Re: [pronut-hiv] MALAWI: Malnutrition still a threat (4)

["jpeterson" <jpeterson@hki.org>]

Hey Stacia -

Although I definitely see your point (and agree with you whole heartedly), I also see progress!  When I worked in Malawi 9 years ago, you would never 
have seen statements like this:

"Mary Shawa, principal secretary in the Office of the President and Cabinet 
responsible for nutrition and HIV and AIDS, described malnutrition as a 
silent crisis. She called for a comprehensive study to establish whether the bumper harvests in the 2005/06 and 2006/07 growing seasons had any impact on reducing malnutrition levels. "

I think this might even be called a Eureka moment!  It appears (from a huge 
distance) that a lot of progress has been made, at least at the political 
level. Although I am sure much remains to be done to change the dietary 
practices at the household level (we have major work to do in the US on that score as well), it is great to see that at least the government has stopped (or some important people in the government have stopped) equating food security with maize. Congratulations!!

I think so many dietary changes are just developing new habits and norms. 
It is not impossible - cereal companies seem to have had a lot of success 
changing the dietary practices of americans.  You just need serious buy in 
from influential community members, and try to make the change as cheap and 
easy as possible to adopt.  In the Fouta Djallon region of Guinea, people 
have some excellent traditional dietary practices, including adding red palm oil to their sauce when it is almost done (no blanching) and always eating fruit after every meal. We are still pretty rice focused, but they mix it up with cassava a few times a week, and we eat lots of nutritious leaf sauces. 
We also have milk products, which helps significantly.  Anemia levels are 
quite high (76% of kids under 5), but lowest in the Fouta (62%; even lower 
than in Conakry).  However, despite these positive practices, malnutrition 
remains a problem in Guinea (where drought is almost unheard of).  Stunting 
is 35%, underweight 26%, wasting almost 10%.  It appears that our nutrition 
problems here are more closely correlated to disease incidence - diarrhea, 
malaria, worms - and breastfeeding practices.  

However, it has been useful 
to bring families and farmers from other regions and from neighboring Sierra Leone to the Fouta to show them that alternative food lifestyles exist, and are within their economic reach.

In the area where I lived in Congo/DRC many moons ago, everyone washed their hands before eating.  It was absolutely a cultural norm, and there were entire rituals around hand washing.  I have tried to instill that same 
practice here (and everywhere I have lived), without much success. 
Unfortunately, I think a farmer field visit to Congo might be a little 
extreme at this point :>).  The worst part is, I am getting out of the habit myself!

Anyway, I think the nutrition community in Malawi should be congratulated 
for the progress that has been made, and I wish you all the best in taking 
it to the next level, and reaching the hearts and minds of parents and 
caregivers who control kids diets, and create the dietary habits of the next generation. With Stacia working on school health in Malawi, I am pretty optimistic that positive changes will be seen soon!

Du courage, et khala suru -

Jen

Jennifer Peterson
Country Representative
Helen Keller International, Guinea and Sierra Leone

BP 6050, 4me etage, Immeuble Fawas, Coleah, Conakry, Guinee
35 Nelson Lane, Tengbeh Town, Freetown, Sierra Leone

jpeterson@hki.org; guinea@hki.org; sierraleone@hki.org

(224) 60 25 70 72; 64 45 86 80
(232) 076 859 625

----- "Stacia Nordin, RD" wrote:


This article highlights the irony that we are dealing with here in
Malawi.  It states that maize harvests have been 75% higher than the
average for the last five years, but even with the increase in
(so-called) /"food security"/, malnutrition remains at record highs with
thousands of people in nutritional rehab centers and almost half the
children in the country stunted.

We need to realize that /maize /security will _*never *_equal food
security.

Unfortunately, many of the government, NGO, and donor policies are still
aimed at ensuring higher yields of /maize (or other high carbohydrate
source in other countries) /through input programmes such as subsidies,
revolving funds, coupons, starter packs, and other efforts to offset the
high costs accrued by farmers due to a /maize/-based agriculture.

The time has come to truly embrace the diversity of foods that Malawi
has access to, the year-round growing conditions, and the unlimited
potential that an agricultural-based country such as Malawi has to
provide food security in each of the 6 food groups--not just one.

There were glimpses of the answers in the article below where references
to other foods were made, but the ending line--making it sound dependent
on finances--was a move in the wrong direction.  If even a /fraction /of
the money, time, and energy that is devoted to /maize /production were
converted into encouraging true food nutrient diversity, soil health,
water management practices, and focusing on the abundance of Malawian
foods and seeds that we have available here for free--we'd end up using
LESS money, time and energry on our food production.

We'd also save additional money in the long run by reducing the amount
of resources that are used up in "emergency" responses to the
"mono-maize system" and reducing dependency on hand-outs and high-inputs.
_
*/The term Food Security/* _ needs to be used appropriately in all
policies, programmes, media messages, and in everything that we do.  The
definition of Food security in short IS a sustainable NUTRITIOUS diet.
2 commonly used definitions are:

  Food security exists when all people, at all times, have access to
sufficient,
  safe and nutritious food to meet their dietary needs and food
preferences for
  an active and healthy life. (FAO)

  Food security for a household means access by all members at all times to
  enough food for an active, healthy life. Food security includes at a
minimum
  (1) the ready availability of nutritionally adequate and safe foods,
and (2)
  an assured ability to acquire acceptable foods in socially acceptable
ways
  (that is, without resorting to emergency food supplies, scavenging,
stealing,
  or other coping strategies). (USDA)

Answers and solutions are here, it is the mindset that needs to change
at every level.

Stacia & Kristof Nordin

Stacia Nordin, RD
Registered Dietitian
School Health & Nutrition Advisor
Malawi Ministry of Education

Kristof, Khalidwe & Stacia Nordin
Sustainable Food and Nutrition Security Consultants
Crossroads Post Dot Net x-124, Lilongwe, Malawi
nordin@eomw.net
www.NeverEndingFood.org
t: +265 1-707-213 Malawi is + 2 GMT
c: +265 9-333-073 (Stacia)
c: +265 9-926-153 (Kristof)
c: +265 9-281-700 (Khalidwe)


---ProNut-HIV wrote:
> LILONGWE, 20 December 2007 (IRIN) - Despite two years of bumper
> harvests, malnutrition, partly a consequence of Malawi's famine in 2005,
> still lingers. "The scale of the malnutrition problem in Malawi is
> clearly very large and, given its consequences for economic development
> and child survival, calls for immediate and large-scale action," said
> Aida Girma, UNICEF Resident Representative.
>
> "Micronutrient deficiencies, which are often referred to as hidden
> hunger, are also very high." Malnutrition is characterised by key
> indicators, such as the number of underweight children and levels of
> stunting, wasting and micronutrient deficiencies: stunting levels were
> at 46 percent, 19 percent of children up to 59 months were underweight,
> and wasting was 4 percent, the UN Children's Fund representative added.
>
> After the drought
>
> Malawi has turned the page on the 2005 drought that left about five
> million people in need of food aid. According to government estimates
> the 2007 maize harvest, the staple food, increased by 22 percent over
> the 2006 crop, and was 73 percent higher than the average for the past
> five years.
>
> Mary Shawa, principal secretary in the Office of the President and
> Cabinet responsible for nutrition and HIV and AIDS, described
> malnutrition as a silent crisis. She called for a comprehensive study to
> establish whether the bumper harvests in the 2005/06 and 2006/07 growing
> seasons had had any impact on reducing malnutrition levels.
>
> "We have started to see improvements in the food security situation in
> Malawi in the past two years [but] malnutrition is still a challenge,"
> UNICEF's Nutrition Officer, Stanley Chitekwe, told IRIN.
>
> He said malnutrition was caused by three underlying causes: the first,
> household food security, had shown improvement; the other two - care for
> children and women, and the availability of health services - were still
> inadequate.
>
> "Malawi is heading in the right direction by meeting one of the three
> requisites for nutrition," he commented, but addressing the other issues
> would "require more investment in building capacity to improve care
> practices and health seeking behaviours", because "there is still more
> work required in promoting diversified crops rich in vitamins and
> nutrients, and in food processing and preservation."
>
> HIV/AIDS also "undermines nutrition improvements by directly causing
> ill-health and eroding capacity at various levels - family and
> institutions - to care, produce food and provide services," Chitekwe
> added.
>
> The hunger gap, a pre-harvest period when food from the previous crop
> was often depleted, meant that seasonal variations in household food
> availability still resulted in higher levels of malnutrition from
> September to March/April each year, he said.
>
> Filling the hunger gap
>
> A 2005 National Nutrition Survey found that 90 percent of children in
> Malawi were malnourished. Tapiwa Ngulube, principal nutritionist in the
> ministry of health, said since then the government had established 95
> Nutrition Rehabilitation Units, where free food was given to
> malnourished children and mothers were trained to feed them correctly.
>
> "Our aim is to ensure that the children are healthy and have gained
> weight by the time they leave rehabilitation units; children who are
> malnourished lose up to 11 centimetres in height if they are not treated
> for malnutrition and stunting," Ngulube noted.
>
> Around 39,000 children are still being treated at rehabilitation centres
> throughout the country, but "our efforts are hampered by a shortage of
> medical personnel," Ngulube said.
>
> UNICEF's Girma attributed micronutrient deficiency to the low nutrient
> content in local diets, which are based mainly on cereals, roots and
> tubers and said diets needed to be supplemented with micronutrient-rich
> foods like fish, meat, eggs, milk and dairy products.
>
> But in a country where over half the people live on less than US$1 a
> day, most households struggle to come up with two meals a day.
>