This article by Lucy Mizen, left, won the Guardian International Development Journalism Competition 2012. Shortly after her Introduction to Journalism course she reported from Burkina Faso on the fight against child malnutrition.
“Our grain’s nearly finished,” Lamoussa Ouédraogo whispers, a pale shirt hanging off her thin body. “We have enough food left for three meals. After that, I don’t know what we’ll do.”
It is early morning at the health centre in Noaka, near the city of Kaya, Burkina Faso, but already the sun is hot. Standing in the shade of a tree, rich with green leaves, Ouédraogo cradles her newborn baby in her arms. This is child number four, a beautiful little girl called Claire.
The baby begins to cry and Ouédraogo moves her top. Claire begins to drink, but pulls away, crying with frustration. Carefully Ouédraogo tries to tease more milk from her breast – she looks up, her eyes filled with despair. Her baby is hungry, but she is struggling to provide. “My milk’s not sufficient and I wonder when this food is finished what I will do?” she says.
With four children, plus grandparents, Ouédraogo and her husband have a family of 10 to feed. The lack of rain in 2011 means their farm – a couple of fields – produced only enough harvest to last until Christmas. With no other income, the family had to beg for food from neighbours and relatives throughout her pregnancy.
Studies show that the 1,000-day window between pregnancy and a child’s second birthday is critical. Nutritious food and sufficient calories pre- and post-pregnancy are essential – chronic malnutrition in the first two years of a child’s life causes irreversible effects.
Dr Rajiv Shah, administrator of the US Agency for International Development, explains why: “Good nutrition is crucial to developing a child’s cognitive capacity and physical growth. A well-nourished child will perform better in school, more effectively fight off disease and even earn more as an adult.”
Exclusive breastfeeding is one of the most significant factors in ensuring a child receives the best start to life. The World Health Organisation (WHO) recommends infants start breastfeeding within one hour of life and are exclusively breastfed for six months. Then, they can start with gradual introduction of safely prepared complementary foods, while continuing breastfeeding up to two years of age or beyond.
Biochemist and nutritionist, Dr Marcel Bengaly is funded by Unicef to lead research on breastfeeding practices across Burkina Faso: “Studies show that children who do not receive exclusive breast milk in the developing world are seven times more likely to die from diseases such as diarrhoea and pneumonia,” he says.
According to the WHO and Unicef report, Countdown to 2015, in Burkina Faso in 2009 just 16% of infants under six months were exclusively breastfed. This low number is a consequence of lack of education and belief in traditional practices.
“The first milk, colostrum, the most important for nutrition, is seen as bad milk and so is not given to the newborn,” Bengaly explains.
Another myth Bengaly’s team try to dispel is that a baby cannot last six months without drinking water. As a result, infants are given unclean water – damaging their young bodies.
Organisations such as WHO and Unicef are working to combat these myths and provide education for young mothers to ensure practices change. However, Bengaly believes a possible solution lies with the children’s grandmothers.
“Grandmothers are considered holders of traditional knowledge in the care and feeding of the baby,” says Bengaly, “So by communicating to grandmothers we have seen great success and behaviour change of up to 50% in some communities.”
Education about breastfeeding is essential, yet damage can begin while the mother is still pregnant. Insufficient food during the critical 1,000-day window results in both the mother and baby not receiving the nutrients they need.
Across Burkina Faso, the poor harvest of 2011 has wreaked havoc, with around two million people affected and food prices soaring. Many families grow only enough to feed themselves and once that’s gone finding the money to buy food is impossible. Millet, flour and groundnuts, together with leaves from the baobab tree can provide a highly nutritious meal at a cost of 20 pence per child. However, for many families this is just not possible.
“Last year we used to sell rice and sorghum for 150 West African CFA francs (about 20p) per kilogram,” explains Guiala Agui, who sells at small markets throughout Kaya district. “But this year it is 450 CFA francs per kilogram. So it makes a very big problem in the community.”
The harsh reality is that this leaves hundreds of thousands of children at risk from severe malnutrition. Rarely appearing on death certificates, this slow, debilitating illness has been nicknamed the “hidden killer” as it is often the underlying cause of more obvious illnesses such as diarrhoea.
Ending this cycle of hunger requires long-term solutions – helping local governments and communities to establish coping mechanisms. One approach is to offer education about market gardening techniques. As climate change continues to affect rainfall, diversifying their range of crops gives farmers with better opportunities.
Linked implicitly with food security is the need for more health workers across Burkina Faso – improving knowledge and changing perceptions of how young children should be fed.
Save the Children is tackling malnutrition as part of its global newborn and child survival campaign. Nutritionist Aminata Kiemde has been working for Save the Children in Burkina Faso for the last four years. In 2008, Kiemde helped set up 52 community health centres across the district of Kaya.
Run by trained, government-funded health workers, the health centres play an essential role. Every week, hundreds of mothers visit their local centre to have their child monitored for signs of malnutrition. If a child appears to be severely malnourished, they are sent to the stabilisation clinic at Kaya’s regional hospital. Kiemde says all children under the age of five now receive free treatment.
The staff at the centres run training sessions on the importance of breastfeeding, family planning and simple, yet effective, ways to add basic vitamins and minerals to a diet.
Lack of financial support
Save the Children is encouraging the government to provide more health workers and to make healthcare free for children under five across the whole of the country. However, with the food crisis and economic difficulties, the government is unable to provide financial support for this.
While aid agencies and the government continue to tackle the root causes of the problem, Lamoussa Ouédraogo knows the road to recovery from last year’s drought is going to be hard. In the past, the youngest and most vulnerable members of the family would have been the victims, but with free accessible healthca