At the health centre in Dar Naim, a working class neighbourhood of Nouakchott, the building for malnourished children is always full: in rural areas the seasons and crops affect malnutrition levels whereas in the capital this phenomenon remains constant throughout the year.
The most recent nutrition survey carried out in July by the Ministry of Health and the UN Children’s Fund (UNICEF) using SMART methodology focused on assessing the nutritional situation for children between harvests.
The survey revealed that three regions of the country (southeast, south and centre) had the highest rates of global acute malnutrition (GAM). In central areas the rate was 19.2 percent, well above the World Health Organization’s emergency threshold of 15 percent.
In rural areas there tends to be various causes for malnutrition, notes Mohamed Moustapha Kane, head of the Health Ministry nutrition service.
General poverty levels in the country – more than 46 percent of the population live below the poverty threshold, according to the UN – and the lean season both contribute to malnutrition, but in addition in rural areas, although they are "agropastoral regions, not everyone has [cattle or land]. People also lack knowledge…of [good nutritional practices]. Isolation and lack of infrastructure are also an issue: access to health, drinking water or [hygiene]".
According to the July 2009 study the GAM rate in Nouakchott (7.9 percent) is much lower than in other areas. However the difference is that in the capital, as opposed to in rural areas, the seasons have little influence on the phenomenon: the December 2008 SMART study during a post-harvest period showed a 5.9-percent rate in Nouakchott compared to 11.9 percent in the central region.
Many observers have noted that the time of year does not affect food availability in urban areas. According to Nené Koné, who has been in charge of child nutrition at the Dar Naim health centre since 1991, in large part a lack of money perpetuates the problem in Nouakchott.
When mothers arrive at the centre with their children, "the main issue that comes across is their extreme poverty,” Koné told IRIN. "If the mother is hungry because she has not been able to eat, then she has no milk [to breastfeed]".
"Families are heavily in debt throughout the year,” said Isabel Marco of Communauté des Filles de la Charité, who support the centre. The huge increase in global food prices in 2008 has made the situation even worse for urban families who do not produce any food and have to buy everything: 25 litres of milk cost 35,000 ouguiya (US$134), compared to $53 in 2004, said Marco. Today it costs 24,000 ouguiya ($92) – the equivalent of one month’s minimum wage in a country where "traditionally we drink a lot of milk”.
Child malnutrition in urban areas is also linked to the financial situation of many Mauritanians deteriorating over the last few decades. Tahya Sidiekhreye, in her 50s, has brought up "lots" of children. She arrived at the Dar Naim centre at the start of October with her grandson, who is 15 months old and suffering from acute severe malnutrition.
"I never had these problems with my children: my husband and I always managed to get by [to feed them], but now it’s too hard,” she said. "[My grandson] has been ill for four months and I haven’t got the money to care for him. [His mother] doesn’t work and his Dad is unemployed, so they cannot care for him.”
She is looking after her grandson because her daughter does not know what to do, she told IRIN; the child’s mother is 15. When mothers lack nutritional knowledge and do not have enough milk they are unable to breastfeed, many experts have noted. And in urban areas in particular certain practices that lead to malnutrition have become common.
"In the past breastfeeding was highly socially valued, but there is now a trend of using milk substitute,” Brahim Ould Isselmou, communications officer at UNICEF, told IRIN. Despite the cost of this practice – a tin of baby milk that lasts five days is sold for around 1,600 ouguiyas ($6) – it also changes habits. "After a few months some mothers become confused and sometimes you see [some of] them giving meat to six-month-old babies.”
While health services are more accessible in urban areas than rural, the quality of care and support for malnutrition is not always guaranteed, as Sidiekhreye discovered. Before finally getting care for her grandson at the Dar Naim health centre she spoke with a private doctor who referred her to a hospital as the child was showing worrying symptoms. "He was vomiting a lot and was dehydrated but they did not hospitalize him: they just gave me a prescription for [paracetamol] and sent me away,” she told IRIN.
In order to standardize care and support services for malnutrition and among other things improve quality, the authorities developed a national protocol in 2007, which all centres are expected to follow. The protocol called for standardizing how malnutrition is assessed, referred and monitored and how care and support are provided. At Dar Naim and other health centres staff have been trained on this protocol with support from UNICEF.
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The most recent nutrition survey carried out in July by the Ministry of Health and the UN Children’s Fund (UNICEF) using SMART methodology focused on assessing the nutritional situation for children between harvests.
The survey revealed that three regions of the country (southeast, south and centre) had the highest rates of global acute malnutrition (GAM). In central areas the rate was 19.2 percent, well above the World Health Organization’s emergency threshold of 15 percent.
In rural areas there tends to be various causes for malnutrition, notes Mohamed Moustapha Kane, head of the Health Ministry nutrition service.
General poverty levels in the country – more than 46 percent of the population live below the poverty threshold, according to the UN – and the lean season both contribute to malnutrition, but in addition in rural areas, although they are "agropastoral regions, not everyone has [cattle or land]. People also lack knowledge…of [good nutritional practices]. Isolation and lack of infrastructure are also an issue: access to health, drinking water or [hygiene]".
According to the July 2009 study the GAM rate in Nouakchott (7.9 percent) is much lower than in other areas. However the difference is that in the capital, as opposed to in rural areas, the seasons have little influence on the phenomenon: the December 2008 SMART study during a post-harvest period showed a 5.9-percent rate in Nouakchott compared to 11.9 percent in the central region.
Many observers have noted that the time of year does not affect food availability in urban areas. According to Nené Koné, who has been in charge of child nutrition at the Dar Naim health centre since 1991, in large part a lack of money perpetuates the problem in Nouakchott.
When mothers arrive at the centre with their children, "the main issue that comes across is their extreme poverty,” Koné told IRIN. "If the mother is hungry because she has not been able to eat, then she has no milk [to breastfeed]".
"Families are heavily in debt throughout the year,” said Isabel Marco of Communauté des Filles de la Charité, who support the centre. The huge increase in global food prices in 2008 has made the situation even worse for urban families who do not produce any food and have to buy everything: 25 litres of milk cost 35,000 ouguiya (US$134), compared to $53 in 2004, said Marco. Today it costs 24,000 ouguiya ($92) – the equivalent of one month’s minimum wage in a country where "traditionally we drink a lot of milk”.
Photo: Anne Isabelle Leclercq/IRIN  |
| Tahya Sidiekhreye cares for her 15-month-old grandson, who suffers severe malnutrition |
"I never had these problems with my children: my husband and I always managed to get by [to feed them], but now it’s too hard,” she said. "[My grandson] has been ill for four months and I haven’t got the money to care for him. [His mother] doesn’t work and his Dad is unemployed, so they cannot care for him.”
She is looking after her grandson because her daughter does not know what to do, she told IRIN; the child’s mother is 15. When mothers lack nutritional knowledge and do not have enough milk they are unable to breastfeed, many experts have noted. And in urban areas in particular certain practices that lead to malnutrition have become common.
"In the past breastfeeding was highly socially valued, but there is now a trend of using milk substitute,” Brahim Ould Isselmou, communications officer at UNICEF, told IRIN. Despite the cost of this practice – a tin of baby milk that lasts five days is sold for around 1,600 ouguiyas ($6) – it also changes habits. "After a few months some mothers become confused and sometimes you see [some of] them giving meat to six-month-old babies.”
While health services are more accessible in urban areas than rural, the quality of care and support for malnutrition is not always guaranteed, as Sidiekhreye discovered. Before finally getting care for her grandson at the Dar Naim health centre she spoke with a private doctor who referred her to a hospital as the child was showing worrying symptoms. "He was vomiting a lot and was dehydrated but they did not hospitalize him: they just gave me a prescription for [paracetamol] and sent me away,” she told IRIN.
In order to standardize care and support services for malnutrition and among other things improve quality, the authorities developed a national protocol in 2007, which all centres are expected to follow. The protocol called for standardizing how malnutrition is assessed, referred and monitored and how care and support are provided. At Dar Naim and other health centres staff have been trained on this protocol with support from UNICEF.
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This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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