Between Hope and Doubt in Madagascar – Recovering from Severe Malnutrition

Two families living in in one of the poorest regions of one of the poorest countries struggle to treat their children for severe malnutrition

Abela Ralaivita
Paysage du Sud de Madagascar
27 January 2021
Elysa et Elysette avec leur parents

Elysa and Elysette are 11 month old twins living with their parents and six siblings in the rural commune of Maroalipoty, in southern Madagascar. Elysa suffers from severe acute malnutrition, or wasting. Her twin sister also suffers from acute malnutrition but in a more moderate form.

Maho dans les bras de son père

In a neighbouring village, Maho, 21 months, also suffers from severe acute malnutrition. Here she waits with her father for her mother to return from fetching water from a distant well.  

Paysage recouvert de vent de sable

This region of Madagascar has for years been affected by drought caused by poor rainfall and aggravated by the El niño phenomenon. In addition, the south wind called "Tiomena" has ravaged agriculture in this part of the island. Clouds of dust now blow over the ravaged fields.

La culture est détruite par le vent de sable

Sambo, the father of the twins is upset as he surveys his cassava plantation destroyed by the wind and sand. "Now we're buying cassava when we're supposed to be harvesting it," says Sambo, overwhelmed by the situation.

Un bol de manioc pour toute la famille

Sambo has to buy 4 kg of cassava per day to feed the 10 people in his household. To do this, he sells water, which has become a luxury item in many homes, or household utensils to other villagers.

Chercher de l'eau au puits d'Ampasipoty

The whole family gets involved in the water collection, walking several kilometers to the nearest well. Everyone has  role to lay in the family’s survival.

Toromasy mère de Maho

Nearby, Maho’s mother, Toromasy, 20, cleans the pots and plates using the small amount of water she has just collected.

eau insalubre

Her child's malnutrition is caused partly by the consumption of non-potable water that has the colour of chocolate and is one of the main factors causing diarrhea and malnutrition.


Feuilles de manioc

The five members of the household now have only cassava leaves as food. With many families turning to this last resort food source, the leaves themselves are disappearing.

Docteur Tsida Randriatsiafara

Thanks to funding from the European Commission's Directorate General for European Civil Protection and Humanitarian Aid Operations (ECHO) and support from UNICEF, children suffering from severe acute malnutrition are receiving treatment with ready-to-use therapeutic foods. "This situation is getting worse and worse, but fortunately we still have these products available to keep up," says Dr. Tsida Randriatsiafara. 

Elysa à la pesée

At the health centre in Maroalipoty, women bring their children to be screened for malnutrition and to monitor their child's state of health. The twins are among those who arrived earlier and Elysa is being weighed to follow-up on her recovery. 

Elysa n’a pas pris de poids

Unfortunately, Elysa did not gain weight and the measurement of her upper arm still indicates red,  a warning that she is still too thin. She will continue her treatment at the health centre until she reaches the target weight.   

Myriam, chef du centre de santé offre du savon

Myriam, the head of the health center, provides soap to the family as she encourages them to continue their efforts to avoid falling into the same situation again. "It makes me proud when a child is cured. I always insist that the parents follow up the treatment at the health centre," she says.

La famille des jumelles

The whole family returns home with a sense of great relief. Despite their smiles, they say they still worry about what the future will bring.