Investigating Patterns, Trends and Determinants of Malnourishment in a Period of Armed Conflict: A Study of The Sudan

Abstract

The prevalence of childhood malnourishment in The Sudan is among the highest in the world. Previous research identifies a number of key factors associated with children’s poor nutrition including poverty, the high prevalence of infectious diseases and poor health care services and infrastructure. While these are common features in developing countries, the recent history of armed conflict in The Sudan is theorised to be an important likely additional factor shaping the patterns and trends of malnourishment in the country and adding extra challenges in combating this serious health issue. Using three large nationally representative data (2006, 2010 and 2014) from The Sudan Multiple Indicator Cluster Survey (MICS), this thesis seeks to measure and better understand the patterns and trends of malnutrition in The Sudan with a particular focus on the influence of recent armed conflict. The analysis starts with a bivariate and time series analyses to examine the spatio-temporal variation in malnourishment at national- and state-level, over the eight-year period between 2006 and 2014. This is followed by an investigation of the determinants of malnutrition using the most recent 2014 dataset. Drawing on a theoretical model developed by the United Nations Children’s Fund (UNICEF) and exploratory analysis of The Sudan data, a series of multilevel multivariable regression models (MLM) are developed to test the association between armed conflict and malnourishment incorporating key socioeconomic and demographic factors at child-, household-, cluster- and state-level. Results showed that; based on the classification of the World Health Organization (WHO) for assessing severity of malnourishment, rates of malnourishment in the majority of the states are either above the threshold of “very high prevalence” or in the upper class of “high prevalence”, with upward trends between 2006 and 2014. Furthermore, states undergoing armed conflicts are shown to have particularly high scores of malnourishment throughout the eight years; however, these high records were also found in some states free of conflict, including the capital Khartoum. Results of MLM found statistically significant associations between malnourishment and a number of explanatory variables including child age, the incidence of diarrhoea, mother/caretaker education, household wealth and area of residence (urban-rural). However, even after controlling for these a statistically significant association remains between severe underweight prevalence and armed conflict. These findings make an important empirical contribution to the understanding of the determinants of childhood malnourishment in general, and the influence of armed conflict in particular.

Date of Award	1 Aug 2019
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Mark Brown (Supervisor) & Laia Becares (Supervisor)