Silently, malnutrition is laying siege
Unnoticed, malnutrition is destroying the progress of the country with the corrosive power of an acid drop. There are efforts to stop it. But are these efforts adequate? CHARLES MPAKA reports
Sprawling between the towering Mulanje Mountain to the South and the inland Lake Chilwa to the North, Phalombe district is largely an expanse of well-watered and fertile plain sitting just 716 metres above sea level.
Out of this land, the district produces in abundance food crops such as rice, maize, beans, pigeon peas and all range of vegetables.
As is the case with most rural households in Malawi, many homes in the district keep livestock such as goats and chickens largely for domestic consumption.
And because of the closeness of the district to Lake Chilwa, the second most important fishing ground in the country after Lake Malawi, fish trade is a common errand in many parts of the district.
Which is why people like Agnes Lufeyo, 62, do not understand that malnutrition should be such a huge public health concern in the district.
Lufeyo, who we found selling self-grown rice at Mpasa Trading Centre which is located not too far from the district headquarters, admitted that children and adults alike have been dying in her area.
She has seen many of them losing weight –without good explanation.
She has seen young children losing their skin and hair colour.
She knows a few children in her area that are rather shorter than their age.
“I don’t know whether it is because of malnutrition,” she said when asked what she knew about malnutrition and its dangers.
So, what did she think is the cause of all that?
Shrugging her shoulders, she said: “May be witchcraft. May be HIV.”
Witchcraft or not, HIV or not, the fact is that malnutrition is a big health concern in the district, according to the District Health Office.
But with low levels of literacy and some strong traditional beliefs, many people don’t seem to understand this, it says.
The 2010 Demographic Health Survey found stunted condition being at 47 percent in the district.
Even in the absence of a similar survey recently, chances are that the situation has not changed that much, says Phalombe District Medical Officer, Henry Chibowa Jr.
“The population has increased over the years, public health concerns have risen sharply and resources for us to ably respond to both emerging and long-standing health problems have been on the decline,” he says.
Chibowa says health facilities in the district have been registering increasing cases of malnutrition among both adults and children.
“It’s a big health challenge here,” he says.
Nationally, the picture isn’t that encouraging.
A joint study by the Ministry of Finance, the African Union and the United Nations’ World Food Programme (WFP) on the nutrition status in Malawi came up with staggering findings.
In its report which was released in May this year, the study found that between 2008 and 2012, almost 82,000 child deaths in Malawi were estimated to be directly associated with under-nutrition.
That toll represented 23 percent of all child mortalities in that period.
The report details how malnutrition has laid siege on the country’s social and economic progress through reduced productivity, decimation of potential workforce, straining of health and education resources and retarding growth in working-age Malawians.
According to the report, entitled ‘The cost of hunger in Africa: The social and economic impact of child undernutrition in Malawi’, the country lost US$597 million in 2012 alone because of child undernutrition.
That loss was equivalent to 10.3 percent of the country’s GDP, experts say.
It is in this frame that Phalombe district finds itself.
But it is noteworthy that the DHO is taking steps to fight the condition in the district.
The DHO has in place the District Nutrition Coordination Committee (DNCC) at the district council level. The committee, chaired by the District Planning and Development officer, comprises officials from agriculture, education and health.
Chibowa says they believe that the fight against malnutrition is not just a health issue.
“Our colleagues in agriculture have the know-how on the right crops to grow. Those in education can deliver the messages to children in the schools or through adult literacy classes,” says Chibowa.
In addition, the District Nutrition Officer coordinates with health surveillance assistants (HSAs) who, working in their communities, register malnutrition cases, provide messages and encourage hospital visits.
“So we have some structure in place to drive the nutrition campaign throughout the district, supported in that cause by our health education department,” says Chibowa.
But this work, he admits, is bogged down by perennial lack of resources.
The efforts of the DHO in the district are however being shored up by the support of organisations such as World Food Programme, Save the Children, Unicef and World Vision, among others.
Alongside the DHO, these partners make up a front that is tackling one of the roots of the problem: illiteracy. Experts say illiteracy is a hindrance to access to information which would enable people shape their behaviours.
Thus, besides some of the partners providing food to households struck by hunger and under-nutrition conditions and initiating agricultural production programmes, there are also direct community sensitisation activities aimed at keeping the people aware of the condition and how to deal with it.
Malawi is responding to the situation nationally too.
In March 2011, the country joined the Scaling up Nutrition (Sun), a global movement driven by the mission to improve nutrition.
The purpose is to mobilise resources and support the implementation of interventions
in line with the country’s Food and Nutrition Security Policy (2005) and the National Nutrition Policy and Strategic Plan (2007 – 2015).
Under the initiative, Malawi also focused on community-based action, with the 1,000 Special days National Nutrition Education and Communication Strategy (Necs) prioritised for the period 2012 – 2017.
This is aimed at reducing stunting though behaviour change and awareness raising, says a brief on Malawi’s joining of the movement.
And it would seem the message is being driven home, although in trickles.
Traders at Mpasa Trading Centre acknowledged that officials from the district council and some NGOs do visit their areas with the messages on nutrition.
“But it’s not as comprehensive as it is with HIV and Aids,” said Chikumbutso Sayenda, a groceries shop owner at the market.
“Mostly, we get the messages on nutrition when we visit a health centre and when you have that problem.”
And, agreeing with Lufeyo, Sayenda said the campaign on nutrition in the district has a formidable foe in what he described as an overriding belief in witchcraft.
“That belief is so strong here. So it is common that when people fall sick, they want to go to Mulanje or to Mozambique [to seek help from traditional healers],” said the 32-year old, a form three drop-out.
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