Niger Fights Malnutrition Through Education

By Lane Hartill

Amina has been to the lectures, she knows what to do. She can tell you that beans have protein and that moringa leaves have vitamins. She knows her kids should eat mutton and oranges. Money for these groceries, surprisingly, isn't too much of a problem. In this depressed village, her husband is a farmer and blacksmith. They have cattle and goats. Amina has five of her own, the equivalent of a flush savings account in rural Niger.

The problem, to be frank, is breast milk. Amina can't produce enough.

The little milk that she does produce goes to the twins, Ousseini and Hassana, who are climbing on her lap in their matching lime-green outfits, digging for lunch. The two 13-month-olds are fairly healthy. So are Rahina, 6, and Basaria, 5, her other daughters. They sit beside her quietly, like polite little women, miniature versions of their mother.

But Hamisou is a different story. He's her 3-year-old, the one who is sitting front of her in the dirt with a bare bottom and a cut on his leg that's red as a huckleberry. He's mewling like a cat. He's hungry.

Hamisou, like 138 other children in this village, is malnourished. Amina could have been breastfeeding him when the twins were born. He lost weight. She's already taken him to the feeding center in the main city of Zinder south of here, but what little he gained melted away. He weighs a little over 17 pounds. The optimal weight for a 3-year-old is around 28 pounds.

Hungry Months

In Amina's village of Bakari, which receives no electricity and few outside visitors, a trip to the child feeding center is common. Mothers all too frequently perch over limp infants at the feeding centers, urging them to drink therapeutic fluids.

The hungry months between June and October are the toughest; the heat crackles across the scrub and farmers wait to harvest their crops. At night when the temperature dips south of 100 degrees, Nigeriens tip gourds of millet mixed with water to their lips. Millet in Niger is like rice in China: It's found at most meals. In the United States, the most common use for millet is birdseed.

"Even when the harvest is good, in certain villages, the diet isn't diversified," says Moussa Mahamane Laouali, the head of Catholic Relief Services' office in Zinder. "That means children may eat the same thing three times a day: boule in the morning, noon and night."

Boule is millet-based dough that Amina makes for most meals. It has the consistency of wet spackle. Sometimes it's mixed with milk, but more often with water. The millet grain has iron and magnesium in it, but little else. She also makes tuwo, a spongy millet-based mush that she spoons sauce over. The sauce has some nutritional value depending on what it contains. But the danger—and this is the cause of much of the hunger in parts of Niger—is when children eat nothing but millet for months on end. Malnutrition often follows.

That's why CRS, along with its partners, is working in Bakari. Every month, volunteers slip babies into a blue sling and record their weight. They also gather mothers in the shade and discuss what they should feed their children.

Forbidden Foods

"In some of our villages there are still taboos and forbidden foods, especially for women and children, that expose them to malnutrition," says Laouali. "For example, one can hear that 'If a child eats eggs, they will become a thief.' "

Volunteers talk about exclusive breastfeeding. They tell mothers that the cultural custom of giving the child goat's milk after birth—because some women think the colostrum in the first breast milk is too concentrated and bad for the baby—is wrong. Colostrum is full of antibodies and minerals. The women listen. They are no longer throwing it away.

But the link between cultural practices and malnutrition is sensitive. It's not always easy to change minds. One of them is the plat familial, or the family dish. Children usually eat what their siblings and parents eat. There's no baby food here.

But CRS and its partners are working to teach families what to feed their children. And it seems to be working. There's Sahiya, 22, and her 2-month-old son, Mashaullah, who takes up every inch of her lap. He's a chunk, weighing in at more than 11 pounds. Sahiya's secret: Exclusive breastfeeding. The old tradition of goat's milk at birth, then giving the baby water after three weeks, followed by millet gruel at four months, is finished.

Sahiya bought into the lesson and can feel the results in Mashaullah's chubby legs and arms. Malnourished children haven't disappeared from Bakari, but their numbers are dropping.

In August 2008, 331 babies were weighed in Bakari. And 137 were malnourished. In October, volunteers weighed 363 babies and 139 were malnourished. The decrease in the percentage of malnourished children was likely caused by the recent harvest and the classes CRS is supporting.

Hard Life

Amina crouches in the shade of a fence made from millet stalks. Five of her six children sit in the sand in front of her. She doesn't caress them; there's no dandling them on her knee, or cooing to them. She looks down into their brown eyes and sags a little deeper. The stress radiates off her like a heat. She hands a bowl of clean water to Hamisou. He drinks long and deep directly from the bowl.

Her life has always been a strain: a hard childhood, only two years of school, married early, divorced, and six children. As she recounts her past, Hassana crawls on her lap, wanting to nurse. She relents. While she's nursing, Amina pulls a sliver of wood from the fence and scrapes mucus from Hamisou's nose.

Then she gets up and takes her blue plastic kettle, fills it with water and starts her ritual cleansing in preparation for prayers. It's her only respite: the five times a day when she spreads out the flour sack on the ground and prays.

It might seem like Amina has hit bottom. But in fact she has it better than many other women. Her husband is good to her. He hooks a bull to the cart and hauls a 50-gallon drum of water from the well to the house. Amina doesn't have to leave the compound. She told him what she learned at the health sessions and he shelled out money for oranges. They ate meat two weeks ago—an eternity for some, but fairly recently for a Nigerien family.

Free Health Care

Amina received some good news this April when the Nigerien government required free health care for pregnant women and all children under 5 years old. With this new opportunity, plus the nutrition education provided by CRS and its partners in the village, she has hopes that Hamisou and the twins will gain weight.

When night falls, Amina is working on supper. Her kitchen is a mud hut. She stays close to the floor where there is no smoke. There are no lights, just the glow of the fire that illuminates her face. She stirs a cauldron of the millet porridge and a sauce made from moringa leaves and beans. It's a healthy dish, to be sure.

Hamisou is still hungry, sitting by himself in the middle of the compound. Amina moves slowly and methodically from the kitchen, Hassana tied to her back. She hands Hamisou his own plate. He takes the spongy millet and mops up the sauce with it. It's pitch-black, and he can't see what he's eating. But that doesn't slow him down. The only sounds in the compound are the goats chewing their cud, the occasional cough and the sounds of children eating.

Amina hasn't eaten since this morning. Once everything is cleaned up, the dishes are done, and the kids are in bed, Amina will sit in the dark, eat her millet, and think about Hamisou.

Lane Hartill is the West Africa regional information officer for Catholic Relief Services. He is based in Dakar, Senegal.