Govt battles malnutrition

Almost a month ago, an emaciated Christian Rakotoniania and her two-year-old daughter were admitted to the government-run Intensive Nutritional and Rehabilitation Centre (CRENI) in the Malagasy capital, Antananarivo. She has not only benefited from balanced meals provided three times a day, but also picked up tips on how to feed her family on a budget of less than one US dollar a day. Both Rakotoniania and her husband are unemployed. "That is the tragedy of the situation - it is a vicious cycle - we send healthy mothers and children back into poverty where they barely manage to eat one proper meal a day," commented Dr Julia Rasoaharimalala, who heads the centre. "At times we are tempted to keep the mothers here longer so they can get stronger. However, we often have to send them back earlier because they have children to look after at home". Rasoaharimalala said the centre also attempted to provide poverty-stricken families with advice on how to supplement their diet with vegetables grown in pots or any little strip of land available to them. Malnutrition is one of Madagascar's most pressing problems. Ranked at 150 out of 177 nations on the UN Development programme's Human Development Index, the Indian Ocean island is one of the poorest countries in the world, where seven out of 10 people live on less than one dollar a day and one in 10 children is chronically malnourished. The Malagasy government, along with the UN Children's Fund (UNICEF) and the World Food Programme (WFP), has been running an aggressive campaign to combat malnutrition through 36 CRENI across the country. UNICEF spokeswoman Misbah Sheik pointed out that child mortality rates had dropped by almost half between 1997 and 2004, but "60,000 children aged under five continue to die each year from malaria, diarrhoea and acute respiratory infections - illnesses that are all exacerbated by pervasive malnutrition". Under its Poverty Reduction Strategy Paper (PRSP), which aims to halve poverty by 2015, the government intends providing 84 percent of children aged from six to 59 months with vitamin A supplements, and 73 percent of the women coming in for prenatal consultations with iron supplements. The PRSP is prepared by the governments of low-income countries through a participatory process involving domestic stakeholders as well as external development partners, including the International Monetary Fund and the World Bank. UNICEF has offered assistance to Madagascar in four main areas of intervention, in terms of its Child Survival Programme: reducing child mortality; preventing HIV/AIDS; education, and 'governance for child rights'. Under the child survival programme, assistance is provided to local partners in developing child-focused health, nutrition, water and sanitation policies. These include features such as improving access to essential vaccines, raising awareness of and treating common childhood illnesses, counselling and care for expectant mothers, and constructing water points and latrines in schools and health centres. Sheik pointed out that these programmes often offered incentives. "For instance, a woman who comes in for all three antenatal visits receives an insecticide-treated bed-net to protect her and newborn child from malaria, or a mother who takes her child to a health centre for a biannual dose of vitamin A is also able to have the child dewormed at the same time." The government also wants to increase to 3,608 the number of WFP-supported community-based nutrition sites, called SEECALIN, which are expecting to feed 28,000 children this year. The sites are located in some of the most poverty-stricken areas, often in the deep interior of Madagascar. But unless the Malagasy have access to better jobs and incomes, interventions alone cannot sustain the health of a child or a mother in the long run, according to doctors at one of the CRENI. Rakotoniania could be back within a few months.