Solving the malnutrition problem

Sandwiched between the foothills of Nthwezulu and the shores of Lake Malawi, Usisya is a low-lying and an underdeveloped hard-to-reach area in Nkhata Bay North.

Its terrain, mostly of smooth golden sands, hills and rocky outcrops, is the cause for its spectacular scenery. But inside that beauty, lies a beast that has gone loose after families.

Edness Nkhwazi from Mdoye Village, Traditional Authority (T/A) M’bwana, says the terrain is selective of crops.

“The terrain is bad for other crops except cassava,” she says. “So, our daily meal here is Kondowole [nsima made out of cassava flour] and fish from the lake.”

Such a monotonous type of a meal is blamed as the cause of malnutrition cases in the area. Nkhwazi is one of the victims and her 18 months child is malnourished.

“The health officer told me that I lack vital nutrients to have a healthy child,” says the 20-year-old woman.

Health surveillance assistant Jumbo Chakwanika says Nkhwazi’s child is one of the 100 malnourished children in his area of jurisdiction. The catchment area has around 500 children.

“We have since put these children under a supplementary feeding programme to improve their nutritional status,” he says.

Nkhata Bay District Health Office nutrition coordinator Davie Panyani says Nkhata Bay has one of the highest cases of malnutrition in the country.

Statistics show that stunting, one indicator of malnutrition, is at 32.2 percent down from 48.3 percent in 2010.

Comparatively, the district is also below the national percentage of 37 (also a decrease from 47 percent as recorded in 2010), according to the 2015 Malawi Demographic and Health Survey.

However, Panyani says a lot needs to be done to reduce the cases further, especially in rural areas like Usisya where malnutrition remains extremely high.

For example, the prevalence of stunting is greater among children in rural areas (39 percent) compared to 25 percent in urban areas. It decreases with increasing levels of the mother’s education.

“We should accept this remains a bigger challenge. We are not yet done with malnutrition. We still need to work in reducing the figures further to less than 20 percent by 2025,” says Panyani.

According to experts, children suffer from malnutrition due to diets low in nutrients, poor child care, feeding practices and chronically undernourished mothers.

Among other symptoms, children under the age of five are usually short for their age, wasted and underweight. Such symptoms have long-term repercussions such as poor brain development and increased susceptibility to disease.

Prevention of malnutrition can help break the cycle of poverty because children with high nutritional status develop in all spheres of life and are able to maximise their potential.

Department of Nutrition, HIV and Aids nutritionist Chimbizgani Phoster Kachali says 50 percent growth failure accrued by age two, occurs in the womb.

“So, pre-pregnancy period is very critical to prevent malnutrition. Mothers need to eat balanced meals 270 days before pregnancy and 730 days after conceiving. We call this the 1 000 days window of opportunity,” he says.

However, Story Workshop Education Trust (Swet), which is implementing a nutrition project in Nkhata Bay, found that ignorance on good health in communities is one of the reasons the country continues to grapple with high cases of malnutrition.

Swet project officer Given Chichitike says lack of coherence in communication between authorities is affecting people to attain knowledge on balanced diet.

“The Department of Nutrition has put in place a communication structure that coordinates all players to improve issues of nutrition.

“But at the moment, there are gaps in care group structures, from the Department of Nutrition to district and area committees in coordinating issues of nutrition,” he observes.

But Senior Chief M’bwana at Usisya says issues of malnutrition do not need sophisticated projects to be addressed. He says the answer lies within communities to use locally available resources to have a balanced diet.

Led by the chief, the community has embarked on initiatives to improve diet at household level. Each household has been tasked to have a backyard garden and grow vegetables, particularly locals ones, which are believed to be more nutritious. The community has intensified production of crop manure to support yield in the small gardens.

“In a sandy terrain like ours, all we need is to enrich the soil with manure and cultivate different crops to diversify our meals.

“We also need to venture into poultry farming so that we do not depend on fish alone. That is what we are urging communities to do in defeating malnutrition,” he says.

The innovations at Usisya complement the strategy in the just launched 2018-2022 National Muiti-sectoral Nutrition Policy and Strategic Plan which encourages growing of nutrient-rich crops.

However, it may be too early to celebrate the government’s direction because Malawi performs poorly both in funding and implementing policies.

Oxfam interim country director Lingalireni Mihowa recently warned that: “Investments in nutrition are still a very small portion of the overall domestic budgets in Malawi.”

Her sentiments were also shared by King Letsei III of Lesotho during his recent visit to Malawi. While acknowledging efforts made, he challenged government to make “appropriate investment in nutrition”.

Thus, while communities are standing up to address nutrition in their communities, government has to come up with a holistic system (funding and policy implementation) that support the course and ensure all communication systems are functioning. n