In the north acute malnutrition - 7.2 percent among children under five - is down from 18 percent in 2008, but chronic malnutrition has risen from 30.6 percent in 2008 to 44.7 percent, according to preliminary results of a 2009 nutrition study by the Ministry of Health, with the UN Children's Fund, World Food Programme and the Office for the Coordination of Humanitarian Affairs (OCHA). The study showed chronic malnutrition is at 40 percent in the west.
"If these malnutrition levels are not dealt with, the next hit will be a drama," Eric Gerard, head of NGO Merlin told IRIN. "The Ministry of Health is well-intentioned [when it comes to nutrition] but it is overwhelmed and is struggling to cope."
A 2008 study addressed the nutrition situation in the north as a whole but this year's survey analyzed five northern regions separately so as to have more precise information by location, and was expanded to three regions in the west.
The reasons for such high chronic malnutrition in the north and west are partly developmental, said Julie Bélanger, head of OCHA in Côte d'Ivoire, who pointed to a lack of education, poor diets and feeding practices, and reduced access to land due to conflict.
Just 11 percent of women in five of the eight districts studied practice exclusive breastfeeding, according to the report. And between 5.3 percent and 19.2 percent of households can access safe water.
In 18 Montagnes region in the west, 9 percent of households regularly feed their children meals representing the four necessary food groups, the study found. Government hospital director Paul Kouhon in Danané, 80km from the regional capital Man, told IRIN: "Children here may eat three times a day but there is nothing nutritious in the food."
Chronic malnutrition could worsen if food insecurity continues, combined with inconsistent rains and poor access to healthcare, the study warns.
Food insecurity is generally high in the regions studied, largely due to farmers being displaced, vulnerability to 2008 food price hikes and inconsistent rains.
Responding to chronic malnutrition requires reducing poverty, improving health services and food security, as well as changing behaviour, said Yeo Seydou, UN Food and Agriculture Organization (FAO) representative in 18 Montagnes.
FAO is addressing the latter in Man by working with local NGO Idée Afrique, whose nutritionist Tanaka Noel runs a feeding and nutrition-awareness centre next to a government health clinic.
He teaches mothers with malnourished children to make nutritious cereal powder for their babies, discusses foods to avoid for children and encourages mothers to feed their children more protein, vegetables and fruit.
Manioc and rice are the staple foods, with chicken, eggs and fish going to the adults, Noel told IRIN.
Romaine Dose Chabel, 21, used to feed her eight-month-old Rebecca just rice with sauce but now she feeds her manioc, vegetables and fish, she told IRIN.
Malnutrition is still a source of shame for some. "I didn't have any shame in bringing my daughter here but I know many mothers who do. I knew I had to because it was a question of safety."
FAO gave Chabel a gardening kit so she could grow vegetables to eat or sell. FAO runs 36 such centres in northern and western regions in collaboration with the National Nutrition Programme (PNN), UNICEF, WFP and NGO Action Contre la Faim.
The nutrition study recommends improving growth monitoring of babies and nutritional education in health centres, and pushes centres to do more to urge women to go for pre- and post-natal checks. National nutrition surveys also need to be set up to regularly monitor developments, it says.
The PNN is raising nutrition on the government agenda and recently issued a nutrition strategy, but it does not have enough resources to put adequate staff in place in vulnerable areas, said ACF nutrition coordinator Raffaella Gentilini.
"Malnutrition is an example of just how fragile the overall health situation is here," she said.