Many mothers just do not know how good breast milk is for their babies, especially in the first six months. In Niger, for example, it is the custom to give babies water to drink in the hottest months, even if it has come from a polluted source, which is often the case.
Diahorrea is the consequence, the number one cause of malnutrition, and Niger is one of the worst sufferers; here nearly 17 percent of the under-fives are malnourished, or more than half a million children. Over 15 percent malnutrition is considered an emergency.
Earlier this year the nutrition crisis was magnified by a food crisis. Shortages spurred the Niger authorities along with the international community and NGOs in pulling off a minor miracle. There was no famine, no humanitarian disaster.
“Our idea is to efficiently do checkups on all the children, make lists of the severely and moderately malnourished, and refer those needing hospital treatment. We are trying to improve detection and then treatment, going from door-to-door with BEFEN-Alima community agents. They diagnose whether day care centre or residential care is needed, and whether national or local resources are needed,” says Dr. Maidadji Oumaru.
Tracking down the malnourished takes the team to a village near Mirriah in the southern Zinder region.
“This child’s seven months old, about seven, who we judge to be severly malnourished. He’s right up against a number of red lines, so we’re trying to persuade his mother to bring him into a local health centre,” says nutritionist Elisabeth Zanou.
Tsahara was not keen on taking Fatima into a health centre, even the closest one. She had to find someone to look after her other 3 children.
Mirriah now has an Integrated Heath Centre or CSI within which there is a Regional Centre for Severe Nutritional Outreach unit, or CRENAS.
Here the children are weighed, measured, and diagnosed for a range of diseases. Fatima has malaria and weighs four and a half kilos instead of nearly seven, but if she can pass the appetite test she will have a better chance says Zanou:
“It’s a confirmed severe case, but there are complications and her appetite is way down, so the hospital and the CRENI will take over.
Here she didn’t eat the PlumpyNut, so the CSI can’t take her. In hospital she’ll be given therapeutic milk and she’ll recover her strength quicker.”
If Fatima had eaten her PlumpyNut, a delicious peanut-based pasta, she could have stayed in the local centre and her mother would have been able to make a weekly visit. There she would have been given lessons on diets and nutrition, and more PlumpyNut.
For these overstretched mothers housework, other children and distance are often the worst enemies. Taking a child to the doctor requires a major decision.
Since the start of this year in either mobile clinics or health centres over 240,000 children suffering from malnutrition have been treated.
Today there are more than 800 nutrition centres across Niger. Five years ago at the peak of the food crisis, there were just 9.
However beyond the emergency cover the UN wants to go further with prevention being given the top priority.
“We wanted to talk about prevention, put the accent on prevention. Mothers needed to be educated about local foods, there are things we can feed children to stop malnutrition.
There are two social assistants here to educate the mothers, and family members, on rules of hygiene, vaccination, family planning and preventing malnutrition,” says Fatima Inche Oumara.
Niger is one of the world’s poorest nations. Last year it was last on the UN’s Human Development Index, below Afghanistan. Every woman here has, on average, more than seven children and at this rate Niger’s population will go from 15 million today to 50 in just 40 years. The director of Tsangui school tries to explain to pupils and parents that this is unsustainable growth.
“There are five primary classes, but when the occasion presents itself and the whole village gets together we get the message across to every family; if you don’t follow the family planning rules you’ll always have problems because there’ll always be too many people for not enough food,” says Amadou Moussa.
Over the last school year half of this school’s 80 pupils left with their parents. The food crisis that affected seven million people in Niger created a massive rural exodus.
This year’s rainy season has been more generous. Harvests have allowed the immediate horizon to be viewed with a certain optimism, but feeding everyone all year round remains a challenge.
Chamanounou Abdou Hassane has eight children, and farms nearly two and a half hectares of millet, sorghum, and peanuts. He also grows vegetables, and most of this is sold. The family lives off millet, with an occasional vegetable. His wife Gambou says she won’t need help to feed her children this year, but her husband says they’ll have to leave for a month next year when the food and money run out.
This shifting population makes any community-based project difficult;
“I’ve closely followed this situation. I’ve been coming here for other things, and I’ve seen why people come here. Food. Finding food dominates everything. So when you come here you see a woman, it’s generally women, and they’ll point you towards food, but do nothing about nutrition. They can’t do their job because they’re keeping people alive. I’ve seen it happen in front of me. But now it’s the rainy season and the harvests are coming in, the situation’s stabilised. Getting the nutrition message across was the problem – nobody came,” says the Red Cross’s Habou Yaou.
Prevention and education are the keywords in this UN campaign in Niger. To stop malnutrition real changes must be made to people’s hygiene and food habits. To respond to the world food crisis this year the international community found 350 million euros in emergency aid. Now is the time to find the money to tackle structural problems.