UNICEF reports on how a multi-sector plan is targeting chronic malnutrition in Burundi.
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By Shantha Bloemen
Jacqueline Bangirinama knows hunger. As part of a multi-sector plan to reduce Burundi’s high rate of chronic malnutrition, she is learning how to fight it.
MUYINGA PROVINCE, Burundi, 17 June 2013 – Jacqueline Bangirinama knows hunger. She sees it when her 2-month-old daughter clings to her breast, suckling without respite. She sees it when her 2-year-old daughter cries restlessly, unable to find comfort, and when she and her 4-year-old sister fight over a small piece of boiled potato, hours before the family’s one meal a day. And she sees it when she sends her 7-year-old son, who looks small for his age, off on his long walk to school with an empty stomach.
High rate of chronic malnutrition
A recent study in the Lancet showed nutrition-related causes of mortality contribute to the deaths of 3.1 million children under 5 every year. In many countries in Africa, malnutrition, especially chronic malnutrition and stunting, is little understood. Unlike acute malnutrition, which manifests in severe wasting or nutritional oedema, chronic malnutrition takes its toll over a longer period by stunting a child’s physical and intellectual growth.
Burundi, a small, densely populated country in East Africa, is home to more than eight million people. About 90 per cent live in rural areas. Despite the rolling green hills neatly carved into individual plots of farmland, the country has the highest level of hunger among the 120 countries for which the 2012 Global Hunger Index was calculated. Nearly two thirds, or 58 per cent, of all children under 5 years old are chronically malnourished – one of the highest rates in the world.
Jacqueline’s situation is much like that of her neighbours in Muyinga province. She and her four young children live in a humble home. She is a subsistence farmer.
High socio-economic cost of chronic malnutrition
The socio-economic cost of chronic malnutrition in Burundi is enormous. Burundi is one of the poorest countries in the world; four out of five people live on less than US$1.25 per day, and the country is ranked 178 out of 187 in the UNDP’s Human Development Index.
Children in a classroom in Burundi, one of the poorest countries in the world - with one of the highest rates of chronic malnutrition among children. Burundi has joined the Scaling Up Nutrition movement to tackle malnutrition.
“The national-level data shows that it is costing Burundi US$102 million each year, so it is clear we have to manage malnutrition,” says Vice Chief of Cabinet in the Second Vice Presidency and nutrition focal point Dr. Deo-Guide Rurema, who acknowledges that the figure was more than twice the Ministry of Health’s budget in 2012.
“This amount could have been invested into other sectors that could be productive towards economic growth for sustainable development of our country,” he adds. Multi-sector plan to reduce chronic malnutrition
In July 2012, a major political milestone was reached when Burundi became one of 40 countries to join the Scaling up Nutrition (SUN) initiative. Together with development partners, the private sector and government ministries, it is building a coherent and multi-sector approach to tackle malnutrition, with the common goal of reducing chronic malnutrition from 58 percent to 48 percent by 2016.
For UNICEF Representative in Burundi Johannes Wedenig, who has been advocating for a more united approach, the high-level political leadership is a significant step towards concrete action on the ground. “Society is really realizing at the highest level that nutrition is a real challenge and that we have to act in a concerted way,” he says. “It makes no sense to work in parallel, as we won’t have an impact. We all have to work together, and, in the end, we have to converge on the family because that’s where the difference needs to be seen.”
Malnutrition screening. Burundi is also using its community-based infrastructure to combat chronic malnutrition. Parents of children who are malnourished can follow a 12-day course to learn to feed them better through mixing local foods in new ways.
Community-based infrastructure against chronic malnutrition
Since 2005, when years of conflict in Burundi came to an end, the Ministry of Health, with support from UNICEF, has focused on building a community-based approach to treat acute malnutrition. It has succeeded in reducing the prevalence to 6 per cent, through a mix of awareness and increasing the use of ready-to-use therapeutic foods. The plan is to use this approach and established systems to tackle the longer-term consequences of chronic malnutrition.
“We have a lot of women bringing their children to be screened for acute malnutrition, so we can build on this and introduce other activities,” explains Chief of Health and Nutrition at UNICEF Burundi Sophie Leonard. “We can educate women on how to take care of their children, we can focus on early childhood development, we can also reinforce the community culture by gathering women for income-generating activities – and we can also start some agriculture activity, so there are many things to do based on that entry point.” Ms. Leonard believes a recent shift in understanding has moved nutrition from being an isolated and silent public health emergency to a much more urgent issue that has an impact on society at large.
A 12-day course to beat chronic malnutrition
It was at a mass malnutrition screening site that Ms. Bangirinama discovered her children were underweight and malnourished. She was referred to a 12-day course in her community hosted by an elected health education volunteer to improve the weight of her children and to learn how she can better feed her children through mixing local foods in new ways. The daily two-hour classes also focus on the importance of better hygiene and sanitation to avoid diseases like diarrhoea, as well better birth spacing between children.
Ms. Bangirinama knows the immediate challenges of feeding her children will not simply disappear after 12 days. However, the hope is that, through the support of the group, she will be equipped with information and new skills to help improve her children’s health both now – and in the future.