SIKASSO, 29 December 2009 (IRIN) - Sikasso is one of Mali's most fertile regions, but under-five malnutrition is as high here as in the country's barren north, according to government health data.

Health workers and agricultural experts explain the paradox as a combination of a lack of nutritional awareness, and the concentration on export-oriented cash crop production.

"We are the country's economic purse," said the Agriculture Ministry's Sikasso representative, Seydou Keita. He told IRIN the southern region has traditionally been the top cotton and fruit producer.

"But the problem is we do not consume our wealth. We are rich and malnourished. Our residents consume calories, but they are not getting nourished."

The national average for acute malnutrition was 15 percent in 2006, when the most recent government health survey was done; the rate in Sikasso was 16 percent.

The government and UN Children's Fund (UNICEF) are working on a nutritional survey; results are due in 2010.

Malnutrition care

Malnutrition is a leading cause of under-five deaths in Sikasso, according to regional hospital paediatric director, Eugène Dembélé. "Despite the efforts of health centres and their [NGO] partners, childhood malnutrition continues to be a worrisome situation in the region."
Children are often brought in for consultations too late, said Oumar Guindo, a community health centre doctor. "When mothers bring their children to find out what is wrong with them, it is after they have [consulted] the traditional healers. Then, we find out [here at the health centre] that it is a case of malnutrition."

Farm work competes with child care as a priority for mothers, said community educator Oumou Cissé. "In Sikasso, women are very active. They compete with men in the fields, which means they are absorbed not only with their field work, but also their housework. The children are not their only focus. We neglect a bit the children's health care."

Feeding the country

Farmers prefer to sell their products so they can buy more fertilizer and seeds in order to continue producing, the Agriculture Ministry's Keita told IRIN. "They are essentially going hungry so they can feed this country."

The government's Keita said local farmers contract with buyers from neighbouring Burkina Faso and Côte d'Ivoire, as well as clients from the capital Bamako. "We should be eating the potatoes that grow on this land, but instead we are selling them. Same with mangoes, and sometimes at ridiculously low prices."

In addition to what is legally sold, Keita said an unknown quantity of food is smuggled past customs, evading export taxes.

Fertilizer-driven choices

To encourage diversification from cotton, a sector whose profits have plummeted, the government provides a 50-percent subsidy for fertilizer – US$27 per 100kg bag – if used for maize, rice or potatoes.

Local producer Oumar Diamoutene told IRIN that in 2008 he sold one tonne of potatoes for $382 and purchased 300kg of maize for his family at $34 per 100kg. "I needed 10 sacks [of maize] to be able to feed my family, but what I could afford was three," he told IRIN. He cares for two wives and 15 children.

Moussa Diamoutene told IRIN he has less access to subsidized fertilizer because he no longer grows cotton. "I grow less millet and sorghum for my family because I would have to pay twice as much for that fertilizer [as opposed to for potatoes]. What I can buy for my family does not last all year."

Of the money he earned from his potato sales in 2008, he used some for taxes and health care, $875 for three weddings, $110 for six baptisms and $790 for fertilizer, he told IRIN.

Multi-dimensional

The causes of malnutrition are varied and often overlooked, according to Didier Verse, food advisor with the European Commission humanitarian aid department (ECHO). "The causes are rooted in culture, behaviour, health, agriculture. We cannot say that with more food the problem will go away, because it does not. We need to go deeper to solve the problem."

Malnutrition in Sikasso is not linked to seasonal hunger – during harvest time when there is less food in the fields and in the markets – but rather to whether people can access health services and practice good hygiene, according to UNICEF.

The non-profit Save the Children is analyzing a household economic survey that it conducted in Sikasso, covering the period October 2008 to September 2009. Results of the survey, financed by ECHO, are expected in January 2010.

Since 2006 ECHO has given $21.6 million to projects in Mali aimed to prevent malnutrition.
Malnutrition should be tackled as aggressively as other diseases, said the head of a Sikasso resident association in Bamako, Soumaila Berthé. "There is simply a lack of information about malnutrition. Authorities should carry out large campaigns as they do for mosquito net distribution."

Save the Children's director in Mali, Thomas McCormack, said decades of nutrition interventions have led to little noticeable improvement in Sikasso. "It is discouraging. We need to pull together the disparate approaches to child hunger. When I was a [US] Peace Corps volunteer in Sikasso, we observed the same problem. What we are seeing now is simply renewed focus on an old problem."


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