KOUSSERI, 27 August 2010 (IRIN) - Northern Cameroon, as in much of Africa's western Sahel band, has unusually high child malnutrition this lean season between harvests - high even for an impoverished region where poor nutrition is common and most of the five million people lack access to safe water and sanitation.

Six children died from malnutrition in Kousseri hospital, northern Cameroon, in July alone. Tending to 23 children at the hospital's therapeutic feeding centre, centre director Fanta Abba Adam told IRIN: "We don't generally have this many deaths."

"We are overwhelmed by cases of malnutrition," Mahamat Ousman, a local Health Ministry official told IRIN. He said workers from health centres throughout the district of Kousseri generally come to the main hospital for supplies once a month, but since June many have come four times per month.

"In the 10 health centres in Kousseri city, malnutrition cases [moderate and severe] went from 75 in May to 166 in July," he said.

Even outside the lean season, 55,000 under-five children in Cameroon's North and Far North regions have severe acute malnutrition, according to the UN Children's Fund (UNICEF). That is about 70 percent of the country's severely malnourished under-fives, while the zone is home to one-third of the country's children.

The children who died recently or who are in a fragile state at Kousseri hospital "came to hospital in an advanced state of malnutrition and with medical complications," nutritional centre head Abba told IRIN. "In such cases, it is almost impossible to save them."

In many instances the late arrival in health centres stems from reticence to say a child is malnourished, Abba told IRIN. But access to treatment is also a problem; 20 of the 43 health districts in the North and Far North regions have the trained staff, equipment and means to provide free malnutrition treatment, according to Health Ministry officials, who say setting up treatment in the remaining centres is under way, and the slowness is partly due to a lack of funds.

But one health worker who requested anonymity said part of the reason the structures are lacking is that many government leaders are not aware of the magnitude of Cameroon's malnutrition problem.

Poverty

As in other countries across West and Central Africa the causes of malnutrition in Cameroon are many - crop failure on top of chronic poverty, poor weaning and infant feeding practices and lack of access to basic services.

For 24-year-old Falmata Ousmanou, poverty and a lack of financial support from her ex-husband are at the root of her 18-month-old's acute malnutrition. She spoke with IRIN as she sat holding the child, who weighs 4.6kg, at the main hospital in the Far North town of Maroua.

She said she knew her baby at a certain age needed to have vitamins and minerals; she simply could not afford them.

"When my baby was 11 months old, health workers advised me to give him porridge enriched with peanut butter and milk," said 24-year-old Ousmanou, who has three children after a fourth died.

"But he has been losing weight since. I think it's a lack of minerals. The corn porridge I give him rarely has all the ingredients it should. Sometimes I don't even have porridge to give him. Sometimes I have to borrow flour from my neighbours - but I can't do that all the time."

Floods, cholera

Health Ministry nutritionist Augustin Ndongmo Nanfack, just back from a tour of the Far North region, said heavy flooding and a cholera outbreak in the area are exacerbating the nutrition problem.

"The situation is worrying," he told IRIN. "I fear with the floods, which have destroyed crops, the nutrition situation will worsen." In many areas of West and Central Africa, floods are destroying crops families planted in the hope of bouncing back from food deficits caused by drought or erratic rains in 2009.