So What is Malnutrition?
Malnutrition is not just about food availability or even food consumption, but about the absorption of nutrients- vitamins, minerals, proteins and so forth. There is a relationship between health and nutrition, such that a body that absorbs nutrients well is a health body, and a healthy body absorbs nutrients better. In this way, disease and access to public health services are both critical in how malnutrition develops. In societies where there is a lot of disease (such as malaria, or diarrhoeal disease), and where health care systems are not strong enough to overcome these diseases, you end up with more sick people (particularly children). These sick children are then less able to absorb nutrients. They then become more vulnerable to disease as a result, and then become even less capable to absorb nutrients, and so forth. If this spiral is not interrupted, death is the outcome.
A further contributing factor to the interplay between disease and nutrition is that of clean water. Poor water supplies encourage diseases such as cholera and acute water diarrhoea, and make it harder to prevent these diseases spreading. Further compounding this are childcare practices. Some practices- like feeding newborn infants dirty water instead of colostrum- the thick, highly nutritious discharge a new mother produces immediately following birth- further undermine child health.
In many parts of rural West Africa, these factors exist at significant levels. Diseases such as malaria and diarrhoeal disease are endemic. Poor maternal education means that information we take for granted, such as washing hands before feeding a child, is not widely known.
Poor development over decades means that health care systems have poor reach in remote areas and cycles of disease are not stopped. Dirty water sources and poor hygiene services ensure that diseases spread easily. In addition, over-reliance on single crops such as millet or sorghum means diets are not nutritionally balanced. Factor in uncertain growing seasons and unreliable food supply in households, and the recipe is there for a high level of background chronic malnutrition.High chronic malnutrition is the case across West Africa. And as a result, when events do occur that affect a family’s ability to maintain its food supply, the vulnerable- especially children-quickly transition from a state of chronic malnutrition, to one of acute malnutrition.
We refer to these events as ‘shocks’, and at the household
level they might include things such as the main wage-earner losing their job, or somebody in the family falling sick. When they occur at a regional or national level
, they can include things like a disease outbreak (such as a bad season for malaria), a drought that cuts food production and lowers yields over a large area, a downturn in the economy, a spike in regional food prices, a locust invasion, or a range of other factors, sometimes occurring at the same time to push a large portion of a country or several countries into a state of high vulnerability.This is, in essence, what is happening in West Africa this year.
There are two really important things to note about the current situation in West Africa. The first is that the crisis has come about in West Africa because of the long-term background vulnerability of the region
- its under-developed status. The second is that the ‘shock’ is actually a nexus of several factors working together, not just a failed harvest (indeed last year’s harvest wasn’t that bad at a regional level). The upshot of these two facts is that the food crisis does not affect everybody the same way, but affects vulnerable households in particular areas where these factors have a particularly heavy impact.
This means we’re looking at quite a different situation to last year’s famine in the Horn of Africa, where large portions of territory were fairly uniformly impacted by food shortages.
In West Africa, in each of the affected countries, we’re seeing a situation where specific vulnerable communities over a large area are being very seriously impacted, while other less vulnerable communities are faring better.
Why does any of this understanding matter? Well, it then dictates how we need to deal with the crisis.
If we know that a crisis is due to poor harvests and low food supply, then the obvious solution is to throw food at it- namely, distribute food rations to communities to make up the shortfall and resolve the crisis.
If we know that the crisis is in fact nutritional in nature, then simply providing food may not provide a solution - we need to understand that nutrition relates to health and the ability to absorb the right kinds of food - so our solution needs to be tailored accordingly, with aspects of health care and providing the right sort of food easily absorbed.In the case of West Africa, we know that the crisis is due to a range of issues, some of them short-term, and some of them relating to the long-term vulnerability of communities. In this way, we need to ensure that our response is two-pronged.
One part of the response must look at the short-term needs, such as preventing children from becoming acutely malnourished in the first place, and helping to keep them alive if they do. Another part of the response must look at dealing with the long-term issues, such as access to reliable public health services or clean water supplies.
World Vision has long-term programs running in Senegal, Mauritania, Niger, Mali and Chad, and in all five of those countries, there are people affected by the crisis in our areas of long-term programming. World Vision runs programs to improve health, education, food supply and water access across West Africa in an effort to remove some of the factors that make communities so vulnerable to food insecurity and nutrition crises, and it continues to run them even during times of crisis, as this long-term view is essential to preventing crises arising in the first place.
However in the short-term as this crisis continues to build, World Vision has stepped up its emergency response activities, particularly focusing on activities to prevent children with acute malnutrition from deteriorating, and getting sick and dying. This type of intervention saves lives - countless thousands of them- and is a cornerstone of World Vision’s response being undertaken now.
The situation in West Africa is only just beginning to take hold, and it’s going to get worse before it gets better.
In the Horn of Africa, the accusation has been made that the international community did not act soon enough to stop needless deaths, deaths that could have been averted.
World Vision responded as best it could early in the Horn of Africa, and is doing so in West Africa as well, with emergency response activities already well underway in several countries, and particularly Niger where the crisis appears to be deepest.
World Vision continues to call on its supporters, on governments, and on the international community to step in early.
Tristan has worked with World Vision on emergency management since 2003. A member of the Humanitarian and Emergency Affairs team and formerly a member of World Vision's Global Rapid Response Team, Tristan has supported dozens of emergency programs in more than 20 countries. He has held emergency management posts in West Africa and the Pacific, with more recent deployments covering the conflict in Sri Lanka, Typhoon Ketsana in the Philippines, the malnutrition crisis in Niger, and most recently, the Horn of Africa drought and hunger emergency.
From mid-2005 to mid-2006, Tristan worked with World Vision’s Niger Drought Response.
Tristan has a Bachelor Degree in Geography and a Masters in Development and the Environment. His work has a global focus, with emphasis on emergency response, fragile states and aid worker safety. He is also an avid photographer.