In the Sahel
A child is tested with a MUAC, the bracelet which measure acute malnutrition, at the community screening in Nokou, in the Kanem region, Western Chad.
In 2010, Sahelian countries (Burkina Faso, Chad, Mali, Mauritania and Niger) are affected by a major food crisis that will worsen even further child malnutrition.
UNICEF estimates that 859,000 children under the age of five in Burkina Faso, Mali, Niger, Northern Nigeria and Chad will need urgent life-saving treatment for severe acute malnutrition in 2010.
The impact of severe food insecurity on children from 6 months to 5 years old can already be seen in Niger and Chad, where thousands of households are out of food. A notable rise in the number of admissions of children with acute malnutrition in therapeutic feedings centers is expected.
We know how to fight malnutrition and treat affected children. Many different organizations are involved under a common plan of actions, which aim to prevent deaths and long term damage to young children in this crisis situation, by providing supplementary and therapeutic feeding to acutely malnourished children.
In the Sahel, the UNICEF strategy also addresses the underlying causes of malnutrition: protect, promote and support optimal infant and young child feeding practices, provide vitamins and minerals through fortified foods and supplements, and promote access to sanitation and clean water and preventive and curative health interventions.
These live-saving interventions which proved efficient in the past rely on community-based actions.
According to national Nutrition and Child Survival surveys led in the past years and supported by UNICEF in the countries of the Sahel, malnutrition is already equal or above emergency rates in "normal times". Poor access to health care, clean water and sanitation and a low rate of exclusive breastfeeding among lactating women explain these high levels of malnutrition.
Facts and figures
- The Sahel has some of the highest child mortality rates in the world. The regional underfive mortality rate in the Sahel is 222 per 1,000 live births (i.e. 449,000 child deaths annually). This means that one in five Sahelian children dies before age five.
- In the Sahel, malnutrition is an associated cause of over 50% of child deaths. This means that more than half the child mortality burden in the Sahel is attributable to child malnutrition, which causes about 225,000 child deaths annually.
- The Sahel also has some of the highest acute malnutrition rates in children worldwide. The latest available surveys in these five countries show that 1.5 million children under five years of age suffer from acute malnutrition.
- Acute malnutrition is affecting primarily infants and young children. Over 80% of under fives with acute malnutrition are young children under three. An estimated 18% of children under three (i.e. 1 million children) suffer from acute malnutrition.
- The prevalence of acute malnutrition in the region is over emergency thresholds.According to WHO, when the prevalence of acute malnutrition in children 6 to 59 months old is greater than 10% the nutrition situation of children is considered serious; when it is greater than 15% the nutrition situation of children is considered critical.
- Chronic malnutrition in children is widespread and severe. An estimated 40% of under fives (i.e. 4.3 million children) suffer from chronic malnutrition. Moreover, 50% of underfives who are chronically malnourished suffer from severe chronic malnutrition.
- Rates of malnutrition in children have remained over critical levels for at least a decade. During the hunger season, this prevalence can increase to a critical 15%. These stagnant prevalence figures combined with rapid population growth translate into a 40 to 50% increase in the absolute number of malnourished children over the last ten years.
- In the Sahel, the rate of global acute malnutrition is higher between 6 months and 2 years old, because of sub-optimal infant and young child feeding practices; for instance the rate of exclusive breastfeeding in the first six months of life - 20% - is very low compared to 40% in other African regions.
- Child malnutrition is not limited to rural areas; children living in urban areas are equally affected. National surveys showed a high prevalence of malnutrition in city centers. In Ouagadougou and N’Djamena, up to 16% of underfives suffer from acute malnutrition.
- Child malnutrition is not limited to food insecure areas. Very high rates of child malnutrition are found in regions not classified as food-insecure. For example, in Niger (2005), some of the highest rates of acute malnutrition in children were found in Zinder, a region classified among those with the lowest proportion of food-insecure households.
Determinants of malnutrition in the Sahel
In the Sahel, the major determinants of child malnutrition include:
- Inadequate food and feeding practices in the first two years of life (breastfeeding and complementary foods and feeding practices);
- Poor care practices for infants, young children and women particularly during pregnancy and lactation;
- High morbidity levels and poor access to essential health services, safe drinking water and a healthy environment;
- Women’s lack of access to education, life-saving information, and decision-making power. This leads to a vicious cycle of malnutrition and disease, the cause of unacceptably high child mortality, ill growth and poor development.
In the Sahel, a nutrition crisis in children is underway which requires an urgent and effective response to ensure that a range of evidence-based, low-cost, high impact interventions essential to child nutrition and survival are delivered at national scale through a combination of facility-based, outreach, and community-based implementation schemes.
Key interventions to respond to and prevent malnutrition
These essential interventions are three pronged:
- Food and feeding practices;
- Health, hygiene and care practices;
- Education, information and support.
These essential interventions are meant to prevent that children become malnourished and to care for malnourished children.
Prevention and care are achieved through improved:
- Prenatal nutrition for low birth weight prevention,
- Breastfeeding practices in the first two years of life,
- Complementary foods and feeding practices in the first two years of life,
- Micronutrient nutrition in early childhood and during pregnancy and lactation,
- Anemia control in early childhood, during pregnancy and lactation,
- Feeding and care for children with severe malnutrition,
- Women’s education and access to information and decision-making capacity.
Policy implications to reach MDG 1 and 4
If the Millennium Development Goals to reduce child malnutrition rates by half and child mortality rates by two-thirds between 1990 and 2015 are to be reached in the Sahel, changing the status quo and tackling unacceptable levels of child malnutrition needs to become a policy, programme and investment priority.
National Governments need to be in the driving seat, as the primary responsibility in the fight against child malnutrition is theirs.
National governments need to acknowledge the unacceptable nutrition situation of children and act upon it through adequate and sustained policy and programme action, including the allocation of appropriate human and financial resources.
United Nations agencies, humanitarian and development partners and international financial institutions need to support national efforts to prioritize the fight against child malnutrition in national development frameworks and budgets.
Finally, communities and community resource persons need to be involved as agents of change.