Community Plays Key Role in Fighting Malnutrition
Yadouno Bannou feels she owes her son’s recovery to a knock at her door four weeks ago.
The visitor, a community health volunteer and a member of Ya-G-Tu, “the Association for the Promotion of Women” in the local language Dogon, was making house-to-house visits in her village, checking on the nutritional status of the children. Two-year-old Kanda was spotted straightaway.
“He had just recovered from malaria, and had lost a lot of weight, but he still would not eat,” says his mother, Bannou. She has already lost two of her children due to illness. Although she was worried about Kanda, Bonnou points out that the nearest health centre is a two and a half-hour walk away and she has a household of 40 extended family members to help care for.
The community health volunteer explained that Bannou could bring her son to a feeding centre, set up in her village, in Boro, in the eastern region of Bandiagara, and run by the community. The community feeding centre is one of the first of its kind in a country where malnutrition contributes significantly to high infant and child mortality rates. One child under five years dies every five minutes in Mali; half of those deaths are nutrition related.
Many malnourished children who survive will never fully recover. Their growth will be stunted and their cognitive development retarded; around 38 per cent of children in Mali are stunted. The causes of child malnutrition are many. It often starts during pregnancy when 68 per cent of pregnant women experience anaemia due to poor nutrition and illness such as malaria, and these conditions result in the low weight of the child at birth. Moreover, although breastfeeding is common, few practice immediate and exclusive breastfeeding for six months and give water, other liquids or solid food in addition to breast milk. Children under five years are especially vulnerable to preventable diseases such as malaria, diarrhoea, and pneumonia, which will also leave a child malnourished and prone to other diseases. And once a child is weaned, they need a well balanced diet, which few have, often due to lack of knowledge about sound nutrition practices.
In Kanda’s case, his mother, who has never been to school, explains that even before he suffered from malaria, Kanda was small for his age. Like about two-thirds of Malian children, he was not exclusively breastfed during the first six months of his life. His mother introduced water at two months. After weaning, he was also not eating enough food. The large extended family just survives off subsistence farming. “He was eating one meal a day out of the same bowl as the adults,” says his mother. The food too was not varied, and only rarely is she able to put fish or meat on the table.
Malnutrition is not just restricted to rural areas. Children in urban areas are especially vulnerable to the impact of the recent hikes in food prices due to the current global economic crisis. And like children in the rural areas, they are vulnerable to childhood diseases and poor feeding practices.
Fourteen- month Tiemoko’s condition is more serious than Kanda’s. He requires therapeutic care in a hospital. “He used to be able to walk,” says his grandmother, Maimourna Traoré sitting on a hospital bed in the capital, Bamako. His frail body lies limply in her arms, and he coughs and whimpers as he struggles to take the milk she patiently spoons into his mouth. His mother, 19-year-old Diarra Coulibaly watches anxiously. She explains that she had left her baby with her paternal grandmother while she continued school, some 240 kilometres away. The young mother is unaware how her son became severely malnourished. There is a lack of community awareness about good family practices for maternal, newborn, as well as health and nutrition. It is often believed that it is “God’s will” that a child is unhealthy or dies. UNICEF is supporting participatory research on beliefs, attitudes and social norms to have a better understanding why certain behaviours are difficult to change.
UNICEF also supports the scaling up of the management of acute malnutrition through routine health services nationwide. The support includes the provision of vitamin A and de-worming for all children between 6 months and 5 years, iron tablets for women of childbearing ages as well as providing materials for education on breastfeeding, infant feeding and nutrition for children under five years.
UNICEF also funds an 11-day training programme for low cost and high impact community-run initiatives, like the one that Kanda has benefitted from. Twenty eight women in Ya-G-Tu took part in the training. They learnt how to prevent malnutrition by applying simple behaviours like exclusive breastfeeding, hand washing with soap, sleeping under bednets, and how to identify a malnourished child by measuring his or her mid-upper arm circumference, using a special measuring tape, also provided by UNICEF.
Yaigueré Tembelydike Fifi, the founding member of the Ya-G-Tu, speaks passionately about the work they do. The women prepare their own high energy and nutritious supplementary food on the premises, known as Misola, which consists mainly of millet, soya and peanuts. Each day children like Kanda are brought into the centre where they receive a pack of Misola which they must consume before they return home. “If they take it home, other family members could also eat it,” explains Fifi. It is free for the first 18 days and then they pay 100 francs, about 20 cents) per pack, which is a subsidized price, made possible by support from a French association called “Main dans la Main Autour du Monde”.
The sale of Misola is key to the sustainability of the feeding centre. Six of the women working at the centre receive 5,000 francs a month ($10), and the rest are volunteers. The women also measure and monitor the children who are under their supervision, and educate the mothers about exclusive breastfeeding, infant feeding and the importance of a balanced diet.
Fifi says that since 2005, when the centre began, 260 children from the village have been given Misola. They have also referred 20 other children suffering severe malnutrition to the hospital. “This type of feeding centre should be set up throughout the whole of our country,” says Fifi forcefully. “If we are to overcome our problem of malnutrition here in Mali, it must be tackled by the community.