportion of overlap in the individual diagnosis of children as acutely malnourished was low between WHZ and absolute MUAC diagnosis (18.1%) and also between WHZ and MUACAZ (28.3%). Results show that age, sex and stunting status of the child affected the likelihood of being diagnosed as acutely malnourished to varying degrees, depending on the indicator used. Conclusions: The MUAC-for-age (MUACZ) indicator yielded acute malnutrition prevalence estimates convergent with those obtained by WHZ indicator. However, the degree of overlap between these two indicators for individual diagnosis of acute malnutrition is low. Further studies of MUACAZ as an alternative indicator for nutrition surveillance are needed.JRC.D.5-Food Securit

MUAC-for-age more useful than absolute MUAC for nutritional surveillance in Somalia: results from nineteen cross-sectional surveys (2007-2016)

Background: Somalia is affected by a civil war and a protracted humanitarian crisis for more than two decades. The international community has put in place nutrition surveillance systems to monitor the situation and inform decisions. However, the indicators commonly used to identify acute malnutrition, weight-for-height Z-score (WHZ) and mid upper arm circumference (MUAC), do not always converge in their estimations of acute malnutrition, creating challenges for decision making. Furthermore, the divergences are not consistent across livelihood populations within the country. We explored the MUAC-for-age Z-score (MUACAZ) as an alternative indicator in Somalia to minimize the discrepancy. Methods: We analyzed data from nineteen cross-sectional surveys conducted in Somalia between 2007 and 2016. We compared the acute malnutrition prevalence estimates by each of the indicators and the degree of overlap in the individual diagnosis of acute malnutrition between the WHZ and the MUAC-based indicators. We performed multivariate regression analysis with sex, age and stunting as independent variables and acute malnutrition as the dependent outcome, defined by WHZ, MUAC or MUACAZ. We performed all the analysis in the population overall and in each of the livelihood populations separately. Results: A total 255 623 measurements of children 6-59 months of age were analyzed. The overall prevalence of global acute malnutrition by MUACAZ (15.8%) was similar to the one obtained using WHZ (16%), whereas prevalence based on MUAC was much lower (7.8%). These patterns of divergence were sustained throughout the nineteen surveys and the livelihoods studied, with only few exceptions. However, the proportion of overlap in the individual diagnosis of children as acutely malnourished was low between WHZ and absolute MUAC diagnosis (18.1%) and also between WHZ and MUACAZ (28.3%). Results show that age, sex and stunting status of the child affected the likelihood of being diagnosed as acutely malnourished to varying degrees, depending on the indicator used. Conclusions: The MUAC-for-age (MUACZ) indicator yielded acute malnutrition prevalence estimates convergent with those obtained by WHZ indicator. However, the degree of overlap between these two indicators for individual diagnosis of acute malnutrition is low. Further studies of MUACAZ as an alternative indicator for nutrition surveillance are needed.JRC.D.5-Food Securit

Additional file 1: of MUAC-for-age more useful than absolute MUAC for nutritional surveillance in Somalia: results from nineteen cross-sectional surveys (2007–2016)

Table S1. Comparison of acute malnutrition diagnosis by WHZ and/or absolute MUAC in four Somalian livelihoods. Proportion of children with acute malnutrition (GAM or SAM) as defined by WHZ and/or absolute MUAC (see Methods section for definitions) that are diagnosed as malnourished by WHZ only, by absolute MUAC only, or by both criteria simultaneously. Table S2. Comparison of acute malnutrition diagnosis by WHZ and/or MUACAZ in four Somalian livelihoods. Proportion of children with acute malnutrition (GAM or SAM) as defined by WHZ and/or absolute MUACAZ (see Methods section for definitions) that are diagnosed as malnourished by WHZ only, by MUACAZ only, or by both criteria simultaneously. Table S3. Factors associated with GAM diagnosis based on WHZ, absolute MUAC and MUACAZ by livelihood. Results of the multivariate regression on GAM as measured by either three of the indicators (WHZ, MUAC and MUACAZ) conducted in each of the four livelihood populations. Table S4. Factors associated with SAM diagnosis bases on WHZ, MUAC and MUACAZ by livelihood. Results of the multivariate regression on SAM as measured by either three of the indicators (WHZ, MUAC and MUACAZ) conducted in each of the four livelihood populations. (PDF 211 kb