The humanitarian emergency in Burundi: evaluation of the operational strategy for management of nutritional crisis

OBJECTIVE: To evaluate the impact and appropriateness of programmes for the management and treatment of severe malnutrition in emergency situations. DESIGN: A central unified database was set up with all data and statistics provided by nutritional centres (NC) active in Burundi. SETTING: The paper describes the case of Burundi as an example of the response of the humanitarian community to nutritional crisis. SUBJECTS: Since 1999, more than one million (1,054,210) severely malnourished patients were treated in NC established in Burundi. RESULTS: Peaks of beneficiaries were registered in 2000 and 2001; the admission rate started to decrease in 2002. In 2004, twenty therapeutic feeding centres (TFC) and 224 supplementary feeding centres (SFC) were active for the treatment of 127,420 beneficiaries. Nutritional programmes were present in every province with a coverage rate of 55%. The most convincing impact of the nutritional programme in Burundi was the reduction of mortality rate in children under 5 years of age; an impact on the prevalence of acute malnutrition could not be demonstrated. Children under 5 years old accounted for 62% of beneficiaries in TFC and 76% in SFC. TFC performance indicators fulfilled the minimum standards in disaster response; the performance of SFC was not so optimal with a low recovery rate (69% v. >80%) and a high non-respondent rate (16% v. <5%). With the combination of coverage and cure rate, the programme met 44% of the assessed needs in 2004. CONCLUSIONS: In Burundi the stabilisation of security conditions permitted a combination of humanitarian responses ranging from emergency activities to strengthening of community-based initiatives that could correct the coverage and impact limitations.