My research in Madagascar

Pictures from the nutritional study conducted in Ambovombe

ABSTRACT

Infant malnutrition in developing countries is an area of major concern. NGO’s and UN agencies are collaborating with governments across the world to fight this problem. In Madagascar, the Nutrimad project led by GRET, IRD and the Antananarivo University, has been running since 1997. Its goal is to improve the nutritional status of children in Madagascar. Particular attention has been focused on the dry Androy region in the South of Madagascar where famine in recent years has resulted in high levels of malnutrition.

It was proposed that a nutritional survey of infants under two years old should be carried out concentrating on the assessment of the nutritional status of these children and their feeding practices in order to evaluate the possibility of future interventions to reduce child malnutrition within the region. The survey carried out in 2005 consisted of three main parts; a nutritional survey of children under two years old, an anthropological study of the mother-child relationship and the characterization of complementary feeding. In order to find out what kind of coping strategies the population uses against food insecurity a comparison between two communes was also incorporated into this study. One considered as a vulnerable territory (Sihanamaro) and the other as a secure territory (Beanantara) according to the SAP classification Methodology.

The exhaustive nutritional survey of 1553 children involved the measurement of the child and the mother (height, weight for both and MUAC for the child only). The anthropological study was carried out by an anthropologue and Sophie Goudet consisting of informal interviews with mothers of different profiles. The characterization of complementary feeding was based on taking two samples of complementary feeding in each village (one which was taken at random, and the other one chosen for its nutritional interest).

The anthropological study revealed that traditional Antandroy feeding practices involve the introduction of beverages other than breast milk to infants at a very young age. These drinks are often made with contaminated water and can lead to illnesses resulting in malnutrition. It is also customary within the region to wean infants at the age of one year. Previous studies have shown that this early end to breast feeding is detrimental to the health of children.

The nutritional survey found 24,5% of the infants surveyed to have a low height for their age, 6,4% to have a low weight for their height and 23,2% to have a low weight for their age (<-2ET). These malnutrition rates are lower than the national average based on the latest national nutritional survey (EDSIII 2003 – 2004). These results come after two years of good harvest and it is believed that due to the agricultural vulnerability of the region a poor harvest could result in a rapid rise in malnutrition levels. The malnutrition rates were also higher in the secure territory than in the vulnerable territory. The exclusive breastfeeding rate is 25,5% compared to 15% on national level. The median ablactation age is 20 month compared to 21,6% at national level. The median age of introducing semi-liquid food is 7 month and 14 months for solid food such as family meal.

The results from the chemical analysis showed that the density of the semi-liquid food is not sufficient and that quantity of food taken is not adequate for children to meet their energy needs.  The same conclusion could be brought forward regarding solid foods.

It was found that the nutritional state of the child is significantly related to his status of vitamin A supplementation and to the number of hours of the mother activities. All the other socio-economic variables are not associated with the nutritional state.

Based upon the results of the survey it has been recommended that a four part hygiene, nutrition and health sensibilization and education program is introduced into the region specifically targeting three vulnerable groups; infants under two years, school children and mothers. This should consist of; a sensibilization program involving local volunteers, strengthening of existing community structures, a complimentary feeding program and further investigation into the root causes of malnutrition – specifically in this case the supply of clean water. In September 2005, a three year EU funded project was approved to carry out these recommendations.

Keys words : Infant malnutrition, Food insecurity, Androy, Madagascar,