Chronic malnutrition dogs Côte d'Ivoire's north

Forty percent of Ivoirian children in the northern region are chronically malnourished, the country's highest rate, which has not fallen for the past six years. The effects of a drawn-out conflict, desertion by aid groups and inadequate medical staff have contributed to the situation. Food scarcity here is often due to harsh weather and high food costs.

The average rate of chronic malnutrition nationally is not much lower though, at 30 percent. Côte d'Ivoire's northern region is mostly arid and on the fringes of the Sahel. Malnutrition levels here compare to Niger's 40 percent and are slightly higher than Burkina Faso's 34 percent.

The 2002-2009 political turmoil that split Côte d'Ivoire into rebel-held north and government-controlled south devastated public services in the in the north. Under rebel rule, private firms also fled, while the economy tumbled and insecurity rose. The region was, however, spared much of the violence sparked by the 2010 election dispute.

"The crisis significantly weakened the already precarious food security levels in this part of the country. Population displacements disrupted agricultural activities from 2002 to 2005," said Bernard Kouamé, a nutrition expert based in the commercial capital Abidjan.

"Health infrastructure was degraded. The absence of health personnel for months on end and the fracturing of the health system greatly affected access to health services. The country has not totally recovered from these problems," he said.

The withdrawal of aid organizations such as Action Against Hunger (ACF) in 2011 also reversed some improvements in nutrition among children under five, Kouamé noted.

Andrea Dominici, ACF's country director said: "ACF is no longer in the north and has no plans to return, mainly because of lack of donor support, but also because the Ivoirian government and UNICEF [UN Children's Fund] are able to respond in case of an emergency."

"The humanitarian organizations played an important role against malnutrition. Fortified foods [donated by aid groups] helped many women, but since their departure we no longer have food and fewer women are coming to our nutrition centres," said Diarrassouba Issouf of the Family Protection Unit in the northern city of Korhogo.

Nutrition centres now rely on local foods to fight malnutrition, but many women are unable to afford such foods due to extreme poverty, Issouf said. The government in 2008 began setting up nutrition centres at health centres and hospitals. So far, 14 nutrition centres have been established in the northern and eastern regions.

"NGOs and development partners are willing to help fight malnutrition through rapid diagnosis and donating equipment, but sometime down the line we find ourselves abandoned with no further support," said an NGO official in northern Côte d'Ivoire who preferred anonymity.

Few physicians

Lack of qualified medical personnel in the north has also stoked chronic malnutrition. Côte d'Ivoire has 0.14 physicians per 10,000 people, according to the World Health Organization (WHO). The sub-Saharan average health worker-to-patient ratio is 1.3:10,000. Countries with fewer than 23 physicians, nurses and midwives per 10,000 people generally fail to achieve adequate coverage for selected primary health care interventions, says WHO.

"The government does not have proper follow-up mechanism here in the north. For instance, there are very few visits inside villages to find children suffering from malnutrition or patients who have stopped coming to the clinic due to lack of finances" Malnutrition is responsible for 54 percent of deaths and over a third of ailments among children under five in Côte d'Ivoire, says the National Nutrition Programme. Basile Koukoui Janvier, a nutrition expert with UNICEF in Côte d'Ivoire, said that acute malnutrition was slowly being reduced, but chronic malnutrition needed a stronger response.

Broadly, the government's strategy to reduce malnutrition focused on the improvement of prenatal and infant health, as well as boosting food nutrition for mothers and school-age children.

But the NGO official who spoke to IRIN on condition of anonymity criticized government authorities for failing to sustain the fight against malnutrition in the north of the country.

"The government does not have proper follow-up mechanism here in the north. For instance, there are very few visits inside villages to find children suffering from malnutrition or patients who have stopped coming to the clinic due to lack of finances," argued the official.

"The government's nutrition training programme for health workers cannot also work due to lack of resources for public information campaigns and the treatment of malnutrition."

Lean season

In addition to widespread poverty, many families do not reap enough harvest to take them through the June-September lean season, mainly due to unpredictable weather.

"The lean season will start in a few weeks. We are already worried because due to poverty, and more so erratic rainfall, families may not be having enough food stocks," said UNICEF's Janvier.

Korhogo farmer Fougnigué Silué said he has had three consecutive seasons of poor harvests. "Those who produce enough food prefer to sell to markets in the southern regions or to neighbouring countries, whereas we could help each other [here]."

Three UN agencies warned in 2012 that northern Côte d'Ivoire was threatened by chronic malnutrition and food shortages due to a high number of people displaced by the 2010-2011 violence as well as poor rainfall and an extended lean season.