A magical powder for the children of Sikasso

Despite being the breadbasket of the country, Sikasso region has the highest rate of stunting in all of Mali

By Fatou Diagne
Chatou Dembele, âgé de 6 mois, mange de la bouillie enrichie en poudre de micronutriments. Bien qu'elle soit le grenier du pays, la région de Sikasso a le taux de retard de croissance le plus élevé au Mali. Un enfant sur trois a un retard de croissance. Sikasso, août 2019.
UNICEF Mali/2019/Keita
13 December 2019

A rooster crows in the pre-dawn morning, waking up the inhabitants of the Zebala village. Minata Traore is joined by her husband Moussa and their three children on the dark green woven mat where they have breakfast. The children eagerly grab their ladles, ready to dig into their porridge. The porridge contains rice, water and sugar, and its nutritional value for children is limited.

Le fermier Moussa Dembele et sa famille prennent leur petit-déjeuner ensemble. Un repas préparé avec du riz, de l'eau et du sucre. Bien qu'elle soit le grenier du pays, la région de Sikasso a le taux de retard de croissance le plus élevé au Mali. Un enfant sur trois a un retard de croissance. Sikasso, août 2019.
UNICEF Mali/2019/Keita

Feeding children in Mali’s breadbasket region of Sikasso is complex. Lack of information, local beliefs, and farming and market practices mean that children often don’t benefit from the nutritious and balanced meals they need to grow up healthy. Despite the impressive farms spread across Sikasso’s fertile land, one in three children here is stunted – the highest rate in the entire country.

Minata’s next door neighbour, little Alimatou Goita, is already showing visible signs of stunting. At 23 months, she only measures 74 cm, well below the average for her age, which should be at least 85 cm.

Portrait d'Alimatou Goïta, 2 mois, souffrant de retard de croissance, lors d'un suivi avec sa mère. Alimatou bénéficie de compléments alimentaires d'enrichissement à domicile avec des poudres de micronutriments. Bien qu'elle soit le grenier du pays, la région de Sikasso a le taux de retard de croissance le plus élevé au Mali. Un enfant sur trois a un retard de croissance. Sikasso, août 2019.
UNICEF Mali/2019/Keita

"Stunting is linked to a diet which is not diversified, despite the substantial production in our region. That’s what we commonly call the Sikasso paradox," explains Abdoulaye Koné, the Nutrition Focal Point at the Regional Direction of Health in Sikasso region. Children suffering from stunting have impaired cognitive development, a weakened immune system, get sick more often and have more difficulties at school.

Part of the issue is lack of knowledge of infant and young child feeding practices, as well as persistent beliefs around certain foods. "I used to be convinced that feeding children eggs would delay them from speaking," remembers Minata. Having learnt that children require complementary food after six months, she fed six-month-old Chatou eggs, something she had not done for her older children, Ali, 9, and Kadidia, 6.

Another issue is linked to farming and market practices, which can mean nutrient-rich fruits and vegetables may be sold on the market rather than kept for home consumption.

Portrait de Moussa Dembele, père de trois enfants, agriculteur du village de Zebala, dans son domaine familial. Il cultive des céréales (maïs, millet et riz), des légumes (haricots, aubergines, gombo, patates douces, tomates et concombres) et des fruits (oranges, papayes, bananes, etc.). Bien qu'elle soit le grenier du pays, la région de Sikasso a le taux de retard de croissance le plus élevé au Mali. Un enfant sur trois a un retard de croissance. Sikasso, août 2019.
UNICEF Mali/2019/Keita

Minata’s husband Moussa Dembélé is a farmer and their family farm stretches over 3 hectares. The family grows cereals such as maize, millet and rice, vegetables such as beans, eggplants, okra, sweet potatoes, tomatoes and cucumbers and fruit including oranges, papayas, and bananas. Despite the abundance of their produce, the family sells 80 per cent of their harvest on the market while cereals are kept for feeding the family. At the bustling marketplace just a few kilometers away from the border with Burkina Faso, there are many takers for Moussa’s fresh fruit and vegetables.

"I sell our produce to buyers from all over Mali and some neighboring countries, such as Burkina Faso, Ivory Coast and Guinea," explains Moussa, all the while haggling with a customer.

Moussa Dembele, père de trois enfants et agriculteur du village de Zebala, vend ici ses légumes et fruits au marché. Il cultive des céréales (maïs, millet et riz), des légumes (haricots, aubergines, gombo, patates douces, tomates et concombres) et des fruits (oranges, papayes, bananes, etc.). Bien qu'elle soit le grenier du pays, la région de Sikasso a le taux de retard de croissance le plus élevé au Mali. Un enfant sur trois a un retard de croissance. Sikasso, août 2019.
UNICEF Mali/2019/Keita

With all these factors in play, the nutritional situation of Mali's children has not improved significantly over the last 10 years. UNICEF Mali is supporting the Government of Mali with a host of strategies to reduce stunting and fight micro nutrient deficiencies, including through supporting Nutritional Support Groups in villages to promote healthy infant and young child feeding practices.

As an innovation, thanks to funding from the Italian Agency for Development Cooperation, UNICEF and the Ministry of Health have also started a home fortification programme to correct micronutrient deficiencies and stunting in two health districts of Sikasso, Koutiala and Yorosso.

Micronutrient powders are dry, tasteless powders that can be added to any semi-solid or solid food that is ready for consumption. Easy-to-use, they contain 10 vitamins and 5 minerals, including Vitamins A, C, and B12, as well as folic acid, iron, zinc, and iodine.

Le docteur Macoura Oulare, chef du développement de la survie de l'enfant au bureau de l'UNICEF au Mali, explique aux mères l'importance de ces micronutriments en poudre pour leurs enfants. Bien qu'elle soit le grenier du pays, la région de Sikasso a le taux de retard de croissance le plus élevé au Mali. Un enfant sur trois a un retard de croissance. Sikasso, août 2019.
UNICEF Mali/2019/Keita

"The mother can simply give her child this powder at home, mixing it in with porridge. In a spoonful you can give life and health to your child every day,” explains Doctor Macoura Oulare, Chief of Child Survival Development at UNICEF Mali.

Minata is already seeing the benefits of the micronutrient powders. "I find this powder magical, because my daughter Chatou has more appetite now and gets sick less often," she says, stirring the powder into Chatou’s porridge.

"I find this powder magical, because my daughter Chatou has more appetite now and gets sick less often"

Minata
Un sachet de poudres de micronutriments qui contiennent 10 vitamines et 5 minéraux (principalement Vit A, C, B12, acide folique, fer, zinc et iode) mélangés dans de la bouillie. Bien qu'elle soit le grenier du pays, la région de Sikasso a le taux de retard de croissance le plus élevé au Mali. Un enfant sur trois a un retard de croissance. Sikasso, août 2019.
UNICEF Mali/2019/Keita

The roll out of the home fortification programme builds on other ongoing interventions to reduce stunting in the region. In Sikasso region, communities are leading the fight against child malnutrition. Minata’s friend Balakissa Dembele, 29, is a Role Model Mother with the 10-member Nutrition Support Group in Zebala. Every week, she goes door-to-door and educates parents on good nutrition during pregnancy, exclusive breastfeeding for the first six months, dietary diversification from 6 months, prevention of malaria, and the importance of hygiene and cognitive stimulation. Balakissa was the one who taught her about the nutritional value of eggs.

"Thanks to Balakissa's advice, I exclusively breastfed Chatou until 6 months, something I didn’t do with my other children,” Minata says proudly. “I also attended my four prenatal consultations and play with my children a lot, because I understood that interaction is key to early learning."

Today, Balakissa is visiting Minata for a very specific purpose. "The health center has introduced micronutrient powders, so I came today to follow up with Minata and make sure that she is giving the necessary daily dose to Chatou,” she says. “I'm really proud to see her applying the advice to the letter."

Balakissa Dembele, 29 ans, est une mère modèle avec le groupe de soutien nutritionnel de 10 membres dans le village de Zebala. Chaque semaine, elle fait du porte-à-porte et éduque les parents pour assurer une bonne nutrition pendant la grossesse, promouvoir l'allaitement maternel exclusif pendant les six premiers mois, encourager la diversification alimentaire à partir de 6 mois; promouvoir la prévention du paludisme, l'importance de l'hygiène et la stimulation cognitive en mettant l'accent sur les 1000 pre
UNICEF Mali/2019/Keita

The strategies to reduce malnutrition put in place by the Government of Mali with the support of UNICEF Mali and its partners have already led to laudable results. In Sikasso, chronic malnutrition was reduced from 35.5 percent to 28.9 percent between 2015 to 2018.

In the capable hands of the health workers and role model mothers of Sikasso, the future of the children here only seems brighter and brighter.