Malnutrition in Madagascar – A ‘Silent Crisis’

Every Friday, mothers and their children gather at the community nutrition centre in the little village of Rantolava, 450 kilometres north east of Antananarivo, the Malagasy capital, to learn more about a healthy diet.

The day begins with a weigh-in, to assess the children's development, followed by a cooking demonstration. The workshop facilitator teaches the mothers how to make a dish of yams with milk: the morning's project soon becomes a tasty breakfast shared by all the children.

The weekly workshops are part of the 3.5 million dollar National Community Nutrition Programme (PNNC) being implemented at 6,000 centres across the country. Madagascar is among the six countries suffering the worst rates of malnutrition in the world – half of all children under five on this large island nation suffer from chronic malnutrition, and diversifying their diet is a key element in the national programme.

Jean Serge Rambeloson works for Madagascar's National Office for Nutrition or ONN, monitoring the PNNC at sites like Rantolava. He told IPS that the goal of the cooking demonstration is to give mothers recipes which will help them vary their children's diets, as well as tips on how to preserve food.

"For example, we teach them how to make flour out of locally available produce."

To give people access to a wider range of foods, the PNNC has also set up a programme to popularise new crops.

In Rantolava, the nutrition centre has a piece of land set aside for growing various vegetables. "We've planted zucchini, tomatoes, cabbage, moringa, yam, green beans, and chinese cabbage as well," said Viviane Vaviaby, who is responsible for the centre's garden.

An extension worker shows the villagers how to grow each of these food crops. "People are used to eating rice. It is important that they learn how to vary their diet – and that of their children – based on local produce," said Angelo Tiandrazana, the regional coordinator for ONN.

"Chronic malnutrition is not simply a matter of access to enough food, but also a question of access to a variety of foods," Stephen Lauwerier, the Madagascar resident representative of the United Nations Children Fund (UNICEF), told IPS.

Unlike acute malnutrition, which shows itself in skinny, evidently underweight children, the effects of chronic malnutrition are more subtly revealed in delayed growth. Parents may not realise how seriously affected their children are when many other children of the same age are equally small.

Dr. Toky Raharimanana is the head doctor at the Basic Health Centre in Mahambo, a commune neighbouring Rantolava.

"Malnourished children are small, and they reach physical development milestones later than their better-fed peers. They are also more fragile and more susceptible to illnesses – like diarrhoea or malaria – than normal children. They have limited cognitive development and don't do as well at school," he said.

Delayed physical development can also have longer term consequences for childbearing. For example, Madagascar's 2008-2009 Demographic Health Survey showed that women of small build, as a consequence of childhood chronic malnutrition, run an additional risk of complications during pregnancy and labour.

The diversification of children's diets is not by itself a solution to chronic malnutrition in Madagascar. According to UNICEF, it is also important to improve access to clean water, sanitation and health care, to reduce the incidence of early pregnancy and marriage, and to improve nutrition for teenagers and women, particularly those who are pregnant or breastfeeding.

Chronic malnutrition is a problem of poverty, Lauwerier said, and requires attention from the government and its development partners.

"Chronic malnutrition is unseen, it's a silent crisis," he said. "It's one of the biggest development issues in Madagascar. When a child is poorly nourished over the long term, her brain doesn't develop properly. This has an impact on the development of the child and the future of the country."



Focus on malnutrition in Madagascar and efforts at alleviating it.

A nutrition programme aims to diversify the diet of locals, by equipping them with skills, to help tackle chronic malnutrition on the island nation that is among the worst affected in the world.