Child Nutrition in Mali
More than one-third (34 percent) of Mali’s children are stunted, and one in 10 (11 percent) suffers from wasting. Even more stark is the fact that there has been no improvement in either statistic over the past decade and a half – stunting levels were basically the same in 1996 (33 percent) as they are now, and since then the prevalence of wasting has more than doubled (from 5 percent in 1996) (UNICEF 2003–08).
Mali, a landlocked country in West Africa with an estimated population of 13.5 million (Samaké 2007), is one of the poorest countries in the world. In 2006, more than half of the population was living on less than US$1.25 a day and more than 70 percent on less than US$2 a day. More than two-thirds of the population lives in rural areas, and the vast majority of the population (approximately 80 percent) works in agriculture (République du Mali 2005).
As in much of the Sahel, depending on agriculture for one’s primary livelihood is a risky endeavor in Mali. In the absence of irrigation systems, most crops are dependent solely on rainfall. That rainfall is generally limited and inconsistent. As a result, dramatic fluctuations in annual agricultural production are the norm, and families, particularly children, are at risk of suffering as a result of these shortfalls.
Seasonal locust and granivore infestations compound the effects of drought, and the result can be crippling for the average farming household. Such was the case in 2004, when poor harvests across the country led to a severe food crisis in 2005. A similar crisis unfolded in northern Mali in early 2010 following unusually low rainfall the year before. A drought appeal was launched, and the emergency response continued throughout 2010 although some would argue such emergency measures are often “too little, too late.”
The underlying causes of undernutrition all exist in Mali. Pervasive poverty and high food insecurity exist alongside limited access to healthcare, water, and sanitation services, and maternal and child caring practices are suboptimal in many areas. In a national survey in 2006, the majority of rural women (72 percent) cited major barriers to gaining access to healthcare, the most common being a lack of money (59 percent), followed by distance to health centers (48.2 percent) and lack of transportation (42 percent) (Samaké 2007).
Initial assessments determined that health promotion at the community level was weak but that some dormant community health volunteers did exist. While a cadre of volunteers had been trained previously, most were no longer active because of lack of follow-up support. Building on this existing capacity, the project identified and reactivated these volunteers by providing refresher training on a wide range of nutrition- and health-related topics and providing supportive supervision through the project’s health advisers.
Changing feeding habits in northwest Mali is a challenge. Families have strong traditional beliefs that babies should be fed animal milk, and women have a very low level of education. In this context, it proved critical to train community health volunteers not only in the key messages, but also in how to speak with people. All volunteers received training in interpersonal communication, the qualities of a good facilitator, and how to conduct educational discussions, counseling, and home visits. To reinforce the messages of the community health volunteers, the same key messages were broadcast by radio in the local language.
There are indications that mothers in the project area are adopting improved practices based on the messages and counseling they are receiving from volunteers. One mother said she had abandoned the traditional practice of discarding the mother’s first milk, the nutrient-dense colostrum, and had moved toward exclusively breastfeeding and improved complementary feeding for her most recent child:
Now for the first six months we only give breast milk. Before, the first milk given to a newborn was goat’s milk; now we give mother’s milk first. The volunteer has explained that if we look at animals, such as goats, cows, and horses, we see that they give the first milk to their newborns. If other animals give the first milk, it must not be poison... Before, we did not know how to make appropriate foods with locally available products; when we were eating we would just give a portion [from the adult’s plate] to our child. I have seen a change from the birth of my [youngest] child until now since I was counseled. She received breast milk for the first six months and was fed appropriately after that. I can see a difference from my previous child. Since her birth my youngest child has not fallen sick.
The volunteers also conducted cooking presentations using recipes based on locally available foods, providing for a balanced diet.
Improving access to healthcare
Increasing the knowledge of health volunteers was the first step toward ensuring that undernourished children receive the appropriate treatment, as one of the project’s health advisers explained:
In the training we showed pictures of children with different types of malnutrition, including kwashiorkor, marasmus, and edema. We used pictures of children from the area. They had never seen pictures of malnourished children before. At first volunteers did not believe they were malnourished or did not believe the children were from the area.
And a volunteer confirms: “We did not know the signs. Now we see that it is a problem, and we know how to address it.” In order to ensure that mothers of malnourished children can overcome barriers to gaining access to healthcare, community nutrition funds were established from money contributed by households and matched by the project. The fund is managed by a community committee and is kept in a local banking facility. One mother spoke about the fund in her village:
We now have a community nutrition fund. If a child is sick and the community health staff refers him to the center in Nioro, we take money from the fund for the transportation of the child.
By January 2010, community nutrition funds had been established in 48 villages, and 1,583,075 CFA francs (about US$3,130) had been raised. The staff at the public health centers confirmed that more community members are using the centers, with a particular increase in the number of undernourished children being referred. This suggests that more children are being treated.
Improving access to quality foods
Increased knowledge of feeding practices and healthy diets can make a difference only if there is sufficient access to food. The initial baseline study identified inconsistent rain, poor soil quality, erosion, and poor quality of seeds as key barriers to ensuring levels of agricultural production that would close the seasonal “hunger gap.”
Based on a further study that looked at the needs and available resources in each village, a variety of food security, agriculture, and community capacity-building activities were implemented in the program area. Training was carried out for heads of households on erosion control methods including construction of check dams, seed improvement, and seed multiplication. The aims were to maximize production of rainfed plots and to encourage diversification of crops. These activities were combined with training in correct storage, especially during the dry season. The project also supported the formation of women’s garden associations and the construction of wells.
Though initially skeptical, farmers were soon convinced by the early successes and began to engage in further program activities.
In the first year, we only sowed a small portion of the new seeds. We saw how much better it worked and did larger amounts in the second year... Now this year there are some that are only using the new seeds. The new seeds produce around 500 kilos for every 1 kilo of seeds. The old seeds only produced around 300 kilos... Before, the level of production of beans was so low that we only had enough for part of the year. Now households have enough beans to last the whole year.
This initial trust and confidence are critical to the next step, which is to work with farmers to expand replication of their own and improved seed varieties to replenish their stocks.
Training for the members of the garden associations led to increased diversity of food produced, eaten, and sold. One village woman reported:
We grow a wide variety of vegetables including onions, cabbage, tomatoes, carrots, and eggplant. Before, we only knew about lettuce and onions... The first portion that we harvest is eaten, but if the production is large, then we sell a proportion to add to our savings. The project built one large well and two small wells in our village. We do not have to go to the neighboring village to get water anymore. Even now in June, there are some that are still gardening.
After two years of implementation, 289 women gardeners had been trained in vegetable drying and conservation techniques in order to improve access to diversified foods throughout the “hunger gap” period.
Through small steps, the project has made considerable contributions to household income and food security.
